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PubMed2006

Virtual reality applications to agoraphobia: a protocol.

Recently, educators and instructional designers have focused on the development and implementation of virtual learning environments that effectively combine theoretical and applied knowledge to teach university students. One of the trusts of the Psychology Virtual Teaching Laboratory in collaboration with the IXTLI observatory is to develop dissemination programs to promote the insertion of virtual reality (VR) technologies applied to rehabilitation in their clinical practice. This paper describes the development of (1) agoraphobia VR learning objects to be use as a teaching support tools in class and (2) a multimedia teaching program that incorporate digital video and VR scenarios address to students in the field of mental health. Promotion among professors and students about the use of this technology will allow us to initiate research in our country as well as to validate contextualized applications for our culture, therefore contributing with new advances in this field.

Agoraphobia↗
PubMed2006

Effects of a personified guide on adherence to an online program for alcohol abusers.

The quality of the therapeutic alliance has robust effects on the outcome of psychotherapy and psychopharmacologic interventions. Automated behavioral health programs that are being developed to increase access to mental health treatment are administered in the absence of direct human participation, thereby precluding the development of a traditional therapeutic relationship. The aim of this study was to develop a personified guide designed to stimulate reactions similar to those experienced in a therapeutic relationship, and evaluate the effect of the guide on adherence to and satisfaction with an online alcohol use evaluation program. After completing a battery of four standard questionnaires used to evaluate problem drinking, 288 subjects were randomized to receive feedback on their results in text form or via a multimedia condition involving a personified guide. Those who received feedback via the guide demonstrated greater levels of program adherence by completing more modules. Reported satisfactions levels did not differ between the two conditions. Encouraging the personification of an automated behavioral health intervention may lead to greater levels of engagement with the program.

Adult↗
PubMed2004

Tele-diagnostic and therapeutic guidance in urology.

PURPOSE: To design a Web-based network for diagnostic and therapeutic guidance in urology. MATERIALS AND METHODS: We designed an architectural model of a low-cost multimedia Web platform that runs on a collection of distributed collaborative network nodes to provide a set of urologist-oriented Web-enabled services. Any node of the platform was able to share patient-oriented data via automated processes with appropriate authorization, confidentiality, and high-security protocols. The urologist can show the details of the records of patients and additionally enrich the world experience with his or her own cases. Video clips maintained locally at the nodes will be accessible by clinicians in a trouble-free way with MS Windows Media player and a relatively small amount of source code. RESULTS AND CONCLUSIONS: The primary advantage of this architectural model is that it provides Web-enabled integrated urologic services while using a distributed storage scheme for urological video files (AVI format) and a global repository of laboratory results using Extensible Markup Language (XML) and Data Grid technologies. In addition, this model provides decision-support services (knowledge from a global database and predefined procedures). The architecture model is based entirely on HTTP, XML, GRID-like environment and DotNet technologies. Finally, the platform provides extensibility and scalability targeted to large-scale Web-enabled global urologic databases.

Decision Support Techniques↗
PubMed1998

Telemedicine activities at memorial University of Newfoundland: a historical review, 1975-1997.

Memorial University of Newfoundland has been continuously involved in telemedicine activities since 1975. Unlike most early telemedicine programs, which did not continue after grant funding ended, Memorial made the transition to create a self-sufficient Telemedicine Centre. Key to its success was the vision and drive of its founder, Dr. Max House, and adherence to the following principles: (1) all activities were based on a legitimate need; (2) the simplest, least expensive technology was used to meet the need; (3) the network was shared by a variety of users; and (4) users were given proper training and support. Over the years, Memorial has been involved in 30 telemedicine projects, many of which became ongoing services. Although most initial activity was health related, educational activities have played an increasingly important role. In 1997, the Telemedicine Centre delivered approximately 7000 hours of programming and administered a network of 247 dedicated audioconference sites in 161 communities (168 of the sites had telewriter workstations and 75 had multimedia workstations) and eight videoconferencing sites. Approximately 70% of all programming was distant high school and university education, 20% health education, 5% clinical activities, and 5% other uses. Current clinical activities include tele-electroencephalograms, tele-ultrasonography, tele-nuclear medicine, child telepsychiatry, general teleconsultation from a remote nursing station, and general teleconsultation from an offshore oil platform. Lessons learned from more than 20 years of telemedicine experience are presented.

Education, Distance↗
PubMed2005

Adaptive tele-application for remote neurology diagnosis.

This paper presents the Collaborative Tele-Neurology (TeNeCi) project which allows practitioners to use telecommunication technologies to provide medical information and services for neurological diseases. Specificities of remote neurology are described and the Cooperative Application Framework (CAliF) multimedia platform on which TeNeCi relies is presented. The technical requirements of such a project in terms of communication and consistency management, audio and video transmissions, and network support, as well as implementation of TeNeCi was evaluated. The software used in this application is composed of several services, such as a Digital Imaging and Communications in Medicine (DICOM) explorer, a DICOM viewer, and a security service. Tests performed on this first TeNeCi release showed good results, and allowed us to explore a larger collaborative experimentation between hospitals in France and Switzerland.

Emergency Medical Services↗
PubMed2000

Getting nutrition education into medical schools: a computer-based approach.

Despite awareness of the importance of nutrition as part of medical student's education, numerous barriers exist to incorporating nutrition education into the medical school curriculum. Chief among such barriers is that most medical schools do not have faculty trained specifically in nutrition. A curriculum is needed that can deliver comprehensive nutrition information that is consistent across medical schools. One way to deliver this information is to use computer-assisted instruction (CAI). To meet the different needs of medical schools and provide a consistent base of nutrition information, we developed a series of interactive, multimedia educational programs (Nutrition in Medicine) that teach the basic principles of nutritional science and apply those principles in a case-oriented approach. Curriculum content is derived from the American Society for Clinical Nutrition consensus guidelines. These modules offer the advantages of accessibility, self-paced study, interactivity, immediate feedback, and tracking of student performance. Modules are distributed free to all US medical schools. Preliminary data from surveys gathered by our team at the University of North Carolina at Chapel Hill indicate that 73 US medical schools use, or are planning to use, these modules; more schools are currently evaluating the programs. Successful implementation of CAI requires easy program access, faculty training, adequate technical support, and faculty commitment to the programs as a valuable resource. CAI fails when the program is just placed in the library and students are told to use it when they can find the time.

Computer-Assisted Instruction↗
PubMed1999

Telemedicine and telepharmacy: current status and future implications.

Uses of telemedicine are described and potential roles for pharmacists are discussed. Telemedicine has been defined as "the use of electronic information and communications technologies to provide and support health care when distance separates the participants." Technologies included in telemedicine are videoconferencing, telephones, computers, the Internet, fax, radio, and television. Telepharmacy has the same basic definition but refers to pharmaceutical care provision. Although the videotelemedicine market is expected to grow considerably, lack of reimbursement and high costs are continuing obstacles. Pharmacy is using video-conferencing for education, training, and management purposes. The telephone has changed from a dial-and-talk instrument to a multimedia access tool. Medical devices are being attached to telephone lines to provide remote monitoring and therapy, and call centers are providing medication counseling, prior authorization, refill authorization, and formulary compliance monitoring. Although the Internet has quickly become a star performer, utilization by health care lags behind that of other industries. The Internet-fueled empowerment of consumers and their expectations for speed, access, and convenience are creating more unmet expectations of the traditional health care system. Pharmacy has both organizational and individual practitioner Web sites, but it is online drugstores that are attracting most attention. Potential benefits of telemedicine include improved access to care, greater efficiency in diagnosis and treatment, higher productivity, and market positioning for the coming century. Telemedicine will tax the economic, regulatory, legal, ethical, and clinical care expertise of the entire health care system. Studies of the effectiveness, cost, and societal implications of telemedicine are needed, along with practice models and standards, training programs, and solutions to regulatory, licensing, and legal questions. Securing reimbursement for cognitive services remains a problem for telemedicine and telepharmacy. Telemedicine presents profound opportunities and challenges to pharmacy and other health care professions.

Accreditation↗
PubMed2000

Six-fold speed-up of Smith-Waterman sequence database searches using parallel processing on common microprocessors.

MOTIVATION: Sequence database searching is among the most important and challenging tasks in bioinformatics. The ultimate choice of sequence-search algorithm is that of Smith-Waterman. However, because of the computationally demanding nature of this method, heuristic programs or special-purpose hardware alternatives have been developed. Increased speed has been obtained at the cost of reduced sensitivity or very expensive hardware. RESULTS: A fast implementation of the Smith-Waterman sequence-alignment algorithm using Single-Instruction, Multiple-Data (SIMD) technology is presented. This implementation is based on the MultiMedia eXtensions (MMX) and Streaming SIMD Extensions (SSE) technology that is embedded in Intel's latest microprocessors. Similar technology exists also in other modern microprocessors. Six-fold speed-up relative to the fastest previously known Smith-Waterman implementation on the same hardware was achieved by an optimized 8-way parallel processing approach. A speed of more than 150 million cell updates per second was obtained on a single Intel Pentium III 500 MHz microprocessor. This is probably the fastest implementation of this algorithm on a single general-purpose microprocessor described to date.

Algorithms↗
PubMed1991

A model community education program on depression and suicide in later life.

This paper describes the development and evaluation of a 3-hour multimedia community education program on depression and suicide in later life. Designed for families, older adults, and service providers, the program provides information and teaches skills needed to recognize and respond to depression and suicidal behavior in the elderly. Compared with a control group, program participants had significant gains in knowledge and in their intent to take appropriate action in support of a depressed person.

Adult↗
PubMed1999

Reducing caregiver burden: a randomized psychoeducational intervention for caregivers of persons with dementia.

This 3-year randomized clinical trial tested the effectiveness of an interdisciplinary psychoeducational family group intervention in decreasing the caregivers' perceptions of the frequency and severity of behavioral problems in persons with dementia and their reactions to those problems, and in decreasing caregiver burden and depression. The intervention consisted of seven weekly, 2-hour multimedia training sessions that included education, family support, and skills training for 94 primary caregivers and their families. Repeated measures ANOVA was used to test for significant differences between the intervention and waiting list control groups over a 5-month period. The intervention was successful in reducing caregivers' negative reactions to disruptive behaviors and in reducing caregiver burden over time.

Aged↗
PubMed2006

Driving and dementia in older adults: Implementation and evaluation of a continuing education project.

PURPOSE: We aimed to develop and evaluate a multimedia workshop curriculum to educate physicians and other health professionals about (a) driving-related assessment in older adults with dementia, and (b) strategies to encourage driving retirement for impaired individuals. DESIGN AND METHODS: A curriculum developed by the Older Drivers Project of the American Medical Association was expanded for presentation by a multidisciplinary team. One pilot and seven test workshops were offered. A program evaluation method-testing knowledge, confidence, attitudes, and practice behaviors-was employed at four points in time: T1 (Time 1; pretest focusing on the previous 12 months), T2 (Time 2; same-day post-test), T3 (Time 3; post-test at 3 months), and T4 (Time 4; post-test at 12 months). RESULTS: At T1, participants (N = 147) expressed high agreement that an assessment of driving ability is an important issue in clinical dementia care, but they reported low knowledge of assessment strategies, resources, and state reporting requirements. Modest gains in knowledge and confidence were demonstrated at both T3 (n = 93) and T4 (n = 63). In addition, the frequency of driving-related practice behaviors (i.e., incorporation of driving-related questions into clinical evaluation, chart documentation, reporting of impaired drivers) had increased significantly by T3 and T4. IMPLICATIONS: The results indicate that a focused workshop curriculum, with practical and immediate applications to care, can motivate measurable changes in clinical practice. Once they are informed, health professionals can address issues of driving ability in older patients with dementia and, with the support of available resources, encourage impaired individuals to retire from driving for the safety of everyone on the road.

Aged↗
PubMedDate not supplied

Development of the human dispermic embryo.

In a recent CD-ROM, we portrayed the microstructure of the pre-implantation human embryo (Sathananthan et al., 1999), which was a multimedia production with computer colour-enhanced electron micrographs of mainly monospermic embryos. This disk portrays light and electron micrographs of over 250 tripronuclear (3PN), dispermic, human embryos during pre-implantation development, viewed in thick and thin Araldite sections, as well as appearances of whole embryos flat embedded in Araldite blocks visualized with the light microscope. The 100 figures were computerized (IBM TIFF format), edited and labelled using Adobe Photoshop 5. Some of the figures were coloured on computer. The early development of 3PN embryos overtly resembles that of normal embryos but there are important differences in their microstructure which are portrayed in this presentation. This is a multicentric study involving researchers from four IVF centres.

Aneuploidy↗
PubMed1990

Exposure analysis and assessment for low-risk cancer agents.

The analysis of exposure is a necessary feature of epidemiological studies. In the case of low-risk cancer agents, the examination of potential exposure should follow a sequence that prioritizes the major media and routes of concern. This will minimize the misclassification of exposure and the failure to identify important co-factors, e.g. contamination in other media, etc. The manuscript describes specific components of exposure analysis and provides examples that pertain to single and multimedia exposure problems. The approach is examined by using the Total Human Environmental Exposure Study (THEES) for benzo(a)pyrene as a potential model for low-risk cancer agents. Since benzo(a)pyrene can be found in air, water, soil and food, and has a number of sources, THEES illustrates how to prioritize an exposure assessment, take advantage of opportunities to conduct micro-environmental measurements, and collect personal monitoring and biological marker samples. A daily activity log is briefly described.

Benzo(a)pyrene↗
PubMed2005

PARALIGN: rapid and sensitive sequence similarity searches powered by parallel computing technology.

PARALIGN is a rapid and sensitive similarity search tool for the identification of distantly related sequences in both nucleotide and amino acid sequence databases. Two algorithms are implemented, accelerated Smith-Waterman and ParAlign. The ParAlign algorithm is similar to Smith-Waterman in sensitivity, while as quick as BLAST for protein searches. A form of parallel computing technology known as multimedia technology that is available in modern processors, but rarely used by other bioinformatics software, has been exploited to achieve the high speed. The software is also designed to run efficiently on computer clusters using the message-passing interface standard. A public search service powered by a large computer cluster has been set-up and is freely available at www.paralign.org, where the major public databases can be searched. The software can also be downloaded free of charge for academic use.

Algorithms↗
PubMed2002

Digitization of photographic slides: simple, effective, fast, and inexpensive method.

The technological evolution has changed multiple areas of plastic surgery, including photography. The photograph is one of the instruments used most by the plastic surgeon, and it cannot be eliminated by technological changes. The principal change in photography is that images can be scanned through digital cameras instead of slides. Despite the multiple advantages that digital photography represents, many surgeons are resisting the change. One of the main reasons for this resistance is the large quantity of photographic slides that need to be digitized to be used at scientific conferences as well as in publications. The methods and existing techniques for digitizing slides are costly and time-consuming, and there is risk for loss of definition and image brightness. The authors present a simple, effective, fast, and inexpensive method for digitizing slides. This method has been validated by various plastic surgeons and is effective for use in multimedia presentations and for paper printouts with publication quality.

Computers↗
PubMed1995

Anatomy of the clinical simulation.

Computer-based clinical simulations have been used in medical education for the past 25 years. During this period, the technology has evolved from mainframe computers to microcomputers to multimedia. All designers of simulations must decide which elements of reality to include explicitly in a simulated case, which to leave to the user's imagination, and when to intervene for educational purposes. Once these decisions are made, developers of simulations have many options for structuring the simulation itself. They can develop simulations with single or multiple patient encounters, with menu or natural-language requests for data, with varying levels of volunteered information about the simulated patient, with interpreted or uninterpreted clinical findings, with deterministic or probablistic evolution of the case, with various ways to give users feedback about their progress through the case, and with manual or automated creation of specific cases. Simulations derive their specific character from how these options are implemented.

Computer Simulation↗
PubMed1996

A consumer-oriented model for evaluating computer-assisted instructional materials for medical education.

Computer-assisted instruction (CAI) can enhance medical education, but course directors and curriculum designers need thorough, credible evaluative data to make sound decisions about procuring and implementing CAI programs. There has been extensive research on the merits of CAI in general (although much of it is flawed by methodologic shortcomings), but sufficient evaluative data on specific programs are rarely available. The author proposes that a consumer-oriented model would be useful for evaluating CAI programs, and he discusses one published, consumer-oriented evaluation of a multimedia CAI program for ophthalmology students. The author contends that if CAI programs were routinely evaluated using the consumer-oriented model, and if CAI program developers used this model to evaluate their programs during the developmental phase, medical educators would be better able to choose and implement the programs that would best serve their needs.

Computer-Assisted Instruction↗
PubMed2002

New medical licensing examination using computer-based case simulations and standardized patients.

PURPOSE: To evaluate a new method, used for the first time in Italy, of administering the Medical Licensing Examination (MLE). METHOD: Eighty medical school graduates taking the MLE were studied. The MLE was based on the Multimedia Integrated Pilot Project (MIPP), a single two-step examination that combines computer-based case simulations (step 1) and clinical encounters using standardized patients (step 2). Step 1 assessed mainly clinical knowledge and decision-making skills. Step 2 measured the ability to obtain a focused history, perform a relevant physical examination, prioritize a differential diagnosis and management plan, and provide patient education or counseling. The correlations between the total MIPP scores and the exam scores students obtained during the six-year medical school curriculum were evaluated. RESULTS: The step 1, step 2, and total MIPP scores were moderately correlated with the curriculum scores. A moderate correlation also existed between the scores reported in step 1 and those of step 2. CONCLUSIONS: The MIPP is a good tool for assessing clinical competence. Internationally, computer-based and standardized patient assessments are being used more often in licensing examinations. Continuous use of this method could improve medical graduates' performances.

Clinical Competence↗