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PubMedDate not supplied

Remote analysis of physiological data from neurosurgical ICU patients.

Recent technical advances in Internet-based client/server applications and new multimedia communications protocols are enabling the development of cost-effective, platform-independent solutions to the problem of remote access to continuously acquired physiological data. The UCLA Neurosurgery Intensive Care Unit (ICU) has developed a distributed computer system that provides access over the World Wide Web (WWW) to current and previously acquired physiological data, such as intracranial pressure, cerebral perfusion pressure, and heart rate from critical care patients. Physicians and clinical researchers can access these data through personal computers from their offices, from their homes, or even while on the road. The system creates and continuously updates a database of all monitored parameters in data formats that can readily be used for further clinical studies. This paper describes an extension to this system that allows for remote interaction with and analysis of the data via the WWW. Physicians can now pose a limited, predefined set of clinically relevant questions to the system without having to be at the patient's bedside.

Computer Communication Networks↗
PubMedDate not supplied

Telemedicine expanding the scope of health care information.

The definition of health information is growing to include multimedia audio, video, and high-resolution still images. This article describes the telemedicine program at East Carolina University School of Medicine, including the telemedicine applications presently in use and the virtual reality applications currently under development' Included are the major design criteria that shape the telemedicine network some of the lessons learned in developing the network, and a discussion of the future of telemedicine, including efforts to incorporate telemedicine within a fully integrated health information system.

Computer Communication Networks↗
PubMedDate not supplied

Consumer informatics in chronic illness.

OBJECTIVE: To explore the informatic requirements in the home care of chronically ill patients. DESIGN: A number of strategies were deployed to help evoke a picture of home care informatics needs: A detailed questionnaire evaluating informational needs and assessing programmable technologies was distributed to a clinic population of parents of children with cancer. Open ended questionnaires were distributed to medical staff and parents soliciting a list of questions asked of medical staff. Parent procedure training was observed to evaluate the training dialog, and parents were observed interacting with a prototype information and education computer offering. RESULTS: Parents' concerns ranged from the details of managing day to day, to conceptual information about disease and treatment, to management of psychosocial problems. They sought information to solve problems and to provide emotional support, which may create conflicts of interest when the material is threatening. Whether they preferred to be informed by a doctor, nurse, or another parent depended on the nature of the information. Live interaction was preferred to video, which was preferred to text for all topics. Respondents used existing technologies in a straightforward way but were enthusiastic about the proposed use of computer technology to support home care. Multimedia solutions appear to complement user needs and preferences. CONCLUSION: Consumers appear positively disposed toward on-line solutions. On-line systems can offer breadth, depth and timeliness currently unattainable. Patients should be involved in the formation and development process in much the same way that users are involved in user-centered computer interface design. A generic framework for patient content is presented that could be applied across multiple disorders.

Adaptation, Psychological↗
PubMedDate not supplied

The HL7 Clinical Document Architecture.

Many people know of Health Level 7 (HL7) as an organization that creates health care messaging standards. Health Level 7 is also developing standards for the representation of clinical documents (such as discharge summaries and progress notes). These document standards make up the HL7 Clinical Document Architecture (CDA). The HL7 CDA Framework, release 1.0, became an ANSI-approved HL7 standard in November 2000. This article presents the approach and objectives of the CDA, along with a technical overview of the standard. The CDA is a document markup standard that specifies the structure and semantics of clinical documents. A CDA document is a defined and complete information object that can include text, images, sounds, and other multimedia content. The document can be sent inside an HL7 message and can exist independently, outside a transferring message. The first release of the standard has attempted to fill an important gap by addressing common and largely narrative clinical notes. It deliberately leaves out certain advanced and complex semantics, both to foster broad implementation and to give time for these complex semantics to be fleshed out within HL7. Being a part of the emerging HL7 version 3 family of standards, the CDA derives its semantic content from the shared HL7 Reference Information Model and is implemented in Extensible Markup Language. The HL7 mission is to develop standards that enable semantic interoperability across all platforms. The HL7 version 3 family of standards, including the CDA, are moving us closer to the realization of this vision.

Computer Communication Networks↗
PubMed1998

Pathologists dislike sound? Evaluation of a computerised training microscope.

AIM: To evaluate the use of multimedia enhancements, using a computerised microscope, in the training of microscope skills. METHODS: The HOME microscope provides facilities to highlight features of interest in conjunction with either text display or aural presentation. A pilot study was carried out with 10 individuals, eight of whom were at different stages of pathology training. A tutorial was implemented employing sound or text, and each individual tested each version. Both the subjective impressions of users and objective measurement of their patterns of use were recorded. RESULTS: Although both versions improved learning, users took longer to work through the aural than the text version; 90% of users preferred the text only version, including all eight individuals involved in pathology training. CONCLUSIONS: Pathologists appear to prefer visual rather than aural input when using teaching systems such as the HOME microscope and sound does not give added value to the training experience.

Attitude of Health Personnel↗
PubMed1999

Image sampling in static telepathology for frozen section diagnosis.

BACKGROUND: A frozen section diagnostic service is often not directly available in small rural or mountain hospitals. In these cases, it could be possible to provide frozen section diagnosis through telepathology systems. Telepathology is based on two main methods: static and dynamic. The former is less expensive, but involves the crucial problem of image sampling. AIMS: To characterise the differences in image sampling for static telepathology when undertaken by pathologists with different experience. METHODS: As a test field, a previously studied telepathology method based on multimedia email was adopted. Using this method, three pathologists with different levels of experience sampled images from 155 routine frozen sections and sent them to a distant pathology institute, where diagnoses were made on digital images. After the telepathology diagnoses, the glass slides of both the frozen sections and the definitive sections were sent to the remote pathologists for review. RESULTS: Four of 155 transmissions were considered inadequate by the remote pathologist. In the remaining 151 cases, the telepathology diagnosis agreed with the gold standard in 146 (96.7%). There was no significant divergence between the three pathologists in their sampling of the images. Each case comprised five images on average, acquired in four minutes. The overall time for transmission was about 19 minutes. CONCLUSIONS: The results suggest that in routine frozen section diagnosis an inexperienced pathologist can sample images sufficiently well to permit remote diagnosis. However, as expected, the internet is too unreliable for such a time dependent task. An improvement in the system would involve integrated real time features, so that there could be interaction between the two pathologists.

Frozen Sections↗
PubMed2004

A relational database application in support of integrated neuroscience research.

The development of relational databases has significantly improved the performance of storage, search, and retrieval functions and has made it possible for applications that perform real-time data acquisition and analysis to interact with these types of databases. The purpose of this research was to develop a user interface for interaction between a data acquisition and analysis application and a relational database using the Oracle9i system. The overall system was designed to have an indexing capability that threads into the data acquisition and analysis programs. Tables were designed and relations within the database for indexing the files and information contained within the files were established. The system provides retrieval capabilities over a broad range of media, including analog, event, and video data types. The system's ability to interact with a data capturing program at the time of the experiment to create both multimedia files as well as the meta-data entries in the relational database avoids manual entries in the database and ensures data integrity and completeness for further interaction with the data by analysis applications.

Database Management Systems↗
PubMed1993

The computer in the radiologist's office.

Today, the radiologist is able to equip his or her office with a powerful personal computer system equivalent to the large mainframe computers of just a few years ago. If funds permit, purchase of a 486 equivalent system with 200-300 Mbytes of hard-disk storage, 16 Mbytes of random access memory (RAM), a high-resolution color video card and monitor, and a laser printer is recommended. The practical uses for such a system are almost limitless and include word processing, spreadsheet and data-base management, telecommunications, multimedia presentations, business applications, teleradiology, resident and medical student education, and research applications. No matter how much one becomes involved in computer applications, it is essential to establish good habits for backing up critical data files and programs. Becoming familiar with computer technology is not easy at first. Finding a good computer buddy, taking simple night school courses, and reading computer articles and magazines are good ways to get started. Computers are wonderful devices. The day is fast approaching when they will become a necessary tool for every radiologist.

Microcomputers↗
PubMed1994

The virtual hospital: a new paradigm for lifelong learning in radiology.

Medical training in radiology should be viewed as a continuum that begins in medical school and proceeds throughout the years in practice. Unfortunately, there are significant barriers to providing continuing medical education. One key barrier is the physical separation between the information source and the workplace. A multimedia medical library distributed via wide area networks has been developed that provides needed information at the point of use. The distribution software (Mosaic) that makes this project possible is found in the public domain.

Computer Communication Networks↗
PubMed1995

Inside BrighamRAD: providing radiology teaching cases on the Internet.

The Internet provides opportunities for widely distributing educational materials such as teaching files. Since a teaching file is both a tradition and a requirement in an accredited diagnostic radiology training program, many of the same resources can be committed to designing it for Internet access. The advantages include easier availability for the department residents and fellows, communication to a wider audience, the opportunity for networking and collaboration with other institutions during development, and making information available for more rapidly than traditional publications. Since material available on the Internet represents an alternative means of publication, all cases in an electronic teaching file, as is the case with BrighamRad, should be subject to peer review. A successful computer-based teaching file requires department-wide commitment of trainees and staff as well as additional expertise in multimedia instruction, computer-based graphics and design, image manipulation, programming, and database management. Quality efforts take time and require continual adaptation and support as technology and the laws and customs governing the use of electronically published material evolve. The process should be ongoing, and the departmental commitment must be long term and continuous.

Computer Communication Networks↗
PubMedDate not supplied

The GI Project: a prototype electronic textbook for high school biology.

A prototype electronic science textbook for secondary education was developed to help bridge the gap between state-of-the-art medical technology and the basic science classroom. The prototype combines the latest in radiologic imaging techniques with a user-friendly multimedia computer program to teach the anatomy, physiology, and diseases of the gastrointestinal (GI) tract. The program includes original text, illustrations, photographs, animations, images from upper GI studies, plain radiographs, computed tomographic images, and three-dimensional reconstructions. These features are intended to create a stimulus-rich environment in which the high school science student can enjoy a variety of interactive experiences that will facilitate the learning process. The computer-based book is a new educational tool that promises to play a prominent role in the coming years. Current research suggests that computer-based books are valuable as an alternative educational medium. Although it is not yet clear what form textbooks will take in the future, computer-based books are already proving valuable as an alternative educational medium. For beginning students, they reinforce the material found in traditional textbooks and class presentations; for advanced students, they provide motivation to learn outside the traditional classroom.

Biology↗
PubMedDate not supplied

Development of an electronic radiologist's office in a private institute.

A computer system that improves the quality, user-friendliness, accessibility, and management of radiology data (images, reports, databases, knowledge) was implemented at a private institute. A picture archiving and communication system (PACS) was integrated with the radiology information system (RIS). Two servers and 12 personal computers form the integrated system. The first server is dedicated to management and archiving of Digital Imaging and Communications in Medicine (DICOM) images. The second server is dedicated to management of the RIS and archiving of patient data (Structured Query Language database), reports (hypertext markup language [HTML]), and images in the Joint Photographic Experts Group (JPEG) format (mini-PACS). There are three main client-server networks: a common network of imaging modalities (magnetic resonance imaging, computed tomography, ultrasonography, digital radiography) and two fast Ethernet networks (the PACS network and the RIS network). The RIS-PACS is linked remotely with other workstations and servers via Integrated Services Digital Network (ISDN). Images and reports can be distributed to referring physicians in the form of multimedia HTML and JPEG documents, which can also be used for quick and easy archiving, distribution, and reviewing within the institute. However, referring physicians have been reluctant to use electronic reports and images.

Attitude of Health Personnel↗
PubMedDate not supplied

A five-step approach to digital image manipulation for the radiologist.

Digital manipulation of images plays a key role in development of multimedia presentations. Five basic steps to digitizing images and preparing them for publication and computer presentation are scanning, correction, editing and labeling, saving files, and producing final output. These steps can be completed with commercially available hardware and image manipulation software (eg, Photoshop). The higher the quality of the original scanned image, the more image data there will be to edit: A good image cannot be created from an inferior scan. The most important functions for properly scanning images are size, resolution, and color. Resolutions of 300 ppi and 72 ppi should be used for print publication and computer presentations, respectively. The higher resolution image has the larger file size. The scanned image should be saved as a TIFF (tagged image file format), which is an uncompressed file type used for printed images. The Joint Photographic Experts Group (JPEG) format compresses the size of the image file but also reduces image quality. The JPEG format is a good choice if a small file size is needed, such as in Web and PowerPoint presentations. If the user needs to save an image as a JPEG file, the image should be edited first and then saved once in JPEG format. With Photoshop, the user can rotate and crop an image; adjust its brightness, contrast, and color; remove unwanted patient information, dust, and scratches; and add text and symbol labels to enhance images for teaching purposes. Digital manipulation can be fast and effective if the user has some basic knowledge and tools.

Humans↗
PubMed1995

Radiology on the information superhighway.

PURPOSE: To explore the potential for the information superhighway to provide radiologists with new opportunities. MATERIALS AND METHODS: The Internet was used as the communication and distribution medium. MOSAIC, a graphical interface, provided access for clients, and a computer was used to serve text, images, sound, and cine onto the Internet. RESULTS: The system can be used to send reports and images to referring physicians or consulting radiologists; to provide a large database that is constantly available; to provide an increasing collection of teaching files; and to distribute interactive, multimedia teaching tools that can be used on any computer system. The use of the MOSAIC interface facilitates interaction, which allows users with limited computer experience to access the system. CONCLUSION: The Internet can dramatically expand the ways radiologists interact with their colleagues. These preliminary results indicate that there will be great challenges and opportunities for improving care and teaching in the future.

Computer Communication Networks↗
PubMed1994

Computers as teachers: learning from animations.

The effectiveness of an interactive multimedia computer program, the "Electronic Textbook in Human Physiology," in improving the knowledge of students studying cardiovascular physiology was determined from scores on tests given before and immediately after completion of a two-hour animation program on the Cardiac Cycle and Introduction to Electrocardiography and by comparison of performance on a final examination taken later with their unexposed (control) classmates. Unsigned comments on the use of the program were obtained from all participants and were universally laudatory. A marked and significant improvement in the immediate posttest compared with the pretest scores was found. More importantly, the students who had used the computer program achieved a significantly higher grade in the cardiovascular section of the final exam than their (control) classmates. Several possible explanations of the results are offered; the most likely one is that the use of the computer program facilitated learning. The implications of this, especially for curriculum planning, are discussed.

Cardiovascular Physiological Phenomena↗
PubMed1997

Use of World Wide Web server and browser software to support a first-year medical physiology course.

We describe the use of a World Wide Web (Web) server to support a team-taught physiology course for first-year medical students. Our objectives were to reduce the number of formal lecture hours and enhance student enthusiasm by using more multimedia materials and creating opportunities for interactive learning. On-line course materials, consisting of administrative documents, lecture notes, animations, digital movies, practice tests, and grade reports, were placed on a departmental computer with an Internet connection. Students used Web browsers to access on-line materials from a variety of computing platforms on campus, at home, and at remote sites. To assess use of the materials and their effectiveness, we analyzed 1) log files from the server, and 2) the results of a written course evaluation completed by all students. Lecture notes and practice tests were the most-used documents. The students' evaluations indicated that computer use in class made the lecture material more interesting, while the on-line documents helped reinforce lecture materials and the textbook. We conclude that the effectiveness of on-line materials depends on several different factors, including 1) the number of instructors that provide materials; 2) the quantity of other materials handed out; 3) the degree to which computer use is demonstrated in class and integrated into lectures; and 4) the ease with which students can access the materials. Finally, we propose that additional implementation of Internet-based resources beyond what we have described would further enhance a physiology course for first-year medical students.

Computer Communication Networks↗
PubMed1998

Current and future impact of technology on physiology education.

There are at least three areas in which technology can impact education: teaching, learning, and assessment. Teaching, when viewed as communication of information, has been transformed by the technology revolution. Word processing, multimedia, distance learning, and access to the World Wide Web are some prominent examples. The impact of technology on learning, defined as knowledge or skill acquired by instruction or study, has been less dramatic, in part because of our limited understanding of cognitive processes. Some forms of assessment, the collection of evidence of learning, have benefited from technology, such as item analysis of multiple-choice questions. To be effective, the focus on instruction must start with the learner and, from there, consider what should be done to enhance learning. An emphasis on what is technologically appropriate, rather than what is technologically possible, will improve the quality of both teaching and learning.

Curriculum↗
PubMed2000

Student test scores are improved in a virtual learning environment.

This study evaluates the effectiveness of delivering the core curriculum of an introductory neuroscience course using a software application referred to as a virtual learning interface (VLI). The performance of students in a virtual learning environment (VLE) is compared with that of students in a conventional lecture hall in which the same lecturer presented the same material. This study was not designed to determine whether grades are improved by augmenting a lecture with other information. The VLI takes advantage of audio, video, animation, and text in a multimedia computer environment. Our results indicate that raw average scores on weekly examinations were 14 percentage points higher for students in the VLE compared with those for students in a conventional lecture hall setting. Moreover, normalized test scores were over 5 points higher for students in the VLE. This analysis suggest that a core curriculum can be effectively presented to students using the VLE, thereby making it possible for faculty to spend less class time relaying facts and more time engaging students in discussion of scientific theory.

Data Collection↗