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PubMed2004

Computer-based testing: initial report of extensive use in a medical school curriculum.

BACKGROUND: Computer-based digital technology offers many opportunities in medical education. One type of digital technology, computer-based testing (CBT), has potentially wide application in undergraduate, graduate, and continuing medical education. DESCRIPTION: This articles describes the development of CBT in an undergraduate medical curriculum. EVALUATION: An early step in evaluating CBT is to be sure that the exam format is measuring the examinees' knowledge and not their comfort level or confidence with the technology. It is, therefore, important that the CBT reproduce or accommodate traditional test-taking behavior. CBT also provides for a number of enhancements not easily achieved with traditional paper-and-pencil exams. These include easier control and editing of exam items, better incorporation of testing into the learning environment using specific feedback, and enhancing the questions by incorporating multimedia. CBT does present some unique challenges in testing security, and this article discusses the approach to the security issues. In addition, before initiating CBT into a medical curriculum, the institution must understand the technical and infrastructure requirements for CBT. CONCLUSIONS: By providing a 5-year experience with CBT in the medical curriculum, this article hopes to facilitate discussions among medical educators in its appropriate application and evaluation.

Clinical Competence↗
PubMed2005

Synchronous distance interactive classroom conferencing.

BACKGROUND: New medical schools have been opened in the eastern and southeastern regions of the country. They are also in great need of basic medical science teachers. However, due to security reasons over the past two decades, teachers from the established universities do not desire to travel to these medical schools for lectures. The objective of this study was to develop a synchronous classroom conferencing system to teach basic science courses between two general purpose technology enhanced classrooms of two different universities--Istanbul University (IU) and Istanbul and Harran University (HU), Urfa--located 1,500 miles apart in Turkey. DESCRIPTION: I videostreamed the instructor, content from document camera, Power Point presentations at IU, and the students at both places, IU and HU. In addition, I synchronously broadcast two whiteboards by attaching two mimio devices to the two blackboards in the IU classroom to capture and convert everything written or drawn on them into broadcasting over the intranet. This technique is called "boardcasting," which allows users to stream ink and audio together over the Internet or intranet live. A total of 260 students at IU and 150 students at HU were involved. Off-campus HU students also have asynchronous access to the stored lecture video materials at any time. Midterm and final examinations were administered simultaneously using the same questions at both sites in two universities under the observation of the teaching faculty using the very same system. EVALUATION: This system permitted interaction between the students in the class at IU and remote-campus students at HU and the instructor in real time. The instructors at IU were able to maintain a significant level of spontaneity in using their multimedia materials and electronic whiteboards. The mean midterm and final exam scores of students at both universities were similar. CONCLUSION: The system developed in this study can be used by the medical faculty at the main teaching hospitals to deliver their lectures in real time to the medical students when they are on placement in general practices, ambulatory clinics, and district hospitals in rural areas or to the students of other medical schools. This is an efficacious system in developing countries where availability of high-speed networks and cost of communication are major concerns.

Education, Distance↗
PubMed2004

From the echocardiography machine to the lecture room: a simple method for transferring echocardiographic frames and loops to a personal computer.

UNLABELLED: The use of computers in scientific and educational presentations is rapidly increasing. As a digital presentation is ideal for showing moving images, the use of multimedia files, e.g., echocardiographic loops within these presentations, is common. Even though recent echocardiography machines store acquired data in a digital format, these data are often not readily accessible to be transferred to a personal computer. We present an easy and cost-efficient method for transferring frames and loops from any echocardiography machine into a personal computer using a digital video camera equipped with a standard analog input and flash memory. Still images and movies are stored in the camera to be subsequently transferred to a personal computer. In the computer, still images and movies are post-processed with graphical and video editing software. Finally, the still images and movies can be projected from the video camera or presented with specialized software such as PowerPoint. The images can also be used for Web-based publications and production of educational material or books on electronic media such as CD-ROM. The described method can also be used to transfer images from other proprietary devices and programs, as long as the devices are equipped with an analog video outlet. IMPLICATIONS: The transfer of frames and loops from echocardiographic machines to personal computers is often useful for publication, teaching, and educational purposes. We present an easy and cost-effective method for transferring frames and loops from any echocardiography machine into a personal computer using a digital video camera.

Audiovisual Aids↗
PubMed2003

Maternal mRNAs of PEM and macho 1, the ascidian muscle determinant, associate and move with a rough endoplasmic reticulum network in the egg cortex.

Localization of maternal mRNAs in the egg cortex is an essential feature of polarity in embryos of Drosophila, Xenopus and ascidians. In ascidians, maternal mRNAs such as macho 1, a determinant of primary muscle-cell fate, belong to a class of postplasmic RNAs that are located along the animal-vegetal gradient in the egg cortex. Between fertilization and cleavage, these postplasmic RNAs relocate in two main phases. They further concentrate and segregate in small posterior blastomeres into a cortical structure, the centrosome-attracting body (CAB), which is responsible for unequal cleavages. By using high-resolution, fluorescent, in situ hybridization in eggs, zygotes and embryos of Halocynthia roretzi, we showed that macho 1 and HrPEM are localized on a reticulated structure situated within 2 mum of the surface of the unfertilized egg, and within 8 mum of the surface the vegetal region and then posterior region of the zygote. By isolating cortices from eggs and zygotes we demonstrated that this reticulated structure is a network of cortical rough endoplasmic reticulum (cER) that is tethered to the plasma membrane. The postplasmic RNAs macho 1 and HrPEM were located on the cER network and could be detached from it. We also show that macho 1 and HrPEM accumulated in the CAB and the cER network. We propose that these postplasmic RNAs relocalized after fertilization by following the microfilament- and microtubule-driven translocations of the cER network to the poles of the zygote. We also suggest that the RNAs segregate and concentrate in posterior blastomeres through compaction of the cER to form the CAB. A multimedia BioClip 'Polarity inside the egg cortex' tells the story and can be downloaded at www.bioclips.com/bioclip.html

Animals↗
PubMed2000

The Centre for Minimal Access Surgery--teaching for tomorrow.

The Centre for Minimal Access Surgery (CMAS) was established as a state-of-the-art multidisciplinary technological education and research centre for minimal access surgical techniques. Up-to-date training models were obtained to facilitate skill acquisition. Among these were the Minimal Access Therapy trainer and the Body Form Simulator, which provide simulations of the human form on which students can practise operative procedures. The CMAS also acquired the MIST Virtual Reality system, a computer program that facilitates the acquisition of laparoscopy skills. Finally, the CMAS compiled a multimedia library of resources. While many skills can be gained in these synthetic and didactic environments, they cannot provide all the preparation necessary to practise competently. To facilitate the realtime observation of surgical procedures and the telementoring process, the CMAS has commissioned the development of an integrated videoconferencing system that permits the high-quality, rapid transfer of multi-feed video and audio data of surgical procedures from an operating room to the classroom.

General Surgery↗
PubMed2001

Online eye care in prisons in Western Australia.

In prisons, prison medical officers provide general medical care. However, if specialist care is needed then the prisoner is transported to a specialist medical centre. This is a costly procedure and prison escapes occur during transportation. We have tested our Internet-based eye care system in prisons in Western Australia. Medical and ophthalmic history, visual acuity and intraocular pressure were stored in a browser-based multimedia database. Digital images of the retina and the external eye were recorded and transmitted to a central server. Based on the medical data and the digital images, the specialist ophthalmologist could provide a diagnosis within 24 h. Eleven patients (mean age 48, range 30-82 years) were reviewed during two separate visits to a maximum-security prison in Western Australia. Our main aim was to train prison medical officers and nurses to operate the portable ophthalmic imaging instruments and to use the Internet-based eye care system. The outcome of the pilot study indicated that considerable savings could be made in transport costs and the security risk could be reduced. The Ministry of Justice in Western Australia has decided to implement telemedicine services to provide regular ophthalmic consultation to its prisons.

Adult↗
PubMed2002

Continuing education in physical rehabilitation using Internet-based modules.

A rehabilitation outreach team created evidence-based and peer-reviewed educational modules using standard desktop presentation software. Eighteen modules on various topics in physical rehabilitation were published in several formats, including Web pages, directly from the presentation file, for the benefit of health-care providers in eastern and north-eastern Ontario. An online evaluation form could be completed by anyone visiting the Website; the people responsible for community rehabilitation services were asked to encourage their staff to complete the forms. A total of 174 forms were received. The module 'Principles of transfers for health-care workers' accounted for 18% of the evaluations and the module 'Assisted range-of-motion exercises for arms and legs to maintain joint flexibility' accounted for 14%. Thirty-nine per cent of respondents were registered nurses, 13% were physiotherapists and 26% were people with disabilities. Thirty per cent of the participants had limited or no experience with online learning. In the evaluation, high ratings were given for satisfaction and usefulness. From an educator's perspective, multimedia content could be created and distributed without a substantial investment in equipment, software, training and publication time; this represents a 'write once, publish everywhere' approach.

Attitude of Health Personnel↗
PubMed2003

The quality of medical records in teleconsultation.

We collected and examined the medical records from telemedicine cases dealt with by the telemedicine centre of Shanghai Hospital No. 85. This centre handles the second largest number of teleconsultations in the entire network. There were 658 telemedicine cases in total. The medical records included the patient record in 599 cases (91%), transmitted images in 392 cases (60%), the consultant's opinion in 595 cases (90%) and a video-recording of the teleconsultation in 203 cases (31%). The quality of patient records was reviewed and found to be acceptable in 58% of cases. In total, 1794 radiology images (85% of all images) were transmitted via the telemedicine network. The consultant considered 352 of them (20%) to be unreadable on the screen (i.e. 80% of radiology images were considered to be acceptable). For optimum performance of telemedicine, the patient record and associated images should be delivered in advance and the relevant parts of the patient record should be available during a teleconsultation. Three aspects of the management of the medical records for teleconsultations are particularly important: multimedia collection, standardization of patient/record identification and classification, and information management.

Humans↗
PubMed2003

A clinical and educational telemedicine link between Bulgaria and Greece.

During its transition to a market economy, Bulgaria benefited from foreign aid provided by Greece. One of the projects was the clinical and educational telemedicine link between the Medical University of Varna in Bulgaria and the Faculty of Medicine of Aristotle University of Thessaloniki in Greece. This began in 1997. In terms of the educational activities, the Bulgarian side of the network supports: an electronic classroom equipped with personal workstations, multimedia projectors and videoconference facilities; electronic design and publishing activities; Web hosting and mail server activities; and satellite communications. Communications are via ISDN. The main clinical experience has been remote consultations in immunology. This experience (admittedly limited) demonstrates that telemedicine can be used to provide assistance to remote colleagues. In addition, the use of telemedicine can greatly improve the quality of care available to travellers and migrant workers in cases where the patient cannot communicate with the attending physician because of a language barrier.

Bulgaria↗
PubMed2003

A tele-otology course for primary care providers.

The shortage of otolaryngologists and the high incidence of ear disease in remote areas are major problems in Australia. We have developed a multimedia course for primary care providers that incorporates material about ear anatomy and physiology, ear disease, video-otoscopy and telemedicine software. The computer-based course was followed by a practical one-day course. A multiple-choice test was given to participants before and at the end of the course and a form was used to record feedback. The course was conducted with 30 aboriginal health workers. The participants were able to obtain images of reasonable to good quality after a short period of training. There was an average improvement of about 25% in the test scores, and the feedback regarding the course was extremely positive. The CD-ROM and the Website provide a valuable resource to assist primary care providers in their care of patients with ear disorders.

Attitude of Health Personnel↗
PubMed2004

A multi-functional, portable device with wireless transmission for home monitoring of children with a learning disability.

A portable monitoring device was developed to assist in the management of children with a learning disability. The device was designed for continuous home monitoring of blood oxygen saturation, heart and respiration rates, and patient activity. It could be worn on a belt, while the patient continued normal activities. Data were stored on a multimedia card and automatically transmitted to a PC at prescribed intervals via a Bluetooth wireless link. From the PC the data were transmitted to a Web server, where the information was made available to the staff involved in the patient's care. Preliminary clinical studies were performed with nine patients (four with Down's syndrome, three with cerebral palsy and two with mental retardation). Patients and families considered the device easy to use and to wear. The monitoring device identified events of possible clinical interest. Although it was designed for monitoring children with a learning disability, it may also be useful with other groups, such as elderly people.

Child↗
PubMed2004

Development of an online, team-based programme in telecare.

Few health-care providers have experience of delivering telecare and access to formal training is limited. We therefore developed an online training programme in telecare. A participatory design approach was used and telecare providers were invited to participate in each stage of the course design cycle. The course content, learning activities and learning materials such as video were based on the results of interviews with providers from various health disciplines and observations in the telecare workplace. The approach led to the development of a six-week, multimedia, online course for members of the health-care team. Participants were asked to review the prototype course for completeness and accuracy of content, quality of course design and the utility of learning activities. Overall feedback was favourable. Learners found the course content and learning activities helpful, and it met their needs. The learning material was then reviewed by a panel of experts and further revisions were made. Including providers in the development process led to the creation of a course that appears likely to improve the implementation and practice of telecare.

Attitude of Health Personnel↗
PubMed2004

A simple telemedicine system to provide second-opinion advice to the patients of an Albanian diagnostic centre.

Since August 2003, the IKEDA Klinika diagnostic centre in Tirana, Albania, has offered patients telemedical help from Greece. The teleconsultation service is based on Internet technologies adapted to telemedical use, including the use of forms (e.g. for the patient history), multimedia file exchanges (e.g. for radiographs and electroencephalograms) and videoconferencing. The teleconsultants assist in treatment planning and, when necessary, in organizing the transfer of patients to Greece. The four cornerstones of the service are: the provision of second opinions by telemedicine; assistance in treatment planning; assistance to patients during transfer; and the continuity of medical care on their repatriation. Based on the first six months of operation, we estimate that, if bureaucratic visa restrictions to patient movement between Albania and Greece are removed, more than 2000 patients per year will benefit from the service and more than 400 patients will be transferred to Greek hospitals for treatment.

Albania↗
PubMed2005

Data conferencing in health care.

Data conferencing is a computing technique that helps people to communicate in realtime and to share information with others simultaneously. The T.120 standard provides a base for: (1) multipoint data sharing; (2) interoperability; (3) reliable data transfer; (4) scalability, transparency and independence; (5) platform independence; (6) application independence. A review of the health-care data-conferencing literature identified 25 articles. Ten articles provided detailed information about data-conferencing applications. Of these, eight focused on application sharing, seven on whiteboards, two on chat and one on screen sharing. Articles published before the year 2000 typically focused on the use of NetMeeting and Intel ProShare with low-bandwidth network connections. After 2000, high-speed Internet connections became more popular and Web-based multimedia data conferencing became feasible. While there are undoubted benefits of data conferencing, more research and evaluation are required before the technique is widely implemented in health care.

Computer Communication Networks↗
PubMed2005

Establishment of the Brazilian telehealth network for paediatric oncology.

A telemedicine network has been established in Brazil to support distance medical practice in paediatric oncology. ONCONET comprises a national network of universities, research institutes and medical institutions. The system is Web-based and hosted on a high-performance computing infrastructure based on clusters of computers. It is based on open-source software, designed to provide high performance, fault tolerance and high availability. The ONCONET began operation in 2004. Currently, 30 hospitals affiliated to the Brazilian Society for Paediatric Oncology are users of the ONCONET. Six hospitals are connected by broadband access through the National Education and Research Network and 24 by conventional Internet access. The Multimedia Patients Registry also became operational in 2004, and its database contains information on 3,200 patients from the 30 hospitals. The technological platform was notable for its low production cost. It thus appears to be a sustainable solution to the problem of delivering continuing medical education in a large country with widely dispersed health professionals.

Brazil↗
PubMed2006

Tele-education.

Tele-education has been used for many years to deliver continuing education programmes to rural health-care professionals. The main modes are audio, video and computer. Audio technologies involve the transmission of the spoken word (voice) between learners and instructors, either synchronously or asynchronously. Examples of the former include audioconferencing and short-wave radio; examples of the latter include audiotape or audiocassette. Video for distance learning, like audio, can be used in either synchronous or asynchronous fashion. Videoconferencing, or interactive television, are considered synchronous because there is the opportunity for live visual and verbal interaction between instructors and learners. Asynchronous instructional video tools include slow-scan video, interactive videodiscs and videotapes. Computer-assisted learning or instruction can be defined as any learning that is mediated by a computer and which requires no direct interaction between the user and a human instructor in order to run. It is becoming increasingly common. Examples include: the Internet and World Wide Web, email, synchronous and asynchronous computer-mediated communication applications and interactive multimedia applications on CD-ROM. Tele-education technologies have an important role to play in addressing the professional isolation which is experienced by rural and remote health-care professionals.

Audiovisual Aids↗
PubMed1996

Integrated telematic support for paediatrics: a practical model.

This paper describes the benefits gained and the organizational and practical considerations involved in establishing a relatively low-cost telematic support network for paediatric care and research. It is based on a case study in north-east England, where such a system has been implemented, supporting multimedia conferencing and reference facilities, postgraduate education and management information. The role of this type of service in regional health-care provision is discussed, for paediatrics and other disciplines.

Computer Communication Networks↗
PubMed1997

Comprehensive standardized ophthalmic telemedicine.

The Electrodiagnostic Neurophysiological Automated Analysis (ENAA) telematic system was developed in the EU EUREKA project. To validate the system 2500 electrodiagnostic tests were administered in a standardized manner during a three-year period. The tests were performed on 70 normal subjects and 500 patients in five laboratories in three European countries. The data were transmitted to the Bristol Telematic Electrodiagnostic Centre in the Bristol Eye Hospital. Data from normal subjects were not significantly different between laboratories. Data from patients were reported upon and the conclusions transmitted to the place of origin. The system provided the remote consultant with multimedia data, including medical images such as colour fundus photography and angiography, video and sound.

Humans↗