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PubMed2004

Multimedia presentations in the age of the Health Insurance and Accountability Act.

The privacy rule of the Health Insurance Portability and Accountability Act (HIPAA) has made all physicians think more about their patients' privacy. In addition to safeguarding health information in routine office practice, doctors now are starting to consider the effects of the regulations on other professional activities including professional clinical multimedia presentations. This article explains specifically where and how multimedia (e.g., images, video) patient information may be used and shared. Although HIPAA itself is a lengthy and detailed document, a few simple rules can be extracted, which when followed, ensure that neither presentations nor patient privacy need to be sacrificed.

Confidentiality↗

PubMed2004

A multimedia psychosocial support program for couples receiving infertility treatment: a feasibility study.

OBJECTIVE: To develop and test the feasibility of a theory-driven, psychosocial support CD-ROM prototype for couples in infertility treatment. DESIGN: Focus group meetings with reproductive health experts, semistructured interviews with infertility patients, and content analysis of an infertility message board to determine content domains of the CD-ROM. Usability and acceptance testing of prototype CD-ROM based on predetermined feasibility criteria. SETTING: Private offices and fertility centers. PATIENT(S): Expert panel of 5 reproductive health specialists; interviews with 62 individuals with infertility (35 women, 27 men); feasibility study with 12 patients and 12 experts in reproductive medicine and infertility support. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Product usability/acceptance test. RESULT(S): Participant feedback and content analysis informed the development of a prototype patient education CD-ROM that uses audio, video, interactive tasks, and personalized feedback. Over 80% of participants successfully completed usability tasks, and over 90% rated prototype satisfaction as "good" to "excellent." Some areas were noted for improvement in navigation and refinement in delivery of instructions. Results strongly indicate an interest in an infertility multimedia support tool. CONCLUSION(S): Multimedia methods may serve as an effective, innovative psychosocial intervention for infertility patients and overcome barriers of limited local access to educational and support services.

CD-ROM↗

PubMed2005

[Multimedia educational material. A tool of support to the Otolaryngology training].

Due to multimedia technologies, the medical information has taken an extraordinary growing. Nevertheless, the education at University will turn out to be a more complex pedagogic process. We present a multimedia educational material (MEM), developed as an online course to "Seminars of Otolaryngology", and available free at the University website. MEM was designed and edited by, ENT teachers, pedagogues, and image and computer experts. It has been structured as a series of modules that integrate texts, images, movie clips, video, audio and animations. The schematic presentation stands out with progressive access to the topics through internal and external links. The pedagogic resources give additional support by learning objectives, glossary, references, index and searcher. Finally, the activities and instrumental simulations complete the training in diagnosis and treatment. The MEM is an interactive useful software program for medical training in Otolaryngology, without avoiding the key figure of the teacher.

Humans↗

PubMed2004

Evaluation of computer-assisted multimedia instruction in intravenous injection.

The purpose of this study was to develop a computer-assisted multimedia training course for intravenous injection and evaluate its effect on the knowledge and self-perceived performance of intravenous injection for novice nurses. Eighty-one novice nurses randomly assigned to the experimental group and control group participated a designed training procedure and took pretest and posttests. The test results were analyzed using statistical methods. From the study it could be concluded that the training course had a significant effect on the intravenous injection's knowledge. Besides, a high rate of satisfaction for the multimedia program showed the self-developed program was successful.

Adult↗

PubMed2001

Developing a multimedia model of chemical dynamics in an urban area.

A multimedia model has been developed to account for the movement of semi-volatile organic compounds (SOCs) in an urban environment. The model, based on a Level III fugacity model of D. Mackay (Multimedia Environmental Models: The Fugacity Approach, Lewis Publishers, Boca Raton, FL, 1991), consists of six compartments: air, surface water, sediment, soil, vegetation, and an organic film that coats impervious surfaces. The latter is a newly identified compartment into which gas-phase SOCs partition and particle-phase SOCs are believed to be efficiently captured (M.L. Diamond, S.E. Gingrich, K. Fertuck, B.E. McCarry, G.A. Stern, B. Billeck, B. Grift, D. Brooker, T.D. Yager, Environ. Sci. Technol., 34 (2000a), 2900-2908). The model, parameterized for downtown Toronto, Ontario, Canada, and run with an illustrative emission rate for selected polycyclic aromatic hydrocarbons and homologues of polychlorinated dibenzodioxins, indicates that the film achieves the highest concentrations among media but that soils are the greatest sink for all but the least hydrophobic chemicals. The film "reflects" the more volatile chemicals into air, facilitates removal to surface waters by wash-off, and provides a surface on which photolytic degradation can occur. As such, the film is a transient sink that increases chemical mobility in urban areas by increasing air concentrations and the cycling of these compounds between air and urban surfaces and increasing water concentrations. Vegetation also accumulates SOCs, a portion of which is transferred to soil that reduces chemical mobility.

Air Movements↗

PubMed2001

Fugacity superposition: a new approach to dynamic multimedia fate modeling.

The fugacities, concentrations, or inventories of pollutants in environmental compartments as determined by multimedia environmental fate models of the Mackay type can be superimposed on each other. This is true for both steady-state (level III) and dynamic (level IV) models. Any problem in multimedia fate models with linear, time-invariant transfer and transformation coefficients can be solved through a superposition of a set of n independent solutions to a set of coupled, homogeneous first-order differential equations, where n is the number of compartments in the model. For initial condition problems in dynamic models, the initial inventories can be separated, e.g. by a compartment. The solution is obtained by adding the single-compartment solutions. For time-varying emissions, a convolution integral is used to superimpose solutions. The advantage of this approach is that the differential equations have to be solved only once. No numeric integration is required. Alternatively, the dynamic model can be simplified to algebraic equations using the Laplace transform. For time-varying emissions, the Laplace transform of the model equations is simply multiplied with the Laplace transform of the emission profile. It is also shown that the time-integrated inventories of the initial conditions problems are the same as the inventories in the steady-state problem. This implies that important properties of pollutants such as potential dose, persistence, and characteristic travel distance can be derived from the steady state.

Environmental Pollutants↗

PubMed2003

Delivery of medical multimedia contents through the TCP/IP network using RealSystem.

We developed a low cost, user-friendly multimedia delivery system, to provide medical lectures saved as multimedia contents to persons engaged in medicine. This system was created using the RealSystem package with the TCP/IP network. Users can review lectures and medical meeting presentations with video and audio through the Internet, whenever convenient. Each medical source of video and slide has been clearly displayed on a screen. Members of medical associations or medical students can easily review the most interesting parts of these files. This system is being used efficiently in distance learning and aids the diffusion of the latest information and technology to busy physicians and medical students.

Computer-Assisted Instruction↗

PubMed1999

CARDIOMEDIA: a communicable multimedia medical record on Intranet and digital optical memory card.

As part of French health reform, French physicians were computerised by the end of 1998. A specific Intranet network will be used to communicate medical data between the health professionals. The objectives of the CARDIOMEDIA project were to develop and evaluate the feasibility of a coronary multimedia data record stored on an optical card and communicable on Intranet within the hospital. Patients treated by angioplasty at the University Hospital of Rennes participated in the experiment. In general, patients are treated in the University Hospital and are followed up by another health care provider closer to their home. The patient leaves the University Hospital with his card, which is directly available elsewhere for emergency or for consultation. This approach is assumed to reduce the number of examinations and to offer a better patient follow-up. The CARDIOMEDIA card is a specialised record including various data types: text, images, image sequences of coronarography and ECG signals. For this purpose an optical card with its large memory is very convenient. We used the DICOM format for image exchange and management. It is combined with CARDIOMEDIA specific compressing software. For the multimedia record the HTML format and web Intranet method are chosen. This provides an intuitive interface which can combine various data types and helper applications like a DICOM image viewer.

Angioplasty↗

PubMedDate not supplied

Economic analysis of bilingual interactive multimedia nutrition education.

CONTEXT: Interactive multimedia (IMM) provides a means to deliver accurate, consistent, and convenient nutrition education. OBJECTIVE: To compare direct costs of bilingual IMM and peer nutrition education methods. DESIGN: Cost per unit of nutrition education for each delivery method was calculated. SETTING: Touch-screen computer kiosk systems in food assistance programs. PARTICIPANTS: Approximately 727 low-income and Hispanic persons. INTERVENTION: Bilingual IMM and nutrition education classes taught by peer educators. MAIN OUTCOME MEASURES: Cost per unit of nutrition education delivered. ANALYSIS: Descriptive: to compare costs and determine break-even points. RESULTS: Initially, costs for both methods dropped and then nearly leveled for the peer method at a break-even point of 633 units, whereas those for IMM continued to decrease. CONCLUSIONS: Interactive multimedia is a cost-effective method of delivering nutrition education, especially to large numbers of people. IMPLICATIONS: Use of this technology could reach additional low-income persons at decreasing costs.

Computer-Assisted Instruction↗

PubMed2003

Computerized, interactive, multimedia cognitive-behavioural program for anxiety and depression in general practice.

BACKGROUND: Cognitive-behavioural therapy (CBT) brings about significant clinical improvement in anxiety and depression, but therapists are in short supply. We report the first phase of a randomized controlled trial of an interactive multimedia program of cognitive-behavioural techniques, Beating the Blues (BtB), in the treatment of patients in general practice with anxiety, depression or mixed anxiety/depression. METHOD: One hundred and sixty-seven adults suffering from anxiety and/or depression and not receiving any form of psychological treatment or counselling were randomly allocated to receive, with or without medication, BtB or treatment as usual (TAU). Measures were taken on five occasions: prior to treatment, 2 months later, and at 1, 3 and 6 months follow-up using the Beck Depression Inventory, Beck Anxiety Inventory and Work and Social Adjustment Scale. RESULTS: Patients who received BtB showed significantly greater improvement in depression and anxiety compared to TAU by the end of treatment (2 months) and to 6 months follow-up. Symptom reduction was paralleled by improvement in work and social adjustment. There were no interactions of BtB with concomitant pharmacotherapy or duration of illness, but evidence, on the Beck Anxiety Inventory only, of interaction with primary care practice. Importantly, there was no interaction between the effects of BtB and baseline severity of depression, from which we conclude that the effects of the computer program are independent of starting level of depression. CONCLUSIONS: These results demonstrate that computerized interactive multimedia cognitive-behavioural techniques under minimal clinical supervision can bring about improvements in depression and anxiety, as well as in work and social adjustment, with and without pharmacotherapy and in patients with pre-treatment illness of durations greater or less than 6 months. Thus, our results indicate that wider dissemination of cognitive-behavioural techniques is possible for patients suffering from anxiety and/or depression.

Adult↗

PubMed2005

Multimedia fate and human intake modeling: spatial versus nonspatial insights for chemical emissions in Western Europe.

Multimedia fate and multipathway human exposure models are widely adopted in assessments of toxicological risks of chemical emissions at the regional scale. This paper addresses the question of how much spatial detail is necessary in such models when estimating the intake by the entire population in large, heterogeneous regions such as Europe. The paper presents a spatially resolved multimedia fate and multipathway exposure model for Western Europe, available as IMPACT 2002. This model accounts for relationships between the location of food production and drinking water extraction as well as where population cohorts live relative to where chemical emissions occur. The model facilitates estimation of environmental concentration distributions, related levels of contaminants in foods, and the fraction of a chemical release that will be taken in by the entire human population (the intake fraction) at the regional scale. To evaluate the necessary spatial resolution, the paper compares estimates of environmental concentrations and the intake fraction from the spatially resolved model with the results of a consistent clone without spatial resolution. An evaluation for disperse emissions of PeCDF (2,3,4,7,8-pentachlorodibenzofuran, CAS# 5120731-4) suggests reasonable agreement with monitoring data for most impact pathways with both versions of the model, but that the generic vegetation models for estimating contaminant concentrations in agricultural produce require improvement. A broader comparison for a range of organic chemicals demonstrates that the nonspatial models are likely to be appropriate in general for assessing dispersed sources of emissions. However, it is necessary to include generic compartments in such nonspatial models to account separately for emissions that enter lakes with long residence times versus rivers that feed directly into seas. For assessing an emission source in a specific location, using models that are not spatially resolved can result in underestimation, or overestimation, of the population's intake by at least 3 orders of magnitude for some chemicals.

Benzofurans↗

PubMed2001

Limitations of multimedia models for use in environmental decision making.

The United States currently is engaged in a complex, multi-billion dollar effort to cleanup a legacy of both privately- and federally-owned hazardous waste sites. Decisions regarding the best approach for remediation of these sites often are based on the analysis of potential risks to human health and the environment. A cornerstone of such analysis is the frequent use of computerized multimedia environmental transport models, to evaluate the large quantities of information necessary to understand the present and future implications of contamination at a site. One barrier to wide-spread use of this analytical procedure is the view that results obtained using computer models are highly dependent on user input, and therefore, subject to manipulation. It is widely recognized that for decisions to be both credible and implementable, the public must have confidence in both the scientific basis for judgments involved and the decision processes employed (NRC, 1983). Our purpose in this article is to overview the difficulties associated with application of multimedia models to real world problems and the contribution these models can make to technically sound estimates of exposure and risk.

Benchmarking↗

PubMed2006

Multimedia hearing handicap inventory: reliability and clinical utility.

PURPOSE: This preliminary study evaluated the test-retest reliability, internal-consistency reliability, and listener reactions to the design and functional utility of the Multimedia Hearing Handicap Inventory (MHHI). METHOD: Participants were 51 adults exhibiting hearing sensitivity ranging from normal hearing to severe hearing loss. Different test-retest sequences, using different combinations of the long and short programs of the MHHI, were administered to 3 experimental groups composed of 17 participants each. An exit interview was used to evaluate the MHHI's clinical utility. RESULTS: Results revealed the MHHI to have high test-retest reliability and high internal-consistency reliability, and thus to have statistical properties similar to those of the original screening versions of the Hearing Handicap Inventories for Adults and for the Elderly. Participant feedback regarding the MHHI's overall clinical utility, the informational content of its long program, and the Hearing Profile feature was highly positive. CONCLUSIONS: Results demonstrate the clinical potential of a multimedia approach in advancing the audiologic rehabilitation process.

Adult↗

PubMed2003

Concept and realization of a multimedia program for veterinary physiology.

A multimedia program, a non-linear system which supplements the traditional, linear way of learning (e.g. with a text book), was developed. Non-linear systems allow the direct use of information in a free sequence. A problem of these systems is the danger that the reader becomes lost in detail. Therefore, a program was constructed which tries to combine the properties of linear and non-linear teaching systems. Student groups were continuously involved during all stages of the project. The program is organized in several levels. These are: (1) choice of chapters; (2) table of contents of one chapter; (3) summary; (4) text and (5) pictures, animations, simulations and video sequences. The program can be used in different ways. In the linear mode, the reader selects via action words different levels of the program. The user can read either only on the level of the summaries or on detailed information (text, pictures, simulations and videos). In the non-linear mode the user jumps via menu items or buttons to selected pictures, simulations or a searched term. In this way, more than 3500 screen pages are integrated into a multimedia program for veterinary physiology. The program is written in TOOLBOOK, and can be used on a personal computer with Windows 95 or higher.

Animal Population Groups↗

PubMed2000

Multimedia education in headache: the European Neurological Network.

The European Neurological Network is a European Economic Community supported project. The purpose of the project was to develop a multimedia educational tool for general practitioners in order to improve their management of sleep disorders, epilepsy and headache. The project involves approximately one hundred engineers and physicians from Belgium, Denmark, England, Finland, France, Germany, Italy, Portugal and Spain. This paper concerns the multimedia educational tool on headache. The system consists of five different modules, i.e. classification, clinical data, headache tutorial, diagnostic headache diary and nomenclature. It is possible to move between the modules both vertically and horizontally. The headache classification of the International Headache Society is provided in full text as a work of reference. This classification is used world wide and has been adopted by International Classification of Diseases 10 Neurological Adaptation (ICD-10 NA) and the World Health Organisation. The clinical data concentrate on migraine and tension-type headache, the two most common headache disorders, but data on familial hemiplegic migraine, cluster headache, drug-induced headache and secondary headaches are also available. The headache tutorial consists of case records that the user can test their diagnostic abilities on. The diagnostic headache diary is an expert system on headache diagnostics. It can be filled in during a consultation in order to provide the headache diagnosis or it can be printed and used by the headache patient to record headache attacks and medicine consumption. The nomenclature module provides an explanation of words and expressions used in the system.

Education, Medical, Continuing↗

PubMed2005

[Simplified production of multimedia based radiological learning objects using the flash format].

PURPOSE: Evaluation of the applicability of the Flash Format for the production of radiological learning objects used in an e-learning environment. MATERIAL AND METHODS: Five exemplary learning objects with different didactic purposes referring to radiological diagnostics are presented. They have been intended for the use within the multimedia, internet-based e-learning environment LaMedica. Interactive learning objects were composed using the Flash 5.0 software (Macromedia, San Francisco, USA) on the basis of digital CT and MR images, digitized conventional radiographs and different graphical elements prepared as TIFF files or in a vector graphics format. RESULTS: After a short phase of initial skill adaptation training, a radiologist author was soon able to create independently all learning objects. The import of different types of images and graphical elements was carried out without complications. Despite manifold design options, handling of the program is easy due to clear arrangement and structure, thus enabling the creation of simple as well as complex learning objects that provided a high degree of attractiveness and interaction. Data volume and bandwidth demand for online use was significantly reduced by the Flash Format compression without a substantial loss of visual quality. CONCLUSION: The universally compatible Flash Format offers an opportunity for the simple production of radiological learning objects that fulfill all relevant needs of modern internet based e-learning environments, such as interactivity, employment of multimedia and convertibility.

Computer Graphics↗

PubMed2003

Public education regarding resuscitation: effects of a multimedia intervention.

STUDY OBJECTIVE: Previous studies have demonstrated inaccuracies in knowledge and perceptions regarding cardiopulmonary resuscitation (CPR) among the general public. This study was undertaken to determine the effect of a multimedia educational intervention on knowledge base and resuscitation preferences among the lay public. METHODS: In this prospective interventional study with preintervention and postintervention measurements, a validated multisite survey was administered to 310 volunteer lay participants in community-based settings during 2001 and 2002. The survey was piloted and validated (percentage of agreement index 98.6%; 95% confidence interval [CI] 0.9810 to 0.9900). An original 8-minute multimedia educational video was written and produced by physicians to provide educational information about cardiac resuscitation to the lay public. RESULTS: Among 310 participants, the mean age was 40 years (range 17 to 92 years), 67% were female, and 57% reported household incomes of more than 30,000 US dollars. Participants' median estimates of predicted postcardiac arrest survival rate before and after the educational intervention were 50% and 16%, respectively (median change 30%; 95% CI 25% to 35%). Median estimated durations of resuscitative efforts in the emergency department before and after the educational intervention were 30 minutes and 19 minutes, respectively (median change 10 minutes; 95% CI 5 to 15 minutes). For a series of hypothetical scenarios, significantly more participants indicated that they would refuse resuscitative efforts in scenarios involving terminally ill patients after the educational intervention. CONCLUSION: Inaccurate perceptions regarding cardiac resuscitation and postarrest survival exist among the lay public. A novel educational intervention demonstrated effective improvements in knowledge base regarding resuscitation, resulting in significant effects on resuscitation preferences among the lay public. Improved public education regarding resuscitation is needed to improve knowledge regarding CPR among the lay public.

Adolescent↗

PubMed2001

Impact of a multimedia breast cancer education intervention on use of mammography by low-income Latinas.

BACKGROUND: This paper describes the results of a study of a multimedia breast cancer educational intervention for low-education, low-income Latinas. METHODS: Study participants were first exposed to an interactive, multimedia breast cancer educational intervention and then interviewed four months later to ascertain their mammography status. RESULTS: About 40% of the women who had either obtained or scheduled mammography since the intervention attributed their decision to the intervention. CONCLUSION: Women who had previously been screened and who understood that mammography was used as a breast cancer screening method were more likely to have scheduled or obtained mammography than other women.

Adult↗