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PubMed2003

Validation of medical modeling & simulation training devices and systems.

For almost a decade, research has been conducted in many areas of science to develop medical simulation training devices and even comprehensive training systems. To propel the field, the Telemedicine and Advanced Technology Research Center (TATRC), an agency of the United States Army Medical Research Materiel Command (USAMRMC), has been managing a portfolio of research projects in the area of Medical Modeling and Simulation (MM&S) since 1999. Significant progress has made to identify and harness enabling technologies. Generally, these developments can be categorized in four areas: (1) PC-based interactive multimedia, (2) Digitally Enhanced Mannequins, (3) Virtual Workbench, or "part-task", simulators, and (4) Total Immersion Virtual Reality (TIVR). Many medical simulation-training systems have shown great potential to improve medical training, but the potential shown has been based largely on anecdotal feedback from informal user studies. Formal assessment is needed to determine the degree to which simulator(s) train medical skills and the degree to which skills learned on a simulator transfer to the practice of care. A robust methodology is required as a basis for these assessments. Several scientific workshops sponsored in 2001 focused on algorithm and metrics development in support of surgical simulation. Also in 2001, TATRC chartered a Simulation Working Group (SWG) to develop a robust methodology upon which to base an assessment of the effectiveness of simulation training devices and systems. After the terrorist attacks of September 11, 2001, attention was redirected for a period, and progress was delayed. In the summer of 2002, TATRC chartered a follow-on group called the Validation, Metrics and Simulation (VMAS) Committee. The poster will highlight and summarize the development of the methodology and identify validation studies to be conducted (supported by various funding sources and research programs). The interaction between TATRC and the National Capital Area Medical Simulation Center (NCAMSC) will be noted.

Computer Simulation↗
PubMed2002

Wireless live streaming video of laparoscopic surgery: a bandwidth analysis for handheld computers.

Over the last six years, streaming media has emerged as a powerful tool for delivering multimedia content over networks. Concurrently, wireless technology has evolved, freeing users from desktop boundaries and wired infrastructures. At the University of Kentucky Medical Center, we have integrated these technologies to develop a system that can wirelessly transmit live surgery from the operating room to a handheld computer. This study establishes the feasibility of using our system to view surgeries and describes the effect of bandwidth on image quality. A live laparoscopic ventral hernia repair was transmitted to a single handheld computer using five encoding speeds at a constant frame rate, and the quality of the resulting streaming images was evaluated. No video images were rendered when video data were encoded at 28.8 kilobytes per second (Kbps), the slowest encoding bitrate studied. The highest quality images were rendered at encoding speeds greater than or equal to 150 Kbps. Of note, a 15 second transmission delay was experienced using all four encoding schemes that rendered video images. We believe that the wireless transmission of streaming video to handheld computers has tremendous potential to enhance surgical education. For medical students and residents, the ability to view live surgeries, lectures, courses and seminars on handheld computers means a larger number of learning opportunities. In addition, we envision that wireless enabled devices may be used to telemonitor surgical procedures. However, bandwidth availability and streaming delay are major issues that must be addressed before wireless telementoring becomes a reality.

Computers, Handheld↗
PubMed2002

Development of universal electronic health record in cardiology.

In the paper we discuss the vision and experiences in development of electronic health record based on universal structure of collectable data, multimedia objects, all equipped by supporting systems for data verification and medical guidelines connection. This development is based on existing European and international standards in the field of medical informatics.

Cardiology↗
PubMed2004

Electronic curriculum implementation at North American dental schools.

Electronic curriculum, or E-curriculum, refers to computer-based learning including educational materials available on CD or DVD, online courses, electronic mechanisms to search the literature, email, and various applications of instructional technology including providing laptops to students, multimedia projection systems, and Internet-compatible classrooms. In spite of enthusiasm about the potential for E-curriculum to enhance dental education, there is minimal guidance in the literature to assist schools with implementation. The study objectives were: 1) identify U.S. and Canadian dental schools that have initiated mandatory laptop programs and assess cost, faculty development issues, extent of curricular use, problems, and qualitative perceptions; 2) determine the extent to which twenty-two other E-curriculum resources were available and used at North American dental schools; and 3) identify factors that influenced E-curriculum implementation. A twenty-six item questionnaire, known as the Electronic Curriculum Implementation Survey (ECIS), was mailed to all sixty-six North American dental schools (ten Canadian and fifty-six U.S. schools) during 2002-03 with a response rate of 100 percent. Twenty-five of the twenty-six ECIS questions employed a menu-driven, forced choice format, but respondents could provide amplifying comments. Fifty-three questionnaires were completed by associate deans for academic affairs, three by deans, and ten by instructional technology (IT) managers, IT committee chairs, or directors of dental informatics departments. The survey found that E-curriculum implementation among North American dental schools is following the classic innovation pattern in which a few early adopting institutions proceed rapidly while the majority of potential adopters make modifications slowly. Fourteen U.S. dental schools have established mandatory laptop programs for students. Ten of these laptop programs were created in the past two years; respondents reported numerous growing pains but were generally pleased with their progress. Other E-curriculum capabilities were incorporated into courses more frequently at laptop schools than the fifty-two non-laptop schools including websites, online course evaluations, and instructor use of email to communicate with students. Few dental schools use online courses, and at most schools, few faculty have received training in online instructional techniques. Virtually all North American dental schools have provided substantial instructional technology resources to their faculty, but use of twenty-two components and capabilities of E-curriculum was limited, especially at schools without laptop programs. Various faculty-related issues were reported as implementation barriers including lack of time, skill, and incentive to develop educational software. We conclude that many North American dental schools, especially those with laptop programs, are functioning at the "learn by doing" phase of initial implementation in a four-stage innovation adoption model. E-curriculum planners should pay close attention to implementation problems that occur at this stage where many innovation efforts break down.

Canada↗
PubMed2002

[EGG used in laryngeal diseases].

OBJECTIVE: To analyze the EGG of laryngeal diseases and to evaluate the significance of Electroglottgrapihc waveform in the diagnosis of laryngeal diseases. METHOD: The computer multimedia program of Dr. Speech science for Windows was used to obtain the EGG parameters in 120 cases of vocal polyp, 42 cases of vocal nodule, 21 cases of vocal cord paralysis, 42 cases of laryngeal cancer and 38 cases of Reinke's edema. The ECG parameters were analyzed. RESULT: The special abnormal changes in the waves of EGG were related to the formation (type, position and size ) of laryngeal disease. CONCLUSION: The changes of Electroglottgraphic waveform perform a quantitative and objective index to the diagnosis of the laryngeal disease.

Adolescent↗
PubMed2004

DentSim - a future teaching option for dentists.

Apart from a requirement to acquire more and more academic knowledge, during their training, dental students need to acquire a full range of highly precise manual and technical skills, including excellent hand/eye coordination, to enable them to visualize and understand how to prepare cavities, prior to placing restorations. Furthermore, unlike medical students, dental students are in the position of administering treatment to patients very early in their training. The increasing academic workload means that these skills have to be mastered in a short space of time. This you will gain in the future only through the use of effective methods of the educations - for example by the use of the computer-assisted dental simulators (DentSim/DenX), which serves the visual-, audio- and practical learning channel simultaneously. Unlike the conventional phantom heads, the DentSim-unit has the following advantages - the acquisition of knowledge takes place in a multimedia learning environment with a high audio-visual content and degree of interaction and complexity, - problem-oriented learning takes place through clinically relevant work, - individual students can work to personalized programs through the digital tutor function, - two-dimensional knowledge is transferred into three-dimensional spatial work, - three-dimensional preparations can be easily analysed by two-dimensional error analysis, - all preparation exercises are recorded for error and effectiveness analysis. Apart from student training, the computer-assisted simulators can also be used for the evaluation of the effectiveness or the quality control of various teaching methods in the context of Evidence Based Dental Education.

Computer Simulation↗
PubMed2004

Dentocase - open-source education management system in dentistry.

Since 2001, an interdisciplinary project on multimedia education in medicine has been sponsored by the Federal Ministry of Education and Research at the Charité. One part of the project is on dentistry. In the light of the results of a survey of dental students, an Internet-based education management system was created using open-source back-end systems. It supports four didactic levels for editing documentation of patient treatments. Each level corresponds to the learning abilities of the students. The patient documentation is organized to simulate the working methods of a physician or dentist. The system was tested for the first time by students in the summer semester of 2003 and has been used since the winter semester of 2003 as part of the curriculum.

Computer-Assisted Instruction↗
PubMed2004

A clinical and educational telemedicine link between Bulgaria and Greece.

During its transition to a free 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 (a) electronic design and publishing activities, (b) web hosting and mail server activities and (c) satellite communications. In addition it supports an electronic classroom equipped with personal workstations, multimedia projectors and videoconference facilities. Communications are via the ISDN network. In terms of its telemedicine activities, the network provides remote medical assistance to "language handicapped" travellers and to migrant workers in both countries. The main clinical experience is remote consultations in immunology. This admittedly limited experience demonstrates that telemedicine can be used to provide assistance to remote colleagues. In cases where the patient cannot communicate with the attending physician, the use of telemedicine can greatly improve the quality of care available to travellers and migrant workers.

Bulgaria↗
PubMed2004

Georgia's Cancer Awareness and Education Campaign: combining public health models and private sector communications strategies.

The Georgia Cancer Awareness and Education Campaign was launched in September 2002 with the goals of supporting cancer prevention and early detection efforts, heightening awareness of and understanding about the five leading cancers among Georgia residents, and enhancing awareness and education about the importance of proper nutrition, exercise, and healthy lifestyles. The inaugural year of the campaign is outlined, beginning with adherence to the public health principles of surveillance, risk factor identification, intervention evaluation, and implementation. A strategic and integrated communications campaign, using tactics such as paid advertising, public service announcements, local community relations, media releases, a documentary film, special events, and other components, is described in detail with links to multimedia samples. With an estimated budget of 3.1 million dollars, the first year of the campaign focuses on breast and cervical cancer screening and early detection.

Aged↗
PubMed2004

VERB - a social marketing campaign to increase physical activity among youth.

The VERB campaign is a multiethnic media campaign with a goal to increase and maintain physical activity among tweens, or children aged nine to 13 years. Parents, especially mothers aged 29 to 46, and other sources of influence on tweens (e.g., teachers, youth program leaders) are the secondary audiences of the VERB initiative. VERB applies sophisticated commercial marketing techniques to address the public health problem of sedentary lifestyles of American children, using the social marketing principles of product, price, place, and promotion. In this paper, we describe how these four principles were applied to formulate the strategies and tactics of the VERB campaign, and we provide examples of the multimedia materials (e.g., posters, print advertising, television, radio spots) that were created.

Adolescent↗
PubMedDate not supplied

[WebSurg and the Virtual University].

Multimedia medical education has been demonstrated to be effective, and in some situations, superior to traditional methods of instruction, surgeons being able to acquire new skills from a distance. The purpose of this project was to develop an instructional aid that can be used for surgical education in laparoscopic techniques. A concept of "Virtual University" was developed for surgeons in the field of laparoscopic and minimally invasive surgery. This concept permits surgeons to update their knowledge from a distance any time they want. Using new technologies surgical techniques can be presented in a new fashion, more attractive for surgeons. With the aid of the internet we are now able to add animations and color illustrations with no limits, either in terms of size and number. Contributions were commissioned to international opinion leaders, under the control and seal of approval of national and international societies. The WebSurg site contains surgical techniques (rich illustrated), films presenting surgical procedures and films of expert's opinion. All partners (authors, reviewers, editors, sponsors, owners) must be in agreement with content, and also accept editorial independence. Scientific integrity and academic environment are the key factors to get high quality standards. Codes of ethics have been issued for internet information and must be followed by all websites.

General Surgery↗
PubMed2004

Selected impressions on the beginning of the electronic medical record and patient information.

OBJECTIVES: To present an overview of early European and American work on Electronic Medical Records and patient information. METHOD: The invited lectures of "pioneers of electronic patient information" given at the farewell symposium of Wolfgang Giere in Frankfurt, Germany, are summarized and discussed. RESULTS: The origin of medical record writing goes back to Hippocrates and over many centuries this important medical duty was regarded as an annoying, laborious and error-prone task. First steps towards a better medical record started in 1936 with punch cards. In the 1960s the minimum basic data set, a unique patient ID was introduced and even for outpatients first computerized medical record systems were developed applying some important standards and well accepted data structures. Nowadays multimedia are included in patient record systems, highly specialized subsystems e.g. for radiology or cardiology are available, and semantic and statistic mining techniques as well as medical classifications and standardized terminologies support evaluation. All these methods should primarily improve the quality of care, reduce errors, improve communication between multiple specialists, reduce wait times for patients and improve efficiency. CONCLUSIONS: Over decades it became obvious that the structure of a medical record notably for coded data but also for narrative text and pictures must be carefully modelled. Well maintained standardized health terminologies and medical classifications are important issues for a user-friendly electronic medical record, which bring benefits for clinicians and patients.

Diffusion of Innovation↗
PubMed2004

MUDRLite - health record tailored to your particular needs.

Nowadays most hospitals use electronic health records as part of their hospital information systems. However, these systems are more suitable for hospital management than for physicians. The health record is not sufficiently structured; it includes a lot of free-text information, and the set of collected attributes is fixed and practically impossible to extend. Physicians, gathering information for the purpose of medical studies, often use varied proprietary solutions based on MS Access databases or MS Excel Sheets. The EuroMISE Centre - Cardio is developing an electronic health record (EHR) application called MUDRLite, which could easily fill the gap between existing EHRs. MUDRLite is the result of applied research in the field of EHR design, which is based on experience gathered during cooperation in the TripleC project. MUDRLite development is an extra branch in the MUDR (MUltimedia Distributed Record) development; it simplifies both the MUDR architecture and the MUDR data storage principles.MUDRLite itself is an empty body, which has to be filled in with an XML configuration file. This file completely describes the visual aspects and the behavior of the EHR application. It includes simple 4GL-like constructs written in the MUDRLite Language (MLL). This enables - using the event-oriented programming principles - to program various handling procedures for a range of actions, e.g. clicking a button fills a form with the result of an SQL statement. MUDRLite can be tailored to particular needs of any healthcare provider. This makes the MUDRLite application easy to use in specific environments. In the first instance, we are testing it at the Neurovascular Department of the Central Military Hospital in Prague.

Artificial Intelligence↗
PubMed2004

Telelearning standards and their application in medical education.

Medial education, both on the graduate and postgraduate levels, has become a real challenge nowadays. The volume of information in medical sciences grows so rapidly that many health professionals experience essential problems in keeping track of the state of the art in this domain. e-learning offers important advantages to medical education continuation due to its universal availability and opportunity for implementation of flexible patterns of training. An important trace of medical education is developing practical skills. Some examples of standardization efforts include: the CEN/ISSS Workshop on Learning Technology (WSLT), the Advanced Learning Infrastructure Consortium (ALIC), Education Network Australia (EdNA) and PROmoting Multimedia access to Education and Training in European Society (PROMETEUS). Sun Microsystems' support (Sun ONE, iPlanetTM ) for many of the above-mentioned standards is described as well. Development of a medical digital video library with recordings of invasive procedures incorporating additional information and commentary may improve the efficiency of the training process in interventional medicine. A digital video library enabling access to videos of interventional procedures performed in the area of thoracic medicine may be a valuable element for developing practical skills. The library has been filled with video resources recorded at the Department of Interventional Pulmonology; it enhances training options for pulmonologists and thoracic surgeons. The main focus was put on demonstration of bronchofiberoscopic and videothoracoscopic procedures. The opportunity to browse video recordings of procedures performed in the specific field also considerably enhances the options for training in other medical specialties. In the era of growing health consumer awareness, patients are also perceived as the target audience for medical digital libraries. As a case study of Computer-Based Training systems, the Medical Digital Video Library is presented.

Education, Distance↗
PubMed2004

Evolutionary epistemology and dynamical virtual learning networks.

This paper is an attempt to define the main features of a new educational model aimed at satisfying the needs of a rapidly changing society. The evolutionary epistemology paradigm of culture diffusion in human groups could be the conceptual ground for the development of this model. Multidimensionality, multi-disciplinarity, complexity, connectivity, critical thinking, creative thinking, constructivism, flexible learning, contextual learning, are the dimensions that should characterize distance learning models aimed at increasing the epistemological variability of learning communities. Two multimedia educational software, Dynamic Knowledge Networks (DKN) and Dynamic Virtual Learning Networks (DVLN) are described. These two complementary tools instantiate these dimensions, and were tested in almost 150 online courses. Even if the examples are framed in the medical context, the analysis of the shortcomings of the traditional educational systems and the proposed solutions can be applied to the vast majority of the educational contexts.

Computer Communication Networks↗
PubMed2005

A new platform for laparoscopic training and education.

A new platform for laparoscopic training and education is presented. Fundamental requirements about a flexible haptic interface, specter of training areas, skill assessment, educational content, and level of realism are presented and discussed. The new system, including a new and flexible haptic interface and a broad specter of training modules combined with the use of multimedia content, is described.

Computer Simulation↗
PubMed2004

Non-telephone healthcare: the role of 4G and emerging mobile systems for future m-health systems.

The next generation of "m-health technologies" is a new and evolving topic in the areas of telemedical and telecare systems. These technologies involve the exploitation of mobile telecommunication and multimedia technologies to provide better access to healthcare personnel on the move, by removing the key disadvantage of trailing wires in current systems. These technologies provide equal access to medical information and expert care by overcoming the boundaries of separation that exist today between different users of such medical information. A great benefit to all users will be a more efficient use of resources and far greater location independence. In this paper we will address some notes and future trends in these emerging areas and their applications for m-health systems. Especially we will discuss the role of 4G and emerging mobile systems for future m-health systems. The new technologies can make the remote medical monitoring, consulting, and health care more flexible and convenient. But, there are challenges for successful wireless telemedicine, which are addressed in this paper.

Access to Information↗