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[Medical informatics education at medical schools in Bosnia and Herzegovina].

AIM: Standardization of education process and almost every aspect of life in EU moved the authors of this paper to evaluate medical informatics education at medical schools in Bosnia and Herzegovina. A very complex political structure and existence of two entities, one district and ten cantons in the Federation of Bosnia and Herzegovina caused great differences in the curricula, teaching methods and quality of acquired knowledge among medical schools in the country. Also, on the example of the teaching process at the Medical School, University of Sarajevo, the authors propose a future united and integrated system in the area. METHOD: Method of the study is descriptive, comparing education in medical informatics at five B&H medical schools. Over 500 students answered questionnaires designed at medical schools in Sarajevo and Tuzla. The questions tackled the contents of the subject of medical informatics, the possibility of acquiring knowledge from both practical and theoretic lessons, "good" and "bad" sides of the curricula as well as students' computer literacy. RESULTS: The subject of medical informatics is being taught in at least 3-4 different ways. Medical schools in Banja Luka and Foca/Srbinje are under a strong influence of the University of Belgrade, Serbia and Montenegro; the teaching staff in Mostar are from Croatia; the University of Tuzla has its own way; and Medical School in Sarajevo maintains high quality values and principles. Things and events that distinguish the Medical School, University of Sarajevo is the fact that it is the only medical school in Bosnia and Herzegovina which has a web site of of the Department of Medical Informatics, organized a number of events including a distance learning course, and has a highly competent teaching staff. Medical School in Sarajevo is the oldest medical school in Bosnia and Herzegovina established in 1944. As a required subject, medical informatics was introduced in the academic year 1992/1993, and it is the only medical school in Bosnia and Herzegovina where medical informatics is taught in two semesters, second and eleventh. DISCUSSION: Three important areas are discussed: the quality of education in secondary schools should be improved; the lack of multimedia equipment, good LAN, high-speed connection to Internet and well organized web design, and issues related to maintenance of equipment; and students should have free access to computer rooms to enable them to extend their knowledge in spare time; general information about health system should be available to students to allow them to require the role and importance of medical informatics in "real life". Naturally, we raise the question of unique and systematic medical informatics education in the whole country, irrespective of entities, nationality or religion of students. CONCLUSION: Medical informatics education at Medical School, University of Sarajevo, is based on the same concept as on prestigious universities all over the world and in accordance with recommendations of the working groups on education of EFMI and IMIA. Other medical schools in Bosnia and Herzegovina should employ the same methodology and system of work in order to have standardized education in medical informatics and to achieve high quality in education. To enable us to follow the European and global achievements in this area, the power of fact should predominate in the education system as well as in the health system.

Bosnia and Herzegovina↗

[Good medical education is impossible without computers].

Computers are medical instruments, for which reason they must be included in the medical curriculum. As educational tools, electronic teaching environments, multimedia applications and computers stimulate self-study. Moreover, computers make the medical literature readily accessible and facilitate the administration of the training programme. They are thus an indispensable part of medical education, and of academic and student administration.

Computer-Assisted Instruction↗

A student-oriented study tool for heterogeneous HyperCard courseware.

Several computer-assisted instruction initiatives at our institution rely on a shared laserdisc for image storage and HyperCard for interactive programming. This paper furnishes a brief overview of problems encountered with multimedia projects and how we are attempting to overcome them using a generic, student-oriented study tool. The tool provides bookmarks, annotations, quotations, and other utilities across our entire HyperCard courseware collection.

Computer Graphics↗

Application development in the DeSyGNER environment: dynamic assembly of independent information resources via direct manipulation authoring.

Dynamic assembly of applications from diverse and possibly disparate collections of information components is a key element for powerful information management environments. Traditional methods of application development hinder flexible integration of information components because they treat computer programs as single units of functionality; inter-application connections and sharing of intra-application information components are achieved only by special cooperation between program authors. We have created a multimedia applications development architecture called DeSyGNER (the Decision Systems Group Nucleus of Extensible Resources) that provides a generalized framework for the inter-connection of independently developed units into applications. By focusing on composition methods or paradigms for constructing applications from modular, reusable units, DeSyGNER fosters sharing and cooperation in application development.

Authorship↗

Computer based decision support in dentistry.

Work analyses in dental practices have revealed a need for improvements especially in regard to patient dental record, decision support for diagnosis and therapy and patient recall. An adequate decision support for diagnosis, therapy and prevention requires the use of the most advanced methods of informatics and computer bases interactive multimedia technology as well as of advanced human-computer interface techniques.

Appointments and Schedules↗

[Magneto-optical disk filing system for oral diagnostic reports and their synchronized images].

The rewritable and compact media of magneto-optical disk (MOD) is firstly applied to store medical images with spoken reporting. The MOD has multi-media function of communication and filing. Our system is optimized in terms of recording length of speech based upon our clinical research. The results will have influences over the future PACS. One of their examples is possibility of multimedia PACS with images, speeches and demographic data. Another example is prevention of dispersion of images which have no interpretations by radiologists. Our next step is to recognize filed speech in background processing for printing reports.

Optical Storage Devices↗

Factors that contribute to Medicare HMO risk contract success.

In 1985, federal legislation was implemented that allowed HMOs to contract with the Health Care Financing Administration for Medicare enrollees on a risk basis. This change stimulated the development of risk contractors and a growth in HMO Medicare enrollees. This paper examines selected factors that contributed to large Medicare risk contract enrollment in four geographical locations: Los Angeles, Minneapolis-St. Paul, New York City, and Portland, Oregon. The primary types of factors examined were: HMO market conditions, HMO characteristics, and HMO marketing strategies and practices. The market competition varied substantially across the four areas. HMO plan age, total number of HMO enrollees, low premium, and the use of multimedia marketing strategies were positively associated with large Medicare risk contract enrollment.

Aged↗

[Campaign strategy against AIDS in Africa: Congolese procedures and experience].

Compared with US and European countries, AIDS prevention in Africa has two specificities: there are no peculiar risk groups and the HIV is transmitted mainly through heterosexual relations. In Congo, the prevention strategy aims at the followings: information and in-service training for health workers; medical and psychological care for contaminated persons; and information to the general public. As AIDS spreads much more in urban areas (3.8%) than in rural areas (less than 1%), the first decision has been to organise a systematic screening of blood donors in Brazzaville, together with a face-to-face counselling for everyone and particularly to HIV positives. The public information is based on public sessions with half-an-hour information and a two-hour discussion. As condoms are not yet psychologically and economically accessible to the African people, the prevention campaigns have to give a panel of possible solutions, including abstinence, decrease in the number of partners, fidelity,.... The approaches are multimedia including theater, songs, posters, TV and radio.

Acquired Immunodeficiency Syndrome↗

[Presentation of an urologic laser video-disc].

The authors participated in the development of the first medical laser video-disc of the National Education department, together with 80 other French teams. Among the 40,000 images recorded in this version, of the 100,000 possible, 1,500 are of direct application to urology, which is already considerable and very largely sufficient for the institution of a good methodology of use of this new data support. The laser video-disc is produced from simple colour slides or professional video recordings of very high quality. Images are transcribed onto a stock reel, photographed to harmonize quality and then transferred to a master disc allowing pressing of numerous laser discs in a not too costly manner. The image in these discs remains analogic in contrast to digital CD ROM discs. The images can be read singly, with rapid access, or in sequence. Recording of comments on images is initially by computer with a very detailed, normalized protocol. This allows subsequent practical use of the Philips laservision video-disc with a computer and a high performance, if possible, expert system program. Creation of this basic model of multimedia medical data of large capacity requires, the development of original methodologies of use. Thousands of images are proposed and thousands of good practical uses should be proposed by us, for example: pedagogic for different audiences, in therapy, as an aid to diagnosis, to assist recording of medical images, in order to ensure effective cost/benefit ratios for the media. The innovation of a medical thesaurus specialized in imaging technics is essential to ensure maximum use of this disc, and the authors are currently developing means for insertion of the disc in the daily life of a university hospital.

Information Systems↗

Skin cancer comic book: evaluation of a public educational vehicle.

A 16-page 4-color comic book was developed as part of a multimedia public education campaign designed to improve skin cancer knowledge and prevention/detection behavior. A concentrated comic book distribution to each of 8,000 households in a predominantly Caucasian area was preceded and followed by personal interviews with 300 residents randomly selected from this area. In households reading the comic book (N-122), respondents reported the following changes as a direct result of readership--avoidance of sun exposure between 10 am and 2 pm (44.3%), use of sunscreens with SPF 8 and over (38.5%), skin self-examination (34.4%), and use of protective clothing (29.5%). To a lesser extent nonreaders also showed positive increases, suggesting exposure to other educational efforts of the skin cancer campaign. Over 90% of the readers felt that the comic book was easy to read, easy to understand, and interesting. The comic book appealed less to males and to those above the age of 50 years.

Adolescent↗

Promoting the use of seat belts. Wessex Positive Health Team.

A six-month study into the effect of a substantial programme of integrated health education promoting the use of seat belts showed no major change in the rates for occupants of front seats, which remained around 35%. Though there were increases of up to 5% in the rates for wearing seat belts immediately after the multimedia campaigns which achieved high penetration, only those among women drivers were sustained. Of the methods used to disseminate information, television had the greatest impact on the community, followed by press reports and radio broadcasts. It is concluded that health education alone is insufficient to increase significantly the use of car seat belts. Britain should follow its European partners and pass legislation requiring front seat occupants to wear belts. As the recent experience in Australia shows, the benefits will be considerable in terms of reducing mortality, morbidity, and consequential expenditure.

Advertising↗

The application of educational technology to occupational safety and health training.

For years, lectures and films have formed the basis of health and safety training. New communication systems, however, allow trainees such luxuries as receiving instruction from a source that might be hundreds of miles away. Various multimedia systems are described, including CD-ROM, virtual reality, and others that may some day become the mainstays of worker training.

Audiovisual Aids↗

The medical information superhighway.

Commercial and private use of the Internet has grown exponentially over the last few years. Its estimated size increases by more than 10% per month. Medical information and resources are now available to aid physicians in practice and in research. Users can utilize email to communicate with other medical professionals around the world. The newest and possibly most significant development on the Internet is the World Wide Web. Through it, physicians may access multimedia resources such as databases of medical information, recent news and research, atlases, and electronic journals using an intuitive graphics interface. Medically related software can be obtained from the vast archives on the Internet via the FTP function. As the Internet expands and becomes more ubiquitious, its uses will multiply and become an important mode of medical information dissemination and acquisition.

Computer Communication Networks↗

[New kinds of 3-dimensional atlases of the anatomy and function of the human body].

It is a drawback of classical multimedia programs for the visualization of spatial knowledge, that they are based on a limited number of predefined views. This paper describes a model that combines pictorial and symbolic knowledge about spatial structures in a way that allows arbitrary views of the scene and the interrogation of the model in the context of the actual view. The style of the pictorial presentation only depends on the objective and the phantasy of the user. The functionality of the approach is demonstrated with the example of the human head. It is furthermore shown that the model potentially allows the simulation or generation of all classical visual teaching aids for anatomy.

Anatomy, Artistic↗

BibleCard: network-based virtual database for laboratory information.

The clinical laboratory's use of computers has evolved beyond the single minicomputer stand-alone system. Our laboratory information system is now part of an institutional network. The laboratory also uses smaller systems and workstations for a wide variety of functions, often with much data duplication among systems. We have been developing a network-based virtual database for laboratory test information. This system uses World Wide Web standards for hypertext and multimedia displays, which allows for the display of information retrieved from various department computer sources without the necessity of data duplication, modification of existing systems, or centralization of data. The medical technologists can continue to write testing procedures on their word processors. Maintenance of reference values, specimen requirements, etc., can continue as a laboratory information system function. Yet information from all of these disparate sources can be viewed in a consolidated format that has platform independence.

Chemistry, Clinical↗

Development of a computer program for teaching periodontal diagnosis based on clinical epidemiological principles.

Multimedia teaching tools in dental education are still rare. This paper describes the development of an inexpensive yet powerful computer program for instruction in the principles of clinical epidemiology. The application was developed in the context of periodontal diagnostic methodologies at the third year D.D.S. level. Principles of probabilistic thinking are invoked as the student is guided from the application of raw research data to the derivation of likelihood ratios and how they affect clinical decision making. A questionnaire was used to evaluate student satisfaction with the program and the responses indicated good acceptance of the concepts presented in the program and an interest in further computer-aided instruction.

Computer-Assisted Instruction↗

[Evaluation of a computer assisted training program for hypertensive patients].

ISIS tutorial program (French abbreviation for Animated and Computerized Initiation into Health) was carried out for Macintosh type computers to place a modern and interactive learning device at cardiovascular risk patients' disposal. Such a program combines strict scientific explanations and aesthetic attractiveness of multimedia communication. To test the effect of this device on health knowledge gain, 158 hypertensives admitted in one-day or in half-week clinics for an initial check-up or for a therapeutic adjustment were randomised into two groups: a control group (n = 79), receiving usual education (contacts with physicians, nurses, dieticians, health oriented booklets), and an experimental or "ISIS" group (n = 79) undergoing an interactive session with the computer during 30 to 60 minutes, in addition to usual education. Health knowledge of both groups was assessed through a 28-item questionnaire, before any education procedure, two months after the discharge, through a standardized interview by phone, thanks to the same investigator. On the whole, 69 + 69 = 138 complete case records could be analysed. Initial health knowledge mean score, at admission to the hospital, was 14.3 +/- 4.2 (range: 4 to 25). This score significantly improved among the whole population (difference between the two evaluations: 3.7 +/- 3.5 points; p = 0.0001). Improvement was greater in ISIS group than in controls (p = 0.02). Among hypertensives with initial scores < or = 16, improvement was respectively 4.5 +/- 3.6 and 2.9 +/- 3.0 for ISIS and control groups (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗