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PubMed2005

Botulinum toxin therapy for abductor spasmodic dysphonia.

Botulinum toxin has been widely accepted as an effective therapy for controlling the symptoms of adductor spasmodic dysphonia (ADSD). Reported experience with botulinum treatment for abductor spasmodic dysphonia (ABSD) has been less impressive. Factors that may impair outcomes for ABSD include differences in the pathophysiology of ADSD and ABSD and limitation of maximal dose from airway restriction with posterior cricoarytenoid muscle (PCA) weakness. We report our experience with botulinum injection of the PCA with an asymmetric dose escalation protocol, based on clinical observations that in ABSD, abductor spasms are often stronger on one side, usually the left. The nondominant side was injected with 1.25 units. Dominant side dose began at 5 units, with step-wise increments of 5 units per week until one of three endpoints was reached: Elimination of breathy voice breaks, complete abductor paralysis of the dominant side, or airway compromise. Fourteen of 17 patients achieved good or fair voice, with dominant-side doses ranging from 10 to 25 units. Exercise intolerance limited PCA dose in two patients. One patient had persisting breathiness that improved with medialization thyroplasty. Asymmetric botulinum toxin injection into PCA muscles can suppress abductor spasm in patients with ABSD, but breathiness may persist, because of inadequate glottal closure.

Botulinum Toxins↗
PubMed2003

Postictal laughter following absence status epilepticus.

Acute pathologic neurologic laughter has been described as an ictal phenomenon in epilepsy, as a result of electrical brain stimulation to the cortex and to deep brain structures, in brain tumors, and in stroke. We report what is, to our knowledge, the first report of a case of postictal pathologic laughter. Previously diagnosed with medically refractory complex partial seizures, our patient was admitted to the hospital with phenytoin toxicity. During video-EEG monitoring she experienced multiple brief absence seizures as well as a prolonged episode of absence status epilepticus. Immediately following cessation of the seizure she began to laugh. Her laughter was mirthful and infectious. This lasted several minutes and was followed immediately by several minutes of crying and then a return to normal. We propose that diffuse cortical inhibition led to release of subcortical structures involved in emotional expression. Possible neural substrates of laughter are discussed.

Adult↗
PubMed2004

The Zebrafish DVD Exchange Project: a bioinformatics initiative.

Scientists who study zebrafish currently have an acute need to increase the rate of visual data exchange within their international community. Although the Internet has provided a revolutionary transformation of information exchange, the Internet is at present unable to serve as a vehicle for the efficient exchange of massive amounts of visual information. Much like an overburdened public water system, the Internet has inherent limits to the services it can provide. It is possible, however, for zebrafishologists to develop and use virtual intranets (such as the approach we outlined in this chapter) to adapt to the growing informatics need of our expanding research community. We need to assess qualitatively the economics of visual bioinformatics in our research community and evaluate the benefit:investment ratio of our collective information-sharing activities. The development of the World Wide Web started in the early 1990s by particle physicists who needed to rapidly exchange visual information within their collaborations. However, because of current limitations in information bandwidth, the World Wide Web cannot be used to easily exchange gigabytes of visual information. The Zebrafish DVD Exchange Project is aimed at by-passing these limitations. Scientists are curiosity-driven tool makers as well as curiosity-driven tool users. We have the capacity to assimilate new tools, as well as to develop new innovations, to serve our collective research needs. As a proactive research community, we need to create new data transfer methodologies (e.g., the Zebrafish DVD Exchange Project) to stay ahead of our bioinformatics needs.

Animals↗
PubMed1993

Interactive videodisc and compact disc-interactive for ophthalmic basic science and continuing medical education.

BACKGROUND: The authors designed and implemented a complete curriculum in ophthalmic pathology using IBM- and Macintosh-based interactive videodisc (IVD) technology. They also redesigned a portion of this curriculum for a new television-based platform, compact disc-interactive (CD-I). METHODS: The following issues were addressed: curriculum design, instructional design, the assembly of illustrations and the ownership of such materials, the generation of computer-based medical art and animation, and programming. The issue of academic credit for faculty participating in this effort also was considered. RESULTS: The computer-based IVD program provides the following features: (1) rapid access to thousands of high-quality illustrations with the option of superimposing graphic labels and text directly over pictures; (2) the ability to view enlargements of photographs; (3) an online glossary to view definition of terms coupled with high-quality photographs; and (4) a dynamic introduction to pathophysiology using interactive animation sequences. The authors were able to incorporate the same interactive features into the CD-I version. High-quality medical illustrations can be used effectively on the CD-I platform. CONCLUSIONS: Computer-based multimedia workstations are relatively expensive for personal use but may be useful if the equipment can be shared in a learning center or library. Compared with interactive computer-based solutions, consumer-oriented television-based technology such as CD-I is a relatively inexpensive vehicle for providing continuing medical education programs intended for use in the individual practitioner's office or home.

Compact Disks↗
PubMed1989

A computer based handbook and atlas of pathology.

The Diagnostic Encyclopaedia Workstation (DEW) is a computerized handbook of pathology intended for use in diagnostic practice. It consists of a combination of a personal computer (PC), a video disc player (VDP), for which a specially developed disc is used, two monitors, a mouse and software. The hard disc of the computer contains textual information on diagnoses in categories such as macroscopy, common histology, immunopathology, clinical observations and prognosis and case histories. This information is frequently illustrated by pictures on a video disc which is automatically addressed by the computer software. All pictures, at present some 3000, pertain to case histories which are included in the system. Also integrated are classification aids in two categories: diagnostic criteria and differential diagnosis. Advantages of DEW over the use of conventional manuals are 1) the extensive volume of text, 2) the large number of high quality illustrations, 3) the immediate access to cross references and 4) the potential for continuous revision.

Anatomy, Artistic↗
PubMed2002

An investigation of a video-based patient repositioning technique.

PURPOSE: We have investigated a video-based patient repositioning technique designed to use skin features for radiotherapy repositioning. We investigated the feasibility of the clinical application of this system by quantitative evaluation of performance characteristics of the methodology. METHODS AND MATERIALS: Multiple regions of interest (ROI) were specified in the field of view of video cameras. We used a normalized correlation pattern-matching algorithm to compute the translations of each ROI pattern in a target image. These translations were compared against trial translations using a quadratic cost function for an optimization process in which the patient rotation and translational parameters were calculated. RESULTS: A hierarchical search technique achieved high-speed (compute correlation for 128 x 128 ROI in 512 x 512 target image within 0.005 s) and subpixel spatial accuracy (as high as 0.2 pixel). By treating the observed translations as movements of points on the surfaces of a hypothetical cube, we were able to estimate accurately the actual translations and rotations of the test phantoms used in our experiments to less than 1 mm and 0.2 degrees with a standard deviation of 0.3 mm and 0.5 degrees respectively. For human volunteer cases, we estimated the translations and rotations to have an accuracy of 2 mm and 1.2 degrees. CONCLUSION: A personal computer-based video system is suitable for routine patient setup of fractionated conformal radiotherapy. It is expected to achieve high-precision repositioning of the skin surface with high efficiency.

Algorithms↗
PubMed1994

Joseph E Whitley, MD, Award. Computer-assisted instruction with interactive videodisc versus textbook for teaching radiology.

RATIONALE AND OBJECTIVES: We compared computer-assisted instruction with interactive videodisc (CAI-videodisc) with a textbook to study differences in educational efficacy, time spent, and subjective preferences. METHODS: Two modules of CAI-videodisc, one concerning the radiology of arthritis and the other skeletal trauma, were prepared specifically for advanced medical students and junior house staff. Because the modules were derived from an actual textbook, we were able to conduct a controlled comparison. Our participants were 103 third- and fourth-year medical students taking a required 2-week clerkship in diagnostic radiology. They were assigned as part of their coursework the CAI-video-disc version of one module and the textbook version of the other. Pre- and posttests were administered. RESULTS: The mean scores improved from pre- to posttest after students used both modules in either version (P < 0.001). The gain in score was greater for students using CAI-videodisc; this difference was small only for the arthritis module (P < 0.092), but it was large for the trauma module, even when adjusted for differences in time spent learning (P < 0.001). Significantly more time was spent on the CAI-videodisc versions than the textbook versions (P < 0.004). Subjectively, 43% of the students preferred the CAI-videodisc, 45% preferred the textbook, and 11% had no preference. CONCLUSION: Medical students learned more radiology using a CAI-videodisc program than reading a textbook, but spent more time doing so. Their subjective preferences were equally split.

Awards and Prizes↗
PubMed2006

[Interactive educational DVD on hoof protection, horseshoeing and diseases of the hoof].

Good cooperation between farrier, veterinarian and horse owner is an important prerequisite for optimal support of the horse with regards to shoeing and hoof health. The introduction of a joint educational aid aims to improve the level of education of both veterinarians and farriers. The interactive, multimedia approach represents an innovative new dimension in instruction techniques, predominantly provided through images and videos. The contents of the new teaching aid will focus on detailed anatomy of the foot and distal limb, as well as currently accepted shoeing practices and techniques and pathologic conditions of the hoof and foot.

Animals↗
PubMed1992

Speechreading performance under different conditions of video image, repetition, and speech rate.

Speechreading was assessed under different conditions of video image, repetition, and speech rate in three experiments on children who are deaf. The objective of the experiments was to obtain information for the design of interactive speechreading training programs using an interactive laser videodisc. Results of Experiment 1 showed that three different video images of testers (Entire-Face, 2/3 Profile, and Lips-Only), did not result in significantly different scores. Experiment 2 assessed which form of repetition (Entire-Face, 2/3 Profile, Lips-Only,) after the first Entire-Face presentation had the biggest effect on improving speechreading performance. The three different forms of repetition appeared to lead to a similar significant improvement. In Experiment 3, various speechreading stimuli were presented at four different speech rates. It appeared that these four speech rates did not significantly influence the speechreading scores. Results suggest that there is a wide range within which speaker-sender variables may vary without affecting the overall speechreading results.

Adolescent↗
PubMed2003

The effect of intra-operative video on patient anxiety.

We conducted a randomised controlled study to evaluate whether watching video compact discs intra-operatively using a liquid crystal display (LCD) unit decreased anxiety. Forty-four patients undergoing elective surgery under regional anaesthesia were assigned to either the LCD or control group. Anxiety was measured using the Chinese version of the State-Trait Anxiety Inventory (STAI) and visual analogue score (VAS). The mean (SD) anxiety trait scores were 46.15 (6.28) and 46.40 (7.32) in the control and LCD groups, respectively. The state anxiety of the LCD group [35.50 (7.96)] measured immediately postoperatively was significantly lower than the control group [41.50 (9.02); p = 0.03]. The median (range) reduction in VAS anxiety score was not significantly greater in the LCD group [20 (20 to 80) mm] compared with the control group [12.5 (70 to 60) mm]. Watching video intra-operatively reduces patient anxiety as measured by the STAI.

Adolescent↗
PubMed1989

Computerized information sources in toxicology and their use in a poisons centre.

The increasing volume of calls received by a poisons centre, such as the National Poisons Unit, Guy's Hospital, London is placing the present information services under escalating pressure. Recent developments in the technologies used to store and manipulate data have resulted in a number of public and private computerized systems being made available. In order to maximize the benefit of the new technologies to a Poisons Centre Information Service it would be desirable to create an integrated system to link the currently unrelated systems. Such an integrated system would be capable of retrieving bibliographic information from bibliographic files similar to MEDLINE and EMBASE and data from source information files such as RTECS and ECDIN, with the user only having to make one enquiry. This paper examines the current position with regard to computerized information sources in toxicology and discusses how an integrated system might improve the efficiency of a poisons centre's information retrieval service and outlines some of the obstacles to the development of such a system.

Catalogs as Topic↗
PubMed2000

Randomized, controlled trial of an interactive videodisc decision aid for patients with ischemic heart disease.

OBJECTIVE: To determine the effect of the Ischemic Heart Disease Shared Decision-Making Program (IHD SDP) an interactive videodisc designed to assist patients in the decision-making process involving treatment choices for ischemic heart disease, on patient decision-making. DESIGN: Randomized, controlled trial. SETTING: The Toronto Hospital, University of Toronto, Toronto, Ontario, Canada. PARTICIPANTS: Two hundred forty ambulatory patients with MEASUREMENTS AND MAIN RESULTS: The primary outcome was patient satisfaction with the decision-making process. This was measured using the 12-item Decision-Making Process Questionnaire that was developed and validated in a randomized trial of the benign prostatic hyperplasia SDP. Secondary outcomes included patient knowledge (measured using 20 questions about knowledge deemed necessary for an informed treatment decision), treatment decision, patient-angiographer agreement on decision, and general health scores. Outcomes were measured at the time of treatment decision and/or at 6 months follow-up. Shared decision-making program scores were similar for the intervention and control group (71% and 70%, respectively; 95% confidence interval [CI] for 1% difference, -3% to 7%). The intervention group had higher knowledge scores (75% vs 62%; 95% CI for 13% difference, 8% to 18%). The intervention group chose to pursue revascularization less often (58% vs 75% for the controls; 95% CI for 17% difference, 4% to 31%). At 6 months, 52% of the intervention group and 66% of the controls had undergone revascularization (95% CI for 14% difference, 0% to 28%). General health and angina scores were not different between the groups at 6 months. Exposure to the IHD SDP resulted in more patient-angiographer disagreement about treatment decisions. CONCLUSIONS: There was no significant difference in satisfaction with decision-making process scores between the IHD SDP and usual practice groups. The IHD SDP patients were more knowledgeable, underwent less revascularization (interventional therapies), and demonstrated increased patient decision-making autonomy without apparent impact on quality of life.

Confidence Intervals↗
PubMed2003

CD/DVD technology.

For storage of large amounts of data, there are many options to consider, including both CD and DVD methods. Given that these are now becoming very cheap alternatives, and that we work in a specialty which generates large volumes of digital data, it is now obvious why CD and DVD burning is of interest to radiologists. These technologies can most assuredly be of great benefit to both our professional and personal lives.

CD-ROM↗