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PubMed2002

An innovative partnership in service.

OBJECTIVE: Stimulated by the need for better alignment of educational content and goals with evolving societal needs, practice patterns, and scientific developments, many medical schools are implementing new and creative educational experiences for students. Tulane University School of Medicine and Apple Computers have established an innovative partnership in which Apple laptop computers support and enhance students' service learning projects. The partnership also provides a unique opportunity to meet the Medical School Objectives Project (MSOP) objectives in Medical Informatics and Population Health, as outlined in Report II.(1) DESCRIPTION: Apple Computers has a commitment to the New Orleans community as part of its corporate strategic plan to support educational programs at all levels; Tulane has a longstanding commitment to and experience with student-led service learning as part of the Foundations in Medicine Course.(2) Senior administrative personnel from Tulane and Apple discussed these common interests, resulting in a partnership to enhance the potential impact on the community served. Apple agreed to donate 20 G3 Powerbooks and a complete set of the Apple Learning series of software to support new and ongoing service-learning projects. A committee of Tulane faculty and students, information technology staff, and an Apple representative developed the project. To maximize students' access to the laptops while managing the administration's liability, the laptops were identically configured with standardized software packages (database development and maintenance, Web access, word processing, presentation development and execution, automated backup, and individual project access to protected server space). To maximize the use of the laptops, students from the service-learning organizations can check out the laptops on a just-in-time basis, because the projects have different needs over time. Student-service leaders are currently defining and developing the exact uses for the laptops. We anticipate that this project will enhance the administrative management of service-learning programs (e.g., schedules, directions to sites), the presentation of educational programs (e.g., teaching in schools), the creation of new media to support programs (e.g., our restaurant choking program has a partnership with the American Heart Association to create a video and training manual to be used nationwide), and data tracking (e.g., sites and clients served, outcomes achieved). Students' use of the laptops should support the achievement of several of the MSOP Report II Medical Informatics objectives. To assess that, all first-year medical students are completing a pre- and post-project survey based on those objectives. DISCUSSION: The availability of laptops and software should significantly enhance the service-learning programs. The students participating should gain important skills in the use of computer technology related to their roles as lifelong learners, educators and communicators, researchers, and managers.(1) We plan to report the results of the pre- and post-project surveys once they have been completed. Students' feedback on the project has been very positive, and we hope it can serve as a model for other medical school, corporate, and community partnerships.

Health Services↗

PubMed2006

Neurophysiology of prehension. I. Posterior parietal cortex and object-oriented hand behaviors.

Hand manipulation neurons in areas 5 and 7b/anterior intraparietal area (AIP) of posterior parietal cortex were analyzed in three macaque monkeys during a trained prehension task. Digital video recordings of hand kinematics synchronized to neuronal spike trains were used to correlate firing rates of 128 neurons with hand actions as the animals grasped and lifted rectangular and round objects. We distinguished seven task stages: approach, contact, grasp, lift, hold, lower, and relax. Posterior parietal cortex (PPC) firing rates were highest during object acquisition; 88% of task-related area 5 neurons and 77% in AIP/7b fired maximally during stages 1, 2, or 3. Firing rates rose 200-500 ms before contact, peaked at contact, and declined after grasp was secured. 83% of area 5 neurons and 72% in AIP/7b showed significant increases in mean rates during approach as the fingers were preshaped for grasp. Somatosensory signals at contact provided feedback concerning the accuracy of reach and helped guide the hand to grasp sites. In error trials, tactile information was used to abort grasp, or to initiate corrective actions to achieve task goals. Firing rates declined as lift began. 41% of area 5 neurons and 38% in AIP/7b were inhibited during holding, and returned to baseline when grasp was relaxed. Anatomical connections suggest that area 5 provides somesthetic information to circuits linking AIP/7b to frontal motor areas involved in grasping. Area 5 may also participate in sensorimotor transformations coordinating reach and grasp behaviors and provide on-line feedback needed for goal-directed hand movements.

Action Potentials↗

PubMed1991

Simulator for evaluating shoulder motion as a command source for FES grasp restoration systems.

A simulator has been developed to evaluate the command channels through which a quadriplegic patient controls an upper limb neural prosthesis. The simulator consists of an animated grasping task implemented on a video screen. The patient controls the motion of an animated hand on the screen by moving his or her own hand while the animated hand opens and closes under control of the tested command channel. Experiments were performed using both able-bodied and quadriplegic subjects to evaluate shoulder motion as a command-channel source. The results demonstrated that optimal combinations of shoulder command-channel parameters are subject specific, which suggests using the simulator in the prescription of upper limb neural prostheses and in training quadriplegic persons who use them. Additionally, the experimental results quantified the reduction in performance that came from using ipsilateral vs contralateral shoulder control and the enhancement in performance realized when using substitute sensory force-feedback displays.

Computers↗

PubMed2000

Development of a speech-based dialogue system for report dictation and machine control in the endoscopic laboratory.

BACKGROUND AND STUDY AIMS: Reporting and machine control based on speech technology can enhance work efficiency in the gastrointestinal endoscopy laboratory. MATERIALS AND METHODS: The status and activation of endoscopy laboratory equipment were described as a multivariate parameter and function system. Speech recognition, text evaluation and action definition engines were installed. Special programs were developed for the grammatical analysis of command sentences, and a rule-based expert system for the definition of machine answers. A speech backup engine provides feedback to the user. Techniques were applied based on the "Hidden Markov" model of discrete word, user-independent speech recognition and on phoneme-based speech synthesis. Speech samples were collected from three male low-tone investigators. RESULTS: The dictation module and machine control modules were incorporated in a personal computer (PC) simulation program. Altogether 100 unidentified patient records were analyzed. The sentences were grouped according to keywords, which indicate the main topics of a gastrointestinal endoscopy report. They were: "endoscope", "esophagus", "cardia", "fundus", "corpus", "antrum", "pylorus", "bulbus", and "postbulbar section", in addition to the major pathological findings: "erosion", "ulceration", and "malignancy". "Biopsy" and "diagnosis" were also included. We implemented wireless speech communication control commands for equipment including an endoscopy unit, video, monitor, printer, and PC. The recognition rate was 95%. CONCLUSIONS: Speech technology may soon become an integrated part of our daily routine in the endoscopy laboratory. A central speech and laboratory computer could be the most efficient alternative to having separate speech recognition units in all items of equipment.

Artificial Intelligence↗

PubMed2004

Setting a standard for performance assessment of doctor-patient communication in general practice.

CONTEXT: Continuing professional development (CPD) of general practitioners. OBJECTIVE: Criterion-referenced standards for assessing performance in the real practice of general practitioners (GPs) should be available to identify learning needs or poor performers for CPD. The applicability of common standard setting procedures in authentic assessment has not been investigated. METHODS: To set a standard for assessment of GP-patient communication with video observation of daily practice, we investigated 2 well known examples of 2 different standard setting approaches. An Angoff procedure was applied to 8 written cases. A borderline regression method was applied to videotaped consultations of 88 GPs. The procedures and outcomes were evaluated by the applicability of the procedure, the reliability of the standards and the credibility as perceived by the stakeholders, namely, the GPs. RESULTS: Both methods are applicable and reliable; the obtained standards are credible according to the GPs. CONCLUSIONS: Both modified methods can be used to set a standard for assessment in daily practice. The context in which the standard will be used - i.e. the specific purpose of the standard, the moment the standard must be available or if specific feedback must be given - is important because methods differ in practical aspects.

Clinical Competence↗

PubMed2005

Automated external defibrillators on board merchant vessels? Preliminary report article for discussion.

OBJECTIVES: Acute heart diseases are the most frequent causes for fatalities on merchant vessels. Presently there is no sufficient therapy available to treat ventricular fibrillation. The aim of this study was to test whether common automated external defibrillators [AED] may be appropriate for the use aboard merchant vessels. METHODS: In 2005, nine seafarers were introduced to four common models of AED (HeartStartFR2+, Lifepak500, AEDplus, FREDeasy) using standard video or DVD presentations. AED handling by the subjects was tested in standardized simulated emergency scenarios. After training, they subjectively rated each AED on 24 factors involved in the introduction and handling of the device. An actual ECG was then obtained with each AED at a site located beside the ship's main engine to test under maximum vibration. The ECG data were extracted and sent as an e-mail attachment via satellite to the German Telemedical Maritime Assistance Service [TMAS] in Cuxhaven. RESULTS AND CONCLUSIONS: All subjects handled the AED correctly. The AED received a total amount of points in the range between 2125 to 2241 (of 2400 possible). The subjects preferred AED with coloured as well as light marked buttons which gave a feedback (e.g. audible tones) when they were pressed. All AED were able to register an ECG in the vibrating ambient. Due to interface problems it was only possible to extract three ECG files, and only two files (data < 300 kB) could be sent as e-mail attachment via satellite to the German TMAS. In noisy areas the AED must guide the user, e.g. by screen massages and/or pictograms. Displays should provide additional data to help assess resuscitation effectiveness. A special procedure is necessary to ensure that ships and TMAS own the same software to read the transmitted ECG files, which are not allowed to exceed a size of 300 kB.

Adolescent↗

PubMed1995

Virtual reality, telesurgery, and the new world order of medicine.

We are seeing the emergence of medical applications for virtual reality (VR). These include telepresence surgery, three-dimensional (3-D) visualization of anatomy for medical education, VR surgical simulators, and virtual prototyping of surgical equipment and operating rooms. Today, approximately 90% of the knowledge a physician requires can be obtained through electronic means, such as diagnostic sensors and imaging modalities, directly seeing the patient with a video camera for medical consultation, or using electronic medical records. In addition, with telepresence, a therapy can be effected electronically, regardless of the physical location of the patient. Therefore, it makes sense to send the electronic information or manipulation, rather than sending the patient or blood samples, to obtain tests or to produce a cure. In that these applications are mediated through the computer interface, they are the embodiment of VR as the major force for change in the field of medicine. The Green Telepresence Surgery System consists of two components, the surgical workstation and the remote worksite. At the remote site are a 3-D camera system and responsive manipulators with sensory input. At the workstation are a 3-D monitor and dexterous handles with force feedback. The next generation in medical education can learn anatomy from a new perspective by "flying" inside and around the organs, using sophisticated computer systems and 3-D visualization. The VR surgical simulator is a stylized recreation of the human abdomen with several essential organs. Using this, students and surgeons can practice surgical procedures with virtual scalpels and clamps. To support these advanced technologies, the operating room and hospital of the future will first be designed and tested in virtual reality, allowing multiple iterations of equipment and surgical rooms before they are actually built. Insofar as all these technologies are based on digital information, they are the building blocks for the digital physician of the 21st century.

Computer Simulation↗

PubMed2003

Odor localization requires visual feedback during free flight in Drosophila melanogaster.

Adult fruit flies follow attractive odors associated with food and oviposition sites through widely varied visual landscapes. To examine the interaction between olfactory and visual cues during search behavior, we recorded three-dimensional flight trajectories as individuals explored controlled sensory landscapes. When presented with the source of an attractive odor invisibly embedded in the floor of a 1 m arena, flies spend most of their time hovering back and forth over the source when flying within a randomly textured visual background but fail to localize the source when searching within a uniform white surround. To test whether flies are associating unique features of the visual background with the strength of odor cues, we flew them within arenas containing evenly spaced vertical stripes. Flies readily localized the odor when flying within visual landscapes lacking azimuthal landmarks provided that vertical edges were present. Flies failed to localize odor when flying within a background pattern consisting of horizontal stripes. These results suggest that, whereas flies do not require spatially unique visual patterns to localize an odor source, they do require visual feedback generated by vertical edges. Quantitative shifts in several components of flight behavior accompanied successful odor localization. Flies decrease flight altitude, turn more often and approach visually textured walls of the arena near an odor source. A simple model based on the statistics of flight behavior supports the hypothesis that a subtle influence on these behaviors is sufficient to lead a fly to its food.

Animals↗

PubMed1999

Sphingosine and phorbol ester modulate protein kinase C activity and modify ATP-evoked calcium mobilization in glioma C6 cells.

The effect of sphingosine and 12-O-tetradecanoyl-phorbol-13-acetate (TPA) on ATP-evoked Ca(2+) mobilization in glioma C6 cells was studied with the Fura-2 video-imaging technique. Treatment of the cells with TPA, an activator of protein kinase C, reduced the ATP-evoked release of Ca(2+) from the intracellular stores, whereas sphingosine, known from in vitro studies as a protein kinase C inhibitor, potentiated Ca(2+) release synergistically with ATP. ATP-induced Ca(2+) mobilization was also enhanced by a specific protein kinase C inhibitor, GF 109203X. Pretreatment of the cells with GF 109203X prevented TPA action, whereas TPA diminished the stimulatory effect of sphingosine. However, this sphingosine effect was only observed after a short (1 min) treatment, whereas a longer treatment (5 min) reduced ATP-evoked Ca(2+) release. It is therefore concluded that sphingosine has two apparent actions: it inhibits protein kinase C providing a positive feedback regulation of receptor signals and it releases Ca(2+) from intracellular stores by an unknown mechanism, possibly independent of protein kinase C.

Adenosine Triphosphate↗

PubMed2002

MEDICOL: online learning in medicine and dentistry.

OBJECTIVE: MEDICOL (Medicine and Dentistry Integrated Curriculum Online) provides a variety of Web-based resources that act as important adjuncts to all the teaching components of the medical and dental undergraduate curriculum. It uses WebCT, a course-management system, to provide the following educational functions: (1) track students' progress and present course information such as time-tables, learning objectives, handout materials, images, references, course assignments, and evaluations; (2) promote student-to-student and student-to-instructor interactions (through e-mail and bulletin boards); and (3) deliver self-directed learning components, including weekly self-assessment quizzes that provide immediate feedback and multimedia learning modules (clinical skills, radiology, evidence-based medicine, etc.). DESCRIPTION: The University of British Columbia Faculties of Medicine and Dentistry feature a problem-based learning (PBL) curriculum in which students access many of the same tools they will utilize in their professional practice. In the PBL curriculum, students must access the relevant clinical data and educational resources. A MEDICOL site has also been developed for medical students to use during their rural family practice, a four- to six-week experience in the summer after their second year. This site has been designed to be a supplemental learning environment for not only these students, but also for their physician preceptors. It is intended to foster communication among participants, bring new resources to the rural setting, and allow preceptors to develop their Internet skills with the help of students who are already familiar with the electronic environment. The MEDICOL sites enable the exchange of information about the learning issues between, as well as within, tutorial groups. MEDICOL also provides students with faculty-reviewed resources that are listed online; multimedia presentations; and access to histology, radiology, and pathology images through an online image database. Each week, students have access to a new interactive and automatically graded self-assessment quiz for individual study. These quizzes test learning objectives from tutorial, lecture, and lab material for each week of the curriculum and are modeled after summative examinations held twice each year. Question authors provide immediately accessible quality feedback to students. A comprehensive quiz databank of approximately 1,500 questions has been attained. WebCT enables MEDICOL to deliver anonymous, online program-evaluation questionnaires during clinical clerkships (resulting in a 99% response rate after a few e-mail reminders), with easy and timely data collection and reporting methods. Summative assessments have also been delivered through MEDICOL. DISCUSSION: Use statistics indicate that over 90% of students regularly use the MEDICOL sites and have found them helpful. University of British Columbia medical school enrollment will increase because of collaborations with campuses and medical centers across the province. MEDICOL will likely play an increased role in distance learning by continuing to deliver the resources already described, as well as facilitating synchronous communications (e.g., PBL chat rooms) and teaching (e.g., video-streamed lectures) to students located across the province.

Education, Dental↗

PubMed2002

Teaching communication skills: a skills-based approach.

OBJECTIVES: The purpose of this project was to design structured training activities to emphasize key points about patient-physician communication. Effective communication has been shown to enhance patient satisfaction, compliance with treatment, and medical decisions and outcomes. Basic communication skills and behavioral-change interview skills are taught. DESCRIPTION: Communication is a core "building block" of a four-semester, two-year Essentials of Clinical Medicine Course (ECM), which is in its second year of existence. Four interactive lab sessions have been designed, each with structured learning exercises. At the beginning of each session, students work in groups of 30 completing activities based on videos developed by the Bayer Institute for HealthCare Communication.(1) Subsequently, two groups of three students each work with a behavioral or physician facilitator. A formal training and administration manual for all activities has been developed and an evaluation system developed and implemented. Session 1, "Initial Interview Skills," teaches opening, mirroring, and encouraging non-interrogation activities. Session 2, "Empathic Responses," includes activities entitled "Cue Detection," "Accurate Empathy," and "Getting the Story Straight." In Session 3, "Obtaining an HPI," students view an exemplary medical interview, then role-play computerized cases(2) and practice the HPI data collection based on clinical facts taken from the computerized cases. During the Session 4, "Putting It All Together," students interview a standardized patient (SP) for five to seven minutes and receive and give feedback from peers, SPs, and facilitators. Subsequent to the communication lab, students conduct six physician-supervised patient interviews practicing their medical interviewing skills and write-ups. Two subsequent small-group sessions include "group" interviews of SPs in which students assess readiness for behavioral change (e.g., quitting smoking, losing weight) and also learn to conduct more "difficult' health-promotion conversations (e.g., sexual behavior, alcohol use). Evaluation methods include the use of a professional behavior evaluation form completed by communication facilitators and small-group leaders. This assessment form consists of ratings on: reliability and responsibility, relationships with others, self-improvement and adaptability, upholding professional standards, and communication skills dimensions. A formal interview-behavior checklist is used during the training and in the feedback sessions. Finally, SP OSCEs of communication and behavioral-change interviewing occur at the end of the first year of training. DISCUSSION: The communication labs have been well received by students. Students have reported increased understanding of their upcoming roles as physicians, have stated they have gained insights about the importance of connecting with patients in order to give them proper medical treatment, and have requested additional training in communication. Students have reported increased confidence in their interviewing skills prior to interactions with "actual" patients, and clinical preceptors have reported increased levels of preparedness among students who have participated in the structured learning experience. Future plans include adding communication training with problem patients, and about end-of-life and other challenging issues.

Communication↗

PubMed2001

Videoconferencing can be used to assess neonatal resuscitation skills.

OBJECTIVE: To examine the hypothesis that an instructor in a remote site can accurately assess the practical skills of a provider performing a simulated neonatal resuscitation (megacode) using videoconferencing. METHODS: Using volunteer NRP providers and instructors, two local telemedicine sites were linked using six telephone lines. Camera angles, sound settings and equipment placement were optimized. Instructors tested providers at the other site. Instructors recorded their observations on checklists based on those of the Neonatal Resuscitation Program (NRP), and all participants completed feedback forms and gave verbal feedback. Based on the results of the pilot study, the protocol and recording tools were developed, and providers at a rural centre were tested. Tests were carried out with local and remote instructors. Observations of local and remote instructors were collected independently, and compared. Opinions of providers were also collected. RESULTS: Observations of the local and remote instructors on the performances of the providers were consistent; 15 of 18 megacodes reached the required standard. Six telephone lines were required for transmission without noticeable delay in sound transmission. Viewing quality was sufficient for remote instructors to provide feedback on ventilation technique. Providers indicated that videoconferencing did not interfere with their performance and would willingly repeat the experience. Cronbach's alpha for assessment of the technical features was 0.80 or greater for all groups. CONCLUSIONS: Videoconferencing can be used to test resuscitation providers in remote centres. It can enhance neonatal resuscitation education in areas where experienced instructors are in short supply.

Clinical Competence↗

PubMed1998

Gynaecological examination: a teaching package integrating assessment with learning (693).

A self-directed learning package which includes assessment was developed to allow students to acquire the psychosocial and motor skills needed to conduct a gynaecological examination with sensitivity. The package integrates assessment with learning and uses the Assessment Form as an educational instrument. The introduction, including a video of a vaginal examination and pap smear, is followed by five learning stations for groups of 3 or 4 students to visit. At each station a series of tasks are given which enable the objectives of the station to be fulfilled. The materials necessary to complete the tasks are provided. Gynaecological assistants, themselves trained by participation in the learning sessions, guide the students throughout the session and act as adviser 'patients' to help students acquire the necessary motor skills. In the assessment, students are required to integrate what they have learnt in the learning stations. The students assess themselves and the 'patient' and an observer assesses the student using the same Assessment Form. The form assesses and gives examples of the psychosocial, including legal and motor skills required. The assistants-observers give feedback to the students about their performance and make suggestions for future improvement. Of the 232 medical students completing their clinical terms in Obstetrics and Gynaecology in 1995, those students receiving the learning package rated their practical experience as significantly better. They rate the learning method, content, enjoyment and package overall very highly (median 4, 5 point scale 1-5). Open-ended comments by students confirmed these findings.

Education, Medical, Undergraduate↗

PubMed2006

The impact of the Stanford Faculty Development Program on ambulatory teaching behavior.

CONTEXT: Faculty development has received considerable investment of resources from medical institutions, though the impact of these efforts has been infrequently studied. OBJECTIVE: To measure the impact of the Stanford Faculty Development Program in Clinical Teaching on ambulatory teaching behavior. DESIGN: Pre-post. SETTING AND PARTICIPANTS: Eight internal medicine faculty participating in local faculty development. INTERVENTION: Participants received 7 2-hour sessions of faculty development. Each session included didactic, role-play, and videotaped performance evaluation. MAIN OUTCOME MEASURE: Before and after the intervention, faculty were video-taped during a case presentation from a standardized learner, who had been trained to portray 3 levels of learners: a third-year medical student, an intern, and a senior medical resident. Teacher and learner utterances (i.e, phrases) were blindly and randomly coded, using the Teacher Learner Interaction Analysis System, into categories that capture both the nature and intent of the utterances. We measured change in teaching behavior as detected through analysis of the coded utterances. RESULTS: Among the 48 videotaped encounters, there were a total of 7,119 utterances, with 3,203 (45%) by the teacher. Examining only the teacher, the total number of questions asked declined (714 vs 426, P=.02) with an increase in the proportion of higher-level, analytic questions (44% vs 55%, P<.0001). The quality of feedback also improved, with less "minimal" feedback (87% vs 76%, P<.0005) and more specific feedback (13% vs 22%) provided. CONCLUSIONS: Teaching behaviors improved after participation in this faculty development program, specifically in the quality of questions asked and feedback provided.

Ambulatory Care↗

PubMed2007

The use of classroom training and simulation in the training of medical responders for airport disaster.

There is a dire need to have complementary form of disaster training which is cost effective, relatively easy to conduct, comprehensive, effective and acceptable. This will complement field drills training. A classroom-based training and simulation module was built by combining multiple tools: Powerpoint lectures, simulations utilising the Kuala Lumpur International Airport (KLIA) schematic module into 'floortop' model and video show of previous disaster drill. 76 participants made up of medical responders, categorised as Level 1 (specialists and doctors), Level 2 (paramedics), Level 3 (assistant paramedics) and Level 4 (health attendants and drivers) were trained using this module. A pre-test with validated questions on current airport disaster plans was carried out before the training. At the end of training, participants answered similar questions as post-test. Participants also answered questionnaire for assessment of training's acceptance. There was a mean rise from 47.3 (18.8%) to 84.0 (18.7%) in post-test (p<0.05). For Levels 1, 2, 3 and 4 the scores were 94.8 (6.3)%, 90.1 (11)%, 80.3 (20.1)% and 65 (23.4)% respectively. Nevertheless Level 4 group gained most increase in knowledge rise from baseline pre-test score (51.4%). Feedback from the questionnaire showed that the training module was highly acceptable. A classroom-based training can be enhanced with favourable results. The use of classroom training and simulation effectively improves the knowledge of disaster plan significantly on the back of its low cost, relatively-easy to conduct, fun and holistic nature. All Levels of participants (from specialists to drivers) can be grouped together for training. Classroom training and simulation can overcome the problem of "dead-document" phenomenon or "paper-plan syndrome".

Aviation↗

PubMed1993

Amplification of nitric oxide signaling by interstitial cells isolated from canine colon.

The effects of nitric oxide (NO) on intracellular Ca2+ concentration ([Ca2+]i) were studied in enzymatically dispersed interstitial cells (ICs) and smooth muscle cells (SMCs) isolated from canine colon. [Ca2+]i was monitored by using fluo-3 and video fluorescence imaging techniques. Exogenous NO caused an increase in [Ca2+]i in ICs and a decrease in [Ca2+]i in SMCs. Effects of NO on ICs were not blocked by removal of extracellular Ca2+ but were blocked by ryanodine, suggesting that NO caused release of Ca2+ from intracellular stores. When [Ca2+]i was elevated in an IC by micropressure ejection of Bay K 8644, [Ca2+]i decreased in nearby SMCs, suggesting release of a diffusible substance. The diffusible substance may be NO or an NO-related substance based on blockade of transmission by NG-nitro-L-arginine methyl ester, NG-monomethyl-L-arginine, or oxyhemoglobin. The elevation of [Ca2+]i in ICs by NO, which, in turn, might cause further release of NO and elevation of [Ca2+]i, suggests a positive feedback and amplification mechanism in these cells. Elevation of [Ca2+]i in SMCs had no effect on adjacent SMCs. Our data suggest that ICs may play a central role in amplification of NO signaling and propagation of inhibitory wave fronts.

Animals↗

PubMed2006

Betterland: an interactive cd-rom guide for children with cystic fibrosis.

Effective management of cystic fibrosis (CF) depends on adherence to a daily multi-component regimen. Segregation policies have been reported to lead to a dramatic fall in the incidence of cross infection rates in specialist CF centres. Previously, peers provided a valuable source of information and support; segregation means that there is virtually no contact with other people with CF. In this context the Betterland CD-ROM was developed with the aim of improving knowledge and understanding and helping children and young people cope with time-consuming CF treatments (inhalation therapies and physiotherapy) and painful procedures by using filmed-model approaches. Betterland is an interactive computer game, designed in the style of a theme park. Patient and carer feedback has been positive and the CD-ROM has been incorporated into a nurse-led Moving to High School (MotHS) programme, as well as the patient education work of the CF multidisciplinary team, particularly clinical nurse specialists.

Adaptation, Psychological↗

PubMed2002

Using videoconferencing to deliver a health education program to women health consumers in rural and remote Queensland: an early attempt and future plans.

Women's Health Queensland Wide, a non-government education and information organisation funded by Queensland Health, used videoconferencing to present a public education seminar on menopausal health to women health consumers across south-west Queensland. A panel of speakers addressed a live audience in a provincial city, with a further 10 sites participating remotely via videoconferencing, each with a local health worker supporting the seminar. Both local and remote audience members were given opportunities to ask questions of the speakers. Audience members were asked to complete feedback forms and their responses are presented. Overall, audience members were very positive about both the content of the event and its method of delivery. They also provided comments relating to the structure of the program, the difficulties of running a live and distant seminar and the needs of remote audiences. Based on this information, Women's Health Queensland Wide has adapted future videoconference seminars to better meet the needs of rural and remote women.

Data Collection↗