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An Improved Publication Process for the UMVF.

The "Université Médicale Virtuelle Francophone" (UMVF) is a federation of French medical schools. Its main goal is to share the production and use of pedagogic medical resources generated by academic medical teachers. We developed an Open-Source application based upon a workflow system which provides an improved publication process for the UMVF. For teachers, the tool permits easy and efficient upload of new educational resources. For web masters it provides a mechanism to easily locate and validate the resources. For both the teachers and the web masters, the utility provides the control and communication functions that define a workflow system.For all users, students in particular, the application improves the value of the UMVF repository by providing an easy way to find a detailed description of a resource and to check any resource from the UMVF to ascertain its quality and integrity, even if the resource is an old deprecated version. The server tier of the application is used to implement the main workflow functionalities and is deployed on certified UMVF servers using the PHP language, an LDAP directory and an SQL database. The client tier of the application provides both the workflow and the search and check functionalities and is implemented using a Java applet through a W3C compliant web browser. A unique signature for each resource, was needed to provide security functionality and is implemented using the MD5 Digest algorithm. The testing performed by Rennes and Lille verified the functionality and conformity with our specifications.

Education, Medical↗

Evolution of web site design: implications for medical education on the Internet.

Since its inception, the world wide web (WWW) has possessed the potential for becoming a 'watershed' medium for conveying complex, structured information across vast temporal and geographical barriers. In 1995, the MedWorld project (http:(/)/medworld.stanford.edu) was created at the Stanford University School of Medicine in an effort to innovate and explore the design process of creating WWW applications specifically for medical education. Until recently, the evolution of WWW applications has been mainly driven by technological advances in client-server technology, enabling or translating traditional modes of collaborative medical education (e.g. voice, presence, print, motion) into WWW devices and applications. Many of these applications, while technologically advanced, lack focused development of interface and interactivity design, which may enhance learning experiences. WWW applications which incorporate design innovation in parity with advances in client-server technology have been termed, 'third generation' web sites and have the potential to improve the quality of WWW applications designed for medical education. This work describes how the MedWorld project has created a 'third generation' WWW application by utilizing innovation in information, interface and interactivity design to create innovative WWW technology for the medical education arena.

Communications Media↗

A development environment for predictive modelling in foods.

Waikato Environment for Knowledge Analysis (WEKA) is a comprehensive suite of Java class libraries that implement many state-of-the-art machine learning/data mining algorithms. Non-programmers interact with the software via a user interface component called the Knowledge Explorer. Applications constructed from the WEKA class libraries can be run on any computer with a web-browsing capability, allowing users to apply machine learning techniques to their own data regardless of computer platform. This paper describes the user interface component of the WEKA system in reference to previous applications in the predictive modelling of foods.

Algorithms↗

[Clinical and pharmacological databases for personal digital assistants].

Personal digital assistants (PDAs) are part of the new technologies applied to medicine, which could improve both access to and storage of distinct databases. The present article reviews some general technical features, as well as the utility of these devices for consulting specific pediatric, clinical and pharmacological databases. A search was performed in Medline (1999 to 2004) and of web pages that described the use of PDAs and a total of 46 useful applications were identified, including pediatric diagnostic and treatment guidelines, databases of diagnostic procedures, guidelines for antibiotic therapy in the pediatric and adult populations, databases to establish the diagnosis and treatment of patients in emergency and intensive care medicine, catalogues of general drugs with complete pharmacological data (indications, doses, adverse effects, interactions, toxicology, pregnancy, lactation), specific databases of neonatology, otorhinolaryngology and pediatric surgery, and medical calculator software. Each reference details the contents, source of the reference information, memory requirements, operating system, cost, web page for downloads and whether there is a test version. There is a wide variety of pediatrics software for PDAs. Once the quality of these databases has been assessed, each user should evaluate which application will be most useful depending on his or her needs.

Computers, Handheld↗

AstexViewer: a visualisation aid for structure-based drug design.

AstexViewer is a Java molecular graphics program that can be used for visualisation in many aspects of structure-based drug design. This paper describes its functionality, implementation and examples of its use. The program can run as an Applet in a web browser allowing structures to be displayed without installing additional software. Applications of its use are described for visualisation and as part of a structure based design platform. The software is being made freely available to the community and may be downloaded from http://www.astex-technology.com/AstexViewer.

Computer Graphics↗

Combinatorial codons: a computer program to approximate amino acid probabilities with biased nucleotide usage.

Using techniques from optimization theory, we have developed a computer program that approximates a desired probability distribution for amino acids by imposing a probability distribution on the four nucleotides in each of the three codon positions. These base probabilities allow for the generation of biased codons for use in mutational studies and in the design of biologically encoded libraries. The dependencies between codons in the genetic code often makes the exact generation of the desired probability distribution for amino acids impossible. Compromises are often necessary. The program, therefore, not only solves for the "optimal" approximation to the desired distribution (where the definition of "optimal" is influenced by several types of parameters entered by the user), but also solves for a number of "sub-optimal" solutions that are classified into families of similar solutions. A representative of each family is presented to the program user, who can then choose the type of approximation that is best for the intended application. The Combinatorial Codons program is available for use over the web from http://www.wi.mit.edu/kim/computing.html.

Amino Acids↗

Cost-effective design for dental randomized clinical trials with longitudinal observations.

In general, randomized clinical trials (RCT) in dentistry involve longitudinal observations. In such studies, the total cost is a function of the number of study subjects and visits, the study duration, and the type and number of examinations at each visit. In this paper, we derived the minimum cost design for longitudinal RCTs with 2 treatment arms and multiple visits. We optimized the number of subjects, visits and repeated measurements under the constraints of the requirements for statistical significance, power and minimum total study cost. A SAS macro was written and made available on the World Wide Web, so interested clinical investigators can easily find optimal designs. The application of the program is illustrated using an example.

Cost-Benefit Analysis↗

Hyperad: augmenting and visualizing free text radiology reports.

Hyperad is an automated computer system designed to extract key concepts from thoracic radiology reports and give physicians access to a large database containing the reports and key concepts. The concepts are extracted from textual documents with natural language processing techniques, then stored with the original documents in the database, which can be queried in terms of findings or associated attributes from an intuitive and easily accessible interface. The extracted concepts are represented both textually in a coded hypertext format and graphically on a coronal cross-sectional anatomy atlas, an idealized graphical model of human anatomy. To facilitate implementation, the communication protocols and standards of the World Wide Web (Web) were adopted. The reports and associated forms are encoded in standard hypertext markup language, which makes it possible to use hypermedia links to navigate the Hyperad database with any graphical Web browser. In the future, Hyperad may prove useful for other applications.

Computer Systems↗

Handheld computing: the next technology frontier for school nurses.

The purpose of this article is to demonstrate the potential utilization of handheld personal digital assistants for school nurses. Handheld devices and their general uses are described. Clinical programs available through downloading and Web sites with handheld resources are included. Finally, specific handheld computer applications that can be adapted for school nurses are discussed.

Forecasting↗

Development of required postgraduate palliative care training for internal medicine residents and medical oncology fellows.

BACKGROUND: The need for better care for terminally ill patients led us to create an educational program to provide internal medicine residents and medical oncology fellows basic competency in palliative and end-of-life care. METHODS: An interdisciplinary team identified educational strategies, course objectives, content, and evaluation instruments. RESULTS AND CONCLUSIONS: Our strategy is to use a required Web-based course to establish a knowledge base upon which specific training during clinical rotations build skills. Field testing of the Web course showed it was an effective tool for delivering clinically applicable content. Skill building experiences are now being integrated into selected clinical rotations.

Attitude of Health Personnel↗

Recent trends in carbohydrate modeling.

The exploding activities in modeling of carbohydrates during the past few years is reviewed with emphasis on advances in improving force fields, coupling of NMR measurements with molecular dynamics simulations, direct calculation of thermodynamic properties, application of quantum chemical methods on a large scale, and web-access to modeling.

Carbohydrates↗

Towards a sharable numeric and symbolic knowledge base on cerebral cortex anatomy: lessons learned from a prototype.

We propose a knowledge base that combines numeric and symbolic knowledge about sulco-gyral brain cortex. This knowledge base is implemented using Web technologies. It is intended to be easily reusable in various application contexts such as teaching, decision support in neurosurgery and sharing of neuroimaging data for research purposes. Our analysis shows that (1) a formal representation of taxonomy and mereotopology, and (2) use of identity criteria to represent symbolic concepts, are needed to serve those applications.

Artificial Intelligence↗

A service based approach for medical image distribution in healthcare Intranets.

The Digital Imaging and Communications in Medicine (DICOM) protocol is currently the ubiquitous standard for the communication of medical images and related data within the radiology department. However, seamless image distribution within the healthcare enterprise and especially with research and educational information systems is still hard to achieve, as software developers of such third-party applications have to go through the rather cumbersome task of adapting the DICOM communication model and implementing the DICOM protocol. This paper gives a brief outline of current trends in medical image distribution in the healthcare enterprise, and proposes a new technological approach for distributing DICOM images and related data through commonplace Internet technologies, based on the emerging web services software paradigm. In particular, the paper describes the DICOM Image Management (DIM) web service which acts as a façade for conventional DICOM sources allowing DICOM image data and related information, to be transformed into XML documents encapsulated in SOAP messages, enabling integration at the application level through general purpose standardized web technologies. Implementation issues are discussed and a demonstration of engaging the DIM web service is included.

Computer Communication Networks↗

A metastrategy for World-Wide Web information retrieval in clinical medicine.

The metastrategy for World-Wide Web information retrieval was presented as an integrated approach to end-user searching in clinical medicine, although its application may be made to any search for WWW information. Certain distinctions, such as between anticipated and unanticipated clinical information needs and between WWW catalogs for retrieving Web sites and WWW databases for retrieving Web pages, were made. These distinctions are important in the end-user strategy because they help maximize the productivity of the WWW for clinicians.

Clinical Medicine↗

Web-based data and knowledge sharing between stroke units and general practitioners.

We describe a telemedicine application for emergency management in Stroke Units, where prompt decisions must be taken, often knowing neither the clinical history nor the stroke symptoms onset modality. We have designed and implemented an Information and Communication Technology architecture for the situation in which a general practitioner is called for a suspected stroke and provides for the admission to a Stroke Unit. By means of a palmtop and a wireless Internet connection, he can send to the Stroke Unit the demographic data, the list of the patient's problems, current and/or recent therapies, and a guideline-based stroke-specific form with the objective examination results. In this way, the Stroke Unit team is alerted and informed before the patient arrival, and can manage the urgency at the best. The proposal involved 20 general practitioners and one Stroke Unit in the Lombardia Region, Italy.

Computer Systems↗

Applications of nanotechnology in orthopaedics.

Nanotechnology is the application of science and engineering at the nanoscale. A diverse range of applications are beginning to emerge in all areas of medicine. We performed a survey from November 2005 to March 2006 using the Internet search engines PubMed, ScienceDirect, ISI Web of Knowledge, and Google Scholar. We report on the role of nanotechnology in orthopaedics, exploring current and potential applications. Nanostructured materials have been proposed as the next generation of orthopaedic implant properties by creating a surface environment more conducive for osteoblast function. Bone substitute materials, whose nanoscale composition emulates the hierarchic organization of natural bone, shows initiation of the desirable formation of an apatite layer. Nanotechnology also has been harnessed to improve the cutting performance and quality of surgical blades. Postoperative infection rates may be reduced by using nanofibrous membrane wound dressings containing antibacterial properties. The most notable application of nanotechnology in orthopaedics may be drug delivery, including nanotherapeutics for treating bone cancer and arthritis. Nanotechnology is being used in orthopaedics, and likely will play a valuable role in future developments.

Biocompatible Materials↗

An implementation of a virtual patient record using Web services.

Virtual patient records provide a means for integrated access to patient information that may be scattered around different healthcare settings. Within the boundaries of a health district providing all levels of care, this concept can be implemented in a corporate Intranet environment to support longitudinal patient care activities across the participating healthcare providers. In this context, a virtual patient record implementation enables autonomous healthcare providers to operate in a cooperative working environment and apply continuity of care. Workflow and web services technologies provide an appropriate infrastructure for satisfying collaboration and coordination requirements by integrating heterogeneous healthcare applications and by automatically routing the medical information needed to authorized actors in a healthcare process. This paper presents a virtual patient record architecture that allows integrating geographically dispersed medical information within a health district and enhancing collaboration and coordination of authorized workgroups using workflow and web services technologies. An implementation of the proposed architecture is also presented.

Efficiency, Organizational↗

How medical students use the computer and Internet at a Turkish military medical school.

The aim of this study was to determine how medical students use the computer and World Wide Web at a Turkish military medical school and to discuss characteristics related to this computer use. The study was conducted in 2003 in the Department of Public Health at the Gulhane Military Medical School in Ankara, Turkey. A survey developed by the authors was distributed to 508 students, after pretest. Responses were analyzed statistically by using a computer. Most of the students (86.4%) could access a computer and the Internet and all of the computers that were used by students had Internet connections, and a small group (8.9%) had owned their own computers. One-half of the students use notes provided by attending stuff and textbooks as assistant resources for their studies. The most common usage of computers was connecting to the Internet (91.9%), and the most common use of the Internet was e-mail communication (81.6%). The most preferred site category for daily visit was newspaper sites (62.8%). Approximately 44.1% of students visited medical sites when they were surfing. Also, there was a negative correlation between school performance and the time spent for computer and Internet use (-0.056 and -0.034, respectively). It was observed that medical students used the computer and Internet essentially for nonmedical purposes. To encourage students to use the computer and Internet for medical purposes, tutors should use the computer and Internet during their teaching activities, and software companies should produce assistant applications for medical students. Also, medical schools should build interactive World Wide Web sites, e-mail groups, discussion boards, and study areas for medical students.

Computers↗