Computer-based Training and Electronic Publishing in the Health Sector: Tools and Trends

CBT (computer-based training) applications and hypermedia publications are two different approaches to the utilisation of computers in medical education.

Medical CBT software continues to playa minor role in spite of the increasing availability, whereas hypermedia have become very popular through the World Wide Web (WWW). Based on the HTML format they can be designed by non-programmers using inexpensive tools while the production of CBT applications requires programming expertise. HTML documents can be easily developed to be distributed by a web-server or to run as local applications.

In developed countries CBT and hypermedia have to compete with an abundance of printed or audio-visual media and a wealth of lectures, conferences, etc., whereas in developing countries these media are scarce and expensive. Here CBT programs, and hypermedia publications in particular, may be a cost-effective way to improve quality of education in the health sector.

Challenges facing European agriculture and possible biotechnological solutions

Agriculture faces many challenges to maximize yields while it is required to operate in an environmentally sustainable manner. In the present study, we analyze the major agricultural challenges identified by European farmers (primarily related to biotic stresses) in 13 countries, namely Belgium, Bulgaria, the Czech Republic, France, Germany, Hungary, Italy, Portugal, Romania, Spain, Sweden, UK and Turkey, for nine major crops (barley, beet, grapevine, maize, oilseed rape, olive, potato, sunflower and wheat). Most biotic stresses (BSs) are related to fungi or insects, but viral diseases, bacterial diseases and even parasitic plants have an important impact on yield and harvest quality. We examine how these challenges have been addressed by public and private research sectors, using either conventional breeding, marker-assisted selection, transgenesis, cisgenesis, RNAi technology or mutagenesis. Both national surveys and scientific literature analysis followed by text mining were employed to evaluate genetic engineering (GE) and non-GE approaches. This is the first report of text mining of the scientific literature on plant breeding and agricultural biotechnology research. For the nine major crops in Europe, 128 BS challenges were identified with 40% of these addressed neither in the scientific literature nor in recent European public research programs. We found evidence that the private sector was addressing only a few of these "neglected" challenges. Consequently, there are considerable gaps between farmer's needs and current breeding and biotechnology research. We also provide evidence that the current political situation in certain European countries is an impediment to GE research in order to address these agricultural challenges in the future. This study should also contribute to the decision-making process on future pertinent international consortia to fill the identified research gaps.

Two years of German summer school of nursing informatics: Did we reach the goals?

This paper describes a continuous effort to improve the knowledge of nursing informatics among German nurses. The authors have co-operated in the nursing informatics working group of the German Medical Informatics Association GMDS. Besides, one of the authors has been active in the European summer school of nursing informatics (Essoni) for several years. The authors have now established a national counterpart to the Essoni program, the German summer school of nursing informatics. This event in German language is centred around nursing informatics topics. Students may opt for one of the several study tracks to gain insight in topics such as nursing classifications and nursing terminologies, clinical information systems and their implementation or teaching requirements in nursing informatics. They go through a 5-day curriculum consisting of plenary sessions, lectures and opportunities for self learning and self teaching. At the end they demonstrate to the fellow students from the other tracks what they have achieved in their own field of study. The German Summer School is open to interested nurses, nurse executives and nurse teachers. In this paper, we will describe the curriculum, talk about the participants and show results of the questionnaire-based evaluation for the first two events in 1998 and 1999.

How can we improve informatics education for German nurses? Statements derived from the first German nursing informatics summer school

For German nurses it is difficult to join training in health informatics besides their professional activity. The authors have successfully established a German nursing informatics summer school in shape of a 5 day intensive curriculum which they offer to German nurses during the summer holidays. The summer school introduces nurses into health informatics and nursing informatics. It targets interested nursing staff, nurse executives, and nurse teachers. It promotes self learning abilities for continued self education of the participants. One of its goals is to enable participants to formulate their own requirements in health information processing and to influence system design and system introduction. The paper presents the curriculum, talks about first experiences, and demonstrates the results of an evaluation among the participants. Conclusions are drawn in a set of statements on informatics education of nurses.

Realization of a CPR using HL7 queries from communication server to information server

A communication server is often used in Germany to interface legacy systems. It handles the translation, duplication, and transmission of messages to all systems that might need this information. Based on the principles of "for every data there is only one master" and "information on demand" we have built an information server that reduces the messages required and simplifies the handling of messages, the update of data already sent compared to a communication server. It also allows to implement a security policy as required by the German data privacy legislature.

Experience with PACS in an ATM/Ethernet switched network environment

Legacy local area network (LAN) technologies based on shared media concepts are not adequate for the growth of a large-scale picture archiving and communication system (PACS) in a client-server architecture. First, an asymmetric network load, due to the requests of a large number of PACS clients for only a few main servers, should be compensated by communication links to the servers with a higher bandwidth compared to the clients. Secondly, as the number of PACS nodes increases, the network throughout should not measurably cut production. These requirements can easily be fulfilled using switching technologies. Here asynchronous transfer mode (ATM) is clearly one of the hottest topics in networking because the ATM architecture provides integrated support for a variety of communication services, and it supports virtual networking. On the other hand, most of the imaging modalities are not yet ready for integration into a native ATM network. For a lot of nodes already joining an Ethernet, a cost-effective and pragmatic way to benefit from the switching concept would be a combined ATM/Ethernet switching environment. This incorporates an incremental migration strategy with the immediate benefits of high-speed, high-capacity ATM (for servers and high-sophisticated display workstations), while preserving elements of the existing network technologies. In addition, Ethernet switching instead of shared media Ethernet improves the performance considerably. The LAN emulation (LANE) specification by the ATM forum defines mechanisms that allow ATM networks to coexist with legacy systems using any data networking protocol. This paper points out the suitability of this network architecture in accordance with an appropriate system design.

Quality criteria for electronic publications in medicine

This paper defines "electronic publications in medicine (EPM)" as computer based training programs, databases, knowledge-based systems, multimedia applications and electronic books running on standard platforms and available by usual distribution channels. A detailed catalogue of quality criteria as a basis for development and evaluation of EPMs is presented. The necessity to raise the quality level of electronic publications is stressed considering aspects of domain knowledge, software engineering, media development, interface design and didactics.

Computer-based training and electronic publishing in the health sector: tools and trends

CBT (computer-based training) applications and hypermedia publications are two different approaches to the utilisation of computers in medical education. Medical CBT software continues to play a minor role in spite of the increasing availability, whereas hypermedia have become very popular through the World Wide Web (WWW). Based on the HTML format they can be designed by non-programmers using inexpensive tools while the production of CBT applications requires programming expertise. HTML documents can be easily developed to be distributed by a web-server or to run as local applications. In developed countries CBT and hypermedia have to compete with an abundance of printed or audio-visual media and a wealth of lectures, conferences, etc., whereas in developing countries these media are scarce and expensive. Here CBT programs, and hypermedia publications in particular, may be a cost-effective way to improve quality of education in the health sector.

Critical success factors for a hospital-wide PACS

Since 1996 a picture archiving and communications system (PACS) is installed at the university hospital of Freiburg. The PACS is integrated in the hospital information system (HIS) and several modalities of different vendors are attached to it. During the implementation phase three critical factors to the success of our PACS installation where identified: the support of the workflow, the interface of the radiological information system (RIS) to the modalities, and the security policy to allow hospital-wide access to the images and results in the PACS.

CareBase: a reference base for nursing

Due to the lack of generally accepted nursing classifications and standards in Germany the introduction of nursing information systems for planning and documentation of care is a very time consuming process since the classifications and standards must be defined locally to adjust the systems. At the University Hospital Freiburg a nursing reference system was developed to collect this knowledge, make it available for easy reference and as a source usable for the initialisation of nursing information systems to be installed in the future.

Nonopioid effects of beta-casomorphin-5 in guinea pig heart: alterations to the beta-adrenoceptor-G-protein complex and inhibition of myocardial responses to isoproterenol

The influence of beta-casomorphin-5 on the beta-adrenoceptor complex in guinea pig heart membranes was studied by means of binding studies, G-protein investigations and isolated heart preparations. In nanomolar concentrations beta-CM-5 induced an increase in receptor affinity towards the agonist isoproterenol whereas the antagonist affinity was reduced. The isoproterenol-stimulated increase in cardiac contractility, moreover, is reduced by 10 nM beta-CM-5. Furthermore, beta-CM-5 was found to inhibit the isoproterenol-induced GDP/GTP exchange as well as the [35S]GTP[S] binding to guinea pig heart membranes, indicating an involvement of G-proteins. These findings suggest that low concentrations of beta-CM-5 modulate the functional properties of the myocardial beta-adrenoceptor-G-protein complex, presumably resulting in its desensitization. The observed effects of beta-CM-5 are not prevented by naloxone and, therefore, are nonopioid in nature.

[Follow-up study of accuracy of fit of crowns, prepared for phantom head under practice conditions]

Mesial, distal, oral and vestibular measurement of fissure spaces in 39 crowns and 51 bridges (divided with interlock-connection) made in the context of propedeutic instruction showed a mean marginal discrepancy of 62-90 microns in a range of 30-160 microns. A simple method to evaluate the fissure space was described. In actually discussion the results would be helpful to determine criterions for quality on fixed restorations.

Opioid receptor affinities of the blood-derived tetrapeptides hemorphin and cytochrophin

Hemorphin-4 and cytochrophin-4 displayed affinities for mu- and delta-opioid receptors that were in the same range as those observed for the structurally related beta-casomorphins. However, they showed markedly higher affinities at kappa-opioid binding sites when compared to the beta-casomorphins. These blood-derived peptides could be involved in blood pressure regulation.