Apuntes de Electromedicina Xavier Pardell

Apuntes de Electromedicina características y funcionamiento de elementos electromédicos

[Electronic fetal monitoring and management of adverse outcomes: how to perform and improve a training program for clinicians?]. / L'enregistrement du rythme cardiaque fœtal et la gestion des événements indésirables graves : pourquoi et comment élaborer un programme de formation des cliniciens ?

Electronic fetal monitoring during labor is the most commonly used method to evaluate the fetal status, but it remains exposed to some criticism. By comparison with intermittent auscultation and in the light of the results of the great studies in the last 30 years, it may be accused its failure to improve the neonatal outcome and its responsibility in the increase on operative deliveries. Actually, the electronic fetal monitoring is a tool whose effectiveness is linked to the accuracy of the analysis developed by the clinician. Studies on assessment of the tracing interpretation indicate that there is always a lack of quality, which may be improved through training programs. It also reveals the benefit of the fetal blood sampling to reduce operative deliveries and the generalization of this method, in addition to electronic fetal monitoring, is recommended by referral agencies. More generally, the continuous monitoring is only a part of the patient safety strategy in the labour ward and we are currently observing, in some European countries and in the United States, the development of training programs concerning the management of the adverse outcomes in obstetrics. The good performances related to the quality of care are demonstrated by the findings of the studies performed in the centers that have implemented an active training policy. In France, the professionals directly involved in the field of the perinatology should benefit from such educational programs that could be organized within the care networks under the authority of referral agencies.

A inserção da engenharia biomédica nos cursos de graduação de engenharia elétrica no Brasil / The insertion of biomedical engineering in electrical engineering undergraduate courses in Brazil

A inserção de temas específicos da Engenharia Biomédica (EB) nos cursos de graduação em Engenharia Elétrica (EE) foi examinada em levantamento da oferta de disciplinas nesta área, realizado nos 214 cursos de EE que possuem dados sobre as grades curriculares e disciplinas em seus sítios na internet. Foram levantadas informações sobre os cursos de pós-graduação (PG) em EB existentes no Brasil, relacionadas à oferta de disciplinas de EB na graduação. Nossos dados indicam que apenas 7,5% dos cursos de EE examinados possuem pelo menos uma disciplina de EB, concentrados nas escolas públicas (87,5%) e nas regiões sul e sudeste do país (75%). Nestes poucos cursos, foram identificadas 40 disciplinas de EB. Apenas 11 delas oferecem introdução geral aos diferentes aspectos da área; os 3/4 restantes restringem-se a aspectos específicos de subáreas da EB. Além disso, 87,5% destas disciplinas são de caráter eletivo (ou não-obrigatório), com abordagem exclusivamente teórica dos temas (14,0% do total de horas-aula nas disciplinas de EB). Dos 10 programasde PG em EB, 60,0% estão em IES cujos cursos de EE possuem disciplinas específicas EB; 62,5% das disciplinas de EB são oferecidas por IES que não têm programas de PG na área, indicando pouca correlação entre a existência de um programa de PG em EB e a oferta de conteúdos nesta área para a graduação em EE. Estes dados sugerem a necessidade de inserção mais substancial e estruturada de temas de EB nos cursos de graduação em EE, em especial nas instituições privadas de ensino, e de estímulo a uma maior contribuição dos programas de PG no ensino de graduação em EE.

The present study surveyed the disciplines on Biomedical Engineering (BE) offered in 214 Electrical Engineering (EE) undergraduate courses in Brazilian Universities. Data on discipline content and other characteristics, as well as their association with graduate courses, were gathered from Internet sites in August and September, 2007. Our data indicate that only 7.5% of the Brazilian EE courses present at least one discipline on EB themes, greatly concentrated in public institutions and in the more developed south/southeast states. In only 25% of these few courses there are introductory disciplines presenting most of the different EB areas. In the remaining courses, only specific aspects of particular EB areas are presented in a fragmentary, isolated and non contextualized way. Furthermore, 87.5% of these EB disciplines are optional in the curriculium, and practical classes or approaches were offered in only 14% of the total class schedule. While 62.5% of the EB disciplines are offered by institutions that have graduating courses in EB, only 60% of the Brazilian graduation courses are involved in undergraduate EB disciplines. These data point to the need of a more structured and intensive inclusion of EB themes in the undergraduate courses (particularly in private institutions), as well as to the importance of a closer involvement of graduate courses in undergraduate instruction.

Transition from film to electronic media in the first-year medical school gross anatomy lab.

For the benefit of the first-year gross anatomy students, we digitized and published on a Web site images that had been collected over a 30-year period. We provided a CD-ROM (compact disk, read-only media) containing the image set in higher quality format to students and faculty. We supplemented basic images with hot topics such as CT angiography, virtual colonography, computer-aided diagnosis, and 3D post-processing. Full motion video and moving JPEG (Joint Photo Expert Group) animations were integrated into the atlas. On the post course questionnaire medical students reported that the images on CD-ROM were helpful during the course and for review prior to examinations. Faculty and medical students used the CD-ROM for problem-based learning sections and facilitator training. The images were clear and easily projected during review sessions and were useful for the small group sessions, where they served as examples of normal anatomy.

Shaping the experience of behavior: construct of an electronic teaching module in nonpharmacologic analgesia and anxiolysis.

RATIONALE AND OBJECTIVES: The authors' purpose was to develop an electronic teaching module in nonpharmacologic analgesia and anxiolysis for use in the radiology department. MATERIALS AND METHODS: The teaching document was derived from previous training courses validated by patient outcome. Skills in structured empathic attention and guidance of self-hypnotic relaxation were tested in a previous prospective, randomized study with 241 patients and shown to affect positively patients' perception of pain and anxiety. Patients undergoing hypnosis had the greatest relief and most hemodynamic stability. The skills applied also saved, on average, 17 minutes of procedure time and approximately $340 in sedation cost per case. With these validated behavioral skills, an electronic teaching module was constructed. RESULTS: The mode of teaching reflected the content of teaching, which was achieved through a multimedia format containing text, audio, video, pictures, and animation. Advanced navigation tools put the students in control of their learning experience. Inclusion of experiential components, congruity of language with Ericksonian syntax, and provision of an electronic journal catered to the development of greater biobehavioral awareness. CONCLUSION: Electronic teaching modules for biobehavioral skill training are feasible and promise to reduce the time need for life interactions with instructors.

E-conferencing for delivery of residency didactics.

OBJECTIVE: While didactic conferences are an important component of residency training, delivering them efficiently is a challenge for many programs, especially when residents are located in multiple sites, as they are at Wayne State University School of Medicine in the Department of Family Medicine. Our residents find it difficult to travel from our hospitals or rotation sites to a centralized location for conferences. In order to overcome this barrier, we implemented distance learning and electronically delivered the conferences to the residents. DESCRIPTION: We introduced an Internet-delivered, group-learning interactive conference model in which the lecturer is in one location with a group of residents and additional residents are in multiple locations. We launched the project in July 2001 using external company meeting services to schedule, coordinate, support, and archive the conferences. Equipment needed in each location consisted of a computer with an Internet connection, a telephone line, and a LCD projector (a computer monitor sufficed for small groups). We purposely chose simple distance-learning technology and used widely available equipment. Our e-conferencing had two components: (1) audio transmission via telephone connection and (2) visual transmission of PowerPoint presentations via the Internet. The telephone connection was open to all users, allowing residents to ask questions or make comments. Residents chose a conference location depending on geographic proximity to their rotation locations. Although we could accommodate up to 50 sites, we focused on a small number of locations in order to facilitate interaction among residents and faculty. Each conference session is archived and stored on the server for one week so those residents whose other residency-related responsibilities precluded attendance can view any conferences they have missed. DISCUSSION: E-conferencing proved to be an effective method of delivering didactics in our residency program. Its many advantages included ease of use, cost-efficiency, and wide availability of equipment. Residents had the advantage of both geographic and temporal independence. Our e-conferences were interactive, and in addition to a PowerPoint presentation, faculty provided Web sites and hyperlinks for references. Initial problems included slow-speed connection, the requirement for digital materials, and the need for residents and faculty to adjust to a new learning method. There was also a need for increased coordination at the sites and reliance on electronic communication. To assess the effectiveness of the program, residents completed knowledge pre- and post-tests and a conference evaluation form. We also monitored conference attendance rates. Preliminary results indicated positive resident attitudes toward distance learning and significant increases in conference attendance. To objectively evaluate this instructional delivery method, we will compare residents' knowledge gains in the face-to-face instructor group with those of the group to which the lecture is broadcast. Ultimately, we are hoping to offer this educational opportunity to other family practice residency programs in the area, to medical students interested in family medicine, and to community family physicians for continuing medical education. We are considering the addition of streaming video to the presentations in the future, once the bandwidth of the Internet connections is sufficient.

An analysis of training activities in the use of critical care equipment within hospitals in the United Kingdom.

We investigated how training in the use of electromedical devices in adult and neonatal intensive care departments is organised, designed and delivered. Forty-one departments within two Regional Health Authorities in the United Kingdom returned a detailed questionnaire, from which several nonlinear models were developed using fuzzy logic analysis. The results clearly indicate that training in the use of equipment is a very minor activity, with less than 1% of departmental time spent on providing or receiving such training. Departments that had a higher level of expertise required less assistance from technical personnel. Critical care equipment can be utilised more fully, cost effectively and safely if a formal and regular training programme is implemented.

Manutençäo de equipamentos médico-eletrônicos / Medical electronics equipaments maintenance

Este artigo descreve o planejamento para a consolidaçäo do Centro de Engenharia Biomédica do HSVP. Apresenta também os primeiros números, resultado de 24 meses de investimento da direçäo do hospital na implantaçäo do setor de eletrônica, marco inicial de toda a estrutura

[Filling out medical certificates (u. f. 086/u)]. / O zapolnenii meditsinskoi spravki u. f. 086/u.

The analysis of 1100 health certificates (Form 086/y) received by the selection committee of the Institute of Automated Systems and Radioelectronics showed that only 7.76% of them met the requirements. The rest of health certificates had the following faults: incompetence when determining physical fitness, insufficient data, diagnostic errors, inadequate drawing up of medical documents. It is concluded that such health certificates do not possess complete data on applicants' health status, thus continuity of medical care being distorted. It is proposed to re-establish the point on PT lessons at school in the new form of the health certificate.

A course in electronics and instrumentation.

In response to the continued development of electronic instrumentation in all disciplines of clinical laboratory science, we have designed a new format for teaching electronic instrumentation. This course provides basic concepts in electronics, including safety precautions, the use of electronic testing equipment, methods for determining precision and accuracy of instruments, interpretation of the operating manual, and preventive maintenance. Students apply concepts by actually maintaining and adjusting improperly functioning instruments, using systematic techniques for trouble-shooting and adjustment. Student examinations indicate that the objectives are being met.

A first-degree course in electronics, with medical instrumentation as a background topic.

A course is described in which undergraduate students of electronics can study aspects of medical instrumentation throughout a three-year period. This course includes as much electornics as a normal B.Sc programme in Electronics but contains a background theme of medical engineering and bioengineering amounting to 20% of the total work load. The course is compared with two similar courses in Britain and also with courses abroad. Some consideration is given to the educational content of this course as well as to employment opportunities and social trends.

Position of bioengineering education in Hungary.

Medical electronic equipment has been produced in Hungary since the early forties. Industrial production of bioengineering started only in 1957. At the same time the bioengineering section of the Scientific Society of Measurement and Automation was founded. This Section was instrumental in recognizing the necessity for and establishing a structured education programme in bioengineering which started in the Postgraduate Institute for Engineers within Budapest Technical University. Later this was incorporated in the programme of the Technical University as an optional subject. Today there is also a specialised engineering course at the Technical University. There are significant developments in the bioengineering education of physicians and medical students. This paper deals with the possibility of classification bioengineering devices which has proved useful in education in Hungary.

A BSc level option in biomedical electronics.

1. The application of electronic instruments in medical diagnosis and therapy is well established. 2. There is a demand for electronic engineers both in industry and in the Health Service at all ranges of educational attainment. 3. It is possible to identify a set of objectives for a first degree course in Biomedical Electronics. An important element of this course should be the provision of practical experience in industry and in hospitals. 4. Such courses are available both in Europe and in the United States. Although the postgraduate course provision was satisfactory in the UK in the early seventies, only one full time undergraduate course was in operation. 5. A sandwich course can be designed in Biomedical Electronics as a major option of an existing BSc course in Electrical and Electronic Engineering. Provision can be made for entering and leaving the option. The option can be arranged to follow the guidelines laid down by the IEE for exemption from its educational requirements. 6. The option described started at the Lanchester Polytechnic in Coventry in September 1977.