Impacto de curso on-line sobre el grado de conocimiento del programa OMI-AP para médicos / Impact of an on-line course on the level of knowledge of the OMI-AP program for primary care doctors

Objetivo. Evaluar el impacto de un curso on-line sobre el nivel de conocimiento del programa OMI-AP (Oficina Médica Informatizada en Atención Primaria) en el personal médico. Material y métodos. Ciclo de Mejora para optimizar el conocimiento y uso de OMI-AP por los médicos de Familia del Servicio Murciano de Salud. Participaron 55 médicos de familia que realizaron el curso on-line sobre OMI-AP. Se realizó un curso on-line de 2 meses de duración en el que a través de 9 módulos se dio una formación de nivel avanzado sobre OMI-AP. Las mediciones efectuadas se realizaron en 2 fases: 1) una semana antes de comenzar el curso se aplicó a los alumnos inscritos un cuestionario sobre el nivel de conocimientos sobre OMI-AP (10 preguntas). 2) Una semana después de finalizar el curso se aplicó el mismo cuestionario. Resultados. Se analizó la nota media del cuestionario que fue de 5,31 puntos previamente a la realización del curso y de 7,70 puntos tras la finalización del curso (p<0,05). En 9 de las 10 preguntas analizadas el porcentaje de respuestas correctas mejoró significativamente tras la realización de curso. Conclusiones. La impartición del curso on-line de OMI-AP para médicos supuso una mejora significativa en el nivel de conocimiento de dicho programa, básico para la consulta diaria de los médicos de familia de nuestro servicio de salud. La formación on-line facilitó enormemente la formación de los profesionales al posibilitar una gestión del tiempo acorde a las necesidades del alumno (AU)

Objective. To evaluate the impact of an online course on the level of knowledge of the OMI-AP (Computerised Medical Office in Primary Care) program in medical personnel. Methods. Improvement cycle to optimize the knowledge and use of OMI-AP by family physicians in the Murcia Health Service. A total of 55 family physicians who completed an on-line course on OMI-AP were included. Advanced level training on the OMI-AP was given over a 2 month period via 9 modules. The measurements made were performed in two phases: 1st) A questionnaire on the level of knowledge of OMI-AP (10 questions) was completed one week before the students enrolled in the course. 2nd) The same questionnaire was used one week after completing the course. Results. The average score of the questionnaire was 5.31 points before the completion of the course and 7.70 points after the completion of the course (P<05). In 9 of the 10 questions analysed the percentage of correct answers significantly improved after the completion of the course. Conclusions. The delivery of the on-line OMI-AP course for doctors has led to a significant improvement in the level of knowledge of the program, essential for the daily practice of family physicians in our health service. On-line training greatly facilitates the training of professionals by enabling time management according to student needs (AU)

[Impact of an on-line course on the level of knowledge of the OMI-AP program for primary care doctors]. / Impacto de curso on-line sobre el grado de conocimiento del programa OMI-AP para médicos.

OBJECTIVE: To evaluate the impact of an online course on the level of knowledge of the OMI-AP (Computerised Medical Office in Primary Care) program in medical personnel. MATERIAL AND METHODS: Improvement cycle to optimize the knowledge and use of OMI-AP by family physicians in the Murcia Health Service. A total of 55 family physicians who completed an on-line course on OMI-AP were included. Advanced level training on the OMI-AP was given over a 2 month period via 9 modules. The measurements made were performed in two phases: 1st) A questionnaire on the level of knowledge of OMI-AP (10 questions) was completed one week before the students enrolled in the course. 2nd) The same questionnaire was used one week after completing the course. RESULTS: The average score of the questionnaire was 5.31 points before the completion of the course and 7.70 points after the completion of the course (P < 05). In 9 of the 10 questions analysed the percentage of correct answers significantly improved after the completion of the course. CONCLUSIONS: The delivery of the on-line OMI-AP course for doctors has led to a significant improvement in the level of knowledge of the program, essential for the daily practice of family physicians in our health service. On-line training greatly facilitates the training of professionals by enabling time management according to student needs.

Robots que soñaron ser cirujanos: de la Clepsidra al Da Vinci Surgical System / Robots that have dream to be surgeons: from Clepsidra to the Da Vinci Surgical System

La fabricación de máquinas que imitan al ser humano se ha mantenido desde hace más de 3.000 años. En la robótica clásica destacaron inventores como Arquitas de Tarento (hacia 400 a.C.), Heron de Alejandría, Bacon, Turriano, Leonardo, Va cancón o von Kempelen. En 1942 Asimov publica las tres leyes de la robótica. Con el desarrollo moderno de las ramas de la ingeniería se han desarrollado robots capaces de realizar de forma autónoma tareas de gran complejidad técnica, entre ellas la cirugía. A partir de 1985 se desarrollan robots cirujanos como World First, Robodoc, Gaspar; Acrobot, Zeus, AESOP, Probot o PAKI-RCP. En el año 2000 la FDA aprueba el Da Vinci Surgical System (Intuitive Surgical Inc, Sunnyvale, CA, USA) un robot asistente del cirujano (AU)

The desire to design automatic machines imitating humans continued for more tan 3000 years. Archytas of Tarentum (at around 400 a.c.) Heron of Alexandria, Bacon, Turriano, Leonardo, Vaucancon o von Kempelen were robot inventors. At 1942 Asimov published the three robotics laws. Mechanics, electronics and informatics advances at XXTh century developed robots to be able to do very complex self governing works. From 195 they were designed surgical robots like World First, Robodoc, Gaspar, Acrobot, Zeus, AESOP, Probot o PAKI-RCP. At 2000 the FDA approved the da Vinci Surgical System (Intuitive Surgical Inc, Sunnyvale, CA, USA), a robot to assist surgeons (AU)

Influence of prefabricated post dimensions on restored maxillary central incisors.

The aim of this study was to test the following hypothesis: biomechanical performance (fracture strength and stress distribution) of restored teeth is less sensitive to post diameter and post length when using glass fibre posts than when using stainless steel posts. First, an experimental fracture strength test was performed on 80 extracted human maxillary central incisors. Teeth were decoronated, treated endodontically and restored (40 with glass fibre posts and 40 with stainless steel posts), and the length and diameter of the posts varied uniformly. Failure loads were recorded and results were compared using an ancova analysis. Secondly, the finite element technique was used to develop a model of the restored tooth. The post diameter had a significant effect on the biomechanical performance of teeth restored with stainless steel posts. Lower failure loads were found as post diameter increased. However, the post diameter of those teeth restored with glass fibre posts, and the post length for both post systems under consideration, did not affect the biomechanical performance of restored teeth to a significant degree. The stress distributions predicted by the developed model corroborated these findings, confirmed the assumed hypothesis, and permitted the proposal of the use of glass fibre posts to achieve a restorative technique that is less sensitive to post dimensions, and thus more robust.

Influence of prefabricated post material on restored teeth: fracture strength and stress distribution.

AIMS: This work studied how prefabricated intraradicular post material affects the mechanical performance of restored teeth. The effect of using two different materials (glass fiber and stainless steel) with significantly different elastic moduli was studied. METHODS: A combined theoretical and experimental method was used: first, an experimental fracture strength test was performed on 60 extracted human maxillary central incisors. The teeth were decoronated, treated endodontically and restored, 30 with glass fiber posts and 30 with stainless steel posts. The data were recorded and the results compared using an ANOVA test. Then, the finite element technique was used to develop a model of the restored tooth. For both post systems, the model allowed for the study of stress distribution patterns on the restored tooth under external loads. RESULTS: For teeth restored with stainless steel posts, a significantly lower failure load was found, as compared with those teeth restored with glass fiber posts (520 N versus 803 N). The estimated distributions confirmed a worse mechanical performance on teeth restored using stainless steel posts, with a high stress concentration due to the significant difference between the elastic moduli of the steel and the surrounding materials. CONCLUSION: Within the limitations of this study, post systems, where the elastic modulus of the post is similar to that of dentin and core, have a better biomechanical performance.

[MIR family medicine program: cross-professional interaction in a complex reality]. / Programa MIR de medicina familiar: una interacción transprofesional en una realidad compleja.

OBJECTIVE: To find the view of trainers (tutors and teaching assistants) of third-year family and community medicine (FCM) residents concerning their own teaching activity in areas such as training, the skills and qualities required to be a teacher and the inter-professional relationships that are current and that are needed in a primary care teaching team. DESIGN: Qualitative study developed between June 2000 and May 2002. Sample design with a volunteer population. SETTING: FCM teaching unit under the Primary Care Administration of Murcia. PARTICIPANTS AND/OR CONTEXTS: Tutors and teaching assistants in the FCM residents' programme. METHOD: Semi-structured interview for information gathering. Contents analysis to construct results on the basis of the semiological analysis of the textual discourse. Systematic return of the results. RESULTS: Belonging to the teaching team is the highest motivation for taking part in teaching. It gives the tutors more benefits (affective, care load) than difficulties (organisational adaptation). The tutor profile is sustained by his/her scientific-technical and personal qualities; that of the nurse, by his/her community qualities. Collaboration between nurse and tutor is informal and the teaching strategies most employed by tutors are guidance, guide-lines and encouragement of residents' autonomy. Nurses collaborate with teaching by transmitting a model of professional development and facilitating teamwork. CONCLUSIONS: The complexity of the training process stands out. Postgraduate FCM training is cross-professional, not exclusively circumscribed by the tutor-resident teaching relationship. The qualitative paradigm is shown to be useful for obtaining a vision of the teaching process from the perspective of different actors.

Clinical and radiological improvement of periodontal disease in patients with type 2 diabetes mellitus treated with alendronate: a randomized, placebo-controlled trial.

BACKGROUND: Alendronate (ALN) is an aminobisphosphonate commonly used for osteoporosis in postmenopausal women. We studied the effect of ALN on bone loss prevention in type 2 diabetes mellitus patients with periodontal disease. METHODS: In a controlled double-blind, randomized study we evaluated prospectively diabetic patients paired by gender and years since diagnosis for 6 months. The study included 40 patients (20 men and 20 women), 50 to 60 years old, with more than 5 years since diagnosis of diabetes and established periodontitis. They were randomly allocated to alendronate (10 mg/daily) or placebo treatment for 6 months. The endpoints of treatment were: the distance between the alveolar bone border and the cemento-enamel-junction (CEJ) evaluated by means of digital radiographic imaging, a biochemical marker of bone resorption (urine N-telopeptide) (Ntx), and periodontal parameters. Metabolic control was assessed at baseline and after 6 months. RESULTS: Baseline and 6-month glycated hemoglobin levels were similar in both groups. Alendronate induced a significant decrease in NTx at 6 months (P = 0.006). Periodontal parameters improved in both groups. However, they were significantly better for the ALN treated group. Alveolar bone border-CEJ distance increased in the placebo, but decreased in the ALN group (P = 0.0003). CONCLUSIONS: In type-2 diabetic patients, alendronate induced more improvement in alveolar bone crest height than control therapy. No differences in urinary N-telopeptide or glycated hemoglobin were observed in this short-term randomized controlled pilot trial.

Automatic recognition of biological shapes using the Hotelling transform.

We present two contour-based techniques, for computerized object recognition that avoid the difficulties due to translations, rotations and scaling. Our techniques do not require any shape representation. The first technique uses the scale-space filtered coordinate functions of contours and their "largest diameters". The second, uses the Hotelling transform of the vector representations of the points of contours. We applied both techniques to recognize human corneal endothelial cells, embedded in a sample of tissue. The results obtained using the Hotelling transform represent a considerable improvement when compared to those previously obtained using the coordinate functions, the curvature function and Fourier descriptors as representations of shape.

Quantitative image quality analysis of a nonlinear spatio-temporal filter.

Digital temporal and spatial filtering of fluoroscopic image sequences can be used to improve the quality of images acquired at low X-ray exposure. In this study, we characterized a nonlinear edge preserving, spatio-temporal noise reduction filter, the bidirectional multistage (BMS) median filter of Arce (1991). To assess image quality, signal detection and discrimination experiments were performed on stationary targets using a four-alternative forced-choice paradigm. A measure of detectability, d', was obtained for filtered and unfiltered noisy image sequences at different signal amplitudes. Filtering gave statistically significant, average d' improvements of 20% (detection) and 31% (discrimination). A nonprewhitening detection model modified to include the human spatio-temporal visual system contrast-sensitivity underestimated enhancement, predicting an improvement of 6%. Pixel noise standard deviation, a commonly applied image quality measure, greatly overestimated effectiveness giving 67% improvement in d'. We conclude that human testing is required to evaluate the filter effectiveness and that human perception models must be improved to account for the spatio-temporal filtering of image sequences.

Automatic recognition of biological shapes with and without representations of shape.

In this work it is described how to use the curvature function, the Fourier descriptors, and the coordinate functions of a contour to achieve automatic recognition of biological shapes. Those representations of shape and the coordinate functions were applied to recognize human corneal endothelial cells embedded in a sample of tissue. We assume that when the coordinates of the points of contours are analyzed directly, no representation of shape is being used. We applied scale-space filtering to the coordinate functions, to compensate the effects of scaling and to minimize the error due to quantization. A technique for compensating the effects of rotation, with or without the use of a representation of shape, is proposed. Our results show that, for a wide range of biological shapes, no representation of shape is required to solve or avoid the problems caused by translation, scaling, and rotation. We conclude that for certain applications the use of a representation of shape can provide some advantages. However, the coordinate functions of contours, evolved in scale-space, can be efficiently used, yielding even better results in applications of robotics and computer vision related to the recognition of biological shapes.

Automatic segmentation of contours of corneal cells.

A fully automatic computerized method for segmenting contours of corneal endothelial cells is proposed. As part of the method, scale-space filtering (i.e. Gaussian filtering) is used to achieve tasks different from noise removal. This type of filtering is applied making use of the separability property of Gaussian kernels, avoiding the erosion of images. A variant of unsharp masking is used to considerably increase the visibility of dark areas of images. It is shown how the overflow that occurs when two images are subtracted can be handled to produce better results than normal unsharp masking. The method is exemplified with a low quality specular micrograph. To test the performance of the method, its output is used to automatically calculate the average cell size of images of different samples of tissue and different visual quality. The obtained results are successfully compared to those obtained with a manual semi-automatic method. A method for reading the segmented contours is suggested as well as two shape representations to achieve morphometric analysis of individual cells.

The curvature function evolved in scale-space as a representation of biological shapes.

A new and simple approach for calculating the curvature functions of arbitrary non-analytical (biological) contours of planar shapes is described. This approach does not require either parametrization or the evaluation of derivatives, which eliminates sources of error and noise amplification. It is shown that this method provides better results than the traditional procedure and the procedure employing polar coordinates. The paper describes how to evolve contours in scale-space, and it is discussed how, due to its invariant properties, curvature functions, evolved in scale-space, are suitable as representations of shapes. The techniques described are applied to the digitized contours of isolated corneal endothelial cells.