Computers and Otolaryngology

Maintaining lifelong learning for clinicians, with their increasingly busy lives, requires creative solutions to meet the needs of continuing professional development. As technology has evolved, computer assisted learning has taken on an increasing role to meet these needs. Computers have come a long way since the first large mainframe computer that filled entire rooms, yet had limited memory and processing capacities, to today’s powerful mobile handheld computers. This technology has also addressed the important consideration of easy access to quality information worldwide, especially through the Internet with its growing medical resources and journals. Multimedia applications have enriched the learning experience and improved the learning process.

Doctors have a duty to 'keep their  professional knowledge and skills up to date(1) and to acquire new skills for the  benefit of their patients. Continuing professional development (CPD) is the  process by which individual doctors keep themselves up to date in order to  maintain high standards of professional practice(2), to improve their clinical  competence and patient care, to comply with accepted standards, and to  contribute towards clinical governance and revalidation, as well as to help  progress their careers(3).
Various activities can constitute CPD, including: attendance or presentations  at meetings, conferences and courses; teaching and examinations and  self-directed learning such as reading journals, information searches,  undertaking research and contributing to the published literature(4). Much of this is resource-intensive and particularly time-intensive and, with increasingly  busy lives, doctors often find it difficult to maintain a reasonable work-life  balance.
Computers are increasingly playing a part in the CPD process as they enable  access to information 24 hours a day. Modern technology offers smaller and  increasingly more powerful mobile access to such information. There is also no  doubt that the advent of multimedia applications has enriched the learning  experience and improved the learning process.
Some of the applications and resources that are currently  available to enhance clinician learning and professional development are  introduced.

PDA Resources

AvantGo content delivery service
Web browsers for personal digital assistants (PDAs) have come a long way  recently but still do not offer the most usable way of viewing web pages that  were originally designed for personal computer (PC) monitors. AvantGo®  (www.AvantGo.com) is a service which packages web content for handheld computer  access and which enables browsing of content offline. This application allows  the user the opportunity either to create customised channels for their PDA from any website or to subscribe to one of the many freely available channels,  including those carrying news and sport as well as information on health-related  matters. Once registered, it is possible to download software that allows  viewing of material on a PDA; it is also easy to synchronise and to rapidly  update this material. The advantage of such an application is that content from  various resources can be collected in one location and updates can easily be  synchronised via a desktop PC internet connection or directly via a wireless  connection. Many websites, including those for journals, now offer Really Simple  Syndication (RSS) feeds which can also be accessed as an AvantGo channel. Such  feeds are essentially a link to information which is updated dynamically and  many otolaryngology journals now offer such feeds of current journal abstracts.
The Journal of Laryngology & Otology offers a version of the current issue as an AvantGo channel in order to enable subscribers to read articles on  their PDA. Thus, subscribers can access the full text of all main articles  wherever they are, without having to carry the paper edition (click here for more information).

MobiPocket reader
The MobiPocket (www.mobipocket.com) is a universal reader for personal  digital assistants that allows easy reading of e-books. E-medicine (www.emedicine.com) offers an otolaryngology e-textbook that can be downloaded for MobiPocket,  such that this knowledge base can be accessed directly and easily in any  location. The search functionality enables you to find any chosen topic and also  to highlight areas of text, add bookmarks and even insert personalised clinical  notes.

RepliGo
RepliGo (www.cerience.com) document mobility software enables viewing of  virtually any document via a PDA. It converts Microsoft Office documents,  portable document format (PDF) files, web pages and hundreds of other documents  into replicas which can then be viewed easily. The advantage of such documents  is the ability to zoom and to text wrap to the screen, thus eliminating the need  for tedious horizontal scrolling on the PDA. All content (such as fonts, charts,  graphics, images and tables) can easily be viewed using a streamlined document  navigation interface. This application is also ideal for storing PowerPoint  slideshows on a PDA, either for personal perusal or for presentation via a data  projector. A RepliGo document is created, following software installation, by simply  printing the document after selecting the RepliGo software as the printer. This  will then print to file and create a RepliGo document at the user's location of  choice.

E-journal

e-Journals
The internet has changed the way information is received and stored. Only a  few years ago, pages of information required a filing cabinet for storage and to  enable reference at a later date. Nowadays information is stored electronically  and important documents are painlessly located via powerful search functions.  Electronic journals are able to provide linking to cross references and to  Medline directly, with the added advantages of saving searches and articles for  future use. Many journals have utilised this technology and offer an electronic  version of their content. Some journals also offer extra content in the e-journal that is not available in the paper version (online only content). For example The Journal of Laryngology & Otology  currently offers free access to abstracts of each issue as well as to back  issues to 2000 (JLO e-journal); subscribers can also access full articles in PDF and hypertext  markup language (HTML) formats. In the future all previous issues will be  available electronically, which will provide a huge educational resource that was previously only accessible through national  libraries. This resource will be available worldwide through the internet.

Online Article Submission
The internet has provided an efficient tool to transfer and exchange information easily and rapidly without the limitations of distance. Authors from all over the world can take advantage of online submission where previously they were limited to sending hard copies over several miles by surface mail. The Journal of Laryngology and Otology offers such a service allowing authors to complete a simple online article submission form and electronically attach the article manuscript. Submitted articles are received instantly and this improves the chance of quality work being published within a reasonable timeframe.

Forthcoming articles
An exciting development in journal publishing is incremental publishing. This  allows work to be published online ahead of its paper publication; it can thus  be cited much faster than was previously possible. When an article is published  online it receives a unique digital object identification (DOI) number and is  thus universally accepted as a published document which can be quoted. Authors  benefit from their work being released in a timely fashion and readers benefit  from early access to important research findings. To access Forthcoming articles from The Journal of Laryngology and Otology please click here.

Abstract selection
Keeping abreast of recent developments in the field involves scan-reading  abstracts from many different journals, which requires time. A useful method of  receiving a selection of abstracts from nominated journals is provided by Amedeo  (http://www.amedeo.com/medicine/orl.htm); selected abstracts are sent directly to subscribers' e-mail  in-boxes every week.

Information Searching

Bio informatics toolbar
The MolBiolNet toolbar (www.bioinformatics.vg/toolbar), added to one's  internet browser, is the fastest and easiest way to get information from  National Center for Biotechnology Information (NCBI) databases such as PubMed  and from other biological web resources. MolBiolNet's normal search engine  facility allows searching of Google and the Amazon books directory and contains  links for fast redirection to literature databases. The MolBiolNet Toolbar is  free to download and appears every time a new Internet Explorer window is  opened.

Google Scholar
Google Scholar (www.scholar.google.com) provides a very simple way to search  the literature. From one site many sources can be searched, including  peer-reviewed papers, theses, books, abstracts and articles. In ranking the article, Google takes into account the text, the author, the journal and the number of times the article has been cited.

Google Alerts
With rapid changes in the processes of healthcare delivery, patients are  often more aware than clinicians of new medical developments. Google Alerts  (www.google.com/alerts) offers to deliver into subscribers' e-mail in-boxes the  results of their chosen searches from various news and web resources, thus  ensuring that they do not miss important medical news articles.

PubMed alerts
PubMed (www.pubmed.gov) is a service of the US National Library of Medicine  which includes over 16 million citations from Medline and from other life  science journals as well as other biomedical articles. It searches back to the  1950s. PubMed offers updated e-mail alerts of subscribers' chosen information  searches as and when new articles appear in the literature. Subscribers can  choose to receive these alerts weekly, monthly or as often as requested. For  example you can be alerted when the next article is published on 'stapedectomy'  and you are then supplied with a link to the full abstract.

Newsreaders

With more than a billion web pages available, it can be somewhat  time-consuming to find the information one needs by clicking from site to site.  Really Simple Syndication feeds alert subscribers when nominated sites (from  throughout the internet) have added new content. The latest headlines and  articles (and even audio files, photographs and videos) can be accessed in one  place, as soon as they are published, without the user having to remember to  visit each site regularly. Really Simple Syndication feeds are a type of web  page designed to be read by a Newsreader application. Many websites, including  many otolaryngology journal websites, now offer RSS feeds of their content  allowing one to effortlessly receive abstracts of current journal issues at one  location. There are many Newsreader applications available, including Google Reader (www.google.com/reader).

Electronic Resources

There are many useful electronic resources available including on-line web resources and off-line digital video disc (DVD) multimedia resources. They include: online specialist libraries for ENT and  audiology; resources for clinical guidance and evidence-based medicine, clinical  databases and electronic books and journals. Various practical guides to surgery  are also becoming available, with interactive DVDs that incorporate text, images, sound and video. 

Please visit the JLO WebWatch for a list of these useful links.

The future

With the capability to view simultaneous text, images, sound and video via computer, the e-learning experience has been enhanced and enriched. The future  holds the promise of increased e-learning opportunities for clinicians with the  advent of multimedia resources approved for CPD available through the medical  royal colleges(5).
In common with other journals, The Journal of Laryngology & Otology has  been working on providing such content, and it hopes to start in the near future  by providing multimedia presentations of lectures given by its visiting  professors. These presentations will allow online streaming of the lecture slides, together with a video of the presenter, so that a virtual experience  akin to being in the lecture theatre is provided.
The future is exciting, and we at The Journal of Laryngology & Otology  hope to be a part of it by providing, through this website, a range of materials  that we hope will act both as adjuncts to the written word and also as  educational resources for our subscribers.

References
1 The duties of a doctor. General Medical Council (UK). http://www.gmc-uk.org  [25 July 2006]
2 Ten principles for continuing professional development. Academy of Medical  Royal Colleges (UK). http://www.aomrc.org.uk/ [25 July 2006]
3 Continuing professional development, a manual for SIGN guideline  developers. Scottish Intercollegiate Guidelines Network, http://www.sign.ac.uk  [25 July 2006]
4 Continuing professional development for UK Physicians. Federation of the  Royal College of Physicians of UK. http://www.rcplondon.ac.uk/ [25 July 2006]
5 Executive summary of the meeting of the academy of medical royal colleges  (UK). Academy of Medical Royal Colleges (UK), http://www.aomrc.org.uk/ [25 July  2006]