Filming

For our videos we use a green screen and ‘chromakeying’ - a technique that enables us to put whatever background we like behind the presenter - even an animated one. Our filming studio is set up as shown:

We use five lights - two bright ones directed at the presenter, one acting as a backlight, and two directed at the green screen itself so that it is a flat colour onscreen. We also use two cameras, one positioned centrally which records the full view of the presenter and the product, and one which zooms in on certain aspects of the product for close-ups during a demonstration. We record with both cameras simultaneously and then edit the close-up shots in over the full view later. We have one microphone set up around the presenters neck which is connected to the main camera so we can record high quality sound without any background noise.

Editing

To edit our videos we use an editing program called Sony Vegas which is perfect for what we intend to do. First we import the full-view video into the main workspace, then we import the close-up video into the ‘trimmer’ workspace. This enables us to see both videos at the same time and to work on them together. Excess video at the beginning and end are trimmed off first, then we start matching up the close-up shots in with the wide shots, clipping sections of the close-ups so they correspond with the sound and video of the main video. This can be tricky to master, as we only use the sound recording from the full-view camera, and if the clipped section is even slightly out of synch it will look very strange. Once the various close-ups are included in the main video we begin chromakeying the background. We black out the green screen behind using the chromakeying function in Sony Vegas, adjust it so that we have a solid definition between the presenter and the background and then simply drag and drop the required background image onto another layer behind the main movie and stretch it out so it covers the entire length of the film. We use another separate layer for the Medisave TV logo, this time above the movie itself, and this again covers the entire length of the film. For the ending, we simply fade to solid black, then use the background and a big logo together with a shimmering visual effect and a twinkly sound effect to finish off the film.

We save and render this video, adjusting it to the right size for our website and then upload it so it shows in the video section of the product that is being demonstrated. The Littmann Stethoscope Spares video is an excellent example of what our finished videos look like and contains all the elements described above.

Using an ophthalmoscope may seem simple, and is not difficult to use but it does require practice. If used for every neurological examination, it will soon become second nature.

Some obvious things to bear in mind are checking the batteries are working - they may be flat which will affect reliability, or as with some ophthalmoscopes, the small cover over the aperture may be closed which may lead you to believe it is not working.

Important factors to consider are room lighting (off or dimmed), preparing your patient, (warn them it could be dazzling and ask to fixate on exact area), and make sure you examine eye to eye (your left with their left, your right with their right).

Advice indicates to follow a routine: red reflex, anterior segment, disc, vessels and then lastly macula. If you find an abnormality, keep looking for a second one.The red-free filter is useful for enhancing the appearance of blood vessels and bleeds by showing them as black.

The most common error made by physicians when using an ophthalmoscope is not getting close enough. Advice suggests being almost cheek to cheek to enable the widest field of view.

An Internet journal has, on the basis of experience from Jacob Urkin (M.D., M.P.H. Ben Gurion University of the Negev) listed various uses of the physicians office primary tool, the otoscope . The otoscope was originally developed in France and Germany in the 19th century and has not really changed since it’s development. Beyond its primary role, Jacob Urkin (M.D., M.P.H) cites the otoscope as a valuable tool and lists uses below from his experience.

The otoscope as a tool for transillumination includes finding a vein for venipuncture, examination of the content of the scrotal sac, diagnosis of intracranial fluids and diagnosis of sinusitis. In dermatology, examination of surface lesions, controlling the spray while performing cryotherapy and removal of small mites have been listed.

Other than ear examination, the otoscope has also been used for examination of intaranasal deformities/lesions, detection of intraurethral warts, detection of foreign bodies, removal of splinter in umbilicus, paediatric genital examination and suction of cerumen. Also listed is detection of strabismus, red reflex, cataracts, hyphema and foreign bodies in the eyes plus checking eye movement and pupil’s reflex.

The journal lists other uses of the light and the pump for reduction of anxiety, encouraging forced experium and checking fine motor coordination.

It also has uses for laboratory and vetinary medicine including intubation of small mammals, liver biopsy, detection of avian gender, detection of cataract in fish and checking animal body orifices. And finally, for non medical use “looking into small dark places”

Many physicians may well already be familiar with some of the applications listed above, but the wealth of different applications may not be as widely known. The perception of the otoscope as a tool for ear examination only however is slowly changing with the pace and diversity of a modern physicians office.