Genetics in Clinical Practice User manual
Contents
1. by playing system sounds IN WINDOWS 98 M E 2000 NT 4 e Begin by clicking the Start button point to Settings and click Control Panel Then double dick on the Sounds icon to open the Sound Properties dialog box Guide to Genetics in Clinical Practice 13 modified July 12 2002 e f the Events box lists items in black select one e g Default and dick the Play button If you hear nothing check your hardware again If problems persist check the manual that came with your sound device If the events in the Events list are grayed out then the Windows drivers for your sound device are not correctly installed or the computer does not have sound capability Refer to the manual that came with your sound device for proper installation procedures Step 3 In Windows 98 N T 2000 check volume levels From the Windows Start M enu select Programs Accessories M ultimedia then Volume Control e f you do not have the Volume Control installed on your system select Settings Control Panel from the Start menu Double click on the M ultimedia icon and click on the Audio tab to set the volume Step 4 Update your sound driver to the most current version See U pdating Windows Device D rivers below for information about how to get the most recent updates Step 5 Check the README file for more details If you are still having problems with audio playback please refer to the README file located in the Genetics in Clinical P2. laboratories Learning Resources Room The Learning Resources area at the top right of the Clinic contains three kiosks which from left to right allow access to lectures Internet web sites and patient interviews They are described in more detail below Lectures There are six topics on the lectures kiosk that you may be interested in Each lecture can be done their entirety usually 5 to 10 minutes each or by subtopic Internet access Y ou can access pertinent World Wide Web links from the middle kiosk in the Learning Resources room Assuming you have a connection to the Internet established clicking on the graphic of the computer will launch your default web browser application enabling you to visit some approved Internet sites When you are ready to return to the Virtual Clinic click on the minimized tab Genetics in Clinical Practice on your Windows taskbar usually at the bottom of your screen The Patient Interviews kiosk on the right lets you meet some real people whose lives have been affected by genetic conditions View as many interviews as you d like they don t last morethan a couple of minutes each USING THE VIRTUAL CLINIC Guide to Genetics in Clinical Practice 9 modified July 12 2002 Moving around There are a couple of ways to move around in the Clinic from the Overview map or from the Hallway Overview You get to this view by clicking on any of the map icons they look like evacuation diagrams that ar
3. and Prevention CDC via a subaward from the Association of Teachers of Preventive M edicine Guide to Genetics in Clinical Practice 2 modified July 12 2002 TABLE OF CONTENTS ABOUT THISMANUAL GUIDE TO THE GENETICS VIRTUAL CLINIC Background Ideal Continuing Education Faculty Getting Started Hardware requirements Installation Windows Macintosh Starting the Program Features of the Virtual Clinic Using the Virtual Clinic H otkeys Updates Credits TECHNICAL REFERENCE Troubleshooting Windows Troubleshooting M acintosh 2 license Guide to Genetics in Clinical Practice 3 modified July 12 2002 ABOUT THISMANUAL This manual is divided into two parts a Guideto the Genetics Virtual Clinic and a Technical Reference The Guide gives some background about the Virtual Clinic and Virtual Mini fellowship gives biographical sketches for its faculty tells how to install the program and offers some suggestions about how to do the mini fellowship The Technical Reference can help solve technical problems you might encounter using the program GUIDE TO THE VIRTUAL CLINIC Ideally a continuing education experience would provide for effective efficient and enjoyable learning It would probably involvea visit to a major medical center with opportunities to counsel evaluate and manage a variety of patients interact with renowned experts who act as mentors and attend excellent lectures Of course it would
4. GENETICS IN CLINICAL PRACTICE A TEAM APPROACH GUIDE TO THE VIRTUAL CLINIC AND TECHNICAL REFERENCE Windows and M acintosh CD ROM DEVELOPED BY INTERACTIVE MEDIA LABORATORY DARTMOUTH MEDICAL SCHOOL LEBANON NEW HAMPSHIRE Guide to Genetics in Clinical Practice 1 modified July 12 2002 TRADEMARKS Microsoft and Windows are registered trademarks of Microsoft Corporation Apple and Macintosh 9 are registered trademarks of Apple Computer Inc COPYRIGHT STATEMENT 2002 The Trustees of Dartmouth College This manual and the computer program it describes are protected by copyright law and international treaties Unauthorized reproduction or distribution of this program or any portion of it may result in severe civil and criminal penalties and will be prosecuted to the maximum extent possible under the law This manual and the software are subject to license agreements with Dartmouth College and are not to be copied or used except as specified in such agreement Some materials in this program are from copyrighted publications and products owned by others Refer to the publication data included in bibliographic citations and the copyright notices in the original published form of the contained publications all of which are incorporated herein by reference Information in this document is subject to change without notice Development of this program was funded through an educational grant from the Centers for Disease Control
5. Windows version of Genetics in Clinical Practice displays video using a modified version of 2 5 VP3 codec TheOn2 VP3 Video Codec is subject to the VP3 2 Public License Version 0 1 the License you may not usethis file except in compliance with the License You may obtain a copy of theLicense at http www vp3 cony license Software distributed under the License is distributed on an 5 15 basis WITHOUT WARRANTY OF ANY KIND either express or implied Seethe Licensefor the specific language governing rights and limitations under theLicense The Original Codeis TheOn2 VP3 Video Codec Thelnitial Developer of the Original Codeis On2 Technologies The Duck Corporation Portions created by the On2 Technologies are Copyright 2001 2002 by On2 Technologies The Duck Corporation Portions created by the Interactive M edia Lab are Copyright 2002 by the Trustees of Dartmouth College Rights Reserved Contributor s Interactive M edia Lab at the Dartmouth M edical School ADDITIONAL TECHNICAL SUPPORT Additional technical support information for the Genetics in Clinical Practice program is on the web site of the Interactive M edia Laboratory at http iml dartmouth edu education cme Genetics Guide to Genetics in Clinical Practice 17 modified July 12 2002
6. all be scheduled around your busy dinical practice available whenever you had thetime without travel Virtual Mini fdlowships aspire to meet these desirable qualities for continuing education with a Virtual Clinic a highly detailed computer based environment that is intuitive and easy to use This program dealing with genetics in clinical practice isavailable anytime on most commonly available computer system e applies sound pedagogy and learning theory to create a carefully designed well produced comprehensive program of instruction e provides case based learning with simulated patients allowing you to explore medical and psycho social dimensions of genetic counseling e features faculty members who are experts in their field who e provide detailed and insightful case discussions in context with each simulated patient encounter e offer mini lectures on a variety of relevant genetic topics e provides examples of best practice genetic counseling e offers links to recommended Web sites for further information e allows you to interview real patients with genetic conditions FACULTY Host Case Discussions Counseling D emonstration Ed McCabe MD PhD Physician in Chief Mattel Children s Hospital at UCLA Professor and Executive Chair of Pediatrics UCLA School of M edicine Host Case Discussions Counseling D emonstration Michelle Fox MS CGC Senior Genetic Counselor Pediatrics Genetics UCLA School of Medicin
7. ase discussion screens by dicking on the VCR like control strip at the bottom of the screen Thefive buttons from left to right have the following effect 1 fast rewind to the previous screen 2 rewind to the beginning of the currently playing screen 3 stop the audio with options to resume or end your current section 4 play indicator 5 fast forward to the next screen Note that these controls are not available during video or when no audio is playing If the cursor isn t responding while trying to click these buttons the program is probably busy and will return control shortly 1 Fast rewind 3 Stop Resume 5 Fast forward N sj pr I 2 Rewind 4 Play Exiting and Resuming the Program It can take from 5 10 hours to complete this program so you ll probably want to do your mini fellowship in several sessions To exit the program go to the Clinic s overview by dicking on any map icon in the hallways it look like a schematic map of the Clinic Then click on the EXIT sign in the right lower corner Alternately you can press Alt4Q Win or Apple Q Mac Either way your progress in the mini fellowship will be saved When you come back to the program sign in with the same name you used before and dick the Restore button to pick up where you left off Only select Start Over if you really want to begin your mini fellowship as a new user If you simply wantto show someone the pr
8. e Host Case Discussions Laboratory O verview Guide to Genetics in Clinical Practice 4 modified July 12 2002 WayneGrody MD PhD Professor Divisions of M edical Genetics and Molecular Pathology Director Diagnostic Molecular Pathology Laboratory UCLA School of Medicine Counseling D emonstration Brenda Finucane MS CGC Director Genetic Services Elwyn Training and Research Institute Elwyn Pennsylvania Case Discussion Sharon M cDonnell MD MPH Medical Epidemiologist Epidemiology Program Office Centers for Disease Control and Prevention Case Discussion Randi Hagerman MD Tsakopoulos Vismara Chair of Pediatrics Director M I N D Institute UC Davis Health System Case Discussion Mark H Greene MD Chief Clinical Genetics Branch Division of Cancer Epidemiology amp Genetics National Cancer Institute Lecturer Francis Collins M D PhD Director N ational Human Genome Research Institute National Institutes of H ealth Guide to Genetics in Clinical Practice 5 modified July 12 2002 Lecturer Alan Guttmacher M D Senior Clinical Advisor to the Director National Human Genome Research Institute National Institutes of Health Lecturer Elizabeth Betsy Gettig MS CGC Director Genetic Counseling Program Department of H uman Genetics Graduate School of Public H ealth University of Pittsburgh Lecturer W Andrew Faucett MS CGC ATPM CDA Laboratory Genomics Branch Centers for Disease Contr
9. e most current versions The majority of sound and video problems will be corrected by updating Windows drivers Your hardware dealer should have access to the most recent drivers In addition Microsoft has made a great deal of information and help availablethrough the Windows Driver Library WDL and the Microsoft Download Service M SDL the M SDL phone number is 206 936 M SDL 6735 Internet addresses are World Wide Web http www microsoft com ftp ftp microsoft com If you have a modem you can download the drivers Follow instructions found in the WDL TXT file WINDOWS PERFORMANCE Hereis a summary of things to try if you are having performance problems Do not run processor intensive programs while the Virtual Clinic program is running especially on a lower end machine e Turn off CD ROM drive caching to improve video performance Turn off any screen savers e Disconnect your computer from your network Defragment your hard drive refer to instructions which came with your operating system TROUBLESHOOTING MACINTOSH Using multimedia programs can sometimes be frustrating because of the various hardware software and operating system components that must work together M ost problems can be solved by simply inspecting the hardware and software setup of your machine Guide to Genetics in Clinical Practice 15 modified July 12 2002 Below are step by step guiddines for checking the most common causes of problems when ru
10. e scattered throughout the dinic From the map just dick on any area that interests you and that drops you into the appropriate location in the Hallway The Virtual Clinic Overview Laarnireg Fieacurceas Laden Conia esia Room rrini kaaturan by gorgias Desa Rice Expert Ene L tul ewant Web ds c runss br s ds a aks cas patie nt Mosk Room V infero ims woth 4 Ezari iu DI Fri seco pha Dry ga nanc tare 4 mih gt pate nis raer the grensa pal ree MT erwies Lab An cenama ci turing saih abyor of lees plur hone us are grass the ab ird i ry pealessenals perpen on generic Hallway To enter a room dick on its doorknob To move down the hallway dick the mouse in the direction you want to go Viewing patient records Before starting a simulation with a patient you can read his or her patient chart by dicking on the colored folder on the door Turn pages by dicking on the appropriate side of the chart Some charts have record Tabs on the side to help you page through the documents When finished viewing the chart click on the Done tab Guide to Genetics in Clinical Practice 10 modified July 12 2002 Navigating through Lectures Case Discussions You can move forward and backward through the lectures and c
11. ll sign in to the mini fellowship It s important that you use the same first and last name each time you log on if you want to maintain your progress records especially if you are using the program to get continuing education credit Once past the credit screen and introductory video you ll be offered an Orientation It only takes afew minutes and gives a good overview of the Clinic and thethings you can do there Simulated patients The core of the program lies in interacting with simulated patients which you access from the grid like Patient Visit Roster in the hallway With each patient you ll be asked to assess and counsel your patient s and make decisions about their care Conference Room At the end of each patient visit your host Dr M cCabe will offer you the chance to hear case discussions on issues raised by that encounter H e ll tell you what topics will be covered who will be discussing the case and how long they ll take so you ll know what to expect Y ou can return to these case discussions at any time by going to the Conference Room Counseling Room The counseling room provides two examples of best practice genetics counseling These video segments are abridged counseling sessions that emphasize the issues of immediate concern to their patients Laboratory Here you can get an overview of genetic testing from Dr Wayne Grody Then you can view some video tours of Biochemical Genetics M olecular Genetics and Cytogenetics
12. ms with the Virtual Clinic program start by checking system requirements This program requires at least 10M B of RAM 16 bit color and 32 MB of hard drive space If you do not have sufficient memory on your system the program will not run KNOWN ISSUES The edges of lines and boxes drawn by the program may overlap under Windows 98 noticeable particularly during the patient pedigree Windows2000 SP1 is known to have problems recommended solution is to upgrade to service pack 2 or above You can check which service pack you have by Right click on M y Computer Select properties This will open up a new window You should be on the general tab Under the heading of system the last line will tell you your service pack level If you are not at service pack 2 go to Start Windows Update This will open a web browser and take you to the M icrosoft site and the appropriate place to download and install this service pack WINDOWS SOUND Sound problems occur for many reasons so they re often hard to track down H ere are some general guidelines for checking the various things that can go wrong with sound Step 1 Verify all hardware components Check that all cables are properly connected that speakers are plugged in and turned on that the volume on your speakers is set appropriately Step 2 Check sound drivers by playing system sounds If your hardware is properly set up make sure that you have Windows sound drivers installed
13. nning the Virtual Clinic program under M acintosh If you are experiencing problems with the Virtual Clinic program start by checking system requirements This program requires 8 MB of RAM and 32 MB of hard drive space If you do not have sufficient memory on your system the program will not run MACINTOSH SOUND All Macintosh computers listed under the minimum requirements can produce sound without additional speakers or hardware If there is no audio and you areusing external speakers the first thing to check is that they are plugged in turned on and all cables are properly connected You may also need to adjust the software volume control ere s how Go to the A pple menu and select Control Panel When the submenu appears open the Sound control panel e ChooseVolume from the submenu and click and drag the volume control to an appropriate level You may also need to ensure that the Playthrough checkbox is selected under the Options section of the Sound In submenu MACINTOSH VIDEO DISPLAY Be aware that occasionally you may see brief stuttering effects that are the result of normal system demands unless these effects occur frequently or are of long duration they are no cause for concern If synchronization problems are persistent try disabling control panels and extensions that may betaxing the processor In particular try this e Goto Chooser under the Apple menu and turn off AppleTalk by clicking the Inactive radio but
14. ogram from the beginning try signing in with a different name from the one you re using for your mini fellowship HOTKEYS some special keystrokes that make it easier to use and navigate through the Virtual Clinic Windows users should hold down the Alt key while pressing the letter below while Macintosh users use the Command Apple key Goto dinic Overview Alt O letter Go to case discussions in Conference Room Pause video or audio A It P press again to continue Make all patient Visits available QUIT the program or Alt Q interrupt a patient simulation Additionally the ESC Button Windows or Mac will skip through video or audio clip Use this function sparingly as it will advance you through possibly vital information Guide to Genetics in Clinical Practice 11 modified July 12 2002 PROGRAM UPDATES The developers and the publisher of this program have taken careto make certain that the information presented is correct and compatible with standards of care generally accepted in the United States at the time of publication Neither the publisher the developers the care providers nor other individuals participating in the program assume any responsibility or liability for the consequences of any health care decisions made by a user of the program or other person with access to the information in the program CREDITS Director Writer D esigner and Producer Jo
15. ol and Prevention Designed Directed Written and Produced by Joseph V Henderson MD Joe Henderson directs the Interactive Laboratory at Dartmouth M edical School Having developed award winning interactive media programs for 15 years Dr Henderson is well known as a medical educator with a firm grasp of technology based learning and its power to involve and inform His goal is to provide for learning experiences that are intellectually and emotionally stimulating enjoyable and in the best of cases profound Guide to Genetics in Clinical Practice 6 modified July 12 2002 INSTALLING THE VIRTUAL CLINIC PROGRAM Important ote Please consult the Read Me file on the Genetics in Clinical Practice CD for additional technical information and troubleshooting tips WINDOWS Microsoft Windows 98 M E N T 4 2000 ome XP Professional System Specifications Computer type CD ROM Drive Sound Card Operating System Windows Installation Intel Pentium 11 or 100 Intel compatible microprocessor 300M hz with 32MB hard disk space 2MB video RAM 16 bit color or better at 640x480 2x CD ROM drive with 300kBps data transfer rate SoundBlaster or 10096 SoundBlaster compatible sound card and speakers Windows 98 ME Windows NT 4 x 2000 Windows XP Home Windows XP Professional Recommended Pentium 1 hz or better 32M hard disk space 4MB video RAM 24 bit col
16. or at 640x480 or higher 4x CD ROM driveor faster 16 bit SoundBlaster or 100 SoundBlaster compatible and speakers Windows 98 ME Windows 2000 Windows XP Home Windows XP Professional Note Windows NT Windows 2000 and Windows XP systems need administrator access to install the Genetics in Clinical Practice program Please see your systems administrator if you need assistance Insert the Genetics in Clinical Practice CD in your CD ROM drive 2 Open My Computer from Desktop and open the CD ROM icon Start the installation by double clicking Setup exe Y ou can install to the default location C Program Files Genetics in Clinical Practice or choose your own location Guide to Genetics in Clinical Practice 7 modified July 12 2002 3 This program requires QuickTime software from A pple Computer Inc that displays video and audio version 5 0 or higher If it is not currently installed you will be led through its installation 4 The program also requires On2 s video codec which will be installed as needed Macintosh Macintosh System Specifications Recommended Computer type Macintosh Macintosh G4 G3 processor and 32M processor hard disk space and 32MB hard disk space Video Thousands Millions of colors of colors 64MB RAM 128 RAM CD ROM 2x CD ROM 4x CD ROM drive Drive drive Operating System System 9 2 System 9 2 Macintosh Installation Insert the Genetic
17. ractice program group This file provides detailed information on a variety of configurations and specific cards VIDEO ON WINDOWS When running the Virtual Clinic program you may see brief stuttering effects during video Unless these effects occur frequently or are of long duration they are no cause for concern Installing the most current version of your video driver might help See Updating Windows Device Drivers for information about how to get the most recent updates This program has been tested with QuickTime 5 0 2 if you are having trouble playing audio or video try re installing QuickTime from the installers included on the CD or find this version of QuickTime on the web http www apple com quicktime If your fonts look particularly ragged check to make sure that following TrueType fonts are installed on your system Arial Times New Roman and Courier New To double check fonts in Windows 98 select Settings Control Panel from the Start menu and double click on the Fonts icon WINDOWS SCREEN SAVERS If you are experiencing display corruption dueto your screen saver disable it To disable the built in screen saver for Windows 98 NT e Click the Start menu then point to Settings and choose Control Panel e Doubleclick on the Display icon to get the Display Properties dialog box Choose the Screen Saver tab Find the Name box and use the down arrow to the right of the box to highlight the option None Click OK G
18. s in Clinical Practice Disc in your CD ROM drive 2 Double dick the Install M ac Genetics icon and follow the instructions on screen 3 IfQuickTimeis not currently on your computer it will beinstalled during this process and your Macintosh will need to be restarted for system changes to take effect 4 The program also requires On2 s video codec You will be led to install each time theinstaller is launched even though it only needs to be done once STARTING THE PROGRAM Before starting the program check your monitor settings This program works best at 640x480 or 800x600 screen resolution and 24 bits per pixel millions of colors The program will not run in 8 bit mode 256 colors Usually monitor resolution higher than 1024x768 will makethe video appear unacceptably small Please refer to your computer system manual for guidance in how to establish these settings If you havea PC running Windows Select Programs G enetics in Clinical Practice and the corresponding program icon from the Start menu If you have a Macintosh Double click on the Genetics program icon in the Genetics in Clinical Practice folder A TRAVEL GUIDE TO YOUR MINI FELLOWSHIP Guide to Genetics in Clinical Practice 8 modified July 12 2002 The Virtual Clinic is an idealized environment for learning about genetics in clinical practice Here are some of the major areas you can visit After inserting your CD and launching the program you wi
19. seph V Henderson MD Interactive M edia Laboratory Dartmouth M edical School Multimedia Programmer Douglas Campbell Macintosh Windows Programming Chuck Officer Sean Sharp Eric Kidd Elizabeth H amon Video and Audio Editing Jay Beaudoin Lead JoeHenderson MD Sukdith Punjasthitkul Graphics and Animation Production Susan K Johnson Mini fellowship Assistant D irector Mary Beth Dinulos MD Digital Compression and Compositing Sukdith Punjasthitkul Audio Engineering Jay Beaudoin Sukdith Punjasthitkul M ark Noel William Tishler Administrator Alison Burton Sharon Irwin Joshua N elson Graphic D esign for CD Packaging William Scavone Testing Lisa Snook Joshua N elson Music JoeHenderson MD Guide to Genetics in Clinical Practice 12 modified July 12 2002 TECHNICAL REFERENCE TROUBLESHOOTING WINDOWS Using multimedia programs can sometimes be frustrating because of the various hardware software and operating system components that must work together Below are step by step guidelines for checking the most common causes of problems when running the Virtual Clinic program under Windows Most technical difficulties are caused by outdated drivers for video CD ROM and sound cards or from improperly configured equipment Your hardware manufacturer should be ableto provide you with updated drivers M anuals for your equipment and for Windows may explain optimal settings for your system If you are experiencing proble
20. ton e Then go to the Sharing Setup Control Panel and turn off file sharing e To disable extensions use Extension M anager if your system has it or drag extensions into a different folder e g Extensions Disabled e You will need to reboot your system for these changes to take effect You can restore extensions when you are not using the Virtual Clinic program by turning them back on in Extension M anager or by restoring them to the active Extensions folder in your System folder The program was designed to usethe True Type suitcase fonts Times New Roman and Helvetica which should be already installed in your system If these fonts are disabled or have been replaced with postscript or type 1 fonts the computer will try to use what it considers the closest font which may cause text layout problems crowding words off screen strange line breaks etc If this happens reinstall original fonts MACINTOSH PERFORMANCE Hereis a summary of things to try if you are having performance problems Set your monitor resolution to a lower setting like 640x480 Do not run processor intensive programs while the Virtual Clinic program is running including screen savers email or web browser applications e Disconnect your computer from your network Defragment your hard drive refer to instructions which came with your operating system Guide to Genetics in Clinical Practice 16 modified July 12 2002 ON2VP3LICENSE The
21. uide to Genetics in Clinical Practice 14 modified July 12 2002 CONFLICTS WITH OTHER WINDOWS PROGRAMS Do not run processor intensive programs while running this program Exit any other programs that may be running in the background eg email browsers CD Player or music playing application IN WINDOWS 98 you can reconfigure your startup folder to prevent Windows 98 from automatically starting applications that run in the background and may conflict with the Virtual Clinic program Select the Start button in Windows 98 In the Settings menu choose Taskbar to get the Taskbar Properties dialog box Click Start M enu Programs e Click Advanced in the Customize Start Menu Group e Double click on Programs folder Create a new folder called Startbk by selecting New and Folder from the File menu Open the Startup folder move items to the new folder by clicking and holding the right mouse button and dragging the selected item into the new folder Choose Move here when prompted and repeat until the Startup folder is empty e Restart Windows It is possible that changes to the system after installation such as the installation of another multimedia program may cause unexpected problems For example a program that uses an earlier version of QuickTime might cause conflicts reinstall the Virtual Clinic program to redress this problem UPDATING WINDOWS DEVICE DRIVERS We recommend that you update your Windows device drivers to th
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