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Biomedical subjects

Charles R Doarn

Publications and source records attributed to Charles R Doarn.

At least 19 recordsLinked to original sources
PubMed2005

Evaluation of surgical skills in microgravity using force sensing.

INTRODUCTION: Force measurements can be used to characterize surgical maneuvers in microgravity. METHODS: : A series of surgical tasks was performed by a group of 20 participants (n=20) both in 1g on the ground and in 0 g aboard NASA's KC-135 aircraft in parabolic flight. The group included astronauts, a flight surgeon, surgeons, physicians, Ph.D.-scientists, and technical personnel. The interaction forces between the surgical instruments and the mock tissue were measured for a clip-applying, suturing, grasping, and cutting. Seven evaluations in 1g and a single evaluation in 0 g were performed by each of the participants. RESULTS: The data from a single participant are examined in detail. Statistical results for the group of 20 participants do not show significant differences in the average or peak forces during clip-applying or in the average forces applied during suturing in 0 g versus in 1g. However, the results do show statistically greater (43% higher) peak forces during suturing in microgravity. DISCUSSION: These data show the usefulness of analyzing force information to assess surgical task performance in microgravity. Although peak suturing forces were statistically higher in microgravity, their clinical relevance is unknown, but likely would not result in a change in clinical outcome. Overall, the data suggest that forces exerted during surgical tasks will not pose a significant barrier to effective surgery in microgravity.

Aerospace Medicine↗
PubMed2005

Acquisition and evaluation of radiography images by digital camera.

To determine applicability of low-cost digital imaging for different radiographic modalities used in consultations from remote areas of the Ecuadorian rainforest with limited resources, both medical and financial. Low-cost digital imaging, consisting of hand-held digital cameras, was used for image capture at a remote location. Diagnostic radiographic images were captured in Ecuador by digital camera and transmitted to a password-protected File Transfer Protocol (FTP) server at VCU Medical Center in Richmond, Virginia, using standard Internet connectivity with standard security. After capture and subsequent transfer of images via low-bandwidth Internet connections, attending radiologists in the United States compared diagnoses to those from Ecuador to evaluate quality of image transfer. Corroborative diagnoses were obtained with the digital camera images for greater than 90% of the plain film and computed tomography studies. Ultrasound (U/S) studies demonstrated only 56% corroboration. Images of radiographs captured utilizing commercially available digital cameras can provide quality sufficient for expert consultation for many plain film studies for remote, underserved areas without access to advanced modalities.

Adolescent↗
PubMed2005

A review of telemedicine in Uzbekistan.

The government of Uzbekistan has recognized the need for telemedicine. With the support of several international groups, three telemedicine programmes have been established. This international assistance has provided equipment and training. There is a national network of emergency medical services, and two e-referral projects, one led by the Swinfen Charitable Trust and the other by NATO. Although these have been successful, they continue to face similar difficulties. However, telemedicine has shown its value.

Developing Countries↗
PubMed2005

Assessment of simulated surgical skills in parabolic microgravity.

BACKGROUND: During spaceflight crew health is paramount in the success of flight missions. The delivery of healthcare during flight requires crew readiness for medical and surgical response. METHODS: There were 20 participants who were evaluated for accurate performance of 4 basic laparoscopic surgical skills (clip applying, cutting, grasping, and suturing) during parabolic weightlessness using an inanimate workstation aboard the NASA KC-135 aircraft. RESULTS: Data indicate that motor skill performance decreased within the parabolic microgravity flight environment. Performance in parabolic microgravity flight included futile effort with an increase in number of tasks attempted and a decrease in tasks completed successfully. CONCLUSIONS: There is a decreased frequency of accurate task completion in parabolic microgravity flight, but it is not an obstacle to implementation of effective training for providing in-flight medical care. The data reveal that individuals perform basic laparoscopic surgical simulation with greater effort in microgravity following simulation training.

Aerospace Medicine↗
PubMed2004

Measurement of laparoscopic skills in microgravity anticipates the space surgeon.

BACKGROUND: There clearly must be a surgical capability to support the exploration of the solar system by humans. We hypothesized that microgravity would impair surgical task performance and sought to measure degree and criticality of task erosion. METHODS: Twenty subjects performed basic laparoscopic exercises (grasping, cutting, clipping, and suturing) in an inanimate trainer on the ground and during the microgravity phase of a parabolic flight. Skill assessment involved time, accuracy, and force transfer. RESULTS: A decrease in the total number of on-target task completions was observed in microgravity compared with the ground performance for all tasks. The ratio between the total number of attempts and the number of completions was higher in microgravity. The amount of force introduced into the system was not significantly higher in microgravity. CONCLUSIONS: We conclude that although tasks are performed with much greater deliberation and work in microgravity, there is no barrier to accurate and effective laparoscopic surgery.

Aerospace Medicine↗
PubMed2004

Digital video capture and synchronous consultation in open surgery.

OBJECTIVE: To achieve real-time or simultaneous surgical consultation and education to students in distant locations, we report the successful integration of robotics, video-teleconferencing, and intranet transmission using currently available hardware and Internet capabilities. SUMMARY BACKGROUND DATA: Accurate visualization of the surgical field with high-resolution video imaging cameras such as the closed-coupled device (CCD) of the laparoscope can serve to insure clear visual observation of surgery and share the surgical procedure with trainees and, or consultants in a distant location. Prior work has successfully applied optics and technical advances to achieve precise visualization in laparoscopy. METHODS: Twenty-five thyroidectomy explorations in 15 patients were monitored and transmitted bidirectionally with audio and video data in real-time. Remotely located surgical trainees (n = 4) and medical students (n = 3) confirmed 7 different anatomic landmarks during each surgical procedure. The study used the Socrates System (Computer Motion, Inc. [CMI], Goleta, CA), an interactive telementoring system inclusive of a telestration whiteboard, in conjunction with the AESOP robotic arm and Hermes voice command system (CMI). A 10-mm flat laparoscopic telescope was used to capture the optical surgical field. As voice, telestrator, or marker confirmed each anatomic landmark the image parameters of resolution, chroma (light position and intensity), and luminance were assessed with survey responses. RESULTS: Confirmation of greater than 90% was achieved for the majority of relevant anatomic landmarks, which were viewed by the remote audience. CONCLUSION: The data presented in this study support the feasibility for mentoring and consultation to a remote audience with visual transmission of the surgical field, which is otherwise very difficult to share. Additionally, validation of technical protocols as teaching tools for robotic instrumentation and computer imaging of surgical fields was documented.

Education, Medical↗
PubMed2004

Case report of remote anesthetic monitoring using telemedicine.

UNLABELLED: We report a case supporting the use of telecommunications technology from a remote location to monitor anesthetic events. Vital signs, data, and video were transmitted from surgery conducted in the remote Amazonian rainforests of Ecuador to Richmond, VA. This application of telemedicine technologies makes available expert advice from remote locations during surgical procedures. IMPLICATIONS: This study validates the use of telecommunications technology from a remote location to monitor an anesthetic event. This type of work makes expert advice available during surgical procedures.

Adult↗
PubMed2004

A review of telemedicine in Romania.

Romania is an eastern European country that is undergoing rapid reform of its medical system. We conducted an assessment of the potential for telemedicine in the country, through a literature review, personal visits to Romania and discussions with individuals from academia, the Ministry of Health and Family, and businesses. The results suggest that telemedicine has the potential to accelerate health-care reform. The main hospitals and universities could promote the wider distribution and development of telemedicine within Romania, which in turn would bring benefits to the Romanian people, 46% of whom live in rural areas.

Female↗
PubMed2004

Challenges and barriers to development of telemedicine programs.

The collection of data is a vital step in assuring that a system works, a method is correct and the process is adequate. As data is collected databases are created. These databases could be nothing more than a box or it could be in a computer-based, indexed database. Over the past 200 years, technology has played an increasingly larger role in health care delivery. With the advent of telecommunications capabilities and information systems, medicine has embraced these two disciplines, resulting in a new tool - telemedicine. This new tool is undergoing rigorous peer review and scientific challenge. This has lead to a plethora of data, which indicates telemedicine is an excellent tool for medicine.

Databases as Topic↗
PubMed2003

Asynchronous confirmation of anatomical landmarks by optical capture in open surgery.

HYPOTHESIS: Asynchronous remote telementoring and teleproctoring with anatomical subject matter relevant to surgical procedures is an effective instructional tool for surgical trainees. DESIGN: A validation model was established to assess the capabilities of current technologies to conduct effective instruction of surgical procedures in a remote location relative to the actual surgical procedure. A total of 23 unilateral thyroid dissections in 13 patients using a laparoscope affixed to a stationary robotic arm were videotaped. Anatomical confirmation was sought for the superior flap, middle thyroid vein, carotid sheath, 2 parathyroids, inferior thyroidal artery, recurrent laryngeal nerve, and superior thyroid pole. MAIN OUTCOME MEASURES: Ten surgical trainees reviewed video segments of these 8 anatomical landmarks at a later time after surgery. During observation of the video segments, these physicians were asked to validate the anatomical landmarks on a survey by choosing concur, do not concur, or uncertain. The review panel was also asked to score the images for quality of light, focus (clarity), field range, and contrast. CONCLUSION: This study validates the use of asynchronous education with high-quality optical capture for distance education and collaboration in open surgery.

Education, Distance↗
PubMed2003

The role of low-bandwidth telemedicine in surgical prescreening.

PURPOSE: Low-bandwidth, Internet-based telemedicine is an inexpensive technology that could help deliver heath care in medically underserved areas. The purpose of this study was to evaluate the usefulness of low-bandwidth telemedicine in remote surgical evaluation. METHODS: A group of surgeons and nurses traveled to Mombasa, Kenya to provide surgical assistance at the Coast Province General Hospital (CPGH). Before the visit of the surgical team, surgeons evaluated patients via low-bandwidth telemedicine. Prescreening was performed through use of an Internet-based desktop computer system that was supported technically by the Virginia Commonwealth University (VCU) Medical Informatics and Technology Applications Consortium (MITAC) telemedicine laboratory. Surgical patients were evaluated remotely regarding appropriateness of surgical intervention by reviewing e-mails that included the patient's age, history, physical examination, digital images of the patient, and digital images of pertinent radiographs. RESULTS: Fifty-one patients, including 7 pediatric patients, were prescreened. Thirty-three of the 51 patients (65%) were deemed inappropriate for surgery before this trip because of advanced disease or absence of necessary local medical resources. Of the 18 patients determined to be appropriate candidates for surgery by remote prescreening, 18 (100%) were operated on successfully during the relief effort. Sixty patients including 9 (15%) pediatric patients underwent surgery over the course of 5 days in CPGH. Pediatric cases included various laparoscopic, oncologic, and soft tissue reconstruction. CONCLUSIONS: Low-bandwidth, Internet-based telemedicine is a cost-effective technology that can efficiently and effectively prescreen surgical patients in remote areas.

Adult↗