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Biomedical subjects

Ronald C Merrell

Publications and source records attributed to Ronald C Merrell.

49 records · Page 3Linked to original sources
PubMed2003

Telemedicine for the operating room of the future.

Telemedicine is becoming a subset of information science and should benefit tremendously from the geometric growth of information architecture in hospitals. The use of telemedicine to break the isolation of the operating room is a highly achievable goal. An open operating room has information on demand for the personnel, fluid communication among operating room personnel, and broad interaction with the learner community and consultants. In an operating room with significant data capture, the patient is brought into the process not only as a real person, but also as a huge data set that acquires all the events of the surgery. The data include the visual, electrical, and mechanical events that define the surgical procedure. As part of a dynamic electronic medical record, they are available to those who are present and those who are asked to help from even a great distance away with real-time advice. The data are also available to those who seek to understand what happened to the patient afterwards for the purpose of root cause analysis, near miss analysis, instruction, or more accurate medical records.

Humans↗
PubMed2002

Training in laparoscopic suturing skills using a new computer-based virtual reality simulator (MIST-VR) provides results comparable to those with an established pelvic trainer system.

BACKGROUND: We hypothesized that the Minimally Invasive Surgery Trainer (MIST-VR; VP Medical R, London, U.K.) would be as effective as the Yale Laparoscopic Skills Course in improving laparoscopic intracorporeal suturing skills. MATERIALS AND METHODS: Each student made six attempts to tie a knot laparoscopically. Students were then randomized to train on the MIST-VR for five sessions (six skills/session) or the Yale Skills for five sessions (three skills/session) over 5 days. On completion of training, all students were evaluated by a test consisting of six attempts to tie a laparoscopic knot. RESULTS: The percentage improvement in knot tying time did not differ significantly in the pelvic trainer group (30 +/- 21%) (from 443 +/- 135 to 311 +/- 137 seconds) and the MIST-VR group (39 +/- 21%) (from 409 +/- 109 to 256 +/- 140 seconds) (P = 0.308). CONCLUSIONS: The MIST-VR is equivalent to the Yale Skills Course for training in the advanced laparoscopic skill of intracorporeal suturing.

Adult↗
PubMed2002

A novel telemedicine method for viewing the open surgical field.

BACKGROUND AND PURPOSE: The surgical theater has undergone a series of transformations from an open stadium-like environment to the closed environment of minimally invasive endoscopic surgery. Paradoxically, evolution from open surgery performed under direct vision to closed surgery performed through use of video images has been accompanied by improved viewing of the operative field by student observers. The objective of these experiments was to determine if a laparoscope mounted on the operating table during open surgery would provide students a better view of the operative field than that provided while standing behind the operating surgeon or via an optimally positioned hand-held video camera. MATERIALS AND METHODS: An endoscopic video camera and telescope were attached to an operating table by an Alpha Virtual Port, which facilitates use of the laparoscope in open surgery by fixing it to the operating table in the position of interest. Additional imaging systems were set up so as to simulate viewing of the surgical field by direct vision or a hand-held video camera. Common objects were placed on the operating table in mock surgical fields of various depth-to-aperture ratios. Images of these surgical fields were obtained by each of these systems and placed in a Web-based tool. Eleven people with a wide range of medical training evaluated the images and determined that the Alpha Port-mounted surgical telescope provided optimal visibility of the mock open surgical field. RESULTS AND CONCLUSION: The benefit of use of the mounted telescope was more pronounced as the depth-to-aperture ratio of the surgical field increased. Use of the Alpha Port-mounted laparoscope in open surgical procedures improves student viewing of the open surgical field.

Laparoscopes↗
PubMed2002

Telemedicine to integrate intermittent surgical services into primary care.

Assessment of the logistics, economic feasibility, and accuracy of presurgical and postsurgical telemedicine consultations is reported. Virtual patient-surgeon consults were achieved through the use of desktop and laptop computers, digital video, and still cameras using two communications modalities. Patients were selected from rural clinics in the southern Oriente region and from communities located in the Andes Mountain range outside of Cuenca, Ecuador. Patients were evaluated preoperatively and postoperatively by general surgeons working with the Cinterandes Foundation, a not-for-profit organization providing surgical care in remote regions of Ecuador in cooperation with the Ministry of Health's primary care program. Preoperative and postoperative telemedicine consultations had a high measure of clinical accuracy and some economic value. Data were collected from several sites throughout the country during the course of the project. Formidable challenges were encountered and are reported here.

Attitude of Health Personnel↗
PubMed2002

Teleconsultation practice guidelines: report from G8 Global Health Applications Subproject 4.

This report presents a series of recommendations derived from deliberations of the G8 countries Subproject 4 Group (SP4 Group) of the Global Health Care Applications Project entitled, A Teleconsultation Practice Guideline. The recommendations provide an initial step toward developing a general guideline platform for the practice of telemedicine/teleconsultation.

Computer Security↗
PubMedDate not supplied

Differentiated approach to surgical treatment of patients with perforated duodenal ulcer.

From 1995-2001, 264 patients with perforated duodenal ulcer were treated by the Emergency Surgical Service of Azerbaijan State Medical University in Baku. In a time of evolving standards and scientific understanding of acid peptic disease, a treatment formula was applied with excellent results. Treatment was tailored to the stage of peritonitis by time from perforation. This time was objectively evaluated by analysis of the peritoneal exudate. The value of laparoscopy was also assessed. Simple closure was performed in 94 patients (open procedure in 46, laparoscopic suture of perforated ulcer in 48 patients). Resection was performed in 170 patients (partial gastrectomy Billroth I in 118 patients, partial gastrectomy Billroth II in 18 patients and antrectomy vagotomy in 34). Application of the algorithm reduced mortality after simple closure to 6.4% and after resection to 1.2%.

Adolescent↗
PubMedDate not supplied

Evaluation of operative imaging techniques in surgical education.

BACKGROUND: Certain open surgical procedures are difficult to observe, and poor visualization of the surgical field results in a compromised teaching environment for residents and medical students. In an attempt to improve the visualization of the open surgical field, we performed an open surgical procedure while viewing it via a laparoscope mounted to the side of the operating room table with an alpha port. These images were then compared in a blinded fashion with images from a boom-mounted camera positioned above the surgical field and a head-mounted camera positioned on the operating surgeon. METHODS: Participants viewed all 3 images from a remote location in a blinded, random fashion. All participants then completed a Likert questionnaire evaluating each image. RESULTS: Fourteen participants were in the study. The alpha port/laparoscope image was superior to the head-cam image in all 8 categories. The alpha port/laparoscope image was superior to the sky-cam image in 4 of 8 categories. All 14 participants felt the alpha port/laparoscope image would benefit surgical education CONCLUSIONS: Use of a laparoscope mounted via an alpha port to an operating room table provides superior images during open surgery. This provides a unique and affordable way to teach residents and medical students operative procedures that are otherwise difficult to view.

Adult↗