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PubMed2006

Robotic surgery and training: electromyographic correlates of robotic laparoscopic training.

BACKGROUND: Robotic laparoscopic surgery has been shown to decrease task completion time, reduce errors, and decrease training time, as compared with manual laparoscopic surgery. However, current literature has not addressed the physiologic effects, in particular muscle responses, to training with a robotic surgical system. The authors seek to determine the frequency response of electromyographic (EMG) signals of specific arm and hand muscles with training using the da Vinci Surgical System. METHODS: Seven right-handed medical students were trained in three tasks with the da Vinci Surgical System over 4 weeks. These subjects, along with eight control subjects, were tested before and after training. Electromyographic (EMG) signals were collected from four arm and hand muscles during the testing sessions, and the median EMG frequency and bandwidth were computed. RESULTS: The median frequency and frequency bandwidth both were increased after training for two of the three tasks. CONCLUSION: The results suggest that training reduces muscle fatigue as a result of faster and more deliberate movements. These changes occurred predominantly in muscles that were the dominant muscles for each task, whereas the more demanding task recruited more diverse motor units. An evaluation of the physiologic demands of robotic laparoscopic surgery using electromyography can provide us with a meaningful quantitative way to examine performance and skill acquisition.

Adult↗

PubMed2006

The European Working Time Directive and the effects on training of surgical specialists (doctors in training): a position paper of the surgical disciplines of the countries of the EU.

Legislation launched with the EWTD was born as a "Protection of the clinical personnel against overwork for the benefit of Patients" (consumer protection and safety). It appeared that this legislation is in direct and severe conflict with former EU legislation to train competent surgical specialists. First experiences with the EWTD show far reaching and serious consequences on the training of surgical specialists as well as on medical care. There will be a reduction of about 30-35% of clinical and operative experience acquired during the usual 6 yrs of training, with many other negative aspects (see p. 7). All measures proposed so far to overcome the ensuing problems are unworkable. The training of competent surgical specialists as required by the Directive 93/16 EEC is no longer possible and serious problems with safe patient care will occur in the short term, if no political actions are taken. The surgical specialties, represented in the UEMS, provide a proposal for a working hour model consisting of 48 hrs working time (incl. service duties) plus additional 12 hrs reserved and protected for teaching and training. This model would adhere to the EWTD on the one hand, yet maintain the desired standard of training. This proposed exemption from the EWTD would be limited to the time of specialist training. We ask the responsible politicians to find a solution rapidly to prevent serious negative consequences. This motion is supported by the surgical specialties (neurosurgery, general surgery, orthopaedic surgery, paediatric surgery, cardio-thoracic surgery, vascular surgery, oto-rhino-laryngology, list not complete) of the member states of the EU, representing more than 80,000 surgical specialists.

Academic Medical Centers↗

PubMed1989

Physical training and relaxation therapy in cardiac rehabilitation assessed through a composite criterion for training outcome.

One hundred fifty-six myocardial infarction patients were randomly assigned to either exercise plus relaxation and breathing therapy (treatment A, n = 76) or to exercise training only (treatment B, n = 80). Effects on exercise testing showed a more pronounced training bradycardia and a remarkable improvement in ST abnormalities in treatment A (p less than 0.005). A model was developed to integrate the various exercise parameters into a single measure for training benefit. Approximately half the patients showed a training success, with a more positive and less negative outcome in treatment A (p = 0.09). The odds for failure were 0.25 for treatment A and 0.51 for treatment B (odds ratio: 2.04; 95% confidence interval, 0.94 to 4.6). Thus the risk of failure was reduced by half when relaxation was added to exercise training. These results indicate that exercise training is not successful in all MI patients and that relaxation therapy enhances training benefit.

Breathing Exercises↗

PubMed2004

Comparative analysis of conventional training and a computer-based interactive training program for celiac disease patients.

Gluten-free diet (GFD) protects against the complications of celiac disease (CD). However, training in the dietetic field is rare in Germany. Thus, CD patients are likely to benefit from a computer-based interactive training program (CBITP) combined with interactive exercises. We compared a CBITP and a conventional training for CD patients regarding increased knowledge, transferability and sustainability. In that context we analyzed whether CD patients are more able to judge the risk of a food or a situation after practicing with the interactive training software. Sixty-four CD patients were included and randomized in two groups. While the first group used the CBITP, the control group received written instructions. Before and after taking part in the training program and 3 weeks later, the participants filled in a questionnaire for celiac knowledge. The results show that both intervention and control groups increased knowledge about CD. However, the intervention group showed significantly better outcome. A CBITP significantly increases knowledge and sustainability as compared to a conventional training for CD patients. CBITPs can enhance patients' training and treatment.

Adult↗

PubMed1988

Post-training and pretest effects of adrenocorticotropin on retention: the influence of the hour of the day, the training-test interval, and pretest naloxone administration.

Rats received an ip injection of 0.2 microgram/kg of ACTH-(1-39) 1 min after step-down inhibitory avoidance training and/or 5 min prior to retention testing. Experiments were carried out either in the morning or in the afternoon using either a 3- or a 24-h training-test interval. Post-training ACTH induced memory facilitation in the morning and amnesia in the afternoon at both training-test intervals. Pretest ACTH reversed the afternoon amnesic effect, also at both training-test intervals. In addition, pretest ACTH induced a naloxone-reversible memory enhancement, both on its own and in animals treated with a facilitatory post-training dose of ACTH in the morning; this effect was seen only at the 24-h training-test interval. Naloxone had no effect of its own and did not influence the reversal of ACTH-induced amnesia caused by pretest ACTH in the afternoon. The results point to the variety of memory modulatory influences of ACTH, and to some of the factors involved in the elicitation of one or other effect, namely, the presumable basal rate of secretion of endogenous ACTH, and the previous pharmacological history of the animal.

Adrenocorticotropic Hormone↗

PubMed1999

Neuromuscular fatigue during repeated exhaustive submaximal static contractions of knee extensor muscles in endurance-trained, power-trained and untrained men.

The neural and muscular changes during fatigue produced in repeated submaximal static contractions of knee extensors were measured. Three groups of differently adapted male subjects (power-trained, endurance-trained and untrained, 15 in each) performed the exercise that consisted of 10 trials of submaximal static contractions at the level of 40% of maximal voluntary contraction (MVC) force till exhaustion with the inter-trial rest intervals of 1 min. MVC force, reaction time and patellar reflex time components before and after the fatiguing exercise and following 5, 10 and 15 min of recovery were recorded. Endurance-trained athletes had a significantly longer holding times for all the 10 trials compared with power-trained athletes and untrained subjects. However, no significant differences in static endurance between power-trained athletes and untrained subjects were noted. The fatigue test significantly prolonged the time between onset of electrical and mechanical activity (electromechanical delay) in voluntary and reflex contractions. The electromechanical delay in voluntary contraction condition for power-trained and untrained subjects and in reflex condition for endurance-trained subjects had not recovered 15 min after cessation of exercise. No significant changes in the central component of visual reaction time (premotor time of MVC) and latency of patellar reflex were noted after fatiguing static exercise. It is concluded, that in this type of exercise the fatigue development may be largely owing to muscle contractile failure.

Adult↗

PubMed2002

Training intensity influences leptin and thyroid hormones in highly trained rowers.

Leptin (L) is associated with body-weight-regulating and adipostatic functions. Its receptors also may be found centrally. Thyroid hormones regulate metabolic processes mainly by binding at peripheral receptors. Aim of this study was to show if there is a link between those central and peripheral regulation systems and to investigate the influence of different training intensities on L and the hypothalamic-thyroid-axis (HTA) in highly trained rowers. Six rowers (18.9 +/- 2.6 y; BMI 22.8 +/- 2.1 kg/m (2)) undertook high intensity resistance training (RT) for three weeks followed by three weeks of endurance training (ET). After each training cycle the subjects had one week for recovery (R1, R2). Blood samples were taken before and at the end of RT, R1, ET and R2. L, thyroid stimulating hormone (TSH), free T3 (fT3) and free T4 (fT4) were measured. After RT, a significant reduction in L, TSH and fT3 was found (p < 0.05). fT4 was unchanged. L remained decreased until the end of R1. After ET, a significant increase of TSH was found. L correlated to basal TSH levels (r = 0.49, p = 0.006) during R. BMI and body fat were unchanged throughout the study and were not correlated with hormonal levels. We speculate a high energy flux during intensified training (RT) caused the decrease of L and the HTA, independent of BMI or body fat. Thus, we conclude a depression of L and HTA is associated with training intensity.

Adolescent↗

PubMed2006

[Quality assured ultrasound simulation training for the detection of fetal malformations--can a training benefit be evidenced?].

INTRODUCTION: The factual sonographic training in obstetrics differs in Germany in a broad range. In this context, a tendency towards minimalistic dealings with this issue prevails. In contrast to this, the provisions of the German maternity guidelines relating to ultrasound clearly define quality oriented requirements serving altogether as a basic sonographic standard which mandatorily has to be met by all German Obstetricians. In order to close this gap between professional education and social demand, a training concept regarding obstetric ultrasound was devised by the German Association of Gynecologists utilizing the ultrasound simulator system. The aim of this study was to evaluate the usefulness and the effectiveness of this method and its potential role and benefit in structured sonographic training. MATERIAL AND METHODS: Between October 2004 and August 2005, 74 obstetric ultrasound training courses according to the ultrasound simulator concept of the Medical School of Hanover were realized in nine federal states of Germany by the German Academy of Gynecology. The aim of these courses was it to procure ultrasound knowledge regarding the structured sonographic exclusion of fetal malformations in a compact manner. As a measure of quality assurance, a standardized questionnaire was issued before and after the courses in order to analyze the benefit of these simulator-based ultrasound courses. RESULTS: The concept found prevailing approval (90 %) at the level of principle, practical implementation and clinical usefulness. 88,2 % of the participants estimated their subjective training effect as being good. The analysis of the questionnaire showed a statistically significant improvement of sonographic knowledge. On average, 74.1 % of the questions were answered correctly by the end of the course as opposed to a mere 46.3 % at the beginning. CONCLUSION: Structured ultrasound training courses based on the ultrasound simulator system seem to be able to define a basic quality of training and significantly improves examiners' skills in prenatal medicine possible independent of local or structural factors. Hence they seem to be a suitable instrument to close the gap between the sonographic education worthy of improvement and the existing social demand for efficiacy of obstetric sonography.

Congenital Abnormalities↗

PubMed1998

High-intensity physical training in adults with asthma. A comparison between training on land and in water.

The purpose of this study was to determine whether inactive asthmatic patients could perform high-intensity physical training equally well on land as in water, and to compare the effects of these training forms. Thirty-two adults with asthma, randomized into two groups, underwent a 10-week supervised rehabilitation program with emphasis on physical training. All patients, irrespective of training form, were able to exercise to maximal intensity (80-90% of estimated maximal heart rate). No asthmatic attacks occurred in connection with the training sessions. Respiratory variables remained almost unchanged in both groups. The asthma symptoms declined during the rehabilitation period, and the subjects needed less acute asthma care after the rehabilitation. The cardiovascular condition improved significantly and similarly in the two groups. Ten patients, 5 in each group, had exercise-induced asthma at the start of the rehabilitation. Only 3 patients, 2 from the water group and 1 from the land group, had exercise-induced asthma after 10 weeks. We conclude that indoor training, either on land or in water, is beneficial. The effects of these two training forms are almost equivalent.

Adult↗

PubMed1999

Enhanced learning of proportional math through music training and spatial-temporal training.

It was predicted, based on a mathematical model of the cortex, that early music training would enhance spatial-temporal reasoning. We have demonstrated that preschool children given six months of piano keyboard lessons improved dramatically on spatial-temporal reasoning while children in appropriate control groups did not improve. It was then predicted that the enhanced spatial-temporal reasoning from piano keyboard training could lead to enhanced learning of specific math concepts, in particular proportional math, which is notoriously difficult to teach using the usual language-analytic methods. We report here the development of Spatial-Temporal Math Video Game software designed to teach fractions and proportional math, and its strikingly successful use in a study involving 237 second-grade children (age range six years eight months-eight years five months). Furthermore, as predicted, children given piano keyboard training along with the Math Video Game training scored significantly higher on proportional math and fractions than children given a control training along with the Math Video Game. These results were readily measured using the companion Math Video Game Evaluation Program. The training time necessary for children on the Math Video Game is very short, and they rapidly reach a high level of performance. This suggests that, as predicted, we are tapping into fundamental cortical processes of spatial-temporal reasoning. This spatial-temporal approach is easily generalized to teach other math and science concepts in a complementary manner to traditional language-analytic methods, and at a younger age. The neural mechanisms involved in thinking through fractions and proportional math during training with the Math Video Game might be investigated in EEG coherence studies along with priming by specific music.

Child↗

PubMed2005

Design your own memory strategies! Self-generated strategy training versus mnemonic training in old age: an 8-month follow-up.

We examined maintenance effects following training in a self-generated strategy versus a mnemonic strategy, designed to improve recall of four-digit numbers in older adults. This was accomplished by reassessing participants from a previous study eight months after completion of training. A control group that received no training was also included. The results showed that both training groups maintained training-related gains in number recall performance eight months later in a criterion task providing cognitive support. However, when no support was provided, number recall performance for the mnemonic group dropped slightly whereas performance for the self-generated strategy group improved. The control group maintained performance across assessments. These data indicate the numerical memory training may result in long-term effects in older adults and that, under some conditions, practising one's own memory strategies may have advantages over mnemonic training in old age.

Aged↗

PubMed2006

Comparison of results of virtual-reality simulator and training model for basic ureteroscopy training.

BACKGROUND AND PURPOSE: The traditional method of acquiring surgical skills is by apprenticeship and involves an extensive period of training with patients. Model-based and virtual reality simulation is gaining interest as alternative training, allowing repetitive practice in a low-risk environment. The objective of this study was to determine if a materials, model-based training format and an interactive virtual-reality simulator could provide equivalent teaching of basic ureteroscopy skills to the inexperienced medical student. SUBJECTS AND METHODS: Sixteen first-year medical students received the same didactic session and video viewing on cystoscopy, guidewire access to the upper urinary tract, and ureteroscopy with intracorporeal laser lithotripsy and stone extraction by the same instructor. The participants were then randomized into two study groups: Group 1 was trained on the ureteroscopy training model (TMU) from Limbs & Things and Group 2 on the Simbionix UROMentor virtual-reality simulator (VRS) until the participants could perform the procedure independently. Two months later, the participants independently performed a ureteroscopic procedure on a pig kidney/ureter model and were graded from 1 to 5 on their ability to complete the steps of the procedure and the quality of their performance (handling of tissue, efficiency, instrument handling, knowledge of instruments, flow of operation, use of assistants, and knowledge of the specific procedure) for a possible total of 35 points. RESULTS: All participants were able to perform the steps of the procedure correctly. The TMU group and the VRS group received a mean of 22.9 +/- 4.8 and 23.6 +/- 5.4 points, respectively (P = 0.38) for their qualitative assessment. CONCLUSION: The medical students' skills and ability to perform a basic ureteroscopic stone-management procedure was independent of the training modality (VRS or TMU). Incorporating either of these devices into the preliminary training of urology residents may improve their initial clinical performance of these skills.

Adult↗

PubMed1997

Training adaptation and biological changes among well-trained male triathletes.

The distinction between training and overtraining responses is an important prerequisite for any potential marker for monitoring overtraining in athletes. In this study, eight well-trained male triathletes undertook physical performance assessments, at 6 weekly intervals, throughout a 9-month intensive training season. At each assessment, a resting blood sample was obtained for determination of a number of biological parameters previously associated with overtraining. All athletes produced significant (P < 0.05) improvements in running speed at anaerobic threshold (ATRS) from 15.6 +/- 0.2 k.h-1 at the start of the season to 16.6 +/- 0.6 k.h-1 at the time of major competitions. This improvement in performance was taken as evidence of well balanced training programs. Significant changes (P < 0.05) in plasma glutamine and plasma uric acid concentrations were observed during the training season, and both correlated moderately with ATRS (r = 0.365 and r = -0.328, respectively). None of the other parameters measured showed any significant changes during the training season. The elevations in plasma glutamine concentration observed in response to long-term balanced training may be distinguishable from previous reports of decreased glutamine concentrations in overtrained athletes, making it a potentially valuable tool in the monitoring of overtraining in athletes.

Adult↗

PubMed2005

User patterns and satisfaction with on-line trainings completed on the North Carolina Center for Public Health Preparedness Training Web Site.

Short online training modules have been developed by the North Carolina Center for Public Health Preparedness (NCCPHP) and provided to registered users for free on its Training Web Site. Use of these modules can improve the knowledge, skills, and awareness of public health professionals in topics related to public health preparedness. According to the results of a survey implemented in October 2004, the NCCPHP Training Web Site is effectively reaching its target audience of local and state public health workers. The utilization of distance learning technology allows for broad distribution of training materials, with registered users in all 50 US states and 122 foreign countries. In addition, the NCCPHP Training Web Site is providing training materials in topics most requested by the public health workforce. According to the findings of this survey, online training in public health preparedness and response is an efficient way to improve the knowledge and skills of our public health workforce to increase competency.

Consumer Behavior↗

PubMed1996

Free-living, 24-hour, and sleeping energy expenditure in sedentary, strength-trained, and endurance-trained men.

Fifteen adult male volunteers were assigned to sedentary, moderately strength-trained, and moderately endurance-trained groups (5 per group) to determine the effect of exercise training on energy expenditure (EE). Subjects were matched for age, weight, and height. Group appointments were based on activity questionnaires and American College of Sports Medicine standards. Subjects consumed a mixed diet of 40% fat, 20% protein, and 40% carbohydrate at weight maintenance intake for 3 weeks while continuing their exercise training programs. There was no significant difference between groups for 24-hr EE measured in the controlled environment of a room-sized calorimeter. Free-living EE measured with 2H2(18)O in endurance- and strength-trained groups was significantly higher (19.4% and 35.1%, respectively) than in the sedentary group. Moderate endurance and strength training increased free-living EE but did not affect 24-hr EE when groups followed standardized activity schedules. These results suggest that increased EE caused by moderate exercise training is limited to the energy required to complete the exercise.

Adult↗

PubMed2005

Muscle size and strength are increased following walk training with restricted venous blood flow from the leg muscle, Kaatsu-walk training.

Previous studies have shown that low-intensity resistance training with restricted muscular venous blood flow (Kaatsu) causes muscle hypertrophy and strength gain. To investigate the effects of daily physical activity combined with Kaatsu, we examined the acute and chronic effects of walk training with and without Kaatsu on MRI-measured muscle size and maximum dynamic (one repetition maximum) and isometric strength, along with blood hormonal parameters. Nine men performed Kaatsu-walk training, and nine men performed walk training alone (control-walk). Training was conducted two times a day, 6 days/wk, for 3 wk using five sets of 2-min bouts (treadmill speed at 50 m/min), with a 1-min rest between bouts. Mean oxygen uptake during Kaatsu-walk and control-walk exercise was 19.5 (SD 3.6) and 17.2 % (SD 3.1) of treadmill-determined maximum oxygen uptake, respectively. Serum growth hormone was elevated (P < 0.01) after acute Kaatsu-walk exercise but not in control-walk exercise. MRI-measured thigh muscle cross-sectional area and muscle volume increased by 4-7%, and one repetition maximum and maximum isometric strength increased by 8-10% in the Kaatsu-walk group. There was no change in muscle size and dynamic and isometric strength in the control-walk group. Indicators of muscle damage (creatine kinase and myoglobin) and resting anabolic hormones did not change in both groups. The results suggest that the combination of leg muscle blood flow restriction with slow-walk training induces muscle hypertrophy and strength gain, despite the minimal level of exercise intensity. Kaatsu-walk training may be a potentially useful method for promoting muscle hypertrophy, covering a wide range of the population, including the frail and elderly.

Adult↗

PubMed2003

Functional strength training in cerebral palsy: a pilot study of a group circuit training class for children aged 4-8 years.

OBJECTIVE: To determine the effects of intensive task-specific strength training on lower limb strength and functional performance in children with cerebral palsy. DESIGN: A nonrandomized ABA trial. SETTING: Sydney school. SUBJECTS: Eight children with cerebral palsy, aged 4-8 years, seven with diagnosis of spastic diplegia, one of spastic/ataxic quadriplegia. INTERVENTION: Four weeks of after-school exercise class, conducted for one hour twice weekly as group circuit training. Each work station was set up for intensive repetitive practice of an exercise. Children moved between stations, practising functionally based exercises including treadmill walking, step-ups, sit-to-stands and leg presses. MAIN OUTCOME MEASURES: Baseline test obtained two weeks before training, a pre-test immediately before and a post-test following training, with follow-up eight weeks later. Lower limb muscle strength was tested by dynamometry and Lateral Step-up Test; functional performance by Motor Assessment Scale (Sit-to-Stand), minimum chair height test, timed 10-m test, and 2-minute walk test. RESULTS: Isometric strength improved pre- to post-training by a mean of 47% (SD 16) and functional strength, on Lateral Step-up Test, by 150% (SD 15). Children walked faster over 10 m, with longer strides, improvements of 22% and 38% respectively. Sit-to-stand performance had improved, with a reduction of seat height from 27 (SD 15) to 17 (SD 11) cm. Eight weeks following cessation of training all improvements had been maintained. CONCLUSIONS: A short programme of task-specific strengthening exercise and training for children with cerebral palsy, run as a group circuit class, resulted in improved strength and functional performance that was maintained over time.

Cerebral Palsy↗

PubMed2003

Exercise training in patients with chronic heart failure improves endothelial function predominantly in the trained extremities.

The present study investigates whether lower-limb dominant exercise training in patients with chronic heart failure (CHF) improves endothelial function primarily in the trained lower extremities or equally in the upper and lower extremities. Twenty-eight patients with CHF were randomized to the exercise or control group. The exercise group underwent cycle ergometer training for 3 months while controls continued an inactive sedentary lifestyle. Exercise capacity (6-min walk test) and flow-mediated vasodilation in the brachial and posterior tibial arteries were evaluated. After 3 months, walking performance increased only in the exercise group (488+/-16 to 501+/-14 m [control]; 497+/-23 to 567+/-39 m [exercise, p<0.05]). The flow-mediated vasodilation in the brachial arteries did not change in either group (4.2+/-0.5 to 4.5+/-0.4% [control]; 4.3+/-0.5 to 4.6+/-0.4% [exercise]), but that in the posterior tibial arteries increased only in the exercise group (4.1+/-0.5 to 4.1+/-0.3% [control]; 3.6+/-0.3 to 6.4+/-0.6% [exercise, p<0.01]). Cycle ergometer training improved flow-mediated vasodilation in the trained lower limbs, but not in the untrained upper limbs. Exercise training appears to correct endothelial dysfunction predominantly by a local effect in the trained extremities.

Arm↗