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Results for “Simulation Training”

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PubMed1999

The effects of antidromic discharges on orthodromic firing of primary afferents in the cat.

This study investigated the effects of antidromically conducted nerve impulses on the transmission of orthodromic volleys in primary afferents of the hindlimb in decerebrated paralyzed cats. Two protocols were used: (A) Single skin and muscle afferents (N=20) isolated from the distal part of cut dorsal rootlets (L7-S1) were recorded while stimulation was applied more caudally. The results showed that during the trains of three to 20 stimuli, the orthodromic firing frequency decreased or ceased, depending on the frequency of stimulation. Remarkably, subsequent to these trains, the occurrence of orthodromic spikes could be delayed for hundreds of ms (15/20 afferents) and sometimes stopped for several seconds (10/20 afferents). Longer stimulation trains, simulating antidromic bursts reported during locomotion, caused a progressive decrease, and a slow recovery of, orthodromic firing frequency (7/20 afferents), indicating a cumulative long-lasting depressing effect from successive bursts. (B) Identified stretch-sensitive muscle afferents were recorded intra-axonally and antidromic spikes were evoked by the injection of square pulses of current through the micropipette. In this case, one to three antidromic spikes were sufficient to delay the occurrence of the next orthodromic spike by more than one control inter-spike interval. If the control inter-spike interval was decreased by stretching the muscle, the delay evoked by antidromic spikes decreased proportionally. Overall, these findings suggest that antidromic activity could alter the mechanisms underlying spike generation in peripheral sensory receptors and modify the orthodromic discharges of afferents during locomotion.

Action Potentials↗

PubMed2000

Interrupted laparoscopic suture secured with the needle-through-the-sliding-loop knot.

A special needle holder with a step and knot-forming stand was designed to permit wrapping sutures into distinctive sliding loops around the needle holder, outside the abdomen. The loaded instrument was introduced into the abdomen and the appropriate stitch was made. The suture next to the needle was grasped with the needle holder and pulled through the sliding loops(s) to establish a knot. When the needle was passed through a simple noose the needle-through-the-noose knot was created. This knot maintained tension on captured tissues, but it required additional half-hitches to secure. When the needle was passed through rolling hitch loops it established a knot that was secure in simple applications, but required one additional half-hitch to secure in vulnerable applications involving slippery sutures or tissue purchases subjected to disruptive tension. The procedures were first practiced on inanimate models using a laparoscopy training simulator and then performed successfully over 20 times in 11 patients who had laparoscopic myomectomy or hysterectomy.

Female↗

PubMed2003

Microsystems in health care: Part 6. Designing patient safety into the microsystem.

BACKGROUND: This article explores patient safety from a microsystems perspective and from an injury epidemiological perspective and shows how to embed safety into a microsystem's operations. MICROSYSTEMS PATIENT SAFETY SCENARIO: Allison, a 5-year-old preschooler with a history of "wheezy colds," and her mother interacted with several microsystems as they navigated the health care system. At various points, the system failed to address Allison's needs. The Haddon matrix provides a useful framework for analyzing medical failures in patient safety, setting the stage for developing countermeasures. CASE STUDY: The case study shows the types of failures that can occur in complex medical care settings such as those associated with pediatric procedural sedation. Six patient safety principles, such as "design systems to identify, prevent, absorb, and mitigate errors," can be applied in a clinical setting. In response to this particular case, its subsequent analysis, and the application of microsystems thinking, the anesthesiology department of the Children's Hospital at Dartmouth developed the PainFree Program to provide optimal safety for sedated patients. CONCLUSION: Safety is a property of a microsystem and it can be achieved only through thoughtful and systematic application of a broad array of process, equipment, organization, supervision, training, simulation, and team-work changes.

Academic Medical Centers↗

PubMedDate not supplied

Analysis of patient load data from the 2002 FIFA World Cup Korea/Japan.

INTRODUCTION: Past history of mass casualties related to international football games brought the importance of practical planning, preparedness, simulation training, and analysis of potential patient presentations to the forefront of emergency research. METHODS: The Japanese Ministry of Health, Labor, and Welfare established the Health Research Team (HRT-MHLW) for the 2002 FIFA World Cup game (FIFAWC). The HRT-MHLW collected patient data related to the games and analyzed the related factors regarding patient presentations. RESULTS: A total of 1661 patients presented for evaluation and care from all 32 games in Japan. The patient presentation rate per 1000 spectators per game was 1.21 and the transport-to-hospital rate was 0.05. The step-wise regression analysis identified that the patient presentations rate increased where access was difficult. As the number of total spectators increased, the patient presentation rate decreased. (p < 0.0001, r = 0.823, r2 = 0.677). CONCLUSION: In order to develop mass-gathering medical-care plans in accordance with the types and sizes of mass gatherings, it is necessary to collect data and examine risk factors for patient presentations for a variety of events.

Adolescent↗

PubMed2001

Complaints related to respiratory events in anaesthesia and intensive care medicine from 1994 to 1998 in Denmark.

BACKGROUND: In Denmark, a National Board of Patients' Complaints (NBPC) was founded in 1988. This study analyses anaesthetic complaints related to adverse respiratory events filed at the NBPC from 1994 to 1998 to point out directions for possible preventive measures. METHODS: All decisions made by the NBPC from 1994 to 1998 concerning personnel employed in the Danish health care system were scrutinized. Cases related to anaesthesia and intensive care medicine were reviewed. Adverse respiratory events were identified and classified by mechanism of the incident that had caused the complaint. Detailed information on anaesthetic technique, personnel involved, sequence of events, clinical manifestation of injury, and outcome was recorded. RESULTS: A total of 284 cases was identified. One-fifth (n=60) of the complaints were related to an adverse respiratory event. The overall mortality in these cases was 50% (n=30). In 19 complaints (32%), the treatment was considered substandard. CONCLUSION: Complaints related to respiratory events reveal that inadequate anaesthetic and intensive care medicine treatment leads to patient damage and death. Preventive strategies should be directed at the development of guidelines for handling the difficult airway, education in the management of the difficult airway, instruction in the correct use of anaesthetic equipment, improvement of interpersonnel communication routines, as well as implementation of simulator training.

Adolescent↗

PubMed2000

[Hybrid 3D visualization and virtual endoscopy in cochlear implants].

PURPOSE: The aim of this study was to demonstrate on a complex anatomical structure the possibilities and the advantages of a superimposition of a color-coded surface and volume rendering (hybrid rendering) method with the possibility of the performance of a virtual endoscopy. MATERIAL AND METHOD: In 6 patients with cochlear implants a high-resolution spiral computed tomography of the petrous bone was performed. The cochlear implants, the middle and inner ear structures were visualized using a color-coded surface rendering method, either shaded or as a grid. The petrous bone was visualized using a transparent volume rendering method. RESULTS: The hybrid 3D visualization uses the advantages of both the color-coded 3D surface and volume rendering method. In comparison to the axial source images, the hybrid 3D visualization thus facilitates a clearer representation and better assessment of the complex topographical relationship without loss of diagnostic information. The virtual endoscopy facilitates an intraluminal visualization and inspection of all color-coded 3D surface- and volume rendered structures. CONCLUSIONS: The hybrid rendering and virtual endoscopy make the morphological assessment of cochlear implants easier by the simultaneous visualization of the surrounding structures and thereby support the diagnostic imaging methods. This image processing method can be used pre-operatively for the individual planning, simulation, training and further development of surgical procedures and interventions and post-operatively for the control of the position and further developments of implants.

Adolescent↗

PubMed2002

The metabolic cost of operating a bicycle generator light.

The purpose of the study was to determine the metabolic cost of operating a bicycle generator (dynamo) light. Nineteen subjects (12 males, 7 females) volunteered to participate in the study. All tests were conducted using a multigeared road bicycle mounted on a Velodyne computer-controlled, electromagnetically-braked bicycle training simulator. A tyre sidewall-driven 6V 3W bicycle generator was attached to the bicycle frame. Tyre pressure was maintained at 6.12 atm. Gears were prescribed to produce simulated riding speeds of approximately 13 and 21 km h(-1) at 62 rpm. Subjects rode four, 5-min stages during the test session to evaluate riding under conditions of generator OFF or ON at each speed. Oxygen consumption, heart rate, and rating of perceived exertion (RPE) were recorded at the end of each minute. Paired samples t tests revealed significant differences between generator OFF and ON conditions for both the metabolic cost of cycling and heart rate at each of the speeds tested. There were no significant differences found between conditions for RPE. Bicycling with the generator ON increased oxygen consumption by 8.4% at 13 km h(-1) and 9.6% at 21 km h(-1).

Bicycling↗

PubMed2006

Value of debriefing during simulated crisis management: oral versus video-assisted oral feedback.

BACKGROUND: The debriefing process during simulation-based education has been poorly studied despite its educational importance. Videotape feedback is an adjunct that may enhance the impact of the debriefing and in turn maximize learning. The purpose of this study was to investigate the value of the debriefing process during simulation and to compare the educational efficacy of two types of feedback, oral feedback and videotape-assisted oral feedback, against control (no debriefing). METHODS: Forty-two anesthesia residents were enrolled in the study. After completing a pretest scenario, participants were randomly assigned to receive no debriefing, oral feedback, or videotape-assisted oral feedback. The debriefing focused on nontechnical skills performance guided by crisis resource management principles. Participants were then required to manage a posttest scenario. The videotapes of all performances were later reviewed by two blinded independent assessors who rated participants' nontechnical skills using a validated scoring system. RESULTS: Participants' nontechnical skills did not improve in the control group, whereas the provision of oral feedback, either assisted or not assisted with videotape review, resulted in significant improvement (P < 0.005). There was no difference in improvement between oral and video-assisted oral feedback groups. CONCLUSIONS: Exposure to a simulated crisis without constructive debriefing by instructors offers little benefit to trainees. The addition of video review did not offer any advantage over oral feedback alone. Valuable simulation training can therefore be achieved even when video technology is not available.

Adult↗

PubMed1996

The Richard C. Schneider Lecture. New dimensions of neurosurgery in the realm of high technology: possibilities, practicalities, realities.

Fueled by a buoyant economy, popular attitudes and demands, and parallel progress in transferable technical and biological areas, neurosurgery has enjoyed a remarkable quarter of a century of progress. Developmental trends in the discipline have included the following: 1) a refinement of preoperative definition of the structural substrate, 2) miniaturization of operative corridors, 3) reduction of operative trauma, 4) increased effectiveness at the target site, and 5) incorporation of improved technical adjuvants and physical operative tools into treatment protocols. In particular, the computer has become a formidable ally in diagnostic and surgical events. Trends in technical development indicate that we are entering an exciting era of advanced surgery of the human cerebrum, which is heralded by the following: 1) current developments in areas of imaging, sensors, and visualization; 2) new devices for localization and navigation; 3) new capabilities for action at the target point; and 4) innovative concepts related to advanced operative venues. Imaging has provided structurally based surgical maps, which now are being given the new dimension of function in complex and integrated formats for preoperative planning and intraoperative tactical direction. Cerebral localization and navigation based on these advances promise to provide further refinement to the field of stereotactic neurosurgery, as linked systems are superseded by more flexible nonlinked methodologies in functionally defined volume-oriented navigational databases. Target point action now includes not only ablative capabilities through micro-operative methods and the use of stereotactically directed high-energy forms but also the emergence of restorative capabilities through applications of principles of genetic engineering in the areas of molecular and cellular neurosurgery. Complex, dedicated, and self-contained operative venues will be required to optimize the emergence and development of these computer-oriented micro/stereotactic capabilities, which appear to be unavoidably required as locales for the practice and development of virtual reality-based stations for operative rehearsal, simulation, training, and, ultimately, enhancement of operative events through robotic interfaces. Primary impetus for progress has relied upon new combinations of technologies, disciplines, and industries. Philosophical and practical problems include the spectrum of availability of these methods to the population at large, the training of individuals to properly administer these methods, defining the acceptable envelope of expertise, and maintaining suitable delivery and progress while containing spiraling costs. Advanced neurological surgery and the use and development of high-technology adjuvants require a robust economy that has a populace willing to invest in the luxury of such developments. The current socioeconomic situation is fragile from the standpoint of both economics and attitudes of the patients and health care providers, with diversion of economic resources, redistribution of funding bases, modification of patient referrals, practice styles, and service attitudes undermining progress. Economic pressures have brought high-technology methods under great scrutiny regarding their effectiveness and cost-effectiveness. Reform proposals have specifically targeted technology-oriented services, and the Office of Technology Assessment has recommended increasing the use of managed care providers who look to information on cost-effectiveness and clinical practice guidelines to establish efficient management strategies and issue "report cards." Although the premise is laudable and "gimmickry" needs to be identified, it might be argued that such scrutiny and control might be overbearing and overused, impeding appropriate delivery and progress.

Cost-Benefit Analysis↗

PubMed1979

Real-time computer verification for radiation therapy treatment machines.

A computer based verification system which monitors the operation of a 4-MV linear accelerator is described. Fourteen parameters can be checked for proper alignment prior to irradiation. A training simulator was also built to minimize interference with treatment schedules and to provide technicians with experience in using the system during the developmental stages of the project.

Computers↗

PubMed2005

The Steinberg-Bernstein Centre for Minimally Invasive Surgery at McGill University.

Surgical skills and simulation centers have been developed in recent years to meet the educational needs of practicing surgeons, residents, and students. The rapid pace of innovation in surgical procedures and technology, as well as the overarching desire to enhance patient safety, have driven the development of simulation technology and new paradigms for surgical education. McGill University has implemented an innovative approach to surgical education in the field of minimally invasive surgery. The goal is to measure surgical performance in the operating room using practical, reliable, and valid metrics, which allow the educational needs of the learner to be established and enable feedback and performance to be tracked over time. The GOALS system and the MISTELS program have been developed to measure operative performance and minimally invasive surgical technical skills in the inanimate skills lab, respectively. The MISTELS laparoscopic simulation-training program has been incorporated as the manual skills education and evaluation component of the Fundamentals of Laparoscopic Surgery program distributed by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and the American College of Surgeons.

Academic Medical Centers↗

PubMed2006

Initial evaluation of the "Trauma surgery course".

BACKGROUND: The consequence of the low rate of penetrating injuries in Europe and the increase in non-operative management of blunt trauma is a decrease in surgeons' confidence in managing traumatic injuries has led to the need for new didactic tools. The aim of this retrospective study was to present the Corso di Chirurgia del Politrauma (Trauma Surgery Course), developed as a model for teaching operative trauma techniques, and assess its efficacy. METHOD: the two-day course consisted of theoretical lectures and practical experience on large-sized swine. Data of the first 126 participants were collected and analyzed. RESULTS: All of the 126 general surgeons who had participated in the course judged it to be an efficient model to improve knowledge about the surgical treatment of trauma. CONCLUSION: A two-day course, focusing on trauma surgery, with lectures and life-like operation situations, represents a model for simulated training and can be useful to improve surgeons' confidence in managing trauma patients. Cooperation between organizers of similar initiatives would be beneficial and could lead to standardizing and improving such courses.

Journal Article↗

PubMed1989

Teaching self-catheterization skills to children with neurogenic bladder complications.

We examined the effects of simulation training on the acquisition of self-catheterization skills in 2 female children with spina bifida. Based on a task analysis, the children were taught to perform on a doll each of the components of preparation, and, using a mirror to locate the urinary meatus, to insert and remove the catheter and to clean-up. Before, during, and after training, the children's performance of the skills on the doll and on themselves was assessed. Results of a multiple baseline design across subjects and skill components showed that doll training facilitated the children's acquisition of self-catheterization skills.

Behavior Therapy↗

PubMed2006

Finite element modeling for soft tissue surgery based on linear and nonlinear elasticity behavior.

New surgical techniques require fine control from the surgeon's point of view. Until recently, the necessary experience was only obtainable through traditional training protocols (using cadavers, animals, etc.). However, numerous training simulators have now been developed for use in this area. We present a new approach based on a three-dimensional finite element software and on different kinds of linear and nonlinear elastic constitutive equations that is able to predict realistic results. To classify these equations in terms of accuracy, we performed ex-vivo experimental measurements on lamb kidneys. The software has been applied to soft tissue deformation, namely lamb kidney and human uterus, and the numerical results have been compared to experimental ones.

Animals↗

PubMed1998

TELONC system for oncology education.

The paper describes a pilot project of TELONC computer system designed to assist oncology education. At present the system is being implemented and its elements are subject to more detailed preliminary examinations. The system is of module structure and at the present stage of implementation special attention is being paid to patterns for histopathological examinations, information on drugs with aggressive impact on human organism together with suitable instructions on their usage, as well as to certain elements of the training simulator module.

Computer-Assisted Instruction↗

PubMed2000

Underwater disorientation as induced by two helicopter ditching devices.

BACKGROUND: Spatial orientation is based on the integration of concordant and redundant information from the visual, vestibular, and somatosensory systems. When a person is submerged underwater, somatosensory cues are reduced, and vestibular cues are ambiguous with respect to upright or inverted position. Visual cues may be lost as a result of reduced ambient light. Underwater disorientation has been cited as one of the major factors that could inhibit emergency egress after a helicopter ditching into water. One countermeasure to familiarize aircrew with underwater disorientation is emergency egress training. This study examined the relative degree of underwater disorientation induced by the Modular Egress Training Simulator (METS) and the Shallow Water Egress Trainer (SWET). METHODS: There were 36 healthy subjects (28 males and 8 females) who participated in the study. Underwater disorientation was quantified by measuring the deviation of subjective vertical-pointing from the gravitational vertical, time to egress, and subjective reports of disorientation and ease of egress. A repeated measure design was employed with seat position (SWET chair, METS window, and METS aisle) as the sole factor. RESULTS: Subjective response data indicated that the degree of disorientation is rated significantly higher, and the ease of egress is rated worse from the two METS seat positions than from the SWET. This is supported by the findings that subjective vertical-pointing accuracy is worse in the METS seat positions than in the SWET (p < 0.01). The time to egress is longer from the two METS seat positions than from SWET (p < 0.01). CONCLUSION: Our results indicate that the METS device is effective for inducing underwater disorientation as provoked by simulated helicopter ditching. disorientation, vestibular, subjective pointing.

Accidents, Aviation↗

PubMed2002

[Adrenoreactivity as a criterion for the evaluation of some professionally important qualities of the human operator].

Adrenoreactivity parameter (beta-ARM, one of the characteristics of individual sympathoadrenal system (SAS), can enhance the system of professional psycho-logical screening (PPS). The parameter is determined with a new technique of quantifying changes in osmoresistance of erythrocytes in the presence of adrenoblocker. The normal beta-ARM range lies within 2.0-20.0 conditional units with a rise up to 60 cond. units in consequence of regular increases in the SAS activity. To accept or reject beta-ARM as a PPS criterion, data of a series of three investigations were analyzed in attempt to correlate individual psychophysiological characteristics, operator's efficiency, cardiovascular reactions, and beta-ARM. In the first investigation, 30 male volunteers imitated operator's duties which included two-dimensional compensatory tracking with simultaneous choice between two alternatives on a training simulator. In the second investigation, 39 first-year students of a flight school were tested with the use of an automated psychological assessment system at the end of the first semester. In the third investigation, four navigators and 3 qualified test-pilots performed two-compensatory tracking using standard hand controls following exposure to radial aerobatic g-loads in and w/o anti-g suits. It was found that beta-ARM within the range of 10-20 cond. units is a criterion of good job efficiency. beta-ARM below 10 cond. units attests high adrenoreactivity only in stable conditions of work and with good skill in a particular operation. In contingency high reactivity to catecholamines may lead to loss of concentration, deterioration of temporary memory and job efficiency. beta-ARM above 20 cond. units may be determined at high operator's performance; however, during screening the risk of stress-related diseases should be taken into consideration, too.

Adult↗

PubMed2002

Virtual image grafting: image based generation and visualization of virtual skin defects.

We have developed methods for rapidly generating 3d dermatologic datasets for use in education, training simulations and procedure planning. By compositing local surface features of cutaneous wounds onto patient images and 3d models, one can flexibly generate large patient variability from a small initial 3d library. The wound database is generated from clinically captured photographic images. The wound image is extracted from the image of the surrounding tissue. The 3d anatomy database is generated from MRI scans and from multiple photographic views. Extracted wound images can be moved rotated and scaled and blended in the final composite.

Databases as Topic↗