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At least 415 records · Page 23Linked to original sources

PubMed2002

Using virtual reality technology for aircraft visual inspection training: presence and comparison studies.

The aircraft maintenance industry is a complex system consisting of several interrelated human and machine components. Recognizing this, the Federal Aviation Administration (FAA) has pursued human factors related research. In the maintenance arena the research has focused on the aircraft inspection process and the aircraft inspector. Training has been identified as the primary intervention strategy to improve the quality and reliability of aircraft inspection. If training is to be successful, it is critical that we provide aircraft inspectors with appropriate training tools and environment. In response to this need, the paper outlines the development of a virtual reality (VR) system for aircraft inspection training. VR has generated much excitement but little formal proof that it is useful. However, since VR interfaces are difficult and expensive to build, the computer graphics community needs to be able to predict which applications will benefit from VR. To address this important issue, this research measured the degree of immersion and presence felt by subjects in a virtual environment simulator. Specifically, it conducted two controlled studies using the VR system developed for visual inspection task of an aft-cargo bay at the VR Lab of Clemson University. Beyond assembling the visual inspection virtual environment, a significant goal of this project was to explore subjective presence as it affects task performance. The results of this study indicated that the system scored high on the issues related to the degree of presence felt by the subjects. As a next logical step, this study, then, compared VR to an existing PC-based aircraft inspection simulator. The results showed that the VR system was better and preferred over the PC-based training tool.

Adult↗

PubMed2003

Virtual 3D IVUS vessel model for intravascular brachytherapy planning. I. 3D segmentation, reconstruction, and visualization of coronary artery architecture and orientation.

Intravascular brachytherapy (IVB) can significantly reduce the risk of restenosis after interventional treatment of stenotic arteries, if planned and applied correctly. To facilitate computer-based IVB planning, a three-dimensional vessel model has been derived from information on coronary artery segments acquired by intravascular ultrasound (IVUS) and biplane angiography. Part I describes the approach of model construction and presents possibilities of visualization. The vessel model is represented by a voxel volume. Polygonal information about the vessel wall structure is derived by segmentation from a sequence of IVUS images automatically acquired ECG gated during pull back of the IVUS transducer. To detect horizontal, vertical, and radial contours, modified Canny-Edge and Shen-Castan filters are applied on Cartesian and polar coordinate representations of the IVUS tomograms as edge detectors. The spatial course of the vessel wall layers is traced in reconstructed longitudinal IVUS scans. By resampling the sequence of IVUS frames the voxel volume is obtained. For this purpose the frames are properly located in space and augmented with additional intermediate frames generated by interpolation. Their spatial location and orientation is derived from biplane X-ray angiography which is performed simultaneously. For resampling, two approaches are proposed: insertion of the vertices of the rectangular goal grid into the cells of a deformed hexahedral mesh derived from the IVUS sequence, and insertion of the vertices of the hexahedral mesh into the cells of the rectangular grid. Finally, the vessel model is visualized by methods of combined volume and polygon rendering. The segmentation process is verified as being in good agreement with results obtained by manual contour tracing with a commercial system. Our approach of construction of the vessel model has been implemented into an interactive software system, 3D IVUS-View, serving as the basis of a future system for intracoronary brachytherapy treatment planning being currently under development (Part II).

Algorithms↗

PubMed2006

Active surveillance versus radical treatment for favorable-risk localized prostate cancer.

Widespread prostate-specific antigen (PSA) screening in North America has resulted in a profound stage migration and a marked increase in incidence. One in six men is now diagnosed, many with small-volume, low-grade cancer. This incidence is dramatically higher than the 3% lifetime risk of prostate cancer death that characterized the pre-screening era. This article summarizes the case for active surveillance for "favorable-risk" prostate cancer with selective delayed intervention for rapid biochemical progression, assessed by increasing PSA levels, or grade progression. The results of a large phase II trial using this approach are reviewed. To date, this study has shown that virtually all men with favorable-risk prostate cancer managed in this fashion will die of unrelated causes. Based on the Swedish randomized trial of radical prostatectomy versus watchful waiting, the Connecticut observation series, and the Toronto active surveillance experience, a number needed to treat analysis of the benefit of radical treatment of all newly diagnosed favorable-risk prostate cancer patients, compared with a strategy of active surveillance with selective delayed intervention, is presented. This suggests that approximately 73 patients will require radical treatment for each prostate cancer death averted. This translates into a 3- to 4-week survival benefit, unadjusted for quality of life. This figure is confirmed based on an analysis of the 2004 D'Amico et al. PSA velocity data in favorable-risk disease. The approach of active surveillance with selective delayed intervention based on PSA doubling time and repeat biopsy represents a practical compromise between radical therapy for all patients (which results in overtreatment for patients with indolent disease) and watchful waiting with palliative therapy only (which results in undertreatment for those with aggressive disease).

Disease Progression↗

PubMedDate not supplied

The evolving role of interventional pain management in oncology.

Patients with cancer frequently experience chronic pain, especially in the terminal phases of illness. Fortunately, most patients (90%) can achieve good pain relief using standard and adjuvant analgesics. For those patients who experience severe pain resistant to traditional analgesic therapies, interventional pain management techniques often provide welcome pain relief. The use of neurolytic substances has been used for many decades but has found a niche in the treatment of pain related to abdominal and pelvic cancers. Simple, percutaneous injections of alcohol or phenol can provide much needed pain relief for patients with pancreatic, colon, or gynecologic cancers. The percutaneous placement of catheters for the chronic infusion of spinal analgesics can provide pain relief for virtually any part of the body. Internal or external infusion pumps can be well managed at home, improving quality of life. The physician treating the pain should be aware of these and other interventional pain management techniques to provide alternative therapies to patients with refractory cancer pain.

Analgesics↗

PubMedDate not supplied

MR diagnosis of vein of Galen aneurysmal malformations using virtual cisternoscopy.

Vein of Galen aneurysmal malformations (VGAMs) are rarely seen intracranial congenital vascular malformations with extremely complex vascular architectures. We present two newborns with an unclear intracranial mass being discovered in routine intrauterine ultrasonography. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) identified these lesions as VGAMs. Besides conventional MRA analysis, "virtual cisternoscopy"-a special kind of virtual endoscopy combining perspective volume rendering and motion-was applied to assess the intracranial vasculature. One newborn was treated by means of interventional neuroradiology with coiling of the median prosencephalic vein. The clinical outcome in this case was excellent. The other will undergo interventional therapy shortly.

Cerebral Veins↗

PubMed2001

The imager replacing the pathologist in the diagnosis of hepatobiliary and pancreatic disease.

Advances in imaging technology, specifically cross-sectional imaging techniques (ultrasonography, computer tomography, magnetic resonance imaging), are dynamic and rapid. They have dramatically changed the management of hepatobiliary and pancreatic diseases. Although imaging is not identical to the traditional gold standard of a tissue diagnosis, it often obviates its need and provides a much better insight into clinically relevant pathology compared with a biopsy. However, this requires a thorough insight into the clinical and pathologic aspects of the disease, knowledge of limitations of imaging techniques, and insight in management implications. The clear identification of characteristic disease findings on imaging, such as a cirrhotic configuration of the liver or gallstones that match clinical findings, are most helpful. Imaging and tissue investigation often have a complementary role in patient management. Their yield is highest if they are part of a critical integration of clinical findings by a multidisciplinary team. The latter should help as much in identifying specific opportunities for treatment as preventing futile and potential harmful interventions. The contribution of imagers and pathologists to the management of patients will continue to be redefined in the new century. Noninvasive and virtual imaging will develop further. A specific and challenging role for the pathologists and clinical imagers in close cooperation with many other disciplines will be to identify sensitive molecular targets that can be used to provide noninvasive images that not only accurately provide a diagnosis, but also resolution of disease and response to specific therapy. Ann Diagn Pathol 5:57-66, 2001.

Bile Ducts↗

PubMed1987

The stability and attitudinal correlates of warmth and caring in medical students.

It is often said that medical school admits students who are compassionate, nurturant and person-oriented, and transforms them into cold, impersonal graduates. These attributes describe two ends of a personality trait continuum referred to as psychological femininity. The Femininity Scale of the Personal Attributes Questionnaire was administered to a class of medical students four times over 3 years. Measures of empathy, attitudes towards doctor-patient relations and attitudes towards professional psychological help were also obtained. Femininity appears to be normally distributed, remarkably stable over a 28-month interval and predictive of attitudinal measures of empathy, readiness to make psychiatric referrals, recognition of one's own need for psychological help, and a non-cynical, person-oriented approach to patient care. Such findings suggest a different state of affairs within medical training than is usually portrayed. Rather than viewing medical school as having a universally adverse effect on student compassion, medical school has virtually no effect on self-reports of warmth, kindness, helpfulness, etc. Students at different ends of the femininity continuum may require different interventions aimed at teaching communication skills and interpersonal sensitivity.

Attitude of Health Personnel↗

PubMed1980

Application of a social skills training program in the modification of interpersonal deficits among retarded adults: a clinical replication.

Six mentally retarded adults, equally divided into two treatment groups, were provided with individualized social skills training programs. Treatment, evaluated via a multiple-baseline design strategy, was sequentially and cumulatively applied across target behaviors over a four-week intervention period. Behavioral observation probes and social validation measures served as the primary dependent variables. Results indicated that (a) treatment was effective for virtually all behaviors across all subjects, (b) improvements occurred for both training and generalization scenes, and (c) behavioral performance was maintained one month following the termination of treatment.

Adult↗

PubMed1997

Virtual reality, disability and rehabilitation.

Virtual reality, or virtual environment computer technology, generates simulated objects and events with which people can interact. Existing and potential applications for this technology in the field of disability and rehabilitation are discussed. The main benefits identified for disabled people are that they can engage in a range of activities in a simulator relatively free from the limitations imposed by their disability, and they can do so in safety. Evidence that the knowledge and skills acquired by disabled individuals in simulated environments can transfer to the real world is presented. In particular, spatial information and life skills learned in a virtual environment have been shown to transfer to the real world. Applications for visually impaired people are discussed, and the potential for medical interventions and the assessment and treatment of neurological damage are considered. Finally some current limitations of the technology, and ethical concerns in relation to disability, are discussed.

Activities of Daily Living↗

PubMed1999

[Bladder augmentation in reconstruction of the urinary tract (1985-1997)].

Bladder augmentation with intestinal or urinary segments has virtually replaced other treatments in the management of both neuropathic and no neuropathic bladder dysfunction that has not responded to pharmacotherapy nor other intervention. We present herein our experience in 55 patients who underwent augmentation cystoplasty. Their mean age were 12.2 years (range 2.5-22.8) and the mean follow-up time was 4 years (1-13.1). They were divided in three groups according to the diagnosis: vesical or cloacal exstrophy (14 patients), neuropathic bladder (36) and posterior urethral valves (5 patients). Indications were: 1) to get a low pressure, high volume reservoir and avoid upper urinary tract damage in low-compliance bladders (41 patients); 2) as an undiversion (8 patients), and 3) prior to renal transplantation. Cystoplasty was performed with bowel segments in 47 cases and ureter in 8, adding some other urological procedures in 22 patients. Mean bladder capacity after 1 year was 400 ml versus 112 as previous value. 52 out of the 55 patients are continent after augmentation. There was no impairment of the renal function in the 5 patients with prior renal failure who underwent cystoplasty. Vesicoureteral reflux disappeared in 78.6% of the patients after cystoplasty. The complications were urinary stones in 5 cases, upper urinary tract infections in 3, and spontaneous bladder perforation in 1 patient. Augmentation cystoplasty is the best choice to achieve a low pressure reservoir, to assure contingency and to avoid progressive damage of the upper urinary tract in neuropathic or no neuropathic pediatric bladder dysfunctions.

Adolescent↗

PubMed1990

Diagnostic imaging evaluation of benign prostatic hyperplasia.

The optimal evaluation of the patient with symptomatic BPH should include the diagnostic testing necessary to supplement the clinical examination and select a suitable medical, surgical, or interventional therapeutic option. A variety of imaging modalities offer unique but often unnecessary, superfluous, or very expensive information. Rarely is therapeutic intervention for symptomatic BPH denied a patient because of lesions detected with screening imaging tests; it may be only delayed rather than withheld. Virtually all pretreatment IVUs in patients with BPH are normal. Estimates range from 73 to 93 per cent of the studies as normal or having only insignificant findings. Significant pathology, either life-threatening or sufficient to alter or delay treatment, is found between 0.5 and 10 per cent of the time. Upper tract hydronephrosis is the most common finding (3 to 13 per cent). Renal or urothelial cancer prevalence in the patient population with BPH is really no different than in the general population. If signs or symptoms are not present to alert the clinician to some risk factor other than the symptoms of BPH, there is no benefit for routine urography solely for upper tract cancer detection. Furthermore, with the growing use of nonionic contrast media for elderly patients, the cost of the preoperative routine IVU will increase even further as the added charge for contrast ($100 or more) is tacked onto the cost of the study. Azotemic patients are best served by diagnostic ultrasound or by Foley catheter drainage prior to urography when indicated. Ultrasound remains an operator-dependent and technology-limited examination that cannot measure renal function, but the sensitivity and specificity, as well as the overall diagnostic accuracy, are equal to or greater than those of urography for the detection of hydronephrosis, cystic renal masses, and bladder or prostate abnormalities. False-positive ultrasound scans do occur secondary to reflux caused by bladder diverticula, megacalicosis, or other congenital abnormalities. However, these lesions are distinctly rare. Sensitivity for urothelial malignancy is not good, but endoscopic, clinical, and laboratory evaluations should provide adequate pretherapy diagnostic screening. In spite of the preoperative comfort that a normal IVU may give the patient and the operating surgeon, routine intravenous urography for all BPH patients should no longer be considered necessary. Diagnostic ultrasound, either transabdominal or transrectal, also offers the ability to evaluate the kidneys, ureters, and bladder, effectively replacing routine intravenous urography.(ABSTRACT TRUNCATED AT 400 WORDS)

Humans↗

PubMed2005

Percutaneous valve procedures: what is the future?

PURPOSE OF REVIEW: Since its introduction 27 years ago by Andreas Gruntzig, interventional cardiology has expanded its scope from coronary disease to peripheral, congenital, and also valve diseases.Percutaneous mitral commissurotomy and aortic valvuloplasty have been performed since the mid 1980s. Balloon commissurotomy has been used in tens of thousands of patients worldwide and provides good short- and long-term results in a wide range of patients. It has virtually replaced surgical commissurotomy in the management of mitral stenosis. On the other hand, percutaneous aortic valvuloplasty is almost abandoned worldwide due to its lack of efficacy and the risks involved. RECENT FINDINGS: The new techniques of percutaneous valve intervention are aortic valve replacement, and mitral valve repair. Both are at an early stage since the first in-man applications only started in 2002. Preliminary series show that these techniques are feasible; however, they must be further evaluated in comparison with contemporary treatment to accurately assess efficacy and risks. Today potential applications concern high-risk patients, however, after thorough evaluation this may be extended to others in the future. SUMMARY: Therefore, percutaneous interventions already play an important role in management of valvular heart disease, which is likely to grow in the future.

Aortic Valve↗

PubMed2002

Future of technology to augment patient support in hospitals.

This chapter explores the potential of using computer technology to support and augment psychotherapeutic interventions in hospitals, communities and homes. We describe two applications piloted at Children's Hospital Boston. The first pilot explored how patients with pediatric heart disease used the Storytelling Agent Generation Environment (SAGE) computer program to create interactive storytellers and share their personal stories. The second involved youngsters on hemodialysis for end stage renal disease using the Zora graphical multi-user environment to create a virtual city and form a therapeutic virtual community. In this chapter we show how computer technology can be used to help patients explore their identity, cope with their illness and provide mutual support and interaction. We also present design recommendations for future interventions of this kind.

Adaptation, Psychological↗

PubMed1997

Virtual reality in endonasal surgery.

Virtual environments provide a new dimension of graphic simulation. The interaction between the human and the computer is now intuitive for the user. The use of virtual reality (VR) gives the user the feeling of participating in a (computer generated) scenario very much like reality. This feeling is an essential requirement for simulation of surgical interventions using digital data. Especially in the fields of sinus and skull-base surgery, computer assisted simulation could present a valuable and effective alternative method for honing endoscopic skills. Traditionally, surgeons gain experience through anatomic preparation and education by more experienced colleagues. Landmarks like skull base, carotid arteria or optical nerve have to be identified intraoperatively in order to orientate in this critical region. Highly sensitive structures can be damaged most easily. The quality of surgical skills can be characterized as the sum of knowledge, individual experience and manual dexterity. It is conceivable that a surgeon's level of training and experience could be significantly increased by use of VR. With this in mind, a VR-based simulator for procedures in sinus surgery will improve most of these parts. To provide the virtual environment, a realistic representation of the region of interest with all relevant anatomical structures is required. Based on data from tomographic imaging studies, a three-dimensional representation of the paranasal sinuses is semiautomatically reconstructed. Textures derived from endoscopic images are superimposed on the virtual anatomic structures and provide better realism. Two main components of the VR interface can be distinguished: the 3-D interaction to guide the surgical instruments and the 2-D graphical user interface for visual feedback and control of the session. Moreover, the 3-D interaction has to be realized by means of Virtual Reality techniques providing a simulation of an endoscope and an intuitive handling of other surgical instruments.

Computer Simulation↗

PubMed2002

How virtual reality may enhance training in obstetrics and gynecology.

OBJECTIVE: Contemporary training in obstetrics and gynecology is aimed at the acquisition of a complex set of skills oriented to both the technical and personal aspects of patient care. The ability to create clinical simulations through virtual reality (VR) may facilitate the accomplishment of these goals. The purpose of this paper is 2-fold: (1) to review the circumstances and equipment in industry, science, and education in which VR has been successfully applied, and (2) to explore the possible role of VR for training in obstetrics and gynecology and to suggest innovative and unique approaches to enhancing this training. MATERIAL AND METHODS: Qualitative assessment of the literature describing successful applications of VR in industry, law enforcement, military, and medicine from 1995 to 2000. Articles were identified through a computer-based search using Medline, Current Contents, and cross referencing bibliographies of articles identified through the search. RESULTS: One hundred and fifty-four articles were reviewed. This review of contemporary literature suggests that VR has been successfully used to simulate person-to-person interactions for training in psychiatry and the social sciences in a variety of circumstances by using real-time simulations of personal interactions, and to launch 3-dimensional trainers for surgical simulation. These successful applications and simulations suggest that this technology may be helpful and should be evaluated as an educational modality in obstetrics and gynecology in two areas: (1) counseling in circumstances ranging from routine preoperative informed consent to intervention in more acute circumstances such as domestic violence or rape, and (2) training in basic and advanced surgical skills for both medical students and residents. CONCLUSION: Virtual reality is an untested, but potentially useful, modality for training in obstetrics and gynecology. On the basis of successful applications in other nonmedical and medical areas, VR may have a role in teaching essential elements of counseling and surgical skill acquisition.

Clinical Competence↗

PubMed2005

Elimination of HIV infection in infants in Europe--challenges and demand for response.

Effective interventions for the prevention of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) infection now exist and where these are fully implemented, MTCT rates of 1-2% are achievable. Virtual elimination of HIV in infants by 2010 has therefore been set as a goal for European region. There are, however, many challenges. The eastern European and central Asian countries are facing the fastest growing HIV epidemic in the world with a dramatic increase in numbers of HIV-positive pregnancies and new HIV infected infants. Nevertheless, the prevalence of HIV among pregnant women is still relatively low and the high coverage with antenatal care provide an opportunity to decrease the number of new HIV cases among infants to minimal level. The challenge is to move national strategies for prevention of HIV infection among infants from a disease-focused vertical approach towards effective preventive interventions integrated into mother-child health (MCH) and reproductive health services. The scaling up of prevention interventions among those most at risk and hard-to-reach women are key priority actions. This goes beyond clinical care and needs to include a range of care and protection issues, both in health institutions and in the community. The WHO Regional Office for Europe, together with other UNAIDS co-sponsors, has developed a regional strategic framework for prevention of HIV infection in infants. The strategic framework promotes a comprehensive approach comprising the four interrelated elements: (1) primary prevention of HIV infection; (2) prevention of unintended pregnancies among HIV-infected women; (3) prevention of HIV transmission from HIV-infected women to their children; (4) provision of care and support to HIV-infected women, their infants and families. Implementation of all four pillars of the strategic framework would help European countries to achieve the goal of virtual elimination of HIV infection in infants.

Anti-Retroviral Agents↗

PubMed1978

A simple technique for increasing cancer patients knowledge of informed consent to treatment.

Seventy-seven sequential patients referred to a radiation oncology clinic for treatment of malignant neoplasms were tested for their immediate recall of information presented, recorded, and signed on informed consent documents. An experimental group of 40 patients were given the intervention of taking the completed form home before signing. Results support the usefulness of the intervention. The experimental patients were found to possess greater information than the 37 patients who signed the form after the usual clinic procedure in virtually every area required of informed consent. The most significant gains were made in patients' understanding of proposed treatment procedures and appropriate treatment alternatives. Women recalled more information relevant to informed consent than did men. Results also indicated a tendency for younger patients to recall more informed consent information than older patients.

Adolescent↗

PubMed2005

The co-occurrence of smoking and drinking among young adults in college: national survey results from the United States.

BACKGROUND: In US colleges, alcohol and tobacco pose substantial health risks but little is known about their co-occurrence, limiting development and use of appropriately targeted prevention efforts. METHODS: Data from the 2001 HSPH College Alcohol Study (student n = 10,924; college n = 120) were analyzed using multivariate logistic regression. Co-occurring smoking/drinking risks were examined in aggregate, by gender, and by age of onset of regular drinking and smoking across 10 measures of drinking style, three categories of transitional drinking behavior, and by treatment behavior. RESULTS: Over 98% of current smokers drink; a fraction (<1%) of lifetime and 7% of past year alcohol abstainers smoke. Across drinking pattern measures, 44-59% of drinkers smoke. Co-occurrence risks are greatest among youth reporting high total alcohol consumption (adjusted OR 4.21, p < 0.0001), drinking problems (adjusted OR 3.31, p < 0.0001) or symptoms of diagnosable alcohol abuse (adjusted OR 3.02, p < 0.0001). Risks are sharply elevated among students who self-medicate for drinking problems and do not seek/receive help (adjusted OR 1.87, p < 0.0001), and those reporting symptoms of diagnosable alcohol abuse who may or may not seek/receive help (adjusted OR 2.67, p < 0.01 and 2.96, p < 0.01, respectively). Females and students reporting early adolescent onset of regular smoking are at greatest risk. CONCLUSIONS: Virtually all college smokers drink, and smoking and drinking are powerfully interrelated across drinking measures. Efficiency argues for jointly targeting both behaviors and developing interventions tailored to the special vulnerabilities of young women, students experiencing difficulties adjusting to college, and students reporting early onset of regular smoking.

Adolescent↗