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At least 523 records · Page 29Linked to original sources
PubMed1996

Diagnostic accuracy of technologies used in low back pain assessment. Thermography, triaxial dynamometry, spinoscopy, and clinical examination.

STUDY DESIGN: A prospective blind study compared three new technologies to assess back pain. OBJECTIVE: To assess the diagnostic accuracy and comparability of thermography, triaxial dynamometry, and spinoscopy in the assessment of recent onset work-related low back pain. SUMMARY OF BACKGROUND DATA: The role of these technologies in assessing patients with low back pain is unproved. METHODS: Forty-one patients with low back pain and 46 control subjects were assessed by each technology and by two clinical examiners blind to clinical status. Twenty patients were trained to simulate a healthy back without low back pain, and 50% of the control subjects were trained to simulate the presence of a low back pain disorder. Each technology was interpreted on two occasions by each of two readers. RESULTS: Thermography performed significantly worse than did triaxial dynamometry, spinoscopy, and clinical examination. The diagnostic accuracy of the last three was similar, and inter-rater comparability did not differ significantly. Among simulators, the diagnostic accuracy of triaxial dynamometry and spinoscopy was significantly higher than that of clinical examination, although considerable inaccuracy remained in assessing individual subjects. CONCLUSIONS: The diagnostic accuracy of thermography in recent onset low back pain does not support its use. Among those simulating normality or low back pain, triaxial dynamometry and spinoscopy have greater diagnostic accuracy than does a single clinical evaluation. However, for an individual, the inaccuracy that remains limits the use of triaxial dynamometry or spinoscopy for diagnosis in recent onset low back pain.

Adult↗
PubMed2002

Effects of inspiratory muscle training on time-trial performance in trained cyclists.

We evaluated the effects of specific inspiratory muscle training on simulated time-trial performance in trained cyclists. Using a double-blind, placebo-controlled design, 16 male cyclists (VO2max = 64 +/- 2 ml x kg(-1) x min(-1); mean +/- s(x)) were assigned at random to either an experimental (pressure-threshold inspiratory muscle training) or sham-training control (placebo) group. Pulmonary function, maximum dynamic inspiratory muscle function and the physiological and perceptual responses to maximal incremental cycling were assessed. Simulated time-trial performance (20 and 40 km) was quantified as the time to complete pre-set amounts of work. Pulmonary function was unchanged after the intervention, but dynamic inspiratory muscle function improved in the inspiratory muscle training group (P < or = 0.05). After the intervention, the inspiratory muscle training group experienced a reduction in the perception of respiratory and peripheral effort (Borg CR10: 16 +/- 4% and 18 +/- 4% respectively; compared with placebo, P < or = 0.01) and completed the simulated 20 and 40 km time-trials faster than the placebo group [66 +/- 30 and 115 +/- 38 s (3.8 +/- 1.7% and 4.6 +/- 1.9%) faster respectively; P = 0.025 and 0.009]. These results support evidence that specific inspiratory muscle training attenuates the perceptual response to maximal incremental exercise. Furthermore, they provide evidence of performance enhancements in competitive cyclists after inspiratory muscle training.

Adult↗
PubMed2006

Using eye movements to evaluate a PC-based risk awareness and perception training program on a driving simulator.

OBJECTIVE: Evaluation of the effects of a PC-based training program on risk perception in a driving simulator. BACKGROUND: Novice drivers have a fatality rate some eight times higher than that of the most experienced group of drivers, primarily because of the novice driver's inability to predict ahead of time the risks that will appear in the roadway. Current driver education programs, at least those in the United States, do not emphasize the teaching of risk awareness skills to novice drivers. METHOD: A PC-based risk awareness and perception training program was developed and evaluated. The training involved using plan (top-down) views of 10 risky scenarios that helped novice drivers identify where potential risks were located and what information should be attended. Both the 24 trained novice drivers and 24 untrained novice drivers were evaluated on an advanced driving simulator. The eye movements of both groups of drivers were measured. The evaluation on the driving simulator included both scenarios used in the training and others not used in training. RESULTS: The set of trained novice drivers were almost twice as likely as untrained drivers to fixate appropriately either on the regions where potential risks might appear or on signs that warned of potentially risky situations ahead, both for the scenarios they had encountered in training and for novel scenarios. APPLICATION: The PC training program developed, which is portable and can be widely used, has great promise in improving risk perception for novice drivers on the road.

Adolescent↗
PubMedDate not supplied

EVATS: a proactive solution to improve surgical education and maintain flexibility in the new training era.

OBJECTIVE: To describe the development of the EVATS rotation. DESIGN: Descriptive document. SETTING: University teaching hospital. PARTICIPANTS: Faculty and residents of the University of Washington. METHODS: In July 2003 we identified the need for a new, independent, educational module within our residency training. Requirements for this rotation included dedicated time for technical skills training on simulators, independent competency learning modules, academic research project time, vacation time and coverage, and flexibility for unplanned leave (eg, interview travel, m/paternity leave). RESULTS: An EVATS rotation was created in July 2003 that is provided at each training level and lasts from 4 to 8 weeks depending on R-level. EVATS meets the following challenges: Emergency coverage (EVATS residents available for last-minute service coverage), vacation time/vacation coverage (2 weeks vacation + 1 week vacation coverage; this maintains vacations for all residents every 6 months), academic time (residents now must complete 1 academic project for graduation) and ACGME competency learning and assessment, and technical skills training (includes simulator work for open/lap skills). Initial implementation indices are high and include resident satisfaction, 80-hour work week compliance, academic productivity, and patient continuity of care. CONCLUSIONS: The 21st century brought new challenges for surgical training. Increased societal demands for skills training in a laboratory setting using simulators and the 6 ACGME competencies all require classroom-type training periods. Paradoxically, the 80-hour work week restricted the time available for these educational activities and made it more difficult for programs to accommodate resident vacations and emergencies. These challenges provided an opportunity to enhance the educational experience for our residency program. The product was the EVATS rotation. Early data after implementation are favorable.

Adult↗
PubMed2004

A comparison of the CathSim system and simulated limbs for teaching intravenous cannulation.

The present study describes a comparison between the CathSim VR simulator and simulated limbs for training IV cannulation. Two groups of physician assistant students underwent 2 hours of training on either method. Performance was assessed before and after training with a standardized assessment form. The results showed that all students improved after training, but the degree of improvement was greater for those trained with the simulated limbs. These findings may be due to differences between the two training methods as well as the methodology adopted in the present study.

Extremities↗
PubMed2005

Microsurgical skills training: a new concept for simulation of vessel-wall suturing.

Initiation of training in basic microsurgical suturing technique usually involves placing sutures on incisions made on latex sheets, and then progressing to a live anastomosis in a rat model. A straight incision resembles a skin incision and does not mechanically simulate vessel wall suturing, and various modifications and innovative prosthetic models continue to be developed to bring the simulation closer to a live anastomosis. We developed two models which closely simulate vessel wall suturing and require the application of similar skills by the trainee. In the first model (the "I" model), the straight 1-cm incision is converted to an I-shaped incision which increases the instability of the edge to be sutured, depending on the length of the horizontal incision, putting greater demand on dexterity in suture placement similar to a vessel. The length (1 cm) of the edge does not constrain the spacing of the sutures and can be used for the beginner. The second model (the "double triangle" model) creates a narrow and unstable edge for placing sutures, and puts greater demand on bimanual coordination and instrument control for training in accuracy of suture placement as well as spacing between sutures. Both these models are cost-effective and simple to construct.

Anastomosis, Surgical↗
PubMed1986

The use of simulated patients in the assessment of actual clinical performance in general practice.

This pilot study assessed a novel approach to the evaluation of clinical performance in the practice setting, using actors trained to simulate real patients. Thirteen general practitioner teachers, 10 family medicine training programme registrars, and 10 recent graduates of the FMTP were recruited. They agreed to be consulted by an unknown simulated patient. Two young patients with classical migraine were selected. Two young actors, a male and a female, were trained to simulate their symptomatology and history. A scoring system was devised to broadly assess a single general practice first consultation, and the simulators were trained to score. Eighty-five percent of respondents were willing to take part in a further study. Seventy-three percent had no suspicion at all that the patient was simulated. The average consultation time was 17 minutes (range 4-40). The average score was 67% (range 10-100%). The diagnosis was made in every case and a wide variety of treatments were prescribed. This appears to be a practical and acceptable method of assessing clinical performance.

Clinical Competence↗
PubMed2004

The effect of feedback training on lumbosacral compression during simulated occupational lifting.

This study measured the effect of a feedback training program on lumbar compression during simulated occupational lifting. Two distinct types of feedback were compared: real-time electromyographic feedback, vs. an acceleration index delivered verbally post-lift. Kinematic data were collected from 28 subjects during symmetrical sagittal plane lifts. Following a baseline session, two feedback training sessions were provided, with a 1-week interval between each session. A control group followed the same protocols, but without receiving feedback training. A post-training session, using protocols identical to the baseline session, was used to assess pre-to-post changes in the dependent variable: peak lumbosacral compression computed using a dynamic linked-segment model. All three groups showed reductions in peak compression from pre-to-post: on average the control group improved by 11.2%, the EMG group by 16.7%, and the acceleration group by 25.3%. The results revealed an interaction between the improvement and the group (p=0.023), and a difference between the improvement in the control group and that in the verbal acceleration feedback group (p<0.01). These reductions in lumbosacral compression persisted after a 7-day interval without feedback training, suggesting that this approach could provide sustained risk-reduction during manual materials handling.

Acceleration↗
PubMedDate not supplied

Training in carotid artery stenting: do carotid simulation systems really help?

Virtual reality (VR) simulations have long been used for training in aviation and other professions. High-fidelity endovascular procedure simulators are now available, providing procedure simulations with real-time interactions; two-dimensional graphic displays of angiographic anatomy; mechanical interfaces with guidewires, sheaths, and catheters that provide some degree of haptic feedback; modeling of physiologic and pharmacology responses; and other features. Simulators have been incorporated into training programs for physicians learning carotid artery stenting (CAS). For the first time, US Food and Drug Administration approval of a new device (CAS systems) has included a requirement for physician training that incorporates the use of VR simulators. Early experience has shown that simulation is well accepted by trainees, performance on simulators improves with training and practice, and simulation prior to first performing endovascular procedures can improve clinical performance. Specific to CAS, the value of education programs using simulators appears to be tangible as trained but inexperienced CAS operators have clinical results comparable to those of physicians with extensive CAS experience.

Carotid Stenosis↗
PubMed2004

Training with a computer-based simulator achieves basic manual skills required for upper endoscopy: a randomized controlled trial.

BACKGROUND: Changes in medical practice have constrained the time available for education and the availability of patients for training. Computer-based simulators have been devised that can be used to achieve manual skills without patient contact. This study prospectively compared, in a clinical setting, the efficacy of a computer-based simulator for training in upper endoscopy. METHODS: Twenty-two fellows with no experience in endoscopy were randomly assigned to two groups: one group underwent 10 hours of preclinical training with a computer-based simulator, and the other did not. Each trainee performed upper endoscopy in 19 or 20 patients. Performance parameters evaluated included the following: esophageal intubation, procedure duration and completeness, and request for assistance. The performance of the trainees also was evaluated by the endoscopy instructor. RESULTS: A total of 420 upper endoscopies were performed; the computer pretrained group performed 212 and the non-pretrained group, 208. The pretrained group performed more complete procedures (87.8% vs. 70.0%; p < 0.0001), required less assistance (41.3% vs. 97.9%; p < 0.0001), and the instructor assessed performance as "positive" more often for this group (86.8% vs. 56.7%; p < 0.0001). The length of procedures was comparable for the two groups. CONCLUSIONS: The computer-based simulator is effective in providing novice trainees with the skills needed for identification of anatomical landmarks and basic endoscopic maneuvers, and in reducing the need for assistance by instructors.

Adult↗
PubMed1996

Networks with lateral connectivity. III. Plasticity and reorganization of somatosensory cortex.

1. Mechanisms underlying cortical reorganizations were studied using a three-layered neural network model with neuronal groups already formed in the cortical layer. 2. Dynamic changes induced in cortex by behavioral training or intracortical microstimulation (ICMS) were simulated. Both manipulations resulted in reassembly of neuronal groups and formation of stimulus-dependent assemblies. Receptive fields of neurons and cortical representation of inputs also changed. Many neurons that had been weakly responsive or silent became active. 3. Several types of learning models were examined in simulating behavioral training, ICMS-induced dynamic changes, deafferentation, or cortical lesion. Each learning model most accurately reproduced features of experimental data from different manipulations, suggesting that more than one plasticity mechanism might be able to induce dynamic changes in cortex. 4. After skin or cortical stimulation ceased, as spontaneous activity continued, the stimulus-dependent assemblies gradually reverted into structure-dependent neuronal groups. However, relationships among individual neurons and identities of many neurons did not return to their original states. Thus a different set of neurons would be recruited by the same training stimulus sequence on its next presentation. 5. We also reproduced several typical long-term reorganizations caused by pathological manipulations such as cortical lesions, input loss, and digit fusion. 6. In summary, with Hebbian plasticity rules on lateral connections, the network model is capable of reproducing most characteristics of experiments on cortical reorganization. We propose that an important mechanism underlying cortical plastic changes is formation of temporary assemblies that are related to receipt of strongly synchronized localized input. Such stimulus-dependent assemblies can be dissolved by spontaneous activity after removal of the stimuli.

Afferent Pathways↗
PubMed2003

Engineering requirements for a haptic simulator for knee arthroscopy training.

This paper describes the initial development of an innovative haptic device that will be integrated into an existing virtual reality training system for knee arthroscopy. The resulting system will be called WISHKATS (Warwick, Imperial, Sheffield Knee Arthroscopy Training System). This haptic device will enable the trainee to feel realistic forces on the probing tool and will work together with software, which will simulate tissue deformation. The proposed haptic system is a compact, multi-degree of freedom, motorised mechanism with force sensors, and will be used to simulate the diagnostic aspects of knee arthroscopy. There are a number of problems associated with the development of a suitable haptic system and this paper explores the engineering requirements of such a device.

Arthroscopy↗
PubMed2002

Virtual reality training improves operating room performance: results of a randomized, double-blinded study.

OBJECTIVE: To demonstrate that virtual reality (VR) training transfers technical skills to the operating room (OR) environment. SUMMARY BACKGROUND DATA: The use of VR surgical simulation to train skills and reduce error risk in the OR has never been demonstrated in a prospective, randomized, blinded study. METHODS: Sixteen surgical residents (PGY 1-4) had baseline psychomotor abilities assessed, then were randomized to either VR training (MIST VR simulator diathermy task) until expert criterion levels established by experienced laparoscopists were achieved (n = 8), or control non-VR-trained (n = 8). All subjects performed laparoscopic cholecystectomy with an attending surgeon blinded to training status. Videotapes of gallbladder dissection were reviewed independently by two investigators blinded to subject identity and training, and scored for eight predefined errors for each procedure minute (interrater reliability of error assessment r > 0.80). RESULTS: No differences in baseline assessments were found between groups. Gallbladder dissection was 29% faster for VR-trained residents. Non-VR-trained residents were nine times more likely to transiently fail to make progress (P <.007, Mann-Whitney test) and five times more likely to injure the gallbladder or burn nontarget tissue (chi-square = 4.27, P <.04). Mean errors were six times less likely to occur in the VR-trained group (1.19 vs. 7.38 errors per case; P <.008, Mann-Whitney test). CONCLUSIONS: The use of VR surgical simulation to reach specific target criteria significantly improved the OR performance of residents during laparoscopic cholecystectomy. This validation of transfer of training skills from VR to OR sets the stage for more sophisticated uses of VR in assessment, training, error reduction, and certification of surgeons.

Cholecystectomy, Laparoscopic↗
PubMed2006

Currently available simulators: ex vivo models.

The introduction of the ex vivo tissue endoscopy simulators represents a major advance in endoscopic training, particularly in therapeutic endoscopy. The simulators have been popular teaching tools from the start, and the data supporting their benefit are accruing, especially in hemostasis training. Simulators like the compact EASIE may prove most beneficial as training tools for interventional skills that require repetitive practice and a larger volume of procedures than may occur naturally during the course of standard endoscopy practice. More data are needed to confirm that hands-on simulator training improves outcomes in clinical endoscopic performance and to characterize better the influence of such simulator work on subsequent endoscopic practice. As ex vivo simulators become more available, it is likely that these models will enhance initial training and also allow practicing gastroenterologists to acquire new techniques, maintain their skills, and demonstrate proficiency for credentialing purposes.

Animals↗