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At least 613 records · Page 34Linked to original sources
PubMed2005

The feasibility of sharing simulation-based evaluation scenarios in anesthesiology.

UNLABELLED: We prospectively assessed the feasibility of international sharing of simulation-based evaluation tools despite differences in language, education, and anesthesia practice, in an Israeli study, using validated scenarios from a multi-institutional United States (US) study. Thirty-one Israeli junior anesthesia residents performed four simulation scenarios. Training sessions were videotaped and performance was assessed using two validated scoring systems (Long and Short Forms) by two independent raters. Subjects scored from 37 to 95 (70 +/- 12) of 108 possible points with the "Long Form" and "Short Form" scores ranging from 18 to 35 (28.2 +/- 4.5) of 40 possible points. Scores >70% of the maximal score were achieved by 61% of participants in comparison to only 5% in the original US study. The scenarios were rated as very realistic by 80% of the participants (grade 4 on a 1-4 scale). Reliability of the original assessment tools was demonstrated by internal consistencies of 0.66 for the Long and 0.75 for the Short Form (Cronbach alpha statistic). Values in the original study were 0.72-0.76 for the Long and 0.71-0.75 for the Short Form. The reliability did not change when a revised Israeli version of the scoring was used. Interrater reliability measured by Pearson correlation was 0.91 for the Long and 0.96 for the Short Form (P < 0.01). The high scores for plausibility given to the scenarios and the similar reliability of the original assessment tool support the feasibility of using simulation-based evaluation tools, developed in the US, in Israel. The higher scores achieved by Israeli residents may be related to the fact that most Israeli residents are immigrants with previous training in anesthesia. IMPLICATIONS: Simulation-based assessment tools developed in a multi-institutional study in the United States can be used in Israel despite the differences in language, education, and medical system.

Anaphylaxis↗
PubMed1999

Surgical simulation: an animal tissue model for training in therapeutic and diagnostic bronchoscopy.

A series of surgical simulation exercises has been developed using an animal model to allow trainees to practise basic instrument handling and develop psychomotor skills in bronchoscopy, without risk to patients. A pig model was found to be most suitable. After suitable preparation the model can be used for diagnostic and therapeutic exercises in bronchoscopy, including lavage, biopsy and the removal of various foreign bodies. The model is a safe, inexpensive and convenient means of bronchoscopic training for otolaryngology trainees. For the trained specialist who has to remove bronchial foreign bodies infrequently, the model is a useful way of maintaining skills.

Animals↗
PubMed2003

Information transmission rates of cat retinal ganglion cells.

To assess the information encoded in retinal spike trains and how it might be decoded by recipient neurons in the brain, we recorded from individual cat X and Y ganglion cells and visually stimulated them with randomly modulated patterns of various contrast and spatial configuration. For each pattern, we estimated the information rate of the cells using linear or nonlinear algorithms and for some patterns by directly measuring response probability distributions. We show that ganglion cell spike trains contain information from the receptive field center and surround, that the center and surround have similar signaling capacity, that antagonism between the mechanisms reduces information transmission, and that the total information rate is limited. We also show that a linear decoding algorithm can capture all of the information available in retinal spike trains about weak inputs, but it misses a substantial amount about strong inputs. For the strongest stimulus we used, the information rate of the best linear decoder averaged 40-70 bits/s across ganglion cell types, while the directly measured rate was around 20-40 bits/s greater. This implies that under certain stimulus conditions, visual information is encoded in the temporal structure of retinal spike trains and that a nonlinear decoding algorithm is needed to extract the temporally coded information. Using simulated spike trains, we demonstrate that much of the temporal structure may be explained by the threshold for spike generation and is not necessarily indicative of a complex coding scheme.

Algorithms↗
PubMed2006

Construct and face validity and task workload for laparoscopic camera navigation: virtual reality versus videotrainer systems at the SAGES Learning Center.

BACKGROUND: Laparoscopic camera navigation (LCN) training on simulators has demonstrated transferability to actual operations, but no comparative data exist. The objective of this study was to compare the construct and face validity, as well as workload, of two previously validated virtual reality (VR) and videotrainer (VT) systems. METHODS: Attendees (n = 90) of the SAGES 2005 Learning Center performed two repetitions on both VR (EndoTower) and VT (Tulane Trainer) LCN systems using 30 degrees laparoscopes and completed a questionnaire regarding demographics, simulator characteristics, and task workload. Construct validity was determined by comparing the performance scores of subjects with various levels of experience according to five parameters and face validity according to eight. The validated NASA-TLX questionnaire that rates the mental, physical, and temporal demand of a task as well as the performance, effort, and frustration of the subject was used for workload measurement. RESULTS: Construct validity was demonstrated for both simulators according to the number of basic laparoscopic cases (p = 0.005), number of advanced cases (p < 0.001), and frequency of angled scope use (p < 0.001), and only for VT according to training level (p < 0.001) and fellowship training (p = 0.008). Face validity ratings on a 1-20 scale averaged 15.4 +/- 3 for VR vs. 16 +/- 2.6 for VT (p = 0.04). Ninety-six percent of participants rated both simulators as valid educational tools. The NASA-TLX overall workload score was 69.5 +/- 24 for VR vs. 68.8 +/- 20.5 for VT (p = 0.31). CONCLUSIONS: This is the largest study to date that compares two validated LCN simulators. While subtle differences exist, both VR and VT simulators demonstrated excellent construct validity, good face validity, and acceptable workload parameters. These systems thus represent useful training devices and should be widely used to improve surgical performance.

Adult↗
PubMedDate not supplied

Physician's interviewing styles and medical information obtained from patients.

This paper investigates the association between physicians' interviewing styles and medical information obtained during simulated patient encounters. The sources of data are audiotapes and transcripts of two standardized patient cases presented by trained patient simulators to 43 primary care practitioners. Transcripts were scored for physician proficiency using expert-generated criteria and were content-analyzed to assess the process of communication and information content. Relevant patient disclosure was also scored from the transcripts based on expert-generated criteria. Findings were: 1) On the whole, physicians elicited only slightly more than 50% of the medical information considered important according to expert consensus, with a range from 9% to 85%. 2) Both open and closed questions were substantially related to patient disclosure of medical information to the physician, but open questions were substantially more so (Pearson correlations of 0.37 and 0.72, respectively). 3) Patient education, particularly information regarding prognosis, cause, and prevention, was substantially related to patient disclosure of medical information to the physician (Pearson correlations of 0.44, 0.36, and 0.34, respectively). 5) Finally, clinical expertise was only weakly associated with patient disclosure of medical information to the physician (Pearson correlation of 0.16).

Humans↗
PubMed2004

Wavelet-based processing of neuronal spike trains prior to discriminant analysis.

Investigations of neural coding in many brain systems have focused on the role of spike rate and timing as two means of encoding information within a spike train. Recently, statistical pattern recognition methods, such as linear discriminant analysis (LDA), have emerged as a standard approach for examining neural codes. These methods work well when data sets are over-determined (i.e., there are more observations than predictor variables). But this is not always the case in many experimental data sets. One way to reduce the number of predictor variables is to preprocess data prior to classification. Here, a wavelet-based method is described for preprocessing spike trains. The method is based on the discriminant pursuit (DP) algorithm of Buckheit and Donoho [Proc. SPIE 2569 (1995) 540-51]. DP extracts a reduced set of features that are well localized in the time and frequency domains and that can be subsequently analyzed with statistical classifiers. DP is illustrated using neuronal spike trains recorded in the motor cortex of an awake, behaving rat [Laubach et al. Nature 405 (2000) 567-71]. In addition, simulated spike trains that differed only in the timing of spikes are used to show that DP outperforms another method for preprocessing spike trains, principal component analysis (PCA) [Richmond and Optican J. Neurophysiol. 57 (1987) 147-61].

Action Potentials↗
PubMed1994

Maximal inspiratory pressure following endurance training at altitude.

Effects of endurance training on maximal inspiratory pressure and fatigue were evaluated after 5 weeks. Twelve male and 9 female untrained subjects were matched in the three groups for sex and maximal oxygen uptake (VO2 max). Training was performed at 70% VO2max; 45 min day-1; 5 days week-1 (n = 7); and at the same relative (n = 7) and absolute (n = 7) work loads in a pressure chamber corresponding to 2500 m (560 mmHg). Work load was increased every week to maintain the training heart rate. Maximal respiratory pressure was measured at the mouth before and 30, 60 and 120 s after maximal exercise. With no significant difference between the three groups of subjects, VO2max increased from 2.96 (1.98-4.47) (median and range for 21 subjects) to 3.33 (2.50-4.72) 1 min-1 (p < 0.001) and ventilation (VE max) from 109 (57-147) to 123 (73-148) 1 min-1 (p < 0.001), while maximal heart rate decreased from 193 (180-211) to 192 (169-207) beats min-1 (p < 0.01). Maximal inspiratory pressure (87 (56-115) mmHg), inspiratory muscle fatigue (18 (-2-43)%, p < 0.001), and arterial oxygen tension during exercise (12.4 (9.9-15.6)kPa) were similar before and after training. The results demonstrate that training at simulated altitude at 2500 m does not increase VE max or VO2 max above the increases obtained from training at sea level. Furthermore, VEmax and VO2 max increased approximately 13% despite unchanged maximal inspiratory pressure and inspiratory muscle fatigue.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2005

Can firefighter instructors perform a simulated rescue after a live fire training exercise?

Two studies were undertaken to determine whether firefighter instructors are capable of performing a simulated rescue task after undertaking a live fire training exercise (LFTE) lasting approximately 40 min. In the first study, ten instructors performed two simulated rescue tasks in air at 19 degrees C, involving dragging an 81-kg dummy for 15 m along a corridor and down two flights of stairs. The first rescue acted as a control (Rcontrol) and was conducted when they were euhydrated and normothermic. The second task was undertaken 10.4 (3.3) min [mean (SD)] after a LFTE resulting in an average rectal temperature of 38.1 (0.4) degrees C (Rhot). All instructors were able to successfully complete Rcontrol and Rhot in 90.1 (28.6) s and 78.7 (15.6) s respectively. Heart rate (HR) and rating of perceived exertion (RPE) were higher after the LFTE [162 (16) beats min(-1) versus 180 (15) beats min(-1); and 13.3 (2.4) versus 15.7 (2.1), respectively, P<0.001]. In the second study, six instructors (one instructor participated twice giving seven trials) undertook a simulated rescue task in 16 degrees C involving dragging an 85-kg dummy along a flat surface 79 (65) s after a LFTE that increased rectal temperature to 38.3 (0.7) degrees C. On six occasions the instructor was able to successfully complete the full 30-m drag in 41.7 (6.9) s and one instructor dragged the dummy for 20 m before stopping through exhaustion. HR during the rescue task reached 173 (19) beats min(-1) and RPE was 16.3 (2.4). In conclusion, most of the instructors were able to perform a rescue task after the LFTE, however they were close to their physical limit.

Adult↗
PubMed2005

Design considerations for computer-based surgical simulators.

Computers will allow the creation of novel training environments in ways that can only be imagined at the present time. The design of computer-based simulators for training of surgical procedures is a highly complex and ever-more sophisticated process. A thorough understanding of human learning principles as well as the capabilities and limitations of simulation training is required. Only development teams with expertise in medicine and surgery, computer science, hardware engineering, and simulation training will be able to create the useful surgical simulators of tomorrow.

Journal Article↗
PubMedDate not supplied

Virtual reality in ophthalmology training.

Current training models are limited by an unstructured curriculum, financial costs, human costs, and time constraints. With the newly mandated resident surgical competency, training programs are struggling to find viable methods of assessing and documenting the surgical skills of trainees. Virtual-reality technologies have been used for decades in flight simulation to train and assess competency, and there has been a recent push in surgical specialties to incorporate virtual-reality simulation into residency programs. These efforts have culminated in an FDA-approved carotid stenting simulator. What role virtual reality will play in the evolution of ophthalmology surgical curriculum is uncertain. The current apprentice system has served the art of surgery for over 100 years, and we foresee virtual reality working synergistically with our current curriculum modalities to streamline and enhance the resident's learning experience.

Computer Simulation↗
PubMed2003

[Effect of hypoxia on muscular performance capacity: "living low--training high"].

Altitude training is very popular among endurance athletes. But athletes respond very different on acute altitude exposure and altitude training. There are individual differences in the decrement of maximal oxygen consumption making general advices on the effect of altitude training very difficult. During the last few years different altitude training regimes have been developed. Beside "living high--training low," the concept of "living low--training high" becomes more and more popular. By this regime, athletes train under simulated or natural hypoxic conditions, while recovery time is spent at sea-level. Several studies show that with "living low--training high" maximal oxygen consumption as well as aerobic and anaerobic endurance performance can be improved. Molecular analysis reveal that a transcription factor called Hypoxia-Inducible Factor 1 (HIF-1) acts as a master gene in the regulation of hypoxia-dependent gene expression. In human skeletal muscle "living low-training high" induces the expression of glycolytic enzymes, the angiogenic factor VEGF, myoglobin as well as the increase of capillarity and mitochondrial content in parallel to the induction of the HIF-1 system. In trained human skeletal muscle, these adaptations cause a shift of substrate selection to an increased oxidation of carbohydrates as well as to an improvement of the conditions for transport and utilization of oxygen. Depending on the kind of sports, "living low--training high" can be used to train these muscular adaptations and to increase exercise performance.

Acid-Base Equilibrium↗
PubMed1977

Auditory reaction times for functional and nonfunctional hearing loss.

Differences in decision processes as measured by auditory reaction times of simulated or actual functional hearing-loss subjects and nonfunctional subjects were investigated. Sensation level data are presented that reflect marked differences between such individuals with regard to probability of response, and means and standard deviations of auditory reaction times. Means and standard deviations of auditory reaction times for nonfunctional subjects are greatly reduced when compared with results obtained by simulated or actual functional subjects. Probability of response data was less effective in differentiating functional from nonfunctional subjects. Individuals who were trained to simulate hearing loss responded in a manner similar to functional patients. The results of this study suggest that auditory reaction time measures can be employed to determine the existence or nonexistence of functional hearing loss with considerable accuracy.

Audiometry↗
PubMed2002

Earthquake drills and simulations in community-based training and preparedness programmes.

The San Francisco, California, bay area is subject to continuous seismic risk. One particular response has been the development of community-based training programmes designed to teach residents basic emergency response skills. Citizens are taught emergency medical techniques, search and rescue, fire suppression and other fundamental response skills. Current estimates in the Bay Area place the number of programmes at more than 100. Many programmes now include an annual community drill to reinforce the training and to evaluate the programme. The study described here is based on an evaluation of an effort initiated by BayNET (Bay Area Neighborhood Emergency Training), a voluntary association of communities with community-based disaster preparedness programmes. In April 1996, BayNET asked all of its members to hold a community earthquake drill. After the drill, a mail survey was conducted of all programme managers. The survey examined the structure and administration of the programmes, training efforts and other related components. This paper describes the typology of drill formats that communities used, the role of the simulation in the city's preparedness efforts, the qualitative costs and benefits, as well as an assessment of the drill based on survey respondents.

Community Participation↗
PubMed2026

Immersive virtual reality-assisted anatomy training improves endotracheal intubation performance in simulation: a randomized controlled trial among Chinese non-anesthesiology residents.

INTRODUCTION: This study aimed to compare immersive virtual reality (IVR)-assisted versus conventional anatomy training for teaching endotracheal intubation (ETI) to novice non-anesthesiology residents enrolled in China's Standardized Residency Training program. METHODS: A total of 90 non-anesthesiology residents without prior ETI experience were randomly assigned to either an IVR group receiving IVR-assisted anatomy training (n&#x2009;=&#x2009;45) or a control group receiving conventional anatomy training (n&#x2009;=&#x2009;45). All participants underwent a standardized teaching protocol. The primary endpoint was residents' ETI performance on a simulator, assessed using both the Global Rating Scale (GRS) and a task-specific checklist. The secondary endpoints included changes in written multiple-choice question (MCQ) scores and residents' evaluations of the course. RESULTS: In practical ETI assessments on a manikin, the IVR group achieved significantly higher scores on the task-specific checklist than the control group (90.34&#x2009;&#xb1;&#x2009;2.89 vs. 87.20&#x2009;&#xb1;&#x2009;3.29; p&#x2009;<&#x2009;0.001), whereas GRS scores were comparable between groups. Both groups showed significant post-training improvement in knowledge scores (p&#x2009;<&#x2009;0.001), with the IVR group showing a greater gain in theoretical knowledge (54.0% vs. 36.3%; p&#x2009;<&#x2009;0.001). Participants in the IVR group also expressed a stronger preference for their training method (80.8%) and reported higher levels of motivation, confidence, and enjoyment (all p&#x2009;<&#x2009;0.05). CONCLUSION: IVR-assisted anatomy training enhances the effectiveness of ETI training for novice non-anesthesiology residents, offering an interactive, engaging, and reproducible approach within China's Standardized Residency Training framework.

Humans↗
PubMed2002

Training and assessment of laparoscopic skills using a haptic simulator.

Surgical simulation is a promising technique for training of laparoscopic surgery. Computer based simulation provides not only a cost effective alternative to traditional training but also a way to assess the surgeons performance. In this paper, we present a haptic simulator that allows for training and assessment of basic laparoscopic skills. The skills trained are modeled around a cholecystectomy procedure and include bi-manual dissection, clips setting, catheter insertion and cutting. The system uses accurate anatomic models of the organs involved in the procedure. This combined with effective methods for soft tissue deformation and haptic feedback, giving the surgeon a precise feeling of the interaction between organs and surgical instruments, provides a realistic training environment. The system has been designed with procedural training in mind and by putting together the individual tasks it will be possible to train on performing a complete cholecystectomy procedure.

Anatomy, Cross-Sectional↗
PubMed2026

Standardized visual overlays enhance laparoscopic instruction: A mixed-methods evaluation.

Effective communication during laparoscopic procedures is frequently undermined by spatial disorientation and inconsistent terminology between instructors and trainees. This study examined whether standardized visual overlays on endoscopic monitors could enhance communication and learning. We conducted a three-phase mixed-methods study: qualitative observation of 20 laparoscopic teaching cases; a randomized trial of 63 second-year medical students assigned to control, clock, or alphanumeric grid (AG) overlays during three trials of a standardized transfer task; and intraoperative implementation in 44 cases (30 AG, 14 clock) with post-case surveys and qualitative feedback. In simulation, the clock overlay produced the fastest completion times, whereas the AG yielded the lowest error scores, and both overlays outperformed the control. Intraoperatively, the AG was rated higher than the clock for communication clarity, spatial orientation, perceived operative efficiency, and trainee confidence. Standardized visual overlays, particularly the AG, appear to support intraoperative teaching by providing a shared spatial frame of reference.

Laparoscopy↗