PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Simulation Training”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 757 records · Page 42Linked to original sources
PubMed1999

Robotics for surgery.

Robotic technology is enhancing surgery through improved precision, stability, and dexterity. In image-guided procedures, robots use magnetic resonance and computed tomography image data to guide instruments to the treatment site. This requires new algorithms and user interfaces for planning procedures; it also requires sensors for registering the patient's anatomy with the preoperative image data. Minimally invasive procedures use remotely controlled robots that allow the surgeon to work inside the patient's body without making large incisions. Specialized mechanical designs and sensing technologies are needed to maximize dexterity under these access constraints. Robots have applications in many surgical specialties. In neurosurgery, image-guided robots can biopsy brain lesions with minimal damage to adjacent tissue. In orthopedic surgery, robots are routinely used to shape the femur to precisely fit prosthetic hip joint replacements. Robotic systems are also under development for closed-chest heart bypass, for microsurgical procedures in ophthalmology, and for surgical training and simulation. Although results from initial clinical experience is positive, issues of clinician acceptance, high capital costs, performance validation, and safety remain to be addressed.

Biomedical Engineering↗
PubMedDate not supplied

Elastodynamic shape modeler: a tool for defining the deformation behavior of virtual tissues.

A main goal of surgical simulators is the creation of virtual training environments for prospective surgeons. Thus, students can rehearse the various steps of surgical procedures on a computer system without any risk to the patient. One main condition for realistic training is the simulated interaction with virtual medical devices, such as endoscopic instruments. In particular, the virtual deformation and transection of tissues are important. For this application, a neuro-fuzzy model has been developed, which allows the description of the visual and haptic deformation behavior of the simulated tissue by means of expert knowledge in the form of medical terms. Pathologic conditions affecting the visual and haptic tissue response can be easily changed by a medical specialist without mathematical knowledge. By using the personal computer-based program Elastodynamic Shape Modeler, these conditions can be adjusted via a graphical user interface. With a force feedback device, which is similar to a real laparoscopic instrument, virtual deformations can be performed and the resulting haptic feedback can be felt. Thus, use of neuro-fuzzy technologies for the definition and calculation of virtual deformations seems applicable to the simulation of surgical interventions in virtual environments.

Computer Graphics↗
PubMed2003

Hyperpolarization-activated current (Ih) in the inferior colliculus: distribution and contribution to temporal processing.

Neurons in the inferior colliculus (IC) process acoustic information converging from inputs from almost all nuclei of the auditory brain stem. Despite its importance in auditory processing, little is known about the distribution of ion currents in IC neurons, namely the hyperpolarization-activated current Ih. This current, as shown in neurons of the auditory brain stem, contributes to the precise analysis of temporal information. Distribution and properties of the Ih current and its contribution to membrane properties and synaptic integration were examined by current- and voltage-clamp recordings obtained from IC neurons in acute slices of rats (P17-P19). Based on firing patterns to positive current injection, three basic response types were distinguished: onset, adapting, and sustained firing neurons. Onset and adapting cells showed an Ih-dependent depolarizing sag and had a more depolarized resting membrane potential and lower input resistance than sustained neurons. Ih amplitudes were largest in onset, medium in adapting, and small in sustained neurons. Ih activation kinetics was voltage dependent in all neurons and faster in onset and adapting compared with sustained neurons. Injecting trains of simulated synaptic currents into the neurons or evoking inhibitory postsynaptic potentials (IPSPs) by stimulating the lemniscal tract showed that Ih reduced temporal summation of excitatory and inhibitory potentials in onset but not in sustained neurons. Blocking Ih also abolished afterhyperpolarization and rebound spiking. These results suggest that, in a large proportion of IC cells, namely the onset and adapting neurons, Ih improves precise temporal processing and contributes to the temporal analysis of input patterns.

Animals↗
PubMed2002

Unitary events in multiple single-neuron spiking activity: II. Nonstationary data.

In order to detect members of a functional group (cell assembly) in simultaneously recorded neuronal spiking activity, we adopted the widely used operational definition that membership in a common assembly is expressed in near-simultaneous spike activity. Unitary event analysis, a statistical method to detect the significant occurrence of coincident spiking activity in stationary data, was recently developed (see the companion article in this issue). The technique for the detection of unitary events is based on the assumption that the underlying processes are stationary in time. This requirement, however, is usually not fulfilled in neuronal data. Here we describe a method that properly normalizes for changes of rate: the unitary events by moving window analysis (UEMWA). Analysis for unitary events is performed separately in overlapping time segments by sliding a window of constant width along the data. In each window, stationarity is assumed. Performance and sensitivity are demonstrated by use of simulated spike trains of independently firing neurons, into which coincident events are inserted. If cortical neurons organize dynamically into functional groups, the occurrence of near-simultaneous spike activity should be time varying and related to behavior and stimuli. UEMWA also accounts for these potentially interesting nonstationarities and allows locating them in time. The potential of the new method is illustrated by results from multiple single-unit recordings from frontal and motor cortical areas in awake, behaving monkey.

Action Potentials↗
PubMed2005

NMDA/AMPA ratio impacts state transitions and entrainment to oscillations in a computational model of the nucleus accumbens medium spiny projection neuron.

We describe a computational model of the principal cell in the nucleus accumbens (NAcb), the medium spiny projection (MSP) neuron. The model neuron, constructed in NEURON, includes all of the known ionic currents in these cells and receives synaptic input from simulated spike trains via NMDA, AMPA, and GABAA receptors. After tuning the model by adjusting maximal current conductances in each compartment, the model cell closely matched whole-cell recordings from an adult rat NAcb slice preparation. Synaptic inputs in the range of 1000-1300 Hz are required to maintain an "up" state in the model. Cell firing in the model required concurrent depolarization of several dendritic branches, which responded independently to afferent input. Depolarization from action potentials traveled to the tips of the dendritic branches and increased Ca2+ influx through voltage-gated Ca2+ channels. As NMDA/AMPA current ratios were increased, the membrane showed an increase in hysteresis of "up" and "down" state dwell times, but intrinsic bistability was not observed. The number of oscillatory inputs required to entrain the model cell was determined to be approximately 20% of the "up" state inputs. Altering the NMDA/AMPA ratio had a profound effect on processing of afferent input, including the ability to entrain to oscillations in afferent input in the theta range (4-12 Hz). These results suggest that afferent information integration by the NAcb MSP cell may be compromised by pathology in which the NMDA current is altered or modulated, as has been proposed in both schizophrenia and addiction.

Animals↗
PubMed1994

EPIZOO: a computer software package of methods for animal population health analysis and programming.

An animal population health and disease software package entitled 'EPIZOO' has been developed. This computer program comprises an integral and complex system of selected indicators contained in ten modules and over one hundred sub-programs, with approximately two hundred methods for use in problem solving, training and simulation. This fully user-friendly software is applicable to any animal disease, and makes analysis and programming easier and quicker. The software includes general methods for use in a number of fields: animal population health and disease situation (structure, dynamics, diagnosis, analysis and consequences) animal population characteristics of epizootiological importance animal health programme preparation, cost calculation and evaluation selected sampling other statistical procedures. EPIZOO is a relatively simple tool for field and management veterinarians, as well as veterinary students.

Animal Diseases↗
PubMed1988

Nitrogen metabolism in mature horses at varying levels of work.

Nitrogen metabolism was measured in five mature geldings performing varying levels of work that simulated race training. Following an initial maintenance period without forced exercise, workload was increased in succeeding 18-d periods by doubling the distance the horses were galloped in each period from period 2 through 4. A 4-d N balance experiment was conducted at the end of each 18-d period. The maximum distance galloped daily, which was in period 4, was repeated in period 5. Then, workloads were decreased through period 7. Nitrogen balance was determined in two additional periods, 8 and 9, while the geldings were at maintenance with no forced exercise. Geldings were fed diets containing similar protein-to-calorie ratios in all periods. Nitrogen retention increased (P less than .05) as workload increased from period 1 to period 3 and remained elevated throughout the rest of the experiment. Nitrogen retention did not (P greater than .05) decrease from highest values, observed at maximum workload during periods 4 and 5, until period 9, which was 34 d postexercise during a maintenance period. Nitrogen retention was higher (P less than .05) following training than before training.

Animals↗
PubMed2000

How does human error affect safety in anesthesia?

Anesthesia morbidity and mortality, while acceptable, are not zero. Most mishaps have a multifactorial cause in which human error plays a significant part. Good design of anesthesia machines, ventilators, and monitors can prevent some, but not all, human error. Attention to the system in which the errors occur is important. Modern training with simulators is designed to reduce the frequency of human errors and to teach anesthesiologists how to deal with the consequences of such errors.

Anesthesia↗
PubMed2000

Material property determination of sub-surface objects in a viscoelastic environment.

Modeling human organs and soft tissue or anatomic regions for the purpose of medical training and simulation is a relatively new area. The data presented here is the groundwork for our ongoing development of a real-time haptic virtual environment for abdominal soft tissue palpation. The purpose of modeling the human abdomen is twofold. First, to provide a mathematical description of soft tissue and organs and second, to simulate the behavior of realistic interactions in real-time within a virtual environment. We have developed a, non-invasive, system that will allow us to determine mathematical functions that model the deformation of individual layers of soft tissue within the human abdomen. This system has been tested, experimentally, with a viscoelastic polyester foam model. We have been able to determine the stiffness and force/displacement function of an object beneath two layers of foam having different material characteristics. These experimental results correlate well with known polyester foam material characteristics. In general, the calculated stiffness constants were within 5% of the actual value. The data presented in this study shows that this system may be a viable tool for accurate measurement of human soft tissue properties and behavioral response to palpation.

Abdomen↗
PubMed2001

Psychological casualties resulting from chemical and biological weapons.

This symposium addresses the complications encountered by medical planners when confronted by the use or threat of the use of weapons of mass destruction. The types of chemical warfare agents (CWA), their principal target organs, and physiological effects are discussed. We have reviewed the use of CWA in 20th century warfare and otherwise with emphasis on five cases: (1) use of sulfur mustard during World War I; (2) use by Italy against Ethiopia; (3) use in the Sino-Japanese War; (4) relatively well-studied use in the Iran-Iraq conflict; and (5) the use of sarin in the Tokyo subway terrorist incident. We reviewed the additional physiological and psychological consequences of their use and threat of use. Results from training and simulation are discussed. Finally, we present our conclusions derived from the analysis of these historical situations.

Biological Warfare↗
PubMed2004

Impact of an educational intervention to improve prescribing by private physicians in Uganda.

INTRODUCTION: Private physicians in urban Uganda treat a large percentage of common adult illnesses. Improving their prescribing would not only encourage more rational drug use, but also reduce costs to patients. Interventions to improve drug use are generally more successful when face-to-face educational methods are included. OBJECTIVES: To determine the effectiveness of a face-to-face educational intervention on the treatment of acute respiratory infections (ARI), malaria, and non-dysenteric diarrhoea by private physicians in three urban areas of Uganda. METHODS: The study used an intervention with comparison group design to evaluate the impact of the educational intervention. A total of 108 private physicians was divided into intervention (n = 30) and control (n = 78) groups. Surrogate patients, trained to simulate presenting symptoms and signs of the target conditions, were used to collect data on the medical practices and prescribing behaviours of the physicians. Intervention physicians were invited to a one-day interactive educational seminar facilitated by local opinion leaders that covered principles of rational drug use and the National Standard Treatment Guidelines for treating the target conditions. Physicians were also provided with data about baseline practices. RESULTS: Baseline data indicated high rates of inappropriate treatment practices by both intervention and control groups. There was nearly universal antibiotic use for ARI (over 90%), high rates of injections recommended for malaria (over 30%), and high rates of polypharmacy (over thee drugs per patient). After the intervention, some significant improvements in key practices were observed in the intervention group. Compared to control physicians, antibiotic prescribing for ARI decreased by 23% in the intervention group, use of combination products for malaria declined by 28%, there were trends towards better adherence to guidelines for ARI and malaria, and marginal decreases in drug costs. However, the overall impacts of the intervention were limited, especially on quality indicators concerning history taking, adequate examination, and advice to patients. CONCLUSION: The face-to-face educational intervention resulted in some small improvements in key prescribing practices of private physicians. However, an intervention that involved repeated contacts with prescribers and which addressed economic considerations would be needed to obtain larger improvements. Private physicians need to be sensitized to and encouraged to use the National Standard Treatment Guidelines, and attempts to improve their prescribing should be supported by community education.

Acute Disease↗
PubMedDate not supplied

[Socio-psychological and ecological aspects within the system of nuclear radiation risk mitigation].

The authors bring into light several aspects of nuclear radiation risks, i.e. physical safety of nuclear technologies and ecology, place of operator within the nuclear radiation safety system (proficiency, protective culture, safety guides) and consider approaches to the human factor quantification within the system of mitigation of risks from nuclear technologies, and IAEA recommendations on probable risk estimation. Future investigations should be aimed at extension of the radiation sensitivity threshold, personnel selection as by psychological so genetic testing for immunity to ionizing radiation, development of pharmachemical and physical protectors and methods of enhancing nonspecific resistance to extreme, including radiation, environments, and building of radiation event simulators for training.

Ecology↗
PubMed2005

[Bioterrorism].

Biological terrorism is intentionally to use infectious substances for developing diseases or death in animals or humans, leading to disaster and panic in our community. Bioterrorism-associated diseases are mostly rare or eradicated infectious diseases, and recently, we do not have experience to make a clinical and laboratory diagnosis. In particular, these infectious diseases have incubation periods from infection to development of the disease. The staff working at public health institutions, including legal medicine, must be involved in as a first responder when bioterrorism would happen. The preparedness in general against bioterrorism and the bioterrorism-related diseases, such as anthrax, smallpox, viral hemorrhagic fever, tularemia, and botulinum toxin, important for us are described. Both medical knowledge of bioterrorism and the preparedness with training under simulation should be required in advance.

Animals↗
PubMed2005

The use of OSCE (Objective Structured Clinical Examination) as an assessment tool--initial experiences at the University of Malaya.

Formative and summative student assessment has always been of concern to medical teachers, and this is especially important at the level of graduating doctors. The effectiveness and comprehensiveness of the clinical training provided is tested with the use of clinical cases, either with real patients who have genuine medical conditions, or with the use of standardised patients who are trained to simulate accurately actual patients. The Objective Structured Clinical Examination (OSCE) is one method of assessing the adequacy of clinical skills of medical students, and their level of competence. It can be used to test a variety of skills such as history taking (communication and interpersonal skills) and performing aspects of physical examination, undertaking emergency procedures, and interpreting investigational data. It can also be used to ensure an adequate depth and breadth of coverage of clinical skills expected of a graduating doctor.

Clinical Competence↗
PubMed2006

[Clinical value of multislice spiral CT in caudal block].

OBJECTIVE: To explore a new method for body surface orientation of the puncture site, determination of the direction of the needling and puncture depth for caudal block. METHODS: Three-dimensional reconstruction of the pelvis was performed in 8 cases for measuring the distances between the sacral hiatus and the planned site of anesthetic delivery and the size of the sacral hiatus. After image processing with the technique of shaded surface display (SSD), the shapes of sacral hiatus and sacral tube were evaluated. RESULTS: Three-dimensional reconstruction of the pelvis in the 8 cases allowed clear view from any directions of the sacral hiatus and sacral tube and accurate measurement of the size of the sacral hiatus. After simulated cutting of half of the rumpbone, the distances between the sacral hiatus and the drug injection site were accurately measured. With these measurements, accurate preoperative localization of the puncture site on the skin was achieved and the anesthesia was successful in all the cases. CONCLUSIONS: This technique can provide accurate data for localization of the puncture site on the skin and determination of the direction of the needling and the puncture depth for caudal block to increase the successful rate of anesthesia, lower the operative risks and allow simulated operative training.

Adolescent↗
PubMed2006

Patient safety: a tale of two institutions.

The Johns Hopkins Medical Institutions and the University of Pittsburgh Medical Center are both working to improve patient safety. Johns Hopkins is focused on creating a culture of safety--frontline interventions at its Children's Center include a focus on the "Culture of Safety" and three programs that use information technology to "fix the broken medication process." Quantitative data indicate these programs are making care safer. At UPMC, efforts launched under the Robert Wood Johnson Foundation and the Institute of Health Care Improvement, a program named Transforming Care at the Bedside, are redesigning care processes to support nurses and focus on patients. Interventions include family-initiated rapid response teams and other changes designed to streamline processes and use information technology to make care patient-centered. Simulation-based training targets critical procedures and performance for physicians and nurses, and a "smart room" is slated for development.

Baltimore↗
PubMed1986

Image processing--principles and its future applications in reconstructive and aesthetic plastic surgery.

Although the great importance of the visual aspect to medical science, and plastic surgery in particular, is beyond doubt, the utilization of image systems for transmission, storage, and processing of images is not at all widespread. The main reason for this phenomenon is that owing to the high complexity of imaging-related equipment, in comparison with other means such as audio equipment (telephone, tape recorders, and so on), more complicated systems are required, including wider broadcasting channels, much larger storage capacities, and higher processing speeds than are available now. Except for extensive research and development activities in the universities, research institutes, and military organizations, the large potential of the artificial visual aspect is not commonly utilized. In the future, efficient utilization of image processing capabilities in the service of plastic surgery will be achieved by the emerging capabilities for many complicated procedures. These include huge image data base processing, automatic detection of pathologic cases by enhancement of details and recognition of patterns, accurate measurements of the changes and distortions in the processed images, prediction of results to allow planning of treatment, simulation, and training on computerized cases. The new capabilities also include visual control of robotic arms for complicated operations, better audio-visual communication between faraway clinics and medical centers via sophisticated teleconferencing systems--which will save traveling expenses and time and will enable the updating of medical information--and many more applications that will be developed when the basic equipment becomes an integrated part of the clinics and plastic surgery departments. Future image processing will enhance the visual aspect in the plastic surgeon's work and will enable the doctor to expand his or her professional capabilities.

Automation↗