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At least 955 records · Page 53Linked to original sources

PubMed1999

Cardiac biomagnetic source estimation with a heart-torso model and a trained neural network.

The intensity of the cardiac sources for normal adult subjects was estimated from given magnetic field profiles with a trained neural network based on the relationship of the electrical activity of the heart to the cardiac magnetic fields. The input for training the neural network consisted of the magnetic field profiles above the torso during the heartbeat. The outputs were the dipole intensities which produced those magnetic field profiles. A back propagating algorithm with bias and momentum was utilized for training. The measured and simulated torso magnetic field profiles and magnetocardiograms were used for training the neural network. Estimation of the dipole intensities was performed for unknown magnetic field profiles with the trained neural network. The estimated cardiac dipole intensities were reasonably close to the true dipole intensities. These results show the feasibility of the estimation of cardiac dipole intensities with a trained neural network under a very restricted forward model of the cardiac magnetic fields. Generalization of the results to cover a large population base could be difficult because the activation isochrones are different from subject to subject.

Adult↗

PubMed1996

Casualty modeling for real-time medical training.

We present a model for simulating casualties in virtual environments for real-time medical training. It allows a user to choose diagnostic and therapeutic actions to carry out on a simulated casualty who will manifest appropriate physiological, behavioral, and physical responses. Currently, the user or a "stealth instructor" can specify one or more injuries that the casualty has sustained. The model responds by continuously determining the state of the casualty, responding appropriately to medical assessment and treatment procedures. So far, we have modeled four medical conditions and over 20 procedures. The model has been designed to handle the addition of other injuries and medical procedures.

Computer Simulation↗

PubMed2001

Military medical modeling and simulation in the 21st century.

As we enter the 21st century, military medicine struggles with critical issues. One of the most important issues is how to train medical personnel in peace for the realities of war. In April, 1998, The General Accounting Office (GAO) reported, "Military medical personnel have almost no chance during peacetime to practice battlefield trauma care skills. As a result, physicians both within and outside the Department of Defense (DOD) believe that military medical personnel are not prepared to provide trauma care to the severely injured soldiers in wartime. With some of today's training methods disappearing, the challenge of providing both initial; and sustainment training for almost 100,000 military medical personnel is becoming insurmountable. The "training gap" is huge and impediments to training are mounting. For example, restrictions on animal use are increasing and the cost of conducting live mass casualty exercises is prohibitive. Many medical simulation visionaries believe that four categories of medical simulation are emerging to address these challenges. These categories include PC-based multimedia, digital mannequins, virtual workbenches, and total immersion virtual reality (TIVR). The use of simulation training can provide a risk = free realistic learning environment for the spectrum of medical skills training, from buddy-aid to trauma surgery procedures. This will, in turn, enhance limited hands on training opportunities and revolutionize the way we train in peace to deliver medicine in war. High-fidelity modeling will permit manufacturers to prototype new devices before manufacture. Also, engineers will be able to test a device for themselves in a variety of simulated anatomical representations, permitting them to "practice medicine".

Computer Simulation↗

PubMed2006

Simulation improves resident performance in catheter-based intervention: results of a randomized, controlled study.

OBJECTIVES: Surgical simulation has been shown to enhance the training of general surgery residents. Since catheter-based techniques have become an important part of the vascular surgeon's armamentarium, we explored whether simulation might impact the acquisition of catheter skills by surgical residents. METHODS: Twenty general surgery residents received didactic training in the techniques of catheter intervention. Residents were then randomized with 10 receiving additional training with the Procedicus, computer-based, haptic simulator. All 20 residents then participated in 2 consecutive mentored catheter-based interventions for lower extremity occlusive disease in an OR/angiography suite. Resident performance was graded by attending surgeons blinded to the resident's training status, using 18 procedural steps as well as a global rating scale. RESULTS: There were no differences between the 2 resident groups with regard to demographics or scores on a visuospatial test administered at study outset. Overall, residents exposed to simulation scored higher than controls during the first angio/OR intervention: procedural steps (simulation/control) (50 +/- 6 vs. 33 +/- 9, P = 0.0015); global rating scale (30 +/- 7 vs. 19 +/- 5, P = 0.0052). The advantage provided by simulator training persisted with the second intervention (53 +/- 6 vs. 36 +/- 7, P = 0.0006); global rating scale (33 +/- 6 vs. 21 +/- 6, P = 0.0015). Moreover, simulation training, particularly for the second intervention, led to enhancement in almost all of the individual measures of performance. CONCLUSION: Simulation is a valid tool for instructing surgical residents and fellows in basic endovascular techniques and should be incorporated into surgical training programs. Moreover, simulators may also benefit the large number of vascular surgeons who seek retraining in catheter-based intervention.

Angiography↗

PubMed2006

Report of a group developing a virtual reality simulator for arthroscopic surgery of the knee joint.

Apprenticeship training of surgical skills is time consuming and can lead to surgical errors. Our group is developing an arthroscopic virtual reality knee simulator for training orthopaedic residents in arthroscopic surgery before live-patient operating room experience. The simulator displays realistic human knee anatomy derived from the Visible Human Dataset developed by the National Library of Medicine and incorporates active force-feedback haptic technology. Our premise is that postgraduate year 2 residents completing a formal virtual education program who are trained to reach a proficiency standard in the techniques and protocol for an arthroscopic knee examination will complete a diagnostic arthroscopy on an actual patient in less time with greater accuracy, less iteration of movement of the arthroscope, and less damage to the patient's tissue compared with residents in the control group learning and practicing the arthroscopic knee examination procedures through the residency program's established education and training program. The validation study, done at eight orthopaedic residency programs, will commence in early 2006 and will take one year to complete. We anticipate that proficiency obtained on the simulator will transfer to surgical skills in the operating room.

Arthroscopy↗

PubMed1992

The Bezold-Brücke effect in the color vision system of the honeybee.

Evidence is presented that intensity dependent color shifts (Bezold-Brücke effect) occur in the color vision system of the honeybee. The evidence comes from a fit between the choices of monochromatic lights in training experiments (Menzel, R., 1981; Journal of Comparative Physiology A, 141, 389-393) and the choice percentages derived now from recently presented quantitative predictions from the color opponent coding (COC) model for the bee (Backhaus, W., 1991; Vision Research, 31, 1381-1397) for the Bezold-Brücke effect. The only open parameter in the simulations of the training experiments is an experiment type dependent factor describing the weighting of color differences (judgement values) in the choice behavior. The results show (1) that the Bezold-Brücke effect exists in the bee. The results (2) confirm the color opponent coding (COC) model which was developed to describe the physiological components of the color vision system in the bee, (3) the general psychophysical assumptions about the structure of the color space, (4) the color difference formula, and (5) the general psychophysical assumptions about the (triadic) structure of judgements as tested in color similarity experiments.

Animals↗

PubMed2006

Simulation and virtual reality in medical education and therapy: a protocol.

Continuing medical education has historically been provided primarily by didactic lectures, though adult learners prefer experiential or self-directed learning. Young physicians have extensive experience with computer-based or "video" games, priming them for medical education--and treating their patients--via new technologies. We report our use of standardized patients (SPs) to educate physicians on the diagnosis and treatment of biological and chemical warfare agent exposure. We trained professional actors to serve as SPs representing exposure to biological agents such as anthrax and smallpox. We rotated workshop participants through teaching stations to interview, examine, diagnose and treat SPs. We also trained SPs to simulate a chemical mass casualty (MASCAL) incident. Workshop participants worked together to treat MASCAL victims, followed by discussion of key teaching points. More recently, we developed computer-based simulation (CBS) modules of patients exposed to biological agents. We compare the strengths and weaknesses of CBS vs. live SPs. Finally, we detail plans for a randomized controlled trial to assess the efficacy of virtual reality (VR) exposure therapy compared to pharmacotherapy for post-traumatic stress disorder (PTSD). PTSD is associated with significant disability and healthcare costs, which may be ameliorated by the identification of more effective therapy.

Biological Warfare↗

PubMed2006

The assessment and treatment of the acutely ill patient--the role of the patient simulator as a teaching tool in the undergraduate programme.

The assessment and treatment of the acutely ill patient is an essential part of the role of the pre-registration house officer, and research has demonstrated that management of such patients in the ward setting is often sub-optimal. However, this is an area which is difficult to teach at an undergraduate level, particularly without exposing patients to unnecessary risk. A patient simulator such as the SimMan could allow these issues to be addressed in a safe, reproducible and controlled environment. A protocol for the assessment and treatment of the acutely ill patient was designed. This was then implemented using a series of three teaching sessions during which small groups of final year medical students took part in simulated clinical scenarios on the SimMan mannequin. A questionnaire was administered to participating students before and after teaching to assess their perceived confidence and competence in a number of areas deemed important for newly qualified house officers. Data from 23 students were obtained and demonstrated a significant improvement in students' perceived levels of confidence and competence following training on the simulator. Feedback from students was extremely positive with all students reporting that sessions were a valuable addition to the final year programme. The SimMan allows students to gain knowledge and skills in a vital area of clinical practice which hitherto had been poorly covered within the curriculum. The sessions will be incorporated into the teaching programme for all future final-year students.

Acute Disease↗

PubMed1992

Implications of lower- and upper-limb training procedures in patients with chronic airway obstruction.

In assessing the effectiveness of lower-limb and upper-limb nonspecific physical training, we have considered 3 objectives in this study: (1) determination of clinical and functional actual state in patients with chronic airway obstruction (CAO), before and after training; (2) determination of the tests, level of work, and duration of the session training as well as how to increase the training load throughout the training program; and (3) the "particular" upper-limb exercise training in patients with CAO. Many personal factors such as psychologic (personality, degree of patient motivation), alcohol and smoking habits, physical activity, malnutrition, as well as routine tests, at rest and maximal exercise, including the control of metabolic acidosis (lactate) and arterial blood gases (or at least of SaO2), should be considered. Exercise training has the potential to improve exercise tolerance in those who develop metabolic acidosis. The pattern of lactates during exercise represents a good criterion on the selection of patient's training. Two ergospirometric strategies, at high intensity exercise, established from the anaerobic threshold (AT) are described: (a) the above AT 45 min constant exercise (high work rate), at 60% of the difference between AT and maximum VO2 or 80% of the maximal tolerated power (MTP), and (b) the "45 min square-wave endurance exercise test" (SWEET), simulating an interval training session, established from the MTP and the AT. To the SWEET's base (% MTP from AT or aerobic training), a peak of 60 s at MTP (anaerobic training) is added every 5 min. While those 2 protocols, after 6 to 8 weeks of training, lactate and ventilation were lower for identical work rate. In addition, endurance (time in "a" and total physical work in "b") increased up to 60%. Further, maximal exercise ventilation and maximum VO2 increased after SWEET training. Roughly every 7 training sessions, a 10% to 15% reduction in heart rate (HR), during the training program, allows the patient to increase the work rate of the sessions. Evaluation of training the upper limb in patients with CAO requires measurements of MTP and maximum VO2. With the upper limb (wheelchair ergometer), Wmax, maximum VO2, and HR represent 30%, 65%, and 95%, respectively, of the lower limb (ergometer). Further, some expiratory and inspiratory accessory muscles show electromyographic fatigue at the MTP upper-limb level. This may contribute to the rationale for training respiratory muscles.(ABSTRACT TRUNCATED AT 400 WORDS)

Acidosis, Lactic↗

PubMed2001

Outlet Dysfunction Constipation.

The diagnosis of outlet dysfunction constipation in patients with idiopathic constipation that responds poorly or not at all to conservative measures, such as fiber supplements, fluids, and stimulant laxatives, is based upon diagnostic testing. These tests include colonic transit of radio-opaque markers, anorectal manometry or electromyography, barium defecography, and expulsion of a water-filled balloon. The literature suggests that conditions such as pelvic floor dyssynergia exist but may be over-diagnosed as a laboratory artifact. In our laboratory, we screen patients with balloon expulsion studies, and then test for dyssynergia only if the result of the balloon expulsion test is abnormal. In my opinion, anal sphincter electromyogram and manometry are equivalent in establishing the diagnosis. Barium defecography is helpful in making a diagnosis of a rectocele, but I prefer to document that vaginal pressure on the rectocele significantly improves rectal evacuation. Manometry also helps to establish the presence of megarectum, hypotonia, and weak expulsion efforts. Conceptually, biofeedback training, which incorporates simulated defecation, is the most logical approach to pelvic floor dyssynergia. It incurs no risk and benefits 60% to 80% of patients. The drawbacks are the time-intensive nature of the therapy and the short-term costs, which are offset if there is sustained benefit. There is no evidence that biofeedback is helpful in children with constipation. Habit training has established benefits, but recurrences are frequent and long-term reinforcement is helpful to maintain success. Laxatives and enemas are adjunctive therapies in both habit training and biofeedback. Surgery is effective in those uncommon patients with physiologically significant rectoceles, but surgical division of the puborectalis muscle is risky and unproven. Likewise, botulinum toxin injection into the puborectalis is unproven, but the effects are rarely permanent should incontinence occur. Diagnostic measures and therapeutic success are enhanced when patients are seen in centers experienced with the evaluation of these disorders.

Journal Article↗

PubMed2006

A longitudinal study of internal medicine residents' retention of advanced cardiac life support skills.

BACKGROUND: Internal medicine residents must be competent in Advanced Cardiac Life Support (ACLS) for board certification. Traditional ACLS courses have limited ability to enable residents to achieve and maintain skills. Educational programs featuring reliable measurements and improved retention of skills would be useful for residency education. METHOD: We developed a training program using a medical simulator, small-group teaching and deliberate practice. Residents received traditional ACLS education and subsequently participated in four two-hour educational sessions using the simulator. Resident performance in six simulated ACLS scenarios was assessed using a standardized checklist. RESULTS: After the program, resident ACLS skill improved significantly. The cohort was followed prospectively for 14 months and the skills did not decay. CONCLUSIONS: Use of a simulation-based educational program enabled us to achieve and maintain high levels of resident performance in simulated ACLS events. Given the limitations of traditional methods to train, assess and maintain competence, simulation technology can be a useful adjunct in high-quality ACLS education.

Advanced Cardiac Life Support↗

PubMed1999

CathSim: an intravascular catheterization simulator on a PC.

The development of a medical simulator that incorporates substantial training value and realism into an affordable product has been a huge challenge for the simulation community. A large hurdle to making an inexpensive simulator has been the high cost of the computers needed for adequate realism. We have met this challenge by developing CathSim, a low-cost medical simulator that integrates force feedback, multimedia, and 3D graphics simulation technology on an industry standard PC. This product is commercially available and is currently being used by numerous training institutions and hospitals. The CathSim system includes software and a force feedback interface device. The platform and device can be used to train health care providers to perform needle-stick medical procedures. Our first module teaches users the techniques of peripheral intravenous (i.v.) catheterization. Other training modules that will be added to the CathSim platform include central venous catheter (CVC) insertion and peripherally inserted central catheter (PICC) placement. This paper discusses the challenges of this project and the trade-offs and solutions that we developed to overcome them. We describe our process of analyzing and prioritizing the medical tasks necessary to correctly perform peripheral intravenous catheterization. This analysis and prioritization was used to decide which tasks would be included in the simulator and how the included tasks would be replicated. We discuss the method by which we obtained the needed realism in the 3D graphics rendering and in the tactile feedback of the input device. We illustrate how we blended together simulation and multimedia technology to ensure adequate immersion and training efficacy, while keeping the system cost to a minimum.

Computer Simulation↗

PubMed2003

Rasmussen's model of human behavior in laparoscopy training.

AIMS: Compared to aviation, where virtual reality (VR) training has been standardized and simulators have proven their benefits, the objectives, needs, and means of VR training in minimally invasive surgery (MIS) still have to be established. The aim of the study presented is to introduce Rasmussen's model of human behavior as a practical framework for the definition of the training objectives, needs, and means in MIS. METHODS: Rasmussen distinguishes three levels of human behavior: skill-, rule-, and knowledge-based behaviour. The training needs of a laparoscopic novice can be determined by identifying the specific skill-, rule-, and knowledge-based behavior that is required for performing safe laparoscopy. Future objectives of VR laparoscopy trainers should address all three levels of behavior. RESULTS: Although most commercially available simulators for laparoscopy aim at training skill-based behavior, especially the training of knowledge-based behavior during complications in surgery will improve safety levels. However, the cost and complexity of a training means increases when the training objectives proceed from the training of skill-based behavior to the training of complex knowledge-based behavior. CONCLUSION: In aviation, human behavior models have been used successfully to integrate the training of skill-, rule-, and knowledge-based behavior in a full flight simulator. Understanding surgeon behavior is one of the first steps towards a future full-scale laparoscopy simulator.

Algorithms↗

PubMed1989

The time course of postflight simulator sickness symptoms.

Reports of posteffects following training sessions in Navy and Army flight simulators were obtained from pilots to determine the time course of recovery from simulator sickness. Results imply that posteffects may be a more serious problem than previously considered; 45% of all those queried (N greater than 700) reported having experienced symptoms of simulator sickness; 25% of the symptoms lasted more than 1 h after leaving the simulator; and 8% lasted more than 6 h. Postexposure symptoms were classified into three categories: visuomotor (based on disturbances in oculomotor control; e.g., eyestrain), disorientation (based on disturbance in postural control; e.g., dizziness), and nausea (vagal/autonomic symptoms). A safety risk may be posed particularly by the moderately high frequency of symptoms involving postural disequilibrium. Guidelines for coping with risks are discussed.

Adaptation, Psychological↗

PubMed2004

Assessing the ability of medical students to perform osteopathic manipulative treatment techniques.

While osteopathic and allopathic medicine share many commonalities, there are key practice-based differences that uniquely characterize the two professions. For osteopathic medicine, one such defining feature is the use of osteopathic manipulative treatment (OMT). Unfortunately, while various treatment modalities are taught in osteopathic medical schools, there has been relatively little work done to establish standardized evaluation protocols. The purpose of this investigation was to explore the use of OMT assessment in the context of a multistation standardized patient examination. Analysis of performance data from 121 fourth-year osteopathic medical students indicated that the ability to do OMT can be reliably and validly assessed using a combination of simulated patient encounters, trained osteopathic physician raters, and an objective rating tool. Additional studies that incorporate a larger sample of students and focus on modifications to the assessment tool and rating protocols are warranted.

Clinical Competence↗

PubMed2006

Implementation and case-study results of potentially better practices for collaboration between obstetrics and neonatology to achieve improved perinatal outcomes.

OBJECTIVE: The objective of this study was to make improvements in communication and collaboration between neonatal and obstetric specialties. Five NICUs from the Vermont Oxford Network's Evidence-Based Quality Improvement Collaborative in Neonatal and Perinatal Medicine tested potentially better practices that overlap obstetric and NICU care. METHODS: One area of practice improvement was the management of the pregnancy at the margin of viability. Another included the use of team training and video simulation to improve team performance during high-risk deliveries using aviation-based communication techniques. Another focus of the collaborative was the creation of a multicenter database to measure combined perinatal and neonatal outcomes. RESULTS: The principle outcomes are increased patient satisfaction with teamwork between neonatology and obstetric services and improved team response times for emergent deliveries and the increased use of team communication skills during video simulations of high-risk deliveries. CONCLUSIONS: Implementing these potentially better practices can result in improved communication and collaboration related to perinatal and neonatal care.

Communication↗

PubMed2003

[Review of visual display system in flight simulator].

Visual display system is the key part and plays a very important role in flight simulators and flight training devices. The developing history of visual display system is recalled and the principle and characters of some visual display systems including collimated display systems and back-projected collimated display systems are described. The future directions of visual display systems are analyzed.

Aviation↗

PubMed2005

[Multimedia educational material. A tool of support to the Otolaryngology training].

Due to multimedia technologies, the medical information has taken an extraordinary growing. Nevertheless, the education at University will turn out to be a more complex pedagogic process. We present a multimedia educational material (MEM), developed as an online course to "Seminars of Otolaryngology", and available free at the University website. MEM was designed and edited by, ENT teachers, pedagogues, and image and computer experts. It has been structured as a series of modules that integrate texts, images, movie clips, video, audio and animations. The schematic presentation stands out with progressive access to the topics through internal and external links. The pedagogic resources give additional support by learning objectives, glossary, references, index and searcher. Finally, the activities and instrumental simulations complete the training in diagnosis and treatment. The MEM is an interactive useful software program for medical training in Otolaryngology, without avoiding the key figure of the teacher.

Humans↗