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At least 973 records · Page 54Linked to original sources

PubMed2003

Effect of sleep deprivation on the performance of simulated laparoscopic surgical skill.

BACKGROUND: Resident work hours may impact patient care. We hypothesized that "call-associated" acute sleep deprivation has no effect on technical dexterity as measured on a minimally invasive surgery trainer, virtual reality (MIST VR) surgical simulator. METHODS: Thirty-five surgical residents were prospectively evaluated pre-call (rested), on-call (rested), and post-call (acutely sleep deprived). Participants completed questionnaires regarding sleep hours and level of fatigue. Technical skill was assessed using the MIST VR. Speed, errors, and economy of motion were automatically recorded by the MIST VR computer simulator. Data were analyzed by paired Student t test and analysis of variance. RESULTS: Estimated hours of sleep and subjective indicators of fatigue were different between rested and sleep-deprived residents. The number of errors and time to complete all tasks increased at the post-call assessment. CONCLUSIONS: Resident work schedules lead to sleep deprivation and fatigue. Call-associated sleep deprivation and fatigue are associated with increased technical errors in the performance of simulated laparoscopic surgical skills.

Adult↗

PubMed1996

Laparoscopic skills enhancement.

BACKGROUND: Laparoscopy requires a unique subset of surgical skills that, for the inexperienced, can significantly delay the development of basic operative skills. We hypothesized that learning laparoscopic suturing and knot tying would improve laparoscopic skills. METHODS: A laparoscopic training seminar for junior surgical residents was established to test this hypothesis. Emphasis was placed on laparoscopic knot tying and suturing. Skills were assessed at the beginning and the end of the course. RESULTS: All residents showed significant improvement. Dominant and nondominant hand skills improved by 30.2% and 26.9%, respectively. Two-handed skills improved by 58.6% and 30.1%. Overall scores improved by 28.9%. CONCLUSIONS: A structured laparoscopic skills course stressing knot tying and suturing is an effective way to develop dexterity and significantly improve the performance of laparoscopic tasks. These improvements can be accomplished in a cost-effective curriculum that should enhance the surgical education of residents and speed the acquisition of competent operative skills.

Curriculum↗

PubMed2001

Is the GraftConnector a valid alternative to running suture in end-to-side coronary arteries anastomoses?

BACKGROUND: An animal study was carried out to compare long-term patency rates of coronary anastomoses performed with the GraftConnector versus running suture technique. METHODS: 10 sheep, 45 to 55 kg, underwent off-pump coronary artery bypass grafting (right internal mammary artery to left anterior descending artery). In 5 animals, the anastomosis was performed with a GraftConnector and in 5 animals with 7-0 running suture. Intraoperative fluoroscopy and a fluoroscopic control at 6 months were performed. After 6 months, the animals were sacrificed and the anastomoses were examined histologically. RESULTS: All animals survived at 6 months with 100% anastomosis patency rates in both groups. In the GraftConnector group, the anastomosis diameter at 6 months fluoroscopy was 118% of native left anterior descending artery versus 97% of the control group. Luminal anastomotic width at histology was 1.7 +/- 0.2 mm in the device group versus 1.6 +/- 0.1 mm in the control group. Mean intimal hyperplasia thickness was 0.21 +/- 0.1 mm in the device group versus 0.01 mm in the control group. CONCLUSIONS: The GraftConnector provides a consistent and reproducible coronary artery anastomosis and reduces technical demand and manual dexterity in coronary operations. Long-term results demonstrate that off-pump coronary artery bypass grafting performed with the GraftConnector had the same patency rate and luminal width as those performed with running suture.

Anastomosis, Surgical↗

PubMed2003

Robotic mitral valve repair: experience with the da Vinci system.

BACKGROUND: As part of a Food and Drug Administration trial, mitral repairs were performed in 38 patients using the robotic da Vinci surgical system (Intuitive Surgical, Inc, Mountain View, CA). Prospectively, we evaluated safety and efficacy in performing both simple and complex mitral repairs. METHODS: Eligible patients had nonischemic moderate to severe mitral insufficiency. Operative techniques included peripheral cardiopulmonary perfusion, a 4- to 5-cm mini-thoracotomy, transthoracic aortic occlusion, and antegrade blood cardioplegia. Transesophageal echocardiograms were done intraoperatively with three-dimensional reconstructions. Successful repairs were defined as mild or less residual regurgitation. RESULTS: Enhanced three-dimensional visualization of mitral leaflets and the subvalvar apparatus allowed safe, dexterous intracardiac tissue manipulation. All patients had successful valve repairs including quadrangular resections, sliding plasties, and edge-to-edge approximations, as well as both chordal transfers and replacements. There were no operative deaths, strokes, or device-related complications. One patient required valve replacement for hemolysis and 1 was reexplored for bleeding. There were no incisional conversions. Both robotic repair and total operating times decreased significantly from 1.9 +/- 0.1 and 5.1 +/- 0.1 hours (mean +/- standard error of the mean) for the first 19 patients to 1.5 +/- 0.1 (p = 0.002) and 4.4 +/- 0.1 hours (p = 0.04) for the last 19 operations, respectively. Total hospital length of stay for patients was 3.8 +/- 0.6 days. Of all patients, 31 (82%) had a 4-day or less length of stay. Seven patients (18%) had stays between 5 and 9 days (6.4 +/- 1.0). CONCLUSIONS: This study shows that the da Vinci surgical system (Intuitive Surgical, Inc) has few limitations in performing complex valve repairs. Articulated wrist-like instruments and three-dimensional visualization enabled precise tissue telemanipulation. Future robotic design advances and adjunctive suture technologies may promote continuing evolution of robotic cardiac operations.

Cardiac Surgical Procedures↗

PubMed2003

Limitations for manual and telemanipulator-assisted motion tracking--implications for endoscopic beating-heart surgery.

BACKGROUND: Surgical performance is limited by human factors. Beating-heart surgery requires full dexterity and motion tracking. Currently techniques for total endoscopic beating-heart bypass grafting using telemanipulation systems are being developed. The aim of this study was to assess the limitations for manual and telemanipulator-assisted motion tracking using the da Vinci telemanipulator system. METHODS: To simulate beating-heart conditions an endoscopic trainer was developed. Twenty subjects were asked to touch targets manually and with telemanipulator assistance with different patterns of increasing index of difficulty (resting model, unstabilized, and stabilized model with a frequency of 35, 60, and 90 beats per minute). In addition one task was performed using different scaling ratios on a resting model. The times between hits as well as errors were electronically recorded. RESULTS: There was no significant impact of various frequencies and amplitudes for manual tracking. The average values for the delay (k(m)[ms]) and information-processing (c(m) [ms/bit]) constants for the manual tasks were 201 ms and 86 ms/bit respectively. Both the delay constant (k(t) = 630 ms; p < 0.0005) and the information-processing constant (c(t) = 250 ms/bit; p < 0.0005) were increased for the telemanipulator-assisted tasks at rest. When working on moving targets telemanipulator-assisted tracking required significantly more time and led to more errors. At a frequency of 90 beats per minute telemanipulator-assisted tracking became more difficult. CONCLUSIONS: Endoscopic beating-heart bypass grafting requires optimal stabilization to avoid inaccuracies due to incomplete motion tracking. At higher frequencies telemanipulator-assisted tracking became more difficult, demonstrating the technical limits of current telemanipulator technology.

Cardiac Surgical Procedures↗

PubMed1995

Community-dwelling older adults' attributions about falls.

OBJECTIVE: To examine the extent to which 162 older adults attributed the cause of their fall to their own limitations and to their surroundings, and the relationship of these attributions with selected sociodemographic, health-related, locus of control, and fall-related characteristics. DESIGN: A stratified (by age > or = 65, gender, and area of residence) random sample; needs assessment survey on products and services to enhance independent living among older adults; included section on falls. SETTING: Community-dwelling individuals in both urban and rural settings. PARTICIPANTS: Potential respondents were drawn from the Manitoba Health database. Overall refusal rate was 22%. Final number of 1,406 participants were interviewed; 162 of these participants reported a fall. MAIN MEASURES: Outcome measures were: (1) the extent to which the fall was attributed to "own limitations" (internal attribution), and (2) the extent to which the fall was attributed to "surroundings" (external attribution). RESULTS: There is diversity in the extent to which individuals attribute falls to internal and external causes. Stepwise regression analyses indicated those reporting poorer self-rated health (p < .001); having dexterity difficulties (p < .01); and living in an apartment (p < .05) were more likely to attribute the fall to their own limitations. Those reporting better self-rated health (p < .01); and falling outdoors (p < .01) were more likely to attribute the fall to the surroundings. CONCLUSIONS: Fall attributions need to be more fully examined in the context of self-rated health and fall prevention programs.

Accidental Falls↗

PubMed1996

The cerebellum and cognitive function: implications for rehabilitation.

OBJECTIVE: To characterize the cognitive effects of isolated cerebellar lesions. DESIGN: Review of two inpatient cases. SETTING: The rehabilitation unit of a tertiary general hospital. PATIENTS OR OTHER PARTICIPANTS: Two patients with acute ischemic strokes who had solitary cerebellar infarcts. INTERVENTIONS: Assessment with standard neuropsychological tests. Scores were compared with patients' premorbid levels and standardized test norms. A classical conditioning eyeblink paradigm was performed. MAIN OUTCOME MEASURES: Neuropsychological measures of intellectual and executive functions, learning and memory, visual-spatial abilities, language functioning, fine motor speed, and dexterity. RESULTS: Test findings suggested lesion-associated deficits in higher aspects of cognition (visuospatial reasoning, verbal and visual memory, and intellectual and executive functions). These functions are not usually associated with the fundamentally motoric role of the cerebellum. CONCLUSIONS: (1) Lesions in the cerebellum can be associated with impairments in higher cognitive functioning. (2) Such effects may be severe enough for a diagnosis of dementia under current diagnostic criteria. (3) These rehabilitation patients may benefit from comprehensive cognitive examination to determine if cognitive effects will detract from their participation. (4) Further research is needed to localize which cerebellar areas affect which cognitive abilities.

Aged↗

PubMed1999

Clinical evaluation of the bionic glove.

OBJECTIVE: Clinical evaluation of the Bionic Glove, a prototype of a new functional electrical stimulation device designed to improve the function of the paralyzed hand after spinal cord injury. PATIENTS: Twelve people with spinal cord injury at C5-C7 who had used the device 6 months or more. SETTING: Measurements were made at the Institute "Dr Miroslav Zotović" in Belgrade as a part of a multicenter clinical trial. METHODS: Measures include Upper Extremity Function Test, Functional Independence Measure, and Quadriplegia Index of Function. RESULTS: The daily use of a Bionic Glove had two major effects: (1) increasing the power grasp; and (2) increasing the range of movements. Active force was significantly greater than passive tenodesis force, as shown in other studies. Most manual tasks improved significantly with the use of the assistive system, as judged by the time needed to complete a task or the subject's qualitative ratings of a task difficulty. Most subjects who retained some dexterity without the assistive system hesitated to use the assistive system to manipulate small objects. CONCLUSION: The Bionic Glove can significantly improve independence in people with C5-C7 spinal cord injury if their initial Functional Independence Measure and Quadriplegia Index of Function scores are 20% to 50% of the maximum values.

Activities of Daily Living↗

PubMed2004

Additional task-related practice improves mobility and upper limb function early after stroke: a randomised controlled trial.

The purpose of this study was to investigate whether additional practice of either upper limb or mobility tasks improved functional outcome during inpatient stroke rehabilitation. This prospective, randomised, single blind clinical trial recruited 30 stroke subjects into either an Upper Limb or a Mobility Group. All subjects received their usual rehabilitation and an additional session of task-related practice using a circuit class format. Independent assessors, blinded to group allocation, tested all subjects. Outcome measures used were three items of the Jebsen Taylor Hand Function Test (JTHFT), two arm items of the Motor Assessment Scale (MAS), and three mobility measures, the Timed Up and Go Test (TUGT), Step Test, and Six Minute Walk Test (6MWT). Both groups improved significantly between pre- and post-tests on all of the mobility measures, however only the Upper Limb Group made a significant improvement on the JTHFT and MAS upper arm items. Following four weeks training, the Mobility Group had better locomotor ability than the Upper Limb Group (between-group differences in the 6MWT of 116.4 m, 95% CI 31.4 to 201.3 m, Step Test 2.6 repetitions, 95% CI -1.0 to 6.2 repetitions, and TUGT -7.6 sec, 95% CI -15.5 to 0.2 sec). The JTHFT dexterity scores in the Upper Limb Group were 6.5 sec (95% CI -7.4 to 20.4 sec) faster than the Mobility Group. Our findings support the use of additional task-related practice during inpatient stroke rehabilitation. The circuit class format was a practical and effective means to provide supervised additional practice that led to significant and meaningful functional gains.

Arm↗

PubMed2001

Molecular chaperones and the regulation of neurotransmitter exocytosis.

Regulated neurotransmitter release depends on a precise sequence of events that lead to repeated cycles of exocytosis and endocytosis. These events are mediated by a series of molecular interactions among vesicular, plasma membrane, and cytosolic proteins. An emerging theme has been that molecular chaperones may guide the sequential restructuring of stable or transient protein complexes to promote a temporal and spatial regulation of the endo- and exocytotic machinery and to ensure a vectorial passage through the vesicle cycle. Chaperones, specialized for a few substrates, are ideally suited to participate in regulatory processes that require some molecular dexterity to rearrange conformational or oligomeric protein structures. This article emphasizes the significance of three molecular chaperone systems in regulated neurotransmitter release: the regulation of soluble NSF attachment protein receptor (SNARE) complexes by N-ethylmaleimide-sensitive factor (NSF) and the soluble NSF attachment protein (SNAP), the uncoating of clathrin-coated vesicles by the 70 kDa heat-shock cognate protein (Hsc70), and the regulation of SNARE complex-associated protein interactions by cysteine-string protein and Hsc70.

Adaptor Proteins, Vesicular Transport↗

PubMed1999

Psychomotor performance and monoamine function in bipolar and unipolar affective disorders.

BACKGROUND: Affective disorders are associated with prominent psychomotor abnormalities that may be related to changes in arousal or motivation due to altered catecholamine function. METHODS: We investigated relationships between performance on psychomotor tests of motor speed (reaction time and tapping speed) and visual tracking (trail making and dot placement) and catecholamine system function including cerebrospinal fluid (CSF) or urinary concentrations of catecholamines or their metabolites. Subjects were medicine-free inpatients with unipolar depression or with manic, depressive, or mixed episodes of bipolar disorder, and healthy controls matched by gender and stratified by age. RESULTS: Unipolar and bipolar depressed patients were impaired in motor speed, dexterity, and visual tracking, whereas manic and mixed patients did not differ from controls. Tapping speed correlated positively with CSF 3-methoxy-4-hydroxyphenylglycol in healthy controls and with CSF homovanillic acid in bipolar depressed subjects. Increased catecholamine function correlated with slowing in all other measures for patients with bipolar disorder. Relationships between catecholamines and psychomotor function were weaker in unipolar depressed subjects. Psychomotor function was related to severity of depression in bipolar, but not in unipolar, patients. CONCLUSIONS: These data suggest that catecholamine systems are associated with increased arousal and psychomotor impairment in patients with bipolar disorder. Similar behavioral changes have different neurotransmitter relationships in unipolar disorder.

Adult↗

PubMed2006

[Robotics and laparoscopic surgery].

Laparoscopic surgery has completely revolutionized modern surgery. In addition to its advantages, however, this approach also presents significant limitations. The most important are loss of the sense of depth, tactile sensation and resistance, as well as loss of natural hand-eye coordination and manual dexterity. The main motivation for the development of surgical robots is the possibility of eliminating all these limitations. Robots have acquired great potential to improve the operative possibilities of surgeons. Given the continual increase in the use of surgical robots, in the near future the structure and appearance of current operating rooms will change. The present article analyzes the origin and development of robotic systems, as well as the characteristics of the latest generation of robots. Because of the strong interest in robotic surgery and its future prospects, surgeons should be familiar with these emerging and innovative techniques.

Humans↗

PubMed1991

Hand preferences in the skilled gathering tasks of mountain gorillas (Gorilla g. berengei).

Manual dexterity of 44 wild gorillas of all ages and both sexes was investigated on six naturally acquired feeding tasks of varied logical structure, which included multi-stage and bimanually coordinated procedures. At least 400 min observation of feeding per animal, and analysis at the level of bouts rather than individual actions, can be expected to produce statistically robust results; 22 years background data allowed effects of genealogy and injury to be investigated. Five tasks elicited very strong hand preferences in most animals (weakest on the simplest task), while one was usually performed with a strategy in which left and right hands were used symmetrically; the preferences were fully established at 3 years old. Preferences were highly correlated within each of two sets of tasks, but between the two sets there was no correlation across animals in direction or strength of preference. No population trends towards left or right handers were found in either set of tasks, or both sets pooled; distributions were U-shaped and approximately symmetric, with a slight bias towards right-handed fine manipulation in one set of tasks. Processing efficiency was only slightly greater with the preferred hand, and similar in left- and right-handed animals. Neither direction nor strength of hand preference showed a tendency to run in families, but females showed greater strength of preference. Major injury masked strong hand preference, but injuries could not account for the overall distribution of preference; instead this may reflect inbreeding. Feedback acting on initially random hand choices, and imitation at the "program" level rather than slavish copying of acts, are proposed to account for the results.

Aging↗

PubMed1986

Handedness is not a unidimensional trait.

Most theories about the inheritance of hand preference assume that handedness is a unidimensional trait which forms a continuous distribution. This paper demonstrates that sampling a wide range of manual activities reveals dimensions of hand preference that are independent. 180 right handed and 110 left handed adults indicated their hand preference for 55 activities according to a five point scale. A Varimax Factor Analysis revealed four factors which accounted for 80 percent of the variance. Factor 3 was of special interest because it represented behaviors which rely upon the axial musculature and involve strength more than dexterity. Hand preference for items on this factor were less laterally biased than on factors which included such fine motor behaviors as writing or drawing. These results suggest that manual preference is governed by more than one neural system and that these systems may be independently lateralized.

Adolescent↗

PubMedDate not supplied

[Apprenticeship in laparoscopic surgery: Tools and methods for the surgeon in training].

The introduction of laparoscopic approaches to surgery has been responsible for increased morbidity and has necessitated the development of a system of apprenticeship training in and out of the operating room for surgeons making their debut in the laparoscopic arena. This study, based on published data in the surgical literature, aims to evaluate the tools currently available for both teaching and evaluating competence in laparascopic surgery. Video simulators currently being used for teaching laparoscopic skills do not permit an objective evaluation of skill acquisition. Virtual reality simulators have the advantage of permitting an apprenticeship in laparoscopic surgical technique and a simultaneous assessment of the acquisition of surgical dexterity. This new technology should enable a better preparation of young surgeons for the operating room of the future.

Animals↗

PubMed1978

Attachment fixation of the overdenture: part II.

Many attachment systems of the bar or stud type increase the stability of an overdenture. When selecting an attachment it is essential to consider the skill of the dentist-laboratory team as well as the dexterity of the patient and to use the easiest system that will still improve stabilization. Generally simplicity in design, ease of maintenance, and minimum leverage should be paramount considerations in selection. Use of a guide such as the EM Gauge and of the EM Attachment Selector significantly reduces the confusion in selecting attachments and increases the working armamentarium for stabilizing an overdenture.

Denture Design↗

PubMed2003

A valid method of laparoscopic simulation training and competence assessment.

BACKGROUND: The purpose of our study was to evaluate the construct validity of laparoscopic technical performance measures and the face validity of three laparoscopic simulations. MATERIALS AND METHODS: Subjects (N = 27) of varying levels of surgical experience performed three laparoscopic simulations, representing appendectomy (LA), cholecystectomy (LC), and inguinal hemiorrhaphy (LH). Five laparoscopic surgeons, blinded to the identity of the subjects, rated the subjects on procedural competence on a binary scale and in four skills categories on a 5-point scale: clinical judgment, dexterity, serial/simultaneous complexity, and spatial orientation. Using a task-specific checklist, non-clinical staff assessed the technical errors. The level of surgical experience was correlated with the ratings, the technical errors, and the time for each procedure. Subject responses to a survey regarding the utility of the inanimate models were evaluated. RESULTS: Years of experience directly correlated with the skills ratings (all P < 0.001) and with the competence ratings across the three procedures (P < 0.01). Experience inversely correlated with the time for each procedure (P < 0.01) and the technical error total across the three models (P < 0.05). Nearly all subjects agreed that the corresponding procedures were well represented by the simulations (LA 96%, LC 96%, LH 100%). CONCLUSION: The laparoscopic simulations demonstrated both face and construct validity. Regardless of the level of surgical experience, the subjects found the models to be suitable representations of actual laparoscopic procedures. Task speed improved with surgical experience. More importantly, the quality of performance increased with experience, as shown by the improvement in the skills assessments by expert laparoscopic surgeons.

Appendectomy↗

PubMed1998

Brain biochemistry in Duchenne muscular dystrophy: a 1H magnetic resonance and neuropsychological study.

Duchenne muscular dystrophy (DMD) is a progressive muscle disorder associated with an intellectual deficit which is non-progressive. We obtained localised 1H magnetic resonance spectra from the left frontal lobe and left cerebellum of 15 boys with DMD (mean age 106 months+/-32) and 15 similarly aged control boys (mean age 115 months+/-31); all boys underwent a battery of neuropsychological tests. We found a significant (P<0.01) increase in the ratio of choline-containing compounds to N-acetylaspartate (Cho/NA) in the left cerebellum in boys with DMD compared with control boys. There was no change in the creatine/NA ratio and a significant increase (P=0.03) in the Cho/creatine ratio, suggesting that the change in Cho/NA ratio was due to an increase in choline-containing compounds; this increase has been previously observed in the brain of the murine model of DMD, the mdx mouse. No significant changes were observed in spectra obtained from left frontal lobe in DMD compared to controls. We also observed a significant association between Cho/NA in the left cerebellum, and the performance of DMD boys on the Matrix Analogies Test (MAT). The MAT is a test of visuo-spatial ability and non-verbal reasoning which requires neither manual dexterity nor a verbal response for an adequate performance. A comparison of DMD boys whose cerebellar Cho/NA fell within 2 standard deviations of the control norm (0.56+/-0.24) with DMD boys whose cerebellar Cho/NA was outside this range (i.e. >0.80) revealed a significant difference in ability on the MAT (P<0.05). DMD boys whose Cho/NA ratio is more than two standard deviations higher than controls perform significantly better on the MAT than DMD boys whose Cho/NA ratio is within the normal range. This finding suggests that the observed elevation in Cho/NA and Cho/creatine is not associated with intellectual deficit (as sampled by the MAT), and may represent a compensatory mechanism. The possible interpretations of these metabolic changes are discussed.

Age Factors↗