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PubMed2003

New direction in PACS education and training.

The picture archiving and communication system (PACS) is an image information system that has become widely installed. For its successful implementation, training has been found indispensable. A review of PACS training thus far shows major emphasis was placed on the use of display workstations. As an integrated system, the PACS is much broader than the display workstations, having many components that need connectivity and customization. With the many potentials of further development, a more comprehensive education program on PACS is called for and a PACS simulator as a standalone training and research tool is deemed necessary.

Computer Simulation↗
PubMed2001

Subspace information criterion for model selection.

The problem of model selection is considerably important for acquiring higher levels of generalization capability in supervised learning. In this article, we propose a new criterion for model selection, the subspace information criterion (SIC), which is a generalization of Mallows's C(L). It is assumed that the learning target function belongs to a specified functional Hilbert space and the generalization error is defined as the Hilbert space squared norm of the difference between the learning result function and target function. SIC gives an unbiased estimate of the generalization error so defined. SIC assumes the availability of an unbiased estimate of the target function and the noise covariance matrix, which are generally unknown. A practical calculation method of SIC for least-mean-squares learning is provided under the assumption that the dimension of the Hilbert space is less than the number of training examples. Finally, computer simulations in two examples show that SIC works well even when the number of training examples is small.

Learning↗
PubMed1995

Dynamics of neurons in the cat lateral geniculate nucleus: in vivo electrophysiology and computational modeling.

1. We investigated the time domain transformation that thalamocortical relay cells of the cat lateral geniculate nucleus (LGN) perform on their retinal input, and used computational modeling to explore the biophysical properties that determine the dynamics of the LGN relay cells in vivo. 2. We recorded simultaneously the input (S potentials) and output (action potentials) of 50 cat LGN relay cells stimulated by drifting sinusoidal gratings of varying temporal frequency. The temporal modulation transfer functions (TMTFs) of the neurons were derived from these data. The burstiness of the LGN spike trains was also assessed using objective criteria. 3. We found that the form of the TMTF was quite variable among cells, ranging from low-pass to strongly band-pass. The optimal temporal frequency of band-pass neurons was between 2 and 8 Hz. In addition, the TMTF of some cells was nonstationary: their temporal tuning changed with time. 4. The temporal tuning of a cell was directly related to the degree of burstiness of its spike train. Tonically firing relay cells had low-pass TMTFs, whereas the most bursty neurons exhibited the most sharply band-pass transfer functions. This was also true for single cells that altered their temporal tuning: a shift to more band-pass tuning was associated with increased burstiness of the spike train, and vice versa. 5. We constructed a computer simulation of the LGN relay cell. The model was a simplified five-channel version of the thalamocortical neuron model of McCormick and Huguenard. It incorporated the quantitative kinetics of the Ca2+ T channel, as well as the Hodgkin-Huxley Na+ and K+ channels, as the only active membrane currents. To simulate the in vivo dynamics of the relay cell, the input to the model consisted of trains of synaptic potentials, recorded as S potentials in our physiological experiments. 6. When the resting membrane potential of the model neuron was relatively depolarized, the model's TMTF was low-pass, with no bursting evident in the simulated spike train. At hyperpolarized resting membrane potentials, however, the modeled TMTF was band-pass, with frequent burst discharges. Thus the biophysical model reproduced not only the range of dynamics seen in real LGN relay cells, but also the dependence of the overall dynamics on the burstiness of the spike train. However, neither of these phenomena could be simulated without the T channel. Thus the simulations demonstrated that the T-type Ca2+ channel was necessary and sufficient to explain the LGN dynamics observed in physiological experiments.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed2006

Effect of tutorial input in addition to augmented feedback on manual dexterity training and its retention.

Virtual reality (VR) simulators can be used as tools in manual dexterity training. The visual feedback guides the subject towards proper performance but creates, at the same time, some dependency on this feedback. To overcome this drawback, the effect of adjunct tutorial input on motor learning behaviour was examined. Novice dental students were randomly assigned to one of two training groups or to a non-training control group, given the task of preparing a geometrical class 1 cavity in phantom teeth. The feedback (FB) group trained under augmented visual feedback conditions, provided by the VR system (DentSim). The feedback-plus (FB+) group received, in addition, standardised expert input to enrich the augmented feedback information. The control group, consisting of same year students, did not participate in any training programme. All preparations were evaluated by the VR scoring system. Performance analyses revealed an overall trend towards significant improvement with practice for the training groups. Performance of the FB+ group was most accurate across training. After 1 day and 3 weeks of no practice, both training groups outperformed the control group. After 4 months, however, only the FB+ condition was significantly more accurate than the control group. The same tendency was noted for the transfer tests. Consequently, cavity preparation experience on a VR system under the condition of frequently provided feedback supplemented with expert input was most beneficial to long time learning.

Computer Simulation↗
PubMed2001

A medical platform for simulation of surgical procedures.

Surgery simulation is a promising technique for training of surgical procedures. The overall goal for any surgical simulator is to allow for efficient training of the skills required and to improve learning by giving the user proper feedback. This goal is easier achieved if the training is performed in a realistic environment. Therefore functionality such as soft tissue deformation, tearing and cutting, penetration of soft tissue etc. is necessary. Furthermore, a realistic simulator must provide haptic feedback so that all senses match, that is, there should be a correspondence between what you see and what you feel with your hands. In this paper we describe a medical platform that provides all this functionality. It is based on the Reachln Magma API, which has been extended for surgery simulation. We describe the development of the platform and illustrate the use of it for the development of two different types of surgical simulators, both of which represents work in progress.

Computer Simulation↗
PubMed2004

Patient-based outcome results from a cluster randomized trial of shared decision making skill development and use of risk communication aids in general practice.

BACKGROUND: Shared decision-making (SDM) between professionals and patients is increasingly advocated from ethical principles. Some data are accruing about the effects of such approaches on health or other patient-based outcomes. These effects often vary substantially between studies. OBJECTIVE: Our aim was to evaluate the effects of training GPs in SDM, and the use of simple risk communication aids in general practice, on patient-based outcomes. METHODS: A cluster randomized trial with crossover was carried out with the participation of 20 recently qualified GPs in urban and rural general practices in Gwent, South Wales. A total of 747 patients with known atrial fibrillation, prostatism, menorrhagia or menopausal symptoms were invited to a consultation to review their condition or treatments. After baseline, participating doctors were randomized to receive training in (i) SDM skills; or (ii) the use of simple risk communication aids, using simulated patients. The alternative training was then provided for the final study phase. Patients were randomly allocated to a consultation during baseline or intervention 1 (SDM or risk communication aids) or intervention 2 phases. A randomly selected half of the consultations took place in 'research clinics' to evaluate the effects of more time for consultations, compared with usual surgery time. Patient-based outcomes were assessed at exit from consultation and 1 month follow-up. These were: COMRADE instrument (principal measures; subscales of risk communication and confidence in decision), and a range of secondary measures (anxiety, patient enablement, intention to adhere to chosen treatment, satisfaction with decision, support in decision making and SF-12 health status measure). Multilevel modelling was carried out with outcome score as the dependent variable, and follow-up point (i.e. exit or 1 month later for each patient), patient and doctor levels of explanatory variables. RESULTS: No statistically significant changes in patient-based outcomes due to the training interventions were found: COMRADE risk communication score increased 0.7 [95% confidence interval (CI) -0.92 to 2.32] after risk communication training and 0.9 (95% CI -0.89 to 2.35) after SDM training; and COMRADE satisfaction with communication score increased by 1.0 (95% CI -1.1 to 3.1) after risk communication, and decreased by 0.6 (95% CI 2.7 to -1.5) after SDM training. Patients' confidence in the decision (2.1 increase, 95% CI 0.7-3.5, P < 0.01) and expectation to adhere to chosen treatments (0.7 increase, 95% CI 0.04-1.36, P < 0.05) were significantly greater among patients seen in the research clinics (when more time was available) compared with usual surgery time. Most outcomes deteriorated between exit and 1 month later. There was no interaction between intervention effects. CONCLUSION: Patients can be more involved in treatment decisions, and risks and benefits of treatment options can be explained in more detail, without adversely affecting patient-based outcomes. SDM and risk communication may be advocated from values and ethical principles even without evidence of health gain or improvement in patient-based outcomes, but the resources required to enhance these professional skills must also be taken into consideration. These data also indicate the benefits of extra consultation time.

Adult↗
PubMed2004

Achieving involvement: process outcomes from a cluster randomized trial of shared decision making skill development and use of risk communication aids in general practice.

BACKGROUND: A consulting method known as 'shared decision making' (SDM) has been described and operationalized in terms of several 'competences'. One of these competences concerns the discussion of the risks and benefits of treatment or care options-'risk communication'. Few data exist on clinicians' ability to acquire skills and implement the competences of SDM or risk communication in consultations with patients. OBJECTIVE: The aims of this study were to evaluate the effects of skill development workshops for SDM and the use of risk communication aids on the process of consultations. METHODS: A cluster randomized trial with crossover was carried out with the participation of 20 recently qualified GPs in urban and rural general practices in Gwent, South Wales. A total of 747 patients with known atrial fibrillation, prostatism, menorrhagia or menopausal symptoms were invited to a consultation to review their condition or treatments. Half the consultations were randomly selected for audio-taping, of which 352 patients attended and were audio-taped successfully. After baseline, participating doctors were randomized to receive training in (i) SDM skills or (ii) the use of simple risk communication aids, using simulated patients. The alternative training was then provided for the final study phase. Patients were allocated randomly to a consultation during baseline or intervention 1 (SDM or risk communication aids) or intervention 2 phases. A randomly selected half of the consultations were audio-taped from each phase. Raters (independent, trained and blinded to study phase) assessed the audio-tapes using a validated scale to assess levels of patient involvement (OPTION: observing patient involvement), and to analyse the nature of risk information discussed. Clinicians completed questionnaires after each consultation, assessing perceived clinician-patient agreement and level of patient involvement in decisions. Multilevel modelling was carried out with the OPTION score as the dependent variable, and rater, consultation and clinician levels of data, standardized by rater within clinician. RESULTS: Following each of the interventions, the clinicians significantly increased their involvement of patients in decision making (OPTION score increased by 10.6 following risk communication training [95% confidence interval (CI) 7.9 -13.3; P < 0.001] and by 12.9 after SDM skill development (95% CI 10 -15.8, P < 0.001), a moderate effect size. The level of involvement achieved by the risk communication aids was significantly increased by the subsequent introduction of the skill development workshops (7.7 increase in OPTION score, 95% CI 3.4-12; P < 0.001). The alternative sequence (skills followed by risk communication aids) did not achieve this effect. The use of most risk information formats increased after the provision of specific risk communication aids (P < 0.001). Clinicians using the risk communication tools perceived significantly higher patient and clinician agreement on treatment (P < 0.001), patient satisfaction with information (P < 0.01), clinician satisfaction with decision (P < 0.01) and general overall satisfaction with the consultation (P < 0.001) than those who were exposed to SDM skill development workshops. CONCLUSIONS: These clinicians were able to acquire the skills to implement SDM competences and to use risk communication aids. Each intervention provided independent effects. Further progress towards greater patient involvement in health care decision making is possible, and skill development in this area should be incorporated into postgraduate professional development programmes.

Adult↗
PubMed1994

Simulations of a ventrolateral medullary neural network for respiratory rhythmogenesis inferred from spike train cross-correlation.

Connections among ventrolateral medullary respiratory neurons inferred from spike train analysis were incorporated into a model and simulated with the program SYSTM11 (MacGregor 1987). Inspiratory (I) and expiratory (E) neurons with augmenting (AUG) and decrementing (DEC) discharge patterns and rostral I-E/I neurons exhibited varying degrees of adaptation, but no endogenous bursting properties. Simulation parameters were adjusted so that respiratory phase durations, neuronal discharge patterns, and short-time scale correlations were similar to corresponding measurements from anesthetized, vagotomized, adult cats. Rhythmogenesis persisted when the strength of each set of connections was increased 100% over a smaller effective value. Changes in phase durations and discharge patterns caused by manipulation of connection strengths or population activity led to several predictions. (a) Excitation of the I-E/I population prolongs the inspiratory phase. (b) Rhythmic activity can be reestablished in the absence of I-E/I activity by unpatterned excitation of I-DEC and I-AUG neurons. (c) An increase in I-DEC neuron activity can cause an apneustic respiratory pattern. (d) A decrease in I-DEC neuron activity increases the slope of the inspiratory ramp and shortens inspiration. (e) Excitation of the E-DEC population prolongs the expiratory phase or produces apnea; inhibition of E-DEC neurons reduces expiratory time. (f) Excitation of E-AUG cells causes I-AUG neurons to exhibit a step rather than a ramp increase in firing rate at the onset of their active phase. The results suggest mechanisms by which the duration of each phase of breathing and neuronal discharge patterns may be regulated.

Animals↗
PubMed2005

Telementoring versus on-site mentoring in virtual reality-based surgical training.

BACKGROUND: Telementoring can be an adjunct to surgical training using virtual reality surgical simulation. Telementoring is hypothesized to be as effective as a local mentor for surgical skills training. METHODS: In this study, 20 Romanian medical students trained using a virtual reality surgical simulator (LapSim) with a telementor or local mentor. All the students watched an instructional module at the beginning of the exercise. The telementor, in the United States, interacted by videoconferencing. Before and after training sessions, tool path length and time for task completion were measured. RESULTS: Instructional media and training with mentoring resulted in similar levels of performance between locally mentored and telementored groups. Right- and left-hand path length and time decreased significantly within each group from the initial to the final evaluation (p < 0.05) for most tasks (grasping, cutting, suturing). No significant difference was achieved for clip-applying. CONCLUSIONS: Integration of instructional media with telementoring can be as effective for the development of surgical skills as local mentoring.

Education, Medical↗
PubMed2005

Twelve tips for developing and maintaining a simulated patient bank.

Simulated patients have become almost indispensable in the education and training of health care professionals. Their contribution to the creation of a safe, yet realistic, learner centred environment is invaluable. Their support in enabling learners at all stages of their professional careers to develop both competence and confidence through repeated practice helps to ensure that learning from real patients can be maximized. A simulated patient bank can enable tracking and training of simulated patients to be coordinated in an effective and efficient way both for patients and learners. This paper shares experiences of developing a simulated patient bank against the background of changes in health care delivery and education and training. Twelve tips to developing and maintaining a simulated patient bank have been identified. The tips focus on the needs of the simulated patient bank and ensure that training is at an appropriate level for the learners, patient care is not compromised and simulated patients feel they are valued members of the educational team.

Communication↗
PubMed1995

Training software for electrophoresis.

Computer programs, simulating electrophoretic separations, were evaluated and discussed with respect to their suitability for training purposes. Quite a number of them, mainly those dealing with steady-state phenomena, are sufficiently fast and user-friendly for the purpose of visualization of electrophoretic principles. Transient-state or dynamic models, however, are more suitable for the advanced user, mainly because of their inherent complexity and long calculation times.

Electrophoresis↗
PubMed2005

[Communication skills training for medical students: from the simple to the complex].

Communication skills training at the Medical School of Copenhagen University aims to teach students basic skills in both interviewing and giving information. The article describes a method whereby the students follow a general communication skills model for giving information. The training is conducted with simulated patients (actors). It begins with providing information about simple diagnostic or operative procedures and routine tests. These skills are also practiced in clinical courses on real patients, under supervision. Later on, the students are trained in breaking bad news, but with simulated patients only.

Clinical Competence↗
PubMed1996

Virtual reality surgical simulation and otolaryngology.

Large-scale flight simulation was pioneered in the 1940s to help meet the training requirements and demand for pilots in World War II. Flight simulators have been effective for training, evaluating, and certifying military and commercial pilots. Accurate scenarios have been developed that allow pilots in training to gain experience without the risk and expense of learning while in flight. The research in aviation simulation suggests a transfer effectiveness ratio of 0.48. This means that 1 hour in the simulator saves a half hour in the air. Because of the successful use of flight simulation as a training technique, computer-based simulators are now used in a variety of domains.

Computer Simulation↗
PubMed1999

Modelling the spread of a viral infection in equine populations managed in Thoroughbred racehorse training yards.

A Monte Carlo model that simulates the management life cycle of a horse population in training on a Thoroughbred flat racing yard (i.e. stable) was developed for computer implementation. Each horse was characterised by several state variables. Discrete events at the horse level were triggered stochastically to reflect uncertainty about some input assumptions and heterogeneity of the horse population in a particular yard. This mathematical model was subsequently used to mimic the spread of equine influenza (EI) within a typical yard following the introduction of one or several infectious horses. Different scenarios were simulated to demonstrate the value of strategies for preventing outbreaks of EI. Under typical UK management conditions and vaccination protocols, the model showed that EI would propagate and that the timing of vaccination in connection with the racing season and the arrival of new horses was a critical factor. The predicted outcomes (based on published characteristics of one EI vaccine) suggested that vaccination in mid-December with boosters in June and September was a viable and successful strategy in preventing the spread of EI in a training establishment.

Animals↗
PubMed2006

Construct validity of the LapSim laparoscopic surgical simulator.

BACKGROUND: Computer-aided simulators may increase the safety and efficiency of training in laparoscopic surgery. Before implementation of the Immersion LapSim (Gaithersburg, MD) simulator in our training curriculum, we wished to determine its construct validity (ie, whether the simulator could differentiate laparoscopic novices from trainees with greater experience). METHODS: Subjects were medical students (MS), residents (RES), and laparoscopic faculty (FAC). Subjects performed 10 repetitions of 6 LapSim tasks. The LapSim measured performance in 6 to 10 parameters per task, and performance was compared between groups. Post hoc t tests were used to make pair-wise comparisons among the 3 groups using the Bonferroni technique. Statistical significance was set at P < .05. RESULTS: The degree of prior laparoscopic experience was reflected in performance on at least 1 parameter for each task. Several patterns of performance between MS, RES, and FAC were observed. CONCLUSIONS: The LapSim has performance parameters that reliably differentiate between subjects with varying laparoscopic experience. However, some performance parameters do not differentiate between groups. To accurately measure a trainee's skill level, only parameters that sensitively measure the true level of performance should be used.

Computer Simulation↗
PubMed1995

Multiple alignment using hidden Markov models.

A simulated annealing method is described for training hidden Markov models and producing multiple sequence alignments from initially unaligned protein or DNA sequences. Simulated annealing in turn uses a dynamic programming algorithm for correctly sampling suboptimal multiple alignments according to their probability and a Boltzmann temperature factor. The quality of simulated annealing alignments is evaluated on structural alignments of ten different protein families, and compared to the performance of other HMM training methods and the ClustalW program. Simulated annealing is better able to find near-global optima in the multiple alignment probability landscape than the other tested HMM training methods. Neither ClustalW nor simulated annealing produce consistently better alignments compared to each other. Examination of the specific cases in which ClustalW outperforms simulated annealing, and vice versa, provides insight into the strengths and weaknesses of current hidden Markov model approaches.

Algorithms↗
PubMed2001

Update for nurse anesthetists. Part 6. Full-body patient simulation technology: gaining experience using a malignant hyperthermia model.

Simulation technology is extremely useful for training workers in a variety of industries. Simulation concepts have been developed and refined in full-body patient simulators. Contemporary full-body patient simulators can be used to teach the essential concepts of many healthcare professions, and they offer practice dealing with critical events, concentrating on the thought and decision-making processes related to favorable patient outcomes. Full-body patient simulators provide practitioners the opportunity to manage realistic and advanced physical findings in a variety of areas and are capable of responding to a large number of pharmacologic agents and a host of clinical interventions. The ability to combine high-fidelity educational tools with both classroom lecture and clinical experience provides nurse anesthetists the opportunity for a unique experience in a highly controlled and safe environment. Numerous technological and educational advantages and the chance for hands-on assessment and treatment of some of anesthesia's rarest and most life-threatening events provide a one-of-a-kind educational session for CRNAs.

Computer-Assisted Instruction↗