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Results for “Simulation Training”

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At least 1,099 records · Page 61Linked to original sources

PubMed2002

Use of a fixed-base driving simulator to evaluate the effects of experience and PC-based risk awareness training on drivers' decisions.

Driver education classes were once seen as a remedy for young drivers' overinvolvement in crashes, but research results from the early 1970s were disappointing. Few changes in the content or methods of instruction occurred until recently, but this could change rapidly. Personal computers (PCs) can now present videos or photorealistic simulations of risky, cognitively demanding traffic scenarios that require quick responses without putting the participant at risk. As such programs proliferate, evaluating their effectiveness poses a major challenge. We report the use of a fixed-base driving simulator to study the effects of both experience on the road and PC-based risk awareness training on younger drivers' part-task simulator driving performance in risky traffic scenarios. We ran three groups of drivers on the simulator: one group first trained on the PC (younger, inexperienced drivers) and two groups who received no PC training (younger, inexperienced and experienced drivers). Overall, the younger, inexperienced drivers who were trained on a PC operated their vehicles in risky scenarios in ways that differed measurably from those of the untrained younger, inexperienced drivers and, more important, in ways that we believe would decrease their exposure to risk considering that, on average, their behavior was more similar to the behavior of the untrained, experienced drivers. More research is needed to demonstrate whether these findings apply on the open road to the larger population of younger drivers. However, at least initially, the research suggests that PC-based risk awareness training programs have the potential to reduce the high crash rate among younger, inexperienced drivers.

Accidents, Traffic↗

PubMed2005

Simulation devices in cardiothoracic and vascular anesthesia.

The subspecialty of cardiothoracic and vascular anesthesia is becoming increasingly complex. Trainees must learn to manage difficult cases and be skilled in performing a variety of procedures. With work hour limitations and societal pressures working to reduce learning and practice opportunities for trainees, new training modalities must be utilized. Simulation is currently being used to increase training efficiency. It allows trainees to experience uncommon clinical situations and complications, repetitive practice opportunities, and can be done on a flexible schedule-all without risk to the patient. Additionally, feedback after a simulation can provide trainees with an assessment of their training progress. Many of the procedures and cases in cardiothoracic and vascular anesthesia can be simulated. Current devices can simulate bronchoscopy, vessel cannulation, complex case management, and cardiopulmonary bypass. They vary from the simple to the complex and from inexpensive homemade wooden devices to high-end computer-controlled virtual reality simulators. Although not all these simulators have been validated as to their educational efficacy, they offer a new avenue to improve training efficacy and efficiency. More research needs to be done to validate these devices and assess their role in anesthesia training.

Anesthesiology↗

PubMed2004

Whole blood and mononuclear cell glutathione response to dietary whey protein supplementation in sedentary and trained male human subjects.

Sedentary male subjects (n=9) on a controlled diet were fed two doses (0.8 or 1.6 g/kg body mass) of a whey protein isolate (WPI), in addition to an isocaloric placebo; blood samples were drawn over a 4-h period and glutathione concentration determined. There was no effect of the supplementation at either level over the 4-h sampling period. The effects of a WPI supplemented diet on glutathione concentrations in whole blood as well as peripheral mononuclear cell populations were also investigated over a 6-week period in male subjects (n=18) involved in arduous aerobic training; blood was collected prior to and following a 40 km simulated cycling trial. The aerobic training period resulted in significantly lower glutathione concentrations in whole blood, an effect that was mitigated by WPI supplementation. A significant increase in mononuclear cell glutathione was also observed in subjects receiving the WPI supplement following the 40 km simulated cycling trial.

Adult↗

PubMed2006

Acquisition of basic fiberoptic intubation skills with a virtual reality airway simulator.

STUDY OBJECTIVE: To test the hypothesis that a virtual reality (VR) airway simulator (the AccuTouch Virtual Reality Bronchsocopy Simulator; Immersion Medical, Gaithersburg, MD) can be used to teach residents basic fiberoptic intubation (FOI) skills effectively. DESIGN: Observational study. SETTING: University anesthesiology department. INTERVENTION: Supervised training was done using a VR airway simulator. MEASUREMENTS: Time to intubation before and after a 4-day training period using an adult VR FOI scenario and time to intubation using a fresh human cadaver two weeks after the training experience were measured. MAIN RESULTS: Residents were able to significantly improve time to intubation in the VR scenario (114 vs 75 seconds; P = 0.001). Novices differed from experienced attending anesthesiologists in time to intubation in the VR scenario, before but not after training (114 vs 79 seconds compared with 75 vs 72 seconds). Novices who had been trained with the simulator performed significantly faster in the cadaver than novices who had not (24 vs 86 seconds; P < 0.001). Furthermore, there was no difference in time to intubation in the cadaver between trained novices and experienced attending anesthesiologists (24 vs 23 seconds; P > 0.05). CONCLUSION: Use of a VR airway simulator enables anesthesia residents to acquire basic FOI skills comparable to those of experienced anesthesiologists in a human cadaver.

Cadaver↗

PubMed2006

Analysis of simulated angiographic procedures: part 1--capture and presentation of audio and video recordings.

PURPOSE: To assess different methods of recording angiographic simulations and to determine how such recordings might be used for training and research. MATERIALS AND METHODS: Two commercially available high-fidelity angiography simulations, the Mentice Vascular Interventional Simulation Trainer and the Simbionix AngioMentor, were used for data collection. Video and audio records of simulated procedures were created by different methods, including software-based screen capture, video splitters and converters, and external cameras. Recording parameters were varied, and the recordings were transferred to computer workstations for postprocessing and presentation. RESULTS: The information displayed on the simulators' computer screens could be captured by each method. Although screen-capture software provided the highest resolution, workflow considerations favored a hardware-based solution that duplicated the video signal and recorded the data stream(s) at lower resolutions. Additional video and audio recording devices were used to monitor the angiographer's actions during the simulated procedures. The multiple audio and video files were synchronized and composited with personal computers equipped with commercially available video editing software. Depending on the needs of the intended audience, the resulting files could be distributed and displayed at full or reduced resolutions. CONCLUSIONS: The capture, editing, presentation, and distribution of synchronized multichannel audio and video recordings holds great promise for angiography training and simulation research. To achieve this potential, technical challenges will need to be met, and content will need to be tailored to suit the needs of trainees and researchers.

Angiography↗

PubMed1985

Synchronous afferent discharge from a passive muscle of the cat: significance for interpreting spike-triggered averages.

Evidence is presented for the existence of synchrony between the spike trains of muscle afferents of the passive cat medial gastrocnemius muscle held at fixed length. Synchrony between the spike trains of a population of muscle afferents was quantified by means of a synchronization index (Is), derived from spike-triggered averages of the muscle-nerve neurogram and the rectified neurogram. A previously used test based solely upon the neurogram average (Watt, Stauffer, Taylor, Reinking & Stuart, 1976) is shown to be invalid. The differences between experimentally derived Is values and theoretical Is values derived for the condition of asynchrony were compared to estimated confidence limits for those differences. This comparison revealed that twenty-two of fifty-three muscle-afferent spike trains whose rectified averages satisfied certain conditions for interpreting the Is were synchronized with the discharge of other afferents. The form of the rectified averages of another eight afferents suggested that these afferents might also have been synchronized. Synchrony in the discharge of muscle afferents was found in three experiments in which the neurogram was recorded from a single nerve branch to medial gastrocnemius, as well as in the data of experiments in which the whole muscle nerve was used. The degree of synchrony was similar for Ia, spindle group II and Ib afferents. The magnitude of the synchrony found in these experiments was judged by comparison to the results of analog simulations and the increase in Is values resulting from the application of small, quick stretches to the medial gastrocnemius muscle. The degree of synchrony found on average was approximately equivalent to that of a single spike occurring once for every four discharges of the reference spike train. Simulations were performed to determine the distortion of monosynaptic excitatory post-synaptic potentials (e.p.s.p.s) obtained by spike-triggered averaging which would be produced by synchrony between the spike trains of Ia and spindle group II afferents of the magnitude found in this study. These simulations indicate that the apparent amplitude would be increased by approximately 4 microV on average. Both the 10-90% rise time and the half-width would increase, the effects being greater for smaller e.p.s.p.s. Consequently, the synchrony found in this study is of most concern in the study of small post-synaptic potentials, such as those due to spindle group II afferents.

Action Potentials↗

PubMed2002

Assessment of basic endoscopic performance using a virtual reality simulator.

BACKGROUND: The objective of this study was to evaluate the effect of supervised training using a state-of-the-art virtual reality (VR) genitourinary endoscopy simulator on the basic endoscopic skills of novice endoscopists. STUDY DESIGN: We evaluated 21 medical students performing an initial VR case scenario (pretest) requiring rigid cystoscopy, flexible ureteroscopy with laser lithotripsy, and basket retrieval of a proximal ureteral stone. All students were evaluated with objective parameters assessed by the VR simulator and by two experienced evaluators using a global rating scale. Students were then randomized to a control group receiving no further training or a training group, which received five supervised training sessions using the VR simulator. All students were then evaluated again in the same manner using the same case scenario (posttest). RESULTS: Comparing the results of pre- and posttests, no major differences were demonstrated for any variable in the control group. In the trained group, posttest results revealed statistically significant improvement from baseline in the following parameters: total procedure time (p = 0.002), time to introduce a ureteral guidewire (p = 0.039), self-evaluation (p < 0.001), and evaluator assessment (p < 0.001). Comparing the posttest results of the control and trained arms, we found significantly better posttest scores in the trained group for the following parameters: ability to perform the task (p = 0.035), overall performance (p = 0.004), and total evaluator score (p < or = 0.001). CONCLUSIONS: Students trained on the VR simulator demonstrated statistically significant improvement on repeat testing, but the control group showed no improvement. Endourologic training using VR simulation facilitates performance of basic endourologic tasks and might translate into better performance in the operating room.

Adult↗

PubMed2006

Laparoscopic gastric banding in the rat model as a means of videolaparoscopic training.

BACKGROUND: The development of laparoscopy in bariatric surgery has attracted a large number of surgeons. Learning this method for future clinical practice requires intensive training with inert tissues, simulators and experimental surgery in animals. Performing these procedures in small animals, with the same equipment used in humans, is feasible, allowing familiarization with and comprehension of the basic techniques. Wistar rats weighing 300-600 g were used. The animals were kept in standard laboratory conditions. A laparoscopic video-system, Veress needle, three ports, a 0 degree optic, a laparoscopic needle-holder, two 5-mm graspers, a 5-mm dissection clamp and a 5-mm scissors were used. An orogastric catheter with three 4-0 nylon sutures and one 6-0 nylon suture were also utilized. For the gastric band, we used a plastic device similar to the human gastric band. The present study describes a simple, inexpensive and reproducible technique for laparoscopic gastric banding in a rat model utilizing the same instruments developed for humans. The experimental rat model is more motivating than simulators, requires less space, and has easier maintenance compared with bigger animals, and consequently allows the use of more animals for teaching, training and application in many scientific studies.

Animals↗

PubMed2002

Randomized prospective blinded study validating acquistion of ureteroscopy skills using computer based virtual reality endourological simulator.

PURPOSE: Surgical simulation has emerged in the last decade as a potential tool for aiding acquisition of technical skills, including anesthesia protocols, trauma management, cardiac catheterization and laparoscopy. We evaluate and validate the use of a computer based ureteroscopy simulator (URO Mentor, Simbionix Ltd., Lod, Israel) in the acquisition of basic ureteroscopic skills. MATERIALS AND METHODS: We assessed 20 novice trainees for the ability to perform basic ureteroscopic tasks on a computer based ureteroscopy simulator. Participants were randomized to receive individualized mentored instruction or no additional training, and subsequently underwent post-testing. Pre-training and post-training improvement in performance was assessed by objective simulator based measurements. Subjective overall performance was rated using a validated endourological global rating scale by an observer blinded to subject training status. RESULTS: Demographics and pre-test scores were similar between groups. Post-testing revealed a significant effect of training on objective and subjective measurements. Spearman rank correlation demonstrated a significant association between objective simulator based measurements and the endourological global rating scale. CONCLUSIONS: Use of a computer based ureteroscopy simulator resulted in rapid acquisition of ureteroscopic skills in trainees with no prior surgical training. Results of this study demonstrate the use of a virtual reality ureteroscopy simulator in endourological training. Correlation of simulator based measurements with a previously validated endourological global rating scale provides initial validation of the ureteroscopy simulator for the assessment of ureteroscopic skills.

Adult↗

PubMed2006

Training multiprofessional trauma teams in Norwegian hospitals using simple and low cost local simulations.

CONTEXT & OBJECTIVE: Norwegian hospitals' trauma teams are seldom exposed to severely injured patients. We developed and implemented a one-day multi-professional training course for hospital trauma teams in order to improve communication, cooperation and leadership. METHODS: Training courses were held in 28 Norwegian hospitals with learning objectives: improved team work, common understanding of treatment priorities and principles, communication skills, and threats to efficient communication. Two trauma teams in each hospital had two consecutive simulations in their hospital's own emergency room, as part of the course. Simulation was based on real cases, with a low-fidelity mannequin as patient. Participants completed questionnaires before and after the training course. RESULTS: A total of 2,860 trauma team members participated in the courses, of which 1,237 took part in the simulation. Independent of hospital size, the participants reported leadership and communication to be major obstacles during their last real trauma team participation. Immediately after the training, all participants reported highly fulfilled educational expectations and a high perception of learning, and taking part in the practical simulation improved the evaluation. Nurses scored their outcome significantly higher than physicians. Participants from minor hospitals reported as great a benefit from the training as personnel from major hospitals. CONCLUSIONS: Local team training is a feasible approach and team simulation offers an excellent opportunity to practise demanding and infrequent challenges. The simulation format makes it possible to integrate training on interpersonal skills as well as communication and leadership under stress. Continued requests for such training in Norway support this conclusion.

Cooperative Behavior↗

PubMed2005

Training, assessment and competency in gynaecologic surgery.

The trainee gynaecologist requires specific teaching to achieve competency in gynaecological surgery. Basic skills such as knot tying and suturing should be acquired outside the operating theatre. They can be learned on simulations, including bench models, using synthetic materials, life-like models and animal tissue. Video training equipment is useful for the development of basic laparoscopic hand-eye coordination. Intermediate and advanced skills require simulations using more sophisticated bench models, live animals and virtual reality computerised systems. Structured teaching and assessment methods are essential. Surgical skills training models should be reliable and valid, and can be incorporated into an objective structured clinical examination, which could be used to assess individual development and allow progression through a training programme. Simulation training does translate into improved operative performance. Supervised operating experience on patients is crucial to training and should be assessed regularly using a global rating form with constructive feedback to facilitate improvement.

Clinical Competence↗

PubMed2000

The use of a simulated environment (easy street) to retrain independent living skills in elderly persons: a randomized controlled trial.

BACKGROUND: Older adults who receive training for functional skills in contextually appropriate environments may show greater functional improvement than persons trained in a traditional environment. Functionally limited older adults receiving training in contextually appropriate environments (simulated home and community settings) may show greater improvement in activities of daily living (ADL) than persons trained in a traditional manner. METHODS: Eighty-eight patients from a day hospital, aged 65 years or older, were randomized to either receive rehabilitation in a simulated environment (Easy Street) or in a gymnasium setting. Rehabilitation focused on retraining functional skills in a contextually appropriate environment (Easy Street) or in a traditional setting (gymnasium) using motor learning principles for a period of 16 weeks. Outcome measures included the Structured Assessment of Instrumental Living Skills (SAILS), a performance measure with criterion and timed components; a self-report health status questionnaire, the Short Form-36 (SF-36); and the patient-orientated goal-directed Canadian Occupational Performance Measure (COPM). RESULTS: There were no group differences on any of the outcome measures: SAILS (p = .3); the SF-36 physical (p = .83) and mental (p = .51); and the COPM performance scale (p = .94) and satisfaction scale (p = .40). CONCLUSIONS: Although we have not excluded benefits of contextually appropriate rehabilitation environments with different intervention approaches, at different stages of rehabilitation or with patients at higher functional levels, our results suggest the appropriateness of a moratorium on these expensive interventions pending demonstration of clear positive effects determined from further study.

Activities of Daily Living↗

PubMed2004

Phasic stimuli evoke precisely timed spikes in intermittently discharging mitral cells.

Mitral cells, the principal cells of the olfactory bulb, respond to sensory stimulation with precisely timed patterns of action potentials. By contrast, the same neurons generate intermittent spike clusters with variable timing in response to simple step depolarizations. We made whole cell recordings from mitral cells in rat olfactory bulb slices to examine the mechanisms by which normal sensory stimuli could generate precisely timed spike clusters. We found that individual mitral cells fired clusters of action potentials at 20-40 Hz, interspersed with periods of subthreshold membrane potential oscillations in response to depolarizing current steps. TTX (1 microM) blocked a sustained depolarizing current and fast subthreshold oscillations in mitral cells. Phasic stimuli that mimic trains of slow excitatory postsynaptic potentials (EPSPs) that occur during sniffing evoked precisely timed spike clusters in repeated trials. The amplitude of the first simulated EPSP in a train gated the generation of spikes on subsequent EPSPs. 4-aminopyridine (4-AP)-sensitive K(+) channels are critical to the generation of spike clusters and reproducible spike timing in response to phasic stimuli. Based on these results, we propose that spike clustering is a process that depends on the interaction between a 4-AP-sensitive K(+) current and a subthreshold TTX-sensitive Na(+) current; interactions between these currents may allow mitral cells to respond selectively to stimuli in the theta frequency range. These intrinsic properties of mitral cells may be important for precisely timing spikes evoked by phasic stimuli that occur in response to odor presentation in vivo.

4-Aminopyridine↗

PubMed1999

Relatively shorter but intensive isotonic exercise in legs prevented the decrease in maximal aerobic power after 20 days of head down tilt bed rest in man.

As a countermeasures for the decrease in maximal oxygen uptake (VO2max) during prolong simulated weightlessness, it has been suggested that intensive isotonic legs exercise was useful. The reason is possibly that a dynamic and intensive resistance exercise training makes to maintain not only the volume of exercising muscles but also cardiac output. For the reason, it has been studied the effects of 3 different exercise training on VO2max during simulated weightlessness.

Bed Rest↗

PubMed1997

Assessing bedside cardiologic examination skills using "Harvey," a cardiology patient simulator.

OBJECTIVE: To assess the cardiovascular physical examination skills of emergency medicine (EM) housestaff and attending physicians. METHODS: Prospective, cohort assessment of EM housestaff and faculty performance on 3 valvular abnormality simulations (mitral regurgitation, mitral stenosis, and aortic regurgitation) conducted on the cardiology patient simulator, "Harvey." Participants examined each of the 3 study disease simulations and proposed a diagnosis (session I). They were then given a cardiac examination form and repeated the programmed simulations (session II). The examination form was used to prompt physicians to interpret 23 separate cardiac findings for each simulation in a multiple-choice format. RESULTS: Forty-six EM housestaff (PGY1-3) and attending physicians were tested over a 2-month study period. Physician responses did not differ significantly among the different levels of postgraduate training. The overall correct response rates for participants were 59% for aortic regurgitation, 48% for mitral regurgitation, and 17% for mitral stenosis. For aortic regurgitation, recognition of a widened pulse pressure and recognition of diastolic decrescendo murmur were associated with a correct diagnosis (p < 0.01). For mitral regurgitation, correct assessment of the contour of the holosystolic murmur predicted a correct diagnosis (p < 0.001). For mitral stenosis, proper characterization of the mitral area diastolic murmur predicted a correct diagnosis (p < 0.001). CONCLUSION: Housestaff and faculty had difficulty establishing a correct diagnosis for simulations of 3 common valvular heart diseases. However, accurate recognition of a few critical signs was associated with a correct diagnosis in each simulation. Training programs may need to focus attention on selected key components of the cardiovascular examination to facilitate teaching of physical diagnosis.

Clinical Competence↗

PubMed2001

Immersive virtual reality used as a platform for perioperative training for surgical residents.

Perioperative preparations such as operating room setup, patient and equipment positioning, and operating port placement are essential to operative success in minimally invasive surgery. We developed an immersive virtual reality-based training system (REMIS) to provide residents (and other health professionals) with training and evaluation in these perioperative skills. Our program uses the qualities of immersive VR that are available today for inclusion in an ongoing training curriculum for surgical residents. The current application consists of a primary platform for patient positioning for a laparoscopic cholecystectomy. Having completed this module we can create many different simulated problems for other procedures. As a part of the simulation, we have devised a computer-driven real-time data collection system to help us in evaluating trainees and providing feedback during the simulation. The REMIS program trains and evaluates surgical residents and obviates the need to use expensive operating room and surgeon time. It also allows residents to train based on their schedule and does not put patients at increased risk. The method is standardized, allows for repetition if needed, evaluates individual performance, provides the possible complications of incorrect choices, provides training in 3-D environment, and has the capability of being used for various scenarios and professions.

Cholecystectomy, Laparoscopic↗

PubMed2004

Development of a valid, cost-effective laparoscopic training program.

BACKGROUND: Practical programs for training and evaluating surgeons in laparoscopy are needed to keep pace with demand for minimally invasive surgery. METHODS: At the University of Kentucky five inexpensive simulations have been developed to train and assess surgical residents. Residents are videotaped performing laparoscopic procedures on models. Five surgeons assess the taped performances on 4 global skills. RESULTS: Creating mechanical models reduces training costs. Trainees agreed procedures were well represented by the simulations. Blinded assessment of performances showed high interrater agreement and correlated with the trainees' level of experience. Nonclinician evaluations on checklists correlated with evaluations by surgeons. CONCLUSIONS: Inexpensive simulations of laparoscopic appendectomy, cholecystectomy, inguinal herniorrhaphy, bowel enterotomy, and splenectomy enable surgical residents to practice laparoscopic skills safely. Obtaining masked, objective, and independent evaluations of basic skills in laparoscopic surgery can assist in reliable assessment of surgical trainees. The simulations described can anchor an innovative educational program during residency for training and assessment.

Education, Medical↗

PubMed2004

Advanced technologies in plastic surgery: how new innovations can improve our training and practice.

Over the last two decades, virtual reality, haptics, simulators, robotics, and other "advanced technologies" have emerged as important innovations in medical learning and practice. Reports on simulator applications in medicine now appear regularly in the medical, computer science, engineering, and popular literature. The goal of this article is to review the emerging intersection between advanced technologies and surgery and how new technology is being utilized in several surgical fields, particularly plastic surgery. The authors also discuss how plastic and reconstructive surgeons can benefit by working to further the development of multimedia and simulated environment technologies in surgical practice and training.

Case Management↗