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At least 1,135 records · Page 63Linked to original sources
PubMed2005

Computer-based training in two-dimensional echocardiography using an echocardiography simulator.

Two-dimensional (2D) echocardiography is a user-dependent technique that poses some inherent problems to the beginner. The first problem for beginners is spatial orientation, especially the orientation of the scan plane in reference to the 3-dimensional (3D) geometry of the heart. The second problem for beginners is steering of the ultrasound probe. We have designed a simulator to teach these skills. On a computer screen a side-by-side presentation of a 3D virtual reality scene on the right side and a 2D echocardiographic view on the left side is given. The virtual scene consists of a 3D heart and an ultrasound probe with scan plane. The 2D echocardiographic image is calculated from 3D echocardiographic data sets that are registered with the heart model to achieve spatial and temporal congruency. The displayed 2D echocardiographic image is defined and controlled by the orientation of the virtual scan plane. To teach hand-eye coordination we equipped a dummy transducer with a 3D tracking system and placed it on a dummy torso. We have evaluated the usability of the simulator in an introductory course for final-year medical students. The simulator was graded realistic and easy to use. According to a subjective self-assessment by a standardized questionnaire the aforementioned skills were imparted effectively.

Adult↗
PubMed2005

Training on bench models improves dexterity in ureteroscopy.

INTRODUCTION: There is a need for alternative training in endourology. Computerised simulators have been introduced but have, so far, not been compared to real surgery. Bench models have proved to be comparable to real surgery when performing standard procedures in the upper urinary tract. OBJECTIVE: To validate training on bench models as a tool to improve dexterity in semi-rigid ureteroscopy. METHODS: Urology residents were tested when performing semi-rigid ureteroscopy on a bench model (Mediskills), before and after training. All standard equipment and instruments, including fluoroscopy, were available. For the test procedure we used a task-specific checklist and a global score (maximum score 10 + 9 = 19). After base line assessment, the participants practised under supervision. After training they were reassessed, using the same procedure as previously. RESULTS: The performance was significantly better after the training. Results before/after were: 5.1/9.2, 2.6/7.8 and 7.7/17.2 for task-specific checklist, global score and total score respectively. All residents felt more familiar with the instruments and the procedure after the training. CONCLUSION: Training on bench models for ureteroscopy enhanced the manual dexterity as well as familiarity with the method and is recommendable before operating on patients.

Education, Medical, Graduate↗
PubMed2004

A multidisciplinary approach to teach responses to weapons of mass destruction and terrorism using combined simulation modalities.

STUDY OBJECTIVE: To reinforce concepts presented in the lectures; understand the complexity and speed of casualty and information generation during a Weapons of Mass Destruction and Terrorism (WMD/T) event; experience the novelty of combined weapons' effects; recognize the time course of the various chemical, biological, and radiation agents; and make challenging decisions with incomplete and conflicting information. SETTINGS: Two environments simulated simultaneously: one a major trauma center emergency room (ER) with two patient simulators and several human actors; the other an Emergency Operations Command Center (EOC). TARGET AUDIENCE: Students for this course included: clinicians, scientists, military and intelligence officers, lawyers, administrators, and logistic personnel whose jobs involve planning and executing emergency response plans to WMD/T. SIMULATION SCRIPT: A WMD/T attack in Washington, D.C., has occurred. Clinical students performed in their real life roles in the simulated ER, while nonclinical students did the same in the simulated EOC. Six ER casualties with combined WMD/T injuries were presented and treated over 40 minutes. In the EOC, each person was given his or her role title with identification tag. The EOC scenario took cues from the action in the ER via two television (TV) news feeds and telephone calls from other Emergency Operations Assets. PERFORMANCE EXPECTATIONS: Students were expected to actively engage in their roles. Student performances were self-evaluated during the debriefing. DEBRIEFING: The two groups were reunited and debriefed utilizing disaster crisis resource management tools. ASSESSMENT OF EFFECTIVENESS: Students answered an 18-point questionnaire to help evaluate the usefulness and acceptance of multimodality patient simulation. LESSONS LEARNED: Large-scale multimodality patient simulation can be used to train both clinicians and nonclinicians for future events of WMD/T. Students accepted the simulation experience and thought that scenario was appropriately realistic, complex, and overwhelming. Difficulties include the extensive man-hours involved in designing and presenting the live simulations. EOC-only sessions could be staged with only a few video cassette recorders, TVs, telephones, and callers.

Disasters↗
PubMed1999

Noninvasive estimation of the maximal lactate steady state in trained cyclists.

PURPOSE: The purposes of this study were to estimate noninvasively the maximal lactate steady state (MLSS) in trained cyclists on a windload simulator with a velocity based technique and to determine whether the HR at MLSS (HR(MLSS)) elicited a similar blood lactate concentration (BLC) during field testing. METHODS: To determine and verify MLSS, 10 male cyclists performed five to seven laboratory trials on separate days, including a VO2max test; a 5-km time trial (TT); and two or more 30-min trials at specific percentages of each subject's average 5-km TT speed (AVS5km). Mean+/-SD for the following variables were obtained at MLSS: velocity was 90.3+/-2.7% of the AVS5km, BLC was 5.4+/-1.6 mM, RPE was 15+/-2.1, VO2 was 80+/-6.3% of VO2max, and HR was 167+/-9.5 beats x min(-1), which was 88+/-3.8% of the mean maximum HR. Field tests included three laps of an 8-km road circuit at HR(MLSS) +/-3 beats x min(-1) and one lap at maximum sustainable velocity (a road TT). RESULTS: There were no significant differences in BLC, HR, and RPE between the three steady-state road laps and the lab MLSS trial. There was also good agreement between the road and lab MLSS velocity/TT velocity ratios. CONCLUSIONS: Our data suggest that 5-km TT cycling velocity, as measured on a windload simulator, may be used to estimate MLSS and the HR at MLSS for training purposes.

Adult↗
PubMed2004

High performance force feedback mechanism for virtual reality training of endotracheal intubation.

A high-performance mechanism has been developed to provide force feedback during virtual reality simulations of endotracheal intubation for training purposes for the first time. The force feedback mechanism (FFM) prototype permits planar motion of the intubation tool with three degrees of freedom, each with force feedback. The FFM is computer controlled using a hybrid position-force feedback algorithm that includes a feedforward term to counterbalance the mechanism. This allows the intubation force profiles to be superimposed onto the FFM weight compensation to complete the overall force feedback effort. The development of a mechanism of this type introduces several theoretical and experimental design challenges that are addressed in this paper.

Algorithms↗
PubMed2002

Quantitative methodology of evaluating surgeon performance in laparoscopic surgery.

Quantitative performance and skill assessments are critical for evaluating the progress of surgical residents and the efficacy of different training programs. Current evaluation methods are subjective and potentially unreliable, so there is a need for objective methods to evaluate surgical performance. We identify a feasible method to measure kinematic data in the live operating room setting and to assess the repeatability of an analysis method based on a hierarchical decomposition of surgical tasks. We used an optoelectronic motion analysis system to acquire postural data and tool tip trajectories of one expert surgeon over a period of four months. To assess repeatability of performance measures, we created a hierarchical decomposition diagram describing the procedure in terms of surgical tasks, tool sequences and fundamental tool actions. From the kinematic data, we extracted characteristic measures of individual tool actions and compared these measured distributions using the Kolmogorov-Smirnov statistic. The comparisons of distributions show consistent performance over time by a trained surgeon and little effect from patient variability, and so are likely reliable measures of performance. An expanded set of reliable kinematic measures will form the basis for quantifying surgical skill and should be useful in validating surgical simulations for use in training, certifying surgeons and designing and evaluating new surgical tools.

Biomechanical Phenomena↗
PubMed2005

Barriers to use of simulation-based education.

PURPOSE: Barriers to simulation-based education in postgraduate and continuing education for anesthesiologists have not been well studied. We hypothesized that the level of training may influence attitudes towards simulation-based education and impact on the use of simulation. This study investigated this issue at the University of Toronto which possesses two sites equipped with high-fidelity patient simulators. METHODS: A 40-question survey of experiences, perceptions, motivations and perceived barriers to simulation-based education, was distributed to 154 anesthesiologists attending a departmental conference. Data were analyzed using descriptive statistics and associations between responses were assessed using either the Chi-Square statistic or a one-way analysis of variance. RESULTS: The rate of response was 58%. Residents had experienced simulation-based education (96%) more often than staff (58%) and fellows (36%), (P < 0.001 respectively). Residents had also attended more simulation sessions than staff and fellows (mean 2.8 vs 1.05 and 1.04, P < 0.001 respectively). Residents and fellows found simulation-based education more relevant for their training than staff (88% vs 65%, P < 0.05). Eighty-one percent of the respondents identified at least one significant barrier that prevents or limits them from attending simulator sessions. Staff anesthesiologists perceived multiple barriers and identified 'time' and 'financial issues' as significant barriers. CONCLUSION: Anesthesiologists' level of training influences their attitudes towards and their perceptions of simulation-based education. This survey has identified perceived barriers that may limit a wider utilization of simulation. These results may be used to implement targeted actions such as course design, incentives, and information strategies, which could improve access and future use of simulation.

Anesthesiology↗
PubMed2006

Effect of reducing frequency of augmented feedback on manual dexterity training and its retention.

OBJECTIVE: The study addressed the impact of the frequency of tutorial-enriched augmented visual feedback, provided by a virtual simulation system (DentSim), on the skill acquisition for a cavity preparation task in novice dental students. METHODS: Thirty-six subjects were assigned to two training groups and a control group. The task consisted of a geometrical cross preparation on the lower left first molar. All subjects performed a pre-test to assess their basic skill level. The training groups received simulation feedback, enriched with tutorial information, across acquisition. One group trained under continuous augmented feedback, while a second group trained under an intermittent (66% of the time) feedback. At both 1-day and 4-month interval, subjects performed a retention test to explore learning specific effects. Two transfer tests were added to assess the extrapolation of the learned skills to an adjacent molar. All tests were performed in the absence of feedback. A control group performed all the tests, without preceding training. All preparations were graded by the simulation system. RESULTS: The training groups performed similarly across acquisition and improved with practice (ANOVA, P<0.001). After 1 day and 4 months of no practice, the training groups outperformed the control group on a retention test (ANOVA, P<0.001) and transfer test (ANOVA, P<0.001). CONCLUSIONS: Performance and learning of a cavity preparation task on a simulation unit was independent of the frequency of tutorial-enriched augmented visual feedback within the range tested. Training sessions on a simulation unit could be alternated with training sessions in the traditional phantom head laboratory.

Adolescent↗
PubMed2004

Teaching subfascial perforator veins surgery: survey on a 2-day hands-on course.

BACKGROUND: The present paper describes a training method with objective evaluation to enhance video-assisted surgical skills in subfascial endoscopic perforator veins surgery (SEPS). Training was scheduled during a 2-day intensive course. METHODS: Hands-on exercises were performed (i) on a simulator to assess whether specific training exercises were helpful in attainment of skills; (ii) on a known animal model that uses the swine abdominal wall and which allows practice in endoscopic dissection and perforator veins (PV) using appropriate instrumentation in an environment that is a reasonable surrogate for the human calf; and (iii) assisting a senior surgeon performing SEPS. Thirty surgeons without experience in SEPS were trained to perform a sequence of standardized drills connected with the SEPS technique. The SEPS simulator consisted of an artificially constructed subfascial space of the leg in which false perforator veins had to be localized, and cut. The participants performed a sequence of drills three times in order to improve their dexterity. The same exercises were then performed on a swine model. The model consisted of the arteries and veins penetrating the rectus fascia and passing into the overlying cutaneous trunci muscle and hypodermis on either side of the midline between the arch of the ribs cranially and the umbilicus caudally. Trainees were required to achieve operative space in the animal subcutaneous fat, to reach and identify the "perforating" subcutaneous vessels, and to interrupt some of them with a 5-mm clamp coagulator ultrasonic scalpel. The time required to perform each dexterity drill was recorded in seconds. Finally, the day after, trainees were asked to drive the senior operator during clinical SEPS performed on eight patients, suggesting the following manoeuvres in order to: (i) enter the subfascial space of the leg; (ii) make operative space; (iii) identify the incompetent perforator vein(s); and (iv) coagulate and divide them with the ultrasonic scalpel. Each of these four steps scored 1 point. RESULTS: All the trainees showed a steady improvement in skill acquisition on the SEPS simulator (P < 0.001), and on the animal model with the single-port technique (P < 0.001). These results reflect positively on the animal model using the dual-port technique, and on the scores achieved in the operating theatre during clinical SEPS. CONCLUSIONS: The validity of the 2-day course was demonstrated by significant improvement in performance with increasing skill on the training models, and in clinical practice.

Animals↗
PubMed1993

Remapping of neural activity in the motor colliculus: a neural network study.

Neurophysiological studies have shown that the deeper layers of the superior colliculus (SC) contain a topographical neural map representing the ocular vectorial displacement required for foveation of the target (motor error). It is known that the location of the active area in this neural map can be updated, not only following changes in retinal error, but also by efference-copy signals representing a change in eye position. Since it can be shown that a two-layer feedforward network cannot perform this task, we have simulated this system by training a three-layered neural network with access to retinal error and efference copy information about eye position. The network was taught to code motor error topographically (as in the collicular motor map) by generating population activity at the appropriate location in its output layer for different combinations of visual and efference copy signals. After the network had learned the required remapping transformation with sufficient precision (error of one deg over an 80 x 80 deg working range), the properties of the trained network were analyzed. From an investigation of the activity patterns of the hidden units in the trained network it appeared that information about target location relative to the head, implicitly present at the level of input signals, is no longer available at the level of the hidden layer. More detailed inspection of the properties of these units revealed that they code motor error. Their movement field is a monotonic function of motor error amplitude, and shows broad direction tuning specific for each unit. Finally, simulations were made with a four layered network with an architecture and access to input signals closely mimicking Robinson's model of the saccadic system. Again, the network was trained to represent motor error topographically in its output layer. The model shows, for the first time, how the computation of the topographical motor error map in the SC from retinal and eye position signals may proceed in two steps, involving a stage where target location is coded in a distributed fashion in craniotopic coordinates and a subsequent supracollicular stage, where radial motor error is represented in a firing-rate code in units with broad tuning characteristics. These two stages in the model show interesting similarities with the characteristics of neuron populations shown neurophysiologically in area 7a and parietal region LIP, respectively.

Brain Mapping↗
PubMed2003

[Continuous target of China's manned space project and research direction of space medico-engineering].

The subject of space medico-engineering which takes manned space flight as its own task, played an important role in China's manned space project, and developed rapidly. According to China's next three manned space objectives: 1) to develop the technology of extra-vehicle activity (EVA) and test the astronauts' performance ability of EVA; 2) to develop the technology of docking with other object spacecraft in space; 3) to found a relatively large space lab, the research directions and key technology of space medico-engineering have been given, including astronaut's selection and training; requirements and evaluation of medicine and ergonomics of the space lab design; the researches of fields in astronauts' medical monitoring and space medicine; technology of environmental control and life support system in space module; technology of EVA or docking; and technology of simulation of astronaut's training.

Aerospace Medicine↗
PubMed2003

A part-task approach to haptic knee arthroscopy training.

This paper describes the research behind a part-task approach to both the development of, and the training offered, by a virtual reality simulator for knee arthroscopy. An ethnographic approach has been taken to examine the nature of task performance and the current training of the arthroscopic diagnosis of the knee. This Human Factors research is used to support the development of WISHKATS. The design addresses the challenge of technically producing haptic feedback for a knee surgery simulator whilst offering sufficient fidelity to train the necessary skills and conform to traditional surgical training.

Arthroscopes↗
PubMed2000

Gait evaluation of a transfemoral prosthetic simulator.

OBJECTIVE: To test a prosthetic simulator developed to allow persons without amputation to walk like a person with a transfemoral (TF) amputation. PATIENTS: Five able-bodied subjects; comparison with data from the literature on persons with TF amputations. SETTING: Motion analysis laboratory. DESIGN: Two 45- to 60-minute gait training sessions before subjects walked along a 10-meter walkway. There were 6 trials: 3 walking with a cane, 3 without a cane. MAIN OBJECTIVE MEASURES: Sagittal plane kinematic and kinetic analysis of ankle, knee, and hip: angular velocity, joint moment, and power. RESULTS: Kinematic and kinetic analyses showed that joint mechanics during walking were similar between the test subjects and comparative results from persons with TF amputations (reported in the literature). Test subjects walked slower and moved their hip and knee joints faster (higher angular velocity values during the terminal swing) than the TF amputee subjects, although these results were not statistically significant (p < .05). These findings were consistent with new prosthetic users who are more tentative during gait training. However, a perfect simulation would show no difference in kinematic results. CONCLUSION: These results support the use of a TF prosthetic simulator to help health care professionals experience the process of fitting the prosthesis from the client's perspective.

Adult↗
PubMed1981

Social validation and training of emergency fire safety skills for potential injury prevention and life saving.

A multifaceted behavioral program designed to teach emergency fire escape procedures to children was evaluated in a multiple-baseline design. Five children were trained to respond correctly to nine home emergency fire situations under simulated conditions. The situations and responses focused upon in training were identified by a social validation procedure involving consultation with several safety agencies, including the direct input of firefighters. Training, carried out in simulated bedrooms at school, resulted in significant improvements in both overt behavior and self-report of fire safety skills. The gains were maintained at a post-check assessment 2 weeks after training had been terminated. The results are discussed in relation both to the importance of social validation of targets and outcomes and the implications for further research in assessing and developing emergency response skills.

Accident Prevention↗
PubMed2005

The rabbit model serves as a valuable operative experience and helps to establish new techniques for abdominal and thoracic endosurgery.

Minimally invasive surgery in infants requires great experience and highly specialised skills. However, in most paediatric surgical departments, the number of patients requiring such surgery is usually small and the personal experience of the surgeon limited. An experimental setting with small animals could improve these training conditions if it adequately simulates the underlying situation and conveys beneficial surgical experiences. The authors implemented an endosurgical training model with New Zealand white rabbits. The mean body weight was 3.3 (range 2.9-3.5) kg. The abdominal cavity had a volume of about 580 ml and the thoracic cavity a volume of about 250 ml, comparable with those of a newborn baby. Several relevant techniques were established (gastrostomy, colostomy, gut biopsies, lung biopsies, and anastomosis of the oesophagus). Overall, the rabbit model served to refine technical skills and operative experience. In paediatric surgical departments with a specific focus on endosurgery in the abdominal and thoracic cavities, this training model could help to introduce new techniques and add valuable educational strategies.

Animals↗
PubMed2002

Visualization and simulation techniques for surgical simulators using actual patient's data.

Because of the increasing complexity of surgical interventions research in surgical simulation became more and more important over the last years. However, the simulation of tissue deformation is still a challenging problem, mainly due to the short response times that are required for real-time interaction. The demands to hard and software are even larger if not only the modeled human anatomy is used but the anatomy of actual patients. This is required if the surgical simulator should be used as training medium for expert surgeons rather than students. In this article, suitable visualization and simulation methods for surgical simulation utilizing actual patient's datasets are described. Therefore, the advantages and disadvantages of direct and indirect volume rendering for the visualization are discussed and a neuro-fuzzy system is described, which can be used for the simulation of interactive tissue deformations. The neuro-fuzzy system makes it possible to define the deformation behavior based on a linguistic description of the tissue characteristics or to learn the dynamics by using measured data of real tissue. Furthermore, a simulator for minimally-invasive neurosurgical interventions is presented that utilizes the described visualization and simulation methods. The structure of the simulator is described in detail and the results of a system evaluation by an experienced neurosurgeon--a quantitative comparison between different methods of virtual endoscopy as well as a comparison between real brain images and virtual endoscopies--are given. The evaluation proved that the simulator provides a higher realism of the visualization and simulation then other currently available simulators.

Artificial Intelligence↗
PubMed1996

Academic education. Creating a laboratory that simulates the critical care environment.

Educating students and practicing nurses for the complexities and demands of critical care is a challenge. Training in a laboratory that simulates the critical care setting is an excellent teaching method that can be used to supplement lectures and clinical experiences. Developing such a laboratory is an exciting and rewarding process that will promote learning and ultimately benefit the care of critically ill patients.

Clinical Competence↗