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A device-trainer intended for individual exercises with patients suffering from an intensively pronounced hearing defect is described. The device permits it to reproduce sound signals amplifying them up to 130 dB in the mono-binaural and also in the stereophonic modes and provides for a wide bandwidth. The originals can be presented by using the auditory and vibro-tactile reception.
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Ozone (O3) toxicity is potentiated by exercise-induced expired minute ventilation (VE) for a given exposure, which may also impair endurance performance. Ten healthy, well-trained long-distance runners were exposed on six occasions for 1 h to O3 concentrations of 0, 0.20, or 0.35 parts per million (ppm), during exercise simulating either training or competition, with mean VE = 77.5 1 X min -1. Standard pulmonary function tests, subjective symptoms, and periodic observations of exercise ventilatory response and respiratory metabolism were obtained. Statistical analyses revealed no significant exercise mode effect for pulmonary function, but a significant O3 effect for forced vital capacity and expiratory volume at 1 s was observed. Altered exercise ventilatory pattern response was noted, but there was no significant O3 effect on exercise oxygen uptake, heart rate, VE, or alveolar ventilation. Subjective symptoms increased with O3 concentration. Statistically significant pulmonary function impairment observed at 0.20 ppm O3 suggests that endurance athletes may be more susceptible to the effects of a given O3 concentration than normal young adult males as a result of sustained high mean VE incurred during training and competition. Three subjects were unable to complete both the training and competitive simulations at 0.35 ppm O3. Performance decrements appeared to be the result of physiologically induced respiratory discomfort rather than decrements in pulmonary gas exchange and/or oxygen transport and delivery.
Extracorporeal life support (ELS) systems may be run by certified perfusionists, specially trained nurses or respiratory therapy staff. Guidelines for the training, certification and retraining of ELS operators have been established by the Extracorporeal Life Support Organization. Recommendations include "... a well defined program for staff training, certification, and retraining". Some clinicians have suggested that ELS operators be certified and recertified in an animal laboratory. But such practice involves veterinary expenses, animal use issues and considerable clean-up and disposal. We describe an alternative method of training, using an in vitro physiologic model designed to simulate various pathophysiologic states. In addition, the in vitro physiologic model may be used to evaluate membrane lung characteristics. This model's ease of construction, maintenance and use for training compared with live animal techniques are discussed. Research capabilities may be more flexible than with the use of the live animal technique. The in vitro physiologic model can be a useful and convenient asset to an extracorporeal membrane oxygenation/extracorporeal carbon dioxide removal (ECMO/ECCO2R) program.
Cumulative depolarization of Hermissenda type B photoreceptors, a short-term neural correlate of associative learning, was produced by simulating associative training in the isolated nervous system (in vitro conditioning). This simulation entailed stimulation and recording from three classes of neurons normally affected by the associative training procedure: a type B photoreceptor, the silent/excitatory (S/E) optic ganglion cell, and a statocyst caudal hair cell. Exposure of the isolated nervous system to five simultaneous pairings of light and current-induced impulse activity of the caudal hair cell resulted in an average 10-mV depolarization of type B cells. Cumulative depolarization was found to be pairing specific, to occur with a minimal number of training trials, and was paralleled by short-term pairing-specific changes in phototactic behavior for the intact animal. Two important determinants of cumulative depolarization were found to be the magnitude and duration of the long-lasting depolarization (LLD) response of type B cells to light, and a pairing-specific synaptic facilitation of the LLD response. The synaptic facilitation arose from two distinct sources: increased excitatory postsynaptic potential (EPSP) feedback on B cells following light and caudal hair cell stimulation pairings, and disinhibition of the type B photoreceptor following pairings. The S/E optic ganglion cell was found to be a potent regulator of B cell EPSPs. Cumulative depolarization was substantially reduced when the S/E cell was hyperpolarized throughout the course of pairings. Conversely, pairings of light with depolarizing current stimulation of the S/E cell were sufficient to produce cumulative depolarization of B cells. Precluding disinhibition of the B cell from the caudal hair cell was also found to attenuate cumulative depolarization. Additional constraints, inherent to the neural organization of the visual and statocyst neural systems were found to further limit the degree of cumulative depolarization. Among the most important of these were the interpairing interval and light intensity. Exposure of intact animals of five pairings of light and rotation resulted in short-term suppression of phototactic behavior. Like the cumulative depolarization of B cells with in vitro conditioning procedures, these changes were relatively pairing specific and persisted for comparable durations of time. Cumulative depolarization of B cells appears to be an important initial step in the production of long-term associative neural and behavioral changes in Hermissenda.
Ventilatory and circulatory drives elicited by exercise-simulating perfusion of the circulatory isolated hindleg were examined in 10 trained (TR) and untrained (UTR) rats. TR were submitted to endurance training on a motordriven treadmill (30.min-1 at a grade of 10%, 5 days a week for 30 min). Exercise was simulated by perfusion with modified tyrode solutions: I.) hypoxic, enriched with lactic acid (15 mmol.l-1), II.) normoxic, enriched with lactic acid. III.) hypoxic without lactic acid. Perfusion was performed in anaesthetized animals through cannulae in the femoral artery and vein; the hindled was connected to the rest of the body only by nerve and bone. 10 min of control perfusion (normoxic tyrode solution) was followed by a 20 min test period and another 10 min control perfusion. Apart from heart rate (HR), respiratory rate (RR) and several outflow parameters were measured ([K+], [Na+], [lactate], pH, PO2, PCO2). During control period HR was slightly higher in UTR than in TR (375.5 +/- 3.9 (SE) vs. 364.1 +/- 5.5 beats/min-1, p less than 0.6 n.s.), and RR in UTR was significantly higher than those in TR (61.5 +/- 0.4 bpm vs. 55.5 +/- 3.9 breaths.min-1, p less than 0.001). During the test periods both HR and RR in UTR increased significantly while in TR they did not (e.g. in series I mean HR and RR in UTR increased by 8.9 +/- 1.2 beats.min-1 and 1.4 +/- 0.1 breaths.min-1 respectively, whereas in TR the changes were - 2.9 +/- 1.5 beats/min-1 and -0.8 +/- 0.2 breaths.min-1.(ABSTRACT TRUNCATED AT 250 WORDS)
This paper investigates associations between physicians' task-oriented and socioemotional behaviors, on the one hand, and analogue patients' satisfaction, recall of information, and global impressions. The study is based on role-playing subjects' responses to interactions between physicians and simulated patients. Audiotapes of two standardized patient cases presented by trained patient simulators to 43 primary care physicians were rated by role-playing patients (N = 258), and electronically filtered excerpts from the encounters were rated for vocal affect by 37 independent judges. Content analysis was made of the visits' transcripts to assess interaction process and to identify all medical information communicated. Finally, speech error rate was calculated from a combination of audiotape and transcript. Findings revealed that role-playing patients clearly distinguished task from socioemotional behaviors of the physicians, and a consistent pattern of association emerged between physicians' task behaviors and role-playing patients' satisfaction, recall, and impressions. Within the task domain, patient-centered skills (i.e., giving information and counseling) were consistently related to patient effects in a positive direction, but physician-centered behaviors (i.e., giving directions and asking questions) demonstrated the opposite relationship. A negative pattern of association was also evident between physicians' socioemotional behaviors and patient effects.
Although simulated patients are increasingly used in medical education, little research has been carried out on their validity. Validity in this case defines the relationship between performance with a simulated patient and performance with a real patient. One of the objectives of this study was to determine the validity of the use of simulated patients in assessing the consultation skills of trainees in vocational training at the Department of General Practice, University of Utrecht, The Netherlands. A check-list with a rating scale was used to assess the consultation skills of trainees at the department with simulated patients as well as in their training practices with real patients. The simulated and the selected practice cases were patients with complex multi-conditional problems like low back pain, headache and chest pain. The consultation skills were subdivided into four groups: the patient-centered approach, the non-somatic approach, communication skills and interpersonal skills. The measurement of skills, in particular of consultation skills, is very difficult. A description is given of the way the research group solved this problem. The analysis was performed by determining the sensitivity and predictive value of the assessment of a simulated encounter with a routine practice encounter. A difference existed in the assessed level of consultation skills in the simulated encounter compared to the level in the training practice. In simulation the level of consultation skills was higher than in day-to-day practice. This difference can reflect the difference between competence and performance. Competence is defined as what a doctor is capable of doing and performance as what a doctor actually does in day-to-day practice.(ABSTRACT TRUNCATED AT 250 WORDS)
An explosion in flight simulator technology over the past 10 years is revolutionizing U.S. Air Force (USAF) operational training. The single, most important development has been in computer image generation. However, other significant advances are being made in simulator handling qualities, real-time computation systems, and electro-optical displays. These developments hold great promise for achieving high fidelity combat mission simulation. This article reviews the progress to date and predicts its impact, along with that of new computer science advances such as very high speed integrated circuits (VHSIC), on future USAF aircrew simulator training. Some exciting possibilities are multiship, full-mission simulators at replacement training units, miniaturized unit level mission rehearsal training simulators, onboard embedded training capability, and national scale simulator networking.
Although simulated patients have been increasingly used in medical education, the validity of this procedure--that is, the relationship between performance on a simulated patient and performance with a real patient presenting a similar clinical problem--has not been adequately addressed. The study on which this article is based was an attempt to examine this question. Four actual patients with chronic stable findings were used in the study; four simulated patients were then programmed to present the same problem. A sample of 10 residents in family and internal medicine interviewed and examined all eight patients. The order of the presentation of the cases was balanced. No significant differences emerged in number of questions on history and physical examination or in the diagnoses and investigations considered by residents. Residents elicited significantly more historical data from the simulated patient; however, this was found to be due to a single case in which the real patient suffered from a neurological condition characterized by loss of memory. Residents correctly identified 67 percent of the patients as real or simulated against a chance figure of 50 percent. The implications of the study for training of simulated patients are discussed.
This paper investigates the association between physicians' interviewing styles and medical information obtained during simulated patient encounters. The sources of data are audiotapes and transcripts of two standardized patient cases presented by trained patient simulators to 43 primary care practitioners. Transcripts were scored for physician proficiency using expert-generated criteria and were content-analyzed to assess the process of communication and information content. Relevant patient disclosure was also scored from the transcripts based on expert-generated criteria. Findings were: 1) On the whole, physicians elicited only slightly more than 50% of the medical information considered important according to expert consensus, with a range from 9% to 85%. 2) Both open and closed questions were substantially related to patient disclosure of medical information to the physician, but open questions were substantially more so (Pearson correlations of 0.37 and 0.72, respectively). 3) Patient education, particularly information regarding prognosis, cause, and prevention, was substantially related to patient disclosure of medical information to the physician (Pearson correlations of 0.44, 0.36, and 0.34, respectively). 5) Finally, clinical expertise was only weakly associated with patient disclosure of medical information to the physician (Pearson correlation of 0.16).
Effects of endurance training on maximal inspiratory pressure and fatigue were evaluated after 5 weeks. Twelve male and 9 female untrained subjects were matched in the three groups for sex and maximal oxygen uptake (VO2 max). Training was performed at 70% VO2max; 45 min day-1; 5 days week-1 (n = 7); and at the same relative (n = 7) and absolute (n = 7) work loads in a pressure chamber corresponding to 2500 m (560 mmHg). Work load was increased every week to maintain the training heart rate. Maximal respiratory pressure was measured at the mouth before and 30, 60 and 120 s after maximal exercise. With no significant difference between the three groups of subjects, VO2max increased from 2.96 (1.98-4.47) (median and range for 21 subjects) to 3.33 (2.50-4.72) 1 min-1 (p < 0.001) and ventilation (VE max) from 109 (57-147) to 123 (73-148) 1 min-1 (p < 0.001), while maximal heart rate decreased from 193 (180-211) to 192 (169-207) beats min-1 (p < 0.01). Maximal inspiratory pressure (87 (56-115) mmHg), inspiratory muscle fatigue (18 (-2-43)%, p < 0.001), and arterial oxygen tension during exercise (12.4 (9.9-15.6)kPa) were similar before and after training. The results demonstrate that training at simulated altitude at 2500 m does not increase VE max or VO2 max above the increases obtained from training at sea level. Furthermore, VEmax and VO2 max increased approximately 13% despite unchanged maximal inspiratory pressure and inspiratory muscle fatigue.(ABSTRACT TRUNCATED AT 250 WORDS)
Differences in decision processes as measured by auditory reaction times of simulated or actual functional hearing-loss subjects and nonfunctional subjects were investigated. Sensation level data are presented that reflect marked differences between such individuals with regard to probability of response, and means and standard deviations of auditory reaction times. Means and standard deviations of auditory reaction times for nonfunctional subjects are greatly reduced when compared with results obtained by simulated or actual functional subjects. Probability of response data was less effective in differentiating functional from nonfunctional subjects. Individuals who were trained to simulate hearing loss responded in a manner similar to functional patients. The results of this study suggest that auditory reaction time measures can be employed to determine the existence or nonexistence of functional hearing loss with considerable accuracy.
INTRODUCTION: This study aimed to compare immersive virtual reality (IVR)-assisted versus conventional anatomy training for teaching endotracheal intubation (ETI) to novice non-anesthesiology residents enrolled in China's Standardized Residency Training program. METHODS: A total of 90 non-anesthesiology residents without prior ETI experience were randomly assigned to either an IVR group receiving IVR-assisted anatomy training (n = 45) or a control group receiving conventional anatomy training (n = 45). All participants underwent a standardized teaching protocol. The primary endpoint was residents' ETI performance on a simulator, assessed using both the Global Rating Scale (GRS) and a task-specific checklist. The secondary endpoints included changes in written multiple-choice question (MCQ) scores and residents' evaluations of the course. RESULTS: In practical ETI assessments on a manikin, the IVR group achieved significantly higher scores on the task-specific checklist than the control group (90.34 ± 2.89 vs. 87.20 ± 3.29; p < 0.001), whereas GRS scores were comparable between groups. Both groups showed significant post-training improvement in knowledge scores (p < 0.001), with the IVR group showing a greater gain in theoretical knowledge (54.0% vs. 36.3%; p < 0.001). Participants in the IVR group also expressed a stronger preference for their training method (80.8%) and reported higher levels of motivation, confidence, and enjoyment (all p < 0.05). CONCLUSION: IVR-assisted anatomy training enhances the effectiveness of ETI training for novice non-anesthesiology residents, offering an interactive, engaging, and reproducible approach within China's Standardized Residency Training framework.
Effective communication during laparoscopic procedures is frequently undermined by spatial disorientation and inconsistent terminology between instructors and trainees. This study examined whether standardized visual overlays on endoscopic monitors could enhance communication and learning. We conducted a three-phase mixed-methods study: qualitative observation of 20 laparoscopic teaching cases; a randomized trial of 63 second-year medical students assigned to control, clock, or alphanumeric grid (AG) overlays during three trials of a standardized transfer task; and intraoperative implementation in 44 cases (30 AG, 14 clock) with post-case surveys and qualitative feedback. In simulation, the clock overlay produced the fastest completion times, whereas the AG yielded the lowest error scores, and both overlays outperformed the control. Intraoperatively, the AG was rated higher than the clock for communication clarity, spatial orientation, perceived operative efficiency, and trainee confidence. Standardized visual overlays, particularly the AG, appear to support intraoperative teaching by providing a shared spatial frame of reference.
Isokinetic contraction is the muscular contraction that accompanies constant velocity limb movements around a joint. The velocity of movement is maintained constant by a special dynamometer. The resistance of the dynamometer is equal to the muscular forces applied throughout the range of movement. This method allows the measurement of the muscular forces in dynamic conditions and provides optimal loading of the muscles. However, during movements in the vertical plane, the torque registered by the dynamometer is the resultant torque produced by the muscular and gravitational forces. The error depends on the angular position and the torque potential of the tested muscle group. Several methods have been developed for the correction of gravitational errors in isokinetic data. The torque output also contains artefacts that are associated with the inertial forces during acceleration and deceleration periods before the development of the constant preset angular velocity. For an accurate assessment of muscle function, only constant velocity data should be analysed. The most frequently used isokinetic parameters are the maximum torque and the angular position where it was recorded, the torque output at different angular velocities of movement, the torque ratio of reciprocal muscle groups and the torque output during repeated contractions. The unique features of isokinetic dynamometry are optimal loading of the muscles in dynamic conditions and constant preselected velocity of movement. These features provide safety in the rehabilitation of patients with muscular and ligamentous injuries. Isokinetic dynamometry has also been used for the training of various muscle groups in order to improve the muscular performance in dynamic conditions. The movement velocity of different activities can be simulated during training in order to improve the training effect. Data acquisition and analysis have been improved by using computer systems interfaced to isokinetic dynamometers. Recently developed computer systems provide correction for gravitational and inertial errors, accurate computation of isokinetic parameters and real-time display of the torque output.
Memory training programs for cognitively impaired patients have often been criticized for their lack of relevance to everyday activities. We therefore report our experience with two patients suffering from probable Alzheimer's disease who were trained with a new computer-based program recently developed by our research group. An everyday task of personal relevance to the patient was simulated and trained on a PC touch screen using personal photographs of the patient's surroundings and biography. The patient's training performance (time, mistakes, number of advices) improved substantially. While psychopathometric tests showed no significant effects with regard to general cognitive performance, levels of motivation were high and there was a positive acceptance of the training, signs of emotional activation and of a transfer of the trained skills into real situations.