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At least 1,333 records · Page 74Linked to original sources

PubMed2006

A visual graphic/haptic rendering model for hysteroscopic procedures.

Hysteroscopy is an extensively popular option in evaluating and treating women with infertility. The procedure utilises an endoscope, inserted through the vagina and cervix to examine the intra-uterine cavity via a monitor. The difficulty of hysteroscopy from the surgeon's perspective is the visual spatial perception of interpreting 3D images on a 2D monitor, and the associated psychomotor skills in overcoming the fulcrum-effect. Despite the widespread use of this procedure, current qualified hysteroscopy surgeons have not been trained the fundamentals through an organised curriculum. The emergence of virtual reality as an educational tool for this procedure, and for other endoscopic procedures, has undoubtedly raised interests. The ultimate objective is for the inclusion of virtual reality training as a mandatory component for gynaecologic endoscopy training. Part of this process involves the design of a simulator, encompassing the technical difficulties and complications associated with the procedure. The proposed research examines fundamental hysteroscopy factors, current training and accreditation, and proposes a hysteroscopic simulator design that is suitable for educating and training.

Computer Graphics↗

PubMed1998

The views of senior students and young doctors of their training in a skills laboratory.

The study was carried out in the Faculty of Medicine and Health Sciences (FMHS), United Arab Emirates (UAE) University, UAE, where a skills laboratory was set up in 1988 to train medical students in clinical skills before they use such skills on patients. The students learn clinical skills using simulated patients, models and mannequins. The training starts in the first year of the 6-year undergraduate curriculum and continues until the end of the fourth year, after which students rotate through the clinical specialties. This study sought to identify: (1) the views of senior clerks (sixth year) and interns (first postgraduate year) regarding the clinical skills training in the skills laboratory (SKL) during the early years of the medical curriculum; (2) the differences in views between senior clerks and interns; (3) the differences in views between women and men students. Students' views about communication, interviewing, physical examination, therapeutic, diagnostic and laboratory skills were investigated. The results indicated that prior training in clinical skills was helpful to the senior clerks and the interns. Statistically significant differences in opinion were noted between the senior clerks and the interns, the interns being more positive about the usefulness of the SKL training compared with learning clinical skills directly on patients. There was no difference between men and women students except that women students were not comfortable with allowing their peers to examine any part of their bodies. The findings of the study have direct implications for the SKL programme.

Clinical Clerkship↗

PubMed1991

Discussing life-sustaining treatment. A teaching program for residents.

Ideally, physicians and patients should discuss patient preferences for life-sustaining treatment before the onset of cognitive impairment or a life-threatening illness; however, these conversations often do not occur. We developed an educational program in which residents practiced discussing advance directives with volunteer simulated outpatients and then received feedback from the patient, an observing resident, and a faculty member. Residents found the training sessions to be realistic, relevant, and useful. Resident self-ratings improved significantly on eight items representing knowledge, skills, and attitudes about discussing advance directives with patients. Resident learning occurred in four major areas: technical knowledge about advance directives; introducing the topic to patients; giving patients information; and eliciting patients' values and feelings. We conclude that residents need and want training in this area and that simulated patients act as a catalyst for their learning.

Advance Directives↗

PubMed2006

Computer-based anatomy a prerequisite for computer-assisted radiology and surgery.

RATIONALE AND OBJECTIVES: The aim of the study is to show the possibilities opened up by three-dimensional (3D) computer-based models of the human body for education in anatomy, training of radiological and endoscopic examinations, and simulation of surgical procedures. MATERIALS AND METHODS: Based on 3D data sets obtained from the Visible Human and/or clinical cases, virtual body models are created that provide an integrated spatial and symbolic description of the anatomy by using interactive color/intensity-based segmentation, ray casting visualization with subvoxel resolution, a semantic network for knowledge modeling, and augmented QuickTime VR (Apple Computer, Inc, Cupertino, CA) movies for presentation. RESULTS: From these models, various radiological, endoscopic, or haptic manifestations of the body can be derived. This is shown with examples from anatomy teaching, correlation of x-ray images with 3D anatomy for education in radiology, gastrointestinal endoscopy, correlation of ultrasound images with 3D anatomy in endoscopic ultrasonography, and simulation of drilling in temporal bone surgery. CONCLUSION: The presented models provide a means for realistic training in interpretation of radiological and endoscopic images of the human body. Furthermore, certain surgical procedures may be simulated realistically. Used as a complement to the current curriculum, these models have the potential to greatly decrease education times and costs.

Anatomy↗

PubMed2002

Temporal transformation of multiunit activity improves identification of single motor units.

This report describes a temporally based method for identifying repetitive firing of motor units. This approach is ideally suited to spike trains with negative serially correlated inter-spike intervals (ISIs). It can also be applied to spike trains in which ISIs exhibit little serial correlation if their coefficient of variation (COV) is sufficiently low. Using a novel application of the Hough transform, this method (i.e. the modified Hough transform (MHT)) maps motor unit action potential (MUAP) firing times into a feature space with ISI and offset (defined as the latency from an arbitrary starting time to the first MUAP in the train) as dimensions. Each MUAP firing time corresponds to a pattern in the feature space that represents all possible MUAP trains with a firing at that time. Trains with stable ISIs produce clusters in the feature space, whereas randomly firing trains do not. The MHT provides a direct estimate of mean firing rate and its variability for the entire data segment, even if several individual MUAPs are obscured by firings from other motor units. Addition of this method to a shape-based classification approach markedly improved rejection of false positives using simulated data and identified spike trains in whole muscle electromyographic recordings from rats. The relative independence of the MHT from the need to correctly classify individual firings permits a global description of stable repetitive firing behavior that is complementary to shape-based approaches to MUAP classification.

Action Potentials↗

PubMedDate not supplied

Simulation in medicine: addressing patient safety and improving the interface between healthcare providers and medical technology.

Medicine, as an industry in which human lives depend on the skill and performance of operators, must create and maintain a culture of safety, in addition to promoting the design of systems to mitigate errors. The use of medical simulation as a mechanism for training healthcare professionals in a safe environment is expanding rapidly. An important component of systems that ensure the safety of patients in the hospital setting is the interface between humans and technology in the hospital. The objective of this paper is to review: (1) the definition and a brief history of medical simulation, (2) examples of how current medical simulation centers are using simulation to address patient safety, and (3) examples of how simulation can be used to enhance patient safety through improvement of the interface between healthcare practitioners and medical technology. Medical simulation and human factors engineering can be used to examine and enhance the interface between healthcare practitioners and medical technology, with the potential to make a significant contribution to patient safety.

Biomedical Technology↗

PubMed2006

Modelling and evaluation of surgical performance using hidden Markov models.

Minimally invasive surgery has become very widespread in the last ten years. Since surgeons experience difficulties in learning and mastering minimally invasive techniques, the development of training methods is of great importance. While the introduction of virtual reality-based simulators has introduced a new paradigm in surgical training, skill evaluation methods are far from being objective. This paper proposes a method for defining a model of surgical expertise and an objective metric to evaluate performance in laparoscopic surgery. Our approach is based on the processing of kinematic data describing movements of surgical instruments. We use hidden Markov model theory to define an expert model that describes expert surgical gesture. The model is trained on kinematic data related to exercises performed on a surgical simulator by experienced surgeons. Subsequently, we use this expert model as a reference model in the definition of an objective metric to evaluate performance of surgeons with different abilities. Preliminary results show that, using different topologies for the expert model, the method can be efficiently used both for the discrimination between experienced and novice surgeons, and for the quantitative assessment of surgical ability.

Computer Simulation↗

PubMed2002

Developing a new line of patter: can doctors change their consultations for sore throat?

BACKGROUND AND OBJECTIVES: Doctors report pressure from peers to reduce prescribing of antibiotics for minor respiratory illnesses, and from patients to do the opposite. It has been suggested that doctors adopt a more patient-centred consulting style in order to encourage patient satisfaction and shared decision-making. No evidence exists that such changes are achievable. We developed a new, on-site method for training postgraduates and used this for teaching patient-centred intervention. Here, we examine whether this training method is associated with changes in consulting patterns in consultations for sore throat with children, among doctors from a single group practice. METHODS: Audiotaped consultations (simulated and real) conducted before and after training were analysed and interviews were carried out with participants about the impact of training. SETTING: A general practice in South Wales. PARTICIPANTS: Four general practitioners who consulted with 25 real and simulated patients participated in the study. MAIN OUTCOME MEASURES: Four patient-centred skills used by doctors and 2 patient behaviours measured before and after training were identified. RESULTS: Three out of 4 practitioners produced clear evidence of changes in patient-centred consulting skills. These changes were evident in simulated and real consultations 2 and 4 weeks later, respectively. Prior to training the doctors produced only five examples of patient-centred skills in 10 consultations. After training they produced 39 examples in 15 consultations. CONCLUSIONS: Evidence from both consultations and interviews indicated that the intervention and training were well received and had been put into practice.

Communication↗

PubMed2003

Integrating human factors into the medical curriculum.

BACKGROUND: The study of human factors is a scientific discipline that deals with the interactions between human beings and the elements of a system. This is important because shortcomings in these areas, if unchecked, can result in adverse outcomes. Research into human factors in industries where safety is paramount has provided the basis of countermeasures against human error. Adverse outcomes in medicine resulting from human error exact a high cost in both patient suffering and financial outlay. CRM TRAINING: One of the approaches used to minimise the effect of human error is to train people in a set of knowledge, skills and attitudes that underpin the domain-specific competencies for that profession. These are referred to as non-technical skills (NTS). In aviation, such an approach has been shown to be both translatable from the training environment to the workplace and effective in reducing adverse outcomes. DISCUSSION: Medicine has incorporated this style of training, usually centred around simulator-based courses, but as yet in a piecemeal, episodic fashion which relies on participants volunteering to attend courses. Unlike other industries there is no systematic approach to linking the content of this teaching with the more conventional range of topics. As a consequence it is difficult to assess the impact of human factors training in medicine. This is partly because very little work has been done to date in identifying the key non-technical skills required in medicine, and the overall experience of workplace based assessment is limited. Lessons from other high reliability organisations may help to address the main challenges of developing the content, integrating it into the curriculum, reinforcing the concepts in the workplace through staff development and establishing its role in summative assessment.

Clinical Competence↗

PubMed2004

Distributed interactive virtual environments for collaborative experiential learning and training independent of distance over Internet2.

Medical knowledge and skills essential for tomorrow's healthcare professionals continue to change faster than ever before creating new demands in medical education. Project TOUCH (Telehealth Outreach for Unified Community Health) has been developing methods to enhance learning by coupling innovations in medical education with advanced technology in high performance computing and next generation Internet2 embedded in virtual reality environments (VRE), artificial intelligence and experiential active learning. Simulations have been used in education and training to allow learners to make mistakes safely in lieu of real-life situations, learn from those mistakes and ultimately improve performance by subsequent avoidance of those mistakes. Distributed virtual interactive environments are used over distance to enable learning and participation in dynamic, problem-based, clinical, artificial intelligence rules-based, virtual simulations. The virtual reality patient is programmed to dynamically change over time and respond to the manipulations by the learner. Participants are fully immersed within the VRE platform using a head-mounted display and tracker system. Navigation, locomotion and handling of objects are accomplished using a joy-wand. Distribution is managed via the Internet2 Access Grid using point-to-point or multi-casting connectivity through which the participants can interact. Medical students in Hawaii and New Mexico (NM) participated collaboratively in problem solving and managing of a simulated patient with a closed head injury in VRE; dividing tasks, handing off objects, and functioning as a team. Students stated that opportunities to make mistakes and repeat actions in the VRE were extremely helpful in learning specific principles. VRE created higher performance expectations and some anxiety among VRE users. VRE orientation was adequate but students needed time to adapt and practice in order to improve efficiency. This was also demonstrated successfully between Western Australia and UNM. We successfully demonstrated the ability to fully immerse participants in a distributed virtual environment independent of distance for collaborative team interaction in medical simulation designed for education and training. The ability to make mistakes in a safe environment is well received by students and has a positive impact on their understanding, as well as memory of the principles involved in correcting those mistakes. Bringing people together as virtual teams for interactive experiential learning and collaborative training, independent of distance, provides a platform for distributed "just-in-time" training, performance assessment and credentialing. Further validation is necessary to determine the potential value of the distributed VRE in knowledge transfer, improved future performance and should entail training participants to competence in using these tools.

Computer Simulation↗

PubMed2006

Validation of open-surgery VR trainer.

VREST (Virtual Reality Educational Surgical Tools) is developing a universal and autonomous simulation platform which can be used for training and assessment of medical students and for continuing education of physicians. With the VREST - Virtual Lichtenstein Trainer, simulating the open surgery procedure of the inguinal hernia repair according to Lichtenstein, the validation of the simulator is ongoing. Part of this trajectory is the evaluation of the transfer of training of the virtual incision making. One group of students trained incision making on the VREST platform where the control group did not. In an experiment both groups has to perform several incision tasks on a manikin. The results are not available yet but will be presented at the MMVR14 conference.

Computer Simulation↗

PubMed1998

The use of advanced technology for visual inspection training.

In the past, training with traditional methods was shown to improve inspection performance. However, advances in technology have automated training and revolutionized the way training will be delivered in the future. Examples of such technology include computer-based simulators, digital interactive video, computer-based training, and intelligent tutoring systems. Despite the lower cost and increased availability of computer technology, the application of advanced technology to training within the manufacturing industry and specifically for inspection has been limited. In this vein, a case study is presented which shows how advanced technology along with our basic knowledge of training principles, can be used to develop a computer-based training program for a contact lens inspection task. Improvements due to computer-based inspection training were measured in an evaluation study and are reported.

Computer Simulation↗

PubMed2005

New approaches to computer-based interventional neuroradiology training.

For over 20 years, interventional methods have substantially improved the outcomes of patients with cardiovascular disease. However, these procedures require an intricate combination of visual and tactile feedback and extensive training periods. In this paper, a prototype of endovascular therapy training system is presented. A set of core simulation components applicable to most vascular procedures has been designed and integrated into a real-time high-fidelity interventional neuroradiology training system for the prompt treatment of ischemic stroke. We believe it will improve the quality of training and the speed of learning without putting patients at risk.

Computer Simulation↗

PubMed2001

A comparison of the physiological response to simulated altitude exposure and r-HuEpo administration.

Concerns have been raised about the morality of using simulated altitude facilities in an attempt to improve athletic performance. One assumption that has been influential in this debate is the belief that altitude houses simply mimic the physiological effects of illegal recombinant human erythropoietin (r-HuEpo) doping. To test the validity of this assumption, the haematological and physiological responses of 23 well-trained athletes exposed to a simulated altitude of 2650-3000 m for 11-23 nights were contrasted with those of healthy volunteers receiving a low dose (150 IU x kg(-1) per week) of r-HuEpo for 25 days. Serial blood samples were analysed for serum erythropoietin and percent reticulocytes; maximal oxygen uptake (VO2max) was assessed before and after r-HuEpo administration or simulated altitude exposure. The group mean increase in serum erythropoietin (422% for r-HuEpo vs 59% for simulated altitude), percent reticulocytes (89% vs 30%) and VO2max (6.6% vs -2.0%) indicated that simulated altitude did not induce the changes obtained with r-HuEpo administration. Based on the disparity of these responses, we conclude that simulated altitude facilities should not be considered unethical based solely on the tenet that they provide an alternative means of obtaining the benefits sought by illegal r-HuEpo doping.

Adult↗

PubMed1986

Reduced exercise time in competitive simulations consequent to low level ozone exposure.

Ten highly trained endurance athletes were studied to determine the effects of exposure to low ozone (O3) concentrations on simulated competitive endurance performance and associated physiological and subjective symptom responses. Each subject was randomly exposed to filtered air (FA), and to 0.12, 0.18, and 0.24 ppm O3 while performing a 1 h competitive simulation protocol on a bicycle ergometer. Endurance performance was evaluated by the number of subjects unable to complete rides (last 30 min at an intense work load of approximately 86% VO2max). All subjects completed the FA exposure, whereas one, five, and seven subjects did not complete the 0.12, 0.18, and 0.24 ppm O3 exposures, respectively. Statistical analysis indicated a significant (P less than 0.05) increase in the inability of subjects to complete the competitive simulations with increasing O3 concentration, including a significant difference between the 0.24 ppm O3 and FA exposure. Significant decreases (P less than 0.05) were also observed following the 0.18 and 0.24 ppm O3 exposures, respectively, in forced vital capacity (-7.8 and -9.9%), and forced expiratory volume in 1 s (-5.8 and -10.5%). No significant O3 effect was observed for exercise respiratory metabolism or ventilatory pattern responses. However, the number of reported subjective symptoms increased significantly following the 0.18 and 0.24 ppm O3 protocols. These data demonstrate significant decrements in simulated competitive endurance performance and in pulmonary function, with accompanying enhanced subjective symptoms, following exposure to low O3 levels commonly observed in numerous metropolitan environments during the summer months.

Adult↗

PubMed2001

Virtual reality: current urologic applications and future developments.

The concept of virtual reality (VR) involves the computer generation of environments with which a user can interact directly. Virtual reality is now being used for medical applications, especially in the area of surgical simulation. As technology advances, VR simulation will play an important training role for both residents and urologists already in practice. This paper examines the history of VR, current developments, and its future implications for the field of urology.

Computer Simulation↗

PubMed1983

Development of standardized simulated patients for quality control of the clinical interview.

The evaluation and training of clinical trial staff who counsel patients in lifestyle changes for disease prevention is aided by a review of videorecorded interviews conducted with a simulated patient. This report describes the Inventory of Simulated Patient Characteristics, a listing of 34 generic parameters for developing a simulated patient for use in staff training and evaluation in counseling. The Inventory creates a complete person in all critical aspects of counseling for lifestyle change (e.g., daily routines, family, job). The Inventory was used in the Lipid Research Clinics' Coronary Primary Prevention Trial (CPPT) to examine the trial staff's skills in counseling for regimen adherence. In 1979 and 1980, 85 and 52 clinic staff, respectively, conducted a total of 548 interviews with four different simulated patients developed using the Inventory, and rated the portrayals as highly realistic. The Inventory also was used to verify that the simulated patient portrayals were greater than 90% faithful to their characterizations. While simulated patients limited to specific clinical syndromes have been used widely in medical education, no guidelines exist for their use in training trial staff in regimen counseling. The Inventory provides a simple template for creating simulated patients with broad characterizations that closely mimic actual trial participants.

Clinical Trials as Topic↗

PubMed1988

Detection of complex echoes in noise by an echolocating dolphin.

Dolphins echolocate with short broadband acoustic signals that have good time resolution properties. Received echoes are often complex, with many resolvable highlights or components caused by reflection of the incident signal from external and internal boundaries of a target and from different propagational modes within a target. A series of experiments was performed to investigate how dolphins perceive complex echoes. Echoes were produced by a microprocessor-controlled electronic target simulator that captured each emitted click and retransmitted the signal back to the animal after an appropriate time delay. The use of this "phantom" target allowed for precise control of the number of highlights, the time separation between highlights, and the relative amplitudes of highlights in the simulated echoes. An echolocating dolphin was trained to perform a target detection task in the presence of masking noise using these phantom echoes. The properties of simulated echoes were systematically varied, and corresponding shifts in the dolphin's detection threshold were observed, allowing for inferences of how the dolphin perceived echoes. The dolphin performed like an energy detector with an integration time of approximately 264 microseconds.

Acoustic Stimulation↗