PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Simulation Training”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,405 records · Page 78Linked to original sources

Computerized realistic simulation: a teaching module for crisis management in radiology.

OBJECTIVE: Computerized realistic simulation technology has been used as a training tool in fields such as aviation and military training and in the nuclear power industry. More recently, it has been adapted for use in anesthesia crisis resource management. We describe the effectiveness of a simulation program like that used by anesthesiology departments that we developed to teach radiologists the principles of crisis management. MATERIALS AND METHODS: A mock CT scanner and patient simulator were used to simulate the environment in which radiologists encounter crises. Twenty-four residents attended the training program, four at each half-day session. Two responded to and two observed an initial crisis, after which they attended a lecture and watched a videotape review. The second pair then participated in a different crisis scenario. The scenario order was randomized. All scenarios were videotaped and randomly reviewed by two physicians not involved with the course. The following behavioral qualities of the participating residents were evaluated using a five-point scale, ranging from poor (1) to excellent (5): global assessment, communication skills, use of support personnel, use of resources, and role clarity. Residents then rated the course on a five-point scale using the following criteria: overall course usefulness, attainment of course goals, realism of scenarios, quality of lecture, and quality of videotape review. RESULTS: The trainees who had attended the lecture and watched the videotape review before participating in a scenario consistently scored higher than those who had not in the following areas (score after training/score before training): global assessment, 4.08/2.50; communication skills, 4.09/2.67; use of support personnel, 4.17/3.00; use of resources, 4.00/2.92; and role clarity, 4.17/2.67. Moreover, the participants gave the course the following average ratings: overall usefulness, 4.93; attainment of course goals, 4.78; realism of scenarios, 4.63; quality of lecture, 4.63; and quality of videotape review, 4.85. CONCLUSION: Although the critical assessment of a teaching method is difficult and subjective by nature, the improvement in behavioral performance scores suggests that simulation technology effectively conveyed the principles of crisis management. The course ratings show that the program was well accepted by participants.

Clinical Competence↗

Virtual 3D planning and guidance of mandibular distraction osteogenesis.

We present a system for 3D planning and pre-operative rehearsal of mandibular distraction osteogenesis procedures. Two primary architectural components are described: a planning system that allows geometric bone manipulation to rapidly explore various modifications and configurations, and a visuohaptic simulator that allows both general-purpose training and preoperative, patient-specific procedure rehearsal. We provide relevant clinical background, then describe the underlying simulation algorithms and their application to craniofacial procedures.

Computer Simulation↗

A study of the mechanism of Ca2+ current inhibition produced by serotonin in rat dorsal raphe neurons.

Calcium currents and their modulation by 5-HT were studied using both whole-cell and single-channel patch-clamp techniques in acutely isolated adult rat dorsal raphe neurons. Evidence for three types of Ca channels (T, N, L) was obtained in both whole-cell and single-channel experiments. Approximately 4% of the total high-threshold Ca current (L-type) was sensitive to dihydropyridines (DHPs) while approximately 40% of the Ca current (N-type) was sensitive to omega-conotoxin (omega-CgTx). About 56% of the whole-cell current was insensitive to either DHPs or omega-CgTx and may thus represent a different kind of Ca current. 5-HT reduced raphe neuron Ca currents by approximately 50%, while slowing activation. 5-HT inhibited both omega-CgTx-sensitive and -insensitive Ca current. Inhibition by 5-HT was voltage dependent; prepulses to +80 mV lasting for 20 msec almost completely abolished the 5-HT-mediated inhibition. The voltage dependence of the response to 5-HT suggested that trains of action potentials might overcome the inhibition due to 5-HT. Trains of brief depolarizations were used to simulate action potentials; only about 5% of the 5-HT-induced inhibition was relieved by the trains. These results suggest that while large depolarizations could restore the Ca current inhibited by 5-HT, physiological stimuli, such as trains of action potentials, could not. The action of 5-HT was made irreversible by inclusion of GTP-gamma-S in the patch pipette, suggesting a G-protein mediation of the response to 5-HT.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Intravenous catheter training system: computer-based education versus traditional learning methods.

BACKGROUND: Virtual reality simulators allow trainees to practice techniques without consequences, reduce potential risk associated with training, minimize animal use, and help to develop standards and optimize procedures. Current intravenous (IV) catheter placement training methods utilize plastic arms, however, the lack of variability can diminish the educational stimulus for the student. This study compares the effectiveness of an interactive, multimedia, virtual reality computer IV catheter simulator with a traditional laboratory experience of teaching IV venipuncture skills to both nursing and medical students. METHODS: A randomized, pretest-posttest experimental design was employed. A total of 163 participants, 70 baccalaureate nursing students and 93 third-year medical students beginning their fundamental skills training were recruited. The students ranged in age from 20 to 55 years (mean 25). Fifty-eight percent were female and 68% percent perceived themselves as having average computer skills (25% declaring excellence). The methods of IV catheter education compared included a traditional method of instruction involving a scripted self-study module which involved a 10-minute videotape, instructor demonstration, and hands-on-experience using plastic mannequin arms. The second method involved an interactive multimedia, commercially made computer catheter simulator program utilizing virtual reality (CathSim). RESULTS: The pretest scores were similar between the computer and the traditional laboratory group. There was a significant improvement in cognitive gains, student satisfaction, and documentation of the procedure with the traditional laboratory group compared with the computer catheter simulator group. Both groups were similar in their ability to demonstrate the skill correctly. CONCLUSIONS; This evaluation and assessment was an initial effort to assess new teaching methodologies related to intravenous catheter placement and their effects on student learning outcomes and behaviors. Technology alone is not a solution for stand alone IV catheter placement education. A traditional learning method was preferred by students. The combination of these two methods of education may further enhance the trainee's satisfaction and skill acquisition level.

Adult↗

Analytical guide wire motion algorithm for simulation of endovascular interventions.

Performing minimally invasive vascular interventions requires proper training, as a guide wire needs to be manipulated, by the tail, under fluoroscopic guidance. To provide a training environment, the motion of the guide wire inside the human vasculature can be simulated by computer. Such a simulation needs to be based on an algorithm that is both realistic and fast. To meet these two demands, an analytical solution to the problem of guide wire motion has been derived, using a new parametrisation of guide wire shape. The algorithm is highly generic, is entirely based on elementary physics and has good convergence properties (accuracy of 22 micron after two iterations). In an experimental validation of the algorithm in a planar model, the RMS of the spatial discrepancy between the real and simulated catheter positions was about 10% of the lumen size. Comparison of the simulated guide wire motion with 3D rotational angiography data of a real guide wire advanced in a plastic phantom of the cerebral vasculature showed that the new algorithm produced realistic results.

Algorithms↗

Changes in postural mechanics associated with different types of minimally invasive surgical training exercises.

BACKGROUND: Doctors who perform minimally invasive surgery commonly report upper extremity fatigue or joint and muscle pain. The goal of this study was to investigate the changes in postural parameters associated with different laparoscopic training tasks and graspers. METHODS: Three different training tasks (targeted object release, rope passing, and cable tying) were performed with three types of laparoscopic graspers. Joint angles were determined using video analysis, and centers of pressure (COP) were measured with force platforms. RESULTS: Cable tying proved to be the most challenging training task and involved greater joint angle excursions and COP excursions and velocities. Grasper 2 reduced shoulder and wrist flexion-extension over the selected tasks. CONCLUSION: Training tasks should be designed to simulate surgical procedures because different tasks require distinct combinations of joint rotations. Joint rotations and postural balance should be considered when an optimal grasper is selected for a particular training task.

Analysis of Variance↗

Initial state randomness improves sequence learning in a model hippocampal network.

Randomness can be a useful component of computation. Using a computationally minimal, but still biologically based model of the hippocampus, we evaluate the effects of initial state randomization on learning a cognitive problem that requires this brain structure. Greater randomness of initial states leads to more robust performance in simulations of the cognitive task called transverse patterning, a context-dependent discrimination task that we code as a sequence prediction problem. At the conclusion of training, greater initial randomness during training trials also correlates with increased, repetitive firing of select individual neurons, previously named local context neurons. In essence, such repetitively firing neurons recognize subsequences, and previously their presence has been correlated with solving the transverse patterning problem. A more detailed analysis of the simulations across training trials reveals more about initial state randomization. The beneficial effects of initial state randomization derive from enhanced variation, across training trials, of the sequential states of a network. This greater variation is not uniformly present during training; it is largely restricted to the beginning of training and when novel sequences are introduced. Little such variation occurs after extensive or even moderate amounts of training. We explain why variation is high early in training, but not later. This automatic modulation of the initial-state-driven random variation through state space is reminiscent of simulated annealing where modulated randomization encourages a selectively broad search through state space. In contrast to an annealing schedule, the selective occurrence of such a random search here is an emergent property, and the critical randomization occurs during training rather than testing.

Animals↗

3D Real-time FEM based guide wire simulator with force feedback.

Minimally invasive surgical techniques using catheter is now used in many procedures. Development of surgical training of such procedures requires real-time simulation of tool-organ interaction. In such processes, each subsequent step of interaction would be based on the current configuration of the surgical tool (guidewire in this case), leading to development of techniques to solve and visualize the configuration of tool at every time step. This paper presents a Finite Element (FEM) based approach to simulate the tool-organ interaction.

Catheterization↗

A comparison between volunteer drug-abusers and non-drug-abusers on measures of social skills.

This study assessed specific behavior patterns of volunteering "had" drug-abusers in comparison to non-drug-abusers on self-report and behavioral measures of social skills. It was hypothesized that the individual's behavior is affected both by his group affiliation and by the immediate situational variables. Twelve drug-abusers and 12 university students were asked to interact with trained role-players in simulated social situations geared to elicit assertiveness and heterosexual dating behaviors. Task requirements as well as environmental social consequences (role-player's responses) were manipulated. Contingent on the situation type, both groups demonstrated basically the same level of social efficiency on verbal measures, but showed different performances on nonverbal measures. Preferential social interaction responses were found to be affected by the varied environmental feedback. The relevance of an "interactionist" approach to research on drug abuse and some crucial methodological factors are discussed.

Adolescent↗

Three-dimensional reconstruction of urogenital tract from Visible Korean Human.

The three-dimensional (3D) modeling from anatomical images is revealed to be a remarkable learning tool in anatomy. This is particularly true for the pelvis area and the urogenital tract. The authors present here a 3D reconstruction of the male urogenital tract from the Visible Korean Human data. The segmentation of 440 anatomical images was arranged in a pile and processed by the SURFdriver software to build an interactive 3D model. Forty-two anatomical structures were reconstructed, including kidneys, ureters, urinary bladder (outer and inner boundaries), urethra, testes, epididymides, ducti deferens, seminal vesicles, prostate, rectum, anal canal, abdominal aorta, superior mesenteric artery, renal arteries, inferior vena cava, renal veins, lumbar vertebrae, intervertebral discs, sacrum, hip bones, femurs, and skin. Three-dimensional models of 42 anatomical structures can be individually and interactively manipulated. In addition, the use is able to control the transparency of the model. The aim of this computerized modeling is to present a learning tool for students and patients. In the near future, it could be the basis of new simulation tools for surgeon's training.

Asian People↗

Dynamic cardiomyoplasty for treatment of heart failure.

Dynamic cardiomyoplasty is a new surgical procedure proposed for treatment of the failing heart. Clinically, the latissimus dorsi muscle is raised as a pedicled flap and wrapped around the heart. The skeletal muscle is transformed to produce a myocardium-like fatigue-resistant muscle. It is stimulated to contract in synchrony with the heart in hope of assisting the myocardial contraction. An R-wave synchronous pacemaker provides a pulse-train form of stimulation to simulate, for the skeletal muscle, the contractile characteristics of the myocardial syncytium. We have undertaken a critical review of the clinical results of dynamic cardiomyoplasty reported to date. Objective evidence of clinical improvement after dynamic cardiomyoplasty resulting from the contractile assistance of the myoplasty has been modest. Many of the beneficial results reported could be explained by concomitant procedures done, such as aneurysmectomy or coronary artery bypass grafting. Hemodynamic studies have failed to demonstrate consistent and convincing improvement as a result of the cardiomyoplasty stimulation. We have, however, identified an interesting subgroup of patients, in whom a striking hemodynamic response to cardiomyoplasty stimulation has been reported. These patients all possess large resting heart volumes characteristic of dilated cardiomyopathy. Thus, case selection may ultimately be one of the most important factors in determining the success of dynamic cardiomyoplasty for the treatment of heart failure.

Back↗

Effects of ozone inhalation during exercise in selected patients with heart disease.

Although epidemiologic evidence suggests that patients with heart and lung disease are more vulnerable to the acute toxic effects of photochemical air pollution, no laboratory studies have been reported in patients with coronary heart disease. In the present investigation, six male volunteers, ages 46 to 64 years, with clinically documented coronary heart disease and a well-defined symptomatic angina pectoris threshold, served as subjects. Each patient was exposed on three 40-minute occasions to either filtered air or ozone at concentrations of 0.20 or 0.30 parts per million (ppm), while walking on a treadmill at workloads simulating their regularly prescribed exercise training regimen. Results of standard pulmonary function tests and periodic observations of exercise ventilation, respiratory metabolism, electrocardiographic changes, hemodynamic response, and clinical signs and symptoms were recorded. Analysis of variance revealed that none of the patients' physiologic responses to ozone exposure were statistically significant. Furthermore, neither onset of angina pain or ischemic changes were related to ozone exposure in a dose-dependent fashion. Hence, the patients not only failed to exhibit any unexpected cardiovascular strain while exposed to ozone during exercise, but also evidenced no significant pulmonary function impairment or exercise ventilatory pattern alteration, as has been observed in clinically normal subjects exercising at similar ozone concentration levels. This apparent incongruity may be due to the fact that acute ozone toxicity is more closely related to the total amount of ozone inhaled, which is a function of pulmonary ventilation volume and exposure time, as well as ozone concentration. In the patients with angina, symptom-limited exercise tolerance resulted in a lower total amount of ozone inhaled than that observed to effect ozone toxicity in clinically normal subjects who exercised at greater intensities and for longer durations. Patients with angina appear to be no more susceptible to ozone toxicity than are clinically normal subjects at the effective doses imposed. However, had the patients exercised longer, they might well have evidenced pulmonary function impairment and/or cardiovascular strain. Hence, caution is advised in generalizing these observations to other conditions and patient groups.

Angina Pectoris↗

MRI measurements of the dependence on T1 of the echo amplitudes using a multiple spin-echo scheme.

Analytical calculations using the Bloch formalism were performed to assess the dependence on T1 of the echo amplitudes for the Phase-Alternating Phase-Shift (PHAPS) multiple spin-echo protocol. Measurements in a 0.5 T MR imaging unit were performed to ratify the analytical results. Especially for low T2 values, the echo amplitudes were erroneous, with an increasing contribution from stimulated echo components with increasing T1. Apart from affecting T2 estimates, stimulated echoes generated a non-monoexponential signal decay of the echo trains. The results confirmed previous simulation studies as regards the dependence on T1 of T2 estimates from PHAPS.

Artifacts↗

Sudden death in the ED: educating residents to compassionately inform families.

We describe a program used in our emergency medicine residency to help teach residents new skills in interacting with survivors following a patient's sudden death in the emergency department. This teaching module requires about two and a half hours to complete. It includes a brief presentation of new skills, videotapes of family notification, resident role play experiences, and a summary. Trained volunteers are used as simulated survivors in the role plays. Although labor intensive and time consuming, the program offers educational advantages. The residents have an opportunity to practice their communication skills in a protected setting. In addition, they receive immediate and specific feedback from the faculty facilitator, fellow residents, and, most importantly, the simulated survivor. Following the role play sessions, residents feel they are more skillful in meeting survivors' needs.

Clinical Protocols↗

Increasing days at work using function-centered rehabilitation in nonacute nonspecific low back pain: a randomized controlled trial.

OBJECTIVE: To evaluate the effect of function-centered compared with pain-centered inpatient rehabilitation in patients whose absence from work is due to chronic nonspecific low back pain (LBP). DESIGN: Single-blinded randomized controlled trial with follow-up assessments immediately after treatment and at 3 months. SETTING: Center for work rehabilitation in Switzerland. PARTICIPANTS: Patients with more than 6 weeks of work absence due to chronic nonspecific LBP (N=174; 137 men, 37 women; mean age +/- standard deviation, 42+/-8 y; mean sick leave before study, 6.5 mo). INTERVENTIONS: Function-centered treatment (FCT) (4h/d, 6d/wk, for 3 wk) consisted of work simulation, strength, endurance, and cardiovascular training. Pain-centered treatment (PCT) (2.5h/d, 6d/wk, for 3 wk) used a mini back school, individually selected passive and active mobilization, stretching, and low-intensity strength training. MAIN OUTCOME MEASURES: The number of days at work in 3 months after treatment, self-efficacy, lifting capacity, pain, mobility, strength, and global perceived effect. Effect sizes (ESs) (Cohen d ) were defined as small (ES range, 0.2-0.5), moderate (ES range, 0.5-0.8), and large (ES, >0.8). RESULTS: Groups were comparable at baseline. Moderate ESs for the FCT group versus PCT group were found for days at work (25.9 d vs 15.8d, ES=.36, P =.029), self-efficacy (5.9 points vs -7.4 points, ES=.55, P =.003), and lifting capacity (2.3 kg vs 0.2 kg, ES=.54, P =.004). CONCLUSIONS: Function-centered rehabilitation increases the number of work days, self-efficacy, and lifting capacity in patients with nonacute nonspecific LBP.

Adult↗

Colonoscopy training--new approaches, old problems.

Colonoscopy traditionally has been taught using the apprenticeship approach. Assessment of competence has been, at best, informal and based largely on the number of procedures trainees have performed. The advent of colorectal cancer screening has demanded formalization of training and assessment using structured teaching and state-of-the-art training tools, such as computer simulation. New-generation approaches and technology have the ability to raise the standard of coloscopy provided by competent practitioners.

Animals↗

Muscular activity during uphill cycling: effect of slope, posture, hand grip position and constrained bicycle lateral sways.

Despite the wide use of surface electromyography (EMG) to study pedalling movement, there is a paucity of data concerning the muscular activity during uphill cycling, notably in standing posture. The aim of this study was to investigate the muscular activity of eight lower limb muscles and four upper limb muscles across various laboratory pedalling exercises which simulated uphill cycling conditions. Ten trained cyclists rode at 80% of their maximal aerobic power on an inclined motorised treadmill (4%, 7% and 10%) with using two pedalling postures (seated and standing). Two additional rides were made in standing at 4% slope to test the effect of the change of the hand grip position (from brake levers to the drops of the handlebar), and the influence of the lateral sways of the bicycle. For this last goal, the bicycle was fixed on a stationary ergometer to prevent the lean of the bicycle side-to-side. EMG was recorded from M. gluteus maximus (GM), M. vastus medialis (VM), M. rectus femoris (RF), M. biceps femoris (BF), M. semimembranosus (SM), M. gastrocnemius medialis (GAS), M. soleus (SOL), M. tibialis anterior (TA), M. biceps brachii (BB), M. triceps brachii (TB), M. rectus abdominis (RA) and M. erector spinae (ES). Unlike the slope, the change of pedalling posture in uphill cycling had a significant effect on the EMG activity, except for the three muscles crossing the ankle's joint (GAS, SOL and TA). Intensity and duration of GM, VM, RF, BF, BB, TA, RA and ES activity were greater in standing while SM activity showed a slight decrease. In standing, global activity of upper limb was higher when the hand grip position was changed from brake level to the drops, but lower when the lateral sways of the bicycle were constrained. These results seem to be related to (1) the increase of the peak pedal force, (2) the change of the hip and knee joint moments, (3) the need to stabilize pelvic in reference with removing the saddle support, and (4) the shift of the mass centre forward.

Adult↗

Should 'Cyrus the Centipede' take a hike? Effects of exposure to a pedestrian safety program on children's safety knowledge and self-reported behaviors.

INTRODUCTION: We report the first evaluation of the popular "Cyrus the Centipede" child pedestrian safety program. METHOD: A pre-test/post-test control versus experimental condition design was used to assess Cyrus' impact on third graders' pedestrian safety knowledge, and self-reported pedestrian behaviors. RESULTS: Although some beneficial effects were observed, the program was not reliably effective. In particular, the impact of exposure to Cyrus was strongly influenced by the individual teacher who delivered it, likely due to the highly unstructured nature of the curriculum. SUMMARY: We suggest that: (a) the effectiveness and reliability of such programs be demonstrated before they are widely adopted; and (b) programs that focus on training children in actual or simulated traffic environments may be more effective than those that primarily focus on teaching safety facts and rules.

Accidents, Traffic↗