Simulation of patient loading in nuclear magnetic resonance imaging through the use of inductive damping loops.
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Analysis of Variance↗
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Results for “Patient Simulation”
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.
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[A method of determining individual volume of exercise on a bicycle simulator for patients with myocardial infarct].
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Exercise Test↗
Radiation exposures received by patients during simulation for breast radiotherapy.
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Breast Neoplasms↗
[Simulation of patient management in dental education. II. A study on the validity of patient management problems].
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Computer-Assisted Instruction↗
[Simulation of patient management in dental education. I. Patient management problems].
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Computer-Assisted Instruction↗
Radiation exposure to a phantom patient during simulated chiropractic spinal radiography.
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Chiropractic↗
Response optimization of drug dosage: antiarrhythmic studies with tocainide.
The benefits of using antiarrhythmic response to optimize dosage regimens of antiarrhythmic drugs in individual patients have been examined. Graded antiarrhythmic response and simultaneously measured plasma drug concentrations have been obtained in 15 patients receiving multiple oral doses of a new antiarrhythmic, tocainide. Plasma drug concentration-antiarrhythmic response data from each of 11 subjects responding to the drug have been fitted by a generalized concentration effect function which is valid over the entire range of response. With the use of experimentally determined pharmacokinetic parameters to define the dose-plasma concentration relationship and plasma drug concentration-response parameters estimated for individual patients, simulations were carried out to show the effect of various dosage regimens on antiarrhythmic response in individual patients. Such simulations provide a means of assessing antiarrhythmic effect in the range of clinical interest (80% to 100% of maximum effect), where the antiarrhythmic effect is a nonlinear function of dose, plasma drug concentration, or their logarithms. The simulations also demonstrate that for identical daily doses and dosing intervals patients show marked variability in antiarrhythmic response.
Administration, Oral↗
Written simulation of patient-doctor encounters. 3. Comparison of the performance in the simulation with prescription and referral data in reality.
The performance of 19 general practitioners in a written simulation of patient-doctor encounters was compared with real data on prescription and referral from 'sick-fund' patients. Two issues were studied: the amounts of certain drugs prescribed (analgesics and antirheumatics; hypnotics/sedatives and tranquillizers; neuroleptics and antidepressants) and the number of referrals to specialists. In the simulation, experts assessed the 'risk of unnecessary harm to the patient' induced by the therapeutic procedures of these general practitioners, as described previously. A close correlation was found between the ratings of the risk of unnecessary harm in the simulation and the prescription and referral data in reality for general practitioners who were consistently generous or frugal in prescribing the above drugs and referring the patients to specialists. The tentative conclusion is that the written simulation with its rating procedure discriminates reliably between general practitioners who induce less risk of unnecessary harm from those who are likely to cause harm to the patient.
Analgesics↗
Therapists' physiological activation and patient difficulty.
The differential effects of an easy and difficult-to-interview patient on therapist self-reported behavioral arousal and physiological activation were observed. Eighteen experienced white male psychiatrists each interviewed two patient simulators believing they were real patients. Each actress was programed to act the part of a difficult-to-interview patient and an easy-to-interview patient. Each randomly played either part as assigned and the order of patient and role was counterbalanced. Differences in patient roles were validated by the participating therapists and independent raters. Fifteen-minute rest periods with soft music preceded each therapy session such that a complete experimental session consisted of rest 1, therapy 1, rest 2, and therapy 2. Self-reported arousal was assessed during each of the four periods by Thayer's factors from the Nowlis Mood Adjective List. Physiological activation was measured by electromyogram, heart rate, blood pressure (systolic and diastolic), and skin conductance. Therapist self-reported behavioral arousal and measured physiological activation during therapy were significantly greater than during rest. The difficulty of the patient did not appear to affect either behavioral or physiological activation level of the therapists. Several explanations for this are explored.
Arousal↗
Inter-machine variability in the stability of continuous positive airway pressure.
Two studies were performed to investigate the differences in pressure stability performance of the continuous positive airway pressure (CPAP) machines used by our patients. The variations of mask pressures during each respiratory cycle were measured during overnight studies of two groups of patients with obstructive sleep apnoea, who were using either a Sleep-Easy III CPAP machine or a Si-Plan CPAP unit. The patients were well-matched for age, weight and neck circumference. The group using the Si-Plan unit had more constant mask pressures and were using lower CPAP pressures (mean 10.6 cmH2O) than those using the Sleep-Easy III machine (mean 13.8 cmH2O) (p less than 0.02). The pressure stability performance of five CPAP machines used by our patients was also compared using standardized simulated patient breaths produced by a negative pressure cuirass pump. There were large differences between the machines in ability to maintain a constant pressure. Using a tidal volume of 0.5 l and peak flow rates of between 20-40 l.min-1 the pressure variation ranged from 0-67% of the minimum inspiratory pressure. The maintenance of a constant pressure during inspiration and expiration lowers the mean pressure required to eliminate obstructive sleep apnoeas and reduces the likelihood of pressure related side-effects.
Adult↗
Use of a computer simulation to evaluate a seminar on child abuse.
A computerized patient simulation was used to evaluate the effectiveness of a seminar on child abuse in changing students' behavior in assessing the problem and developing a treatment plan. The CAMPS system (DACIS Software) was selected because it allows students freedom to follow any pathway in selecting over 500 items of history, physical examination, laboratory, and treatments. In interacting with this simulation, students demonstrated how they integrate their knowledge into a clinical setting. The three-hour seminar covered the topics of physical and sexual abuse, patient neglect, and utilization of community resources for treatment. The control (n = 43) and experimental (n = 38) groups, enrolled in an introductory course in pediatrics, were given references to read about child abuse as part of the core curriculum, but they may or may not have had exposure to patients in their clinical work. Only the experimental group attended the seminar. As part of the course evaluation program, both groups interacted with eight computer simulations, two of which involved cases of child abuse. In the classic case of child abuse, the control and experimental groups had similar results. In the more difficult diagnostic problem (shaken baby), the groups differed significantly in total score, cost of the evaluation, and percentage of correct diagnosis.
Child↗
A pilot study of the relationship between experts' ratings and scores generated by the NBME's Computer-Based Examination System.
This pilot study evaluates the consistency of experts' ratings of students' performances on the National Board of Medical Examiners' Computer Based Examination (CBX) cases and the relationship of those ratings to the CBX's scoring algorithm. The authors were investigating whether an automated scoring algorithm can adequately assess an examinee's management of a computer-simulated patient. In 1989-90, at the Michigan State University College of Human Medicine, eight students, completing a surgery clerkship, each managed eight CBX cases and took a computer-administered, multiple-choice examination. Six clerkship coordinators rated the students' performances in terms of overall management, efficiency, and dangerous actions. The ratings correlated highly with scores produced by the CBX's scoring system.
Algorithms↗
Design for a constant peak current defibrillator.
A damped sine wave defibrillator that is capable of delivering a constant peak discharge current over a wide range of patient thoracic impedance is shown to be theoretically possible. This is realized in practice by the technique of storing an amount of energy above that required for delivery, and dumping the excess charge when the discharge current has reached a predetermined level, the dumping being triggered by a current sensor. A larger than normal inductance assists in swamping the effect of varying impedance and produces a smooth waveform. The preselected peak current can be delivered with a variation of about +/- 6% to 95% of a normal patient population. The energy expended in a simulated patient circuit is somewhat lower than for conventional defibrillators.
Computer Simulation↗
Computer-assisted instruction: design and content in neuroscience nursing.
Computer-assisted instruction (CAI) includes games, tutorials, simulations, and drills. Computer simulation exercises can be used to simulate patient care and promote diagnostic reasoning skills in nursing. Computer simulation exercises (CSEs) based on case studies of patients with head injury, spinal cord injury, epilepsy, febrile seizures and meningitis have been developed and implemented at the University of Washington School of Nursing, Department of Physiological Nursing, in conjunction with the Health Sciences Center for Educational Resources. These simulations provide a realistic, constantly changing scenerio in which the nurse-learner collects data, analyzes it, and makes decisions about the patient's nursing care. The patient's condition may change dramatically as a result of the decisions made by the nurse-learner.
Computer Simulation↗
Impact of CT-based treatment planning on radiation therapy of carcinoma of the bladder.
Computed tomography (CT) has been an integrated step in the treatment planning of radiation therapy of carcinoma of the bladder in stages T1-T3 in 49 consecutive patients referred to Radiumstationen in Aarhus. The introduction of this technique has led to a considerable increase (26 +/- 4%) in the mean effective target volume of these patients compared with that of 51 conventionally simulated patients. The largest field expansions have been performed in the cranial and ventral directions. The field margins to the bladder have been correlated with the position of the tumour mass. The findings are compared with previously published results on CT-based treatment planning of patients with bladder carcinoma.
Humans↗
A computerized simulator for critical-care training: new technology for medical education.
A patient simulator has been developed for training, certification, modeling, and demonstrating problems in the management of critical-care patients. The Critical Care & Hemodynamic Monitoring Training System consists of a personal computer, software, and a replica of a human torso designed to enable students to practice critical-care medicine. The computer displays patient histories, laboratory results, treatment options, patient responses, and a real-time cardiac monitor. The torso apparatus is used to practice insertion of a hemodynamic monitoring catheter; the cardiac monitor displays catheter pressure readings as the catheter is advanced into the heart and also pulmonary artery and wedge position. Special screen calculators in the program may be used to determine hemodynamic, respiratory, ventilatory, and renal function indices. In contrast to previously described simulators and computer oriented instructional programs, this system contains no inherent data base. Instead, authors build a library of informative cases by using the hardware and software tools provided. Individual "modules" of patient information are authored, and these are transparently linked as a student undertakes management of a patient. Although this system is a technologic achievement, determination of its usefulness as an instructional tool or certification aid must come from broader use and controlled studies.
Clinical Competence↗
Written simulation of patient-doctor encounters. 2. Assessment of the performance of general practitioners.
Two rating procedures were used to judge the performance of 19 general practitioners confronted with a written simulation of patient-doctor encounters. The simulation comprised five patients with vague complaints. A group of three 'expert' general practitioners judged the attention that the doctors paid to somatic aspects or to causes of the complaints. A second group of 18 experts judged the extent to which the therapeutic procedures of the general practitioners might induce a risk of unnecessary harm to the patient. Both rating procedures were shown to be reliable for three of the five simulated patients. A weak correlation between these issues was established for these three patients. The problems of judging the behaviour of the practitioners with the other two patients are discussed. The performance of the general practitioners was relatively constant. Variability between individuals substantially exceeded variability within an individual with respect to the attention given to somatic aspects, but these variabilities were roughly equal with respect to the risk of causing unnecessary harm.
Adult↗
Computer simulation of fluid resuscitation in thermal injury. A. B. Wallace memorial lecture 1987.
Following thermal injury many subsystems of the human body interact closely. The effects both of the pathological event in one subsystem and the subsequent therapy are masked or compensated by changes in other homeostatic subsystems. Not until the capacity of the homeostatic subsystems and/or the therapy is inadequate will the effects become obvious. The very complex postburn situation explains why there are so many different shock-preventing fluid therapy programmes and such crude and insecure monitoring of the therapy. In these situations when there are too many factors to be grasped by the unaided human mind, a computer-based 'patient-simulator' could be of value in diagnosis, monitoring and therapy of the severely ill patient with trauma. An extensive pathophysiological model has been designed to describe fluid shifts and haemodynamics in connection with fluid therapy of traumatic patients. The model makes it possible to calculate and predict clinically important state variables on the basis of fluid input and fluid losses. Sample runs are presented for illustrations in haemorrhage and fluid and salt loading. The model is also used to simulate treatment of a burn patient and the results are compared with measured physiological and biochemical variables. Furthermore, four different formulae for resuscitation of patients with thermal injuries according to Evans, Brooke, Parkland and a hypertonic fluid programme are simulated. The results illustrate the potential use of the 'patient-simulator' for designing fluid resuscitation programmes and attempt to optimize them with respect to infusion rate of the fluid administered.
Animals↗