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PubMed2005

The LapSim: a learning environment for both experts and novices.

BACKGROUND: Simulated environments present challenges to both clinical experts and novices in laparoscopic surgery. Experts and novices may have different expectations when confronted with a novel simulated environment. The LapSim is a computer-based virtual reality laparoscopic trainer. Our aim was to analyze the performance of experienced basic laparoscopists and novices during their first exposure to the LapSim Basic Skill set and Dissection module. METHODS: Experienced basic laparoscopists (n=16) were defined as attending surgeons and chief residents who performed >30 laparoscopic cholecystectomies. Novices (n=13) were surgical residents with minimal laparoscopic experience. None of the subjects had used a computer-based laparoscopic simulator in the past. Subjects were given one practice session on the LapSim tutorial and dissection module and were supervised throughout the testing. Instrument motion, completion time, and errors were recorded by the LapSim. A Performance Score (PS) was calculated using the sum of total errors and time to task completion. A Relative Efficiency Score (RES) was calculated using the sum of the path lengths and angular path lengths for each hand expressed as a ratio of the subject's score to the worst score achieved among the subjects. All groups were compared using the Kruskal-Wallis and Mann-Whitney U-test. RESULTS: Novices achieved better PS and/or RES in Instrument Navigation, Suturing, and Dissection (p<0.05). There was no difference in the PS and RES between experts and novices in the remaining skills. CONCLUSION: Novices tended to have better performance compared to the experienced basic laparoscopists during their first exposure to the LapSim Basic Skill set and Dissection module.

Clinical Competence↗
PubMed1991

A software system for interactive and quantitative visualization of multidimensional biomedical images.

A comprehensive software system called ANALYZE has been developed which permits detailed investigation and evaluation of 3-D biomedical images. The software can be used with any 2-D or 3-D imaging modality, including x-ray computed tomography, radionuclide emission tomography, ultrasound tomography, magnetic resonance imaging and both light and electron microscopy. The package is unique in its synergistic integration of fully interactive modules for direct display, manipulation and measurement of multidimensional image data. Several original algorithms are included which improve image display efficiency and quality. One of the most versatile and powerful algorithms is interactive volume rendering, which is optimized to be fast without compromising image quality. An important advantage of this technique is to display 3-D images directly from the original data and to provide on-the-fly combinations of selected image transformations and/or volume set operations (union, intersection, difference, etc.). The inclusion of a variety of interactive editing and quantitative mensuration tools significantly extends the usefulness of the software. Any curvilinear path or region-of-interest can be manually specified and/or automatically segmented for numerical determination and statistical analyses of distances, areas, volumes, shapes, densities and textures. ANALYZE is written entirely in "C" and runs on several standard UNIX workstations. It is being used in a variety of applications by over 40 institutions around the world, and has been licensed by Mayo to several imaging companies. The software architecture permits systematic enhancements and upgrades which has fostered development of a readily expandable package. ANALYZE comprises a powerful "visualization workshop" for rapid prototyping of specific application packages, including applications to interactive surgery simulation and radiation treatment planning. ANALYZE offers the potential to accurately and reproducibly examine, from images, the structure and function of any cell, tissue, limb, organ or organ system of the body, much like a surgeon or pathologist might do in real life, but entirely non-invasively, without pain or destruction of tissue. These capabilities promise exciting new insights into the basic processes of life, and major advances in health care delivery through improved diagnosis and treatment of disease.

Computer Graphics↗
PubMedDate not supplied

Does nifedipine enhance the cardiovascular depressive effects of bupivacaine?

Inadvertent intravenous administration of bupivacaine has been shown to cause cardiovascular collapse in patients. Patients undergoing peripheral vascular surgery have a high incidence of coronary artery disease and frequently receive calcium channel antagonists such as nifedipine for treatment of angina. In this study, the effects of an accidental intravenous injection of bupivacaine during regional anesthesia in patients taking nifedipine was simulated using dogs. The sling-trained dogs had baseline hemodynamic values recorded. Each dog was given a 10-mg sublingual loading dose of nifedipine in alcohol solvent followed by intravenous infusion of nifedipine at a rate of 5/micrograms/kg/min. After hemodynamic measurements were taken, increasing boluses of intravenous bupivacaine were administered until a 50% decrease in maximum left ventricle change in pressure with respect to time (LV dP/dt max) was observed. On the next day of the experiment, baseline hemodynamic measurements were recorded. The dog was given only the alcohol solvent portion of the nifedipine solution at a dosage and rate equivalent to that of the first day of the experiment. Next, increasing boluses of intravenous bupivacaine were administered exactly as on the first day until a 50% decrease in LV dP/dt max was observed. The results demonstrated that the total dose of bupivacaine given with nifedipine (8.7 +/- 3.7 mg/kg) to reach a 50% drop in LV dP/dt max was significantly less than the total dose of bupivacaine given without nifedipine (14.5 +/- 4.9 mg/kg); and the main effect of the combination of nifedipine and bupivacaine was to accentuate the decrease in LV dp/dt max caused by bupivacaine with the elimination of the compensatory increase in systemic vascular resistance to maintain blood pressure.

Animals↗
PubMedDate not supplied

Simulations: their selection and use in developing nursing competencies.

Efficient and effective use of simulations for teaching or review requires that they be matched carefully to a target nursing competency. Guidelines are provided to assist nursing staff development educators in selecting and using simulations for psychomotor assessment and interpersonal skills as well as problem solving.

Computer Simulation↗
PubMedDate not supplied

Welcome to TLC General Hospital.

This article discusses the development of the computer program titled TLC General Hospital, then offers hints and ideas for nurses contemplating the development of their own instructional packages.

Computer Simulation↗
PubMed1984

Treatment of chronic low-back pain. A community-based comprehensive return-to-work physical rehabilitation program.

A retrospective evaluation of treatment methods used in 1981 and 1982 and the subsequent rate of return to work was conducted on 350 consecutive patients with low-back pain. Two hundred nine patients completed 12 or more treatments in sessions that occurred three times a week. Of these, 120 were chronically disabled. The program aimed at maximizing function and return to work through graded exercise, biomechanics education, work simulation exercises, endurance activities, and flexibility training. All patients remained under the care of their own physicians. Return-to-work or work status improvement was accomplished in 58.1% of the patients. The working hypothesis is that in many back-disabled patients the original cause of disability healed or resolved, and current symptoms were often attributable to deconditioning fear and poor biomechanics. Conservative management is effective in returning many chronic back-pain patients to economic productivity.

Adolescent↗
PubMed1994

The physiology of soccer--with special reference to intense intermittent exercise.

The present thesis is based on 14 original articles published in international journals (I-XIV, see page 8) and a summarizing review. The thesis deals with the physiological demands of soccer, with a particular focus on the physiological response to repeated intense exercise. In chapter I the specific issues are presented and in chapter II the physiological demands in soccer are discussed based on the results of the studies performed. Chapter III contains a short survey of the experiments performed to study specifically muscle metabolism and muscle fatigue with repeated intense muscle contractions. With reference to the topics covered in chapters II and III, fatigue during a soccer match is discussed in chapter IV, and chapter V deals with applications for physical training in soccer. Measurements have been performed during soccer matches and training, as well as in experiments simulating the activities of a soccer match. The information obtained has been compared to results from studies of the physical capacity of top-class soccer players and from laboratory experiments aimed at investigating metabolism and fatigue in intermittent exercise. Studies with whole-body and single muscle group exercises have been performed, the latter mainly with the application of a knee-extension model. In the studies on isolated muscle groups, biopsies taken from exercising muscles as well as arterial and femoral venous blood samples have allowed for detailed analysis of muscle ionic transportation and metabolism. In addition, the magnetic resonance technique has been used for the continuous determination of changes in muscle metabolites and pH during intermittent exercise. Analysis of activities during soccer matches showed that a top-class soccer player covers an average distance of approximately 11 km during a match. The distance differs highly between players and is partly related to the position in a team. Midfield players run more at low speed than defenders and forwards, whereas no difference appears to exist between groups when comparing the distance covered at high speed. The distance covered at high speed is the same in the beginning as in the end of a match. The total distance covered by a player during a soccer match is only to a limited extent a measure of the physiological demands on the player during the match. In addition to running, a player is engaged in many other energy demanding activities, i.e. tackling, jumping, accelerating and turning. A more precise evaluation of the total energy demand during a soccer match may be achieved by performing physiological measurements in connection with soccer matches (I).(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1993

[Improvement in the combat and special training of the medical service].

The analysis of the existing system of training shows that it has accumulated a certain number of organizational, practicoscientifical, methodical and program-informational problems that need to be solved. Alterations must be made first of all in the whole organizational and program-methodical plan, that will considerably change the elements of structure and the proper contents of combat and special training in medical service. The basic elements of these changes are the following: to assure the continuity between the training and practical work of medical officers in peaceful time and war period; to regard the basic (fundamental) training on clinical and other subjects as a key task of training in the higher military medical establishments; to provide the officers' skill training on the basis of complex qualification tasks; to create methodical cabinets (and more later simulator centers) in each unit or establishment; to form the training centers of medical staff on the basis of internship; to create a basic laboratory of new methods of training and medical education on the basis of Military Medical Division in the Russian Medical Academy of Post-Graduate Education.

Curriculum↗
PubMed1997

The Sophus anaesthesia simulator v. 2.0. A Windows 95 control-center of a full-scale simulator.

The Sophus group was founded in Denmark in 1992 with the aims of doing research into human error in anaesthesiology. Development of a simulation-environment was seen as one of the tools for research and training. This article describes the PC user interface of the SOPHUS anaesthesia simulator, SOPHUS v. 2.0 for Windows 95, and the script language, SASL v. 1.2. The script language provides possibilities of making scenarios, which develop in different directions according to the treatment of the patient by means of IF/THEN-statements, loops etc.

Anesthesiology↗
PubMed1977

The use of Metro-Apex in health administration and planning education and training.

Metro-Apex is a computerized gaming-simulation designed to give practitioners and students an understanding of the environment of health care delivery systems. The exercise allows participants to explore the interaction of health roles and the health system's interaction with the larger community system. Originally developed as an air pollution control exercise, it has evolved to be a game about communities and how they operate. In 1972, the Department of Health, Education, and Welfare funded the Center for Multidisciplinary Educational Exercises (COMEX), of the University of Southern California to modify Metro-Apex for use with health service planners, health care administrators, and students in programs leading to these positions. The game runs in several rounds of from three to eight hours for groups of from 40 to 120 persons. Used in both educational and training settings, Metro-Apex is found to be a flexible addition to the health educator's tools.

California↗
PubMedDate not supplied

[Training before departure of volunteers during nutritional emergencies. From inception to evaluation].

Predeparture training is rarely undertaken within emergency nongovernmental organizations. Although field-training is considered as the only real school, the technical requirements are increasingly more constraining. To cope with this problem, the technical officers of Action contre la faim planned a predeparture training project based on self-instruction of any volunteer leaving for a nutritional emergency mission. The project began in 1994. Six self-instruction sessions were produced to enable volunteers to learn. To improve the quality of work, this framework encouraged creativity, constant research and motivation. The training supervisor accompanied the volunteers and put them in simulated situations where various tools were made available to them. A series of measures have been used to improve this basic training: 1) a training contract meant to make the volunteer responsible for his training; 2) better programming to ensure adequate relay from one volunteer to the next; 3) an apprentice report covering the first 15 days of the volunteer's integration into the field, thereby providing important feed-back to the supervisor; 4) an evaluation of the monthly report and an interview-grid used to follow the volunteer in the short and medium-term; 5) and an evaluation form completed by the volunteer which enables the updating of sessions and simulated situations. This initiative has made us aware of the importance of following the volunteers at all stages: this can increase the volunteer's efficiency and their fidelity to the non-governmental organization. Currently, the main objective is to gain the support of qualified technical coordinators who will be the most important factor in continuous training.

Creativity↗
PubMed1983

Theoretical analysis on relationship between the neural activity and the EEG.

Firstly, a collective oscillation mode of the neural activity is derived from the neural network system by using the multicompartment equation and the projection operator technique. This technique takes into account higher order interactions among neurons. The solution of the equation gives a chain structure with an infinite number of circuit loops in which each of them is only composed of four neurons. The obtained eigenvalues are quite similar to the spectrum of frequencies of the EEG. Secondly, the time-dependent behavior of the observed EEG is simulated by starting from the elementary process of action potential trains of neurons, which includes the effect of the collective oscillation mode mentioned above. This gives a comprehensive derivation of the EEG from the neural activity of action potentials. The simulation assumes that information of the action potential trains can be transmitted to the EEG through the intermediate states of the postsynaptic potential trains and the slow waves. The paper reports that a slightly modulated activity of a relatively small amount of neurons can cause a strong influence on the shape of the global EEG and that the calculated results reproduce the characteristic features of the EEG in a rat such as the theta rhythm, the spindle wave and the arousal wave.

Action Potentials↗
PubMed2003

A two-stage unsupervised learning algorithm reproduces multisensory enhancement in a neural network model of the corticotectal system.

Multisensory enhancement (MSE) is the augmentation of the response to sensory stimulation of one modality by stimulation of a different modality. It has been described for multisensory neurons in the deep superior colliculus (DSC) of mammals, which function to detect, and direct orienting movements toward, the sources of stimulation (targets). MSE would seem to improve the ability of DSC neurons to detect targets, but many mammalian DSC neurons are unimodal. MSE requires descending input to DSC from certain regions of parietal cortex. Paradoxically, the descending projections necessary for MSE originate from unimodal cortical neurons. MSE, and the puzzling findings associated with it, can be simulated using a model of the corticotectal system. In the model, a network of DSC units receives primary sensory input that can be augmented by modulatory cortical input. Connection weights from primary and modulatory inputs are trained in stages one (Hebb) and two (Hebb-anti-Hebb), respectively, of an unsupervised two-stage algorithm. Two-stage training causes DSC units to extract information concerning simulated targets from their inputs. It also causes the DSC to develop a mixture of unimodal and multisensory units. The percentage of DSC multisensory units is determined by the proportion of cross-modal targets and by primary input ambiguity. Multisensory DSC units develop MSE, which depends on unimodal modulatory connections. Removal of the modulatory influence greatly reduces MSE but has little effect on DSC unit responses to stimuli of a single modality. The correspondence between model and data suggests that two-stage training captures important features of self-organization in the real corticotectal system.

Algorithms↗
PubMedDate not supplied

Evaluation of virtual reality bronchoscopy as a learning and assessment tool.

BACKGROUND: Conventional training in bronchoscopy involves a trainee performing on a real patient under supervision. This method of training is not only expensive, but there is also potential for increased patient discomfort. Simulators permit the acquisition of necessary technical skills required for the procedure. Virtual reality (VR) has been an integral part of training in aviation, and the application of this technology in medical training needs to be evaluated. OBJECTIVE: This study was conducted to evaluate the efficacy of a VR bronchoscopy simulator as a learning and assessment tool. METHODS: The bronchoscopic simulator (HT Medical Systems, Maryland, USA) is a VR computer programme. The simulator has the ability to assess competence by a set of parameters, which formed the data for the study. Nine novices without previous bronchoscopic experience formed the study group (group 1). Nine experienced bronchoscopists having performed between 200 and 1000 bronchoscopies formed the other group (group 2). We assessed the efficacy of the system as a learning tool by studying whether there was a significant difference between the first and subsequent sessions of the subjects from group 1 and by comparing the performance of the two groups. Statistical analysis was done using the Mann-Whitney U test and the Wilcoxon signed ranks test. RESULTS: There was a significant difference in performance between the first attempt of group 1 and the performance of the experts in terms of percentage of segments visualised and number of wall collisions and the economy of performance. Among the subjects from group 1, there was a significant improvement in percentage of segments visualised by the third attempt (p = 0.04), in the economy of performance by the sixth attempt (0.008) and in the number of wall collisions by the sixth attempt (0.024). When each attempt of the novices was compared with the performance of group 2, the significance in the difference of the percentage of segments studied (p = 0.09) and the economy of performance disappeared by the third attempt (0.06), while the difference in the number of wall collisions disappeared by the fifth attempt (p = 0.06). CONCLUSIONS: This study has been able to establish the face, construct and content validity of the simulator and the potential for it to be an effective training tool.

Bronchoscopy↗
PubMed1997

Simulated recruitment of medial rectus motoneurons by abducens internuclear neurons: synaptic specificity vs. intrinsic motoneuron properties.

Ocular motoneuron firing rate is linearly related to conjugate eye position with slope K above recruitment threshold theta. Within the population of ocular motoneurons K increases as theta increases. These differences in firing rate between motoneurons might be determined either by the intrinsic properties of the motoneurons, or by differences in synaptic input to them, or by a combination of the two. This question was investigated by simulating the input signal to medial rectus motoneurons (MR-MNs) from internuclear neurons of the abducens nucleus (INNs). INNs were represented as input nodes in a two-layer neural net, each with weighted connections to every output node representing an MR-MN. Individual simulated MR-MNs were assigned parameters corresponding to an intrinsic current threshold I(R) and an intrinsic frequency-current (f-I) slope gamma. Their firing rates were calculated from these parameters, together with the effective synaptic current produced by their synaptically weighted INN inputs, with the use of assumptions employed in computer simulations of spinal motoneuron pools. The experimentally observed firing rates of MR-MNs served as training data for the net. The following two training conditions were used: 1) synaptic weights were fixed and the intrinsic parameters of the MR-MNs were allowed to vary, corresponding to the situation in which each MR-MN receives a common synaptic drive and 2) intrinsic MR-MN properties were fixed and synaptic weights were allowed to vary. In each case, the varying quantities were trained with a form of gradient descent error reduction. The simulations revealed the following three problems with the common-drive model: 1) the recruitment of INNs produced nonlinear responses in MR-MNs with low thetas; 2) the range of I(R)s required to reproduce the observed range of theta were generally larger than those measured experimentally for cat ocular motoneurons; and 3) the intrinsic f-I slope gamma increased with I(R). Experimental data from cat indicate that gamma decreases with I(R). When synaptic weights were allowed to vary, all three problems with the common-drive model were overcome. This required MR-MNs receiving selective input from INNs with similar firing rate thresholds. These results suggest that the differences in firing rate properties among MR-MNs in relation to steady-state eye position cannot be derived from their intrinsic properties alone but result at least partly from differences in their synaptic inputs. An MR-MN's individual set of synaptic inputs constitutes, in effect, a premotor receptive field.

Animals↗
PubMed2006

[Traditional training devices for laparoscopy].

Laparoscopy is a new approach to urological surgery with a number of advantages. The learning of this technique is very important. In order to establish this technique as routine practice a considerable amount of training is needed. The learning curve is still very long and training methods are scarce. At the present time there are simple, low-cost simulators available that may be used in any place, thus facilitating training. We have reviewed recent literature on these models, which can be of great help in initial laparoscopic training.

Animals↗