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PubMed1999

A virtual surgical simulator for the lower limbs.

As the body of knowledge concerning human anatomy and physiology continues to grow, new techniques must emerge to convey it more efficiently to future health care professionals. Computer simulation, interaction and visualization technologies are now being used in the development of virtual training environments. This paper presents a real-time virtual surgical simulator that integrates scientific visualization tools into a surround-screen projection-based (SSPB) immersive environment. This environment focuses on procedures for the lower limbs; however, the techniques described can be applied to other portions of the body. The research consists of three phases: environment modeling, volume visualization and immersive surgical simulation. Environment modeling involved modeling an operating room with all of the relevant elements. The volume visualization phase required the application of marching cubes and decimation techniques to the Visible Human Project (VHP) dataset to generate models of the lower limbs. The simulator integrated modeling and volume visualization to facilitate the rehearsal of medical procedures and interaction with medical information. Interactive cutting, suturing and X-Ray CT placement over the virtual patient's legs were used to probe underlying structures. The simulator is intended to aid medical students in learning anatomy, physiology and radiological analysis without jeopardizing patient care.

Computer Simulation↗

PubMed2003

Internet-based standardized patient simulation with automated feedback.

There exist many modalities for teaching and testing medical students. One method being explored is computer-based patient simulation. Traditionally, exposure to a variety of patients has been achieved through years of training under the supervision of experts in the field. Computerized patient simulation has been proposed as a method of creating a standardized patient care experience through algorithms and predefined patient findings. One study reported that after experience with computer-based simulation, 80% of students and mentors felt that it should be a mandatory part of medical education. Access to effective simulations with high-yield cases can be costly. Internet-based tools enjoy easy distribution and centralized maintenance. Simulations distributed via the Internet have proven successful in selected medical fields. Automated scoring of patient interactions has also been proposed as a way to eliminate the effort required for mentor evaluation.

Computer Simulation↗

PubMed2004

Two-handed next generation suturing simulator.

A realistic two-handed surgical suturing simulation would have a broad impact on the way doctors are trained in the field of surgery. Current state-of-the-art in suturing simulators do not accurately represent realistic suturing conditions, leaving many necessary components, i.e. two-handed interaction, skin undermining, skin repositioning etc., out of the model completely. The goal of this research is to develop a next generation immersive suturing simulator that uses an integrated two-handed tension based haptic device for tactile feedback, a hi-fidelity finite element model for more accurate skin, tissue and needle modeling and stereoscopic vision for depth-of-field.

Computer Simulation↗

PubMed1984

Quality control of manual visual field examination by computer simulation.

Quality control of manual visual field examination is impaired because the process is difficult to monitor, and because examiners have minimal formal training and supervision, and are subject to rapid turnover. Computer simulation can be used both to teach perimetry and to provide a reference standard against which performance may be measured.

Community Health Services↗

PubMed1991

Optimizing athletic performance by influence curves.

Recent application of modeling techniques to physical training has opened the possibility for prediction from training. Solution of the inverse problem, determining a training program to produce a desired performance at a specific time, is also possible and may yield strategies for achieving better training and tapering (complete or relative rest for a period before competition) regimens for competitive athletes. A mathematical technique derived from model theory is described in this paper that allows the design of an optimal strategy of physical preparation for an individual to do well in a single future competitive event or cluster of events. Simulation results, using default parameters of a training model, suggest that presently accepted forms of taper for competition may remain too rigorous and short in duration to achieve the best result possible from the training undertaken.

Humans↗

PubMed1997

Improved trauma management with advanced trauma life support (ATLS) training.

OBJECTIVE: To determine the value of advanced trauma life support (ATLS) training for medical staff in a major incident situation, based upon performance in a simulated exercise. METHODS: A major incident exercise was used to assess the management of trauma victims arriving in hospital suffering from multiple or life threatening injuries. The effect of ATLS training, or exposure to an abbreviated form of ATLS training, on the management of patients with simulated life threatening traumatic injuries was examined. The treatment offered by medical staff of different grades and varying exposure to ATLS training was compared. RESULTS: Medical staff who had undertaken ATLS training attained a higher number of ATLS key treatment objectives when treating the simulated trauma victims. CONCLUSION: Medical staff who have either undertaken the full ATLS course or an abbreviated form of the course were more effective in their management of the simulated trauma cases.

Education, Medical, Continuing↗

PubMed2005

[The first practical seminar of difficult airway management in the 51st annual meeting of Japan Society of Anesthesiologists].

Difficult Airway Management (DAM) is one of the most important skills for medical practice, especially for anesthesiologists. A seminar of DAM was held in the 51 st annual meeting of Japan Society of Anesthesiologists. It consisted of a 60-minute lecture about ASA difficult airway management algorithm, and a 120-minute hands-on training session using a mid-fidelity human simulator. The lecture was held twice, and was opened to every JSA member without pre-registration. More than 100 participants attended each lecture. The hands-on training session, which required preregistration, was held three times. Each training session was limited to 8 participants, and a total of 23 participants attended the session. The training session was restricted to only participants and staffs so that their privacy was secured. The questionnaire about DAM was collected after the lectures or the training sessions. Most of the participants of lectures were certified anesthesiologists, and they agreed that the DAM seminar was useful. The questionnaire revealed that the most popular technique for DAM was insertion of laryngeal mask airway (ILMA). Otherwise the invasive techniques were difficult to be experienced in the clinical practice. We suspected that the DAM seminar was useful, especially for the invasive technique without substitute training methods under clinical situation.

Airway Obstruction↗

PubMed2005

Porcine sebaceous cyst model: an inexpensive, reproducible skin surgery simulator.

BACKGROUND: Surgical simulators are an established part of surgical training and are regularly used as part of the objective structured assessment of technical skills. Specific artificial skin models representing cutaneous pathology are available, although they are expensive when compared with pigskin. The limitations of artificial skin models include their difficulty in representing lifelike cutaneous pathology. OBJECTIVE: Our aim was to devise an inexpensive, reproducible surgical simulator that provides the most lifelike representation of the sebaceous cyst. materials and methods: Pigskin, either pig's feet/trotters or pork belly, was incised, and a paintball was inserted subcutaneously and fixed with cyanoacrylic glue. RESULTS: This model has regularly been used in cutaneous surgical courses that we have organized. Either adding more cyanoacrylic glue or allowing more time for the paint ball to absorb fluid from surrounding tissue can also adjust the degree of difficulty. CONCLUSIONS: The degree of correlation with lifelike cutaneous pathology is such that we recommend that all courses involved in basic skin surgery should consider using the porcine sebaceous cyst model when teaching excision of sebaceous cysts.

Animals↗

PubMed2001

Interactional skills of students from traditional and non-traditional medical schools before and after alcohol education.

OBJECTIVE: To compare alcohol-related intervention and general interactional skills performance of medical students from a traditional (Sydney) and a non-traditional (Newcastle) medical school, before and after participation in an alcohol education programme about brief intervention. DESIGN: In two controlled trials, students received either a didactic alcohol education programme or didactic input plus skills-based training. Prior to and after training, all students completed videotaped interviews with simulated patients. SETTING: The Faculties of Medicine at the University of Newcastle and the University of Sydney, Australia. SUBJECTS: Fifth-year medical students (n=154). RESULTS: Both alcohol-related intervention and general interactional skills scores of the Newcastle students were significantly higher than those of the Sydney students at pre-test but not after training. Although alcohol-related interactional skills scores improved after training at both universities, they did not reach a satisfactory level. The educational approach used had no effect on post-test scores at either university. CONCLUSIONS: Significant baseline differences in interactional skills scores favouring non-traditional over traditional students were no longer evident after both groups had been involved in an alcohol education programme. Further research is required to develop more effective alcohol intervention training methods.

Adult↗

PubMed1998

Inhibitory connections in the assembly neural network for texture segmentation.

A neural network with assembly organization is described. This assembly network is applied to the problem of texture segmentation in natural scenes. The network is partitioned into several subnetworks: one for each texture class. Hebb's assemblies are formed in the subnetworks during the process of training the excitatory connections. Also, a structure of the inhibitory connections is formed in the assembly network during a separate training process. The inhibitory connections result in inhibitory interactions between different subnetworks. Computer simulation of the network has been performed. Experiments show that an adequately trained assembly network with inhibitory connections is more efficient than without them.

Journal Article↗

PubMed1985

Adaptive response of human skeletal muscle to simulated hypergravity condition.

The mechanical behaviour of leg extensor muscles of five international-level athletes was evaluated during 13 months training period. Drop jumps, average mechanical power during 15 S continuous jump, and vertical jumps performed with and without extra weights were used to measure explosive power characteristics. The data recorded in vertical jumps was utilized for construction of force-velocity relationship (F-V curve). The athletes did not show improvement in any of the variables studied after 12 months of intensive systematic training programme. It was assumed that the subjects already had reached their upper limit of performance. However, after that the athletes underwent a simulated 3 weeks high-gravity period. The hypergravitational condition was created by wearing a special vest filled with extra loads (11% of BW). The vest was used from morning to evening. No changes in the ordinary training programme were allowed. After the simulated high-gravity conditioning period significant improvement in almost all the variables studied was observed (P less than 0.05-0.001). Vertical jump performance was enhanced from 44.3 to 54.9 cm. The F-V curve remained stable all year but after hypergravity period shifted markedly to the right. The drastic improvement was attributed to be caused by a fast adaptation to the new functional requirements (I.I g). Therefore, once the biological adaptation occurred the mechanical behaviour of the athlete's leg extensor muscle was similar to that which could be experienced in a field at low gravity condition (0.9 g). Adaptive response to the hypergravity conditioning was speculated to occur mainly at neurogenic level and less in myogenic component.

Adaptation, Physiological↗

PubMed2001

Trauma training: virtual reality applications.

Training medics, medical students, nurses, and residents to perform trauma care skills presents many obstacles. These include: emergent nature of the procedures, instructor time, availability of clinical material, and anatomic knowledge. Virtual Reality simulators address each of these obstacles. The National Capital Area Medical Simulation Center is a unique national asset that not only uses state-of-the-art simulators to teach trauma care skills to medical students and others, but adapts existing technology and develops new simulations to teach these skills. Most standard trauma training is performed on either mannequins or anesthetized animals and requires the constant presence of an instructor. VR applications can be stand-alone devices that have built-in scenarios and multiple patients to increase variation and/or level of technical expertise required to successfully complete the required steps of the trauma procedure. Commercial VR simulators to teach trauma skills include: CathSim Intravenous Simulator (HT Medical), UltraSim Ultrasound Simulator (MedSim), Limb Trauma Simulator (Musculographics/BDI), and the Human Patient Simulator (MedSim). Additionally, we have developed two additional simulators based on the HT CathSim; these are the pericardiocentesis simulator and the diagnostic peritoneal lavage simulator. Future applications include virtual environment triage simulation and surgical airway simulators.

Clinical Competence↗

PubMed2000

Physical fitness of young women: carrying simulated patients.

An evaluation of physical fitness prior to employment appears to be mandatory for several occupations in order to protect the employee from overburdening and the employer from placing excess demands on the employee. One such occupation seems to be that of the field medical specialist who needs special physical strength since terrain conditions deny wheel-assisted transport of stretcher patients. The anthropometric and isometric force data of a total of 62 female and 48 male recruits for the medical service of the Bundeswehr were evaluated, together with their ability to carry a patient on a stretcher (weight = 14 kg) within a gymnasium. Initially the 'casualties' were simulated by sandbags weighing 60, 70, 80 and 90 kg each on stretchers; subsequently equivalent-weight water cans were used. The tests were administered at the beginning and at the end of the general Basic Military Training (BMT). While all males were able to carry the simulated 90 kg patient, only 22 out of 62 female recruits were able to do so at the beginning of BMT. At the end, the number had improved to 29 out of 55 women soldiers completing training. At the beginning of BMT 22.5% of the women soldiers were unable to rescue a simulated 70 kg patient; at the end of BMT the number had fallen to 18%. The isometric force values as measured revealed the hand grip strength as the best predictor for the capacity to carry simulated 90 kg patients. It is, therefore, suggested that a hand strength test be administered prior to field medical specialist training in order to channel unsuitable candidates into other training schemes.

Adult↗

PubMed2000

Airway management during spaceflight: A comparison of four airway devices in simulated microgravity.

BACKGROUND: The authors compared airway management in normogravity and simulated microgravity with and without restraints for laryngoscope-guided tracheal intubation, the cuffed oropharyngeal airway, the standard laryngeal mask airway, and the intubating laryngeal mask airway. METHODS: Four trained anesthesiologist-divers participated in the study. Simulated microgravity during spaceflight was obtained using a submerged, full-scale model of the International Space Station Life Support Module and neutrally buoyant equipment and personnel. Customized, full-torso manikins were used for performing airway management. Each anesthesiologist-diver attempted airway management on 10 occasions with each device in three experimental conditions: (1) with the manikin at the poolside (poolside); (2) with the submerged manikin floating free (free-floating); and (3) with the submerged manikin fixed to the floor using a restraint (restrained). Airway management failure was defined as failed insertion after three attempts or inadequate device placement after insertion. RESULTS: For the laryngoscope-guided tracheal intubation, airway management failure occurred more frequently in the free-floating (85%) condition than the restrained (8%) and poolside (0%) conditions (both, P < 0.001). Airway management failure was similar among conditions for the cuffed oropharyngeal airway (poolside, 10%; free-floating, 15%; restrained, 15%), laryngeal mask airway (poolside, 0%; free-floating, 3%; restrained, 0%), and intubating laryngeal mask airway (poolside, 5%; free-floating, 5%; restrained, 10%). Airway management failure for the laryngoscope-guided tracheal intubation was usually caused by failed insertion (> 90%), and for the cuffed oropharyngeal airway, laryngeal mask airway, and intubating laryngeal mask airway, it was always a result of inadequate placement. CONCLUSION: The emphasis placed on the use of restraints for conventional tracheal intubation in microgravity is appropriate. Extratracheal airway devices may be useful when restraints cannot be applied or intubation is difficult.

Adult↗

PubMedDate not supplied

Testing health care professionals' communication skills: the usefulness of highly emotional standardized role-playing sessions with simulators.

Although standardized role-playing sessions (SRPS) with simulators are increasingly used to assess health care professionals' (HCPs) communication skills (CS) and the effectiveness of training workshops (TWs), nothing has been done to date to define the optimal emotional content of SRPS. Three emotionally different SRPS contexts-weakly emotional (WE-), moderately emotional (ME-), and highly emotional (HE-SRPS)-were, therefore, tested in order to assess induced CS and sensitivity to TW-related changes. The study included 25 HCPs. Tape-recorded SRPS, scheduled before and after the TW, were retranscribed, and assessed according to the Cancer Research Campaign Workshop Evaluation Manual (CRCWEM), which provides a rating of form, function and structure for each utterance. Results show that induced CS are different in WE-, ME-, and HE-SRPS, regarding form (HE-SRPS induced more 'directing', 'leading' or 'multiple' questions; WE: 20.7%; ME: 19.7%; HE: 33.7% (p<0.001)); function (HE-SRPS induced more 'inappropriate' information; WE: 6. 5%; ME: 8.2%; HE: 15.6% (p<0.001)); and blocking (HE-SRPS induced more 'blocking' utterances; WE: 7.2%; ME: 13.8%; HE: 30.2% (p<0. 0001)). Finally, CS changes induced by TWs are the highest in HE-SRPS (14.8% increase of 'open' questions for the HE- versus 1.0% for the WE-SRPS; 11.6% decrease of 'inappropriate' information for the HE- versus 3.3% for the WE-SRPS; and 17.5% decrease of 'blocking' for the HE- versus 2.6% for the WE-SRPS). In conclusion, SRPS, with a HE content, induce more inappropriate CS. Moreover, they are more sensitive to TW effects. SRPS with a HE content should, thus, be recommended for the assessment of TW effectiveness.

Adult↗

PubMed1993

IMA to conduct training courses in family planning.

For the last six and a half decades, the Indian Medical Association (IMA) has been actively engaged in Public Health issues, ranging from immunization, ORT, maternal and child health care, and has been cooperating with the Government of India in various National Health Programs. Recently, IMA organized a new and exciting program on India's most significantly health issue--family planning. The training is to be competency based and participatory, with the main emphasis on knowledge, attitude and skills required to provide comprehensive child spacing. IMA has developed this multilevel program to train personnel in all methods of family planning, like: participation in basic oral contraceptive training; supplementary training in other methods; clinical practice for providing information on how to select and manage non-clinical family planning services; simulated practice in IUCD; and clinical practice in IUCD training. Training can also be arranged for vasectomy practicum and minilaparotomy. The main purpose of the training program is to realize the Government's goal of 60% contraceptive prevalence usage by the year 2000. In India, less than 2% of the 132.5 million reproductives, couples use oral contraceptives, because of widespread misconceptions regarding the pill among the general populace and the medical community. This program has been designed to counter these misgivings and thus encourage the "use of modern family planning methods" to take on the menace of the population explosion.

Asia↗

PubMed2005

An integrated environment for plastic surgery support: building virtual patients, simulating interventions, and supporting intraoperative decisions.

In the last decade a number of environments for Computer Supported Plastic Surgery have been presented. Nevertheless, an overall approach for training and intraoperative support is still missing or has not been widely exploited yet. We developed a fully integrated system which allows surgical simulation, planning, and support for computer-guided plastic surgery procedures starting from image acquisition to final intraoperative assistance. The system also provides the user with a radiological workstation able to analyse patient medical images and case studies, with advanced bidimensional and three dimensional image processing functionalities. We intend to demonstrate that such a platform can be built at an affordable cost. The radiological workstation is capable of supporting radiologists and surgeons in real patient case studies and the simulation workstation may be adopted by plastic surgeons in teaching and training of complex surgical planning. Moreover, results of simulation can be used in the operating room with a relatively high benefit in terms of improved accuracy, reduction of surgical risks, and decrease in training costs.

Decision Support Techniques↗

PubMed2006

Advanced virtual endoscopy for endoscopic transsphenoidal pituitary surgery.

OBJECTIVE: Virtual endoscopy (vE) is the navigation of a camera through a virtual anatomical space that is computationally reconstructed from radiological image data. Inside this three-dimensional space, arbitrary movements and adaptations of viewing parameters are possible. Thereby, vE can be used for noninvasive diagnostic purposes and for simulation of surgical tasks. This article describes the development of an advanced system of vE for endoscopic transsphenoidal pituitary surgery and its application to teaching, training, and in the routine clinical setting. METHODS: The vE system was applied to a series of 35 patients with pituitary pathology (32 adenomas, three Rathke's cleft cysts) operated endoscopically via the transsphenoidal route at the Department of Neurosurgery of the Medical University Vienna between 2004 and 2006. RESULTS: The virtual endoscopic images correlated well with the intraoperative view. For the transsphenoidal approach, vE improved intraoperative orientation by depicting anatomical landmarks and variations. For planning a safe and tailored opening of the sellar floor, transparent visualization of the pituitary adenoma and the normal gland in relation to the internal carotid arteries was useful. CONCLUSION: According to our experience, vE can be a valuable tool for endoscopic transsphenoidal pituitary surgery for training purposes and preoperative planning. For the novice, it can act as a simulator for endoscopic anatomy and for training surgical tasks. For the experienced pituitary surgeon, vE can depict the individual patient's anatomy, and may, therefore, improve intraoperative orientation. By prospectively visualizing unpredictable anatomical variations, vE may increase the safety of this surgical procedure.

Adult↗