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 1,675 records · Page 93Linked to original sources
PubMed2001

The U.S. Air Force pilot simulated medical unit: a teaching strategy with multiple applications.

Historically, Air Force military hospitals have provided excellent training platforms for students and nurses to remain proficient and ready to deliver competent care in a war-time environment. Because of a decrease in the number of admissions, the opportunity to maintain competence is diminishing. The concept of a Simulated Medical Unit (SMU) is being developed at Sheppard Air Force Base, Wichita Falls, Texas to assist in the training and evaluation of such skills. The SMU is a simulation of an actual enactment of an inpatient unit that begins with shift report to the oncoming nursing team. The instructor can then guide the student and team through a series of complex situations using specialized mannequins and live actors as "patients." The student is expected to carry out physicians' orders, perform nursing assessments, document nursing care, as well as administer medications and IV fluids. Scenarios can be made to be as simple or as complex as the situation demands and can be adapted to any specialty. The student can practice technical know-how, sharpen critical thinking abilities, and exercise delegation skills. Should an error occur, the instructor can freeze the moment and assist the student in developing more appropriate choices in their delivery of care. The use of algorithms, performance checklists, and videotaping can be used to evaluate the student's performance. Other adaptations for the SMU can include orientation, cross training into different specialties, competency assessment, and upgrade training.

Aerospace Medicine↗
PubMed1994

Craniofacial computer-assisted surgical planning and simulation.

Computer-assisted planning and simulation of craniofacial surgery has progressed from development, through validation, and into clinical use. CT scans are transferred from the radiology department to a graphics workstation in the surgeon's office or laboratory, where data postprocessing and visualization for anatomic evaluation and surgical simulation are performed. Quantitative and qualitative comparative analyses between the plan/simulation and the actual postoperative result provide the feedback that validates or refutes the preoperative assessment and simulated intervention. The optimum surgical solution can be chosen from many possibilities. Interactive computer-assisted surgical simulation is also useful for morbidity-free training of inexperienced surgeons.

Child↗
PubMed1993

A neural network representation of electromyography and joint dynamics in human gait.

Optimization theory and other mathematical algorithms have traditionally been used to model the relationship between muscle activity and lower-limb dynamics during human gait. We introduce here an alternative approach, based on artificial neural networks with the back-propagation algorithm, to map two different transformations: (1) EMG-->joint angles; and (2) EMG-->joint moments. Normal data for 16 muscles and three joint moments and angles (hip, knee, and ankle) were adapted from the literature [Winter (1987), The Biomechanics and Motor Control of Human Gait]. Both networks were successfully trained to map the input vector onto the output vector. The models were tested by feeding in an input vector where all 16 muscles were slightly different (20%) from the training data, and the predicted output vectors suggested that the models were valid. The trained networks were then used to perform two separate simulations: 30% reduction in soleus activity; and removal of rectus femoris. Net 2, in which electromyography was mapped onto joint moments, provided the most reasonable results, suggesting that neural networks can provide a successful platform for both biomechanical modeling and simulation. We believe that this paper has demonstrated the potential of artificial neural networks, and that further efforts should be directed towards the development of larger training sets based on normal and pathological data.

Algorithms↗
PubMed1996

Neural network computer simulation of medical aerosols.

Preliminary investigations have been conducted to assess the potential for using artificial neural networks to simulate aerosol behaviour, with a view to employing this type of methodology in the evaluation and design of pulmonary drug-delivery systems. Details are presented of the general purpose software developed for these tasks; it implements a feed-forward back-propagation algorithm with weight decay and connection pruning, the user having complete run-time control of the network architecture and mode of training. A series of exploratory investigations is then reported in which different network structures and training strategies are assessed in terms of their ability to simulate known patterns of fluid flow in simple model systems. The first of these involves simulations of cellular automata-generated data for fluid flow through a partially obstructed two-dimensional pipe. The artificial neural networks are shown to be highly successful in simulating the behaviour of this simple linear system, but with important provisos relating to the information content of the training data and the criteria used to judge when the network is properly trained. A second set of investigations is then reported in which similar networks are used to simulate patterns of fluid flow through aerosol generation devices, using training data furnished through rigorous computational fluid dynamics modelling. These more complex three-dimensional systems are modelled with equal success. It is concluded that carefully tailored, well trained networks could provide valuable tools not just for predicting but also for analysing the spatial dynamics of pharmaceutical aerosols.

Aerosols↗
PubMed1987

Stress management for essential hypertension: comparison with a minimally effective treatment, predictors of response to treatment, and effects on reactivity.

Few studies of psychological interventions for essential hypertension have incorporated comprehensive coping skills treatment programs, evaluated the efficacy of such programs against credible, minimally effective controls, examined the effects of these interventions on pressor responses, or clarified the nature of person by treatment interactions. The present study examined the relative effectiveness of multimodal stress management training and a minimally effective treatment control (i.e. GSR biofeedback training) in the treatment of essential hypertensives' blood pressure at rest and in response to simulated stressful interpersonal situations. At the conclusion of an 8 week training period, stress management participants exhibited reliably lower resting diastolic blood pressure and tended to exhibit lower systolic pressure than controls. The former condition maintained their lower pressures through a 6-month follow-up period, but decreases in controls over follow-up rendered the conditions equivalent in blood pressure. No differences between conditions emerged in analyses on pressor responses. Stress management training was somewhat more effective for individuals scoring low rather than high on measures of trait anxiety and irritability.

Adult↗
PubMed2004

Effects of decreasing peak flow rate on stomach inflation during bag-valve-mask ventilation.

Reducing inspiratory flow rate and peak airway pressure may be important in order to minimise the risk of stomach inflation when ventilating an unprotected airway with positive pressure ventilation. This study was designed to yield enough power to determine whether employing an inspiratory gas flow limiting bag-valve device (SMART BAG, O-Two Medical Technologies Inc., Ontario, Canada) would also decrease the likelihood of stomach inflation in an established bench model of a simulated unintubated respiratory arrest patient. The bench model consists of a training lung (lung compliance, 50 ml/cm H2O; airway resistance, 4 cm H2O/l/s) and a valve simulating lower oesophageal sphincter opening at a pressure of 19 cm H(2)O. One hundred and ninety-one emergency medicine physicians were requested to ventilate the manikin utilising a standard single-person technique for 1 min (respiratory rate, 12/min; Vt, 500 ml) with both a standard adult bag-valve-mask and the SMART BAG. The volunteers were blinded to the experimental design of the model until completion of the experimental protocol. The SMART BAG versus standard bag-valve-mask resulted in significantly (P < 0.001) lower (mean +/- S.D.) mean airway pressure (14 +/- 2 cm H2O versus 16 +/- 3 cm H2O), respiratory rates (13 +/- 3 breaths per min versus 14 +/- 4 breaths per min), incidence of stomach inflation (4.2% versus 38.7%) and median stomach inflation volumes (351 [range, 18-1211 ml] versus 1426 [20-5882 ml]); lung tidal volumes (538 +/- 97 ml versus 533 +/- 97 ml) were comparable. Inspiratory to expiratory ratios were significantly (P < 0.001) increased (1.7 +/- 0.5 versus 1.5 +/- 0.6). In conclusion, the SMART BAG reduced inspiratory flow, mean airway pressure and both the incidence and actual volume of stomach inflation compared with a standard bag-valve-mask device while maintaining delivered lung tidal volumes and increasing the inspiratory to expiratory ratio.

Equipment Design↗
PubMed1998

Testing and evaluation for astronaut extravehicular activity (EVA) operability.

Because it is the human component that defines space mission success, careful planning is required to ensure that hardware can be operated and maintained by crews on-orbit. Several methods exist to allow researchers and designers to better predict how hardware designs will behave under the harsh environment of low Earth orbit, and whether designs incorporate the necessary features for Extra Vehicular Activity (EVA) operability. Testing under conditions of simulated microgravity can occur during the design concept phase when verifying design operability, during mission training, or concurrently with on-orbit mission operations. The bulk of testing is focused on normal operations, but also includes evaluation of credible mission contingencies or "what would happen if" planning. The astronauts and cosmonauts who fly these space missions are well prepared and trained to survive and be productive in Earth's orbit. The engineers, designers, and training crews involved in space missions subject themselves to Earth based simulation techniques that also expose them to extreme environments. Aircraft falling ten thousand feet, alternating g-loads, underwater testing at 45 foot depth, enclosure in a vacuum chamber and subject to thermal extremes, each carries with it inherent risks to the humans preparing for space missions.

Astronauts↗
PubMed1995

Endoscopic surgery simulation in a virtual environment.

The minimally invasive nature of endoscopic surgery allows operations to be performed on patients through small incisions, often under local anaesthesia. Patient recovery times and cosmetic detriment are thus greatly reduced, while overall quality of care is improved. Presently, surgeons are trained to perform endosurgical procedures in a number of ways: practising with surgical training devices, using animal models and assisting experienced surgeons. In this paper, the focus is on answering the key question: "Can virtual environment technology assist surgeons in training and maintaining endoscopic surgery skills?" Initial developments towards surgical simulators have clearly demonstrated the great potential of virtual environment technology for surgical training purposes. Breakthroughs towards surgery are expected within the next 5 to 10 years.

Clinical Competence↗
PubMed2006

Open surgery in VR: inguinal hernia repair according to Lichtenstein.

VREST (Virtual Reality Educational Surgical Tools) is developing a universal and autonomous simulation platform which can be used for training and assessment of medical students and for continuing education of physicians. A workstation consisting of two haptic devices and a 3D vision system is part of the VREST platform. Another part of the platform is a generic software environment in which lessons can be built by the teacher and performed by their students. Using the platform one can see, feel and decide as in reality. With the assessment tool the progress and skills of the students can be supervised. The first lesson build on the VREST platform is an inguinal hernia repair according to Lichtenstein. This is an open surgery procedure. The VREST platform is used prior to the first operating room surgery of the resident. Interactive models and case dependent feedback is used to enlarge the residents' cognition. This should reduce the training time in the operating room.

Computer Simulation↗
PubMed2003

Learning the skills of flexible sigmoidoscopy - the wider perspective.

BACKGROUND: Nurse-led gastrointestinal endoscopy is a priority clinical area in the UK. Endoscopic procedures are challenging to learn, requiring a combination of technical competence (manipulating a flexible endoscope and interpreting the findings) and interpersonal skills (engaging effectively with a conscious patient who is frequently apprehensive). This paper explores the potential of an innovative, scenario-based approach which links a simulated patient with a computer-driven virtual reality (VR) training device for flexible sigmoidoscopy. Within this safe yet realistic quasi-clinical environment, learners carry out the procedure while interacting with the 'patient'. Communication skills are assessed by simulated patients, while quantitative performance data relating to the procedure is generated automatically by the VR simulator. METHODS: This pilot study took place within a nurse practitioner endoscopy course. A mixed methodology combined qualitative and quantitative data (observation and interview studies, communication rating scales and a range of computer-generated output measures from the VR simulator) in a multifaceted evaluation. RESULTS: Seven nurses took part in the study. Participants found the scenarios to be a convincing and powerful learning experience. All experienced high levels of anxiety. Simulated patients identified strengths in participants' communication skills, together with areas for development. Simulator-based practice led to an improvement in objective performance measures. DISCUSSION: Scenario-based training provides a powerful learning experience, allowing participants to build their technical expertise and apply it within a holistic clinical context without the risk of causing harm. We used this pilot study as a springboard for discussions over wider implications of procedure-based skills training, locating it within the literature on expertise and situated learning.

Clinical Competence↗
PubMed2005

[Interest of mannequin based simulator to evaluate anaesthesia residents].

OBJECTIVE: The aim of this study was to test simulator validity to evaluate the ability of anaesthesia residents to solve two simulated scenarios. STUDY DESIGN: Monocentre, prospective, randomized study. POPULATION: Anaesthesia residents. METHODS: All anaesthesia residents were invited to participate into the study but were free to decline to take part. The authors developed grading forms to evaluate preoperative preparation of anaesthesia room and two simulated scenarios which had been previously validated. All residents were evaluated on the preoperative preparation of anaesthesia room. A randomization was performed to select half of the residents to be tested on one of the simulated scenario. Two experienced anaesthesiologists scored the residents' performance. At the end of the simulated session, residents rated the realism of the scenarios. RESULTS: Among 72 training residents in our institution, 48 participated with 24 beginning and 24 advanced residents. Median scores were similar between beginning (first and second year) and advanced residenced (third and fourth year) for the preoperative preparation of anaesthesia room (17 vs 17 for a maximal score of 25) while scores tended to be higher in advanced residents for simulated scenarios (scenario 1 [34 vs 19 for a maximal score of 55; p = 0.0009], scenario 2 [17 vs 13 for a maximal score of 45; p = 0.58]). However, numerous management errors were observed and some of them did not improve with training. Anaesthesia residents rated the simulator scenarios as realistic. CONCLUSION: This study suggests that mannequin-based simulator appears as a reliable and valid tool to test the performance of anaesthesia residents during critical situations.

Anaphylaxis↗
PubMed2006

Quality of delivery of the Standard Days Method as compared with contraceptive pills in Rwanda.

BACKGROUND AND METHODOLOGY: Replicating a Peruvian study, this research introduced the Standard Days Method (SDM) into Rwanda Ministry of Health clinics and evaluated client counselling on the new method against that given for contraceptive pills. Providers received technical reinforcement concerning established methods in addition to SDM training. To evaluate their quality of care, simulated clients implemented a service test in visits to 20 clinics. RESULTS: As in Peru, providers exchanged significantly more relevant information with clients who chose SDM than with those who chose pills. Also, a minority of providers posed barriers to SDM access by refusing to give SDM tools to the client until she brought her partner for consultation. CONCLUSIONS: The findings of this study confirm that SDM counselling is generally satisfactory, although SDM training needs adjustment, and that the rigour of providers' pill counselling remains below capacity.

Contraceptives, Oral↗
PubMed2006

Optimization of partition-based Weighted Sum filters and their application to image denoising.

Partition-based Weighted Sum (P-WS) filtering is an effective method for processing nonstationary signals, especially those with regularly occurring structures, such as images. P-WS filters were originally formulated as Hard-partition Weighted Sum (HP-WS) filters and were successfully applied to image denoising. This formulation relied on intuitive arguments to generate the filter class. Here we present a statistical analysis that justifies the use of weighted sum filters after observation space partitioning. Unfortunately, the HP-WS filters are nondifferentiable and an analytical solution for their global optimization is therefore difficult to obtain. A two-stage suboptimal training procedure has been reported in the literature, but prior to this research no evaluation on the optimality of this approach has been reported. Here, a Genetic Algorithm (GA) HP-WS optimization procedure is developed that, in simulations, shows that the simpler two-stage training procedure yields near optimal results. Also developed in this paper are Soft-partition Weighted Sum (SP-WS) filters. The SP-WS filters utilize soft, or fuzzy, partitions that yield a differentiable filtering operation, enabling the development of gradient-based optimization procedures. Image denoising simulation results are presented comparing HP-WS and SP-WS filters, their optimization procedures, and wavelet-based image denoising. These results show that P-WS filters, in general, outperform traditional and wavelet-based image filters, and SP-WS filters utilizing soft partitioning not only allow for simple optimization, but also yields improved performance.

Algorithms↗
PubMed2007

The effect of escalating feedback on the acquisition of psychomotor skills for laparoscopy.

BACKGROUND: In the acquisition of new skills that are difficult to master, such as those required for laparoscopy, feedback is a crucial component of the learning experience. Optimally, feedback should accurately reflect the task performance to be improved and be proximal to the training experience. In surgery, however, feedback typically is in vivo. The development of virtual reality training systems currently offers new training options. This study investigated the effect of feedback type and quality on laparoscopic skills acquisition. METHODS: For this study, 32 laparoscopic novices were prospectively randomized into four training conditions, with 8 in each group. Group 1 (control) had no feedback. Group 2 (buzzer) had audio feedback when the edges were touched. Group 3 (voiced error) had an examiner voicing the word "error" each time the walls were touched. Group 4 (both) received both the audio buzzer and "error" voiced by the examiner All the subjects performed a maze-tracking task with a laparoscopic stylus inserted through a 5-mm port to simulate the fulcrum effect in minimally invasive surgery (MIS). A computer connected to the stylus scored an error each time the edge of the maze was touched, and the subjects were made aware of the error in the aforementioned manner. Ten 2-min trials were performed by the subjects while viewing a monitor. At the conclusion of training, all the subjects completed a 2-min trial of a simple laparoscopic cutting task, with the number of correct and incorrect incisions recorded. RESULTS: Group 4 (both) made significantly more correct incisions than the other three groups (F = 12.13; df = 3, 28; p < 0.001), and also made significantly fewer errors or incorrect incisions (F = 14.4; p < 0.0001). Group 4 also made three times more correct incisions and 7.4 times fewer incorrect incisions than group 1 (control). CONCLUSIONS: The type and quality of feedback during psychomotor skill acquisition for MIS have a large effect on the strength of skills generalization to a simple MIS task and should be given serious consideration in curriculum design for surgical training using simulation tasks.

Adult↗
PubMed2005

Evaluation of the airway of the SimMan full-scale patient simulator.

BACKGROUND: SimMan is a full-scale patient simulator, capable of simulating normal and pathological airways. The performance of SimMan has never been critically evaluated. METHODS: Sixty subjects (anesthesiologists, nurse anesthetists, and anesthesia residents) performed mask ventilation, laryngeal mask insertion and endotracheal intubation on SimMan. The simulator's airway was evaluated using visual analog scales (VAS) and by measuring the subject's performances. RESULTS: The SimMan full-scale patient simulator's airway is generally acceptably realistic but it significantly differs from the human airway in important aspects. Mask seal was more difficult than in humans whereas Laryngeal mask (LMA) insertion and function was acceptable. The distance from the teeth to the vallecula was too short. Cervical spine mobility was significantly reduced in the 'reduced neck movement' mode but the intubation was only slightly more difficult than in the 'normal' mode. CONCLUSION: The SimMan full-scale patient simulator's airway is generally acceptably realistic but it significantly differs from the human airway in important aspects. The user must be aware of these aspects in order to obtain maximum benefit from training and evaluation scenarios and when using the simulator for testing new equipment and techniques.

Anesthesiology↗
PubMedDate not supplied

Teaching staff to respond effectively to cognitively impaired residents who display self-protective behaviors.

A randomized controlled trial (RCT) was implemented to evaluate the effectiveness of a 7 1/2 hour educational program designed to provide staff with the knowledge, skill, and confidence to manage physical self-protective behaviors of cognitively impaired long-term care residents. This RCT using a pretest/post-test design was conducted using consenting staff members (n = 40) who were randomly allocated to either a control or experimental group. The main outcome measure was a skills lab that evaluated participants 'responses to simulated patients. Both groups participated in the skills lab prior to training, and six weeks after the experimental group completed the program. Pre- and post-training and skills lab observational field notes were subjected to thematic content analysis. Twenty-eight staff members completed both pre- and post-training assessment measurements. Descriptive statistics and paired t-test analyses yielded statistically significant differences in change scores for performance indicators in three simulation scenarios. Analysis of the qualitative data support the finding that, once trained, staff felt better prepared to manage self-protective behaviors. The results suggest that an initiative to educate staff will enhance knowledge, improve performance, and provide the confidence necessary for staff to respond positively to overt physical behaviors in cognitively impaired elders.

Adolescent↗
PubMed2005

Virtual reality and computer-enhanced training applied to wheeled mobility: an overview of work in Pittsburgh.

Some aspects of assistive technology can be enhanced by the application of virtual reality. Although virtual simulation offers a range of new possibilities, learning to navigate in a virtual environment is not equivalent to learning to navigate in the real world. Therefore, virtual reality simulation is advocated as a useful preparation for assessment and training within the physical environment. We are engaged in several efforts to develop virtual environments and devices for mobility skills assessment and training, exercise training, and environment assessment. Virtual reality offers wheelchair users a training tool in different risk-free environments without any indoor (e.g., walls, furniture, and stairs) and outdoor (e.g., curb cuts, uneven terrain, and street traffic) physical constraints. Virtual reality technology will probably become more common in the field of assistive technology, especially given the rapid expansion of gaming technology and the continued exponential growth of computing power.

Computer Simulation↗