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At least 1,711 records · Page 95Linked to original sources

PubMed1996

[Operating room assistance: an innovative practice].

Professional practice changes in the operating room have led to the development of a new role for nurses--as surgical assistants. Essentially, the surgical assistant nurse helps ensure the patient's safety while providing technical and clinical assistance to the surgeon in such areas as exposing and manipulating tissues, suturing fascia and using various specialized instruments. The surgical assistant nurse function is being implemented through a pilot project at the Institut de cardiologie de Montréal. Developed by representatives of the nursing and surgical departments there, the project was approved by the Collège des médecins du Québec in April 1995 and subsequently by the institute's council of physicians, dentists and pharmacists. It has also gained recognition from the Ordre des infirmières et infirmiers du Québec (OIIQ). The pilot project incorporated a 186-hour training program, which was delivered from May to September 1995 according to three distinct learning modules: maintenance of a safe environment for the patient, clinical assistance and technical assistance. A tutorial approach to learning included individual and team work, simulation exercises, technical courses, lab work and practical training in the operating room. At the end of the training program, two surgical assistant nurses began practising in their new role. An evaluation of the project will be performed in September 1996.

Curriculum↗

PubMed2003

Virtual reality applied to procedural testing: the next era.

OBJECTIVE: To establish the construct validity of a virtual reality-based upper gastrointestinal endoscopy simulator as a tool for the skills training of residents. SUMMARY BACKGROUND DATA: Previous studies have demonstrated the relevance of virtual reality training as an adjunct to traditional operating room learning for residents. The use of specific task trainers, which have the ability to objectively analyze and track user performance, has been shown to demonstrate improvements in performance over time. Using this off-line technology can lessen the financial and ethical concerns of using operative time to teach basic skills. METHODS: Thirty-five residents and fellows from General Surgery and Gastrointestinal Medicine were recruited for this study. Their performance on virtual reality upper endoscopy tasks was analyzed by computer. Assessments were made on parameters such as time needed to finish the examination, completeness of the examination, and number of wall collisions. Subjective experiences were queried through questionnaires. Users were grouped according to their prior level of experience performing endoscopy. RESULTS: Construct validation of this simulator was demonstrated. Performance on visualization and biopsy tasks varied directly with the subjects' prior experience level. Subjective responses indicated that novice and intermediate users felt the simulation to be a useful experience, and that they would use the equipment in their off time if it were available. CONCLUSIONS: Virtual reality simulation may be a useful adjunct to traditional operating room experiences. Construct validity testing demonstrates the efficacy of this device. Similar objective methods of skills evaluation may be useful as part of a residency skills curriculum and as a means of procedural skills testing.

Computer Simulation↗

PubMed1995

A neural network model of phantom limbs.

This paper presents a detailed clinical description of phantom limbs and a neuronal network model that provides a comprehensive and parsimonious explanation of otherwise inexplicable or at least unrelated phenomena. Simulations of self-organizing feature maps (Kohonen networks) that had been trained to recognize input patterns were deprived of parts of their input in order to simulate partial deafferentation. This leads to reorganization processes that are shown to be driven by input noise. In patients with an amputated limb, this noise is generated by dorsal root ganglion sensory neurons which are known to fire irregularly upon laceration. According to this model, the long-standing debate concerning non-cortical vs. cortical contributions to the generation of the phenomenon of phantom limbs can be resolved in that it is the peripherally generated noise that causes cortical reorganization. The model can be tested and may have therapeutic implications.

Cerebral Cortex↗

PubMed1997

A simulation program that teaches clinical decision making in nursing.

The aim of this project is to produce a multimedia computer simulation program, to be used in the training of clinical decision making with nursing students in Swedish schools of nursing. The program is based on a number of clinical scenes filmed in a ward and dealing with the postoperative care of a patient who has undergone reconstruction of the crucial ligament. The student's task is to assess the need for care for a newly postoperative patient and to plan the care for the first 24 hours. Special emphasis is given to pain assessment, pain relief and drug administration.

Computer-Assisted Instruction↗

PubMed1998

Effects of endurance training on transient oxygen uptake responses in cyclists.

The aim of this study was to determine the alterations in oxygen uptake kinetics following endurance training in previously trained athletes. Sixteen competitive cyclists completed 8 weeks of supervised endurance cycle training. Ventilatory threshold, maximal oxygen uptake (VO2max), oxygen uptake kinetics and simulated 40-km time-trial tests were performed three times over a 4-week period before training, and then after 4 and 8 weeks of training. The protocol for measuring oxygen uptake kinetics consisted of three square-wave increments from unloaded cycling to a power output of 78 W followed by a single increment from 78 to 156 W. No significant differences in any variables were observed over the pre-training period. The ventilatory threshold and VO2max increased, and the time for 40 km decreased (P < 0.05) with training. Shorter VO2 time constants and lower heart rates were observed during the protocol for measuring oxygen uptake kinetics (same absolute power output) post-training. These results indicate that oxygen uptake kinetics may be improved with endurance training in previously trained athletes.

Adult↗

PubMed2001

[Simulation and display methods of spatial data in landscape ecology].

Simulating and display ecological data over large geographic areas require much time, many resources, and considerable special training. Based on the latest researches all over the world, 7 simulation methods of ecological spatial data and 4 data display formats were reviewed, and several sampling ways were also discussed. Sample density and its spatial distribution, spatial dependence, and estimation accuracy were primarily considered to be the major factors influencing surface representation.

Computer Simulation↗

PubMed1976

[The clinic simulator, a new working place].

For the preclinical instruction of dental students and the training of dental assistants a working place has been developed which, in contrast to the phantom tables used so far, better simulates clinical treatment of patients.

Dental Assistants↗

PubMed1995

Virtual reality in surgical arthroscopic training.

Arthroscopy has become an irreplaceble method in diagnostics. The arthroscope, with optics and light source, and the exploratory probe are inserted into the knee joint through two small incisions underneath the patella. Currently, the skills required for arthroscopy are taught through hands-on clinical experience. Therefore, the Fraunhofer-Institut fuer Graphische Datenverarbeitung in Darmstadt, in cooperation with the Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, developed a highly interactive medical training system for arthroscopy through computer graphics and virtual reality (VR) techniques. Two main issues are addressed: the three-dimensional (3-D) reconstruction process and the 3-D interaction. The goal of the reconstruction process is to obtain a realistic representation of the knee joint derived from a magnetic resonance image sequence suitable for computer simulation. Moreover, the 3-D interaction of the training system must stimulate real arthroscopy, providing an intuitive handling of the instruments.

Arthroscopy↗

PubMedDate not supplied

Teaching pedestrian skills to retarded persons: generalization from the classroom to the natural environment.

Little attention has been given to teaching adaptive community skills to retarded persons. In this study, five retarded male students were taught basic pedestrian skills in a classroom- Training was conducted on a model built to simulate city traffic conditions. Each subject was taught five specific skills involved in street crossing in sequence, viz. intersection recognition, pedestrian-light skills, traffic-light skills, and skills for two different stop-sign conditions. Before, during, and after training, subjects were tested on generalization probes on model and under actual city traffic conditions. Results of a multiple-baseline design acorss both subjects and behaviors indicated that after receiving classroom training on the skills, each subject exhibited appropriate pedestrian skills under city traffic conditions. In addition, training in some skills appeared to facilitate performance in skills not yet trained.

Activities of Daily Living↗

PubMed1995

ALERT: a clinical case simulator program for serious, communicable, and rare diseases.

ALERT is an intelligent Tutoring System (ITS) based on clinical case simulation. Its purpose is to assist in the training of general practitioners regarding the diagnosis and the control of serious, communicable, and rare diseases, such as anthrax, plague, and smallpox. ALERT provides both monitoring techniques and treatment protocols and is structured into two independent sections: one devoted to the simulation of the clinical case and the other to detailed description of disease.

Communicable Diseases↗

PubMedDate not supplied

A new bursting model of CA3 pyramidal cell physiology suggests multiple locations for spike initiation.

We introduce a novel computational model of hippocampal pyramidal cells physiology based on an up-to-date, detailed description of passive and active biophysical properties and real dendritic morphology. This model constitutes a modification of a previous (1995) model which included complex calcium dynamics and Na(+), K(+), and Ca(2+) currents. Changes reflect recently acquired experimental knowledge regarding the types and spatial distributions of these currents. The updated model responds to simulated somatic current clamp stimulation with a train of spikes (burst). The shape of the burst reproduces the characteristic behavior observed experimentally, similarly to the previous model. However, an analysis of dendritic membrane voltage distribution during the burst shows that the mechanisms underlying this somatic behavior are dramatically different in the two models. In the previous model, all spikes were generated in the soma and backpropagated in the dendrites. In the updated model, in contrast, only the first spike is initiated somatically. The second somatic spike is preceded by a dendritic spike (triggered by the first spike backpropagation), which propagates both backward and forward, reaching the soma just before the rise of the second somatic spike. The third and fourth spikes are similarly caused by a complex spatio-temporal interplay between somatic and dendritic depolarization. These results suggest that the distribution of ionic currents recently characterized in hippocampal pyramidal cells can support both somatic and dendritic spike initiation. In addition, these simulations demonstrate that models with considerably different distributions of active conductances can reproduce the same experimental bursting behavior with distinct biophysical mechanisms.

Action Potentials↗

PubMed1996

Operational evaluation of the EXEMSI project. Experimental Campaign for the European Manned Space Infrastructure.

In general the EXEMSI project has proved to be very successful mission. It has demonstrated that it is indeed possible to perform a major and useful project in a short time and on a moderate budget. In addition to achieving the scientific objectives, this simulation project provided valuable experience in the training of members of chamber crew and ground control crew for their tasks. It covered all aspects of a mission from call for experiment proposals, crew selection and training, integration and testing of the facility and its equipment, to daily monitoring and managing of the mission, and finally post-isolation data collection and evaluation. These other activities were accomplished by a small team of experts in the astoundingly short time of 8 months. What was lacking in manpower, time and funds, was more than made up for by enthusiasm, expertise, team spirit, hard work and long hours well beyond the call of duty of all those involved. In addition to the specific and technological objectives reached, many lessons learned in this operation have been identified, which could help to improve future missions. The experience has shown pitfalls to be avoided in future mission, as well as points where some small increase in effort can make a considerable difference. With the prospect of long-term manned spaceflights looming in the near future and the ever increasing costs of such endeavors, the possibilities offered by running simulated missions on the ground should be seriously considered. Such simulations permit the study of scientific and operational aspects of a space mission prior to its actual implementation. A ground based simulation of an extended space mission may be run at a fraction of the cost of an in-orbit precursor mission of even one-week duration. However, careful planning of the simulation mission is required so that it may yield relevant information and useful experience. Lessons learned from the EXEMSI project should be taken into account in such planning. At the start clear goals should be formulated, that can provide clear guidelines for building up the infrastructure and defining the operational scenario. A long duration mission simulating the conditions on the Russian space station MIR could provide a valuable source of information and experience in preparing for the MIR '95 Mission.

Astronauts↗

PubMed1994

The Leiden anaesthesia simulator.

We describe an anaesthesia simulator capable of simulating all possible situations during anaesthesia. The Leiden anaesthesia simulator (LAS) may be used with most commercially available anaesthesia equipment and monitors, which are connected to the simulated patient as they are to a patient. A commercially available intubation manikin attached to an electromechanical lung model represents the patient. The lung allows both spontaneous and mechanical ventilation. Compliance, resistance, tidal volume and ventilatory frequency may be altered by a controlling computer. Carbon dioxide production and oxygen uptake are simulated. Physiological signals (ECG, arterial, pulmonary arterial and central venous pressure waveforms) generated by a signal generator under software control provide input to the monitors. All types of ECG disturbances may be simulated. There are facilities for simulating non-invasive arterial pressure measurement and pulse oximetry. A series of physiological models is being developed to control interactions between the cardiovascular and respiratory variables. During a simulation session, a pre-defined scenario is presented to the trainee. The task of the trainee is to diagnose and treat the problem as if in real life. The simulator experiences on the LAS were judged as highly realistic by 28 subjects. This simulator is currently being used for teaching and training of anaesthetists, trainees and anaesthesia personnel and for research.

Anesthesiology↗

PubMed2005

Teaching cardiac auscultation: effectiveness of a patient-centered teaching conference on improving cardiac auscultatory skills.

OBJECTIVES: To assess the cardiac auscultatory skills of health care professionals before and after an actual (not simulated) patient-centered cardiac auscultation conference and to determine the effectiveness of this clinical teaching method on Improving diagnostic proficiency. SUBJECTS AND METHODS: Seventy-eight participants at a conference on cardiac auscultation completed preconference and postconference examinations on their ability to diagnose a wide variety of heart sounds and murmurs. Among those tested, 46 (59%) were physicians: 17 (22%) were cardiologists, 19 (24%) were medical Interns or residents, 7 (9%) were cardiology fellows, 2 (3%) were general practitioners, and 1 (1%) was a pediatrician. Thirty-two (41%) of this group of respondents were nonphysicians: 14 (18%) were nurse practitioners, 9 (12%) were nurses, 6 (8%) were physician assistants, 2 (3%) were medical students, and 1 (1%) was a nonmedical professional. All participants were tested on 14 clinically Important cardiac auscultatory events directly recorded from actual (not simulated) patients and transmitted via wireless Infrared stethophones. The auscultatory events tested were wide physiologic splitting of S2 in right bundle branch block, fixed S2 splitting and systolic murmur in atrial septal defect, midsystolic click and late systolic murmur of mitral valve prolapse, S4 gallop, S3 gallop, opening snap of mitral stenosis, innocent systolic murmur, systolic murmur of mitral regurgitation, systolic murmur of tricuspid regurgitation, systolic murmur of hypertrophic obstructive cardiomyopathy, continuous murmur of patent ductus arteriosus, pericardial friction rub, prosthetic valve sounds, and alternation of heart sounds, heart murmurs, and the S3 gallop in congestive heart failure. RESULTS: On the basis of the analysis of the 78 participants who completed preconference and postconference evaluations of the 14 selected cardiac auscultatory events, a preconference Identification score of 26.3% and a postconference score of 44.7% were observed. This represents a statistically significant overall Improvement in diagnostic proficiency (P < .001). CONCLUSIONS: Cardiac auscultatory skills among today's health care professionals are extremely poor, regardless of the level and/or type of training of the professional. An actual (not simulated) patient-centered teaching conference is an effective clinical method of improving cardiac auscultatory skills and diagnostic proficiency of health care professionals.

Cardiology↗

PubMed2006

Intraocular pressure at a simulated altitude of 9000 m with and without 100% oxygen.

INTRODUCTION: Exposure to high altitude may affect intraocular pressure (lOP). This study aimed to determine how IOP was altered by two different inspired oxygen tensions at altitude. METHODS: There were 34 healthy male pilots, ages 26-39 yr (mean 31.9 yr), who were studied at the Air Health Examination and Physiological Training Centre in Eskisehir, Turkey. They were studied at ground level, which is 792 m (2414 ft), and during a training session in a hypobaric chamber at a simulated altitude of 9144 m (30,000 ft). IOP was measured with a Tone-pen XL tonometer before subjects entered the chamber, at altitude while breathing 100% oxygen by mask and after removing the mask, and again 30 min after leaving the chamber. RESULTS: Ground level values for IOP (mean +/- SD) were 12.31 +/* 2.98 mmHg. Levels increased significantly at altitude on oxygen (16.75 +/- 4.14 mmHg) and decreased slightly on breathing ambient air (14.37 +/- 3.44 mmHg). In 30 min after leaving the chamber, IOP was 12.81 +/- 1.74 mmHg, indistinguishable from pre-test values. DISCUSSION: Healthy subjects whose baseline IOP is in the normal range experience only a small, temporary elevation of IOP during passive exposure to high altitude with either normoxia or acute hypoxia.

Adult↗

PubMed2004

Dynamics of the Ablowitz-Ladik soliton train.

It is shown that dynamics of a train of N weakly interacting Ablowitz-Ladik solitons with (almost) equal velocities and masses is governed by the complex Toda chain model. The integrability of the complex Toda chain model provides the means to describe analytically various dynamical regimes of the N-soliton train and to predict initial soliton parameters responsible for each of the regimes. Numerical simulations corroborate well analytical predictions. A specific feature arising for the discrete soliton train system is the appearance of an additional (with respect to the lattice spacing) spatial scale-intersoliton distance. We comment on interplay between both spatial scales.

Journal Article↗

PubMed1978

Public transportation training: in vivo versus classroom instruction.

This study evaluated a classroom program to teach public transportation usage (bus-riding skills) to retarded persons. Based on a task analysis of specific skills, five retarded male students were taught each of the components of locating, signalling, boarding and riding, and exiting a bus. These skills were taught sequentially, using training procedures consisting of role playing, manipulating the actions of a doll on a simulated model, and responding to questions about slide sequences. Before, during, and after training, subjects were tested on generalization probes in the classroom and in the natural environment. Results of a multiple-baseline design across subjects indicated that up to 12 months after termination of training, each subject exhibited appropriate bus-riding skills on actual city buses. Two other subjects were trained on each skill component in vivo, on city buses, in order to compare the relative effectiveness and efficiency of classroom versus in vivo training. Both of these subjects acquired appropriate bus-riding skills; however, the in vivo training procedure was both more time consuming and expensive than classroom training. These findings further demonstrate the effectiveness and practicality of properly designed classroom training procedures for teaching community survival skills to retarded persons.

Journal Article↗

PubMed1998

Resistance training and elite athletes: adaptations and program considerations.

The skepticism surrounding the potential benefits of resistance exercise training prevalent just decades ago has evolved over the years to an understanding of the integral nature muscular overload plays in the training programs for athletes. The science of training elite athletes is progressing rapidly, as insights into the physiological adaptations resulting from varying program configurations become available. Resistance training impacts several body systems, including muscular, endocrine, skeletal, metabolic, immune, neural, and respiratory. An understanding and appreciation of basic scientific principles related to resistance training is necessary in order to optimize training responses. Careful selection of the acute program variables in a workout to simulate sports-specific movements is required for optimal transfer of gains made in training to competition. Thus, whether athletes require predominantly eccentric, isometric, slow-velocity, or high-velocity strength or power in their athletic event will dictate the time commitment to each component and form the basis for designing individual workouts. Program variation over a training period is essential to maximize gains and prevent overtraining.

Adaptation, Physiological↗