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Biomedical subjects

R Satava

Publications and source records attributed to R Satava.

12 recordsLinked to original sources
PubMed2004

Face, content and construct validity of the University of Washington virtual reality transurethral prostate resection trainer.

PURPOSE: We examined the face, content and construct validity of version 1.0 of the University of Washington transurethral prostate resection (TURP) trainer. MATERIALS AND METHODS: Version 1.0 of a virtual reality based simulator for transurethral skills was developed at our laboratory by integrating TURP hardware with our virtual 3-dimensional anatomy, irrigation control, cutting, bleeding and haptics force feedback. A total of 72 board certified urologists and 19 novices completed a pre-task questionnaire, viewed an introductory training video and performed a pre-compiled 5-minute resection task. The simulator logged operative errors, gm resected, blood loss, irrigant volume, foot pedal use and differential time spent with orientation, cutting or coagulation. Trainees and experts evaluated the simulator on a modified likert scale. The 2-tailed Levene t test was used to compare means between experts and novices. RESULTS: Overall version 1.0 content was between slightly and moderately acceptable. Experts spent less time with orientation (p < 0.0001), resected more total tissue (p < 0.0001), had more gm resected per cut (p = 0.002) and less blood loss per gm resected (p = 0.032), used less irrigant per gm resected (p = 0.02) and performed fewer errors (p < 0.0001) than novices. CONCLUSIONS: We established the face, content and construct validity for version 1.0 of the University of Washington TURP trainer to simulate the skills necessary to perform TURP. A predictive validity study showing a translation of skills from the virtual environment to the operating room will complete the validation of this model.

Adult↗
PubMed2004

Identifying and reducing errors with surgical simulation.

The major determinant of a patient's safety and outcome is the skill and judgment of the surgeon. While knowledge base and decision processing are evaluated during residency, technical skills-which are at the core of the profession-are not evaluated. Innovative state of the art simulation devices that train both surgical tasks and skills, without risk to patients, should allow for the detection and analysis of errors and "near misses". Studies have validated the use of a sophisticated endoscopic sinus surgery simulator (ES3) for training residents on a procedural basis. Assessments are proceeding as to whether the integration of a comprehensive ES3 training programme into the residency curriculum will have long term effects on surgical performance and patient outcomes. Using various otolaryngology residencies, subjects are exposed to mentored training on the ES3 as well as to minimally invasive trainers such as the MIST-VR. Technical errors are identified and quantified on the simulator and intraoperatively. Through a web based database, individual performance can be compared against a national standard. An upgraded version of the ES3 will be developed which will support patient specific anatomical models. This advance will allow study of the effects of simulated rehearsal of patient specific procedures (mission rehearsal) on patient outcomes and surgical errors during the actual procedure. The information gained from these studies will help usher in the next generation of surgical simulators that are anticipated to have significant impact on patient safety.

Computer-Assisted Instruction↗
PubMed2001

The benefits of integrating Internet technology with standard communications for telemedicine in extreme environments.

The ability to continuously monitor the vital signs of a person can be beneficial especially if the environment is hazardous or a person simply has general health concerns. We wanted to ascertain if, by integrating the Internet, ubiquitous switching technologies and off-the-shelf tools, this "suite of services" could provide a topology to enable remote monitoring in extreme and remote locations. An evaluation of this approach was conducted at the base camp of Mount Everest in the spring of 1999. Three climbers were outfitted with wireless, wearable sensors and transmitters for 24 h as they ascended through the Khumbu Icefall toward Camp One. The physiologic data was forwarded to the receiving station at Base Camp where it was forwarded to the U.S. mainland. Two of the three devices delivered physiologic data 95%-100% of the time while the third unit operated at only 78%. According to the climbers, the devices were unobtrusive, however, any additional weight while climbing Everest must provide advantage.

Humans↗
PubMed2000

The physiologic cipher at altitude: telemedicine and real-time monitoring of climbers on Mount Everest.

Advanced wearable biosensors for vital-signs monitoring (physiologic cipher) are available to improve quality of healthcare in hospital, nursing home, and remote environments. The objective of this study was to determine reliability of vital-signs monitoring systems in extreme environments. Three climbers were monitored 24 hours while climbing through Khumbu Icefall. Data were transmitted to Everest Base Camp (elevation 17,800 feet) and retransmitted to Yale University via telemedicine. Main outcome measures (location, heart rate, skin temperature, core body temperature, and activity level) all correlated through time-stamped identification. Two of three location devices functioned 100% of the time, and one device failed after initial acquisition of location 75% of the time. Vital-signs monitors functioned from 95%-100% of the time, with the exception of one climber whose heart-rate monitor functioned 78% of the time. Due to architecture of automatic polling and data acquisition of biosensors, no climber was ever without a full set of data for more than 25 minutes. Climbers were monitored continuously in real-time from Mount Everest to Yale University for more than 45 minutes. Heart rate varied from 76 to 164 beats per minute, skin temperature varied from 5 to 10 degrees C, and core body temperature varied only 1-3 degrees C. No direct correlation was observed among heart rate, activity level, and body temperature, though numerous periods suggested intense and arduous activity. Field testing in the extreme environment of Mount Everest demonstrated an ability to track in real time both vital signs and position of climbers. However, these systems must be more reliable and robust. As technology transitions to commercial products, benefits of remote monitoring will become available for routine healthcare purposes.

Altitude Sickness↗
PubMed2000

Telemedicine at the top of the world: the 1998 and 1999 Everest extreme expeditions.

The National Aeronautics and Space Administration (NASA) initially established a Commercial Space Center (CSC) in the Department of Surgery at Yale University School of Medicine to further develop and evaluate technologies in information systems, telecommunications applied to medicine, and physiologic sensors. The CSC is known as the Medical Informatics and Technology Applications Consortium (MITAC). The overall purpose for this NASA program is to leverage technology, innovation, and resources from industry and academia through collaborative partnerships. The Yale-NASA CSC/MITAC organized the Everest Extreme Expeditions (E3) for the spring Himalayan climbing seasons in the years 1998 and 1999. The primary mission was to deliver advanced medical support with global telemedicine capabilities to one of the world's most remote and hostile settings--Mount Everest. The purpose was both humanitarian (providing medical support) and scientific (conducting medical and technology research). The Yale team provided medical care for the Everest Base Camp community; conducted validation experiments for several types of advanced medical technologies in this remote, hostile environment; and performed real-time monitoring of selected climbers, while also assessing the basic science of altitude physiology. Additionally, the teams conducted outreach medical care to the citizens of Nepal and provided several educational forums for a variety of medical and nonmedical personnel--including school-age children. As part of the project's mission, the E3 medical teams at both Nepal and New Haven were on a 24-hour emergency call system to deliver medical care in the event of a crisis. Unlike most of the teams at Everest, the mission of E3 was not to climb the 29,028-foot mountain the Nepalese call Sagarmatha ("Sky Head"). The mountain served as an extreme testing ground for telemedicine. The lessons learned from this testbed are reviewed here and further clarify the abilities to provide better health care in remote and extreme environments--which for some may even be their home environment during/after a medical illness.

Altitude Sickness↗
PubMed1996

Assessing a virtual reality surgical skills simulator.

The Institute for Defense Analyses (IDA) was contracted to perform a military standard task analysis of laparoscopic cholecystectomy, and to study the effectiveness of a virtual reality surgical skills simulator as a tool for surgical training and as a method for recording psychomotor behavior. This report describes the purpose of the study, its design, initial results, and implications for the field of medical education.

Cholecystectomy, Laparoscopic↗
PubMed1992

Balancing the normal appendectomy rate with the perforated appendicitis rate: implications for quality assurance.

Debate continues as to what should be the appropriate "negative" appendectomy rate for patients suspected of having acute appendicitis. The controversy centers around balancing the complications of appendectomy for a normal appendix with those for a perforated appendix. By using a decision analysis approach to the probable outcomes of appendectomy for a normal appendix, acute appendicitis, and perforated appendicitis, this study provides one answer to this question. These outcomes are based on a review of the results of over 10,000 appendectomies. There is an inverse relationship between the normal appendectomy rate and perforated appendicitis rate. The overall complication rate in patients suspected of having appendicitis improved when the rate of perforated appendicitis was lowered, even if this meant raising the negative appendectomy rate. The perforation rate seemed to level off at approximately 10 per cent. The quality of surgical care delivered to a given population should not be judged solely on the normal appendectomy rate, but this rate should be interpreted in the light of the perforated appendicitis rate. Quality assurance assessments should focus first on perforated appendicitis and only later on normal appendectomy.

Appendectomy↗
PubMed1991

Development of a surgical endoscopy database for quality assurance.

In view of the current incorporation of gastrointestinal endoscopy within surgical residency programs and therefore increased performance of these procedures by surgeons, it is appropriate to devise an effective database which allows retrieval of pertinent information for quality assurance (QA) and utilization review (UR) programs. During the development of two complete surgical endoscopy teaching programs, the QA process has been extensively analyzed for the minimal essential information required to perform QA in compliance with regulations of JCAHO and other reviewing authorities. Over the previous five years this information has been gathered on 3098 patients and incorporated into a database which allows for review of the medical record and the endoscopy unit record for QA and UR. Although the data were entered into a computerized database program for ease of data retrieval and analysis, this information can be complied by the "stubby pencil" method in paper files or log books. The QA process is integrated as part of the general surgery QA, not under a separate endoscopy committee. Results demonstrate that the minimal essential data for the medical record included: patient identification data, endoscopist, procedure, additional procedures, medications, indications, preoperative diagnosis, description of procedure, findings, tissue obtained, complications, final diagnosis, and discharge planning. The endoscopy unit record contained: patient identification, endoscopist, procedure, tissue obtained, and suite complications. From these data elements, complete QA was performed and included: completeness of documentation, appropriate indications, complications, endoscopic versus pathologic diagnosis, and unsuccessful procedures. Utilization review included: number of normal procedures, benefits of screening and surveillance procedures, and appropriateness of preoperative evaluation.(ABSTRACT TRUNCATED AT 250 WORDS)

Databases, Factual↗
PubMed1990

Inguinal hernia complicating flexible sigmoidoscopy.

Flexible sigmoidoscopy has become part of routine preoperative workup for patients over the age of fifty who present with an inguinal hernia. A recent experience with two patients with a left inguinal hernia allowing sigmoid colon to herniate into the scrotum bring awareness of the possibility for an increased risk of perforation of the sigmoid colon during flexible sigmoidoscopy, or possible iatrogenic incarceration of the hernia. These cases are presented so this clinical entity can be recognized and the complications prevented.

Barium Sulfate↗