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At least 325 records · Page 18Linked to original sources
PubMed1977

[Recent data on the radiation exposure to the patient in diagnostic radiology (author's transl)].

As a consequence of the x-ray decree (GFR 1973) data are obligatory to assess the radiation exposure to the patient. These data can easily be obtained with an additional device for recording the dose surface product. The value of the fluoroscopy time for calculating the radiation exposure of different organs is discussed. By a high standard of technical equipment and training of the technical personnel, radiation exposure to the patient may be kept low. Recent data on the exposure to the patient in diagnostic radiology and the corresponding somatic and genetic hazards are summarized in this review.

Body Weight↗
PubMed2006

The human face of simulation: patient-focused simulation training.

Simulation is firmly established within health care training but often focuses on training for technical tasks and can overlook crucial skills such as professionalism and physician-patient communication. The authors locate this paper within current developments in health care and relate it to the literature on simulation. They make the case for placing real human "patients" (played by actors) within simulation environments, thereby ensuring that the training experience remains rooted in actual practice. By practicing repeatedly within a safe environment, technical skills, communication with patients and team members, decision making, and clinical judgment may all be practiced and mastered while preserving patient safety. In elaborating this concept of patient-focused simulation (PFS), the authors draw on work already published by their group and several recent studies that are in review. These explore PFS in low, medium, and high complexity settings. Important or rare situations can be recreated and practiced, as well as key procedures required across a range of experience levels and clinical specialties. Finally, the case is made for curriculum redesign to ensure that simulator-based technical skills training and assessment take place within an authentic context that reflects the wider elements of clinical practice.

Computer Simulation↗
PubMed2006

Cognitive versus technical debriefing after simulation training.

BACKGROUND: Recent literature describes "cognitive dispositions to respond" (CDRs) that may lead physicians to err in their clinical reasoning. OBJECTIVES: To assess learner perception of high-fidelity mannequin-based simulation and debriefing to improve understanding of CDRs. METHODS: Emergency medicine (EM) residents were exposed to two simulations designed to bring out the CDR concept known as "vertical line failure." Residents were then block-randomized to a technical/knowledge debriefing covering the medical subject matter or a CDR debriefing covering vertical line failure. They then completed a written survey and were interviewed by an ethnographer. Four investigators blinded to group assignment reviewed the interview transcripts and coded the comments. The comments were qualitatively analyzed and those upon which three out of four raters agreed were quantified. A random sample of 84 comments was assessed for interrater reliability using a kappa statistic. RESULTS: Sixty-two residents from two EM residencies participated. Survey results were compared by technical (group A, n = 32) or cognitive (group B, n = 30) debriefing. There were 255 group A and 176 group B comments quantified. The kappa statistic for coding the interview comments was 0.42. The CDR debriefing group made more, and qualitatively richer, comments regarding CDR concepts. The technical debriefing group made more comments on the medical subjects of cases. Both groups showed an appreciation for the risk of diagnostic error. CONCLUSIONS: Survey data indicate that technical debriefing was better received than cognitive debriefing. The authors theorize that an understanding of CDRs can be facilitated through simulation training based on the analysis of interview comments.

Cognition↗
PubMedDate not supplied

A portable, 8-channel transcutaneous stimulator for paraplegic muscle training and mobility--a technical note.

This paper introduces an 8-channel transcutaneous neuromuscular stimulator, called ExoStim, which was designed and developed to provide stimulation to the lower-limb muscles of spinal cord injured individuals. The intended purposes of the ExoStim were to act as a skin-surface precursor to an implantable neuromuscular stimulator for the specific tasks of increasing paralyzed leg strength and endurance, enabling the performance of basic lower-limb functional tasks, and familiarizing patients with functional electrical stimulation training. The initial design specifications included portability (approximately 500 g), battery-powered output, constant current control (0-300 mA), 8 channels of biphasic stimulation (charge-balanced, constant current), and microprocessor control of all stimulation parameters. Various tests, including output power characteristics, environmental, mechanical, and battery life, were performed on three prototype units to validate our design specifications. Having successfully passed all tests, the ExoStim is now ready to be deployed to clinical trial sites for further evaluation with spinal cord injured subjects.

Electric Stimulation Therapy↗
PubMed1977

The influence of secondary depth cues on the understanding by Nigerian schoolboys of spatial relationships in pictures.

The ability of 105 Nigerian schoolboys to interpret pictures three-dimensionally was studied as a function of changing the number of depth cues on moving from monochrome photographs incorporating the effects of shadow, through fully cued line drawings, to line drawings containing only elevation cues. The experiment also investigated the effects of different amounts of previous formal training in technical drawing on performance in these tasks. The results showed a significant increase in performance as the number of depth cues increased above that contained in the minimum cued line drawings. However, the difference between the effects of fully cued line drawings and the photographs was not significant. Neither the main nor interaction effects relating to levels of formal training in technical drawing were significant.

Adolescent↗
PubMed1996

Assessment of technical competence during ERCP training.

BACKGROUND: Successful performance of diagnostic and therapeutic ERCP requires skillful manipulation of the duodenoscope and accessories. The evaluation process for assessing competency is still in evolution. Recommendations for the number of examinations has ranged from 35 to 200, made without the benefit of prospective data. METHODS: Pancreatic and common bile duct cannulation rates were prospectively recorded for 21 trainees and 9 proctors over 6 years in a large university-based training program. Trainee success rates were compared to those of the proctor and learning curves were constructed. RESULTS: Trainees performed 641 examinations over 6 years. Each did an average of 31 examinations (range, 10 to 96). For both pancreatic duct and common bile duct cannulation, there was a rapid linear rise of the success curve extending up to the fortieth procedure. Pancreatic duct cannulation rates exceeded those of the common bile duct. CONCLUSIONS: This is the first prospective evaluation of acquisition of skills in ERCP. Although the rapid rise of the learning curve ends at the fortieth examination, the 85% level of selective cannulation is not reached for the pancreas duct until the seventieth procedure and is not reached for the common bile duct even at 100 procedures. These data suggest a threshold of at least 100 procedures.

Biliary Tract Diseases↗
PubMed2005

Integrating simulation into a busy residency program.

A mandatory program of computer-driven simulation training was instituted in a medium-sized surgical training program in order to achieve the goal of increased resident performance outside the setting of direct patient care. Postgraduate year (PGY) 1-5 residents received mentored instruction on a virtual reality (VR) laparoscopic surgical trainer in performance of specific tasks appropriate to training level. Training for PGY 1-2 residents consisted of basic manipulative VR tasks. Training for PGY 3-5 residents consisted of VR suturing and intracorporeal knot-tying tasks. Each resident received two to four mentored one-hour sessions, and was instructed to return for self-directed practice during blocked and unscheduled time. PGY 3-5 residents had laparoscopic suturing and knot-tying skills evaluated in an animal model prior to onset of VR training and two to four months after start of training. After seven months of availability of training, PGY 1-2 residents had undertaken significantly more training sessions than PGY 3-5 residents (18+/-3 vs. 9+/-2; p<0.01). All PGY 1-2 residents demonstrated improved task performance, and six achieved expert performance relative to experienced laparoscopic surgeons. The suturing task in the animal lab was accomplished faster post-training (91+/-9 seconds vs. 154+/-16 seconds; p<0.01). Early results suggest that broadly applied VR training is of significant benefit in increasing resident technical skills. Based on early success, a broader program of computer-based simulation has been implemented, using more advanced devices for technical skills training, and a human patient simulator for training critical decision-making skills.

Journal Article↗
PubMed1992

[Combined vocational education and industrial management--presentation of a cooperative project for improved integration of adolescents with learning handicaps].

Major structural labour market changes, i.e. dramatic losses in job opportunities for unskilled labour and continually rising levels of job requirements facing skilled workers on the one hand and an increasing demand for skilled workers on the other, are entailing enhanced job opportunities for disadvantaged societal groups, at the same time however also increasing the occupational risk of these populations, among them the learning disabled. The vocational training centres having for more than a decade been gaining experience in the vocational and social rehabilitation of this latter group, the project outlined is intended to make even better use of their potential. The main objectives of the project are: 1. optimizing the vocational training centres' range of placement-focussed measures by: intensifying industrial training periods, coordinated "start up" support on occupational entry, post-placement services; 2. transfer of the vocational training centres' technical knowledge and experience into industry-based training by: follow-along support services ("ausbildungsbegleitende Hilfen"), workshops on the initial vocational training of learning disabled young adults, and other forms of cooperation. Apart from reaching the goals outlined, the project is expected to give new impulse to the day-to-day practice of the vocational training centres as well as to generate even greater networking of the centres with their industrial environments.

Adolescent↗