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PubMed1999

The effects of computer-assisted instruction on the self-efficacy of baccalaureate nursing students.

As computer-assisted instruction (CAI) use has increased during the past few years, nurse educators have expressed concern regarding its effectiveness. The purpose of this quasiexperimental study was to determine if completion of a computerized simulation about a surgical patient increased baccalaureate nursing students' self-efficacy about caring for surgical patients in the clinical environment. Such an association is desirable because increased levels of self-efficacy have been associated with increased motivation, goal-setting, and achievement. A nonprobability, convenience sample (N = 23) of second-year baccalaureate nursing students was assigned randomly to experimental and control groups. The self-efficacy of the experimental group was measured three times: on an initial pretest; following the intervention of a computer simulation; and after an 8-week clinical rotation. The self-efficacy of the control group was measured on an initial pretest and after the 8-week rotation. Higher preclinical self-efficacy scores (p<.01) of the experimental group support the use of CAI as an important aspect of clinical education. Implications for nursing education, practice, and research are addressed. Computer-assisted instruction (CAI) has been available for several decades; however, its use in nursing education has escalated during the past few years. This intensified interest is the result of a decrease in the cost of computer hardware and an increase in the availability of relevant educational software (Wright, 1995). Cutbacks to educational funding, along with the rising costs of clinical teaching, have motivated studies of this method of nursing education. The purpose of this pilot study was to determine if completion of a supplemental computerized simulation about a surgical patient increased baccalaureate nursing students' self-efficacy about caring for surgical patients in the clinical area. The exploration of a link between CAI and self-efficacy focused on the processes of learning, thereby extending the literature.

Adult↗
PubMed1985

Immediate functional recovery and avoidance of reperfusion injury with surgical revascularization of short-term coronary occlusion.

Functional recovery with surgical revascularization of acutely ischemic myocardium has not been compared with its nonsurgical counterpart in experimental preparations of coronary occlusion. This study compares the functional and metabolic recovery of ischemic (1 hr coronary occlusion) segments revascularized either by restoration of coronary patency (simulating nonsurgical recanalization, e.g., angioplasty) or by surgical revascularization with multidose hypothermic potassium blood cardioplegic solution. Twenty-two anesthetized open-chest dogs were instrumented with Millar micromanometer-tip catheters to measure left ventricular and aortic pressures. Piezoelectric ultrasonic dimension gauges were implanted in the subendocardium supplied by the left anterior descending coronary artery to measure segmental contractile function. In five dogs, only biopsy samples were obtained for control measurements of ATP, creatine phosphate, and tissue water content. In the remaining 17 dogs, the left anterior descending artery and collaterals were ligated for 1 hr. The ligatures were removed in eight dogs and coronary perfusion continued for 2 hr, simulating nonsurgical reperfusion. The remaining nine dogs were placed on cardiopulmonary bypass and the hearts were arrested for 1 hr with multidose (every 20 min) blood cardioplegic solution enhanced with glutamate and aspartate, simulating surgical revascularization (coronary artery bypass grafting). The coronary ligatures were not released until the second cardioplegic infusion, simulating graft placement. One hour of coronary occlusion placed 39.4 +/- 2.5% of the left ventricle at risk, and converted active systolic shortening to persistent paradoxical bulging (25.2 +/- 2.2% to -5.8 +/- 1.2% systolic shortening).(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine Triphosphate↗
PubMed1997

[3-D morphological study of the temporal bone].

OBJECTIVE: To establish the 3-D(three-dimensional) morphological study of the temporal bone by means of computer graphic techniques. METHODS: The serial sections of the temporal bone were processed by the technique of computer-aided 3-D reconstruction. The 3-D images of the multi-structures in the temporal bone were displayed on the monitor. The 3-D parameters of these structures were measured by a special software. The stereo-images of the structures in the temporal bone were obtained by stereoscopy and stereo-pairs. RESULTS: Most structures of the temporal bone were reconstructed in 37 instances for the different purpose of study. Each set of the stereo-pair corresponding to the structures in the temporal bones and many 3-D parameters were obtained. The complex spatial relationship among the reconstructed structures such as the facial nerve, endolymphatic sac, posterior tympanum and posterior ampullary nerve was revealed and the mechanic model of the ossicular chain was set up. According to these results, the surgical approach of the posterior ampullary nerve transection was designed and simulated on the graphic computer. CONCLUSION: The technique of computer-aided 3-D reconstruction provides a new tool for the study of the temporal bone. It is also helpful for the designs and simulations of the surgical approaches. The results of this study contribute to developmout of a new branch of pathology of the temporal bone and a primary 3-D morphological study of the temporal bone.

Ear, Middle↗
PubMed1999

Surgical resource utilization in urban terrorist bombing: a computer simulation.

BACKGROUND: The objective of this study was to analyze the utilization of surgical staff and facilities during an urban terrorist bombing incident. METHODS: A discrete-event computer model of the emergency room and related hospital facilities was constructed and implemented, based on cumulated data from 12 urban terrorist bombing incidents in Israel. RESULTS: The simulation predicts that the admitting capacity of the hospital depends primarily on the number of available surgeons and defines an optimal staff profile for surgeons, residents, and trauma nurses. The major bottlenecks in the flow of critical casualties are the shock rooms and the computed tomographic scanner but not the operating rooms. The simulation also defines the number of reinforcement staff needed to treat noncritical casualties and shows that radiology is the major obstacle to the flow of these patients. CONCLUSION: Computer simulation is an important new tool for the optimization of surgical service elements for a multiple-casualty situation.

Computer Simulation↗
PubMed1997

[Transcallosal and transcortical approaches for tumors at the anterior part of the lateral ventricle: relations between visualized and ventricular size].

The transcallosal approach has been widely used for tumors located near the midline of the anterior part of the lateral ventricle, while the transcortical approach is known to provide a wide surgical field in cases of hydrocephalus. However, it is not always easy to choose the appropriate approach in individual cases. The size of the visualized field obtained via the surgical approach is one of the most important factors determining the accessibility of the lesion. In this study, we investigated the difference in the sizes of the fields afforded by these two approaches on the basis of our clinical experience and simulation studies. We surgically treated intraventricular pathology located at the anterior part of the lateral ventricle in five patients with tumors and one with a cyst. Tumors with lateral extension of less than 20 mm were approached via the transcallosal route, and those with more than 20 mm of lateral extension via the transcortical route. In the simulation study, the size of the surgical field was measured through a 3-cm incision of either the cerebral cortex or the corpus callosum under various conditions of ventricular enlargement. Two patients treated via the transcortical approach underwent subtotal removal; one of them had a large bilaterally extending tumor measuring 50 mm in its greatest diameter, and the other had tumor involvement of the fornix. The other three tumors and the cyst were totally resected. While postoperative subcortical hematoma developed in two patients, one each treated via the transcortical and the transcallosal approach, no deficits remained at discharge. Since enucleation procedure was insufficient in patients with hard tumors, a wider surgical field than that in patients with soft tumors was considered necessary. When combined approaches are considered indispensable for a patient with a massive tumor, the transcortical approach may be indicated for priority of order to prevent bilaterally residual tumors. The simulation study disclosed that, in either approach, wider surgical field was obtained as the size of ventricle increased. However, the transcallosal approach afforded a wider field than did the transcortical approach not only in ventricules of normal size but also in mild hydrocephalus with cortical thickness of between 30 and 40 mm. The transcortical approach, on the other hand, produced a much wider field in more advanced hydrocephalus with a thickness of less than 30 mm. A wider surgical field can be obtained by certain tactics such as upward retraction of the incised corpus callosum, moving the cortical window, or oblique or transverse cortical incision.

Adult↗
PubMed2006

Virtual environment-based training simulator for endoscopic third ventriculostomy.

A virtual environment-based endoscopic third ventriculostomy simulator is being developed for training neurosurgeons as a standardized method for evaluating competency. Magnetic resonance (MR) images of a patient's brain are used to construct the geometry model, realistic behavior in the surgical area is simulated by using physical modeling and surgical instrument handling is replicate by a haptic interface. The completion of the proposed virtual training simulator will help the surgeon to practice the techniques repeatedly and effectively, serving as a powerful educational tool.

Computer Simulation↗
PubMedDate not supplied

Evaluation of a virtual reality simulator for arthroscopy skills development.

We evaluated a virtual reality shoulder arthroscopy simulator using a standardized skills-assessment algorithm in 3 specific groups with various degrees of surgical expertise. The simulator (Mentice Corp, Gothenberg, Sweden) consists of a computer-based, dual-force feedback system with video monitor. Modeled structures include cartilage, labrum, ligaments, biceps tendon, and rotator cuff. The study included 3 groups of volunteers: group 1, medical students interviewing for orthopaedic residency (n = 35); group 2, orthopaedic residents interviewing for sports medicine fellowship (n = 22); and group 3, experienced faculty at a shoulder surgery course (n = 21). Data were collected anonymously and subjects completed a standardized test protocol designed to assess accuracy and efficiency. Subjects used the probe to "touch" a sphere that appeared at various locations within the joint (11 positions total). The sphere changed location immediately on contact with the tip of the probe. The following parameters were calculated by the computer: time (from touching the first ball until touching the eleventh ball), path ratio (percent of measured path length relative to the ideal path), collisions (number of times the probe / arthroscope contacted any tissue), and injuries (collisions beyond a threshold force). Test time and path ratio differed significantly as a function of surgical experience. There was no significant difference in probe collisions between the groups. Arthroscope collisions and injuries averaged 2 or less in all of the groups. There was significant correlation between path ratio and time to complete the test in groups 1 and 2 (r =.527 and r =.827, respectively, P <.001), but not in group 3 (r =.376, P =.10). There was essentially normal distribution of time performance in groups 1 and 2. Time was shorter and more consistent in group 3, suggesting greater consistency in the experienced surgeons. These data suggest that this arthroscopy simulator facilitates discrimination of arthroscopic skills. Computer-based simulation technology provides a major opportunity for surgical skills development without morbidity and operating room inefficiency.

Arthroscopy↗
PubMed2004

Comparison of bench test evaluations of surgical skill with live operating performance assessments.

BACKGROUND: Attempts at assessing surgical proficiency have generally used laboratory simulation to evaluate skill. The aim of this study was to compare technical ability as measured on a bench simulation with actual operative performance. STUDY DESIGN: Twenty-two general surgeons and trainees were recruited: consultants (n = 4), specialist registrars (n = 14), and senior house officers (n = 4). They were assessed while performing a saphenofemoral dissection on an anesthetized patient in the operating theater, and performing the same procedure on an inanimate model within the laboratory. The Objective Structured Assessment of Technical Skill method, consisting of a 7-parameter global rating (maximum score 35) and 17-point step-by-step checklist (maximum score 17) was used to measure performance in both environments. Face, content, and construct validity of the synthetic model were established as part of this study. RESULTS: There was a significant relationship between technical skill as measured on the bench test model and performance within the operating theater with respect to both global rating (Spearman correlation coefficient 0.824, p < 0.001; alpha coefficient 0.89) and checklist ratings (r = 0.514, p < 0.02; alpha coefficient 0.68) rating assessments. Global rating scores correlated with experience for both operative (r = 0.822, p < 0.001) and bench (r = 0.515, p < 0.05) settings. There was no difference in level of measured performance between operating theater and bench model (global rating mean 23.25 +/- 6.66 versus 23.75 +/- 5.62, respectively; paired t-test p = 0.559). CONCLUSIONS: Assessment of technical skill using inanimate procedural simulation translates to actual surgical performance within the operating theater. This further validates use of bench test evaluations to measure surgical technical ability.

Clinical Competence↗
PubMed2003

A laboratory-based study to assess the performance of surgical gloves.

The inherent tear resistance and elasticity of latex and the touch sensitivity it provides has made it the traditional material of choice for surgical gloves, protecting both health care workers and patients from the transmission of bloodborne infections. Although increased incidence of latex allergy has led to increased use of nonlatex surgical gloves, the effectiveness of these gloves as a barrier to infection has not been examined thoroughly. This laboratory-based study compared the performance of latex and nonlatex surgical gloves in a simulated stress protocol. The propensity of surgical gloves to fail was dependent on glove material, manufacturer, and stress. Nonlatex neoprene and nitrile gloves were comparable to latex and can provide a good alternative to latex for allergic patients and health care workers. In this study, isoprene was found to be inferior to latex and other nonlatex materials. The presence or absence of glove powder had no significant influence on the probability of glove failure.

Butadienes↗
PubMed2003

[Perspectives on the standardization of surgical treatment for gastric cancer].

To obtain better outcomes of surgical treatment for gastric cancer, standardization of three major aspects, indications for treatment, surgical technique, and evaluation of the results are required. The practice guidelines for gastric cancer treatment postulated by the Japanese Gastric Cancer Association in 2001 provide optimal indications for treatment, but do not comment on the level of surgical technique and method to evaluate the results. Technical training has been performed in the traditional fashion based on apprenticeship in Japan, and there is no standardized evaluation system of the level of technique. Therefore guarantees of the level of surgical technique should be offered by medical societies and/or authorized associations. Surgical education using simulation system is a promising tool for standardization of the level of surgical technique. In the evaluation of the results of gastrectomy, the survival rate has been widely accepted as an objective evaluation. On the other hand, due to recent advances in the surgical treatment of gastric cancer and the increasing number of cases of early gastric cancer, attention has been paid not only to the survival rate but also to the quality of life(QOL) after gastrectomy. However, the general rules for evaluation of QOL have not been established. The standardization of surgical treatment of gastric cancer based on the estimation of these three aspects may offer a better prognosis and better QOL after gastrectomy.

Gastrectomy↗
PubMed1986

Superiority of surgical versus medical reperfusion after regional ischemia.

This study tests the hypothesis that surgical revascularization (i.e., simulating coronary artery bypass grafting) with control of reperfusion conditions (total vented bypass) and of reperfusate composition (substrate-enriched blood cardioplegic solution) produces better recovery than is possible in the non-surgical setting (i.e., normal blood in beating, working hearts to simulate streptokinase and angioplasty). Eighteen dogs underwent 2 hours of left anterior descending coronary artery ligation (35% of the left ventricle at risk) followed by 2 hours of reperfusion. In five dogs the ligature was released to simulate streptokinase thrombolysis and angioplasty in working hearts (medical). In 13 dogs, surgical reperfusion was accomplished during total vented bypass, where six dogs received normal blood and seven others received substrate-enriched blood cardioplegic solution with 1 additional hour of aortic clamping (i.e., a total of 3 hours of ischemia). Segmental shortening with ultrasonic crystals, tissue water content, and vital staining (triphenyltetrazolium chloride) were assessed. Ischemia produced severe systolic bulging (-42% of control systolic shortening, p less than 0.05). Medical reperfusion resulted in failure to restore regional contractility (-27% systolic shortening, p less than 0.05), severe edema (82.4% H2O content, p less than 0.05), and extensive transmural nonstaining (44%, p less than 0.05). In contrast, surgical reperfusion with substrate-enriched blood cardioplegic solution during total vented bypass restored regional contraction to 46% of control values (p less than 0.05) and resulted in less edema (80.6% H2O content, p less than 0.05), and only mild nonstaining (21%, p less than 0.05) restricted to the subendocardial region. Surgical revascularization with controlled reperfusion conditions and reperfusate composition produces better myocardial salvage than is possible in the medical setting, despite a longer period of ischemia.

Animals↗
PubMed2002

[Non-linear elastic deformable models for real-time surgery simulation].

In this article, we describe the latest developments of the minimally invasive hepatic surgery simulator prototype developed at INRIA. A key problem with such a simulator is the physical modelling of soft tissues. We propose a new deformable model based on non-linear elasticity and the finite element method. This model is valid for large displacements, which means in particular that it is invariant with respect to rotations. This property improves the realism of the deformations and solves the problems related to the shortcomings of linear elasticity, which is only valid for small displacements. We also address the problem of volume variations by adding to our model incompressibility constraints. Finally, we demonstrate the relevance of this approach for the real-time simulation of laparoscopic surgical gestures on the liver.

Computer Simulation↗
PubMed2007

Preoperative simulation for microvascular decompression in patients with idiopathic trigeminal neuralgia: visualization with three-dimensional magnetic resonance cisternogram and angiogram fusion imaging.

OBJECTIVE: Precise assessment of the complex nerve-vessel relationship at the root entry zone of the trigeminal nerve is useful for planning microvascular decompression in patients with idiopathic trigeminal neuralgia. We have applied a fusion imaging technique of three-dimensional (3-D) magnetic resonance cisternography and co-registered 3-D magnetic resonance angiography (MRA) that allows virtual reality for the preoperative simulation of the neurovascular conflict at the trigeminal nerve root entry zone. METHODS: Fusion images of 3-D magnetic resonance cisternograms and angiograms were reconstructed by a perspective volume-rendering algorithm from the volumetric data sets of magnetic resonance cisternography, obtained by a T2-weighted 3-D fast spin echo sequence, and co-registered MRA, by a 3-D time-of-flight sequence. Consecutive series of 12 patients with idiopathic trigeminal neuralgia were studied with fusion 3-D magnetic resonance cisternogram and MRA in the preoperative assessment for the microvascular decompression of the affected trigeminal nerve. RESULTS: The complex anatomical relationship of the offending vessels to the trigeminal nerve root entry zone was depicted on the fusion 3-D magnetic resonance cisternogram and MRA. The presence of offending vessels and compressive site of neurovascular conflict was assessed from the various viewpoints within the cistern and was presumed by the preoperative simulation through the surgical access (surgeon's-eye view). The blinded surgical trajectory was discerned by the virtual image through the opposite direction projected from above (bird's-eye view). The 3-D visualization of the nerve-vessel relationship with fusion images was consistent with the intraoperative trajectory and findings. CONCLUSION: Fusion imaging of 3-D magnetic resonance cisternogram and MRA may prove a useful adjunct for the diagnosis and decision-making process to execute the microvascular decompression in patients with idiopathic trigeminal neuralgia.

Adult↗