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PubMed2006

A vertical scanning Doppler probe identifies blood vessels during laparoscopic surgery.

BACKGROUND: Using a conventional Doppler probe, it is difficult to identify blood vessels precisely in lymph node dissection during laparoscopic surgery. METHODS: For 26 patients undergoing laparoscopic colectomy and 26 patients undergoing laparoscopic subtotal gastrectomy, we used conventional and vertical scanning Doppler probes to compare their ability to identify invisible blood vessels through differences in power output voltage. RESULTS: The vertical scanning Doppler probe was 100% successful in identifying the target blood vessels regardless of the patient's body mass index (BMI), and also was superior to the conventional Doppler probe in detection sensitivity. The vertical scanning Doppler probe was useful for image training of recently qualified surgeons through real-time monitoring of the probe position and response on the monitor. Furthermore, findings showed that the vertical scanning Doppler probe was applicable to lymph node dissection as a forceps for laparoscopic usage. CONCLUSION: The vertical scanning Doppler could identify the target blood vessels regardless of the patient's BMI. It was verified to be useful as a surgical assistive device apart from being a sensor and may serve in the education of recently qualified surgeons.

Arteries↗
PubMed2001

The role of the basic surgical skills course in the acquisition and retention of laparoscopic skill.

BACKGROUND: This study assesses the transfer of laparoscopic skills to a group of Basic Surgical Trainees (BST) attending the Basic Surgical Skills (BSS) course. METHODS: The virtual reality simulator MIST-VR was used to assess 13 trainees before and after the course and again 3 weeks and 3 months later. Analysis of kinematic data using the Imperial College Surgical Assessment Device gave measures of distance traveled, distance efficiency ratio, time taken, number of errors made, and number of movements made in completing a virtual laparoscopic task. The performance of the group was compared to a control group who underwent no training. RESULTS: All parameters improved significantly after the course, with the exception of distance traveled by the instruments. All outcome measures were significantly improved at 3 weeks. The control group showed a nonsignificant trend toward improvement in all parameters. CONCLUSIONS: The Basic Surgical Skills course produces quantifiable improvements in laparoscopic skill that are measurable by MIST-VR. There is a learning effect associated with using MIST-VR alone.

Case-Control Studies↗
PubMed2001

Skill transfer from virtual reality to a real laparoscopic task.

BACKGROUND: To validate the usefulness of virtual reality surgical simulators, we investigated the transfer of skills achieved by their use to real tasks. METHODS: Thirty medical students underwent a pretest using a real laparoscopic trainer. They were then randomized to the following three groups: group I received no training; group II received training using the Minimal Invasive Surgical Trainer in Virtual Reality (MIST-VR); and group III received training using conventional training exercises. Each group then underwent a posttest. Using the Imperial College Surgical Assessment Device (ICSAD), scores were generated for time taken, distance traveled, number of movements made, and speed of instrument movement. RESULTS: Significant changes between the MIST-VR group (group II) and the conventionally trained group (group III), were observed in the speed of movement of the left hand and the numbers of movements taken by each hand, when compared to the untrained group (group I). CONCLUSION: The training of novices using MIST-VR yields quantifiable changes in skill that are transferable to a simple real task and are similar to the results achieved with conventional training.

Clinical Competence↗
PubMed2001

Virtual reality training leads to faster adaptation to the novel psychomotor restrictions encountered by laparoscopic surgeons.

BACKGROUND: The fulcrum effect of the body wall on instrument handling poses a major obstacle to the mastery of instrument coordination for junior laparoscopic surgeons. This study evaluated three types of laparoscopic simulator training to assess their ability to promote the user's adaptation to the fulcrum effect. METHODS: Thirty-two participants with no previous experience in laparoscopic surgery were randomly assigned to one of four groups representing different training conditions. One group was assigned to use a virtual reality simulator (MIST VR); two others were given a laparoscopic Z or U maze-tracking task. The control group received no training. Subjects were asked to perform a 2-min laparoscopic cutting task under normal laparoscopic imaging conditions first before and then after training. RESULTS: In the test trial, subjects who trained on MIST VR made significantly more correct incisions (p < 0.0001) and fewer incorrect incisions (p < 0.0001). CONCLUSION: Training on a virtual reality simulator such as MIST VR helps laparoscopic novices adapt to the fulcrum effect faster.

Clinical Competence↗
PubMed2001

A computer-based laparoscopic skills assessment device differentiates experienced from novice laparoscopic surgeons.

BACKGROUND: The acquisition of laparoscopic skills is difficult to assess. Previously, through the use of a computer-based skills assessment device (SAD), we have shown that assessments of the time needed to perform a task and graded observations of task performance overestimate the speed at which laparoscopic skills can be acquired. The aim of this study was to test the ability of a laparoscopic SAD to differentiate novices from experienced laparoscopic surgeons and thereby further validate its use in surgical education. METHODS: Using a laparoscopic simulator platform integrated with task simulation and data collection software (MIST VR), we tested both experienced and novice laparoscopists. Each group performed three tasks with a minimum of seven repetitions. The tasks consisted of target acquisition, target traversal, and target manipulation with diathermy. Within each task, time (T), errors (E), and economy of movement for each hand (EML, EMR) were assessed. Results were reported as mean +/- SEM, and comparisons were made using an independent samples t-test. RESULTS: For the target acquisition task, the expert group performed the task faster than the novice group (5.5 +/- 0.24 vs 7.6 +/- 0.40 sec, p < 0.05); the experts also made fewer errors (0.5 +/- 0.10 vs 0.8 +/- 0.11 errors, p < 0.05), and achieved both a better EML (1.8 +/- 0.6 vs 2.3 +/- 0.9, p < 0.05) and a better EMR (2.0 +/- 0.1 vs 2.9 +/- 0.21, p < 0.05). In the target traversal task, the experts made fewer errors than the novices (2.2 +/- 0.25 vs 4.6 +/- 0.38 errors, p < 0.05). For the manipulation and diathermy tasks, the expert group completed the task faster (30.8 +/- 1.5 vs 39 +/- 1.5 sec, p < 0.05), made fewer errors (5.3 +/- 0.59 vs 8.1 +/- 0.63 errors, p < 0.05), and had a better EML (6.0 +/- 0.37 vs 7.2 +/- 0.45, p < 0.05) and EMR (4.3 +/- 0.23 vs 5.8 +/- 0.36, p < 0.05) than the novices. CONCLUSION: A laparoscopic skills assessment device can discern levels of laparoscopic manipulative skill. This type of device can be used in surgical training to make objective assessments of the acquisition of laparoscopic skills.

Clinical Competence↗
PubMed1998

The effect of practice on performance in a laparoscopic simulator.

BACKGROUND: Laparoscopic skill was measured objectively in a simulator. Seven tasks were scored in terms of precision and speed. These tasks included transferring, cutting, clip+ divide, placement of a ligating loop, mesh placement+ fixation, and suturing with intracorporeal and extracorporeal knot. METHODS: After baseline evaluation, 12 surgical residents were randomized to either five weekly practice sessions (Group A) or no practice (Group B). Each group was then retested. Performance scores were compared for baseline versus final test, and improvement (baseline to final) for Group A versus Group B. Group A residents had a total of seven repetitions of each task (baseline, five practices, final). Linear regression analysis was used to test for the correlation between score and repetition number. RESULTS: Group A showed significant improvement in their scores (baseline to final) for each task and for the total score (sum of all tasks) (p < 0.05). Group B showed significant improvement in four of seven tasks and for the total score. The magnitude of improvement of Group A versus Group B residents was significantly greater for four of seven tasks (peg transfer, placement of ligating loop, and both suturing skills) and for the total score. The final total score for Group A was 219 +/- 14% of baseline (p < 0.0001), whereas Group B was only 162 +/- 35% of baseline (p = 0.07) and not statistically significant. For Group A residents, there was a highly significant correlation between trial number and performance score (p < 0.05) for each individual task and for the total score. CONCLUSIONS: Laparoscopic skill can be measured objectively in a simulator, and performance improves progressively with practice. These skills can be incorporated into the training and evaluation of residents in laparoscopic surgery.

Educational Technology↗
PubMed2005

A visual query-by-example image database for chest CT images: potential role as a decision and educational support tool for radiologists.

Primary reading or further evaluation of diagnostic imaging examination often needs a comparison between the actual findings and the relevant prior images of the same patient or similar radiological data found in other patients. This support is of clinical importance and may have significant effects on physicians' examination reading efficiency, service-quality, and work satisfaction. We developed a visual query-by-example image database for storing and retrieving chest CT images by means of a visual browser Image Management Environment (IME) and tested its retrieval efficiency. The visual browser IME included four fundamental features (segmentation, indexing, quick load and recall, user-friendly interface) in an integrated graphical environment for a user-friendly image database management. The system was tested on a database of 2000 chest CT images, randomly chosen from the digital archives of our institutions. A sample of eight heterogeneous images were used as queries and, for each of them a team of three expert radiologists selected the most similar images from the database (a set of 15 images containing similar abnormalities in the same position of the query). The sensitivity and the positive predictive factor, both averaged over the 8 test queries and 15 answers, were respectively 0.975 and 0.91 The IME system is currently under evaluation at our institutions as an experimental application. We consider it a useful work-in-progress tool for clinical practice facilitating searches for a variety of radiological tasks.

Database Management Systems↗
PubMed1990

Space Station Freedom crew training.

The nature of the Space Station Freedom Program presents an array of new and enhanced challenges which need to be addressed en route to developing an effective and affordable infrastructure for crew training. Such an infrastructure is essential for the safety and success of the program. The three major challenges that affect crew training are the long lifetime of the program (thirty years), the interdependence of successive increments, and the participation of the three International Partners (Canada, European Space Agency, and Japan) and a myriad of experimenters. This paper addresses these major challenges as they drive the development of a crew training capability and the actual conduct of crew training.

Astronauts↗
PubMed2006

Analysis of a mammography teaching program based on an affordance design model.

RATIONALE AND OBJECTIVES: The wide use of computer technology in education, particularly in mammogram reading, asks for e-learning evaluation. The existing media comparative studies, learner attitude evaluations, and performance tests are problematic. Based on an affordance design model, this study examined an existing e-learning program on mammogram reading. MATERIALS AND METHODS: The selection criteria include content relatedness, representativeness, e-learning orientation, image quality, program completeness, and accessibility. A case study was conducted to examine the affordance features, functions, and presentations of the selected software. Data collection and analysis methods include interviews, protocol-based document analysis, and usability tests and inspection. Also some statistics were calculated. RESULTS: The examination of PBE identified that this educational software designed and programmed some tools. The learner can use these tools in the process of optimizing displays, scanning images, comparing different projections, marking the region of interests, constructing a descriptive report, assessing one's learning outcomes, and comparing one's decisions with the experts' decisions. Further, PBE provides some resources for the learner to construct one's knowledge and skills, including a categorized image library, a term-searching function, and some teaching links. Besides, users found it easy to navigate and carry out tasks. The users also reacted positively toward PBE's navigation system, instructional aids, layout, pace and flow of information, graphics, and other presentation design. CONCLUSION: The software provides learners with some cognitive tools, supporting their perceptual problem-solving processes and extending their capabilities. Learners can internalize the mental models in mammogram reading through multiple perceptual triangulations, sensitization of related features, semantic description of mammogram findings, and expert-guided semantic report construction. The design of these cognitive tools and the software interface matches the findings and principles in human learning and instructional design. Working with PBE's case-based simulations and categorized gallery, learners can enrich and transfer their experience to their jobs.

Breast Neoplasms↗
PubMed2006

Why are meetings.

Explore the source record for details and available documents.

Congresses as Topic↗
PubMed2006

Social marketing: a behavior change technology for infection control.

Changing health care worker behaviors is a core function of infection control programs. The social change technologies of education and institutional policy are limited in their capacity to achieve desired behaviors on a sustained basis because they do not address the importance of opportunity and ability in practice enhancement. Social marketing addresses the health care worker's lack of opportunity and ability by offering a bundle of benefits at low cost with high accessibility and by doing this better than the behavioral status quo. This article introduces some social marketing concepts and explicates them in the context of hand hygiene promotion.

Health Behavior↗
PubMed2005

PREVENT: a program of the National Training Initiative on Injury and Violence Prevention.

Training practitioners to use evidence-based approaches to the primary prevention of violence is challenging as a result of the dearth of well-evaluated intervention programs and the lack of familiarity of some practitioners in drawing critically on existing literature. An element of the National Training Initiative in Injury and Violence Prevention, the PREVENT (Preventing Violence Through Education, Networking, and Technical Assistance) program began in late 2003 to train practitioners to address multiple types of violence by encouraging more widespread use of evidence-based approaches to primary prevention. It is intended to reach practitioners involved in addressing violence against women, sexual violence, child maltreatment, youth violence, and suicide in varied community settings. The program uses a combination of varied types of face-to-face training and distance learning coupled with opportunities for networking and technical assistance. Ultimately the program intends to stimulate and facilitate changes in individual, organizational, and cultural awareness and practices fostering primary prevention of violence. The project employs formative, process, and impact evaluation techniques aimed at improving delivery of the training as well as tracking changes in individual and organizations.

Adolescent↗
PubMed2005

Efficacy and costs of a one-day hands-on EASIE endoscopy simulator train-the-trainer workshop.

BACKGROUND: The efficacy of an intensive hands-on training in endoscopic hemostasis on the compactEASIE simulator has been previously demonstrated in a randomized prospective trial. In the current study, we evaluated how quickly and effectively new tutors, without simulator training experience, are able to acquire teaching skills in endoscopic hemostasis. METHODS: Five tutors with prior Erlangen Active Simulator for Interventional Endoscopy (EASIE) teaching experience instructed 7 endoscopists without prior EASIE experience on how to teach when using the model. These new tutors then independently conducted a workshop for 8 fellows in 4 hemostasis techniques. Results were compared with a historical control trained similarly by experienced tutors. Two one-day workshops in endoscopic hemostasis on the compactEASIE ex vivo endoscopy simulator were conducted in a category A hospital in New York City, New York. Skill scores at the end of training were compared with baseline skills assessments, and qualitative ratings of the new tutors were obtained from both the trainees and the experienced tutors. RESULTS: Significant improvement was achieved by the fellows in all 4 skills areas. Both the expert tutors and the trainees consistently rated the teaching skill of the new tutors highly. Fellows' skill acquisition using new tutors was of similar magnitude to that achieved in the prior EASIE trial using experienced trainers teaching the fellows. CONCLUSIONS: It is feasible to conduct an effective EASIE train-the-trainer course in one day. Tutors trained in this manner are able to provide a similar educational experience with objective improvement in trainee skill to experts who have conducted many hands-on workshops.

Clinical Competence↗
PubMed2006

Currently available simulators: ex vivo models.

The introduction of the ex vivo tissue endoscopy simulators represents a major advance in endoscopic training, particularly in therapeutic endoscopy. The simulators have been popular teaching tools from the start, and the data supporting their benefit are accruing, especially in hemostasis training. Simulators like the compact EASIE may prove most beneficial as training tools for interventional skills that require repetitive practice and a larger volume of procedures than may occur naturally during the course of standard endoscopy practice. More data are needed to confirm that hands-on simulator training improves outcomes in clinical endoscopic performance and to characterize better the influence of such simulator work on subsequent endoscopic practice. As ex vivo simulators become more available, it is likely that these models will enhance initial training and also allow practicing gastroenterologists to acquire new techniques, maintain their skills, and demonstrate proficiency for credentialing purposes.

Animals↗
PubMed2006

AccuTouch Endoscopy Simulator: development, applications and early experience.

These studies suggest that there are several potential advantages to use of the AccuTouch simulators, including (1) improvement of the endoscopic training of trainees before patient contact, (2) possible evaluation for procedural competency, and (3) possible cost savings, increasing the productivity of faculty while the trainees are developing competency using the trainers. Other potential advantages might include the training of endoscopists in new diagnostic and therapeutic techniques and even new devices before patient contact. With continued improvement in software and hardware, endoscopic simulators will become an integral part of endoscopic training programs.

Clinical Competence↗
PubMed2006

Evidence-based assessment of endoscopic simulators for training.

This article focuses on some important key questions: Can the currently available simulators distinguish between the skill levels of a novice who has never performed endoscopic procedures and an expert who teaches the procedure? Do the cases on the simulator accurately simulate the difficulty of the procedure and the skill required to perform therapeutic maneuvers? What is the evidence that the currently available simulators can supplement or even replace bedside training? When are simulators most useful in the learning period? This article examines the published evidence regarding the efficacy of the current generation of endoscopic simulators in endoscopic training.

Animals↗
PubMed2006

Simulator training in endoscopic hemostasis.

Simulation of upper gastrointestinal (GI) hemorrhage provides the opportunity to practice endoscopic hemostasis without the risk of patient harm and time limitations. Various models have been developed to simulate an acute bleeding source in the upper GI tract to evaluate the feasibility of new endoscopic devices or to practice interventional techniques in a calm and controlled environment. Increasingly available ex vivo models provide this opportunity without the ethical concerns involved with live-animal courses. Validation studies have proven acceptance of ex vivo models and improved clinical performance by repetitive training using these models.

Animals↗
PubMed2006

Endoscopic retrograde cholangiopancreatography simulation.

Endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a mainly diagnostic to a mainly therapeutic endoscopic technique. Training in ERCP is labor-intensive and time-consuming. Computer- and animal-model-based simulations have been developed in the hope of standardizing and accelerating training. They also may be useful for evaluating trainees. Early efforts to develop computer simulations of endoscopic procedures were hampered by lack of processing power and memory and the cost of software development. Biologic systems seem to offer more realism at lower cost. Hybrid computer-biologic systems seem likely to be the next generation of ERCP simulators.

Animals↗