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PubMed2001

Virtual reality computer simulation.

BACKGROUND: Objective assessment of psychomotor skills should be an essential component of a modern surgical training program. There are computer systems that can be used for this purpose, but their wide application is not yet generally accepted. The aim of this study was to validate the role of virtual reality computer simulation as a method for evaluating surgical laparoscopic skills. METHODS: The study included 14 surgical residents. On day 1, they performed two runs of all six tasks on the Minimally Invasive Surgical Trainer, Virtual Reality (MIST VR). On day 2, they performed a laparoscopic cholecystectomy on living pigs; afterward, they were tested again on the MIST VR. A group of experienced surgeons evaluated the trainees' performance on the animal operation, giving scores for total performance error and economy of motion. During the tasks on the MIST VR, errors and noneconomy of movements for the left and right hand were also recorded. RESULTS: There were significant correlations between error scores in vivo and three of the six in vitro tasks (p < 0.05). In vivo economy scores correlated significantly with non-economy right-hand scores for five of the six tasks and with non-economy left-hand scores for one of the six tasks (p < 0.05). CONCLUSION: In this study, laparoscopic performance in the animal model correlated significantly with performance on the computer simulator. Thus, the computer model seems to be a promising objective method for the assessment of laparoscopic psychomotor skills.

Animals↗

PubMed2006

Targeted genomic microarray analysis for identification of chromosome abnormalities in 1500 consecutive clinical cases.

OBJECTIVE: To assess the yield of array-based comparative genomic hybridization. STUDY DESIGN: The results of array comparative genomic hybridization were collected on 1500 consecutive clinical cases sent to our laboratory for a variety of developmental problems. Confirmation fluorescence in situ hybridization of metaphase or interphase cells, depending on the aberration, was performed. RESULTS: Of the 1500 cases, 134 (8.9%) showed an abnormality: 36 (2.4%) showed polymorphisms or familial variants, 14 (0.9%) showed alterations of unknown clinical significance, and 84 (5.6%) showed clinically relevant genomic alterations. These included subtelomeric deletions and unbalanced rearrangements, microdeletions and reciprocal duplications, rare abnormalities, and low-level trisomy mosaicism. CONCLUSIONS: A targeted array detects a substantial proportion of abnormalities even in those patients who have already had extensive cytogenetic and/or fluorescence in situ hybridization testing. This study, although not a controlled ascertainment of subjects with specific selection criteria, accurately reflects the reality of clinical cytogenetic practice and provides an estimate of the cytogenetic abnormalities that can be identified with a targeted microarray in a diagnostic laboratory. Microarray analysis likely doubles the current yield of abnormal results detected by conventional cytogenetic analysis.

Child↗

PubMedDate not supplied

Comparative evaluation of alpha-galactosidase A infusions for treatment of Fabry disease.

Enzyme therapy has proven safe and effective in preventing and reversing many manifestations in patients with Gaucher disease. On the basis of this success, enzyme therapy is now becoming a reality for Fabry disease, alpha-galactosidase A deficiency. Two products, agalsidase alpha and beta, have been tested in pivotal trials. The substantial differences between the study structures and outcome measures have made direct comparisons difficult. Here, the strengths and weaknesses of these trials are compared: achievement of stated endpoints, safety and, potential efficacy. In addition, the need for additional long-term data is emphasized because this is not attainable in short-term trials for a chronic disease.

Animals↗

PubMed1975

Deviance and a generalized disposition toward internality: an attributional approach.

Two studies were carried out to test the hypothesis, derived from attribution theory, that adolescents might acquire an identity and mediating beliefs about reality (internal locus of control) by deviating from norms when they perceived adults to be powerful. In line with this expectation, the major study found that students rated by teachers as "deviant," but not those rated as "conformant," showed greater internality in beliefs about man (control ideology), p = .024, under conditions of high power. Despite the following limitations or exceptions, attribution theory seemed to best explain the predicted effect: (1) the effect for beliefs about control was nonsignificantly weaker for females then males, perhaps because of different meanings of deviance for males and females and female socialization for conformity rather than independence; (2) in the major study the effect was absent for questions dealing with respondents' personal feelings of control ("self-attributions"); and (3) in both studies there was a tendency for deviant females to show more personal externality (relative to conformers) when perceived power was high.

Adolescent↗

PubMed2005

Logics of delusion.

Delusion represents an exceptional test case for the principal categories of common sense and philosophical thought, such as 'reason', 'truth' and 'reality'. Via an engagement with the legacy of Freud and the most discussed results of twentieth-century psychiatry, my aim will be to analyse its paradoxical forms and to shed light on the logics that underlie and orient its specific modalities of temporalization, conceptualization and argumentation. Delusion, then, has traditionally been presented as synonymous with irrationality (absurdity, groundlessness, error, chaos), whereas by contrast its mirror image, reason, has been defined in terms of evidence, demonstrability, truth and order. I will analyse and contrast their paradoxical definitions.

Delusions↗

PubMed2003

Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: randomised controlled trial.

BACKGROUND: A recent Cochrane review of reality orientation therapy identified the need for large, well-designed, multi-centre trials. AIMS: To test the hypothesis that cognitive stimulation therapy (CST) for older people with dementia would benefit cognition and quality of life. METHOD: A single-blind, multi-centre, randomised controlled trial recruited 201 older people with dementia. The main outcome measures were change in cognitive function and quality of life. An intention-to-treat analysis used analysis of covariance to control for potential variability in baseline measures. RESULTS: One hundred and fifteen people were randomised within centres to the intervention group and 86 to the control group. At follow-up the intervention group had significantly improved relative to the control group on the Mini-Mental State Examination (P=0.044), the Alzheimer's Disease Assessment Scale - Cognition (ADAS-Cog) (P=0.014) and Quality of Life - Alzheimer's Disease scales (P=0.028). Using criteria of 4 points or more improvement on the ADAS-Cog the number needed to treat was 6 for the intervention group. CONCLUSION: The results compare favourably with trials of drugs for dementia. CST groups may have worthwhile benefits for many people with dementia.

Aged↗

PubMed2001

Development of an experimental paradigm in which to examine human learning using two computer-based formats.

Computer-based self-instructional programs are frequently promoted as means to augment or replace the traditional anatomy curricula taught in medical schools. These programs may range from static slide shows to fully immersive virtual environments. However, the impact of these learning technologies on knowledge acquisition, and their comparative cost/benefit to education remain unclear. As a consequence, we are embarking on a series of experiments to compare knowledge acquisition and the meaningful use of information among students who are learning anatomy using one of two different computer-based self-instructional formats. These studies will be based on a specially developed learning module on basic lung anatomy; they will utilize a variety of assessment tools to measure factual knowledge, conceptual understanding of spatial-anatomic relationships, and the ability to apply newly acquired knowledge of anatomy to clinical problem-solving scenarios. The primary object of this paper is to describe the design and development of the underlying test module and to outline the two computer-based formats that will be evaluated. The virtual reality (VR) environment, UCSD's Anatomic VisualizeR, provides dynamic access to 3-dimensional polygonal models of the lesson content and supports student-centered exploration and learning. The multimedia environment, Microsoft PowerPoint, provides a structured presentation of the lesson content and illustrates important anatomic structures through the use of 2-dimensional images derived by screen captures of models available in the VR learning module. This paper also provides an overview of the first experiment in the series, a pilot study using first-year medical students without previous participation in a medical school anatomy curriculum. For this study, students will be prospectively randomized into two groups, each group learning the lung anatomy lesson using one of the computer-based formats described. Immediate knowledge retention will be measured by asking students to complete the assessment instrument immediately after completing their learning module. The results of the pilot study will be used to refine and improve the design of the remainder of studies planned in this experimental series.

Anatomy↗

PubMed2004

Validation of soft tissue properties in surgical simulation with haptic feedback.

Numerous experiments are being conducted to extract soft tissue values for their integration into VR surgical simulations with haptic feedback. Haptic feedback has been shown to be relevant in laparoscopic surgery, however to date no experiments have been conducted to test user sensitivity to changes in soft tissue values in surgical simulations, and how users perception of 'reality' differs from experimentally determined soft tissue values. In this study we conduct a series of experiments investigating haptic sensitivity, haptic differentiation and comparing experimental and empirical values.

Connective Tissue↗

PubMed2005

A terminological and ontological analysis of the NCI Thesaurus.

OBJECTIVE: The National Cancer Institute Thesaurus is described by its authors as "a biomedical vocabulary that provides consistent, unambiguous codes and definitions for concepts used in cancer research" and which "exhibits ontology-like properties in its construction and use". We performed a qualitative analysis of the Thesaurus in order to assess its conformity with principles of good practice in terminology and ontology design. MATERIALS AND METHODS: We used both the on-line browsable version of the Thesaurus and its OWL-representation (version 04.08b, released on August 2, 2004), measuring each in light of the requirements put forward in relevant ISO terminology standards and in light of ontological principles advanced in the recent literature. RESULTS: We found many mistakes and inconsistencies with respect to the term-formation principles used, the underlying knowledge representation system, and missing or inappropriately assigned verbal and formal definitions. CONCLUSION: Version 04.08b of the NCI Thesaurus suffers from the same broad range of problems that have been observed in other biomedical terminologies. For its further development, we recommend the use of a more principled approach that allows the Thesaurus to be tested not just for internal consistency but also for its degree of correspondence to that part of reality which it is designed to represent.

Computational Biology↗

PubMed1984

[Value of isotope diagnosis in diseases of the ENT area. Status, development and trends].

The nuclear medical diagnostic procedures listed in this article demonstrate the continual change in the significance of modern and recent techniques. The definition of the current status may be as short-lived as some radioisotopes. The tendencies are determined by aspects of radiological hygiene and the development of new technical procedures and the preference of in-vitro-examinations over in-vivo-diagnostic. On the other hand progress in immunology using labelled antibodies opens new possibilities in diagnosis and therapy. Although these possibilities are still somewhat visionary, they have already been translated into reality by experiment. For examination of thyroids further progress in sonography can be expected. In special problems tests using iodine isotopes with short half-lives and consequently lower radiation exposure will be used. At the moment the combination of technetium scintigram with sonography seems optimal and should if possible applied by the same hand. Scintigraphy of salivary gland and of cerebrospinal fluid have their unquestioned position. Brain scintigraphy has lost its importance but may reappear as an examination method using specially labelled agents for research of cerebral metabolism. The position of bone scintigraphy is similar. Its use is still justified when searching for skeletal changes which may not be seen in classical radiology. The knowledge of disturbance of local osseous metabolical disturbances does not give a specific information on the cause but demonstrates the site of disorder. Contrary its present ranking, important developments are to be expected from tumour scintigraphy. Isotope angiography, isotope lymphography and ventilation scintigraphy are to be employed when special questions arise, especially in fundamental research and for controls of therapeutic concepts.

Angiography↗

PubMed1993

Uvulopalatopharyngoplasty for obstructive sleep apnea in adults: clinical correlation with polysomnographic results.

The success of Uvulopalatopharyngoplasty (UPPP) for Obstructive Sleep Apnea (OSA) can be assessed by a variety of parameters including clinical evaluation and polysomnography (PSG). Patients are often reluctant to undergo post-operative testing and insurance companies are often unwilling to reimburse for expensive overnight sleep studies. Due to the reality of these medical and economical problems, can a clinician be confident of the success of UPPP based solely on clinical evaluation? Sixty patients underwent UPPP for the treatment of OSA from July 1987 through June 1992. Patients treated with tracheostomy or other methods were not included in this study. Fifty-three patients (88%) reported an improvement in their symptoms of snoring, daytime somnolence, morning headache and apnea. Twenty-one patients (35%) had post-operative PSG. Eighteen of 21 patients (85%) reported improvement in their symptoms. Eleven of 21 patients (57%) showed objective improvement in their sleep apnea. The objective findings of PSG do not correlate, in a significant number of patients, with subjective clinical improvement of patients treated with UPPP.

Adult↗

PubMed1997

Virtual reality as assessment tool in psychology.

Virtual environments (VEs), offering a new human-computer interaction paradigm, have attracted much attention, in clinical psychology, especially in the treatment of phobias. However, a possible new application of VR in psychology is as assessment tool: VEs can be considered as an highly sophisticated form of adaptive testing. This chapter describes the context of current psychological assessment and underlines possible advantages of a VR based assessment tool. The chapter also details the characteristics of BIVRS, Body Image Virtual Reality Scale, an assessment tool designed to assess cognitive and affective components of body image. It consists of a non-immersive 3D graphical interface through which the patient is able to choose between 9 figures of different size which vary in size from underweight to overweight. The software was developed in two architectures, the first (A) running on a single user desktop computer equipped with a standard virtual reality development software and the second (B) splitted into a server (B1) accessible via Internet and actually running the same virtual ambient as in (A) and a VRML client (B2) so that anyone can access the application.

Computer Graphics↗

PubMed1999

Maternity care calendar wheel. Improved obstetric wheel developed in British Columbia.

PROBLEM BEING ADDRESSED: Gestational calendar "wheels" are not well designed for routine prenatal care or for presenting the uncertainties of predicting date of delivery. OBJECTIVE OF PROGRAM: To design and pilot-test a new gestational calendar wheel that predicts the range of normal due dates in a way that reflects the biological realities of pregnancy. The calendar has prompts that could facilitate provision of antenatal care, support prenatal education, and guide the timing of induction for pregnancies past their due dates. MAIN COMPONENTS OF PROGRAM: The calendar sets out the key issues to be addressed with patients during pregnancy. It is designed to be photocopied while set to patients' dates: patients keep one copy; another is placed in their charts. The probability of delivering on a given date is presented graphically and as a percentage likelihood of giving birth during specified intervals. Twelve practising physicians, 12 residents, and 10 pregnant women pilot-tested and evaluated the wheel. Their responses were favourable. CONCLUSIONS: The Maternity Care Calendar wheel is a substantial advance on existing obstetric calendar wheels. It incorporates evidence-based information that should facilitate prenatal care, promote prenatal education, and foster realistic expectations about the likely timing of delivery. Early in the pregnancy, it can help establish the timing of induction for pregnancies past their due dates. Further testing of the calendar's effectiveness in improving patient outcomes is needed.

Adult↗

PubMed1996

[Test performance with minimal alcoholic intoxication].

Driving ability of 34 males under minor influence of alcohol was tested at the ART 90 test unit of the Austrian Road Safety Board. Furthermore, 22 males not under the influence of alcohol, formed part of the sober control group. Some months previously, all volunteers had completed a driver aptitude test consisting of identical tests for all participants. Therefore a before-and-after analysis as well as a comparison of the different groups could be carried out by means of MANOVA. A high motivational level was guaranteed in the first tests as all test persons' driver qualification depended on the results of their driver aptitude tests. Months later they were invited to participate in this study on a voluntary basis. The second tests took place immediately after a social evening at which 8 volunteers were present at any one time. To create conditions as near to reality as possible, only alcohol that would be readily available to the public was served. An entertainer ensured an equally cheerful and relaxed atmosphere in both the experimental and control groups. Alcohol levels were measured by means of the Siemens breathalyser. Results show that as early as an average alcohol level of 0.67/1000 performance is significantly impaired: three times more errors in concentration tests, twice as many errors in reaction tests, twice as many observation errors in visual structuring and a considerable reduction of reactive stress tolerance. On the other hand quantitative dimensions of performance such as reaction time are not significantly impaired. In addition, the readiness to take risks increases with alcohol consumption as is shown by means of questionnaire.

Adolescent↗

PubMed1997

Performance tests of a satellite-based asymmetric communication network for the 'hyper hospital'.

The Hyper Hospital is a prototype networked telemedicine system which uses virtual reality. We measured the performance of a novel multimedia network based on satellite communications. The network was a hybrid system consisting of a satellite channel in one direction and a terrestrial channel in the other. Each user was equipped with a standard satellite communication receiver and a telephone connection. Requests from the users were sent by modern and telephone line and responses were received by satellite. The user requests were initiated by clicking buttons on a World Wide Web browser screen. The transmission rates of satellite and normal telephone-line communications were compared for standardized text data. Satellite communication was three to five times faster. The transmission rate was also measured for standardized graphical data (GIF format). With a file size of about 400 kByte, satellite-mediated communication was 10 times faster than telephone lines. The effect of simultaneous access on performance was also explored. For simultaneous access of nine users to a single graphics file, 78% of the transmission speed was obtained in comparison with that of a single user. The satellite-based system showed excellent high-speed communication performance, particularly for multimedia data.

Hospitals↗

PubMedDate not supplied

[Study of the sclerosing of varicose veins: comparison between natural fibrinolysis in the blood of the cubital vein and the labeled fibrinogen test in the sclerosed leg].

After intravaricose injection of 3% ethoxysclerol a slight hyperfibrinolysis appears in the blood of a cubital vein. This is too weak to judge of the reality of the sclerosis. On the other hand, a very marked fibrinolysis is not seen after injection of ethoxysclerol. Fibrinogen labelled with iodine 131 however permits an exact control of what is happening at the site of the sclerosant injection. The reaction develops slowly, reaching its maximum not until 5 days after the injection of sclerosant. There is therefore no need to fear a sudden thrombosis which might be difficult to control.

Adult↗

PubMed1989

Genetic testing for neurologic diseases. A rose with thorns.

Genetic testing for neurologic conditions, including HD, requires that the primary concerns of informed consent, counseling and support, and confidentiality be recognized and addressed. A safe, reliable test should be available to those who want the information and understand the limitations of the testing procedure. However, testing should be in the context of multifaceted counseling, which combines a variety of components. Safeguards for confidentiality should be assured. Predictive testing for hereditary disease emphasizes the need to focus on capabilities rather than disability. This is an extension of the larger reality that continuing advances in health care can extend the length of an individual's life and stave off death without restoring health. Certainly, new developments in molecular biology may provide new tools, but the basic ethical problems are fundamental issues independent of technology. Just as change is not necessarily progress, the application of scientific advances to health care does not automatically benefit humanity. Sensitivity to human needs is the art of applying medical technology.

Ethics, Medical↗

PubMed2006

The use of virtual reality computer simulation in learning Port-A cath injection.

Cost-benefit management trends in Taiwan healthcare settings have led nurses to perform more invasive skills, such as Port-A cath administration of medications. Accordingly, nurses must be well-prepared prior to teaching by the mentor and supervision method. The purpose of the current study was to develop a computer-assisted protocol using virtual reality (VR) in performing Port-A cath as a training program for novice nurses. A pre-tested and post-tested control group experimental design was used in this study. Seventy-seven novice nurses were invited from one large medical center hospital in North Taiwan. Thirty-seven and forty nurses were randomly assigned to experimental and control groups. First, we designed a 40 minute port-A cath injection VR simulation. Then, the experimental group practiced this simulation two times over 3 weeks. The control group attended the traditional class. The post-test 1 was right after completion of the simulation practice. The post-test 2 was after the second simulation practice in 3 weeks. The results showed that most novice nurses lacked Port-A cath experience both in the classroom and during the period of their practice training. The knowledge score regarding the Port-A cath technique was significantly higher in the nurses that participated in the simulation training than in the control group. The novice nurses were most satisfied with the reduction in their fear of performing the Port-A cath technique and their enhanced clinical skills. VR simulation significantly reduced error rates and increased correct equipment selection, showing that nurses who participated in the simulation may be better prepared for inserting Port-A cath.

Catheterization, Central Venous↗