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Sample records for patient simulators hps

  1. HPS simulation and acceptance

    Mundim, Luiz Martins [UERJ, Rio de Janeiro, RJ (Brazil); Pol, Maria Elena [CBPF, Rio de Janeiro, RJ (Brazil)

    2013-07-01

    Full text: The High Precision Spectrometer (HPS) is a proposal of sub-detector to be installed in the region of 200-240m from each side of CMS along the LHC beam-line to measure scattered protons from exclusive centrally produced processes, pp → p + X + p. In order to study the protons that reach the detectors, the beam-line of the LHC accelerator has to be taken into account, as the particles are deflected by dipoles and suffer the influence of quadrupoles and other beam devices. The LHC team provides a detailed description of these elements, currents, energies, magnetic fields, and all the information needed to study the propagation of the protons. The program HECTOR, developed at the University of Louvain, uses the information from LHC to calculate at any point along the beam-line the kinematic quantities that characterize the scattered protons. A simple minded program was initially developed for the preliminary studies of acceptances varying the position and size of the foreseen detectors. Also, it took into account vertex and position smearing, to simulate a realistic resolution of the tracking detectors. These studies were performed using a particle gun generator which shoot protons from the IP within reasonable ranges of possible t and ξ (the square of the four-momentum transfer and the fractional energy loss of the outgoing proton in a diffractive collision), and propagated them to the position of the tracking detectors. These kinematic quantities were reconstructed back at the IP using the transport equations from HECTOR. This simplified simulation was afterwards interfaced with the full software of CMS, CMSSW, in such a way that when a diffractive event was fully simulated and reconstructed in the central detector, the outgoing protons were treated by the HPS software and then the complete (CMS+HPS) event was output. The ExHuME generator was used to produce Monte Carlo simulations to study the mass acceptance of the HPS detector, and central and

  2. Effects of Using Human Patient Simulator (HPS versus a CD-ROM on Cognition and Critical Thinking

    Don Johnson, PhD

    2008-01-01

    Full Text Available Background: Very little prospective randomized experimental research exists on the use of simulation as a teaching method, and no studies have compared the two strategies of using the HPS and a CD-ROM. In addition, no researchers have investigated the effects of simulation on various levels of cognition, specifically lower-level and higher-level cognition or critical thinking.Objectives: A prospective pretest-posttest experimental mixed design (within and between was used to determine if there were statistically significant differences in HPS and CD-ROM educational strategies in lower-level, higher-level cognition and critical thinking.Results: A repeated measures multivariate analysis of variance (RMANOVA with LSD post-hoc tests were used to analyze the data. There were no significant differences between the HPS and CD-ROM groups on lower-level cognition scores. The HPS group did significantly better than the CD-ROM group on higher-level cognition and critical thinking scores.Conclusion: This study demonstrated that the choice of teaching strategies for lower-level cognition does not make a statistically significant difference in outcome. However, the HPS is superior to using CD-ROM and should be considered as the choice in teaching.

  3. Simulation of the single-vibronic-level emission spectrum of HPS.

    Mok, Daniel K W; Lee, Edmond P F; Chau, Foo-tim; Dyke, John M

    2014-05-21

    We have computed the potential energy surfaces of the X¹A' and ùA" states of HPS using the explicitly correlated multi-reference configuration interaction (MRCI-F12) method, and Franck-Condon factors between the two states, which include anharmonicity and Duschinsky rotation, with the aim of testing the assignment of the recently reported single-vibronic-level (SVL) emission spectrum of HPS [R. Grimminger, D. J. Clouthier, R. Tarroni, Z. Wang, and T. J. Sears, J. Chem. Phys. 139, 174306 (2013)]. These are the highest level calculations on these states yet reported. It is concluded that our spectral simulation supports the assignments of the molecular carrier, the electronic states involved and the vibrational structure of the experimental laser induced fluorescence, and SVL emission spectra proposed by Grimminger et al. [J. Chem. Phys. 139, 174306 (2013)]. However, there remain questions unanswered regarding the relative electronic energies of the two states and the geometry of the excited state of HPS.

  4. Simulation of the single-vibronic-level emission spectrum of HPS

    Mok, Daniel K. W., E-mail: bcdaniel@polyu.edu.hk, E-mail: epl@soton.ac.uk; Chau, Foo-tim [Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom (Hong Kong); Lee, Edmond P. F., E-mail: bcdaniel@polyu.edu.hk, E-mail: epl@soton.ac.uk [Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom (Hong Kong); School of Chemistry, University of Southampton, Highfield, Southampton SO17 1BJ (United Kingdom); Dyke, John M. [School of Chemistry, University of Southampton, Highfield, Southampton SO17 1BJ (United Kingdom)

    2014-05-21

    We have computed the potential energy surfaces of the X{sup ~1}A{sup ′} and A{sup ~1}A{sup ′′} states of HPS using the explicitly correlated multi-reference configuration interaction (MRCI-F12) method, and Franck–Condon factors between the two states, which include anharmonicity and Duschinsky rotation, with the aim of testing the assignment of the recently reported single-vibronic-level (SVL) emission spectrum of HPS [R. Grimminger, D. J. Clouthier, R. Tarroni, Z. Wang, and T. J. Sears, J. Chem. Phys. 139, 174306 (2013)]. These are the highest level calculations on these states yet reported. It is concluded that our spectral simulation supports the assignments of the molecular carrier, the electronic states involved and the vibrational structure of the experimental laser induced fluorescence, and SVL emission spectra proposed by Grimminger et al. [J. Chem. Phys. 139, 174306 (2013)]. However, there remain questions unanswered regarding the relative electronic energies of the two states and the geometry of the excited state of HPS.

  5. Simulation of the single-vibronic-level emission spectrum of HPS

    Mok, Daniel K. W.; Chau, Foo-tim; Lee, Edmond P. F.; Dyke, John M.

    2014-01-01

    We have computed the potential energy surfaces of the X ~1 A ′ and A ~1 A ′′ states of HPS using the explicitly correlated multi-reference configuration interaction (MRCI-F12) method, and Franck–Condon factors between the two states, which include anharmonicity and Duschinsky rotation, with the aim of testing the assignment of the recently reported single-vibronic-level (SVL) emission spectrum of HPS [R. Grimminger, D. J. Clouthier, R. Tarroni, Z. Wang, and T. J. Sears, J. Chem. Phys. 139, 174306 (2013)]. These are the highest level calculations on these states yet reported. It is concluded that our spectral simulation supports the assignments of the molecular carrier, the electronic states involved and the vibrational structure of the experimental laser induced fluorescence, and SVL emission spectra proposed by Grimminger et al. [J. Chem. Phys. 139, 174306 (2013)]. However, there remain questions unanswered regarding the relative electronic energies of the two states and the geometry of the excited state of HPS

  6. Hantavirus Pulmonary Syndrome (HPS)

    ... to Yosemite FAQ: Non-U.S. Visitors to Yosemite History of HPS Related Links Prevent Rodent Infestations Cleaning Up After Rodents Diseases From Rodent Hantavirus Pulmonary Syndrome (HPS) Recommend on Facebook Tweet Share Compartir Hantavirus Pulmonary Syndrome (HPS) is ...

  7. Identification of a novel mutation in HPS6 in a patient with hemophilia B and oculocutaneous albinism.

    O'Brien, Kevin J; Lozier, Jay; Cullinane, Andrew R; Osorio, Brigitte; Nghiem, Khanh; Speransky, Vladislav; Zein, Wadih M; Mullikin, James C; Neff, Anne T; Simon, Karen L; Malicdan, May Christine V; Gahl, William A; Young, Lisa R; Gochuico, Bernadette R

    2016-11-01

    Hemophilia B, an X-linked disease, manifests with recurrent soft tissue bleeding episodes. Hermansky-Pudlak syndrome, a rare autosomal recessive disorder, is characterized by oculocutaneous albinism and an increased tendency to bleed due to a platelet storage pool defect. We report a novel mutation in HPS6 in a Caucasian man with hemophilia B and oculocutaneous albinism. The patient was diagnosed with hemophilia B at age 4months due to recurrent soft tissue bleeding episodes, and he was also diagnosed with Hermansky-Pudlak syndrome at 32years of age due to unexplained oculocutaneous albinism. His factor IX level was markedly reduced at 13%; whole exome and Sanger sequencing showed the Durham mutation in F9 (NM_000133.3). The diagnosis of Hermansky-Pudlak syndrome subtype 6 was established by demonstrating absence of platelet delta granules on whole mount electron microscopy, an abnormal secondary wave in platelet aggregation studies, and a novel homozygous c.1114 C>T (p.Arg372*) mutation in HPS6 (NM_024747.5) on exome analysis and Sanger sequencing. Clinical phenotyping revealed no evidence of recurrent or unusual infections, interstitial lung disease or pulmonary fibrosis, or neurological disorders. The patient was treated with fresh frozen plasma, recombinant factor IX, and aminocaproic acid. Treatment with desmopressin was added to his regimen after he was diagnosed with Hermansky-Pudlak syndrome. Treatment of bleeding episodes results in effective hemostasis, and the patient has not required platelet or blood product transfusions. This report highlights the need to consider Hermansky-Pudlak syndrome as an etiology of oculocutaneous albinism even in patients with known hematologic disorders associated with bleeding. Identification of a novel mutation in HPS6 in an individual with hemophilia B shows that, although quite rare, patients may be diagnosed with two independent inherited bleeding disorders. No evidence of lung disease was found in this adult patient

  8. Diagnostic imaging of hypertrophic pyloric stenosis (HPS)

    Frkovic, M.; Seronja Kuhar, M.; Perhoc, Z.; Barbaric-Babic, V.; Molnar, M.; Vukovic, J.

    2001-01-01

    Background. Imaging of the abdomen in children with suspected hypertrophic pyloric stenosis has been traditionally performed by plain film radiography and upper gastrointestinal contrast studies. In many clinical situations, this approach has been modified or replaced by ultrasound examination. The authors aimed to analyse the value of diagnostic algorithm in children with hypertrophic pyloric stenosis confirmed at surgery in our hospital. Patients and methods. The authors made a five year retrospective review of hospital records of all children operated on for HPS in Clinical Hospital Centre Zagreb - Rebro and found out that 14 boys, between 2 (17 days) and 10 weeks of life (75 days) underwent surgery due to HPS. Results. Specific radiographic signs were: string sign, double track sign, elongation and narrowing of pyloric canal, mushroom sign, gastric distension with fluid and beak sign. Ultrasound was performed in 9 patients, one of them was false negative (sonographer admitted that he had no experience), the rest were positive. Conclusions. If the physical examination is negative or equivocal, sonography by an experienced sonographer must be performed. If the ultrasound finding is negative, than the infant should undergo to barium upper gastrointestinal studies (UGI). If HPS isn't a primary diagnostic question, it's better to perform UGI first in order to make a correct diagnosis. (author)

  9. Debriefing after Human Patient Simulation and Nursing Students' Learning

    Benhuri, Gloria

    2014-01-01

    Human Patient Simulation (HPS) exercises with life-like computerized manikins provide clinical experiences for nursing students in a safe environment followed by debriefing that promotes learning. Quantitative research in techniques to support learning from debriefing is limited. The purpose of the quantitative quasi-experimental study using a…

  10. The HPS experiment at JLab

    De Napoli Marzio

    2017-01-01

    Full Text Available Many Beyond-Standard-Model theories predict a new massive gauge boson, such as a “dark” or “heavy photon”. The heavy photon is expected to mix with the Standard Model photon through kinetic mixing and therefore have a small coupling to electric charge. The Heavy Photon Search (HPS experiment is searching for a heavy photon at the Thomas Jefferson National Accelerator Facility (JLab, in the mass range 20-500 MeV/c2. In particular HPS looks for the e+e− decay channel of heavy photons radiated by electron Bremsstrahlung, employing both an invariant mass search and detached vertexing techniques. The experiment employs a compact forward spectrometer comprising silicon microstrip detectors for vertexing and tracking and an electromagnetic calorimeter for particle identification and triggering. HPS took data successfully in 2015 and 2016 at 1.05 GeV and 2.3 GeV beam energies, respectively. First results are expected to be presented soon.

  11. The effect of human patient simulation on critical thinking and its predictors in prelicensure nursing students.

    Shinnick, Mary Ann; Woo, Mary A

    2013-09-01

    Human patient simulation (HPS) is becoming a popular teaching method in nursing education globally and is believed to enhance both knowledge and critical thinking. While there is evidence that HPS improves knowledge, there is no objective nursing data to support HPS impact on critical thinking. Therefore, we studied knowledge and critical thinking before and after HPS in prelicensure nursing students and attempted to identify the predictors of higher critical thinking scores. Using a one-group, quasi-experimental, pre-test post-test design, 154 prelicensure nursing students (age 25.7± 6.7; gender=87.7% female) from 3 schools were studied at the same point in their curriculum using a high-fidelity simulation. Pre- and post-HPS assessments of knowledge, critical thinking, and self-efficacy were done as well as assessments for demographics and learning style. There was a mean improvement in knowledge scores of 6.5 points (Pcritical thinking scores. A logistic regression with 10 covariates revealed three variables to be predictors of higher critical thinking scores: greater "age" (P=0.01), baseline "knowledge" (P=0.04) and a low self-efficacy score ("not at all confident") in "baseline self-efficacy in managing a patient's fluid levels" (P=.05). This study reveals that gains in knowledge with HPS do not equate to changes in critical thinking. It does expose the variables of older age, higher baseline knowledge and low self-efficacy in "managing a patient's fluid levels" as being predictive of higher critical thinking ability. Further study is warranted to determine the effect of repeated or sequential simulations (dosing) and timing after the HPS experience on critical thinking gains. Copyright © 2012 Elsevier Ltd. All rights reserved.

  12. Pulse contour analysis of arterial waveform in a high fidelity human patient simulator.

    Persona, Paolo; Saraceni, Elisabetta; Facchin, Francesca; Petranzan, Enrico; Parotto, Matteo; Baratto, Fabio; Ori, Carlo; Rossi, Sandra

    2017-10-03

    The measurement of cardiac output (CO) may be useful to improve the assessment of hemodynamics during simulated scenarios. The purpose of this study was to evaluate the feasibility of introducing an uncalibrated pulse contour device (MostCare, Vytech, Vygon, Padova, Italy) into the simulation environment. MostCare device was plugged to a clinical monitor and connected to the METI human patient simulator (HPS) to obtain a continuous arterial waveform analysis and CO calculation. In six different simulated clinical scenarios (baseline, ventricular failure, vasoplegic shock, hypertensive crisis, hypovolemic shock and aortic stenosis), the HPS-CO and the MostCare-CO were simultaneously recorded. The level of concordance between the two methods was assessed by the Bland and Altman analysis. 150-paired CO values were obtained. The HPS-CO values ranged from 2.3 to 6.6 L min -1 and the MostCare-CO values from 2.8 to 6.4 L min -1 . The mean difference between HPS-CO and MostCare-CO was - 0.3 L min -1 and the limits of agreement were - 1.5 and 0.9 L min -1 . The percentage of error was 23%. A good correlation between HPS-CO and MostCare-CO was observed in each scenario of the study (r = 0.88). Although MostCare-CO tended to underestimate the CO over the study period, good agreements were found between the two methods. Therefore, a pulse contour device can be integrated into the simulation environment, offering the opportunity to create new simulated clinical settings.

  13. Could HPS Improve Problem-Solving?

    Coelho, Ricardo Lopes

    2013-05-01

    It is generally accepted nowadays that History and Philosophy of Science (HPS) is useful in understanding scientific concepts, theories and even some experiments. Problem-solving strategies are a significant topic, since students' careers depend on their skill to solve problems. These are the reasons for addressing the question of whether problem solving could be improved by means of HPS. Three typical problems in introductory courses of mechanics—the inclined plane, the simple pendulum and the Atwood machine—are taken as the object of the present study. The solving strategies of these problems in the eighteenth and nineteenth century constitute the historical component of the study. Its philosophical component stems from the foundations of mechanics research literature. The use of HPS leads us to see those problems in a different way. These different ways can be tested, for which experiments are proposed. The traditional solving strategies for the incline and pendulum problems are adequate for some situations but not in general. The recourse to apparent weights in the Atwood machine problem leads us to a new insight and a solving strategy for composed Atwood machines. Educational implications also concern the development of logical thinking by means of the variety of lines of thought provided by HPS.

  14. The Effect of Learning Styles, Critical Thinking Disposition, and Critical Thinking on Clinical Judgment in Senior Baccalaureate Nursing Students during Human Patient Simulation

    McCormick, Kiyan

    2014-01-01

    Simulated learning experiences using high-fidelity human patient simulators (HPS) are increasingly being integrated into baccalaureate nursing programs. Thus, the purpose of this study was to examine relationships among learning style, critical thinking disposition, critical thinking, and clinical judgment during high-fidelity human patient…

  15. High degree of realism in teaching percutaneous coronary interventions by combining a virtual reality trainer with a full scale patient simulator.

    Schuetz, Michael; Moenk, Stefan; Vollmer, Jochen; Kurz, Sandra; Mollnau, Hanke; Post, Felix; Heinrichs, Wolfgang

    2008-01-01

    The virtual reality coronary angiography simulator "CATHI" (Catheter Instruction System, Mannheim, Germany) simulates coronary arteries with implemented vessel lesions in virtual patients. Like similar systems the software model runs on common PC systems, which are linked to the mechanical device for manual training. We combined the advantages of this skill trainer with the near to reality assembly of a cardiac catheterization laboratory (Cath-lab) by connecting it to a full scale simulator (HPS, METI, Sarasota, FL). We present two methods of synchronizing the heartbeat between both simulation devices. Method A-the hardware solution-uses the electrocardiogram-synchronization signal of the HPS as a pacemaker for CATHI's heartbeat. Method B, a more sophisticated software solution, uses a communication protocol between the HPS software and the CATHI system to realize bi-directional data exchange. In 14 identical courses we performed four different scenarios using the above described setup, all of which had to be undergone by the 143 participants (including nursing staff, experienced- and inexperienced cardiologists). The synchronization of the two systems contributed to a close to reality situation. Scenario control was accomplished via commercially available HPS-software. Tachycardic and bradycardic arrhythmias were predetermined by predefined scenarios of the HPS-software, the trainee's intervention resulting in realistic treatment outcomes. Using either method, the transmitted signals resulted in the same heartbeat in the CATHI-system, making the cardiologic interventions more difficult but more realistic.

  16. HPS instrument calibration laboratory accreditation program

    Masse, F.X; Eisenhower, E.H.; Swinth, K.L.

    1993-12-31

    The purpose of this paper is to provide an accurate overview of the development and structure of the program established by the Health Physics Society (HPS) for accrediting instrument calibration laboratories relative to their ability to accurately calibrate portable health physics instrumentation. The purpose of the program is to provide radiation protection professionals more meaningful direct and indirect access to the National Institute of Standards and Technology (NIST) national standards, thus introducing a means for improving the uniformity, accuracy, and quality of ionizing radiation field measurements. The process is designed to recognize and document the continuing capability of each accredited laboratory to accurately perform instrument calibration. There is no intent to monitor the laboratory to the extent that each calibration can be guaranteed by the program; this responsibility rests solely with the accredited laboratory.

  17. USU Patient Simulation Center

    Federal Laboratory Consortium — he National Capital Area (NCA) Medical Simulation Center is a state-of-the-art training facility located near the main USU campus. It uses simulated patients (i.e.,...

  18. Generation of Hermansky Pudlak syndrome type 2 (HPS2 induced pluripotent stem cells (iPSCs

    Jean Ann Maguire

    2016-03-01

    Full Text Available Hermansky–Pudlak syndrome type 2 (HPS2 is a rare autosomal recessive disorder resulting from functional mutations in the adaptor-related protein complex 3, beta 1 subunit (AP3B1 gene. This gene plays a role in organelle biogenesis associated with melanosomes, platelet dense granules, and lysosomes. Here we describe the generation of an HPS2 iPS cell line (CHOPHPS2 using a Cre-excisable polycistronic STEMCCA lentivirus. This line was derived from human fibroblasts isolated from a patient carrying two mutations in the AP3B1 gene. The patient presented with severe neutropenia, ocular albinism, interstitial pulmonary fibrosis, hemorrhagic diathesis, and an absence of platelet-dense granules.

  19. Discovery of the Electronic Spectra of Hps and Dps

    Grimminger, Robert A.; Wei, Jie; Ellis, Blaine; Clouthier, Dennis J.; Wang, Zhong; Sears, Trevor

    2009-06-01

    The hitherto unknown electronic spectrum of the closed shell transient molecule HPS has been observed in the 685 - 846 nm region by laser-induced fluorescence and single vibronic level emission techniques. HPS (and DPS) were produced in a pulsed electric discharge jet using a precursor mixture of 3% PH_3 and 1% H_2S (or PD_3 and D_2S) in high pressure argon. The weak set of observed bands are assigned to the à ^1A^''-X˜ ^1A^' electronic transition on the basis of chemical evidence, isotope shifts and the correspondence of the vibrational frequencies, excitation energy, and band contours with predictions based on our own high level ab initio calculations. Theory predicts that the HPS bond angle decreases on electronic excitation, contrary to expectations based on Walsh diagrams.

  20. Degrees of reality: airway anatomy of high-fidelity human patient simulators and airway trainers.

    Schebesta, Karl; Hüpfl, Michael; Rössler, Bernhard; Ringl, Helmut; Müller, Michael P; Kimberger, Oliver

    2012-06-01

    Human patient simulators and airway training manikins are widely used to train airway management skills to medical professionals. Furthermore, these patient simulators are employed as standardized "patients" to evaluate airway devices. However, little is known about how realistic these patient simulators and airway-training manikins really are. This trial aimed to evaluate the upper airway anatomy of four high-fidelity patient simulators and two airway trainers in comparison with actual patients by means of radiographic measurements. The volume of the pharyngeal airspace was the primary outcome parameter. Computed tomography scans of 20 adult trauma patients without head or neck injuries were compared with computed tomography scans of four high-fidelity patient simulators and two airway trainers. By using 14 predefined distances, two cross-sectional areas and three volume parameters of the upper airway, the manikins' similarity to a human patient was assessed. The pharyngeal airspace of all manikins differed significantly from the patients' pharyngeal airspace. The HPS Human Patient Simulator (METI®, Sarasota, FL) was the most realistic high-fidelity patient simulator (6/19 [32%] of all parameters were within the 95% CI of human airway measurements). The airway anatomy of four high-fidelity patient simulators and two airway trainers does not reflect the upper airway anatomy of actual patients. This finding may impact airway training and confound comparative airway device studies.

  1. Activities of HPS standards committee in environmental remediation

    Stencel, J.R.

    1994-01-01

    The Health Physics Society (HPS) develops American National Standards in the area of radiation protection using methods approved by the American National Standards Institute (ANSI). Two of its sections, Environmental Health Physics and Contamination Limits, have ongoing standards development which are important to some environmental remediation efforts. This paper describes the role of the HPS standards process and indicates particular standards under development which will be of interest to the reader. In addition, the authors solicit readers to participate in the voluntary standards process by either joining active working groups (WG) or suggesting appropriate and relevant topics which should be placed into the standards process

  2. Searching for heavy photons in the HPS Experiment

    Uemura, Sho [SLAC National Accelerator Lab., Menlo Park, CA (United States)

    2016-11-01

    The Heavy Photon Search (HPS) is a new experiment at Jefferson Lab that searches for a massive U(1) vector boson (known as a heavy photon or A′) in the MeV-GeV mass range and coupling weakly to ordinary matter through a kinetic mixing interaction. The HPS experiment seeks to produce heavy photons by electron bremsstrahlung on a fixed target, is sensitive to heavy photon decays to e+e-, and targets the range in heavy photon mass m_A' ~ 20 - 600 MeV, and kinetic mixing strength epsilon^2 ~ 10^-5 - 10^−10. HPS searches for heavy photons using two signatures: a narrow mass resonance and displaced vertices. This dissertation presents the theoretical and experimental motivations for a heavy photon, the design and operation of the HPS experiment, and the displaced vertex search. The data used in this dissertation is the unblinded fraction of the 2015 HPS run, for the period of operation where the HPS silicon vertex tracker (SVT) was operated at its nominal position. This data was recorded from May 13 to May 18, 2015, at a beam energy of 1.056 GeV and a nominal beam current of 50 nA. The integrated luminosity is 119 nb^-1, which is equivalent to 0.172 days of ideal running at the nominal beam current. This dissertation presents results (signal significance and upper limits) from the displaced vertex search in the mass range m_A' ~ 20 - 60 MeV, and kinetic mixing strength epsilon^2 ~ 2 × 10^-8 - 10^-10. This search does not have sufficient sensitivity to exclude a canonical heavy photon at any combination of m_A' and epsilon^2. The strictest limit achieved in this analysis on the production of a particle that decays like a heavy photon is 115 times the expected production cross-section for a heavy photon. Factors limiting the sensitivity of this analysis are discussed. Projections of HPSperformance with the full 2015 data set, and with planned improvements to theanalysis, are presented. Comparisons are also made to earlier reach estimates.

  3. CDE Perspectives of Providing New-Onset Type 1 Diabetes Education Using Formal Vignettes and Simulation.

    Ramchandani, Neesha; Johnson, Kim; Cullen, Karen; Hamm, Terri; Bisordi, Jean; Sullivan-Bolyai, Susan

    2017-02-01

    Purpose The purpose of this article is to describe the 4 Parent Education Through Simulation-Diabetes (PETS-D) nurse certified diabetes educators' (CDEs) perspectives of teaching parents of children with newly diagnosed type 1 diabetes mellitus (T1DM) early diabetes management skills using formal vignettes and a human patient simulator/human patient simulation (HPS) to augment/enhance the teaching-learning process. Methods A qualitative descriptive approach was used. Four CDEs were interviewed by phone about their teaching experiences. Meticulous notes were taken. Data were analyzed using qualitative content analysis. Results The vignettes (and use of HPS) provided structure, especially for parents who were struggling to learn. Certified diabetes educators described a short learning curve to master the use of the HPS manikin. Human patient simulation-enhanced education was described as helpful for teaching multiple caregivers about diabetes. Certified diabetes educators also described factors that affect parent learning, mechanical issues with the HPS, and additional space requirements for HPS-enhanced education. Conclusion Vignettes and HPS-enhanced education can successfully be used to educate parents of children with new-onset T1DM and were preferred by the CDEs when compared with previous teaching strategies. The results of this study support the use of both vignette-based and HPS-enhanced education when a child is newly diagnosed with T1DM. Further studies need to be done to see if these effects persist with different populations, during different stages of the disease, and for individuals with other chronic illnesses.

  4. Large Scale Deployment of Electric Vehicles (EVs) and Heat Pumps (HPs) in the Nordic Region

    Liu, Zhaoxi; Wu, Qiuwei; Petersen, Pauli Fríðheim

    This report describes the study results of large scale deployment of electric vehicles (EVs) and heat pumps (HPs) in the Nordic countries of Denmark, Norway, Sweden and Finland, focusing on the demand profiles with high peneration of EVs and HPs in 2050......This report describes the study results of large scale deployment of electric vehicles (EVs) and heat pumps (HPs) in the Nordic countries of Denmark, Norway, Sweden and Finland, focusing on the demand profiles with high peneration of EVs and HPs in 2050...

  5. Patient-specific surgical simulation.

    Soler, Luc; Marescaux, Jacques

    2008-02-01

    Technological innovations of the twentieth century have provided medicine and surgery with new tools for education and therapy definition. Thus, by combining Medical Imaging and Virtual Reality, patient-specific applications providing preoperative surgical simulation have become possible.

  6. Cohort study comparing prostate photovaporisation with XPS 180W and HPS 120W laser.

    López, B; Capitán, C; Hernández, V; de la Peña, E; Jiménez-Valladolid, I; Guijarro, A; Pérez-Fernández, E; Llorente, C

    2016-01-01

    Prostate photovaporisation with Greenlight laser for the surgical treatment of benign prostate hyperplasia has rapidly evolve to the new XPS 180W. We have previously demonstrated the safety and efficacy of the HPS 120W. The aim of this study was to assess the functional and safety results, with a year of follow-up, of photovaporisation using the XPS 180W laser compared with its predecessor. A cohort study was conducted with a series of 191 consecutive patients who underwent photovaporisation between 1/2008 and 5/2013. The inclusion criteria were an international prostate symptom score (IPSS) >15 after medical failure, a prostate volume <80 cm(3) and a maximum flow <15 mL/s. We assessed preoperative and intraoperative variables (energy used, laser time and total surgical time), complications, catheter hours, length of stay and functional results (maximum flow, IPSS, prostate-specific antigen and prostate volume) at 3, 6 and 12 months. We analysed the homogeneity in preoperative characteristics of the 2 groups through univariate analysis techniques. The postoperative functional results were assessed through an analysis of variance of repeated measures with mixed models. A total of 109 (57.1%) procedures were performed using HPS 120W, and 82 (42.9%) were performed using XPS. There were no differences between the preoperative characteristics. We observed significant differences both in the surgical time and effective laser time in favour of the XPS system. This advantage was 11% (48 ± 15.7 vs. 53.8 ± 16.2, p<.05) and 9% (32.8 ± 11.7 vs. 36 ± 11.6, p<.05), respectively. There were no statistically significant differences in the rest of the analysed parameters. The technical improvements in the XPS 180W system help reduce surgical time, maintaining the safety and efficacy profile offered by the HPS 120W system, with completely superimposable results at 1 year of follow-up. Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Rabbit Model for Human EBV-Associated Hemophagocytic Syndrome (HPS)

    Hayashi, Kazuhiko; Jin, Zaishun; Onoda, Sachiyo; Joko, Hiromasa; Teramoto, Norihiro; Ohara, Nobuya; Oda, Wakako; Tanaka, Takehiro; Liu, Yi-Xuan; Koirala, Tirtha Raj; Oka, Takashi; Kondo, Eisaku; Yoshino, Tadashi; Takahashi, Kiyoshi; Akagi, Tadaatsu

    2003-01-01

    Epstein-Barr virus-associated hemophagocytic syndrome (EBV-AHS) is often associated with fatal infectious mononucleosis or T-cell lymphoproliferative diseases (LPD). To elucidate the true nature of fatal LPD observed in Herpesvirus papio (HVP)-induced rabbit hemophagocytosis, reactive or neoplastic, we analyzed sequential development of HVP-induced rabbit LPD and their cell lines. All of the seven Japanese White rabbits inoculated intravenously with HVP died of fatal LPD 18 to 27 days after inoculation. LPD was also accompanied by hemophagocytic syndrome (HPS) in five of these seven rabbits. Sequential autopsy revealed splenomegaly and swollen lymph nodes, often accompanied by bleeding, which developed in the last week. Atypical lymphoid cells infiltrated many organs with a “starry sky” pattern, frequently involving the spleen, lymph nodes, and liver. HVP-small RNA-1 expression in these lymphoid cells was clearly demonstrated by a newly developed in situ hybridization (ISH) system. HVP-ISH of immunomagnetically purified lymphoid cells from spleen or lymph nodes revealed HVP-EBER1+ cells in each CD4+, CD8+, or CD79a+ fraction. Hemophagocytic histiocytosis was observed in the lymph nodes, spleen, bone marrow, and thymus. HVP-DNA was detected in the tissues and peripheral blood from the infected rabbits by PCR or Southern blot analysis. Clonality analysis of HVP-induced LPD by Southern blotting with TCR gene probe revealed polyclonal bands, suggesting polyclonal proliferation. Six IL-2-dependent rabbit T-cell lines were established from transplanted scid mouse tumors from LPD. These showed latency type I/II HVP infection and had normal karyotypes except for one line, and three of them showed tumorigenicity in nude mice. These data suggest that HVP-induced fatal LPD in rabbits is reactive polyclonally in nature. PMID:12707056

  8. Alveolar type II epithelial cell dysfunction in rat experimental hepatopulmonary syndrome (HPS.

    Wenli Yang

    Full Text Available The hepatopulmonary syndrome (HPS develops when pulmonary vasodilatation leads to abnormal gas exchange. However, in human HPS, restrictive ventilatory defects are also observed supporting that the alveolar epithelial compartment may also be affected. Alveolar type II epithelial cells (AT2 play a critical role in maintaining the alveolar compartment by producing four surfactant proteins (SPs, SP-A, SP-B, SP-C and SP-D which also facilitate alveolar repair following injury. However, no studies have evaluated the alveolar epithelial compartment in experimental HPS. In this study, we evaluated the alveolar epithelial compartment and particularly AT2 cells in experimental HPS induced by common bile duct ligation (CBDL. We found a significant reduction in pulmonary SP production associated with increased apoptosis in AT2 cells after CBDL relative to controls. Lung morphology showed decreased mean alveolar chord length and lung volumes in CBDL animals that were not seen in control models supporting a selective reduction of alveolar airspace. Furthermore, we found that administration of TNF-α, the bile acid, chenodeoxycholic acid, and FXR nuclear receptor activation (GW4064 induced apoptosis and impaired SP-B and SP-C production in alveolar epithelial cells in vitro. These results imply that AT2 cell dysfunction occurs in experimental HPS and is associated with alterations in the alveolar epithelial compartment. Our findings support a novel contributing mechanism in experimental HPS that may be relevant to humans and a potential therapeutic target.

  9. Optimal Operation of EVs and HPs in the Nordic Power System

    Liu, Zhaoxi

    penetration level in the market environment. • The feasibility investigation of EVs and HPs to provide frequency reserves to the Nordic power system. To accomplish the researches mentioned above, the driving patterns of the vehicles in the Nordic region and the impacts of the EV and HP demand on the day...... that both EVs and HPs can provide considerable frequency reserves to the power system along the day in the Nordic region. Vehicle-to-Grid (V2G) technologies which enable the EVs to discharge the batteries in the reserve operations can further utilize the capacity of the EVs and consequently increase...

  10. The Role of the Endothelium in HPS Pathogenesis and Potential Therapeutic Approaches

    Irina Gavrilovskaya

    2012-01-01

    Full Text Available American hantaviruses cause a highly lethal acute pulmonary edema termed hantavirus pulmonary syndrome (HPS. Hantaviruses nonlytically infect endothelial cells and cause dramatic changes in barrier functions of the endothelium without disrupting the endothelium. Instead hantaviruses cause changes in the function of infected endothelial cells that normally regulate fluid barrier functions of capillaries. The endothelium of arteries, veins, and lymphatic vessels is unique and central to the function of vast pulmonary capillary beds, which regulate pulmonary fluid accumulation. The endothelium maintains vascular barrier functions through a complex series of redundant receptors and signaling pathways that serve to both permit fluid and immune cell efflux into tissues and restrict tissue edema. Infection of the endothelium provides several mechanisms for hantaviruses to alter capillary permeability but also defines potential therapeutic targets for regulating acute pulmonary edema and HPS disease. Here we discuss interactions of HPS causing hantaviruses with the endothelium, potential endothelial cell-directed permeability mechanisms, and therapeutic targeting of the endothelium as a means of reducing the severity of HPS disease.

  11. Superplasticity of Inconel 718 after processing by high-pressure sliding (HPS)

    Takizawa, Y.; Kajita, T.; Král, Petr; Masuda, T.; Watanabe, K.; Yumoto, M.; Otagiri, Y.; Sklenička, Václav; Horita, Z.

    2017-01-01

    Roč. 682, JAN (2017), s. 603-612 ISSN 0921-5093 Institutional support: RVO:68081723 Keywords : High-pressure sliding (HPS) * Severe plastic deformation (SPD) * Ni-based superalloy * Superplasticity * Grain boundary sliding * Lattice diffusion Subject RIV: JG - Metallurgy OBOR OECD: Materials engineering Impact factor: 3.094, year: 2016

  12. Transanal anopexy with HemorPex System (HPS) is effective in treating grade II and III hemorrhoids: medium-term follow-up.

    Basile, M; Di Resta, V; Ranieri, E

    2016-06-01

    Hemorrhoidal disease is a common proctologic disorder. The HemorPex System(®) (HPS) (Angiologica, S. Martino Siccomario PV, Italy) is an innovative surgical technique based on muco-hemorrhoidopexy without Doppler guidance. The aim of this study was to evaluate the efficacy of HPS in on the treatment of grade II and III hemorrhoids. One hundred patients with grade II and III hemorrhoidal disease were included in the study and operated on using HPS without Doppler guidance. The procedure consists of a mucopexy carried out by means of a dedicated rotating anoscope in the 6 relatively constant positions of the terminal branches of the superior hemorrhoidal artery. A direct follow-up was carried out on 100 patients for up to 3 months. A late analysis (>12 months postoperatively) was conducted by telephone interview. At follow-up the following parameters were considered: pain, bleeding, prolapse, difficulties with hygiene and patient satisfaction with treatment. Operative time was 16 ± 5 min. Three-month follow-up showed significant improvement of symptoms: pain was present in 10 (10 %) patients versus 45 (45 %) preoperatively; bleeding in 13 (13 %) of patients versus 57 (57 %) preoperatively; prolapse in 13 (13 %) of patients versus 45 (45 %) preoperatively and difficulties with hygiene in 1 (1 %) versus 24 (24 %) preoperatively (all p hemorrhoidal disease. Our results show that this simple technique may be an effective but due to the important limitations of this study (loss to follow-up, non-comparative study) further studies are required.

  13. Impact of an Aging Simulation Game on Pharmacy Students’ Empathy for Older Adults

    Kiersma, Mary E.; Yehle, Karen S.; Plake, Kimberly S.

    2015-01-01

    Objective. To evaluate changes in empathy and perceptions as well as game experiences among student pharmacists participating in an aging simulation game. Methods. First-year student pharmacists participated in an aging simulation game. Changes were measured pre/post-activity using the Kiersma-Chen Empathy Scale (KCES) and Jefferson Scale of Empathy – Health Professions Scale (JSE-HPS) for empathy and the Aging Simulation Experience Survey (ASES) for perceptions of older adults’ experiences and game experiences. Wilcoxon signed rank tests were used to determine changes. Results. One hundred fifty-six student pharmacists completed the instruments. Empathy using the KCES and JSE-HPS improved significantly. Of the 13 items in the ASES, 9 significantly improved. Conclusion. Simulation games may help students overcome challenges demonstrating empathy and positive attitudes toward elderly patients. PMID:26396274

  14. Impact of an Aging Simulation Game on Pharmacy Students' Empathy for Older Adults.

    Chen, Aleda M H; Kiersma, Mary E; Yehle, Karen S; Plake, Kimberly S

    2015-06-25

    To evaluate changes in empathy and perceptions as well as game experiences among student pharmacists participating in an aging simulation game. First-year student pharmacists participated in an aging simulation game. Changes were measured pre/post-activity using the Kiersma-Chen Empathy Scale (KCES) and Jefferson Scale of Empathy--Health Professions Scale (JSE-HPS) for empathy and the Aging Simulation Experience Survey (ASES) for perceptions of older adults' experiences and game experiences. Wilcoxon signed rank tests were used to determine changes. One hundred fifty-six student pharmacists completed the instruments. Empathy using the KCES and JSE-HPS improved significantly. Of the 13 items in the ASES, 9 significantly improved. Simulation games may help students overcome challenges demonstrating empathy and positive attitudes toward elderly patients.

  15. A two-year experience of an integrated simulation residency curriculum.

    Wittels, Kathleen A; Takayesu, James K; Nadel, Eric S

    2012-07-01

    Human Patient Simulation (HPS) is increasingly used in medical education, but its role in Emergency Medicine (EM) residency education is uncertain. The objective of this study was to evaluate the perceived effectiveness of HPS when fully integrated into an EM residency didactic curriculum. The study design was a cross-sectional survey performed in 2006, 2 years after the implementation of an integrated simulation curriculum. Fifty-four residents (postgraduate year [PGY] 1-4) of a 4-year EM residency were surveyed with demographic and curricular questions on the perceived value of simulation relative to other teaching formats. Survey items were rated on a bipolar linear numeric scale of 1 (strongly disagree) to 9 (strongly agree), with 5 being neutral. Data were analyzed using Student t-tests. Forty residents responded to the survey (74% response rate). The perceived effectiveness of HPS was higher for junior residents than senior residents (8.0 vs. 6.2, respectively, peffectiveness of lectures (7.8 vs. 7.9, respectively, p=0.1), morbidity and mortality conference (8.5 vs. 8.7, respectively, p=0.3), and trauma conference (8.4 vs. 8.8, respectively, p=0.2) between junior and senior residents. Scores for perceptions of improvement in residency training (knowledge acquisition and clinical decision-making) after the integration of HPS into the curriculum were positive for all residents. Residents' perceptions of HPS integration into an EM residency curriculum are positive for both improving knowledge acquisition and learning clinical decision-making. HPS was rated as more effective during junior years than senior years, while the perceived efficacy of more traditional educational modalities remained constant throughout residency training. Copyright © 2012. Published by Elsevier Inc.

  16. Towards a personalised virtual diabetic patient simulator

    Maas, A.H.; Tani, G.; Pul, van C.; Beijerinck, H.C.W.; Cottaar, E.J.E.; Haak, H.R.; Riel, van N.A.W.

    2012-01-01

    The development of a diabetes simulator, an educational software tool which can help diabetic patients to better manage their disease, is described. Education of patients with diabetes mellitus is a fundamental part of diabetes care. One of the goals of diabetes education is to support the patients

  17. Application of Wireless Intelligent Control System for HPS Lamps and LEDs Combined Illumination in Road Tunnel

    Lai, Jinxing; Qiu, Junling; Chen, Jianxun; Wang, Yaqiong; Fan, Haobo

    2014-01-01

    Because of the particularity of the environment in the tunnel, the rational tunnel illumination system should be developed, so as to optimize the tunnel environment. Considering the high cost of traditional tunnel illumination system with high-pressure sodium (HPS) lamps as well as the effect of a single light source on tunnel entrance, the energy-saving illumination system with HPS lamps and LEDs combined illumination in road tunnel, which could make full use of these two kinds of lamps, was proposed. The wireless intelligent control system based on HPS lamps and LEDs combined illumination and microcontrol unit (MCU) Si1000 wireless communication technology was designed. And the remote monitoring, wireless communication, and PWM dimming module of this system were designed emphatically. Intensity detector and vehicle flow detector can be configured in wireless intelligent control system, which gather the information to the master control unit, and then the information is sent to the monitoring center through the Ethernet. The control strategies are got by the monitoring center according to the calculated results, and the control unit wirelessly sends parameters to lamps, which adjust the luminance of each segment of the tunnel and realize the wireless intelligent control of combined illumination in road tunnel. PMID:25587266

  18. Standardised patient-simulated practice learning

    Teaching strategies must link theory to practice, foster critical thinking, be relevant and stimulate ... Standardised patient-simulated practice learning: A rich pedagogical .... relationship for them to grow and develop from novice to expert. They.

  19. Sequence-Based Mapping and Genome Editing Reveal Mutations in Stickleback Hps5 Cause Oculocutaneous Albinism and the casper Phenotype

    James C. Hart

    2017-09-01

    Full Text Available Here, we present and characterize the spontaneous X-linked recessive mutation casper, which causes oculocutaneous albinism in threespine sticklebacks (Gasterosteus aculeatus. In humans, Hermansky-Pudlak syndrome results in pigmentation defects due to disrupted formation of the melanin-containing lysosomal-related organelle (LRO, the melanosome. casper mutants display not only reduced pigmentation of melanosomes in melanophores, but also reductions in the iridescent silver color from iridophores, while the yellow pigmentation from xanthophores appears unaffected. We mapped casper using high-throughput sequencing of genomic DNA from bulked casper mutants to a region of the stickleback X chromosome (chromosome 19 near the stickleback ortholog of Hermansky-Pudlak syndrome 5 (Hps5. casper mutants have an insertion of a single nucleotide in the sixth exon of Hps5, predicted to generate an early frameshift. Genome editing using CRISPR/Cas9 induced lesions in Hps5 and phenocopied the casper mutation. Injecting single or paired Hps5 guide RNAs revealed higher incidences of genomic deletions from paired guide RNAs compared to single gRNAs. Stickleback Hps5 provides a genetic system where a hemizygous locus in XY males and a diploid locus in XX females can be used to generate an easily scored visible phenotype, facilitating quantitative studies of different genome editing approaches. Lastly, we show the ability to better visualize patterns of fluorescent transgenic reporters in Hps5 mutant fish. Thus, Hps5 mutations present an opportunity to study pigmented LROs in the emerging stickleback model system, as well as a tool to aid in assaying genome editing and visualizing enhancer activity in transgenic fish.

  20. Hospital simulated patient programme: a guide.

    Barrett, Jenny; Hodgson, Jan

    2011-12-01

    Many university courses employ simulated patients to work with students in the development of communication skills. Our challenge was to build a sustainable programme that could be adapted for medical, nursing and allied health staff, and groups of students, on our hospital campus. In recognition of the need to provide practice opportunities for junior medical staff to hone their capacity to communicate effectively with parents, we employed professional actors who are also qualified teachers. Junior doctors have multiple opportunities over their training time to work one-to-one with an actor-tutor in the role of simulated parent. The simulated parents are skilled in helping the trainees reflect on the conversation, and the trainees are given a recording of their sessions for further reflection and feedback from a colleague. This model has been adapted to meet the 'topic' needs and scheduling requirements of other staff and hospital-based student groups. In adapting the original medical staff programme, we came to appreciate not only the logistical but also the ethical considerations inherent in a simulated parent/patient programme. Our guide highlights the importance of safeguarding the educational integrity of the design, maintaining the fidelity of the simulations and ensuring the safety of all involved. © Blackwell Publishing Ltd 2011.

  1. Prevalence and severity of hepatopulmonary syndrome and its influence on survival in cirrhotic patients evaluated for liver transplantation.

    Pascasio, J M; Grilo, I; López-Pardo, F J; Ortega-Ruiz, F; Tirado, J L; Sousa, J M; Rodriguez-Puras, M J; Ferrer, M T; Sayago, M; Gómez-Bravo, M A; Grilo, A

    2014-06-01

    The prevalence of hepatopulmonary syndrome (HPS) and its influence on survival before and after liver transplantation (LT) remain controversial. Additionally, the chronology of post-LT reversibility is unclear. This study prospectively analyzed 316 patients with cirrhosis who were evaluated for LT in 2002-2007; 177 underwent LT at a single reference hospital. HPS was defined by a partial pressure of arterial oxygen (PaO2 ) position and positive contrast echocardiography. The prevalence of HPS was 25.6% (81/316 patients), and most patients (92.6%) had mild or moderate HPS. High Child-Pugh scores and the presence of ascites were independently associated with HPS. Patients with and without HPS did not significantly differ in LT waiting list survival (mean 34.6 months vs. 41.6 months, respectively; log-rank, p = 0.13) or post-LT survival (mean 45 months vs. 47.6 months, respectively; log-rank, p = 0.62). HPS was reversed in all cases within 1 year after LT. One-fourth of the patients with cirrhosis who were evaluated for LT had HPS (mostly mild to moderate); the presence of HPS did not affect LT waiting list survival. HPS was always reversed after LT, and patient prognosis did not worsen. © Copyright 2014 The American Society of Transplantation and the American Society of Transplant Surgeons.

  2. Techniques and training with GreenLight HPS120-W laser therapy of the prostate: Position paper

    Muir, Gordon; Gomez Sancha, Fernando; Bachmann, Alexander; Choi, Benjamin; Collins, Edward; de la Rosette, Jean; Reich, Oliver; Tabatabaei, Shahin; Woo, Henry

    2008-01-01

    We report the technical recommendations of the International GreenLight User Group on photoselective vaporization of the prostate in men with benign prostatic hyperplasia using the GreenLight HPS system (American Medical Systems, Minnetonka, Minnesota, USA). This high-power system employs a 120-W

  3. HPS: A space fission power system suitable for near-term, low-cost lunar and planetary bases

    Houts, M.G.; Poston, D.I.; Ranken, W.A.

    1996-01-01

    Near-term, low-cost space fission power systems can enhance the feasibility and utility of lunar and planetary bases. One such system, the Heatpipe Power System (HPS), is described in this paper. The HPS draws on 40 yr of United States and international experience to enable a system that can be developed in <5 yr at a cost of <$100M. Total HPS mass is <600 kg at 5 kWe and <2000 kg at 50 kWe, assuming that thermoelectric power conversion is used. More advanced power conversion systems could reduce system mass significantly. System mass for planetary surface systems also may be reduced (1) if indigenous material is used for radiation shielding and (2) because of the positive effect of the gravitational field on heatpipe operation. The HPS is virtually non-radioactive at launch and is passively subcritical during all credible launch accidents. Full-system electrically heated testing is possible, and a ground nuclear power test is not needed for flight qualification. Fuel burnup limits are not reached for several decades, thus giving the system long-life potential

  4. Airway skills training using a human patient simulator | Moodley ...

    ... of airway management skills using the simulator. Participant satisfaction was much better in the simulator group. The importance of psychomotor reinforcement should be borne in mind when designing simulation courses. Keywords: human patient simulator, simulation, airway management, psychomotor skills ...

  5. Mini Combat Trauma Patient Simulation System Defense Acquisition Challenge Program (DACP): Mini Combat Trauma Patient Simulation (Mini CTPS)

    2004-01-01

    .... It consists of networked realistic casualty generators, patient simulators and computer-based casualty simulations, virtual patients and equipment, data and sensor recorders, and an After- Action Review System...

  6. Hermansky-Pudlak syndrome in a pregnant patient: a case report.

    Harris-Glocker, Miranda; Thornburg, Loralei L; Pressman, Eva K

    2013-01-01

    Hermansky-Pudlak syndrome (HPS), a rare autosomal-recessive disorder encompassing multiple organs, is characterized by oculocutaneous albinism, platelet storage pool deficiency resulting in bleeding diathesis, and ceroid lipofuscin deposition which can lead to pulmonary fibrosis, colitis, cardiomyopathy and renal failure. Pregnancy in a patient with HPS can produce multiple complications such as peripartum hemorrhage and difficulties with administration of anesthesia, either regional or general. We present the case of a patient with HPS also complicated by spontaneous triplet pregnancy. A multidisciplinary approach, including the involvement of obstetric, anesthesia, and hematology teams, is the ideal for an HPS patient with the potential for multiple complications in the peripartum period.

  7. Virtual simulation. First clinical results in patients with prostate cancer

    Buchali, A.; Dinges, S.; Koswig, S.; Rosenthal, P.; Salk, S.; Harder, C.; Schlenger, L.; Budach, V.

    1998-01-01

    Investigation of options of virtual simulation in patients with localized prostate cancer. Twenty-four patients suffering from prostate cancer were virtual simulated. The clinical target volume was contoured and the planning target volume was defined after CT scan. The isocenter of the planning target volume was determined and marked at patient's skin. The precision of patients marking was controlled with conventional simulation after physical radiation treatment planning. Mean differences of the patient's mark revealed between the 2 simulations in all room axes around 1 mm. The organs at risk were visualized in the digital reconstructed radiographs. The precise patient's mark of the isocentre by virtual simulation allows to skip the conventional simulation. The visualisation of organs at risk leeds to an unnecessarity of an application of contrast medium and to a further relieve of the patient. The personal requirement is not higher in virtual simulation than in conventional CT based radiation treatment planning. (orig./MG) [de

  8. Passive Flora? Reconsidering Nature’s Agency through Human-Plant Studies (HPS

    John Charles Ryan

    2012-08-01

    Full Text Available Plants have been—and, for reasons of human sustenance and creative inspiration, will continue to be—centrally important to societies globally. Yet, plants—including herbs, shrubs, and trees—are commonly characterized in Western thought as passive, sessile, and silent automatons lacking a brain, as accessories or backdrops to human affairs. Paradoxically, the qualities considered absent in plants are those employed by biologists to argue for intelligence in animals. Yet an emerging body of research in the sciences and humanities challenges animal-centred biases in determining consciousness, intelligence, volition, and complex communication capacities amongst living beings. In light of recent theoretical developments in our understandings of plants, this article proposes an interdisciplinary framework for researching flora: human-plant studies (HPS. Building upon the conceptual formations of the humanities, social sciences, and plant sciences as advanced by Val Plumwood, Deborah Bird Rose, Libby Robin, and most importantly Matthew Hall and Anthony Trewavas, as well as precedents in the emerging areas of human-animal studies (HAS, I will sketch the conceptual basis for the further consideration and exploration of this interdisciplinary framework.

  9. Investigation of high pressure steaming (HPS) as a thermal treatment for lipid extraction from Chlorella vulgaris.

    Aguirre, Ana-Maria; Bassi, Amarjeet

    2014-07-01

    Biofuels from algae are considered a technically viable energy source that overcomes several of the problems present in previous generations of biofuels. In this research high pressure steaming (HPS) was studied as a hydrothermal pre-treatment for extraction of lipids from Chlorella vulgaris, and analysis by response surface methodology allowed finding operational points in terms of target temperature and algae concentration for high lipid and glucose yields. Within the range covered by these experiments the best conditions for high bio-crude yield are temperatures higher than 174°C and low biomass concentrations (<5 g/L). For high glucose yield there are two suitable operational ranges, either low temperatures (<105°C) and low biomass concentrations (<4 g/L); or low temperatures (<105°C) and high biomass concentrations (<110 g/L). High pressure steaming is a good hydrothermal treatment for lipid recovery and does not significantly change the fatty acids profile for the range of temperatures studied. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. Using a simulated patient to transfer patient-centred skills from simulated practice to real patients in practice

    Yolinda Uys

    2014-11-01

    Conclusion: Using a simulated patient to teach administration of an intramuscular injection enhanced students’ patient-centredness when performing the procedure in practice. Recommendations include making use of a bigger sample and including a pre-test the next time research of this nature is carried out.

  11. Airway skills training using a human patient simulator

    Thesegan Moodley

    2016-04-11

    Apr 11, 2016 ... Airway management problems may be particularly challenging to junior doctors.1 ... They respond to real-time, real-life clinical ... Keywords: human patient simulator, simulation, airway management, psychomotor skills.

  12. DNA vaccine-generated duck polyclonal antibodies as a postexposure prophylactic to prevent hantavirus pulmonary syndrome (HPS.

    Rebecca Brocato

    Full Text Available Andes virus (ANDV is the predominant cause of hantavirus pulmonary syndrome (HPS in South America and the only hantavirus known to be transmitted person-to-person. There are no vaccines, prophylactics, or therapeutics to prevent or treat this highly pathogenic disease (case-fatality 35-40%. Infection of Syrian hamsters with ANDV results in a disease that closely mimics human HPS in incubation time, symptoms of respiratory distress, and disease pathology. Here, we evaluated the feasibility of two postexposure prophylaxis strategies in the ANDV/hamster lethal disease model. First, we evaluated a natural product, human polyclonal antibody, obtained as fresh frozen plasma (FFP from a HPS survivor. Second, we used DNA vaccine technology to manufacture a polyclonal immunoglobulin-based product that could be purified from the eggs of vaccinated ducks (Anas platyrhynchos. The natural "despeciation" of the duck IgY (i.e., Fc removed results in an immunoglobulin predicted to be minimally reactogenic in humans. Administration of ≥ 5,000 neutralizing antibody units (NAU/kg of FFP-protected hamsters from lethal disease when given up to 8 days after intranasal ANDV challenge. IgY/IgYΔFc antibodies purified from the eggs of DNA-vaccinated ducks effectively neutralized ANDV in vitro as measured by plaque reduction neutralization tests (PRNT. Administration of 12,000 NAU/kg of duck egg-derived IgY/IgYΔFc protected hamsters when administered up to 8 days after intranasal challenge and 5 days after intramuscular challenge. These experiments demonstrate that convalescent FFP shows promise as a postexposure HPS prophylactic. Moreover, these data demonstrate the feasibility of using DNA vaccine technology coupled with the duck/egg system to manufacture a product that could supplement or replace FFP. The DNA vaccine-duck/egg system can be scaled as needed and obviates the necessity of using limited blood products obtained from a small number of HPS survivors. This

  13. Viral markers in patients with hemophagocytosis: A prospective study in a tertiary care hospital

    Baijayantimala Mishra

    2012-01-01

    Full Text Available Background : Hemophagocytic syndrome (HPS is a rare clinicopathological condition characterized by the activation of macrophages with prominent hemophagocytosis in bone marrow and other reticulo-endothelial systems. HPS can be familial or secondary to infections including viruses. Aim : To study the viral markers in patients with HPS. Materials and Methods : Serum samples of patients with HPS and control group were screened for anti EBV VCA IgM, and IgG, anti-Parvo B19 IgM, and anti-CMV IgM antibodies using commercially available ELISA kits and CMV and ParvoB19 DNA by polymerase chain reaction (PCR. Results and Discussion : The present prospective study reports the profile of viral markers in HPS cases from north India. Among the 14 HPS cases 43% (6/14 were positive for at least one viral marker tested, of which EBV was found to be the most prevalent (3/6: 50% followed by parvovirus B19(2/6: 33% and cytomegalovirus (1/6: 17%. Mortality was noted in 33% of virus associated HPS patients. Our study highlights the higher association of Epstein-Barr virus (EBV with HPS as compared to other viruses along with higher rate of mortality in both parvovirus B 19 and EBV associated HPS.

  14. Loss of power output and laser fibre degradation during 120 watt lithium-triborate HPS laser vaporisation of the prostate

    Hermanns, Thomas; Sulser, Tullio; Hefermehl, Lukas J.; Strebel, Daniel; Michel, Maurice-Stephan; Müntener, Michael; Meier, Alexander H.; Seifert, Hans-Helge

    2009-02-01

    It has recently been shown that laser fibre deterioration leads to a significant decrease of power output during 80 W potassium titanyl phosphate (KTP) laser vaporisation (LV) of the prostate. This decrease results in inefficient vaporisation especially towards the end of the procedure. For the new 120 W lithium-triborate (LBO) High Performance System (HPS) laser not only higher power but also changes in beam characteristics and improved fibre quality have been advertised. However, high laser power has been identified as a risk factor for laser fibre degradation. Between July and September 2008 25 laser fibres were investigated during routine 120 W LBO-LV in 20 consecutive patients. Laser beam power was measured at baseline and after the application of every 25 kJ during the LV procedure. Postoperatively, the surgeon subjectively rated the performance of the respective fibre on a scale from 1 to 4 (1 indicating perfect and 4 insufficient performance). Additionally, microscopic examination of the fibre tip was performed. Median energy applied was 212 kJ. Changes of power output were similar for all fibres. Typically, a steep decrease of power output within the first 50 kJ was followed by a continuous mild decrease until the end of the procedure. After the application of 50 kJ the median power output was 63% (58-73% interquartile range) of the baseline value. The median power output at the end of the 275 kJ-lifespan of the fibres was 42% (40-47%). The median surgeons' rating of the overall performance of the laser fibres was 2 and the median estimated final decrease of power output 60%. Some degree of degradation at the emission window was microscopically detectable in all cases after the procedure. However, even after the application of 275 kJ, these structural changes were only moderate. Minor degradation of the laser fibre was associated with a significant decrease of power output during 120 W LBO-LV. However, following an early, steep decrease, power output

  15. Standardised patient-simulated practice learning: A rich ...

    This study investigates the use of standardised patients (SPs) in a simulated patient interview as a learning strategy to bridge the theory-practice gap. Simulation helps students to develop skills such as communication, higher cognitive thinking, decision-making and problem-solving. There is evidence to support the use of ...

  16. Construction of the real patient simulator system.

    Chan, Richard; Sun, C T

    2012-05-01

    Simulation for perfusion education has been used for at least the past 25 years. The earlier models were either electronic (computer games) or fluid dynamic models and provided invaluable adjuncts to perfusion training and education. In 2009, the *North Shore-LIJ Health System at Great Neck, New York, opened an innovative "Bioskill Center" dedicated to simulated virtual reality advanced hands-on surgical training as well as perfusion simulation. Professional cardiac surgical organizations now show great interest in using simulation for training and recertification. Simulation will continue to be the direction for future perfusion training and education. This manuscript introduces a cost-effective system developed from discarded perfusion products and it is not intended to detail the actual lengthy process of its construction.

  17. Therapeutic trials for a rabbit model of EBV-associated Hemophagocytic Syndrome (HPS): effects of vidarabine or CHOP, and development of Herpesvirus papio (HVP)-negative lymphomas surrounded by HVP-infected lymphoproliferative disease.

    Hayashi, K; Joko, H; Koirala, T R; Onoda, S; Jin, Z-S; Munemasa, M; Ohara, N; Oda, W; Tanaka, T; Oka, T; Kondo, E; Yoshino, T; Takahashi, K; Yamada, M; Akagi, T

    2003-10-01

    Epstein-Barr virus-associated hemophagocytic syndrome (EBV-AHS), which is often associated with fatal infectious mononucleosis or T-cell lymphoproliferative diseases (LPD), is a distinct disease characterized by high mortality. Treatment of patients with EBV-AHS has proved challenging. To develop some therapeutic interventions for EBV-AHS, we examined the effectiveness of an antiviral agent (vidarabine) or chemotherapy (CHOP), using a rabbit model for EBV-AHS. Fourteen untreated rabbits were inoculated intravenously with cell-free virions of the EBV-like virus Herpesvirus papio (HVP). All of the rabbits died of HVP-associated (LPD) and hemophagocytic syndrome (HPS) between 21 and 31 days after inoculation. Furthermore, three HVP-infected rabbits treated with vidarabine died between days 23 and 28 after inoculation, and their clinicopathological features were no different from those of untreated rabbits, indicating that this drug is not effective at all to treat HVP-induced rabbit LPD and HPS. Three of the infected rabbits that were treated with one course, with an incomplete set of three courses, or with three full courses of CHOP treatment died of HVP-induced LPD and HPS with a bleeding tendency and/or with opportunistic infections. They died on the 26th, 62nd and 105th day after virus inoculation, respectively. CHOP treatment transiently suppressed the HVP-induced LPD and contributed to the prolonged survival time of two infected rabbits. However, it did not remove all of the HVP-infected cells from the infected rabbits, and residual HVP-infected lymphocytes caused recurrences of rabbit LPD and HPS. The most interesting finding of this experiment was observed in the infected rabbit with the longest survival time of 105 days: HVP-negative lymphomas surrounded by HVP-induced LPD developed in the larynx and ileum of this rabbit, causing an obstruction of the lumen. We concluded that these were not secondary lymphomas caused by CHOP treatment, because no suspicious

  18. Simulated patient training: Using inter-rater reliability to evaluate simulated patient consistency in nursing education.

    MacLean, Sharon; Geddes, Fiona; Kelly, Michelle; Della, Phillip

    2018-03-01

    Simulated patients (SPs) are frequently used for training nursing students in communication skills. An acknowledged benefit of using SPs is the opportunity to provide a standardized approach by which participants can demonstrate and develop communication skills. However, relatively little evidence is available on how to best facilitate and evaluate the reliability and accuracy of SPs' performances. The aim of this study is to investigate the effectiveness of an evidenced based SP training framework to ensure standardization of SPs. The training framework was employed to improve inter-rater reliability of SPs. A quasi-experimental study was employed to assess SP post-training understanding of simulation scenario parameters using inter-rater reliability agreement indices. Two phases of data collection took place. Initially a trial phase including audio-visual (AV) recordings of two undergraduate nursing students completing a simulation scenario is rated by eight SPs using the Interpersonal Communication Assessments Scale (ICAS) and Quality of Discharge Teaching Scale (QDTS). In phase 2, eight SP raters and four nursing faculty raters independently evaluated students' (N=42) communication practices using the QDTS. Intraclass correlation coefficients (ICC) were >0.80 for both stages of the study in clinical communication skills. The results support the premise that if trained appropriately, SPs have a high degree of reliability and validity to both facilitate and evaluate student performance in nurse education. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

  19. Discrete event simulation modelling of patient service management with Arena

    Guseva, Elena; Varfolomeyeva, Tatyana; Efimova, Irina; Movchan, Irina

    2018-05-01

    This paper describes the simulation modeling methodology aimed to aid in solving the practical problems of the research and analysing the complex systems. The paper gives the review of a simulation platform sand example of simulation model development with Arena 15.0 (Rockwell Automation).The provided example of the simulation model for the patient service management helps to evaluate the workload of the clinic doctors, determine the number of the general practitioners, surgeons, traumatologists and other specialized doctors required for the patient service and develop recommendations to ensure timely delivery of medical care and improve the efficiency of the clinic operation.

  20. Using Simulated Patients to Teach Clinical Nutrition.

    Carroll, J. Gregory; And Others

    1983-01-01

    "Clinical Nutrition in an Interdisciplinary Setting" is a course designed to introduce basic nutrition knowledge and concepts of nutritional assessment, counseling, and intervention in the clinical care of patients. Provides a brief course overview and descriptions of its development, use, and preliminary evaluation of the patient simulation…

  1. Increased colorectal cancer risk in first-degree relatives of patients with hyperplastic polyposis syndrome

    Boparai, K. S.; Reitsma, J. B.; Lemmens, V.; van Os, T. A. M.; Mathus-Vliegen, E. M. H.; Koornstra, J. J.; Nagengast, F. M.; van Hest, L. P.; Keller, J. J.; Dekker, E.

    2010-01-01

    Introduction Hyperplastic polyposis syndrome (HPS) is characterised by the presence of multiple colorectal hyperplastic polyps and is associated with an increased colorectal cancer (CRC) risk. For first-degree relatives of HPS patients (FDRs) this has not been adequately quantified. Reliable

  2. Increased colorectal cancer risk in first-degree relatives of patients with hyperplastic polyposis syndrome.

    Boparai, K.S.; Reitsma, J.B.; Lemmens, V.; Os, T.A. van; Mathus-Vliegen, E.M.H.; Koornstra, J.J.; Nagengast, F.M.; Hest, L.P. van; Keller, J.J.; Dekker, E. den

    2010-01-01

    INTRODUCTION: Hyperplastic polyposis syndrome (HPS) is characterised by the presence of multiple colorectal hyperplastic polyps and is associated with an increased colorectal cancer (CRC) risk. For first-degree relatives of HPS patients (FDRs) this has not been adequately quantified. Reliable

  3. Increased colorectal cancer risk in first-degree relatives of patients with hyperplastic polyposis syndrome

    Boparai, K. S.; Lemmens, V.; van Os, T. A. M.; Mathus-Vliegen, E. M. H.; Koornstra, J. J.; Nagengast, F. M.; van Hest, L. P.; Keller, J. J.; Dekker, E.; Reitsma, J.

    Introduction Hyperplastic polyposis syndrome (HPS) is characterised by the presence of multiple colorectal hyperplastic polyps and is associated with an increased colorectal cancer (CRC) risk. For first-degree relatives of HPS patients (FDRs) this has not been adequately quantified. Reliable

  4. Validity evidence and reliability of a simulated patient feedback instrument.

    Schlegel, C.; Woermann, U.; Rethans, J.J.; Vleuten, C.P.M. van der

    2012-01-01

    BACKGROUND: In the training of healthcare professionals, one of the advantages of communication training with simulated patients (SPs) is the SP's ability to provide direct feedback to students after a simulated clinical encounter. The quality of SP feedback must be monitored, especially because it

  5. An interprofessional course using human patient simulation to teach patient safety and teamwork skills.

    Vyas, Deepti; McCulloh, Russell; Dyer, Carla; Gregory, Gretchen; Higbee, Dena

    2012-05-10

    To assess the effectiveness of human patient simulation to teach patient safety, team-building skills, and the value of interprofessional collaboration to pharmacy students. Five scenarios simulating semi-urgent situations that required interprofessional collaboration were developed. Groups of 10 to 12 health professions students that included 1 to 2 pharmacy students evaluated patients while addressing patient safety hazards. Pharmacy students' scores on 8 of 30 items on a post-simulation survey of knowledge, skills, and attitudes improved over pre-simulation scores. Students' scores on 3 of 10 items on a team building and interprofessional communications survey also improved after participating in the simulation exercise. Over 90% of students reported that simulation increased their understanding of professional roles and the importance of interprofessional communication. Simulation training provided an opportunity to improve pharmacy students' ability to recognize and react to patient safety concerns and enhanced their interprofessional collaboration and communication skills.

  6. Evacuation of Bed-bound Patients-STEPS Simulations

    Madsen, Anne; Dederichs, Anne Simone

    2016-01-01

    Fires in hospitals occur, and evacuation of bed-bound patients might be necessary in case of emergency. The current study concerns the evacuation of bed-bound patients from a fire section in a hospital using hospital porters. The simulations are performed using the STEPS program. The aim...... of the study is to investigate the evacuation time of bed-bound hospital patients using different walking speeds from the literature, and the influence of the number of hospital porters on the total evacuation times of bed-bound patients. Different scenarios were carried out with varying staff......-to-patient ratios that simulate the horizontal evacuation of 40 bed-bound patients into a different fire section. It was found that the staff-to-patient-ratio affects the total evacuation times. However, the total evacuation times do not decrease linearly and a saturation effect is seen at a staff-to-patient ratio...

  7. [Doctor-Patient Communication Training in Simulated Situations: Emotions and Perceptions of Simulated Patients during Patient-Centered Conversations].

    Butollo, Maria Asisa; Holzinger, Anita; Wagner-Menghin, Michaela

    2018-04-13

    The use of simulated patients (SPs) for doctor-patient communication training has been established in medical curricula as an important didactic method. The study addresses the question, if patients' emotions and perceptions are represented adequately in patient-centered communication. 22 of 37 SPs of the Medical University of Vienna (12 women, 10 men) were asked openly about their feelings after having acted as an SP in a semi-structured interview, which employed the Critical Incident Technique. The interviews were recorded, transcribed, separated into situational analysis units und analyzed deductively; we used the evidence based qualities of patient-centered communication and the "Nationaler Kompetenzbasierter Lernzielkatalog Medizin" as a guideline. Out of 192 analysis units, 67 were evaluated as positive and 125 as negative. The SPs reported positive feelings, such as perceiving "stability and trust in relationships" (22%), perception of congruence (15%), acceptance (27%) and empathy (36%). As to negative feelings, SPs reported "perceiving instability" (18%), "incongruence" (11%), "lack of acceptance" (40%) and "lack of empathy" (30%). Additionally, 50% of SPs were positively affected when observing students' learning success. When SPs perceived patient-centered communication, they reported positive emotions. A lack of patient centeredness, on the contrary, provoked negative emotions. An empathic attitude, as well as a "lack of acceptance" with contrary effects had the strongest influence on the SPs' mental state. The reaction of SPs to patient centeredness is sufficiently authentic to reach learning objectives, however it is also affected by reactions of SPs to the learning success of students, which is irrelevant for the real-life doctor-patient interaction. SP reactions are affected by students' attitudes. Students should therefore be prepared well before interacting with SPs in a roleplay setting. While SPs' behavior is authentic in patient

  8. Computed tomographic simulation of craniospinal fields in pediatric patients: improved treatment accuracy and patient comfort.

    Mah, K; Danjoux, C E; Manship, S; Makhani, N; Cardoso, M; Sixel, K E

    1998-07-15

    To reduce the time required for planning and simulating craniospinal fields through the use of a computed tomography (CT) simulator and virtual simulation, and to improve the accuracy of field and shielding placement. A CT simulation planning technique was developed. Localization of critical anatomic features such as the eyes, cribriform plate region, and caudal extent of the thecal sac are enhanced by this technique. Over a 2-month period, nine consecutive pediatric patients were simulated and planned for craniospinal irradiation. Four patients underwent both conventional simulation and CT simulation. Five were planned using CT simulation only. The accuracy of CT simulation was assessed by comparing digitally reconstructed radiographs (DRRs) to portal films for all patients and to conventional simulation films as well in the first four patients. Time spent by patients in the CT simulation suite was 20 min on average and 40 min maximally for those who were noncompliant. Image acquisition time was absence of the patient, virtual simulation of all fields took 20 min. The DRRs were in agreement with portal and/or simulation films to within 5 mm in five of the eight cases. Discrepancies of > or =5 mm in the positioning of the inferior border of the cranial fields in the first three patients were due to a systematic error in CT scan acquisition and marker contouring which was corrected by modifying the technique after the fourth patient. In one patient, the facial shield had to be moved 0.75 cm inferiorly owing to an error in shield construction. Our analysis showed that CT simulation of craniospinal fields was accurate. It resulted in a significant reduction in the time the patient must be immobilized during the planning process. This technique can improve accuracy in field placement and shielding by using three-dimensional CT-aided localization of critical and target structures. Overall, it has improved staff efficiency and resource utilization.

  9. Computed tomographic simulation of craniospinal fields in pediatric patients: improved treatment accuracy and patient comfort

    Mah, Katherine; Danjoux, Cyril E.; Manship, Sharan; Makhani, Nadiya; Cardoso, Marlene; Sixel, Katharina E.

    1998-01-01

    Purpose: To reduce the time required for planning and simulating craniospinal fields through the use of a computed tomography (CT) simulator and virtual simulation, and to improve the accuracy of field and shielding placement. Methods and Materials: A CT simulation planning technique was developed. Localization of critical anatomic features such as the eyes, cribriform plate region, and caudal extent of the thecal sac are enhanced by this technique. Over a 2-month period, nine consecutive pediatric patients were simulated and planned for craniospinal irradiation. Four patients underwent both conventional simulation and CT simulation. Five were planned using CT simulation only. The accuracy of CT simulation was assessed by comparing digitally reconstructed radiographs (DRRs) to portal films for all patients and to conventional simulation films as well in the first four patients. Results: Time spent by patients in the CT simulation suite was 20 min on average and 40 min maximally for those who were noncompliant. Image acquisition time was <10 min in all cases. In the absence of the patient, virtual simulation of all fields took 20 min. The DRRs were in agreement with portal and/or simulation films to within 5 mm in five of the eight cases. Discrepancies of ≥5 mm in the positioning of the inferior border of the cranial fields in the first three patients were due to a systematic error in CT scan acquisition and marker contouring which was corrected by modifying the technique after the fourth patient. In one patient, the facial shield had to be moved 0.75 cm inferiorly owing to an error in shield construction. Conclusions: Our analysis showed that CT simulation of craniospinal fields was accurate. It resulted in a significant reduction in the time the patient must be immobilized during the planning process. This technique can improve accuracy in field placement and shielding by using three-dimensional CT-aided localization of critical and target structures. Overall

  10. The impact of repeated simulation on health and healthcare perceptions of simulated patients.

    Boerjan, M.; Boone, F.; Anthierens, S.; Weel-Baumgarten, E.M. van; Deveugele, M.

    2008-01-01

    OBJECTIVE: To explore the effect of simulating medical conditions on simulated patients (SPs). Main points of interest are influence on: perception of personal health and perception of their relation with the health care provider (HCP), personal well being. METHODS: Semi-structured interviews were

  11. Recent advancements in medical simulation: patient-specific virtual reality simulation.

    Willaert, Willem I M; Aggarwal, Rajesh; Van Herzeele, Isabelle; Cheshire, Nicholas J; Vermassen, Frank E

    2012-07-01

    Patient-specific virtual reality simulation (PSVR) is a new technological advancement that allows practice of upcoming real operations and complements the established role of VR simulation as a generic training tool. This review describes current developments in PSVR and draws parallels with other high-stake industries, such as aviation, military, and sports. A review of the literature was performed using PubMed and Internet search engines to retrieve data relevant to PSVR in medicine. All reports pertaining to PSVR were included. Reports on simulators that did not incorporate a haptic interface device were excluded from the review. Fifteen reports described 12 simulators that enabled PSVR. Medical procedures in the field of laparoscopy, vascular surgery, orthopedics, neurosurgery, and plastic surgery were included. In all cases, source data was two-dimensional CT or MRI data. Face validity was most commonly reported. Only one (vascular) simulator had undergone face, content, and construct validity. Of the 12 simulators, 1 is commercialized and 11 are prototypes. Five simulators have been used in conjunction with real patient procedures. PSVR is a promising technological advance within medicine. The majority of simulators are still in the prototype phase. As further developments unfold, the validity of PSVR will have to be examined much like generic VR simulation for training purposes. Nonetheless, similar to the aviation, military, and sport industries, operative performance and patient safety may be enhanced by the application of this novel technology.

  12. Comparison of classic simulation and virtual simulation in breast irradiation: prospective study on 14 patients

    Bauduceau, O.; Pons, P.; Romero, L.; Fayolle, M.; Campana, F.; Bollet, M.

    2005-01-01

    Purpose. - To compare conventional 2D simulation and virtual simulation on 14 patients with breast cancer. Patients and methods. - Patients were simulated for treatment using standard procedure. They subsequently underwent CT scan in the treatment position. The CTV was defined as breast tissue. The PTV was obtained by adding a 3D margin of 1 cm around CTV. Organs at risk (lungs and heart) were outlined. Ballistics and dose distribution obtained with the two planning methods were compared. Results. - With conventional simulation, 95% of CTV received 95% of the dose prescribed. Virtual simulation significantly improved dosimetric coverage of PTV without increasing irradiation volume of lung and heart. In 2D simulation, using three slices allowed optimisation by adjusting wedge angle. The five-slice plan was a much better predictor of the maximum dose regions when compared to the three-slice plan. Using entire CT data did not give any benefit. Conclusion. - Variations in CTV delineation and PTV definition limit interest of virtual simulation. In classic simulation, a 5 CT slice-plan can be used to optimise dose distribution. (author)

  13. Simulation of the radiography formation process from CT patient volume

    Bifulco, P; Cesarelli, M; Verso, E; Roccasalva Firenze, M; Sansone, M; Bracale, M [University of Naples, Federico II, Electronic Engineering Department, Bioengineering Unit, Via Claudio, 21 - 80125 Naples (Italy)

    1999-12-31

    The aim of this work is to develop an algorithm to simulate the radiographic image formation process using volumetric anatomical data of the patient, obtained from 3D diagnostic CT images. Many applications, including radiographic driven surgery, virtual reality in medicine and radiologist teaching and training, may take advantage of such technique. The designed algorithm has been developed to simulate a generic radiographic equipment, whatever oriented respect to the patient. The simulated radiography is obtained considering a discrete number of X-ray paths departing from the focus, passing through the patient volume and reaching the radiographic plane. To evaluate a generic pixel of the simulated radiography, the cumulative absorption along the corresponding X-ray is computed. To estimate X-ray absorption in a generic point of the patient volume, 3D interpolation of CT data has been adopted. The proposed technique is quite similar to those employed in Ray Tracing. A computer designed test volume has been used to assess the reliability of the radiography simulation algorithm as a measuring tool. From the errors analysis emerges that the accuracy achieved by the radiographic simulation algorithm is largely confined within the sampling step of the CT volume. (authors) 16 refs., 12 figs., 1 tabs.

  14. Simulation of the radiography formation process from CT patient volume

    Bifulco, P.; Cesarelli, M.; Verso, E.; Roccasalva Firenze, M.; Sansone, M.; Bracale, M.

    1998-01-01

    The aim of this work is to develop an algorithm to simulate the radiographic image formation process using volumetric anatomical data of the patient, obtained from 3D diagnostic CT images. Many applications, including radiographic driven surgery, virtual reality in medicine and radiologist teaching and training, may take advantage of such technique. The designed algorithm has been developed to simulate a generic radiographic equipment, whatever oriented respect to the patient. The simulated radiography is obtained considering a discrete number of X-ray paths departing from the focus, passing through the patient volume and reaching the radiographic plane. To evaluate a generic pixel of the simulated radiography, the cumulative absorption along the corresponding X-ray is computed. To estimate X-ray absorption in a generic point of the patient volume, 3D interpolation of CT data has been adopted. The proposed technique is quite similar to those employed in Ray Tracing. A computer designed test volume has been used to assess the reliability of the radiography simulation algorithm as a measuring tool. From the errors analysis emerges that the accuracy achieved by the radiographic simulation algorithm is largely confined within the sampling step of the CT volume. (authors)

  15. Does simulation enhance nurses' ability to assess deteriorating patients?

    Bliss, Maria; Aitken, Leanne M

    2018-01-01

    Recognising and responding to patient deterioration has been identified as a key skill in nursing care to ensure that care is escalated for prompt, efficient management of the potentially critically ill patient. Simulation is one teaching strategy that has been established in nurse education as a method for enhancing skills. The objective was to explore the experiences of registered nurses to ascertain whether they perceived that simulation enhanced their skills in recognising the deteriorating patient. An exploratory qualitative design was used. Data were collected from registered nurses using semi-structured interviews following a professional development course where scenario-based simulation had been used to assess the patient. Eight registered nurses were interviewed for this study. Semi-structured interviews were conducted face to face. Verbatim transcripts were analysed using thematic analysis to identify major themes. Four themes were identified: knowledge, improved assessment skills in caring for the acutely ill patient, the learning environment and decision making. The use of simulation as a strategy was perceived by nurses to improve their own ability in identifying deteriorating patients. The participants described how their knowledge was transferred to clinical practice, with the overall perception that this led to improved patient care. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. The Multiple-Patient Simulation Toolkit: Purpose, Process, and Pilot.

    Beroz, Sabrina; Sullivan, Nancy; Kramasz, Vanessa; Morgan, Patricia

    Educating nursing students to safely care for multiple patients has become an important but challenging focus for nurse educators. New graduate nurses are expected to manage care for multiple patients in a complex and multifaceted health care system. With patient safety as a priority, multiple-patient assignments are necessary in order for nursing students to learn how to effectively prioritize and delegate care. The purpose of this project was the construction of an adaptable and flexible template for the development of multiple-patient simulations. Through utilization, the template moved to a toolkit adding an operational guide, sample-populated template, and bibliography.

  17. Does the sex of a simulated patient affect CPR?

    Kramer, Chelsea E; Wilkins, Matthew S; Davies, Jan M; Caird, Jeff K; Hallihan, Gregory M

    2015-01-01

    While males and females are equally at risk of sudden cardiac arrest (SCA), females are less likely to be resuscitated. Cardiopulmonary Resuscitation (CPR) may be inhibited by socio-cultural norms about exposing female victims' chests. Empirically confirming this hypothesis is limited by lack of patient simulators modeling realistic female physiques. A commercially-available patient simulator was transformed to evaluate how physical attributes of a patient's sex might influence lay participants who were asked to resuscitate a female versus a male during simulated cardiac arrest. Sixty-nine participants consented to be in the study. Participants were randomly assigned to provide CPR and defibrillation as instructed by a commercially-available automated external defibrillator on a patient simulator presented as either a male or female experiencing cardiac arrest. Rescuers removed significantly more clothing from the male than the female, with men removing less clothing from the female. More rescuers' initial hand placements for CPR were centered between the female's breasts compared to the male, on which placement was distributed across the chest towards the nipples. While rescuers had better hand placement for CPR on the female, both men and women rescuers were reluctant to remove the female's clothing, with men significantly more hesitant. Reticence to remove clothing was often articulated relative to social norms during structured interviews. We suggest that using only male simulators will not allow trainees to experience social differences associated with the care of a female simulated patient. Realistic female patient simulators are needed. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  18. Visualization and simulation techniques for surgical simulators using actual patient's data.

    Radetzky, Arne; Nürnberger, Andreas

    2002-11-01

    Because of the increasing complexity of surgical interventions research in surgical simulation became more and more important over the last years. However, the simulation of tissue deformation is still a challenging problem, mainly due to the short response times that are required for real-time interaction. The demands to hard and software are even larger if not only the modeled human anatomy is used but the anatomy of actual patients. This is required if the surgical simulator should be used as training medium for expert surgeons rather than students. In this article, suitable visualization and simulation methods for surgical simulation utilizing actual patient's datasets are described. Therefore, the advantages and disadvantages of direct and indirect volume rendering for the visualization are discussed and a neuro-fuzzy system is described, which can be used for the simulation of interactive tissue deformations. The neuro-fuzzy system makes it possible to define the deformation behavior based on a linguistic description of the tissue characteristics or to learn the dynamics by using measured data of real tissue. Furthermore, a simulator for minimally-invasive neurosurgical interventions is presented that utilizes the described visualization and simulation methods. The structure of the simulator is described in detail and the results of a system evaluation by an experienced neurosurgeon--a quantitative comparison between different methods of virtual endoscopy as well as a comparison between real brain images and virtual endoscopies--are given. The evaluation proved that the simulator provides a higher realism of the visualization and simulation then other currently available simulators. Copyright 2002 Elsevier Science B.V.

  19. Patient identification errors are common in a simulated setting.

    Henneman, Philip L; Fisher, Donald L; Henneman, Elizabeth A; Pham, Tuan A; Campbell, Megan M; Nathanson, Brian H

    2010-06-01

    We evaluate the frequency and accuracy of health care workers verifying patient identity before performing common tasks. The study included prospective, simulated patient scenarios with an eye-tracking device that showed where the health care workers looked. Simulations involved nurses administering an intravenous medication, technicians labeling a blood specimen, and clerks applying an identity band. Participants were asked to perform their assigned task on 3 simulated patients, and the third patient had a different date of birth and medical record number than the identity information on the artifact label specific to the health care workers' task. Health care workers were unaware that the focus of the study was patient identity. Sixty-one emergency health care workers participated--28 nurses, 16 technicians, and 17 emergency service associates--in 183 patient scenarios. Sixty-one percent of health care workers (37/61) caught the identity error (61% nurses, 94% technicians, 29% emergency service associates). Thirty-nine percent of health care workers (24/61) performed their assigned task on the wrong patient (39% nurses, 6% technicians, 71% emergency service associates). Eye-tracking data were available for 73% of the patient scenarios (133/183). Seventy-four percent of health care workers (74/100) failed to match the patient to the identity band (87% nurses, 49% technicians). Twenty-seven percent of health care workers (36/133) failed to match the artifact to the patient or the identity band before performing their task (33% nurses, 9% technicians, 33% emergency service associates). Fifteen percent (5/33) of health care workers who completed the steps to verify patient identity on the patient with the identification error still failed to recognize the error. Wide variation exists among health care workers verifying patient identity before performing everyday tasks. Education, process changes, and technology are needed to improve the frequency and accuracy of

  20. Discrete Event Simulation of Patient Admissions to a Neurovascular Unit

    S. Hahn-Goldberg

    2014-01-01

    Full Text Available Evidence exists that clinical outcomes improve for stroke patients admitted to specialized Stroke Units. The Toronto Western Hospital created a Neurovascular Unit (NVU using beds from general internal medicine, Neurology and Neurosurgery to care for patients with stroke and acute neurovascular conditions. Using patient-level data for NVU-eligible patients, a discrete event simulation was created to study changes in patient flow and length of stay pre- and post-NVU implementation. Varying patient volumes and resources were tested to determine the ideal number of beds under various conditions. In the first year of operation, the NVU admitted 507 patients, over 66% of NVU-eligible patient volumes. With the introduction of the NVU, length of stay decreased by around 8%. Scenario testing showed that the current level of 20 beds is sufficient for accommodating the current demand and would continue to be sufficient with an increase in demand of up to 20%.

  1. Simulation research to enhance patient safety and outcomes: recommendations of the Simnovate Patient Safety Domain Group

    Pucher, PH; Tamblyn, R; Boorman, D; Dixon-Woods, Mary Margaret; Donaldson, L; Draycott, T; Forster, A; Nadkarni, V; Power, C; Sevdalis, N; Aggarwal, R

    2017-01-01

    The use of simulation-based training has established itself in healthcare but its implementation has been varied and mostly limited to technical and non-technical skills training. This article discusses the possibilities of the use of simulation as part of an overarching approach to improving patient safety, and represents the views of the Simnovate Patient Safety Domain Group, an international multidisciplinary expert group dedicated to the improvement of patient safety. The application and ...

  2. Generating classes of 3D virtual mandibles for AR-based medical simulation.

    Hippalgaonkar, Neha R; Sider, Alexa D; Hamza-Lup, Felix G; Santhanam, Anand P; Jaganathan, Bala; Imielinska, Celina; Rolland, Jannick P

    2008-01-01

    Simulation and modeling represent promising tools for several application domains from engineering to forensic science and medicine. Advances in 3D imaging technology convey paradigms such as augmented reality (AR) and mixed reality inside promising simulation tools for the training industry. Motivated by the requirement for superimposing anatomically correct 3D models on a human patient simulator (HPS) and visualizing them in an AR environment, the purpose of this research effort was to develop and validate a method for scaling a source human mandible to a target human mandible within a 2 mm root mean square (RMS) error. Results show that, given a distance between 2 same landmarks on 2 different mandibles, a relative scaling factor may be computed. Using this scaling factor, results show that a 3D virtual mandible model can be made morphometrically equivalent to a real target-specific mandible within a 1.30 mm RMS error. The virtual mandible may be further used as a reference target for registering other anatomic models, such as the lungs, on the HPS. Such registration will be made possible by physical constraints among the mandible and the spinal column in the horizontal normal rest position.

  3. Simulation of patient encounters using a virtual patient in periodontology instruction of dental students: design, usability, and learning effects in history-taking skills

    Janda, M.S.; Mattheos, N.; Nattestad, A.

    2004-01-01

    computer-assisted learning, effectiveness of learning, health education, patient simulation, virtual patient......computer-assisted learning, effectiveness of learning, health education, patient simulation, virtual patient...

  4. The utility of the macro-aggregated albumin lung perfusion scan in the diagnosis and prognosis of hepatopulmonary syndrome in cirrhotic patients candidates for liver transplantation

    Israel Grilo

    Full Text Available Background: The macro-aggregated albumin lung perfusion scan (99mTc-MAA is a diagnostic method for hepatopulmonary syndrome (HPS. Aim: To determine the sensitivity of 99mTc-MAA in diagnosing HPS, to establish the utility of 99mTc-MAA in determining the influence of HPS on hypoxemia in patients with concomitant pulmonary disease and to determine the correlation between 99mTc-MAA values and other respiratory parameters. Methods: Data from 115 cirrhotic patients who were eligible for liver transplantation (LT were prospectively analyzed. A transthoracic contrast echocardiography and 99mTc-MAA were performed in 85 patients, and 74 patients were diagnosed with HPS. Results: The overall sensitivity of 99mTc-MAA for the diagnosis of HPS was 18.9% (14/74 in all of the HPS cases and 66.7% (4/6 in the severe to very severe cases. In HPS patients who did not have lung disease, the degree of brain uptake of 99mTc-MAA was correlated with the alveolar-arterial oxygen gradient (A-a PO2 (r = 0.32, p < 0.05 and estimated oxygen shunt (r = 0.41, p < 0.05 and inversely correlated with partial pressure of arterial oxygen (PaO2 while breathing 100% O2 (r = -0.43, p < 0.05. The 99mTc-MAA was positive in 20.6% (7/36 of the patients with HPS and lung disease. The brain uptake of 99mTc-MAA was not associated with mortality and normalized in all cases six months after LT. Conclusions: The 99mTc-MAA is a low sensitivity test for the diagnosis of HPS that can be useful in patients who have concomitant lung disease and in severe to very severe cases of HPS. It was not related to mortality, and brain uptake normalized after LT.

  5. [Does simulator-based team training improve patient safety?].

    Trentzsch, H; Urban, B; Sandmeyer, B; Hammer, T; Strohm, P C; Lazarovici, M

    2013-10-01

    Patient safety became paramount in medicine as well as in emergency medicine after it was recognized that preventable, adverse events significantly contributed to morbidity and mortality during hospital stay. The underlying errors cannot usually be explained by medical technical inadequacies only but are more due to difficulties in the transition of theoretical knowledge into tasks under the conditions of clinical reality. Crew Resource Management and Human Factors which determine safety and efficiency of humans in complex situations are suitable to control such sources of error. Simulation significantly improved safety in high reliability organizations, such as the aerospace industry.Thus, simulator-based team training has also been proposed for medical areas. As such training is consuming in cost, time and human resources, the question of the cost-benefit ratio obviously arises. This review outlines the effects of simulator-based team training on patient safety. Such course formats are not only capable of creating awareness and improvements in safety culture but also improve technical team performance and emphasize team performance as a clinical competence. A few studies even indicated improvement of patient-centered outcome, such as a reduced rate of adverse events but further studies are required in this respect. In summary, simulator-based team training should be accepted as a suitable strategy to improve patient safety.

  6. Artificial skin and patient simulator comprising the artificial skin

    2011-01-01

    The invention relates to an artificial skin (10, 12, 14), and relates to a patient simulator (100) comprising the artificial skin. The artificial skin is a layered structure comprising a translucent cover layer (20) configured for imitating human or animal skin, and comprising a light emitting layer

  7. Validity evidence and reliability of a simulated patient feedback instrument.

    Schlegel, Claudia; Woermann, Ulrich; Rethans, Jan-Joost; van der Vleuten, Cees

    2012-01-27

    In the training of healthcare professionals, one of the advantages of communication training with simulated patients (SPs) is the SP's ability to provide direct feedback to students after a simulated clinical encounter. The quality of SP feedback must be monitored, especially because it is well known that feedback can have a profound effect on student performance. Due to the current lack of valid and reliable instruments to assess the quality of SP feedback, our study examined the validity and reliability of one potential instrument, the 'modified Quality of Simulated Patient Feedback Form' (mQSF). Content validity of the mQSF was assessed by inviting experts in the area of simulated clinical encounters to rate the importance of the mQSF items. Moreover, generalizability theory was used to examine the reliability of the mQSF. Our data came from videotapes of clinical encounters between six simulated patients and six students and the ensuing feedback from the SPs to the students. Ten faculty members judged the SP feedback according to the items on the mQSF. Three weeks later, this procedure was repeated with the same faculty members and recordings. All but two items of the mQSF received importance ratings of > 2.5 on a four-point rating scale. A generalizability coefficient of 0.77 was established with two judges observing one encounter. The findings for content validity and reliability with two judges suggest that the mQSF is a valid and reliable instrument to assess the quality of feedback provided by simulated patients.

  8. Implementation of full patient simulation training in surgical residency.

    Fernandez, Gladys L; Lee, Patrick C; Page, David W; D'Amour, Elizabeth M; Wait, Richard B; Seymour, Neal E

    2010-01-01

    Simulated patient care has gained acceptance as a medical education tool but is underused in surgical training. To improve resident clinical management in critical situations relevant to the surgical patient, high-fidelity full patient simulation training was instituted at Baystate Medical Center in 2005 and developed during successive years. We define surgical patient simulation as clinical management performed in a high fidelity environment using a manikin simulator. This technique is intended to be specifically modeled experiential learning related to the knowledge, skills, and behaviors that are fundamental to patient care. We report 3 academic years' use of a patient simulation curriculum. Learners were PGY 1-3 residents; 26 simulated patient care experiences were developed based on (1) designation as a critical management problem that would otherwise be difficult to practice, (2) ability to represent the specific problem in simulation, (3) relevance to the American Board of Surgery (ABS) certifying examination, and/or (4) relevance to institutional quality or morbidity and mortality reports. Although training started in 2005, data are drawn from the period of systematic and mandatory training spanning from July 2006 to June 2009. Training occurred during 1-hour sessions using a computer-driven manikin simulator (METI, Sarasota, Florida). Educational content was provided either before or during presimulation briefing sessions. Scenario areas included shock states, trauma and critical care case management, preoperative processes, and postoperative conditions and complications. All sessions were followed by facilitated debriefing. Likert scale-based multi-item assessments of core competency in medical knowledge, patient care, diagnosis, management, communication, and professionalism were used to generate a performance score for each resident for each simulation (percentage of best possible score). Performance was compared across PGYs by repeated

  9. Situation awareness in undergraduate nursing students managing simulated patient deterioration.

    McKenna, Lisa; Missen, Karen; Cooper, Simon; Bogossian, Fiona; Bucknall, Tracey; Cant, Robyn

    2014-06-01

    Nursing work often occurs in complex and potentially hazardous settings. Awareness of patient and practice environments is an imperative for nurses in practice. To explore nursing students' situation awareness while engaging in simulated patient deterioration scenarios. The educational process of FIRST(2)ACT was the model for the nurse intervention. Situation awareness was measured quantitatively using the Situation Awareness Global Assessment tool. Four domains were measured: physiological perception (patient parameters), global perception (surroundings), comprehension (interpretation of information), and projection (forecasting outcomes). Clinical laboratories at each of three participating universities. Ninety-seven nursing students from three Australian universities. Between March and July 2012, students participated in three video-recorded simulation events, in which a trained actor played patient roles and groups of three students worked as teams. To measure situation awareness, following the simulation each team leader was taken to a separate room and asked to report on a question set regarding the patient's vital signs, bedside setting and medical diagnosis. Overall, situation awareness was low (41%). Of the four domains, physiological perceptions scored the lowest (26%) and projection the highest (59%). Final year nursing students may not have well developed situation awareness skills, especially when dealing with these types of scenarios. Education providers need to consider ways to assist students to fully develop this attribute. Findings suggest that this is an aspect of undergraduate nursing education that requires significant consideration by curriculum developers. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

  10. A java based simulator with user interface to simulate ventilated patients

    Stehle P.

    2015-09-01

    Full Text Available Mechanical ventilation is a life-saving intervention, which despite its use on a routine basis, poses the risk of inflicting further damage to the lung tissue if ventilator settings are chosen inappropriately. Medical decision support systems may help to prevent such injuries while providing the optimal settings to reach a defined clinical goal. In order to develop and verify decision support algorithms, a test bench simulating a patient’s behaviour is needed. We propose a Java based system that allows simulation of respiratory mechanics, gas exchange and cardiovascular dynamics of a mechanically ventilated patient. The implemented models are allowed to interact and are interchangeable enabling the simulation of various clinical scenarios. Model simulations are running in real-time and show physiologically plausible results.

  11. Bio-imaging and visualization for patient-customized simulations

    Luo, Xiongbiao; Li, Shuo

    2014-01-01

    This book contains the full papers presented at the MICCAI 2013 workshop Bio-Imaging and Visualization for Patient-Customized Simulations (MWBIVPCS 2013). MWBIVPCS 2013 brought together researchers representing several fields, such as Biomechanics, Engineering, Medicine, Mathematics, Physics and Statistic. The contributions included in this book present and discuss new trends in those fields, using several methods and techniques, including the finite element method, similarity metrics, optimization processes, graphs, hidden Markov models, sensor calibration, fuzzy logic, data mining, cellular automation, active shape models, template matching and level sets. These serve as tools to address more efficiently different and timely applications involving signal and image acquisition, image processing and analysis, image segmentation, image registration and fusion, computer simulation, image based modelling, simulation and surgical planning, image guided robot assisted surgical and image based diagnosis.  This boo...

  12. Embedding a Virtual Patient Simulator in an Interactive Surgical lecture.

    Kleinert, Robert; Plum, Patrick; Heiermann, Nadine; Wahba, Roger; Chang, De-Huan; Hölscher, Arnulf H; Stippel, Dirk L

    2016-01-01

    Lectures are traditionally used for teaching declarative knowledge. One established tool for clinical education is the demonstration of a real patient. The use of real patients in the daily clinical environment is increasingly difficult. The use of a virtual patient simulator (VPS) can potentially circumvent these problems. Unlimited availability and the opportunity of an electronic feedback system could possibly enrich traditional lectures by enabling more interactivity that meets the expectations of the current student generation. As students face the consequences of their own decisions they take a more active role in the lecture. VPS links declarative knowledge with visual perception that is known to influence students' motivation. Until now, there have been no reports covering the usage and validation of interactive VPS for supporting traditional lectures. In this study, we (1) described the development of a custom-made three-dimensional (3D) VPS for supporting the traditional lecture and (2) performed a feasibility study including an initial assessment of this novel educational concept. Conceptualization included definition of curricular content, technical realization and validation. A custom-made simulator was validated with 68 students. The degree of student acceptance was evaluated. Furthermore, the effect on knowledge gain was determined by testing prelecture and postlecture performance. A custom-made simulator prototype that displays a 3D virtual clinic environment was developed and linked to a PowerPoint presentation. Students were able to connect to the simulator via electronic devices (smartphones and tablets) and to control the simulator via majority vote. The simulator was used in 6 lectures and validated in 2 lectures with 68 students each. Student acceptance and their opinion about effectiveness and applicability were determined. Students showed a high level of motivation when using the simulator as most of them had fun using it. Effect on

  13. A deletion in the Hermansky-Pudlak syndrome 4 (Hps4) gene appears to be responsible for albinism in channel catfish.

    Li, Yueru; Geng, Xin; Bao, Lisui; Elaswad, Ahmed; Huggins, Kevin W; Dunham, Rex; Liu, Zhanjiang

    2017-06-01

    Albinism is caused by a series of genetic abnormalities leading to reduction of melanin production. Albinism is quite frequent in catfish, but the causative gene and the molecular basis were unknown. In this study, we conducted a genome-wide association study (GWAS) using the 250 K SNP array. The GWAS analysis allowed mapping of the albino phenotype in the Hermansky-Pudlak syndrome 4 (Hps4) gene, which is known to be involved in melanosome biosynthesis. Sequencing analysis revealed that a 99-bp deletion was present in all analyzed albino catfish at the intron 2 and exon 3 junction. This deletion led to the skipping of the entire exon 3 which was confirmed by RT-PCR. Therefore, Hps4 was determined to be the candidate gene of the catfish albinism.

  14. Control and diagnostics of technical state of main electro technical and thermal equipment of NPP, TPS and HPS on the basis of thermovision technologies

    Banduryan, B.B.; Fedorenko, G.M.; Ostapchuk, L.B.; Saratov, V.O.

    2006-01-01

    The opportunity of using of thermovision technologies for detection of defects NPP, TPS and HPS electro technical and power equipment is shown. The results of thermovision monitoring of a turbine generator stator technical state are represented. The method for thermovision control of a technical state of a electrical machines and apparatus construction elements, for which the patent of Ukraine have been obtained, is described. he verification of the offered expedient thermovision control and diagnostics at 'Elektrovazhmash' factory was carried out

  15. Rabbit model for human EBV-associated hemophagocytic syndrome (HPS): sequential autopsy analysis and characterization of IL-2-dependent cell lines established from herpesvirus papio-induced fatal rabbit lymphoproliferative diseases with HPS.

    Hayashi, Kazuhiko; Jin, Zaishun; Onoda, Sachiyo; Joko, Hiromasa; Teramoto, Norihiro; Ohara, Nobuya; Oda, Wakako; Tanaka, Takehiro; Liu, Yi-Xuan; Koirala, Tirtha Raj; Oka, Takashi; Kondo, Eisaku; Yoshino, Tadashi; Takahashi, Kiyoshi; Akagi, Tadaatsu

    2003-05-01

    Epstein-Barr virus-associated hemophagocytic syndrome (EBV-AHS) is often associated with fatal infectious mononucleosis or T-cell lymphoproliferative diseases (LPD). To elucidate the true nature of fatal LPD observed in Herpesvirus papio (HVP)-induced rabbit hemophagocytosis, reactive or neoplastic, we analyzed sequential development of HVP-induced rabbit LPD and their cell lines. All of the seven Japanese White rabbits inoculated intravenously with HVP died of fatal LPD 18 to 27 days after inoculation. LPD was also accompanied by hemophagocytic syndrome (HPS) in five of these seven rabbits. Sequential autopsy revealed splenomegaly and swollen lymph nodes, often accompanied by bleeding, which developed in the last week. Atypical lymphoid cells infiltrated many organs with a "starry sky" pattern, frequently involving the spleen, lymph nodes, and liver. HVP-small RNA-1 expression in these lymphoid cells was clearly demonstrated by a newly developed in situ hybridization (ISH) system. HVP-ISH of immunomagnetically purified lymphoid cells from spleen or lymph nodes revealed HVP-EBER1+ cells in each CD4+, CD8+, or CD79a+ fraction. Hemophagocytic histiocytosis was observed in the lymph nodes, spleen, bone marrow, and thymus. HVP-DNA was detected in the tissues and peripheral blood from the infected rabbits by PCR or Southern blot analysis. Clonality analysis of HVP-induced LPD by Southern blotting with TCR gene probe revealed polyclonal bands, suggesting polyclonal proliferation. Six IL-2-dependent rabbit T-cell lines were established from transplanted scid mouse tumors from LPD. These showed latency type I/II HVP infection and had normal karyotypes except for one line, and three of them showed tumorigenicity in nude mice. These data suggest that HVP-induced fatal LPD in rabbits is reactive polyclonally in nature.

  16. A multimedia patient simulation for teaching and assessing endodontic diagnosis.

    Littlefield, John H; Demps, Elaine L; Keiser, Karl; Chatterjee, Lipika; Yuan, Cheng H; Hargreaves, Kenneth M

    2003-06-01

    Teaching and assessing diagnostic skills are difficult due to relatively small numbers of total clinical experiences and a shortage of clinical faculty. Patient simulations could help teach and assess diagnosis by displaying a well-defined diagnostic task, then providing informative feedback and opportunities for repetition and correction of errors. This report describes the development and initial evaluation of SimEndo I, a multimedia patient simulation program that could be used for teaching or assessing endodontic diagnosis. Students interact with a graphical interface that has four pull-down menus and related submenus. In response to student requests, the program presents patient information. Scoring is based on diagnosis of each case by endodontists. Pilot testing with seventy-four junior dental students identified numerous needed improvements to the user interface program. A multi-school field test of the interface program using three patient cases addressed three research questions: 1) How did the field test students evaluate SimEndo I? Overall mean evaluation was 8.1 on a 0 to 10 scale; 2) How many cases are needed to generate a reproducible diagnostic proficiency score for an individual student using the Rimoldi scoring procedure? Mean diagnostic proficiency scores by case ranged from .27 to .40 on a 0 to 1 scale; five cases would produce a score with a 0.80 reliability coefficient; and 3) Did students accurately diagnose each case? Mean correct diagnosis scores by case ranged from .54 to .78 on a 0 to 1 scale. We conclude that multimedia patient simulations offer a promising alternative for teaching and assessing student diagnostic skills.

  17. Comparison of femoroacetabular impingement-related radiographic features in a convenience sample of Japanese patients with and without herniation pits

    Mineta, Kazuaki; Goto, Tomohiro; Wada, Keizo; Tamaki, Yasuaki; Hamada, Daisuke; Higashino, Kosaku; Sairyo, Koichi

    2016-01-01

    To examine the prevalence of herniation pits (HPs) and to evaluate differences in radiographic features related to femoroacetabular impingement - a hip disorder with abnormal abutment between the acetabulum and femur - between hips with and without HPs in a convenience sample of Japanese patients. We reviewed 1,178 hips on each side (695 men, 483 women; mean age, 58.2 years) using computed tomographic images. The radiological assessments of hip morphology were performed by measuring the lateral center edge angle, acetabular index, acetabular version, alpha angle, and femoral head-neck offset. HPs were defined as the round or oval cystic lesions surrounded by sclerotic bone located below the anterior femoral neck cortex. Intraclass and interclass reproducibility of all radiographic measurements was acceptable (ICC: 0.71-0.98). The prevalence of HPs was 13.9 % in all subjects and was significantly higher in men (18.1 %) than in women (7.8 %; p < 0.001). HPs were larger in male (p < 0.001) and elderly subjects (p < 0.005). In subjects with HPs, the alpha angle was larger and femoral head-neck offset and offset ratio were smaller in the cohort overall and in men. Logistic regression analysis revealed the association between radiological cam-type FAI and HPs in all subjects (odds ratio: 1.86, p < 0.001). We revealed the prevalence of HPs and showed it has a predilection for men in this Japanese cohort. Femoral head asphericity or small head-neck offset was more common in subjects with HPs than those without HPs. (orig.)

  18. Evaluation of the airway of the SimMan full-scale patient simulator

    Hesselfeldt, R; Kristensen, M S; Rasmussen, L S

    2005-01-01

    SimMan is a full-scale patient simulator, capable of simulating normal and pathological airways. The performance of SimMan has never been critically evaluated.......SimMan is a full-scale patient simulator, capable of simulating normal and pathological airways. The performance of SimMan has never been critically evaluated....

  19. [Innovation in healthcare processes and patient safety using clinical simulation].

    Rojo, E; Maestre, J M; Díaz-Mendi, A R; Ansorena, L; Del Moral, I

    2016-01-01

    Many excellent ideas are never implemented or generalised by healthcare organisations. There are two related paradigms: thinking that individuals primarily change through accumulating knowledge, and believing that the dissemination of that knowledge within the organisation is the key element to facilitate change. As an alternative, a description and evaluation of a simulation-based inter-professional team training program conducted in a Regional Health Service to promote and facilitate change is presented. The Department of Continuing Education completed the needs assessment using the proposals presented by clinical units and management. Skills and behaviors that could be learned using simulation were selected, and all personnel from the units participating were included. Experiential learning principles based on clinical simulation and debriefing, were used for the instructional design. The Kirkpatrick model was used to evaluate the program. Objectives included: a) decision-making and teamwork skills training in high prevalence diseases with a high rate of preventable complications; b) care processes reorganisation to improve efficiency, while maintaining patient safety; and, c) implementation of new complex techniques with a long learning curve, and high preventable complications rate. Thirty clinical units organised 39 training programs in the 3 public hospitals, and primary care of the Regional Health Service during 2013-2014. Over 1,559 healthcare professionals participated, including nursing assistants, nurses and physicians. Simulation in healthcare to train inter-professional teams can promote and facilitate change in patient care, and organisational re-engineering. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Intern as Patient: A Patient Experience Simulation to Cultivate Empathy in Emergency Medicine Residents

    Sara W. Nelson

    2017-12-01

    Full Text Available Introduction Prior work links empathy and positive physician-patient relationships to improved healthcare outcomes. The objective of this study was to analyze a patient experience simulation for emergency medicine (EM interns as a way to teach empathy and conscientious patient care. Methods We conducted a qualitative descriptive study on an in situ, patient experience simulation held during EM residency orientation. Half the interns were patients brought into the emergency department (ED by ambulance and half were family members. Interns then took part in focus groups that discussed the experience. Data collected during these focus groups were coded by two investigators using a grounded theory approach and constant comparative methodology. Results We identified 10 major themes and 28 subthemes in the resulting qualitative data. Themes were in three broad categories: the experience as a patient or family member in the ED; application to current clinical practice; and evaluation of the exercise itself. Interns experienced firsthand the physical discomfort, emotional stress and confusion patients and families endure during the ED care process. They reflected on lessons learned, including the importance of good communication skills, frequent updates on care and timing, and being responsive to the needs and concerns of patients and families. All interns felt this was a valuable orientation experience. Conclusion Conducting a patient experience simulation may be a practical and effective way to develop empathy in EM resident physicians. Additional research evaluating the effect of participation in the simulation over a longer time period and assessing the effects on residents’ actual clinical care is warranted.

  1. The HPS experiment

    Colaneri, Luca [National Inst. of Nuclear Physics (INFN), Rome (Italy)

    2017-04-01

    With the experimental discovery of the Higgs boson, the Standard Model has been considered veri ed in all its previsions. The Standard Model, though, is still considered an incomplete theory, because it fails to address many theoretical and phenomenological issues. Among those, it doesn't provide any viable Dark Matter candidate. Many Beyond-Standard Model theories, such as the Supersymmetric Standard Model, provide possible solutions. In this work we have reported the experimental observations that led to considerate the existence of a new Force, mediated by a new massive vector boson, that could address all the observed phenomenology. This new dark Force could open an observational channel between the Standard Model and a new Dark Sector, convey by the interaction of the Standard Model photon with the massive dark photon, also called the A'. Purpose of this work was to develop an independent study of the background processes and the implementation of an independent event generator, to better understand the kinematics of the produced particles in the process e- +W → e- +W' + e+ + e- and validate, or invalidate, the o cial event generator.

  2. [Tropical pyomyositis simulating septic arthritis in AIDS patients. Two cases].

    Abouzahir, A; Bouchama, R; Azennag, M; Garcin, J M

    2004-01-01

    Tropical pyomyositis (TP) is an acute bacterial infection of skeletal muscles characterized by rapid formation of abscesses. Since the beginning of the AIDS epidemic, interest in TP has increased because of its rising incidence in association with HIV infection and of the problems that it poses for differential diagnosis. Occurrence of TP is a criterion for classification of HIV infected patients in WHO disease stage III. The purpose of this report is to describe two HIV-infected patients who presented TP simulating septic arthritis of the hip and knee respectively. Medical imaging was particularly useful in establishing accurate topographic diagnosis and needle drainage in decreasing the duration of hospitalization and avoiding the need for surgical debridement. Needle puncture must be guided by ultrasound or scan imaging.

  3. Clinical management and outcomes of patients with Hermansky-Pudlak syndrome pulmonary fibrosis evaluated for lung transplantation.

    El-Chemaly, Souheil; O'Brien, Kevin J; Nathan, Steven D; Weinhouse, Gerald L; Goldberg, Hilary J; Connors, Jean M; Cui, Ye; Astor, Todd L; Camp, Philip C; Rosas, Ivan O; Lemma, Merte; Speransky, Vladislav; Merideth, Melissa A; Gahl, William A; Gochuico, Bernadette R

    2018-01-01

    Pulmonary fibrosis is a progressive, fatal manifestation of Hermansky-Pudlak syndrome (HPS). Some patients with advanced HPS pulmonary fibrosis undergo lung transplantation despite their disease-associated bleeding tendency; others die while awaiting donor organs. The objective of this study is to determine the clinical management and outcomes of a cohort with advanced HPS pulmonary fibrosis who were evaluated for lung transplantation. Six patients with HPS-1 pulmonary fibrosis were evaluated at the National Institutes of Health Clinical Center and one of two regional lung transplant centers. Their median age was 41.5 years pre-transplant. Three of six patients died without receiving a lung transplant. One of these was referred with end-stage pulmonary fibrosis and died before a donor organ became available, and donor organs were not identified for two other patients sensitized from prior blood product transfusions. Three of six patients received bilateral lung transplants; they did not have a history of excessive bleeding. One patient received peri-operative desmopressin, one was transfused with intra-operative platelets, and one received extracorporeal membrane oxygenation and intra-operative prothrombin complex concentrate, platelet transfusion, and desmopressin. One transplant recipient experienced acute rejection that responded to pulsed steroids. No evidence of chronic lung allograft dysfunction or recurrence of HPS pulmonary fibrosis was detected up to 6 years post-transplant in these three lung transplant recipients. In conclusion, lung transplantation and extracorporeal membrane oxygenation are viable options for patients with HPS pulmonary fibrosis. Alloimmunization in HPS patients is an important and potentially preventable barrier to lung transplantation; interventions to limit alloimmunization should be implemented in HPS patients at risk of pulmonary fibrosis to optimize their candidacy for future lung transplants.

  4. Patient Simulation: A Literary Synthesis of Assessment Tools in Anesthesiology

    Alice A. Edler

    2009-12-01

    Full Text Available High-fidelity patient simulation (HFPS has been hypothesized as a modality for assessing competency of knowledge and skill in patient simulation, but uniform methods for HFPS performance assessment (PA have not yet been completely achieved. Anesthesiology as a field founded the HFPS discipline and also leads in its PA. This project reviews the types, quality, and designated purpose of HFPS PA tools in anesthesiology. We used the systematic review method and systematically reviewed anesthesiology literature referenced in PubMed to assess the quality and reliability of available PA tools in HFPS. Of 412 articles identified, 50 met our inclusion criteria. Seventy seven percent of studies have been published since 2000; more recent studies demonstrated higher quality. Investigators reported a variety of test construction and validation methods. The most commonly reported test construction methods included “modified Delphi Techniques” for item selection, reliability measurement using inter-rater agreement, and intra-class correlations between test items or subtests. Modern test theory, in particular generalizability theory, was used in nine (18% of studies. Test score validity has been addressed in multiple investigations and shown a significant improvement in reporting accuracy. However the assessment of predicative has been low across the majority of studies. Usability and practicality of testing occasions and tools was only anecdotally reported. To more completely comply with the gold standards for PA design, both shared experience of experts and recognition of test construction standards, including reliability and validity measurements, instrument piloting, rater training, and explicit identification of the purpose and proposed use of the assessment tool, are required.

  5. Strengthening student communication through pediatric simulated patient encounters

    Ryan Whitt

    2014-08-01

    Full Text Available As medical students enter the role of physician, clinical outcomes not only rely on their mastery of clinical knowledge, but also on the effectiveness in which they can communicate with patients and family members. While students typically have numerous opportunities to practice clinical communication with adult patients, such practice in pediatric settings is limited. This study examines if simulated patient (SP encounters strengthen third-year medical students’ communication skills during the pediatrics clerkship. During 2011-2013, three SP encounters (comprising 3 pediatric scenarios were incorporated into a pediatrics clerkship at one United States medical school to give students a safe venue to practice advanced communication with observation and direct feedback. Third-year medical students engaged in the scenarios and received both written and oral feedback from an evaluator observing the encounter. With IRB approval, students’ self-perceived confidence and abilities at performing the advanced communication skills were measured using an eightitem, Likert scale questionnaire administered pre and post the SP encounter. Pre- and post-questionnaires (n = 215; response rate, 96% analyzed using a Wilcoxon-matched pairs signed-rank test demonstrated statistically significant increases in students’ perception of their confidence and abilities regarding their performance (P < 0.05; Bonferroni correction, P < 0.006. There was an increases in student confidence and self-perceived ability in: first, communicating with children and family members of young patients; second, managing confrontational situations involving parents; third, performing a thorough psychosocial history with an adolescent; and fourth, using Evidence Based Medicine to motivate parents.

  6. Impaired driving simulation in patients with Periodic Limb Movement Disorder and patients with Obstructive Sleep Apnea Syndrome

    Gieteling, Esther W.; Bakker, Marije S.; Hoekema, Aarnoud; Maurits, Natasha M.; Brouwer, Wiebo H.; van der Hoeven, Johannes H.

    Background: Excessive daytime sleepiness (EDS) is considered to be responsible for increased collision rate and impaired driving simulator performance in Obstructive Sleep Apnea Syndrome (OSAS) patients. Periodic Limb Movement Disorder (PLMD) patients also frequently report EDS and may also have

  7. Error identification and recovery by student nurses using human patient simulation: opportunity to improve patient safety.

    Henneman, Elizabeth A; Roche, Joan P; Fisher, Donald L; Cunningham, Helene; Reilly, Cheryl A; Nathanson, Brian H; Henneman, Philip L

    2010-02-01

    This study examined types of errors that occurred or were recovered in a simulated environment by student nurses. Errors occurred in all four rule-based error categories, and all students committed at least one error. The most frequent errors occurred in the verification category. Another common error was related to physician interactions. The least common errors were related to coordinating information with the patient and family. Our finding that 100% of student subjects committed rule-based errors is cause for concern. To decrease errors and improve safe clinical practice, nurse educators must identify effective strategies that students can use to improve patient surveillance. Copyright 2010 Elsevier Inc. All rights reserved.

  8. Assessment of the LV-C2 Stack Sampling Probe Location for Compliance with ANSI/HPS N13.1-1999

    Glissmeyer, John A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Antonio, Ernest J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Flaherty, Julia E. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2015-09-01

    This document reports on a series of tests conducted to assess the proposed air sampling location for the Hanford Tank Waste Treatment and Immobilization Plant (WTP) Low-Activity Waste (LAW) C2V (LV-C2) exhaust stack with respect to the applicable criteria regarding the placement of an air sampling probe. Federal regulations require that a sampling probe be located in the exhaust stack according to the criteria established by the American National Standards Institute/Health Physics Society (ANSI/HPS) N13.1-1999, Sampling and Monitoring Releases of Airborne Radioactive Substances from the Stack and Ducts of Nuclear Facilities. These criteria address the capability of the sampling probe to extract a sample that represents the effluent stream. The tests were conducted on the LV-C2 scale model system. Based on the scale model tests, the location proposed for the air sampling probe in the scale model stack meets the requirements of the ANSI/HPS N13.1-1999 standard for velocity uniformity, flow angle, gas tracer and particle tracer uniformity. Additional velocity uniformity and flow angle tests on the actual stack will be necessary during cold startup to confirm the validity of the scale model results in representing the actual stack.

  9. Ab initio structural and spectroscopic study of HPS{sup x} and HSP{sup x} (x = 0,+1,−1) in the gas phase

    Yaghlane, Saida Ben [Laboratoire de Spectroscopie Atomique, Moléculaire et Applications – LSAMA, Université de Tunis, Tunis (Tunisia); Cotton, C. Eric; Francisco, Joseph S., E-mail: francisc@purdue.edu, E-mail: hochlaf@univ-mlv.fr [Department of Chemistry and Department of Earth and Atmospheric Science, Purdue University, West Lafayette, Indiana 49707 (United States); Linguerri, Roberto; Hochlaf, Majdi, E-mail: francisc@purdue.edu, E-mail: hochlaf@univ-mlv.fr [Laboratoire Modélisation et Simulation Multi Echelle, MSME UMR 8208 CNRS, Université Paris-Est, 5 bd Descartes, 77454 Marne-la-Vallée (France)

    2013-11-07

    Accurate ab initio computations of structural and spectroscopic parameters for the HPS/HSP molecules and corresponding cations and anions have been performed. For the electronic structure computations, standard and explicitly correlated coupled cluster techniques in conjunction with large basis sets have been adopted. In particular, we present equilibrium geometries, rotational constants, harmonic vibrational frequencies, adiabatic ionization energies, electron affinities, and, for the neutral species, singlet-triplet relative energies. Besides, the full-dimensional potential energy surfaces (PESs) for HPS{sup x} and HSP{sup x} (x = −1,0,1) systems have been generated at the standard coupled cluster level with a basis set of augmented quintuple-zeta quality. By applying perturbation theory to the calculated PESs, an extended set of spectroscopic constants, including τ, first-order centrifugal distortion and anharmonic vibrational constants has been obtained. In addition, the potentials have been used in a variational approach to deduce the whole pattern of vibrational levels up to 4000 cm{sup −1} above the minima of the corresponding PESs.

  10. A Novel Cast Removal Training Simulation to Improve Patient Safety.

    Brubacher, Jacob W; Karg, Jeffrey; Weinstock, Peter; Bae, Donald S

    2016-01-01

    Cast application and removal are essential to orthopedics and performed by providers of variable training. Simulation training and practice of proper cast application and removal may reduce injury, optimize outcomes, and reduce health care costs. The purpose of this educational initiative was to develop, validate, and implement a novel simulation trainer and curriculum to improve safety during cast removal. In all, 30 thermocouples (Omega, Stamford, CT) were applied to a radius fracture model (Sawbones, Vashon, WA). After reduction and cast application, a saw (Stryker, Kalamazoo, MI) was used to cut the cast with temperature recording. Both "good" and "poor" techniques-as established by consensus best practices-were used. Maximal temperatures were compared to known thresholds for thermal injury; humans experience pain at temperatures exceeding 47°C and contact temperatures exceeding 60°C may lead to epidermal necrosis. Construct validity was evaluated by assessing novice (postgraduate year 1), intermediate (postgraduate year 3), and expert (pediatric orthopedic attending) performance. With the "good" technique, mean peak temperatures were 43°C + 4.3°C. The highest recorded was 51.9°C. With the "poor" technique, mean peak temperature was 75.2°C + 17.3°C. The maximum temperature recorded with the "poor" technique was 112.4°C. Construct validity testing showed that novices had the highest increases in temperatures (12.9°C). There was a decline in heat generation as experience increased with the intermediate group (9.7°C), and the lowest heat generation was seen in the expert group (5.0°C). A novel task simulator and curriculum have been developed to assess competency and enhance performance in the application and removal of casts. There was a 32.2°C temperature decrease when the proper cast saw technique was used. Furthermore, the "poor" technique consistently achieved temperatures that would cause epidermal necrosis in patients. Clinical experience was a

  11. Dr. Tulp attends the soft machine: patient simulators, user involvement and intellectual disability.

    McClimens, Alex; Lewis, Robin; Brewster, Jacqui

    2012-09-01

    Simulation as a way to teach clinical skills attracts much critical attention. Its benefits, however, might be significantly reduced when the simulation model used relies exclusively on patient simulators. This is particularly true if the intended patient population for students taught is characterized by intellectual disability. Learning to care for people with intellectual disability might be better supplemented when the simulation model used incorporates input from 'real' people. If these people themselves have intellectual disabilities then the verisimilitude of the simulation will be higher and the outcomes for learners and potential patients will also be improved.

  12. Assessment of the Idaho National Laboratory Hot Fuel Examination Facility Stack Monitoring Site for Compliance with ANSI/HPS N13.1 1999

    Glissmeyer, John A.; Flaherty, Julia E.

    2010-01-01

    This document reports on a series of tests to determine whether the location of the air sampling probe in the Hot Fuels Examination Facility (HFEF) heating, ventilation and air conditioning (HVAC) exhaust duct meets the applicable regulatory criteria regarding the placement of an air sampling probe. Federal regulations require that a sampling probe be located in the exhaust stack according to the criteria of the ANSI/HPS N13.1-1999, Sampling and Monitoring Releases of Airborne Radioactive Substances from the Stacks and Ducts of Nuclear Facilities. These criteria address the capability of the sampling probe to extract a sample that is representative of the effluent stream. The tests conducted by PNNL during July 2010 on the HFEF system are described in this report. The sampling probe location is approximately 20 feet from the base of the stack. The stack base is in the second floor of the HFEF, and has a building ventilation stream (limited potential radioactive effluent) as well as a process stream (potential radioactive effluent, but HEPA-filtered) that feeds into it. The tests conducted on the duct indicate that the process stream is insufficiently mixed with the building ventilation stream. As a result, the air sampling probe location does not meet the criteria of the N13.1-1999 standard. The series of tests consists of various measurements taken over a grid of points in the duct cross section at the proposed sampling-probe location. The results of the test series on the HFEF exhaust duct as it relates to the criteria from ANSI/HPS N13.1-1999 are desribed in this report. Based on these tests, the location of the air sampling probe does not meet the requirements of the ANSI/HPS N13.1-1999 standard, and modifications must be made to either the HVAC system or the air sampling probe for compliance. The recommended approaches are discussed and vary from sampling probe modifications to modifying the junction of the two air exhaust streams.

  13. Using a formative simulated patient exercise for curriculum evaluation

    Thompson Margaret E

    2004-05-01

    Full Text Available Abstract Background It is not clear that teaching specific history taking, physical examination and patient teaching techniques to medical students results in durable behavioural changes. We used a quasi-experimental design that approximated a randomized double blinded trial to examine whether a Participatory Decision-Making (PDM educational module taught in a clerkship improves performance on a Simulated Patient Exercise (SPE in another clerkship, and how this is influenced by the time between training and assessment. Methods Third year medical students in an internal medicine clerkship were assessed on their use of PDM skills in an SPE conducted in the second week of the clerkship. The rotational structure of the third year clerkships formed a pseudo-randomized design where students had 1 completed the family practice clerkship containing a training module on PDM skills approximately four weeks prior to the SPE, 2 completed the family medicine clerkship and the training module approximately 12 weeks prior to the SPE or 3 had not completed the family medicine clerkship and the PDM training module at the time they were assessed via the SPE. Results Based on limited pilot data there were statistically significant differences between students who received PDM training approximately four weeks prior to the SPE and students who received training approximately 12 weeks prior to the SPE. Students who received training 12 weeks prior to the SPE performed better than those who received training four weeks prior to the SPE. In a second comparison students who received training four weeks prior to the SPE performed better than those who did not receive training but the differences narrowly missed statistical significance (P Conclusion This pilot study demonstrated the feasibility of a methodology for conducting rigorous curricular evaluations using natural experiments based on the structure of clinical rotations. In addition, it provided preliminary data

  14. Study of Physiological Responses to Acute Carbon Monoxide Exposure with a Human Patient Simulator

    Cesari, Whitney A.; Caruso, Dominique M.; Zyka, Enela L.; Schroff, Stuart T.; Evans, Charles H., Jr.; Hyatt, Jon-Philippe K.

    2006-01-01

    Human patient simulators are widely used to train health professionals and students in a clinical setting, but they also can be used to enhance physiology education in a laboratory setting. Our course incorporates the human patient simulator for experiential learning in which undergraduate university juniors and seniors are instructed to design,…

  15. Fluid, solid and fluid-structure interaction simulations on patient-based abdominal aortic aneurysm models.

    Kelly, Sinead; O'Rourke, Malachy

    2012-04-01

    This article describes the use of fluid, solid and fluid-structure interaction simulations on three patient-based abdominal aortic aneurysm geometries. All simulations were carried out using OpenFOAM, which uses the finite volume method to solve both fluid and solid equations. Initially a fluid-only simulation was carried out on a single patient-based geometry and results from this simulation were compared with experimental results. There was good qualitative and quantitative agreement between the experimental and numerical results, suggesting that OpenFOAM is capable of predicting the main features of unsteady flow through a complex patient-based abdominal aortic aneurysm geometry. The intraluminal thrombus and arterial wall were then included, and solid stress and fluid-structure interaction simulations were performed on this, and two other patient-based abdominal aortic aneurysm geometries. It was found that the solid stress simulations resulted in an under-estimation of the maximum stress by up to 5.9% when compared with the fluid-structure interaction simulations. In the fluid-structure interaction simulations, flow induced pressure within the aneurysm was found to be up to 4.8% higher than the value of peak systolic pressure imposed in the solid stress simulations, which is likely to be the cause of the variation in the stress results. In comparing the results from the initial fluid-only simulation with results from the fluid-structure interaction simulation on the same patient, it was found that wall shear stress values varied by up to 35% between the two simulation methods. It was concluded that solid stress simulations are adequate to predict the maximum stress in an aneurysm wall, while fluid-structure interaction simulations should be performed if accurate prediction of the fluid wall shear stress is necessary. Therefore, the decision to perform fluid-structure interaction simulations should be based on the particular variables of interest in a given

  16. Health Professionals' Perceptions of the Effects of Exercise on Joint Health in Rheumatoid Arthritis Patients.

    Halls, Serena; Law, Rebecca-Jane; Jones, Jeremy G; Markland, David A; Maddison, Peter J; Thom, Jeanette M

    2017-09-01

    Although exercise is an important factor in the management of rheumatoid arthritis (RA), research indicates that patients perceive that health professionals (HPs) are uncertain about the place of exercise in treatment and its relationship with joint damage. The present study investigated the perceptions of HPs regarding the effects of exercise on joint health in RA patients. A questionnaire investigating perceptions of exercise and joint health was distributed via professional networks and websites. Confirmatory factor analysis (CFA) was used to analyse questionnaire data and develop a focus group interview guide. Focus groups were conducted with multidisciplinary teams (MDTs) of rheumatology HPs and analysed using framework analysis. A total of 137 rheumatology HPs (95 female; 27-65 years of age) completed questionnaires. CFA showed that a four-factor model provided a marginally acceptable fit. Analysis of four focus groups (n = 24; 19 female; 30-60 years of age) identified five themes relating to HPs' perceptions of exercise and joint health in RA patients: 'Exercise is beneficial', 'Concerns about damage to joints', 'Patients have barriers to exercise', 'HP knowledge differs' and 'Patients may think service delivery is vague'. HPs were highly aware of the benefits and importance of exercise for RA patients. However, to remove the patient perception that HPs lack certainty and clarity regarding exercise it is important to ensure: (i) consistent promotion of exercise across the whole MDT; (ii) clear provision of information regarding rest, joint protection and exercise; (iii) HP education to ensure consistent, accurate knowledge, and understanding of the potential for conflicting advice when promoting exercise as part of an MDT. Copy © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  17. IMPROVING MEDICAL EDUCATION: SIMULATING CHANGES IN PATIENT ANATOMY USING DYNAMIC HAPTIC FEEDBACK

    Yovanoff, Mary; Pepley, David; Mirkin, Katelin; Moore, Jason; Han, David; Miller, Scarlett

    2016-01-01

    Virtual simulation is an emerging field in medical education. Research suggests that simulation reduces complication rates and improves learning gains for medical residents. One benefit of simulators is their allowance for more realistic and dynamic patient anatomies. While potentially useful throughout medical education, few studies have explored the impact of dynamic haptic simulators on medical training. In light of this research void, this study was developed to examine how a Dynamic-Hapt...

  18. Simulation-based patient flow analysis in an endoscopy unit

    Koo, Pyung-Hoi; Nielsen, Karl Brian; Jang, Jaejin

    2010-01-01

    One of the major elements in improving efficiency of healthcare services is patient flow. Patients require a variety of healthcare resources as they receive healthcare services. Poor management of patient flow results in long waiting time of patients, under/over utilization of medical resources......, low quality of care and high healthcare cost. This article addresses patient flow problems at a Gastrointestinal endoscopy unit. We attempt to analyze the main factors that contribute to the inefficient patient flow and process bottlenecks and to propose efficient patient scheduling and staff...

  19. 3D immersive patient simulators and their impact on learning success: a thematic review.

    Kleinert, Robert; Wahba, Roger; Chang, De-Hua; Plum, Patrick; Hölscher, Arnulf H; Stippel, Dirk L

    2015-04-08

    Immersive patient simulators (IPSs) combine the simulation of virtual patients with a three-dimensional (3D) environment and, thus, allow an illusionary immersion into a synthetic world, similar to computer games. Playful learning in a 3D environment is motivating and allows repetitive training and internalization of medical workflows (ie, procedural knowledge) without compromising real patients. The impact of this innovative educational concept on learning success requires review of feasibility and validity. It was the aim of this paper to conduct a survey of all immersive patient simulators currently available. In addition, we address the question of whether the use of these simulators has an impact on knowledge gain by summarizing the existing validation studies. A systematic literature search via PubMed was performed using predefined inclusion criteria (ie, virtual worlds, focus on education of medical students, validation testing) to identify all available simulators. Validation testing was defined as the primary end point. There are currently 13 immersive patient simulators available. Of these, 9 are Web-based simulators and represent feasibility studies. None of these simulators are used routinely for student education. The workstation-based simulators are commercially driven and show a higher quality in terms of graphical quality and/or data content. Out of the studies, 1 showed a positive correlation between simulated content and real content (ie, content validity). There was a positive correlation between the outcome of simulator training and alternative training methods (ie, concordance validity), and a positive coherence between measured outcome and future professional attitude and performance (ie, predictive validity). IPSs can promote learning and consolidation of procedural knowledge. The use of immersive patient simulators is still marginal, and technical and educational approaches are heterogeneous. Academic-driven IPSs could possibly enhance the

  20. Simulations

    Ngada, Narcisse

    2015-06-15

    The complexity and cost of building and running high-power electrical systems make the use of simulations unavoidable. The simulations available today provide great understanding about how systems really operate. This paper helps the reader to gain an insight into simulation in the field of power converters for particle accelerators. Starting with the definition and basic principles of simulation, two simulation types, as well as their leading tools, are presented: analog and numerical simulations. Some practical applications of each simulation type are also considered. The final conclusion then summarizes the main important items to keep in mind before opting for a simulation tool or before performing a simulation.

  1. Development and Validation of Simulated Virtual Patients to Impart Early Clinical Exposure in Endocrine Physiology

    Gupta, Akriti; Singh, Satendra; Khaliq, Farah; Dhaliwal, Upreet; Madhu, S. V.

    2018-01-01

    In the country presently, preclinical medical students are not routinely exposed to real patients. Thus, when they start clinical postings, they are found to have poor clinical reasoning skills. Simulated virtual patients (SVPs) can improve clinical skills without endangering real patients. This pilot study describes the development of two SVPs in…

  2. Knowledge-Driven Design of Virtual Patient Simulations

    Vergara, Victor; Caudell, Thomas; Goldsmith, Timothy; Panaiotis; Alverson, Dale

    2009-01-01

    Virtual worlds provide unique opportunities for instructors to promote, study, and evaluate student learning and comprehension. In this article, Victor Vergara, Thomas Caudell, Timothy Goldsmith, Panaiotis, and Dale Alverson explore the advantages of using virtual reality environments to create simulations for medical students. Virtual simulations…

  3. High-resolution computed tomography findings in eight patients with hantavirus pulmonary syndrome

    Barbosa, Diego de Lacerda; Hochhegger, Bruno; Souza Junior, Arthur Soares; Zanetti, Glaucia; Escuissato, Dante Luiz; Meirelles, Gustavo de Souza Portes; Funari, Marcelo Buarque de Gusmao; Marchiori, Edson, E-mail: edmarchiori@gmail.com [Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ (Brazil); Santa Casa de Porto Alegre, Porto Alegre, RS (Brazil); Faculdade de Medicina de Sao Jose do Rio Preto (FAMERP), SP (Brazil); Ultra X, Sao Jose do Rio Preto, SP (Brazil); Universidade Federal do Parana (UFPR), Curitiba, PR (Brazil); Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP (Brazil); Grupo Fleury, Sao Paulo, SP (Brazil); Universidade de Sao Paulo (FM/USP), Sao Paulo, SP (Brazil). Faculdade de Medicina

    2017-05-15

    Objective: The purpose of this study was to describe the high-resolution computed tomography (HRCT) findings in patients with hantavirus pulmonary syndrome (HPS). Materials and Methods: We retrospectively reviewed HRCT findings from eight cases of HPS. All patients were men, aged 19-70 (mean, 41.7) years. Diagnoses were established by serological test (enzyme-linked immunosorbent assay) in all patients. Two chest radiologists analyzed the images and reached decisions by consensus. Results: The predominant HRCT findings were ground-glass opacities (GGOs) and smooth inter- and intralobular septal thickening, found in all eight cases; however, the crazy-paving pattern was found in only three cases. Pleural effusion and peribronchovascular thickening were observed in five patients. The abnormalities were bilateral in all patients. Conclusion: The predominant HRCT findings in patients with HPS were GGOs and smooth inter- and intralobular septal thickening, which probably correlate with the histopathologic findings of pulmonary edema. (author)

  4. High-resolution computed tomography findings in eight patients with hantavirus pulmonary syndrome

    Barbosa, Diego de Lacerda; Hochhegger, Bruno; Souza Junior, Arthur Soares; Zanetti, Glaucia; Escuissato, Dante Luiz; Meirelles, Gustavo de Souza Portes; Funari, Marcelo Buarque de Gusmao; Marchiori, Edson; Santa Casa de Porto Alegre, Porto Alegre, RS; Faculdade de Medicina de Sao Jose do Rio Preto; Ultra X, Sao Jose do Rio Preto, SP; Universidade Federal do Parana; Universidade Federal de Sao Paulo; Grupo Fleury, Sao Paulo, SP; Universidade de Sao Paulo

    2017-01-01

    Objective: The purpose of this study was to describe the high-resolution computed tomography (HRCT) findings in patients with hantavirus pulmonary syndrome (HPS). Materials and Methods: We retrospectively reviewed HRCT findings from eight cases of HPS. All patients were men, aged 19-70 (mean, 41.7) years. Diagnoses were established by serological test (enzyme-linked immunosorbent assay) in all patients. Two chest radiologists analyzed the images and reached decisions by consensus. Results: The predominant HRCT findings were ground-glass opacities (GGOs) and smooth inter- and intralobular septal thickening, found in all eight cases; however, the crazy-paving pattern was found in only three cases. Pleural effusion and peribronchovascular thickening were observed in five patients. The abnormalities were bilateral in all patients. Conclusion: The predominant HRCT findings in patients with HPS were GGOs and smooth inter- and intralobular septal thickening, which probably correlate with the histopathologic findings of pulmonary edema. (author)

  5. Quasi-monte carlo simulation and variance reduction techniques substantially reduce computational requirements of patient-level simulation models: An application to a discrete event simulation model

    Treur, M.; Postma, M.

    2014-01-01

    Objectives: Patient-level simulation models provide increased flexibility to overcome the limitations of cohort-based approaches in health-economic analysis. However, computational requirements of reaching convergence is a notorious barrier. The objective was to assess the impact of using

  6. Interprofessional simulation to improve patient participation in transitional care.

    Dyrstad, Dagrunn Nåden; Storm, Marianne

    2017-06-01

    Educating and training healthcare professionals is known to improve the quality of transitional care for older adults. Arranging interprofessional meetings for healthcare professionals might be useful to improve patient participation skills in transitional care. To describe the learning activities used in The Meeting Point programme, focusing on patient participation in transitional care, and assess whether they increase healthcare professionals' awareness of and competencies relating to patient participation in the transitional care of older patients. Data were collected as part of an educational intervention programme, The Meeting Point, including three seminars on 'Patient participation in the transitional care of older patients' and four follow-up meetings. Participants were nurses, care assistants, doctors, physiotherapists, patient coordinators and administrative personnel from hospital, nursing homes and home-based care services. The Meeting Point was organised around four pillars: introduction, teaching session, group work activity and plenary discussion. Qualitative data included log reports, summaries of meetings, notes from group work activities, and reports from participants and from follow-up meetings. Feedback from participants shows that they were satisfied with meeting healthcare professionals from other units of care. A film scenario was perceived relevant for group work activity and useful in focusing participants' attention to patient participation. Follow-up meetings show that some nursing home wards, the emergency department and one medical ward at the hospital continued with ongoing work to improve quality of care. Efforts included implementation of an observational waiting room with comfortable chairs, planning for discharge in hospital admission, a daily patient flow registration system and motivational interviewing during admission to nursing home. The description of the learning activities used at The Meeting Point seminars shows that they

  7. Building patient safety in intensive care nursing : Patient safety culture, team performance and simulation-based training

    Ballangrud, Randi

    2013-01-01

    Aim: The overall aim of the thesis was to investigate patient safety culture, team performance and the use of simulation-based team training for building patient safety in intensive care nursing. Methods: Quantitative and qualitative methods were used. In Study I, 220 RNs from ten ICUs responded to a patient safety culture questionnaire analysed with statistics. Studies II-IV were based on an evaluation of a simulation-based team training programme. Studies II-III included 53 RNs from seven I...

  8. Utilization of simulated patients to assess diabetes and asthma counseling practices among community pharmacists in Qatar.

    Paravattil, Bridget; Kheir, Nadir; Yousif, Adil

    2017-08-01

    Background Patient counseling is one of the most important services a pharmacist can provide to patients. Studies have shown that counseling provided by pharmacists may prevent medication related problems and improve adherence to medication therapy. Objective To explore counseling practices among community pharmacists using simulated patients and to determine if patient, pharmacist, and pharmacy characteristics influence the counseling provided by community pharmacists. Setting Private community pharmacies within Qatar. Method This is a randomized, cross sectional study where simulated patients visited community pharmacies and presented the pharmacist with a new prescription or requested a refill for either a diabetes or asthma medication. Pharmacists completed a questionnaire at the end of the simulated interaction, which was utilized to determine if patient, pharmacist, or pharmacy characteristics had any influence on the counseling provided to patients. A scoring system was devised to assess the pharmacist's counseling practices. Main outcome measure To evaluate the type of information provided by community pharmacists to the simulated patient regarding diabetes and asthma. Results One hundred and twenty-nine pharmacists were enrolled in the study. Eighty one percent of pharmacists had a score master of pharmacy degree provided significantly better counseling (f = 3.261; p = 0.042). Many pharmacists (65%) provided hypoglycemia management to patients, however, 63% referred the patient to the physician when the patient experienced hypoglycemia from inappropriate medication administration. Only 2 (7%) pharmacists correctly counseled the patient on all 8 inhaler administration steps. Majority of pharmacists (50%) educated on the role of the rescue and controller therapy in asthma, however, 33% referred the patient to the physician when the patient inquired about controller therapy use. Conclusion Patient counseling was substandard with the majority of community

  9. Test of a Cardiology Patient Simulator with Students in Fourth-Year Electives.

    Ewy, Gordon A.; And Others

    1987-01-01

    Students at five medical schools participated in an evaluation of a cardiology patient simulator (CPS), a life-size mannequin capable of simulating a wide variety of cardiovascular conditions. The CPS enhances learning both the knowledge and the skills necessary to perform a bedside cardiovascular evaluation. (Author/MLW)

  10. Use of clinical simulations for patient education: targeting an untapped audience.

    Siwe, Karin; Berterö, Carina; Pugh, Carla; Wijma, Barbro

    2009-01-01

    In most cases, the health professional has been the target for simulation based learning curricula. We have developed a simulation based curriculum for patient education. In our curriculum lay-women learn how to perform the clinical female pelvic examination using a manikin-based trainer. Learner assessments show that prior negative expectations turned into positive expectations regarding future pelvic examinations.

  11. Using Simulation to Train Junior Psychiatry Residents to Work with Agitated Patients: A Pilot Study

    Zigman, Daniel; Young, Meredith; Chalk, Colin

    2013-01-01

    Objective: This article examines the benefit and feasibility of introducing a new, simulation-based learning intervention for junior psychiatry residents. Method: Junior psychiatry residents were invited to participate in a new simulation-based learning intervention focusing on agitated patients. Questionnaires were used to explore the success of…

  12. Communication skills of nurses during interactions with simulated cancer patients

    Kruijver, IPM; Kerkstra, A; Bensing, JM; van de Wiel, H.B.M.

    Aim. In this paper the balance of affective and instrumental communication employed by nurses during the admission interview with recently diagnosed cancer patients was investigated. Rationale. The balance of affective and instrumental communication employed by nurses appears to be important,

  13. Communication skills of nurses during interactions with simulated cancer patients.

    Kruijver, I.P.M.; Kerkstra, A.; Bensing, J.M.; Wiel, H.B.M. van der

    2001-01-01

    In this paper the balance of affective and intrumental communication employed by nurses during the admission interview with recently diagnosed cancer patients was investigated. Rationale: The balance of affective and instrumental communication employed by nurses appears to be important, especially

  14. Evolving radiological features of hypothalamo-pituitary lesions in adult patients with Langerhans cell histiocytosis (LCH)

    Makras, P.; Samara, C.; Antoniou, M.; Nikolakopoulou, Z.; Zetos, A.; Papadogias, D.; Piaditis, G.; Kaltsas, G.A.; Toloumis, G.; Andreakos, E.; Kontogeorgos, G.

    2006-01-01

    Langerhans cell histiocytosis (LCH) is a rare, systemic disease caused by monoclonal expansion of dendritic cells that shows a particular predilection for the hypothalamic-pituitary system (HPS). We studied the function (anterior and posterior pituitary hormonal secretion) and morphology using magnetic resonance imaging (MRI) of the HPS in 17 adult patients (seven males, median age 35 years, range 18-59 years) with multisystem LCH. We also evaluated the evolution of structural HPS abnormalities in relation to pituitary function and response to treatment in 12 of these patients during a median follow-up period of 3.75 years (range 1.5-10 years). Of the 17 patients, 14 (82%) had abnormal HPS imaging, and 12 (70%) had more than one area involved. Lack of the bright spot of the posterior pituitary lobe was typically found in all patients with the diagnosis of diabetes insipidus (DI). Eight patients (47%) had infundibular enlargement, six (35%) pituitary infiltration, four (24%) partially or completely empty sella, three (18%) hypothalamic involvement, and two (12%) infundibular atrophy. DI was found in 16 patients (94%) and anterior pituitary hormonal deficiency (APHD) in 10 patients (59%); two patients had single (12%) and 8 (47%) multiple APHD. During the follow-up period there was improvement of the initially demonstrated HPS pathology in seven (47%) patients, and five (33%) of them had received at least one form of treatment. APHD and DI persisted in all patients except in one in whom established gonadotrophin deficiency recovered. In summary, DI and APHD are very common in patients with multisystem LCH and are almost always associated with abnormal HPS imaging. (orig.)

  15. Ovarian adenosarcoma simulating a simple cyst in a young patient

    Leonardo Gomes da Fonseca

    2014-06-01

    Full Text Available Müllerian adenosarcoma is a rare, mixed tumor that can occur throughout the female genital tract, but is most commonly found in the uterus. Ovarian adenosarcoma is rarer and has a poorer prognosis than uterine adenosarcoma. Data on the clinicopathological features of ovarian adenosarcoma are limited, and, due to its rarity, the management is controversial. The authors report a case of a 25-year-old patient who presented with recurrent abdominal pain. Sonography and laparotomy showed an ovarian cyst, and pathologic examination confirmed the diagnosis of cystic low-grade adenosarcoma. The patient remains free of recurrence 6 months after diagnosis. The authors call attention to the differential diagnosis of ovarian masses, especially in young patients, and to the lack of evidence on the management of this neoplasm in the literature.

  16. Teaching cardiopulmonary auscultation in workshops using a virtual patient simulation technology - A pilot study.

    Pereira, D; Gomes, P; Faria, S; Cruz-Correia, R; Coimbra, M

    2016-08-01

    Auscultation is currently both a powerful screening tool, providing a cheap and quick initial assessment of a patient's clinical condition, and a hard skill to master. The teaching of auscultation in Universities is today reduced to an unsuitable number of hours. Virtual patient simulators can potentially mitigate this problem, by providing an interesting high-quality alternative to teaching with real patients or patient simulators. In this paper we evaluate the pedagogical impact of using a virtual patient simulation technology in a short workshop format for medical students, training them to detect cardiac pathologies. Results showed a significant improvement (+16%) in the differentiation between normal and pathological cases, although longer duration formats seem to be needed to accurately identify specific pathologies.

  17. Evaluation of nitrous oxide as a substitute for sulfur hexafluoride to reduce global warming impacts of ANSI/HPS N13.1 gaseous uniformity testing

    Yu, Xiao-Ying; Barnett, J. Matthew; Amidan, Brett G.; Recknagle, Kurtis P.; Flaherty, Julia E.; Antonio, Ernest J.; Glissmeyer, John A.

    2018-03-01

    The ANSI/HPS N13.1-2011 standard requires gaseous tracer uniformity testing for sampling associated with stacks used in radioactive air emissions. Sulfur hexafluoride (SF6), a greenhouse gas with a high global warming potential, has long been the gas tracer used in such testing. To reduce the impact of gas tracer tests on the environment, nitrous oxide (N2O) was evaluated as a potential replacement to SF6. The physical evaluation included the development of a test plan to record percent coefficient of variance and the percent maximum deviation between the two gases while considering variables such as fan configuration, injection position, and flow rate. Statistical power was calculated to determine how many sample sets were needed, and computational fluid dynamic modeling was utilized to estimate overall mixing in stacks. Results show there are no significant differences between the behaviors of the two gases, and SF6 modeling corroborated N2O test results. Although, in principle, all tracer gases should behave in an identical manner for measuring mixing within a stack, the series of physical tests guided by statistics was performed to demonstrate the equivalence of N2O testing to SF6 testing in the context of stack qualification tests. The results demonstrate that N2O is a viable choice leading to a four times reduction in global warming impacts for future similar compliance driven testing.

  18. Assessment of the National Research Universal Reactor Proposed New Stack Sampling Probe Location for Compliance with ANSI/HPS N13.1-1999

    Glissmeyer, John A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Antonio, Ernest J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Flaherty, Julia E. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-29

    This document reports on a series of tests conducted to assess the proposed air sampling location for the National Research Universal reactor (NRU) complex exhaust stack, located in Chalk River, Ontario, Canada, with respect to the applicable criteria regarding the placement of an air sampling probe. Due to the age of the equipment in the existing monitoring system, and the increasing difficulty in acquiring replacement parts to maintain this equipment, a more up-to-date system is planned to replace the current effluent monitoring system, and a new monitoring location has been proposed. The new sampling probe should be located within the exhaust stack according to the criteria established by the American National Standards Institute/Health Physics Society (ANSI/HPS) N13.1-1999, Sampling and Monitoring Releases of Airborne Radioactive Substances from the Stack and Ducts of Nuclear Facilities. These criteria address the capability of the sampling probe to extract a sample that represents the effluent stream. The internal Pacific Northwest National Laboratory (PNNL) project for this task was 65167, Atomic Energy Canada Ltd. Chalk River Effluent Duct Flow Qualification. The testing described in this document was guided by the Test Plan: Testing of the NRU Stack Air Sampling Position (TP-STMON-032).

  19. Assessment of the LV-S2 & LV-S3 Stack Sampling Probe Locations for Compliance with ANSI/HPS N13.1-1999

    Glissmeyer, John A.; Antonio, Ernest J.; Flaherty, Julia E.; Amidan, Brett G.

    2014-09-30

    This document reports on a series of tests conducted to assess the proposed air sampling locations for the Hanford Tank Waste Treatment and Immobilization Plant (WTP) Group 1-2A exhaust stacks with respect to the applicable criteria regarding the placement of an air sampling probe. The LV-C2, LV-S2, and LV-S3 exhaust stacks were tested together as a group (Test Group 1-2A). This report only covers the results of LV-S2 and LV-S3; LV-C2 will be reported on separately. Federal regulations1 require that a sampling probe be located in the exhaust stack according to the criteria established by the American National Standards Institute/Health Physics Society (ANSI/HPS) N13.1-1999, Sampling and Monitoring Releases of Airborne Radioactive Substances from the Stack and Ducts of Nuclear Facilities. 2 These criteria address the capability of the sampling probe to extract a sample that represents the effluent stream.

  20. Assessing the performance and satisfaction of medical residents utilizing standardized patient versus mannequin-simulated training

    Alsaad AA

    2017-07-01

    Full Text Available Ali A Alsaad,1 Swetha Davuluri,2 Vandana Y Bhide,3 Amy M Lannen,4 Michael J Maniaci3 1Department of Internal Medicine, Mayo Clinic, 2University of Miami, Coral Gables, 3Division of Hospital Internal Medicine, 4J. Wayne and Delores Barr Weaver Simulation Center, Mayo Clinic, Jacksonville, FL, USA Background: Conducting simulations of rapidly decompensating patients are a key part of internal medicine (IM residency training. Traditionally, mannequins have been the simulation tool used in these scenarios. Objective: To compare IM residents’ performance and assess realism in specific-simulated decompensating patient scenarios using standardized patients (SPs as compared to mannequin. Methods: Nineteen IM residents were randomized to undergo simulations using either a mannequin or an SP. Each resident in the two groups underwent four different simulation scenarios (calcium channel blocker overdose, severe sepsis, severe asthma exacerbation, and acute bacterial meningitis. Residents completed pretest and post-test evaluations as well as a questionnaire to assess the reality perception (realism score. Results: Nine residents completed mannequin-based scenarios, whereas 10 completed SP-based scenarios. Improvement in the post-test scores was seen in both groups. However, there were significantly higher post-test scores achieved with SP simulations in three out of the four scenarios (P=0.01. When compared with the mannequin group, the SP simulation group showed a significantly higher average realism score (P=0.002. Conclusions: Applying SP-based specific-simulation scenarios in IM residency training may result in better performance and a higher sense of a realistic experience by medical residents. Keywords: simulation, standardized patient, satisfaction, mannequin, assessment, resident education

  1. Cerebral Aneurysm Clipping Surgery Simulation Using Patient-Specific 3D Printing and Silicone Casting.

    Ryan, Justin R; Almefty, Kaith K; Nakaji, Peter; Frakes, David H

    2016-04-01

    Neurosurgery simulator development is growing as practitioners recognize the need for improved instructional and rehearsal platforms to improve procedural skills and patient care. In addition, changes in practice patterns have decreased the volume of specific cases, such as aneurysm clippings, which reduces the opportunity for operating room experience. The authors developed a hands-on, dimensionally accurate model for aneurysm clipping using patient-derived anatomic data and three-dimensional (3D) printing. Design of the model focused on reproducibility as well as adaptability to new patient geometry. A modular, reproducible, and patient-derived medical simulacrum was developed for medical learners to practice aneurysmal clipping procedures. Various forms of 3D printing were used to develop a geometrically accurate cranium and vascular tree featuring 9 patient-derived aneurysms. 3D printing in conjunction with elastomeric casting was leveraged to achieve a patient-derived brain model with tactile properties not yet available from commercial 3D printing technology. An educational pilot study was performed to gauge simulation efficacy. Through the novel manufacturing process, a patient-derived simulacrum was developed for neurovascular surgical simulation. A follow-up qualitative study suggests potential to enhance current educational programs; assessments support the efficacy of the simulacrum. The proposed aneurysm clipping simulator has the potential to improve learning experiences in surgical environment. 3D printing and elastomeric casting can produce patient-derived models for a dynamic learning environment that add value to surgical training and preparation. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Patient dose simulation in X-ray CT using a radiation treatment-planning system

    Nakae, Yasuo; Oda, Masahiko; Minamoto, Takahiro

    2003-01-01

    Medical irradiation dosage has been increasing with the development of new radiological equipment and new techniques like interventional radiology. It is fair to say that patient dose has been increased as a result of the development of multi-slice CT. A number of studies on the irradiation dose of CT have been reported, and the computed tomography dose index (CTDI) is now used as a general means of determining CT dose. However, patient dose distribution in the body varies with the patient's constitution, bowel gas in the body, and conditions of exposure. In this study, patient dose was analyzed from the viewpoint of dose distribution, using a radiation treatment-planning computer. Percent depth dose (PDD) and the off-center ratio (OCR) of the CT beam are needed to calculate dose distribution by the planning computer. Therefore, X-ray CT data were measured with various apparatuses, and beam data were sent to the planning computer. Measurement and simulation doses in the elliptical phantom (Mix-Dp: water equivalent material) were collated, and the CT irradiation dose was determined for patient dose simulation. The rotational radiation treatment technique was used to obtain the patient dose distribution of CT, and patient dose was evaluated through simulation of the dose distribution. CT images of the thorax were sent to the planning computer and simulated. The result was that the patient dose distribution of the thorax was obtained for CT examination. (author)

  3. IMPROVING MEDICAL EDUCATION: SIMULATING CHANGES IN PATIENT ANATOMY USING DYNAMIC HAPTIC FEEDBACK.

    Yovanoff, Mary; Pepley, David; Mirkin, Katelin; Moore, Jason; Han, David; Miller, Scarlett

    2016-09-01

    Virtual simulation is an emerging field in medical education. Research suggests that simulation reduces complication rates and improves learning gains for medical residents. One benefit of simulators is their allowance for more realistic and dynamic patient anatomies. While potentially useful throughout medical education, few studies have explored the impact of dynamic haptic simulators on medical training. In light of this research void, this study was developed to examine how a Dynamic-Haptic Robotic Trainer (DHRT) impacts medical student self-efficacy and skill gains compared to traditional simulators developed to train students in Internal Jugular Central Venous Catheter (IJ CVC) placement. The study was conducted with 18 third year medical students with no prior CVC insertion experience who underwent a pre-test, simulator training (manikin, robotic, or mixed) and post-test. The results revealed the DHRT as a useful method for training CVC skills and supports further research on dynamic haptic trainers in medical education.

  4. Five Topics Health Care Simulation Can Address to Improve Patient Safety

    Sollid, Stephen J M; Dieckman, Peter; Aase, Karina

    2017-01-01

    OBJECTIVES: There is little knowledge about which elements of health care simulation are most effective in improving patient safety. When empirical evidence is lacking, a consensus statement can help define priorities in, for example, education and research. A consensus process was therefore...... initiated to define priorities in health care simulation that contribute the most to improve patient safety.  METHODS: An international group of experts took part in a 4-stage consensus process based on a modified nominal group technique. Stages 1 to 3 were based on electronic communication; stage 4 was a 2......-day consensus meeting at the Utstein Abbey in Norway. The goals of stage 4 were to agree on the top 5 topics in health care simulation that contribute the most to patient safety, identify the patient safety problems they relate to, and suggest solutions with implementation strategies...

  5. Enhancing Student Communication Skills Through Arabic Language Competency and Simulated Patient Assessments.

    Hasan, Sanah; Tarazi, Hamadeh M Khier; Halim Hilal, Dana Abdel

    2017-05-01

    Objective. To assess student communication and patient management skill with introduction of Arabic and use of simulated patient assessments to a communication and counseling course. Design. Five, 3-hour tutorials (clinical skill laboratory) were added to the course covering: listening and empathic responding, non-verbal communications, interviewing skills, assertiveness, counseling in special situations: conflict, anger, worry or rushed situations, and professional decision making. Arabic content was introduced to the course to enhance Arabic communications and competence among students. Simulated patient assessment was used to evaluate student skills. Students' feedback about course changes was evaluated. Assessment. The course now covers a wider content and Arabic language. Students' scores were similar in the assessment and other assessments within the course and between Arabic and English groups. Students favorably rated the changes in the course and provided constructive feedback on content usefulness and adequacy. Conclusion. Expanding the course to include Arabic language and content and simulated patient assessments enhanced student communication skills.

  6. Virtual patient simulator for distributed collaborative medical education.

    Caudell, Thomas P; Summers, Kenneth L; Holten, Jim; Hakamata, Takeshi; Mowafi, Moad; Jacobs, Joshua; Lozanoff, Beth K; Lozanoff, Scott; Wilks, David; Keep, Marcus F; Saiki, Stanley; Alverson, Dale

    2003-01-01

    Project TOUCH (Telehealth Outreach for Unified Community Health; http://hsc.unm.edu/touch) investigates the feasibility of using advanced technologies to enhance education in an innovative problem-based learning format currently being used in medical school curricula, applying specific clinical case models, and deploying to remote sites/workstations. The University of New Mexico's School of Medicine and the John A. Burns School of Medicine at the University of Hawai'i face similar health care challenges in providing and delivering services and training to remote and rural areas. Recognizing that health care needs are local and require local solutions, both states are committed to improving health care delivery to their unique populations by sharing information and experiences through emerging telehealth technologies by using high-performance computing and communications resources. The purpose of this study is to describe the deployment of a problem-based learning case distributed over the National Computational Science Alliance's Access Grid. Emphasis is placed on the underlying technical components of the TOUCH project, including the virtual reality development tool Flatland, the artificial intelligence-based simulation engine, the Access Grid, high-performance computing platforms, and the software that connects them all. In addition, educational and technical challenges for Project TOUCH are identified. Copyright 2003 Wiley-Liss, Inc.

  7. Validation of Patient-Specific Cerebral Blood Flow Simulation Using Transcranial Doppler Measurements

    Derek Groen

    2018-06-01

    Full Text Available We present a validation study comparing results from a patient-specific lattice-Boltzmann simulation to transcranial Doppler (TCD velocity measurements in four different planes of the middle cerebral artery (MCA. As part of the study, we compared simulations using a Newtonian and a Carreau-Yasuda rheology model. We also investigated the viability of using downscaled velocities to reduce the required resolution. Simulations with unscaled velocities predict the maximum flow velocity with an error of less than 9%, independent of the rheology model chosen. The accuracy of the simulation predictions worsens considerably when simulations are run at reduced velocity, as is for example the case when inflow velocities from healthy individuals are used on a vascular model of a stroke patient. Our results demonstrate the importance of using directly measured and patient-specific inflow velocities when simulating blood flow in MCAs. We conclude that localized TCD measurements together with predictive simulations can be used to obtain flow estimates with high fidelity over a larger region, and reduce the need for more invasive flow measurement procedures.

  8. Systematic Review of Patient-Specific Surgical Simulation: Toward Advancing Medical Education.

    Ryu, Won Hyung A; Dharampal, Navjit; Mostafa, Ahmed E; Sharlin, Ehud; Kopp, Gail; Jacobs, William Bradley; Hurlbert, Robin John; Chan, Sonny; Sutherland, Garnette R

    Simulation-based education has been shown to be an effective tool to teach foundational technical skills in various surgical specialties. However, most of the current simulations are limited to generic scenarios and do not allow continuation of the learning curve beyond basic technical skills to prepare for more advanced expertise, such as patient-specific surgical planning. The objective of this study was to evaluate the current medical literature with respect to the utilization and educational value of patient-specific simulations for surgical training. We performed a systematic review of the literature using Pubmed, Embase, and Scopus focusing on themes of simulation, patient-specific, surgical procedure, and education. The study included randomized controlled trials, cohort studies, and case-control studies published between 2005 and 2016. Two independent reviewers (W.H.R. and N.D) conducted the study appraisal, data abstraction, and quality assessment of the studies. The search identified 13 studies that met the inclusion criteria; 7 studies employed computer simulations and 6 studies used 3-dimensional (3D) synthetic models. A number of surgical specialties evaluated patient-specific simulation, including neurosurgery, vascular surgery, orthopedic surgery, and interventional radiology. However, most studies were small in size and primarily aimed at feasibility assessments and early validation. Early evidence has shown feasibility and utility of patient-specific simulation for surgical education. With further development of this technology, simulation-based education may be able to support training of higher-level competencies outside the clinical settingto aid learners in their development of surgical skills. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  9. Simulating clinical trial visits yields patient insights into study design and recruitment

    Lim SS

    2017-07-01

    Full Text Available S Sam Lim,1 Alan J Kivitz,2 Doug McKinnell,3 M Edward Pierson,4 Faye S O’Brien4 1Division of Rheumatology, Department of Medicine, Emory University, Atlanta, GA, USA; 2Altoona Center for Clinical Research, Altoona, PA, USA; 3Deloitte Life Sciences Advisory, Basel, Switzerland; 4Clinical Operations, Global Medicines Development, AstraZeneca, Gaithersburg, MD, USA Purpose: We elicited patient experiences from clinical trial simulations to aid in future trial development and to improve patient recruitment and retention.Patients and methods: Two simulations of draft Phase II and Phase III anifrolumab studies for systemic lupus erythematosus (SLE/lupus nephritis (LN were performed involving African-American patients from Grady Hospital, an indigent care hospital in Atlanta, GA, USA, and white patients from Altoona Arthritis and Osteoporosis Center in Altoona, PA, USA. The clinical trial simulation included an informed consent procedure, a mock screening visit, a mock dosing visit, and a debriefing period for patients and staff. Patients and staff were interviewed to obtain sentiments and perceptions related to the simulated visits.Results: The Atlanta study involved 6 African-American patients (5 female aged 27–60 years with moderate to severe SLE/LN. The Altoona study involved 12 white females aged 32–75 years with mild to moderate SLE/LN. Patient experiences had an impact on four patient-centric care domains: 1 information, communication, and education; 2 responsiveness to needs; 3 access to care; and 4 coordination of care; and continuity and transition. Patients in both studies desired background material, knowledgeable staff, family and friend support, personal results, comfortable settings, shorter wait times, and greater scheduling flexibility. Compared with the Altoona study patients, Atlanta study patients reported greater preferences for information from the Internet, need for strong community and online support, difficulties in

  10. Survey of Australian schools of nursing use of human patient (mannequin) simulation.

    McGarry, Denise Elizabeth; Cashin, Andrew; Fowler, Cathrine

    2014-11-01

    Rapid adoption of high-fidelity human patient (mannequin) simulation has occurred in Australian Schools of Nursing in recent years, as it has internationally. This paper reports findings from a 2012 online survey of Australian Schools of Nursing and builds on findings of earlier studies. The survey design allowed direct comparison with a previous study from the USA but limited its scope to the pre-registration (pre-service Bachelor of Nursing) curriculum. It also included extra mental health specific questions. Australian patterns of adoption and application of high-fidelity human patient (mannequin) simulation in the pre-registration nursing curriculum share features with experiences reported in previous US and Australian surveys. A finding of interest in this survey was a small number of Schools of Nursing that reported no current use of high-fidelity human patient (mannequin) simulation and no plans to adopt it, in spite of a governmental capital funding support programme. In-line with prior surveys, mental health applications were meagre. There is an absence of clearly articulated learning theory underpinnings in the use of high-fidelity human patient (mannequin) simulation generally. It appears the first stage of implementation of high-fidelity human patient (mannequin) simulation into the pre-registration nursing curriculum has occurred and the adoption of this pedagogy is entering a new phase.

  11. In Patients With Cirrhosis, Driving Simulator Performance Is Associated With Real-life Driving.

    Lauridsen, Mette M; Thacker, Leroy R; White, Melanie B; Unser, Ariel; Sterling, Richard K; Stravitz, Richard T; Matherly, Scott; Puri, Puneet; Sanyal, Arun J; Gavis, Edith A; Luketic, Velimir; Siddiqui, Muhammad S; Heuman, Douglas M; Fuchs, Michael; Bajaj, Jasmohan S

    2016-05-01

    Minimal hepatic encephalopathy (MHE) has been linked to higher real-life rates of automobile crashes and poor performance in driving simulation studies, but the link between driving simulator performance and real-life automobile crashes has not been clearly established. Furthermore, not all patients with MHE are unsafe drivers, but it is unclear how to distinguish them from unsafe drivers. We investigated the link between performance on driving simulators and real-life automobile accidents and traffic violations. We also aimed to identify features of unsafe drivers with cirrhosis and evaluated changes in simulated driving skills and MHE status after 1 year. We performed a study of outpatients with cirrhosis (n = 205; median 55 years old; median model for end-stage liver disease score, 9.5; none with overt hepatic encephalopathy or alcohol or illicit drug use within previous 6 months) seen at the Virginia Commonwealth University and McGuire Veterans Administration Medical Center, from November 2008 through April 2014. All participants were given paper-pencil tests to diagnose MHE (98 had MHE; 48%), and 163 patients completed a standardized driving simulation. Data were collected on traffic violations and automobile accidents from the Virginia Department of Motor Vehicles and from participants' self-assessments when they entered the study, and from 73 participants 1 year later. Participants also completed a questionnaire about alcohol use and cessation patterns. The driving simulator measured crashes, run-time, road center and edge excursions, and illegal turns during navigation; before and after each driving simulation session, patients were asked to rate their overall driving skills. Drivers were classified as safe or unsafe based on crashes and violations reported on official driving records; simulation results were compared with real-life driving records. Multivariable regression analyses of real-life crashes and violations was performed using data on

  12. Working as simulated patient has effects on real patient life – Preliminary insights from a qualitative study

    Simmenroth-Nayda, Anne

    2016-05-01

    Full Text Available Background: Persons who simulate patients during medical education understand the routines and the underlying script of medical consultations better. We aimed to explore how simulated patients (SPs integrated this new understanding into their daily life, how this work affected their private life as patients, and what we can learn from these changes for concepts of empowerment.Design, setting, and participants: A qualitative interview study. All SPs of Göttingen medical school who had been working longer than three semesters (n=14 were invited and agreed to take part in an open interview about their daily experience with real doctors. Documentary method was used to identify the main issues. Several cases were chosen according to maximum contrast and analysed by in-depth analysis to provide vivid examples of how simulations may affect the real life of the SPs as patients.Results: Our analysis revealed three main changes in the behaviour of SPs as real patients. They were more attentive, had a better understanding of the circumstances under which doctors work, and acted more self-confidently. From the selected cases it became apparent that working as a SP may lead to a constant and significant decrease of fear of hospitals and medical procedures or, in other cases, may enable the SPs to develop new abilities for giving feedback, questioning procedures, and explanations for real doctors.Conclusion: working as a simulated patient seems to be well-suited to understand own progression of diseases, to increase self-responsibility and to a confident attitude as patient.

  13. Simulation experience enhances physical therapist student confidence in managing a patient in the critical care environment.

    Ohtake, Patricia J; Lazarus, Marcilene; Schillo, Rebecca; Rosen, Michael

    2013-02-01

    Rehabilitation of patients in critical care environments improves functional outcomes. This finding has led to increased implementation of intensive care unit (ICU) rehabilitation programs, including early mobility, and an associated increased demand for physical therapists practicing in ICUs. Unfortunately, many physical therapists report being inadequately prepared to work in this high-risk environment. Simulation provides focused, deliberate practice in safe, controlled learning environments and may be a method to initiate academic preparation of physical therapists for ICU practice. The purpose of this study was to examine the effect of participation in simulation-based management of a patient with critical illness in an ICU setting on levels of confidence and satisfaction in physical therapist students. A one-group, pretest-posttest, quasi-experimental design was used. Physical therapist students (N=43) participated in a critical care simulation experience requiring technical (assessing bed mobility and pulmonary status), behavioral (patient and interprofessional communication), and cognitive (recognizing a patient status change and initiating appropriate responses) skill performance. Student confidence and satisfaction were surveyed before and after the simulation experience. Students' confidence in their technical, behavioral, and cognitive skill performance increased from "somewhat confident" to "confident" following the critical care simulation experience. Student satisfaction was highly positive, with strong agreement the simulation experience was valuable, reinforced course content, and was a useful educational tool. Limitations of the study were the small sample from one university and a control group was not included. Incorporating a simulated, interprofessional critical care experience into a required clinical course improved physical therapist student confidence in technical, behavioral, and cognitive performance measures and was associated with high

  14. A 4D digital phantom for patient-specific simulation of brain CT perfusion protocols.

    van den Boom, Rieneke; Manniesing, Rashindra; Oei, Marcel T H; van der Woude, Willem-Jan; Smit, Ewoud J; Laue, Hendrik O A; van Ginneken, Bram; Prokop, Mathias

    2014-07-01

    Optimizing CT brain perfusion protocols is a challenge because of the complex interaction between image acquisition, calculation of perfusion data, and patient hemodynamics. Several digital phantoms have been developed to avoid unnecessary patient exposure or suboptimum choice of parameters. The authors expand this idea by using realistic noise patterns and measured tissue attenuation curves representing patient-specific hemodynamics. The purpose of this work is to validate that this approach can realistically simulate mean perfusion values and noise on perfusion data for individual patients. The proposed 4D digital phantom consists of three major components: (1) a definition of the spatial structure of various brain tissues within the phantom, (2) measured tissue attenuation curves, and (3) measured noise patterns. Tissue attenuation curves were measured in patient data using regions of interest in gray matter and white matter. By assigning the tissue attenuation curves to the corresponding tissue curves within the phantom, patient-specific CTP acquisitions were retrospectively simulated. Noise patterns were acquired by repeatedly scanning an anthropomorphic skull phantom at various exposure settings. The authors selected 20 consecutive patients that were scanned for suspected ischemic stroke and constructed patient-specific 4D digital phantoms using the individual patients' hemodynamics. The perfusion maps of the patient data were compared with the digital phantom data. Agreement between phantom- and patient-derived data was determined for mean perfusion values and for standard deviation in de perfusion data using intraclass correlation coefficients (ICCs) and a linear fit. ICCs ranged between 0.92 and 0.99 for mean perfusion values. ICCs for the standard deviation in perfusion maps were between 0.86 and 0.93. Linear fitting yielded slope values between 0.90 and 1.06. A patient-specific 4D digital phantom allows for realistic simulation of mean values and

  15. Detection of HIV-1 and Human Proteins in Urinary Extracellular Vesicles from HIV+ Patients

    Samuel I. Anyanwu

    2018-01-01

    Full Text Available Background. Extracellular vesicles (EVs are membrane bound, secreted by cells, and detected in bodily fluids, including urine, and contain proteins, RNA, and DNA. Our goal was to identify HIV and human proteins (HPs in urinary EVs from HIV+ patients and compare them to HIV− samples. Methods. Urine samples were collected from HIV+ (n=35 and HIV− (n=12 individuals. EVs were isolated by ultrafiltration and characterized using transmission electron microscopy, tandem mass spectrometry (LC/MS/MS, and nanoparticle tracking analysis (NTA. Western blots confirmed the presence of HIV proteins. Gene ontology (GO analysis was performed using FunRich and HIV Human Interaction database (HHID. Results. EVs from urine were 30–400 nm in size. More EVs were in HIV+ patients, P<0.05, by NTA. HIV+ samples had 14,475 HPs using LC/MS/MS, while only 111 were in HIV−. HPs in the EVs were of exosomal origin. LC/MS/MS showed all HIV+ samples contained at least one HIV protein. GO analysis showed differences in proteins between HIV+ and HIV− samples and more than 50% of the published HPs in the HHID interacted with EV HIV proteins. Conclusion. Differences in the proteomic profile of EVs from HIV+ versus HIV− samples were found. HIV and HPs in EVs could be used to detect infection and/or diagnose HIV disease syndromes.

  16. Evaluating the practice of Iranian community pharmacists regarding oral contraceptive pills using simulated patients.

    Foroutan, Nazanin; Dabaghzadeh, Fatemeh

    2016-01-01

    As oral contraceptive pills are available over the counter in pharmacies, pharmacists are professionally responsible for checking and informing patients about every aspect of taking these drugs. Simulated patient method is a new and robust way to evaluate professional performance of pharmacists. The aim of the present study was to evaluate the pharmacy practice of Iranian pharmacists regarding over-the-counter use of oral contraceptive pills using simulated patient method. Simulated patients visited pharmacy with a prescription containing ciprofloxacin and asked for oral contraceptive pills. The pharmacist was expected to ask important questions for using these drugs and to inform the patient about them properly. Moreover, the Pharmacists should advise patients in regard to the possible interaction. Ninety four pharmacists participated in this study. In 24 (25.3%) visits, the liable pharmacist was not present at the time of purchase. Furthermore, In 13 (18.57 %) visits by the simulated patients, the liable pharmacists did not pay any attention to the simulated patients even when they asked for consultation. Twenty nine (41.43%) pharmacists did not ask any question during dispensing. Nausea was the most frequent described side effect by pharmacists (27 (38.57%)). Yet important adverse effects of oral contraceptive pills were not mentioned by the pharmacists except for few ones. Only twelve (17.14%) pharmacists mentioned the possible interaction. There was a significant relation between the pharmacists' gender and detection of possible interaction (p value= 0.048). The quality of the pharmacists' consultations regarding the over the counter use of oral contraceptive pills was not satisfactory and required improvement.

  17. Using a Radiofrequency Identification System for Improving the Patient Discharge Process: A Simulation Study.

    Shim, Sung J; Kumar, Arun; Jiao, Roger

    2016-01-01

    A hospital is considering deploying a radiofrequency identification (RFID) system and setting up a new "discharge lounge" to improve the patient discharge process. This study uses computer simulation to model and compare the current process and the new process, and it assesses the impact of the RFID system and the discharge lounge on the process in terms of resource utilization and time taken in the process. The simulation results regarding resource utilization suggest that the RFID system can slightly relieve the burden on all resources, whereas the RFID system and the discharge lounge together can significantly mitigate the nurses' tasks. The simulation results in terms of the time taken demonstrate that the RFID system can shorten patient wait times, staff busy times, and bed occupation times. The results of the study could prove helpful to others who are considering the use of an RFID system in the patient discharge process in hospitals or similar processes.

  18. Design and implementation of a simulation exercise for teaching confidentiality of patient information.

    Snyder, J R

    1982-05-01

    Allied health students, making the transition from a purely academic to a professional school setting, are suddenly faced with judgment decisions about disclosure of medical information. Obscure guidelines and new interpersonal relationships with other members of the health care team complicate this transition and pose a threat to confidentiality of patient information. This article describes the design and implementation of a simulation exercise to reinforce lecture guidelines specifying disclosure of medical information without risk to the patient or student. The simulation is comprised of 10 critical incidents calling for responses ranging from logical to judgmental. Although written primarily for medical technologists, with emphasis on limitations governing release of patient laboratory data, the simulation approach is presented here as a model for other allied health professions. The use of a latent image format provides learners with positive or negative reinforcement as they learn the consequences of their decisions. The simulation activity described is easily adapted to small group discussion or computer-assisted instruction. While the simulation appears to be an accurate representation of reality, peer and real-life pressures could not be totally simulated.

  19. Assessment of Robotic Patient Simulators for Training in Manual Physical Therapy Examination Techniques

    Ishikawa, Shun; Okamoto, Shogo; Isogai, Kaoru; Akiyama, Yasuhiro; Yanagihara, Naomi; Yamada, Yoji

    2015-01-01

    Robots that simulate patients suffering from joint resistance caused by biomechanical and neural impairments are used to aid the training of physical therapists in manual examination techniques. However, there are few methods for assessing such robots. This article proposes two types of assessment measures based on typical judgments of clinicians. One of the measures involves the evaluation of how well the simulator presents different severities of a specified disease. Experienced clinicians were requested to rate the simulated symptoms in terms of severity, and the consistency of their ratings was used as a performance measure. The other measure involves the evaluation of how well the simulator presents different types of symptoms. In this case, the clinicians were requested to classify the simulated resistances in terms of symptom type, and the average ratios of their answers were used as performance measures. For both types of assessment measures, a higher index implied higher agreement among the experienced clinicians that subjectively assessed the symptoms based on typical symptom features. We applied these two assessment methods to a patient knee robot and achieved positive appraisals. The assessment measures have potential for use in comparing several patient simulators for training physical therapists, rather than as absolute indices for developing a standard. PMID:25923719

  20. Assessment of robotic patient simulators for training in manual physical therapy examination techniques.

    Shun Ishikawa

    Full Text Available Robots that simulate patients suffering from joint resistance caused by biomechanical and neural impairments are used to aid the training of physical therapists in manual examination techniques. However, there are few methods for assessing such robots. This article proposes two types of assessment measures based on typical judgments of clinicians. One of the measures involves the evaluation of how well the simulator presents different severities of a specified disease. Experienced clinicians were requested to rate the simulated symptoms in terms of severity, and the consistency of their ratings was used as a performance measure. The other measure involves the evaluation of how well the simulator presents different types of symptoms. In this case, the clinicians were requested to classify the simulated resistances in terms of symptom type, and the average ratios of their answers were used as performance measures. For both types of assessment measures, a higher index implied higher agreement among the experienced clinicians that subjectively assessed the symptoms based on typical symptom features. We applied these two assessment methods to a patient knee robot and achieved positive appraisals. The assessment measures have potential for use in comparing several patient simulators for training physical therapists, rather than as absolute indices for developing a standard.

  1. A simulation framework for mapping risks in clinical processes: the case of in-patient transfers.

    Dunn, Adam G; Ong, Mei-Sing; Westbrook, Johanna I; Magrabi, Farah; Coiera, Enrico; Wobcke, Wayne

    2011-05-01

    To model how individual violations in routine clinical processes cumulatively contribute to the risk of adverse events in hospital using an agent-based simulation framework. An agent-based simulation was designed to model the cascade of common violations that contribute to the risk of adverse events in routine clinical processes. Clinicians and the information systems that support them were represented as a group of interacting agents using data from direct observations. The model was calibrated using data from 101 patient transfers observed in a hospital and results were validated for one of two scenarios (a misidentification scenario and an infection control scenario). Repeated simulations using the calibrated model were undertaken to create a distribution of possible process outcomes. The likelihood of end-of-chain risk is the main outcome measure, reported for each of the two scenarios. The simulations demonstrate end-of-chain risks of 8% and 24% for the misidentification and infection control scenarios, respectively. Over 95% of the simulations in both scenarios are unique, indicating that the in-patient transfer process diverges from prescribed work practices in a variety of ways. The simulation allowed us to model the risk of adverse events in a clinical process, by generating the variety of possible work subject to violations, a novel prospective risk analysis method. The in-patient transfer process has a high proportion of unique trajectories, implying that risk mitigation may benefit from focusing on reducing complexity rather than augmenting the process with further rule-based protocols.

  2. Assessment of robotic patient simulators for training in manual physical therapy examination techniques.

    Ishikawa, Shun; Okamoto, Shogo; Isogai, Kaoru; Akiyama, Yasuhiro; Yanagihara, Naomi; Yamada, Yoji

    2015-01-01

    Robots that simulate patients suffering from joint resistance caused by biomechanical and neural impairments are used to aid the training of physical therapists in manual examination techniques. However, there are few methods for assessing such robots. This article proposes two types of assessment measures based on typical judgments of clinicians. One of the measures involves the evaluation of how well the simulator presents different severities of a specified disease. Experienced clinicians were requested to rate the simulated symptoms in terms of severity, and the consistency of their ratings was used as a performance measure. The other measure involves the evaluation of how well the simulator presents different types of symptoms. In this case, the clinicians were requested to classify the simulated resistances in terms of symptom type, and the average ratios of their answers were used as performance measures. For both types of assessment measures, a higher index implied higher agreement among the experienced clinicians that subjectively assessed the symptoms based on typical symptom features. We applied these two assessment methods to a patient knee robot and achieved positive appraisals. The assessment measures have potential for use in comparing several patient simulators for training physical therapists, rather than as absolute indices for developing a standard.

  3. Patient safety and quality of care: How may clinical simulation contribute?

    Sanne Jensen

    2015-09-01

    Full Text Available The usability of health information technology (IT is increasingly recognized as critically important to the development of systems that ensure patient safety and quality of care. The substantial complexity of organizations, work practice and physical environments within the healthcare sector influences the development and application of health IT. When health IT is introduced in local clinical work practices, potential patient safety hazards and insufficient support of work practices need to be examined. Qualitative methods, such as clinical simulation, may be used to evaluate new technology in correlation with the clinical context and to study the interaction between users, technology and work practice. Compared with the “classic” methods, such as heuristic inspection and usability testing, clinical simulation takes the clinical context into account. Clinical simulation can be useful in many processes in the human-centred design cycle. In the requirement specification, clinical simulation can be useful to analyze user requirements and work practice as well to evaluate requirements. In the design of health IT, clinical simulation can be used to evaluate clinical information systems and serve as common ground to help to achieve a shared understanding between various communities of practice. In a public procurement process, a clinical simulation-based assessment can help give insight into different solutions and how they support work practice. Before organizational implementation, clinical simulation is a very suitable means, by which to assess an application in connection with work practice.

  4. Effectiveness of Standardized Patient Simulations in Teaching Clinical Communication Skills to Dental Students.

    McKenzie, Carly T; Tilashalski, Ken R; Peterson, Dawn Taylor; White, Marjorie Lee

    2017-10-01

    The aim of this study was to investigate dental students' long-term retention of clinical communication skills learned in a second-year standardized patient simulation at one U.S. dental school. Retention was measured by students' performance with an actual patient during their fourth year. The high-fidelity simulation exercise focused on clinical communication skills took place during the spring term of the students' second year. The effect of the simulation was measured by comparing the fourth-year clinical performance of two groups: those who had participated in the simulation (intervention group; Class of 2016) and those who had not (no intervention/control group; Class of 2015). In the no intervention group, all 47 students participated; in the intervention group, 58 of 59 students participated. Both instructor assessments and students' self-assessments were used to evaluate the effectiveness of key patient interaction principles as well as comprehensive presentation of multiple treatment options. The results showed that students in the intervention group more frequently included cost during their treatment option presentation than did students in the no intervention group. The instructor ratings showed that the intervention group included all key treatment option components except duration more frequently than did the no intervention group. However, the simulation experience did not result in significantly more effective student-patient clinical communication on any of the items measured. This study presents limited evidence of the effectiveness of a standardized patient simulation to improve dental students' long-term clinical communication skills with respect to thorough presentation of treatment options to a patient.

  5. [Innovative education: simulation-based training at the Institute of Health Sciences, Semmelweis University, Hungary].

    Csóka, Mária; Deutsch, Tibor

    2011-01-02

    In Hungary, the Institute of Health Sciences at Semmelweis University was the first institution to introduce patient simulation-based practical training of non-physician professionals. Before introducing this novel educational methodology, students could only practice particular examinations and interventions on demonstration tools. Using the simulator they can also follow and analyze the effects of the interventions that have been made. The high fidelity, adult Human Patients Emergency Care Simulator (HPS-ECS, Medical Education Technologies Incorporation, Sarasota, Florida, USA) is particularly suitable for acquiring skills related to the management of various emergency situations. The 180 cm and 34 kg mannequin which can operate in lying and sitting positions has both respiration and circulation which can be examined the same way as in a living person. It is capable to produce several physical and clinical signs such as respiration with chest movement, electric cardiac activity, palpable pulse, and measurable blood pressure. In addition, it can also exhibit blinking, swelling of the tongue and whole-body trembling while intestinal, cardiac and pulmonary sounds can equally be examined. The high fidelity simulator allows various interventions including monitoring, oxygen therapy, bladder catheterization, gastric tube insertion, injection, infusion and transfusion therapy to be practiced as part of complex patient management. Diagnostic instruments such as ECG recorder, sphygmomanometer, pulse-oxymeter can be attached to the simulator which can also respond to different medical interventions such as intubation, defibrillation, pacing, liquid supplementing, and blood transfusion. The mannequin's physiological response can be followed up and monitored over time to assess whether the selected intervention has been proven adequate to achieve the desired outcome. Authors provide a short overview of the possible applications of clinical simulation for education and

  6. Feelings of Clinician-Patient Similarity and Trust Influence Pain: Evidence From Simulated Clinical Interactions.

    Losin, Elizabeth A Reynolds; Anderson, Steven R; Wager, Tor D

    2017-07-01

    Pain is influenced by many factors other than external sources of tissue damage. Among these, the clinician-patient relationship is particularly important for pain diagnosis and treatment. However, the effects of the clinician-patient relationship on pain remain underexamined. We tested the hypothesis that patients who believe they share core beliefs and values with their clinician will report less pain than patients who do not. We also measured feelings of perceived clinician-patient similarity and trust to see if these interpersonal factors influenced pain. We did so by experimentally manipulating perceptions of similarity between participants playing the role of clinicians and participants playing the role of patients in simulated clinical interactions. Participants were placed in 2 groups on the basis of their responses to a questionnaire about their personal beliefs and values, and painful thermal stimulation was used as an analog of a painful medical procedure. We found that patients reported feeling more similarity and trust toward their clinician when they were paired with clinicians from their own group. In turn, patients' positive feelings of similarity and trust toward their clinicians-but not clinicians' feelings toward patients or whether the clinician and patient were from the same group-predicted lower pain ratings. Finally, the most anxious patients exhibited the strongest relationship between their feelings about their clinicians and their pain report. These findings increase our understanding of context-driven pain modulation and suggest that interventions aimed at increasing patients' feelings of similarity to and trust in health care providers may help reduce the pain experienced during medical care. We present novel evidence that the clinician-patient relationship can affect the pain experienced during medical care. We found that "patients" in simulated clinical interactions who reported feeling more similarity and trust toward their

  7. Assessing Critical Thinking Outcomes of Dental Hygiene Students Utilizing Virtual Patient Simulation: A Mixed Methods Study.

    Allaire, Joanna L

    2015-09-01

    Dental hygiene educators must determine which educational practices best promote critical thinking, a quality necessary to translate knowledge into sound clinical decision making. The aim of this small pilot study was to determine whether virtual patient simulation had an effect on the critical thinking of dental hygiene students. A pretest-posttest design using the Health Science Reasoning Test was used to evaluate the critical thinking skills of senior dental hygiene students at The University of Texas School of Dentistry at Houston Dental Hygiene Program before and after their experience with computer-based patient simulation cases. Additional survey questions sought to identify the students' perceptions of whether the experience had helped develop their critical thinking skills and improved their ability to provide competent patient care. A convenience sample of 31 senior dental hygiene students completed both the pretest and posttest (81.5% of total students in that class); 30 senior dental hygiene students completed the survey on perceptions of the simulation (78.9% response rate). Although the results did not show a significant increase in mean scores, the students reported feeling that the use of virtual patients was an effective teaching method to promote critical thinking, problem-solving, and confidence in the clinical realm. The results of this pilot study may have implications to support the use of virtual patient simulations in dental hygiene education. Future research could include a larger controlled study to validate findings from this study.

  8. Simulated human patients and patient-centredness: The uncanny hybridity of nursing education, technology, and learning to care.

    Ireland, Aileen V

    2017-01-01

    Positioned within a hybrid of the human and technology, professional nursing practice has always occupied a space that is more than human. In nursing education, technology is central in providing tools with which practice knowledge is mobilized so that students can safely engage with simulated human patients without causing harm to real people. However, while there is an increased emphasis on deploying these simulated humans as emissaries from person-centred care to demonstrate what it is like to care for real humans, the nature of what is really going on in simulation-what is real and what is simulated-is very rarely discussed and poorly understood. This paper explores how elements of postcolonial critical thought can aid in understanding the challenges of educating nurses to provide person-centred care within a healthcare culture that is increasingly reliant on technology. Because nursing education is itself a hybrid of real and simulated practice, it provides an appropriate case study to explore the philosophical question of technology in healthcare discourse, particularly as it relates to the relationship between the human patient and its uncanny simulated double. Drawing on postcolonial elements such as the uncanny, diaspora, hybridity, and créolité, the hybrid conditions of nursing education are examined in order to open up new possibilities of thinking about how learning to care is entangled with this technological space to assist in shaping professional knowledge of person-centred care. Considering these issues through a postcolonial lens opens up questions about the nature of the difficulty in using simulated human technologies in clinical education, particularly with the paradoxical aim of providing person-centred care within a climate that increasingly characterized as posthuman. © 2016 John Wiley & Sons Ltd.

  9. Simulation

    Gould, Derek A; Chalmers, Nicholas; Johnson, Sheena J

    2012-01-01

    Recognition of the many limitations of traditional apprenticeship training is driving new approaches to learning medical procedural skills. Among simulation technologies and methods available today, computer-based systems are topical and bring the benefits of automated, repeatable, and reliable p...... performance assessments. Human factors research is central to simulator model development that is relevant to real-world imaging-guided interventional tasks and to the credentialing programs in which it would be used....

  10. Simulating Category Learning and Set Shifting Deficits in Patients Weight-Restored from Anorexia Nervosa

    2014-01-01

    Neuropsychology, in press     Simulating Category Learning and Set Shifting Deficits in Patients Weight-Restored from Anorexia Nervosa J...University   Objective: To examine set shifting in a group of women previously diagnosed with anorexia nervosa (AN) who are now weight-restored (AN-WR...participant fails to switch to the new rule but rather persists with the previously correct rule. Adult patients with Anorexia Nervosa (AN) are often impaired

  11. Preventing Hantavirus Pulmonary Syndrome (HPS)

    ... Seoul Virus Infection Testing for Seoul Virus in Pet Rats: Information For Veterinarians Yosemite National Park Case Count Maps Epi ... or minimize contact with rodents in your home, workplace, or campsite. If rodents don’t find that ...

  12. Does teaching non-technical skills to medical students improve those skills and simulated patient outcome?

    Hagemann, Vera; Herbstreit, Frank; Kehren, Clemens; Chittamadathil, Jilson; Wolfertz, Sandra; Dirkmann, Daniel; Kluge, Annette; Peters, Jürgen

    2017-03-29

    The purpose of this study is to evaluate the effects of a tailor-made, non-technical skills seminar on medical student's behaviour, attitudes, and performance during simulated patient treatment. Seventy-seven students were randomized to either a non-technical skills seminar (NTS group, n=43) or a medical seminar (control group, n=34). The human patient simulation was used as an evaluation tool. Before the seminars, all students performed the same simulated emergency scenario to provide baseline measurements. After the seminars, all students were exposed to a second scenario, and behavioural markers for evaluating their non-technical skills were rated. Furthermore, teamwork-relevant attitudes were measured before and after the scenarios, and perceived stress was measured following each simulation. All simulations were also evaluated for various medical endpoints. Non-technical skills concerning situation awareness (ptechnical skills to improve student's non-technical skills. In a next step, to improve student's handling of emergencies and patient outcomes, non-technical skills seminars should be accompanied by exercises and more broadly embedded in the medical school curriculum.

  13. Fluid Structure Interaction simulation of heart prosthesis in patient-specific left-ventricle/aorta anatomies

    Le, Trung; Borazjani, Iman; Sotiropoulos, Fotis

    2009-11-01

    In order to test and optimize heart valve prosthesis and enable virtual implantation of other biomedical devices it is essential to develop and validate high-resolution FSI-CFD codes for carrying out simulations in patient-specific geometries. We have developed a powerful numerical methodology for carrying out FSI simulations of cardiovascular flows based on the CURVIB approach (Borazjani, L. Ge, and F. Sotiropoulos, Journal of Computational physics, vol. 227, pp. 7587-7620 2008). We have extended our FSI method to overset grids to handle efficiently more complicated geometries e.g. simulating an MHV implanted in an anatomically realistic aorta and left-ventricle. A compliant, anatomic left-ventricle is modeled using prescribed motion in one domain. The mechanical heart valve is placed inside the second domain i.e. the body-fitted curvilinear mesh of the anatomic aorta. The simulations of an MHV with a left-ventricle model underscore the importance of inflow conditions and ventricular compliance for such simulations and demonstrate the potential of our method as a powerful tool for patient-specific simulations.

  14. Patient outcomes in simulation-based medical education: a systematic review.

    Zendejas, Benjamin; Brydges, Ryan; Wang, Amy T; Cook, David A

    2013-08-01

    Evaluating the patient impact of health professions education is a societal priority with many challenges. Researchers would benefit from a summary of topics studied and potential methodological problems. We sought to summarize key information on patient outcomes identified in a comprehensive systematic review of simulation-based instruction. Systematic search of MEDLINE, EMBASE, CINAHL, PsychINFO, Scopus, key journals, and bibliographies of previous reviews through May 2011. Original research in any language measuring the direct effects on patients of simulation-based instruction for health professionals, in comparison with no intervention or other instruction. Two reviewers independently abstracted information on learners, topics, study quality including unit of analysis, and validity evidence. We pooled outcomes using random effects. From 10,903 articles screened, we identified 50 studies reporting patient outcomes for at least 3,221 trainees and 16,742 patients. Clinical topics included airway management (14 studies), gastrointestinal endoscopy (12), and central venous catheter insertion (8). There were 31 studies involving postgraduate physicians and seven studies each involving practicing physicians, nurses, and emergency medicine technicians. Fourteen studies (28 %) used an appropriate unit of analysis. Measurement validity was supported in seven studies reporting content evidence, three reporting internal structure, and three reporting relations with other variables. The pooled Hedges' g effect size for 33 comparisons with no intervention was 0.47 (95 % confidence interval [CI], 0.31-0.63); and for nine comparisons with non-simulation instruction, it was 0.36 (95 % CI, -0.06 to 0.78). Focused field in education; high inconsistency (I(2) > 50 % in most analyses). Simulation-based education was associated with small-moderate patient benefits in comparison with no intervention and non-simulation instruction, although the latter did not reach statistical

  15. Minimizing patient waiting time in emergency department of public hospital using simulation optimization approach

    Ibrahim, Ireen Munira; Liong, Choong-Yeun; Bakar, Sakhinah Abu; Ahmad, Norazura; Najmuddin, Ahmad Farid

    2017-04-01

    Emergency department (ED) is the main unit of a hospital that provides emergency treatment. Operating 24 hours a day with limited number of resources invites more problems to the current chaotic situation in some hospitals in Malaysia. Delays in getting treatments that caused patients to wait for a long period of time are among the frequent complaints against government hospitals. Therefore, the ED management needs a model that can be used to examine and understand resource capacity which can assist the hospital managers to reduce patients waiting time. Simulation model was developed based on 24 hours data collection. The model developed using Arena simulation replicates the actual ED's operations of a public hospital in Selangor, Malaysia. The OptQuest optimization in Arena is used to find the possible combinations of a number of resources that can minimize patients waiting time while increasing the number of patients served. The simulation model was modified for improvement based on results from OptQuest. The improvement model significantly improves ED's efficiency with an average of 32% reduction in average patients waiting times and 25% increase in the total number of patients served.

  16. THE SIMULATED SOCIAL-INTERACTION TEST - A PSYCHOMETRIC EVALUATION WITH DUTCH SOCIAL PHOBIC PATIENTS

    MERSCH, PPA; BREUKERS, P; EMMELKAMP, PMG

    1992-01-01

    The Simulated Social Interaction Test (SSIT) was translated and adjusted for use on a population of Dutch males and females. Seventy-four social phobic patients were assessed with the SSIT, a conversation test, and an interview with an independent observer. Results show that the SSIT is a relatively

  17. In Patients with Cirrhosis, Driving Simulator Performance is Associated With Real-life Driving

    Lauridsen, Mette Enok Munk; Thacker, Leroy R; White, Melanie B

    2016-01-01

    BACKGROUND & AIMS: Minimal hepatic encephalopathy (MHE) has been linked to higher real-life rates of automobile crashes and poor performance in driving simulation studies, but the link between driving simulator performance and real-life automobile crashes has not been clearly established. Further......, not all patients with MHE are unsafe drivers, but it is unclear how to distinguish them from unsafe drivers. We investigated the link between performance on driving simulators and real-life automobile accidents and traffic violations. We also aimed to identify features of unsafe drivers with cirrhosis...... and evaluated changes in simulated driving skills and MHE status after 1 year. METHODS: We performed a study of outpatients with cirrhosis (n=205; median 55 years old; median model for end-stage liver disease score, 9.5; none with overt hepatic encephalopathy or alcohol or illicit drug use within previous 6...

  18. Using soft systems methodology to develop a simulation of out-patient services.

    Lehaney, B; Paul, R J

    1994-10-01

    Discrete event simulation is an approach to modelling a system in the form of a set of mathematical equations and logical relationships, usually used for complex problems, which are difficult to address by using analytical or numerical methods. Managing out-patient services is such a problem. However, simulation is not in itself a systemic approach, in that it provides no methodology by which system boundaries and system activities may be identified. The investigation considers the use of soft systems methodology as an aid to drawing system boundaries and identifying system activities, for the purpose of simulating the outpatients' department at a local hospital. The long term aims are to examine the effects that the participative nature of soft systems methodology has on the acceptability of the simulation model, and to provide analysts and managers with a process that may assist in planning strategies for health care.

  19. Sampling for Patient Exit Interviews: Assessment of Methods Using Mathematical Derivation and Computer Simulations.

    Geldsetzer, Pascal; Fink, Günther; Vaikath, Maria; Bärnighausen, Till

    2018-02-01

    (1) To evaluate the operational efficiency of various sampling methods for patient exit interviews; (2) to discuss under what circumstances each method yields an unbiased sample; and (3) to propose a new, operationally efficient, and unbiased sampling method. Literature review, mathematical derivation, and Monte Carlo simulations. Our simulations show that in patient exit interviews it is most operationally efficient if the interviewer, after completing an interview, selects the next patient exiting the clinical consultation. We demonstrate mathematically that this method yields a biased sample: patients who spend a longer time with the clinician are overrepresented. This bias can be removed by selecting the next patient who enters, rather than exits, the consultation room. We show that this sampling method is operationally more efficient than alternative methods (systematic and simple random sampling) in most primary health care settings. Under the assumption that the order in which patients enter the consultation room is unrelated to the length of time spent with the clinician and the interviewer, selecting the next patient entering the consultation room tends to be the operationally most efficient unbiased sampling method for patient exit interviews. © 2016 The Authors. Health Services Research published by Wiley Periodicals, Inc. on behalf of Health Research and Educational Trust.

  20. A study on the usefulness of high fidelity patient simulation in undergraduate medical education

    Bikramjit Pal

    2018-01-01

    Full Text Available Introduction: Simulation is the imitation of the operation of a real-world process or system over time. Innovative simulation training solutions are now being used to train medical professionals in an attempt to reduce the number of safety concerns that have adverse effects on the patients. Objectives: (a To determine its usefulness as a teaching or learning tool for management of surgical emergencies, both in the short term and medium term by students’ perception. (b To plan future teaching methodology regarding hi-fidelity simulation based on the study outcomes and re-assessment of the current training modules. Methods: Quasi-experimental time series design with pretest-posttest interventional study. Quantitative data was analysed in terms of Mean, Standard Deviation and standard error of Mean. Statistical tests of significance like Repeated Measure of Analysis of Variance (ANOVA were used for comparisons. P value < 0.001 was considered to be statistically significant. Results: The students opined that the simulated sessions on high fidelity simulators had encouraged their active participation which was appropriate to their current level of learning. It helped them to think fast and the training sessions resembled a real life situation. The study showed that learning had progressively improved with each session of simulation with corresponding decrease in stress. Conclusion: Implementation of high fidelity simulation based learning in our Institute had been perceived favourably by a large number of students in enhancing their knowledge over time in management of trauma and surgical emergencies.

  1. Subjective and neurovegetative changes in healthy volunteers and panic patients performing simulated public speaking.

    Parente, Alexandre C B V; Garcia-Leal, Cybele; Del-Ben, Cristina M; Guimarães, Francisco S; Graeff, Frederico G

    2005-12-01

    Drug-free symptomatic panic patients, drug-treated nonsymptomatic patients and healthy controls were submitted to simulated public speaking. Subjective anxiety, cognitive impairment and discomfort measured by the visual analog mood scale as well as skin conductance level were higher in symptomatic patients than in controls at the beginning of the experimental session, nonsymptomatic patients lying in between. Subjective sedation, spontaneous fluctuations of skin conductance, heart rate and blood pressure were similar in the three groups. Preparation and performance of speech decreased sedation while increasing anxiety, cognitive impairment, level and fluctuations of skin conductance, heart rate and blood pressure. Anxiety, cognitive impairment and conductance level were less increased in symptomatic patients than in controls. Electrodermal activity, but not cardiovascular measures of sympathetic arousal correlated with anticipatory anxiety. Chronic treatment with serotonin uptake inhibitors attenuated the differences between panic patients and controls, supporting the participation of serotonin in panic disorder.

  2. Patients' Perspectives on Information and Communication About Sexual and Relational Issues in Rheumatology Health Care.

    Helland, Ylva; Dagfinrud, Hanne; Haugen, Mona-Iren; Kjeken, Ingvild; Zangi, Heidi

    2017-06-01

    Men and women with rheumatic diseases report a significantly negative impact on multiple areas of life, including sexuality. Research indicates that patients want to discuss sexual issues with health professionals (HPs) in rheumatology care but these issues are rarely addressed in consultations. The objective of the present study was to explore patients' experiences of communication with HPs about disease-related sexual issues, their perceptions of the relevance of these issues in rheumatology care and their preferences for how these topics should be handled. A qualitative design was used and 18 semi-structured interviews were performed, including eight women and ten men with inflammatory rheumatic joint diseases, aged 29-62 years. The interviews were recorded and transcribed verbatim. Data were analysed thematically. Four main themes were derived from the interviews: (i) relevance of sexual issues; (ii) vital conditions for communication; (iii) individual preferences in mode and timing of information and communication; and (iv) benefits of information and communication. The participants expressed that, although sexual issues are relevant, necessary conditions for good communication are largely lacking. HPs' knowledge, experience and personal skills, as well as having sufficient time were essential. HPs lack of initiating sexual topics contributed to uncertainty about whether their sexual challenges were disease related and whether it was a legitimate topic to discuss in rheumatology care. Patients wanted HPs to possess knowledge about possible disease-related challenges in sexual life and intimate relationships, and to facilitate communication about these aspects. There is a need to develop practice guidelines to enable HPs to integrate sexual issues as an aspect of healthcare delivery in a patient-friendly manner. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  3. Simulation

    Ross, Sheldon

    2006-01-01

    Ross's Simulation, Fourth Edition introduces aspiring and practicing actuaries, engineers, computer scientists and others to the practical aspects of constructing computerized simulation studies to analyze and interpret real phenomena. Readers learn to apply results of these analyses to problems in a wide variety of fields to obtain effective, accurate solutions and make predictions about future outcomes. This text explains how a computer can be used to generate random numbers, and how to use these random numbers to generate the behavior of a stochastic model over time. It presents the statist

  4. Numerical simulation of cerebrospinal fluid hydrodynamics in the healing process of hydrocephalus patients

    Gholampour, S.; Fatouraee, N.; Seddighi, A. S.; Seddighi, A.

    2017-05-01

    Three-dimensional computational models of the cerebrospinal fluid (CSF) flow and brain tissue are presented for evaluation of their hydrodynamic conditions before and after shunting for seven patients with non-communicating hydrocephalus. One healthy subject is also modeled to compare deviated patients data to normal conditions. The fluid-solid interaction simulation shows the CSF mean pressure and pressure amplitude (the superior index for evaluation of non-communicating hydrocephalus) in patients at a greater point than those in the healthy subject by 5.3 and 2 times, respectively.

  5. Population pharmacodynamic modeling and simulation of the respiratory effect of acetazolamide in decompensated COPD patients.

    Nicholas Heming

    Full Text Available Chronic obstructive pulmonary disease (COPD patients may develop metabolic alkalosis during weaning from mechanical ventilation. Acetazolamide is one of the treatments used to reverse metabolic alkalosis.619 time-respiratory (minute ventilation, tidal volume and respiratory rate and 207 time-PaCO2 observations were obtained from 68 invasively ventilated COPD patients. We modeled respiratory responses to acetazolamide in mechanically ventilated COPD patients and then simulated the effect of increased amounts of the drug.The effect of acetazolamide on minute ventilation and PaCO2 levels was analyzed using a nonlinear mixed effect model. The effect of different ventilatory modes was assessed on the model. Only slightly increased minute ventilation without decreased PaCO2 levels were observed in response to 250 to 500 mg of acetazolamide administered twice daily. Simulations indicated that higher acetazolamide dosage (>1000 mg daily was required to significantly increase minute ventilation (P0.75 L min(-1 in 60% of the population. The model also predicts that 45% of patients would have a decrease of PaCO2>5 mmHg with doses of 1000 mg per day.Simulations suggest that COPD patients might benefit from the respiratory stimulant effect after the administration of higher doses of acetazolamide.

  6. Management of queues in out-patient departments: the use of computer simulation.

    Aharonson-Daniel, L; Paul, R J; Hedley, A J

    1996-01-01

    Notes that patients attending public outpatient departments in Hong Kong spend a long time waiting for a short consultation, that clinics are congested and that both staff and patients are dissatisfied. Points out that experimentation of management changes in a busy clinical environment can be both expensive and difficult. Demonstrates computerized simulation modelling as a potential tool for clarifying processes occurring within such systems, improving clinic operation by suggesting possible answers to problems identified and evaluating the solutions, without interfering with the clinic routine. Adds that solutions can be implemented after they had proved to be successful on the model. Demonstrates some ways in which managers in health care facilities can benefit from the use of computerized simulation modelling. Specifically, shows the effect of changing the duration of consultation and the effect of the application of an appointment system on patients' waiting time.

  7. Ventriculostomy Simulation Using Patient-Specific Ventricular Anatomy, 3D Printing, and Hydrogel Casting.

    Ryan, Justin R; Chen, Tsinsue; Nakaji, Peter; Frakes, David H; Gonzalez, L Fernando

    2015-11-01

    Educational simulators provide a means for students and experts to learn and refine surgical skills. Educators can leverage the strengths of medical simulators to effectively teach complex and high-risk surgical procedures, such as placement of an external ventricular drain. Our objective was to develop a cost-effective, patient-derived medical simulacrum for cerebral lateral ventriculostomy. A cost-effective, patient-derived medical simulacrum was developed for placement of an external lateral ventriculostomy. Elastomeric and gel casting techniques were used to achieve realistic brain geometry and material properties. 3D printing technology was leveraged to develop accurate cranial properties and dimensions. An economical, gravity-driven pump was developed to provide normal and abnormal ventricular pressures. A small pilot study was performed to gauge simulation efficacy using a technology acceptance model. An accurate geometric representation of the brain was developed with independent lateral cerebral ventricular chambers. A gravity-driven pump pressurized the ventricular cavities to physiologic values. A qualitative study illustrated that the simulation has potential as an educational tool to train medical professionals in the ventriculostomy procedure. The ventricular simulacrum can improve learning in a medical education environment. Rapid prototyping and multi-material casting techniques can produce patient-derived models for cost-effective and realistic surgical training scenarios. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Learning outcomes associated with patient simulation method in pharmacotherapy education: an integrative review.

    Aura, Suvi M; Sormunen, Marjorita S T; Jordan, Sue E; Tossavainen, Kerttu A; Turunen, Hannele E

    2015-06-01

    The aims of this systematic integrative review were to identify evidence for the use of patient simulation teaching methods in pharmacotherapy education and to explore related learning outcomes. A systematic literature search was conducted using 6 databases as follows: CINAHL, PubMed, SCOPUS, ERIC, MEDIC, and the Cochrane Library, using the key words relating to patient simulation and pharmacotherapy. The methodological quality of each study was evaluated. Eighteen articles met the inclusion criteria. The earliest article was published in 2005. The selected research articles were subjected to qualitative content analysis. Patient simulation has been used in pharmacotherapy education for preregistration nursing, dental, medical, and pharmacy students and for the continuing education of nurses. Learning outcomes reported were summarized as follows: (1) commitment to pharmacotherapy learning, (2) development of pharmacotherapy evaluation skills, (3) improvement in pharmacotherapy application skills, and (4) knowledge and understanding of pharmacotherapy. To develop effective teaching methods and ensure health care professionals' competence in medication management, further research is needed to determine the educational and clinical effectiveness of simulation teaching methods.

  9. A simulation framework for mapping risks in clinical processes: the case of in-patient transfers

    Ong, Mei-Sing; Westbrook, Johanna I; Magrabi, Farah; Coiera, Enrico; Wobcke, Wayne

    2011-01-01

    Objective To model how individual violations in routine clinical processes cumulatively contribute to the risk of adverse events in hospital using an agent-based simulation framework. Design An agent-based simulation was designed to model the cascade of common violations that contribute to the risk of adverse events in routine clinical processes. Clinicians and the information systems that support them were represented as a group of interacting agents using data from direct observations. The model was calibrated using data from 101 patient transfers observed in a hospital and results were validated for one of two scenarios (a misidentification scenario and an infection control scenario). Repeated simulations using the calibrated model were undertaken to create a distribution of possible process outcomes. The likelihood of end-of-chain risk is the main outcome measure, reported for each of the two scenarios. Results The simulations demonstrate end-of-chain risks of 8% and 24% for the misidentification and infection control scenarios, respectively. Over 95% of the simulations in both scenarios are unique, indicating that the in-patient transfer process diverges from prescribed work practices in a variety of ways. Conclusions The simulation allowed us to model the risk of adverse events in a clinical process, by generating the variety of possible work subject to violations, a novel prospective risk analysis method. The in-patient transfer process has a high proportion of unique trajectories, implying that risk mitigation may benefit from focusing on reducing complexity rather than augmenting the process with further rule-based protocols. PMID:21486883

  10. Web-based multimedia courseware for emergency cardiac patient management simulations.

    Ambrosiadou, V; Compton, T; Panchal, T; Polovina, S

    2000-01-01

    This is a multidisciplinary inter-departmental/faculty project between the departments of computer science, electronic, communications and electrical engineering and nursing and paramedic sciences. The objective is to develop a web based multimedia front end to existing simulations of cardiac emergency scenaria. It will be used firstly in the teaching of nurses. The University of Hertfordshire is the only University in Britain using simulations of cardiac emergency scenaria for nurse and paramedic science education and therefore this project will add the multimedia dimension in distributed courses over the web and will assess the improvement in the educational process. The use of network and multimedia technologies, provide interactive learning, immediate feedback to students' responses, individually tailored instructions, objective testing and entertaining delivery. The end product of this project will serve as interactive material to enhance experiential learning for nursing students using the simulations of cardiac emergency scenaria. The emergency treatment simulations have been developed using VisSim and may be compiled as C code. The objective of the project is to provide a web based user friendly multimedia interface in order to demonstrate the way in which patients may be managed in critical situations by applying advanced technological equipment and drug administration. Then the user will be able to better appreciate the concepts involved by running the VisSim simulations. The evaluation group for the proposed software will be the Department of Nursing and Paramedic Sciences About 200 nurses use simulations every year for training purposes as part of their course requirements.

  11. TH-CD-207A-08: Simulated Real-Time Image Guidance for Lung SBRT Patients Using Scatter Imaging

    Redler, G; Cifter, G; Templeton, A; Lee, C; Bernard, D; Liao, Y; Zhen, H; Turian, J; Chu, J [Rush University Medical Center, Chicago, IL (United States)

    2016-06-15

    Purpose: To develop a comprehensive Monte Carlo-based model for the acquisition of scatter images of patient anatomy in real-time, during lung SBRT treatment. Methods: During SBRT treatment, images of patient anatomy can be acquired from scattered radiation. To rigorously examine the utility of scatter images for image guidance, a model is developed using MCNP code to simulate scatter images of phantoms and lung cancer patients. The model is validated by comparing experimental and simulated images of phantoms of different complexity. The differentiation between tissue types is investigated by imaging objects of known compositions (water, lung, and bone equivalent). A lung tumor phantom, simulating materials and geometry encountered during lung SBRT treatments, is used to investigate image noise properties for various quantities of delivered radiation (monitor units(MU)). Patient scatter images are simulated using the validated simulation model. 4DCT patient data is converted to an MCNP input geometry accounting for different tissue composition and densities. Lung tumor phantom images acquired with decreasing imaging time (decreasing MU) are used to model the expected noise amplitude in patient scatter images, producing realistic simulated patient scatter images with varying temporal resolution. Results: Image intensity in simulated and experimental scatter images of tissue equivalent objects (water, lung, bone) match within the uncertainty (∼3%). Lung tumor phantom images agree as well. Specifically, tumor-to-lung contrast matches within the uncertainty. The addition of random noise approximating quantum noise in experimental images to simulated patient images shows that scatter images of lung tumors can provide images in as fast as 0.5 seconds with CNR∼2.7. Conclusions: A scatter imaging simulation model is developed and validated using experimental phantom scatter images. Following validation, lung cancer patient scatter images are simulated. These simulated

  12. TH-CD-207A-08: Simulated Real-Time Image Guidance for Lung SBRT Patients Using Scatter Imaging

    Redler, G; Cifter, G; Templeton, A; Lee, C; Bernard, D; Liao, Y; Zhen, H; Turian, J; Chu, J

    2016-01-01

    Purpose: To develop a comprehensive Monte Carlo-based model for the acquisition of scatter images of patient anatomy in real-time, during lung SBRT treatment. Methods: During SBRT treatment, images of patient anatomy can be acquired from scattered radiation. To rigorously examine the utility of scatter images for image guidance, a model is developed using MCNP code to simulate scatter images of phantoms and lung cancer patients. The model is validated by comparing experimental and simulated images of phantoms of different complexity. The differentiation between tissue types is investigated by imaging objects of known compositions (water, lung, and bone equivalent). A lung tumor phantom, simulating materials and geometry encountered during lung SBRT treatments, is used to investigate image noise properties for various quantities of delivered radiation (monitor units(MU)). Patient scatter images are simulated using the validated simulation model. 4DCT patient data is converted to an MCNP input geometry accounting for different tissue composition and densities. Lung tumor phantom images acquired with decreasing imaging time (decreasing MU) are used to model the expected noise amplitude in patient scatter images, producing realistic simulated patient scatter images with varying temporal resolution. Results: Image intensity in simulated and experimental scatter images of tissue equivalent objects (water, lung, bone) match within the uncertainty (∼3%). Lung tumor phantom images agree as well. Specifically, tumor-to-lung contrast matches within the uncertainty. The addition of random noise approximating quantum noise in experimental images to simulated patient images shows that scatter images of lung tumors can provide images in as fast as 0.5 seconds with CNR∼2.7. Conclusions: A scatter imaging simulation model is developed and validated using experimental phantom scatter images. Following validation, lung cancer patient scatter images are simulated. These simulated

  13. The role of simulation in mixed-methods research: a framework & application to patient safety.

    Guise, Jeanne-Marie; Hansen, Matthew; Lambert, William; O'Brien, Kerth

    2017-05-04

    Research in patient safety is an important area of health services research and is a national priority. It is challenging to investigate rare occurrences, explore potential causes, and account for the complex, dynamic context of healthcare - yet all are required in patient safety research. Simulation technologies have become widely accepted as education and clinical tools, but have yet to become a standard tool for research. We developed a framework for research that integrates accepted patient safety models with mixed-methods research approaches and describe the performance of the framework in a working example of a large National Institutes of Health (NIH)-funded R01 investigation. This worked example of a framework in action, identifies the strengths and limitations of qualitative and quantitative research approaches commonly used in health services research. Each approach builds essential layers of knowledge. We describe how the use of simulation ties these layers of knowledge together and adds new and unique dimensions of knowledge. A mixed-methods research approach that includes simulation provides a broad multi-dimensional approach to health services and patient safety research.

  14. Simulation-based multidisciplinary team training decreases time to critical operations for trauma patients.

    Murphy, Margaret; Curtis, Kate; Lam, Mary K; Palmer, Cameron S; Hsu, Jeremy; McCloughen, Andrea

    2018-05-01

    Simulation has been promoted as a platform for training trauma teams. However, it is not clear if this training has an impact on health service delivery and patient outcomes. This study evaluates the association between implementation of a simulation based multidisciplinary trauma team training program at a metropolitan trauma centre and subsequent patient outcomes. This was a retrospective review of trauma registry data collected at an 850-bed Level 1 Adult Trauma Centre in Sydney, Australia. Two concurrent four-year periods, before and after implementation of a simulation based multidisciplinary trauma team training program were compared for differences in time to critical operations, Emergency Department (ED) length of stay (LOS) and patient mortality. There were 2389 major trauma patients admitted to the hospital during the study, 1116 in the four years preceding trauma team training (the PREgroup) and 1273 in the subsequent 4 years (the POST group). There were no differences between the groups with respect to gender, body region injured, incidence of polytrauma, and pattern of arrival to ED. The POST group was older (median age 54 versus 43 years, p team training was associated with a reduction in time to critical operation while overall ED length of stay increased. Simulation is promoted as a platform for training teams; but the complexity of trauma care challenges efforts to demonstrate direct links between multidisciplinary team training and improved outcomes. There remain considerable gaps in knowledge as to how team training impacts health service delivery and patient outcomes. Retrospective comparative therapeutic/care management study, Level III evidence. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

  15. Using Simulations to Improve Electronic Health Record Use, Clinician Training and Patient Safety: Recommendations From A Consensus Conference

    Mohan, Vishnu; Woodcock, Deborah; McGrath, Karess; Scholl, Gretchen; Pranaat, Robert; Doberne, Julie W.; Chase, Dian A.; Gold, Jeffrey A.; Ash, Joan S.

    2017-01-01

    A group of informatics experts in simulation, biomedical informatics, patient safety, medical education, and human factors gathered at Corbett, Oregon on April 30 and May 1, 2015. Their objective: to create a consensus statement on best practices for the use of electronic health record (EHR) simulations in education and training, to improve patient safety, and to outline a strategy for future EHR simulation work. A qualitative approach was utilized to analyze data from the conference and gene...

  16. Using screen-based simulation of inhaled anaesthetic delivery to improve patient care.

    Philip, J H

    2015-12-01

    Screen-based simulation can improve patient care by giving novices and experienced clinicians insight into drug behaviour. Gas Man(®) is a screen-based simulation program that depicts pictorially and graphically the anaesthetic gas and vapour tension from the vaporizer to the site of action, namely the brain and spinal cord. The gases and vapours depicted are desflurane, enflurane, ether, halothane, isoflurane, nitrogen, nitrous oxide, sevoflurane, and xenon. Multiple agents can be administered simultaneously or individually and the results shown on an overlay graph. Practice exercises provide in-depth knowledge of the subject matter. Experienced clinicians can simulate anaesthesia occurrences and practices for application to their clinical practice, and publish the results to benefit others to improve patient care. Published studies using this screen-based simulation have led to a number of findings, as follows: changing from isoflurane to desflurane toward the end of anaesthesia does not accelerate recovery in humans; vital capacity induction can produce loss of consciousness in 45 s; simulated context-sensitive decrement times explain recovery profiles; hyperventilation does not dramatically speed emergence; high fresh gas flow is wasteful; fresh gas flow and not the vaporizer setting should be reduced during intubation; re-anaesthetization can occur with severe hypoventilation after extubation; and in re-anaesthetization, the anaesthetic redistributes from skeletal muscle. Researchers using screen-based simulations can study fewer subjects to reach valid conclusions that impact clinical care. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  17. Use of multiple patient simulators to enhance prioritizing and delegating skills for senior nursing students.

    Kaplan, Barbara; Ura, Darla

    2010-07-01

    The student clinical experience is rich, yet challenges arise in providing experiences where leadership skills can be developed and used in nursing practice. To increase student confidence and enhance student ability to safely and effectively prioritize, delegate, and implement care for numerous patients, a simulation-based learning (SBL) experience was developed. The SBL experience involves multiple patient simulators, case study analysis, and a debriefing session. Ninety-seven senior nursing students participated in this program. Students reported through Likert surveys to either "agree" or "strongly agree" that the SBL was well organized (87%, n = 84), prompted realistic expectations (59%, n = 57), the scenarios were believable (73%, n = 71), case studies increased understanding (66%, n = 64), and that the SBL experience increased understanding of prioritizing and delegating care (69%, n = 67). Seventy-eight percent (n = 76) reported "more confidence in ability to work as a team" and 55% (n = 52) reported "more confidence in prioritizing and delegating care." Copyright 2010, SLACK Incorporated.

  18. Encouraging post-stroke patients to be active seems possible: results of an intervention study with knowledge brokers.

    Willems, Mia; Schröder, Carin; van der Weijden, Trudy; Post, Marcel W; Visser-Meily, Anne M

    2016-08-01

    Although physical activity and exercise for stroke patients is highly recommended for fast recovery, patients in hospitals and rehabilitation centres are insufficiently encouraged to be physically active. In this study, we investigated the impact of knowledge brokers (KBs), enterprising nurses and therapists, on health professionals' (HP) performance to encourage stroke inpatients to be physically active. This multicenter intervention study used a pre-post test design. Two or three KBs were trained in each stroke unit of 12 hospitals and 10 rehabilitation centres in The Netherlands. Questionnaires were completed by patients and HPs before and after the KB-intervention. The primary outcome was encouragement given by HPs to their patients to be physically active, as reported by patients and HPs. After the KB-intervention, many more patients (48%; N=217) reported at least some encouragement by HPs to be physically active than before (26%; N=243, pbrokers (KBs), since the KB-intervention was shown to increase the encouragement felt by stroke patients to be physically active. It seems worthwhile to involve physicians, nurses and patients' families more frequently in efforts to encourage stroke patients to be physically active.

  19. ADAM, a hands-on patient simulator for teaching principles of drug disposition and compartmental pharmacokinetics.

    Zuna, Ines; Holt, Andrew

    2017-11-01

    To design, construct and validate a pharmacokinetics simulator that offers students hands-on opportunities to participate in the design, administration and analysis of oral and intravenous dosing regimens. The Alberta Drug Administration Modeller (ADAM) is a mechanical patient in which peristaltic circulation of water through a network of silicone tubing and glass bottles creates a representation of the outcomes of drug absorption, distribution, metabolism and elimination. Changing peristaltic pump rates and volumes in bottles allows values for pharmacokinetic constants to be varied, thereby simulating differences in drug properties and in patient physiologies and pathologies. Following administration of methylene blue dye by oral or intravenous routes, plasma and/or urine samples are collected and drug concentrations are determined spectrophotometrically. The effectiveness of the simulator in enhancing student competence and confidence was assessed in two undergraduate laboratory classes. The simulator effectively models one- and two-compartment drug behaviour in a mathematically-robust and realistic manner. Data allow calculation of numerous pharmacokinetic constants, by traditional graphing methods or with curve-fitting software. Students' competence in solving pharmacokinetic problems involving calculations and graphing improved significantly, while an increase in confidence and understanding was reported. The ADAM is relatively inexpensive and straightforward to construct, and offers a realistic, hands-on pharmacokinetics learning opportunity for students that effectively complements didactic lectures. © 2017 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.

  20. Collaborative learning in nursing simulation: near-peer teaching using standardized patients.

    Owen, Amy M; Ward-Smith, Peggy

    2014-03-01

    Simulation in nursing education uses specific patient scenarios to provide students with hands-on learning experiences. A near-peer teaching experience, using upper-level nursing students as standardized patients, was created as an educational intervention. The premises of social cognitive theory, which include cognitive, behavioral, and environmental factors, were incorporated into this teaching activity. The upper-level students played the role of a patient, while they also practiced leadership, teaching, and mentoring of first-semester nursing students. In the scenario, the first-semester students provided care to the patient, while focusing on safety, identifying the problem, and practicing clinical decision making. Faculty were present to provide guidance and promote communication in debriefing. Near-peer teaching provided a learning opportunity for all students, facilitated teamwork, and encouraged knowledge and skills attainment. Copyright 2014, SLACK Incorporated.

  1. Patient safety and quality of care: how may clinical simulation contribute?

    Jensen, Sanne

    2015-01-01

    The usability of health information technology (IT) is increasingly recognized as critically important to the development of systems that ensure patient safety and quality of care. The substantial complexity of organizations, work practice and physical environments within the healthcare sector...... influences the development and application of health IT. When health IT is introduced in local clinical work practices, potential patient safety hazards and insufficient support of work practices need to be examined. Qualitative methods, such as clinical simulation, may be used to evaluate new technology...

  2. Quantitative Simulations Predict Treatment Strategies Against Fungal Infections in Virtual Neutropenic Patients.

    Timme, Sandra; Lehnert, Teresa; Prauße, Maria T E; Hünniger, Kerstin; Leonhardt, Ines; Kurzai, Oliver; Figge, Marc Thilo

    2018-01-01

    The condition of neutropenia, i.e., a reduced absolute neutrophil count in blood, constitutes a major risk factor for severe infections in the affected patients. Candida albicans and Candida glabrata are opportunistic pathogens and the most prevalent fungal species in the human microbiota. In immunocompromised patients, they can become pathogenic and cause infections with high mortality rates. In this study, we use a previously established approach that combines experiments and computational models to investigate the innate immune response during blood stream infections with the two fungal pathogens C. albicans and C. glabrata . First, we determine immune-reaction rates and migration parameters under healthy conditions. Based on these findings, we simulate virtual patients and investigate the impact of neutropenic conditions on the infection outcome with the respective pathogen. Furthermore, we perform in silico treatments of these virtual patients by simulating a medical treatment that enhances neutrophil activity in terms of phagocytosis and migration. We quantify the infection outcome by comparing the response to the two fungal pathogens relative to non-neutropenic individuals. The analysis reveals that these fungal infections in neutropenic patients can be successfully cleared by cytokine treatment of the remaining neutrophils; and that this treatment is more effective for C. glabrata than for C. albicans .

  3. Feasibility of utilizing a commercial eye tracker to assess electronic health record use during patient simulation.

    Gold, Jeffrey Allen; Stephenson, Laurel E; Gorsuch, Adriel; Parthasarathy, Keshav; Mohan, Vishnu

    2016-09-01

    Numerous reports describe unintended consequences of electronic health record implementation. Having previously described physicians' failures to recognize patient safety issues within our electronic health record simulation environment, we now report on our use of eye and screen-tracking technology to understand factors associated with poor error recognition during an intensive care unit-based electronic health record simulation. We linked performance on the simulation to standard eye and screen-tracking readouts including number of fixations, saccades, mouse clicks and screens visited. In addition, we developed an overall Composite Eye Tracking score which measured when, where and how often each safety item was viewed. For 39 participants, the Composite Eye Tracking score correlated with performance on the simulation (p = 0.004). Overall, the improved performance was associated with a pattern of rapid scanning of data manifested by increased number of screens visited (p = 0.001), mouse clicks (p = 0.03) and saccades (p = 0.004). Eye tracking can be successfully integrated into electronic health record-based simulation and provides a surrogate measure of cognitive decision making and electronic health record usability. © The Author(s) 2015.

  4. Medical images of patients in voxel structures in high resolution for Monte Carlo simulation

    Boia, Leonardo S.; Menezes, Artur F.; Silva, Ademir X.

    2011-01-01

    This work aims to present a computational process of conversion of tomographic and MRI medical images from patients in voxel structures to an input file, which will be manipulated in Monte Carlo Simulation code for tumor's radiotherapic treatments. The problem's scenario inherent to the patient is simulated by such process, using the volume element (voxel) as a unit of computational tracing. The head's voxel structure geometry has voxels with volumetric dimensions around 1 mm 3 and a population of millions, which helps - in that way, for a realistic simulation and a decrease in image's digital process techniques for adjustments and equalizations. With such additional data from the code, a more critical analysis can be developed in order to determine the volume of the tumor, and the protection, beside the patients' medical images were borrowed by Clinicas Oncologicas Integradas (COI/RJ), joined to the previous performed planning. In order to execute this computational process, SAPDI computational system is used in a digital image process for optimization of data, conversion program Scan2MCNP, which manipulates, processes, and converts the medical images into voxel structures to input files and the graphic visualizer Moritz for the verification of image's geometry placing. (author)

  5. A tool for assessing case history and feedback skills in audiology students working with simulated patients.

    Hughes, Jane; Wilson, Wayne J; MacBean, Naomi; Hill, Anne E

    2016-12-01

    To develop a tool for assessing audiology students taking a case history and giving feedback with simulated patients (SP). Single observation, single group design. Twenty-four first-year audiology students, five simulated patients, two clinical educators, and three evaluators. The Audiology Simulated Patient Interview Rating Scale (ASPIRS) was developed consisting of six items assessing specific clinical skills, non-verbal communication, verbal communication, interpersonal skills, interviewing skills, and professional practice skills. These items are applied once for taking a case history and again for giving feedback. The ASPIRS showed very high internal consistency (α = 0.91-0.97; mean inter-item r = 0.64-0.85) and fair-to-moderate agreement between evaluators (29.2-54.2% exact and 79.2-100% near agreement; κ weighted up to 0.60). It also showed fair-to-moderate absolute agreement amongst evaluators for single evaluator scores (intraclass correlation coefficient [ICC] r = 0.35-0.59) and substantial consistency of agreement amongst evaluators for three-evaluator averaged scores (ICC r = 0.62-0.81). Factor analysis showed the ASPIRS' 12 items fell into two components, one containing all feedback items and one containing all case history items. The ASPIRS shows promise as the first published tool for assessing audiology students taking a case history and giving feedback with an SP.

  6. Medical images of patients in voxel structures in high resolution for Monte Carlo simulation

    Boia, Leonardo S.; Menezes, Artur F.; Silva, Ademir X., E-mail: lboia@con.ufrj.b, E-mail: ademir@con.ufrj.b [Universidade Federal do Rio de Janeiro (PEN/COPPE/UFRJ), RJ (Brazil). Coordenacao dos Programas de Pos-Graduacao de Engenharia. Programa de Engenharia Nuclear; Salmon Junior, Helio A. [Clinicas Oncologicas Integradas (COI), Rio de Janeiro, RJ (Brazil)

    2011-07-01

    This work aims to present a computational process of conversion of tomographic and MRI medical images from patients in voxel structures to an input file, which will be manipulated in Monte Carlo Simulation code for tumor's radiotherapic treatments. The problem's scenario inherent to the patient is simulated by such process, using the volume element (voxel) as a unit of computational tracing. The head's voxel structure geometry has voxels with volumetric dimensions around 1 mm{sup 3} and a population of millions, which helps - in that way, for a realistic simulation and a decrease in image's digital process techniques for adjustments and equalizations. With such additional data from the code, a more critical analysis can be developed in order to determine the volume of the tumor, and the protection, beside the patients' medical images were borrowed by Clinicas Oncologicas Integradas (COI/RJ), joined to the previous performed planning. In order to execute this computational process, SAPDI computational system is used in a digital image process for optimization of data, conversion program Scan2MCNP, which manipulates, processes, and converts the medical images into voxel structures to input files and the graphic visualizer Moritz for the verification of image's geometry placing. (author)

  7. Development, implementation and pilot evaluation of a Web-based Virtual Patient Case Simulation environment – Web-SP

    Boberg Jonas; Johnson Gunilla; Zary Nabil; Fors Uno GH

    2006-01-01

    Abstract Background The Web-based Simulation of Patients (Web-SP) project was initiated in order to facilitate the use of realistic and interactive virtual patients (VP) in medicine and healthcare education. Web-SP focuses on moving beyond the technology savvy teachers, when integrating simulation-based education into health sciences curricula, by making the creation and use of virtual patients easier. The project strives to provide a common generic platform for design/creation, management, e...

  8. SimTCM: A human patient simulator with application to diagnostic accuracy studies of Chinese medicine.

    Ferreira, Arthur de Sá; Pacheco, Antonio Guilherme

    2015-01-01

    The aim of this work is to develop and implement the SimTCM, an advanced computational model that incorporates relevant aspects from traditional Chinese medicine (TCM) theory as well as advanced statistical and epidemiological techniques for simulation and analysis of human patients. SimTCM presents five major attributes for simulation: representation of true and false profiles for any single pattern; variable count of manifestations for each manifestation profile; empirical distributions of patterns and manifestations in a disease-specific population; incorporation of uncertainty in clinical data; and the combination of the four examinations. The proposed model is strengthened by following international standards for reporting diagnostic accuracy studies, and incorporates these standards in its treatment of study population, sample size calculation, data collection of manifestation profiles, exclusion criteria and missing data handling, reference standards, randomization and blinding, and test reproducibility. Simulations using data from patients diagnosed with hypertension and post-stroke sensory-motor impairments yielded no significant differences between expected and simulated frequencies of patterns (P=0.22 or higher). Time for convergence of simulations varied from 9.90 s (9.80, 10.27) to 28.31 s (26.33, 29.52). The ratio iteration profile necessary for convergence varied between 1:1 and 5:1. This model is directly connected to forthcoming models in a large project to design and implement the SuiteTCM: ProntTCM, SciTCM, DiagTCM, StudentTCM, ResearchTCM, HerbsTCM, AcuTCM, and DataTCM. It is expected that the continuity of the SuiteTCM project enhances the evidence-based practice of Chinese medicine. The software is freely available for download at: http://suitetcm.unisuam.edu.br.

  9. Educational effects using a robot patient simulation system for development of clinical attitude.

    Abe, S; Noguchi, N; Matsuka, Y; Shinohara, C; Kimura, T; Oka, K; Okura, K; Rodis, O M M; Kawano, F

    2017-11-01

    The aim of this study was to assess the effectiveness of improving the attitude of dental students towards the use of a full-body patient simulation system (SIMROID) compared to the traditional mannequin (CLINSIM) for dental clinical education. The participants were 10 male undergraduate dental students who had finished clinical training in the university hospital 1 year before this study started. They performed a crown preparation on an upper pre-molar tooth using SIMROID and CLINSIM as the practical clinical trials. The elapsed time for preparation was recorded. The taper of the abutment teeth was measured using a 3-dimensional shape-measuring device after this trial. In addition, a self-reported questionnaire was collected that included physical pain, treatment safety and maintaining a clean area for each simulator. Qualitative data analysis of a free format report about SIMROID was performed using text mining analysis. This trial was performed twice at 1-month intervals. The students considered physical pain, treatment safety and a clean area for SIMROID significantly better than that for CLINSIM (P mining analysis, most of the students wrote that SIMROID was similar to real patients. The use of SIMROID was proven to be effective in improving the attitude of students towards patients, thereby giving importance to considerations for actual patients during dental treatment. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Are Non-Newtonian Effects Important in Hemodynamic Simulations of Patients With Autogenous Fistula?

    Javid Mahmoudzadeh Akherat, S M; Cassel, Kevin; Boghosian, Michael; Dhar, Promila; Hammes, Mary

    2017-04-01

    Given the current emphasis on accurate computational fluid dynamics (CFD) modeling of cardiovascular flows, which incorporates realistic blood vessel geometries and cardiac waveforms, it is necessary to revisit the conventional wisdom regarding the influences of non-Newtonian effects. In this study, patient-specific reconstructed 3D geometries, whole blood viscosity data, and venous pulses postdialysis access surgery are used as the basis for the hemodynamic simulations of renal failure patients with native fistula access. Rheological analysis of the viscometry data initially suggested that the correct choice of constitutive relations to capture the non-Newtonian behavior of blood is important because the end-stage renal disease (ESRD) patient cohort under observation experience drastic variations in hematocrit (Hct) levels and whole blood viscosity throughout the hemodialysis treatment. For this purpose, various constitutive relations have been tested and implemented in CFD practice, namely Quemada and Casson. Because of the specific interest in neointimal hyperplasia and the onset of stenosis in this study, particular attention is placed on differences in nonhomeostatic wall shear stress (WSS) as that drives the venous adaptation process that leads to venous geometric evolution over time in ESRD patients. Surprisingly, the CFD results exhibit no major differences in the flow field and general flow characteristics of a non-Newtonian simulation and a corresponding identical Newtonian counterpart. It is found that the vein's geometric features and the dialysis-induced flow rate have far greater influence on the WSS distribution within the numerical domain.

  11. Are Non-Newtonian Effects Important in Hemodynamic Simulations of Patients With Autogenous Fistula?

    Javid Mahmoudzadeh Akherat, S. M.; Cassel, Kevin; Boghosian, Michael; Dhar, Promila; Hammes, Mary

    2017-01-01

    Given the current emphasis on accurate computational fluid dynamics (CFD) modeling of cardiovascular flows, which incorporates realistic blood vessel geometries and cardiac waveforms, it is necessary to revisit the conventional wisdom regarding the influences of non-Newtonian effects. In this study, patient-specific reconstructed 3D geometries, whole blood viscosity data, and venous pulses postdialysis access surgery are used as the basis for the hemodynamic simulations of renal failure patients with native fistula access. Rheological analysis of the viscometry data initially suggested that the correct choice of constitutive relations to capture the non-Newtonian behavior of blood is important because the end-stage renal disease (ESRD) patient cohort under observation experience drastic variations in hematocrit (Hct) levels and whole blood viscosity throughout the hemodialysis treatment. For this purpose, various constitutive relations have been tested and implemented in CFD practice, namely Quemada and Casson. Because of the specific interest in neointimal hyperplasia and the onset of stenosis in this study, particular attention is placed on differences in nonhomeostatic wall shear stress (WSS) as that drives the venous adaptation process that leads to venous geometric evolution over time in ESRD patients. Surprisingly, the CFD results exhibit no major differences in the flow field and general flow characteristics of a non-Newtonian simulation and a corresponding identical Newtonian counterpart. It is found that the vein's geometric features and the dialysis-induced flow rate have far greater influence on the WSS distribution within the numerical domain. PMID:28249082

  12. Design, development, and performance of an adapter for simulation of ocular melanoma patients in supine position for proton beam therapy

    Daftari, I.; Phillips, T.L.

    2003-01-01

    A patient assembly adapter system for ocular melanoma patient simulation was developed and its performance evaluated. The aim for the construction of the apparatus was to simulate the patients in supine position using a commercial x-ray simulator. The apparatus consists of a base plate, head immobilization holder, patient assembly system that includes fixation light and collimator system. The reproducibility of the repeated fixation was initially tested with a head phantom. Simulation and verification films were studied for seven consecutive patients treated with proton beam therapy. Patient's simulation was performed in a supine position using a dental fixation bite block and a thermoplastic head mask immobilization device with a patient adapter system. Two orthogonal x rays were used to obtain the x, y, and z coordinates of sutured tantalum rings for treatment planning with the EYEPLAN software. The verification films were obtained in treatment position with the fixation light along the central axis of the eye. The results indicate good agreement within 0.5 mm deviations. The results of this investigation showed that the same planning accuracy could be achieved by performing simulation using the adapter described above with a patient in the supine position as that obtained by performing simulation with the patient in the seated, treatment position. The adapter can also be attached to the head of the chair for simulating in the seated position using a fixed x-ray unit. This has three advantages: (1) this will save radiation therapists time; (2) it eliminates the need for arranging access to the treatment room, thus avoiding potential conflicts in treatment room usage; and (3) it allows the use of a commercial simulator

  13. Design, development, and performance of an adapter for simulation of ocular melanoma patients in supine position for proton beam therapy

    Daftari, I.; Phillips, T. L.

    2003-06-01

    A patient assembly adapter system for ocular melanoma patient simulation was developed and its performance evaluated. The aim for the construction of the apparatus was to simulate the patients in supine position using a commercial x-ray simulator. The apparatus consists of a base plate, head immobilization holder, patient assembly system that includes fixation light and collimator system. The reproducibility of the repeated fixation was initially tested with a head phantom. Simulation and verification films were studied for seven consecutive patients treated with proton beam therapy. Patient's simulation was performed in a supine position using a dental fixation bite block and a thermoplastic head mask immobilization device with a patient adapter system. Two orthogonal x rays were used to obtain the x, y, and z coordinates of sutured tantalum rings for treatment planning with the EYEPLAN software. The verification films were obtained in treatment position with the fixation light along the central axis of the eye. The results indicate good agreement within 0.5 mm deviations. The results of this investigation showed that the same planning accuracy could be achieved by performing simulation using the adapter described above with a patient in the supine position as that obtained by performing simulation with the patient in the seated, treatment position. The adapter can also be attached to the head of the chair for simulating in the seated position using a fixed x-ray unit. This has three advantages: (1) this will save radiation therapists time; (2) it eliminates the need for arranging access to the treatment room, thus avoiding potential conflicts in treatment room usage; and (3) it allows the use of a commercial simulator.

  14. The cost of harm and savings through safety: using simulated patients for leadership decision support.

    Denham, Charles R; Guilloteau, Franck R

    2012-09-01

    The ultimate objective of this program is to provide an approach to understanding and communicating health-care harm and cost to compel health-care provider leadership teams to vote "yes" to investments in patient safety initiatives, with the confidence that clinical, financial, and operational performance will be improved by such programs. Through a coordinated combination of literature evaluations, careful mapping of high impact scenarios using simulated patients and consensus review of clinical, operational, and financial factors, we confirmed value in such approaches to decision support information for hospital leadership teams to invest in patient safety projects. The study resulted in the following preliminary findings: ·Communication between hospital quality and finance departments can be much improved by direct collaborative relationships through regular meetings to help both clarify direct costs, indirect costs, and the savings of waste and harm to patients by avoidance of infections. ·Governance leaders and the professional administrative leaders should consider establishing the structures and systems necessary to act on risks and hazards as they evolve to deploy resources to areas of harm and risk. ·Quality and Infection Control Professionals can best wage their war on healthcare waste and harm by keeping abreast of the latest literature regarding the latest measures, standards, and safe practices for healthcare-acquired infections and hospital-acquired conditions. ·Regular reviews of patients with health-careYassociated infections, with direct attention to the attributable cost of treatment and how financial waste and harm to patients may be avoided, may provide hospital leaders with new insights for improvement. ·If hospitals developed their own risk scenarios to determine impact of harm and waste from hospital-acquired conditions in addition to impact scenarios for specific processes through technology and process innovations, they would have

  15. Embedding patient simulation in a pediatric cardiology rotation: a unique opportunity for improving resident education.

    Mohan, Shaun; Follansbee, Christopher; Nwankwo, Ugonna; Hofkosh, Dena; Sherman, Frederick S; Hamilton, Melinda F

    2015-01-01

    High-fidelity patient simulation (HFPS) has been used in medical education to bridge gaps in medical knowledge and clinical skills. Few studies have analyzed the impact of HFPS in subspecialty rotations for pediatric residents. We hypothesized that pediatric residents exposed to HFPS with a structured content curriculum would perform better on a case quiz than residents without exposure to HFPS. Prospective randomized controlled Tertiary-care free standing children's hospital During a cardiology rotation, senior pediatric residents completed an online pediatric cardiology curriculum and a cardiology quiz. After randomization into two groups, the study group participated in a fully debriefed HFPS session. The control group had no HFPS. Both groups completed a case quiz. Confidence surveys pre- and postsimulation were completed. From October 2010 through March 2013, 55 residents who rotated through the pediatric cardiology rotation were used in the final analysis (30 control, 25 in the study group). There was no significant difference between groups on the initial cardiology quiz. The study group scored higher on the case quiz compared with the control group (P = .024). Based on pre- and postsimulation questionnaires, residents' confidence in approaching a pediatric cardiology patient improved from an average Likert score of 5.1 to 7.5 (on scale of 0-10) (P cardiology rotation was feasible and well received. Our study suggests that simulation promotes increased confidence and may modestly improve clinical reasoning compared to traditional educational techniques. Targeted simulation sessions may readily be incorporated into pediatric subspecialty rotations. © 2014 Wiley Periodicals, Inc.

  16. A Simulation Study of a Radiofrequency Localization System for Tracking Patient Motion in Radiotherapy

    Mark Ostyn

    2016-04-01

    Full Text Available One of the most widely used tools in cancer treatment is external beam radiotherapy. However, the major risk involved in radiotherapy is excess radiation dose to healthy tissue, exacerbated by patient motion. Here, we present a simulation study of a potential radiofrequency (RF localization system designed to track intrafraction motion (target motion during the radiation treatment. This system includes skin-wearable RF beacons and an external tracking system. We develop an analytical model for direction of arrival measurement with radio frequencies (GHz range for use in a localization estimate. We use a Monte Carlo simulation to investigate the relationship between a localization estimate and angular resolution of sensors (signal receivers in a simulated room. The results indicate that the external sensor needs an angular resolution of about 0.03 degrees to achieve millimeter-level localization accuracy in a treatment room. This fundamental study of a novel RF localization system offers the groundwork to design a radiotherapy-compatible patient positioning system for active motion compensation.

  17. A Simulation Study of a Radiofrequency Localization System for Tracking Patient Motion in Radiotherapy.

    Ostyn, Mark; Kim, Siyong; Yeo, Woon-Hong

    2016-04-13

    One of the most widely used tools in cancer treatment is external beam radiotherapy. However, the major risk involved in radiotherapy is excess radiation dose to healthy tissue, exacerbated by patient motion. Here, we present a simulation study of a potential radiofrequency (RF) localization system designed to track intrafraction motion (target motion during the radiation treatment). This system includes skin-wearable RF beacons and an external tracking system. We develop an analytical model for direction of arrival measurement with radio frequencies (GHz range) for use in a localization estimate. We use a Monte Carlo simulation to investigate the relationship between a localization estimate and angular resolution of sensors (signal receivers) in a simulated room. The results indicate that the external sensor needs an angular resolution of about 0.03 degrees to achieve millimeter-level localization accuracy in a treatment room. This fundamental study of a novel RF localization system offers the groundwork to design a radiotherapy-compatible patient positioning system for active motion compensation.

  18. An efficient parallel simulation of unsteady blood flows in patient-specific pulmonary artery.

    Kong, Fande; Kheyfets, Vitaly; Finol, Ender; Cai, Xiao-Chuan

    2018-04-01

    Simulation of blood flows in the pulmonary artery provides some insight into certain diseases by examining the relationship between some continuum metrics, eg, the wall shear stress acting on the vascular endothelium, which responds to flow-induced mechanical forces by releasing vasodilators/constrictors. V. Kheyfets, in his previous work, studies numerically a patient-specific pulmonary circulation to show that decreasing wall shear stress is correlated with increasing pulmonary vascular impedance. In this paper, we develop a scalable parallel algorithm based on domain decomposition methods to investigate an unsteady model with patient-specific pulsatile waveforms as the inlet boundary condition. The unsteady model offers tremendously more information about the dynamic behavior of the flow field, but computationally speaking, the simulation is a lot more expensive since a problem which is similar to the steady-state problem has to be solved many times, and therefore, the traditional sequential approach is not suitable anymore. We show computationally that simulations using the proposed parallel approach with up to 10 000 processor cores can be obtained with much reduced compute time. This makes the technology potentially usable for the routine study of the dynamic behavior of blood flows in the pulmonary artery, in particular, the changes of the blood flows and the wall shear stress in the spatial and temporal dimensions. Copyright © 2017 John Wiley & Sons, Ltd.

  19. High-fidelity haptic and visual rendering for patient-specific simulation of temporal bone surgery.

    Chan, Sonny; Li, Peter; Locketz, Garrett; Salisbury, Kenneth; Blevins, Nikolas H

    2016-12-01

    Medical imaging techniques provide a wealth of information for surgical preparation, but it is still often the case that surgeons are examining three-dimensional pre-operative image data as a series of two-dimensional images. With recent advances in visual computing and interactive technologies, there is much opportunity to provide surgeons an ability to actively manipulate and interpret digital image data in a surgically meaningful way. This article describes the design and initial evaluation of a virtual surgical environment that supports patient-specific simulation of temporal bone surgery using pre-operative medical image data. Computational methods are presented that enable six degree-of-freedom haptic feedback during manipulation, and that simulate virtual dissection according to the mechanical principles of orthogonal cutting and abrasive wear. A highly efficient direct volume renderer simultaneously provides high-fidelity visual feedback during surgical manipulation of the virtual anatomy. The resulting virtual surgical environment was assessed by evaluating its ability to replicate findings in the operating room, using pre-operative imaging of the same patient. Correspondences between surgical exposure, anatomical features, and the locations of pathology were readily observed when comparing intra-operative video with the simulation, indicating the predictive ability of the virtual surgical environment.

  20. Translating medical documents improves students' communication skills in simulated physician-patient encounters.

    Bittner, Anja; Bittner, Johannes; Jonietz, Ansgar; Dybowski, Christoph; Harendza, Sigrid

    2016-02-27

    Patient-physician communication should be based on plain and simple language. Despite communication skill trainings in undergraduate medical curricula medical students and physicians are often still not aware of using medical jargon when communicating with patients. The aim of this study was to compare linguistic communication skills of undergraduate medical students who voluntarily translate medical documents into plain language with students who do not participate in this voluntary task. Fifty-nine undergraduate medical students participated in this study. Twenty-nine participants were actively involved in voluntarily translating medical documents for real patients into plain language on the online-platform https://washabich.de (WHI group) and 30 participants were not (non-WHI group). The assessment resembled a virtual consultation hour, where participants were connected via skype to six simulated patients (SPs). The SPs assessed participants' communication skills. All conversations were transcribed and assessed for communication skills and medical correctness by a blinded expert. All participants completed a self-assessment questionnaire on their communication skills. Across all raters, the WHI group was assessed significantly (p = .007) better than the non-WHI group regarding the use of plain language. The blinded expert assessed the WHI group significantly (p = .018) better regarding the use of stylistic devices of communication. The SPs would choose participants from the WHI group significantly (p = .041) more frequently as their personal physician. No significant differences between the two groups were observed with respect to the medical correctness of the consultations. Written translation of medical documents is associated with significantly more frequent use of plain language in simulated physician-patient encounters. Similar extracurricular exercises might be a useful tool for medical students to enhance their communication skills with

  1. Description of web-enhanced virtual character simulation system to standardize patient hand-offs.

    Filichia, Lori; Halan, Shivashankar; Blackwelder, Ethan; Rossen, Brent; Lok, Benjamin; Korndorffer, James; Cendan, Juan

    2011-04-01

    The 80-h work week has increased discontinuity of patient care resulting in reports of increased medication errors and preventable adverse events. Graduate medical programs are addressing these shortcomings in a number of ways. We have developed a computer simulation platform called the Virtual People Factory (VPF), which allows us to capture and simulate the dialogue between a real user and a virtual character. We have converted the system to reflect a physician in the process of "checking-out" a patient to a covering physician. The responses are tracked and matched to educator-defined information termed "discoveries." Our proof of concept represented a typical post-operative patient with tachycardia. The system is web enabled. So far, 26 resident users at two institutions have completed the module. The critical discovery of tachycardia was identified by 62% of users. Residents spend 85% of the time asking intraoperative, postoperative, and past medical history questions. The system improves over time such that there is a near-doubling of questions that yield appropriate answers between users 13 and 22. Users who identified the virtual patient's underlying tachycardia expressed more concern and were more likely to order further testing for the patient in a post-module questionnaire (P = 0.13 and 0.08, respectively, NS). The VPF system can capture unique details about the hand-off interchange. The system improves with sequential users such that better matching of questions and answers occurs within the initial 25 users allowing rapid development of new modules. A catalog of hand-off modules could be easily developed. Wide-scale web-based deployment was uncomplicated. Identification of the critical findings appropriately translated to user concern for the patient though our series was too small to reach significance. Performance metrics based on the identification of critical discoveries could be used to assess readiness of the user to carry off a successful hand

  2. Fluid-Structure Simulations of a Ruptured Intracranial Aneurysm: Constant versus Patient-Specific Wall Thickness

    S. Voß

    2016-01-01

    Full Text Available Computational Fluid Dynamics is intensively used to deepen the understanding of aneurysm growth and rupture in order to support physicians during therapy planning. However, numerous studies considering only the hemodynamics within the vessel lumen found no satisfactory criteria for rupture risk assessment. To improve available simulation models, the rigid vessel wall assumption has been discarded in this work and patient-specific wall thickness is considered within the simulation. For this purpose, a ruptured intracranial aneurysm was prepared ex vivo, followed by the acquisition of local wall thickness using μCT. The segmented inner and outer vessel surfaces served as solid domain for the fluid-structure interaction (FSI simulation. To compare wall stress distributions within the aneurysm wall and at the rupture site, FSI computations are repeated in a virtual model using a constant wall thickness approach. Although the wall stresses obtained by the two approaches—when averaged over the complete aneurysm sac—are in very good agreement, strong differences occur in their distribution. Accounting for the real wall thickness distribution, the rupture site exhibits much higher stress values compared to the configuration with constant wall thickness. The study reveals the importance of geometry reconstruction and accurate description of wall thickness in FSI simulations.

  3. Death of a Simulated Pediatric Patient: Toward a More Robust Theoretical Framework.

    McBride, Mary E; Schinasi, Dana Aronson; Moga, Michael Alice; Tripathy, Shreepada; Calhoun, Aaron

    2017-12-01

    A theoretical framework was recently proposed that encapsulates learner responses to simulated death due to action or inaction in the pediatric context. This framework, however, was developed at an institution that allows simulated death and thus does not address the experience of those centers at which this technique is not used. To address this, we performed a parallel qualitative study with the intent of augmenting the initial framework. We conducted focus groups, using a constructivist grounded theory approach, using physicians and nurses who have experienced a simulated cardiac arrest. The participants were recruited via e-mail. Transcripts were analyzed by coders blinded to the original framework to generate a list of provisional themes that were iteratively refined. These themes were then compared with the themes from the original article and used to derive a consensus model that incorporated the most relevant features of each. Focus group data yielded 7 themes. Six were similar to those developed in the original framework. One important exception was noted; however, those learners not exposed to patient death due to action or inaction often felt that the mannequin's survival was artificial. This additional theme was incorporated into a revised framework. The original framework addresses most aspects of learner reactions to simulated death. Our work suggests that adding the theme pertaining to the lack of realism that can be perceived when the mannequin is unexpectedly saved results in a more robust theoretical framework transferable to centers that do not allow mannequin death.

  4. Patients setup verification tool for RT (PSVTs): DRR, simulation, portal and digital images

    Lee, Suk; Seong, Jin Sil; Chu, Sung Sil; Lee, Chang Geol; Suh, Chang Ok; Kwon, Soo Il

    2003-01-01

    To develop a patients' setup verification tool (PSVT) to verify the alignment of the machine and the target isocenters, and the reproducibility of patients' setup for three dimensional conformal radiotherapy (3DCRT) and intensity modulated radiotherapy (MRT). The utilization of this system is evaluated through phantom and patient case studies. We developed and clinically tested a new method for patients' setup verification, using digitally reconstructed radiography (DRR), simulation, portal and digital images. The PSVT system was networked to a Pentium PC for the transmission of the acquired images to the PC for analysis. To verify the alignment of the machine and target isocenters, orthogonal pairs of simulation images were used as verification images. Errors in the isocenter alignment were measured by comparing the verification images with DRR of CT images. Orthogonal films were taken of all the patients once a week. These verification films were compared with the DRR were used for the treatment setup. By performing this procedure every treatment, using humanoid phantom and patient cases, the errors of localization can be analyzed, with adjustments made from the translation. The reproducibility of the patients' setup was verified using portal and digital images. The PSVT system was developed to verify the alignment of the machine and the target isocenters, and the reproducibility of the patients' setup for 3DCRT and IMRT The results show that the localization errors are 0.8±0.2 mm (AP) and 1.0±0.3 mm (Lateral) in the cases relating to the brain and 1.1± 0.5 mm (AP) and 1.0±0.6 mm (Lateral) in the cases relating to the pelvis. The reproducibility of the patients' setup was verified by visualization, using real-time image acquisition, leading to the practical utilization of our software. A PSVT system was developed for the verification of the alignment between machine and the target isocenters, and the reproducibility of the patients' setup in 3DCRT and IMRT

  5. Effect of Advanced Trauma Life Support program on medical interns' performance in simulated trauma patient management.

    Ahmadi, Koorosh; Sedaghat, Mohammad; Safdarian, Mahdi; Hashemian, Amir-Masoud; Nezamdoust, Zahra; Vaseie, Mohammad; Rahimi-Movaghar, Vafa

    2013-01-01

    Since appropriate and time-table methods in trauma care have an important impact on patients'outcome, we evaluated the effect of Advanced Trauma Life Support (ATLS) program on medical interns' performance in simulated trauma patient management. A descriptive and analytical study before and after the training was conducted on 24 randomly selected undergraduate medical interns from Imam Reza Hospital in Mashhad, Iran. On the first day, we assessed interns' clinical knowledge and their practical skill performance in confronting simulated trauma patients. After 2 days of ATLS training, we performed the same study and evaluated their score again on the fourth day. The two findings, pre- and post- ATLS periods, were compared through SPSS version 15.0 software. P values less than 0.05 were considered statistically significant. Our findings showed that interns'ability in all the three tasks improved after the training course. On the fourth day after training, there was a statistically significant increase in interns' clinical knowledge of ATLS procedures, the sequence of procedures and skill performance in trauma situations (P less than 0.001, P equal to 0.016 and P equal to 0.01 respectively). ATLS course has an important role in increasing clinical knowledge and practical skill performance of trauma care in medical interns.

  6. Solving the patient zero inverse problem by using generalized simulated annealing

    Menin, Olavo H.; Bauch, Chris T.

    2018-01-01

    Identifying patient zero - the initially infected source of a given outbreak - is an important step in epidemiological investigations of both existing and emerging infectious diseases. Here, the use of the Generalized Simulated Annealing algorithm (GSA) to solve the inverse problem of finding the source of an outbreak is studied. The classical disease natural histories susceptible-infected (SI), susceptible-infected-susceptible (SIS), susceptible-infected-recovered (SIR) and susceptible-infected-recovered-susceptible (SIRS) in a regular lattice are addressed. Both the position of patient zero and its time of infection are considered unknown. The algorithm performance with respect to the generalization parameter q˜v and the fraction ρ of infected nodes for whom infection was ascertained is assessed. Numerical experiments show the algorithm is able to retrieve the epidemic source with good accuracy, even when ρ is small, but present no evidence to support that GSA performs better than its classical version. Our results suggest that simulated annealing could be a helpful tool for identifying patient zero in an outbreak where not all cases can be ascertained.

  7. Ease of use and patient preference injection simulation study comparing two prefilled insulin pens.

    Clark, Paula E; Valentine, Virginia; Bodie, Jennifer N; Sarwat, Samiha

    2010-07-01

    To determine patient ease of use and preference for the Humalog KwikPen* (prefilled insulin lispro [Humalog dagger] pen, Eli Lilly and Company, Indianapolis, IN, USA) (insulin lispro pen) versus the Next Generation FlexPen double dagger (prefilled insulin aspart [NovoRapid section sign ] pen, Novo Nordisk A/S, Bagsvaerd, Denmark) (insulin aspart pen). This was a randomized, open-label, 2-period, 8-sequence crossover study in insulin pen-naïve patients with diabetes. Randomized patients (N = 367) received device training, then simulated low- (15 U) and high- (60 U) dose insulin injections with an appliance. Patients rated pens using an ease of use questionnaire and were asked separately for final pen preferences. The Insulin Device 'Ease of Use' Battery is a 10-item questionnaire with a 7-point scale (higher scores reflect greater ease of use). The primary objective was to determine pen preference for 'easy to press to inject my dose' (by comparing composite scores [low- plus high-dose]). Secondary objectives were to determine pen preference on select questionnaire items (from composite scores), final pen preference, and summary responses for all questionnaire items. On the primary endpoint, 'easy to press to inject my dose,' a statistically significant majority of patients with a preference chose the insulin lispro pen over the insulin aspart pen (68.4%, 95% CI = 62.7-73.6%). Statistically significant majorities of patients with a preference also favored the insulin lispro pen on secondary items: 'easy to hold in my hand when I inject' (64.9%, 95% CI = 58.8-70.7%), 'easy to use when I am in a public place' (67.5%, 95% CI = 61.0-73.6%), and 'overall easy to use' (69.9%, 95% CI = 63.9-75.4%). A statistically significant majority of patients had a final preference for the insulin lispro pen (67.3%, 95% CI = 62.2-72.1%). Among pen-naïve patients with diabetes who had a preference, the majority preferred the insulin lispro pen over the insulin aspart pen with regard

  8. Understanding the impact of simulated patients on health care learners' communication skills: a systematic review.

    Kaplonyi, Jessica; Bowles, Kelly-Ann; Nestel, Debra; Kiegaldie, Debra; Maloney, Stephen; Haines, Terry; Williams, Cylie

    2017-12-01

    Effective communication skills are at the core of good health care. Simulated patients (SPs) are increasingly engaged as an interactive means of teaching, applying and practising communication skills with immediate feedback. There is a large body of research into the use of manikin-based simulation but a gap exists in the body of research on the effectiveness of SP-based education to teach communication skills that impact patient outcomes. The aim of this systematic review was to critically analyse the existing research, investigating whether SP-based communication skills training improves learner-patient communication, how communication skill improvement is measured, and who measures these improvements. The databases Medline, ProQuest (Health & Medical Complete, Nursing and Allied Health Source) and CINAHL (EBSCOhost) Education Resources Information Centre (ERIC) were searched for articles that investigated the effects of SP-based education on the communication skills of medical, nursing and allied health learners. There were 60 studies included in the review. Only two studies reported direct patient outcomes, one reporting some negative impact, and no studies included an economic analysis. Many studies reported statistically significant third-party ratings of improved communication effectiveness following SP-based education; however, studies were unable to be pooled for meta-analysis because of the outcome collection methods. There were a small number of studies comparing SP with no training at all and there were no differences between communication skills, contradicting the results from studies reporting benefits. Of the 60 studies included for analysis, 54 (90%) met the minimum quality score of 7/11, with four articles (7%) scoring 11/11. SP-based education is widely accepted as a valuable and effective means of teaching communication skills but there is limited evidence of how this translates to patient outcomes and no indication of economic benefit for this

  9. Simulation modelling of a patient surge in an emergency department under disaster conditions

    Muhammet Gul

    2015-10-01

    Full Text Available The efficiency of emergency departments (EDs in handling patient surges during disaster times using the available resources is very important. Many EDs require additional resources to overcome the bottlenecks in emergency systems. The assumption is that EDs consider the option of temporary staff dispatching, among other options, in order to respond to an increased demand or even the hiring temporarily non-hospital medical staff. Discrete event simulation (DES, a well-known simulation method and based on the idea of process modeling, is used for establishing ED operations and management related models. In this study, a DES model is developed to investigate and analyze an ED under normal conditions and an ED in a disaster scenario which takes into consideration an increased influx of disaster victims-patients. This will allow early preparedness of emergency departments in terms of physical and human resources. The studied ED is located in an earthquake zone in Istanbul. The report on Istanbul’s disaster preparedness presented by the Japan International Cooperation Agency (JICA and Istanbul Metropolitan Municipality (IMM, asserts that the district where the ED is located is estimated to have the highest injury rate. Based on real case study information, the study aims to suggest a model on pre-planning of ED resources for disasters. The results indicate that in times of a possible disaster, when the percentage of red patient arrivals exceeds 20% of total patient arrivals, the number of red area nurses and the available space for red area patients will be insufficient for the department to operate effectively. A methodological improvement presented a different distribution function that was tested for service time of the treatment areas. The conclusion is that the Weibull distribution function used in service process of injection room fits the model better than the Gamma distribution function.

  10. Bridging burn care education with modern technology, an integration with high fidelity human patient simulation.

    Reeves, Patrick T; Borgman, Matthew A; Caldwell, Nicole W; Patel, Leela; Aden, James; Duggan, John P; Serio-Melvin, Maria L; Mann-Salinas, Elizabeth A

    2018-08-01

    The Advanced Burn Life Support (ABLS) program is a burn-education curriculum nearly 30 years in the making, focusing on the unique challenges of the first 24h of care after burn injury. Our team applied high fidelity human patient simulation (HFHPS) to the established ABLS curriculum. Our hypothesis was that HFHPS would be a feasible, easily replicable, and valuable adjunct to the current curriculum that would enhance learner experience. This prospective, evidenced-based practice project was conducted in a single simulation center employing the American Burn Association's ABLS curriculum using HFHPS. Participants managed 7 separate simulated polytrauma and burn scenarios with resultant clinical complications. After training, participants completed written and practical examinations as well as satisfaction surveys. From 2012 to 2013, 71 students participated in this training. Simulation (ABLS-Sim) participants demonstrated a 2.5% increase in written post-test scores compared to traditional ABLS Provider Course (ABLS Live) (p=0.0016). There was no difference in the practical examination when comparing ABLS-Sim versus ABLS Live. Subjectively, 60 (85%) participants completed surveys. The Educational Practice Questionnaire showed best practices rating of 4.5±0.7; with importance of learning rated at 4.4±0.8. The Simulation Design Scale rating for design was 4.6±0.6 with an importance rating of 4.4±0.8. Overall Satisfaction and Self-Confidence with Learning were 4.4±0.7 and 4.5±0.7, respectfully. Integrating HFHPS with the current ABLS curriculum led to higher written exam scores, high levels of confidence, satisfaction, and active learning, and presented an evidenced-based model for education that is easily employable for other facilities nationwide. Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.

  11. Addressing Dual Patient and Staff Safety Through A Team-Based Standardized Patient Simulation for Agitation Management in the Emergency Department.

    Wong, Ambrose H; Auerbach, Marc A; Ruppel, Halley; Crispino, Lauren J; Rosenberg, Alana; Iennaco, Joanne D; Vaca, Federico E

    2018-06-01

    Emergency departments (EDs) have seen harm rise for both patients and health workers from an increasing rate of agitation events. Team effectiveness during care of this population is particularly challenging because fear of physical harm leads to competing interests. Simulation is frequently employed to improve teamwork in medical resuscitations but has not yet been reported to address team-based behavioral emergency care. As part of a larger investigation of agitated patient care, we designed this secondary study to examine the impact of an interprofessional standardized patient simulation for ED agitation management. We used a mixed-methods approach with emergency medicine resident and attending physicians, Physician Assistants (PAs) and Advanced Practice Registered Nurses (APRNs), ED nurses, technicians, and security officers at two hospital sites. After a simulated agitated patient encounter, we conducted uniprofessional and interprofessional focus groups. We undertook structured thematic analysis using a grounded theory approach. Quantitative data consisted of responses to the KidSIM Questionnaire addressing teamwork and simulation-based learning attitudes before and after each session. We reached data saturation with 57 participants. KidSIM scores revealed significant improvements in attitudes toward relevance of simulation, opportunities for interprofessional education, and situation awareness, as well as four of six questions for roles/responsibilities. Two broad themes emerged from the focus groups: (1) a team-based agitated patient simulation addressed dual safety of staff and patients simultaneously and (2) the experience fostered interprofessional discovery and cooperation in agitation management. A team-based simulated agitated patient encounter highlighted the need to consider the dual safety of staff and patients while facilitating interprofessional dialog and learning. Our findings suggest that simulation may be effective to enhance teamwork in

  12. Linking Six Sigma to simulation: a new roadmap to improve the quality of patient care.

    Celano, Giovanni; Costa, Antonio; Fichera, Sergio; Tringali, Giuseppe

    2012-01-01

    Improving the quality of patient care is a challenge that calls for a multidisciplinary approach, embedding a broad spectrum of knowledge and involving healthcare professionals from diverse backgrounds. The purpose of this paper is to present an innovative approach that implements discrete-event simulation (DES) as a decision-supporting tool in the management of Six Sigma quality improvement projects. A roadmap is designed to assist quality practitioners and health care professionals in the design and successful implementation of simulation models within the define-measure-analyse-design-verify (DMADV) or define-measure-analyse-improve-control (DMAIC) Six Sigma procedures. A case regarding the reorganisation of the flow of emergency patients affected by vertigo symptoms was developed in a large town hospital as a preliminary test of the roadmap. The positive feedback from professionals carrying out the project looks promising and encourages further roadmap testing in other clinical settings. The roadmap is a structured procedure that people involved in quality improvement can implement to manage projects based on the analysis and comparison of alternative scenarios. The role of Six Sigma philosophy in improvement of the quality of healthcare services is recognised both by researchers and by quality practitioners; discrete-event simulation models are commonly used to improve the key performance measures of patient care delivery. The two approaches are seldom referenced and implemented together; however, they could be successfully integrated to carry out quality improvement programs. This paper proposes an innovative approach to bridge the gap and enrich the Six Sigma toolbox of quality improvement procedures with DES.

  13. How do pharmacists respond to complaints of acute insomnia? A simulated patient study.

    Kippist, Carly; Wong, Keith; Bartlett, Delwyn; Saini, Bandana

    2011-04-01

    It is known that many people with insomnia choose to self medicate and present at community pharmacies, particularly in cases of acute insomnia. The objective of this study is to investigate how community pharmacists respond to complaints of acute insomnia from people who seek self treatment and determine the factors affecting this response. Community pharmacies in New South Wales, Australia. A simulated patient study was conducted in 100 randomly selected pharmacies located in Newcastle and Sydney, Australia. A standardized scenario of acute sleep onset insomnia and a scoring system was used in each pharmacy. Main outcome measures included supply/non supply of an over the counter sleep aid to the simulated patient, and scores for pharmacists for skills in eliciting information prior to supply of medication (Pre Supply Score), counseling about medication (Supply Score), or about sleep (Sleep Score). Of the 100 pharmacies, upon simulated patient presentation, 96% supplied a product, the remaining 4% referred to a physician. Non-pharmacological advice was provided in 42%. Pharmacists scored highly on advice provided with supply of a medication (Supply scores/4, 3.1 ± 0.9), but lower on skills in eliciting information prior to supply (Pre-supply score/8, 3.6 ± 1.9) and sleep related counselling (Sleep Score/9, 2.1 ± 1.7). Lower estimated pharmacist age, being in a chain type pharmacy, and having a visible symbol of quality accreditation were found to significantly improve (P Supply Score (P Supply scores (P < 0.05). The results of this study suggest that many pharmacists are responding appropriately to complaints of sleeplessness in terms of eliciting insomnia type and counseling about medicines use. However more education for pharmacists would help to further promote good sleep health, and address behaviors including reliance on medicines taking that can progressively worsen insomnia.

  14. Non-prescription treatment of NSAID induced GORD by Australian pharmacies: a national simulated patient study.

    MacFarlane, Brett; Matthews, Andrew; Bergin, Jenny

    2015-10-01

    Patients regularly present to community pharmacies for advice about and treatment for reflux symptoms and NSAIDs are a common cause of these symptoms. There is no published literature detailing the approach that pharmacies take to these enquiries, the pharmacotherapy they recommend or whether they contribute to the safe and effective use of reflux medicines. To assess in an observational study design the clinical history gathering, recommendations for GORD management and counselling provided by community pharmacies in a simulated patient scenario involving suspected NSAID induced reflux symptoms. Setting Australian community pharmacies. Simulated patients visited 223 community pharmacies to request treatment for reflux symptoms. The interaction was audiotaped and assessed against guidelines for the treatment of reflux symptoms. Alignment of community pharmacies with international expert gastroenterologist guidance and national professional practice guidelines for the treatment of reflux symptoms by pharmacists including: consultation with a pharmacist; confirmation of reflux diagnosis based on symptoms; recommendation of short courses proton pump inhibitor (PPI) therapy; advice on the safe and effective use of reflux medicines and referral to a doctor for further assessment. Pharmacists consulted with the simulated patient in 77% of cases. Symptoms were enquired about in 95% of cases and a medicines history taken in 69% of cases. Recommendations for treatment included: PPIs (18%), histamine H2 antagonists (57%) and antacids (19%). Advice on product use was given in 83% of cases. Referral to a doctor to discuss reflux symptoms was made in 63% of cases. When assessing patients for the symptoms of GORD, Australian pharmacists and non-pharmacist support staff take a comprehensive history including symptomatology, duration of symptoms, concomitant medicines and medical conditions and any GORD treatments previously trialled. They provide comprehensive counselling on the

  15. The Impact of Simulated Nature on Patient Outcomes: A Study of Photographic Sky Compositions.

    Pati, Debajyoti; Freier, Patricia; O'Boyle, Michael; Amor, Cherif; Valipoor, Shabboo

    2016-01-01

    To examine whether incorporation of simulated nature, in the form of ceiling mounted photographic sky compositions, influences patient outcomes. Previous studies have shown that most forms of nature exposure have a positive influence on patients. However, earlier studies have mostly focused on wall-hung nature representations. The emergence of simulated nature products has raised the question regarding the effects of the new product on patient outcomes. A between-subject experimental design was adopted, where outcomes from five inpatient rooms with sky composition ceiling fixture were compared to corresponding outcomes in five identical rooms without the intervention. Data were collected from a total of 181 subjects on 11 outcomes. Independent sample tests were performed to identify differences in mean outcomes. Significant positive outcomes were observed in environmental satisfaction and diastolic blood pressure (BP). Environmental satisfaction in the experimental group was 12.4% higher than the control group. Direction of association for diastolic BP, nausea/indigestion medication, acute stress, anxiety, pain, and environmental satisfaction were consistent with a priori hypothesis. A post hoc exploratory assessment involving patients who did not self-request additional pain and sleep medication demonstrated confirmatory directions for all outcomes except Systolic BP, and statistically significant outcomes for Acute Stress and Anxiety-Acute Stress and Anxiety levels of the experimental group subjects was 53.4% and 34.79% lower, respectively, than that of the control group subjects. Salutogenic benefits of photographic sky compositions render them better than traditional ceiling tiles and offer an alternative to other nature interventions. © The Author(s) 2015.

  16. Use of simulated patients to develop communication skills in nursing education: An integrative review.

    MacLean, Sharon; Kelly, Michelle; Geddes, Fiona; Della, Phillip

    2017-01-01

    Registered nurses are expected to communicate effectively with patients. To improve on this skill education programmes in both hospital and tertiary settings are increasingly turning to simulation modalities when training undergraduate and registered nurses. The roles simulated patients (SPs) assume can vary according to training purposes and approach. The first aim is to analyse how SPs are used in nursing education to develop communication skills. The second aim is to evaluate the evidence that is available to support the efficacy of using SPs for training nurses in communication skills and finally to review the SP recruitment and training procedure. An Integrative review. A search was conducted on CINAHL, Psych-info, PubMed, Google Scholar, Scopus, Ovid, Medline, and ProQuest databases. Keywords and inclusion/exclusion criteria were determined and applied to the search strategy. The integrative review included Nineteen studies from 2006-2016. Critical Appraisal Skills Program (CASP) method of evaluation was utilised. Emergent themes were extracted with similar and divergent perspectives. Analysis identified seven clinical contexts for communication skills training (CST) and two SP roles from the eighteen studies. SPs were either directly involved in the teaching of communication (active role) or used in the evaluation of the effectiveness of a communication skills program (passive role). A majority of studies utilised faculty-designed measurement instruments. The evidence presented in the 19 articles indicates that the use of SPs to teach nurse-patient communication skills targets more challenging clinical interactions. Engaging SPs in both CST program facilitation and course evaluation provides nurse educators with a strong foundation to develop further pedagogical and research capacity. Expanding the utilisation of SPs to augment nurses' communication skills and ability to engage with patients in a broader range of clinical contexts with increased

  17. A Student Assessment Tool for Standardized Patient Simulations (SAT-SPS): Psychometric analysis.

    Castro-Yuste, Cristina; García-Cabanillas, María José; Rodríguez-Cornejo, María Jesús; Carnicer-Fuentes, Concepción; Paloma-Castro, Olga; Moreno-Corral, Luis Javier

    2018-05-01

    The evaluation of the level of clinical competence acquired by the student is a complex process that must meet various requirements to ensure its quality. The psychometric analysis of the data collected by the assessment tools used is a fundamental aspect to guarantee the student's competence level. To conduct a psychometric analysis of an instrument which assesses clinical competence in nursing students at simulation stations with standardized patients in OSCE-format tests. The construct of clinical competence was operationalized as a set of observable and measurable behaviors, measured by the newly-created Student Assessment Tool for Standardized Patient Simulations (SAT-SPS), which was comprised of 27 items. The categories assigned to the items were 'incorrect or not performed' (0), 'acceptable' (1), and 'correct' (2). 499 nursing students. Data were collected by two independent observers during the assessment of the students' performance at a four-station OSCE with standardized patients. Descriptive statistics were used to summarize the variables. The difficulty levels and floor and ceiling effects were determined for each item. Reliability was analyzed using internal consistency and inter-observer reliability. The validity analysis was performed considering face validity, content and construct validity (through exploratory factor analysis), and criterion validity. Internal reliability and inter-observer reliability were higher than 0.80. The construct validity analysis suggested a three-factor model accounting for 37.1% of the variance. These three factors were named 'Nursing process', 'Communication skills', and 'Safe practice'. A significant correlation was found between the scores obtained and the students' grades in general, as well as with the grades obtained in subjects with clinical content. The assessment tool has proven to be sufficiently reliable and valid for the assessment of the clinical competence of nursing students using standardized patients

  18. Simulating obstructive sleep apnea patients' oxygenation characteristics into a mouse model of cyclical intermittent hypoxia.

    Lim, Diane C; Brady, Daniel C; Po, Pengse; Chuang, Li Pang; Marcondes, Laise; Kim, Emily Y; Keenan, Brendan T; Guo, Xiaofeng; Maislin, Greg; Galante, Raymond J; Pack, Allan I

    2015-03-01

    Mouse models of cyclical intermittent hypoxia (CIH) are used to study the consequences of both hypoxia and oxidative stress in obstructive sleep apnea (OSA). Whether or not a mouse model of CIH that simulates OSA patients' oxygenation characteristics would translate into improved patient care remains unanswered. First we identified oxygenation characteristics using the desaturation and resaturation time in 47 OSA subjects from the Molecular Signatures of Obstructive Sleep Apnea Cohort (MSOSA). We observe that a cycle of intermittent hypoxia is not sinusoidal; specifically, desaturation time increases in an almost linear relationship to the degree of hypoxia (nadir), whereas resaturation time is somewhat constant (∼15 s), irrespective of the nadir. Second, we modified the Hycon mouse model of CIH to accommodate a 15-s resaturation time. Using this modified CIH model, we explored whether a short resaturation schedule (15 s), which includes the characteristics of OSA patients, had a different effect on levels of oxidative stress (i.e., urinary 8,12-iso-iPF2α-VI levels) compared with sham and a long resaturation schedule (90 s), a schedule that is not uncommon in rodent models of CIH. Results suggest that shorter resaturation time may result in a higher level of 8,12-iso-iPF2α-VI compared with long resaturation or sham conditions. Therefore, simulating the rodent model of CIH to reflect this and other OSA patients' oxygenation characteristics may be worthy of consideration to better understand the effects of hypoxia, oxidative stress, and their interactions. Copyright © 2015 the American Physiological Society.

  19. Using Simulations to Improve Electronic Health Record Use, Clinician Training and Patient Safety: Recommendations From A Consensus Conference.

    Mohan, Vishnu; Woodcock, Deborah; McGrath, Karess; Scholl, Gretchen; Pranaat, Robert; Doberne, Julie W; Chase, Dian A; Gold, Jeffrey A; Ash, Joan S

    2016-01-01

    A group of informatics experts in simulation, biomedical informatics, patient safety, medical education, and human factors gathered at Corbett, Oregon on April 30 and May 1, 2015. Their objective: to create a consensus statement on best practices for the use of electronic health record (EHR) simulations in education and training, to improve patient safety, and to outline a strategy for future EHR simulation work. A qualitative approach was utilized to analyze data from the conference and generate recommendations in five major categories: (1) Safety, (2) Education and Training, (3) People and Organizations, (4) Usability and Design, and (5) Sociotechnical Aspects.

  20. Physiological and psychological effects of delivering medical news using a simulated physician-patient scenario.

    Cohen, Lorenzo; Baile, Walter F; Henninger, Evelyn; Agarwal, Sandeep K; Kudelka, Andrzej P; Lenzi, Renato; Sterner, Janet; Marshall, Gailen D

    2003-10-01

    We examined the acute stress response associated with having to deliver either bad or good medical news using a simulated physician-patient scenario. Twenty-five healthy medical students were randomly assigned to a bad medical news (BN), a good medical news (GN), or a control group that read magazines during the session. Self-report measures were obtained before and after the task. Blood pressure and heart rate were measured throughout the task period. Four blood samples were obtained across the task period. The BN and GN tasks produced significant increases in self-reported distress and cardiovascular responses compared with the control group. There was also a significant increase in natural killer cell function 10 min into the task in the BN group compared with the control group. The BN task was also somewhat more stressful than the GN task, as shown by the self-report and cardiovascular data. These findings suggest that a simulated physician-patient scenario produces an acute stress response in the "physician," with the delivery of bad medical news more stressful than the delivery of good medical news.

  1. Virtual patient simulation in psychiatric care - A pilot study of digital support for collaborate learning.

    Sunnqvist, Charlotta; Karlsson, Karin; Lindell, Lisbeth; Fors, Uno

    2016-03-01

    Psychiatric and mental health nursing is built on a trusted nurse and patient relationship. Therefore communication and clinical reasoning are two important issues. Our experiences as teachers in psychiatric educational programmes are that the students feel anxiety and fear before they start their clinical practices in psychiatry. Therefore there is a need for bridging over the fear. Technology enhanced learning might support such activities so we used Virtual patients (VPs), an interactive computer simulations of real-life clinical scenarios. The aim of this study was to investigate 4th term nursing students' opinions on the use of Virtual Patients for assessment in a Mental Health and Ill-health course module. We asked 24 volunteering students to practise with five different VP cases during almost 10 weeks before the exam. The participants were gathered together for participating in a written and an oral evaluation. The students were positive to the use of VPs in psychiatry and were very positive to use VPs in their continued nursing education. It seems that Virtual Patients can be an activity producing pedagogic model promoting students' independent knowledge development, critical thinking, reflection and problem solving ability for nurse students in psychiatric care. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Using a Lego-based communications simulation to introduce medical students to patient-centered interviewing.

    Harding, S R; D'Eon, M F

    2001-01-01

    Teaching patient-centered interviewing skills to medical students can be challenging. We have observed that 1st-year medical students, in particular, do not feel free to concentrate on the interviewing skills because they are preoccupied with complicated technical medical knowledge. The Lego simulation we use with our 1st-year students as part of a professional-skills course overcomes that difficulty. The Lego activity is a role play analogous to a doctor-patient interview that uses identical sets of Legos for the "doctor" and for the "patients" and a small construction that represents a patient history. With a simple questionnaire, data were collected from students at different points during instruction. Results indicate that the Lego activity was very effective in helping students learn the importance of open-ended questioning. It also was rated as highly as the very dynamic interactive part of the instructional session. The effectiveness of the Lego activity may be due to the properties of analogies.

  3. An integrative literature review on preparing nursing students through simulation to recognize and respond to the deteriorating patient.

    Fisher, Duana; King, Lindy

    2013-11-01

    To synthesize studies that explored simulation as preparation of nursing students for recognition and response to the deteriorating patient. New graduate nurses are expected to have the skills to recognize and respond to rapidly deteriorating patient conditions. To this end, education programmes have turned increasingly to simulation to assist students to gain the necessary skills. Integrative review. CINAHL, Informit, ProQuest, Ovid MEDLINE, SAGE Journals and Web of Knowledge electronic databases, keywords and inclusion/exclusion criteria were searched. Eighteen studies published between 2004-2012 were found. Studies were appraised using recognized evaluation tools. Thematic analysis was undertaken and emergent themes were extracted with similar and divergent perspectives sought. Six themes were identified namely, 'transferability of simulation skills to clinical practice', 'exposure to broader range of experiences', 'confidence levels in relation to simulation training', 'competence/performance', 'clinical judgment' and 'student perceptions of preparedness for practice following simulation'. Simulation exposes students to a broader range of experiences whilst in a safe environment with transference of skills to clinical practice occurring. Confidence, clinical judgement, knowledge and competence, all vital in the care of a deteriorating patient, were enhanced. However, evidence of simulation used specifically to prepare nursing students to recognize and respond to the deteriorating patient appeared limited. This educational field appears rich for interprofessional collaboration and further research. © 2013 John Wiley & Sons Ltd.

  4. Preoperative planning with three-dimensional reconstruction of patient's anatomy, rapid prototyping and simulation for endoscopic mitral valve repair.

    Sardari Nia, Peyman; Heuts, Samuel; Daemen, Jean; Luyten, Peter; Vainer, Jindrich; Hoorntje, Jan; Cheriex, Emile; Maessen, Jos

    2017-02-01

    Mitral valve repair performed by an experienced surgeon is superior to mitral valve replacement for degenerative mitral valve disease; however, many surgeons are still deterred from adapting this procedure because of a steep learning curve. Simulation-based training and planning could improve the surgical performance and reduce the learning curve. The aim of this study was to develop a patient-specific simulation for mitral valve repair and provide a proof of concept of personalized medicine in a patient prospectively planned for mitral valve surgery. A 65-year old male with severe symptomatic mitral valve regurgitation was referred to our mitral valve heart team. On the basis of three-dimensional (3D) transoesophageal echocardiography and computed tomography, 3D reconstructions of the patient's anatomy were constructed. By navigating through these reconstructions, the repair options and surgical access were chosen (minimally invasive repair). Using rapid prototyping and negative mould fabrication, we developed a process to cast a patient-specific mitral valve silicone replica for preoperative repair in a high-fidelity simulator. Mitral valve and negative mould were printed in systole to capture the pathology when the valve closes. A patient-specific mitral valve silicone replica was casted and mounted in the simulator. All repair techniques could be performed in the simulator to choose the best repair strategy. As the valve was printed in systole, no special testing other than adjusting the coaptation area was required. Subsequently, the patient was operated, mitral valve pathology was validated and repair was successfully done as in the simulation. The patient-specific simulation and planning could be applied for surgical training, starting the (minimally invasive) mitral valve repair programme, planning of complex cases and the evaluation of new interventional techniques. The personalized medicine could be a possible pathway towards enhancing reproducibility

  5. A Monte-Carlo simulation framework for joint optimisation of image quality and patient dose in digital paediatric radiography

    Menser, Bernd; Manke, Dirk; Mentrup, Detlef; Neitzel, Ulrich

    2016-01-01

    In paediatric radiography, according to the as low as reasonably achievable (ALARA) principle, the imaging task should be performed with the lowest possible radiation dose. This paper describes a Monte-Carlo simulation framework for dose optimisation of imaging parameters in digital paediatric radiography. Patient models with high spatial resolution and organ segmentation enable the simultaneous evaluation of image quality and patient dose on the same simulated radiographic examination. The accuracy of the image simulation is analysed by comparing simulated and acquired images of technical phantoms. As a first application example, the framework is applied to optimise tube voltage and pre-filtration in newborn chest radiography. At equal patient dose, the highest CNR is obtained with low-kV settings in combination with copper filtration. (authors)

  6. Taurolidine-citrate-heparin lock reduces catheter-related bloodstream infections in intestinal failure patients dependent on home parenteral support

    Tribler, Siri; Brandt, Christopher F.; Petersen, Anne H.

    2017-01-01

    Background: In patients with intestinal failure who are receiving home parenteral support (HPS), catheter-related bloodstream infections (CRBSIs) inflict health impairment and high costs.Objective: This study investigates the efficacy and safety of the antimicrobial catheter lock solution, taurol...

  7. Evaluating medical student engagement during virtual patient simulations: a sequential, mixed methods study.

    McCoy, Lise; Pettit, Robin K; Lewis, Joy H; Allgood, J Aaron; Bay, Curt; Schwartz, Frederic N

    2016-01-16

    Student engagement is an important domain for medical education, however, it is difficult to quantify. The goal of this study was to investigate the utility of virtual patient simulations (VPS) for increasing medical student engagement. Our aims were specifically to investigate how and to what extent the VPS foster student engagement. This study took place at A.T. Still University School of Osteopathic Medicine in Arizona (ATSU-SOMA), in the USA. First year medical students (n = 108) worked in teams to complete a series of four in-class virtual patient case studies. Student engagement was measured, defined as flow, interest, and relevance. These dimensions were measured using four data collection instruments: researcher observations, classroom photographs, tutor feedback, and an electronic exit survey. Qualitative data were analyzed using a grounded theory approach. Triangulation of findings between the four data sources indicate that VPS foster engagement in three facets: 1) Flow. In general, students enjoyed the activities, and were absorbed in the task at hand. 2) Interest. Students demonstrated interest in the activities, as evidenced by enjoyment, active discussion, and humor. Students remarked upon elements that caused cognitive dissonance: excessive text and classroom noise generated by multi-media and peer conversations. 3) Relevance. VPS were relevant, in terms of situational clinical practice, exam preparation, and obtaining concrete feedback on clinical decisions. Researchers successfully introduced a new learning platform into the medical school curriculum. The data collected during this study were also used to improve new learning modules and techniques associated with implementing them in the classroom. Results of this study assert that virtual patient simulations foster engagement in terms of flow, relevance, and interest.

  8. Using the Statecharts paradigm for simulation of patient flow in surgical care.

    Sobolev, Boris; Harel, David; Vasilakis, Christos; Levy, Adrian

    2008-03-01

    Computer simulation of patient flow has been used extensively to assess the impacts of changes in the management of surgical care. However, little research is available on the utility of existing modeling techniques. The purpose of this paper is to examine the capacity of Statecharts, a system of graphical specification, for constructing a discrete-event simulation model of the perioperative process. The Statecharts specification paradigm was originally developed for representing reactive systems by extending the formalism of finite-state machines through notions of hierarchy, parallelism, and event broadcasting. Hierarchy permits subordination between states so that one state may contain other states. Parallelism permits more than one state to be active at any given time. Broadcasting of events allows one state to detect changes in another state. In the context of the peri-operative process, hierarchy provides the means to describe steps within activities and to cluster related activities, parallelism provides the means to specify concurrent activities, and event broadcasting provides the means to trigger a series of actions in one activity according to transitions that occur in another activity. Combined with hierarchy and parallelism, event broadcasting offers a convenient way to describe the interaction of concurrent activities. We applied the Statecharts formalism to describe the progress of individual patients through surgical care as a series of asynchronous updates in patient records generated in reaction to events produced by parallel finite-state machines representing concurrent clinical and managerial activities. We conclude that Statecharts capture successfully the behavioral aspects of surgical care delivery by specifying permissible chronology of events, conditions, and actions.

  9. Dose estimation of patients in CT examinations using EGS4 Monte-Carlo simulation of voxel phantom

    Akahane, K.; Kai, M.; Kusama, T.; Saito, K.

    2002-01-01

    A voxel phantom based on CT images of one Japanese male have developed in Japan Atomic Energy Research Institute. Dose calculations of patients in X-ray CT examinations were performed using the voxel phantom and EGS4 Monte-Carlo simulation code. The organ doses of the patients were estimated

  10. Dose estimation of patients in CT examinations using EGS4 Monte-Carlo simulation of voxel phantom

    Akahane, K.; Kai, M.; Kusama, T. [Oita Univ., of Nursing and Health Sciences, Oita-Ken (Japan); Saito, K. [JAERI, Ibaraki-ken (Japan)

    2002-07-01

    A voxel phantom based on CT images of one Japanese male have developed in Japan Atomic Energy Research Institute. Dose calculations of patients in X-ray CT examinations were performed using the voxel phantom and EGS4 Monte-Carlo simulation code. The organ doses of the patients were estimated.

  11. The role of specific visual subfields in collisions with oncoming cars during simulated driving in patients with advanced glaucoma.

    Kunimatsu-Sanuki, Shiho; Iwase, Aiko; Araie, Makoto; Aoki, Yuki; Hara, Takeshi; Fukuchi, Takeo; Udagawa, Sachiko; Ohkubo, Shinji; Sugiyama, Kazuhisa; Matsumoto, Chota; Nakazawa, Toru; Yamaguchi, Takuhiro; Ono, Hiroshi

    2017-07-01

    To assess the role of specific visual subfields in collisions with oncoming cars during simulated driving in patients with advanced glaucoma. Normal subjects and patients with glaucoma with mean deviation glaucoma. And, 5 of the 100 patients with advanced glaucoma experienced simulator sickness during the main test and were thus excluded. In total, 95 patients with advanced glaucoma and 43 normal subjects completed the main test of DS. Advanced glaucoma patients had significantly more collisions than normal patients in one or both DS scenarios (pglaucoma who were involved in collisions were older (p=0.050) and had worse visual acuity in the better eye (pglaucoma. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  12. 3D printed simulation models based on real patient situations for hands-on practice.

    Kröger, E; Dekiff, M; Dirksen, D

    2017-11-01

    During the last few years, the curriculum of many dentistry schools in Germany has been reorganised. Two key aspects of the applied changes are the integration of up-to-date teaching methods and the promotion of interdisciplinarity. To support these efforts, an approach to fabricating individualised simulation models for hands-on courses employing 3D printing is presented. The models are based on real patients, thus providing students a more realistic preparation for real clinical situations. As a wide variety of dental procedures can be implemented, the simulation models can also contribute to a more interdisciplinary dental education. The data used for the construction of the models were acquired by 3D surface scanning. The data were further processed with 3D modelling software. Afterwards, the models were fabricated by 3D printing with the PolyJet technique. Three models serve as examples: a prosthodontic model for training veneer preparation, a conservative model for practicing dental bonding and an interdisciplinary model featuring carious teeth and an insufficient crown. The third model was evaluated in a hands-on course with 22 fourth-year dental students. The students answered a questionnaire and gave their personal opinion. Whilst the concept of the model received very positive feedback, some aspects of the implementation were criticised. We discuss these observations and suggest ways for further improvement. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. Fluid structure interaction simulations of the upper airway in obstructive sleep apnea patients before and after maxillomandibular advancement surgery.

    Chang, Kwang K; Kim, Ki Beom; McQuilling, Mark W; Movahed, Reza

    2018-06-01

    The purpose of this study was to analyze pharyngeal airflow using both computational fluid dynamics (CFD) and fluid structure interactions (FSI) in obstructive sleep apnea patients before and after maxillomandibular advancement (MMA) surgery. The airflow characteristics before and after surgery were compared with both CFD and FSI. In addition, the presurgery and postsurgery deformations of the airway were evaluated using FSI. Digitized pharyngeal airway models of 2 obstructive sleep apnea patients were generated from cone-beam computed tomography scans before and after MMA surgery. CFD and FSI were used to evaluate the pharyngeal airflow at a maximum inspiration rate of 166 ml per second. Standard steady-state numeric formulations were used for airflow simulations. Airway volume increased, pressure drop decreased, maximum airflow velocity decreased, and airway resistance dropped for both patients after the MMA surgery. These findings occurred in both the CFD and FSI simulations. The FSI simulations showed an area of marked airway deformation in both patients before surgery, but this deformation was negligible after surgery for both patients. Both CFD and FSI simulations produced airflow results that indicated less effort was needed to breathe after MMA surgery. The FSI simulations demonstrated a substantial decrease in airway deformation after surgery. These beneficial changes positively correlated with the large improvements in polysomnography outcomes after MMA surgery. Copyright © 2018 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

  14. Population pharmacokinetics and dosing simulations of imipenem in serious bacteraemia in immunocompromised patients with febrile neutropenia.

    Jaruratanasirikul, Sutep; Wongpoowarak, Wibul; Jullangkoon, Monchana; Samaeng, Maseetoh

    2015-02-01

    The aims of this study were to i) reveal the population pharmacokinetics; and ii) assess the probability of target attainment (PTA) and cumulative fraction of response (CFR) (defined as the expected population PTA for a specific drug dose and a specific population of microorganisms) of imipenem in febrile neutropenic patients with bacteraemia. Ten patients were randomised into two groups: Group I received a 0.5-h infusion of 0.5 g of imipenem every 6 h (q6h) for 8 doses; and Group II received a 4-h infusion of 0.5 g q6h for 8 doses. A Monte Carlo simulation was performed to determine the PTA. The volume of distribution and total clearance of imipenem were 20.78 ± 1.35 l and 23.19 ± 1.34 l/h, respectively. Only a 4-h infusion of 1 g q6h regimen achieved a PTA >93% for 80% T>MIC for a MIC of 2 μg/ml. A 4-h infusion of all simulated regimens and a 0.5-h infusion of 0.5 g q6h and 1 g q6h achieved targets (CFR ≥ 90%) against Escherichia coli and Klebsiella spp. However, against Pseudomonas aeruginosa and Acinetobacter spp., no regimens achieved their targets. In conclusion, the results indicate that a higher than manufacturer's dosage recommendation is required to maximize the activity of imipenem. Copyright © 2014 Japanese Pharmacological Society. Production and hosting by Elsevier B.V. All rights reserved.

  15. Use of simulated patients to evaluate combined oral contraceptive dispensing practices of community pharmacists.

    Paulo Roque Obreli-Neto

    Full Text Available BACKGROUND: Combined oral contraceptive (COC use is the most commonly used reversible method of birth control. The incorrect use of COCs is frequent and one of the most common causes of unintended pregnancies. Community pharmacists (CPs are in a strategic position to improve COC use because they are the last health professional to interact with patients before drug use. OBJECTIVE: To evaluate the COC dispensing practices of CPs in a developing country. METHOD: A cross-sectional study was conducted in community pharmacies of Assis and Ourinhos microregions, Brazil, between June 1, 2012, and October 30, 2012. Four simulated patients (SPs (with counseled audio recording visited community pharmacies with a prescription for Ciclo 21(® (a COC containing ethinyl estradiol 30 mcg + levonorgestrel 15 mcg. The audio recording of every SP visit was listened to independently by 3 researchers to evaluate the COC dispensing practice. The percentage of CPs who performed a screening for safe use of COCs (i.e., taking of patients' medical and family history, and measuring of blood pressure and provided counseling, as well as the quality of the screening and counseling, were evaluated. RESULTS: Of the 185 CPs contacted, 41 (22.2% agreed to participate in the study and finished the study protocol. Only 3 CPs asked the SP a question (1 question asked by each professional, and all of the questions were closed-ended, viz., "do you smoke?" (n = 2 and "what is your age?" (n = 1. None of the CPs measured the patient's blood pressure. Six CPs provided counseling when dispensing COCs (drug dosing, 5 CPs; possible adverse effects, 2 CPs, and one CP provided counseling regarding both aspects. CONCLUSION: The CPs evaluated did not dispense COC appropriately and could influence in the occurrence of negatives therapeutic outcomes such as adverse effects and treatment failure.

  16. What counts as effective communication in nursing? Evidence from nurse educators' and clinicians' feedback on nurse interactions with simulated patients.

    O'Hagan, Sally; Manias, Elizabeth; Elder, Catherine; Pill, John; Woodward-Kron, Robyn; McNamara, Tim; Webb, Gillian; McColl, Geoff

    2014-06-01

    To examine the feedback given by nurse educators and clinicians on the quality of communication skills of nurses in interactions with simulated patients. The quality of communication in interactions between nurses and patients has a major influence on patient outcomes. To support the development of effective nursing communication in clinical practice, a good understanding of what constitutes effective communication is helpful. An exploratory design was used involving individual interviews, focus groups and written notes from participants and field notes from researchers to investigate perspectives on nurse-patient communication. Focus groups and individual interviews were held between August 2010-September 2011 with a purposive sample of 15 nurse educators and clinicians who observed videos of interactions between nurses and simulated patients. These participants were asked to give oral feedback on the quality and content of these interactions. Verbatim transcriptions were undertaken of all data collected. All written notes and field notes were also transcribed. Thematic analysis of the data was undertaken. Four major themes related to nurse-patient communication were derived from the educators' and clinicians' feedback: approach to patients and patient care, manner towards patients, techniques used for interacting with patients and generic aspects of communication. This study has added to previous research by contributing grounded evidence from a group of nurse educators and clinicians on the aspects of communication that are relevant for effective nurse-patient interactions in clinical practice. © 2013 John Wiley & Sons Ltd.

  17. A trial of e-simulation of sudden patient deterioration (FIRST2ACT WEB) on student learning.

    Bogossian, Fiona E; Cooper, Simon J; Cant, Robyn; Porter, Joanne; Forbes, Helen

    2015-10-01

    High-fidelity simulation pedagogy is of increasing importance in health professional education; however, face-to-face simulation programs are resource intensive and impractical to implement across large numbers of students. To investigate undergraduate nursing students' theoretical and applied learning in response to the e-simulation program-FIRST2ACT WEBTM, and explore predictors of virtual clinical performance. Multi-center trial of FIRST2ACT WEBTM accessible to students in five Australian universities and colleges, across 8 campuses. A population of 489 final-year nursing students in programs of study leading to license to practice. Participants proceeded through three phases: (i) pre-simulation-briefing and assessment of clinical knowledge and experience; (ii) e-simulation-three interactive e-simulation clinical scenarios which included video recordings of patients with deteriorating conditions, interactive clinical tasks, pop up responses to tasks, and timed performance; and (iii) post-simulation feedback and evaluation. Descriptive statistics were followed by bivariate analysis to detect any associations, which were further tested using standard regression analysis. Of 409 students who commenced the program (83% response rate), 367 undergraduate nursing students completed the web-based program in its entirety, yielding a completion rate of 89.7%; 38.1% of students achieved passing clinical performance across three scenarios, and the proportion achieving passing clinical knowledge increased from 78.15% pre-simulation to 91.6% post-simulation. Knowledge was the main independent predictor of clinical performance in responding to a virtual deteriorating patient R(2)=0.090, F(7, 352)=4.962, plearning. The web-based e-simulation program FIRST2ACTTM effectively enhanced knowledge, virtual clinical performance, and self-assessed knowledge, skills, confidence, and competence in final-year nursing students. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Interprofessional Communication of Clinicians Using a Mobile Phone App: A Randomized Crossover Trial Using Simulated Patients.

    Patel, Bhavesh; Johnston, Maximilian; Cookson, Natalie; King, Dominic; Arora, Sonal; Darzi, Ara

    2016-04-06

    Most hospitals use paging systems as the principal communication system, despite general dissatisfaction by end users. To this end, we developed an app-based communication system (called Hark) to facilitate and improve the quality of interpersonal communication. The objectives of our study were (1) to assess the quality of information transfer using pager- and app-based (Hark) communication systems, (2) to determine whether using mobile phone apps for escalation of care results in additional delays in communication, and (3) to determine how end users perceive mobile phone apps as an alternative to pagers. We recruited junior (postgraduate year 1 and 2) doctors and nurses from a range of specialties and randomly assigned them to 2 groups who used either a pager device or the mobile phone-based Hark app. We asked nurses to hand off simulated patients while doctors were asked to receive handoff information using these devices. The quality of information transfer, time taken to respond to messages, and users' satisfaction with each device was recorded. Each participant used both devices with a 2-week washout period in between uses. We recruited 22 participants (13 nurses, 9 doctors). The quality of the referrals made by nurses was significantly better when using Hark (Hark median 118, range 100-121 versus pager median 77, range 39-104; P=.001). Doctors responded to messages using Hark more quickly than when responding to pagers, although this difference was not statistically significant (Hark mean 86.6 seconds, SD 96.2 versus pager mean 136.5 seconds, SD 201.0; P=.12). Users rated Hark as significantly better on 11 of the 18 criteria of an information transfer device (P<.05) These included "enhances interprofessional efficiency," "results in less disturbance," "performed desired functions reliably," and "allows me to clearly transfer information." Hark improved the quality of transfer of information about simulated patients and was rated by users as more effective and

  19. Empowering the registered nurses of tomorrow: students' perspectives of a simulation experience for recognising and managing a deteriorating patient.

    Kelly, Michelle A; Forber, Jan; Conlon, Lisa; Roche, Michael; Stasa, Helen

    2014-05-01

    Recognising and responding to patients who are deteriorating are key aspects to improving outcomes. Simulations provide students with exposure to deteriorating patient scenarios and the role of nurses in such events. The number of programmes seeking to provide best possible simulation experiences is growing exponentially. Robust evaluation of these experiences is crucial to ensure maximum benefit. To assess the impact of a deteriorating patient simulation experience on students' technical and communication skills; and to determine if differing study programmes and years of previous nursing experience influenced students' responses and experiences. A convenience sample of final year nursing students (N=57) in a medical-surgical course at a large urban university completed a descriptive pre/post simulation survey rating their technical skills and communication abilities in recognising and responding to patient deterioration. Changes in pre/post scores were analysed including influence of study programme (3-year, 2-year Enrolled Nurse, 2-year Graduate Entry); gender; and years nursing experience (beyond course clinical practicum). Statistically significant improvements in post-simulation survey scores were demonstrated for combined student group data. Students with greater years of nursing experience had statistically higher scores than those with less experience in both pre- and post-surveys. Specific improvements were identified for: assessing a deteriorating patient; and in seeking help from the medical officer or external service. All student groups gained benefit in participating in a deteriorating patient simulation. For this group, greater years of prior nursing experience led to higher pre- and post-survey scores. The learning activity provided students an experience of the importance of recognising and responding to an acute situation in a timely manner which may be recalled in subsequent clinical situations. © 2013.

  20. Simulation-based team training for multi-professional obstetric care teams to improve patient outcome : a multicentre, cluster randomised controlled trial

    Fransen, A F; van de Ven, J; Schuit, E; van Tetering, Aac; Mol, B W; Oei, S G

    OBJECTIVE: To investigate whether simulation-based obstetric team training in a simulation centre improves patient outcome. DESIGN: Multicentre, open, cluster randomised controlled trial. SETTING: Obstetric units in the Netherlands. POPULATION: Women with a singleton pregnancy beyond 24 weeks of

  1. An agent-based simulation model of patient choice of health care providers in accountable care organizations.

    Alibrahim, Abdullah; Wu, Shinyi

    2018-03-01

    Accountable care organizations (ACO) in the United States show promise in controlling health care costs while preserving patients' choice of providers. Understanding the effects of patient choice is critical in novel payment and delivery models like ACO that depend on continuity of care and accountability. The financial, utilization, and behavioral implications associated with a patient's decision to forego local health care providers for more distant ones to access higher quality care remain unknown. To study this question, we used an agent-based simulation model of a health care market composed of providers able to form ACO serving patients and embedded it in a conditional logit decision model to examine patients capable of choosing their care providers. This simulation focuses on Medicare beneficiaries and their congestive heart failure (CHF) outcomes. We place the patient agents in an ACO delivery system model in which provider agents decide if they remain in an ACO and perform a quality improving CHF disease management intervention. Illustrative results show that allowing patients to choose their providers reduces the yearly payment per CHF patient by $320, reduces mortality rates by 0.12 percentage points and hospitalization rates by 0.44 percentage points, and marginally increases provider participation in ACO. This study demonstrates a model capable of quantifying the effects of patient choice in a theoretical ACO system and provides a potential tool for policymakers to understand implications of patient choice and assess potential policy controls.

  2. Simulation studies of optimum energies for DXA: dependence on tissue type, patient size and dose model

    Michael, G. J.; Henderson, C. J.

    1999-01-01

    Dual-energy x-ray absorptiometry (DXA) is a well established technique for measuring bone mineral density (BMD). However, in recent years DXA is increasingly being used to measure body composition in terms of fat and fat-free mass. DXA scanners must also determine the soft tissue baseline value from soft-tissue-only regions adjacent to bone. The aim of this work is to determine, using computer simulations, the optimum x- ray energies for a number of dose models, different tissues, i.e. bone mineral, average soft tissue, lean soft tissue and fat; and a range of anatomical sites and patient sizes. Three models for patient dose were evaluated total beam energy, entrance exposure and absorbed dose calculated by Monte Carlo modelling. A range of tissue compositions and thicknesses were chosen to cover typical patient variations for the three sites femoral neck, PA spine and lateral spine. In this work, the optimisation of the energies is based on (1) the uncertainty that arises from the quantum statistical nature of the number of x-rays recorded by the detector, and (2) the radiation dose received by the patient. This study has deliberately not considered other parameters such as detector response, electronic noise, x-ray tube heat load etc, because these are technology dependent parameters, not ones that are inherent to the measuring technique. Optimisation of the energies is achieved by minimisation of the product of variance of density measurement and dose which is independent of the absolute intensities of the x-ray beams. The results obtained indicate that if solving for bone density, then E-low in the range 34 to 42 keV, E-high in the range 100 to 200 keV and incident intensity ratio (low energy/high energy) in the range 3 to 10 is a reasonable compromise for the normal range of patient sizes. The choice of energies is complicated by the fact that the DXA unit must also solve for fat and lean soft tissue in soft- tissue-only regions adjacent to the bone. In this

  3. Three-dimensional prototyping for procedural simulation of transcatheter mitral valve replacement in patients with mitral annular calcification.

    El Sabbagh, Abdallah; Eleid, Mackram F; Matsumoto, Jane M; Anavekar, Nandan S; Al-Hijji, Mohammed A; Said, Sameh M; Nkomo, Vuyisile T; Holmes, David R; Rihal, Charanjit S; Foley, Thomas A

    2018-01-23

    Three-dimensional (3D) prototyping is a novel technology which can be used to plan and guide complex procedures such as transcatheter mitral valve replacement (TMVR). Eight patients with severe mitral annular calcification (MAC) underwent TMVR. 3D digital models with digital balloon expandable valves were created from pre-procedure CT scans using dedicated software. Five models were printed. These models were used to assess prosthesis sizing, anchoring, expansion, paravalvular gaps, left ventricular outflow tract (LVOT) obstruction, and other potential procedure pitfalls. Results of 3D prototyping were then compared to post procedural imaging to determine how closely the achieved procedural result mirrored the 3D modeled result. 3D prototyping simulated LVOT obstruction in one patient who developed it and in another patient who underwent alcohol septal ablation prior to TMVR. Valve sizing correlated with actual placed valve size in six out of the eight patients and more than mild paravalvular leak (PVL) was simulated in two of the three patients who had it. Patients who had mismatch between their modeled valve size and post-procedural imaging were the ones that had anterior leaflet resection which could have altered valve sizing and PVL simulation. 3D printed model of one of the latter patients allowed modification of anterior leaflet to simulate surgical resection and was able to estimate the size and location of the PVL after inserting a valve stent into the physical model. 3D prototyping in TMVR for severe MAC is feasible for simulating valve sizing, apposition, expansion, PVL, and LVOT obstruction. © 2018 Wiley Periodicals, Inc.

  4. Detection of Infectious Influenza Virus in Cough Aerosols Generated in a Simulated Patient Examination Room

    Noti, John D.; Lindsley, William G.; Blachere, Francoise M.; Cao, Gang; Kashon, Michael L.; Thewlis, Robert E.; McMillen, Cynthia M.; King, William P.; Szalajda, Jonathan V.; Beezhold, Donald H.

    2015-01-01

    Background The potential for aerosol transmission of infectious influenza virus (ie, in healthcare facilities) is controversial. We constructed a simulated patient examination room that contained coughing and breathing manikins to determine whether coughed influenza was infectious and assessed the effectiveness of an N95 respirator and surgical mask in blocking transmission. Methods National Institute for Occupational Safety and Health aerosol samplers collected size-fractionated aerosols for 60 minutes at the mouth of the breathing manikin, beside the mouth, and at 3 other locations in the room. Total recovered virus was quantitated by quantitative polymerase chain reaction and infectivity was determined by the viral plaque assay and an enhanced infectivity assay. Results Infectious influenza was recovered in all aerosol fractions (5.0% in >4 µm aerodynamic diameter, 75.5% in 1–4 µm, and 19.5% in <1 µm; n = 5). Tightly sealing a mask to the face blocked entry of 94.5% of total virus and 94.8% of infectious virus (n = 3). A tightly sealed respirator blocked 99.8% of total virus and 99.6% of infectious virus (n = 3). A poorly fitted respirator blocked 64.5% of total virus and 66.5% of infectious virus (n = 3). A mask documented to be loosely fitting by a PortaCount fit tester, to simulate how masks are worn by healthcare workers, blocked entry of 68.5% of total virus and 56.6% of infectious virus (n = 2). Conclusions These results support a role for aerosol transmission and represent the first reported laboratory study of the efficacy of masks and respirators in blocking inhalation of influenza in aerosols. The results indicate that a poorly fitted respirator performs no better than a loosely fitting mask. PMID:22460981

  5. Advancing interprofessional education through the use of high fidelity human patient simulators

    Kane-Gill SL

    2013-06-01

    Full Text Available Background: Modern medical care increasingly requires coordinated teamwork and communication between healthcare professionals of different disciplines. Unfortunately, healthcare professional students are rarely afforded the opportunity to learn effective methods of interprofessional (IP communication and teamwork strategies during their education. The question of how to best incorporate IP interactions in the curricula of the schools of health professions remains unanswered.Objective: We aim to solve the lack of IP education in the pharmacy curricula through the use of high fidelity simulation (HFS to allow teams of medical, pharmacy, nursing, physician assistant, and social work students to work together in a controlled environment to solve cases of complex medical and social issues.Methods: Once weekly for a 4-week time period, students worked together to complete complex simulation scenarios in small IP teams consisting of pharmacy, medical, nursing, social work, and physician assistant students. Student perception of the use of HFS was evaluated by a survey given at the conclusion of the HFS sessions. Team communication was evaluated through the use of Communication and Teamwork Skills (CATS Assessment by 2 independent evaluators external to the project.Results: The CATS scores improved from the HFS sessions 1 to 2 (p = 0.01, 2 to 3 (p = 0.035, and overall from 1 to 4 (p = 0.001. The inter-rater reliability between evaluators was high (0.85, 95% CI 0.71, 0.99. Students perceived the HFS improved: their ability to communicate with other professionals (median =4; confidence in patient care in an IP team (median=4. It also stimulated student interest in IP work (median=4.5, and was an efficient use of student time (median=4.5Conclusion: The use of HFS improved student teamwork and communication and was an accepted teaching modality. This method of exposing students of the health sciences to IP care should be incorporated throughout the

  6. Numerical simulation of magnetic nano drug targeting in a patient-specific coeliac trunk

    Boghi, Andrea, E-mail: a.boghi@cranfield.ac.uk [School of Water, Energy and Environment, Cranfield University, Cranfield, Bedfordshire MK43 0AL (United Kingdom); Russo, Flavia; Gori, Fabio [Department of Mechanical Engineering, University of Rome Tor Vergata, Via del Politecnico 1, 00133 Rome (Italy)

    2017-09-01

    Highlights: • A mathematical model, describing magnetic nanoparticles in blood flow is proposed. • The model has been validated against MHD channel flow analytical solutions. • Four simulations have been carried out to study the parameters sensitivity. • The results show the limits of magnetic drug delivery applied to hepatic tumor. • Three parameters are deemed responsible for the low performances of the technique. - Abstract: Magnetic nano drug targeting, through the use of an external magnetic field, is a new technique for the treatment of several diseases, which can potentially avoid the dispersion of drugs in undesired locations of the body. Nevertheless, due to the limitations on the intensity of the magnetic field applied, the hydrodynamic forces can reduce the effectiveness of the procedure. This technique is studied in this paper with the Computational Fluid Dynamics (CFD), focusing on the influence of the magnetic probe position, and the direction of the circulating electric current. A single rectangular coil is used to generate the external magnetic field. A patient-specific geometry of the coeliac trunk is reconstructed from DICOM images, with the use of VMTK. A new solver, coupling the Lagrangian dynamics of the nanoparticles with the Eulerian dynamics of the blood, is implemented in OpenFOAM to perform the simulations. The resistive pressure, the Womersley’s profile for the inlet velocity and the magnetic field of a rectangular coil are implemented in the software as boundary conditions. The results show the influence of the position of the probe, as well as the limitations associated with the rectangular coil configuration.

  7. Numerical simulation of magnetic nano drug targeting in a patient-specific coeliac trunk

    Boghi, Andrea; Russo, Flavia; Gori, Fabio

    2017-01-01

    Highlights: • A mathematical model, describing magnetic nanoparticles in blood flow is proposed. • The model has been validated against MHD channel flow analytical solutions. • Four simulations have been carried out to study the parameters sensitivity. • The results show the limits of magnetic drug delivery applied to hepatic tumor. • Three parameters are deemed responsible for the low performances of the technique. - Abstract: Magnetic nano drug targeting, through the use of an external magnetic field, is a new technique for the treatment of several diseases, which can potentially avoid the dispersion of drugs in undesired locations of the body. Nevertheless, due to the limitations on the intensity of the magnetic field applied, the hydrodynamic forces can reduce the effectiveness of the procedure. This technique is studied in this paper with the Computational Fluid Dynamics (CFD), focusing on the influence of the magnetic probe position, and the direction of the circulating electric current. A single rectangular coil is used to generate the external magnetic field. A patient-specific geometry of the coeliac trunk is reconstructed from DICOM images, with the use of VMTK. A new solver, coupling the Lagrangian dynamics of the nanoparticles with the Eulerian dynamics of the blood, is implemented in OpenFOAM to perform the simulations. The resistive pressure, the Womersley’s profile for the inlet velocity and the magnetic field of a rectangular coil are implemented in the software as boundary conditions. The results show the influence of the position of the probe, as well as the limitations associated with the rectangular coil configuration.

  8. Organ doses for reference pediatric and adolescent patients undergoing computed tomography estimated by Monte Carlo simulation

    Lee, Choonsik; Kim, Kwang Pyo; Long, Daniel J.; Bolch, Wesley E.

    2012-01-01

    Purpose: To establish an organ dose database for pediatric and adolescent reference individuals undergoing computed tomography (CT) examinations by using Monte Carlo simulation. The data will permit rapid estimates of organ and effective doses for patients of different age, gender, examination type, and CT scanner model. Methods: The Monte Carlo simulation model of a Siemens Sensation 16 CT scanner previously published was employed as a base CT scanner model. A set of absorbed doses for 33 organs/tissues normalized to the product of 100 mAs and CTDI vol (mGy/100 mAs mGy) was established by coupling the CT scanner model with age-dependent reference pediatric hybrid phantoms. A series of single axial scans from the top of head to the feet of the phantoms was performed at a slice thickness of 10 mm, and at tube potentials of 80, 100, and 120 kVp. Using the established CTDI vol - and 100 mAs-normalized dose matrix, organ doses for different pediatric phantoms undergoing head, chest, abdomen-pelvis, and chest-abdomen-pelvis (CAP) scans with the Siemens Sensation 16 scanner were estimated and analyzed. The results were then compared with the values obtained from three independent published methods: CT-Expo software, organ dose for abdominal CT scan derived empirically from patient abdominal circumference, and effective dose per dose-length product (DLP). Results: Organ and effective doses were calculated and normalized to 100 mAs and CTDI vol for different CT examinations. At the same technical setting, dose to the organs, which were entirely included in the CT beam coverage, were higher by from 40 to 80% for newborn phantoms compared to those of 15-year phantoms. An increase of tube potential from 80 to 120 kVp resulted in 2.5-2.9-fold greater brain dose for head scans. The results from this study were compared with three different published studies and/or techniques. First, organ doses were compared to those given by CT-Expo which revealed dose differences up to

  9. Investigation of realistic PET simulations incorporating tumor patient's specificity using anthropomorphic models: Creation of an oncology database

    Papadimitroulas, Panagiotis; Efthimiou, Nikos; Nikiforidis, George C.; Kagadis, George C. [Department of Medical Physics, School of Medicine, University of Patras, Rion, GR 265 04 (Greece); Loudos, George [Department of Biomedical Engineering, Technological Educational Institute of Athens, Ag. Spyridonos Street, Egaleo GR 122 10, Athens (Greece); Le Maitre, Amandine; Hatt, Mathieu; Tixier, Florent; Visvikis, Dimitris [Medical Information Processing Laboratory (LaTIM), National Institute of Health and Medical Research (INSERM), 29609 Brest (France)

    2013-11-15

    Purpose: The GATE Monte Carlo simulation toolkit is used for the implementation of realistic PET simulations incorporating tumor heterogeneous activity distributions. The reconstructed patient images include noise from the acquisition process, imaging system's performance restrictions and have limited spatial resolution. For those reasons, the measured intensity cannot be simply introduced in GATE simulations, to reproduce clinical data. Investigation of the heterogeneity distribution within tumors applying partial volume correction (PVC) algorithms was assessed. The purpose of the present study was to create a simulated oncology database based on clinical data with realistic intratumor uptake heterogeneity properties.Methods: PET/CT data of seven oncology patients were used in order to create a realistic tumor database investigating the heterogeneity activity distribution of the simulated tumors. The anthropomorphic models (NURBS based cardiac torso and Zubal phantoms) were adapted to the CT data of each patient, and the activity distribution was extracted from the respective PET data. The patient-specific models were simulated with the Monte Carlo Geant4 application for tomography emission (GATE) in three different levels for each case: (a) using homogeneous activity within the tumor, (b) using heterogeneous activity distribution in every voxel within the tumor as it was extracted from the PET image, and (c) using heterogeneous activity distribution corresponding to the clinical image following PVC. The three different types of simulated data in each case were reconstructed with two iterations and filtered with a 3D Gaussian postfilter, in order to simulate the intratumor heterogeneous uptake. Heterogeneity in all generated images was quantified using textural feature derived parameters in 3D according to the ground truth of the simulation, and compared to clinical measurements. Finally, profiles were plotted in central slices of the tumors, across lines

  10. Investigation of realistic PET simulations incorporating tumor patient's specificity using anthropomorphic models: Creation of an oncology database

    Papadimitroulas, Panagiotis; Efthimiou, Nikos; Nikiforidis, George C.; Kagadis, George C.; Loudos, George; Le Maitre, Amandine; Hatt, Mathieu; Tixier, Florent; Visvikis, Dimitris

    2013-01-01

    Purpose: The GATE Monte Carlo simulation toolkit is used for the implementation of realistic PET simulations incorporating tumor heterogeneous activity distributions. The reconstructed patient images include noise from the acquisition process, imaging system's performance restrictions and have limited spatial resolution. For those reasons, the measured intensity cannot be simply introduced in GATE simulations, to reproduce clinical data. Investigation of the heterogeneity distribution within tumors applying partial volume correction (PVC) algorithms was assessed. The purpose of the present study was to create a simulated oncology database based on clinical data with realistic intratumor uptake heterogeneity properties.Methods: PET/CT data of seven oncology patients were used in order to create a realistic tumor database investigating the heterogeneity activity distribution of the simulated tumors. The anthropomorphic models (NURBS based cardiac torso and Zubal phantoms) were adapted to the CT data of each patient, and the activity distribution was extracted from the respective PET data. The patient-specific models were simulated with the Monte Carlo Geant4 application for tomography emission (GATE) in three different levels for each case: (a) using homogeneous activity within the tumor, (b) using heterogeneous activity distribution in every voxel within the tumor as it was extracted from the PET image, and (c) using heterogeneous activity distribution corresponding to the clinical image following PVC. The three different types of simulated data in each case were reconstructed with two iterations and filtered with a 3D Gaussian postfilter, in order to simulate the intratumor heterogeneous uptake. Heterogeneity in all generated images was quantified using textural feature derived parameters in 3D according to the ground truth of the simulation, and compared to clinical measurements. Finally, profiles were plotted in central slices of the tumors, across lines with

  11. Oncology clinicians' defenses and adherence to communication skills training with simulated patients: an exploratory study.

    Bernard, Mathieu; de Roten, Yves; Despland, Jean-Nicolas; Stiefel, Friedrich

    2012-06-01

    The aim of this exploratory study was to assess the impact of clinicians' defense mechanisms-defined as self-protective psychological mechanisms triggered by the affective load of the encounter with the patient-on adherence to a communication skills training (CST). The population consisted of oncology clinicians (N=31) who participated in a CST. An interview with simulated cancer patients was recorded prior and 6 months after CST. Defenses were measured before and after CST and correlated with a prototype of an ideally conducted interview based on the criteria of CST-teachers. Clinicians who used more adaptive defense mechanisms showed better adherence to communication skills after CST than clinicians with less adaptive defenses (F(1, 29) =5.26, p=0.03, d=0.42). Improvement in communication skills after CST seems to depend on the initial levels of defenses of the clinician prior to CST. Implications for practice and training are discussed. Communication has been recognized as a central element of cancer care [1]. Ineffective communication may contribute to patients' confusion, uncertainty, and increased difficulty in asking questions, expressing feelings, and understanding information [2, 3], and may also contribute to clinicians' lack of job satisfaction and emotional burnout [4]. Therefore, communication skills trainings (CST) for oncology clinicians have been widely developed over the last decade. These trainings should increase the skills of clinicians to respond to the patient's needs, and enhance an adequate encounter with the patient with efficient exchange of information [5]. While CSTs show a great diversity with regard to their pedagogic approaches [6, 7], the main elements of CST consist of (1) role play between participants, (2) analysis of videotaped interviews with simulated patients, and (3) interactive case discussion provided by participants. As recently stated in a consensus paper [8], CSTs need to be taught in small groups (up to 10

  12. Optimal learning in a virtual patient simulation of cranial nerve palsies: the interaction between social learning context and student aptitude.

    Johnson, Teresa R; Lyons, Rebecca; Chuah, Joon Hao; Kopper, Regis; Lok, Benjamin C; Cendan, Juan C

    2013-01-01

    Simulation in medical education provides students with opportunities to practice interviews, examinations, and diagnosis formulation related to complex conditions without risks to patients. To examine differences between individual and team participation on learning outcomes and student perspectives through use of virtual patients (VPs) for teaching cranial nerve (CN) evaluation. Fifty-seven medical students were randomly assigned to complete simulation exercises either as individuals or as members of three-person teams. Students interviewed, examined, and diagnosed VPs with possible CN damage in the neurological exam rehearsal virtual environment (NERVE). Knowledge of CN abnormalities was assessed pre- and post-simulation. Student perspectives of system usability were evaluated post-simulation. An aptitude-treatment interaction (ATI) effect was detected; at pre-test scores ≤ 50%, students in teams scored higher (83%) at post-test than did students as individuals (62%, p = 0.02). Post-simulation, students in teams reported greater confidence in their ability to diagnose CN abnormalities than did students as individuals (p = 0.02; mean rating = 4.0/5.0 and 3.4/5.0, respectively). The ATI effect allows us to begin defining best practices for the integration of VP simulators into the medical curriculum. We are persuaded to implement future NERVE exercises with small teams of medical students.

  13. Optimal learning in a virtual patient simulation of cranial nerve palsies: The interaction between social learning context and student aptitude

    JOHNSON, TERESA R.; LYONS, REBECCA; CHUAH, JOON HAO; KOPPER, REGIS; LOK, BENJAMIN C.; CENDAN, JUAN C.

    2013-01-01

    Background Simulation in medical education provides students with opportunities to practice interviews, examinations, and diagnosis formulation related to complex conditions without risks to patients. Aim To examine differences between individual and team participation on learning outcomes and student perspectives through use of virtual patients (VPs) for teaching cranial nerve (CN) evaluation. Methods Fifty-seven medical students were randomly assigned to complete simulation exercises either as individuals or as members of three-person teams. Students interviewed, examined, and diagnosed VPs with possible CN damage in the Neurological Exam Rehearsal Virtual Environment (NERVE). Knowledge of CN abnormalities was assessed pre- and post-simulation. Student perspectives of system usability were evaluated post-simulation. Results An aptitude-treatment interaction (ATI) effect was detected; at pre-test scores ≤50%, students in teams scored higher (83%) at post-test than did students as individuals (62%, p = 0.02). Post-simulation, students in teams reported greater confidence in their ability to diagnose CN abnormalities than did students as individuals (p = 0.02; mean rating = 4.0/5.0 and 3.4/5.0, respectively). Conclusion The ATI effect allows us to begin defining best practices for the integration of VP simulators into the medical curriculum. We are persuaded to implement future NERVE exercises with small teams of medical students. PMID:22938679

  14. Numerical Simulation of Pulsation Flow in the Vapour Channel of Short Low Temperature Heat Pipes at High Heat Loads

    Seryakov, A. V.; Konkin, A. V.

    2017-11-01

    The results of the numerical simulation of pulsations in the Laval-liked vapour channel of short low-temperature range heat pipes (HPs) are presented. The numerical results confirmed the experimentally obtained increase of the frequency of pulsations in the vapour channel of short HPs with increasing overheat of the porous evaporator relative to the boiling point of the working fluid. The occurrence of pressure pulsations inside the vapour channel in a short HPs is a complex phenomenon associated with the boiling beginning in the capillary-porous evaporator at high heat loads, and appearance the excess amount of vapour above it, leading to the increase in pressure P to a value at which the boiling point TB of the working fluid becomes higher than the evaporator temperature Tev. Vapour clot spreads through the vapour channel and condense, and then a rarefaction wave return from condenser in the evaporator, the boiling in which is resumed and the next cycle of the pulsations is repeated. Numerical simulation was performed using finite element method implemented in the commercial program ANSYS Multiphisics 14.5 in the two-dimensional setting of axis symmetric moist vapour flow with third kind boundary conditions.

  15. EFFECTS OF PARENT ARTERY SEGMENTATION AND ANEURISMALWALL ELASTICITY ON PATIENT-SPECIFIC HEMODYNAMIC SIMULATIONS

    CHEN Jia-liang; DING Guang-hong; YANG Xin-jian; LI Hai-yun

    2011-01-01

    It is well known that hemodynamics and wall tension play an important role in the formation,growth and rupture of aneurysms.In the present study,the authors investigated the influence of parent artery segmentation and aneurismal-wall elasticity on patient-specific hemodynamic simulations with two patient-specific eases of cerebral aneurysms.Realistic models of the aneurysms were constructed from 3-D angiography images and blood flow dynamics was studied under physiologically representative waveform of inflow.For each aneurysm three computational models were constructed:Model 1 with more extensive upstream parent artery with the rigid arterial and aneurismal wall,Model 2 with the partial upstream parent artery with the elastic arterial and aneurismal wall,Model 3 with more extensive upstream parent artery with the rigid wall for arterial wall far from the aneurysm and the elastic wall for arterial wall near the aneurysm.The results show that Model 1 could predict complex intra-aneurismal flow patterns and wall shear stress distribution in the aneurysm,but is unable to give aneurismal wall deformation and tension,Model 2 demonstrates aneurismal wall deformation and tension,but fails to properly model inflow pattern contributed by the upstream parent artery,resulting in local misunderstanding Wall Shear Stress (WSS) distribution,Model 3 can overcome limitations of the former two models,and give an overall and accurate analysis on intra-aneurismal flow patterns,wall shear stress distribution,aneurismal-wall deformation and tension.Therefore we suggest that the proper length of extensive upstream parent artery and aneuri-smal-wall elasticity should be considered carefully in establishing computational model to predict the intra-aneurismal hemodynamic and wall tension.

  16. The Effects of Moderate- and High-Fidelity Patient Simulator Use on Critical Thinking in Associate Degree Nursing Students

    Vieck, Jana

    2013-01-01

    The purpose of this study was to examine the impact of moderate- and high-fidelity patient simulator use on the critical thinking skills of associate degree nursing students. This quantitative study used a quasi-experimental design and the Health Sciences Reasoning Test (HSRT) to evaluate the critical thinking skills of third semester nursing…

  17. Does Mental Illness Stigma Contribute to Adolescent Standardized Patients' Discomfort With Simulations of Mental Illness and Adverse Psychosocial Experiences?

    Hanson, Mark D.; Johnson, Samantha; Niec, Anne; Pietrantonio, Anna Marie; High, Bradley; MacMillan, Harriet; Eva, Kevin W.

    2008-01-01

    Objective: Adolescent mental illness stigma-related factors may contribute to adolescent standardized patients' (ASP) discomfort with simulations of psychiatric conditions/adverse psychosocial experiences. Paradoxically, however, ASP involvement may provide a stigma-reduction strategy. This article reports an investigation of this hypothetical…

  18. Numerical simulation of magnetic nano drug targeting in patient-specific lower respiratory tract

    Russo, Flavia; Boghi, Andrea; Gori, Fabio

    2018-04-01

    Magnetic nano drug targeting, with an external magnetic field, can potentially improve the drug absorption in specific locations of the body. However, the effectiveness of the procedure can be reduced due to the limitations of the magnetic field intensity. This work investigates this technique with the Computational Fluid Dynamics (CFD) approach. A single rectangular coil generates the external magnetic field. A patient-specific geometry of the Trachea, with its primary and secondary bronchi, is reconstructed from Digital Imaging and Communications in Medicine (DICOM) formatted images, throughout the Vascular Modelling Tool Kit (VMTK) software. A solver, coupling the Lagrangian dynamics of the magnetic nanoparticles with the Eulerian dynamics of the air, is used to perform the simulations. The resistive pressure, the pulsatile inlet velocity and the rectangular coil magnetic field are the boundary conditions. The dynamics of the injected particles is investigated without and with the magnetic probe. The flow field promotes particles adhesion to the tracheal wall. The particles volumetric flow rate in both cases has been calculated. The magnetic probe is shown to increase the particles flow in the target region, but at a limited extent. This behavior has been attributed to the small particle size and the probe configuration.

  19. The pillars of well-constructed simulated patient programs: A qualitative study with experienced educators.

    Pritchard, Shane A; Blackstock, Felicity C; Keating, Jennifer L; Nestel, Debra

    2017-11-01

    The inclusion of simulated patients (SPs) in health professional education is growing internationally. However, there is limited evidence for best practice in SP methodology. This study investigated how experienced SP educators support SPs in providing SP-based education for health professional students. Experienced SP educators were identified via relevant professional associations, peer-reviewed publications, and peer referral. Semi-structured individual interviews were conducted via telephone. Data were analyzed independently by three researchers using principles of inductive thematic analysis. Four themes were identified that represent the key structural components of SP programs considered by educators seeking to optimize learning for health professional students in SP programs: managing SPs by operationalizing an effective program, selecting SPs by rigorously screening for suitability, preparing SPs by educating for a specific scenario, and directing SPs by leading safe and meaningful interactions. Within these components, subthemes were described, with considerable variation in approaches. Key structural components to SP programs were consistently described by experienced SP educators who operationalize them. A framework has been proposed to assist educators in designing high-quality SP programs that support SPs and learners. Future research is required to evaluate and refine this framework and other evidence-based resources for SP educators.

  20. Numerical simulation of magnetic nano drug targeting in a patient-specific coeliac trunk

    Boghi, Andrea; Russo, Flavia; Gori, Fabio

    2017-09-01

    Magnetic nano drug targeting, through the use of an external magnetic field, is a new technique for the treatment of several diseases, which can potentially avoid the dispersion of drugs in undesired locations of the body. Nevertheless, due to the limitations on the intensity of the magnetic field applied, the hydrodynamic forces can reduce the effectiveness of the procedure. This technique is studied in this paper with the Computational Fluid Dynamics (CFD), focusing on the influence of the magnetic probe position, and the direction of the circulating electric current. A single rectangular coil is used to generate the external magnetic field. A patient-specific geometry of the coeliac trunk is reconstructed from DICOM images, with the use of VMTK. A new solver, coupling the Lagrangian dynamics of the nanoparticles with the Eulerian dynamics of the blood, is implemented in OpenFOAM to perform the simulations. The resistive pressure, the Womersley's profile for the inlet velocity and the magnetic field of a rectangular coil are implemented in the software as boundary conditions. The results show the influence of the position of the probe, as well as the limitations associated with the rectangular coil configuration.

  1. Use of simulated patients to assess the clinical and communication skills of community pharmacists.

    Weiss, Marjorie C; Booth, Anneka; Jones, Bethan; Ramjeet, Sarah; Wong, Eva

    2010-06-01

    To investigate the quality and appropriateness of Emergency Hormonal Contraception (EHC) supply from community pharmacies. Community pharmacies in the southwest of England during 2007. Two simulated patient ('mystery shopper') scenarios to each participating pharmacy, one where the supply of EHC would be appropriate (scenario 1) and one where there was a drug interaction between EHC and St John's Wort, and the supply inappropriate (scenario 2). Pharmacy consultations were rated using criteria developed from two focus groups: one with pharmacist academics and one with female university students. Feedback to pharmacists to inform their continuing professional development was provided. Scores on rating scales encompassing the clinical and communication skills of the participating community pharmacists completed immediately after each mystery shopper visit. 40 pharmacist visits were completed: 21 for scenario 1 and 19 for scenario 2. Eighteen pharmacists were visited twice. Five pharmacists visited for scenario 2 supplied EHC against professional guidance, although other reference sources conflicted with this advice. Pharmacies which were part of the local PGD scheme scored higher overall in scenario 1 (P = 0.005) than those not part of the scheme. Overall the communication skills of pharmacists were rated highly although some pharmacists used jargon when explaining the interaction for scenario 2. Formatively assessing communication skills in an integrative manner alongside clinical skills has been identified as an important part of the medical consultation skills training and can be incorporated into the routine assessment and feedback of pharmacy over-the-counter medicines advice.

  2. SU-E-J-90: MRI-Based Treatment Simulation and Patient Setup for Radiation Therapy of Brain Cancer

    Yang, Y [UCLA School of Medicine, Los Angeles, AA (United States); Cao, M; Han, F; Santhanam, A; Neylon, J; Gomez, C; Kaprealian, T; Sheng, K; Agazaryan, N; Low, D; Hu, P

    2014-06-01

    Purpose: Traditional radiation therapy of cancer is heavily dependent on CT. CT provides excellent depiction of the bones but lacks good soft tissue contrast, which makes contouring difficult. Often, MRIs are fused with CT to take advantage of its superior soft tissue contrast. Such an approach has drawbacks. It is desirable to perform treatment simulation entirely based on MRI. To achieve MR-based simulation for radiation therapy, bone imaging is an important challenge because of the low MR signal intensity from bone due to its ultra-short T2 and T1, which presents difficulty for both dose calculation and patient setup in terms of digitally reconstructed radiograph (DRR) generation. Current solutions will either require manual bone contouring or multiple MR scans. We present a technique to generate DRR using MRI with an Ultra Short Echo Time (UTE) sequence which is applicable to both OBI and ExacTrac 2D patient setup. Methods: Seven brain cancer patients were scanned at 1.5 Tesla using a radial UTE sequence. The sequence acquires two images at two different echo times. The two images were processed using in-house software. The resultant bone images were subsequently loaded into commercial systems to generate DRRs. Simulation and patient clinical on-board images were used to evaluate 2D patient setup with MRI-DRRs. Results: The majority bones are well visualized in all patients. The fused image of patient CT with the MR bone image demonstrates the accuracy of automatic bone identification using our technique. The generated DRR is of good quality. Accuracy of 2D patient setup by using MRI-DRR is comparable to CT-based 2D patient setup. Conclusion: This study shows the potential of DRR generation with single MR sequence. Further work will be needed on MR sequence development and post-processing procedure to achieve robust MR bone imaging for other human sites in addition to brain.

  3. Identification of hepatitis B and C screening and patient management guidelines and availability of training for chronic viral hepatitis among health professionals in six European countries: Results of a semi-quantitative survey

    A. Bechini (Angela); A. Falla (Abby); R.A. Ahmad (Riris); I.K. Veldhuijzen (Irene); S. Boccalini (Sara); B. Porchia (Barbara); M. Levi (Miriam)

    2015-01-01

    textabstractBackground: As part of the EU funded project "HEPscreen", the aim of this study is to identify hepatitis B and C screening and patient management guidelines, to assess the awareness of these among health professionals (HPs) and to explore the availability of hepatitis B/C training

  4. The Effect of Screen-to-Screen Versus Face-to-Face Consultation on Doctor-Patient Communication: An Experimental Study with Simulated Patients.

    Tates, Kiek; Antheunis, Marjolijn L; Kanters, Saskia; Nieboer, Theodoor E; Gerritse, Maria Be

    2017-12-20

    Despite the emergence of Web-based patient-provider contact, it is still unclear how the quality of Web-based doctor-patient interactions differs from face-to-face interactions. This study aimed to examine (1) the impact of a consultation medium on doctors' and patients' communicative behavior in terms of information exchange, interpersonal relationship building, and shared decision making and (2) the mediating role of doctors' and patients' communicative behavior on satisfaction with both types of consultation medium. Doctor-patient consultations on pelvic organ prolapse were simulated, both in a face-to-face and in a screen-to-screen (video) setting. Twelve medical interns and 6 simulated patients prepared 4 different written scenarios and were randomized to perform a total of 48 consultations. Effects of the consultations were measured by questionnaires that participants filled out directly after the consultation. With respect to patient-related outcomes, satisfaction, perceived information exchange, interpersonal relationship building, and perceived shared decision making showed no significant differences between face-to-face and screen-to-screen consultations. Patients' attitude toward Web-based communication (b=-.249, P=.02 and patients' perceived time and attention (b=.271, P=.03) significantly predicted patients' perceived interpersonal relationship building. Patients' perceived shared decision making was positively related to their satisfaction with the consultation (b=.254, P=.005). Overall, patients experienced significantly greater shared decision making with a female doctor (mean 4.21, SD 0.49) than with a male doctor (mean 3.66 [SD 0.73]; b=.401, P=.009). Doctor-related outcomes showed no significant differences in satisfaction, perceived information exchange, interpersonal relationship building, and perceived shared decision making between the conditions. There was a positive relationship between perceived information exchange and doctors

  5. Fetal doses to pregnant patients from CT with tube current modulation calculated using Monte Carlo simulations and realistic phantoms

    Gu, J.; George Xu, X.; Caracappa, P. F.; Liu, B.

    2013-01-01

    To investigate the radiation dose to the fetus using retrospective tube current modulation (TCM) data selected from archived clinical records. This paper describes the calculation of fetal doses using retrospective TCM data and Monte Carlo (MC) simulations. Three TCM schemes were adopted for use with three pregnant patient phantoms. MC simulations were used to model CT scanners, TCM schemes and pregnant patients. Comparisons between organ doses from TCM schemes and those from non-TCM schemes show that these three TCM schemes reduced fetal doses by 14, 18 and 25 %, respectively. These organ doses were also compared with those from ImPACT calculation. It is found that the difference between the calculated fetal dose and the ImPACT reported dose is as high as 46 %. This work demonstrates methods to study organ doses from various TCM protocols and potential ways to improve the accuracy of CT dose calculation for pregnant patients. (authors)

  6. Real time Monte Carlo simulation for evaluation of patient doses involved in radiological examinations

    Fulea, D.; Cosma, C.

    2006-01-01

    In order to apply the Monte Carlo simulation technique for usual radiological examinations we developed a Pc program, 'IradMed', written entirely in Java. The main purpose of this program is to compute the organ doses and the effective dose of patients, which are exposed at a X-ray beam having photon energies in 10 to 150 keV radiodiagnostic range. Three major radiological procedures are considered, namely mammography, radiography and CT. The fluoroscopy implies an irregular geometry and therefore it is neglected. Nevertheless, a gross estimation of patient doses can be made taking into account the fluoroscopy as being composed of several radiographic examinations applied in different anatomical regions. The interactions between radiation and matter are well-known, and the accuracy of the calculation is limited by the accuracy of the anatomical model used to describe actual patients and by characterisation of the radiation field applied. In this version of IradMed, it is assumed that the absorbed dose is equal with kerma for all tissues. No procedure has been used to take account of the finite range of the secondary electrons that are produced by photoelectric or Compton interactions. These ranges are small compared with the dimensions of the organs, and the absorbed dose will not change abruptly with distance except at boundary where composition and density change. However these boundary effects would have little effect in the determination of the average doses to almost all organs, except the active bone marrow which is treated separately. Another justification for this kerma approximation is the fact that the sum of all electron energies that exit the organ is statistically equal with the sum of all electron energies that enter in that particular organ. In this version of program, it is considered the following interactions: the Rayleigh scattering, the Compton scattering and the photoelectric effect. The Compton scattering is modeled by several methods which

  7. Real time Monte Carlo simulation for evaluation of patient doses involved in radiological examinations

    Fulea, D [Institute of Public Health ' Prof.Dr.Iuliu Moldovan' , Cluj-Napoca (Romania); Cosma, C [Babes-Bolyai Univ., Faculty of Physics, Cluj-Napoca (Romania)

    2006-07-01

    In order to apply the Monte Carlo simulation technique for usual radiological examinations we developed a Pc program, 'IradMed', written entirely in Java. The main purpose of this program is to compute the organ doses and the effective dose of patients, which are exposed at a X-ray beam having photon energies in 10 to 150 keV radiodiagnostic range. Three major radiological procedures are considered, namely mammography, radiography and CT. The fluoroscopy implies an irregular geometry and therefore it is neglected. Nevertheless, a gross estimation of patient doses can be made taking into account the fluoroscopy as being composed of several radiographic examinations applied in different anatomical regions. The interactions between radiation and matter are well-known, and the accuracy of the calculation is limited by the accuracy of the anatomical model used to describe actual patients and by characterisation of the radiation field applied. In this version of IradMed, it is assumed that the absorbed dose is equal with kerma for all tissues. No procedure has been used to take account of the finite range of the secondary electrons that are produced by photoelectric or Compton interactions. These ranges are small compared with the dimensions of the organs, and the absorbed dose will not change abruptly with distance except at boundary where composition and density change. However these boundary effects would have little effect in the determination of the average doses to almost all organs, except the active bone marrow which is treated separately. Another justification for this kerma approximation is the fact that the sum of all electron energies that exit the organ is statistically equal with the sum of all electron energies that enter in that particular organ. In this version of program, it is considered the following interactions: the Rayleigh scattering, the Compton scattering and the photoelectric effect. The Compton scattering is modeled by several methods which

  8. Real time Monte Carlo simulation for evaluation of patient doses involved in radiological examinations

    Fulea, D. [Institute of Public Health ' Prof.Dr.Iuliu Moldovan' , Cluj-Napoca (Romania); Cosma, C. [Babes-Bolyai Univ., Faculty of Physics, Cluj-Napoca (Romania)

    2006-07-01

    In order to apply the Monte Carlo simulation technique for usual radiological examinations we developed a Pc program, 'IradMed', written entirely in Java. The main purpose of this program is to compute the organ doses and the effective dose of patients, which are exposed at a X-ray beam having photon energies in 10 to 150 keV radiodiagnostic range. Three major radiological procedures are considered, namely mammography, radiography and CT. The fluoroscopy implies an irregular geometry and therefore it is neglected. Nevertheless, a gross estimation of patient doses can be made taking into account the fluoroscopy as being composed of several radiographic examinations applied in different anatomical regions. The interactions between radiation and matter are well-known, and the accuracy of the calculation is limited by the accuracy of the anatomical model used to describe actual patients and by characterisation of the radiation field applied. In this version of IradMed, it is assumed that the absorbed dose is equal with kerma for all tissues. No procedure has been used to take account of the finite range of the secondary electrons that are produced by photoelectric or Compton interactions. These ranges are small compared with the dimensions of the organs, and the absorbed dose will not change abruptly with distance except at boundary where composition and density change. However these boundary effects would have little effect in the determination of the average doses to almost all organs, except the active bone marrow which is treated separately. Another justification for this kerma approximation is the fact that the sum of all electron energies that exit the organ is statistically equal with the sum of all electron energies that enter in that particular organ. In this version of program, it is considered the following interactions: the Rayleigh scattering, the Compton scattering and the photoelectric effect. The Compton scattering is modeled by several

  9. Patient Simulation for Assessment of Layperson Management of Opioid Overdose with Intranasal Naloxone in a Recently-Released Prisoner Cohort

    Kobayashi, Leo; Green, Traci C.; Bowman, Sarah E.; Ray, Madeline C.; McKenzie, Michelle S.; Rich, Josiah D.

    2016-01-01

    Introduction Investigators applied simulation to an experimental program that educated, trained and assessed at-risk, volunteering prisoners on opioid overdose (OD) prevention, recognition and layperson management with intranasal (IN) naloxone. Methods Consenting inmates were assessed for OD-related experience and knowledge then exposed on-site to standardized didactics and educational DVD (without simulation). Subjects were provided with IN naloxone kits at time of release and scheduled for post-release assessment. At follow-up, subjects were evaluated for their performance of layperson opioid OD resuscitative skills during video-recorded simulations. Two investigators independently scored each subject’s resuscitative actions with a 21-item checklist; post-hoc video reviews were separately completed to adjudicate subjects’ interactions for overall benefit or harm. Results One hundred and three prisoners completed the baseline assessment and study intervention then were prescribed IN naloxone kits. One-month follow-up and simulation data were available for 85 subjects (82.5% of trained recruits) who had been released and resided in the community. Subjects’ simulation checklist median score was 12.0 (IQR 11.0–15.0) out of 21 total indicated actions. Forty-four participants (51.8%) correctly administered naloxone; 16 additional subjects (18.8%) suboptimally administered naloxone. Non-indicated actions, primarily chest compressions, were observed in 49.4% of simulations. Simulated resuscitative actions by 80 subjects (94.1%) were determined post-hoc to be beneficial overall for patients overdosing on opioids. Conclusions As part of an opioid OD prevention research program for at-risk inmates, investigators applied simulation to 1-month follow-up assessments of knowledge retention and skills acquisition in post-release participants. Simulation supplemented traditional research tools for investigation of layperson OD management. PMID:28146450

  10. Evaluation of patient dose using a virtual CT scanner: Applications to 4DCT simulation and Kilovoltage cone-beam imaging

    DeMarco, J J; Agazaryan, N; McNitt-Gray, M F; Cagnon, C H; Angel, E; Zankl, M

    2008-01-01

    This work evaluates the effects of patient size on radiation dose from simulation imaging studies such as four-dimensional computed tomography (4DCT) and kilovoltage cone-beam computed tomography (kV-CBCT). 4DCT studies are scans that include temporal information, frequently incorporating highly over-sampled imaging series necessary for retrospective sorting as a function of respiratory phase. This type of imaging study can result in a significant dose increase to the patient due to the slower table speed as compared with a conventional axial or helical scan protocol. Kilovoltage cone-beam imaging is a relatively new imaging technique that requires an on-board kilovoltage x-ray tube and a flat-panel detector. Instead of porting individual reference fields, the kV tube and flat-panel detector are rotated about the patient producing a cone-beam CT data set (kV-CBCT). To perform these investigations, we used Monte Carlo simulation methods with detailed models of adult patients and virtual source models of multidetector computed tomography (MDCT) scanners. The GSF family of three-dimensional, voxelized patient models, were implemented as input files using the Monte Carlo code MCNPX. The adult patient models represent a range of patient sizes and have all radiosensitive organs previously identified and segmented. Simulated 4DCT scans of each voxelized patient model were performed using a multi-detector CT source model that includes scanner specific spectra, bow-tie filtration, and helical source path. Standard MCNPX tally functions were applied to each model to estimate absolute organ dose based upon an air-kerma normalization measurement for nominal scanner operating parameters

  11. A hippotherapy simulator is effective to shift weight bearing toward the affected side during gait in patients with stroke.

    Sung, Yun-Hee; Kim, Chang-Ju; Yu, Byong-Kyu; Kim, Kyeong-Mi

    2013-01-01

    We investigated whether a hippotherapy simulator has influence on symmetric body weight bearing during gait in patients with stroke. Stroke patients were divided into a control group (n = 10) that received conventional rehabilitation for 60 min/day, 5 times/week for 4 weeks and an experimental group (n = 10) that used a hippotherapy simulator for 15 min/day, 5 times/week for 4 weeks after conventional rehabilitation for 45 min/day. Temporospatial gait assessed using OptoGait and trunk muscles (abdominis and erector spinae on affected side) activity evaluated using surface electromyography during sit-to-stand and gait. Prior to starting the experiment, pre-testing was performed. At the end of the 4-week intervention, we performed post-testing. Activation of the erector spinae in the experimental group was significantly increased compared to that in the control group (p hippotherapy simulator compared to control group (p hippotherapy simulator to patients with stroke can improve asymmetric weight bearing by influencing trunk muscles.

  12. After-hours/on-call experience during primary care nurse practitioner education utilizing standard scenarios and simulated patients.

    Kelly, Michelle M; Blunt, Elizabeth; Nestor, Kelly

    2017-12-01

    Few nurse practitioner (NP) programs include an after-hours/on-call component in their clinical preparation of NP students. This role is expected in many primary and specialty care practices, and is one that students feel unprepared to competently navigate. Utilizing simulated callers as patients or parents, NP students participated in a simulated after-hours/on-call experience that included receiving the call, managing the patient, and submitting documentation of the encounter. Students completed pre- and postparticipation evaluations, and were evaluated by the simulated patient callers and faculty using standardized evaluation tools. NP students rated the experience as an educationally valuable experience despite feeling anxious and nervous about the experience. Several essential skills were identified including critical thinking, clear communication, self-confidence, and access to resources. After participation NP students were more receptive to an NP position with an on-call component. Inclusion of a simulated on-call experience is a feasible component of NP education and should be added to the NP curriculum. ©2017 American Association of Nurse Practitioners.

  13. A mathematical model of coronary blood flow control: simulation of patient-specific three-dimensional hemodynamics during exercise

    Lau, Kevin D.; Asrress, Kaleab N.; Redwood, Simon R.; Figueroa, C. Alberto

    2016-01-01

    This work presents a mathematical model of the metabolic feedback and adrenergic feedforward control of coronary blood flow that occur during variations in the cardiac workload. It is based on the physiological observations that coronary blood flow closely follows myocardial oxygen demand, that myocardial oxygen debts are repaid, and that control oscillations occur when the system is perturbed and so are phenomenological in nature. Using clinical data, we demonstrate that the model can provide patient-specific estimates of coronary blood flow changes between rest and exercise, requiring only the patient's heart rate and peak aortic pressure as input. The model can be used in zero-dimensional lumped parameter network studies or as a boundary condition for three-dimensional multidomain Navier-Stokes blood flow simulations. For the first time, this model provides feedback control of the coronary vascular resistance, which can be used to enhance the physiological accuracy of any hemodynamic simulation, which includes both a heart model and coronary arteries. This has particular relevance to patient-specific simulation for which heart rate and aortic pressure recordings are available. In addition to providing a simulation tool, under our assumptions, the derivation of our model shows that β-feedforward control of the coronary microvascular resistance is a mathematical necessity and that the metabolic feedback control must be dependent on two error signals: the historical myocardial oxygen debt, and the instantaneous myocardial oxygen deficit. PMID:26945076

  14. A mathematical model of coronary blood flow control: simulation of patient-specific three-dimensional hemodynamics during exercise.

    Arthurs, Christopher J; Lau, Kevin D; Asrress, Kaleab N; Redwood, Simon R; Figueroa, C Alberto

    2016-05-01

    This work presents a mathematical model of the metabolic feedback and adrenergic feedforward control of coronary blood flow that occur during variations in the cardiac workload. It is based on the physiological observations that coronary blood flow closely follows myocardial oxygen demand, that myocardial oxygen debts are repaid, and that control oscillations occur when the system is perturbed and so are phenomenological in nature. Using clinical data, we demonstrate that the model can provide patient-specific estimates of coronary blood flow changes between rest and exercise, requiring only the patient's heart rate and peak aortic pressure as input. The model can be used in zero-dimensional lumped parameter network studies or as a boundary condition for three-dimensional multidomain Navier-Stokes blood flow simulations. For the first time, this model provides feedback control of the coronary vascular resistance, which can be used to enhance the physiological accuracy of any hemodynamic simulation, which includes both a heart model and coronary arteries. This has particular relevance to patient-specific simulation for which heart rate and aortic pressure recordings are available. In addition to providing a simulation tool, under our assumptions, the derivation of our model shows that β-feedforward control of the coronary microvascular resistance is a mathematical necessity and that the metabolic feedback control must be dependent on two error signals: the historical myocardial oxygen debt, and the instantaneous myocardial oxygen deficit. Copyright © 2016 the American Physiological Society.

  15. Simulator-based crew resource management training for interhospital transfer of critically ill patients by a mobile ICU.

    Droogh, Joep M; Kruger, Hanneke L; Ligtenberg, Jack J M; Zijlstra, Jan G

    2012-12-01

    Transporting critically ill ICU patients by standard ambulances, with or without an accompanying physician, imposes safety risks. In 2007 the Dutch Ministry of Public Health required that all critically ill patients transferred between ICUs in different hospitals be transported by a mobile ICU (MICU). Since March 2009 a specially designed MICU and a retrieval team have served the region near University Medical Center Groningen, in the northeastern region of the Netherlands. The MICU transport program includes simulator-based crew resource management (CRM) training for the intensivists and ICU nurses, who, with the drivers, constitute the MICU crews. Training entails five pivotal aspects: (1) preparation, (2) teamwork, (3) new equipment, (4) mobility, and (5) safety. For example, the training accustoms participants to working in the narrow, moving ambulance and without benefit of additional manpower. The scenario-based team training, which takes about four hours, occurs in a training facility, with its reconstructed ICU, and then in the MICU itself. A "wireless" patient simulator that is able to mimic hemodynamic and respiratory patterns and to simulate lung and heart sounds is used. All scenarios can be adjusted to simulate medical, logistic, or technical problems. Since the start of MICU training in 2009, more than 70 training sessions, involving 100 team members, have been conducted. Quality issues identified include failure to anticipate possible problems (such as failing to ask for intubation of a respiratory-compromised patient at intake); late responses to alarms of the ventilator, perfusor pump, or monitor; and not anticipating a possible shortage of medication. Setting up and implementing simulator-based CRM training provides feasible and helpful preparation for an MICU team.

  16. Patient flow improvement for an ophthalmic specialist outpatient clinic with aid of discrete event simulation and design of experiment.

    Pan, Chong; Zhang, Dali; Kon, Audrey Wan Mei; Wai, Charity Sue Lea; Ang, Woo Boon

    2015-06-01

    Continuous improvement in process efficiency for specialist outpatient clinic (SOC) systems is increasingly being demanded due to the growth of the patient population in Singapore. In this paper, we propose a discrete event simulation (DES) model to represent the patient and information flow in an ophthalmic SOC system in the Singapore National Eye Centre (SNEC). Different improvement strategies to reduce the turnaround time for patients in the SOC were proposed and evaluated with the aid of the DES model and the Design of Experiment (DOE). Two strategies for better patient appointment scheduling and one strategy for dilation-free examination are estimated to have a significant impact on turnaround time for patients. One of the improvement strategies has been implemented in the actual SOC system in the SNEC with promising improvement reported.

  17. Efficient computation of electrograms and ECGs in human whole heart simulations using a reaction-eikonal model.

    Neic, Aurel; Campos, Fernando O; Prassl, Anton J; Niederer, Steven A; Bishop, Martin J; Vigmond, Edward J; Plank, Gernot

    2017-10-01

    Anatomically accurate and biophysically detailed bidomain models of the human heart have proven a powerful tool for gaining quantitative insight into the links between electrical sources in the myocardium and the concomitant current flow in the surrounding medium as they represent their relationship mechanistically based on first principles. Such models are increasingly considered as a clinical research tool with the perspective of being used, ultimately, as a complementary diagnostic modality. An important prerequisite in many clinical modeling applications is the ability of models to faithfully replicate potential maps and electrograms recorded from a given patient. However, while the personalization of electrophysiology models based on the gold standard bidomain formulation is in principle feasible, the associated computational expenses are significant, rendering their use incompatible with clinical time frames. In this study we report on the development of a novel computationally efficient reaction-eikonal (R-E) model for modeling extracellular potential maps and electrograms. Using a biventricular human electrophysiology model, which incorporates a topologically realistic His-Purkinje system (HPS), we demonstrate by comparing against a high-resolution reaction-diffusion (R-D) bidomain model that the R-E model predicts extracellular potential fields, electrograms as well as ECGs at the body surface with high fidelity and offers vast computational savings greater than three orders of magnitude. Due to their efficiency R-E models are ideally suitable for forward simulations in clinical modeling studies which attempt to personalize electrophysiological model features.

  18. Trauma Simulation Training Increases Confidence Levels in Prehospital Personnel Performing Life-Saving Interventions in Trauma Patients

    Christine M. Van Dillen

    2016-01-01

    Full Text Available Introduction. Limited evidence is available on simulation training of prehospital care providers, specifically the use of tourniquets and needle decompression. This study focused on whether the confidence level of prehospital personnel performing these skills improved through simulation training. Methods. Prehospital personnel from Alachua County Fire Rescue were enrolled in the study over a 2- to 3-week period based on their availability. Two scenarios were presented to them: a motorcycle crash resulting in a leg amputation requiring a tourniquet and an intoxicated patient with a stab wound, who experienced tension pneumothorax requiring needle decompression. Crews were asked to rate their confidence levels before and after exposure to the scenarios. Timing of the simulation interventions was compared with actual scene times to determine applicability of simulation in measuring the efficiency of prehospital personnel. Results. Results were collected from 129 participants. Pre- and postexposure scores increased by a mean of 1.15 (SD 1.32; 95% CI, 0.88–1.42; P<0.001. Comparison of actual scene times with simulated scene times yielded a 1.39-fold difference (95% CI, 1.25–1.55 for Scenario 1 and 1.59 times longer for Scenario 2 (95% CI, 1.43–1.77. Conclusion. Simulation training improved prehospital care providers’ confidence level in performing two life-saving procedures.

  19. Crisis management on surgical wards: a simulation-based approach to enhancing technical, teamwork, and patient interaction skills.

    Arora, Sonal; Hull, Louise; Fitzpatrick, Maureen; Sevdalis, Nick; Birnbach, David J

    2015-05-01

    To establish the efficacy of simulation-based training for improving residents' management of postoperative complications on a surgical ward. Effective postoperative care is a crucial determinant of patient outcome, yet trainees learn this through the Halstedian approach. Little evidence exists on the efficacy of simulation in this safety-critical environment. A pre-/postintervention design was employed with 185 residents from 5 hospitals. Residents participated in 2 simulated ward-based scenarios consisting of a deteriorating postoperative patient. A debriefing intervention was implemented between scenarios. Resident performance was evaluated by calibrated, blinded assessors using the validated Global Assessment Toolkit for Ward Care. This included an assessment of clinical skills (checklist of 35 tasks), team-working skills (score range 1-6 per skill), and physician-patient interaction skills. Excellent interrater reliability was achieved in all assessments (reliability 0.89-0.99, P pre = 73.7% vs post = 94.8%, P pre = 21.1% vs post = 84.2% P pre = 42.1% vs post = 100%, P pre = 36.8% vs post = 89.8%, P pre = 1.75 vs post = 3.43), leadership (pre = 2.43 vs post = 4.20), and decision-making skills (pre = 2.20 vs post = 3.81, P < 0.001). Finally, residents improved in all elements of interaction with patients: empathy, organization, and verbal and nonverbal expression (Ps < 0.001). The study provides evidence for the efficacy of ward-based team training using simulation. Such exercises should be formally incorporated into training curricula to enhance patient safety in the high-risk surgical ward environment.

  20. Dose Titration of Pregabalin in Patients with Painful Diabetic Peripheral Neuropathy: Simulation Based on Observational Study Patients Enriched with Data from Randomized Studies.

    Alexander, Joe; Edwards, Roger A; Manca, Luigi; Grugni, Roberto; Bonfanti, Gianluca; Emir, Birol; Whalen, Edward; Watt, Stephen; Parsons, Bruce

    2018-03-01

    Achieving a therapeutic response to pregabalin in patients with painful diabetic peripheral neuropathy (pDPN) requires adequate upward dose titration. Our goal was to identify relationships between titration and response to pregabalin in patients with pDPN. Data were integrated from nine randomized, placebo-controlled clinical trials as well as one 6-week open-label observational study conducted by 5808 physicians (2642 patients with pDPN) in standard outpatient settings in Germany. These studies evaluated pregabalin for treatment of pDPN. Using these data, we examined "what if" scenarios using a microsimulation platform that integrates data from randomized and observational sources as well as autoregressive-moving-average with exogenous inputs models that predict pain outcomes, taking into account weekly changes in pain, sleep interference, dose, and other patient characteristics that were unchanging. Final pain levels were significantly different depending on dose changes (P titration regardless of baseline pain severity. Altogether, 78.5% of patients with pDPN had 0-1 dose change, and 15.2% had ≥ 2 dose changes. Simulation demonstrated that the 4.8% of inadequately titrated patients who did not improve/very much improve their pain levels would have benefited from ≥ 2 dose changes. Patient satisfaction with tolerability (range 90.3-96.2%) was similar, regardless of baseline pain severity, number of titrations, or extent of improvement, suggesting that tolerability did not influence treatment response patterns. Upward dose titration reduced pain in patients with pDPN who actually received it. Simulation also predicted pain reduction in an inadequately titrated nonresponder subgroup of patients had they actually received adequate titration. The decision not to uptitrate must have been driven by factors other than tolerability. Pfizer, Inc.

  1. Evaluation of patients with gastric polyps.

    Olmez, Sehmus; Sayar, Suleyman; Saritas, Bunyamin; Savas, Ayla Yildiz; Avcioglu, Ufuk; Tenlik, Ilyas; Ozaslan, Ersan; Koseoglu, Hasan Tankut; Altiparmak, Emin

    2018-01-01

    The incidence of gastric polyps (GPs) greatly differs according to study populations and was found to be 0.33%-6.7% in various studies. The majority of GPs are composed of hyperplastic polyps (HPs), fundic gland polyps (FGPs), and adenomatous polyps (APs). Although APs have a high risk of malignant potential, sporadic FGPs have no malignant potential. Conversely, HPs have a low risk of malignant potential. It is not sufficient to perform a biopsy to identify the polyp type and the presence of dysplasia; thus, some polyps may require multiple biopsies or total excision. This retrospective study included patients with GPs or polypoid lesions found on esophagogastroscopy with polyp or malignant histology on biopsy at Ankara Numune Training and Research Hospital Endoscopy Unit between 2005 and 2011. In a series of 56.300 upper endoscopies, 192 patients (0.34%) were found to have GPs. Among the patients, 51 (26.6%) were men and 151 (73.4%) were women. The average age of the patients was 61.9±13.3 (14-90) years. The frequency of HPs, APs, and FGPs were 88%, 2.6%, and 1.6%, respectively. The size of the polyps was ≤1 cm in 137 (70%) patients. One polyp was determined in 141 (73.4%) patients. The most common localizations of polyps were the antrum and corpus. Endoscopic snare polypectomy was performed in 64 patients. One bleeding episode was observed, which required endoscopic treatment after ESP. In our study, the GP frequency was low (0.34%), whereas the frequency of HP maybe high due to the high frequency of Helicobacter pylori (HPy) infection in our country. The frequency of FGP is probably low due to the high frequency of HPy infection and the short-term use of proton-pump inhibitors.

  2. Medical students' situational motivation to participate in simulation based team training is predicted by attitudes to patient safety.

    Escher, Cecilia; Creutzfeldt, Johan; Meurling, Lisbet; Hedman, Leif; Kjellin, Ann; Felländer-Tsai, Li

    2017-02-10

    Patient safety education, as well as the safety climate at clinical rotations, has an impact on students' attitudes. We explored medical students' self-reported motivation to participate in simulation-based teamwork training (SBTT), with the hypothesis that high scores in patient safety attitudes would promote motivation to SBTT and that intrinsic motivation would increase after training. In a prospective cohort study we explored Swedish medical students' attitudes to patient safety, their motivation to participate in SBTT and how motivation was affected by the training. The setting was an integrated SBTT course during the surgical semester that focused on non-technical skills and safe treatment of surgical emergencies. Data was collected using the Situational Motivation Scale (SIMS) and the Attitudes to Patient Safety Questionnaire (APSQ). We found a positive correlation between students' individual patient safety attitudes and self-reported motivation (identified regulation) to participate in SBTT. We also found that intrinsic motivation increased after training. Female students in our study scored higher than males regarding some of the APSQ sub-scores and the entire group scored higher or on par with comparable international samples. In order to enable safe practice and professionalism in healthcare, students' engagement in patient safety education is important. Our finding that students' patient safety attitudes show a positive correlation to motivation and that intrinsic motivation increases after training underpins patient safety climate and integrated teaching of patient safety issues at medical schools in order to help students develop the knowledge, skills and attitudes required for safe practice.

  3. Improving doctor-patient communication: content validity examination of a novel urinary system-simulating physical model.

    Hu, WenGang; Song, YaJun; Zhong, Xiao; Feng, JiaYu; Wang, PingXian; Huang, ChiBing

    2016-01-01

    Effective doctor-patient communication is essential for establishing a successful doctor-patient relationship and implementing high-quality health care. In this study, a novel urinary system-simulating physical model was designed and fabricated, and its content validity for improving doctor-patient communication was examined by conducting a randomized controlled trial in which this system was compared with photographs. A total of 240 inpatients were randomly selected and assigned to six doctors for treatment. After primary diagnosis and treatment had been determined, these patients were randomly divided into the experimental group and the control group. Patients in the experimental group participated in model-based doctor-patient communication, whereas control group patients received picture-based communication. Within 30 min after this communication, a Demographic Information Survey Scale and a Medical Interview Satisfaction Scale (MISS) were distributed to investigate patients' demographic characteristics and their assessments of total satisfaction, distress relief, communication comfort, rapport, and compliance intent. The study results demonstrated that the individual groups were comparable with respect to demographic variables but that relative to patients in the picture-based communication group, patients in the model-based communication group had significantly higher total satisfaction scores and higher ratings for distress relief, communication comfort, rapport, and compliance intent. These results indicate that the physical model is more effective than the pictures at improving doctor-patient communication and patient outcomes. The application of the physical model in doctor-patient communication is helpful and valuable and therefore merits widespread clinical popularization.

  4. Modeling and simulation of stand-alone hybrid power system with fuzzy MPPT for remote load application

    Bogaraj T.

    2015-09-01

    Full Text Available Many parts of remote locations in the world are not electrified even in this Advanced Technology Era. To provide electricity in such remote places renewable hybrid energy systems are very much suitable. In this paper PV/Wind/Battery Hybrid Power System (HPS is considered to provide an economical and sustainable power to a remote load. HPS can supply the maximum power to the load at a particular operating point which is generally called as Maximum Power Point (MPP. Fuzzy Logic based MPPT (FLMPPT control method has been implemented for both Solar and Wind Power Systems. FLMPPT control technique is implemented to generate the optimal reference voltage for the first stage of DC-DC Boost converter in both the PV and Wind energy system. The HPS is tested with variable solar irradiation, temperature, and wind speed. The FLMPPT method is compared with P&O MPPT method. The proposed method provides a good maximum power operation of the hybrid system at all operating conditions. In order to combine both sources, the DC bus voltage is made constant by employing PI Controllers for the second stage of DC-DC Buck-Boost converter in both Solar and Wind Power Systems. Battery Bank is used to store excess power from Renewable Energy Sources (RES and to provide continuous power to load when the RES power is less than load power. A SPWM inverter is designed to convert DC power into AC to supply three phase load. An LC filter is also used at the output of inverter to get sinusoidal current from the PWM inverter. The entire system was modeled and simulated in Matlab/Simulink Environment. The results presented show the validation of the HPS design.

  5. An Evaluation of Navy En Route Care Training Using a High-Fidelity Medical Simulation Scenario of Interfacility Patient Transport.

    DeForest, Christine A; Blackman, Virginia; Alex, John E; Reeves, Lauren; Mora, Alejandra; Perez, Crystal; Maddry, Joseph; Selby, Domenique; Walrath, Benjamin

    2018-03-14

    Military prehospital and en route care (ERC) directly impacts patient morbidity and mortality. Provider knowledge and skills are critical variables in the effectiveness of ERC. No Navy doctrine defines provider choice for patient transport or requires standardized provider training. Frequently, Search and Rescue Medical Technicians (SMTs) and Navy Nurses (ERC RNs) are tasked with this mission though physicians have also been used. Navy ERC provider training varies greatly by professional role. Historically, evaluations of ERC and patient outcomes have been based on retrospective analyses of incomplete data sets that provide limited insight on ERC practices. Little evidence exists to determine if current training is adequate to care for the most common injuries seen in combat trauma patients. Simulation technology facilitates a standardized patient encounter to enable complete, prospective data collection while studying provider type as the independent variable. Information acquired through skill performance observation can be used to make evidence-based recommendations to improve ERC training. This IRB approved multi-center study funded through a Congressionally Directed Medical Research Program grant from the Combat Casualty Care Intramural Research Joint En Route Care portfolio evaluated Navy ERC providers. The study evaluated 84 SMT, ERC RN, and physician participants in the performance of critical and secondary actions during an immersive, high-fidelity, patient transport simulation scenario focused on the care during an interfacility transfer. Simulation evaluators with military ERC expertise, blinded to participant training and background, graded each participant's performance. Inter-rater reliability was calculated using Cohen's Kappa to evaluate concordance between evaluator assessments. Categorical data were reported as frequencies and percentages. Performance attempt and accuracy rates were compared with likelihood ratio chi-square or Fisher's exact test

  6. I simulated, therefore I can- I reflected, therefore I know - I acted as a patient, therefore I feel

    Selberg, Hanne; Hovedskov, Jette; Steenberg Holtzmann, Jette

    setting enhances the transfer. Collaboration between project leader, clinical experts and educators was crucial in order to create an appreciative and safe learning environment. The personal physical experience both in relation to hands-on and patient acting brought about a more lasting learning...... a dynamic simulation learning model as decribed by Dr Roger Kneebone into a Danish hospital setting enabling students and staff to provide better care.Summary of work:Real-life scenarious were embedded in the authentic clinical setting,interactive role-play and hand-on training in addition to sessions...... identified as learning outcomes.Conclusions:The real-life scenarious contributed to the learning environmentin a safe and appreciative manner, changing the culture around patient- safety and interprofessional collaborationTake-home messages:The interaction between simulation and the authentic clinical...

  7. Patient-specific surgical simulator for the pre-operative planning of single-incision laparoscopic surgery with bimanual robots.

    Turini, Giuseppe; Moglia, Andrea; Ferrari, Vincenzo; Ferrari, Mauro; Mosca, Franco

    2012-01-01

    The trend of surgical robotics is to follow the evolution of laparoscopy, which is now moving towards single-incision laparoscopic surgery. The main drawback of this approach is the limited maneuverability of the surgical tools. Promising solutions to improve the surgeon's dexterity are based on bimanual robots. However, since both robot arms are completely inserted into the patient's body, issues related to possible unwanted collisions with structures adjacent to the target organ may arise. This paper presents a simulator based on patient-specific data for the positioning and workspace evaluation of bimanual surgical robots in the pre-operative planning of single-incision laparoscopic surgery. The simulator, designed for the pre-operative planning of robotic laparoscopic interventions, was tested by five expert surgeons who evaluated its main functionalities and provided an overall rating for the system. The proposed system demonstrated good performance and usability, and was designed to integrate both present and future bimanual surgical robots.

  8. Didactic Content and Experiential Aging Simulation for Developing Patient-Centered Strategies and Empathy for Older Adults.

    Johnson, Carole E; Jilla, Anna Marie; Danhauer, Jeffrey L

    2018-02-01

    The number of people over 65 years of age is increasing, and many of those individuals will have sensorineural hearing loss in addition to other chronic health conditions. Future hearing health care providers need to be sensitive to the needs of elderly patients. The purpose of this article is to describe an experiential learning curriculum used in the Doctor of Audiology program in the Department of Communication Sciences and Disorders at the University of Oklahoma Health Sciences Center. The curriculum uses simulations of sensory disorders common in the elderly to transform knowledge and active experience into patient-centered, empathetic counseling skills and strategies to use with older adults with hearing loss.

  9. Evaluation of irradiation position in respiratory-gated radiotherapy using a phantom system simulating patient respiration

    Oyama, Masaya; Ueda, Takashi; Kitoh, Satoshi; Tanaka, Takashi; Goka, Tomonori; Ogino, Takashi

    2006-01-01

    Respiratory-gated (RG) radiotherapy is useful for minimizing the irradiated volume of normal tissues resulting from the shifting of internal structures caused by respiratory movement. The present study was conducted to evaluate the treatment field in RG radiotherapy using a phantom system simulating patient respiration. A phantom system consisting of a 3-cm ball-shaped dummy tumor and film placed in a cork lung phantom was used (THK Co., Ltd.). RG radiotherapy was employed in the expiratory phase. The phantom movement distance was set to 2 cm, and the gating signals from a respiratory-gating system (AZ-733V, Anzai Medical) were varied. The settings used for irradiation were an X-ray energy of 6 MV (PRIMUS, Toshiba Medical Systems), treatment field of 5 cm x 7 cm, and X-ray dose of 100 MU. Images were acquired using an electric portal-imaging device (EPID, OPTIVUE 500), and the X-ray dose distribution was measured by the film method. In images acquired using the EPID, the tumor margins became less clear when the gating signals were increased, and the ITVs were determined to be 3.6 cm, 3.7 cm, 4.2 cm, and 5.1 cm at gating rates of 10%, 25%, 50%, and no gate, respectively. With regard to the X-ray dose distribution measured by the film method, the dose profile in the cephalocaudal direction was shifted toward the expiratory phase, and the degree of shift became greater when the gating signals were increased. In addition, the optimal treatment fields in the cephalocaudal direction were determined to be 5.2 cm, 5.2 cm, 5.6 cm, and 7.0 cm at gating rates of 10%, 25%, 50%, and no gating, respectively. Although RG radiotherapy is useful for improving the accuracy of radiotherapy, the characteristics of the RG radiotherapy technique and the radiotherapy system must be clearly understood when this method is to be employed in clinical practice. Image-guided radiotherapy (IGRT) is now assuming a central role in radiotherapy, and properly identifying internal margins is an

  10. A 4D Digital Phantom for Patient-Specific Simulation of Brain CT Perfusion Protocols

    Boom, R. van den; Manniesing, R.; Oei, M.T.H.; Woude, W.J. van der; Smit, E.J.; Laue, H.O.A.; Ginneken, B. van; Prokop, M.

    2014-01-01

    Purpose Optimizing CT brain perfusion protocols is a challenge because of the complex interaction between image acquisition, calculation of perfusion data and patient hemodynamics. Several digital phantoms have been developed to avoid unnecessary patient exposure or suboptimum choice of parameters.

  11. Dexmedetomidine provides optimum conditions during awake fiberoptic intubation in simulated cervical spine injury patients

    Pooja Chopra

    2016-01-01

    Conclusions: Dexmedetomidine provides optimum sedation without compromising airway or hemodynamic instability with better patient tolerance and satisfaction for AFOI. It also preserves patient arousability for the postintubation neurological assessment.

  12. A Simulation Study on Patient Setup Errors in External Beam Radiotherapy Using an Anthropomorphic 4D Phantom

    Payam Samadi Miandoab

    2016-12-01

    Full Text Available Introduction Patient set-up optimization is required in radiotherapy to fill the accuracy gap between personalized treatment planning and uncertainties in the irradiation set-up. In this study, we aimed to develop a new method based on neural network to estimate patient geometrical setup using 4-dimensional (4D XCAT anthropomorphic phantom. Materials and Methods To access 4D modeling of motion of dynamic organs, a phantom employs non-uniform rational B-splines (NURBS-based Cardiac-Torso method with spline-based model to generate 4D computed tomography (CT images. First, to generate all the possible roto-translation positions, the 4D CT images were imported to Medical Image Data Examiner (AMIDE. Then, for automatic, real time verification of geometrical setup, an artificial neural network (ANN was proposed to estimate patient displacement, using training sets. Moreover, three external motion markers were synchronized with a patient couch position as reference points. In addition, the technique was validated through simulated activities by using reference 4D CT data acquired from five patients. Results The results indicated that patient geometrical set-up is highly depended on the comprehensiveness of training set. By using ANN model, the average patient setup error in XCAT phantom was reduced from 17.26 mm to 0.50 mm. In addition, in the five real patients, these average errors were decreased from 18.26 mm to 1.48 mm various breathing phases ranging from inhalation to exhalation were taken into account for patient setup. Uncertainty error assessment and different setup errors were obtained from each respiration phase. Conclusion This study proposed a new method for alignment of patient setup error using ANN model. Additionally, our correlation model (ANN could estimate true patient position with less error.

  13. Development, implementation and pilot evaluation of a Web-based Virtual Patient Case Simulation environment--Web-SP.

    Zary, Nabil; Johnson, Gunilla; Boberg, Jonas; Fors, Uno G H

    2006-02-21

    The Web-based Simulation of Patients (Web-SP) project was initiated in order to facilitate the use of realistic and interactive virtual patients (VP) in medicine and healthcare education. Web-SP focuses on moving beyond the technology savvy teachers, when integrating simulation-based education into health sciences curricula, by making the creation and use of virtual patients easier. The project strives to provide a common generic platform for design/creation, management, evaluation and sharing of web-based virtual patients. The aim of this study was to evaluate if it was possible to develop a web-based virtual patient case simulation environment where the entire case authoring process might be handled by teachers and which would be flexible enough to be used in different healthcare disciplines. The Web-SP system was constructed to support easy authoring, management and presentation of virtual patient cases. The case authoring environment was found to facilitate for teachers to create full-fledged patient cases without the assistance of computer specialists. Web-SP was successfully implemented at several universities by taking into account key factors such as cost, access, security, scalability and flexibility. Pilot evaluations in medical, dentistry and pharmacy courses shows that students regarded Web-SP as easy to use, engaging and to be of educational value. Cases adapted for all three disciplines were judged to be of significant educational value by the course leaders. The Web-SP system seems to fulfil the aim of providing a common generic platform for creation, management and evaluation of web-based virtual patient cases. The responses regarding the authoring environment indicated that the system might be user-friendly enough to appeal to a majority of the academic staff. In terms of implementation strengths, Web-SP seems to fulfil most needs from course directors and teachers from various educational institutions and disciplines. The system is currently in

  14. Development, implementation and pilot evaluation of a Web-based Virtual Patient Case Simulation environment – Web-SP

    Boberg Jonas

    2006-02-01

    Full Text Available Abstract Background The Web-based Simulation of Patients (Web-SP project was initiated in order to facilitate the use of realistic and interactive virtual patients (VP in medicine and healthcare education. Web-SP focuses on moving beyond the technology savvy teachers, when integrating simulation-based education into health sciences curricula, by making the creation and use of virtual patients easier. The project strives to provide a common generic platform for design/creation, management, evaluation and sharing of web-based virtual patients. The aim of this study was to evaluate if it was possible to develop a web-based virtual patient case simulation environment where the entire case authoring process might be handled by teachers and which would be flexible enough to be used in different healthcare disciplines. Results The Web-SP system was constructed to support easy authoring, management and presentation of virtual patient cases. The case authoring environment was found to facilitate for teachers to create full-fledged patient cases without the assistance of computer specialists. Web-SP was successfully implemented at several universities by taking into account key factors such as cost, access, security, scalability and flexibility. Pilot evaluations in medical, dentistry and pharmacy courses shows that students regarded Web-SP as easy to use, engaging and to be of educational value. Cases adapted for all three disciplines were judged to be of significant educational value by the course leaders. Conclusion The Web-SP system seems to fulfil the aim of providing a common generic platform for creation, management and evaluation of web-based virtual patient cases. The responses regarding the authoring environment indicated that the system might be user-friendly enough to appeal to a majority of the academic staff. In terms of implementation strengths, Web-SP seems to fulfil most needs from course directors and teachers from various educational

  15. The case of "Miss Jacobs": adolescent simulated patients and the quality of their role playing, feedback, and personal impact.

    Bokken, Lonneke; van Dalen, Jan; Rethans, Jan-Joost

    2010-12-01

    Adolescents as standardized patients are relatively new in medical education. Studies have mostly explored the impact of role playing on adolescents trained to perform standardized patient roles for assessment purposes. No studies were found with regard to the quality of adolescents' role playing. We evaluated the effects of performing a patient role on adolescents trained as simulated patients (SPs) for teaching purposes (in contrast to standardized patients) and evaluated the quality of adolescent SPs' role playing and feedback. Nine young women, aged 16 to 18 years, were trained to portray roles of adolescents asking their general practitioner for an oral contraceptive. Three adolescent men were trained to portray roles of some of the girls' boyfriends. Each role was developed in consultation with the individual adolescent and was largely based on her own personal experience. Students rated the quality of the adolescent SP's role playing and feedback after each SP encounter on a previously validated questionnaire (the Maastricht Assessment of Simulated Patients). Both the adolescent SPs and faculty teachers both completed questionnaires on their experiences. Three hundred forty-one students rated the quality of the SPs' role playing and feedback with a mean score of 7.5 of 10. The faculty teachers were also generally positive about the role playing and feedback. Nevertheless, there were some concerns about the quality of the feedback. Adolescent SPs reported no negative effects because of their performance. Generally, students and teachers were satisfied with the quality of the role playing and feedback provided by the adolescent SPs. The adolescent SPs experienced no negative effects related to their performance, which confirms earlier findings among adolescent standardized patients.

  16. Early bedside care during preclinical medical education: can technology-enhanced patient simulation advance the Flexnerian ideal?

    Gordon, James A; Hayden, Emily M; Ahmed, Rami A; Pawlowski, John B; Khoury, Kimberly N; Oriol, Nancy E

    2010-02-01

    Flexner wanted medical students to study at the patient bedside-a remarkable innovation in his time-so that they could apply science to clinical care under the watchful eye of senior physicians. Ever since his report, medical schools have reserved the latter years of their curricula for such an "advanced" apprenticeship, providing clinical clerkship experiences only after an initial period of instruction in basic medical sciences. Although Flexner codified the segregation of preclinical and clinical instruction, he was committed to ensuring that both domains were integrated into a modern medical education. The aspiration to fully integrate preclinical and clinical instruction continues to drive medical education reform even to this day. In this article, the authors revisit the original justification for sequential preclinical-clinical instruction and argue that modern, technology-enhanced patient simulation platforms are uniquely powerful for fostering simultaneous integration of preclinical-clinical content in a way that Flexner would have applauded. To date, medical educators tend to focus on using technology-enhanced medical simulation in clinical and postgraduate medical education; few have devoted significant attention to using immersive clinical simulation among preclinical students. The authors present an argument for the use of dynamic robot-mannequins in teaching basic medical science, and describe their experience with simulator-based preclinical instruction at Harvard Medical School. They discuss common misconceptions and barriers to the approach, describe their curricular responses to the technique, and articulate a unifying theory of cognitive and emotional learning that broadens the view of what is possible, feasible, and desirable with simulator-based medical education.

  17. Leadership and teamwork in medical emergencies: performance of nursing students and registered nurses in simulated patient scenarios.

    Endacott, Ruth; Bogossian, Fiona E; Cooper, Simon J; Forbes, Helen; Kain, Victoria J; Young, Susan C; Porter, Joanne E

    2015-01-01

    To examine nursing students' and registered nurses' teamwork skills whilst managing simulated deteriorating patients. Studies continue to show the lack of timely recognition of patient deterioration. Management of deteriorating patients can be influenced by education and experience. Mixed methods study conducted in two universities and a rural hospital in Victoria, and one university in Queensland, Australia. Three simulation scenarios (chest pain, hypovolaemic shock and respiratory distress) were completed in teams of three by 97 nursing students and 44 registered nurses, equating to a total of 32 student and 15 registered nurse teams. Data were obtained from (1) Objective Structured Clinical Examination rating to assess performance; (2) Team Emergency Assessment Measure scores to assess teamwork; (3) simulation video footage; (4) reflective interview during participants' review of video footage. Qualitative thematic analysis of video and interview data was undertaken. Objective structured clinical examination performance was similar across registered nurses and students (mean 54% and 49%); however, Team Emergency Assessment Measure scores differed significantly between the two groups (57% vs 38%, t = 6·841, p student teams: r = 0·530, p = 0·004, registered nurse teams r = 0·903, p student teams: r = 0·534, p = 0·02, registered nurse teams: r = 0·535, p = 0·049). Themes generated from the analysis of the combined quantitative and qualitative data were as follows: (1) leadership and followership behaviours; (2) help-seeking behaviours; (3) reliance on previous experience; (4) fixation on a single detail; and (5) team support. There is scope to improve leadership, team work and task management skills for registered nurses and nursing students. Simulation appears to be beneficial in enabling less experienced staff to assess their teamwork skills. There is a need to encourage less experienced staff to become leaders and for all staff to develop improved

  18. Simulated settings; powerful arenas for learning patient safety practices and facilitating transference to clinical practice. A mixed method study.

    Reime, Marit Hegg; Johnsgaard, Tone; Kvam, Fred Ivan; Aarflot, Morten; Breivik, Marit; Engeberg, Janecke Merethe; Brattebø, Guttorm

    2016-11-01

    Poor teamwork is an important factor in the occurrence of critical incidents because of a lack of non-technical skills. Team training can be a key to prevent these incidents. The purpose of this study was to explore the experience of nursing and medical students after a simulation-based interprofessional team training (SBITT) course and its impact on professional and patient safety practices, using a concurrent mixed-method design. The participants (n = 262) were organized into 44 interprofessional teams. The results showed that two training sequences the same day improved overall team performance. Making mistakes during SBITT appeared to improve the quality of patient care once the students returned to clinical practice as it made the students more vigilant. Furthermore, the video-assisted oral debriefing provided an opportunity to strengthen interprofessional teamwork and share situational awareness. SBITT gave the students an opportunity to practice clinical reasoning skills and to share professional knowledge. The students conveyed the importance of learning to speak up to ensure safe patient practices. Simulated settings seem to be powerful arenas for learning patient safety practices and facilitating transference of this awareness to clinical practice. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Monte Carlo simulation tool for online treatment monitoring in hadrontherapy with in-beam PET: A patient study.

    Fiorina, E; Ferrero, V; Pennazio, F; Baroni, G; Battistoni, G; Belcari, N; Cerello, P; Camarlinghi, N; Ciocca, M; Del Guerra, A; Donetti, M; Ferrari, A; Giordanengo, S; Giraudo, G; Mairani, A; Morrocchi, M; Peroni, C; Rivetti, A; Da Rocha Rolo, M D; Rossi, S; Rosso, V; Sala, P; Sportelli, G; Tampellini, S; Valvo, F; Wheadon, R; Bisogni, M G

    2018-05-07

    Hadrontherapy is a method for treating cancer with very targeted dose distributions and enhanced radiobiological effects. To fully exploit these advantages, in vivo range monitoring systems are required. These devices measure, preferably during the treatment, the secondary radiation generated by the beam-tissue interactions. However, since correlation of the secondary radiation distribution with the dose is not straightforward, Monte Carlo (MC) simulations are very important for treatment quality assessment. The INSIDE project constructed an in-beam PET scanner to detect signals generated by the positron-emitting isotopes resulting from projectile-target fragmentation. In addition, a FLUKA-based simulation tool was developed to predict the corresponding reference PET images using a detailed scanner model. The INSIDE in-beam PET was used to monitor two consecutive proton treatment sessions on a patient at the Italian Center for Oncological Hadrontherapy (CNAO). The reconstructed PET images were updated every 10 s providing a near real-time quality assessment. By half-way through the treatment, the statistics of the measured PET images were already significant enough to be compared with the simulations with average differences in the activity range less than 2.5 mm along the beam direction. Without taking into account any preferential direction, differences within 1 mm were found. In this paper, the INSIDE MC simulation tool is described and the results of the first in vivo agreement evaluation are reported. These results have justified a clinical trial, in which the MC simulation tool will be used on a daily basis to study the compliance tolerances between the measured and simulated PET images. Copyright © 2018 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  20. Barriers and enablers to the use of high-fidelity patient simulation manikins in nurse education: an integrative review.

    Al-Ghareeb, Amal Z; Cooper, Simon J

    2016-01-01

    This integrative review identified, critically appraised and synthesised the existing evidence on the barriers and enablers to using high-fidelity human patient simulator manikins (HPSMs) in undergraduate nursing education. In nursing education, specifically at the undergraduate level, a range of low to high-fidelity simulations have been used as teaching aids. However, nursing educators encounter challenges when introducing new teaching methods or technology, despite the prevalence of high-fidelity HPSMs in nursing education. An integrative review adapted a systematic approach. Medline, CINAHL plus, ERIC, PsychINFO, EMBASE, SCOPUS, Science Direct, Cochrane database, Joanna Brigge Institute, ProQuest, California Simulation Alliance, Simulation Innovative Recourses Center and the search engine Google Scholar were searched. Keywords were selected and specific inclusion/exclusion criteria were applied. The review included all research designs for papers published between 2000 and 2015 that identified the barriers and enablers to using high-fidelity HPSMs in undergraduate nursing education. Studies were appraised using the Critical Appraisal Skills Programme criteria. Thematic analysis was undertaken and emergent themes were extracted. Twenty-one studies were included in the review. These studies adopted quasi-experimental, prospective non-experimental and descriptive designs. Ten barriers were identified, including "lack of time," "fear of technology" and "workload issues." Seven enablers were identified, including "faculty training," "administrative support" and a "dedicated simulation coordinator." Barriers to simulation relate specifically to the complex technologies inherent in high-fidelity HPSMs approaches. Strategic approaches that support up-skilling and provide dedicated technological support may overcome these barriers. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Accuracy assessment of and 111In quantification protocol using Monte Carlo simulated patients

    Castillo Lopez, J.; Coca, M. A.; Torres, L. A.; Gomez Facenda, A.

    2013-01-01

    The analyzed protocol showed a tendency to overestimate activity, revealed in the mean difference of -0.3MBq. Still, determined activity was never separated more than 10% from simulated one. Differences between calculated and simulated activity followed a Lorentzian distribution with a correlation coefficient of 0.99. The graphical interface exhibited an average difference of 0.001MBq with a standard deviation of 0.5MBq in relation to reference software. It was implemented and evaluated a methodology to perform quantitative calculations of 1 11In activity using whole body studies. Its application with a proposed graphical interface was also assessed. (Author)

  2. Search for HPs in lungs by autoradiography

    Radev, S.; Bosevski, V.; Belokonski, Il.; Minev, L.; Bonchev, T.; Uzunov, I.; Kolev, Z.; Radev, V.

    1993-01-01

    Samples from human lungs have been investigated in order to localize deposited hot particles. The samples are taken from 5 people died in accidents during February-June 1987. The method of sample preparation and exposure arrangements are described in detail. After 40 days of exposure on standard X-ray films, hot particles (HP) have been detected in two of the samples, each one containing 11 and 1 HP respectively. The sample containing 11 HP has been taken from a construction worker who had died on April 20, 1987. The HP activity have been in the range 0.05 to 0.5 Bq. 2 figs., 6 refs

  3. How People Get Hantavirus Pulmonary Syndrome (HPS)

    ... Preventing Seoul Virus Infection in Pet Rats and People FAQs: Seoul Virus Cleaning Up After Pet Rodents to Reduce the Risk of Seoul Virus ... Bolivia, Brazil, Chile, Panama, Paraguay, and Uruguay. Can pets ... rodents into contact with people if they catch such animals and carry them ...

  4. Reported Cases of HPS (Hantavirus Pulmonary Syndrome)

    ... Brazil, Chile, Ecuador, Paraguay, Panama and Uruguay and Venezuela. Large outbreaks have been rare and have usually ... Watch RSS ABOUT About CDC Jobs Funding LEGAL Policies Privacy FOIA No Fear Act OIG 1600 Clifton ...

  5. Variation in effectiveness of a cardiac auscultation training class with a cardiology patient simulator among heart sounds and murmurs.

    Kagaya, Yutaka; Tabata, Masao; Arata, Yutaro; Kameoka, Junichi; Ishii, Seiichi

    2017-08-01

    Effectiveness of simulation-based education in cardiac auscultation training is controversial, and may vary among a variety of heart sounds and murmurs. We investigated whether a single auscultation training class using a cardiology patient simulator for medical students provides competence required for clinical clerkship, and whether students' proficiency after the training differs among heart sounds and murmurs. A total of 324 fourth-year medical students (93-117/year for 3 years) were divided into groups of 6-8 students; each group participated in a three-hour training session using a cardiology patient simulator. After a mini-lecture and facilitated training, each student took two different tests. In the first test, they tried to identify three sounds of Category A (non-split, respiratory split, and abnormally wide split S2s) in random order, after being informed that they were from Category A. They then did the same with sounds of Category B (S3, S4, and S3+S4) and Category C (four heart murmurs). In the second test, they tried to identify only one from each of the three categories in random order without any category information. The overall accuracy rate declined from 80.4% in the first test to 62.0% in the second test (pauscultation training. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  6. Real-time surgery simulation of intracranial aneurysm clipping with patient-specific geometries and haptic feedback

    Fenz, Wolfgang; Dirnberger, Johannes

    2015-03-01

    Providing suitable training for aspiring neurosurgeons is becoming more and more problematic. The increasing popularity of the endovascular treatment of intracranial aneurysms leads to a lack of simple surgical situations for clipping operations, leaving mainly the complex cases, which present even experienced surgeons with a challenge. To alleviate this situation, we have developed a training simulator with haptic interaction allowing trainees to practice virtual clipping surgeries on real patient-specific vessel geometries. By using specialized finite element (FEM) algorithms (fast finite element method, matrix condensation) combined with GPU acceleration, we can achieve the necessary frame rate for smooth real-time interaction with the detailed models needed for a realistic simulation of the vessel wall deformation caused by the clamping with surgical clips. Vessel wall geometries for typical training scenarios were obtained from 3D-reconstructed medical image data, while for the instruments (clipping forceps, various types of clips, suction tubes) we use models provided by manufacturer Aesculap AG. Collisions between vessel and instruments have to be continuously detected and transformed into corresponding boundary conditions and feedback forces, calculated using a contact plane method. After a training, the achieved result can be assessed based on various criteria, including a simulation of the residual blood flow into the aneurysm. Rigid models of the surgical access and surrounding brain tissue, plus coupling a real forceps to the haptic input device further increase the realism of the simulation.

  7. Simulation training for foundation doctors on the management of the acutely ill patient

    Cachia M

    2015-12-01

    Full Text Available Monique Cachia,1 Michael Pace-Bardon,2 Gabriella Balzan,2 Russel Tilney,2 Josef Micallef,2 Martin Balzan2 1Department of Medicine, 2Department of Respiratory Medicine, Mater Dei Hospital, Msida, Malta Background: A study evaluating subjective trainee responses to simulation training organized by the Malta Foundation Program in particular whether this changed their clinical practice. Method: Feedback using a standardized questionnaire was obtained from 120 (M=55% participants. A 0–10 Likert scale was used to evaluate responses. Results: Participants scored the simulation sessions as “useful” at 7.7 (95% confidence interval [CI] 7.4–8.0, rated “the overall experience” at 7.5 (95% CI 7.2–7.8, and thought it made a change in “daily practice” at 5.83 (95% CI 5.4–6.3. The score for the tutor “creating a satisfactory learning environment” and “quality of simulator equipment” was 7.8 (95% CI 7.6–8.1 and 7.7 (95% CI 7.4–8, respectively. Trainees rated “how close was the simulation to a real-life scenario” as 6.24 (95% CI 5.9–6.6. When asked whether the presence of colleagues hindered or helped, the majority were neutral 50 (41.7%, 36 (30% said it hindered, while only 21 (28.3% felt it helped. In contrast, 94 (78.33% stated it was useful to observe colleagues while only 5 (4.2% stated it was not. Likelihood for future participation was 7.4 (95% CI 7–7.8. Trainees recommended a median of 3 (interquartile range 2–5 simulations per year. Conclusion: Trainees rated the sessions as useful and asked for more sessions possibly at an undergraduate level. Rating for equipment and tutors was positive; however, some felt that the effect on daily practice was limited. Most were comfortable observing others and uncomfortable being observed. The value of increasing sessions to 3–4 per year, timing them before clinical attachments and audiovisual prebriefing for candidates naïve to simulation needs to be evaluated in future

  8. Decolonization of patients and health care workers to control nosocomial spread of methicillin-resistant Staphylococcus aureus: a simulation study.

    Gurieva, Tatiana V; Bootsma, Martin C J; Bonten, Marc J M

    2012-11-14

    Control of methicillin-resistant Staphylococcus aureus (MRSA) transmission has been unsuccessful in many hospitals. Recommended control measures include isolation of colonized patients, rather than decolonization of carriage among patients and/or health care workers. Yet, the potential effects of such measures are poorly understood. We use a stochastic simulation model in which health care workers can transmit MRSA through short-lived hand contamination, or through persistent colonization. Hand hygiene interrupts the first mode, decolonization strategies the latter. We quantified the effectiveness of decolonization of patients and health care workers, relative to patient isolation in settings where MRSA carriage is endemic (rather than sporadic outbreaks in non-endemic settings caused by health care workers). Patient decolonization is the most effective intervention and outperforms patient isolation, even with low decolonization efficacy and when decolonization is not achieved immediately. The potential role of persistently colonized health care workers in MRSA transmission depends on the proportion of persistently colonized health care workers and the likelihood per colonized health care worker to transmit. As stand-alone intervention, universal screening and decolonization of persistently colonized health care workers is generally the least effective intervention, especially in high endemicity settings. When added to patient isolation, such a strategy would have maximum benefits if few health care workers cause a large proportion of the acquisitions. In high-endemicity settings regular screening of health care workers followed by decolonization of MRSA-carriers is unlikely to reduce nosocomial spread of MRSA unless there are few persistently colonized health care workers who are responsible for a large fraction of the MRSA acquisitions by patients. In contrast, decolonization of patients can be very effective.

  9. Differences in Faculty and Standardized Patient Scores on Professionalism for Second-Year Podiatric Medical Students During a Standardized Simulated Patient Encounter.

    Mahoney, James M; Vardaxis, Vassilios; Anwar, Noreen; Hagenbucher, Jacob

    2018-03-01

    This study examined the differences between faculty and trained standardized patient (SP) evaluations on student professionalism during a second-year podiatric medicine standardized simulated patient encounter. Forty-nine second-year podiatric medicine students were evaluated for their professionalism behavior. Eleven SPs performed an assessment in real-time, and one faculty member performed a secondary assessment after observing a videotape of the encounter. Five domains were chosen for evaluation from a validated professionalism assessment tool. Significant differences were identified in the professionalism domains of "build a relationship" ( P = .008), "gather information" ( P = .001), and share information ( P = .002), where the faculty scored the students higher than the SP for 24.5%, 18.9%, and 26.5% of the cases, respectively. In addition, the faculty scores were higher than the SP scores in all of the "gather information" subdomains; however, the difference in scores was significant only in the "question appropriately" ( P = .001) and "listen and clarify" ( P = .003) subdomains. This study showed that professionalism scores for second-year podiatric medical students during a simulated patient encounter varied significantly between faculty and SPs. Further consideration needs to be given to determine the source of these differences.

  10. Tried and true: self-regulation theory as a guiding framework for teaching parents diabetes education using human patient simulation.

    Sullivan-Bolyai, Susan; Johnson, Kimberly; Cullen, Karen; Hamm, Terry; Bisordi, Jean; Blaney, Kathleen; Maguire, Laura; Melkus, Gail

    2014-01-01

    Parents become emotionally upset when learning that their child has type 1 diabetes, yet they are expected to quickly learn functional diabetes management. The purpose of this article is to describe the application of self-regulation theory to guide a family-focused education intervention using human patient simulation to enhance the initial education of parents in diabetes management. A brief description is provided of the intervention framed by self-regulation theory. On the basis of the literature, we describe the educational vignettes used based on self-regulation in the randomized controlled trial entitled "Parent Education Through Simulation-Diabetes." Examples of theory-in-practice will be illustrated by parental learning responses to this alternative educational innovation.

  11. Identifying Facilitators and Barriers for Patient Safety in a Medicine Label Design System Using Patient Simulation and Interviews

    Dieckmann, Peter; Clemmensen, Marianne Hald; Sørensen, Trine Kart

    2016-01-01

    Objectives Medicine label design plays an important role in improving patient safety. This study aimed at identifying facilitators and barriers in a medicine label system to prevent medication errors in clinical use by health care professionals. Methods The study design is qualitative and explora......Objectives Medicine label design plays an important role in improving patient safety. This study aimed at identifying facilitators and barriers in a medicine label system to prevent medication errors in clinical use by health care professionals. Methods The study design is qualitative...... of the system and some inconsistencies (different meaning of colors) posed challenges, when considered with the actual application context, in which there is little time to get familiar with the design features. Conclusions For optimizing medicine labels and obtaining the full benefit of label design features...

  12. Effects of Simulation With Problem-Based Learning Program on Metacognition, Team Efficacy, and Learning Attitude in Nursing Students: Nursing Care With Increased Intracranial Pressure Patient.

    Lee, Myung-Nam; Nam, Kyung-Dong; Kim, Hyeon-Young

    2017-03-01

    Nursing care for patients with central nervous system problems requires advanced professional knowledge and care skills. Nursing students are more likely to have difficulty in dealing with adult patients who have severe neurological problems in clinical practice. This study investigated the effect on the metacognition, team efficacy, and learning attitude of nursing students after an integrated simulation and problem-based learning program. A real scenario of a patient with increased intracranial pressure was simulated for the students. The results showed that this method was effective in improving the metacognitive ability of the students. Furthermore, we used this comprehensive model of simulation with problem-based learning in order to assess the consequences of student satisfaction with the nursing major, interpersonal relationships, and importance of simulation-based education in relation to the effectiveness of the integrated simulation with problem-based learning. The results can be used to improve the design of clinical practicum and nursing education.

  13. Towards an in-plane methodology to track breast lesions using mammograms and patient-specific finite-element simulations

    Lapuebla-Ferri, Andrés; Cegoñino-Banzo, José; Jiménez-Mocholí, Antonio-José; Pérez del Palomar, Amaya

    2017-11-01

    In breast cancer screening or diagnosis, it is usual to combine different images in order to locate a lesion as accurately as possible. These images are generated using a single or several imaging techniques. As x-ray-based mammography is widely used, a breast lesion is located in the same plane of the image (mammogram), but tracking it across mammograms corresponding to different views is a challenging task for medical physicians. Accordingly, simulation tools and methodologies that use patient-specific numerical models can facilitate the task of fusing information from different images. Additionally, these tools need to be as straightforward as possible to facilitate their translation to the clinical area. This paper presents a patient-specific, finite-element-based and semi-automated simulation methodology to track breast lesions across mammograms. A realistic three-dimensional computer model of a patient’s breast was generated from magnetic resonance imaging to simulate mammographic compressions in cranio-caudal (CC, head-to-toe) and medio-lateral oblique (MLO, shoulder-to-opposite hip) directions. For each compression being simulated, a virtual mammogram was obtained and posteriorly superimposed to the corresponding real mammogram, by sharing the nipple as a common feature. Two-dimensional rigid-body transformations were applied, and the error distance measured between the centroids of the tumors previously located on each image was 3.84 mm and 2.41 mm for CC and MLO compression, respectively. Considering that the scope of this work is to conceive a methodology translatable to clinical practice, the results indicate that it could be helpful in supporting the tracking of breast lesions.

  14. Altered Insular and Occipital Responses to Simulated Vertical Self-Motion in Patients with Persistent Postural-Perceptual Dizziness

    Roberta Riccelli

    2017-10-01

    Full Text Available BackgroundPersistent postural-perceptual dizziness (PPPD is a common functional vestibular disorder characterized by persistent symptoms of non-vertiginous dizziness and unsteadiness that are exacerbated by upright posture, self-motion, and exposure to complex or moving visual stimuli. Recent physiologic and neuroimaging data suggest that greater reliance on visual cues for postural control (as opposed to vestibular cues—a phenomenon termed visual dependence and dysfunction in central visuo-vestibular networks may be important pathophysiologic mechanisms underlying PPPD. Dysfunctions are thought to involve insular regions that encode recognition of the visual effects of motion in the gravitational field.MethodsWe tested for altered activity in vestibular and visual cortices during self-motion simulation obtained via a visual virtual-reality rollercoaster stimulation using functional magnetic resonance imaging in 15 patients with PPPD and 15 healthy controls (HCs. We compared between groups differences in brain responses to simulated displacements in vertical vs horizontal directions and correlated the difference in directional responses with dizziness handicap in patients with PPPD.ResultsHCs showed increased activity in the anterior bank of the central insular sulcus during vertical relative to horizontal motion, which was not seen in patients with PPPD. However, for the same comparison, dizziness handicap correlated positively with activity in the visual cortex (V1, V2, and V3 in patients with PPPD.ConclusionWe provide novel insight into the pathophysiologic mechanisms underlying PPPD, including functional alterations in brain processes that affect balance control and reweighting of space-motion inputs to favor visual cues. For patients with PPPD, difficulties using visual data to discern the effects of gravity on self-motion may adversely affect balance control, particularly for individuals who simultaneously rely too heavily on visual

  15. Changes in self-efficacy, collective efficacy and patient outcome following interprofessional simulation training on postpartum haemorrhage.

    Egenberg, Signe; Øian, Pål; Eggebø, Torbjørn Moe; Arsenovic, Mirjana Grujic; Bru, Lars Edvin

    2017-10-01

    To examine whether interprofessional simulation training on management of postpartum haemorrhage enhances self-efficacy and collective efficacy and reduces the blood transfusion rate after birth. Postpartum haemorrhage is a leading cause of maternal morbidity and mortality worldwide, although it is preventable in most cases. Interprofessional simulation training might help improve the competence of health professionals dealing with postpartum haemorrhage, and more information is needed to determine its potential. Multimethod, quasi-experimental, pre-post intervention design. Interprofessional simulation training on postpartum haemorrhage was implemented for midwives, obstetricians and auxiliary nurses in a university hospital. Training included realistic scenarios and debriefing, and a measurement scale for perceived postpartum haemorrhage-specific self-efficacy, and collective efficacy was developed and implemented. Red blood cell transfusion was used as the dependent variable for improved patient outcome pre-post intervention. Self-efficacy and collective efficacy levels were significantly increased after training. The overall red blood cell transfusion rate did not change, but there was a significant reduction in the use of ≥5 units of blood products related to severe bleeding after birth. The study contributes to new knowledge on how simulation training through mastery and vicarious experiences, verbal persuasion and psychophysiological state might enhance postpartum haemorrhage-specific self-efficacy and collective efficacy levels and thereby predict team performance. The significant reduction in severe postpartum haemorrhage after training, indicated by reduction in ≥5 units of blood transfusions, corresponds well with the improvement in collective efficacy, and might reflect the emphasis on collective efforts to counteract severe cases of postpartum haemorrhage. Interprofessional simulation training in teams may contribute to enhanced prevention and

  16. Patient-specific electric field simulations and acceleration measurements for objective analysis of intraoperative stimulation tests in the thalamus

    Simone Hemm-Ode

    2016-11-01

    Full Text Available Despite an increasing use of deep brain stimulation (DBS the fundamental mechanisms of action remain largely unknown. Simulation of electric entities has previously been proposed for chronic DBS combined with subjective symptom evaluations, but not for intraoperative stimulation tests. The present paper introduces a method for an objective exploitation of intraoperative stimulation test data to identify the optimal implant position of the chronic DBS lead by relating the electric field simulations to the patient-specific anatomy and the clinical effects quantified by accelerometry. To illustrate the feasibility of this approach, it was applied to five patients with essential tremor bilaterally implanted in the ventral intermediate nucleus (VIM. The VIM and its neighborhood structures were preoperatively outlined in 3D on white matter attenuated inversion recovery MR images. Quantitative intraoperative clinical assessments were performed using accelerometry. Electric field simulations (n = 272 for intraoperative stimulation test data performed along two trajectories per side were set-up using the finite element method for 143 stimulation test positions. The resulting electric field isosurface of 0.2V/mm was superimposed to the outlined anatomical structures. The percentage of volume of each structure's overlap was calculated and related to the corresponding clinical improvement. The proposed concept has been successfully applied to the five patients. For higher clinical improvements, not only the VIM but as well other neighboring structures were covered by the electric field isosurfaces. The percentage of the volumes of the VIM, of the nucleus intermediate lateral of the thalamus and the prelemniscal radiations within the prerubral field of Forel increased for clinical improvements higher than 50% compared to improvements lower than 50%. The presented new concept allows a detailed and objective analysis of a high amount of intraoperative data to

  17. Use of human patient simulation and the situation awareness global assessment technique in practical trauma skills assessment.

    Hogan, Michael P; Pace, David E; Hapgood, Joanne; Boone, Darrell C

    2006-11-01

    Situation awareness (SA) is defined as the perception of elements in the environment within a volume of time and space, the comprehension of their meaning, and the projection of their status in the near future. This construct is vital to decision making in intense, dynamic environments. It has been used in aviation as it relates to pilot performance, but has not been applied to medical education. The most widely used objective tool for measuring trainee SA is the Situation Awareness Global Assessment Technique (SAGAT). The purpose of this study was to design and validate SAGAT for assessment of practical trauma skills, and to compare SAGAT results to traditional checklist style scoring. Using the Human Patient Simulator, we designed SAGAT for practical trauma skills assessment based on Advanced Trauma Life Support objectives. Sixteen subjects (four staff surgeons, four senior residents, four junior residents, and four medical students) participated in three scenarios each. They were assessed using SAGAT and traditional checklist assessment. A questionnaire was used to assess possible confounding factors in attaining SA and overall trainee satisfaction. SAGAT was found to show significant difference (analysis of variance; p level of training lending statistical support to construct validity. SAGAT was likewise found to display reliability (Cronbach's alpha 0.767), and significant scoring correlation with traditional checklist performance measures (Pearson's coefficient 0.806). The questionnaire revealed no confounding factors and universal satisfaction with the human patient simulator and SAGAT. SAGAT is a valid, reliable assessment tool for trauma trainees in the dynamic clinical environment created by human patient simulation. Information provided by SAGAT could provide specific feedback, direct individualized teaching, and support curriculum change. Introduction of SAGAT could improve the current assessment model for practical trauma education.

  18. Simulation with standardized patients to prepare undergraduate nursing students for mental health clinical practice: An integrative literature review.

    Øgård-Repål, Anita; De Presno, Åsne Knutson; Fossum, Mariann

    2018-04-22

    To evaluate the available evidence supporting the efficacy of using simulation with standardized patients to prepare nursing students for mental health clinical practice. Integrative literature review. A systematic search of the electronic databases CINAHL (EBSCOhost), Embase, MEDLINE, PsycINFO, and SveMed+ was conducted to identify empirical studies published until November 2016. Multiple search terms were used. Original empirical studies published in English and exploring undergraduate nursing students' experiences of simulation with standardized patients as preparation for mental health nursing practice were included. A search of reference lists and gray literature was also conducted. In total, 1677 studies were retrieved; the full texts of 78 were screened by 2 of the authors, and 6 studies reminded in the review. The authors independently reviewed the studies in three stages by screening the titles, abstracts, and full texts, and the quality of the included studies was assessed in the final stage. Design-specific checklists were used for quality appraisal. The thematic synthesizing method was used to summarize the findings of the included studies. The studies used four different research designs, both qualitative and quantitative. All studies scored fairly low in the quality appraisal. The five themes identified were enhanced confidence, clinical skills, anxiety regarding the unknown, demystification, and self-awareness. The findings of this study indicate that simulation with standardized patients could decrease students' anxiety level, shatter pre-assumptions, and increase self-confidence and self-awareness before entering clinical practice in mental health. More high-quality studies with larger sample sizes are required because of the limited evidence provided by the six studies in the present review. Copyright © 2018 Elsevier Ltd. All rights reserved.

  19. Diagnostic Challenge of Hepatopulmonary Syndrome in a Patient with Coexisting Structural Heart Disease

    Jorge M. Hurtado-Cordovi

    2011-01-01

    Full Text Available Hepatopulmonary syndrome (HPS is a severe complication seen in advance liver disease. Its prevalence among cirrhotic patients varies from 4–47 percent. HPS exact pathogenesis remains unknown. Patient presents with signs/symptoms of chronic liver disease, and dypsnea of variable severity. Our patient is a 62 years old white male with a known history of chronic hepatitis C, cirrhosis, ascites, and hypothyroidism who presented to GI/liver clinic complaining of 1 episode BRBPR, and exacerbating dypsnea associated with nausea and few episodes of non-bloody vomit. Physical exam showed, icterus, jaundice, few small spider angiomas on the chest, decrease breath sounds bilateral right more than left, and mild tachycardic. Abdominal exam revealed mid-line scar, moderated size ventral hernia, distention, diffused tenderness, and dullness to percussion. Laboratory result: CBC 5.2/13.2/37.6/83, LFTs 83/217/125/5.2/4.7/7.4, Pt 22.6 INR 1.9 PTT35.4. CT scan showed liver cirrhosis, abdominal varices, and moderated ascites collection around ventral hernia. Calculated A-a gradient was 49.5. Echocardiography revealed patent foramen ovale (PFO with predominant left to right shunt. In our case, existence of paten foramen ovale (PFO and atelectasis precludes definitive diagnosis of HPS. Presence of cardiopulmonary shunt could be partially responsible for the patient’s dypsnea exacerbation.

  20. Assessment of complex dissociative disorder patients and simulated dissociation in forensic contexts.

    Brand, Bethany L; Webermann, Aliya R; Frankel, A Steven

    Few assessors receive training in assessing dissociation and complex dissociative disorders (DDs). Potential differential diagnoses include anxiety, mood, psychotic, substance use, and personality disorders, as well as exaggeration and malingering. Individuals with DDs typically elevate on many clinical and validity scales on psychological tests, yet research indicates that they can be distinguished from DD simulators. Becoming informed about the testing profiles of DD individuals and DD simulators can improve the accuracy of differential diagnoses in forensic settings. In this paper, we first review the testing profiles of individuals with complex DDs and contrast them with DD simulators on assessment measures used in forensic contexts, including the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Personality Assessment Inventory (PAI), and the Structured Inventory of Reported Symptoms (SIRS), as well as dissociation-specific measures such as the Dissociative Experiences Scale (DES) and Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D-R). We then provide recommendations for assessing complex trauma and dissociation through the aforementioned assessments. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Patient-specific simulations and measurements of the magneto-hemodynamic effect in human primary vessels

    Kyriakou, Adamos; Neufeld, Esra; Szczerba, Dominik; Kuster, Niels; Kainz, Wolfgang; Luechinger, Roger; Kozerke, Sebastian; McGregor, Robert

    2012-01-01

    This paper investigates the main characteristics of the magneto-hemodynamic (MHD) response for application as a biomarker of vascular blood flow. The induced surface potential changes of a volunteer exposed to a 3 T static B0 field of a magnetic resonance imaging (MRI) magnet were measured over time at multiple locations by an electrocardiogram device and compared to simulation results. The flow simulations were based on boundary conditions derived from MRI flow measurements restricted to the aorta and vena cava. A dedicated and validated low-frequency electromagnetic solver was applied to determine the induced temporal surface potential change from the obtained 4D flow distribution using a detailed whole-body model of the volunteer. The simulated MHD signal agreed with major characteristics of the measured signal (temporal location of main peak, magnitude, variation across chest and along torso) except in the vicinity of the heart. The MHD signal is mostly influenced by the aorta; however, more vessels and better boundary conditions are needed to analyze the finer details of the response. The results show that the MHD signal is strongly position dependent with highly variable but reproducibly measurable distinguished characteristics. Additional investigations are necessary before determining whether the MHD effect is a reliable reference for location-specific information on blood flow. (paper)

  2. The effect of high-fidelity patient simulation on the critical thinking and clinical decision-making skills of new graduate nurses.

    Maneval, Rhonda; Fowler, Kimberly A; Kays, John A; Boyd, Tiffany M; Shuey, Jennifer; Harne-Britner, Sarah; Mastrine, Cynthia

    2012-03-01

    This study was conducted to determine whether the addition of high-fidelity patient simulation to new nurse orientation enhanced critical thinking and clinical decision-making skills. A pretest-posttest design was used to assess critical thinking and clinical decision-making skills in two groups of graduate nurses. Compared with the control group, the high-fidelity patient simulation group did not show significant improvement in mean critical thinking or clinical decision-making scores. When mean scores were analyzed, both groups showed an increase in critical thinking scores from pretest to posttest, with the high-fidelity patient simulation group showing greater gains in overall scores. However, neither group showed a statistically significant increase in mean test scores. The effect of high-fidelity patient simulation on critical thinking and clinical decision-making skills remains unclear. Copyright 2012, SLACK Incorporated.

  3. Procedures for high precision setup verification and correction of lung cancer patients using CT-simulation and digitally reconstructed radiographs (DRR).

    Sornsen de Koste, van J.R.; Boer, de HC; Schuchhard-Schipper, RH; Senan, S.; Heijmen, BJ

    2003-01-01

    PURPOSE: In a recent study, large systematic setup errors were detected in patients with lung cancer when a conventional simulation procedure was used to define and mark the treatment isocenter. In the present study, we describe a procedure to omit the session at a conventional simulator to remove

  4. Patient-specific scatter correction in clinical cone beam computed tomography imaging made possible by the combination of Monte Carlo simulations and a ray tracing algorithm

    Slot Thing, Rune; Bernchou, Uffe; Mainegra-Hing, Ernesto

    2013-01-01

    Abstract Purpose. Cone beam computed tomography (CBCT) image quality is limited by scattered photons. Monte Carlo (MC) simulations provide the ability of predicting the patient-specific scatter contamination in clinical CBCT imaging. Lengthy simulations prevent MC-based scatter correction from...

  5. Estimation of left ventricular blood flow parameters: clinical application of patient-specific CFD simulations from 4D echocardiography

    Larsson, David; Spühler, Jeannette H.; Günyeli, Elif; Weinkauf, Tino; Hoffman, Johan; Colarieti-Tosti, Massimiliano; Winter, Reidar; Larsson, Matilda

    2017-03-01

    Echocardiography is the most commonly used image modality in cardiology, assessing several aspects of cardiac viability. The importance of cardiac hemodynamics and 4D blood flow motion has recently been highlighted, however such assessment is still difficult using routine echo-imaging. Instead, combining imaging with computational fluid dynamics (CFD)-simulations has proven valuable, but only a few models have been applied clinically. In the following, patient-specific CFD-simulations from transthoracic dobutamin stress echocardiography have been used to analyze the left ventricular 4D blood flow in three subjects: two with normal and one with reduced left ventricular function. At each stress level, 4D-images were acquired using a GE Vivid E9 (4VD, 1.7MHz/3.3MHz) and velocity fields simulated using a presented pathway involving endocardial segmentation, valve position identification, and solution of the incompressible Navier-Stokes equation. Flow components defined as direct flow, delayed ejection flow, retained inflow, and residual volume were calculated by particle tracing using 4th-order Runge-Kutta integration. Additionally, systolic and diastolic average velocity fields were generated. Results indicated no major changes in average velocity fields for any of the subjects. For the two subjects with normal left ventricular function, increased direct flow, decreased delayed ejection flow, constant retained inflow, and a considerable drop in residual volume was seen at increasing stress. Contrary, for the subject with reduced left ventricular function, the delayed ejection flow increased whilst the retained inflow decreased at increasing stress levels. This feasibility study represents one of the first clinical applications of an echo-based patient-specific CFD-model at elevated stress levels, and highlights the potential of using echo-based models to capture highly transient flow events, as well as the ability of using simulation tools to study clinically complex

  6. Magnetic resonance imaging may simulate progressive multifocal leucoencephalopathy in a patient with chronic lymphocytic leukemia after fludarabine therapy

    Kalita J

    2008-01-01

    Full Text Available A 60-year-old male with chronic lymphatic leukemia (CLL after 6 months of fludarabine therapy was admitted with status epilepticus and developed left hemiplegia. His magnetic resonance imaging revealed multiple T2 hyperintense lesions in the right frontal and left parieto-occipital lesion, simulating progressive multifocal leucoencephalopathy (PML. Cerebrospinal fluid Polymerase Chain Reaction (PCR for JC virus was negative. We suggest the possible role of fludarabine in producing PML-like lesions in patients with Chronic Lymphocytic Leukemia (CLL.

  7. Carotid DSA based CFD simulation in assessing the patient with asymptomatic carotid stenosis: a preliminary study.

    Zhang, Dong; Xu, Pengcheng; Qiao, Hongyu; Liu, Xin; Luo, Liangping; Huang, Wenhua; Zhang, Heye; Shi, Changzheng

    2018-03-12

    Cerebrovascular events are frequently associated with hemodynamic disturbance caused by internal carotid artery (ICA) stenosis. It is challenging to determine the ischemia-related carotid stenosis during the intervention only using digital subtracted angiography (DSA). Inspired by the performance of well-established FFRct technique in hemodynamic assessment of significant coronary stenosis, we introduced a pressure-based carotid arterial functional assessment (CAFA) index generated from computational fluid dynamic (CFD) simulation in DSA data, and investigated its feasibility in the assessment of hemodynamic disturbance preliminarily using pressure-wired measurement and arterial spin labeling (ASL) MRI as references. The cerebral multi-delay multi-parametric ASL-MRI and carotid DSA including trans-stenotic pressure-wired measurement were implemented on a 65-year-old man with asymptomatic unilateral (left) ICA stenosis. A CFD simulation using simplified boundary condition was performed in DSA data to calculate the CAFA index. The cerebral blood flow (CBF) and arterial transit time (ATT) of ICA territories were acquired. CFD simulation showed good correlation (r = 0.839, P = 0.001) with slight systematic overestimation (mean difference - 0.007, standard deviation 0.017) compared with pressure-wired measurement. No significant difference was observed between them (P = 0.09). Though the narrowing degree of in the involved ICA was about 70%, the simulated and measured CAFA (0.942/0.937) revealed a functionally nonsignificant stenosis which was also verified by a compensatory final CBF (fronto-temporal/fronto-parietal region: 51.58/45.62 ml/100 g/min) and slightly prolonged ATT (1.23/1.4 s) in the involved territories, together with a normal left-right percentage difference (2.1-8.85%). The DSA based CFD simulation showed good consistence with invasive approach and could be used as a cost-saving and efficient way to study the relationship between

  8. Simulation reframed.

    Kneebone, Roger L

    2016-01-01

    Simulation is firmly established as a mainstay of clinical education, and extensive research has demonstrated its value. Current practice uses inanimate simulators (with a range of complexity, sophistication and cost) to address the patient 'as body' and trained actors or lay people (Simulated Patients) to address the patient 'as person'. These approaches are often separate.Healthcare simulation to date has been largely for the training and assessment of clinical 'insiders', simulating current practices. A close coupling with the clinical world restricts access to the facilities and practices of simulation, often excluding patients, families and publics. Yet such perspectives are an essential component of clinical practice. This paper argues that simulation offers opportunities to move outside a clinical 'insider' frame and create connections with other individuals and groups. Simulation becomes a bridge between experts whose worlds do not usually intersect, inviting an exchange of insights around embodied practices-the 'doing' of medicine-without jeopardising the safety of actual patients.Healthcare practice and education take place within a clinical frame that often conceals parallels with other domains of expert practice. Valuable insights emerge by viewing clinical practice not only as the application of medical science but also as performance and craftsmanship.Such connections require a redefinition of simulation. Its essence is not expensive elaborate facilities. Developments such as hybrid, distributed and sequential simulation offer examples of how simulation can combine 'patient as body' with 'patient as person' at relatively low cost, democratising simulation and exerting traction beyond the clinical sphere.The essence of simulation is a purposeful design, based on an active process of selection from an originary world, abstraction of what is criterial and re - presentation in another setting for a particular purpose or audience. This may be done within

  9. Development of a head simulator for exposure dose estimation on patients exposed by odontological X-rays

    Moura Neto, Francisco N.; Batista, Eutropio V.; Santos, Adriano M.

    2009-01-01

    In the obtaining a odontological radiography, the individual is exposed to te radiation and part of that radiation will be absorbed by his organism. The estimative of absorbed dose can be accomplished through calculations where are considered: the distance from the source to the individual, the energy of the emitted X-ray at the moment of the exposure and the bode region exposed; and as that option does not possess great precision, alternative forms are seek for the quantification such doses. This work proposes the construction of a head simulator to be used in the estimative of absorbed dose in patients, during the accomplishment of the odontological radiographic examinations. As a perspective of work, it is intended to use the phantom to help in the absorbed doses for obtainment of parameters in X-ray odontological devices, contributing of image obtainment with more quality and less radiation dose in the patient

  10. Influence of patient mispositioning on SAR distribution and simulated temperature in regional deep hyperthermia

    Aklan, Bassim; Gierse, Pia; Hartmann, Josefin; Ott, Oliver J.; Fietkau, Rainer; Bert, Christoph

    2017-06-01

    Patient positioning plays an important role in regional deep hyperthermia to obtain a successful hyperthermia treatment. In this study, the influence of possible patient mispositioning was systematically assessed on specific absorption rate (SAR) and temperature distribution. With a finite difference time domain approach, the SAR and temperature distributions were predicted for six patients at 312 positions. Patient displacements and rotations as well as the combination of both were considered inside the Sigma-Eye applicator. Position sensitivity is assessed for hyperthermia treatment planning -guided steering, which relies on model-based optimization of the SAR and temperature distribution. The evaluation of the patient mispositioning was done with and without optimization. The evaluation without optimization was made by creating a treatment plan for the patient reference position in the center of the applicator and applied for all other positions, while the evaluation with optimization was based on creating an individual plan for each position. The parameter T90 was used for the temperature evaluation, which was defined as the temperature that covers 90% of the gross tumor volume (GTV). Furthermore, the hotspot tumor quotient (HTQ) was used as a goal function to assess the quality of the SAR and temperature distribution. The T90 was shown considerably dependent on the position within the applicator. Without optimization, the T90 was clearly decreased below 40 °C by patient shifts and the combination of shifts and rotations. However, the application of optimization for each positon led to an increase of T90 in the GTV. Position inaccuracies of less than 1 cm in the X-and Y-directions and 2 cm in the Z-direction, resulted in an increase of HTQ of less than 5%, which does not significantly affect the SAR and temperature distribution. Current positioning precision is sufficient in the X (right-left)-direction, but position accuracy is required in the Y-and Z-directions.

  11. Simulated bone metastases: a case study of two patients with breast cancer

    Ainslie, J.; Drummond, R.; Blakey, D.; Bishop, M.; Hicks, R.; McKenzie, A.

    1999-01-01

    Two case studies are used to discuss topical issues current in follow-up management of patients with early stage breast cancer. These issues include the role of screening and diagnostic bone scintigraphy and patient self-advocacy in clinical management. Breast cancer is common. Standard clinical practice in Australia for patients treated for early stage carcinoma of the breast is regular follow-up, usually lasting 5 years, and often 10 years. There are numerous benefits for patients receiving regular clinical checkups post-treatment of breast cancer. However, the three prime objectives are early detection of recurrence, assessment of treatment-related morbidity, and provision of psychological support. Not surprisingly, a variety of intercurrent clinical events can occur in a population of post-treatment breast cancer patients on long-term follow-up. In this article we describe two interesting cases, each presenting with a solitary new destructive rib lesion highly suggestive of a first clinical diagnosis of metastatic breast cancer. Subsequent biopsy revealed the lesions to be benign. Copyright (1999) Blackwell Science Pty Ltd

  12. Patient dose simulations for scanning-beam digital x-ray tomosynthesis of the lungs

    Nelson, Geoff; Fahrig, Rebecca; Yoon, Sungwon; Krishna, Ganesh; Wilfley, Brian

    2013-01-01

    Purpose: An improved method of image guidance for lung tumor biopsies could help reduce the high rate of false negatives. The aim of this work is to optimize the geometry of the scanning-beam digital tomography system (SBDX) for providing real-time 3D tomographic reconstructions for target verification. The unique geometry of the system requires trade-offs between patient dose, imaging field of view (FOV), and tomographic angle.Methods: Tomosynthetic angle as a function of tumor-to-detector distance was calculated. Monte Carlo Software (PCXMC) was used to calculate organ doses and effective dose for source-to-detector distances (SDDs) from 90 to 150 cm, patient locations with the tumor at 20 cm from the source to 20 cm from the detector, and FOVs centered on left lung and right lung as well as medial and distal peripheries of the lungs. These calculations were done for two systems, a SBDX system and a GE OEC-9800 C-arm fluoroscopic unit. To evaluate the dose effect of the system geometry, results from PCXMC were calculated using a scan of 300 mAs for both SBDX and fluoroscopy. The Rose Criterion was used to find the fluence required for a tumor SNR of 5, factoring in scatter, air-gap, system geometry, and patient position for all models generated with PCXMC. Using the calculated fluence for constant tumor SNR, the results from PCXMC were used to compare the patient dose for a given SNR between SBDX and fluoroscopy.Results: Tomographic angle changes with SDD only in the region near the detector. Due to their geometry, the source array and detector have a peak tomographic angle for any given SDD at a source to tumor distance that is 69.7% of the SDD assuming constant source and detector size. Changing the patient location in order to increase tomographic angle has a significant effect on organ dose distribution due to geometrical considerations. With SBDX and fluoroscopy geometries, the dose to organs typically changes in an opposing manner with changing patient

  13. Patient dose simulations for scanning-beam digital x-ray tomosynthesis of the lungs

    Nelson, Geoff; Fahrig, Rebecca [Department of Radiology, Stanford University, Stanford, California 94305 (United States); Yoon, Sungwon [Varian Medical Systems, Palo Alto, California 94304 (United States); Krishna, Ganesh [Palo Alto Medical Foundation, Mountain View, California 94040 (United States); Wilfley, Brian [Triple Ring Technologies, Inc., Newark, California 94560 (United States)

    2013-11-15

    Purpose: An improved method of image guidance for lung tumor biopsies could help reduce the high rate of false negatives. The aim of this work is to optimize the geometry of the scanning-beam digital tomography system (SBDX) for providing real-time 3D tomographic reconstructions for target verification. The unique geometry of the system requires trade-offs between patient dose, imaging field of view (FOV), and tomographic angle.Methods: Tomosynthetic angle as a function of tumor-to-detector distance was calculated. Monte Carlo Software (PCXMC) was used to calculate organ doses and effective dose for source-to-detector distances (SDDs) from 90 to 150 cm, patient locations with the tumor at 20 cm from the source to 20 cm from the detector, and FOVs centered on left lung and right lung as well as medial and distal peripheries of the lungs. These calculations were done for two systems, a SBDX system and a GE OEC-9800 C-arm fluoroscopic unit. To evaluate the dose effect of the system geometry, results from PCXMC were calculated using a scan of 300 mAs for both SBDX and fluoroscopy. The Rose Criterion was used to find the fluence required for a tumor SNR of 5, factoring in scatter, air-gap, system geometry, and patient position for all models generated with PCXMC. Using the calculated fluence for constant tumor SNR, the results from PCXMC were used to compare the patient dose for a given SNR between SBDX and fluoroscopy.Results: Tomographic angle changes with SDD only in the region near the detector. Due to their geometry, the source array and detector have a peak tomographic angle for any given SDD at a source to tumor distance that is 69.7% of the SDD assuming constant source and detector size. Changing the patient location in order to increase tomographic angle has a significant effect on organ dose distribution due to geometrical considerations. With SBDX and fluoroscopy geometries, the dose to organs typically changes in an opposing manner with changing patient

  14. Differences in Simulated Doctor and Patient Medical Decision Making: A Construal Level Perspective

    Zhang, Yan; Liu, Quanhui; Miao, Danmin; Xiao, Wei

    2013-01-01

    Background Patients are often confronted with diverse medical decisions. Often lacking relevant medical knowledge, patients fail to independently make medical decisions and instead generally rely on the advice of doctors. Objective This study investigated the characteristics of and differences in doctor–patient medical decision making on the basis of construal level theory. Methods A total of 420 undergraduates majoring in clinical medicine were randomly assigned to six groups. Their decisions to opt for radiotherapy and surgery were investigated, with the choices described in a positive/neutral/negative frame × decision making for self/others. Results Compared with participants giving medical advice to patients, participants deciding for themselves were more likely to select radiotherapy (F1, 404 = 13.92, p = 011). Participants from positive or neutral frames exhibited a higher tendency to choose surgery than did those from negative frames (F2, 404 = 22.53, peffect of framing on independent decision making was nonsignificant (F2, 404 = 1.07, p = 35); however the effect of framing on the provision of advice to patients was significant (F2, 404 = 12.95, peffect of construal level was significant in the positive frame (F1, 404 = 8.06, p = 005) and marginally significant in the neutral frame (F2, 404 = 3.31, p = 07) but nonsignificant in the negative frame (F2, 404 = .29, p = 59). Conclusion Both social distance and framing depiction significantly affected medical decision making and exhibited a significant interaction. Differences in medical decision making between doctors and patients need further investigation. PMID:24244445

  15. Differences in simulated doctor and patient medical decision making: a construal level perspective.

    Jiaxi Peng

    Full Text Available BACKGROUND: Patients are often confronted with diverse medical decisions. Often lacking relevant medical knowledge, patients fail to independently make medical decisions and instead generally rely on the advice of doctors. OBJECTIVE: This study investigated the characteristics of and differences in doctor-patient medical decision making on the basis of construal level theory. METHODS: A total of 420 undergraduates majoring in clinical medicine were randomly assigned to six groups. Their decisions to opt for radiotherapy and surgery were investigated, with the choices described in a positive/neutral/negative frame × decision making for self/others. RESULTS: Compared with participants giving medical advice to patients, participants deciding for themselves were more likely to select radiotherapy (F1, 404 = 13.92, p = 011. Participants from positive or neutral frames exhibited a higher tendency to choose surgery than did those from negative frames (F2, 404 = 22.53, p<.001. The effect of framing on independent decision making was nonsignificant (F2, 404 = 1.07, p = 35; however the effect of framing on the provision of advice to patients was significant (F2, 404 = 12.95, p<.001. The effect of construal level was significant in the positive frame (F1, 404 = 8.06, p = 005 and marginally significant in the neutral frame (F2, 404 = 3.31, p = 07 but nonsignificant in the negative frame (F2, 404 = .29, p = 59. CONCLUSION: Both social distance and framing depiction significantly affected medical decision making and exhibited a significant interaction. Differences in medical decision making between doctors and patients need further investigation.

  16. Differences in simulated doctor and patient medical decision making: a construal level perspective.

    Peng, Jiaxi; He, Fei; Zhang, Yan; Liu, Quanhui; Miao, Danmin; Xiao, Wei

    2013-01-01

    Patients are often confronted with diverse medical decisions. Often lacking relevant medical knowledge, patients fail to independently make medical decisions and instead generally rely on the advice of doctors. This study investigated the characteristics of and differences in doctor-patient medical decision making on the basis of construal level theory. A total of 420 undergraduates majoring in clinical medicine were randomly assigned to six groups. Their decisions to opt for radiotherapy and surgery were investigated, with the choices described in a positive/neutral/negative frame × decision making for self/others. Compared with participants giving medical advice to patients, participants deciding for themselves were more likely to select radiotherapy (F1, 404 = 13.92, p = 011). Participants from positive or neutral frames exhibited a higher tendency to choose surgery than did those from negative frames (F2, 404 = 22.53, pframing on independent decision making was nonsignificant (F2, 404 = 1.07, p = 35); however the effect of framing on the provision of advice to patients was significant (F2, 404 = 12.95, pframe (F1, 404 = 8.06, p = 005) and marginally significant in the neutral frame (F2, 404 = 3.31, p = 07) but nonsignificant in the negative frame (F2, 404 = .29, p = 59). Both social distance and framing depiction significantly affected medical decision making and exhibited a significant interaction. Differences in medical decision making between doctors and patients need further investigation.

  17. Preliminary study of the distribution of dose in patients with Graves' disease undergoing examination of uptake of iodine-131 using Monte Carlo simulation

    Schwarcke, Marcelo; Marques, Tatiana; Nicolucci, Patricia; Baffa, Oswaldo; Bornemann, Clarissa

    2010-01-01

    Patients with Graves disease have a high hormonal disorder, which causes behavioral changes. One way to treat this disease is the use of high doses of 131 Iodine, requiring that the patient carries out the examination of 131 I uptake to estimate the activity to be administered. Using these data capture and compared with the simulated data using the Monte Carlo code PENELOPE is possible to determine a distribution of dose to the region surrounding the thyroid. As noted the difference between the simulated values and the experimentally obtained were 10.36%, thus showing the code of simulation for accurate determination of absorbed dose in tissue near the thyroid. (author)

  18. Absolute electrical impedance tomography (aEIT) guided ventilation therapy in critical care patients: simulations and future trends.

    Denaï, Mouloud A; Mahfouf, Mahdi; Mohamad-Samuri, Suzani; Panoutsos, George; Brown, Brian H; Mills, Gary H

    2010-05-01

    Thoracic electrical impedance tomography (EIT) is a noninvasive, radiation-free monitoring technique whose aim is to reconstruct a cross-sectional image of the internal spatial distribution of conductivity from electrical measurements made by injecting small alternating currents via an electrode array placed on the surface of the thorax. The purpose of this paper is to discuss the fundamentals of EIT and demonstrate the principles of mechanical ventilation, lung recruitment, and EIT imaging on a comprehensive physiological model, which combines a model of respiratory mechanics, a model of the human lung absolute resistivity as a function of air content, and a 2-D finite-element mesh of the thorax to simulate EIT image reconstruction during mechanical ventilation. The overall model gives a good understanding of respiratory physiology and EIT monitoring techniques in mechanically ventilated patients. The model proposed here was able to reproduce consistent images of ventilation distribution in simulated acutely injured and collapsed lung conditions. A new advisory system architecture integrating a previously developed data-driven physiological model for continuous and noninvasive predictions of blood gas parameters with the regional lung function data/information generated from absolute EIT (aEIT) is proposed for monitoring and ventilator therapy management of critical care patients.

  19. Towards personalised management of atherosclerosis via computational models in vascular clinics: technology based on patient-specific simulation approach

    Di Tomaso, Giulia; Agu, Obiekezie; Pichardo-Almarza, Cesar

    2014-01-01

    The development of a new technology based on patient-specific modelling for personalised healthcare in the case of atherosclerosis is presented. Atherosclerosis is the main cause of death in the world and it has become a burden on clinical services as it manifests itself in many diverse forms, such as coronary artery disease, cerebrovascular disease/stroke and peripheral arterial disease. It is also a multifactorial, chronic and systemic process that lasts for a lifetime, putting enormous financial and clinical pressure on national health systems. In this Letter, the postulate is that the development of new technologies for healthcare using computer simulations can, in the future, be developed as in-silico management and support systems. These new technologies will be based on predictive models (including the integration of observations, theories and predictions across a range of temporal and spatial scales, scientific disciplines, key risk factors and anatomical sub-systems) combined with digital patient data and visualisation tools. Although the problem is extremely complex, a simulation workflow and an exemplar application of this type of technology for clinical use is presented, which is currently being developed by a multidisciplinary team following the requirements and constraints of the Vascular Service Unit at the University College Hospital, London. PMID:26609369

  20. A Tissue Relevance and Meshing Method for Computing Patient-Specific Anatomical Models in Endoscopic Sinus Surgery Simulation

    Audette, M. A.; Hertel, I.; Burgert, O.; Strauss, G.

    This paper presents on-going work on a method for determining which subvolumes of a patient-specific tissue map, extracted from CT data of the head, are relevant to simulating endoscopic sinus surgery of that individual, and for decomposing these relevant tissues into triangles and tetrahedra whose mesh size is well controlled. The overall goal is to limit the complexity of the real-time biomechanical interaction while ensuring the clinical relevance of the simulation. Relevant tissues are determined as the union of the pathology present in the patient, of critical tissues deemed to be near the intended surgical path or pathology, and of bone and soft tissue near the intended path, pathology or critical tissues. The processing of tissues, prior to meshing, is based on the Fast Marching method applied under various guises, in a conditional manner that is related to tissue classes. The meshing is based on an adaptation of a meshing method of ours, which combines the Marching Tetrahedra method and the discrete Simplex mesh surface model to produce a topologically faithful surface mesh with well controlled edge and face size as a first stage, and Almost-regular Tetrahedralization of the same prescribed mesh size as a last stage.

  1. Simulations Test Impact Of Education, Employment, And Income Improvements On Minority Patients With Mental Illness.

    Alegria, Margarita; Drake, Robert E; Kang, Hyeon-Ah; Metcalfe, Justin; Liu, Jingchen; DiMarzio, Karissa; Ali, Naomi

    2017-06-01

    Social determinants of health, such as poverty and minority background, severely disadvantage many people with mental disorders. A variety of innovative federal, state, and local programs have combined social services with mental health interventions. To explore the potential effects of such supports for addressing poverty and disadvantage on mental health outcomes, we simulated improvements in three social determinants-education, employment, and income. We used two large data sets: one from the National Institute of Mental Health that contained information about people with common mental disorders such as anxiety and depression, and another from the Social Security Administration that contained information about people who were disabled due to severe mental disorders such as schizophrenia and bipolar disorder. Our simulations showed that increasing employment was significantly correlated with improvements in mental health outcomes, while increasing education and income produced weak or nonsignificant correlations. In general, minority groups as well as the majority group of non-Latino whites improved in the desired outcomes. We recommend that health policy leaders, state and federal agencies, and insurers provide evidence-based employment services as a standard treatment for people with mental disorders. Project HOPE—The People-to-People Health Foundation, Inc.

  2. A Modeling and Simulation Framework for Adverse Events in Erlotinib-Treated Non-Small-Cell Lung Cancer Patients.

    Suleiman, Ahmed Abbas; Frechen, Sebastian; Scheffler, Matthias; Zander, Thomas; Nogova, Lucia; Kocher, Martin; Jaehde, Ulrich; Wolf, Jürgen; Fuhr, Uwe

    2015-11-01

    Treatment with erlotinib, an epidermal growth factor receptor tyrosine kinase inhibitor used for treating non-small-cell lung cancer (NSCLC) and other cancers, is frequently associated with adverse events (AE). We present a modeling and simulation framework for the most common erlotinib-induced AE, rash, and diarrhea, providing insights into erlotinib toxicity. We used the framework to investigate the safety of high-dose erlotinib pulses proposed to limit acquired resistance while treating NSCLC. Continuous-time Markov models were developed using rash and diarrhea AE data from 39 NSCLC patients treated with erlotinib (150 mg/day). Exposure and different covariates were investigated as predictors of variability. Rash was also tested as a survival predictor. Models developed were used in a simulation analysis to compare the toxicities of different regimens, including the previously mentioned pulsed strategy. Probabilities of experiencing rash or diarrhea were found to be highest early during treatment. Rash, but not diarrhea, was positively correlated with erlotinib exposure. In contrast with some common understandings, radiotherapy decreased transitioning to higher rash grades by 81% (p simulations predicted that the proposed pulsed regimen (1600 mg/week + 50 mg/day remaining week days) results in a maximum of 20% of the patients suffering from severe rash throughout the treatment course in comparison to 12% when treated with standard dosing (150 mg/day). In conclusion, the framework demonstrated that radiotherapy attenuates erlotinib-induced rash, providing an opportunity to use radiotherapy and erlotinib together, and demonstrated the tolerability of high-dose pulses intended to address acquired resistance to erlotinib.

  3. [Simulation-based intervention to improve anesthesiology residents communication with families of critically ill patients--preliminary prospective evaluation].

    Berkenstadt, Haim; Perlson, Daria; Shalomson, Orit; Tuval, Atalia; Haviv-Yadid, Yael; Ziv, Amitai

    2013-08-01

    Although effective communication with families of critically ill patients is a vital component of quality care, training in this field is neglected. The article aims to validate communication skills training program for anesthesiology residents in the intensive care set up. Ten anesthesia residents, following 3 months of Intensive Care Unit (ICU) rotation, had 4 hours of lectures and one day simulation-based communication skills training with families of critically ill patients. Participants completed an attitude questionnaire over 3 time periods--before training [t1], immediately following training (t2) and three months following training (t3). The participants' communication skills were assessed by two blinded independent observers using the SEGUE framework while performing a simulation-based scenario at t1 and t3. Seven participants finished the study protocol. Participants ndicated communication importance as 3.68 +/- 0.58 (t1), 4.05 +/- 0.59 (t2), 4.13 +/- 0.64 (t3); their communication ability as 3.09 +/- 0.90 (t1), 3.70 +/- 0.80 (t2), 3.57 +/- 0.64 (t3); the contribution of lecture to communication 3.04 +/- 0.43 (t1), 3.83 +/- 0.39 (t2), 3.87 +/- 0.51 (t3), and contribution of simulation training to communication 3.00 +/- 0.71 (t1), 4.04 +/- 0.52 (t2), 3.84 +/- 0.31 (t3). The differences did not reach statistical significance. Objective assessment of the communication skills using the SEGUE framework indicated that 6/7 participants improved their communication skills, with communication ability before training at 2.66 +/- 0.83 and 1 month following training it was 3.38 +/- 0.78 (p = 0.09). This preliminary study demonstrates the value of communication skills training in the intensive care environment.

  4. Establishing an individual dosing system for patients undergoing interventional transcatheter arterial embolization: Radiochromic film and Monte Carlo simulation

    Tsai, Hui-Yu; Lai, Pei-Ling; Li, Yang-Ying; Tyan, Yeu-Sheng

    2011-01-01

    Less invasive imaging-guided vascular interventions with fluoroscopy and digital subtraction angiography have recently become widespread and have been successfully used for treating various diseases. However, interventional fluoroscopy procedures may present deterministic and stochastic radiation risks. The International Commission on Radiological Protection (ICRP) and the Food and Drug Administration have requested identifying procedures that may involve patient doses greater than the recommended thresholds. In this study, radiochromic dosimetric media, known as self-developing films, and measurement-based Monte Carlo simulations were used to establish an interventional radiology dosing system for individual patients undergoing interventional transcatheter arterial embolization. The peak skin dose, evaluated from the entrance surface dose distribution, was 21% less than the cumulated dose reported from the console. A 3D dose map incorporated into CT images was established. The organ doses and effective doses for individual patients were evaluated using this dosing system. This system could be applied very well to other fluoroscopic or interventional procedures for patient dose management.

  5. Communication between nurses and simulated patients with cancer: evaluation of a communication training programme.

    Kruijver, I.P.M.; Kerkstra, A.; Kerssens, J.J.; Holtkamp, C.C.M.; Bensing, J.M.; Wiel, H.B.M. van de

    2001-01-01

    In this paper the effect of a communication training programme on the instrumental and affective communication skills employed by ward nurses during the admittance interview with recently diagnosed cancer patients was investigated. The training focused on teaching nurses skills to discuss and handle

  6. Patient Specific Multiscale Simulations of Blood Flow in Coronary Artery Bypass Surgery

    Bangalore Ramachandra, Abhay; Sankaran, Sethuraman; Kahn, Andrew M.; Marsden, Alison L.

    2013-11-01

    Coronary artery bypass surgery is performed to revascularize blocked coronary arteries in roughly 400,000 patients per year in the US.While arterial grafts offer superior patency, vein grafts are used in more than 70% of procedures, as most patients require multiple grafts. Vein graft failure (approx. 50% within 10 years) remains a major clinical issue. Mounting evidence suggests that hemodynamics plays a key role as a mechano-biological stimulus contributing to graft failure. However, quantifying relevant hemodynamic quantities (e.g. wall shear stress) invivo is not possible directly using clinical imaging techniques. We numerically compute graft hemodynamics in a cohort of 3-D patient specific models using a stabilized finite element method. The 3D flow domain is coupled to a 0D lumped parameter circulatory model. Boundary conditions are tuned to match patient specific blood pressures, stroke volumes & heart rates. Results reproduce clinically observed coronary flow waveforms. We quantify differences in multiple hemodynamic quantities between arterial & venous grafts & discuss possible correlations between graft hemodynamics & clinically observed graft failure.Such correlations will provide further insight into mechanisms of graft failure and may lead to improved clinical outcomes.

  7. Use of simulation-based education to improve resident learning and patient care in the medical intensive care unit: a randomized trial.

    Schroedl, Clara J; Corbridge, Thomas C; Cohen, Elaine R; Fakhran, Sherene S; Schimmel, Daniel; McGaghie, William C; Wayne, Diane B

    2012-04-01

    The purpose of this study is to determine the effect of simulation-based education on the knowledge and skills of internal medicine residents in the medical intensive care unit (MICU). From January 2009 to January 2010, 60 first-year residents at a tertiary care teaching hospital were randomized by month of rotation to an intervention group (simulator-trained, n = 26) and a control group (traditionally trained, n = 34). Simulator-trained residents completed 4 hours of simulation-based education before their medical intensive care unit (MICU) rotation. Topics included circulatory shock, respiratory failure, and mechanical ventilation. After their rotation, residents completed a standardized bedside skills assessment using a 14-item checklist regarding respiratory mechanics, ventilator settings, and circulatory parameters. Performance of simulator-trained and traditionally trained residents was compared using a 2-tailed independent-samples t test. Simulator-trained residents scored significantly higher on the bedside skills assessment compared with traditionally trained residents (82.5% ± 10.6% vs 74.8% ± 14.1%, P = .027). Simulator-trained residents were highly satisfied with the simulation curriculum. Simulation-based education significantly improved resident knowledge and skill in the MICU. Knowledge acquired in the simulated environment was transferred to improved bedside skills caring for MICU patients. Simulation-based education is a valuable adjunct to standard clinical training for residents in the MICU. Copyright © 2012 Elsevier Inc. All rights reserved.

  8. Patient-Specific Simulation Models of the Abdominal Aorta With and Without Aneurysms

    Enevoldsen, Marie Sand

    to be isotropic, which may allow simpler phenomenological models to capture these effects. There is a pressing need, however, for more detailed histological information coupled with more complete experimental data for the systemic arteries. The second study was aimed at developing computational simulation models...... relations for computational analysis, and evaluation of the material model predictability. The constitutive framework applied is the four fiber family (4FF) model. This model assumes that the wall is a constrained mixture of an amorphous isotropic elastin dominated matrix reinforced by collagen fibers....... The collagen fibers are grouped in four directions of orientation. The purpose of the first study was to investigate whether significant risk factors related to AAA development can be identified from a specific pattern in the material parameters of the 4FF model. Smoking is a leading self-inflicted risk factor...

  9. Patient-specific scatter correction in clinical cone beam computed tomography imaging made possible by the combination of Monte Carlo simulations and a ray tracing algorithm

    Thing, Rune S.; Bernchou, Uffe; Brink, Carsten; Mainegra-Hing, Ernesto

    2013-01-01

    Purpose: Cone beam computed tomography (CBCT) image quality is limited by scattered photons. Monte Carlo (MC) simulations provide the ability of predicting the patient-specific scatter contamination in clinical CBCT imaging. Lengthy simulations prevent MC-based scatter correction from being fully implemented in a clinical setting. This study investigates the combination of using fast MC simulations to predict scatter distributions with a ray tracing algorithm to allow calibration between simulated and clinical CBCT images. Material and methods: An EGSnrc-based user code (egs c bct), was used to perform MC simulations of an Elekta XVI CBCT imaging system. A 60keV x-ray source was used, and air kerma scored at the detector plane. Several variance reduction techniques (VRTs) were used to increase the scatter calculation efficiency. Three patient phantoms based on CT scans were simulated, namely a brain, a thorax and a pelvis scan. A ray tracing algorithm was used to calculate the detector signal due to primary photons. A total of 288 projections were simulated, one for each thread on the computer cluster used for the investigation. Results: Scatter distributions for the brain, thorax and pelvis scan were simulated within 2 % statistical uncertainty in two hours per scan. Within the same time, the ray tracing algorithm provided the primary signal for each of the projections. Thus, all the data needed for MC-based scatter correction in clinical CBCT imaging was obtained within two hours per patient, using a full simulation of the clinical CBCT geometry. Conclusions: This study shows that use of MC-based scatter corrections in CBCT imaging has a great potential to improve CBCT image quality. By use of powerful VRTs to predict scatter distributions and a ray tracing algorithm to calculate the primary signal, it is possible to obtain the necessary data for patient specific MC scatter correction within two hours per patient

  10. Impact of patient weight on tumor visibility based on human-shaped phantom simulation study in PET imaging system

    Musarudin, M.; Saripan, M.I.; Mashohor, S.; Saad, W.H.M.; Nordin, A.J.; Hashim, S.

    2015-01-01

    Energy window technique has been implemented in all positron emission tomography (PET) imaging protocol, with the aim to remove the unwanted low energy photons. Current practices in our institution however are performed by using default energy threshold level regardless of the weight of the patient. Phantom size, which represents the size of the patient's body, is the factor that determined the level of scatter fraction during PET imaging. Thus, the motivation of this study is to determine the optimum energy threshold level for different sizes of human-shaped phantom, to represent underweight, normal, overweight and obese patients. In this study, the scanner was modeled by using Monte Carlo code, version MCNP5. Five different sizes of elliptical-cylinder shaped of human-sized phantoms with diameter ranged from 15 to 30 cm were modeled. The tumor was modeled by a cylindrical line source filled with 1.02 MeV positron emitters at the center of the phantom. Various energy window widths, in the ranged of 10–50% were implemented to the data. In conclusion, the phantom mass volume did influence the scatter fraction within the volume. Bigger phantom caused more scattering events and thus led to coincidence counts lost. We evaluated the impact of phantom sizes on the sensitivity and visibility of the simulated models. Implementation of wider energy window improved the sensitivity of the system and retained the coincidence photons lost. Visibility of the tumor improved as an appropriate energy window implemented for the different sizes of phantom. - Highlights: • Optimizing the energy window improved the sensitivity of the PET system. • Improving the visibility of the tumors using the optimized energy window. • Recommendations on the optimized energy windows for different body sizes. • Using simulated phantom using MCNP to determine various body sizes

  11. Low validity of the Sensewear Pro3 activity monitor compared to indirect calorimetry during simulated free living in patients with osteoarthritis of the hip

    Hermann, Andreas; Ried-Larsen, Mathias; Jensen, Andreas Emil Kryger

    2014-01-01

    BACKGROUND: To validate physical activity estimates by the Sensewear Pro3 activity monitor compared with indirect calorimetry during simulated free living in patients diagnosed with osteoarthritis of the hip pre or post total hip arthroplasty. METHODS: Twenty patients diagnosed with hip osteoarth...

  12. Computer-Based 3D Simulation: A Study of Communication Practices in a Trauma Team Performing Patient Examination and Diagnostic Work

    Krange, Ingeborg; Moen, Anne; Ludvigsen, Sten

    2012-01-01

    Diagnostic work in trauma teams is critical for the patient's condition and for the possibility of survival. It is a difficult situation to train due to the inherently unpredictable and time-critical practice when an injured patient presents in the Emergency Room (ER). Different types of simulations have been developed for specialized training of…

  13. Virtual simulation of the postsurgical cosmetic outcome in patients with Pectus Excavatum

    Vilaça, João L.; Moreira, António H. J.; L-Rodrigues, Pedro; Rodrigues, Nuno; Fonseca, Jaime C.; Pinho, A. C. M.; Correia-Pinto, Jorge

    2011-03-01

    Pectus excavatum is the most common congenital deformity of the anterior chest wall, in which several ribs and the sternum grow abnormally. Nowadays, the surgical correction is carried out in children and adults through Nuss technic. This technic has been shown to be safe with major drivers as cosmesis and the prevention of psychological problems and social stress. Nowadays, no application is known to predict the cosmetic outcome of the pectus excavatum surgical correction. Such tool could be used to help the surgeon and the patient in the moment of deciding the need for surgery correction. This work is a first step to predict postsurgical outcome in pectus excavatum surgery correction. Facing this goal, it was firstly determined a point cloud of the skin surface along the thoracic wall using Computed Tomography (before surgical correction) and the Polhemus FastSCAN (after the surgical correction). Then, a surface mesh was reconstructed from the two point clouds using a Radial Basis Function algorithm for further affine registration between the meshes. After registration, one studied the surgical correction influence area (SCIA) of the thoracic wall. This SCIA was used to train, test and validate artificial neural networks in order to predict the surgical outcome of pectus excavatum correction and to determine the degree of convergence of SCIA in different patients. Often, ANN did not converge to a satisfactory solution (each patient had its own deformity characteristics), thus invalidating the creation of a mathematical model capable of estimating, with satisfactory results, the postsurgical outcome.

  14. Tissue classifications in Monte Carlo simulations of patient dose for photon beam tumor treatments

    Lin, Mu-Han; Chao, Tsi-Chian; Lee, Chung-Chi; Tung-Chieh Chang, Joseph; Tung, Chuan-Jong

    2010-07-01

    The purpose of this work was to study the calculated dose uncertainties induced by the material classification that determined the interaction cross-sections and the water-to-material stopping-power ratios. Calculations were made for a head- and neck-cancer patient treated with five intensity-modulated radiotherapy fields using 6 MV photon beams. The patient's CT images were reconstructed into two voxelized patient phantoms based on different CT-to-material classification schemes. Comparisons of the depth-dose curve of the anterior-to-posterior field and the dose-volume-histogram of the treatment plan were used to evaluate the dose uncertainties from such schemes. The results indicated that any misassignment of tissue materials could lead to a substantial dose difference, which would affect the treatment outcome. To assure an appropriate material assignment, it is desirable to have different conversion tables for various parts of the body. The assignment of stopping-power ratio should be based on the chemical composition and the density of the material.

  15. Tissue classifications in Monte Carlo simulations of patient dose for photon beam tumor treatments

    Lin, Mu-Han; Chao, Tsi-Chian; Lee, Chung-Chi; Tung-Chieh Chang, Joseph; Tung, Chuan-Jong

    2010-01-01

    The purpose of this work was to study the calculated dose uncertainties induced by the material classification that determined the interaction cross-sections and the water-to-material stopping-power ratios. Calculations were made for a head- and neck-cancer patient treated with five intensity-modulated radiotherapy fields using 6 MV photon beams. The patient's CT images were reconstructed into two voxelized patient phantoms based on different CT-to-material classification schemes. Comparisons of the depth-dose curve of the anterior-to-posterior field and the dose-volume-histogram of the treatment plan were used to evaluate the dose uncertainties from such schemes. The results indicated that any misassignment of tissue materials could lead to a substantial dose difference, which would affect the treatment outcome. To assure an appropriate material assignment, it is desirable to have different conversion tables for various parts of the body. The assignment of stopping-power ratio should be based on the chemical composition and the density of the material.

  16. The effects of using high-fidelity simulators and standardized patients on the thorax, lung, and cardiac examination skills of undergraduate nursing students.

    Tuzer, Hilal; Dinc, Leyla; Elcin, Melih

    2016-10-01

    Existing research literature indicates that the use of various simulation techniques in the training of physical examination skills develops students' cognitive and psychomotor abilities in a realistic learning environment while improving patient safety. The study aimed to compare the effects of the use of a high-fidelity simulator and standardized patients on the knowledge and skills of students conducting thorax-lungs and cardiac examinations, and to explore the students' views and learning experiences. A mixed-method explanatory sequential design. The study was conducted in the Simulation Laboratory of a Nursing School, the Training Center at the Faculty of Medicine, and in the inpatient clinics of the Education and Research Hospital. Fifty-two fourth-year nursing students. Students were randomly assigned to Group I and Group II. The students in Group 1 attended the thorax-lungs and cardiac examination training using a high-fidelity simulator, while the students in Group 2 using standardized patients. After the training sessions, all students practiced their skills on real patients in the clinical setting under the supervision of the investigator. Knowledge and performance scores of all students increased following the simulation activities; however, the students that worked with standardized patients achieved significantly higher knowledge scores than those that worked with the high-fidelity simulator; however, there was no significant difference in performance scores between the groups. The mean performance scores of students on real patients were significantly higher compared to the post-simulation assessment scores (psimulator in increasing the knowledge scores of students on thorax-lungs and cardiac examinations; however, practice on real patients increased performance scores of all students without any significant difference in two groups. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. A Markov computer simulation model of the economics of neuromuscular blockade in patients with acute respiratory distress syndrome

    Chow John L

    2006-03-01

    Full Text Available Abstract Background Management of acute respiratory distress syndrome (ARDS in the intensive care unit (ICU is clinically challenging and costly. Neuromuscular blocking agents may facilitate mechanical ventilation and improve oxygenation, but may result in prolonged recovery of neuromuscular function and acute quadriplegic myopathy syndrome (AQMS. The goal of this study was to address a hypothetical question via computer modeling: Would a reduction in intubation time of 6 hours and/or a reduction in the incidence of AQMS from 25% to 21%, provide enough benefit to justify a drug with an additional expenditure of $267 (the difference in acquisition cost between a generic and brand name neuromuscular blocker? Methods The base case was a 55 year-old man in the ICU with ARDS who receives neuromuscular blockade for 3.5 days. A Markov model was designed with hypothetical patients in 1 of 6 mutually exclusive health states: ICU-intubated, ICU-extubated, hospital ward, long-term care, home, or death, over a period of 6 months. The net monetary benefit was computed. Results Our computer simulation modeling predicted the mean cost for ARDS patients receiving standard care for 6 months to be $62,238 (5% – 95% percentiles $42,259 – $83,766, with an overall 6-month mortality of 39%. Assuming a ceiling ratio of $35,000, even if a drug (that cost $267 more hypothetically reduced AQMS from 25% to 21% and decreased intubation time by 6 hours, the net monetary benefit would only equal $137. Conclusion ARDS patients receiving a neuromuscular blocker have a high mortality, and unpredictable outcome, which results in large variability in costs per case. If a patient dies, there is no benefit to any drug that reduces ventilation time or AQMS incidence. A prospective, randomized pharmacoeconomic study of neuromuscular blockers in the ICU to asses AQMS or intubation times is impractical because of the highly variable clinical course of patients with ARDS.

  18. Combining patient journey modelling and visual multi-agent computer simulation: a framework to improving knowledge translation in a healthcare environment.

    Curry, Joanne; Fitzgerald, Anneke; Prodan, Ante; Dadich, Ann; Sloan, Terry

    2014-01-01

    This article focuses on a framework that will investigate the integration of two disparate methodologies: patient journey modelling and visual multi-agent simulation, and its impact on the speed and quality of knowledge translation to healthcare stakeholders. Literature describes patient journey modelling and visual simulation as discrete activities. This paper suggests that their combination and their impact on translating knowledge to practitioners are greater than the sum of the two technologies. The test-bed is ambulatory care and the goal is to determine if this approach can improve health services delivery, workflow, and patient outcomes and satisfaction. The multidisciplinary research team is comprised of expertise in patient journey modelling, simulation, and knowledge translation.

  19. Evaluating organ delineation, dose calculation and daily localization in an open-MRI simulation workflow for prostate cancer patients

    Doemer, Anthony; Chetty, Indrin J; Glide-Hurst, Carri; Nurushev, Teamour; Hearshen, David; Pantelic, Milan; Traughber, Melanie; Kim, Joshua; Levin, Kenneth; Elshaikh, Mohamed A; Walker, Eleanor; Movsas, Benjamin

    2015-01-01

    This study describes initial testing and evaluation of a vertical-field open Magnetic Resonance Imaging (MRI) scanner for the purpose of simulation in radiation therapy for prostate cancer. We have evaluated the clinical workflow of using open MRI as a sole modality for simulation and planning. Relevant results related to MRI alignment (vs. CT) reference dataset with Cone-Beam CT (CBCT) for daily localization are presented. Ten patients participated in an IRB approved study utilizing MRI along with CT simulation with the intent of evaluating the MRI-simulation process. Differences in prostate gland volume, seminal vesicles, and penile bulb were assessed with MRI and compared to CT. To evaluate dose calculation accuracy, bulk-density-assignments were mapped onto respective MRI datasets and treated IMRT plans were re-calculated. For image localization purposes, 400 CBCTs were re-evaluated with MRI as the reference dataset and daily shifts compared against CBCT-to-CT registration. Planning margins based on MRI/CBCT shifts were computed using the van Herk formalism. Significant organ contour differences were noted between MRI and CT. Prostate volumes were on average 39.7% (p = 0.002) larger on CT than MRI. No significant difference was found in seminal vesicle volumes (p = 0.454). Penile bulb volumes were 61.1% higher on CT, without statistical significance (p = 0.074). MRI-based dose calculations with assigned bulk densities produced agreement within 1% with heterogeneity corrected CT calculations. The differences in shift positions for the cohort between CBCT-to-CT registration and CBCT-to-MRI registration are −0.15 ± 0.25 cm (anterior-posterior), 0.05 ± 0.19 cm (superior-inferior), and −0.01 ± 0.14 cm (left-right). This study confirms the potential of using an open-field MRI scanner as primary imaging modality for prostate cancer treatment planning simulation, dose calculations and daily image localization

  20. Optimizing patient flow in a large hospital surgical centre by means of discrete-event computer simulation models.

    Ferreira, Rodrigo B; Coelli, Fernando C; Pereira, Wagner C A; Almeida, Renan M V R

    2008-12-01

    This study used the discrete-events computer simulation methodology to model a large hospital surgical centre (SC), in order to analyse the impact of increases in the number of post-anaesthetic beds (PABs), of changes in surgical room scheduling strategies and of increases in surgery numbers. The used inputs were: number of surgeries per day, type of surgical room scheduling, anaesthesia and surgery duration, surgical teams' specialty and number of PABs, and the main outputs were: number of surgeries per day, surgical rooms' use rate and blocking rate, surgical teams' use rate, patients' blocking rate, surgery delays (minutes) and the occurrence of postponed surgeries. Two basic strategies were implemented: in the first strategy, the number of PABs was increased under two assumptions: (a) following the scheduling plan actually used by the hospital (the 'rigid' scheduling - surgical rooms were previously assigned and assignments could not be changed) and (b) following a 'flexible' scheduling (surgical rooms, when available, could be freely used by any surgical team). In the second, the same analysis was performed, increasing the number of patients (up to the system 'feasible maximum') but fixing the number of PABs, in order to evaluate the impact of the number of patients over surgery delays. It was observed that the introduction of a flexible scheduling/increase in PABs would lead to a significant improvement in the SC productivity.

  1. Impact of patient weight on tumor visibility based on human-shaped phantom simulation study in PET imaging system

    Musarudin, M.; Saripan, M. I.; Mashohor, S.; Saad, W. H. M.; Nordin, A. J.; Hashim, S.

    2015-10-01

    Energy window technique has been implemented in all positron emission tomography (PET) imaging protocol, with the aim to remove the unwanted low energy photons. Current practices in our institution however are performed by using default energy threshold level regardless of the weight of the patient. Phantom size, which represents the size of the patient's body, is the factor that determined the level of scatter fraction during PET imaging. Thus, the motivation of this study is to determine the optimum energy threshold level for different sizes of human-shaped phantom, to represent underweight, normal, overweight and obese patients. In this study, the scanner was modeled by using Monte Carlo code, version MCNP5. Five different sizes of elliptical-cylinder shaped of human-sized phantoms with diameter ranged from 15 to 30 cm were modeled. The tumor was modeled by a cylindrical line source filled with 1.02 MeV positron emitters at the center of the phantom. Various energy window widths, in the ranged of 10-50% were implemented to the data. In conclusion, the phantom mass volume did influence the scatter fraction within the volume. Bigger phantom caused more scattering events and thus led to coincidence counts lost. We evaluated the impact of phantom sizes on the sensitivity and visibility of the simulated models. Implementation of wider energy window improved the sensitivity of the system and retained the coincidence photons lost. Visibility of the tumor improved as an appropriate energy window implemented for the different sizes of phantom.

  2. The use of a written assessment checklist for the provision of emergency contraception via community pharmacies: a simulated patient study

    Schneider CR

    2013-09-01

    Full Text Available Background: The Pharmaceutical Society of Australia recommends use of a written assessment checklist prior to supply of emergency contraception by pharmacists. Objective: The aim of this research was to determine the prevalence of use of a written assessment checklist by community pharmacists and secondly, to ascertain the effect of the checklist on appropriate assessment and supply.Methods: Three female simulated patients visited 100 randomly selected pharmacies requesting supply of ‘the morning after pill’. Information provided when assessed by the pharmacist was that she had missed one inactive pill of her regular hormonal contraception. The amount of assessment provided and the appropriateness of supply were used as comparative outcome measures.Results: Eighty-three pharmacies used a written assessment checklist. Twenty-four of the pharmacies visited provided the appropriate outcome of non-supply. Pharmacies that used a written assessment checklist provided a greater quantity and consistency of assessment (11.3 ±2.5 v. 6.5 ±3.8 questions, p<0.0001 but this did not result in an improved frequency of an appropriate outcome (20%, n=16 v. 23%, n=3. Conclusions: While a written patient assessment checklist improved the quantity and consistency of patient assessment, it did not improve the advice provided by community pharmacies when handling requests for emergency contraception.

  3. Clinical, laboratory and molecular signs of immunodeficiency in patients with partial oculo-cutaneous albinism.

    Dotta, Laura; Parolini, Silvia; Prandini, Alberto; Tabellini, Giovanna; Antolini, Maddalena; Kingsmore, Stephen F; Badolato, Raffaele

    2013-10-17

    Hypopigmentation disorders that are associated with immunodeficiency feature both partial albinism of hair, skin and eyes together with leukocyte defects. These disorders include Chediak Higashi (CHS), Griscelli (GS), Hermansky-Pudlak (HPS) and MAPBP-interacting protein deficiency syndromes. These are heterogeneous autosomal recessive conditions in which the causal genes encode proteins with specific roles in the biogenesis, function and trafficking of secretory lysosomes. In certain specialized cells, these organelles serve as a storage compartment. Impaired secretion of specific effector proteins from that intracellular compartment affects biological activities. In particular, these intracellular granules are essential constituents of melanocytes, platelets, granulocytes, cytotoxic T lymphocytes (CTLs) and natural killer (NK) cells. Thus, abnormalities affect pigmentation, primary hemostasis, blood cell counts and lymphocyte cytotoxic activity against microbial pathogens. Among eight genetically distinct types of HPS, only type 2 is characterized by immunodeficiency. Recently, a new subtype, HPS9, was defined in patients presenting with immunodeficiency and oculocutaneous albinism, associated with mutations in the pallidin-encoding gene, PLDN.Hypopigmentation together with recurrent childhood bacterial or viral infections suggests syndromic albinism. T and NK cell cytotoxicity are generally impaired in patients with these disorders. Specific clinical and biochemical phenotypes can allow differential diagnoses among these disorders before molecular testing. Ocular symptoms, including nystagmus, that are usually evident at birth, are common in patients with HPS2 or CHS. Albinism with short stature is unique to MAPBP-interacting protein (MAPBPIP) deficiency, while hemophagocytic lymphohistiocytosis (HLH) mainly suggests a diagnosis of CHS or GS type 2 (GS2). Neurological disease is a long-term complication of CHS, but is uncommon in other syndromic albinism. Chronic

  4. Effect of Engaging Trainees by Assessing Peer Performance: A Randomised Controlled Trial Using Simulated Patient Scenarios

    Charlotte Loumann Krogh

    2014-01-01

    Full Text Available Introduction. The aim of this study was to explore the learning effect of engaging trainees by assessing peer performance during simulation-based training. Methods. Eighty-four final year medical students participated in the study. The intervention involved trainees assessing peer performance during training. Outcome measures were in-training performance and performance, both of which were measured two weeks after the course. Trainees’ performances were videotaped and assessed by two expert raters using a checklist that included a global rating. Trainees’ satisfaction with the training was also evaluated. Results. The intervention group obtained a significantly higher overall in-training performance score than the control group: mean checklist score 20.87 (SD 2.51 versus 19.14 (SD 2.65 P=0.003 and mean global rating 3.25 SD (0.99 versus 2.95 (SD 1.09 P=0.014. Postcourse performance did not show any significant difference between the two groups. Trainees who assessed peer performance were more satisfied with the training than those who did not: mean 6.36 (SD 1.00 versus 5.74 (SD 1.33 P=0.025. Conclusion. Engaging trainees in the assessment of peer performance had an immediate effect on in-training performance, but not on the learning outcome measured two weeks later. Trainees had a positive attitude towards the training format.

  5. Foreign Body Granulomas Simulating Recurrent Tumors in Patients Following Colorectal Surgery for Carcinoma: a Report of Two Cases

    Kim, Sang Won; Shin, Hyeong Cheol; Kim, Il Young; Baek, Moo Joon; Cho, Hyun Deuk [Cheonan Hospital, Soonchunhyang University, Cheonan (Korea, Republic of)

    2009-06-15

    We report here two cases of foreign body granulomas that arose from the pelvic wall and liver, respectively, and simulated recurrent colorectal carcinomas in patients with a history of surgery. On contrast-enhanced CT and MR images, a pelvic wall mass appeared as a well-enhancing mass that had invaded the distal ureter, resulting in the development of hydronephrosis. In addition, a liver mass had a hypointense rim that corresponded to the fibrous wall on a T2-weighted MR image, and showed persistent peripheral enhancement that corresponded to the granulation tissues and fibrous wall on dynamic MR images. These lesions also displayed very intense homogeneous FDG uptake on PET/CT.

  6. A patient specific finite element simulation of intramedullary nailing to predict the displacement of the distal locking hole.

    Mortazavi, Javad; Farahmand, Farzam; Behzadipour, Saeed; Yeganeh, Ali; Aghighi, Mohammad

    2018-05-01

    Distal locking is a challenging subtask of intramedullary nailing fracture fixation due to the nail deformation that makes the proximally mounted targeting systems ineffective. A patient specific finite element model was developed, based on the QCT data of a cadaveric femur, to predict the position of the distal hole of the nail postoperatively. The mechanical interactions of femur and nail (of two sizes) during nail insertion was simulated using ABAQUS in two steps of dynamic pushing and static equilibrium, for the intact and distally fractured bone. Experiments were also performed on the same specimen to validate the simulation results. A good agreement was found between the model predictions and the experimental observations. There was a three-point contact pattern between the nail and medullary canal, only on the proximal fragment of the fractured bone. The nail deflection was much larger in the sagittal plane and increased for the larger diameter nail, as well as for more distally fractured or intact femur. The altered position of the distal hole was predicted by the model with an acceptable error (mean: 0.95; max: 1.5 mm, in different tests) to be used as the compensatory information for fine tuning of proximally mounted targeting systems. Copyright © 2018 IPEM. Published by Elsevier Ltd. All rights reserved.

  7. Fast evaluation of patient set-up during radiotherapy by aligning features in portal and simulator images

    Bijhold, J.; Herk, M. van; Vijlbrief, R.; Lebesque, J.V.

    1991-01-01

    A new fast method is presented for the quantification of patient set-up errors during radiotherapy with external photon beams. The set-up errors are described as deviations in relative position and orientation of specified anatomical structures relative to specified field shaping devices. These deviations are determined from parameters of the image transformations that make their features in a portal image align with the corresponding features in a simulator image. Knowledge of some set-up parameters during treatment simulation is required. The method does not require accurate knowledge about the position of the portal imaging device as long as the positions of some of the field shaping devices are verified independently during treatment. By applying this method, deviations in a pelvic phantom set-up can be measured with a precision of 2 mm within 1 minute. Theoretical considerations and experiments have shown that the method is not applicable when there are out-of-plane rotations larger than 2 degrees or translations larger than 1 cm. Inter-observer variability proved to be a source of large systematic errors, which could be reduced by offering a precise protocol for the feature alignment. (author)

  8. Interprofessional communication skills training for serious illness: evaluation of a small-group, simulated patient intervention.

    Bays, Alison M; Engelberg, Ruth A; Back, Anthony L; Ford, Dee W; Downey, Lois; Shannon, Sarah E; Doorenbos, Ardith Z; Edlund, Barbara; Christianson, Phyllis; Arnold, Richard W; O'Connor, Kim; Kross, Erin K; Reinke, Lynn F; Cecere Feemster, Laura; Fryer-Edwards, Kelly; Alexander, Stewart C; Tulsky, James A; Curtis, J Randall

    2014-02-01

    Communication with patients and families is an essential component of high-quality care in serious illness. Small-group skills training can result in new communication behaviors, but past studies have used facilitators with extensive experience, raising concerns this is not scalable. The objective was to investigate the effect of an experiential communication skills building workshop (Codetalk), led by newly trained facilitators, on internal medicine trainees' and nurse practitioner students' ability to communicate bad news and express empathy. Trainees participated in Codetalk; skill improvement was evaluated through pre- and post- standardized patient (SP) encounters. The subjects were internal medicine residents and nurse practitioner students at two universities. The study was carried out in anywhere from five to eight half-day sessions over a month. The first and last sessions included audiotaped trainee SP encounters coded for effective communication behaviors. The primary outcome was change in communication scores from pre-intervention to post-intervention. We also measured trainee characteristics to identify predictors of performance and change in performance over time. We enrolled 145 trainees who completed pre- and post-intervention SP interviews-with participation rates of 52% for physicians and 14% for nurse practitioners. Trainees' scores improved in 8 of 11 coded behaviors (p<0.05). The only significant predictors of performance were having participated in the intervention (p<0.001) and study site (p<0.003). The only predictor of improvement in performance over time was participating in the intervention (p<0.001). A communication skills intervention using newly trained facilitators was associated with improvement in trainees' skills in giving bad news and expressing empathy. Improvement in communication skills did not vary by trainee characteristics.

  9. Voxel-based registration of simulated and real patient CBCT data for accurate dental implant pose estimation

    Moreira, António H. J.; Queirós, Sandro; Morais, Pedro; Rodrigues, Nuno F.; Correia, André Ricardo; Fernandes, Valter; Pinho, A. C. M.; Fonseca, Jaime C.; Vilaça, João. L.

    2015-03-01

    The success of dental implant-supported prosthesis is directly linked to the accuracy obtained during implant's pose estimation (position and orientation). Although traditional impression techniques and recent digital acquisition methods are acceptably accurate, a simultaneously fast, accurate and operator-independent methodology is still lacking. Hereto, an image-based framework is proposed to estimate the patient-specific implant's pose using cone-beam computed tomography (CBCT) and prior knowledge of implanted model. The pose estimation is accomplished in a threestep approach: (1) a region-of-interest is extracted from the CBCT data using 2 operator-defined points at the implant's main axis; (2) a simulated CBCT volume of the known implanted model is generated through Feldkamp-Davis-Kress reconstruction and coarsely aligned to the defined axis; and (3) a voxel-based rigid registration is performed to optimally align both patient and simulated CBCT data, extracting the implant's pose from the optimal transformation. Three experiments were performed to evaluate the framework: (1) an in silico study using 48 implants distributed through 12 tridimensional synthetic mandibular models; (2) an in vitro study using an artificial mandible with 2 dental implants acquired with an i-CAT system; and (3) two clinical case studies. The results shown positional errors of 67+/-34μm and 108μm, and angular misfits of 0.15+/-0.08° and 1.4°, for experiment 1 and 2, respectively. Moreover, in experiment 3, visual assessment of clinical data results shown a coherent alignment of the reference implant. Overall, a novel image-based framework for implants' pose estimation from CBCT data was proposed, showing accurate results in agreement with dental prosthesis modelling requirements.

  10. Quantifying Aerosol Delivery in Simulated Spontaneously Breathing Patients With Tracheostomy Using Different Humidification Systems With or Without Exhaled Humidity.

    Ari, Arzu; Harwood, Robert; Sheard, Meryl; Alquaimi, Maher Mubarak; Alhamad, Bshayer; Fink, James B

    2016-05-01

    Aerosol and humidification therapy are used in long-term airway management of critically ill patients with a tracheostomy. The purpose of this study was to determine delivery efficiency of jet and mesh nebulizers combined with different humidification systems in a model of a spontaneously breathing tracheotomized adult with or without exhaled heated humidity. An in vitro model was constructed to simulate a spontaneously breathing adult (tidal volume, 400 mL; breathing frequency, 20 breaths/min; inspiratory-expiratory ratio, 1:2) with a tracheostomy using a teaching manikin attached to a test lung through a collecting filter (Vital Signs Respirgard II). Exhaled heat and humidity were simulated using a cascade humidifier set to deliver 37°C and >95% relative humidity. Albuterol sulfate (2.5 mg/3 mL) was administered with a jet nebulizer (AirLife Misty Max) operated at 10 L/min and a mesh nebulizer (Aeroneb Solo) using a heated pass-over humidifier, unheated large volume humidifier both at 40 L/min output and heat-and-moisture exchanger. Inhaled drug eluted from the filter was analyzed via spectrophotometry (276 nm). Delivery efficiency of the jet nebulizer was less than that of the mesh nebulizer under all conditions (P < .05). Aerosol delivery with each nebulizer was greatest on room air and lowest when heated humidifiers with higher flows were used. Exhaled humidity decreased drug delivery up to 44%. The jet nebulizer was less efficient than the mesh nebulizer in all conditions tested in this study. Aerosol deposition with each nebulizer was lowest with the heated humidifier with high flow. Exhaled humidity reduced inhaled dose of drug compared with a standard model with nonheated/nonhumidified exhalation. Further clinical research is warranted to understand the impact of exhaled humidity on aerosol drug delivery in spontaneously breathing patients with tracheostomy using different types of humidifiers. Copyright © 2016 by Daedalus Enterprises.

  11. Treating Dehydration at Home Avoids Healthcare Costs Associated With Emergency Department Visits and Hospital Readmissions for Adult Patients Receiving Home Parenteral Support.

    Konrad, Denise; Roberts, Scott; Corrigan, Mandy L; Hamilton, Cindy; Steiger, Ezra; Kirby, Donald F

    2017-06-01

    Administration of home parenteral support (HPS) has proven to be cost-effective over hospital care. Avoiding hospital readmissions became more of a focus for healthcare institutions in 2012 with the implementation of the Affordable Care Act. In 2010, our service developed a protocol to treat dehydration at home for HPS patients by ordering additional intravenous fluids to be kept on hand and to focus patient education on the symptoms of dehydration. A retrospective analysis was completed through a clinical management database to identify HPS patients with dehydration. The hospital finance department and homecare pharmacy were utilized to determine potential cost avoidance. In 2009, 64 episodes (77%) of dehydration were successfully treated at home versus 6 emergency department (ED) visits (7.5%) and 13 readmissions (15.5%). In 2010, we successfully treated 170 episodes (84.5%) at home, with 9 episodes (4.5%) requiring ED visits and 22 hospital readmissions (11%). The number of dehydration episodes per patient was significantly higher in 2010 ( P dehydration identified and treated at home in 2010 versus 2009. Our protocol helped educate and provide the resources required to resolve dehydration at home when early signs were recognized. By reducing ED visits and hospital readmissions, healthcare costs were avoided by a factor of 29 when home treatment was successful.

  12. A simulated training model for laparoscopic pyloromyotomy: Is 3D printing the way of the future?

    Williams, Andrew; McWilliam, Morgan; Ahlin, James; Davidson, Jacob; Quantz, Mackenzie A; Bütter, Andreana

    2018-05-01

    Hypertrophic pyloric stenosis (HPS) is a common neonatal condition treated with open or laparoscopic pyloromyotomy. 3D-printed organs offer realistic simulations to practice surgical techniques. The purpose of this study was to validate a 3D HPS stomach model and assess model reliability and surgical realism. Medical students, general surgery residents, and adult and pediatric general surgeons were recruited from a single center. Participants were videotaped three times performing a laparoscopic pyloromyotomy using box trainers and 3D-printed stomachs. Attempts were graded independently by three reviewers using GOALS and Task Specific Assessments (TSA). Participants were surveyed using the Index of Agreement of Assertions on Model Accuracy (IAAMA). Participants reported their experience levels as novice (22%), inexperienced (26%), intermediate (19%), and experienced (33%). Interrater reliability was similar for overall average GOALS and TSA scores. There was a significant improvement in GOALS (p3D-printed stomach model for simulated laparoscopic pyloromyotomy is a useful training tool for learners to improve laparoscopic skills. The GOALS and TSA provide reliable technical skills assessments. II. Copyright © 2018 Elsevier Inc. All rights reserved.

  13. Reduction of radiation-induced xerostomia in nasopharyngeal carcinoma using CT simulation with laser patient marking and three-field irradiation technique

    Nishioka, Takeshi; Shirato, Hiroki; Arimoto, Takuro; Kaneko, Masanori; Kitahara, Toshihiro; Oomori, Keiichi; Yasuda, Motoyuki; Fukuda, Satoshi; Inuyama, Yukio; Miyasaka, Kazuo

    1997-01-01

    Purpose: Tumor control and reduction of postirradiation xerostomia in patients with nasopharyngeal carcinoma (NPC) using the three-field irradiation technique based on the CT-based simulation with laser patient marking was investigated. Methods and Materials: Seventy-eight patients with NPC were consecutively treated between 1983 and 1993. In 33 patients treated before 1987, target volume was determined using a conventional x-ray simulator with a reference of CT images, and the primary site was treated by the conventional parallel-opposed two-field technique (Group I). In 45 patients treated from 1987, target volume was determined using a CT simulator slice by slice, the treatment field was projected onto the patient's skin by a laser beam projector mounted on a C-arm, and the primary site was irradiated by a three-fields (anterior and bilateral) technique (Group II). In Group II, the shape of each field was determined using a beam's eye view to reduce the dose to the bilateral parotid glands. The three-field technique reduced the dose to the superficial lobe of parotid gland to about two-thirds of the dose given by the two-field technique. Radiation-induced xerostomia was evaluated by clinical symptoms and radio-isotope sialography. Results: The 5-year survival rate and disease-free survival rate were 46.6 and 31.2% in Group I, and 46.8 and 46.5% in Group II. A large variation in the volume of parotid glands were demonstrated, ranging from 9 cm 3 to 61 cm 3 among patients treated with CT simulation. Forty percent of the patients in Group II showed no or mild xerostomia, whereas all of the patients in Group I showed moderate to severe xerostomia (p < 0.01). The radioisotope sialography study showed that the mean secretion ratio by acid stimulation was improved from 3.8% in the Group I to 15.2% in the Group II (p < 0.01). Conclusions: CT simulation was useful to determine the size and shape of each field to reduce the dose to the parotid gland, of which size varies

  14. From 4D medical images (CT, MRI, and Ultrasound) to 4D structured mesh models of the left ventricular endocardium for patient-specific simulations

    Canè, Federico; Verhegghe, Benedict; De Beule, Matthieu; Bertrand, Philippe B.; Van der Geest, Rob J.; Segers, Patrick; De Santis, Gianluca

    2018-01-01

    With cardiovascular disease (CVD) remaining the primary cause of death worldwide, early detection of CVDs becomes essential. The intracardiac flow is an important component of ventricular function, motion kinetics, wash-out of ventricular chambers, and ventricular energetics. Coupling between Computational Fluid Dynamics (CFD) simulations and medical images can play a fundamental role in terms of patient-specific diagnostic tools. From a technical perspective, CFD simulations with moving boun...

  15. Using Virtual Patient Simulations to Prepare Primary Health Care Professionals to Conduct Substance Use and Mental Health Screening and Brief Intervention.

    Albright, Glenn; Bryan, Craig; Adam, Cyrille; McMillan, Jeremiah; Shockley, Kristen

    2017-07-01

    Primary health care professionals are in an excellent position to identify, screen, and conduct brief interventions for patients with mental health and substance use disorders. However, discomfort in initiating conversations about behavioral health, time concerns, lack of knowledge about screening tools, and treatment resources are barriers. This study examines the impact of an online simulation where users practice role-playing with emotionally responsive virtual patients to learn motivational interviewing strategies to better manage screening, brief interventions, and referral conversations. Baseline data were collected from 227 participants who were then randomly assigned into the treatment or wait-list control groups. Treatment group participants then completed the simulation, postsimulation survey, and 3-month follow-up survey. Results showed significant increases in knowledge/skill to identify and engage in collaborative decision making with patients. Results strongly suggest that role-play simulation experiences can be an effective means of teaching screening and brief intervention.

  16. Initial assessment of tumor tracking with a gimbaled linac system in clinical circumstances: A patient simulation study

    Depuydt, Tom; Poels, Kenneth; Verellen, Dirk; Engels, Benedikt; Collen, Christine; Haverbeke, Chloe; Gevaert, Thierry; Buls, Nico; Van Gompel, Gert; Reynders, Truus; Duchateau, Michael; Tournel, Koen; Boussaer, Marlies; Steenbeke, Femke; Vandenbroucke, Frederik; De Ridder, Mark

    2013-01-01

    Purpose: To have an initial assessment of the Vero Dynamic Tracking workflow in clinical circumstances and quantify the performance of the tracking system, a simulation study was set up on 5 lung and liver patients. Methods and materials: The preparatory steps of a tumor tracking treatment, based on fiducial markers implanted in the tumor, were executed allowing pursuit of the tumor with the gimbaled linac and monitoring X-rays acquisition, however, without activating the 6 MV beam. Data were acquired on workflow time-efficiency, tracking accuracy and imaging exposure. Results: The average time between the patient entering the treatment room and the first treatment field was about 9 min. The time for building the correlation model was 3.2 min. Tracking errors of 0.55 and 0.95 mm (1σ) were observed in PAN/TILT direction and a 2D range of 3.08 mm. A skin dose was determined of 0.08 mGy/image, with a source-to-skin distance of 900 mm and kV exposure of 1 mAs. On average 1.8 mGy/min kV skin dose was observed for 1 Hz monitoring. Conclusion: The Vero tracking solution proved to be fully functional and showed performance comparable with other real-time tracking systems

  17. Using a high-fidelity patient simulator with first-year medical students to facilitate learning of cardiovascular function curves.

    Harris, David M; Ryan, Kathleen; Rabuck, Cynthia

    2012-09-01

    Students are relying on technology for learning more than ever, and educators need to adapt to facilitate student learning. High-fidelity patient simulators (HFPS) are usually reserved for the clinical years of medical education and are geared to improve clinical decision skills, teamwork, and patient safety. Finding ways to incorporate HFPS into preclinical medical education represents more of a challenge, and there is limited literature regarding its implementation. The main objective of this study was to implement a HFPS activity into a problem-based curriculum to enhance the learning of basic sciences. More specifically, the focus was to aid in student learning of cardiovascular function curves and help students develop heart failure treatment strategies based on basic cardiovascular physiology concepts. Pretests and posttests, along with student surveys, were used to determine student knowledge and perception of learning in two first-year medical school classes. There was an increase of 21% and 22% in the percentage of students achieving correct answers on a posttest compared with their pretest score. The median number of correct questions increased from pretest scores of 2 and 2.5 to posttest scores of 4 and 5 of a possible total of 6 in each respective year. Student survey data showed agreement that the activity aided in learning. This study suggests that a HFPS activity can be implemented during the preclinical years of medical education to address basic science concepts. Additionally, it suggests that student learning of cardiovascular function curves and heart failure strategies are facilitated.

  18. Mesenchymal Stromal Cells Cultured in Serum from Heart Failure Patients Are More Resistant to Simulated Chronic and Acute Stress

    Timo Z. Nazari-Shafti

    2018-01-01

    Full Text Available Despite regulatory issues surrounding the use of animal-derived cell culture supplements, most clinical cardiac cell therapy trials using mesenchymal stromal cells (MSCs still rely on fetal bovine serum (FBS for cell expansion before transplantation. We sought to investigate the effect of human serum from heart failure patients (HFS on cord blood MSCs (CB-MSCs during short-term culture under regular conditions and during simulated acute and chronic stress. Cell survival, proliferation, metabolic activity, and apoptosis were quantified, and gene expression profiles of selected apoptosis and cell cycle regulators were determined. Compared to FBS, HFS and serum from healthy donors (CS showed similar effects by substantially increasing cell survival during chronic and acute stress and by increasing cell yields 5 days after acute stress. Shortly after the termination of acute stress, both HFS and CS resulted in a marked decrease in apoptotic cells. Transcriptome analysis suggested a decrease in TNF-mediated induction of caspases and decreased activation of mitochondrial apoptosis. Our data confirm that human serum from both healthy donors and heart failure patients results in increased cell yields and increased resistance to cellular stress signals. Therefore, we consider autologous serum a valid alternative to FBS in cell-based therapies addressing severe heart disease.

  19. The effectiveness of virtual simulation in improving student nurses' knowledge and performance during patient deterioration: A pre and post test design.

    Borg Sapiano, Alexis; Sammut, Roberta; Trapani, Josef

    2018-03-01

    Preparing nursing students to perform competently in complex emergency situations, such as during rapid patient deterioration, is challenging. Students' active engagement in such scenarios cannot be ensured, due to the unexpected nature of such infrequent events. Many students may consequently not experience and integrate the management of patient deterioration into their knowledge and practical competency by the end of their studies, making them unprepared to manage such situations as practicing nurses. This study investigated the effectiveness of virtual simulation in improving performance during rapid patient deterioration. To investigate the effectiveness of virtual simulation in improving student nurses' knowledge and performance during rapid patient deterioration. A pre- and post-test design was used. Nursing students at a university in Malta were invited to participate in a virtual simulation program named FIRST 2 ACTWeb™, using their own computer devices. A total of 166 (response rate=50%) second and third year diploma and degree nursing students participated in the study. The simulation included three scenarios (Cardiac-Shock-Respiratory) portraying deteriorating patients. Performance feedback was provided at the end of each scenario. Students completed pre- and post-scenario knowledge tests and performance during each scenario was recorded automatically on a database. Findings showed a significant improvement in the students' post-scenario knowledge (z=-6.506, psimulation as an effective learning tool for pre-registration nursing students in different programs. Simulation improves both knowledge about and performance during patient deterioration. Virtual simulation of rare events should be a key component of undergraduate nurse education, to prepare students to manage complex situations as practicing nurses. Copyright © 2018 Elsevier Ltd. All rights reserved.

  20. Pitfalls in training simulated patients to respond appropriately to questions from medical students in family history-taking activities: the current situation surrounding the training of simulated patients for learning activities at Nippon Medical School.

    Aso, Ryoko; Inoue, Chikako; Yoshimura, Akinobu; Shimura, Toshiro

    2013-01-01

    Our goal was to train simulated patients (SPs) to respond appropriately to questions about family history from medical students in simulated medical interviews. To this end, we carried out a survey of 91 SPs and 76 4th-year medical students to investigate their notions of what constitutes a family. All of the SPs and students surveyed deemed parents and children living together to be members of a family. In a situation where one spouse's parents live together with the basic family unit, 93% of the SPs considered them to be members of the family, whereas only 79% of the students did. Married children living apart from their parents were considered members of the family by 18% of the SPs and 39% of the students. These results indicate clear differences between the SPs and students in their notions of the family. To verify the level of understanding of the definitions of family and blood relatives in particular scenarios used in simulated medical interviews, we administered a written test to 14 SPs who were training to assist in the nationwide common achievement test in medicine, the Objective Structured Clinical Examination (OSCE). The overall score of the SPs was 93.5%; the incorrect answers were "a sibling is not a blood relative" and "a spouse is a blood relative." We analyzed the performance of these 14 SPs in medical interviews carried out after training for the OSCE, in which they were asked questions that required them to reveal their understanding of blood relatives, cohabiting relatives, and the family. All of the SPs responded appropriately to the students' questions about family history. After the OSCE, we asked the SPs to assess themselves on how well they had given their family histories and to evaluate the usefulness of the SP training they had received. Their mean self-assessment score on providing a family history was 3.6 (scale: 1-4); on the usefulness of training, it was 3.4 (scale: 1-4). In conclusion, training SPs to respond appropriately to

  1. Design and evaluation of simulation scenarios for a program introducing patient safety, teamwork, safety leadership, and simulation to healthcare leaders and managers.

    Cooper, Jeffrey B; Singer, Sara J; Hayes, Jennifer; Sales, Michael; Vogt, Jay W; Raemer, Daniel; Meyer, Gregg S

    2011-08-01

    We developed a training program to introduce managers and informal leaders of healthcare organizations to key concepts of teamwork, safety leadership, and simulation to motivate them to act as leaders to improve safety within their sphere of influence. This report describes the simulation scenario and debriefing that are core elements of that program. Twelve teams of clinician and nonclinician managers were selected from a larger set of volunteers to participate in a 1-day, multielement training program. Two simulation exercises were developed: one for teams of nonclinicians and the other for clinicians or mixed groups. The scenarios represented two different clinical situations, each designed to engage participants in discussions of their safety leadership and teamwork issues immediately after the experience. In the scenarios for nonclinicians, participants conducted an anesthetic induction and then managed an ethical situation. The scenario for clinicians simulated a consulting visit to an emergency room that evolved into a problem-solving challenge. Participants in this scenario had a limited time to prepare advice for hospital leadership on how to improve observed safety and cultural deficiencies. Debriefings after both types of scenarios were conducted using principles of "debriefing with good judgment." We assessed the relevance and impact of the program by analyzing participant reactions to the simulation through transcript data and facilitator observations as well as a postcourse questionnaire. The teams generally reported positive perceptions of the relevance and quality of the simulation with varying types and degrees of impact on their leadership and teamwork behaviors. These kinds of clinical simulation exercises can be used to teach healthcare leaders and managers safety leadership and teamwork skills and behaviors.

  2. Cannabidiol Reduces the Anxiety Induced by Simulated Public Speaking in Treatment-Naïve Social Phobia Patients

    Bergamaschi, Mateus M; Queiroz, Regina Helena Costa; Chagas, Marcos Hortes Nisihara; de Oliveira, Danielle Chaves Gomes; De Martinis, Bruno Spinosa; Kapczinski, Flávio; Quevedo, João; Roesler, Rafael; Schröder, Nadja; Nardi, Antonio E; Martín-Santos, Rocio; Hallak, Jaime Eduardo Cecílio; Zuardi, Antonio Waldo; Crippa, José Alexandre S

    2011-01-01

    Generalized Social Anxiety Disorder (SAD) is one of the most common anxiety conditions with impairment in social life. Cannabidiol (CBD), one major non-psychotomimetic compound of the cannabis sativa plant, has shown anxiolytic effects both in humans and in animals. This preliminary study aimed to compare the effects of a simulation public speaking test (SPST) on healthy control (HC) patients and treatment-naïve SAD patients who received a single dose of CBD or placebo. A total of 24 never-treated patients with SAD were allocated to receive either CBD (600 mg; n=12) or placebo (placebo; n=12) in a double-blind randomized design 1 h and a half before the test. The same number of HC (n=12) performed the SPST without receiving any medication. Each volunteer participated in only one experimental session in a double-blind procedure. Subjective ratings on the Visual Analogue Mood Scale (VAMS) and Negative Self-Statement scale (SSPS-N) and physiological measures (blood pressure, heart rate, and skin conductance) were measured at six different time points during the SPST. The results were submitted to a repeated-measures analysis of variance. Pretreatment with CBD significantly reduced anxiety, cognitive impairment and discomfort in their speech performance, and significantly decreased alert in their anticipatory speech. The placebo group presented higher anxiety, cognitive impairment, discomfort, and alert levels when compared with the control group as assessed with the VAMS. The SSPS-N scores evidenced significant increases during the testing of placebo group that was almost abolished in the CBD group. No significant differences were observed between CBD and HC in SSPS-N scores or in the cognitive impairment, discomfort, and alert factors of VAMS. The increase in anxiety induced by the SPST on subjects with SAD was reduced with the use of CBD, resulting in a similar response as the HC. PMID:21307846

  3. Use of Monte Carlo Simulations to Determine Optimal Carbapenem Dosing in Critically Ill Patients Receiving Prolonged Intermittent Renal Replacement Therapy.

    Lewis, Susan J; Kays, Michael B; Mueller, Bruce A

    2016-10-01

    Pharmacokinetic/pharmacodynamic analyses with Monte Carlo simulations (MCSs) can be used to integrate prior information on model parameters into a new renal replacement therapy (RRT) to develop optimal drug dosing when pharmacokinetic trials are not feasible. This study used MCSs to determine initial doripenem, imipenem, meropenem, and ertapenem dosing regimens for critically ill patients receiving prolonged intermittent RRT (PIRRT). Published body weights and pharmacokinetic parameter estimates (nonrenal clearance, free fraction, volume of distribution, extraction coefficients) with variability were used to develop a pharmacokinetic model. MCS of 5000 patients evaluated multiple regimens in 4 different PIRRT effluent/duration combinations (4 L/h × 10 hours or 5 L/h × 8 hours in hemodialysis or hemofiltration) occurring at the beginning or 14-16 hours after drug infusion. The probability of target attainment (PTA) was calculated using ≥40% free serum concentrations above 4 times the minimum inhibitory concentration (MIC) for the first 48 hours. Optimal doses were defined as the smallest daily dose achieving ≥90% PTA in all PIRRT combinations. At the MIC of 2 mg/L for Pseudomonas aeruginosa, optimal doses were doripenem 750 mg every 8 hours, imipenem 1 g every 8 hours or 750 mg every 6 hours, and meropenem 1 g every 12 hours or 1 g pre- and post-PIRRT. Ertapenem 500 mg followed by 500 mg post-PIRRT was optimal at the MIC of 1 mg/L for Streptococcus pneumoniae. Incorporating data from critically ill patients receiving RRT into MCS resulted in markedly different carbapenem dosing regimens in PIRRT from those recommended for conventional RRTs because of the unique drug clearance characteristics of PIRRT. These results warrant clinical validation. © 2016, The American College of Clinical Pharmacology.

  4. The impact of rural hospital closures on equity of commuting time for haemodialysis patients: simulation analysis using the capacity-distance model

    Matsumoto Masatoshi

    2012-07-01

    Full Text Available Abstract Background Frequent and long-term commuting is a requirement for dialysis patients. Accessibility thus affects their quality of lives. In this paper, a new model for accessibility measurement is proposed in which both geographic distance and facility capacity are taken into account. Simulation of closure of rural facilities and that of capacity transfer between urban and rural facilities are conducted to evaluate the impacts of these phenomena on equity of accessibility among dialysis patients. Methods Post code information as of August 2011 of all the 7,374 patients certified by municipalities of Hiroshima prefecture as having first or third grade renal disability were collected. Information on post code and the maximum number of outpatients (capacity of all the 98 dialysis facilities were also collected. Using geographic information systems, patient commuting times were calculated in two models: one that takes into account road distance (distance model, and the other that takes into account both the road distance and facility capacity (capacity-distance model. Simulations of closures of rural and urban facilities were then conducted. Results The median commuting time among rural patients was more than twice as long as that among urban patients (15 versus 7 minutes, p  Conclusions Closures of dialysis facilities in rural areas have a substantially larger impact on equity of commuting times among dialysis patients than closures of urban facilities. The accessibility simulations using thecapacity-distance model will provide an analytic framework upon which rational resource distribution policies might be planned.

  5. Quantification of gross tumour volume changes between simulation and first day of radiotherapy for patients with locally advanced malignancies of the lung and head/neck.

    Kishan, Amar U; Cui, Jing; Wang, Pin-Chieh; Daly, Megan E; Purdy, James A; Chen, Allen M

    2014-10-01

    To quantify changes in gross tumour volume (GTV) between simulation and initiation of radiotherapy in patients with locally advanced malignancies of the lung and head/neck. Initial cone beam computed tomography (CT) scans from 12 patients with lung cancer and 12 with head/neck cancer (head and neck squamous cell carcinoma (HNSCC)) treated with intensity-modulated radiotherapy with image guidance were rigidly registered to the simulation CT scans. The GTV was demarcated on both scans. The relationship between percent GTV change and variables including time interval between simulation and start, tumour (T) stage, and absolute weight change was assessed. For lung cancer patients, the GTV increased a median of 35.06% (range, -16.63% to 229.97%) over a median interval of 13 days (range, 7-43), while for HNSCC patients, the median GTV increase was 16.04% (range, -8.03% to 47.41%) over 13 days (range, 7-40). These observed changes are statistically significant. The magnitude of this change was inversely associated with the size of the tumour on the simulation scan for lung cancer patients (P lung cancer cases) did not correlate with degree of GTV change (P > 0.1). While the observed changes in GTV were moderate from the time of simulation to start of radiotherapy, these findings underscore the importance of image guidance for target localisation and verification, particularly for smaller tumours. Minimising the delay between simulation and treatment initiation may also be beneficial. © 2014 The Royal Australian and New Zealand College of Radiologists.

  6. Prospective Randomized Controlled Study on the Efficacy of Multimedia Informed Consent for Patients Scheduled to Undergo Green-Light High-Performance System Photoselective Vaporization of the Prostate

    Dong Yeub Ham

    2016-04-01

    Full Text Available Purpose: The aim of this study was to evaluate the efficacy of a multimedia informed consent (IC presentation on the understanding and satisfaction of patients who were scheduled to receive 120-W green-light high-performance system photoselective vaporization of the prostate (HPS-PVP. Materials and Methods: A multimedia IC (M-IC presentation for HPS-PVP was developed. Forty men with benign prostatic hyperplasia who were scheduled to undergo HPS-PVP were prospectively randomized to a conventional written IC group (W-IC group, n=20 or the M-IC group (n=20. The allocated IC was obtained by one certified urologist, followed by a 15-question test (maximum score, 15 to evaluate objective understanding, and questionnaires on subjective understanding (range, 0∼10 and satisfaction (range, 0∼10 using a visual analogue scale. Results: Demographic characteristics, including age and the highest level of education, did not significantly differ between the two groups. No significant differences were found in scores reflecting the objective understanding of HPS-PVP (9.9±2.3 vs. 10.6±2.8, p=0.332 or in subjective understanding scores (7.5±2.1 vs. 8.6±1.7, p=0.122; however, the M-IC group showed higher satisfaction scores than the W-IC group (7.4±1.7 vs. 8.4±1.5, p=0.033. After adjusting for age and educational level, the M-IC group still had significantly higher satisfaction scores. Conclusions: M-IC did not enhance the objective knowledge of patients regarding this surgical procedure. However, it improved the satisfaction of patients with the IC process itself.

  7. Prospective Randomized Controlled Study on the Efficacy of Multimedia Informed Consent for Patients Scheduled to Undergo Green-Light High-Performance System Photoselective Vaporization of the Prostate

    Ham, Dong Yeub; Choi, Woo Suk; Song, Sang Hoon; Ahn, Young-Joon; Park, Hyoung Keun; Kim, Hyeong Gon

    2016-01-01

    Purpose The aim of this study was to evaluate the efficacy of a multimedia informed consent (IC) presentation on the understanding and satisfaction of patients who were scheduled to receive 120-W green-light high-performance system photoselective vaporization of the prostate (HPS-PVP). Materials and Methods A multimedia IC (M-IC) presentation for HPS-PVP was developed. Forty men with benign prostatic hyperplasia who were scheduled to undergo HPS-PVP were prospectively randomized to a conventional written IC group (W-IC group, n=20) or the M-IC group (n=20). The allocated IC was obtained by one certified urologist, followed by a 15-question test (maximum score, 15) to evaluate objective understanding, and questionnaires on subjective understanding (range, 0~10) and satisfaction (range, 0~10) using a visual analogue scale. Results Demographic characteristics, including age and the highest level of education, did not significantly differ between the two groups. No significant differences were found in scores reflecting the objective understanding of HPS-PVP (9.9±2.3 vs. 10.6±2.8, p=0.332) or in subjective understanding scores (7.5±2.1 vs. 8.6±1.7, p=0.122); however, the M-IC group showed higher satisfaction scores than the W-IC group (7.4±1.7 vs. 8.4±1.5, p=0.033). After adjusting for age and educational level, the M-IC group still had significantly higher satisfaction scores. Conclusions M-IC did not enhance the objective knowledge of patients regarding this surgical procedure. However, it improved the satisfaction of patients with the IC process itself. PMID:27169129

  8. Exploratory modeling and simulation to support development of motesanib in Asian patients with non-small cell lung cancer based on MONET1 study results.

    Claret, L; Bruno, R; Lu, J-F; Sun, Y-N; Hsu, C-P

    2014-04-01

    The motesanib phase III MONET1 study failed to show improvement in overall survival (OS) in non-small cell lung cancer, but a subpopulation of Asian patients had a favorable outcome. We performed exploratory modeling and simulations based on MONET1 data to support further development of motesanib in Asian patients. A model-based estimate of time to tumor growth was the best of tested tumor size response metrics in a multivariate OS model (P Simulations indicated that a phase III study in 500 Asian patients would exceed 80% power to confirm superior efficacy of motesanib combination therapy (expected HR: 0.74), suggesting that motesanib combination therapy may benefit Asian patients.

  9. Development of three-dimensional patient face model that enables real-time collision detection and cutting operation for a dental simulator.

    Yamaguchi, Satoshi; Yamada, Yuya; Yoshida, Yoshinori; Noborio, Hiroshi; Imazato, Satoshi

    2012-01-01

    The virtual reality (VR) simulator is a useful tool to develop dental hand skill. However, VR simulations with reactions of patients have limited computational time to reproduce a face model. Our aim was to develop a patient face model that enables real-time collision detection and cutting operation by using stereolithography (STL) and deterministic finite automaton (DFA) data files. We evaluated dependence of computational cost and constructed the patient face model using the optimum condition for combining STL and DFA data files, and assessed the computational costs for operation in do-nothing, collision, cutting, and combination of collision and cutting. The face model was successfully constructed with low computational costs of 11.3, 18.3, 30.3, and 33.5 ms for do-nothing, collision, cutting, and collision and cutting, respectively. The patient face model could be useful for developing dental hand skill with VR.

  10. Simulation of Post-Thyroidectomy Treatment Alternatives for Triiodothyronine or Thyroxine Replacement in Pediatric Thyroid Cancer Patients

    Ben-Shachar, Rotem; Huang, Stephen A.; DiStefano, Joseph J.

    2012-01-01

    Background As in adults, thyroidectomy in pediatric patients with differentiated thyroid cancer is often followed by 131I remnant ablation. A standard protocol is to give normalizing oral thyroxine (T4) or triiodothyronine (T3) after surgery and then withdraw it for 2 to 6 weeks. Thyroid remnants or metastases are treated most effectively when serum thyrotropin (TSH) is high, but prolonged withdrawals should be avoided to minimize hypothyroid morbidity. Methods A published feedback control system model of adult human thyroid hormone regulation was modified for children using pediatric T4 kinetic data. The child model was developed from data for patients ranging from 3 to 9 years old. We simulated a range of T4 and T3 replacement protocols for children, exploring alternative regimens for minimizing the withdrawal period, while maintaining normal or suppressed TSH during replacement. The results are presented with the intent of providing a quantitative basis to guide further studies of pediatric treatment options. Replacement was simulated for up to 3 weeks post-thyroidectomy, followed by various withdrawal periods. T4 vs. T3 replacement, remnant size, dose size, and dose frequency were tested for effects on the time for TSH to reach 25 mU/L (withdrawal period). Results For both T3 and T4 replacement, higher doses were associated with longer withdrawal periods. T3 replacement yielded shorter withdrawal periods than T4 replacement (up to 3.5 days versus 7–10 days). Higher than normal serum T3 concentrations were required to normalize or suppress TSH during T3 monotherapy, but not T4 monotherapy. Larger remnant sizes resulted in longer withdrawal periods if T4 replacement was used, but had little effect for T3 replacement. Conclusions T3 replacement yielded withdrawal periods about half those for T4 replacement. Higher than normal hormone levels under T3 monotherapy can be partially alleviated by more frequent, smaller doses (e.g., twice a day). LT4 may be the

  11. [Current state of training in pharmacy education using a problem-based learning/tutorial model with simulated patients and standardized patients at National University Corporation].

    Irie, Tetsumi; Nitta, Atsumi; Akaike, Akinori

    2012-01-01

    Simulated/standardized patient-based (SP) education and problem-based learning (PBL) tutorial education become a powerful tool to heighten the pharmacy students' will to learn in order to cultivate the responsibility to contribute to public health and welfare as a clinical professional and to facilitate students' competences to solve problems by themselves. What this program is trying to do is: 1) to establish the system to train, educate and supply SP who are effective in the training and education of pharmacy students in close cooperation with the medical schools and their affiliated hospitals; 2) to improve the quality of the current PBL tutorial education and thereby establish it as an advanced education program in the education of senior students. We carried out the questionnaire to National University Corporation which establishes a school of pharmacy, as to the training and education of SP. The analysis of the answers to the questionnaire revealed the present status of SP in the Pharmaceutical Objective Structured Clinical Examination (OSCE) in the Pharmaceutical Common Achievement Test, and the existence of the problems on how to standardize SP as well as how to cover such expenses. Furthermore, the activity of the first year consisted of the exchange and sharing of information regarding the existing method of training and education of SP and PBL tutorial education and the identification of the problems to be solved in order to improve the quality of the educational program.

  12. Preliminary study of the distribution of dose in patients with Graves disease undergoing examination of uptake of iodine-131 using Monte Carlo simulation

    Schwarcke, Marcelo; Marques, Tatiana; Alva, Mirko; Baffa, Oswaldo; Nicolucci, Patricia

    2009-01-01

    Patients with Graves' disease have a high hormonal disorder, which causes the change of behavior in society. One way to treat this disease is the use of doses of Iodine-131, requiring that the patient carries out the examination of uptake of 131 I estimates for completion of the activity to be administered. Using these data capture and compared with the simulated data using the Monte Carlo code Penelope is possible to determine a distribution of dose to the region surrounding the thyroid. As noted the difference between the simulated values and the experimentally obtained were 10.36%, thus showing the code of simulation for accurate determination of absorbed dose in tissue near the thyroid. (author)

  13. Simulating the behavior of patients who leave a public hospital emergency department without being seen by a physician: a cellular automaton and agent-based framework

    Milad Yousefi

    2018-01-01

    Full Text Available The objective of this study was to develop an agent based modeling (ABM framework to simulate the behavior of patients who leave a public hospital emergency department (ED without being seen (LWBS. In doing so, the study complements computer modeling and cellular automata (CA techniques to simulate the behavior of patients in an ED. After verifying and validating the model by comparing it with data from a real case study, the significance of four preventive policies including increasing number of triage nurses, fast-track treatment, increasing the waiting room capacity and reducing treatment time were investigated by utilizing ordinary least squares regression. After applying the preventing policies in ED, an average of 42.14% reduction in the number of patients who leave without being seen and 6.05% reduction in the average length of stay (LOS of patients was reported. This study is the first to apply CA in an ED simulation. Comparing the average LOS before and after applying CA with actual times from emergency department information system showed an 11% improvement. The simulation results indicated that the most effective approach to reduce the rate of LWBS is applying fast-track treatment. The ABM approach represents a flexible tool that can be constructed to reflect any given environment. It is also a support system for decision-makers to assess the relative impact of control strategies.

  14. Simulating the behavior of patients who leave a public hospital emergency department without being seen by a physician: a cellular automaton and agent-based framework.

    Yousefi, Milad; Yousefi, Moslem; Fogliatto, F S; Ferreira, R P M; Kim, J H

    2018-01-11

    The objective of this study was to develop an agent based modeling (ABM) framework to simulate the behavior of patients who leave a public hospital emergency department (ED) without being seen (LWBS). In doing so, the study complements computer modeling and cellular automata (CA) techniques to simulate the behavior of patients in an ED. After verifying and validating the model by comparing it with data from a real case study, the significance of four preventive policies including increasing number of triage nurses, fast-track treatment, increasing the waiting room capacity and reducing treatment time were investigated by utilizing ordinary least squares regression. After applying the preventing policies in ED, an average of 42.14% reduction in the number of patients who leave without being seen and 6.05% reduction in the average length of stay (LOS) of patients was reported. This study is the first to apply CA in an ED simulation. Comparing the average LOS before and after applying CA with actual times from emergency department information system showed an 11% improvement. The simulation results indicated that the most effective approach to reduce the rate of LWBS is applying fast-track treatment. The ABM approach represents a flexible tool that can be constructed to reflect any given environment. It is also a support system for decision-makers to assess the relative impact of control strategies.

  15. Training simulated patients: evaluation of a training approach using self-assessment and peer/tutor feedback to improve performance

    Abdullah Juriah

    2009-06-01

    Full Text Available Abstract Background Most medical schools use simulated patients (SPs for teaching. In this context the authenticity of role play and quality of feedback provided by SPs is of paramount importance. The available literature on SP training mostly addresses instructor led training where the SPs are given direction on their roles. This study focuses on the use of peer and self evaluation as a tool to train SPs. Methods SPs at the medical school participated in a staff development and training programme which included a self-assessment of their performance while observing video-tapes of their role play using a structured guide and b peer group assessment of their performance under tutor guidance. The pre and post training performance in relation to authenticity of role play and quality of feedback was blindly assessed by students and tutors using a validated instrument and the scores were compared. A focus group discussion and a questionnaire assessed acceptability of the training programme by the SPs. Results The post-training performance assessment scores were significantly higher (p Conclusion Use of structured self-reflective and peer-interactive, practice based methods of SP training is recommended to improve SP performance. More studies on these methods of training may further refine SP training and lead to improvement of SP performance which in turn may positively impact medical education.

  16. Training simulated patients: evaluation of a training approach using self-assessment and peer/tutor feedback to improve performance.

    Perera, Jennifer; Perera, Joachim; Abdullah, Juriah; Lee, Nagarajah

    2009-06-29

    Most medical schools use simulated patients (SPs) for teaching. In this context the authenticity of role play and quality of feedback provided by SPs is of paramount importance. The available literature on SP training mostly addresses instructor led training where the SPs are given direction on their roles. This study focuses on the use of peer and self evaluation as a tool to train SPs. SPs at the medical school participated in a staff development and training programme which included a) self-assessment of their performance while observing video-tapes of their role play using a structured guide and b) peer group assessment of their performance under tutor guidance. The pre and post training performance in relation to authenticity of role play and quality of feedback was blindly assessed by students and tutors using a validated instrument and the scores were compared. A focus group discussion and a questionnaire assessed acceptability of the training programme by the SPs. The post-training performance assessment scores were significantly higher (p performance. More studies on these methods of training may further refine SP training and lead to improvement of SP performance which in turn may positively impact medical education.

  17. Faculty Development for Small-Group-Teaching with Simulated Patients (SP) - Design and Evaluation of a Competency-based Workshop.

    Hölzer, Henrike; Freytag, Julia; Sonntag, Ulrike

    2017-01-01

    Objective: The introduction of innovative teaching formats and methods in medical education requires a specific didactic training for teachers to use complicated formats effectively. This paper describes preliminary considerations, design, implementation and evaluation of a skills-based workshop (7,5 hours long) for teaching with simulated patients. The aim is to describe the essential components for a lasting effect of the workshop so that the concept can be adapted to other contexts. Method: We present the theoretical framework, the objectives, the didactic methodology and the implementation of the workshop. The evaluation of the workshop was carried out using questionnaires. First the participants (teachers of the faculty of medicine, clinical and science subjects) were asked to estimate how well they felt prepared for small group teaching immediately after workshop. Later, after some teaching experience of their own, they gave feedback again as a part of the general evaluation of the semester. Results: In the course of three years 27 trainings were conducted and evaluated with a total of 275 participants. In the context of semester evaluation 452 questionnaires were evaluated on the quality of training. Conclusion: The evaluation shows that participants appreciate the concept of the workshop and also feel sufficiently well prepared. As a limitation it must be said that this is so far only the lecturers' self-assessment. Nevertheless, it can be stated that even a one-day workshop with a stringent teaching concept shows long term results regarding innovative teaching methods.

  18. An observational study investigating the impact of simulated patients in teaching communication skills in preclinical dietetic students.

    Gibson, S J; Davidson, Z E

    2016-08-01

    Simulated patients (SPs) are often used in dietetics for the teaching and assessment of communication skills. The present study aimed to determine the impact of a SP encounter on communication skills in undergraduate preclinical dietetic students in the context of the resources required for delivering this educational strategy. This observational study collected assessment data from four cohorts of third-year dietetic students to examine the effect of participation in SP-embedded Objective Structured Clinical Exams. Students completed two SP interviews, 2 weeks apart, and communication skills were measured on both occasions. A subgroup of students received a video of their SP encounter. Differences between the two SP interview scores were compared to assess the impact of the SP encounter on communication skills. The required staff and resources were described. Data were collected involving 215 students. Out of 30 marks, there was a modest mean (SD) improvement in communication skills from the first to the second SP interview of 2.5 (4.2) (P skills, with failing students demonstrating the greatest improvement between SP encounters. There were no observed benefits for the subset of students who received videos. Providing repeat SP interview opportunities results in only modest improvement in communication skills for most students. The use of SPs needs to be considered in context of the substantial costs and resources involved and tailored to student ability. © 2015 The British Dietetic Association Ltd.

  19. Reliable assessment of general surgeons' non-technical skills based on video-recordings of patient simulated scenarios.

    Spanager, Lene; Beier-Holgersen, Randi; Dieckmann, Peter; Konge, Lars; Rosenberg, Jacob; Oestergaard, Doris

    2013-11-01

    Nontechnical skills are essential for safe and efficient surgery. The aim of this study was to evaluate the reliability of an assessment tool for surgeons' nontechnical skills, Non-Technical Skills for Surgeons dk (NOTSSdk), and the effect of rater training. A 1-day course was conducted for 15 general surgeons in which they rated surgeons' nontechnical skills in 9 video recordings of scenarios simulating real intraoperative situations. Data were gathered from 2 sessions separated by a 4-hour training session. Interrater reliability was high for both pretraining ratings (Cronbach's α = .97) and posttraining ratings (Cronbach's α = .98). There was no statistically significant development in assessment skills. The D study showed that 2 untrained raters or 1 trained rater was needed to obtain generalizability coefficients >.80. The high pretraining interrater reliability indicates that videos were easy to rate and Non-Technical Skills for Surgeons dk easy to use. This implies that Non-Technical Skills for Surgeons dk (NOTSSdk) could be an important tool in surgical training, potentially improving safety and quality for surgical patients. Copyright © 2013 Elsevier Inc. All rights reserved.

  20. Video-recorded simulated patient interactions: can they help develop clinical and communication skills in today's learning environment?

    Seif, Gretchen A; Brown, Debora

    2013-01-01

    It is difficult to provide real-world learning experiences for students to master clinical and communication skills. The purpose of this paper is to describe a novel instructional method using self- and peer-assessment, reflection, and technology to help students develop effective interpersonal and clinical skills. The teaching method is described by the constructivist learning theory and incorporates the use of educational technology. The learning activities were incorporated into the pre-clinical didactic curriculum. The students participated in two video-recording assignments and performed self-assessments on each and had a peer-assessment on the second video-recording. The learning activity was evaluated through the self- and peer-assessments and an instructor-designed survey. This evaluation identified several themes related to the assignment, student performance, clinical behaviors and establishing rapport. Overall the students perceived that the learning activities assisted in the development of clinical and communication skills prior to direct patient care. The use of video recordings of a simulated history and examination is a unique learning activity for preclinical PT students in the development of clinical and communication skills.

  1. SU-E-T-64: CG-Based Radiation Therapy Simulator with Physical Modeling for Avoidance of Collisions Between Gantry and Couch Or Patient

    Yamanouchi, M; Arimura, H; Yuda, I

    2014-01-01

    Purpose: It is time-consuming and might cause re-planning to check couch-gantry and patient-gantry collisions on a radiotherapy machine when using couch rotations for non-coplanar beam angles. The aim of this study was to develop a computer-graphics (CG)-based radiation therapy simulator with physical modeling for avoidance of collisions between gantry and couch or patient on a radiotherapy machine. Methods: The radiation therapy simulator was three-dimensionally constructed including a radiotherapy machine (Clinac iX, Varian Medical Systems), couch, and radiation treatment room according to their designs by using a physical-modeling-based computer graphics software (Blender, free and open-source). Each patient was modeled by applying a surface rendering technique to their planning computed tomography (CT) images acquired from 16-slice CT scanner (BrightSpeed, GE Healthcare). Immobilization devices for patients were scanned by the CT equipment, and were rendered as the patient planning CT images. The errors in the collision angle of the gantry with the couch or patient between gold standards and the estimated values were obtained by fixing the gantry angle for the evaluation of the proposed simulator. Results: The average error of estimated collision angles to the couch head side was -8.5% for gantry angles of 60 to 135 degree, and -5.5% for gantry angles of 225 to 300 degree. Moreover, the average error of estimated collision angles to the couch foot side was -1.1% for gantry angles of 60 to 135 degree, and 1.4% for gantry angles of 225 to 300 degree. Conclusion: The CG-based radiation therapy simulator could make it possible to estimate the collision angle between gantry and couch or patient on the radiotherapy machine without verifying the collision angles in the radiation treatment room

  2. The impact of rural hospital closures on equity of commuting time for haemodialysis patients: simulation analysis using the capacity-distance model.

    Matsumoto, Masatoshi; Ogawa, Takahiko; Kashima, Saori; Takeuchi, Keisuke

    2012-07-23

    Frequent and long-term commuting is a requirement for dialysis patients. Accessibility thus affects their quality of lives. In this paper, a new model for accessibility measurement is proposed in which both geographic distance and facility capacity are taken into account. Simulation of closure of rural facilities and that of capacity transfer between urban and rural facilities are conducted to evaluate the impacts of these phenomena on equity of accessibility among dialysis patients. Post code information as of August 2011 of all the 7,374 patients certified by municipalities of Hiroshima prefecture as having first or third grade renal disability were collected. Information on post code and the maximum number of outpatients (capacity) of all the 98 dialysis facilities were also collected. Using geographic information systems, patient commuting times were calculated in two models: one that takes into account road distance (distance model), and the other that takes into account both the road distance and facility capacity (capacity-distance model). Simulations of closures of rural and urban facilities were then conducted. The median commuting time among rural patients was more than twice as long as that among urban patients (15 versus 7 minutes, psimulation, when five rural public facilitiess were closed, Gini coefficient of commuting times among the patients increased by 16%, indicating a substantial worsening of equity, and the number of patients with commuting times longer than 90 minutes increased by 72 times. In contrast, closure of four urban public facilities with similar capacities did not affect these values. Closures of dialysis facilities in rural areas have a substantially larger impact on equity of commuting times among dialysis patients than closures of urban facilities. The accessibility simulations using the capacity-distance model will provide an analytic framework upon which rational resource distribution policies might be planned.

  3. Stemcell Information: SKIP000282 [SKIP Stemcell Database[Archive

    Full Text Available SKIP000282 ... Diseased HPS0272 HPS0272 ... アトピー性皮膚炎 L209 Atopic dermatitis 603165...atitis. HPS0270 and HPS0271 are derived from the same patient. 疾患特異的iPS細胞株。アトピー性皮膚炎患者由来。HPS0270、HPS0271と同一人由

  4. Integrating hinge axis approximation and the virtual facial simulation of prosthetic outcomes for treatment with CAD-CAM immediate dentures: A clinical report of a patient with microstomia.

    Kuric, Katelyn M; Harris, Bryan T; Morton, Dean; Azevedo, Bruno; Lin, Wei-Shao

    2017-09-29

    This clinical report describes a digital workflow using extraoral digital photographs and volumetric datasets from cone beam computed tomography (CBCT) imaging to create a 3-dimensional (3D), virtual patient with photorealistic appearance. In a patient with microstomia, hinge axis approximation, diagnostic casts simulating postextraction alveolar ridge profile, and facial simulation of prosthetic treatment outcome were completed in a 3D, virtual environment. The approach facilitated the diagnosis, communication, and patient acceptance of the treatment of maxillary and mandibular computer-aided design and computer-aided manufacturing (CAD-CAM) of immediate dentures at increased occlusal vertical dimension. Copyright © 2017 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  5. Benefits of virtual reality based cognitive rehabilitation through simulated activities of daily living: a randomized controlled trial with stroke patients.

    Faria, Ana Lúcia; Andrade, Andreia; Soares, Luísa; I Badia, Sergi Bermúdez

    2016-11-02

    Stroke is one of the most common causes of acquired disability, leaving numerous adults with cognitive and motor impairments, and affecting patients' capability to live independently. There is substancial evidence on post-stroke cognitive rehabilitation benefits, but its implementation is generally limited by the use of paper-and-pencil methods, insufficient personalization, and suboptimal intensity. Virtual reality tools have shown potential for improving cognitive rehabilitation by supporting carefully personalized, ecologically valid tasks through accessible technologies. Notwithstanding important progress in VR-based cognitive rehabilitation systems, specially with Activities of Daily Living (ADL's) simulations, there is still a need of more clinical trials for its validation. In this work we present a one-month randomized controlled trial with 18 stroke in and outpatients from two rehabilitation units: 9 performing a VR-based intervention and 9 performing conventional rehabilitation. The VR-based intervention involved a virtual simulation of a city - Reh@City - where memory, attention, visuo-spatial abilities and executive functions tasks are integrated in the performance of several daily routines. The intervention had levels of difficulty progression through a method of fading cues. There was a pre and post-intervention assessment in both groups with the Addenbrooke Cognitive Examination (primary outcome) and the Trail Making Test A and B, Picture Arrangement from WAIS III and Stroke Impact Scale 3.0 (secondary outcomes). A within groups analysis revealed significant improvements in global cognitive functioning, attention, memory, visuo-spatial abilities, executive functions, emotion and overall recovery in the VR group. The control group only improved in self-reported memory and social participation. A between groups analysis, showed significantly greater improvements in global cognitive functioning, attention and executive functions when comparing VR to

  6. Recognizing and managing a deteriorating patient: a randomized controlled trial investigating the effectiveness of clinical simulation in improving clinical performance in undergraduate nursing students.

    Stayt, Louise Caroline; Merriman, Clair; Ricketts, Barry; Morton, Sean; Simpson, Trevor

    2015-11-01

    To report the results of a randomized controlled trial which explored the effectiveness of clinical simulation in improving the clinical performance of recognizing and managing an adult deteriorating patient in hospital. There is evidence that final year undergraduate nurses may lack knowledge, clinical skills and situation awareness required to manage a deteriorating patient competently. The effectiveness of clinical simulation as a strategy to teach the skills required to recognize and manage the early signs of deterioration needs to be evaluated. This study was a two centre phase II single, randomized, controlled trial with single blinded assessments. Data were collected in July 2013. Ninety-eight first year nursing students were randomized either into a control group, where they received a traditional lecture, or an intervention group where they received simulation. Participants completed a pre- and postintervention objective structured clinical examination. General Perceived Self Efficacy and Self-Reported Competency scores were measured before and after the intervention. Student satisfaction with teaching was also surveyed. The intervention group performed significantly better in the post-objective structured clinical examination. There was no significant difference in the postintervention General Perceived Self Efficacy and Self-Reported Competency scores between the control and intervention group. The intervention group was significantly more satisfied with their teaching method. Simulation-based education may be an effective educational strategy to teach nurses the skills to effectively recognize and manage a deteriorating patient. © 2015 John Wiley & Sons Ltd.

  7. Intensive care nurses' perceptions of simulation-based team training for building patient safety in intensive care: a descriptive qualitative study.

    Ballangrud, Randi; Hall-Lord, Marie Louise; Persenius, Mona; Hedelin, Birgitta

    2014-08-01

    To describe intensive care nurses' perceptions of simulation-based team training for building patient safety in intensive care. Failures in team processes are found to be contributory factors to incidents in an intensive care environment. Simulation-based training is recommended as a method to make health-care personnel aware of the importance of team working and to improve their competencies. The study uses a qualitative descriptive design. Individual qualitative interviews were conducted with 18 intensive care nurses from May to December 2009, all of which had attended a simulation-based team training programme. The interviews were analysed by qualitative content analysis. One main category emerged to illuminate the intensive care nurse perception: "training increases awareness of clinical practice and acknowledges the importance of structured work in teams". Three generic categories were found: "realistic training contributes to safe care", "reflection and openness motivates learning" and "finding a common understanding of team performance". Simulation-based team training makes intensive care nurses more prepared to care for severely ill patients. Team training creates a common understanding of how to work in teams with regard to patient safety. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. The Effectiveness of the Human Patient Simulator in Teaching Anesthesia Pharmacology to First Year Nurse Anesthesia Students

    Hall, Annie

    2002-01-01

    .... There is no substitute for case-based experience; however, recent innovations in computer technology provide high fidelity, realistic simulators, which are being used in many anesthesia programs...

  9. Hepatobiliary scanning in cardiac transplant patients maintained on cyclosporine

    Dhekne, R.D.; Long, S.E.; Moore, W.H.; Frazier, O.H.

    1987-01-01

    Many patients receiving cyclosporine (CSA) develop hepatic dysfunction or pancreatitis. The authors reviewed 106 records of cardiac transplant patients maintained on CSA. Eleven patients underwent 16 hepatobiliary scans (HBSs) for abdominal pain and/or abnormal liver function. Of 16 HBSs, ten demonstrated normal gallbladder visualization. Follow-up in all cases confirmed scan findings. Five patients had no gallbladder visualization; confirmation of acute cholecystitis was obtained by surgery in two and by autopsy in three. One patient had previous cholecystectomy. The authors found HPS useful for evaluating acute cholecystitis in patients receiving CSA with or without associated drug-related pancreatitis and hepatic insufficiency and suggest that HBS can assist in the selection of patients for CSA dose adjustment

  10. Meaning of care for terminally Ill HIV-infected patients by HIV-infected peer caregivers in a simulation-based training program in South Korea.

    Kim, Sunghee; Shin, Gisoo

    2015-01-01

    The purpose of this study was to develop a simulation-based training program for people living with HIV (PLWH) as peer caregivers who would take care of terminally ill, HIV-infected patients. We used qualitative research methods and standardized patients to explore the meaning of caring for patients as peer caregivers. Study participants included 32 patients registered as PLWH at the South Korea Federation for HIV/AIDS. The meanings of peer caregiving were categorized into four dimensions: physical, psychological, relational, and economic. Our study had benefits in knowledge acquisition for caregivers as well as care recipients, empathy with HIV-infected care recipients, improvement in self-esteem and social participation, and financial self-sufficiency to enable independent living for caregivers. The simulation training program for PLWH peer caregivers for terminally ill HIV-infected patients demonstrated value, for both PLWH caregivers and terminally ill HIV-infected patients in South Korea, to improve the quality of care. Copyright © 2015 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

  11. Hypoalgesia after exercise and the cold pressor test is reduced in chronic musculuskeletal pain patients with high pain sensitivity

    Vægter, Henrik Bjarke; Handberg, Gitte; Graven-Nielsen, Thomas

    2016-01-01

    OBJECTIVES: In chronic pain patients, impaired conditioned pain modulation (CPM) and exercise-induced hypoalgesia (EIH) have been reported. No studies have compared CPM and EIH in chronic musculoskeletal pain patients with high pain sensitivity (HPS) and low pain sensitivity (LPS). MATERIALS.......005). Pain tolerance increased after the cold pressor test and exercise in both groups (PCPM and EIH were partly impaired in chronic pain patients with high versus less pain sensitivity, suggesting that the CPM and EIH responses depend on the degree of pain sensitivity. This has clinical...

  12. A structured framework improves clinical patient assessment and nontechnical skills of early career emergency nurses: a pre-post study using full immersion simulation.

    Munroe, Belinda; Curtis, Kate; Murphy, Margaret; Strachan, Luke; Considine, Julie; Hardy, Jennifer; Wilson, Mark; Ruperto, Kate; Fethney, Judith; Buckley, Thomas

    2016-08-01

    The aim of this study was to evaluate the effect of the new evidence-informed nursing assessment framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, reassessment and communication) on the quality of patient assessment and fundamental nontechnical skills including communication, decision making, task management and situational awareness. Assessment is a core component of nursing practice and underpins clinical decisions and the safe delivery of patient care. Yet there is no universal or validated system used to teach emergency nurses how to comprehensively assess and care for patients. A pre-post design was used. The performance of thirty eight emergency nurses from five Australian hospitals was evaluated before and after undertaking education in the application of the HIRAID assessment framework. Video recordings of participant performance in immersive simulations of common presentations to the emergency department were evaluated, as well as participant documentation during the simulations. Paired parametric and nonparametric tests were used to compare changes from pre to postintervention. From pre to postintervention, participant performance increases were observed in the percentage of patient history elements collected, critical indicators of urgency collected and reported to medical officers, and patient reassessments performed. Participants also demonstrated improvement in each of the four nontechnical skills categories: communication, decision making, task management and situational awareness. The HIRAID assessment framework improves clinical patient assessments performed by emergency nurses and has the potential to enhance patient care. HIRAID should be considered for integration into clinical practice to provide nurses with a systematic approach to patient assessment and potentially improve the delivery of safe patient care. © 2016 John Wiley & Sons Ltd.

  13. Optical design of a novel instrument that uses the Hartmann-Shack sensor and Zernike polynomials to measure and simulate customized refraction correction surgery outcomes and patient satisfaction

    Yasuoka, Fatima M. M.; Matos, Luciana; Cremasco, Antonio; Numajiri, Mirian; Marcato, Rafael; Oliveira, Otavio G.; Sabino, Luis G.; Castro N., Jarbas C.; Bagnato, Vanderlei S.; Carvalho, Luis A. V.

    2016-03-01

    An optical system that conjugates the patient's pupil to the plane of a Hartmann-Shack (HS) wavefront sensor has been simulated using optical design software. And an optical bench prototype is mounted using mechanical eye device, beam splitter, illumination system, lenses, mirrors, mirrored prism, movable mirror, wavefront sensor and camera CCD. The mechanical eye device is used to simulate aberrations of the eye. From this device the rays are emitted and travelled by the beam splitter to the optical system. Some rays fall on the camera CCD and others pass in the optical system and finally reach the sensor. The eye models based on typical in vivo eye aberrations is constructed using the optical design software Zemax. The computer-aided outcomes of each HS images for each case are acquired, and these images are processed using customized techniques. The simulated and real images for low order aberrations are compared using centroid coordinates to assure that the optical system is constructed precisely in order to match the simulated system. Afterwards a simulated version of retinal images is constructed to show how these typical eyes would perceive an optotype positioned 20 ft away. Certain personalized corrections are allowed by eye doctors based on different Zernike polynomial values and the optical images are rendered to the new parameters. Optical images of how that eye would see with or without corrections of certain aberrations are generated in order to allow which aberrations can be corrected and in which degree. The patient can then "personalize" the correction to their own satisfaction. This new approach to wavefront sensing is a promising change in paradigm towards the betterment of the patient-physician relationship.

  14. Undergraduate nursing students' performance in recognising and responding to sudden patient deterioration in high psychological fidelity simulated environments: an Australian multi-centre study.

    Bogossian, Fiona; Cooper, Simon; Cant, Robyn; Beauchamp, Alison; Porter, Joanne; Kain, Victoria; Bucknall, Tracey; Phillips, Nicole M

    2014-05-01

    Early recognition and situation awareness of sudden patient deterioration, a timely appropriate clinical response, and teamwork are critical to patient outcomes. High fidelity simulated environments provide the opportunity for undergraduate nursing students to develop and refine recognition and response skills. This paper reports the quantitative findings of the first phase of a larger program of ongoing research: Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST2ACTTM). It specifically aims to identify the characteristics that may predict primary outcome measures of clinical performance, teamwork and situation awareness in the management of deteriorating patients. Mixed-method multi-centre study. High fidelity simulated acute clinical environment in three Australian universities. A convenience sample of 97 final year nursing students enrolled in an undergraduate Bachelor of Nursing or combined Bachelor of Nursing degree were included in the study. In groups of three, participants proceeded through three phases: (i) pre-briefing and completion of a multi-choice question test, (ii) three video-recorded simulated clinical scenarios where actors substituted real patients with deteriorating conditions, and (iii) post-scenario debriefing. Clinical performance, teamwork and situation awareness were evaluated, using a validated standard checklist (OSCE), Team Emergency Assessment Measure (TEAM) score sheet and Situation Awareness Global Assessment Technique (SAGAT). A Modified Angoff technique was used to establish cut points for clinical performance. Student teams engaged in 97 simulation experiences across the three scenarios and achieved a level of clinical performance consistent with the experts' identified pass level point in only 9 (1%) of the simulation experiences. Knowledge was significantly associated with overall teamwork (p=.034), overall situation awareness (p=.05) and clinical performance in two of the three scenarios

  15. Clinical trial simulations in pediatric patients using realistic covariates: application to teduglutide, a glucagon-like peptide-2 analog in neonates and infants with short-bowel syndrome.

    Mouksassi, M S; Marier, J F; Cyran, J; Vinks, A A

    2009-12-01

    Teduglutide, a synthetic glucagon-like peptide-2 (GLP-2) analog with activity relating to the regeneration, maintenance, and repair of the intestinal epithelium, is currently being evaluated for the treatment of short-bowel syndrome (SBS), Crohn's disease, and other gastrointestinal disorders. On the basis of promising results from teduglutide studies in adults with SBS and from studies in neonatal and juvenile animal models, a pediatric multiple-dose phase I clinical study was designed to determine the safety, efficacy, and pharmacokinetics of teduglutide in pediatric patients with SBS who have undergone resection for necrotizing enterocolitis, malrotation, or intestinal atresia. This report details the application of clinical trial simulations coupled with a novel approach using generalized additive modeling for location, scale, and shape (GAMLSS) that facilitates the simulation of demographic covariates specific to the targeted patient populations. The goal was to optimize phase I dosing strategies and the likelihood of achieving target exposure and therapeutic effect.

  16. The effects of a simulated laughter programme on mood, cortisol levels, and health-related quality of life among haemodialysis patients.

    Heo, Eun Hwa; Kim, Sehyun; Park, Hye-Ja; Kil, Suk Yong

    2016-11-01

    This study aimed to evaluate the effects of a simulated laughter programme on mood, cortisol levels, and health-related quality of life among haemodialysis patients. Forty participants were randomly assigned to a laughter group (n = 20) or a control group (n = 20). Eleven participants completed the laughter programme after haemodialysis sessions and 18 control participants remained. The 4-week simulated laughter programme included weekly 60 min group sessions of simulated laughter, breathing, stretching exercises, and meditation, as well as daily 15 s individual laughter sessions administered via telephone. Mood, cortisol levels, and health-related quality of life were analysed using the rank analysis of covariance, and Wilcoxon's signed rank test. The laughter group exhibited improvements in mood, symptoms, social interaction quality, and role limitations due to physical health. The simulated laughter programme may help improve mood and health-related quality of life among haemodialysis patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Long-term effect of galantamine on cognitive function in patients with Alzheimer’s disease versus a simulated disease trajectory: an observational study in the clinical setting

    Nakagawa R

    2017-04-01

    Full Text Available Ryoko Nakagawa,1 Takashi Ohnishi,1 Hisanori Kobayashi,1 Toshio Yamaoka,2 Tsutomu Yajima,3 Ai Tanimura,4 Toshiya Kato,4 Kazutake Yoshizawa1 1Evidence Generation Department, Medical Affairs Division, 2Clinical Data Management Department, R&D Division, 3Biostatistics Department, Quantitative Science Division, 4Drug Surveillance Department, R&D Division, Janssen Pharmaceutical K.K., Tokyo, Japan Background: Long-term maintenance of cognitive function is an important goal of treatment for Alzheimer’s disease (AD, but evidence about the long-term efficacy of cholinesterase inhibitors is sparse. To evaluate the long-term efficacy and safety of galantamine for AD in routine clinical practice, we conducted a 72-week post-marketing surveillance study. The effect of galantamine on cognitive function was estimated in comparison with a simulated disease trajectory. Patients and methods: Patients with mild-to-moderate AD received flexible dosing of galantamine (16–24 mg/day during this study. Cognitive function was assessed by the mini mental state examination (MMSE and the clinical status was determined by the Clinical Global Impression-Improvement (CGI-I. Changes of the MMSE score without treatment were estimated in each patient using Mendiondo’s model. Generalized linear mixed model analysis was performed to compare the simulated MMSE scores with the actual scores. Results: Of the 661 patients who were enrolled, 642 were evaluable for safety and 554 were assessed for efficacy. The discontinuation rate was 46.73%. Cognitive decline indicated by the mean change of actual MMSE scores was significantly smaller than the simulated decline. Individual analysis demonstrated that >70% of patients had better actual MMSE scores than their simulated scores. Significant improvement of CGI-I was also observed during the observation period. Adverse events occurred in 28.5% of patients and were serious in 8.41%. The reported events generally corresponded with the

  18. Computer-Assisted Orthognathic Surgery for Patients with Cleft Lip/Palate: From Traditional Planning to Three-Dimensional Surgical Simulation

    Lonic, Daniel; Pai, Betty Chien-Jung; Yamaguchi, Kazuaki; Chortrakarnkij, Peerasak; Lin, Hsiu-Hsia; Lo, Lun-Jou

    2016-01-01

    Background Although conventional two-dimensional (2D) methods for orthognathic surgery planning are still popular, the use of three-dimensional (3D) simulation is steadily increasing. In facial asymmetry cases such as in cleft lip/palate patients, the additional information can dramatically improve planning accuracy and outcome. The purpose of this study is to investigate which parameters are changed most frequently in transferring a traditional 2D plan to 3D simulation, and what planning parameters can be better adjusted by this method. Patients and Methods This prospective study enrolled 30 consecutive patients with cleft lip and/or cleft palate (mean age 18.6±2.9 years, range 15 to 32 years). All patients received two-jaw single-splint orthognathic surgery. 2D orthodontic surgery plans were transferred into a 3D setting. Severe bony collisions in the ramus area after 2D plan transfer were noted. The position of the maxillo-mandibular complex was evaluated and eventually adjusted. Position changes of roll, midline, pitch, yaw, genioplasty and their frequency within the patient group were recorded as an alternation of the initial 2D plan. Patients were divided in groups of no change from the original 2D plan and changes in one, two, three and four of the aforementioned parameters as well as subgroups of unilateral, bilateral cleft lip/palate and isolated cleft palate cases. Postoperative OQLQ scores were obtained for 20 patients who finished orthodontic treatment. Results 83.3% of 2D plans were modified, mostly concerning yaw (63.3%) and midline (36.7%) adjustments. Yaw adjustments had the highest mean values in total and in all subgroups. Severe bony collisions as a result of 2D planning were seen in 46.7% of patients. Possible asymmetry was regularly foreseen and corrected in the 3D simulation. Conclusion Based on our findings, 3D simulation renders important information for accurate planning in complex cleft lip/palate cases involving facial asymmetry that is

  19. Standardized patient simulation versus didactic teaching alone for improving residents' communication skills when discussing goals of care and resuscitation: A randomized controlled trial.

    Downar, James; McNaughton, Nancy; Abdelhalim, Tarek; Wong, Natalie; Lapointe-Shaw, Lauren; Seccareccia, Dori; Miller, Kim; Dev, Shelly; Ridley, Julia; Lee, Christie; Richardson, Lisa; McDonald-Blumer, Heather; Knickle, Kerry

    2017-02-01

    Communication skills are important when discussing goals of care and resuscitation. Few studies have evaluated the effectiveness of standardized patients for teaching medical trainees to communicate about goals of care. To determine whether standardized patient simulation offers benefit over didactic sessions alone for improving skill and comfort discussing goals of care. Single-blind, randomized, controlled trial of didactic teaching plus standardized patient simulation versus didactic teaching alone. First-year internal medicine residents. Changes in communication comfort and skill between baseline and 2 months post-training assessed using the Consultation and Relational Empathy measure. We enrolled 94 residents over a 2-year period. Both groups reported a significant improvement in comfort when discussing goals of care with patients. There was no difference in Consultation and Relational Empathy scores following the workshop ( p = 0.79). The intervention group showed a significant increase in Consultation and Relational Empathy scores post-workshop compared with pre-workshop (35.0 vs 31.7, respectively; p = 0.048), whereas there was no improvement in Consultation and Relational Empathy scores in the control group (35.6 vs 36.0; p = 0.4). However, when the results were adjusted for baseline differences in Consultation and Relational Empathy scores in a multivariable regression analysis, group assignment was not associated with an improvement in Consultation and Relational Empathy score. Improvement in comfort scores and perception of benefit were not associated with improvements in Consultation and Relational Empathy scores. Simulation training may improve communication skill and comfort more than didactic training alone, but there were important confounders in this study and further studies are needed to determine whether simulation is better than didactic training for this purpose.

  20. Risk for intracranial pressure increase related to enclosed air in post-craniotomy patients during air ambulance transport: a retrospective cohort study with simulation.

    Brändström, Helge; Sundelin, Anna; Hoseason, Daniela; Sundström, Nina; Birgander, Richard; Johansson, Göran; Winsö, Ola; Koskinen, Lars-Owe; Haney, Michael

    2017-05-12

    Post-craniotomy intracranial air can be present in patients scheduled for air ambulance transport to their home hospital. We aimed to assess risk for in-flight intracranial pressure (ICP) increases related to observed intracranial air volumes, hypothetical sea level pre-transport ICP, and different potential flight levels and cabin pressures. A cohort of consecutive subdural hematoma evacuation patients from one University Medical Centre was assessed with post-operative intracranial air volume measurements by computed tomography. Intracranial pressure changes related to estimated intracranial air volume effects of changing atmospheric pressure (simulating flight and cabin pressure changes up to 8000 ft) were simulated using an established model for intracranial pressure and volume relations. Approximately one third of the cohort had post-operative intracranial air. Of these, approximately one third had intracranial air volumes less than 11 ml. The simulation estimated that the expected changes in intracranial pressure during 'flight' would not result in intracranial hypertension. For intracranial air volumes above 11 ml, the simulation suggested that it was possible that intracranial hypertension could develop 'inflight' related to cabin pressure drop. Depending on the pre-flight intracranial pressure and air volume, this could occur quite early during the assent phase in the flight profile. DISCUSSION: These findings support the idea that there should be radiographic verification of the presence or absence of intracranial air after craniotomy for patients planned for long distance air transport. Very small amounts of air are clinically inconsequential. Otherwise, air transport with maintained ground-level cabin pressure should be a priority for these patients.

  1. Does a competitive voucher program for adolescents improve the quality of reproductive health care? A simulated patient study in Nicaragua

    Gorter Anna C

    2006-08-01

    Full Text Available Abstract Background Little is known about how sexual and reproductive (SRH health can be made accessible and appropriate to adolescents. This study evaluates the impact and sustainability of a competitive voucher program on the quality of SRH care for poor and underserved female adolescents and the usefulness of the simulated patient (SP method for such evaluation. Methods 28,711 vouchers were distributed to adolescents in disadvantaged areas of Managua that gave free-of-charge access to SRH care in 4 public, 10 non-governmental and 5 private clinics. Providers received training and guidelines, treatment protocols, and financial incentives for each adolescent attended. All clinics were visited by female adolescent SPs requesting contraception. SPs were sent one week before, during (with voucher and one month after the intervention. After each consultation they were interviewed with a standardized questionnaire. Twenty-one criteria were scored and grouped into four categories. Clinics' scores were compared using non-parametric statistical methods (paired design: before-during and before-after. Also the influence of doctors' characteristics was tested using non-parametric statistical methods. Results Some aspects of service quality improved during the voucher program. Before the program started 8 of the 16 SPs returned 'empty handed', although all were eligible contraceptive users. During the program 16/17 left with a contraceptive method (p = 0.01. Furthermore, more SPs were involved in the contraceptive method choice (13/17 vs.5/16, p = 0.02. Shared decision-making on contraceptive method as well as condom promotion had significantly increased after the program ended. Female doctors had best scores before- during and after the intervention. The improvements were more pronounced among male doctors and doctors older than 40, though these improvements did not sustain after the program ended. Conclusion This study illustrates provider

  2. Do Simulation-Based Skill Exercises and Post-Encounter Notes Add Additional Value to a Standardized Patient-Based Clinical Skills Examination?

    Michael D. Prislin

    2011-01-01

    Full Text Available Background. Standardized patient (SP clinical assessments have limited utility in assessing higher-level clinical competencies. This study explores the value of including simulation exercises and postencounter notes in an SP clinical skills examination. Methods. Two exercises involving cardiac auscultation and ophthalmic funduscopy simulations along with written post encounter notes were added to an SP-based performance examination. Descriptive analyses of students' performance and correlations with SP-based performance measures were obtained. Results. Students' abilities to detect abnormalities on physical exam were highly variable. There were no correlations between SP-based and simulation-derived measures of physical examination competency. Limited correlations were found between students' abilities to perform and document physical examinations and their formulation of appropriate differential diagnoses. Conclusions. Clinical simulation exercises add depth to SP-based assessments of performance. Evaluating the content of post encounter notes offers some insight into students' integrative abilities, and this appears to be improved by the addition of simulation-based post encounter skill exercises. However, further refinement of this methodology is needed.

  3. An eFTD-VP framework for efficiently generating patient-specific anatomically detailed facial soft tissue FE mesh for craniomaxillofacial surgery simulation.

    Zhang, Xiaoyan; Kim, Daeseung; Shen, Shunyao; Yuan, Peng; Liu, Siting; Tang, Zhen; Zhang, Guangming; Zhou, Xiaobo; Gateno, Jaime; Liebschner, Michael A K; Xia, James J

    2018-04-01

    Accurate surgical planning and prediction of craniomaxillofacial surgery outcome requires simulation of soft tissue changes following osteotomy. This can only be achieved by using an anatomically detailed facial soft tissue model. The current state-of-the-art of model generation is not appropriate to clinical applications due to the time-intensive nature of manual segmentation and volumetric mesh generation. The conventional patient-specific finite element (FE) mesh generation methods are to deform a template FE mesh to match the shape of a patient based on registration. However, these methods commonly produce element distortion. Additionally, the mesh density for patients depends on that of the template model. It could not be adjusted to conduct mesh density sensitivity analysis. In this study, we propose a new framework of patient-specific facial soft tissue FE mesh generation. The goal of the developed method is to efficiently generate a high-quality patient-specific hexahedral FE mesh with adjustable mesh density while preserving the accuracy in anatomical structure correspondence. Our FE mesh is generated by eFace template deformation followed by volumetric parametrization. First, the patient-specific anatomically detailed facial soft tissue model (including skin, mucosa, and muscles) is generated by deforming an eFace template model. The adaptation of the eFace template model is achieved by using a hybrid landmark-based morphing and dense surface fitting approach followed by a thin-plate spline interpolation. Then, high-quality hexahedral mesh is constructed by using volumetric parameterization. The user can control the resolution of hexahedron mesh to best reflect clinicians' need. Our approach was validated using 30 patient models and 4 visible human datasets. The generated patient-specific FE mesh showed high surface matching accuracy, element quality, and internal structure matching accuracy. They can be directly and effectively used for clinical

  4. The Effect of Screen-to-Screen Versus Face-to-Face Consultation on Doctor-Patient Communication: An Experimental Study with Simulated Patients

    Tates, K.; Antheunis, M.L.; Kanters, S.; Nieboer, T.E.; Gerritse, M.B.E.

    2017-01-01

    BACKGROUND: Despite the emergence of Web-based patient-provider contact, it is still unclear how the quality of Web-based doctor-patient interactions differs from face-to-face interactions. OBJECTIVE: This study aimed to examine (1) the impact of a consultation medium on doctors' and patients'

  5. Decolonization of patients and health care workers to control nosocomial spread of methicillin-resistant Staphylococcus aureus: a simulation study

    Gurieva, T.; Bootsma, M.C.; Bonten, M.J.M.

    2012-01-01

    Background Control of methicillin-resistant Staphylococcus aureus (MRSA) transmission has been unsuccessful in many hospitals. Recommended control measures include isolation of colonized patients, rather than decolonization of carriage among patients and/or health care workers. Yet, the potential

  6. Computer-Assisted Orthognathic Surgery for Patients with Cleft Lip/Palate: From Traditional Planning to Three-Dimensional Surgical Simulation.

    Daniel Lonic

    Full Text Available Although conventional two-dimensional (2D methods for orthognathic surgery planning are still popular, the use of three-dimensional (3D simulation is steadily increasing. In facial asymmetry cases such as in cleft lip/palate patients, the additional information can dramatically improve planning accuracy and outcome. The purpose of this study is to investigate which parameters are changed most frequently in transferring a traditional 2D plan to 3D simulation, and what planning parameters can be better adjusted by this method.This prospective study enrolled 30 consecutive patients with cleft lip and/or cleft palate (mean age 18.6±2.9 years, range 15 to 32 years. All patients received two-jaw single-splint orthognathic surgery. 2D orthodontic surgery plans were transferred into a 3D setting. Severe bony collisions in the ramus area after 2D plan transfer were noted. The position of the maxillo-mandibular complex was evaluated and eventually adjusted. Position changes of roll, midline, pitch, yaw, genioplasty and their frequency within the patient group were recorded as an alternation of the initial 2D plan. Patients were divided in groups of no change from the original 2D plan and changes in one, two, three and four of the aforementioned parameters as well as subgroups of unilateral, bilateral cleft lip/palate and isolated cleft palate cases. Postoperative OQLQ scores were obtained for 20 patients who finished orthodontic treatment.83.3% of 2D plans were modified, mostly concerning yaw (63.3% and midline (36.7% adjustments. Yaw adjustments had the highest mean values in total and in all subgroups. Severe bony collisions as a result of 2D planning were seen in 46.7% of patients. Possible asymmetry was regularly foreseen and corrected in the 3D simulation.Based on our findings, 3D simulation renders important information for accurate planning in complex cleft lip/palate cases involving facial asymmetry that is regularly missed in conventional 2D

  7. 3D Rapid Prototyping for Otolaryngology—Head and Neck Surgery: Applications in Image-Guidance, Surgical Simulation and Patient-Specific Modeling

    Chan, Harley H. L.; Siewerdsen, Jeffrey H.; Vescan, Allan; Daly, Michael J.; Prisman, Eitan; Irish, Jonathan C.

    2015-01-01

    The aim of this study was to demonstrate the role of advanced fabrication technology across a broad spectrum of head and neck surgical procedures, including applications in endoscopic sinus surgery, skull base surgery, and maxillofacial reconstruction. The initial case studies demonstrated three applications of rapid prototyping technology are in head and neck surgery: i) a mono-material paranasal sinus phantom for endoscopy training ii) a multi-material skull base simulator and iii) 3D patient-specific mandible templates. Digital processing of these phantoms is based on real patient or cadaveric 3D images such as CT or MRI data. Three endoscopic sinus surgeons examined the realism of the endoscopist training phantom. One experienced endoscopic skull base surgeon conducted advanced sinus procedures on the high-fidelity multi-material skull base simulator. Ten patients participated in a prospective clinical study examining patient-specific modeling for mandibular reconstructive surgery. Qualitative feedback to assess the realism of the endoscopy training phantom and high-fidelity multi-material phantom was acquired. Conformance comparisons using assessments from the blinded reconstructive surgeons measured the geometric performance between intra-operative and pre-operative reconstruction mandible plates. Both the endoscopy training phantom and the high-fidelity multi-material phantom received positive feedback on the realistic structure of the phantom models. Results suggested further improvement on the soft tissue structure of the phantom models is necessary. In the patient-specific mandible template study, the pre-operative plates were judged by two blinded surgeons as providing optimal conformance in 7 out of 10 cases. No statistical differences were found in plate fabrication time and conformance, with pre-operative plating providing the advantage of reducing time spent in the operation room. The applicability of common model design and fabrication techniques

  8. 3D Rapid Prototyping for Otolaryngology-Head and Neck Surgery: Applications in Image-Guidance, Surgical Simulation and Patient-Specific Modeling.

    Chan, Harley H L; Siewerdsen, Jeffrey H; Vescan, Allan; Daly, Michael J; Prisman, Eitan; Irish, Jonathan C

    2015-01-01

    The aim of this study was to demonstrate the role of advanced fabrication technology across a broad spectrum of head and neck surgical procedures, including applications in endoscopic sinus surgery, skull base surgery, and maxillofacial reconstruction. The initial case studies demonstrated three applications of rapid prototyping technology are in head and neck surgery: i) a mono-material paranasal sinus phantom for endoscopy training ii) a multi-material skull base simulator and iii) 3D patient-specific mandible templates. Digital processing of these phantoms is based on real patient or cadaveric 3D images such as CT or MRI data. Three endoscopic sinus surgeons examined the realism of the endoscopist training phantom. One experienced endoscopic skull base surgeon conducted advanced sinus procedures on the high-fidelity multi-material skull base simulator. Ten patients participated in a prospective clinical study examining patient-specific modeling for mandibular reconstructive surgery. Qualitative feedback to assess the realism of the endoscopy training phantom and high-fidelity multi-material phantom was acquired. Conformance comparisons using assessments from the blinded reconstructive surgeons measured the geometric performance between intra-operative and pre-operative reconstruction mandible plates. Both the endoscopy training phantom and the high-fidelity multi-material phantom received positive feedback on the realistic structure of the phantom models. Results suggested further improvement on the soft tissue structure of the phantom models is necessary. In the patient-specific mandible template study, the pre-operative plates were judged by two blinded surgeons as providing optimal conformance in 7 out of 10 cases. No statistical differences were found in plate fabrication time and conformance, with pre-operative plating providing the advantage of reducing time spent in the operation room. The applicability of common model design and fabrication techniques

  9. 3D Rapid Prototyping for Otolaryngology-Head and Neck Surgery: Applications in Image-Guidance, Surgical Simulation and Patient-Specific Modeling.

    Harley H L Chan

    Full Text Available The aim of this study was to demonstrate the role of advanced fabrication technology across a broad spectrum of head and neck surgical procedures, including applications in endoscopic sinus surgery, skull base surgery, and maxillofacial reconstruction. The initial case studies demonstrated three applications of rapid prototyping technology are in head and neck surgery: i a mono-material paranasal sinus phantom for endoscopy training ii a multi-material skull base simulator and iii 3D patient-specific mandible templates. Digital processing of these phantoms is based on real patient or cadaveric 3D images such as CT or MRI data. Three endoscopic sinus surgeons examined the realism of the endoscopist training phantom. One experienced endoscopic skull base surgeon conducted advanced sinus procedures on the high-fidelity multi-material skull base simulator. Ten patients participated in a prospective clinical study examining patient-specific modeling for mandibular reconstructive surgery. Qualitative feedback to assess the realism of the endoscopy training phantom and high-fidelity multi-material phantom was acquired. Conformance comparisons using assessments from the blinded reconstructive surgeons measured the geometric performance between intra-operative and pre-operative reconstruction mandible plates. Both the endoscopy training phantom and the high-fidelity multi-material phantom received positive feedback on the realistic structure of the phantom models. Results suggested further improvement on the soft tissue structure of the phantom models is necessary. In the patient-specific mandible template study, the pre-operative plates were judged by two blinded surgeons as providing optimal conformance in 7 out of 10 cases. No statistical differences were found in plate fabrication time and conformance, with pre-operative plating providing the advantage of reducing time spent in the operation room. The applicability of common model design and

  10. Impact of a Two-step Emergency Department Triage Model with START, then CTAS, on Patient Flow During a Simulated Mass-casualty Incident.

    Lee, James S; Franc, Jeffrey M

    2015-08-01

    A high influx of patients during a mass-casualty incident (MCI) may disrupt patient flow in an already overcrowded emergency department (ED) that is functioning beyond its operating capacity. This pilot study examined the impact of a two-step ED triage model using Simple Triage and Rapid Treatment (START) for pre-triage, followed by triage with the Canadian Triage and Acuity Scale (CTAS), on patient flow during a MCI simulation exercise. Hypothesis/Problem It was hypothesized that there would be no difference in time intervals nor patient volumes at each patient-flow milestone. Physicians and nurses participated in a computer-based tabletop disaster simulation exercise. Physicians were randomized into the intervention group using START, then CTAS, or the control group using START alone. Patient-flow milestones including time intervals and patient volumes from ED arrival to triage, ED arrival to bed assignment, ED arrival to physician assessment, and ED arrival to disposition decision were compared. Triage accuracy was compared for secondary purposes. There were no significant differences in the time interval from ED arrival to triage (mean difference 108 seconds; 95% CI, -353 to 596 seconds; P=1.0), ED arrival to bed assignment (mean difference 362 seconds; 95% CI, -1,269 to 545 seconds; P=1.0), ED arrival to physician assessment (mean difference 31 seconds; 95% CI, -1,104 to 348 seconds; P=0.92), and ED arrival to disposition decision (mean difference 175 seconds; 95% CI, -1,650 to 1,300 seconds; P=1.0) between the two groups. There were no significant differences in the volume of patients to be triaged (32% vs 34%; 95% CI for the difference -16% to 21%; P=1.0), assigned a bed (16% vs 21%; 95% CI for the difference -11% to 20%; P=1.0), assessed by a physician (20% vs 22%; 95% CI for the difference -14% to 19%; P=1.0), and with a disposition decision (20% vs 9%; 95% CI for the difference -25% to 4%; P=.34) between the two groups. The accuracy of triage was similar

  11. Images created in a model eye during simulated cataract surgery can be the basis for images perceived by patients during cataract surgery

    Inoue, M; Uchida, A; Shinoda, K; Taira, Y; Noda, T; Ohnuma, K; Bissen-Miyajima, H; Hirakata, A

    2014-01-01

    Purpose To evaluate the images created in a model eye during simulated cataract surgery. Patients and methods This study was conducted as a laboratory investigation and interventional case series. An artificial opaque lens, a clear intraocular lens (IOL), or an irrigation/aspiration (I/A) tip was inserted into the ‘anterior chamber' of a model eye with the frosted posterior surface corresponding to the retina. Video images were recorded of the posterior surface of the model eye from the rear during simulated cataract surgery. The video clips were shown to 20 patients before cataract surgery, and the similarity of their visual perceptions to these images was evaluated postoperatively. Results The images of the moving lens fragments and I/A tip and the insertion of the IOL were seen from the rear. The image through the opaque lens and the IOL without moving objects was the light of the surgical microscope from the rear. However, when the microscope light was turned off after IOL insertion, the images of the microscope and operating room were observed by the room illumination from the rear. Seventy percent of the patients answered that the visual perceptions of moving lens fragments were similar to the video clips and 55% reported similarity with the IOL insertion. Eighty percent of the patients recommended that patients watch the video clip before their scheduled cataract surgery. Conclusions The patients' visual perceptions during cataract surgery can be reproduced in the model eye. Watching the video images preoperatively may help relax the patients during surgery. PMID:24788007

  12. Modeling and simulation of sexual activity daily diary data of patients with female sexual arousal disorder treated with sildenafil citrate (Viagra).

    Claret, Laurent; Cox, Eugene H; McFadyen, Lynn; Pidgen, Alwyn; Johnson, Patrick J; Haughie, Scott; Boolell, Mitra; Bruno, Rene

    2006-08-01

    To develop a model to explore the dose-response of sildenafil citrate in patients with female sexual arousal disorder (FSAD) based on telephone sexual activity daily diary (TSADD) data obtained in double-blind, placebo controlled clinical studies. Data were available on 614 patients with FSAD. A parametric model (Weibull distribution) was developed to describe the probability density function of the time between sexual events. Orgasm satisfaction scores and overall sexual satisfaction scores were simultaneously modeled as ordered categorical variables. Simulations were performed to evaluate the expected clinical response in patients with FSAD. The expected time between sexual events was approximately 3.5 days. Satisfaction scores increased with time to achieve a plateau after 3 to 4 weeks on treatment. The expected probability of satisfying orgasm (score of 3 and higher) ranged from 34.7% for placebo to 41.6% for 100 mg sildenafil citrate. Treatment effect (difference from placebo) was 6.9% for 100 mg sildenafil citrate, ranging from 0.6 to 24.7% for testosterone levels of 0.1 to 4.0 pg/ml. The treatment effect in postmenopausal women was larger than in premenopausal women. A modeling and simulation framework to support drug development in FSAD was developed. Sildenafil citrate demonstrated a dose-dependent effect in patients with FSAD.

  13. Measurement-based Monte Carlo simulation of high definition dose evaluation for nasopharyngeal cancer patients treated by using intensity modulated radiation therapy

    Yeh, C.Y.; Tung, C.J.; Lee, C.C.; Lin, M.H.; Chao, T.C.

    2014-01-01

    Measurement-based Monte Carlo (MBMC) simulation using a high definition (HD) phantom was used to evaluate the dose distribution in nasopharyngeal cancer (NPC) patients treated with intensity modulated radiation therapy (IMRT). Around nasopharyngeal cavity, there exists many small volume organs-at-risk (OARs) such as the optic nerves, auditory nerves, cochlea, and semicircular canal which necessitate the use of a high definition phantom for accurate and correct dose evaluation. The aim of this research was to study the advantages of using an HD phantom for MBMC simulation in NPC patients treated with IMRT. The MBMC simulation in this study was based on the IMRT treatment plan of three NPC patients generated by the anisotropic analytical algorithm (AAA) of the Eclipse treatment planning system (Varian Medical Systems, Palo Alto, CA, USA) using a calculation grid of 2 mm 2 . The NPC tumor was treated to a cumulative dose of 7000 cGy in 35 fractions using the shrinking-field sequential IMRT (SIMRT) method. The BEAMnrc MC Code was used to simulate a Varian EX21 linear accelerator treatment head. The HD phantom contained 0.5 × 0.5 × 1 mm 3 voxels for the nasopharyngeal area and 0.5 × 0.5 × 3 mm 3 for the rest of the head area. An efficiency map was obtained for the amorphous silicon aS1000 electronic portal imaging device (EPID) to adjust the weighting of each particle in the phase-space file for each IMRT beam. Our analysis revealed that small volume organs such as the eighth cranial nerve, semicircular canal, cochlea and external auditory canal showed an absolute dose difference of ≥200 cGy, while the dose difference for larger organs such as the parotid glands and tumor was negligible for the MBMC simulation using the HD phantom. The HD phantom was found to be suitable for Monte Carlo dose volume analysis of small volume organs. - Highlights: • HD dose evaluation for IMRT of NPC patients have been verified by the MC method. • MC results shows

  14. Simulation as a Tool to Facilitate Practice Changes in Teams Taking Care of Patients Under Investigation for Ebola Virus Disease in Spain.

    Rojo, Elena; Oruña, Clara; Sierra, Dolores; García, Gema; Del Moral, Ignacio; Maestre, Jose M

    2016-04-01

    We analyzed the impact of simulation-based training on clinical practice and work processes on teams caring for patients with possible Ebola virus disease (EVD) in Cantabria, Spain. The Government of Spain set up a special committee for the management of EVD, and the Spanish Ministry of Health and foreign health services created an action protocol. Each region is responsible for selecting a reference hospital and an in-house care team to care for patients under investigation. Laboratory-confirmed cases of EVD have to be transferred to the Carlos III Health Institute in Madrid. Predeployment training and follow-up support are required to help personnel work safely and effectively. Simulation-based scenarios were designed to give staff the opportunity to practice before encountering a real-life situation. Lessons learned by each team during debriefings were listed, and a survey administered 3 months later assessed the implementation of practice and system changes. Implemented changes were related to clinical practice (eg, teamwork principles application), protocol implementation (eg, addition of new processes and rewriting of confusing parts), and system and workflow (eg, change of shift schedule and rearrangement of room equipment). Simulation can be used to detect needed changes in protocol or guidelines or can be adapted to meet the needs of a specific team.

  15. Quantitative Approach Based on Wearable Inertial Sensors to Assess and Identify Motion and Errors in Techniques Used during Training of Transfers of Simulated c-Spine-Injured Patients

    Karina Lebel

    2018-01-01

    Full Text Available Patients with suspected spinal cord injuries undergo numerous transfers throughout treatment and care. Effective c-spine stabilization is crucial to minimize the impacts of the suspected injury. Healthcare professionals are trained to perform those transfers using simulation; however, the feedback on the manoeuvre is subjective. This paper proposes a quantitative approach to measure the efficacy of the c-spine stabilization and provide objective feedback during training. Methods. 3D wearable motion sensors are positioned on a simulated patient to capture the motion of the head and trunk during a training scenario. Spatial and temporal indicators associated with the motion can then be derived from the signals. The approach was developed and tested on data obtained from 21 paramedics performing the log-roll, a transfer technique commonly performed during prehospital and hospital care. Results. In this scenario, 55% of the c-spine motion could be explained by the difficulty of rescuers to maintain head and trunk alignment during the rotation part of the log-roll and their difficulty to initiate specific phases of the motion synchronously. Conclusion. The proposed quantitative approach has the potential to be used for personalized feedback during training sessions and could even be embedded into simulation mannequins to provide an innovative training solution.

  16. Cone-beam computed tomography-based diagnosis and treatment simulation for a patient with a protrusive profile and a gummy smile

    Imamura, Toshihiro; Kokai, Satoshi; Ono, Takashi

    2018-01-01

    For