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Patient simulator

Andrew G Geeslin, Jorge Chahla, Gilbert Moatshe, Kyle J Muckenhirn, Bradley M Kruckeberg, Alex W Brady, Ashley Coggins, Grant J Dornan, Alan M Getgood, Jonathan A Godin, Robert F LaPrade
BACKGROUND: The individual kinematic roles of the anterolateral ligament (ALL) and the distal iliotibial band Kaplan fibers in the setting of anterior cruciate ligament (ACL) deficiency require further clarification. This will improve understanding of their potential contribution to residual anterolateral rotational laxity after ACL reconstruction and may influence selection of an anterolateral extra-articular reconstruction technique, which is currently a matter of debate. Hypothesis/Purpose: To compare the role of the ALL and the Kaplan fibers in stabilizing the knee against tibial internal rotation, anterior tibial translation, and the pivot shift in ACL-deficient knees...
March 1, 2018: American Journal of Sports Medicine
Daniel O Scharfstein, Aidan McDermott
Randomized trials with patient-reported outcomes are commonly plagued by missing data. The analysis of such trials relies on untestable assumptions about the missing data mechanism. To address this issue, it has been recommended that the sensitivity of the trial results to assumptions should be a mandatory reporting requirement. In this paper, we discuss a recently developed methodology (Scharfstein et al., Biometrics, 2018) for conducting sensitivity analysis of randomized trials in which outcomes are scheduled to be measured at fixed points in time after randomization and some subjects prematurely withdraw from study participation...
January 1, 2018: Statistical Methods in Medical Research
Mercedes G Vázquez, Pablo N Affranchino, Andrea Schon, Eduardo Otero, Pablo Young, Patricia Breyter
Goldbloom syndrome is a rare clinical entity, of unknown etiology that happens almost exclusively in pediatric population. It is a prolonged febrile syndrome with periosteal hyperostosis and dysproteinemia, and often simulates an hematooncology or lymphoproliferative disease. The diagnosis is to rule out the different causes of bone pain associated with hypergammaglobulinemia, hypoalbuminemia, high erythrocyte sedimentation rate and periostitis at the radiographies. Symptomatology, radiology and laboratory parameters refer in a variable time, usually from 3 to 12 months...
April 1, 2018: Archivos Argentinos de Pediatría
Min Cheol Joo, Chul Hwan Jang, Jong Tae Park, Seung Won Choi, Seungil Ro, Min Seob Kim, Moon Young Lee
Although electrical stimulation is therapeutically applied for neural regeneration in patients, it remains unclear how electrical stimulation exerts its effects at the molecular level on spinal cord injury (SCI). To identify the signaling pathway involved in electrical stimulation improving the function of injured spinal cord, 21 female Sprague-Dawley rats were randomly assigned to three groups: control (no surgical intervention, n = 6), SCI (SCI only, n = 5), and electrical simulation (ES; SCI induction followed by ES treatment, n = 10)...
February 2018: Neural Regeneration Research
Yaeji Lim, Ji Soo Choi, Kiyoun Kim, Mira Park, Seonwoo Kim
Diagnostic procedures are mostly used to detect a particular disease, and each procedure indicates the presence or absence of the disease in an individual. Sensitivity and positive predictive value, which are measures of the effectiveness of a diagnostic procedure, are simply calculated as the proportion of the individuals diagnosed with the disease by the test among the patients with the disease, and of the diseased persons among the individuals in whom the disease was detected by the test, respectively. For a diagnosis with such a binary result, sensitivity and the positive predictive value of diagnostic procedures can be compared using the chi-square statistic...
January 1, 2018: Statistical Methods in Medical Research
Amelia K Sofjan, Benjamin O Casey, Boxin A Xu, Jonathan Amadio, Alejandro Restrepo, M Jahangir Alam, Kevin W Garey
BACKGROUND: The Accelerate PhenoTestTM BC kit (AXDX) provides rapid organism identification (ID) and antimicrobial susceptibility testing (AST) results. Its potential role for antimicrobial stewardship is unknown. OBJECTIVE: To compare the diagnostic accuracy of AXDX with conventional methods (CMs) and assess AXDX's potential role for antimicrobial stewardship in patients with Gram-positive bloodstream infections (BSIs). METHODS: This retrospective cohort study included adults with Staphylococcus aureus or Enterococcus spp BSIs from July 2014 to January 2016 at a tertiary care medical center...
March 1, 2018: Annals of Pharmacotherapy
Ji-Bin Zhang, Li-Rong Zhao, Tian-Xiang Cui, Xie-Wan Chen, Qiao Yang, Yi-Bing Zhou, Zheng-Tang Chen, Shao-Xiang Zhang, Jian-Guo Sun
The aim of the present study was to investigate the optimal strategy and dosimetric measurement of thoracic radiotherapy based on three-dimensional (3D) modeling of mediastinal lymph nodes (MLNs). A 3D model of MLNs was constructed from a Chinese Visible Human female dataset. Image registration and fusion between reconstructed MLNs and original chest computed tomography (CT) images was conducted in the Eclipse™ treatment planning system (TPS). There were three plans, including 3D conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT), which were designed based on 10 cases of simulated lung lesions (SLLs) and MLNs...
April 2018: Oncology Letters
J C Bader, E A Lakota, Shawn Flanagan, V Ong, Taylor Sandison, C M Rubino, S M Bhavnani, P G Ambrose
Rezafungin (CD101) is a novel echinocandin antifungal agent with activity against Aspergillus and Candida species, including azole- and echinocandin-resistant isolates. The objective of these analyses was to conduct pharmacokinetic-pharmacodynamic (PK-PD) target attainment analyses to evaluate single and once-weekly rezafungin dosing to provide dose selection support for future clinical studies. Using a previously developed rezafungin population PK model, Monte Carlo simulations were conducted utilizing the following three IV rezafungin dosing regimens: (i) single 400-mg dose, (ii) 400 mg for Week 1 followed by 200 mg weekly for 5 weeks, and (iii) 400 mg weekly for 6 weeks...
March 19, 2018: Antimicrobial Agents and Chemotherapy
Gaëlle Cheisson, Sophie Jacqueminet, Emmanuel Cosson, Carole Ichai, Anne-Marie Leguerrier, Bogdan Nicolescu-Catargi, Alexandre Ouattara, Igor Tauveron, Paul Valensi, Dan Benhamou
Follow on from continuous intravenous administration of insulin with an electronic syringe (IVES) is an important element in the postoperative management of a diabetic patient. The basal-bolus scheme is the most suitable taking into account the nutritional supply and variable needs for insulin, reproducing the physiology of a normal pancreas: (i) slow (long-acting) insulin (= basal) which should immediately take over from IVES insulin simulating basal secretion; (ii) ultra-rapid insulin to simulate prandial secretion (= bolus for the meal); and (iii) correction of possible hyperglycaemia with an additional ultra-rapid insulin bolus dose...
March 16, 2018: Anaesthesia, Critical Care & Pain Medicine
Tarek Malas, Talal Al-Atassi, Tim Brandys, Viren Naik, Harry Lapierre, Buu-Khanh Lam
OBJECTIVE: There is mounting evidence supporting the benefit of surgical simulation on the learning of skills independently and in a patient-safe environment. The objective of this study was to examine the effect of visualization of surgical steps via instructional media on performance of an end-to-side microvascular anastomosis. METHODS: Thirty-two first- and second-year surgical trainees from the University of Ottawa received an expert-guided, didactic lecture on vascular anastomosis and performed an end-to-side anastomosis on a procedural model to assess baseline skills...
April 2018: Journal of Thoracic and Cardiovascular Surgery
Diego F Munoz, Cong Xu, Sylvia K Plevritis
We present a Monte Carlo simulation model that reproduces US invasive breast cancer incidence and mortality trends from 1975 to 2010 as a function of screening and adjuvant treatment. This model was developed for multiple purposes, including to quantify the impact of screening and adjuvant therapy on past and current trends, predict future trends, and evaluate potential outcomes under hypothetical screening and treatment interventions. The model first generates the life histories of individual breast cancer patients by determining the patient's age, tumor size, estrogen receptor (ER) status, human epidermal growth factor 2 (HER2) status, SEER (Surveillance, Epidemiology, and End Results) historic stage, detection mode at time of detection, preclinical tumor course, and death age and cause of death (breast cancer v...
April 2018: Medical Decision Making: An International Journal of the Society for Medical Decision Making
Theodorus M van Bakel, Christopher J Arthurs, Joost A van Herwaarden, Frans L Moll, Kim A Eagle, Himanshu J Patel, Santi Trimarchi, C Alberto Figueroa
OBJECTIVES: Aortic arch repair remains a major surgical challenge. Multiple manufacturers are developing branched endografts for Zone 0 endovascular repair, extending the armamentarium for minimally invasive treatment of aortic arch pathologies. We hypothesize that the design of the Zone 0 endograft has a significant impact on the postoperative haemodynamic performance, particularly in the cervical arteries. The goal of our study was to compare the postoperative haemodynamic performance of different Zone 0 endograft designs...
March 15, 2018: European Journal of Cardio-thoracic Surgery
Aida Niñerola-Baizán, Judith Gallego, Albert Cot, Pablo Aguiar, Francisco Lomeña, Javier Pavía, Domenec Ros
The aim of this work was to obtain a set of parameters to be applied in [123I]FP-CIT SPECT reconstruction in order to minimize the error between standardized and true values of the Specific Uptake Ratio (SUR) in dopaminergic neurotransmission SPECT studies. To this end, Monte Carlo simulation was used to generate a database of 1,380 projection data-sets from 23 subjects, including normal cases and a variety of pathologies. Studies were reconstructed using Filtered Back Projection (FBP) with attenuation correction and Ordered Subset Expectation Maximization (OSEM) with correction for different degradations (attenuation, scatter and PSF)...
March 19, 2018: Physics in Medicine and Biology
Mersedeh TariVerdi, Elise Miller-Hooks, Thomas Kirsch
Mass casualty incidents are a concern in many urban areas. A community's ability to cope with such events depends on the capacities and capabilities of its hospitals for handling a sudden surge in demand of patients with resource-intensive and specialized medical needs. This paper uses a whole-hospital simulation model to replicate medical staff, resources, and space for the purpose of investigating hospital responsiveness to mass casualty incidents. It provides details of probable demand patterns of different mass casualty incident types in terms of patient categories and arrival patterns, and accounts for related transient system behavior over the response period...
March 19, 2018: Disaster Medicine and Public Health Preparedness
Sabine Landau, Richard Emsley, Graham Dunn
BACKGROUND: Random allocation avoids confounding bias when estimating the average treatment effect. For continuous outcomes measured at post-treatment as well as prior to randomisation (baseline), analyses based on (A) post-treatment outcome alone, (B) change scores over the treatment phase or (C) conditioning on baseline values (analysis of covariance) provide unbiased estimators of the average treatment effect. The decision to include baseline values of the clinical outcome in the analysis is based on precision arguments, with analysis of covariance known to be most precise...
March 1, 2018: Clinical Trials: Journal of the Society for Clinical Trials
Xiao-Meng Zhang, Yong-Nan Jin, Bing Zhang, Ning Li
Rheumatoid arthritis (RA) has the characteristics of long course of disease and difficulty in treatment. The conventional therapy may easily induce adverse drug reactions or events (ADR/ADE) due to the long-time medication. Thus, it should be given special attentions to treatment benefit and medication risk of RA patients. Aconitum, a kind of toxic traditional Chinese herbs, is an important complement therapy for RA, with some controversy in clinical application. Coming straight to the practical problem of combined use of traditional Chinese medicines (TCM) and Western medicines (WM), this study conducted quantitative assessment on the benefits and risks of Aconitum using combined with WM or not, which was carried out by the method of multi-criteria decision analysis model...
January 2018: Zhongguo Zhong Yao za Zhi, Zhongguo Zhongyao Zazhi, China Journal of Chinese Materia Medica
Chen Sun, Jianxia Li
PURPOSE: To investigate the expression of microRNA (miRNA-137) in oral squamous cell carcinoma (OSCC) and its effects on activity, invasion and proliferation of OSCC human squamous cell carcinoma cell lines 2 (HSC-2 cell line). METHODS: 158 cases of pathologically-confirmed OSCC tissues and corresponding para-cancerous tissues were collected. The tissue mRNA was extracted and miRNA-137 expression in tissues was detected using real-time polymerase chain reaction (RT-PCR)...
January 2018: Journal of B.U.ON.: Official Journal of the Balkan Union of Oncology
Suman Lahiry, Christopher Levi, Joosup Kim, Dominique A Cadilhac, Andrew Searles
Background: In regional and rural Australia, patients experiencing ischemic stroke do not have equitable access to an intravenous recombinant tissue plasminogen activator (tPA). Although thrombolysis with tPA is a clinically proven and cost-effective treatment for eligible stroke patients, there are few economic evaluations on pre-hospital triage interventions to improve access to tPA. Aim: To describe the potential cost-effectiveness of the pre-hospital acute stroke triage (PAST) protocol implemented to provide priority transfer of appropriate patients from smaller hospitals to a primary stroke center (PSC) in regional New South Wales, Australia...
2018: Frontiers in Public Health
Hanish Kataria, Abhinav Seth, Ashok Kumar Attri, Raj Pal Singh Punia
Amebiasis is common in tropical and developing countries with variable symptoms. Ameboma of the colon occurs rarely due to the annular growth of granulation tissue and can present as mass lesion simulating colonic carcinoma in elderly individuals. Due to diagnostic dilemma or in case of complications, for example, acute intestinal obstruction, perforation, or bleeding per rectum, the patient requires urgent surgical exploration and final diagnosis is made on histopathological examination.
January 2018: International Journal of Applied and Basic Medical Research
Luisa Flohr, Shaylene Beaudry, K Taneille Johnson, Nicholas West, Catherine M Burns, J Mark Ansermino, Guy A Dumont, David Wensley, Peter Skippen, Matthias Gorges
The pediatric intensive care unit (ICU) is a complex environment, in which a multidisciplinary team of clinicians (registered nurses, respiratory therapists, and physicians) continually observe and evaluate patient information. Data are provided by multiple, and often physically separated sources, cognitive workload is high, and team communication can be challenging. Our aim is to combine information from multiple monitoring and therapeutic devices in a mobile application, the VitalPAD , to improve the efficiency of clinical decision-making, communication, and thereby patient safety...
2018: IEEE Journal of Translational Engineering in Health and Medicine
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