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Clinical simulation

David L Tirschwell, Mark Turner, David Thaler, James Choulerton, David Marks, John Carroll, Lee MacDonald, Richard W Smalling, Maria Koullick, Ning Yan Gu, Jeffrey L Saver
OBJECTIVE: Compared to medical therapy alone, percutaneous closure of patent foramen ovale (PFO) further reduces risk of recurrent ischemic strokes in carefully selected young to middle-aged patients with a recent cryptogenic ischemic stroke. The objective of this study was to evaluate the cost-effectiveness of this therapy in the context of the United Kingdom (UK) healthcare system. METHODS: A Markov cohort model consisting of 4 health states (Stable after index stroke, Post-Minor Recurrent Stroke, Post-Moderate Recurrent Stroke, and Death) was developed to simulate the economic outcomes of device-based PFO closure compared to medical therapy...
March 22, 2018: Journal of Medical Economics
Luan Carvalho Martins, Pedro Henrique Monteiro Torres, Renata Barbosa de Oliveira, Pedro Geraldo Pascutti, Elio A Cino, Rafaela Salgado Ferreira
Chagas disease remains a major health problem in South America, and throughout the world. The two drugs clinically available for its treatment have limited efficacy and cause serious adverse effects. Cruzain is an established therapeutic target of Trypanosoma cruzi, the protozoan that causes Chagas disease. Our group recently identified a competitive cruzain inhibitor (compound 1) with an IC50  = 15 µM that is also more synthetically accessible than the previously reported lead, compound 2. Prior studies, however, did not propose a binding mode for compound 1, hindering understanding of the structure-activity relationship and optimization...
March 21, 2018: Journal of Computer-aided Molecular Design
Julio Flecha-Lescún, Begoña Calvo, Jesús Zurita, Miguel Ángel Ariza-Gracia
Keratoconus is an idiopathic, non-inflammatory and degenerative corneal disease characterised by a loss of the organisation in the corneal collagen fibrils. As a result, keratoconic corneas present a localised thinning and conical protrusion with irregular astigmatism and high myopia that worsen visual acuity. Intracorneal ring segments (ICRSs) are used in clinic to regularise the corneal surface and to prevent the disease from progressing. Unfortunately, the post-surgical effect of the ICRS is not explicitly accounted beforehand...
March 21, 2018: Biomechanics and Modeling in Mechanobiology
Sherwin K B Sy, Yen Lin Chia, Toufigh Gordi, Ute Hoch, Michael A Eldon
PURPOSE: Etirinotecan pegol (EP), a long-acting topoisomerase-1 inhibitor, is a polyethylene glycol conjugate of irinotecan, with an intended indication for treatment of breast cancer with brain metastases. The objective of this study was to develop a population pharmacokinetic (popPK) model of EP and four of its metabolites (irinotecan, SN38, SN38-glucuronide, and APC) and determine covariates affecting their pharmacokinetics. METHODS: Data from 83 cancer patients enrolled in phase 1 studies were used...
March 21, 2018: Cancer Chemotherapy and Pharmacology
Derek P Lindsey, Ali Kiapour, Scott A Yerby, Vijay K Goel
AIM: To analyze how various implants placement variables affect sacroiliac (SI) joint range of motion. METHODS: An experimentally validated finite element model of the lumbar spine and pelvis was used to simulate a fusion of the SI joint using various placement configurations of triangular implants (iFuse Implant System® ). Placement configurations were varied by changing implant orientation, superior implant length, and number of implants. The range of motion of the SI joint was calculated using a constant moment of 10 N-m with a follower load of 400 N...
March 18, 2018: World Journal of Orthopedics
Cheng-Te Chen, Yu-Lan Chen, Yu-Ching Lin, Ching-Lin Hsieh, Jeng-Yi Tzeng, Kuan-Lin Chen
OBJECTIVE: The purpose of this study was to construct a computerized adaptive test (CAT) for measuring self-care performance (the CAT-SC) in children with developmental disabilities (DD) aged from 6 months to 12 years in a content-inclusive, precise, and efficient fashion. METHODS: The study was divided into 3 phases: (1) item bank development, (2) item testing, and (3) a simulation study to determine the stopping rules for the administration of the CAT-SC. A total of 215 caregivers of children with DD were interviewed with the 73-item CAT-SC item bank...
2018: PloS One
Mary Lavelle, Jennifer Abthorpe, Thomas Simpson, Gabriel Reedy, Fiona Little, Anita Banerjee
The majority of maternal deaths in the UK are due to pre-existing or new-onset medical conditions, known as 'indirect deaths'. The MBRRACE report identified serious gaps in clinicians' human factors skills, including communication, leadership and teamwork, which contributed to maternal death. In response, we developed the first multi-disciplinary simulation-based training programme designed to address Medical Emergencies in Obstetrics (MEmO). Employing a mixed methods design, this study evaluated the educational impact of this training programme on the healthcare staff (n = 140), including the medical doctors (n = 91) and the midwives (n = 49)...
March 21, 2018: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
Diego de Souza Gonçalves, Marina da Silva Ferreira, Susie Coutinho Liedke, Kamilla Xavier Gomes, Gabriel Afonso de Oliveira, Pedro Ernesto Lopes Leão, Gabriele Vargas Cesar, Sergio H Seabra, Juliana Reis Cortines, Arturo Casadevall, Leonardo Nimrichter, Gilberto Barbosa Domont, Magno Rodrigues Junqueira, Jose Mauro Peralta, Allan J Guimaraes
Acanthamoeba castellanii (Ac) are ubiquitously distributed in nature, and by contaminating medical devices such as heart valves and contact lenses, they cause a broad range of clinical presentations to humans. Although several molecules have been described to play a role in Ac pathogenesis, including parasite host-tissue invasion and escaping of host-defense, little information is available on their mechanisms of secretion. Herein, we describe the molecular components secreted by Ac, under different protein availability conditions to simulate host niches...
March 21, 2018: Virulence
N Jmail, M Zaghdoud, A Hadriche, T Frikha, C Ben Amar, C Bénar
To define the neural networks responsible of an epileptic seizure, it is useful to perform advanced signal processing techniques. In this context, electrophysiological signals present three types of waves: oscillations, spikes, and a mixture of both. Recent studies show that spikes and oscillations should be separated properly in order to define the accurate neural connectivity during the pre-ictal, seizure and inter-ictal states. Retrieving oscillatory activity is a sensitive task due to the frequency overlap between oscillations and transient activities...
February 2018: Heliyon
Zhichao Wu, Felipe A Medeiros
Visual field testing is an important endpoint in glaucoma clinical trials, and the testing paradigm used can have a significant impact on the sample size requirements. To investigate this, this study included 353 eyes of 247 glaucoma patients seen over a 3-year period to extract real-world visual field rates of change and variability estimates to provide sample size estimates from computer simulations. The clinical trial scenario assumed that a new treatment was added to one of two groups that were both under routine clinical care, with various treatment effects examined...
March 20, 2018: Scientific Reports
Jonathan T Ma, Christina Tang, Le Kang, Judith A Voynow, Bruce K Rubin
BACKGROUND: Cystic fibrosis (CF) airway secretions are abnormal, contributing to decreased clearance and a cycle of infection and inflammation. CF sputum properties may predict disease progression. We hypothesized that sputum viscoelasticity and clearance abnormalities would inversely correlate with pulmonary function during exacerbation and that sputum properties would return to baseline after therapy. METHODS: We collected sputa longitudinally from 13 CF subjects with moderate to severe lung disease during both clinical stability and exacerbation...
March 17, 2018: Chest
Esben S Worm, Morten Høyer, Rune Hansen, Lars P Larsen, Britta Weber, Cai Grau, Per R Poulsen
PURPOSE: Intrafraction motion can compromise the treatment accuracy in liver stereotactic body radiation therapy (SBRT). Respiratory gating can improve treatment delivery; however, gating based on external motion surrogates is inaccurate. The present study reports the use of Calypso-based internal electromagnetic motion monitoring for gated liver SBRT. METHODS AND MATERIALS: Fifteen patients were included in a study of 3-fraction respiratory gated liver SBRT guided by 3 implanted electromagnetic transponders...
February 13, 2018: International Journal of Radiation Oncology, Biology, Physics
Jennifer R George, Alan H Tyroch, Stacey A Milan
We sought to determine whether simulation-based medical education using Trauma Evaluation and Management® (TEAM®) training module contributes to a positive impression of resident and faculty teaching. Qualitative and quantitative data regarding medical students' experience of TEAM® training and their interaction with instructors were collected using anonymous surveys after the completion of the training module. A combination of yes or no responses, as well as classification of student confidence and perceptions on the utility of TEAM® training obtained using Likert-type scales, was evaluated...
March 1, 2018: American Surgeon
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
Aine Cafferkey, Elizabeth Coyle, David Greaney, Sinead Harte, Niamh Hayes, Miriam Langdon, Birgitt Straub, Crina Burlacu
BACKGROUND: Simulation-based education is a modern training modality that allows healthcare professionals to develop knowledge and practice skills in a safe learning environment. The College of Anaesthetists of Ireland (CAI) was the first Irish postgraduate medical training body to introduce mandatory simulation training into its curriculum. Extensive quality assurance and improvement data has been collected on all simulation courses to date. AIMS: Describe The College of Anaesthetists of Ireland Simulation Training (CAST) programme and report the analysis of course participants' feedback...
March 20, 2018: Irish Journal of Medical Science
Erdem Kucukal, Jane A Little, Umut A Gurkan
Non-adherence and deformability are the key intrinsic biomechanical features of the red blood cell (RBC), which allow it to tightly squeeze and pass through even the narrowest of microcirculatory networks. Blockage of microcirculatory flow, also known as vaso-occlusion, is a consequence of abnormal cellular adhesion to the vascular endothelium. In sickle cell disease (SCD), an inherited anaemia, even though RBCs have been shown to be heterogeneous in adhesiveness and deformability, this has not been studied in the context of physiologically relevant dynamic shear gradients at the microscale...
March 20, 2018: Integrative Biology: Quantitative Biosciences From Nano to Macro
Elif Bilgic, Madoka Takao, Pepa Kaneva, Satoshi Endo, Toshitatsu Takao, Yusuke Watanabe, Katherine M McKendy, Liane S Feldman, Melina C Vassiliou
BACKGROUND: Needs assessment identified a gap regarding laparoscopic suturing skills targeted in simulation. This study collected validity evidence for an advanced laparoscopic suturing task using an Endo StitchTM device. METHODS: Experienced (ES) and novice surgeons (NS) performed continuous suturing after watching an instructional video. Scores were based on time and accuracy, and Global Operative Assessment of Laparoscopic Surgery. Data are shown as medians [25th-75th percentiles] (ES vs NS)...
March 1, 2018: Surgical Innovation
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
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