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standard patients simulation

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
Jonathan P Cranford, Thomas J O'Hara, Christopher T Villongco, Omar M Hafez, Robert C Blake, Joseph Loscalzo, Jean-Luc Fattebert, David F Richards, Xiaohua Zhang, James N Glosli, Andrew D McCulloch, David E Krummen, Felice C Lightstone, Sergio E Wong
Patient-specific models of the ventricular myocardium, combined with the computational power to run rapid simulations, are approaching the level where they could be used for personalized cardiovascular medicine. A major remaining challenge is determining model parameters from available patient data, especially for models of the Purkinje-myocardial junctions (PMJs): the sites of initial ventricular electrical activation. There are no non-invasive methods for localizing PMJs in patients, and the relationship between the standard clinical ECG and PMJ model parameters is underexplored...
March 16, 2018: Cardiovascular Engineering and Technology
Christine A DeForest, Virginia Blackman, John E Alex, Lauren Reeves, Alejandra Mora, Crystal Perez, Joseph Maddry, Domenique Selby, Benjamin Walrath
Introduction: 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...
March 14, 2018: Military Medicine
Bhavik N Patel, Alfredo Farjat, Christoph Schabel, Petar Duvnjak, Achille Mileto, Juan Carlos Ramirez-Giraldo, Daniele Marin
OBJECTIVE: The purpose of this study was to determine in vitro and in vivo the optimal threshold for renal lesion vascularity at low-energy (40-60 keV) virtual monoenergetic imaging. MATERIALS AND METHODS: A rod simulating unenhanced renal parenchymal attenuation (35 HU) was fitted with a syringe containing water. Three iodinated solutions (0.38, 0.57, and 0.76 mg I/mL) were inserted into another rod that simulated enhanced renal parenchyma (180 HU). Rods were inserted into cylindric phantoms of three different body sizes and scanned with single- and dual-energy MDCT...
March 16, 2018: AJR. American Journal of Roentgenology
Barbara Wiśniowska, Sebastian Polak
The current study is an example of drug-disease interaction modeling where a drug induces a condition which can affect the pharmacodynamics of other concomitantly taken drugs. The electrophysiological effects of hypokaliemia and heart rate changes induced by the antiasthmatic drugs were simulated with the use of the cardiac safety simulator. Biophysically detailed model of the human cardiac physiology-ten Tusscher ventricular cardiomyocyte cell model-was employed to generate pseudo-ECG signals and QTc intervals for 44 patients from four clinical studies...
March 15, 2018: Journal of Pharmacokinetics and Pharmacodynamics
P Stefan, M Pfandler, P Wucherer, S Habert, J Fürmetz, S Weidert, E Euler, U Eck, M Lazarovici, M Weigl, N Navab
Surgical simulators are being increasingly used as an attractive alternative to clinical training in addition to conventional animal models and human specimens. Typically, surgical simulation technology is designed for the purpose of teaching technical surgical skills (so-called task trainers). Simulator training in surgery is therefore in general limited to the individual training of the surgeon and disregards the participation of the rest of the surgical team. The objective of the project Assessment and Training of Medical Experts based on Objective Standards (ATMEOS) is to develop an immersive simulated operating room environment that enables the training and assessment of multidisciplinary surgical teams under various conditions...
March 15, 2018: Der Unfallchirurg
Violeta González-Salvado, Cristian Abelairas-Gómez, Carlos Peña-Gil, Carmen Neiro-Rey, Roberto Barcala-Furelos, José Ramón González-Juanatey, Antonio Rodríguez-Núñez
AIM: Early basic life support is crucial to enhance survival from out-of-hospital cardiac arrest but rates remain low, especially in households. High-risk groups' training has been advocated, but the optimal method is unclear. The CArdiac REhabilitation and BAsic life Support (CAREBAS) project aims to compare the effectiveness of two basic life support educational strategies implemented in a cardiac rehabilitation program. METHODS: A community intervention study including consecutive patients enrolled on an exercise-based cardiac rehabilitation program after acute coronary syndrome or revascularization was conducted...
March 12, 2018: Resuscitation
Che-Wei Lin, Elizabeth H Chang, Daniel L Clinciu, Yun-Ting Peng, Wen-Chen Huang, Chien-Chih Wu, Jen-Chieh Wu, Yu-Chuan Li
BACKGROUND AND OBJECTIVE: Objective Structured Clinical Examination (OSCE) has been used in many areas of healthcare training over the years. However, it constantly needs to be upgraded and enhanced due to technological and teaching changes. We aim at implementing an integrative OSCE method which employs informatics via the virtual patient within the pharmacy education curriculum at Taipei Medical University to enhance the pharmacy students' competence for using and disseminating information and to also improve critical thinking and clinical reasoning...
May 2018: Computer Methods and Programs in Biomedicine
Chengshuai Yang, Shunyao Shen, Jingyang Wu, Shilei Zhang
Mandibular reconstruction after partial or subtotal resection is considered a challenging procedure that is crucial for facial contour and function. Many reports regarding the reconstruction of mandibular defects have been published over the years. The fibula free flap has become a popular option for mandibular reconstruction since its introduction by Hidalgo in 1989. However, the locations of the reconstructed mandibular angle and the condyle of the fibular bone segments play a crucial role in facial symmetry and function...
February 20, 2018: Journal of Oral and Maxillofacial Surgery
Nils Große Hokamp, Alexandra Hellerbach, Andreas Gierich, David W Jordan, Veerle Visser-Vandewalle, David Maintz, Stefan Haneder
OBJECTIVES: The aim of this study was to evaluate the reduction of artifacts from deep brain stimulation electrodes (DBS) using an iterative metal artifact reduction algorithm (O-MAR), virtual monoenergetic images (VMI), and both in combination in postoperative spectral detector computed tomography using a dual-layer detector (spectral detector computed tomography [SDCT]) of the head. MATERIAL AND METHODS: Nonanthropomorphic phantoms with different DBS leads were examined on SDCT; in 1 phantom periprocedural bleeding was simulated...
March 14, 2018: Investigative Radiology
Yobelli A Jimenez, Steven Cumming, Wei Wang, Kirsty Stuart, David I Thwaites, Sarah J Lewis
PURPOSE: Improved access to technology in the radiation therapy (RT) workforce education has resulted in opportunities for innovative patient education methods. This study investigated the impact of a newly developed education tool using the Virtual Environment for Radiotherapy Training (VERT) system on patients' RT knowledge and anxiety. METHOD: Breast cancer patients were recruited into a control group (CG) (n = 18) who underwent the standard pre-RT education package at a targeted cancer therapy centre, followed by a VERT group (VG) (n = 19)...
March 13, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Caroline Fertleman, Phoebe Aubugeau-Williams, Carmel Sher, Ai-Nee Lim, Sophie Lumley, Sylvie Delacroix, Xueni Pan
Background: Virtual reality technology is an exciting and emerging field with vast applications. Our study sets out the viewpoint that virtual reality software could be a new focus of direction in the development of training tools in medical education. We carried out a panel discussion at the Center for Behavior Change 3rd Annual Conference, prompted by the study, "The Responses of Medical General Practitioners to Unreasonable Patient Demand for Antibiotics--A Study of Medical Ethics Using Immersive Virtual Reality" (1)...
2018: Frontiers in Public Health
Michael J Martens, Brent R Logan
Competing risks endpoints arise when patients can fail therapy from several causes. Analyzing these outcomes allows one to assess directly the benefit of treatment on a primary cause of failure in a clinical trial setting. Regression models can be used in clinical trials to adjust for residual imbalances in patient characteristics, improving the power to detect treatment differences. But, none of the competing risks methods currently available for use in group sequential trials adjust for covariates. We propose a group sequential test for treatment effect that, because it is based on the Fine-Gray model, permits adjustment for covariates...
March 13, 2018: Biometrics
Jason D Pasley, William A Teeter, William B Gamble, Philip Wasick, Anna N Romagnoli, Amelia M Pasley, Thomas M Scalea, Megan L Brenner
BACKGROUND: The management of noncompressible torso hemorrhage remains a significant issue at the point of injury. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used in the hospital to control bleeding and bridge patients to definitive surgery. Smaller delivery systems and wirefree devices may be used more easily at the point of injury by nonphysician providers. We investigated whether independent duty military medical technicians (IDMTs) could learn and perform REBOA correctly and rapidly as assessed by simulation...
2018: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
Johanna Mielke, Heinz Schmidli, Byron Jones
For the approval of biosimilars, it is, in most cases, necessary to conduct large Phase III clinical trials in patients to convince the regulatory authorities that the product is comparable in terms of efficacy and safety to the originator product. As the originator product has already been studied in several trials beforehand, it seems natural to include this historical information into the showing of equivalent efficacy. Since all studies for the regulatory approval of biosimilars are confirmatory studies, it is required that the statistical approach has reasonable frequentist properties, most importantly, that the Type I error rate is controlled-at least in all scenarios that are realistic in practice...
March 13, 2018: Biometrical Journal. Biometrische Zeitschrift
Jessica A Zaman, Tejender Paul Singh
Though laparoscopic cholecystectomy (LC) was highly criticized in its early stages, it quickly grew to become a new standard of care and has revolutionized the field of general surgery. Now emerging robotic technology is making its way into the minimally invasive arena. Robotic cholecystectomy (RC) is often disparaged as a costly technology that can lead to increased operative times with outcomes that are quite similar to LC. However, this perspective is skewed as many existing studies were performed in the early phase of learning for this procedure...
February 2018: Hepatobiliary Surgery and Nutrition
Pelle Hanberg, Kristina Öbrink-Hansen, Anders Thorsted, Mats Bue, Mikkel Tøttrup, Lena E Friberg, Tore Forsingdal Hardlei, Kjeld Søballe, Jakob Gjedsted
The objectives of this study were to describe meropenem pharmacokinetics (PK) in plasma and/or subcutaneous adipose tissue (SCT) in critically ill patients receiving ECMO treatment, and to develop a population PK model to simulate alternative dosing regimens and modes of administration. We conducted a prospective observational study. Ten patients on ECMO treatment received meropenem (1 or 2 g) intravenously over 5 min every 8 hours. Serial SCT concentrations were determined using microdialysis and compared with plasma concentrations...
March 12, 2018: Antimicrobial Agents and Chemotherapy
Ronald W Gimbel, Ronald G Pirrallo, Steven C Lowe, David W Wright, Lu Zhang, Min-Jae Woo, Paul Fontelo, Fang Liu, Zachary Connor
BACKGROUND: The frequency of head computed tomography (CT) imaging for mild head trauma patients has raised safety and cost concerns. Validated clinical decision rules exist in the published literature and on-line sources to guide medical image ordering but are often not used by emergency department (ED) clinicians. Using simulation, we explored whether the presentation of a clinical decision rule (i.e. Canadian CT Head Rule - CCHR), findings from malpractice cases related to clinicians not ordering CT imaging in mild head trauma cases, and estimated patient out-of-pocket cost might influence clinician brain CT ordering...
March 12, 2018: BMC Medical Informatics and Decision Making
Dong Zhang, Pengcheng Xu, Hongyu Qiao, Xin Liu, Liangping Luo, Wenhua Huang, Heye Zhang, Changzheng Shi
BACKGROUND: 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...
March 12, 2018: Biomedical Engineering Online
Saeed Bagherzadeh, Nasrollah Jabbari, Hamid Reza Khalkhali
PURPOSE: The present study attempts to calculate organ-absorbed and effective doses for cancer patients to estimate the possible cancer induction and cancer mortality risks resulting from 64-slice abdominopelvic computed tomography (CT) simulations for radiotherapy treatment planning (RTTP). MATERIALS AND METHODS: A group of 70 patients, who underwent 64-slice abdominopelvic CT scan for RTTP, voluntarily participated in the present study. To calculate organ and effective doses in a standard phantom of 70 kg, the collected dosimetric parameters were used with the ImPACT CT Patient Dosimetry Calculator...
March 12, 2018: International Journal of Radiation Biology
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