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Am J Surg ; 217(2): 362-367, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30514436


BACKGROUND: The objective of this study was to determine whether gaze patterns could differentiate expertise during simulated ultrasound-guided Internal Jugular Central Venous Catheterization (US-IJCVC) and if expert gazes were different between simulators of varying functional and structural fidelity. METHODS: A 2017 study compared eye gaze patterns of expert surgeons (n = 11), senior residents (n = 4), and novices (n = 7) during CVC needle insertions using the dynamic haptic robotic trainer (DHRT), a system which simulates US-IJCVC. Expert gaze patterns were also compared between a manikin and the DHRT. RESULTS: Expert gaze patterns were consistent between the manikin and DHRT environments (p = 0.401). On the DHRT system, CVC experience significantly impacted the percent of time participants spent gazing at the ultrasound screen (p < 0.0005) and the needle and ultrasound probe (p < 0.0005). CONCLUSION: Gaze patterns differentiate expertise during ultrasound-guided IJCVC placement and the fidelity of the simulator does not impact gaze patterns.

Cateterismo Venoso Central , Competência Clínica , Educação de Pós-Graduação em Medicina/métodos , Internato e Residência/métodos , Manequins , Robótica/educação , Ultrassonografia de Intervenção , Humanos
J Surg Res ; 233: 351-359, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30502270


BACKGROUND: Training for ultrasound-guided central venous catheterization (CVC) is typically conducted on static manikin simulators with real-time feedback from a skilled observer. Dynamic haptic robotic trainers (DHRTs) are an alternative method that simulates various patient anatomies and provides consistent feedback for each insertion. This study evaluates CVC needle insertion efficiency and skill gains of both methods. MATERIALS AND METHODS: Fifty-two first-year surgical residents were trained by placing internal jugular (IJ) CVC needles in manikins (n = 26) or robots (n = 26). Manikin-trained participants received verbal feedback from an experienced observer, whereas robotically trained participants received quantitative feedback from the personalized DHRT learning interface. All participants were pretested on a Blue Phantom manikin; participants completed posttesting on a Blue Phantom manikin (n = 26) or a novel manikin (n = 26) with different vessel depth and position. During pretests and posttests residents were timed, motion-tracked, and scored on an IJ CVC checklist. RESULTS: (1) All skills on the IJ CVC checklist showed significant (P < 0.014) improvements from pretests to posttest; (2) Average angle of insertion, path length, and jerk improved significantly (P < 0.005); (3) Average procedural completion time, with standard error (SE) reported, decreased significantly from pretest (M = 3.516 min, SE = 0.277) to posttest (M = 1.997, SE = 0.409). CONCLUSIONS: No significant group differences were observed in overall skill gains, but residents' average procedural completion time decreased significantly from pretests to posttest. Overall results support DHRT as an effective method for training IJ CVC skills.

Cateterismo Venoso Central/métodos , Educação de Pós-Graduação em Medicina/métodos , Treinamento por Simulação/métodos , Cateterismo Venoso Central/instrumentação , Competência Clínica/estatística & dados numéricos , Avaliação Educacional/métodos , Avaliação Educacional/estatística & dados numéricos , Feminino , Cirurgia Geral/educação , Humanos , Internato e Residência , Masculino , Manequins , Agulhas , Robótica , Fatores de Tempo , Ultrassonografia de Intervenção
Simul Healthc ; 13(3): 149-153, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29620705


INTRODUCTION: Training using ultrasound phantoms allows for safe introduction to clinical skills and is associated with improved in-hospital performance. Many materials have been used to simulate human tissue in phantoms including commercial manikins, agar, gelatin, and Ballistics Gel; however, phantom tissues could be improved to provide higher-fidelity ultrasound images or tactile sensation. This article describes a novel phantom tissue mixture of a modified polyvinyl chloride (PVC) polymer, mineral oil, and chalk powder and evaluates needle cutting and ultrasonic properties of the modified PVC polymer mixture compared with a variety of phantom tissues. METHODS: The first experiment measured axial needle forces of a needle insertion into nine phantom materials, including three formulations of modified PVC. The second experiment used a pairwise comparison survey of ultrasound images to determine the perceived realism of phantom ultrasound images. RESULTS: It was found that the materials of Ballistics Gel and one of the PVC mixtures provide stiff force feedback similar to cadaver tissue. Other phantom materials including agar and gelatin provide very weak unrealistic force feedback. The survey results showed the PVC mixtures being viewed as the most realistic by the survey participants, whereas agar and Ballistics Gel were seen as the least realistic. CONCLUSIONS: The realism in cutting force and ultrasound visualization was determined for a variety of phantom materials. Novel modified PVC polymer has great potential for use in ultrasound phantoms because of its realistic ultrasound imaging and modifiable stiffness. This customizability allows for easy creation of multilayer tissue phantoms.

Educação Médica/métodos , Manequins , Imagens de Fantasmas , Cloreto de Polivinila/química , Ultrassonografia de Intervenção/métodos , Carbonato de Cálcio/química , Géis , Humanos , Óleo Mineral/química
Am J Physiol Lung Cell Mol Physiol ; 313(2): L218-L229, 2017 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-28495854


Tuberculosis (TB) is one of the oldest known human diseases and is transmitted by the bacteria Mycobacterium tuberculosis (Mtb). TB has a rich history with evidence of TB infections dating back to 5,800 bc TB is unique in its ability to remain latent in an individual for decades, with the possibility of later reactivation, causing widespread systemic symptoms. Currently, it is estimated that more than one-third of the world's population (~2 billion people) are infected with Mtb. Prolonged periods of therapy and complexity of treatment regimens, especially in active infection, have led to poor compliance in patients being treated for TB. Therefore, it is vitally important to have a thorough knowledge of the pathophysiology of Mtb to understand the disease progression, as well as to develop novel diagnostic tests and treatments. Alveolar macrophages represent both the primary host cell and the first line of defense against the Mtb infection. Apoptosis and autophagy of macrophages play a vital role in the pathogenesis and also in the host defense against Mtb. This review will outline the role of these two cellular processes in defense against Mtb with particular emphasis on innate immunity and explore developing therapies aimed at altering host responses to the disease.

Apoptose/imunologia , Autofagia/imunologia , Tuberculose/imunologia , Animais , Humanos , Imunidade Celular/imunologia , Imunidade Inata/imunologia , Macrófagos/imunologia , Mycobacterium tuberculosis/imunologia
J Oral Maxillofac Surg ; 75(1): 149-152, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27528104


Increased salivary demand can lead to enlarged parotid salivary glands, and increased activity of the masseter muscles can cause masseter hypertrophy. This report describes a most unusual case of simultaneous bilateral hypertrophies of the parotid gland and masseter muscle originating from the very extensive habit of chewing gum. An extensive literature review uncovered many cases of the independent existence of masseteric or parotid hypertrophy, but no example of the simultaneous occurrence of these 2 conditions.

Goma de Mascar/efeitos adversos , Hipertrofia/complicações , Músculo Masseter/anormalidades , Músculo Masseter/patologia , Glândula Parótida/patologia , Feminino , Humanos , Hipertrofia/etiologia , Hipertrofia/patologia , Pessoa de Meia-Idade