Can We "Up Our Game" in Bronchoscopy Procedural Training?
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ABSTRACT:
SUBMITTER: Myers R
PROVIDER: S-EPMC8043297 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Background: Video game playing requires many of the same skill sets as medical procedures such as bronchoscopy. These include visual-spatial awareness, rapid decision making, and psychomotor skills. The role of video game cross-training on learning bronchoscopy is unknown. Objective: We studied the association of baseline video gaming experience with, and the impact of short-term video game playing on, visual-spatial awareness and acquisition of basic bronchoscopic skills among medical trainees. Methods: Bronchoscopy-naive medical trainees underwent formal didactic and hands-on instruction on basic bronchoscopy, along with a baseline assessment measuring bronchoscopic and visual-spatial skills. Half of the subjects were subsequently randomized to playing a videogame (Rocket League) for 8 weeks. All participants returned at 4 weeks for a refresher course and at 8 weeks for a final assessment. Results: Thirty subjects completed the study, 16 of them in the intervention arm who all met the minimum video game playing time requirement. At baseline, video game players had significantly lower airway collision rates (6.82 collisions/min vs. 11.64 collisions/min; P = 0.02) and higher scores on the Purdue Visual Spatial Test: Visualization of Rotations test (27.5 vs. 23.54; P = 0.04). At completion, the intervention group had no significant differences in airway collisions, bronchoscopy time, or Bronchoscopy Skills and Tasks Assessment Tool scores. There was moderate correlation between airway collision rate and mean Purdue Visual Spatial Test: Visualization of Rotations score (Spearman's rho, -0.59; P < 0.001). Conclusion: At baseline, learners with former video game-playing experience have higher visual-spatial awareness and fewer airway collisions. The impact of video game playing as an aid to simulation-based bronchoscopic education is uncertain.
| S-EPMC8043293 | biostudies-literature
Project description:Stenosis of the pulmonary arteries frequently occurs during staged palliation of hypoplastic left heart syndrome and variants, often necessitating stent angioplasty. A complication of stent angioplasty is compression of the ipsilateral mainstem bronchus. Following such a case, we re-evaluated our approach to PA stent angioplasty in these patients. The incident case is described. A retrospective observational study of children and adults with superior (SCPC) and/or total cavopulmonary connection (TCPC) undergoing left pulmonary artery (LPA) stent angioplasty between January 1, 2005 and January 5, 2014 and subsequent chest CT was performed to assess the incidence of bronchial compression. The current strategy of employing bronchoscopy to assess bronchial compression during angioplasty is described with short-term results. Sixty-five children and adults underwent LPA stent angioplasty. Other than the incident case, none had symptomatic bronchial compression. Of the total study population, 12 % had subsequent CT, of which one subject had moderate bronchial compression. To date, seven subjects have undergone angioplasty of LPA stenosis and bronchoscopy. In one case, stent angioplasty was not performed because of baseline bronchial compression, exacerbated during angioplasty. In the rest of cases, mild-moderate compression was seen during angioplasty. Following stent angioplasty, the resultant compression was not worse than that seen on test angioplasty. Bronchial compression is a rare complication of stent angioplasty of the pulmonary arteries in children and adults with SCPC/TCPC. Angioplasty of the region of interest with procedural bronchoscopy can help to identify patients at risk of this complication.
| S-EPMC4814319 | biostudies-literature
Project description:BACKGROUND:Conventional training in bronchoscopy is performed either on patients (apprenticeship model) or phantoms. While the former is associated with increased rate of patient complications, procedure time, and amount of sedation, the latter does not offer any form of feedback to the trainee. This paper presents a study which investigates whether a bronchoscopy guidance system may be a helpful tool for training of novice bronchoscopists. METHODS:A randomized controlled study with 48 medical students was carried out with two different groups (control and test group, each N?=?24). Whereas the control group performed a conventional bronchoscopy on phantom the test group carried out an Electromagnetic Navigation Bronchoscopy (ENB) for tracking of the bronchoscopal tip in the bronchial system. All volunteers had a common task: to perform a complete and systematic diagnostic bronchoscopy within 10?min. RESULTS:The test group examined significantly more lobes than the control group (p?=?0.009). Due to the real-time feedback of the system, all students of test group felt more confident having analyzed the entire lung. Additionally, they were unanimous that the system would be helpful during the next bronchoscopy. CONCLUSIONS:In sum, this technology may play a major role in unsupervised learning by improving accuracy, dexterity but above all by increasing the confidence of novices, students as well as physicians. Due to good acceptance, there may be a great potential of this tool in clinical routine.
| S-EPMC6868732 | biostudies-literature
Project description:Marked aneurysmal dilation of the central and branch pulmonary arteries in utero in patients with tetralogy of Fallot with absent pulmonary valve can often exhibit extrinsic compression of the trachea and bronchi. The major morbidity in these patients remains postoperative ventilation issues. This case report highlights the role of intraoperative bronchoscopy in providing guidance for obtaining optimal bronchial decompression that was achieved by an initial pulmonary arteriopexy followed by an aortopexy.
| S-EPMC8404592 | biostudies-literature
Project description:Simulation-based bronchoscopy training is increasingly used, but effectiveness remains uncertain. We sought to perform a comprehensive synthesis of published work on simulation-based bronchoscopy training.We searched MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Web of Science, and Scopus for eligible articles through May 11, 2011. We included all original studies involving health professionals that evaluated, in comparison with no intervention or an alternative instructional approach, simulation-based training for flexible or rigid bronchoscopy. Study selection and data abstraction were performed independently and in duplicate. We pooled results using random effects meta-analysis.From an initial pool of 10,903 articles, we identified 17 studies evaluating simulation-based bronchoscopy training. In comparison with no intervention, simulation training was associated with large benefits on skills and behaviors (pooled effect size, 1.21 [95% CI, 0.82-1.60]; n=8 studies) and moderate benefits on time (0.62 [95% CI, 0.12-1.13]; n=7). In comparison with clinical instruction, behaviors with real patients showed nonsignificant effects favoring simulation for time (0.61 [95% CI, -1.47 to 2.69]) and process (0.33 [95% CI, -1.46 to 2.11]) outcomes (n=2 studies each), although variation in training time might account for these differences. Four studies compared alternate simulation-based training approaches. Inductive analysis to inform instructional design suggested that longer or more structured training is more effective, authentic clinical context adds value, and animal models and plastic part-task models may be superior to more costly virtual-reality simulators.Simulation-based bronchoscopy training is effective in comparison with no intervention. Comparative effectiveness studies are few.
| S-EPMC3707173 | biostudies-other
Project description:Video games contain elaborate reinforcement and reward schedules that have the potential to maximize motivation. Neuroimaging studies suggest that video games might have an influence on the reward system. However, it is not clear whether reward-related properties represent a precondition, which biases an individual toward playing video games, or if these changes are the result of playing video games. Therefore, we conducted a longitudinal study to explore reward-related functional predictors in relation to video gaming experience as well as functional changes in the brain in response to video game training. Fifty healthy participants were randomly assigned to a video game training (TG) or control group (CG). Before and after training/control period, functional magnetic resonance imaging (fMRI) was conducted using a non-video game related reward task. At pretest, both groups showed strongest activation in ventral striatum (VS) during reward anticipation. At posttest, the TG showed very similar VS activity compared to pretest. In the CG, the VS activity was significantly attenuated. This longitudinal study revealed that video game training may preserve reward responsiveness in the VS in a retest situation over time. We suggest that video games are able to keep striatal responses to reward flexible, a mechanism which might be of critical value for applications such as therapeutic cognitive training.
| S-EPMC4318496 | biostudies-literature
Project description:Computer games are increasingly being used for training cognitive functions like working memory and attention among the growing population of older adults. While cognitive training games often include elements like difficulty adaptation, rewards, and visual themes to make the games more enjoyable and effective, the effect of different degrees of afforded user control in manipulating these elements has not been systematically studied. To address this issue, two distinct implementations of the three aforementioned game elements were tested among healthy older adults (N = 21, 69.9 ± 6.4 years old) playing a game-like version of the n-back task on a tablet at home for 3 weeks. Two modes were considered, differentiated by the afforded degree of user control of the three elements: user control of difficulty vs. automatic difficulty adaptation, difficulty-dependent rewards vs. automatic feedback messages, and user choice of visual theme vs. no choice. The two modes ("USER-CONTROL" and "AUTO") were compared for frequency of play, duration of play, and in-game performance. Participants were free to play the game whenever and for however long they wished. Participants in USER-CONTROL exhibited significantly higher frequency of playing, total play duration, and in-game performance than participants in AUTO. The results of the present study demonstrate the efficacy of providing user control in the three game elements, while validating a home-based study design in which participants were not bound by any training regimen, and could play the game whenever they wished. The results have implications for designing cognitive training games that elicit higher compliance and better in-game performance, with an emphasis on home-based training.
| S-EPMC4653717 | biostudies-literature
Project description:BackgroundAt teaching hospitals, bedside procedures (paracentesis, thoracentesis, lumbar puncture, arthrocentesis and central venous catheter insertion) are performed by junior residents and supervised by senior peers. Residents' perceptions about supervision or how often peer supervision produces unsafe clinical situations are unknown.ObjectiveTo examine the experience and practice patterns of residents performing bedside procedures.Design and participantsCross-sectional e-mail survey of 653 internal medicine (IM) residents at seven California teaching hospitals.MeasurementsSurveys asked questions in three areas: (1) resident experience performing procedures: numbers of procedures performed and whether they received other (e.g., simulator) training; (2) resident comfort performing and supervising procedures; (3) resident reports of their current level of supervision doing procedures, experience with complications as well as perceptions of factors that may have contributed to complications.ResultsThree hundred sixty-seven (56%) of the residents responded. Most PGY1 residents had performed fewer than five of any of the procedures, but most PGY-3 residents had performed at least ten by the end of their training. Resident comfort for each procedure increased with the number of procedures performed (p < 0.001). Although residents reported that peer supervision happened often, they also reported high rates of supervising a procedure before feeling comfortable with proper technique. The majority of residents (64%) reported at least one complication and did not feel supervision would have prevented complications, even though many reported complications represented technique- or preparation-related problems.ConclusionsResidents report low levels of comfort and experience with procedures, and frequently report supervising prior to feeling comfortable. Our findings suggest a need to examine best practices for procedural supervision of trainees.
| S-EPMC2842555 | biostudies-literature
Project description:ObjectiveWhile short-term gains in performance of critical emergency procedures are demonstrated after simulation, long-term retention is relatively uncertain. Our objective was to determine whether simulation of critical emergency procedures promotes long-term retention of skills in nonsurgical physicians.MethodsWe searched multiple electronic databases using a peer-reviewed strategy. Eligible studies 1) were observational cohorts, quasi-experimental or randomized controlled trials; 2) assessed intubation, cricothyrotomy, pericardiocentesis, tube thoracostomy, or central line placement performance by nonsurgical physicians; 3) utilized any form of simulation; and 4) assessed skill performance immediately after and at ≥ 3 months after simulation. The primary outcome was skill performance at or above a preset performance benchmark at ≥ 3 months after simulation. Secondary outcomes included procedural skill performance at 3, 6, and ≥ 12 months after simulation.ResultsWe identified 1,712 citations, with 10 being eligible for inclusion. Methodologic quality was moderate with undefined primary outcomes; inadequate sample sizes; and use of nonstandardized, unvalidated tools. Three studies assessed performance to a specific performance benchmark. Two demonstrated maintenance of the minimum performance benchmark while two demonstrated significant skill decay. A significant decline in the mean performance scores from immediately after simulation to 3, 6, and ≥ 12 months after simulation was observed in four of four, three of four, and two of five studies, respectively. Scores remained significantly above baseline at 3, 6, and ≥ 12 months after simulation in three of four, three of four, and four of four studies, respectively.ConclusionThere were a limited number of studies examining the retention of critical skills after simulation training. While there was some evidence of skill retention after simulation, overall most studies demonstrated skill decline over time.
| S-EPMC8166305 | biostudies-literature
Project description:Cognitive control is defined by a set of neural processes that allow us to interact with our complex environment in a goal-directed manner. Humans regularly challenge these control processes when attempting to simultaneously accomplish multiple goals (multitasking), generating interference as the result of fundamental information processing limitations. It is clear that multitasking behaviour has become ubiquitous in today's technologically dense world, and substantial evidence has accrued regarding multitasking difficulties and cognitive control deficits in our ageing population. Here we show that multitasking performance, as assessed with a custom-designed three-dimensional video game (NeuroRacer), exhibits a linear age-related decline from 20 to 79 years of age. By playing an adaptive version of NeuroRacer in multitasking training mode, older adults (60 to 85 years old) reduced multitasking costs compared to both an active control group and a no-contact control group, attaining levels beyond those achieved by untrained 20-year-old participants, with gains persisting for 6 months. Furthermore, age-related deficits in neural signatures of cognitive control, as measured with electroencephalography, were remediated by multitasking training (enhanced midline frontal theta power and frontal-posterior theta coherence). Critically, this training resulted in performance benefits that extended to untrained cognitive control abilities (enhanced sustained attention and working memory), with an increase in midline frontal theta power predicting the training-induced boost in sustained attention and preservation of multitasking improvement 6 months later. These findings highlight the robust plasticity of the prefrontal cognitive control system in the ageing brain, and provide the first evidence, to our knowledge, of how a custom-designed video game can be used to assess cognitive abilities across the lifespan, evaluate underlying neural mechanisms, and serve as a powerful tool for cognitive enhancement.
| S-EPMC3983066 | biostudies-literature