https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(00)02490-9.pdf

The importance of selenium to human health

SUMMARY Review date: 1969 to 2003, 34 years. Background and context: Simulations are now in widespread use in medical education and medical personnel evaluation. Outcomes research on the use and effectiveness of simulation technology in medical education is scattered, inconsistent and varies widely in methodological rigor and substantive focus. Objectives: Review and synthesize existing evidence in educational science that addresses the question, ‘What are the features and uses of high-fidelity medical simulations that lead to most effective learning?’. Search strategy: The search covered five literature databases (ERIC, MEDLINE, PsycINFO, Web of Science and Timelit) and employed 91 single search terms and concepts and their Boolean combinations. Hand searching, Internet searches and attention to the ‘grey literature’ were also used. The aim was to perform the most thorough literature search possible of peer-reviewed publications and reports in the unpublished literature that have been judged for academic quality. Inclusion and exclusion criteria: Four screening criteria were used to reduce the initial pool of 670 journal articles to a focused set of 109 studies: (a) elimination of review articles in favor of empirical studies; (b) use of a simulator as an educational assessment or intervention with learner outcomes measured quantitatively; (c) comparative research, either experimental or quasi-experimental; and (d) research that involves simulation as an educational intervention. Data extraction: Data were extracted systematically from the 109 eligible journal articles by independent coders. Each coder used a standardized data extraction protocol. Data synthesis: Qualitative data synthesis and tabular presentation of research methods and outcomes were used. Heterogeneity of research designs, educational interventions, outcome measures and timeframe precluded data synthesis using meta-analysis. Headline results: Coding accuracy for features of the journal articles is high. The extant quality of the published research is generally weak. The weight of the best available evidence suggests that high-fidelity medical simulations facilitate learning under the right conditions. These include the following:

/pdf/features-and-uses-of-high-fidelity-medical-simulations-that-51wb8k5opy.pdf

Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review

The essential trace mineral, selenium, is of fundamental importance to human health. As a constituent of selenoproteins, selenium has structural and enzymic roles, in the latter context being best-known as an antioxidant and catalyst for the production of active thyroid hormone. Selenium is needed for the proper functioning of the immune system, and appears to be a key nutrient in counteracting the development of virulence and inhibiting HIV progression to AIDS. It is required for sperm motility and may reduce the risk of miscarriage. Deficiency has been linked to adverse mood states. Findings have been equivocal in linking selenium to cardiovascular disease risk although other conditions involving oxidative stress and inflammation have shown benefits of a higher selenium status. An elevated selenium intake may be associated with reduced cancer risk. Large clinical trials are now planned to confirm or refute this hypothesis. In the context of these health effects, low or diminishing selenium status in some parts of the world, notably in some European countries, is giving cause for concern.

The importance of selenium to human health.

In this paper, the current "state of the art" for virtual reality (VR) applications in the field of motor rehabilitation is reviewed. The paper begins with a brief overview of available equipment options. Next, a discussion of the scientific rationale for use of VR in motor rehabilitation is provided. Finally, the major portion of the paper describes the various VR systems that have been developed for use with patients, and the results of clinical studies reported to date in the literature. Areas covered include stroke rehabilitation (upper and lower extremity training, spatial and perceptual-motor training), acquired brain injury, Parkinson's disease, orthopedic rehabilitation, balance training, wheelchair mobility and functional activities of daily living training, and the newly developing field of telerehabilitation. Four major findings emerge from these studies: (1) people with disabilities appear capable of motor learning within virtual environments; (2) movements learned by people with disabilities in VR transfer to real world equivalent motor tasks in most cases, and in some cases even generalize to other untrained tasks; (3) in the few studies (n = 5) that have compared motor learning in real versus virtual environments, some advantage for VR training has been found in all cases; and (4) no occurrences of cybersickness in impaired populations have been reported to date in experiments where VR has been used to train motor abilities.

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Virtual environments for motor rehabilitation: review.

In the past few years, considerable developments have been made in the objective assessment of technical proficiency of surgeons. Technical skills should be assessed during training, and various methods have been developed for this purpose 

Surgical competence entails a combination of knowledge, technical skills, decision making, communication skills, and leadership skills. Of these, dexterity or technical proficiency is considered to be of paramount importance among surgical trainees. The assessment of technical skills during training has been considered to be a form of quality assurance for the future.1 Typically surgical learning is based on an apprenticeship model. In this model the assessment of technical proficiency is the responsibility of the trainers. However, their assessment is largely subjective.2 Objective assessment is essential because deficiencies in training and performance are difficult to correct without objective feedback.3

The introduction of the Calman system in the United Kingdom, the implementation of the European Working Time Directive, and the financial pressures to increase productivity4 have reduced the opportunity to learn surgical skills in the operating theatre. Studies have shown that these changes have resulted in nearly halving the surgical case load that trainees are exposed to.5 Surgical proficiency must therefore be acquired in less time, with the risk that some surgeons may not be sufficiently skilled at the completion of training.6 This and increasing attention of the public and media on the performance of doctors have given rise to an interest in the development of robust methods of assessment of technical skills.7 We review the research in this field in the past decade. Our objectives are to explore all the available methods, establish their validity and reliability, and examine the possibility of using these methods on the basis of the available evidence.

We collected information for this review from …

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Objective assessment of technical skills in surgery

New technologies, in particular virtual reality and robotics, will have a major impact on health care in the next decade. Clinically validated, powerful medical simulators are now available and in use across the world. General surgery leads in the use of simulators, and neurosurgery leads with augmented reality and image guided surgery. Robotics are used in orthopaedics and cardiology. Other virtual reality applications are being used in mental health, anaesthetics, and emergency medicine. Rapid developments in the internet and “e-learning” domains have accelerated the dissemination of simulation techniques, interactive 3D images, and structured courseware. This review describes the application of virtual reality and robotics to surgical training and planning and the execution of procedures in theatre and discusses the near term future of this new technology.

A successful medical simulator or surgical system based on virtual reality requires the participation of a team of specialists including experts in ergonomics and applied psychology, software engineering and digital 3D design, electromechanical engineering, robotics, and microtechnology. Consequently, no single database adequately covers all the issues involved. This review is based on our experience supplemented with data from searches of Medline and the Ergonomics Information Analysis Centre (University of Birmingham) and of the internet with various web search engines.

Current virtual reality surgical systems owe their existence to pioneering developments in the early and middle 1980s. Organisations developing robots to replace humans from hostile and hazardous environments—undersea, in nuclear installations, in space, and on the battlefield—turned to an emerging technology that seemed to offer the ideal solution. The developers claimed that, with a special helmet equipped with head tracking devices and 3D displays, it was possible to create an illusion for the wearer that he or she was present in such an environment (“telepresence”) and, with a fibre optic glove, possible for them to …

https://www.bmj.com/content/bmj/323/7318/912.full.pdf

Science, medicine, and the future. Virtual reality in surgery.

Objectives:Intra-abdominal hypertension (IAH) contributes to organ failure in patients with abdominal trauma and sepsis and leads to the development of abdominal compartment syndrome (ACS). This study aims to investigate the clinical significance of IAH in patients with severe acute pancreatitis (SA

Clinical relevance of intra-abdominal hypertension in patients with severe acute pancreatitis.

In just a few years, the roles of medical and surgical practitioners have undergone a major transformation, owing to developments in a new generation of advanced technologies such as surgical robotics, in-theatre interactive three dimensional displays, speech recognition for the control of critical theatre systems, virtual reality simulators, telemedicine, telecare, and e-learning. Yet despite the research and development community's enthusiasm for innovation, the end users—practitioners and specialists—are often ignored during the design and development processes, sometimes with serious consequences. We describe the growing relevance of ergonomics or human factors principles and methodologies to medical and surgical practice, emphasising the importance of moving away from “technology push” (the assumption that a high tech approach to the design of information technology systems will always provide a robust, reliable solution) to one that is more focused on the needs of the human in the design of medical equipment, systems, and processes.

The discipline of ergonomics has attempted to make important changes over half a century by introducing human centred processes to the design of equipment, systems, and working practices in many domains of activity, including health care. This review is based on our experience in introducing ergonomics into medical research and development programmes, together with data taken from sources bridging medical, industrial, and defence communities, including information obtained through key texts, the UK Ergonomics Information Analysis Centre, the US Human Systems Information Analysis Center, and international ergonomics and medical websites.

Ergonomics is the study (or science) of the interaction between humans and their working environment (box 1). Also known as human factors (a term originating from the United States, but gaining popularity in Europe), it has had a long and successful history of influencing the uptake of human centred design processes in different domains, such as the automotive industry and defence, and, to …

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Ergonomics in medicine and surgery.

Virtual reality laparoscopic simulator for assessment in gynaecology

The Manchester ‘oxidant stress’ hypothesis for the development of pancreatitis accommodates published information on both chronic pancreatitis and acute pancreatitis Oxidant stress, mainly from react

Rory F. McCloy

Papers

Science, medicine, and the future. Virtual reality in surgery.

Clinical relevance of intra-abdominal hypertension in patients with severe acute pancreatitis.

Ergonomics in medicine and surgery.

Virtual reality laparoscopic simulator for assessment in gynaecology

Chronic pancreatitis at Manchester, UK. Focus on antioxidant therapy.