micro-ultrasound-guided-transperineal-prostate-biopsy-clinic-based

Micro-Ultrasound Guided Transperineal Prostate Biopsy: A Clinic-Based Procedure

Prostate cancer is the most common solid malignancy in men and requires a biopsy for diagnosis. This manuscript describes a freehand micro-ultrasound ...

University of Florida College of Medicine

University of Florida

Using pharmacokinetic and pharmacodynamic data published in the scientific literature, we have developed interactive on-line simulations to model administration of propofol and fospropofol, a new water-soluble prodrug formulation of propofol. The prodrug formulation of fospropofol leads to a delayed onset to peak concentrations of propofol. A comparison simulation that overlays administration of fospropofol and propofol allows clinicians to understand the differences of administering fospropofol and traditional propofol. The simulations have the added advantage of allowing for differences among patients documented in test studies and the use of different models.

Interactive web simulation for propofol and fospropofol, a new propofol prodrug.

The purpose of this study was to measure the prevalence and configuration of dependent loops in urinary drainage systems in hospitalized, catheterized adults.

Prevalence of dependent loops in urinary drainage systems in hospitalized patients.

We present a race-specific model of propofol-induced loss of consciousness that is based on pharmacodynamic data collected and adapted from the peer-reviewed literature. In the proposed race-specific model that includes EC05 and EC95 concentrations, the median (EC50) (and where available 95%CI) propofol concentrations at the effect site compartment for propofol-induced loss of consciousness for whites, Chinese, blacks, and Indians are 2.8 (2.7-2.9), 2.2 (2.2-2.3), 2.0, and 1.9 μg/mL, respectively.

Race-Specific Pharmacodynamic Model of Propofol-Induced Loss of Consciousness.

The Role for Virtual Patients in the Future of Medical Education.

We investigated whether visual augmentation (3D, real-time, color visualization) of a procedural simulator improved performance during training in the supraclavicular approach to the subclavian vein, not as widely known or used as its infraclavicular counterpart.

Visualization Improves Supraclavicular Access to the Subclavian Vein in a Mixed Reality Simulator.

In a study with 76 anesthesia providers on a mixed reality simulator, central venous access via the supraclavicular approach to the subclavian vein, without ultrasonography required less attempts compared to the infraclavicular approach. Participants had shorter times to venous access and larger improvements in confidence. Results from this simulation-based study indicate that the supraclavicular approach may deserve consideration as an alternative approach for central venous access in deployed military environments. The use of ultrasonography during the supraclavicular approach to the subclavian vein is also described which may improve its safety profile. This technique could be more appropriate in scenarios when central venous access is preferred over intraosseous access for patients being transported to another location for further care.

Reduced Complications of Supraclavicular Approach in Simulated Central Venous Access: Applicability to Military Medicine.

Develop and pilot test a simulator that presents ten commonly encountered representative clinical contexts for trainees to learn basic electroencephalogram (EEG) interpretation skills.

An online, interactive, screen-based simulator for learning basic EEG interpretation.

 Prostate biopsy false negative percentages are 21% to 47% and 16% to 30% for systematic and fused biopsy, respectively. An intuitive three-dimensional (3D) observed user interface may help reduce these percentages by providing real-time guidance and feedback during transrectal or transperineal biopsy.  We track the moving prostate (including template locations and regions of interest), the transrectal ultrasound (TRUS) probe, and the biopsy device to construct a 3D environment. Users observe, aim, sample, and receive feedback in real time. Using a , 48 participants performed freehand systematic prostate biopsy with traditional TRUS guidance and afterward with visualized prostate biopsy (vPBx).  During  biopsy, vPBx reduced the false negative percentage for a 0.5-mL spherical apical lesion from 52% to 2% ( < 0.001).  Preliminary results during  systematic biopsy warrant retrofitting the vPBx to actual TRUS equipment as a step toward clinical trials with patients.

Visualized Prostate Biopsy: An Intuitive Three-Dimensional User Interface for Systematic and Targeted Biopsy.

To develop and validate on a simulator a learnable technique to decrease deviation of biopsied cores from the template schema during freehand, side-fire systematic prostate biopsy (sPBx) with the goal of reducing prostate biopsy (PBx) false-negatives, thereby facilitating earlier sampling, diagnosis and treatment of clinically significant prostate cancer.

Attitude is everything: keep probe pitch neutral during side-fire prostate biopsy. A simulator study.

Introduction Continuous electroencephalography (EEG) is an important monitoring modality in the intensive care unit and a key skill for critical care fellows (CCFs) to learn. Our objective was to evaluate with CCFs an EEG educational curriculum on a web-based simulator. Methods This prospective cohort study was conducted at a major academic medical center in Florida. After Institutional Review Board approval, 13 CCFs from anesthesiology, surgery, and pulmonary medicine consented to take an EEG curriculum. A 25-item EEG assessment was completed at baseline, after 10 EEG interpretations with a neurophysiologist, and after 10 clinically relevant EEG-based simulations providing clinical EEG interpretation hints. A 50-minute tutorial podcast was viewed after the baseline assessment. Main assessment outcomes included multiple outcomes related to web-based simulator performance: percent of hints used, percent of first words on EEG interpretation correct, and percent hint-based EEG interpretation score correct, with higher scores indicating more correct answers. Participants completed a 25-item EEG assessment before (baseline) and after the web-based simulator. Results All 13 CCFs completed the curriculum. Between scenarios, there were differences in percent of hints used (F = 11.7, p < 0.001), percent of first words correct (F = 13.6, p < 0.001), and overall percent hint-based score (F = 14.0, p < 0.001). Nonconvulsive status epilepticus had the lowest percent of hints used (15%) and the highest hint-based score (87%). Overall percent hint-based score (mean across all scenarios) was positively correlated with change in performance as the number of correct answers on the 25-item EEG assessment from before to after the web-based simulator activity (Spearman's rho = 0.67, p = 0.023). Conclusions A self-paced EEG interpretation curriculum involving a flipped classroom and screen-based simulation each requiring less than an hour to complete significantly improved CCF scores on the EEG assessment compared to baseline.

David Lizdas

Department of Anesthesiology

University of Florida College of Medicine

Micro-Ultrasound Guided Transperineal Prostate Biopsy: A Clinic-Based Procedure

David Lizdas

.css-o250i3{font-size:18px;font-family:Open Sans,sans-serif;line-height:21.6px;}Department of Anesthesiology

University of Florida College of Medicine

Micro-Ultrasound Guided Transperineal Prostate Biopsy: A Clinic-Based Procedure

Department of Anesthesiology