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3. Learning impact of a virtual brain electrical activity simulator among neurophysiology students:mixed-methods intervention study

Author

Björn, M. H. (Marko Henrik), Laurila, J. M. (Jonne MM), Ravyse, W. (Werner), Kukkonen, J. (Jari), Leivo, S. (Sanna), Mäkitalo, K. (Kati), and Keinonen, T. (Tuula)

Subjects
Virtual simulation, Psychomotor, Theoretical knowledge, Neurophysiology, Electroencephalography, Brain activity
Abstract

Background: Virtual simulation is the re-creation of reality depicted on a computer screen. It offers the possibility to exercise motor and psychomotor skills. In biomedical and medical education, there is an attempt to find new ways to support students’ learning in neurophysiology. Traditionally, recording electroencephalography (EEG) has been learned through practical hands-on exercises. To date, virtual simulations of EEG measurements have not been used. Objective: This study aimed to examine the development of students’ theoretical knowledge and practical skills in the EEG measurement when using a virtual EEG simulator in biomedical laboratory science in the context of a neurophysiology course. Methods: A computer-based EEG simulator was created. The simulator allowed virtual electrode placement and EEG graph interpretation. The usefulness of the simulator for learning EEG measurement was tested with 35 participants randomly divided into three equal groups. Group 1 (experimental group 1) used the simulator with fuzzy feedback, group 2 (experimental group 2) used the simulator with exact feedback, and group 3 (control group) did not use a simulator. The study comprised pre- and posttests on theoretical knowledge and practical hands-on evaluation of EEG electrode placement. Results: The Wilcoxon signed-rank test indicated that the two groups that utilized a computer-based electrode placement simulator showed significant improvement in both theoretical knowledge (Z=1.79, P=.074) and observed practical skills compared with the group that studied without a simulator. Conclusions: Learning electrode placement using a simulator enhances students’ ability to place electrodes and, in combination with practical hands-on training, increases their understanding of EEG measurement.

Published
2020

5. Unruptured intracranial aneurysms--risk of rupture and risks of surgical intervention

Author

Wiebers, D., Whisnant, J., Forbes, G., Meissner, I., Brown, R., Piepgras, D., Huston, J., Nichols, D., O Fallon, W., Peacock, J., Jaeger, L., Kassell, N., Kongable-Beckman, G., Torner, J., Rajput, M., Drake, C., Kurtzke, J., Marler, J., Walker, M., Meyer, F., Atkinson, J., Marsh, W., Thielen, K., Ferguson, G., Barr, H., Lownie, S., Hachinski, V., Fox, A., Sahjpaul, R., Parrent, A., Mayer, C., Lindsay, K., Teasdale, E., Bone, I., Fatukasi, J., Lindsay, M., Cail, W., Sagher, O., Davis, M., Sengupta, R., Bates, D., Gholkar, A., Murdy, J., Wilson, S., Praharaj, S., Partridge, G., Reynolds, C., Hind, N., Ogilvy, C., Crowell, R., Gress, D., Schaefer, P., Choi, I., Buckley, D., Sloan, K., King, D., Giannotta, S., Ameriso, S., Teitelbaum, T., Thomson, E., Fishback, D., Vajda, J., Nyary, I., Czirjak, S., Horvath, M., Szikora, I., Pasztor, E., Varady, P., Erdos, A., Edner, G., Wahlgren, N., Lindqvist, M., Antonsson, A., Da Pian, R., Pasqualin, A., Chioffi, F., Beltramello, A., Zampieri, G., Benati, A., Rossi, G., Ronkainen, A., Hernesniemi, J., Vapalahti, M., Rinne, J., Luukkonen, M., Vihavainen, M., Savolainen, S., Koivisto, T., Leivo, S., Helin, K., Steinberg, G., Marks, M., Vanefsky, M., Norbash, A., Thompson, R., Bell, T., Marcellus, M., Meyer, A., Kerr, R., Adams, C., Molyneux, A., Vinden, S., Bacon, F., Shrimpton, J., Parker, S., Day, A., Nadeau, S., Stachniak, J., Friedman, W., Fessler, R., Peters, K., Jacob, R., Roper, S., Smith, A., Lafrentz, P., Howard, M., Loftus, C., Adams, H., Crosby, D., Rogers, M., Broderick, J., Tew, J., Brott, T., Loveren, H., Yeh, H., Zuccarello, M., Tomsick, T., Gaskill-Shipley, M., Minneci, L., Mcmahon, N., Castel, J., Orgogozo, J., Loiseau, H., Bourgeois, P., Berge, J., Dousset, V., Cuny, E., Richard, M., Agbi, C., Hugenholtz, H., Benoit, B., Morrish, W., Wee, R., Grahovac, S., Pratt, L., Mortensen, M., Andreoli, A., Testa, C., Comani, V., Trevisan, C., Limoni, P., Carlucci, F., Leonardi, M., Sturiale, C., Pendl, G., Eder, H., Klein, G., Eder, M., Leber, K., Horner, T., Leipzig, T., Payner, T., Denardo, A., Scott, J., Redelman, K., Fisher, W., Rosner, M., Vitek, G., Hand, M., Flack, Wf, Sichez, J., Pertuiset, B., Fohanno, D., Marsault, C., Casasco, A., Biondi, A., Capelle, L., Duffau, H., Winn, H., Grady, M., Newell, D., Longstreth, W., Thompson, P., Bybee, H., Jones, D., Findlay, J., Petruk, K., Steinke, D., Ashforth, R., Stenerson, P., Schindel, D., Vanderhoven, H., Neves, J., Zager, E., Flamm, E., Raps, E., Hurst, R., Parrott, S., Sellers, M., Torchia, M., Anderson, B., West, M., Fewer, D., Hill, N., Sutherland, G., Ross, I., Mcclarty, B., Brownstone, R., Williams, O., Narotam, P., Christane, L., Mcginn, G., Gladish, D., Kirkpatrick, P., Pickard, J., Antoun, N., Simpson, D., Higgins, N., Turner, C., Tebbs, S., Holness, R., Malloy, D., Phillips, S., Maloney, W., Molina-De-Orozco, V., Baxter, B., Connolly-Campbell, K., Macdougall, A., Gentili, F., Wallace, M., Ter Brugge, K., Willinsky, R., Tymianski, M., Rickards, L., Tucker, W., Lambert, C., Montanera, W., Rychlewski, C., Flood, C., Villani, R., Sganzerla, E., Tomei, G., Bettinelli, A., Ceccarelli, G., Righini, A., Bello, L., Marras, C., Nelson, R., Lewis, T., Renowden, C., Clarke, Y., Varian, L., Chyatte, D., Sila, C., Perl, J., Masaryk, T., Porterfield, R., Shaw, M., Foy, P., Nixon, T., Dunn, L., Clitheroe, N., Smith, T., Eldridge, P., Humphrey, P., Wiseman, J., Hawkins, K., Owen, L., Ost, K., Saminaden, S., Mohr, G., Schondorf, R., Carlton, J., Maleki, M., Just, N., Brien, S., Entis, S., Tampieri, D., Simons, N., Mooij, J., Metzemackers, J., Hew, J., Beks, J., Veen, A., Bosma, I., Sprengers, M., Rinkel, G., Gijn, J., Ramos, L., Tulleken, C., Greebe, P., Vliet, F., Borgesen, S., Jespersen, B., Boge-Rasmussen, T., Willumsen, L., Homer, D., Eller, T., Carpenter, J., Meyer, J., Munson, R., Small, B., Nussbaum, E., Heros, R., Latchaw, R., Camarata, P., Lundgren, J., Mattsen, N., Whittle, I., Sellar, R., O Sullivan, M., Steers, A., Statham, P., Malcolm, G., Price, R., Hoffman, B., Yonas, H., Wechsler, L., Thompson-Dobkin, J., Jungreis, C., Kassam, A., Kirby, L., Parent, A., Lewis, A., Azordegan, P., Smith, R., Alexander, L., Gordon, D., Russell, W., Benashvili, G., Perry, R., Scalzo, D., Mandybur, G., Morgan, C., Karanjia, P., Madden, K., Kelman, D., Gallant, T., Vanderspek, H., Choucair, A., Neal, J., Mancl, K., Saveland, H., Brandt, L., Holtas, S., Trulsson, B., Macdonald, R., Weir, B., Mojtahedi, S., Amidei, C., Vermeulen, M., Bosch, D., Hulsmans, F., Albrecht, K., Roos, Y., Vet, A., Gorissen, A., Mechielsen, M., Martin, N., Gobin, Y., Saver, J., Vinuela, F., Duckwiler, G., Kelly, D., Frazee, J., Da Graca, R., Gravori, T., Illingworth, R., Richards, P., Wade, J., Colquhoun, I., Bashir, E., Shortt, S., Weaver, J., Fisher, M., Stone, B., Chaturvedi, S., Davidson, R., Davidson, K., Giombini, S., Solero, C., Boiardi, A., Cimino, C., Valentini, S., Antonio Silvani, Alberts, M., Friedman, A., Gentry, A., Hoffman, K., Hughes, R., Lillihei, K., Earnest, M., Nichols, J., Kindt, G., Anderson, A., Levy, S., Breeze, R., Noonan, V., Dowd, C., Vanwestrop, J., Wilson, C., Berger, M., Hannegan, L., Marcos, J., Ugarte, L., Kitchen, N., Taylor, W., Kumar, M., Grieve, J., Durity, F., Boyd, M., Fairholm, D., Griesdale, D., Honey, C., Redekop, G., Toyota, B., Turnbull, I., Woodhurst, W., Zwimpfer, T., Teal, P., Grabe, D., Brevner, A., Piepgras, A., Schmiedek, P., Schwartz, A., Weber, T., Biller, J., Brem, S., Cybulski, G., Chadwick, L., Bronstein, K., Pietila, T., Brock, M., Krug, D., Krznaric, I., and Kivisaari, R.

Subjects
Adult, Male, medicine.medical_specialty, International Subarachnoid Aneurysm Trial, Adolescent, Rupture rate, Aneurysm, Ruptured, Risk Factors, Intervention (counseling), Unruptured cerebral aneurysm, Medicine, Humans, Prospective Studies, Aged, Probability, Retrospective Studies, Aged, 80 and over, Rupture, Spontaneous, business.industry, Age Factors, Intracranial Aneurysm, General Medicine, Middle Aged, Subarachnoid Hemorrhage, Emergency medicine, Female, business, Vascular Surgical Procedures
Abstract

The management of unruptured intracranial aneurysms requires knowledge of the natural history of these lesions and the risks of repairing them.A total of 2621 patients at 53 participating centers in the United States, Canada, and Europe were enrolled in the study, which had retrospective and prospective components. In the retrospective component, we assessed the natural history of unruptured intracranial aneurysms in 1449 patients with 1937 unruptured intracranial aneurysms; 727 of the patients had no history of subarachnoid hemorrhage from a different aneurysm (group 1), and 722 had a history of subarachnoid hemorrhage from a different aneurysm that had been repaired successfully (group 2). In the prospective component, we assessed treatment-related morbidity and mortality in 1172 patients with newly diagnosed unruptured intracranial aneurysms.In group 1, the cumulative rate of rupture of aneurysms that were less than 10 mm in diameter at diagnosis was less than 0.05 percent per year, and in group 2, the rate was approximately 11 times as high (0.5 percent per year). The rupture rate of aneurysms that were 10 mm or more in diameter was less than 1 percent per year in both groups, but in group 1, the rate was 6 percent the first year for giant aneurysms (or =25 mm in diameter). The size and location of the aneurysm were independent predictors of rupture. The overall rate of surgery-related morbidity and mortality was 17.5 percent in group 1 and 13.6 percent in group 2 at 30 days and was 15.7 percent and 13.1 percent, respectively, at 1 year. Age independently predicted surgical outcome.The likelihood of rupture of unruptured intracranial aneurysms that were less than 10 mm in diameter was exceedingly low among patients in group 1 and was substantially higher among those in group 2. The risk of morbidity and mortality related to surgery greatly exceeded the 7.5-year risk of rupture among patients in group 1 with unruptured intracranial aneurysms smaller than 10 mm in diameter.

Published
1998

11. Learning Impact of a Virtual Brain Electrical Activity Simulator Among Neurophysiology Students: Mixed-Methods Intervention Study.

Author

Björn MH, Laurila JM, Ravyse W, Kukkonen J, Leivo S, Mäkitalo K, and Keinonen T

Abstract

Background: Virtual simulation is the re-creation of reality depicted on a computer screen. It offers the possibility to exercise motor and psychomotor skills. In biomedical and medical education, there is an attempt to find new ways to support students' learning in neurophysiology. Traditionally, recording electroencephalography (EEG) has been learned through practical hands-on exercises. To date, virtual simulations of EEG measurements have not been used., Objective: This study aimed to examine the development of students' theoretical knowledge and practical skills in the EEG measurement when using a virtual EEG simulator in biomedical laboratory science in the context of a neurophysiology course., Methods: A computer-based EEG simulator was created. The simulator allowed virtual electrode placement and EEG graph interpretation. The usefulness of the simulator for learning EEG measurement was tested with 35 participants randomly divided into three equal groups. Group 1 (experimental group 1) used the simulator with fuzzy feedback, group 2 (experimental group 2) used the simulator with exact feedback, and group 3 (control group) did not use a simulator. The study comprised pre- and posttests on theoretical knowledge and practical hands-on evaluation of EEG electrode placement., Results: The Wilcoxon signed-rank test indicated that the two groups that utilized a computer-based electrode placement simulator showed significant improvement in both theoretical knowledge (Z=1.79, P=.074) and observed practical skills compared with the group that studied without a simulator., Conclusions: Learning electrode placement using a simulator enhances students' ability to place electrodes and, in combination with practical hands-on training, increases their understanding of EEG measurement., (©Marko Henrik Björn, Jonne MM Laurila, Werner Ravyse, Jari Kukkonen, Sanna Leivo, Kati Mäkitalo, Tuula Keinonen. Originally published in JMIR Serious Games (http://games.jmir.org), 30.12.2020.)

Published
2020
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12. Evaluation of patients' sleep by nurses in an ICU.

Author

Ritmala-Castren M, Virtanen I, Vahlberg T, Leivo S, Kaukonen KM, and Leino-Kilpi H

Subjects
Adult, Female, Heart Rate, Humans, Male, Nurse-Patient Relations, Nursing Assessment methods, Sleep physiology, Sleep Wake Disorders nursing, Critical Illness nursing, Intensive Care Units, Nursing Diagnosis methods, Polysomnography nursing
Abstract

Aims and Objectives: To determine how intensive care unit evaluations of patients' sleep by nurses correspond to polysomnography and if changes in patients' physiologic parameters could be helpful in sleep evaluation., Background: The evaluations of patients' sleep by nurses have not corresponded very well with objective sleep recordings, so there is a need for further knowledge in this field., Design: Correlational study of patients' sleep, nurses' sleep evaluations and the sleep-related heart rate and blood pressure changes., Methods: The standard overnight polysomnography was recorded on 21 patients. Simultaneously, nurses marked into an electronic patient care documentation system all the changes noted in the patients' sleep status. Patients' arterial blood pressure and heart-rate data were automatically saved into the electronic patient care documentation., Results: The evaluations of patients' sleep/wake state by nurses corresponded to polysomnography 68% of the time. A correlation was found between nurses' evaluations and polysomnography recordings only on total sleep time. There was no correlation in the other sleep aspects (sleep latency, amount of awakenings or movements during sleep). Most patients' blood pressures and heart rate varied according to sleep/wake state. There was less variation if the patient had received noradrenalin for blood pressure control., Conclusion: The evaluations of patients' sleep/wake state by nurses only correspond to the polysomnography two-thirds of the time. Thus, more sophisticated evaluation methods should be developed to aid nurses in sleep evaluations. Sleep-related changes in blood pressure and heart rate can be seen in intensive care unit patients, so using these parameters as part of the patients' sleep evaluation should be further explored., Relevance to Clinical Practice: The nurses' evaluation practices of intensive care unit patients' sleep need further development. Monitoring the changes in patients' heart rate and blood pressure may aid in evaluating his/her sleep., (© 2016 John Wiley & Sons Ltd.)

Published
2016
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13. Sleep and nursing care activities in an intensive care unit.

Author

Ritmala-Castren M, Virtanen I, Leivo S, Kaukonen KM, and Leino-Kilpi H

Subjects
Aged, Female, Finland, Humans, Male, Middle Aged, Polysomnography, Intensive Care Units, Night Care, Nursing Care, Sleep
Abstract

This study aimed to describe the quality of sleep of non-intubated patients and the night-time nursing care activities in an intensive care unit. The study also aimed to evaluate the effect of nursing care activities on the quality of sleep. An overnight polysomnography was performed in 21 alert, non-intubated, non-sedated adult patients, and all nursing care activities that involved touching the patient were documented by the bedside nurse. The median (interquartile range) amount of sleep was 387 (170, 486) minutes. The portion of deep non-rapid-eye-movement (non-REM) sleep varied from 0% to 42% and REM sleep from 0% to 65%. The frequency of arousals and awakenings varied from two to 73 per hour. The median amount of nursing care activities was 0.6/h. Every tenth activity presumably awakened the patient. Patients who had more care activities had more light N1 sleep, less light N2 sleep, and less deep sleep. Nursing care was often performed while patients were awake. However, only 31% of the intervals between nursing care activities were over 90 min. More attention should be paid to better clustering of care activities., (© 2015 Wiley Publishing Asia Pty Ltd.)

Published
2015
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