Local metabolic changes in subcutaneous adipose tissue during intravenous and epidural analgesia.

BACKGROUND: This clinical study aimed at investigating the impact of postoperative thoracic epidural analgesia on extracellular glycerol concentration and glucose metabolism in subcutaneous adipose tissue, using the microdialysis technique. The sympathetic nervous activity, which can be attenuated by epidural anesthesia, influences lipolysis and the release of glycerol. METHODS: Fourteen patients who underwent major abdominal or thoraco-abdominal surgery were studied postoperatively over 3 days. For postoperative analgesia the patients were prospectively randomized to receive either thoracic epidural analgesia with a bupivacaine/morphine infusion (EPI-group, n=6) or a continuous i.v. infusion of morphine (MO-group, n=8). The concentration of glycerol, glucose and lactate in the abdominal and deltoid subcutaneous adipose tissue were measured using a microdialysis technique. RESULTS: The abdominal glycerol levels were equal in both groups. In the deltoid region of the EPI-group, glycerol concentrations started to increase on Day 2, and reached significantly higher levels on Day 3 compared with the MO-group. The glucose and lactate levels showed no differences between groups in the two regions. CONCLUSION: The uniform glycerol levels in abdominal subcutaneous adipose tissue in conjunction with the difference in glycerol levels in the deltoid area indicate that the local lipolysis is different in the two study groups. This might be explained by a regional metabolic influence of thoracic epidural analgesia, possibly via the sympathetic nervous system

Clinical Virtual Worlds

The deployment of virtual worlds into clinical practice is gradually becoming an accepted if innovative approach. This chapter offers an overview of the application of virtual worlds in a healthcare settings with specific focus on the application of virtual worlds in clinical practice. When combined with dynamic patient data models, facilitators are able to customize and deliver real time immersive clinical training experiences in a range of contexts. Given that virtual worlds are now being implemented in some of the more complex areas of healthcare, this chapter then explores how the lessons being learnt in this context could be applied more widely to other areas of professional development in the healthcare sector and concludes that direct and valuable lessons from mainstream clinical practice with virtual worlds are ready to be applied now more widely in the healthcare sector.</jats:p

Effects of pre-training using serious game technology on CPR performance : an exploratory quasi-experimental transfer study

Background: Multiplayer virtual world (MVW) technology creates opportunities to practice medical procedures and team interactions using serious game software. This study aims to explore medical students' retention of knowledge and skills as well as their proficiency gain after pre-training using a MVW with avatars for cardio-pulmonary resuscitation (CPR) team training. Methods: Three groups of pre-clinical medical students, n = 30, were assessed and further trained using a high fidelity full-scale medical simulator: Two groups were pre-trained 6 and 18 months before assessment. A reference control group consisting of matched peers had no MVW pre-training. The groups consisted of 8, 12 and 10 subjects, respectively. The session started and ended with assessment scenarios, with 3 training scenarios in between. All scenarios were video-recorded for analysis of CPR performance. Results: The 6 months group displayed greater CPR-related knowledge than the control group, 93 (+/- 11)% compared to 65 (+/- 28)% (p &lt; 0.05), the 18 months group scored in between (73 (+/- 23)%). At start the pre-trained groups adhered better to guidelines than the control group; mean violations 0.2 (+/- 0.5), 1.5 (+/- 1.0) and 4.5 (+/- 1.0) for the 6 months, 18 months and control group respectively. Likewise, in the 6 months group no chest compression cycles were delivered at incorrect frequencies whereas 54 (+/- 44)% in the control group (p &lt; 0.05) and 44 (+/- 49)% in 18 months group where incorrectly paced; differences that disappeared during training. Conclusions: This study supports the beneficial effects of MVW-CPR team training with avatars as a method for pre-training, or repetitive training, on CPR-skills among medical students

Clinical Virtual Worlds

The deployment of virtual worlds into clinical practice is gradually becoming an accepted if innovative approach. This chapter offers an overview of the application of virtual worlds in a healthcare settings with specific focus on the application of virtual worlds in clinical practice. When combined with dynamic patient data models, facilitators are able to customize and deliver real time immersive clinical training experiences in a range of contexts. Given that virtual worlds are now being implemented in some of the more complex areas of healthcare, this chapter then explores how the lessons being learnt in this context could be applied more widely to other areas of professional development in the healthcare sector and concludes that direct and valuable lessons from mainstream clinical practice with virtual worlds are ready to be applied now more widely in the healthcare sector. </jats:p