Comparison of virtual patient simulation with mannequin-based simulation for improving clinical performances in assessing and managing clinical deterioration: randomized controlled trial.

PubMed

Liaw, Sok Ying; Chan, Sally Wai-Chi; Chen, Fun-Gee; Hooi, Shing Chuan; Siau, Chiang

2014-09-17

Virtual patient simulation has grown substantially in health care education. A virtual patient simulation was developed as a refresher training course to reinforce nursing clinical performance in assessing and managing deteriorating patients. The objective of this study was to describe the development of the virtual patient simulation and evaluate its efficacy, by comparing with a conventional mannequin-based simulation, for improving the nursing students' performances in assessing and managing patients with clinical deterioration. A randomized controlled study was conducted with 57 third-year nursing students who were recruited through email. After a baseline evaluation of all participants' clinical performance in a simulated environment, the experimental group received a 2-hour fully automated virtual patient simulation while the control group received 2-hour facilitator-led mannequin-based simulation training. All participants were then re-tested one day (first posttest) and 2.5 months (second posttest) after the intervention. The participants from the experimental group completed a survey to evaluate their learning experiences with the newly developed virtual patient simulation. Compared to their baseline scores, both experimental and control groups demonstrated significant improvements (P<.001) in first and second post-test scores. While the experimental group had significantly lower (P<.05) second post-test scores compared with the first post-test scores, no significant difference (P=.94) was found between these two scores for the control group. The scores between groups did not differ significantly over time (P=.17). The virtual patient simulation was rated positively. A virtual patient simulation for a refreshing training course on assessing and managing clinical deterioration was developed. Although the randomized controlled study did not show that the virtual patient simulation was superior to mannequin-based simulation, both simulations have demonstrated

Evaluation of the Use of a Virtual Patient on Student Competence and Confidence in Performing Simulated Clinic Visits.

PubMed

Taglieri, Catherine A; Crosby, Steven J; Zimmerman, Kristin; Schneider, Tulip; Patel, Dhiren K

2017-06-01

Objective. To assess the effect of incorporating virtual patient activities in a pharmacy skills lab on student competence and confidence when conducting real-time comprehensive clinic visits with mock patients. Methods. Students were randomly assigned to a control or intervention group. The control group completed the clinic visit prior to completing virtual patient activities. The intervention group completed the virtual patient activities prior to the clinic visit. Student proficiency was evaluated in the mock lab. All students completed additional exercises with the virtual patient and were subsequently assessed. Student impressions were assessed via a pre- and post-experience survey. Results. Student performance conducting clinic visits was higher in the intervention group compared to the control group. Overall student performance continued to improve in the subsequent module. There was no change in student confidence from pre- to post-experience. Student rating of the ease of use and realistic simulation of the virtual patient increased; however, student rating of the helpfulness of the virtual patient decreased. Despite student rating of the helpfulness of the virtual patient program, student performance improved. Conclusion. Virtual patient activities enhanced student performance during mock clinic visits. Students felt the virtual patient realistically simulated a real patient. Virtual patients may provide additional learning opportunities for students.

Use of simulated patients to evaluate combined oral contraceptive dispensing practices of community pharmacists.

PubMed

Obreli-Neto, Paulo Roque; Pereira, Leonardo Régis Leira; Guidoni, Camilo Molino; de Oliveira Baldoni, André; Marusic, Srecko; de Lyra-Júnior, Divaldo Pereira; de Almeida, Kelsen Luis; Pazete, Ana Claudia Montolezi; do Nascimento, Janaina Dutra; Kos, Mitja; Girotto, Edmarlon; Cuman, Roberto Kenji Nakamura

2013-01-01

Combined oral contraceptive (COC) use is the most commonly used reversible method of birth control. The incorrect use of COCs is frequent and one of the most common causes of unintended pregnancies. Community pharmacists (CPs) are in a strategic position to improve COC use because they are the last health professional to interact with patients before drug use. To evaluate the COC dispensing practices of CPs in a developing country. A cross-sectional study was conducted in community pharmacies of Assis and Ourinhos microregions, Brazil, between June 1, 2012, and October 30, 2012. Four simulated patients (SPs) (with counseled audio recording) visited community pharmacies with a prescription for Ciclo 21(®) (a COC containing ethinyl estradiol 30 mcg + levonorgestrel 15 mcg). The audio recording of every SP visit was listened to independently by 3 researchers to evaluate the COC dispensing practice. The percentage of CPs who performed a screening for safe use of COCs (i.e., taking of patients' medical and family history, and measuring of blood pressure) and provided counseling, as well as the quality of the screening and counseling, were evaluated. Of the 185 CPs contacted, 41 (22.2%) agreed to participate in the study and finished the study protocol. Only 3 CPs asked the SP a question (1 question asked by each professional), and all of the questions were closed-ended, viz., "do you smoke?" (n = 2) and "what is your age?" (n = 1). None of the CPs measured the patient's blood pressure. Six CPs provided counseling when dispensing COCs (drug dosing, 5 CPs; possible adverse effects, 2 CPs), and one CP provided counseling regarding both aspects. The CPs evaluated did not dispense COC appropriately and could influence in the occurrence of negatives therapeutic outcomes such as adverse effects and treatment failure.

Combining simulated patients and simulators: pilot study of hybrid simulation in teaching cardiac auscultation.

PubMed

Friederichs, Hendrik; Weissenstein, Anne; Ligges, Sandra; Möller, David; Becker, Jan C; Marschall, Bernhard

2014-12-01

Auscultation torsos are widely used to teach position-dependent heart sounds and murmurs. To provide a more realistic teaching experience, both whole body auscultation mannequins and torsos have been used in clinical examination skills training at the Medical Faculty of the University of Muenster since the winter term of 2008-2009. This training has since been extended by simulated patients, which are normal, healthy subjects who have undergone attachment of the electronic components of the auscultation mannequins to their chests to mimic pathophysiological conditions ("hybrid models"). The acceptance of this new learning method was examined in the present pilot study. In total, 143 students in their second preclinical year who were participating in auscultation training were randomized into an intervention group (hybrid models) and a control group (auscultation mannequins). One hundred forty-two (99.3%) of these students completed a self-assessment Likert-scale questionnaire regarding different teaching approaches (where 1 = "very poor" to 100 = "very good"). The questionnaire focused on the "value of learning" of different teaching approaches. Direct comparison showed that students evaluated the hybrid models to be significantly more effective than the auscultation mannequins (median: 83 vs. 64, P < 0.001). The cardiac auscultation training was generally assessed positively (median: 88). Additionally, verbal feedback was obtained from simulated patients and tutors (trained students who had successfully passed the course a few semesters earlier). Personal feedback showed high satisfaction from student tutors and simulated patients. Hybrid simulators for teaching cardiac auscultation elucidated positive responses from students, tutors, and simulated patients. Copyright © 2014 The American Physiological Society.

Novel Approach to Simulate Sleep Apnea Patients for Evaluating Positive Pressure Therapy Devices.

PubMed

Isetta, Valentina; Montserrat, Josep M; Santano, Raquel; Wimms, Alison J; Ramanan, Dinesh; Woehrle, Holger; Navajas, Daniel; Farré, Ramon

2016-01-01

Bench testing is a useful method to characterize the response of different automatic positive airway pressure (APAP) devices under well-controlled conditions. However, previous models did not consider the diversity of obstructive sleep apnea (OSA) patients' characteristics and phenotypes. The objective of this proof-of-concept study was to design a new bench test for realistically simulating an OSA patient's night, and to implement a one-night example of a typical female phenotype for comparing responses to several currently-available APAP devices. We developed a novel approach aimed at replicating a typical night of sleep which includes different disturbed breathing events, disease severities, sleep/wake phases, body postures and respiratory artefacts. The simulated female OSA patient example that we implemented included periods of wake, light sleep and deep sleep with positional changes and was connected to ten different APAP devices. Flow and pressure readings were recorded; each device was tested twice. The new approach for simulating female OSA patients effectively combined a wide variety of disturbed breathing patterns to mimic the response of a predefined patient type. There were marked differences in response between devices; only three were able to overcome flow limitation to normalize breathing, and only five devices were associated with a residual apnea-hypopnea index of <5/h. In conclusion, bench tests can be designed to simulate specific patient characteristics, and typical stages of sleep, body position, and wake. Each APAP device behaved differently when exposed to this controlled model of a female OSA patient, and should lead to further understanding of OSA treatment.

Intern as Patient: A Patient Experience Simulation to Cultivate Empathy in Emergency Medicine Residents.

PubMed

Nelson, Sara W; Germann, Carl A; MacVane, Casey Z; Bloch, Rebecca B; Fallon, Timothy S; Strout, Tania D

2018-01-01

Prior work links empathy and positive physician-patient relationships to improved healthcare outcomes. The objective of this study was to analyze a patient experience simulation for emergency medicine (EM) interns as a way to teach empathy and conscientious patient care. We conducted a qualitative descriptive study on an in situ, patient experience simulation held during EM residency orientation. Half the interns were patients brought into the emergency department (ED) by ambulance and half were family members. Interns then took part in focus groups that discussed the experience. Data collected during these focus groups were coded by two investigators using a grounded theory approach and constant comparative methodology. We identified 10 major themes and 28 subthemes in the resulting qualitative data. Themes were in three broad categories: the experience as a patient or family member in the ED; application to current clinical practice; and evaluation of the exercise itself. Interns experienced firsthand the physical discomfort, emotional stress and confusion patients and families endure during the ED care process. They reflected on lessons learned, including the importance of good communication skills, frequent updates on care and timing, and being responsive to the needs and concerns of patients and families. All interns felt this was a valuable orientation experience. Conducting a patient experience simulation may be a practical and effective way to develop empathy in EM resident physicians. Additional research evaluating the effect of participation in the simulation over a longer time period and assessing the effects on residents' actual clinical care is warranted.

Degrees of reality: airway anatomy of high-fidelity human patient simulators and airway trainers.

PubMed

Schebesta, Karl; Hüpfl, Michael; Rössler, Bernhard; Ringl, Helmut; Müller, Michael P; Kimberger, Oliver

2012-06-01

Human patient simulators and airway training manikins are widely used to train airway management skills to medical professionals. Furthermore, these patient simulators are employed as standardized "patients" to evaluate airway devices. However, little is known about how realistic these patient simulators and airway-training manikins really are. This trial aimed to evaluate the upper airway anatomy of four high-fidelity patient simulators and two airway trainers in comparison with actual patients by means of radiographic measurements. The volume of the pharyngeal airspace was the primary outcome parameter. Computed tomography scans of 20 adult trauma patients without head or neck injuries were compared with computed tomography scans of four high-fidelity patient simulators and two airway trainers. By using 14 predefined distances, two cross-sectional areas and three volume parameters of the upper airway, the manikins' similarity to a human patient was assessed. The pharyngeal airspace of all manikins differed significantly from the patients' pharyngeal airspace. The HPS Human Patient Simulator (METI®, Sarasota, FL) was the most realistic high-fidelity patient simulator (6/19 [32%] of all parameters were within the 95% CI of human airway measurements). The airway anatomy of four high-fidelity patient simulators and two airway trainers does not reflect the upper airway anatomy of actual patients. This finding may impact airway training and confound comparative airway device studies.

Clinical Simulation: A Protocol for Evaluation of Mobile Technology.

PubMed

Mather, Carey; Jensen, Sanne; Cummings, Elizabeth

2017-01-01

For mobile technology to be accepted at point of care in healthcare environments there is a need to demonstrate benefits whilst ameliorating the risks and challenges. To provide a standardised approach to evaluation of mobile technology a simulation protocol was developed to provide guidance for its use in healthcare environments. Simulated conditions provide the opportunity to assess intended and unintended consequences and identify potential workarounds when using technology. The protocol can also be used to demonstrate the importance of the development of digital professionalism by end-users prior to students entering the clinical practice setting. The mobile technology protocol was adapted from a health information systems protocol developed and used at the ITX Lab, Denmark for use in other simulation laboratories. Use case scenarios were developed to enable evaluation of mobile technology for mobile learning of nurses, nurse supervisors, students and patients. The scenarios can be used in a range of simulated environments including hospital bedside, outpatient clinic or community settings. A case study exemplar of a nurse and patient is included to demonstrate how the mobile technology protocol can be applied.

Discrete event simulation modelling of patient service management with Arena

NASA Astrophysics Data System (ADS)

Guseva, Elena; Varfolomeyeva, Tatyana; Efimova, Irina; Movchan, Irina

2018-05-01

This paper describes the simulation modeling methodology aimed to aid in solving the practical problems of the research and analysing the complex systems. The paper gives the review of a simulation platform sand example of simulation model development with Arena 15.0 (Rockwell Automation).The provided example of the simulation model for the patient service management helps to evaluate the workload of the clinic doctors, determine the number of the general practitioners, surgeons, traumatologists and other specialized doctors required for the patient service and develop recommendations to ensure timely delivery of medical care and improve the efficiency of the clinic operation.

Assessing Mental Health First Aid Skills Using Simulated Patients

PubMed Central

Chen, Timothy F.; Moles, Rebekah J.; O’Reilly, Claire

2018-01-01

Objective. To evaluate mental health first aid (MHFA) skills using simulated patients and to compare self-reported confidence in providing MHFA with performance during simulated patient roleplays. Methods. Pharmacy students self-evaluated their confidence in providing MHFA post-training. Two mental health vignettes and an assessment rubric based on the MHFA Action Plan were developed to assess students’ observed MHFA skills during audio-recorded simulated patient roleplays. Results. There were 163 students who completed the MHFA training, of which 88% completed self-evaluations. There were 84% to 98% of students who self-reported that they agreed or strongly agreed they were confident providing MHFA. Postnatal depression (PND) and suicide vignettes were randomly assigned to 36 students. More students participating in the PND roleplay took appropriate actions, compared to those participating in the suicide role-play. However, more students participating in the suicide role play assessed alcohol and/or drug use. Ten (71%) participants in the PND roleplay and six (40%) in the suicide roleplay either avoided using suicide-specific terminology completely or used multiple terms rendering their inquiry unclear. Conclusion. Self-evaluated confidence levels in providing MHFA did not always reflect observed performance. Students had difficulty addressing suicide with only half passing the suicide vignette and many avoiding suicide-specific terminology. This indicates that both self-reported and observed behaviors should be used for post-training assessments. PMID:29606711

Effectiveness of patient simulation in nursing education: meta-analysis.

PubMed

Shin, Sujin; Park, Jin-Hwa; Kim, Jung-Hee

2015-01-01

The use of simulation as an educational tool is becoming increasingly prevalent in nursing education, and a variety of simulators are utilized. Based on the results of these studies, nursing facilitators must find ways to promote effective learning among students in clinical practice and classrooms. To identify the best available evidence about the effects of patient simulation in nursing education through a meta-analysis. This study explores quantitative evidence published in the electronic databases: EBSCO, Medline, ScienceDirect, and ERIC. Using a search strategy, we identified 2503 potentially relevant articles. Twenty studies were included in the final analysis. We found significant post-intervention improvements in various domains for participants who received simulation education compared to the control groups, with a pooled random-effects standardized mean difference of 0.71, which is a medium-to-large effect size. In the subgroup analysis, we found that simulation education in nursing had benefits, in terms of effect sizes, when the effects were evaluated through performance, the evaluation outcome was psychomotor skills, the subject of learning was clinical, learners were clinical nurses and senior undergraduate nursing students, and simulators were high fidelity. These results indicate that simulation education demonstrated medium to large effect sizes and could guide nurse educators with regard to the conditions under which patient simulation is more effective than traditional learning methods. Copyright © 2014 Elsevier Ltd. All rights reserved.

Test of a Cardiology Patient Simulator with Students in Fourth-Year Electives.

ERIC Educational Resources Information Center

Ewy, Gordon A.; And Others

1987-01-01

Students at five medical schools participated in an evaluation of a cardiology patient simulator (CPS), a life-size mannequin capable of simulating a wide variety of cardiovascular conditions. The CPS enhances learning both the knowledge and the skills necessary to perform a bedside cardiovascular evaluation. (Author/MLW)

Creating Simulated Microgravity Patient Models

NASA Technical Reports Server (NTRS)

Hurst, Victor; Doerr, Harold K.; Bacal, Kira

2004-01-01

The Medical Operational Support Team (MOST) has been tasked by the Space and Life Sciences Directorate (SLSD) at the NASA Johnson Space Center (JSC) to integrate medical simulation into 1) medical training for ground and flight crews and into 2) evaluations of medical procedures and equipment for the International Space Station (ISS). To do this, the MOST requires patient models that represent the physiological changes observed during spaceflight. Despite the presence of physiological data collected during spaceflight, there is no defined set of parameters that illustrate or mimic a 'space normal' patient. Methods: The MOST culled space-relevant medical literature and data from clinical studies performed in microgravity environments. The areas of focus for data collection were in the fields of cardiovascular, respiratory and renal physiology. Results: The MOST developed evidence-based patient models that mimic the physiology believed to be induced by human exposure to a microgravity environment. These models have been integrated into space-relevant scenarios using a human patient simulator and ISS medical resources. Discussion: Despite the lack of a set of physiological parameters representing 'space normal,' the MOST developed space-relevant patient models that mimic microgravity-induced changes in terrestrial physiology. These models are used in clinical scenarios that will medically train flight surgeons, biomedical flight controllers (biomedical engineers; BME) and, eventually, astronaut-crew medical officers (CMO).

Systematic Review of Patient-Specific Surgical Simulation: Toward Advancing Medical Education.

PubMed

Ryu, Won Hyung A; Dharampal, Navjit; Mostafa, Ahmed E; Sharlin, Ehud; Kopp, Gail; Jacobs, William Bradley; Hurlbert, Robin John; Chan, Sonny; Sutherland, Garnette R

Simulation-based education has been shown to be an effective tool to teach foundational technical skills in various surgical specialties. However, most of the current simulations are limited to generic scenarios and do not allow continuation of the learning curve beyond basic technical skills to prepare for more advanced expertise, such as patient-specific surgical planning. The objective of this study was to evaluate the current medical literature with respect to the utilization and educational value of patient-specific simulations for surgical training. We performed a systematic review of the literature using Pubmed, Embase, and Scopus focusing on themes of simulation, patient-specific, surgical procedure, and education. The study included randomized controlled trials, cohort studies, and case-control studies published between 2005 and 2016. Two independent reviewers (W.H.R. and N.D) conducted the study appraisal, data abstraction, and quality assessment of the studies. The search identified 13 studies that met the inclusion criteria; 7 studies employed computer simulations and 6 studies used 3-dimensional (3D) synthetic models. A number of surgical specialties evaluated patient-specific simulation, including neurosurgery, vascular surgery, orthopedic surgery, and interventional radiology. However, most studies were small in size and primarily aimed at feasibility assessments and early validation. Early evidence has shown feasibility and utility of patient-specific simulation for surgical education. With further development of this technology, simulation-based education may be able to support training of higher-level competencies outside the clinical settingto aid learners in their development of surgical skills. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Does the sex of a simulated patient affect CPR?

PubMed

Kramer, Chelsea E; Wilkins, Matthew S; Davies, Jan M; Caird, Jeff K; Hallihan, Gregory M

2015-01-01

While males and females are equally at risk of sudden cardiac arrest (SCA), females are less likely to be resuscitated. Cardiopulmonary Resuscitation (CPR) may be inhibited by socio-cultural norms about exposing female victims' chests. Empirically confirming this hypothesis is limited by lack of patient simulators modeling realistic female physiques. A commercially-available patient simulator was transformed to evaluate how physical attributes of a patient's sex might influence lay participants who were asked to resuscitate a female versus a male during simulated cardiac arrest. Sixty-nine participants consented to be in the study. Participants were randomly assigned to provide CPR and defibrillation as instructed by a commercially-available automated external defibrillator on a patient simulator presented as either a male or female experiencing cardiac arrest. Rescuers removed significantly more clothing from the male than the female, with men removing less clothing from the female. More rescuers' initial hand placements for CPR were centered between the female's breasts compared to the male, on which placement was distributed across the chest towards the nipples. While rescuers had better hand placement for CPR on the female, both men and women rescuers were reluctant to remove the female's clothing, with men significantly more hesitant. Reticence to remove clothing was often articulated relative to social norms during structured interviews. We suggest that using only male simulators will not allow trainees to experience social differences associated with the care of a female simulated patient. Realistic female patient simulators are needed. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

What can virtual patient simulation offer mental health nursing education?

PubMed

Guise, V; Chambers, M; Välimäki, M

2012-06-01

This paper discusses the use of simulation in nursing education and training, including potential benefits and barriers associated with its use. In particular, it addresses the hitherto scant application of diverse simulation devices and dedicated simulation scenarios in psychiatric and mental health nursing. It goes on to describe a low-cost, narrative-based virtual patient simulation technique which has the potential for wide application within health and social care education. An example of the implementation of this technology in a web-based pilot course for acute mental health nurses is given. This particular virtual patient technique is a simulation type ideally suited to promoting essential mental health nursing skills such as critical thinking, communication and decision making. Furthermore, it is argued that it is particularly amenable to e-learning and blended learning environments, as well as being an apt tool where multilingual simulations are required. The continued development, implementation and evaluation of narrative virtual patient simulations across a variety of health and social care programmes would help ascertain their success as an educational tool. © 2011 Blackwell Publishing.

Development of a patient simulator for teaching and evaluation of the basic cardio-pulmonary reanimation protocol.

PubMed

Villagómez, C; Suarez, F; Gómez, S; Dávila, A; Vega-Gonzalez, A; Gómez-González, J

2011-01-01

Providing appropriate cardio-pulmonary reanimation after cardio-pulmonary arrest is paramount for survival. An effective and low-cost approach to learn and practice the cardio-pulmonary reanimation is through a computerized life-size patient simulator. The present work describes the development of a patient simulator for the Centre of Education and Certification of Medical Aptitudes (CECAM) from the UNAM's Faculty of Medicine. This patient simulator has many new and innovative features, such real-time feedback to the medical student, which improves the whole teaching/learning experience.

Rituals of verification: the role of simulation in developing and evaluating empathic communication.

PubMed

Wear, Delese; Varley, Joseph D

2008-05-01

The use of simulation and standardized patients in medical education is firmly established. In this "point-counterpoint" format we debate not their important function but the extent to which they are used to establish "evidence" for trainees' empathic communication skills beyond their surface manifestations. We also question such issues as the power dynamics implicit in simulation when patients are not really worried or dependent but rather students who are under the evaluative surveillance gaze, often relying on formulaic and superficial behaviors associated with good communication. We offer educative experiences in narrative domains as opportunities to develop the habits of thinking and authentic feeling often absent in evaluative-based simulations.

Evaluating best educational practices, student satisfaction, and self-confidence in simulation: A descriptive study.

PubMed

Zapko, Karen A; Ferranto, Mary Lou Gemma; Blasiman, Rachael; Shelestak, Debra

2018-01-01

The National League for Nursing (NLN) has endorsed simulation as a necessary teaching approach to prepare students for the demanding role of professional nursing. Questions arise about the suitability of simulation experiences to educate students. Empirical support for the effect of simulation on patient outcomes is sparse. Most studies on simulation report only anecdotal results rather than data obtained using evaluative tools. The aim of this study was to examine student perception of best educational practices in simulation and to evaluate their satisfaction and self-confidence in simulation. This study was a descriptive study designed to explore students' perceptions of the simulation experience over a two-year period. Using the Jeffries framework, a Simulation Day was designed consisting of serial patient simulations using high and medium fidelity simulators and live patient actors. The setting for the study was a regional campus of a large Midwestern Research 2 university. The convenience sample consisted of 199 participants and included sophomore, junior, and senior nursing students enrolled in the baccalaureate nursing program. The Simulation Days consisted of serial patient simulations using high and medium fidelity simulators and live patient actors. Participants rotated through four scenarios that corresponded to their level in the nursing program. Data was collected in two consecutive years. Participants completed both the Educational Practices Questionnaire (Student Version) and the Student Satisfaction and Self-Confidence in Learning Scale. Results provide strong support for using serial simulation as a learning tool. Students were satisfied with the experience, felt confident in their performance, and felt the simulations were based on sound educational practices and were important for learning. Serial simulations and having students experience simulations more than once in consecutive years is a valuable method of clinical instruction. When

Enhancing Student Communication Skills Through Arabic Language Competency and Simulated Patient Assessments.

PubMed

Hasan, Sanah; Tarazi, Hamadeh M Khier; Halim Hilal, Dana Abdel

2017-05-01

Objective. To assess student communication and patient management skill with introduction of Arabic and use of simulated patient assessments to a communication and counseling course. Design. Five, 3-hour tutorials (clinical skill laboratory) were added to the course covering: listening and empathic responding, non-verbal communications, interviewing skills, assertiveness, counseling in special situations: conflict, anger, worry or rushed situations, and professional decision making. Arabic content was introduced to the course to enhance Arabic communications and competence among students. Simulated patient assessment was used to evaluate student skills. Students' feedback about course changes was evaluated. Assessment. The course now covers a wider content and Arabic language. Students' scores were similar in the assessment and other assessments within the course and between Arabic and English groups. Students favorably rated the changes in the course and provided constructive feedback on content usefulness and adequacy. Conclusion. Expanding the course to include Arabic language and content and simulated patient assessments enhanced student communication skills.

Enhancing Student Communication Skills Through Arabic Language Competency and Simulated Patient Assessments

PubMed Central

Tarazi, Hamadeh (M. Khier); Halim Hilal, Dana Abdel

2017-01-01

Objective. To assess student communication and patient management skill with introduction of Arabic and use of simulated patient assessments to a communication and counseling course. Design. Five, 3-hour tutorials (clinical skill laboratory) were added to the course covering: listening and empathic responding, non-verbal communications, interviewing skills, assertiveness, counseling in special situations: conflict, anger, worry or rushed situations, and professional decision making. Arabic content was introduced to the course to enhance Arabic communications and competence among students. Simulated patient assessment was used to evaluate student skills. Students’ feedback about course changes was evaluated. Assessment. The course now covers a wider content and Arabic language. Students’ scores were similar in the assessment and other assessments within the course and between Arabic and English groups. Students favorably rated the changes in the course and provided constructive feedback on content usefulness and adequacy. Conclusion. Expanding the course to include Arabic language and content and simulated patient assessments enhanced student communication skills. PMID:28630517

A multimedia patient simulation for teaching and assessing endodontic diagnosis.

PubMed

Littlefield, John H; Demps, Elaine L; Keiser, Karl; Chatterjee, Lipika; Yuan, Cheng H; Hargreaves, Kenneth M

2003-06-01

Teaching and assessing diagnostic skills are difficult due to relatively small numbers of total clinical experiences and a shortage of clinical faculty. Patient simulations could help teach and assess diagnosis by displaying a well-defined diagnostic task, then providing informative feedback and opportunities for repetition and correction of errors. This report describes the development and initial evaluation of SimEndo I, a multimedia patient simulation program that could be used for teaching or assessing endodontic diagnosis. Students interact with a graphical interface that has four pull-down menus and related submenus. In response to student requests, the program presents patient information. Scoring is based on diagnosis of each case by endodontists. Pilot testing with seventy-four junior dental students identified numerous needed improvements to the user interface program. A multi-school field test of the interface program using three patient cases addressed three research questions: 1) How did the field test students evaluate SimEndo I? Overall mean evaluation was 8.1 on a 0 to 10 scale; 2) How many cases are needed to generate a reproducible diagnostic proficiency score for an individual student using the Rimoldi scoring procedure? Mean diagnostic proficiency scores by case ranged from .27 to .40 on a 0 to 1 scale; five cases would produce a score with a 0.80 reliability coefficient; and 3) Did students accurately diagnose each case? Mean correct diagnosis scores by case ranged from .54 to .78 on a 0 to 1 scale. We conclude that multimedia patient simulations offer a promising alternative for teaching and assessing student diagnostic skills.

Improving prospective memory performance with future event simulation in traumatic brain injury patients.

PubMed

Mioni, Giovanna; Bertucci, Erica; Rosato, Antonella; Terrett, Gill; Rendell, Peter G; Zamuner, Massimo; Stablum, Franca

2017-06-01

Previous studies have shown that traumatic brain injury (TBI) patients have difficulties with prospective memory (PM). Considering that PM is closely linked to independent living it is of primary interest to develop strategies that can improve PM performance in TBI patients. This study employed Virtual Week task as a measure of PM, and we included future event simulation to boost PM performance. Study 1 evaluated the efficacy of the strategy and investigated possible practice effects. Twenty-four healthy participants performed Virtual Week in a no strategy condition, and 24 healthy participants performed it in a mixed condition (no strategy - future event simulation). In Study 2, 18 TBI patients completed the mixed condition of Virtual Week and were compared with the 24 healthy controls who undertook the mixed condition of Virtual Week in Study 1. All participants also completed a neuropsychological evaluation to characterize the groups on level of cognitive functioning. Study 1 showed that participants in the future event simulation condition outperformed participants in the no strategy condition, and these results were not attributable to practice effects. Results of Study 2 showed that TBI patients performed PM tasks less accurately than controls, but that future event simulation can substantially reduce TBI-related deficits in PM performance. The future event simulation strategy also improved the controls' PM performance. These studies showed the value of future event simulation strategy in improving PM performance in healthy participants as well as in TBI patients. TBI patients performed PM tasks less accurately than controls, confirming prospective memory impairment in these patients. Participants in the future event simulation condition out-performed participants in the no strategy condition. Future event simulation can substantially reduce TBI-related deficits in PM performance. Future event simulation strategy also improved the controls' PM performance. �

Use of Simulated Patients to Evaluate Combined Oral Contraceptive Dispensing Practices of Community Pharmacists

PubMed Central

Obreli-Neto, Paulo Roque; Pereira, Leonardo Régis Leira; Guidoni, Camilo Molino; Baldoni, André de Oliveira; Marusic, Srecko; de Lyra-Júnior, Divaldo Pereira; de Almeida, Kelsen Luis; Pazete, Ana Claudia Montolezi; do Nascimento, Janaina Dutra; Kos, Mitja; Girotto, Edmarlon; Cuman, Roberto Kenji Nakamura

2013-01-01

Background Combined oral contraceptive (COC) use is the most commonly used reversible method of birth control. The incorrect use of COCs is frequent and one of the most common causes of unintended pregnancies. Community pharmacists (CPs) are in a strategic position to improve COC use because they are the last health professional to interact with patients before drug use. Objective To evaluate the COC dispensing practices of CPs in a developing country. Method A cross-sectional study was conducted in community pharmacies of Assis and Ourinhos microregions, Brazil, between June 1, 2012, and October 30, 2012. Four simulated patients (SPs) (with counseled audio recording) visited community pharmacies with a prescription for Ciclo 21® (a COC containing ethinyl estradiol 30 mcg + levonorgestrel 15 mcg). The audio recording of every SP visit was listened to independently by 3 researchers to evaluate the COC dispensing practice. The percentage of CPs who performed a screening for safe use of COCs (i.e., taking of patients’ medical and family history, and measuring of blood pressure) and provided counseling, as well as the quality of the screening and counseling, were evaluated. Results Of the 185 CPs contacted, 41 (22.2%) agreed to participate in the study and finished the study protocol. Only 3 CPs asked the SP a question (1 question asked by each professional), and all of the questions were closed-ended, viz., “do you smoke?” (n = 2) and “what is your age?” (n = 1). None of the CPs measured the patient’s blood pressure. Six CPs provided counseling when dispensing COCs (drug dosing, 5 CPs; possible adverse effects, 2 CPs), and one CP provided counseling regarding both aspects. Conclusion The CPs evaluated did not dispense COC appropriately and could influence in the occurrence of negatives therapeutic outcomes such as adverse effects and treatment failure. PMID:24324584

Improving Patient Safety through Simulation Training in Anesthesiology: Where Are We?

PubMed Central

2016-01-01

There have been colossal technological advances in the use of simulation in anesthesiology in the past 2 decades. Over the years, the use of simulation has gone from low fidelity to high fidelity models that mimic human responses in a startlingly realistic manner, extremely life-like mannequin that breathes, generates E.K.G, and has pulses, heart sounds, and an airway that can be programmed for different degrees of obstruction. Simulation in anesthesiology is no longer a research fascination but an integral part of resident education and one of ACGME requirements for resident graduation. Simulation training has been objectively shown to increase the skill-set of anesthesiologists. Anesthesiology is leading the movement in patient safety. It is rational to assume a relationship between simulation training and patient safety. Nevertheless there has not been a demonstrable improvement in patient outcomes with simulation training. Larger prospective studies that evaluate the improvement in patient outcomes are needed to justify the integration of simulation training in resident education but ample number of studies in the past 5 years do show a definite benefit of using simulation in anesthesiology training. This paper gives a brief overview of the history and evolution of use of simulation in anesthesiology and highlights some of the more recent studies that have advanced simulation-based training. PMID:26949389

Simulation studies for the evaluation of health information technologies: experiences and results.

PubMed

Ammenwerth, Elske; Hackl, Werner O; Binzer, Kristine; Christoffersen, Tue E H; Jensen, Sanne; Lawton, Kitta; Skjoet, Peter; Nohr, Christian

It is essential for new health information technologies (IT) to undergo rigorous evaluations to ensure they are effective and safe for use in real-world situations. However, evaluation of new health IT is challenging, as field studies are often not feasible when the technology being evaluated is not sufficiently mature. Laboratory-based evaluations have also been shown to have insufficient external validity. Simulation studies seem to be a way to bridge this gap. The aim of this study was to evaluate, using a simulation methodology, the impact of a new prototype of an electronic medication management system on the appropriateness of prescriptions and drug-related activities, including laboratory test ordering or medication changes. This article presents the results of a controlled simulation study with 50 simulation runs, including ten doctors and five simulation patients, and discusses experiences and lessons learnt while conducting the study. Although the new electronic medication management system showed tendencies to improve medication safety when compared with the standard system, this tendency was not significant. Altogether, five distinct situations were identified where the new medication management system did help to improve medication safety. This simulation study provided a good compromise between internal validity and external validity. However, several challenges need to be addressed when undertaking simulation evaluations including: preparation of adequate test cases; training of participants before using unfamiliar applications; consideration of time, effort and costs of conducting the simulation; technical maturity of the evaluated system; and allowing adequate preparation of simulation scenarios and simulation setting. Simulation studies are an interesting but time-consuming approach, which can be used to evaluate newly developed health IT systems, particularly those systems that are not yet sufficiently mature to undergo field evaluation studies.

Does teaching non-technical skills to medical students improve those skills and simulated patient outcome?

PubMed

Hagemann, Vera; Herbstreit, Frank; Kehren, Clemens; Chittamadathil, Jilson; Wolfertz, Sandra; Dirkmann, Daniel; Kluge, Annette; Peters, Jürgen

2017-03-29

The purpose of this study is to evaluate the effects of a tailor-made, non-technical skills seminar on medical student's behaviour, attitudes, and performance during simulated patient treatment. Seventy-seven students were randomized to either a non-technical skills seminar (NTS group, n=43) or a medical seminar (control group, n=34). The human patient simulation was used as an evaluation tool. Before the seminars, all students performed the same simulated emergency scenario to provide baseline measurements. After the seminars, all students were exposed to a second scenario, and behavioural markers for evaluating their non-technical skills were rated. Furthermore, teamwork-relevant attitudes were measured before and after the scenarios, and perceived stress was measured following each simulation. All simulations were also evaluated for various medical endpoints. Non-technical skills concerning situation awareness (p<.01, r=0.5) and teamwork (p<.01, r=0.45) improved from simulation I to II in the NTS group. Decision making improved in both groups (NTS: p<.01, r=0.39; control: p<.01, r=0.46). The attitude 'handling errors' improved significantly in the NTS group (p<.05, r=0.34). Perceived stress decreased from simulation I to II in both groups. Medical endpoints and patients´ outcome did not differ significantly between the groups in simulation II. This study highlights the effectiveness of a single brief seminar on non-technical skills to improve student's non-technical skills. In a next step, to improve student's handling of emergencies and patient outcomes, non-technical skills seminars should be accompanied by exercises and more broadly embedded in the medical school curriculum.

Evaluation of effective dose with chest digital tomosynthesis system using Monte Carlo simulation

NASA Astrophysics Data System (ADS)

Kim, Dohyeon; Jo, Byungdu; Lee, Youngjin; Park, Su-Jin; Lee, Dong-Hoon; Kim, Hee-Joung

2015-03-01

Chest digital tomosynthesis (CDT) system has recently been introduced and studied. This system offers the potential to be a substantial improvement over conventional chest radiography for the lung nodule detection and reduces the radiation dose with limited angles. PC-based Monte Carlo program (PCXMC) simulation toolkit (STUK, Helsinki, Finland) is widely used to evaluate radiation dose in CDT system. However, this toolkit has two significant limits. Although PCXMC is not possible to describe a model for every individual patient and does not describe the accurate X-ray beam spectrum, Geant4 Application for Tomographic Emission (GATE) simulation describes the various size of phantom for individual patient and proper X-ray spectrum. However, few studies have been conducted to evaluate effective dose in CDT system with the Monte Carlo simulation toolkit using GATE. The purpose of this study was to evaluate effective dose in virtual infant chest phantom of posterior-anterior (PA) view in CDT system using GATE simulation. We obtained the effective dose at different tube angles by applying dose actor function in GATE simulation which was commonly used to obtain the medical radiation dosimetry. The results indicated that GATE simulation was useful to estimate distribution of absorbed dose. Consequently, we obtained the acceptable distribution of effective dose at each projection. These results indicated that GATE simulation can be alternative method of calculating effective dose in CDT applications.

Development of a preoperative simulation technique for carotid endarterectomy in patients with contrast contraindications.

PubMed

Nomura, Shunsuke; Hayashi, Motohiro; Ishikawa, Tatsuya; Yamaguchi, Koji; Kawamata, Takakazu

2018-05-19

Vascular and osteological parameters, such as the heights of the carotid bifurcation and distal end of the plaque, are important preoperative considerations for patients undergoing carotid stenosis procedures such as carotid endarterectomy. However, for patients with contrast contraindications such as allergies or nephropathies, three-dimensional computed tomography angiography (3D-CTA) is unavailable, and preoperative evaluation remains challenging. In the present study, we aimed to develop a preoperative simulation for use in patients with contrast-contraindicated carotid stenosis. Images from non-contrast neck CT and magnetic resonance imaging obtained without the Leksell stereotactic frame were uploaded to GammaPlan. Following delineation of various structures, we performed preoperative simulations to determine the relationships between vascular and osteological structures. We applied this technique in 10 patients with carotid stenosis to verify the accuracy of the simulation. In all patients, the GammaPlan simulation successfully visualized the heights of the carotid bifurcation and distal end of the plaque without the use of contrast medium. Furthermore, information regarding the location of internal arterial structures, such as calcifications and unstable plaques, could be incorporated into GammaPlan images. Thereafter, we verified simulation accuracy by comparing the simulation results with 3D-CTA and operative findings. Simulations created using GammaPlan can be used to obtain accurate vascular and osteological information regarding the heights of the carotid bifurcation and distal end of the plaque, without the use of contrast medium. The reconstruction of delineated structures using this technique may be effective for preoperative evaluation in patients with contrast-contraindicated carotid stenosis. Copyright © 2018 Elsevier Inc. All rights reserved.

Assessment of Robotic Patient Simulators for Training in Manual Physical Therapy Examination Techniques

PubMed Central

Ishikawa, Shun; Okamoto, Shogo; Isogai, Kaoru; Akiyama, Yasuhiro; Yanagihara, Naomi; Yamada, Yoji

2015-01-01

Robots that simulate patients suffering from joint resistance caused by biomechanical and neural impairments are used to aid the training of physical therapists in manual examination techniques. However, there are few methods for assessing such robots. This article proposes two types of assessment measures based on typical judgments of clinicians. One of the measures involves the evaluation of how well the simulator presents different severities of a specified disease. Experienced clinicians were requested to rate the simulated symptoms in terms of severity, and the consistency of their ratings was used as a performance measure. The other measure involves the evaluation of how well the simulator presents different types of symptoms. In this case, the clinicians were requested to classify the simulated resistances in terms of symptom type, and the average ratios of their answers were used as performance measures. For both types of assessment measures, a higher index implied higher agreement among the experienced clinicians that subjectively assessed the symptoms based on typical symptom features. We applied these two assessment methods to a patient knee robot and achieved positive appraisals. The assessment measures have potential for use in comparing several patient simulators for training physical therapists, rather than as absolute indices for developing a standard. PMID:25923719

Learning outcomes associated with patient simulation method in pharmacotherapy education: an integrative review.

PubMed

Aura, Suvi M; Sormunen, Marjorita S T; Jordan, Sue E; Tossavainen, Kerttu A; Turunen, Hannele E

2015-06-01

The aims of this systematic integrative review were to identify evidence for the use of patient simulation teaching methods in pharmacotherapy education and to explore related learning outcomes. A systematic literature search was conducted using 6 databases as follows: CINAHL, PubMed, SCOPUS, ERIC, MEDIC, and the Cochrane Library, using the key words relating to patient simulation and pharmacotherapy. The methodological quality of each study was evaluated. Eighteen articles met the inclusion criteria. The earliest article was published in 2005. The selected research articles were subjected to qualitative content analysis. Patient simulation has been used in pharmacotherapy education for preregistration nursing, dental, medical, and pharmacy students and for the continuing education of nurses. Learning outcomes reported were summarized as follows: (1) commitment to pharmacotherapy learning, (2) development of pharmacotherapy evaluation skills, (3) improvement in pharmacotherapy application skills, and (4) knowledge and understanding of pharmacotherapy. To develop effective teaching methods and ensure health care professionals' competence in medication management, further research is needed to determine the educational and clinical effectiveness of simulation teaching methods.

Evaluation of trainees' ability to perform obstetrical ultrasound using simulation: challenges and opportunities.

PubMed

Chalouhi, Gihad E; Bernardi, Valeria; Gueneuc, Alexandra; Houssin, Isabelle; Stirnemann, Julien J; Ville, Yves

2016-04-01

Evaluation of trainee's ability in obstetrical ultrasound is a time-consuming process, which requires involving patients as volunteers. With the use of obstetrical ultrasound simulators, virtual reality could help in assessing competency and evaluating trainees in this field. The objective of the study was to test the validity of an obstetrical ultrasound simulator as a tool for evaluating trainees following structured training by comparing scores obtained on obstetrical ultrasound simulator with those obtained on volunteers and by assessing correlations between scores of images and of dexterity given by 2 blinded examiners. Trainees, taking the 2013 French national examination for the practice of obstetrical ultrasound were asked to obtain standardized ultrasound planes both on volunteer pregnant women and on an obstetrical ultrasound simulator. These planes included measurements of biparietal diameter, abdominal circumference, and femur length as well as reference planes for cardiac 4-chamber and outflow tracts, kidneys, stomach/diaphragm, spine, and face. Images were stored and evaluated subsequently by 2 national examiners who scored each picture according to previously established quality criteria. Dexterity was also evaluated and subjectively scored between 0 and 10. The Raghunathan's modification of Pearson, Filon's z, Spearman's rank correlation, and analysis of variance tests were used to assess correlations between the scores by the 2 examiners and scores of dexterity and also to compare the final scores between the 2 different methods. We evaluated 29 trainees. The mean dexterity scores in simulation (6.5 ± 2.0) and real examination (5.9 ± 2.3) were comparable (P = .31). Scores with an obstetrical ultrasound simulator were significantly higher than those obtained on volunteers (P = .027). Nevertheless, there was a good correlation between the scores of the 2 examiners judging on simulation (R = 0.888) and on volunteers (R = 0.873) (P = .81). An

An intersubject variable regional anesthesia simulator with a virtual patient architecture.

PubMed

Ullrich, Sebastian; Grottke, Oliver; Fried, Eduard; Frommen, Thorsten; Liao, Wei; Rossaint, Rolf; Kuhlen, Torsten; Deserno, Thomas M

2009-11-01

The main purpose is to provide an intuitive VR-based training environment for regional anesthesia (RA). The research question is how to process subject-specific datasets, organize them in a meaningful way and how to perform the simulation for peripheral regions. We propose a flexible virtual patient architecture and methods to process datasets. Image acquisition, image processing (especially segmentation), interactive nerve modeling and permutations (nerve instantiation) are described in detail. The simulation of electric impulse stimulation and according responses are essential for the training of peripheral RA and solved by an approach based on the electric distance. We have created an XML-based virtual patient database with several subjects. Prototypes of the simulation are implemented and run on multimodal VR hardware (e.g., stereoscopic display and haptic device). A first user pilot study has confirmed our approach. The virtual patient architecture enables support for arbitrary scenarios on different subjects. This concept can also be used for other simulators. In future work, we plan to extend the simulation and conduct further evaluations in order to provide a tool for routine training for RA.

Interprofessional Education Among Student Health Professionals Using Human Patient Simulation

PubMed Central

Chmil, Joyce V.

2014-01-01

Objective. To describe the planning, implementation, and outcomes of an interprofessional education clinical laboratory facilitated through human patient simulation. Design. An interprofessional education clinical laboratory was developed with a patient-care scenario of acute exacerbation of heart failure that incorporated the use of a high-fidelity patient simulator. Pharmacy and nursing students assumed clinical roles in this realistic scenario and collaborated to diagnose and treat the patient. Assessment. Student attitudes toward and readiness to participate in interprofessional education improved following participation in the laboratory. Students reported that the greatest benefit of the experience was in their communication skills. Conclusion. Students’ ability to participate in interprofessional education experiences and their attitudes toward them improved following participation in this curricular initiative. Further evaluation of the impact of interprofessional education on student learning outcomes and changes in practice is warranted. PMID:24954934

Patients with Chronic Conditions: Simulate to Educate?

ERIC Educational Resources Information Center

Lefèvre, Thomas; Gagnayre, Rémi; Gignon, Maxime

2017-01-01

Simulation in healthcare in an way to train professionals but it is not yet use commonly to train patient or their caregivers. Recently, it has been suggested to extend simulations to patients with chronic conditions. Simulations could help patients and caregivers to acquire psychosocial and self-management skills. This approach proved to be…

Simulation in interprofessional education for patient-centred collaborative care.

PubMed

Baker, Cynthia; Pulling, Cheryl; McGraw, Robert; Dagnone, Jeffrey Damon; Hopkins-Rosseel, Diana; Medves, Jennifer

2008-11-01

This paper is a report of preliminary evaluations of an interprofessional education through simulation project by focusing on learner and teacher reactions to the pilot modules. Approaches to interprofessional education vary widely. Studies indicate, however, that active, experiential learning facilitate it. Patient simulators require learners to incorporate knowing, being and doing in action. A theoretically based competency framework was developed to guide interprofessional education using simulation. The framework includes a typology of shared, complementary and profession-specific competencies. Each competency type is associated with an intraprofessional, multiprofessional, or interprofessional teaching modality and with the professional composition of learner groups. The project is guided by an action research approach in which ongoing evaluation generates knowledge to modify and further develop it. Preliminary evaluations of the first pilot module, cardiac resuscitation rounds, among 101 nursing students, 42 medical students and 70 junior medical residents were conducted in 2005-2007 using a questionnaire with rating scales and open-ended questions. Another 20 medical students, 7 junior residents and 45 nursing students completed a questionnaire based on the Interdisciplinary Education Perception scale. Simulation-based learning provided students with interprofessional activities they saw as relevant for their future as practitioners. They embraced both the interprofessional and simulation components enthusiastically. Attitudinal scores and responses were consistently positive among both medical and nursing students. Interprofessional education through simulation offers a promising approach to preparing future healthcare professionals for the collaborative models of healthcare delivery being developed internationally.

Learning outcomes evaluation of a simulation-based introductory course to anaesthesia.

PubMed

Rábago, J L; López-Doueil, M; Sancho, R; Hernández-Pinto, P; Neira, N; Capa, E; Larraz, E; Redondo-Figuero, C G; Maestre, J M

2017-10-01

An increased number of errors and reduced patient safety have been reported during the incorporation of residents, as this period involves learning new skills. The objectives were to evaluate the learning outcomes of an immersive simulation boot-camp for incoming residents before starting the clinical rotations. Airway assessment, airway control with direct laryngoscopy, and epidural catheterization competencies were evaluated. Twelve first-year anaesthesiology residents participated. A prospective study to evaluate transfer of endotracheal intubation skills learned at the simulation centre to clinical practice (primary outcome) was conducted. A checklist of 28 skills and behaviours was used to assess the first supervised intubation performed during anaesthesia induction in ASA I/II patients. Secondary outcome was self-efficacy to perform epidural catheterization. A satisfaction survey was also performed. Seventy-five percent of residents completed more than 21 out of 28 skills and behaviours to assess and control the airway during their first intubation in patients. Twelve items were performed by all residents and 5 by half of them. More than 83% of participants reported a high level of self-efficacy in placing an epidural catheter. All participants would recommend the course to their colleagues. A focused intensive simulation-based boot-camp addressing key competencies required to begin anaesthesia residency was well received, and led to transfer of airway management skills learned to clinical settings when performing for first time on patients, and to increased self-reported efficacy in performing epidural catheterization. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

Patient identification errors are common in a simulated setting.

PubMed

Henneman, Philip L; Fisher, Donald L; Henneman, Elizabeth A; Pham, Tuan A; Campbell, Megan M; Nathanson, Brian H

2010-06-01

We evaluate the frequency and accuracy of health care workers verifying patient identity before performing common tasks. The study included prospective, simulated patient scenarios with an eye-tracking device that showed where the health care workers looked. Simulations involved nurses administering an intravenous medication, technicians labeling a blood specimen, and clerks applying an identity band. Participants were asked to perform their assigned task on 3 simulated patients, and the third patient had a different date of birth and medical record number than the identity information on the artifact label specific to the health care workers' task. Health care workers were unaware that the focus of the study was patient identity. Sixty-one emergency health care workers participated--28 nurses, 16 technicians, and 17 emergency service associates--in 183 patient scenarios. Sixty-one percent of health care workers (37/61) caught the identity error (61% nurses, 94% technicians, 29% emergency service associates). Thirty-nine percent of health care workers (24/61) performed their assigned task on the wrong patient (39% nurses, 6% technicians, 71% emergency service associates). Eye-tracking data were available for 73% of the patient scenarios (133/183). Seventy-four percent of health care workers (74/100) failed to match the patient to the identity band (87% nurses, 49% technicians). Twenty-seven percent of health care workers (36/133) failed to match the artifact to the patient or the identity band before performing their task (33% nurses, 9% technicians, 33% emergency service associates). Fifteen percent (5/33) of health care workers who completed the steps to verify patient identity on the patient with the identification error still failed to recognize the error. Wide variation exists among health care workers verifying patient identity before performing everyday tasks. Education, process changes, and technology are needed to improve the frequency and accuracy of

Patient Simulators Train Emergency Caregivers

NASA Technical Reports Server (NTRS)

2014-01-01

Johnson Space Center teamed up with Sarasota, Florida-based METI (now CAE Healthcare) through the STTR program to ruggedize the company’s patient simulators for training astronauts in microgravity environments. The design modifications were implemented in future patient simulators that are now used to train first responders in the US military as well as fire departments and other agencies that work in disaster zones.

Teaching cardiopulmonary auscultation in workshops using a virtual patient simulation technology - A pilot study.

PubMed

Pereira, D; Gomes, P; Faria, S; Cruz-Correia, R; Coimbra, M

2016-08-01

Auscultation is currently both a powerful screening tool, providing a cheap and quick initial assessment of a patient's clinical condition, and a hard skill to master. The teaching of auscultation in Universities is today reduced to an unsuitable number of hours. Virtual patient simulators can potentially mitigate this problem, by providing an interesting high-quality alternative to teaching with real patients or patient simulators. In this paper we evaluate the pedagogical impact of using a virtual patient simulation technology in a short workshop format for medical students, training them to detect cardiac pathologies. Results showed a significant improvement (+16%) in the differentiation between normal and pathological cases, although longer duration formats seem to be needed to accurately identify specific pathologies.

Recent advancements in medical simulation: patient-specific virtual reality simulation.

PubMed

Willaert, Willem I M; Aggarwal, Rajesh; Van Herzeele, Isabelle; Cheshire, Nicholas J; Vermassen, Frank E

2012-07-01

Patient-specific virtual reality simulation (PSVR) is a new technological advancement that allows practice of upcoming real operations and complements the established role of VR simulation as a generic training tool. This review describes current developments in PSVR and draws parallels with other high-stake industries, such as aviation, military, and sports. A review of the literature was performed using PubMed and Internet search engines to retrieve data relevant to PSVR in medicine. All reports pertaining to PSVR were included. Reports on simulators that did not incorporate a haptic interface device were excluded from the review. Fifteen reports described 12 simulators that enabled PSVR. Medical procedures in the field of laparoscopy, vascular surgery, orthopedics, neurosurgery, and plastic surgery were included. In all cases, source data was two-dimensional CT or MRI data. Face validity was most commonly reported. Only one (vascular) simulator had undergone face, content, and construct validity. Of the 12 simulators, 1 is commercialized and 11 are prototypes. Five simulators have been used in conjunction with real patient procedures. PSVR is a promising technological advance within medicine. The majority of simulators are still in the prototype phase. As further developments unfold, the validity of PSVR will have to be examined much like generic VR simulation for training purposes. Nonetheless, similar to the aviation, military, and sport industries, operative performance and patient safety may be enhanced by the application of this novel technology.

Design and evaluation of a simulation for pediatric dentistry in virtual worlds.

PubMed

Papadopoulos, Lazaros; Pentzou, Afroditi-Evaggelia; Louloudiadis, Konstantinos; Tsiatsos, Thrasyvoulos-Konstantinos

2013-10-29

Three-dimensional virtual worlds are becoming very popular among educators in the medical field. Virtual clinics and patients are already used for case study and role play in both undergraduate and continuing education levels. Dental education can also take advantage of the virtual world's pedagogical features in order to give students the opportunity to interact with virtual patients (VPs) and practice in treatment planning. The objective of this study was to design and evaluate a virtual patient as a supplemental teaching tool for pediatric dentistry. A child VP, called Erietta, was created by utilizing the programming and building tools that online virtual worlds offer. The case is about an eight-year old girl visiting the dentist with her mother for the first time. Communication techniques such as Tell-Show-Do and parents' interference management were the basic elements of the educational scenario on which the VP was based. An evaluation of the simulation was made by 103 dental students in their fourth year of study. Two groups were formed: an experimental group which was exposed to the simulation (n=52) and a control group which did not receive the simulation (n=51). At the end, both groups were asked to complete a knowledge questionnaire and the results were compared. A statistically significant difference between the two groups was found by applying a t test for independent samples (P<.001), showing a positive learning effect from the VP. The majority of the participants evaluated the aspects of the simulation very positively while 69% (36/52) of the simulation group expressed their preference for using this module as an additional teaching tool. This study demonstrated that a pediatric dentistry VP built in a virtual world offers significant learning potential when used as a supplement to the traditional teaching techniques.

Human Patient Simulations: Evaluation of Self-Efficacy and Anxiety in Clinical Skills Performance

ERIC Educational Resources Information Center

Onovo, Grace N.

2013-01-01

The relationship between self-efficacy (self-confidence) and anxiety levels, and the use of Human Patient Simulations (HPS) as a teaching-learning strategy, has not been sufficiently studied in the area of clinical nursing education. Despite the evidence in the literature indicating that HPS increases self-efficacy/self-confidence and decreases…

Do Simulations Enhance Student Learning? An Empirical Evaluation of an IR Simulation

ERIC Educational Resources Information Center

Shellman, Stephen M.; Turan, Kursad

2006-01-01

There is a nascent literature on the question of whether active learning methods, and in particular simulation methods, enhance student learning. In this article, the authors evaluate the utility of an international relations simulation in enhancing learning objectives. Student evaluations provide evidence that the simulation process enhances…

The Many Faces of Patient-Centered Simulation: Implications for Researchers.

PubMed

Arnold, Jennifer L; McKenzie, Frederic Rick D; Miller, Jane Lindsay; Mancini, Mary E

2018-06-01

Patient-centered simulation for nonhealthcare providers is an emerging and innovative application for healthcare simulation. Currently, no consensus exists on what patient-centered simulation encompasses and outcomes research in this area is limited. Conceptually, patient-centered simulation aligns with the principles of patient- and family-centered care bringing this educational tool directly to patients and caregivers with the potential to improve patient care and outcomes. This descriptive article is a summary of findings presented at the 2nd International Meeting for Simulation in Healthcare Research Summit. Experts in the field delineated a categorization for better describing patient-centered simulation and reviewed the literature to identify a research agenda. Three types of patient-centered simulation patient-directed, patient-driven, and patient-specific are presented with research priorities identified for each. Patient-centered simulation has been shown to be an effective educational tool and has the potential to directly improve patient care outcomes. Presenting a typology for patient-centered simulation provides direction for future research.

Embedding a Virtual Patient Simulator in an Interactive Surgical lecture.

PubMed

Kleinert, Robert; Plum, Patrick; Heiermann, Nadine; Wahba, Roger; Chang, De-Huan; Hölscher, Arnulf H; Stippel, Dirk L

2016-01-01

Lectures are traditionally used for teaching declarative knowledge. One established tool for clinical education is the demonstration of a real patient. The use of real patients in the daily clinical environment is increasingly difficult. The use of a virtual patient simulator (VPS) can potentially circumvent these problems. Unlimited availability and the opportunity of an electronic feedback system could possibly enrich traditional lectures by enabling more interactivity that meets the expectations of the current student generation. As students face the consequences of their own decisions they take a more active role in the lecture. VPS links declarative knowledge with visual perception that is known to influence students' motivation. Until now, there have been no reports covering the usage and validation of interactive VPS for supporting traditional lectures. In this study, we (1) described the development of a custom-made three-dimensional (3D) VPS for supporting the traditional lecture and (2) performed a feasibility study including an initial assessment of this novel educational concept. Conceptualization included definition of curricular content, technical realization and validation. A custom-made simulator was validated with 68 students. The degree of student acceptance was evaluated. Furthermore, the effect on knowledge gain was determined by testing prelecture and postlecture performance. A custom-made simulator prototype that displays a 3D virtual clinic environment was developed and linked to a PowerPoint presentation. Students were able to connect to the simulator via electronic devices (smartphones and tablets) and to control the simulator via majority vote. The simulator was used in 6 lectures and validated in 2 lectures with 68 students each. Student acceptance and their opinion about effectiveness and applicability were determined. Students showed a high level of motivation when using the simulator as most of them had fun using it. Effect on

Numerical simulation of cerebrospinal fluid hydrodynamics in the healing process of hydrocephalus patients

NASA Astrophysics Data System (ADS)

Gholampour, S.; Fatouraee, N.; Seddighi, A. S.; Seddighi, A.

2017-05-01

Three-dimensional computational models of the cerebrospinal fluid (CSF) flow and brain tissue are presented for evaluation of their hydrodynamic conditions before and after shunting for seven patients with non-communicating hydrocephalus. One healthy subject is also modeled to compare deviated patients data to normal conditions. The fluid-solid interaction simulation shows the CSF mean pressure and pressure amplitude (the superior index for evaluation of non-communicating hydrocephalus) in patients at a greater point than those in the healthy subject by 5.3 and 2 times, respectively.

Importance of preclinical evaluation of wear in hip implant designs using simulator machines.

PubMed

Trommer, Rafael Mello; Maru, Márcia Marie

2017-01-01

Total hip arthroplasty (THA) is a surgical procedure that involves the replacement of the damaged joint of the hip by an artificial device. Despite the recognized clinical success of hip implants, wear of the articulating surfaces remains as one of the critical issues influencing performance. Common material combinations used in hip designs comprise metal-on-polymer (MoP), ceramic-on-polymer (CoP), metal-on-metal (MoM), and ceramic-on-ceramic (CoC). However, when the design of the hip implant is concerned besides the materials used, several parameters can influence its wear performance. In this scenario, where the safety and efficacy for the patient are the main issues, it is fundamental to evaluate and predict the wear rate of the hip implant design before its use in THA. This is one of the issues that should be taken into account in the preclinical evaluation step of the product, in which simulated laboratory tests are necessary. However, it is fundamental that the applied motions and loads can reproduce the wear mechanisms physiologically observed in the patient. To replicate the in vivo angular displacements and loadings, special machines known as joint simulators are employed. This article focuses on the main characteristics related to the wear simulation of hip implants using mechanical simulators, giving information to surgeons, researchers, regulatory bodies, etc., about the importance of preclinical wear evaluation. A critical analysis is performed on the differences in the principles of operation of simulators and their effects on the final results, and about future trends in wear simulation.

The Design, Development, and Evaluation of an Evaluative Computer Simulation.

ERIC Educational Resources Information Center

Ehrlich, Lisa R.

This paper discusses evaluation design considerations for a computer based evaluation simulation developed at the University of Iowa College of Medicine in Cardiology to assess the diagnostic skills of primary care physicians and medical students. The simulation developed allows for the assessment of diagnostic skills of physicians in the…

After-hours/on-call experience during primary care nurse practitioner education utilizing standard scenarios and simulated patients.

PubMed

Kelly, Michelle M; Blunt, Elizabeth; Nestor, Kelly

2017-12-01

Few nurse practitioner (NP) programs include an after-hours/on-call component in their clinical preparation of NP students. This role is expected in many primary and specialty care practices, and is one that students feel unprepared to competently navigate. Utilizing simulated callers as patients or parents, NP students participated in a simulated after-hours/on-call experience that included receiving the call, managing the patient, and submitting documentation of the encounter. Students completed pre- and postparticipation evaluations, and were evaluated by the simulated patient callers and faculty using standardized evaluation tools. NP students rated the experience as an educationally valuable experience despite feeling anxious and nervous about the experience. Several essential skills were identified including critical thinking, clear communication, self-confidence, and access to resources. After participation NP students were more receptive to an NP position with an on-call component. Inclusion of a simulated on-call experience is a feasible component of NP education and should be added to the NP curriculum. ©2017 American Association of Nurse Practitioners.

Simulated Patients in Physical Therapy Education: Systematic Review and Meta-Analysis.

PubMed

Pritchard, Shane A; Blackstock, Felicity C; Nestel, Debra; Keating, Jenny L

2016-09-01

Traditional models of physical therapy clinical education are experiencing unprecedented pressures. Simulation-based education with simulated (standardized) patients (SPs) is one alternative that has significant potential value, and implementation is increasing globally. However, no review evaluating the effects of SPs on professional (entry-level) physical therapy education is available. The purpose of this study was to synthesize and critically appraise the findings of empirical studies evaluating the contribution of SPs to entry-level physical therapy education, compared with no SP interaction or an alternative education strategy, on any outcome relevant to learning. A systematic search was conducted of Ovid MEDLINE, PubMed, AMED, ERIC, and CINAHL Plus databases and reference lists of included articles, relevant reviews, and gray literature up to May 2015. Articles reporting quantitative or qualitative data evaluating the contribution of SPs to entry-level physical therapy education were included. Two reviewers independently extracted study characteristics, intervention details, and quantitative and qualitative evaluation data from the 14 articles that met the eligibility criteria. Pooled random-effects meta-analysis indicated that replacing up to 25% of authentic patient-based physical therapist practice with SP-based education results in comparable competency (mean difference=1.55/100; 95% confidence interval=-1.08, 4.18; P=.25). Thematic analysis of qualitative data indicated that students value learning with SPs. Assumptions were made to enable pooling of data, and the search strategy was limited to English. Simulated patients appear to have an effect comparable to that of alternative educational strategies on development of physical therapy clinical practice competencies and serve a valuable role in entry-level physical therapy education. However, available research lacks the rigor required for confidence in findings. Given the potential advantages for

Development of a patient-specific surgical simulator for pediatric laparoscopic procedures.

PubMed

Saber, Nikoo R; Menon, Vinay; St-Pierre, Jean C; Looi, Thomas; Drake, James M; Cyril, Xavier

2014-01-01

The purpose of this study is to develop and evaluate a pediatric patient-specific surgical simulator for the planning, practice, and validation of laparoscopic surgical procedures prior to intervention, initially focusing on the choledochal cyst resection and reconstruction scenario. The simulator is comprised of software elements including a deformable body physics engine, virtual surgical tools, and abdominal organs. Hardware components such as haptics-enabled hand controllers and a representative endoscopic tool have also been integrated. The prototype is able to perform a number of surgical tasks and further development work is under way to simulate the complete procedure with acceptable fidelity and accuracy.

Comparison of self, physician, and simulated patient ratings of pharmacist performance in a family practice simulator.

PubMed

Lau, Elaine; Dolovich, Lisa; Austin, Zubin

2007-03-01

The Family Practice Simulator (FPS) was piloted as a teaching, learning, and assessment opportunity for pharmacists making the transition into primary care practice. During this one-day simulation of a typical day in a family physician's office, nine pharmacists rotated through a series of 13 OSCE stations where they interacted with physicians, patients, nurses and office staff while completing primary care activities and receiving performance evaluations. Pharmacists' performance ratings from self, physician, and standardized patient evaluations were compared using Global Rating Scales (GRS) scores and station-specific key points checklists. The mean (SD) overall GRS scores obtained by pharmacists across all stations in the FPS were 4.56 (SD = 0.60) from standardized patients, 3.95 (SD = 0.63) from physicians, and 3.60 (SD = 0.63) from self-assessment (out of a maximum score of 5). Agreement between pharmacists' and patients' GRS ratings ranged from moderate to good (generalizability coefficient (G) = 0.45 to 0.72) for all except one station. Agreement in GRS scores between pharmacists and physicians was at most fair for every station (G = 0.02 - 0.26). There was fair agreement on key points scores between pharmacists and patients (weighted kappa = 27%; 95% CI 7%, 47%) and moderate agreement between pharmacists and physicians (weighted kappa = 45%; 95% CI 21%, 70%). Although there was at best moderate agreement in rating scores between pharmacists, standardized patients, and physicians, the FPS provided an important opportunity to measure expectations regarding the professional role, responsibilities, and performance of pharmacists from a multi-professional perspective, thus better preparing pharmacists for integration into primary care practice. Differences in agreement may have been due to different preconceptions and expectations among raters.

Advancing renal education: hybrid simulation, using simulated patients to enhance realism in haemodialysis education.

PubMed

Dunbar-Reid, Kylie; Sinclair, Peter M; Hudson, Denis

2015-06-01

Simulation is a well-established and proven teaching method, yet its use in renal education is not widely reported. Criticisms of simulation-based teaching include limited realism and a lack of authentic patient interaction. This paper discusses the benefits and challenges of high-fidelity simulation and suggests hybrid simulation as a complementary model to existing simulation programmes. Through the use of a simulated patient, hybrid simulation can improve the authenticity of renal simulation-based education while simultaneously teaching and assessing technologically enframed caring. © 2015 European Dialysis and Transplant Nurses Association/European Renal Care Association.

[Doctor-Patient Communication Training in Simulated Situations: Emotions and Perceptions of Simulated Patients during Patient-Centered Conversations].

PubMed

Butollo, Maria Asisa; Holzinger, Anita; Wagner-Menghin, Michaela

2018-04-13

The use of simulated patients (SPs) for doctor-patient communication training has been established in medical curricula as an important didactic method. The study addresses the question, if patients' emotions and perceptions are represented adequately in patient-centered communication. 22 of 37 SPs of the Medical University of Vienna (12 women, 10 men) were asked openly about their feelings after having acted as an SP in a semi-structured interview, which employed the Critical Incident Technique. The interviews were recorded, transcribed, separated into situational analysis units und analyzed deductively; we used the evidence based qualities of patient-centered communication and the "Nationaler Kompetenzbasierter Lernzielkatalog Medizin" as a guideline. Out of 192 analysis units, 67 were evaluated as positive and 125 as negative. The SPs reported positive feelings, such as perceiving "stability and trust in relationships" (22%), perception of congruence (15%), acceptance (27%) and empathy (36%). As to negative feelings, SPs reported "perceiving instability" (18%), "incongruence" (11%), "lack of acceptance" (40%) and "lack of empathy" (30%). Additionally, 50% of SPs were positively affected when observing students' learning success. When SPs perceived patient-centered communication, they reported positive emotions. A lack of patient centeredness, on the contrary, provoked negative emotions. An empathic attitude, as well as a "lack of acceptance" with contrary effects had the strongest influence on the SPs' mental state. The reaction of SPs to patient centeredness is sufficiently authentic to reach learning objectives, however it is also affected by reactions of SPs to the learning success of students, which is irrelevant for the real-life doctor-patient interaction. SP reactions are affected by students' attitudes. Students should therefore be prepared well before interacting with SPs in a roleplay setting. While SPs' behavior is authentic in patient

Simulation Genres and Student Uptake: The Patient Health Record in Clinical Nursing Simulations

ERIC Educational Resources Information Center

Campbell, Lilly

2017-01-01

Drawing on fieldwork, this article examines nursing students' design and use of a patient health record during clinical simulations, where small teams of students provide nursing care for a robotic patient. The student-designed patient health record provides a compelling example of how simulation genres can both authentically coordinate action…

Effectiveness of Standardized Patient Simulations in Teaching Clinical Communication Skills to Dental Students.

PubMed

McKenzie, Carly T; Tilashalski, Ken R; Peterson, Dawn Taylor; White, Marjorie Lee

2017-10-01

The aim of this study was to investigate dental students' long-term retention of clinical communication skills learned in a second-year standardized patient simulation at one U.S. dental school. Retention was measured by students' performance with an actual patient during their fourth year. The high-fidelity simulation exercise focused on clinical communication skills took place during the spring term of the students' second year. The effect of the simulation was measured by comparing the fourth-year clinical performance of two groups: those who had participated in the simulation (intervention group; Class of 2016) and those who had not (no intervention/control group; Class of 2015). In the no intervention group, all 47 students participated; in the intervention group, 58 of 59 students participated. Both instructor assessments and students' self-assessments were used to evaluate the effectiveness of key patient interaction principles as well as comprehensive presentation of multiple treatment options. The results showed that students in the intervention group more frequently included cost during their treatment option presentation than did students in the no intervention group. The instructor ratings showed that the intervention group included all key treatment option components except duration more frequently than did the no intervention group. However, the simulation experience did not result in significantly more effective student-patient clinical communication on any of the items measured. This study presents limited evidence of the effectiveness of a standardized patient simulation to improve dental students' long-term clinical communication skills with respect to thorough presentation of treatment options to a patient.

[Innovation in healthcare processes and patient safety using clinical simulation].

PubMed

Rojo, E; Maestre, J M; Díaz-Mendi, A R; Ansorena, L; Del Moral, I

2016-01-01

Many excellent ideas are never implemented or generalised by healthcare organisations. There are two related paradigms: thinking that individuals primarily change through accumulating knowledge, and believing that the dissemination of that knowledge within the organisation is the key element to facilitate change. As an alternative, a description and evaluation of a simulation-based inter-professional team training program conducted in a Regional Health Service to promote and facilitate change is presented. The Department of Continuing Education completed the needs assessment using the proposals presented by clinical units and management. Skills and behaviors that could be learned using simulation were selected, and all personnel from the units participating were included. Experiential learning principles based on clinical simulation and debriefing, were used for the instructional design. The Kirkpatrick model was used to evaluate the program. Objectives included: a) decision-making and teamwork skills training in high prevalence diseases with a high rate of preventable complications; b) care processes reorganisation to improve efficiency, while maintaining patient safety; and, c) implementation of new complex techniques with a long learning curve, and high preventable complications rate. Thirty clinical units organised 39 training programs in the 3 public hospitals, and primary care of the Regional Health Service during 2013-2014. Over 1,559 healthcare professionals participated, including nursing assistants, nurses and physicians. Simulation in healthcare to train inter-professional teams can promote and facilitate change in patient care, and organisational re-engineering. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

Evaluation of a computer-based educational intervention to improve medical teamwork and performance during simulated patient resuscitations.

PubMed

Fernandez, Rosemarie; Pearce, Marina; Grand, James A; Rench, Tara A; Jones, Kerin A; Chao, Georgia T; Kozlowski, Steve W J

2013-11-01

To determine the impact of a low-resource-demand, easily disseminated computer-based teamwork process training intervention on teamwork behaviors and patient care performance in code teams. A randomized comparison trial of computer-based teamwork training versus placebo training was conducted from August 2010 through March 2011. This study was conducted at the simulation suite within the Kado Family Clinical Skills Center, Wayne State University School of Medicine. Participants (n = 231) were fourth-year medical students and first-, second-, and third-year emergency medicine residents at Wayne State University. Each participant was assigned to a team of four to six members (nteams = 45). Teams were randomly assigned to receive either a 25-minute computer-based training module targeting appropriate resuscitation teamwork behaviors or a placebo training module. Teamwork behaviors and patient care behaviors were video recorded during high-fidelity simulated patient resuscitations and coded by trained raters blinded to condition assignment and study hypotheses. Teamwork behavior items (e.g., "chest radiograph findings communicated to team" and "team member assists with intubation preparation") were standardized before combining to create overall teamwork scores. Similarly, patient care items ("chest radiograph correctly interpreted"; "time to start of compressions") were standardized before combining to create overall patient care scores. Subject matter expert reviews and pilot testing of scenario content, teamwork items, and patient care items provided evidence of content validity. When controlling for team members' medically relevant experience, teams in the training condition demonstrated better teamwork (F [1, 42] = 4.81, p < 0.05; ηp = 10%) and patient care (F [1, 42] = 4.66, p < 0.05; ηp = 10%) than did teams in the placebo condition. Computer-based team training positively impacts teamwork and patient care during simulated patient resuscitations. This low

A tool for assessing case history and feedback skills in audiology students working with simulated patients.

PubMed

Hughes, Jane; Wilson, Wayne J; MacBean, Naomi; Hill, Anne E

2016-12-01

To develop a tool for assessing audiology students taking a case history and giving feedback with simulated patients (SP). Single observation, single group design. Twenty-four first-year audiology students, five simulated patients, two clinical educators, and three evaluators. The Audiology Simulated Patient Interview Rating Scale (ASPIRS) was developed consisting of six items assessing specific clinical skills, non-verbal communication, verbal communication, interpersonal skills, interviewing skills, and professional practice skills. These items are applied once for taking a case history and again for giving feedback. The ASPIRS showed very high internal consistency (α = 0.91-0.97; mean inter-item r = 0.64-0.85) and fair-to-moderate agreement between evaluators (29.2-54.2% exact and 79.2-100% near agreement; κ weighted up to 0.60). It also showed fair-to-moderate absolute agreement amongst evaluators for single evaluator scores (intraclass correlation coefficient [ICC] r = 0.35-0.59) and substantial consistency of agreement amongst evaluators for three-evaluator averaged scores (ICC r = 0.62-0.81). Factor analysis showed the ASPIRS' 12 items fell into two components, one containing all feedback items and one containing all case history items. The ASPIRS shows promise as the first published tool for assessing audiology students taking a case history and giving feedback with an SP.

Evaluation of pharmacy students' knowledge and perceptions of pharmacogenetics before and after a simulation activity.

PubMed

Patel, Radha V; Chudow, Melissa; Vo, Teresa T; Serag-Bolos, Erini S

The purpose of this study was to evaluate students' knowledge and perceptions of the clinical application of pharmacogenetics through a simulation activity and to assess communication of pharmacogenetic-guided treatment recommendations utilizing standardized patients. Third-year students in the four-year doctor of pharmacy (PharmD) program at University of South Florida College of Pharmacy completed a pharmacogenetics simulation involving a patient case review, interpretation of pharmacogenetic test results, completion of a situation, background, assessment, recommendation (SBAR) note with drug therapy recommendations, and patient counseling. Voluntary assessments were completed before and after the simulation, which included demographics, knowledge, and perceptions of students' ability to interpret and communicate pharmacogenetic results. Response rates for the pre- and post-simulation assessments were 109 (98%) and 104 (94%), respectively. Correct responses in application-type questions improved after the simulation (74%) compared to before the simulation (44%, p < 0.01). Responses to perception questions shifted towards "strongly agree" or "agree" after the simulation (p < 0.01). The simulation gave students an opportunity to apply pharmacogenetics knowledge and allowed them to gain an appreciation of pharmacists' roles within the pharmacogenetics field. Copyright © 2017 Elsevier Inc. All rights reserved.

A development of surgical simulator for training of operative skills using patient-specific data.

PubMed

Ogata, Masato; Nagasaka, Manabu; Inuiya, Toru; Makiyama, Kazuhide; Kubota, Yoshinobu

2011-01-01

At the Advanced Medical Research Center at Yokohama City University School of Medicine, we have been developing a practical surgical simulator for renal surgery. Unlike already commercialized laparoscopic surgical simulators, our surgical simulator is capable of using patient-specific models for preoperative training and improvement of laparoscopic surgical skills. We have been evaluating the simulator clinically with the aim of using it in renal surgery training at Yokohama City University Hospital. The simulator can be applied to other types of laparoscopic surgery, such as gynecological, thoracic, and gastrointestinal. Here, we report on the technical aspects of the simulator.

Effectiveness of a Web-Based Simulation in Improving Nurses' Workplace Practice With Deteriorating Ward Patients: A Pre- and Postintervention Study.

PubMed

Liaw, Sok Ying; Wong, Lai Fun; Lim, Eunice Ya Ping; Ang, Sophia Bee Leng; Mujumdar, Sandhya; Ho, Jasmine Tze Yin; Mordiffi, Siti Zubaidah; Ang, Emily Neo Kim

2016-02-19

Nurses play an important role in detecting patients with clinical deterioration. However, the problem of nurses failing to trigger deteriorating ward patients still persists despite the implementation of a patient safety initiative, the Rapid Response System. A Web-based simulation was developed to enhance nurses' role in recognizing and responding to deteriorating patients. While studies have evaluated the effectiveness of the Web-based simulation on nurses' clinical performance in a simulated environment, no study has examined its impact on nurses' actual practice in the clinical setting. The objective of this study was to evaluate the impact of Web-based simulation on nurses' recognition of and response to deteriorating patients in clinical settings. The outcomes were measured across all levels of Kirkpatrick's 4-level evaluation model with clinical outcome on triggering rates of deteriorating patients as the primary outcome measure. A before-and-after study was conducted on two general wards at an acute care tertiary hospital over a 14-month period. All nurses from the two study wards who undertook the Web-based simulation as part of their continuing nursing education were invited to complete questionnaires at various time points to measure their motivational reaction, knowledge, and perceived transfer of learning. Clinical records on cases triggered by ward nurses from the two study wards were evaluated for frequency and types of triggers over a period of 6 months pre- and 6 months postintervention. The number of deteriorating patients triggered by ward nurses in a medical general ward increased significantly (P<.001) from pre- (84/937, 8.96%) to postintervention (91/624, 14.58%). The nurses reported positively on the transfer of learning (mean 3.89, SD 0.49) from the Web-based simulation to clinical practice. A significant increase (P<.001) on knowledge posttest score from pretest score was also reported. The nurses also perceived positively their motivation

Does Training Learners on Simulators Benefit Real Patients?

ERIC Educational Resources Information Center

Teteris, Elise; Fraser, Kristin; Wright, Bruce; McLaughlin, Kevin

2012-01-01

Despite limited data on patient outcomes, simulation training has already been adopted and embraced by a large number of medical schools. Yet widespread acceptance of simulation should not relieve us of the duty to demonstrate if, and under which circumstances, training learners on simulation benefits real patients. Here we review the data on…

Faculty Development for Small-Group-Teaching with Simulated Patients (SP) - Design and Evaluation of a Competency-based Workshop.

PubMed

Hölzer, Henrike; Freytag, Julia; Sonntag, Ulrike

2017-01-01

Objective: The introduction of innovative teaching formats and methods in medical education requires a specific didactic training for teachers to use complicated formats effectively. This paper describes preliminary considerations, design, implementation and evaluation of a skills-based workshop (7,5 hours long) for teaching with simulated patients. The aim is to describe the essential components for a lasting effect of the workshop so that the concept can be adapted to other contexts. Method: We present the theoretical framework, the objectives, the didactic methodology and the implementation of the workshop. The evaluation of the workshop was carried out using questionnaires. First the participants (teachers of the faculty of medicine, clinical and science subjects) were asked to estimate how well they felt prepared for small group teaching immediately after workshop. Later, after some teaching experience of their own, they gave feedback again as a part of the general evaluation of the semester. Results: In the course of three years 27 trainings were conducted and evaluated with a total of 275 participants. In the context of semester evaluation 452 questionnaires were evaluated on the quality of training. Conclusion: The evaluation shows that participants appreciate the concept of the workshop and also feel sufficiently well prepared. As a limitation it must be said that this is so far only the lecturers' self-assessment. Nevertheless, it can be stated that even a one-day workshop with a stringent teaching concept shows long term results regarding innovative teaching methods.

Simulated Patient Studies: An Ethical Analysis

PubMed Central

Rhodes, Karin V; Miller, Franklin G

2012-01-01

Context In connection with health care reform, the U.S. Department of Health and Human Services commissioned a “mystery shopper,” or simulated patient study, to measure access to primary care. But the study was shelved because of public controversy over “government spying” on doctors. Opponents of the study also raised ethical concerns about the use of deception with human subjects without soliciting their informed consent. Methods We undertook an ethical analysis of the use of simulated patient techniques in health services research, with a particular focus on research measuring access to care. Using a case study, we explored relevant methodological considerations and ethical principles relating to deceptive research without informed consent, as well as U.S. federal regulations permitting exceptions to consent. Findings Several relevant considerations both favor and oppose soliciting consent for simulated patient studies. Making research participation conditional on informed consent protects the autonomy of research subjects and shields them from unreasonable exposure to research risks. However, scientific validity is also an important ethical principle of human subjects research, as the net risks to subjects must be justified by the value to society of the knowledge to be gained. The use of simulated patients to monitor access is a naturalistic and scientifically sound experimental design that can answer important policy-relevant questions, with minimal risks to human subjects. As interaction between researchers and subjects increases, however, so does the need for consent. Conclusions As long as adequate protections of confidentiality of research data are in place, minimally intrusive simulated patient research that gathers policy-relevant data on the health system without the consent of individuals working in that system can be ethically justified when the risks and burdens to research subjects are minimal and the research has the potential to generate

Nurse training with simulation: an innovative approach to teach complex microsurgery patient care.

PubMed

Flurry, Mitchell; Brooke, Sebastian; Micholetti, Brett; Natoli, Noel; Moyer, Kurtis; Mnich, Stephanie; Potochny, John

2012-10-01

Simulation has become an integral part of education at all levels within the medical field. The ability to allow personnel to practice and learn in a safe and controlled environment makes it a valuable tool for initial training and continued competence verification. An area of specific interest to the reconstructive microsurgeon is assurance that the nursing staff has adequate training and experience to provide optimum care for microsurgery patients. Plastic surgeons in institutions where few microsurgeries are performed face challenges teaching nurses how to care for these complex patients. Because no standard exists to educate microsurgery nurses, learning often happens by chance on-the-job encounters. Outcomes, therefore, may be affected by poor handoffs between inexperienced personnel. Our objective is to create a course that augments such random clinical experience and teaches the knowledge and skills necessary for successful microsurgery through simulated patient scenarios. Quality care reviews at our institution served as the foundation to develop an accredited nursing course providing clinical training for the care of microsurgery patients. The course combined lectures on microsurgery, pharmacology, and flap monitoring as well as simulated operating room, surgical intensive care unit, postanesthesia care unit, Trauma Bay, and Floor scenarios. Evaluation of participants included precourse examination, postcourse examination, and a 6-month follow-up. Average test scores were 72% precourse and 92% postcourse. Educational value, effectiveness of lectures and simulation, and overall course quality was rated very high or high by 86% of respondents; 0% respondents rated it as low. Six-month follow-up test score average was 88%. Learning to care for microsurgery patients should not be left to chance patient encounters on the job. Simulation provides a safe, reproducible, and controlled clinical experience. Our results show that simulation is a highly rated and

Evaluating performance of risk identification methods through a large-scale simulation of observational data.

PubMed

Ryan, Patrick B; Schuemie, Martijn J

2013-10-01

There has been only limited evaluation of statistical methods for identifying safety risks of drug exposure in observational healthcare data. Simulations can support empirical evaluation, but have not been shown to adequately model the real-world phenomena that challenge observational analyses. To design and evaluate a probabilistic framework (OSIM2) for generating simulated observational healthcare data, and to use this data for evaluating the performance of methods in identifying associations between drug exposure and health outcomes of interest. Seven observational designs, including case-control, cohort, self-controlled case series, and self-controlled cohort design were applied to 399 drug-outcome scenarios in 6 simulated datasets with no effect and injected relative risks of 1.25, 1.5, 2, 4, and 10, respectively. Longitudinal data for 10 million simulated patients were generated using a model derived from an administrative claims database, with associated demographics, periods of drug exposure derived from pharmacy dispensings, and medical conditions derived from diagnoses on medical claims. Simulation validation was performed through descriptive comparison with real source data. Method performance was evaluated using Area Under ROC Curve (AUC), bias, and mean squared error. OSIM2 replicates prevalence and types of confounding observed in real claims data. When simulated data are injected with relative risks (RR) ≥ 2, all designs have good predictive accuracy (AUC > 0.90), but when RR < 2, no methods achieve 100 % predictions. Each method exhibits a different bias profile, which changes with the effect size. OSIM2 can support methodological research. Results from simulation suggest method operating characteristics are far from nominal properties.

Runway Incursion Prevention System Simulation Evaluation

NASA Technical Reports Server (NTRS)

Jones, Denise R.

2002-01-01

A Runway Incursion Prevention System (RIPS) was evaluated in a full mission simulation study at the NASA Langley Research center in March 2002. RIPS integrates airborne and ground-based technologies to provide (1) enhanced surface situational awareness to avoid blunders and (2) alerts of runway conflicts in order to prevent runway incidents while also improving operational capability. A series of test runs was conducted in a high fidelity simulator. The purpose of the study was to evaluate the RIPS airborne incursion detection algorithms and associated alerting and airport surface display concepts. Eight commercial airline crews participated as test subjects completing 467 test runs. This paper gives an overview of the RIPS, simulation study, and test results.

Developing integrated patient pathways using hybrid simulation

NASA Astrophysics Data System (ADS)

Zulkepli, Jafri; Eldabi, Tillal

2016-10-01

Integrated patient pathways includes several departments, i.e. healthcare which includes emergency care and inpatient ward; intermediate care which patient(s) will stay for a maximum of two weeks and at the same time be assessed by assessment team to find the most suitable care; and social care. The reason behind introducing the intermediate care in western countries was to reduce the rate of patients that stays in the hospital especially for elderly patients. This type of care setting has been considered to be set up in some other countries including Malaysia. Therefore, to assess the advantages of introducing this type of integrated healthcare setting, we suggest develop the model using simulation technique. We argue that single simulation technique is not viable enough to represent this type of patient pathways. Therefore, we suggest develop this model using hybrid techniques, i.e. System Dynamics (SD) and Discrete Event Simulation (DES). Based on hybrid model result, we argued that the result is viable to be as references for decision making process.

Management of queues in out-patient departments: the use of computer simulation.

PubMed

Aharonson-Daniel, L; Paul, R J; Hedley, A J

1996-01-01

Notes that patients attending public outpatient departments in Hong Kong spend a long time waiting for a short consultation, that clinics are congested and that both staff and patients are dissatisfied. Points out that experimentation of management changes in a busy clinical environment can be both expensive and difficult. Demonstrates computerized simulation modelling as a potential tool for clarifying processes occurring within such systems, improving clinic operation by suggesting possible answers to problems identified and evaluating the solutions, without interfering with the clinic routine. Adds that solutions can be implemented after they had proved to be successful on the model. Demonstrates some ways in which managers in health care facilities can benefit from the use of computerized simulation modelling. Specifically, shows the effect of changing the duration of consultation and the effect of the application of an appointment system on patients' waiting time.

Application of a nonrandomized stepped wedge design to evaluate an evidence-based quality improvement intervention: a proof of concept using simulated data on patient-centered medical homes.

PubMed

Huynh, Alexis K; Lee, Martin L; Farmer, Melissa M; Rubenstein, Lisa V

2016-10-21

Stepped wedge designs have gained recognition as a method for rigorously assessing implementation of evidence-based quality improvement interventions (QIIs) across multiple healthcare sites. In theory, this design uses random assignment of sites to successive QII implementation start dates based on a timeline determined by evaluators. However, in practice, QII timing is often controlled more by site readiness. We propose an alternate version of the stepped wedge design that does not assume the randomized timing of implementation while retaining the method's analytic advantages and applying to a broader set of evaluations. To test the feasibility of a nonrandomized stepped wedge design, we developed simulated data on patient care experiences and on QII implementation that had the structures and features of the expected data from a planned QII. We then applied the design in anticipation of performing an actual QII evaluation. We used simulated data on 108,000 patients to model nonrandomized stepped wedge results from QII implementation across nine primary care sites over 12 quarters. The outcome we simulated was change in a single self-administered question on access to care used by Veterans Health Administration (VA), based in the United States, as part of its quarterly patient ratings of quality of care. Our main predictors were QII exposure and time. Based on study hypotheses, we assigned values of 4 to 11 % for improvement in access when sites were first exposed to implementation and 1 to 3 % improvement in each ensuing time period thereafter when sites continued with implementation. We included site-level (practice size) and respondent-level (gender, race/ethnicity) characteristics that might account for nonrandomized timing in site implementation of the QII. We analyzed the resulting data as a repeated cross-sectional model using HLM 7 with a three-level hierarchical data structure and an ordinal outcome. Levels in the data structure included patient ratings

Family Medicine Residents' Performance with Detected Versus Undetected Simulated Patients Posing as Problem Drinkers.

PubMed

Kahan, Meldon; Liu, Eleanor; Borsoi, Diane; Wilson, Lynn; Brewster, Joan M; Sobell, Mark B; Sobell, Linda C

2004-12-01

Simulated patients are commonly used to evaluate medical trainees. Unannounced simulated patients provide an accurate measure of physician performance. To determine the effects of detection of SPs on physician performance, and identify factors leading to detection. Fixty-six family medicine residents were each visited by two unannounced simulated patients presenting with alcohol-induced hypertension or insomnia. Residents were then surveyed on their detection of SPs. SPs were detected on 45 out of 104 visits. Inner city clinics had higher detection rates than middle class clinics. Residents' checklist and global rating scores were substantially higher on detected than undetected visits, for both between-subject and within-subject comparisons. The most common reasons for detection concerned SP demographics and behaviour; the SP "did not act like a drinker" and was of a different social class than the typical clinic patient. Multi-clinic studies involving residents experienced with SPs should ensure that the SP role and behavior conform to physician expectations and the demographics of the clinic. SP station testing does not accurately reflect physicians' actual clinical behavior and should not be relied on as the primary method of evaluation. The study also suggests that physicians' poor performance in identifying and managing alcohol problems is not entirely due to lack of skill, as they demonstrated greater clinical skills when they became aware that they were being evaluated. Physicians' clinical priorities, sense of responsibility and other attitudinal determinants of their behavior should be addressed when training physicians on the management of alcohol problems.

A discrete event simulation model to evaluate the use of community services in the treatment of patients with Parkinson's disease in the United Kingdom.

PubMed

Lebcir, Reda; Demir, Eren; Ahmad, Raheelah; Vasilakis, Christos; Southern, David

2017-01-18

The number of people affected by Parkinson's disease (PD) is increasing in the United Kingdom driven by population ageing. The treatment of the disease is complex, resource intensive and currently there is no known cure to PD. The National Health Service (NHS), the public organisation delivering healthcare in the UK, is under financial pressures. There is a need to find innovative ways to improve the operational and financial performance of treating PD patients. The use of community services is a new and promising way of providing treatment and care to PD patients at reduced cost than hospital care. The aim of this study is to evaluate the potential operational and financial benefits, which could be achieved through increased integration of community services in the delivery of treatment and care to PD patients in the UK without compromising care quality. A Discrete Event Simulation model was developed to represent the PD care structure including patients' pathways, treatment modes, and the mix of resources required to treat PD patients. The model was parametrised with data from a large NHS Trust in the UK and validated using information from the same trust. Four possible scenarios involving increased use of community services were simulated on the model. Shifting more patients with PD from hospital treatment to community services will reduce the number of visits of PD patients to hospitals by about 25% and the number of PD doctors and nurses required to treat these patients by around 32%. Hospital based treatment costs overall should decrease by 26% leading to overall savings of 10% in the total cost of treating PD patients. The simulation model was useful in predicting the effects of increased use of community services on the performance of PD care delivery. Treatment policies need to reflect upon and formalise the use of community services and integrate these better in PD care. The advantages of community services need to be effectively shared with PD patients

Evaluation of decadal hindcasts using satellite simulators

NASA Astrophysics Data System (ADS)

Spangehl, Thomas; Mazurkiewicz, Alex; Schröder, Marc

2013-04-01

The evaluation of dynamical ensemble forecast systems requires a solid validation of basic processes such as the global atmospheric water and energy cycle. The value of any validation approach strongly depends on the quality of the observational data records used. Current approaches utilize in situ measurements, remote sensing data and reanalyses. Related data records are subject to a number of uncertainties and limitations such as representativeness, spatial and temporal resolution and homogeneity. However, recently several climate data records with known and sufficient quality became available. In particular, the satellite data records offer the opportunity to obtain reference information on global scales including the oceans. Here we consider the simulation of satellite radiances from the climate model output enabling an evaluation in the instrument's parameter space to avoid uncertainties stemming from the application of retrieval schemes in order to minimise uncertainties on the reference side. Utilizing the CFMIP Observation Simulator Package (COSP) we develop satellite simulators for the Tropical Rainfall Measuring Mission precipitation radar (TRMM PR) and the Infrared Atmospheric Sounding Interferometer (IASI). The simulators are applied within the MiKlip project funded by BMBF (German Federal Ministry of Education and Research) to evaluate decadal climate predictions performed with the MPI-ESM developed at the Max Planck Institute for Meteorology. While TRMM PR enables the evaluation of the vertical structure of precipitation over tropical and sub-tropical areas, IASI is used to support the global evaluation of clouds and radiation. In a first step the reliability of the developed simulators needs to be explored. The simulation of radiances in the instrument space requires the generation of sub-grid scale variability from the climate model output. Furthermore, assumptions are made to simulate radiances such as, for example, the distribution of different

Rifaximin Improves Driving Simulator Performance in a Randomized Trial of Patients with Minimal Hepatic Encephalopathy

PubMed Central

Bajaj, Jasmohan S; Heuman, Douglas M; Wade, James B; Gibson, Douglas P; Saeian, Kia; Wegelin, Jacob A; Hafeezullah, Muhammad; Bell, Debulon E; Sterling, Richard K; Stravitz, R. Todd; Fuchs, Michael; Luketic, Velimir; Sanyal, Arun J

2010-01-01

Background & Aims Patients with cirrhosis and minimal hepatic encephalopathy (MHE) have driving difficulties but the effects of therapy on driving performance have not been assessed. We evaluated whether performance on a driving simulator improves in patients with MHE following treatment with rifaximin. Methods Patients with MHE who were current drivers were randomly assigned to placebo or rifaximin groups and followed for 8 weeks (n=42). Patients underwent driving simulation (driving and navigation tasks) at the start (baseline) and end of the study. We evaluated patients’ cognitive abilities, quality-of-life (using the Sickness Impact Profile [SIP]), serum levels of ammonia, levels of inflammatory cytokines, and MELD scores. The primary outcome was percent who improved in driving performance, calculated by: total driving errors=speeding + illegal turns + collisions. Results Over the 8-week study period, patients given rifaximin made significantly greater improvements than those given placebo in avoiding total driving errors (76% vs. 31%, P=0.013), speeding (81% vs. 33%, P=0.005), and illegal turns (62% vs. 19%, P=0.01). Of patients given rifaximin, 91% improved their cognitive performance, compared with 61% of patients given placebo (P=0.01); they also made improvements in the psycho-social dimension of the SIP, compared with the placebo group (P=0.04). Adherence to the assigned drug averaged 92%. Neither group had changes in ammonia levels or MELD scores, but patients in the rifaximin group had increased levels of the anti-inflammatory cytokine interleukin-10. Conclusions Patients with MHE significantly improve driving simulator performance following treatment with rifaximin, compared with placebo. PMID:20849805

Development of an antimicrobial stewardship-based infectious diseases elective that incorporates human patient simulation technology.

PubMed

Falcione, Bonnie A; Meyer, Susan M

2014-10-15

To design an elective for pharmacy students that facilitates antimicrobial stewardship awareness, knowledge, and skill development by solving clinical cases, using human patient simulation technology. The elective was designed for PharmD students to describe principles and functions of stewardship programs, select, evaluate, refine, or redesign patient-specific plans for infectious diseases in the context of antimicrobial stewardship, and propose criteria and stewardship management strategies for an antimicrobial class at a health care institution. Teaching methods included active learning and lectures. Cases of bacterial endocarditis and cryptococcal meningitis were developed that incorporated human patient simulation technology. Forty-five pharmacy students completed an antimicrobial stewardship elective between 2010 and 2013. Outcomes were assessed using student perceptions of and performance on rubric-graded assignments. A PharmD elective using active learning, including novel cases conducted with human patient simulation technology, enabled outcomes consistent with those desired of pharmacists assisting in antimicrobial stewardship programs.

Planning acetabular fracture reduction using patient-specific multibody simulation of the hip

NASA Astrophysics Data System (ADS)

Oliveri, Hadrien; Boudissa, Mehdi; Tonetti, Jerome; Chabanas, Matthieu

2017-03-01

Acetabular fractures are a challenge in orthopedic surgery. Computer-aided solutions were proposed to segment bone fragments, simulate the fracture reduction or design the osteosynthesis fixation plates. This paper addresses the simulation part, which is usually carried out by freely moving bone fragments with six degrees of freedom to reproduce the pre-fracture state. Instead we propose a different paradigm, closer to actual surgeon's requirements: to simulate the surgical procedure itself rather than the desired result. A simple, patient-specific, biomechanical multibody model is proposed, integrating the main ligaments and muscles of the hip joint while accounting for contacts between bone fragments. Main surgical tools and actions can be simulated, such as clamps, Schanz screws or traction of the femur. Simulations are computed interactively, which enables clinicians to evaluate different strategies for an optimal surgical planning. Six retrospective cases were studied, with simple and complex fracture patterns. After interactively building the models from preoperative CT, gestures from the surgical reports were reproduced. Results of the simulations could then be compared with postoperative CT data. A qualitative study shows the model behavior is excellent and the simulated reductions fit the observed data. A more quantitative analysis is currently being completed. Two cases are particularly significant, for which the surgical reduction actually failed. Simulations show it was indeed not possible to reduce these fractures with the chosen approach. Had our simulator being used, a better planning may have avoided a second surgery to these patients.

Differences in Faculty and Standardized Patient Scores on Professionalism for Second-Year Podiatric Medical Students During a Standardized Simulated Patient Encounter.

PubMed

Mahoney, James M; Vardaxis, Vassilios; Anwar, Noreen; Hagenbucher, Jacob

2018-03-01

This study examined the differences between faculty and trained standardized patient (SP) evaluations on student professionalism during a second-year podiatric medicine standardized simulated patient encounter. Forty-nine second-year podiatric medicine students were evaluated for their professionalism behavior. Eleven SPs performed an assessment in real-time, and one faculty member performed a secondary assessment after observing a videotape of the encounter. Five domains were chosen for evaluation from a validated professionalism assessment tool. Significant differences were identified in the professionalism domains of "build a relationship" ( P = .008), "gather information" ( P = .001), and share information ( P = .002), where the faculty scored the students higher than the SP for 24.5%, 18.9%, and 26.5% of the cases, respectively. In addition, the faculty scores were higher than the SP scores in all of the "gather information" subdomains; however, the difference in scores was significant only in the "question appropriately" ( P = .001) and "listen and clarify" ( P = .003) subdomains. This study showed that professionalism scores for second-year podiatric medical students during a simulated patient encounter varied significantly between faculty and SPs. Further consideration needs to be given to determine the source of these differences.

Evaluation of Viral Surrogate Markers for Study of Pathogen Dissemination During Simulations of Patient Care

PubMed Central

Alhmidi, Heba; John, Amrita; Mana, Thriveen C.; Koganti, Sreelatha; Cadnum, Jennifer L.; Shelton, Melissa B.

2017-01-01

Abstract During patient care simulations, cauliflower mosaic virus DNA and bacteriophage MS2 performed similarly as surrogate markers of pathogen dissemination. These markers disseminated to the environment in a manner similar to Clostridium difficile spores but were more frequently detected on skin and clothing of personnel after personal protective equipment removal. PMID:28752103

Simulation in the Executive Suite: Lessons Learned for Building Patient Safety Leadership.

PubMed

Rosen, Michael A; Goeschel, Christine A; Che, Xin-Xuan; Fawole, Joseph Oluyinka; Rees, Dianne; Curran, Rosemary; Gelinas, Lillee; Martin, Jessica N; Kosel, Keith C; Pronovost, Peter J; Weaver, Sallie J

2015-12-01

Simulation is a powerful learning tool for building individual and team competencies of frontline health care providers with demonstrable impact on performance. This article examines the impact of simulation in building strategic leadership competencies for patient safety and quality among executive leaders in health care organizations. We designed, implemented, and evaluated a simulation as part of a larger safety leadership network meeting for executive leaders. This simulation targeted knowledge competencies of governance priority, culture of continuous improvement, and internal transparency and feedback. Eight teams of leaders in health care organizations-a total of 55 participants-participated in a 4-hour session. Each team performed collectively as a new chief executive officer (CEO) tasked with a goal of rescuing a hospital with a failing safety record. Teams worked on a modifiable simulation board reflecting the current dysfunctional organizational structure of the simulated hospital. They assessed and redesigned accountability structures based on information acquired in encounter sessions with confederates playing the role of internal staff and external consultants. Data were analyzed, and results are presented as qualitative themes arising from the simulation exercise, participant reaction data, and performance during the simulation. Key findings include high degrees of variability in solutions developed for the dysfunctional hospital system and generally positive learner reactions to the simulation experience. This study illustrates the potential value of simulation as a mechanism for learning and strategy development for executive leaders grappling with patient safety issues. Future research should explore the cognitive or functional fidelity of organizational simulations and the use of custom scenarios for strategic planning.

The effects of simulated patients and simulated gynecologic models on student anxiety in providing IUD services.

PubMed

Khadivzadeh, Talat; Erfanian, Fatemeh

2012-10-01

Midwifery students experience high levels of stress during their initial clinical practices. Addressing the learner's source of anxiety and discomfort can ease the learning experience and lead to better outcomes. The aim of this study was to find out the effect of a simulation-based course, using simulated patients and simulated gynecologic models on student anxiety and comfort while practicing to provide intrauterine device (IUD) services. Fifty-six eligible midwifery students were randomly allocated into simulation-based and traditional training groups. They participated in a 12-hour workshop in providing IUD services. The simulation group was trained through an educational program including simulated gynecologic models and simulated patients. The students in both groups then practiced IUD consultation and insertion with real patients in the clinic. The students' anxiety in IUD insertion was assessed using the "Spielberger anxiety test" and the "comfort in providing IUD services" questionnaire. There were significant differences between students in 2 aspects of anxiety including state (P < 0.001) and trait (P = 0.024) and the level of comfort (P = 0.000) in providing IUD services in simulation and traditional groups. "Fear of uterine perforation during insertion" was the most important cause of students' anxiety in providing IUD services, which was reported by 74.34% of students. Simulated patients and simulated gynecologic models are effective in optimizing students' anxiety levels when practicing to deliver IUD services. Therefore, it is recommended that simulated patients and simulated gynecologic models be used before engaging students in real clinical practice.

Evaluations of lunar regolith simulants

NASA Astrophysics Data System (ADS)

Taylor, Lawrence A.; Pieters, Carle M.; Britt, Daniel

2016-07-01

Apollo lunar regolith samples are not available in quantity for engineering studies with In-Situ Resource Utilization (ISRU). Therefore, with expectation of a return to the Moon, dozens of regolith (soil) simulants have been developed, to some extent a result of inefficient distribution of NASA-sanctioned simulants. In this paper, we review many of these simulants, with evaluations of their short-comings. In 2010, the NAC-PSS committee instructed the Lunar Exploration Advisory Group (LEAG) and CAPTEM (the NASA committee recommending on the appropriations of Apollo samples) to report on the status of lunar regolith simulants. This report is reviewed here-in, along with a list of the plethora of lunar regolith simulants and references. In addition, and importantly, a special, unique Apollo 17 soil sample (70050) discussed, which has many of the properties sought for ISRU studies, should be available in reasonable amounts for ISRU studies.

Evaluation of Branched-Narrative Virtual Patients for Interprofessional Education of Psychiatry Residents.

PubMed

Wilkening, G Lucy; Gannon, Jessica M; Ross, Clint; Brennan, Jessica L; Fabian, Tanya J; Marcsisin, Michael J; Benedict, Neal J

2017-02-01

This pilot study evaluated the utility of branched-narrative virtual patients in an interprofessional education series for psychiatry residents. Third-year psychiatry residents attended four interprofessional education advanced psychopharmacology sessions that involved completion of a branched-narrative virtual patient and a debriefing session with a psychiatric pharmacist. Pre- and post-assessments analyzed resident learning and were administered around each virtual patient. Simulation 4 served as a comprehensive review. The primary outcome was differences in pre- and post-assessment scores. Secondary outcomes included resident satisfaction with the virtual patient format and psychiatric pharmacist involvement. Post-test scores for simulations 1, 2, and 3 demonstrated significant improvement (p < 0.05) from pre-test scores. Scores for simulation 4 did not retain significance. Resident satisfaction with the branched-narrative virtual patient format and psychiatric pharmacist involvement was high throughout the series (100 %; n = 18). Although there are important methodological limitations to this study including a small sample size and absence of a comparator group, this pilot study supports the use of branched-narrative virtual patients in an interprofessional education series for advanced learners.

Use of simulated pages to prepare medical students for internship and improve patient safety.

PubMed

Schwind, Cathy J; Boehler, Margaret L; Markwell, Stephen J; Williams, Reed G; Brenner, Michael J

2011-01-01

During the transition from medical school to internship, trainees experience high levels of stress related to pages on the inpatient wards. The steep learning curve during this period may also affect patient safety. The authors piloted the use of simulated pages to improve medical student preparedness, decrease stress related to pages, and familiarize medical students with common patient problems. A multidisciplinary team at Southern Illinois University School of Medicine developed simulated pages that were tested among senior medical students. Sixteen medical students were presented with 11 common patient scenarios. Data on assessment, management, and global performance were collected. Mean confidence levels were evaluated pre- and postintervention. Students were also surveyed on how the simulated pages program influenced their perceived comfort in managing patient care needs and the usefulness of the exercise in preparing them to handle inpatient pages. Mean scores on the assessment and management portions of the scenarios varied widely depending on the scenario (range -15.6 ± 41.6 to 95.7 ± 9.5). Pass rates based on global performance ranged from 12% to 93%. Interrater agreement was high (mean kappa = 0.88). Students' confidence ratings on a six-point scale increased from 1.87 preintervention to 3.53 postintervention (P < .0001). Simulated pages engage medical students and may foster medical student preparedness for internship. Students valued the opportunity to simulate "on call" responsibilities, and exposure to simulated pages significantly increased their confidence levels. Further studies are needed to determine effects on patient safety outcomes.

Evaluation of the impact of a simulation-enhanced breaking bad news workshop in pediatrics.

PubMed

Tobler, Kathleen; Grant, Estee; Marczinski, Cecile

2014-08-01

Our goal was to develop and evaluate the effectiveness of a simulation-based workshop for teaching pediatric trainees' communication skills in breaking bad news. A simulation-based workshop was developed to teach skills in breaking bad news. After a classroom-based introduction, small groups of residents participated in 3 scenarios, each starting with a simulated resuscitation, followed by 2 conversations with the patient's parent, played by actors. Each conversation was observed through a 1-way mirror and was followed by a debriefing. After the workshop, the residents completed workshop evaluations and a self-assessment. Before and after the workshop, residents were evaluated in Objective Structured Clinical Examination stations where they were required to give bad news. Two physician experts and 2 parents who personally experienced receiving bad news about their child evaluated resident performance using a previously validated communication evaluation tool. Residents' ratings of the workshop were very high for all items, and 100% of the residents reported improvement in their ability to deliver bad news after the workshop. Statistically significant improvement was found in 14 of 17 items of the evaluation tool used by experts and parents, with the parents reporting greater improvement than the experts. This reflective, simulation-based workshop successfully improved pediatric trainees' skills in having difficult conversations with families, as evaluated by the participants, by physician experts, and, most importantly, by parents who have experienced these conversations in real life.

Impact of pharmacy automation on patient waiting time: an application of computer simulation.

PubMed

Tan, Woan Shin; Chua, Siang Li; Yong, Keng Woh; Wu, Tuck Seng

2009-06-01

This paper aims to illustrate the use of computer simulation in evaluating the impact of a prototype automated dispensing system on waiting time in an outpatient pharmacy and its potential as a routine tool in pharmacy management. A discrete event simulation model was developed to investigate the impact of a prototype automated dispensing system on operational efficiency and service standards in an outpatient pharmacy. The simulation results suggest that automating the prescription-filing function using a prototype that picks and packs at 20 seconds per item will not assist the pharmacy in achieving the waiting time target of 30 minutes for all patients. Regardless of the state of automation, to meet the waiting time target, 2 additional pharmacists are needed to overcome the process bottleneck at the point of medication dispense. However, if the automated dispensing is the preferred option, the speed of the system needs to be twice as fast as the current configuration to facilitate the reduction of the 95th percentile patient waiting time to below 30 minutes. The faster processing speed will concomitantly allow the pharmacy to reduce the number of pharmacy technicians from 11 to 8. Simulation was found to be a useful and low cost method that allows an otherwise expensive and resource intensive evaluation of new work processes and technology to be completed within a short time.

Development of an Antimicrobial Stewardship-based Infectious Diseases Elective that Incorporates Human Patient Simulation Technology

PubMed Central

Meyer, Susan M.

2014-01-01

Objective. To design an elective for pharmacy students that facilitates antimicrobial stewardship awareness, knowledge, and skill development by solving clinical cases, using human patient simulation technology. Design. The elective was designed for PharmD students to describe principles and functions of stewardship programs, select, evaluate, refine, or redesign patient-specific plans for infectious diseases in the context of antimicrobial stewardship, and propose criteria and stewardship management strategies for an antimicrobial class at a health care institution. Teaching methods included active learning and lectures. Cases of bacterial endocarditis and cryptococcal meningitis were developed that incorporated human patient simulation technology. Assessment. Forty-five pharmacy students completed an antimicrobial stewardship elective between 2010 and 2013. Outcomes were assessed using student perceptions of and performance on rubric-graded assignments. Conclusion. A PharmD elective using active learning, including novel cases conducted with human patient simulation technology, enabled outcomes consistent with those desired of pharmacists assisting in antimicrobial stewardship programs. PMID:25386016

Human Simulators and Standardized Patients to Teach Difficult Conversations to Interprofessional Health Care Teams

PubMed Central

Zimmerman, Christine; Kennedy, Christopher; Schremmer, Robert; Smith, Katharine V.

2010-01-01

Objective To design and implement a demonstration project to teach interprofessional teams how to recognize and engage in difficult conversations with patients. Design Interdisciplinary teams consisting of pharmacy students and residents, student nurses, and medical residents responded to preliminary questions regarding difficult conversations, listened to a brief discussion on difficult conversations; formed ad hoc teams and interacted with a standardized patient (mother) and a human simulator (child), discussing the infant's health issues, intimate partner violence, and suicidal thinking; and underwent debriefing. Assessment Participants evaluated the learning methods positively and a majority demonstrated knowledge gains. The project team also learned lessons that will help better design future programs, including an emphasis on simulations over lecture and the importance of debriefing on student learning. Drawbacks included the major time commitment for design and implementation, sustainability, and the lack of resources to replicate the program for all students. Conclusion Simulation is an effective technique to teach interprofessional teams how to engage in difficult conversations with patients. PMID:21088725

An analysis of nursing students' decision-making in teams during simulations of acute patient deterioration.

PubMed

Bucknall, Tracey K; Forbes, Helen; Phillips, Nicole M; Hewitt, Nicky A; Cooper, Simon; Bogossian, Fiona

2016-10-01

The aim of this study was to examine the decision-making of nursing students during team based simulations on patient deterioration to determine the sources of information, the types of decisions made and the influences underpinning their decisions. Missed, misinterpreted or mismanaged physiological signs of deterioration in hospitalized patients lead to costly serious adverse events. Not surprisingly, an increased focus on clinical education and graduate nurse work readiness has resulted. A descriptive exploratory design. Clinical simulation laboratories in three Australian universities were used to run team based simulations with a patient actor. A convenience sample of 97 final-year nursing students completed simulations, with three students forming a team. Four teams from each university were randomly selected for detailed analysis. Cued recall during video review of team based simulation exercises to elicit descriptions of individual and team based decision-making and reflections on performance were audio-recorded post simulation (2012) and transcribed. Students recalled 11 types of decisions, including: information seeking; patient assessment; diagnostic; intervention/treatment; evaluation; escalation; prediction; planning; collaboration; communication and reflective. Patient distress, uncertainty and a lack of knowledge were frequently recalled influences on decisions. Incomplete information, premature diagnosis and a failure to consider alternatives when caring for patients is likely to lead to poor quality decisions. All health professionals have a responsibility in recognizing and responding to clinical deterioration within their scope of practice. A typology of nursing students' decision-making in teams, in this context, highlights the importance of individual knowledge, leadership and communication. © 2016 John Wiley & Sons Ltd.

Research on simulated infrared image utility evaluation using deep representation

NASA Astrophysics Data System (ADS)

Zhang, Ruiheng; Mu, Chengpo; Yang, Yu; Xu, Lixin

2018-01-01

Infrared (IR) image simulation is an important data source for various target recognition systems. However, whether simulated IR images could be used as training data for classifiers depends on the features of fidelity and authenticity of simulated IR images. For evaluation of IR image features, a deep-representation-based algorithm is proposed. Being different from conventional methods, which usually adopt a priori knowledge or manually designed feature, the proposed method can extract essential features and quantitatively evaluate the utility of simulated IR images. First, for data preparation, we employ our IR image simulation system to generate large amounts of IR images. Then, we present the evaluation model of simulated IR image, for which an end-to-end IR feature extraction and target detection model based on deep convolutional neural network is designed. At last, the experiments illustrate that our proposed method outperforms other verification algorithms in evaluating simulated IR images. Cross-validation, variable proportion mixed data validation, and simulation process contrast experiments are carried out to evaluate the utility and objectivity of the images generated by our simulation system. The optimum mixing ratio between simulated and real data is 0.2≤γ≤0.3, which is an effective data augmentation method for real IR images.

Lost in translation: using bilingual simulated patients to improve consulting across language barriers.

PubMed

Escott, Sarah; Lucas, Beverley; Pearson, David

2009-03-01

In the light of rapid demographic change and increased globalisation of health, ways to consult effectively across language barriers are increasingly important. This article describes the development, organisation and evaluation of a UK workshop designed to develop the skills of undergraduate medical students consulting with patients with limited English proficiency, using specially recruited and trained bilingual simulated patients. The authors discuss the advantages and areas for development of the approach, before considering possible future developments.

Obstetric simulation as a risk control strategy: course design and evaluation.

PubMed

Gardner, Roxane; Walzer, Toni B; Simon, Robert; Raemer, Daniel B

2008-01-01

Patient safety initiatives aimed at reducing medical errors and adverse events are being implemented in Obstetrics. The Controlled Risk Insurance Company (CRICO), Risk Management Foundation (RMF) of the Harvard Medical Institutions pursued simulation as an anesthesia risk control strategy. Encouraged by their success, CRICO/RMF promoted simulation-based team training as a risk control strategy for obstetrical providers. We describe the development, implementation, and evaluation of an obstetric simulation-based team training course grounded in crisis resource management (CRM) principles. We pursued systematic design of course development, implementation, and evaluation in 3 phases, including a 1-year or more posttraining follow-up with self-assessment questionnaires. The course was highly rated overall by participants immediately after the course and 1-year or more after the course. Most survey responders reported having experienced a critical clinical event since the course and that various aspects of their teamwork had significantly or somewhat improved as a result of the course. Most (86%) reported CRM principles as useful for obstetric faculty and most (59%) recommended repeating the simulation course every 2 years. A simulation-based team-training course for obstetric clinicians was developed and is a central component of CRICO/RMF's obstetric risk management incentive program that provides a 10% reduction in annual obstetrical malpractice premiums. The course was highly regarded immediately and 1 year or more after completing the course. Most survey responders reported improved teamwork and communication in managing a critical obstetric event in the interval since taking the course. Simulation-based CRM training can serve as a strategy for mitigating adverse perinatal events.

Manikin Human-Patient Simulator Training.

PubMed

Horn, Gregory T; Bowling, F Y; Lowe, David E; Parimore, James G; Stagliano, David R; Studer, Nicholas M

Human-patient simulators (HPSs) may help enhance medical education. Manikin HPS devices respond to common field medical interventions, such as cricothyroidotomy, and have realistic feedback features, such as respirations and pulses. This study surveys Special Operations Medics for evaluations of HPS features. Of 518 subjects, 376 completed testing and surveys with valid responses. A total of 102 variables were divided into three categories-general characteristics, procedures, and injuries-and assessed on a fivepoint Likert scale. The Student t test was used to analyze data together and as separate groups against each other and against an aggregated mean. Features that received high scores (i.e., higher than 4.5/5) corresponded closely with pillars of the Tactical Combat Casualty Care (TCCC) curriculum, basic life support, and realism. US Army Special Operations Command and US Special Operations Command Medics have overall high confidence in manikin HPS devices and specifically in those that align with TCCC training and lifesaving procedures. The skills most valued coincide with difficult-to-practice measures, such as cricothyroidotomy and wound packing. Features such as prerecorded sounds, sex, automated movements, skin color, defibrillation, bowel sounds, and electrocardiogram are rated lower. These evaluations may guide future development or procurement of manikin HPS devices. 2017.

Exploring Simulation Utilization and Simulation Evaluation Practices and Approaches in Undergraduate Nursing Education

ERIC Educational Resources Information Center

Zitzelsberger, Hilde; Coffey, Sue; Graham, Leslie; Papaconstantinou, Efrosini; Anyinam, Charles

2017-01-01

Simulation-based learning (SBL) is rapidly becoming one of the most significant teaching-learning-evaluation strategies available in undergraduate nursing education. While there is indication within the literature and anecdotally about the benefits of simulation, abundant and strong evidence that supports the effectiveness of simulation for…

Clinical results of computerized tomography-based simulation with laser patient marking.

PubMed

Ragan, D P; Forman, J D; He, T; Mesina, C F

1996-02-01

Accuracy of a patient treatment portal marking device and computerized tomography (CT) simulation have been clinically tested. A CT-based simulator has been assembled based on a commercial CT scanner. This includes visualization software and a computer-controlled laser drawing device. This laser drawing device is used to transfer the setup, central axis, and/or radiation portals from the CT simulator to the patient for appropriate patient skin marking. A protocol for clinical testing is reported. Twenty-five prospectively, sequentially accessioned patients have been analyzed. The simulation process can be completed in an average time of 62 min. Under many cases, the treatment portals can be designed and the patient marked in one session. Mechanical accuracy of the system was found to be within +/- 1mm. The portal projection accuracy in clinical cases is observed to be better than +/- 1.2 mm. Operating costs are equivalent to the conventional simulation process it replaces. Computed tomography simulation is a clinical accurate substitute for conventional simulation when used with an appropriate patient marking system and digitally reconstructed radiographs. Personnel time spent in CT simulation is equivalent to time in conventional simulation.

The Impact of Music Therapy on Anxiety in Cancer Patients Undergoing Simulation for Radiation Therapy.

PubMed

Rossetti, Andrew; Chadha, Manjeet; Torres, B Nelson; Lee, Jae K; Hylton, Donald; Loewy, Joanne V; Harrison, Louis B

2017-09-01

Radiation therapy (RT) is associated with high stress levels. The role of music therapy (MT) for patients receiving RT is not well described. This study evaluates the impact of MT on anxiety and distress during simulation in patients with newly diagnosed head and neck or breast cancer. This institutional review board-approved randomized trial of MT versus no MT at the time of simulation included the pre-State-Trait Anxiety Inventory (STAI-S Anxiety) questionnaire and Symptom Distress Thermometer (SDT). Patients randomized to MT received a consultation with a music therapist, during which music of the patients' choice to be played during simulation was selected. The no-MT patients did not receive the MT consultation, nor did they hear prerecorded music during simulation. Subsequent to the simulation, all patients repeated the STAI-S Anxiety questionnaire and the SDT. Of the 78 patients enrolled (39 in MT group and 39 in no-MT group), 38 had breast cancer and 40 had head and neck cancer. The male-female ratio was 27:51. The overall mean pre- and post-simulation STAI-S scores were 38.7 (range, 20-60) and 35.2 (range, 20-72), respectively. The overall mean pre- and post-simulation SDT scores were 3.2 (range, 0-10) and 2.5 (range, 0-10), respectively. The MT group had mean pre- and post-simulation STAI-S scores of 39.1 and 31.0, respectively (P<.0001), and the mean SDT scores before and after simulation were 3.2 and 1.7, respectively (P<.0001). The no-MT group's mean pre- and post-simulation STAI-S scores were 38.3 and 39.5, respectively (P=.46), and the mean SDT scores were 3 and 3.2, respectively (P=.51). MT significantly lowered patient anxiety and distress during the simulation procedure on the basis of the STAI-S questionnaire and SDT. Incorporating culturally centered individualized MT may be an effective intervention to reduce stressors. Continued research defining the role of MT intervention in improving the patient experience by reducing anxiety is

Evaluation of Aztreonam Dosing Regimens in Patients With Normal and Impaired Renal Function: A Population Pharmacokinetic Modeling and Monte Carlo Simulation Analysis.

PubMed

Xu, Hongmei; Zhou, Wangda; Zhou, Diansong; Li, Jianguo; Al-Huniti, Nidal

2017-03-01

Aztreonam is a monocyclic β-lactam antibiotic often used to treat infections caused by Enterobacteriaceae or Pseudomonas aeruginosa. Despite the long history of clinical use, population pharmacokinetic modeling of aztreonam in renally impaired patients is not yet available. The aims of this study were to assess the impact of renal impairment on aztreonam exposure and to evaluate dosing regimens for patients with renal impairment. A population model describing aztreonam pharmacokinetics following intravenous administration was developed using plasma concentrations from 42 healthy volunteers and renally impaired patients from 2 clinical studies. The final pharmacokinetic model was used to predict aztreonam plasma concentrations and evaluate the probability of pharmacodynamic target attainment (PTA) in patients with different levels of renal function. A 2-compartment model with first-order elimination adequately described aztreonam pharmacokinetics. The population mean estimates of aztreonam clearance, intercompartmental clearance, volume of distribution of the central compartment, and volume of distribution of the peripheral compartment were 4.93 L/h, 9.26 L/h, 7.43 L, and 6.44 L, respectively. Creatinine clearance and body weight were the most significant variables to explain patient variability in aztreonam clearance and volume of distribution, respectively. Simulations using the final pharmacokinetic model resulted in a clinical susceptibility break point of 4 and 8 mg/L, respectively, based on the clinical use of 1- and 2-g loading doses with the same or reduced maintenance dose every 8 hours for various renal deficiency patients. The population pharmacokinetic modeling and PTA estimation support adequate PTAs (>90% PTA) from the aztreonam label for dose adjustment of aztreonam in patients with moderate and severe renal impairment. © 2016, The American College of Clinical Pharmacology.

Evaluation of nursing students' work technique after proficiency training in patient transfer methods during undergraduate education.

PubMed

Johnsson, A Christina E; Kjellberg, Anders; Lagerström, Monica I

2006-05-01

The aim of this study was to investigate if nursing students improved their work technique when assisting a simulated patient from bed to wheelchair after proficiency training, and to investigate whether there was a correlation between the nursing students' work technique and the simulated patients' perceptions of the transfer. 71 students participated in the study, 35 in the intervention group and 36 in the comparison group. The students assisted a simulated patient to move from a bed to a wheelchair. In the intervention group the students made one transfer before and one after training, and in the comparison group they made two transfers before training. Six variables were evaluated: work technique score; nursing students' ratings of comfort, work technique and exertion, and the simulated patients' perceptions of comfort and safety during the transfer. The result showed that nursing students improved their work technique, and that there was a correlation between the work technique and the simulated patients' subjective ratings of the transfer. In conclusion, nursing students improved their work technique after training in patient transfer methods, and the work technique affected the simulated patients' perceptions of the transfer.

An interprofessional communication training using simulation to enhance safe care for a deteriorating patient.

PubMed

Liaw, Sok Ying; Zhou, Wen Tao; Lau, Tang Ching; Siau, Chiang; Chan, Sally Wai-Chi

2014-02-01

Communication and teamwork between doctors and nurses are critical for optimal patient care. Simulation and interprofessional team learning are emerging as significant learning strategies to promote teamwork and communication between different health professionals. The aim of the study is to describe the development, implementation and evaluation of a simulation-based interprofessional educational (Sim-IPE) program, using a presage-process-product (3P) model, for improving medical and nursing students' communication skills in caring of a patient with physiological deterioration. The program was conducted using full-scale simulation and communication strategies adapted from Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS). 127 medical and nursing students participated in a 3-hour small group interprofessional learning that incorporated simulation scenarios of deteriorating patients. Pre and post-tests were conducted to assess the students' self-confidence in interprofessional communication and perception in interprofessional learning. After the training, the students completed a satisfaction questionnaire. Both medicine and nursing groups demonstrated a significant improvement on post-test score from pre-test score for self-confidence (p<.0001) and perception (p<.0001) with no significant differences detected between the two groups. The participants were highly satisfied with their simulation learning. The Sim-IPE has better prepared the medical and nursing students in communicating with one another in providing safe care for deteriorating patient. In addition, it has improved their perception towards interprofessional learning. This pre-registration interprofessional education could prepare them for more comprehensive interprofessional team learning at post-registration level. Copyright © 2014 Elsevier Ltd. All rights reserved.

Comparison of standardized patients with high-fidelity simulators for managing stress and improving performance in clinical deterioration: A mixed methods study.

PubMed

Ignacio, Jeanette; Dolmans, Diana; Scherpbier, Albert; Rethans, Jan-Joost; Chan, Sally; Liaw, Sok Ying

2015-12-01

The use of standardized patients in deteriorating patient simulations adds realism that can be valuable for preparing nurse trainees for stress and enhancing their performance during actual patient deterioration. Emotional engagement resulting from increased fidelity can provide additional stress for student nurses with limited exposure to real patients. To determine the presence of increased stress with the standardized patient modality, this study compared the use of standardized patients (SP) with the use of high-fidelity simulators (HFS) during deteriorating patient simulations. Performance in managing deteriorating patients was also compared. It also explored student nurses' insights on the use of standardized patients and patient simulators in deteriorating patient simulations as preparation for clinical placement. Fifty-seven student nurses participated in a randomized controlled design study with pre- and post-tests to evaluate stress and performance in deteriorating patient simulations. Performance was assessed using the Rescuing A Patient in Deteriorating Situations (RAPIDS) rating tool. Stress was measured using salivary alpha-amylase levels. Fourteen participants who joined the randomized controlled component then participated in focus group discussions that elicited their insights on SP use in patient deterioration simulations. Analysis of covariance (ANCOVA) results showed no significant difference (p=0.744) between the performance scores of the SP and HFS groups in managing deteriorating patients. Amylase levels were also not significantly different (p=0.317) between the two groups. Stress in simulation, awareness of patient interactions, and realism were the main themes that resulted from the thematic analysis. Performance and stress in deteriorating patient simulations with standardized patients did not vary from similar simulations using high-fidelity patient simulators. Data from focus group interviews, however, suggested that the use of

Support for stroke patients in resumption of driving: patient survey and driving simulator trial

PubMed Central

Hitosugi, Masahito; Takehara, Itaru; Watanabe, Shu; Hayashi, Yasufumi; Tokudome, Shogo

2011-01-01

Background: Encouragement of stroke patients to resume driving is important to promote their reintegration into the community. Limited rehabilitation has been performed in this regard, owing to lack of specific knowledge on the part of medical staff. To establish an effective support program for stroke patients who wish to resume driving, we propose comprehensive training by medical staff using a driving simulator. Methods: A survey of stroke patients admitted to the Tokyo Metropolitan Rehabilitation Hospital was first performed. A questionnaire was sent to 525 patients. Of 218 responses, the answers of 118 patients who had been driving before their stroke were analyzed. More than 80% of stroke patients did not obtain enough information about resuming driving during their hospital stay, and 38.1% of patients would have liked to have had driving training with a simulator. From these results, we set out to determine the effect of driving training using a realistic and technically advanced driving simulator. Twenty-four stroke patients and 20 healthy controls were included in the study. Results: Repeat training with the simulator resulted in an increased ability to perform braking and an improvement in driving ability. The majority of stroke patients who had the mental and physical ability to drive a car were likely to be assessed as being able to resume driving as a result of the training program. Conclusion: This study indicates that comprehensive support by medical staff and provision of adequate information about resumption of driving and the opportunity for training on a driving simulator are likely to aid resumption of driving by stroke patients, thus enhancing their rehabilitation and social reintegration. PMID:21475633

Simulators for corporate pilot training and evaluation

NASA Technical Reports Server (NTRS)

Treichel, Curt

1992-01-01

Corporate aviation relies heavily on simulation to meet training and evaluation requirements. It appreciates the savings in fuel, money, noise, and time, and the added safety it provides. Also, simulation provides opportunities to experience many emergencies that cannot be safely practiced in the aircraft. There is a need to focus on the advantages of simulator training over aircraft training and to provide appropriate changes in the regulations to allow the community to make it possible for users to take full advantage of simulation.

Evaluation of lung recruitment maneuvers in acute respiratory distress syndrome using computer simulation.

PubMed

Das, Anup; Cole, Oana; Chikhani, Marc; Wang, Wenfei; Ali, Tayyba; Haque, Mainul; Bates, Declan G; Hardman, Jonathan G

2015-01-12

Direct comparison of the relative efficacy of different recruitment maneuvers (RMs) for patients with acute respiratory distress syndrome (ARDS) via clinical trials is difficult, due to the heterogeneity of patient populations and disease states, as well as a variety of practical issues. There is also significant uncertainty regarding the minimum values of positive end-expiratory pressure (PEEP) required to ensure maintenance of effective lung recruitment using RMs. We used patient-specific computational simulation to analyze how three different RMs act to improve physiological responses, and investigate how different levels of PEEP contribute to maintaining effective lung recruitment. We conducted experiments on five 'virtual' ARDS patients using a computational simulator that reproduces static and dynamic features of a multivariable clinical dataset on the responses of individual ARDS patients to a range of ventilator inputs. Three recruitment maneuvers (sustained inflation (SI), maximal recruitment strategy (MRS) followed by a titrated PEEP, and prolonged recruitment maneuver (PRM)) were implemented and evaluated for a range of different pressure settings. All maneuvers demonstrated improvements in gas exchange, but the extent and duration of improvement varied significantly, as did the observed mechanism of operation. Maintaining adequate post-RM levels of PEEP was seen to be crucial in avoiding cliff-edge type re-collapse of alveolar units for all maneuvers. For all five patients, the MRS exhibited the most prolonged improvement in oxygenation, and we found that a PEEP setting of 35 cm H2O with a fixed driving pressure of 15 cm H2O (above PEEP) was sufficient to achieve 95% recruitment. Subsequently, we found that PEEP titrated to a value of 16 cm H2O was able to maintain 95% recruitment in all five patients. There appears to be significant scope for reducing the peak levels of PEEP originally specified in the MRS and hence to avoid exposing the lung to

Fluid structure interaction simulations of the upper airway in obstructive sleep apnea patients before and after maxillomandibular advancement surgery.

PubMed

Chang, Kwang K; Kim, Ki Beom; McQuilling, Mark W; Movahed, Reza

2018-06-01

The purpose of this study was to analyze pharyngeal airflow using both computational fluid dynamics (CFD) and fluid structure interactions (FSI) in obstructive sleep apnea patients before and after maxillomandibular advancement (MMA) surgery. The airflow characteristics before and after surgery were compared with both CFD and FSI. In addition, the presurgery and postsurgery deformations of the airway were evaluated using FSI. Digitized pharyngeal airway models of 2 obstructive sleep apnea patients were generated from cone-beam computed tomography scans before and after MMA surgery. CFD and FSI were used to evaluate the pharyngeal airflow at a maximum inspiration rate of 166 ml per second. Standard steady-state numeric formulations were used for airflow simulations. Airway volume increased, pressure drop decreased, maximum airflow velocity decreased, and airway resistance dropped for both patients after the MMA surgery. These findings occurred in both the CFD and FSI simulations. The FSI simulations showed an area of marked airway deformation in both patients before surgery, but this deformation was negligible after surgery for both patients. Both CFD and FSI simulations produced airflow results that indicated less effort was needed to breathe after MMA surgery. The FSI simulations demonstrated a substantial decrease in airway deformation after surgery. These beneficial changes positively correlated with the large improvements in polysomnography outcomes after MMA surgery. Copyright © 2018 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Evaluation of Computer Simulations for Teaching Apparel Merchandising Concepts.

ERIC Educational Resources Information Center

Jolly, Laura D.; Sisler, Grovalynn

1988-01-01

The study developed and evaluated computer simulations for teaching apparel merchandising concepts. Evaluation results indicated that teaching method (computer simulation versus case study) does not significantly affect cognitive learning. Student attitudes varied, however, according to topic (profitable merchandising analysis versus retailing…

Evaluation of the medical and occupational shielding in cerebral angiography using Monte Carlo simulations and virtual anthropomorphic phantoms

NASA Astrophysics Data System (ADS)

Santos, William S.; Neves, Lucio P.; Perini, Ana P.; Caldas, Linda V. E.; Maia, Ana F.

2015-12-01

Cerebral angiography exams may provide valuable diagnostic information for the patients with suspect of cerebral diseases, but it may also deliver high doses of radiation to the patients and medical staff. In order to evaluate the medical and occupational expositions from different irradiation conditions, Monte Carlo (MC) simulations were employed. Virtual anthropomorphic phantoms (MASH) were used to represent the patient and the physician inside a typical fluoroscopy room, also simulated in details, incorporated in the MCNPX 2.7.0 MC code. The evaluation was carried out by means of dose conversion coefficients (CCs) for equivalent (H) and effective (E) doses normalized by the air kerma-area product (KAP). The CCs for the surface entrance dose of the patient (ESD) and equivalent dose for the eyes of the medical staff were determined, because CA exams present higher risks for those organs. The tube voltage was 80 kVp, and Al filters with thicknesses of 2.5 mm, 3.5 mm and 4.0 mm were positioned in the beams. Two projections were simulated: posterior-anterior (PA) and right-lateral (RLAT). In all situations there was an increase of the CC values with the increase of the Al filtration. The highest dose was obtained for a RLAT projection with a 4.0 mm Al filter. In this projection, the ESD/KAP and E/KAP values to patient were 11 (14%) mGy/Gy cm2 and 0.12 (0.1%) mSv/Gy cm2, respectively. For the physician, the use of shield lead glass suspended and lead curtain attached to the surgical table resulted in a significant reduction of the CCs. The use of MC simulations proved to be a very important tool in radiation protection dosimetry, and specifically in this study several parameters could be evaluated, which would not be possible experimentally.

Performance evaluation of an agent-based occupancy simulation model

DOE PAGES

Luo, Xuan; Lam, Khee Poh; Chen, Yixing; ...

2017-01-17

Occupancy is an important factor driving building performance. Static and homogeneous occupant schedules, commonly used in building performance simulation, contribute to issues such as performance gaps between simulated and measured energy use in buildings. Stochastic occupancy models have been recently developed and applied to better represent spatial and temporal diversity of occupants in buildings. However, there is very limited evaluation of the usability and accuracy of these models. This study used measured occupancy data from a real office building to evaluate the performance of an agent-based occupancy simulation model: the Occupancy Simulator. The occupancy patterns of various occupant types weremore » first derived from the measured occupant schedule data using statistical analysis. Then the performance of the simulation model was evaluated and verified based on (1) whether the distribution of observed occupancy behavior patterns follows the theoretical ones included in the Occupancy Simulator, and (2) whether the simulator can reproduce a variety of occupancy patterns accurately. Results demonstrated the feasibility of applying the Occupancy Simulator to simulate a range of occupancy presence and movement behaviors for regular types of occupants in office buildings, and to generate stochastic occupant schedules at the room and individual occupant levels for building performance simulation. For future work, model validation is recommended, which includes collecting and using detailed interval occupancy data of all spaces in an office building to validate the simulated occupant schedules from the Occupancy Simulator.« less

Performance evaluation of an agent-based occupancy simulation model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Luo, Xuan; Lam, Khee Poh; Chen, Yixing

Occupancy is an important factor driving building performance. Static and homogeneous occupant schedules, commonly used in building performance simulation, contribute to issues such as performance gaps between simulated and measured energy use in buildings. Stochastic occupancy models have been recently developed and applied to better represent spatial and temporal diversity of occupants in buildings. However, there is very limited evaluation of the usability and accuracy of these models. This study used measured occupancy data from a real office building to evaluate the performance of an agent-based occupancy simulation model: the Occupancy Simulator. The occupancy patterns of various occupant types weremore » first derived from the measured occupant schedule data using statistical analysis. Then the performance of the simulation model was evaluated and verified based on (1) whether the distribution of observed occupancy behavior patterns follows the theoretical ones included in the Occupancy Simulator, and (2) whether the simulator can reproduce a variety of occupancy patterns accurately. Results demonstrated the feasibility of applying the Occupancy Simulator to simulate a range of occupancy presence and movement behaviors for regular types of occupants in office buildings, and to generate stochastic occupant schedules at the room and individual occupant levels for building performance simulation. For future work, model validation is recommended, which includes collecting and using detailed interval occupancy data of all spaces in an office building to validate the simulated occupant schedules from the Occupancy Simulator.« less

Does simulation enhance nurses' ability to assess deteriorating patients?

PubMed

Bliss, Maria; Aitken, Leanne M

2018-01-01

Recognising and responding to patient deterioration has been identified as a key skill in nursing care to ensure that care is escalated for prompt, efficient management of the potentially critically ill patient. Simulation is one teaching strategy that has been established in nurse education as a method for enhancing skills. The objective was to explore the experiences of registered nurses to ascertain whether they perceived that simulation enhanced their skills in recognising the deteriorating patient. An exploratory qualitative design was used. Data were collected from registered nurses using semi-structured interviews following a professional development course where scenario-based simulation had been used to assess the patient. Eight registered nurses were interviewed for this study. Semi-structured interviews were conducted face to face. Verbatim transcripts were analysed using thematic analysis to identify major themes. Four themes were identified: knowledge, improved assessment skills in caring for the acutely ill patient, the learning environment and decision making. The use of simulation as a strategy was perceived by nurses to improve their own ability in identifying deteriorating patients. The participants described how their knowledge was transferred to clinical practice, with the overall perception that this led to improved patient care. Copyright © 2017 Elsevier Ltd. All rights reserved.

The information-giving skills of resident physicians: relationships with confidence and simulated patient satisfaction.

PubMed

Ishikawa, Hirono; Son, Daisuke; Eto, Masato; Kitamura, Kiyoshi; Kiuchi, Takahiro

2017-02-08

Sharing information is crucial for discussion of problems and treatment decision making by patients and physicians. However, the focus of communication skills training in undergraduate medical education has been on building the relationship and gathering information; thus, resident physicians tend to be less confident about sharing information and planning treatment. This study evaluated the medical interviews conducted by resident physicians with a focus on information giving, and investigated its relationships with their confidence in communication and simulated patient (SP) satisfaction. Among 137 junior resident physicians at a university hospital in Japan who participated in a survey of communication skills, 25 volunteered to conduct simulated medical interviews. The medical interviews were video-recorded and analyzed using the Roter Interaction Analysis System, together with additional coding to explore specific features of information giving. The SPs evaluated their satisfaction with the medical interview. Resident physicians who were more confident in their communication skills provided more information to the patients, while SP satisfaction was associated only with patient-prompted information giving. SPs were more satisfied when the physicians explained the rationales for their opinions and recommendations. Our findings underscore the importance of providing relevant information in response to the patient requests, and explaining the rationales for the opinions and recommendations. Further investigation is needed to clinically confirm our findings and develop an appropriate communication skills training program.

Using and Evaluating Resampling Simulations in SPSS and Excel.

ERIC Educational Resources Information Center

Smith, Brad

2003-01-01

Describes and evaluates three computer-assisted simulations used with Statistical Package for the Social Sciences (SPSS) and Microsoft Excel. Designed the simulations to reinforce and enhance student understanding of sampling distributions, confidence intervals, and significance tests. Reports evaluations revealed improved student comprehension of…

Piloted evaluation of an integrated propulsion and flight control simulator

NASA Technical Reports Server (NTRS)

Bright, Michelle M.; Simon, Donald L.

1992-01-01

This paper describes a piloted evaluation of the integrated flight and propulsion control simulator at NASA Lewis Research Center. The purpose of this evaluation is to demonstrate the suitability and effectiveness of this fixed based simulator for advanced integrated propulsion and airframe control design. The evaluation will cover control effector gains and deadbands, control effectiveness and control authority, and heads up display functionality. For this evaluation the flight simulator is configured for transition flight using an advanced Short Take-Off and vertical Landing fighter aircraft model, a simplified high-bypass turbofan engine model, fighter cockpit, displays, and pilot effectors. The paper describes the piloted tasks used for rating displays and control effector gains. Pilot comments and simulation results confirm that the display symbology and control gains are very adequate for the transition flight task. Additionally, it is demonstrated that this small-scale, fixed base flight simulator facility can adequately perform a real time, piloted control evaluation.

Assessment of students' ability to incorporate a computer into increasingly complex simulated patient encounters.

PubMed

Ray, Sarah; Valdovinos, Katie

Pharmacy students should be exposed to and offered opportunities to practice the skill of incorporating a computer into a patient interview in the didactic setting. Faculty sought to improve retention of student ability to incorporate computers into their patient-pharmacist communication. Students were required to utilize a computer to document clinical information gathered during a simulated patient encounter (SPE). Students utilized electronic worksheets and were evaluated by instructors on their ability to effectively incorporate a computer into a SPE using a rubric. Students received specific instruction on effective computer use during patient encounters. Students were then re-evaluated by an instructor during subsequent SPEs of increasing complexity using standardized rubrics blinded from the students. Pre-instruction, 45% of students effectively incorporated a computer into a SPE. After receiving instruction, 67% of students were effective in their use of a computer during a SPE of performing a pharmaceutical care assessment for a patient with chronic obstructive pulmonary disease (COPD) (p < 0.05 compared to pre-instruction), and 58% of students were effective in their use of a computer during a SPE of retrieving a medication list and social history from a simulated alcohol-impaired patient (p = 0.087 compared to pre-instruction). Instruction can improve pharmacy students' ability to incorporate a computer into SPEs, a critical skill in building and maintaining rapport with patients and improving efficiency of patient visits. Complex encounters may affect students' ability to utilize a computer appropriately. Students may benefit from repeated practice with this skill, especially with SPEs of increasing complexity. Copyright © 2016 Elsevier Inc. All rights reserved.

Patient-specific simulation in carotid artery stenting.

PubMed

Willaert, Willem; Aggarwal, Rajesh; Bicknell, Colin; Hamady, Mo; Darzi, Ara; Vermassen, Frank; Cheshire, Nicholas

2010-12-01

Patient-specific virtual reality (VR) simulation is a technologic advancement that allows planning and practice of the carotid artery stenting (CAS) procedure before it is performed on the patient. The initial findings are reported, using this novel VR technique as a tool to optimize technical and nontechnical aspects of this complex endovascular procedure. In the angiography suite, the same interventional team performed the VR rehearsal and the actual CAS on the patient. All proceedings were recorded to allow for video analysis of team, technical, and nontechnical skills. Analysis of both procedures showed identical use of endovascular tools, similar access strategy, and a high degree of similarity between the angiography images. The total procedure time (24.04 vs 60.44 minutes), fluoroscopy time (11.19 vs 21.04 minutes), and cannulation of the common carotid artery (1.35 vs 9.34) took considerably longer in reality. An extensive questionnaire revealed that all team members found that the rehearsal increased the subjective sense of teamwork (4/5), communication (4/5), and patient safety (4/5). A VR procedure rehearsal is a practical and feasible preparatory tool for CAS and shows a high correlation with the real procedure. It has the potential to enhance the technical, nontechnical, and team performance. Further research is needed to evaluate if this technology can lead to improved outcomes for patients. Copyright © 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Simulation training for improving the quality of care for older people: an independent evaluation of an innovative programme for inter-professional education.

PubMed

Ross, Alastair J; Anderson, Janet E; Kodate, Naonori; Thomas, Libby; Thompson, Kellie; Thomas, Beth; Key, Suzie; Jensen, Heidi; Schiff, Rebekah; Jaye, Peter

2013-06-01

This paper describes the evaluation of a 2-day simulation training programme for staff designed to improve teamwork and inpatient care and compassion in an older persons' unit. The programme was designed to improve inpatient care for older people by using mixed modality simulation exercises to enhance teamwork and empathetic and compassionate care. Healthcare professionals took part in: (a) a 1-day human patient simulation course with six scenarios and (b) a 1-day ward-based simulation course involving five 1-h exercises with integrated debriefing. A mixed methods evaluation included observations of the programme, precourse and postcourse confidence rating scales and follow-up interviews with staff at 7-9 weeks post-training. Observations showed enjoyment of the course but some anxiety and apprehension about the simulation environment. Staff self-confidence improved after human patient simulation (t=9; df=56; p<0.001) and ward-based exercises (t=9.3; df=76; p<0.001). Thematic analysis of interview data showed learning in teamwork and patient care. Participants thought that simulation had been beneficial for team practices such as calling for help and verbalising concerns and for improved interaction with patients. Areas to address in future include widening participation across multi-disciplinary teams, enhancing post-training support and exploring further which aspects of the programme enhance compassion and care of older persons. The study demonstrated that simulation is an effective method for encouraging dignified care and compassion for older persons by teaching team skills and empathetic and sensitive communication with patients and relatives.

Using the Simulated Patient Methodology to Assess Paracetamol-Related Counselling for Headache

PubMed Central

Horvat, Nejc; Koder, Marko; Kos, Mitja

2012-01-01

Objectives Firstly, to assess paracetamol-related counselling. Secondly, to evaluate the patient’s approach as a determinant of counselling and to test the acceptability of the simulated patient method in Slovenian pharmacies. Methods The simulated patient methodology was used in 17 community pharmacies. Three scenarios related to self-medication for headaches were developed and used in all participating pharmacies. Two scenarios were direct product requests: scenario 1: a patient with an uncomplicated short-term headache; scenario 2: a patient with a severe, long-duration headache who takes paracetamol for too long and concurrently drinks alcohol. Scenario 3 was a symptom-based request: a patient asking for medicine for a headache. Pharmacy visits were audio recorded and scored according to predetermined criteria arranged in two categories: counselling content and manner of counselling. The acceptability of the methodology used was evaluated by surveying the participating pharmacists. Results The symptom-based request was scored significantly better (a mean 2.17 out of a possible 4 points) than the direct product requests (means of 1.64 and 0.67 out of a possible 4 points for scenario 1 and 2, respectively). The most common information provided was dosage and adverse effects. Only the symptom-based request stimulated spontaneous counselling. No statistically significant differences in the duration of the consultation between the scenarios were found. There were also no significant differences in the quality of counselling between the Masters of Pharmacy and Pharmacy Technicians. The acceptability of the SP method was not as high as in other countries. Conclusion The assessment of paracetamol-related counselling demonstrates room for practice improvement. PMID:23300691

In Patients With Cirrhosis, Driving Simulator Performance Is Associated With Real-life Driving.

PubMed

Lauridsen, Mette M; Thacker, Leroy R; White, Melanie B; Unser, Ariel; Sterling, Richard K; Stravitz, Richard T; Matherly, Scott; Puri, Puneet; Sanyal, Arun J; Gavis, Edith A; Luketic, Velimir; Siddiqui, Muhammad S; Heuman, Douglas M; Fuchs, Michael; Bajaj, Jasmohan S

2016-05-01

Minimal hepatic encephalopathy (MHE) has been linked to higher real-life rates of automobile crashes and poor performance in driving simulation studies, but the link between driving simulator performance and real-life automobile crashes has not been clearly established. Furthermore, not all patients with MHE are unsafe drivers, but it is unclear how to distinguish them from unsafe drivers. We investigated the link between performance on driving simulators and real-life automobile accidents and traffic violations. We also aimed to identify features of unsafe drivers with cirrhosis and evaluated changes in simulated driving skills and MHE status after 1 year. We performed a study of outpatients with cirrhosis (n = 205; median 55 years old; median model for end-stage liver disease score, 9.5; none with overt hepatic encephalopathy or alcohol or illicit drug use within previous 6 months) seen at the Virginia Commonwealth University and McGuire Veterans Administration Medical Center, from November 2008 through April 2014. All participants were given paper-pencil tests to diagnose MHE (98 had MHE; 48%), and 163 patients completed a standardized driving simulation. Data were collected on traffic violations and automobile accidents from the Virginia Department of Motor Vehicles and from participants' self-assessments when they entered the study, and from 73 participants 1 year later. Participants also completed a questionnaire about alcohol use and cessation patterns. The driving simulator measured crashes, run-time, road center and edge excursions, and illegal turns during navigation; before and after each driving simulation session, patients were asked to rate their overall driving skills. Drivers were classified as safe or unsafe based on crashes and violations reported on official driving records; simulation results were compared with real-life driving records. Multivariable regression analyses of real-life crashes and violations was performed using data on

Evaluation of simSchool: An Instructional Simulation for Pre-Service Teachers

ERIC Educational Resources Information Center

Deale, Deb; Pastore, Ray

2014-01-01

This study uses theory-based design principles to evaluate the effectiveness of an instructional simulation, simSchool. It begins by examining the simulation and evaluation literature, followed by an evaluation of the simSchool software. It is a Web-based simulation designed to emulate various students (reactions) in order to provide practice for…

Performance and cost evaluation of health information systems using micro-costing and discrete-event simulation.

PubMed

Rejeb, Olfa; Pilet, Claire; Hamana, Sabri; Xie, Xiaolan; Durand, Thierry; Aloui, Saber; Doly, Anne; Biron, Pierre; Perrier, Lionel; Augusto, Vincent

2018-06-01

Innovation and health-care funding reforms have contributed to the deployment of Information and Communication Technology (ICT) to improve patient care. Many health-care organizations considered the application of ICT as a crucial key to enhance health-care management. The purpose of this paper is to provide a methodology to assess the organizational impact of high-level Health Information System (HIS) on patient pathway. We propose an integrated performance evaluation of HIS approach through the combination of formal modeling using the Architecture of Integrated Information Systems (ARIS) models, a micro-costing approach for cost evaluation, and a Discrete-Event Simulation (DES) approach. The methodology is applied to the consultation for cancer treatment process. Simulation scenarios are established to conclude about the impact of HIS on patient pathway. We demonstrated that although high level HIS lengthen the consultation, occupation rate of oncologists are lower and quality of service is higher (through the number of available information accessed during the consultation to formulate the diagnostic). The provided method allows also to determine the most cost-effective ICT elements to improve the care process quality while minimizing costs. The methodology is flexible enough to be applied to other health-care systems.

Using in situ simulation to evaluate operational readiness of a children's hospital-based obstetrics unit.

PubMed

Ventre, Kathleen M; Barry, James S; Davis, Deborah; Baiamonte, Veronica L; Wentworth, Allen C; Pietras, Michele; Coughlin, Liza; Barley, Gwyn

2014-04-01

Relocating obstetric (OB) services to a children's hospital imposes demands on facility operations, which must be met to ensure quality care and a satisfactory patient experience. We used in situ simulations to prospectively and iteratively evaluate operational readiness of a children's hospital-based OB unit before it opened for patient care. This project took place at a 314-bed, university-affiliated children's hospital. We developed 3 full-scale simulation scenarios depicting a concurrent maternal and neonatal emergency. One scenario began with a standardized patient experiencing admission; the mannequin portrayed a mother during delivery. We ran all 3 scenarios on 2 dates scheduled several weeks apart. We ran 2 of the scenarios on a third day to verify the reliability of key processes. During the simulations, content experts completed equipment checklists, and participants identified latent safety hazards. Each simulation involved a unique combination of scheduled participants who were supplemented by providers from responding ancillary services. The simulations involved 133 scheduled participants representing OB, neonatology, and anesthesiology. We exposed and addressed operational deficiencies involving equipment availability, staffing, interprofessional communication, and systems issues such as transfusion protocol failures and electronic order entry challenges. Process changes between simulation days 1 to 3 decreased the elapsed time between transfusion protocol activation and blood arrival to the operating room and labor/delivery/recovery/postpartum setting. In situ simulations identified multiple operational deficiencies on the OB unit, allowing us to take corrective action before its opening. This project may guide other children's hospitals regarding care processes likely to require significant focus and possible modification to accommodate an OB service.

Simulation-based ongoing professional practice evaluation in psychiatry: a novel tool for performance assessment.

PubMed

Gorrindo, Tristan; Goldfarb, Elizabeth; Birnbaum, Robert J; Chevalier, Lydia; Meller, Benjamin; Alpert, Jonathan; Herman, John; Weiss, Anthony

2013-07-01

Ongoing professional practice evaluation (OPPE) activities consist of a quantitative, competency-based evaluation of clinical performance. Hospitals must design assessments that measure clinical competencies, are scalable, and minimize impact on the clinician's daily routines. A psychiatry department at a large academic medical center designed and implemented an interactive Web-based psychiatric simulation focusing on violence risk assessment as a tool for a departmentwide OPPE. Of 412 invited clinicians in a large psychiatry department, 410 completed an online simulation in April-May 2012. Participants received scheduled e-mail reminders with instructions describing how to access the simulation. Using the Computer Simulation Assessment Tool, participants viewed an introductory video and were then asked to conduct a risk assessment, acting as a clinician in the encounter by selecting actions from a series of drop-down menus. Each action was paired with a corresponding video segment of a clinical encounter with a standardized patient. Participants were scored on the basis of their actions within the simulation (Measure 1) and by their responses to the open-ended questions in which they were asked to integrate the information from the simulation in a summative manner (Measure 2). Of the 410 clinicians, 381 (92.9%) passed Measure 1,359 (87.6%) passed Measure 2, and 5 (1.2%) failed both measures. Seventy-five (18.3%) participants were referred for focused professional practice evaluation (FPPE) after failing either Measure 1, Measure 2, or both. Overall, Web-based simulation and e-mail engagement tools were a scalable and efficient way to assess a large number of clinicians in OPPE and to identify those who required FPPE.

Evaluation of air traffic control models and simulations.

DOT National Transportation Integrated Search

1971-06-01

Approximately two hundred reports were identified as describing Air Traffic Control (ATC) modeling and simulation efforts. Of these, about ninety analytical and simulation models dealing with virtually all aspects of ATC were formally evaluated. The ...

An electric scooter simulation program for training the driving skills of stroke patients with mobility problems: a pilot study.

PubMed

Jannink, Michiel J A; Erren-Wolters, C Victorien; de Kort, Alexander C; van der Kooij, Herman

2008-12-01

This paper describes an electric scooter simulation program and a first evaluation study in which we explored if it is possible to train the driving skills of future users of electric mobility scooters by means of an electric scooter simulation program in addition to conventional electric scooter training. Within this explorative study,10 stroke survivors were randomly assigned to either the control (n=5) or the electric scooter simulation intervention group (n=5). Participants were assessed twice on the functional evaluating rating scale. During the followup measurement, subjective experiences regarding both forms of electric scooter training were elicited by a questionnaire. After a training period of 5 weeks, both groups improved on the Functional Evaluation Rating Scale. It can be concluded that the patients with stroke were satisfied with the electric scooter simulation training.

Computer Simulation of Human Service Program Evaluations.

ERIC Educational Resources Information Center

Trochim, William M. K.; Davis, James E.

1985-01-01

Describes uses of computer simulations for the context of human service program evaluation. Presents simple mathematical models for most commonly used human service outcome evaluation designs (pretest-posttest randomized experiment, pretest-posttest nonequivalent groups design, and regression-discontinuity design). Translates models into single…

Piloted evaluation of an integrated propulsion and flight control simulator

NASA Technical Reports Server (NTRS)

Bright, Michelle M.; Simon, Donald L.

1992-01-01

A piloted evaluation of the integrated flight and propulsion control simulator for advanced integrated propulsion and airframe control design is described. The evaluation will cover control effector gains and deadbands, control effectiveness and control authority, and heads up display functionality. For this evaluation the flight simulator is configured for transition flight using an advanced Short Take-Off and Vertical Landing fighter aircraft model, a simplified high-bypass turbofan engine model, fighter cockpit displays, and pilot effectors. The piloted tasks used for rating displays and control effector gains are described. Pilot comments and simulation results confirm that the display symbology and control gains are very adequate for the transition flight task. Additionally, it is demonstrated that this small-scale, fixed base flight simulator facility can adequately perform a real time, piloted control evaluation.

An approach to value-based simulator selection: The creation and evaluation of the simulator value index tool.

PubMed

Rooney, Deborah M; Hananel, David M; Covington, Benjamin J; Dionise, Patrick L; Nykamp, Michael T; Pederson, Melvin; Sahloul, Jamal M; Vasquez, Rachael; Seagull, F Jacob; Pinsky, Harold M; Sweier, Domenica G; Cooke, James M

2018-04-01

Currently there is no reliable, standardized mechanism to support health care professionals during the evaluation of and procurement processes for simulators. A tool founded on best practices could facilitate simulator purchase processes. In a 3-phase process, we identified top factors considered during the simulator purchase process through expert consensus (n = 127), created the Simulator Value Index (SVI) tool, evaluated targeted validity evidence, and evaluated the practical value of this SVI. A web-based survey was sent to simulation professionals. Participants (n = 79) used the SVI and provided feedback. We evaluated the practical value of 4 tool variations by calculating their sensitivity to predict a preferred simulator. Seventeen top factors were identified and ranked. The top 2 were technical stability/reliability of the simulator and customer service, with no practical differences in rank across institution or stakeholder role. Full SVI variations predicted successfully the preferred simulator with good (87%) sensitivity, whereas the sensitivity of variations in cost and customer service and cost and technical stability decreased (≤54%). The majority (73%) of participants agreed that the SVI was helpful at guiding simulator purchase decisions, and 88% agreed the SVI tool would help facilitate discussion with peers and leadership. Our findings indicate the SVI supports the process of simulator purchase using a standardized framework. Sensitivity of the tool improved when factors extend beyond traditionally targeted factors. We propose the tool will facilitate discussion amongst simulation professionals dealing with simulation, provide essential information for finance and procurement professionals, and improve the long-term value of simulation solutions. Limitations and application of the tool are discussed. Copyright © 2017 Elsevier Inc. All rights reserved.

Evaluation of TEAM dynamics before and after remote simulation training utilizing CERTAIN platform.

PubMed

Pennington, Kelly M; Dong, Yue; Coville, Hongchuan H; Wang, Bo; Gajic, Ognjen; Kelm, Diana J

2018-12-01

The current study examines the feasibility and potential effects of long distance, remote simulation training on team dynamics. The study design was a prospective study evaluating team dynamics before and after remote simulation. Study subjects consisted of interdisciplinary teams (attending physicians, physicians in training, advanced care practitioners, and/or nurses). The study was conducted at nine training sites in eight countries. Study subjects completed 2-3 simulation scenarios of acute crises before and after training with the Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN). Pre- and post-CERTAIN training simulations were evaluated by two independent reviewers utilizing the Team Emergency Assessment Measure (TEAM), which is a 11-item questionnaire that has been validated for assessing teamwork in the intensive care unit. Any discrepancies of greater than 1 point between the two reviewers on any question on the TEAM assessment were sent to a third reviewer to judge. The score that was deemed discordant by the third judge was eliminated. Pre- and post-CERTAIN training TEAM scores were averaged and compared. Of the nine teams evaluated, six teams demonstrated an overall improvement in global team performance following CERTAIN virtual training. For each of the 11 TEAM assessments, a trend toward improvement following CERTAIN training was noted; however, no assessment had universal improvement. 'Team composure and control' had the least absolute score improvement following CERTAIN training. The greatest improvement in the TEAM assessment scores was in the 'team's ability to complete tasks in a timely manner' and in the 'team leader's communication to the team'. The assessment of team dynamics using long distance, virtual simulation training appears to be feasible and may result in improved team performance during simulated patient crises; however, language and video quality were the two largest barriers noted during the review process.

Use of simulated patients to develop communication skills in nursing education: An integrative review.

PubMed

MacLean, Sharon; Kelly, Michelle; Geddes, Fiona; Della, Phillip

2017-01-01

Registered nurses are expected to communicate effectively with patients. To improve on this skill education programmes in both hospital and tertiary settings are increasingly turning to simulation modalities when training undergraduate and registered nurses. The roles simulated patients (SPs) assume can vary according to training purposes and approach. The first aim is to analyse how SPs are used in nursing education to develop communication skills. The second aim is to evaluate the evidence that is available to support the efficacy of using SPs for training nurses in communication skills and finally to review the SP recruitment and training procedure. An Integrative review. A search was conducted on CINAHL, Psych-info, PubMed, Google Scholar, Scopus, Ovid, Medline, and ProQuest databases. Keywords and inclusion/exclusion criteria were determined and applied to the search strategy. The integrative review included Nineteen studies from 2006-2016. Critical Appraisal Skills Program (CASP) method of evaluation was utilised. Emergent themes were extracted with similar and divergent perspectives. Analysis identified seven clinical contexts for communication skills training (CST) and two SP roles from the eighteen studies. SPs were either directly involved in the teaching of communication (active role) or used in the evaluation of the effectiveness of a communication skills program (passive role). A majority of studies utilised faculty-designed measurement instruments. The evidence presented in the 19 articles indicates that the use of SPs to teach nurse-patient communication skills targets more challenging clinical interactions. Engaging SPs in both CST program facilitation and course evaluation provides nurse educators with a strong foundation to develop further pedagogical and research capacity. Expanding the utilisation of SPs to augment nurses' communication skills and ability to engage with patients in a broader range of clinical contexts with increased

Laboratory evaluation of 10 heat and moisture exchangers using simulated aeromedical evacuation conditions.

PubMed

Suliman, Huda S; Fecura, Stephen E; Baskin, Jonathan; Kalns, John E

2011-06-01

Heat and moisture exchangers (HMEs) are used for airway humidification in mechanically ventilated patients and have been evaluated only under hospital conditions. U.S. Air Force aeromedical evacuation transports are performed under rugged conditions further complicated by the cold and dry environment in military aircrafts, and HMEs are used to provide airway humidification for patients. This study evaluated 10 commercial HMEs using a test system that simulated aeromedical evacuation conditions. Although the American National Standards Institute recommends inspired air to be at an absolute humidity value of > or = 30 mg/L for mechanically ventilated patients, the highest absolute humidity by any HME was approximately 20 mg/L. Although none of the HMEs were able to maintain a temperature high enough to achieve the humidity standard of the American National Standards Institute, the clinical significance of this standard may be less important than the relative humidity maintained in the respired air, especially on evacuation flights of short duration.

A new infant hybrid respiratory simulator: preliminary evaluation based on clinical data.

PubMed

Stankiewicz, Barbara; Pałko, Krzysztof J; Darowski, Marek; Zieliński, Krzysztof; Kozarski, Maciej

2017-11-01

A new hybrid (numerical-physical) simulator of the respiratory system, designed to simulate spontaneous and artificial/assisted ventilation of preterm and full-term infants underwent preliminary evaluation. A numerical, seven-compartmental model of the respiratory system mechanics allows the operator to simulate global and peripheral obstruction and restriction of the lungs. The physical part of the simulator is a piston-based construction of impedance transformer. LabVIEW real-time software coordinates the work of both parts of the simulator and its interaction with a ventilator. Using clinical data, five groups of "artificial infants" were examined: healthy full-term infants, very low-birth-weight preterm infants successfully (VLBW) and unsuccessfully extubated (VLBWun) and extremely low-birth-weight preterm infants without (ELBW) and with bronchopulmonary dysplasia (ELBW_BPD). Pressure-controlled ventilation was simulated to measure peak inspiratory pressure, mean airway pressure, total (patient + endotracheal tube) airway resistance (R), total dynamic compliance of the respiratory system (C), and total work of breathing by the ventilator (WOB). The differences between simulation and clinical parameters were not significant. High correlation coefficients between both types of data were obtained for R, C, and WOB (γ R  = 0.99, P < 0.0005; γ C  = 0.85, P < 0.005; γ WOB  = 0.96, P < 0.05, respectively). Thus, the simulator accurately reproduces infant respiratory system mechanics.

Simulation in mental health nurse education: The development, implementation and evaluation of an educational innovation.

PubMed

Felton, Anne; Wright, Nicola

2017-09-01

Simulation is an important learning approach for the development of skills for healthcare practice. However, it remains under used in the education of mental health practitioners. This article examines the development, implementation and evaluation of a simulated learning experience for final year undergraduate BSc mental health nursing students in the UK. Scenarios involving managing care in an acute in patient ward and community older persons' team were designed to enable students to develop their complex decision making skills. An evaluation of the simulation experience was undertaken. This was informed by the principles of improvement science methodology and data was collected from the student participants using questionnaires. The findings indicated that simulation provided a realistic environment in which students were able to develop skills and manage clinical situations autonomously without fear of being assessed or making mistakes. Reflecting Dieckmann et al.'s (2007) position that simulation is a social situation in itself, the learning approach enabled mental health students to both experience the safety of the Higher Education setting and also the reality of clinical practice. Simulation may therefore provide an important tool to prepare students for the responsibilities of a qualified nurse. Copyright © 2017. Published by Elsevier Ltd.

Sampling for Patient Exit Interviews: Assessment of Methods Using Mathematical Derivation and Computer Simulations.

PubMed

Geldsetzer, Pascal; Fink, Günther; Vaikath, Maria; Bärnighausen, Till

2018-02-01

(1) To evaluate the operational efficiency of various sampling methods for patient exit interviews; (2) to discuss under what circumstances each method yields an unbiased sample; and (3) to propose a new, operationally efficient, and unbiased sampling method. Literature review, mathematical derivation, and Monte Carlo simulations. Our simulations show that in patient exit interviews it is most operationally efficient if the interviewer, after completing an interview, selects the next patient exiting the clinical consultation. We demonstrate mathematically that this method yields a biased sample: patients who spend a longer time with the clinician are overrepresented. This bias can be removed by selecting the next patient who enters, rather than exits, the consultation room. We show that this sampling method is operationally more efficient than alternative methods (systematic and simple random sampling) in most primary health care settings. Under the assumption that the order in which patients enter the consultation room is unrelated to the length of time spent with the clinician and the interviewer, selecting the next patient entering the consultation room tends to be the operationally most efficient unbiased sampling method for patient exit interviews. © 2016 The Authors. Health Services Research published by Wiley Periodicals, Inc. on behalf of Health Research and Educational Trust.

Implementation and evaluation of a dilation and evacuation simulation training curriculum.

PubMed

York, Sloane L; McGaghie, William C; Kiley, Jessica; Hammond, Cassing

2016-06-01

To evaluate obstetrics and gynecology resident physicians' performance following a simulation curriculum on dilation and evacuation (D&E) procedures. This study included two phases: simulation curriculum development and resident physician performance evaluation following training on a D&E simulator. Trainees participated in two evaluations. Simulation training evaluated participants performing six cases on a D&E simulator, measuring procedural time and a 26-step checklist of D&E steps. The operative training portion evaluated residents' performance after training on the simulator using mastery learning techniques. Intra-operative evaluation was based on a 21-step checklist score, Objective Structured Assessment of Technical Skills (OSATS), and percentage of cases completed. Twenty-two residents participated in simulation training, demonstrating improved performance from cases one and two to cases five and six, as measured by checklist score and procedural time (p<.001 and p=.001, respectively). Of 10 participants in the operative training, all performed at least three D&Es, while seven performed at least six cases. While checklist scores did not change significantly from the first to sixth case (mean for first case: 18.3; for sixth case: 19.6; p=.593), OSATS ratings improved from case one (19.7) to case three (23.5; p=.001) and to case six (26.8; p=.005). Trainees completed approximately 71.6% of their first case (range: 21.4-100%). By case six, the six participants performed 81.2% of the case (range: 14.3-100%). D&E simulation using a newly-developed uterine model and simulation curriculum improves resident technical skills. Simulation training with mastery learning techniques transferred to high level of performance in OR using checklist. The OSATS measured skills and showed improvement in performance with subsequent cases. Implementation of a D&E simulation curriculum offers potential for improved surgical training and abortion provision. Copyright © 2016

Utilization of simulated patients to assess diabetes and asthma counseling practices among community pharmacists in Qatar.

PubMed

Paravattil, Bridget; Kheir, Nadir; Yousif, Adil

2017-08-01

Background Patient counseling is one of the most important services a pharmacist can provide to patients. Studies have shown that counseling provided by pharmacists may prevent medication related problems and improve adherence to medication therapy. Objective To explore counseling practices among community pharmacists using simulated patients and to determine if patient, pharmacist, and pharmacy characteristics influence the counseling provided by community pharmacists. Setting Private community pharmacies within Qatar. Method This is a randomized, cross sectional study where simulated patients visited community pharmacies and presented the pharmacist with a new prescription or requested a refill for either a diabetes or asthma medication. Pharmacists completed a questionnaire at the end of the simulated interaction, which was utilized to determine if patient, pharmacist, or pharmacy characteristics had any influence on the counseling provided to patients. A scoring system was devised to assess the pharmacist's counseling practices. Main outcome measure To evaluate the type of information provided by community pharmacists to the simulated patient regarding diabetes and asthma. Results One hundred and twenty-nine pharmacists were enrolled in the study. Eighty one percent of pharmacists had a score <35%. Medication name (95%), directions (47%), indication (43%), and dose (41%) were the most frequently counseled components by pharmacists during the simulated interaction. Male patients received better counseling compared to the female patients (t = 6.177; p < 0.0001). Pharmacists with a master of pharmacy degree provided significantly better counseling (f = 3.261; p = 0.042). Many pharmacists (65%) provided hypoglycemia management to patients, however, 63% referred the patient to the physician when the patient experienced hypoglycemia from inappropriate medication administration. Only 2 (7%) pharmacists correctly counseled the patient on all 8 inhaler

Collision Avoidance for Airport Traffic Simulation Evaluation

NASA Technical Reports Server (NTRS)

Jones, Denise R.; Prinzel, Lawrence J., III; Shelton, Kevin J.; Bailey, Randall E.; Otero, Sharon D.; Barker, Glover D.

2010-01-01

A Collision Avoidance for Airport Traffic (CAAT) concept for the airport Terminal Maneuvering Area (TMA) was evaluated in a simulation study at the National Aeronautics and Space Administration (NASA) Langley Research Center. CAAT is being designed to enhance surface situation awareness and provide cockpit alerts of potential conflicts during runway, taxi, and low altitude air-to-air operations. The purpose of the study was to evaluate pilot reaction to conflict events in the TMA near the airport, different alert timings for various scenarios, alerting display concepts, and directive alerting concepts. This paper gives an overview of the conflict detection and resolution (CD&R) concept, simulation study, and test results

The Impact of Human Patient Simulation on the Attainment of Learning Outcomes

ERIC Educational Resources Information Center

Re, Antonio

2011-01-01

Human patient simulation, and more specifically, high fidelity patient simulation is a growing teaching technique that enables students in medical and health related professions to learn through interacting with a simulator. This study examined the uses of high fidelity simulation with 106 students enrolled in nursing and respiratory therapist…

Vestibular models for design and evaluation of flight simulator motion

NASA Technical Reports Server (NTRS)

Bussolari, S. R.; Sullivan, R. B.; Young, L. R.

1986-01-01

The use of spatial orientation models in the design and evaluation of control systems for motion-base flight simulators is investigated experimentally. The development of a high-fidelity motion drive controller using an optimal control approach based on human vestibular models is described. The formulation and implementation of the optimal washout system are discussed. The effectiveness of the motion washout system was evaluated by studying the response of six motion washout systems to the NASA/AMES Vertical Motion Simulator for a single dash-quick-stop maneuver. The effects of the motion washout system on pilot performance and simulator acceptability are examined. The data reveal that human spatial orientation models are useful for the design and evaluation of flight simulator motion fidelity.

The Modified, Multi-patient Observed Simulated Handoff Experience (M-OSHE): Assessment and Feedback for Entering Residents on Handoff Performance.

PubMed

Gaffney, Sean; Farnan, Jeanne M; Hirsch, Kristen; McGinty, Michael; Arora, Vineet M

2016-04-01

Despite the identification of transfer of patient responsibility as a Core Entrustable Professional Activity for Entering Residency, rigorous methods to evaluate incoming residents' ability to give a verbal handoff of multiple patients are lacking. Our purpose was to implement a multi-patient, simulation-based curriculum to assess verbal handoff performance. Graduate Medical Education (GME) orientation at an urban, academic medical center. Eighty-four incoming residents from four residency programs participated in the study. The curriculum featured an online training module and a multi-patient observed simulated handoff experience (M-OSHE). Participants verbally "handed off" three mock patients of varying acuity and were evaluated by a trained "receiver" using an expert-informed, five-item checklist. Prior handoff experience in medical school was associated with higher checklist scores (23% none vs. 33% either third OR fourth year vs. 58% third AND fourth year, p = 0.021). Prior training was associated with prioritization of patients based on acuity (12% no training vs. 38% prior training, p = 0.014). All participants agreed that the M-OSHE realistically portrayed a clinical setting. The M-OSHE is a promising strategy for teaching and evaluating entering residents' ability to give verbal handoffs of multiple patients. Prior training and more handoff experience was associated with higher performance, which suggests that additional handoff training in medical school may be of benefit.

Field of View Evaluation for Flight Simulators Used in Spatial Disorientation Training

DTIC Science & Technology

2014-01-01

Naval Medical Research Unit Dayton FIELD OF VIEW EVALUATION FOR FLIGHT SIMULATORS USED IN SPATIAL DISORIENTATION TRAINING WILLIAMS, H.P...COVERED (from – to) 2013JUL30 to 2014JUN30 4. TITLE Field of View Evaluation for Flight Simulators Used in Spatial Disorientation Training 5a...simulator systems as well, and implications and recommendations for SD training are discussed. 3 Field of View Evaluation for Flight Simulators

Effectiveness evaluation of simulative workshops for newly licensed drivers.

PubMed

Rosenbloom, Tova; Eldror, Ehud

2014-02-01

The current study set to examine the effects of simulator use in driving instruction on newly licensed drivers, comparing the road safety knowledge and reported intended behavior, as well as the actual driving performance of new drivers. Participants consisted of 280 newly licensed driver, of which 140 whose drivers license training included additional simulator-based lessons, and 140 drivers whose training precluded simulator-based lessons. All drivers answered questionnaires pertaining to their intended safe driving behaviors (according to Ajzen's (2000) theory of planned behavior), and to their traffic safety knowledge. Of the initial sample, 40 drivers received actual driving performance evaluation by an expert driving instructor, as well as by in-vehicle data recorders (IVDRs). We assumed that safer drivers report safer driving intentions, demonstrate greater traffic safety knowledge, evaluated as safer drivers by the driving instructor, and display lower and stable driving parameters on the IVDRs. We hypothesized that theoretical driving studies combined with practical training on simulators will elevate the safety level of novices driving. Hierarchical regression analyses on driving intentions indicated that drivers who did not receive simulator-based lessons demonstrated safer driving intentions compared to drivers who received simulator-based lessons. This pattern possibly indicating the drivers who received simulator-based lessons felt more confident in their driving abilities compared to drivers who did not receive simulated training. No significant difference was found in traffic safety knowledge, or in the evaluation of the expert driving instructor. IDVR data comparisons indicated drivers who received simulator-based lessons braked more often and were less prone to headway events, suggesting a more responsive driving style. These findings do not point to any significant advantage or disadvantage of the current simulator-based driving training over

Technology evaluation, assessment, modeling, and simulation: the TEAMS capability

NASA Astrophysics Data System (ADS)

Holland, Orgal T.; Stiegler, Robert L.

1998-08-01

The United States Marine Corps' Technology Evaluation, Assessment, Modeling and Simulation (TEAMS) capability, located at the Naval Surface Warfare Center in Dahlgren Virginia, provides an environment for detailed test, evaluation, and assessment of live and simulated sensor and sensor-to-shooter systems for the joint warfare community. Frequent use of modeling and simulation allows for cost effective testing, bench-marking, and evaluation of various levels of sensors and sensor-to-shooter engagements. Interconnectivity to live, instrumented equipment operating in real battle space environments and to remote modeling and simulation facilities participating in advanced distributed simulations (ADS) exercises is available to support a wide- range of situational assessment requirements. TEAMS provides a valuable resource for a variety of users. Engineers, analysts, and other technology developers can use TEAMS to evaluate, assess and analyze tactical relevant phenomenological data on tactical situations. Expeditionary warfare and USMC concept developers can use the facility to support and execute advanced warfighting experiments (AWE) to better assess operational maneuver from the sea (OMFTS) concepts, doctrines, and technology developments. Developers can use the facility to support sensor system hardware, software and algorithm development as well as combat development, acquisition, and engineering processes. Test and evaluation specialists can use the facility to plan, assess, and augment their processes. This paper presents an overview of the TEAMS capability and focuses specifically on the technical challenges associated with the integration of live sensor hardware into a synthetic environment and how those challenges are being met. Existing sensors, recent experiments and facility specifications are featured.

Using gaming simulation to evaluate bioterrorism and emergency readiness education.

PubMed

Olson, Debra K; Scheller, Amy; Larson, Susan; Lindeke, Linda; Edwardson, Sandra

2010-01-01

We performed an outcome evaluation of the impact of public health preparedness training as a group comparison posttest design to determine the differences in the way individuals who had participated in training performed in a simulated emergency. The Experimental Group 1 included students who had graduated from or were currently enrolled in the bioterrorism and emergency readiness (BT/ER) curriculum at the University of Minnesota School of Public Health. The comparison groups included individuals who had access to the Internet and were aware of the 2006 online simulation Disaster in Franklin County: A Public Health Simulation. The evaluation process employed surveys and the gaming simulation as sources for primary data. Participants in the BT/ER curriculum (p=0.0001) and other participants completing at least 45 hours of training in the past year (p=0.0001) demonstrated higher effectiveness scores (accuracy of chosen responses within the simulation) than participants who did not report significant amounts of training. This evaluation research demonstrated that training is significantly associated with better performance in a simulated emergency using gaming technology.

Linking simulation-based educational assessments and patient-related outcomes: a systematic review and meta-analysis.

PubMed

Brydges, Ryan; Hatala, Rose; Zendejas, Benjamin; Erwin, Patricia J; Cook, David A

2015-02-01

To examine the evidence supporting the use of simulation-based assessments as surrogates for patient-related outcomes assessed in the workplace. The authors systematically searched MEDLINE, EMBASE, Scopus, and key journals through February 26, 2013. They included original studies that assessed health professionals and trainees using simulation and then linked those scores with patient-related outcomes assessed in the workplace. Two reviewers independently extracted information on participants, tasks, validity evidence, study quality, patient-related and simulation-based outcomes, and magnitude of correlation. All correlations were pooled using random-effects meta-analysis. Of 11,628 potentially relevant articles, the 33 included studies enrolled 1,203 participants, including postgraduate physicians (n = 24 studies), practicing physicians (n = 8), medical students (n = 6), dentists (n = 2), and nurses (n = 1). The pooled correlation for provider behaviors was 0.51 (95% confidence interval [CI], 0.38 to 0.62; n = 27 studies); for time behaviors, 0.44 (95% CI, 0.15 to 0.66; n = 7); and for patient outcomes, 0.24 (95% CI, -0.02 to 0.47; n = 5). Most reported validity evidence was favorable, though studies often included only correlational evidence. Validity evidence of internal structure (n = 13 studies), content (n = 12), response process (n = 2), and consequences (n = 1) were reported less often. Three tools showed large pooled correlations and favorable (albeit incomplete) validity evidence. Simulation-based assessments often correlate positively with patient-related outcomes. Although these surrogates are imperfect, tools with established validity evidence may replace workplace-based assessments for evaluating select procedural skills.

Regional Evaluation of the Severity-Based Stroke Triage Algorithm for Emergency Medical Services Using Discrete Event Simulation.

PubMed

Bogle, Brittany M; Asimos, Andrew W; Rosamond, Wayne D

2017-10-01

The Severity-Based Stroke Triage Algorithm for Emergency Medical Services endorses routing patients with suspected large vessel occlusion acute ischemic strokes directly to endovascular stroke centers (ESCs). We sought to evaluate different specifications of this algorithm within a region. We developed a discrete event simulation environment to model patients with suspected stroke transported according to algorithm specifications, which varied by stroke severity screen and permissible additional transport time for routing patients to ESCs. We simulated King County, Washington, and Mecklenburg County, North Carolina, distributing patients geographically into census tracts. Transport time to the nearest hospital and ESC was estimated using traffic-based travel times. We assessed undertriage, overtriage, transport time, and the number-needed-to-route, defined as the number of patients enduring additional transport to route one large vessel occlusion patient to an ESC. Undertriage was higher and overtriage was lower in King County compared with Mecklenburg County for each specification. Overtriage variation was primarily driven by screen (eg, 13%-55% in Mecklenburg County and 10%-40% in King County). Transportation time specifications beyond 20 minutes increased overtriage and decreased undertriage in King County but not Mecklenburg County. A low- versus high-specificity screen routed 3.7× more patients to ESCs. Emergency medical services spent nearly twice the time routing patients to ESCs in King County compared with Mecklenburg County. Our results demonstrate how discrete event simulation can facilitate informed decision making to optimize emergency medical services stroke severity-based triage algorithms. This is the first step toward developing a mature simulation to predict patient outcomes. © 2017 American Heart Association, Inc.

Evaluation of leadership skills during the simulation education course for the initial management of blunt trauma.

PubMed

Schott, Eric; Brautigam, Robert T; Smola, Jacqueline; Burns, Karyl J

2012-04-01

Leadership skills of senior residents, trauma fellows, and a nurse practitioner were assessed during simulation training for the initial management of blunt trauma. This was a pilot, observational study, that in addition to skill development and assessment also sought to determine the need for a dedicated leadership training course for surgical residents. The study evaluated the leadership skills and adherence to Advance Trauma Life Support (ATLS) guidelines of the team leaders during simulation training. The team leaders' performances on criteria regarding prearrival planning, critical actions based on ATLS, injury identification, patient management, and communication were evaluated for each of five blunt-trauma scenarios. Although there was a statistically significant increase in leadership skills for performing ATLS critical actions, P < 0.05, there were 10 adverse events. A structured simulation program dedicated to developing skills for team leadership willbe a worthwhile endeavor at our institution.

Accessing primary care: a simulated patient study.

PubMed

Campbell, John L; Carter, Mary; Davey, Antoinette; Roberts, Martin J; Elliott, Marc N; Roland, Martin

2013-03-01

Simulated patient, or so-called 'mystery-shopper', studies are a controversial, but potentially useful, approach to take when conducting health services research. To investigate the construct validity of survey questions relating to access to primary care included in the English GP Patient Survey. Observational study in 41 general practices in rural, urban, and inner-city settings in the UK. Between May 2010 and March 2011, researchers telephoned practices at monthly intervals, simulating patients requesting routine, but prompt, appointments. Seven measures of access and appointment availability, measured from the mystery-shopper contacts, were related to seven measures of practice performance from the GP Patient Survey. Practices with lower access scores in the GP Patient Survey had poorer access and appointment availability for five out of seven items measured directly, when compared with practices that had higher scores. Scores on items from the national survey that related to appointment availability were significantly associated with direct measures of appointment availability. Patient-satisfaction levels and the likelihood that patients would recommend their practice were related to the availability of appointments. Patients' reports of ease of telephone access in the national survey were unrelated to three out of four measures of practice call handling, but were related to the time taken to resolve an appointment request, suggesting responders' possible confusion in answering this question. Items relating to the accessibility of care in a the English GP patient survey have construct validity. Patients' satisfaction with their practice is not related to practice call handling, but is related to appointment availability.

Implementation and evaluation of a simulation curriculum for paediatric residency programs including just-in-time in situ mock codes.

PubMed

Sam, Jonathan; Pierse, Michael; Al-Qahtani, Abdullah; Cheng, Adam

2012-02-01

To develop, implement and evaluate a simulation-based acute care curriculum in a paediatric residency program using an integrated and longitudinal approach. Curriculum framework consisting of three modular, year-specific courses and longitudinal just-in-time, in situ mock codes. Paediatric residency program at BC Children's Hospital, Vancouver, British Columbia. The three year-specific courses focused on the critical first 5 min, complex medical management and crisis resource management, respectively. The just-in-time in situ mock codes simulated the acute deterioration of an existing ward patient, prepared the actual multidisciplinary code team, and primed the surrounding crisis support systems. Each curriculum component was evaluated with surveys using a five-point Likert scale. A total of 40 resident surveys were completed after each of the modular courses, and an additional 28 surveys were completed for the overall simulation curriculum. The highest Likert scores were for hands-on skill stations, immersive simulation environment and crisis resource management teaching. Survey results also suggested that just-in-time mock codes were realistic, reinforced learning, and prepared ward teams for patient deterioration. A simulation-based acute care curriculum was successfully integrated into a paediatric residency program. It provides a model for integrating simulation-based learning into other training programs, as well as a model for any hospital that wishes to improve paediatric resuscitation outcomes using just-in-time in situ mock codes.

An evaluation of dental operative simulation materials.

PubMed

He, Li-Hong; Foster Page, Lyndie; Purton, David

2012-01-01

The study was to evaluate the performance of different materials used in dental operative simulation and compare them with those of natural teeth. Three typical phantom teeth materials were compared with extracted permanent teeth by a nanoindentation system and evaluated by students and registered dentists on the drilling sensation of the materials. Moreover, the tool life (machinability) of new cylindrical diamond burs on cutting the sample materials was tested and the burs were observed. Although student and dentist evaluations were scattered and inconclusive, it was found that elastic modulus (E) and hardness (H) were not the main factors in determining the drilling sensation of the materials. The sensation of drilling is a reflection of cutting force and power consumption.An ideal material for dental simulation should be able to generate similar drilling resistance to that of natural tooth, which is the machinability of the material.

Assessing Critical Thinking Outcomes of Dental Hygiene Students Utilizing Virtual Patient Simulation: A Mixed Methods Study.

PubMed

Allaire, Joanna L

2015-09-01

Dental hygiene educators must determine which educational practices best promote critical thinking, a quality necessary to translate knowledge into sound clinical decision making. The aim of this small pilot study was to determine whether virtual patient simulation had an effect on the critical thinking of dental hygiene students. A pretest-posttest design using the Health Science Reasoning Test was used to evaluate the critical thinking skills of senior dental hygiene students at The University of Texas School of Dentistry at Houston Dental Hygiene Program before and after their experience with computer-based patient simulation cases. Additional survey questions sought to identify the students' perceptions of whether the experience had helped develop their critical thinking skills and improved their ability to provide competent patient care. A convenience sample of 31 senior dental hygiene students completed both the pretest and posttest (81.5% of total students in that class); 30 senior dental hygiene students completed the survey on perceptions of the simulation (78.9% response rate). Although the results did not show a significant increase in mean scores, the students reported feeling that the use of virtual patients was an effective teaching method to promote critical thinking, problem-solving, and confidence in the clinical realm. The results of this pilot study may have implications to support the use of virtual patient simulations in dental hygiene education. Future research could include a larger controlled study to validate findings from this study.

Web-based multimedia courseware for emergency cardiac patient management simulations.

PubMed

Ambrosiadou, V; Compton, T; Panchal, T; Polovina, S

2000-01-01

This is a multidisciplinary inter-departmental/faculty project between the departments of computer science, electronic, communications and electrical engineering and nursing and paramedic sciences. The objective is to develop a web based multimedia front end to existing simulations of cardiac emergency scenaria. It will be used firstly in the teaching of nurses. The University of Hertfordshire is the only University in Britain using simulations of cardiac emergency scenaria for nurse and paramedic science education and therefore this project will add the multimedia dimension in distributed courses over the web and will assess the improvement in the educational process. The use of network and multimedia technologies, provide interactive learning, immediate feedback to students' responses, individually tailored instructions, objective testing and entertaining delivery. The end product of this project will serve as interactive material to enhance experiential learning for nursing students using the simulations of cardiac emergency scenaria. The emergency treatment simulations have been developed using VisSim and may be compiled as C code. The objective of the project is to provide a web based user friendly multimedia interface in order to demonstrate the way in which patients may be managed in critical situations by applying advanced technological equipment and drug administration. Then the user will be able to better appreciate the concepts involved by running the VisSim simulations. The evaluation group for the proposed software will be the Department of Nursing and Paramedic Sciences About 200 nurses use simulations every year for training purposes as part of their course requirements.

Simulator scene display evaluation device

NASA Technical Reports Server (NTRS)

Haines, R. F. (Inventor)

1986-01-01

An apparatus for aligning and calibrating scene displays in an aircraft simulator has a base on which all of the instruments for the aligning and calibrating are mounted. Laser directs beam at double right prism which is attached to pivoting support on base. The pivot point of the prism is located at the design eye point (DEP) of simulator during the aligning and calibrating. The objective lens in the base is movable on a track to follow the laser beam at different angles within the field of vision at the DEP. An eyepiece and a precision diopter are movable into a position behind the prism during the scene evaluation. A photometer or illuminometer is pivotable about the pivot into and out of position behind the eyepiece.

Impact of a Paper vs Virtual Simulated Patient Case on Student-Perceived Confidence and Engagement

PubMed Central

Gallimore, Casey E.; Pitterle, Michael; Morrill, Josh

2016-01-01

Objective. To evaluate online case simulation vs a paper case on student confidence and engagement. Design. Students enrolled in a pharmacotherapy laboratory course completed a patient case scenario as a component of an osteoarthritis laboratory module. Two laboratory sections used a paper case (n=53); three sections used an online virtual case simulation (n=81). Student module performance was assessed through a submitted subjective objective assessment plan (SOAP) note. Students completed pre/post surveys to measure self-perceived confidence in providing medication management. The simulation group completed postmodule questions related to realism and engagement of the online virtual case simulation. Group assessments were performed using chi-square and Mann Whitney tests. Assessment. A significant increase in all 13 confidence items was seen in both student groups following completion of the laboratory module. The simulation group had an increased change of confidence compared to the paper group in assessing medication efficacy and documenting a thorough assessment. Comparing the online virtual simulation to a paper case, students agreed the learning experience increased interest, enjoyment, relevance, and realism. The simulation group performed better on the subjective SOAP note domain though no differences in total SOAP note scores was found between the two groups. Conclusion. Virtual case simulations result in increased student engagement and may lead to improved documentation performance in the subjective domain of SOAP notes. However, virtual patient cases may offer limited benefit over paper cases in improving overall student self-confidence to provide medication management. PMID:26941442

Impact of a Paper vs Virtual Simulated Patient Case on Student-Perceived Confidence and Engagement.

PubMed

Barnett, Susanne G; Gallimore, Casey E; Pitterle, Michael; Morrill, Josh

2016-02-25

To evaluate online case simulation vs a paper case on student confidence and engagement. Students enrolled in a pharmacotherapy laboratory course completed a patient case scenario as a component of an osteoarthritis laboratory module. Two laboratory sections used a paper case (n=53); three sections used an online virtual case simulation (n=81). Student module performance was assessed through a submitted subjective objective assessment plan (SOAP) note. Students completed pre/post surveys to measure self-perceived confidence in providing medication management. The simulation group completed postmodule questions related to realism and engagement of the online virtual case simulation. Group assessments were performed using chi-square and Mann Whitney tests. A significant increase in all 13 confidence items was seen in both student groups following completion of the laboratory module. The simulation group had an increased change of confidence compared to the paper group in assessing medication efficacy and documenting a thorough assessment. Comparing the online virtual simulation to a paper case, students agreed the learning experience increased interest, enjoyment, relevance, and realism. The simulation group performed better on the subjective SOAP note domain though no differences in total SOAP note scores was found between the two groups. Virtual case simulations result in increased student engagement and may lead to improved documentation performance in the subjective domain of SOAP notes. However, virtual patient cases may offer limited benefit over paper cases in improving overall student self-confidence to provide medication management.

Teaching clinical opioid pharmacology with the Human Patient Simulator.

PubMed

Hassan, Zaki; DiLorenzo, Amy; Sloan, Paul

2010-01-01

Postoperative pain should be aggressively treated to decrease the development of chronic postsurgical pain. There has been an increase in the use of Human Patient Simulator (HPS) for teaching advanced courses in pharmacology to medical students, residents, and nurses. The aim of this educational investigation was to pilot the HPS for the training of medical students and surgical recovery room staff nurses in the pharmacology of opioids for the management of postoperative pain. The computerized HPS mannequin is fully monitored with appropriate displays and includes a voice speaker mounted in the head. Medical students and Postanesthesia care unit nurses, led by faculty in the Department of Anesthesiology in small groups of 4-6, participated in a 2- to 3-hour HPS course on the use of opioids for the management of acute postoperative pain. Trainees were asked to treat the acute and severe postoperative pain of a simulated patient. Opioid effects and side effects (such as respiratory depression) were presented on the mannequin in real time to the participants. Side effects of naloxone to reverse opioid depression were presented as a crisis in real time to the participants. Participants completed a 10-item course evaluation using a 5-point Likert scale (1 = strongly disagree; 5 = strongly agree). Twenty-two nurses and nine medical students completed the HPS opioid pharmacology scenario. Almost all participants rated the HPS course very highly and rated every item as either agree or strongly agree. Most participants agreed that the simulator session improved their understanding of opioid pharmacology including opioid side effects and management of opioid complications. Course participants felt most strongly (median, interquartile range) that the simulator session improved their understanding of naloxone pharmacology (5, 0), simulators serve as a useful teaching tool (5, 0), and that they would be pleased to participate in any additional HPS teaching sessions (5, 0). The

Computer Simulation Shows the Effect of Communication on Day of Surgery Patient Flow.

PubMed

Taaffe, Kevin; Fredendall, Lawrence; Huynh, Nathan; Franklin, Jennifer

2015-07-01

To improve patient flow in a surgical environment, practitioners and academicians often use process mapping and simulation as tools to evaluate and recommend changes. We used simulations to help staff visualize the effect of communication and coordination delays that occur on the day of surgery. Perioperative services staff participated in tabletop exercises in which they chose the delays that were most important to eliminate. Using a day-of-surgery computer simulation model, the elimination of delays was tested and the results were shared with the group. This exercise, repeated for multiple groups of staff, provided an understanding of not only the dynamic events taking place, but also how small communication delays can contribute to a significant loss in efficiency and the ability to provide timely care. Survey results confirmed these understandings. Copyright © 2015 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Virtual patient simulation at US and Canadian medical schools.

PubMed

Huang, Grace; Reynolds, Robby; Candler, Chris

2007-05-01

"Virtual patients" are computer-based simulations designed to complement clinical training. These applications possess numerous educational benefits but are costly to develop. Few medical schools can afford to create them. The purpose of this inventory was to gather information regarding in-house virtual patient development at U.S. and Canadian medical schools to promote the sharing of existing cases and future collaboration. From February to September 2005, the authors contacted 142 U.S. and Canadian medical schools and requested that they report on virtual patient simulation activities at their respective institutions. The inventory elicited information regarding the pedagogic and technical characteristics of each virtual patient application. The schools were also asked to report on their willingness to share virtual patients. Twenty-six out of 108 responding schools reported that they were producing virtual patients. Twelve schools provided additional data on 103 cases and 111 virtual patients. The vast majority of virtual patients were media rich and were associated with significant production costs and time. The reported virtual patient cases tended to focus on primary care disciplines and did not as a whole exhibit racial or ethnic diversity. Funding sources, production costs, and production duration influenced the extent of schools' willingness to share. Broader access to and cooperative development of these resources would allow medical schools to enhance their clinical curricula. Virtual patient development should include basic science objectives for more integrative learning, simulate the consequences of clinical decision making, and include additional cases in cultural competency. Together, these efforts can enhance medical education despite external constraints on clinical training.

A new cardiology patient simulator.

PubMed

Takashina, T; Shimizu, M; Katayama, H

1997-01-01

We report a new cardiology patient simulator developed through the application of new digital computer technology, capable of playing back selected physical findings (jugular-venous waves, arterial pulses of carotid, brachial, radial and femoral arteries, and cardiac impulses), as well as cardiac sounds, murmurs and respiratory sounds that have been prerecorded from actual patients. The examining physician uses an ordinary type of stethoscope. Four built-in speakers are located in the human-sized mannequin at the classic auscultatory sites (aortic, pulmonic, tricuspid and mitral). This compact and portable educational apparatus should facilitate medical training in the bedside cardiac examination, of physicians, medical students, nurses and paramedics throughout the world.

Patient-individualized boundary conditions for CFD simulations using time-resolved 3D angiography.

PubMed

Boegel, Marco; Gehrisch, Sonja; Redel, Thomas; Rohkohl, Christopher; Hoelter, Philip; Doerfler, Arnd; Maier, Andreas; Kowarschik, Markus

2016-06-01

Hemodynamic simulations are of increasing interest for the assessment of aneurysmal rupture risk and treatment planning. Achievement of accurate simulation results requires the usage of several patient-individual boundary conditions, such as a geometric model of the vasculature but also individualized inflow conditions. We propose the automatic estimation of various parameters for boundary conditions for computational fluid dynamics (CFD) based on a single 3D rotational angiography scan, also showing contrast agent inflow. First the data are reconstructed, and a patient-specific vessel model can be generated in the usual way. For this work, we optimize the inflow waveform based on two parameters, the mean velocity and pulsatility. We use statistical analysis of the measurable velocity distribution in the vessel segment to estimate the mean velocity. An iterative optimization scheme based on CFD and virtual angiography is utilized to estimate the inflow pulsatility. Furthermore, we present methods to automatically determine the heart rate and synchronize the inflow waveform to the patient's heart beat, based on time-intensity curves extracted from the rotational angiogram. This will result in a patient-individualized inflow velocity curve. The proposed methods were evaluated on two clinical datasets. Based on the vascular geometries, synthetic rotational angiography data was generated to allow a quantitative validation of our approach against ground truth data. We observed an average error of approximately [Formula: see text] for the mean velocity, [Formula: see text] for the pulsatility. The heart rate was estimated very precisely with an average error of about [Formula: see text], which corresponds to about 6 ms error for the duration of one cardiac cycle. Furthermore, a qualitative comparison of measured time-intensity curves from the real data and patient-specific simulated ones shows an excellent match. The presented methods have the potential to accurately

Integrated Clinical Training for Space Flight Using a High-Fidelity Patient Simulator in a Simulated Microgravity Environment

NASA Technical Reports Server (NTRS)

Hurst, Victor; Doerr, Harold K.; Polk, J. D.; Schmid, Josef; Parazynksi, Scott; Kelly, Scott

2007-01-01

This viewgraph presentation reviews the use of telemedicine in a simulated microgravity environment using a patient simulator. For decades, telemedicine techniques have been used in terrestrial environments by many cohorts with varied clinical experience. The success of these techniques has been recently expanded to include microgravity environments aboard the International Space Station (ISS). In order to investigate how an astronaut crew medical officer will execute medical tasks in a microgravity environment, while being remotely guided by a flight surgeon, the Medical Operation Support Team (MOST) used the simulated microgravity environment provided aboard DC-9 aircraft teams of crew medical officers, and remote flight surgeons performed several tasks on a patient simulator.

Simulating patient-specific heart shape and motion using SPECT perfusion images with the MCAT phantom

NASA Astrophysics Data System (ADS)

Faber, Tracy L.; Garcia, Ernest V.; Lalush, David S.; Segars, W. Paul; Tsui, Benjamin M.

2001-05-01

The spline-based Mathematical Cardiac Torso (MCAT) phantom is a realistic software simulation designed to simulate single photon emission computed tomographic (SPECT) data. It incorporates a heart model of known size and shape; thus, it is invaluable for measuring accuracy of acquisition, reconstruction, and post-processing routines. New functionality has been added by replacing the standard heart model with left ventricular (LV) epicaridal and endocardial surface points detected from actual patient SPECT perfusion studies. LV surfaces detected from standard post-processing quantitation programs are converted through interpolation in space and time into new B-spline models. Perfusion abnormalities are added to the model based on results of standard perfusion quantification. The new LV is translated and rotated to fit within existing atria and right ventricular models, which are scaled based on the size of the LV. Simulations were created for five different patients with myocardial infractions who had undergone SPECT perfusion imaging. Shape, size, and motion of the resulting activity map were compared visually to the original SPECT images. In all cases, size, shape and motion of simulated LVs matched well with the original images. Thus, realistic simulations with known physiologic and functional parameters can be created for evaluating efficacy of processing algorithms.

Optimal learning in a virtual patient simulation of cranial nerve palsies: the interaction between social learning context and student aptitude.

PubMed

Johnson, Teresa R; Lyons, Rebecca; Chuah, Joon Hao; Kopper, Regis; Lok, Benjamin C; Cendan, Juan C

2013-01-01

Simulation in medical education provides students with opportunities to practice interviews, examinations, and diagnosis formulation related to complex conditions without risks to patients. To examine differences between individual and team participation on learning outcomes and student perspectives through use of virtual patients (VPs) for teaching cranial nerve (CN) evaluation. Fifty-seven medical students were randomly assigned to complete simulation exercises either as individuals or as members of three-person teams. Students interviewed, examined, and diagnosed VPs with possible CN damage in the neurological exam rehearsal virtual environment (NERVE). Knowledge of CN abnormalities was assessed pre- and post-simulation. Student perspectives of system usability were evaluated post-simulation. An aptitude-treatment interaction (ATI) effect was detected; at pre-test scores ≤ 50%, students in teams scored higher (83%) at post-test than did students as individuals (62%, p = 0.02). Post-simulation, students in teams reported greater confidence in their ability to diagnose CN abnormalities than did students as individuals (p = 0.02; mean rating = 4.0/5.0 and 3.4/5.0, respectively). The ATI effect allows us to begin defining best practices for the integration of VP simulators into the medical curriculum. We are persuaded to implement future NERVE exercises with small teams of medical students.

Optimal learning in a virtual patient simulation of cranial nerve palsies: The interaction between social learning context and student aptitude

PubMed Central

JOHNSON, TERESA R.; LYONS, REBECCA; CHUAH, JOON HAO; KOPPER, REGIS; LOK, BENJAMIN C.; CENDAN, JUAN C.

2013-01-01

Background Simulation in medical education provides students with opportunities to practice interviews, examinations, and diagnosis formulation related to complex conditions without risks to patients. Aim To examine differences between individual and team participation on learning outcomes and student perspectives through use of virtual patients (VPs) for teaching cranial nerve (CN) evaluation. Methods Fifty-seven medical students were randomly assigned to complete simulation exercises either as individuals or as members of three-person teams. Students interviewed, examined, and diagnosed VPs with possible CN damage in the Neurological Exam Rehearsal Virtual Environment (NERVE). Knowledge of CN abnormalities was assessed pre- and post-simulation. Student perspectives of system usability were evaluated post-simulation. Results An aptitude-treatment interaction (ATI) effect was detected; at pre-test scores ≤50%, students in teams scored higher (83%) at post-test than did students as individuals (62%, p = 0.02). Post-simulation, students in teams reported greater confidence in their ability to diagnose CN abnormalities than did students as individuals (p = 0.02; mean rating = 4.0/5.0 and 3.4/5.0, respectively). Conclusion The ATI effect allows us to begin defining best practices for the integration of VP simulators into the medical curriculum. We are persuaded to implement future NERVE exercises with small teams of medical students. PMID:22938679

Furniture rough mill costs evaluated by computer simulation

Treesearch

R. Bruce Anderson

1983-01-01

A crosscut-first furniture rough mill was simulated to evaluate processing and raw material costs on an individual part basis. Distributions representing the real-world characteristics of lumber, equipment feed speeds, and processing requirements are programed into the simulation. Costs of parts from a specific cutting bill are given, and effects of lumber input costs...

Preoperative planning with three-dimensional reconstruction of patient's anatomy, rapid prototyping and simulation for endoscopic mitral valve repair.

PubMed

Sardari Nia, Peyman; Heuts, Samuel; Daemen, Jean; Luyten, Peter; Vainer, Jindrich; Hoorntje, Jan; Cheriex, Emile; Maessen, Jos

2017-02-01

Mitral valve repair performed by an experienced surgeon is superior to mitral valve replacement for degenerative mitral valve disease; however, many surgeons are still deterred from adapting this procedure because of a steep learning curve. Simulation-based training and planning could improve the surgical performance and reduce the learning curve. The aim of this study was to develop a patient-specific simulation for mitral valve repair and provide a proof of concept of personalized medicine in a patient prospectively planned for mitral valve surgery. A 65-year old male with severe symptomatic mitral valve regurgitation was referred to our mitral valve heart team. On the basis of three-dimensional (3D) transoesophageal echocardiography and computed tomography, 3D reconstructions of the patient's anatomy were constructed. By navigating through these reconstructions, the repair options and surgical access were chosen (minimally invasive repair). Using rapid prototyping and negative mould fabrication, we developed a process to cast a patient-specific mitral valve silicone replica for preoperative repair in a high-fidelity simulator. Mitral valve and negative mould were printed in systole to capture the pathology when the valve closes. A patient-specific mitral valve silicone replica was casted and mounted in the simulator. All repair techniques could be performed in the simulator to choose the best repair strategy. As the valve was printed in systole, no special testing other than adjusting the coaptation area was required. Subsequently, the patient was operated, mitral valve pathology was validated and repair was successfully done as in the simulation. The patient-specific simulation and planning could be applied for surgical training, starting the (minimally invasive) mitral valve repair programme, planning of complex cases and the evaluation of new interventional techniques. The personalized medicine could be a possible pathway towards enhancing reproducibility

Evaluation of chemical simulations from EMEP4ASIA

NASA Astrophysics Data System (ADS)

Pommier, M.; Gauss, M.; Fagerli, H.; Benedictow, A.; Nyiri, A.; Valdebenito, Á.; Wind, P.

2016-12-01

The EMEP/MSC-W chemistry transport model (CTM) has been used for decades to simulate concentrations of surface air pollutants over Europe and to calculate source-receptor relationships between European countries. Within the framework of the operational air pollution forecasts for East Asia, being offered by the EU project PANDA, this study aims to evaluate the EMEP/MSC-W CTM in simulating high pollution events over Asian cities. This work is the first attempt to use this CTM with a fine horizontal resolution (0.1°×0.1°) over Asia and to simulate the pollution over urban regions. The main part of the work has been to focus on the evaluation of the EMEP/MSC-W CTM with measurements from different platforms (satellite, ground-based, in situ) and to identify the biases or the errors in the simulation. This evaluation is important in order to establish the capabilities of the model to identify air pollution sources. Regional distributions and temporal variation of main pollutants are thus discussed. For example, the daily variation in Ox is well captured while the NOx is under-predicted and the O3 is overestimated, especially in winter. The CTM performs also very well on day-to-day variation in PM25 or on the regional distribution in CO total column as over Beijing.

Using Simulation for Launch Team Training and Evaluation

NASA Technical Reports Server (NTRS)

Peaden, Cary J.

2005-01-01

This document describes some of the histor y and uses of simulation systems and processes for the training and evaluation of Launch Processing, Mission Control, and Mission Management teams. It documents some of the types of simulations that are used at Kennedy Space Center (KSC) today and that could be utilized (and possibly enhanced) for future launch vehicles. This article is intended to provide an initial baseline for further research into simulation for launch team training in the near future.

Path selection system simulation and evaluation for a Martian roving vehicle

NASA Technical Reports Server (NTRS)

Boheim, S. L.; Prudon, W. C.

1972-01-01

The simulation and evaluation of proposed path selection systems for an autonomous Martian roving vehicle was developed. The package incorporates a number of realistic features, such as the simulation of random effects due to vehicle bounce and sensor-reading uncertainty, to increase the reliability of the results. Qualitative and quantitative evaluation criteria were established. The performance of three different path selection systems was evaluated to determine the effectiveness of the simulation package, and to form some preliminary conclusions regarding the tradeoffs involved in a path selection system design.

Koppen bioclimatic evaluation of CMIP historical climate simulations

DOE PAGES

Phillips, Thomas J.; Bonfils, Celine J. W.

2015-06-05

Köppen bioclimatic classification relates generic vegetation types to characteristics of the interactive annual-cycles of continental temperature (T) and precipitation (P). In addition to predicting possible bioclimatic consequences of past or prospective climate change, a Köppen scheme can be used to pinpoint biases in model simulations of historical T and P. In this study a Köppen evaluation of Coupled Model Intercomparison Project (CMIP) simulations of historical climate is conducted for the period 1980–1999. Evaluation of an example CMIP5 model illustrates how errors in simulating Köppen vegetation types (relative to those derived from observational reference data) can be deconstructed and related tomore » model-specific temperature and precipitation biases. Measures of CMIP model skill in simulating the reference Köppen vegetation types are also developed, allowing the bioclimatic performance of a CMIP5 simulation of T and P to be compared quantitatively with its CMIP3 antecedent. Although certain bioclimatic discrepancies persist across model generations, the CMIP5 models collectively display an improved rendering of historical T and P relative to their CMIP3 counterparts. Additionally, the Köppen-based performance metrics are found to be quite insensitive to alternative choices of observational reference data or to differences in model horizontal resolution.« less

Tetrahedral and polyhedral mesh evaluation for cerebral hemodynamic simulation--a comparison.

PubMed

Spiegel, Martin; Redel, Thomas; Zhang, Y; Struffert, Tobias; Hornegger, Joachim; Grossman, Robert G; Doerfler, Arnd; Karmonik, Christof

2009-01-01

Computational fluid dynamic (CFD) based on patient-specific medical imaging data has found widespread use for visualizing and quantifying hemodynamics in cerebrovascular disease such as cerebral aneurysms or stenotic vessels. This paper focuses on optimizing mesh parameters for CFD simulation of cerebral aneurysms. Valid blood flow simulations strongly depend on the mesh quality. Meshes with a coarse spatial resolution may lead to an inaccurate flow pattern. Meshes with a large number of elements will result in unnecessarily high computation time which is undesirable should CFD be used for planning in the interventional setting. Most CFD simulations reported for these vascular pathologies have used tetrahedral meshes. We illustrate the use of polyhedral volume elements in comparison to tetrahedral meshing on two different geometries, a sidewall aneurysm of the internal carotid artery and a basilar bifurcation aneurysm. The spatial mesh resolution ranges between 5,119 and 228,118 volume elements. The evaluation of the different meshes was based on the wall shear stress previously identified as a one possible parameter for assessing aneurysm growth. Polyhedral meshes showed better accuracy, lower memory demand, shorter computational speed and faster convergence behavior (on average 369 iterations less).

Evaluation of the BreastSimulator software platform for breast tomography

NASA Astrophysics Data System (ADS)

Mettivier, G.; Bliznakova, K.; Sechopoulos, I.; Boone, J. M.; Di Lillo, F.; Sarno, A.; Castriconi, R.; Russo, P.

2017-08-01

The aim of this work was the evaluation of the software BreastSimulator, a breast x-ray imaging simulation software, as a tool for the creation of 3D uncompressed breast digital models and for the simulation and the optimization of computed tomography (CT) scanners dedicated to the breast. Eight 3D digital breast phantoms were created with glandular fractions in the range 10%-35%. The models are characterised by different sizes and modelled realistic anatomical features. X-ray CT projections were simulated for a dedicated cone-beam CT scanner and reconstructed with the FDK algorithm. X-ray projection images were simulated for 5 mono-energetic (27, 32, 35, 43 and 51 keV) and 3 poly-energetic x-ray spectra typically employed in current CT scanners dedicated to the breast (49, 60, or 80 kVp). Clinical CT images acquired from two different clinical breast CT scanners were used for comparison purposes. The quantitative evaluation included calculation of the power-law exponent, β, from simulated and real breast tomograms, based on the power spectrum fitted with a function of the spatial frequency, f, of the form S(f)  =  α/f   β . The breast models were validated by comparison against clinical breast CT and published data. We found that the calculated β coefficients were close to that of clinical CT data from a dedicated breast CT scanner and reported data in the literature. In evaluating the software package BreastSimulator to generate breast models suitable for use with breast CT imaging, we found that the breast phantoms produced with the software tool can reproduce the anatomical structure of real breasts, as evaluated by calculating the β exponent from the power spectral analysis of simulated images. As such, this research tool might contribute considerably to the further development, testing and optimisation of breast CT imaging techniques.

Patient-specific surgical simulator for the pre-operative planning of single-incision laparoscopic surgery with bimanual robots.

PubMed

Turini, Giuseppe; Moglia, Andrea; Ferrari, Vincenzo; Ferrari, Mauro; Mosca, Franco

2012-01-01

The trend of surgical robotics is to follow the evolution of laparoscopy, which is now moving towards single-incision laparoscopic surgery. The main drawback of this approach is the limited maneuverability of the surgical tools. Promising solutions to improve the surgeon's dexterity are based on bimanual robots. However, since both robot arms are completely inserted into the patient's body, issues related to possible unwanted collisions with structures adjacent to the target organ may arise. This paper presents a simulator based on patient-specific data for the positioning and workspace evaluation of bimanual surgical robots in the pre-operative planning of single-incision laparoscopic surgery. The simulator, designed for the pre-operative planning of robotic laparoscopic interventions, was tested by five expert surgeons who evaluated its main functionalities and provided an overall rating for the system. The proposed system demonstrated good performance and usability, and was designed to integrate both present and future bimanual surgical robots.

The educational impact of web-based and face-to-face patient deterioration simulation programs: An interventional trial.

PubMed

Chung, Catherine; Cooper, Simon J; Cant, Robyn P; Connell, Cliff; McKay, Angela; Kinsman, Leigh; Gazula, Swapnali; Boyle, Jayne; Cameron, Amanda; Cash, Penny; Evans, Lisa; Kim, Jeong-Ah; Masud, Rana; McInnes, Denise; Norman, Lisa; Penz, Erika; Rotter, Thomas; Tanti, Erin; Breakspear, Tom

2018-05-01

There are international concerns relating to the management of patient deterioration. The "failure to rescue" literature identifies that nursing staff miss cues of deterioration and often fail to call for assistance. Simulation-based educational approaches may improve nurses' recognition and management of patient deterioration. To investigate the educational impact of the First2Act web-based (WB) and face-to-face (F2F) simulation programs. A mixed methods interventional cohort trial with nursing staff from four Australian hospitals. Nursing staff working in four public and private hospital medical wards in the State of Victoria. In 2016, ward nursing staff (n = 74) from a public and private hospital completed three F2F laboratory-based team simulations with a patient actor in teams of three. 56 nursing staff from another public and private hospital individually completed a three-scenario WB simulation program (First2ActWeb) [A 91% participation rate]. Validated tools were used to measure knowledge (multi-choice questionnaire), competence (check-list of actions) and confidence (self-rated) before and after the intervention. Both WB and F2F participants' knowledge, competence and confidence increased significantly after training (p ≤0.001). Skill performance for the WB group increased significantly from 61% to 74% (p ≤ 0.05) and correlated significantly with post-test knowledge (p = 0.014). No change was seen in the F2F groups' performance scores. Course evaluations were positive with median ratings of 4/5 (WB) and 5/5 (F2F). The F2F program received significantly more positive evaluations than the WB program (p < 0.05), particularly with regard to quality of feedback. WB and F2F simulation are effective education strategies with both programs demonstrating positive learning outcomes. WB programs increase ease of access to training whilst F2F enable the development of tactile hands on skills and teamwork. A combined blended learning education

Implementation and evaluation of a simulation curriculum for paediatric residency programs including just-in-time in situ mock codes

PubMed Central

Sam, Jonathan; Pierse, Michael; Al-Qahtani, Abdullah; Cheng, Adam

2012-01-01

OBJECTIVE: To develop, implement and evaluate a simulation-based acute care curriculum in a paediatric residency program using an integrated and longitudinal approach. DESIGN: Curriculum framework consisting of three modular, year-specific courses and longitudinal just-in-time, in situ mock codes. SETTING: Paediatric residency program at BC Children’s Hospital, Vancouver, British Columbia. INTERVENTIONS: The three year-specific courses focused on the critical first 5 min, complex medical management and crisis resource management, respectively. The just-in-time in situ mock codes simulated the acute deterioration of an existing ward patient, prepared the actual multidisciplinary code team, and primed the surrounding crisis support systems. Each curriculum component was evaluated with surveys using a five-point Likert scale. RESULTS: A total of 40 resident surveys were completed after each of the modular courses, and an additional 28 surveys were completed for the overall simulation curriculum. The highest Likert scores were for hands-on skill stations, immersive simulation environment and crisis resource management teaching. Survey results also suggested that just-in-time mock codes were realistic, reinforced learning, and prepared ward teams for patient deterioration. CONCLUSIONS: A simulation-based acute care curriculum was successfully integrated into a paediatric residency program. It provides a model for integrating simulation-based learning into other training programs, as well as a model for any hospital that wishes to improve paediatric resuscitation outcomes using just-in-time in situ mock codes. PMID:23372405

Clinical Pharmacy Education in Japan: Using Simulated Patients in Laboratory-Based Communication-Skills Training before Clinical Practice.

PubMed

Kubota, Rie; Shibuya, Kiyoshi; Tanaka, Yoichi; Aoki, Manahito; Shiomi, Megumi; Ando, Wataru; Otori, Katsuya; Komiyama, Takako

2018-06-01

The Japanese pharmaceutical curriculum was extended from four to six years in 2006. Students now receive practical communication-skills training in their fourth year, before progressing to train in hospital and community pharmacies in their fifth year. Kitasato University School of Pharmacy, Tokyo, had established a program to meet these aims before the 2006 guidance. In the present study, we discuss and evaluate the features of this communication-skills training program. This study enrolled 242 fourth-year pharmacy students at Kitasato University. Students filled out a questionnaire survey after completing the laboratory element of their undergraduate education. As part of training, students were asked to obtain patient data from a model medical chart, before performing simulated patient interviews covering hospital admission and patient counseling. These simulations were repeated in a small group, and feedback was provided to students by both the simulated patient and the faculty after each presentation. It was found that students were able to develop their communication skills through this approach. Thus, an effective system of gradual and continuous training has been developed, which allows students to acquire clinical and practical communication skills.

Patient-specific simulation of guidewire deformation during transcatheter aortic valve implantation.

PubMed

Vy, Phuoc; Auffret, Vincent; Castro, Miguel; Badel, Pierre; Rochette, Michel; Haigron, Pascal; Avril, Stéphane

2018-06-01

Transcatheter aortic valve implantation is a recent mini-invasive procedure to implant an aortic valve prosthesis. Prosthesis positioning in transcatheter aortic valve implantation appears as an important aspect for the success of the intervention. Accordingly, we developed a patient-specific finite element framework to predict the insertion of the stiff guidewire, used to position the aortic valve. We simulated the guidewire insertion for 2 patients based on their pre-operative CT scans. The model was designed to primarily predict the position and the angle of the guidewires in the aortic valve, and the results were successfully compared with intraoperative images. The present paper describes extensively the numerical model, which was solved by using the ANSYS software with an implicit resolution scheme, as well as the stabilization techniques which were used to overcome numerical instabilities. We performed sensitivity analysis on the properties of the guidewire (curvature angle, curvature radius, and stiffness) and the conditions of insertion (insertion force and orientation). We also explored the influence of the model parameters. The accuracy of the model was quantitatively evaluated as the distance and the angle difference between the simulated guidewires and the intraoperative ones. A good agreement was obtained between the model predictions and intraoperative views available for 2 patient cases. In conclusion, we showed that the shape of the guidewire in the aortic valve was mainly determined by the geometry of the patient's aorta and by the conditions of insertion (insertion force and orientation). Copyright © 2018 John Wiley & Sons, Ltd.

Use of ultraviolet-fluorescence-based simulation in evaluation of personal protective equipment worn for first assessment and care of a patient with suspected high-consequence infectious disease.

PubMed

Hall, S; Poller, B; Bailey, C; Gregory, S; Clark, R; Roberts, P; Tunbridge, A; Poran, V; Evans, C; Crook, B

2018-06-01

Variations currently exist across the UK in the choice of personal protective equipment (PPE) used by healthcare workers when caring for patients with suspected high-consequence infectious diseases (HCIDs). To test the protection afforded to healthcare workers by current PPE ensembles during assessment of a suspected HCID case, and to provide an evidence base to justify proposal of a unified PPE ensemble for healthcare workers across the UK. One 'basic level' (enhanced precautions) PPE ensemble and five 'suspected case' PPE ensembles were evaluated in volunteer trials using 'Violet'; an ultraviolet-fluorescence-based simulation exercise to visualize exposure/contamination events. Contamination was photographed and mapped. There were 147 post-simulation and 31 post-doffing contamination events, from a maximum of 980, when evaluating the basic level of PPE. Therefore, this PPE ensemble did not afford adequate protection, primarily due to direct contamination of exposed areas of the skin. For the five suspected case ensembles, 1584 post-simulation contamination events were recorded, from a maximum of 5110. Twelve post-doffing contamination events were also observed (face, two events; neck, one event; forearm, one event; lower legs, eight events). All suspected case PPE ensembles either had post-doffing contamination events or other significant disadvantages to their use. This identified the need to design a unified PPE ensemble and doffing procedure, incorporating the most protective PPE considered for each body area. This work has been presented to, and reviewed by, key stakeholders to decide on a proposed unified ensemble, subject to further evaluation. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

Validity evidence and reliability of a simulated patient feedback instrument

PubMed Central

2012-01-01

Background In the training of healthcare professionals, one of the advantages of communication training with simulated patients (SPs) is the SP's ability to provide direct feedback to students after a simulated clinical encounter. The quality of SP feedback must be monitored, especially because it is well known that feedback can have a profound effect on student performance. Due to the current lack of valid and reliable instruments to assess the quality of SP feedback, our study examined the validity and reliability of one potential instrument, the 'modified Quality of Simulated Patient Feedback Form' (mQSF). Methods Content validity of the mQSF was assessed by inviting experts in the area of simulated clinical encounters to rate the importance of the mQSF items. Moreover, generalizability theory was used to examine the reliability of the mQSF. Our data came from videotapes of clinical encounters between six simulated patients and six students and the ensuing feedback from the SPs to the students. Ten faculty members judged the SP feedback according to the items on the mQSF. Three weeks later, this procedure was repeated with the same faculty members and recordings. Results All but two items of the mQSF received importance ratings of > 2.5 on a four-point rating scale. A generalizability coefficient of 0.77 was established with two judges observing one encounter. Conclusions The findings for content validity and reliability with two judges suggest that the mQSF is a valid and reliable instrument to assess the quality of feedback provided by simulated patients. PMID:22284898

Validity evidence and reliability of a simulated patient feedback instrument.

PubMed

Schlegel, Claudia; Woermann, Ulrich; Rethans, Jan-Joost; van der Vleuten, Cees

2012-01-27

In the training of healthcare professionals, one of the advantages of communication training with simulated patients (SPs) is the SP's ability to provide direct feedback to students after a simulated clinical encounter. The quality of SP feedback must be monitored, especially because it is well known that feedback can have a profound effect on student performance. Due to the current lack of valid and reliable instruments to assess the quality of SP feedback, our study examined the validity and reliability of one potential instrument, the 'modified Quality of Simulated Patient Feedback Form' (mQSF). Content validity of the mQSF was assessed by inviting experts in the area of simulated clinical encounters to rate the importance of the mQSF items. Moreover, generalizability theory was used to examine the reliability of the mQSF. Our data came from videotapes of clinical encounters between six simulated patients and six students and the ensuing feedback from the SPs to the students. Ten faculty members judged the SP feedback according to the items on the mQSF. Three weeks later, this procedure was repeated with the same faculty members and recordings. All but two items of the mQSF received importance ratings of > 2.5 on a four-point rating scale. A generalizability coefficient of 0.77 was established with two judges observing one encounter. The findings for content validity and reliability with two judges suggest that the mQSF is a valid and reliable instrument to assess the quality of feedback provided by simulated patients.

Dynamic Evaluation of Two Decades of CMAQ Simulations ...

EPA Pesticide Factsheets

This presentation focuses on the dynamic evaluation of the CMAQ model over the continental United States using multi-decadal simulations for the period from 1990 to 2010 to examine how well the changes in observed ozone air quality induced by variations in meteorology and/or emissions are simulated by the model. We applied spectral decomposition of the ozone time-series using the KZ filter to assess the variations in the strengths of synoptic (weather-induced variations) and baseline (long-term variation) forcings, embedded in the simulated and observed concentrations. The results reveal that CMAQ captured the year-to-year variability (more so in the later years than the earlier years) and the synoptic forcing in accordance with what the observations are showing. The National Exposure Research Laboratory (NERL) Computational Exposure Division (CED) develops and evaluates data, decision-support tools, and models to be applied to media-specific or receptor-specific problem areas. CED uses modeling-based approaches to characterize exposures, evaluate fate and transport, and support environmental diagnostics/forensics with input from multiple data sources. It also develops media- and receptor-specific models, process models, and decision support tools for use both within and outside of EPA.

Interactive Simulated Patient: Experiences with Collaborative E-Learning in Medicine

ERIC Educational Resources Information Center

Bergin, Rolf; Youngblood, Patricia; Ayers, Mary K.; Boberg, Jonas; Bolander, Klara; Courteille, Olivier; Dev, Parvati; Hindbeck, Hans; Edward, Leonard E., II; Stringer, Jennifer R.; Thalme, Anders; Fors, Uno G. H.

2003-01-01

Interactive Simulated Patient (ISP) is a computer-based simulation tool designed to provide medical students with the opportunity to practice their clinical problem solving skills. The ISP system allows students to perform most clinical decision-making procedures in a simulated environment, including history taking in natural language, many…

Economic Evaluation of Bariatric Surgery in Mexico Using Discrete Event Simulation.

PubMed

Zanela, Olivo Omar; Cabra, Hermilo Arturo; Meléndez, Guillermo; Anaya, Pablo; Rupprecht, Frederic

2012-12-01

Morbid obesity represents high costs to health institutions in controlling associated comorbidities. It has been shown that bariatric surgery resolves or improves comorbidities, thus reducing resource utilization. This analysis estimated the total costs of treating morbid obesity and related comorbidities through conventional treatment compared to bariatric surgery under the Mexican public health system perspective. An economic evaluation model was developed by using discrete event simulation. One hundred fifty patients were created in each arm, with considered comorbidities allocated randomly. Preoperative comorbidity prevalences and bariatric surgery's efficacy for resolving them were obtained from published literature. Comorbidity treatment costs were obtained from the 2007 Mexican Institute of Social Security diagnosis-related group list and publications from the National Institute of Public Health. Only 12 patients were operated each month on the surgical arm. Complications associated with comorbidities were not considered. The considered time frame for simulation was 10 years, with a 4.5% annual discount rate. Return on investment, or cost breakeven point, for bariatric surgery was obtained after 6.8 years. Total costs for the surgical group were 52% less than conventional treatment group costs after 10 years. Bariatric surgery reduced the cost of treating type 2 diabetes, hypertension, and hypercholesterolemia by 59%, 53%, and 65%, respectively. Return on investment for bariatric surgery in patients with type 2 diabetes as the only comorbidity was 4.4 years. Despite conservative assumptions, investment in bariatric surgery is recouped in 6.8 years, generating relevant potential savings in the treatment of morbidly obese patients. In high-risk subpopulations, return on investment time is shorter. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Dr. Tulp attends the soft machine: patient simulators, user involvement and intellectual disability.

PubMed

McClimens, Alex; Lewis, Robin; Brewster, Jacqui

2012-09-01

Simulation as a way to teach clinical skills attracts much critical attention. Its benefits, however, might be significantly reduced when the simulation model used relies exclusively on patient simulators. This is particularly true if the intended patient population for students taught is characterized by intellectual disability. Learning to care for people with intellectual disability might be better supplemented when the simulation model used incorporates input from 'real' people. If these people themselves have intellectual disabilities then the verisimilitude of the simulation will be higher and the outcomes for learners and potential patients will also be improved.

Performance and evaluation of small construction safety training simulations.

PubMed

Wojcik, S M; Kidd, P S; Parshall, M B; Struttmann, T W

2003-06-01

Back- and fall-related injuries occur frequently in construction and are costly in terms of workers' compensation claims and lost productivity. Interventions are needed that address the susceptibility to these injuries. The purpose of this study was to develop and test a safety training intervention for small construction companies (evaluation of these simulation exercises, not their effectiveness in preventing injuries. The intervention consisted of six latent-image narrative simulation exercises targeted at prevention of back- or fall-related injuries, which emphasized both the economic impact of injuries and the benefits of individual and organizational prevention strategies. Participants included owner-operators, supervisors and employees. Analyses were completed to determine participant scores on the intervention along with their perceptions of the quality, realism and applicability of the training. Mean pooled performance scores (percentage correct) were 83.3% [standard deviation (SD) = 8.9, n = 143] for three back simulations and 85.2% (SD = 8.9, n = 159) for three fall-related simulations. Mean total evaluation scores (percentage of maximum) were 83.1% (SD = 11.6) and 85.5% (SD = 11.7) for the back and fall simulations, respectively. Quality and realism evaluation scores were significantly higher than scores for applicability to work. Simulations were well received as safety training exercises. Given the heterogeneous work classifications found in small construction companies, it may be preferable to target safety intervention content to specific trades rather than aim for generality across trades.

Accessing primary care: a simulated patient study

PubMed Central

Campbell, John L; Carter, Mary; Davey, Antoinette; Roberts, Martin J; Elliott, Marc N; Roland, Martin

2013-01-01

Background Simulated patient, or so-called ‘mystery-shopper’, studies are a controversial, but potentially useful, approach to take when conducting health services research. Aim To investigate the construct validity of survey questions relating to access to primary care included in the English GP Patient Survey. Design and setting Observational study in 41 general practices in rural, urban, and inner-city settings in the UK. Method Between May 2010 and March 2011, researchers telephoned practices at monthly intervals, simulating patients requesting routine, but prompt, appointments. Seven measures of access and appointment availability, measured from the mystery-shopper contacts, were related to seven measures of practice performance from the GP Patient Survey. Results Practices with lower access scores in the GP Patient Survey had poorer access and appointment availability for five out of seven items measured directly, when compared with practices that had higher scores. Scores on items from the national survey that related to appointment availability were significantly associated with direct measures of appointment availability. Patient-satisfaction levels and the likelihood that patients would recommend their practice were related to the availability of appointments. Patients’ reports of ease of telephone access in the national survey were unrelated to three out of four measures of practice call handling, but were related to the time taken to resolve an appointment request, suggesting responders’ possible confusion in answering this question. Conclusion Items relating to the accessibility of care in a the English GP patient survey have construct validity. Patients’ satisfaction with their practice is not related to practice call handling, but is related to appointment availability. PMID:23561783

Comparison of the medical students' perceived self-efficacy and the evaluation of the observers and patients.

PubMed

Ammentorp, Jette; Thomsen, Janus Laust; Jarbøl, Dorte Ejg; Holst, René; Øvrehus, Anne Lindebo Holm; Kofoed, Poul-Erik

2013-04-08

The accuracy of self-assessment has been questioned in studies comparing physicians' self-assessments to observed assessments; however, none of these studies used self-efficacy as a method for self-assessment. The aim of the study was to investigate how medical students' perceived self-efficacy of specific communication skills corresponds to the evaluation of simulated patients and observers. All of the medical students who signed up for an Objective Structured Clinical Examination (OSCE) were included. As a part of the OSCE, the student performance in the "parent-physician interaction" was evaluated by a simulated patient and an observer at one of the stations. After the examination the students were asked to assess their self-efficacy according to the same specific communication skills. The Calgary Cambridge Observation Guide formed the basis for the outcome measures used in the questionnaires. A total of 12 items was rated on a Likert scale from 1-5 (strongly disagree to strongly agree). We used extended Rasch models for comparisons between the groups of responses of the questionnaires. Comparisons of groups were conducted on dichotomized responses. Eighty-four students participated in the examination, 87% (73/84) of whom responded to the questionnaire. The response rate for the simulated patients and the observers was 100%. Significantly more items were scored in the highest categories (4 and 5) by the observers and simulated patients compared to the students (observers versus students: -0.23; SE:0.112; p=0.002 and patients versus students:0.177; SE:0.109; p=0.037). When analysing the items individually, a statistically significant difference only existed for two items. This study showed that students scored their communication skills lower compared to observers or simulated patients. The differences were driven by only 2 of 12 items. The results in this study indicate that self-efficacy based on the Calgary Cambridge Observation guide seems to be a reliable

Simulation as a preoperative planning approach in advanced heart failure patients. A retrospective clinical analysis.

PubMed

Capoccia, Massimo; Marconi, Silvia; Singh, Sanjeet Avtaar; Pisanelli, Domenico M; De Lazzari, Claudio

2018-05-02

Modelling and simulation may become clinically applicable tools for detailed evaluation of the cardiovascular system and clinical decision-making to guide therapeutic intervention. Models based on pressure-volume relationship and zero-dimensional representation of the cardiovascular system may be a suitable choice given their simplicity and versatility. This approach has great potential for application in heart failure where the impact of left ventricular assist devices has played a significant role as a bridge to transplant and more recently as a long-term solution for non eligible candidates. We sought to investigate the value of simulation in the context of three heart failure patients with a view to predict or guide further management. CARDIOSIM © was the software used for this purpose. The study was based on retrospective analysis of haemodynamic data previously discussed at a multidisciplinary meeting. The outcome of the simulations addressed the value of a more quantitative approach in the clinical decision process. Although previous experience, co-morbidities and the risk of potentially fatal complications play a role in clinical decision-making, patient-specific modelling may become a daily approach for selection and optimisation of device-based treatment for heart failure patients. Willingness to adopt this integrated approach may be the key to further progress.

Evaluation of regional climate simulations for air quality modelling purposes

NASA Astrophysics Data System (ADS)

Menut, Laurent; Tripathi, Om P.; Colette, Augustin; Vautard, Robert; Flaounas, Emmanouil; Bessagnet, Bertrand

2013-05-01

In order to evaluate the future potential benefits of emission regulation on regional air quality, while taking into account the effects of climate change, off-line air quality projection simulations are driven using weather forcing taken from regional climate models. These regional models are themselves driven by simulations carried out using global climate models (GCM) and economical scenarios. Uncertainties and biases in climate models introduce an additional "climate modeling" source of uncertainty that is to be added to all other types of uncertainties in air quality modeling for policy evaluation. In this article we evaluate the changes in air quality-related weather variables induced by replacing reanalyses-forced by GCM-forced regional climate simulations. As an example we use GCM simulations carried out in the framework of the ERA-interim programme and of the CMIP5 project using the Institut Pierre-Simon Laplace climate model (IPSLcm), driving regional simulations performed in the framework of the EURO-CORDEX programme. In summer, we found compensating deficiencies acting on photochemistry: an overestimation by GCM-driven weather due to a positive bias in short-wave radiation, a negative bias in wind speed, too many stagnant episodes, and a negative temperature bias. In winter, air quality is mostly driven by dispersion, and we could not identify significant differences in either wind or planetary boundary layer height statistics between GCM-driven and reanalyses-driven regional simulations. However, precipitation appears largely overestimated in GCM-driven simulations, which could significantly affect the simulation of aerosol concentrations. The identification of these biases will help interpreting results of future air quality simulations using these data. Despite these, we conclude that the identified differences should not lead to major difficulties in using GCM-driven regional climate simulations for air quality projections.

Improving outpatient phlebotomy service efficiency and patient experience using discrete-event simulation.

PubMed

Yip, Kenneth; Pang, Suk-King; Chan, Kui-Tim; Chan, Chi-Kuen; Lee, Tsz-Leung

2016-08-08

Purpose - The purpose of this paper is to present a simulation modeling application to reconfigure the outpatient phlebotomy service of an acute regional and teaching hospital in Hong Kong, with an aim to improve service efficiency, shorten patient queuing time and enhance workforce utilization. Design/methodology/approach - The system was modeled as an inhomogeneous Poisson process and a discrete-event simulation model was developed to simulate the current setting, and to evaluate how various performance metrics would change if switched from a decentralized to a centralized model. Variations were then made to the model to test different workforce arrangements for the centralized service, so that managers could decide on the service's final configuration via an evidence-based and data-driven approach. Findings - This paper provides empirical insights about the relationship between staffing arrangement and system performance via a detailed scenario analysis. One particular staffing scenario was chosen by manages as it was considered to strike the best balance between performance and workforce scheduled. The resulting centralized phlebotomy service was successfully commissioned. Practical implications - This paper demonstrates how analytics could be used for operational planning at the hospital level. The authors show that a transparent and evidence-based scenario analysis, made available through analytics and simulation, greatly facilitates management and clinical stakeholders to arrive at the ideal service configuration. Originality/value - The authors provide a robust method in evaluating the relationship between workforce investment, queuing reduction and workforce utilization, which is crucial for managers when deciding the delivery model for any outpatient-related service.

Flight Tasks and Metrics to Evaluate Laser Eye Protection in Flight Simulators

DTIC Science & Technology

2017-07-07

AFRL-RH-FS-TR-2017-0026 Flight Tasks and Metrics to Evaluate Laser Eye Protection in Flight Simulators Thomas K. Kuyk Peter A. Smith Solangia...34Flight Tasks and Metrics to Evaluate Laser Eye Protection in Flight Simulators" (AFRL-RH-FS-TR- 2017 - 0026 SHORTER.PATRI CK.D.1023156390 Digitally...SUBTITLE Flight Tasks and Metrics to Evaluate Laser Eye Protection in Flight Simulators 5a. CONTRACT NUMBER FA8650-14-D-6519 5b. GRANT NUMBER 5c

Effect of Advanced Trauma Life Support program on medical interns' performance in simulated trauma patient management.

PubMed

Ahmadi, Koorosh; Sedaghat, Mohammad; Safdarian, Mahdi; Hashemian, Amir-Masoud; Nezamdoust, Zahra; Vaseie, Mohammad; Rahimi-Movaghar, Vafa

2013-01-01

Since appropriate and time-table methods in trauma care have an important impact on patients'outcome, we evaluated the effect of Advanced Trauma Life Support (ATLS) program on medical interns' performance in simulated trauma patient management. A descriptive and analytical study before and after the training was conducted on 24 randomly selected undergraduate medical interns from Imam Reza Hospital in Mashhad, Iran. On the first day, we assessed interns' clinical knowledge and their practical skill performance in confronting simulated trauma patients. After 2 days of ATLS training, we performed the same study and evaluated their score again on the fourth day. The two findings, pre- and post- ATLS periods, were compared through SPSS version 15.0 software. P values less than 0.05 were considered statistically significant. Our findings showed that interns'ability in all the three tasks improved after the training course. On the fourth day after training, there was a statistically significant increase in interns' clinical knowledge of ATLS procedures, the sequence of procedures and skill performance in trauma situations (P less than 0.001, P equal to 0.016 and P equal to 0.01 respectively). ATLS course has an important role in increasing clinical knowledge and practical skill performance of trauma care in medical interns.

Patient-specific coronary artery blood flow simulation using myocardial volume partitioning

NASA Astrophysics Data System (ADS)

Kim, Kyung Hwan; Kang, Dongwoo; Kang, Nahyup; Kim, Ji-Yeon; Lee, Hyong-Euk; Kim, James D. K.

2013-03-01

Using computational simulation, we can analyze cardiovascular disease in non-invasive and quantitative manners. More specifically, computational modeling and simulation technology has enabled us to analyze functional aspect such as blood flow, as well as anatomical aspect such as stenosis, from medical images without invasive measurements. Note that the simplest ways to perform blood flow simulation is to apply patient-specific coronary anatomy with other average-valued properties; in this case, however, such conditions cannot fully reflect accurate physiological properties of patients. To resolve this limitation, we present a new patient-specific coronary blood flow simulation method by myocardial volume partitioning considering artery/myocardium structural correspondence. We focus on that blood supply is closely related to the mass of each myocardial segment corresponding to the artery. Therefore, we applied this concept for setting-up simulation conditions in the way to consider many patient-specific features as possible from medical image: First, we segmented coronary arteries and myocardium separately from cardiac CT; then the myocardium is partitioned into multiple regions based on coronary vasculature. The myocardial mass and required blood mass for each artery are estimated by converting myocardial volume fraction. Finally, the required blood mass is used as boundary conditions for each artery outlet, with given average aortic blood flow rate and pressure. To show effectiveness of the proposed method, fractional flow reserve (FFR) by simulation using CT image has been compared with invasive FFR measurement of real patient data, and as a result, 77% of accuracy has been obtained.

Pharmacokinetic evaluation of doxorubicin plasma levels in normal and overweight patients with breast cancer and simulation of dose adjustment by different indexes of body mass.

PubMed

Barpe, Deise Raquel; Rosa, Daniela Dornelles; Froehlich, Pedro Eduardo

2010-11-20

Although being used for decades in the treatment of several types of cancer, either alone or in association, only a few data about the pharmacokinetics of doxorubicin (DOX) in humans are available. DOX is frequently used in association with other anticancer drugs in the management of breast cancer. Pharmacokinetic data available in the literature show that after i.v. administration DOX follows a two-compartment open model, with a fast distribution phase followed by a very slow elimination phase. The objective of this work is to perform a pilot study in order to verify if the usual dose adjustment based on body surface area (BSA) would be producing the same plasma concentration-time profiles in patients with normal (<25) and above normal (>25) body mass index (BMI). In order to assess the pharmacokinetics of DOX after a short-term i.v. infusion of 60mg/m(2) of BSA, an experimental design using only five plasma samples of each patient was applied. Samples were collected at 0.00, 0.66 (right after the end of infusion), 1.66, 8.66, and 24.66h. DOX pharmacokinetic profiles were evaluated after quantification of DOX using a new HPLC method developed and validated. Pharmacokinetic parameters (AUC(0-24.66) and C(max)) were analyzed by non-compartmental and compartmental approaches. Significant differences (α=0.05) between overweight and normal weight groups were found with respect to AUC and C(max). After adjustment of dose by weight and by BMI, the compartmental model was used to simulate plasma concentrations and new values for C(max) and AUC(0-24.66) were calculated. The new values obtained using both body weight (BW) and BMI were closer to the normal group than those obtained with BSA. According to the simulation, the differences of AUC and C(max) between the overweight group and the group of patients with normal weight were lower when the dose was adjusted by BW and BMI. These results suggest that more studies must be conducted, with more patients, in order to

Methodology development for evaluation of selective-fidelity rotorcraft simulation

NASA Technical Reports Server (NTRS)

Lewis, William D.; Schrage, D. P.; Prasad, J. V. R.; Wolfe, Daniel

1992-01-01

This paper addressed the initial step toward the goal of establishing performance and handling qualities acceptance criteria for realtime rotorcraft simulators through a planned research effort to quantify the system capabilities of 'selective fidelity' simulators. Within this framework the simulator is then classified based on the required task. The simulator is evaluated by separating the various subsystems (visual, motion, etc.) and applying corresponding fidelity constants based on the specific task. This methodology not only provides an assessment technique, but also provides a technique to determine the required levels of subsystem fidelity for a specific task.

Multidisciplinary Obstetric Simulated Emergency Scenarios (MOSES): Promoting Patient Safety in Obstetrics with Teamwork-Focused Interprofessional Simulations

ERIC Educational Resources Information Center

Freeth, Della; Ayida, Gubby; Berridge, Emma Jane; Mackintosh, Nicola; Norris, Beverley; Sadler, Chris; Strachan, Alasdair

2009-01-01

Introduction: We describe an example of simulation-based interprofessional continuing education, the multidisciplinary obstetric simulated emergency scenarios (MOSES) course, which was designed to enhance nontechnical skills among obstetric teams and, hence, improve patient safety. Participants' perceptions of MOSES courses, their learning, and…

Definition and evaluation of testing scenarios for knee wear simulation under conditions of highly demanding daily activities.

PubMed

Schwiesau, Jens; Schilling, Carolin; Kaddick, Christian; Utzschneider, Sandra; Jansson, Volkmar; Fritz, Bernhard; Blömer, Wilhelm; Grupp, Thomas M

2013-05-01

The objective of our study was the definition of testing scenarios for knee wear simulation under various highly demanding daily activities of patients after total knee arthroplasty. This was mainly based on a review of published data on knee kinematics and kinetics followed by the evaluation of the accuracy and precision of a new experimental setup. We combined tibio-femoral load and kinematic data reported in the literature to develop deep squatting loading profiles for simulator input. A servo-hydraulic knee wear simulator was customised with a capability of a maximum flexion of 120°, a tibio-femoral load of 5000N, an anterior-posterior (AP) shear force of ±1000N and an internal-external (IE) rotational torque of ±50Nm to simulate highly demanding patient activities. During the evaluation of the newly configurated simulator the ability of the test machine to apply the required load and torque profiles and the flexion kinematics in a precise manner was examined by nominal-actual profile comparisons monitored periodically during subsequent knee wear simulation. For the flexion kinematics under displacement control a delayed actuator response of approximately 0.05s was inevitable due to the inertia of masses in movement of the coupled knee wear stations 1-3 during all applied activities. The axial load and IE torque is applied in an effective manner without substantial deviations between nominal and actual load and torque profiles. During the first third of the motion cycle a marked deviation between nominal and actual AP shear load profiles has to be noticed but without any expected measurable effect on the latter wear simulation due to the fact that the load values are well within the peak magnitude of the nominal load amplitude. In conclusion the described testing method will be an important tool to have more realistic knee wear simulations based on load conditions of the knee joint during activities of daily living. Copyright © 2012 IPEM. Published by

Interactive Graphics Simulator: Design, Development, and Effectiveness/Cost Evaluation. Final Report.

ERIC Educational Resources Information Center

Pieper, William J.; And Others

This study was initiated to design, develop, implement, and evaluate a videodisc-based simulator system, the Interactive Graphics Simulator (IGS) for 6883 Converter Flight Control Test Station training at Lowry Air Force Base, Colorado. The simulator provided a means for performing task analysis online, developing simulations from the task…

Addressing Dual Patient and Staff Safety Through A Team-Based Standardized Patient Simulation for Agitation Management in the Emergency Department.

PubMed

Wong, Ambrose H; Auerbach, Marc A; Ruppel, Halley; Crispino, Lauren J; Rosenberg, Alana; Iennaco, Joanne D; Vaca, Federico E

2018-06-01

Emergency departments (EDs) have seen harm rise for both patients and health workers from an increasing rate of agitation events. Team effectiveness during care of this population is particularly challenging because fear of physical harm leads to competing interests. Simulation is frequently employed to improve teamwork in medical resuscitations but has not yet been reported to address team-based behavioral emergency care. As part of a larger investigation of agitated patient care, we designed this secondary study to examine the impact of an interprofessional standardized patient simulation for ED agitation management. We used a mixed-methods approach with emergency medicine resident and attending physicians, Physician Assistants (PAs) and Advanced Practice Registered Nurses (APRNs), ED nurses, technicians, and security officers at two hospital sites. After a simulated agitated patient encounter, we conducted uniprofessional and interprofessional focus groups. We undertook structured thematic analysis using a grounded theory approach. Quantitative data consisted of responses to the KidSIM Questionnaire addressing teamwork and simulation-based learning attitudes before and after each session. We reached data saturation with 57 participants. KidSIM scores revealed significant improvements in attitudes toward relevance of simulation, opportunities for interprofessional education, and situation awareness, as well as four of six questions for roles/responsibilities. Two broad themes emerged from the focus groups: (1) a team-based agitated patient simulation addressed dual safety of staff and patients simultaneously and (2) the experience fostered interprofessional discovery and cooperation in agitation management. A team-based simulated agitated patient encounter highlighted the need to consider the dual safety of staff and patients while facilitating interprofessional dialog and learning. Our findings suggest that simulation may be effective to enhance teamwork in

Using Simulation as an Investigational Methodology to Explore the Impact of Technology on Team Communication and Patient Management: A Pilot Evaluation of the Effect of an Automated Compression Device.

PubMed

Gittinger, Matthew; Brolliar, Sarah M; Grand, James A; Nichol, Graham; Fernandez, Rosemarie

2017-06-01

This pilot study used a simulation-based platform to evaluate the effect of an automated mechanical chest compression device on team communication and patient management. Four-member emergency department interprofessional teams were randomly assigned to perform manual chest compressions (control, n = 6) or automated chest compressions (intervention, n = 6) during a simulated cardiac arrest with 2 phases: phase 1 baseline (ventricular tachycardia), followed by phase 2 (ventricular fibrillation). Patient management was coded using an Advanced Cardiovascular Life Support-based checklist. Team communication was categorized in the following 4 areas: (1) teamwork focus; (2) huddle events, defined as statements focused on re-establishing situation awareness, reinforcing existing plans, and assessing the need to adjust the plan; (3) clinical focus; and (4) profession of team member. Statements were aggregated for each team. At baseline, groups were similar with respect to total communication statements and patient management. During cardiac arrest, the total number of communication statements was greater in teams performing manual compressions (median, 152.3; interquartile range [IQR], 127.6-181.0) as compared with teams using an automated compression device (median, 105; IQR, 99.5-123.9). Huddle events were more frequent in teams performing automated chest compressions (median, 4.0; IQR, 3.1-4.3 vs. 2.0; IQR, 1.4-2.6). Teams randomized to the automated compression intervention had a delay to initial defibrillation (median, 208.3 seconds; IQR, 153.3-222.1 seconds) as compared with control teams (median, 63.2 seconds; IQR, 30.1-397.2 seconds). Use of an automated compression device may impact both team communication and patient management. Simulation-based assessments offer important insights into the effect of technology on healthcare teams.

[Simulation-based intervention to improve anesthesiology residents communication with families of critically ill patients--preliminary prospective evaluation].

PubMed

Berkenstadt, Haim; Perlson, Daria; Shalomson, Orit; Tuval, Atalia; Haviv-Yadid, Yael; Ziv, Amitai

2013-08-01

Although effective communication with families of critically ill patients is a vital component of quality care, training in this field is neglected. The article aims to validate communication skills training program for anesthesiology residents in the intensive care set up. Ten anesthesia residents, following 3 months of Intensive Care Unit (ICU) rotation, had 4 hours of lectures and one day simulation-based communication skills training with families of critically ill patients. Participants completed an attitude questionnaire over 3 time periods--before training [t1], immediately following training (t2) and three months following training (t3). The participants' communication skills were assessed by two blinded independent observers using the SEGUE framework while performing a simulation-based scenario at t1 and t3. Seven participants finished the study protocol. Participants ndicated communication importance as 3.68 +/- 0.58 (t1), 4.05 +/- 0.59 (t2), 4.13 +/- 0.64 (t3); their communication ability as 3.09 +/- 0.90 (t1), 3.70 +/- 0.80 (t2), 3.57 +/- 0.64 (t3); the contribution of lecture to communication 3.04 +/- 0.43 (t1), 3.83 +/- 0.39 (t2), 3.87 +/- 0.51 (t3), and contribution of simulation training to communication 3.00 +/- 0.71 (t1), 4.04 +/- 0.52 (t2), 3.84 +/- 0.31 (t3). The differences did not reach statistical significance. Objective assessment of the communication skills using the SEGUE framework indicated that 6/7 participants improved their communication skills, with communication ability before training at 2.66 +/- 0.83 and 1 month following training it was 3.38 +/- 0.78 (p = 0.09). This preliminary study demonstrates the value of communication skills training in the intensive care environment.

Evaluation of tocopherol recovery through simulation of molecular distillation process.

PubMed

Moraes, E B; Batistella, C B; Alvarez, M E Torres; Filho, Rubens Maciel; Maciel, M R Wolf

2004-01-01

DISMOL simulator was used to determine the best possible operating conditions to guide, in future studies, experimental works. This simulator needs several physical-chemical properties and often it is very difficult to determine them because of the complexity of the involved components. Their determinations must be made through correlations and/or predictions, in order to characterize the system and calculate it. The first try is to have simulation results of a system that later can be validated with experimental data. To implement, in the simulator, the necessary parameters of complex systems is a difficult task. In this work, we aimed to determe these properties in order to evaluate the tocopherol (vitamin E) recovery using a DISMOL simulator. The raw material used was the crude deodorizer distillate of soya oil. With this procedure, it is possible to determine the best operating conditions for experimental works and to evaluate the process in the separation of new systems, analyzing the profiles obtained from these simulations for the falling film molecular distillator.

Evaluation of Intersection Traffic Control Measures through Simulation

NASA Astrophysics Data System (ADS)

Asaithambi, Gowri; Sivanandan, R.

2015-12-01

Modeling traffic flow is stochastic in nature due to randomness in variables such as vehicle arrivals and speeds. Due to this and due to complex vehicular interactions and their manoeuvres, it is extremely difficult to model the traffic flow through analytical methods. To study this type of complex traffic system and vehicle interactions, simulation is considered as an effective tool. Application of homogeneous traffic models to heterogeneous traffic may not be able to capture the complex manoeuvres and interactions in such flows. Hence, a microscopic simulation model for heterogeneous traffic is developed using object oriented concepts. This simulation model acts as a tool for evaluating various control measures at signalized intersections. The present study focuses on the evaluation of Right Turn Lane (RTL) and Channelised Left Turn Lane (CLTL). A sensitivity analysis was performed to evaluate RTL and CLTL by varying the approach volumes, turn proportions and turn lane lengths. RTL is found to be advantageous only up to certain approach volumes and right-turn proportions, beyond which it is counter-productive. CLTL is found to be advantageous for lower approach volumes for all turn proportions, signifying the benefits of CLTL. It is counter-productive for higher approach volume and lower turn proportions. This study pinpoints the break-even points for various scenarios. The developed simulation model can be used as an appropriate intersection lane control tool for enhancing the efficiency of flow at intersections. This model can also be employed for scenario analysis and can be valuable to field traffic engineers in implementing vehicle-type based and lane-based traffic control measures.

Quantitative Evaluation of PET Respiratory Motion Correction Using MR Derived Simulated Data

NASA Astrophysics Data System (ADS)

Polycarpou, Irene; Tsoumpas, Charalampos; King, Andrew P.; Marsden, Paul K.

2015-12-01

The impact of respiratory motion correction on quantitative accuracy in PET imaging is evaluated using simulations for variable patient specific characteristics such as tumor uptake and respiratory pattern. Respiratory patterns from real patients were acquired, with long quiescent motion periods (type-1) as commonly observed in most patients and with long-term amplitude variability as is expected under conditions of difficult breathing (type-2). The respiratory patterns were combined with an MR-derived motion model to simulate real-time 4-D PET-MR datasets. Lung and liver tumors were simulated with diameters of 10 and 12 mm and tumor-to-background ratio ranging from 3:1 to 6:1. Projection data for 6- and 3-mm PET resolution were generated for the Philips Gemini scanner and reconstructed without and with motion correction using OSEM (2 iterations, 23 subsets). Motion correction was incorporated into the reconstruction process based on MR-derived motion fields. Tumor peak standardized uptake values (SUVpeak) were calculated from 30 noise realizations. Respiratory motion correction improves the quantitative performance with the greatest benefit observed for patients of breathing type-2. For breathing type-1 after applying motion correction, SUVpeak of 12-mm liver tumor with 6:1 contrast was increased by 46% for a current PET resolution (i.e., 6 mm) and by 47% for a higher PET resolution (i.e., 3 mm). Furthermore, the results of this study indicate that the benefit of higher scanner resolution is small unless motion correction is applied. In particular, for large liver tumor (12 mm) with low contrast (3:1) after motion correction, the SUVpeak was increased by 34% for 6-mm resolution and by 50% for a higher PET resolution (i.e., 3-mm resolution. This investigation indicates that there is a high impact of respiratory motion correction on tumor quantitative accuracy and that motion correction is important in order to benefit from the increased resolution of future PET

Evaluating the introduction of extracorporeal life support technology to a tertiary-care pediatric institution: Smoothing the learning curve through interprofessional simulation training.

PubMed

Sanchez-Glanville, Carlos; Brindle, Mary E; Spence, Tanya; Blackwood, Jaime; Drews, Tanya; Menzies, Steve; Lopushinsky, Steven R

2015-05-01

Extracorporeal life support (ECLS) is a life-saving technology for the critically ill child. Our objective was to evaluate the outcomes of an educational curriculum designed to introduce an ECLS program to a noncardiac pediatric surgical center. An interdisciplinary curriculum was developed consisting of didactic courses, animal labs, simulations, and debrief sessions. We reviewed all patients requiring ECLS between October 2011 and December 2013. All health care practitioners involved in the ECLS training curriculum were surveyed to evaluate their perception of the educational program. Primary outcomes include successful cannulation and 30-day survival. The knowledge and confidence improved with statistical significance (p<0.0001-0.0003) for all of the components of the training curriculum. The highest score was given to the simulations. Twenty-one patients underwent cannulation. All patients were successfully cannulated to bypass, including six (28.6%) ECPR. Median time from activation to cutting was 52min (IQR 40-72), and from cutting to bypass 40min (IQR 30-45). Sixteen patients (76.2%) were decannulated to a sustainable cardiac rhythm and survived 30-days. An ECLS curriculum incorporating simulation and dedicated practice seems to have eliminated the potential learning curve associated with the introduction of a complex technology to a novice environment. Copyright © 2015 Elsevier Inc. All rights reserved.

Simulation in undergraduate paediatric nursing curriculum: Evaluation of a complex 'ward for a day' education program.

PubMed

Gamble, Andree S

2017-03-01

Simulation in health education has been shown to increase confidence, psychomotor and professional skills, and thus positively impact on student preparedness for clinical placement. It is recognised as a valuable tool to expose and engage students in realistic patient care encounters without the potential to cause patient harm. Although inherent challenges exist in the development and implementation of simulation, variability in clinical placement time, availability and quality dictates the need to provide students with learning opportunities they may otherwise not experience. With this, and a myriad of other issues providing the impetus for improved clinical preparation, 28 final semester undergraduate nursing students in a paediatric nursing course were involved in an extended multi-scenario simulated clinical shift prior to clinical placement. The simulation focussed on a complex ward experience, giving students the opportunity to demonstrate a variety of psychomotor skills, decision making, leadership, team work and other professional attributes integral for successful transition into the clinical arena. Evaluation data were collected at 3 intermittent points; post-simulation, post clinical placement, and 3 months after commencing employment as a Registered Nurse. Quantitative and qualitative analysis suggested positive impacts on critical nursing concepts and psychomotor skills resulted for participants in both clinical placement and beyond into the first months of employment. Copyright © 2017 Elsevier Ltd. All rights reserved.

Audio Taping Simulated Patient Encounters in Community Pharmacy to Enhance the Reliability of Assessments

PubMed Central

Werner, Joel Benjamin

2008-01-01

Objectives To assess whether audio taping simulated patient interactions can improve the reliability of manually documented data and result in more accurate assessments. Methods Over a 3-month period, 1340 simulated patient visits were made to community pharmacies. Following the encounters, data gathered by the simulated patient were relayed to a coordinator who completed a rating form. Data recorded on the forms were later compared to an audiotape of the interaction. Corrections were tallied and reasons for making them were coded. Results Approximately 10% of cases required corrections, resulting in a 10%-20% modification in the pharmacy's total score. The difference between postcorrection and precorrection scores was significant. Conclusions Audio taping simulated patient visits enhances data integrity. Most corrections were required because of the simulated patients' poor recall abilities. PMID:19325956

Simulator platform motion requirements for recurrent airline pilot training and evaluation

DOT National Transportation Integrated Search

2004-09-30

This report presents the results of two studies that examined the effect of enhanced hexapod-simulator motion on recurrent evaluation in the simulator, on the course of recurrent training in the simulator, and on "quasi-transfer" of this recurrent tr...

Simulation-based multidisciplinary team training decreases time to critical operations for trauma patients.

PubMed

Murphy, Margaret; Curtis, Kate; Lam, Mary K; Palmer, Cameron S; Hsu, Jeremy; McCloughen, Andrea

2018-05-01

Simulation has been promoted as a platform for training trauma teams. However, it is not clear if this training has an impact on health service delivery and patient outcomes. This study evaluates the association between implementation of a simulation based multidisciplinary trauma team training program at a metropolitan trauma centre and subsequent patient outcomes. This was a retrospective review of trauma registry data collected at an 850-bed Level 1 Adult Trauma Centre in Sydney, Australia. Two concurrent four-year periods, before and after implementation of a simulation based multidisciplinary trauma team training program were compared for differences in time to critical operations, Emergency Department (ED) length of stay (LOS) and patient mortality. There were 2389 major trauma patients admitted to the hospital during the study, 1116 in the four years preceding trauma team training (the PREgroup) and 1273 in the subsequent 4 years (the POST group). There were no differences between the groups with respect to gender, body region injured, incidence of polytrauma, and pattern of arrival to ED. The POST group was older (median age 54 versus 43 years, p < 0.001) and had a higher incidence of falls and assaults (p < 0.001). There was a reduction in time to critical operation, from 2.63 h (IQR 1.23-5.12) in the PRE-group to 0.55 h (IQR 0.22-1.27) in the POST-group, p < 0.001. The overall ED LOS increased, and there was no reduction in mortality. Post-hoc analysis found LOS in ED was reduced in the cohort requiring critical operations, p < 0.001. The implementation of trauma team training was associated with a reduction in time to critical operation while overall ED length of stay increased. Simulation is promoted as a platform for training teams; but the complexity of trauma care challenges efforts to demonstrate direct links between multidisciplinary team training and improved outcomes. There remain considerable gaps in knowledge as to how team

SU-F-T-50: Evaluation of Monte Carlo Simulations Performance for Pediatric Brachytherapy Dosimetry

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chatzipapas, C; Kagadis, G; Papadimitroulas, P

Purpose: Pediatric tumors are generally treated with multi-modal procedures. Brachytherapy can be used with pediatric tumors, especially given that in this patient population low toxicity on normal tissues is critical as is the suppression of the probability for late malignancies. Our goal is to validate the GATE toolkit on realistic brachytherapy applications, and evaluate brachytherapy plans on pediatrics for accurate dosimetry on sensitive and critical organs of interest. Methods: The GATE Monte Carlo (MC) toolkit was used. Two High Dose Rate (HDR) 192Ir brachytherapy sources were simulated (Nucletron mHDR-v1 and Varian VS2000), and fully validated using the AAPM and ESTROmore » protocols. A realistic brachytherapy plan was also simulated using the XCAT anthropomorphic computational model .The simulated data were compared to the clinical dose points. Finally, a 14 years old girl with vaginal rhabdomyosarcoma was modelled based on clinical procedures for the calculation of the absorbed dose per organ. Results: The MC simulations resulted in accurate dosimetry in terms of dose rate constant (Λ), radial dose gL(r) and anisotropy function F(r,θ) for both sources.The simulations were executed using ∼1010 number of primaries resulting in statistical uncertainties lower than 2%.The differences between the theoretical values and the simulated ones ranged from 0.01% up to 3.3%, with the largest discrepancy (6%) being observed in the dose rate constant calculation.The simulated DVH using an adult female XCAT model was also compared to a clinical one resulting in differences smaller than 5%. Finally, a realistic pediatric brachytherapy simulation was performed to evaluate the absorbed dose per organ and to calculate DVH with respect to heterogeneities of the human anatomy. Conclusion: GATE is a reliable tool for brachytherapy simulations both for source modeling and for dosimetry in anthropomorphic voxelized models. Our project aims to evaluate a variety of pediatric

Atmospheric Model Evaluation Tool for meteorological and air quality simulations

EPA Pesticide Factsheets

The Atmospheric Model Evaluation Tool compares model predictions to observed data from various meteorological and air quality observation networks to help evaluate meteorological and air quality simulations.

Practice Skill Development Through the Use of Human Patient Simulation

PubMed Central

2011-01-01

Human patient simulation (HPS) is used in health care education to enhance the transition from classroom learning to competent performance. It has been used frequently in nursing and medical schools and less often in pharmacy and other allied health professions. HPS is used to improve the development of pharmacy practice skills such as physical assessment, pharmacotherapy plan development, and monitoring plans. Engaging multiple health care disciplines in simulations enables participants to practice teamwork and communication skills that are essential in preventing errors and events of harm to patients. This article reviews current literature and use of simulation in pharmacy curricula for the development, enhancement, and assessment of pharmacy practice skills. PMID:22171116

Correction for FDG PET dose extravasations: Monte Carlo validation and quantitative evaluation of patient studies.

PubMed

Silva-Rodríguez, Jesús; Aguiar, Pablo; Sánchez, Manuel; Mosquera, Javier; Luna-Vega, Víctor; Cortés, Julia; Garrido, Miguel; Pombar, Miguel; Ruibal, Alvaro

2014-05-01

Current procedure guidelines for whole body [18F]fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET) state that studies with visible dose extravasations should be rejected for quantification protocols. Our work is focused on the development and validation of methods for estimating extravasated doses in order to correct standard uptake value (SUV) values for this effect in clinical routine. One thousand three hundred sixty-seven consecutive whole body FDG-PET studies were visually inspected looking for extravasation cases. Two methods for estimating the extravasated dose were proposed and validated in different scenarios using Monte Carlo simulations. All visible extravasations were retrospectively evaluated using a manual ROI based method. In addition, the 50 patients with higher extravasated doses were also evaluated using a threshold-based method. Simulation studies showed that the proposed methods for estimating extravasated doses allow us to compensate the impact of extravasations on SUV values with an error below 5%. The quantitative evaluation of patient studies revealed that paravenous injection is a relatively frequent effect (18%) with a small fraction of patients presenting considerable extravasations ranging from 1% to a maximum of 22% of the injected dose. A criterion based on the extravasated volume and maximum concentration was established in order to identify this fraction of patients that might be corrected for paravenous injection effect. The authors propose the use of a manual ROI based method for estimating the effectively administered FDG dose and then correct SUV quantification in those patients fulfilling the proposed criterion.

Correction for FDG PET dose extravasations: Monte Carlo validation and quantitative evaluation of patient studies

DOE Office of Scientific and Technical Information (OSTI.GOV)

Silva-Rodríguez, Jesús, E-mail: jesus.silva.rodriguez@sergas.es; Aguiar, Pablo, E-mail: pablo.aguiar.fernandez@sergas.es; Servicio de Medicina Nuclear, Complexo Hospitalario Universidade de Santiago de Compostela

Purpose: Current procedure guidelines for whole body [18F]fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET) state that studies with visible dose extravasations should be rejected for quantification protocols. Our work is focused on the development and validation of methods for estimating extravasated doses in order to correct standard uptake value (SUV) values for this effect in clinical routine. Methods: One thousand three hundred sixty-seven consecutive whole body FDG-PET studies were visually inspected looking for extravasation cases. Two methods for estimating the extravasated dose were proposed and validated in different scenarios using Monte Carlo simulations. All visible extravasations were retrospectively evaluated using a manualmore » ROI based method. In addition, the 50 patients with higher extravasated doses were also evaluated using a threshold-based method. Results: Simulation studies showed that the proposed methods for estimating extravasated doses allow us to compensate the impact of extravasations on SUV values with an error below 5%. The quantitative evaluation of patient studies revealed that paravenous injection is a relatively frequent effect (18%) with a small fraction of patients presenting considerable extravasations ranging from 1% to a maximum of 22% of the injected dose. A criterion based on the extravasated volume and maximum concentration was established in order to identify this fraction of patients that might be corrected for paravenous injection effect. Conclusions: The authors propose the use of a manual ROI based method for estimating the effectively administered FDG dose and then correct SUV quantification in those patients fulfilling the proposed criterion.« less

Simulator evaluation of the final approach spacing tool

NASA Technical Reports Server (NTRS)

Davis, Thomas J.; Erzberger, Heinz; Green, Steven M.

1990-01-01

The design and simulator evaluation of an automation tool for assisting terminal radar approach controllers in sequencing and spacing traffic onto the final approach course is described. The automation tool, referred to as the Final Approach Spacing Tool (FAST), displays speed and heading advisories for arrivals as well as sequencing information on the controller's radar display. The main functional elements of FAST are a scheduler that schedules and sequences the traffic, a 4-D trajectory synthesizer that generates the advisories, and a graphical interface that displays the information to the controller. FAST was implemented on a high performance workstation. It can be operated as a stand-alone in the Terminal Radar Approach Control (TRACON) Facility or as an element of a system integrated with automation tools in the Air Route Traffic Control Center (ARTCC). FAST was evaluated by experienced TRACON controllers in a real-time air traffic control simulation. Simulation results show that FAST significantly reduced controller workload and demonstrated a potential for an increase in landing rate.

Can a Rescuer or Simulated Patient Accurately Assess Motion During Cervical Spine Stabilization Practice Sessions?

PubMed Central

Shrier, Ian; Boissy, Patrick; Brière, Simon; Mellette, Jay; Fecteau, Luc; Matheson, Gordon O.; Garza, Daniel; Meeuwisse, Willem H.; Segal, Eli; Boulay, John; Steele, Russell J.

2012-01-01

Context: Health care providers must be prepared to manage all potential spine injuries as if they are unstable. Therefore, most sport teams devote resources to training for sideline cervical spine (C-spine) emergencies. Objective: To determine (1) how accurately rescuers and simulated patients can assess motion during C-spine stabilization practice and (2) whether providing performance feedback to rescuers influences their choice of stabilization technique. Design: Crossover study. Setting: Training studio. Patients or Other Participants: Athletic trainers, athletic therapists, and physiotherapists experienced at managing suspected C-spine injuries. Intervention(s): Twelve lead rescuers (at the patient's head) performed both the head-squeeze and trap-squeeze C-spine stabilization maneuvers during 4 test scenarios: lift-and-slide and log-roll placement on a spine board and confused patient trying to sit up or rotate the head. Main Outcome Measure(s): Interrater reliability between rescuer and simulated patient quality scores for subjective evaluation of C-spine stabilization during trials (0 = best, 10 = worst), correlation between rescuers' quality scores and objective measures of motion with inertial measurement units, and frequency of change in preference for the head-squeeze versus trap-squeeze maneuver. Results: Although the weighted κ value for interrater reliability was acceptable (0.71–0.74), scores varied by 2 points or more between rescuers and simulated patients for approximately 10% to 15% of trials. Rescuers' scores correlated with objective measures, but variability was large: 38% of trials scored as 0 or 1 by the rescuer involved more than 10° of motion in at least 1 direction. Feedback did not affect the preference for the lift-and-slide placement. For the log-roll placement, 6 of 8 participants who preferred the head squeeze at baseline preferred the trap squeeze after feedback. For the confused patient, 5 of 5 participants initially preferred

Implementing economic evaluation in simulation-based medical education: challenges and opportunities.

PubMed

Lin, Yiqun; Cheng, Adam; Hecker, Kent; Grant, Vincent; Currie, Gillian R

2018-02-01

Simulation-based medical education (SBME) is now ubiquitous at all levels of medical training. Given the substantial resources needed for SBME, economic evaluation of simulation-based programmes or curricula is required to demonstrate whether improvement in trainee performance (knowledge, skills and attitudes) and health outcomes justifies the cost of investment. Current literature evaluating SBME fails to provide consistent and interpretable information on the relative costs and benefits of alternatives. Economic evaluation is widely applied in health care, but is relatively scarce in medical education. Therefore, in this paper, using a focus on SBME, we define economic evaluation, describe the key components, and discuss the challenges associated with conducting an economic evaluation of medical education interventions. As a way forward to the rigorous and state of the art application of economic evaluation in medical education, we outline the steps to gather the necessary information to conduct an economic evaluation of simulation-based education programmes and curricula, and describe the main approaches to conducting an economic evaluation. A properly conducted economic evaluation can help stakeholders (i.e., programme directors, policy makers and curriculum designers) to determine the optimal use of resources in selecting the modality or method of assessment in simulation. It also helps inform broader decision making about allocation of scarce resources within an educational programme, as well as between education and clinical care. Economic evaluation in medical education research is still in its infancy, and there is significant potential for state-of-the-art application of these methods in this area. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Fluid, solid and fluid-structure interaction simulations on patient-based abdominal aortic aneurysm models.

PubMed

Kelly, Sinead; O'Rourke, Malachy

2012-04-01

This article describes the use of fluid, solid and fluid-structure interaction simulations on three patient-based abdominal aortic aneurysm geometries. All simulations were carried out using OpenFOAM, which uses the finite volume method to solve both fluid and solid equations. Initially a fluid-only simulation was carried out on a single patient-based geometry and results from this simulation were compared with experimental results. There was good qualitative and quantitative agreement between the experimental and numerical results, suggesting that OpenFOAM is capable of predicting the main features of unsteady flow through a complex patient-based abdominal aortic aneurysm geometry. The intraluminal thrombus and arterial wall were then included, and solid stress and fluid-structure interaction simulations were performed on this, and two other patient-based abdominal aortic aneurysm geometries. It was found that the solid stress simulations resulted in an under-estimation of the maximum stress by up to 5.9% when compared with the fluid-structure interaction simulations. In the fluid-structure interaction simulations, flow induced pressure within the aneurysm was found to be up to 4.8% higher than the value of peak systolic pressure imposed in the solid stress simulations, which is likely to be the cause of the variation in the stress results. In comparing the results from the initial fluid-only simulation with results from the fluid-structure interaction simulation on the same patient, it was found that wall shear stress values varied by up to 35% between the two simulation methods. It was concluded that solid stress simulations are adequate to predict the maximum stress in an aneurysm wall, while fluid-structure interaction simulations should be performed if accurate prediction of the fluid wall shear stress is necessary. Therefore, the decision to perform fluid-structure interaction simulations should be based on the particular variables of interest in a given

Current concepts in simulation-based trauma education.

PubMed

Cherry, Robert A; Ali, Jameel

2008-11-01

The use of simulation-based technology in trauma education has focused on providing a safe and effective alternative to the more traditional methods that are used to teach technical skills and critical concepts in trauma resuscitation. Trauma team training using simulation-based technology is also being used to develop skills in leadership, team-information sharing, communication, and decision-making. The integration of simulators into medical student curriculum, residency training, and continuing medical education has been strongly recommended by the American College of Surgeons as an innovative means of enhancing patient safety, reducing medical errors, and performing a systematic evaluation of various competencies. Advanced human patient simulators are increasingly being used in trauma as an evaluation tool to assess clinical performance and to teach and reinforce essential knowledge, skills, and abilities. A number of specialty simulators in trauma and critical care have also been designed to meet these educational objectives. Ongoing educational research is still needed to validate long-term retention of knowledge and skills, provide reliable methods to evaluate teaching effectiveness and performance, and to demonstrate improvement in patient safety and overall quality of care.

On the practice of ignoring center-patient interactions in evaluating hospital performance.

PubMed

Varewyck, Machteld; Vansteelandt, Stijn; Eriksson, Marie; Goetghebeur, Els

2016-01-30

We evaluate the performance of medical centers based on a continuous or binary patient outcome (e.g., 30-day mortality). Common practice adjusts for differences in patient mix through outcome regression models, which include patient-specific baseline covariates (e.g., age and disease stage) besides center effects. Because a large number of centers may need to be evaluated, the typical model postulates that the effect of a center on outcome is constant over patient characteristics. This may be violated, for example, when some centers are specialized in children or geriatric patients. Including interactions between certain patient characteristics and the many fixed center effects in the model increases the risk for overfitting, however, and could imply a loss of power for detecting centers with deviating mortality. Therefore, we assess how the common practice of ignoring such interactions impacts the bias and precision of directly and indirectly standardized risks. The reassuring conclusion is that the common practice of working with the main effects of a center has minor impact on hospital evaluation, unless some centers actually perform substantially better on a specific group of patients and there is strong confounding through the corresponding patient characteristic. The bias is then driven by an interplay of the relative center size, the overlap between covariate distributions, and the magnitude of the interaction effect. Interestingly, the bias on indirectly standardized risks is smaller than on directly standardized risks. We illustrate our findings by simulation and in an analysis of 30-day mortality on Riksstroke. © 2015 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd.

Information Theoretic Evaluation of a Noiseband-Based Cochlear Implant Simulator

PubMed Central

Aguiar, Daniel E.; Taylor, N. Ellen; Li, Jing; Gazanfari, Daniel K.; Talavage, Thomas M.; Laflen, J. Brandon; Neuberger, Heidi; Svirsky, Mario A.

2015-01-01

Noise-band vocoders are often used to simulate the signal processing algorithms used in cochlear implants (CIs), producing acoustic stimuli that may be presented to normal hearing (NH) subjects. Such evaluations may obviate the heterogeneity of CI user populations, achieving greater experimental control than when testing on CI subjects. However, it remains an open question whether advancements in algorithms developed on NH subjects using a simulator will necessarily improve performance in CI users. This study assessed the similarity in vowel identification of CI subjects and NH subjects using an 8-channel noise-band vocoder simulator configured to match input and output frequencies or to mimic output after a basalward shift of input frequencies. Under each stimulus condition, NH subjects performed the task both with and without feedback/training. Similarity of NH subjects to CI users was evaluated using correct identification rates and information theoretic approaches. Feedback/training produced higher rates of correct identification, as expected, but also resulted in error patterns that were closer to those of the CI users. Further evaluation remains necessary to determine how patterns of confusion at the token level are affected by the various parameters in CI simulators, providing insight into how a true CI simulation may be developed to facilitate more rapid prototyping and testing of novel CI signal processing and electrical stimulation strategies. PMID:26409068

The Regional Climate Model Evaluation System: A Systematic Evaluation Of CORDEX Simulations Using Obs4MIPs

NASA Astrophysics Data System (ADS)

Goodman, A.; Lee, H.; Waliser, D. E.; Guttowski, W.

2017-12-01

Observation-based evaluations of global climate models (GCMs) have been a key element for identifying systematic model biases that can be targeted for model improvements and for establishing uncertainty associated with projections of global climate change. However, GCMs are limited in their ability to represent physical phenomena which occur on smaller, regional scales, including many types of extreme weather events. In order to help facilitate projections in changes of such phenomena, simulations from regional climate models (RCMs) for 14 different domains around the world are being provided by the Coordinated Regional Climate Downscaling Experiment (CORDEX; www.cordex.org). However, although CORDEX specifies standard simulation and archiving protocols, these simulations are conducted independently by individual research and modeling groups representing each of these domains often with different output requirements and data archiving and exchange capabilities. Thus, with respect to similar efforts using GCMs (e.g., the Coupled Model Intercomparison Project, CMIP), it is more difficult to achieve a standardized, systematic evaluation of the RCMs for each domain and across all the CORDEX domains. Using the Regional Climate Model Evaluation System (RCMES; rcmes.jpl.nasa.gov) developed at JPL, we are developing easy to use templates for performing systematic evaluations of CORDEX simulations. Results from the application of a number of evaluation metrics (e.g., biases, centered RMS, and pattern correlations) will be shown for a variety of physical quantities and CORDEX domains. These evaluations are performed using products from obs4MIPs, an activity initiated by DOE and NASA, and now shepherded by the World Climate Research Program's Data Advisory Council.

Patient-specific 3D printing simulation to guide complex coronary intervention.

PubMed

Oliveira-Santos, Manuel; Oliveira Santos, Eduardo; Marinho, Ana Vera; Leite, Luís; Guardado, Jorge; Matos, Vítor; Pego, Guilherme Mariano; Marques, João Silva

2018-05-07

The field of three-dimensional printing applied to patient-specific simulation is evolving as a tool to enhance intervention results. We report the first case of a fully simulated percutaneous coronary intervention in a three-dimensional patient-specific model to guide treatment. An 85-year-old female presented with symptomatic in-stent restenosis in the ostial circumflex and was scheduled for percutaneous coronary intervention. Considering the complexity of the anatomy, patient setting and intervention technique, we elected to replicate the coronary anatomy using a three-dimensional model. In this way, we simulated the intervention procedure beforehand in the catheterization laboratory using standard materials. The procedure was guided by optical coherence tomography, with pre-dilatation of the lesion, implantation of a single drug-eluting stent in the ostial circumflex and kissing balloon inflation to the left anterior descending artery and circumflex. Procedural steps were replicated in the real patient's treatment, with remarkable parallelism in angiographic outcome and luminal gain at intracoronary imaging. In this proof-of-concept report, we show that patient-specific simulation is feasible to guide the treatment strategy of complex coronary artery disease. It enables the surgical team to plan and practice the procedure beforehand, and possibly predict complications and gain confidence. Copyright © 2018 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

Using simulated fluorescence cell micrographs for the evaluation of cell image segmentation algorithms.

PubMed

Wiesmann, Veit; Bergler, Matthias; Palmisano, Ralf; Prinzen, Martin; Franz, Daniela; Wittenberg, Thomas

2017-03-18

Manual assessment and evaluation of fluorescent micrograph cell experiments is time-consuming and tedious. Automated segmentation pipelines can ensure efficient and reproducible evaluation and analysis with constant high quality for all images of an experiment. Such cell segmentation approaches are usually validated and rated in comparison to manually annotated micrographs. Nevertheless, manual annotations are prone to errors and display inter- and intra-observer variability which influence the validation results of automated cell segmentation pipelines. We present a new approach to simulate fluorescent cell micrographs that provides an objective ground truth for the validation of cell segmentation methods. The cell simulation was evaluated twofold: (1) An expert observer study shows that the proposed approach generates realistic fluorescent cell micrograph simulations. (2) An automated segmentation pipeline on the simulated fluorescent cell micrographs reproduces segmentation performances of that pipeline on real fluorescent cell micrographs. The proposed simulation approach produces realistic fluorescent cell micrographs with corresponding ground truth. The simulated data is suited to evaluate image segmentation pipelines more efficiently and reproducibly than it is possible on manually annotated real micrographs.

Cloud evaluation using satellite simulators and cloud changes for global nonhydrostatic simulations with NICAM

NASA Astrophysics Data System (ADS)

Satoh, M.; Noda, A. T.; Kodama, C.; Yamada, Y.; Hashino, T.

2012-12-01

Global cloud distributions and properties simulated by the global nonhydrostatic model, NICAM (Nonhydrostatic Icosahedral Atmospheric Model), are evaluated and their future changes are discussed. First, we evaluated the simulated cloud properties produced by a case study of the 3.5km mesh experiment of NICAM using the satellite simulator package (the Joint-simulator) with cloud microphysics oriented approach (Hashino et al. 2012). Then, we analyzed future cloud changes using various sets of simulations under the present and the future global warming conditions. The results show that the zonal averaged ice water path (IWP) generally decreases or marginally unchanged in the tropics, while IWP in the extra-tropics increases. The upper cloud fraction increases both in the tropics and in the extra-tropics in general. We further analyzed contributions of cloud systems such as cloud clusters, tropical cyclones (TCs), and storm-tracks to these changes. Probability distribution of the larger cloud clusters decreases, while that of the smaller ones increases, consistent with the decrease in the number of tropical cyclones in the future climate. Average liquid water path (LWP) and IWP associated with each tropical cyclone are diagnosed, and it is found that both the associated LWP and IWP increase under the warmer condition. Even though, since the number of the intensive cloud systems decrease, the average IWP decreases. It should be remarked that the change in TC tracks largely contribute to the change in the horizontal distribution of clouds. The NICAM simulations also show that the storm-tracks shift poleward, and the storms become less frequent and stronger in the extra-tropics, similar to the results of other general circulation models. Both LWP and IWP associated with the storms also increase in the warmer climate in the NICAM simulations. This results in increase in the upper clouds under the warmer climate condition, as described by Miura et al. (2005). References

Crisis management on surgical wards: a simulation-based approach to enhancing technical, teamwork, and patient interaction skills.

PubMed

Arora, Sonal; Hull, Louise; Fitzpatrick, Maureen; Sevdalis, Nick; Birnbach, David J

2015-05-01

To establish the efficacy of simulation-based training for improving residents' management of postoperative complications on a surgical ward. Effective postoperative care is a crucial determinant of patient outcome, yet trainees learn this through the Halstedian approach. Little evidence exists on the efficacy of simulation in this safety-critical environment. A pre-/postintervention design was employed with 185 residents from 5 hospitals. Residents participated in 2 simulated ward-based scenarios consisting of a deteriorating postoperative patient. A debriefing intervention was implemented between scenarios. Resident performance was evaluated by calibrated, blinded assessors using the validated Global Assessment Toolkit for Ward Care. This included an assessment of clinical skills (checklist of 35 tasks), team-working skills (score range 1-6 per skill), and physician-patient interaction skills. Excellent interrater reliability was achieved in all assessments (reliability 0.89-0.99, P < 0.001). Clinically, improvements were obtained posttraining in residents' ability to recognize/respond to falling saturations (pre = 73.7% vs post = 94.8%, P < 0.01), check circulatory status (pre = 21.1% vs post = 84.2% P < 0.001), continuously reassess patient (pre = 42.1% vs post = 100%, P < 0.001), and call for help (pre = 36.8% vs post = 89.8%, P < 0.001). Regarding teamwork, there was a significant improvement in residents' communication (pre = 1.75 vs post = 3.43), leadership (pre = 2.43 vs post = 4.20), and decision-making skills (pre = 2.20 vs post = 3.81, P < 0.001). Finally, residents improved in all elements of interaction with patients: empathy, organization, and verbal and nonverbal expression (Ps < 0.001). The study provides evidence for the efficacy of ward-based team training using simulation. Such exercises should be formally incorporated into training curricula to enhance patient safety in the high-risk surgical ward environment.

Evaluation of articulation simulation system using artificial maxillectomy models.

PubMed

Elbashti, M E; Hattori, M; Sumita, Y I; Taniguchi, H

2015-09-01

Acoustic evaluation is valuable for guiding the treatment of maxillofacial defects and determining the effectiveness of rehabilitation with an obturator prosthesis. Model simulations are important in terms of pre-surgical planning and pre- and post-operative speech function. This study aimed to evaluate the acoustic characteristics of voice generated by an articulation simulation system using a vocal tract model with or without artificial maxillectomy defects. More specifically, we aimed to establish a speech simulation system for maxillectomy defect models that both surgeons and maxillofacial prosthodontists can use in guiding treatment planning. Artificially simulated maxillectomy defects were prepared according to Aramany's classification (Classes I-VI) in a three-dimensional vocal tract plaster model of a subject uttering the vowel /a/. Formant and nasalance acoustic data were analysed using Computerized Speech Lab and the Nasometer, respectively. Formants and nasalance of simulated /a/ sounds were successfully detected and analysed. Values of Formants 1 and 2 for the non-defect model were 675.43 and 976.64 Hz, respectively. Median values of Formants 1 and 2 for the defect models were 634.36 and 1026.84 Hz, respectively. Nasalance was 11% in the non-defect model, whereas median nasalance was 28% in the defect models. The results suggest that an articulation simulation system can be used to help surgeons and maxillofacial prosthodontists to plan post-surgical defects that will be facilitate maxillofacial rehabilitation. © 2015 John Wiley & Sons Ltd.

The Effects of Moderate- and High-Fidelity Patient Simulator Use on Critical Thinking in Associate Degree Nursing Students

ERIC Educational Resources Information Center

Vieck, Jana

2013-01-01

The purpose of this study was to examine the impact of moderate- and high-fidelity patient simulator use on the critical thinking skills of associate degree nursing students. This quantitative study used a quasi-experimental design and the Health Sciences Reasoning Test (HSRT) to evaluate the critical thinking skills of third semester nursing…

The Impact of Human Patient Simulation on Nursing Clinical Knowledge

ERIC Educational Resources Information Center

Shinnick, Mary Ann

2010-01-01

Public health relies on well trained nurses and clinical experience is an important component of that training. However, clinical experience training for student nurses also has significant challenges, as it can place patients at risk. Also it is difficult to schedule/predict patient conditions and procedures. Human patient simulation (HPS) can…

Patient-Centered Appointment Scheduling Using Agent-Based Simulation

PubMed Central

Turkcan, Ayten; Toscos, Tammy; Doebbeling, Brad N.

2014-01-01

Enhanced access and continuity are key components of patient-centered care. Existing studies show that several interventions such as providing same day appointments, walk-in services, after-hours care, and group appointments, have been used to redesign the healthcare systems for improved access to primary care. However, an intervention focusing on a single component of care delivery (i.e. improving access to acute care) might have a negative impact other components of the system (i.e. reduced continuity of care for chronic patients). Therefore, primary care clinics should consider implementing multiple interventions tailored for their patient population needs. We collected rapid ethnography and observations to better understand clinic workflow and key constraints. We then developed an agent-based simulation model that includes all access modalities (appointments, walk-ins, and after-hours access), incorporate resources and key constraints and determine the best appointment scheduling method that improves access and continuity of care. This paper demonstrates the value of simulation models to test a variety of alternative strategies to improve access to care through scheduling. PMID:25954423

Using simulation to determine the need for ICU beds for surgery patients.

PubMed

Troy, Philip Marc; Rosenberg, Lawrence

2009-10-01

As the need for surgical ICU beds at the hospital increases, the mismatch between demand and supply for those beds has led to the need to understand the drivers of ICU performance. A Monte Carlo simulation study of ICU performance was performed using a discrete event model that captured the events, timing, and logic of ICU patient arrivals and bed stays. The study found that functional ICU capacity, ie, the number of occupied ICU beds at which operative procedures were canceled if they were known to require an ICU stay, was the main determinant of the wait, the number performed, and the number of cancellations of operative procedures known to require an ICU stay. The study also found that actual and functional ICU capacity jointly explained ICU utilization and the mean number of patients that should have been in the ICU that were parked elsewhere. The study demonstrated the necessity of considering actual and functional ICU capacity when analyzing surgical ICU bed requirements, and suggested the need for additional research on synchronizing demand with supply. The study also reinforced the authors' sense that simulation facilitates the evaluation of trade-offs between surgical management alternatives proposed by experts and the identification of unexpected drawbacks or opportunities of those proposals.

The Use and Evaluation of Interest Inventories and Simulations.

ERIC Educational Resources Information Center

Holland, John L.

This paper provides a general perspective for evaluating interest inventories and simulations and outlines some activities to stimulate the development of more useful inventories. Previous evaluations have been primarily instrument-specific; have relied generally on opinion rather than evidence; and have focused only on possible sex, age, race, or…

Patient-Specific Simulation of Cardiac Blood Flow From High-Resolution Computed Tomography.

PubMed

Lantz, Jonas; Henriksson, Lilian; Persson, Anders; Karlsson, Matts; Ebbers, Tino

2016-12-01

Cardiac hemodynamics can be computed from medical imaging data, and results could potentially aid in cardiac diagnosis and treatment optimization. However, simulations are often based on simplified geometries, ignoring features such as papillary muscles and trabeculae due to their complex shape, limitations in image acquisitions, and challenges in computational modeling. This severely hampers the use of computational fluid dynamics in clinical practice. The overall aim of this study was to develop a novel numerical framework that incorporated these geometrical features. The model included the left atrium, ventricle, ascending aorta, and heart valves. The framework used image registration to obtain patient-specific wall motion, automatic remeshing to handle topological changes due to the complex trabeculae motion, and a fast interpolation routine to obtain intermediate meshes during the simulations. Velocity fields and residence time were evaluated, and they indicated that papillary muscles and trabeculae strongly interacted with the blood, which could not be observed in a simplified model. The framework resulted in a model with outstanding geometrical detail, demonstrating the feasibility as well as the importance of a framework that is capable of simulating blood flow in physiologically realistic hearts.

Knowledge-Driven Design of Virtual Patient Simulations

ERIC Educational Resources Information Center

Vergara, Victor; Caudell, Thomas; Goldsmith, Timothy; Panaiotis; Alverson, Dale

2009-01-01

Virtual worlds provide unique opportunities for instructors to promote, study, and evaluate student learning and comprehension. In this article, Victor Vergara, Thomas Caudell, Timothy Goldsmith, Panaiotis, and Dale Alverson explore the advantages of using virtual reality environments to create simulations for medical students. Virtual simulations…

A quantitative approach to evaluating caring in nursing simulation.

PubMed

Eggenberger, Terry L; Keller, Kathryn B; Chase, Susan K; Payne, Linda

2012-01-01

This study was designed to test a quantitative method of measuring caring in the simulated environment. Since competency in caring is central to nursing practice, ways of including caring concepts in designing scenarios and in evaluation of performance need to be developed. Coates' Caring Efficacy scales were adapted for simulation and named the Caring Efficacy Scale-Simulation Student Version (CES-SSV) and Caring Efficacy Scale-Simulation Faculty Version (CES-SFV). A correlational study was designed to compare student self-ratings with faculty ratings on caring efficacy during an adult acute simulation experience with traditional and accelerated baccalaureate students in a nursing program grounded in caring theory. Student self-ratings were significantly correlated with objective ratings (r = 0.345, 0.356). Both the CES-SSV and the CES-SFV were found to have excellent internal consistency and significantly correlated interrater reliability. They were useful in measuring caring in the simulated learning environment.

The effects of a simulated laughter programme on mood, cortisol levels, and health-related quality of life among haemodialysis patients.

PubMed

Heo, Eun Hwa; Kim, Sehyun; Park, Hye-Ja; Kil, Suk Yong

2016-11-01

This study aimed to evaluate the effects of a simulated laughter programme on mood, cortisol levels, and health-related quality of life among haemodialysis patients. Forty participants were randomly assigned to a laughter group (n = 20) or a control group (n = 20). Eleven participants completed the laughter programme after haemodialysis sessions and 18 control participants remained. The 4-week simulated laughter programme included weekly 60 min group sessions of simulated laughter, breathing, stretching exercises, and meditation, as well as daily 15 s individual laughter sessions administered via telephone. Mood, cortisol levels, and health-related quality of life were analysed using the rank analysis of covariance, and Wilcoxon's signed rank test. The laughter group exhibited improvements in mood, symptoms, social interaction quality, and role limitations due to physical health. The simulated laughter programme may help improve mood and health-related quality of life among haemodialysis patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

Evaluation of Long-Term Cloud-Resolving Model Simulations Using Satellite Radiance Observations and Multi-Frequency Satellite Simulators

NASA Technical Reports Server (NTRS)

Matsui, Toshihisa; Zeng, Xiping; Tao, Wei-Kuo; Masunaga, Hirohiko; Olson, William S.; Lang, Stephen

2008-01-01

This paper proposes a methodology known as the Tropical Rainfall Measuring Mission (TRMM) Triple-Sensor Three-step Evaluation Framework (T3EF) for the systematic evaluation of precipitating cloud types and microphysics in a cloud-resolving model (CRM). T3EF utilizes multi-frequency satellite simulators and novel statistics of multi-frequency radiance and backscattering signals observed from the TRMM satellite. Specifically, T3EF compares CRM and satellite observations in the form of combined probability distributions of precipitation radar (PR) reflectivity, polarization-corrected microwave brightness temperature (Tb), and infrared Tb to evaluate the candidate CRM. T3EF is used to evaluate the Goddard Cumulus Ensemble (GCE) model for cases involving the South China Sea Monsoon Experiment (SCSMEX) and Kwajalein Experiment (KWAJEX). This evaluation reveals that the GCE properly captures the satellite-measured frequencies of different precipitating cloud types in the SCSMEX case but underestimates the frequencies of deep convective and deep stratiform types in the KWAJEX case. Moreover, the GCE tends to simulate excessively large and abundant frozen condensates in deep convective clouds as inferred from the overestimated GCE-simulated radar reflectivities and microwave Tb depressions. Unveiling the detailed errors in the GCE s performance provides the best direction for model improvements.

[Use of Simulated Pacients in Psychiatry].

PubMed

Corso, Silvia J Franco; Delgado, Marta Beatriz; Gómez-Restrepo, Carlos

2012-01-01

Scientific advances and the complexity of human knowledge generate a constant need for creating new tools intended to facilitate learning in an agreeable and lasting form. Simulated patients are one of such tools in medical education. Standardized or simulated patients are actors or people vigorously trained to represent a medical history or, if possible, specific physical findings with the purpose of using such representations as an educational and evaluating supplement in clinic practice. The use of simulated patients has been very well received, particularly in the psychiatric field; however, its usefulness in areas such as psychotherapy or evaluation of residents remains questionable. A search was made in PubMed with the MESH words ("Psychiatry/education" and "Patient Simulation"); a search was also made in LILACS and scholar Google using similar words. Simulated patients are widely used throughout the world in the psychiatry field and their usefulness as an academic tool for pre-graduate students is confirmed in most of the literature reviewed. One of the main benefits of the use of this kind of patients is the acquisition of specific abilities (e.g.: medical history recording); nevertheless, its efficacy in more complex experiences like psychotherapy or certification of psychiatry residents is questioned. Notwithstanding the controversy, most of the literature reviewed confirms the benefits and acceptance of this methodology in the formation of students and psychiatrists. Copyright © 2012 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

A SAS-based solution to evaluate study design efficiency of phase I pediatric oncology trials via discrete event simulation.

PubMed

Barrett, Jeffrey S; Jayaraman, Bhuvana; Patel, Dimple; Skolnik, Jeffrey M

2008-06-01

Previous exploration of oncology study design efficiency has focused on Markov processes alone (probability-based events) without consideration for time dependencies. Barriers to study completion include time delays associated with patient accrual, inevaluability (IE), time to dose limiting toxicities (DLT) and administrative and review time. Discrete event simulation (DES) can incorporate probability-based assignment of DLT and IE frequency, correlated with cohort in the case of DLT, with time-based events defined by stochastic relationships. A SAS-based solution to examine study efficiency metrics and evaluate design modifications that would improve study efficiency is presented. Virtual patients are simulated with attributes defined from prior distributions of relevant patient characteristics. Study population datasets are read into SAS macros which select patients and enroll them into a study based on the specific design criteria if the study is open to enrollment. Waiting times, arrival times and time to study events are also sampled from prior distributions; post-processing of study simulations is provided within the decision macros and compared across designs in a separate post-processing algorithm. This solution is examined via comparison of the standard 3+3 decision rule relative to the "rolling 6" design, a newly proposed enrollment strategy for the phase I pediatric oncology setting.

Inter-professional in-situ simulated team and resuscitation training for patient safety: Description and impact of a programmatic approach.

PubMed

Zimmermann, Katja; Holzinger, Iris Bachmann; Ganassi, Lorena; Esslinger, Peter; Pilgrim, Sina; Allen, Meredith; Burmester, Margarita; Stocker, Martin

2015-10-29

Inter-professional teamwork is key for patient safety and team training is an effective strategy to improve patient outcome. In-situ simulation is a relatively new strategy with emerging efficacy, but best practices for the design, delivery and implementation have yet to be evaluated. Our aim is to describe and evaluate the implementation of an inter-professional in-situ simulated team and resuscitation training in a teaching hospital with a programmatic approach. We designed and implemented a team and resuscitation training program according to Kern's six steps approach for curriculum development. General and specific needs assessments were conducted as independent cross-sectional surveys. Teamwork, technical skills and detection of latent safety threats were defined as specific objectives. Inter-professional in-situ simulation was used as educational strategy. The training was embedded within the workdays of participants and implemented in our highest acuity wards (emergency department, intensive care unit, intermediate care unit). Self-perceived impact and self-efficacy were sampled with an anonymous evaluation questionnaire after every simulated training session. Assessment of team performance was done with the team-based self-assessment tool TeamMonitor applying Van der Vleuten's conceptual framework of longitudinal evaluation after experienced real events. Latent safety threats were reported during training sessions and after experienced real events. The general and specific needs assessments clearly identified the problems, revealed specific training needs and assisted with stakeholder engagement. Ninety-five interdisciplinary staff members of the Children's Hospital participated in 20 in-situ simulated training sessions within 2 years. Participant feedback showed a high effect and acceptance of training with reference to self-perceived impact and self-efficacy. Thirty-five team members experiencing 8 real critical events assessed team performance with Team

Virtual Patient Simulations for Medical Education: Increasing Clinical Reasoning Skills through Deliberate Practice

ERIC Educational Resources Information Center

McCoy, Lise

2014-01-01

Virtual Patient Simulations (VPS) are web-based exercises involving simulated patients in virtual environments. This study investigates the utility of VPS for increasing medical student clinical reasoning skills, collaboration, and engagement. Many studies indicate that VPS provide medical students with essential practice in clinical decision…

Direct Operational Field Test Evaluation, Simulation And Modeling

DOT National Transportation Integrated Search

1998-08-01

THE PURPOSE OF THE SIMULATION EVALUATION IS TO ASSESS THE EXPECTED FUTURE IMPACTS OF THE DIRECT TECHNOLOGIES UNDER SCENARIOS OF FULL DEPLOYMENT. THIS PROVIDED SOME INDICATION OF THE LEVEL OF BENEFITS THAT CAN BE EXPECTED FROM DIRECT IN THE FUTURE. BE...

Walking simulator for evaluation of ophthalmic devices

NASA Astrophysics Data System (ADS)

Barabas, James; Woods, Russell L.; Peli, Eli

2005-03-01

Simulating mobility tasks in a virtual environment reduces risk for research subjects, and allows for improved experimental control and measurement. We are currently using a simulated shopping mall environment (where subjects walk on a treadmill in front of a large projected video display) to evaluate a number of ophthalmic devices developed at the Schepens Eye Research Institute for people with vision impairment, particularly visual field defects. We have conducted experiments to study subject's perception of "safe passing distance" when walking towards stationary obstacles. The subject's binary responses about potential collisions are analyzed by fitting a psychometric function, which gives an estimate of the subject's perceived safe passing distance, and the variability of subject responses. The system also enables simulations of visual field defects using head and eye tracking, enabling better understanding of the impact of visual field loss. Technical infrastructure for our simulated walking environment includes a custom eye and head tracking system, a gait feedback system to adjust treadmill speed, and a handheld 3-D pointing device. Images are generated by a graphics workstation, which contains a model with photographs of storefronts from an actual shopping mall, where concurrent validation experiments are being conducted.

in silico Surveillance: evaluating outbreak detection with simulation models

PubMed Central

2013-01-01

Background Detecting outbreaks is a crucial task for public health officials, yet gaps remain in the systematic evaluation of outbreak detection protocols. The authors’ objectives were to design, implement, and test a flexible methodology for generating detailed synthetic surveillance data that provides realistic geographical and temporal clustering of cases and use to evaluate outbreak detection protocols. Methods A detailed representation of the Boston area was constructed, based on data about individuals, locations, and activity patterns. Influenza-like illness (ILI) transmission was simulated, producing 100 years of in silico ILI data. Six different surveillance systems were designed and developed using gathered cases from the simulated disease data. Performance was measured by inserting test outbreaks into the surveillance streams and analyzing the likelihood and timeliness of detection. Results Detection of outbreaks varied from 21% to 95%. Increased coverage did not linearly improve detection probability for all surveillance systems. Relaxing the decision threshold for signaling outbreaks greatly increased false-positives, improved outbreak detection slightly, and led to earlier outbreak detection. Conclusions Geographical distribution can be more important than coverage level. Detailed simulations of infectious disease transmission can be configured to represent nearly any conceivable scenario. They are a powerful tool for evaluating the performance of surveillance systems and methods used for outbreak detection. PMID:23343523

Development of three-dimensional patient face model that enables real-time collision detection and cutting operation for a dental simulator.

PubMed

Yamaguchi, Satoshi; Yamada, Yuya; Yoshida, Yoshinori; Noborio, Hiroshi; Imazato, Satoshi

2012-01-01

The virtual reality (VR) simulator is a useful tool to develop dental hand skill. However, VR simulations with reactions of patients have limited computational time to reproduce a face model. Our aim was to develop a patient face model that enables real-time collision detection and cutting operation by using stereolithography (STL) and deterministic finite automaton (DFA) data files. We evaluated dependence of computational cost and constructed the patient face model using the optimum condition for combining STL and DFA data files, and assessed the computational costs for operation in do-nothing, collision, cutting, and combination of collision and cutting. The face model was successfully constructed with low computational costs of 11.3, 18.3, 30.3, and 33.5 ms for do-nothing, collision, cutting, and collision and cutting, respectively. The patient face model could be useful for developing dental hand skill with VR.

Pre-flight evaluation of adult patients with cystic fibrosis: a cross-sectional study.

PubMed

Edvardsen, Elisabeth; Akerø, Aina; Skjønsberg, Ole Henning; Skrede, Bjørn

2017-02-06

Air travel may imply a health hazard for patients with cystic fibrosis (CF) due to hypobaric environment in the aircraft cabin. The objective was to identify pre-flight variables, which might predict severe hypoxaemia in adult CF patients during air travel. Thirty adult CF-patients underwent pre-flight evaluation with spirometry, arterial oxygen tension (PaO 2 ), pulse oximetry (SpO 2 ) and cardiopulmonary exercise testing (CPET) at sea level (SL). The results were related to the PaO 2 obtained during a hypoxia-altitude simulation test (HAST) in which a cabin altitude of 2438 m (8000 ft) was simulated by breathing 15.1% oxygen. Four patients fulfilled the criteria for supplemental oxygen during air travel (PaO 2 HAST  < 6.6 kPa). While walking slowly during HAST, another eleven patients dropped below PaO 2 HAST 6.6 kPa. Variables obtained during CPET (PaO 2 CPET , SpO 2 CPET , minute ventilation/carbon dioxide output, maximal oxygen uptake) showed the strongest correlation to PaO 2 HAST . Exercise testing might be of value for predicting in-flight hypoxaemia and thus the need for supplemental oxygen during air travel in CF patients. Trial registration The study is retrospectively listed in the ClinicalTrials.gov Protocol Registration System: NCT01569880 (date; 30/3/2012).

Simulating clinical trial visits yields patient insights into study design and recruitment.

PubMed

Lim, S Sam; Kivitz, Alan J; McKinnell, Doug; Pierson, M Edward; O'Brien, Faye S

2017-01-01

We elicited patient experiences from clinical trial simulations to aid in future trial development and to improve patient recruitment and retention. Two simulations of draft Phase II and Phase III anifrolumab studies for systemic lupus erythematosus (SLE)/lupus nephritis (LN) were performed involving African-American patients from Grady Hospital, an indigent care hospital in Atlanta, GA, USA, and white patients from Altoona Arthritis and Osteoporosis Center in Altoona, PA, USA. The clinical trial simulation included an informed consent procedure, a mock screening visit, a mock dosing visit, and a debriefing period for patients and staff. Patients and staff were interviewed to obtain sentiments and perceptions related to the simulated visits. The Atlanta study involved 6 African-American patients (5 female) aged 27-60 years with moderate to severe SLE/LN. The Altoona study involved 12 white females aged 32-75 years with mild to moderate SLE/LN. Patient experiences had an impact on four patient-centric care domains: 1) information, communication, and education; 2) responsiveness to needs; 3) access to care; and 4) coordination of care; and continuity and transition. Patients in both studies desired background material, knowledgeable staff, family and friend support, personal results, comfortable settings, shorter wait times, and greater scheduling flexibility. Compared with the Altoona study patients, Atlanta study patients reported greater preferences for information from the Internet, need for strong community and online support, difficulties in discussing SLE, emphasis on transportation and child care help during the visits, and concerns related to financial matters; and they placed greater importance on time commitment, understanding of potential personal benefit, trust, and confidentiality of patient data as factors for participation. Using these results, we present recommendations to improve study procedures to increase retention, recruitment, and compliance

Digital autopilots: Design considerations and simulator evaluations

NASA Technical Reports Server (NTRS)

Osder, S.; Neuman, F.; Foster, J.

1971-01-01

The development of a digital autopilot program for a transport aircraft and the evaluation of that system's performance on a transport aircraft simulator is discussed. The digital autopilot includes three axis attitude stabilization, automatic throttle control and flight path guidance functions with emphasis on the mode progression from descent into the terminal area through automatic landing. The study effort involved a sequence of tasks starting with the definition of detailed system block diagrams of control laws followed by a flow charting and programming phase and concluding with performance verification using the transport aircraft simulation. The autopilot control laws were programmed in FORTRAN 4 in order to isolate the design process from requirements peculiar to an individual computer.

Design and implementation of a simulation exercise for teaching confidentiality of patient information.

PubMed

Snyder, J R

1982-05-01

Allied health students, making the transition from a purely academic to a professional school setting, are suddenly faced with judgment decisions about disclosure of medical information. Obscure guidelines and new interpersonal relationships with other members of the health care team complicate this transition and pose a threat to confidentiality of patient information. This article describes the design and implementation of a simulation exercise to reinforce lecture guidelines specifying disclosure of medical information without risk to the patient or student. The simulation is comprised of 10 critical incidents calling for responses ranging from logical to judgmental. Although written primarily for medical technologists, with emphasis on limitations governing release of patient laboratory data, the simulation approach is presented here as a model for other allied health professions. The use of a latent image format provides learners with positive or negative reinforcement as they learn the consequences of their decisions. The simulation activity described is easily adapted to small group discussion or computer-assisted instruction. While the simulation appears to be an accurate representation of reality, peer and real-life pressures could not be totally simulated.

Development and psychometric evaluation of the "Neurosurgical Evaluation of Attitudes towards simulation Training" (NEAT) tool for use in neurosurgical education and training.

PubMed

Kirkman, Matthew A; Muirhead, William; Nandi, Dipankar; Sevdalis, Nick

2014-01-01

Neurosurgical simulation training is becoming increasingly popular. Attitudes toward simulation among residents can contribute to the effectiveness of simulation training, but such attitudes remain poorly explored in neurosurgery with no psychometrically proven measure in the literature. The aim of the present study was to evaluate prospectively a newly developed tool for this purpose: the Neurosurgical Evaluation of Attitudes towards simulation Training (NEAT). The NEAT tool was prospectively developed in 2 stages and psychometrically evaluated (validity and reliability) in 2 administrations with the same participants. The tool comprises a questionnaire with 9 Likert scale items and 2 free-text sections assessing attitudes toward simulation in neurosurgery. The evaluation was completed with 31 neurosurgery residents in London, United Kingdom, who were generally favorable toward neurosurgical simulation. The internal consistency of the questionnaire was high, as demonstrated by the overall Cronbach α values (α=0.899 and α=0.955). All but 2 questionnaire items had "substantial" or "almost perfect" test-retest reliability following repeated survey administrations (median Pearson r correlation=0.688; range, 0.248-0.841). NEAT items were well correlated with each other on both occasions, showing good validity of content within the NEAT tool. There was no significant relationship between either gender or length of neurosurgical experience and item ratings. NEAT is the first psychometrically evaluated tool for evaluating attitudes toward simulation in neurosurgery. Further implementation of NEAT is required in wider neurosurgical populations to establish whether specific population groups differ. Use of NEAT in studies of neurosurgical simulation could offer an additional outcome measure to performance metrics, permitting evaluation of the impact of neurosurgical simulation on attitudes toward simulation both between participants and within the same participants over

Creation and Delphi-method refinement of pediatric disaster triage simulations.

PubMed

Cicero, Mark X; Brown, Linda; Overly, Frank; Yarzebski, Jorge; Meckler, Garth; Fuchs, Susan; Tomassoni, Anthony; Aghababian, Richard; Chung, Sarita; Garrett, Andrew; Fagbuyi, Daniel; Adelgais, Kathleen; Goldman, Ran; Parker, James; Auerbach, Marc; Riera, Antonio; Cone, David; Baum, Carl R

2014-01-01

There is a need for rigorously designed pediatric disaster triage (PDT) training simulations for paramedics. First, we sought to design three multiple patient incidents for EMS provider training simulations. Our second objective was to determine the appropriate interventions and triage level for each victim in each of the simulations and develop evaluation instruments for each simulation. The final objective was to ensure that each simulation and evaluation tool was free of bias toward any specific PDT strategy. We created mixed-methods disaster simulation scenarios with pediatric victims: a school shooting, a school bus crash, and a multiple-victim house fire. Standardized patients, high-fidelity manikins, and low-fidelity manikins were used to portray the victims. Each simulation had similar acuity of injuries and 10 victims. Examples include children with special health-care needs, gunshot wounds, and smoke inhalation. Checklist-based evaluation tools and behaviorally anchored global assessments of function were created for each simulation. Eight physicians and paramedics from areas with differing PDT strategies were recruited as Subject Matter Experts (SMEs) for a modified Delphi iterative critique of the simulations and evaluation tools. The modified Delphi was managed with an online survey tool. The SMEs provided an expected triage category for each patient. The target for modified Delphi consensus was ≥85%. Using Likert scales and free text, the SMEs assessed the validity of the simulations, including instances of bias toward a specific PDT strategy, clarity of learning objectives, and the correlation of the evaluation tools to the learning objectives and scenarios. After two rounds of the modified Delphi, consensus for expected triage level was >85% for 28 of 30 victims, with the remaining two achieving >85% consensus after three Delphi iterations. To achieve consensus, we amended 11 instances of bias toward a specific PDT strategy and corrected 10

Qualitative Evaluation of a Role Play Bullying Simulation.

PubMed

Gillespie, Gordon L; Brown, Kathryn; Grubb, Paula; Shay, Amy; Montoya, Karen

Bullying against nurses is becoming a pervasive problem. In this article, a role play simulation designed for undergraduate nursing students is described. In addition, the evaluation findings from a subsample of students who participated in a role play simulation addressing bullying behaviors are reported. Focus group sessions were completed with a subset of eight students who participated in the intervention. Sessions were audiorecorded, transcribed verbatim, and analyzed using Colaizzi's procedural steps for qualitative analysis. Themes derived from the data were "The Experience of Being Bullied", "Implementation of the Program", "Desired Outcome of the Program", and "Context of Bullying in the Nursing Profession". Role play simulation was an effective and active learning strategy to diffuse education on bullying in nursing practice. Bullying in nursing was identified as a problem worthy of incorporation into the undergraduate nursing curriculum. To further enhance the learning experience with role play simulation, adequate briefing instructions, opportunity to opt out of the role play, and comprehensive debriefing are essential.

A trial of e-simulation of sudden patient deterioration (FIRST2ACT WEB) on student learning.

PubMed

Bogossian, Fiona E; Cooper, Simon J; Cant, Robyn; Porter, Joanne; Forbes, Helen

2015-10-01

High-fidelity simulation pedagogy is of increasing importance in health professional education; however, face-to-face simulation programs are resource intensive and impractical to implement across large numbers of students. To investigate undergraduate nursing students' theoretical and applied learning in response to the e-simulation program-FIRST2ACT WEBTM, and explore predictors of virtual clinical performance. Multi-center trial of FIRST2ACT WEBTM accessible to students in five Australian universities and colleges, across 8 campuses. A population of 489 final-year nursing students in programs of study leading to license to practice. Participants proceeded through three phases: (i) pre-simulation-briefing and assessment of clinical knowledge and experience; (ii) e-simulation-three interactive e-simulation clinical scenarios which included video recordings of patients with deteriorating conditions, interactive clinical tasks, pop up responses to tasks, and timed performance; and (iii) post-simulation feedback and evaluation. Descriptive statistics were followed by bivariate analysis to detect any associations, which were further tested using standard regression analysis. Of 409 students who commenced the program (83% response rate), 367 undergraduate nursing students completed the web-based program in its entirety, yielding a completion rate of 89.7%; 38.1% of students achieved passing clinical performance across three scenarios, and the proportion achieving passing clinical knowledge increased from 78.15% pre-simulation to 91.6% post-simulation. Knowledge was the main independent predictor of clinical performance in responding to a virtual deteriorating patient R(2)=0.090, F(7, 352)=4.962, p<0.001. The use of web-based technology allows simulation activities to be accessible to a large number of participants and completion rates indicate that 'Net Generation' nursing students were highly engaged with this mode of learning. The web-based e-simulation program FIRST

Fuzzy control for closed-loop, patient-specific hypnosis in intraoperative patients: a simulation study.

PubMed

Moore, Brett L; Pyeatt, Larry D; Doufas, Anthony G

2009-01-01

Research has demonstrated the efficacy of closed-loop control of anesthesia using bispectral index (BIS) as the controlled variable, and the recent development of model-based, patient-adaptive systems has considerably improved anesthetic control. To further explore the use of model-based control in anesthesia, we investigated the application of fuzzy control in the delivery of patient-specific propofol-induced hypnosis. In simulated intraoperative patients, the fuzzy controller demonstrated clinically acceptable performance, suggesting that further study is warranted.

A unique control system simulator for the evaluation of pulsed plasma thrusters

NASA Technical Reports Server (NTRS)

Dahlgren, J. B.

1973-01-01

Because of the low thrust characteristics of solid-propellant pulsed plasma thrusters and their operational requirement to operate in a vacuum environment, unique and sensitive test techniques are required. A technique evolved for testing and evaluating pulsed plasma thrusters in an open- or closed-loop system mode employs a unique air bearing platform as a single-axis simulator on which the thruster is mounted. The simulator described was developed to evaluate pulsed plasma thrusters in the low micropound range; however, the simulator can be extended to cover the operational range of currently developed millipound thrusters.

Teaching Tip: Development of Veterinary Anesthesia Simulations for Pre-Clinical Training: Design, Implementation, and Evaluation Based on Student Perspectives.

PubMed

Jones, Jana L; Rinehart, Jim; Spiegel, Jacqueline Jordan; Englar, Ryane E; Sidaway, Brian K; Rowles, Joie

2018-01-01

Anesthesia simulations have been used in pre-clinical medical training for decades to help learners gain confidence and expertise in an operating room environment without danger to a live patient. The authors describe a veterinary anesthesia simulation environment (VASE) with anesthesia scenarios developed to provide a re-creation of a veterinarian's task environment while performing anesthesia. The VASE uses advanced computer technology with simulator inputs provided from standard monitoring equipment in common use during veterinary anesthesia and a commercial canine training mannequin that allows intubation, ventilation, and venous access. The simulation outputs are determined by a script that outlines routine anesthesia scenarios and describes the consequences of students' hands-on actions and interventions during preestablished anesthetic tasks and critical incidents. Patients' monitored physiologic parameters may be changed according to predetermined learner events and students' interventions to provide immediate learner feedback and clinical realism. A total of 96 students from the pre-clinical anesthesia course participated in the simulations and the pre- and post-simulation surveys evaluating students' perspectives. Results of the surveys and comparisons of overall categorical cumulative responses in the pre- and post-simulation surveys indicated improvement in learners' perceived preparedness and confidence as a result of the simulated anesthesia experience, with significant improvement in the strongly agree, moderately agree, and agree categories (p<.05 at a 95% CI). These results suggest that anesthesia simulations in the VASE may complement traditional teaching methods through experiential learning and may help foster classroom-to-clinic transference of knowledge and skills without harm to an animal.

Preoperative patient education: evaluating postoperative patient outcomes.

PubMed

Meeker, B J

1994-04-01

Preoperative teaching is an important part of patient care and can prevent complications, as well as promote patient fulfillment during hospitalization. A study was conducted at Alton Ochsner Medical Foundation in New Orleans, LA, in 1989, to determine the impact of a preoperative teaching program on the incidence of postoperative atelectasis and patient satisfaction. Results showed no significant difference of postoperative complications and patient gratification after participating in a structured preoperative teaching program. As part of this study, it was identified that a patient evaluation tool for a preoperative teaching class needed to be developed. The phases of this process are explained in the following article.

Bringing skin assessments to life using human patient simulation: an emphasis on cancer prevention and early detection.

PubMed

Kuhrik, Marilee; Seckman, Christy; Kuhrik, Nancy; Ahearn, Tina; Ercole, Patrick

2011-12-01

Skin cancer is the most common cancer in the United States, with about 1,000,000 people developing the disease each year. The incidence of melanoma has rapidly increased in young white women between the ages of 15-34 over the last three decades. While melanoma accounts for approximately 3% of skin cancers, it causes more than 75% of skin cancer deaths. Thorough skin assessments and awareness of new or changing appearance of skin lesions are critical to early detection and treatment of skin cancer, as well as teaching sun-protective behaviors. Educators created a novel approach to "bring to life" skin cancer assessment skills to promote awareness of prevention and early detection of skin cancer using moulage in a human patient simulation lab. Through the use of moulage-like lesions, simulated patients were evaluated and taught skin cancer prevention and early detection principles by baccalaureate nursing students. The average age of study participants (n = 104) was 26.50 years. The majority of responders were female. At the end of the lab, students' average responses to an evaluation based on program goals were very positive. Anecdotal comments affirmed positive student perceptions of their simulation experience. Data analyses indicated item means were consistently higher for upper-division students. The age and gender of students who participated in this study align with the NCI statistics on age and gender of the population with increased incidence of melanoma.

Objective Fidelity Evaluation in Multisensory Virtual Environments: Auditory Cue Fidelity in Flight Simulation

PubMed Central

Meyer, Georg F.; Wong, Li Ting; Timson, Emma; Perfect, Philip; White, Mark D.

2012-01-01

We argue that objective fidelity evaluation of virtual environments, such as flight simulation, should be human-performance-centred and task-specific rather than measure the match between simulation and physical reality. We show how principled experimental paradigms and behavioural models to quantify human performance in simulated environments that have emerged from research in multisensory perception provide a framework for the objective evaluation of the contribution of individual cues to human performance measures of fidelity. We present three examples in a flight simulation environment as a case study: Experiment 1: Detection and categorisation of auditory and kinematic motion cues; Experiment 2: Performance evaluation in a target-tracking task; Experiment 3: Transferrable learning of auditory motion cues. We show how the contribution of individual cues to human performance can be robustly evaluated for each task and that the contribution is highly task dependent. The same auditory cues that can be discriminated and are optimally integrated in experiment 1, do not contribute to target-tracking performance in an in-flight refuelling simulation without training, experiment 2. In experiment 3, however, we demonstrate that the auditory cue leads to significant, transferrable, performance improvements with training. We conclude that objective fidelity evaluation requires a task-specific analysis of the contribution of individual cues. PMID:22957068

Data mining to support simulation modeling of patient flow in hospitals.

PubMed

Isken, Mark W; Rajagopalan, Balaji

2002-04-01

Spiraling health care costs in the United States are driving institutions to continually address the challenge of optimizing the use of scarce resources. One of the first steps towards optimizing resources is to utilize capacity effectively. For hospital capacity planning problems such as allocation of inpatient beds, computer simulation is often the method of choice. One of the more difficult aspects of using simulation models for such studies is the creation of a manageable set of patient types to include in the model. The objective of this paper is to demonstrate the potential of using data mining techniques, specifically clustering techniques such as K-means, to help guide the development of patient type definitions for purposes of building computer simulation or analytical models of patient flow in hospitals. Using data from a hospital in the Midwest this study brings forth several important issues that researchers need to address when applying clustering techniques in general and specifically to hospital data.

Transfer of learning and patient outcome in simulated crisis resource management: a systematic review.

PubMed

Boet, Sylvain; Bould, M Dylan; Fung, Lillia; Qosa, Haytham; Perrier, Laure; Tavares, Walter; Reeves, Scott; Tricco, Andrea C

2014-06-01

Simulation-based learning is increasingly used by healthcare professionals as a safe method to learn and practice non-technical skills, such as communication and leadership, required for effective crisis resource management (CRM). This systematic review was conducted to gain a better understanding of the impact of simulation-based CRM teaching on transfer of learning to the workplace and subsequent changes in patient outcomes. Studies on CRM, crisis management, crew resource management, teamwork, and simulation published up to September 2012 were searched in MEDLINE(®), EMBASE™, CINAHL, Cochrane Central Register of Controlled Trials, and ERIC. All studies that used simulation-based CRM teaching with outcomes measured at Kirkpatrick Level 3 (transfer of learning to the workplace) or 4 (patient outcome) were included. Studies measuring only learners' reactions or simple learning (Kirkpatrick Level 1 or 2, respectively) were excluded. Two authors independently reviewed all identified titles and abstracts for eligibility. Nine articles were identified as meeting the inclusion criteria. Four studies measured transfer of simulation-based CRM learning into the clinical setting (Kirkpatrick Level 3). In three of these studies, simulation-enhanced CRM training was found significantly more effective than no intervention or didactic teaching. Five studies measured patient outcomes (Kirkpatrick Level 4). Only one of these studies found that simulation-based CRM training made a clearly significant impact on patient mortality. Based on a small number of studies, this systematic review found that CRM skills learned at the simulation centre are transferred to clinical settings, and the acquired CRM skills may translate to improved patient outcomes, including a decrease in mortality.

Computer-Assisted Orthognathic Surgery for Patients with Cleft Lip/Palate: From Traditional Planning to Three-Dimensional Surgical Simulation

PubMed Central

Lonic, Daniel; Pai, Betty Chien-Jung; Yamaguchi, Kazuaki; Chortrakarnkij, Peerasak; Lin, Hsiu-Hsia; Lo, Lun-Jou

2016-01-01

Background Although conventional two-dimensional (2D) methods for orthognathic surgery planning are still popular, the use of three-dimensional (3D) simulation is steadily increasing. In facial asymmetry cases such as in cleft lip/palate patients, the additional information can dramatically improve planning accuracy and outcome. The purpose of this study is to investigate which parameters are changed most frequently in transferring a traditional 2D plan to 3D simulation, and what planning parameters can be better adjusted by this method. Patients and Methods This prospective study enrolled 30 consecutive patients with cleft lip and/or cleft palate (mean age 18.6±2.9 years, range 15 to 32 years). All patients received two-jaw single-splint orthognathic surgery. 2D orthodontic surgery plans were transferred into a 3D setting. Severe bony collisions in the ramus area after 2D plan transfer were noted. The position of the maxillo-mandibular complex was evaluated and eventually adjusted. Position changes of roll, midline, pitch, yaw, genioplasty and their frequency within the patient group were recorded as an alternation of the initial 2D plan. Patients were divided in groups of no change from the original 2D plan and changes in one, two, three and four of the aforementioned parameters as well as subgroups of unilateral, bilateral cleft lip/palate and isolated cleft palate cases. Postoperative OQLQ scores were obtained for 20 patients who finished orthodontic treatment. Results 83.3% of 2D plans were modified, mostly concerning yaw (63.3%) and midline (36.7%) adjustments. Yaw adjustments had the highest mean values in total and in all subgroups. Severe bony collisions as a result of 2D planning were seen in 46.7% of patients. Possible asymmetry was regularly foreseen and corrected in the 3D simulation. Conclusion Based on our findings, 3D simulation renders important information for accurate planning in complex cleft lip/palate cases involving facial asymmetry that is

Improving Attitudes and Perceived Competence in Caring for Dying Patients: An End-of-Life Simulation.

PubMed

Lippe, Megan Pfitzinger; Becker, Heather

2015-01-01

The aim of this study was to assess learning outcomes from a simulation on providing care to a critically ill patient from whom care is ultimately withdrawn. Nursing students have anxiety and low perceived competence for caring for dying patients. Effective strategies for teaching communication, assessment, and basic nursing skills are needed. A pretest-posttest design compared perceived competence and attitudes in caring for dying patients with three separate cohorts of undergraduate nursing students performing the simulation. The cohorts had significantly improved scores on the perceived competence (p < .001) and attitude (p < .01) measures following the simulation. Reliability for a new instrument to assess perceived competence in caring for dying patients was also established. This study's simulation offers a robust teaching strategy for improving nursing students' attitudes and perceived competence in caring for dying patients.

Using gaming simulation to evaluate bioterrorism and emergency readiness training.

PubMed

Olson, Debra K; Scheller, Amy; Wey, Andrew

2014-01-01

The University of Minnesota: Simulations, Exercises and Effective Education: Preparedness and Emergency Response Learning Center uses simulations, which allow trainees to participate in realistic scenarios, to develop and evaluate competency. In a previous study, participants in Disaster in Franklin County: A Public Health Simulation demonstrated that prior bioterrorism and emergency readiness training (BT/ER) is significantly associated with better performance in a simulated emergency. We conducted a second analysis with a larger data set, remapping simulation questions to the Public Health Preparedness and Response Core Competency Model, Version 1.0. We performed an outcome evaluation of the impact of public health preparedness training. In particular, we compared individuals with significant BT/ER training to individuals without training on the basis of performance in a simulated emergency. We grouped participants as group 1 (≥45 hours of BT/ER training) and group 2 (<45 hours). Dependent variables included effectiveness of chosen responses within the gaming simulation, which was measured as the proportion of questions answered correctly for each participant. The relationship of effectiveness with significant BT/ER training was estimated using either multiple linear or logistic regression. For overall effectiveness, group 1 had 2% more correct decisions, on average, than group 2 (P < .001). Group 1 performed significantly better, on average, than group 2 for competency 1.1 (P = .001) and competency 2.3 (P < .001). However, group 1 was significantly worse on competency 1.2 than group 2. Results indicate that prior training is significantly associated with better performance in a simulated emergency using gaming technology. Effectiveness differed by competency, indicating that more training may be needed in certain competency areas. Next steps to enhancing the usefulness of simulations in training should go beyond questioning if the learner learned and included

An ARM data-oriented diagnostics package to evaluate the climate model simulation

NASA Astrophysics Data System (ADS)

Zhang, C.; Xie, S.

2016-12-01

A set of diagnostics that utilize long-term high frequency measurements from the DOE Atmospheric Radiation Measurement (ARM) program is developed for evaluating the regional simulation of clouds, radiation and precipitation in climate models. The diagnostics results are computed and visualized automatically in a python-based package that aims to serve as an easy entry point for evaluating climate simulations using the ARM data, as well as the CMIP5 multi-model simulations. Basic performance metrics are computed to measure the accuracy of mean state and variability of simulated regional climate. The evaluated physical quantities include vertical profiles of clouds, temperature, relative humidity, cloud liquid water path, total column water vapor, precipitation, sensible and latent heat fluxes, radiative fluxes, aerosol and cloud microphysical properties. Process-oriented diagnostics focusing on individual cloud and precipitation-related phenomena are developed for the evaluation and development of specific model physical parameterizations. Application of the ARM diagnostics package will be presented in the AGU session. This work is performed under the auspices of the U.S. Department of Energy by Lawrence Livermore National Laboratory under Contract DE-AC52-07NA27344, IM release number is: LLNL-ABS-698645.

A Student Assessment Tool for Standardized Patient Simulations (SAT-SPS): Psychometric analysis.

PubMed

Castro-Yuste, Cristina; García-Cabanillas, María José; Rodríguez-Cornejo, María Jesús; Carnicer-Fuentes, Concepción; Paloma-Castro, Olga; Moreno-Corral, Luis Javier

2018-05-01

The evaluation of the level of clinical competence acquired by the student is a complex process that must meet various requirements to ensure its quality. The psychometric analysis of the data collected by the assessment tools used is a fundamental aspect to guarantee the student's competence level. To conduct a psychometric analysis of an instrument which assesses clinical competence in nursing students at simulation stations with standardized patients in OSCE-format tests. The construct of clinical competence was operationalized as a set of observable and measurable behaviors, measured by the newly-created Student Assessment Tool for Standardized Patient Simulations (SAT-SPS), which was comprised of 27 items. The categories assigned to the items were 'incorrect or not performed' (0), 'acceptable' (1), and 'correct' (2). 499 nursing students. Data were collected by two independent observers during the assessment of the students' performance at a four-station OSCE with standardized patients. Descriptive statistics were used to summarize the variables. The difficulty levels and floor and ceiling effects were determined for each item. Reliability was analyzed using internal consistency and inter-observer reliability. The validity analysis was performed considering face validity, content and construct validity (through exploratory factor analysis), and criterion validity. Internal reliability and inter-observer reliability were higher than 0.80. The construct validity analysis suggested a three-factor model accounting for 37.1% of the variance. These three factors were named 'Nursing process', 'Communication skills', and 'Safe practice'. A significant correlation was found between the scores obtained and the students' grades in general, as well as with the grades obtained in subjects with clinical content. The assessment tool has proven to be sufficiently reliable and valid for the assessment of the clinical competence of nursing students using standardized patients

Pulse contour analysis of arterial waveform in a high fidelity human patient simulator.

PubMed

Persona, Paolo; Saraceni, Elisabetta; Facchin, Francesca; Petranzan, Enrico; Parotto, Matteo; Baratto, Fabio; Ori, Carlo; Rossi, Sandra

2017-10-03

The measurement of cardiac output (CO) may be useful to improve the assessment of hemodynamics during simulated scenarios. The purpose of this study was to evaluate the feasibility of introducing an uncalibrated pulse contour device (MostCare, Vytech, Vygon, Padova, Italy) into the simulation environment. MostCare device was plugged to a clinical monitor and connected to the METI human patient simulator (HPS) to obtain a continuous arterial waveform analysis and CO calculation. In six different simulated clinical scenarios (baseline, ventricular failure, vasoplegic shock, hypertensive crisis, hypovolemic shock and aortic stenosis), the HPS-CO and the MostCare-CO were simultaneously recorded. The level of concordance between the two methods was assessed by the Bland and Altman analysis. 150-paired CO values were obtained. The HPS-CO values ranged from 2.3 to 6.6 L min -1 and the MostCare-CO values from 2.8 to 6.4 L min -1 . The mean difference between HPS-CO and MostCare-CO was - 0.3 L min -1 and the limits of agreement were - 1.5 and 0.9 L min -1 . The percentage of error was 23%. A good correlation between HPS-CO and MostCare-CO was observed in each scenario of the study (r = 0.88). Although MostCare-CO tended to underestimate the CO over the study period, good agreements were found between the two methods. Therefore, a pulse contour device can be integrated into the simulation environment, offering the opportunity to create new simulated clinical settings.

Disability evaluation in arthritis patients.

PubMed

Luck, J V; Beardmore, T D; Kaufman, R

1987-08-01

During the working years, rheumatic conditions are the foremost cause of disability in the United States. Disability evaluation for Social Security applicants and Workers' Compensation patients is commonplace in orthopedic practices. Yet, formal education in this aspect of patient care is rare both during and after residency. Because of a lack of understanding and sophistication the physician who knows the patient better than any other evaluator often play a minor role in the determination of disability. Disability Evaluation Under Social Security--A Handbook for Physicians lists the medical criteria necessary for qualification. Severely disabled arthritis patients will not always fit into these various categories and may have to be considered under the rule of medical equivalency. Workers' Compensation statutes vary somewhat from state to state but generally include disability criteria. Familiarity with these criteria and the process involved will allow the orthopedist to communicate more meaningfully with administrators and will reduce much of the frustration and some of the cost inherent in this system. When subjective complaint (illness) is in excess of apparent organic pathology (disease), team evaluation under the direction of the treating physician will help sort out the dilemma and develop a treatment plan. One hopes that this will bring the illness more in line with the disease, and thus reduce the disability.

A review and comparison of methods for recreating individual patient data from published Kaplan-Meier survival curves for economic evaluations: a simulation study.

PubMed

Wan, Xiaomin; Peng, Liubao; Li, Yuanjian

2015-01-01

In general, the individual patient-level data (IPD) collected in clinical trials are not available to independent researchers to conduct economic evaluations; researchers only have access to published survival curves and summary statistics. Thus, methods that use published survival curves and summary statistics to reproduce statistics for economic evaluations are essential. Four methods have been identified: two traditional methods 1) least squares method, 2) graphical method; and two recently proposed methods by 3) Hoyle and Henley, 4) Guyot et al. The four methods were first individually reviewed and subsequently assessed regarding their abilities to estimate mean survival through a simulation study. A number of different scenarios were developed that comprised combinations of various sample sizes, censoring rates and parametric survival distributions. One thousand simulated survival datasets were generated for each scenario, and all methods were applied to actual IPD. The uncertainty in the estimate of mean survival time was also captured. All methods provided accurate estimates of the mean survival time when the sample size was 500 and a Weibull distribution was used. When the sample size was 100 and the Weibull distribution was used, the Guyot et al. method was almost as accurate as the Hoyle and Henley method; however, more biases were identified in the traditional methods. When a lognormal distribution was used, the Guyot et al. method generated noticeably less bias and a more accurate uncertainty compared with the Hoyle and Henley method. The traditional methods should not be preferred because of their remarkable overestimation. When the Weibull distribution was used for a fitted model, the Guyot et al. method was almost as accurate as the Hoyle and Henley method. However, if the lognormal distribution was used, the Guyot et al. method was less biased compared with the Hoyle and Henley method.

A Review and Comparison of Methods for Recreating Individual Patient Data from Published Kaplan-Meier Survival Curves for Economic Evaluations: A Simulation Study

PubMed Central

Wan, Xiaomin; Peng, Liubao; Li, Yuanjian

2015-01-01

Background In general, the individual patient-level data (IPD) collected in clinical trials are not available to independent researchers to conduct economic evaluations; researchers only have access to published survival curves and summary statistics. Thus, methods that use published survival curves and summary statistics to reproduce statistics for economic evaluations are essential. Four methods have been identified: two traditional methods 1) least squares method, 2) graphical method; and two recently proposed methods by 3) Hoyle and Henley, 4) Guyot et al. The four methods were first individually reviewed and subsequently assessed regarding their abilities to estimate mean survival through a simulation study. Methods A number of different scenarios were developed that comprised combinations of various sample sizes, censoring rates and parametric survival distributions. One thousand simulated survival datasets were generated for each scenario, and all methods were applied to actual IPD. The uncertainty in the estimate of mean survival time was also captured. Results All methods provided accurate estimates of the mean survival time when the sample size was 500 and a Weibull distribution was used. When the sample size was 100 and the Weibull distribution was used, the Guyot et al. method was almost as accurate as the Hoyle and Henley method; however, more biases were identified in the traditional methods. When a lognormal distribution was used, the Guyot et al. method generated noticeably less bias and a more accurate uncertainty compared with the Hoyle and Henley method. Conclusions The traditional methods should not be preferred because of their remarkable overestimation. When the Weibull distribution was used for a fitted model, the Guyot et al. method was almost as accurate as the Hoyle and Henley method. However, if the lognormal distribution was used, the Guyot et al. method was less biased compared with the Hoyle and Henley method. PMID:25803659

Designing and evaluating an interactive multimedia Web-based simulation for developing nurses' competencies in acute nursing care: randomized controlled trial.

PubMed

Liaw, Sok Ying; Wong, Lai Fun; Chan, Sally Wai-Chi; Ho, Jasmine Tze Yin; Mordiffi, Siti Zubaidah; Ang, Sophia Bee Leng; Goh, Poh Sun; Ang, Emily Neo Kim

2015-01-12

Web-based learning is becoming an increasingly important instructional tool in nursing education. Multimedia advancements offer the potential for creating authentic nursing activities for developing nursing competency in clinical practice. This study aims to describe the design, development, and evaluation of an interactive multimedia Web-based simulation for developing nurses' competencies in acute nursing care. Authentic nursing activities were developed in a Web-based simulation using a variety of instructional strategies including animation video, multimedia instructional material, virtual patients, and online quizzes. A randomized controlled study was conducted on 67 registered nurses who were recruited from the general ward units of an acute care tertiary hospital. Following a baseline evaluation of all participants' clinical performance in a simulated clinical setting, the experimental group received 3 hours of Web-based simulation and completed a survey to evaluate their perceptions of the program. All participants were re-tested for their clinical performances using a validated tool. The clinical performance posttest scores of the experimental group improved significantly (P<.001) from the pretest scores after the Web-based simulation. In addition, compared to the control group, the experimental group had significantly higher clinical performance posttest scores (P<.001) after controlling the pretest scores. The participants from the experimental group were satisfied with their learning experience and gave positive ratings for the quality of the Web-based simulation. Themes emerging from the comments about the most valuable aspects of the Web-based simulation include relevance to practice, instructional strategies, and fostering problem solving. Engaging in authentic nursing activities using interactive multimedia Web-based simulation can enhance nurses' competencies in acute care. Web-based simulations provide a promising educational tool in institutions

Design, Implementation, and Evaluation of a Simulation-Based Clinical Correlation Curriculum as an Adjunctive Pedagogy in an Anatomy Course.

PubMed

Coombs, Carmen M; Shields, Ryan Y; Hunt, Elizabeth A; Lum, Ying Wei; Sosnay, Patrick R; Perretta, Julianne S; Lieberman, Rhett H; Shilkofski, Nicole A

2017-04-01

Because reported use of simulation in preclinical basic science courses is limited, the authors describe the design, implementation, and preliminary evaluation of a simulation-based clinical correlation curriculum in an anatomy course for first-year medical students at Perdana University Graduate School of Medicine (in collaboration with Johns Hopkins University School of Medicine). The simulation curriculum, with five weekly modules, was a component of a noncadaveric human anatomy course for three classes (n = 81 students) from September 2011 to November 2013. The modules were designed around major anatomical regions (thorax; abdomen and pelvis; lower extremities and back; upper extremities; and head and neck) and used various types of simulation (standardized patients, high-fidelity simulators, and task trainers). Several methods were used to evaluate the curriculum's efficacy, including comparing pre- versus posttest scores and comparing posttest scores against the score on 15 clinical correlation final exam questions. A total of 81 students (response rate: 100%) completed all pre- and posttests and consented to participate. Posttest scores suggest significant knowledge acquisition and better consistency of performance after participation in the curriculum. The comparison of performance on the posttests and final exam suggests that using simulation as an adjunctive pedagogy can lead to excellent short-term knowledge retention. Simulation-based medical education may prove useful in preclinical basic science curricula. Next steps should be to validate the use of this approach, demonstrate cost-efficacy or the "return on investment" for educational and institutional leadership, and examine longer-term knowledge retention.

Evaluation of simulation training in cardiothoracic surgery: the Senior Tour perspective.

PubMed

Fann, James I; Feins, Richard H; Hicks, George L; Nesbitt, Jonathan C; Hammon, John W; Crawford, Fred A

2012-02-01

The study objective was to introduce senior surgeons, referred to as members of the "Senior Tour," to simulation-based learning and evaluate ongoing simulation efforts in cardiothoracic surgery. Thirteen senior cardiothoracic surgeons participated in a 2½-day Senior Tour Meeting. Of 12 simulators, each participant focused on 6 cardiac (small vessel anastomosis, aortic cannulation, cardiopulmonary bypass, aortic valve replacement, mitral valve repair, and aortic root replacement) or 6 thoracic surgical simulators (hilar dissection, esophageal anastomosis, rigid bronchoscopy, video-assisted thoracoscopic surgery lobectomy, tracheal resection, and sleeve resection). The participants provided critical feedback regarding the realism and utility of the simulators, which served as the basis for a composite assessment of the simulators. All participants acknowledged that simulation may not provide a wholly immersive experience. For small vessel anastomosis, the portable chest model is less realistic compared with the porcine model, but is valuable in teaching anastomosis mechanics. The aortic cannulation model allows multiple cannulations and can serve as a thoracic aortic surgery model. The cardiopulmonary bypass simulator provides crisis management experience. The porcine aortic valve replacement, mitral valve annuloplasty, and aortic root models are realistic and permit standardized training. The hilar dissection model is subject to variability of porcine anatomy and fragility of the vascular structures. The realistic esophageal anastomosis simulator presents various approaches to esophageal anastomosis. The exercise associated with the rigid bronchoscopy model is brief, and adding additional procedures should be considered. The tracheal resection, sleeve resection, and video-assisted thoracoscopic surgery lobectomy models are highly realistic and simulate advanced maneuvers. By providing the necessary tools, such as task trainers and assessment instruments, the Senior

Development and evaluation of a decision-based simulation for assessment of team skills.

PubMed

Andrew, Brandon; Plachta, Stephen; Salud, Lawrence; Pugh, Carla M

2012-08-01

There is a need to train and evaluate a wide variety of nontechnical surgical skills. The goal of this project was to develop and evaluate a decision-based simulation to assess team skills. The decision-based exercise used our previously validated Laparoscopic Ventral Hernia simulator and a newly developed team evaluation survey. Five teams of 3 surgical residents (N = 15) were tasked with repairing a 10 × 10-cm right upper quadrant hernia. During the simulation, independent observers (N = 6) completed a 6-item survey assessing: (1) work quality; (2) communication; and (3) team effectiveness. After the simulation, team members self-rated their performance by using the same survey. Survey reliability revealed a Cronbach's alpha of r = .811. Significant differences were found when we compared team members' (T) and observers' (O) ratings for communication (T = 4.33/5.00 vs O = 3.00/5.00, P < .01) and work quality (T = 4.33/5.00 vs O = 3.33/5.00, P < .05). The team with the greatest survey ratings was the only group to successfully complete the task. The team evaluation survey had good reliability and correlated with task performance on the simulator. Our current and previous work provides strong evidence that nontechnical and team related skills can be assessed without simulating a crisis situation. Copyright © 2012 Mosby, Inc. All rights reserved.

Patient-Specific Geometry Modeling and Mesh Generation for Simulating Obstructive Sleep Apnea Syndrome Cases by Maxillomandibular Advancement

PubMed Central

Ito, Yasushi; Cheng, Gary C.; Shih, Alan M.; Koomullil, Roy P.; Soni, Bharat K.; Sittitavornwong, Somsak; Waite, Peter D.

2011-01-01

The objective of this paper is the reconstruction of upper airway geometric models as hybrid meshes from clinically used Computed Tomography (CT) data sets in order to understand the dynamics and behaviors of the pre- and postoperative upper airway systems of Obstructive Sleep Apnea Syndrome (OSAS) patients by viscous Computational Fluid Dynamics (CFD) simulations. The selection criteria for OSAS cases studied are discussed because two reasonable pre- and postoperative upper airway models for CFD simulations may not be created for every case without a special protocol for CT scanning. The geometry extraction and manipulation methods are presented with technical barriers that must be overcome so that they can be used along with computational simulation software as a daily clinical evaluation tool. Eight cases are presented in this paper, and each case consists of pre- and postoperative configurations. The results of computational simulations of two cases are included in this paper as demonstration. PMID:21625395

Qualitative Evaluation of a Role Play Bullying Simulation

PubMed Central

Gillespie, Gordon L.; Brown, Kathryn; Grubb, Paula; Shay, Amy; Montoya, Karen

2015-01-01

Bullying against nurses is becoming a pervasive problem. In this article, a role play simulation designed for undergraduate nursing students is described. In addition, the evaluation findings from a subsample of students who participated in a role play simulation addressing bullying behaviors are reported. Focus group sessions were completed with a subset of eight students who participated in the intervention. Sessions were audiorecorded, transcribed verbatim, and analyzed using Colaizzi’s procedural steps for qualitative analysis. Themes derived from the data were “The Experience of Being Bullied”, “Implementation of the Program”, “Desired Outcome of the Program”, and “Context of Bullying in the Nursing Profession”. Role play simulation was an effective and active learning strategy to diffuse education on bullying in nursing practice. Bullying in nursing was identified as a problem worthy of incorporation into the undergraduate nursing curriculum. To further enhance the learning experience with role play simulation, adequate briefing instructions, opportunity to opt out of the role play, and comprehensive debriefing are essential. PMID:26504502

The case of "Miss Jacobs": adolescent simulated patients and the quality of their role playing, feedback, and personal impact.

PubMed

Bokken, Lonneke; van Dalen, Jan; Rethans, Jan-Joost

2010-12-01

Adolescents as standardized patients are relatively new in medical education. Studies have mostly explored the impact of role playing on adolescents trained to perform standardized patient roles for assessment purposes. No studies were found with regard to the quality of adolescents' role playing. We evaluated the effects of performing a patient role on adolescents trained as simulated patients (SPs) for teaching purposes (in contrast to standardized patients) and evaluated the quality of adolescent SPs' role playing and feedback. Nine young women, aged 16 to 18 years, were trained to portray roles of adolescents asking their general practitioner for an oral contraceptive. Three adolescent men were trained to portray roles of some of the girls' boyfriends. Each role was developed in consultation with the individual adolescent and was largely based on her own personal experience. Students rated the quality of the adolescent SP's role playing and feedback after each SP encounter on a previously validated questionnaire (the Maastricht Assessment of Simulated Patients). Both the adolescent SPs and faculty teachers both completed questionnaires on their experiences. Three hundred forty-one students rated the quality of the SPs' role playing and feedback with a mean score of 7.5 of 10. The faculty teachers were also generally positive about the role playing and feedback. Nevertheless, there were some concerns about the quality of the feedback. Adolescent SPs reported no negative effects because of their performance. Generally, students and teachers were satisfied with the quality of the role playing and feedback provided by the adolescent SPs. The adolescent SPs experienced no negative effects related to their performance, which confirms earlier findings among adolescent standardized patients.

Simulation approach for the evaluation of tracking accuracy in radiotherapy: a preliminary study.

PubMed

Tanaka, Rie; Ichikawa, Katsuhiro; Mori, Shinichiro; Sanada, Sigeru

2013-01-01

Real-time tumor tracking in external radiotherapy can be achieved by diagnostic (kV) X-ray imaging with a dynamic flat-panel detector (FPD). It is important to keep the patient dose as low as possible while maintaining tracking accuracy. A simulation approach would be helpful to optimize the imaging conditions. This study was performed to develop a computer simulation platform based on a noise property of the imaging system for the evaluation of tracking accuracy at any noise level. Flat-field images were obtained using a direct-type dynamic FPD, and noise power spectrum (NPS) analysis was performed. The relationship between incident quantum number and pixel value was addressed, and a conversion function was created. The pixel values were converted into a map of quantum number using the conversion function, and the map was then input into the random number generator to simulate image noise. Simulation images were provided at different noise levels by changing the incident quantum numbers. Subsequently, an implanted marker was tracked automatically and the maximum tracking errors were calculated at different noise levels. The results indicated that the maximum tracking error increased with decreasing incident quantum number in flat-field images with an implanted marker. In addition, the range of errors increased with decreasing incident quantum number. The present method could be used to determine the relationship between image noise and tracking accuracy. The results indicated that the simulation approach would aid in determining exposure dose conditions according to the necessary tracking accuracy.

Using a human patient simulation mannequin to teach interdisciplinary team skills to pharmacy students.

PubMed

Fernandez, Rosemarie; Parker, Dennis; Kalus, James S; Miller, Douglas; Compton, Scott

2007-06-15

To determine the effectiveness and student acceptance of using a human patient simulation (HPS) training module focused on interdisciplinary teamwork skills. During their second-professional year, all pharmacy students were in enrolled in Principles of Pharmacotherapy 4: Cardiovascular Diseases and Patient Care Lab IV, a problem-based learning course. As part of the patient care laboratory, students participated in a simulated case of an acutely ill patient with a hypertensive emergency. During the simulation, students performed a history and physical examination. They then worked as a team to make treatment recommendations to the nursing and physician staff members. Following the exercise, a facilitated debriefing session was conducted. Students completed satisfaction surveys to assess the quality and effectiveness of the session. Over 98% of students agreed or strongly agreed that they learned material relevant to their current studies. When compared to student lectures, 90% of students felt that they learned clinical patient care better when using a HPS mannequin in simulated patient scenarios. HPS-based learning offers a realistic training experience through which clinical knowledge and interpersonal teamwork skills can be taught. Students enjoy the experience and find it relevant to their future practice. Simulation-based training may teach certain topics better than traditional lecture formats and as such could help to fill gaps in the current pharmacy curriculum.

Evaluation of the Inertial Response of Variable-Speed Wind Turbines Using Advanced Simulation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Scholbrock, Andrew K; Muljadi, Eduard; Gevorgian, Vahan

In this paper, we focus on the temporary frequency support effect provided by wind turbine generators (WTGs) through the inertial response. With the implemented inertial control methods, the WTG is capable of increasing its active power output by releasing parts of the stored kinetic energy when the frequency excursion occurs. The active power can be boosted temporarily above the maximum power points, but the rotor speed deceleration follows and an active power output deficiency occurs during the restoration of rotor kinetic energy. We evaluate and compare the inertial response induced by two distinct inertial control methods using advanced simulation. Inmore » the first stage, the proposed inertial control methods are analyzed in offline simulation. Using an advanced wind turbine simulation program, FAST with TurbSim, the response of the researched wind turbine is comprehensively evaluated under turbulent wind conditions, and the impact on the turbine mechanical components are assessed. In the second stage, the inertial control is deployed on a real 600kW wind turbine - Controls Advanced Research Turbine, 3-bladed (CART3), which further verifies the inertial control through a hardware-in-the-loop (HIL) simulation. Various inertial control methods can be effectively evaluated based on the proposed two-stage simulation platform, which combines the offline simulation and real-time HIL simulation. The simulation results also provide insights in designing inertial control for WTGs.« less

SU-F-T-619: Dose Evaluation of Specific Patient Plans Based On Monte Carlo Algorithm for a CyberKnife Stereotactic Radiosurgery System

DOE Office of Scientific and Technical Information (OSTI.GOV)

Piao, J; PLA 302 Hospital, Beijing; Xu, S

2016-06-15

Purpose: This study will use Monte Carlo to simulate the Cyberknife system, and intend to develop the third-party tool to evaluate the dose verification of specific patient plans in TPS. Methods: By simulating the treatment head using the BEAMnrc and DOSXYZnrc software, the comparison between the calculated and measured data will be done to determine the beam parameters. The dose distribution calculated in the Raytracing, Monte Carlo algorithms of TPS (Multiplan Ver4.0.2) and in-house Monte Carlo simulation method for 30 patient plans, which included 10 head, lung and liver cases in each, were analyzed. The γ analysis with the combinedmore » 3mm/3% criteria would be introduced to quantitatively evaluate the difference of the accuracy between three algorithms. Results: More than 90% of the global error points were less than 2% for the comparison of the PDD and OAR curves after determining the mean energy and FWHM.The relative ideal Monte Carlo beam model had been established. Based on the quantitative evaluation of dose accuracy for three algorithms, the results of γ analysis shows that the passing rates (84.88±9.67% for head,98.83±1.05% for liver,98.26±1.87% for lung) of PTV in 30 plans between Monte Carlo simulation and TPS Monte Carlo algorithms were good. And the passing rates (95.93±3.12%,99.84±0.33% in each) of PTV in head and liver plans between Monte Carlo simulation and TPS Ray-tracing algorithms were also good. But the difference of DVHs in lung plans between Monte Carlo simulation and Ray-tracing algorithms was obvious, and the passing rate (51.263±38.964%) of γ criteria was not good. It is feasible that Monte Carlo simulation was used for verifying the dose distribution of patient plans. Conclusion: Monte Carlo simulation algorithm developed in the CyberKnife system of this study can be used as a reference tool for the third-party tool, which plays an important role in dose verification of patient plans. This work was supported in part by the

A system for the simulation and evaluation of satellite communication networks

NASA Technical Reports Server (NTRS)

Bagwell, J. W.

1983-01-01

With the emergence of a new era in satellite communications brought about by NASA's thrust into the Ka band with multibeam and onboard processing technologies, new and innovative techniques for evaluating these concepts and systems are required. To this end, NASA, in conjunction with its extensive program for advanced communications technology development, has undertaken to develop a concept for the simulation and evaluation of a complete communications network. Incorporated in this network will be proof of concept models of the latest technologies proposed for future satellite communications systems. These include low noise receivers, matrix switches, baseband processors, and solid state and tube type high power amplifiers. To accomplish this, numerous supporting technologies must be added to those aforementioned proof of concept models. These include controllers for synchronization, order wire, and resource allocation, gain compensation, signal leveling, power augmentation, and rain fade and range delay simulation. Taken together, these will be assembled to comprise a system capable of addressing numerous design and performance questions. The simulation and evaluation system as planned will be modular in design and implementation, capable of modification and updating to track and evaluate a continuum emerging concepts and technologies.

Predictive validity of driving-simulator assessments following traumatic brain injury: a preliminary study.

PubMed

Lew, Henry L; Poole, John H; Lee, Eun Ha; Jaffe, David L; Huang, Hsiu-Chen; Brodd, Edward

2005-03-01

To evaluate whether driving simulator and road test evaluations can predict long-term driving performance, we conducted a prospective study on 11 patients with moderate to severe traumatic brain injury. Sixteen healthy subjects were also tested to provide normative values on the simulator at baseline. At their initial evaluation (time-1), subjects' driving skills were measured during a 30-minute simulator trial using an automated 12-measure Simulator Performance Index (SPI), while a trained observer also rated their performance using a Driving Performance Inventory (DPI). In addition, patients were evaluated on the road by a certified driving evaluator. Ten months later (time-2), family members observed patients driving for at least 3 hours over 4 weeks and rated their driving performance using the DPI. At time-1, patients were significantly impaired on automated SPI measures of driving skill, including: speed and steering control, accidents, and vigilance to a divided-attention task. These simulator indices significantly predicted the following aspects of observed driving performance at time-2: handling of automobile controls, regulation of vehicle speed and direction, higher-order judgment and self-control, as well as a trend-level association with car accidents. Automated measures of simulator skill (SPI) were more sensitive and accurate than observational measures of simulator skill (DPI) in predicting actual driving performance. To our surprise, the road test results at time-1 showed no significant relation to driving performance at time-2. Simulator-based assessment of patients with brain injuries can provide ecologically valid measures that, in some cases, may be more sensitive than a traditional road test as predictors of long-term driving performance in the community.

Computer-Assisted Orthognathic Surgery for Patients with Cleft Lip/Palate: From Traditional Planning to Three-Dimensional Surgical Simulation.

PubMed

Lonic, Daniel; Pai, Betty Chien-Jung; Yamaguchi, Kazuaki; Chortrakarnkij, Peerasak; Lin, Hsiu-Hsia; Lo, Lun-Jou

2016-01-01

Although conventional two-dimensional (2D) methods for orthognathic surgery planning are still popular, the use of three-dimensional (3D) simulation is steadily increasing. In facial asymmetry cases such as in cleft lip/palate patients, the additional information can dramatically improve planning accuracy and outcome. The purpose of this study is to investigate which parameters are changed most frequently in transferring a traditional 2D plan to 3D simulation, and what planning parameters can be better adjusted by this method. This prospective study enrolled 30 consecutive patients with cleft lip and/or cleft palate (mean age 18.6±2.9 years, range 15 to 32 years). All patients received two-jaw single-splint orthognathic surgery. 2D orthodontic surgery plans were transferred into a 3D setting. Severe bony collisions in the ramus area after 2D plan transfer were noted. The position of the maxillo-mandibular complex was evaluated and eventually adjusted. Position changes of roll, midline, pitch, yaw, genioplasty and their frequency within the patient group were recorded as an alternation of the initial 2D plan. Patients were divided in groups of no change from the original 2D plan and changes in one, two, three and four of the aforementioned parameters as well as subgroups of unilateral, bilateral cleft lip/palate and isolated cleft palate cases. Postoperative OQLQ scores were obtained for 20 patients who finished orthodontic treatment. 83.3% of 2D plans were modified, mostly concerning yaw (63.3%) and midline (36.7%) adjustments. Yaw adjustments had the highest mean values in total and in all subgroups. Severe bony collisions as a result of 2D planning were seen in 46.7% of patients. Possible asymmetry was regularly foreseen and corrected in the 3D simulation. Based on our findings, 3D simulation renders important information for accurate planning in complex cleft lip/palate cases involving facial asymmetry that is regularly missed in conventional 2D planning.

Discrete event simulation: the preferred technique for health economic evaluations?

PubMed

Caro, Jaime J; Möller, Jörgen; Getsios, Denis

2010-12-01

To argue that discrete event simulation should be preferred to cohort Markov models for economic evaluations in health care. The basis for the modeling techniques is reviewed. For many health-care decisions, existing data are insufficient to fully inform them, necessitating the use of modeling to estimate the consequences that are relevant to decision-makers. These models must reflect what is known about the problem at a level of detail sufficient to inform the questions. Oversimplification will result in estimates that are not only inaccurate, but potentially misleading. Markov cohort models, though currently popular, have so many limitations and inherent assumptions that they are inadequate to inform most health-care decisions. An event-based individual simulation offers an alternative much better suited to the problem. A properly designed discrete event simulation provides more accurate, relevant estimates without being computationally prohibitive. It does require more data and may be a challenge to convey transparently, but these are necessary trade-offs to provide meaningful and valid results. In our opinion, discrete event simulation should be the preferred technique for health economic evaluations today. © 2010, International Society for Pharmacoeconomics and Outcomes Research (ISPOR).

A structured framework improves clinical patient assessment and nontechnical skills of early career emergency nurses: a pre-post study using full immersion simulation.

PubMed

Munroe, Belinda; Curtis, Kate; Murphy, Margaret; Strachan, Luke; Considine, Julie; Hardy, Jennifer; Wilson, Mark; Ruperto, Kate; Fethney, Judith; Buckley, Thomas

2016-08-01

The aim of this study was to evaluate the effect of the new evidence-informed nursing assessment framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, reassessment and communication) on the quality of patient assessment and fundamental nontechnical skills including communication, decision making, task management and situational awareness. Assessment is a core component of nursing practice and underpins clinical decisions and the safe delivery of patient care. Yet there is no universal or validated system used to teach emergency nurses how to comprehensively assess and care for patients. A pre-post design was used. The performance of thirty eight emergency nurses from five Australian hospitals was evaluated before and after undertaking education in the application of the HIRAID assessment framework. Video recordings of participant performance in immersive simulations of common presentations to the emergency department were evaluated, as well as participant documentation during the simulations. Paired parametric and nonparametric tests were used to compare changes from pre to postintervention. From pre to postintervention, participant performance increases were observed in the percentage of patient history elements collected, critical indicators of urgency collected and reported to medical officers, and patient reassessments performed. Participants also demonstrated improvement in each of the four nontechnical skills categories: communication, decision making, task management and situational awareness. The HIRAID assessment framework improves clinical patient assessments performed by emergency nurses and has the potential to enhance patient care. HIRAID should be considered for integration into clinical practice to provide nurses with a systematic approach to patient assessment and potentially improve the delivery of safe patient care. © 2016 John Wiley & Sons Ltd.

Procedural training and assessment of competency utilizing simulation.

PubMed

Sawyer, Taylor; Gray, Megan M

2016-11-01

This review examines the current environment of neonatal procedural learning, describes an updated model of skills training, defines the role of simulation in assessing competency, and discusses potential future directions for simulation-based competency assessment. In order to maximize impact, simulation-based procedural training programs should follow a standardized and evidence-based approach to designing and evaluating educational activities. Simulation can be used to facilitate the evaluation of competency, but must incorporate validated assessment tools to ensure quality and consistency. True competency evaluation cannot be accomplished with simulation alone: competency assessment must also include evaluations of procedural skill during actual clinical care. Future work in this area is needed to measure and track clinically meaningful patient outcomes resulting from simulation-based training, examine the use of simulation to assist physicians undergoing re-entry to practice, and to examine the use of procedural skills simulation as part of a maintenance of competency and life-long learning. Copyright © 2016 Elsevier Inc. All rights reserved.

TH-CD-207A-08: Simulated Real-Time Image Guidance for Lung SBRT Patients Using Scatter Imaging

DOE Office of Scientific and Technical Information (OSTI.GOV)

Redler, G; Cifter, G; Templeton, A

2016-06-15

Purpose: To develop a comprehensive Monte Carlo-based model for the acquisition of scatter images of patient anatomy in real-time, during lung SBRT treatment. Methods: During SBRT treatment, images of patient anatomy can be acquired from scattered radiation. To rigorously examine the utility of scatter images for image guidance, a model is developed using MCNP code to simulate scatter images of phantoms and lung cancer patients. The model is validated by comparing experimental and simulated images of phantoms of different complexity. The differentiation between tissue types is investigated by imaging objects of known compositions (water, lung, and bone equivalent). A lungmore » tumor phantom, simulating materials and geometry encountered during lung SBRT treatments, is used to investigate image noise properties for various quantities of delivered radiation (monitor units(MU)). Patient scatter images are simulated using the validated simulation model. 4DCT patient data is converted to an MCNP input geometry accounting for different tissue composition and densities. Lung tumor phantom images acquired with decreasing imaging time (decreasing MU) are used to model the expected noise amplitude in patient scatter images, producing realistic simulated patient scatter images with varying temporal resolution. Results: Image intensity in simulated and experimental scatter images of tissue equivalent objects (water, lung, bone) match within the uncertainty (∼3%). Lung tumor phantom images agree as well. Specifically, tumor-to-lung contrast matches within the uncertainty. The addition of random noise approximating quantum noise in experimental images to simulated patient images shows that scatter images of lung tumors can provide images in as fast as 0.5 seconds with CNR∼2.7. Conclusions: A scatter imaging simulation model is developed and validated using experimental phantom scatter images. Following validation, lung cancer patient scatter images are simulated. These

Evaluation of Subgrid-Scale Models for Large Eddy Simulation of Compressible Flows

NASA Technical Reports Server (NTRS)

Blaisdell, Gregory A.

1996-01-01

The objective of this project was to evaluate and develop subgrid-scale (SGS) turbulence models for large eddy simulations (LES) of compressible flows. During the first phase of the project results from LES using the dynamic SGS model were compared to those of direct numerical simulations (DNS) of compressible homogeneous turbulence. The second phase of the project involved implementing the dynamic SGS model in a NASA code for simulating supersonic flow over a flat-plate. The model has been successfully coded and a series of simulations has been completed. One of the major findings of the work is that numerical errors associated with the finite differencing scheme used in the code can overwhelm the SGS model and adversely affect the LES results. Attached to this overview are three submitted papers: 'Evaluation of the Dynamic Model for Simulations of Compressible Decaying Isotropic Turbulence'; 'The effect of the formulation of nonlinear terms on aliasing errors in spectral methods'; and 'Large-Eddy Simulation of a Spatially Evolving Compressible Boundary Layer Flow'.

Evaluating Clouds in Long-Term Cloud-Resolving Model Simulations with Observational Data

NASA Technical Reports Server (NTRS)

Zeng, Xiping; Tao, Wei-Kuo; Zhang, Minghua; Peters-Lidard, Christa; Lang, Stephen; Simpson, Joanne; Kumar, Sujay; Xie, Shaocheng; Eastman, Joseph L.; Shie, Chung-Lin;

An evaluation of an expert system for detecting critical events during anesthesia in a human patient simulator: a prospective randomized controlled study.

PubMed

Görges, Matthias; Winton, Pamela; Koval, Valentyna; Lim, Joanne; Stinson, Jonathan; Choi, Peter T; Schwarz, Stephan K W; Dumont, Guy A; Ansermino, J Mark

2013-08-01

Perioperative monitoring systems produce a large amount of uninterpreted data, use threshold alarms prone to artifacts, and rely on the clinician to continuously visually track changes in physiological data. To address these deficiencies, we developed an expert system that provides real-time clinical decisions for the identification of critical events. We evaluated the efficacy of the expert system for enhancing critical event detection in a simulated environment. We hypothesized that anesthesiologists would identify critical ventilatory events more rapidly and accurately with the expert system. We used a high-fidelity human patient simulator to simulate an operating room environment. Participants managed 4 scenarios (anesthetic vapor overdose, tension pneumothorax, anaphylaxis, and endotracheal tube cuff leak) in random order. In 2 of their 4 scenarios, participants were randomly assigned to the expert system, which provided trend-based alerts and potential differential diagnoses. Time to detection and time to treatment were measured. Workload questionnaires and structured debriefings were completed after each scenario, and a usability questionnaire at the conclusion of the session. Data were analyzed using a mixed-effects linear regression model; Fisher exact test was used for workload scores. Twenty anesthesiology trainees and 15 staff anesthesiologists with a combined median (range) of 36 (29-66) years of age and 6 (1-38) years of anesthesia experience participated. For the endotracheal tube cuff leak, the expert system caused mean reductions of 128 (99% confidence interval [CI], 54-202) seconds in time to detection and 140 (99% CI, 79-200) seconds in time to treatment. In the other 3 scenarios, a best-case decrease of 97 seconds (lower 99% CI) in time to diagnosis for anaphylaxis and a worst-case increase of 63 seconds (upper 99% CI) in time to treatment for anesthetic vapor overdose were found. Participants were highly satisfied with the expert system (median

Evaluation of Cost Leadership Strategy in Shipping Enterprises with Simulation Model

NASA Astrophysics Data System (ADS)

Ferfeli, Maria V.; Vaxevanou, Anthi Z.; Damianos, Sakas P.

2009-08-01

The present study will attempt the evaluation of cost leadership strategy that prevails in certain shipping enterprises and the creation of simulation models based on strategic model STAIR. The above model is an alternative method of strategic applications evaluation. This is held in order to be realised if the strategy of cost leadership creates competitive advantage [1] and this will be achieved via the technical simulation which appreciates the interactions between the operations of an enterprise and the decision-making strategy in conditions of uncertainty with reduction of undertaken risk.

SU-E-J-90: MRI-Based Treatment Simulation and Patient Setup for Radiation Therapy of Brain Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yang, Y; Cao, M; Han, F

2014-06-01

Purpose: Traditional radiation therapy of cancer is heavily dependent on CT. CT provides excellent depiction of the bones but lacks good soft tissue contrast, which makes contouring difficult. Often, MRIs are fused with CT to take advantage of its superior soft tissue contrast. Such an approach has drawbacks. It is desirable to perform treatment simulation entirely based on MRI. To achieve MR-based simulation for radiation therapy, bone imaging is an important challenge because of the low MR signal intensity from bone due to its ultra-short T2 and T1, which presents difficulty for both dose calculation and patient setup in termsmore » of digitally reconstructed radiograph (DRR) generation. Current solutions will either require manual bone contouring or multiple MR scans. We present a technique to generate DRR using MRI with an Ultra Short Echo Time (UTE) sequence which is applicable to both OBI and ExacTrac 2D patient setup. Methods: Seven brain cancer patients were scanned at 1.5 Tesla using a radial UTE sequence. The sequence acquires two images at two different echo times. The two images were processed using in-house software. The resultant bone images were subsequently loaded into commercial systems to generate DRRs. Simulation and patient clinical on-board images were used to evaluate 2D patient setup with MRI-DRRs. Results: The majority bones are well visualized in all patients. The fused image of patient CT with the MR bone image demonstrates the accuracy of automatic bone identification using our technique. The generated DRR is of good quality. Accuracy of 2D patient setup by using MRI-DRR is comparable to CT-based 2D patient setup. Conclusion: This study shows the potential of DRR generation with single MR sequence. Further work will be needed on MR sequence development and post-processing procedure to achieve robust MR bone imaging for other human sites in addition to brain.« less

Effects of Armodafinil on Simulated Driving and Self-Report Measures in Obstructive Sleep Apnea Patients prior to Treatment with Continuous Positive Airway Pressure

PubMed Central

Kay, Gary G.; Feldman, Neil

2013-01-01

Study Objectives: Obstructive sleep apnea (OSA) has been associated with an increased risk of motor vehicle crashes. This driving risk can be reduced (≥ 50%) by treatment with continuous positive airway pressure (CPAP). However residual excessive daytime sleepiness (EDS) can persist for some patients who regularly use CPAP. The current study was designed to assess the effect of armodafinil on simulated driving performance and subsequent CPAP treatment compliance in newly diagnosed OSA patients with EDS during a 2-week “waiting period” prior to initiation of CPAP. Methods: Sixty-nine newly diagnosed OSA patients, awaiting CPAP therapy, were randomized (1:1) to placebo or armodafinil (150 mg/day) treatment. Simulated driving tests and self-report measures were completed at baseline, after 2 weeks of drug treatment, and following 6 weeks of CPAP treatment. CPAP compliance was evaluated at the end of 6 weeks of CPAP. Results: Compared to placebo, armodafinil improved simulated driving safety performance in OSA patients awaiting CPAP therapy (p = 0.03). Improvement was seen in lane position deviation (p = 0.002) and number of lane excursions (p = 0.02). Improvement was also observed on measures of sleepiness using the Epworth Sleepiness Scale (ESS) and sleep related quality of life. Following 6 weeks of CPAP, there was also significant improvement observed on multiple measures of simulated driving performance. CPAP compliance did not differ between armodafinil-treated and placebo-treated patients (p = 0.80). Conclusions: Armodafinil was found to improve simulated driving performance in OSA patients with EDS prior to initiation of CPAP. Treatment with armodafinil showed no effect on subsequent CPAP compliance. Citation: Kay GG; Feldman N. Effects of armodafinil on simulated driving and self-report measures in obstructive sleep apnea patients prior to treatment with continuous positive airway pressure. J Clin Sleep Med 2013;9(5):445-454. PMID:23674935

Parametric model of human body shape and ligaments for patient-specific epidural simulation.

PubMed

Vaughan, Neil; Dubey, Venketesh N; Wee, Michael Y K; Isaacs, Richard

2014-10-01

This work is to build upon the concept of matching a person's weight, height and age to their overall body shape to create an adjustable three-dimensional model. A versatile and accurate predictor of body size and shape and ligament thickness is required to improve simulation for medical procedures. A model which is adjustable for any size, shape, body mass, age or height would provide ability to simulate procedures on patients of various body compositions. Three methods are provided for estimating body circumferences and ligament thicknesses for each patient. The first method is using empirical relations from body shape and size. The second method is to load a dataset from a magnetic resonance imaging (MRI) scan or ultrasound scan containing accurate ligament measurements. The third method is a developed artificial neural network (ANN) which uses MRI dataset as a training set and improves accuracy using error back-propagation, which learns to increase accuracy as more patient data is added. The ANN is trained and tested with clinical data from 23,088 patients. The ANN can predict subscapular skinfold thickness within 3.54 mm, waist circumference 3.92 cm, thigh circumference 2.00 cm, arm circumference 1.21 cm, calf circumference 1.40 cm, triceps skinfold thickness 3.43 mm. Alternative regression analysis method gave overall slightly less accurate predictions for subscapular skinfold thickness within 3.75 mm, waist circumference 3.84 cm, thigh circumference 2.16 cm, arm circumference 1.34 cm, calf circumference 1.46 cm, triceps skinfold thickness 3.89 mm. These calculations are used to display a 3D graphics model of the patient's body shape using OpenGL and adjusted by 3D mesh deformations. A patient-specific epidural simulator is presented using the developed body shape model, able to simulate needle insertion procedures on a 3D model of any patient size and shape. The developed ANN gave the most accurate results for body shape, size and ligament thickness. The

Development and validation of the simulation-based learning evaluation scale.

PubMed

Hung, Chang-Chiao; Liu, Hsiu-Chen; Lin, Chun-Chih; Lee, Bih-O

2016-05-01

The instruments that evaluate a student's perception of receiving simulated training are English versions and have not been tested for reliability or validity. The aim of this study was to develop and validate a Chinese version Simulation-Based Learning Evaluation Scale (SBLES). Four stages were conducted to develop and validate the SBLES. First, specific desired competencies were identified according to the National League for Nursing and Taiwan Nursing Accreditation Council core competencies. Next, the initial item pool was comprised of 50 items related to simulation that were drawn from the literature of core competencies. Content validity was established by use of an expert panel. Finally, exploratory factor analysis and confirmatory factor analysis were conducted for construct validity, and Cronbach's coefficient alpha determined the scale's internal consistency reliability. Two hundred and fifty students who had experienced simulation-based learning were invited to participate in this study. Two hundred and twenty-five students completed and returned questionnaires (response rate=90%). Six items were deleted from the initial item pool and one was added after an expert panel review. Exploratory factor analysis with varimax rotation revealed 37 items remaining in five factors which accounted for 67% of the variance. The construct validity of SBLES was substantiated in a confirmatory factor analysis that revealed a good fit of the hypothesized factor structure. The findings tally with the criterion of convergent and discriminant validity. The range of internal consistency for five subscales was .90 to .93. Items were rated on a 5-point scale from 1 (strongly disagree) to 5 (strongly agree). The results of this study indicate that the SBLES is valid and reliable. The authors recommend that the scale could be applied in the nursing school to evaluate the effectiveness of simulation-based learning curricula. Copyright © 2016 Elsevier Ltd. All rights reserved.

Using Simulated Patients to Teach Clinical Nutrition.

ERIC Educational Resources Information Center

Carroll, J. Gregory; And Others

1983-01-01

"Clinical Nutrition in an Interdisciplinary Setting" is a course designed to introduce basic nutrition knowledge and concepts of nutritional assessment, counseling, and intervention in the clinical care of patients. Provides a brief course overview and descriptions of its development, use, and preliminary evaluation of the patient simulation…

A simulation-based approach for evaluating logging residue handling systems.

Treesearch

B. Bruce Bare; Benjamin A. Jayne; Brian F. Anholt

1976-01-01

Describes a computer simulation model for evaluating logging residue handling systems. The flow of resources is traced through a prespecified combination of operations including yarding, chipping, sorting, loading, transporting, and unloading. The model was used to evaluate the feasibility of converting logging residues to chips that could be used, for example, to...

Evaluating the use of simulation with beginning nursing students.

PubMed

Alfes, Celeste M

2011-02-01

The purpose of this quasi-experimental study was to evaluate and compare the effectiveness of simulation versus a traditional skills laboratory method in promoting self-confidence and satisfaction with learning among beginning nursing students. A single convenience sample of 63 first-semester baccalaureate nursing students learning effective comfort care measures were recruited to compare the two teaching methods. Students participating in the simulation experience were statistically more confident than students participating in the traditional group. There was a slight, nonsignificant difference in satisfaction with learning between the two groups. Bivariate analysis revealed a significant positive relationship between self-confidence and satisfaction. Students in both groups reported higher levels of self-confidence following the learning experiences. Findings may influence the development of simulation experiences for beginning nursing students and encourage the implementation of simulation as a strand from beginning to end in nursing curricula. Copyright 2011, SLACK Incorporated.

Simulation of patient flow in multiple healthcare units using process and data mining techniques for model identification.

PubMed

Kovalchuk, Sergey V; Funkner, Anastasia A; Metsker, Oleg G; Yakovlev, Aleksey N

2018-06-01

An approach to building a hybrid simulation of patient flow is introduced with a combination of data-driven methods for automation of model identification. The approach is described with a conceptual framework and basic methods for combination of different techniques. The implementation of the proposed approach for simulation of the acute coronary syndrome (ACS) was developed and used in an experimental study. A combination of data, text, process mining techniques, and machine learning approaches for the analysis of electronic health records (EHRs) with discrete-event simulation (DES) and queueing theory for the simulation of patient flow was proposed. The performed analysis of EHRs for ACS patients enabled identification of several classes of clinical pathways (CPs) which were used to implement a more realistic simulation of the patient flow. The developed solution was implemented using Python libraries (SimPy, SciPy, and others). The proposed approach enables more a realistic and detailed simulation of the patient flow within a group of related departments. An experimental study shows an improved simulation of patient length of stay for ACS patient flow obtained from EHRs in Almazov National Medical Research Centre in Saint Petersburg, Russia. The proposed approach, methods, and solutions provide a conceptual, methodological, and programming framework for the implementation of a simulation of complex and diverse scenarios within a flow of patients for different purposes: decision making, training, management optimization, and others. Copyright © 2018 Elsevier Inc. All rights reserved.

Comprehensive evaluation of garment assembly line with simulation

NASA Astrophysics Data System (ADS)

Xu, Y.; Thomassey, S.; Chen, Y.; Zeng, X.

2017-10-01

In this paper, a comprehensive evaluation system is established to assess the garment production performance. It is based on performance indicators and supported with the corresponding results obtained by manual calculation or computer simulation. The assembly lines of a typical men’s shirt are taken as the study objects. With the comprehensive evaluation results, garments production arrangement scenarios are better analysed and then the appropriate one is supposed to be put into actual production. This will be a guidance given to companies on quick decision-making and multi-objective optimization of garment production.

Simulated ward round: reducing costs, not outcomes.

PubMed

Ford, Helen; Cleland, Jennifer; Thomas, Ian

2017-02-01

Distractions and interruptions on the ward pose substantial patient safety risks, but medical students receive little training on their management. Although there is some evidence that medical students can be taught how to manage distractions and interruptions in a simulated ward environment, the only model to date is based on individual feedback, which is resource-expensive, mitigating curricular integration. Our aim was to assess the educational utility of a cost-efficient approach to a patient safety-focused simulated ward round. Twenty-three of 55 final-year medical students took part in a cost-reduced simulated ward round. Costs were minimised by providing group rather than individualised feedback, thereby shortening the duration of each simulation and reducing the number of interruptions. The utility of the simulation was assessed via student evaluation and performance on a patient safety station of an objective structured clinical examination (OSCE). The direct costs of the simulation were more than 50 per cent lower per student compared with the original study, mostly as a result of a reduction in the time that faculty members took to give feedback. Students managed distractions better and received higher scores in the OSCE station than those who had not undergone the ward round. Group feedback was evaluated positively by most participants: 94 per cent of those who provided feedback agreed or strongly agreed that the simulation would make them a safer doctor and would improve their handling of distractions. Our aim was to assess the educational utility of a cost-efficient approach to a patient safety-focused simulated ward round DISCUSSION: The costs of a simulated ward round can be significantly reduced whilst maintaining educational utility. These findings should encourage medical schools to integrate ward simulation into curricula. © 2016 John Wiley & Sons Ltd.

Non-vascular interventional procedures: effective dose to patient and equivalent dose to abdominal organs by means of DICOM images and Monte Carlo simulation.

PubMed

Longo, Mariaconcetta; Marchioni, Chiara; Insero, Teresa; Donnarumma, Raffaella; D'Adamo, Alessandro; Lucatelli, Pierleone; Fanelli, Fabrizio; Salvatori, Filippo Maria; Cannavale, Alessandro; Di Castro, Elisabetta

2016-03-01

This study evaluates X-ray exposure in patient undergoing abdominal extra-vascular interventional procedures by means of Digital Imaging and COmmunications in Medicine (DICOM) image headers and Monte Carlo simulation. The main aim was to assess the effective and equivalent doses, under the hypothesis of their correlation with the dose area product (DAP) measured during each examination. This allows to collect dosimetric information about each patient and to evaluate associated risks without resorting to in vivo dosimetry. The dose calculation was performed in 79 procedures through the Monte Carlo simulator PCXMC (A PC-based Monte Carlo program for calculating patient doses in medical X-ray examinations), by using the real geometrical and dosimetric irradiation conditions, automatically extracted from DICOM headers. The DAP measurements were also validated by using thermoluminescent dosemeters on an anthropomorphic phantom. The expected linear correlation between effective doses and DAP was confirmed with an R(2) of 0.974. Moreover, in order to easily calculate patient doses, conversion coefficients that relate equivalent doses to measurable quantities, such as DAP, were obtained. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Using simulation in out-patient queues: a case study.

PubMed

Huarng, F; Lee, M H

1996-01-01

Overwork and overcrowding in some periods was an important issue for the out-patient department of a local hospital in Chia-Yi in Taiwan. The hospital administrators wanted to manage the patient flow effectively. Describes a study which focused on the utilization of doctors and staff in the out-patient department, the time spent in the hospital by an out-patient, and the length of the out-patient queue. Explains how a computer simulation model was developed to study how changes in the appointment system, staffing policies and service units would affect the observed bottleneck. The results show that the waiting time was greatly reduced and the workload of the doctor was also reduced to a reasonable rate in the overwork and overcrowding periods.

Core discrete event simulation model for the evaluation of health care technologies in major depressive disorder.

PubMed

Vataire, Anne-Lise; Aballéa, Samuel; Antonanzas, Fernando; Roijen, Leona Hakkaart-van; Lam, Raymond W; McCrone, Paul; Persson, Ulf; Toumi, Mondher

2014-03-01

A review of existing economic models in major depressive disorder (MDD) highlighted the need for models with longer time horizons that also account for heterogeneity in treatment pathways between patients. A core discrete event simulation model was developed to estimate health and cost outcomes associated with alternative treatment strategies. This model simulated short- and long-term clinical events (partial response, remission, relapse, recovery, and recurrence), adverse events, and treatment changes (titration, switch, addition, and discontinuation) over up to 5 years. Several treatment pathways were defined on the basis of fictitious antidepressants with three levels of efficacy, tolerability, and price (low, medium, and high) from first line to third line. The model was populated with input data from the literature for the UK setting. Model outputs include time in different health states, quality-adjusted life-years (QALYs), and costs from National Health Service and societal perspectives. The codes are open source. Predicted costs and QALYs from this model are within the range of results from previous economic evaluations. The largest cost components from the payer perspective were physician visits and hospitalizations. Key parameters driving the predicted costs and QALYs were utility values, effectiveness, and frequency of physician visits. Differences in QALYs and costs between two strategies with different effectiveness increased approximately twofold when the time horizon increased from 1 to 5 years. The discrete event simulation model can provide a more comprehensive evaluation of different therapeutic options in MDD, compared with existing Markov models, and can be used to compare a wide range of health care technologies in various groups of patients with MDD. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Evaluation and development the routing protocol of a fully functional simulation environment for VANETs

NASA Astrophysics Data System (ADS)

Ali, Azhar Tareq; Warip, Mohd Nazri Mohd; Yaakob, Naimah; Abduljabbar, Waleed Khalid; Atta, Abdu Mohammed Ali

2017-11-01

Vehicular Ad-hoc Networks (VANETs) is an area of wireless technologies that is attracting a great deal of interest. There are still several areas of VANETS, such as security and routing protocols, medium access control, that lack large amounts of research. There is also a lack of freely available simulators that can quickly and accurately simulate VANETs. The main goal of this paper is to develop a freely available VANETS simulator and to evaluate popular mobile ad-hoc network routing protocols in several VANETS scenarios. The VANETS simulator consisted of a network simulator, traffic (mobility simulator) and used a client-server application to keep the two simulators in sync. The VANETS simulator also models buildings to create a more realistic wireless network environment. Ad-Hoc Distance Vector routing (AODV), Dynamic Source Routing (DSR) and Dynamic MANET On-demand (DYMO) were initially simulated in a city, country, and highway environment to provide an overall evaluation.

Flight Simulator Motion Literature Pertinent to Airline-Pilot Recurrent Training and Evaluation.

DOT National Transportation Integrated Search

2011-08-08

There has been much debate over the years regarding the need for flight simulator motion for airline-pilot training and evaluation. From the intuitive perspective there is the dictum, The airplane moves, so the simulator must move but intui...

Validity evidence for the Simulated Colonoscopy Objective Performance Evaluation scoring system.

PubMed

Trinca, Kristen D; Cox, Tiffany C; Pearl, Jonathan P; Ritter, E Matthew

2014-02-01

Low-cost, objective systems to assess and train endoscopy skills are needed. The aim of this study was to evaluate the ability of Simulated Colonoscopy Objective Performance Evaluation to assess the skills required to perform endoscopy. Thirty-eight subjects were included in this study, all of whom performed 4 tasks. The scoring system measured performance by calculating precision and efficiency. Data analysis assessed the relationship between colonoscopy experience and performance on each task and the overall score. Endoscopic trainees' Simulated Colonoscopy Objective Performance Evaluation scores correlated significantly with total colonoscopy experience (r = .61, P = .003) and experience in the past 12 months (r = .63, P = .002). Significant differences were seen among practicing endoscopists, nonendoscopic surgeons, and trainees (P < .0001). When the 4 tasks were analyzed, each showed significant correlation with colonoscopy experience (scope manipulation, r = .44, P = .044; tool targeting, r = .45, P = .04; loop management, r = .47, P = .032; mucosal inspection, r = .65, P = .001) and significant differences in performance between the endoscopist groups, except for mucosal inspection (scope manipulation, P < .0001; tool targeting, P = .002; loop management, P = .0008; mucosal inspection, P = .27). Simulated Colonoscopy Objective Performance Evaluation objectively assesses the technical skills required to perform endoscopy and shows promise as a platform for proficiency-based skills training. Published by Elsevier Inc.

Use of clinical simulations for patient education: targeting an untapped audience.

PubMed

Siwe, Karin; Berterö, Carina; Pugh, Carla; Wijma, Barbro

2009-01-01

In most cases, the health professional has been the target for simulation based learning curricula. We have developed a simulation based curriculum for patient education. In our curriculum lay-women learn how to perform the clinical female pelvic examination using a manikin-based trainer. Learner assessments show that prior negative expectations turned into positive expectations regarding future pelvic examinations.

Study of Physiological Responses to Acute Carbon Monoxide Exposure with a Human Patient Simulator

ERIC Educational Resources Information Center

Cesari, Whitney A.; Caruso, Dominique M.; Zyka, Enela L.; Schroff, Stuart T.; Evans, Charles H., Jr.; Hyatt, Jon-Philippe K.

2006-01-01

Human patient simulators are widely used to train health professionals and students in a clinical setting, but they also can be used to enhance physiology education in a laboratory setting. Our course incorporates the human patient simulator for experiential learning in which undergraduate university juniors and seniors are instructed to design,…

Simulation and evaluation of rupturable coated capsules by finite element method.

PubMed

Yang, Yan; Fang, Jie; Shen, Lian; Shan, Weiguang

2017-03-15

The objective of this study was to simulate and evaluate the burst behavior of rupturable coated capsules by finite element method (FEM). Film and coated capsules were prepared by dip-coating method and their dimensions were determined by stereomicroscope. Mechanical properties of the film were measured by tensile test and used as material properties of FEM models. Swelling pressure was determined by restrained expansion method and applied to the internal surface of FEM models. Water uptake of coated capsules was determined to study the formation of internal pressure. Burst test and in vitro dissolution was used to verify the FEM models, which were used to study and predict the coating burst behavior. Simulated results of coating burst behavior were well agreed with the experiment results. Swelling pressure, material properties and dimensions of coating had influence on the maximum stress. Burst pressure and critical L-HPC content were calculated for burst prediction and formulation optimization. FEM simulation was a feasible way to simulate and evaluate the burst behavior of coated capsules. Copyright © 2017 Elsevier B.V. All rights reserved.

Biomechanical testing simulation of a cadaver spine specimen: development and evaluation study.

PubMed

Ahn, Hyung Soo; DiAngelo, Denis J

2007-05-15

This article describes a computer model of the cadaver cervical spine specimen and virtual biomechanical testing. To develop a graphics-oriented, multibody model of a cadaver cervical spine and to build a virtual laboratory simulator for the biomechanical testing using physics-based dynamic simulation techniques. Physics-based computer simulations apply the laws of physics to solid bodies with defined material properties. This technique can be used to create a virtual simulator for the biomechanical testing of a human cadaver spine. An accurate virtual model and simulation would complement tissue-based in vitro studies by providing a consistent test bed with minimal variability and by reducing cost. The geometry of cervical vertebrae was created from computed tomography images. Joints linking adjacent vertebrae were modeled as a triple-joint complex, comprised of intervertebral disc joints in the anterior region, 2 facet joints in the posterior region, and the surrounding ligament structure. A virtual laboratory simulation of an in vitro testing protocol was performed to evaluate the model responses during flexion, extension, and lateral bending. For kinematic evaluation, the rotation of motion segment unit, coupling behaviors, and 3-dimensional helical axes of motion were analyzed. The simulation results were in correlation with the findings of in vitro tests and published data. For kinetic evaluation, the forces of the intervertebral discs and facet joints of each segment were determined and visually animated. This methodology produced a realistic visualization of in vitro experiment, and allowed for the analyses of the kinematics and kinetics of the cadaver cervical spine. With graphical illustrations and animation features, this modeling technique has provided vivid and intuitive information.

Cerebral Aneurysm Clipping Surgery Simulation Using Patient-Specific 3D Printing and Silicone Casting.

PubMed

Ryan, Justin R; Almefty, Kaith K; Nakaji, Peter; Frakes, David H

2016-04-01

Neurosurgery simulator development is growing as practitioners recognize the need for improved instructional and rehearsal platforms to improve procedural skills and patient care. In addition, changes in practice patterns have decreased the volume of specific cases, such as aneurysm clippings, which reduces the opportunity for operating room experience. The authors developed a hands-on, dimensionally accurate model for aneurysm clipping using patient-derived anatomic data and three-dimensional (3D) printing. Design of the model focused on reproducibility as well as adaptability to new patient geometry. A modular, reproducible, and patient-derived medical simulacrum was developed for medical learners to practice aneurysmal clipping procedures. Various forms of 3D printing were used to develop a geometrically accurate cranium and vascular tree featuring 9 patient-derived aneurysms. 3D printing in conjunction with elastomeric casting was leveraged to achieve a patient-derived brain model with tactile properties not yet available from commercial 3D printing technology. An educational pilot study was performed to gauge simulation efficacy. Through the novel manufacturing process, a patient-derived simulacrum was developed for neurovascular surgical simulation. A follow-up qualitative study suggests potential to enhance current educational programs; assessments support the efficacy of the simulacrum. The proposed aneurysm clipping simulator has the potential to improve learning experiences in surgical environment. 3D printing and elastomeric casting can produce patient-derived models for a dynamic learning environment that add value to surgical training and preparation. Copyright © 2016 Elsevier Inc. All rights reserved.

Piloted simulator evaluation of a relaxed static stability fighter at high angle-of-attack

NASA Technical Reports Server (NTRS)

Lapins, M.; Klein, R. W.; Martorella, R. P.; Cangelosi, J.; Neely, W. R., Jr.

1982-01-01

A piloted simulator evaluation of the stability and control characteristics of a relaxed static stability fighter aircraft was conducted using a differential maneuvering simulator. The primary purpose of the simulation was to evaluate the effectiveness of the limiters in preventing departure from controlled flight. The simulation was conducted in two phases, the first consisting of open-loop point stability evaluations over a range of subsonic flight conditions, the second concentrating on closed-loop tracking of a preprogrammed target in low speed, high angle-of-attack air combat maneuvering. The command limiters were effective in preventing departure from controlled flight while permitting competent levels of sustained maneuvering. Parametric variations during the study included the effects of pitch control power and wing-body static margin. Stability and control issues were clearly shown to impact the configuration design.

Hemodynamic Evaluation of a Biological and Mechanical Aortic Valve Prosthesis Using Patient-Specific MRI-Based CFD.

PubMed

Hellmeier, Florian; Nordmeyer, Sarah; Yevtushenko, Pavlo; Bruening, Jan; Berger, Felix; Kuehne, Titus; Goubergrits, Leonid; Kelm, Marcus

2018-01-01

Modeling different treatment options before a procedure is performed is a promising approach for surgical decision making and patient care in heart valve disease. This study investigated the hemodynamic impact of different prostheses through patient-specific MRI-based CFD simulations. Ten time-resolved MRI data sets with and without velocity encoding were obtained to reconstruct the aorta and set hemodynamic boundary conditions for simulations. Aortic hemodynamics after virtual valve replacement with a biological and mechanical valve prosthesis were investigated. Wall shear stress (WSS), secondary flow degree (SFD), transvalvular pressure drop (TPD), turbulent kinetic energy (TKE), and normalized flow displacement (NFD) were evaluated to characterize valve-induced hemodynamics. The biological prostheses induced significantly higher WSS (medians: 9.3 vs. 8.6 Pa, P = 0.027) and SFD (means: 0.78 vs. 0.49, P = 0.002) in the ascending aorta, TPD (medians: 11.4 vs. 2.7 mm Hg, P = 0.002), TKE (means: 400 vs. 283 cm 2 /s 2 , P = 0.037), and NFD (means: 0.0994 vs. 0.0607, P = 0.020) than the mechanical prostheses. The differences between the prosthesis types showed great inter-patient variability, however. Given this variability, a patient-specific evaluation is warranted. In conclusion, MRI-based CFD offers an opportunity to assess the interactions between prosthesis and patient-specific boundary conditions, which may help in optimizing surgical decision making and providing additional guidance to clinicians. © 2017 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Effects of simulator motion and visual characteristics on rotorcraft handling qualities evaluations

NASA Technical Reports Server (NTRS)

Mitchell, David G.; Hart, Daniel C.

1993-01-01

The pilot's perceptions of aircraft handling qualities are influenced by a combination of the aircraft dynamics, the task, and the environment under which the evaluation is performed. When the evaluation is performed in a groundbased simulator, the characteristics of the simulation facility also come into play. Two studies were conducted on NASA Ames Research Center's Vertical Motion Simulator to determine the effects of simulator characteristics on perceived handling qualities. Most evaluations were conducted with a baseline set of rotorcraft dynamics, using a simple transfer-function model of an uncoupled helicopter, under different conditions of visual time delays and motion command washout filters. Differences in pilot opinion were found as the visual and motion parameters were changed, reflecting a change in the pilots' perceptions of handling qualities, rather than changes in the aircraft model itself. The results indicate a need for tailoring the motion washout dynamics to suit the task. Visual-delay data are inconclusive but suggest that it may be better to allow some time delay in the visual path to minimize the mismatch between visual and motion, rather than eliminate the visual delay entirely through lead compensation.

A hippotherapy simulator is effective to shift weight bearing toward the affected side during gait in patients with stroke.

PubMed

Sung, Yun-Hee; Kim, Chang-Ju; Yu, Byong-Kyu; Kim, Kyeong-Mi

2013-01-01

We investigated whether a hippotherapy simulator has influence on symmetric body weight bearing during gait in patients with stroke. Stroke patients were divided into a control group (n = 10) that received conventional rehabilitation for 60 min/day, 5 times/week for 4 weeks and an experimental group (n = 10) that used a hippotherapy simulator for 15 min/day, 5 times/week for 4 weeks after conventional rehabilitation for 45 min/day. Temporospatial gait assessed using OptoGait and trunk muscles (abdominis and erector spinae on affected side) activity evaluated using surface electromyography during sit-to-stand and gait. Prior to starting the experiment, pre-testing was performed. At the end of the 4-week intervention, we performed post-testing. Activation of the erector spinae in the experimental group was significantly increased compared to that in the control group (p < 0.01), whereas activation of the rectus abdominis decreased during sit-to-stand. Of the gait parameters, load response, single support, total double support, and pre-swing showed significant changes in the experimental group with a hippotherapy simulator compared to control group (p < 0.05). Moreover, activation of the erector spinae and rectus abdominis in gait correlate with changes of gait parameters including load response, single support, total double support, and pre-swing in experimental group. These findings suggest that use of a hippotherapy simulator to patients with stroke can improve asymmetric weight bearing by influencing trunk muscles.

Does the virtual refractor patient-simulator improve student competency when refracting in the consulting room?

PubMed

Alhazmi, Mohammed S; Butler, Craig W; Junghans, Barbara M

2018-06-12

The use of patient simulators in ophthalmic education appears limited. This study examines the effects of the addition of the 'Virtual Refractor' patient simulator learning activity into a short unit preparing students to determine the power of the spectacle lenses required by patients in a clinic. Twenty-four year one optometry students were randomly assigned to either the simulator-intervention group (n = 12) or the non-intervention group. All students attended tutorials on refraction and the use of a refractor-head. Simulator-intervention students additionally attended a tutorial on the Virtual Refractor. All answered a questionnaire concerning time spent studying, perceived knowledge and confidence. Twenty-four short-sighted patients were recruited. Two refractions per student were timed and the accuracy compared with that of an experienced optometrist. Ten students from each group completed the study. Students who used the simulator were significantly (p < 0.05) more accurate at a clinical level (within 0.22 ± 0.22 DS, 95 per cent CI 0.12-0.32) than those who did not (within 0.60 ± 0.67 DS, 95 per cent CI 0.29-0.92) and 13 per cent quicker (4.7 minutes, p < 0.05). Students who used the simulator felt more knowledgeable (p < 0.05) and confident (p < 0.05), but had spent more time reading about refraction and practised on the Virtual Refractor at home for 5.7 ± 1.3 hours. The Virtual Refractor has many features of high-fidelity medical simulation known to lead to effective learning and it also offers flexible independent learning without a concomitant increase in the student time-burden. The improved accuracy and speed on first patient encounters found in this study validates the use of this patient simulator as a useful bridge for students early in training to successfully transfer theoretical knowledge prior to entering the consulting room. The translational benefits resulting from compulsory learning activities on a

Managing emergency department overcrowding via ambulance diversion: a discrete event simulation model.

PubMed

Lin, Chih-Hao; Kao, Chung-Yao; Huang, Chong-Ye

2015-01-01

Ambulance diversion (AD) is considered one of the possible solutions to relieve emergency department (ED) overcrowding. Study of the effectiveness of various AD strategies is prerequisite for policy-making. Our aim is to develop a tool that quantitatively evaluates the effectiveness of various AD strategies. A simulation model and a computer simulation program were developed. Three sets of simulations were executed to evaluate AD initiating criteria, patient-blocking rules, and AD intervals, respectively. The crowdedness index, the patient waiting time for service, and the percentage of adverse patients were assessed to determine the effect of various AD policies. Simulation results suggest that, in a certain setting, the best timing for implementing AD is when the crowdedness index reaches the critical value, 1.0 - an indicator that ED is operating at its maximal capacity. The strategy to divert all patients transported by ambulance is more effective than to divert either high-acuity patients only or low-acuity patients only. Given a total allowable AD duration, implementing AD multiple times with short intervals generally has better effect than having a single AD with maximal allowable duration. An input-throughput-output simulation model is proposed for simulating ED operation. Effectiveness of several AD strategies on relieving ED overcrowding was assessed via computer simulations based on this model. By appropriate parameter settings, the model can represent medical resource providers of different scales. It is also feasible to expand the simulations to evaluate the effect of AD strategies on a community basis. The results may offer insights for making effective AD policies. Copyright © 2012. Published by Elsevier B.V.

Eleven-Year Retrospective Report of Super-Selective Venous Sampling for the Evaluation of Recurrent or Persistent Hyperparathyroidism in 32 Patients.

PubMed

Habibollahi, Peiman; Shin, Benjamin; Shamchi, Sara P; Wachtel, Heather; Fraker, Douglas L; Trerotola, Scott O

2018-01-01

Parathyroid venous sampling (PAVS) is usually reserved for patients with persistent or recurrent hyperparathyroidism after parathyroidectomy with inconclusive noninvasive imaging studies. A retrospective study was performed to evaluate the diagnostic efficacy of super-selective PAVS (SSVS) in patients needing revision neck surgery with inconclusive imaging. Patients undergoing PAVS between 2005 and 2016 due to persistent or recurrent hyperparathyroidism following surgery were reviewed. PAVS was performed in all patients using super-selective technique. Single-value measurements within central neck veins performed as part of super-selective PAVS were used to simulate selective venous sampling (SVS) and allow for comparison to data, which might be obtained in a non-super-selective approach. 32 patients (mean age 51 ± 15 years; 8 men and 24 women) met inclusion and exclusion criteria. The sensitivity and positive predictive value (PPV) of SSVS for localizing the source of elevated PTH to a limited area in the neck or chest was 96 and 84%, respectively. Simulated SVS, on the other hand, had a sensitivity of 28% and a PPV of 89% based on the predefined gold standard. SSVS had a significantly higher sensitivity compared to simulated SVS (p < 0.001). SSVS is highly effective in localizing the source of hyperparathyroidism in patients undergoing revision surgery for hyperparathyroidism in whom noninvasive imaging studies are inconclusive. SSVS data had also markedly higher sensitivity for localizing disease in these patients compared to simulated SVS.

The use of vestibular models for design and evaluation of flight simulator motion

NASA Technical Reports Server (NTRS)

Bussolari, Steven R.; Young, Laurence R.; Lee, Alfred T.

1989-01-01

Quantitative models for the dynamics of the human vestibular system are applied to the design and evaluation of flight simulator platform motion. An optimal simulator motion control algorithm is generated to minimize the vector difference between perceived spatial orientation estimated in flight and in simulation. The motion controller has been implemented on the Vertical Motion Simulator at NASA Ames Research Center and evaluated experimentally through measurement of pilot performance and subjective rating during VTOL aircraft simulation. In general, pilot performance in a longitudinal tracking task (formation flight) did not appear to be sensitive to variations in platform motion condition as long as motion was present. However, pilot assessment of motion fidelity by means of a rating scale designed for this purpose, were sensitive to motion controller design. Platform motion generated with the optimal motion controller was found to be generally equivalent to that generated by conventional linear crossfeed washout. The vestibular models are used to evaluate the motion fidelity of transport category aircraft (Boeing 727) simulation in a pilot performance and simulator acceptability study at the Man-Vehicle Systems Research Facility at NASA Ames Research Center. Eighteen airline pilots, currently flying B-727, were given a series of flight scenarios in the simulator under various conditions of simulator motion. The scenarios were chosen to reflect the flight maneuvers that these pilots might expect to be given during a routine pilot proficiency check. Pilot performance and subjective rating of simulator fidelity was relatively insensitive to the motion condition, despite large differences in the amplitude of motion provided. This lack of sensitivity may be explained by means of the vestibular models, which predict little difference in the modeled motion sensations of the pilots when different motion conditions are imposed.

The virtual child: evaluation of an internet-based pediatric behavior management simulation.

PubMed

Boynton, James R; Green, Thomas G; Johnson, Lynn A; Nainar, S M Hashim; Straffon, Lloyd H

2007-09-01

This article describes an Internet-based instructional tool designed to give predoctoral dental students a virtual simulation of clinical pediatric dentistry to develop their pediatric behavior management knowledge. Effectiveness of this tool was evaluated using two consecutive classes of junior dental students. The control group was exposed to the traditional behavior management curriculum (two lectures) in a spring term course. The next class of dental students was exposed to the two lectures and, in addition, completed the behavior management simulation during the following spring term. Both groups completed a two-part examination (objective section=18 questions; open-ended section=responses to a clinical situation) designed to test their behavior management knowledge. The simulation group performed significantly better in both parts of the examination (objective section: p=.028; open-ended section: p=.012). The simulation was evaluated by students and perceived by most to be an effective addition to the curriculum. It was concluded that the experimental behavior management simulation, when added to the traditional lecture curriculum, improved pediatric behavior management knowledge in predoctoral dental students.

Realistic simulated MRI and SPECT databases. Application to SPECT/MRI registration evaluation.

PubMed

Aubert-Broche, Berengere; Grova, Christophe; Reilhac, Anthonin; Evans, Alan C; Collins, D Louis

2006-01-01

This paper describes the construction of simulated SPECT and MRI databases that account for realistic anatomical and functional variability. The data is used as a gold-standard to evaluate four SPECT/MRI similarity-based registration methods. Simulation realism was accounted for using accurate physical models of data generation and acquisition. MRI and SPECT simulations were generated from three subjects to take into account inter-subject anatomical variability. Functional SPECT data were computed from six functional models of brain perfusion. Previous models of normal perfusion and ictal perfusion observed in Mesial Temporal Lobe Epilepsy (MTLE) were considered to generate functional variability. We studied the impact noise and intensity non-uniformity in MRI simulations and SPECT scatter correction may have on registration accuracy. We quantified the amount of registration error caused by anatomical and functional variability. Registration involving ictal data was less accurate than registration involving normal data. MR intensity nonuniformity was the main factor decreasing registration accuracy. The proposed simulated database is promising to evaluate many functional neuroimaging methods, involving MRI and SPECT data.

Nursing simulation: a community experience.

PubMed

Gunowa, Neesha Oozageer; Elliott, Karen; McBride, Michelle

2018-04-02

The education sector faces major challenges in providing learning experiences so that newly qualified nurses feel adequately prepared to work in a community setting. With this in mind, higher education institutions need to develop more innovative ways to deliver the community-nurse experience to student nurses. This paper presents and explores how simulation provides an opportunity for educators to support and evaluate student performance in an environment that models a complete patient encounter in the community. Following the simulation, evaluative data were collated and the answers analysed to identify key recommendations.

Dose Titration of Pregabalin in Patients with Painful Diabetic Peripheral Neuropathy: Simulation Based on Observational Study Patients Enriched with Data from Randomized Studies.

PubMed

Alexander, Joe; Edwards, Roger A; Manca, Luigi; Grugni, Roberto; Bonfanti, Gianluca; Emir, Birol; Whalen, Edward; Watt, Stephen; Parsons, Bruce

2018-03-01

Achieving a therapeutic response to pregabalin in patients with painful diabetic peripheral neuropathy (pDPN) requires adequate upward dose titration. Our goal was to identify relationships between titration and response to pregabalin in patients with pDPN. Data were integrated from nine randomized, placebo-controlled clinical trials as well as one 6-week open-label observational study conducted by 5808 physicians (2642 patients with pDPN) in standard outpatient settings in Germany. These studies evaluated pregabalin for treatment of pDPN. Using these data, we examined "what if" scenarios using a microsimulation platform that integrates data from randomized and observational sources as well as autoregressive-moving-average with exogenous inputs models that predict pain outcomes, taking into account weekly changes in pain, sleep interference, dose, and other patient characteristics that were unchanging. Final pain levels were significantly different depending on dose changes (P < 0.0001), with greater proportions improving with upward titration regardless of baseline pain severity. Altogether, 78.5% of patients with pDPN had 0-1 dose change, and 15.2% had ≥ 2 dose changes. Simulation demonstrated that the 4.8% of inadequately titrated patients who did not improve/very much improve their pain levels would have benefited from ≥ 2 dose changes. Patient satisfaction with tolerability (range 90.3-96.2%) was similar, regardless of baseline pain severity, number of titrations, or extent of improvement, suggesting that tolerability did not influence treatment response patterns. Upward dose titration reduced pain in patients with pDPN who actually received it. Simulation also predicted pain reduction in an inadequately titrated nonresponder subgroup of patients had they actually received adequate titration. The decision not to uptitrate must have been driven by factors other than tolerability. Pfizer, Inc.

Comprehensive Performance Evaluation for Hydrological and Nutrients Simulation Using the Hydrological Simulation Program–Fortran in a Mesoscale Monsoon Watershed, China

PubMed Central

Luo, Chuan; Jiang, Kaixia; Wan, Rongrong; Li, Hengpeng

2017-01-01

The Hydrological Simulation Program–Fortran (HSPF) is a hydrological and water quality computer model that was developed by the United States Environmental Protection Agency. Comprehensive performance evaluations were carried out for hydrological and nutrient simulation using the HSPF model in the Xitiaoxi watershed in China. Streamflow simulation was calibrated from 1 January 2002 to 31 December 2007 and then validated from 1 January 2008 to 31 December 2010 using daily observed data, and nutrient simulation was calibrated and validated using monthly observed data during the period from July 2009 to July 2010. These results of model performance evaluation showed that the streamflows were well simulated over the study period. The determination coefficient (R2) was 0.87, 0.77 and 0.63, and the Nash-Sutcliffe coefficient of efficiency (Ens) was 0.82, 0.76 and 0.65 for the streamflow simulation in annual, monthly and daily time-steps, respectively. Although limited to monthly observed data, satisfactory performance was still achieved during the quantitative evaluation for nutrients. The R2 was 0.73, 0.82 and 0.92, and the Ens was 0.67, 0.74 and 0.86 for nitrate, ammonium and orthophosphate simulation, respectively. Some issues may affect the application of HSPF were also discussed, such as input data quality, parameter values, etc. Overall, the HSPF model can be successfully used to describe streamflow and nutrients transport in the mesoscale watershed located in the East Asian monsoon climate area. This study is expected to serve as a comprehensive and systematic documentation of understanding the HSPF model for wide application and avoiding possible misuses. PMID:29257117

Comprehensive Performance Evaluation for Hydrological and Nutrients Simulation Using the Hydrological Simulation Program-Fortran in a Mesoscale Monsoon Watershed, China.

PubMed

Li, Zhaofu; Luo, Chuan; Jiang, Kaixia; Wan, Rongrong; Li, Hengpeng

2017-12-19

The Hydrological Simulation Program-Fortran (HSPF) is a hydrological and water quality computer model that was developed by the United States Environmental Protection Agency. Comprehensive performance evaluations were carried out for hydrological and nutrient simulation using the HSPF model in the Xitiaoxi watershed in China. Streamflow simulation was calibrated from 1 January 2002 to 31 December 2007 and then validated from 1 January 2008 to 31 December 2010 using daily observed data, and nutrient simulation was calibrated and validated using monthly observed data during the period from July 2009 to July 2010. These results of model performance evaluation showed that the streamflows were well simulated over the study period. The determination coefficient ( R ²) was 0.87, 0.77 and 0.63, and the Nash-Sutcliffe coefficient of efficiency (Ens) was 0.82, 0.76 and 0.65 for the streamflow simulation in annual, monthly and daily time-steps, respectively. Although limited to monthly observed data, satisfactory performance was still achieved during the quantitative evaluation for nutrients. The R ² was 0.73, 0.82 and 0.92, and the Ens was 0.67, 0.74 and 0.86 for nitrate, ammonium and orthophosphate simulation, respectively. Some issues may affect the application of HSPF were also discussed, such as input data quality, parameter values, etc. Overall, the HSPF model can be successfully used to describe streamflow and nutrients transport in the mesoscale watershed located in the East Asian monsoon climate area. This study is expected to serve as a comprehensive and systematic documentation of understanding the HSPF model for wide application and avoiding possible misuses.

Use of the Marshall Space Flight Center solar simulator in collector performance evaluation

NASA Technical Reports Server (NTRS)

Humphries, W. R.

1978-01-01

Actual measured values from simulator checkout tests are detailed. Problems encountered during initial startup are discussed and solutions described. Techniques utilized to evaluate collector performance from simulator test data are given. Performance data generated in the simulator are compared to equivalent data generated during natural outdoor testing. Finally, a summary of collector performance parameters generated to date as a result of simulator testing are given.

Value of Collaboration With Standardized Patients and Patient Facilitators in Enhancing Reflection During the Process of Building a Simulation.

PubMed

Stanley, Claire; Lindsay, Sally; Parker, Kathryn; Kawamura, Anne; Samad Zubairi, Mohammad

2018-05-09

We previously reported that experienced clinicians find the process of collectively building and participating in simulations provide (1) a unique reflective opportunity; (2) a venue to identify different perspectives through discussion and action in a group; and (3) a safe environment for learning. No studies have assessed the value of collaborating with standardized patients (SPs) and patient facilitators (PFs) in the process. In this work, we describe this collaboration in building a simulation and the key elements that facilitate reflection. Three simulation scenarios surrounding communication were built by teams of clinicians, a PF, and SPs. Six build sessions were audio recorded, transcribed, and thematically analyzed through an iterative process to (1) describe the steps of building a simulation scenario and (2) identify the key elements involved in the collaboration. The five main steps to build a simulation scenario were (1) storytelling and reflection; (2) defining objectives and brainstorming ideas; (3) building a stem and creating a template; (4) refining the scenario with feedback from SPs; and (5) mock run-throughs with follow-up discussion. During these steps, the PF shared personal insights, challenging participants to reflect deeper to better understand and consider the patient's perspective. The SPs provided unique outside perspective to the group. In addition, the interaction between the SPs and the PF helped refine character roles. A collaborative approach incorporating feedback from PFs and SPs to create a simulation scenario is a valuable method to enhance reflective practice for clinicians.

Clinical evaluation of a commercial orthopedic metal artifact reduction tool for CT simulations in radiation therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li Hua; Noel, Camille; Chen, Haijian

Purpose: Severe artifacts in kilovoltage-CT simulation images caused by large metallic implants can significantly degrade the conspicuity and apparent CT Hounsfield number of targets and anatomic structures, jeopardize the confidence of anatomical segmentation, and introduce inaccuracies into the radiation therapy treatment planning process. This study evaluated the performance of the first commercial orthopedic metal artifact reduction function (O-MAR) for radiation therapy, and investigated its clinical applications in treatment planning. Methods: Both phantom and clinical data were used for the evaluation. The CIRS electron density phantom with known physical (and electron) density plugs and removable titanium implants was scanned on amore » Philips Brilliance Big Bore 16-slice CT simulator. The CT Hounsfield numbers of density plugs on both uncorrected and O-MAR corrected images were compared. Treatment planning accuracy was evaluated by comparing simulated dose distributions computed using the true density images, uncorrected images, and O-MAR corrected images. Ten CT image sets of patients with large hip implants were processed with the O-MAR function and evaluated by two radiation oncologists using a five-point score for overall image quality, anatomical conspicuity, and CT Hounsfield number accuracy. By utilizing the same structure contours delineated from the O-MAR corrected images, clinical IMRT treatment plans for five patients were computed on the uncorrected and O-MAR corrected images, respectively, and compared. Results: Results of the phantom study indicated that CT Hounsfield number accuracy and noise were improved on the O-MAR corrected images, especially for images with bilateral metal implants. The {gamma} pass rates of the simulated dose distributions computed on the uncorrected and O-MAR corrected images referenced to those of the true densities were higher than 99.9% (even when using 1% and 3 mm distance-to-agreement criterion), suggesting

Clinical evaluation of a commercial orthopedic metal artifact reduction tool for CT simulations in radiation therapy

PubMed Central

Li, Hua; Noel, Camille; Chen, Haijian; Harold Li, H.; Low, Daniel; Moore, Kevin; Klahr, Paul; Michalski, Jeff; Gay, Hiram A.; Thorstad, Wade; Mutic, Sasa

2012-01-01

Purpose: Severe artifacts in kilovoltage-CT simulation images caused by large metallic implants can significantly degrade the conspicuity and apparent CT Hounsfield number of targets and anatomic structures, jeopardize the confidence of anatomical segmentation, and introduce inaccuracies into the radiation therapy treatment planning process. This study evaluated the performance of the first commercial orthopedic metal artifact reduction function (O-MAR) for radiation therapy, and investigated its clinical applications in treatment planning. Methods: Both phantom and clinical data were used for the evaluation. The CIRS electron density phantom with known physical (and electron) density plugs and removable titanium implants was scanned on a Philips Brilliance Big Bore 16-slice CT simulator. The CT Hounsfield numbers of density plugs on both uncorrected and O-MAR corrected images were compared. Treatment planning accuracy was evaluated by comparing simulated dose distributions computed using the true density images, uncorrected images, and O-MAR corrected images. Ten CT image sets of patients with large hip implants were processed with the O-MAR function and evaluated by two radiation oncologists using a five-point score for overall image quality, anatomical conspicuity, and CT Hounsfield number accuracy. By utilizing the same structure contours delineated from the O-MAR corrected images, clinical IMRT treatment plans for five patients were computed on the uncorrected and O-MAR corrected images, respectively, and compared. Results: Results of the phantom study indicated that CT Hounsfield number accuracy and noise were improved on the O-MAR corrected images, especially for images with bilateral metal implants. The γ pass rates of the simulated dose distributions computed on the uncorrected and O-MAR corrected images referenced to those of the true densities were higher than 99.9% (even when using 1% and 3 mm distance-to-agreement criterion), suggesting that dose

Designing and Evaluating an Interactive Multimedia Web-Based Simulation for Developing Nurses’ Competencies in Acute Nursing Care: Randomized Controlled Trial

PubMed Central

Wong, Lai Fun; Chan, Sally Wai-Chi; Ho, Jasmine Tze Yin; Mordiffi, Siti Zubaidah; Ang, Sophia Bee Leng; Goh, Poh Sun; Ang, Emily Neo Kim

2015-01-01

Background Web-based learning is becoming an increasingly important instructional tool in nursing education. Multimedia advancements offer the potential for creating authentic nursing activities for developing nursing competency in clinical practice. Objective This study aims to describe the design, development, and evaluation of an interactive multimedia Web-based simulation for developing nurses’ competencies in acute nursing care. Methods Authentic nursing activities were developed in a Web-based simulation using a variety of instructional strategies including animation video, multimedia instructional material, virtual patients, and online quizzes. A randomized controlled study was conducted on 67 registered nurses who were recruited from the general ward units of an acute care tertiary hospital. Following a baseline evaluation of all participants’ clinical performance in a simulated clinical setting, the experimental group received 3 hours of Web-based simulation and completed a survey to evaluate their perceptions of the program. All participants were re-tested for their clinical performances using a validated tool. Results The clinical performance posttest scores of the experimental group improved significantly (P<.001) from the pretest scores after the Web-based simulation. In addition, compared to the control group, the experimental group had significantly higher clinical performance posttest scores (P<.001) after controlling the pretest scores. The participants from the experimental group were satisfied with their learning experience and gave positive ratings for the quality of the Web-based simulation. Themes emerging from the comments about the most valuable aspects of the Web-based simulation include relevance to practice, instructional strategies, and fostering problem solving. Conclusions Engaging in authentic nursing activities using interactive multimedia Web-based simulation can enhance nurses’ competencies in acute care. Web

Debriefing after Human Patient Simulation and Nursing Students' Learning