Dissertations / Theses on the topic 'Virtual patient simulation'

There is currently an international shortage of Audiologists (McIntyre, 2010). Audiology is a professional degree undertaken at a postgraduate level at most universities around the world. Students have training in anatomy and physiology, hearing aids, cochlear implants, electrophysiology and acoustics; combined with a clinical component to the course. The clinical component is undertaken throughout the entirety of the course and involves a mixture of observation and supervised clinical practice in a variety of settings. Clinical training often begins with students crowded around a single piece of equipment, such as an audiometer for testing puretone-hearing thresholds or by pairing up and simulating a hearing loss. This process creates time and access constraints for students as it restricts their ability to practice performing audiometry, particularly if there is a shortage of equipment, and also limits their exposure to a wide variety of hearing loss pathologies. The potential for universities worldwide to use Virtual Reality and Computer Based Simulations to provide Audiology students with basic clinical skills without relying on extensive support from external clinics warrants further investigation. In particular, it needs to be determined whether Audiology students value these simulations as a useful supplement to their clinical training, and whether the use of these simulations translates into measurable improvements in student abilities in real clinical placements. A computer based training program for Audiology students developed at the Human Interface Technology Lab (HITLAB) New Zealand is evaluated in this study as an educational tool at the University of Canterbury, New Zealand. The present study aims to determine if a sample of twelve first year Audiology students felt their interactions with Virtual Patients improved their ability to interact with clients and perform masking which is often part of a basic audiometric assessment for a patient with hearing loss. The study measures the students’ competency in performing masking in puretone audiometry on the Virtual Patient and then on a patient in a real-world setting to see whether the Audiology Simulator training tool improved the student’s basic audiometry skills (a training effect) and whether these skills were maintained after a period of four weeks (a maintenance effect). Statistical analysis is applied to determine any training and maintenance effects. Students also gave subjective feedback on the usefulness of the simulator and suggestions for ways in which it could be improved. Results indicated that there was no statistically significant training effect between students that had used the Audiology Simulator and those that hadn’t. Once all students had used the Virtual Patient there was an overall maintenance effect present in that student’s scores stayed the same or improved even for those students who had not used the Virtual Patient for a period of time. Students overall reported that they found the Virtual Patient to be ‘Moderately Useful’ and had many recommendations for ways in which it could be improved to further assist their learning.The present study indicates that computer based simulation programs like the Virtual Patient are able to present and simulate realistic hearing losses to an acceptable level of complexity for students studying in the field of audiology and that the Audiology Simulator can be a useful and complementary training tool for components of audiological clinical competence, such as puretone audiometry and masking.

Objetivos: Descrever todo o processo de implantação dos laboratórios de prática de simulação farmacêutica e desenvolver e avaliar um simulador virtual de seguimento farmacoterapêutico adaptando o software SIACC. Métodos: Para a implantação dos laboratórios de prática foi realizado o planejamento da área física, incluindo o fluxo de atividades, identificados os materiais e equipamentos necessários a realização das práticas, os procedimentos que ali serão realizados, bem como a validação dos mesmos, por meio de desenvolvimento, avaliação de realização e correção de desenvolvido. Em relação ao simulador, a metodologia do estudo foi realizada em quatro fases: Fase de planejamento: a adaptação do SIACC para o ensino da prática farmacêutica; Fase de uso do simulador; Desempenho dos usuários; Fase de avaliação do simulador que foi realizada utilizando dois instrumentos de avaliação: ISO 9126 e as Dez Regras de Ouro para avaliação de software. A avaliação foi qualitativa e quantitativa. Na avaliação qualitativa, utilizou-se a Técnica do Grupo Nominal. Resultados: No que se refere a implantação dos laboratórios de prática de simulação, o estudo descreveu todas as etapas da implantação dos laboratórios de prática para a formação do profissional farmacêutico. A avaliação do software com base na ISO 9126 mostrou que não houve diferença estatísticas (p < 0,05) das dimensões avaliadas por dois grupos diferentes: estudantes e especialistas. Também não houve diferença estatística (p < 0,05) das dimensões avaliadas em relação a três grupos: os que não utilizam a informática na educação, os que utilizam apenas para fazer apresentação e os que utilizam mais de um recurso computacional na educação. Na avaliação com base nas Dez Regras de Ouro, apenas dois dos dez itens avaliados tiverem a média < 4 (média máxima: 5,0). Os resultados da avaliação qualitativa corroboraram com a avaliação quantitativa. Conclusões: Estes são os resultados da investigação destinada a desenvolver modelos para a aplicação de métodos de aprendizagem ativos usando novas tecnologias que se destina a ser implementado inicialmente na Escola de Farmácia da UFRGS.<br>Objectives: The aim was to describe the entire implantation process of the simulation practice laboratories and to develop and evaluate a virtual simulator for pharmacotherapeutic follow-up by adapting IASCC software. Methods: In order to set up the laboratories, the planning of the physical area was carried out to include the flow of activities and the materials and the equipment needed were identified. Also, the procedures that would be done were validated through development and evaluation of achievement and then correction was proposed. In relation to simulator, the methodological development study was conducted in four phases: Planning phase: the adaptation of SIACC for pharmaceutical practice teaching; A second phase using the simulator; and a third consisting of grading the performance of users; and finally, the evaluation of software using two instruments: ISO 9126 and the Ten Golden Rules. The assessment was qualitative and quantitative. In qualitative evaluation, was used the Nominal Group Technique. Results: Regarding the implantation of the simulation practice laboratories, the study described all steps needed to set up laboratories for the training of pharmacists. The evaluation based on the ISO 9126 showed that there was no statistical difference (p < 0.05) between the factors evaluated by two different groups: students and experts in this field. Also, there was no statistical difference (p < 0.05) among the factors evaluated by three groups: those who do not use information technology in education, those who use it only to make presentations and those who use more than one IT resource in education. In the evaluation based on the Ten Golden Rules, only two of the ten items evaluated had an average < 4.0 (maximum average: 5.0). The results of the qualitative evaluation corroborate the quantitative assessment. Conclusions: These are the results of the authors’ research aimed to develop models for the application of active learning methods using new technology to be initially implemented at UFRGS School of Pharmacy.

This thesis explores the support of learning through reflection, in the context of medical students and practitioners, working through a series of simulated consultations involving the diagnosis and management of chronic illness. A model of the medical consultative process was defined, on which a web-based patient simulation was developed. This simulation can be accessed over the Internet using commonly available web-browsers. It enables users to interact with a virtual patient by taking a history, examining the patient, requesting and reviewing investigations, and choosing appropriate management strategies. The virtual patient can be reviewed over a number of consultations, and the patient outcome is dependant on the management strategy selected by the user. A second model was also developed, that adds a layer of reflection over the consultative process. While interacting with the virtual patient users are asked to formulate and test their hypotheses. Simple tools are included to encourage users to record their observations and thoughts for further learning, as well as providing links to web-based library resources. At the end of each consultation, users are asked to review their actions and indicate whether they think their actions were critical, relevant, or not relevant to the diagnosis and management of the patient in light of their current knowledge. Users also have the opportunity to compare their activity to their peers or an expert in the case under study. Three formal cycles of evaluation were undertaken during the design and development of the software. A number of clinicians were involved in the initial design to ensure there was an appropriate structure that matched clinical practice. Formative evaluation was conducted to review the usability of the application, and based on user feedback a number of changes were made to the user interface and structure of the application. A third, end user, evaluation was undertaken using a single case concerning the diagnosis and management of hypertriglyceridaemia in the context of Type 1B Glycogen Storage Disease. This evaluation involved ten medical students, five general practitioners and two specialists. The evaluation involved observation using a simplified think-aloud, as well as administration of a questionnaire. Users were engaged by the simulation, and were able to use the application with only a short period of training. Usability issues still exist with respect to the processing of natural language input, especially when asking questions of the virtual patient. Until such time that natural language recognition is able to provide satisfactory performance, alternative, list-based, methods of interaction will be required. Evaluation involving medical students, general practitioners, and specialist medical practitioners demonstrated that reflection can be supported and encouraged by providing appropriate tools, as well as by judiciously interrupting the consultative process and providing time for reflection to take place. Reflection could have been further enhanced if users had been educated on reflection as a learning modality prior to using SIMPRAC. Further work is also required to improve the simulation environment, improve the interfaces for supporting reflection, and further define the benefits of using this approach for medical education and professional development with respect to learning outcomes and behavioural change.

This thesis is to establish a framework to guide the development of a simulated, multimedia-enriched, immersive, learning environment (SMILE) framework. This framework models essential media components used to describe a scenario applied in healthcare (in a dementia context), demonstrates interactions between the components, and enables scalability of simulation implementation. The thesis outcomes also include a simulation system developed in accordance with the guidance framework and a preliminary evaluation through a user study involving ten nursing students and practicioners. The results show that the proposed framework is feasible and effective for designing a simulation system in dementia healthcare training.

Simulation, in its many forms, has been a part of nursing education and practice for many years. The use of games, computer-assisted instruction, standardized patients, virtual reality, and low-fidelity to high-fidelity mannequins have appeared in the past 40 years, whereas anatomical models, partial task trainers, and role playing were used earlier. A historical examination of these many forms of simulation in nursing is presented, followed by a discussion of the roles of simulation in both nursing education and practice. A viewpoint concerning the future of simulation in nursing concludes this article.

The aim of this work was to develop and validate a new pre-operative planning in acetabular surgery based on a patient-specific biomechal model. During the first part of this work we brought enhancement in each step of the planning process for acetabular fracture surgery. The first step was to generate 3D models of several acetabular fracture patterns using semi-automatic segmentation methods. In the same time, we showed that the segmented fragments bone could be usefull to correctly classify acetabular fracture by unexperimented residents. The second step was to generate a patient-specific model, in a very simple way, that could be used in clinical practice by surgeons. A literature review of acetabular planning models was performed to identify that a new paradigm was required because of the limitations of the existing models. Once the objectives of patient-specific modelling was identified, a literature review of hips models was performed to record biomechanical properties of the elements that we had to modelize. A compromise between simplicity and realistic behaviour was found to generate patient-specifics biomechanical models, in a limited time, that could be used in clinical practice. Clinical studies on 14 operated cases, then 29 operated cases and finally 39 operated cases, were performed to validate retrospectively the simulations. The results were quite promising. Only open-source softwares with their own weaknesses were used because validity and feasability of the procedure was required before bigger investissment. The proof of concept was done. A prospective clinical study has shown the efficiency of the patient-specific biomechanical simulation and its feasibility in a daily clinical practice. This work opens a door for new approaches in surgical planning and patient-specific modelling<br>L’objectif de cette thèse est de développer et valider une nouvelle méthode de planification pré-opératoire en chirurgie traumatique de l’acetabulum reposant sur un modèle biomécanique patient-spécifique. La première partie de ce travail a consisté en l’élaboration et l’amélioration progressive de ce nouvel outil de planification. La première étape était de générer des modèles tri-dimensionnels de plusieurs fractures acétabulaires à l’aide d’une méthode de segmentation semi-automatique. Dans le même temps, nous avons démontré que les fragments osseux segmentés pouvaient être utile pour classer correctement les fractures acétabulaires par des internes non expérimentés. La seconde étape était de générer un modèle biomécanique patient-spécifique, le plus simplement possible pour pouvoir être compatible avec une pratique clinique régulière. Une revue de la littérature à propos des différentes méthodes de planifications péri-opératoire en traumatologie de l’acetabulum a été réalisée afin d’identifier qu’un nouveau paradigme était nécessaire du fait des limites des méthodes existantes. Une fois les objectifs d’une modélisation biomécanique patient-spécifique définis, une revue de la littérature des différents modèles biomécanique de la hanche a été réalisée pour définir les propriétés biomécaniques des différents éléments à modéliser. Un compromis entre simplicité et comportement réaliste du modèle a été trouvé pour générer un modèle biomécanique patient-spécifique, dans un temps limité, compatible avec une utilisation courante en pratique clinique. Des études cliniques portant sur 14 cas de fractures acétabulaires opérées, puis 29 et finalement 39 cas ont été réalisées pour valider rétrospectivement les simulations biomécaniques. Les résultats montraient une parfaite adéquation avec la réalité. Seuls des logiciels en libre accès, avec leurs faiblesses, étaient utilisés car la fiabilité et la validité de la simulation étaient nécessaires avant d’envisager plus d’investissements. La preuve de concept était donnée. Enfin, une étude clinique prospective a démontré l’efficacité de la simulation biomécanique patient-spécifique et sa faisabilité en pratique clinique quotidienne. Ce travail ouvre la porte à de nouvelles approches en matière de planification chirurgicale et de modélisation patient-spécifique

Se cree que la medicina in silico supondrá uno de los cambios más disruptivos en el futuro próximo. A lo largo de la última década se ha invertido un gran esfuerzo en el desarrollo de modelos computacionales predictivos para mejorar el poder de diagnóstico de los médicos y la efectividad de las terapias. Un punto clave de esta revolución, será la personalización, que conlleva en la mayoría de los casos, la creación de modelos computacionales específicos de paciente, también llamados gemelos digitales. Esta práctica está actualmente extendida en la investigación y existen en el mercado varias herramientas de software que permiten obtener modelos a partir de imágenes. A pesar de eso, para poderse usar en la práctica clínica, estos métodos se necesita reducir drásticamente el tiempo y el trabajo humano necesarios para la creación de los modelos numéricos. Esta tésis se centra en la propuesta de la versión basada en imágenes del Cartesian grid Finite Element Method (cgFEM), una técnica para obtener de forma automática modelos a partir de imágenes y llevar a cabo análisis estructurales lineales de huesos, implantes o materiales heterogéneos. En la técnica propuesta, tras relacionar la escala de los datos de la imágen con valores de propiedades mecánicas, se usa toda la información contenida en los píxeles para evaluar las matrices de rigidez de los elementos que homogenizan el comportamiento elástico de los grupos de píxeles contenidos en cada elemento. Se h-adapta una malla cartesiana inicialmente uniforme a las características de la imágen usando un procedimiento eficiente que tiene en cuenta las propiedades elásticas locales asociadas a los valores de los píxeles. Con eso, se evita un suavizado excesivo de las propiedades elásticas debido a la integración de los elementos en áreas altamente heterogéneas, pero, no obstante, se obtienen modelos finales con un número razonable de grados de libertad. El resultado de este proceso es una malla no conforme en la que se impone la continudad C0 de la solución mediante restricciones multi-punto en los hanging nodes. Contrariamente a los procedimientos estandar para la creación de modelos de Elementos Finitos a partir de imágenes, que normalmente requieren la definición completa y watertight de la geometrá y tratan el resultado como un CAD estandar, con cgFEM no es necesario definir ninguna entidad geométrica dado que el procedimiento propuesto conduce a una definición implícita de los contornos. Sin embargo, es inmediato incluirlas en el modelo en el caso de que sea necesario, como por ejemplo superficies suaves para imponer condiciones de contorno de forma más precisa o volúmenes CAD de dispositivos para la simulación de implantes. Como consecuencia de eso, la cantidad de trabajo humano para la creación de modelos se reduce drásticamente. En esta tesis, se analiza en detalles el comportamiento del nuevo método en problemas 2D y 3D a partir de CT-scan y radiográfias sintéticas y reales, centrandose en tres clases de problemas. Estos incluyen la simulación de huesos, la caracterización de materiales a partir de TACs, para lo cual se ha desarrollado la cgFEM virtual characterisation technique, y el análisis estructural de futuros implantes, aprovechando la capacidad del cgFEM de combinar fácilmente imágenes y modelos de CAD.<br>Es creu que la medicina in silico suposarà un dels canvis més disruptius en el futur pròxim. Al llarg de l'última dècada, s'ha invertit un gran esforç en el desenvolupament de models computacionals predictius per millorar el poder de diagnòstic dels metges i l'efectivitat de les teràpies. Un punt clau d'aquesta revolució, serà la personalització, que comporta en la majoria dels casos la creació de models computacionals específics de pacient. Aquesta pràctica està actualment estesa en la investigació i hi ha al mercat diversos software que permeten obtenir models a partir d'imatges. Tot i això, per a poder-se utilitzar en la pràctica clínica aquests métodes es necessita reduir dràsticament el temps i el treball humà necessaris per a la seva creació. Aquesta tesi es centra en la proposta d'una versió basada en imatges del Cartesian grid Finite Element Method (cgFEM), una técnica per obtenir de forma automàticament models a partir d'imatges i dur a terme anàlisis estructurals lineals d'ossos, implants o materials heterogenis. Després de relacionar l'escala del imatge a propietats macàniques corresponents, s'usa tota la informació continguda en els píxels per a integrar les matrius de rigidesa dels elements que homogeneïtzen el comportament elàstic dels grups de píxels continguts en cada element. Es emphh-adapta una malla inicialment uniforme a les característiques de la imatge usant un procediment eficient que té en compte les propietats elàstiques locals associades als valors dels píxels. Amb això, s'evita un suavitzat excessiu de les propietats elàstiques a causa de la integració dels elements en àrees altament heterogénies, però, tot i això, s'obtenen models finals amb un nombre raonable de graus de llibertat. El resultat d'aquest procés és una malla no conforme en la qual s'imposa la continuïtat C0 de la solució mitjançant restriccions multi-punt en els hanging nodes. Contràriament als procediments estàndard per a la creació de models d'Elements finits a partir d'imatges, que normalment requereixen la definició completa i watertight de la geometria i tracten el resultat com un CAD estàndard, amb cgFEM no cal definir cap entitat geométrica. No obstant això, és immediat incloure-les en el model en el cas que sigui necessari, com ara superfícies suaus per imposar condicions de contorn de forma més precisa o volums CAD de dispositius per a la simulació d'implants. Com a conseqüéncia d'això, la quantitat de treball humà per a la creació de models es redueix dràsticament. En aquesta tesi, s'analitza en detalls el comportament del nou métode en problemes 2D i 3D a partir de CT-scan i radiografies sintétiques i reals, centrant-se en tres classes de problemes. Aquestes inclouen la simulació d'ossos, la caracterització de materials a partir de TACs, per a la qual s'ha desenvolupat la cgFEM virtual characterisation technique, i l'anàlisi estructural de futurs implants, aprofitant la capacitat del cgFEM de combinar fàcilment imatges i models de CAD.<br>In silico medicine is believed to be one of the most disruptive changes in the near future. A great effort has been carried out during the last decade to develop predicting computational models to increase the diagnostic capabilities of medical doctors and the effectiveness of therapies. One of the key points of this revolution, will be personalisation, which means in most of the cases creating patient specific computational models, also called digital twins. This practice is currently wide-spread in research and there are quite a few software products in the market to obtain models from images. Nevertheless, in order to be usable in the clinical practice, these methods have to drastically reduce the time and human intervention required for the creation of the numerical models. This thesis focuses on the proposal of image-based Cartesian grid Finite Element Method (cgFEM), a technique to automatically obtain numerical models from images and carry out linear structural analyses of bone, implants or heterogeneous materials. In the method proposed in this thesis, after relating the image scale to corresponding elastic properties, all the pixel information will be used for the integration of the element stiffness matrices, which homogenise the elastic behaviour of the groups of pixels contained in each element. An initial uniform Cartesian mesh is h-adapted to the image characteristics by using an efficient refinement procedure which takes into account the local elastic properties associated to the pixel values. Doing so we avoid an excessive elastic property smoothing due to element integration in highly heterogeneous areas, but, nonetheless obtain final models with a reasonable number of degrees of freedom. The result of the process is non-conforming mesh in which C0 continuity is enforced via multipoint constraints at the hanging nodes. In contrast to the standard procedures for the creation of Finite Element models from images, which usually require a complete and watertight definition of the geometry and treat the result as a standard CAD, with cgFEM it is not necessary to define any geometrical entity, as the procedure proposed leads to an implicit definition of the boundaries. Nonetheless, they are straightforward to include in the model if necessary, such as smooth surfaces to impose the boundary conditions more precisely or CAD device volumes for the simulation of implants. As a consequence, the amount of human work required for the creation of the numerical models is drastically reduced. In this thesis, we analyse in detail the new method behaviour in 2D and 3D problems from CT-scans and X-ray images and synthetic images, focusing on three classes of problems. These include the simulation of bones, the material characterisation of solid foams from CT scans, for which we developed the cgFEM virtual characterisation technique, and the structural analysis of future implants, taking advantage of the capability of cgFEM to easily mix images and CAD models.<br>Giovannelli, L. (2018). Direct creation of patient-specific Finite Element models from medical images and preoperative prosthetic implant simulation using h-adaptive Cartesian grids [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/113644<br>TESIS

La complexité des patients de réanimation justifie le recours à des systèmes d’aide à la décision thérapeutique. Ces systèmes rassemblent des protocoles automatisés de prise en charge permettant le respect des recommandations et des simulateurs physiologiques ou patients virtuels, utilisables pour personnaliser de façon sécuritaire les prises en charge. Ces dispositifs fonctionnant à partir d’algorithmes et d’équations mathématiques ne peuvent être développés qu’à partir d’un grand nombre de données de patients. Le principal objectif de cette thèse était la mise en place d’une base de données haute résolution automatiquement collectée de patients de réanimation pédiatrique dont le but sera de servir au développement et à la validation d’un simulateur physiologique : SimulResp© . Ce travail présente l’ensemble du processus de mise en place de la base de données, du concept jusqu’à son utilisation<br>The complexity of the patients in the intensive care unit requires the use of clinical decision support systems. These systems bring together automated management protocols that enable adherence to guidelines and virtual physiological or patient simulators that can be used to safely customize management. These devices operating from algorithms and mathematical equations can only be developed from a large number of patients’ data. The main objective of the work was the elaboration of a high resolution database automatically collected from critically ill children. This database will be used to develop and validate a physiological simulator called SimulResp© . This manuscript presents the whole process of setting up the database from concept to use

The term Virtual Patient (VP) refers to the use of virtual characters which embody patients in a virtual environment. They are implemented in computer simulations to create realistic clinical encounters. VPs have been used successfully in health education to promote and foster clinical communication skills. Additionally, computer simulations offer the advantage of being standardized, safe, repeatable, and do not require as much resources as role-play simulations which rely on actors. This thesis addresses the design and evaluation of a VP-based system aimed for clinical trainees, and uses the field of audiology as a case study. The system is designed to simulate real client encounters and allows students to practice using a standard set of procedures that they have to master in their profession. A wide range of VPs have been implemented for this purpose. The system was evaluated with audiology students, reinforcing the ecological validity of the research. The design of the system was guided by an iterative process of implementation, usability testing, and experiments focusing on students' learning outcomes. The Clinical Audiology Simulator (CAS) was evaluated during five experiments, assessing students learning gains following exposure to the CAS. Learning gains have been assessed through the use of role-play simulations and paper assessments. The procedures evaluated are clinical history taking, pure tone audiometry, and speech audiometry. A further experiment assessed the impact of additional formative feedback on students learning gains, using the pure tone audiometry procedure as an example. The results of these experiments suggest that the system has a great potential to foster students learning, with measurable gains in some of these procedures. They also indicate that feedback and its delivery take an important role in this process. This thesis elaborates how VP-based simulations can reinforce young clinicians' ability to learn procedural skills. I highlight some of the challenges a researcher faces in designing and evaluating such systems, focusing on the implementation of interaction scripts for the VPs, the assessment of learning gains and transfer of skills, and the evaluation of computer simulations as part of a curriculum. VPs have the potential to promote clinical trainees' learning of skills, and to provide students with more opportunities for safe practice in a field where beginning trainees often have few opportunities for actual hands on experience.

The aim of this study was to examine the effectiveness of different types of feedback on learning pure-tone audiometry using a simulator. Participants were 51 undergraduate students in the Department of Communication Disorders. Participants were randomly allocated to one of two groups whilst undertaking pure-tone audiometry training with the Clinical Audiology Simulator (CAS). One group received summative feedback during the learning task while the second group received formative feedback. Probes were administered to examine participants’ knowledge of pure-tone audiometry following training. In addition, a subjective workload analysis was used to measure perceived cognitive load during training and assessment. Between-groups analysis was conducted to establish the effect of feedback on learning and cognitive load. Data regarding how much time each student spent training on the simulator was also collected, and a regression analysis was conducted to evaluate the relationship between time and learning. Formative feedback was found to have a large positive effect on learning in comparison to summative feedback. Cognitive load was perceived as being higher for students receiving formative feedback during training compared to those receiving summative feedback. In subsequent assessment, the formative feedback group reported a lower cognitive load than the summative feedback group. No relationship was observed between time spent training on the simulator and probes outcome. The formative feedback training mode of the CAS proved to be effective in supporting learning and cognitive load in novice students. The findings suggest that the type of feedback employed when using simulators affects learning outcomes for users.

Purpose: Hearing loss is a common problem worldwide, and there is an ever- increasing need for more audiologists to be trained. Unfortunately, audiology students cannot always get the clinical experience they need during training. Virtual reality involving computer-based simulation of real-life training experiences is one way of compensating for this. While there are several virtual audiometers available for student use, few of these include the vital case history component. This study sought to develop an interactive virtual patient that includes this component, and to objectively measure the effect of training with this software on student performance. Method: Development of the Patient Simulator Program (PSP) took place in two phases – Phase One involved development of audiometric information and a brief case history summary for 25 patient cases, and Phase Two involved development of comprehensive case histories for these and identification of triggering phrases and keywords for eliciting each piece of information from the virtual patient. Twelve first year audiology students were recruited from the University of Canterbury and divided into matched groups based on their pre-test scores. An alternating treatment design across groups was used to evaluate participants on their verbal and written accuracy, experience, confidence, and efficiency scores on case history tasks. Results: A significant difference was found in verbal accuracy scores between groups at the mid-way assessment point (following simulator training), but not for written accuracy. Differences between groups were not significant at all assessment points for efficiency and experience measures. Confidence gains were greater for the second group to train with the simulator than the first, while performance gains were greater for the first group. Conclusion: These findings support the evidence that simulation training can enhance student’s skills, and provide the first objective evidence for the benefits of training for case history tasks with an interactive virtual patient. While the effect size was small, these findings are a promising springboard for future research into this area. While the PSP is not adequate to replace real clinical encounters, it has potential as an adjunct to the current training program.

Virtual patients (VPs) are routinely used in the training of medicine and nursing professionals but uptake into pharmacy has been slower. The pharmacy pre-registration training year takes place in the workplace and a disparity in the perceptions of support provided and the pre-registration examination pass rates has been established between the training sectors. This programme of work aimed to evaluate the effectiveness of virtual patients (VPs) at supporting pre-registration training when compared to a non-interactive (NI) learning tool. Following institutional ethical approval, a mixed methods approach was adopted to evaluate the VP technology. A purposive sample of 165 pre-registration trainees (2014-2015) who were completing their training in a UK-based community or hospital pharmacy were recruited. Participants were randomly stratified to receive three VP or NI case studies. Knowledge surrounding the case studies was assessed using a quasi-experimental evaluation and thoughts on the two learning tools were obtained and compared via questionnaires and semi-structured telephone interviews. Quantitative data was analysed using descriptive and inferential statistics and qualitative data was analysed using content analysis (questionnaire) and framework analysis (interviews).No significant differences in knowledge improvement between pre-registration trainees in the VP and NI groups were obtained. Significant improvements in knowledge were found between the sectors of training for the three case studies. Pre-registration trainees reported that the VP enabled them to apply their learning and engage in experiential learning. The VP case studies were associated with greater satisfaction and were reported to provide a more realistic, interactive and enjoyable learning experience. Pre-registration trainee’s perspectives of the VP technology as a learning tool were more favourable regarding the development of real-life complex skills and aspects of learning, which provides a remit for further evaluation of the technology in undergraduate and postgraduate pharmacy training.

Rationale: Audiology student training in New Zealand faces many difficulties with a limited number of qualified instructors and suitable external placements. With a continued shortage of audiologists in New Zealand, new methods of training need to be introduced and implemented. One solution is through the use of realistic, computer-based virtual patient simulators (VPS). HIT Lab New Zealand in conjunction with the University of Canterbury has designed a VPS for New Zealand audiology students. A speech audiometry component is to be developed based on best practice recommendations, and needs to be validated. Method: Two studies, one with 18 Master of Audiology (“expert”) and another with 18 (“novice”) undergraduate students, were evenly divided into simulator and non-simulator user groups. Simulator users had to complete 5 virtual patient cases in addition to the non-simulator users’ requirement to refer to provided lecture notes and speech audiometry protocols. Novice students were assessed on declarative, procedural and retained knowledge of speech audiometry; expert students were additionally assessed on training transfer. The intervention period was set at two weeks, and the retention assessment at four weeks post-intervention.   Results: Expert students who used the simulator significantly improved their training transfer skills. No significant differences were found between and within groups for declarative knowledge and procedural knowledge. Training transfer and procedural knowledge were retained for both groups, but only non-simulator users retained declarative knowledge. Novice students who used the simulator significantly increased their declarative knowledge. Both groups’ procedural knowledge significantly regressed post-intervention. Declarative and procedural knowledge were retained for both groups. Implications: Simulator use appears to accelerate learning outcomes otherwise achievable through traditional learning methods, and does depend on the users’ existing knowledge base. Regular use may be necessary to retain desired learning outcomes. Improvements (e.g., more detailed feedback systems) are to be incorporated into the simulator, and sole reliance on the simulator for learning is not recommended. Future research into more holistic aspects of virtual patient use within the field of audiology and allied health care is warranted.

Agitation and aggression are challenging symptoms commonly experienced by hospitalised cognitively impaired patients. Pain is one well-established cause; however, nurses may not recognise pain-related agitation. This descriptive correlational study examined the clinical decisions of 274 nurses in a virtual simulation of pain-related agitation. Despite high formal knowledge about pain, 95% failed to recognise pain-related agitation and 89% administered antipsychotics. Experiential knowledge, the unconscious but accurate classification of available cues, was identified as crucial to performance. To develop accurate experiential knowledge about pain-related agitation, workplaces may need conditions for deliberate practice, where nurses receive immediate and accurate feedback about their performance.

Les facteurs déterminants des caractéristiques biomécaniques chez la mandibule humaine sont les propriétés des tissues et sa géométrie externe et interne. Des procédures non-invasives pour prédire de façon précise, les contraintes des mandibules soumis aux stress mécaniques sont importantes dans des diverses situations en Odontologie. Les modèles éléments finis (EF), montrent une bonne capacité d’évaluer les relations géométriques, mécaniques et fonctionnelles sur la mandibule. Malgré les progrès récents, la conception de modèles numériques présente encore des limites, liées au manque de connaissances des propriétés mécaniques de tous les tissus, à la conception intégrale du modèles et la possibilité de personnalisation de ceux-ci en tenant compte de la variabilité anatomique, morphologique, physiologique et biologique des individus. Le présent travail vise à définir un modèle d'éléments finis de la mâchoire pouvant être modélisé en fonction des conditions anatomiques et morphologiques particulières d'un individu, de manière à prédire avec précision les réponses mécaniques et biologiques de la mandibule. La définition des paramètres pertinents à l’obtention des modèles de simulation, permettra une évaluation in silico des réponses spécifiques chez les patients aux traitements pratiqués dans le domaine dentaire, en tenant compte de la variabilité morphologique de la mandibule associée aux pertes dentaires. L’objectif de cette recherche est la parameterisation géométrique et mécanique d’un modèle EF d’une mandibule, intégrant les particularités anatomiques d'un individu et permettant de prédire, avec précision, les réponses mécaniques vis-à-vis des traitements dentaires<br>The determining factors of biomechanical characteristics in the human mandible are the properties of the tissues and its external and internal geometry. Non-invasive procedures to predict accurately the mandible stress and strains under mechanical loads are important in a variety of dental situations. The finite element models shows a good ability to evaluate the geometric, mechanical and functional relations on the mandible. Despite recent advances, the design of numerical models still has limitations: the lack of knowledge of the mechanical properties of all tissues, the integral design of the models and the possibility of personalization of these, taking into account the anatomical, morphological, physiological and biological variability of individuals. The present work aims to define a model of finite elements of the jaw that can be modeled according to the particular anatomical and morphological conditions of an individual, in order to accurately predict the mechanical and biological responses of the mandible against loads or mechanical stimuli that affect them. The definition of the parameters relevant to obtaining the appropriate simulation models will enable an in silico assessment of any specific patient responses to dental treatments, in particular in dental implantology, taking into account the morphological variability of the mandible with dental losses. . The objective of this research is the geometrical and mechanical parametrization of an EF model of a mandible, integrating the anatomical particularities of an individual and allowing predicting with precision, the mechanical responses to dental treatments

abstract: 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 making before they encounter real life patients. The utility of a recursive, inductive VPS for increasing clinical decision-making skills, collaboration, or engagement is unknown. Following a design-based methodology, VPS were implemented in two phases with two different cohorts of first year medical students: spring and fall of 2013. Participants were 108 medical students and six of their clinical faculty tutors. Students collaborated in teams of three to complete a series of virtual patient cases, submitting a ballpark diagnosis at the conclusion of each session. Student participants subsequently completed an electronic, 28-item Exit Survey. Finally, students participated in a randomized controlled trial comparing traditional (tutor-led) and VPS case instruction methods. This sequence of activities rendered quantitative and qualitative data that were triangulated during data analysis to increase the validity of findings. After practicing through four VPS cases, student triad teams selected accurate ballpark diagnosis 92 percent of the time. Pre-post test results revealed that PPT was significantly more effective than VPS after 20 minutes of instruction. PPT instruction resulted in significantly higher learning gains, but both modalities supported significant learning gains in clinical reasoning. Students collaborated well and held rich clinical discussions; the central phenomenon that emerged was "synthesizing evidence inductively to make clinical decisions." Using an inductive process, student teams collaborated to analyze patient data, and in nearly all instances successfully solved the case, while remaining cognitively engaged. This is the first design-based study regarding virtual patient simulation, reporting iterative phases of implementation and design improvement, culminating in local theories (petite generalizations) about VPS design. A thick, rich description of environment, process, and findings may benefit other researchers and institutions in designing and implementing effective VPS.<br>Dissertation/Thesis<br>Ed.D. Educational Leadership and Policy Studies 2014

Leung, Yiu Cho Joseph.<br>Thesis (M.Phil.)--Chinese University of Hong Kong, 2011.<br>Includes bibliographical references (leaves 116-118).<br>Abstracts in English and Chinese.<br>LIST OF ABBREVIATIONS --- p.viii<br>LIST OF TABLES --- p.xiii<br>LIST OF FIGURES --- p.xv<br>Chapter CHAPTER 1: --- INTRODUCTION --- p.1<br>Chapter CHAPTER 2: --- VIRTUAL PATIENT AND IT USES AROUND THE WORLD --- p.5<br>Chapter 2.1: --- Introduction --- p.5<br>Chapter 2.2: --- Advantages of Virtual Patient --- p.6<br>Chapter 2.2.1: --- Improved Access to Learning Material --- p.6<br>Chapter 2.2.2: --- Development of Higher Order Learning Skills --- p.6<br>Chapter 2.2.3: --- Provide an Environment for Safe Practice --- p.7<br>Chapter 2.2.4: --- Efficient Use of Teacher's Time --- p.7<br>Chapter 2.2.5: --- Teach Interdisciplinary Care --- p.7<br>Chapter 2.2.6: --- Used for Assessment --- p.8<br>Chapter 2.3: --- Categorizing Virtual Patients --- p.8<br>Chapter 2.4: --- Virtual Patient Authoring System --- p.9<br>Chapter 2.5: --- Virtual Patients Authoring Systems around the World --- p.10<br>Chapter 2.5.1: --- Introduction --- p.10<br>Chapter 2.5.2: --- The CASUS System --- p.10<br>Chapter 2.5.3: --- The CAMPUS System --- p.10<br>Chapter 2.5.4: --- Web-SP --- p.11<br>Chapter 2.5.5: --- OpenLabyrinth --- p.11<br>Chapter 2.5.6: --- vpSim --- p.12<br>Chapter 2.5.7: --- Others Centres Using VPs --- p.12<br>Chapter CHAPTER 3: --- FORMATIVE ASSESSMENT CASES STUDIES --- p.13<br>Chapter 3.1: --- History of FACS --- p.13<br>Chapter 3.2: --- FACS Authoring System --- p.13<br>Chapter 3.3: --- Teaching and Learning Resources Centre --- p.16<br>Chapter CHAPTER 4: --- ANAESTHESIA TEACHING IN CUHK --- p.18<br>Chapter 4.1: --- Introduction --- p.18<br>Chapter 4.2: --- E-learning in Anaesthesia in CUHK --- p.19<br>Chapter 4.2.1: --- Introduction: --- p.19<br>Chapter 4.2.2: --- Preoperative Assessment FACS --- p.19<br>Chapter 4.2.3: --- Storyline Virtual Patient --- p.23<br>Chapter 4.3: --- Preparing the VPs --- p.27<br>Chapter 4.3.1: --- Introduction --- p.27<br>Chapter 4.3.2: --- Focus Group Interview --- p.28<br>Chapter 4.3.3: --- Summary of Findings --- p.29<br>Chapter 4.4.1: --- Methods --- p.29<br>Chapter 4.4.2: --- Results --- p.31<br>Chapter 4.4.2.1: --- Student Usage --- p.31<br>Chapter 4.4.2.2: --- Surveys --- p.32<br>Chapter CHAPTER 5: --- ACUTE PAIN MANAGEMENT VIRTUAL PATIENTS --- p.37<br>Chapter 5.1: --- Introduction --- p.37<br>Chapter 5.2: --- Acute Pain Management FACS --- p.38<br>Chapter 5.3: --- Storyline Virtual Patient Chapter 6 --- p.40<br>Chapter CHAPTER 6: --- COMPARING FACS AND SL-VP ON APM (2009-2010) --- p.41<br>Chapter 6.1: --- Introduction --- p.41<br>Chapter 6.2: --- Study Design --- p.42<br>Chapter 6.2.1: --- Background Information --- p.42<br>Chapter 6.2.2: --- Research Plan --- p.43<br>Chapter 6.3: --- Hypothesis --- p.44<br>Chapter 6.4: --- Module MCQ Examination --- p.44<br>Chapter 6.4.1 --- Administration of Test: --- p.44<br>Chapter 6.4.2 --- IDEAL Programme: --- p.46<br>Chapter 6.5: --- Module MEQ Examination --- p.51<br>Chapter 6.6: --- Final MEQ Examination --- p.52<br>Chapter 6.7: --- Login Data --- p.52<br>Chapter 6.8: --- Survey --- p.53<br>Chapter 6.9: --- Student-Teacher Questionnaire --- p.53<br>Chapter 6.10: --- Results and Findings --- p.54<br>Chapter 6.10.1: --- Introduction --- p.54<br>Chapter 6.10.2 --- Module MCQ Examination --- p.55<br>Chapter 6.10.2.1: --- Result --- p.55<br>Chapter 6.10.2.2: --- Discussion --- p.58<br>Chapter 6.10.3: --- Module MEQ Examination --- p.59<br>Chapter 6.10.3.1: --- Result --- p.59<br>Chapter 6.10.3.2: --- Discussion --- p.61<br>Chapter 6.10.4.1: --- Result --- p.62<br>Chapter 6.10.4.2: --- Discussion --- p.67<br>Chapter 6.10.5: --- Login Time --- p.68<br>Chapter 6.10.5.1: --- Result --- p.68<br>Chapter 6.10.5.2: --- Discussion --- p.69<br>Chapter 6.10.6: --- Survey --- p.70<br>Chapter 6.10.6.1: --- Usage --- p.70<br>Chapter 6.10.6.2: --- E-Learning Material from Anaesthesia Department --- p.71<br>Chapter 6.10.6.3: --- Comparisons between FACS and SL-VP --- p.72<br>Chapter 6.10.6.4: --- Improving Students for their Future Role as Surgical House Officers --- p.73<br>Chapter 6.10.6.5: --- Students' opinion on teaching methods --- p.74<br>Chapter 6.10.6.6: --- Free text comments --- p.74<br>Chapter 6.10.6.7: --- Discussion --- p.75<br>Chapter 6.10.7: --- Student-Teacher Questionnaire --- p.77<br>Chapter 6.10.7.1: --- Result --- p.77<br>Chapter 6.11: --- Discussion --- p.78<br>Chapter 6.11.1: --- VPs on students' examination outcome --- p.78<br>Chapter 6.11.2: --- Comparing between FACS and SL-VP --- p.79<br>Chapter 7.1: --- Introduction --- p.82<br>Chapter 7.2: --- Study Design --- p.82<br>Chapter 7.3: --- Research Plan --- p.83<br>Chapter 7.3.1: --- Module MCQ Examination --- p.84<br>Chapter 7.3.2: --- Module MEQ Examination --- p.84<br>Chapter 7.3.3: --- Final MEQ Examination --- p.84<br>Chapter 7.4: --- Hypothesis --- p.85<br>Chapter 7.5: --- Result and Findings --- p.85<br>Chapter 7.5.1: --- Introduction --- p.85<br>Chapter 7.4.2: --- Module MCQ Examination --- p.85<br>Chapter 7.4.2.1: --- Result --- p.85<br>Chapter 7.4.2.2: --- Discussion --- p.88<br>Chapter 7.4.3: --- Module MEQ Examination --- p.89<br>Chapter 7.4.3.1: --- Result --- p.89<br>Chapter 7.4.3.2: --- Discussion --- p.90<br>Chapter 7.4.4: --- Final MEQ Examination --- p.91<br>Chapter 7.4.4.1: --- Result --- p.91<br>Chapter 7.4.4.2: --- Discussion --- p.92<br>Chapter 7.5: --- Conclusion --- p.93<br>Chapter CHAPTER 8: --- SUMMARY AND CONCLUSION --- p.94<br>Chapter 8.1: --- Summary of thesis --- p.94<br>Chapter 8.2: --- Limitation --- p.94<br>Chapter 8.3: --- Conclusion --- p.95<br>APPENDIX --- p.96<br>REFERENCES --- p.116

L’observance, qui décrit à quel degré le patient suit la prescription, est un facteur essentiel pour que le traitement réussisse. Les observances des patients varient beaucoup et l’efficacité du médicament varie parallèlement. Par conséquent, il faut avoir des paramètres sensibles et fiables pour mesurer l’observance. Dans la littérature, on trouve beaucoup de paramètres pour évaluer l’observance mais leurs avantages, limites et inconvénients, en ce qui concerne l’évaluation de l’impact de l’observance sur les effets des médicaments n’ont pas encore été étudiés en profondeur. L’évaluation de ces paramètres nécessite de les tester dans différentes situations. Comme les données disponibles sur l’observance ne concernent pas un ensemble exhaustif de situations, le recours à la simulation, en s’inspirant des cas réels ou plausibles, est très pertinent. On a ainsi réussi à développer un modèle dont les paramètres sont simples et compréhensibles et qui est pratique et flexible pour simuler les différents cas et même les cas extrêmes de l’observance. On a proposé de nouveaux paramètres pour mesurer l’impact biopharmaceutique de l’observance. Ensuite, on a comparé la performance, en termes de sensibilité et la fiabilité, des paramètres proposés et celles de paramètres déjà utilisés. En conclusion, on peut souligner qu’il n’y a pas de paramètre parfait étant donné que chacun a ses propres limites. Par exemple, pour les médicaments dont les effets sont directement liés aux leurs concentrations plasmatiques, le pourcentage des doses prises, qui est le paramètre le plus utilisé, offre la pire performance; par contre, le pourcentage des doses correctes nettes qui est un nouveau paramètre possède une bonne performance et des avantages prometteurs.<br>Compliance, which refers to the degree of the conformity to the prescription, is an essential factor for a successful treatment. The compliances of patients vary widely and the effectiveness of medication varies in parallel. Therefore, we need to have reliable and sensible parameters to measure it. In literature, there are many parameters to describe it, but their advantages, disadvantages and limitations regarding the assessment of the impact of compliance on drug have not yet been studied in depth. The evaluation of these parameters requires testing them in different situations. As available compliance data are not exhaustive, the use of the simulation, based on real or plausible cases, is very relevant. We succeeded to develop a model whose parameters are simple and understandable and which is convenient and flexible to simulate the different cases and even the extreme cases of compliance. We proposed new parameters for measuring the biopharmaceutical impact of compliance. Then, we compared the performance, in terms of sensibility and reliability, of these parameters and those already used to assess compliance and discussed their performances and limitations. In conclusion, we can emphasize that there is no ideal parameter since each one has its own limitations. For example, for drugs whose effects are directly related to their plasma concentrations, the percentage of taken doses, which is the most used parameter, has the worst performance, on the other hand, the percentage of the weighted correct doses, which is a new parameter, possesses a good performance and promising advantages.

碩士<br>國立清華大學<br>動力機械工程學系<br>103<br>Numerical method is employed to simulate the muscle material characteristics of obstructive sleep apnea (OSA) patients. A set of averaged muscle material characteristics for the range of body mass index (BMI) examined is concluded to predict the expansion of the patient’s upper airway after surgery for the clinic reference before the surgery. Firstly, the mandibular bone, chin, neck and upper airway models of three patients, whose BMI are similar, are reconstructed based on the computed tomography (CT) images before and after surgery. Then, the model structures before and after “virtual surgery” are simulated by computational solid mechanics (CSM) with the assumptions of elasticity, anisotropy and homogeneous muscle material characteristics. Iterations are subsequently performed through comparing the model outlines obtained by “virtual surgery” simulation and the clinical surgery to acquire the appropriate muscle material characteristics of patients. A set of proper muscle material characteristics of patients is thus attained for 21<BMI<23. On the other hand, the flow structures and pressure lose of upper airway both before and after clinical surgery as well as after “virtual surgery” are investigated and compared using computational fluid dynamics (CFD) with k-ωSST model at a flow rate 5×〖10〗^(-4) m^3/s of healthy persons. The results of CSM “virtual surgery” and CFD simulations show that the average differences of upper airway narrow rate and total inhaling pressure drop are 2.1% and 4.1% respectively. It suggests that the new proposed CSM “virtual surgery”-CFD together with the “working procedure” is able to provide useful clinical reference for the condition of upper airway after surgery.