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Koller, Marius. "Supporting Patients and Therapists in Virtual Reality Exposure Therapy." Licentiate thesis, KTH, Skolan för elektroteknik och datavetenskap (EECS), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-244035.
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This thesis explores challenges for the design of Virtual Reality Exposure Therapy (VRET) systems. Exposure therapy is the established method for treatment of anxiety disorders and is typically delivered in-vivo, i.e. exposure to phobic stimulus in real environments. Virtual reality (VR), instead, offers the potential to conduct exposure therapy at the clinic. This approach has several benefits in terms of efficiency, customization and control, amount of exposure, and as an transition phase to real situations. However, currently many systems are limited in scope and are designed for research purposes without informing the design from therapist's practices. My research aims to contribute towards the understanding of current practices in exposure therapy and investigates challenges for the design of these systems for the two main user groups, patients and therapists. Three different focus areas have been prevalent. First, we have studied therapist in real sessions to inform the design and development of VRET-systems. Second, we have evaluated two different VRET implementations supporting therapists to interact with patients. Third, on the patient's side, we have studied presence on healthy participants focusing on the influence of virtual bodies and patient movement in VR. This thesis summarises and discusses these studies. Overall, the studies emphasize the complexity of exposure therapy and the need for individualized patient conditions. This poses multiple challenges for the design of VRET-systems such as, first, the systems must offer flexibility to the therapists to orchestrate individualized therapy. Second, the systems must enable rich therapists-patient interaction. Third, the complexity of individualization of scenarios and sessions must be addressed in the design of the therapist's interface. Fourth, for patients, body avatars influences presence differently depending on the scenario and locomotion is challenging as offices are typically small.QC 20190214
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Toro-Troconis, Maria. "Game-based learning for virtual patients in Second Life®." Doctoral thesis, Luleå tekniska universitet, Arbetsvetenskap, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-25863.
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In the field of medicine, various representative simulations have been developed to support the decreasing number of learning opportunities with real patients; the use of virtual patients is among them. Virtual patients are real-life clinical scenarios used for the purpose of medical education. They usually follow a linear or branching approach and they are usually accessed via a computer browser or as part of a computer programme. The purpose of this thesis was to design, and develop a platform for the delivery of virtual patients following a game-based approach in the virtual world of Second Life®, investigating attitudes and gender differences among medical students at Imperial College London. Virtual worlds, such as Second Life®, are 3D spaces in which users meet and interact and in which learning opportunities can take place. Second Life® was selected for this study due to its popularity among UK Higher Education Institutions at the time of the development. The virtual patients’ activities were designed following game-based learning and pedagogic principles. The technical infrastructure was designed following a Component-Based System (CBS) structure as a distributed three tier architecture presenting information via a Heads-Up-Display (HUD). The first study carried out concentrated on the survey “My feelings when playing games” developed by Bonnano and Kommers (2008). The survey was comprised of 21 statements. Six statements related to the affective component, five statements are about perceived usefulness, six statements about perceived control and four statements about behavioral components. Two groups were involved, one accessing a virtual patient via Second Life® and the other via an e-module. This study involved 42 Year 3 undergraduate medical students (21 years old). The gender distribution of the respondents was 42.85% female (n = 18) and 57.14% male (n = 24). The tendency encountered in each group towards the different attitudinal components was analysed as well as gender-related attitudes. Both groups showed very similar results in relation to the Attitudinal Components. In general, females demonstrated a more positive attitude overall for the perceived usefulness component. Other studies looked at and contrasted, provided interesting thoughts and reflections on gender tendencies and game play. It was concluded that more inclusive and holistic studies in this area ought to be carried out in order to identify game play tendencies in professional-level simulation with adults at university level, which may counteract outdated perceptions about age and gender differences in game play. The second study described the use of the Nominal Group Technique (NGT) to assess students’ attitudes again. Two groups of undergraduate medical students (Yr 3, n=14) were invited to participate. The research question posed was: “In your opinion what are the advantages and disadvantages of learning in Second Life® compared with other methods?” The results provide a different perspective to the ones highlighted in the first study. Results from the first group focused on the learning experience highlighting its importance for clinical diagnosis as a structure for learning. The second group focused on the clinical exposure although they were ambivalent about the advantages of this type of delivery mode. In general, learners did not find the virtual patient activities challenging enough. The results of this thesis show that although a game-based learning approach was followed in the design of the virtual patient activities and interfaces, the repetitive linear presentation of the cases did not motivate the students enough, targeting only low-end Cognitive skills which may be more suitable for students in Year 1 and 2. The use of more challenging branching learning experiences, such as the ones developed by the PIVOTE authoring system are suggested for the delivery of virtual patients in clinical years. All the programming code used in the CBS has been released as open source, licensed under a Creative Commons Attribution-Non Commercial 3.0 License, in order to stimulate other interested parties in the development of similar applications in the virtual world of Second Life®.Godkänd; 2011; 20111110 (andbra); DISPUTATION Ämnesområde: Genus och teknik/Gender and Technology Opponent: Professor Jan Gulliksen, School of Computer Scicence and Communication, Kungliga Tekniska Högskolan, Stockholm Ordförande: Professor Ulf Mellström, Centrum för genusforskning, Karlstads universitet/ Luleå tekniska universitet. Tid: Fredag den 16 december 2011, kl 13.00 Plats: F531, Luleå tekniska universitet
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Duboc, Jean-Remy. "Dynamic feedback generation in virtual patients using semantic web technologies." Thesis, University of Southampton, 2013. https://eprints.soton.ac.uk/355540/.
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Virtual patients are interactive tools commonly used by medical schools for teaching and learning, and as training tools for the development of clinical reasoning. The feedback delivered to students is a crucial feature in virtual patients. Personalised feedback, in particular, helps students to reflect on their mistakes and to organise their knowledge in order to use it appropriately in a clinical context. However, authoring personalised feedback in virtual patient systems can become a di�cult task, due to the large number of choices available to students and the complex implications of each choice. Additionally, the current technologies used for the design and exchange of virtual patients have limitations in terms of interoperability and data reusability. Semantic web technologies are designed to model complex knowledge in a flexible manner, allowing easy data sharing from multiple sources and automatic data processing. This thesis demonstrates the benefitts of Semantic Web technologies for the design of virtual patients, in particular for the automatic generation of personalised feedback. Seven important types of personalised feedback were identified from the literature, and a preliminary survey showed that students in year 3 to 5 consider two of these types of feedback to be particularly useful: feedback indicating actions that each student should have chosen but neglected, and feedback indicating the diagnoses that each student should have tested and rule out or confi�rmed, given the initial presentation of the patient. SemVP, a Semantic Web-based virtual patient system, was created and evaluated by medical students, using a quantitative survey and qualitative interviews. This study showed that SemVP can generate useful personalised feedback, without the need for a virtual case author to write feedback manually, using a semantic model representing both the virtual patient and each student's actions, and leveraging existing data sources available online.
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Zary, Nabil. "Virtual patients for education, assessment and research : a web-based approach /." Stockholm, 2007. http://diss.kib.ki.se/2007/978-91-7357-272-9/.
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Burge, Tracey Ann. "The usability of virtual patients to facilitate clinical reasoning in physiotherapy." Thesis, Brunel University, 2016. http://bura.brunel.ac.uk/handle/2438/12446.
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Clinical reasoning is essential for effective physiotherapy practice, but its complexity makes it difficult to teach and learn. The literature suggests it is learnt within the practice environment and improves with patient-centred experience. However, physiotherapy education has a diminishing availability of practice-based learning. Patient simulation is used within medicine to counteract the decline in practice-based learning and to ease the theory-practice gap. This thesis explores the use of patient simulation to ease the theory-practice gap within physiotherapy. The literature relating to clinical reasoning, technology enhanced learning, simulation and virtual patients was reviewed. An institutional focus study was undertaken which explored the implementation of technology enhanced learning in physiotherapy education and detailed the development of a virtual patient simulation. A case study approach was used to explore the usability of virtual patient simulation to facilitate clinical reasoning and ease the theory-practice gap. Twenty-six physiotherapy students participated. Three virtual patients were made available for three months for self-directed learning. Data was collected using focus groups and the think-aloud method was employed to capture the verbalised thought processes of nine participants while assessing a virtual patient. This was supported by electronic data capture methods within the virtual patient software. Thematic analysis was used to interpret the qualitative data sets. Findings showed the fidelity of virtual patients facilitated clinical reasoning and eased the theory-practice gap. Participants perceived the virtual patient concept had merit and should be used in peer learning as part of their curriculum. Usability issues were identified and improvements suggested The think-aloud method revealed the value of educators supervising physiotherapy students verbalise their clinical reasoning, to identify errors and improve learning.
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Sham, Rosalind. "Virtual reality-based spatial memory intervention in patients with mild cognitive impairment." Thesis, McGill University, 2013. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=114495.
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Patients with Mild Cognitive Impairment (MCI) typically show atrophy of the hippocampus, which is a major risk factor for developing Alzheimer's disease. Prevention of hippocampal atrophy is therefore important as it may delay the onset of dementia. Previous research in our laboratory showed a specific association between the hippocampus and spatial memory (i.e., memory for locations or places). We thus developed a computerized spatial memory improvement program (SMIP) that stimulates the hippocampus. In this study, healthy older adults and participants with MCI were assigned to receive SMIP training, or not. Following training, we found that SMIP-trained healthy older adults showed significant spatial memory improvements. SMIP-trained MCI participants likewise showed individual spatial memory improvements after training. Though these results are preliminary, they are promising and suggest the effectiveness of SMIP at reducing symptoms associated with MCI.Les patients atteints de trouble cognitif léger (TCL) présentent habituellement une atrophie de l'hippocampe, un facteur de risque majeur pour le développement de la maladie d'Alzheimer. Il est donc important de prévenir cette atrophie hippocampale car cela pourrait permettre de repousser la venue de la démence. Des études précédentes menées au sein de notre laboratoire ont démontré qu'il existe une association spécifique entre l'hippocampe et la mémoire spatiale, définie comme étant la mémoire des lieux. Nous avons donc développé un programme d'entrainement de la mémoire spatiale (PEMS) informatisé qui stimule l'hippocampe. Dans la présente étude, des patients atteints de TCL et des personnes âgées saines ont été assignées soit au groupe recevant l'entrainement PEMS soit au groupe contrôle sans entrainement. Après l'entraînement, les participants sains ayant été entrainés à l'aide du PEMS ont présenté une amélioration significative de la mémoire. Les participants TCL ayant reçu l'entrainement ont de même démontré des améliorations individuelles de la mémoire spatiale. Bien que ces résultats soient préliminaires, ils sont prometteurs et suggèrent que le PEMS pourrait effectivement aider à réduire les symptômes associés au TCL.
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Andrews, Tresa. "Virtual environments and memory training : a preliminary investigation into the feasibility and efficacy of training amnesic patients in a virtual environment." Thesis, University of East London, 1999. http://roar.uel.ac.uk/3649/.
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Virtual Reality, despite its strong association with the entertainment industry, has recently been suggested for use within the field of neurological rehabilitation. However, to date there has been a relative absence of systematic studies carried out to assess the feasibility, or the potential benefits, for the widespread use of Virtual Environments (VEs) in memory rehabilitation. This investigation aimed to provide preliminary responses to two basic questions concerning the use of VEs in the field of memory training: (1) are VEs a feasible approach and; (2) are they an effective approach to training memory of patients with amnesia resulting from a wide crosssection of single neurological insults and progressive neurological diseases. Six single case experiments were described. All participants presented with amnesia. Three participants were resident in a neurological rehabilitation unit prior to study. The other three were resident in a dementia care unit. The participants' responses to the use of VEs were gained. All participants performed routes in a detailed computer-generated 3D VE based on a rehabilitation unit. Participants also received training on routes, with one of two other route training methods. Their subsequent performance on routes in the real unit was compared to assess the relative merits of training in the VE and with one of the other training methods (map or real unit training). Whilst it was acknowledged that the design of this study (single-case) only allowed the results gained to be regarded as exploratory, the present study provided evidence for the feasibility of using VEs with a varied population of patients with single neurological insult. However, it did not provide evidence for the feasibility of using VEs with a varied population of patients with progressive neurological disease. In terms of specific benefits, the findings from the present study were regarded as promising in suggesting a role for VEs in enhancing impaired memory, for those with single neurological insult. Whereas, for those with progressive neurological disease, the present findings were regarded as less promising.
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Kotitsa, Maria. "Planning and organizational abilities in patients with frontal lobe neurosurgery investigated using virtual reality." Thesis, King's College London (University of London), 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.422311.
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Shakra, Ismail. "Design and development of a virtual reality haptic-based rehabilitation framework for post-stroke patients." Thesis, University of Ottawa (Canada), 2006. http://hdl.handle.net/10393/27294.
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The recovery of hand functions in post-stroke patients relies on the length of therapy that is available to them. Rehabilitation exercises supervised by occupational therapists are characterized by repetitiveness and a constant increase in intensity. The facilities and time allocated to recovering stroke patients restrict the maximum level of rehabilitation that can be attained. Various efforts have been materialized into rehabilitation themes set in virtual environments and carried out via haptic devices. This thesis carries forward in that direction by implementing virtual reality, haptic-based exercises for the purposes of hand rehabilitation. This building step aspires to catalyze the motion to bring about a haptic-based rehabilitation system that can be set in the patient's own house to provide him/her with treatment that is not restricted by time and facilities and that offers continuous evaluation of the patient's improvement.
This thesis presents a framework that implemented virtual reality exercises carried out with the use of haptic devices with the aim of being used by recovering stroke patients. The exercises were tested with healthy subjects to collect information pertaining to the hand performance; namely about the movement and grip of the hand. The information collected was extracted from data recorded during the exercise, like position of the hand in the virtual space, and angles made by fingers when grasping objects. By analyzing the data carefully, the research effort deduced certain analysis patterns that would provide occupational therapists with a means to continuously evaluate a patient's performance, and hence provide him/her with adaptive recovery courses.
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Morris, Linzette Deidre. "Virtual reality exposure therapy as treatment for pain catastrophizing in Fibromyalgia patients : proof-of-concept." Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/79876.
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Thesis (PhD)--Stellenbosch University, 2013.ENGLISH ABSTRACT: Research objective To test a novel concept that exposing patients with fibromyalgia syndrome (FMS) to visuals of exercise activities elicits neurophysiological changes in functional brain areas associated with pain catastrophization; thereby providing preliminary support for the further development/testing of a virtual reality exposure therapy (VRET) exercise program aimed at reducing pain catastrophization toward exercise therapy in patients with FMS. Methods The main study of this research consisted of a three-phase exploratory fMRI study. Phase 1 involved the development/validation of the fMRI visual task. Phase 2 involved the exploration of the differences in neural correlates associated with pain catastrophizing between participants with FMS and healthy controls when exposed to various visuals of exercise and passive/relaxing activities. Phase 3 involved the testing of the preliminary efficacy of a novel VRET exercise program on pain catastrophization in participants with FMS. The fMRI task consisted of two stimuli: active (exercise activity visuals)/passive (relaxing activity visuals). Structural images as well as blood-oxygenation-level-dependent (BOLD) contrasts were acquired for the conditions and compared within-subjects/groups and between-groups. The condition of interest was the active>passive condition (where brain activations for the passive condition were subtracted from the active condition). The brain volumes collected during ‗on‘ conditions were compared with the brain volumes collected during ‗off‘ conditions using Students‘ t test. Statistic images were thresholded using clusters determined by Z>2.3 and a (corrected) cluster significance threshold of p=0.05. Results The right (R) middle and inferior frontal gyrus and R posterior cerebellum were significantly activated for the participants with FMS, and not the healthy control group, during the active>passive condition (phase 2). At baseline, during the active>passive condition (phase 3), the intervention/VRET group showed significant activation (p<0.05) in the R insular cortex, R anterior and posterior cerebellum, R parahippocampal gyrus, R middle frontal gyrus, R corpus callosum, R thalamus, R supramarginal gyrus and R middle and superior temporal gyrus; the control group showed significant activation in the R anterior and posterior cerebellum, R middle and superior temporal gyrus, R middle frontal gyrus, R insular cortex, R supramarginal gyrus and R precentral gyrus. Post-intervention, during the active>passive condition, R posterior cerebellum activation was still significant (p<0.05) for the intervention group; R anterior cerebellum, left (L) middle and inferior frontal gyrus, and R superior parietal lobe activation was found to be significant (p<0.000) for the control group, although these areas were not found to be significantly activated at baseline for the control group. Conclusion We could not provide confirmatory evidence for the efficacy of a novel VRET program for pain catastrophization in patients with FMS. However, the findings of this study does suggest that pain catastrophization in patients with FMS could be confirmed with fMRI. Research is therefore warranted to further develop a proper VRET exercise program and to test the effect of this program on pain catastrophization in patients with FMS.
AFRIKAANSE OPSOMMING: Navorsing doelstelling Om 'n nuwe konsep dat die blootstelling van pasiënte met fibromialgie sindroom (FMS) aan beeldmateriaal van oefening, ontlok neurofisiologiese veranderinge in funksionele brein-areas wat verband hou met pyn katastrofering te toets; sodoende voorlopige steun vir die verdere ontwikkeling/toetsing van 'n virtuele realiteit blootstelling terapie (VRET) oefenprogram wat gemik is op die vermindering van pyn katastrofering na oefenterapie in pasiënte met die FMS te bied. Metodes Die hoofstudie van hierdie navorsing bestaan uit 'n drie-fase verkennende fMRI studie. Fase 1 het die ontwikkeling/validering van die fMRI visuele taak behels. Fase 2 het die ondersoek van die verskille in die neurale korrelate geassosieer met pyn katastrofering tussen deelnemers met FMS en gesonde kontroles wanneer hulle blootgestel word aan verskeie beeldmateriaal van oefening en passiewe/ontspannende aktiwiteite behels. Fase 3 het die toets van die voorlopige effektiwiteit van 'n nuwe VRET oefenprogram op pyn katastrofering in deelnemers met FMS behels. Die fMRI taak het bestaan uit twee stimuli: aktiewe (oefening aktiwiteit beeldmateriaal)/passiewe (ontspannende aktiwiteit beeldmateriaal). Strukturele beelde sowel as bloed-suurstof-vlak-afhanklike (BSVA) kontraste is vir die toestande verkry en vergelyk binne-deelnemers/groepe en tussen-groepe. Die toestand van belang was die aktiewe>passiewe toestand (waar brein aktivering vir die passiewe toestand afgetrek is van die aktiewe toestand). Die brein volumes wat ingesamel tydens die 'aan' toestande is vergelyk met die brein volumes wat ingesamel is gedurende die 'af' toestande met die gebruik van Studente se t-toets. Drempel statistiek beelde is gegroepeer deur Z> 2,3 en 'n (gekorrigeerde) groepeerde betekenisvolle drempel van p = 0.05. Resultate Die regter (R) middel- en inferior-frontale gyrus en R posterior serebellum is betekenisvol geaktiveer vir die deelnemers met FMS, maar nie vir die gesonde kontrole groep nie, gedurende die aktiewe>passiewe toestand (fase 2). By basislyn, tydens die aktiewe>passiewe toestand (fase 3), die intervensie / VRET groep het betekenisvolle aktivering (p <0.05) in die R insulaire korteks, R anterior en posterior serebellum, R para- hippokampus gyrus, R middel-frontale gyrus, R korpus kallosum, R talamus, R supramarginale gyrus en R middel- en superior-temporale gyrus; die kontrole groep het betekenisvolle aktivering in die R anterior en posterior serebellum, R middel- en superior-temporale gyrus, R middel-frontale gyrus, R insulaire korteks, R supramarginale gyrus en R presentrale gyrus. Post-intervensie, tydens die aktiewe>passiewe toestand, was R posterior serebellum aktivering betekenisvol (p <0.05) vir die intervensie groep; R anterior serebellum, links (L) middel- en inferior-frontale gyrus en R superior pariëtale lob aktivering was betekenisvol (p <0.000) vir die kontrole groep, alhoewel geen betekenisvolle basislyn aktivering in hierdie areas by die kontrole groep plaasgevind het nie. Gevolgtrekking Ons kan nie bewyse vir die effektiwiteit van 'n nuwe VRET program vir pyn katastrofering in pasiënte met FMS bevestig nie. Nietemin, dui die bevindinge van hierdie studie wel daarop dat pyn katastrofering in pasiënte met FMS bevestig kon word met fMRI. Verdere navorsing is dus geregverdig om 'n behoorlike VRET oefenprogram te ontwikkel en die uitwerking van hierdie program op pyn katastrofering in pasiënte met FMS te toets.
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Лобода, Андрій Миколайович, Андрей Николаевич Лобода, and Andrii Mykolaiovych Loboda. "A consortium approach to revolutionising subject-based teaching in the medical curriculum of post-Soviet countries: What can ePBLnet teach us?" Thesis, The Association for Medical Education in Europe (AMEE), 2013. http://essuir.sumdu.edu.ua/handle/123456789/31890.
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Початкова презентація описує загальну структуру пострадянських навчальних програм. Учасники вивчають шляхи трансформації власних навчальних програм (з демонстрацією копій цих перетворень), а також розглядають питання про потенціал ePBLnet для напрацювання спільних межвуніверситетських підходів.
При цитуванні документа, використовуйте посилання http://essuir.sumdu.edu.ua/handle/123456789/31890Начальная презентация описывает общую структуру постсоветских учебных программ. Участники изучают пути трансформации собственных учебных программ (с демонстрацией копий этих преобразований), а также рассматривают вопрос о потенциале ePBLnet для выработки общих межвуниверситетских подходов. При цитировании документа, используйте ссылку http://essuir.sumdu.edu.ua/handle/123456789/31890
An initial presentation will describe the common structure of Post Soviet curricula. Participants explore ways in which they could modify their own curricula (they may wish to bring a copy with them), and consider whether the cross-institutional approach of ePBLnet has potential for them. When you are citing the document, use the following link http://essuir.sumdu.edu.ua/handle/123456789/31890
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Palathinkal, Joel. "The effectiveness of virtual humans vs. pre-recorded humans in a standardized patient performance assessment." Doctoral diss., University of Central Florida, 2011. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/4817.
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A Standardized Patient (SP) is a trained actor who portrays a particular illness to provide training to medical students and professionals. SPs primarily use written scripts and additional paper-based training for preparation of practical and board exams. Many institutions use various methods for training such as hiring preceptors for reenactment of scenarios, viewing archived videos, and computer based training. Currently, the training that is available can be enhanced to improve the level of quality of standardized patients. The following research is examining current processes in standardized patient training and investigating new methods for clinical skills education in SPs. The modality that is selected for training can possibly affect the performance of the actual SP case. This paper explains the results of a study that investigates if there is a difference in the results of an SP performance assessment. This difference can be seen when comparing a virtual human modality to that of a pre-recorded human modality for standardized patient training. The sample population navigates through an interactive computer based training module which provides informational content on what the roles of an SP are, training objectives, a practice session, and an interactive performance assessment with a simulated Virtual Human medical student. Half of the subjects interact with an animated virtual human medical student while the other half interacts with a pre-recorded human. The interactions from this assessment are audio-recorded, transcribed, and then graded to see how the two modalities compare. If the performance when using virtual humans for standardized patients is equal to or superior to pre-recorded humans, this can be utilized as a part task trainer that brings standardized patients to a higher level of effectiveness and standardization.; In addition, if executed properly, this tool could potentially be used as a part task trainer which could provide savings in training time, resources, budget, and staff to military and civilian healthcare facilities.ID: 030646195; System requirements: World Wide Web browser and PDF reader.; Mode of access: World Wide Web.; Thesis (Ph.D.)--University of Central Florida, 2011.; Includes bibliographical references (p. 128-134).
Ph.D.
Doctorate
Psychology
Sciences
Modeling and Simulation
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Pompeii, Jo Anna. "Nonpharmacological pain management in pediatric patients in the acute care setting." Honors in the Major Thesis, University of Central Florida, 2009. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/1308.
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This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.Bachelors
Nursing
Nursing
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Chavez, Arreola Arturo. "Mechanical analysis of a virtual Ganz periacetabular osteotomy in patients suffering hip malformations by using finite element analysis." Thesis, University of Manchester, 2016. https://www.research.manchester.ac.uk/portal/en/theses/mechanical-analysis-of-a-virtual-ganz-periacetabular-osteotomy-in-patients-suffering-hip-malformations-by-using-finite-element-analysis(7abe47ac-4a7f-48c7-b338-d44ff328e1f7).html.
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Developmental dysplasia of the hip (DDH) refers to some hip disorders, from mildly dysplastic to hip joint dislocation. The main feature of DDH is the deficient acetabular coverage, which is related to a small contact area in the hip joint, and causes an increase in contact pressure. Ganz periacetabular osteotomy (PAO) is a surgical procedure to correct acetabular orientation in DDH. It changes the position of the acetabulum to increase the femoral head coverage and distribute the contact pressure over the cartilage surface. The procedure of Ganz PAO is technically demanding and its success depends significantly on the surgeon’s experience. The aim of this research is to investigate whether it is possible to optimize the position of the acetabular fragment in patients suffering DDH before a Ganz PAO by using finite element (FE) analysis. Using computed tomography (CT) data from patients with DDH, five three-dimensional (3D) hip models were developed. A virtual Ganz PAO was then performed on the hip models. FE analyses were carried out on the hip models before and after virtual Ganz PAO. Contact area, contact pressure and Von Mises stress in the hip cartilage were checked and analysed in order to find an optimal acetabular position. The first virtual surgery performed was only to rotate the acetabular fragment in the lateral direction to improve the acetabular coverage. Analyses were conducted under loading conditions associated with four commonly daily activities: one leg stance, normal walking, descending stairs and knee bend. Second virtual surgery performed was to rotate the fragment in both the lateral and anterior directions and FE analysis conducted for one leg stance loading condition. Contact area, contact pressure and Von Mises stress in the cartilage all varied according to the change of the acetabular fragment position through virtual Ganz PAO. The optimal lateral position of the acetabular fragment occurs close to the inferior border of its normal range. Large anterior position of the acetabular fragment results in large contact area, low contact pressure and Von Mises stress. However, an overcorrection of the acetabular fragment, especially in the anterior correction, leads to problems in performing normal hip movements. The optimal anterior position of the acetabular fragment is therefore close to the superior limit of the normal range. In conclusion, the present analysis shows that an optimal position of the acetabular fragment for patients suffering DDH which improves the acetabular femoral head coverage in the normal range, maximizes the contact area and minimizes the contact pressure and Von Mises stress can be established using 3D models and FE analysis. This information will be useful to the surgeons for the planning of PAO.
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Ho, Wai-sze, and 何惠思. "An evidence-based guideline on using virtual reality analgesia for procedural pain in adult burn patients in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B44623471.
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Graham, Frederick. "Do hospital nurses recognise pain in older agitated patients with cognitive impairment? A descriptive correlational study using virtual simulation." Thesis, Queensland University of Technology, 2021. https://eprints.qut.edu.au/207250/1/Frederick_Graham_Thesis.pdf.
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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.
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Morris, Linzette Deidre. "Effect of a low-cost virtual reality system on reducing pain and anxiety in adult burn injury patients during physiotherapy." Thesis, Stellenbosch : University of Stellenbosch, 2009. http://hdl.handle.net/10019.1/4820.
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A thesis presented in partial fulfillment of the requirements for the degree of
M.Sc. in Physiotherapy at the Stellenbosch University.Thesis (MSc (Interdisciplinary Health Sciences. Physiotherapy))--University of Stellenbosch, 2009.
ENGLISH ABSTRACT: Background Albeit Virtual Reality (VR) has been shown to be a useful adjunct in the reduction of pain during burn care and therapy, the current VR systems are expensive and may not be economically feasible for developing countries such as South Africa, where health budgets are stringent. Objective The purpose of this study was to ascertain the effect of a lowcost VR system (eMagin Z800 3DVisor), used in conjunction with pharmacologic analgesics, on reducing pain and anxiety in adult burn injury patients undergoing physiotherapy treatment, compared to pharmacologic analgesics alone at a South African hospital. Study design Single-blinded, within-subject study design. Methods Pain and anxiety outcome measures were measured by a blinded assessor using the Numeric Pain Rating Scale and Burn Specific Pain and Anxiety Scale. Descriptive statistics, Chi-square tests as well as the Student’s paired t-test were used to analyze data. Main findings Eleven eligible adult burn injury patients consented to participate in this study (3 female, 8 male; median age 33 years: range 23-54 years). A marginal (p=0.06) to insignificant (p=0.13) difference between the two conditions (analgesics with VR and analgesics alone) in reducing pain was found. No significant difference (p=0.58) was found between the two conditions (analgesics with VR and analgesics alone) for anxiety. Interpretation There is a trend that a low-cost VR system, when added to routine pharmacologic analgesics, is an economically feasible and safe adjunct therapy and could be of considerable benefit if implemented into the current pain management regimen of burn injury patients at a South African Hospital.
AFRIKAANSE OPSOMMING: Agtergrond Ofskoon dit al bewys is dat Virtuele Realiteit (VR) ’n nuttige hulpmiddel is om pyn tydens die versorging en behandeling van brandslagoffers te verlig, is die huidige VR stelsels duur en dalk nie uitvoerbaar in ontwikkelende lande soos Suid-Afrika waar die gesondheidsbegrotings beperk is nie. Doel Om die uitwerking te bepaal van ’n laekoste VR stelsel (eMagin Z800 3DVisor) op die vermindering van pyn en angs by volwasse pasiënte met brandwonde wat fisioterapeutiese behandeling in ’n Suid-Afrikaanse hospitaal ondergaan. Studieplan ’n Enkel-blinde, binnesubjek-ontwerp. Metodes Volwasse proefpersone is opeenvolgend gewerf by die brandeenheid van die Tygerberg-hospitaal. Die laekoste VR stelsel, tesame met pynstillers, is ewekansig aan een helfte van die pasiënte in’n fisioterapeutiese behandelingsessie toegewys en die proefpersone is slegs een keer getoets. Die pyn en angs se resultaatmetings is deur ’n blinde meting gedoen deur die numeriese pynskattingskaal en die brandspesifieke pyn- en angsskaal te gebruik. Beskrywende statistieke, Chi-kwadraat-toetse en studente se gepaarde t-toets is gebruik om die data te analiseer. Bevindings Elf geskikte volwasse pasiënte met brandwonde het ingestem om aan die studie deel te neem, drie was vroulik en agt was manlik (mediaan-ouderdom 33; reeks 23-54). ’n Marginale (p=0.06) tot onbeduidende verskil (p=0.13) is gevind tussen die twee kondisies om pyn te verlig (met of sonder die toediening van VR). Wat angs betref, is geen beduidende verskille (p=0.58) tussen die twee kondisies (met of sonder die toediening van VR) gevind nie. Interpretasie Daar is ’n neiging dat ’n laekoste VR-stelsel, wanneer dit saam met die gewone farmakologiese pynstillers gebruik word, ’n veilige en ekonomiese praktiese adjunk therapie is en beduidend voordelig kan wees wanneer dit geïmplementeer word as deel van die huidige pynbeheerregimen van brandslagofferpasiënte by ’n Suid-Afrikaanse hospitaal.
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Schladen, Manon Maitland. "Formative Research on an Instructional Design Theory for Virtual Patients in Clinical Education: A Pressure Ulcer Prevention Clinical Reasoning Case." NSUWorks, 2015. http://nsuworks.nova.edu/gscis_etd/35.
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Despite advances in health care over the past decades, medical errors and omissions remain significant threats to patient safety and health. A large number of these mistakes are made by trainees, persons who are just beginning to build the case-based experiences that will transform them from novices to expert practitioners. Clinicians use both intuitive and deductive problem-solving skills in caring for patients and they acquire expertise in applying these skills through interaction with many and varied cases.
The contemporary heath care environment, with decreased lengths of stay for patients and reduced duty hours for trainees, makes getting optimal patient exposure difficult. Virtual patients (VPs), online, interactive patient cases, may help close the case exposure gap. Evidence has shown that VPs improve clinical reasoning skills, but no formal instructional design theory of VPs has been advanced. The goal was to conduct formative research to develop an instructional design theory of VPs to help novice clinicians cultivate clinical reasoning and diagnostic skills. The instructional design theory, goal-based scenarios (GBS), grounded in the learning theory, Case-based Reasoning, provided methods that promised to be appropriate to the goal.
An existing, two-module, multimedia VP, Matt Lane, A Pressure Ulcer Prevention Virtual Patient, was tested with 10 medical trainees to determine which methods of GBS it incorporated and which of its methods were not part of GBS. Leaners' experience of what worked and didn't work to promote learning in the VP was analyzed. The VP was found to incorporate all GBS methods and one significant method, the Life Model, that was not part of GBS. The Life Model Method involved replicating, with a high degree of fidelity, the experiences of a real patient in creating the VP scenario.
Recommendations for customization of GBS for VPs included more explicit advertisement of learning goals and leverage of Internet search engines to provide just-in-time resources to support problem-solving. Incorporation of the Life Model was also recommended along with the Simplifying Conditions Method from Elaboration Theory to manage the complexity inherent in the Life Model. The resultant, enhanced GBS theory may be particularly relevant in teaching patient-centered care.
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Akinladejo, Felix O. "Computer-Supported Rehabilitation Management A Case Study of Using Virtual Reality Technology in Ambulatory Training for Post-Acute Stroke Patients." NSUWorks, 2005. http://nsuworks.nova.edu/gscis_etd/383.
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This study investigated the use of virtual reality (VR) technology in ambulatory training for post-acute stroke patients, and sought to determine whether skills gained in virtual environments transfer to real-world conditions. Patients with stroke typically suffer dysfunctions that impair the complex set of motions involved in walking. The limited amount of therapy and resources offered by the current health care system does not provide the frequency and intensity of training needed for functional recovery of the walking skills in patients following stroke assaults. This study, therefore, developed and investigated an alternative intervention technique capable of providing the frequency and intensity needed for improving the walking skills in post-acute stroke patients. The study also helped clarify the controversies surrounding the issue of whether skills gained in the virtual environment transfer to the real world.
The research study employed the single case design method to report the results observed from four post-acute stroke patients who trained on a computer-based therapy program for about half an hour per day, five days a week, for a period of four consecutive weeks. The patients performed a VR exercise using a head-mounted display, and their gait variables were analyzed to determine the usefulness of virtual reality technology in ambulatory training for post-acute stroke patients.
A follow up examination conducted one week after the intervention sought to determine whether the patients could perform the skills learned on the VR-based intervention program in the real world. The results of the research showed that all the patients improved on their gait parameters and could walk better after the computer-based intervention program. An observational gait analysis carried out showed that the skills gained in the virtual environment transferred to real-world conditions.
The study contributes to the current effort to provide wider access to therapeutic intervention techniques using computer technology, and helps to further resolve the disputed issue of whether skills gained in the virtual environment transfer to real-world conditions. Researchers and professionals in the fields of rehabilitation engineering, physical therapy, physiology, and other fields concerned with the study of human movement, could find the outcome of this work useful in improving their professional practice. Other clinicians could also use the results of this work in formulating realistic treatment goals in problem areas involving physical therapy.
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Roomkham, Sirinthip. "Design a simulated multimedia enriched immersive learning environment (SMILE) for nursing care of dementia patient." Thesis, Queensland University of Technology, 2016. https://eprints.qut.edu.au/94175/1/Sirinthip_Roomkham_Thesis.pdf.
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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.
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Bramley, Chelsea L. "Distraction interventions during invasive procedures to improve quality of life in pediatric oncology patients." Honors in the Major Thesis, University of Central Florida, 2010. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/1366.
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This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.Bachelors
Nursing
Nursing
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Fordell, Helena. "Virtual Reality for Enriched Rehabilitation of Stroke Patients with Spatial Neglect : Diagnostics and the Rehabilitation Effect on Spatial Attention and Neuronal Activity." Doctoral thesis, Umeå universitet, Institutionen för farmakologi och klinisk neurovetenskap, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-141920.
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Background: Approximately a third of all stroke patients develop spatial neglect, a debilitating symptom associated with poor outcome. Spatial neglect is clinically defined as a deficit in processing and responding to stimuli presented on the contralesional side of the body, or the space surrounding that side of the body. The heterogenetic, multi-sensory nature of the symptoms renders it difficult to diagnose and treat; therefor effective methods for screening and intervention for neglect are needed. Virtual reality (VR) is a method of brain–computer interaction that involves realtime simulation of an environment, scenario or activity that allows for user interaction and targets multiple senses. We hypothesize that VR can facilitate identification of spatial neglect in stroke patients and that training with this interface will improve patient’s functional outcome, through stimulation to neuronal networks including those controlling attention. Objective: The objective was to construct and validate a computerized test battery for spatial neglect and to investigate its usability in stroke patients. Also to design and develop a VR rehabilitation method for spatial neglect and to evaluate its effects on spatial attention and on neuronal activity in the brain. Method: We designed, developed and evaluated a new concept for assessment (VR-DiSTRO®) and training (RehAtt®) of spatial attention, using VR technology. The hardware consisted of a PC, monitor, 3D-glasses and a force feedback device to control the tasks (i.e., a robotic pen). The software enabled targets to be moved, rotated and manipulated in the 3D environment using the robotic pen. RehAtt® made it possible to combine intense visual scanning training, multi-sensory stimulation (i.e., audio, visual, tactile) and sensory-motor activation of the contralesional arm. In a first study on 31 stroke patients we performed a construct validation of VR-DiSTRO® against Rivermead Behavioural Test Battery (BIT) and investigated the usability. In a second study, 15 subjects with chronic spatial neglect (symptoms >6 month) had self-training, 3 x 1 hour for 5 weeks using RehAtt®. Outcome were measured by changes in neglect tests and in Cathrine Bergego Scale (CBS). Training-related changes in neuronal activity of the brain was studied using fMRI during task and in resting state. Results: VR-DiSTRO® correctly identified all patients with neglect. The sensitivity was 100% and the specificity 82% for VR-DiSTRO® compared to BIT. Usability was high and no side-effects were noted. Using repeated measurement analysis, improvements due to the RehAtt® intervention were found for Baking tray task (p < 0.001), Star cancellation test (p = 0.006) and Extinction test (p = 0.05). Improvements were also seen in the Posner task as fewer missed targets (p = 0.024). Improvement in activities of daily living (CBS) was shown immediately after training (p < 0.01) and patients still reported improvement at 6 months follow-up. Trainingrelated changes in neuronal activity were seen as an increased task-evoked brain activity in prefrontal and temporal cortex, mainly outside the attention network but in related cortical areas. During resting state, changes in network connectivity were seen after intervention with RehAtt® in the Dorsal Attention Network (DAN) and interhemispheric connectivity. Conclusion: VR-DiSTRO® identified visuospatial neglect in stroke patients quickly and with a high accuracy. RehAtt® training improved in spatial attention in chronic neglect with transfer to functions in daily living. Increased neuronal brain activity was found in and between attention networks and related brain structures. This could represent a compensatory effect in addition to sign of a restorative effect from the RehAtt training. The results obtained in this study are promising, encourage further development of the methods and merit for further studies.
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León, Vargas Fabian Mauricio. "Design and implementation of a closed-loop blood glucose control system in patients with type 1 diabetes." Doctoral thesis, Universitat de Girona, 2013. http://hdl.handle.net/10803/125007.
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In the work presented in this dissertation, open-loop and closed-loop control strategies that were aimed at resolving major glucose control problems in the postprandial period were developed. A new model-based control algorithm for postprandial glucose regulation in open-loop, which is based on set-inversion technology, was developed. It automatically and efficiently coordinates the values of basal-bolus insulin to achieve certain predefined control objectives. The algorithm was designed to enable integration into existing smart insulin pumps. Closed-loop control strategies based on sliding mode techniques and insulin-on-board constraints were implemented to reduce the risk of late hypoglycaemic events and to obtain safer controller performance without increasing the period of hyperglycaemia. Extensive evaluation and validation of the control robustness was performed in a comprehensive virtual environment that was specifically designed and implemented to facilitate realistic simulations. A practical methodology to “virtualise” a cohort of real Type 1 diabetic patients was also developedEn aquesta investigació, es desenvolupen estratègies de control en llaç obert i llaç tancat encaminades a superar els principals problemes de control de glucosa al període postprandial. Es va desenvolupar un nou algoritme de control basat en models en llaç obert amb tecnologia d'inversió de conjunts. Aquest coordina automàticament els valors d'insulina basal-bol d'una manera eficient per tal d'aconseguir certs objectius de control predefinits. L'algoritme va ser dissenyat per permetre la seva integració en bombes d'insulina intel•ligents. També, es van implementar estratègies de regulació en llaç tancat basades en tècniques de control en mode lliscant i limitacions de la insulina a bord, per reduir el risc d'episodis d'hipoglucèmia tardana per tal d'aconseguir un acompliment més segur sense augmentar el temps a hiperglucèmia. La robustesa dels controladors va ser demostrada mitjançant una àmplia avaluació i validació en un entorn virtual integral específicament dissenyat i implementat en aquesta tesi per permetre simulacions realistes
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Reid, Noreen. "An action research study to investigate the strategies that can be used by health care professionals, during video consultations with palliative care patients, to enhance the therapeutic alliance." Thesis, University of Stirling, 2017. http://hdl.handle.net/1893/27690.
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Background: The use of telemedicine was gaining momentum. Although the strength of the therapeutic alliance (TA) correlated with treatment outcomes, there was no research exploring the skills, attitudes and behaviours that enhanced the TA during Skype consultations in palliative care. Aims: This study identified the skills, attitudes and behaviours that affected the TA between palliative care patients and health care professionals during Skype consultations and identified strategies that enhanced the TA. Study Design: Two cycles of action research engaged the participants in self-reflective inquiry and encouraged the identification of strategies that enhanced the TA and the Skype experience. Participants: Six health professionals and nine patients were recruited from a Hospice out patient service in one Health Authority in England. Data Collection: Data from the audio-recorded consultation were managed quantitatively and the TA was measured using the Working Alliance Inventory (S). Qualitative data were collected from participant interviews and focus groups attended by the professionals. Data Analysis: The analysis ran in parallel with the data collection, started after the first consultation and all sources of data were cross-referenced. Thematic analysis was used to sequentially code the qualitative data to help identify, examine and record patterns within the data set. Findings: The findings suggested that it was possible to establish and a positive therapeutic alliance between health professionals and palliative care patients when using Skype. There was a shift in perception for those health professionals who had reservations about their ability to establish a therapeutic alliance (TA) via a computer link. It was demonstrated that advanced communication skills were transferrable between face to face and video consultations. No additional communication skills training was needed to enable a strong TA when using Skype. Including some social talk, working with the patient’s as opposed to the professional’s agenda and actively offering solutions improved the Skype experience for the patients. The strategies that health professionals promoted to enhance the TA included using Skype with appropriately selected patients to complement the existing Service. Mandatory training in the effective use of Skype was recommended even for those health professionals who used Skype socially. Clarification to address the challenge of clinical governance was recommended. In keeping with an action research design the change impacted on both the health professionals own practice and the Organisation’s approach to telemedicine. The potential for using action research to engage nurses and doctors in critical self-reflective inquiry and to empower them to be change facilitators was demonstrated. Conclusion: Although a small sample size, this study identified strategies that enhanced the TA during Skype consultations. The findings were significant because they added to the current body of knowledge about using Skype to facilitate consultations within the palliative care population. Additionally, the findings may be transferable to different populations and healthcare contexts.
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Keil, Christiane, Dominik Haim, Ines Zeidler-Rentzsch, Franz Tritschel, Bernhard Weiland, Olaf Müller, Thomas Treichel, and Günter Lauer. "3D-volldigitalisierte Behandlungsplanung bei Lippen-Kiefer-Gaumenspalten (LKGS-3D)." Thelem Universitätsverlag & Buchhandlung GmbH & Co. KG, 2021. https://tud.qucosa.de/id/qucosa%3A75877.
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Die Idealvorstellung eines vollständig digitalisierten Behandlungsalltags rückt mit fortschreitender technologischer und informationeller Entwicklung stetig näher an die Realität. Zu Beginn bestand lediglich die Möglichkeit einer elektronischen Patientenakte, hinzu kamen vielfältige Möglichkeiten der digitalen Bildgebung und wurden schließlich um das Ziel eines vollständigen digitalen Workflows ergänzt. Die Planung der interdisziplinären kieferorthopädischen / kieferchirurgischen Versorgung von Patienten mit Lippen-Kiefer-Gaumen-Spalten (LKGS) wurde bis vor kurzem am Universitätsklinikum Dresden noch hauptsächlich analog durchgeführt. Eine volldigitalisierte Behandlungsplanung unter Einbeziehung aller beteiligten Behandler fand nicht statt. Ziel des Projektes war es deshalb, eine digitale Plattform zur interdisziplinären zahnmedizinischen Versorgung von LKGS-Patienten zu schaffen. Dazu wurde zuerst die bisher erforderliche Abdrucknahme mittels Alginat und die anschließende Herstellung eines Gipsmodells durch einen intraoralen 3D-Scan der Zahnbögen des Patienten abgelöst. Anhand des intraoralen 3D-Scans können nun die erforderlichen Trinkplatten mittels 3D-Druck erstellt werden. Zweiter Schritt war die Anfertigung von 3D-Aufnahmen der Weichteile des Gesichtes mittels eines extraoralen 3D-Scanners. Als dritter Schritt erfolgte die Anfertigung von Digitalen Volumentomografie (DVT)-Aufnahmen zur 3D-Darstellung des Schädelknochens und Kieferskeletts. Nach der Anfertigung wurden diese bildbasierten Datensätze zu einem „digitalen Zwilling“ (virtuelles 3D-Modell aus DVT, intra- und extraoralen 3D-Scan) zusammengefasst, wodurch erstmalig ein umfassendes 3D-Modell des Mund-Kiefer-Raumes einschließlich wichtiger Informationen zum Kiefergelenk und der anliegenden Weichteile entstand. Dieses virtuelle Modell bildet jetzt die Grundlage für die Behandlungsplanung und die Planung der weiteren zahnmedizinischen und medizinischen Versorgung. Es konnte also im Projekt die komplette Digitalisierung der Diagnostik, die Etablierung einer Fusionsplattform und der Datenaustausch zwischen Uniklinik und privater Praxis umgesetzt werden.
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Brossier, David. "Élaboration et validation d'une base de données haute résolution destinée à la calibration d'un patient virtuel utilisable pour l'enseignement et la prise en charge personnalisée des patients en réanimation pédiatrique Perpetual and Virtual Patients for Cardiorespiratory Physiological Studies Creating a High-Frequency Electronic Database in the PICU: The Perpetual Patient Qualitative subjective assessment of a high-resolution database in a paediatric intensive care unit-Elaborating the perpetual patient's ID card Validation Process of a High-Resolution Database in a Pediatric Intensive Care Unit – Describing the Perpetual Patient’s Validation Evaluation of SIMULRESP©: a simulation software of child and teenager cardiorespiratory physiology." Thesis, Normandie, 2019. http://www.theses.fr/2019NORMC428.
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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 utilisationThe 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
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Fornstedt, Cecilia. "Medical Technology and eHealth for Prevention against LifestyleRelated Diseases : A survey of attitudes among health center personnel and patients prescribed with physical activity on prescription (PAP)." Thesis, KTH, Människa och Kommunikation, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-210310.
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With an aging population that suffers from comorbidity, healthcare is facing grand challenges. In order to meet the demand, digitalization is thought to be an opportunity. Digitalization of curative care, such as diagnostics and treatment, have been initiated and is today used and appreciated. Preventative care, on the other hand, has not been included in the digital adaptions to the same extent and there are few scientific studies within the area. Nonetheless, a further proactive care that meets patients and healthcare personnel are of interest to several actors. The Swedish Government has a vision that Sweden, in 2025, will be world leading within eHealth. For that to be possible, digital preventative care have to support and complete the preventative work that is performed today. The present study has investigated the attitude towards Connected Medical Devices for Prevention (CMDfP) within the primary care. By a mixed-methodology including questionnaires, the opinions of 24 health center personnel and 17 patients prescribed with Physical Activity on Prescription (PAP) were collected and analyzed. The results show that health center personnel are willing to prescribe connected eHealth devices for prevention and patients are willing to use the devices prescribed. Additionally, among the respondents there is a belief that CMDfP could facilitate in order to increase the adherence to PAP without any major impact on the personnel's workload. By digitalizing preventative care, it is possible that people will be able to live healthier and therefore not require care to the same extent as today. Reasons to the possible results are that digital tools within curative care have been shown to generate positive outcomes to chronically ill patients that utilize home care. Additionally, studies of preventative care have generated positive outcomes to the health of the population in several countries. It is therefore likely that the combination, digital preventative care, would be rapidly relished. These thoughts align with the positive results on attitudes of this study. Before CMDfP could be prescribed to patients, pilot studies have to be performed and new work routines including reimbursement models, have to be established within healthcare. These are all areas of future work within medical engineering.Med en åldrande population som lider av samsjuklighet, står hälso- och sjukvården inför stora utmaningar. För att möta behovet är digitalisering en möjlighet. Digitalisering av åtgärdande vård, så som diagnostik och behandling, har redan påbörjats och är idag uppskattat. Preventiv vård har, å andra sidan, inte varit inkluderad i den digitala utvecklingen och därav saknas det vetenskapliga studier inom området. Dock är en mer proaktiv vård av stort intresse för flera aktörer. Sveriges regering har en vision att Sverige, år 2025, ska vara världsledande inom eHälsa. För att detta ska vara möjligt måste digital preventiv vård möta och komplettera det preventiva arbete som bedrivs idag. Denna studie har undersökt attityderna till Uppkopplade Medicinsktekniska Hjälpmedel för Prevention (UMHfP) bland primärvården. Genom en metod som inkluderat enkätundersökningar, inhämtades och analyserades attityden av 24 personer från personalen på vårdcentraler och 17 patienter med Fysisk Aktivitet på Recept (FaR). Resultaten visade att primärvårdspersonal är villiga att förskriva UMHfP och att patienter vill använda de hjälpmedlen som förskrivs. Dessutom har respondenterna tro att UMHfP kan underlätta att förbättra följsamheten till FaR utan att påverka personalens arbetsbörda nämnvärt. Genom att digitalisera den preventiva vården är det troligt att befolkningen kommer få ett hälsosammare leverne och därför inte behöva vård i samma utsträckning som idag. En anledning till detta är att digitala hjälpmedel för åtgärdande vård har visat sig vara positivt för kroniskt sjuka patienter som hemsjukvårdas. Dessutom har studier inom preventiv vård indikerat flera positiva konsekvenser för invånares hälsa världen över. Det är därför troligt att digitala hjälpmedel i kombination med preventivt arbete snabbt kommer bli uppskattat. Dessa spekulationer sammanfaller väl med det positiva resultatet från denna studie. Innan UMHfP kan förskrivas till patienter måste pilotstudier genomföras och nya arbetssätt inklusive betalningsmodeller måste införas i hälso- och sjukvården. Detta är kommande arbeten inom medicinsk teknik.
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Nehring, Wendy M., and Felissa R. Lashley. "Nursing Simulation: A Review of the Past 40 Years." Digital Commons @ East Tennessee State University, 2009. https://dc.etsu.edu/etsu-works/6706.
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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.
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Bateman, James. "Virtual patient design in undergraduate education." Thesis, University of Warwick, 2013. http://wrap.warwick.ac.uk/62110/.
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Background Virtual patients (VPs) are computerised online representations of realistic clinical cases. Recent technology and software advances position VPs as a standardised, accessible, collaborative teaching tool. We do not know how they should be designed. My research question is: how do different VP design principles influence student experiences when completing VPs? The aim of this study is to provide qualitative and quantitative research evidence to support VP design and development. Methods This research project uses qualitative and quantitative methods to evaluate how VP design influences medical student learning, based on groups of students from three UK medical schools (Warwick, Birmingham, Keele). The initial qualitative research component is a grounded theory (GT) focus group study evaluating VP design properties. The literature review and qualitative research identified the two most important VP properties to research were: (1) branching within the cases; and (2) structured clinical reasoning instruction (SR) intended to promote good clinical decision making in the VPs. The quantitative research component is a multi-centre randomised experimental 2x2 factorial study of undergraduate students at three UK medical schools, conducted to a published protocol. I investigate two most important independent VP design variables: (1) branching, present or absent; (2) SR, present or absent. Outcomes including: (a) VP scores; (b) VP student evaluations; (c) metrics collected from the VP environment; (d) student self-reported case preferences and (e) summative assessment results. The study has institution ethics approval. Results In the qualitative study of six focus groups (n=46), I produced a model describing how VP design influences learning. In the quantitative research, 572 students completed 1773 VPs, and 1223 evaluations, with 296 (50.1%) students completing all four VPs (1184). Key findings were: student expressed preferred SR when present (70.5% of student, P<0.001); there were no significant differences in adjusted global VP scores or evaluation scores (all p>0.3 for the independent variables); institution factors played an important role with higher scores at one centre (p<0.001); and there were significant improvements in Bayesian reasoning with SR present (7% improvement, p<0.001). Discussion This original research is the first GT study into VPs. The quantitative component is the largest study to date in the literature exploring VP design variables. It provides practical lessons for authors and institutions for design and delivery of VPs. All VPs used are available as open education resources.
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Boyle, Brian William. "Evaluation of the Extent to Which Massachusetts General Hospital Emergency Department Triage of Transient Ischemic Attack Patients Aligns With Virtual TIA Clinic Protocol: A Pilot Cross-Sectional Medical Record-Review to Inform Care Redesign Efforts." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:17295888.
Full textAbstract:
The Virtual TIA Clinic Protocol was developed as part of the Partners Care Redesign
effort to reduce costs and increase quality in the care of patients presenting with symptoms of
transient ischemic attack, through risk stratification, triage, and follow-up based on factors
including the ABCD2 score. The work presented here is a small N, pilot cross-sectional study
which compares actual practice in the MGH ED to what the protocol would suggest, in an effort
both to validate the components of the protocol and to better understand further opportunities to
create value in the care of this patient population. It was found that actual practice resulted in
triage patterns similar to what would have been dictated by the protocol in question. This
suggests that full implementation of the protocol – with the costs associated – may not be
justified. Further work could involve refinement of the protocol to achieve the desired effect on
triage, with future, similar studies made more effective by a code to designate patients in whom
TIA is possible but who do not ultimately receive the code for such under the current
documentation system.
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Chandhoke, Gursimran Singh. "A Framework for Virtual Patient Navigation Applications." Thesis, Université d'Ottawa / University of Ottawa, 2017. http://hdl.handle.net/10393/36031.
Full textAbstract:
According to the Canadian Cancer Society, half of Ontario’s population will be diagnosed
with cancer in their lifetime. Many patients being assessed for cancer however become
overwhelmed when having to manage information overload, many appointments with different
instructions and locations, and recommendations on how to improve their lifestyle.
This causes much anxiety and uncertainty among patients. Some cancer assessment clinics
offer some guidance in the form of paper-based patient navigators, which provide much
reliable information to patients but are limited in terms of dynamic updates to appointments,
opportunities for sharing knowledge between healthcare providers and patients, and
of patients supporting each other.
This thesis proposes a new web-based, mobile, and user-friendly virtual patient
navigator application framework named Care Ami, which incorporates the information
found in an existing paper-based navigator along with the new features such as remote
updates to personal care paths and calendars, personalized navigation guidance, sharing of
symptoms/medications information, and peer group support. Unlike existing solutions,
Care Ami is configurable to support multiple types of diseases (e.g., lung cancer and breast
cancer). This application is evaluated through testing and the usage of heuristic evaluation
guidelines related to usability, and a comparison with related work highlights its many
benefits.
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Papageorgiou, Eleni [Verfasser], and Ulrich [Akademischer Betreuer] Schiefer. "Assessment of performance in patients with homonymous visual field defects by analysis of their visual exploration, using standardized, virtual reality environments – a study for critical comparison with the current approach by conventional perimetry. / Eleni Papageorgiou ; Betreuer: Ulrich Schiefer." Tübingen : Universitätsbibliothek Tübingen, 2011. http://d-nb.info/1162699116/34.
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Laubie, Raphaëlle. "Les Déterminants de l’Action Collective en Ligne dans les Communautés Virtuelles de Patients : une Approche Multi-Méthodes." Thesis, Paris Sciences et Lettres (ComUE), 2017. http://www.theses.fr/2017PSLED036/document.
Full textAbstract:
Au cours des dernières années, les communautés virtuelles de patients se sont énormément développées sur l'Internet. Ces communautés permettent des échanges fréquents entre les patients, qui peuvent partager des informations liées à la santé dans un environnement interactif. Alors que beaucoup s'accordent sur l'opportunité représentée par ces communautés pour ses utilisateurs, les connaissances sur ce qui détermine l'action collective en ligne des patients ainsi que sur les fondamentaux de l'action collective en ligne dans ces espaces virtuels sont relativement peu développées. En conséquence, ce travail doctoral examine les raisons pour lesquelles les patients interagissent entre eux et comment ils procèdent. En nous appuyant sur le modèle du comportement orienté vers un but, la théorie de la valeur de l'attente, la théorie des forces du champ, les concepts de dons et les interviews menées, nous avons développé un modèle qui examine les interactions en ligne des patients dans un contexte d'action collective en ligne. Une approche multi-méthode, qualitative et quantitative, permet d'explorer les interactions des patients et de mesurer les déterminants de l'action collective en ligne sur ces espaces virtuels. L'analyse qualitative de 54 entretiens menés avec des patients, des proches de patients, des professionnels de la santé 2.0, des médecins et des soignants permet d'affiner le modèle de recherche, qui a ensuite été testé au travers d'une enquête quantitative auprès de 269 patients. Cette recherche contribue à la recherche en systèmes d'information en augmentant nos connaissances sur la dynamique individuelle et les interactions qui entourent les communautés de patients en ligneOver the last few years, virtual patients’communities have been developing tremendously over the Internet. These Web 2.0 communities allow frequent interactions among patients, who can share health-related information within an interactive environment. While many agree on the opportunity represented by those communities for its users, we know very little about what determines patients’ online collective action, specifically on virtual communities as well as the fundamentals of online collective action in these virtual spaces. Accordingly, this doctoral work examines why patients interact with others and how they interact on topics related to their disease through these virtual communities. Drawing on the goal-directed behavior (MGB), the expectancy-value (EVT) theories, the field force theory, gift concepts and field interviews, we have developed a model for examining patients’ online interactions and identified gift-giving behaviors in the context of online collective action. A multi-method, qualitative and quantitative approaches, enables us to explore patients’ interactions and measures the determinants of online collective action on these virtual spaces. The qualitative analysis of 54 interviews conducted with patients, patient’s relatives, Health 2.0 professionals, doctors and caregivers allows refining the research model, which has then been tested through a survey handled with 269 patients, members of patient’s communities. This research contributes to IS research by increasing our knowledge regarding the individual dynamics and interactions that surround online patients’ communities
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Kuenne, Christoph W., Sabrina Adamczyk, Matthias Rass, Angelika C. Bullinger, and Kathrin M. Möslein. "IT-based Interaction Platforms to Foster Virtual Patient Communities." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-143583.
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Kuenne, Christoph W., Sabrina Adamczyk, Matthias Rass, Angelika C. Bullinger, and Kathrin M. Möslein. "IT-based Interaction Platforms to Foster Virtual Patient Communities." Technische Universität Dresden, 2011. https://tud.qucosa.de/id/qucosa%3A28075.
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Heitz, Alexandre. "Improving Clinical Education Through the Use of Virtual Patient-based Computer Simulations." Thesis, University of Canterbury. HIT Lab NZ, 2013. http://hdl.handle.net/10092/8193.
Full textAbstract:
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.
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Howland, Sarah Caroline. "Immersive education: virtual reality in clinical audiology: a pilot study of the effectiveness of a new patient simulator program on audiology students’ performance on case history tasks." Thesis, University of Canterbury. Communication Disorders, 2012. http://hdl.handle.net/10092/7263.
Full textAbstract:
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.
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Guard, Lynda May. "Formative feedback in a virtual patient simulator for clinical audiology training." Thesis, University of Canterbury. Communication Disorders, 2013. http://hdl.handle.net/10092/7946.
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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.
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Mishra, Sankalp. "Use Of Virtual Reality Technology In Medical Training And Patient Rehabilitation." Wright State University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=wright1559144258671291.
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Posel, Nancy. "Making a case: validating criterion-referenced guidelines for virtual patient case authoring." Thesis, McGill University, 2011. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=103514.
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Virtual patient cases are a valuable component of medical education informatics. The supporting literature is largely theoretical; there is a dearth of empirical research on (a) measurable outcomes and (b) components of effective virtual patient cases. Author guidelines, based on principles of pedagogy, cognition, and identification of technically relevant specifications, do not exist. This qualitative, multiple-case study developed and validated research-based, comprehensive, theory-grounded, and educationally relevant authoring guidelines. Nine faculty members at six medical schools, chosen for their expertise and leadership in medical education informatics, and experience in virtual patient case authoring, provided their own criteria for case design and reviewed the criterion-referenced guidelines generated for this study. Five of their cases were examined in relation to these guidelines. Access to the guidelines increased the number of design criteria cited as important. The validated guidelines can now be used to further research and development in medical education informatics and virtual patient cases.Les patients virtuels sont un volet très utile de l'informatique appliquée à l'enseignement médical. Or, la documentation disponible est en grande partie théorique. Il existe peu de recherche empirique sur (a) des résultats mesurables et (b) des éléments de cas efficaces de patients virtuels. On ne trouve pas de principes directeurs de conception, basés sur des principes de pédagogie, de cognition et d'identification de spécifications intéressantes sur le plan technique. La présente étude qualitative de cas multiples a développé et validé des principes directeurs pour la conception qui sont fondés sur la recherche et la théorie, qui englobent tous les aspects et qui sont valables sur le plan pédagogique. Neuf membres du corps professoral de six écoles de médecine, choisis pour leur expertise et leur influence en informatique de l'enseignement médical, et leur expérience en création de cas de patients virtuels, ont proposé leurs propres critères pour la conception de cas et ont étudié les principes directeurs à référence critérielle mis au point pour cette étude. Cinq de leurs cas ont été examinés par rapport à ces principes directeurs. L'accès aux principes directeurs a augmenté le nombre de critères de conception cités comme étant importants. Les principes directeurs validés peuvent désormais servir à l'avancement de la recherche et développement concernant l'informatique de l'enseignement médical et les cas de patients virtuels.
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Sanderson, Elizabeth Anne. "Evaluating the Use Of A Virtual Reality Patient Simulator an An Educational Tool In An Audiological Setting." Thesis, University of Canterbury. Communication Disorders, 2013. http://hdl.handle.net/10092/10368.
Full textAbstract:
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.
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Barbosa, Ana Paula de Oliveira. "Simulação de práticas clínicas em farmácia : desenvolvimento de estrutura e simulador de processo de cuidado à saúde." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2015. http://hdl.handle.net/10183/149499.
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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.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.
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Proix, Timothée. "Large-scale modeling of epileptic seizures dynamics." Thesis, Aix-Marseille, 2015. http://www.theses.fr/2015AIXM4058.
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Les crises épileptiques sont des épisodes paroxysmiques d'activité cérébrale hypersynchrone. Ce travail de thèse s'attache à examiner les mécanismes de propagation des crises d'épilepsie sur une échelle temporelle lente et une grande échelle spatiale dans le cerveau humain et à les appliquer au contexte clinique. Chez les patients souffrant d'épilepsie partielle réfractaire, les crises débutent dans certaines régions localisées du cerveau, dénommées zone épileptogène, avant de recruter des régions distantes. Le succès de l'ablation chirurgicale de la zone epileptogène dépend principalement de sa délimitation adéquate, un problème souvent épineux en pratique clinique. À cela s'ajoute notre compréhension parcellaire des mécanismes à l'origine des crises et de leur propagation. Nous utilisons un modèle mathématique de masse neuronale reproduisant le décours temporel de l'activité moyenne critique et intercritique d'une région cérébrale, guidé de manière autonome par une variable permittive lente. Nous introduisons tout d'abord un couplage permittif lent entre ces masses neuronales, afin de révéler l'importance de la variété lente dans le recrutement des régions cérébrales dans la crise. Nous présentons ensuite un pipeline de traitement des données structurelles et de diffusion IRM pour reconstruire automatiquement le cerveau virtuel d'un patient. Nous utilisons ensuite une analyse de stabilité linéaire et la connectivité large-échelle pour prédire la zone de propagation. Nous appliquons notre méthode à un jeu de données de 15 patients épileptiques et démontrons l'importance du connectome pour prédire la direction de propagation des crisesEpileptic seizures are paroxysmal hypersynchronizations of brain activity, spanning several temporal and spatial scales. In the present thesis, we investigate the mechanisms of epileptic seizure propagation on a slow temporal and large spatial scale in the human brain and apply them to a clinical context. For patients with partial refractory epilepsy, seizures arise from a localized region of the brain, the so-called epileptogenic zone, before recruiting distant regions. Success of the resective surgery of the epileptogenic zone depends on its correct delineation, which is often difficult in clinical practice. Furthermore, the mechanisms of seizure onset and recruitment are still largely unknown. We use a mathematical neural mass model to reproduce the time course of interictal and ictal mean activity of a brain region, in which the switching between these states is guided by an autonomous slow permittivity variable. We first introduce a slow permittivity coupling function between these neural masses, hypothesizing the importance of the slow manifold in the recruitment of brain regions into the seizure. Before exploring large-scale networks of such coupled systems, we present a processing pipeline for automatic reconstruction of a patient's virtual brain, including surface and connectivity (i.e., connectome), using structural and diffusion MRI, and tractography methods. Using linear stability analysis and large-scale connectivity, we predict the propagation zone. We apply our method to a dataset of 15 epileptic patients and establish the importance of the connectome in determining large-scale propagation of epileptic seizures
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Kilbreath, Eric Howard. "Applying thomistic virtue ethics to patients with chronic illness." Thesis, University of Bristol, 2000. http://hdl.handle.net/1983/a6e68092-4f42-4e81-a374-eeead1f73ea0.
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Vieira, Marques Pedro Manuel. "Agent based virtual electronic patient record. From intra to inter-institution data integration." Doctoral thesis, Universitat Autònoma de Barcelona, 2014. http://hdl.handle.net/10803/285560.
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A través dels anys els sistemes d’informació mèdica (SIM) s’han desenvolupat i
desplegat, seguint agendes específiques abordant els problemes individuals. Encara
que hi ha hagut diversos esforços, encara és necessari millorar la integració
de sistemes per tal de superar les barreres de disponibilitat de les dades, sobretot
quan l’status quo revela que la majoria de les vegades els sistemes coexisteixen
com autistes.
L’assoliment d’una visió integrada i transversal de tots els registres d’un pacient
no és una tasca fàcil, ja que els patrons de producció i la utilització de les
dades en l’assistència sanitària són molt complexes i involucren actors heterogenis
i un flux de dades complexe. Aquest és un problema real, tant dins com
entre les institucions de salut que fan la tasca d’integració difícil i molt sovint ni
tan sols possible.
Els agents són entitats de programari autònomes que poden percebre el caràcter
dinàmic de l’entorn, permetent proactivitat respecte a les accions que s’adapten
millor a un usuari particular per a un determinat conjunt d’objectius. Els
agents actuen en representació dels seus usuaris, i a través de la seva activitat
social poden interactuar amb l’usuari, amb altres agents i amb el propi entorn
a través de l’intercanvi de missatges o fent ús de dispositius auxiliars. La seva
flexibilitat per integrar altres tecnologies pot millorar l’escalabilitat del sistema
i la seva tolerància a fallades, en la direcció d’una inter-operabilitat global dels
sistemes.
En aquest sentit, un enfocament multi-agent es presenta com un candidat fort
per fer front als problemes de la integració dels Sistemes d’Informació Mèdica.
El treball d’aquesta tesi neix d’aquestes premisses, i es centra en les següents
preguntes: pot la tecnologia dels agents millorar o ajudar en la integració de
sistemes d’Informació Mèdica dins d’una sola institució sanitària? Com es pot
estendre el model basat en agents per a una única institució cap a una integració
de sistemes de salut multi-institució?
Per tal d’abordar aquesta qüestió es van definir una sèrie d’objectius: Identificar
l’estat de l’art pel que fa a la utilització d’agents en el sector sanitari,
adreçar els problemes d’integració d’informació mèdica en una mateixa institució
de salut, proposar un model, especificar l’aplicació d’agents per a la integració
intra-institució de les dades i informació mèdica entre diferents institucions
de salut mitjançant l’ampliació dels models i especificacions del model
anterior a un escenari d’integració de dades entre múltiples institucions.
Les principals contribucions d’aquesta tesi són: una caracterització de com
s’està utilitzant la tecnologia d’agents per resoldre problemes en l’àmbit mèdic;
un sistema d’agents intra-institucional d’integració de dades mèdiques; una caracterització
de perfil de dades necessàries de professionals de la salut; la identificació
dels camins per a la optimització del sistema i la gestió de prioritats
basada en el tipus i la font de les dades; i un sistema basat en agents per a la
integració de dades mèdiques inter-institucionals.Através dos anos, os Sistemas de Informação em Saúde (SIS) foram desenvolvidos seguindo agendas específicas, muitas vezes direcionados para a resolução de problemas particulares e de âmbito departamental. Apesar dos esforços desenvolvidos, a realidade mostra ser ainda necessário o desenvolvimento de processos de integração de sistemas tendo em vista superar as barreiras ainda existentes e permitir a disponibilidade de dados de uma forma transversal. Esta situação é particularmente relevante quando o status quo revela que os sistemas desenvolvidos coexistem de um modo autista. Alterar este estado não é uma tarefa fácil uma vez que os padrões de produção e uso de dados em cuidados de saúde são complexos e envolvem atores heterogêneos. Este é um problema real não só dentro das instituições mas também entre instituições de saúde o que torna a tarefa de integração difícil. Os Agentes são entidades de software autónomas capazes de se adaptar a um ambiente dinâmico, sendo pró-ativos na identificação das ações que são mais adequadas tendo em vista um conjunto de objectivos pré-definidos. Os Agentes são socialmente ativos e podem interagir com o utilizador, outros agentes e com o seu ambiente através de troca de mensagens ou fazendo uso de dispositivos auxiliares. Neste sentido, agindo em nome do profissional de saúde na sua busca por informação, a abordagem baseada em Agents apresenta-se como uma forma interessante de mitigar os problemas que dificultam a troca de dados entre sistemas de Informação na Saúde. O trabalho desta tese evolui a partir destas premissas, e foca-se nas seguintes perguntas: Pode a tecnologia baseada em Agentes ajudar a integração de Sistemas de Informação em Saúde dentro de uma única instituição de saúde? Como pode um modelo baseado em Agentes de integração de dados dentro de uma instituição ser estendido para um ambiente de integração entre sistemas de informação de várias instituições? Por forma a responder a estas questões, um conjunto de objetivos foram definidos: Identificar o estado da arte em relação ao uso de agentes em na área da Saúde; tendo em consideração os problemas na integração de informação dentro de uma instituição de saúde, propor um modelo, especificação e implementação de um sistema baseado em agentes que promova o acesso alargado aos dados existentes; e alargando a abrangência do acesso aos dados para fora da barreira institucional, estender o modelo e especificações para um cenário de integração de dados entre múltiplas instituições de saúde. As principais contribuições da tese são: a caracterização de como os Agents são usados na resolução de problemas na área da saúde; um sistema baseado em agentes para a integração de dados de saúde intra-instituição; uma análise de diferentes perfis de profissionais de saúde reflectindo as diferentes necessidades de informação em diversos cenários de prestação de cuidados; a identificação de caminhos para a otimização do sistema e agendamento de ações com base no tipo e fonte de dados; e um sistema baseado em agentes para a integração de dados de saúde entre múltiplas instituições de saúde.
Through the years, Health Information Systems (HIS) have been developed and deployed following specific agendas, addressing individual or departamental problems. Albeit several efforts, system integration enhancements are still needed in order to surmount data availability barriers particularly when the status quo reveals that most of the time they coexist as autistic systems. Achieving an integrated and transversal view of all records of one patient is not an easy task as the patterns of data production and usage in healthcare are highly complex, involving heterogeneous actors and an intricate data flow. This is a real issue both within and between health institutions making the integration task difficult and quite commonly not even possible. Agents are autonomous software entities which can perceive the dynamic character of the surrounding environment enabling pro-activeness regarding the actions that are better suited to a particular user and a given set of goals. They act on behalf of their users and by being socially active they can engage the user, other agents and the environment through message exchanging or auxiliary devices. In this sense, and by acting on behalf of health professionals in their quest for information, a Multi-Agent approach presents itself as strong candidate for tackling problems in Health Information Systems integration. The work on this thesis grows from these premises, and is focused on the following questions: Can agent technology enhance or help Health Information Systems integration within a single health institution? How can a single institution agent based approach model be extended for multi-institution health systems integration? In order to address these questions, a set of objectives were defined: identify the state of the art regarding the use of agents in Healthcare; to address health information integration issues within a single health institution by proposing a model, specification and implementation for agent based intra-institution health data integration; and to address health information integration between different health institutions by extending the models and specification of the previous model to a multiple health institution data integration scenario. The main contributions from this thesis are: a characterisation of how agent technology is being used for solving problems in the healthcare domain; an agent based system for intra-institution health data integration; a characterisation of health professionals data needs profile; identification of paths for system optimisation and priority management based on type and source of data; and an agent based system for inter-institution health data integration.
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Dower, L., M. Overbey, J. Russell, and Deborah Ricker. "Following a Patient from Virtual Simulation to Simulation Lab and Into the Classroom." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/8540.
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Chesher, Douglas. "Exploring the use of a web-based virtual patient to support learning through reflection." University of Sydney. Pathology, 2004. http://hdl.handle.net/2123/645.
Full textAbstract:
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.
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William, Gerard. "Learning outcomes of speech audiometry virtual patient use for expert and novice audiology students." Thesis, University of Canterbury. Department of Communication Disorders, 2013. http://hdl.handle.net/10092/9063.
Full textAbstract:
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.
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Wagenaar, Hendrik Cornelis. "Virtual institutions : community relations and hospital recidivism in the life of the mental patient." Thesis, Massachusetts Institute of Technology, 1987. http://hdl.handle.net/1721.1/78083.
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Stiff, Adam. "Mitigation of Data Scarcity Issues for Semantic Classification in a Virtual Patient Dialogue Agent." The Ohio State University, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=osu1591007163243306.
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