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Littérature scientifique sur le sujet « Patient virtuel »

Auteur : Grafiati
Publié le 4 juin 2021
Mis à jour le 10 février 2022

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Articles de revues sur le sujet "Patient virtuel"

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Leclaire, A., et A. Fall. « Exposition par réalité virtuelle : une approche plus sereine pour nos patients ? » European Psychiatry 30, S2 (novembre 2015) : S115. http://dx.doi.org/10.1016/j.eurpsy.2015.09.220.

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Depuis une vingtaine d’années, on assiste au développement de la réalité virtuelle dans le domaine de la psychopathologie. Elle se définit comme une application permettant à un utilisateur de naviguer et d’interagir en temps réel avec un environnement en trois dimensions généré par un ordinateur [1]. Grâce à cette technologie, les difficultés rencontrées dans les techniques d’exposition de TCC habituelles peuvent être contrées. L’environnement virtuel permet, par exemple, de contrôler les imprévus, d’être exposé à certaines peurs pouvant être difficiles à reproduire en situation réelle, et garantit une meilleure confidentialité [2]. Nous avons acquis, il y a peu un logiciel de thérapie par réalité virtuelle pour les troubles anxieux. Le patient est plongé dans un environnement virtuel relativement proche des situations anxiogènes réelles. Il est progressivement désensibilisé par une exposition virtuelle répétée, prolongée et complète. De nombreuses études ont déjà prouvé l’efficacité de ce genre d’exposition [3]. Nous pensons que cet outil permettrait aux patients d’aborder de manière plus sereine les séances d’exposition. Notre projet d’étude est de présenter à des anxieux sociaux deux techniques d’exposition : in vivo et in virtuo. Dans les deux situations, les sujets sont amenés à faire face à un groupe de personnes : « réelles » (groupe thérapeutique dans la clinique où a lieu l’étude) ou « virtuelle » (salle de classe avec des étudiants, dans l’environnement virtuel). Leur niveau d’anxiété avant chaque séance est évalué grâce à l’inventaire d’anxiété état-trait de Spielberger. Ce poster présente les premiers résultats de l’étude, qui est en cours.
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Besnar, Jeremy, Morgane Pallone, Ghislaine Aubin, Laëtitia Ferracci, Caroline Racineux et Philippe Allain. « Phénomènes de dépendance à l’environnement et conformisme social : intérêts d’une approche interactionniste en neuropsychologie clinique ». Neuropsychologie clinique et appliquée 1, Fall 2017 (2017) : 98–112. http://dx.doi.org/10.46278/j.ncacn.20170913.

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Nous décrivons le cas d’un patient victime d’un traumatisme crânien, responsable de lésions frontales et temporales bilatérales. Ce patient présentait des troubles exécutifs ainsi que des perturbations comportementales, principalement sous forme d’une dépendance à l’environnement. L’objectif de la présente étude était double. D’une part, nous souhaitions évaluer la pertinence d’une interprétation socio-cognitive de la dépendance à l’environnement, au moyen d’un dispositif évaluant le conformisme social, impliquant des situations d’interaction réelle et virtuelle. D’autre part, nous souhaitions étudier l’influence du type de situation sur le conformisme social, de rares études démontrant des différences de performances selon le type d’évaluation (réel ou virtuel). Les résultats démontrent des dissociations de performance en fonction du mode d’évaluation. Le conformisme n’est constaté que lors de l’évaluation en environnement réel. L’intérêt de l’approche interactionniste pour la mise en évidence de troubles socio-comportementaux et le bénéfice des environnements virtuels pour l’évaluation neuropsychologique sont discutés.
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Petitpas, Laurent, et Frédérick Van Meer. « L’utilisation de fichiers 3D pour la création d’un clone virtuel ». Revue d'Orthopédie Dento-Faciale 55, no 1 (février 2021) : 53–72. http://dx.doi.org/10.1051/odf/2021005.

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Si bon nombre de praticiens sont équipés de scanners optiques intrabuccaux pour réaliser leurs empreintes numériques 3D, plus rares sont ceux qui utilisent les fichiers 3D issus de l’Imagerie volumétrique par CBCT (Cone Beam Computed Tomography) et encore moins sont ceux qui utilisent des scans 3D de visage de leur patient. Toutes ces images 3D dont la visualisation de l’image en couleur est attirante permettent déjà une analyse immédiate intéressante du patient. Mais peut-on aller plus loin ? Est-ce que ces fichiers 3D issus des différentes technologies sont interfaçables, connectables ? Les fichiers 3D générés par les différents systèmes technologiques d’acquisition correspondent chacun à une partie virtualisée du patient, malgré des formats de fichiers quelque fois différents, il est possible de les regrouper afin d’obtenir un patient virtuel complet : le « Jumeau virtuel ». Plusieurs logiciels de modélisation graphique 3D permettent d’importer, convertir et utiliser les fichiers des différents types d’acquisition 3D. Évidemment, l’utilisation de ces logiciels nécessitent un certain apprentissage initial mais finalement les procédures numériques sont simples. De la sorte, l’objectif de cet article est de vous sensibiliser avec ces techniques d’utilisation de l’imagerie 3D numérique.
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Park, Mira, et Peter Summons. « An Efficient Virtual Patient Image Model Interview Training in Pharmacy ». International Journal of Bio-Science and Bio-Technology 5, no 6 (31 décembre 2013) : 137–46. http://dx.doi.org/10.14257/ijbsbt.2013.5.6.14.

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Castellanos-Ruiz, Julialba, Mónica Pinzón-Bernal et Etni Giraldo-Samboní. « Aplicación de Realidad Virtual Para Tratamiento de la Mano Espástica en la Hemiplejía. Revisión Sistemática. » Revista Ecuatoriana de Neurologia 29, no 2 (2020) : 67–77. http://dx.doi.org/10.46997/revecuatneurol29200067.

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Introducción. La realidad virtual (RV) es una representación de la realidad generada por computador, cuyo uso en pacientes neurológicos es un proceso innovador para la recuperación de la función motora. Objetivo. Determinar el efecto de la realidad virtual sobre la función motora de la mano espástica del adulto con hemiparesia. Materiales y Métodos. Se realizó búsqueda sistemática en bases de datos PubMeD, Science direct, EMBASSE, PeDro, OT Seeker, Cochrane; de ensayos clínicos controlados acorde con los estándares de calidad establecidos por la estrategia CONSORT 2010 y la calidad metodológica de los estudios fue analizada utilizando la escala de PEDro. Resultados. La terapia de realidad virtual mostró efectividad en la función de la mano espástica en actividades selectivas que implican destreza y ejecución de habilidades de la vida diaria y recuperación de la espasticidad. Conclusiones. La terapia de realidad virtual es una alternativa que puede implementarse en personas con secuelas de ECV con un compromiso leve a moderado, genera adherencia y buena capacidad de respuesta. Sin embargo, estos resultados se deben recomendar con precaución, dada que las medidas de resultado no son estadísticamente significativas, pero presentan una tendencia ligeramente a favor de la realidad virtual.
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Andal,, Elizabeth M. « Quality Virtues in Service ». International Journal of Human Caring 11, no 3 (avril 2007) : 30–34. http://dx.doi.org/10.20467/1091-5710.11.3.30.

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In a materialistic society where economic returns in service are necessary for organizational survival, there is a need to frame the provision of patient care in the context of values—a set of ideals. Quality Virtues in Service (QVS) is the process of care delivery using virtue-driven, quality values. Virtues shape the foundation, fundamentals of patient service utilizing tools of the patient care trade: compassion, honesty, industry, and integrity. The QVS philosophy, model of service, and essential characteristics of the QVS provider are discussed. The expected outcomes or goals of QVS are listed so that healthcare providers can facilitate patient satisfaction, enhance quality of care using the QVS guidelines for practice, and reinforce professional commitment through virtue-driven supportive work interrelationships.
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Brunner, Iris, Jan Sture Skouen, Håkon Hofstad, Jörg Aßmus, Frank Becker, Anne-Marthe Sanders, Hanne Pallesen et al. « Virtual Reality Training for Upper Extremity in Subacute Stroke (VIRTUES) ». Neurology 89, no 24 (15 novembre 2017) : 2413–21. http://dx.doi.org/10.1212/wnl.0000000000004744.

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Objective:To compare the effectiveness of upper extremity virtual reality rehabilitation training (VR) to time-matched conventional training (CT) in the subacute phase after stroke.Methods:In this randomized, controlled, single-blind phase III multicenter trial, 120 participants with upper extremity motor impairment within 12 weeks after stroke were consecutively included at 5 rehabilitation institutions. Participants were randomized to either VR or CT as an adjunct to standard rehabilitation and stratified according to mild to moderate or severe hand paresis, defined as ≥20 degrees wrist and 10 degrees finger extension or less, respectively. The training comprised a minimum of sixteen 60-minute sessions over 4 weeks. The primary outcome measure was the Action Research Arm Test (ARAT); secondary outcome measures were the Box and Blocks Test and Functional Independence Measure. Patients were assessed at baseline, after intervention, and at the 3-month follow-up.Results:Mean time from stroke onset for the VR group was 35 (SD 21) days and for the CT group was 34 (SD 19) days. There were no between-group differences for any of the outcome measures. Improvement of upper extremity motor function assessed with ARAT was similar at the postintervention (p = 0.714) and follow-up (p = 0.777) assessments. Patients in VR improved 12 (SD 11) points from baseline to the postintervention assessment and 17 (SD 13) points from baseline to follow-up, while patients in CT improved 13 (SD 10) and 17 (SD 13) points, respectively. Improvement was also similar for our subgroup analysis with mild to moderate and severe upper extremity paresis.Conclusions:Additional upper extremity VR training was not superior but equally as effective as additional CT in the subacute phase after stroke. VR may constitute a motivating training alternative as a supplement to standard rehabilitation.ClinicalTrials.gov identifier:NCT02079103.Classification of evidence:This study provides Class I evidence that for patients with upper extremity motor impairment after stroke, compared to conventional training, VR training did not lead to significant differences in upper extremity function improvement.
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Webster, Laura Bentley, et Jamie L. Shirley. « No Need to Object : Ethical Obligations for Interprofessional Collaboration in Emergency Department Discharge Planning ». Annual Review of Nursing Research 34, no 1 (janvier 2016) : 183–98. http://dx.doi.org/10.1891/0739-6686.34.183.

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Emergency departments (EDs) serve a wide range of patient needs. A crucial aspect of safe and effective care in the ED is to appropriately transition patients to the next level of care. In most EDs, this disposition planning is done exclusively by physicians, which has the potential to result in unacceptable harm. A virtue ethics approach demonstrates the need for explicit inclusion of nurses in disposition planning. In utilizing this approach, it is necessary to examine four focal virtues as they relate to the work of disposition planning and the moral character of the nurse. The virtues of prudence, trustworthiness, vigilance, and courage show that interprofessional collaboration is needed during disposition planning to promote patient safety, facilitate interprofessional relationships, and prevent moral distress. The majority of literature on disposition planning is empirical in nature; this chapter adds a normative argument and a motive for policy reform.
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Lavelock, Caroline R., Everett L. Worthington, Brandon J. Griffin, Rachel C. Garthe, Aaliah Elnasseh, Don E. Davis et Joshua N. Hook. « Still Waters Run Deep : Humility as a Master Virtue ». Journal of Psychology and Theology 45, no 4 (décembre 2017) : 286–303. http://dx.doi.org/10.1177/009164711704500404.

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We present two intervention studies designed to promote humility and other virtues. In Study 1, we compared the PROVE Humility workbook (Lavelock, Worthington, & Davis, 2012/2013) to alternative workbooks, each designed to promote a particular virtue (e.g., forgiveness, patience, self-control) or mood state (positivity). Participants who completed the PROVE Humility workbook reported greater increases in humility and other virtues when compared to participants in the other conditions. In Study 2, we revised the workbook and tested it against a test-retest control condition. Study 2 replicated the findings from Study 1, such that participants who completed the PROVE Humility workbook reported improvements in humility and other virtues (e.g., forgivingness and patience), as well as reductions in negative affect. These findings support the idea of humility being a master virtue, and we recommend future directions for the clinical application of humility.
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Islam, M. Kamrul, et Iris Brunner. « Cost-analysis of virtual reality training based on the Virtual Reality for Upper Extremity in Subacute stroke (VIRTUES) trial ». International Journal of Technology Assessment in Health Care 35, no 5 (2019) : 373–78. http://dx.doi.org/10.1017/s026646231900059x.

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AbstractObjectivesStroke is a major cause of lasting disability worldwide. Virtual reality (VR) training has been introduced as a means of increasing the effectiveness of rehabilitation by providing large doses of task-related training with many repetitions and different modes of feedback. As VR is increasingly used in neurorehabilitation, cost considerations are important.MethodsA cost-analysis was conducted based on the Virtual Reality for Upper Extremity in Subacute stroke (VIRTUES) trial, a recent international randomized controlled observer-blind multicenter trial. Average therapist time required per therapy session may differ between VR and conventional training (CT), leading to potential cost savings due to a therapist being able to supervise more than one patient at a time. Exploratory cost analyses are presented to explore such assumptions.ResultsBased on our calculations, VR incurs extra costs as compared with CT when the same amount of therapist contact is provided, as was the case in VIRTUES. However, the exploratory analyses demonstrated that these costs may be rapidly counterbalanced when time for therapist supervision can be reduced.ConclusionsExtra costs for VR can be outweighed by reduced therapist time and decreasing VR system costs in the nearer future, and not least by increased patient motivation.
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Thèses sur le sujet "Patient virtuel"

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Guevara, Perez Sonia. « Developpement par éléments finis d'un modèle virtuel personalisable de la mandibule humaine comme un outil de simulation biomécanique en sciences dentaires ». Thesis, Aix-Marseille, 2019. http://www.theses.fr/2019AIXM0576.

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Les facteurs déterminants des caractéristiques biomécaniques chez la mandibule humaine sont les propriétés des tissues et sa géométrie externe et interne. Des procédures non-invasives pour prédire de façon précise, les contraintes des mandibules soumis aux stress mécaniques sont importantes dans des diverses situations en Odontologie. Les modèles éléments finis (EF), montrent une bonne capacité d’évaluer les relations géométriques, mécaniques et fonctionnelles sur la mandibule. Malgré les progrès récents, la conception de modèles numériques présente encore des limites, liées au manque de connaissances des propriétés mécaniques de tous les tissus, à la conception intégrale du modèles et la possibilité de personnalisation de ceux-ci en tenant compte de la variabilité anatomique, morphologique, physiologique et biologique des individus. Le présent travail vise à définir un modèle d'éléments finis de la mâchoire pouvant être modélisé en fonction des conditions anatomiques et morphologiques particulières d'un individu, de manière à prédire avec précision les réponses mécaniques et biologiques de la mandibule. La définition des paramètres pertinents à l’obtention des modèles de simulation, permettra une évaluation in silico des réponses spécifiques chez les patients aux traitements pratiqués dans le domaine dentaire, en tenant compte de la variabilité morphologique de la mandibule associée aux pertes dentaires. L’objectif de cette recherche est la parameterisation géométrique et mécanique d’un modèle EF d’une mandibule, intégrant les particularités anatomiques d'un individu et permettant de prédire, avec précision, les réponses mécaniques vis-à-vis des traitements dentaires
The determining factors of biomechanical characteristics in the human mandible are the properties of the tissues and its external and internal geometry. Non-invasive procedures to predict accurately the mandible stress and strains under mechanical loads are important in a variety of dental situations. The finite element models shows a good ability to evaluate the geometric, mechanical and functional relations on the mandible. Despite recent advances, the design of numerical models still has limitations: the lack of knowledge of the mechanical properties of all tissues, the integral design of the models and the possibility of personalization of these, taking into account the anatomical, morphological, physiological and biological variability of individuals. The present work aims to define a model of finite elements of the jaw that can be modeled according to the particular anatomical and morphological conditions of an individual, in order to accurately predict the mechanical and biological responses of the mandible against loads or mechanical stimuli that affect them. The definition of the parameters relevant to obtaining the appropriate simulation models will enable an in silico assessment of any specific patient responses to dental treatments, in particular in dental implantology, taking into account the morphological variability of the mandible with dental losses. . The objective of this research is the geometrical and mechanical parametrization of an EF model of a mandible, integrating the anatomical particularities of an individual and allowing predicting with precision, the mechanical responses to dental treatments
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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 crises
Epileptic 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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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 utilisation
The complexity of the patients in the intensive care unit requires the use of clinical decision support systems. These systems bring together automated management protocols that enable adherence to guidelines and virtual physiological or patient simulators that can be used to safely customize management. These devices operating from algorithms and mathematical equations can only be developed from a large number of patients’ data. The main objective of the work was the elaboration of a high resolution database automatically collected from critically ill children. This database will be used to develop and validate a physiological simulator called SimulResp© . This manuscript presents the whole process of setting up the database from concept to use
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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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Nilsson, Emma, et Nadja Fadhel. « Generation Digital Patient : En kartläggning av användningen av och attityder till digital vård ». Thesis, Uppsala universitet, Kulturgeografiska institutionen, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-388812.

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Sjukvården i Sverige genomgår just nu en digitalisering för att anpassa vården till ny teknologi samt för att bättre kunna möta patienters behov både nu och i framtiden. En del av denna digitalisering är digital vård som möjliggör att vårdgivare och vårdtagare kan ha ett vårdmöte på distans genom digitala plattformar. Digital vård är ett relativt nytt fenomen inom den svenska sjukvården och har varit ett mål för diskussion, där förtroendet för de digitala vårdtjänsterna varierar bland befolkningen. Denna uppsats ämnar studera och kartlägga användningen av och attityderna till digital vård bland individer i åldersgruppen 18-29 år. Detta genom att använda en huvudsakligen kvantitativ forskningsstrategi och enkät som forskningsmetod.  Resultatet visar bland annat att respondenterna överlag varken har ett lågt eller högt förtroende för digitala vårdtjänster, utan uppfattas ha ett neutralt förtroende. Respondenter som tidigare använt digitala vårdtjänster har emellertid ett högre förtroende för digital vård än respondenter som inte tidigare använt denna typ av vårdtjänst. De utlästa attityderna hos respondenterna kan främst härledas till den rumsliga aspekten av digital vård Många respondenter uppger att de tycker att digital vård är smidigt, flexibelt och enkelt samtidigt som flera är skeptiska till att lika bra vård kan ges vid ett digitalt vårdbesök som vid ett fysiskt. Vidare uppfattas det finnas attityder av politisk karaktär, där frågan snarare gäller privata respektive offentliga vårdaktörer som bidrar till respondenternas attityder till och viljan att använda digital vård.
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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.

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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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Kuenne, Christoph W., Sabrina Adamczyk, Matthias Rass, Angelika C. Bullinger et 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 et 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.

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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.

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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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Livres sur le sujet "Patient virtuel"

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Lemke, H. U., Heinz-Otto Peitgen, Wolfgang Niederlag et Hans Lehrach. Der virtuelle Patient. 2e éd. Berlin : De Gruyter, 2014.

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Niederlag, Wolfgang, Heinz U. Lemke, Hans Lehrach et Heinz-Otto Peitgen, dir. Der virtuelle Patient. Berlin, Boston : DE GRUYTER, 2014. http://dx.doi.org/10.1515/9783110335668.

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Patience Is a Virtue. New York : Diamond Books, 1989.

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Leimeister, Jan Marco. Virtuelle Communities für Patienten. Wiesbaden : Deutscher Universitätsverlag, 2005. http://dx.doi.org/10.1007/978-3-322-81860-7.

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ill, Spellman Susan, et Andersen, H. C. (Hans Christian), 1805-1875, dir. The virtue of patience : The ugly duckling. [Lincolnwood, Ill.] : Publications International, 2002.

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Schopenhauer's ethics of patience : Virtue, salvation, and value. Lewiston, N.Y : Edwin Mellen Press, 2009.

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Jordan, Neil. Schopenhauer's ethics of patience : Virtue, salvation, and value. Lewiston, N.Y : Edwin Mellen Press, 2010.

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Schoenberger, Susan. The virtues of oxygen : A novel. Seattle : Lake Union Publishing, 2014.

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Great Britain. Audit Commission for Local Authorities and the National Health Service in England and Wales. The Virtue of patients : Making best use of ward nursing resources. London : H.M.S.O., 1991.

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Medicine Meets Virtual Reality (2000 San Diego, Calif.). Medicine meets virtual reality 2000 : Envisioning healing : interactive technology and the patient-practitioner dialogue. Amsterdam : IOS Press, 2000.

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Chapitres de livres sur le sujet "Patient virtuel"

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Scherly, D., et M. Nendaz. « Simulation du raisonnement clinique sur ordinateur : le patient virtuel ». Dans La simulation en santé De la théorie à la pratique, 43–50. Paris : Springer Paris, 2013. http://dx.doi.org/10.1007/978-2-8178-0469-9_5.

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Zalis, Michael. « Patient Preparation ». Dans Atlas of Virtual Colonoscopy, 33–36. New York, NY : Springer New York, 2003. http://dx.doi.org/10.1007/978-0-387-21558-7_5.

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Patzelt, Alexandra, et Sebastian B. M. Patzelt. « The Virtual Patient ». Dans Clinical Applications of Digital Dental Technology, 231–40. Chichester, UK : John Wiley & Sons, Inc, 2015. http://dx.doi.org/10.1002/9781119045564.ch12.

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Yee, J. « Patient Preparation for CT Colonography ». Dans Virtual Colonoscopy, 49–59. Berlin, Heidelberg : Springer Berlin Heidelberg, 2010. http://dx.doi.org/10.1007/978-3-540-79886-6_5.

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Oliva, M. Raquel, Ayodale S. Odulate et Koenraad J. Mortele. « The Eligible Patient : Indications and Contraindications ». Dans Virtual Colonoscopy, 38–47. Berlin, Heidelberg : Springer Berlin Heidelberg, 2010. http://dx.doi.org/10.1007/978-3-540-79886-6_4.

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Bauman, Eric B. « Immersive Virtual Reality to Model Physical ». Dans The Digital Patient, 199–206. Hoboken, NJ : John Wiley & Sons, Inc, 2016. http://dx.doi.org/10.1002/9781118952788.ch14.

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Cornick, Jessica E., et Jim Blascovich. « Virtual Reality and Eating, Diabetes, and Obesity ». Dans The Digital Patient, 181–97. Hoboken, NJ : John Wiley & Sons, Inc, 2016. http://dx.doi.org/10.1002/9781118952788.ch13.

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Rizzo, Albert, et Thomas Talbot. « Virtual Reality Standardized Patients for Clinical Training ». Dans The Digital Patient, 255–72. Hoboken, NJ : John Wiley & Sons, Inc, 2016. http://dx.doi.org/10.1002/9781118952788.ch18.

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Riva, Giuseppe, Clelia Malighetti, Alice Chirico, Daniele Di Lernia, Fabrizia Mantovani et Antonios Dakanalis. « Virtual Reality ». Dans Rehabilitation interventions in the patient with obesity, 189–204. Cham : Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-32274-8_12.

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Lenhart, Dipti K., Rocio Perez Johnston et Michael E. Zalis. « Patient Preparation and Tagging ». Dans Atlas of Virtual Colonoscopy, 79–86. New York, NY : Springer New York, 2010. http://dx.doi.org/10.1007/978-1-4419-5852-5_6.

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Actes de conférences sur le sujet "Patient virtuel"

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Cheng, Marvin H., Po-Lin Huang, Hao-Chuan Chu, Li-Han Peng et Ezzat Bakhoum. « Virtual Interaction Between Patients and Occupational Therapists Using an Assistive Robotic Device With Cyber-Physical System ». Dans ASME 2018 International Mechanical Engineering Congress and Exposition. American Society of Mechanical Engineers, 2018. http://dx.doi.org/10.1115/imece2018-87289.

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In this paper, we propose to design, develop, and study a cyber-physical system that enables patients and therapists to virtually interact for rehabilitation activities with assistive robotic devices. The targeted users of this system are post-stroke patients. On the patient’s side, an assistive robotic device can generate the force that the therapist applies to the patient. On the therapist’s side, another robotic device can reproduce the responsive force generated by the patient. With this system, the interaction can be virtually established. In addition, by integrating real human trajectories, the proposed assistive robotic system can help patients to perform rehabilitation activities in their own pace. Such an assistive robotic system and virtual interacting scheme can minimize both patient’s and therapist’s traveling time. The assistive functions of this light weight design can also help patients to in their ADLs.
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Lee, Po-Chih, Arthur G. Erdman, Charles Ledonio et David Polly. « A Framework of Simulating Virtual Spine Patients to Assess Thoracic Volume Variations due to Wedging Deformities ». Dans 2018 Design of Medical Devices Conference. American Society of Mechanical Engineers, 2018. http://dx.doi.org/10.1115/dmd2018-6853.

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In 1964, Dr. Barrows first introduced the standardized patients, who are individuals trained to imitate the pathological symptoms of the real patients, and involved them in teaching and clinical skills assessment for healthcare education. In recent decades, the application of the virtual patient has been rapidly grown and has been widely used in clinical or educational practice among residents, surgeons, or other medical professionals because the virtual patient is cost-effective and time-efficient [1]. The Food and Drug Administration (FDA) collaborated with the Foundation of Research on Information Technologies in Society (IT’IS Foundation, Zürich, Switzerland) to produce a virtual family, which is a set of anatomical computer-aided design (CAD) models of adults and children [2, 3], and those CAD models are used in electromagnetic, thermal, and computer fluid dynamics simulations. However, the meaning of virtual patients or models has varied across the recent years and more and more researchers tried to categorize the terminology of virtual patients. In general, virtual patients can be classified into seven major types including: case presentation, interactive patient scenarios, virtual patient game, high fidelity software simulation, human standardized patients, high fidelity manikins, and virtual standardized patients [4]. The virtual patients discussed in this study can be classified as interactive patient scenarios, whose application includes clinical reasoning, surgical planning, and disease diagnosis.
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Sarmento, Carlos Eduardo, Daniel Guerra, Deborah Dantas, Emanuel Arnaud, Hallysson Santos, João Pedro Dias, Matheus Andrade et Alyson Souza. « POSTER : Dagda - A Virtual Reality Experience for Pediatric Patients with Cancer in Chemotherapy ». Dans XXI Symposium on Virtual and Augmented Reality. Sociedade Brasileira de Computação - SBC, 2019. http://dx.doi.org/10.5753/svr_estendido.2019.8467.

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During the process of chemotherapy of pediatric patients with cancer, the discomfort proves to be one of the many challenges for the patient, intensified by the ease at which the child becomes upset or annoyed. As a form of distraction during part of the treatment, this poster proposes an application of virtual reality to mask the process, and additionally, allows for association within the cancer patient’s situation
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Vaughan, Neil, Venketesh N. Dubey, Michael Y. K. Wee et Richard Isaacs. « Body Shape and Size Modelling Using Regression Analysis and Neural Network Prediction ». Dans ASME 2014 International Design Engineering Technical Conferences and Computers and Information in Engineering Conference. American Society of Mechanical Engineers, 2014. http://dx.doi.org/10.1115/detc2014-35707.

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The aim of this research is to build a patient-specific virtual body shape model for patients of various Body Mass Index (BMI) and body shape. This will enable simulated epidural procedure on patients of various body characteristics, to increase trainee skill, reduce injuries and litigation costs. Regression analysis (RA) and artificial neural networks (ANN) were implemented to accurately calculate body shape in a data-driven approach. Epidural simulator software was developed containing a screen to enter patient characteristics. When the patient BMI is adjusted, the modelled body shape and tissue layer thickness updates allowing patient specific simulation. The model uses anthropometric measurements as input: body mass, height, age, gender and body shape. The developed model enables a virtual representation of any actual patient to be built based on their measured parameters for epidural rehearsal prior to in-vivo procedure.
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Ahlqvist, A., O. Harrysson, T. Conway et J. Nayfeh. « Using Stereolithography Models in Planning Spinal Surgery ». Dans ASME 2002 International Mechanical Engineering Congress and Exposition. ASMEDC, 2002. http://dx.doi.org/10.1115/imece2002-32636.

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CT data of two patients was used to create computer generated 3-dimensional models of portions of their spines. One of the patients suffered from scoliosis and the other patient from tortecolis. The virtual models were then used to create stereolithography models in order to assist the planning of surgery of the two patients. The models increased the surgeons understanding of the deformations of the patients spines by providing a visualization tool. Also, the surgeon was able to use the models for patient education.
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Lanzoni, Daniel, Andrea Vitali, Daniele Regazzoni et Caterina Rizzi. « Medical Assessment Test of Extrapersonal Neglect Using Virtual Reality : A Preliminary Study ». Dans ASME 2020 International Design Engineering Technical Conferences and Computers and Information in Engineering Conference. American Society of Mechanical Engineers, 2020. http://dx.doi.org/10.1115/detc2020-22416.

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Abstract The research work presents a preliminary study to create a virtual reality platform for the medical assessment of spatial extrapersonal neglect, a syndrome affecting human awareness of a hemi-space that may be caused by cerebral lesions. Nowadays, the extrapersonal neglect is assessed by using real objects positioned in the space around the patient, with a poor capability of repetition and data gathering. Therefore, the aim of this research work is the introduction of a virtual reality solution based on consumer technology for the assessment of the extrapersonal neglect. By starting from the needs of the involved medical personnel, an online serious-game platform has been developed, which permits to perform a test and a real-time evaluation by means of objective data tracked by exploited technologies, i.e. an HTC Vive Pro head mounted display and ad-hoc IT solutions. The test is based on a virtual environment composed by a table on which twenty objects have been placed, ten on the right side and ten on the left side. The whole 3D virtual environment has been developed using low-cost and free development tools, such as Unity and Blender. The interaction with the virtual environment is based on voice recognition technology, therefore the patient interact with the application by pronouncing the name of each object aloud. The VR application has been developed according to an online gaming software architecture, which permits to share the 3D scene by exploiting a Wi-Fi hotspot network. Furthermore, the on-line gaming software architecture allows sending and receiving data between the doctor’s laptop and the VR system used by the patient on another laptop. The therapist can see through his/her personal computer a real time faithful replica of the test performed by the patient in order to have a fast feedback on patient’s field of view orientation during the evaluation of 3D objects. A preliminary test has been carried out to evaluate the ease of use for medical personnel of the developed VR platform. The big amount of recorded data and the possibility to manage the selection of objects when the voice commands are not correctly interpreted has been greatly appreciated. The review of the performed test represents for doctors the possibility of objectively reconstructing the improvements of patients during the whole period of the rehabilitation process. Medical feedback highlighted how the developed prototype can already be tested involving patients and thus, a procedure for enrolling a group of patients has been planned. Finally, future tests have been planned to compare the developed solution with the Caterine Bergero Scale to define a future standardization.
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Marzec, Małgorzata, Michał Olech, Ryszard Klempous, Jan Nikodem et Konrad Kluwak. « Virtual reality poststroke rehabilitation with localization algorithm enhancement ». Dans The 5th International Conference on Virtual and Augmented Reality in Education. CAL-TEK srl, 2019. http://dx.doi.org/10.46354/i3m.2019.vare.005.

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"The work presents an analysis of the application of virtual reality technology in rehabilitation after the occurrence of stroke. The needs in poststroke therapy, as well as the requirements and technological possibilities were investigated, with the result being the creation of the application for post-stroke rehabilitation. Tests on the application, as well as analyzed studies have shown that this way of rehabilitation as an isolated therapy is not enough to improve the condition of patients. The combination of rehabilitation in a virtual and conventional manner provides a positive effect on the improvement of medical patient motor functions based on the surveyed patients."
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Covarrubias, Mario, Alessandro Mansutti, Monica Bordegoni et Umberto Cugini. « 2D Shape and Force Tracking in Rehabilitation Therapy of Upper Extremities Through a Multimodal Guidance System ». Dans ASME 2014 International Design Engineering Technical Conferences and Computers and Information in Engineering Conference. American Society of Mechanical Engineers, 2014. http://dx.doi.org/10.1115/detc2014-34425.

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This paper describes a shape and force tracking approach aimed for the assessment and training of patients’ upper extremities functionalities, while performing 2D tasks in a post-stroke rehabilitation program. The 2D tasks are assisted by a Multimodal Guidance System (MGS), which consists in a combination of visual, haptic and sound interaction. The device enables users to haptically interact with a virtual template, which acts as a virtual tool path taking advantage of its force feedback capabilities while the patient performs a 2D task, as sketching and hatching operations. Furthermore, the patient receives sound information, which provides audio feedback related to the hand velocity. By tracking the shape and the forces required to complete the tasks according to the visual feedback provided on the computer screen, the system can inform about quantitative measurement of a patients progress. The paper concludes by presenting a preliminary test using the device for sketching and hatching operations.
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Rosati, Giulio, James E. Bobrow et David J. Reinkensmeyer. « Compliant Control of Post-Stroke Rehabilitation Robots : Using Movement-Specific Models to Improve Controller Performance ». Dans ASME 2008 International Mechanical Engineering Congress and Exposition. ASMEDC, 2008. http://dx.doi.org/10.1115/imece2008-68234.

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Post-stroke neurorehabilitation is an emerging application field of robotics, aiming to design new treatment systems and protocols based on the use of robotic technology and virtual reality to improve patient recovery after stroke. One goal in this field is to develop robotic therapy devices that are compliant but can still assist weakened patients in making desired movements. It is hypothesized that, in this way, the interaction with the robotic system can maintain patient engagement and effort, and promote and stimulate the motor learning process of the patient. One way that has been proposed to maintain compliance while assisting weak patients is to use an adaptive controller with a forgetting term, which allows the robotic system to learn a model of the forces needed to assist the patients during exercises while encouraging patient effort. A limitation of such an approach is that the adaptive gain must be large enough to rapidly change the model for different target movements, which decreases the compliance of the robot. We show here in simulation that by building independent models for different target movements, robot compliance can be increased while still accurately achieving the target movements.
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Onbasıog˘lu, Esin, Bas¸ar Atalay, Dionysis Goularas, Ahu H. Soydan, Koray K. S¸afak et Fethi Okyar. « Visualisation of Burring Operation in Virtual Surgery Simulation ». Dans ASME 2010 10th Biennial Conference on Engineering Systems Design and Analysis. ASMEDC, 2010. http://dx.doi.org/10.1115/esda2010-25233.

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Virtual reality based surgical training have a great potential as an alternative to traditional training methods. In neurosurgery, state-of-the-art training devices are limited and the surgical experience accumulates only after so many surgical procedures. Incorrect surgical movements can be destructive; leaving patients paralyzed, comatose or dead. Traditional techniques for training in surgery use animals, phantoms, cadavers and real patients. Most of the training is based either on these or on observation behind windows. The aim of this research is the development of a novel virtual reality training system for neurosurgical interventions based on a real surgical microscope for a better visual and tactile realism. The simulation works by an accurate tissue modeling, a force feedback device and a representation of the virtual scene on the screen or directly on the oculars of the operating microscope. An intra-operative presentation of the preoperative three-dimensional data will be prepared in our laboratory and by using this existing platform virtual organs will be reconstructed from real patients’ images. VISPLAT is a platform for virtual surgery simulation. It is designed as a patient-specific system that provides a database where patient information and CT images are stored. It acts as a framework for modeling 3D objects from CT images, visualization of the surgical operations, haptic interaction and mechanistic material-removal models for surgical operations. It tries to solve the challenging problems in surgical simulation, such as real-time interaction with complex 3D datasets, photorealistic visualization, and haptic (force-feedback) modeling. Surgical training on this system for educational and preoperative planning purposes will increase the surgical success and provide a better quality of life for the patients. Surgical residents trained to perform surgery using virtual reality simulators will be more proficient and have fewer errors in the first operations than those who received no virtual reality simulated education. VISPLAT will help to accelerate the learning curve. In future VISPLAT will offer more sophisticated task training programs for minimally invasive surgery; this system will record errors and supply a way of measuring operative efficiency and performance, working both as an educational tool and a surgical planning platform quality.
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Rapports d'organisations sur le sujet "Patient virtuel"

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Picho, Katherine, Timothy J. Cleary, Jr Artino, Dong Anthony R. et Ting. Developing and Testing a Self-Regulated Learning Assessment Methodology Combined with Virtual-Patient Simulation in Medical Education. Fort Belvoir, VA : Defense Technical Information Center, avril 2015. http://dx.doi.org/10.21236/ada623009.

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Freeman, Karen, Scott Thompson, Eric Allely, Annette Sobel et Sharon Stansfield. A Virtual Reality Training System for the Triage and Stabilization of Head Trauma and Multiple Injury Patients. Fort Belvoir, VA : Defense Technical Information Center, janvier 1997. http://dx.doi.org/10.21236/ada381347.

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DiAngelo, Lucy, Libby Lowry, Kayla McDaniel, Clare Sauser, Shelby Terry et Erin Williams. Increasing Confidence and Mental Health in Caregivers. University of Tennessee Health Science Center, mai 2021. http://dx.doi.org/10.21007/chp.mot2.2021.0011.

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The purpose of our critically appraised topic is to synthesize the highest-level evidence available regarding interventions for increasing confidence and mental health outcomes in caregivers taking loved ones home from inpatient rehabilitation. The final portfolio contains six research articles from peer-reviewed journals. Study designs include randomized control trials, a systematic review, and a pretest-posttest without a control group. All studies relate directly to the components of the PICO question. Four of the articles discussed both caregiver confidence and mental health while two articles discussed only mental health. There is strong evidence to support that in-person hands on training, in person discussion-based training, and/or virtual resources helped increase confidence in caregivers of patients. There is mixed evidence and only limited improvement to support mental health. The findings from this critically appraised topic will be used to draft new ideas for practice guidelines for addressing caregiver education and caregiver mental health in an inpatient rehabilitation facility.
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Hutchinson, M. L., J. E. L. Corry et R. H. Madden. A review of the impact of food processing on antimicrobial-resistant bacteria in secondary processed meats and meat products. Food Standards Agency, octobre 2020. http://dx.doi.org/10.46756/sci.fsa.bxn990.

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For meat and meat products, secondary processes are those that relate to the downstream of the primary chilling of carcasses. Secondary processes include maturation chilling, deboning, portioning, mincing and other operations such as thermal processing (cooking) that create fresh meat, meat preparations and ready-to-eat meat products. This review systematically identified and summarised information relating to antimicrobial resistance (AMR) during the manufacture of secondary processed meatand meat products (SPMMP). Systematic searching of eight literature databases was undertaken and the resultantpapers were appraised for relevance to AMR and SPMMP. Consideration was made that the appraisal scores, undertaken by different reviewers, were consistent. Appraisal reduced the 11,000 initially identified documents to 74, which indicated that literature relating to AMR and SPMMP was not plentiful. A wide range of laboratory methods and breakpoint values (i.e. the concentration of antimicrobial used to assess sensitivity, tolerance or resistance) were used for the isolation of AMR bacteria.The identified papers provided evidence that AMR bacteria could be routinely isolated from SPMMP. There was no evidence that either confirmed or refuted that genetic materials capable of increasing AMR in non-AMR bacteria were present unprotected (i.e. outside of a cell or a capsid) in SPMMP. Statistical analyses were not straightforward because different authors used different laboratory methodologies.However, analyses using antibiotic organised into broadly-related groups indicated that Enterobacteriaceaeresistant to third generation cephalosporins might be an area of upcoming concern in SPMMP. The effective treatment of patients infected with Enterobacteriaceaeresistant to cephalosporins are a known clinical issue. No AMR associations with geography were observed and most of the publications identified tended to be from Europe and the far east.AMR Listeria monocytogenes and lactic acid bacteria could be tolerant to cleaning and disinfection in secondary processing environments. The basis of the tolerance could be genetic (e.g. efflux pumps) or environmental (e.g. biofilm growth). Persistent, plant resident, AMR L. monocytogenes were shown by one study to be the source of final product contamination. 4 AMR genes can be present in bacterial cultures used for the manufacture of fermented SPMMP. Furthermore, there was broad evidence that AMR loci could be transferred during meat fermentation, with refrigeration temperatures curtailing transfer rates. Given the potential for AMR transfer, it may be prudent to advise food business operators (FBOs) to use fermentation starter cultures that are AMR-free or not contained within easily mobilisable genetic elements. Thermal processing was seen to be the only secondary processing stage that served as a critical control point for numbers of AMR bacteria. There were significant linkages between some AMR genes in Salmonella. Quaternary ammonium compound (QAC) resistance genes were associated with copper, tetracycline and sulphonamide resistance by virtue of co-location on the same plasmid. No evidence was found that either supported or refuted that there was any association between AMR genes and genes that encoded an altered stress response or enhanced the survival of AMR bacteria exposed to harmful environmental conditions.
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