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PubMed2004

[Effect of motion correction associated with echo train length and number of blades in propeller MRI-computer simulation].

The PROPELLER (periodically rotated overlapping parallel lines with enhanced reconstruction) MRI method is available with a technique for motion correction. We studied changes in correction according to differences in echo train length (ETL) and number of blades, and measured correction accuracy according to linear translation and rotation, using computer simulation. A T(2)-weighted axial image of the head taken by FSE was utilized as the basic MR image. We reconstructed other images with differences in quantity of motion, ETL, and number of blades, also using computer simulation. After motion correction was performed, we measured correction accuracy with cross-correlation to the basic image. The method of motion correction was performed by the conversion of k-space data for each blade step using 2D Fourier-transform. After motion correction of the obtained image had been carried out, the image was converted to k-space data using reverse Fourier-transform. For data of 30 pixels with horizontal translation, cross-correlation coefficients for the stationary image were 0.6 for FSE without motion correction, 0.74 for the PROPELLER (ETL 8, blades 32) image without motion correction, and 0.99 for the PROPELLER (ETL 8, blades 32) image with motion correction. For data of 24 degrees with rotation, cross-correlation coefficients were 0.38 for FSE without motion correction, 0.53 for the PROPELLER (ETL 8, blades 32) image without motion correction, and 0.93 for the PROPELLER (ETL 8, blades 32) image with motion correction. The cross-correlation coefficient of liner translation is higher than its rotation. Correction accuracy was better with larger numbers of ETL than without motion correction. The spatial resolution of the image was decreased in the corrected image more by rotation than linear translation. This study indicated that the PR method was able to inspect the imaging technique with little influence on movement.

Computer Simulation↗

PubMed1996

Anaesthesia crisis resource management training: an intimidating concept, a rewarding experience.

PURPOSE: This two-part study was performed to identify and address anaesthetists' concerns regarding anaesthesia simulation and to evaluate the response of practitioners to simulation-based Anaesthesia Crisis Resource Management Training (ACRM). METHODS: First, 150 survey questionnaires were distributed to participants of the Anaesthesia Practice '94 meeting in Toronto and to staff and resident anaesthetists at the Sunnybrook Health Science Centre. In the second part of the study, 35 anaesthetists from the Toronto area who participated in Anaesthesia Crisis Resource Management (ACRM) workshops at the Canadian Simulation Centre completed an anonymous exit evaluation questionnaire. RESULTS: Among staff anaesthetists (n = 42), 19% of the surveyed respondents had never heard about anaesthesia simulation, whereas all residents (n = 17) had heard of, or seen an anaesthesia simulator. Horizontal numerical scale ratings (from 1-10, with 10 being extremely supportive) indicated support for the purchase of a simulator (8.3 +/- 2.0 for staff, 9.2 +/- 1.1 for residents). Staff and residents anticipated substantial anxiety while training with a simulator (6.8 +/- 2.4 and 7.6 +/- 1.4 respectively, with 10 indicating extreme anxiety). Participants in the ACRM workshops at the Canadian Simulation Centre enjoyed the course (1.2 +/- 0.6, on a scale form 1 through 5, with 1 indicating total support and 5 representing no support), felt that it would be beneficial to most anaesthetists (1.2 +/- 0.5) and should be taken, on average, every 18 mo. CONCLUSIONS: Even though the majority of respondents have not been exposed to anaesthesia simulators, they appear to support their use in education strongly. Whereas substantial anxiety could delay the introduction of simulation based education, participants of ACRM workshops enjoy the courses and perceive them as very educational.

Adult↗

PubMed2005

Simulation-based education for cardiac, thoracic, and vascular anesthesiology.

Simulation has been used for medical teaching and testing for at least four decades in some form, such as that used for cardiopulmonary resuscitation training; however, new technology applied to medical and procedural training has recently led to a marked increase in the use of simulation-based instruction. Educational theory has further supported simulation for medical education and procedural training. Simulation-based testing to demonstrate competence with new procedures is already required by the US Food and Drug Administration for one angiographically-placed device, and it is likely that simulation-based credentialing for procedures will be increasingly prevalent. Anesthesiologists, like other physicians, may be credentialed or certified based on their performance in a simulated environment in the future. This review describes some of the current simulation-based education techniques related to cardiovascular and thoracic anesthesiology. Additional discussion covers some of the applicable educational theory and the expected future uses of simulation modalities in healthcare education, testing, and practice.

Anesthesia↗

PubMed2006

The compactEASIE is a feasible training model for endoscopic novices: a prospective randomised trial.

BACKGROUND: The objective benefit of a training using the compact Erlangen Active Simulator for Interventional Endoscopy-simulator was demonstrated in two prospective educational trials (New York, France). The present study analysed whether endoscopic novices are able to reach a comparable level of endoscopic skills as in the above-described projects. METHODS: Twenty-seven endoscopic novices (medical students, first year residents) were enrolled in this prospective, randomised trial. The compact Erlangen Active Simulator for Interventional Endoscopy-simulator with an upper GI-organ package and blood perfusion system was used as a training tool. Basic evaluation of endoscopic skills was performed after a practical and theoretical course in diagnostic upper GI endoscopy followed by a stratified randomisation according to the rating in endoscopic skills into intensive (n=14) and control group (n=13). The intensive group was trained 12 times every second week over 7 months in 4 endoscopic disciplines (manual skills, injection therapy, haemoclip, band ligation) by skilled endoscopist (three trainees/simulator). Assessment was performed (single steps/overall) using an analogue scale from 1 to 10 (1=worst, 10=optimal performance) by expert tutors. The control group was not trained. Blinded final evaluation of all participants was performed in January 2003. RESULTS: We observed in all techniques applied a significant improvement of endoscopic skills and of the performance time in the intensive group compared to the control group (p<0.001). The comparison with the previous projects showed that the intensively trained novices achieved comparable levels of performance to the GI fellows in the New York and France Project (at least 80% of the median score in three out of four techniques). CONCLUSION: Endoscopic novices acquired notable skills in interventional endoscopy in the simulator by an intensive, periodical training using the compactEASIE.

Clinical Competence↗

PubMed2004

The joint effects of person and situation factors on stress in spaceflight.

Psychologists can play an important role in spaceflight and exploration. Indeed, their input at four specific stages in spaceflight can help to ensure successful missions. Psychologists have a role to play in: 1) Selection; 2) Training; 3) Real or Simulated Space Missions; and 4) Post-Flight Problems. During selection, psychologists can provide guidelines as to the appropriate coping styles for reacting to mission-related stressors. During training, psychologists can help astronauts to plan for, and cope with, problems (e.g., group conflict). Training in social sensitivity, or in specific coping styles (i.e., to be high in task-oriented coping), would be beneficial so that astronauts are able to deal with unforeseen problems. Task-oriented coping is related to control and efficiency, and reduces stress and anxiety. Emotion-oriented coping relates to anxiety for controllable situations, and task-oriented coping is most efficacious. A primary role for psychologists would be the investigation of what problems could arise from living with others in a limited space and for long periods of times. As such, investigations into group dynamics, physical and psychological stress caused by such an environment, and the lack of normal ways to deal with these problems should all be considered. It is also clear that the impact of spaceflight on an individual does not end with physical re-entry. On the contrary, the astronaut will also have to make a psychological post-flight "re-entry" readjustment to life on Earth. Psychologists have an important role to play during all four stages of the space program, especially in regards to person by situation interactions. That is, space is a novel environment for human beings, and we need to investigate how we can better improve the fit between astronauts and space situational stressors. Not only are person by situation interactions relevant for each of the four stages discussed above, but each of the stages interacts with one another bidirectionally and even multidirectionally.

Adaptation, Psychological↗

PubMed2004

Comparison of training activities and game demands in the Australian Football League.

his paper serves as a companion to our recent study of the movement patterns and game activities of players (from five different positions) during matches in the 2000 Australian Football League season. Using lapsed-time video analysis, the same individual players (n= 11) as filmed in matches were also monitored during 21 in-season, main training sessions conducted by their clubs in order to assess the degree to which training activities matched game demands. In general, the training sessions did not involve physical pressure; therefore there were very few contested marks and ground balls or tackles, shepherds and spoils, thereby not matching these game demands. Players typically had more possessions (kicks and handballs) at training than in games. They also spent a greater percentage of total time standing and less time walking at training than in games. Fast-running and sprinting efforts at training were almost all for durations of <6 secs, which matched game demands, as did changes of direction when sprinting, which were almost all in a 0-90 degrees arc. However, across all players filmed, high intensity (fast-running and sprinting) movements were not performed as frequently at training (one every 76 secs) as in games (one every 51 secs). Therefore, while some game demands were adequately replicated at training, others were not closely simulated, suggesting that, after careful interpretation of these results, some improvements in training practices could be made.

Australia↗

PubMed2004

Problems facing vascular surgery in 2004.

The most pressing challenges we face in the immediate future are endovascular training for those already in practice and a new educational paradigm for our residents. A number of avenues for training those in practice have been implemented, and newer methods, including computer simulation, are being explored. Vascular training programs should be 3 years in length, include vascular navigation and interventional skills, and follow 3 years of basic general surgical training. These changes in our resident training paradigm can take place only through two avenues: a successful reapplication to the American Board of Medical Specialties for an independent American Board of Vascular Surgery or a full reconfiguration of the training programs for general and vascular surgeons that would have to be spearheaded by the American Board of Surgery. There is skepticism that the latter could take place in the limited time we have left to make the vascular surgery residency attractive to candidates and sufficient in experiential and knowledge content.

Biomedical Research↗

PubMed2000

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

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

Allied Health Personnel↗

PubMed1986

Physical training and +Gz tolerance reevaluated.

The effect of physical training on +Gz tolerance is of vital interest in the aerospace community. The data on the effect of physical training on orthostatic tolerance or simulated air combat maneuvers is equivocal. The effects of aerobic and strength training programs is briefly reviewed. The data suggest a need for careful reinterpretation of research results in light of conflicting reports and methodological shortcomings. Aerobic training cannot be assumed to always be detrimental nor can strength training be assumed to be universally effective in improving +Gz tolerance. In selecting appropriate screening criteria and training regimens for aircraft personnel, it seems prudent to reinvestigate strength and endurance training effects on +Gz tolerance using multivariate research paradigms. Special attention should be directed to commonly accepted physiological principles which may vary under conditions of altered gravitation.

Aerospace Medicine↗

PubMed1997

On the Way to New Horizons: Telemedicine in Oncology.

Breathtaking insights into carcinogenesis and tumor biology have been gained mainly by recent technical advances in molecular-biological and genetic techniques. Thus, dimensions of earlier diagnosis and the development of new concepts in therapy arise, which were previously unavailable. There is no doubt that through these techniques the future role and tasks of surgical oncology will change. New indications will result, for example, in the context of prophylactic therapy of hereditary malignant disease or the removal of tissue predisposed to tumors. However, modes of therapy orientated toward molecular biology will still be dependent on specialist surgical interventions in the future. Examples are such innovative concepts of therapy as transport of a therapeutic device to or into tumor cells (e.g., gene gun), or even simply obtaining the necessary tumor tissue for therapy (vaccination with transfected autologous tumor cells). Therefore, the future of surgical oncology will be influenced quantitatively as well as conceptually by new qualitative requirements. Improving precision of the surgical intervention will have to go hand-in-hand with a further reduction in surgical trauma. The consistent use of laser, video, computer and communication technology can be seen as an important predeterminant here for optimizing diagnostic and therapeutic procedures. If correctly guided, the professional experience of the individual surgeon and his personal efficiency can also be positively influenced by the swift conversion of society to multimedia and information technology. Major advances in interdisciplinary communication, as one important factor in the choice and the course of suitable complex therapies in oncology, will have to target and help to overcome former weak spots. Communication in and outside one department or hospital, as well as external communication between different medical disciplines and specialists, is being developed further and increasingly refined. The possibilities of modern technology in addition to verbal exchange include visual and interactive "tele"-communication. This renders a new option to the physician, as without direct patient contact he is able to observe, counsel and actively interact - the latter even more so in the future. In oncology the increase of knowledge thus far has gone hand-in-hand with further specialization. This explains the difficulties one encounters in the correct evaluation of relevant data of one specific patient. Telemedicine will help to focus on the advantages of specialist knowledge by rendering access to all available data. These possibilities should furthermore be accessible during a consultation, an examination or in the course of a surgical intervention. Real-time modalities are referred to as telepresence and exceed by far a mere electronic version of the patient's medical folder. Especially in oncology, interdisciplinary collaboration is immensely important for successful therapy. Preoperative diagnostic data are still to be evaluated according to the intraoperative findings. At this decisive moment, it is necessary to involve specialists of other oncological disciplines. Real-time communication devices have to be present in order to transfer image data and clinical observations and ensure the best possible transmission quality to resident and geographically distant experts. With further technological perfection and widespread availability of interactive consultation, other applications include the "second opinion" in the daily routine. Another fascinating option in oncology is offered by visual computer simulation in virtual reality (VR). Medical data are visualized according to the human perception by the means of scenic simulation. From that point of view, VR technologies represent a practicable user interface between computer technology and the individual human being. Through VR, three-dimensional worlds containing virtual objects, which consist of computer-generated data, are created, which the user may explore and liberally interact with. The perfect simulation of realistic settings offers a method of training that may be extended to the field of oncology, as it has been known for a comparatively long period of time from flight simulators in space and air technology. In contrast, medical training is currently achieved mainly by "training-on-the-job." There is well-proven and widely acknowledged certainty of the tremendous influence that the number of surgical interventions-in other words, the training skills of the surgeon-has on the success of a diagnostic or therapeutic intervention. Previously, the subjective experience of the physician acquired from earlier cases determined his efficiency to a large extent. It was, in addition, influenced essentially by perception, "performance on the day" and personal attitude. The goal must be to strengthen the objective criteria as the basis for consistent decision-making processes and clear instructions for therapy. Strict quality management as practiced in air technology has clearly led to a reduction in accidents, and, accordingly, a similar effect is imaginable in oncology with continuous training using VR simulators, leading to improved therapeutic outcome. Other possibilities for use are principally implied and similarly useful for medical school and postgraduate training. The idea of computer-guided medical procedures or medical robots is therefore no longer a mere utopia. Telepresence, telerobotic and VR techniques should, in principle, effectively support the physician in diagnostic processes and therapy. The responsibility for coordination and sensible use of new technological developments will still remain with the physician, such as improving and simplifying medical procedures. Technology should be used according to the situation, not to adapt the patient to a technocratic environment, but to emphasize human treatment of the individual patient. From the opinion of the telephone being a futile technical invention to the other extreme of computed technology as a substitute for the physician (Dr. Cyber), the future role of telemedical techniques and their potential for medical advantage or support, especially in the field of oncology, should be critically viewed and evaluated.

Journal Article↗

PubMedDate not supplied

The use of lightly embalmed (fresh tissue) cadavers for resident laparoscopic training.

STUDY OBJECTIVE: The value of a cadaver training program in laparoscopic surgery has rarely been studied. As there is a dearth of cadaver training programs, it is important to evaluate them. The goal of this study was to estimate if our cadaver training program significantly and relatively rapidly taught residents laparoscopic surgical skills. DESIGN: Observational, timed comparative study (Canadian Task Force classification II-3). SETTING: University of Louisville School of Medicine, Fresh Tissue Laboratory, Louisville, KY. PARTICIPANTS: Twenty-nine obstetric/gynecology residents (15 postgraduate year PGY 2 and 14 PGY 3) participated in the study. INTERVENTION: During 5 half days, we compared the performance of each postgraduate year (PGY) 2 and PGY 3 obstetric/gynecology resident to his or her own results on five outcome skills before and after training in lightly embalmed cadavers. The testing was performed at the beginning and at the end of the week so that all improvement was secondary only to the training experience with the cadaver. Residents were assessed using laparoscopic techniques in a physical-reality simulator for three outcomes: bead transfer time, number of beads transferred, and suturing time on a stuffed vinyl glove and in two specific areas of the cadaver pelvis, with one slightly more difficult than the other. Assessment of suturing time was made on the two distinct tasks using the embalmed cadavers. Although the number of residents was relatively small, it covered two levels for one year. MEASUREMENTS AND MAIN RESULTS: The residents were assessed on a simulator before and after laparoscopic surgical training on the cadaver. The median decrease in bead transfer time (task I, simulator) was 38.5 seconds (p=.02); 69% of the residents showed some reduction in time to complete this task. The median increase in the number of beads transferred (task II, simulator) was 2.5 beads (p=.0001); 72.4% of the residents transferred at least one more bead after training. The median decrease in suture time (task III, simulator) was 63.5 seconds (p=.001); 79.3% of the residents performed this task more quickly after training. The median decrease in suture time (task IV, cadaver) was 54.5 seconds (p=.001); 72.4% of the residents showed improved performance on this task after training. The median reduction in suture time (task V, cadaver) was 53.5 seconds (p<.001); 82.8% of the residents completed this task more quickly after training. CONCLUSIONS: This cadaver surgical training program appeared to significantly improve laparoscopic surgical techniques in PGY 2 and PGY 3 obstetric/gynecology residents in a relatively short time. This model teaches residents specific training in the handling and manipulation of tissue as well as practice in surgical techniques for adnexal surgery, pelvic dissection, laparoscopic hysterectomy, and dissection within the space of Retzius that is not possible with mechanical trainers.

Cadaver↗

PubMed2005

Developing and testing competency levels for laparoscopic skills training.

HYPOTHESIS: Expert levels can be developed for use as training end points for a basic video-trainer skills curriculum, and the levels developed will be suitable for training. DESIGN: Fifty subjects with minimal prior simulator exposure were enrolled using an institutional review board-approved protocol. As a measure of baseline performance, medical students (n = 11) and surgery residents (n = 39) completed 3 trials on each of 5 validated video-trainer tasks. Four board-certified surgeons established as laparoscopic experts (with more than 250 basic and more than 50 advanced cases) performed 11 trials on each of the 5 tasks. The mean score was determined and outliers (>2 SDs) were trimmed; the trimmed mean was used as the competency level. Baseline performance of each subject was compared with the competency level for each task. SETTING: All research was performed in a laparoscopic skills training and simulation laboratory. PARTICIPANTS: Medical students, surgical residents, and board-certified surgeons. MAIN OUTCOME MEASURES: Expert scores based on completion time and the number of subjects achieving these scores at baseline testing. RESULTS: For all tasks combined, the competency level was reached by 6% of subjects by the third trial; 73% of these subjects were chief residents, and none were medical students. CONCLUSIONS: These data suggest that the competency level is suitably challenging for novices but is achievable for subjects with more experience. Implementation of this performance criterion may allow trainees to reliably achieve maximal benefit while minimizing unnecessary training.

Clinical Competence↗

PubMed1994

Predicting recovery from aphasia with connectionist networks: preliminary comparisons with multiple regression.

We trained a series of simulated neural networks with the raw scores on the Western Aphasia Battery from 91 aphasic patients. Patients were tested at 3 and at 12 months post onset. The most successful network we trained is able to predict AQ for an individual in 12 months from the raw scores at 3 months post-onset to a tolerance of + or -4.5. We then compared the relative success of a small range of trained networks to predict recovery with linear multiple regression. With the small groups of subjects involved in this preliminary study, the networks appeared to be more successful at predicting recovery.

Aged↗

PubMed2002

Objective surgical performance evaluation based on haptic feedback.

In order to develop effective virtual reality training systems for surgery there is a need to provide appropriate sensory and performance feedback to the user. This paper aims to demonstrate a method by which performance data can be collected. This is used to investigate the effect of haptic feedback on performance. A PHANTOM desktop device was used in conjunction with a suturing simulation A pair of needle-holders was instrumented with strain gauges and attached to the stylus of the PHANTOM allowing the measurement of force application and time. Suturing performance was evaluated in terms of stitch completion time, peak force application, and the length and straightness of the stitch. The effect of the level of force feedback provided by the simulation and performance over time was considered. The results indicate that the presence of force feedback affected task completion time, peak force application and the straightness of the stitch. Task completion time was shown to increase with the level of force feedback provided. Performance was seen to improve over time in terms of task completion time and the accuracy ofthe stitch. The work has examined how the presence and level of force feedback affects performance of a simple task. The accuracy of haptic feedback is important in the design of surgical simulation systems to ensure effective training transfer. A data collection method by which objective performance evaluation can be made is demonstrated. The method can be applied to training using bench models, simulations and potentially in the operating theatre.

Clinical Competence↗

PubMed2002

Representation and extrapolation in multilayer perceptrons.

To give an adequate explanation of cognition and perform certain practical tasks, connectionist systems must be able to extrapolate. This work explores the relationship between input representation and extrapolation, using simulations of multilayer perceptrons trained to model the identity function. It has been discovered that representation has a marked effect on extrapolation.

Cognition↗

PubMed1991

Simulation as a tool in the measurement of human performance.

The paper outlines and discusses issues in the present-day development and application of simulations of complex tasks. It is noted that this development is observed in basic as well as in applied research, resulting in a trend away from the investigation of elementary properties of human functioning in favour of the analysis of complete tasks. One of the problems in simulation concerns appropriate output measures (section 2). Some recent sophisticated measures of performance are derivatives of more elementary measures of time and accuracy, but they still facilitate new insights into the measurement of performance. In addition, recent views are discussed of verbal reports as potential measures of cognitive skills. It is noted that the issue of performance measurement has been severely neglected and ignored in many applications of simulators. The paper also focuses on theoretical models (section 3). It is concluded that models for complete tasks face the problem of excessive complexity, thus inhibiting detailed parametric analysis. In this respect the analysis of elementary properties has a clear advantage. A strategy of back-to-back experimentation, originally proposed by Gopher and Sanders (1984), is reiterated and an example of a back-to-back study is described. Section 4 of the paper is devoted to the issue of validation with major emphasis on the possibilities and limitations of the transfer paradigm and the measurement of direct correspondence. The final section (5) is devoted to some selective remarks about the three main areas where simulators are applied, namely training, equipment design, and personnel assessment. The paper ends by summarizing some emerging trends and issues for future research.

Computer Simulation↗

PubMed2003

Research use of the AIDA www.2aida.org diabetes software simulation program: a review-part 1. decision support testing and neural network training.

The purpose of this two-part review is to overview research use of the AIDA diabetes software simulator. AIDA is a diabetes computer program that permits the interactive simulation of plasma insulin and blood glucose profiles for teaching, demonstration, and self-learning purposes. It has been made freely available, without charge, on the Internet as a noncommercial contribution to continuing diabetes education. Since its launch in 1996 over 300,000 visits have been logged at the main AIDA Website-www.2aida.org-and over 60,000 copies of the AIDA program have been downloaded free-of-charge. This review describes research projects and ventures, undertaken for the most part by other research workers in the diabetes computing field, that have made use of the freeware AIDA software. Relevant research work was identified in three main ways: (i) by personal (e-mail/written) communications from researchers, (ii) via the ISI Web of Science citation database to identify published articles that referred to AIDA-related papers, and (iii) via searches on the Internet. In a number of cases research students who had sought advice about AIDA, and diabetes computing in general, provided copies of their research dissertations/theses upon the completion of their projects. The two reviews highlight some of the many and varied research projects that have made use of the AIDA diabetes simulation software to date. A wide variety of diabetes computing topics have been addressed. In Part 1 of the review, these range from testing decision support prototypes to training artificial neural networks. In Part 2 of the review, issues surrounding dietary assessments, developing new diabetes models, and performance monitoring of closed-loop insulin delivery devices are considered. Overall, research projects making use of AIDA have been identified in Australia, Italy, South Korea, the United Kingdom, and the United States. These reviews confirm an unexpected but useful benefit of distributing medical software, like AIDA, for free via the Internet-demonstrating how it is possible to have a synergistic benefit with other researchers-facilitating their own research projects in related medical fields. The reviews highlight a variety of these projects that have benefited from the free availability of the AIDA diabetes software simulator. In a number of cases these other research projects simply would not have been possible without unrestricted access to the AIDA software and/or technical descriptions of its workings. In addition, some specific common themes begin to emerge from the research ventures that have been reviewed. These include the use of simulated blood glucose data from the AIDA program for preliminary computerlab-based testing of other decision support prototypes. Issues surrounding such use of simulated data for separate prototype testing are discussed further in Part 2 of the review.

Computer Simulation↗

PubMed2005

Fuzzy classification: towards evaluating performance on a surgical simulator.

Computer-based surgical simulators such as the MIST-VR are able to provide scoring metrics such as time taken to complete a task, number of errors made, and economy of movement. Using MIST-VR's basic metrics, we explored the possibility of classifying skill levels using fuzzy logic. Our objective was to create a fuzzy classifier capable of classifying the performance of a subject training on a surgical simulator into 1 of 3 categories: Novice, Intermediate, and Expert. To accomplish this, we needed to establish a baseline skill level for each category. We had four laparoscopic surgeons, four surgical assistants/residents and four non-surgical staff/students with no laparoscopic experience perform two basic tasks on the simulator involving the placement of a ball into a box. We have found, through this preliminary study, that the results were inconclusive. We suspected a number of issues such as the size of our sample space used to train our classifier, and the difficulty of the chosen tasks adversely affected our results.

Canada↗