scholarly journals Implementation and Assessment of a Heart Failure Virtual Patient Simulation in a Required Pharmacotherapy Course

2021 ◽  
pp. 8650
Author(s):  
Ashley E. Woodruff ◽  
Maya R. Chilbert ◽  
William A. Prescott ◽  
Nicole Wilcox ◽  
Omar Marzouk ◽  
...  
Keyword(s):  
Heart Failure ◽  
Patient Simulation ◽  
Virtual Patient

NERVE, InterPLAY, and Design-Based Research: Advancing Experiential Learning and the Design of Virtual Patient Simulation

2018 ◽  
pp. 1-50
Author(s):  
Atsusi Hirumi ◽  
Benjamin Chak Lum Lok ◽  
Teresa R. Johnson ◽  
Kyle Johnsen ◽  
Diego de Jesus Rivera-Gutierrez ◽  
...  
Keyword(s):  
Experiential Learning ◽  
Patient Simulation ◽  
Virtual Patient ◽  
Design Based Research

scholarly journals Increased myocardial stiffness more than impaired relaxation function limits cardiac performance during exercise in heart failure with preserved ejection fraction: a virtual patient study

2020 ◽  
Vol 1 (1) ◽  
pp. 40-50
Author(s):  
Tim van Loon ◽  
Christian Knackstedt ◽  
Richard Cornelussen ◽  
Koen D Reesink ◽  
Hans-Peter Brunner La Rocca ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Relaxation Function ◽  
Wide Spectrum ◽  
Virtual Patient ◽  
Left Ventricular ◽  
Filling Pressure ◽  
Patient Specific ◽  
Preserved Ejection Fraction ◽  
Passive Stiffness

Abstract Aims The relative impact of left ventricular (LV) diastolic dysfunction (LVDD) and impaired left atrial (LA) function on cardiovascular haemodynamics in heart failure with preserved ejection fraction (HFpEF) is largely unknown. We performed virtual patient simulations to elucidate the relative effects of these factors on haemodynamics at rest and during exercise. Methods and results The CircAdapt cardiovascular system model was used to simulate cardiac haemodynamics in wide ranges of impaired LV relaxation function, increased LV passive stiffness, and impaired LA function. Simulations showed that LV ejection fraction (LVEF) was preserved (>50%), despite these changes in LV and LA function. Impairment of LV relaxation function decreased E/A ratio and mildly increased LV filling pressure at rest. Increased LV passive stiffness resulted in increased E/A ratio, LA dilation and markedly elevated LV filling pressure. Impairment of LA function increased E/A ratio and LV filling pressure, explaining inconsistent grading of LVDD using echocardiographic indices. Exercise simulations showed that increased LV passive stiffness exerts a stronger exercise-limiting effect than impaired LV relaxation function does, especially with impaired LA function. Conclusion The CircAdapt model enabled realistic simulation of virtual HFpEF patients, covering a wide spectrum of LVDD and related limitations of cardiac exercise performance, all with preserved resting LVEF. Simulations suggest that increased LV passive stiffness, more than impaired relaxation function, reduces exercise tolerance, especially when LA function is impaired. In future studies, the CircAdapt model can serve as a valuable platform for patient-specific simulations to identify the disease substrate(s) underlying the individual HFpEF patient’s cardiovascular phenotype.

scholarly journals Digitalised remote-delivery of AVATr Simulation in Psychiatry: a unique success in COVID-19 pandemic

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S146-S146
Author(s):  
Vimal Mannali ◽  
Paul Strickland ◽  
Craig laBuscagne ◽  
Joy Clift
Keyword(s):  
Medical Education ◽  
Hybrid Model ◽  
Professional Growth ◽  
Clinical Training ◽  
Care Home ◽  
Training Session ◽  
Patient Simulation ◽  
Virtual Patient ◽  
Capacity Sharing ◽  
Person Perspective

AimsSurrey and Borders NHS Foundation Trust's AVATr (Augmented Virtual-reality Avatar in Training) is a unique ground-breaking Virtual Patient Simulation System, which uses the Xenodu platform to train learners in essential clinical and complex communication skills. Over 30 patient scenarios have been developed after identifying learner-specific development needs, including exploration of overt psychosis, assessment of capacity, sharing bad news, and neglect in care home residents. Actors are filmed responding to several domains of clinical questions, further categorised into three narrative-modes of being ‘Engaged, Neutral or Disengaged’, to build a bank of scenarios. During the session, the trainee is projected on to a large screen, using a camera and video special effects, which results in a life-like interaction with the Virtual Patient. Trainees can view themselves interacting with the Virtual Patient in real-time, from a unique ‘out-of-body' perspective, immersed in a custom-designed interactive virtual environment. The simulation facilitator engages with the learner and determines the appropriate choices of responses for the Virtual Patient and if needed, can prompt with explorative cues to continue the narrative-linked conversation. AVATr model pioneered in United Kingdom the use of an innovative ‘self-observational approach’ in Psychiatry training. This is different to a first-person perspective used in virtual or augmented-reality systems in several clinical specialties. The use of Facilitated-Debrief and Peer-Debrief in sessions, render another layer to the simulation experience.MethodDuring the COVID-19 pandemic, we evolved the AVATr model to remote or hybrid sessions, where simulations were digitally enhanced, and have been run through Microsoft Teams. The simulation facilitator is connected to a multi-user video call, enabling the Virtual Patient to be projected as an attendee using Microsoft Teams.ResultThe hybrid model of AVATr has received tremendous feedback, as it now simulates video-consultations that a vast majority of Psychiatry trainees, especially community-based, undertake due to COVID-19 restrictions. The format of AVATr simulation sessions has remained unchanged, and the remote delivery has been particularly successful as it allows trainees to log in from different remote locations to come together for an interactive training session, without any physical restrictions.ConclusionSince 2015, our simulation platform has been utilised for Post-Graduate Medical Education, to enhance essential professional skills and stimulate professional growth. Currently the hybrid model of AVATr is being expanded to Nursing, Psychology and Allied Health Professional (AHP) clinical training streams, along with Undergraduate Medical Education, to address identified gaps in face-to-face training amidst COVID-19 pandemic.

scholarly journals S0468 Virtual Patient Simulation Improves IBS Diagnosis and Treatment: A CME Study

2020 ◽  
Vol 115 (1) ◽  
pp. S235-S235
Author(s):  
Jovana Lubarda ◽  
Shari Dermer ◽  
Darren M. Brenner ◽  
Brian E. Lacy
Keyword(s):  
Patient Simulation ◽  
Virtual Patient ◽  
Diagnosis And Treatment

scholarly journals 28 How is Postpartum Depression Currently Diagnosed and Managed? Insights from a Virtual Patient Simulation

CNS Spectrums ◽  
2019 ◽  
Vol 24 (1) ◽  
pp. 189-190
Author(s):  
Jovana Lubarda ◽  
Martin Warters ◽  
Piyali Chatterjee ◽  
Marlene P. Freeman ◽  
Roger S. McIntyre
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Postpartum Depression ◽  
Clinical Decision Making ◽  
Patient Simulation ◽  
Clinical Decision ◽  
Virtual Patient ◽  
Evidence Based ◽  
Clinical Decisions ◽  
Practice Gaps

AbstractObjectivesThe goal of this study was to determine physician performance in diagnosis and management of postpartum depression (PPD) and to provide needed education in the consequence free environment of a virtual patient simulation (VPS).Methods∙ A continuing medical education activity was delivered via an online VPS learning platform that offers a lifelike clinical care experience with complete freedom of choice in clinical decision-making and expert personalized feedback to address learner’s practice gaps∙ Physicians including psychiatrists, primary care physicians (PCPs), and obstetricians/gynecologists (ob/gyns) were presented with two cases of PPD designed to model the experience of actual practice by including use of electronic health records∙ Following virtual interactions with patients, physicians were asked to make decisions regarding assessments, diagnoses, and pharmacologic therapies. The clinical decisions were analyzed using a sophisticated decision engine, and clinical guidance (CG) based on current evidence-based recommendations was provided in response to learners’ clinical decisions∙ Impact of the education was measured by comparing participant decisions pre- and post-CG using a 2-tailed, paired t-test; P <.05 was considered statistically significant∙ The activity launched on Medscape Education on April 26, 2018, and data were collected through to June 17,2018.Results∙ From pre- to post-CG in the simulation, physicians were more likely to make evidence-based clinical decisions related to:∙ Ordering appropriate baseline tests including tools/scales to screen for PPD: in case 1, psychiatrists (n=624) improved from 34% to 42% on average (P<.05); PCPs (n=197) improved from 38% to 48% on average (P<.05); and, ob/gyns (n=216) improved from 30% to 38% on average (P<.05)∙ Diagnosing moderate-to-severe PPD: in case 2, psychiatrists (n=531) improved from 46% to 62% (P<.05); PCPs (n=154) improved from 43% to 55% (P<.05); and, ob/gyns (n=137) improved from 55% to 73% (P<.05)∙ Ordering appropriate treatments for moderate-to-severe PPD such as selective serotonin-reuptake inhibitors: in case 2, psychiatrists (n=531) improved from 47% CG to 75% (P<.05); PCPs (n=154) improved from 55% to 74% (P<.05); and, ob/gyns (n=137) improved from 51% to 78% (P<.05)∙ Interestingly, a small percentage of physicians (average of 5%) chose investigational agents for PPD which were in clinical trials pre-CG, and this increased to an average of 9% post-CGConclusionsPhysicians who participated in VPS-based education significantly improved their clinical decision-making in PPD, particularly in selection of validated screening tools/scales, diagnosis, and pharmacologic treatments based on severity. Given that VPS immerses physicians in an authentic, practical learning experience matching the scope of clinical practice, this type of intervention can be used to determine clinical practice gaps and translate knowledge into practice.Funding Acknowledgements: The educational activity and outcomes measurement were funded through an independent educational grant from Sage Therapeutics, Inc.

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