Parvati Dev Amia Tutorial 2009
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This slide set was part of an AMIA 2009 tutorial on Virtual Environments led by Ed Hammond of Duke University.
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Parvati Dev Amia Tutorial 2009
- 2. Simulation Parvati Dev, PhD, FACMI President, Innovation in Learning Inc. Distinguished Scholar, Media-X, Stanford University Former Director, SUMMIT Lab, Stanford University
- 5. Social spaces (Second Life)
- 7. The world feels real - “concrete” Teleplace, previously Qwaq Forums
- 9. Collaboration using visualization Green Phosphor and GlassHouse: http://www.youtube.com/watch?v=Z-EU3LITMmQ
- 10. Visualizing microarray data Green Phosphor and GlassHouse
- 11. Medical visualization Teleplace.com; Cleft Palate patient from NYU Medical Center
- 12. Simulated experiences (Forterra Systems)
- 13. Interactive simulations (Pulse!! - Breakaway)
- 14. Building a 3D space
- 15. From real to “mirror” world Forterra Systems
- 16. Virtual Stanford Forterra Systems
- 18. Building a 3D clinic
- 19. Building Virtual Patients Appearance - normal plus trauma or disease Behavior - movement plus other actions
- 20. Building an Avatar (Poser, )
- 21. Adding trauma appearance (Forterra)
- 22. Specialized Behaviors Simulating Physiology
- 23. Patient state Healthy Bleeds profusely Sick Very sick Hit by car Stable, recover
- 24. Patient Model ‘ PATIENT’ STATE QUERY INTERFACE TEXT SPEECH GRAPHICS ANIMATION INTERVENTION INTERFACE PHYSIOLOGY PROCESS TIME STEP
- 25. TEXT 45 y/o female clerk: open, angulated open fracture. rt. upper humerus, C/o severe pain, feeling faint Brisk arterial and venous bleeding, EOIS = 4 (of 6) GRAPHICS #15 #12 ANIMATION SPEECH
- 26. Patient Model QUERY INTERFACE INTERVENTION INTERFACE
- 27. Basic Logic for Traumatic Hemorrhage Model Vol BP HR Sa0 2 RR • trauma ––> blood loss • blood loss ––> reduced blood volume • reduced blood vol ––> reduced pressure • reduced pressure ––> increased heart rate • increased heart rate ––> decreased Sa0 2 • decreased Sa0 2 ––> increased resp. rate
- 28. Model for Traumatic Hemorrhagic Shock Fractured humerus, Hemorrhage rate: 83 ml/min = 2520ml/30min Cardiac arrest . . 35min to ‘death’
- 29. Model for Traumatic Hemorrhagic Shock 250 200 150 100 50 0 Fractured humerus, Hemorrhage rate: 83 ml/min= 2520ml/30min Victim 12: 45 year old Woman: EOIS = 4 1:42 1:45 1:50 1:55 2:00 2:05 2:10 2:15 2:20 2:25 Time in Minutes Response of Model PR Sa0 2 X X X X X X X X X X X BP-S RR Compression bandage IV Nacl Dobutamide Trendelenberg Transfuse Send to surgery . . . Home in 36hrs
- 30. Ten Trauma Cases #12 illustrated; #13 near death; #11 & 16 walking- wounded B-man, LUQ blow, pain, hemoperitoneum, hypotension, confused M48 5 21 Af-Am, 24wk preg, vag. bleeding, FHT180, S-S anemia, low BP F23 5 20 Obese retiree, RUAbd bruise, hypotension, hemoperitoneum M69 5 19 Exec., traumatic rt. knee disruption, brisk bleeding, hypotension M38 5 18 Athlete, open. frax, rt. tibia & fibula, brisk bleeding, pain, labile BP M22 5 17 Grad. Student, 10cm SQ hematoma, rt mid-thigh, anxious F27 1 16 RLQ penetrating shard, hemoperitoneum, pain, hypotension F58 5 15 Construction worker, crushed chest, ribs visible bilat., hemoptysis M30 6 13 Clerk: open, angulated frax. Rt. humerus, pain, brisk bleeding F45 4 12 Healthy Prof., bleeding lacerations of forearm, anxious, htn M60 1 11 EOIS/THC Score = (0 – 6) based upon anatomic structure, and severity of injury # EOIS Gender-age Description
- 31. Organ Injury Scale Extended – Quantifies the Injuries AVULSION ALL LACERATIONS 12) URETHRA LACERATIONS > 2CM LACERATIONS < 2CM 11) BLADDER ALL INJURIES 10) URETER MAJOR PARENCHYMAL LACERATIONS, HILAR VESSELS MINOR LACERATIONS 9) KIDNEY VENA CAVA, ABD. AORTA ALL VISCERAL VESSELS 8) ABDOMINAL VASCULAR PARENCHYMAL INJURY > 25%, JUXTA-HEPATIC VESSEL LACERAT– LACERATIONS, SUB-CAPSULAR HEMORRHAGE 7) LIVER LACERATIONS OF HILAR VESSELS LACERATIONS, SUB-CAPSULAR HEMORRHAGE 6) SPLEEN RUPTURE LACERATIONS, 5) DIAPHRAM FLAIL, CRUSHED CHEST LACERATIONS, RIB FRAX, 4) CHEST WALL BLUNT, DYSFUNCTION, AND PENETRATING BLUNT, NON-PENETRATING 3) HEART LOBAR, VASCULAR CONTUSION, SIMPLE LAC. 2) LUNG VASCULAR TREE CHEST WALL VESSELS 1) THORACIC VASCULAR EOI-SCALE 4-5 EOI-SCALE 1-3 ORGAN AVULSION ALL LACERATIONS 21) EXTERNAL GENITALS MAJOR VASCULAR INJURY, OPEN OR CLOSED FRACTURES PELVIC WALL VESSELS, REPRODUCTIVE ORGANS 20) PELVIS MAJOR MUSCULAR INJURY, VERTEBRAL FRACTURES LACERATIONS, CLOSED CONTUSIONS 19) BACK, BUTTOCKS MAJOR VASCULAR INJURY, OPEN FRACTURES LACERATIONS, CLOSED FRACTURES 18) LOWER EXTREMITY – Lt. MAJOR VASCULAR INJURY, OPEN FRACTURES LACERATIONS, CLOSED FRACTURES 17) LOWER EXTREMITY – Rt. MAJOR VASCULAR INJURY, OPEN FRACTURES LACERATIONS, CLOSED FRACTURES 16) UPPER EXTREMITY – Lt. MAJOR VASCULAR INJURY, OPEN FRACTURES LACERATIONS, CLOSED FRACTURES 15) UPPER EXTREMITY – Rt. MAJOR VASCULAR INJURY PERFORATIONS, LACERATIONS 14) GI TRACT MAJOR VASCULAR INJURY, FRACTURES LACERATIONS 13) NECK
- 32. Traumatic Hemorrhage Classes (THC) determine Blood Volume Deficit. ATLS Guideline & Rooke, et al. Rooke, et al. 1995 Anesth Analg 80:925-32 Class 4 = 2520ml 47.7 180-irreg. 50 45 Class 5 = 3240ml 37.7 200–AF 30 55 Class 6 = 3880ml 0 0 0 0 (Agonal) (Average Blood Volume = 5000ml) Quantifies the Blood Loss Blood Volume-driven system: e.g., hemorrhage Vol BP HR Sa0 2 RR Class: 0 = 0 ml MAP 96.0 70 98 14 Class 1 = 750 ml 87.7 75 97 16 Class 2 = 1500ml 88.6 86 96 20 Class 3 = 1980ml 57.7 140 80 35
- 33. A Medical Virtual World
- 38. Roles Role player Learner Facilitator
- 39. EMCRM Performance Rating Scale
- 41. EMCRM Performance scores N=15 N=16 0.00 10.00 20.00 30.00 40.00 50.00 HPS Group Pretest Sum Scores Posttest Sum Scores Pretest Sum Scores Posttest Sum Scores Virtual ED Group
- 44. Thank you ! [email_address]
Editor's Notes
- In contrast to the abstract nature of the two-dimensional web, virtual worlds offer a very concrete three-dimensional information structure, modeled after the real world. While these worlds are virtual in being made up out of pixels on a screen, the experience of the users in navigating through such a world is very concrete. Virtual worlds call upon our abilities of perception and locomotion in the same way as the real world does. This means that we do not need a manual to interpret a three-dimensional information structure modeled on the world around us: our whole nervous system has evolved precisely to interact with such a three-dimensional environment. Remembering where you have seen something, storing information in a particular location,getting an overview of a situation, all those functions are far more natural in a 3D environment than in an abstract 2D tree of web pages.
- With the Serious Games movement, the cinematic value and realism became important. We move beyond the clinical encounter. This is now a dynamic patient whose condition evolves with time. Your management of the patient determines the clinical outcome. (Source: 2006, Pulse!!, http://www.sp.tamucc.edu/pulse/home.asp )
- There are many flavors of virtual patients. Online virtual patients fall into a few major categories. This one is probably the most common. (source 1990, Real Problems, Perper, Felciano as key authors, Stanford SUMMIT lab). Presents a snapshot, an encounter with a patient. Particularly useful for teaching the basics of history taking and the principles of physical examination. Also for clinical reasoning.
- Has builds. Purpose is to explain “states” and state transitions.
- Ten trauma situations were developed.
- The team around the bed included Learners and Role Players. The role players played supporting roles in the team, while the learners took the role of the lead physician and the supporting physician. A Facilitator observed the performance of the team members in the virtual world and could, if necessary issue comments, suggestions or instructions.All team members wore headsets with microphones, allowing them to sit in different rooms but to be virtually in a common space, around the patient’s bed.
- Each learning session consisted of one of the trauma scenarios, followed by a debrief session with the facilitator. During the debrief, the facilitator led a non-judgmental discussion about the actions taken during the scenario, with the learners discussing their thoughts, concerns and opinions, Typically, most of the learning takes place during this discussion rather than during the scenario itself.
- The two groups were termed the HPS group (Human Patient Simulator, or the physical manikin) and the VED group (the Virtual Emergency Department). The pre-test and post-test performance was measured for both the groups. The results are graphed above. Two conclusions can be drawn. First, in both the HPS and VED groups, learning occurs, as shown by the improved performance during the post-test compared to the pre-test. Second, both HPS and VED groups show similar improvement from pre- to post-test, indicating that the virtual environment has resulted in learning comparable to that with the gold standard, the physical manikin. This key result encouraged us to continue our development of virtual learning environments,and we will continue to test the efficacy of these new learning environments.