The virtual haptic back: A simulation for training in palpatory diagnosis

<p>Abstract</p> <p>Background</p> <p>Models and simulations are finding increased roles in medical education. The Virtual Haptic Back (VHB) is a virtual reality simulation of the mechanical properties of the human back designed as an aid to teaching clinical palpatory diagnosis.</p> <p>Methods</p> <p>Eighty-nine first year medical students of the Ohio University College of Osteopathic Medicine carried out six, 15-minute practice sessions with the VHB, plus tests before and after the sessions in order to monitor progress in identifying regions of simulated abnormal tissue compliance. Students palpated with two digits, fingers or thumbs, by placing them in gimbaled thimbles at the ends of PHANToM 3.0^®haptic interface arms. The interface simulated the contours and compliance of the back surface by the action of electric motors. The motors limited the compression of the virtual tissues induced by the palpating fingers, by generating counterforces. Users could see the position of their fingers with respect to the back on a video monitor just behind the plane of the haptic back. The abnormal region varied randomly among 12 locations between trials. During the practice sessions student users received immediate feedback following each trial, indicating either a correct choice or the actual location of the abnormality if an incorrect choice had been made. This allowed the user to feel the actual abnormality before going on to the next trial. Changes in accuracy, speed and Weber fraction across practice sessions were analyzed using a repeated measures analysis of variance.</p> <p>Results</p> <p>Students improved in accuracy and speed of diagnosis with practice. The smallest difference in simulated tissue compliance users were able to detect improved from 28% (SD = 9.5%) to 14% (SD = 4.4%) during the practice sessions while average detection time decreased from 39 (SD = 19.8) to 17 (SD = 11.7) seconds. When asked in anonymous evaluation questionnaires if they judged the VHB practice to be helpful to them in the clinical palpation and manual medicine laboratory, 41% said yes, 51% said maybe, and 8% said no.</p> <p>Conclusion</p> <p>The VHB has potential value as a teaching aid for students in the initial phases of learning palpatory diagnosis.</p

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

The virtual haptic back: A simulation for training in palpatory diagnosis-0

F difficulty level.<p><b>Copyright information:</b></p><p>Taken from "The virtual haptic back: A simulation for training in palpatory diagnosis"</p><p>http://www.biomedcentral.com/1472-6920/8/14</p><p>BMC Medical Education 2008;8():14-14.</p><p>Published online 3 Apr 2008</p><p>PMCID:PMC2362113.</p><p></p

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Ich at least 55% of the responses were correct, as a function of practice session number. All visits are significantly different (F = 111, P < 0.001, η= 0.55).<p><b>Copyright information:</b></p><p>Taken from "The virtual haptic back: A simulation for training in palpatory diagnosis"</p><p>http://www.biomedcentral.com/1472-6920/8/14</p><p>BMC Medical Education 2008;8():14-14.</p><p>Published online 3 Apr 2008</p><p>PMCID:PMC2362113.</p><p></p

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Er. Accuracy (blue) is defined as the proportion correct divided by the Weber fraction. All visits are significantly different (F = 96, P < 0.001, η= 0.52). Overall performance (red) includes both accuracy and speed and is defined as the proportion correct divided by the product, (Weber fraction)*(time). All visits are significantly different (F = 87, P < 0.001, η= 0.49).<p><b>Copyright information:</b></p><p>Taken from "The virtual haptic back: A simulation for training in palpatory diagnosis"</p><p>http://www.biomedcentral.com/1472-6920/8/14</p><p>BMC Medical Education 2008;8():14-14.</p><p>Published online 3 Apr 2008</p><p>PMCID:PMC2362113.</p><p></p

The virtual haptic back: A simulation for training in palpatory diagnosis-1

Aximum time permitted for each localization was 60 sec.<p><b>Copyright information:</b></p><p>Taken from "The virtual haptic back: A simulation for training in palpatory diagnosis"</p><p>http://www.biomedcentral.com/1472-6920/8/14</p><p>BMC Medical Education 2008;8():14-14.</p><p>Published online 3 Apr 2008</p><p>PMCID:PMC2362113.</p><p></p

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Iculty level at which mastery was demonstrated. The data for each practice session have been fitted with Gaussian distributions in order to see more easily the shift toward lower Weber fractions with each session. The Rvalues (goodness of fit) for sessions 1 through 6 were 0.87, 0.67, 0.77, 0.81, 0.93, and 0.92, respectively.<p><b>Copyright information:</b></p><p>Taken from "The virtual haptic back: A simulation for training in palpatory diagnosis"</p><p>http://www.biomedcentral.com/1472-6920/8/14</p><p>BMC Medical Education 2008;8():14-14.</p><p>Published online 3 Apr 2008</p><p>PMCID:PMC2362113.</p><p></p

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Culty level at which mastery was demonstrated. The data for each practice session have been fitted with Gaussian distributions in order to see more easily the shift toward lower Weber fractions with each session. The Rvalues (goodness of fit) for sessions 1 through 6 were 0.87, 0.67, 0.77, 0.81, 0.93, and 0.92, respectively.<p><b>Copyright information:</b></p><p>Taken from "The virtual haptic back: A simulation for training in palpatory diagnosis"</p><p>http://www.biomedcentral.com/1472-6920/8/14</p><p>BMC Medical Education 2008;8():14-14.</p><p>Published online 3 Apr 2008</p><p>PMCID:PMC2362113.</p><p></p

The virtual haptic back: A simulation for training in palpatory diagnosis-2

Ask difficulty and practice session number.<p><b>Copyright information:</b></p><p>Taken from "The virtual haptic back: A simulation for training in palpatory diagnosis"</p><p>http://www.biomedcentral.com/1472-6920/8/14</p><p>BMC Medical Education 2008;8():14-14.</p><p>Published online 3 Apr 2008</p><p>PMCID:PMC2362113.</p><p></p