Novel Humanized Biosimulator to Predict Coronary Obstruction in High-Risk Valve-in-Valve Procedures

We developed humanized biosimulator to predict the risk of coronary obstruction among high-risk patients undergoing valve-in-valve (ViV) procedures. In this case, based on unchanged instantaneous wave-free ratio values measured during a ViV simulation session, the procedure was performed safely in the patient the day afterward, without coronary artery issues and with good hemodynamic results. (Level of Difficulty: Advanced.).

Development and Initial Assessment of a Novel Customized Deep Laceration Simulator for Suturing Training

Suturing of different layers, such as deep lacerations, is a challenging clinical skill for residents. Currently, there is a lack of general suturing instructions and practice in undergraduate medicine curricula which would add to the education required during residency and could be impactful to patient safety. Therefore, in order to adequately prepare trainees for clinical practice, training in suturing needs to be made more robust and executable. One way to facilitate this is to provide easy access to equipment that can offer good educational value while allowing for adequate repetition of suturing deep lacerations outside of clinical settings, similar to how it has been done for superficial lacerations. Simulation-based medical education addresses this by training residents in healthcare skills in a safe and controlled environment. Our technical report aims to describe the development and initial evaluation of a deep laceration simulator designed to train residents in suturing. The simulator was made using additive manufacturing techniques such as three-dimensional printing and silicone. Feedback on the simulator was provided by Centre Hospitalier de l'Université de Montréal clinicians from various specialties and residents. The simulator was assessed mainly as being easy to use, durable, and having anatomically accurate characteristics. The main improvements suggested were to make the skin thinner, divide the epidermis and dermis, add a fascia, and create a looser and friable layer of fat. Overall, the respondents rated the simulator as a good educational tool with a few minor adjustments.

Evaluation of Internet-Connected Real-Time Remote Auscultation: An Open-Label Randomized Controlled Pilot Trial

The utility of remote auscultation was unknown. This study aimed to evaluate internet-connected real-time remote auscultation using cardiopulmonary simulators. In this open-label randomized controlled trial, the physicians were randomly assigned to the real-time remote auscultation group (intervention group) or the classical auscultation group (control group). After the training session, the participants had to classify the ten cardiopulmonary sounds in random order as the test session. In both sessions, the intervention group auscultated with an internet-connected electronic stethoscope. The control group performed direct auscultation using a classical stethoscope. The total scores for correctly identified normal or abnormal cardiopulmonary sounds were 97/100 (97%) in the intervention group and 98/100 (98%) in the control group with no significant difference between the groups (p > 0.99). In cardiac auscultation, the test score in the control group (94%) was superior to that in the intervention group (72%, p < 0.05). Valvular diseases were not misclassified as normal sounds in real-time remote cardiac auscultation. The utility of real-time remote cardiopulmonary auscultation using an internet-connected electronic stethoscope was comparable to that of classical auscultation. Classical cardiac auscultation was superior to real-time remote auscultation. However, real-time remote cardiac auscultation is useful for classifying valvular diseases and normal sounds.

Brian2CUDA: Flexible and Efficient Simulation of Spiking Neural Network Models on GPUs

Graphics processing units (GPUs) are widely available and have been used with great success to accelerate scientific computing in the last decade. These advances, however, are often not available to researchers interested in simulating spiking neural networks, but lacking the technical knowledge to write the necessary low-level code. Writing low-level code is not necessary when using the popular Brian simulator, which provides a framework to generate efficient CPU code from high-level model definitions in Python. Here, we present Brian2CUDA, an open-source software that extends the Brian simulator with a GPU backend. Our implementation generates efficient code for the numerical integration of neuronal states and for the propagation of synaptic events on GPUs, making use of their massively parallel arithmetic capabilities. We benchmark the performance improvements of our software for several model types and find that it can accelerate simulations by up to three orders of magnitude compared to Brian's CPU backend. Currently, Brian2CUDA is the only package that supports Brian's full feature set on GPUs, including arbitrary neuron and synapse models, plasticity rules, and heterogeneous delays. When comparing its performance with Brian2GeNN, another GPU-based backend for the Brian simulator with fewer features, we find that Brian2CUDA gives comparable speedups, while being typically slower for small and faster for large networks. By combining the flexibility of the Brian simulator with the simulation speed of GPUs, Brian2CUDA enables researchers to efficiently simulate spiking neural networks with minimal effort and thereby makes the advancements of GPU computing available to a larger audience of neuroscientists.

Optical ultrasound simulation-based training in obstetric sonography

Ultrasound is an imaging modality that is highly operator dependent. This article reviews the challenges in learning how to perform obstetric sonography, as well as the processes necessary to acquire expert performance skills in sonography. Simulation-based education and learning, and the value of medical simulation are also discussed. Ultrasound simulators are an effective means of teaching obstetric sonography, because it provides training, deliberate practice, and performance evaluation/feedback which allows continuous and critical self-evaluation. We review evidence that simulation can improve performance in obstetric ultrasound examination, review current simulators, and discuss the current problems/gaps in ultrasound simulation. Optical positioning ultrasound simulation is a novel high-fidelity simulation learning system, which addresses many of these problems/gaps and is introduced for the first time here.

Training on a virtual reality laparoscopic simulator improves performance of live laparoscopic surgery

INTRODUCTION

To determine whether training laparoscopic nephrectomy (LN) with a virtual reality (VR) simulator improves the performance of porcine LN.

METHODS

Twelve urological residents were assigned to two groups: a training and a non-training group. All participants performed baseline assessments of LN skills and time on the LapPASS® simulator. The training group received preoperative LapPASS® training. Both groups then performed LN using a porcine model. The operations were videotaped and evaluated using the Global Operative Assessment of Laparoscopic Skills (GOALS) system. After porcine LN, the training group performed a final LN with the LapPASS® simulator.

RESULTS

There was no significant difference in the operation time required for porcine LN. There were no significant differences in the total A (autonomy), B (bimanual dexterity), D (depth perception), or T (tissue handling) GOALS scores. However, the total E (efficiency) score in the training group was higher than that in the non-training group (P = .030). The final LN score with LapPASS® was significantly higher than the baseline (P = .004).

CONCLUSIONS

The results of this study demonstrated that VR LN training improved performance in an actual operation. VR-based procedural simulation could become a vital part of the laparoscopic training program for residents.

Mixed Reality and Haptic-Based Dental Simulator for Tooth Preparation: Research, Development, and Preliminary Evaluation

Background

Virtual reality (VR) dental simulators are currently used in preclinical skills training. However, with the development of extended reality technologies, the use of mixed reality (MR) has shown significant advantages over VR.

Objective

This study aimed to describe the research and development of a newly developed MR and haptic–based dental simulator for tooth preparation and to conduct a preliminary evaluation of its face validity.

Methods

A prototype of the MR dental simulator for tooth preparation was developed by integrating a head-mounted display (HMD), special force feedback handles, a foot pedal, computer hardware, and software program. We recruited 34 participants and divided them into the Novice group (n=17) and Skilled group (n=17) based on their clinical experience. All participants prepared a maxillary right central incisor for an all-ceramic crown in the dental simulator, completed a questionnaire afterward about their simulation experience, and evaluated hardware and software aspects of the dental simulator.

Results

Of the participants, 74% (25/34) were satisfied with the overall experience of using the Unidental MR Simulator. Approximately 90% (31/34, 91%) agreed that it could stimulate their interest in learning, and 82% (28/34) were willing to use it for skills training in the future. Differences between the 2 study groups in their experience with the HMD (resolution: P=.95; wearing comfort: P=.10), dental instruments (P=.95), force feedback of the tooth (P=.08), simulation of the tooth preparation process (P=.79), overall experience with the simulation (P=.47), and attitude toward the simulator (improves skills: P=.47; suitable for learning: P=.36; willing to use: P=.89; inspiring for learning: P=.63) were not significant. The Novice group was more satisfied with the simulator’s ease of use (P=.04). There were significant positive correlations between the overall experience with the simulation and the HMD’s resolution (P=.03) and simulation of the preparation process (P=.001).

Conclusions

The newly developed Unidental MR Simulator for tooth preparation has good face validity. It can achieve a higher degree of resemblance to the real clinical treatment environment by improving the positional adjustment of the simulated patients, for a better training experience in dental skills.

The Use of Simulators for Teaching Fine Needle Aspiration Cytology in Veterinary Medicine

Fine needle aspiration (FNA) is widely used by veterinary practitioners, being taught mostly by observation. Simulators are known to enhance students' learning of practice skills, but to our knowledge, FNA simulators have never been assessed in veterinary medicine. Fifty-one undergraduate students with no prior experience in cytology were randomly assigned to two groups that practiced on either a box simulator (with artificial nodules) or a fruit (banana). An in-class flip was followed, in which students first observed a FNA video tutorial and then used their assigned simulator for 15 minutes maximum. Students then attempted a FNA on an animal model and were evaluated through an objective structured clinical examination (OSCE). Learning outcomes of each model was compared through questionnaires, OSCE pass rates, and quality of produced smears. After observing the video, no student reported being able to conduct a FNA on a live animal, whereas most assured that they would be able to do so after using a simulator. Students practiced more on the box model (14.8 ± 0.8 min) than on the fruit (8.5 ± 2.2 min). At evaluation, students who had practiced on the box had more puncturing accuracy than those who had practiced on the fruit. Still, no differences in OSCE pass rates existed. Simulation models thus were effective for learning FNA, but the box simulator seemed to be more successful than the fruit in terms of deliberate practice. This appears to have a positive effect on students' puncturing accuracy, which has clinical relevance.

Simulating Single-Cell Gene Expression Count Data with Preserved Gene Correlations by scDesign2

scDesign2 is a transparent simulator that generates high-fidelity single-cell gene expression count data with gene correlations captured. This article shows how to download and install the scDesign2 R package, how to fit probabilistic models (one per cell type) to real data and simulate synthetic data from the fitted models, and how to use scDesign2 to guide experimental design and benchmark computational methods. Finally, a note is given about cell clustering as a preprocessing step before model fitting and data simulation.

User Experience of Training Pediatric Students on Interactive Simulator During COVID-19 Pandemic

BACKGROUND

COVID-19 pandemic is a reason to revise traditional approaches to medical education. The disadvantage of online education is inability to train practical skills.

PURPOSE

To evaluate the effectiveness of training students on an interactive pediatric simulator during distance learning.

PATIENTS AND METHODS

An online survey was conducted during quarantine COVID-19 to clear out the attitude to distance learning of third-year students of the Sechenov First Moscow State Medical University (n = 150). During training the level of students' motivation to learn decreased, and what is most important their practical skills deteriorated. Eighty-four out of 150 students had the effectiveness of their training on the multimedia simulator "Filatov. Pediatrics" analyzed.

RESULTS

The simulator reproduces clinical tasks using three-dimensional models of children of different ages and genders and has access to personal computers of students. The cases include imitation of a dialogue with a virtual patient, methods of physical examination, the appointment of laboratory and instrumental methods of research, treatment. The use of a pediatric simulator showed greater efficiency in mastering practical skills compared to a group of students who did not use the simulator in class. Summing up the results of the intermediate objective structured clinical exam (OSCE) on physical examination on dummies of the Simulation and Accreditation Center showed better results in the main group (n = 48) compared to the control (n = 36). The students who additionally studied on the simulator completed the tasks on the checklist on a cardiology dummy by 98.3 ± 1.5%. In the control group, the percentage of completed tasks was 94.3 ± 1.3 (p = 0.05). The OSCE for examining the respiratory system on an auscultative dummy revealed 97.3 ± 1.5 and 93.1 ± 1.4%, respectively (p = 0.05).

CONCLUSION

The interactive pediatric simulator is a tool for mastering practical skills of medical students during the COVID-19 pandemic, with the use of which the OSCE results are significantly higher.

Anatomical Evaluation of Rat and Mouse Simulators for Laboratory Animal Science Courses

Simple Summary

Over the past decades simulators of rats and mice have been developed as initial training devices for prospective researchers involved in animal testing. By using these simulators, different techniques such as blood sampling can be be learned prior to working on live animals. As this has the potential to minimize stress and suffering of experimental animals, the use of simulators is demanded by European law. Nevertheless, only little is known about frequency of their use, their anatomical correctness and learning efficiency. With this in mind, a collaborative research project named “SimulRATor” was initiated to systematically evaluate existing rat and mouse simulators. Results will serve as the basis for the development of a new 3D-printed rat simulator with realistic anatomy. In the subproject presented here, simulators were evaluated by experts of the field in order to analyze their anatomical strengths and weaknesses. The evaluation showed, that the limbs and especially the heads were perceived as anatomically unrealistic. Therefore, the authors will focus on these body regions during the construction process by e.g. including movable limbs, and a lower jaw with a tongue. This might positively affect the learning process and outcome and thereby support animal welfare.

Abstract

According to the European Directive 63/2010/EU, education and training involving living rats and mice are classified as an animal experiment and demands the implementation of the 3Rs. Therefore, as a method of refinement, rat and mouse simulators were developed to serve as an initial training device for various techniques, prior to working on living animals. Nevertheless, little is known about the implementation, anatomical correctness, learning efficiency and practical suitability of these simulators. With this in mind, a collaborative research project called “SimulRATor” was initiated to systematically evaluate the existing rat and mouse simulators in a multi-perspective approach. The objective of the study presented here was to identify the anatomical strengths and weaknesses of the available rat and mouse simulators and to determine anatomical requirements for a new anatomically correct rat simulator, specifically adapted to the needs of Laboratory Animal Science (LAS) training courses. Consequently, experts of Veterinary Anatomy and LAS evaluated the anatomy of all currently available rat and mouse simulators. The evaluation showed that compared to the anatomy of living rats and mice, the tails were perceived as the most anatomically realistic body part, followed by the general exterior and the limbs. The heads were rated as the least favored body part.

The Development of a Cost-Effective Infant Intraosseous Infusion Simulator for Neonatal Resuscitation Program Training

Simulation-based medical education (SBME) employs realistic simulators to allow physicians and medical students to learn and practice high acuity, low occurrence (HALO) skills such as the intraosseous (IO) infusion. Previous research was done to develop and evaluate a three-dimensional (3D)-printed adult proximal tibia IO simulator and was rated as a valuable and realistic medical education training tool. This report focuses on implementing this IO simulator for neonatal resuscitation program (NRP) training purposes, as well as to explain the process of redeveloping the previous adult IO simulator and the development of a stand, called the maxSIMbox, to hold the simulators, as well as the tools needed to perform an IO infusion. The feedback provided from stakeholders was helpful, with an emphasis on providing stability to both the infant IO simulator and the maxSIMbox. From this feedback, a functional and cost-effective simulator was developed to practice this HALO skill and is currently being used for NRP training.

Design and Validity Evidence for a Unique Endoscopy Simulator Using a Commercial Video Game

Background Procedural simulation enhances early endoscopy training. Multiple commercial simulators are available; however, their application is limited by cost and poor user compliance. First-person "shooter" (FPS) video games are popular. In this study, we aimed to show that a novel in-house designed colonoscope controller used to play an FPS video game shares similar constructs with real-life endoscopy. Methodology Participants completed the first three levels on an FPS video game, Portal (Valve Corporation, Bellevue, WA), first using a conventional controller and then the modified endoscope controller. A total of 12 expert endoscopists and 12 surgical residents with minimal endoscopy experience were evaluated based on completion time, button presses, and hand motion analyses. Results Experts outperformed novices for completion time (expert: 944 seconds; novice: 1,515 seconds; p = 0.006) and hand movements (expert: 1,263.1; novice: 2,052.6; p = 0.004) in using the novel colonoscope controller. There was no difference in button presses or total path length traveled. Furthermore, performance did not differ using conventional game controls. Conclusions Experts outperformed novices using the endoscope but not the conventional controller with respect to the economy of movement and completion time. This result confirms that our endoscope-controlled video game shares similar paradigms with real-life endoscopy and serves as a first step toward creating a more enjoyable and cheaper alternative to commercially available endoscopy simulators.

Using Haptic Feedback in a Virtual Reality Bone Drilling Simulation to Reduce Plunge Distance

Background Bone drilling is a procedure that demands a high level of dexterity, fine motor skills and spatial awareness from the operating surgeon. An important consideration when drilling bone is minimising soft tissue damage. There are numerous causes of drilling associated soft tissue injury, of which most concerning is drilling into the tissue beyond the far cortex as unseen injury can occur. This is known as plunging. Objectives The objective of this study was to evaluate the impact of haptic feedback in virtual reality (VR) simulation-based training. The acquisition of drilling skill was assessed by changes to their drill plunge depth. Study Design & Methods The participants in the study were medical students, doctors and biomedical scientists. Participants were randomly allocated into two groups. One group had simulation with haptic feedback as part of their VR simulated learning, whereas the second group undertook the same VR simulation but did not receive haptic feedback during the simulation. Following completion of the simulated bone drilling protocol, a bone drilling exercise took place. Each participant was allowed to drill a synthetic tibia bone five times and then the plunge depth was measured. We quantified outcome in the form of plunge depth. Results  There were four participants in each group. The average plunge distance in the group who were able to practice with haptic assisted VR simulation was 46mm (range: 37-56mm), the average plunge distance in the non-haptic group was 79mm (range: 44-136mm). Results showed an average reduction of 33mm in plunge depth from users in the haptic group compared to the non-haptic group. Conclusion  Bone drilling simulation with haptic feedback may be an effective simulator of the motor skills that would be required to perform this action on a live patient. The study results suggest that there could be a reduction in soft tissue damage for users trained in VR simulations with haptic feedback.

Use of an Online Ultrasound Simulator to Teach Basic Psychomotor Skills to Medical Students During the Initial COVID-19 Lockdown: Quality Control Study

BACKGROUND

Teaching medical ultrasound has increased in popularity in medical schools with hands-on workshops as an essential part of teaching. However, the lockdown due to COVID-19 kept medical schools from conducting these workshops.

OBJECTIVE

The aim of this paper is to describe an alternative method used by our medical school to allow our students to acquire the essential psychomotor skills to produce ultrasound images.

METHODS

Our students took online ultrasound courses. Consequently, they had to practice ultrasound exercises on a virtual simulator, using the mouse of their computer to control a simulated transducer. Our team measured the precision reached at the completion of simulation exercises. Before and after completion of the courses and simulator's exercises, students had to complete a questionnaire dedicated to psychomotor skills. A general evaluation questionnaire was also submitted.

RESULTS

A total of 193 students returned the precourse questionnaire. A total of 184 performed all the simulator exercises and 181 answered the postcourse questionnaire. Of the 180 general evaluation questionnaires that were sent out, 136 (76%) were returned. The average precourse score was 4.23 (SD 2.14). After exercising, the average postcourse score was 6.36 (SD 1.82), with a significant improvement (P<.001). The postcourse score was related to the accuracy with which the simulator exercises were performed (Spearman rho 0.2664; P<.001). Nearly two-thirds (n=84, 62.6%) of the students said they enjoyed working on the simulator. A total of 79 (58.0%) students felt that they had achieved the course's objective of reproducing ultrasound images. Inadequate connection speed had been a problem for 40.2% (n=54) of students.

CONCLUSIONS

The integration of an online simulator for the practical learning of ultrasound in remote learning situations has allowed for substantial acquisitions in the psychomotor field of ultrasound diagnosis. Despite the absence of workshops, the students were able to learn and practice how to handle an ultrasound probe to reproduce standard images. This study enhances the value of online programs in medical education, even for practical skills.

Virtual Reality as an Affirmative Spin-Off to Laparoscopic Training: An Updated Review

Latest advancements in science lead to drastic improvements in patient health care. Techniques and technology evolved in surgery over the years have resulted in the improvement of patient outcomes by leaps and bounds. Open surgeries previously done for procedures like appendectomy and cholecystectomy evolved into laparoscopic minimally invasive procedures. Such procedures pose few challenges to the surgeons, like lack of tissue feedback and fulcrum effect of the abdominal wall. But training surgeons for such an advanced skill is still following conventional methods. These procedures can be effectively trained using Virtual Reality (VR), which can simulate operations outside the operating room (OR). To maximize the outcomes of VR training, knowledge on various strategies affecting the skills acquisition and retention in VR training is essential. This review collected information from PubMed, EMBASE, Cochrane Library (CENTRAL) databases. Data from the previous ten years are included in the review. This included documents, clinical trials, meta-analysis, randomized controlled trials, reviews, systematic reviews, letters to editors, and grey literature. After an advanced Medical Subject Headings (MeSH) search, we got 59,532 results, and after the application of filters, 189 results showed up. Out of these, studies that were not exclusively relevant to the use of VR in laparoscopic surgery were manually excluded, and a total of 35 articles were included in the study. VR is found to be an excellent training modality with promising outcomes. It helps the surgeons perform the surgery accurately at a faster pace and improves confidence and multitasking ability in OR. Instructor feedback from mentors and deliberate practice of trainees, and early introduction of haptics in VR resulted in the most effective outcomes of the VR training. Box trainers are also compared with VR trainers as they are the cheaper modalities of training. However, this area needs more research to conclude if box trainers can act as a cheaper alternative to VR training providing similar outcomes.

Three-dimensional simulations of six treatment maneuvers for horizontal canal benign paroxysmal positional vertigo canalithiasis

BACKGROUND AND PURPOSE

Horizontal canal benign paroxysmal positional vertigo (BPPV) is the second most common variant of BPPV after posterior canal BPPV. Various liberatory maneuvers are recommended for the treatment of horizontal canal BPPV canalithiasis (hc-BPPV-ca). The aim of this study was to show how three-dimensional (3D) dynamic simulation models visualize the movement of the clot of otoconia within the canal for a better understanding of the theoretical efficacy.

METHODS

Based on reconstructed magnetic resonance imaging and fluid dynamics, a 3D dynamic simulation model (as a function of time) was developed and applied. Thereby, six treatment maneuvers for hc-BPPV-ca were simulated: two types of the roll maneuver (the original 270° and the modified 360°) as well as two Gufoni and Zuma maneuvers (for geotropic and apogeotropic nystagmus).

RESULTS

The simulations showed that the 360° roll maneuver and Zuma maneuver are effective treatment options for hc-BPPV-ca for debris in all locations within the canal. However, the original 270° roll maneuver will not be effective if the clot is in the ampullary arm of the horizontal canal. The Gufoni maneuver for geotropic hc-BPPV-ca is effective, whereas for apogeotropic hc-BPPV-ca there is a risk of treatment failure due to insufficient repositioning of the debris.

CONCLUSIONS

The 3D simulations for movement of the otoconia clots can be used to test the mechanism of action and the theoretical efficacy of existing maneuvers for the different BPPV variants. For hc-BPPV-ca, the modified 360° roll maneuver and Zuma maneuver are theoretically efficient for all subtypes, whereas Gufoni maneuver is effective for geotropic nystagmus only.

Event Camera Simulator Improvements via Characterized Parameters

It has been more than two decades since the first neuromorphic Dynamic Vision Sensor (DVS) sensor was invented, and many subsequent prototypes have been built with a wide spectrum of applications in mind. Competing against state-of-the-art neural networks in terms of accuracy is difficult, although there are clear opportunities to outperform conventional approaches in terms of power consumption and processing speed. As neuromorphic sensors generate sparse data at the focal plane itself, they are inherently energy-efficient, data-driven, and fast. In this work, we present an extended DVS pixel simulator for neuromorphic benchmarks which simplifies the latency and the noise models. In addition, to more closely model the behaviour of a real pixel, the readout circuitry is modelled, as this can strongly affect the time precision of events in complex scenes. Using a dynamic variant of the MNIST dataset as a benchmarking task, we use this simulator to explore how the latency of the sensor allows it to outperform conventional sensors in terms of sensing speed.

The Utility of Real-Time Remote Auscultation Using a Bluetooth-Connected Electronic Stethoscope: Open-Label Randomized Controlled Pilot Trial

Background

The urgent need for telemedicine has become clear in the COVID-19 pandemic. To facilitate telemedicine, the development and improvement of remote examination systems are required. A system combining an electronic stethoscope and Bluetooth connectivity is a promising option for remote auscultation in clinics and hospitals. However, the utility of such systems remains unknown.

Objective

This study was conducted to assess the utility of real-time auscultation using a Bluetooth-connected electronic stethoscope compared to that of classical auscultation, using lung and cardiology patient simulators.

Methods

This was an open-label, randomized controlled trial including senior residents and faculty in the department of general internal medicine of a university hospital. The only exclusion criterion was a refusal to participate. This study consisted of 2 parts: lung auscultation and cardiac auscultation. Each part contained a tutorial session and a test session. All participants attended a tutorial session, in which they listened to 15 sounds on the simulator using a classic stethoscope and were told the correct classification. Thereafter, participants were randomly assigned to either the real-time remote auscultation group (intervention group) or the classical auscultation group (control group) for test sessions. In the test sessions, participants had to classify a series of 10 lung sounds and 10 cardiac sounds, depending on the study part. The intervention group listened to the sounds remotely using the electronic stethoscope, a Bluetooth transmitter, and a wireless, noise-canceling, stereo headset. The control group listened to the sounds directly using a traditional stethoscope. The primary outcome was the test score, and the secondary outcomes were the rates of correct answers for each sound.

Results

In total, 20 participants were included. There were no differences in age, sex, and years from graduation between the 2 groups in each part. The overall test score of lung auscultation in the intervention group (80/110, 72.7%) was not different from that in the control group (71/90, 78.9%; P=.32). The only lung sound for which the correct answer rate differed between groups was that of pleural friction rubs (P=.03); it was lower in the intervention group (3/11, 27%) than in the control group (7/9, 78%). The overall test score for cardiac auscultation in the intervention group (50/60, 83.3%) was not different from that in the control group (119/140, 85.0%; P=.77). There was no cardiac sound for which the correct answer rate differed between groups.

Conclusions

The utility of a real-time remote auscultation system using a Bluetooth-connected electronic stethoscope was comparable to that of direct auscultation using a classic stethoscope, except for classification of pleural friction rubs. This means that most of the real world’s essential cardiopulmonary sounds could be classified by a real-time remote auscultation system using a Bluetooth-connected electronic stethoscope.

Trial Registration

UMIN-CTR UMIN000040828; https://tinyurl.com/r24j2p6s and UMIN-CTR UMIN000041601; https://tinyurl.com/bsax3j5f

3D-Printed Ophthalmic-Retrobulbar-Anesthesia Simulator: Mimicking Anatomical Structures and Providing Tactile Sensations

Objective: A simulator for retrobulbar anesthesia administration mimicking the orbital anatomy and providing tactile sensation is proposed. Methods: The production process involves 3D modeling of anatomical structures on the basis of computerized tomography (CT) images, printing the models using a 3D printer, and casting the silicone. Twenty ophthalmologists administered retrobulbar anesthesia using the simulator with four different ocular axial lengths (including extreme myopes); the position of the needle tip was evaluated. The effectiveness of this simulator for training was also surveyed. Results: The proportions of the final location of the needle tip were 59.25%, 36.25%, and 4.5% for the retrobulbar space, peribulbar space, and intraocular space, respectively. Experienced ophthalmologists showed lower complication rates than residents (0.5% vs 8.5%, [Formula: see text]) and agreed that this simulator will help young ophthalmologists advance their anesthesia-administering skills. Discussion/Conclusion: The 3D-printered simulator for retrobulbar anesthesia was produced and performance was verified. The technology could be used to simulate critical orbital anatomic features and could be used as a training tool for resident ophthalmologists.

Design of the UWB Positioning System Simulator for LOS/NLOS Environments

UWB is a rapidly developing technology characterised by high positioning accuracy, additional data transferability, and communication security. Low costs and energy demand makes it a system that meets the requirements of smart cities (e.g., smart mobility). The analysis of the positioning accuracy of moving objects requires a ground truth. For the UWB system, it should have an accuracy of the order of millimetres. The generated data can be used to minimize the cost and time needed to perform field tests. However, there is no UWB simulators which can consider the variable characteristics of operation along with distance to reflect the operation of real systems. This article presents a 2D UWB simulator for outdoor open-air areas with obstacles and a method of analysing data from the real UWB system under line-of-sight (LOS) and non-line-of-sight conditions. Data are recorded at predefined outdoor reference distances, and by fitting normal distributions to this data and modelling the impact of position changes the real UWB system can be simulated and it makes it possible to create virtual measurements for other locations. Furthermore, the presented method of describing the path using time-dependent equations and obstacles using a set of inequalities allows for reconstructing the real test scenario with moving tags with high accuracy.

MIIND : A Model-Agnostic Simulator of Neural Populations

MIIND is a software platform for easily and efficiently simulating the behaviour of interacting populations of point neurons governed by any 1D or 2D dynamical system. The simulator is entirely agnostic to the underlying neuron model of each population and provides an intuitive method for controlling the amount of noise which can significantly affect the overall behaviour. A network of populations can be set up quickly and easily using MIIND's XML-style simulation file format describing simulation parameters such as how populations interact, transmission delays, post-synaptic potentials, and what output to record. During simulation, a visual display of each population's state is provided for immediate feedback of the behaviour and population activity can be output to a file or passed to a Python script for further processing. The Python support also means that MIIND can be integrated into other software such as The Virtual Brain. MIIND's population density technique is a geometric and visual method for describing the activity of each neuron population which encourages a deep consideration of the dynamics of the neuron model and provides insight into how the behaviour of each population is affected by the behaviour of its neighbours in the network. For 1D neuron models, MIIND performs far better than direct simulation solutions for large populations. For 2D models, performance comparison is more nuanced but the population density approach still confers certain advantages over direct simulation. MIIND can be used to build neural systems that bridge the scales between an individual neuron model and a population network. This allows researchers to maintain a plausible path back from mesoscopic to microscopic scales while minimising the complexity of managing large numbers of interconnected neurons. In this paper, we introduce the MIIND system, its usage, and provide implementation details where appropriate.

Simulation models and training curricula for training in endoscopic enucleation of the prostate: A systematic review from ESUT

The introduction of endoscopic anatomical enucleation of the prostate created a new educational field. We investigated the current literature for simulators, phantoms, and other training models that could be used as a tool for teaching urologists alone or within the boundaries of a course or a curriculum. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement and the European Association of Urology Guidelines office's recommendations for conducting systematic reviews. Seven out of 51 studies met our inclusion criteria and are presented in the current review. The VirtaMed UroSim HoLEP (Holmium Laser Enucleation of the Prostate) Simulator achieved excellent scores for face, content, and construct validity, and participants agreed that it could be used for training. In addition, this simulator offers the opportunity for morcellation training. The Kansai University model for HoLEP does not support morcellation simulation and has only demonstrated face and content validity. The CyberSim (Quanta System, Solbiate Olona, VA, Italy) has not been yet evaluated, but it seems that it can be used for training without tutoring. Only one training curriculum was revealed from the search. The Holmium User Group-Mentorship Program has been proposed since 2005 for training urologists for HoLEP. Simulators and courses or curricula based on a simulator could be valuable learning and training tools. The existent models seem efficient but have not been widely evaluated and accepted yet. It seems that the training field for transurethral enucleation of the prostate will be rapidly developed soon.

Cadaver versus simulator based arthroscopic training in shoulder surgery

Introduction

There are few studies that compare the cadaver dissections with the medical simulators in means of talent improvement. Therefore, the aim of this study is to find out if using cadaver dissections is still the golden standard for surgical training or using the medical simulators in surgery could replace cadaver dissections.

Materials and methods

The study is conducted during the European Orthopaedics & Traumatology Education Platform accredited Shoulder Club International Cadaver Course including a number of 34 orthopedics trainees. The participants were randomly divided into two groups to be trained with the simulator (Group 1) and on cadavers (Group 2), followed by a test performed on shoulder arthroscopy simulator (Virtamed ArthroS, Switzerland). There was no conflict of interest before, during, or after the study. Informed consent was obtained from all individual participants included in the study.

Results

Group 2 had statistically significant higher simulation overview procedure time values than Group 1 (p < 0.05), the meaning of which is participants trained with the simulator completed the given tasks in a shorter period of time. Group 2 had statistically significant higher scratching of humerus cartilage values than Group 1 (p < 0.05), which means that participants trained with simulation have less scratching done on the humerus cartilage than the participants trained on a cadaver.

Conclusion

To the best of our knowledge, this study is the first one to compare virtual reality (VR) simulators with cadavers for surgical education in an objective manner, while using qualitative and quantitative data. According to this study, it is possible to state that VR simulators are just as effective as cadavers in means of training subjects. As medical education will face a total change all around the world after the COVID-19 pandemic, this study has the potential to be an important guide during and after this period.

Reworking protocols of ophthalmic resident surgical training in the COVID-19 era - Experiences of a tertiary care institute in northern India

Purpose:

Coronavirus Disease 2019 (COVID-19) pandemic has negatively impacted medical professionals in all fields of medicine and surgery in their academic, clinical and surgical training. The impact of surgical training has been described as ‘severe’ by most ophthalmology residents worldwide due to their duties in COVID-19 wards, disruption of outpatient and camp services.

Methods:

Ophthalmic surgery demands utmost accuracy and meticulousness. Fine motor proficiencies, stereoscopic skills and hand–eye coordination required can only be achieved by practice. So, a multileveled structured wet-lab teaching schedule was prepared for the residents and implemented to bridge this gap between theory and practice at our tertiary care institute. A semester-wise training schedule was made with the proper distribution of wet-lab and simulator training. Surgeries like phacoemulsification, scleral buckling, pars plana lensectomy and vitrectomy, trabeculectomy and intravitreal injections were practised by the residents on the goat eyes. Simulator training was provided for phacoemulsification and vitrectomy to increase the hand–eye coordination of the residents.

Results:

Residents noticed improvement in their surgical skills and ambidexterity post wet-lab and simulator training . It also increased their confidence and provided essential surgical skills required to be used in the operation theater later.

Conclusion:

It is imperative that wet-lab training be included in the residency training programme in this COVID-19 era.