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Pattern recognition technology allows for more intuitive control of myoelectric prostheses. However, the need to collect electromyographic data to initially train the pattern recognition system, and to re-train it during prosthesis use, adds complexity that can make using such a system difficult. Although experienced clinicians may be able to guide users to ensure successful data collection methods, they may not always be available when a user needs to (re)train their device. Here we present an engaging and interactive virtual reality environment for optimal training of a myoelectric controller. Using this tool, we evaluated the importance of training a classifier actively (i.e., moving the residual limb during data collection) compared to passively (i.e., maintaining the limb in a single, neutral orientation), and whether computational adaptation through serious gaming can improve performance. We found that actively trained classifiers performed significantly better than passively trained classifiers for non-amputees (P < 0.05). Furthermore, collecting data passively with minimal instruction, paired with computational adaptation in a virtual environment, significantly improved real-time performance of myoelectric controllers. These results further support previous work which suggested active movements during data collection can improve pattern recognition systems. Furthermore, adaptation within a virtual guided serious game environment can improve real-time performance of myoelectric controllers.

Background Hysterectomy rates are decreasing in many countries, and virtual reality (VR) simulators bring new training opportunities for residents. As coaching interventions while training on a simulated complex procedure represents a resource challenge, alternative strategies to improve surgical skills must be investigated. We sought to determine whether self-guided learning using a video-based self-assessment (SA) leads to improved surgical skills in laparoscopic hysterectomy (LH) on a VR simulator. Methods Twenty-four gynecology residents from two university hospitals were randomized into an SA group ( n  = 12) and a Control group ( n  = 12). Each participant’s baseline performance on a validated VR basic task was assessed. Both groups then performed three virtually simulated LHs during which the participants received no guidance nor feedback. Following each LH, the SA group participants rated the video of their own performance using a generic and a procedure-specific rating scale, while the Control group participants watched an LH video demonstration. The LH videos of both groups’ participants were blindly reviewed and rated by expert surgeons, using modified Objective Structured Assessment of Technical Skills scores (OSATS). Objective metrics recorded by the VR simulator were also compared. Results There was no difference between the groups’ baseline performances on the VR basic task. For the first LH, the OSATS-derived scores did not differ between SA and Control groups (9 [7–13] versus 9 [8–14]; p  = 0.728). For the third LH, the OSATS-derived scores were higher for the SA group than for the Control group (17 [15–21] versus 15 [11–17], p  = 0.039). Between the two groups, the objective metrics did not differ from the first to the third LH. Conclusions The use of a structured video-based SA leads to improved procedural skills in LH on a VR simulator compared to watching benchmark expert performance, in a population of residents with moderate experience in the operating room.

Systematic communication, such as the ISBAR (identification, situation, background, assessment, recommendation) approach, comprises a generic, transferable nontechnical skill. It can be used during the handover of patients set to undergo surgery and can be practiced in various ways, including virtual reality (VR). VR increasingly has been implemented and valued in nursing education as a positive contribution to teach students about pre- and postoperative nursing. A new nonimmersive 3D learning activity called the Preoperative ISBAR Desktop VR Application has been developed for undergraduate nursing students to learn preoperative handover using the ISBAR approach. However, the usability of this learning activity has not been studied. This study aimed to investigate how second-year undergraduate nursing students evaluated the usability of the Preoperative ISBAR Desktop VR Application. This was a qualitative study with observation and interviews. The inclusion criteria were undergraduate second-year nursing students of varying ages, gender, and anticipated technological competence. The System Usability Scale (SUS) questionnaire was used to get a score on overall usability. A total of 9 second-year nursing students aged 22-29 years participated in the study. The average score on the SUS was 83 (range 0-100), which equals a \"B\" on the graded scale and is excellent for an adjective-grade rating. The students expressed increased motivation to learn while working in self-instructed desktop VR. Still, a few technical difficulties occurred, and some students reported that they experienced some problems comprehending the instructions provided in the application. Long written instructions and a lack of self-pacing built into the application were considered limitations. The nursing students found the application to be usable overall, giving it an excellent usability score and noting that the application provided opportunities for active participation, which was motivational and facilitated their perceived learning outcomes. The next version of the application, to be used in a randomized controlled trial, will be upgraded to address technological and comprehension issues.

The aim of this study is to investigate in detail the specific tendencies of conflict management strategies displayed by trained and untrained synchronous computer-mediated communication (CMC) teams over time. A laboratory experiment was carried out with 54 virtual teams of four members each randomly assigned to the two conditions: experimental condition and control condition. In the experimental condition 28 teams received a training program for improving virtual team functioning among session 1 and 2, consisting in a team self-guided training. These results were compared with 26 control teams, who did not receive any training program. Content analysis of the chat was used as research method. Our results showed that trained synchronous CMC teams use more frequently functional conflict management strategies, like open communication and rotating responsibilities, and less dysfunctional conflict management strategies (avoiding) over time. In contrast, untrained synchronous CMC teams tend to use more frequently dysfunctional conflict management strategies (avoiding) and less frequently functional conflict management strategies (rotating responsibility) over time. Our study shows that team self-guided training can be useful for virtual teams. Feedback given to teams about their processes and results improves group conflict management in a virtual context.

In preparing novice anesthesiologists to perform their first ultrasound-guided axillary brachial plexus blockade, we hypothesized that virtual reality simulation-based training offers an additional learning benefit over standard training. We carried out pilot testing of this hypothesis using a prospective, single blind, randomized controlled trial. We planned to recruit 20 anesthesiologists who had no experience of performing ultrasound-guided regional anesthesia. Initial standardized training, reflecting current best available practice was provided to all participating trainees. Trainees were randomized into one of two groups; (i) to undertake additional simulation-based training or (ii) no further training. On completion of their assigned training, trainees attempted their first ultrasound-guided axillary brachial plexus blockade. Two experts, blinded to the trainees' group allocation, assessed the performance of trainees using validated tools. This study was discontinued following a planned interim analysis, having recruited 10 trainees. This occurred because it became clear that the functionality of the available simulator was insufficient to meet our training requirements. There were no statistically significant difference in clinical performance, as assessed using the sum of a Global Rating Score and a checklist score, between simulation-based training [mean 32.9 (standard deviation 11.1)] and control trainees [31.5 (4.2)] (p = 0.885). We have described a methodology for assessing the effectiveness of a simulator, during its development, by means of a randomized controlled trial. We believe that the learning acquired will be useful if performing future trials on learning efficacy associated with simulation based training in procedural skills. ClinicalTrials.gov identifier: NCT01965314. Registered October 17th 2013.

This study addresses for the first time the relationship between working memory and performance measures in image-guided instrument navigation with Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) and GI Mentor II (a simulator for gastroendoscopy). In light of recent research on simulator training, it is now prime time to ask why in a search for mechanisms rather than show repeatedly that conventional curriculum for simulation training has effect. The participants in this study were 28 Swedish medical students taking their course in basic surgery. Visual and verbal working memory span scores were assessed by a validated computer program (RoboMemo) and correlated with visual-spatial ability (MRT-A test), total flow experience (flow scale), mental strain (Borg scale), and performance scores in manipulation and diathermy (MD) using Procedicus MIST-VR and GI Mentor 11 (exercises 1 and 3). Significant Pearson's r correlations were obtained between visual working memory span scores for visual data link (a RoboMemo exercise) and movement economy (r = -0.417; p < 0.05), total time (r = -0.495; p < 0.01), and total score (r = -0.390; p < 0.05) using MIST-MD, as well as total time (r = -0.493; p < 0.05) and efficiency of screening (r = 0.469; p < 0.05) using GI Mentor 11 (exercise 1). Correlations also were found between visual working memory span scores in rotating data link (another RoboMemo exercise) and both total time (r = -0.467; p < 0.05) and efficiency of screening (r = -0.436; p < 0.05) using GI Mentor 11 (exercise 3). Significant Pearson's r correlations also were found between visual-spatial ability scores and several performance scores for the MIST and GI Mentor II exercises. Findings for the first time demonstrate that visual working memory for surgical novices may be important for performance in virtual simulator training with two well-known and validated simulators.

The development of a novel self-guided tour exercise for user orientation at the Pilkington Library, Loughborough University of Technology in Leicester, UK, is described. The background to the project is sketched and the factors leading to a move away from traditional conducted library tours, including their perceived lack of effectiveness and resource intensity at a time of pressure, are considered. Included is a consideration of the impact of library organization on orientation and users generally. The philosophic basis, aims, and objectives of the Loughborough approach to orientation are outlined, followed by a detailed, description of how the program evolved. This comprises a self-guided tour, supported by printed material as its main component, together with a limited number of individually tailored extended tours for users with specialized needs. The practical introduction of the program within the university is described, including publicity and evaluation. A description of the task force involved in the project is also included.