Cardiopulmonary resuscitation training in high school using avatars in virtual worlds: an international feasibility study.

BACKGROUND: Approximately 300,000 people suffer sudden cardiac arrest (SCA) annually in the United States. Less than 30% of out-of-hospital victims receive cardiopulmonary resuscitation (CPR) despite the American Heart Association training over 12 million laypersons annually to conduct CPR. New engaging learning methods are needed for CPR education, especially in schools. Massively multiplayer virtual worlds (MMVW) offer platforms for serious games that are promising learning methods that take advantage of the computer capabilities of today's youth (ie, the digital native generation). OBJECTIVE: Our main aim was to assess the feasibility of cardiopulmonary resuscitation training in high school students by using avatars in MMVM. We also analyzed experiences, self-efficacy, and concentration in response to training. METHODS: In this prospective international collaborative study, an e-learning method was used with high school students in Sweden and the United States. A software game platform was modified for use as a serious game to train in emergency medical situations. Using MMVW technology, participants in teams of 3 were engaged in virtual-world scenarios to learn how to treat victims suffering cardiac arrest. Short debriefings were carried out after each scenario. A total of 36 high school students (Sweden, n=12; United States, n=24) participated. Their self-efficacy and concentration (task motivation) were assessed. An exit questionnaire was used to solicit experiences and attitudes toward this type of training. Among the Swedish students, a follow-up was carried out after 6 months. Depending on the distributions, t tests or Mann-Whitney tests were used. Correlation between variables was assessed by using Spearman rank correlation. Regression analyses were used for time-dependent variables. RESULTS: The participants enjoyed the training and reported a self-perceived benefit as a consequence of training. The mean rating for self-efficacy increased from 5.8/7 (SD 0.72) to 6.5/7 (SD 0.57, P<.001). In the Swedish follow-up, it subsequently increased from 5.7/7 (SD 0.56) to 6.3/7 (SD 0.38, P=.006). In the Swedish group, the mean concentration value increased from 52.4/100 (SD 9.8) to 62.7/100 (SD 8.9, P=.05); in the US group, the concentration value increased from 70.8/100 (SD 7.9) to 82.5/100 (SD 4.7, P<.001). We found a significant positive correlation (P<.001) between self-efficacy and concentration scores. Overall, the participants were moderately or highly immersed and the software was easy to use. CONCLUSIONS: By using online MMVWs, team training in CPR is feasible and reliable for this international group of high school students (Sweden and United States). A high level of appreciation was reported among these adolescents and their self-efficacy increased significantly. The described training is a novel and interesting way to learn CPR teamwork, and in the future could be combined with psychomotor skills training.

Stanford university medical media and information technologies hosts open source surgical simulation workshop.

Stanford University Medical Media and Information Technologies's technical workshop "Prototyping of Surgical Simulators using Open Source Simulation Software" was held in August 2006 at Stanford University. The objectives, program, and topics covered are presented in this short report.

Project hydra--a new paradigm of internet-based surgical simulation.

Computer-based surgical simulation systems have produced tremendous benefits and demonstrated validity as a better method for many areas of surgical skills acquisition. However, despite these benefits, broad proliferation of these systems has continued to be elusive. While in large part this lag in adoption of this technology is due to social factors (organizational momentum, curriculum integration difficulties, etc), the cost of computer-based simulation systems has certainly remained a major deterrent toward broad deployment. Instead, what if it were possible to eliminate the cost of the large computer completely from the system, yet provide a much more extensive and detailed simulation than currently available? Finally, what if a simulation with even greater detail over a wider anatomical area were possible?This is the genesis of Project Hydra- a shared simulation supercomputer were made available for free and all that is required to access it is a low-end Internet-connected computer and, optionally, interaction/haptics devices as needed for the particular task. This would enable supercomputer-class simulation at every desktop with much greater fidelity than any user could individually afford and provide an online community for simulation research and application. Further, Internet-based simulation provides for many other benefits as well. By the user merely plugging optional, additional hardware into their existing, low-end PC and using the Internet as a means of simulation dissemination, distribution, and delivery means that the user can have immediate access to simulation updates/upgrades and download/access new content (didactic curriculum and cases). Further, this ease of access and use could lead to accelerated adoption and use of simulation within the medical curriculum and this access is provided anywhere in the world 24 x 7. In addition, once connected, a server-based simulation system would be a natural point for performing easy, automated clinical studies of surgical performance and skills.

Linking olfaction with nausea and vomiting of pregnancy, recurrent abortion, hyperemesis gravidarum, and migraine headache.

OBJECTIVE: The experience of women was sought about nausea and vomiting, its relation to olfaction, its occurrence among pregnant women with anosmia, and the potential association of hyperemesis gravidarum and migraine headache. METHODS: We performed a community-based study with a physician/patient-directed questionnaire, and a retrospective analysis of hospital records. RESULTS: Nearly all women (n = 163 parous women) experience nausea (98%) and vomiting (97%). The highest frequency causes of nausea and vomiting were "food poisoning" (65%), "flu" (58%), pregnancy (54%), and offensive odors (52%); vomiting occurred as frequently as nausea for the first 2 causes, and one half as often for the latter causes. Most women reported that the pain experienced during vomiting exceeded that of parturition. Among 9 women with hypogonadotropic anosmia with advanced reproductive technology-induced pregnancies, 2 experienced nausea and vomiting, one from "food poisoning." Among 37 women with migraine headache, 10 (27%) had experienced hyperemesis gravidarum, and among 16 who experienced hyperemesis gravidarum, 5 (37%) had migraine headaches. CONCLUSIONS: The frequency of nausea and vomiting, caused most often by nonpregnancy-related triggers, is high among women. In a small sample of women with congenital anosmia, nausea and vomiting of pregnancy occurred in only 1 pregnancy, suggesting that olfaction is a highly selected trigger for nausea and vomiting of pregnancy. The shared nausea and vomiting experience of hyperemesis gravidarum and migraine headache among women suggests a common mechanism, possibly based on allelic variations within the DRD2 (dopaminergic receptor) gene. Because olfactory receptors, odor types, and MHC antigens are closely integrated, and because olfactory stimuli often incite episodes of pregnancy, nausea, and vomiting, hyperemesis gravidarum, and migraine headache, these genes and their products invite further scrutiny. The pregnancy-conserving effect of PNV and the MHC antigen overlap in couples with recurrent abortion are important clues possibly relating olfaction, MHC antigens, and reproductive success or failure.