Introdução: a proficiência técnica é fundamental para o treinamento cirúrgico. Em virtude da complexidade crescente das cirurgias minimamente invasivas (CMI), o treinamento apenas em campo cirúrgico é insuficiente e impraticável. Os simuladores de realidade são comprovadamente uma ponte fundamental para esse aprendizado e para aplicação dessas técnicas em campo cirúrgico. Objetivo: avaliar a efetividade do simulador de realidade virtual comparado com a caixa-preta para o aprendizado dos participantes em técnicas minimamente invasivas. Métodos: foi realizada uma revisão sistemática da literatura nas bases CENTRAL, MEDLINE, EMBASE, Scopus, CINAHL, LILACS e literatura cinzenta. Os desfechos primários avaliados foram o tempo necessário para realizar uma cirurgia minimamente invasiva e o escore de desempenho ao realizar uma cirurgia minimamente invasiva. Após selecionados, os artigos foram submetidos a uma avaliação da qualidade metodológica e do risco de vieses dos estudos incluídos. Adicionalmente, foram extraídos os dados demográficos e contínuos possíveis para realização da metanálise. Os resultados encontrados foram submetidos à avaliação da qualidade da evidência. Resultados: 20 ensaios clínicos randomizados foram incluídos na análise qualitativa e 14 foram usados na metanálise. Ao todo, 350 participantes foram randomizados para os simuladores de realidade virtual (SRV) e 345, para a caixa-preta (CP). A maioria dos estudos treinou por 10 ou mais sessões cada habilidade. Somente na execução da tarefa de transferência de pinos, o treinamento com SRV foi mais eficiente que com CP (p < 0,00001; IC95%: -35,08 a - 25,01). Em análise descritiva, quanto ao escore de desempenho na realização de uma CMI, houve superioridade do grupo SRV em relação ao grupo CP. Não houve diferença estatística na metanálise quanto ao tempo para realizar uma cirurgia, tempo para execução e pontuação em escalas de desempenho de outras tarefas básicas ou avançadas. Conclusões: na pontuação em escores de desempenho ao realizar uma CMI e na execução da tarefa básica de transferência de pinos, o treinamento com SRV é melhor que o treinamento com CP. Nos demais desfechos, independentemente do nível de experiência do aluno ou do tipo de atividade treinada, as duas formas de treinamento são equivalentes / Introduction: technical proficiency is fundamental to surgical training. Due to the increasing complexity of minimally invasive surgeries (MIS), training inthe surgical field alone is insufficient and impractical. The simulator trainings are proven to be a fundamental bridge for their application in the surgical field. Objective: to evaluate the effectiveness of the virtual reality simulator compared to the black box for the learning of participants in minimally invasive techniques. Methods: a systematic review of the literature was performed on the bases CENTRAL, MEDLINE, EMBASE, Scopus, CINAHL, LILACS. The primary outcomes were time to perform a MIS and the performance score in a MIS. After being selected, the articles were submitted to an evaluation of the methodological quality and risk of bias. In addition, the possible demographic and continuous data for the meta-analysis were extracted. The results were submitted to an evaluation of the quality of the evidence. Results: 20 randomized clinical trials were included in the qualitative analysis and 14 were used in the meta-analysis. Three hundred and fifty participants were randomized to virtual reality simulators (VRS) and 345 to the black box (BB). Most of the training included 10 or more sessions for each skill. To time to complete Peg transfer task, VRS training was more efficient than BB training (p < 0.00001, 95% CI: -35.08 to -25.01). In a descriptive analysis, VRS training was better than BB training in the performance score to perform a MIS. There was no statistical difference in the meta-analysis to time to perform a surgery, time to complete basics or advanced tasks and performance score for basic or advanced tasks. Conclusions: VRS training was better than BB training to evaluate performance scores when performing a MIS and time to complete the basic task of peg transfer. In all other outcomes, regardless of the student\'s level of experience or type of activity, the two forms of training are equivalent

A punção venosa periférica é a inserção de dispositivos por veia periférica para acesso à corrente sanguínea, como na coleta de sangue para exames; embora seja um procedimento comum no tratamento intra-hospitalar, é complexo e exige competência profissional. A realização desse procedimento de forma inadequada pode colocar em risco a saúde do paciente, podendo provocar diversas complicações ao seu tratamento. A pesquisa teve como objetivo desenvolver e validar a primeira versão de um simulador de realidade virtual (RV) imersiva para o procedimento de punção venosa periférica para coleta de sangue a vácuo no paciente adulto. Revisão integrativa da literatura permitiu verificar as estratégias de ensino de punção venosa periférica na enfermagem. Procedeu-se, em seguida, um estudo com delineamento metodológico para desenvolver e validar a primeira versão do simulador. O uso de recursos tecnológicos como estratégias de ensino em enfermagem está em expansão, porém a simulação com RV, principalmente no ensino de punção venosa periférica, ainda é um vasto campo a ser explorado. Foi desenvolvida a primeira versão de um simulador de RV para a coleta de sangue à vácuo no adulto - o VIDA-Enfermagem v1.0, o qual foi avaliado por profissionais e graduandos de enfermagem. Foram considerados válidos 79,6% dos itens avaliados pelos profissionais e 66,7% dos itens avaliados pelos graduandos. As sugestões propostas pelos sujeitos da pesquisa para melhorias do sistema, em sua maioria, são passíveis de aceitação no decorrer do incremento das versões seguintes. Mesmo havendo necessidade de revisão de diversos itens, na avaliação dos participantes, o simulador foi considerado uma ferramenta promissora e inovadora para o ensino do procedimento de punção venosa periférica para coleta de sangue a vácuo em paciente adulto, para graduandos de enfermagem que estão se iniciando no estudo da temática e da técnica, como estratégia a ser combinada com os recursos já utilizados atualmente no ensino do procedimento. É relevante que se invista em estratégias inovadoras e motivadoras para aplicação no ensino de enfermagem, principalmente com o uso da realidade virtual imersiva / Peripheral venipuncture is the insertion of a peripheral venous device to access bloodstream, such as in blood collection for tests; although it is a common procedure in in-hospital treatment, it is complex and requires professional competence. Failure to perform this procedure may put the patient\'s health at risk, and may cause several complications to his/her treatment. This study aimed to develop and validate the first version of an immersive virtual reality (VR) simulator for the peripheral venipuncture procedure for vacuum blood collection in adult patient. Teaching strategies of peripheral venipuncture in nursing were verified through an integrative literature review. Then, a study with a methodological design was performed to develop and validate the first version of the simulator. The use of technological resources such as teaching strategies in nursing is expanding; however, the simulation with VR, mainly in the teaching of peripheral venipuncture, is still a vast field to be explored. The first version of a VR simulator for vacuum blood collection in adult patient was developed - VIDA-Enfermagem v1.0, which was evaluated by professionals and undergraduate nursing students. 79.6% of the items evaluated by the professionals and 66.7% of the items evaluated by the undergraduate students were considered valid. The suggestions proposed by the research subjects for system improvements, for the most part, may be included in the following versions. Although it was necessary to review several items, in the evaluation of the participants, the simulator was considered a promising and innovative tool for the teaching of the peripheral venipuncture procedure for vacuum blood collection in adult patients, for nursing undergraduate students who are beginning the study of the subject and technique, as a strategy to be combined with the resources already used in the teaching of the procedure. It is relevant to invest in innovative and motivating strategies for application in nursing teaching, especially with the use of immersive virtual reality

Objetivo: O impacto da experiência em laparoscopia nas habilidades de cirurgia robótica ainda não está claramente estabelecido. Nosso estudo tem como objetivo comparar habilidades básicas em cirurgia robótica, usando o simulador de realidade virtual dVTrainer ®, entre cirurgiões com experiência laparoscópica e residentes de cirurgia do primeiro ano. Métodos: Vinte cirurgiões com experiência em laparoscopia (grupo 1) e vinte residentes de cirurgia do primeiro ano (grupo 2) foram incluídos no estudo. Cada participante completou quatro tentativas dos exercícios Peg Board 2, Ring and Rail 1 e Suture Sponge 1 no dVTrainer ®. O desempenho foi avaliado utilizando um algoritmo de pontuação computadorizado incorporado ao simulador. As pontuações e as métricas foram comparadas entre os grupos 1 e 2, e entre a primeira tentativa e as demais Resultados: Os escores gerais para os exercícios Peg Board 2 (738,04 ± 267,83 vs 730,39 ± 225,31; p = 0,57), Ring and Rail 1 (919,03 ± 242,69 vs 965,84 ± 222,96; p = 0,13) e Suture Sponge 1 (563,62 ± 185,50 vs 560,99 ± 152,71; p = 0,67) não apresentaram diferença significativa entre os grupos 1 e 2. O grupo 1 apresentou melhores resultados na área de trabalho dos controles mestres nos exercícios Peg Board 2 e Ring and Rail 1. O grupo 2 apresentou melhores resultados na economia de movimentos nos exercícios Peg Board 2 e Ring and Rail 1 e na força excessiva dos instrumentos no exercício Ring and Rail 1. Nos dois grupos os escores gerais na terceira ou quarta tentativas foram significativamente melhores em comparação com a primeira. Conclusões: Não há diferença significativa nas habilidades básicas da cirurgia robótica entre cirurgiões com experiência laparoscópica e residentes de cirurgia sem experiência em laparoscopia. Algumas diferenças existem quando consideramos métricas específicas, mas essas diferenças não foram capazes de modificar os resultados finais. Podemos considerar que a experiência em laparoscopia pode não se constituir em requisito essencial na aprendizagem da cirurgia robótica. / Objective: The actual impact of laparoscopic experience on robotic skills is uncertain. This study aimed to compare basic robotic surgical skills using the virtual reality simulator dVTrainer ® between laparoscopically experienced surgeons and first-year surgical residents. Methods: Twenty laparoscopically experienced surgeons (group 1) and 20 first-year surgical residents (group 2) were included. Each participant completed four trials of the following tasks on the dV-Trainer®: Peg Board 2, Ring and Rail 1 and Suture Sponge 1. Performance was recorded using a computerized built-in scoring algorithm. Scores and metrics were compared between groups 1 and 2 and between the 1st and subsequent trials Results: The overall scores for Peg Board 2 (738.04 ± 267.83 vs 730.39 ± 225.31, p = 0.57), Ring and Rail 1 (919.03 ± 242.69 vs 965.84 ± 222.96, p = 0.13) and Suture Sponge 1 (563.62 ± 185.50 vs 560.99 ± 152.71, p = 0.67) did not differ significantly between groups 1 and 2. Group 1 had better results for master workspace range in Peg Board 2 and Ring and Rail 1. Group 2 had higher scores for economy of motion in Peg Board 2 and Ring and Rail 1 and for excessive instrument force in Ring and Rail 1. In both groups, the overall scores in the 3rd or 4th trials were significantly higher than those in the 1st trial. Conclusions: There is no significant difference in basic robotic surgical skills between laparoscopically experienced surgeons and laparoscopically naïve surgical residents. Some slight differences were observed in specific metrics, but these differences were not sufficient to change the final results. We may assume that laparoscopic experience should not be an essential step in the learning curve of robotic surgery.

Health and feeding outcomes for preterm infants depend upon healthcare providers’ ability to recognize non-verbal signs of distress during bottle-feeding. Methods of training future providers’ to interpret feeding behavior in preterm infants are unclear. This study used a pre-test/post-test design to compare the effects of in- vivo simulation and video-simulation training on students’ knowledge of feeding abnormalities, clinical judgment, and documentation accuracy. Fifty-two graduate level speech-language pathology students were assigned to the in-vivo (N= 27) or video-simulation (N= 25) group. Results revealed that both methods proved beneficial for increasing knowledge and clinical judgment skills. Participants trained using video-simulation training documented a greater number of distress signs. The use of patient simulators to train graduate level speech-language pathology students to use correct clinical judgment for managing abnormal feeding behavior is efficacious.

Preterm infants exhibit clinical distress markers during bottle-feeding due to underdevelopment. Simulation training provides effective means for learners. Twenty-two SLP students split into two groups, video-simulation(VT) and in-vivo-simulation training(IT). Results revealed VT had higher clinical judgment and lower anxiety levels than IT group. Both groups significantly improved distress markers identification.

Objetivo: O impacto da experiência em laparoscopia nas habilidades de cirurgia robótica ainda não está claramente estabelecido. Nosso estudo tem como objetivo comparar habilidades básicas em cirurgia robótica, usando o simulador de realidade virtual dVTrainer ®, entre cirurgiões com experiência laparoscópica e residentes de cirurgia do primeiro ano. Métodos: Vinte cirurgiões com experiência em laparoscopia (grupo 1) e vinte residentes de cirurgia do primeiro ano (grupo 2) foram incluídos no estudo. Cada participante completou quatro tentativas dos exercícios Peg Board 2, Ring and Rail 1 e Suture Sponge 1 no dVTrainer ®. O desempenho foi avaliado utilizando um algoritmo de pontuação computadorizado incorporado ao simulador. As pontuações e as métricas foram comparadas entre os grupos 1 e 2, e entre a primeira tentativa e as demais Resultados: Os escores gerais para os exercícios Peg Board 2 (738,04 ± 267,83 vs 730,39 ± 225,31; p = 0,57), Ring and Rail 1 (919,03 ± 242,69 vs 965,84 ± 222,96; p = 0,13) e Suture Sponge 1 (563,62 ± 185,50 vs 560,99 ± 152,71; p = 0,67) não apresentaram diferença significativa entre os grupos 1 e 2. O grupo 1 apresentou melhores resultados na área de trabalho dos controles mestres nos exercícios Peg Board 2 e Ring and Rail 1. O grupo 2 apresentou melhores resultados na economia de movimentos nos exercícios Peg Board 2 e Ring and Rail 1 e na força excessiva dos instrumentos no exercício Ring and Rail 1. Nos dois grupos os escores gerais na terceira ou quarta tentativas foram significativamente melhores em comparação com a primeira. Conclusões: Não há diferença significativa nas habilidades básicas da cirurgia robótica entre cirurgiões com experiência laparoscópica e residentes de cirurgia sem experiência em laparoscopia. Algumas diferenças existem quando consideramos métricas específicas, mas essas diferenças não foram capazes de modificar os resultados finais. Podemos considerar que a experiência em laparoscopia pode não se constituir em requisito essencial na aprendizagem da cirurgia robótica. / Objective: The actual impact of laparoscopic experience on robotic skills is uncertain. This study aimed to compare basic robotic surgical skills using the virtual reality simulator dVTrainer ® between laparoscopically experienced surgeons and first-year surgical residents. Methods: Twenty laparoscopically experienced surgeons (group 1) and 20 first-year surgical residents (group 2) were included. Each participant completed four trials of the following tasks on the dV-Trainer®: Peg Board 2, Ring and Rail 1 and Suture Sponge 1. Performance was recorded using a computerized built-in scoring algorithm. Scores and metrics were compared between groups 1 and 2 and between the 1st and subsequent trials Results: The overall scores for Peg Board 2 (738.04 ± 267.83 vs 730.39 ± 225.31, p = 0.57), Ring and Rail 1 (919.03 ± 242.69 vs 965.84 ± 222.96, p = 0.13) and Suture Sponge 1 (563.62 ± 185.50 vs 560.99 ± 152.71, p = 0.67) did not differ significantly between groups 1 and 2. Group 1 had better results for master workspace range in Peg Board 2 and Ring and Rail 1. Group 2 had higher scores for economy of motion in Peg Board 2 and Ring and Rail 1 and for excessive instrument force in Ring and Rail 1. In both groups, the overall scores in the 3rd or 4th trials were significantly higher than those in the 1st trial. Conclusions: There is no significant difference in basic robotic surgical skills between laparoscopically experienced surgeons and laparoscopically naïve surgical residents. Some slight differences were observed in specific metrics, but these differences were not sufficient to change the final results. We may assume that laparoscopic experience should not be an essential step in the learning curve of robotic surgery.

Objetivo: O impacto da experiência em laparoscopia nas habilidades de cirurgia robótica ainda não está claramente estabelecido. Nosso estudo tem como objetivo comparar habilidades básicas em cirurgia robótica, usando o simulador de realidade virtual dVTrainer ®, entre cirurgiões com experiência laparoscópica e residentes de cirurgia do primeiro ano. Métodos: Vinte cirurgiões com experiência em laparoscopia (grupo 1) e vinte residentes de cirurgia do primeiro ano (grupo 2) foram incluídos no estudo. Cada participante completou quatro tentativas dos exercícios Peg Board 2, Ring and Rail 1 e Suture Sponge 1 no dVTrainer ®. O desempenho foi avaliado utilizando um algoritmo de pontuação computadorizado incorporado ao simulador. As pontuações e as métricas foram comparadas entre os grupos 1 e 2, e entre a primeira tentativa e as demais Resultados: Os escores gerais para os exercícios Peg Board 2 (738,04 ± 267,83 vs 730,39 ± 225,31; p = 0,57), Ring and Rail 1 (919,03 ± 242,69 vs 965,84 ± 222,96; p = 0,13) e Suture Sponge 1 (563,62 ± 185,50 vs 560,99 ± 152,71; p = 0,67) não apresentaram diferença significativa entre os grupos 1 e 2. O grupo 1 apresentou melhores resultados na área de trabalho dos controles mestres nos exercícios Peg Board 2 e Ring and Rail 1. O grupo 2 apresentou melhores resultados na economia de movimentos nos exercícios Peg Board 2 e Ring and Rail 1 e na força excessiva dos instrumentos no exercício Ring and Rail 1. Nos dois grupos os escores gerais na terceira ou quarta tentativas foram significativamente melhores em comparação com a primeira. Conclusões: Não há diferença significativa nas habilidades básicas da cirurgia robótica entre cirurgiões com experiência laparoscópica e residentes de cirurgia sem experiência em laparoscopia. Algumas diferenças existem quando consideramos métricas específicas, mas essas diferenças não foram capazes de modificar os resultados finais. Podemos considerar que a experiência em laparoscopia pode não se constituir em requisito essencial na aprendizagem da cirurgia robótica. / Objective: The actual impact of laparoscopic experience on robotic skills is uncertain. This study aimed to compare basic robotic surgical skills using the virtual reality simulator dVTrainer ® between laparoscopically experienced surgeons and first-year surgical residents. Methods: Twenty laparoscopically experienced surgeons (group 1) and 20 first-year surgical residents (group 2) were included. Each participant completed four trials of the following tasks on the dV-Trainer®: Peg Board 2, Ring and Rail 1 and Suture Sponge 1. Performance was recorded using a computerized built-in scoring algorithm. Scores and metrics were compared between groups 1 and 2 and between the 1st and subsequent trials Results: The overall scores for Peg Board 2 (738.04 ± 267.83 vs 730.39 ± 225.31, p = 0.57), Ring and Rail 1 (919.03 ± 242.69 vs 965.84 ± 222.96, p = 0.13) and Suture Sponge 1 (563.62 ± 185.50 vs 560.99 ± 152.71, p = 0.67) did not differ significantly between groups 1 and 2. Group 1 had better results for master workspace range in Peg Board 2 and Ring and Rail 1. Group 2 had higher scores for economy of motion in Peg Board 2 and Ring and Rail 1 and for excessive instrument force in Ring and Rail 1. In both groups, the overall scores in the 3rd or 4th trials were significantly higher than those in the 1st trial. Conclusions: There is no significant difference in basic robotic surgical skills between laparoscopically experienced surgeons and laparoscopically naïve surgical residents. Some slight differences were observed in specific metrics, but these differences were not sufficient to change the final results. We may assume that laparoscopic experience should not be an essential step in the learning curve of robotic surgery.

There is limited research using small-scale simulation in applied behavior analysis. We used small-scale simulation to train firearm safety skills to 3 to 5-years-old children and assessed whether the skills generalized to the natural environment through in situ assessment. Three participants completed the training and all participants learned the safety skills from simulation training. Two of the participants acquired the safety skills after the first simulation training and the third participant required one booster training before demonstrating the safety skills in the natural environment.

This thesis assesses the potential of using computer simulation to aid existing lean manufacturing training methods such as lecture and live simulation. An investigation of this possibility was carried out in conjunction with UMEP's Lean 101 class. In the study, two experimental computer simulation models demonstrating the push and pull production scenarios were constructed using ProModel software. Simulation models were equipped with a Visual Basic interface to aid trainees to manipulate the model via ActiveX. Constructed computer simulation was compared with live simulation to answer these research questions: 1. Was computer simulation able to teach additional lean concepts not covered in live simulations? 2. Was training time less for trainees going through a computer simulation than for those going through a live simulation? 3. Was a computer simulation quicker and easier to set up than a live simulation for trainers? 4. Did computer simulation achieve comparable educational objectives as live simulation? Objective measurements for first three questions were positive and conclusive. For the fourth one, a survey was conducted among trainees of a treatment group (computer simulation only) and a control group (live simulation only) to collect responses. Statistical analysis of the subjective responses indicated the computer simulation aided the trainees to learn and implement lean manufacturing, but was not as effective as live simulation. Holistically, these results did not warrant the complete changeover from live simulation to computer simulation. Yet, a combined implementation of computer simulation and live simulation was proposed to reap the benefits from the best of both approaches.

The goal of this work has been to develop a design suggestion of a visualization system that supports training instructors and air force units during After Action Reviews (AAR) in training at the Swedish Air Force Combat Simulation Center (FLSC). The suggestion was developed through a design study consisting of interviews, a demonstration and a design workshop in parallel with an iterative prototyping process. The study resulted in a visualization system that indicates enemy aircraft at threatening distances to support identification of critical situations. To support the following threat assessment, visualizations that automatically present radar lock-on information and missile envelopes are suggested. Although radar lock-on information and missile envelopes has been presented in earlier visualizations they have not been adapted to the mode of operations of the AAR. Adapting the visualizations to the AAR would make the threat assessment easier and more effective to conduct. The purpose of the visualization is to make it easier for training instructors and air force units with limited experience of simulation training to conduct a high quality AAR through emphasizing relevant situations and points of interest.