Posts Tagged ‘University of Washington’

drwietimg_4481In 1999, the Institute of Medicine published a study that concluded the following: medical errors in the US cost the lives of as many as 98,000 people each year (and run up a $17- $29 billion bill to boot). Ten years later, the Safe Patient Project reported that, rather than showing improvement, in the intervening decade the situation may have actually gotten worse—to the tune of more than 100,000 deaths each year as a result of “preventable medical harm.” Given that the CDC puts the number of deaths from hospital infections alone at around 99,000 annually, the SPP’s number seems conservative.

Let me put this into perspective. A Boeing 737—the most popular aircraft family in service today—seats 360 people, give or take. So consider this: the Safe Patient Project’s estimate of preventable fatalities is akin to 277 airliners plummeting to Earth and killing everyone on board—every year. How long do you think the FAA—or the public, for that matter—would stand for that?

Fortunately there’s a solution: video games.

Being a videogamer doesn’t get a lot of respect in a lot of mainstream professions, but it has been instrumental to me in becoming a surgeon.”

red_dragon

Red Dragon simulator, ISIS

That’s Dr. Andy Wright, surgeon and core faculty member at the University of Washington’s Institute for Simulation and Interprofessional Studies (ISIS). The Institute’s goal is to use technology to improve the quality of healthcare education, patient safety, and surgical outcomes. Simulations are particularly effective as they allow trainees to easily repeat procedures until they’re successful, and provide a safe place for them to fail when they’re not. In Dr. Wright’s experience, the skill and manual dexterity necessary to play video games proficiently translate directly to surgical simulators—resulting in more effective training and fewer accidents in the OR.

Gamers have a higher level of executive function. They have the ability to process information and make decisions quickly, they have to remember cues to what’s going around [them] and [they] have to make split-second decisions.”

Accomplished gamers show heightened abilities to focus on critical elements while maintaining peripheral awareness of the surrounding environment, function amidst distraction, and effectively improvise if a situation doesn’t go according to plan. Past studies have repeatedly demonstrated this, and it makes sense: effectively navigating through and surviving a video game’s virtual world demands it. There are other characteristics of video games that make them particularly well-suited to prepare surgeons for the operating room: you interact with the game’s world through a video screen, and you have to be adept at manipulating images and items with a handheld controller. These skills are especially useful in the areas of laparoscopic (see my previous post here) and robot-assisted surgery.

da Vinci Surgical System

da Vinci Surgical System

Take da Vinci, for example. It’s a robotic surgical system that allows surgeons to perform delicate, complex procedures through tiny incisions. The da Vinci system combines 3D, high definition video with four interactive robot arms (there’s even a dual-console option where trainees can watch an actual procedure, and a switching mechanism that allows surgeons and trainees to exchange control during an operation). Surgeons manipulate these arms using precision controllers that scale the speed and range of their movements down to the much smaller size of the surgical instruments, allowing for unparalleled accuracy. Put simply, the most advanced robotic surgical system in the world employs an interface intimately familiar to video gamers.

Take gaming into the land of simulation, though, and you can start tapping into the medium’s real power. Virtual reality (VR) simulators are an effective means of getting fledgling surgeons comfortable with a variety of procedures, allowing them to perform a given surgery dozens of times before ever opening up a live patient. They also provide an environment in which surgeons can, in essence, fail safely. Within a simulation, they can develop critical skills and expertise without putting anyone at risk, experimenting with different techniques, learning what does—and doesn’t—work, and becoming safer and more effective. A 2002 Yale University study provided strong evidence for this: surgical residents trained in VR were 29 percent faster and six times less likely to make mistakes than their non-VR trained colleagues.

virtual_surgery-chirurgie_virtuelle_1You can also customize a simulation to closely reflect reality, matching the conditions and characteristics of actual patients. In 2009, Halifax neurosurgeon Dr. David Clarke made history when he became the first person to remove a brain tumor in a patient less than 24 hours after removing the same tumor virtually, on a 3D rendering of that same patient. Two years later, doctors in Mumbai performed PSI knee replacement surgery on a patient after first running the operation virtually on an exact 3D replica of the patient’s knee.

Earlier this year, VR training took another leap forward: using the online virtual world Second Life, London’s St. Mary’s Hospital developed three VR environments—a standard hospital ward, an intensive care unit, and an emergency room—and built modules for three common scenarios (at three levels of complexity, for interns, junior residents, and senior residents) within them. According to Dr. Rajesh Aggarwal, a National Institute for Health Research (NIHR) clinician scientist in surgery at St. Mary’s Imperial College,

The way we learn in residency currently has been called ‘training by chance,’ because you don’t know what is coming through the door next. What we are doing is taking the chance encounters out of the way residents learn and forming a structured approach to training. What we want to do—using this simulation platform—is to bring all the junior residents and senior residents up to the level of the attending surgeon, so that the time is shortened in terms of their learning curve in learning how to look after surgical patients.”

After running interns and junior and senior residents through the VR training, researchers compared their performances of specific procedures against those of attending surgeons. They found substantial performance gaps between interns, residents, and attendings—validating the VR scenarios as training tools. As Dr. Aggarwal explained,

What we have shown scientifically is that these three simulated scenarios at the three different levels are appropriate for the assessment of interns, junior residents, and senior residents and their management of these cases.”

In the future, the team at St. Mary’s plans to study how this type of VR training can improve clinical outcomes of patients treated by residents—ultimately using this tool to bring their interns’ and residents’ skills up to the level of the attendings, help them better manage clinical patients, and, at the end of the day save lives.

When you’re talking about pain, nothing comes close to the excruciating intensity of burning alive. Survivors of severe burns report trying anything—anything—to stop the pain, sometimes resigning themselves to death and hoping they won’t be on fire much longer before the end.

And that’s just during the event. Those who are lucky enough to live through the experience have another nightmare to look forward to: recovery. Burn wounds are especially susceptible to infection, and have to be cleaned daily. For the victim, this amounts to reliving the torture of being burned over and over again. The pain is nearly as severe, and the drugs to alleviate it are woefully inadequate. Morphine and other opioids are effective when patients are resting, but during treatment, they just don’t cut it: invented to relieve pain in 1804, morphine hasn’t changed since. For all intents and purposes, pain management’s been stuck in the 19th century.

Until recently, that is. Beginning in late 2006, caregivers received a new tool for fighting pain, one that doesn’t require a prescription and has no risk of dependency. It’s a videogame called SnowWorld, and it’s the first immersive virtual world designed specifically for reducing pain.

The environment of SnowWorld is as far from hot as you can get: icy, snow-covered, and populated with penguins, snowmen, and woolly mammoths. Patients undergoing treatment for severe burns don a VR headset or look through a pair of goggles, and find themselves transported into this world where they can run around and toss snowballs at the inhabitants for as long as the PT session lasts. And, believe it or not, it gets results. Says University of Washington researcher Hunter Hoffman, who worked with combat veterans from Iraq and Afghanistan,

What was encouraging was the ones that needed it the most showed the most pain reduction, so the patients that were in the most pain showed the most pain reduction from SnowWorld.”

The idea behind SnowWorld predates the game by a decade. It’s called immersive VR distraction, and it was co-developed in 1996 by Hoffman and Dr. David Patterson, head of the Division of Psychology of the University of Washington’s Department of Rehabilitation Medicine. Dr. Patterson also works with patients at the university’s Harborview Burn Center, studying psychological techniques for reducing severe burn pain. According to Patterson, the concept is simple:

It takes a certain amount of attention to process pain. If you are able to put that attention elsewhere, there is less attention to process pain, and consequently, people will feel less pain.”

This is born out not only in interviews with patients, who universally report drastic pain reduction, but in MRI scans that clearly show less activity in the brain’s pain centers when physical rehab is combined with immersion into SnowWorld.

GQ Magazine just reported the case of First Lieutenant Sam Brown, horribly burned after his Humvee rolled over an IED in Iraq. His full story is here, but some of the descriptions are a bit gruesome, so those of a more delicate constitution might want to read the NPR story here.

Sergeant Oscar Libretto experienced a similar event in 2009, and you can find his story here.

These are only two of the hundreds of veterans from Iraq and Afghanistan who’ve returned after surviving one of the most horrific experiences a human being can endure. But survival is only the beginning of their struggle. Wound care and rehab is taxing and painful, both physically and mentally—on the servicemen and women, the caregivers, and their families. For all of them, the immersive distraction of videogames like SnowWorld is a nothing less than a godsend, improving recovery, providing relief from unimaginable suffering, and offering a glimpse—however fleeting—of a future beyond pain.

To learn more about the Harborview Burn Center, click here.

You can read about immersive VR for pain control here.

And you can watch a video of SnowWorld in action here.

For about 33 million people around the world, videogames may be a matter of life and death. That’s because gamers have just accomplished something that had confounded scientists for 15 years: They’ve unlocked one of the great mysteries of AIDS.

And they did it in three weeks.

Using an online game called FoldIt, gamers cracked the protein structure of a retrovirus similar to HIV—a critical step in understanding the cause of AIDS and developing drugs to beat it. Faced with a seemingly insurmountable challenge, scientists enlisted the help of gamers worldwide—and were astonished at how quickly they got results. Published yesterday in the journal “Nature Structural & Molecular Biology,” this is the first time gamers have solved a long-standing scientific problem, and may be the only time in history that gamers and scientists have appeared as co-authors. Bear in mind, also, that very few, if any, of the gamers have a background in biochemistry. Calling this a monumental accomplishment is an understatement on the level of referring to the Sun as a bit warm.

FoldIt screenshot

So how did they do it? Through modeling. Developed by the University of Washington in 2008, FoldIt is a game with a purpose: groups of players compete against each other to unfold chains of amino acids—the building blocks of proteins. When players sit down at their computers to play the game, they are presented with a 3-D model of an amino acid. As they work to unfold it, they can use online tools to rotate the model and view it from any angle. This allows players to “see” the protein structure in a way impossible through a microscope: in full 3-D. Why is this important? Pharmacologists need 3-D pictures of a protein in order to identify potential target sites for drugs. Seth Cooper, one of FoldIt’s creators, explained the gamers’ success simply:

People have spatial reasoning skills, something computers are not yet good at.”

And while that’s inarguably true, Firas Khatib, of the University of Washington’s biochem lab, acknowledged and validated something that gamers have always known. He said,

The ingenuity of game players is a formidable force that, if properly directed, can be used to solve a wide range of scientific problems.”

Kudos to all the gamers who made this a reality. Now just imagine what else we could solve if more people put that energy to use.

To read the original paper, click here.

You can also check out this article in Yahoo! News.

And to learn more about FoldIt, check out the website here

… and watch a video of the game in action here.