JP7228829B2 - Auscultation training system and auscultation training program - Google Patents

Description

Application of Article 30, Paragraph 2 of the Patent Law Published on March 5, 2018, in the publication material ("Proposal of stethoscope-mounted heart sound reproduction module used for neonatal resuscitation simulation") at Information Processing Society of Japan Interaction 20183A-15

The present invention relates to technology of a simulation device for training neonatal resuscitation.

When a doctor diagnoses a medical condition or disease name, a stethoscope (more precisely, the sound pickup part) is placed on the affected part of the patient and listens to body sounds (breathing sounds, heart sounds, bowel sounds, etc.) as part of the medical examination. judgment is made.

Here, a stethoscope is roughly divided into a sound pickup part, a tube (also called a rubber tube), and an ear tube.

Conventionally, there have been reports of auscultation training systems for training trainees, such as medical students aiming to become doctors and nursing students aiming to become nurses, to acquire auscultation techniques.

For example, the auscultation training device disclosed in Patent Document 1 includes a human body model formed by simulating the upper body of a human body, a simulated stethoscope for performing auscultatory motions on the human model, and a simulated stethoscope. an auscultation detection sensor for detecting auscultation by means of a stethoscope, a stethoscope simulator, and an auscultation detection sensor, respectively; and a control unit that performs processing for reproducing body sounds such as heart sounds and breathing sounds at the auscultation position corresponding to the detection signal from the body sound reproducing unit.

However, such auscultation training systems are primarily intended for auscultation training on adult patients.

On the other hand, the neonatal mortality rate at birth (early neonatal mortality rate) in Japan is 0.7 per 1,000 live births. This figure is extremely low compared to other developed countries (3.7 cases in the US), and it can be said that a high level of safety is ensured in the delivery environment in Japan. Of course, this is due to the high level of medical care in Japan.

・Many deliveries take place in obstetric clinics or midwifery clinics, not in general hospitals.

・Pediatricians (neonatologists) are basically absent outside of general hospitals.

• General hospitals have a high proportion of high-risk mothers, but not all deliveries are attended by a pediatrician.

According to the statistics shown in Non-Patent Document 2, the number of medical workers involved in childbirth in Japan in 2014 was, for example, 510 obstetricians, 36,000 midwives, and 1 neonatal doctor. , 238, 8,625 anesthesiologists, and 10,575 obstetricians and gynecologists.

This is where the latent challenges of Japan's medical system lie. In the past few years, the number of births in Japan has fallen below 1 million, but the number of neonatal doctors who specialize in neonates is only one-thousandth of that, and neonatal resuscitation specialists are not present at many deliveries. do not have. Furthermore, many obstetricians and midwives are specialists in pregnancy and delivery, and lack specialized skills for neonatal resuscitation. In such a medical system, the above-mentioned fact that the neonatal mortality rate has been suppressed to 0.7 per 1000 people can be said to be the result of the tireless efforts of the medical field.

A specific activity is the neonatal cardio-pulmonary resuscitation (NCPR) dissemination project that the Japanese Society of Perinatal and Neonatal Medicine has been developing since 2008. In reality, according to statistics from the Ministry of Health, Labor and Welfare in 2015, about 100,000 newborns out of 1 million births in Japan are in a state of asphyxia due to unstable respiratory circulation immediately after birth and require resuscitation. . As mentioned above, there is not enough time for all newborns to be delivered by specialists alone. This means that NCPR training for skill improvement including must be continuously implemented and the technique must be maintained. For this purpose, training courses on neonatal resuscitation are held regularly throughout the country.

The goal of the NCPR training course is to "lead the trainee's 'awareness' through resuscitation scenario exercises (using a simulator) and conduct effective reflections." A workshop is organized. In classroom lectures, students will learn the surgical techniques and basic knowledge of neonatal resuscitation. In the technique practice and scenario practice, a simulator that simulates a newborn baby is used to learn techniques such as artificial respiration and chest compression, and practice along the scenario.

The simulators used in this scenario training range from high-performance simulators that can reproduce not only the body structure of newborns, but also various vitals, to simple newborn models that reproduce only the body structure of newborns. ing.

(high performance simulator)
One example of a high-performance simulator, Leardl's SimBaby (registered trademark), reproduces the conditions of a newborn baby, such as heartbeat sounds, breathing sounds, and skin color, and a controller allows the instructor to manipulate the conditions. The system also provides various training scenarios, which the trainee can simulate. These functions are controlled by a computer. Needless to say, it is desirable for effective training because more realistic vital (biological) information such as heartbeat sound and cyanosis can be presented and can be reproduced in many situations. However, due to the high price of the simulator itself, the need for regular maintenance, and the instructor's skill in operating the simulator in order to smoothly proceed with the scenario exercises, it is difficult to guide and maintain the simulator. As a result, it is not widely used.

(Neonatal resuscitation model)
Therefore, simulators used in actual NCPR training sites are mainly simple and inexpensive neonatal models that reproduce only a partial structure of a newborn. Since such a simple newborn model cannot reproduce the vitals, the lecturer communicates the vitals to the trainees in a way that is far from the actual one, such as tapping the desk to convey the heart rate or verbally conveying the heart rate. .

For this reason, it is difficult for trainees to obtain appropriate feedback during scenario exercises, and as a result, it is feared that independent behavior, which is emphasized in lectures, will be hindered, and the learning effect of lectures will be affected. . Therefore, in order to realize training with a sense of urgency that is closer to reality, sufficient motivation and efforts of both instructors and trainees are required. In addition, in this simple model, in order to realize a high-quality course in which "reproduction of the course scenario", "guidance of the students", and "evaluation of the course results" are carried out at the same time, it is necessary to rely on the skill of the lecturer. do not have.

In order to deal with such problems, Patent Document 2 discloses an auscultatory training system. In this auscultation training system, the simulated sound pickup part of the simulated stethoscope for simulating auscultation of a human body model formed by simulating the human body of a newborn baby can be attached to and detached from the rubber tube of a general stethoscope. is. When the sensor of the simulated sound pick-up unit determines that the simulated sound pick-up unit is in close contact with the epidermis of the human body model, the control computer transmits heart sound data to the simulated sound pick-up unit, and the simulated sound pick-up unit detects the corresponding heart sounds. Reproduce.

With such a configuration, in the auscultation training system for neonatal resuscitation training, the introduction cost can be reduced and at the same time, the training effect can be improved. However, there were still issues to be addressed in order to enhance the effectiveness of training based on “realism”.

As of September 2011, 118,805 people had attended the seminars through the NCPR dissemination project that began in 2008, a number that far exceeds the total number of laborers in Japan. On the other hand, early neonatal mortality during this period has not shown a clear reduction. On the other hand, the Japanese Society of Perinatal and Neonatal Medicine, which has jurisdiction over the NCPR project, said, ``Real and high-quality neonatal resuscitation education is available only at some specialized facilities with high-performance simulators, and there is a sufficient educational environment. and 'How can we ensure that laborers receive high-quality neonatal resuscitation training and are adequately educated for technical support?' has been viewed as a problem. On the other hand, in 2015, the Japan Resuscitation Council newly recommended “training using a realistic simulator”, and even in the guideline of Non-Patent Document 2, “continuous toning more than once a year” is proposed. It became a thing.

JP-A-2005-77521

JP 2017-153640 A

Unicef,Child Mortality,report2017 https://www.unicef.org/publications/files/Child－Mortality-Report_2017.pdf

JRC Resuscitation Guidelines 2015 Online version: http://www.NCPR.jp/guideline_update/pdf/jrc_guideline_2015.pdf

As mentioned above, in the neonatal field, there is a system that provides resuscitation simulation that satisfies both "low cost" and "realism" as effective training over a wide area. It is difficult to provide education widely and continuously, and in particular, the system to support the activities of instructors in the community has not been sufficiently developed.

At present, the format is that "a trainee visually judges the heart rate indicated by the lecturer while putting a stethoscope on a mannequin for resuscitation, rather than auditory information." The current situation is far from "Ning". In addition, in many cases, NCPR seminars were attended by a mixed group of participants from local delivery facilities, which made it difficult to develop non-technical skills among staff at the facility.

In addition, the lecturer observes the behavior of the trainee during the scenario practice, and if there is a problem with the procedure, he checks it and gives advice (debriefing) on the spot. There are so many tasks that need to be done at the same time, such as communicating information to Therefore, it is difficult for a lecturer to proceed smoothly unless he or she is an experienced lecturer.

Therefore, as a solution to the problems faced by the NCPR training, it is desirable to have a solution that allows the use of existing simple neonatal models. To provide an auscultation training system which can efficiently derive a "realization" and which can be taken "from anywhere" and "at any time".

According to one aspect of the present invention, there is provided an auscultation training system comprising a human body model formed to imitate a human body and a simulated auscultation module attachable to a student's stethoscope. The simulated auscultation module includes a storage part capable of accommodating and fixing the sound pickup part of the stethoscope, a sensor for detecting the degree of contact of the simulated auscultation module with the epidermis of the human body model, and a sensor according to the detection result of the sensor. a first reproducing unit for reproducing a sound corresponding to the body sound data and a first communication unit for receiving the body sound data when the body sound data is determined to be in a contact state; Further comprising a control device for controlling the operation of the system, the control device comprising: a second communication section for transmitting and receiving data to and from the first communication section; and body sounds including heart sounds emitted from the human body. and a body sound transmitting unit for transmitting the body sound data to the first reproducing unit via the second communication unit.

Preferably, the human body is a neonatal human body.

Preferably, the device further comprises a terminal device functioning as a simulated medical device for displaying biological information sent from the control device via the second communication unit, wherein the terminal device transmits and receives data to and from the control device. and a first display device for displaying biological information.

Preferably, the control device transmits data for displaying the arterial blood oxygen saturation value and the pulse rate value as biological information on the input means and the first display device via the second communication unit. The test information management means updates the value of the arterial blood oxygen saturation and the value of the pulse rate according to the input from the input means.

Preferably, the body sound data includes sound data corresponding to crying of a newborn baby, the test information management means updates the sound data corresponding to crying in response to an input from the input means, and the terminal device receives the second The second reproducing unit reproduces the sound data corresponding to the cry received via the third communication unit.

Preferably, the controller controls the input means, the second display device, the current step in the coping algorithm on the second display device and the current step in the coping algorithm according to a predetermined coping algorithm consisting of a plurality of steps. a test information management means for displaying an input screen of check items, the test information management means i) storing check information corresponding to the check items input from the input means in the storage means in association with steps; 2.) The check information stored in the storage means is sequentially reproduced on the first and second display devices in accordance with the instructions input from the input means and in accordance with the steps of the coping algorithm.

Preferably, the test information management means further includes imaging means for imaging a moving image of the trainee during the training period, and the test information managing means i) sets chapter marks for the moving image according to the input from the input means, and ii) inputs Images corresponding to the chapter marks in the moving image are sequentially reproduced on the first and second display devices together with the check information in accordance with the instructions input from the means and the steps of the coping algorithm.

INDUSTRIAL APPLICABILITY According to the present invention, the auscultation training system for neonatal resuscitation training can target trainees in a wide range of areas at a reduced introduction cost and at the same time can enhance the training effect.

1 is a conceptual diagram for explaining an example of an auscultation training system according to an embodiment; FIG. 1 is a schematic diagram for explaining the configuration of an auscultation training system 1000; FIG. 1 is an external view for explaining the configuration of stethoscope 100. FIG. 2 is an external view showing the external appearance of a simulated auscultation module 200 and a chestpiece 10. FIG. 3 is a functional block diagram for explaining configurations of a controller 2000 and a simulated medical device 3000; FIG. 2 is a functional block diagram for explaining the configuration of a simulated auscultation module 200; FIG. 2 is a block diagram showing the hardware configuration of a controller 2000; FIG. It is an algorithm diagram for demonstrating a "neonatal resuscitation method algorithm." 10 is a flow chart for explaining operations of the controller 2000, the simulated medical device 3000, and the simulated auscultation module 200 during training. 10 is a flow chart for explaining operations of the controller 2000, the simulated medical device 3000, and the simulated auscultation module 200 during training. FIG. 11 is a diagram showing an example of a display screen on a display device 2120; FIG. FIG. 2 is a conceptual diagram showing a comparison between a conventionally used simulator and the auscultation training system of the present embodiment;

An auscultation training system according to an embodiment of the present invention will be described below with reference to the drawings.
[Embodiment]
FIG. 1 is a conceptual diagram for explaining an example of an auscultation training system 1000 according to this embodiment.

As shown in FIG. 1, the auscultation training system of the present embodiment is an IoT-type stethoscope (hereinafter referred to as an IoT-type stethoscope) used by trainees to perform simulated auscultatory movements on a model doll imitating the human body of a newborn baby. , a “simulated auscultation module 200”), and a controller 2000 for controlling the auscultation training on the instructor side.

Although not particularly limited, for example, the controller 2000 on the lecturer side can be connected to the simulated auscultation module 200 and the simulated medical equipment 3000 on the trainee side through a communication line from a regional base hospital or the like at a local hospital or overseas hospital. Data is exchanged between

That is, the auscultation training system 1000 includes a simulated auscultatory module 200 which is attached to a stethoscope 100 used by a trainee and which incorporates a sensor and a communication function part described later, and a simulated vital sign (biological information) of a neonatal simulator. It comprises a simulated medical device 3000 for live presentation and a controller 2000 for the lecturer to control the vitals of the neonatal simulator, and all functions other than the simulated auscultation module 200 can be implemented as application software.

Students can use their own stethoscopes that they usually use. Also, the simulated medical device 3000 and the controller 2000 can use hardware having a function of executing application software, such as a personal computer, a tablet terminal, or a smart phone.

The biological information to be presented corresponds to the heart rate, oxygen saturation, crying, electrocardiogram, etc., which are the selection criteria for resuscitation actions by medical personnel shown in the guidelines of the NCPR course. The simulated auscultation module 200 attached to the chest bead of the stethoscope 100 applied to the patient's body incorporates a contact sensor 18 (not shown) for measuring the amount of reflected light emitted by itself. In the simulated auscultation module 200, when the bottom surface of the simulated auscultation module 200 is applied to the body surface of the newborn model, the contact sensor 18 measures a change in the amount of light to determine whether or not there is contact. Then, the simulated auscultation module 200 transmits and receives information to and from the near field wireless communication device 4000 (not shown) or the simulated medical device 3000 via a short-range wireless system, for example, a Bluetooth (registered trademark) wireless line, The proximity wireless communication device 4000 or the simulated medical device 3000 is connected to the controller 2000 via a communication line such as the Internet or a mobile phone line via a wireless LAN (Local Area Network) access point 4010 (not shown). Send and receive data with

The controller 2000 generates an instruction to display and reproduce heart sounds at the heart rate set by the instructor, and sends display instructions to the simulated medical device 3000 and heart sound data to the simulated auscultation module 200 via a communication line. . The simulated auscultation module 200 connected to the close proximity wireless communication device 4000 or the simulated medical device 3000 via Bluetooth (registered trademark) is provided with a small earphone as a speaker that reproduces heart sounds. is detected, the reproduced heart sounds are output to the stethoscope 100 fixed to the simulated auscultation module 200 .

Therefore, only when the trainee applies the simulated auscultation module 200 to the body surface of the newborn model doll, the trainee hears the heartbeat at the heart rate set by the lecturer, which is almost the same as the normal auscultatory operation with the stethoscope 100. By performing similar actions, auscultation can be simulated in the same way as "actual auscultation".

Of course, with this method, the heartbeat will be reproduced no matter where the stethoscope is placed. However, for the trainee, the stethoscope 100 can be placed anywhere near the heart of the newborn baby as long as it is just to examine the heart rate, and it is not necessary to place it at a different site during the training. No problem.

Rather than the unnaturalness of hearing the heartbeat in other places on the newborn model, the unnaturalness of giving the heartbeat verbally or by the sound of tapping the desk, as in conventional training, is more suitable for practical training. It hampers effectiveness and motivation. This will lead to the behavior of the trainee to listen to the heartbeat and judge it independently, and will bring about a completely different experience from the training using the conventional simple model.

Furthermore, except for the simulated auscultation module 200, both the controller 2000 and the simulated medical device 3000 can be used simply by installing application software on, for example, a smartphone or tablet terminal, so the cost of the instructor is extremely low.

In the following description, the simulated auscultation module 200 is assumed to transmit and receive information to and from the close proximity wireless communication device 4000 via a short distance wireless communication system, for example, a Bluetooth (registered trademark) wireless line. However, as described above, the simulated auscultation module 200 is configured to transmit and receive information to and from the controller 2000 via the simulated medical device 3000 using a proximity wireless system, for example, a Bluetooth (registered trademark) wireless line. good too.

FIG. 2 is a schematic diagram for explaining the configuration of the auscultation training system 1000. As shown in FIG.

As shown in FIG. 2, the auscultation training system 1000 of the present embodiment includes a stethoscope 100 and a stethoscope 100 used by a trainee to simulate auscultation of a model doll 2 imitating the human body of a newborn baby. A stethoscope simulation module 200; a controller 2000 that incorporates a body sound database as described later and generates and transmits appropriate body sounds to the auscultation simulation module 200; , and a simulated medical device 3000 for displaying pulse rate and oxygen saturation values, simulating a pulse oximeter.

Simulated medical device 3000 is connected to network 4100 via access point 4010 , and controller 2000 is connected to network 4100 via access point 4200 . Note that the video camera 80 may be a web camera connected to the network 4100 via the access point 4010 , or may be configured to connect to the network 4100 via the simulated medical device 3000 . In the latter case, the simulated medical device 3000 and the video camera 80 may be wired or wirelessly connected.

Note that the simulated medical device 3000 will be described below as an example using a so-called tablet terminal.

Here, "pulse oximeter" is a medical device that monitors pulse rate and percutaneous arterial blood oxygen saturation (SpO ₂ ) noninvasively by attaching a probe to a fingertip or ear. . "Percutaneous arterial blood oxygen saturation" is an index representing what percentage of oxygen is bound to hemoglobin. Thereby, the arterial blood oxygen partial pressure can be estimated. When the percutaneous arterial blood oxygen saturation is 90% or less, clinical symptoms such as dyspnea, increased or decreased blood pressure, increased pulse rate, and clouded consciousness generally appear.

It is also possible to configure the controller 2000 to transmit simulated voice data corresponding to the cry of a newborn baby to the simulated medical device 3000 and reproduce the simulated medical device 3000 through its speakers.

It is also possible to use a video camera 80 to pick up moving images including both the trainee and the newborn model doll, and reproduce the images on the instructor's display device in real time. In this case, for example, the moving image data can be stored in the storage device of the controller 2000 while appropriately adding marking data such as chapter marks according to the input from the lecturer. With such moving image data with chapter marks, it is possible for the lecturer and the instructor to share the playback of the moving image and review it, thereby enhancing the effectiveness of the training.

It should be noted that the storage of the moving image data with chapter marks is not necessarily limited to the storage device in the controller 2000, but may be the storage device on the side of the simulated medical device 3000, or the network. A storage device (not shown) in a server connected to 4100 may also be used. In addition to the chapter marks, "comments" selected by the lecturer from among those displayed according to the steps on the application side may be associated with the moving image and stored in such a storage device.

FIG. 3 is an external view for explaining the configuration of stethoscope 100. As shown in FIG.

A general stethoscope is roughly divided into a sound pickup part, a tube (for example, when rubber is used as a material, it is also called a rubber tube; hereinafter referred to as a "tube part"), and an ear tube. Note that the sound pickup unit is also called a chest piece.

As shown in FIG. 3, the stethoscope 100 is used by doctors and nurses during auscultation at actual medical sites. In the configuration of the stethoscope 100, the chestpiece 10, which is a sound pickup unit, is attached to the simulated auscultation module 200, as will be described later.

Therefore, as shown in FIG. 3, the stethoscope 100 includes a sound pickup unit 10 attached to a simulated auscultation module 200 having an auscultatory surface that abuts against the body surface of the model doll 2, and a sound pickup unit 10. A Y-shaped tube part 20 made of a soft material which is detachably connected and branched into two is attached to each end of the branched Y-shaped part of the Y-shaped tube part 20 and inserted into the ear hole of the trainee. possible ear canal sections 30a and 30b.

FIG. 4 is an external view showing the appearance of the simulated auscultation module 200 and the chestpiece 10. FIG.

The upper surface of the simulated auscultation module 200 has an accommodating portion 210 having a shape capable of accommodating and fixing the chestpiece 10 , and a speaker 16 is provided on the upper surface side within the accommodating portion 210 .

Further, the bottom surface of the simulated auscultation module 200 is provided with a contact sensor 18 as described later.

FIG. 5 is a functional block diagram for explaining the configuration of controller 2000 and simulated medical device 3000. As shown in FIG.

In FIG. 5, the functions executed by the controller 2000 or the simulated medical device 3000 are executed based on a program by a central processing unit (CPU) in the controller 2000 or the simulated medical device 3000, as will be described later. be.

Referring to FIG. 5, wireless interface 3090 in simulated medical device 3000 exchanges data with controller 2000 via access point 4010 by wireless communication.

A wireless communication method between the wireless interface 3090 and the access point 4010 is not particularly limited, but for example, a wireless LAN can be used. Via access point 4010 , network 4100 and access point 4200 , wireless interface 3090 performs communication for sending and receiving data between controller 2000 and simulated medical device 3000 .

Arithmetic device 3200 performs processing for displaying an image corresponding to a signal received via wireless interface 3090 on display device 3120 of simulated medical device 3000, and predetermined processing according to input from input device 3100. . Memory 3080 may store programs for functions to be performed by simulated medical device 3000, or temporary storage of data corresponding to signals received from controller 2000 during training, status flags of simulated medical device 3000, and the like. used.

If the simulated medical device 3000 is configured to store moving image data from the camera 80, the memory 3080 stores the data.

On the other hand, the wireless interface 2090 of the controller 2000 exchanges data wirelessly not only with the simulated medical device 3000 but also with the simulated auscultation module 200 via the access point 4200, the network 4100 and the access point 4010. .

From the auscultation simulation module 200, the detection result of the contact sensor 18 indicating whether or not the auscultation simulation module 200 is in close contact with the body surface of the model doll 2 is transmitted to the controller 2000 via the close proximity wireless communication device 4000. may be configured. In this case, when the contact sensor 2420 in the controller 2000 determines that the simulated auscultation module 200 is in close contact with the body surface of the model doll 2 based on the received signal from the contact sensor 18, The state is stored in the test history information DB 2450d.

On the other hand, controller 2000 transmits currently set body sound data to simulated auscultation module 200 via access point 4010 and proximity wireless communication device 4000 .

The currently set pulse rate and oxygen saturation values are transmitted from the controller 2000 to the simulated medical device 3000, and the simulated medical device 3000 displays the received data.

Body sound sending unit 2430 transmits currently set body sound data (for example, heart sound data corresponding to the set heart rate) to simulated auscultation module 200 via wireless interface 2090 at a predetermined timing. Send. Here, one of the predetermined timings may be, for example, when communication is established for the first time after the system is activated, or when the simulated auscultation module 200 is transmitted from the simulated auscultation module 200 to the body surface of the model doll 2. It may be the time when the detection result indicating that they are in close contact is transmitted to the controller 2000 for the first time.

Then, the body sound transmitting unit 2430 reads body sound data currently set by the body state information 2450b from the body sound database (hereinafter referred to as body sound DB) 2450a stored in the non-volatile storage device 2080, and performs simulated auscultation. Send to module 200 .

It is assumed that body sound DB 2450a stores, for example, data of heart sounds corresponding to symptoms, data of body sounds expected to be auscultated during resuscitation of newborns, and data of crying voices. The heart sound data may be stored in advance for each heart rate, or the sound data of a predetermined reference heart rate is stored, and the body sound sending unit 2430 designates the sound data of the reference heart rate. heart rate data.

Body sound DB 2450a is stored in a storage device in a server connected to network 4100 described above, and is transmitted from this server to simulated auscultation module 200 in accordance with an instruction from body sound transmission unit 2430. It may be a configuration.

The test algorithm information 2450c stored in the non-volatile storage device 2080 stores scenario information corresponding to a neonatal resuscitation algorithm, which will be described later. heart rate, percutaneous arterial oxygen saturation values, etc. are stored. The biological condition information 2450b stores initial values as well as current values.

Based on information stored as test algorithm information 2450c and biological condition information 2450b, the test information management unit 2460 provides information for displaying images on the display device 2120 of the controller 2000 and information for displaying images on the simulated medical device 3000. Generate information for Information about the image to be displayed is transmitted to the simulated medical device 3000 via the wireless interface 2090 .

If the simulated medical device 3000 is a tablet terminal or the like and has a built-in speaker, the body sound transmission unit 2430 outputs breathing sound data and crying data as part of the currently set body sound data. may be transmitted to the simulated medical device 3000 via the wireless interface 2090, and the simulated medical device 3000 may play back the breathing sounds and crying sounds of the newborn in a simulated manner. In this case, it is possible to change the breathing rate according to the input from the input device 2100 of the lecturer. The set respiration rate is stored in the biological condition information 2450b.

Based on the time information from the timer 2470, the test history recording unit 2470 associates the time information from the start of training with the test history information about the trainee during training, and stores it in a test history database (hereinafter referred to as test history DB) 2450d. , for each student. The test history information includes, for example, the progress history of training steps according to the time from the start of the test (including heart rate information and percutaneous arterial blood oxygen saturation history information. Preferably, respiratory rate history is included. ), and "check result information" by the lecturer, which will be described later, and furthermore, moving image data captured by the camera 80 or still images cut out from the moving image data according to chapter marks. may

After the training is completed, the test history reproduction unit 2490 reads the test history information about the designated trainee from the test history DB 2450d based on the designation from the input device 2100, and reproduces and displays it on the display device 2120. At this time, the test history information is also transmitted to the simulated medical device 3000 via the wireless interface 2090 and played back on the simulated medical device 3000, so that the lecturer and students can review while sharing information. can be configured. At this time, not only the test history information is transmitted and received, but also communication data for enabling mutual communication and lecturer's comment data to be shared are transmitted and received between the simulated medical device 3000 and the controller 2000. can be configured.

As described above, the moving image data with chapter marks is not stored in the controller 2000, but in the simulated medical device 3000 side storage, or in the server connected to the network 4100 (not shown). ), the information stored in such a storage device can be configured to be reproduced in simulated medical device 3000 and controller 2000 according to instructions from test history reproduction unit 2490. .

FIG. 6 is a functional block diagram for explaining the configuration of the simulated auscultation module 200. As shown in FIG.

The simulated auscultation module 200 includes a receptacle 210 shaped to receive and secure the chestpiece 10 .

A contact sensor 18 is provided near the center of the surface (bottom surface) of the simulated auscultation module 200 on the side opposite to the accommodating portion 210 . Since the simulated auscultation module 200 is made of a non-light-transmitting material, when the surface of the model doll 2 comes into close contact with the body surface of the model doll 2, the contact sensor 18 receives the light emitted from the light emitting element of the contact sensor 18. The amount of light incident on the sensor decreases below a predetermined value. Therefore, the degree of close contact of the simulated auscultation module 200 can be determined based on the value detected by the contact sensor 18 .

Note that the sensor for detecting the degree of close contact of the simulated auscultation module 200 is not limited to such a contact sensor, and other pressure sensors or the like may be used.

The simulated auscultation module 200 contains a wireless communication unit 12 for wirelessly communicating with the close proximity wireless communication device 4000 , body sound data received by the wireless communication unit 12 , and body sound data received by the wireless communication unit 12 . During the period in which this is detected, the signal from the audio reproducing unit 14 for converting into an audio signal and reproducing, the small speaker 16 for outputting the output of the audio reproducing unit 14 as sound, and the contact sensor 18 , a sense data transmission unit 21 for converting into a data format to be transmitted to the controller 2000 via the wireless communication unit 12, and a battery unit 20 for supplying power to each unit. The small speaker 16 outputs reproduced sound to the sound pickup side of the chestpiece 10 housed in the housing portion 210 .

(Hardware configuration)
FIG. 7 is a block diagram showing the hardware configuration of the controller 2000. As shown in FIG.

Here, it is assumed that the controller 2000 is a personal computer.

7, a computer main body 2010 of the controller 2000 includes a memory drive 2020, a disk drive 2030, a CPU 2040, a bus 2050 connected to the disk drive 2030 and the memory drive 2020, and a boot-up program and other programs. ROM 2060, RAM 2070 for temporarily storing application program instructions and providing temporary storage space, and a non-volatile storage device (for example, SSD: Solid State Memory) for storing application programs, system programs, and data. Drive) 2080, and a wireless communication interface 2090 for communicating with an external device via a network or the like.

Each function of FIG. 5 described above is realized by the arithmetic processing executed by the CPU 2040 based on the program.

A program that causes the controller 2000 to execute functions such as information processing in the above-described embodiments is stored in the CD-ROM 2200 or the memory medium 2210, is inserted into the disk drive 2030 or the memory drive 2020, and is further stored in the non-volatile storage device. 2080 may be transferred. Alternatively, the program may be transmitted to computer main body 2010 via a network (not shown) and stored in nonvolatile storage device 2080 . Programs are loaded into RAM 2070 during execution.

The controller 2000 further includes a keyboard 2100a and a mouse 2100b as input devices 2100, and a display 2120 as an output device.

The program for realizing the functions described above does not necessarily include an operating system (OS) that causes the computer main body 2010 to execute functions such as an information processing device. A program need only contain those parts of instructions that call the appropriate functions (modules) in a controlled manner to produce the desired result. How the controller 2000 operates is well known, and detailed description is omitted.

Also, the CPU 2040 may have a single-core configuration or a so-called multi-core configuration. The number of computers that execute the above programs may be singular or plural. That is, centralized processing may be performed, or distributed processing may be performed.

Note that the controller 2000 may also be a so-called tablet terminal or smart phone. In that case, input device 2100 may be a touch-sensitive display integrated into display 2120 . Also, disk drives are omitted.

Furthermore, the hardware configuration of the simulated medical device 3000 is basically the same as that of the controller 2000, and as described above, the simulated medical device 3000 may also be a tablet terminal.
[Neonatal Resuscitation Algorithm]
FIG. 8 is an algorithm diagram for explaining the "neonatal resuscitation algorithm" disclosed in Non-Patent Document 2. As shown in FIG.

This "neonatal resuscitation method algorithm" is detailed in Non-Patent Document 2, so the outline thereof will be described below.

First, this "neonatal resuscitation algorithm" targets resuscitation of infants (less than 1 month corrected age) hospitalized in the delivery room, neonatal unit, and neonatal intensive care unit (NICU). .

Infant cardiopulmonary resuscitation may be applied for cardiac arrest in infants (neonatals) less than 28 days old in emergency resuscitation in hospital wards and outpatients, including prehospital care, pediatric wards and pediatric intensive care units.

(Flow of resuscitation)
Judgment as to whether or not resuscitation is necessary for a newborn immediately after birth is made based on three items: i) premature infant, ii) weak respiration/weak crying, and iii) decreased muscle tone (S100).

Routine care is performed by the mother for the child who does not accept all of them (S110).

Routine care includes warmth, airway opening, and skin drying, followed by further evaluation of the infant.

(Resuscitation step)
On the other hand, if at least one of the three items applies in S100, the resuscitation step is entered.

That is, if it is determined in S100 that resuscitation is necessary, the infant in need of resuscitation evaluates whether the following measures are necessary in order.
(1) Initial treatment for resuscitation (wiping off amniotic fluid from the skin, keeping warm, positioning the subject to secure the airway, sucking the airway if necessary, and stimulating the skin to induce respiration) (S120)
(2) Artificial respiration and respiratory assistance (S132)
(3) Chest compression (S136)
(4) Drug administration or fluid replacement (S140)
Whether to proceed to the next step is first determined by simultaneously evaluating two vital signs (heart rate and respiration). Complete the previous step before proceeding to the next step. Each step allows approximately 30 seconds to perform the treatment to reevaluate the effectiveness of the treatment and decide whether to proceed.

1) Initial treatment for resuscitation and its evaluation (S120-S130)
The initial treatment for resuscitation (S120) consists of wiping amniotic fluid from the skin, keeping warm, positioning to secure the airway, aspirating the airway if necessary, and stimulating the skin to induce respiration.

Approximately 330 seconds after birth, the effect of resuscitation is evaluated by heart rate and respiration (S130). Heart rate is more reliably confirmed by auscultation than by palpation of umbilical cord beats. Also, consider placement of a pulse oximeter to assess heart rate and oxygenation in infants foreseeing need for resuscitation.

If there is spontaneous respiration and the heart rate is 100/min or higher, the presence or absence of forced respiration and central cyanosis is evaluated (S150). Consider installing an ECG (electrocardiogram) monitor as needed for faster and more accurate heart rate measurement, especially for infants receiving mechanical ventilation.

When forced respiration and central cyanosis are observed, a pulse oximeter is attached and continuous positive airway pressure (CPAP) using air or free-flow oxygen administration is started (S152).

The SpO ₂ value corresponds to the time after birth, and a rough guideline is 60% at 1 _minute after birth, 70% at 3 minutes after birth, 80% at 5 minutes after birth, and 90% at 10 minutes after birth. You don't necessarily have to wait for results.

After approximately 30 seconds, the heart rate and respiration are evaluated (S154), and artificial respiration is started when improvement in forced respiration and central cyanosis is not observed despite the heart rate being 100/min or more (S156). .

The number of artificial respirations should be 40-60 times/min. If only one of them persists (“None” in S154), select an appropriate response while searching for the cause (congenital heart disease, transient tachypnea of the newborn, respiratory distress syndrome, etc.) (S158, S160). ).

On the other hand, if there is no spontaneous respiration or the heart rate is less than 100/min in the evaluation after the initial treatment (S130), artificial respiration is started and a pulse oximeter is worn (S132). Treat gasping in the same way as apnea. The number of artificial respirations should be 40-60 times/min.

Approximately 30 seconds after starting effective artificial respiration, heart rate and respiration are evaluated (S134), and if the heart rate is less than 60-100/min, appropriate ventilation should be confirmed, and tracheal intubation should be considered.

If the heart rate is less than 60/min even after effective artificial respiration for 30 seconds or longer (S134), chest compression and artificial respiration are started in conjunction (S136). However, when performing artificial respiration, if adequate ventilation is not possible, do not proceed to chest compressions and concentrate on securing and implementing ventilation. The ratio of chest compression and artificial respiration should be 3:1, and one cycle should be 2 seconds.

(drug administration or fluid replacement)
If the heart rate is less than 60/min despite effective artificial respiration and chest compression (S138), administration of adrenaline is considered (S140). However, the evidence for adrenaline is scarce, and it is not a treatment that involves interrupting artificial respiration and chest compressions. Consider administering them while giving priority to artificial respiration and chest compressions. For adrenaline, intravenous administration of 0.01 to 0.03 mg/kg is the first choice.

If blood loss in the infant is suspected, 10 ml/kg of a circulating blood expander (such as normal saline) is given IV over 5 to 10 minutes. Continue chest compressions and artificial respirations in conjunction with drug administration.

As will be described below, the auscultation training system of the present embodiment provides training for a student to appropriately perform such procedures of the "neonatal resuscitation algorithm."

9 and 10 are flow charts for explaining the operation of the controller 2000, the simulated medical device 3000, and the simulated auscultation module 200 during training.

Referring to FIG. 9, when the process is started, first, the lecturer inputs the training date and time and the name of the lecturer from the controller 2000 (S200), and the trainee inputs the name of the trainee from the simulated medical device 3000. etc. to exchange information (S300).

The input of the name of the lecturer, the input of the name of the trainee, etc. may be input of an ID, etc., as long as it is information that can identify these individuals. The input training date and time, the input of the instructor name, and the information of the trainee name are stored in the test history DB 2450d.

Subsequently, in response to a start input by the instructor, the controller 2000 initializes the screen display and variables, and starts clocking with the timer 2480 (S202).

Next, the test information management unit 2460 displays the neonatal resuscitation algorithm diagram shown in FIG. S204). Furthermore, the information of the algorithm diagram and the diagram showing the state of the current step is transmitted to the simulated medical device 3000, and the simulated medical device 3000 displays the corresponding information (S302).

The test information management unit 2460 reads the current heart rate and the percutaneous arterial blood oxygen saturation value from the pulse oximeter from the biological condition information 2450b, and displays the corresponding values on the display device 2120 (S206).

The test information management unit 2460 also causes the display device 3120 to display the current heart rate and percutaneous arterial blood oxygen saturation values.

In the initial state, the pulse oximeter is not attached, so at this point, a display indicating that the user is not attached is displayed instead of displaying a specific value.

Further, in the controller 2000, the body sound sending unit 2430 reads the current heart rate from the body condition information 2450b, generates corresponding heart sound data, and sends it to the simulated auscultation module 200 (S206). The simulated auscultation module 200 receives the heart sound data, and the voice reproduction unit 14 stores the voice data (S402).

In the simulated auscultation module 200, when the heart sound data is received, the audio reproduction unit 14 performs contact determination based on the signal from the contact sensor 18 (S404). The heart sound data obtained is reproduced (S410), and the process returns to S404 for contact determination. On the other hand, if the audio reproduction unit 14 determines that the contact state is not established (N in S408), the audio reproduction unit 14 waits without reproducing audio until it is determined that the contact state is established. However, even in the standby state, if it is determined that the heart sound data has been received (Y in S406), the process returns to step S402.

Subsequently, the test information management section 2460 displays the check items in the current step on the display device 2120 (S210).

FIG. 11 is a diagram showing an example of a display screen on the display device 2120 in such a state.

The "neonatal resuscitation algorithm" shown in FIG. 8 is displayed on the left side of FIG. 11, and the current step is displayed by a bold frame and color changes. On the right side of FIG. 11, check items are displayed, as well as the current heart rate and percutaneous arterial blood oxygen saturation values, the elapsed time since the current step, whether or not breathing sounds are being played, etc. are displayed. be done.

The heart rate and percutaneous arterial oxygen saturation values can be changed by the instructor by moving the display bar.

As for the check items, the result of checking the displayed contents by the lecturer is input. An input as to whether to proceed to the next step in the flow of FIG. 8 is also displayed. It should be noted that it may be possible to return the processing from the current step to the previous step by inputting whether to return to the previous step in the flow of FIG.

Returning to FIG. 9, the test information management unit 2460 determines whether the instructor has input a change in the values of heart rate and percutaneous arterial blood oxygen saturation, and if the change has been input (Y in S212). , the biological condition information 2450b is updated and recorded, and the corresponding value is displayed on the display device 2120 (S214). Also, based on the signal from the test information management unit 2460, the display unit 3120 of the simulated medical device 3000 displays the updated values of heart rate and percutaneous arterial blood oxygen saturation (S316). Body sound sending unit 2430 reads out the updated heart rate from biological state information 2450b, generates corresponding heart sound data, and sends it to simulated auscultation module 200 (S214).

When the simulated auscultation module 200 determines in S406 that heart sound data is received via the network 4100, it receives and stores the heart sound data (S402).

Next, the test information management unit 2460 determines whether or not the instructor has input any check items (S218), and if there is any input, changes the display contents to indicate that the display device 2120 has been checked. (S220), the test history recording unit 2470 stores the current step, the current time, and the contents of the check items in the test history DB 2450d (S222).

Next, referring to FIG. 10, test information management unit 2460 determines whether or not the lecturer has input an instruction to interrupt (Y in S224). The time is recorded in the test history DB 2450d (S226). Furthermore, the test information management unit 2460 waits until there is an input to cancel the interruption (N in S228), and if the interruption is canceled (Y in S228), the test history recording unit 2470 saves the cancellation time to the test history DB 2450d. (S230).

Next, the test information management section 2460 determines whether the instructor has input a transition to the next step (S232). The history recording unit 2470 records the time when the step was finished in the test history DB 2450d (S234), and returns the process to step S204.

On the other hand, the test information management unit 2460 ends the process if the instructor instructs to end (Y in S240), and returns the process to step S206 if the end is not instructed (N in S240). .

As described above, according to the auscultation training system of the present embodiment, by attaching the simulated auscultation module 200 to an ordinary stethoscope, the auscultatory motion in the neonatal resuscitation procedure and the flow of processing necessary for resuscitation can be performed. is performed on the model doll 2, the trainee can experience the same tension as the actual treatment.

In addition, since the instructor can appropriately change the condition of the newborn in a simulated manner during the training, the training can be performed in a condition that is even closer to the actual treatment.

In addition, since the history data during training is saved one by one, after the training is completed, the instructor and the trainee can share the treatment during the training with the moving image or the still image extracted from the moving image. It is easy to look back while watching, and it is possible to enhance the training effect.

In addition, since the parts constituting the training system are composed of simple and low-cost parts and materials, if specific trainees are proficient to some extent, it is easy for trainees to conduct auscultation training together.

The effects of the auscultatory training system according to the present embodiment will be additionally described below.

FIG. 12 is a conceptual diagram showing a comparison between the conventionally used simulator as described above and the auscultation training system of the present embodiment.

In FIG. 12, it is indicated by axes of introduction and training effect. There is a trade-off relationship between the training effect and the ease of introduction, and the auscultation training system of the present embodiment is easy to introduce and has a high training effect.

Here, in order to enhance the training effect, it is considered that it can be achieved simply by making the simulator more realistic.

In neonatal resuscitation training, the following vital reproduction techniques are conceivable in order to make a simulator that simply imitates only the shape of a newborn give a response similar to that of a real newborn.

a) Heart rate can be measured by auscultation b) Arterial blood oxygen saturation (SpO2) can be displayed and confirmed by a pulse oximeter c) The state of a newborn baby varies depending on the treatment of the trainee Therefore, the auscultation training system of the present embodiment Now, the content that needs to be reproduced can be realized in a simulated manner.

In addition, in the auscultation training system of the present embodiment, as described above, in order to enhance the training effect, it is necessary for the trainee to be able to perform auscultation in the same way as in a clinical setting, even if the training is conducted at a location away from the instructor. There is In addition, the student performs a treatment according to the heart rate, and the heart rate changes due to the treatment. Therefore, the instructor changes the heart rate while watching the student's treatment.

In order to solve these problems, the auscultation training system of this embodiment achieves the following functions.

Function 1) A simulator that allows the trainee to independently perform auscultation Function 2) A controller that enables the instructor to freely control the heart rate according to the treatment of the trainee Function 3) Even if the instructor and the trainee are in separate locations, a sense of realism can be felt. Communication environment for training (student side simulator)
As mentioned above, the trainee simulator consists of a neonatal resuscitation model and a simulated auscultation module with built-in sensors. In actual diagnosis, correct auscultation cannot be performed unless the bottom surface of the simulated auscultation module attached to the chestpiece portion is brought into close contact with the chest of the newborn.

When the detected value of the contact sensor falls below a certain value, it is determined that the students are in close contact, and by playing the heartbeat sound set by the lecturer from the speaker incorporated in the simulated auscultation module, a simulator is realized in which the trainee can perform auscultation. be done.
(Instructor side controller)
On the other hand, on the controller screen of the controller 2000, there are a flow chart representing the algorithm for neonatal resuscitation created by the Japan Resuscitation Council, a checklist for each item in the flow chart provided by the Neonatal Resuscitation Promotion Project, and a heart rate selection bar. , arterial oxygen saturation selection bar, and elapsed time are displayed.

In scenario-based training, the scenario operates according to a flow chart, so the instructor can check the progress of the training on the flow chart. In addition, the checklists are switched and displayed according to each treatment item so that the trainee's behavior for the ongoing treatment can be immediately evaluated. Also, according to the scenario, an input cover is prepared to operate the heart rate and arterial blood oxygen saturation that can be heard from the chestpiece so that the instructor can change the heart rate and arterial blood oxygen saturation at any time while watching the student's treatment. there is

In addition, the neonatal resuscitation algorithm has an approximate time to perform the procedure, and the elapsed training time is also displayed so that the instructor can check whether the student is performing the procedure on time.

In addition, students are encouraged to review their simulation results after completing the training.

Therefore, in order to provide materials for trainees to reflect on the simulation, it is possible for the instructor to present the results of a checklist that checks the trainee's behavior during the training process after the training is completed. For example, it is possible to indicate whether or not all checklists for each item have been checked by ◯×, or to indicate the check status of all checklists in a list form.

Furthermore, since the instructor asks questions to the trainees during the training using the scenario in the workshop, it is also equipped with a function to temporarily stop and restart the training and display the elapsed time accordingly.

In addition, as an effective feedback to the trainee, it is also possible to display the flow of the scenario planned by the lecturer and the result of the action actually taken by the trainee as a flow in the flow chart presented at the time of review. good.

Furthermore, since it is possible to determine how the newborn is breathing from the voice of the newborn, the voice of the newborn may be reproduced according to the scenario.

Also, in the above description, the model doll is assumed to be a newborn baby. Auscultation training system 1000 of the present embodiment can also be used for training in coping with a prescribed coping algorithm for symptoms of a prescribed disease.

The embodiments disclosed this time are examples of configurations for specifically implementing the present invention, and do not limit the technical scope of the present invention. The technical scope of the present invention is indicated by the scope of claims rather than the description of the embodiments, and includes changes within the scope of the claims and their equivalent meanings. is intended.

2 model doll, 10 simulated sound pickup device, 11 head unit, 12 wireless communication unit, 14 voice reproduction unit, 16 small speaker, 18 illuminance sensor, 19 marker reading sensor, 20 pipe unit, 21 sense data transmission unit, 22 contact unit , 24 coupling member 30a, 30b ear canal part 32 connection tube 100 stethoscope 200 simulated auscultation module 1000 auscultation training system 2000 controller 2080 nonvolatile storage device 2090 wireless interface 2100 input device 2120 display device , 2420 Adhesion determining unit 2430 Body sound sending unit 2430 Body sound sending unit 2450a Body sound DB 2450b Biological state information 2450c Test algorithm information 2450d Test history DB 2460 Test information management unit 2470 Test history recording unit , 2480 timer, 3120 display.

Claims (7)

A stethoscope training system comprising:
a human body model formed in imitation of the human body;
Equipped with a simulated stethoscope module that can be attached to the stethoscope of the trainee,
The simulated auscultation module includes:
a storage section capable of housing and fixing the sound pickup section of the stethoscope;
a sensor for detecting the degree of contact of the simulated auscultation module with the epidermis of the human body model;
a first reproducing unit for reproducing a sound corresponding to the body sound data when it is determined that the contact state is in accordance with the detection result of the sensor;
a first communication unit for receiving the body sound data;
further comprising a controller for controlling operation of the auscultation training system;
The control device is
a second communication unit for transmitting and receiving data to and from the first communication unit;
storage means for storing body sound data corresponding to body sounds including heart sounds emitted from the human body;
an auscultation training system, comprising: a body sound transmitting unit that transmits the body sound data to the first reproducing unit via the second communication unit. 2. The auscultation training system of claim 1, wherein the human body is a neonatal human body. further comprising a terminal device functioning as a simulated medical device for displaying biological information sent from the control device via the second communication unit;
The terminal device
a third communication unit for transmitting and receiving data to and from the control device;
3. The auscultation training system according to claim 1, further comprising a first display device for displaying said biological information. The control device is
an input means;
Data for displaying a value of arterial blood oxygen saturation and a value of pulse rate as the biological information on the first display device to the third communication unit via the second communication unit further comprising a test information management means for transmitting;
4. The auscultation training system according to claim 3, wherein said test information management means updates said arterial blood oxygen saturation value and said pulse rate value in accordance with the input from said input means. the body sound data includes sound data corresponding to crying of a newborn;
The test information management means updates the sound data corresponding to the cry according to the input from the input means,
The terminal device
5. The auscultation training system according to claim 4, further comprising a second reproduction section, wherein the second reproduction section reproduces sound data corresponding to the cry received via the third communication section. The control device is
an input means;
a second display device;
a test information management means for displaying, on the second display device, an input screen for a current step in the coping algorithm and a check item corresponding to the current step, according to a predetermined coping algorithm consisting of a plurality of steps;
The test information management means
i) storing check information corresponding to the check item input from the input means in the storage means in association with the step;
ii) causing said first and second display devices to sequentially reproduce said check information stored in said storage means in accordance with steps of said coping algorithm in response to instructions input from said input means; 3. The auscultatory training system of claim 3. Further comprising an imaging means for capturing a moving image of the trainee during the training period,
The test information management means
i) setting a chapter mark for the moving image according to the input from the input means;
ii) displaying an image corresponding to the chapter mark in the moving image together with the check information on the first and second display devices in accordance with the instruction input from the input means and in accordance with the step of the coping algorithm; 7. The auscultation training system of claim 6, wherein the auscultation training system sequentially reproduces the

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