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In previous "Diabetes Information Technology & WebWatch" columns, various user experiences with an interactive educational virtual diabetes patient simulator, called AIDA, have been documented. The simulator is available free of charge from www.2aida.org on the Web. In the 5+ years since the program was first made available on the Internet, over 125,000 people have visited the AIDA Website and over 27,000 copies of the program have been downloaded, gratis. User comments that have been received about the program have highlighted some of the many and varied ways in which a range of people have been applying the diabetes simulations in their own particular situations and practices. Inevitably, up to now, a great deal of attention has focused on use of the program by individuals with diabetes and their relatives, as well as by health-care professionals such as diabetologists/endocrinologists, diabetes educators, and primary care physicians (general practitioners [GPs]). However, an important group of health-carers involved in the provision of day-to-day care for many people with diabetes are nurses. The current "Diabetes Information Technology & WebWatch" column overviews a workshop held in June 2001 in Italy to gain experience with application of the AIDA diabetes simulation approach as a teaching tool for student nurses. Feedback obtained from participants attending the workshop was generally very positive, with the student nurses reporting the simulation approach to be both of interest and of use. Further workshops involving other health-care students and professionals-in particular, medical students and qualified nurses-are planned.
Diabetes Technol Ther 2001
PMID:Use of the AIDA diabetes simulation software--www.2aida.org--as an interactive educational tool for teaching student nurses. 1191 Nov 81

This "Diabetes Information Technology & WebWatch" column continues the diabetes simulation theme from previous issues and overviews various user experience with the AIDA v4 interactive educational freeware diabetes simulator. AIDA is a diabetes computer program that permits the interactive simulation of plasma insulin and blood glucose (BG) profiles for educational, demonstration, and self-learning purposes. It has been made freely available, without charge, via the Web as a noncommercial contribution to continuing diabetes education. Since its Internet launch in 1996, over 145,000 visits have been logged at the AIDA Website--www.2aida.org--and over 29,000 copies of the program have been downloaded, free of charge. While these statistics may appear impressive, they do not tell the personal story of how people have been making use of the software, and what they actually think about the program. In this respect, this column documents some of the independent user comments about AIDA sent in spontaneously via electronic mail (email) by patients with diabetes and their relatives, as well as by health-care professionals. Comments posted to diabetes newsgroups and diabetes email lists, as well as a selection of those which have been found at other, linked, diabetes Websites are also highlighted.
Diabetes Technol Ther 2002
PMID:Further user comments regarding usage of an interactive educational diabetes simulator (AIDA). 1201 14

AIDA is a novel diabetes-computing program freely available from www.2aida.org on the Web. The software is intended to serve as an educational support tool and can be used by anyone-patient with diabetes, relative of patient, health-care professional, or student-who has a minimal knowledge of the pathophysiology of diabetes. However, to obtain maximum benefit from the program, a teacher or demonstrator may be helpful. How much (or little) experience should the potential teacher have prior to giving formal lessons with the program? There is no hard or fast "rigid" answer to this. However, one of the aims of this article is to try and encourage people to consider these issues. In this respect it is important to make clear that health-carers cannot just download the program and start teaching with it the next day (or week) if they want their patients to get the most out of lessons with the program. As with many teaching interventions, the rewards of education-"what one gets out of it"-are in part dependent on the effort that one is willing to put in. Therefore teachers have to invest some time and effort into finding out how they can best work with the program to teach their patients in their particular local hospital/clinic setting. A further purpose of this article, and the one that follows in a future issue, is to generate some guidelines and provide some minimum recommendations for small group teaching sessions using AIDA. Previous experience of the authors has revealed a number of ways to improve the outcome of lessons that make use of the software. Among the most important points seem to be the preparation of the teacher, consideration of how to impart preliminary information to help patients understand the pathophysiology of diabetes, the optimum selection of topics to be covered, the arrangement of the lessons, how to involve each of the participants, and how to deal with questions. Other important topics include how to spot and deal with some of the difficulties that may be encountered by participants who apparently seem disinterested, obtaining feedback from the lessons, and practical ideas on how to lead a class.
Diabetes Technol Ther 2002
PMID:Using the AIDA--www.2aida.org--diabetes simulator. Part 1: recommended guidelines for health-carers planning to teach with the software. 1216 78

The purpose of this paper is to report an audit of 2437 downloads of the AIDA interactive educational diabetes simulator. AIDA is a diabetes computer program that permits the interactive simulation of plasma insulin and blood glucose profiles for educational, demonstration, and self-learning purposes. It has been made freely available, without charge, on the Internet as a noncommercial contribution to continuing diabetes education. Since its launch in 1996 over 200000 visits have been logged at the AIDA Website - www.2aida.org - and over 37000 copies of the AIDA program have been downloaded free-of-charge. This report documents an audit of downloaders of the software, with the intended goals of the study being to demonstrate the use of the Internet for auditing and surveying diabetes software users and to confirm the proportion of patients with diabetes and their relatives who are actually making use of the AIDA v4.3 program. The Internet-based survey methodology was confirmed to be robust and reliable. Over a 7(1/2)-month period (from mid-July 2000 to early March 2001) 2437 responses were received. During the corresponding period 4100 actual downloads of the software were independently logged via the same route at the AIDA Website - giving a response rate to this audit of 59.4%. Responses were received from participants in 61 countries - although over half of these (n = 1533; 62.9%) originated from the United States and United Kingdom. Of these responses 1,361 (55.8%) were received from patients with diabetes and 303 (12.4%) from relatives of patients, with fewer responses from doctors, diabetes educators, students, nurses, pharmacists, and other end users. This study has confirmed the feasibility of using the Internet to survey, at no real cost, a large number of medical software downloaders/users. In addition, it has yielded up-to-date and interesting data about who are the main downloaders of the AIDA program.
Diabetes Technol Ther 2002
PMID:Who is downloading the freeware AIDA v43 interactive educational diabetes simulator? An audit of 2437 downloads. 1239 41

The purpose of this article is to document some recommended training requirements for health-carers planning to teach using the AIDA interactive educational diabetes simulator. AIDA is a diabetes computer program that permits the interactive simulation of plasma insulin and blood glucose profiles for teaching, demonstration, and self-learning purposes. It has been made freely available, without charge, on the Internet as a noncommercial contribution to continuing diabetes education. Since its launch in 1996 over 200,000 visits have been logged at the AIDA Website--www.2aida.org--and over 40,000 copies of the AIDA program have been downloaded free-of-charge. This report describes various training requirements that are recommended for health-care professionals who are interested in teaching with the software. Intended goals of this article are to answer possible questions from teachers using the program, highlight some minimum recommended training requirements for the software, suggest some "hints and tips" for teaching ideas, explain the importance of performing more studies/trials with the program, overview randomised controlled trial usage of the software, and highlight the importance of obtaining feedback from lesson participants. The recommendations seem to be straightforward and should help in formalising training with the program, as well as in the development of a network of teachers "accredited" to give lessons using the software. This report, together with the previous article (Part 1, Diabetes Technol Ther 2002;4:401-414), highlights the utility of providing guidelines and suggesting recommended training requirements for health-carers planning to make use of educational medical/diabetes software.
Diabetes Technol Ther 2002
PMID:Using the AIDA--www.2aida.org--diabetes simulator. Part 2: recommended training requirements for health-carers planning to teach with the software. 1245 Apr 52

The purpose of this paper is to report a pilot survey about why people are downloading the AIDA interactive educational diabetes simulator. AIDA is a diabetes computer program that permits the interactive simulation of plasma insulin and blood glucose profiles for teaching, demonstration, and self-learning purposes. It has been made freely available, without charge, on the Internet as a noncommercial contribution to continuing diabetes education. Since its launch in 1996 well over 200,000 visits have been logged at the main AIDA Website--www.2aida.org--and over 40,000 copies of the AIDA program have been downloaded free-of-charge. This article documents a pilot survey of comments left by Website visitors while they were downloading the AIDA software, before they had a chance to actually use the program. The overall paradigm adopted for this study has endeavored to establish why people are resorting to the Internet to obtain diabetes information. Specific intended goals of the study were: (1) to demonstrate ongoing use of the World Wide Web for surveying diabetes software users by obtaining their free-text comments; (2) to identify what sort of things people were planning to do with the AIDA software simulator; and (3) to more generally gain some insight into why people are turning to the Web for healthcare-related information. The Internet-based survey methodology was found to be robust and reliable. Over an 8-month period (from February 2, 2001 to October 1, 2001) 642 responses were received. During the corresponding period 2,248 actual visits were made to the Website survey page--giving a response rate to this pilot study of 28.6%. Responses were received from participants in over 56 countries--although over half of these (n = 343; 53.4%) originated from the United States and United Kingdom. Two hundred forty-four responses (38.0%) were received from patients with diabetes, and 73 (11.4%) from relatives of patients, with fewer responses from doctors, students, diabetes educators, nurses, pharmacists, and other end users. This pilot survey has confirmed the feasibility of using the Internet to obtain free-text comments, at no real cost, from a large number of medical software downloaders/users. The survey has also offered a valuable insight into why members of the public are turning to the Internet for medical information. Furthermore it has provided useful information about why people are actually downloading the AIDA interactive educational "virtual diabetes patient" simulator.
Diabetes Technol Ther 2002
PMID:Why are people downloading the freeware AIDA diabetes computing software program: a pilot study. 1268 3

AIDA is a diabetes-computing program freely available from www.2aida.org on the Web. The software is intended to serve as an educational support tool, and can be used by anyone who has an interest in diabetes, whether they be patients, relatives, health-care professionals, or students. In previous "Diabetes Information Technology & WebWatch" columns various indicators of usage of the AIDA program have been reviewed, and various comments from users of the software have been documented. One aspect of AIDA, though, that has been of considerable interest has been to investigate its Web-based distribution as a wider paradigm for more general medically related usage of the Internet. In this respect we have been keen to understand in general terms: (1) why people are turning to the Web for health-care/diabetes information; (2) more specifically, what sort of people are making use of the AIDA software; and (3) what benefits they feel might accrue from using the program. To answer these types of questions we have been conducting a series of audits/surveys via the AIDA Website, and via the software program itself, to learn as much as possible about who the AIDA end users really are. The rationale for this work is that, in this way, it should be possible to improve the program as well as tailor future versions of the software to the interests and needs of its users. However, a recurring observation is that data collection is easiest if it is as unobtrusive and innocuous as possible. One aspect of learning as much as possible about diabetes Website visitors and users may be to apply techniques that do not necessitate any visitor or user interaction. There are various programs that can monitor what pages visitors are viewing at a site. As these programs do not require visitors to do anything special, over time some interesting insights into Website usage may be obtained. For the current study we have reviewed anonymous logstats data, which are automatically collected at many Websites, to try and establish a baseline level of usage for the AIDA site. For the initial pilot study the analysis was performed from October 1, 2000 to November 1, 2001. The study has yielded an interesting insight into how the AIDA Website is being used. The results also confirm those of previous audits based on different self-reported methodologies, confirming, amongst other things, what countries people are visiting from and what operating systems/computers they are using. These analyses have been informative and useful. Given this, it is proposed to repeat the current pilot survey approach on a routine basis, in the future, as a way of monitoring on-going usage of the AIDA Website.
Diabetes Technol Ther 2003
PMID:Usage of the www.2aida.org AIDA diabetes software Website: a pilot study. 1272 10

The purpose of this two-part review is to overview research use of the AIDA diabetes software simulator. AIDA is a diabetes computer program that permits the interactive simulation of plasma insulin and blood glucose profiles for teaching, demonstration, and self-learning purposes. It has been made freely available, without charge, on the Internet as a noncommercial contribution to continuing diabetes education. Since its launch in 1996 over 300,000 visits have been logged at the main AIDA Website-www.2aida.org-and over 60,000 copies of the AIDA program have been downloaded free-of-charge. This review describes research projects and ventures, undertaken for the most part by other research workers in the diabetes computing field, that have made use of the freeware AIDA software. Relevant research work was identified in three main ways: (i) by personal (e-mail/written) communications from researchers, (ii) via the ISI Web of Science citation database to identify published articles that referred to AIDA-related papers, and (iii) via searches on the Internet. In a number of cases research students who had sought advice about AIDA, and diabetes computing in general, provided copies of their research dissertations/theses upon the completion of their projects. The two reviews highlight some of the many and varied research projects that have made use of the AIDA diabetes simulation software to date. A wide variety of diabetes computing topics have been addressed. In Part 1 of the review, these range from testing decision support prototypes to training artificial neural networks. In Part 2 of the review, issues surrounding dietary assessments, developing new diabetes models, and performance monitoring of closed-loop insulin delivery devices are considered. Overall, research projects making use of AIDA have been identified in Australia, Italy, South Korea, the United Kingdom, and the United States. These reviews confirm an unexpected but useful benefit of distributing medical software, like AIDA, for free via the Internet-demonstrating how it is possible to have a synergistic benefit with other researchers-facilitating their own research projects in related medical fields. The reviews highlight a variety of these projects that have benefited from the free availability of the AIDA diabetes software simulator. In a number of cases these other research projects simply would not have been possible without unrestricted access to the AIDA software and/or technical descriptions of its workings. In addition, some specific common themes begin to emerge from the research ventures that have been reviewed. These include the use of simulated blood glucose data from the AIDA program for preliminary computerlab-based testing of other decision support prototypes. Issues surrounding such use of simulated data for separate prototype testing are discussed further in Part 2 of the review.
Diabetes Technol Ther 2003
PMID:Research use of the AIDA www.2aida.org diabetes software simulation program: a review-part 1. decision support testing and neural network training. 1282 27

AIDA is a diabetes-computing program freely available at www.2aida.org on the Web. The software is intended to serve as an educational support tool and can be used by anyone who has an interest in diabetes, whether they be patients, relatives, health-care professionals, or students. In previous "Diabetes Information Technology & WebWatch" columns various indicators of usage of the AIDA program have been reviewed, and various comments from users of the software have been documented. The purpose of this column is to overview a proof-of-concept semi-automated analysis about why people are downloading the latest version of the AIDA educational diabetes program. AIDA permits the interactive simulation of plasma insulin and blood glucose profiles for teaching, demonstration, self-learning, and research purposes. It has been made freely available, without charge, on the Internet as a noncommercial contribution to continuing diabetes education. Since its launch in 1996 over 300,000 visits have been logged at the main AIDA Website-www.2aida.org-and over 60,000 copies of the AIDA program have been downloaded free-of-charge. This column documents the results of a semi-automated analysis of comments left by Website visitors while they were downloading the AIDA software, before they had a chance to use the program. The Internet-based survey methodology and semi-automated analysis were both found to be robust and reliable. Over a 5-month period (from October 3, 2001 to February 28, 2002) 400 responses were received. During the corresponding period 1,770 actual visits were made to the Website survey page-giving a response rate to this proof-of-concept study of 22.6%. Responses were received from participants in over 54 countries-with nearly half of these (n = 194; 48.5%) originating from the United States, United Kingdom, and Canada; 208 responses (52.0%) were received from patients with diabetes, 50 (12.5%) from doctors, 49 (12.3%) from relatives of patients, with fewer responses from students, diabetes educators, nurses, pharmacists, and other end users. The semi-automated analysis adopted for this study has re-affirmed the feasibility of using the Internet to obtain free-text comments, at no real cost, from a substantial number of medical software downloaders/users. The survey has also offered some insight into why members of the public continue to turn to the Internet for medical information. Furthermore it has provided useful information about why people are actually downloading the AIDA v4.3a interactive educational "virtual diabetes patient" simulator.
Diabetes Technol Ther 2003
PMID:Why people download the freeware AIDA v4.3a diabetes software program: a proof-of-concept semi-automated analysis. 1282 35

AIDA is an interactive educational diabetes simulator that is useful for recreating clinically realistic diabetes situations. It is available without charge from http://www.2aida.org on the Web. This paper describes a prospective, clinical randomised-controlled trial (RCT) run at the Ospedale di Marino (Italy) for evaluating the educational utility of AIDA in small group teaching sessions. Twenty-four volunteers (12 male and 12 female) with Type 1 diabetes of more than 6-year duration, aged 19-48 years, who gave written informed consent, were randomly assigned to one of two study groups, each receiving different teaching interventions. Group A was exposed to the AIDA diabetes simulator, while Group B (the control group) received conventional lessons with slides and transparencies. Six lessons were held for each group (one per week). At the end of the conventional lessons, after a 'washout' period of 4 weeks, Group B entered a partial cross-over phase with the simulator during a further 6-week block of lessons. Before and after the 6 weeks of lessons, twice for Group A and 3 times for Group B, all subjects had their HbA1c measured. The subjects also carefully documented the incidence of any symptomatic hypoglycaemic episodes ('hypos'), whether mild (sweating, dizziness), moderate (nausea, vomiting), or severe (requiring assistance). All data were analysed using non-parametric statistics (Wilcoxon signed rank tests). HbA1c levels in Group A dropped significantly from 7.2% to 6.4% after lessons with the diabetes simulator (p = 0.01). No significant changes in HbA1c were observed in Group B between baseline (7.1%) and the end of the control lessons (7.0%), or the end of the cross-over phase lessons (6.8%). The number of 'hypos' decreased significantly from 31 to 14 in Group A (p = 0.03) after AIDA lessons, but did not change significantly in Group B from baseline (n = 20) to after the control lessons (n = 22). However, the number of 'hypos' did decrease significantly (to n = 10) in Group B after exposure to the simulator during the cross-over phase (p = 0.03 vs 6-week data). Larger trials involving more patients in more centres are clearly needed, but this proof-of-concept (pilot) study does demonstrate the feasibility of using a prospective RCT approach for the evaluation of educational diabetes simulation software such as AIDA.
Diabetes Nutr Metab 2003 Feb
PMID:A prospective randomised-controlled pilot study for evaluating the teaching utility of interactive educational diabetes simulators. 1284 1


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