Piloting mobile mixed reality simulation in paramedic distance education

New pedagogical methods delivered through mobile mixed reality (via a user-supplied mobile phone incorporating 3d printing and augmented reality) are becoming possible in distance education, shifting pedagogy from 2D images, words and videos to interactive simulations and immersive mobile skill training environments. This paper presents insights from the implementation and testing of a mobile mixed reality intervention in an Australian distance paramedic science classroom. The context of this mobile simulation study is skills acquisition in airways management focusing on direct laryngoscopy with foreign body removal. The intervention aims to assist distance education learners in practicing skills prior to attending mandatory residential schools and helps build a baseline equality between those students that study face to face and those at a distance. Outcomes from the pilot study showed improvements in several key performance indicators in the distance learners, but also demonstrated problems to overcome in the pedagogical method

Toward future 'mixed reality' learning spaces for STEAM education

Digital technology is becoming more integrated and part of modern society. As this begins to happen, technologies including augmented reality, virtual reality, 3d printing and user supplied mobile devices (collectively referred to as mixed reality) are often being touted as likely to become more a part of the classroom and learning environment. In the discipline areas of STEAM education, experts are expected to be at the forefront of technology and how it might fit into their classroom. This is especially important because increasingly, educators are finding themselves surrounded by new learners that expect to be engaged with participatory, interactive, sensory-rich, experimental activities with greater opportunities for student input and creativity. This paper will explore learner and academic perspectives on mixed reality case studies in 3d spatial design (multimedia and architecture), paramedic science and information technology, through the use of existing data as well as additional one-on-one interviews around the use of mixed reality in the classroom. Results show that mixed reality can provide engagement, critical thinking and problem solving benefits for students in line with this new generation of learners, but also demonstrates that more work needs to be done to refine mixed reality solutions for the classroom

Implementation of Telemedicine in Otorhinolaryngology

Telemedicine is a term that covers all procedures supported by communication technology, which has the purpose of providing health services at a specific spatial distance. This is an area that is developing rapidly and has found particular application in otorhinolaryngology, given that a large number of surgeries are performed with the help of endoscopes and microscopes. Telemedicine also represents a significant advantage during the coronavirus pandemic, both in terms of treating patients and monitoring them more effectively. For the purpose of preparing this article, research published on Scopus, PubMed, Google Scholar, and Google was reviewed using the keywords “telemedicine” and “otorhinolaryngology”. This review article provides a summary and the latest insights in this broad and fast-growing area. The development of telemedicine in Croatia as well as a special review of the application of telemedicine during the coronavirus pandemic is also presented in this article

How, for Whom, and in Which Contexts or Conditions Augmented and Virtual Reality Training Works in Upskilling Health Care Workers: Realist Synthesis

BACKGROUND: Using traditional simulators (eg, cadavers, animals, or actors) to upskill health workers is becoming less common because of ethical issues, commitment to patient safety, and cost and resource restrictions. Virtual reality (VR) and augmented reality (AR) may help to overcome these barriers. However, their effectiveness is often contested and poorly understood and warrants further investigation. OBJECTIVE: The aim of this review is to develop, test, and refine an evidence-informed program theory on how, for whom, and to what extent training using AR or VR works for upskilling health care workers and to understand what facilitates or constrains their implementation and maintenance. METHODS: We conducted a realist synthesis using the following 3-step process: theory elicitation, theory testing, and theory refinement. We first searched 7 databases and 11 practitioner journals for literature on AR or VR used to train health care staff. In total, 80 papers were identified, and information regarding context-mechanism-outcome (CMO) was extracted. We conducted a narrative synthesis to form an initial program theory comprising of CMO configurations. To refine and test this theory, we identified empirical studies through a second search of the same databases used in the first search. We used the Mixed Methods Appraisal Tool to assess the quality of the studies and to determine our confidence in each CMO configuration. RESULTS: Of the 41 CMO configurations identified, we had moderate to high confidence in 9 (22%) based on 46 empirical studies reporting on VR, AR, or mixed simulation training programs. These stated that realistic (high-fidelity) simulations trigger perceptions of realism, easier visualization of patient anatomy, and an interactive experience, which result in increased learner satisfaction and more effective learning. Immersive VR or AR engages learners in deep immersion and improves learning and skill performance. When transferable skills and knowledge are taught using VR or AR, skills are enhanced and practiced in a safe environment, leading to knowledge and skill transfer to clinical practice. Finally, for novices, VR or AR enables repeated practice, resulting in technical proficiency, skill acquisition, and improved performance. The most common barriers to implementation were up-front costs, negative attitudes and experiences (ie, cybersickness), developmental and logistical considerations, and the complexity of creating a curriculum. Facilitating factors included decreasing costs through commercialization, increasing the cost-effectiveness of training, a cultural shift toward acceptance, access to training, and leadership and collaboration. CONCLUSIONS: Technical and nontechnical skills training programs using AR or VR for health care staff may trigger perceptions of realism and deep immersion and enable easier visualization, interactivity, enhanced skills, and repeated practice in a safe environment. This may improve skills and increase learning, knowledge, and learner satisfaction. The future testing of these mechanisms using hypothesis-driven approaches is required. Research is also required to explore implementation considerations

Robot-assisted gastrectomy and oesophagectomy for cancer

Background: Robot-assisted surgery is a technically feasible alternative to open and laparoscopic surgery, which is being more frequently used in general surgery. We undertook this review to investigate whether robotic assistance provides a significant benefit for oesophagogastric cancer surgery. Methods: Electronic databases were searched for original English-language publications for robotic-assisted gastrectomy and oesophagectomy between January 1990 and October 2013. Results: Sixty-one publications were included. Thirty-five included gastrectomy, 31 included oesophagectomy and five included both operations. Several publications suggest that robot-assisted subtotal gastrectomy can be as safe and effective as an open or laparoscopic procedure, with equal outcomes with regard to the number of lymph nodes resected, overall morbidity and perioperative mortality, and length of hospital stay. Robotic assistance is associated with longer operation times but also with less blood loss in some reports. A significant benefit for robotic assistance has not been shown for the more extensive operations of oesophagectomy or total gastrectomy with D2-lymphadenectomy. There are very few oncologic data regarding local recurrence or long-term survival for any of the robotic operations. Conclusions: No significant differences in morbidity, mortality or number of lymph node harvested have been shown between robot-assisted and laparoscopic gastrectomy or oesophagectomy. Robotic surgery, with its relatively short learning curve, may facilitate reproducible minimally invasive surgery in this field but operation times are reportedly longer and cost differences remain unclear. Randomized trials with oncologic outcomes and cost comparisons are needed

Advances on Mechanics, Design Engineering and Manufacturing III

This open access book gathers contributions presented at the International Joint Conference on Mechanics, Design Engineering and Advanced Manufacturing (JCM 2020), held as a web conference on June 2–4, 2020. It reports on cutting-edge topics in product design and manufacturing, such as industrial methods for integrated product and process design; innovative design; and computer-aided design. Further topics covered include virtual simulation and reverse engineering; additive manufacturing; product manufacturing; engineering methods in medicine and education; representation techniques; and nautical, aeronautics and aerospace design and modeling. The book is organized into four main parts, reflecting the focus and primary themes of the conference. The contributions presented here not only provide researchers, engineers and experts in a range of industrial engineering subfields with extensive information to support their daily work; they are also intended to stimulate new research directions, advanced applications of the methods discussed and future interdisciplinary collaborations

A comprehensive evaluation of work and simulation based assessment in otolaryngology training

Introduction: The otolaryngology curriculum requires trainees to show evidence of operative competence before completion of training. The General Medical Council recommended that structured assessment be used throughout training to monitor and guide trainee progression. Despite the reduction in operative exposure and the variation in trainee performance, a ‘one size fits all’ approach continues to be applied. The number of procedures performed remains the main indicator of competence. Objectives: To analyse the utilisation, reliability and validity of workplace-based assessments in otolaryngology training. To identify, develop and validate a series of simulation platforms suitable for incorporation into the otolaryngology curriculum. To develop a model of interchangeable workplace- and simulation-based assessment that reflects trainee’s trajectory, audit the delivery of training and set milestones for modular learning. Methods: A detailed review of the literature identified a list of procedure-specific assessment tools as well as simulators suitable to be used as assessment platforms. A simulation-integrated training programme was piloted and models were tested for feasibility, face, content and construct validity before being incorporated into the North London training programme. The outcomes of workplace- and simulation-based assessments of all core and specialty otolaryngology trainees were collated and analysed. Results: The outcomes of 6535 workplace-based assessments were analysed. The strengths and weaknesses of 4 different assessment tools are highlighted. Validated platforms utilising cadavers, animal tissue, synthetic material and virtual reality simulators were incorporated into the curriculum. 60 trainees and 40 consultants participated in the process and found it of great educational value. Conclusion: Assessment with structured feedback is integral to surgical training. Assessment using validated simulation modules can complement that undertaken in the workplace. The outcomes of structures assessments can be used to monitor and guide trainee trajectory at individual and regional level. The derived learning curves can shape and audit future otolaryngological training.Open Acces

A review for indications in transoral robotic surgery in oropharyngeal cancer

Εισαγωγή: H καθιερωμένη αντιμετώπιση των ασθενών με καρκίνο του στοματοφάρυγγα είναι χειρουργική, συχνά σε συνδυασμό με ακτινοθεραπεία ή/και λεμφαδενικό καθαρισμό. Σύμφωνα με τις επιδημιολογικές μελέτες, όμως, παρατηρείται πλέον μια αυξημένη επίπτωση του καρκίνου του στοματοφάρυγγα. Έτσι λοιπόν λόγω πρόσθετων εξελίξεων, ο ρόλος του ρομποτικού συστήματος Da Vinci έχει πολλαπλασιαστεί δραματικά, ενώ εφαρμόζεται σε μια πλειάδα επεμβάσεων στην κεφαλή και τον τράχηλο, ιδίως διαστοματικά. Σκοπός: H διεξαγωγή ανασκόπησης στη βιβλιογραφία, όσον αφορά τις αναδυόμενες ενδείξεις εφαρμογής της διαστοματικής ρομποτικής χειρουργικής (TORS) στις κακοήθειες του στοματοφάρυγγα. . Μέθοδοι: Τα άρθρα εντοπίστηκαν μέσω αναζήτησης των ακόλουθων λέξεων-κλειδιών: «διαστοματική ρομποτική χειρουργική», «καρκίνος στοματοφάρυγγα», «οροφάρυγγας και TORS», «άγνωστο πρωτοπαθές», «TORS και οπισθοφαρυγγικό διάστημα» και «TORS και ρίζα γλώσσας». Αναλύθηκαν 2011 μελέτες για τον καρκίνο του στοματοφάρυγγα και όλες οι δημοσιεύσεις για τις αναφαινόμενες ενδείξεις εφαρμογής του TORS. Εξαιρέθηκαν περιλήψεις, μεμονωμένα περιστατικά, οι απόψεις των εμπειρογνωμόνων και οι μη αγγλόφωνες δημοσιεύσεις. Τελικά μελετήθηκαν 27 άρθρα, δημοσιευμένα έως τον Ιανουάριο 2016. Αποτελέσματα: Ο συνολικός αριθμός των ασθενών σε όλες τις μελέτες ήταν 1729. Στα άρθρα που αναλύθηκαν, υπήρχαν 36 σειρές ασθενών που υποβλήθηκαν σε TORS για καρκίνο στοματοφάρυγγα διαφορετικής εντόπισης. Συμπεράσματα: H διαστοματική ρομποτική χειρουργική αλλάζει σημαντικά τον αριθμό των καρκίνων αγνώστου πρωτοπαθούς που διαγιγνώσκονται, ενώ επιτρέπει τη λιγότερο επεμβατική χειρουργική τεχνική σε καρκίνο προχωρημένου σταδίου. Επιπλέον, φαίνεται να υπερέχει διαγνωστικά της πανενδοσκόπησης, ιδίως σε περιπτώσεις όγκων κεφαλής και τραχήλου που προσεγγίζονται δύσκολα ή όταν η δυνατότητα εξασφάλισης αρνητικών ορίων εκτομής, ίσως συνεπάγεται αποφυγή χημειοθεραπείας ή/και ελάττωση της δόσης και των πεδίων ακτινοβόλησης.Background:Standard treatment for patients with oropharyngeal cancer has been surgery, in some cases including Radiation Therapy and/or neck dissection. According to epidemiological studies however, there has been an increase in the incidence of oropharyngeal cancer. As a result the role of the Da-Vinci robot has also increased dramatically because of additional developments and renements, and it has been used for a wide range of procedures in the head and neck, particularly transorally. Aim:A review of literature on all emerging applications of transoral robotic surgery (TORS) in oropharyngeal malignancies. Methods:Articles were identified through the following keyword searches: “transoral robotic surgery”, “oropharyngeal cancer”, “oropharynx-TORS”, “unknown primary’, “TORS-retropharyngeal space’’ and “TORS-tongue base”. 2011 reviews for SCC oropharyngeal cancer and all available publications for all the other emerging oropharyngeal applications were analyzed. Abstracts, case reports, expert opinions, as well as non-English publications were excluded. The complete search yielded 27 studies, published until January 2016. Results:The total number of patients in all trials was 1729. From the articles analyzed there were 36 series of patients who underwent TORS for different subsites of oropharyngeal cancer. Conclusions:TORS changes the number of unknown primary tumors of head and neck that is diagnosed, whereas it permits less invasive surgical techniques in cancer of advanced stage. TORS is superior to the procedure of panendoscopy, particularly when treating head and neck tumors that are accessed with difficulty, or when the potential for surgical resection with negative margins may prevent the use of chemotherapy and/or may lessen the fields of radiation treatment

Cable-driven parallel robot for transoral laser phonosurgery

Transoral laser phonosurgery (TLP) is a common surgical procedure in otolaryngology. Currently, two techniques are commonly used: free beam and fibre delivery. For free beam delivery, in combination with laser scanning techniques, accurate laser pattern scanning can be achieved. However, a line-of-sight to the target is required. A suspension laryngoscope is adopted to create a straight working channel for the scanning laser beam, which could introduce lesions to the patient, and the manipulability and ergonomics are poor. For the fibre delivery approach, a flexible fibre is used to transmit the laser beam, and the distal tip of the laser fibre can be manipulated by a flexible robotic tool. The issues related to the limitation of the line-of-sight can be avoided. However, the laser scanning function is currently lost in this approach, and the performance is inferior to that of the laser scanning technique in the free beam approach. A novel cable-driven parallel robot (CDPR), LaryngoTORS, has been developed for TLP. By using a curved laryngeal blade, a straight suspension laryngoscope will not be necessary to use, which is expected to be less traumatic to the patient. Semi-autonomous free path scanning can be executed, and high precision and high repeatability of the free path can be achieved. The performance has been verified in various bench and ex vivo tests. The technical feasibility of the LaryngoTORS robot for TLP was considered and evaluated in this thesis. The LaryngoTORS robot has demonstrated the potential to offer an acceptable and feasible solution to be used in real-world clinical applications of TLP. Furthermore, the LaryngoTORS robot can combine with fibre-based optical biopsy techniques. Experiments of probe-based confocal laser endomicroscopy (pCLE) and hyperspectral fibre-optic sensing were performed. The LaryngoTORS robot demonstrates the potential to be utilised to apply the fibre-based optical biopsy of the larynx.Open Acces