Simulation training approaches in intracranial aneurysm surgery-a systematic review.

BACKGROUND With the increasing complexity and decreasing exposure to intracranial aneurysm surgery, training and maintenance of the surgical skills have become challenging. This review elaborated on simulation training for intracranial aneurysm clipping. METHODS A systematic review was performed according to the PRISMA guidelines to identify studies on aneurysm clipping training using models and simulators. The primary outcome was the identification of the predominant modes of the simulation process, models, and training methods associated with a microsurgical learning curve. The secondary outcomes included assessments of the validation of such simulators and the learning capability from the use of such simulators. RESULTS Of the 2068 articles screened, 26 studies met the inclusion criteria. The chosen reports used a wide range of simulation approaches including ex vivo methods (n = 6); virtual reality (VR) platforms (n = 11); and static (n = 6) and dynamic (n = 3) 3D-printed aneurysm models (n = 6). The ex vivo training methods have limited availability, VR simulators lack haptics and tactility, while 3D static models lack important microanatomical components and the simulation of blood flow. 3D dynamic models including pulsatile flow are reusable and cost-effective but miss microanatomical components. CONCLUSIONS The existing training methods are heterogenous and do not realistically simulate the complete microsurgical workflow. The current simulations lack certain anatomical features and crucial surgical steps. Future research should focus on developing and validating a reusable, cost-effective training platform. No systematic validation method exists for the different training models, so there is a need to build homogenous assessment tools and validate the role of simulation in education and patient safety

Augmented Reality: Mapping Methods and Tools for Enhancing the Human Role in Healthcare HMI

Background: Augmented Reality (AR) represents an innovative technology to improve data visualization and strengthen the human perception. Among Human–Machine Interaction (HMI), medicine can benefit most from the adoption of these digital technologies. In this perspective, the literature on orthopedic surgery techniques based on AR was evaluated, focusing on identifying the limitations and challenges of AR-based healthcare applications, to support the research and the development of further studies. Methods: Studies published from January 2018 to December 2021 were analyzed after a comprehensive search on PubMed, Google Scholar, Scopus, IEEE Xplore, Science Direct, and Wiley Online Library databases. In order to improve the review reporting, the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used. Results: Authors selected sixty-two articles meeting the inclusion criteria, which were categorized according to the purpose of the study (intraoperative, training, rehabilitation) and according to the surgical procedure used. Conclusions: AR has the potential to improve orthopedic training and practice by providing an increasingly human-centered clinical approach. Further research can be addressed by this review to cover problems related to hardware limitations, lack of accurate registration and tracking systems, and absence of security protocols

Preoperative psychological interventions to promote behavioural recovery in patients with a high anaesthetic risk :a systematic review

Background: In the United Kingdom high anaesthetic risk surgical patients (those pre-disposed to complications because of for example, pre-existing conditions), have increased chance of irreversible disability or death; accounting for 80% of perioperative mortality (Pearse, Holt and Grocott 2011). Psychological preparation for surgery under General Anaesthetic (GA) can improve postoperative outcomes in a general population (Johnston and Vogele 1993; Powell, Scott, Manyande et al. 2016). Powell, Scott, Manyande et al. (2016) suggested benefit on postoperative pain, negative affect, length of stay (LOS) and behavioural recovery. However, psychological optimisation by Preoperative Assessment Services remains outside usual care and to date no systematic review has been undertaken relating to high-risk GA patients. Arguably, the best indicators of postoperative recovery for this high-risk group are behavioural recovery and quality of life (QoL). Aims: 1. To assess whether preoperative psychological interventions are effective for improving behavioural recovery outcomes for high-risk anaesthetic patients, compared to standard care alone? 2. To assess whether preoperative psychological interventions, are effective at maintaining or improving QoL at one-month or more post-surgery compared to standard care alone? Methods: Twelve databases were searched up to November 2017. Published Randomized Controlled Trials of adults undergoing elective surgery were included if outcomes were examined one-month to one-year postoperatively. Reference lists and forward citation searching followed. No language or date restrictions were imposed. Findings were pooled using continuous: d (hedges g) outcome type, and narrative synthesis was undertaken where meta-analysis was unsuitable. Eppi-reviewer4 software was used to manage the review (EPPI-Centre 2017). Results: Eleven papers (n=1272) met eligibility criteria. Five were appropriate for meta-analysis; the remainder were narratively reviewed. Findings demonstrated no effect on behavioural recovery from any psychological intervention (SMD- 0.11, 95% confidence interval (CI) -0.61-0.40). QoL was not improved by psychological interventions either (SMD- 0.50, 95% CI -1.69-0.69 for total QoL and SMD -1.35, 95% CI -2.95-0.25. Narrative synthesis demonstrated psychological interventions did positively influence behavioural 15 recovery and improved mental and physical QoL was demonstrated to be statistically significant in the intervention group of two papers reviewed narritively. However, one paper concluded that the intervention favoured the control group and therefore it is harmful. Results should be treated cautiously as there were high levels of heterogeneity for the outcome behavioural recovery. There were insufficient studies to determine the most effective intervention type. Conclusion: Evidence suggested no improvement in behavioural recovery or QOL of high-risk anaesthetic patients when psychological interventions were delivered preoperatively. The quality of evidence was low, and no practice recommendations can be made. There is a need for further high-quality research examining larger samples of this patient population

Augmented Reality

Augmented Reality (AR) is a natural development from virtual reality (VR), which was developed several decades earlier. AR complements VR in many ways. Due to the advantages of the user being able to see both the real and virtual objects simultaneously, AR is far more intuitive, but it's not completely detached from human factors and other restrictions. AR doesn't consume as much time and effort in the applications because it's not required to construct the entire virtual scene and the environment. In this book, several new and emerging application areas of AR are presented and divided into three sections. The first section contains applications in outdoor and mobile AR, such as construction, restoration, security and surveillance. The second section deals with AR in medical, biological, and human bodies. The third and final section contains a number of new and useful applications in daily living and learning

2019 EACTS Expert Consensus on long-term mechanical circulatory support

Long-term mechanical circulatory support (LT-MCS) is an important treatment modality for patients with severe heart failure. Different devices are available, and many-sometimes contradictory-observations regarding patient selection, surgical techniques, perioperative management and follow-up have been published. With the growing expertise in this field, the European Association for Cardio-Thoracic Surgery (EACTS) recognized a need for a structured multidisciplinary consensus about the approach to patients with LT-MCS. However, the evidence published so far is insufficient to allow for generation of meaningful guidelines complying with EACTS requirements. Instead, the EACTS presents an expert opinion in the LT-MCS field. This expert opinion addresses patient evaluation and preoperative optimization as well as management of cardiac and non-cardiac comorbidities. Further, extensive operative implantation techniques are summarized and evaluated by leading experts, depending on both patient characteristics and device selection. The faculty recognized that postoperative management is multidisciplinary and includes aspects of intensive care unit stay, rehabilitation, ambulatory care, myocardial recovery and end-of-life care and mirrored this fact in this paper. Additionally, the opinions of experts on diagnosis and management of adverse events including bleeding, cerebrovascular accidents and device malfunction are presented. In this expert consensus, the evidence for the complete management from patient selection to end-of-life care is carefully reviewed with the aim of guiding clinicians in optimizing management of patients considered for or supported by an LT-MCS device

Evaluation System for Craniosynostosis Surgeries with Computer Simulation and Statistical Modelling

Craniosynostosis is a pathology in infants when one or more sutures prematurely closed, leading to abnormal skull shape. It has been classified according to the specific suture that has been closed, each of which has a typical skull shape. Surgery is the common treatment to correct the deformed skull shape and to reduce the excessive intracranial pressure. Since every case is unique, the cranial facial teams have difficulties to select an optimum solution for a specific patient from multiple options. In addition, there is not an appropriate quantified measurement existed currently to help cranial facial team to quantitatively evaluate their surgeries. We aimed to develop a head model of a craniosynostosis patient, which allows neurosurgeons to perform any potential surgeries on it so as to simulate the postoperative head development. Therefore, neurosurgeons could foresee the surgical results and is able to select the optimal one. In this thesis, we have developed a normal head model, and built mathematical models for possible dynamic behaviors. We also modified this model by closing one or two sutures to simulate common types of craniosynostosis. The abnormal simulation results showed a qualitative match with real cases and the normal simulation indicated a higher growth rate of cranial index than clinical data. We believed that this discrepancy caused by the rigidity of our skull plates, which will be adapted to deformable object in the future. In order to help neurosurgeons to better evaluate a surgery, we hope to develop an algorithm to quantify the level of deformity of a skull. We have designed a set of work flow and targeted curvatures as the key role. A training data was carefully selected to search for an optimal system to characterize different shapes. A set of test data was used to validate our algorithm to assess the performance of the optimal system. With a stable evaluating system, we can evaluate a surgery by comparing the preoperative and postoperative skulls from the patient. An effective surgery can be considered if the postoperative skull shifted toward normal shape from preoperative shape

Evaluation techniques used to evaluate extended reality (XR) head mounted displays (HMDs) used in healthcare: A literature review

Extended Reality (XR) Head Mounted Displays (HMDs) are used across various healthcare pathways for staff/student education and training, and for improving patient experiences. As XR HMDs become affordable, accessible and their acceptance increases, it is critical to document the techniques used for evaluating the technology, processes of user engagement and immersion, and outcomes. At present there is limited research on evaluation techniques used to evaluate XR HMDs. This manuscript presents findings from 104 clinical studies that use XR HMDs. The aim of this review is to give the user an insight into the current healthcare XR HMD landscape by presenting the different HMDs used, variety of XR interventions and their applications across medical pathways and intended research outcomes of the XR applications. The manuscript further guides the reader toward a detailed documentation of evaluation techniques used to investigate antecedents and consequences of using XR and delivers a critical discussion and suggestions for improvement of XR evaluation practices. This paper will be of excellent use to clinicians, academics, funding bodies and hospital decision makers who would like suggestions for evaluating the efficacy and effectiveness of XR HMDs. The authors hope to encourage discussions on the importance of improving XR evaluation practices