Utilization profile of the Canadian-led coalition Role 2 Medical Treatment Facility in Iraq: the growing requirement for multinational interoperability.

Background: The Canadian Armed Forces deployed a Role 2 Medical Treatment Facility (R2MTF) to Iraq in November 2016 as part of Operation IMPACT. We compared the multinational interoperability required of this R2MTF with that of similar facilities previously deployed by Canada or other nations. Methods: We reviewed data (Nov. 4, 2016, to Oct. 3, 2017) from the electronic Disease and Injury Surveillance Report and the Daily Medical Situation Report. Clinical activity was stratified by Global Burden of Diseases category, ICD-10 code, mechanism of injury, services used, encounter type, nationality and blood product usage. We reviewed the literature to identify utilization profiles for other MTFs over the last 20 years. Results: In total, 1487 patients were assessed. Of these, 5.0% had battle injuries requiring damage-control resuscitation and/or damage-control surgery, with 55 casualties requiring medical evacuation after stabilization. Trauma and disease non-battle injuries accounted for 44% and 51% of patient encounters, respectively. Other than dental conditions, musculoskeletal disorders accounted for most presentations. Fifty-seven units of fresh frozen plasma and 64 units of packed red blood cells were used, and the walking blood bank was activated 7 times. Mass casualty activations involved coordination of health care and logistical resources from more than 12 countries. In addition to host nation military and civilian casualties, patients from 15 different countries were treated with similar frequency. Conclusion: The experience of the Canadian R2MTF in Iraq demonstrates the importance of multinational interoperability in providing cohesive medical care in coalition surgical facilities. Multinational interoperability derives from a unique relationship between higher medical command collaboration, international training and adherence to common standards for equipment and clinical practice

Collaborative team training in virtual reality is superior to individual learning for performing complex open surgery: a randomised controlled trial

Objective: To assess if multiplayer virtual reality (VR) training was superior to single player training for acquisition of both technical and non-technical skills in learning complex surgery. Summary Background Data: Superior team-work in the operating room (OR) is associated with improved technical performance and clinical outcomes. VR can successfully train OR staff individually, however VR team training has yet to be investigated. Method: Forty participants were randomised to individual or team VR training. Individually-trained participants practiced alongside virtual avatar counterparts, whilst teams trained live in pairs. Both groups underwent five VR training sessions over 6-weeks. Subsequently, they underwent a real-life assessment in which they performed Anterior Approach Total Hip Arthroplasty (AA-THA) surgery on a high-fidelity model with real equipment in a simulated OR. Teams performed together and individually-trained participants were randomly paired up. Videos were marked by two blinded assessors recording the NOTSS, NOTECHS II and SPLINTS scores. Secondary outcomes were procedure time and number of technical errors. Results: Teams outperformed individually-trained participants for non-technical skills in the real-world assessment (NOTSS 13.1±1.5 vs 10.6±1.6, P=0.002, NOTECHS-II score 51.7±5.5 vs 42.3±5.6, P=0.001 and SPLINTS 10±1.2 vs 7.9±1.6, P=0.004). They completed the assessment 28.1% faster (27.2 minutes±5.5 vs 41.8 ±8.9, P<0.001), and made fewer than half the number of technical errors (10.4±6.1 vs 22.6±5.4, P<0.001). Conclusions: Multiplayer training leads to faster surgery with fewer technical errors and the development of superior non-technical skills

Transitions of Care: Complications and Solutions

The delivery of medical care relies on effective, succinct, and ongoing communication between healthcare providers, called handoffs. Handoffs involve the transfer of professional responsibility and accountability for aspects of care for patients to another clinician or clinical team on a temporary or permanent basis. Handoffs have the potential for deleterious clinical impact if inadequately done. Only recently has data become available that demonstrate improvements in handoffs reduce the rate of subsequent clinical care error. This clinical vignette and subsequent discussion focuses on physician, particularly the resident physician in training, transfer of care: handoff complications, barriers to effective handoffs, regulatory agencies’ input on handoff improvement, standardization of the handoff process, assessment of the quality of handoff, handoff error avoidance, and improving the quality of handoff

Investigation of a holistic human-computer interaction (HCI) framework to support the design of extended reality (XR) based training simulators

In recent years, the use of Extended Reality (XR) based simulators for training has increased rapidly. In this context, there is a need to explore novel HCI-based approaches to design more effective 3D training environments. A major impediment in this research area is the lack of an HCI-based framework that is holistic and serves as a foundation to integrate the design and assessment of HCI-based attributes such as affordance, cognitive load, and user-friendliness. This research addresses this need by investigating the creation of a holistic framework along with a process for designing, building, and assessing training simulators using such a framework as a foundation. The core elements of the proposed framework include the adoption of participatory design principles, the creation of information-intensive process models of target processes (relevant to the training activities), and design attributes related to affordance and cognitive load. A new attribute related to affordance of 3D scenes is proposed (termed dynamic affordance) and its role in impacting user comprehension in data-rich 3D training environments is studied. The framework is presented for the domain of orthopedic surgery. Rigorous user-involved assessment of the framework and simulation approach has highlighted the positive impact of the HCI-based framework and attributes on the acquisition of skills and knowledge by healthcare users

Educating Future Generations of Surgeons across Borders:Novel Global Linked Hybrid Live Cadaveric Peripheral Nerve Surgical Training Course

Background: This study aimed to evaluate a novel, multi-site, technology-facilitated education and training course in peripheral nerve surgery. The program was developed to address the training gaps in this specialized field by integrating a structured curriculum, high-fidelity cadaveric dissection, and surgical simulation with real-time expert guidance. Methods: A collaboration between the Global Nerve Foundation and Esser Masterclass facilitated the program, which was conducted across three international sites. The curriculum was developed by a panel of experienced peripheral nerve surgeons and included both text-based and multimedia resources. Participants’ knowledge and skills were assessed using pre- and postcourse questionnaires. Results: A total of 73 participants from 26 countries enrolled and consented for data usage for research purposes. The professional background was diverse, including hand surgeons, plastic surgeons, orthopedic surgeons, and neurosurgeons. Participants reported significant improvements in knowledge and skills across all covered topics (p &lt; 0.001). The course received a 100% recommendation rate, and 88% confirmed that it met their educational objectives. Conclusions: This study underscores the potential of technology-enabled, collaborative expert-led training programs in overcoming geographical and logistical barriers, setting a new standard for globally accessible, high-quality surgical training. It highlights the practical and logistical challenges of multi-site training, such as time zone differences and participant fatigue. It also provides practical insights for future medical educational endeavors, particularly those that aim to be comprehensive, international, and technologically facilitated.</p

Open tibia fracture management in lesser-resourced settings:Latin America

Injuries are a leading cause of morbidity and mortality worldwide, with musculoskeletal trauma representing 11% of the current Global Burden of Disease. Notably, over 90% of these injuries occur in low-and middle-income countries (LMICs), disproportionately impacting those in lesser-resourced settings, where trauma care is less accessible. A major contributor to this Global Burden is road traffic accidents, which continue to increase annually, leading to high rates of musculoskeletal injuries, including open tibia fractures. Latin America, a region primarily made up of LMICs, has the highest rates of road traffic fatalities per capita worldwide. As a result, open tibia fractures are a significantly problematic regional health issue, with a high rate of incidence, risk of complications, and associated poor long-term outcomes. Despite the prevalence and severity of these injuries, the current state of management of open tibia fractures in Latin America is not well documented. This is largely due to a lack of published orthopaedic trauma studies, limiting the understanding of the region’s musculoskeletal burden and ability to develop management strategies for trauma-related conditions. There is a clear need for population-specific research on the management of open tibia fractures in Latin America. The purpose of this thesis was to 1) identify barriers to conducting clinical research, 2) define regional priorities and the management of open tibia fractures, and 3) address the treatment of these injuries through interventions and best practice guidelines

Simulation for early years surgical training

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