Feasibility Evaluation of Commercially Available Video Conferencing Devices to Technically Direct Untrained Nonmedical Personnel to Perform a Rapid Trauma Ultrasound Examination.

Introduction: Point-of-care ultrasound (POCUS) is a rapidly expanding discipline that has proven to be a valuable modality in the hospital setting. Recent evidence has demonstrated the utility of commercially available video conferencing technologies, namely, FaceTime (Apple Inc, Cupertino, CA, USA) and Google Glass (Google Inc, Mountain View, CA, USA), to allow an expert POCUS examiner to remotely guide a novice medical professional. However, few studies have evaluated the ability to use these teleultrasound technologies to guide a nonmedical novice to perform an acute care POCUS examination for cardiac, pulmonary, and abdominal assessments. Additionally, few studies have shown the ability of a POCUS-trained cardiac anesthesiologist to perform the role of an expert instructor. This study sought to evaluate the ability of a POCUS-trained anesthesiologist to remotely guide a nonmedically trained participant to perform an acute care POCUS examination. Methods: A total of 21 nonmedically trained undergraduate students who had no prior ultrasound experience were recruited to perform a three-part ultrasound examination on a standardized patient with the guidance of a remote expert who was a POCUS-trained cardiac anesthesiologist. The examination included the following acute care POCUS topics: (1) cardiac function via parasternal long/short axis views, (2) pneumothorax assessment via pleural sliding exam via anterior lung views, and (3) abdominal free fluid exam via right upper quadrant abdominal view. Each examiner was given a handout with static images of probe placement and actual ultrasound images for the three views. After a brief 8 min tutorial on the teleultrasound technologies, a connection was established with the expert, and they were guided through the acute care POCUS exam. Each view was deemed to be complete when the expert sonographer was satisfied with the obtained image or if the expert sonographer determined that the image could not be obtained after 5 min. Image quality was scored on a previously validated 0 to 4 grading scale. The entire session was recorded, and the image quality was scored during the exam by the remote expert instructor as well as by a separate POCUS-trained, blinded expert anesthesiologist. Results: A total of 21 subjects completed the study. The average total time for the exam was 8.5 min (standard deviation = 4.6). A comparison between the live expert examiner and the blinded postexam reviewer showed a 100% agreement between image interpretations. A review of the exams rated as three or higher demonstrated that 87% of abdominal, 90% of cardiac, and 95% of pulmonary exams achieved this level of image quality. A satisfaction survey of the novice users demonstrated higher ease of following commands for the cardiac and pulmonary exams compared to the abdominal exam. Conclusions: The results from this pilot study demonstrate that nonmedically trained individuals can be guided to complete a relevant ultrasound examination within a short period. Further evaluation of using telemedicine technologies to promote POCUS should be evaluated

Virtual Reality Technologies in Health Care: A Literature Review of Theoretical Foundations

The digitization of health care promises an improvement of medical care through the adoption of virtual reality (VR) related technologies. Although most undergoing mechanisms of clinical effectiveness are yet not defined theoretically, research approaches have already taken place in several empirical settings. To structure current and upcoming scientific work in this field, we conducted a literature review with regard to theoretical implications of both IS-related and healthcare-related research. We found several theoretical bases to build upon in the field of psychology, but expressed a need for enrichment of theoretical foundations in the field of IS research. We therefore plead for a theoretical foundation enriched by synergetic concepts of clinically effective VR related technologies. Finally, we conclude that VR related technologies appear as a promising approach worth further theoretical and empirical research in order to improve medical care

The Changing Environment in Postgraduate Education in Orthopedic Surgery and Neurosurgery and Its Impact on Technology-Driven Targeted Interventional and Surgical Pain Management : Perspectives from Europe, Latin America, Asia, and The United States

Personalized care models are dominating modern medicine. These models are rooted in teaching future physicians the skill set to keep up with innovation. In orthopedic surgery and neurosurgery, education is increasingly influenced by augmented reality, simulation, navigation, robotics, and in some cases, artificial intelligence. The postpandemic learning environment has also changed, emphasizing online learning and skill- and competency-based teaching models incorporating clinical and bench-top research. Attempts to improve work–life balance and minimize physician burnout have led to work-hour restrictions in postgraduate training programs. These restrictions have made it particularly challenging for orthopedic and neurosurgery residents to acquire the knowledge and skill set to meet the requirements for certification. The fast-paced flow of information and the rapid implementation of innovation require higher efficiencies in the modern postgraduate training environment. However, what is taught typically lags several years behind. Examples include minimally invasive tissue-sparing techniques through tubular small-bladed retractor systems, robotic and navigation, endoscopic, patient-specific implants made possible by advances in imaging technology and 3D printing, and regenerative strategies. Currently, the traditional roles of mentee and mentor are being redefined. The future orthopedic surgeons and neurosurgeons involved in personalized surgical pain management will need to be versed in several disciplines ranging from bioengineering, basic research, computer, social and health sciences, clinical study, trial design, public health policy development, and economic accountability. Solutions to the fast-paced innovation cycle in orthopedic surgery and neurosurgery include adaptive learning skills to seize opportunities for innovation with execution and implementation by facilitating translational research and clinical program development across traditional boundaries between clinical and nonclinical specialties. Preparing the future generation of surgeons to have the aptitude to keep up with the rapid technological advances is challenging for postgraduate residency programs and accreditation agencies. However, implementing clinical protocol change when the entrepreneur–investigator surgeon substantiates it with high-grade clinical evidence is at the heart of personalized surgical pain management

Effectiveness analysis of traditional and mixed reality simulations in medical training: a methodological approach for the assessment of stress, cognitive load and performance

La simulazione nell'educazione in medicina è considerata un metodo di formazione in grado di migliorare le competenze cliniche e il comportamento degli operatori sanitari e, di conseguenza, la qualità dell'assistenza per il paziente. Inoltre, l'utilizzo di nuove tecnologie come la Realtà Aumentata, offre ai discenti l'opportunità di esercitarsi in un ambiente immersivo. L'opportunità di sperimentare questo innovativo metodo didattico è efficace non solo nel ridurre il rischio di errori e approcci sbagliati ma anche nel provare ansia e stress simili a quelli avvertiti nella pratica reale. La sfida sta nel trovare il giusto equilibrio. I discenti devono infatti provare lo stesso stress che avvertirebbero lavorando ad un vero caso clinico ma, allo stesso tempo, devono essere controllati ed evitati possibili disturbi da stress post-traumatico, verificabili soprattutto nel campo della gestione delle emergenze (pronto soccorso). Inoltre, è fondamentale anche ottenere alte prestazioni e un apprendimento adeguato, evitando sovraccarichi cognitivi che influenzerebbero negativamente l’apprendimento. Tuttavia, ad oggi mancano ancora studi approfonditi sull'impatto che le simulazioni mediche hanno su stress, frustrazione, carico cognitivo e apprendimento dei discenti. Per questo motivo, l'obiettivo principale di questo studio è valutare l'efficacia del training tramite simulazione, analizzando prestazioni, ansia, stress e carico cognitivo durante simulazioni cliniche tradizionali (con manichino) ed avanzate (in realtà mista). A questo scopo, è stato sviluppato un approccio metodologico strutturato e completo per valutare le prestazioni, le condizioni emotive e cognitive degli studenti. Questo comprende l'acquisizione e l'analisi di parametri psicologici (valutazione soggettiva), segnali biometrici (valutazione oggettiva) e prestazioni. Questa indagine consente di evidenziare i punti deboli delle simulazioni e offre l'opportunità di definire utili linee guida per la riprogettazione e l'ottimizzazione delle stesse. La metodologia è stata applicata su tre casi studio: il primo si riferisce a simulazioni ad alta fedeltà per la gestione del paziente in pronto soccorso, il secondo si riferisce a simulazioni a bassa fedeltà per la pratica della rachicentesi. Per il terzo caso studio, è stato progettato e sviluppato un prototipo di simulatore in realtà mista per la rachicentesi, con l'obiettivo di migliorare il senso di realismo e immersione della simulazione a bassa fedeltà. 148 studenti sono stati coinvolti nei primi due casi studio osservazionali, mentre soltanto 36 studenti hanno preso parte allo studio pilota sulla simulazione in realtà mista. In tutti i casi di studio sono state effettuate analisi descrittive delle prestazioni, degli stati cognitivi ed emotivi. Per le simulazioni ad alta e bassa fedeltà, le analisi di regressione statistica hanno evidenziato quali variabili influenzano le prestazioni, lo stress e il carico cognitivo degli studenti. Per lo studio pilota sulla realtà mista, l'analisi della user experience ha sottolineato i limiti tecnici della nuova tecnologia.Simulation in medical education is considered a training method capable of improving clinical competence and practitioners’ behaviour, and, consequently quality of care and patient’s outcome. Moreover, the use of new technologies, such as augmented reality, offers to the learners the opportunity to engage themselves in an immersive environment. The opportunity to experiment with this innovative instructional method is effective not only in reducing the risk of errors and wrong approaches but also in experiencing anxiety and stress as in real practice. The challenge is to find the right stress balance: learners have to feel as if they were practicing in the real stressful clinical case, and, at the same time, post-traumatic stress disorders, verifiable especially in the emergency field, must be controlled and avoided. Moreover, it is fundamental also to obtain high performance and learning, thus avoiding cognitive overloads. However, extensive researches about the impact of medical simulations on students’ stress, frustration, cognitive load, and learning are still lacking. For this reason, the main objective of this study is to assess simulation training effectiveness by analysing performance, anxiety, stress, and cognitive load during traditional (with manikin) and advanced (with augmented reality) clinical simulations. A structured and comprehensive methodological approach to assess performance, emotional and cognitive conditions of students has been developed. It includes the acquisition and analysis of psychological parameters (subjective assessment), biometric signals (objective assessment), and task performance. This investigation allows to point out simulations’ weaknesses and offers the opportunity to define useful optimisation guidelines. The methodology has been applied to three case studies: the first one refers to high-fidelity simulations, for the patient management in the emergency room, the second one refers to low-fidelity simulation for rachicentesis. For the third case study, a prototype of a mixed reality simulator for the rachicentesis practice has been designed and developed aiming at improving the sense of realism and immersion of the low-fidelity simulation. While 148 students have been enrolled in the first two case studies, only 36 students have taken part in the pilot study about mixed reality simulation. Descriptive analysis about performance, cognitive and emotional states have been done in all the case studies. For the high-fidelity and low-fidelity simulations, the statistical regression analysis has pointed out which variables affect students’ performance, stress, and cognitive load. For the pilot study about mixed reality, the user experience analysis highlighted the technical limitations of the new technology

Usability analysis of contending electronic health record systems

In this paper, we report measured usability of two leading EHR systems during procurement. A total of 18 users participated in paired-usability testing of three scenarios: ordering and managing medications by an outpatient physician, medicine administration by an inpatient nurse and scheduling of appointments by nursing staff. Data for audio, screen capture, satisfaction rating, task success and errors made was collected during testing. We found a clear difference between the systems for percentage of successfully completed tasks, two different satisfaction measures and perceived learnability when looking at the results over all scenarios. We conclude that usability should be evaluated during procurement and the difference in usability between systems could be revealed even with fewer measures than were used in our study. © 2019 American Psychological Association Inc. All rights reserved.Peer reviewe

Virtual and Augmented Reality: New Frontiers for Clinical Psychology

In the last decades, the applied approach for the use of virtual reality (VR) and augmented reality (AR) on clinical and health psychology has grown exponentially. These technologies have been used to treat several mental disorders, for example, phobias, stress-related disorders, depression, eating disorders, and chronic pain. The importance of VR/AR for the mental health field comes from three main concepts: (1) VR/AR as an imaginal technology, people can feel “as if they are” in a reality that does not exist in external world; (2) VR/AR as an embodied technology, the experience to feel user’s body inside the virtual environment; and (3) VR/AR as connectivity technology, the “end of geography’. In this chapter, we explore the opportunities provided by VR/AR as technologies to improve people’s quality of life and to discuss new frontiers for their application in mental health and psychological well-being promotion