Ophthalmoscopy simulation: advances in training and practice for medical students and young ophthalmologists

Objective: To describe and appraise the latest simulation models for direct and indirect ophthalmoscopy as a learning tool in the medical field. Methods: The present review was conducted using four national and international databases PubMed, Scielo, Medline and Cochrane. Initial set of articles was screened based on title and abstracts, followed by full text analysis. It comprises of articles that were published in the past fifteen years (2002-2017). Results: Eighty-three articles concerning simulation models for medical education were found in national and international databases, with only a few describing important aspects of ophthalmoscopy training and current application of simulation in medical education. After secondary analysis, 38 articles were included. Conclusion: Different ophthalmoscopy simulation models have been described, but only very few studies appraise the effectiveness of each individual model. Comparison studies are still required to determine best approaches for medical education and skill enhancement through simulation models, applied to both medical students as well as young ophthalmologists in training.Laureate Int Univ, Sch Med, Dept Ophthalmol, Rua Doutor Almeida Lima 1-134, BR-03164000 Sao Paulo, SP, BrazilFed Univ Sao Paulo UNIFESP, Dept Ophthalmol, Sao Paulo, SP, BrazilFed Univ Sao Paulo UNIFESP, Dept Ophthalmol, Sao Paulo, SP, BrazilWeb of Scienc

A VIRTUAL SIMULATOR AS A TOOL FOR TEACHING REFRACTOMETRY

Significance: Several educational technological innovations are developed with the purpose of contributing to the training of future optometrists and ophthalmologists. However, very little is available for teaching refractometry. EYE REFRACTION is a simulator mobile applications (App) that works as a fast, straightforward and interactive interface tool for teaching refractometry. Purpose: Develop novel mobile application software (EYE REFRACTION) as a tool for teaching refractometry in medical schools. Methods: EYE REFRACTION software was developed by the emerging company “Ciência Ilustrada studio” incubated at “INOVA Metrópole” of the Digital Metropolis Institute of the Universidade Federal do Rio Grande do Norte, Brazil (IMD-UFRN), using the XCode 4.6.2. program (Apple Computer, Inc. Cupertino, CA, USA). This application software (App) was created for Tablets and has a fully interactive workspace, where after inserting the refraction data of the patient, the user can observe points or focal lines of the refractive errors and all the arrangements resulting from the various possible corrections. Results: After 90 days of blind and random simulations of the EYE REFRACTION App performed by volunteered ophthalmologists, six failures were detected and promptly corrected. Two were detected when refractive errors were simulated (simple myopic astigmatism), two during simulations of hypermetropic astigmatism, being one simple and the other compound, and two others during the simulation of mixed astigmatism. Conclusion: A novel App for teaching refractometry was successfully developed, where it enabled a real-time observation of refractive errors and their arrangements. The EYE REFRACTION App is currently available at Apple App Store

Realidade aumentada num simulador virtual de tomada de decisão clínica

A presente investigação teve como objetivo verificar se a Realidade Aumentada (RA) potencia o desenvolvimento de competências de tomada de decisão clínica no diagnóstico e tratamento de feridas crónicas, aumenta a motivação dos estudantes e a usabilidade do simulador virtual e-FER. O e-FER é um simulador online de tomada de decisão clínica utilizado na formação inicial de enfermeiros, permitindo simular o diagnóstico e tratamento de casos clínicos virtuais de feridas crónicas. Para o presente estudo foi acrescentada uma componente de RA com novos casos clínicos, no sentido de investigar os seus efeitos na motivação, usabilidade e desenvolvimento de competências no diagnóstico e tratamento de feridas crónicas. Desenvolveu-se um estudo quase-experimental com uma amostra de 54 estudantes a frequentar o primeiro ano de Enfermagem. Realizou-se uma análise comparativa entre o desempenho dos grupos experimental (que utilizou o e-FER tradicional e depois com RA) e de controlo (que utilizou apenas o e-FER tradicional), com base nos dados extraídos a partir do simulador virtual e-FER. Os dados relativos à motivação dos estudantes e usabilidade do sistema foram recolhidos através de questionário. Os resultados obtidos permitem concluir que a RA potenciou o desempenho dos estudantes, particularmente nos parâmetros de diagnóstico da ferida, com diferenças estatisticamente muito significativas (p<0,001) nos testes de Mann-Whitney U e Wilcoxon, registando-se ainda índices elevados de motivação e usabilidade do simulador, mesmo com a introdução de um dispositivo adicional na atividade.The goal of this investigation was to verify if Augmented Reality (AR) enhances the development of clinical decision-making skills in wound diagnosis and treatment, increases student motivation and the usability of the e-FER virtual simulator. The e-FER is an online clinical decision-making simulator used in the initial training of nurses, allowing to simulate the diagnosis and treatment of virtual clinical cases of chronic wounds. In this study an AR component was added with new clinical cases, in order to investigate its effects on motivation, usability and the development of wound diagnosis and treatment skills. A quasi-experimental study was conducted with a sample of 54 students attending the first year of a Nursing program. A comparative analysis between the progress of the experimental group (who used the traditional e-FER and then with AR) and the control group (who used only the traditional e-FER) was made using the data extracted from the e-FER virtual simulator. Data on student's motivation and system usability were collected through a questionnaire. The results showed that AR enhanced student performance, particularly in wound diagnostic parameters, with highly statistically significant differences (p<0,001) in the Mann-Whitney U and Wilcoxon tests, and registering high levels of motivation and simulator usability, even with the introduction of an additional device in the activity

Algorithms for Building High-Accurate Optical Tracking Systems

Die vorliegende Arbeit präsentiert eine Untersuchung von Einflussfaktoren auf die Genauigkeit eines optischen Trackingsystems zur hoch präzisen Koordinatenmessung, wie sie beispielsweise im Bereich der Computer-unterstützten Chirurgie benötigt wird. Zu den Haupteinflussfaktoren gehören die Modellierung der Aufnahmegeometrie, die verwendeten Bildverarbeitungsalgorithmen zur Markensegmentierung, welche sowohl während der Systemkalibrierung als auch während des eigentlichen Messvorgangs verwendet werden, und nicht zuletzt thermische Einflüsse.Wahrend die Modellierung der Kamerageometrie ein gut erforschter Gegenstand sowohl im Bereich der Photogrammetrie als auch des Maschinellen Sehens darstellt, existieren fur den Vergleich von verschiedenen Markentypen und deren Segmentierungsalgorithmen in bezug auf die Messgenauigkeit noch keine umfassenden Ergebnisse. Einen weiteren Bereich, der nahezu nicht untersucht ist, bilden thermische Einflüsse auf die zugrundeliegende Aufnahmegeometrie. Die vorliegende Arbeit legt ihren Schwerpunkt auf diese zwei Bereiche. Zum einen werden verschiedene Algorithmen zur Segmentierung von Messmarken vorgestellt und miteinander verglichen. Den zweiten großen Schwerpunkt bildet eine Analyse von thermischen Einflussen auf Kameras. Es wird ein Verfahren entwickelt, welches den Einfluss von Temperaturänderungen modelliert und so Messfehler kompensieren kann. Die Ergebnisse dieser Arbeit finden Anwendung in der Entwicklung eines optischen Trackingsystems fur den Einsatz in der orthopädischen Chirurgie

Ein modulares optisches Trackingsystem für medizintechnische Anwendungen: integrierte Datenflussarchitektur in Hard- und Software und Applikationsframework

Die vorliegende Arbeit beschreibt die Entwicklung eines modularen optischen Trackingsystems, ausgerichtet auf die speziellen Anforderungen im medizintechnischen Umfeld. Das Spektrum der vorgestellten Anwendungen des Systems reicht dabei von der Erfassung der Benutzerinteraktion in verschiedenen medizinischen Simulatoren (z.B. für Ophthalmochirurgie, Ophthalmoskopie und Neurochirurgie) bis hin zur Positionserfassung eines handgehaltenen Operationsroboters. Im Unterschied zu verfügbaren kommerziellen Trackingsystemem mit ihren eng umrissenen Anwendungsbereichen wird ein universell ausgelegtes Baukastensystem vorgestellt, das sich mit geringem Entwicklungsaufwand an die speziellen Anforderungen der jeweiligen Anwendungen anpassen lässt (so u.a. sehr kleine Geometrien, deformierbare Objekte, Einsatz von Originalinstrumenten, geringe Ressourcenverfügbarkeit im Simulator-PC). Zu diesem Zweck wird ein modulares Systemkonzept entwickelt, welches von der spezialisierten Datenverarbeitung gängiger Trackingsysteme abstrahiert und auf einer generalisierten, modularen Systemarchitektur für den Einsatz aller Arten von Markern mit drei Freiheitsgraden aufbaut. Neben den verbreiteten infrarotbasierten Signaliserungstechniken werden dabei auch passive Farbmarker zur Objektsignalisierung unterstützt. Die Implementierung von Bildverarbeitungsaufgaben in spezialisierter Hardware (FPGAs) direkt auf dem Kameradatenstrom ermöglicht eine frühzeitige Datenreduktion und damit niedrige Latenzzeiten. Der Entwicklungsprozess für neuartige Trackinglösungen wird vereinfacht durch die enge Integration der Hard- und Softwaremodule in einer einheitlichen durchgängigen Datenflussarchitektur, die flexibel an die jeweilige Aufgabenstellung anpassbar ist. Ein erweiterbares graphisches Frontend schließlich unterstützt bei Betrieb und Konfiguration und erlaubt auch die Simulation ganzer Systeme während der Entwicklung

Online courses for healthcare professionals: is there a role for social learning?

Background: All UK postgraduate medical trainees receive supervision from trained supervisors. Training has traditionally been delivered via face to face courses, but with increasing time pressures and complex shift patterns, access to these is difficult. To meet this challenge, we developed a two-week massive open online course (MOOC) for faculty development of clinical supervisors. Summary of Work: The MOOC was developed by a group of experienced medical educators and delivered via the FutureLearn (FL) platform which promotes social learning through interaction. This facilitates building of communities of practice, learner interaction and collaboration. We explored learner perceptions of the course, in particular the value of social learning in the context of busy healthcare professionals. We analysed responses to pre- and post-course surveys for each run of the MOOC in 2015, FL course statistics, and learner discussion board comments. Summary of Results: Over 2015, 7,225 learners registered for the course, though 6% left the course without starting. Of the 3,055 learners who began the course, 35% (1073/3055) were social learners who interacted with other participants. Around 31% (960/3055) learners participated fully in the course; this is significantly higher than the FL average of 22%. Survey responses suggest that 68% learners worked full-time, with over 75% accessing the course at home or while commuting, using laptops, smart phones and tablet devices. Discussion: Learners found the course very accessible due to the bite-sized videos, animations, etc which were manageable at the end of a busy working day. Inter-professional discussions and social learning made the learning environment more engaging. Discussion were rated as high quality as they facilitated sharing of narratives and personal reflections, as well as relevant resources. Conclusion: Social learning added value to the course by promoting sharing of resources and improved interaction between learners within the online environment. Take Home Messages: 1) MOOCs can provide faculty development efficiently with a few caveats. 2) Social learning added a new dimension to the online environment

Clamp-assisted retractor advancement for lower eyelid involutional entropion

Scientific Poster 144PURPOSE: To describe a novel approach to internal repair of lower lid entropion using the Putterman clamp. METHODS: Retrospective, consecutive case series of patients with entropion who underwent retractor advancement using the clamp. RESULTS: Seven eyes of 6 patients (average age: 80; 4 women and 2 men) were analyzed. Complete resolution was achieved in 5 of the 6 patients (83.3%). The 1 patient with recurrence had 2 previous entropion surgeries on each eye over the past 4 years; there was lid laxity, and horizontal tightening was needed. No severe adverse events occurred in the patients. CONCLUSION: Clamp-assisted lower lid retractor advancement offers a safe and effective, minimally invasive approach to involutional entropion. Further study is needed to assess its role in recurrent entropion.postprin