La simulazione medica nel futuro: un tentativo di visioning The health simulation in the future: an attempt of visioning

La pratica clinica è un componente indispensabile dell’apprendimento e del mantenimento delle competenze in molte delle discipline sanitarie e la simulazione offre l’opportunità di praticare in maniera sicura ed efficace senza rischi per il paziente. La simulazione nella didattica medica si è già ampiamente evoluta rispetto alle sue fasi iniziali. L’introduzione dei simulatori di pazienti umani, intorno alla fine del XX secolo, rappresenta una tappa fondamentale nella scienza dell’educazione in sanità. Fino ad oggi l’attenzione degli sviluppatori si è concentrata da un lato sulla capacità dei simulatori di dare feedback verosimili e coerenti con il comportamento del paziente e con la fisiologia umana e dall’altro sull’interazione fra simulatore e utilizzatore. Le emergenti tecnologie nel campo della percezione sensoriale apporteranno miglioramenti significativi sia nella formazione in simulazione che nella gestione della simulazione stessa. Basandosi sull’analisi delle tecnologie attualmente disponibili e in via di sviluppo, questo scritto vuole essere uno sforzo di visioning sul futuro delle tecniche di simulazione. Nano-sensori e nano-attuatori, usati nella realtà aumentata/virtuale/ mista, permetteranno sia la concettualizzazione di sistemi capaci di aumentare il livello di realismo e di immersione sensoriale ma anche di mappare i movimenti e le azioni al fine di generare protocolli univoci di intervento. Proiettandoci in un ipotetico 2025, la simulazione medica sarà un’esperienza democratica, largamente accessibile, dinamica e immersiva a 360°, grazie alle tecniche di implementazione neuro-percettive.Practice is a key component of skills learning and maintenance in many health disciplines and simulation offers the opportunity to practice in a safe and effective manner improving patient safety. Simulation for healthcare training has already evolved through its initial historical phases. The introduction of human patient simulator toward the end of the 20th century was a milestone in health sciences education. To date the attention of developers has been paid to the capability of the simulator to give feedback, consistent with patient behavior and physiologic response, and the interaction between simulator and users. The emerging technologies in the field of sensorial perception will bring improvements both in education and in management of the simulation. Grounding on the analysis of current and under-development technology, the manuscript is an attempt of visioning simulation-based training in health education in a coming future. Nano-sensors and nano-actuators, used in augmented/virtual/mixed reality, will allow the conceptualization of systems increasing the level of realism and the sensorial immersion, and the mapping of movements and action in order to generate univocal protocols of intervention. Projecting ourselves in 2025, medical simulation will be a democratic, largely accessible, dynamic and 360° sensorial experience, thanks to techniques of neuro-perceptive implementation

Assessment of gastric pouch blood supply with indocyanine green fluorescence in conversional and revisional bariatric surgery: a prospective comparative study

Abstract Our study aimed to evaluate the usefulness of indocyanine green (ICG) angiography during conversional or revisional bariatric surgery. We prospectively enrolled all patients scheduled for reoperative bariatric surgery with gastric pouch resizing and ICG assessment and we compared them with a retrospective series of similar patients who did not receive ICG. The primary outcome was the rate of intraoperative change in the surgical strategy due to the ICG test. We included 32 prospective patients receiving intraoperatively an ICG perfusion test and 48 propensity score-matched controls. The mean age was 50.7 ± 9.7 years, 67 (83.7%) patients were female, and the mean BMI was 36.8 ± 5.3 kg/m2. The patient characteristics were similar in both groups. The ICG angiography was successfully conducted in all patients, and no change of the surgical strategy was necessary. Postoperative complications were similar in both groups (6.2% vs. 8.3%, p = 0.846), as well as operative time (125 ± 43 vs. 133 ± 47 min, p = 0.454) and length of hospital stay (2.8 ± 1.0 vs. 3.3 ± 2.2 days, p = 0.213). Our study suggested that ICG fluorescence angiography might not have been useful for assessing the blood supply of the gastric pouch in patients who underwent reoperative bariatric surgery. Therefore, it remains uncertain whether the application of this technique is indicated

Validation of the Italian version of the PSP Quality of Life questionnaire

Progressive supranuclear palsy (PSP) is a rare rapidly progressive, neurodegenerative disease characterized by falls and ocular movement disturbances. The use of health-related quality of life (HR-QoL) measures allows assessing changes in health status induced by therapeutic interventions or disease progress in neurodegenerative diseases. The PSP-QoL is a 45-item, self-administered questionnaire designed to evaluate HR-QoL in PSP