3D - Printed Patient Specific Instrumentation in Corrective Osteotomy of the Femur and Pelvis: A Review of the Literature

Background: The paediatric patient population has considerable variation in anatomy. The use of Computed Tomography (CT)-based digital models to design three-dimensionally printed patient specific instrumentation (PSI) has recently been applied for correction of deformity in orthopedic surgery. This review sought to determine the existing application of this technology currently in use within paediatric orthopaedics, and assess the potential benefits that this may provide to patients and surgeons. Methods: A review was performed of MEDLINE, EMBASE, and CENTRAL for published literature, as well as Web of Science and clinicaltrials.gov for grey literature. The search strategy revolved around the research question: “What is the clinical impact of using 3D printed PSI for proximal femoral or pelvic osteotomy in paediatric orthopaedics?” Two reviewers, using predetermined inclusion criteria, independently performed title and abstract review in order to select articles for full text review. Data extracted included effect on operating time and intraoperative image use, as well as osteotomy and screw positioning accuracy. Data were combined in a narrative synthesis; meta-analysis was not performed given the diversity of study designs and interventions. Results: In total, ten studies were included: six case control studies, three case series and a case report. Five studies directly compared operating time using PSI to conventional techniques, with two showing a significant decrease in the number of intraoperative images and operative time. Eight studies reported improved accuracy in executing the surgical plan compared to conventional methods. Conclusion: Compared to conventional methods of performing femoral or pelvic osteotomy, use of PSI has led to improved accuracy and precision, decreased procedure times, and decreased intra-operative imaging requirements. Additionally, the technology has become more cost effective and accessible since its initial inception and use

Exploring the value of three-dimensional printing and virtualization in paediatric healthcare: A multi-case quality improvement study

Background Three-dimensional printing is being utilized in clinical medicine to support activities including surgical planning, education, and medical device fabrication. To better understand the impacts of this technology, a survey was implemented with radiologists, specialist physicians, and surgeons at a tertiary care hospital in Canada, examining multidimensional value and considerations for uptake. Objectives To examine how three-dimensional printing can be integrated into the paediatric context and highlight areas of impact and value to the healthcare system using Kirkpatrick's Model. Secondarily, to explore the perspective of clinicians utilizing three-dimensional models and how they make decisions about whether or not to use the technology in patient care. Methods A post-case survey. Descriptive statistics are provided for Likert-style questions, and a thematic analysis was conducted to identify common patterns in open-ended responses. Results In total, 37 respondents were surveyed across 19 clinical cases, providing their perspectives on model reaction, learning, behaviour, and results. We found surgeons and specialists to consider the models more beneficial than radiologists. Results further showed that the models were more helpful when used to assess the likelihood of success or failure of clinical management strategies, and for intraoperative orientation. We demonstrate that three-dimensional printed models could improve perioperative metrics, including a reduction in operating room time, but with a reciprocal effect on pre-procedural planning time. Clinicians who shared the models with patients and families thought it increased understanding of the disease and surgical procedure, and had no effect on their consultation time. Conclusions Three-dimensional printing and virtualization were used in preoperative planning and for communication among the clinical care team, trainees, patients, and families. Three-dimensional models provide multidimensional value to clinical teams, patients, and the health system. Further investigation is warranted to assess value in other clinical areas, across disciplines, and from a health economics and outcomes perspective

Comparing a Virtual Reality–Based Simulation App (VR-MRI) With a Standard Preparatory Manual and Child Life Program for Improving Success and Reducing Anxiety During Pediatric Medical Imaging: Randomized Clinical Trial

BackgroundThe experience of undergoing magnetic resonance imaging (MRI) can be anxiety provoking, particularly for pediatric patients and their families. Alternative methods to improve success and experiences without the use of sedation are needed. ObjectiveThis study aims to compare the effectiveness of a virtual reality (VR)—based simulation app (VR-MRI) with a standard preparatory manual (SPM) and a hospital-based Child Life Program (CLP) on success and anxiety during a simulated pediatric MRI scan. Our secondary aim is to compare caregivers’ reported anxiety, procedural data, caregiver usability, child satisfaction, and fun. MethodsThis unblinded, randomized, triple-arm clinical trial involved 92 children aged 4-13 years and their caregivers. Recruitment was conducted through posters, public libraries, community centers, and social media. At a 2-hour session, participants were instructed to prepare for a simulated MRI head scan using one of three randomly assigned preparation materials: the VR-MRI app, SPM, or the CLP. Data were collected before preparation, during a simulated MRI head scan, and after the simulated scan. The primary outcomes were the success of the simulated MRI scan (MoTrak head motion tracking system), and child-reported anxiety (Venham picture test). We secondarily measured caregivers’ reported anxiety (short State-Trait Anxiety Inventory), procedural data (minutes), usability (Usefulness, Satisfaction, and Ease of Use Questionnaire), and child-reported satisfaction and fun (visual analog scales). ResultsA total of 84 participants were included in the final analysis (VR-MRI: 30/84, 36%; SPM: 24/84, 29%; and CLP: 30/84, 36%). There were no clinically significant differences between the groups in terms of success during the MRI simulation (P=.27) or the children’s reported anxiety at any timepoint (timepoint 1, P=.99; timepoint 2, P=.008; timepoint 3, P=.10). Caregivers reported being significantly more anxious after preparing with the manual than caregivers in the other 2 groups (P<.001). Child and caregiver anxiety had a significant relationship, increasing together with moderate effect (r84=0.421; P<.001). Participants using VR-MRI took the most time to prepare (P<.001) and participants using the manual took the least time (P<.001). No statistically significant relationships were found between time preparing and time completing the simulated assessment (P=.13). There were no differences found in ease of use (P=.99), ease of learning (P=.48), and usefulness (P=.11) between the groups; however, caregivers reported being significantly more satisfied with the VR-MRI app and CLP than SPM (P<.001). Children reported the most satisfaction with the CLP (P<.001). There were no differences in how much fun the preparation materials were perceived to be (P=.37). ConclusionsDigital preparation experiences using VR-based media could be a viable solution to improve the success of nonsedated MRI scans, with outcomes comparable with hospital-based in-person preparatory programs. Future research should focus on validating the results in a real MRI setting. Trial RegistrationClinicaltrials.gov NCT03931382; https://clinicaltrials.gov/ct2/show/NCT0393138

Analyzing Implicit Science and Math Outcomes in Engineering and Technology Programs

One of the key steps when developing pathways between baccalaureate and diploma programs is comparing learning goals between the programs. This paper presents application of a seven-dimensional framework (cognitive process, transferability, depth of analysis, interdependence, question novelty, scaffolding and communication) to analyze the implicit learning outcomes in 11 of Ontario’s post-secondary programs in engineering and engineering technology. We collected 319 calculus questions (179 from six technology programs and 140 from five engineering programs) and 205 physics questions (122 from two technology programs and 83 from four engineering programs). Content specialists assessed each question in the first four of these dimensions, and instructors from the participating institutions scored random questions from their own disclosed questions on the remaining dimensions. Analysis of scaffolding in physics questions showed that engineering questions mostly required the students to choose from or synthetize a range of approaches while technology questions often required the students to use a specific approach. The study found that technology programs focused more on discipline-specific physics concepts and their applications than physics courses in engineering. Calculus questions from both sectors mostly required application of mathematical concepts in non-contextualized scenarios or a general engineering context, with no significant difference in question novelty, scaffolding and level of communication. From a credits perspective, these results suggest that direct credit for bidirectional transfers may be warranted, and that small bridging learning modules targeting missing outcomes may be able to support efficient transfer pathways.Une des étapes principales lors du développement de trajectoires entre les programmes menant à un baccalauréat et ceux menant à un diplôme consiste à comparer les objectifs d’apprentissage entre ces programmes. Cet article présente l’application de sept cadres dimensionnels (processus cognitif, possibilité de transfert, profondeur d’analyse, interdépendance, nouveauté de la question, échafaudage et communication) pour analyser les résultats d’apprentissage implicites dans 11 programmes d’enseignement post-secondaire d’Ontario en génie et en technologie. Nous avons recueilli 319 questions de calcul (179 de six programmes de technologie et 140 de cinq programmes de génie) et 205 questions de physique (122 de deux programmes de technologie et 83 de quatre programmes de génie). Des spécialistes du contenu ont évalué chaque question dans les quatre premières de ces dimensions et les instructeurs des établissements participants ont noté des questions prises au hasard de leurs propres questions divulguées pour les dimensions restantes. L’analyse de l’échafaudage pour les questions de physique a indiqué que les questions de génie exigeaient principalement que les étudiants choisissent parmi une variété d’approches ou qu’ils en fassent la synthèse, alors que les questions de technologie exigeaient souvent que les étudiants utilisent une approche spécifique. Cette étude a montré que les programmes de technologie se concentraient davantage sur des concepts de physique spécifiques à la discipline et sur leurs applications par rapport aux programmes de physique en génie. Les questions de calcul des deux secteurs exigeaient principalement l’application de concepts mathématiques dans des scénarios non contextualisés ou dans un contexte de génie général, et il n’y avait pas de différence significative en ce qui concerne la nouveauté de la question, l’échafaudage et le niveau de communication. D’un point de vue des crédits, ces résultats suggèrent que le crédit direct pour les transferts bidirectionnels peut se justifier et que des petits modules d’apprentissage de relais qui ciblent les résultats manquants peuvent permettre de soutenir des trajectoires de transfert efficaces