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Escobar-Castillejos D, Noguez J, Bello F, et al., 2020, A review of training and guidance systems in medical surgery, Applied Sciences, Vol: 10, Pages: 1-35, ISSN: 2076-3417
In this paper, a map of the state of the art of recent medical simulators that provide evaluation and guidance for surgical procedures is performed. The systems are reviewed and compared from the viewpoint of the used technology, force feedback, learning evaluation, didactic and visual aid, guidance, data collection and storage, and type of solution (commercial or non-commercial). The works’ assessment was made to identify if—(1) current applications can provide assistance and track performance in training, and (2) virtual environments are more suitable for practicing than physical applications. Automatic analysis of the papers was performed to minimize subjective bias. It was found that some works limit themselves to recording the session data to evaluate them internally, while others assess it and provide immediate user feedback. However, it was found that few works are currently implementing guidance, aid during sessions, and assessment. Current trends suggest that the evaluation process’s automation could reduce the workload of experts and let them focus on improving the curriculum covered in medical education. Lastly, this paper also draws several conclusions, observations per area, and suggestions for future work.
Haghighi Osgouei R, Soulsby D, Bello F, 2020, Rehabilitation Exergames: use of motion sensing and machine learning to quantify exercise performance in healthy volunteers, JMIR Rehabilitation and Assistive Technologies, Vol: 7, ISSN: 2369-2529
Background:Performing physiotherapy exercises in front of a physiotherapist yields qualitative assessment notes and immediate feedback. However, practicing the exercises at home lacks feedback on how well or not patients are performing the prescribed tasks. The absence of proper feedback might result in patients doing the exercises incorrectly, which could worsen their condition.Objective:We propose the use of two machine learning algorithms, namely Dynamic Time Warping (DTW) and Hidden Markov Model (HMM), to quantitively assess the patient’s performance with respects to a reference.Methods:Movement data were recorded using a Kinect depth sensor, capable of detecting 25 joints in the human skeleton model, and were compared to those of a reference. 16 participants were recruited to perform four different exercises: shoulder abduction, hip abduction, lunge, and sit-to-stand. Their performance was compared to that of a physiotherapist as a reference.Results:Both algorithms show a similar trend in assessing participants' performance. However, their sensitivity level was different. While DTW was more sensitive to small changes, HMM captured a general view of the performance, being less sensitive to the details.Conclusions:The chosen algorithms demonstrated their capacity to objectively assess physical therapy performances. HMM may be more suitable in the early stages of a physiotherapy program to capture and report general performance, whilst DTW could be used later on to focus on the detail.
Muangpoon T, Haghighi Osgouei R, Escobar-Castillejos D, et al., 2020, Augmented reality system for digital rectal examination training and assessment: system validation, Journal of Medical Internet Research, Vol: 22, Pages: 1-13, ISSN: 1438-8871
Background: Digital rectal examination is a difficult examination to learn and teach because of limited opportunities for practice; however, the main challenge is that students and tutors cannot see the finger when it is palpating the anal canal and prostate gland inside the patients.Objective: This paper presents an augmented reality system to be used with benchtop models commonly available in medical schools with the aim of addressing the problem of lack of visualization. The system enables visualization of the examining finger, as well as of the internal organs when performing digital rectal examinations. Magnetic tracking sensors are used to track the movement of the finger, and a pressure sensor is used to monitor the applied pressure. By overlaying a virtual finger on the real finger and a virtual model on the benchtop model, students can see through the examination and finger maneuvers.Methods: The system was implemented in the Unity game engine (Unity Technologies) and uses a first-generation HoloLens (Microsoft Inc) as an augmented reality device. To evaluate the system, 19 participants (9 clinicians who routinely performed digital rectal examinations and 10 medical students) were asked to use the system and answer 12 questions regarding the usefulness of the system.Results: The system showed the movement of an examining finger in real time with a frame rate of 60 fps on the HoloLens and accurately aligned the virtual and real models with a mean error of 3.9 mm. Users found the movement of the finger was realistic (mean 3.9, SD 1.2); moreover, they found the visualization of the finger and internal organs were useful for teaching, learning, and assessment of digital rectal examinations (finger: mean 4.1, SD 1.1; organs: mean 4.6, SD 0.8), mainly targeting a novice group.Conclusions: The proposed augmented reality system was designed to improve teaching and learning of digital rectal examination skills by providing visualization of the finger and internal or
Clark AE, Shaw CJ, Bello F, et al., 2020, Quantitating skill acquisition with optical ultrasound simulation, Australasian Journal of Ultrasound in Medicine, Vol: 23, Pages: 183-193, ISSN: 1836-6864
ObjectiveTo investigate and compare the effect of simulator training on quantitative scores for ultrasound‐related skills for trainees with novice level ultrasound experience and expert ultrasound operators.MethodsThree novice (comprising of 11, 32, 23 participants) and one expert (10 participants) subgroups undertook an ultrasound simulation training session. Pre‐ and post‐training test scores were collected for each subgroup. Outcome measures were as follows: mean accuracy score for obtaining the correct anatomical plane, percentage of correctly acquired target planes, mean number of movements, time to achieve image, distance travelled by probe and accumulated angling of the probe.ResultsThe novices showed improvement in image acquisition after completion of the simulation training session with an improvement in the rate of correctly acquired target planes from 28–57% to 39–83%. This was not replicated in the experts. The novice’s individual ratios based on pre‐ vs. post‐training metrics improved between 1.7‐ and 4.3‐fold for number of movements, 1.9‐ and 6.7‐fold for distance, 2.0‐ and 5.2‐fold for time taken and 1.8‐ and 7.3‐fold for accumulated angling. Among the experts, there was no relationship between pre‐training simulator metrics and years of ultrasound experience.ConclusionsThe individual simulation metrics suggest the sessions were delivered at an appropriate level for basic training as novice trainees were able to show demonstrable improvements in both efficiency and accuracy on the simulator. Experts did not improve after the simulation modules, and the novice scores post‐training were similar to those of experts, suggesting the exercises were valid in testing ultrasound skills at novice but not expert level.
Marechal L, Balland P, Lindenroth L, et al., 2020, Toward a common framework and database of materials for soft robotics, Soft Robotics, Vol: 8, Pages: 1-14, ISSN: 2169-5172
To advance the field of soft robotics, a unified database of material constitutive models and experimental characterizations is of paramount importance. This will facilitate the use of finite element analysis to simulate their behavior and optimize the design of soft-bodied robots. Samples from seventeen elastomers, namely Body Double™ SILK, Dragon Skin™ 10 MEDIUM, Dragon Skin 20, Dragon Skin 30, Dragon Skin FX-Pro, Dragon Skin FX-Pro + Slacker, Ecoflex™ 00–10, Ecoflex 00–30, Ecoflex 00–50, Rebound™ 25, Mold Star™ 16 FAST, Mold Star 20T, SORTA-Clear™ 40, RTV615, PlatSil® Gel-10, Psycho Paint®, and SOLOPLAST 150318, were subjected to uniaxial tensile tests according to the ASTM D412 standard. Sample preparation and tensile test parameters are described in detail. The tensile test data are used to derive parameters for hyperelastic material models using nonlinear least-squares methods, which are provided to the reader. This article presents the mechanical characterization and the resulting material properties for a wide set of commercially available hyperelastic materials, many of which are recognized and commonly applied in the field of soft robotics, together with some that have never been characterized. The experimental raw data and the algorithms used to determine material parameters are shared on the Soft Robotics Materials Database GitHub repository to enable accessibility, as well as future contributions from the soft robotics community. The presented database is aimed at aiding soft roboticists in designing and modeling soft robots while providing a starting point for future material characterizations related to soft robotics research.
Cox W, Cavenagh P, Bello F, 2020, What are the benefits and risks of sharing patients’ diagnostic radiological images with them? A cross-sectional study of the perceptions of patients and clinicians in the UK, BMJ Open, Vol: 10, ISSN: 2044-6055
Objectives The objective for this work was to assess clinical experts’ and patients’ opinions on the benefits and risks of sharing patients’ diagnostic radiological images with them.Setting This study was conducted outside of the primary and secondary care settings. Clinical experts were recruited at a UK national imaging and oncology conference, and patients were recruited via social media.Participants 121 clinical experts and 282 patients completed the study. A further 73 patient and 10 clinical expert responses were discounted due to item non-response. Individuals were required to be a minimum of 18 years of age at the time of participation.Primary and secondary outcome measures This study was exploratory in nature. As such, the outcomes to be measured for demonstration of the successful completion of this study were generated organically through the process of the investigation itself. These were: (1) the delineation of the benefits available from, and the risks posed by, widening access to diagnostic radiological images; (2) establishment of the level and nature of demand for access to diagnostic radiological images; and (3) the identification of stakeholder requirements for accessing available benefit from diagnostic radiological images.Results 403 usable questionnaires were returned consisting of responses from clinical experts (n=121) and patients (n=282). Both groups acknowledge the potential benefits of this practice. Examples included facilitating communication, promoting patient engagement and supporting patients in accepting health information shared with them. However, both groups also recognised risks associated with image sharing, such as the potential for patients to be upset or confused by their images.Conclusions There is a demand from patients for access to their diagnostic radiological images alongside acknowledgement from clinical experts that there may be benefits available from this. However, due to the acknowledged risks, t
Haghighi Osgouei R, Marechal L, Kontovounisios C, et al., 2020, Soft pneumatic actuator for rendering anal sphincter tone, IEEE Transactions on Haptics, Vol: 13, Pages: 183-190, ISSN: 1939-1412
Sphincter tone examination, as part of digital rectal examination (DRE), can provide essential information to support the early detection of colorectal cancer. Mastering DRE skills for junior doctors is always challenging due to the lack of real training cases. In this article, we developed a soft pneumatic active actuator,made of a compound of silicone rubber materials, to mimic human sphincter muscles and simulate various anal sphincter tones for the purpose of training. Different pumping actuation (syringe and bellows) and driving mechanisms (linear, stepper, and servo motor) were implemented and compared for their effect on the rendered tones. A further comparison was made with a previous prototype based on a cable-driven mechanism. Both quantitative and qualitative assessments were conducted to evaluate the performance of each mechanism. A differential pressure sensor was used to measure applied pressure on a catheter balloon placed inside the sphincter, comparing the readings with anorectal manometry data obtained from real patients. Qualitative feedback was gathered through a user study with ten colorectal expert practitioners. Four questions were asked targeting reaction/response time, pressure level, pressure quality, and similarity to a real case. The results show the capacity and limitation of each mechanism, with the one based on a servo motor and a bellows being the most favourably rated.
Kebria PM, Nahavandi D, Khosravi A, et al., 2020, Adaptive Neural Network-based Perception and Awareness of Teleoperation Systems in Human-Machine Interactions, 1st IEEE International Conference on Human-Machine Systems (ICHMS), Publisher: IEEE, Pages: 178-183
Najdovski Z, Deshpande S, Wei L, et al., 2020, Investigating the Effectiveness of a Cable-driven Pinch-Grasp Haptic Interface, 14th Annual IEEE International Systems Conference (SysCon), Publisher: IEEE, ISSN: 1944-7620
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Haghighi Osgouei R, Soulsby D, Bello F, 2019, Rehabilitation exergames: use of motion sensing and machine learning to quantify exercise performance in healthy volunteers, Publisher: JMIR Publications
Background:Performing physiotherapy exercises in front of a physiotherapist yields qualitative assessment notes and immediate feedback. However, practicing the exercises at home lacks feedback on how well or not patients are performing the prescribed tasks. The absence of proper feedback might result in patients doing the exercises incorrectly, which could worsen their condition.Objective:We propose the use of two machine learning algorithms, namely Dynamic Time Warping (DTW) and Hidden Markov Model (HMM), to quantitively assess the patient’s performance with respects to a reference.Methods:Movement data were recorded using a Kinect depth sensor, capable of detecting 25 joints in the human skeleton model, and were compared to those of a reference. 16 participants were recruited to perform four different exercises: shoulder abduction, hip abduction, lunge, and sit-to-stand. Their performance was compared to that of a physiotherapist as a reference.Results:Both algorithms show a similar trend in assessing participants' performance. However, their sensitivity level was different. While DTW was more sensitive to small changes, HMM captured a general view of the performance, being less sensitive to the details.Conclusions:The chosen algorithms demonstrated their capacity to objectively assess physical therapy performances. HMM may be more suitable in the early stages of a physiotherapy program to capture and report general performance, whilst DTW could be used later on to focus on the detail.
Kelay TK, Ako E, Cook C, et al., 2019, Physician-patient interactions & communication with conscious patients during simulated cath-lab procedures: An exploratory study, BMJ Simulation & Technology Enhanced Learning, Vol: 5, ISSN: 2056-6697
Background This exploratory study investigates the feasibility for observing and evaluating intraoperative communication practices using simulation techniques. Complex procedures are increasingly performed on patients under local anaesthesia, where patients are fully conscious. Interventional cardiac procedures are one such example where patients have reported high levels of anxiety undergoing procedures. Although communication styles can serve to alleviate patient anxiety during interventions, leading to a better patient experience, there has been little observational research on communication, while patient perspectives in intraoperative contexts have been underexplored.Methods In this mixed-methods study, observational analysis was conducted on 20 video-recorded simulated scenarios, featuring physician operators (of varied experience levels), communication and interactions with a simulated patient (trained actor), in a controlled and highly realistic catheter laboratory setting. Two independent raters and the simulated patient embedded in scenarios retrospectively rated physician communication styles and interactions with the patient via four key parameters. Patient perspectives of communication were further explored via a quantitative measure of anxiety and semistructured qualitative interviews.Results While independent ratings of physician–patient communications demonstrated few discernible differences according to physicians’ experience level, patient ratings were consistently higher for experienced physicians and lower for novice physicians for the four interaction styles. Furthermore, the patient’s anxiety scores were differentiable according to operators’ experience level. Thematic analysis provided further insights into how patient perspectives, including affective dimensions are characterised, and how physician interactions can amplify or attenuate feelings of anxiety through tone of voice, continuity in communication during the pr
Kebria PM, Khosravi A, Nahavandi S, et al., 2019, Robust adaptive synchronisation of a single-master multi-slave teleoperation system over delayed communication, IEEE International Conference on Industrial Technology (IEEE ICIT), Publisher: IEEE, Pages: 193-198, ISSN: 2643-2978
Considering communication delays in networked multi-robot teleoperation systems, this paper proposes a new control strategy for synchronisation and stability purposes. A single-master and multi-slave (SMMS) networked robotic teleoperation system is considered. Based on a sliding surface combined with a smooth filtering and estimation methodology, a robust adaptive control is developed to guarantee the synchronisation and stability of the system in the presence of network-induced time-varying delays. Extensive simulation studies demonstrate the effectiveness of the developed control scheme.
Ramli HR, Misron N, Iqbal Saripan M, et al., 2019, A novel haptic interface for the simulation of endovascular interventions, International AsiaHaptics conference, Publisher: Springer, Pages: 178-182, ISSN: 1876-1100
Endovascular interventions are minimally invasive surgical procedures that are performed to diagnose and treat vascular diseases using flexible instruments known as guidewire and catheter. A popular method of developing the skills required to manipulate the instruments successfully is through the use of virtual reality (VR) simulators. However, the interfaces of current VR simulators have several shortcomings due to limitations in the instrument tracking and haptic feedback design. A major challenge in developing training simulators for endovascular interventional procedures is to unobtrusively access the central, co-axial guidewire for tracking and haptics. In this work, we designed a haptic interface using novel approaches to both. Instrument tracking is performed using a combination of an optical sensor and a transparent catheter. Haptic feedback is supplied by both off-the-shelf actuators and a bespoke electromagnetic actuator embedded within the catheter hub. Initial test results by expert interventionists have shown positive responses and further development is ongoing.
Imran A, Holden B, Weldon SM, et al., 2019, 'How to help your unwell child': a sequential simulation project, BMJ Simulation and Technology Enhanced Learning, Vol: 6, Pages: 127-128, ISSN: 2056-6697
Cox W, Cavenagh P, Bello F, 2019, Is the diagnostic radiological image an underutilised resource? Exploring the literature, Insights into Imaging, Vol: 10, ISSN: 1869-4101
The number of diagnostic imaging examinations being undertaken in the UK is rising. Due to the expensive nature of producing these examinations, and the risks associated with exposing living tissue to the ionising radiation used by many of the imaging techniques, this growth comes with both a financial and a human cost. In a time of limited resources, it is important that we are able to maximise the benefits which we extract from these resources. Therefore, a broad search of the current literature was undertaken to assess our current understanding of the nature of benefit available from diagnostic radiological images. Two broad categories of benefit were identified: Primary benefit (n=470) and Secondary benefit (n=49). Primary benefits are those which are related to the justification for undertaking the imaging, e.g., abnormality detection, to assist in diagnosis or staging, or acting as an aid to clinical decision making, or intervention. Secondary benefits are those that are not related to the justification for imaging, e.g. to promote patient engagement and understanding or to facilitate communication. Existing work considering Primary benefits is comprehensive. Secondary benefit, however is less well recognised and may not be reliably realised. Use of the image to realise these benefits has far reaching potential. Particularly, there may be underexplored benefits which access to the images may provide to patients. This represents a gap in existing research which should be addressed.
Kontovounisios C, Tekkis P, Bello F, 2019, 3D imaging and printing in pelvic colorectal cancer: 'The New Kid on the Block', Techniques in Coloproctology, Vol: 23, Pages: 171-173, ISSN: 1123-6337
Ramli HR, Arof MAM, Saripan MI, et al., 2019, Design of a modular testing platform for the handling and study of endovascular devices, IEEE-EMBS Conference on Biomedical Engineering and Sciences (IECBES), Publisher: IEEE, Pages: 255-258, ISSN: 2374-3220
A design for a modular testing platform to objectively evaluate the behavior and characteristics of specialized endovascular instruments (guidewires/catheters) was presented and discussed. The platform comprises of an instrument driving mechanism and an interchangeable channel module depending on the parameter that is being measured. This platform could be used to study and benchmark commercial endovascular instruments. Such a guide would be useful to assist clinicians in the selection of the best tools for a given procedure. and derive the behavioral model for each instrument.
Thanh N, Ngoc DN, Bello F, et al., 2019, A New Tensioning Method using Deep Reinforcement Learning for Surgical Pattern Cutting, IEEE International Conference on Industrial Technology (IEEE ICIT), Publisher: IEEE, Pages: 1339-1344, ISSN: 2643-2978
Ramli HR, Misron N, Saripan MI, et al., 2019, Development of a Haptic Feedback Actuator for an Endovascular Interventions Simulator Interface, 17th IEEE International Symposium on Haptic Audio-Visual Environments and Games (HAVE), Publisher: IEEE
Weil A, Weldon SM, Kronfli M, et al., 2018, A new approach to multi-professional end of life care training using a sequential simulation (SqS Simulation™) design: a mixed methods study, Nurse Education Today, Vol: 71, Pages: 26-33, ISSN: 0260-6917
BACKGROUND: A need for improved education and training for hospital staff caring for patients in the last year of life was identified at an urban UK hospital. Sequential Simulation (SqS Simulation™) is a type of simulation that recreates a patient's journey, considering the longitudinal element of care and how this might impact on the patient's experiences, wishes and needs. OBJECTIVES: The aim of this study was to investigate a new end of life care training intervention for multi-professional hospital staff, and its effect on their confidence in managing patients at the end of their life. SETTING/PARTICIPANTS: Based on the results of a formal Training Needs Analysis, four SqS Simulation™ specialty-based courses were designed for general medical and surgical multidisciplinary teams in an acute UK hospital. METHODS: Over three months, seven SqS Simulation™ sessions were attended by fifty-seven multidisciplinary healthcare professionals. A quasi-experimental mixed-methods study was conducted using open and closed-ended questionnaires, pre and post-intervention. Changes in course attendees' confidence levels were analysed and qualitative data from free-text answers informed potential reasons for any differences identified. RESULTS: Confidence improved for all professional cohorts (p < 0.001). The differences were found to be highly significant for 'doctors' (p < 0.001), significant for 'therapists' (p = 0.02) and not significant for the 'nurses' cohort (p = 0.238). This was explored further using a qualitative explanatory framework. Categories included: Communicating with Families; Teamwork; Goal Planning; Do Not Attempt Cardiopulmonary Resuscitation; Course Usefulness; Prior Training; and Clinical Experience. CONCLUSION: This study has shown an overall improvement in confidence across disciplines after attending a SqS Simulation™ course. The differences in quantitative results between disciplines were explored through the qualitative data
Haghighi Osgouei R, Soulsbv D, Bello F, 2018, An objective evaluation method for rehabilitation exergames, 2018 IEEE Games, Entertainment, Media Conference (GEM), Publisher: IEEE, Pages: 28-34
The aim of this work is to objectively evaluate the performance of patients using a virtual rehabilitation system called MIRA. MIRA is a software platform which converts conventional therapeutic exercises into games, enabling the user to practice the given exercise by playing a game. The system includes a motion sensor to track and capture user's movements. Our assessment of the performance quality is based on the recorded trajectories of the human skeleton joints. We employ two different machine learning approaches, dynamic time warping (DTW) and hidden Markov modeling (HMM), both widely used for gesture recognition, to compare the user's performance with that of a reference as ground truth.
Granados A, Low-Beer N, Higham J, et al., 2018, Real-time visualisation and analysis of clinicians’ performance during alpation in physical examinations, IEEE Transactions on Biomedical Engineering, Vol: 65, Pages: 2042-2051, ISSN: 0018-9294
Objective: Motivated by the fact that palpation skills are challenging to learn and teach, particularly during Digital Rectal Examinations (DRE), and the lack of understanding of what constitutes adequate performance, we present a visualization and analysis system that uses small position and pressure sensors located on the examining finger, allowing the quantitative analysis of duration, steps, and pressure applied. Methods: The system is first described, followed by an experimental study of 20 experts from four clinical specialties performing ten DREs each on a benchtop model using the proposed system. Analysis of the constitutive steps was conducted to improve understanding of the examination. A Markov model representing executed tasks and analysis of pressure applied is also introduced. Results: The proposed system successfully allowed the visualization and analysis during the experimental study. General practitioners and nurses were found to execute more tasks compared to urologists and colorectal surgeons. Urologists executed the least number of tasks and were the most consistent group compared to others. Conclusion: The ability to “see through” allowed us to better characterize the performance of experts when conducting a DRE on a benchtop model, comparing the performance of relevant specialties, and studying executed tasks and the pressure applied. The Markov model presented summarizes task execution of experts and could be used to compare the performance of novices against that of experts. Significance: This approach allows for the analysis of performance based on continuous sensor data recording that can be easily extended to real subjects and other types of physical examinations.
Naveed H, Hudson R, Khatib M, et al., 2018, Basic skin surgery interactive simulation: system description and randomised educational trial, Advances in Simulation, Vol: 3, ISSN: 2059-0628
Background: Learning the skills required for open surgery is essential for trainee progression towards more advanced technical procedures. Simulation supports skill enhancement at a time when exposure to actual surgical procedures and traditional apprentice-based teaching has declined. The proliferation of smartphone and tablet devices with rich, touch sensitive displays and increasing processing power makes a compelling argument for expanding accessibility further by development of mobile virtual simulations for training on demand in any setting, at any time.We present a tablet-based mobile simulation App for educating surgical trainees in the planning and surgical procedures involved in facial lesion resection and local skin flap surgery. Methods: Novel algorithms were developed and modules included in a mobile simulation App to teach concepts required for three defect reconstruction techniques: elliptical closure, bilateral advancement (H flap) and the semi-circular rotation flap, with additional resources such as videos and formal guidelines made available at relevant points in the simulation. A randomised educational trial was conducted using the mobile simulation App with 18 medical students that were divided equally into two groups: the intervention group learning using the new mobile simulation App, and a control group, undergoing traditional text-based self-study. The students were then assessed on knowledge and skills' acquisition through an MCQ and a task analysis score. Results: There was a statistically significant difference between the scores of students in the intervention group and the students in the non-intervention group in both forms of assessment, with an average multiple-choice assessment score of 62.95% points versus 56.73%, respectively (p = 0.0285), and an average task analysis score of 3.53 versus 2.58, respectively (p = 0.0139). Conclusions: Touch-based simulation provided an efficient and superior method of learni
Weldon SM, Kronfli M, Bello F, et al., 2018, Using a Variety of Research Methods and Angles to Understand a New Approach That Explores Health-Care Services, Qualitative Health Research Conference, Publisher: SAGE PUBLICATIONS INC, Pages: 57-57, ISSN: 1609-4069
Korzeniowski P, White R, Bello F, 2017, VCSim3 - a VR Simulator for Cardiovascular Interventions, International Journal of Computer Assisted Radiology and Surgery, Vol: 13, Pages: 135-149, ISSN: 1861-6429
Purpose: Effective and safe performance of cardiovascular interventions requires excellent catheter / guidewire manipulation skills. These skills are currently mainly gained through an apprenticeship on real patients, which may not be safe or cost-effective. Computer simulation offers an alternative for core skills training. However, replicating the physical behaviour of real instruments navigated through blood vessels is a challenging task. Methods: We have developed VCSim3 – a virtual reality simulator for cardiovascular interventions. The simulator leverages an inextensible Cosserat rod to model virtual catheters and guidewires. Their mechanical properties were optimized with respect to their real counterparts scanned in a silicone phantom using x-ray CT imaging. The instruments are manipulated via a VSP haptic device. Supporting solutions such as fluoroscopic visualization, contrast flow propagation, cardiac motion, balloon inflation and stent deployment, enable performing a complete angioplasty procedure. Results: We present detailed results of simulation accuracy of the virtual instruments, along with their computational performance. In addition, the results of a preliminary face and content validation study conveyed on a group of 17 interventional radiologists are given. Conclusions: VR simulation of cardiovascular procedure can contribute to surgical training and improve the educational experience without putting patients at risk, raising ethical issues or requiring expensive animal or cadaver facilities. VCSim3 is still a prototype, yet the initial results indicate that it provides promising foundations for further development.
Kelay TK, Chan KL, Ako E, et al., 2017, Distributed Simulation as a modelling tool for the development of a simulation-based training programme for cardiovascular specialties, Advances in Simulation, Vol: 2, ISSN: 2059-0628
Aims and backgroundDistributed Simulation is the concept of portable, high-fidelity immersive simulation. Here, it is used for the development of a simulation-based training programme for cardiovascular specialities. We present an evidence base for how accessible, portable and self-contained simulated environments can be effectively utilised for the modelling, development and testing of a complex training framework and assessment methodology. Iterative user feedback through mixed-methods evaluation techniques resulted in the implementation of the training programme.ApproachFour phases were involved in the development of our immersive simulation-based training programme: (1) initial conceptual stage for mapping structural criteria and parameters of the simulation training framework and scenario development (n = 16), (2) training facility design using Distributed Simulation, (3) test cases with clinicians (n = 8) and collaborative design, where evaluation and user feedback involved a mixed-methods approach featuring (a) quantitative surveys to evaluate the realism and perceived educational relevance of the simulation format and framework for training and (b) qualitative semi-structured interviews to capture detailed feedback including changes and scope for development. Refinements were made iteratively to the simulation framework based on user feedback, resulting in (4) transition towards implementation of the simulation training framework, involving consistent quantitative evaluation techniques for clinicians (n = 62). For comparative purposes, clinicians’ initial quantitative mean evaluation scores for realism of the simulation training framework, realism of the training facility and relevance for training (n = 8) are presented longitudinally, alongside feedback throughout the development stages from concept to delivery, including the implementation stage (n = 62).FindingsInitially, mean evaluation scores fluctuated from low to average, rising incrementally. T
Plumptre I, Mulki O, Granados A, et al., 2017, Standardizing bimanual vaginal examination using cognitive task analysis., International Journal of Gynecology & Obstetrics, Vol: 139, Pages: 114-119, ISSN: 1879-3479
OBJECTIVE: To create a standardized universal list of procedural steps for bimanual vaginal examination (BVE) for teaching, assessment, and simulator development. METHODS: This observational study, conducted from June-July 2012 and July-December 2014, collected video data of 10 expert clinicians performing BVE in a nonclinical environment. Video data were analyzed to produce a cognitive task analysis (CTA) of the examination steps performed. The CTA was further refined through structured interviews to make it suitable for teaching or assessment. It was validated through its use as a procedural examination checklist to rate expert clinician performance. RESULTS: BVE was deconstructed into 88 detailed steps outlining the complete examination process. These initial 88 steps were reduced to 35 by focusing on the unseen internal examination, then further refined through interviews with five experts into 30 essential procedural steps, five of which are additional steps if pathology is suspected. Using the CTA as a procedural checklist, the mean number of steps performed and/or verbalized was 21.6 ± 3.12 (72% ± 10.4%; range, 15.9-27.9, 53%-93%). CONCLUSION: This approach identified 30 essential steps for performing BVE, producing a new technique and standardized tool for teaching, assessment, and simulator development.
Marechal L, Granados A, Ethapemi L, et al., 2017, Modelling of anal sphincter tone based on pneumatic and cable-driven mechanisms, 2017 IEEE World Haptics Conference, WHC 2017, Publisher: IEEE, Pages: 376-381
Motivated by the need for improving a haptics-based simulation tool for learning and training digital rectal examinations, a sphincter tone model and its actuation is conceived and developed. Two approaches are presented: One based on pneumatics actuation and the other using cable-driven mechanical actuation using servo motors. Clinical scenarios are modelled as profiles based on studies of anorectal manometry and adapted with clinical input. Both designed mechanisms and scenarios were experimentally evaluated by six experts, Nurse Practitioners in Continence and Colorectal Surgeons. Results show that both mechanisms produce enough pressure on examining finger and profiles are able to generate a wide range of healthy and abnormal cases. Either approach could be used to provide a more realistic experience during training of sphincter tone assessment.
Weldon SM, Kelay T, Ako E, et al., 2017, Sequential simulation used as a novel educational tool aimed at healthcare managers: a patient-centred approach, BMJ Simulation & Technology Enhanced Learning, Vol: 4, Pages: 13-18, ISSN: 2056-6697
Background A new challenge for healthcare managers is to improve the patient experience. Simulation is often used for clinical assessment and rarely for those operating outside of direct clinical care. Sequential simulation (SqS) is a form of simulation that re-creates care pathways, widening its potential use.Local problem Numbers, outcome measures and system profiling are used to inform healthcare decisions. However, none of these captures the personal subtleties of a patient’s experience.Intervention 56 students attended a teaching module using SqS and facilitated workshops as part of their induction week on an MSc International Health Management course. The workshop was voluntary and was offered as an opportunity for the students to gain an insight into the UK health system through the medium of simulation.Methods An evaluation survey incorporating quantitative and qualitative student feedback was conducted. Descriptive statistics were generated from the quantitative data, and thematic analysis was undertaken for the qualitative data.Results There was strong agreement for the acceptability of the workshop approach in relation to the aims and objectives. Likert scale (1–-5) mean total=4.49. Participants responded enthusiastically (revealed through the qualitative data) with ideas related to perspectives sharing, understanding healthcare management and processes and the consideration of feasibility and practicalities. They also suggested other applications that SqS could be used for.Conclusion The SqS approach has demonstrated that simulation has a wider potential than for clinical assessment alone. Further studies are required to determine its potential uses and affordances beyond its current format.
Granados A, Maréchal L, Barrow A, et al., 2017, Relax and tighten—a haptics-based approach to simulate sphincter tone assessment, Asia Haptics 2016, Publisher: Springer, Pages: 327-333, ISSN: 1876-1100
Digital Rectal Examination (DRE) is a physical examination performed by clinicians to diagnose anorectal and prostate abnormalities. Amongst these, sphincter tone assessment is a crucial task where a clinician asks the patient to relax or squeeze, whilst measuring its function by the amount of pressure felt on the examining finger. DRE is difficult to learn and current models fail to reproduce the dynamic function of anorectal abnormalities. We propose a haptics-based approach to incorporate sphincter tone into our current simulator by motor-controlled pulling and releasing of cables that are coiled around a silicone model of the sphincters. A range of healthy and abnormal sphincter tone cases can be modelled by controlling the motors symmetrically and asymmetrically.
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