Imperial College London

ProfessorFernandoBello

Faculty of MedicineDepartment of Surgery & Cancer

Professor of Surgical Computing and Simulation Science
 
 
 
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Contact

 

+44 (0)20 3315 8231f.bello Website

 
 
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Location

 

G3.50Chelsea and Westminster HospitalChelsea and Westminster Campus

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Summary

 

Publications

Publication Type
Year
to

232 results found

Nahavandi S, Alizadehsani R, Nahavandi D, Lim CP, Kelly K, Bello Fet al., 2024, Machine learning meets advanced robotic manipulation

Automated industries lead to high quality production, lower manufacturing cost and better utilization of human resources. Robotic manipulator arms have major role in the automation process. However, for complex manipulation tasks, hard coding efficient and safe trajectories is challenging and time consuming. Machine learning methods have the potential to learn such controllers based on expert demonstrations. Despite promising advances, better approaches must be developed to improve safety, reliability, and efficiency of ML methods in both training and deployment phases. This survey aims to review cutting edge technologies and recent trends on ML methods applied to real-world manipulation tasks. After reviewing the related background on ML, the rest of the paper is devoted to ML applications in different domains such as industry, healthcare, agriculture, space, military, and search and rescue. The paper is closed with important research directions for future works.

Other

Xu Y, Jiang Z, Ting DSW, Kow AWC, Bello F, Car J, Tham Y-C, Wong TYet al., 2024, Medical education and physician training in the era of artificial intelligence., Singapore Med J, Vol: 65, Pages: 159-166

With the rise of generative artificial intelligence (AI) and AI-powered chatbots, the landscape of medicine and healthcare is on the brink of significant transformation. This perspective delves into the prospective influence of AI on medical education, residency training and the continuing education of attending physicians or consultants. We begin by highlighting the constraints of the current education model, challenges in limited faculty, uniformity amidst burgeoning medical knowledge and the limitations in 'traditional' linear knowledge acquisition. We introduce 'AI-assisted' and 'AI-integrated' paradigms for medical education and physician training, targeting a more universal, accessible, high-quality and interconnected educational journey. We differentiate between essential knowledge for all physicians, specialised insights for clinician-scientists and mastery-level proficiency for clinician-computer scientists. With the transformative potential of AI in healthcare and service delivery, it is poised to reshape the pedagogy of medical education and residency training.

Journal article

Grayson N, Haghighi Osgouei R, Huang R, Tekkis P, Bello F, Kontovounisios Cet al., 2024, Validation of a Tool-Based Visual Anorectal Examination Advanced Simulator for the Early Detection of Colorectal Cancer, Journal of Clinical Medicine, Vol: 13

Rectal examination through proctoscopy or rigid sigmoidoscopy is a common investigation in clinical practice. It is an important diagnostic tool for the workup and management of anorectal pathologies. Performing the examination can be daunting not only for patients but also for junior doctors. There are associated risks with the procedure, such as pain, diagnostic failure, and perforation of the bowel. Simulation-based training is recognised as an important adjunct in clinical education. It allows students and doctors to practice skills and techniques at their own pace in a risk-free environment. These skills can then be transferred to and developed further in clinical practice. There is extensive research published regarding the role of simulation-based training in endoscopy, however, we identified no published study regarding simulation-based training in rigid sigmoidoscopy or proctoscopy. This study aims to establish the initial face, content, and construct validity of a tool-based visual anorectal examination advanced simulator model for proctoscopy and rigid sigmoidoscopy. This innovative, highly realistic simulated environment aims to enhance the training of healthcare professionals and improve the efficiency of detecting and diagnosing distal colorectal disease.

Journal article

Benítez TM, Xu Y, Boudreau JD, Kow AWC, Bello F, Phuoc LV, Wang X, Sun X, Leung GK-K, Lan Y, Wang Y, Cheng D, Tham Y-C, Wong TY, Chung KCet al., 2024, Harnessing the potential of large language models in medical education: promise and pitfalls, Journal of the American Medical Informatics Association, Vol: 31, Pages: 776-783, ISSN: 1067-5027

OBJECTIVES: To provide balanced consideration of the opportunities and challenges associated with integrating Large Language Models (LLMs) throughout the medical school continuum. PROCESS: Narrative review of published literature contextualized by current reports of LLM application in medical education. CONCLUSIONS: LLMs like OpenAI's ChatGPT can potentially revolutionize traditional teaching methodologies. LLMs offer several potential advantages to students, including direct access to vast information, facilitation of personalized learning experiences, and enhancement of clinical skills development. For faculty and instructors, LLMs can facilitate innovative approaches to teaching complex medical concepts and fostering student engagement. Notable challenges of LLMs integration include the risk of fostering academic misconduct, inadvertent overreliance on AI, potential dilution of critical thinking skills, concerns regarding the accuracy and reliability of LLM-generated content, and the possible implications on teaching staff.

Journal article

Brown J, Bello F, 2023, Design and Characterisation of Particle Jamming-Based Variable Stiffness Displays using Non-pneumatic Actuators, IEEE Haptics Symposium, ISSN: 2324-7355

Conference paper

Chappell D, Bello F, Kormushev P, Rojas Net al., 2023, The hydra hand: a mode-switching underactuated gripper with precision and power grasping modes, IEEE Robotics and Automation Letters, Vol: 8, Pages: 7599-7606, ISSN: 2377-3766

Human hands are able to grasp a wide range of object sizes, shapes, and weights, achieved via reshaping and altering their apparent grasping stiffness between compliant power and rigid precision. Achieving similar versatility in robotic hands remains a challenge, which has often been addressed by adding extra controllable degrees of freedom, tactile sensors, or specialised extra grasping hardware, at the cost of control complexity and robustness. We introduce a novel reconfigurable four-fingered two-actuator underactuated gripper—the Hydra Hand—that switches between compliant power and rigid precision grasps using a single motor, while generating grasps via a single hydraulic actuator—exhibiting adaptive grasping between finger pairs, enabling the power grasping of two objects simultaneously. The mode switching mechanism and the hand's kinematics are presented and analysed, and performance is tested on two grasping benchmarks: one focused on rigid objects, and the other on items of clothing. The Hydra Hand is shown to excel at grasping large and irregular objects, and small objects with its respective compliant power and rigid precision configurations. The hand's versatility is then showcased by executing the challenging manipulation task of safely grasping and placing a bunch of grapes, and then plucking a single grape from the bunch.

Journal article

Assaf N, Scholtz S, Ahmed A, Bello Fet al., 2023, THE ACCEPTABILITY AND FEASIBILITY OF 3D RECONSTRUCTION AND VIRTUAL REALITY IN ADDRESSING BODY IMAGE IN BARIATRIC SURGERY, 26th International-Federation-for-the-Surgery-of-Obesity-and-Metabolic-Disorders World Congress (IFSO), Publisher: SPRINGER, Pages: 312-312, ISSN: 0960-8923

Conference paper

Jenkinson G, Houghton N, van Zalk N, Waller J, Bello F, Tzemanaki Aet al., 2023, Acceptability of automated robotic clinical breast examination: survey study, Journal of Participatory Medicine, Vol: 15, Pages: 1-16, ISSN: 2152-7202

Background:In the United Kingdom, women aged 50 to 70 years are invited to undergo mammography. However, 10% of invasive breast cancers occur in women aged ≤45 years, representing an unmet need for young women. Identifying a suitable screening modality for this population is challenging; mammography is insufficiently sensitive, whereas alternative diagnostic methods are invasive or costly. Robotic clinical breast examination (R-CBE)—using soft robotic technology and machine learning for fully automated clinical breast examination—is a theoretically promising screening modality with early prototypes under development. Understanding the perspectives of potential users and partnering with patients in the design process from the outset is essential for ensuring the patient-centered design and implementation of this technology.Objective:This study investigated the attitudes and perspectives of women regarding the use of soft robotics and intelligent systems in breast cancer screening. It aimed to determine whether such technology is theoretically acceptable to potential users and identify aspects of the technology and implementation system that are priorities for patients, allowing these to be integrated into technology design.Methods:This study used a mixed methods design. We conducted a 30-minute web-based survey with 155 women in the United Kingdom. The survey comprised an overview of the proposed concept followed by 5 open-ended questions and 17 closed questions. Respondents were recruited through a web-based survey linked to the Cancer Research United Kingdom patient involvement opportunities web page and distributed through research networks’ mailing lists. Qualitative data generated via the open-ended questions were analyzed using thematic analysis. Quantitative data were analyzed using 2-sample Kolmogorov-Smirnov tests, 1-tailed t tests, and Pearson coefficients.Results:Most respondents (143/155, 92.3%) indicated that they would definitely or

Journal article

Lee JWY, Bello F, 2023, Readiness of Health Care Professionals in Singapore to Teach Online and Their Technology-Related Teaching Needs: Quantitative Cross-sectional Pilot Study., JMIR Med Educ, Vol: 9, ISSN: 2369-3762

BACKGROUND: With the increasing acceptance of face-to-face classes transitioning to web-based learning due to COVID-19, there is an increasing need to have educators trained and equipped to teach online. The ability to teach in-person may not necessarily mean that one is ready teach in a web-based environment. OBJECTIVE: The objective of our study was to investigate the readiness of health care professionals in Singapore to teach online and their technology-related teaching needs. METHODS: This was a quantitative cross-sectional pilot study conducted among health care administrative staff and professionals in medicine, nursing, allied health, and dentistry. Participants were recruited via an open invitation email to all staff members of Singapore's largest group of health care institutions. Data were collected using a web-based questionnaire. Differences in the readiness of the professionals to teach online were analyzed using analysis of variance, and a 1-sided independent sample t test was performed to analyze the differences between respondents younger than 40 years and those older than 41 years. RESULTS: A total of 169 responses was analyzed. Full-time academic faculty members scored the highest for readiness to teach online (2.97), followed by nursing professionals (2.91), medicine professionals (2.88), administrative staff members (2.83), and allied health professionals (2.76). However, there was no statistically significant difference (P=.77) among all the respondents in their readiness to teach online. There was an agreement among all professionals in their need for software tools to teach; in particular, there was a significant difference in the software needs among the professionals for streaming videos (P=.01). There was no statistically significant difference in the readiness to teach online between those younger than 40 years and those older than 41 years (P=.48). CONCLUSIONS: Our study shows that there are still some gaps in terms of readiness to teach

Journal article

Kebria PM, Nahavandi S, Enticott P, Bello Fet al., 2023, Haptically-Enabled Robotic Teleoperation for Transcranial Magnetic Stimulation (TeleTMS), Pages: 2100-2105, ISSN: 1062-922X

Transcranial Magnetic Stimulation (TMS) is a non-invasive and painless technique used in both clinical trials and research on cortical activity and brain networks. TMS involves the use of an electromagnetic coil, which can induce powerful but brief magnetic pulses. When the coil is headed against the scalp, it can induce electrical activity in underlying brain tissue. For effective results, the TMS coil should be in appropriate contact with patients' scalp and positioned for consistent stimulation. In many cases, it requires researchers and clinicians to not only hold and position the coil on subjects' head, also to take care to ensure appropriate and consistent contact between the TMS coil and subject's scalp. This task is noticeably tiresome for the operators considering weight of the coil and a dense cable attached to it. On the other side, the patient or participant has to sit motionless; otherwise, the contact will be lost and the stimulation will have a reduced impact. In this paper, we propose and develop a haptically-enabled teleoperated robotic platform that removes all those limitations and burdensome from both TMS operators and patients/participants. The operator, through a haptic interface, remotely controls a robotic arm holding the coil. This system provides the operator with the sense of touch to feel the contact force between the coil and patient/participant's head. Therefore, operators and patients/participants do not need to be in the same location while conducting TMS, including the 'motor thresholding' procedure. This will offer a huge benefit to the healthcare services in rural areas. Experimental evaluations carried out to demonstrate the effectiveness of the proposed robotic system.

Conference paper

Chappell D, Yang Z, Son HW, Bello F, Kormushev P, Rojas Net al., 2022, Towards instant calibration in myoelectric prosthetic hands: a highly data-efficient controller based on the Wasserstein distance, International Conference on Rehabilitation Robotics (ICORR), Publisher: IEEE

Prosthetic hand control research typically focuses on developing increasingly complex controllers to achieve diminishing returns in pattern recognition of muscle activity signals, making models less suitable for user calibration. Some works have investigated transfer learning to alleviate this, but such approaches increase model size dramatically—thus reducing their suitability for implementation on real prostheses. In this work, we propose a novel, non-parametric controller that uses the Wasserstein distance to compare the distribution of incoming signals to those of a set of reference distributions,with the intended action classified as the closest distribution. This controller requires only a single capture of data per reference distribution, making calibration almost instantaneous. Preliminary experiments building a reference library show that, in theory, users are able to produce up to 9 distinguishable muscle activity patterns. However, in practice, variation whenrepeating actions reduces this. Controller accuracy results show that 10 non-disabled and 1 disabled participant were able to use the controller with a maximum of two recalibrations to perform 6 actions at an average accuracy of 89.9% and 86.7% respectively. Practical experiments show that the controller allows users to complete all tasks of the Jebsen-Taylor HandFunction Test, although the task of picking and placing small common objects required on average more time than the protocol’s maximum time.

Conference paper

Chua PSB, Lee CZ, Teng DRK, Susanto J, Ong WD, Tan KL, Cheow PC, Lai SH, Tan MB, Khoo X, Bello Fet al., 2022, Affordable and accessible 3D printed models of the liver to support medical education, Materials Today: Proceedings, Vol: 70, Pages: 258-264, ISSN: 2214-7853

Three-dimensional (3D) printing (also termed additive manufacturing) has been on the rise across industries and application areas. Advances in materials, printing technologies and affordability have sparked substantial activity in the healthcare and medical education domains, ranging from highly realistic 3D anatomical models for teaching and procedure rehearsal, as well as personalised implants and sophisticated MedTech devices. 3D printing is known for its ability to make people understand complex physical structures and produce difficult to obtain models.Our aim is to explore the use of low-cost SLA and FDM 3D printers to produce realistic anatomical models. Working closely with clinicians from Duke-NUS Medical School and Singapore General Hospital, a use case of the liver was chosen for anatomy teaching and simulation-based skills training, making use of a range of resins and multi-materials.The liver was selected as a good example of a solid organ with internal anatomical detail.In this paper, we will share our progress in 3D-printing liver models from both SLA and FDM printers, as well as the challenges, advantages, and disadvantages of using each of these technologies.

Journal article

Lee JWY, Bello F, 2022, Readiness of Health Care Professionals in Singapore to Teach Online and Their Technology-Related Teaching Needs: Quantitative Cross-sectional Pilot Study (Preprint)

<sec> <title>BACKGROUND</title> <p>With the increasing acceptance of face-to-face classes transitioning to web-based learning due to COVID-19, there is an increasing need to have educators trained and equipped to teach online. The ability to teach in-person may not necessarily mean that one is ready teach in a web-based environment.</p> </sec> <sec> <title>OBJECTIVE</title> <p>The objective of our study was to investigate the readiness of health care professionals in Singapore to teach online and their technology-related teaching needs.</p> </sec> <sec> <title>METHODS</title> <p>This was a quantitative cross-sectional pilot study conducted among health care administrative staff and professionals in medicine, nursing, allied health, and dentistry. Participants were recruited via an open invitation email to all staff members of Singapore’s largest group of health care institutions. Data were collected using a web-based questionnaire. Differences in the readiness of the professionals to teach online were analyzed using analysis of variance, and a 1-sided independent sample &lt;i&gt;t&lt;/i&gt; test was performed to analyze the differences between respondents younger than 40 years and those older than 41 years.</p> </sec> <sec> <title>RESULTS</title> <p>A total of 169 responses was analyzed. Full-time academic faculty members scored the highest for readiness to teach online (2.97), followed by nursing professionals (2.91), medicine professionals (2.88), administrative staff members (2.83), and allied health professiona

Journal article

Berkovic A, Laganier C, Chappell D, Nanayakkara T, Kormushev P, Bello F, Rojas Net al., 2022, A multi-modal haptic armband for finger-level sensory feedback from a prosthetic hand, EuroHaptics, Publisher: Springer

This paper presents the implementation and evaluation of three specific, yet complementary, mechanisms of haptic feedback—namely, normal displacement, tangential position, and vibration—to render, at a finger-level, aspects of touch and proprioception from a prosthetic hand without specialised sensors. This feedback is executed by an armband worn around the upper arm divided into five somatotopic modules, one per each finger. To evaluate the system, just-noticeable difference experiments for normal displacement and tangential position were carried out, validating that users are most sensitive to feedback from modules located on glabrous (hairless) skin regions of the upper arm. Moreover, users identifying finger-level contact using multi-modal feedback of vibration followed by normal displacement performed significantly better than those using vibration feedback alone, particularly when reporting exact combinations of fingers. Finally, the point of subjective equality of tangential position feedback was measured simultaneously for all modules, which showed promising results, but indicated that further development is required to achieve full finger-level position rendering.

Conference paper

Robb H, Scrimgeour G, Boshier P, Przedlacka A, Balyasnikova S, Brown G, Bello F, Kontovounisios Cet al., 2022, The current and possible future role of 3D modelling within oesophagogastric surgery: a scoping review, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 36, Pages: 5907-5920, ISSN: 0930-2794

Background3D reconstruction technology could revolutionise medicine. Within surgery, 3D reconstruction has a growing role in operative planning and procedures, surgical education and training as well as patient engagement. Whilst virtual and 3D printed models are already used in many surgical specialities, oesophagogastric surgery has been slow in their adoption. Therefore, the authors undertook a scoping review to clarify the current and future roles of 3D modelling in oesophagogastric surgery, highlighting gaps in the literature and implications for future research.MethodsA scoping review protocol was developed using a comprehensive search strategy based on internationally accepted guidelines and tailored for key databases (MEDLINE, Embase, Elsevier Scopus and ISI Web of Science). This is available through the Open Science Framework (osf.io/ta789) and was published in a peer-reviewed journal. Included studies underwent screening and full text review before inclusion. A thematic analysis was performed using pre-determined overarching themes: (i) surgical training and education, (ii) patient education and engagement, and (iii) operative planning and surgical practice. Where applicable, subthemes were generated.ResultsA total of 56 papers were included. Most research was low-grade with 88% (n = 49) of publications at or below level III evidence. No randomised control trials or systematic reviews were found. Most literature (86%, n = 48) explored 3D reconstruction within operative planning. These were divided into subthemes of pre-operative (77%, n = 43) and intra-operative guidance (9%, n = 5). Few papers reported on surgical training and education (14%, n = 8), and were evenly subcategorised into virtual reality simulation (7%, n = 4) and anatomical teaching (7%, n = 4). No studies utilising 3D modelling for patient engagement and education were found.ConclusionThe use

Journal article

Chappell D, Son HW, Clark AB, Yang Z, Bello F, Kormushev P, Rojas Net al., 2022, Virtual reality pre-prosthetic hand training with physics simulation and robotic force interaction, IEEE Robotics and Automation Letters, Vol: 7, Pages: 1-1, ISSN: 2377-3766

Virtual reality (VR) rehabilitation systems have been proposed to enable prosthetic hand users to perform training before receiving their prosthesis. Improving pre-prosthetic training to be more representative and better prepare the patient for prosthesis use is a crucial step forwards in rehabilitation. However, existing VR platforms lack realism and accuracy in terms of the virtual hand and the forces produced when interacting with the environment. To address these shortcomings, this work presents a VR training platform based on accurate simulation of an anthropomorphic prosthetic hand, utilising an external robot arm to render realistic forces that the user would feel at the attachment point of their prosthesis. Experimental results with non-disabled participants show that training with this platform leads to a significant improvement in Box and Block scores compared to training in VR alone and a control group with no prior training. Results performing pick-and-place tasks with a wider range of objects demonstrates that training in VR alone negatively impacts performance, whereas the proposed platform has no significant impact on performance. User perception results highlight that the platform is much closer to using a physical prosthesis in terms of physical demand and effort, however frustration is significantly higher during training.

Journal article

Cher PH, Lee JWY, Bello F, 2022, Machine Learning Techniques to Evaluate Lesson Objectives, Editors: Rodrigo, Matsuda, Cristea, Dimitrova, Publisher: SPRINGER INTERNATIONAL PUBLISHING AG, Pages: 193-205, ISBN: 978-3-031-11643-8

Book chapter

Lo SL, Cher PH, Bello F, 2022, Reflection as an Agile Course Evaluation Tool, Editors: Rodrigo, Matsuda, Cristea, Dimitrova, Publisher: SPRINGER INTERNATIONAL PUBLISHING AG, Pages: 293-297, ISBN: 978-3-031-11646-9

Book chapter

Przedlacka A, Pellino G, Fletcher J, Bello F, Tekkis PP, Kontovounisios Cet al., 2021, Current and future role of three-dimensional modelling technology in rectal cancer surgery: a systematic review, World Journal of Gastrointestinal Surgery, Vol: 13, Pages: 1754-1769, ISSN: 1948-9366

BACKGROUND: Three-dimensional (3D) modelling technology translates the patient-specific anatomical information derived from two-dimensional radiological images into virtual or physical 3D models, which more closely resemble the complex environment encountered during surgery. It has been successfully applied to surgical planning and navigation, as well as surgical training and patient education in several surgical specialties, but its uptake lags behind in colorectal surgery. Rectal cancer surgery poses specific challenges due to the complex anatomy of the pelvis, which is difficult to comprehend and visualise. AIM: To review the current and emerging applications of the 3D models, both virtual and physical, in rectal cancer surgery. METHODS: Medline/PubMed, Embase and Scopus databases were searched using the keywords "rectal surgery", "colorectal surgery", "three-dimensional", "3D", "modelling", "3D printing", "surgical planning", "surgical navigation", "surgical education", "patient education" to identify the eligible full-text studies published in English between 2001 and 2020. Reference list from each article was manually reviewed to identify additional relevant papers. The conference abstracts, animal and cadaveric studies and studies describing 3D pelvimetry or radiotherapy planning were excluded. Data were extracted from the retrieved manuscripts and summarised in a descriptive way. The manuscript was prepared and revised in accordance with PRISMA 2009 checklist. RESULTS: Sixteen studies, including 9 feasibility studies, were included in the systematic review. The studies were classified into four categories: feasibility of the use of 3D modelling technology in rectal cancer surgery, preoperative planning and intraoperative navigation, surgical education and surgical device design. Thirteen studies used virtual models, one 3D printed model and 2 both types of mod

Journal article

Kim M, Bello F, 2021, Multi-shape free-form deformation framework for efficient data transmission in AR-based medical training simulators, Applied Sciences, Vol: 11, Pages: 1-13, ISSN: 2076-3417

Augmented reality medical training simulators can provide a realistic and immersive experience by overlapping the virtual scene on to the real world. Latency in augmented reality (AR) medical training simulators is an important issue as it can lead to motion sickness for users. This paper proposes a framework that can achieve real-time rendering of the 3D scene aligned to the real world using a head-mounted display (HMD). Model deformation in the 3D scene is categorised into local deformation derived from user interaction and global deformation determined by the simulation scenario. Target shapes are predefined by a simulation scenario, and control points are placed to embed the predefined shapes. Free-form deformation (FFD) is applied to multiple shapes to efficiently transfer the simulated model to the HMD. Global deformation is computed by blending a mapping matrix of each FFD with an assigned weighting value. The local and global deformation are then transferred through the control points updated from a deformed surface mesh and its corresponding weighting value. The proposed framework is verified in terms of latency caused by data transmission and the accuracy of a transmitted surface mesh in a vaginal examination (VE) training simulation. The average latency is reduced to 7 ms, less than the latency causing motion sickness in virtual reality simulations. The maximum relative error is less than 3%. Our framework allows seamless rendering of a virtual scene to the real world with substantially reduced latency and without the need for an external tracking system.

Journal article

Kontovounisios C, 2021, The current and possible future role of 3D modelling within oesophagogastric surgery: a scoping review protocol, BMJ Open, Vol: 11, Pages: 1-4, ISSN: 2044-6055

IntroductionThree-dimensional (3D) reconstruction describes the generation of either virtual or physically printed anatomically accurate 3D models from two-dimensional (2D) medical images. Their implementation has revolutionised medical practice. Within surgery, key applications include growing roles in operative planning and procedures, surgical education and training as well as patient engagement and education. In comparison to other surgical specialties, oesophagogastric surgery has been slow in their adoption of this technology. Herein the authors outline a scoping review protocol that aims to analyse the current role of 3D modelling in oesophagogastric surgery and highlight any unexplored avenues for future research. Methods and AnalysisThe protocol was generated using internationally accepted methodological frameworks. A succinct primary question was devised, and a comprehensive search strategy developed for key databases (MEDLINE, Embase, Elsevier Scopus and ISI Web of Science). These were searched from their inception to 1/6/2020. Reference lists will be reviewed by hand and grey literature identified using OpenGrey and Grey Literature Report. The protocol was registered to the Open Science Framework (osf.io/ta789). Two independent reviewers will screen titles, abstracts and perform full text reviews for study selection. There will be no methodological quality assessment to ensure a full thematic analysis is possible. A data charting tool will be created by the investigatory team. Results will be analysed to generate descriptive numerical tabular results and a thematic analysis performed. Ethics and Dissemination Ethical approval was not required for the collection and analysis of the published data. The scoping review report will be disseminated through a peer-reviewed publication and international conferences.Registration detailsThe scoping review protocol has been registered on the Open Science Framework (osf.io/ta789)

Journal article

Neville JJ, Chacon CS, Haghighi-Osgouei R, Houghton N, Bello F, Clarke SAet al., 2021, Development and validation of a novel 3D-printed simulation model for open oesophageal atresia and tracheo-oesophageal fistula repair, Pediatric Surgery International, Vol: 38, Pages: 133-141, ISSN: 0179-0358

BackgroundThe role of simulation training in paediatric surgery is expanding as more simulation devices are designed and validated. We aimed to conduct a training needs assessment of UK paediatric surgical trainees to prioritise procedures for simulation, and to validate a novel 3D-printed simulation model for oesophageal atresia and tracheo-oesophageal fistula (OA-TOF) repair.MethodsA questionnaire was sent to UK trainee paediatric surgeons surveying the availability and utility of simulation. The operation ranked as most useful to simulate was OA-TOF repair. 3D-printing techniques were used to build an OA-TOF model. Content, face and construct validity was assessed by 40 paediatric surgeons of varying experience.ResultsThirty-four paediatric surgeons completed the survey; 79% had access to surgical simulation at least monthly, and 47% had access to paediatric-specific resources. Perceived utility of simulation was 4.1/5. Validation of open OA-TOF repair was conducted by 40 surgeons. Participants rated the model as useful 4.9/5. Anatomical realism was scored 4.2/5 and surgical realism 3.9/5. The model was able to discriminate between experienced and inexperienced surgeons.ConclusionUK paediatric surgeons voted OA-TOF repair as the most useful procedure to simulate. In response we have developed and validated an affordable 3D-printed simulation model for open OA-TOF repair.

Journal article

Korzeniowski P, Chacon CS, Russell VR, Clarke SA, Bello Fet al., 2021, Virtual reality simulator for pediatric laparoscopic inguinal hernia repair, Journal of Laparoendoscopic and Advanced Surgical Techniques, Vol: 31, Pages: 1322-1330, ISSN: 1092-6410

Purpose: Due to the small space environment, the learning curve of pediatric laparoscopic procedures is steep and requires excellent procedural skills. These are mainly gained through an apprenticeship on real patients. Computer-based virtual reality (VR) simulators offer a safe, cost-effective, and configurable training environment free from ethical and patient safety issues.Materials and Methods: We have developed a prototype VR simulator for core manual skills training for pediatric laparoscopic hernia repair. The simulator currently consists of a hernia suturing task on a virtual nonanatomic trainer at a real pediatric scale.Results: A simulation realism validation study was carried out by obtaining subjective feedback (face and content validity) through a questionnaire from 36 pediatric surgeons. The overall simulation realism was on average marked 3.08 on a 5-point Likert scale (1: “very unrealistic” and 5: “very realistic”). The participants were most satisfied with the visual realism (3.33) and most critical about the behavior of virtual tissue. The simulator showed good content validity; its usefulness as a training tool for hernia repair, suturing in general, and in learning fundamental laparoscopic skills was marked 3.61, 3.64, and 3.89, respectively.Conclusions: VR simulation of pediatric laparoscopic procedures can contribute to surgical training and improve the educational experience without putting our youngest patients at risk. This simulator is a first prototype, and the initial results indicate that it provides promising foundations for further development. More formal and larger studies such as construct validity and transfer of skills are envisaged as the prototype is developed further.

Journal article

Al Asmri MA, Ennis J, Stone RJ, Bello F, Haque MS, Parle Jet al., 2021, Effectiveness of technology-enhanced simulation in teaching digital rectal examination: a systematic review narrative synthesis, BMJ Simulation & Technology Enhanced Learning, Vol: 7, Pages: 414-421, ISSN: 2056-6697

Background Digital rectal examination (DRE) is a challenging examination to learn.Objective To synthesise evidence regarding the effectiveness of technology-enhanced simulation (TES) for acquiring DRE skills.Study selection EMBASE, Medline, CINAHL, Cochrane, Web of Knowledge (Science and Social Science), Scopus and IEEE Xplore were searched; the last search was performed on 3 April 2019. Included were original research studies evaluating TES to teach DRE. Data were abstracted on methodological quality, participants, instructional design and outcomes; a descriptive synthesis was performed. Quality was assessed using a modified Medical Education Research Study Quality Instrument. The study design domain was modified by scoring the papers based on (1) evaluation of risk of bias for randomised controlled trials, (2) description of participants and (3) assessment of robustness and degree of simulation fidelity of the assessments used to evaluate learning.Findings 863 articles were screened; 12 were eligible, enrolling 1507 prequalified medical/clinical students and 20 qualified doctors. For skill acquisition, role player was statistically significantly superior to a static manikin (2 studies). For knowledge acquisition, manikin use was significantly superior to role player (1 study); 2 studies showed no difference. For confidence, manikin use was significantly superior to no manikin (4 studies). For comfort, manikin use was significantly superior to no manikin (2 studies). For anxiety, role player was significantly superior to manikin (1 study).Median overall quality score (QS) was 48% (27–62). Highest median QS was 73% (33–80) for data analysis; lowest median QS was 20% (7–40) for the validity of instrument. Six papers scored over 50% of the maximum score for overall quality.Conclusions TES training is associated with improved DRE skills and should be used more widely.

Journal article

Fawcett M, Coughlan C, McGeorge E, Imran A, Bello F, Kneebone R, Watson Met al., 2021, Qualitative evaluation of asthma services for young people: a sequential simulation study, BMJ Simulation && Technology Enhanced Learning, Vol: 7, Pages: 134-139, ISSN: 2056-6697

Background Asthma is the most common chronic disease of childhood and an important preventable cause of mortality in children and young people (CYP). Few studies have brought together CYP and health professionals to understand the patient perspective of routine asthma care. We sought to explore how young people engage with routine asthma care in North West London through sequential simulation.Method We designed a sequential simulation focusing on routine asthma management in young people aged 12–18. A 20 min simulation was developed with four young people to depict typical interactions with school nurses and primary care services. This was performed to a mixed audience of young people, general practitioners (GPs), paediatricians, school nurses and commissioners. Young people were invited to attend by their GPs and through social media channels. Attendees participated in audio-recorded, facilitated discussions exploring the themes arising from the simulation. Recordings were transcribed and subjected to thematic analysis.Results 37 people attended the sequential simulation. Themes arising from postsimulation discussions included recognition of chaotic family lifestyles as a key barrier to accessing care; the importance of strong communication between multidisciplinary team professionals and recognition of the role school nurses can play in delivering routine asthma care.Conclusion Sequential simulation allows healthcare providers to understand routine asthma care for CYP from the patient perspective. We propose improved integration of school nurses into routine asthma care and regular multidisciplinary team meetings to reduce fragmentation, promote interprofessional education and address the widespread professional complacency towards this lethal condition.

Journal article

Racy M, Barrow A, Tomlinson J, Bello Fet al., 2021, Development and validation of a virtual reality haptic femoral nailing simulator, Journal of Surgical Education, Vol: 78, Pages: 1013-1023, ISSN: 0149-7944

OBJECTIVE: To create a virtual reality (VR) femoral nailing simulator combining haptics and image intensifier functionality and then carry out validation studies to assess its educational value. DESIGN: The simulator consisted of a 3D virtual environment, a haptic device and 3D printed drill handle and a VR headset. The environment was created using a video game development engine, interfaced with plugins to allow haptic feedback and image intensifier functionality. Two tasks were created within the simulator as part of an antegrade femoral intramedullary (IM) nail procedure: proximal guidewire entry and distal locking.For the validation study, participants performed the above tasks on the simulator. Metrics were collected including time taken, number of X-rays and tool distance travelled and used to assess construct validity. A questionnaire was then completed to assess authenticity and content validity. SETTING: Simulator development in centre for simulation and engagement science laboratory. Validation study in a teaching hospital environment. PARTICIPANTS: Orthopedic specialist trainees and consultants. RESULTS: Surgeon experience (number of IM nails performed/postgraduate year) correlated with significantly improved task performance. More experienced surgeons took less time, used fewer X-rays and had greater economy of movement than less experienced surgeons. Authenticity and content validity were well rated, with criticisms primarily due to hardware limitations. CONCLUSIONS: To our knowledge this is the first orthopedic simulator to combine immersive VR with haptics and full image intensifier functionality. By combining multiple aspects of surgical practice within a single device, we aimed to improve participant immersion and educational value. Our work so far has focused on technical skills, demonstrating good authenticity, content and construct validity, however our findings show promise in other applications such as nontechnical skill development and assess

Journal article

Kebria PM, Nahavandi D, Jalali SMJ, Khosravi A, Nahavandi S, Bello F, Mc Ginn Cet al., 2020, Robust collaboration of a haptically-enabled double-slave teleoperation system under random communication delays, IEEE International Conference on Systems, Man, and Cybernetics (SMC), Publisher: IEEE, Pages: 2919-2924, ISSN: 1062-922X

Communication delays are known to create stability and performance issues in multilateral teleoperation systems. Multilateral teleoperation configurations usually include more than two communication channels, which can become problematic for robot control when limitations in network bandwidth results in delays and uncertainties in data transmission routes. This study develops a sliding surface based on the synchronization errors characterized between each sides of the considered multilateral teleoperation system. Here, two slave robots receive commands from the master system to cooperatively execute the desired teleoperation task in the remote, shared workspace. Lyapunov stability analysis approach guarantees the performance of the proposed controller. Moreover, the effectiveness of the controller is experimentally evaluated through a real-world Internet-based double-slave teleoperation system.

Conference paper

Kebria PM, Khosravi A, Nahavandi S, Wu D, Bello Fet al., 2020, Adaptive type-2 fuzzy neural-network control for teleoperation systems with delay and uncertainties, IEEE Transactions on Fuzzy Systems, Vol: 28, Pages: 2543-2554, ISSN: 1063-6706

Interacting with human operators, remote environment, and communication networks, teleoperation systems are considerably suffering from complexities and uncertainties. Managing these is of paramount importance for safe and smooth performance of teleoperation systems. Among the countless solutions developed by researchers, type-2 fuzzy (T2F) algorithms have shown an outstanding performance in modeling complex systems and tackling uncertainties. Moreover, artificial neural networks (NNs) are well known for their adaptive learning potentials. This article proposes an adaptive interval type-2 fuzzy neural-network control scheme for teleoperation systems with time-varying delays and uncertainties. The T2F models are developed based on the experimental data collected from a teleoperation setup over a local computer network. However, the resulted controller is evaluated on an intercontinental communication network through the Internet between Australia and Scotland. Moreover, the slave robot and the remote workspace are completely different and unforeseen. Stability and performance of the proposed control is analyzed by Lyapunov-Krasovskii method. Comprehensive comparative studies demonstrate that the proposed controller outperforms traditional techniques in experimental evaluations.

Journal article

Granados A, Cox S, Low-Beer N, Higham J, Kneebone R, Bello Fet al., 2020, Taking the pressure off the patient - understanding digital rectal examinations on a real subject, IEEE Transactions on Biomedical Engineering, Vol: 67, Pages: 2798-2805, ISSN: 0018-9294

Better understanding of palpation techniques during unsighted physical examinations has mostly been limited to qualitative and quantitative studies of performance of experts whilst conducting examinations on plastic benchtop models. However, little is known about their performance when conducting such examinations on real subjects. OBJECTIVE: The aim of this paper is to better understand palpation techniques of experts whilst conducting a Digital Rectal Examination on a real subject. METHODS: We recruited four consultants from relevant specialties and asked them to conduct two DREs on a Rectal Teaching Assistant whilst wearing small position and pressure sensors on their examining finger. We segmented the relevant anatomy from an MRI taken of the pelvic region, registered 3D models and analysed retrospectively performance in relation to executed tasks, supination/pronation, palpation convex hull and pressure applied. RESULTS: Primary care consultants examined the anatomy more holistically compared to secondary care experts, the maximum pressure applied across experiments is 3.3N, overall the pressure applied on the prostate is higher than that applied to rectal walls, and the urologist participant not only applied the highest pressure but also did so with the highest most prominent frequency (15.4 and 25.3 Hz). CONCLUSIONS: The results of our research allow for better understanding of experts' technical performance from relevant specialities when conducting a DRE, and suggest the range of pressure applied whilst palpating anatomy. SIGNIFICANCE: This research will be valuable in improving the design of haptics-based learning tools, as well as in encouraging reflection on palpation styles across different specialities to develop metrics of performance.

Journal article

Przedlacka A, Cox S, Tekkis P, Bello F, Kontovounisios Cet al., 2020, Rectal 3D MRI modelling for benign and malignant disease, British Journal of Surgery, Vol: 107, Pages: e561-e562, ISSN: 0007-1323

Journal article

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