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
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209 results found

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, ISSN: 0179-0358

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 & ADVANCED SURGICAL TECHNIQUES, ISSN: 1092-6429

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, Jafar Jalali SM, Khosravi A, Nahavandi S, Bello F, Ginn CMet al., 2020, Robust Collaboration of a Haptically-Enabled Double-Slave Teleoperation System under Random Communication Delays, Pages: 2919-2924, ISSN: 2168-2216

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

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

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

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

Kebria PM, Nahavandi D, Khosravi A, Nahavandi S, Bello Fet al., 2020, Adaptive Neural Network-based Perception and Awareness of Teleoperation Systems in Human-Machine Interactions

This paper addresses the problem of perception and awareness of teleoperation systems in the presence of human collaboratives/objects in the workspace. Although the term teleoperation generally refers to operations being executed remotely, in many applications, like telemedicine, there exist human beings in the remote workspace. Hence, it is critically important that the teleoperator system to operate safely enough in the presence of human kinds in the workspace. In this paper, we propose a perception and awareness scheme for a teleoperation system that prevents the teleoperator from imposing extreme and unwanted forces/movements. To achieve this goal, we train a neural network to estimate and predict the motion and force commands from the human operator. Furthermore, we develop an adaptive algorithm for fine-Tuning network parameters for robustness purposes. Theoretically proven, stability and performance of the proposed scheme is comparatively evaluated in comprehensive simulations.

Conference paper

Najdovski Z, Deshpande S, Wei L, Salaken SM, Mohajer N, Nahavandi S, Bello Fet al., 2020, Investigating the Effectiveness of a Cable-driven Pinch-Grasp Haptic Interface

Characterisation of virtual objects and their properties is made more efficient through a grasping interface device with force feedback. The requirement for such dexterity has produced complex haptic interface structures that impose limitations on device transparency and fidelity. This study examines the effectiveness of a cable-driven pinch-grasp haptic interface to accurately generate forces to a user's fingertips during object interaction in a virtual environment. Usability experiments were completed and comprised of size and stiffness discrimination tasks. Both studies compared grasping virtual objects under two modality configurations with the pinch-grasp interface. One configuration encompassed the combination of force and vision feedback, and the other maintained solely vision interaction with the device. Task completion times and correct identification were determined. Results demonstrate that the device improved task completion times in the two experiments when both force and vision feedback modalities were active. The percentage of correct identification was also greater in both experiments with force and vision feedback. These results motivate the use of a bidirectional cable actuation system for the development of multipoint dexterous haptic interface devices.

Conference paper

Escobar-Castillejos D, Noguez J, Bello F, Neri L, Magana AJ, Benes Bet 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.

Journal article

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.

Journal article

Muangpoon T, Haghighi Osgouei R, Escobar-Castillejos D, Kontovounisios C, Bello Fet 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

Journal article

Clark AE, Shaw CJ, Bello F, Chalouhi GE, Lees CCet 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.

Journal article

Marechal L, Balland P, Lindenroth L, Petrou F, Kontovounisios C, Bello Fet 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.

Journal article

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

Journal article

Haghighi Osgouei R, Marechal L, Kontovounisios C, Bello Fet 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.

Journal article

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.

Working paper

Kelay TK, Ako E, Cook C, Yasin M, Gold M, Chan KL, Bello F, Kneebone R, Malik Iet 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

Journal article

Kebria PM, Khosravi A, Nahavandi S, Bello F, Krishnan Set 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.

Conference paper

Ramli HR, Misron N, Iqbal Saripan M, Bello Fet 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.

Conference paper

Imran A, Holden B, Weldon SM, Boak D, Klaber B, Kneebone R, Watson M, Bello Fet 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

Journal article

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.

Journal article

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

Journal article

Ramli HR, Arof MAM, Saripan MI, Bello Fet 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.

Conference paper

Thanh N, Ngoc DN, Bello F, Nahavandi Set 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

Conference paper

Ramli HR, Misron N, Saripan MI, Bello Fet 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

Conference paper

Weil A, Weldon SM, Kronfli M, Watkins B, Kneebone R, Bello F, Cox Set 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

Journal article

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.

Conference paper

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