Does virtual reality simulation have a role in training trauma and orthopaedic surgeons?

Aims The aim of this study was to assess the current evidence relating to the benefits of virtual reality (VR) simulation in orthopaedic surgical training, and to identify areas of future research. Materials and Methods A literature search using the MEDLINE, Embase, and Google Scholar databases was performed. The results’ titles, abstracts, and references were examined for relevance. Results A total of 31 articles published between 2004 and 2016 and relating to the objective validity and efficacy of specific virtual reality orthopaedic surgical simulators were identified. We found 18 studies demonstrating the construct validity of 16 different orthopaedic virtual reality simulators by comparing expert and novice performance. Eight studies have demonstrated skill acquisition on a simulator by showing improvements in performance with repeated use. A further five studies have demonstrated measurable improvements in operating theatre performance following a period of virtual reality simulator training. Conclusion The demonstration of ‘real-world’ benefits from the use of VR simulation in knee and shoulder arthroscopy is promising. However, evidence supporting its utility in other forms of orthopaedic surgery is lacking. Further studies of validity and utility should be combined with robust analyses of the cost efficiency of validated simulators to justify the financial investment required for their use in orthopaedic training. Cite this article: Bone Joint J 2018;100-B:559–65.

Download Full-text

The application of virtual reality in health professions� digital education: a narrative review (Preprint)

10.2196/preprints.12220 ◽

2018 ◽

Author(s):

Lorraine Tudor Car ◽

Bhone Myint Kyaw ◽

Josip Car

Keyword(s):

Virtual Reality ◽

Professional Education ◽

Health Professions ◽

Health Professions Education ◽

Narrative Review ◽

Current Evidence ◽

Future Research ◽

Educational Content ◽

Potential Applications

BACKGROUND Digital technology called Virtual Reality (VR) is increasingly employed in health professions’ education. Yet, based on the current evidence, its use is narrowed around a few most applications and disciplines. There is a lack of an overview that would capture the diversity of different VR applications in health professions’ education and inform its use and research. OBJECTIVE This narrative review aims to explore different potential applications of VR in health professions’ education. METHODS The narrative synthesis approach to literature review was used to analyse the existing evidence. RESULTS We outline the role of VR features such as immersion, interactivity and feedback and explain the role of VR devices. Based on the type and scope of educational content VR can represent space, individuals, objects, structures or their combination. Application of VR in medical education encompasses environmental, organ and micro level. Environmental VR focuses on training in relation to health professionals’ environment and human interactions. Organ VR educational content targets primarily human body anatomy; and micro VR microscopic structures at the level of cells, molecules and atoms. We examine how different VR features and health professional education areas match these three VR types. CONCLUSIONS We conclude by highlighting the gaps in the literature and providing suggestions for future research.

Download Full-text

Recommendations for the Design and Implementation of Virtual Reality for Acquired Brain Injury Rehabilitation: Systematic Review

Journal of Medical Internet Research ◽

10.2196/26344 ◽

2021 ◽

Vol 23 (7) ◽

pp. e26344

Author(s):

Sophie Brassel ◽

Emma Power ◽

Andrew Campbell ◽

Melissa Brunner ◽

Leanne Togher

Keyword(s):

Systematic Review ◽

Virtual Reality ◽

Brain Injury ◽

Systematic Reviews ◽

Methodological Quality ◽

Current Evidence ◽

Future Research ◽

Inclusion Criteria ◽

Design And Implementation ◽

Assessment And Treatment

Background Virtual reality (VR) is increasingly being used for the assessment and treatment of impairments arising from acquired brain injuries (ABIs) due to perceived benefits over traditional methods. However, no tailored options exist for the design and implementation of VR for ABI rehabilitation and, more specifically, traumatic brain injury (TBI) rehabilitation. In addition, the evidence base lacks systematic reviews of immersive VR use for TBI rehabilitation. Recommendations for this population are important because of the many complex and diverse impairments that individuals can experience. Objective This study aims to conduct a two-part systematic review to identify and synthesize existing recommendations for designing and implementing therapeutic VR for ABI rehabilitation, including TBI, and to identify current evidence for using immersive VR for TBI assessment and treatment and to map the degree to which this literature includes recommendations for VR design and implementation. Methods This review was guided by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A comprehensive search of 11 databases and gray literature was conducted in August 2019 and repeated in June 2020. Studies were included if they met relevant search terms, were peer-reviewed, were written in English, and were published between 2009 and 2020. Studies were reviewed to determine the level of evidence and methodological quality. For the first part, qualitative data were synthesized and categorized via meta-synthesis. For the second part, findings were analyzed and synthesized descriptively owing to the heterogeneity of data extracted from the included studies. Results In the first part, a total of 14 papers met the inclusion criteria. Recommendations for VR design and implementation were not specific to TBI but rather to stroke or ABI rehabilitation more broadly. The synthesis and analysis of data resulted in three key phases and nine categories of recommendations for designing and implementing VR for ABI rehabilitation. In the second part, 5 studies met the inclusion criteria. A total of 2 studies reported on VR for assessment and three for treatment. Studies were varied in terms of therapeutic targets, VR tasks, and outcome measures. VR was used to assess or treat impairments in cognition, balance, and anxiety, with positive outcomes. However, the levels of evidence, methodological quality, and inclusion of recommendations for VR design and implementation were poor. Conclusions There is limited research on the use of immersive VR for TBI rehabilitation. Few studies have been conducted, and there is limited inclusion of recommendations for therapeutic VR design and implementation. Future research in ABI rehabilitation should consider a stepwise approach to VR development, from early co-design studies with end users to larger controlled trials. A list of recommendations is offered to provide guidance and a more consistent model to advance clinical research in this area.

Download Full-text

Virtual reality simulation—the future of orthopaedic training? A systematic review and narrative analysis

Advances in Simulation ◽

10.1186/s41077-020-00153-x ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Elinor Clarke

Keyword(s):

Systematic Review ◽

Virtual Reality ◽

Narrative Analysis ◽

Systemic Review ◽

Cochrane Library ◽

Future Research ◽

Simulation Tools ◽

Surgical Trainees ◽

Vr Training ◽

Orthopaedic Training

Abstract Background Virtual reality (VR) simulation provides users with an immersive, 3D experience that can be used to allow surgical trainees to practice skills and operations in a safe yet realistic environment. The field of orthopaedics is yet to include VR in core teaching, despite its advantages as a teaching aid, particularly against current simulation tools. This study aims to conduct a systematic review to investigate the efficacy of VR in orthopaedic training, against current methods. Methods A systemic review of databases Medline, Embase and the Cochrane Library for randomized controlled trials focusing on VR training against conventional training in orthopaedic surgery was performed. Data synthesis was performed through narrative analysis due to the heterogeneous nature of the data. Results A total of 16 studies from 140 titles were identified, across 6 specialty areas. Four hundred and thirty-one participants were included. Control groups included VR, cadaver and benchtop simulators. Forty-seven outcomes were measured, focusing on skill and proficiency assessment. No outcomes focused on patient safety. Although significance between intervention and control was not always achieved, most studies found that the intervention outperformed the control. Conclusion VR provides a modern and immersive teaching tool that can develop skills and give confidence to trainees. This study demonstrates the potential for VR simulation as a training aid in orthopaedics and encourages its use alongside conventional teaching methods. However, long-term analysis of the results of VR training on surgical trainees has yet to be conducted. To provide conclusive justification for its inclusion in surgical training, this study recommends that future research follows trainees using VR into the operating room, to determine that VR teaches skills that are transferable onto actual surgeries, subsequently leading to better patient outcomes.

Download Full-text

Recommendations for the Design and Implementation of Virtual Reality for Acquired Brain Injury Rehabilitation: Systematic Review (Preprint)

10.2196/preprints.26344 ◽

2020 ◽

Author(s):

Sophie Brassel ◽

Emma Power ◽

Andrew Campbell ◽

Melissa Brunner ◽

Leanne Togher

Keyword(s):

Systematic Review ◽

Virtual Reality ◽

Brain Injury ◽

Systematic Reviews ◽

Methodological Quality ◽

Current Evidence ◽

Future Research ◽

Inclusion Criteria ◽

Design And Implementation ◽

Assessment And Treatment

BACKGROUND Virtual reality (VR) is increasingly being used for the assessment and treatment of impairments arising from acquired brain injuries (ABIs) due to perceived benefits over traditional methods. However, no tailored options exist for the design and implementation of VR for ABI rehabilitation and, more specifically, traumatic brain injury (TBI) rehabilitation. In addition, the evidence base lacks systematic reviews of immersive VR use for TBI rehabilitation. Recommendations for this population are important because of the many complex and diverse impairments that individuals can experience. OBJECTIVE This study aims to conduct a two-part systematic review to identify and synthesize existing recommendations for designing and implementing therapeutic VR for ABI rehabilitation, including TBI, and to identify current evidence for using immersive VR for TBI assessment and treatment and to map the degree to which this literature includes recommendations for VR design and implementation. METHODS This review was guided by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A comprehensive search of 11 databases and gray literature was conducted in August 2019 and repeated in June 2020. Studies were included if they met relevant search terms, were peer-reviewed, were written in English, and were published between 2009 and 2020. Studies were reviewed to determine the level of evidence and methodological quality. For the first part, qualitative data were synthesized and categorized via meta-synthesis. For the second part, findings were analyzed and synthesized descriptively owing to the heterogeneity of data extracted from the included studies. RESULTS In the first part, a total of 14 papers met the inclusion criteria. Recommendations for VR design and implementation were not specific to TBI but rather to stroke or ABI rehabilitation more broadly. The synthesis and analysis of data resulted in three key phases and nine categories of recommendations for designing and implementing VR for ABI rehabilitation. In the second part, 5 studies met the inclusion criteria. A total of 2 studies reported on VR for assessment and three for treatment. Studies were varied in terms of therapeutic targets, VR tasks, and outcome measures. VR was used to assess or treat impairments in cognition, balance, and anxiety, with positive outcomes. However, the levels of evidence, methodological quality, and inclusion of recommendations for VR design and implementation were poor. CONCLUSIONS There is limited research on the use of immersive VR for TBI rehabilitation. Few studies have been conducted, and there is limited inclusion of recommendations for therapeutic VR design and implementation. Future research in ABI rehabilitation should consider a stepwise approach to VR development, from early co-design studies with end users to larger controlled trials. A list of recommendations is offered to provide guidance and a more consistent model to advance clinical research in this area. CLINICALTRIAL

Download Full-text

The Relationship of Endoscopic Proficiency to Educational Expense for Virtual Reality Simulator Training Amongst Surgical Trainees

The American Surgeon ◽

10.1177/000313481508100727 ◽

2015 ◽

Vol 81 (7) ◽

pp. 747-752 ◽

Cited By ~ 6

Author(s):

Jessica Raque ◽

Adam Goble ◽

Veronica M. Jones ◽

Lindsey E. Waldman ◽

Erica Sutton

Keyword(s):

Virtual Reality ◽

Cost Effective ◽

Flexible Endoscopy ◽

Simulator Training ◽

Training Methods ◽

Endoscopy Training ◽

Fundamentals Of Endoscopic Surgery ◽

Surgical Trainees ◽

Faculty Time ◽

The Cost

With the introduction of Fundamentals of Endoscopic Surgery™, training methods in flexible endoscopy are being augmented with simulation-based curricula. The investment for virtual reality simulators warrants further research into its training advantage. Trainees were randomized into bedside or simulator training groups (BED vs SIM). SIM participated in a proficiency-based virtual reality curriculum. Trainees’ endoscopic skills were rated using the Global Assessment of Gastrointestinal Endoscopic Skills (GAGES) in the patient care setting. The number of cases to reach 90 per cent of the maximum GAGES score and calculated costs of training were compared. Nineteen residents participated in the study. There was no difference in the average number of cases required to achieve 90 per cent of the maximum GAGES score for esophagogastroduodenoscopy, 13 (SIM) versus11 (BED) ( P = 0.63), or colonoscopy 21 (SIM) versus 4 (BED) ( P = 0.34). The average per case cost of training for esophagogastroduodenoscopy was $35.98 (SIM) versus $39.71 (BED) ( P = 0.50), not including the depreciation costs associated with the simulator ($715.00 per resident over six years). Use of a simulator appeared to increase the cost of training without accelerating the learning curve or decreasing faculty time spent in instruction. The importance of simulation in endoscopy training will be predicated on more cost-effective simulators.

Download Full-text

Virtual Reality Simulator Training for Shoulder Arthroscopy Procedures

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2017.07.422 ◽

2017 ◽

Vol 225 (4) ◽

pp. S185-S186

Author(s):

Anthony E. Johnson ◽

Christopher J. Roach ◽

Travis C. Burns ◽

Jessica C. Rivera

Keyword(s):

Virtual Reality ◽

Shoulder Arthroscopy ◽

Simulator Training ◽

Virtual Reality Simulator

Download Full-text

Attraction of prey

10.1093/oso/9780198779841.003.0012 ◽

2018 ◽

Cited By ~ 2

Author(s):

John D. Horner ◽

Bartosz J. Płachno ◽

Ulrike Bauer ◽

Bruno Di Giusto

Keyword(s):

Visual Cues ◽

Synergistic Action ◽

Carnivorous Plants ◽

Future Research ◽

Acoustic Cues ◽

Qualitative And Quantitative Analysis ◽

Qualitative And Quantitative ◽

The Past ◽

The Cost ◽

Prey Attraction

The ability to attract prey has long been considered a universal trait of carnivorous plants. We review studies from the past 25 years that have investigated the mechanisms by which carnivorous plants attract prey to their traps. Potential attractants include nectar, visual, olfactory, and acoustic cues. Each of these has been well documented to be effective in various species, but prey attraction is not ubiquitous among carnivorous plants. Directions for future research, especially in native habitats in the field, include: the qualitative and quantitative analysis of visual cues, volatiles, and nectar; temporal changes in attractants; synergistic action of combinations of attractants; the cost of attractants; and responses to putative attractants in electroantennograms and insect behavioral tests.

Download Full-text

Institutions and the Embedded Entrepreneur

The Oxford Handbook of Entrepreneurship and Collaboration ◽

10.1093/oxfordhb/9780190633899.013.6 ◽

2019 ◽

pp. 115-134

Author(s):

Maryann Feldman ◽

Paige Clayton

Keyword(s):

Current Evidence ◽

Future Research ◽

Institutional Logic ◽

The Relationship ◽

Regional Resources

This chapter examines the relationship between entrepreneurs and the communities in which they are embedded. It argues that the actions of entrepreneurs and their firms are contextually situated in specific geographies that make their actions endogenous in the development of place and define a place-specific institutional logic. This argument is at odds with the view that industry clustering is due to the role of incumbent firms. This chapter reconciles these views by adopting a temporal view, allowing both incumbents and geography to co-occur and influence clustering. It then considers the current evidence of entrepreneurs’ effects on regional resources and capacity, and concludes with suggestions for future research.

Download Full-text

Monitoring the technological processes in the wood industry in order to make them more efficient through technical overhauling

MATEC Web of Conferences ◽

10.1051/matecconf/201929002007 ◽

2019 ◽

Vol 290 ◽

pp. 02007

Author(s):

Radu Dan Paltan ◽

Cristina Biriş ◽

Loredana Anne-Marie Rădulescu

Keyword(s):

Automotive Industry ◽

Operating Mode ◽

Solid Wood ◽

Production Costs ◽

Operating Costs ◽

Future Research ◽

Wood Industry ◽

Research Article ◽

State Of Research ◽

The Cost

Of many techniques that are used to optimize production and costs, the studies conducted within a profile company lead to our choice for testing the 6Sigma method (the most used method in the automotive industry) in view of the economic efficiency applied in the wood Industry company. This method measures how many flaws exist in a process and determines in a systematic way how to improve it by technical overhauling and eliminating or minimizing the process for efficiency. This research article aims to study the state of research on the optimization of the production process through technical overhauling for panels reconstituted from solid wood and ways to make production more efficient by cutting costs through technical overhauling. From preliminary research, we estimate that all the items founded and others that will result from further research will result in a significant decrease in production costs that are reflected in the cost of the finished product and consequently in increasing the yield of the company by maximizing its profit. At the same time it may be the basis of future research studies in the field. The easier it is to maximize profits, the lower the operating costs are and the higher recovery rate of investments are, that will result a change in the operating mode: “working smarter not harder”.

Download Full-text

An explanatory study of the use of e-mail investor communication by South African listed companies

SA Journal of Information Management ◽

10.4102/sajim.v18i1.743 ◽

2016 ◽

Vol 18 (1) ◽

Author(s):

Roelof Baard ◽

George Nel

Keyword(s):

Listed Companies ◽

Future Research ◽

Contact Method ◽

Interactive Communication ◽

Handling Performance ◽

Corporate Websites ◽

Use Of Social Media ◽

Almost All ◽

The Cost ◽

E Mail

Background: Although research shows that almost all listed companies have corporate websites with dedicated investor relations (IR) sections that enable companies to ‘push’ information to investors, it was argued that such an asymmetrical approach to communication is insufficient for companies wishing to exercise good IR. The purpose of this study was to test the effectiveness of the Internet to act as a mechanism to achieve more interactive communication between companies and investors.Objectives: The objectives of the study were to measure the responsiveness, timeliness and relevance of companies’ responses to e-mail requests, and to test for the determinants (size, market-to-book ratio, profitability, leverage and liquidity) thereof.Method: The mystery investor approach and a content analysis were used to study the e-mail handling performance of companies. The associations between company-specific characteristics were statistically tested.Results: It was found that the e-mail handling performance of companies in this study was poor compared with previous studies. Significant relationships between company size and responsiveness and relevance, and between market-to-book ratio and relevance were reported, as well as between the contact method used to request information and relevance and the use of social media and timeliness.Conclusion: Specific areas where companies could improve their investor communications were identified. The need for further research was discussed to explain some of the relationships found, as well as those not found, in contrast to what was expected. Future research is warranted to examine the relationship between the e-mail handling performance of companies and information asymmetry and the cost of equity of companies.

Download Full-text