[TeleCOVID Hessen: implications for the development of new indication areas]. / TeleCOVID Hessen: Implikationen für die Erschließung neuer Indikationsgebiete.

BACKGROUND: During the SARS-CoV­2 pandemic, the TeleCOVID application was developed in Hessen to connect the intensive care units via telemedicine. After successful implementation, the application should be extended to other indication areas in intensive care medicine. OBJECTIVES: The purpose of this study was to evaluate other indications for which the application can be used and which technical requirements are associated with this. MATERIALS AND METHODS: To answer these questions, guideline-based expert interviews were conducted, which were evaluated using a qualitative content analysis. RESULTS: The survey showed that TeleCOVID can be extended to other indication areas in intensive care. Numerous technical requirements were formulated that should be specifically considered when the application is further developed. CONCLUSIONS: The telemedical networking of intensive care units generates added value for the actors involved. However, it is important that the data is collected in the best possible standardized and structured way. The communication process should be automated wherever possible to minimise the workload for the participating persons.

A Clinical User Study Investigating the Benefits of Adaptive Volumetric Illumination Sampling.

Accurate and fast understanding of the patient's anatomy is crucial in surgical decision making and particularly important in visceral surgery. Sophisticated visualization techniques such as 3D Volume Rendering can aid the surgeon and potentially lead to a benefit for the patient. Recently, we proposed a novel volume rendering technique called Adaptive Volumetric Illumination Sampling (AVIS) that can generate realistic lighting in real-time, even for high resolution images and volumes but without introducing additional image noise. In order to evaluate this new technique, we conducted a randomized, three-period crossover study comparing AVIS to conventional Direct Volume Rendering (DVR) and Path Tracing (PT). CT datasets from 12 patients were evaluated by 10 visceral surgeons who were either senior physicians or experienced specialists. The time needed for answering clinically relevant questions as well as the correctness of the answers were analyzed for each visualization technique. In addition to that, the perceived workload during these tasks was assessed for each technique, respectively. The results of the study indicate that AVIS has an advantage in terms of both time efficiency and most aspects of the perceived workload, while the average correctness of the given answers was very similar for all three methods. In contrast to that, Path Tracing seems to show particularly high values for mental demand and frustration. We plan to repeat a similar study with a larger participant group to consolidate the results.

Virtual Reality for Surgical Planning - Evaluation Based on Two Liver Tumor Resections.

Purpose: For complex cases, preoperative surgical planning is a standard procedure to ensure patient safety and keep the surgery time to a minimum. Based on the available information, such as MRI or CT images, and prior anatomical knowledge the surgeons create their own mental 3D model of the organ of interest. This is challenging, requires years of training and an inherent uncertainty remains even for experienced surgeons. Goal: Virtual reality (VR) is by nature excellent in showing spatial relationships through its stereoscopic displays. Therefore, it is well suited to be used to support the understanding of individual anatomy of patient-specific 3D organ models generated from MRI or CT data. Utilizing this potential, we developed a VR surgical planning tool that provides a 3D view of the medical data for better spatial understanding and natural interaction with the data in 3D space. Following a user-centered design process, in this first user study, we focus on usability, usefulness, and target audience feedback. Thereby, we also investigate the individual impact the tool and the 3D presentation of the organ have on the understanding of the 3D structures for the surgical team. Methods: We employed the VR prototype for surgical planning using a standard VR setup to two real cases of patients with liver tumors who were scheduled for surgery at a University Hospital for Visceral Surgery. Surgeons (N = 4) used the VR prototype before the surgery to plan the procedure in addition to their regular planning process. We used semi-structured interviews before and after the surgery to explore the benefits and pitfalls of VR surgical planning. Results: The participants used on average 14.3 min (SD = 3.59) to plan the cases in VR. The reported usability was good. Results from the interviews and observations suggest that planning in VR can be very beneficial for surgeons. They reported an improved spatial understanding of the individual anatomical structures and better identification of anatomical variants. Additionally, as the surgeons mentioned an improved recall of the information and better identification of surgical relevant structures, the VR tool has the potential to improve the surgery and patient safety.

[Prophylaxis of parastomal, perineal and incisional hernias in colorectal surgery]. / Prophylaxe von parastomalen, perinealen und Narbenhernien in der kolorektalen Chirurgie.

This article gives an overview of the relevant evidence from the literature on the topic of prophylactic use of meshes to prevent incisional and parastomal hernias in colorectal surgery. In addition, based on a structured literature search the incidence of hernias in colorectal surgery over the past 5 years was analyzed. A slight majority (54%) of articles recommended the use of prophylactic mesh implantation in colorectal surgery. The prophylactic use of meshes appears to reduce the risk of hernias in colorectal surgery but is associated with a slightly increased perioperative wound infection rate. Parastomal hernias are associated with higher incidence rates compared with incisional hernias and also appear to benefit more from prophylactic mesh implantation. The evidence in the literature is still unclear regarding the use of synthetic or biological implants due to the lack of randomized controlled trials. Perineal hernias were excluded from the analysis due to the incomparability of the mainly casuistic literature. An overview is given in the discussion. The analysis of the literature and also in reflection of our own experience comes to the conclusion that the disrupted integrity of the abdominal wall due to the operation should be prophylactically reinforced with a mesh after colorectal surgery. An evidence-based recommendation is not possible based on the current state of research on implantation techniques, e.g. onlay, sublay intraperitoneal onlay mesh (IPOM) and selection of the implant.

Improving professional health literacy in hospitals: study protocol of a participatory codesign and implementation study.

INTRODUCTION: In connection with a hospital stay, patients have to make important health-related decisions. They need to find, understand, assess and apply health-related information, and therefore, require health literacy. Adequately responding to the needs of patients requires promoting the communication skills of healthcare professionals within healthcare organisations. Health-literate healthcare organisations can provide an environment strengthening professionals' and patients' health literacy. When developing health-literate healthcare organisations, it has to be considered that implementing organisational change is typically challenging. In this study, a communication concept based on previously evaluated communication training is codesigned, implemented and evaluated in four clinical departments of a university hospital. METHOD AND ANALYSIS: In a codesign phase, focus group interviews among employees and patients as well as a workshop series with employees and hospital management are used to tailor the communication concept to the clinical departments and to patients' needs. Also, representatives responsible for the topic of health literacy are established among employees. The communication concept is implemented over a 12-month period; outcomes studied are health literacy on the organisational and patient levels. Longitudinal survey data acquired from a control cohort prior to the implementation phase are compared with data of an intervention cohort after the implementation phase. Moreover, survey data from healthcare professionals before and after the implementation are compared. For formative evaluation, healthcare professionals are interviewed in focus groups. ETHICS AND DISSEMINATION: The study protocol was approved by the Ethics Committee of the Medical Faculty of the University of Oldenburg and is in accordance with the Declaration of Helsinki. Study participants are asked to provide written informed consent. The results are disseminated via direct communication within the hospital, publications and conference presentations. If the intervention turns out to be successful, the intervention and implementation strategies will be made available to other hospitals. TRIAL REGISTRATION NUMBER: DRKS00019830.