Impact of haptic feedback on surgical training outcomes: A Randomised Controlled Trial of haptic versus non-haptic immersive virtual reality training.

Objective: This study aimed to evaluate the educational impact of integrated haptic feedback in an immersive VR bone drilling simulation on the performance of a cohort of junior surgeons. Design: Block randomised, controlled, double-blinded study. Setting: St Georges University Hospital, London, United Kingdom. Participants: and methods: 31 trainee doctors (postgraduate years 1-3) with limited orthopaedic experience were recruited to participate in this randomised controlled study through e-mail and poster advertising. They were allocated to haptic or non-haptic group through block randomisation prior to entering the study environment. All participants provided verbal and written consent to participate in this study. All participants were blinded to the nature of the study as well as its intervention arms. All participants completed an immersive virtual reality training module with either haptic feedback or no haptic feedback in which they had to drill 3 bicortical holes in a VR tibia bone model in preparation for screw insertion followed by an ex vivo equivalent task on a tibial sawbone model once again drilling 3 holes through both cortices of the tibia. Outcome measures were plunge gap distance, drilling time and objective structures assessment of technical skills (OSAT) as well as qualitative questionnaire outcomes. Results: Haptic feedback in the VR training module showed significantly less plunge gap distance compared to the non-haptic group (7.6 mm ± 4.3 vs 13.6 mm ± 7.4 (p = 0.012)). The haptic group also had longer drill times (17.5 s ± 4.0 vs 13.8 s ± 4.2 (p = 0.027)), higher combined OSAT cores (14 (10,17) vs 8.5 (7.75, 12), p = 0.0006) and greater number of safe drills of <5 mm plunge gap in at least 2 out of 3 attempts (6 (40) vs 0 (0), p = 0.021. Conclusions: This study demonstrates better performance for an orthopaedic surgical task when using a VR-based simulation model incorporating haptic feedback, compared to one without haptic feedback supporting the pursuit and implementation of haptics in surgical training simulation models to enhance their educational value.

Using Haptic Feedback in a Virtual Reality Bone Drilling Simulation to Reduce Plunge Distance.

Background Bone drilling is a procedure that demands a high level of dexterity, fine motor skills and spatial awareness from the operating surgeon. An important consideration when drilling bone is minimising soft tissue damage. There are numerous causes of drilling associated soft tissue injury, of which most concerning is drilling into the tissue beyond the far cortex as unseen injury can occur. This is known as plunging. Objectives The objective of this study was to evaluate the impact of haptic feedback in virtual reality (VR) simulation-based training. The acquisition of drilling skill was assessed by changes to their drill plunge depth. Study Design & Methods The participants in the study were medical students, doctors and biomedical scientists. Participants were randomly allocated into two groups. One group had simulation with haptic feedback as part of their VR simulated learning, whereas the second group undertook the same VR simulation but did not receive haptic feedback during the simulation. Following completion of the simulated bone drilling protocol, a bone drilling exercise took place. Each participant was allowed to drill a synthetic tibia bone five times and then the plunge depth was measured. We quantified outcome in the form of plunge depth. Results  There were four participants in each group. The average plunge distance in the group who were able to practice with haptic assisted VR simulation was 46mm (range: 37-56mm), the average plunge distance in the non-haptic group was 79mm (range: 44-136mm). Results showed an average reduction of 33mm in plunge depth from users in the haptic group compared to the non-haptic group. Conclusion  Bone drilling simulation with haptic feedback may be an effective simulator of the motor skills that would be required to perform this action on a live patient. The study results suggest that there could be a reduction in soft tissue damage for users trained in VR simulations with haptic feedback.

The adoption of an e-learning system using information systems success model: a case study of Jazan University.

BACKGROUND: The e-learning system has gained a phenomenal significance than ever before in the present COVID-19 crisis. The E-learning delivery mechanisms have evolved to enhanced levels facilitating the education delivery with greater penetration and access to mass student population worldwide. Nevertheless, there is still scope to conduct further research in order to innovate and improve higher quality delivery mechanism using the state-of-the-art information and communication technologies (ICT) available today. In the present pandemic crisis all the stakeholders in the higher education system, i.e., the governments, institutions, and the students expect seamless and efficient content delivery via e-learning platforms. This study proposes the adoption of the e-learning system by the integration of the model proposed by Delon and Mcclean "Information System Success Model" in Jazan University, Kingdom of Saudi Arabia (KSA) and further attempts to identify the factors affecting E-learning applications' success among the students. METHODS: The data were gathered from 568 respondents. The Statistical Package for the Social Sciences version 26 (SPSS v.26.0) was used for the data analysis and one-way ANOVA is applied to test the hypothesis. RESULT: The overall results of this study allude to the fact that there is a significant relationship between Information system Success Model factors and the adoption of e-learning systems. The research results indicated that the information system success model has a strong associating cost-benefit value towards the adoption of e-learning systems across the Jazan University that may be further expanded to the other Saudi universities.

Salvage Procedures for Management of Prosthetic Joint Infection After Hip and Knee Replacements.

BACKGROUND: The increasing load placed by joint replacement surgery on health care systems makes infection, even with the lowest rates, a serious concern that needs to be thoroughly studied and addressed using all possible measures. METHODS: A comprehensive review of the current literature on salvage procedures for recurrent PJIs using PubMed, EMBASE and CINAHL has been conducted. RESULTS: Prolonged suppressive antibiotic therapy (PSAT), resection arthroplasty and arthrodesis were the most common procedures performed. Suppressive antibiotic therapy is based on the use of well tolerated long term antibiotics in controlling sensitive organisms. Resection arthroplasty which should be reserved as a last resort provided more predictable outcomes in the hip whereas arthrodesis was associated with better outcomes in the knee. Various methods for arthrodesis including internal and external fixation have been described. CONCLUSION: Despite good union and infection control rates, all methods were associated with complications occasionally requiring further surgical interventions.

Relationship between pulmonary function and degree of spinal deformity, location of apical vertebrae and age among adolescent idiopathic scoliosis patients

<p><b>INTRODUCTION</b>This retrospective review aimed to examine the relationship between preoperative pulmonary function and the Cobb angle, location of apical vertebrae and age in adolescent idiopathic scoliosis (AIS). To our knowledge, there have been no detailed analyses of preoperative pulmonary function in relation to these three factors in AIS.</p><p><b>METHODS</b>A total of 38 patients with thoracic or thoracolumbar scoliosis were included. Curvature of spinal deformity was measured using the Cobb method. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were used to evaluate preoperative pulmonary function. Statistical methods were used to analyse the relationship between preoperative pulmonary function and the factors that may contribute to poor pulmonary function.</p><p><b>RESULTS</b>The mean age of the patients was 16.68 ± 6.04 years. An inverse relationship was found between the degree of the Cobb angle and FVC as well as FEV1; however, the relationships were not statistically significant (p = 0.057 and p = 0.072, respectively). There was also a trend towards a significant negative correlation between the thoracic curve and FVC (p = 0.014). Patients with larger thoracic curves had lower pulmonary function. A one-year increase in age significantly decreased FVC by 1.092 units (p = 0.044). No significant relationship between age and preoperative FEV1 was found. The median FVC was significantly higher in patients with affected apical vertebrae located at levels L1-L3 than at T6-T8 or T9-T12 (p = 0.006).</p><p><b>CONCLUSION</b>Lung function impairment was seen in more severe spinal deformities, proximally-located curvature and older patients.</p>

High rates of sexual and urinary dysfunction after surgically treated displaced pelvic ring injuries.

BACKGROUND: Pelvic ring injuries may be associated with genitourinary injury (GUI) and result in urinary or sexual dysfunction. QUESTIONS/PURPOSES: We determined (1) incidence of new sexual and urinary dysfunction after surgically treated pelvic ring injuries, (2) association of sexual or urinary dysfunction to fracture type and GUI, and (3) incidence and association between new sexual and urinary dysfunction in male and female patients without GUI. METHODS: We retrospectively studied 151 patients by postal questionnaire after pelvic reconstruction. Presence, type, and severity of new sexual dysfunction and urinary dysfunction were related to GUI and type of pelvic fracture using the Young and Burgess classification. Minimum followup was 1 year (median, 5 years; range, 1-12 years). RESULTS: New sexual dysfunction occurred in 61 of 143 (43%) and urinary dysfunction in 61 of 150 (41%) responding patients. Neither new sexual nor urinary dysfunction was associated with sex or GUI. In patients with no GUI, new sexual dysfunction was associated with chronologic age (odds ratio [OR], 1.04/year; 95% CI, 1.01-1.07) and pelvic fracture type. Lateral compression injury was less likely to result in new sexual or urinary dysfunction compared with AP type (sexual OR, 1.73; 95% CI, 0.67-4.47; urinary OR, 2.97; 95% CI, 1.15-7.66) and vertical shear type (sexual OR, 2.60; 95% CI, 1.02-6.64; urinary OR, 4.6; 95% CI, 1.81-11.73). CONCLUSIONS: Our data suggest new sexual and urinary dysfunction occur at relatively high rates after pelvic fracture in patients with or without GUI. We recommend early assessment and referral for specialist treatment. LEVEL OF EVIDENCE: Level III, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

In vitro pressurization of the acetabular cement mantle: the effect of a flange.

A model was developed to assess the effect of an acetabular flange on pressure within different zones of the cement mantle during insertion. Two prosthetic designs were assessed in 3 different sizes. Flanged components produced significantly higher mean pressures than unflanged ones (P < .01). The effect of a flange was more pronounced at the rim than at the pole. Delayed insertion resulted in a further significant rise in mean pressure (P < .01), but this did not compensate for the lack of a flange. This experimental model supports the use of a flange to increase pressure within the cement mantle on component insertion. The beneficial effect is more marked in the area that is most likely to show deficiency in the cement-bone interface on postoperative radiographs.