Simulation in New Zealand: what have you done for me lately? New Zealand Association for Simulation in Healthcare (NZASH) white paper.

Medical simulation has become an integral aspect of modern healthcare education and practice. It has evolved to become an essential aspect of teaching core concepts and skills, common and rare presentations, algorithms and protocols, communication, interpersonal and teamworking skills and testing new equipment and systems. Simulation-based learning (SBL) is useful for the novice to the senior clinician. Healthcare is a complex adaptive system built from very large numbers of mutually interacting subunits (e.g., different professions, departments, equipment). These subunits generate multiple repeated interactions that have the potential to result in rich, collective behaviour that feeds back into the organisation. There is a unique opportunity in New Zealand with the formation of Te Whatu Ora - Health New Zealand and Te Aka Whai Ora - Maori Health Authority and the reorganisation of the healthcare system. This viewpoint is a white paper for the integration of SBL into our healthcare system. We describe our concerns in the current system and list our current capabilities. The way SBL could be implemented in pre- and post-registration phases of practice are explored as well as the integration of communication and culture. Interprofessional education has been shown to improve outcomes and is best done with an interprofessional simulation curriculum. We describe ways that simulation is currently used in our system and describe other uses such as quality improvement, safety and systems engineering and integration. The aim of this viewpoint is to alert Te Whatu Ora and Te Aka Whai Ora of the existing infrastructure of the simulation community in New Zealand and encourage them to invest in its future.

Measuring the forces of middle ear surgery; evaluating a novel force-detection instrument.

HYPOTHESIS: The forces applied to the middle ear structures during surgery are measurable. BACKGROUND: Surgical forces applied to the middle ear are often cited as a cause of postoperative sensorineural hearing loss; however, no literature exists on how much total force is applied during common middle ear procedures. METHODS: Using our novel middle ear surgical force sensor, we took measurements from 6 temporal bones of common middle ear manipulations. RESULTS: Temporal bones of 3 males and 3 females yielded 72 measurements for an average peak applied force and 68 measurements for total applied force across 3 levels of operator experience. Statistically significant differences were seen between different levels of operator and how much force was applied, with senior operators using less force. CONCLUSION: We show it is possible to measure the applied forces in middle ear surgery and that some of these forces are very large. Larger forces are seen in destructive procedures and in procedures performed by inexperienced operators. This project is an important first step in investigating the association between surgically applied middle ear forces and postoperative sensorineural hearing loss.

Development of a surgical instrument for measuring forces applied to the ossicles of the middle ear.

Surgery of the middle ear is a delicate process that requires the surgeon to manipulate the ossicles, the smallest bones in the body. Excessive force applied to the ossicles can easily be transmitted through to the inner ear which may cause a permanent sensorineural hearing loss. An instrument was required to measure the forces applied to cadaveric temporal bone ossicles with the vision of measuring forces in vivo at a later stage. A feasibility study was conducted to investigate a method of measuring force and torque applied to the ossicles of the middle ear. Information from research papers was gathered to determine the expected amplitudes. The study looked at commercially available transducers as well as constructing an instrument using individual axis transducers coupled together. A prototype surgical instrument was constructed using the ATI industrial automation Nano17 six axis transducer. The Nano17 allows for the measurement of force and torque in the X, Y and Z axis to a resolution of 1/320 N. The use of the Nano17 enabled rapid development of the surgical instrument. It meets the requirements for its use on cadaveric models and has the potential to be a useful data collection tool in vivo.