Augmented and Mixed Reality: Technologies for Enhancing the Future of IR.

Augmented and mixed reality are emerging interactive and display technologies. These technologies are able to merge virtual objects, in either 2 or 3 dimensions, with the real world. Image guidance is the cornerstone of interventional radiology. With augmented or mixed reality, medical imaging can be more readily accessible or displayed in actual 3-dimensional space during procedures to enhance guidance, at times when this information is most needed. In this review, the current state of these technologies is addressed followed by a fundamental overview of their inner workings and challenges with 3-dimensional visualization. Finally, current and potential future applications in interventional radiology are highlighted.

Videoconference for psychotherapy training and supervision: two case examples.

Psychotherapy supervision and training are now widely available online. However, many supervisors still may be unclear on how online supervision actually works, or what it actually looks like in practice. In this article, three case examples of online videoconference-based supervision programs will be described. Partial transcripts from two online supervision sessions are provided. The benefits and limitations of online supervision are discussed, including discussion of supervision process, ethics, privacy, and security.

Designing post-graduate Master's degree programs: the advanced training program in Dental Functional Analysis and Therapy as one example.

INTRODUCTION: The decision to consolidate European higher education was reached by the Bologna Conference. Based on the Anglo-American system, a two-cycle degree program (Bachelor and Master) has been introduced. Subjects culminating in a state examination, such as Medicine and Dentistry, were excluded from this reform. Since the state examination is already comparable in its caliber to a Master's degree in Medicine or Dentistry, only advanced Master's degree programs with post-graduate specializations come into consideration for these subjects. In the field of dentistry numerous post-graduate study programs are increasingly coming into existence. Many different models and approaches are being pursued. METHOD: Since the 2004-2005 winter semester, the University of Greifswald has offered the Master's degree program in Dental Functional Analysis and Therapy. Two and a half years in duration, this program is structured to allow program participation while working and targets licensed dentists who wish to attain certified skills for the future in state-of-the-art functional analysis and therapy. AIM: The design of this post-graduate program and the initial results of the evaluation by alumni are presented here. CONCLUSION: Our experiences show that the conceptual idea of an advanced Master's program has proved successful. The program covers a specialty which leads to increased confidence in handling challenging patient cases. The sharing of experiences among colleagues was evaluated as being especially important.

Collaborative learning about e-health for mental health professionals and service users in a structured anonymous online short course: pilot study.

BACKGROUND: Professionals are interested in using e-health but implementation of new methods is slow. Barriers to implementation include the need for training and limited awareness or experience. Research may not always convince mental health professionals (MHPs). Adding the 'voice' of mental health service users (MHSUs) in collaborative learning may help. Involving MHSUs in face-face education can be difficult. We had previously been unable to engage MHPs in online discussion with MHSUs. Here we assessed the feasibility of short online courses involving MHSUs and MHPs. METHODS: We ran three e-health courses, comprising live interactive webcast, week's access to a discussion forum, and final live interactive webcast. We recruited MHPs via posters, newsletters, and telephone from a local NHS trust, and online via mailing lists and personal contacts from NHS trusts and higher education. We recruited MHSUs via a previous project and an independent user involvement service. Participants were presented with research evidence about e-health and asked to discuss topics using professional and lived experience. Feasibility was assessed through recruitment and attrition, participation, and researcher workloads. Outcomes of self-esteem and general self-efficacy (MHSUs), and Internet self-efficacy and confidence (MHPs) were piloted. RESULTS: Online recruiting was effective. We lost 15/41 from registration to follow-up but only 5/31 that participated in the course failed to complete follow-up. Nineteen MHPs and 12 MHSUs took part and engaged with each other in online discussion. Feedback was positive; three-quarters of MHPs indicated future plans to use the Internet for practice, and 80% of MHSUs felt the course should be continued. Running three courses for 31 participants took between 200 to 250 hours. Before and after outcome measures were completed by 26/31 that participated. MHP Internet self-efficacy and general Internet confidence, MHSU self-esteem and general self-efficacy, all seemed reliable and seemed to show some increase. CONCLUSIONS: Collaborative learning between MHSUs and MHPs in a structured online anonymous environment over a one-week course is feasible, may be more practical and less costly than face-face methods, and is worthy of further study.

Computer-assisted management of attention-deficit/hyperactivity disorder.

OBJECTIVES: Medication management of attention-deficit/hyperactivity disorder (ADHD) is often suboptimal. We examined whether (1) brief physician training plus computer-assisted medication management led to greater reduction in ADHD symptoms and (2) adherence to the recommended titration protocol produced greater symptomatic improvement. METHODS: A randomized medication trial was conducted that included 24 pediatric practices. Children who met criteria for ADHD were randomly assigned by practice to treatment-as-usual or a specialized care group in which physicians received 2 hours of didactic training on medication management of ADHD plus training on a software program to assist in monitoring improvement. Parent and teacher reports were obtained before treatment and 4, 9, and 12 months after starting medication. RESULTS: Children in both specialized care and treatment-as-usual groups improved on the ADHD Rating Scales and SNAP-IV, but there were no group differences in improvement rates. Brief physician training alone did not produce improvements. When recommended titration procedures were followed, however, outcomes were better for total and inattentive ADHD symptoms on both the ADHD Rating Scales and SNAP-IV parent and teacher scales. Results were not attributable to discontinuation because of adverse effects or failure to find an effective medication dose. CONCLUSIONS: Brief physician training alone did not lead to reductions in ADHD symptoms, but adherence to a protocol that involved titration until the child's symptoms were in the average range and had shown a reliable change led to better symptom reduction. Computer-assisted medication management can contribute to better treatment outcomes in primary care medication treatment of ADHD.

Enhancing Self-Practice/Self-Reflection (SP/SR) approach to cognitive behaviour training through the use of reflective blogs.

BACKGROUND: Self-Practice/Self-Reflection (SP/SR) is increasingly beginning to feature as a central component of CBT training programmes (Bennett-Levy et al., 2001). Programmes including a reflective element, however, are not unproblematic and it has been documented that simply setting time aside for reflection does not necessarily result in trainees using such time to reflect. Such limitations may be overcome by including a requirement to post reflections on reflective blogs. AIM: To examine the effect that a requirement to contribute to a reflective blog had upon a SP/SR approach to CBT training. METHOD: A focus group methodology was adopted with data analyzed using a general inductive qualitative approach. RESULTS: The requirement to use blogs to reflect upon the self-practice of CBT techniques enhanced SP/SR, established a learning community, and improved course supervision, although some technical difficulties arose. CONCLUSIONS: Consideration should be given towards using reflective blogs to support a SP/SR approach to CBT training. Benefits afforded by the use of reflective blogs further establish SP/SR as a valid and flexible training approach.

Accesibilidad y usabilidad de las aplicaciones computarizadas de estimulación cognitiva: Telecognitio® / Accesibility and usability of computer-based cognitive stimulation: Telecognitio®

IntroducciónEl objetivo principal de este trabajo es realizar una aproximación al grado de adaptación de dos aplicaciones de psicoestimulación utilizadas en nuestro medio. Así mismo, a través de la observación de los problemas de uso de estas dos aplicaciones uso en una pequeña muestra de personas mayores, se elabora una tabla de requisitos mínimos que a nuestro juicio deberían cumplir. Finalmente, se presenta Telecognitio®, una aplicación para la estimulación cognitiva de los mayores que incorpora ciertas funcionalidades de interés.Material y métodosSe evalúa el uso de dos herramientas de intervención cognitiva sobre una muestra de sujetos mayores a través de un cuestionario elaborado al efecto. Se realiza un análisis descriptivo de los resultados obtenidos y se sugieren posibles relaciones entre los resultados y el nivel cognitivo del sujeto.ResultadosObservamos que las personas mayores, especialmente si tienen deterioro cognitivo, presentan dificultades en la comprensión de los enunciados que transmiten las instrucciones para las diferentes actividades. Así mismo, el tiempo para responder a las cuestiones planteadas parece ser insuficiente. Cuando la pantalla es táctil se producen errores, tanto de precisión como de mantenimiento de la presión, aunque el uso de este dispositivo resulte más intuitivo que el ratón convencional.ConclusionesLas aplicaciones computarizadas de valoración y estimulación cognitiva van a constituirse en herramientas de uso generalizado entre la población de personas mayores, por lo que sería conveniente adaptarlas mejorando su accesibilidad y usabilidad(AU)

IntroductionDespite of the huge technological advance in the field of computer-based cognitive interventions, very few applications have been designed to be used by the elderly.IntroductionThe main objective of this study was to assess the adaptability of two psycho-stimulation applications used in geriatrics. A further aim was to design a table of the minimum requirements to be met through the use of these applications in a small sample of elders. In addition, Telecognitio®—an application with some interesting functionalities—is presented.Material and methodsWe performed a pilot test of two cognitive intervention tools, which were evaluated by a sample of elderly people through a specifically designed questionnaire. A descriptive study of the results was performed, as well as of the possible correspondence between the subjects’ cognitive status and the results.ResultsThe results of this study indicate that, in general, elderly people and especially those with cognitive impairment had difficulties in understanding the instructions for the various activities, as well as little time to answer the questions. In the case of a touch screen, errors occurred, both due to accuracy and pulse time, although this device is more intuitive than the conventional mouse.ConclusionsComputer-based cognitive stimulation and evaluation applications will become widely used among the elderly. Therefore, these applications should be adapted for universal accessibility and usability(AU)

[Development and assessment of a multimedia computer program to teach pleural drainage techniques]. / Desenvolvimento e avaliação de um programa multimídia de computador para ensino de drenagem pleural.

OBJECTIVE: To develop a multimedia educational computer program designed to teach pleural drainage techniques to health professionals, as well as to evaluate its efficacy. METHODS: We planned and developed a program, which was evaluated by 35 medical students, randomized into two groups. Group 1 comprised 18 students who studied using the program, and group 2 comprised 17 students who attended a traditional theoretical class given by an experienced teacher. Group 1 students were submitted to two subjective evaluations using questionnaires, and both groups took an objective theoretical test with multiple choice questions and descriptive questions. The results of the theoretical test were compared using the Mann-Whitney test. RESULTS: The subjective evaluation of the technological aspects and content of the program ranged from excellent to very good and good. The software was considered highly instructive by 16 students (88.9%), and 17 students (94.4%) thought it might partially substitute for traditional classes. Between the two groups, there was no significant difference in the multiple choice test results, although there was such a difference in the descriptive question results (p < 0.001), group 1 students scoring higher than did those in group 2. CONCLUSIONS: The computer program developed at the Federal University of São Paulo Paulista School of Medicine proved to be a feasible means of teaching pleural drainage techniques. The subjective evaluation of this new teaching method revealed a high level of student satisfaction, and the objective evaluation showed that the program was as efficacious as is traditional instruction.

Desenvolvimento e avaliação de um programa multimídia de computador para ensino de drenagem pleural / Development and assessment of a multimedia computer program to teach pleural drainage techniques

OBJETIVO: Desenvolver um programa educacional de computador sobre drenagem pleural voltado a profissionais de saúde, com recursos de multimídia, e avaliar sua eficácia com alunos. MÉTODOS: Foi planejado o desenvolvimento do programa e a avaliação foi realizada com 35 alunos do curso de medicina divididos aleatoriamente em dois grupos. O grupo 1, composto por 18 alunos, estudou com o programa e o grupo 2, com 17 alunos, recebeu uma aula teórica tradicional, com professor experiente. Os alunos do grupo 1 foram submetidos a duas avaliações subjetivas por questionários, e os alunos de ambos os grupos foram submetidos a uma prova teórica objetiva com testes de múltipla escolha e questões descritivas. Os resultados da prova teórica foram comparados por meio do teste de Mann-Whitney. RESULTADOS: A avaliação subjetiva quanto aos aspectos de informática e conteúdo mostrou resultados entre ótimo, muito bom e bom. O programa foi considerado totalmente didático por 16 alunos (88,9 por cento) e 17 alunos (94,4 por cento) responderam que pode vir a substituir parcialmente as aulas tradicionais. Não houve diferença significante entre os dois grupos nos testes de múltipla escolha, mas houve diferença significante nas questões descritivas (p < 0,001). O grupo 1 obteve notas maiores que as do grupo 2. CONCLUSÕES: O desenvolvimento do programa de computador para ensino de drenagem pleural na Universidade Federal de São Paulo/Escola Paulista de Medicina mostrou-se factível. A avaliação subjetiva deste novo método de ensino mostrou-se altamente satisfatória e a avaliação objetiva mostrou que o programa foi tão eficaz quanto o ensino tradicional.

OBJECTIVE: To develop a multimedia educational computer program designed to teach pleural drainage techniques to health professionals, as well as to evaluate its efficacy. METHODS: We planned and developed a program, which was evaluated by 35 medical students, randomized into two groups. Group 1 comprised 18 students who studied using the program, and group 2 comprised 17 students who attended a traditional theoretical class given by an experienced teacher. Group 1 students were submitted to two subjective evaluations using questionnaires, and both groups took an objective theoretical test with multiple choice questions and descriptive questions. The results of the theoretical test were compared using the Mann-Whitney test. RESULTS: The subjective evaluation of the technological aspects and content of the program ranged from excellent to very good and good. The software was considered highly instructive by 16 students (88.9 percent), and 17 students (94.4 percent) thought it might partially substitute for traditional classes. Between the two groups, there was no significant difference in the multiple choice test results, although there was such a difference in the descriptive question results (p < 0.001), group 1 students scoring higher than did those in group 2. CONCLUSIONS: The computer program developed at the Federal University of São Paulo Paulista School of Medicine proved to be a feasible means of teaching pleural drainage techniques. The subjective evaluation of this new teaching method revealed a high level of student satisfaction, and the objective evaluation showed that the program was as efficacious as is traditional instruction.

Use of computer assisted and interactive cognitive training programmes with moderate to severely demented individuals: a preliminary study.

The purpose of this study was to investigate the potential effects of interactive cognitive training and computer-assisted programmes in reducing decline in older adults with dementia. The primary goal of this programme was to maintain participants' level of cognitive function. This study included six moderately to severely demented older adults living in a secured memory-impairment unit within an assisted living community. The participants were assessed with neuropsychological tests prior to, and immediately following, an intensive six-week cognitive training programme. The results showed that the participants improved significantly on measures of overall cognitive function, including short-term memory and cognitive failures. Caregiver reports also indicated significant improvement in the participants' behaviour signs and socialization. Additionally, these participants did not demonstrate significant decline on any of the measures from pre-test to post-test levels. This preliminary study indicates that a combined interactive cognitive training and individual-based computer training programme may effectively reduce decline and even improve some cognitive and behavioural functioning in demented older adults. A follow-up of the participants after four weeks of no training revealed some decline in some of the cognitive and behavioural measures, thus supporting the effectiveness of the training programmes.

Use of the voice-controlled and computer-assisted surgical system ZEUS for endoscopic coronary artery bypass grafting.

OBJECTIVE: With the aim of performing a completely endoscopic coronary bypass anastomosis, we have undertaken an experimental and clinical study using robotic instrumentation and voice-controlled camera guidance. METHODS: The ZEUS Robotic Surgical System (Computer Motion Inc, Goleta, Calif) consists of three interactive robotic arms and a control unit, allowing the surgeon to move the instrument arms in a scaled down mode. The third arm (AESOP, Computer Motion) positions the endoscope via voice control. PHASE I: In a phantom model, vascular grafts were anastomosed to the left anterior descending coronary artery (LAD) of 50 pig hearts with either 2- or 3-dimensional visualization. PHASE II: In 6 dogs (FBI 20-25 kg) the left internal thoracic artery (LITA) was harvested endoscopically. Then the animals were placed on an endovascular cardiopulmonary bypass system (Port-Access, Heartport, Inc, Redwood City, Calif). Anastomosis of the LITA to the LAD was performed endoscopically with the telemetric ZEUS instruments. Flow rates through the LITA were measured by Doppler analysis. PHASE III: Two patients were operated on with the ZEUS system. After endoscopic harvesting of the LITA and cardiopulmonary bypass with the Port-Access system, the bypass graft (LITA-LAD) was anastomosed endoscopically with the ZEUS system through three thoracic ports. RESULTS: In the dry laboratory, the time range required for the robotically assisted coronary anastomosis was 35 to 60 minutes with 2-dimensional visualization and 16 to 32 minutes with 3-dimensional visualization. In the animal experiments, the median time for endoscopic harvesting of the LITA was 86 minutes (range 56-120 minutes) and for the anastomosis, 42 minutes (range 35-105 minutes); flow rates through the LITA ranged between 22 and 45 mL/min. In the clinical cases, preparation times for the LITA were 83 and 110 minutes, respectively, and anastomosis times, 42 and 40 minutes, respectively. Doppler flow rates measured 125 and 85 mL/min, respectively. Both patients had an uneventful follow-up angiogram and postoperative course. CONCLUSIONS: With sophisticated robotic technology, a completely endoscopic anastomosis of the LITA to the LAD is possible, allowing technically precise operations within acceptable time limits.