Novel Three-Dimensional Image-Guided Surgery: Application of a Computed Tomography-Based Three-Dimensional Model Using a Tablet Device

OBJECTIVE: A tablet device has several medical applications because it's portability. Most importantly, its powerful graphics and touch-based features have several benefits in the surgical field, especially for generating three-dimensional (3D) images based on patients' computed tomography (CT) scans. METHODS: In this study, 3D objects were manipulated by an operator on an iPad during several laparoscopic surgeries of intra-abdominal organs. Before surgery, 3D structures, such as vessels, soft tissues, and bones, were reconstructed by the surgeon using the patients' CT scans on the patients' bed-side personal computer. RESULTS: In this study, 3D image-guided surgeries were performed using an iPad in five patients. The benefits of this technique were recorded and analyzed in detail by the surgeon. CONCLUSION: Although in a pilot phase with unresolved issues, direct intra-operative handling of a patient-tailored 3D model developed using a tablet device could be useful compared with conventional two-dimensional imaging.

Visual Fatigue Induced by Viewing a Tablet Computer with a High-resolution Display

PURPOSE: In the present study, the visual discomfort induced by smart mobile devices was assessed in normal and healthy adults. METHODS: Fifty-nine volunteers (age, 38.16 ± 10.23 years; male : female = 19 : 40) were exposed to tablet computer screen stimuli (iPad Air, Apple Inc.) for 1 hour. Participants watched a movie or played a computer game on the tablet computer. Visual fatigue and discomfort were assessed using an asthenopia questionnaire, tear film break-up time, and total ocular wavefront aberration before and after viewing smart mobile devices. RESULTS: Based on the questionnaire, viewing smart mobile devices for 1 hour significantly increased mean total asthenopia score from 19.59 ± 8.58 to 22.68 ± 9.39 (p < 0.001). Specifically, the scores for five items (tired eyes, sore/aching eyes, irritated eyes, watery eyes, and hot/burning eye) were significantly increased by viewing smart mobile devices. Tear film break-up time significantly decreased from 5.09 ± 1.52 seconds to 4.63 ± 1.34 seconds (p = 0.003). However, total ocular wavefront aberration was unchanged. CONCLUSIONS: Visual fatigue and discomfort were significantly induced by viewing smart mobile devices, even though the devices were equipped with state-of-the-art display technology.

Korean Version Self-testing Application for Reading Speed

PURPOSE: This study introduces a reading chart application for the iPad tablet in the Korean language and investigates the reading speed in a normal-sighted population according to age group. METHODS: Sixty-three Korean sentences were selected from textbooks for second grade elementary school students. A commonly used typeface in everyday printed material, “BatangChe,” was used. Letter size was presented in logarithm of the minimum angle of resolution (logMAR) 0.0 to 1.0 at 0.1 logMAR steps at a reading distance of 40 cm. A third generation retina display iPad was used to present the chart, and the sentences were presented randomly for each size of letter. The subjects repeated the test silently (reading only) and out loud (reading and speaking) to prevent them from skipping reading words. Pilot testing followed in 65 normal vision adults under 60 years of age. RESULTS: The mean reading only speed for logMAR 0.5 optotype (point 10) was 121.1 ± 47.2 words per minute (wpm) for people in their 20s (n=21), 116.5 ± 38.3 in their 30s (n=27), 93.8 ± 12.6 in their 40s (n=9), and 56.5 ± 42.7 (n=8) in their 50s. There was a significant correlation between age and reading and speaking speed (r=−0.48, p<0.001). The mean reading only speed for logMAR 0.5 optotype (point 10) was 202.3 ± 88.4 wpm and the mean reading and speaking speed was 129.7 ± 25.9 wpm, with significantly different (p<0.001). CONCLUSIONS: This Korean reading chart application could present a new standard when checking reading speed according to age groups.

A randomised, double-blinded clinical study on the efficacy of multimedia presentation using an iPad for patient education of postoperative hip surgery patients in a public hospital in Singapore

<p><b>INTRODUCTION</b>This study compared patient satisfaction and recall of physiotherapy patient education among patients who had undergone hip surgery, with information presented via an iPad versus a standard paper booklet.</p><p><b>METHODS</b>Patients who had undergone hip surgery joined and completed this single-centre study, which utilised a randomised parallel group design. They were randomly allocated to either Group A (received information on hip surgery physiotherapy via an iPad) or Group B (received the same information via a paper booklet). The participants were blinded to the intervention received by the other group and the testers were blinded to the intervention received by the participants. The interventions were carried out during the patients' first four postoperative physiotherapy sessions. The outcome measures were recorded using pre-validated questionnaires.</p><p><b>RESULTS</b>A total of 42 participants (mean age 70 ± 12 years) were recruited. After the intervention, patients in both groups had improved recall of the information presented during patient education. However, the patients in Group A had a significantly better recall score than those in Group B (4.0 points higher, p < 0.001). The level of patient satisfaction was also significantly higher in Group A than in Group B (8.5 points higher, p < 0.001).</p><p><b>CONCLUSION</b>While the use of an iPad and a paper booklet both had positive outcomes for patient recall and satisfaction, the use of an iPad was found to be more effective at improving patient satisfaction and recall of physiotherapy patient education in the present study.</p>

Application of iPad and its Software in Rehabilitation of Children with Autism:Four Cases Report / 中国康复理论与实践

Objective To explore the application of iPad-based software Let'S Talk in the rehabilitation of children with autism. Meth-ods From March to September, 2015, iPad-based software Let'S Talk was applied in four children with autism. The language ability, emo-tion and behavior control ability, self-consciousness and eye contact were observed. The Psycho-educational Profile-3rd (PEP-3), Autism Be-havior Checklist (ABC) and Childhood Autism Rating Scale (CARS) were used to access the months of age, behavior characteristics, and the severity of autism before and after application. Results The language ability and behavior control ability improved, as well as the self-consciousness and eye contact, and the bad behaviors reduced. The months of age rose in PEP-3, and the scores of ABC and CARS de-creased. Conclusion IPad-based software Let'S Talk could be applied in the rehabilitation of children with autism.

Validity of Korean Version Reading Speed Application and Measurement of Reading Speed: Pilot Study

PURPOSE: Reading speed is one of the methods used to measure near visual function. Although several versions of reading charts in different languages have been introduced, there is no Korean version of the reading chart yet. Therefore, we investigated the reading speed of normal-sighted Korean people using a recently developed reading speed application for the iPad tablet in Korea. METHODS: Normal-sighted participants without presbyopia were included and a third generation retina display iPad was used to measure reading speed. The iPad screen was set to maximum brightness and the examination was performed at a distance of 40 cm. Reading speeds were recorded twice: one for reading the sentence silently (reading only) and one for reading the sentence out loud (reading & speaking). RESULTS: The test sentences used in the application had 18.9 ± 2.6 letters and 6.5 ± 0.7 words on average. Twenty-five males and seventeen females were included. The average of the reading only speed was 202.3 ± 88.4 words per minute (WPM), and that of the reading & speaking speed was 129.7 ± 25.9 WPM, showing a statistically significant difference (p < 0.001). CONCLUSIONS: This Korean reading chart application is the first self-reporting reading chart in Korean. This chart could present a new standard for measuring both reading only and reading & speaking speeds.

A comparative study of postoperative pain for open thyroidectomy versus bilateral axillo-breast approach robotic thyroidectomy using a self-reporting application for iPad

PURPOSE: Postoperative pain for robotic thyroid surgeries including bilateral axillo-breast approach (BABA) has not been well studied. In this study, we have developed a self-reporting application (SRA) for iPad and prospectively collected pain scores from open thyroidectomy (OT) and BABA robotic thyroidectomy (RT) patients. METHODS: Female patients who underwent total thyroidectomy for papillary thyroid carcinoma were included. Patients recorded pain scores for throat, anterior neck, posterior neck, chest, and back on postoperative days 1, 2, and 3. Once discharged, on postoperative day 14, a survey was also conducted on satisfaction of SRA and cosmesis. RESULTS: A total of 54 patients were enrolled (27 BABA RT and 27 OT). There were no significant differences between the 2 groups in clinicopathological characteristics and postoperative complication rates. Postoperative pain scores at days 1, 2, 3, and 14 were not significantly different between the groups for throat, anterior neck, posterior neck, or back. Postoperative analgesic requirements were similar between the 2 groups. Wound satisfaction scores were significantly higher in the BABA RT group (BABA RT 7.4 vs. OT 5.7; P = 0.016). Satisfaction scores for the usefulness of SRA were above 7.2 for all four questionnaire items on the 10-point scale. CONCLUSION: Postoperative pain for BABA RT is equivalent to OT but offers greater cosmetic satisfaction for patients. A mobile device application such as SRA may facilitate proper assessment and management of pain in postoperative patients.

Research Electronic Data Capture (REDCap) electronic Informed Consent Form (eICF) is compliant and feasible in a clinical research setting.

Background: Electronic consent for research has shown success in clinical trial models, but has not been rigorously evaluated as an alternative to conventional paper consent. We sought to design a 21 CFR Part 11 compliant iPad-based electronic Informed Consent Form (eICF) with Research Electronic Data Capture (REDCap). As a secondary aim, we sought to compare subject workload between eICF and paper consent groups. Methods: This is a prospective, randomized study of subjects who completed an iPad-based eICF versus paper consent for research. The eICF was designed with REDCap and presented on an iPad. Subject workload was measured with the NASA Task Load Index (NASA-TLX) and subjective feedback in regards to consent process was collected. Results: A total of 116 subjects were screened for consent. Of which, 51 (44%) subjects provided informed consent and completed all study related procedures. Twenty-five (49%) eICF and 26 (51%) paper consents were completed. The eICF group rated a significantly greater preference to use the eICF for future research studies (6.4±1.5) compared to the paper consent group (5.0±1.9), p<0.01. There were no significant differences in NASA-TLX Weighted Scale or Total-TLX Scores between groups. One error resulted in the eICF group due to an inadvertent submission by a single subject. Conclusion: In summary, we have demonstrated that an iPad-based eICF designed with REDCap is both 21 CFR Part 11 compliant and feasible in the clinical research setting. The eICF does not appear to be more technically difficult or demanding than conventional paper consent.

Research on Ocular Fatigability Induced by Multimedia and Instrument Features

PURPOSE: The aim of the present study was to evaluate the different features of such instruments and how they cause ocular fatigability. METHODS: Under the same settings and circumstances, 75 participants were asked to read the novel, "You without me?" in different formats including paper book, E-book (biscuit(R), Interpark Inc., LG INNOTECK LTD, Korea) and LCD reader (iPad(R), Apple Inc., United States). For every 10 minutes of reading, 10 minutes of rest was provided. After finishing the novel, the participants were asked to complete a questionnaire, and the data obtained were statistically analyzed using univariate analysis. RESULTS: Compared to paper book readers (1.93), LCD readers (2.40) complained of insufficient lubrication in the eye (p = 0.038), and experience more letter-floating illusions (1.92) than did paper book readers (1.49) (p = 0.043). Moreover, compared to the other formats including the E-book (20%) and paper book (8%), LCD readers (72%) experienced more significant glare symptoms (n = 23) and could read at a faster rate than the other groups of readers (n = 26). CONCLUSIONS: In the present study, the I-Pad caused ocular fatigability more easily than the other formats examined. No statistical significance of ocular discomfort or fatigability was observed among the different format groups. Further investigation with a greater number of age-controlled participants should be conducted prior to designing a study to determine the best format for reading.