A Systematic Review of Randomised Control Trials Evaluating the Efficacy and Safety of Open and Endoscopic Carpal Tunnel Release.

INTRODUCTION: Carpal tunnel syndrome is the most prevalent form of nerve compression syndrome of the upper limb; therefore, it is of clinical significance to critique treatment methods. There is an ongoing debate amongst clinicians as to which surgical method-open or endoscopic carpal tunnel release-provides better overall symptom relief and faster recovery time. This systematic review aimed to investigate the evidence from randomised control trials to evaluate the effectiveness and safety of open and endoscopic carpal tunnel release surgery. METHODS: Database searches were carried out to identify literature. An inclusion and exclusion criteria was applied to only include randomised control trials which compared open and endoscopic surgery. Publications were then selected according to PRISMA guidelines, risk of bias was assessed and patient outcome was assessed. RESULTS: Twenty-three studies were selected for this systematic review. It was found that for improvement to grip strength and symptom severity, the endoscopic group had more significant improvement in the short term, resulting in a quicker return to work time compared to the open group. The complication rate for both intervention groups was low despite more severe and irreversible complications such as prolonged pain and wound infections being observed in the open group; however, the endoscopic group reported a higher risk of needing repeat surgery. CONCLUSION: The quicker recovery time, improved cosmetic result and less severe complications observed with the endoscopic technique suggest that it should be used more often. However, this review found no convincing evidence of a significantly superior technique in the long term.

What Not to Do with PPE: A Digital Application to Raise Awareness of Proper PPE Protocol.

With a rise in personal protective equipment (PPE) use by all healthcare professionals (HCP) as a prime infection control strategy in the wake of the COVID-19 pandemic comes the potential increase in its misuse. Evidence suggests this failure to follow proper PPE protocol to prevent self-contamination and transmission can be attributed to both a lack of formal training and guidance and, now, atrophy of infrequently used skills, with many senior professionals demonstrating a lack of proficiency despite years of service. Previous research shows current written and illustrated instructional material depicting PPE guidelines are abundant but does not provide an answer on how best to target violations in protocol and better instruct those that are providing pre-hospital emergency healthcare.In this chapter, we aim to address the gap in paramedic-specific research into PPE protocol and provide an educational, digital tool to work alongside the current guidelines, potentially exploring the cognitive load theory as a design strategy. The use of 3D, interactive animations depicting errors in protocol and their potential contamination consequences in a device-based application could engage clinicians in a more effective way, thus increasing protection and decreasing transmission. This chapter describes the methodology behind the design and development of such an application for emergency care providers and provides the relevant materials needed to carry out user testing and evaluation once participants have been recruited.

Augmented Reality Application of Schizocosa ocreata: A Tool for Reducing Fear of Arachnids Through Public Outreach.

This study aims to create a mobile application for public interaction around the subject of wolf spiders, specifically the brush-legged wolf spider. The hope is that the public will have a reduced level of fear towards arachnids when given a chance to view arachnids in a digital setting. To assist this, the application employs augmented reality animation, which has been shown to have a positive impact on the viewer's interest and learning. With the opportunity to view a digital spider interacting with surfaces in a repeatable and informative manner, viewers may find that their fears are more understood and can be controlled for both their benefit and that of the local arachnids. In order to accommodate multiple audiences, the application was set up to have a more cartoonish and simpler text as well as a realistic and advanced text. The area of information covered the brush-legged wolf spider's anatomy, mating behaviour, and general safety practices for handling and avoiding wolf spiders. The modelling and animation were created using Zbrush and Blender, respectively. The programming and application creations used were Unity with Android and AR plugins.

What the Tech? The Management of Neurological Dysfunction Through the Use of Digital Technology.

Worldwide, it is estimated that millions of individuals suffer from a neurological disorder which can be the result of head injuries, ischaemic events such as a stroke, or neurodegenerative disorders such as Parkinson's disease (PD) and multiple sclerosis (MS). Problems with mobility and hemiparesis are common for these patients, making daily life, social factors and independence heavily affected. Current therapies aimed at improving such conditions are often tedious in nature, with patients often losing vital motivation and positive outlook towards their rehabilitation. The interest in the use of digital technology in neuro-rehabilitation has skyrocketed in the past decade. To gain insight, a systematic review of the literature in the field was conducting following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines for three categories: stroke, Parkinson's disease and multiple sclerosis. It was found that the majority of the literature (84%) was in favour of the use of digital technologies in the management of neurological dysfunction; with some papers taking a "neutral" or "against" standpoint. It was found that the use of technologies such as virtual reality (VR), robotics, wearable sensors and telehealth was highly accepted by patients, helped to improve function, reduced anxiety and make therapy more accessible to patients living in more remote areas. The most successful therapies were those that used a combination of conventional therapies and new digital technologies.

Engaging with Children Using Augmented Reality on Clothing to Prevent Them from Smoking.

Smoking is a harmful habit, causing a range of severe consequences which could lead to premature death. This habit is still prevalent amongst young people. In order to protect children, effective early interventions supported by public instances need to be set in place. Raising awareness and educating the youth is crucial to change their mindset about the severity of smoking. Emerging technologies, such as augmented reality (AR) on mobile devices, have been shown to be useful in providing engaging experiences and educating children about a range of issues, including health and anatomy. This chapter presents a research which explores the use of AR as an exciting and engaging medium to effectively help educating children from 5 to 13 years about the effects of smoking. A mobile application, called SmokAR, was developed. This app includes AR visualization amongst other functionalities, whereby children are presented a realistic model of the human lungs of a healthy person and of a smoker. The aim of this research is to propose a transformative experience in order to put children off this dangerous habit whilst they gain knowledge about the effect of smoking on their organs. The anatomical accuracy of the 3D models and animations proposed by the app has been verified by an expert anatomist. A group of children (n = 17) also took part in usability and knowledge acquisition testing at the Glasgow Science Centre. Findings showed a significant high usability suggesting a user-friendly app design. Moreover, results also suggested that participants gained knowledge to a certain extent and felt discouraged from smoking after seeing the model of the smoker's lungs. Although there were several limitations to the study, the potential of the app to support learning and raising awareness is encouragingly positive. In addition, user testing in a more controlled environment, such as a classroom, can help gain further insights into the effectiveness and usability of the app. In the future, this simple but engaging approach to raise public awareness and support education could be used to further communicate with children about negative health effects of other harmful habits such as alcohol or drug consumption.

Enabling More Accessible MS Rehabilitation Training Using Virtual Reality.

Multiple sclerosis (MS) is an autoimmune disorder caused by damage to the myelin that protects nerve fibres, resulting in demyelinated lesions and causing various symptoms, one of which is muscle weakness. Physical rehabilitation is an integral part of managing MS, as well as its symptoms, and over time, the forms of implementing rehabilitation have changed according to novel technologies. Virtual reality (VR) has already been successfully applied to many fields of life sciences. VR can recreate engaging virtual environments for the specific purpose of physical rehabilitation that one can experience from the home environment. As a proof of concept, three games were developed for multiple sclerosis (MS) through the ground-breaking game engine Unity: a Piano game, a Recycle game and a Tidy Up game. The Piano game had three levels, starting from learning simple keys and ending with small well-known songs, in order to gradually challenge the user as they progress through their rehabilitation. The Recycle game focused on entertainment; it was playful providing a simpler but engaging and fun experience that used items that are seen in everyday life. In addition, a scoring system was implemented in order to motivate the user. Finally, the Tidy Up game had three different levels giving the user goals to work towards; at each level, the time available to complete the game became shorter giving the user less time to tidy up the table. These games were presented to individuals with MS, who had never used VR. Feedback was collected in order to assess the usability and the perceived sense of presence generated by the proposed approach. The testing also aimed to better understand rehabilitation techniques including factors affecting motivation. The games for rehabilitation were warmly received, and feedback was positive regarding both the usability of the system and the perceived sense of presence within digital environments. Although the tested sample size limits were small, a limitation of the validity of the results, these initial findings suggest VR must be beneficial in MS physical rehabilitation of the upper limb although larger, more formal evaluation is required.

Collect the Bones, Avoid the Cones: A Game-Based App for Public Engagement.

Game-based applications (apps) and serious games enable educationalists to teach complex life sciences topics. Gamification principles (i.e. challenges, problem solving, critical thinking) improve learners' motivation and can also help science communicators discuss important scientific subjects and their real-world context in an effective, enjoyable manner. The aim of this study was to design, develop and evaluate a science communication game-based app, entitled Collect the Bones, Avoid the Cones, on human skull anatomy for use in public engagement activities with younger audiences. Specifically, the app contextualised three-dimensional (3D) skull anatomy within a narrative about cycling and helmet safety. The app was tested at the Glasgow Science Centre, with ethical approval from the Glasgow School of Art, to assess its potential pedagogical value, in terms of pre- and post-app knowledge and confidence, and general user evaluation. In total, 50 participants were recruited (mean age 15.6 ± 1.647, range 7-64) with 62% of participants aged 7-12. Usability and educational value were rated highly with 70% of participants agreeing they could use the app without any external instructions and 90% agreeing they understand the anatomy of the skull better after app use. The enjoyability of the game was also positively perceived with 94% of participants agreeing they enjoyed the game. Although there was no statistical significance in pre- and post-app knowledge scores, there was a statistically significant increase in players' confidence relating to skull anatomy (pre-app: 3.00 ± 1.265, post-app: 4.00 ± 1.00, Z = -5.111, p < 0.001). These results provide promising insight into the potential of game-based apps for public engagement in anatomical sciences. Future research on how the app influences attitudes towards helmet use in different demographic groups would be valuable in identifying its full pedagogical potential.

A Serious Game on Skull Anatomy for Dental Undergraduates.

Knowledge of the anatomy of the skull and its bones forms an important part of the understanding required for the study and practice of safe clinical dentistry. The use of serious games in healthcare education is well-documented, but there is comparatively little evidence for their use in dental education. Intrinsically integrated rewards are a game mechanic that can be motivational for serious game users. A research gap was identified in the delivery of skull anatomy education to dental undergraduate students via a serious game with intrinsically integrated rewards. A serious game, titled Visualisation Studio Sim, was developed with Unity, featuring three-dimensional models and assets designed and modified with 3ds Max and Instant Meshes. Two versions of the game were built, one with the addition of intrinsically integrated rewards and one without it, and the game versions were tested by a convenience sample to gather open-ended feedback on the usability and suitability of the game mechanic for dental undergraduate education. Feedback suggested that it was straightforward to interact with the skull models but that the rewards were not as well integrated into the flow and immersion of the game as intended, and the game might not have been as challenging as desired for the intended cohort warranting future refinements in these aspects.

Augmented and Virtual Reality in Anatomical Education - A Systematic Review.

Learning anatomy traditionally has depended on traditional techniques like human cadaveric dissection and the use of textbooks. As technology advances at an ever-rapid speed, there are revolutionary ways to learn anatomy. A number of technologies, techniques and methodologies are utilised in anatomical education, but ones specifically receiving a lot of interest and traction is that of augmented reality and virtual reality. Although there has been a surge in interest in the use of these technologies, the literature is sparse in terms of its evaluation as to the effectiveness of such tools. Therefore, the purpose of this study is to examine in greater detail the literature specifically to see what the best practice in this field could be. By undertaking a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched for articles in both Web of Science and PubMed. Using the terms "augmented reality and teaching anatomy" yielded 88 articles. We then used "virtual reality and teaching anatomy" which resulted in 200 articles. We examined these articles, including that on augmented reality and virtual reality used to teach anatomy to undergraduate and postgraduate students, residents, dentistry, nursing and veterinary students. Articles were excluded if they were systematic reviews, literature reviews, review articles, news articles, articles not written in English and any literature that presented how a virtual model was created without the evidence of students testing it. The inclusion and exclusion criteria for virtual reality were the same as augmented reality. In addition, we examined the articles to identify if they contained data which was quantitative, qualitative or both. The articles were further separated into those which were pro, neutral or against for the use of these digital technologies. Of the 288 articles, duplicate articles totalling 67 were removed and 134 articles were excluded according to our exclusion criteria. Of the 31 articles related to augmented reality, 30 were pro, one neutral and no articles against the use of this technology. Fifty-six articles related to virtual reality were categorised resulted in 45 pro, eight neutral and three against the use of this technology. Overall, the results indicate most articles identified related to both virtual and augmented reality were for the use of those technologies, than neutral or against. This systemic review highlights the recent advances of both augmented reality and virtual reality to implementing the technology into the anatomy course.

Use of a virtual 3D anterolateral thigh model in medical education: Augmentation and not replacement of traditional teaching?

There is a pressing need for simulated forms of medical, and in particular, anatomical learning. Current modalities of teaching are limited to either traditional 2-dimensional forms of learning, such as textbook, research papers and lectures, or more costly 3-dimensional modes including cadaveric dissection. Despite the overwhelmingly 3-dimensional nature of plastic surgery, virtual 3D models are limited. Here, we provide the first description of the development and utilisation of a virtual 3D flap model in medical education in the undergraduate curriculum. Methods and results: A 3D anterolateral (ALT) model was developed with close integration of specialists in simulation and visualisation, anatomists and clinicians, allowing 'virtual dissection' of the anatomy of the ALT flap. This was utilised in a B.Sc. Anatomy undergraduate course in 2017/18 and 2018/19. Student feedback noted an overwhelming preference for the 3D model (74%) as the first choice of educational methodology, versus lectures (26%), textbooks (0%) and research papers (0%) (p = 0.0035). Extraneous cognitive load may be reduced with 3D models, with students rating these as easier to learn from than textbook or research papers (p = 0.00014 and p < 0.00001, respectively). Notably, no statistically significant difference was found in the perceived ease of learning between 3D models and lectures. Conclusions: This study highlights a striking user preference for virtual 3D models as compared to for traditional teaching methods. Nonetheless, 3D models are likely to enhance rather than replace lectures, with this study suggesting that teaching by experts is likely to remain an essential part of medical education.

Recommended Workflow Methodology in the Creation of an Interactive Application for Patient's Diagnosed with Pancreatic Cancer.

Pancreatic cancer is a leading cause of cancer related deaths in the UK. However, public knowledge and understanding of the pancreas is generally poor, therefore pancreatic cancer patients often have to contend with understanding large quantities of new information at a pivotal time in their lives.Despite utilisation of digital visualisation techniques in medical education, very rarely are they being used to help clinicians communicate information to their patients. Specifically, there is no literature describing use of an interactive digital application for use by healthcare professionals to aid discussions specific to pancreatic cancer.Therefore, we developed a workflow methodology, and created an interactive application, thus creating a tool that could help clinicians explain pancreatic cancer anatomy, and staging, to their patients. Three-dimensional (3D) digital models were created using ZBrush and Autodesk 3DS Max, and exported into the Unity game engine. Within Unity, the interactivity of models was maximally utilised, and a simple user interface created.The application centres on anatomically accurate, visually simple, 3D digital models, demonstrating a variety of common scenarios that arise in pancreatic cancer. The design of the application is such that the clinician can select which model is relevant to the patient, and can give an explanation of the anatomy and disease process at a speed and level appropriate to that person. This simple, robust and effective workflow methodology for the development of an application could be useful in any clinical setting that needs visual and interactive tools to enhance patient understanding of a clinical condition.

Evaluation of Child-Friendly Augmented Reality Tool for Patient-Centered Education in Radiology and Bone Reconstruction.

The use of augmented reality (AR) has a rich history and is used in a number of fields. Its application in healthcare and anatomy education is developing considerable interest. However, although its popularity is on the rise, its use as an educational and practical tool has not been sufficiently evaluated, especially with children. Therefore, this study presents the design, development and evaluation of an educational tablet-based application with AR functionality for children. A distal radius fracture was chosen, as it is one of the more common fractures in the younger age group. Following a standardized software engineering methodology, we identified functional and non-functional requirements, creating a child-friendly tablet based AR application. This used industry standard software and incorporated three-dimensional models of a buckle fracture, object and image target marker recognition, interactivity and educational elements. In addition, we surveyed children at the Glasgow Science Centre on its usability, design and educational effectiveness. Seventy-one children completed a questionnaire (25 also underwent a short structured interview). Overall, the feedback was positive relating to entertainment value, graphic design, usability and educational scope of the application. Notably, it was shown to increase user understanding of radiology across all age groups following a trial of the application. This study shows the great potential of using digital technologies, and more particularly augmented information, in engaging future generations in science from a young age. Creation of educational materials using digital technologies, and evaluating its effectiveness, highlights the great scope novel technology could have in anatomical education and training.

Interactive 3D Visualisation of the Mammalian Circadian System.

The daily fluctuations that govern an organism's physiology and behaviour are referred to as the circadian rhythm. Dramatic changes in our internal or external environment can affect these fluctuations by causing them to shift abnormally. Chronic readjustment in circadian rhythmicity can lead to health defects that extend throughout the organism. These patterns have been known to affect nearly every facet of our health, from our mental state to our physiological wellbeing. Thus, it is important for healthcare professionals from a range of backgrounds to comprehend these connections early on in their education and incorporate this knowledge into patient guidance and treatment.Traditionally, the teaching of the circadian rhythm is undertaken by didactic teaching, 2-dimensional (2D) diagrams, and biochemical processes shown from a fixed perspective. There has been a surge in technologies used to develop educational products, but the field of the circadian rhythm has been lagging behind.Therefore, the purpose of this study was to create an interactive learning application for the end-stage user, incorporating industry standard and widely available software packages. Using a mixture of 3DS Max, Photoshop, MeshLab, Mudbox, Unity and Pro Tools, we created a fully interactive package incorporating educational resources and an interactive self test quiz section.Here, we demonstrate a simple workflow methodology that can be used in the creation of a fully interactive learning application for the circadian rhythm, and its wider effects on the human body. With a small-scale study based on feedback demonstrating positive results, and with limited resources in this field, there is enormous potential for this to be applied in the educational and wider public engagement environment related to the circadian rhythm. Indeed, this also provides an excellent framework and platform for development of educational resources for any type of field that needs modernising and updating with modern technological advances, engaging a wider audience.

Medical Imaging and Facial Soft Tissue Thickness Studies for Forensic Craniofacial Approximation: A Pilot Study on Modern Cretans.

Forensic cases may require craniofacial approximations for unidentifiable victims. The accuracy of these approximations is improved by using population-specific average soft tissue depths. This study used CT scans from 64 Cretan adults (32 male and 32 female) to produce three-dimensional models of each individual's cranium and skin surface. Using the models, the soft tissue depths were measured at 36 craniofacial landmarks; the means and standard deviations were calculated for the general Cretan population, and for male and female Cretans separately. Cretan facial soft tissue depths were then compared to those of French, Slovak, and Korean adults. 16 of the 36 landmarks exhibited sex differences among Cretans, with males having consistently thicker depths than females. The facial soft tissue depths of Cretan adults also presented significant differences when compared to other populations. Overall, the average soft tissue depths obtained represent the first database for the craniofacial approximation of Cretan (Greek) adults.

The Co-design of Hand Rehabilitation Exercises for Multiple Sclerosis Using Hand Tracking System.

Multiple sclerosis (MS) often affects motor function, leading to an adverse effect on daily living. Rehabilitation is important in terms of improving mobility and activities of daily living. Virtual environments (VE) are increasing in popularity within this research area, but research in terms of VE is still rare, for both the upper and lower limb, in people with MS. Leap Motion (LM), a hand motion tracking system, has demonstrated success in stroke research but has yet to be investigated within MS. Following a co-design approach, five participants with MS discussed in a focus group (FG) their hand mobility issues, their thoughts about this technology-based rehabilitation and motivational factors. Findings were incorporated into the design of a series of gamified upper limb rehabilitation exercises, using LM, on Unity Game Engine. Three participants returned and engaged in user testing session and a FG in order to evaluate and discuss their experience. Overall participants found the proposed technology-based exercises to be engaging, immersive and a desirable approach to rehabilitation. Participant feedback underlined the usefulness of co-creation, especially in accommodating the range of motivators and user preferences. However, the study highlighted the loss of tracking of hand movements with LM as one of the limitations. Participants stated they would be likely to use this approach at home if there was a definite rehabilitation benefit and related more to visualising which muscle groups or actions they were aiming to improve.

The Use of Social Media in Anatomical and Health Professional Education: A Systematic Review.

Social media is used by many students at universities, with sites such as Facebook, Twitter and YouTube being the most popular. Initially these social networking sites were mainly used for recreational purposes, but they have been increasingly used in an educational setting. Educators in the anatomical sciences and health professions have utilised many forms of technology to supplement and enhance a student's learning. However, the true effectiveness of using social media in anatomical and health professions education has not been fully explored. It has been hypothesised that social media in anatomical sciences and health professional education could enhance learner engagement, raise morale, relieve anxieties and improve communication. However, the evidence is limited. Therefore, the purpose of this study is to undertake a comprehensive literature review to examine the effectiveness, or otherwise, of these tools when implemented. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method for reviewing the literature. By using specific keywords and using Google Scholar, PubMed, ERIC and OVID, we performed an extensive literature search to examine the use of social media in anatomical sciences and health professional education. A total of 155 studies were identified in this systematic review, with 99 studies investigating a variety of social networking sites being included. Overall, the evidence is supportive, with 79.8% of the studies supporting the use social media in education. Furthermore, when the use of social media in the anatomical sciences and health professional was investigated, the majority of studies advocated for its implementation. Despite this, there are some factors that limit the significance of these results, and the amount of evidence was indeed limited. Additional research must be carried out if social media is to influence modern pedagogical practices, with more focus on how the intervention affects academic achievement.

A Game Changer: 'The Use of Digital Technologies in the Management of Upper Limb Rehabilitation'.

Hemiparesis is a symptom of residual weakness in half of the body, including the upper extremity, which affects the majority of post stroke survivors. Upper limb function is essential for daily life and reduction in movements can lead to tremendous decline in quality of life and independence. Current treatments, such as physiotherapy, aim to improve motor functions, however due to increasing NHS pressure, growing recognition on mental health, and close scrutiny on disease spending there is an urgent need for new approaches to be developed rapidly and sufficient resources devoted to stroke disease. Fortunately, a range of digital technologies has led to revived rehabilitation techniques in captivating and stimulating environments. To gain further insight, a meta-analysis literature search was carried out using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) method. Articles were categorized and pooled into the following groups; pro/anti/neutral for the use of digital technology. Additionally, most literature is rationalised by quantitative and qualitative findings. Findings displayed, the majority of the inclusive literature is supportive of the use of digital technologies in the rehabilitation of upper extremity following stroke. Overall, the review highlights a wide understanding and promise directed into introducing devices into a clinical setting. Analysis of all four categories; (1) Digital Technology, (2) Virtual Reality, (3) Robotics and (4) Leap Motion displayed varying qualities both-pro and negative across each device. Prevailing developments on use of these technologies highlights an evolutionary and revolutionary step into utilizing digital technologies for rehabilitation purposes due to the vast functional gains and engagement levels experienced by patients. The influx of more commercialised and accessible devices could alter stroke recovery further with initial recommendations for combination therapy utilizing conventional and digital resources.

Proof of concept of a workflow methodology for the creation of basic canine head anatomy veterinary education tool using augmented reality.

Neuroanatomy can be challenging to both teach and learn within the undergraduate veterinary medicine and surgery curriculum. Traditional techniques have been used for many years, but there has now been a progression to move towards alternative digital models and interactive 3D models to engage the learner. However, digital innovations in the curriculum have typically involved the medical curriculum rather than the veterinary curriculum. Therefore, we aimed to create a simple workflow methodology to highlight the simplicity there is in creating a mobile augmented reality application of basic canine head anatomy. Using canine CT and MRI scans and widely available software programs, we demonstrate how to create an interactive model of head anatomy. This was applied to augmented reality for a popular Android mobile device to demonstrate the user-friendly interface. Here we present the processes, challenges and resolutions for the creation of a highly accurate, data based anatomical model that could potentially be used in the veterinary curriculum. This proof of concept study provides an excellent framework for the creation of augmented reality training products for veterinary education. The lack of similar resources within this field provides the ideal platform to extend this into other areas of veterinary education and beyond.