Joseph M. Rosen

Surgical simulation: An emerging technology for training in emergency medicine

The current methods of training medical personnel to provide emergency medical care have several important shortcomings. For example, in the training of wound debridement techniques, animal models are used to gain experience treating traumatic injuries. We propose an alternative approach by creating a three-dimensional, interactive computer model of the human body that can be used within a virtual environment to learn and practice wound debridement techniques and Advanced Trauma Life Support (ATLS) procedures. As a first step, we have developed a computer model that represents the anatomy and physiology of a normal and injured lower limb. When visualized and manipulated in a virtual environment, this computer model will reduce the need for animals in the training of trauma management and potentially provide a superior training experience. This article describes the development choices that were made in implementing the preliminary system and the challenges that must be met to create an effective medical training environment.

Disseminating surgery effectively and efficiently in Haiti.

The need for surgical care in Haiti remains vast despite the enormous relief efforts after the earthquake in 2010. As the poorest country in the Western hemisphere, Haiti lacks the necessary infrastructure to provide surgical care to its inhabitants. In light of this, a multidisciplinary approach led by Partners In Health and Dartmouth-Hitchcock Medical Center is improving the access to surgical care and offering treatment of a broad spectrum of pathology. This article discusses how postearthquake Haiti partnerships involving academic institutions can alleviate the surgical burden of disease and, in the process, serve as a profound educational experience for the academic community. The lessons learned from Haiti prove applicable in other resource-constrained settings and invaluable for the next generation of surgeons.

98 – Virtual Reality and Surgery

The critical steps toward realizing the promise of virtual reality in surgery involve continued significant development in the fields of human models, interface devices, and system verification. Human modeling by far poses the greatest challenge and will require several generations of improved computer mathematical algorithms to achieve accurate representation of normal humans and pathologic conditions. This is especially true for predicting changes over time. The second critical component, haptic or visual interface tools, will continue to evolve with the help of many industries (e.g., defense contractors) that also benefit from improving this technology. The third requirement, system verification, is the key to the acceptance of virtual reality (VR) by practicing surgeons and consists of two components. The first is the scientific demonstration of how well virtual reality systems provide the “touch” and “feel” of true reality. Second, one will need to prove that a training experience in a virtual reality simulator translates into actual improvement in the performance of the clinician. Just as the incorporation and acceptance of flight simulators in pilot training took many years, a serious, long-term research effort will be necessary before the tools and interfaces of virtual reality become an integral dimension of surgery.

Parental attitudes regarding the integration of children living with HIV/AIDS into public schools in Hanoi, Vietnam

In some areas of Vietnam, stigmatisation of HIV-infected children by parents in the community represents a major barrier to integration of such youth into public schools. To investigate parental perceptions of integration, researchers interviewed a total of 60 parents from one rural and one urban school district within Hanoi, Vietnam. Resistance to integration stemmed largely from misinformation about disease transmission and worry about protecting HIV-negative children. Educational campaigns targeted at parents, combined with higher levels of trust in the preparedness of teachers to handle situations involving HIV-positive children, could decrease current stigma and opposition to integration into public primary schools.

Application of Total Care Time and Payment per Unit Time Model for Physician Reimbursement for Common General Surgery Operations

BACKGROUND The relative value unit system relies on subjective measures of physician input in the care of patients. A payment per unit time model incorporates surgeon reimbursement to the total care time spent in the operating room, postoperative in-house, and clinic time to define payment per unit time. We aimed to compare common general surgery operations by using the total care time and payment per unit time method in order to demonstrate a more objective measurement for physician reimbursement. STUDY DESIGN Average total physician payment per case was obtained for 5 outpatient operations and 4 inpatient operations in general surgery. Total care time was defined as the sum of operative time, 30 minutes per hospital day, and 30 minutes per office visit for each operation. Payment per unit time was calculated by dividing the physician reimbursement per case by the total care time. RESULTS Total care time, physician payment per case, and payment per unit time for each type of operation demonstrated that an average payment per time spent for inpatient operations was

Perceptions of the Feasibility and Practicalities of Text Messaging-Based Infectious Disease Surveillance: A Questionnaire Survey

455.73 and slightly more at

Improving efficiency in endoscopy with robotic technology

467.51 for outpatient operations. Partial colectomy with primary anastomosis had the longest total care time (8.98 hours) and the least payment per unit time (

The biological disaster challenge: Why we are least prepared for the most devastating threat and what we need to do about it

188.52). Laparoscopic gastric bypass had the highest payment per time (

VP209 Two-Way Short Message Service (SMS) For Better Engagement And Quality Bio-Surveillance System

707.30). CONCLUSIONS The total care time and payment per unit time method can be used as an adjunct to compare reimbursement among different operations on an institutional level as well as on a national level. Although many operations have similar payment trends based on time spent by the surgeon, payment differences using this methodology are seen and may be in need of further review.

9. Patient Care

Background In Vietnam, infectious disease surveillance data are collected via a paper-based system through four government tiers leading to a large delay. Meanwhile, mobile phones are abundant and very popular in the country, and known to be a useful tool in health care worldwide. Therefore, there is a great potential for the development of a timely disease surveillance system through the use of mobile phone short message service (SMS) text messages. Objective This study aims to explore insights about the feasibility and practicalities of the utilization of SMS text messaging-based interventions in disease-reporting systems by identifying potential challenges and barriers in the text messaging process and looking at lessons learned. Methods An SMS text messaging-based disease tracking system was set up in Vietnam with patient reports texted by clinic staff. Two 6-month trials utilizing this disease tracking system were designed and implemented in two northern provinces of Vietnam to report two infectious diseases: diarrhea and influenza-like illness. A structured self-reported questionnaire was developed to measure the feasibility and practicalities of the system from the participants. On the completion of the second trial in 2013, participating health staff from 40 commune health centers in the two pilot provinces were asked to complete the survey (N=80). Results Most participants were female (61%, 49/80) and nearly half (44%, 35/80) were heads of a commune health center. Approximately two-thirds (63%, 50/80) of participants retained the basic structure of the SMS text message report and there was a strong influence (OR 28.2, 95% CI 5.3-151.2) of those people on the time they spent texting the information. The majority (88%, 70/80) felt the information conveyed in the SMS text message report was not difficult to understand. Most (86%, 69/80) believed that they could report all 28 infectious diseases asked for by the Ministry of Health by using SMS text messaging. Conclusions From a health center staff perspective, a disease-reporting system utilizing text messaging technology is easy to use and has great potential to be implemented and expanded nationwide. The survey showed positive perceptions and feedback from the participants and contributed to a promising practical solution to improve the surveillance system of infectious disease in Vietnam.