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Guruswamy J, Chhina A, Mitchell JD, Shah S, Uribe-Marquez S. Virtual Reality and Augmented Reality in Anesthesiology Education. Int Anesthesiol Clin 2024; 62:64-70. [PMID: 38798152 DOI: 10.1097/aia.0000000000000445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Affiliation(s)
- Jayakar Guruswamy
- Department of Anesthesiology, Pain Management, and Perioperative Medicine, Henry Ford Health, Michigan State University, Detroit, Michigan
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Moreau S, Thérond A, Cerda IH, Studer K, Pan A, Tharpe J, Crowther JE, Abd-Elsayed A, Gilligan C, Tolba R, Ashina S, Schatman ME, Kaye AD, Yong RJ, Robinson CL. Virtual Reality in Acute and Chronic Pain Medicine: An Updated Review. Curr Pain Headache Rep 2024:10.1007/s11916-024-01246-2. [PMID: 38587725 DOI: 10.1007/s11916-024-01246-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE OF REVIEW This review critically analyzes the recent literature on virtual reality's (VR) use in acute and chronic pain management, offering insights into its efficacy, applications, and limitations. RECENT FINDINGS Recent studies, including meta-analyses and randomized controlled trials, have demonstrated VR's effectiveness in reducing pain intensity in various acute pain scenarios, such as procedural/acute pain and in chronic pain conditions. The role of factors such as immersion and presence in enhancing VR's efficacy has been emphasized. Further benefits have been identified in the use of VR for assessment as well as symptom gathering through conversational avatars. However, studies are limited, and strong conclusions will require further investigation. VR is emerging as a promising non-pharmacological intervention in pain management for acute and chronic pain. However, its long-term efficacy, particularly in chronic pain management, remains an area requiring further research. Key findings highlight that VR programs vary in efficacy depending on the specificity of the origin of pain.
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Affiliation(s)
- Sacha Moreau
- Massachusetts Institute of Technology, Boston, MA, USA
| | - Alexandra Thérond
- Department of Psychology, Université du Québec a Montréal, 100 Sherbrooke St W, Montréal, QC, H2X 3P2, Canada.
| | - Ivo H Cerda
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kachina Studer
- Department of Earth and Planetary Science, Harvard University, Cambridge, MA, USA
- Department Mechanical Engineering, Massachusetts Institute of Technology (MIT), Cambridge, MA, USA
| | - Alicia Pan
- Northeastern University, Boston, MA, USA
| | - Jacob Tharpe
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts, Worcester, MA, USA
| | - Jason E Crowther
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts, Worcester, MA, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | | | - Reda Tolba
- Pain Management Department in the Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Sait Ashina
- Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health-Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | | | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Singhal M, Chaudhary K. Augmented reality for facilitation of paediatric peribulbar block administration - A case report. Indian J Anaesth 2024; 68:402-403. [PMID: 38586267 PMCID: PMC10993935 DOI: 10.4103/ija.ija_1231_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 04/09/2024] Open
Affiliation(s)
- Meghna Singhal
- Department of Anaesthesia, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi, India
| | - Kapil Chaudhary
- Department of Anaesthesia, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi, India
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Feinstein M, Katz D, Demaria S, Hofer IS. Remote Monitoring and Artificial Intelligence: Outlook for 2050. Anesth Analg 2024; 138:350-357. [PMID: 38215713 PMCID: PMC10794024 DOI: 10.1213/ane.0000000000006712] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
Remote monitoring and artificial intelligence will become common and intertwined in anesthesiology by 2050. In the intraoperative period, technology will lead to the development of integrated monitoring systems that will integrate multiple data streams and allow anesthesiologists to track patients more effectively. This will free up anesthesiologists to focus on more complex tasks, such as managing risk and making value-based decisions. This will also enable the continued integration of remote monitoring and control towers having profound effects on coverage and practice models. In the PACU and ICU, the technology will lead to the development of early warning systems that can identify patients who are at risk of complications, enabling early interventions and more proactive care. The integration of augmented reality will allow for better integration of diverse types of data and better decision-making. Postoperatively, the proliferation of wearable devices that can monitor patient vital signs and track their progress will allow patients to be discharged from the hospital sooner and receive care at home. This will require increased use of telemedicine, which will allow patients to consult with doctors remotely. All of these advances will require changes to legal and regulatory frameworks that will enable new workflows that are different from those familiar to today's providers.
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Affiliation(s)
- Max Feinstein
- Department of Anesthesiology Pain and Perioperative Medicine, Icahn School of Medicine at Mount Sinai
| | - Daniel Katz
- Department of Anesthesiology Pain and Perioperative Medicine, Icahn School of Medicine at Mount Sinai
| | - Samuel Demaria
- Department of Anesthesiology Pain and Perioperative Medicine, Icahn School of Medicine at Mount Sinai
| | - Ira S. Hofer
- Department of Anesthesiology Pain and Perioperative Medicine, Icahn School of Medicine at Mount Sinai
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Chamberland C, Bransi M, Boivin A, Jacques S, Gagnon J, Tremblay S. The effect of augmented reality on preoperative anxiety in children and adolescents: A randomized controlled trial. Paediatr Anaesth 2024; 34:153-159. [PMID: 37925608 DOI: 10.1111/pan.14793] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/29/2023] [Accepted: 10/16/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND AND AIMS Virtual reality has been shown to be an effective non-pharmacological intervention for reducing anxiety of pediatric patients. A newer immersive technology, that of augmented reality, offers some practical advantages over virtual reality, and also seems to show beneficial effects on anxiety. The main objective of this study was to determine whether augmented reality could reduce preoperative anxiety in pediatric patients undergoing elective day surgeries. A secondary outcome was to document the level of satisfaction from pediatric patients toward augmented reality intervention. METHODS Children and adolescents aged between 5 and 17 years old scheduled for elective day surgery under general anesthesia were randomly divided into two groups. Patients in the control group received standard care, whereas patients in the augmented reality group were accompanied by two virtual characters who taught them relaxation techniques and provided emotional and informational support. Anxiety was measured at the time of admission and at the time of induction using the short version of the modified Yale Preoperative Anxiety Scale. RESULTS The analysis included 37 pediatric patients in the augmented reality group and 64 in the control group. Anxiety scores were statistically significantly lower in the augmented reality group than those in the control group at the time of admission (median difference [95% CI]: 6.3 [0-10.4], p = .01), while no difference was observed between groups at the time of induction (median difference [95% CI]: -4.2 [-5.2-4.2], p = .58). Most patients in the augmented reality group wished to wear the glasses again and reported to be very satisfied with the intervention. CONCLUSION To our knowledge, this study is the first large randomized controlled trial to provide empirical evidence of reduction in anxiety for children and adolescents using augmented reality prior to induction of general anesthesia.
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Affiliation(s)
| | - Myriam Bransi
- Université Laval, Quebec City, Quebec, Canada
- CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Ariane Boivin
- Université Laval, Quebec City, Quebec, Canada
- CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Sandra Jacques
- Université Laval, Quebec City, Quebec, Canada
- CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Joël Gagnon
- Université Laval, Quebec City, Quebec, Canada
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Bastola P, Atreya A, Bhandari PS, Parajuli S. The evolution of anesthesiology education: Embracing new technologies and teaching approaches. Health Sci Rep 2024; 7:e1765. [PMID: 38299206 PMCID: PMC10825374 DOI: 10.1002/hsr2.1765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 11/06/2023] [Accepted: 11/28/2023] [Indexed: 02/02/2024] Open
Abstract
Background and aims Medical education requires regular reforms to include emerging best practices and technologies, while also critically evaluating effectiveness of traditional didactic teaching methods. This manuscript examines the challenges and opportunities associated with modernizing the anesthesiology curriculum. Methods Narrative review of literature on innovations in medical education, with a specific emphasis on anesthesiology training. Results Educators face difficulties implementing new teaching approaches and evaluating their effectiveness. However, active learning methods, blended with selected traditional techniques, can enhance learner engagement and competencies. Self-directed learning and simulations prepare students for real-world practice, while flipped classrooms and online platforms increase accessibility. Conclusions A blended approach, integrating interactive technology alongside modified lectures and seminars, may optimize anesthesiology education. Despite the promise of improved pedagogies, further research is required to assess outcomes. By embracing innovation while retaining certain foundational methods, programs can equip anesthesiologists with modern skills. This evolution is key to meeting the needs of 21st-century anesthesia care needs. Remaining at the forefront of this transformation will be vital in preparing competent future anesthesiologists through state-of-the-art education.
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Affiliation(s)
- Priska Bastola
- Department of Cardiothoracic and Vascular Anaesthesiology, Manmohan Cardiothoracic and Vascular Center, Maharajgunj Medical Campus, Institute of MedicineTribhuvan UniversityKathmanduNepal
| | - Alok Atreya
- Department of Forensic MedicineLumbini Medical CollegePalpaNepal
| | - Prawesh S. Bhandari
- Department of Orthopedics, Maharajgunj Medical Campus, Institute of MedicineTribhuvan University Teaching Hospital, Tribhuvan UniversityKathmanduNepal
| | - Subigya Parajuli
- Research Program Coordinator, Department of Surgery and Perioperative CareThe University of TexasAustinTexasUSA
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Cascella M, Tracey MC, Petrucci E, Bignami EG. Exploring Artificial Intelligence in Anesthesia: A Primer on Ethics, and Clinical Applications. SURGERIES 2023; 4:264-274. [DOI: 10.3390/surgeries4020027] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Abstract
The field of anesthesia has always been at the forefront of innovation and technology, and the integration of Artificial Intelligence (AI) represents the next frontier in anesthesia care. The use of AI and its subtypes, such as machine learning, has the potential to improve efficiency, reduce costs, and ameliorate patient outcomes. AI can assist with decision making, but its primary advantage lies in empowering anesthesiologists to adopt a proactive approach to address clinical issues. The potential uses of AI in anesthesia can be schematically grouped into clinical decision support and pharmacologic and mechanical robotic applications. Tele-anesthesia includes strategies of telemedicine, as well as device networking, for improving logistics in the operating room, and augmented reality approaches for training and assistance. Despite the growing scientific interest, further research and validation are needed to fully understand the benefits and limitations of these applications in clinical practice. Moreover, the ethical implications of AI in anesthesia must also be considered to ensure that patient safety and privacy are not compromised. This paper aims to provide a comprehensive overview of AI in anesthesia, including its current and potential applications, and the ethical considerations that must be considered to ensure the safe and effective use of the technology.
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Affiliation(s)
- Marco Cascella
- Pain Unit and Research, Istituto Nazionale Tumori IRCCS Fondazione Pascale, 80100 Napoli, Italy
| | - Maura C. Tracey
- Rehabilitation Medicine Unit, Strategic Health Services Department, Istituto Nazionale Tumori-IRCCS-Fondazione Pascale, 80100 Naples, Italy
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L’Aquila, 67100 L’Aquila, Italy
| | - Elena Giovanna Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
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Daniel D, Wolbrink TA. Online educational interventions in pediatric intensive care medicine. Front Pediatr 2023; 11:1127754. [PMID: 36969296 PMCID: PMC10033549 DOI: 10.3389/fped.2023.1127754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/14/2023] [Indexed: 03/29/2023] Open
Abstract
Background Online education has experienced explosive growth, particularly in the wake of the COVID-19 pandemic. We explored the current state of the evidence base for online education targeted towards healthcare professionals working in pediatric intensive care units (PICUs), to report how we are using online education in our field. Materials and Methods We performed a literature review by systematically generating a list of publications indexed in PubMed describing online educational interventions in the PICU, using Medical Subject Header (MeSH)-based search terms and the following inclusion criteria: studies published after 2005 that describe online educational interventions aimed at healthcare professional working in the PICU. We reviewed the full text of all included articles, and summarized the study aims, design, and results. Results Our initial search yielded 1,071 unique articles. After screening abstracts and titles, then full texts, eight articles were included in the review. Many online learning modalities are represented, including websites, self-study modules, videos, videoconferencing, online self-assessment with feedback, virtual patient cases, screen-based simulation, and podcasts. Three studies focused on residents, two studies on nurses, two studies on a multidisciplinary team, and one study on transport nurses and paramedics. Most studies utilized participant surveys to assess satisfaction, and half included pre- and post-intervention multiple-choice question tests. Only one study included a patient-related outcome measure. Conclusions Despite growth in online medical educational intervention research, there are relatively few published studies in pediatric critical care, and only one study evaluated the impact of online learning on patient outcomes. There remain significant opportunities for PICU educators to assess the impact of online educational interventions, especially related to clinician behaviors and patient outcomes.
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Rochlen LR, Putnam E, Levine R, Tait AR. Mixed reality simulation for peripheral intravenous catheter placement training. BMC MEDICAL EDUCATION 2022; 22:876. [PMID: 36528576 PMCID: PMC9758658 DOI: 10.1186/s12909-022-03946-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Despite the advantages of simulation-based training, trainees are typically unable to view internal anatomical structures. This limitation can be overcome by using mixed reality (MR) wherein 3-D virtual anatomical images can be projected. This study was designed to evaluate the efficacy of an MR trainer for peripheral intravenous catheter (PIVC) placement. METHODS Sixty-two participants used projected images of arm veins to place a PIVC in a mannequin arm. Participants were evaluated using a checklist on their ability to successfully place the PIVC. Participants completed a survey to elicit demographic information and perceptions of the trainer. A follow-up survey at two-weeks assessed clinical experiences with PIVC placement since using the MR trainer. RESULTS First attempt catheter placement was successful in 48 (77.4%) cases. Only 11 (17.7%) and 3 (4.8%) of participants caused 'extravasation' and 'hematoma' formation on their first attempt, respectively. Fifty-nine participants (95.2%) agreed that ability to see internal structures was useful, and 58 (93.5%, respectively) agreed that the interactivity promoted learning and that MR should be included in training. CONCLUSIONS Results of this study showed that use of a novel MR trainer for PIVC placement appears to provide an environment conducive to successful learning. Most participants were successful at PIVC placement on their first attempt and an overwhelming number found it helpful in identifying landmarks and confirming correct needle angles for insertion. Given the increasing emphasis on simulation training, highly immersive MR tools appear to offer promise to close the gap between classroom instruction and clinical experience.
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Affiliation(s)
- Lauryn R Rochlen
- Department of Anesthesiology, University of Michigan, 1H247 University Hospital, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Elizabeth Putnam
- Department of Anesthesiology, University of Michigan, 1H247 University Hospital, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Robert Levine
- Emergency Care Center, Jackson Memorial Hospital, 1611 NW 12th Ave, Miami, FL, 33136, USA
- ArchieMD, Inc., 6420 Congress Ave, Suite 2050, Boca Raton, FL, 33487, USA
| | - Alan R Tait
- Department of Anesthesiology, University of Michigan, 1H247 University Hospital, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Michigan Institute for Clinical & Health Research, 1600 Huron Parkway, Ann Arbor, MI, 48105, USA
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Hatzl J, Böckler D, Meisenbacher K, Barb A, Hartmann N, Henning D, Uhl C. Mixed Reality in der Gefäßchirurgie – ein Scoping Review. Zentralbl Chir 2022; 147:439-446. [DOI: 10.1055/a-1939-7686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Zusammenfassung
Hintergrund „Mixed Reality“ (MR) erlaubt die Projektion von virtuellen Objekten in das Sichtfeld des Anwenders durch ein Head-mounted Display (HMD). Im gefäßchirurgischen
Behandlungsspektrum könnten MR-Anwendungen in Zukunft einen Nutzen darstellen. Im folgenden Scoping Review soll eine Orientierung über die aktuelle Anwendung der genannten Technologien im
Bereich der Gefäßchirurgie gegeben und Forschungsziele für die Zukunft definiert werden. Material und Methoden Es erfolgte eine systematische Literaturrecherche in PubMed (MEDLINE)
mit den Suchbegriffen „aorta“, „intervention“, „endovsacular intervention“, „vascular surgery“, „aneurysm“, „endovascular“, „vascular access“ jeweils in Kombination mit „mixed reality“ oder
„augmented reality“. Die Suche erfolgte nach PRISMA-Leitlinie (Preferred Reporting Items for Systematic reviews and Meta-Analyses) für Scoping Reviews. Ergebnisse Aus 547
Literaturstellen konnten 8 relevante Studien identifiziert werden. Die Suchergebnisse konnten in 2 Anwendungskategorien eingeteilt werden: (1) MR mit dem Ziel des Informationsmanagements und
zur Verbesserung der periprozeduralen Ergonomie gefäßchirurgischer Eingriffe (n = 3) sowie (2) MR mit dem Ziel der intraoperativen Navigation bei gefäßchirurgischen Eingriffen (n = 5). Die
Registrierung des physischen Patienten mit dem virtuellen Objekt und das Tracking von Instrumenten in der MR-Umgebung zur intraoperativen Navigation ist dabei im Fokus des wissenschaftlichen
Interesses und konnte technisch erfolgreich am Phantom- und Tiermodell gezeigt werden. Die bisher vorgestellten Methoden sind jedoch mit hohem infrastrukturellem Aufwand und relevanten
Limitationen verbunden. Schlussfolgerung Der Einsatz von MR im Bereich der Gefäßchirurgie ist grundsätzlich vielversprechend. Für die Zukunft sollten alternative, pragmatische
Registrierungsmethoden mit entsprechender Quantifizierung des Positionierungsfehlers angestrebt werden. Die entwickelten Soft- und Hardwarelösungen sollten auf das Anforderungsprofil der
Gefäßchirurgie angepasst werden. Das elektromagnetische Instrumenten-Tracking erscheint als sinnvolle, komplementäre Technologie zur Umsetzung der MR-assistierten Navigation.
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Affiliation(s)
- Johannes Hatzl
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
| | - Dittmar Böckler
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
| | - Katrin Meisenbacher
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
| | - Alexandru Barb
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
| | - Niklas Hartmann
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
| | - Daniel Henning
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
| | - Christian Uhl
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
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Cata JP, Corrales G, Fuller C, Choi JE, Rosburg NM, Feng L, Sinton JW. Augmented reality in paediatric oncology patients undergoing surgery: a feasibility randomised controlled trial. Br J Anaesth 2022; 129:e87-e90. [PMID: 35965112 DOI: 10.1016/j.bja.2022.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/14/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Juan P Cata
- Department of Anesthesiology and Perioperative Medicine, University of Texas-MD Anderson Cancer Centre, Houston, TX, USA.
| | - German Corrales
- Department of Anesthesiology and Perioperative Medicine, University of Texas-MD Anderson Cancer Centre, Houston, TX, USA
| | - Clinton Fuller
- Department of Anesthesiology, Baylor College of Medicine-Texas Children's Hospital, Houston, TX, USA
| | - Jae E Choi
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA; Michigan Centre for Translational Pathology, University of Michigan, Ann Arbor, MI, USA; ALTality, Inc., Ann Arbor, MI, USA
| | - Nicole M Rosburg
- Division of Pediatrics, University of Texas-MD Anderson Cancer Centre, Houston, TX, USA
| | - Lei Feng
- Department of Biostatistics, University of Texas-MD Anderson Cancer Centre, Houston, TX, USA
| | - Jamie W Sinton
- Department of Anesthesiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
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