Combining physical and virtual contexts through augmented reality: design and evaluation of a prototype using a drug box as a marker for antibiotic training

Design and evaluation of a prototype of augmented reality applied to medical devices

BACKGROUND

According to current legislation, medical devices have to incorporate all the necessary information to eliminate or greatly minimise any problem associated with their use. However, the physical capacity of the actual device's packaging may frequently not be enough to contain all this information. To address this limitation, this study aimed to design and evaluate a prototype app for mobile devices applying augmented reality technology. The main feature of this kind of technology is combining virtual images with images from the real world.

METHODS

This work, carried out in Spain, was developed in three different phases. 1) Assessment of users' needs: Through a focus group and an online questionnaire, information was obtained about the following aspects: type of medical devices likely to be included in the app, relevant information that should be included and format in which this information should be presented. 2) Development of the prototype: Considering all the functional features identified in the previous phase, the software was developed by a team of professionals specialised in AR technology and applying a user-centred model. 3) Evaluation of the software: functionality and usability were assessed by means of the think-aloud method.

RESULTS

1) Assessment of users' needs: a total of 11 nurses participated in the focus group and 280 healthcare professionals answered the questionnaire. Their findings showed that users consider that information about the following aspects of medical devices should be included in the app: instructions for use, indications for use, brief description of the device, special precautions and biocompatibility, image of the content with its components and meaning of icons. 2) Description of the prototype: Once the app has been launched, when the user scans the medical device with the mobile device camera, access to the home screen is activated, where three sections can be found: name of the medical device, image of the device and four icons which provide access to: a brief description of the device, a detailed description of it, the packaging iconography and a video about use of the device. 3) Evaluation of the software: the app was defined by users as "very intuitive". They highlighted, as one of its main positive aspects, the chance to obtain information about the medical device just by scanning the object. Additionally, the evaluation performed through the think-aloud method identified potential improvements in the app. These improvements were subsequently implemented to make the prototype more functional.

CONCLUSION

Working with potential prototype users made it possible to identify information considered relevant for these users and to delve into the format which they consider more appropriate to show this information in the prototype. Our results show that AR technology can be used as support for clinical practice.

A review of antimicrobial stewardship training in medical education

OBJECTIVES

We reviewed the published literature on antimicrobial stewardship training in undergraduate and postgraduate medical education to determine which interventions have been implemented, the extent to which they have been evaluated, and to understand which are most effective.

METHODS

We searched Ovid MEDLINE and EMBASE from inception to December 2016. Four thousand three hundred eighty-five (4385) articles were identified and underwent title and abstract review. Only those articles that addressed antimicrobial stewardship interventions for medical trainees were included in the final review. We employed Kirkpatrick's four levels of evaluation (reaction, learning, behaviour, results) to categorize intervention evaluations.

RESULTS

Our review included 48 articles. The types of intervention varied widely amongst studies worldwide. Didactic teaching was used heavily in all settings, while student-specific feedback was used primarily in the postgraduate setting. The high-level evaluation was sparse, with 22.9% reporting a Kirkpatrick Level 3 evaluation; seventeen reported no evaluation. All but one article reported positive results from the intervention. No articles evaluated the impact of an intervention on undergraduate trainees' prescribing behaviour after graduation.

CONCLUSIONS

This study enhances our understanding of the extent of antimicrobial stewardship in the context of medical education. While our study demonstrates that medical schools are implementing antimicrobial stewardship interventions, rigorous evaluation of programs to determine whether such efforts are effective is lacking. We encourage more robust evaluation to establish effective, evidence-based approaches to training prescribers in light of the global challenge of antimicrobial resistance.