David Hananel - Academia.edu (original) (raw)

Papers by David Hananel

Smith's Textbook of Endourology, 2018

Comprehensive Healthcare Simulation: Pediatrics, 2019

Airway interventions and management, such as laryngoscopy, endotracheal intubation, and cricothyr... more Airway interventions and management, such as laryngoscopy, endotracheal intubation, and cricothyrotomy, are important medical skills, and improvements to the existing training models are expected Recent technology advances in medical imaging, visualization, and fast-prototyping have enabled us to design new airway mannequins with greater detail of anatomy and to produce them in a cost-efficient manner. Innovations in VR interfaces, wearable or comfortable sensors [7], can augment a learner's experience with both physical and virtual presentations Methods Anatomical data of this airway model were captured by magnetic resonance imaging (MRI). Over 700 MRI slices were taken to study the dynamic configuration of the human airway and its surrounding structures at varying head-neck positions. Segmentation of the volumetric data resulted in five categories: bones, cartilages and ligaments, muscles, connective tissues, and airway passage. Computer mesh models of individual structures w...

La presente invention concerne un systeme d'evaluation de la performance d'une procedure ... more La presente invention concerne un systeme d'evaluation de la performance d'une procedure comprenant un modele de tissu ou un outil comprenant des indicateurs d'evaluation qui lui sont appliques, un ou plusieurs dispositifs de capture d'image pour capturer une ou plusieurs images d'evaluation des indicateurs d'evaluation pendant ou apres qu'un utilisateur execute la procedure medicale, et un processeur configure pour analyser les indicateurs d'evaluation dans lesdites une ou plusieurs images d'evaluation et fournir une retroaction a l'utilisateur. Un systeme peut egalement comprendre un modele de tissu, un ou plusieurs dispositifs de capture d'image, chacun configure pour capturer une ou plusieurs images du modele de tissu, et un processeur configure pour analyser lesdites une ou plusieurs images desdits un ou plusieurs dispositifs de capture d'image afin de determiner une deformation du modele de tissu et determiner une force exercee s...

Studies in health technology and informatics, 2016

Restoring airway function is a vital task in many medical scenarios. Although various simulation ... more Restoring airway function is a vital task in many medical scenarios. Although various simulation tools have been available for learning such skills, recent research indicated that fidelity in simulating airway management deserves further improvements. In this study, we designed and implemented a new prototype for practicing relevant tasks including laryngoscopy, intubation and cricothyrotomy. A large amount of anatomical details or landmarks were meticulously selected and reconstructed from medical scans, and 3D-printed or molded to the airway intervention model. This training model was augmented by virtually and physically presented interactive modules, which are interoperable with motion tracking and sensor data feedback. Implementation results showed that this design is a feasible approach to develop higher fidelity airway models that can be integrated with mixed reality interfaces.

Background. Currently there is no reliable, standardized mechanism to support health care profess... more Background. Currently there is no reliable, standardized mechanism to support health care professionals during the evaluation of and procurement processes for simulators. A tool founded on best practices could facilitate simulator purchase processes. Methods. In a 3-phase process, we identified top factors considered during the simulator purchase process through expert consensus (n = 127), created the Simulator Value Index (SVI) tool, evaluated targeted validity evidence, and evaluated the practical value of this SVI. A web-based survey was sent to simulation professionals. Participants (n = 79) used the SVI and provided feedback. We evaluated the practical value of 4 tool variations by calculating their sensitivity to predict a preferred simulator. Results. Seventeen top factors were identified and ranked. The top 2 were technical stability/reliability of the simulator and customer service, with no practical differences in rank across institution or stakeholder role. Full SVI varia...

Journal of the American College of Surgeons, 2021

OBJECTIVE To assess whether an integrated Advanced Modular Manikin (AMM) provides improved partic... more OBJECTIVE To assess whether an integrated Advanced Modular Manikin (AMM) provides improved participant experience compared to use of peripheral simulators alone, during a standardized trauma team scenario. BACKGROUND Simulation-based team training has been shown to improve team performance. To address limitations of existing manikin simulators the AMM platform was created, that enables interconnectedness, interoperability and integration of multiple simulators ("peripherals") into an adaptable, comprehensive training system. METHODS A randomized single-blinded, cross-over study with two conditions was employed to assess learner experience differences when using the integrated AMM platform versus peripheral simulators. First responders, anesthesiologists, and surgeons rated their experience and workload with the conditions in a 3-scene standardized trauma scenario. Participant ratings were compared and focus groups conducted to obtain insight into participant experience. RESULTS Fourteen teams (n=42) participated. Team experience ratings were higher for the integrated AMM condition compared with peripherals (Cohen's d = .25, p = .016). Participant experience varied by background with surgeons and first responders rating their experience significantly higher compared with anesthesiologists (p < .001). Higher workload ratings were observed with the integrated AMM condition (Cohen's d = .35, p = .014) driven primarily by anesthesiologist ratings. Focus groups revealed that participants preferred the integrated AMM condition based upon its increased realism, physiologic responsiveness, and feedback provided on their interventions. CONCLUSION This first comprehensive evaluation suggests that integration with the AMM platform provides benefits over individual peripheral simulators and has the potential to expand simulation-based learning opportunities and enhance learner experience, especially for surgeons.

Military Medicine, 2021

ABSTRACTIntroductionCurrent thinking in healthcare education stipulates a holistic approach with ... more ABSTRACTIntroductionCurrent thinking in healthcare education stipulates a holistic approach with a focus on patient management, bringing together technical skills, decision-making, and team performance. In parallel, training opportunities with actual patients have diminished, and the number of different interventions to master has increased. Training on simulators has become broadly accepted; however, requirements for such training devices have outpaced the development of new simulators. The Department of Defense (DoD) targeted this gap with a development challenge. This article introduces the Advanced Modular Manikin (AMM) platform and describes the path followed to address the challenge.Materials and MethodsUnder Contract # W81XWH-14-C-0101, our interdisciplinary team of healthcare providers, educators, engineers, and scientists, together with partners in industry and the government collaborated to establish a set of comprehensive requirements and develop an overarching system arc...

Surgery, Apr 1, 2018

Currently there is no reliable, standardized mechanism to support health care professionals durin... more Currently there is no reliable, standardized mechanism to support health care professionals during the evaluation of and procurement processes for simulators. A tool founded on best practices could facilitate simulator purchase processes. In a 3-phase process, we identified top factors considered during the simulator purchase process through expert consensus (n = 127), created the Simulator Value Index (SVI) tool, evaluated targeted validity evidence, and evaluated the practical value of this SVI. A web-based survey was sent to simulation professionals. Participants (n = 79) used the SVI and provided feedback. We evaluated the practical value of 4 tool variations by calculating their sensitivity to predict a preferred simulator. Seventeen top factors were identified and ranked. The top 2 were technical stability/reliability of the simulator and customer service, with no practical differences in rank across institution or stakeholder role. Full SVI variations predicted successfully t...

Journal of Medical Devices, 2016

Simulation in Healthcare: Journal of the Society for Simulation in Healthcare, 2014

Hypothesis Over the past decade the number, variety and cost of available simulators have risen d... more Hypothesis Over the past decade the number, variety and cost of available simulators have risen dramatically. Decisions associated with simulator selection can be challenging, particularly when multiple stakeholders are involved in the acquisition process. Consensus can be even more elusive when definitions of value diverge, and/or priorities are misaligned across the stakeholders involved. Currently, there is no reliable, standardized mechanism to support technicians, faculty, administrators, and leadership during the simulator evaluation and procurement process. We propose a tool founded on scientific evidence could be used to facilitate the simulator evaluation and purchase process. Methods Using a Delphi method that included 2 rounds of surveys and 2 focus groups, we collected data from members from SSIH (n=88) and ACS AEI (n=69) societies. The survey consisted of 31 factors organized across six domains. Participants rated each on a 4-point rating scale, ranging from 1(Not considered/not important to me when I consider a simulator purchase) to 4 (Critical to me when I consider a simulator purchase). Demographics were also captured. Societies’ rankings were compared using Wilcoxon signed rank test. Rating differences across professional society, institution type, and participants’ self-reported stakeholder role were evaluated using a Rasch model. Inter-item reliabilities were estimated using Cronbach alpha. Results Participant demographics are reviewed in detail. The top 17 factors were identified and ranked, with top two as Technical stability/reliability of simulator and Customer service. Top 17 factors were incorporated into an Excel® spreadsheet. The majority of Round 2 focus group participants 27 (87.1%) agreed that the resulting SVI Worksheet adequately represented all critical factors considered during a simulator purchase. Conclusion The product from this work (SVI Worksheet tool) can be applied aid the simulator purchase process across countries, institutions, and stakeholder. We are hopeful that simulator purchase processes might include the SVI Worksheet with the intention to maintain alignment with educational goals, while still accounting for other factors considered at the institutional level. At the same time, common measures might facilitate future communication across academic medical institutions and simulator industry. More evaluation is required following broad-scaled implementation. References 1. Britt RC, Novosel TJ, Britt LD, Sullivan M (2009). The impact of central line simulation before the ICU experience. Am J Surg Apr;197(4):533-6. Epub 2009 Feb 27. 2. Dayan AB, Ziv A, Berkenstadt H, Munz Y (2008). A simple, low-cost platform for basic laparoscopic skills training. Surg Innov Jun;15(2):136–42. 3. Conroy S (2010). Competence and retention in performance of the lumbar puncture procedure in a task trainer model. Simul Healthc;5: 133–138. 4. Parent RJ, Plerhoples TA, Long EE, etal (2010). Early, intermediate, and late effects of a surgical skills “boot camp” on an objective structured assessment of technical skills: a randomized controlled study. J Am Coll Surg; 210(6):984–9. 5. Lim WS, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax, 58(5):377-82, 2003 May. 6. Gage BF, et al. Validation of Clinical Classifications Schemes for Predicting Stroke, Results From the National Registry of Atrial Fibrillation. JAMA, 285(22):2864-70, June 2001. 7. Dalkey N, Helme O (1963). An experimental application of the Delphi method to the use ofexperts. Management Science 1963; 9(3): 458–467. 8. Brown B (1968). Delphi Process: A Methodology Used for the Elicitation of Opinions of Experts.“ : An earlier paper published by RAND (Document No: P-3925, 1968, 15 pages). 9. Rasch G (1960/1980). Probabilistic models for some intelligence and attainment tests.(Copenhagen, Danish Institute for Educational Research), expanded edition (1980) with foreword and afterword by B.D. Wright. Chicago: The University of Chicago Press. 10. Andrich D (1988). Rasch models for measurement. Beverly Hills: Sage Publications. Disclosures None

Journal of Endourology Part B, Videourology, 2015

Abstract Introduction and Objectives: Achieving proper renal access is a challenging component of... more Abstract Introduction and Objectives: Achieving proper renal access is a challenging component of the percutaneous nephrolithotomy (PCNL) procedure. The SimPORTAL C-Arm trainer (CAT) is a fluoro-le...

The Journal of Urology, 2015

Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2015

The purpose of our study was to develop a low-fidelity surgical simulator for basic arthroscopic ... more The purpose of our study was to develop a low-fidelity surgical simulator for basic arthroscopic skills training, with the goal of creating a pretrained novice ready with the basic skills necessary for all joint arthroscopic procedures. Methods: A panel of education, arthroscopy, and simulation experts designed and evaluated a basic arthroscopic skills training and testing box. Task deconstruction was used to create 2 modules, which incorporate core skills common to all arthroscopic procedures. Core metrics measured were time to completion, number of trials to steady state, and number of errors. Face validity was evaluated using a questionnaire. Construct validity was examined by comparing 8 medical students with 8 expert orthopaedic surgeons. Results: Surgeons were faster than students on both module 1 (P ¼ .0013), simulating triangulation skills, and module 2 (P ¼ .0190) simulating object manipulation skills. Surgeons demonstrated fewer errors (6.9 errors versus 28.1; P ¼ .0073). All surgeons were able to demonstrate steady state (i.e., perform 2 trials that were within 10% of each other for time to completion and errors) on both modules within 3 trials on each module. Only 2 novices were able to demonstrate steady state on either module, and both did so within 3 trials. Furthermore, face validity of the skills trainer was shown by the expert arthroscopists. Conclusions: We describe a basic arthroscopy skills simulator that has face and construct validity. Our expert panel was able to design a simulator that differentiated between experienced arthroscopists and novices. Clinical Relevance: Surgical simulation is an important part of efficient surgical education. This simulator shows good construct and face validity and provides a low-fidelity option for teaching the entrylevel arthroscopist.

SAE Technical Paper Series, 1990

Quality and Safety in Health Care, 2010

Background Simulation-based medical education enables knowledge, skills and attitudes to be acqui... more Background Simulation-based medical education enables knowledge, skills and attitudes to be acquired for all healthcare professionals in a safe, educationally orientated and efficient manner. Procedure-based skills, communication, leadership and team working can be learnt, be measured and have the potential to be used as a mode of certification to become an independent practitioner. Results Simulation-based training initially began with lifelike manikins and now encompasses an entire range of systems, from synthetic models through to high fidelity simulation suites. These models can also be used for training in new technologies, for the application of existing technologies to new environments and in prototype testing. The level of simulation must be appropriate to the learners' needs and can range from focused tuition to mass trauma scenarios. The development of simulation centres is a global phenomenon which should be encouraged, although the facilities should be used within appropriate curricula that are methodologically sound and cost-effective. Discussion A review of current techniques reveals that simulation can successfully promote the competencies of medical expert, communicator and collaborator. Further work is required to develop the exact role of simulation as a training mechanism for scholarly skills, professionalism, management and health advocacy.

Journal of the American College of Surgeons, 2003

Minimally invasive surgery (MIS) has introduced a new and unique set of psychomotor skills for a ... more Minimally invasive surgery (MIS) has introduced a new and unique set of psychomotor skills for a surgeon to acquire and master. Although assessment technologies have been proposed, precise and objective psychomotor skills assessment of surgeons performing laparoscopic procedures has not been detailed. Two hundred ten surgeons attending the 2001 annual meeting of the American College of Surgeons in New Orleans who reported having completed more than 50 laparoscopic procedures participated. Subjects were required to complete one box-trainer laparoscopic cutting task and a similar virtual reality task. These tasks were specifically designed to test only psychomotor and not cognitive skills. Both tasks were completed twice. Performance of tasks was assessed and analyzed. Demographic and laparoscopic experience data were also collected. Complete data were available on 195 surgeons. In this group, surgeons performed the box-trainer task better with their dominant hand (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001) and there was a strong and statistically significant correlation between trials (r = 0.47 - 0.64, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). After transforming raw data to z-scores (mean = 0 and SD = 1) it was shown that between 2% and 12% of surgeons performed more than two standard deviations from the mean. Some…