PR Newswire

PEORIA, Ill., Aug. 14, 2023

PEORIA, Ill., Aug. 14, 2023 /PRNewswire/ -- OSF HealthCare and academic partners working on a new virtual reality platform say Iowa was the only state where opioid-related deaths did not increase last year. And, there's mounting evidence of the need for better awareness and interventions. The American Medical Association says more than 105,000 opioid overdose deaths were reported in the United States between December 2021 and December 2022.

Federal health officials blame the steep increase in opioid overdose deaths, in part, to the rapid growth of highly potent and often deadly fentanyl that can be added to look-alike opioid drugs. The surgeon general recommends more individuals, including family, friends and those personally at risk for opioid overdose, keep on hand and know how to use naloxone, a safe antidote to a suspected overdose.  When given in time, naloxone can save a life.

Scott Barrows, director of the OSF Innovation Design Lab at Jump Trading Simulation & Education Center, is working on an Illinois Innovation Network-funded education project called Virtual Reality Embedded Naloxone Training (VENT). It includes researchers at Illinois State University (ISU) in Normal and Southern Illinois University (SIU) in Carbondale, Illinois. The work centers around developing mixed-use or augmented reality education for an immersive, engaging approach to train people on how to provide someone naloxone, often sold as a nasal spray under the name Narcan.

Barrows says the research will make use of cutting-edge technology, which blends the virtual and physical worlds.

"The mixed-reality portion of this being physical and virtual, will combine the genuine spray device and a manikin so that people can practice the genuine physical spraying with a manikin as well as having this virtual world that is valuable at the same time."

The opioid epidemic is affecting all demographics, but Barrows points out underserved populations have the least access to resources for prevention, education and treatment. So, the training will be designed with input from a variety of stakeholders.

Keeping it simple and realistic

"It has to be simple. It has to be easy to use. It has to be intuitive, but it also needs to be sensitive to the community experience whether it's rural, urban, suburban, no matter what age, so that's going to be the trick of the design process," Barrows stresses.

The U.S. Food and Drug Administration made naloxone nasal spray available over the counter in March. It's part of a strategy that includes harm reduction through innovation and education.

Joanna Willett, MSN, RN, a certified nurse educator who directs the nursing simulation lab at ISU's Mennonite College of Nursing,  believes research and development of innovative training can result in education that an average citizen, using a virtual reality headset, could use fairly easily.

"I've seen dozens of adults of all ages, parents, grandparents, sim lab visitors, etc. navigate our current nursing VR software without issue, and without nurses' training, take lifesaving steps to save a patient with respiratory distress," Willett says.  "I personally have no doubt that the intended audience of non-medical adults of all ages will benefit from this experience."  

Virtual reality training has an advantage because it can be easily accessible and repeatable without significant setup or cost.  Willett believes once it is developed, the simulation training will be  easy to maintain as an educational program. A prototype will be field-tested in community settings and at the Illinois State University simulation lab using 15 average citizens and five experts with diverse backgrounds.

Roy Magnuson, an assistant professor of Creative Technologies at ISU, will work with graduate students to design a prototype and make adjustments based on feedback. Magnuson has already developed music composition and conducting software for virtual reality. He'll work with graduate students to create an immersive world, swapping out medical variables for ones he's used for his other software development.

Magnuson is thrilled to take on the challenge.

"The immediacy and quantitative nature of working on a project like this is thrilling, humbling and inspiring in a completely new way. To say I am excited to spend my creative energy to have a chance to literally save a life is an understatement."-Roy Magnuson, assistant professor Creative Technologies, Illinois State University

Barrows believes the more immersive training will help people recall important best practices while in a high-stress, opioid overdose situation in real life.

"Providing as realistic a situation as possible, we think is more effective than certainly a classroom situation or watching a video or something that doesn't really provide that as-close-to-reality experience that we think we're doing."

The second phase of research would seek additional funding to conduct a randomized, controlled trial to determine if VENT is more effective than traditional education approaches, in addition to examining whether the training is easier to use and accessible to the target audience.

But during the initial development phase, Wasantha Jayawardene, MD, PhD, will tap resources at the Social Perception Lab at SIU to assess the degree to which an individual's subconscious bias against people with drug addiction influences how they would respond when someone suffers an overdose. Individuals trying the new education prototype will be given an evaluation called an Implicit Association Test (IAT) that can reveal their implicit bias before they test-drive the VENT prototype.

According to Jayawardene, "Based on the IAT results, the VENT will include a model that addresses implicit bias, which can help the layperson responders to become more conscious of their own biases and their potential impact on helping a victim in a real-life scenario."

There is $54 billion available in lawsuit settlement money tied to companies for their role in fueling the opioid crisis through actions such as downplaying the risks of prescription opioids and promoting the use of the drugs. States are required to spend 85% of settlement funds on opioid remediation and Barrows hopes to explore the potential of tapping that source in the future to make training available using VENT.

Additional assets including video, audios and photos are available on the OSF Newsroom.

OSF HealthCare is an integrated health system owned and operated by The Sisters of the Third Order of St. Francis, headquartered in Peoria, Illinois. OSF HealthCare has 15 hospitals – 10 acute care, five critical access - with 2,084 licensed beds throughout Illinois and Michigan. OSF employs nearly 24,000 Mission Partners throughout 150+ locations; has two colleges of nursing; operates OSF Home Care Services, an extensive network of home health and hospice services; owns Pointcore, Inc., comprised of health care-related businesses; OSF HealthCare Foundation, the philanthropic arm for the organization; and OSF Ventures, which provides investment capital for promising health care innovation startups. OSF OnCall, a digital health operating unit, was established in 2020 to Excellerate patient experience, using digital tools for 24/7 communication, on-demand care, remote patient monitoring, and offers the largest hospital-at-home program in Illinois. OSF HealthCare has been recognized by Fortune as one of the most innovative companies in the country. More at osfhealthcare.org.

Jump Simulation, a part of OSF Innovation, is a collaboration between University of Illinois College of Medicine Peoria and OSF HealthCare. The center replicates a variety of patient care settings to ensure novice and seasoned clinicians can practice handling medical situations in a life-like environment. Boasting six floors and 168,000 square feet, the center is one of the largest of its kind and provides space for conferences, anatomic training, virtual reality and innovation. For more information, visit jumpsimulation.org/.

OSF Innovation is a collaborative network of different disciplines that inspires, mentors and partners to transform care for patients and providers. With expertise in everything from ideation to commercialization, the division designs bold, strategic solutions, connecting everyday needs with inventive approaches and bold advances. More at osfinnovation.org/.

Contact: Colleen Reynolds | Media Relations Coordinator – OSF HealthCare | (309) 825-7255

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Reports of adverse outcomes caused by technical errors during surgery and better understanding of the components of surgical competency have highlighted the importance of teaching surgical technical skills in a safe and pedagogically efficient environment.^[1] This need has been further emphasized by the rapid development of new approaches, such as minimally invasive surgery and endoluminal therapies, both of which require proficiency with sophisticated technical skills. The old approach of 'see one do one, teach one' is no longer acceptable to either the surgical profession or to the well-informed and demanding public. New tools have been developed for teaching and assessing technical skills outside the operating room using virtual reality simulation, which has been applied for many years with great success in many industries including aviation and the military.

Traditionally, surgical virtual reality simulators facilitated training in basic skills relevant for laparoscopic surgery by enabling users to perform maneuvers using abstract graphics (low-fidelity simulation). With software development, the simulators now enable users to perform complete procedures with the added simulation of rare anatomical variations and various pathological conditions. The interface of these high-fidelity systems enables the surgeon to 'feel' the tissue (haptic feedback). The realism, however, of these simulated procedures is still suboptimal, and the high cost of virtual reality simulators limits their widespread distribution. Furthermore, the advantages of the high-fidelity, high-cost systems have not yet been demonstrated and future studies are needed to establish the potential advantages of procedure-specific simulation.

Laparoscopy poses significant psychomotor challenges to the surgeon because of the loss of three-dimensional depth perception and the fulcrum effect of the body wall on instrument handling.^[2] Virtual reality simulators facilitate repeated practice of standardized tasks to help surgical trainees become familiar with specific psychomotor skills before performing procedures in the operating room, which is a stressful and high-cost environment. Furthermore, the simulator software often incorporates extensive teaching guidance, eliminating the need for an instructor and, therefore, offering a flexible training schedule to fit the busy day of a surgical trainee. The simulators also offer the unique possibility to quantify surgical performance on the basis of objective measures, which provides an unbiased assessment of surgical performance.^[3]

Despite these obvious advantages, there are still areas that require improvement. Most of the available high-fidelity systems have undergone substantial developments in both graphics and haptics; however, their level of realism requires refinement. The objective measures used in these systems to assess performance are excellent; however, they are difficult to interpret by the trainee and this limits their value as a source for constructive feedback. A major disadvantage is the high cost of simulator systems, which poses a significant challenge for many institutions. Finally, most simulator systems provide training in psychomotor skills only and do not address the other components of surgical competence (i.e. knowledge, decision making and communication).

Validation of virtual reality simulation as a surgical training tool requires evidence of the transferability of skills acquired in the virtual reality environment to the operating room. Two studies have compared virtual reality training versus conventional training and have shown that surgical trainees who undergo simulator training outperform their colleagues without simulator experience.^[4,5] In a randomized, controlled trial of 16 surgical trainees, those who had received virtual reality training for a laparoscopic procedure were faster, made fewer errors and showed greater economy of motion compared with those who had not received such training. Virtual reality training, therefore, contributes to the development of skills relevant for real procedures and might shorten the learning curve for new procedures. Most educators agree that virtual reality simulators are efficient training tools in laparoscopic surgery and should be widely implemented in the surgical training curricula.

If applied to a residency curriculum, virtual reality assessment can be used for continuous monitoring of a trainee's performance as well as for early intervention when the speed of a trainee's skill acquisition is suboptimal. Studies have demonstrated that constructive feedback based on objective criteria contributes to improved learning and has the potential to shorten the learning curve of a procedure in the operating room.^[6]

There is a considerable amount of evidence confirming that virtual reality simulators provide an instantaneous, unbiased, reliable and valid assessment of technical skills for laparoscopic surgery. Face and construct validity (the degree of resemblance between the system and the procedure it intends to simulate and the ability of the system to discriminate between individuals from different experience levels) have been demonstrated for most of the commercially available virtual reality systems. The most powerful evidence of validity-predictive validity (the extent to which the scores on a test are predictive of genuine performance in the operating room)-has so far been shown in two observational studies.^[7,8] This substantial evidence on the validity of virtual reality simulation has been summarized in a consensus document by the European Association of Endoscopic Surgery who indicated level 2 recommendations for the assessed simulator systems.^[9] As evidence continues to evolve, clinicians will observe validation of curricula for resident training as well as certification and recertification of practicing surgeons on the basis of objective assessment. Virtual reality simulation will without doubt play a major role in these processes.

Most of the commercially available simulation systems are offered with a broad range of settings with no predefined proficiency criteria and no information on the intensity or duration of training needed to achieve technical competency. In order to standardize the process of virtual reality training, there four questions that must be addressed. Firstly, what should the difficulty setting be set at for each task? Secondly, has the validity for each difficulty setting been established? Thirdly, has the learning curve for each setting and task been assessed? Finally, have performance proficiency criteria been established for procedures on the basis of expert assessment? An evidence-based proficiency curriculum can be designed only after each of these questions has been answered.

Previous studies have investigated and validated curricula for simulator training in basic laparoscopy.^[10] It should be highlighted, however, that virtual reality simulators are mainly technical skills trainers and a comprehensive residency curriculum should include additional tools such as box trainers, animal models, cadavers and human patient simulators.^[11]

Virtual reality simulation will continue to have an important role in the training of basic and procedure-specific skills in various surgical specialties, and endoscopy and endoluminal therapies. Future efforts should investigate the impact of this type of training on the quality and speed of skills acquisition of trainee surgeons to facilitate the production of excellent surgeons in a safe and pedagogically supportive environment.

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