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Virtual Reality-Enhanced Haptic Simulation to Improve Self-Regulation of Applied Delivery Force During Shoulder Dystocia

虚拟现实增强触觉模拟可改善肩难产期间施加的分娩力的自我调节

基本信息

批准号：
10668325
负责人：
EDITH DIAMENT GUREWITSCH ALLEN
金额：
$ 38.64万
依托单位：
ALBERT EINSTEIN COLLEGE OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-01 至 2024-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10668325
关键词：
Virtual Reality Enhanced Haptic Simulation

项目摘要

Shoulder dystocia, the obstructed delivery of an infant's shoulders and body after emergence of the head in the final mo- ments of birth, occurs unpredictably as an obstetric emergency in up to 1 in 25 vaginal deliveries. Prompt recognition and performance of specialized delivery maneuvers mitigates against brachial plexus injuries associated with up to 40% of shoulder dystocia-complicated deliveries. Although some success with simulation training has been demonstrated, re- duced rates of brachial plexus injury has not been achieved consistently. Questions persist about differing simulation training schemes and instructional content utilized between successful and unsuccessful interventions. Unless content and methodology utilized for shoulder dystocia simulation training is proven effective in mitigating birth injury, use of simu- lation for skills acquisition is of limited utility in advancing patient safety. If simulation-derived metrics are not validated, otherwise competent obstetricians could be inaccurately deemed not to be appropriately skilled, leading to workforce re- ductions that negatively impact access to safe obstetric care for women and children. We delineate specific positive (pre- scriptive) instructional content emphasizing maneuvers shown to decrease strain on the brachial plexus. We also consider several negative (proscriptive) instructions – to avoid excessive and laterally-directed or torsional traction – to be essential for inclusion in simulation training. We deliver relevant learning content using virtual (video) and haptic (mannequin) for- mats and perform objective (force measurement) and subjective (preceptor scores) assessments of provider technique. Although successful in reducing clinical brachial plexus injuries, such programs are labor-intensive and rarely tailored to providers' educational needs. Our multidisciplinary collaborative team of obstetric, biomedical engineering and simulation educators from Albert Einstein College of Medicine-Montefiore Medical Center proposes a virtual reality-enhanced haptic simulation to improve obstetric providers' self-regulation of applied delivery force during shoulder dystocia. A mixed meth- ods approach will be used to evaluate our novel content and format for skills acquisition and competency assessment of providers' management of shoulder dystocia. The overall objective for this application is to determine the relative contribu- tion of positive and negative instructional content and of virtual and haptic methods of simulation training. Our central hy- pothesis is that deliberate demonstrative instruction improves skill acquisition and reduces improper potential injury- producing techniques. We aim to 1) assess the relative contribution of positive and negative instructional content to effec- tive simulation-based skill acquisition and competency; 2) evaluate virtual and haptic methods of simulation training for shoulder dystocia management and 3) validate objective and subjective simulation-derived metrics for demonstrating transfer of skills to clinical practice. The expected outcome of the proposed research is the ability to reliably, efficiently and effectively deliver an evidence-based validated simulation program with integrated virtual and haptic components tailored to provider experience that positively impacts the ability to reduce brachial plexus injuries following shoulder dystocia.

肩难产，指在分娩的最后一个月，婴儿的头部出现后，婴儿的肩部和身体受到阻碍。在25例阴道分娩中，多达1例发生不可预测的产科急症。及时识别和专门的输送操作可减轻高达40%的臂丛神经损伤，肩难产-难产虽然模拟训练取得了一些成功，但重新- 臂丛神经损伤的发生率并没有持续降低。关于不同模拟的问题仍然存在成功干预和不成功干预之间使用的培训计划和教学内容。除非内容肩难产模拟训练的方法学被证明在减轻产伤方面是有效的，技能获取的定义在提高患者安全性方面的效用有限。如果仿真导出的度量未得到验证，否则，合格的产科医生可能被不准确地认为没有适当的技能，导致劳动力重新配置，对妇女和儿童获得安全产科护理产生负面影响的分娩。我们描绘了特定的阳性（前- 强调能减少臂丛神经紧张的动作的指导性内容。我们还认为几个负面（禁止性）说明-避免过度和侧向或扭转牵引-至关重要纳入模拟训练。我们使用虚拟（视频）和触觉（人体模型）提供相关的学习内容- 垫和执行客观（力测量）和主观（教练评分）评估供应商的技术。虽然成功地减少临床臂丛神经损伤，这样的程序是劳动密集型的，很少量身定制，供应商的教育需求。我们的产科、生物医学工程和模拟的多学科协作团队阿尔伯特·爱因斯坦医学院-蒙蒂菲奥里医学中心的教育工作者提出了一种虚拟现实增强触觉模拟提高肩难产时助产士对分娩力的自我调节。一种混合冰毒- ods方法将用于评估我们的新内容和格式的技能获取和能力评估，提供者对肩难产的管理。本申请的总体目标是确定相对贡献率，积极与消极的教学内容以及模拟训练的虚拟和触觉方法。我们的中央卫生- 假设是有意的示范性教学可以提高技能的获得，减少不适当的潜在伤害- 生产技术。我们的目标是1）评估积极和消极的教学内容对效果的相对贡献，主动模拟为基础的技能获取和能力; 2）评估虚拟和触觉模拟训练的方法，肩难产管理和3）验证客观和主观模拟衍生的指标，将技能转移到临床实践中。拟议研究的预期成果是能够可靠、有效和有效地提供一个基于证据的验证模拟程序与集成的虚拟和触觉组件定制提供经验，积极影响的能力，以减少臂丛神经损伤后肩难产。