Background: Ensuring access to accurate and verified information is essential for effective patient treatment and diagnosis. Although health workers rely on the internet for clinical data, there is a need for a more streamlined approach. Objective: This systematic review aims to assess the current state of artificial intelligence (AI) and natural language processing (NLP) techniques in health care to identify their potential use in electronic health records and automated information searches. Methods: A search was conducted in the PubMed, Embase, ScienceDirect, Scopus, and Web of Science online databases for articles published between January 2000 and April 2023. The only inclusion criteria were (1) original research articles and studies on the application of AI-based medical clinical decision support using NLP techniques and (2) publications in English. A Critical Appraisal Skills Programme tool was used to assess the quality of the studies. Results: The search yielded 707 articles, from which 26 studies were included (24 original articles and 2 systematic reviews). Of the evaluated articles, 21 (81%) explained the use of NLP as a source of data collection, 18 (69%) used electronic health records as a data source, and a further 8 (31%) were based on clinical data. Only 5 (19%) of the articles showed the use of combined strategies for NLP to obtain clinical data. In total, 16 (62%) articles presented stand-alone data review algorithms. Other studies (n=9, 35%) showed that the clinical decision support system alternative was also a way of displaying the information obtained for immediate clinical use. Conclusions: The use of NLP engines can effectively improve clinical decision systems’ accuracy, while biphasic tools combining AI algorithms and human criteria may optimize clinical diagnosis and treatment flows. Trial Registration: PROSPERO CRD42022373386; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=373386

Background: Simulation in virtual environments has become a new paradigm for surgeon training in minimally invasive surgery (MIS). However, this technology is expensive and difficult to access.Objective: This study aims first to describe the development of a new gesture-based simulator for learning skills in MIS and, second, to establish its fidelity to the criterion and sources of content-related validity evidence.Methods: For the development of the gesture-mediated simulator for MIS using virtual reality (SIMISGEST-VR), a design-based research (DBR) paradigm was adopted. For the second objective, 30 participants completed a questionnaire, with responses scored on a 5-point Likert scale. A literature review on the validity of the MIS training-VR (MIST-VR) was conducted. The study of fidelity to the criterion was rated using a 10-item questionnaire, while the sources of content-related validity evidence were assessed using 10 questions about the simulator training capacity and 6 questions about MIS tasks, and an iterative process of instrument pilot testing was performed.Results: A good enough prototype of a gesture-based simulator was developed with metrics and feedback for learning psychomotor skills in MIS. As per the survey conducted to assess the fidelity to the criterion, all 30 participants felt that most aspects of the simulator were adequately realistic and that it could be used as a tool for teaching basic psychomotor skills in laparoscopic surgery (Likert score: 4.07-4.73). The sources of content-related validity evidence showed that this study’s simulator is a reliable training tool and that the exercises enable learning of the basic psychomotor skills required in MIS (Likert score: 4.28-4.67).Conclusions: The development of gesture-based 3D virtual environments for training and learning basic psychomotor skills in MIS opens up a new approach to low-cost, portable simulation that allows ubiquitous learning and preoperative warm-up. Fidelity to the criterion was duly evaluated, which allowed a good enough prototype to be achieved. Content-related validity evidence for SIMISGEST-VR was also obtained.

Background: The high cost and low availability of virtual reality simulators in surgical specialty training programs in low- and middle-income countries make it necessary to develop and obtain sources of validity for new models of low-cost portable simulators that enable ubiquitous learning of psychomotor skills in minimally invasive surgery. Objective: The aim of this study was to obtain validity evidence for relationships to other variables, internal structure, and consequences of testing for the task scores of a new low-cost portable simulator mediated by gestures for learning basic psychomotor skills in minimally invasive surgery. This new simulator is called SIMISGEST-VR (Simulator of Minimally Invasive Surgery mediated by Gestures - Virtual Reality). Methods: In this prospective observational validity study, the authors looked for multiple sources of evidence (known group construct validity, prior videogaming experience, internal structure, test-retest reliability, and consequences of testing) for the proposed SIMISGEST-VR tasks. Undergraduate students (n=100, reference group), surgical residents (n=20), and experts in minimally invasive surgery (n=28) took part in the study. After answering a demographic questionnaire and watching a video of the tasks to be performed, they individually repeated each task 10 times with each hand. The simulator provided concurrent, immediate, and terminal feedback and obtained the task metrics (time and score). From the reference group, 29 undergraduate students were randomly selected to perform the tasks 6 months later in order to determine test-retest reliability. Results: Evidence from multiple sources, including strong intrarater reliability and internal consistency, considerable evidence for the hypothesized consequences of testing, and partial confirmation for relations to other variables, supports the validity of the scores and the metrics used to train and teach basic psychomotor skills for minimally invasive surgery via a new low-cost portable simulator that utilizes interaction technology mediated by gestures. Conclusions: The results obtained provided multiple sources of evidence to validate SIMISGEST-VR tasks aimed at training novices with no prior experience and enabling them to learn basic psychomotor skills for minimally invasive surgery.

BACKGROUND Simulation in virtual environments has become a new paradigm for surgeon training in minimally invasive surgery (MIS). However, this technology is expensive and difficult to access. OBJECTIVE This study aims first to describe the development of a new gesture-based simulator for learning skills in MIS and, second, to establish its fidelity to the criterion and sources of content-related validity evidence. METHODS For the development of the gesture-mediated simulator for MIS using virtual reality (SIMISGEST-VR), a design-based research (DBR) paradigm was adopted. For the second objective, 30 participants completed a questionnaire, with responses scored on a 5-point Likert scale. A literature review on the validity of the MIS training-VR (MIST-VR) was conducted. The study of fidelity to the criterion was rated using a 10-item questionnaire, while the sources of content-related validity evidence were assessed using 10 questions about the simulator training capacity and 6 questions about MIS tasks, and an iterative process of instrument pilot testing was performed. RESULTS A good enough prototype of a gesture-based simulator was developed with metrics and feedback for learning psychomotor skills in MIS. As per the survey conducted to assess the fidelity to the criterion, all 30 participants felt that most aspects of the simulator were adequately realistic and that it could be used as a tool for teaching basic psychomotor skills in laparoscopic surgery (Likert score: 4.07-4.73). The sources of content-related validity evidence showed that this study’s simulator is a reliable training tool and that the exercises enable learning of the basic psychomotor skills required in MIS (Likert score: 4.28-4.67). CONCLUSIONS The development of gesture-based 3D virtual environments for training and learning basic psychomotor skills in MIS opens up a new approach to low-cost, portable simulation that allows ubiquitous learning and preoperative warm-up. Fidelity to the criterion was duly evaluated, which allowed a good enough prototype to be achieved. Content-related validity evidence for SIMISGEST-VR was also obtained.

BACKGROUND The increasingly pervasive presence of technology in the operating room (OR) raises the need to study the interaction between the surgeon and the computer system. A new generation of tools known as commercial off-the-shelf (COTS) devices that enable non-contact gesture-based human-computer interaction (HCI) are currently being explored as a solution in surgical environments. OBJECTIVE The aim of this systematic review was to provide an account of the state-of-the-art of COTS devices in the detection of manual gestures in surgery, and to identify their use as a simulation tool for teaching motor skills in minimally invasive surgery (MIS). METHODS A systematic literature review was conducted in PubMed, Embase, ScienceDirect and IEEE for articles published between January 2000 and 2016 on the use of COTS devices for gesture detection in surgical environments, and in simulation for surgical skills learning in MIS RESULTS A total of 2709 studies were identified, 76 of which met the search selection criteria. The Microsoft KinectTM and the Leap Motion ControllerTM were the most widely used COTS devices. The most common intervention was image manipulation in surgical and interventional radiology environments, followed by interaction with virtual reality environments for educational or interventional purposes; the possibility of using this technology to develop portable, low-cost simulators for skills learning in MIS was also examined. Given that the vast majority of articles found in this systematic review were proof-of-concept or prototype user and feasibility testing, we can conclude that this is a field that is still in the exploration phase in areas that require touchless manipulation in environments and settings that must adhere to asepsis and antisepsis protocols, such as angiography suites and operating rooms. CONCLUSIONS COTS devices applied to hand and instrument GBIs in the field of simulation for skills learning and training in MIS could open up a promising field to achieve the ubiquitous training and pre-surgical warm-up.