Ramesh Mark Nataraja

Background: Surgical assessment often relies on subjective expert observation, which may introduce bias. We aimed to objectively differentiate skill levels in a complex simulated operative procedure using hand‐tracking metrics through a wearable mixed reality headset. Methods: A validated paediatric open inguinal herniotomy simulator was used to simulate a surgical task composed of multiple sequential operative steps. Novices (medical students) and experts (paediatric surgeons) were recruited. After completing a pre‐task questionnaire, participants performed the task while wearing the mixed reality headset (Microsoft HoloLens 2). A post‐task questionnaire was completed. Metrics collected included total path length, average path length, average movement velocity and total time. Data are reported as mean (± SD) and analysis included descriptive statistics, frequency counts and comparative testing using t ‐tests. A p ‐value of < 0.05 was considered significant. Results: A total of 33 participants were recruited (9 experts, 24 novices). The expert group had a shorter mean total path length: 287.0 ± 60.0 cm versus 450.1 ± 55.7 cm ( p < 0.0001). They also had a shorter mean path length; 71.8 ± 15.1 cm versus 112.5 ± 13.9 cm ( p < 0.0001). The expert mean velocity of movement was 0.17 ± 0.07 cm/s versus 0.14 ± 0.02 cm/s in novices ( p = 0.13). Experts took less time to complete the task: 458.1 ± 65.8 s versus 836.0 ± 70.0 s ( p < 0.0001). Conclusions: This study objectively demonstrated that experts had a more efficient economy of movement and that hand‐tracking metrics can differentiate between novice and expert performance during a simulated complex surgical task.

Introduction: Healthcare workers in the Pacific Islands are distributed across many geographically remote areas. Online learning has significant potential to increase the accessibility of education; however, little is known about its use in this region. The primary aim of this review was to investigate the distribution and effectiveness of online learning for Pacific Island healthcare workers, information that may be useful to inform future online educational practices to maximise their outcomes. Methods: The review was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (ID: CRD42024502877). Six databases and two grey literature sources were searched over a 22-year period (2003–2025). Data were collected relating to learner populations, learning features, learning methods and outcome evaluation. Results were analysed and presented with descriptive statistics and narrative synthesis. Results: After retrieving 12,091 records, 42 studies were included. Learners were most often from Fiji (38%) or Vanuatu (31%), and the most prevalent groups were doctors (55%) and nurses (48%). Frequently used learning methods were lecture/seminar/conference (62%) and modular learning (36%). Where reported, learning approaches were balanced between asynchronous (31%), synchronous (29%) and mixed (31%). Twenty-six studies conducted outcome evaluation (62%), while eight programs (18%) analysed improvements using statistical methods. Thirty studies (71%) were published from 2021–2025. Conclusions: Online learning for healthcare workers has been increasingly used in the Pacific Islands. However, few studies conducted comprehensive evaluations, which limits conclusions regarding effectiveness. Publications often reported learning methods in limited detail. More robust research is needed to realise the full potential of online learning in the Pacific Islands.

Growing emphasis has been placed on the importance of local authorship in research from low and middle-income countries (LMICs). This study aimed to investigate local authorship of simulation-based education research conducted in LMICs through an in-depth authorship analysis of publications retrieved from a systematic review. After retrieving 27,738 records, 97 studies from 50 LMICs were included. The median number of authors was 8, ranging was from 2 to 18. Ninety-three studies (95%) included a local author, and local authors composed 145/291 (49%) of the total first, second, or final (FSF) authorship positions. Although there was a substantial increase in the number of published studies, there were no significant changes to the proportion of local FSF authors over time: 44% in 2002-2006; 63% in 2007-2011; 47% in 2012-2016; and 49% in 2017-2022 ( P = 0.45). The representation of local FSF authors is lower compared with other fields, though this may be reflective of including only studies that conducted high-level evaluation, or the fact that simulation is a relatively new field. Simulation researchers should actively support and include local authors to ensure programs are appropriate, contextualized and impactful, while making concerted efforts to develop local research capacity in LMICs.

Background: Simulation-based education is a valuable tool in paediatric surgery. Inguinal hernias are a common paediatric surgical presentation with an incidence of 1–5% in full-term infants. While previous simulators have been created for adult inguinal hernias and laparoscopic paediatric inguinal hernias, there are limited models for the open paediatric procedure. We aimed to create and validate a simulator for a paediatric open inguinal hernia repair. Methods: Essential procedural steps of an open inguinal herniotomy were determined, and a low-cost paediatric simulator was developed. Novices (medical students) and experts (paediatric surgeons) were recruited. A questionnaire on an 11-point Likert-type scale assessed face validity, content validity, and functional task alignment. Median scores > 7.0/10.0 were deemed valid. The total number and type of procedural errors were assessed to determine construct validity. Statistical analysis included Fisher’s exact test, a p-value < 0.05 was considered significant. Results: A total of 34 participants were recruited (expert:10, novice:24). The simulator received favourable median scores in the following content validity domains: useful for surgical trainees (7.0/10.0), useful to train open surgical skills (7.5/10.0), and logical flow of procedural steps (9.0/10.0). It was not deemed a valuable training tool for experts (2.0/10.0). The simulator had median scores below 7.0/10.0 for face validity domains, including its tissue and visual realism. Construct validity was demonstrated by novices making more errors on the simulator, p = 0.02. Conclusions: This low-cost open inguinal herniotomy simulator demonstrated content validity, construct validity, and a high degree of functional task alignment.

The collection of clinical audit data are important for audit, research and other quality improvement processes. Low- and middle-income countries (LMICs) face a range of challenges to effective data collection and use. In this study, we explored factors affecting the collection of clinical data at a tertiary centre in Papua New Guinea. This qualitative study was based on semi-structured individual interviews with healthcare workers at a tertiary hospital in Papua New Guinea. Questions focused on participants' experiences and perspectives regarding the collection of clinical data. We transcribed the interviews and analysed them using reflexive thematic analysis. We collected demographics using a short survey. Reporting of the research was guided by COREQ. We conducted 20 interviews with predominantly nursing staff (n/N = 15/20; 75%). Of the participants, 16/20 (80%) had previously collected data for an audit or research project. Five themes and eight subthemes were conceptualised. Themes related to organisational culture, staff workload, data documentation practices, research infrastructure and study procedures. Although participants were motivated to complete data collection, they faced significant challenges that hindered their ability to do so. While staff often had to choose between collecting data and providing patient care, data collection initiatives could also improve patient care by improving communication between healthcare workers. In this study, we revealed numerous factors which affect the success of clinical data collection for audit and research purposes. These factors may be considered in the design of future initiatives. This has significant implications given the public health importance of strengthening data collection in Papua New Guinea, the Pacific Islands and LMICs in other regions.

Background: Children diagnosed with leukemia require prolonged central venous access for chemotherapy, transfusions, and supportive care. Due to their immunocompromised status, coagulopathies, and intensive treatment protocols, they may be at increased risk for central venous access device (CVAD)‐related complications, including infection, thrombosis, and mechanical failure. This study aimed to quantify the incidence and characterize the nature of CVAD‐associated complications in this high‐risk pediatric population. Methods: A systematic review (1970–2025) was conducted using PRISMA guidelines, including studies describing CVAD‐associated complications in children (≤ 18 years old) undergoing treatment for leukemia. The Risk of Bias in Non‐Randomized Studies of Interventions (ROBINS‐I) tool was used to assess the studies' quality. Meta‐analysis and proportional meta‐analysis for non‐comparative studies (Freeman–Tukey transformation) using the random‐effects model were conducted. Results: Six databases were searched identifying 1126 articles: 1102 were excluded and 24 studies with 13 879 CVADs were included. CVAD‐associated complications identified included: device failure 18.5% (95% CI 10.8–27.8), central line‐associated bloodstream infection (CLABSI) 31.3% (95% CI 23.6–39.6), local infection 5.4% (95% CI 2.5–9.3), CVAD‐associated venous thromboembolism (VTE) 5.2% (95% CI 2.9–8.3), dislodgement/migration 2.4% (95% CI 1.5–3.5), breakage/rupture 3% (95% CI 1.9–4.3), occlusion 5.3% (95% CI 1.5–11.2), wound dehiscence 4.4% (95% CI 2.2–7.3), and accidental removal 4.9% (95% CI 2.0–9.0). Tunneled central venous access devices (TCVADs) were associated with a higher proportion of complications when compared to totally implantable venous access devices (TIVADs). Conclusion: Device failure and CLABSI are the CVAD‐associated complications with the highest incidence rates. Comparing CVAD subtypes, TCVADs may have a higher complication risk than TIVADs. Further large prospective studies with long‐term follow‐up are needed to investigate these findings and determine their impact on patient morbidity and mortality.