{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T05:08:42Z","timestamp":1791954522493,"version":"4.3.4"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Cleft lip affects one in 700 children globally, and the prevalence far surpasses capacity to deliver cleft care in underresourced and endemic regions. A hands-on educational presence is needed to promote overseas surgical autonomy, build overseas capacity, and ensure a sustained clinical and educational infrastructure. The goal of this study was to build and assess an augmented reality educational platform that allows a remote yet virtual interactive presence to transfer cleft surgery knowledge\/skills to overseas colleagues.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A prospective study assessing a 13-month overseas augmented reality\u2013based cleft surgery curriculum was conducted. Three semiannual site visits engaged two Peruvian surgeons in evidence-based didactics, on-site cleft surgery, and familiarization with the augmented reality platform. During 10 remote augmented reality visits, a surgeon stationed in United States guided the same Peruvian surgeons through cleft surgery. Quarterly assessments of the Peruvian surgeons were performed using visual analogue scale questionnaires.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Visual analogue scale scores by both the remote and overseas surgeons demonstrated significant, progressive improvement in all facets of cleft lip repair throughout the curriculum. Site visits preferentially built capacity for cleft diagnosis and preoperative counseling (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001), principles of repair (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001), repair technique (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.02) and intraoperative decision-making (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001). Remote sessions preferentially developed understanding of cleft operative design\/anthropometry (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.04), cleft anatomy (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.01), and operative efficiency (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001). At 30-month follow-up, no children with cleft lip required transfer to tertiary care centers.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>A curriculum that combines on-site training and augmented reality\u2013based hands-on remote teaching can build sustained capacity of comprehensive cleft care in underresourced areas.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/prs.0000000000007293","type":"journal-article","created":{"date-parts":[[2020,10,22]],"date-time":"2020-10-22T20:01:45Z","timestamp":1603396905000},"page":"622e-629e","source":"Crossref","is-referenced-by-count":50,"title":["Using Virtual Augmented Reality to Remotely Proctor Overseas Surgical Outreach: Building Long-Term International Capacity and Sustainability"],"prefix":"10.1097","volume":"146","author":[{"given":"Raj M.","family":"Vyas","sequence":"first","affiliation":[{"name":"From the Department of Plastic Surgery, University of California, Irvine; and the Global Smile Foundation."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lohrasb Ross","family":"Sayadi","sequence":"additional","affiliation":[{"name":"From the Department of Plastic Surgery, University of California, Irvine; and the Global Smile Foundation."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Bendit","sequence":"additional","affiliation":[{"name":"From the Department of Plastic Surgery, University of California, Irvine; and the Global Smile Foundation."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Usama S.","family":"Hamdan","sequence":"additional","affiliation":[{"name":"From the Department of Plastic Surgery, University of California, Irvine; and the Global Smile Foundation."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,10,23]]},"reference":[{"key":"R1-20230801","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.cps.2013.12.009","article-title":"Unilateral cleft lip repair.","volume":"41","author":"Vyas","year":"2014","journal-title":"Clin Plast Surg"},{"key":"R2-20230801","doi-asserted-by":"crossref","first-page":"55","DOI":"10.4103\/0971-9261.55152","article-title":"Psychological issues in cleft lip and cleft palate.","volume":"14","author":"Sousa","year":"2009","journal-title":"J Indian Assoc Pediatr Surg"},{"issue":"Suppl 1","key":"R3-20230801","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1002\/lary.24747","article-title":"Cleft lip-cleft palate in Zimbabwe: Estimating the distribution of the surgical burden of disease using geographic information systems.","volume":"125(","author":"Tollefson","year":"2015","journal-title":"Laryngoscope"},{"key":"R4-20230801","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/s00268-014-2628-6","article-title":"Unmet burden of cleft lip and palate in rural Gujarat, India: A population-based study.","volume":"39","author":"Khajanchi","year":"2015","journal-title":"World J Surg"},{"key":"R5-20230801","doi-asserted-by":"crossref","first-page":"1680","DOI":"10.1097\/SCS.0000000000001208","article-title":"Scalable, sustainable cost-effective surgical care: A model for safety and quality in the developing world, part II: Program development and quality care.","volume":"25","author":"Campbell","year":"2014","journal-title":"J Craniofac Surg"},{"key":"R6-20230801","doi-asserted-by":"crossref","first-page":"1674","DOI":"10.1097\/SCS.0000000000001209","article-title":"Scalable, sustainable cost-effective surgical care: A model for safety and quality in the developing world, part I: Challenge and commitment.","volume":"25","author":"Campbell","year":"2014","journal-title":"J Craniofac Surg"},{"key":"R7-20230801","doi-asserted-by":"crossref","first-page":"1685","DOI":"10.1097\/SCS.0000000000001207","article-title":"Scalable, sustainable cost-effective surgical care: A model for safety and quality in the developing world, part III: Impact and sustainability.","volume":"25","author":"Campbell","year":"2014","journal-title":"J Craniofac Surg"},{"key":"R8-20230801","doi-asserted-by":"crossref","first-page":"326","DOI":"10.3109\/10929080209146521","article-title":"Use of three-dimensional computer graphic animation to illustrate cleft lip and palate surgery.","volume":"7","author":"Cutting","year":"2002","journal-title":"Comput Aided Surg"},{"key":"R9-20230801","doi-asserted-by":"crossref","first-page":"2093","DOI":"10.1097\/PRS.0b013e3181f5289f","article-title":"Creating a virtual surgical atlas of craniofacial procedures: Part II. Surgical animations.","volume":"126","author":"Flores","year":"2010","journal-title":"Plast Reconstr Surg"},{"key":"R10-20230801","doi-asserted-by":"crossref","first-page":"2084","DOI":"10.1097\/PRS.0b013e3181f526f6","article-title":"Creating a virtual surgical atlas of craniofacial procedures: Part I. Three-dimensional digital models of craniofacial deformities.","volume":"126","author":"Flores","year":"2010","journal-title":"Plast Reconstr Surg"},{"key":"R13-20230801","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1597\/11-256","article-title":"Adult cleft lip repair under local anesthesia: An effective technique in resource-poor settings.","volume":"50","author":"Eberlin","year":"2013","journal-title":"Cleft Palate Craniofac J"},{"key":"R14-20230801","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1597\/07-094.1","article-title":"Quality assurance guidelines for surgical outreach programs: A 20-year experience.","volume":"45","author":"Eberlin","year":"2008","journal-title":"Cleft Palate Craniofac J"},{"key":"R15-20230801","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1597\/13-082","article-title":"Use of safety measures, including the modified World Health Organization surgical safety checklist, during international outreach cleft missions.","volume":"51","author":"Patel","year":"2014","journal-title":"Cleft Palate Craniofac J"},{"key":"R16-20230801","doi-asserted-by":"crossref","first-page":"631e","DOI":"10.1097\/PRS.0b013e3182827776","article-title":"Implementation of an emergency response protocol for overseas surgical outreach initiatives.","volume":"131","author":"Vyas","year":"2013","journal-title":"Plast Reconstr Surg"},{"key":"R17-20230801","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1097\/PRS.0000000000004708","article-title":"A novel innovation for surgical flap markings using projected stencils.","volume":"142","author":"Sayadi","year":"2018","journal-title":"Plast Reconstr Surg"},{"key":"R18-20230801","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1097\/BRS.0000000000002876","article-title":"Pedicle screw placement using augmented reality surgical navigation with intraoperative 3D imaging: A first in-human prospective cohort study.","volume":"44","author":"Terander","year":"2018","journal-title":"Spine (Phila Pa 1976)"},{"key":"R19-20230801","doi-asserted-by":"crossref","first-page":"e1958","DOI":"10.1002\/rcs.1958","article-title":"A novel augmented reality (AR) scheme for knee replacement surgery by considering cutting error accuracy.","volume":"15","author":"Pokhrel","year":"2019","journal-title":"Int J Med Robot"},{"key":"R20-20230801","first-page":"e008","article-title":"Augmented reality visualization-guided microscopic spine surgery: Transvertebral anterior cervical foraminotomy and posterior foraminotomy.","volume":"2","author":"Umebayashi","year":"2018","journal-title":"J Am Acad Orthop Surg Glob Res Rev"},{"key":"R21-20230801","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.wneu.2015.08.053","article-title":"Virtual interactive presence in global surgical education: International collaboration through augmented reality.","volume":"86","author":"Davis","year":"2016","journal-title":"World Neurosurg"},{"key":"R22-20230801","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1007\/s00268-008-9525-9","article-title":"Surgery and global health: A view from beyond the OR.","volume":"32","author":"Farmer","year":"2008","journal-title":"World J Surg"},{"key":"R23-20230801","doi-asserted-by":"crossref","first-page":"e442","DOI":"10.1371\/journal.pmed.0030442","article-title":"Projections of global mortality and burden of disease from 2002 to 2030.","volume":"3","author":"Mathers","year":"2006","journal-title":"PLoS Med"},{"key":"R24-20230801","doi-asserted-by":"crossref","first-page":"1520","DOI":"10.1001\/jama.2009.1456","article-title":"Experts say projected surgeon shortage a \u201clooming crisis\u201d for patient care.","volume":"302","author":"Voelker","year":"2009","journal-title":"JAMA"},{"key":"R25-20230801","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1097\/SLA.0b013e3181f886b6","article-title":"Access to care and the surgeon shortage: American Surgical Association forum.","volume":"252","author":"Sheldon","year":"2010","journal-title":"Ann Surg"},{"key":"R26-20230801","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.yasu.2008.04.006","article-title":"The global health workforce shortage: Role of surgeons and other providers.","volume":"42","author":"Sheldon","year":"2008","journal-title":"Adv Surg"}],"container-title":["Plastic &amp; 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