et al. Current and future applications of 3D printing in congenital cardiology and cardiac surgery. Br J Radiol 2018; 91: 20180389.aBStract Three-dimensional (3D) printing technology in congenital cardiology and cardiac surgery has experienced a rapid development over the last decade. In presence of complex cardiac and extra-cardiac anatomies, the creation of a physical, patient-specific model is attractive to most clinicians. However, at the present time, there is still a lack of strong scientific evidence of the benefit of 3D models in clinical practice and only qualitative evaluation of the models has been used to investigate their clinical use. 3D models can be printed in rigid or flexible materials, and the original size can be augmented depending on the application the models are needed for. The most common applications of 3D models at present include procedural planning of complex surgical or interventional cases, in vitro simulation for research purposes, training and communication with patients and families. The aim of this pictorial review is to describe the basic principles of this technology and present its current and future applications.
BackgroundAn interdisciplinary framework including a narrative element could allow addressing lack of awareness or excessive anxieties and teasing out divergences between patients’ health status and their expectations. This could be particularly relevant for adolescents with congenital heart disease (CHD).ObjectiveTo develop a collective narrative ensuing from a creative activity involving adolescents with CHD, in order to explore their health perceptions and expectations.DesignArtist-led workshop process supported by a multidisciplinary team.Setting and participantsYoung people with CHD (n=5, age 17–18 years, two men) were involved in the creative process, which encouraged them, over two sessions, to elaborate imagery relating to their uniqueness as individuals and their hearts. On top of creative activities (including self-portraits, embossing, body mapping and creative writing), participants were also shown their hearts in the form of cardiovascular MRIs and three-dimensional (3D) models manufactured by means of 3D printing.MethodsA composite first-person narrative approach was adopted to handle the emerged phenomenological descriptions and creative outputs, in order to shape a unified story.ResultsThe composite first-person narrative highlighted themes central to the patients, including their interpretation of medical references, their resilience and their awareness of anatomical complexity.Discussion and conclusionsExploring the narrative of adolescents with CHD can offer unique insight into the way they view their hearts at a crucial stage of their care. An artist-led creative workshop supported by a multidisciplinary team can be a valuable approach to collect such narratives from patients and begin exploring them.
An arts workshop investigated the process of communicating the notion of uniqueness with young people with congenital heart disease (CHD) and whether threedimensional (3D) visualization could be more effective than two-dimensional (2D) visualization for elaborating CHD anatomy and increasing awareness. Young people with CHD (n=7, 14–18 years old) were invited to a workshop by a multidisciplinary team (a visual artist, a bioengineer, two psychologists and an adolescent clinical nurse specialist). The artist guided the participants through self-portrait exercises, creative writing, painting a body map, discussions and reflections. Participants also discussed a range of 3D-printed heart models. Participants unanimously agreed that a 3D-sculpted self-portrait form was more immediate than a 2D portrait form for representing themselves. Body maps provided insight into their inner landscape. In discussing 3D heart models, different preferences emerged, at times contrasting or even opposed. The quality of engagement was excellent throughout. An interdisciplinary approach can be successfully used to explore the potentially sensitive theme of uniqueness in CHD.
The arts can aid the exploration of individual and collective illness narratives, with empowering effects on both patients and caregivers. The artist, partly acting as conduit, can translate and re-present illness experiences into artwork. But how are these translated experiences received by the viewer—and specifically, how does an audience respond to an art installation themed around paediatric heart transplantation and congenital heart disease? The installation, created by British artist Sofie Layton and titled Making the Invisible Visible, was presented at an arts-and-health event. The piece comprised three-dimensional printed medical models of hearts with different congenital defects displayed under bell jars on a stainless steel table reminiscent of the surgical theatre, surrounded by hospital screens. The installation included a soundscape, where the voice of a mother recounting the journey of her son going through heart transplantation was interwoven with the voice of the artist reading medical terminology. A two-part survey was administered to capture viewers’ expectations and their response to the piece. Participants (n=125) expected to acquire new knowledge around heart disease, get a glimpse of patients’ experiences and be surprised by the work, while after viewing the piece they mostly felt empathy, surprise, emotion and, for some, a degree of anxiety. Viewers found the installation more effective in communicating the experience of heart transplantation than in depicting the complexity of cardiovascular anatomy (p<0.001, z=7.56). Finally, analysis of open-ended feedback highlighted the intimacy of the installation and the privilege viewers felt in sharing a story, particularly in relation to the soundscape, where the connection to the narrative in the piece was reportedly strengthened by the use of sound. In conclusion, an immersive installation including accurate medical details and real stories narrated by patients can lead to an empathic response and an appreciation of the value of illness narratives.
As the profile of the arts-and-health sector grows and interdisciplinary projects with public outcomes become more common, it is important to explore roles and ways of working at the interface between different disciplines. The complex role of producer, likely to become increasingly relevant in this landscape, is here analysed. While incorporating aspects of existing roles (e.g. hospital arts manager, cultural venue participatory producer, independent creative producer, public engagement manager), the producer has a very specific raison d’être and could be defined as ‘relational producer’. This role is not well understood and yet central to this field of practice.
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