The ergonomics of ventilated operating theatre clothing

Abstract

The results of a recent Department of Health and Social Security/Medical Research Council (DHSS/MRC) trial into the use of ultra-clean ventilation systems shows that these can bring about a reduction in the rate of wound sepsis in orthopaedic operations, particularly when body exhaust ventilated clothing is worn by members of the surgical team.

Although considerable information exists about the reduction of bacteria shedding from individuals wearing body exhaust gowns, little information is available about wearer comfort and related problems. This study was carried out to examine the ergonomic consequences for operating theatre staff of wearing ventilated clothing and to compare these with the results for other forms of specialized surgical garments.

The investigation consisted of observations of theatre staff at work, interviews and an experimental simulation of the orthopaedic surgeon's task.

The results showed that there were measurable differences in skin temperature and sweat rate between ventilated and non-ventilated gowns. Subjectively there was a significant preference for certain garments based on general comfort and thermal perceptions. It was concluded that the ’Mandarin’ body exhaust ventilated gown gave high levels of both objectively and subjectively assessed thermal comfort for the wearer. Where there were operational difficulties or objections to using a ventilated gown, it was concluded that a gown made from ’Gore-tex’ was a possible alternative. It is important that the ergonomic and comfort aspects of these gowns should be related to the attenuation in bacterial shedding that they produce.     

Scheduling an operating theatre under human resource constraints

In the present economic context, the operating theatre is considered as a critical activity in health care management. By virtue of its huge consumption of human and material resources, the operating theatre is one of the most important sources of expenses of the hospitals. A less costly organization of the operating rooms calls for a more rational use of the resources and a more refined planning of the surgical units. In addition to these considerations, we are concerned about the well-being of the medical staff. We integrate this human factor into the optimization procedure by stressing the human resources’ availabilities in the design of the schedules. This planning process is typically decomposed in two sequential phases: a planning stage followed by a scheduling stage. Due to this decomposition the resulting solutions may turn out to be sub-optimal. In this paper, we propose a formulation that includes both the planning and scheduling of the surgical operations. We also propose a heuristic solution procedure based on genetic algorithms to counter the large running times inherent in tackling this kind of hard optimization problem.     

Measuring intra-operative interference from distraction and interruption observed in the operating theatre

An observational tool was developed to record distraction and interruption in the operating theatre during surgery. Observed events were assigned to pre-defined categories and rated in relation to the level of team involvement - the sum of which was treated as a measure of intra-operative interference. Many events (0.29 +/- 0.02 per min) were observed and rated in 50 general operations sampled from a single operating theatre. The rating of individual events (r(s) = 0.65) and of cases (r(s) = 0.89) correlated between independent observers. Interference levels (1.04 +/- 0.07/min) also correlated with door opening frequency (0.68 +/- 0.03/min) (r = 0.47, p < 0.001). Some sources of interference were intrinsic to the work of the surgical team, including equipment, procedure and environment, while others were extraneous, including bleepers, phone calls and external staff. The findings highlight the need to further develop measures of interference, to assess its variation, intensity and its effect on surgical team performance.     

The design of supervisory rule-based control in the operating theatre via an anaesthesia simulator

The development of online drug administration strategies in operating theatres represents a highly safety-critical situation. The usefulness of different levels of simulation prior to clinical trials has been shown in previous studies in muscle relaxant anaesthesia. Thus, in earlier work on predictive self-tuning control for muscle relaxation a dual computer real-time simulation was undertaken, subsequent to algorithm validation via off-line simulation. In the present approach a supervised rule-based control algorithm is used. The control software was implemented on the actual machine to be used in theatre, while another computer acted as a real-time patient simulator. This set-up has further advantages of providing accurate timing and also finite data accuracy via the ADC/DAC interface, or the equivalent digital lines. Also, it provides for controller design fast simulation studies compared to the real-time application. In this paper, a new architecture which combines several hierarchical levels for control (a Mamdani-type fuzzy controller), adaptation (self-organizing fuzzy logic control) and performance monitoring (fault detection, isolation and accommodation) is developed and applied to a computer real-time simulation platform for muscle relaxant anaesthesia. Experimental results showed that the proposed algorithm fulfilled successfully the requirements for autonomy, i.e. automatic control, adaptation and supervision, and proved effective in dealing with the faults and disturbances which are normally encountered in operating theatres during surgery.     

Operating theatre scheduling with patient recovery in both operating rooms and recovery beds

This paper investigates the impact of allowing patient recovery in the operating room when no recovery bed is available. Three types of identical resources are considered: transporters, operating rooms and recovery beds. A fixed number of patients must be planned over a term horizon, usually one or two weeks. The surgery process is modelled as follows: each patient is transported from the ward to the operating theatre. Then the patient visits an operating room for surgery operation and is transferred to the recovery room. If no recovery bed is available, the patient wakes up in the operating room until a bed becomes available. The operating room needs to be cleaned after the patient’s departure, before starting another operation. Finally, the patient is transported back to the ward after his recovery. We consider several criteria based on patients’ completion times. We propose a Lagrangian relaxation-based method to solve this operating theatre scheduling problem. The efficiency of this method is then validated by numerical experiments. A comprehensive numerical experiment is then performed to quantify the benefit of allowing patient recovery in operating rooms. We show that the benefit is high when the workload of the recovery beds is high.     

Automation of legal sensemaking in e-discovery

Retrieval of relevant unstructured information from the ever-increasing textual communications of individuals and businesses has become a major barrier to effective litigation/defense, mergers/acquisitions, and regulatory compliance. Such e-discovery requires simultaneously high precision with high recall (high-P/R) and is therefore a prototype for many legal reasoning tasks. The requisite exhaustive information retrieval (IR) system must employ very different techniques than those applicable in the hyper-precise, consumer search task where insignificant recall is the accepted norm. We apply Russell, et al.’s cognitive task analysis of sensemaking by intelligence analysts to develop a semi-autonomous system that achieves high IR accuracy of F1 ≥ 0.8 compared to F1 < 0.4 typical of computer-assisted human-assessment (CAHA) or alternative approaches such as Roitblat, et al.’s. By understanding the ‘Learning Loop Complexes’ of lawyers engaged in successful small-scale document review, we have used socio-technical design principles to create roles, processes, and technologies for scalable human-assisted computer-assessment (HACA). Results from the NIST-TREC Legal Track’s interactive task from both 2008 and 2009 validate the efficacy of this sensemaking approach to the high-P/R IR task.     

A planning and scheduling problem for an operating theatre using an open scheduling strategy

The objective of this paper is to design a weekly surgery schedule in an operating theatre where time blocks are reserved for surgeons rather than specialities. Both operating rooms and places in the recovery room are assumed to be multifunctional, and the objectives are to maximise the utilisation of the operating rooms, to minimise the overtime cost in the operating theatre, and to minimise the unexpected idle time between surgical cases. This weekly operating theatre planning and scheduling problem is solved in two phases. First, the planning problem is solved to give the date of surgery for each patient, allowing for the availability of operating rooms and surgeons. Then a daily scheduling problem is devised to determine the sequence of operations in each operating room in each day, taking into account the availability of recovery beds. The planning problem is described as a set-partitioning integer-programming model and is solved by a column-generation-based heuristic (CGBH) procedure. The daily scheduling problem, based on the results obtained in the planning phase, is treated as a two-stage hybrid flow-shop problem and solved by a hybrid genetic algorithm (HGA). Our results are compared with several actual surgery schedules in a Belgian university hospital, where time blocks have been assigned to either specific surgeons or specialities several months in advance. According to the comparison results, surgery schedules obtained by the proposed method have less idle time between surgical cases, much higher utilisation of operating rooms and produce less overtime.     

Telelearning in the virtual lecture theatre

The concept of a virtual lecture theatre has been realised at the Faculty of Economics, Business Administration and Social Sciences in Nuremberg since 1995. Interdisciplinary courses are being held for local students at one faculty and are interactively broadcast for students joining in from remote locations. Various demands concerning the teleteaching environment have to be met in order to enable remote students to attend lectures virtually and interact synchronously by sending contributions via conferencing tools to the central lecture theatre. In addition, recorded lectures are digitised and stored on a multimedia server to provide asynchronous access for all students, constituting a “lecture on demand” system. Furthermore, remote students are able to co-operate virtually with other students, i.e. join exercise groups by means of video and audio communication, share screens and applications, exchange documents and software, etc. To fulfil the corresponding multimedia communication needs, a broadband ATM (asynchronous transfer mode) network connects the lecture theatre in Nuremberg with remote lecture theatres, remote conferencing rooms and separate workplaces at the university or at home.     

Student sensemaking with science diagrams in a computer-based setting

This paper reports on a study of students’ conceptual sensemaking with science diagrams within a computer-based learning environment aimed at supporting collaborative learning. Through the microanalysis of students’ interactions in a project about energy and heat transfer, we demonstrate how representations become productive social and cognitive resources in the students’ conceptual sensemaking. Taking a socio-cultural approach, the study aims to contribute on two levels. First, by providing insight into the interactional processes in which students encounter a particular type of representation: science diagrams. Second, the study aims to demonstrate that an important aspect of students’ encounters with science representations concerns making sense of how to respond to institutional norms and social practices embedded within the context of schooling. The findings demonstrate how the science diagrams become productive social and individual resources for the students by slowing down the students’ conceptual sensemaking processes and by opening up a space for the interpretation and negotiation of scientific concepts, as well as of the representations themselves. The study also shows the challenges involved when students move from oral to written accounts in their inquiries.     

Supporting geographically-aware web document foraging and sensemaking

This paper reports on the development and application of strategies and tools for geographic information seeking and knowledge building that leverages unstructured text resources found on the web. Geographic knowledge building from unstructured web sources starts with web document foraging during which the quantity, scope and diversity of web-based information create incredible cognitive burdens on an analyst’s or researcher’s ability to judge information relevancy. Determining information relevancy is ultimately a process of sensemaking. In this paper, we present our research on visually supporting web document foraging and sensemaking. In particular, we present the Sense-of-Place (SensePlace) analytic environment. The scientific goal of SensePlace is to visually and computationally support analyst sensemaking with text artifacts that have potential place, time, and thematic relevance to an analytical problem through identification and visual highlighting of named entities (people, places, times, and organizations) in documents, automated inference to determine document relevance using stored knowledge, and a visual interface with coupled geographic map, timeline, and concept graph displays that are used to contextualize the contexts of potentially relevant documents. We present the results of a case study analysis using SensePlace to uncover potential population migration, geopolitical, and other infectious disease dynamics drivers for measles and other epidemics in Niger. Our analysis allowed us to demonstrate how our approach can support analysis of complex situations along (a) multi-scale geographic dimensions (i.e., vaccine coverage areas), (b) temporal dimensions (i.e., seasonal population movement and migrations), and (c) diverse thematic dimensions (effects of political upheaval, food security, transient movement, etc.).     

The theatre through the computer

There is a long history of the theatre being used with educational purposes. Now the evolution of multimedia resources provide an opportunity to implement theatre through the computer. Although software for the production of multimedia stories exist, they give little attention to the necessary interface aspects required for a virtual theatre implementation. The objective of this work is to present the Theatre in the Computer (TC); software especially developed for the education of children. This software can be used to produce and to distribute plays through the Internet. The educational possibilities of TC are discussed here.     

Scalable growth in IT-enabled service provisioning: a sensemaking perspective

Vendors of IT-enabled services must address equivocal and changing requirements from diverse customers while simultaneously making a profit. However, our knowledge of how these organizations can achieve the necessary scalability is limited. Against this backdrop, we leverage organizational sensemaking to investigate how a large vendor attempted to create a scalable service infrastructure through three sequential strategies. This in-depth case study reveals key factors that challenged the efficacy of each strategy. First, addressing equivocality through structural separation exacerbated the organization’s challenges because of misaligned collective identities between business units. Second, reducing equivocality through market segmentation proved to be inadequate because individual-level cognitive constraints shaped pre-packaged solutions that lacked functionality. Third, responding to equivocality through service modularization was challenged due to lack of social interaction about standardization of component interfaces, system and process redundancies, and inflexible process architectures. We offer a detailed analysis of these strategies and discuss implications in relation to theory and practice.     

Metaphors in managerial and employee sensemaking in an information systems project

This longitudinal study looks at the metaphors used in a public sector information systems development project from the perspective of cognitive metaphor theory (Lakoff & Johnson, 1980 ). We examine the use of metaphors by project team members, including representatives of the users, software developers and the managers guiding the project work. The findings indicate that project team members and managers use a rich set of metaphors to make sense of the project and the records management system they are working on. Notably, distinct sets of metaphors are used in different project phases and among the project personnel and management. As the differences in the metaphors also coincide with key events in the trajectory of the project, we contend that metaphors have significant power in sensemaking, influencing action and project outcomes. In particular, we find that in highly ambiguous, knowledge‐intensive situations, metaphor use with unclear intentions and purpose hinders learning and creates more chaos than order. From a practical perspective, our study highlights the relevance of metaphor use for project management. We suggest that intentional selection of metaphors by management could be beneficial for many complex information systems projects. © 2016 John Wiley & Sons Ltd     

Heart rates of surgeons in theatre

Abstract

The heart rates often surgeons were measured during work, leisure and sleep over 4 × 24 hour periods. Oxygen consumption was measured while the surgeons were Operating; the environmental conditions in the operating theatres were monitored. In addition, each surgeon performed two multi-staged exercise tests to ascertain the oxygen-consumption/hcart-rate relationship. The findings were that oxygen consumption was rather low (0 26-0.411min^?1) during operations, heart rates during operating were commensurate with the oxygen consumption, and the additional factors of arm work and isometric contractions, suggesting that little of the heart rate during operating resulted from mental stress.