The multimodal world of medical monitoring displays

A vision of the future of intraoperative monitoring for anesthesia is presented-a multimodal world based on advanced sensing capabilities. I explore progress towards this vision, outlining the general nature of the anesthetist's monitoring task and the dangers of attentional capture. Research in attention indicates different kinds of attentional control, such as endogenous and exogenous orienting, which are critical to how awareness of patient state is maintained, but which may work differently across different modalities. Four kinds of medical monitoring displays are surveyed: (1) integrated visual displays, (2) head-mounted displays, (3) advanced auditory displays and (4) auditory alarms. Achievements and challenges in each area are outlined. In future research, we should focus more clearly on identifying anesthetists' information needs and we should develop models of attention in different modalities and across different modalities that are more capable of guiding design. (c) 2006 Elsevier Ltd. All rights reserved.

Managing healthcare quality using logical framework analysis

Purpose - The purpose of this paper is to develop an integrated quality management model that identifies problems, suggests solutions, develops a framework for implementation and helps to evaluate dynamically healthcare service performance. Design/methodology/approach - This study used the logical framework analysis (LFA) to improve the performance of healthcare service processes. LFA has three major steps - problems identification, solution derivation, and formation of a planning matrix for implementation. LFA has been applied in a case-study environment to three acute healthcare services (Operating Room utilisation, Accident and Emergency, and Intensive Care) in order to demonstrate its effectiveness. Findings - The paper finds that LFA is an effective method of quality management of hospital-based healthcare services. Research limitations/implications - This study shows LFA application in three service processes in one hospital. This very limited population sample needs to be extended. Practical implications - The proposed model can be implemented in hospital-based healthcare services in order to improve performance. It may also be applied to other services. Originality/value - Quality improvement in healthcare services is a complex and multi-dimensional task. Although various quality management tools are routinely deployed for identifying quality issues in healthcare delivery, they are not without flaws. There is an absence of an integrated approach, which can identify and analyse issues, provide solutions to resolve those issues, develop a project management framework to implement those solutions. This study introduces an integrated and uniform quality management tool for healthcare services. © Emerald Group Publishing Limited.

Integrated approach to healthcare quality management:a case study

Purpose - The purpose of the paper is to develop an integrated quality management model, which identifies problems, suggests solutions, develops a framework for implementation and helps evaluate performance of health care services dynamically. Design/methodology/approach - This paper uses logical framework analysis (LFA), a matrix approach to project planning for managing quality. This has been applied to three acute healthcare services (Operating room utilization, Accident and emergency, and Intensive care) in order to demonstrate its effectiveness. Findings - The paper finds that LFA is an effective method of quality management of hospital-based healthcare services. Research limitations/implications - This paper shows LFA application in three service processes in one hospital. However, ideally this is required to be tested in several hospitals and other services as well. Practical implications - In the paper the proposed model can be practised in hospital-based healthcare services for improving performance. Originality/value - The paper shows that quality improvement in healthcare services is a complex and multi-dimensional task. Although various quality management tools are routinely deployed for identifying quality issues in health care delivery and corrective measures are taken for superior performance, there is an absence of an integrated approach, which can identify and analyze issues, provide solutions to resolve those issues, develop a project management framework (planning, monitoring, and evaluating) to implement those solutions in order to improve process performance. This study introduces an integrated and uniform quality management tool. It integrates operations with organizational strategies. © Emerald Group Publishing Limited.

Managing healthcare technology in quality management framework

Healthcare services available these days deploy high technology to satisfy both internal and external customers by continuously improving various quality parameters. Quality improvement in healthcare services is a complex and multidimensional task. Although various quality management tools are routinely deployed for identifying quality issues in healthcare delivery, there is absence of an integrated approach, which can identify and analyse issues, provide solutions to resolve those issues and develop a project management framework to implement and evaluate those solutions. This study introduces an integrated and uniform quality management framework for healthcare services. This study uses the Logical Framework Analysis (LFA) to improve the performance of healthcare services. LFA has three major steps - problem identification, solution derivation and formation of a planning matrix for implementation and evaluation. LFA has been applied in a case study environment to three acute healthcare services (Operating Room (OR) utilisation, Accident and Emergency (A&E) and intensive care) in order to demonstrate its effectiveness. Copyright © 2007 Inderscience Enterprises Ltd.

Multimodal Man-machine Interface and Virtual Reality for Assistive Medical Systems

The results of research the intelligence multimodal man-machine interface and virtual reality means for assistive medical systems including computers and mechatronic systems (robots) are discussed. The gesture translation for disability peoples, the learning-by-showing technology and virtual operating room with 3D visualization are presented in this report and were announced at International exhibition "Intelligent and Adaptive Robots–2005".

A smart surgical robotic for cochlear implantation

In this paper a surgical robotic device for cochlear implantation surgery is described that is able to discriminate tissue interfaces and other controlling parameters ahead of a drill tip. The advantage in surgery is that tissues at interfaces can be preserved. The smart tool is able to control interaction with respect to the flexing tissue to avoid penetration control the extent of protrusion with respect to the real-time position of the tissue. To interpret drilling conditions, and conditions leading up to breakthrough at a tissue interface, the sensing scheme used enables discrimination between the variety of conditions posed in the drilling environment. The result is a robust fully autonomous system able to respond to tissue type, behaviour and deflection in real-time. The paper describes the robotic tool that has been designed to be used in the surgical environment where it has been used in the operating room.

Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)

© 2014, Canadian Anesthesiologists' Society.Optimal perioperative fluid management is an important component of Enhanced Recovery After Surgery (ERAS) pathways. Fluid management within ERAS should be viewed as a continuum through the preoperative, intraoperative, and postoperative phases. Each phase is important for improving patient outcomes, and suboptimal care in one phase can undermine best practice within the rest of the ERAS pathway. The goal of preoperative fluid management is for the patient to arrive in the operating room in a hydrated and euvolemic state. To achieve this, prolonged fasting is not recommended, and routine mechanical bowel preparation should be avoided. Patients should be encouraged to ingest a clear carbohydrate drink two to three hours before surgery. The goals of intraoperative fluid management are to maintain central euvolemia and to avoid excess salt and water. To achieve this, patients undergoing surgery within an enhanced recovery protocol should have an individualized fluid management plan. As part of this plan, excess crystalloid should be avoided in all patients. For low-risk patients undergoing low-risk surgery, a “zero-balance” approach might be sufficient. In addition, for most patients undergoing major surgery, individualized goal-directed fluid therapy (GDFT) is recommended. Ultimately, however, the additional benefit of GDFT should be determined based on surgical and patient risk factors. Postoperatively, once fluid intake is established, intravenous fluid administration can be discontinued and restarted only if clinically indicated. In the absence of other concerns, detrimental postoperative fluid overload is not justified and “permissive oliguria” could be tolerated.

A Virtual Joystick as a Novel Interaction Modality for Surgeon-Computer Interaction During Computer-Assisted Surgical Procedures

Interacting with a computer system in the operating room (OR) can be a frustrating experience for a surgeon, who currently has to verbally delegate to an assistant every computer interaction task. This indirect mode of interaction is time consuming, error prone and can lead to poor usability of OR computer systems. This thesis describes the design and evaluation of a joystick-like device that allows direct surgeon control of the computer in the OR. The device was tested extensively in comparison to a mouse and delegated dictation with seven surgeons, eleven residents, and five graduate students. The device contains no electronic parts, is easy to use, is unobtrusive, has no physical connection to the computer and makes use of an existing tool in the OR. We performed a user study to determine its effectiveness in allowing a user to perform all the tasks they would be expected to perform on an OR computer system during a computer-assisted surgery. Dictation was found to be superior to the joystick in qualitative measures, but the joystick was preferred over dictation in user satisfaction responses. The mouse outperformed both joystick and dictation, but it is not a readily accepted modality in the OR.

Algoritmi Euristici per la Schedulazione degli Interventi nel Blocco Operatorio

Questa tesi riguarda il problema della schedulazione degli interventi nel blocco operatorio di un presidio ospedaliero, noto anche come Operating Theatre Planning & Scheduling. Il blocco operatorio è la struttura che eroga servizi a più alto impatto sui costi di un presidio ospedaliero ed è legato ad attività ad alto rischio. E' quindi fondamentale gestire in modo ottimale questa risorsa. In questa tesi, si considera come caso studio l'applicazione reale di un presidio ospedaliero dell'Emilia Romagna con un orizzonte temporale di una settimana, ovvero la cosiddetta programmazione operativa. L'obiettivo è quello di ottenere un utilizzo efficiente del blocco operatorio, garantendo al contempo la priorità agli interventi più urgenti. Data la complessità del problema, vengono proposti algoritmi euristici che permettano di ottenere buone soluzioni in tempi di calcolo ridotti. Studi precedenti hanno infatti evidenziato la difficoltà di trovare soluzioni ottime al problema, mediante l'utilizzo di solver commerciali per modelli di Programmazione Lineare Intera, senza introdurre ipotesi semplificative. Sono stati elaborati tre algoritmi euristici costruttivi di tipo multi-start che permettono di generare soluzioni ammissibili con diverse caratteristiche. Gli algoritmi si differenziano principalmente per le modalità con cui collocano gli interventi nel tempo disponibile delle risorse (induction room, operating room, recovery room), cercando di migliorarne l’utilizzazione e dando priorità ai pazienti più urgenti. Gli algoritmi sono stati implementati utilizzando il linguaggio JAVA e sono stati testati su istanze realistiche fornite dal presidio ospedaliero. I risultati hanno evidenziato un alto grado di utilizzazione delle sale operatorie, un fattore molto rilevante per una ottimale gestione del blocco operatorio. E' stata, infine, svolta un'analisi di sensitività alla variabilità delle durate.

Vacuum-assisted closure treatment of leg skin necrosis after angiographic embolization of a giant plexiform neurofibroma

Type 1 neurofibromatosis is a relatively common inherited disease of the nervous system, with a frequency of almost 1 in 3000. It is associated with neurofibromas of various sites. Our case report is about the surgical management of a giant neurofibroma of the right gluteal fold in a 46-year-old male with NF1. The patient presented with increasing edema and accelerated growth of the mass; he underwent percutaneous embolization of lesion vessels that induced necrosis of the neurofibroma. The patient was taken to the operating room, where surgical resection of the bulk of the lesion was undertaken. The postoperative course was complicated by delayed wound closure managed with antibiotics and vacuum-assisted wound closure. Giant neurofibromas similar to this tumor require complex preoperative, intraoperative and postoperative management strategies. Surgical debulk is best managed with preoperative percutaneous embolization that help to avoid surgical bleeding. Postoperative delayed wound closure was managed with the application of negative pressure in a closed environment that triggers granulation and tissue formation.

Handover between anaesthetists and post anaesthetic care unit nursing staff using ISBAR principles: a quality improvement study

A structured approach to communication between health care professionals contains introduction/identification; situation; background; assessment and request/recommendation (ISBAR). ISBAR was introduced into the post-anaesthetic care unit (PACU) of a large Victorian health service in 2013. The aim of this study was to measure the effect of an education program on ISBAR compliance. 

Conduction bottleneck in silicon nanochain single electron transistors operating at room temperature

Single electron transistors are fabricated on single Si nanochains, synthesised by thermal evaporation of SiO solid sources. The nanochains consist of one-dimensional arrays of ~10nm Si nanocrystals, separated by SiO 2 regions. At 300 K, strong Coulomb staircases are seen in the drain-source current-voltage (I ds-V ds) characteristics, and single-electron oscillations are seen in the drain-source current-gate voltage (I ds-V ds) characteristics. From 300-20 K, a large increase in the Coulomb blockade region is observed. The characteristics are explained using singleelectron Monte Carlo simulation, where an inhomogeneous multiple tunnel junction represents a nanochain. Any reduction in capacitance at a nanocrystal well within the nanochain creates a conduction " bottleneck", suppressing current at low voltage and improving the Coulomb staircase. The single-electron charging energy at such an island can be very high, ~20k BT at 300 K. © 2012 The Japan Society of Applied Physics.

8 mu m strain-compensated quantum cascade laser operating at room temperature

We report on the material growth and device performance characterization of a strain-compensated In0.54Ga0.46As/In0.51Al0.49As quantum cascade laser at lambda similar to 8 mu m. For 2 mu s pulse at a 5 kHz repetition rate, laser action is achieved up to room temperature (30 degrees C). The tuning coefficient d lambda/dT is 1.37 nm K-1 between 83 K and 163 K and 0.60 nm K-1 in the range from 183 K to 303 K. The peak output power is reported to be similar to 11.3 mW per facet at 293 K and the corresponding threshold current density is 5.69 kA cm(-2).

Realization of quantum cascade laser operating at room temperature

X-ray diffraction, as an effective probe and simple method, is used to ascertain the precise control of the epilayer thickness and composition. Intersubband absorption from the whole structure of the QC laser is used to monitor the wavelength of the QC laser and the material quality. Path for growth of high-quality InP-based InGaAs/InAlAs quantum cascade laser material is realized. The absorption between two quantized energy levels is achieved at similar to4.7 mum. Room temperature laser action is achieved at lambda approximate to 5.1 - 5.2 mum. For some devices, if the peak output power is kept at 2 mW, quasi-continuous wave operation at room temperature can persist for more than I It. (C) 2002 Elsevier Science B.V. All rights reserved.