Análise de desconforto térmico local em ambientes cirúrgicos com o uso de manequim, medição de variáveis ambientais e avaliação subjetiva

Na avaliação de conforto térmico em ambientes interiores não basta analisar as condições de conforto para o corpo como um todo, pois há a necessidade de se analisar também as condições de desconforto térmico local. Em ambientes complexos, tais como os ambientes cirúrgicos, onde os membros da equipe cirúrgica ocupam diferentes posições no ambiente e desempenham atividades distintas, a análise de condições de desconforto térmico local torna-se ainda mais premente. No presente trabalho foram analisadas condições de desconforto térmico local devido a assimetrias da temperatura radiante, diferença vertical de temperatura do ar e risco de correntes de ar utilizando manequim, medição de variáveis ambientais e avaliação subjetiva. Resultados da avaliação subjetiva mostraram níveis de insatisfação de até 35 % dos anestesistas e enfermeiros com correntes de ar e de até 85% dos cirurgiões com o calor do foco cirúrgico. Resultados similares foram obtidos a partir da medição de variáveis ambientais e com o uso de manequim. Estes resultados ressaltam ainda mais a grande dificuldade de se prover condições de conforto térmico neste tipo de ambiente. Entretanto, a utilização de diferentes ferramentas de análise pode auxiliar na busca de se prover condições de conforto térmico as melhores possíveis para todos os membros da equipe cirúrgica.

Case Study: Interacting with Volumetric Medical Datasets in Networked CAVE Environments

Virtual Reality (VR) is widely used in visualizing medical datasets. This interest has emerged due to the usefulness of its techniques and features. Such features include immersion, collaboration, and interactivity. In a medical visualization context, immersion is important, because it allows users to interact directly and closelywith detailed structures in medical datasets. Collaboration on the other hand is beneficial, because it gives medical practitioners the chance to share their expertise and offer feedback and advice in a more effective and intuitive approach. Interactivity is crucial in medical visualization and simulation systems, because responsiveand instantaneous actions are key attributes in applications, such as surgical simulations. In this paper we present a case study that investigates the use of VR in a collaborative networked CAVE environment from a medical volumetric visualization perspective. The study will present a networked CAVE application, which has been built to visualize and interact with volumetric datasets. We will summarize the advantages of such an application and the potential benefits of our system. We also will describe the aspects related to this application area and the relevant issues of such implementations.

Simulator training on pulsatile vascular models significantly improves surgical skills and the quality of carotid patch plasty

Vascular surgeons perform numerous highly sophisticated and delicate procedures. Due to restrictions in training time and the advent of endovascular techniques, new concepts including alternative environments for training and assessment of surgical skills are required. Over the past decade, training on simulators and synthetic models has become more sophisticated and lifelike. This study was designed to evaluate the impact of a 3-day intense training course in open vascular surgery on both specific and global vascular surgical skills.

Augmented environments for the targeting of hepatic lesions during image-guided robotic liver surgery

BACKGROUND Stereotactic navigation technology can enhance guidance during surgery and enable the precise reproduction of planned surgical strategies. Currently, specific systems (such as the CAS-One system) are available for instrument guidance in open liver surgery. This study aims to evaluate the implementation of such a system for the targeting of hepatic tumors during robotic liver surgery. MATERIAL AND METHODS Optical tracking references were attached to one of the robotic instruments and to the robotic endoscopic camera. After instrument and video calibration and patient-to-image registration, a virtual model of the tracked instrument and the available three-dimensional images of the liver were displayed directly within the robotic console, superimposed onto the endoscopic video image. An additional superimposed targeting viewer allowed for the visualization of the target tumor, relative to the tip of the instrument, for an assessment of the distance between the tumor and the tool for the realization of safe resection margins. RESULTS Two cirrhotic patients underwent robotic navigated atypical hepatic resections for hepatocellular carcinoma. The augmented endoscopic view allowed for the definition of an accurate resection margin around the tumor. The overlay of reconstructed three-dimensional models was also used during parenchymal transection for the identification of vascular and biliary structures. Operative times were 240 min in the first case and 300 min in the second. There were no intraoperative complications. CONCLUSIONS The da Vinci Surgical System provided an excellent platform for image-guided liver surgery with a stable optic and instrumentation. Robotic image guidance might improve the surgeon's orientation during the operation and increase accuracy in tumor resection. Further developments of this technological combination are needed to deal with organ deformation during surgery.

Correcting for bias when estimating the cost of hospital-acquired infection : an analysis of lower respiratory tract infections in non-surgical patients

Hospital acquired infections (HAI) are costly but many are avoidable. Evaluating prevention programmes requires data on their costs and benefits. Estimating the actual costs of HAI (a measure of the cost savings due to prevention) is difficult as HAI changes cost by extending patient length of stay, yet, length of stay is a major risk factor for HAI. This endogeneity bias can confound attempts to measure accurately the cost of HAI. We propose a two-stage instrumental variables estimation strategy that explicitly controls for the endogeneity between risk of HAI and length of stay. We find that a 10% reduction in ex ante risk of HAI results in an expected savings of £693 ($US 984).

Skill development for innovative procurement environments in construction

The construction industry should be a priority to all governments because it impacts economically and socially on all citizens. Sector turnover in industrialised economies typically averages 8-12% of GDP. Further, construction is critical to economic growth. Recent Australian studies estimate that a 10% gain in efficiency in construction translates to a 2.5% increase in GDP Inefficiencies in the Australian construction industry have been identified by a number of recent studies modelling the building process. They have identified potential savings in time of between 25% and 40% by reducing non-value added steps in the process. A culture of reform is now emerging in the industry – one in which alternate forms of project delivery are being trialed. Government and industry have identified Alliance Contracting as a means to increase efficiency in the construction industry as part of a new innovative procurement environment. Alliance contracting requires parties to form relationships and work cooperatively to provide a more complete service. This is a significant cultural change for the construction industry, with its well-known adversarial record in traditional contracting. Alliance contracts offer enormous potential benefits, but the Australian construction industry needs to develop new skills to effectively participate in the new relationship environment. This paper describes a collaborative project identifying skill needs for clients and construction professionals to more effectively participate in an increasingly sophisticated international procurement environment. The aim of identifying these skill needs is to assist industry, government, and skill developers to prepare the Australian construction workforce for the future. The collaborating Australian team has been fortunate to secure the Australian National Museum in Canberra as its live case study. The Acton Peninsula Development is the first major building development in the world awarded on the basis of a joint alliance contract.