Abdominal surgery process modeling frameworkfor simulation using spreadsheets

We provide a continuation of the existing Activity Table Modeling methodology with a modu-lar spreadsheets simulation. The simulation model developed is comprised of 28 modelingelements for the abdominal surgery cycle process. The simulation of a two-week patientflow in an abdominal clinic with 75 beds demonstrates the applicability of the methodol-ogy. The simulation does not include macros, thus programming experience is not essentialfor replication or upgrading the model. Unlike the existing methods, the proposed solu-tion employs a modular approach for modeling the activities that ensures better readability,the possibility of easily upgrading the model with other activities, and its easy extensionand connectives with other similar models. We propose a first-in-first-served approach forsimulation of servicing multiple patients. The uncertain time duration of the activities ismodeled using the function “rand()”. The patients movements from one activity to the nextone is tracked with nested “if()” functions, thus allowing easy re-creation of the processwithout the need of complex programming

Applicability of advanced planning and scheduling on surgical blocks

An assessment of the suitability of Advanced Planning and Scheduling software on operating rooms and materials centre is carried out. From data gathering and process mapping a scheduling system is implemented and compared to a private hospital’s approach and information system. A method for compromising schedule assertiveness and productivity is proposed and tested on a simulation setting. Final remarks contend that Advanced Planning and Scheduling is a viable tool for surgical block scheduling on the studied hospital and may improve synchronicity with materials centre, sophisticate rescheduling and enable scenario comparison through scheduling simulation

Development of spreadsheet simulation models of gas cylinders inventory management

The solution of the problem of managing the inventory of an enterprise whose activities are related to the purchase and sale of gas cylinders is considered. To solve the problem, it was necessary to investigate and choose the best inventory management strategy that provides the minimum value of the average inventory balance in the warehouse with the established upper limit of the average deficit. The problem of determining the best strategy is presented as a discrete programming problem, the required variables of which depend on the replenishment method. With a periodic replenishment strategy, the controlled variables are the volume of the delivery line and the delivery interval, with a threshold one, the minimum inventory level and the volume of the delivery line. Let’s also consider replenishment with a predicted inventory level, where the delivery level and the minimum inventory level are used as control variables. Three tabular simulation models with a given delivery time and random demand are proposed. Using the Chi-square test, it was found that the quantity demanded has a normal distribution law. By carrying out computational experiments, the optimal values of controlled variables were determined. The best objective function values were obtained using a model with a predicted inventory level and a threshold replenishment strategy. Experiments conducted on the basis of historical data have shown the advantage of the two model strategies compared to the strategy currently used in the enterprise. The use of a model with a predictable inventory level would reduce the average inventory balance by 46 %, and, consequently, save working capital. The results of the study can be useful for managers of enterprises whose activities are related to inventory managemen

Deliberate Practice of IV Medication Procedures by Student Nurses: Feasibility, Acceptability, and Preliminary Outcomes: A Dissertation

Background: Medication errors continue to be one of the most prevalent problems in healthcare related to patient safety, often resulting in injury or death, with higher incidences of error occurring with intravenous medications. The purpose of this study was to explore the use of deliberate practice (DP) with second-degree nursing students in developing and maintaining fundamental intravenous medication management practices required for safe practice. Method: This was a feasibility study using a two-arm, single-blind, randomized controlled trial design. Vygotsky’s Zone of Proximal Development model was used to explore the use of a DP teaching intervention to achieve competency in skills associated with safe IV medication management. A convenience sample of first-year, first-semester nursing students enrolled in an accelerated graduate program (N = 32) were invited to participate; 19 enrolled, and 12 completed the study. Students (n = 12) received three 30- minute one-on-one practice sessions at 2-week intervals with an expert nurse (the intervention group focused on IV skills and the control group on skills unrelated to IVs). Pre- and post-intervention instruments tested participants’ confidence with IV management and safety skills. The primary outcome was their ability to safely administer and monitor IV medications during a 20-minute videotaped medication administration scenario. Results: Low recruitment (19 of 32) and high attrition (37%) were observed. Participants completing the study (5 in the intervention group and 7 in the control group) reported that the time required to attend the sessions was not burdensome (91.7%); time allotted was adequate (100%); 100% reported positive experience; 91.7% found the DP sessions essential to learning. Change in confidence scores for IV skills were not significant (P = 0.210), but were higher in the intervention group (2.97–4.14 = 1.50 change) compared to the control group (2.71–3.77 = 1.04 change). Significant differences were found in overall medication administration skills between the control and intervention groups (t [-2.302], p = 0.044) in favor of the intervention group, particularly with medication preparation skills (p = 0.039). Overall raw scores were low in both groups; only 16–42 (26%–70%) of the total 60 steps required for safe practice were completed. Participants scored lowest in the evaluation phase, with all participants performing less than 50% of the 14 steps. Conclusion: Even though participant satisfaction was high, significant attrition occurred. Students reported the DP sessions to be beneficial and they felt more confident in performing skills, but three 30-minute sessions (90 minutes) were not adequate to develop, maintain, or refine all the IV-management skills associated with safe medication practices. Determining the length and duration of DP sessions as well as comparing the efficacy of DP sessions between individual and group sessions with varying doses and frequencies is needed to advance our understanding of using DP within nursing education

Development of a force-feedback laparoscopic surgery simulator

Thesis (S.M.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 1999.Includes bibliographical references (p. 77-78).The work presented here addressed the development of an electro-mechanical force-feedback device to provide more realistic and complete sensations to a laparoscopic surgery simulator than currently available. A survey of the issues surrounding haptic (touch) displays and training for laparoscopic or "keyhole" procedures was performed. A number of primary and secondary sources including surgeon consultation , operating room observations, and task analyses were used to accumulate a list of needs. Subsequent requirements analysis translated these into a set of specifications for the kinematics, dynamics and actuators, and configuration of the device. These suggested a design with five actuated axes (pitch and yaw about the entrance to the abdomen, insertion, rotation about the tool axis, and gripper feedback) amenable to a configuration including two actuated tools in a lifelike torso. These specifications were the basis for the generation and selection of design concepts. The PHANTOM haptic interface from Sensable Devices was chosen from among a number of existing devices and original designs to actuate the pitch, yaw, and insertion degrees of freedom. A separate end effector actuator was specified to supply feedback to the handle rotation and gripper. Mechanisms were proposed for each of these axes; a linear cable capstan was selected for the gripper and a cable capstan/drum for the rotation. The kinematics, bearings, transmissions, and user interface for both axes were designed in detail, and first- and second generation prototypes were built. The finished devices were integrated with the PHANTOM hardware, electronics, and software. Performance and design evaluations were performed, and plans for future device improvements and user studies were outlined.by Ela Ben-Ur.S.M

The Impact of Debriefing for Meaningful Learning on Knowledge Development, Knowledge Retention, and Knowledge Application Among Baccalaureate Nursing Students

Debriefing offers an opportunity to ensure that students can master critical components of nursing that they might not otherwise learn and to remove epistemological roadblocks to knowledge acquisition. Within this study, Debriefing for Meaningful Learning (DML), a theoretically-derived, evidence based and structured debriefing method, was used to explore student’s knowledge acquisition, knowledge retention, and application of knowledge from one patient situation to a different, yet parallel, situation. This quasi-experimental pretest, posttest study explored the impact of the type of debriefing method on the development of knowledge, knowledge retention, and knowledge application. Eighty-two prelicensure baccalaureate nursing students, enrolled in an adult health (medical-surgical nursing) theory course, participated in this study testing the use of Debriefing for Meaningful Learning compared with customary debriefing. The outcomes of this study revealed a significant difference in knowledge acquisition, knowledge retention, and knowledge application with DML compared to customary debriefing. These findings are significant for nurse educators using simulation to potentiate clinical learning in prelicensure students and add to the growing evidence regarding the impact of debriefing

Structural and Care Process Improvement of Ward-based Postoperative Care to Optimise Surgical Outcomes

Much of the variation seen in surgical outcomes can be explained by differences in the quality of management of post-operative complications and ward-based care. The surgical ward round (WR) is critical to determining post-operative care and serves as the primary point of interaction between clinician and patient. Despite this, it is an area not subject to training or assessment at present. This thesis demonstrates the high degree of variability which exists in the conduct of WRs. It establishes the link between suboptimal patient assessment and increased risk of preventable post-operative complications. These place patients not only at risk of short-term deterioration, but result in reduced long-term survival as well. In order to quantify WR quality, a novel assessment tool has been developed and validated within a simulated environment. Ward simulation is a nascent branch of simulation which has been only preliminarily explored to date. A simulation environment was developed to take advantage of the known benefits of simulation such as controllability, reproducibility, and recordability, whilst maintaining a high level of fidelity and realism. An evidence-based curriculum for surgical WR training was designed and implemented in a simulation-based course. By focusing on structured generic processes of patient assessment and management, this resulted in significant improvement of trainee performance in routine WRs. To ensure standardised and optimum management of specific conditions, checklists have proven themselves to be of great value in a number of surgical and medical disciplines. Surgical complications are common, yet their management often suboptimal. As part of this thesis, evidence-based protocols for the management of the six most common complications were designed and validated. The implementation of these in a simulation-based randomised, controlled trial has resulted in greatly increased adherence to evidence-based standards of care, as well as improved communication and clinician performance. This thesis explores the variance currently present in surgical ward rounds, and the potentially grave consequences of this for patient outcomes. To date, WRs have been one of the last areas of surgical care still dependent on the Halstedian principle of experiential learning alone. The tools have now been developed with which to assess, improve, and standardise critical structures and care processes in the assessment and management of the post-operative surgical patient. Future implementation of these and integration into surgical curricula will benefit clinician training, patient care, and surgical outcomes alike.Open Acces

Umjetna inteligencija i robotika kao pokretačka snaga modernog društva

In synergy with other technologies, the AI significantly accelerates the scientific and technological development of human society. New possibilities of the application of technological achievements are constantly opening up – in industry, healthcare and everyday life. AI-based robotics is the main driver of the present industrial revolution. Robots have already played an important role in production and changed the production economy over the past decade. New generations of smart robots, or smart technical systems in general, are turning to new applications, especially in service industries, medicine and home use. In the future, autonomous and mobile robots will be able to assist the elderly and immobile, help with household chores, act as caregivers and perform repetitive, tedious or dangerous jobs in nursing homes, hospitals, military environments, disaster sites and schools. The potential benefits are great, but they pose significant ethical challenges too. Our autonomy may be compromised and social interaction obstructed. Expanded use of robots can lead to reduced contact among people and possible restrictions on personal freedoms. Machines of these kinds shape the new world radically, leading to significant economic and cultural changes, creating both winners and losers on a global scale.U sinergiji s drugim tehnologijama AI značajno ubrzava znanstveni i tehnološki razvoj ljudskog društva. Neprestano se otvaraju nove mogućnosti primjene tehnoloških dostignuća, kako u industriji, zdravstvu tako i u svakodnevnom životu. Robotika temeljena na umjetnoj inteligenciji glavni je pokretač sadašnje industrijske revolucije. Roboti su već odigrali važnu ulogu u proizvodnji i promijenili proizvodnu ekonomiju tijekom posljednjih desetak godina. Nove generacije pametnih robota, ili općenito pametnih tehničkih sustava, okreću se novim primjenama, posebno u uslužnim djelatnostima, medicini i kućnoj uporabi. Autonomni i mobilni roboti u budućnosti će moći pomagati starijim i nepokretnim osobama, pomagati u kućanskim poslovima, djelovati kao njegovatelji i obavljati ponavljajuće, dosadne ili opasne poslove u staračkim domovima, bolnicama, vojnim okruženjima, mjestima katastrofe i školama. Potencijalne prednosti su velike, ali također predstavljaju značajne etičke izazove. Naša autonomija može biti ugrožena, a društvena interakcija opstruirana. Prošireno korištenje robota može dovesti do smanjenog kontakta među ljudima i mogućih ograničenja osobnih sloboda. Strojevi ove vrste oblikuju radikalno novi svijet, što dovodi do značajnih ekonomskih i kulturoloških promjena, stvarajući jednako pobjednike kao i gubitnike na globalnoj svjetskoj razini