Etude de l’impact des nouvelles technologies sur les stratégies opératoires des chirurgiens par l’analyse des communications sur le terrain

peer reviewedThis study aimed to analyse the impact of the introduction of new technologies in the complex and dynamic field of surgery according to the expertise. The medical sector is one of the most investigated in ergonomics and work psychology studies. Although the study of this phenomenon is not new, our purpose is relevant because of the rapid introduction of new technology in surgery (with very few studies on its organisational impact), its implication for surgeon’s training and the risks for the patient. Furthermore, our conclusions might be extended to other complex work situations. Surgery has considerably evolved and a lot of interventions are now performed by laparoscopy: in this procedure, a camera and the instruments are introduced into very small incisions in the skin and surgeons guide their movements by watching a 2D screen. This technique involves some disadvantages (principally, a 2D view and instruments with low dexterity) that are now removed by a new robotic system (Da Vinci Robotic System). Nevertheless, if this new system offers some essential advantages, it provokes many changes and new constraints in the way to operate and in the role and status of all actors: with this system, the surgeon is isolated and operates with a 3D view and high dexterity instruments while the rest of the team has to manage with a 2D view and instruments with very low dexterity. By all these aspects, the new system may generate different situational references for each actor and might be at the origin of new human errors. In this context, we evaluated the adaptation processes and the changes produced by this system using the communication analysis. In a first field study, we evaluated the impact of its introduction on short-term adaptation processes by a comparison of the communications in classical laparoscopy with the communications with the robotic system. In a second study, we analysed the difference between novices and experts using this system in order to emphasize the long-term adaptation evolution and the steps in the training with this system. Our results showed that the robotic system was more complex and necessitates a long adaptation time when subjects were novices. This complexity led to an increase in the communications between the team members in order to construct common action references despite of diverse quality images. Our data from the second study showed that all categories of communication do not have the same role in the adaptation process and that their occurrence varied according to the expertise level. Indeed, the novice-expert comparison allowed us to emphasize which communications were necessary in the learning phase and which communications were permanent and thus useful for experts too. We showed that the communications might be distinguished in two main types: (1) some were necessary for the learning and disappeared with expertise, these communications concerned the spatial orientation and manipulation categories, (2) while communications about order and confirmation did not decrease and seemed to be indispensable for an accurate cooperative work and common situation awareness. These communications show an accommodation process that transforms the activity by a work division. This last finding is relevant because robotic surgery is similar to the remote control situations in which communications constitute the only way to construct and keep a same situational reference for all involved actors

Psychological interventions influence patients' attitudes and beliefs about their chronic pain.

Background: Patients' changing attitudes and beliefs about pain are considered as improvements in the treatment of chronic pain. Multidisciplinary approaches to pain allow modifications of coping strategies of patients, from passive to active. Methods: We investigate how two therapeutic treatments impact patients' attitudes and beliefs regarding pain, as measured with the Survey of Pain Attitudes (SOPA). We allocated 415 patients with chronic pain either to psychoeducation combined with physiotherapy, self-hypnosis combined with self-care learning, or to control groups. Pain intensity, global impression of change, and beliefs and attitudes regarding pain were assessed before and after treatment. Results: Our main results showed a significant effect of psychoeducation/physiotherapy on control, harm, and medical cure SOPA subscales; and a significant effect of self-hypnosis/self-care on control, disability and medical cure subscales. Correlation results showed that pain perception was negatively associated with control, while positively associated with disability, and a belief that hurt signifies harm. Patients' impression of improvement was associated with greater control, lower disability, and lower belief that hurt signifies harm. Conclusions: The present study showed that self-hypnosis/self-care and psychoeducation/physiotherapy were associated with patients' evolution of coping strategies from passive to active, allowing them to reduce pain perception and improve their global impression of treatment effectiveness. Keywords: Chronic pain, Hypnosis, Psychoeducation, Coping, Pain belief

Hypnose et recherche : que se passe-t-il à Liège ?

Depuis quelques années, il est de plus en plus clair que l’hypnose présente un champ de recherche fondamentale et appliquée important. L’Hôpital Universitaire (CHU) ainsi que l’Université de Liège font partie des centres pionniers s’intéressant à l’étude de l’hypnose en tant qu’objet de recherche. Ces équipes ont pour objectif de comprendre les bases neurophysiologiques de la conscience humaine, les effets de la suggestion et les dimensions biopsychologiques qui en découlent pour pouvoir intégrer cet outil au mieux dans la pratique médicale à Liège

Etude de l'impact de techniques non-pharmacologiques (auto-hypnose/auto-bienveillance) sur les plaintes cognitives de patients atteints d'un cancer

Cancer diagnosis generates a number of physical, psychological and cognitive impairments such as memory, attentional and informational processing deficits that can undermine patients’ quality of life (QoL). Self-hypnosis combined to self-care learning have been used in the past years to treat these symptoms, at the moment of diagnosis, during and/or after the cancer treatments. However, the impact of self-hypnosis/self-care upon cognitive difficulties has not been investigated yet.The aim of this study is to better understand the impact of self hypnosis/self-care upon the cognitive functions by means of the Functional Assessment of Cancer Therapy-Cognitive Function1 (FACT-COG).Etude de l'impact de techniques non-pharmacologiques (autohypnose/ auto-bienveillance) sur le bien-être, les plaintes cognitives et le retour/maintien au travail de personnes atteintes d'un cance

The use of simulators as training tools

peer reviewe

Integrating cognitive and collective aspects of work in evaluating technology

Ergonomic criteria are receiving increasing attention from designers but their applications do not ensure that technology matches the user's abilities, needs, and work constraints. In this paper, we used two series of studies conducted in the healthcare system to illustrate how important work analysis is in evaluating new technology in order to identify critical dimensions of work and anticipate the impact of the devices on these dimensions: one looking at a new automatic drug device for anesthetists and one at a new robotic surgery system. Given the results, we developed a methodology for evaluation of new technology in complex systems. The aim is to insist to assess the impacts of technology on all the dimensions of work: technical, performance, cognitive, organizational, and economic. Which dimensions and criteria will be developed more in detail depends on the results of the work analysis