Ergonomics in health care : working conditions in the operating theatre

Hospital management is often confronted with discussions concerning (re)building of the operating theatre. Criteria regarding working conditions and well-being of the staff cannot easily be set. In order to get more insight, relevant aspects were studied interdependently. These were climate, illumination, acoustics, ventilation of anaesthetic gases and concentration of bacteria and dust particles in the operating-room air. The influence of working postures and movements of the operating-room personnel on air quality is briefly characterized. Most measurements were performed during open-heart surgeries, although for some a simulation needed to be set up. Some remarkable results were found. Ventilation systems do not operate as was intended because of the heat production of the surgical team. Microcirculations originating thereof may cause high local concentrations of anaesthetic gases and heavily contaminated spots in the incision area . The hierarchical air pressure distribution in the ward is disturbed by the intense 'traffic'. The static and dynamic load on the surgical team can give rise to complaints. Unless precautions are taken, the indoor climate cannot be comfortable and safe for everybody at the same time. Monjtoring systems have to be developed to check the quality of ventilation systems, to visualize microcirculations with respect to bacteria and anaesthetic gases, and to synchronize all different registrations. Optimization of the working conditions concerned implies an indispensable co-operation between a variety of medical and technical disciplines that does not develop automatically

Horizons in extension

INTRODUCTION Over 10% of the research capacity of the Eindhoven University is directed towards the field of Biomedical and Health-Care Technology. Being a University of Technology this covers activities in which technical knowledge and skills are applied to problems in health-care and biology. These activities are multidisciplinary in nature an therefore require cooperation between a variety of medical and technical scientists, medical clinicians, and Medical Technology (MT)-Industries. Development, selection and management of projects in these fields must include an attention for ethical, economical, organizational, and political aspects as well. A multidisciplinary project is directed towards a synergetical combination of several sources of knowledge, skills and information. Dealing with these combining activities over a time span of 15 years has proved to be a very demanding task. Furthermore it always requires good insight in the main characteristics of these contributing sources, and a judgement about their possibilities, as well as their impossibilities. Structuring communication processes in multidisciplinary set ups, towards common goals, requires attention to the specific areas as well as the finite "horizons" of the participating experts and parties concerned. Extension processes have to be included beyond these "horizons", carefully designed and guided during the entire progress of such a multidisciplinary project. The theoretical structure for Knowledge and Information Systems (KIS) of the Extension Science Department of the Wageningen University (Niels Roling et all 1989 [1]) provides a workable set up for the exchange of ideas and experiences on this topic. This paper focusses on the formulation of some generalities for extension in multidisciplinary activities and aims to project these on this theoretical framework, here referred to as N-KIS. MARKET-IN Generality 1 The effective management of knowledge and information is increasingly important for the continuity of organisations. However for many small organisations and for small industries in particular this is already becoming to difficult. The line of thoughts in the paper has to start by stressing the importance of KISmanagement as expressed in this statement. The knowledge transfer from university to (MT) industry is discussed briefly as a first case of extension activity. In doing so some marketing concepts are presented. Considering the need of small industries, as stated above, a University of Technology has much to offer. The university can provide knowledge products for a market consisting of industrial companies. In industry and trade it is well known that the continuity in the long run requires a strong "market-in" orientation, meaning that products must be developed that fit to real needs in the market and are based on careful research with respect to that. This truism, however, is often neglected and instead a so called "product-out" orientation is governing the product development policy, i.e. an attitude with a too strong belief in the product and a too strong disregard for the real needs of the market. Generality 2 University knowledge centres usually have a "product-out" orientation, and this has to change to a more "market-in" approach. The N-KIS-theoretical structure of Wageningen stresses a strong need for more "upstream" influence instead of a too dominant focus on "downstream" transfer of "on-the-shelf' knowledge products. This aspect of the N-KIS framework can not be stressed enough. Generality 2 expresses the same aspect using other concepts. Facilitating this upstream influence in the case University -(MT) Industry is initially taken care of by field research. Such a field exploration provides an example of market characterization for products of a knowledge centre. Since much of this approach may be projected on other fields, as well, the main findings are given in short terms The need for more knowledge in small industries (generality 1) was found to exist in the following topics, that are all generalities in themselves: -Increasing knowledge contents of products. -Increasing responsibilities for the products, which requires increasing care for product qualities. -Increasing costs of product development. -Faster obsolesence of production systems. -Reducing life cycles of products, causing the necessity of a higher rate of product innovations. -Reducing space for unsuccessful product innovations. -More care for the environment in solutions for technological problems. 3 -Increasing need for effective management in a strategic perspective Le. over longer periods and over a broad spectrum of product-market-technology combinations. In this survey of (MT)-industry characteristics were found affecting the capabilities for extending the knowledge and information system: -The finite capacity of the management and the large workload for mostly one, or a few persons, bearing the continuity of a small industry. -A dominating "short-term-orientation" caused by the necessity to fulfill short term goals continuously. -Specific knowledge, stored in a few persons, who also have a finite knowledge horizon, leading to weaknesses within the broadening spectrum of relevant knowledge on which the KIS of such a small industry should grow. -Limited financial means. A market for knowledge products has to be known very well for processes of knowledge transfer, even in much extended details as presented in this case. In order to enhance "upstream" effects substantially, a lot more has to be achieved. In most cases this is not realizable without compatible intermediaries. INTERMEDIARlES In the Wageningen theoretical frame work (N-KIS) much attention is given to the so called interfaces and linkage mechanisms. For example in most situations the "cultural distance" between research groups and target groups for extension is too big to bridge without such interfaces, Le. intermediaries. In the theoretical structure of the N-KIS this is believed to be one of the most important items. Moreover it provides a practical approach to the design of knowledge and information systems. Fig. 1 Good decision making regarding medical technology requires effective interactions between these domains In general more than two domains are involved in multidisciplinary projects. In the field of Medical Technology there always exist interactions between three general domains: Health-Care, Industry, University (see 4 Such a multidisciplinary project usually cannot function without effective intermediaries. It mostly needs a powerful "system integrator". The management or coordination of such a project must facilitate mutual extension processes. A joint KIS has to be built up around the goals of the project and incentives of the parties involved should be projected on the general aim of the project. Real cooperation only works when all participants are gaining enough to make it worthwhile to invest all the required extra effort in multidisciplinary set ups. An important finding in this respect is that this includes also the "system integrator" sometimes referred to as "system moderator". The fulfillment of the function of system integrator must be made beneficial, economical or otherwise. Generality 3 In designing a KIS the intermediaries do form key elements (as pointed out in the theoretical framework of Wageningen); each lOS needs a powerful "system integrator", mostly being the intermediary (or one of them); the function of "system integrator" has to be rewarding in itself. TIME HORIZONS The life cycle of any distinguished medical technology is presented i

The influence of physical activity and fractures on ultrasound parameters in elderly people

In this cross-sectional study we investigated the relationship between ultrasound measurements in the calcaneus versus daily physical activity and fractures sustained in the past in elderly subjects. Ultrasound measurements were performed at both heels, which enabled us to examine determinants of differences between contralateral heels. Participants were 132 men and 578 women, aged 70 years and over (mean age and standard deviation (SD): 83 ± 6 years), living in homes for the elderly (n = 343) or apartment houses for the elderly (n = 367). Broadband ultrasound attenuation (BUA) and speed of sound (SOS) were measured in the right and left calcaneus. The median difference (and interquartile range) between the two heels for BUA and SOS, expressed as a percentage of the mean value for each individual, was 9.6% (4.2-15.7%) and 1.0% (0.4-1.7%), corresponding to 25% and 40% of the study population SDI respectively. Greater differences in BUA between the two heels were associated with variables indicating poorer functional status, such as past fractures at the lower extremities. The level of daily physical activity was obtained by means of a questionnaire regarding household and leisure activities. Subsequently sumscores were calculated for daily physical activity and a subscore indicating weight-bearing physical activity. After adjustment for age, gender, residence, and body weight, physical activity scores were positively linearly related to both BUA and SOS. Each 5 point increase on the weight-bearing physical activity score, corresponding to, for example, walking for 2.5 h per week, was associated with a difference in BUA of 4.7 dB/MHz and in SOS of 5.1 m/s, which is similar to the differences associated with 10 kg higher body weight, or 10 years younger age. After the age of 50 years 47 subjects had fractured a hip, 61 subjects had sustained another lower extremity fracture, 104 subjects a wrist fracture, and 62 subjects another upper extremity fracture. After adjusting for age, gender and residence, odds ratios for all fracture types in the lowest terciles of BUA and SOS versus the highest terciles ranged from 1.9 to 3.8. This study showed significant differences in ultrasound measurements between the left and the right heel, indicating that measurements at both sides are necessary for optimal evaluation of bone strength. Furthermore, after careful adjustments, ultrasound parameters had higher values with higher daily physical activity in elderly subjects and discriminated subjects with a history of fracture from those without