Tracking Clinical Staff Behaviors in an Operating Room.

Inadequate staff behaviors in an operating room (OR) may lead to environmental contamination and increase the risk of surgical site infection. In order to assess this statement objectively, we have developed an approach to analyze OR staff behaviors using a motion tracking system. The present article introduces a solution for the assessment of individual displacements in the OR by: (1) detecting human presence and quantifying movements using a motion capture (MOCAP) system and (2) observing doors' movements by means of a wireless network of inertial sensors fixed on the doors and synchronized with the MOCAP system. The system was used in eight health care facilities sites during 30 cardiac and orthopedic surgery interventions. A total of 119 h of data were recorded and analyzed. Three hundred thirty four individual displacements were reconstructed. On average, only 10.6% individual positions could not be reconstructed and were considered undetermined, i.e., the presence in the room of the corresponding staff member could not be determined. The article presents the hardware and software developed together with the obtained reconstruction performances.

Preference of cancer patients and family members regarding delivery of bad news and differences in clinical practice among medical staff.

OBJECTIVES: To study the preferences of cancer patients and their families in way of being informed of their condition and, by comparing their preferences with the medical staff's clinical practices, explore the factors underlying the latter's preferences. METHODS: A survey was conducted with 216 cancer patients, 242 families, and 176 clinical staff members with the Medical Status Communication questionnaire (Simplified Chinese edition). RESULTS: The clinical staff scored lower than the cancer patients and their families in terms of the total score, way of communication, emotional support, and additional information (F = 16.134, p < .001; F = 28.604, p < .001; F = 13.839, p < .001; F = 16.745, p < .001). Factors underlying the medical staff's clinical practices included, as revealed by the multiple linear regression analysis, gender (p = .03), and willingness to improve the way of communication about cancer (p = .006). CONCLUSIONS: A gap existed between the medical staff's clinical practice and the preferences of the cancer patients and their families. The medical staff should receive adequate training in cancer communication skills and techniques for improvement in this respect. When designing training for skills in delivering bad news to cancer patients, the well-being of cancer patients and their families must be thoroughly considered, and patient demands for information should be satisfied in the context of the information explosion of the current age.

From cure to palliation: agreement, timing, and decision making within the staff.

Important issues in the transition from curative treatment to palliative care are agreement, timing, and decision making. A survey of 309 nurses and 415 physicians in Sweden showed that 61% of the nurses and 83% of the physicians thought agreement was current practice. None said that the decisions were made too early, but 19% of the nurses and 14% of the physicians thought that they often were made too late. Very few respondents stated that such decisions are changed, 0% and 1%, respectively. More than half of the informants made detailed comments on such transitions indicating that awareness and flexibility are desirable to make well-informed decisions. Three themes that emerged from the analysis concerning the decision to stop curative treatment and focus on palliative care were that the staff members should (if possible) make such decisions in agreement and should sometimes make the decisions earlier and that well-based reasons are required to make changes.

Ética y perinatología: una visita a terra incógnita / Ethics and perinatology: a visit to inknown land

Las distintas aplicaciones técnicas alcanzadas en el área perinatal a partir de los años 70 consiguieron revertir muchas situaciones que hasta entonces condenaban al niño a una muerte segura. Sin embargo esa reducción notoria de la mortalidad no fue acompañada por una disminución acorde en la morbilidad. Los neonatos de muy bajo peso (inferior a 1500 gramos al nacer) son el ejemplo más contundente y númericamente significativo pues, aunque superen los problemas del nacimiento, su futuro continúa siendo incierto y poco alentador. El estado, basándose en análisis de costo/beneficio, reniega de seguir invirtiendo importantes cantidades de dinero en estos neonatos, mientras que los voceros del niño claman por un igualitario acceso a la salud y el respeto de la vida humana. Las decisiones cientifico técnicas que adopte al respecto el cuerpo médico estarán comprometidas con algunos de los intereses en pugna y, por lo tanto, evidenciaran su filiación ética. Se analizan las diferentes actitudes profesionales respecto de los neonatos con muy bajo peso al nacer y se revisan los criterios en los cuales se fundamentan esas acciones. Se proponen por último, recomendaciones en los niveles preventivo de tratamiento y secuelas, destacando la figura del Comité Hospitalario de Ética para dirimir situaciones dilemáticas.