Subjective Comfort Level Research Articles

Structured operative reporting: a randomized trial using dictation templates to improve operative reporting

Background Few studies have addressed the quality of dictated operative reports (ORs). This study documents changes in resident dictation after the introduction of a standardized OR template. Methods Twenty residents dictated an OR based on a surgical procedure video. Residents were randomized to receive an OR template or no intervention. Residents dictated another report 3 months later. Outcomes measures were dictation quality using a previously validated tool and resident comfort with dictation. Results There was no overall difference in quality in the intervention group as measured by the Structured Assessment Form (SAF) (28.6 vs 30.0, P = .36) and Global Quality Ratings Scale (GQRS) (21.7 vs 21.8, P = .96). However, junior resident subgroup analysis revealed an improvement in the intervention group on both the SAF (23.2 vs 28.3, P = .02) and GQRS (17.1 vs 20.4, P = .02). Subjective comfort level improved in the intervention group ( P = .02). Conclusions The operative dictation template can significantly improve resident comfort level with dictation and has the potential to improve the quality of junior resident dictations.

Neuroimaging Week: A Novel, Engaging, and Effective Curriculum for Teaching Neuroimaging to Junior Psychiatric Residents

Neuroimaging techniques are increasingly important in psychiatric research and clinical practice, but few postgraduate psychiatry programs offer formal training in neuroimaging. To address this need, the authors developed a course to prepare psychiatric residents to use neuroimaging techniques effectively in independent practice. The authors present the format and curriculum of a highly interactive, 5-day intensive neuroimaging course, taught by psychiatry, neurology, radiology, nuclear medicine, and sleep medicine staff, covering psychiatrically oriented neuroanatomy; neuroimaging techniques and principles; clinical skills, including interpretation of computed tomography and MRI in neuropsychiatric cases; and formal approaches to critiquing neuroimaging research and applying its findings to clinical practice. Detailed questionnaires assessed the subjective and objective impact of the course on residents' knowledge of, and attitudes toward, neuroimaging in psychiatry before and after the course. Twenty-five first-year residents completed the questionnaires. Participants were enthusiastic about the content and interested in improving their skills in interpreting clinical neuroimaging studies. By the end of the course, residents also reported large gains in subjective comfort level with neuroimaging literature appraisal and functional neuroanatomy and believed that the course was effective in meeting their own specific learning objectives. Objective measures showed significant gains in most areas of the curriculum. This short, intensive course effectively teaches clinically oriented neuroimaging principles to psychiatric residents and can be readily adapted to other postgraduate programs or continuing medical education.

Malpractice carrier underwrites Fundamentals of Laparoscopic Surgery training and testing: a benchmark for patient safety

Fundamentals of Laparoscopic Surgery (FLS) is a validated program developed by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) to educate and assess competency in minimally invasive surgery (MIS). This study reports the first malpractice carrier-sponsored FLS course for surgeons in practice underwritten by the Controlled Risk Insurance Company of Harvard's Risk Management Foundation (CRICO/RMF). The study investigated the participating surgeons' pattern of MIS skills acquisition, subjective laparoscopic comfort level, operative activity, and perception of the FLS role in surgical education, credentialing, and patient safety. A 1-day postgraduate continuous medical education (CME) course consisted of didactic presentations of the leading MIS faculty, proctored FLS hands-on training, psychomotor testing, and cognitive computer-based examination. Voluntary anonymous pre- and postcourse surveys were distributed to the participants at registration and at completion of both the didactic teaching and the skills modules of the program. The course was attended by 37 practicing surgeons in the Harvard system, and 86% of the survey forms were returned. The major driving forces for attending the course were directive from the chief/chairman (50%), improvement in MIS didactic knowledge (56%), and the belief that FLS would become a standard such as advanced trauma life support (ATLS), advanced cardiac life support (ACLS), or the like (53%). Surgeons reported that the FLS exam content was appropriate (Likert 4.41 +/- 0.91) and that mastery of the course material would improve safety (Likert 4.13 +/- 0.79) and technical knowledge of MIS (Likert 4.03 +/- 1.00). This unique cooperative effort between a liability carrier, a professional surgical society, and proactive surgeons should be considered a model for advancing competency and patient safety. The survey results indicate a positive view of FLS in surgical training, safety, and MIS education.

Subjective assessment of mastication as parameter for successful prosthetic therapy

Introduction. Success in functional rehabilitation of the craniomandibular system in patients without teeth, which have total prosthesis, can be assessed using different clinical and functional methods. Subjective assessment, motivation, comfort level and functional efficacy are important elements for adaptation to dental prosthesis as well as base for success in prosthetic therapy. The aim of this study was to evaluate the importance of subjective assessment of the mastication in people with new dental prosthesis as well as to assess the value of that parameter in determining the successful prosthetic therapy. Material and Methods. Study was conducted at the Dental Clinic in Novi Sad. Thirty patients (16 males and 14 females) with average age of 62.5 years who received total prosthesis were included. Analysis was done according to the data from the medical records and conducted survey in the form of questionnaire which was adjusted to our clinical examinations. Results. Results showed that 96.6% of the patients were satisfied with new prosthesis. Subjective assessment of the quality of their mastication before therapy showed that 63.4% consider their mastication as unsatisfied, 26.6% satisfied while 10% of toothless patients thought their mastication was good. Statistic analysis showed there was significant difference in subjective assessment before and after the therapy (p<0.01). In fact, there was significant connection between subjective assessment of the mastication and satisfaction with new prosthesis and therapy at all (p<0.01). Conclusion. Patients satisfaction with total prosthesis and subjective assessment of mastication are in direct correlation with successful prosthetic treatment. Results of subjective assessment of the mastication are important and can be used as a parameter for success along with precise survey.

Workspace zone differentiation tool for visualization of seated postural comfort

Over the past several years, significant advances have been made in the area of posture prediction. However, to make simulations more useful for vehicle design, additional unique tools are needed. This research focuses on the development of one such tool, called workspace zone differentiation or zone differentiation. This new tool allows users to visualize not only the complete reach envelope but also the interior comfort levels of the envelope. It uses a color map to display the relative values of various human performance measures (i.e., comfort) at points surrounding an avatar. This is done by leveraging an optimization-based approach to seated posture prediction. Using this tool, a vehicle designer can visually display the impact that the placement of a control (switch, button, etc.) has on a driver's seated postural comfort. The comfort values are displayed in a manner similar to how finite element analysis (FEA) programs display stress and strain results. Within multi-objective optimization (MOO) for seated posture prediction, the objective function is defined as the mathematical rating model for discomfort. A direct mapping method is used to correlate subjective (survey) comfort levels with the mathematical rating model. Based on the correlated mathematical model, we develop the graphical user interface to display the comfort zones.

58. Stories - Structured operative reporting in enteric surgerys

The purpose of this study was to determine whether the introduction of a Standardized Operative Dictation Template improved the quality of resident dictation.
 General surgery residents (N = 20) from the University of Manitoba participated in the study. All residents were shown a standardized surgical procedure video and then asked to dictate an operative report. Residents were randomized with the intervention group receiving the Operative Dictation Template. Three months later, all residents were retested. Resident comfort level with dictation and satisfaction with the template was evaluated with a questionnaire. Dictations were evaluated by two blinded independent reviewers using the previously validated SAFE-OR assessment tool. This tool consists of a Structured Assessment Form (SAF) scored out of 45 and a Global Quality Ratings Scale (GQRS) out of 36. Pre and post scores were analyzed using a two-tailed Wilcoxon signed rank test. 
 Subjective comfort level with dictation, as measured by responses on a five point Likert scale, improved significantly in the intervention group (p=0.02). In addition, 90% of residents in the intervention group subjectively reported their dictations improved because of the template. There was no overall difference in the quality of dictation in the intervention group pre and post intervention as measured by the SAF (28.6 vs. 30.0; p=0.36) and GQRS (21.7 vs. 21.8, p=0.96). However, junior resident subgroup analysis revealed statistically significant improvement in the intervention on both the SAF (23.2 vs. 28.3; p=0.02) and GQRS (17.1 vs. 20.4; p=0.02). Senior resident subgroup analysis showed no difference in the intervention group on either the SAF (36.8 vs. 32.4; p=0.07) and GQRS (28.5 vs. 23.9; p=0.07). 
 The Operative Dictation Template can result in a significant improvement in resident comfort level with dictation and has the potential to improve the quality of junior resident dictations. 
 Eichholz AC, Van Voorhis BJ, Sorosky JI, Smith BJ, Sood AK. Operative note dictation: should it be taught routinely in residency programs? Obstetrics and Gynecology 2004; 103:342-6.
 Menzin AW, Spitzer M. Teaching operative dictation. A survey of obstetrics/gynecology residency program directors. Journal of Reproductive Medicine 2003; 48:850-2.
 Moore RA. The dictated operative note: important but is it being taught? Journal of the American College of Surgeons 2000; 190:639-40.

Universal accessibility assessments through virtual interactive design

This study introduced a real-time virtual interactive design methodology for justifying human-machine interface design modifications. Reaching behaviour was examined with participants from the general population ranging from 5th to 95th percentile who were accessing an Automatic Teller Machine while seated in a wheelchair. Product height and task were independent variables. Subjective comfort ratings, objective comfort measures and electromyography were dependent variables. The results of a test of twelve subjects showed that the height of the product affects the subjective comfort level and can be detected through motion capture data imported into the computer-aided ergonomics assessment software called JACK™. The JACK comfort analysis tool is based on joint angles and is compared to subjective measures. This study demonstrates that additional focus should be given to verification and validation in digital human modelling, based on the current capabilities and limitations in the technologies that were observed.

19.5L: Late‐News Paper: Effect of Diffuse Reflectance of Monitor Bezel Color on Human Performance, Preference, and Comfort

AbstractThe effect of monitor bezel color (diffuse reflectance) on task performance, visual abilities, subjective comfort level, and preference in using software with graphical user interfaces was measured. Frame color had no effect on task performance or visual metrics (acuity, contrast sensitivity). Subjective ratings of discomfort were similarly higher at the end of 4 hours of work across all monitor bezel colors. The darkest bezel color was preferred by 2/3 of the participants at the end of 3 days, after using a different monitor bezel color on each day.

Physiologic responses during rest on a sleep system at varied degrees of firmness in a normal population

This study explores the hypothesis that a high degree of sustained muscle activity associated with a sub-optimal spinal orientation may compromise an individual's ability to relax or initiate sleep. Data from 22 participants who were considered to be part of a normal, back-pain-free population were used in these studies. Participants laid down on a mattress in a foetal position (i.e. on their sides) at three varying bed pressures while EMG activities, heart rates, blood pressures, subjective comfort levels and spinal alignment data were recorded. Minor effects of mattress inflation pressures were associated with changes in EMG activity, heart rate, blood pressure and/or subjective comfort. In contrast, spinal alignment assessment revealed significant differences between the three different inflation pressures studied (827.4, 2413.2 and 3999.0 Pa). It was concluded that in a population of normal participants, although mattress inflation pressure induced significant changes in spinal alignment, these changes were of little physiological consequence. Nevertheless, this data provides baseline information needed to assess similar correlations in a symptomatic population (e.g. those with either acute or chronic neck or back pain).

Ergonomic design and evaluation of a new VDT workstation chair with keyboard–mouse support

A new-concept VDT workstation chair with an adjustable keyboard/mouse support was proposed to minimize the physical discomfort and the risk of cumulative trauma disorders (CTDs) at work sites. A three-dimensional human modeling tool (SAFEWORK ®) was used to design the new chair which satisfies the anthropometric specifications of the Korean population. Based upon the result of 3-D graphical simulations, a mock-up chair was constructed with an adjustable keyboard/mouse support directly attached to the chair body. An experiment was conducted to compare the new workstation chair to a conventional computer chair without a keyboard–mouse support by measuring muscle fatigue and subjective discomfort. Six volunteer subjects participated in six 1-hour word-processing sessions with two different chairs and three different work postures. Statistical results indicated that the new-concept VDT chair generally improved subjective comfort level and reduced fatigue in the finger flexor/extensor and the low back muscles. Implications of the new design and suggestions for further development are addressed. Relevance to industry The proposed VDT chair in this study can be used by certain VDT users such as telephone operators who are potentially exposed to CTDs. Since the number of computer users has greatly increased, the market share of better-designed VDT chairs is expected to increase rapidly. Moreover, the new VDT chair can impact design and manufacturing industries that make new products and accessories which support the new VDT environment.

Human comfort in relation to sinusoidal vibration : B. Jones and B. K. N. Rao, Paper 14. (31 pages, 10 figures, 6 tables, 19 references)

An investigation was made to assess the overall subjective comfort levels to sinusoidal excitations over the range 1 to 19 Hz using a two axis electrohydraulic vibration simulator. Exposure durations of 16 minutes, 25 minutes, 1 hour, and 2.5 hours have been considered. Subjects were not exposed over such durations, but were instructed to estimate the overall comfort levels preferred had they been constantly subjected to vibration over such durations.