Biomedical subjects

A N Healey

Publications and source records attributed to A N Healey.

7 recordsLinked to original sources

PubMed2006

Defining the technical skills of teamwork in surgery.

Developments in surgical technology and procedure have accelerated and altered the work carried out in the operating theatre/room, but team modelling and training have not co-evolved. Evidence suggests that team structure and role allocation are sometimes unclear and contentious, and coordination and communication are not fully effective. To improve teamwork, clinicians need models that specify team resources, structure, process and tasks. They also need measures to assess performance and methods to train teamwork strategically. An effective training strategy might be to incorporate teamwork with other technical skills training in simulation. However, the measures employed for enhancing teamwork in training and practice will need to vary in their object of analysis, level of technical specificity, and system scope.

Clinical Competence↗

PubMed2004

Objects and positions in visual scenes: effects of perirhinal and postrhinal cortex lesions in the rat.

The authors assessed rats' encoding of the appearance or egocentric position of objects within visual scenes containing 3 objects (Experiment 1) or 1 object (Experiment 2A). Experiment 2B assessed encoding of the shape and fill pattern of single objects, and encoding of configurations (object + position, shape + fill). All were assessed by testing rats' ability to discriminate changes from familiar scenes (constant-negative paradigm). Perirhinal cortex lesions impaired encoding of objects and their shape; postrhinal cortex lesions impaired encoding of egocentric position, but the effect may have been partly due to entorhinal involvement. Neither lesioned group was impaired in detecting configural change. In Experiment 1, both lesion groups were impaired in detecting small changes in relative position of the 3 objects, suggesting that more sensitive tests might reveal configural encoding deficits.

Animals↗

PubMed2004

Developing observational measures of performance in surgical teams.

Team performance is increasingly recognised as an essential foundation of good surgical care and a determinant of good surgical outcome. To understand team performance and to develop team training, reliable and valid measures of team performance are necessary. Currently there is no firm consensus on how to measure teamwork, partly because of a lack of empirical data to validate measures. The input-process-output model provides a framework for surgical team studies. Objective observational measures are needed in surgery as a basis for interdisciplinary team assessment and training. The "observational teamwork assessment for surgery" (OTAS) tool assesses two facets of the surgical process. Observer 1 monitors specific tasks carried out by team members, under the categories patient, environment, equipment, provisions, and communications. Observer 2 uses a behavioural observation scale to rate behaviour for the three surgical phases (pre-operative, operative, and post-operative) with components of teamwork: cooperation, leadership, coordination, awareness, and communication. Illustrative data from an initial series of 50 cases is presented here. The OTAS tool enables two independent observers, a surgeon and psychologist, to record detailed information both on what the theatre team does and how they do it, and has the potential to identify constraints on performance that might relate to surgical outcome.

Humans↗

PubMed2003

Learning associations between places and visual cues without learning to navigate: neither fornix nor entorhinal cortex is required.

Rats with fornix transection, or with cytotoxic retrohippocampal lesions that removed entorhinal cortex plus ventral subiculum, performed a task that permits incidental learning about either allocentric (Allo) or egocentric (Ego) spatial cues without the need to navigate by them. Rats learned eight visual discriminations among computer-displayed scenes in a Y-maze, using the constant-negative paradigm. Every discrimination problem included two familiar scenes (constants) and many less familiar scenes (variables). On each trial, the rats chose between a constant and a variable scene, with the choice of the variable rewarded. In six problems, the two constant scenes had correlated spatial properties, either Allo (each constant appeared always in the same maze arm) or Ego (each constant always appeared in a fixed direction from the start arm) or both (Allo + Ego). In two No-Cue (NC) problems, the two constants appeared in randomly determined arms and directions. Intact rats learn problems with an added Allo or Ego cue faster than NC problems; this facilitation provides indirect evidence that they learn the associations between scenes and spatial cues, even though that is not required for problem solution. Fornix and retrohippocampal-lesioned groups learned NC problems at a similar rate to sham-operated controls and showed as much facilitation of learning by added spatial cues as did the controls; therefore, both lesion groups must have encoded the spatial cues and have incidentally learned their associations with particular constant scenes. Similar facilitation was seen in subgroups that had short or long prior experience with the apparatus and task. Therefore, neither major hippocampal input-output system is crucial for learning about allocentric or egocentric cues in this paradigm, which does not require rats to control their choices or navigation directly by spatial cues.

Animals↗

PubMed2001

Configural learning without configural training.

Rats learned discriminations in which 2 familiar compound visual stimuli AB and CD were nonreinforced, whereas less-familiar compounds (EF, GH, IJ...) were reinforced (constant-negative paradigm). Such discriminations can in principle be acquired through elemental (nonconfigural) learning. Three different types of compound--object/object, object/position, and shape/fill-pattern--were used, and the number of familiar compounds extended to 3 or 4. In all cases, when rats were tested for the first time with previously unseen recombinations of the familiar elements--for example, AC, BD--they preferred these to the familiar compounds, implying that they had encoded configural information during the original training. Moreover, preference remained constant despite extended exposure to configural training in the test phase. The findings extend the evidence that configural representations are formed independently of explicit configural training.

Animals↗

PubMed2000

Rats with hippocampal lesions learn about allocentric place cues in a non-navigational task.

Hippocampal-lesioned rats (HPC) and sham controls (SH) learned constant-negative visual discriminations among scenes in a Y-maze. Any arm could be start arm for a trial. Two choice scenes ("constant" and "variable") were shown in the other arms. In Experiment 1, each problem had 2 constants. One or the other constant appeared on every trial, and the variable changed every trial; choosing the variable was rewarded. There were 4 problem types. Each constant might be always in a given direction from the start arm (added egocentric [Ego] cue), always in a given maze arm (added allocentric [Allo] cue), both, or neither. SH rats' visual learning was enhanced by Ego and by Allo cues. HPC rats' visual learning was enhanced by Ego cues, and by Allo cues, but only if there was no Ego cue. Experiment 2 confirmed that Allo cues helped HPC rats as much as SH, in the absence of Ego cues. Rats with HPC lesions can learn about allocentric place cues when navigation and idiothetic cue control are not required.

Animals↗

PubMedDate not supplied

Measuring intra-operative interference from distraction and interruption observed in the operating theatre.

An observational tool was developed to record distraction and interruption in the operating theatre during surgery. Observed events were assigned to pre-defined categories and rated in relation to the level of team involvement - the sum of which was treated as a measure of intra-operative interference. Many events (0.29 +/- 0.02 per min) were observed and rated in 50 general operations sampled from a single operating theatre. The rating of individual events (r(s) = 0.65) and of cases (r(s) = 0.89) correlated between independent observers. Interference levels (1.04 +/- 0.07/min) also correlated with door opening frequency (0.68 +/- 0.03/min) (r = 0.47, p < 0.001). Some sources of interference were intrinsic to the work of the surgical team, including equipment, procedure and environment, while others were extraneous, including bleepers, phone calls and external staff. The findings highlight the need to further develop measures of interference, to assess its variation, intensity and its effect on surgical team performance.

Anesthesiology↗