Hierarchical decomposition of complex behaviour and systems is a valuable research methodology from human factors and information-processing psychology that can be applied to laparoscopic surgery. This article describes results of research on surgeons performing several different laparoscopic procedures, conducted in Vancouver, Canada 1995–98. Through top-down analyses of surgical procedures and bottom-up analyses of tool motions, results included detailed decomposition of the procedures through surgical steps, sub-steps, tasks, sub-tasks and tool motions. Analyses at all levels provided valuable information. In addition to specific surgeon- and technology-related observations, such as the effect of dividing the short gastrics on performance of Nissen fundoplication, gaze patterns of surgeons and factors related to patient safety were analysed. The hierarchical decomposition approach can be extended to other aspects of the complex system that consists of the surgeon and operating room team, the technologies and the operating room environment. Other frameworks for assessment are also considered.

Prevalence of MS in Newcastle has risen linearly and is contributed to by a substantial increase in new cases over the preceding decade. Female predominance of MS cases continues to increase with a new diagnosis three times more likely in women.

Values for sensitivity and specificity indicate that telephone transmission is a useful diagnostic tool for assessing pacemaker function at a distance. Negative predictive value is 99.9%, indicating that normal telephone transmissions are very reassuring of normal pacemaker function. Telephone transmission is equally successful in all age groups, genders, distances from a tertiary referral center, underlying diagnoses, pacing modes, and pacemaker models. Compliance with telephone transmission follow-up was higher in our population than in previous studies.

No abstract

Public reporting burden for the collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to a penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.