Stress-Adaptive Training: An Adaptive Psychomotor Training According to Stress Measured by Grip Force

Impact of fatigue in surgeons on performance and patient outcome: systematic review

BACKGROUND

While fatigue is an inevitable aspect of performing surgical procedures, lack of consensus remains on its effect on surgical performance. The aim of this systematic review was to assess the effect of non-muscular fatigue on surgical outcome.

METHODS

MEDLINE and Embase were searched up to 17 January 2023. Studies on students, learning, duty-hour restrictions, muscle fatigue, non-surgical or subjective outcome, the weekend effect, or time of admission were excluded. Studies were categorized based on real-life or simulated surgery. The Cochrane risk-of-bias tool was used to assess RCTs and the Newcastle-Ottawa scale was used to assess cohort studies. Due to heterogeneity among studies, data pooling was not feasible and study findings were synthesized narratively.

RESULTS

From the 7251 studies identified, 134 studies (including 1 684 073 cases) were selected for analysis (110 real-life studies and 24 simulator studies). Of the simulator studies, 46% (11 studies) reported a deterioration in surgical outcome when fatigue was present, using direct measures of fatigue. In contrast, only 35.5% (39 studies) of real-life studies showed a deterioration, observed in only 12.5% of all outcome measures, specifically involving aggregated surgical outcomes.

CONCLUSION

Almost half of simulator studies, along with one-third of real-life studies, consistently report negative effects of fatigue, highlighting a significant concern. The discrepancy between simulator/real-life studies may be explained by heightened motivation and effort investment in real-life studies. Currently, published fatigue and outcome measures, especially in real-life studies, are insufficient to fully define the impact of fatigue on surgical outcomes due to the absence of direct fatigue measures and crude, post-hoc outcome measures.

Frustrated Total Internal Reflection Measurement System for Pilot Inceptor Grip Pressure

Sensing the interaction between the pilot and the control inceptors can provide important information about the pilot's activity during flight, potentially enabling the objective measurement of the pilot workload, the application of preventive actions against loss of situational awareness, and the identification of the insurgence of adverse couplings with the vehicle dynamics. This work presents an innovative pressure-sensing device developed to be seamlessly integrated into the grips of conventional aircraft control inceptors. The sensor, based on frustrated total internal reflection of light, is composed of low-cost elements and can be easily manufactured to be applicable to different hand pressure ranges. The characteristics of the sensor are first demonstrated in laboratory calibration tests. Subsequently, applications in flight simulator testing are presented, focusing on the objective representation of the pilot's instantaneous workload.

Stress and Workload Assessment in Aviation-A Narrative Review

In aviation, any detail can have massive consequences. Among the potential sources of failure, human error is still the most troublesome to handle. Therefore, research concerning the management of mental workload, attention, and stress is of special interest in aviation. Recognizing conditions in which a pilot is over-challenged or cannot act lucidly could avoid serious outcomes. Furthermore, knowing in depth a pilot's neurophysiological and cognitive-behavioral responses could allow for the optimization of equipment and procedures to minimize risk and increase safety. In addition, it could translate into a general enhancement of both the physical and mental well-being of pilots, producing a healthier and more ergonomic work environment. This review brings together literature on the study of stress and workload in the specific case of pilots of both civil and military aircraft. The most common approaches for studying these phenomena in the avionic context are explored in this review, with a focus on objective methodologies (e.g., the collection and analysis of neurophysiological signals). This review aims to identify the pros, cons, and applicability of the various approaches, to enable the design of an optimal protocol for a comprehensive study of these issues.

Mapping Grip Force Characteristics in the Measurement of Stress in Driving

Reducing drivers' stress can potentially increase road safety. However, state-of-the-art physiological stress indices are intrusive and limited by long time lags. Grip force is an innovative index of stress that is transparent to the user and, according to our previous findings, requires a two- to five-second time window. The aim of this study was to map the various parameters affecting the relationship between grip force and stress during driving tasks. Two stressors were used: the driving mode and the distance from the vehicle to a crossing pedestrian. Thirty-nine participants performed a driving task during either remote driving or simulated driving. A pedestrian dummy crossed the road without warning at two distances. The grip force on the steering wheel and the skin conductance response were both measured. Various model parameters were explored, including time window parameters, calculation types, and steering wheel surfaces for the grip force measurements. The significant and most powerful models were identified. These findings may aid in the development of car safety systems that incorporate continuous measurements of stress.