How are we handling protein drugs in hospitals? A human factors and systems engineering approach to compare two hospitals and suggest a best practice

Biopharmaceuticals are complex biological molecules that require careful storage and handling to ensure medication integrity. In this study, a work system analysis of real-world protein drug (PD) handling was performed with the following goals: identify main barriers and facilitators for successful adherence to accepted recommendations in PD handling, analyse differences in two organizations, and define a Best Current Practice in the real-life handling of PDs based on the results of the work system analysis. Observational study was held in two university hospitals in Spain and Sweden. Based on the Systems Engineering Initiative for Patient Safety (SEIPS) model, the tools chosen were: the PETT scan, in order to indicate the presence of barriers or facilitators for the PETT components (People, Environment, Tools, Tasks); the Tasks and tools matrices to construct a checklist to record direct observations during the real-life handling of biopharmaceuticals, and the Journey map to depict the work process. Observations were performed between March and November 2022. Each episode of direct observation included a single protein drug in some point of the supply chain and considered all the elements in the work system. Based on the results of the work system analysis and the literature review, the authors propose a list of items which could be assumed as Best Current Practice for PDs handling in hospitals. There were a total of 34 observations involving 19 PDs. Regarding People involved in the work process, there was a diversity of professionals with different previous training and knowledge, leading to an information gap. With respect to Environment, some structural and organizational differences between hospitals lead to risks related to the time exposure of PDs to room temperature and mechanical stress. Some differences also existed in the Tools and Tasks involved in the process, being especially relevant to the lack of compatibility information of PDs with new technologies, such as pneumatic tube system, robotic reconstitution, or closed-system transfer devices. Finally, 15 suggestions for best current practice are proposed. Main barriers found for compliance with accepted recommendations were related to the information gap detected in professionals involved in the handling of protein drugs, unmonitored temperature, and the lack of compatibility information of protein drugs with some new technologies. By applying a Human Factors and Systems Engineering Approach, the comparison of two European hospitals has led to a suggested list of Best Current Practices in the handling of protein drugs in a hospital.

Comparative study on electroencephalography characteristics of professional and non-professional drivers in tunnel sections: A field investigation

BACKGROUND

The tunnel section is a complex traffic scenario and an accident prone area. There are differences in the performance of different driving groups in tunnel environments, which may have an impact on traffic safety.

OBJECTIVE

To study the differences in the impact of tunnel environment on professional and non-professional drivers.

METHODS

Based on the vehicle experimental data, the electroencephalography (EEG) power was compared for professional and non-professional drivers. The impact of illumination changes and longitudinal slope on different driving groups was analyzed.

RESULTS

At tunnel entrance with severely reduced lighting, the adaptation time of non-professional drivers to the light environment is 1.5 times that of professional drivers. When driving on the longitudinal slope, professional drivers perform better. The greater the longitudinal slope, the more obvious the advantages of professional drivers. However, in areas with relatively good traffic conditions, professional drivers are more prone to be distracted.

CONCLUSION

Professional and non-professional drivers have their own advantages and disadvantages in the tunnel environment. In general, the driving adaptability of professional drivers is better than that of non-professional drivers in tunnel sections. The research conclusions provide a reference for driver safety training.

Spatiotemporal variation and driving factor of vegetation coverage from 2000 to 2020 in southern Jiangxi Province, China

Vegetation plays a critical role in the water and carbon cycling and energy flow, serving as an indicator for regulating land carbon balance and reflecting climate change and human activities. We analyzed the spatiotemporal variations of normalized difference vegetation index (NDVI) during the growing season in southern Jiangxi from 2000 to 2020, using statistical methods, including the Mann-Kendall test, Theil-Sen Median analysis, Hurst index, and coefficient of variation. We employed the geodetector model to comprehensively assess the impacts of climate, topography, soil and human factors on spatial differentiation of vegetation NDVI. The results showed NDVI exhibited an upward fluctuating trend with a rate of 0.003 per year from 2000 to 2020. The proportion of high-grade and medium-high-grade NDVI areas were 55.8% and 41.9%, respectively, while the areas with low and relatively low fluctuations accounted for 92.3%. The proportions of areas showing extremely significant improvement and significant improvement were 40.4% and 19.4%, respectively. In contrast, the combined proportion of areas displaying extremely significant degradation and significant degradation was only 2.2%. The proportions of areas demonstrating continuous improvement and future improvement were 28.0% and 60.2%, respectively. Elevation, precipitation, relative humidity, temperature, landform type, land use type, population density, and nighttime light were identified as the major factors for the vairations of NDVI in the study area, followed by slope, soil type, and GDP, while slope aspect and vegetation type had indirect influence. Throughout the study period, NDVI in southern Jiangxi was overall stable, with future changes primarily indicating improvement. Notably, human factors such as land use type, population density, and nighttime light index exhibited an upward trend in their impacts on NDVI.

Assessing Barriers and Adherence to Insulin Injection Technique in People With Diabetes: Development and Validation of New Assessment Tools

BACKGROUND

The correct injection technique is crucial for people with insulin therapy. However, barriers to insulin injections exist, which can lead to problems with injections. In addition, injection behavior may deviate from recommendations leading to lower adherence to the correct injection technique. We developed two scales to assess barriers and adherence to the correct technique.

METHODS

Two item pools were created to assess barriers to insulin injections (barriers scale) and adherence to the correct technique (adherence scale). In an evaluation study, participants completed the two newly created scales, as well as other questionnaires used for criterion validity. Exploratory factor analysis, correlational analysis, and receiver operating characteristics analysis were computed to analyze the validity of the scales.

RESULTS

A total of 313 people with type 1 and type 2 diabetes using an insulin pen for insulin injections participated. For the barriers scale, 12 items were selected achieving a reliability of 0.74. The factor analysis revealed three factors namely emotional, cognitive, and behavioral barriers. For the adherence scale, nine items were selected achieving a reliability of 0.78. Both scales showed significant associations with diabetes self-management, diabetes distress, diabetes acceptance, and diabetes empowerment. Receiver operating characteristics analysis showed significant area under the curves for both scales in classifying people with current skin irritations.

CONCLUSIONS

Reliability and validity of the two scales assessing barriers and adherence to insulin injection technique were demonstrated. The two scales can be used in clinical practice to identify persons in need of education in insulin injection technique.

Issues with the Swedish e-prescribing system - An analysis of health information technology-related incident reports using an existing classification system

Objective

To identify issues with the Swedish e-prescribing system and devise a set of recommendations to overcome the identified challenges.

Methods

A number of health information technology-related incidents were collected retrospectively from various sources using purposive and snowball sampling. A search term containing five keywords was used to identify the electronic prescription-related incidents. The identified incidents (n = 24) were subjected to an existing framework, i.e., the Health Information Technology Classification System. Special attention was paid to the software-related issues, which were analysed using thematic analysis.

Results

Several types of software-related issues (n = 22) were identified: system configuration, interface with other software systems or components, software functionality, data storage and backup, record migration, software not accessible, and network/server down or slow. Both human and technical factors contributed to these incidents, including prescriptions not cancelled actively, drug handling errors, software programming errors, and system updates/upgrades. These software problems led to various consequences, such as incidents affecting multiple patients’ care management, delays in patient care, and risks of serious deterioration of health. Several temporary initiatives or administrative adjustments, for instance, cover letters to patients and local strategies, were used to overcome some of these challenges.

Conclusions

This study provides insights into the challenges related to the e-prescribing system, contributing factors, consequences, and actions taken to mitigate those risks. Therefore, healthcare organisations using the e-prescribing system should adopt the provided recommendations to minimise the risks of design and developmental challenges, implementation and use-related issues, and the problems related to monitoring, evaluation, and optimisation.

Safety management in times of crisis: Lessons learned from a nationwide status-analysis on German intensive care units during the COVID-19 pandemic

Background

The status of Safety Management is highly relevant to evaluate an organization's ability to deal with unexpected events or errors, especially in times of crisis. However, it remains unclear to what extent Safety Management was developed and sufficiently implemented within the healthcare system during the COVID-19 pandemic. Providing insights of potential for improvement is expected to be directional for ongoing Safety Management efforts, in times of crisis and beyond.

Method

A nationwide survey study was conducted among healthcare professionals and auxiliary staff on German Intensive Care Units (ICUs) evaluating their experiences during the first wave of the COVID-19 pandemic. Error Management and Patient Safety Culture (PSC) measures served to operationalize Safety Management. Data were analyzed descriptively and by using quantitative content analysis (QCA).

Results

Results for n = 588 participants from 53 hospitals show that there is a gap between errors occurred, reported, documented, and addressed. QCA revealed that low quality of safety culture (27.8%) was the most mentioned reason for errors not being addressed. Overall, ratings of PSC ranged from 26.7 to 57.9% positive response with Staffing being the worst and Teamwork Within Units being the best rated dimension. While assessments showed a similar pattern, medical staff rated PSC on ICUs more positively in comparison to nursing staff.

Conclusion

The status-analysis of Safety Management in times of crisis revealed relevant potential for improvement. Human Factor plays a crucial role in the occurrence and the way errors are dealt with on ICUs, but systemic factors should not be underestimated. Further intensified efforts specifically in the fields of staffing and error reporting, documentation and communication are needed to improve Safety Management on ICUs. These findings might also be applicable across nations and sectors beyond the medical field.

A novel hazard avoidance model based on young drivers' characteristics: A driving simulator study

This paper aims to examine the key factors influencing young drivers' hazard avoidance in Iran. In this study, a hazard avoidance index is defined and calculated for investigating the effect of impulsiveness, behavioral, and psychological characteristics on driving hazard avoidance. A questionnaire and go-no-go and flanker computer tests as well as a driving simulator are used for collecting data from 173 Iranian drivers under the age of 30. For this purpose, different scenarios were used, such as pedestrian crossing, the presence of fixed obstacles, and animals crossing the road, whose various characteristics are also changed. Structural equation modeling and the partial least squares method are applied for investigating the relationship between different variables and the hazard avoidance index. The results show that the driver hazard avoidance index is mostly affected by variables such as inhibitory control, opposite directional response, attentional impulsiveness, motion impulsiveness, non-planning impulsiveness, disregarding the law, and lapses and error. The results could help policymakers to assess diving hazard avoidance and improve training programs related to traffic safety based on the variables that are more effective on inexperienced and novice drivers' hazard avoidance.

Endoscopists performance in optical diagnosis of colorectal polyps in artificial intelligence studies

Widespread adoption of optical diagnosis of colorectal neoplasia is prevented by suboptimal endoscopist performance and lack of standardized training and competence evaluation. We aimed to assess diagnostic accuracy of endoscopists in optical diagnosis of colorectal neoplasia in the framework of artificial intelligence (AI) validation studies. Literature searches of databases (PubMed/MEDLINE, EMBASE, Scopus) up to April 2022 were performed to identify articles evaluating accuracy of individual endoscopists in performing optical diagnosis of colorectal neoplasia within studies validating AI against a histologically verified ground-truth. The main outcomes were endoscopists' pooled sensitivity, specificity, positive and negative predictive value (PPV/NPV), positive and negative likelihood ratio (LR) and area under the curve (AUC for sROC) for predicting adenomas versus non-adenomas. Six studies with 67 endoscopists and 2085 (IQR: 115-243,5) patients were evaluated. Pooled sensitivity and specificity for adenomatous histology was respectively 84.5% (95% CI 80.3%-88%) and 83% (95% CI 79.6%-85.9%), corresponding to a PPV, NPV, LR+, LR- of 89.5% (95% CI 87.1%-91.5%), 75.7% (95% CI 70.1%-80.7%), 5 (95% CI 3.9%-6.2%) and 0.19 (95% CI 0.14%-0.25%). The AUC was 0.82 (CI 0.76-0.90). Expert endoscopists showed a higher sensitivity than non-experts (90.5%, [95% CI 87.6%-92.7%] vs. 75.5%, [95% CI 66.5%-82.7%], p < 0.001), and Eastern endoscopists showed a higher sensitivity than Western (85%, [95% CI 80.5%-88.6%] vs. 75.8%, [95% CI 70.2%-80.6%]). Quality was graded high for 3 studies and low for 3 studies. We show that human accuracy for diagnosis of colorectal neoplasia in the setting of AI studies is suboptimal. Educational interventions could benefit by AI validation settings which seem a feasible framework for competence assessment.

An Observational Study of Physicians' Workflow Interruptions in Outpatient Departments in China

Background

Workflow interruptions are frequent in hospital outpatient clinics. Eventually, not only reducing the work efficiency and quality, but also further threatening patient safety. Over the last 10–15 years, research on workflow interruptions in inpatient care has increased, but there is a lack of research on the interruptions in outpatient clinics. The present study aimed to study the differences in physicians' workflow interruptions among outpatient departments in the tertiary hospital in China.

Methods

In a tertiary hospital, a standardized observational study of 32 doctors' workflow in outpatient department of four typical clinical specialties was conducted. The record of workflow interruptions was based on a self-made observation instrument after verifying its reliability and validity. Linear regression methods were used to assess outpatient characteristics as predictors of the number of interruptions. The Kruskal-Wallis test was used to analyze the difference about the duration of interruptions among specialties, and the Chi-Square Test was used to examine the sources of interruptions among different specialties, to determine whether interruption source is associated with specialty.

Results

The number of patients was the significant independent predictor of the number of interruptions (p < 0.001). In terms of work tasks being interrupted, the highest interruption rate occurred when physicians were asking health history: 19.95 interruptions per hour. The distribution of interruption sources among the four clinical specialties were statistically different (X² = 16.988, p = 0.049).

Conclusion

The findings indicate that physicians' workflow interruptions are connected with many contents in the work system. Further emphasis should be placed on the effective application of hospital management measures in an interrupted environment to promote a safe and efficiency outpatient care.

EEG-Based Index for Timely Detecting User's Drowsiness Occurrence in Automotive Applications

Human errors are widely considered among the major causes of road accidents. Furthermore, it is estimated that more than 90% of vehicle crashes causing fatal and permanent injuries are directly related to mental tiredness, fatigue, and drowsiness of the drivers. In particular, driving drowsiness is recognized as a crucial aspect in the context of road safety, since drowsy drivers can suddenly lose control of the car. Moreover, the driving drowsiness episodes mostly appear suddenly without any prior behavioral evidence. The present study aimed at characterizing the onset of drowsiness in car drivers by means of a multimodal neurophysiological approach to develop a synthetic electroencephalographic (EEG)-based index, able to detect drowsy events. The study involved 19 participants in a simulated scenario structured in a sequence of driving tasks under different situations and traffic conditions. The experimental conditions were designed to induce prominent mental drowsiness in the final part. The EEG-based index, so-called “MDrow index”, was developed and validated to detect the driving drowsiness of the participants. The MDrow index was derived from the Global Field Power calculated in the Alpha EEG frequency band over the parietal brain sites. The results demonstrated the reliability of the proposed MDrow index in detecting the driving drowsiness experienced by the participants, resulting also more sensitive and timely sensible with respect to more conventional autonomic parameters, such as the EyeBlinks Rate and the Heart Rate Variability, and to subjective measurements (self-reports).

Characterizing healthcare incidents in Sweden related to health information technology affecting care management of multiple patients

This study aimed to examine health information technology-related incidents and identify risks associated with multiple patients' management. Sources of information comprised interviews with healthcare professionals and three small sets of local voluntary incident reports using two sampling strategies, purposive and snowball sampling. Incident reports, in the form of free-text narratives, were aggregated for analysis using the Health Information Technology Classification System and thematic analysis. Of 95 incidents, 176 issues were identified, comprising 77% (n = 136) technical issues, and 23% (n = 40) use or human-related issues. Human issues were over two times more likely to harm patients (OR 2.25, 95% CI 1.01 - 4.98) than technical issues. Incidents that affected multiple patients' care accounted for 70% (n = 66) of the total sample, and large-scale events comprised 39% (n = 26) of the incidents that affected multiple patients' care. Systematically identifying and characterizing such incidents should be prioritized for health information technology implementations.

Development of an Active Training Method for Belt Conveyor

The global situation related to the COVID-19 pandemic has forced employers to find an adequate way to conduct training in order to ensure work safety. The underground mining industry is one of the industries which, due to its nature, was not able to switch to remote work. Conducting traditional training risked spreading the virus among workers. For this purpose, it was necessary to start a search for a form of training that would be safe and would not cause additional stress for employees. Research on the development of an active employee training method and testing of the method itself was conducted online. In order to develop a method of active training, one of the most important workstations was selected, which is the operation of the conveyor belt. The training method comprises four training modules. The modules cover questions related to the operation of the conveyor belt, emergencies, its assembly and disassembly, repair and maintenance. The developed issues also take into account questions concerning natural hazards and work safety. The entire training course lasts 10 days. Every day, an employee receives a set of eight questions sent to their email address, which they must answer before starting work. The article describes the methodology and implementation of the training.

Characterizing the Influence of Confirmation Bias on Web Search Behavior

In this study, we analyzed the relationship between confirmation bias, which causes people to preferentially view information that supports their opinions and beliefs, and web search behavior. In an online user study, we controlled confirmation bias by presenting prior information to participants that manipulated their impressions of health search topics and analyzed their behavioral logs during web search tasks. We found that web search users with poor health literacy and negative prior beliefs about the health search topic did not spend time examining the list of web search results, and these users demonstrated bias in webpage selection. In contrast, web search users with high health literacy and negative prior beliefs about the search topic spent more time examining the list of web search results. In addition, these users attempted to browse webpages that present different opinions. No significant difference in web search behavior was observed between users with positive prior beliefs about the search topic and those with neutral belief.

The Role of Physicians in Digitalizing Health Care Provision: Web-Based Survey Study

Background

Digitalization affects all areas of society, including the health care sector. However, the digitalization of health care provision is progressing slowly compared to other sectors. In the professional and political literature, physicians are partially portrayed as digitalization sceptics. Thus, the role of physicians in this process requires further investigation. The theory of “digital natives” suggests a lower hurdle for younger generations to engage with digital technologies.

Objective

The objective of this study was to investigate the role of physicians in the process of digitalizing health care provision in Germany and to assess the age factor.

Methods

We conducted a large-scale study to assess the role of this professional group in the progress of the digital transformation of the German health care sector. Therefore, in an anonymous online survey, we inquired about the current digital penetration of the personal working environment, expectations, attitude toward, and concerns regarding digitalization. Based on these data, we studied associations with the nominal variable age and variations across 2 age groups.

Results

The 1274 participants included in the study generally showed a high affinity towards digitalization with a mean of 3.88 on a 5-point Likert scale; 723 respondents (56.75%) stated they personally use mobile apps in their everyday working life, with a weak tendency to be associated with the respondents’ age (η=0.26). Participants saw the most noticeable existing benefits through digitalization in data quality and readability (882/1274, 69.23%) and the least in patient engagement (213/1274, 16.72%). Medical practitioners preponderantly expect further improvements through increased digitalization across almost all queried areas but the most in access to medical knowledge (1136/1274, 89.17%), treatment of orphan diseases (1016/1274, 79.75%), and medical research (1023/1274, 80.30%).

Conclusions

Respondents defined their role in the digitalization of health care provision as ambivalent: “scrutinizing” on the one hand but “active” and “open” on the other. A gap between willingness to participate and digital sovereignty was indicated. Thus, education on digitalization as a means to support health care provision should not only be included in the course of study but also in the continuing process of further and advanced training.

CyberGenomics: Application of Behavioral Genetics in Cybersecurity

Cybersecurity (CS) is a contemporary field for research and applied study of a range of aspects from across multiple disciplines. A cybersecurity expert has an in-depth knowledge of technology but is often also recognized for the ability to view technology in a non-standard way. This paper explores how CS specialists are both a combination of professional computing-based skills and genetically encoded traits. Almost every human behavioral trait is a result of many genome variants in action altogether with environmental factors. The review focuses on contextualizing the behavior genetics aspects in the application of cybersecurity. It reconsiders methods that help to identify aspects of human behavior from the genetic information. And stress is an illustrative factor to start the discussion within the community on what methodology should be used in an ethical way to approach those questions. CS positions are considered stressful due to the complexity of the domain and the social impact it can have in cases of failure. An individual risk profile could be created combining known genome variants linked to a trait of particular behavior using a special biostatistical approach such as a polygenic score. These revised advancements bring challenging possibilities in the applications of human behavior genetics and CS.

The Importance of the Human Factor in Safety for the Transport of Dangerous Goods

This article discusses the issues related to the safety for the transport of dangerous goods by road. Research on accidents in transport unambiguously points to the human factor, which is the most responsible for causing accidents. Determining the causes of driver unreliability in the human−vehicle−environment system requires thorough research. Unfortunately, in this case, experimental research with human involvement is limited in scope. This leaves modeling and simulation of the behavior of the human factor, i.e., the driver transporting dangerous goods. The human being, because of its complexity, is a challenging element to parameterize. The literature presents various attempts to model human actions. Herein, the authors used heuristic methods, specifically fuzzy set techniques, to build a human factor model. In these models, human actions were specified using a verbal or linguistic description. The specificity of the fuzzy sets allowed for “naturally” limiting the “precision” in describing human behavior. The model was built based on the author’s questionnaire and expert research, based on which individual features were selected. Then, the traits were assigned appropriate states. The output parameter of the model was λ_L—the intensity of human error. The obtained values of the intensity of the accident caused by the driver’s error were implemented into the author’s method of risk assessment. They constituted one of the factors determining the probability of an accident in the transport of dangerous goods, which allowed for determining the optimal route for the transport of these goods characterized by the lowest risk of an undesirable event on the route. The article presents the model’s assumptions, structure, and the features included in the model, all of which have the most significant influence on shaping the intensity of human error. The results of the simulation studies showed a diversified effect of the analyzed characteristics on the driver’s efficiency.

A review of use errors reported in human factor validation studies of biological combination products

Drug-device combination products should be safe and effective for intended uses by intended users under intended use environment during human factor (HF) studies. All known use errors and use-related problems should be considered during design of device and use-related risk analysis. Availability of such information in a compiled manner is scarce. This review compiles information of use errors reported during HF validation studies of biological combination products (drug + device) approved by USFDA's Centre for Drug Evaluation and Research between 21 June 2011 and 31 December 2019. Information regarding product, indication, type of devices, use errors, root causes and mitigation strategies were collected from published documents. Total 280 use errors were reported during HF validation studies of 39 devices across 5 categories. Overall approach and methodology for use error data collection during HF validation studies was in line with the US FDA recommendations. Performance of participants for critical and essential tasks was evaluated during HF validation studies via simulated use assessment, knowledge task assessment and interview. The root causes for use errors reported during HF validation studies were identified and use errors were mitigated by suitable corrective measures. Instructions for use clarification/improvement and labelling improvement were the most common mitigation strategies implemented across devices.

Situation Awareness Measurement in Remotely Controlled Cars

This study reviews the current information concerning the measurement of the situation awareness (SA) of the teleoperated drivers of remotely controlled cars. The teleoperated drivers who drive these cars are in a remote location, and they control the cars through a communication interface. The objective methods with probes are beneficial in measuring SA on a closed circuit without real traffic. Questions specifically should address the information provided on the road by haptic sensations, such as the slope of the road and the vehicle's speed. Methods for measuring SA that involve probes and interruptions obviously are not suitable for use on public roads. A stable environment for the display and control of the communication interface is suitable for an eye tracker in measuring SA. These features also facilitate the use of subjective observer-rating methods. Both of these methods are suitable for driving on real roads because they are not intrusive. SA research in a real-road environment also should demonstrate how the SA of other drivers is affected by seeing a car without a driver. Given the remote character of driving, cultural differences in cognition may have a significant influence on the SA of the teleoperated driver.

The frequency and effects of distractions in operating theatres

BACKGROUND

Operating theatres (OTs) are complex environments where team members complete difficult tasks under stress. Distractions in these environments can lead to errors that compromise patient safety. A range of potential distractions exist in OTs and previous research suggests they are common. This study assesses the nature, frequency and impact of distracting events in the OT at a tertiary New Zealand hospital.

METHODS

Prospective observational study of the frequency, type and impact of OT distractions during a 3-month period. Two observational methods - the frequency of door openings and a validated tool - were used to categorize OT distractions for a range of acute and elective, paediatric and adult surgical procedures according to their cause and effect.

RESULTS

There were 57 procedures (2037 intraoperative minutes) observed. During this time, 721 door openings and 1152 other distracting events were recorded. On average, either a door opening or other distracting event was recorded 56 times per hour of intraoperative time. The frequency of distractions did not vary in relation to acute versus elective or paediatric versus adult procedures but were more common in the morning. Communication unrelated to the case was the most common distracting event: these and equipment issues had the greatest effect on the entire surgical team, usually by causing some interruption to operative flow.

CONCLUSION

Distractions in OTs were common, occurring nearly every minute. Most were trivial, but some had the potential to disrupt the operative procedure and result in patient harm. Reducing distractions in surgery could reduce patient harm and improve resource use.

Implementation of Crisis-Resource-Management-based Team Training in Lower Austria

Objective

Sequelae of medical errors are a significant problem in acute care. Human-factor-based events are frequent but avoidable causes. Thus, non-technical skills are crucial. In 2008, crisis-resource-management (CRM)-based simulation training was established for the medical staff of the Lower Austria Regional Hospitals, one of the largest hospital operators in Europe.

Methods

Implementation and development of simulation training from 2008 until today are described, costs and performance data retrospectively analysed over a 10-year period. The applied methodology and organisational aspects of CRM training are highlighted. To complete the picture, activities triggered through CRM training throughout the hospitals with potential to further improve patient safety are shown.

Results

With an initial funding of €100,000 by the Landeskliniken Holding and course rates of €350 to €500, a simulation programme was established for approximately 1,900 co-workers in the acute care setting. In the past 10 years, more than 2,300 doctors and nurses took part in one of the courses, held by 14 qualified trainers. Training was held in the simulation centre as well as in hospitals. Over the time, simulation facilities have been expanded to 8 different manikins, high-fidelity ventilation and monitoring simulation. In addition, a variety of patient safety activities like implementation of critical incident reporting, OR checklists and anaesthesia briefing was accompanied by the trainer team. The total cost of the project was just under €20, 00,000.

Conclusion

Simulation-based CRM training was successfully introduced and sustainably institutionalised at the NOE LKH group of hospitals. The demand for and acceptance of the training were both excellent. The previous costs of training were relatively low; the organisational model of an independent, non-profit registered association allowed the training activities to be implemented without reducing the availability of the instructors in their clinical roles.

A Pilot Study of Human Factors in an Italian Pediatric Hospital

The introduction of robotic neurorehabilitation among the most recent technologies in pediatrics represents a new opportunity to treat pediatric patients. This study aims at evaluating the response of physiotherapists, patients and their parents to this new technology. The study considered the outcomes of technological innovation in physiotherapists (perception of the workload, satisfaction), as well as that in patients and their parents (quality of life, expectations, satisfaction) by comparing the answers to subjective questionnaires of those who made use of the new technology with those who used the traditional therapy. A total of 12 workers, 46 patients and 47 parents were enrolled in the study. Significant differences were recorded in the total workload score of physiotherapists who use the robotic technology compared with the traditional therapy (p < 0.001). Patients reported a higher quality of life and satisfaction after the use of the robotic neurorehabilitation therapy. The parents of patients undergoing the robotic therapy have moderately higher expectations and satisfaction than those undergoing the traditional therapy. In this pilot study, the robotic neurorehabilitation technique involved a significant increase in the patients’ and parents’ expectations. As it frequently happens in the introduction of new technologies, physiotherapists perceived a greater workload. Further studies are needed to verify the results achieved.

A multi-objective model for a nurse scheduling problem by emphasizing human factors

Assigning nurses to appropriate departments and work shifts based on human factors can strengthen teamwork and boost the efficiency of healthcare systems. The human factors considered in this study include skill, preference, and compatibility of nurses. In this regard, a unique multi-objective mathematical model for nurse scheduling is proposed in this article, in which nurses' decision-making styles are taken into account. Three objectives, including minimization of the total cost of staffing, minimization of the sum of incompatibility among nurses' decision-making styles assigned to the same shift days, and maximization of the overall satisfaction of nurses for their assigned shifts, are addressed in this model. Three meta-heuristics, namely, multi-objective Keshtel algorithm, non-dominated sorting genetic algorithm II, and multi-objective tabu search, are developed to solve the problem. Moreover, a data envelopment analysis method is employed to rank the obtained Pareto solutions. Afterwards, a real-life case at a large hospital in Tehran, Iran, is investigated. Eventually, the applicability and effectiveness of the proposed model are assessed based on the experimental results.

Human Factors in the Cybersecurity of Autonomous Vehicles: Trends in Current Research

The cybersecurity of autonomous vehicles (AVs) is an important emerging area of research in traffic safety. Because human failure is the most common reason for a successful cyberattack, human-factor researchers and psychologists might improve AV cybersecurity by researching how to decrease the probability of a successful attack. We review some areas of research connected to the human factor in cybersecurity and find many potential issues. Psychologists might research the characteristics of people prone to cybersecurity failure, the types of scenarios they fail in and the factors that influence this failure or over-trust of AV. Human behavior during a cyberattack might be researched, as well as how to educate people about cybersecurity. Multitasking has an effect on the ability to defend against a cyberattack and research is needed to set the appropriate policy. Human-resource researchers might investigate the skills required for personnel working in AV cybersecurity and how to detect potential defectors early. The psychological profile of cyber attackers should be investigated to be able to set policies to decrease their motivation. Finally, the decrease of driver's driving skills as a result of using AV and its connection to cybersecurity skills is also worth of research.

Buckling Force Variability of Semmes⁻Weinstein Monofilaments in Successive Use Determined by Manual and Automated Operation

(1) Objective: This study was conducted with the objective of characterizing the variability of a force on a simulated skin surface using the Semmes⁻Weinstein monofilament test (SWMT). (2) Research Design and Methods: Two distinct experiments were performed to determine the effects of human hand motion variability on the monofilament buckling force, and to determine the monofilament's mechanical properties using a positioning stage. (3) Results: In manual operation (by human hand motion), the buckling force over the ten compressions decreased by over 10%, and the human hand motion variations during the SWMT may have impacted the buckling force. When the SWMT was performed under manual control, the buckling force was closely correlated with the number of compressions. In automated operation (by positioning stage), the buckling force was affected not only by the number of compressions but also by both the velocity and the contact angle between the monofilament and the skin surface. (4) Conclusions: The buckling force decreased in ten successive compressions, independent of the hand motion. Hence, medical staff need to consider not only the operator's hand motion but also the effect of repeated trials.

EEG-Based Mental Workload Neurometric to Evaluate the Impact of Different Traffic and Road Conditions in Real Driving Settings

Car driving is considered a very complex activity, consisting of different concomitant tasks and subtasks, thus it is crucial to understand the impact of different factors, such as road complexity, traffic, dashboard devices, and external events on the driver's behavior and performance. For this reason, in particular situations the cognitive demand experienced by the driver could be very high, inducing an excessive experienced mental workload and consequently an increasing of error commission probability. In this regard, it has been demonstrated that human error is the main cause of the 57% of road accidents and a contributing factor in most of them. In this study, 20 young subjects have been involved in a real driving experiment, performed under different traffic conditions (rush hour and not) and along different road types (main and secondary streets). Moreover, during the driving tasks different specific events, in particular a pedestrian crossing the road and a car entering the traffic flow just ahead of the experimental subject, have been acted. A Workload Index based on the Electroencephalographic (EEG), i.e., brain activity, of the drivers has been employed to investigate the impact of the different factors on the driver's workload. Eye-Tracking (ET) technology and subjective measures have also been employed in order to have a comprehensive overview of the driver's perceived workload and to investigate the different insights obtainable from the employed methodologies. The employment of such EEG-based Workload index confirmed the significant impact of both traffic and road types on the drivers' behavior (increasing their workload), with the advantage of being under real settings. Also, it allowed to highlight the increased workload related to external events while driving, in particular with a significant effect during those situations when the traffic was low. Finally, the comparison between methodologies revealed the higher sensitivity of neurophysiological measures with respect to ET and subjective ones. In conclusion, such an EEG-based Workload index would allow to assess objectively the mental workload experienced by the driver, standing out as a powerful tool for research aimed to investigate drivers' behavior and providing additional and complementary insights with respect to traditional methodologies employed within road safety research.

Analysing the effects of working period on psychophysiological states of seafarers

BACKGROUND

Human factor has become a critical issue due to the fact that all operational processes in maritime transportation have been accelerated with technological innovations. Irregular and long working hours, rapid change of working environments and other organisational and/or individual factors have negative impact on the performance of the seafarers as well as other transportation workers and/or shift workers. Seafarers working under the influence of these stressor factors, naturally, are affected from psychophysiological and cognitive aspects, which in return decrease their overall performances. The study mainly aimed to investigate which of the above mentioned affecting factors had greater impact on seafarers' performances.

MATERIALS AND METHODS

For this purpose, data for 14 healthy male seafarers on board different vessels was collected. The collected data included the number of port visits, frequency of change of circadian rhythm, total working hours and watchkeeping periods in the recent month. In order to analyse the psychophysiological effect of working period, electrodermal activity and heart rate variability measurements for arousal mood and data from 2-choice reaction time tests for cognitive performance were collected from the seafarers.

RESULTS

Obtained data was analysed in SPSS software programme applying multiple regression with factor analysis to model the dependence between psychophysiological states of seafarers and working periods.

CONCLUSIONS

According to the results, it was determined that the change of circadian rhythm is the main determinant factor for seafarers. The results showed that when seafarer's circadian rhythm is changed more frequently, they experience more drowsiness.

Human factor-designed multimodal intervention reduces the rate of unused peripheral intravenous cannula insertion

OBJECTIVE

Our objective was to examine the impact of a human factor-designed multimodal intervention on the proportion of unused peripheral i.v. cannula (PIVC) insertion in our ED.

METHODS

A pre- and post-multimodal intervention retrospective cohort study was conducted using a structured electronic medical record review within a single adult tertiary ED in Australia. Pre-intervention data was collected 30 days prior to the multimodal intervention, with 30 day post-intervention data collected 3 months after the intervention commenced. The rates of PIVC inserted, the unused rate and the unused but appropriately inserted cannulas were the main outcome measures.

RESULTS

Intravenous cannula insertion rates decreased by 12.9% (95% confidence interval [CI] 12.19-13.61) between the pre-intervention (1413/4167 [33.9%]; 95% CI 32.5-35.4) and post-intervention cohort (928/4421 [21.0%]; 95% CI 19.8-22.2). An analysis of 754 cases (376 pre-intervention and 378 post-intervention) showed that 139 of 376 (37.0%; 95% CI 32.1-42.1) i.v. cannulas were unused pre-intervention, while 73 of 378 (19.3%; 95% CI 15.4-23.7) was unused post-intervention; an absolute reduction of 17.7% (95% CI 14.98-20.42). The relative risk of an unused i.v. cannula was 0.52 (95% CI 0.41-0.67). The proportion of unused but appropriately inserted i.v. cannulas remained unchanged in both cohorts, with a relative risk of 0.91 (95% CI 0.58-1.42).

CONCLUSION

Our multimodal intervention successfully reduced the number of unused PIVCs inserted in the ED, with a reduction in overall and unused PIVC insertions without any change in appropriate insertions.

A comprehensive prediction and evaluation method of pilot workload

BACKGROUND:

The prediction and evaluation of pilot workload is a key problem in human factor airworthiness of cockpit.

OBJECTIVE:

A pilot traffic pattern task was designed in a flight simulation environment in order to carry out the pilot workload prediction and improve the evaluation method.

METHODS:

The prediction of typical flight subtasks and dynamic workloads (cruise, approach, and landing) were built up based on multiple resource theory, and a favorable validity was achieved by the correlation analysis verification between sensitive physiological data and the predicted value.

RESULTS:

Statistical analysis indicated that eye movement indices (fixation frequency, mean fixation time, saccade frequency, mean saccade time, and mean pupil diameter), Electrocardiogram indices (mean normal-to-normal interval and the ratio between low frequency and sum of low frequency and high frequency), and Electrodermal Activity indices (mean tonic and mean phasic) were all sensitive to typical workloads of subjects.

CONCLUSION:

A multinominal logistic regression model based on combination of physiological indices (fixation frequency, mean normal-to-normal interval, the ratio between low frequency and sum of low frequency and high frequency, and mean tonic) was constructed, and the discriminate accuracy was comparatively ideal with a rate of 84.85%.

Value of Face-to-Face Interactions Between Clinician-Educators and Patients or Students to Improve Health Care Education

The power and outreach of the media is enormous and has restructured our society today; the author acknowledges the impact and appreciates the outreach. However, I question the relative lack of focus on physical human interactions and express concern over future training efforts. I have compared and attempted to highlight the components of two interaction scenarios: those of teacher-student, and those of physician-patient. The physician-educators need to generate a discussion regarding the value of each interaction. As a teacher, there is value in online classrooms, and a different value in face-to-face interactions. Similarly, a physician can have major outreach impact by online tele-medicine and tele-education efforts, but in some instances, may need to have the human, physical interaction with the patient. The value of these interactions depends on the roles in which these interactions are experienced. Medical education training must incorporate an understanding of the unique value of different interactions.

[Comparative study on evaluation algorithms for neck muscle fatigue based on surface electromyography signal]

The purpose of this study is to compare the differences among neck muscle fatigue evaluation algorithms and to find a more effective algorithm which can provide a human factor quantitative evaluation method for neck muscle fatigue during bending over the desk. We collected surface electromyography signal of sternocleidomastoid muscle of 15 subjects using wireless physiotherapy Bio-Radio when they bent over the desk using memory pillows for 12 minutes. Five algorithms including mean power frequency, spectral moments ratio, discrete wavelet transform, fuzzy approximation entropy and the complexity algorithms were used to calculate the corresponding muscle fatigue index. The least squares method was used to calculate the corresponding coefficient of determination R2 and slope k of the linear regression of the muscle fatigue metric. The coefficient of determination R2 evaluates anti-interference ability of algorithms. The maximum vertical distance Lmax which is obtained by the Kolmogorov-Smirnov test for the slopes k evaluates the ability to distinguish fatigue of algorithms. The results indicate that in the aspect of anti-interference ability, the fuzzy approximation entropy has the largest R2 when using memory pillows with different heights. When the fuzzy approximate entropy is compared with average power frequency or the discrete wavelet transform, the differences are significant ( P < 0.05). In terms of distinguishing the degree of fatigue, the approximate entropy is still the largest, with a maximum of 0.496 7. Fuzzy approximation entropy is superior to other algorithms in ability of anti-interference and distinguishing fatigue. Therefore, fuzzy approximation entropy can be used as a better evaluation algorithm in the evaluation of cervical muscle fatigue.

Improvement of polytrauma management-quality inspection of a newly introduced course concept

RATIONALE, AIMS, AND OBJECTIVES

A systematic literature search for training course concepts for care of severely injured and severely ill patients respecting improvement of process and outcome yielded little data. For several years, the University Hospital of Bonn has hosted a shock-room management course which, on the one hand, communicates human factor aspects and, on the other hand, pursues interdisciplinary and interprofessional team training. The Bonn shock-room management course (BSM-course®) differs from other courses in both format and principles. The aim of this study was to evaluate the quality of the structure of the course based on course evaluations of participants and its impact on the quality of the process and results for polytrauma care.

METHODS

Single-center retrospective evaluation study (2011 to 2014). It was based on data from simulator training and records from the German Trauma Registry (DGU)®.

RESULTS

Subjective evaluation of participants (n = 188) of the structure quality of Bonn's shock-room management course was overall positive. Objective measures of course participant performance also improved during simulation training (P = 0.012). An increasing number of trained employees also had a positive influence in reducing process time for shock-room care. Further, the course likewise had a positive impact on documentation quality (degree of completion), with regard to 4 relevant predictive parameters. Early mortality during the first 24 hours remained constant at 6.0-6.5% between 2011 and 2013, yet it decreased to 3.1% in 2014.

CONCLUSION

The BSM-course® represents a symbiosis of horizontal team approach of trauma care and human factor training. The course format is able to ensure interdisciplinary and interprofessional team training with a high degree of efficiency. Furthermore, the presented work shows that a modern course concept can improve the quality of trauma care.

[The psychological profile of pilots of passenger planes: Analysis of temperamental traits, aggression and risk]

BACKGROUND

Over the years it has been assumed, that the greater the number of pilot flight hours, the better the development of problem-solving skills among pilots. Research suggests, however, that the problem is more complex than that. Not only one's experience is of importance - temperament, aggression and risk may also affect the decision-making process under stressful conditions.

MATERIAL AND METHODS

We examined 97 male pilots of passenger planes, who had flew ATRs, Boeings, Airbuses, Embraers, and Saabs. The comparative group was made up of 127 graduates of technical studies (not connected with aviation). In our study, we used the following methods: the PTS (Pavlovian Temperament Survey) Temperament Questionnaire by Strelau, the Aggression Questionnaire by Buss and Perry, and the Stimulating-Instrumental Risk Inventory (SIRI) by Zaleśkiewicz.

RESULTS

Following the analyses we could categorize the pilots into 3 distinct groups: group 1 - strong type of nervous system with a tendency to avoid risk; group 2 - strong type of nervous system with a tendency to take risks; group 3 - the relatively weakest type of nervous system with a tendency toward aggressive behavior.

CONCLUSIONS

Members of each group were analyzed to assess how they function in a task situation, i.e., whilst piloting a passenger plane. The study showed that individuals with high need for stimulation may - consciously or not - seek situations of excessive or unnecessary risks, and this is done in order to reach the right level of stimulation. A constellation of the following variables: temperament, risk, and aggression could be - we argue - useful in psychological examinations, and should be taken into account in training procedures for pilots. Med Pr 2017;68(5):639-651.

A New Perspective for the Training Assessment: Machine Learning-Based Neurometric for Augmented User's Evaluation

Inappropriate training assessment might have either high social costs and economic impacts, especially in high risks categories, such as Pilots, Air Traffic Controllers, or Surgeons. One of the current limitations of the standard training assessment procedures is the lack of information about the amount of cognitive resources requested by the user for the correct execution of the proposed task. In fact, even if the task is accomplished achieving the maximum performance, by the standard training assessment methods, it would not be possible to gather and evaluate information about cognitive resources available for dealing with unexpected events or emergency conditions. Therefore, a metric based on the brain activity (neurometric) able to provide the Instructor such a kind of information should be very important. As a first step in this direction, the Electroencephalogram (EEG) and the performance of 10 participants were collected along a training period of 3 weeks, while learning the execution of a new task. Specific indexes have been estimated from the behavioral and EEG signal to objectively assess the users' training progress. Furthermore, we proposed a neurometric based on a machine learning algorithm to quantify the user's training level within each session by considering the level of task execution, and both the behavioral and cognitive stabilities between consecutive sessions. The results demonstrated that the proposed methodology and neurometric could quantify and track the users' progresses, and provide the Instructor information for a more objective evaluation and better tailoring of training programs.

Acute Supramaximal Exercise Increases the Brain Oxygenation in Relation to Cognitive Workload

Single bout of exercise can improve the performance on cognitive tasks. However, cognitive responses may be controversial due to different type, intensity, and duration of exercise. In addition, the mechanism of the effect of acute exercise on brain is still unclear. This study was aimed to investigate the effects of supramaximal exercise on cognitive tasks by means of brain oxygenation monitoring. The brain oxygenation of Prefrontal cortex (PFC) was measured on 35 healthy male volunteers via functional near infrared spectroscopy (fNIRS) system. Subjects performed 2-Back test before and after the supramaximal exercise wingate anerobic test (WAnT) lasting 30-s on cycle ergometer. The PFC oxygenation change evaluation revealed that PFC oxygenation rise during post-exercise 2-Back task was considerably higher than those in pre-exercise 2-Back task. In order to describe the relationship between oxygenation change and exercise performance, subjects were divided into two groups as high performers (HP) and low performers (LP) according to their peak power values (PP) obtained from the supramaximal test. The oxy-hemoglobin (oxy-Hb) values were compared between pre- and post-exercise conditions within subjects and also between subjects according to peak power. When performers were compared, in the HP group, the oxy-Hb values in post-exercise 2-Back test were significantly higher than those in pre-exercise 2-Back test. HP had significantly higher post-exercise oxy-Hb change (Δ) than those of LP. In addition, PP of the total group were significantly correlated with Δoxy-Hb.The key findings of the present study revealed that acute supramaximal exercise has an impact on the brain oxygenation during a cognitive task. Also, the higher the anerobic PP describes the larger the oxy-Hb response in post-exercise cognitive task. The current study also demonstrated a significant correlation between peak power (exercise load) and post-exercise hemodynamic responses (oxy-, deoxy- and total-Hb). The magnitude of this impact might be related with the physical performance capacities of the individuals. This can become a valuable parameter for future studies on human factor.

Computerized Tomography Scanning and Magnetic Resonance Imaging Will Terminate the Era of the Autopsy - A Hypothesis

Background: Reports on a marked reduction of the number of autopsies performed worldwide to less than 5% of hospital deaths remain without a satisfactory explanation. The premature disappearance of the autopsy might represent a medical tragedy of a major order. One of the causes for the decrease in autopsies is poorly documented: we suspect that the attending physician might show some reluctance when requesting a consent for an autopsy from the bereaved family. Moreover, this officer might consider that the post mortem will add little information to that already obtained from the computerized tomography scanner or the magnetic resonance imaging.

Methods: In order to confirm our hypothesis, we carried out a review of 300 articles indexed as "radiologic-histologic correlation", 118 of which were selected for a significant correlation. From the abstracts, we retrieved the type of the article, the degree of correlation as assessed by the authors and the form of imaging employed, and we computed them.

Results & conclusions: The most striking correlation was observed in the small prospective series. An additional search for the "radiologic-autopsy correlation" supported a marked reduction in the number of post-mortems, especially those related with prospective studies. Based on the present study, we cannot determine precisely the role of the house officer in this tragedy. We may have demonstrated, however, that the modern radiologic methods have not yet reached a high enough performance quality to achieve the status of a candidate substitute for the autopsy.