Sample records for obstetric anesthesia workload

  1. 21 CFR 884.5100 - Obstetric anesthesia set.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Obstetric anesthesia set. 884.5100 Section 884... § 884.5100 Obstetric anesthesia set. (a) Identification. An obstetric anesthesia set is an assembly of... anesthetic drug. This device is used to administer regional blocks (e.g., paracervical, uterosacral, and...

  2. 21 CFR 884.5100 - Obstetric anesthesia set.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Obstetric anesthesia set. 884.5100 Section 884... § 884.5100 Obstetric anesthesia set. (a) Identification. An obstetric anesthesia set is an assembly of... anesthetic drug. This device is used to administer regional blocks (e.g., paracervical, uterosacral, and...

  3. 21 CFR 884.5100 - Obstetric anesthesia set.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Obstetric anesthesia set. 884.5100 Section 884.5100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Obstetrical and Gynecological Therapeutic Devices...

  4. 21 CFR 884.5100 - Obstetric anesthesia set.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Obstetric anesthesia set. 884.5100 Section 884.5100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Obstetrical and Gynecological Therapeutic Devices...

  5. 21 CFR 884.5100 - Obstetric anesthesia set.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Obstetric anesthesia set. 884.5100 Section 884.5100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Obstetrical and Gynecological Therapeutic Devices...

  6. The 2013 Gerard W. Ostheimer Lecture: What's New in Obstetric Anesthesia?

    PubMed

    Palanisamy, A

    2014-02-01

    The "What's New in Obstetric Anesthesia?" lecture is delivered annually in honor of the eminent obstetric anesthesiologist Gerard. W. Ostheimer. This lecture summarizes topics of importance and clinical relevance published in the fields of obstetric anesthesia, obstetrics, and perinatology in the preceding year. The review is a redacted version of the lecture delivered at the Society for Obstetric Anesthesia and Perinatology's Annual Meeting in April 2013. Special emphasis is placed on non-invasive technologies and biomarkers that have the potential to improve clinical care of the pregnant woman. Furthermore, sufficient attention is focused on medical diseases that have their onset or are worsened during pregnancy. Copyright © 2013 Elsevier Ltd. All rights reserved.

  7. [Anesthesia in obstetrics: Tried and trusted methods, current standards and new challenges].

    PubMed

    Kranke, P; Annecke, T; Bremerich, D H; Hanß, R; Kaufner, L; Klapp, C; Ohnesorge, H; Schwemmer, U; Standl, T; Weber, S; Volk, T

    2016-01-01

    Obstetric analgesia and anesthesia have some specific aspects, which in particular are directly related to pathophysiological alterations during pregnancy and also to the circumstance that two or even more individuals are always affected by complications or therapeutic measures. This review article deals with some evergreens and hot topics of obstetric anesthesia and essential new knowledge on these aspects is described. The article summarizes the talks given at the 16th symposium on obstetric anesthesia organized by the Scientific Committee for Regional Anaesthesia and Obstetric Anaesthesia within the German Society of Anaesthesiology. The topics are in particular, special features and pitfalls of informed consent in the delivery room, challenges in education and training in obstetric anesthesia, expedient inclusion of simulation-assisted training and further education on risk minimization, knowledge and recommendations on fasting for the delivery room and cesarean sections, monitoring in obstetric anesthesia by neuraxial and alternative procedures, the possibilities and limitations of using ultrasound for lumbal epidural catheter positioning in the delivery room, recommended approaches in preparing peridural catheters for cesarean section, basic principles of cardiotocography, postoperative analgesia after cesarean section, the practice of early bonding in the delivery room during cesarean section births and the management of postpartum hemorrhage.

  8. Magnesium in obstetric anesthesia and intensive care.

    PubMed

    Kutlesic, Marija S; Kutlesic, Ranko M; Mostic-Ilic, Tatjana

    2017-02-01

    Magnesium, one of the essential elements in the human body, has numerous favorable effects that offer a variety of possibilities for its use in obstetric anesthesia and intensive care. Administered as a single intravenous bolus dose or a bolus followed by continuous infusion during surgery, magnesium attenuates stress response to endotracheal intubation, and reduces intraoperative anesthetic and postoperative analgesic requirements, while at the same time preserving favorable hemodynamics. Applied as part of an intrathecal or epidural anesthetic mixture, magnesium prolongs the duration of anesthesia and diminishes total postoperative analgesic consumption with no adverse maternal or neonatal effects. In obstetric intensive care, magnesium represents a first-choice medication in the treatment and prevention of eclamptic seizures. If used in recommended doses with close monitoring, magnesium is a safe and effective medication.

  9. Continuous Spinal Anesthesia for Obstetric Anesthesia and Analgesia

    PubMed Central

    Veličković, Ivan; Pujic, Borislava; Baysinger, Charles W.; Baysinger, Curtis L.

    2017-01-01

    The widespread use of continuous spinal anesthesia (CSA) in obstetrics has been slow because of the high risk for post-dural puncture headache (PDPH) associated with epidural needles and catheters. New advances in equipment and technique have not significantly overcome this disadvantage. However, CSA offers an alternative to epidural anesthesia in morbidly obese women, women with severe cardiac disease, and patients with prior spinal surgery. It should be strongly considered in parturients who receive an accidental dural puncture with a large bore needle, on the basis of recent work suggesting significant reduction in PDPH when intrathecal catheters are used. Small doses of drug can be administered and extension of labor analgesia for emergency cesarean delivery may occur more rapidly compared to continuous epidural techniques. PMID:28861414

  10. Applications of magnesium sulfate in obstetrics and anesthesia.

    PubMed

    Barbosa, Fabiano Timbó; Barbosa, Luciano Timbó; Jucá, Mário Jorge; Cunha, Rafael Martins da

    2010-01-01

    Magnesium is predominantly an intracellular ion. Its blocking effects on NMDA receptors are responsible for the analgesic and sedative characteristics of this ion. The objective of this study was to review the physiology, pharmacology, and decreased plasma levels of magnesium, as well as its applications in obstetrics and anesthesia. Magnesium is an intracellular cation with multiple functions: it is a cofactor for enzymes of the glucose metabolism and those that participate in the degradation of nucleic acids, proteins, and fatty acids; it regulates the movements of transmembrane ions; and it intervenes in the activity of several enzymes. Critical patients have a tendency to develop hypomagnesemia, and the treatment consists in correcting the cause, whenever possible, and replacement of magnesium. A reduction in the minimum alveolar concentration (MAC) of inhalational agents in animals and the use of opioids in humans under anesthesia has been demonstrated. Magnesium sulfate has been used in obstetrics with good results, inhibiting premature labor and in the treatment of eclampsia-associated seizures. It is potentially analgesic and sedative, and could be used as adjuvant during general anesthesia, attenuating the blood pressure response to tracheal intubation and decreasing the need of anesthetics.

  11. Safer obstetric anesthesia through education and mentorship: a model for knowledge translation in Rwanda.

    PubMed

    Livingston, Patricia; Evans, Faye; Nsereko, Etienne; Nyirigira, Gaston; Ruhato, Paulin; Sargeant, Joan; Chipp, Megan; Enright, Angela

    2014-11-01

    High rates of maternal mortality remain a widespread problem in the developing world. Skilled anesthesia providers are required for the safe conduct of Cesarean delivery and resuscitation during obstetrical crises. Few anesthesia providers in low-resource settings have access to continuing education. In Rwanda, anesthesia technicians with only three years of post-secondary training must manage complex maternal emergencies in geographically isolated areas. The purpose of this special article is to describe implementation of the SAFE (Safer Anesthesia From Education) Obstetric Anesthesia course in Rwanda, a three-day refresher course designed to improve obstetrical anesthesia knowledge and skills for practitioners in low-resource areas. In addition, we describe how the course facilitated the knowledge-to-action (KTA) cycle whereby a series of steps are followed to promote the uptake of new knowledge into clinical practice. The KTA cycle requires locally relevant teaching interventions and continuation of knowledge post intervention. In Rwanda, this meant carefully considering educational needs, revising curricula to suit the local context, employing active experiential learning during the SAFE Obstetric Anesthesia course, encouraging supportive relationships with peers and mentors, and using participant action plans for change, post-course logbooks, and follow-up interviews with participants six months after the course. During those interviews, participants reported improvements in clinical practice and greater confidence in coordinating team activities. Anesthesia safety remains challenged by resource limitations and resistance to change by health care providers who did not attend the course. Future teaching interventions will address the need for team training.

  12. Pharmacogenetics in obstetric anesthesia.

    PubMed

    Landau, Ruth; Kraft, John C

    2010-06-01

    Genomic research in pain, anesthesia and analgesia generated some hope that pharmacogenetics may guide anesthesiologists to provide effective medicine in a 'tailored' manner. Within the field of obstetric anesthesia, relatively few studies have evaluated the effect of polymorphisms on the perception of labor or postcesarean pain or the response to analgesics for childbirth. Because of the multifactorial nature of labor and delivery pain and particularly challenging clinical context, many consider that 'titration of drugs to the desired effect works just fine'. With recent evidence highlighting an association between severe postdelivery pain and persistent pain, early recognition of an increased susceptibility for acute pain has become particularly relevant. Neuraxial labor analgesia is influenced by a common polymorphism of the mu-opioid receptor gene. This polymorphism also affects the analgesic response to systemic opioids for postcesarean pain and other types of surgeries. Finally, the risk for persistent pain after cesarean deliveries may be associated with a certain genetic profile. Although still premature to anticipate clinical implications and a change in practice based on these recent discoveries, genetic variability clearly appears to affect pain perception, response to analgesics and predisposition for the development of chronic pain.

  13. Long-term forecasting of anesthesia workload in operating rooms from changes in a hospital's local population can be inaccurate.

    PubMed

    Masursky, Danielle; Dexter, Franklin; O'Leary, Colleen E; Applegeet, Carol; Nussmeier, Nancy A

    2008-04-01

    Anesthesia department planning depends on forecasting future demand for perioperative services. Little is known about long-range forecasting of anesthesia workload. We studied operating room (OR) times at Hospital A over 16 yr (1991-2006), anesthesia times at Hospital B over 26 yr (1981-2006), and cases at Hospital C over 13 yr (1994-2006). Each hospital is >100 yr old and is located in a US city with other hospitals that are >50 yr old. Hospitals A and B are the sole University hospitals in their metropolitan statistical areas (and many counties beyond). Hospital C is the sole tertiary hospital for >375 km. Each hospital's choice of a measure of anesthesia work to be analyzed was likely unimportant, as the annual hours of anesthesia correlated highly both with annual numbers of cases (r = 0.98) and with American Society of Anesthesiologist's Relative Value Guide units of work (r = 0.99). Despite a 2% decline in the local population, the hours of OR time at Hospital A increased overall (Pearson r = -0.87, P < 0.001) and for children (r = -0.84). At Hospital B, there was a strong positive correlation between population and hours of anesthesia (r = 0.97, P < 0.001), but not between annual increases in population and workload (r = -0.18). At Hospital C, despite a linear increase in population, the annual numbers of cases increased, declined with opening of two outpatient surgery facilities, and then stabilized. The predictive value of local personal income was low. In contrast, the annual increases in the hours of OR time and anesthesia could be modeled using simple time series methods. Although growth of the elderly population is a simple justification for building more ORs, managers should be cautious in arguing for strategic changes in capacity at individual hospitals based on future changes in the national age-adjusted population. Local population can provide little value in forecasting future anesthesia workloads at individual hospitals. In addition, anesthesia

  14. A Contemporary Analysis of Medicolegal Issues in Obstetric Anesthesia Between 2005 and 2015.

    PubMed

    Kovacheva, Vesela P; Brovman, Ethan Y; Greenberg, Penny; Song, Ellen; Palanisamy, Arvind; Urman, Richard D

    2018-05-10

    Detailed reviews of closed malpractice claims have provided insights into the most common events resulting in litigation and helped improve anesthesia care. In the past 10 years, there have been multiple safety advancements in the practice of obstetric anesthesia. We investigated the relationship among contributing factors, patient injuries, and legal outcome by analyzing a contemporary cohort of closed malpractice claims where obstetric anesthesiology was the principal defendant. The Controlled Risk Insurance Company (CRICO) is the captive medical liability insurer of the Harvard Medical Institutions that, in collaboration with other insurance companies and health care entities, contributes to the Comparative Benchmark System database for research purposes. We reviewed all (N = 106) closed malpractice cases related to obstetric anesthesia between 2005 and 2015 and compared the following classes of injury: maternal death and brain injury, neonatal death and brain injury, maternal nerve injury, and maternal major and minor injury. In addition, settled claims were compared to the cases that did not receive payment. χ, analysis of variance, Student t test, and Kruskal-Wallis tests were used for comparison between the different classes of injury. The largest number of claims, 54.7%, involved maternal nerve injury; 77.6% of these claims did not receive any indemnity payment. Cases involving maternal death or brain injury comprised 15.1% of all cases and were more likely to receive payment, especially in the high range (P = .02). The most common causes of maternal death or brain injury were high neuraxial blocks, embolic events, and failed intubation. Claims for maternal major and minor injury were least likely to receive payment (P = .02) and were most commonly (34.8%) associated with only emotional injury. Compared to the dropped/denied/dismissed claims, settled claims more frequently involved general anesthesia (P = .03), were associated with delays in care (P = .005

  15. Implications of National Anesthesia Workload on the Staffing of a Call Center: The Malignant Hyperthermia Consultant Hotline.

    PubMed

    Dexter, Franklin; Rosenberg, Henry; Epstein, Richard H; Semo, Judith Jurin; Litman, Ronald S

    2015-08-01

    Recently, we analyzed data from the American Society of Anesthesiologist's (ASA) Anesthesia Quality Institute (AQI) to report the United States (U.S.) anesthesia workload by time of day and day of the week. The AQI data were reported using the Central Time zone. Times for the N = 613 calls to the Malignant Hyperthermia Association of the United States (MHAUS) Malignant Hyperthermia (MH) Hotline from August 1, 2012, through March 7, 2014, were adjusted similarly. The MH Hotline effectively provides at all times to each anesthesia group an additional board-certified anesthesiologist who has expertise in managing, diagnosing, and/or preventing MH crises. We compared the timing of calls with the MH Hotline consultants relative to times of most anesthesia workload nationally. The interval 6:30 AM to 6:30 PM Central Time on regular workdays accounted for most (P < 0.0001) calls to the MH Hotline (62.5% ± 2.0% [mean ± standard error]). However, the interval accounted for significantly less than the 82.2% of anesthesia minutes and 84.5% of general anesthesia minutes during that interval nationally (both P < 0.0001). Thus, most calls to the MH Hotline occurred when anesthesia groups nationwide were the busiest. Weekends accounted for 15.3% ± 1.5% of MH Hotline calls, significantly greater than the rates of 5.2% of anesthesia minutes and 4.3% of general anesthesia minutes during weekends nationally (both P < 0.0001). Thus, the MH Hotline was used proportionately more often when anesthesia providers have fewer colleagues present and available for consultation (all P < 0.0001). These findings may be expected of other (future) national support centers for anesthesia.

  16. Influence of Obstetric Practice on Workload and Practice Patterns of Family Physicians and Obstetrician-Gynecologists

    PubMed Central

    Dresden, Graham M.; Baldwin, Laura-Mae; Andrilla, C. Holly A.; Skillman, Susan M.; Benedetti, Thomas J.

    2008-01-01

    PURPOSE Obstetric practice among family physicians has declined in recent years. This study compared the practice patterns of family physicians and obstetrician-gynecologists with and without obstetric practices to provide objective information on one potential reason for this decline—the impact of obstetrics on physician lifestyle. METHODS In 2004, we surveyed all obstetrician-gynecologists, all rural family physicians, and a random sample of urban family physicians identified from professional association lists (N =2,564) about demographics, practice characteristics, and obstetric practices. RESULTS A total of 1,197 physicians (46.7%) overall responded to the survey (41.5% of urban family physicians, 54.7% of rural family physicians, and 55.0% of obstetrician-gynecologists). After exclusions, 991 were included in the final data set. Twenty-seven percent of urban family physicians, 46% of rural family physicians, and 79% of obstetrician-gynecologists practiced obstetrics. The mean number of total professional hours worked per week was greater with obstetric practice than without for rural family physicians (55.4 vs 50.2, P=.005) and for obstetrician-gynecologists (58.3 vs 43.5, P = .000), but not for urban family physicians (47.8 vs 49.5, P = .27). For all 3 groups, physicians practicing obstetrics were more likely to provide inpatient care and take call than physicians not practicing obstetrics. Large proportions of family physicians, but not obstetrician-gynecologists, took their own call for obstetrics. Concerns about the litigation environment and personal issues were the most frequent reasons for stopping obstetric practice. CONCLUSIONS Practicing obstetrics is associated with an increased workload for family physicians. Organizing practices to decrease the impact on lifestyle may support family physicians in practicing obstetrics. PMID:18195307

  17. Current applications of big data in obstetric anesthesiology.

    PubMed

    Klumpner, Thomas T; Bauer, Melissa E; Kheterpal, Sachin

    2017-06-01

    The narrative review aims to highlight several recently published 'big data' studies pertinent to the field of obstetric anesthesiology. Big data has been used to study rare outcomes, to identify trends within the healthcare system, to identify variations in practice patterns, and to highlight potential inequalities in obstetric anesthesia care. Big data studies have helped define the risk of rare complications of obstetric anesthesia, such as the risk of neuraxial hematoma in thrombocytopenic parturients. Also, large national databases have been used to better understand trends in anesthesia-related adverse events during cesarean delivery as well as outline potential racial/ethnic disparities in obstetric anesthesia care. Finally, real-time analysis of patient data across a number of disparate health information systems through the use of sophisticated clinical decision support and surveillance systems is one promising application of big data technology on the labor and delivery unit. 'Big data' research has important implications for obstetric anesthesia care and warrants continued study. Real-time electronic surveillance is a potentially useful application of big data technology on the labor and delivery unit.

  18. Working toward quality in obstetric anesthesia: a business approach.

    PubMed

    Lynde, Grant C

    2017-06-01

    Physicians are increasingly required to demonstrate that they provide quality care. How does one define quality? A significant body of literature in industries outside of health care provides guidance on how to define appropriate metrics, create teams to troubleshoot problem areas, and sustain those improvements. The modern quality movement in the United States began in response to revolutionary gains in both quality and productivity in Japanese manufacturing in the 1980's. Applying these lessons to the healthcare setting has been slow. Hospitals are only now introducing tools such as failure mode and effect analysis, Lean and Six Sigma into their quality divisions and are seeing significant cost reductions and outcomes improvements. The review will discuss the process for creating an effective quality program for an obstetric anesthesia division. Sustainable improvements in delivered care need to be based on an evaluation of service line needs, defining appropriate metrics, understanding current process flows, changing and measuring those processes, and developing mechanisms to ensure the new processes are maintained.

  19. To press or not to press, and if so, with what? A single question-focused meta-analysis of vasopressor choice during regional anesthesia in obstetrics.

    PubMed

    Biddle, Chuck

    2013-08-01

    Given the underlying assumption that reasonable maternal hemodynamics can be achieved with either ephedrine or phenylephrine, this focused meta-analysis addresses the impact of vasopressor choice on resultant neonatal Apgar scores during regional anesthesia. The literature was systematically searched for randomized trials of obstetric vasopressor use employing standard search tools. Only the highest quality trials were included. Of 142 studies retrieved, 9 met the defined inclusion criteria. Apgar scores at 1 and 5 minutes in the ephedrine group (served as control) vs the phenylephrine group did not differ at either time epoch; no abnormal values prevailed in either group (relative risk, 0.88; CI, 0.79-1.16). This meta-analysis focused on the most clinically relevant, immediately available information pertinent in the obstetric suite, the Apgar score, and found that ephedrine and phenylephrine did not differ in their effect on this metric. The current meta-analysis provides an updated, evidence-based validation of vasopressor use from the American Society of Anesthesiologists' 2007 "Practice Guidelines for Obstetric Anesthesia".

  20. Racial and Ethnic Disparities in Mode of Anesthesia for Cesarean Delivery

    PubMed Central

    Butwick, Alexander J; Blumenfeld, Yair J; Brookfield, Kathleen F.; Nelson, Lorene M; Weiniger, Carolyn F

    2015-01-01

    Background Racial and ethnic disparities have been identified in the provision of neuraxial labor analgesia. These disparities may exist in other key aspects of obstetric anesthesia care. We sought to determine if racial/ethnic disparities exist in mode of anesthesia for cesarean delivery (CD). Methods Women who underwent CD between 1999 and 2002 at 19 different obstetric centers in the United States were identified from the Maternal-Fetal Medicine Units Network Cesarean Registry. Race/ethnicity was categorized as: Caucasian, African-American, Hispanic, Non-Hispanic Others (NHOs). Mode of anesthesia was classified as neuraxial anesthesia (spinal, epidural or combined spinal-epidural anesthesia) or general anesthesia. To account for obstetric and nonobstetric covariates that may have influenced mode of anesthesia, multiple logistic regression analyses were performed using sequential sets of covariates. Results The study cohort comprised 50,974 women who underwent CD. Rates of general anesthesia among racial/ethnic groups were: 5.2% for Caucasians, 11.3% for African Americans, 5.8% for Hispanics and 6.6% for NHOs. After adjustment for obstetric and nonobstetric covariates, African Americans had the highest odds of receiving general anesthesia compared to Caucasians (adjusted odds ratio (aOR) = 1.7; 95% CI: 1.5 – 1.8; P<0.001). The odds of receiving general anesthesia were also higher among Hispanics (aOR = 1.1; 95% CI: 1.0 – 1.3; P=0.02) and NHOs (aOR = 1.2; 95% CI: 1.0 – 1.4; P=0.03) compared to Caucasians, respectively. In our sensitivity analysis, we reconstructed the models after excluding women who underwent neuraxial anesthesia prior to general anesthesia. The adjusted odds of receiving general anesthesia were similar to those in the main analysis: African-Americans (aOR=1.7; 95% CI=1.5 – 1.9; P<0.001; Hispanics (aOR=1.2; 95% CI=1.1 – 1.4; P=0.006); and NHOs (aOR=1.2; 95% CI=1.0 – 1.5; P=0.05). Conclusion Based on data from the Cesarean Registry

  1. Labor epidural anesthesia, obstetric factors and breastfeeding cessation.

    PubMed

    Dozier, Ann M; Howard, Cynthia R; Brownell, Elizabeth A; Wissler, Richard N; Glantz, J Christopher; Ternullo, Sharon R; Thevenet-Morrison, Kelly N; Childs, Cynthia K; Lawrence, Ruth A

    2013-05-01

    Breastfeeding benefits both infant and maternal health. Use of epidural anesthesia during labor is increasingly common and may interfere with breastfeeding. Studies analyzing epidural anesthesia's association with breastfeeding outcomes show mixed results; many have methodological flaws. We analyzed potential associations between epidural anesthesia and overall breast-feeding cessation within 30 days postpartum while adjusting for standard and novel covariates and uniquely accounting for labor induction. A pooled analysis using Kaplan-Meier curves and modified Cox Proportional Hazard models included 772 breastfeeding mothers from upstate New York who had vaginal term births of healthy singleton infants. Subjects were drawn from two cohort studies (recruited postpartum between 2005 and 2008) and included maternal self-report and maternal and infant medical record data. Analyses of potential associations between epidural anesthesia and overall breastfeeding cessation within 1 month included additional covariates and uniquely accounted for labor induction. After adjusting for standard demographics and intrapartum factors, epidural anesthesia significantly predicted breastfeeding cessation (hazard ratio 1.26 [95% confidence interval 1.10, 1.44], p < 0.01) as did hospital type, maternal age, income, education, planned breastfeeding goal, and breastfeeding confidence. In post hoc analyses stratified by Baby Friendly Hospital (BFH) status, epidural anesthesia significantly predicted breastfeeding cessation (BFH: 1.19 [1.01, 1.41], p < 0.04; non-BFH: 1.65 [1.31, 2.08], p < 0.01). A relationship between epidural anesthesia and breastfeeding was found but is complex and involves institutional, clinical, maternal and infant factors. These findings have implications for clinical care and hospital policies and point to the need for prospective studies.

  2. The Society for Obstetric Anesthesia and Perinatology consensus statement on the management of cardiac arrest in pregnancy.

    PubMed

    Lipman, Steven; Cohen, Sheila; Einav, Sharon; Jeejeebhoy, Farida; Mhyre, Jill M; Morrison, Laurie J; Katz, Vern; Tsen, Lawrence C; Daniels, Kay; Halamek, Louis P; Suresh, Maya S; Arafeh, Julie; Gauthier, Dodi; Carvalho, Jose C A; Druzin, Maurice; Carvalho, Brendan

    2014-05-01

    This consensus statement was commissioned in 2012 by the Board of Directors of the Society for Obstetric Anesthesia and Perinatology to improve maternal resuscitation by providing health care providers critical information (including point-of-care checklists) and operational strategies relevant to maternal cardiac arrest. The recommendations in this statement were designed to address the challenges of an actual event by emphasizing health care provider education, behavioral/communication strategies, latent systems errors, and periodic testing of performance. This statement also expands on, interprets, and discusses controversial aspects of material covered in the American Heart Association 2010 guidelines.

  3. [Study on the first translated obstetrics book Tai chan ju yao (Essentials in Obstetrics)].

    PubMed

    Wu, M

    2018-01-28

    In 1893, Wan Tsun-mo translated and published Tai chan ju yao ( Essentials in Obstetrics ), the first monograph of western obstetrics in modern China, symbolizing the independence of obstetrics from such maternal and child books as Fu ying xin shuo and Fu ke jing yun tu shuo , which occupies an important position in the history of the development of modern Chinese obstetrics. The book introduced anatomy, physiology, pathology, embryology, diagnostics, surgery, pharmacology and other knowledge of obstetrics in a catechismal form, and had a detailed discussion of such advanced obstetrical technologies as antiseptic, anesthesia, forceps and cesarean section for the first time.Judging from the content and translation of Tai chan ju yao , this book has already possessed the basic knowledge system of modern obstetrics, though the translation appeared to be somewhat jerky and not elegant and the terminology needing to be further improved, it was not only used as an important medium for the introduction of obstetrical knowledge, but also of great clinical value.However, its influence was so weak that later researchers seldom mentioned this book.

  4. Labor Epidural Anesthesia, Obstetric Factors and Breastfeeding Cessation

    PubMed Central

    Dozier, Ann M.; Howard, Cynthia R.; Brownell, Elizabeth A.; Wissler, Richard N.; Glantz, J. Christopher; Ternullo, Sharon R.; Thevenet-Morrison, Kelly N.; Childs, Cynthia K.; Lawrence, Ruth A.

    2013-01-01

    Objective Breastfeeding benefits both infant and maternal health. Use of epidural anesthesia during labor is increasingly common and may interfere with breastfeeding. Studies analyzing epidural anesthesia’s association with breastfeeding outcomes show mixed results; many have methodological flaws. We analyzed potential associations between epidural anesthesia and overall breast-feeding cessation within 30 days postpartum while adjusting for standard and novel covariates and uniquely accounting for labor induction. Methods A pooled analysis using Kaplan-Meier curves and modified Cox Proportional Hazard models included 772 breastfeeding mothers from upstate New York who had vaginal term births of healthy singleton infants. Subjects were drawn from two cohort studies (recruited postpartum between 2005 and 2008) and included maternal self-report and maternal and infant medical record data. Results Analyses of potential associations between epidural anesthesia and overall breastfeeding cessation within one month included additional covariates and uniquely accounted for labor induction. After adjusting for standard demographics and intrapartum factors, epidural anesthesia significantly predicted breastfeeding cessation (hazard ratio 1.26 [95%confidence interval 1.10, 1.44], p<.01) as did hospital type, maternal age, income, education, planned breastfeeding goal, and breastfeeding confidence. In post hoc analyses stratified by Baby Friendly Hospital (BFH) status, epidural anesthesia significantly predicted breastfeeding cessation (BFH: 1.19 [1.01,1.41], p<.04; non-BFH: 1.65 [1.31, 2.08], p<.01). Conclusions A relationship between epidural anesthesia and breastfeeding was found but is complex and involves institutional, clinical, maternal and infant factors. These findings have implications for clinical care and hospital policies and point to the need for prospective studies. PMID:22696104

  5. Establishing Obstetric Anesthesiology Practice Guidelines in the Republic of Armenia: A Global Health Collaboration.

    PubMed

    Yuill, Gordon; Amroyan, Ashot; Millar, Simon; Vardapetyan, Emil; Habib, Ashraf S; Owen, Medge D

    2017-08-01

    Disparity exists in anesthesia practices between high- and low-to-middle income countries, and awareness has been raised within the global health community to improve the standards of anesthesia care and patient safety. The establishment of international collaborations and appropriate practice guidelines may help address clinical care deficiencies. This report's aim was to assess the impact of a multiyear collaboration on obstetric anesthesia practices in the Republic of Armenia. An invited multinational team of physicians conducted six visits to Armenia between 2006 and 2015 to observe current practice and establish standards of obstetric anesthesia care. The Armenian Society of Anaesthesiologists and Intensive Care specialists collected data on the numbers of vaginal delivery, cesarean delivery, and neuraxial anesthesia use in maternity units during the period. Data were analyzed with the Fisher exact or chi-square test, as appropriate. Neuraxial anesthesia use for cesarean delivery increased significantly (P < 0.0001) in all 10 maternity hospitals within the capital city of Yerevan. For epidural labor analgesia, there was sustained or increased use in only two hospitals. For hospitals located outside the capital city, there was a similar increase in the use of neuraxial anesthesia for cesarean delivery that was greater in hospitals that were visited by an external team (P < 0.0001); however, use of epidural labor analgesia was not increased significantly. Over the course of the collaboration, guidelines for obstetric anesthesia were drafted and approved by the Armenian Ministry of Health. Collaboration between Armenian anesthesiologists and dedicated visiting physicians to update and standardize obstetric anesthesia practices led to national practice guidelines and sustained improvements in clinical care in the Republic of Armenia.

  6. Fluoride-Containing Metabolites after Methoxyflurane Anesthesia,

    DTIC Science & Technology

    Methoxyflurane (2,2-dichloro-1,1-difluoroethyl methyl ether) has been used for about 12 years for analgesia and anesthesia in surgery and obstetrics...Interest in methoxyflurane fluorometabolites arose when markedly elevated serum fluoride concentrations in a nephrotoxic patient were traced to the...use of methoxyflurane anesthesia for surgery. These high fluoride levels were peculiar in that the ionselective fluoride electrode did not detect a

  7. Operating room clinicians' ratings of workload: a vignette simulation study.

    PubMed

    Wallston, Kenneth A; Slagle, Jason M; Speroff, Ted; Nwosu, Sam; Crimin, Kimberly; Feurer, Irene D; Boettcher, Brent; Weinger, Matthew B

    2014-06-01

    Increased clinician workload is associated with medical errors and patient harm. The Quality and Workload Assessment Tool (QWAT) measures anticipated (pre-case) and perceived (post-case) clinical workload during actual surgical procedures using ratings of individual and team case difficulty from every operating room (OR) team member. The purpose of this study was to examine the QWAT ratings of OR clinicians who were not present in the OR but who read vignettes compiled from actual case documentation to assess interrater reliability and agreement with ratings made by clinicians involved in the actual cases. Thirty-six OR clinicians (13 anesthesia providers, 11 surgeons, and 12 nurses) used the QWAT to rate 6 cases varying from easy to moderately difficult based on actual ratings made by clinicians involved with the cases. Cases were presented and rated in random order. Before rating anticipated individual and team difficulty, the raters read prepared clinical vignettes containing case synopses and much of the same written case information that was available to the actual clinicians before the onset of each case. Then, before rating perceived individual and team difficulty, they read part 2 of the vignette consisting of detailed role-specific intraoperative data regarding the anesthetic and surgical course, unusual events, and other relevant contextual factors. Surgeons had higher interrater reliability on the QWAT than did OR nurses or anesthesia providers. For the anticipated individual and team workload ratings, there were no statistically significant differences between the actual ratings and the ratings obtained from the vignettes. There were differences for the 3 provider types in perceived individual workload for the median difficulty cases and in the perceived team workload for the median and more difficult cases. The case difficulty items on the QWAT seem to be sufficiently reliable and valid to be used in other studies of anticipated and perceived clinical

  8. Regional Obstetric Anesthesia and Newborn Behavior: A Reanalysis toward Synergistic Effects.

    ERIC Educational Resources Information Center

    Lester, Barry M.; And Others

    1982-01-01

    The Brazelton Neonatal Behavioral Assessment Scale was administered to 54 full-term, healthy infants on days 1 through 5 and on days 7 and 10. Infants were divided into eight groups, differing in terms of the obstetrical medication mothers received. Low dosages of obstetrical medication were found to have significant but subtle effects on the…

  9. Mental health of residents during Obstetrics and Gynecology training in Thailand.

    PubMed

    Prasertsiri, K; Suntharasaj, T; Pitanupong, J

    2006-03-01

    To evaluate mental health of residents during Obstetrics and Gynecology training and identify the factors that affect mental health problems. During January-April 2004, one hundred and sixty Obstetrics and Gynecology residents (62% of 259) had completed a self-administered questionnaire composed of demographic data, workload, self-report of life stressors, and the Thai Mental Health Questionnaire (TMHQ-70). The prevalence of mental health problems was 29% (46/160). Somatization and social function were found in the first and second rank (18.1% and 11.9%), respectively. A resident who was younger than 25 years old, was married, cared for more than 20 patients per 8 hours in the labor room, performed more than 10 academic activities per year, or attended more than 5 examinations per year was at risk to develop social function problems. About one-third of residents training in Obstetrics and Gynecology have faced mental health problems--somatization, social function, depression and anxiety. The significant risk factors associated with social function problems were younger age, marriage and excessive workload

  10. [Importance of an outpatient record in obstetric anesthesia].

    PubMed

    Lanza, V; Mercadante, S; Pignataro, A; Guglielmo, L; Villari, P; Di Fiore, G; Sapio, M; De Michele, P; Vegna, G

    1991-01-01

    A computerised record was used to collect data following an anesthesiological check-up of pregnant women at approximately 30 weeks of pregnancy. The record was input onto a portable PC in the anesthesia outpatient clinic, memorized on disk (3.5") and then transferred onto a PC network (one PC for each operating theatre) for "real time" consultation of each patient's data. All pregnant women attending the antenatal clinico were also given a folder illustrating epidural anesthetic techniques. Seven hundred and nine outpatient visits have been performed over the past two years with a 62% utilisation ratio. The collection of data using a computerised system allows a rapid and efficacious system of communication to be set up among the membranes of the anesthesiological team, thus encouraging the use of epidural techniques during labour. The distribution of the folder also facilitated the task of the anesthetist who found that pregnant women visiting the anesthesia clinic were already familiar with the epidural technique.

  11. An Early History of Anesthesia in Labor.

    PubMed

    Gibson, Mary E

    Fear of pain often overshadows childbirth, and each woman must decide whether to receive anesthesia to combat labor pain. Historically, this choice resulted in unintended consequences and marked the beginnings of medical interventions in labor and birth. The purpose of this article is to trace the use of anesthesia in childbirth from the mid-19th to the mid-20th centuries and to explore its influence on childbearing women and nurses. Copyright © 2017 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

  12. Anesthesia for cesarean delivery in the Czech Republic: a 2011 national survey.

    PubMed

    Stourac, Petr; Blaha, Jan; Klozova, Radka; Noskova, Pavlina; Seidlova, Dagmar; Brozova, Lucie; Jarkovsky, Jiri

    2015-06-01

    The purpose of this national survey was to determine current anesthesia practices for cesarean delivery in the Czech Republic. In November 2011, we invited all departments of obstetric anesthesia in the Czech Republic to participate in a prospective study to monitor consecutive peripartum obstetric anesthesia procedures. Data were recorded online in the TrialDB database (Yale University, New Haven, CT). The response rate was 51% (49 of 97 departments); participating centers represented 60% of all births in the country during the study period. There were 1943 cases of peripartum anesthesia care, of which 1166 cases (60%) were anesthesia for cesarean delivery. Estimates were weighted based on population distribution of cesarean delivery among types of participating centers. Neuraxial anesthesia was used in 55.6% (95% confidence interval [CI], 52.8%-58.5%); the distribution of anesthesia techniques differed among type of participating center. The rate of neuraxial anesthesia in university hospitals was 55.6% (95% CI, 51.5%-59.6%), 32.4% (95% CI, 26.4%-39.0%) in regional hospitals, and 60.7% (95% CI, 55.2%-66.0%) in local hospitals. The reasons for cesarean delivery under general anesthesia were emergency procedure (67%), refusal of neuraxial blockade by parturient (30%), failure of neuraxial anesthesia (6%), and preoperative administration of low-molecular-weight heparin (3%). Postcesarean analgesia was primarily provided by systemic opioid (66%) and nonopioid analgesics (61%), solely or in combination. Epidural postoperative analgesia was used in 14% of cases. Compared with national neuraxial anesthesia rate data published in the 1990s (6.7% in 1993), there has been an upward trend in the use of neuraxial anesthesia for cesarean delivery during the 21st century (40.5% in 2000) in the Czech Republic. The rate of neuraxial anesthesia use for cesarean delivery has increased in the Czech Republic in the last 2 decades. However, the current rate of general anesthesia is

  13. Clinical outcomes after external cephalic version with spinal anesthesia after failure of a first attempt without anesthesia.

    PubMed

    Massalha, Manal; Garmi, Gali; Zafran, Noah; Carmeli, Julia; Gimburg, Genady; Salim, Raed

    2017-12-01

    To determine whether repeat external cephalic version (ECV) with spinal anesthesia affects clinical outcomes and cesarean delivery rates. A retrospective study was conducted using data collected at one hospital in Israel between January 1, 2009, and December 31, 2015. Women with non-vertex singleton pregnancies (≥37 weeks) who had a failed ECV attempt without spinal anesthesia were included in the analysis. All women were offered a repeat ECV with spinal anesthesia. Outcomes assessed were rates of vertex presentation at delivery, successful repeat ECV, and cesarean delivery. Overall, 145 of 213 ECV attempts without spinal anesthesia were successful. Of the 68 women with a failed attempt, 5 (7%) experienced spontaneous version and 18 (26%) delivered at another institution or went into spontaneous labor. Among the remaining 45 women, 28 (62%) agreed to a repeat ECV with spinal anesthesia; 11 (39%) of these procedures were successful. All 11 women experienced vertex presentation at delivery versus none of the 17 women who refused repeat ECV (P=0.003). The cesarean delivery rate was 64% (18/28) versus 100% (17/17), respectively (P=0.007). Repeat ECV with spinal anesthesia after a failed first attempt without spinal anesthesia increased vertex presentation at birth and decreased the rate of cesarean delivery. © 2017 International Federation of Gynecology and Obstetrics.

  14. Retrospective analysis of obstetric and anesthetic management of patients with placenta accreta spectrum disorders.

    PubMed

    Riveros-Perez, Efrain; Wood, Cristina

    2018-03-01

    To assess the management and maternal outcomes of placenta accreta spectrum (PAS) disorders. A retrospective chart review was conducted of patients diagnosed with PAS disorders (placenta creta, increta, or percreta) who were treated at a US tertiary care center between February 1, 2011, and January 31, 2016. Obstetric management, anesthetic management, and maternal outcomes were analyzed. A total of 43 cases were identified; placenta previa was diagnosed among 33 (77%). Median age was 33 years (range 23-42). Median blood loss was 1500 mL (interquartile range 1000-2500); blood loss was greatest among the 10 patients with placenta percreta (3250 mL, interquartile range 2200-6000). Transfusion of blood products was necessary among 14 (33%) patients, with no difference in frequency according to the degree of placental invasion (P=0.107). Surgical complications occurred among 10 (23%) patients. Overall, 30 (70%) patients received combined spinal-epidural plus general anesthesia, 4 (9%) received only general anesthesia, and 9 (21%) underwent surgery with combined spinal-epidural anesthesia. One patient experienced difficult airway and another experienced accidental dural puncture. Placenta previa and accreta coexist in many patients, leading to substantial bleeding related to the degree of myometrial invasion. An interdisciplinary team approach plus the use of combined spinal-epidural anesthesia, transitioning to general anesthesia, were advisable and safe. © 2017 International Federation of Gynecology and Obstetrics.

  15. [Cranial nerve damage after neuroaxial methods of anesthesia in puerperas].

    PubMed

    Floka, S E; Shifman, E M

    2007-01-01

    The paper describes cranial nerve damage, a rare complication of neuroaxial anesthesia in obstetric care. In the literature, there are summarized data on 17 cases of neurological deficit developing after subarachnoidal or epidural anesthesia in puerperas. The etiological and pathogenetic factors of the above complications may be suggested to be the high disposition of a local anesthetic, arterial hypotension due to neuroaxial anesthetics, the outflow of cerebrospinal fluid after pachymeningeal puncture (including after unintended puncture during epidural anesthesia), and ischemic injury after the blood packing performed to relieve postpuncture headache. Closer consideration of these risk factors seems to reduce the incidence of cranial nerve damage in puerperas.

  16. In Defense of the Obstetrician and Obstetrics

    PubMed Central

    Hoffman, Ralph L.

    1965-01-01

    Changes and advances in obstetrics are emphasized by the comparative study of private and one hospital practice in 1939 and 1964. Education, prenatal care, anesthesia, antibiotics, transfusions have all been instrumental. Old problems—abortion, toxemia, prematurity, developmental abnormalities—remain with us. New developments, both professional and economic, some not desirable, face us and demand that active practicing obstetricians take an active role in helping direct their course. PMID:5847740

  17. Simulated Crisis in Obstetric Anesthesia: Design and Evaluation of a Distance Education Presentation

    PubMed Central

    Murray, W. Bosseau; Schneider, Art; Underberg, Karin; Henry, Jody; Foster, Pat; Vaduva, Sorin; Venable, J. Clark; Shindel, Michelle

    2001-01-01

    Patient simulators are useful tools for training residents and all levels of medical personnel. Simulator usefulness, in small group sessions, is limited by the costs of training large numbers of people. We present an interrupted methodology designed to involve a large group at a location remote from the simulator. The goal was to enable the remote participants to take part in decision making while under time pressure. Two volunteers were chosen as hands-on participants while eighteen remaining anesthesiology residents observed from a lecture room via a closed circuit audio/video feed. A series of five crises in obstetric anesthesia was presented. After each crisis the simulation was paused and the observers were given three minutes to formulate a differential diagnosis and plan to be carried out. At the end of the session facilitators led a debriefing session with all participants. Surveys completed after the simulation indicated that most residents felt personally involved in the simulation, despite being physically removed from it. Surveys also showed that residents believed they learned more from this format than they would have from a lecture. Residents recalled an average of 3.4 crises two days after the session. This paper presents a model for distance education using a simulator and shows that residents believed remote, interrupted, interactive simulator training is valuable. The interrupted nature and involvement of remotely located peers differentiate this methodology from a passive viewing of a remote session. Further study is warranted to quantify the effectiveness of group and/or distance training with a simulator. PMID:27175412

  18. Predicting obstetric anal sphincter injuries in a modern obstetric population.

    PubMed

    Meister, Melanie R L; Cahill, Alison G; Conner, Shayna N; Woolfolk, Candice L; Lowder, Jerry L

    2016-09-01

    sphincter injuries. After adjusted analysis, significant predictors for laceration included nulliparity, non-black race, longer second stage, nonsmoking status, higher infant birthweight, and operative delivery. Private health insurance, labor induction, pushing duration, and regional anesthesia were not statistically significant in adjusted analyses. Significant risk factors for obstetric anal sphincter injury were similar to predictors for any laceration; nulliparity and operative vaginal delivery had the highest predictive value. Area under the curve for the predictive ability of the models was 0.70 for overall perineal laceration, and 0.83 for obstetric anal sphincter injury. When limited to primiparous patients, 1996 term vaginal deliveries were recorded. One hundred ninety-two women sustained an obstetric anal sphincter injury; 1796 women did not. After adjusted analysis, significant predictors for laceration included non-black race, age, obesity, and nonsmoking status. In secondary analyses, significant predictors for obstetric anal sphincter injury included non-black race, nonsmoking status, longer duration of pushing, operative vaginal delivery, and infant birthweight. Area under the curve for the predictive ability of the models was 0.60 for any laceration and 0.77 for obstetric anal sphincter injury. Significant risk factors for sustaining any laceration and obstetric anal sphincter injury during vaginal deliveries were identified. These results will help identify clinically at-risk patients and assist providers in counseling patients about modifications to decrease these risks. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Generalizable items of quantitative and qualitative cornerstones for personnel requirement of physicians in anesthesia

    PubMed Central

    Weiss, Manfred; Rossaint, Rolf; Iber, Thomas

    2017-01-01

    Anesthesiologists perform a broad spectrum of tasks. However, in many countries, there is no legal basis for personnel staffing of physicians in anesthesia. Also, the German diagnosis related groups system for refunding does not deliver such a basis. Thus, in 2006 a new calculation base for the personnel requirement that included an Excel calculation sheet was introduced by the German Board of Anesthesiologists (BDA) and the German Society of Anesthesiology and Intensive Care Medicine (DGAI), and updated in 2009 and 2015. Oriented primarily to organizational needs, in 2015, BDA/DGAI defined quantitative and qualitative cornerstones for personnel requirement of physicians in anesthesia, especially reflecting recent laws governing physician’s working conditions and competence in the field of anesthesia, as well as demands of strengthened legal rights of patients, patient care and safety. We present a workload-oriented model, integrating core working hours, shift work or standby duty, quality of care, efficiency of processes, legal, educational, controlling, local, organizational and economic aspects for calculating personnel demands. Auxiliary tables enable physicians to calculate personnel demands due to differing employee workload, non-patient oriented tasks and reimbursement of full-equivalents due to parental leave, prohibition of employment, or long-term illness. After 10 years of experience with the first calculation tool, we report the generalizable key aspects and items of a necessary calculation tool which may help physicians to justify realistic workload-oriented personnel staffing demands in anesthesia. A modular, flexible nature of a calculation tool should allow adaption to the respective legal and organizational demands of different countries. PMID:28529910

  20. [Drugs for intravenous induction of anesthesia: barbiturates].

    PubMed

    Dumps, C; Halbeck, E; Bolkenius, D

    2018-05-09

    The discovery of barbituric acid and research on its derivatives have long been of importance in advancements in modern anesthesia. Decades of clinical use of barbiturates worldwide and their abuse has led to an enormous amount of knowledge. Thiopental and methohexital are ultra-short acting derivatives of barbiturates. Their clinical application has been accompanied by an enormous increase in the knowledge of the pharmacology of cerebrally active drugs, in particular gamma-aminobutyric acid (GABA A ) receptor and GABA-induced effects on nerve cell membranes. Despite the development of newer substances, thiopental still has a firm place in clinical applications. Currently it is mainly used in obstetrics for induction of cesarean sections under general anesthesia. A disadvantage, when properly used to induce anesthesia, is usually only the prolonged elimination kinetics of barbiturates. It is beneficial that barbiturates do not require side effect provoking solubilizers.

  1. Comparison of 25-gauge, Quincke and Whitacre needles for postdural puncture headache in obstetric patients.

    PubMed

    Bano, Fauzia; Haider, Saeeda; Aftab, Sadqa; Sultan, S Tipu

    2004-11-01

    To compare the frequency of postdural puncture headache (PDPH) and failure rate of spinal anesthesia using 25-gauge Quincke and 25-gauge Whitacre needles in obstetric patients. Single blinded, interventional experimental study. This study was conducted at the Department of Anesthesiology, Pain Management and Surgical Intensive Care Unit, Dow University of Health Sciences and Civil Hospital, Karachi from November 1, 2003-April 15, 2004. One hundred females, aged 18-35 years, ASA physical status I and II, with singleton pregnancy undergoing elective or emergency cesarean section under spinal anesthesia were randomly allocated to receive spinal anesthesia either by using 25-gauge Quincke or 25-gauge Whitacre needles. Patients were followed for 3 days postoperatively. Headache, its relation with posture, onset, duration, severity and response to the treatment were recorded. Compared with the Whitacre group, frequency of postdural puncture headache was significantly higher in Quincke group (*p=0.015), while the overall occurrence of non-postdural puncture headache (NPDPH) did not differ significantly between two groups (p=0.736). Most of PDPH developed on 2nd postoperative day, were mild in nature and resolved within 48 hours of their onset. There was no significant difference in the failure rate of spinal anesthesia in both groups (p=0.149). It is suggested that use of 25-gauge Whitacre needle reduces the frequency of PDPH without increasing the failure rate of spinal anesthesia in obstetric patients.

  2. Assessment of workload using NASA Task Load Index in perianesthesia nursing.

    PubMed

    Young, Gloria; Zavelina, Lyubov; Hooper, Vallire

    2008-04-01

    According to the Institute of Medicine (IOM), as many as 44,000 to 98,000 people in the United States die in hospitals every year due to medical errors. Multiple physiological and psychological factors can impact the health care provider's attention span, making medical errors more likely. Some of these factors include increased workload, fatigue, cognitive overload, ineffective interpersonal communications, and faulty information processing. Postanesthesia nurses, responsible for providing care to unstable patients emerging from anesthesia with multiple life-threatening conditions, must make critical decisions on a minute-by-minute basis. The current ASPAN Patient Classification/Recommended Staffing Guidelines does not adequately take into account varying care requirements among the patients. If a tool could be found that effectively evaluated staff's workload, ongoing assessment would be enhanced and resources better used. The National Aeronautics and Space Administration-Task Load Index (NASA-TLX), a multifaceted tool for evaluating perceptual (subjective) workload, has seen extensive applications and is widely regarded as the strongest tool available for reporting perceptions of workload. This article will survey various uses of the NASA-TLX and consider the potential uses for this tool in perianesthesia nursing.

  3. The Workload Curve: Subjective Mental Workload.

    PubMed

    Estes, Steven

    2015-11-01

    In this paper I begin looking for evidence of a subjective workload curve. Results from subjective mental workload assessments are often interpreted linearly. However, I hypothesized that ratings of subjective mental workload increase nonlinearly with unitary increases in working memory load. Two studies were conducted. In the first, the participant provided ratings of the mental difficulty of a series of digit span recall tasks. In the second study, participants provided ratings of mental difficulty associated with recall of visual patterns. The results of the second study were then examined using a mathematical model of working memory. An S curve, predicted a priori, was found in the results of both the digit span and visual pattern studies. A mathematical model showed a tight fit between workload ratings and levels of working memory activation. This effort provides good initial evidence for the existence of a workload curve. The results support further study in applied settings and other facets of workload (e.g., temporal workload). Measures of subjective workload are used across a wide variety of domains and applications. These results bear on their interpretation, particularly as they relate to workload thresholds. © 2015, Human Factors and Ergonomics Society.

  4. Compliance with the CONSORT checklist in obstetric anaesthesia randomised controlled trials.

    PubMed

    Halpern, S H; Darani, R; Douglas, M J; Wight, W; Yee, J

    2004-10-01

    The Consolidated Standards for Reporting of Trials (CONSORT) checklist is an evidence-based approach to help improve the quality of reporting randomised controlled trials. The purpose of this study was to determine how closely randomised controlled trials in obstetric anaesthesia adhere to the CONSORT checklist. We retrieved all randomised controlled trials pertaining to the practice of obstetric anaesthesia and summarised in Obstetric Anesthesia Digest between March 2001 and December 2002 and compared the quality of reporting to the CONSORT checklist. The median number of correctly described CONSORT items was 65% (range 36% to 100%). Information pertaining to randomisation, blinding of the assessors, sample size calculation, reliability of measurements and reporting of the analysis were often omitted. It is difficult to determine the value and quality of many obstetric anaesthesia clinical trials because journal editors do not insist that this important information is made available to readers. Both clinicians and clinical researchers would benefit from uniform reporting of randomised trials in a manner that allows rapid data retrieval and easy assessment for relevance and quality.

  5. Obstetric simulation as a risk control strategy: course design and evaluation.

    PubMed

    Gardner, Roxane; Walzer, Toni B; Simon, Robert; Raemer, Daniel B

    2008-01-01

    Patient safety initiatives aimed at reducing medical errors and adverse events are being implemented in Obstetrics. The Controlled Risk Insurance Company (CRICO), Risk Management Foundation (RMF) of the Harvard Medical Institutions pursued simulation as an anesthesia risk control strategy. Encouraged by their success, CRICO/RMF promoted simulation-based team training as a risk control strategy for obstetrical providers. We describe the development, implementation, and evaluation of an obstetric simulation-based team training course grounded in crisis resource management (CRM) principles. We pursued systematic design of course development, implementation, and evaluation in 3 phases, including a 1-year or more posttraining follow-up with self-assessment questionnaires. The course was highly rated overall by participants immediately after the course and 1-year or more after the course. Most survey responders reported having experienced a critical clinical event since the course and that various aspects of their teamwork had significantly or somewhat improved as a result of the course. Most (86%) reported CRM principles as useful for obstetric faculty and most (59%) recommended repeating the simulation course every 2 years. A simulation-based team-training course for obstetric clinicians was developed and is a central component of CRICO/RMF's obstetric risk management incentive program that provides a 10% reduction in annual obstetrical malpractice premiums. The course was highly regarded immediately and 1 year or more after completing the course. Most survey responders reported improved teamwork and communication in managing a critical obstetric event in the interval since taking the course. Simulation-based CRM training can serve as a strategy for mitigating adverse perinatal events.

  6. The impact of curve severity on obstetric complications and regional anesthesia utilization in pregnant patients with adolescent idiopathic scoliosis: a preliminary analysis.

    PubMed

    Chan, Emily W; Gannon, Stephen R; Shannon, Chevis N; Martus, Jeffrey E; Mencio, Gregory A; Bonfield, Christopher M

    2017-10-01

    OBJECTIVE Adolescent idiopathic scoliosis (AIS), the most common type of scoliosis, often presents immediately prior to a woman's childbearing years; however, research investigating the impact of AIS on women's health, particularly pregnancy delivery outcomes, is sparse, with existing literature reporting mixed findings. Similarly limited are studies examining the change in scoliotic curve during or after pregnancy. Therefore, this study aims to determine 1) the impact of scoliotic curvature on obstetric complications (preterm births, induction of labor, and urgent/emergency caesarean section delivery), 2) regional anesthetic decision making and success during delivery for these patients, and 3) the effect of pregnancy on curve progression. METHODS Records of all pregnant patients diagnosed with AIS at the authors' institution who delivered between January 2002 and September 2016 were retrospectively reviewed. Demographic information, pre- and postpartum radiographic Cobb angles, and clinical data for each pregnancy and delivery were recorded and analyzed. The Wilcoxon rank-sum test and the Wilcoxon signed-rank test were used for statistical analyses. RESULTS Fifty-nine patients (84 deliveries) were included; 14 patients had undergone prior posterior spinal fusion. The median age at AIS diagnosis was 15.2 years, and the median age at delivery was 21.8 years. Overall, the median major Cobb angle prior to the first pregnancy was 25° (IQR 15°-40°). Most births were by spontaneous vaginal delivery (n = 45; 54%); elective caesarean section was performed in 17 deliveries (20%). Obstetric complications included preterm birth (n = 18; 21.4%), induction of labor (n = 20; 23.8%), and urgent/emergency caesarean section (n = 12; 14.0%); none were associated with severity of scoliosis curve or prior spinal fusion. Attempts at spinal anesthesia were successful 99% of the time (70/71 deliveries), even among the patients who had undergone prior spinal fusion (n = 13). There

  7. Review article: safety aspects of anesthesia in under-resourced locations.

    PubMed

    Enright, Angela

    2013-02-01

    Improving patient safety during anesthesia and surgery is the focus of much effort worldwide. Major advances have occurred since the 1980s, especially in economically advantaged areas. This paper is a review of some of the challenges that face those who work in resource-poor areas of the world. There is a shortage of trained anesthesia providers, both physician and non-physician, and this is particularly acute outside urban areas. Anesthesia is still sometimes delivered by unqualified people, which results in expected high rates of morbidity and mortality. Residency training programs in low-income countries ought to increase their output as anesthesiologists must be available to supervise non-physician providers. All groups require continuing medical education. In addition, increased efforts are needed to recruit trainees into the specialty of anesthesia and to retain them locally. There is a well-recognized shortage of resources for anesthesia. Consequently, concerted efforts are necessary to ensure reliable supplies of drugs, and attention should be paid to the procurement of anesthesia equipment appropriate for the location. Biomedical support must also be developed. Lifebox is a charitable foundation dedicated to supplying pulse oximeters to low- and middle-income countries. Adoption of the World Health Organization's Surgical Safety Checklist could further reduce morbidity and mortality. Much time, effort, planning, and resources are required to ensure that anesthesia in low-income areas can reach internationally accepted standards. Such investment in anesthesia would result in wider access to surgical and obstetrical care, and the quality and safety of that care would be much improved.

  8. The state of Illinois obstetric hemorrhage project: pre-project and post-training examination scores.

    PubMed

    Wong, Cynthia A; Scott, Shirley; Jones, Robin L; Walzer, Jennifer; Geller, Stacie

    2016-03-01

    The Illinois Department of Public Health mandated that all clinicians who provide care to obstetric patients participate in the Illinois Obstetric Hemorrhage Project. The aim of the current report is to describe change in knowledge among providers engaged in the project, as assessed by pre- and post-tests. The project, implemented 2008 to 2010, included four components: a written 25-item multiple-choice examination (pre-test), a didactic lecture, skill stations (for teaching blood loss estimation), and a simulation drill and debriefing. Participants completed a post-test 6 months later. Pre- and post-test examination scores were compared. Data from 95 hospitals are included in this analysis (9456 paired test results). The proportion of participants who scored ≥88% correct answers increased from 10.9% on the pre-test to 49.1% on the post-test (p < 0.0001). Registered nurses made greater improvements in test scores than anesthesia and obstetric providers (p < 0.0001). The Illinois Obstetric Hemorrhage Project was successful in improving knowledge of obstetric hemorrhage in a large number of providers with different expertise and experience levels. Further long-term study is essential to determine whether the skills acquired during the Project contribute to improved obstetric hemorrhage outcomes for the women of Illinois.

  9. [A day in the busy obstetric unit from the anesthesiologist point of view, experience at the Cleveland clinic; Cleveland, Ohio].

    PubMed

    Ootaki, Chiyo; Barsoum, Sabri

    2009-10-01

    Cleveland Clinic Labor and Delivery Unit is a syntactical delivery facility and comprised of 16 delivery rooms, 3 operating rooms, 3 triage rooms, and 1 recovery room that has a capacity of 6 beds, 43 postpartum rooms, 2 nurseries, and 1 neonatal intensive care unit (NICU). Cleveland Clinic Labor and Delivery Unit (LDU) had 3,691 delivery cases in 2007. The ratio of neuraxial analgesia (NA) during labor is 84.2% (2,348/ 2,787), using epidural anesthesia or combined spinalepidural anesthesia (CSEA). This article introduces the obstetrical (OB) anesthesia practice at the Cleveland Clinic and our novel anesthetic regime as typical of one typical busy day.

  10. Mode of anesthesia and postoperative symptoms following abdominal hysterectomy in a fast-track setting.

    PubMed

    Wodlin, Ninnie Borendal; Nilsson, Lena; Arestedt, Kristofer; Kjølhede, Preben

    2011-04-01

    To determine whether postoperative symptoms differ between women who undergo abdominal benign hysterectomy in a fast-track model under general anesthesia or spinal anesthesia with intrathecal morphine. Secondary analysis from a randomized, open, multicenter study. Five hospitals in south-east Sweden. One-hundred and eighty women scheduled for benign hysterectomy were randomized; 162 completed the study; 82 were allocated to spinal and 80 to general anesthesia. The Swedish Postoperative Symptoms Questionnaire, completed daily for 1 week and thereafter once a week until 5 weeks postoperatively. Occurrence, intensity and duration of postoperative symptoms. Women who had hysterectomy under spinal anesthesia with intrathecal morphine experienced significantly less discomfort postoperatively compared with those who had the operation under general anesthesia. Spinal anesthesia reduced the need for opioids postoperatively. The most common symptoms were pain, nausea and vomiting, itching, drowsiness and fatigue. Abdominal pain, drowsiness and fatigue occurred significantly less often and with lower intensity among the spinal anesthesia group. Although postoperative nausea and vomiting was reported equally in the two groups, vomiting episodes were reported significantly more often during the first day after surgery in the spinal anesthesia group. Spinal anesthesia was associated with a higher prevalence of postoperative itching. Spinal anesthesia with intrathecal morphine carries advantages regarding postoperative symptoms and recovery following fast-track abdominal hysterectomy. © 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.

  11. Liberian surgical and anesthesia infrastructure: a survey of county hospitals.

    PubMed

    Knowlton, Lisa Marie; Chackungal, Smita; Dahn, Bernice; LeBrun, Drake; Nickerson, Jason; McQueen, Kelly

    2013-04-01

    There is a significant burden of disease in low-income countries that can benefit from surgical intervention. The goal of this survey was to evaluate the current ability of the Liberian health care system to provide safe surgical care and to identify unmet needs in regard to trained personnel, equipment, infrastructure, and outcomes measurement. A comprehensive survey tool was developed to assess physical infrastructure of operative facilities, education and training for surgical and anesthesia providers, equipment and medications, and the capacity of the surgical system to collect and evaluate surgical outcomes at district-level hospitals in Africa. This tool was implemented in a sampling of 11 county hospitals in Liberia (January 2011). Data were obtained from the Ministry of Health and by direct government-affiliated hospital site visits. The total catchment area of the 11 hospitals surveyed was 2,313,429--equivalent to roughly 67 % of the population of Liberia (3,476,608). There were 13 major operating rooms and 34 (1.5 per 100,000 population) physicians delivering surgical, obstetric, or anesthesia care including 2 (0.1 per 100,000 population) who had completed formal postgraduate training programs in these specialty areas. The total number of surgical cases for 2010 was 7,654, with approximately 43 % of them being elective procedures. Among the facilities that tracked outcomes in 2010, a total of 11 intraoperative deaths (145 per 100,000 operative cases) were recorded for 2009. The 30-day postoperative mortality at hospitals providing data was 44 (1,359 per 100,000 operative cases). Metrics were also used to evaluate surgical output, safety of anesthesia, and the burden of obstetric disease. A significant volume of surgical care is being delivered at county hospitals throughout Liberia. The density and quality of appropriately trained personnel and infrastructure remain critically low. There is strong evidence for continued development of emergency and

  12. Change in risk status during labor in a large Norwegian obstetric department: a prospective study.

    PubMed

    Lippert, Tonje; Nesje, Ellen; Koss, Karen Sofie; Oian, Pål

    2013-06-01

    This study aimed to observe risk status on admission to hospital and change in risk status during labor. A prospective observational study allocating all women into low-risk and high-risk groups on admittance to hospital and during labor based on prespecified risk criteria. Department of Obstetrics and Gynecology in a district hospital. All 6406 deliveries from 2 May 2004 to 30 September 2006. A special form was filled out for all women admitted to the department in labor classifying them as either low or high risk. A change in risk status during labor was also recorded. Risk status (low and high risk) on admittance to hospital and change in risk status during first stage of labor. On admittance, 67% of women with an intended vaginal delivery were low risk. During the first stage of labor, 41% of the low-risk women changed risk status. Use of epidural anesthesia gave rise to 73% of the risk changes during the first stage of labor and use of oxytocin caused 12%. Two-thirds of the women were low risk before labor, and 39% of these remained low-risk at the end of the first stage of labor. The main reason for a change of risk status in the obstetric department was the use of epidural anesthesia. © 2013 The Authors Acta Obstetricia et Gynecologica Scandinavica © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

  13. Closed-loop control of anesthesia: a primer for anesthesiologists.

    PubMed

    Dumont, Guy A; Ansermino, J Mark

    2013-11-01

    Feedback control is ubiquitous in nature and engineering and has revolutionized safety in fields from space travel to the automobile. In anesthesia, automated feedback control holds the promise of limiting the effects on performance of individual patient variability, optimizing the workload of the anesthesiologist, increasing the time spent in a more desirable clinical state, and ultimately improving the safety and quality of anesthesia care. The benefits of control systems will not be realized without widespread support from the health care team in close collaboration with industrial partners. In this review, we provide an introduction to the established field of control systems research for the everyday anesthesiologist. We introduce important concepts such as feedback and modeling specific to control problems and provide insight into design requirements for guaranteeing the safety and performance of feedback control systems. We focus our discussion on the optimization of anesthetic drug administration.

  14. Panel workload assessment in US primary care: accounting for non-face-to-face panel management activities.

    PubMed

    Arndt, Brian; Tuan, Wen-Jan; White, Jennifer; Schumacher, Jessica

    2014-01-01

    An understanding of primary care provider (PCP) workload is an important consideration in establishing optimal PCP panel size. However, no widely acceptable measure of PCP workload exists that incorporates the effort involved with both non-face-to-face patient care activities and face-to-face encounters. Accounting for this gap is critical given the increase in non-face-to-face PCP activities that has accompanied electronic health records (EHRs) (eg, electronic messaging). Our goal was to provide a comprehensive assessment of perceived PCP workload, accounting for aspects of both face-to-face and non-face-to-face encounters. Internal medicine, family medicine, and pediatric PCPs completed a self-administered survey about the perceived workload involved with face-to-face and non-face-to-face panel management activities as well as the perceived challenge associated with caring for patients with particular biomedical, demographic, and psychosocial characteristics (n = 185). Survey results were combined with EHR data at the individual patient and PCP service levels to assess PCP panel workload, accounting for face-to-face and non-face-to-face utilization. Of the multiple face-to-face and non-face-to-face activities associated with routine primary care, PCPs considered hospital admissions, obstetric care, hospital discharges, and new patient preventive health visits to be greater workload than non-face-to-face activities such as telephone calls, electronic communication, generating letters, and medication refills. Total workload within PCP panels at the individual patient level varied by overall health status, and the total workload of non-face-to-face panel management activities associated with routine primary care was greater than the total workload associated with face-to-face encounters regardless of health status. We used PCP survey results coupled with EHR data to assess PCP workload associated with both face-to-face as well as non-face-to-face panel management

  15. Risk factors for failed conversion of labor epidural analgesia to cesarean delivery anesthesia: a systematic review and meta-analysis of observational trials.

    PubMed

    Bauer, M E; Kountanis, J A; Tsen, L C; Greenfield, M L; Mhyre, J M

    2012-10-01

    This systematic review and meta-analysis evaluates evidence for seven risk factors associated with failed conversion of labor epidural analgesia to cesarean delivery anesthesia. Online scientific literature databases were searched using a strategy which identified observational trials, published between January 1979 and May 2011, which evaluated risk factors for failed conversion of epidural analgesia to anesthesia or documented a failure rate resulting in general anesthesia. 1450 trials were screened, and 13 trials were included for review (n=8628). Three factors increase the risk for failed conversion: an increasing number of clinician-administered boluses during labor (OR=3.2, 95% CI 1.8-5.5), greater urgency for cesarean delivery (OR=40.4, 95% CI 8.8-186), and a non-obstetric anesthesiologist providing care (OR=4.6, 95% CI 1.8-11.5). Insufficient evidence is available to support combined spinal-epidural versus standard epidural techniques, duration of epidural analgesia, cervical dilation at the time of epidural placement, and body mass index or weight as risk factors for failed epidural conversion. The risk of failed conversion of labor epidural analgesia to anesthesia is increased with an increasing number of boluses administered during labor, an enhanced urgency for cesarean delivery, and care being provided by a non-obstetric anesthesiologist. Further high-quality studies are needed to evaluate the many potential risk factors associated with failed conversion of labor epidural analgesia to anesthesia for cesarean delivery. Copyright © 2012 Elsevier Ltd. All rights reserved.

  16. Keeping ether "en-vogue": the role of Nathan Cooley Keep in the history of ether anesthesia.

    PubMed

    Guralnick, Walter C; Kaban, Leonard B

    2011-07-01

    In this report, we explore the little known role of Dr Nathan Cooley Keep in the dissemination of ether anesthesia in Boston. Keep was a prominent Boston dentist who, for a short time, taught and employed both William Morton and Horace Wells. He used ether anesthesia for a variety of dental and other surgical procedures requiring pain control. Keep administered ether to anesthetize Henry Wadsworth Longfellow's wife during the delivery of their daughter. This was the first use of ether for obstetric anesthesia. Dr Keep was also the first Dean of the Harvard Dental School and convinced the Massachusetts General Hospital to appoint a dentist to the staff of the hospital for the first time. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  17. Selection and concentration of obstetric facilities in Japan: Longitudinal study based on national census data.

    PubMed

    Matsumoto, Masatoshi; Koike, Soichi; Matsubara, Shigeki; Kashima, Saori; Ide, Hiroo; Yasunaga, Hideo

    2015-06-01

    A shortage of obstetricians with increased workload is a social problem in Japan. In response, the government and professional bodies have accelerated the 'selection and concentration' of obstetric facilities. The aim of this study was to evaluate the recent trend of selection and concentration. We used data on the number of deliveries and of obstetricians in each hospital and clinic in Japan, according to the Static Survey of Medical Institutions in 2005, 2008 and 2011. To evaluate the inter-facility equality of distribution of the number of deliveries, number of obstetricians and number of deliveries per obstetrician, Gini coefficients were calculated. The number of obstetric hospitals decreased by 20% and the number of deliveries per hospital increased by 26% between 2005 and 2011. Hospital obstetricians increased by 16% and the average number of obstetricians per hospital increased by 19% between 2008 and 2011. Gini coefficient of deliveries has significantly decreased. In contrast, Gini coefficient of deliveries per obstetrician has significantly increased. The degree of increase in obstetricians and of decrease in deliveries per obstetrician was largest at the hospitals with the highest proportion of cesarean sections. The proportion of obstetric hospitals with the optimal volume of deliveries and obstetricians, as defined by Japan Society of Obstetrics and Gynecology, was 4% in 2008, and it had doubled to 8.1% 3 years later. The selection and concentration of obstetric facilities is progressing rapidly and effectively in Japan. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

  18. Recommendations for anesthesia and perioperative management in patients with Ehlers-Danlos syndrome(s)

    PubMed Central

    2014-01-01

    Ehlers-Danlos syndrome (EDS, ORPHA98249) comprises a group of clinically and genetically heterogeneous heritable connective tissue disorders, chiefly characterized by joint hypermobility and instability, skin texture anomalies, and vascular and soft tissue fragility. As many tissues can be involved, the underlying molecular defect can manifest itself in many organs and with varying degrees of severity, with widespread implications for anesthesia and perioperative management. This review focuses on issues relevant for anesthesia for elective and emergency surgery in EDS. We searched the literature for papers related to all EDS variants; at the moment most of the published data deals with the vascular subtype and, to a lesser extent, classic and hypermobility EDS. Knowledge is fragmented and consists mostly of case reports, small case series and expert opinion. Because EDS patients commonly require surgery, we have summarized some recommendations for general, obstetrical and regional anesthesia, as well as for hemostatic therapy. PMID:25053156

  19. Flight Crew Workload Evaluation Based on the Workload Function Distribution Method.

    PubMed

    Zheng, Yiyuan; Lu, Yanyu; Jie, Yuwen; Fu, Shan

    2017-05-01

    The minimum flight crew on the flight deck should be established according to the workload for individual crewmembers. Typical workload measures consist of three types: subjective rating scale, task performance, and psychophysiological measures. However, all these measures have their own limitations. To reflect flight crew workload more specifically and comprehensively within the flight environment, and more directly comply with airworthiness regulations, the Workload Function Distribution Method, which combined the basic six workload functions, was proposed. The analysis was based on the different conditions of workload function numbers. Each condition was analyzed from two aspects, which were overall proportion and effective proportion. Three types of approach tasks were used in this study and the NASA-TLX scale was implemented for comparison. Neither the one-function condition nor the two-function condition had the same results with NASA-TLX. However, both the three-function and the four- to six- function conditions were identical with NASA-TLX. Further, the significant differences were different on four to six conditions. The overall proportion was insignificant, while the effective proportions were significant. The results show that the conditions with one function and two functions seemed to have no influence on workload, while executing three functions and four to six functions had an impact on workload. Besides, effective proportions of workload functions were more precisely compared with the overall proportions to indicate workload, especially in the conditions with multiple functions.Zheng Y, Lu Y, Jie Y, Fu S. Flight crew workload evaluation based on the workload function distribution method. Aerosp Med Hum Perform. 2017; 88(5):481-486.

  20. Aplastic anemia during pregnancy: a review of obstetric and anesthetic considerations

    PubMed Central

    Riveros-Perez, Efrain; Hermesch, Amy C; Barbour, Linda A; Hawkins, Joy L

    2018-01-01

    Aplastic anemia is a hematologic condition occasionally presenting during pregnancy. This pathological process is associated with significant maternal and neonatal morbidity and mortality. Obstetric and anesthetic management is challenging, and treatment requires a coordinated effort by an interdisciplinary team, in order to provide safe care to these patients. In this review, we describe the current state of the literature as it applies to the complexity of aplastic anemia in pregnancy, focusing on pathophysiologic aspects of the disease in pregnancy, as well as relevant obstetric and anesthetic considerations necessary to treat this challenging problem. A multidisciplinary-team approach to the management of aplastic anemia in pregnancy is necessary to coordinate prenatal care, optimize maternofetal outcomes, and plan peripartum interventions. Conservative transfusion management is critical to prevent alloimmunization. Although a safe threshold-platelet count for neuraxial anesthesia has not been established, selection of anesthetic technique must be evaluated on a case-to-case basis. PMID:29535558

  1. Nursing workload in the acute-care setting: A concept analysis of nursing workload.

    PubMed

    Swiger, Pauline A; Vance, David E; Patrician, Patricia A

    2016-01-01

    A pressing need in the field of nursing is the identification of optimal staffing levels to ensure patient safety. Effective staffing requires comprehensive measurement of nursing workload to determine staffing needs. Issues surrounding nursing workload are complex, and the volume of workload is growing; however, many workload systems do not consider the numerous workload factors that impact nursing today. The purpose of this concept analysis was to better understand and define nursing workload as it relates to the acute-care setting. Rogers' evolutionary method was used for this literature-based concept analysis. Nursing workload is influenced by more than patient care. The proposed definition of nursing workload may help leaders identify workload that is unnoticed and unmeasured. These findings could help leaders consider and identify workload that is unnecessary, redundant, or more appropriate for assignment to other members of the health care team. Published by Elsevier Inc.

  2. Patient injuries from anesthesia gas delivery equipment: a closed claims update.

    PubMed

    Mehta, Sonya P; Eisenkraft, James B; Posner, Karen L; Domino, Karen B

    2013-10-01

    Improvements in anesthesia gas delivery equipment and provider training may increase patient safety. The authors analyzed patient injuries related to gas delivery equipment claims from the American Society of Anesthesiologists Closed Claims Project database over the decades from 1970s to the 2000s. After the Institutional Review Board approval, the authors reviewed the Closed Claims Project database of 9,806 total claims. Inclusion criteria were general anesthesia for surgical or obstetric anesthesia care (n = 6,022). Anesthesia gas delivery equipment was defined as any device used to convey gas to or from (but not involving) the airway management device. Claims related to anesthesia gas delivery equipment were compared between time periods by chi-square test, Fisher exact test, and Mann-Whitney U test. Anesthesia gas delivery claims decreased over the decades (P < 0.001) to 1% of claims in the 2000s. Outcomes in claims from 1990 to 2011 (n = 40) were less severe, with a greater proportion of awareness (n = 9, 23%; P = 0.003) and pneumothorax (n = 7, 18%; P = 0.047). Severe injuries (death/permanent brain damage) occurred in supplemental oxygen supply events outside the operating room, breathing circuit events, or ventilator mishaps. The majority (85%) of claims involved provider error with (n = 7) or without (n = 27) equipment failure. Thirty-five percent of claims were judged as preventable by preanesthesia machine check. Gas delivery equipment claims in the Closed Claims Project database decreased in 1990-2011 compared with earlier decades. Provider error contributed to severe injury, especially with inadequate alarms, improvised oxygen delivery systems, and misdiagnosis or treatment of breathing circuit events.

  3. Comparing two anesthesia information management system user interfaces: a usability evaluation.

    PubMed

    Wanderer, Jonathan P; Rao, Anoop V; Rothwell, Sarah H; Ehrenfeld, Jesse M

    2012-11-01

    Anesthesia information management systems (AIMS) have been developed by multiple vendors and are deployed in thousands of operating rooms around the world, yet not much is known about measuring and improving AIMS usability. We developed a methodology for evaluating AIMS usability in a low-fidelity simulated clinical environment and used it to compare an existing user interface with a revised version. We hypothesized that the revised user interface would be more useable. In a low-fidelity simulated clinical environment, twenty anesthesia providers documented essential anesthetic information for the start of the case using both an existing and a revised user interface. Participants had not used the revised user interface previously and completed a brief training exercise prior to the study task. All participants completed a workload assessment and a satisfaction survey. All sessions were recorded. Multiple usability metrics were measured. The primary outcome was documentation accuracy. Secondary outcomes were perceived workload, number of documentation steps, number of user interactions, and documentation time. The interfaces were compared and design problems were identified by analyzing recorded sessions and survey results. Use of the revised user interface was shown to improve documentation accuracy from 85.1% to 92.4%, a difference of 7.3% (95% confidence interval [CI] for the difference 1.8 to 12.7). The revised user interface decreased the number of user interactions by 6.5 for intravenous documentation (95% CI 2.9 to 10.1) and by 16.1 for airway documentation (95% CI 11.1 to 21.1). The revised user interface required 3.8 fewer documentation steps (95% CI 2.3 to 5.4). Airway documentation time was reduced by 30.5 seconds with the revised workflow (95% CI 8.5 to 52.4). There were no significant time differences noted in intravenous documentation or in total task time. No difference in perceived workload was found between the user interfaces. Two user interface

  4. Anesthetic management of an obstetric patient with MELAS syndrome: case report and literature review.

    PubMed

    Maurtua, M; Torres, A; Ibarra, V; DeBoer, G; Dolak, J

    2008-10-01

    Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS syndrome) is a mitochondrial disorder associated with neurologic, cardiac, neuromuscular, hepatic, metabolic and gastrointestinal dysfunction and potential anesthetic and obstetric complications. The case of a parturient with MELAS syndrome requiring labor analgesia is presented. A Medline literature search limited to the English language was undertaken to review cases of MELAS syndrome. Based on our experience and literature review, parturients with MELAS syndrome appear to benefit from neuraxial analgesia and anesthesia, which blunt excessive oxygen consumption and acidosis.

  5. Human Factors Research in Anesthesia Patient Safety

    PubMed Central

    Weinger, Matthew B.; Slagle, Jason

    2002-01-01

    Patient safety has become a major public concern. Human factors research in other high-risk fields has demonstrated how rigorous study of factors that affect job performance can lead to improved outcome and reduced errors after evidence-based redesign of tasks or systems. These techniques have increasingly been applied to the anesthesia work environment. This paper describes data obtained recently using task analysis and workload assessment during actual patient care and the use of cognitive task analysis to study clinical decision making. A novel concept of “non-routine events” is introduced and pilot data are presented. The results support the assertion that human factors research can make important contributions to patient safety. Information technologies play a key role in these efforts.

  6. Human factors research in anesthesia patient safety.

    PubMed Central

    Weinger, M. B.; Slagle, J.

    2001-01-01

    Patient safety has become a major public concern. Human factors research in other high-risk fields has demonstrated how rigorous study of factors that affect job performance can lead to improved outcome and reduced errors after evidence-based redesign of tasks or systems. These techniques have increasingly been applied to the anesthesia work environment. This paper describes data obtained recently using task analysis and workload assessment during actual patient care and the use of cognitive task analysis to study clinical decision making. A novel concept of "non-routine events" is introduced and pilot data are presented. The results support the assertion that human factors research can make important contributions to patient safety. Information technologies play a key role in these efforts. PMID:11825287

  7. Anesthesia

    MedlinePlus

    ... arm or leg. A common type is epidural anesthesia, which is often used during childbirth. General - makes ... afterwards. Sedation can be used with or without anesthesia. The type of anesthesia or sedation you get ...

  8. Mental workload measurement: Event-related potentials and ratings of workload and fatigue

    NASA Technical Reports Server (NTRS)

    Biferno, M. A.

    1985-01-01

    Event-related potentials were elicited when a digitized word representing a pilot's call-sign was presented. This auditory probe was presented during 27 workload conditions in a 3x3x3 design where the following variables were manipulated: short-term load, tracking task difficulty, and time-on-task. Ratings of workload and fatigue were obtained between each trial of a 2.5-hour test. The data of each subject were analyzed individually to determine whether significant correlations existed between subjective ratings and ERP component measures. Results indicated that a significant number of subjects had positive correlations between: (1) ratings of workload and P300 amplitude, (2) ratings of workload and N400 amplitude, and (3) ratings of fatigue and P300 amplitude. These data are the first to show correlations between ratings of workload or fatigue and ERP components thereby reinforcing their validity as measures of mental workload and fatigue.

  9. Contemporary Obstetric Triage.

    PubMed

    Sandy, Edward Allen; Kaminski, Robert; Simhan, Hygriv; Beigi, Richard

    2016-03-01

    The role of obstetric triage in the care of pregnant women has expanded significantly. Factors driving this change include the Emergency Medical Treatment and Active Labor Act, improved methods of testing for fetal well-being, increasing litigation risk, and changes in resident duty hour guidelines. The contemporary obstetric triage facility must have processes in place to provide a medical screening examination that complies with regulatory statues while considering both the facility's maternal level of care and available resources. This review examines the history of the development of obstetric triage, current considerations in a contemporary obstetric triage paradigm, and future areas for consideration. An example of a contemporary obstetric triage program at an academic medical center is presented. A successful contemporary obstetric triage paradigm is one that addresses the questions of "sick or not sick" and "labor or no labor," for every obstetric patient that presents for care. Failure to do so risks poor patient outcome, poor patient satisfaction, adverse litigation outcome, regulatory scrutiny, and exclusion from federal payment programs. Understanding the role of contemporary obstetric triage in the current health care environment is important for both providers and health care leadership. This study is for obstetricians and gynecologists as well as family physicians. After completing this activity, the learner should be better able to understand the scope of a medical screening examination within the context of contemporary obstetric triage; understand how a facility's level of maternal care influences clinical decision making in a contemporary obstetric triage setting; and understand the considerations necessary for the systematic evaluation of the 2 basic contemporary obstetric questions, "sick or not sick?" and "labor or no labor?"

  10. Epidemiology of anesthesia-related complications in labor and delivery, New York State, 2002-2005.

    PubMed

    Cheesman, Khadeen; Brady, Joanne E; Flood, Pamela; Li, Guohua

    2009-10-01

    Epidemiologic data on anesthesia-related complications occurring during labor and delivery are essential for measuring and evaluating the safety and quality of obstetric anesthesia care but are lacking. We aimed to fill this research gap by exploring the epidemiologic patterns and risk factors of anesthesia-related complications in a large sample of women giving birth in New York hospitals. Using the Healthcare Cost and Utilization Project State Inpatient Databases files, we identified all discharge records for labor and delivery from New York hospitals between 2002 and 2005. We then identified women who experienced any recorded anesthesia-related complication during labor and delivery as determined by International Classification of Diseases, Ninth Revision, Clinical Modification codes. The incidence of anesthesia-related complications was calculated by demographic and clinical characteristics. Multivariate logistic regression was performed to assess risk factors of anesthesia-related complications. Of the 957,471 deliveries studied, 4438 (0.46%) had at least one anesthesia-related complication. The majority (55%) of anesthesia-related events occurring during labor and delivery were spinal complications, followed by systemic complications (43%) and overdose or adverse effects (2%). Multivariate logistic regression revealed five risk factors of anesthesia-related complications: cesarean delivery (odds ratio [OR] 2.51, 95% confidence interval [CI] 2.36-2.68), rural area (OR 1.33, 95% CI 1.21-1.46), Charlson-Deyo Comorbidity Index >or=1 (OR 1.47, 95% CI 1.28-1.69), Caucasian race (OR 1.37, 95% CI 1.24-1.52), and scheduled admission (OR 1.10, 95% CI 1.03-1.18). Anesthesia-related complications were associated with about a one-day increase in the average length of stay (3.89 +/- 3.69 [mean +/- SD] days vs 2.92 +/- 2.38 days for deliveries without anesthesia-related complications, P < 0.0001) and a 22-fold increased risk of maternal mortality (OR 22.26, 95% CI 11

  11. [Gender stereotypes in gynecology and obstetrics: obstacles for young male physicians?].

    PubMed

    Buddeberg-Fischer, Barbara

    2003-10-01

    Up to the mid 1990s, a 'feminization' of medicine took place that was especially pronounced in the field of gynecology. The present paper looks into the reasons for this change based on the literature and results from a study conducted by the author. In 2001, two thirds of the new qualifications in gynecology/obstetrics were awarded to women. The feminist movement has led to the emancipation of women and the assertion that women should be treated by female doctors only. Parallel to this development, gender roles also underwent a change: nowadays, the ideal woman or man is 'androgynous'. Young physicians are both highly instrumental and highly expressive. The increasing similarities between the sexes exert an influence on lifestyle and biographical planning. An increasing number of young physicians no longer prioritize their profession. Male physicians with high expressiveness are often family oriented and consciously refrain from choosing to specialize in gynecology/obstetrics because of the long hours and heavy workload. On the other hand, quite a few women physicians are more instrumental and prioritize their professional commitment. If more male physicians are not attracted into gynecology/obstetrics over the next few years, a process of 'horizontal segregation' could occur, with women physicians accomplishing the patient-focused work while their male colleagues take over the surgery and scientific part of the specialty. It is the very differences between the sexes, however, and the exchange between them, which allow a medical discipline to thrive.

  12. Heavy vehicle driver workload assessment. Task 4, review of workload and related research

    DOT National Transportation Integrated Search

    This report reviews literature on workload measures and related research. It depicts the preliminary development of a theoretical basis for relating driving workload to highway safety and a selective review of driver performance evaluation, workload ...

  13. Obstetric Ultrasound

    PubMed Central

    Nicholson, Stuart F.; Nimrod, Carl A.

    1988-01-01

    This article addresses the current indications for an obstetric ultrasound and describes the findings that it is reasonable to expect when reading an ultrasound report. The authors discuss several common obstetrical problems focussing the attention on the usefulness of the imaging information. Finally, they provide a glimpse into the future direction of obstetric ultrasound by discussing vaginal scanning, Doppler assessment of fetal blood flow, and routine ultrasound in pregnancy. PMID:21253229

  14. Maximum Movement Workloads and High-Intensity Workload Demands by Position in NCAA Division I Collegiate Football.

    PubMed

    Sanders, Gabriel J; Roll, Brad; Peacock, Corey A; Kollock, Roger O

    2018-05-02

    Sanders, GJ, Roll, B, Peacock, CA, and Kollock, RO. Maximum movement workloads and high-intensity workload demands by position in NCAA division I collegiate football. J Strength Cond Res XX(X): 000-000, 2018-The purpose of the study was to quantify the average and maximum (i.e., peak) movement workloads, and the percent of those workloads performed at high intensity by NCAA division I football athletes during competitive games. Using global positioning system devices (Catapult Sports), low, moderate, and high and total multidirectional movement workloads were quantified by each position. Strategically achieving maximal workloads may improve both conditioning and rehabilitation protocols for athletes as they prepare for competition or return to play after an injury. A total of 40 football athletes were included in the analysis. For the data to be included, athletes were required to participate in ≥75% of the offensive or defensive snaps for any given game. There was a total of 286 data downloads from 13 different games for 8 different football positions. Data were calculated and compared by offensive and defensive position to establish the mean, SD, and maximum workloads during competitive games. The percent high-intensity workload profile was established to assess the total number and percent of high-intensity movement workloads by position. The profile was calculated by dividing a position's maximal high-intensity movement workload by the total (e.g., sum of maximal low, moderate, and high-intensity movements) movement workload. One-way analysis of variances revealed that there was a main effect of football position for total movement workloads and the percent of workloads performed at high intensities (p ≤ 0.025 for all). Maximal high-intensity workloads were 1.6-4.3 times greater than average high-intensity workloads, and the percent of total workloads performed at high intensities varied greatly by position. Strategically training for and using maximal

  15. Heavy vehicle driver workload assessment. Task 5, workload assessment protocol

    DOT National Transportation Integrated Search

    This report presents a description of a prescriptive workload assessment protocol for use in evaluating in-cab devices in heavy vehicles. The primary objective of this heavy vehicle driver workload assessment protocol is to identify the components an...

  16. Toward competency-based curriculum: Application of workplace-based assessment tools in the National Saudi Arabian Anesthesia Training Program.

    PubMed

    Boker, Ama

    2016-01-01

    The anesthesia training program of the Saudi Commission for health specialties has introduced a developed competency-based anesthesia residency program starting from 2015 with the utilization of the workplace-based assessment (WBA) tools, namely mini-clinical exercises (mini-CEX), direct observation of procedural skills (DOPS), and case-based discussion (CBD). This work aimed to describe the process of development of anesthesia-specific list of mini-CEX, DOPS, and CBD tools within the Saudi Arabian Anesthesia Training Programs. To introduce the main concepts of formative WBA tools and to develop anesthesia-specific applications for each of the selected WBA tools, four 1-day workshops were held at the level of major training committees at eastern (Dammam), western (Jeddah), and central (Riyadh) regions in the Kingdom were conducted. Sixty-seven faculties participated in these workshops. After conduction of the four workshops, the anesthesia-specific applications setting of mini-CEX, DOPS, and CBD tools among the 5-year levels were fully described. The level of the appropriate consultation skills was divided according to the case complexity adopted from the American Society of Anesthesiologists physical classification for adult and obstetric and pediatric patient as well as the type of the targeted anesthetic procedure. WBA anesthesia-specific lists of mini-CEX, DOPS, and CBD forms were easily incorporated first into guidelines to help the first stage of implementation of formative assessment in the Saudi Arabian Anesthesia Residency Program, and this can be helpful to replicate such program within other various training programs in Saudi Arabia and abroad.

  17. The workload book: Assessment of operator workload to engineering systems

    NASA Technical Reports Server (NTRS)

    Gopher, D.

    1983-01-01

    The structure and initial work performed toward the creation of a handbook for workload analysis directed at the operational community of engineers and human factors psychologists are described. The goal, when complete, will be to make accessible to such individuals the results of theoretically-based research that are of practical interest and utility in the analysis and prediction of operator workload in advanced and existing systems. In addition, the results of laboratory study focused on the development of a subjective rating technique for workload that is based on psychophysical scaling techniques are described.

  18. Comparison of stress and burnout among anesthesia and surgical residents in a tertiary care teaching hospital in North India.

    PubMed

    Gandhi, K; Sahni, N; Padhy, S K; Mathew, P J

    2017-10-23

    The residents undergoing training at hospitals in our country face challenges in terms of infrastructure and high workload with undefined working hours. The aim of the study was to compare the stress and burnout levels in trainee doctors doing residency in surgical fields and anesthesia at a tertiary care academic center in North India. A comparative, observational study was conducted in a tertiary care teaching hospital in North India. After Ethics Committee approval, 200 residents (100 each from surgical branches and anesthesia) were required to fill a questionnaire with information about age, sex, year of residency, marital status, and the Perceived Stress Scale-10, and Burnout Clinical Subtype Questionnaire-12. Burnout and perceived stress were compared between residents of anesthesia and surgical specialties. Residents of both surgical and anesthesia branches scored high in perceived stress, namely 21 and 18, respectively. The score was significantly higher in surgical residents (P = 0.03) and increased progressively with the year of residency. The majority of residents (90% surgical, 80% anesthesia) felt that they were being overloaded with work. However, only 20%-30% of respondents felt that there was lack of development of individual skills and still fewer (<10%) reported giving up in view of difficulties. There is high level of stress and overload dimension of burnout among the residents of anesthesia and surgical branches at our tertiary care academic institution and the surgical residents score marginally higher than anesthesia residents.

  19. FMP study of pilot workload. Qualification of workload via instrument scan

    NASA Technical Reports Server (NTRS)

    Tolel, J. R.; Vivaudou, M.; Harris, R. L., Sr.; Ephrath, A.

    1982-01-01

    Various methods of measuring a pilot's mental workload are discussed. Scanning the various flight instruments with good scan pattern and other verbal tasks during instrument landings is given special attention for measuring pilot workload.

  20. Predicting operator workload during system design

    NASA Technical Reports Server (NTRS)

    Aldrich, Theodore B.; Szabo, Sandra M.

    1988-01-01

    A workload prediction methodology was developed in response to the need to measure workloads associated with operation of advanced aircraft. The application of the methodology will involve: (1) conducting mission/task analyses of critical mission segments and assigning estimates of workload for the sensory, cognitive, and psychomotor workload components of each task identified; (2) developing computer-based workload prediction models using the task analysis data; and (3) exercising the computer models to produce predictions of crew workload under varying automation and/or crew configurations. Critical issues include reliability and validity of workload predictors and selection of appropriate criterion measures.

  1. Obstetric antiphospholipid syndrome.

    PubMed

    Esteve-Valverde, E; Ferrer-Oliveras, R; Alijotas-Reig, J

    2016-04-01

    Obstetric antiphospholipid syndrome is an acquired autoimmune disorder that is associated with various obstetric complications and, in the absence of prior history of thrombosis, with the presence of antiphospholipid antibodies directed against other phospholipids, proteins called cofactors or PL-cofactor complexes. Although the obstetric complications have been related to the procoagulant properties of antiphospholipid antibodies, pathological studies of human placenta have shown the proinflammatory capacity of antiphospholipid antibodies via the complement system and proinflammatory cytokines. There is no general agreement on which antiphospholipid antibodies profile (laboratory) confers the greatest obstetric risk, but the best candidates are categories I and IIa. Combined treatment with low doses of aspirin and heparin achieves good obstetric and maternal outcomes. In this study, we also review the therapeutic possibilities in refractory cases, although the likelihood of progressing to other autoimmune diseases is low. We briefly comment on incomplete obstetric antiphospholipid syndrome, also known as antiphospholipid antibody-mediated pregnancy morbidity syndrome. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  2. Interchangeability of counts of cases and hours of cases for quantifying a hospital's change in workload among four-week periods of 1 year.

    PubMed

    Dexter, Franklin; Epstein, Richard H; Ledolter, Johannes; Wanderer, Jonathan P

    2018-05-16

    Recent studies have made longitudinal assessments of case counts using State (e.g., United States) and Provincial (e.g., Canada) databases. Such databases rarely include either operating room (OR) or anesthesia times and, even when duration data are available, there are major statistical limitations to their use. We evaluated how to forecast short-term changes in OR caseload and workload (hours) and how to decide whether changes are outliers (e.g., significant, abrupt decline in anesthetics). Observational cohort study. Large teaching hospital. 35 years of annual anesthesia caseload data. Annual data were used without regard to where or when in the year each case was performed, thereby matching public use files. Changes in caseload or hours among four-week periods were examined within individual year-long periods using 159 consecutive four-week periods from the same hospital. Series of 12 four-week periods of the hours of cases performed on workdays lacked trend or correlation among periods for 49 of 50 series and followed normal distributions for 50 of 50 series. These criteria also were satisfied for 50 of 50 series based on counts of cases. The Pearson r = 0.999 between hours of anesthetics and cases. For purposes of time series analysis of total workload at a hospital within 1-year, hours of cases and counts of cases are interchangeable. Simple control chart methods of detecting sudden changes in workload or caseload, based simply on the sample mean and standard deviation from the preceding year, are appropriate. Copyright © 2018 Elsevier Inc. All rights reserved.

  3. Personality Traits Moderate the Effect of Workload Sources on Perceived Workload in Flying Column Police Officers

    PubMed Central

    Chiorri, Carlo; Garbarino, Sergio; Bracco, Fabrizio; Magnavita, Nicola

    2015-01-01

    Previous research has suggested that personality traits of the Five Factor Model play a role in worker's response to workload. The aim of this study was to investigate the association of personality traits of first responders with their perceived workload in real-life tasks. A flying column of 269 police officers completed a measure of subjective workload (NASA-Task Load Index) after intervention tasks in a major public event. Officers' scores on a measure of Five Factor Model personality traits were obtained from archival data. Linear Mixed Modeling was used to test the direct and interaction effects of personality traits on workload scores once controlling for background variables, task type and workload source (mental, temporal and physical demand of the task, perceived effort, dissatisfaction for the performance and frustration due to the task). All personality traits except extraversion significantly interacted at least with one workload source. Perceived workload in flying column police officers appears to be the result of their personality characteristics interacting with the workload source. The implications of these results for the development of support measures aimed at reducing the impact of workload in this category of workers are discussed. PMID:26640456

  4. Effects of Anesthesia

    MedlinePlus

    Skip to content Menu Anesthesia 101 Pain Management Preparing for Surgery Stories Resources About Policymakers Media ASA Member Toolkit Anesthesia 101 Effects of Anesthesia Explore this page: Effects of Anesthesia ...

  5. School Nurse Workload.

    PubMed

    Endsley, Patricia

    2017-02-01

    The purpose of this scoping review was to survey the most recent (5 years) acute care, community health, and mental health nursing workload literature to understand themes and research avenues that may be applicable to school nursing workload research. The search for empirical and nonempirical literature was conducted using search engines such as Google Scholar, PubMed, CINAHL, and Medline. Twenty-nine empirical studies and nine nonempirical articles were selected for inclusion. Themes that emerged consistent with school nurse practice include patient classification systems, environmental factors, assistive personnel, missed nursing care, and nurse satisfaction. School nursing is a public health discipline and population studies are an inherent research priority but may overlook workload variables at the clinical level. School nurses need a consistent method of population assessment, as well as evaluation of appropriate use of assistive personnel and school environment factors. Assessment of tasks not directly related to student care and professional development must also be considered in total workload.

  6. Workload: Measurement and Management

    NASA Technical Reports Server (NTRS)

    Gore, Brian Francis; Casner, Stephen

    2010-01-01

    Poster: The workload research project has as its task to survey the available literature on: (1) workload measurement techniques; and (2) the effects of workload on operator performance. The first set of findings provides practitioners with a collection of simple-to-use workload measurement techniques along with characterizations of the kinds of tasks each technique has been shown reliably address. This allows design practitioners to select and use the most appropriate techniques for the task(s) at hand. The second set of findings provides practitioners with the guidance they need to design for appropriate kinds and amounts of workload across all tasks for which the operator is responsible. This guidance helps practitioners design systems and procedures that ensure appropriate levels of engagement across all tasks, and avoid designs and procedures that result in operator boredom, complacency, loss of awareness, undue levels of stress, or skill atrophy that can result from workload that distracts operators from the tasks they perform and monitor, workload levels that are too low, too high, or too consistent or predictable. Only those articles that were peer reviewed, long standing and generally accepted in the field, and applicable to a relevant range of conditions in a select domain of interest, in analogous "extreme" environments to those in space were included. In addition, all articles were reviewed and evaluated on uni-dimensional and multi-dimensional considerations. Casner & Gore also examined the notion of thresholds and the conditions that may benefit mostly from the various methodological approaches. Other considerations included whether the tools would be suitable for guiding a requirement-related and design-related question. An initial review of over 225 articles was conducted and entered into an EndNote database. The reference list included a range of conditions in the domain of interest (subjective/objective measures), the seminal works in workload, as

  7. Anesthesia Fact Sheet

    MedlinePlus

    ... News & Meetings Science Education About NIGMS NIGMS Home > Science Education > Anesthesia Anesthesia Tagline (Optional) Middle/Main Content Area En español PDF Version (464 KB) Other Fact Sheets What is anesthesia? Anesthesia is a medical ...

  8. Supporting Academic Workloads in Online Learning

    ERIC Educational Resources Information Center

    Haggerty, Carmel E.

    2015-01-01

    Academic workloads in online learning are influenced by many variables, the complexity of which makes it difficult to measure academic workloads in isolation. While researching issues associated with academic workloads, professional development stood out as having a substantive impact on academic workloads. Many academics in applied health degrees…

  9. Defining the subjective experience of workload

    NASA Technical Reports Server (NTRS)

    Hart, S. G.; Childress, M. E.; Bortolussi, M.

    1981-01-01

    Flight scenarios that represent different types and levels of pilot workload are needed in order to conduct research about, and develop measures of, pilot workload. In order to be useful, however, the workload associated with such scenarios and the component tasks must be determined independently. An initial study designed to provide such information was conducted by asking a panel of general aviation pilots to evaluate flight-related tasks for the overall, perceptual, physical, and cognitive workload they impose. These ratings will provide the nucleus for a data base of flight-related primary tasks that have been independently rated for workload to use in workload assessment research.

  10. The workload analysis in welding workshop

    NASA Astrophysics Data System (ADS)

    Wahyuni, D.; Budiman, I.; Tryana Sembiring, M.; Sitorus, E.; Nasution, H.

    2018-03-01

    This research was conducted in welding workshop which produces doors, fences, canopies, etc., according to customer’s order. The symptoms of excessive workload were seen from the fact of employees complaint, requisition for additional employees, the lateness of completion time (there were 11 times of lateness from 28 orders, and 7 customers gave complaints). The top management of the workshop assumes that employees’ workload was still a tolerable limit. Therefore, it was required workload analysis to determine the number of employees required. The Workload was measured by using a physiological method and workload analysis. The result of this research can be utilized by the workshop for a better workload management.

  11. Workload - An examination of the concept

    NASA Technical Reports Server (NTRS)

    Gopher, Daniel; Donchin, Emanuel

    1986-01-01

    The relations between task difficulty and workload and workload and performance are examined. The architecture and limitations of the central processor are discussed. Various procedures for measuring workload are described and evaluated. Consideration is given to normative and descriptive approaches; subjective, performance, and arousal measures; performance operating characteristics; and psychophysiological measures of workload.

  12. Factors Influencing the Choice of Anesthesia as a Career by Undergraduates of the University of Rwanda.

    PubMed

    Chan, Denise M; Wong, Rex; Runnels, Sean; Muhizi, Epaphrodite; McClain, Craig D

    2016-08-01

    Rwanda currently faces a severe shortage of trained medical personnel, including physician anesthesiologists. The recruitment of residents into the anesthesia program has been consistently low. This study aimed at determining the factors that influence undergraduates' decision to pursue anesthesia as a career choice. A questionnaire was created and administered to final year undergraduate medical students at the University of Rwanda. The questionnaire was created based on factors identified from literature review and key informant interviews. The questionnaire was translated, field-tested, and refined. The final survey questionnaire contains 27 4-point Likert scale items and 4 free-text questions. Seventy-nine final year undergraduate medical students responded to the survey. Only 2 students (2.5%) chose anesthesia as their top choice for postgraduate training. The most frequently named factors for not choosing anesthesiology were long work hours and high stress level, insufficient mentorship, and low job opportunity. The issues identified by our survey must be considered when making efforts toward increasing anesthesia recruitment in Rwanda. Factors such as lack of material resources and high workload will not be easily addressed. Others can be addressed through changes in medical student anesthesiology rotations and better mentorship by anesthesiologists during formative years. Focusing on factors that can be changed now may increase enrollment into anesthesiology. Future studies will include broadening the survey population and further investigating the influencing factors elucidated by this study.

  13. Workload and Stress in New Zealand Universities.

    ERIC Educational Resources Information Center

    Boyd, Sally; Wylie, Cathy

    This study examined the workloads of academic, general, support, library, and technical staff of New Zealand universities. It focused on current levels of workload, changes in workload levels and content, connections between workload and stress, and staff attitudes towards the effects of workload changes and educational reforms on the quality of…

  14. Robotic Anesthesia – A Vision for the Future of Anesthesia

    PubMed Central

    Hemmerling, Thomas M; Taddei, Riccardo; Wehbe, Mohamad; Morse, Joshua; Cyr, Shantale; Zaouter, Cedrick

    2011-01-01

    Summary This narrative review describes a rationale for robotic anesthesia. It offers a first classification of robotic anesthesia by separating it into pharmacological robots and robots for aiding or replacing manual gestures. Developments in closed loop anesthesia are outlined. First attempts to perform manual tasks using robots are described. A critical analysis of the delayed development and introduction of robots in anesthesia is delivered. PMID:23905028

  15. Operator Workload: Comprehensive Review and Evaluation of Operator Workload Methodologies

    DTIC Science & Technology

    1989-06-01

    chocking for system failures or emergency conditions. It seems fair to characterize the changes In operator functions as more mental or cognitive In nature ...that the operator, the system hardware, and the evMronment all interact in affecting performance and this Interaction can change the nature of the task...a) classifying the nature of the operator tasks and (b) classifying workload assessment techniques. Task taxonomies are useful because some workload

  16. [Comparison of epidural anesthesia and general anesthesia for patients with bronchial asthma].

    PubMed

    Kasaba, T; Suga, R; Matsuoka, H; Iwasaki, T; Hidaka, N; Takasaki, M

    2000-10-01

    We prospectively investigated the incidence of asthmatic attacks in 94 patients (1.5%) who were diagnosed as definite asthma. We separated the patients into three groups: epidural anesthesia (n = 10) including combined spinal/epidural anesthesia (n = 7), combined epidural and general anesthesia (n = 23), and general anesthesia (n = 54). General anesthesia was induced with propofol or midazolam and maintained with N2O and O2 with sevoflurane in adults. Patients who underwent epidural anesthesia and combined spinal and epidural anesthesia showed no asthmatic attacks. The incidence of bronchospasm with combined epidural and general anesthesia was 2/23. The incidence of bronchospasm with general anesthesia was 4/54. Bronchoconstriction occurred after tracheal intubation in 5 patients except in one patient, in whom it occurred after induction of anesthesia with midazolam. All episodes of bronchospasm in the operative period were treated successfully. The frequency of bronchospasm did not depend on the severity of asthmatic symptoms or the chronic use of bronchodilators before operation. These findings suggest that tracheal intubation, not the choice of anesthetic, plays an important role in the pathogenesis of bronchospasm.

  17. A user-oriented synthetic workload generator

    NASA Technical Reports Server (NTRS)

    Kao, Wei-Lun

    1991-01-01

    A user oriented synthetic workload generator that simulates users' file access behavior based on real workload characterization is described. The model for this workload generator is user oriented and job specific, represents file I/O operations at the system call level, allows general distributions for the usage measures, and assumes independence in the file I/O operation stream. The workload generator consists of three parts which handle specification of distributions, creation of an initial file system, and selection and execution of file I/O operations. Experiments on SUN NFS are shown to demonstrate the usage of the workload generator.

  18. Memory and subjective workload assessment

    NASA Technical Reports Server (NTRS)

    Staveland, L.; Hart, S.; Yeh, Y. Y.

    1986-01-01

    Recent research suggested subjective introspection of workload is not based upon specific retrieval of information from long term memory, and only reflects the average workload that is imposed upon the human operator by a particular task. These findings are based upon global ratings of workload for the overall task, suggesting that subjective ratings are limited in ability to retrieve specific details of a task from long term memory. To clarify the limits memory imposes on subjective workload assessment, the difficulty of task segments was varied and the workload of specified segments was retrospectively rated. The ratings were retrospectively collected on the manipulations of three levels of segment difficulty. Subjects were assigned to one of two memory groups. In the Before group, subjects knew before performing a block of trials which segment to rate. In the After group, subjects did not know which segment to rate until after performing the block of trials. The subjective ratings, RTs (reaction times) and MTs (movement times) were compared within group, and between group differences. Performance measures and subjective evaluations of workload reflected the experimental manipulations. Subjects were sensitive to different difficulty levels, and recalled the average workload of task components. Cueing did not appear to help recall, and memory group differences possibly reflected variations in the groups of subjects, or an additional memory task.

  19. [Regulation of hypnosis in Propofol anesthesia administration based on non-linear control strategy].

    PubMed

    Ilyas, Muhammad; Khaqan, Ali; Iqbal, Jamshed; Riaz, Raja Ali

    Continuous adjustment of Propofol in manual delivery of anesthesia for conducting a surgical procedure overburdens the workload of an anesthetist who is working in a multi-tasking scenario. Going beyond manual administration and Target Controlled Infusion, closed-loop control of Propofol infusion has the potential to offer several benefits in terms of handling perturbations and reducing the effect of inter-patient variability. This paper proposes a closed-loop automated drug administration approach to control Depth Of Hypnosis in anesthesia. In contrast with most of the existing research on anesthesia control which makes use of linear control strategies or their improved variants, the novelty of the present research lies in applying robust control strategy i.e. Sliding Mode Control to accurately control drug infusion. Based on the derived patient's model, the designed controller uses measurements from EEG to regulate DOH on Bispectral Index by controlling infusion rate of Propofol. The performance of the controller is investigated and characterized with real dataset of 8 patients undergoing surgery. Results of this in silico study indicate that for all the patients, with 0% overshoot observed, the steady state error lies in between ±5. Clinically, this implies that in all the cases, without any overdose, the controller maintains the desired DOH level for smooth conduction of surgical procedures. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  20. Regulation of hypnosis in Propofol anesthesia administration based on non-linear control strategy.

    PubMed

    Ilyas, Muhammad; Khaqan, Ali; Iqbal, Jamshed; Riaz, Raja Ali

    Continuous adjustment of Propofol in manual delivery of anesthesia for conducting a surgical procedure overburdens the workload of an anesthetist who is working in a multi-tasking scenario. Going beyond manual administration and Target Controlled Infusion, closed-loop control of Propofol infusion has the potential to offer several benefits in terms of handling perturbations and reducing the effect of inter-patient variability. This paper proposes a closed-loop automated drug administration approach to control Depth Of Hypnosis in anesthesia. In contrast with most of the existing research on anesthesia control which makes use of linear control strategies or their improved variants, the novelty of the present research lies in applying robust control strategy i.e. Sliding Mode Control to accurately control drug infusion. Based on the derived patient's model, the designed controller uses measurements from EEG to regulate DOH on Bispectral Index by controlling infusion rate of Propofol. The performance of the controller is investigated and characterized with real dataset of 8 patients undergoing surgery. Results of this in silico study indicate that for all the patients, with 0% overshoot observed, the steady state error lies in between ±5. Clinically, this implies that in all the cases, without any overdose, the controller maintains the desired DOH level for smooth conduction of surgical procedures. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  1. Lessons learned from a single institution's retrospective analysis of emergent cesarean delivery following external cephalic version with and without neuraxial anesthesia.

    PubMed

    Ainsworth, A; Sviggum, H P; Tolcher, M C; Weaver, A L; Holman, M A; Arendt, K W

    2017-05-01

    To evaluate the risk of emergent cesarean delivery with the use of neuraxial anesthesia for external cephalic version in a single practice. Randomized trials have shown increased external cephalic version success when neuraxial anesthesia is used, without additional risk. We hypothesized that in our actual clinical practice, outside the confines of randomized trials, neuraxial anesthesia could be associated with an increased risk of emergent cesarean delivery. This retrospective cohort study included all women who underwent external cephalic version at a single institution with and without neuraxial anesthesia. The primary outcome was the incidence of emergent cesarean delivery (defined as delivery within 4hours of version). Secondary outcomes were version success and ultimate mode of delivery. A total of 135 women underwent external cephalic version procedures; 58 with neuraxial anesthesia (43.0%) and 77 without (57.0%). Location of the procedure, tocolytic therapy, and gestational age were different between groups. An increased rate of emergent cesarean delivery was found in procedures with neuraxial anesthesia compared to procedures without (5/58 (8.6%) compared to 0/77 (0.0%); 95% CI for difference, 1.4 to 15.8%; P=0.013). In this single hospital's practice, patients who may be at higher risk of complications and have a lesser likelihood of success were provided NA for ECV. As a result, the use of neuraxial anesthesia for external cephalic version was associated with a higher rate of emergent cesarean delivery. Obstetric and anesthetic practices should evaluate their patient selection and procedure protocol for external cephalic version under neuraxial anesthesia. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Measuring perceived mental workload in children.

    PubMed

    Laurie-Rose, Cynthia; Frey, Meredith; Ennis, Aristi; Zamary, Amanda

    2014-01-01

    Little is known about the mental workload, or psychological costs, associated with information processing tasks in children. We adapted the highly regarded NASA Task Load Index (NASA-TLX) multidimensional workload scale (Hart & Staveland, 1988) to test its efficacy for use with elementary school children. We developed 2 types of tasks, each with 2 levels of demand, to draw differentially on resources from the separate subscales of workload. In Experiment 1, our participants were both typical and school-labeled gifted children recruited from 4th and 5th grades. Results revealed that task type elicited different workload profiles, and task demand directly affected the children's experience of workload. In general, gifted children experienced less workload than typical children. Objective response time and accuracy measures provide evidence for the criterion validity of the workload ratings. In Experiment 2, we applied the same method with 1st- and 2nd-grade children. Findings from Experiment 2 paralleled those of Experiment 1 and support the use of NASA-TLX with even the youngest elementary school children. These findings contribute to the fledgling field of educational ergonomics and attest to the innovative application of workload research. Such research may optimize instructional techniques and identify children at risk for experiencing overload.

  3. Risk Factors for the Development of Obstetric Anal Sphincter Injuries in Modern Obstetric Practice.

    PubMed

    Ramm, Olga; Woo, Victoria G; Hung, Yun-Yi; Chen, Hsuan-Chih; Ritterman Weintraub, Miranda L

    2018-02-01

    To characterize the rate of obstetric anal sphincter injuries and identify key risk factors of obstetric anal sphincter injuries, including duration of the second stage of labor. This retrospective cohort study included all singleton, term, cephalic vaginal deliveries within Kaiser Permanente Northern California between January 2013 and December 2014 (N=22,741). Incidence of obstetric anal sphincter injuries, defined as third- or fourth-degree perineal lacerations, was the primary outcome. Multiple logistic regression models were conducted to identify obstetric anal sphincter injury risk factors and high-risk subpopulations. The overall incidence rate of obstetric anal sphincter injuries was 4.9% (3.6% of women who delivered spontaneously vs 24.0% of women who had a vacuum-assisted vaginal delivery, P<.001, CI 18.1-22.6%). In bivariate and multivariate analyses, obstetric anal sphincter injury incidence was higher among women with second stage of labor longer than 2 hours, Asian race, nulliparity, vaginal birth after cesarean delivery, episiotomy, and vacuum delivery. Women with a vacuum-assisted vaginal delivery had four times the odds of obstetric anal sphincter injury (adjusted odds ratio [OR] 4.23, 95% CI 3.59-4.98) and those whose second stage of labor lasted at least 180 minutes vs less than 60 minutes had three times the odds of incurring obstetric anal sphincter injury (adjusted OR 3.20, 95% CI 2.62-3.89). Vacuum-assisted vaginal delivery conferred the highest odds of obstetric anal sphincter injury followed by prolonged duration of the second stage of labor, particularly among certain subpopulations. Understanding these risk factors and their complex interactions can inform antepartum and intrapartum decision-making with the goal of reducing obstetric anal sphincter injury incidence.

  4. Malpractice Burden, Rural Location, and Discontinuation of Obstetric Care: A Study of Obstetric Providers in Michigan

    PubMed Central

    Xu, Xiao; Siefert, Kristine A.; Jacobson, Peter D.; Lori, Jody R.; Gueorguieva, Iana; Ransom, Scott B.

    2011-01-01

    Context It has long been a concern that professional liability problems disproportionately affect the delivery of obstetrical services to women living in rural areas. Michigan, a state with a large number of rural communities, is considered to be at risk for a medical liability crisis. Purpose This study examined whether higher malpractice burden on obstetric providers was associated with an increased likelihood of discontinuing obstetric care and whether there were rural-urban differences in the relationship. Methods Data on 500 obstetrician-gynecologists and family physicians who had provided obstetric care at some point in their career (either currently or previously) were obtained from a statewide survey in Michigan. Statistical tests and multivariate regression analyses were performed to examine the interrelationship among malpractice burden, rural location, and discontinuation of obstetric care. Findings After adjusting for other factors that might influence a physician’s decision about whether to stop obstetric care, our results showed no significant impact of malpractice burden on physicians’ likelihood to discontinue obstetric care. Rural-urban location of the practice did not modify the nature of this relationship. However, family physicians in rural Michigan had a nearly four fold higher likelihood of withdrawing obstetric care when compared to urban family physicians. Conclusions The higher likelihood of rural family physicians to discontinue obstetric care should be carefully weighed in future interventions to preserve obstetric care supply. More research is needed to better understand the practice environment of rural family physicians and the reasons for their withdrawal from obstetric care. PMID:19166559

  5. Accumulated workloads and the acute:chronic workload ratio relate to injury risk in elite youth football players

    PubMed Central

    Bowen, Laura; Gross, Aleksander Stefan; Gimpel, Mo; Li, François-Xavier

    2017-01-01

    Aim The purpose of this study was to investigate the relationship between physical workload and injury risk in elite youth football players. Methods The workload data and injury incidence of 32 players were monitored throughout 2 seasons. Multiple regression was used to compare cumulative (1, 2, 3 and 4-weekly) loads and acute:chronic (A:C) workload ratios (acute workload divided by chronic workload) between injured and non-injured players for specific GPS and accelerometer-derived variables:total distance (TD), high-speed distance (HSD), accelerations (ACC) and total load. Workloads were classified into discrete ranges by z-scores and the relative risk was determined. Results A very high number of ACC (≥9254) over 3 weeks was associated with the highest significant overall (relative risk (RR)=3.84) and non-contact injury risk (RR=5.11). Non-contact injury risk was significantly increased when a high acute HSD was combined with low chronic HSD (RR=2.55), but not with high chronic HSD (RR=0.47). Contact injury risk was greatest when A:C TD and ACC ratios were very high (1.76 and 1.77, respectively) (RR=4.98). Conclusions In general, higher accumulated and acute workloads were associated with a greater injury risk. However, progressive increases in chronic workload may develop the players' physical tolerance to higher acute loads and resilience to injury risk. PMID:27450360

  6. Needle-less local anesthesia: clinical evaluation of the effectiveness of the jet anesthesia Injex in local anesthesia in dentistry.

    PubMed

    Dabarakis, Nikolaos N; Alexander, Veis; Tsirlis, Anastasios T; Parissis, Nikolaos A; Nikolaos, Maroufidis

    2007-01-01

    To clinically evaluate the jet injection Injex (Rösch AG Medizintechnik) using 2 different anesthetic solutions, and to compare the jet injection and the standard needle injection techniques. Of the 32 patients in the study, 10 received mepivacaine 3% anesthetic solution by means of the jet injection technique, while the remaining 22 patients received lidocaine 2% with epinephrine 1:80,000 by the same method. The 14 patients in whom pulp anesthesia was achieved were selected for an additional evaluation of the pulp reaction using standard needle injection anesthesia. The differences between the 2 compounds with Injex were statistically evaluated by means of independent-samples t test analysis. The differences between subgroups receiving both jet injection and needle injection anesthesia were evaluated by means of paired t test analysis. The administration of mepivacaine 3% using Injex did not achieve pulp anesthesia in any of the 10 patients, although the soft tissue anesthesia was successful. The administration of lidocaine with epinephrine using Injex resulted in pulp anesthesia in only 14 patients; soft tissue anesthesia was observed in all patients of this group. There was no statistically significant difference between Injex and the needle injection technique in onset of anesthesia. However, the duration of anesthesia was significantly longer for the needle infiltration group than for the Injex injection group. The anesthetic solution should be combined with a vasoconstriction agent when the Injex technique is implemented.

  7. Reconsidering the conceptualization of nursing workload: literature review.

    PubMed

    Morris, Roisin; MacNeela, Padraig; Scott, Anne; Treacy, Pearl; Hyde, Abbey

    2007-03-01

    This paper reports a literature review that aimed to analyse the way in which nursing intensity and patient dependency have been considered to be conceptually similar to nursing workload, and to propose a model to show how these concepts actually differ in both theoretical and practical terms. The literature on nursing workload considers the concepts of patient 'dependency' and nursing 'intensity' in the realm of nursing workload. These concepts differ by definition but are used to measure the same phenomenon, i.e. nursing workload. The literature search was undertaken in 2004 using electronic databases, reference lists and other available literature. Papers were sourced from the Medline, Psychlit, CINAHL and Cochrane databases and through the general search engine Google. The keywords focussed on nursing workload, nursing intensity and patient dependency. Nursing work and workload concepts and labels are defined and measured in different and often contradictory ways. It is vitally important to understand these differences when using such conceptualizations to measure nursing workload. A preliminary model is put forward to clarify the relationships between nursing workload concepts. In presenting a preliminary model of nursing workload, it is hoped that nursing workload might be better understood so that it becomes more visible and recognizable. Increasing the visibility of nursing workload should have a positive impact on nursing workload management and on the provision of patient care.

  8. Are Anesthesia Providers Ready for Hypnosis? Anesthesia Providers' Attitudes Toward Hypnotherapy.

    PubMed

    Stone, Alexander B; Sheinberg, Rosanne; Bertram, Amanda; Seymour, Anastasia Rowland

    2016-04-01

    This study sought to measure current attitudes toward hypnosis among anesthesia providers using an in-person survey distributed at a single grand rounds at a single academic teaching hospital. One hundred twenty-six anesthesia providers (anesthesiologists and nurse anesthetists) were included in this study. A 10-question Institutional Review Board (IRB)-approved questionnaire was developed. One hundred twenty-six (73% of providers at the meeting) anesthesia providers completed the survey. Of the respondents, 54 (43%) were anesthesiologists, 42 (33%) were trainees (interns/residents/fellows) in anesthesia, and 30 (24%) were nurse anesthetists. Over 70% of providers, at each level of training, rated their knowledge of hypnosis as either below average or having no knowledge. Fifty-two (42%) providers agreed or strongly agreed that hypnotherapy has a place in the clinical practice of anesthesia, while 103 (83%) believed that positive suggestion has a place in the clinical practice of anesthesia (p < .0001). Common reasons cited against using hypnosis were that it is too time consuming (41%) and requires special training (34%). Only three respondents (2%) believed that there were no reasons for using hypnosis in their practice. These data suggest that there is a self-reported lack of knowledge about hypnosis among anesthesia providers, although many anesthesia providers are open to the use of hypnosis in their clinical practice. Anesthesia providers are more likely to support the use of positive suggestion in their practice than hypnosis. Practical concerns should be addressed if hypnosis and therapeutic verbal techniques are to gain more widespread use.

  9. [Sleep and anesthesia--part 2, on the relationship between sleep and general anesthesia].

    PubMed

    Kushikata, Tetsuya; Yosmda, Hitoshi; Yasuda, Tadanobu; Tose, Ryuji; Hirota, Kazuyoshi; Matsuki, Akitomo

    2007-10-01

    We reviewed historical and current trends on study regarding the relationship between sleep and general anesthesia. Historically, sleep has been recognized as a completely different physiological phenomenon from general anesthesia. Therefore, sleep study has been thought that it has no merit in anesthesia study. However, on the basis of recent evidence, sleep may share some part of its mechanism with general anesthesia; thus, studies focusing sleep mechanism may also contribute to elucidate some mechanism of general anesthesia. Moreover, research to solve anesthesia related-sleep disorder would be useful to improve patient's quality of life and save much medical resource.

  10. Anesthesia-related cardiac arrest in children: the Thai Anesthesia Incidents Study (THAI Study).

    PubMed

    Bunchungmongkol, Nutchanart; Punjasawadwong, Yodying; Chumpathong, Saowapark; Somboonviboon, Wanna; Suraseranivongse, Suwannee; Vasinanukorn, Mayuree; Srisawasdi, Surirat; Thienthong, Somboon; Pranootnarabhal, Tharnthip

    2009-04-01

    The Thai Anesthesia Incidents study (THAI Study) is the first national study of anesthesia outcomes during anesthesia practice in Thailand. The authors extracted data of 25,098 pediatric cases from the THAI Study in order to examine the incidence, suspected causes, contributory factors, and suggested corrective strategies associated with anesthesia-related cardiac arrest. A multi-centered prospective descriptive study was conducted among 20 hospitals across Thailand over a year between March 1, 2003 and February 28, 2004. Data of cardiac arrests in children aged 15 years and younger were collected during anesthesia, in the recovery room and 24 hours postoperative period, and reviewed independently by at least two reviewers. Incidence of anesthesia- related cardiac arrest was 5.1 per 10,000 anesthetics, with 46% mortality rate. Infants accounted for 61% of cases. Incidences of overall cardiac arrest and anesthesia-related arrest were significantly higher in infants than older children and in children with ASA physical status 3-5 than those with ASA physical status 1-2. Most of the anesthesia-related arrests occurred in the operating room (61%) during induction or maintenance of anesthesia (84%). Respiratory-related cardiac arrest was the most common suspected cause of anesthesia-related cardiac arrest. Improving supervision, additional training, practice guidelines, efficient blood bank, equipment maintenance, and quality assurance monitoring are suggested corrective strategies to improve the quality of care in pediatric anesthesia. The incidence of anesthesia-related cardiac arrest was 5.1:10,000 anesthetics. Major risk factors were children younger than 1 year of age and ASA 3-5. The identifications of airway management and medication-related problems as the main causes of anesthesia-related cardiac arrest have important implications for preventive strategies.

  11. Pregnancy Outcome Using General Anesthesia Versus Spinal Anesthesia for In Vitro Fertilization

    PubMed Central

    Azmude, Azra; Agha'amou, Shahrzad; Yousefshahi, Fardin; Berjis, Katayoun; Mirmohammad'khani, Majid; Sadaat'ahmadi, Farahnaz; Ghods, Kamran; Dabbagh, Ali

    2013-01-01

    Background There is a considerable rate of fertility failure and this causes a great burden of untoward effects for patients. Usually a considerable number of these patients undergo anesthesia for their treatment. Objectives This study was designed to compare the effects of general and spinal anesthesia on these patients. Patients and Methods In a randomized clinical trial, after taking informed written consent from the patients, 200 patients entered the study; 100 in each. During a 2 year period, women aged 20 to 40 years entered the study (one group receiving spinal anesthesia and the other, receiving general anesthesia). Ovum retrieval protocols were the same. Nonparametric and parametric analyses were used for data analysis. P value less than 0.05 was considered significant. Results There was no difference between the two groups regarding demographic variables. 15 of 100 patients (15%) in the general anesthesia group and 27 of 100 patients (27%) in the spinal anesthesia group had successful pregnancy after IVF; so, spinal anesthesia increased significantly the chance of IVF success (P value < 0.001; Chi Square). Conclusions The results of this study demonstrated that spinal anesthesia increased the chance of fertilization success. PMID:24282775

  12. Pregnancy outcome using general anesthesia versus spinal anesthesia for in vitro fertilization.

    PubMed

    Azmude, Azra; Agha'amou, Shahrzad; Yousefshahi, Fardin; Berjis, Katayoun; Mirmohammad'khani, Majid; Sadaat'ahmadi, Farahnaz; Ghods, Kamran; Dabbagh, Ali

    2013-09-01

    There is a considerable rate of fertility failure and this causes a great burden of untoward effects for patients. Usually a considerable number of these patients undergo anesthesia for their treatment. This study was designed to compare the effects of general and spinal anesthesia on these patients. In a randomized clinical trial, after taking informed written consent from the patients, 200 patients entered the study; 100 in each. During a 2 year period, women aged 20 to 40 years entered the study (one group receiving spinal anesthesia and the other, receiving general anesthesia). Ovum retrieval protocols were the same. Nonparametric and parametric analyses were used for data analysis. P value less than 0.05 was considered significant. There was no difference between the two groups regarding demographic variables. 15 of 100 patients (15%) in the general anesthesia group and 27 of 100 patients (27%) in the spinal anesthesia group had successful pregnancy after IVF; so, spinal anesthesia increased significantly the chance of IVF success (P value < 0.001; Chi Square). The results of this study demonstrated that spinal anesthesia increased the chance of fertilization success.

  13. FORENSIC OBSTETRICS

    PubMed Central

    Russell, Keith P.

    1959-01-01

    Some of the more important and current aspects of forensic obstetrics are, broadly, 1. Fulfillment of basic criteria in all cases of alleged traumatic abortion. 2. Utilization of therapeutic abortion review boards, as well as sterilization committees, in all hospitals, with the active support of such committees by all those physicians interested in advancing the art and practice of obstetrics. 3. Early and active joint study of professional liability problems by combined groups of physicians and lawyers in every community. PMID:14440311

  14. Pilot Workload and Speech Analysis: A Preliminary Investigation

    NASA Technical Reports Server (NTRS)

    Bittner, Rachel M.; Begault, Durand R.; Christopher, Bonny R.

    2013-01-01

    Prior research has questioned the effectiveness of speech analysis to measure the stress, workload, truthfulness, or emotional state of a talker. The question remains regarding the utility of speech analysis for restricted vocabularies such as those used in aviation communications. A part-task experiment was conducted in which participants performed Air Traffic Control read-backs in different workload environments. Participant's subjective workload and the speech qualities of fundamental frequency (F0) and articulation rate were evaluated. A significant increase in subjective workload rating was found for high workload segments. F0 was found to be significantly higher during high workload while articulation rates were found to be significantly slower. No correlation was found to exist between subjective workload and F0 or articulation rate.

  15. AANA Journal course: update for nurse anesthetists--ERR WATCH: anesthesia crisis resource management from the nurse anesthetist's perspective.

    PubMed

    Fletcher, J L

    1998-12-01

    Anesthesia crisis resource management (ACRM) was developed by David Gaba, MD, and colleagues at Stanford University in the early 1990s. Derived from cockpit resource management of the aviation industry, ACRM addresses the issues of human performance and patient safety in anesthesia. Due to the inherent complexity of our dynamic work environment, we are frequently faced with situations that could escalate into critical incidents. ACRM explains the role of personal and environmental factors that can contribute to the evolution of critical incidents and provides the practitioner with some behavioral and intellectual guidelines to manage the risks more effectively. ERR WATCH is an acronym I developed to interpret the principles of ACRM from the nurse anesthetist's perspective. It provides a quick review of the major principles of ACRM, which are Environment, Resources, Reevaluation, Workload, Attention, Teamwork, Communication, and Help. Used together with good clinical management, these principles may provide an edge in solving complex problems and improving performance.

  16. [Automated anesthesia record system].

    PubMed

    Zhu, Tao; Liu, Jin

    2005-12-01

    Based on Client/Server architecture, a software of automated anesthesia record system running under Windows operation system and networks has been developed and programmed with Microsoft Visual C++ 6.0, Visual Basic 6.0 and SQL Server. The system can deal with patient's information throughout the anesthesia. It can collect and integrate the data from several kinds of medical equipment such as monitor, infusion pump and anesthesia machine automatically and real-time. After that, the system presents the anesthesia sheets automatically. The record system makes the anesthesia record more accurate and integral and can raise the anesthesiologist's working efficiency.

  17. Estimating anesthesia and surgical procedure times from medicare anesthesia claims.

    PubMed

    Silber, Jeffrey H; Rosenbaum, Paul R; Zhang, Xuemei; Even-Shoshan, Orit

    2007-02-01

    Procedure times are important variables that often are included in studies of quality and efficiency. However, due to the need for costly chart review, most studies are limited to single-institution analyses. In this article, the authors describe how well the anesthesia claim from Medicare can estimate chart times. The authors abstracted information on time of induction and entrance to the recovery room ("anesthesia chart time") from the charts of 1,931 patients who underwent general and orthopedic surgical procedures in Pennsylvania. The authors then merged the associated bills from claims data supplied from Medicare (Part B data) that included a variable denoting the time in minutes for the anesthesia service. The authors also investigated the time from incision to closure ("surgical chart time") on a subset of 1,888 patients. Anesthesia claim time from Medicare was highly predictive of anesthesia chart time (Kendall's rank correlation tau = 0.85, P < 0.0001, median absolute error = 5.1 min) but somewhat less predictive of surgical chart time (Kendall's tau = 0.73, P < 0.0001, median absolute error = 13.8 min). When predicting chart time from Medicare bills, variables reflecting procedure type, comorbidities, and hospital type did not significantly improve the prediction, suggesting that errors in predicting the chart time from the anesthesia bill time are not related to these factors; however, the individual hospital did have some influence on these estimates. Anesthesia chart time can be well estimated using Medicare claims, thereby facilitating studies with vastly larger sample sizes and much lower costs of data collection.

  18. Patient Safety Incidents and Nursing Workload 1

    PubMed Central

    Carlesi, Katya Cuadros; Padilha, Kátia Grillo; Toffoletto, Maria Cecília; Henriquez-Roldán, Carlos; Juan, Monica Andrea Canales

    2017-01-01

    ABSTRACT Objective: to identify the relationship between the workload of the nursing team and the occurrence of patient safety incidents linked to nursing care in a public hospital in Chile. Method: quantitative, analytical, cross-sectional research through review of medical records. The estimation of workload in Intensive Care Units (ICUs) was performed using the Therapeutic Interventions Scoring System (TISS-28) and for the other services, we used the nurse/patient and nursing assistant/patient ratios. Descriptive univariate and multivariate analysis were performed. For the multivariate analysis we used principal component analysis and Pearson correlation. Results: 879 post-discharge clinical records and the workload of 85 nurses and 157 nursing assistants were analyzed. The overall incident rate was 71.1%. It was found a high positive correlation between variables workload (r = 0.9611 to r = 0.9919) and rate of falls (r = 0.8770). The medication error rates, mechanical containment incidents and self-removal of invasive devices were not correlated with the workload. Conclusions: the workload was high in all units except the intermediate care unit. Only the rate of falls was associated with the workload. PMID:28403334

  19. Laparoscopic Surgery Using Spinal Anesthesia

    PubMed Central

    Gurwara, A. K.; Gupta, S. C.

    2008-01-01

    Background: Laparoscopic abdominal surgery is conventionally done under general anesthesia. Spinal anesthesia is usually preferred in patients where general anesthesia is contraindicated. We present our experience using spinal anesthesia as the first choice for laparoscopic surgery for over 11 years with the contention that it is a good alterative to anesthesia. Methods: Spinal anesthesia was used in 4645 patients over the last 11 years. Laparoscopic cholecystectomy was performed in 2992, and the remaining patients underwent other laparoscopic surgeries. There was no modification in the technique, and the intraabdominal pressure was kept at 8mm Hg to 10mm Hg. Sedation was given if required, and conversion to general anesthesia was done in patients not responding to sedation or with failure of spinal anesthesia. Results were compared with those of 421 patients undergoing laparoscopic surgery while under general anesthesia. Results: Twenty-four (0.01%) patients required conversion to general anesthesia. Hypotension requiring support was recorded in 846 (18.21%) patients, and 571(12.29%) experienced neck or shoulder pain, or both. Postoperatively, 2.09% (97) of patients had vomiting compared to 29.22% (123 patients) of patients who were administered general anesthesia. Injectable diclofenac was required in 35.59% (1672) for abdominal pain within 2 hours postoperatively, and oral analgesic was required in 2936 (63.21%) patients within the first 24 hours. However, 90.02% of patients operated on while under general anesthesia required injectable analgesics in the immediate postoperative period. Postural headache persisting for an average of 2.6 days was seen in 255 (5.4%) patients postoperatively. Average time to discharge was 2.3 days. Karnofsky Performance Status Scale showed a 98.6% satisfaction level in patients. Conclusions: Laparoscopic surgery done with the patient under spinal anesthesia has several advantages over laparoscopic surgery done with the patient under

  20. A tele-obstetric broadband service including ultrasound, videoconferencing and cardiotocogram. A high cost and a low volume of patients.

    PubMed

    Norum, Jan; Bergmo, Trine S; Holdø, Bjørn; Johansen, May V; Vold, Ingar N; Sjaaeng, Elisabeth E; Jacobsen, Heidi

    2007-01-01

    We established a tele-obstetric service connecting the Department of Obstetrics and Gynaecology at the Nordland Hospital in Bodø to the delivery unit at the Nordland Hospital in Lofoten. The telemedicine service included a videoconferencing link (3 Mbit/s) for transmission of ultrasound scans and a low-speed data link (telephone modem) for transmission of cardiotocograms (CTGs). One hundred and thirty pregnant women entered the antenatal clinic in Lofoten during the eight-month study period. A total of 140 CTGs were recorded. The tele-ultrasound service was used in five cases (4%). The cases were serious malformation, Down's syndrome, breech presentation, vaginal bleeding during pregnancy and triplets. Analysis showed that the cost of patient travel was NOK 2460 per transfer. The variable cost of videoconferencing was NOK 250 per consultation. However, the total investment costs for the telemedicine service, including the broadband infrastructure, was NOK 1.7 million (Euro 212,000). The telemedicine service was not cost saving at annual workloads below 208. We conclude that the installation has to be used by other medical specialities to make it cost-effective.

  1. Evidence-based clinical hypnosis for obstetrics, labor and delivery, and preterm labor.

    PubMed

    Brown, Donald Corey; Hammond, D Corydon

    2007-07-01

    This paper reviews the benefits and effectiveness of hypnosis in obstetrics and labor and delivery, demonstrating significant reductions in the use of analgesics and anesthesia and in shorter Stages 1 and 2 labors. It presents empirical and theoretical rationales for use of hypnosis in preterm labor (PTL) and labor and delivery at term. The benefits of hypnosis in relation to labor length, pain levels, and the enjoyment of labor, as well as its effectiveness in preterm labor are noted in randomized controlled trials and in a meta-analysis. Risk factors are reported for preterm delivery; hypnosis significantly prolongs pregnancy. Six cases are presented of hypnosis stopping PTL a number of times and when indicated at term. A case report of successful use of hypnosis in quadruplets is presented with some scripts. Suggestions are made for further research.

  2. Pupillometric measurement of operator workload

    NASA Technical Reports Server (NTRS)

    Beatty, J.

    1981-01-01

    Pupillometry as a method of measuring workload is described. Pupillometric measures provide an indication of momentary fluctuations in central nervous system excitability that occur as cognitive operations are performed; the magnitude of these changes may serve as a sensitive indicator of the workload imposed by cognitive tasks.

  3. Transport pilot workload - A comparison of two subjective techniques

    NASA Technical Reports Server (NTRS)

    Battiste, Vernol; Bortolussi, Michael

    1988-01-01

    Although SWAT and NASA-TLX workload scales have been compared on numerous occasions, they have not been compared in the context of transport operations. Transport pilot workload has traditionally been classified as long periods of low workload with occasional spikes of high workload. Thus, the relative sensitivity of the scales to variations in workload at the low end of the scale were evaluated. This study was a part of a larger study which investigated workload measures for aircraft certification, conducted in a Phase II certified Link/Boeing 727 simulator. No significant main effects were found for any performance-based measures of workload. However, both SWAT and NASA-TLX were sensitive to differences between high and low workload flights and to differences among flight segments. NASA-TLX (but not SWAT) was sensitive to the increase in workload during the cruise segment of the high workload flight. Between-subject variability was high for SWAT. NASA-TLX was found to be stable when compared in the test/retest paradigm. A test/retest by segment interaction suggested that this was not the case for SWAT ratings.

  4. Combining Quick-Turnaround and Batch Workloads at Scale

    NASA Technical Reports Server (NTRS)

    Matthews, Gregory A.

    2012-01-01

    NAS uses PBS Professional to schedule and manage the workload on Pleiades, an 11,000+ node 1B cluster. At this scale the user experience for quick-turnaround jobs can degrade, which led NAS initially to set up two separate PBS servers, each dedicated to a particular workload. Recently we have employed PBS hooks and scheduler modifications to merge these workloads together under one PBS server, delivering sub-1-minute start times for the quick-turnaround workload, and enabling dynamic management of the resources set aside for that workload.

  5. Anesthesia Methods in Laser Resurfacing

    PubMed Central

    Gaitan, Sergio; Markus, Ramsey

    2012-01-01

    Laser resurfacing technology offers the ability to treat skin changes that are the result of the aging process. One of the major drawbacks of laser resurfacing technologies is the pain associated with the procedure. The methods of anesthesia used in laser resurfacing to help minimize the pain include both noninvasive and invasive procedures. The noninvasive procedures can be divided into topical, cryoanesthesia, and a combination of both. The invasive methods of anesthesia include injected forms (infiltrative, nerve blocks, and tumescent anesthesia) and supervised anesthesia (monitored anesthesia care and general anesthesia). In this review, the authors summarize the types of anesthesia used in laser resurfacing to aid the provider in offering the most appropriate method for the patient to have as painless a procedure as possible. PMID:23904819

  6. [Classification of local anesthesia methods].

    PubMed

    Petricas, A Zh; Medvedev, D V; Olkhovskaya, E B

    The traditional classification methods of dental local anesthesia must be modified. In this paper we proved that the vascular mechanism is leading component of spongy injection. It is necessary to take into account the high effectiveness and relative safety of spongy anesthesia, as well as versatility, ease of implementation and the growing prevalence in the world. The essence of the proposed modification is to distinguish the methods in diffusive (including surface anesthesia, infiltration and conductive anesthesia) and vascular-diffusive (including intraosseous, intraligamentary, intraseptal and intrapulpal anesthesia). For the last four methods the common term «spongy (intraosseous) anesthesia» may be used.

  7. Propofol anesthesia.

    PubMed

    Short, C E; Bufalari, A

    1999-05-01

    Although questions may still remain regarding the use of this unique sedative-hypnotic drug with anesthetic properties in high-risk patients, our studies have provided cardiopulmonary and neurological evidence of the efficacy and safety of propofol when used as an anesthetic under normal and selected impaired conditions in the dog. 1. Propofol can be safely and effectively used for the induction and maintenance of anesthesia in normal healthy dogs. Propofol is also a reliable and safe anesthetic agent when used during induced cardiovascular and pulmonary-impaired conditions without surgery. The propofol requirements to induce the safe and prompt induction of anesthesia prior to inhalant anesthesia with and without surgery have been determined. 2. The favorable recovery profile associated with propofol offers advantages over traditional anesthetics in clinical situations in which rapid recovery is important. Also, propofol compatibility with a large variety of preanesthetics may increase its use as a safe and reliable i.v. anesthetic for the induction and maintenance of general anesthesia and sedation in small animal veterinary practice. Although propofol has proven to be a valuable adjuvant during short ambulatory procedures, its use for the maintenance of general anesthesia has been questioned for surgery lasting more than 1 hour because of increased cost and marginal differences in recovery times compared with those of standard inhalant or balanced anesthetic techniques. When propofol is used for the maintenance of anesthesia in combination with a sedative/analgesic, the quality of anesthesia is improved as well as the ease with which the practitioner can titrate propofol; therefore, practitioners are able to use i.v. anesthetic techniques more effectively in their clinical practices. 3. Propofol can induce significant depression of respiratory function, characterized by a reduction in the rate of respiration. Potent alpha 2 sedative/analgesics (e.g., xylazine

  8. [Complications in pediatric anesthesia].

    PubMed

    Becke, K

    2014-07-01

    As in adult anesthesia, morbidity and mortality could be significantly reduced in pediatric anesthesia in recent decades. This fact cannot conceal the fact that the incidence of anesthetic complications in children is still much more common than in adults and sometimes with a severe outcome. Newborns and infants in particular but also children with emergency interventions and severe comorbidities are at increased risk of potential complications. Typical complications in pediatric anesthesia are respiratory problems, medication errors, difficulties with the intravenous puncture and pulmonal aspiration. In the postoperative setting, nausea and vomiting, pain, and emergence delirium can be mentioned as typical complications. In addition to the systematic prevention of complications in pediatric anesthesia, it is important to quickly recognize disturbances of homeostasis and treat them promptly and appropriately. In addition to the expertise of the performing anesthesia team, the institutional structure in particular can improve quality and safety in pediatric anesthesia.

  9. Mental workload during brain-computer interface training.

    PubMed

    Felton, Elizabeth A; Williams, Justin C; Vanderheiden, Gregg C; Radwin, Robert G

    2012-01-01

    It is not well understood how people perceive the difficulty of performing brain-computer interface (BCI) tasks, which specific aspects of mental workload contribute the most, and whether there is a difference in perceived workload between participants who are able-bodied and disabled. This study evaluated mental workload using the NASA Task Load Index (TLX), a multi-dimensional rating procedure with six subscales: Mental Demands, Physical Demands, Temporal Demands, Performance, Effort, and Frustration. Able-bodied and motor disabled participants completed the survey after performing EEG-based BCI Fitts' law target acquisition and phrase spelling tasks. The NASA-TLX scores were similar for able-bodied and disabled participants. For example, overall workload scores (range 0-100) for 1D horizontal tasks were 48.5 (SD = 17.7) and 46.6 (SD 10.3), respectively. The TLX can be used to inform the design of BCIs that will have greater usability by evaluating subjective workload between BCI tasks, participant groups, and control modalities. Mental workload of brain-computer interfaces (BCI) can be evaluated with the NASA Task Load Index (TLX). The TLX is an effective tool for comparing subjective workload between BCI tasks, participant groups (able-bodied and disabled), and control modalities. The data can inform the design of BCIs that will have greater usability.

  10. [Obstetric hysterectomy. Incidence, indications and complications].

    PubMed

    Vázquez, Juan A Reveles; Rivera, Geannyne Villegas; Higareda, Salvador Hernández; Páez, Fernando Grover; Vega, Carmen C Hernández; Segura, Agustin Patiño

    2008-03-01

    Obstetric hysterectomy is indicated when patient's life is at risk, and it is a procedure that requires a highly experienced and skilled medical team to solve any complication. To identify incidence, indications, and complications of obstetric hysterectomy within a high-risk population. Transversal, retrospective study from July 1st 2004 to June 30 2006 at Unidad Medica de Alta Especialidad, Hospital de Ginecoobstetricia, Centro Medico Nacional de Occidente, IMSS. There were reviewed 103 patient' files with obstetric hysterectomy. Incidence was calculated, and clinical and socio-demographic characteristics, indications, and complications of obstetric hysterectomy identified and expressed in frequency, percentages, and central tendency measurements. Incidence of obstetric hysterectomy was 8 cases within every 1,000 obstetric consultation. Age average was 31.1 +/- 5.1 years. 72.8% had cesarean surgery history. Main indication was placenta previa associated with placenta accreta (33%), followed by uterine hypotony (22.3%). Complications were hypovolemic shock (56.3%), and vesical injuries (5.8%). There were no maternal deaths. Cesarean history induces higher obstetric hysterectomy incidence in women with high-risk pregnancy, due to its relation to placentation disorders, as placenta previa that increases hemorrhage possibility, and thus, maternal morbidity and mortality.

  11. Side effects and complications of intraosseous anesthesia and conventional oral anesthesia

    PubMed Central

    Peñarrocha-Oltra, David; Ata-Ali, Javier; Oltra-Moscardó, María J.; Peñarrocha, Miguel

    2012-01-01

    Objective: To analyze the side effects and complications following intraosseous anesthesia (IA), comparing them with those of the conventional oral anesthesia techniques. Material and method: A simple-blind, prospective clinical study was carried out. Each patient underwent two anesthetic techniques: conventional (local infiltration and locoregional anesthetic block) and intraosseous, for respective dental operations. In order to allow comparison of IA versus conventional anesthesia, the two operations were similar and affected the same two teeth in opposite quadrants. Heart rate was recorded in all cases before injection of the anesthetic solution and again 30 seconds after injection. The complications observed after anesthetic administration were recorded. Results: A total of 200 oral anesthetic procedures were carried out in 100 patients. Both IA and conventional anesthesia resulted in a significant increase in heart rate, though the increase was greater with the latter technique. Incidents were infrequent with either anesthetic technique, with no significant differences between them. Regarding the complications, there were significant differences in pain at the injection site, with more intense pain in the case of IA (x2=3.532, p=0.030, Φ2=0.02), while the limitation of oral aperture was more pronounced with conventional anesthesia (x2=5.128, p<0.05, Φ2=0.014). Post-anesthetic biting showed no significant differences (x2=4.082, p=0.121, Φ2=0.009). Conclusions: Both anesthetic techniques significantly increased heart rate, and IA caused comparatively more pain at the injection site, while limited oral aperture was more frequent with conventional anesthesia. Post-anesthetic biting showed no significant differences between the two techniques. Key words:Intraosseous anesthesia, oral anesthesia, mandibular block, heart rate, adrenalin, complications. PMID:22143716

  12. Crew workload strategies in advanced cockpits

    NASA Technical Reports Server (NTRS)

    Hart, Sandra G.

    1990-01-01

    Many methods of measuring and predicting operator workload have been developed that provide useful information in the design, evaluation, and operation of complex systems and which aid in developing models of human attention and performance. However, the relationships between such measures, imposed task demands, and measures of performance remain complex and even contradictory. It appears that we have ignored an important factor: people do not passively translate task demands into performance. Rather, they actively manage their time, resources, and effort to achieve an acceptable level of performance while maintaining a comfortable level of workload. While such adaptive, creative, and strategic behaviors are the primary reason that human operators remain an essential component of all advanced man-machine systems, they also result in individual differences in the way people respond to the same task demands and inconsistent relationships among measures. Finally, we are able to measure workload and performance, but interpreting such measures remains difficult; it is still not clear how much workload is too much or too little nor the consequences of suboptimal workload on system performance and the mental, physical, and emotional well-being of the human operators. The rationale and philosophy of a program of research developed to address these issues will be reviewed and contrasted to traditional methods of defining, measuring, and predicting human operator workload. Viewgraphs are given.

  13. Anesthesia for ambulatory anorectal surgery.

    PubMed

    Gudaityte, Jūrate; Marchertiene, Irena; Pavalkis, Dainius

    2004-01-01

    The prevalence of minor anorectal diseases is 4-5% of adult Western population. Operations are performed on ambulatory or 24-hour stay basis. Requirements for ambulatory anesthesia are: rapid onset and recovery, ability to provide quick adjustments during maintenance, lack of intraoperative and postoperative side effects, and cost-effectiveness. Anorectal surgery requires deep levels of anesthesia. The aim is achieved with 1) regional blocks alone or in combination with monitored anesthesia care or 2) deep general anesthesia, usually with muscle relaxants and tracheal intubation. Modern general anesthetics provide smooth, quickly adjustable anesthesia and are a good choice for ambulatory surgery. Popular regional methods are: spinal anesthesia, caudal blockade, posterior perineal blockade and local anesthesia. The trend in regional anesthesia is lowering the dose of local anesthetic, providing selective segmental block. Adjuvants potentiating analgesia are recommended. Postoperative period may be complicated by: 1) severe pain, 2) urinary retention due to common nerve supply, and 3) surgical bleeding. Complications may lead to hospital admission. In conclusion, novel general anesthetics are recommended for ambulatory anorectal surgery. Further studies to determine an optimal dose and method are needed in the group of regional anesthesia.

  14. Hypotensive Anesthesia versus Normotensive Anesthesia during Major Maxillofacial Surgery: A Review of the Literature

    PubMed Central

    Yoav, Leiser; Abu el-Naaj, Imad

    2015-01-01

    Steady blood pressure within normal limits during surgery is one of the markers of the ideal and skillful anesthesia. Yet, reduced blood pressure is advantageous in some settings because it can contribute to a reduction in overall blood loss and improve the surgical field conditions. Controlled hypotension during anesthesia or hypotensive anesthesia is often used in major maxillofacial operations. Since hypotensive anesthesia carries the risk of hypoperfusion to important organs and tissues, mainly the brain, heart, and kidneys, it cannot be applied safely in all patients. In this paper we review the medical literature regarding hypotensive anesthesia during major maxillofacial surgery, the means to achieve it, and the risks and benefits of this technique, in comparison to normotensive anesthesia. PMID:25811042

  15. No-anesthesia clear corneal phacoemulsification versus topical and topical plus intracameral anesthesia. Randomized clinical trial.

    PubMed

    Pandey, S K; Werner, L; Apple, D J; Agarwal, A; Agarwal, A; Agarwal, S

    2001-10-01

    To compare the intraoperative pain scores during clear corneal phacoemulsification under no anesthesia, topical anesthesia, and topical plus intracameral anesthesia. Dr. Agarwal's Eye Hospital and Eye Research Center, Chennai, India. Seventy-five patients were randomized to have phacoemulsification under no anesthesia, topical anesthesia, or topical plus intracameral anesthesia. Uncooperative or illiterate patients and those with hard cataract, a shallow anterior chamber, or small pupils were excluded. A protocol was established for supplemental anesthesia in case of breakthrough pain during the surgery. Each patient was asked to grade the overall severity of intraoperative pain immediately after surgery on a 10-point visual analog scale. Also evaluated were the general discomfort during surgery, discomfort from the microscope lights, surgeon stress during surgery, and total surgical time. Comparison among the 3 groups was performed using an analysis of variance. No supplemental anesthesia was required in any group. No significant difference was noted in the mean scores of the subjective sensation of pain with or without topical anesthesia (P =.610). The mean scores of patient discomfort from the microscope lights and surgical time were also statistically insignificant. Patient discomfort and surgeon stress during surgery were significantly greater in the no-anesthesia group than in the topical and topical plus intracameral groups (P =.0235 and P = 0.0206, respectively). No-anesthesia clear corneal phacoemulsification was performed by a highly experienced, skilled surgeon without causing an unacceptable level of pain. However, this technique is not suitable for every cataract surgeon or patient.

  16. PDPH in obstetric anesthesia: comparison of 24-gauge Sprotte and 25-gauge Quincke needles and effect of subarachnoid administration of fentanyl.

    PubMed

    Devcic, A; Sprung, J; Patel, S; Kettler, R; Maitra-D'Cruze, A

    1993-01-01

    Postdural puncture headache (PDPH) is a frequent complication of spinal anesthesia. Some investigators have recommended the use of the Sprotte needle to reduce the incidence of this serious complication. This study prospectively compared the incidence of PDPH with two spinal needles of different size and design: the 24-gauge Sprotte (noncutting point) versus the 25-gauge Quincke (diamond, cutting point). The hypothesis that subarachnoid fentanyl will reduce the incidence of PDPH, as suggested in the literature, was also studied. Only patients for emergency or elective cesarean delivery were studied. One hundred ninety four patients were randomly assigned to receive spinal anesthesia with one of the two needles (Sprotte, n = 96; Quincke, n = 98). Simultaneously, each patient was assigned to receive hyperbaric 0.75% bupivacaine local anesthetic or a combination of the same concentration of local anesthetic with 20 micrograms of fentanyl (Sprotte with fentanyl, n = 47; Sprotte without fentanyl, n = 49; Quincke with fentanyl, n = 49; Quincke without fentanyl, n = 49). All patients were evaluated during the first 4 postoperative days, and follow-up telephone interviews were conducted 3 weeks after discharge. Four patients (4.2%) in the Sprotte group and seven (7.1%) in the Quincke group developed PDPH. Three out of four patients with headache in the Sprotte and four out of seven in the Quincke group received fentanyl as an adjunct for spinal anesthesia. Two patients in the Sprotte group required an epidural blood patch as a therapy for PDPH. Two patients in the Quincke group had severe headache and required an epidural blood patch. In the current study, the use of the 24-gauge Sprotte spinal needle resulted in a low incidence of severe PDPH, but was not significantly different when compared with the use of a 25-gauge Quincke needle (oriented parallel to the longitudinal dural fibers). The addition of fentanyl to hyperbaric bupivacaine spinal anesthesia did not reduce

  17. Duty Rosters and Workloads of Obstetricians in Germany: Results of a Germany-wide Survey.

    PubMed

    Neimann, Johannes; Knabl, Julia; Puppe, Julian; Bayer, Christian Michael; Gass, Paul; Gabriel, Lena; Seelbach-Goebel, Birgit; Lermann, Johannes; Schott, Sarah

    2017-08-01

    Compiling a daily hospital roster which complies with existing laws and tariff regulations and meets the requirements for ongoing professional training while also taking the legal regulations on the health of employees into account makes planning the duty roster a challenge. The aim of this study was to obtain a realistic picture of existing duty roster systems and of the current workloads of obstetricians in Germany. This online survey was sent to 2770 physicians training to become obstetricians or specializing in specific areas of obstetric care. The survey consisted of an anonymized 95-item questionnaire which collected data on different types of duty roster systems and the workload of obstetricians in Germany for the period from 17.02.2015 to 16.05.2015. Out of a total of 2770 physicians who were contacted, 437 (16%) completed the questionnaire. Across all forms of care, the care provided outside normal working hours usually (75%) consisted of a combination of regular working times and on-call duty or even consisted entirely of standby duty. Level I perinatal centers were most likely 20% (n = 88) to have a shift system in place. Working a shift system was significantly more common in care facilities which had previously carried out a job analysis. The number of physicians in hospitals who are present during the night shift was higher in facilities with higher numbers of births and in facilities which offered higher levels of care. In addition to regularly working overtime and the fact that often not all the hours worked were recorded, it was notable that the systems used to compile duty rosters often did not comply with legal regulations or with collectively agreed working hours nor were they compatible with the staff planning requirements. The results of this study show that the conditions of work, the working times, and the organization of working times in obstetric departments are in need of improvement. Recording the actual times worked together with an

  18. Automated clustering-based workload characterization

    NASA Technical Reports Server (NTRS)

    Pentakalos, Odysseas I.; Menasce, Daniel A.; Yesha, Yelena

    1996-01-01

    The demands placed on the mass storage systems at various federal agencies and national laboratories are continuously increasing in intensity. This forces system managers to constantly monitor the system, evaluate the demand placed on it, and tune it appropriately using either heuristics based on experience or analytic models. Performance models require an accurate workload characterization. This can be a laborious and time consuming process. It became evident from our experience that a tool is necessary to automate the workload characterization process. This paper presents the design and discusses the implementation of a tool for workload characterization of mass storage systems. The main features of the tool discussed here are: (1)Automatic support for peak-period determination. Histograms of system activity are generated and presented to the user for peak-period determination; (2) Automatic clustering analysis. The data collected from the mass storage system logs is clustered using clustering algorithms and tightness measures to limit the number of generated clusters; (3) Reporting of varied file statistics. The tool computes several statistics on file sizes such as average, standard deviation, minimum, maximum, frequency, as well as average transfer time. These statistics are given on a per cluster basis; (4) Portability. The tool can easily be used to characterize the workload in mass storage systems of different vendors. The user needs to specify through a simple log description language how the a specific log should be interpreted. The rest of this paper is organized as follows. Section two presents basic concepts in workload characterization as they apply to mass storage systems. Section three describes clustering algorithms and tightness measures. The following section presents the architecture of the tool. Section five presents some results of workload characterization using the tool.Finally, section six presents some concluding remarks.

  19. A Model of Student Workload

    ERIC Educational Resources Information Center

    Bowyer, Kyle

    2012-01-01

    Student workload is a contributing factor to students deciding to withdraw from their study before completion of the course, at significant cost to students, institutions and society. The aim of this paper is to create a basic workload model for a group of undergraduate students studying business law units at Curtin University in Western…

  20. Effect of low-flow anesthesia education on knowledge, attitude and behavior of the anesthesia team.

    PubMed

    Hanci, Volkan; Yurtlu, Serhan; Ayoğlu, Hilal; Okyay, Rahşan Dilek; Erdoğan, Gülay; Abduşoğlu, Mustafa; Sayin, Esin; Turan, Işil Ozkoçak

    2010-08-01

    The aim of this study was to evaluate the effect of education on the knowledge, attitude and behavior of anesthesiology staff and residents towards low-flow anesthesia. The staff and residents in the Department of Anesthesia and Reanimation, Zonguldak Karaelmas University were given theoretical and practical training in delivering low-flow anesthesia. To evaluate their attitudes and behaviors toward low-flow anesthesia, we collected data during the 6 months before training, during the first 3 months after training, and at 4-6 months after training. Anesthesia follow-up records, operation time, volatile anesthetic agent used, and the amount (in liters) of fresh gas low mid-anesthesia were recorded in all three stages. A total of 3,158 patients received general anesthesia and inhalation anesthesia was used in 3,115 of these patients. Our study group consisted of 2,752 patients who had no absolute or relative contraindications to low-flow anesthesia. While the mean fresh gas flow was 4.00 +/- 0.00 L/min before training, this level dropped to 2.98 L/min in the first 3 months after training, and to 3.26 L/min in the following 3 months. The mean fresh gas flow was significantly lower at the two post-training assessments than before training (p < 0.05). In conclusion, low-flow anesthesia may be used more frequently if educational seminars are provided to anesthetists. The use of low-flow anesthesia may increase further by allocating more time to this technique in anesthesia training programs provided at regular intervals. Copyright 2010 Elsevier. Published by Elsevier B.V. All rights reserved.

  1. Use of local anesthesia during dental rehabilitation with general anesthesia: a survey of dentist anesthesiologists.

    PubMed

    Townsend, Janice A; Hagan, Joseph L; Smiley, Megann

    2014-01-01

    The purpose of this study was to document current practices of dentist anesthesiologists who are members of the American Society of Dentist Anesthesiologists regarding the supplemental use of local anesthesia for children undergoing dental rehabilitation under general anesthesia. A survey was administered via e-mail to the membership of the American Society of Dentist Anesthesiologists to document the use of local anesthetic during dental rehabilitations under general anesthesia and the rationale for its use. Seventy-seven (42.1%) of the 183 members responded to this survey. The majority of dentist anesthesiologists prefer use of local anesthetic during general anesthesia for dental rehabilitation almost always or sometimes (90%, 63/70) and 40% (28/70) prefer its use with rare exception. For dentist anesthesiologists who prefer the administration of local anesthesia almost always, they listed the following factors as very important: "stabilization of vital signs/decreased depth of general anesthesia" (92.9%, 26/28) and "improved patient recovery" (82.1%, 23/28). There was a significant association between the type of practice and who determines whether or not local anesthesia is administered during cases. The majority of respondents favor the use of local anesthesia during dental rehabilitation under general anesthesia.

  2. Obstetric fistula: what about gender power?

    PubMed

    Roush, Karen; Kurth, Ann; Hutchinson, M Katherine; Van Devanter, Nancy

    2012-01-01

    Despite over 40 years of research there has been little progress in the prevention of obstetric fistula and women continue to suffer in unacceptable numbers. Gender power imbalance has consistently been shown to have serious implications for women's reproductive health and is known to persist in regions where obstetric fistula occurs. Yet, there is limited research about the role gender power imbalance plays in childbirth practices that put women at risk for obstetric fistula. This information is vital for developing effective maternal health interventions in regions affected by obstetric fistula.

  3. Mental workload in decision and control

    NASA Technical Reports Server (NTRS)

    Sheridan, T. B.

    1979-01-01

    This paper briefly reviews the problems of defining and measuring the 'mental workload' of aircraft pilots and other human operators of complex dynamic systems. Of the alternative approaches the author indicates a clear preference for the use of subjective scaling. Some recent experiments from MIT and elsewhere are described which utilize subjective mental workload scales in conjunction with human decision and control tasks in the laboratory. Finally a new three-dimensional mental workload rating scale, under current development for use by IFR aircraft pilots, is presented.

  4. The malpractice premium costs of obstetrics.

    PubMed

    Norton, S A

    1997-01-01

    This study examined, in 1992, the variation in the level of malpractice premiums, and the incremental malpractice premium costs associated with the practice of obstetrics for family practitioners and obstetricians. On average, in 1992 obstetricians and family practitioners providing obstetric services paid malpractice premiums of roughly $44,000 and $16,000, respectively. The incremental increase in malpractice premium costs represented roughly 70% of the premium the physicians would have paid had they not provided obstetric services. These results suggest that for both family practitioners and obstetricians, there is a considerable premium penalty associated with providing obstetric services which may have implications for women's access to obstetric services. Moreover, the results make it clear that physicians practicing in different states, and different specialists within a state, may face very different malpractice premium costs.

  5. The relationship between workload and training - An introduction

    NASA Technical Reports Server (NTRS)

    Hart, Sandra G.

    1986-01-01

    This paper reviews the relationships among workload, performance, and training. Its goal is to introduce the concepts of workload and training and to suggest how they may be related. It suggests some of the practical and theoretical benefits to be derived from their joint consideration. Training effectiveness can be improved by monitoring trainee workload and the reliability of workload predictions, and measures can be improved by identifying and controlling the training levels of experimental subjects.

  6. [Study on mental workload of teachers in primary schools].

    PubMed

    Xiao, Yuan-mei; Wang, Zhi-ming; Wang, Mian-zhen; Lan, Ya-jia; Fan, Guang-qin; Feng, Chang

    2011-12-01

    To investigate the distribution characteristics and influencing factors of mental workload of teachers in primary schools. National Aeronautics and Space Administration-Task Load Index (NASA-TLX) was used to assess the mental workload levels for 397 teachers of primary schools in a city. The mental workload (64.34+10.56) of female teachers was significantly higher than that (61.73+ 9.77) of male teachers (P<0.05). The mental workload (65.66+10.42) of "-35" years old group was the highest. When age of teachers was younger than 35 years old, there was a positive correlation between the mental workload and age (r=0.146, P<0.05). When age of teachers was older than 35 years old, there was a negative correlation between the mental workload and age (r=-0.190, P<0.05). The teachers with higher education level felt higher mental workload (unstandardized coefficients B=1.524, standardized coefficients /=0.111, P<0.05). There was a positive correlation between the mental workload and working hours per day (unstandardized coefficients B =4.659, standardized coefficients/3 =0.223, P<0.001). Mental workload of the teachers in primary schools is closely related to age, educational level and work hours per day. Work hours per day is an important risk factor for mental workload. Reducing work hours per day (8 hours) is an effective measure of alleviating the mental workload of teachers in primary schools.

  7. Administration of Anesthesia

    MedlinePlus Videos and Cool Tools

    ... more. Anesthesia Download Download the ebook for further information Anesthesia: Safety and Comfort in the OMS Office ... comfortable as possible when you get home. The information provided here is not intended as a substitute ...

  8. 'In situ simulation' versus 'off site simulation' in obstetric emergencies and their effect on knowledge, safety attitudes, team performance, stress, and motivation: study protocol for a randomized controlled trial

    PubMed Central

    2013-01-01

    Background Unexpected obstetric emergencies threaten the safety of pregnant women. As emergencies are rare, they are difficult to learn. Therefore, simulation-based medical education (SBME) seems relevant. In non-systematic reviews on SBME, medical simulation has been suggested to be associated with improved learner outcomes. However, many questions on how SBME can be optimized remain unanswered. One unresolved issue is how 'in situ simulation' (ISS) versus 'off site simulation' (OSS) impact learning. ISS means simulation-based training in the actual patient care unit (in other words, the labor room and operating room). OSS means training in facilities away from the actual patient care unit, either at a simulation centre or in hospital rooms that have been set up for this purpose. Methods and design The objective of this randomized trial is to study the effect of ISS versus OSS on individual learning outcome, safety attitude, motivation, stress, and team performance amongst multi-professional obstetric-anesthesia teams. The trial is a single-centre randomized superiority trial including 100 participants. The inclusion criteria were health-care professionals employed at the department of obstetrics or anesthesia at Rigshospitalet, Copenhagen, who were working on shifts and gave written informed consent. Exclusion criteria were managers with staff responsibilities, and staff who were actively taking part in preparation of the trial. The same obstetric multi-professional training was conducted in the two simulation settings. The experimental group was exposed to training in the ISS setting, and the control group in the OSS setting. The primary outcome is the individual score on a knowledge test. Exploratory outcomes are individual scores on a safety attitudes questionnaire, a stress inventory, salivary cortisol levels, an intrinsic motivation inventory, results from a questionnaire evaluating perceptions of the simulation and suggested changes needed in the

  9. 'In situ simulation' versus 'off site simulation' in obstetric emergencies and their effect on knowledge, safety attitudes, team performance, stress, and motivation: study protocol for a randomized controlled trial.

    PubMed

    Sørensen, Jette Led; Van der Vleuten, Cees; Lindschou, Jane; Gluud, Christian; Østergaard, Doris; LeBlanc, Vicki; Johansen, Marianne; Ekelund, Kim; Albrechtsen, Charlotte Krebs; Pedersen, Berit Woetman; Kjærgaard, Hanne; Weikop, Pia; Ottesen, Bent

    2013-07-17

    Unexpected obstetric emergencies threaten the safety of pregnant women. As emergencies are rare, they are difficult to learn. Therefore, simulation-based medical education (SBME) seems relevant. In non-systematic reviews on SBME, medical simulation has been suggested to be associated with improved learner outcomes. However, many questions on how SBME can be optimized remain unanswered. One unresolved issue is how 'in situ simulation' (ISS) versus 'off site simulation' (OSS) impact learning. ISS means simulation-based training in the actual patient care unit (in other words, the labor room and operating room). OSS means training in facilities away from the actual patient care unit, either at a simulation centre or in hospital rooms that have been set up for this purpose. The objective of this randomized trial is to study the effect of ISS versus OSS on individual learning outcome, safety attitude, motivation, stress, and team performance amongst multi-professional obstetric-anesthesia teams.The trial is a single-centre randomized superiority trial including 100 participants. The inclusion criteria were health-care professionals employed at the department of obstetrics or anesthesia at Rigshospitalet, Copenhagen, who were working on shifts and gave written informed consent. Exclusion criteria were managers with staff responsibilities, and staff who were actively taking part in preparation of the trial. The same obstetric multi-professional training was conducted in the two simulation settings. The experimental group was exposed to training in the ISS setting, and the control group in the OSS setting. The primary outcome is the individual score on a knowledge test. Exploratory outcomes are individual scores on a safety attitudes questionnaire, a stress inventory, salivary cortisol levels, an intrinsic motivation inventory, results from a questionnaire evaluating perceptions of the simulation and suggested changes needed in the organization, a team-based score on video

  10. Relationship between workload and mind-wandering in simulated driving

    PubMed Central

    2017-01-01

    Mental workload and mind-wandering are highly related to driving safety. This study investigated the relationship between mental workload and mind-wandering while driving. Participants (N = 40) were asked to perform a car following task in driving simulator, and report whether they had experienced mind-wandering upon hearing a tone. After driving, participants reported their workload using the NASA-Task Load Index (TLX). Results revealed an interaction between workload and mind-wandering in two different perspectives. First, there was a negative correlation between workload and mind-wandering (r = -0.459, p < 0.01) for different individuals. Second, from temporal perspective workload and mind-wandering frequency increased significantly over task time and were positively correlated. Together, these findings contribute to understanding the roles of workload and mind-wandering in driving. PMID:28467513

  11. Practical guidelines for workload assessment

    NASA Technical Reports Server (NTRS)

    Tattersall, Andrew J.

    1994-01-01

    The practical problems that might be encountered in carrying out workload evaluations in work settings have been outlined. Different approaches have been distinguished that may determine the type of research design used and provide assistance in the difficult choice between workload assessment techniques. One approach to workload assessment is to examine the short-term consequences of combining various tasks. Theoretical models of attention allocation will underpin specific studies of interference and the consequences of task demand and task conflict for performance. A further approach with a different temporal orientation may lead us to a better understanding of the relationships between work demands and strain through the analysis of individual differences in cognitive control processes. The application of these processes may depend on individual differences in long term styles and short term strategies, but may be used to prevent decrements in work performance under difficult conditions. However, control may attract costs as well as benefits in terms of changes in effective state and physiological activity. Thus, strain associated with work demands may only be measurable in the form of tradeoffs between performance and other domains of individual activity. The methodological implications are to identify patterns of adjustment to workload variations using repeated measures and longitudinal sampling of performance as well as subjective and physiological measures. Possible enhancements to workplace design must take into account these human factors considerations of workload in order to avoid potential decrements in individual performance and associated organizational problems.

  12. The impact of service-specific staffing, case scheduling, turnovers, and first-case starts on anesthesia group and operating room productivity: a tutorial using data from an Australian hospital.

    PubMed

    McIntosh, Catherine; Dexter, Franklin; Epstein, Richard H

    2006-12-01

    In this tutorial, we consider the impact of operating room (OR) management on anesthesia group and OR labor productivity and costs. Most of the tutorial focuses on the steps required for each facility to refine its OR allocations using its own data collected during patient care. Data from a hospital in Australia are used throughout to illustrate the methods. OR allocation is a two-stage process. During the initial tactical stage of allocating OR time, OR capacity ("block time") is adjusted. For operational decision-making on a shorter-term basis, the existing workload can be considered fixed. Staffing is matched to that workload based on maximizing the efficiency of use of OR time. Scheduling cases and making decisions on the day of surgery to increase OR efficiency are worthwhile interventions to increase anesthesia group productivity. However, by far, the most important step is the appropriate refinement of OR allocations (i.e., planning service-specific staffing) 2-3 mo before the day of surgery. Reducing surgical and/or turnover times and delays in first-case-of-the-day starts generally provides small reductions in OR labor costs. Results vary widely because they are highly sensitive both to the OR allocations (i.e., staffing) and to the appropriateness of those OR allocations.

  13. Measuring workload in collaborative contexts: trait versus state perspectives.

    PubMed

    Helton, William S; Funke, Gregory J; Knott, Benjamin A

    2014-03-01

    In the present study, we explored the state versus trait aspects of measures of task and team workload in a disaster simulation. There is often a need to assess workload in both individual and collaborative settings. Researchers in this field often use the NASATask Load Index (NASA-TLX) as a global measure of workload by aggregating the NASA-TLX's component items. Using this practice, one may overlook the distinction between traits and states. Fifteen dyadic teams (11 inexperienced, 4 experienced) completed five sessions of a tsunami disaster simulator. After every session, individuals completed a modified version of the NASA-TLX that included team workload measures.We then examined the workload items by using a between-subjects and within-subjects perspective. Between-subjects and within-subjects correlations among the items indicated the workload items are more independent within subjects (as states) than between subjects (as traits). Correlations between the workload items and simulation performance were also different at the trait and state levels. Workload may behave differently at trait (between-subjects) and state (within-subjects) levels. Researchers interested in workload measurement as a state should take a within-subjects perspective in their analyses.

  14. Gynaecological and obstetric management of women with inherited bleeding disorders.

    PubMed

    Demers, Christine; Derzko, Christine; David, Michèle; Douglas, Joanne

    2006-10-01

    The prevalence of bleeding disorders, notably von Willebrand disease (vWD), among adult women with objectively documented menorrhagia is consistently reported to be 10% to 20% and is even higher in adolescents presenting with menorrhagia. This consensus document has been developed by a multidisciplinary committee consisting of an anesthesiologist, 2 hematologists, and an obstetrician/gynaecologist and has been endorsed by their relevant specialty bodies. It has been prepared with the express purpose of providing guidelines for both women with inherited bleeding disorders and for their caregivers regarding the gynaecological and obstetric management of these women, including appropriate anesthesia support where indicated. Diagnostic tools and specific medical and, where appropriate, surgical alternatives to management are reviewed and evidence-based recommendations presented. A MEDLINE search of the English literature between January 1975 and November 2003 was performed using the following key words: menorrhagia, uterine bleeding, pregnancy, von Willebrand, congenital bleeding disorder, desmopressin/DDAVP, tranexamic acid, oral contraceptives, medroxyprogesterone, therapy, hysterectomy, anesthesia, epidural, spinal. Recommendations from other society guidelines were reviewed. 1. Inherited bleeding disorders should be considered in the differential diagnosis of all patients presenting with menorrhagia (II-2B). The graphical scoring system presented is a validated tool which offers a simple yet practical method that can be used by patients to quantify their blood loss (II-2B). 2. Because underlying bleeding disorders are frequent in women with menorrhagia, physicians should consider performing a hemoglobin/hematocrit, platelet count, ferritin, PT (INR) and APTT in women with menorrhagia. In women who have a personal history of other bleeding or a family history of bleeding, further investigation should be considered, including a vWD workup (factor VIII, vWF antigen

  15. Gynaecological and obstetric management of women with inherited bleeding disorders.

    PubMed

    Demers, Christine; Derzko, Christine; David, Michèle; Douglas, Joanne

    2005-07-01

    The prevalence of bleeding disorders, notably von Willebrand disease (vWD), among adult women with objectively documented menorrhagia is consistently reported to be 10% to 20% and is even higher in adolescents presenting with menorrhagia. This consensus document has been developed by a multidisciplinary committee consisting of an anesthesiologist, 2 hematologists, and an obstetrician/gynaecologist and has been endorsed by their relevant specialty bodies. It has been prepared with the express purpose of providing guidelines for both women with inherited bleeding disorders and for their caregivers regarding the gynaecological and obstetric management of these women, including appropriate anesthesia support where indicated. Diagnostic tools and specific medical and, where appropriate, surgical alternatives to management are reviewed and evidence-based recommendations presented. A MEDLINE search of the English literature between January 1975 and November 2003 was performed using the following key words: menorrhagia, uterine bleeding, pregnancy, von Willebrand, congenital bleeding disorder, desmopressin/DDAVP, tranexamic acid, oral contraceptives, medroxyprogesterone, therapy, hysterectomy, anesthesia, epidural, spinal. Recommendations from other society guidelines were reviewed. 1. Inherited bleeding disorders should be considered in the differential diagnosis of all patients presenting with menorrhagia (II-2B). The graphical scoring system presented is a validated tool which offers a simple yet practical method that can be used by patients to quantify their blood loss (II-2B). 2. Because underlying bleeding disorders are frequent in women with menorrhagia, physicians should consider performing a hemoglobin/hematocrit, platelet count, ferritin, PT (INR) and APTT in women with menorrhagia. In women who have a personal history of other bleeding or a family history of bleeding, further investigation should be considered, including a vWD workup (factor VIII, vWF antigen

  16. Preliminary Investigation of Workload on Intrastate Bus Traffic Controllers

    NASA Astrophysics Data System (ADS)

    Yen Bin, Teo; Azlis-Sani, Jalil; Nur Annuar Mohd Yunos, Muhammad; Ismail, S. M. Sabri S. M.; Tajedi, Noor Aqilah Ahmad

    2016-11-01

    The daily routine of bus traffic controller which involves high mental processes would have a direct impact on the level of workload. To date, the level of workload on the bus traffic controllers in Malaysia is relatively unknown. Excessive workload on bus traffic controllers would affect the control and efficiency of the system. This paper served to study the workload on bus traffic controllers and justify the needs to conduct further detailed research on this field. The objectives of this research are to identify the level of workload on the intrastate bus traffic controllers. Based on the results, recommendations will be proposed for improvements and future studies. The level of workload for the bus traffic controllers is quantified using questionnaire adapted from NASA TLX. Interview sessions were conducted for validation of workload. Sixteen respondents were involved and it was found that the average level of workload based on NASA TLX was 6.91. It was found that workload is not affected by gender and marital status. This study also showed that the level of workload and working experience of bus traffic controllers has a strong positive linear relationship. This study would serve as a guidance and reference related to this field. Since this study is a preliminary investigation, further detailed studies could be conducted to obtain a better comprehension regarding the bus traffic controllers.

  17. Rural-Urban Inequity in Unmet Obstetric Needs and Functionality of Emergency Obstetric Care Services in a Zambian District.

    PubMed

    Ng'anjo Phiri, Selia; Fylkesnes, Knut; Moland, Karen Marie; Byskov, Jens; Kiserud, Torvid

    2016-01-01

    Zambia has a high maternal mortality ratio, 398/100,000 live births. Few pregnant women access emergency obstetric care services to handle complications at childbirth. We aimed to assess the deficit in life-saving obstetric services in the rural and urban areas of Kapiri Mposhi district. A cross-sectional survey was conducted in 2011 as part of the 'Response to Accountable priority setting for Trust in health systems' (REACT) project. Data on all childbirths that occurred in emergency obstetric care facilities in 2010 were obtained retrospectively. Sources of information included registers from maternity ward admission, delivery and operation theatre, and case records. Data included age, parity, mode of delivery, obstetric complications, and outcome of mother and the newborn. An approach using estimated major obstetric interventions expected but not done in health facilities was used to assess deficit of life-saving interventions in urban and rural areas. A total of 2114 urban and 1226 rural childbirths occurring in emergency obstetric care facilities (excluding abortions) were analysed. Facility childbirth constituted 81% of expected births in urban and 16% in rural areas. Based on the reference estimate that 1.4% of childbearing women were expected to need major obstetric intervention, unmet obstetric need was 77 of 106 women, thus 73% (95% CI 71-75%) in rural areas whereas urban areas had no deficit. Major obstetric interventions for absolute maternal indications were higher in urban 2.1% (95% CI 1.60-2.71%) than in rural areas 0.4% (95% CI 0.27-0.55%), with an urban to rural rate ratio of 5.5 (95% CI 3.55-8.76). Women in rural areas had deficient obstetric care. The likelihood of under-going a life-saving intervention was 5.5 times higher for women in urban than rural areas. Targeting rural women with life-saving services could substantially reduce this inequity and preventable deaths.

  18. Upper Extremity Regional Anesthesia

    PubMed Central

    Neal, Joseph M.; Gerancher, J.C.; Hebl, James R.; Ilfeld, Brian M.; McCartney, Colin J.L.; Franco, Carlo D.; Hogan, Quinn H.

    2009-01-01

    Brachial plexus blockade is the cornerstone of the peripheral nerve regional anesthesia practice of most anesthesiologists. As part of the American Society of Regional Anesthesia and Pain Medicine’s commitment to providing intensive evidence-based education related to regional anesthesia and analgesia, this article is a complete update of our 2002 comprehensive review of upper extremity anesthesia. The text of the review focuses on (1) pertinent anatomy, (2) approaches to the brachial plexus and techniques that optimize block quality, (4) local anesthetic and adjuvant pharmacology, (5) complications, (6) perioperative issues, and (6) challenges for future research. PMID:19282714

  19. Mental Workload during Brain-Computer Interface Training

    PubMed Central

    Felton, Elizabeth A.; Williams, Justin C.; Vanderheiden, Gregg C.; Radwin, Robert G.

    2012-01-01

    It is not well understood how people perceive the difficulty of performing brain-computer interface (BCI) tasks, which specific aspects of mental workload contribute the most, and whether there is a difference in perceived workload between participants who are able-bodied and disabled. This study evaluated mental workload using the NASA Task Load Index (TLX), a multi-dimensional rating procedure with six subscales: Mental Demands, Physical Demands, Temporal Demands, Performance, Effort, and Frustration. Able-bodied and motor disabled participants completed the survey after performing EEG-based BCI Fitts’ law target acquisition and phrase spelling tasks. The NASA-TLX scores were similar for able-bodied and disabled participants. For example, overall workload scores (range 0 – 100) for 1D horizontal tasks were 48.5 (SD = 17.7) and 46.6 (SD 10.3), respectively. The TLX can be used to inform the design of BCIs that will have greater usability by evaluating subjective workload between BCI tasks, participant groups, and control modalities. PMID:22506483

  20. [Anesthesia and lumbar epidural anesthesia in an infant with third-degree burns].

    PubMed

    Arqués Teixidor, P; Maged Mabrok, M; Marco Valls, J; Moral García, V

    1989-01-01

    Epidural route is widely used in adults for injection of drugs, but it is not so often used in pediatric patients. We present the case of a 8 month old burned infant who received anesthesia and analgesia through a lumbar epidural catheter. The insertion of epidural catheter is described. Two surgical procedures were performed under epidural anesthesia with 0.5% bupivacaine an epinephrine 1:200.000 (2.5 mg/kg). 16 hours of postoperative analgesia was obtained with epidural morphine (0.05 mg/kg). No side effects were seen. We analyze the uses of epidural anesthesia in pediatric patients, the catheter care in the burned child, the hemodynamic changes observed during anesthesia and the results of peridural morphine.

  1. Comparative study between manual injection intraosseous anesthesia and conventional oral anesthesia

    PubMed Central

    Ata-Ali, Javier; Oltra-Moscardó, María J.; Peñarrocha-Diago, María; Peñarrocha, Miguel

    2012-01-01

    Objective: To compare intraosseous anesthesia (IA) with the conventional oral anesthesia techniques. Materials and methods: A simple-blind, prospective clinical study was carried out. Each patient underwent two anesthetic techniques: conventional (local infiltration and locoregional anesthetic block) and intraosseous, for res-pective dental operations. In order to allow comparison of IA versus conventional anesthesia, the two operations were similar and affected the same two teeth in opposite quadrants. Results: A total of 200 oral anesthetic procedures were carried out in 100 patients. The mean patient age was 28.6±9.92 years. Fifty-five vestibular infiltrations and 45 mandibular blocks were performed. All patients were also subjected to IA. The type of intervention (conservative or endodontic) exerted no significant influence (p=0.58 and p=0.62, respectively). The latency period was 8.52±2.44 minutes for the conventional techniques and 0.89±0.73 minutes for IA – the difference being statistically significant (p<0.05). Regarding patient anesthesia sensation, the infiltrative techniques lasted a maximum of one hour, the inferior alveolar nerve blocks lasted between 1-3 hours, and IA lasted only 2.5 minutes – the differences being statistically significant (p≤0.0000, Φ=0.29). Anesthetic success was recorded in 89% of the conventional procedures and in 78% of the IA. Most patients preferred IA (61%) (p=0.0032). Conclusions: The two anesthetic procedures have been compared for latency, duration of anesthetic effect, anesthetic success rate and patient preference. Intraosseous anesthesia has been shown to be a technique to be taken into account when planning conservative and endodontic treatments. Key words: Anesthesia, intraosseous, oral anesthesia, Stabident®, infiltrative, mandibular block. PMID:22143700

  2. Risk-stratification, resource availability, and choice of surgical location for the management of parturients with abnormal placentation: a survey of United States-based obstetric anesthesiologists.

    PubMed

    Grant, T R; Ellinas, E H; Kula, A O; Muravyeva, M Y

    2018-05-01

    Parturients with abnormally adherent placentas present anesthetic challenges that include risk-stratification, management planning and resource utilization. The labor and delivery unit may be remote from the main operating room services. Division chiefs of North American obstetric anesthesiology services were surveyed about their practices and management of parturients with an abnormally adherent placenta. Eighty-four of 122 chiefs, representing 103 hospital sites, responded to the survey (response rate 69%). Sixty-one percent of respondents agreed that women with preoperative placental imaging that was "suspicious" of placenta accreta represented a lower risk category; all other suggested descriptions fell into a higher risk category. Seventy-nine percent of respondents indicated that lower risk cases were managed on the labor and delivery unit, while 71% indicated that higher risk cases would be managed in the main operating room. Institutions where all cases were managed on the labor and delivery unit had better access to human and technical resources, were less remote from their main operating areas, and promoted neuraxial rather than general anesthesia, even for parturients perceived to be at higher risk. Obstetric anesthesia leaders identified patients at lower clinical risk and those less likely to require greater resources. Additional resources were available in institutions where all abnormal placentation cases were managed on the labor and delivery unit. Practitioners should consider risk-stratification and resource availability when planning high-risk cases. Copyright © 2018 Elsevier Ltd. All rights reserved.

  3. Managing Teacher Workload: Work-Life Balance and Wellbeing

    ERIC Educational Resources Information Center

    Bubb, Sara; Earley, Peter

    2004-01-01

    This book is divided into three sections. In the First Section, entitled "Wellbeing and Workload", the authors examine teacher workload and how teachers spend their time. Chapter 1 focuses on what the causes and effects of excessive workload are, especially in relation to wellbeing, stress and, crucially, recruitment and retention?…

  4. Quantitative EEG patterns of differential in-flight workload

    NASA Technical Reports Server (NTRS)

    Sterman, M. B.; Mann, C. A.; Kaiser, D. A.

    1993-01-01

    Four test pilots were instrumented for in-flight EEG recordings using a custom portable recording system. Each flew six, two minute tracking tasks in the Calspan NT-33 experimental trainer at Edwards AFB. With the canopy blacked out, pilots used a HUD display to chase a simulated aircraft through a random flight course. Three configurations of flight controls altered the flight characteristics to achieve low, moderate, and high workload, as determined by normative Cooper-Harper ratings. The test protocol was administered by a command pilot in the back seat. Corresponding EEG and tracking data were compared off-line. Tracking performance was measured as deviation from the target aircraft and combined with control difficulty to achieve an estimate of 'cognitive workload'. Trended patterns of parietal EEG activity at 8-12 Hz were sorted according to this classification. In all cases, high workload produced a significantly greater suppression of 8-12 Hz activity than low workload. Further, a clear differentiation of EEG trend patterns was obtained in 80 percent of the cases. High workload produced a sustained suppression of 8-12 Hz activity, while moderate workload resulted in an initial suppression followed by a gradual increment. Low workload was associated with a modulated pattern lacking any periods of marked or sustained suppression. These findings suggest that quantitative analysis of appropriate EEG measures may provide an objective and reliable in-flight index of cognitive effort that could facilitate workload assessment.

  5. Multidisciplinary Delphi Development of a Scale to Evaluate Team Function in Obstetric Emergencies: The PETRA Scale.

    PubMed

    Balki, Mrinalini; Hoppe, David; Monks, David; Cooke, Mary Ellen; Sharples, Lynn; Windrim, Rory

    2017-06-01

    The objective of this study was to develop a new interdisciplinary teamwork scale, the Perinatal Emergency: Team Response Assessment (PETRA), for the management of obstetric crises, through consensus agreement of obstetric caregivers. This prospective study was performed using expert consensus, based on a Delphi method. The study investigators developed a new PETRA tool, specifically related to obstetric crisis management, based on the existing literature and discussions among themselves. The scale was distributed to a selected panel of experts in the field for the Delphi process. After each round of Delphi, every component of the scale was analyzed quantitatively by the percentage of agreement ratings and each comment reviewed by the blinded investigators. The assessment scale was then modified, with components of less than 80% agreement removed from the scale. The process was repeated on three occasions to reach a consensus and final PETRA scale. Fourteen of 24 invited experts participated in the Delphi process. The original PETRA scale included six categories and 48 items, one global scale item, and a 3-point rubric for rating. The overall percentage agreement by experts in the first, second, and third rounds was 95.0%, 93.2%, and 98.5%, respectively. The final scale after the third round of Delphi consisted of the following seven categories: shared mental model, communication, situational awareness, leadership, followership, workload management, and positive/effective behaviours and attitudes. There were 34 individual items within these categories, each with a 5-point rating rubric (1 = unacceptable to 5 = perfect). Using a structured Delphi method, we established the face and content validity of this assessment scale that focuses on important aspects of interdisciplinary teamwork in the management of obstetric crises. Copyright © 2017 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada

  6. A workload model and measures for computer performance evaluation

    NASA Technical Reports Server (NTRS)

    Kerner, H.; Kuemmerle, K.

    1972-01-01

    A generalized workload definition is presented which constructs measurable workloads of unit size from workload elements, called elementary processes. An elementary process makes almost exclusive use of one of the processors, CPU, I/O processor, etc., and is measured by the cost of its execution. Various kinds of user programs can be simulated by quantitative composition of elementary processes into a type. The character of the type is defined by the weights of its elementary processes and its structure by the amount and sequence of transitions between its elementary processes. A set of types is batched to a mix. Mixes of identical cost are considered as equivalent amounts of workload. These formalized descriptions of workloads allow investigators to compare the results of different studies quantitatively. Since workloads of different composition are assigned a unit of cost, these descriptions enable determination of cost effectiveness of different workloads on a machine. Subsequently performance parameters such as throughput rate, gain factor, internal and external delay factors are defined and used to demonstrate the effects of various workload attributes on the performance of a selected large scale computer system.

  7. Modified Petri net model sensitivity to workload manipulations

    NASA Technical Reports Server (NTRS)

    White, S. A.; Mackinnon, D. P.; Lyman, J.

    1986-01-01

    Modified Petri Nets (MPNs) are investigated as a workload modeling tool. The results of an exploratory study of the sensitivity of MPNs to work load manipulations in a dual task are described. Petri nets have been used to represent systems with asynchronous, concurrent and parallel activities (Peterson, 1981). These characteristics led some researchers to suggest the use of Petri nets in workload modeling where concurrent and parallel activities are common. Petri nets are represented by places and transitions. In the workload application, places represent operator activities and transitions represent events. MPNs have been used to formally represent task events and activities of a human operator in a man-machine system. Some descriptive applications demonstrate the usefulness of MPNs in the formal representation of systems. It is the general hypothesis herein that in addition to descriptive applications, MPNs may be useful for workload estimation and prediction. The results are reported of the first of a series of experiments designed to develop and test a MPN system of workload estimation and prediction. This first experiment is a screening test of MPN model general sensitivity to changes in workload. Positive results from this experiment will justify the more complicated analyses and techniques necessary for developing a workload prediction system.

  8. Anesthesia Capacity in Ghana: A Teaching Hospital's Resources, and the National Workforce and Education.

    PubMed

    Brouillette, Mark A; Aidoo, Alfred J; Hondras, Maria A; Boateng, Nana A; Antwi-Kusi, Akwasi; Addison, William; Hermanson, Alec R

    2017-12-01

    Quality anesthetic care is lacking in low- and middle-income countries (LMICs). Global health leaders call for perioperative capacity reports in limited-resource settings to guide improved health care initiatives. We describe a teaching hospital's resources and the national workforce and education in this LMIC capacity report. A prospective observational study was conducted at Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana, during 4 weeks in August 2016. Teaching hospital data were generated from observations of hospital facilities and patient care, review of archival records, and interviews with KATH personnel. National data were obtained from interviews with KATH personnel, correspondence with Ghana's anesthesia society, and review of public records. The practice of anesthesia at KATH incorporated preanesthesia clinics, intraoperative management, and critical care. However, there were not enough physicians to consistently supervise care, especially in postanesthesia care units (PACUs) and the critical care unit (CCU). Clean water and electricity were usually reliable in all 16 operating rooms (ORs) and throughout the hospital. Equipment and drugs were inventoried in detail. While much basic infrastructure, equipment, and medications were present in ORs, patient safety was hindered by hospital-wide oxygen supply failures and shortage of vital signs monitors and working ventilators in PACUs and the CCU. In 2015, there were 10,319 anesthetics administered, with obstetric and gynecologic, general, and orthopedic procedures comprising 62% of surgeries. From 2011 to 2015, all-cause perioperative mortality rate in ORs and PACUs was 0.65% or 1 death per 154 anesthetics, with 99% of deaths occurring in PACUs. Workforce and education data at KATH revealed 10 anesthesia attending physicians, 61 nurse anesthetists (NAs), and 7 anesthesia resident physicians in training. At the national level, 70 anesthesia attending physicians and 565 NAs cared for Ghana's population

  9. Exercise during pregnancy: the role of obstetric providers.

    PubMed

    May, Linda E; Suminski, Richard R; Linklater, Emily R; Jahnke, Sara; Glaros, Alan G

    2013-08-01

    Obstetric providers are logical choices for conveying information about physical activity to their pregnant patients. However, research regarding obstetric providers counseling pregnant patients about physical activity is sparse. To investigate the association between obstetric providers discussing exercise with their pregnant patients and patients' exercise behaviors and to explore factors related to obstetric providers discussing exercise and other health behaviors (tobacco use, alcohol use, and nutrition) with their patients. We received completed surveys from 238 pregnant women and 31 obstetric providers at 12 obstetrician offices. The offices were located throughout the United States and were heterogeneous in regards to patient insurance coverage, number of patients treated per month, and percentage of patients with complications. Women who were "more careful about eating healthy" (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.2-8.0) and who discussed exercise with their obstetric provider (OR, 2.2; 95% CI, 1.1-4.3) were more likely to "maintain or increase exercise" during pregnancy than those who were not conscientious about their diets and those who did not discuss exercise with their obstetric provider, respectively. The odds of obstetric providers discussing exercise with pregnant patients increased 7-fold (OR, 7.1; 95% CI, 1.4-37.3) for each health behavior the obstetric provider discussed with the patient. Patient discussions with obstetric providers about exercise and patient attention to eating habits are associated with exercising during pregnancy. A more multibehavioral approach by obstetric providers may improve the likelihood that patients exercise during pregnancy.

  10. [Nursing workloads and working conditions: integrative review].

    PubMed

    Schmoeller, Roseli; Trindade, Letícia de Lima; Neis, Márcia Binder; Gelbcke, Francine Lima; de Pires, Denise Elvira Pires

    2011-06-01

    This study reviews theoretical production concerning workloads and working conditions for nurses. For that, an integrative review was carried out using scientific articles, theses and dissertations indexed in two Brazilian databases, Virtual Health Care Library (Biblioteca Virtual de Saúde) and Digital Database of Dissertations (Banco Digital de Teses), over the last ten years. From 132 identified studies, 27 were selected. Results indicate workloads as responsible for professional weariness, affecting the occurrence of work accidents and health problems. In order to adequate workloads studies indicate some strategies, such as having an adequate numbers of employees, continuing education, and better working conditions. The challenge is to continue research that reveal more precisely the relationships between workloads, working conditions, and health of the nursing team.

  11. Use of Local Anesthesia During Dental Rehabilitation With General Anesthesia: A Survey of Dentist Anesthesiologists

    PubMed Central

    Townsend, Janice A.; Hagan, Joseph L.; Smiley, Megann

    2014-01-01

    The purpose of this study was to document current practices of dentist anesthesiologists who are members of the American Society of Dentist Anesthesiologists regarding the supplemental use of local anesthesia for children undergoing dental rehabilitation under general anesthesia. A survey was administered via e-mail to the membership of the American Society of Dentist Anesthesiologists to document the use of local anesthetic during dental rehabilitations under general anesthesia and the rationale for its use. Seventy-seven (42.1%) of the 183 members responded to this survey. The majority of dentist anesthesiologists prefer use of local anesthetic during general anesthesia for dental rehabilitation almost always or sometimes (90%, 63/70) and 40% (28/70) prefer its use with rare exception. For dentist anesthesiologists who prefer the administration of local anesthesia almost always, they listed the following factors as very important: “stabilization of vital signs/decreased depth of general anesthesia” (92.9%, 26/28) and “improved patient recovery” (82.1%, 23/28). There was a significant association between the type of practice and who determines whether or not local anesthesia is administered during cases. The majority of respondents favor the use of local anesthesia during dental rehabilitation under general anesthesia. PMID:24697820

  12. Intraosseous anesthesia: a review.

    PubMed

    Brown, R

    1999-10-01

    The recent introduction of intraosseous injection devices has renewed interest in the modality of local anesthesia. Three devices currently available are the Stabident System, the Hypo Brand Intraosseous Needle, and the Cyberjet System. The Stabident System is the most popular and the only one for which published research is available. Primary intraosseous anesthesia is 45 percent to 93 percent effective but of short duration. Supplemental intraosseous anesthesia is 80 percent to 90 percent effective and provides profound anesthesia of long duration (60 minutes or longer). It is used when a prior conventional infiltration or nerve block is inadequate. During use of an anesthetic solution with a vasoconstrictor for intraosseous anesthesia, 46 percent to 100 percent of patients reported an increase in heart rate. There was a 2 percent to 27 percent incidence of moderate and sometimes severe pain during the intraosseous procedure. Postoperative complications occurred in 2 percent to 15 percent of patients and lasted one to 14 days.

  13. Monitoring Workload in Throwing-Dominant Sports: A Systematic Review.

    PubMed

    Black, Georgia M; Gabbett, Tim J; Cole, Michael H; Naughton, Geraldine

    2016-10-01

    The ability to monitor training load accurately in professional sports is proving vital for athlete preparedness and injury prevention. While numerous monitoring techniques have been developed to assess the running demands of many team sports, these methods are not well suited to throwing-dominant sports that are infrequently linked to high running volumes. Therefore, other techniques are required to monitor the differing demands of these sports to ensure athletes are adequately prepared for competition. To investigate the different methodologies used to quantitatively monitor training load in throwing-dominant sports. A systematic review of the methods used to monitor training load in throwing-dominant sports was conducted using variations of terms that described different load-monitoring techniques and different sports. Studies included in this review were published prior to June 2015 and were identified through a systematic search of four electronic databases including Academic Search Complete, CINAHL, Medline and SPORTDiscus. Only full-length peer-reviewed articles investigating workload monitoring in throwing-dominant sports were selected for review. A total of 8098 studies were initially retrieved from the four databases and 7334 results were removed as they were either duplicates, review articles, non-peer-reviewed articles, conference abstracts or articles written in languages other than English. After screening the titles and abstracts of the remaining papers, 28 full-text papers were reviewed, resulting in the identification of 20 articles meeting the inclusion criteria for monitoring workloads in throwing-dominant sports. Reference lists of selected articles were then scanned to identify other potential articles, which yielded one additional article. Ten articles investigated workload monitoring in cricket, while baseball provided eight results, and handball, softball and water polo each contributed one article. Results demonstrated varying techniques

  14. File-access characteristics of parallel scientific workloads

    NASA Technical Reports Server (NTRS)

    Nieuwejaar, Nils; Kotz, David; Purakayastha, Apratim; Best, Michael; Ellis, Carla Schlatter

    1995-01-01

    Phenomenal improvements in the computational performance of multiprocessors have not been matched by comparable gains in I/O system performance. This imbalance has resulted in I/O becoming a significant bottleneck for many scientific applications. One key to overcoming this bottleneck is improving the performance of parallel file systems. The design of a high-performance parallel file system requires a comprehensive understanding of the expected workload. Unfortunately, until recently, no general workload studies of parallel file systems have been conducted. The goal of the CHARISMA project was to remedy this problem by characterizing the behavior of several production workloads, on different machines, at the level of individual reads and writes. The first set of results from the CHARISMA project describe the workloads observed on an Intel iPSC/860 and a Thinking Machines CM-5. This paper is intended to compare and contrast these two workloads for an understanding of their essential similarities and differences, isolating common trends and platform-dependent variances. Using this comparison, we are able to gain more insight into the general principles that should guide parallel file-system design.

  15. Side effects and complications of intraosseous anesthesia and conventional oral anesthesia.

    PubMed

    Peñarrocha-Oltra, David; Ata-Ali, Javier; Oltra-Moscardó, María-José; Peñarrocha-Diago, María; Peñarrocha, Miguel

    2012-05-01

    To analyze the side effects and complications following intraosseous anesthesia (IA), comparing them with those of the conventional oral anesthesia techniques. A simple-blind, prospective clinical study was carried out. Each patient underwent two anesthetic techniques: conventional (local infiltration and locoregional anesthetic block) and intraosseous, for respective dental operations. In order to allow comparison of IA versus conventional anesthesia, the two operations were similar and affected the same two teeth in opposite quadrants. Heart rate was recorded in all cases before injection of the anesthetic solution and again 30 seconds after injection. The complications observed after anesthetic administration were recorded. A total of 200 oral anesthetic procedures were carried out in 100 patients. Both IA and conventional anesthesia resulted in a significant increase in heart rate, though the increase was greater with the latter technique. Incidents were infrequent with either anesthetic technique, with no significant differences between them. Regarding the complications, there were significant differences in pain at the injection site, with more intense pain in the case of IA (x2=3.532, p=0.030, Φ2=0.02), while the limitation of oral aperture was more pronounced with conventional anesthesia (x2=5.128, p<0.05, Φ2=0.014). Post-anesthetic biting showed no significant differences (x2=4.082, p=0.121, Φ2=0.009). Both anesthetic techniques significantly increased heart rate, and IA caused comparatively more pain at the injection site, while limited oral aperture was more frequent with conventional anesthesia. Post-anesthetic biting showed no significant differences between the two techniques.

  16. Composite redesign of obstetrical forceps

    NASA Technical Reports Server (NTRS)

    Lawson, Seth W.; Smeltzer, Stan S.

    1994-01-01

    Due to the increase in the number of children being born recently, medical technology has struggled to keep pace in certain areas. In these areas, particular needs have arisen to which the subject of this paper is directed. In the area of obstetrics, the forceps design and function has remained relatively unchanged for a number of years. In an effort to advance the technology, NASA Marshall Space Flight Center has been asked by the obstetrical community to help in a redesign of the obstetric forceps. Traditionally the forceps design has been of tubular stainless steel, constructed in two halves which interlock and hinge to provide the gripping force necessary to aid in the delivery of an infant. The stainless steel material was used to provide for ease of cleaning and sterilization. However, one of the drawbacks of the non-flexible steel design is that excessive force can be placed upon an infants head which could result in damage or injury to the infant. The redesign of this particular obstetric tool involves applying NASA's knowledge of advanced materials and state of the art instrumentation to create a tool which can be used freely throughout the obstetrics community without the fear of injury to an infant being delivered.

  17. Subjective rating scales as a workload

    NASA Technical Reports Server (NTRS)

    Bird, K. L.

    1981-01-01

    A multidimensional bipolar-adjective rating scale is employed as a subjective measure of operator workload in the performance of a one-axis tracking task. The rating scale addressed several dimensions of workload, including cognitive, physical, and perceptual task loading as well as fatigue and stress effects. Eight subjects performed a one-axis tracking task (with six levels of difficulty) and rated these tasks on several workload dimensions. Performance measures were tracking error RMS (root-mean square) and the standard deviation of control stick output. Significant relationships were observed between these performance measures and skill required, task complexity, attention level, task difficulty, task demands, and stress level.

  18. [Do physicians' gender and workload affect patients?].

    PubMed

    Finnvold, Jon Erik

    2008-10-23

    The article discusses the effect of general practitioners' gender and workload on patients' experience with consultation time, waiting hours, use of out-of-hours services and planned health visits. Data were retrieved from the 2003 version of Statistics Norway's household panel study (5000 persons) and the National Insurance administration's register of regular general practitioners. Health condition was the most important factor related to patient experiences. A high workload was neither associated with more frequent use of out-of-hours services nor satisfaction with time spent in consultation. These results apply to physicians of both genders. Patients who used a female physician with a large workload had to wait longer for an appointment and more often reported dissatisfaction with the waiting time; this was not the case for male physicians. However, male physicians with a low workload had shorter waiting times. Patients who use practitioners with a high workload may have chosen their doctor more deliberately than others, which may be an explanation for few negative outcomes for physicians with a high workload. It is unlikely that these physicians would be as popular if the patients had fewer appointments, shorter consultations or more often had to use the out-of-hours services. Longer waiting time for appointments with female doctors may be related to more part time work, and the fact that female physicians more often are engaged in group practices.

  19. Physiological correlates of mental workload

    NASA Technical Reports Server (NTRS)

    Zacharias, G. L.

    1980-01-01

    A literature review was conducted to assess the basis of and techniques for physiological assessment of mental workload. The study findings reviewed had shortcomings involving one or more of the following basic problems: (1) physiologic arousal can be easily driven by nonworkload factors, confounding any proposed metric; (2) the profound absence of underlying physiologic models has promulgated a multiplicity of seemingly arbitrary signal processing techniques; (3) the unspecified multidimensional nature of physiological "state" has given rise to a broad spectrum of competing noncommensurate metrics; and (4) the lack of an adequate definition of workload compels physiologic correlations to suffer either from the vagueness of implicit workload measures or from the variance of explicit subjective assessments. Using specific studies as examples, two basic signal processing/data reduction techniques in current use, time and ensemble averaging are discussed.

  20. Strategic workload management and decision biases in aviation

    NASA Technical Reports Server (NTRS)

    Raby, Mireille; Wickens, Christopher D.

    1994-01-01

    Thirty pilots flew three simulated landing approaches under conditions of low, medium, and high workload. Workload conditions were created by varying time pressure and external communications requirements. Our interest was in how the pilots strategically managed or adapted to the increasing workload. We independently assessed the pilot's ranking of the priority of different discrete tasks during the approach and landing. Pilots were found to sacrifice some aspects of primary flight control as workload increased. For discrete tasks, increasing workload increased the amount of time in performing the high priority tasks, decreased the time in performing those of lowest priority, and did not affect duration of performance episodes or optimality of scheduling of tasks of any priority level. Individual differences analysis revealed that high-performing subjects scheduled discrete tasks earlier in the flight and shifted more often between different activities.

  1. Pilot workload, performance and aircraft control automation

    NASA Technical Reports Server (NTRS)

    Hart, S. G.; Sheridan, T. B.

    1984-01-01

    Conceptual and practical issues associated with the design, operation, and performance of advanced systems and the impact of such systems on the human operators are reviewed. The development of highly automated systems is driven by the availability of new technology and the requirement that operators safely and economically perform more and more activities in increasingly difficult and hostile environments. It is noted that the operators workload may become a major area of concern in future design considerations. Little research was done to determine how automation and workload relate to each other, although it is assumed that the abstract, supervisory, or management roles that are performed by operators of highly automated systems will impose increased mental workload. The relationship between performance and workload is discussed in relation to highly complex and automated environments.

  2. The effects of practice on tracking and subjective workload

    NASA Technical Reports Server (NTRS)

    Hancock, P. A.; Robinson, M. A.; Chu, A. L.; Hansen, D. R.; Vercruyssen, M.

    1989-01-01

    Six college-age male subjects performed one hundred, two-minute trials on a second-order tracking task. After each trial, subjects estimated perceived workload using both the NASA TLX and SWAT workload assessment procedures. Results confirmed an expected performance improvement on the tracking task which followed traditional learning curves within the performance of each individual. Perceived workload also decreased for both scales across trials. While performance variability significantly decreased across trials, workload variability remained constant. One month later, the same subjects returned to complete the second experiment in the sequence which was a retention replication of the first experiment. Results replicated those for the first experiment except that both performance error and workload were at reduced overall levels. Results in general affirm a parallel workload reduction with performance improvement, an observation consistent with a resource-based view of automaticity.

  3. Timesharing performance as an indicator of pilot mental workload

    NASA Technical Reports Server (NTRS)

    Casper, Patricia A.; Kantowitz, Barry H.; Sorkin, Robert D.

    1988-01-01

    Attentional deficits (workloads) were evaluated in a timesharing task. The results from this and other experiments were incorporated into an expert system designed to provide workload metric selection advice to non-experts in the field interested in operator workload.

  4. Timesharing performance as an indicator of pilot mental workload

    NASA Technical Reports Server (NTRS)

    Casper, Patricia A.

    1988-01-01

    The research was performed in two simultaneous phases, each intended to identify and manipulate factors related to operator mental workload. The first phase concerned evaluation of attentional deficits (workloads) in a timesharing task. Work in the second phase involved incorporating the results from these and other experiments into an expert system designed to provide workload metric selection advice to nonexperts in the field interested in operator workload. The results of the experiments conducted are summarized.

  5. Measuring Pilot Workload in a Moving-base Simulator. Part 2: Building Levels of Workload

    NASA Technical Reports Server (NTRS)

    Kantowitz, B. H.; Hart, S. G.; Bortolussi, M. R.; Shively, R. J.; Kantowitz, S. C.

    1984-01-01

    Pilot behavior in flight simulators often use a secondary task as an index of workload. His routine to regard flying as the primary task and some less complex task as the secondary task. While this assumption is quite reasonable for most secondary tasks used to study mental workload in aircraft, the treatment of flying a simulator through some carefully crafted flight scenario as a unitary task is less justified. The present research acknowledges that total mental workload depends upon the specific nature of the sub-tasks that a pilot must complete as a first approximation, flight tasks were divided into three levels of complexity. The simplest level (called the Base Level) requires elementary maneuvers that do not utilize all the degrees of freedom of which an aircraft, or a moving-base simulator; is capable. The second level (called the Paired Level) requires the pilot to simultaneously execute two Base Level tasks. The third level (called the Complex Level) imposes three simultaneous constraints upon the pilot.

  6. 21 CFR 884.2050 - Obstetric data analyzer.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Obstetric data analyzer. 884.2050 Section 884.2050... § 884.2050 Obstetric data analyzer. (a) Identification. An obstetric data analyzer (fetal status data analyzer) is a device used during labor to analyze electronic signal data obtained from fetal and maternal...

  7. 21 CFR 884.2050 - Obstetric data analyzer.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Obstetric data analyzer. 884.2050 Section 884.2050... § 884.2050 Obstetric data analyzer. (a) Identification. An obstetric data analyzer (fetal status data analyzer) is a device used during labor to analyze electronic signal data obtained from fetal and maternal...

  8. 21 CFR 884.2050 - Obstetric data analyzer.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Obstetric data analyzer. 884.2050 Section 884.2050... § 884.2050 Obstetric data analyzer. (a) Identification. An obstetric data analyzer (fetal status data analyzer) is a device used during labor to analyze electronic signal data obtained from fetal and maternal...

  9. 21 CFR 884.2050 - Obstetric data analyzer.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Obstetric data analyzer. 884.2050 Section 884.2050... § 884.2050 Obstetric data analyzer. (a) Identification. An obstetric data analyzer (fetal status data analyzer) is a device used during labor to analyze electronic signal data obtained from fetal and maternal...

  10. Factors Related to School Nurse Workload

    ERIC Educational Resources Information Center

    Jameson, Beth E.; Engelke, Martha Keehner; Anderson, Lori S.; Endsley, Patricia; Maughan, Erin D.

    2018-01-01

    Recognizing the need for a school nurse workload model based on more than the number of students in a caseload, the National Association of School Nurses issued recommendations related to measuring school nurse workload. Next, a workforce acuity task force (WATF) was charged with identifying the steps needed to further the recommendations. As a…

  11. School Nurse Workload: A Scoping Review of Acute Care, Community Health, and Mental Health Nursing Workload Literature

    ERIC Educational Resources Information Center

    Endsley, Patricia

    2017-01-01

    The purpose of this scoping review was to survey the most recent (5 years) acute care, community health, and mental health nursing workload literature to understand themes and research avenues that may be applicable to school nursing workload research. The search for empirical and nonempirical literature was conducted using search engines such as…

  12. Topical anesthesia for penetrating trabeculectomy.

    PubMed

    Sauder, Gangolf; Jonas, Jost B

    2002-09-01

    To evaluate the efficacy and clinical practicability of topical anesthesia in comparison with retrobulbar anesthesia for penetrating trabeculectomy. The prospective single-surgeon clinical interventional trial included 20 consecutive patients, who were randomly distributed into a topical anesthesia group ( n=10) and a retrobulbar anesthesia group ( n=10). In the topical anesthesia group, patients received preoperatively oxybuprocaine 0.4% eye drops and cocaine hydrochloride eye drops 10%. The patients of the retrobulbar group received 5 ml mepivacaine 2% injected into the retrobulbar space. To assess intraoperative pain, each patient was asked immediately after surgery to quantitate his/her pain using a 10-point pain rating scale. The topical anesthesia group and the retrobulbar anesthesia study group did not vary significantly in duration of surgery (21.5+/-3.37 min vs 20.2+/-4.46 min, P=0.31), preoperative intraocular pressure (32.2+/-14.62 mmHg vs 30.6+/-12.33 mmHg, P=0.22), postoperative intraocular pressure (8.0+/-4.47 mmHg vs 9.12+/-3.13 mmHg, P=0.64), subjective pain score by the patient (2.25+/-1.23 relative units vs 2.33+/-1.08 relative units ( P= 0.71), and practicability score by the surgeon (2.24+/-1.76 vs 2.56+/-1.58, P=0.82). In view of its clinical feasibility and its minimally invasive character, topical anesthesia may be an option for penetrating trabeculectomy.

  13. [Crisis management in pediatric anesthesia].

    PubMed

    Takeuchi, Mamoru; Otsuka, Yoji; Taga, Naoyuki; Sato, Yuki; Iwai, Hidetaka; Okada, Osamu

    2009-05-01

    We describe the risk management of pediatric anesthesia. The most important risk management of pediatric anesthesia is airway and temperature management. Neonates and infants easily become hypoxic due to their insufficient functional residual capacity. Therefore airway management is most important not only during induction of anesthesia but also during maintenance of anesthesia and extubation. The management of patients' temperature, including control of room temperature should be taken into consideration. In addition, careful attention should be paid not to introduce air bubbles in any lines, especially in patients with congenital heart diseases.

  14. Exploring Individual Differences in Workload Assessment

    DTIC Science & Technology

    2014-12-26

    83 Question 3: Do the physiological measures: blinks, saccades, HR, HRV , correlate with the objective workload profile for all...Electrooculography (EOG) signals, and heart rate (HR) and heart rate variability ( HRV ) as determined from Electrocardiography (ECG...3) Do the physiological measures blinks, saccades, HR, and HRV , correlate with the objective workload profile for all divergent participants and

  15. A self-analysis of the NASA-TLX workload measure.

    PubMed

    Noyes, Jan M; Bruneau, Daniel P J

    2007-04-01

    Computer use and, more specifically, the administration of tests and materials online continue to proliferate. A number of subjective, self-report workload measures exist, but the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) is probably the most well known and used. The aim of this paper is to consider the workload costs associated with the computer-based and paper versions of the NASA-TLX measure. It was found that there is a significant difference between the workload scores for the two media, with the computer version of the NASA-TLX incurring more workload. This has implications for the practical use of the NASA-TLX as well as for other computer-based workload measures.

  16. An Annotated Bibliography on Operator Mental Workload Assessment

    DTIC Science & Technology

    1980-03-26

    The descriptors associated with each citation designate the general workload classification, the specific workload classification, tue type of...systems, with all of their advanced sen3ors and avionics, must be compatible with the capabilities and limitations of the aircrew. During the design ...constructs or models was included only if mental workload was at least potentially assessable from the constructs or models. C. Experimental design . A

  17. Workload Measurement in Human Autonomy Teaming: How and Why?

    NASA Technical Reports Server (NTRS)

    Shively, Jay

    2016-01-01

    This is an invited talk on autonomy and workload for an AFRL Blue Sky workshop sponsored by the Florida Institute for Human Machine Studies. The presentation reviews various metrics of workload and how to move forward with measuring workload in a human-autonomy teaming environment.

  18. Mental workload measurement in operator control room using NASA-TLX

    NASA Astrophysics Data System (ADS)

    Sugarindra, M.; Suryoputro, M. R.; Permana, A. I.

    2017-12-01

    The workload, encountered a combination of physical workload and mental workload, is a consequence of the activities for workers. Central control room is one department in the oil processing company, employees tasked with monitoring the processing unit for 24 hours nonstop with a combination of 3 shifts in 8 hours. NASA-TLX (NASA Task Load Index) is one of the subjective mental workload measurement using six factors, namely the Mental demand (MD), Physical demand (PD), Temporal demand (TD), Performance (OP), Effort (EF), frustration levels (FR). Measurement of a subjective mental workload most widely used because it has a high degree of validity. Based on the calculation of the mental workload, there at 5 units (DTU, NPU, HTU, DIST and OPS) at the control chamber (94; 83.33; 94.67; 81, 33 and 94.67 respectively) that categorize as very high mental workload. The high level of mental workload on the operator in the Central Control Room is a requirement to have high accuracy, alertness and can make decisions quickly

  19. Anesthesia Awareness (Waking Up) During Surgery

    MedlinePlus

    Skip to content Menu Anesthesia 101 Pain Management Preparing for Surgery Stories Resources About Policymakers Media ASA Member Toolkit Risks Anesthesia Awareness (Waking Up) During Surgery Explore this page: Anesthesia ...

  20. Front-line ordering clinicians: matching workforce to workload.

    PubMed

    Fieldston, Evan S; Zaoutis, Lisa B; Hicks, Patricia J; Kolb, Susan; Sladek, Erin; Geiger, Debra; Agosto, Paula M; Boswinkel, Jan P; Bell, Louis M

    2014-07-01

    Matching workforce to workload is particularly important in healthcare delivery, where an excess of workload for the available workforce may negatively impact processes and outcomes of patient care and resident learning. Hospitals currently lack a means to measure and match dynamic workload and workforce factors. This article describes our work to develop and obtain consensus for use of an objective tool to dynamically match the front-line ordering clinician (FLOC) workforce to clinical workload in a variety of inpatient settings. We undertook development of a tool to represent hospital workload and workforce based on literature reviews, discussions with clinical leadership, and repeated validation sessions. We met with physicians and nurses from every clinical care area of our large, urban children's hospital at least twice. We successfully created a tool in a matrix format that is objective and flexible and can be applied to a variety of settings. We presented the tool in 14 hospital divisions and received widespread acceptance among physician, nursing, and administrative leadership. The hospital uses the tool to identify gaps in FLOC coverage and guide staffing decisions. Hospitals can better match workload to workforce if they can define and measure these elements. The Care Model Matrix is a flexible, objective tool that quantifies the multidimensional aspects of workload and workforce. The tool, which uses multiple variables that are easily modifiable, can be adapted to a variety of settings. © 2014 Society of Hospital Medicine.

  1. Is Personalized Medicine Achievable in Obstetrics?

    PubMed Central

    Quinney, Sara K; Flockhart, David A; Patil, Avinash S

    2014-01-01

    Personalized medicine seeks to identify the right dose of the right drug for the right patient at the right time. Typically, individualization of therapy is based on the pharmacogenomic make-up of the individual and environmental factors that alter drug disposition and response. In addition to these factors, during pregnancy a woman’s body undergoes many changes that can impact the therapeutic efficacy of medications. Yet, there is minimal research regarding personalized medicine in obstetrics. Adoption of pharmacogenetic testing into the obstetrical care is dependent on evidence of analytical validity, clinical validity, and clinical utility. Here, we briefly present information regarding the potential utility of personalized medicine for treating the obstetric patient for pain with narcotics, hypertension, and preterm labor and discuss the impediments of bringing personalized medicine to the obstetrical clinic. PMID:25282474

  2. A comparison of policies on nurse faculty workload in the United States.

    PubMed

    Ellis, Peggy A

    2013-01-01

    This article describes nurse faculty workload policies from across the nation in order to assess current practice. There is a well-documented shortage of nursing faculty leading to an increase in workload demands. Increases in faculty workload results in difficulties with work-life balance and dissatisfaction threatening to make nursing education less attractive to young faculty. In order to begin an examination of faculty workload in nursing, existing workloads must be known. Faculty workload data were solicited from nursing programs nationwide and analyzed to determine the current workloads. The most common faculty teaching workload reported overall for nursing is 12 credit hours per semester; however, some variations exist. Consideration should be given to the multiple components of the faculty workload. Research is needed to address the most effective and efficient workload allocation for nursing faculty.

  3. Making the transition to workload-based staffing: using the Workload Indicators of Staffing Need method in Uganda.

    PubMed

    Namaganda, Grace; Oketcho, Vincent; Maniple, Everd; Viadro, Claire

    2015-08-31

    Uganda's health workforce is characterized by shortages and inequitable distribution of qualified health workers. To ascertain staffing levels, Uganda uses fixed government-approved norms determined by facility type. This approach cannot distinguish between facilities of the same type that have different staffing needs. The Workload Indicators of Staffing Need (WISN) method uses workload to determine number and type of staff required in a given facility. The national WISN assessment sought to demonstrate the limitations of the existing norms and generate evidence to influence health unit staffing and staff deployment for efficient utilization of available scarce human resources. A national WISN assessment (September 2012) used purposive sampling to select 136 public health facilities in 33/112 districts. The study examined staffing requirements for five cadres (nursing assistants, nurses, midwives, clinical officers, doctors) at health centres II (n = 59), III (n = 53) and IV (n = 13) and hospitals (n = 11). Using health management information system workload data (1 July 2010-30 June 2011), the study compared current and required staff, assessed workload pressure and evaluated the adequacy of the existing staffing norms. By the WISN method, all three types of health centres had fewer nurses (42-70%) and midwives (53-67%) than required and consequently exhibited high workload pressure (30-58%) for those cadres. Health centres IV and hospitals lacked doctors (39-42%) but were adequately staffed with clinical officers. All facilities displayed overstaffing of nursing assistants. For all cadres at health centres III and IV other than nursing assistants, the fixed norms or existing staffing or both fell short of the WISN staffing requirements, with, for example, only half as many nurses and midwives as required. The WISN results demonstrate the inadequacies of existing staffing norms, particularly for health centres III and IV. The results provide an evidence base to

  4. Spinal anesthesia in infants: recent developments.

    PubMed

    Tirmizi, Henna

    2015-06-01

    Spinal anesthesia has long been described as a well-tolerated and effective means of providing anesthesia for infants undergoing lower abdominal surgery. Now, spinal anesthetics are being used for an increasing variety of surgeries previously believed to require a general anesthetic. This, along with increasing concerns over the neurocognitive effects of general anesthetics on developing brains, suggests that further exploration into this technique and its effects is essential. Exposure to spinal anesthesia in infancy has not shown the same suggestions of neurocognitive detriment as those resulting from general anesthesia. Ultrasound guidance has enhanced spinal technique by providing real-time guidance into the intrathecal space and confirming medication administration location, as well as helping avoid adverse outcomes by identifying aberrant anatomy. Spinal anesthesia provides benefits over general anesthesia, including cardiorespiratory stability, shorter postoperative recovery, and faster return of gastrointestinal function. Early findings of spinal anesthesia exposure in infancy have shown it to have no independent effect on neurocognitive delay as well as to provide sound cardiorespiratory stability. With safer means of administering a spinal anesthetic, such as with ultrasound guidance, it is a readily available and desirable tool for those providing anesthesia to infants.

  5. Multidisciplinary Obstetric Simulated Emergency Scenarios (MOSES): Promoting Patient Safety in Obstetrics with Teamwork-Focused Interprofessional Simulations

    ERIC Educational Resources Information Center

    Freeth, Della; Ayida, Gubby; Berridge, Emma Jane; Mackintosh, Nicola; Norris, Beverley; Sadler, Chris; Strachan, Alasdair

    2009-01-01

    Introduction: We describe an example of simulation-based interprofessional continuing education, the multidisciplinary obstetric simulated emergency scenarios (MOSES) course, which was designed to enhance nontechnical skills among obstetric teams and, hence, improve patient safety. Participants' perceptions of MOSES courses, their learning, and…

  6. Assessing Continuous Operator Workload With a Hybrid Scaffolded Neuroergonomic Modeling Approach.

    PubMed

    Borghetti, Brett J; Giametta, Joseph J; Rusnock, Christina F

    2017-02-01

    We aimed to predict operator workload from neurological data using statistical learning methods to fit neurological-to-state-assessment models. Adaptive systems require real-time mental workload assessment to perform dynamic task allocations or operator augmentation as workload issues arise. Neuroergonomic measures have great potential for informing adaptive systems, and we combine these measures with models of task demand as well as information about critical events and performance to clarify the inherent ambiguity of interpretation. We use machine learning algorithms on electroencephalogram (EEG) input to infer operator workload based upon Improved Performance Research Integration Tool workload model estimates. Cross-participant models predict workload of other participants, statistically distinguishing between 62% of the workload changes. Machine learning models trained from Monte Carlo resampled workload profiles can be used in place of deterministic workload profiles for cross-participant modeling without incurring a significant decrease in machine learning model performance, suggesting that stochastic models can be used when limited training data are available. We employed a novel temporary scaffold of simulation-generated workload profile truth data during the model-fitting process. A continuous workload profile serves as the target to train our statistical machine learning models. Once trained, the workload profile scaffolding is removed and the trained model is used directly on neurophysiological data in future operator state assessments. These modeling techniques demonstrate how to use neuroergonomic methods to develop operator state assessments, which can be employed in adaptive systems.

  7. Comparative evaluation of workload estimation techniques in piloting tasks

    NASA Technical Reports Server (NTRS)

    Wierwille, W. W.

    1983-01-01

    Techniques to measure operator workload in a wide range of situations and tasks were examined. The sensitivity and intrusion of a wide variety of workload assessment techniques in simulated piloting tasks were investigated. Four different piloting tasks, psychomotor, perceptual, mediational, and communication aspects of piloting behavior were selected. Techniques to determine relative sensitivity and intrusion were applied. Sensitivity is the relative ability of a workload estimation technique to discriminate statistically significant differences in operator loading. High sensitivity requires discriminable changes in score means as a function of load level and low variation of the scores about the means. Intrusion is an undesirable change in the task for which workload is measured, resulting from the introduction of the workload estimation technique or apparatus.

  8. Migrants and obstetrics in Austria--applying a new questionnaire shows differences in obstetric care and outcome.

    PubMed

    Oberaigner, Willi; Leitner, Hermann; Oberaigner, Karin; Marth, Christian; Pinzger, Gerald; Concin, Hans; Steiner, Horst; Hofmann, Hannes; Wagner, Teresa; Mörtl, Manfred; Ramoni, Angela

    2013-01-01

    Immigration plays a major role in obstetrics in Austria, and about 18 % of the Austrian population are immigrants. Therefore, we aimed to (1) test the feasibility of a proposed questionnaire for assessment of migrant status in epidemiological research and (2) assess some important associations between procedures and outcomes in obstetrics and migration in selected departments in Austria. We adapted a standardized questionnaire to the main immigration groups in Austria. Information on country of origin, length of residence in Austria and German-language ability was collected from eight selected obstetrics departments. Of the 1,971 questionnaires, 1,873 questionnaires of singleton births were selected and included in the analysis. We analyzed a total of 1,873 parturients with singleton births, of which 35 % had migrant status, 12 % were from ex-Yugoslavia, 12 % were from Turkey, and 12 % were from other countries. The proportion of parturients having their first care visit after the 12th week of pregnancy was higher in migrant groups (19 %). Smoking was highest in the migrants from ex-Yugoslavia (21 %). Vaginal delivery was more frequent in migrants from ex-Yugoslavia (78 %) and Turkey (83 %) than in nonmigrants (71 %) and episiotomy was more frequently performed in migrants from other countries. All differences are statistically significant. Administration of a standardized questionnaire for assessment of migrant status in obstetric departments in Austria was shown to be feasible. We assessed differences in obstetric care and outcome and consequently recommend that action should be initiated in Austria toward harmonizing obstetric procedures among the migrant and the nonmigrant groups and toward minimizing risk factors.

  9. Assessing Clinical Trial-Associated Workload in Community-Based Research Programs Using the ASCO Clinical Trial Workload Assessment Tool.

    PubMed

    Good, Marjorie J; Hurley, Patricia; Woo, Kaitlin M; Szczepanek, Connie; Stewart, Teresa; Robert, Nicholas; Lyss, Alan; Gönen, Mithat; Lilenbaum, Rogerio

    2016-05-01

    Clinical research program managers are regularly faced with the quandary of determining how much of a workload research staff members can manage while they balance clinical practice and still achieve clinical trial accrual goals, maintain data quality and protocol compliance, and stay within budget. A tool was developed to measure clinical trial-associated workload, to apply objective metrics toward documentation of work, and to provide clearer insight to better meet clinical research program challenges and aid in balancing staff workloads. A project was conducted to assess the feasibility and utility of using this tool in diverse research settings. Community-based research programs were recruited to collect and enter clinical trial-associated monthly workload data into a web-based tool for 6 consecutive months. Descriptive statistics were computed for self-reported program characteristics and workload data, including staff acuity scores and number of patient encounters. Fifty-one research programs that represented 30 states participated. Median staff acuity scores were highest for staff with patients enrolled in studies and receiving treatment, relative to staff with patients in follow-up status. Treatment trials typically resulted in higher median staff acuity, relative to cancer control, observational/registry, and prevention trials. Industry trials exhibited higher median staff acuity scores than trials sponsored by the National Institutes of Health/National Cancer Institute, academic institutions, or others. The results from this project demonstrate that trial-specific acuity measurement is a better measure of workload than simply counting the number of patients. The tool was shown to be feasible and useable in diverse community-based research settings. Copyright © 2016 by American Society of Clinical Oncology.

  10. Assessing Clinical Trial–Associated Workload in Community-Based Research Programs Using the ASCO Clinical Trial Workload Assessment Tool

    PubMed Central

    Hurley, Patricia; Woo, Kaitlin M.; Szczepanek, Connie; Stewart, Teresa; Robert, Nicholas; Lyss, Alan; Gönen, Mithat; Lilenbaum, Rogerio

    2016-01-01

    Purpose: Clinical research program managers are regularly faced with the quandary of determining how much of a workload research staff members can manage while they balance clinical practice and still achieve clinical trial accrual goals, maintain data quality and protocol compliance, and stay within budget. A tool was developed to measure clinical trial–associated workload, to apply objective metrics toward documentation of work, and to provide clearer insight to better meet clinical research program challenges and aid in balancing staff workloads. A project was conducted to assess the feasibility and utility of using this tool in diverse research settings. Methods: Community-based research programs were recruited to collect and enter clinical trial–associated monthly workload data into a web-based tool for 6 consecutive months. Descriptive statistics were computed for self-reported program characteristics and workload data, including staff acuity scores and number of patient encounters. Results: Fifty-one research programs that represented 30 states participated. Median staff acuity scores were highest for staff with patients enrolled in studies and receiving treatment, relative to staff with patients in follow-up status. Treatment trials typically resulted in higher median staff acuity, relative to cancer control, observational/registry, and prevention trials. Industry trials exhibited higher median staff acuity scores than trials sponsored by the National Institutes of Health/National Cancer Institute, academic institutions, or others. Conclusion: The results from this project demonstrate that trial-specific acuity measurement is a better measure of workload than simply counting the number of patients. The tool was shown to be feasible and useable in diverse community-based research settings. PMID:27006354

  11. Prediction of Nursing Workload in Hospital.

    PubMed

    Fiebig, Madlen; Hunstein, Dirk; Bartholomeyczik, Sabine

    2018-01-01

    A dissertation project at the Witten/Herdecke University [1] is investigating which (nursing sensitive) patient characteristics are suitable for predicting a higher or lower degree of nursing workload. For this research project four predictive modelling methods were selected. In a first step, SUPPORT VECTOR MACHINE, RANDOM FOREST, and GRADIENT BOOSTING were used to identify potential predictors from the nursing sensitive patient characteristics. The results were compared via FEATURE IMPORTANCE. To predict nursing workload the predictors identified in step 1 were modelled using MULTINOMIAL LOGISTIC REGRESSION. First results from the data mining process will be presented. A prognostic determination of nursing workload can be used not only as a basis for human resource planning in hospital, but also to respond to health policy issues.

  12. An Approach to Quantify Workload in a System of Agents

    NASA Technical Reports Server (NTRS)

    Stocker, Richard; Rungta, Neha; Mercer, Eric; Raimondi, Franco; Holbrook, Jon; Cardoza, Colleen; Goodrich, Michael

    2015-01-01

    The role of humans in aviation and other domains continues to shift from manual control to automation monitoring. Studies have found that humans are often poorly suited for monitoring roles, and workload can easily spike in off-nominal situations. Current workload measurement tools, like NASA TLX, use human operators to assess their own workload after using a prototype system. Such measures are used late in the design process and can result in ex- pensive alterations when problems are discovered. Our goal in this work is to provide a quantitative workload measure for use early in the design process. We leverage research in human cognition to de ne metrics that can measure workload on belief-desire-intentions based multi-agent systems. These measures can alert designers to potential workload issues early in design. We demonstrate the utility of our approach by characterizing quantitative differences in the workload for a single pilot operations model compared to a traditional two pilot model.

  13. Evaluation of Mental Workload among ICU Ward's Nurses.

    PubMed

    Mohammadi, Mohsen; Mazloumi, Adel; Kazemi, Zeinab; Zeraati, Hojat

    2015-01-01

    High level of workload has been identified among stressors of nurses in intensive care units (ICUs). The present study investigated nursing workload and identified its influencing perfor-mance obstacles in ICUs. This cross-sectional study was conducted, in 2013, on 81 nurses working in ICUs in Imam Khomeini Hospital in Tehran, Iran. NASA-TLX was applied for assessment of workload. Moreover, ICUs Performance Obstacles Questionnaire was used to identify performance obstacles associated with ICU nursing. Physical demand (mean=84.17) was perceived as the most important dimensions of workload by nurses. The most critical performance obstacles affecting workload included: difficulty in finding a place to sit down, hectic workplace, disorganized workplace, poor-conditioned equipment, waiting for using a piece of equipment, spending much time seeking for supplies in the central stock, poor quality of medical materials, delay in getting medications, unpredicted problems, disorganized central stock, outpatient surgery, spending much time dealing with family needs, late, inadequate, and useless help from nurse assistants, and ineffective morning rounds (P-value<0.05). Various performance obstacles are correlated with nurses' workload, affirms the significance of nursing work system characteristics. Interventions are recommended based on the results of this study in the work settings of nurses in ICUs.

  14. Performance Analysis of the NAS Y-MP Workload

    NASA Technical Reports Server (NTRS)

    Bergeron, Robert J.; Kutler, Paul (Technical Monitor)

    1997-01-01

    This paper describes the performance characteristics of the computational workloads on the NAS Cray Y-MP machines, a Y-MP 832 and later a Y-MP 8128. Hardware measurements indicated that the Y-MP workload performance matured over time, ultimately sustaining an average throughput of 0.8 GFLOPS and a vector operation fraction of 87%. The measurements also revealed an operation rate exceeding 1 per clock period, a well-balanced architecture featuring a strong utilization of vector functional units, and an efficient memory organization. Introduction of the larger memory 8128 increased throughput by allowing a more efficient utilization of CPUs. Throughput also depended on the metering of the batch queues; low-idle Saturday workloads required a buffer of small jobs to prevent memory starvation of the CPU. UNICOS required about 7% of total CPU time to service the 832 workloads; this overhead decreased to 5% for the 8128 workloads. While most of the system time went to service I/O requests, efficient scheduling prevented excessive idle due to I/O wait. System measurements disclosed no obvious bottlenecks in the response of the machine and UNICOS to the workloads. In most cases, Cray-provided software tools were- quite sufficient for measuring the performance of both the machine and operating, system.

  15. Evaluation of Mental Workload among ICU Ward's Nurses

    PubMed Central

    Mohammadi, Mohsen; Mazloumi, Adel; Kazemi, Zeinab; Zeraati, Hojat

    2015-01-01

    Background: High level of workload has been identified among stressors of nurses in intensive care units (ICUs). The present study investigated nursing workload and identified its influencing perfor­mance obstacles in ICUs. Methods: This cross-sectional study was conducted, in 2013, on 81 nurses working in ICUs in Imam Khomeini Hospital in Tehran, Iran. NASA-TLX was applied for assessment of workload. Moreover, ICUs Performance Obstacles Questionnaire was used to identify performance obstacles associated with ICU nursing. Results: Physical demand (mean=84.17) was perceived as the most important dimensions of workload by nurses. The most critical performance obstacles affecting workload included: difficulty in finding a place to sit down, hectic workplace, disorganized workplace, poor-conditioned equipment, waiting for using a piece of equipment, spending much time seeking for supplies in the central stock, poor quality of medical materials, delay in getting medications, unpredicted problems, disorganized central stock, outpatient surgery, spending much time dealing with family needs, late, inadequate, and useless help from nurse assistants, and ineffective morning rounds (P-value<0.05). Conclusion: Various performance obstacles are correlated with nurses' workload, affirms the significance of nursing work system characteristics. Interventions are recommended based on the results of this study in the work settings of nurses in ICUs. PMID:26933647

  16. Assessing physician job satisfaction and mental workload.

    PubMed

    Boultinghouse, Oscar W; Hammack, Glenn G; Vo, Alexander H; Dittmar, Mary Lynne

    2007-12-01

    Physician job satisfaction and mental workload were evaluated in a pilot study of five physicians engaged in a telemedicine practice at The University of Texas Medical Branch at Galveston Electronic Health Network. Several previous studies have examined physician satisfaction with specific telemedicine applications; however, few have attempted to identify the underlying factors that contribute to physician satisfaction or lack thereof. One factor that has been found to affect well-being and functionality in the workplace-particularly with regard to human interaction with complex systems and tasks as seen in telemedicine-is mental workload. Workload is generally defined as the "cost" to a person for performing a complex task or tasks; however, prior to this study, it was unexplored as a variable that influences physician satisfaction. Two measures of job satisfaction were used: The Job Descriptive Index and the Job In General scales. Mental workload was evaluated by means of the National Aeronautics and Space Administration Task Load Index. The measures were administered by means of Web-based surveys and were given twice over a 6-month period. Nonparametric statistical analyses revealed that physician job satisfaction was generally high relative to that of the general population and other professionals. Mental workload scores associated with the practice of telemedicine in this environment are also high, and appeared stable over time. In addition, they are commensurate with scores found in individuals practicing tasks with elevated information-processing demands, such as quality control engineers and air traffic controllers. No relationship was found between the measures of job satisfaction and mental workload.

  17. Is personalized medicine achievable in obstetrics?

    PubMed

    Quinney, Sara K; Patil, Avinash S; Flockhart, David A

    2014-12-01

    Personalized medicine seeks to identify the right dose of the right drug for the right patient at the right time. Typically, individualization of therapy is based on the pharmacogenomic makeup of the individual and environmental factors that alter drug disposition and response. In addition to these factors, during pregnancy, a woman's body undergoes many changes that can impact the therapeutic efficacy of medications. Yet, there is minimal research regarding personalized medicine in obstetrics. Adoption of pharmacogenetic testing into the obstetrical care is dependent on evidence of analytical validity, clinical validity, and clinical utility. Here, we briefly present information regarding the potential utility of personalized medicine for treating the obstetric patient for pain with narcotics, hypertension, and preterm labor, and discuss the impediments of bringing personalized medicine to the obstetrical clinic. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Lift-(gasless) laparoscopic surgery under regional anesthesia.

    PubMed

    Kruschinski, Daniel; Homburg, Shirli

    2005-01-01

    The objective of this Chapter was to investigate the feasibility and outcome of gasless laparoscopy under regional anesthesia. A prospective evaluation of Lift-(gasless) laparoscopic procedures under regional anesthesia (Canadian Task Force classification II-1) was done at three endoscopic gynecology centers (franchise system of EndGyn(r)). Sixty-three patients with gynecological diseases comprised the cohort. All patients underwent Lift-laparoscopic surgery under regional anesthesia: 10 patients for diagnostic purposes, 17 for surgery of ovarian tumors, 14 to remove fibroids, and 22 for hysterectomies. All patients were operated without conversion to general anesthesia and without perioperative or anesthesiologic complications. Lift-laparoscopy under regional anesthesia can be recommended to all patients who desire laparoscopic intervention without general anesthesia. For elderly patients, those with cardiopulmonary risks, during pregnancy, or with contraindications for general anesthesia, Lift-laparoscopy under regional anesthesia should be the procedure of choice.

  19. Activity-based differentiation of pathologists' workload in surgical pathology.

    PubMed

    Meijer, G A; Oudejans, J J; Koevoets, J J M; Meijer, C J L M

    2009-06-01

    Adequate budget control in pathology practice requires accurate allocation of resources. Any changes in types and numbers of specimens handled or protocols used will directly affect the pathologists' workload and consequently the allocation of resources. The aim of the present study was to develop a model for measuring the pathologists' workload that can take into account the changes mentioned above. The diagnostic process was analyzed and broken up into separate activities. The time needed to perform these activities was measured. Based on linear regression analysis, for each activity, the time needed was calculated as a function of the number of slides or blocks involved. The total pathologists' time required for a range of specimens was calculated based on standard protocols and validated by comparing to actually measured workload. Cutting up, microscopic procedures and dictating turned out to be highly correlated to number of blocks and/or slides per specimen. Calculated workload per type of specimen was significantly correlated to the actually measured workload. Modeling pathologists' workload based on formulas that calculate workload per type of specimen as a function of the number of blocks and slides provides a basis for a comprehensive, yet flexible, activity-based costing system for pathology.

  20. Crew workload-management strategies - A critical factor in system performance

    NASA Technical Reports Server (NTRS)

    Hart, Sandra G.

    1989-01-01

    This paper reviews the philosophy and goals of the NASA/USAF Strategic Behavior/Workload Management Program. The philosophical foundation of the program is based on the assumption that an improved understanding of pilot strategies will clarify the complex and inconsistent relationships observed among objective task demands and measures of system performance and pilot workload. The goals are to: (1) develop operationally relevant figures of merit for performance, (2) quantify the effects of strategic behaviors on system performance and pilot workload, (3) identify evaluation criteria for workload measures, and (4) develop methods of improving pilots' abilities to manage workload extremes.

  1. Intra- and interobserver agreement among obstetric experts in court regarding the review of abnormal fetal heart rate tracings and obstetrical management.

    PubMed

    Sabiani, Laura; Le Dû, Renaud; Loundou, Anderson; d'Ercole, Claude; Bretelle, Florence; Boubli, Léon; Carcopino, Xavier

    2015-12-01

    The objective of the study was to evaluate the intra- and interobserver agreement among obstetric experts in court regarding the retrospective review of abnormal fetal heart rate tracings and obstetrical management of patients with abnormal fetal heart rate during labor. A total of 22 French obstetric experts in court reviewed 30 cases of term deliveries of singleton pregnancies diagnosed with at least 1 hour of abnormal fetal heart rate, including 10 cases with adverse neonatal outcome. The experts reviewed all cases twice within a 3-month interval, with the first review being blinded to neonatal outcome. For each case reviewed, the experts were provided with the obstetric data and copies of the complete fetal heart rate recording and the partogram. The experts were asked to classify the abnormal fetal heart rate tracing and to express whether they agreed with the obstetrical management performed. When they disagreed, the experts were asked whether they concluded that an error had been made and whether they considered the obstetrical management as the cause of cerebral palsy in children if any. Compared with blinded review, the experts were significantly more likely to agree with the obstetric management performed (P < .001) and with the mode of delivery (P < .001) when informed about the neonatal outcome and were less likely to conclude that an error had been made (P < .001) or to establish a link with potential cerebral palsy (P = .003). The experts' intraobserver agreement for the review of abnormal fetal heart rate tracing and obstetrical management were both mediocre (kappa = 0.46-0.51 and kappa = 0.48-0.53, respectively). The interobserver agreement for the review of abnormal fetal heart rate tracing was low and was not improved by knowledge of the neonatal outcome (kappa = 0.11-0.18). The interobserver agreement for the interpretation of obstetrical management was also low (kappa = 0.08-0.19) but appeared to be improved by knowledge of the neonatal outcome

  2. Workload Characterization of CFD Applications Using Partial Differential Equation Solvers

    NASA Technical Reports Server (NTRS)

    Waheed, Abdul; Yan, Jerry; Saini, Subhash (Technical Monitor)

    1998-01-01

    Workload characterization is used for modeling and evaluating of computing systems at different levels of detail. We present workload characterization for a class of Computational Fluid Dynamics (CFD) applications that solve Partial Differential Equations (PDEs). This workload characterization focuses on three high performance computing platforms: SGI Origin2000, EBM SP-2, a cluster of Intel Pentium Pro bases PCs. We execute extensive measurement-based experiments on these platforms to gather statistics of system resource usage, which results in workload characterization. Our workload characterization approach yields a coarse-grain resource utilization behavior that is being applied for performance modeling and evaluation of distributed high performance metacomputing systems. In addition, this study enhances our understanding of interactions between PDE solver workloads and high performance computing platforms and is useful for tuning these applications.

  3. A survey of Australasian obstetric anaesthesia audit.

    PubMed

    Smith, S J; Cyna, A M; Simmons, S W

    1999-08-01

    In order to develop a minimal obstetric anaesthesia dataset based on current Australasian clinical audit best practice, we carried out a postal survey of 69 Australasian anaesthetic departments covering an obstetric service. We asked about data being collected, specifically concerning the high risk obstetric patient, epidural analgesia and postoperative anaesthetic review. Examples of any data collection forms were requested. Of the 66 responses, 35 departments (53%) were not collecting any audit data. Twenty-six of the 31 departments (84%) performing obstetric anaesthesia audit responded to our follow-up telephone survey. Eighteen departments believed that there had been an improvement in patient care as a result of their audit and 13 felt that the benefits outweighed the costs involved. However, only six departments (9%) had performed an audit cycle. The importance of feedback to patients or hospital staff and the incidence of post dural puncture headache (PDPH) were cited by some as priorities for obstetric anaesthesia audit. There was however no consistency as to what data should be collected. Many responses suggested a perceived need to collect clinical data without knowing what to do with it. Our survey has highlighted confusion between three distinct objectives; a dataset for obstetric anaesthesia record keeping, data required for continuing patient management in hospital and, a specific minimal dataset for clinical audit purposes. We conclude that current Australasian obstetric anaesthesia audit strategies are inadequate to develop a minimal dataset for cost-effective clinical audit.

  4. Anesthesia-induced epilepsy: causes and treatment.

    PubMed

    Zhao, Xiaojuan; Wang, Xuefeng

    2014-09-01

    Epilepsy is a type of chronic brain disease that results from an abnormally high synchronization of neuronal discharge. The typical clinical features of epilepsy are paroxysms and transient and stereotyped brain dysfunction. Many cases of epileptic seizures occurring during anesthesia have been reportedx. Recently, risk assessment of epileptic seizures during surgery and anesthesia has gained increasing attention. In this review, we systematically summarize the influence of anesthesia on epileptic seizures; the types, durations and frequencies of seizures related to anesthesia; and the epidemiology, prevention, treatment and prognosis of epilepsy. We also explore the possible mechanism of epilepsy and provide guidance for anesthesia during surgeries.

  5. Effects of workload preview on task scheduling during simulated instrument flight.

    PubMed

    Andre, A D; Heers, S T; Cashion, P A

    1995-01-01

    Our study examined pilot scheduling behavior in the context of simulated instrument flight. Over the course of the flight, pilots flew along specified routes while scheduling and performing several flight-related secondary tasks. The first phase of flight was flown under low-workload conditions, whereas the second phase of flight was flown under high-workload conditions in the form of increased turbulence and a disorganized instrument layout. Six pilots were randomly assigned to each of three workload preview groups. Subjects in the no-preview group were not given preview of the increased-workload conditions. Subjects in the declarative preview group were verbally informed of the nature of the flight workload manipulation but did not receive any practice under the high-workload conditions. Subjects in the procedural preview group received the same instructions as the declarative preview group but also flew half of the practice flight under the high-workload conditions. The results show that workload preview fostered efficient scheduling strategies. Specifically, those pilots with either declarative or procedural preview of future workload demands adopted an efficient strategy of scheduling more of the difficult secondary tasks during the low-workload phase of flight. However, those pilots given a procedural preview showed the greatest benefits in overall flight performance.

  6. Pediatric anesthesia in developing countries.

    PubMed

    Bösenberg, Adrian T

    2007-06-01

    To highlight the problems faced in developing countries where healthcare resources are limited, with particular emphasis on pediatric anesthesia. The fact that very few publications address pediatric anesthesia in the developing world is not surprising given that most anesthetics are provided by nonphysicians, nurses or unqualified personnel. In compiling this article information is drawn from pediatric surgical, anesthetic and related texts. In a recent survey more than 80% of anesthesia providers in a poor country acknowledged that with the limited resources available they could not provide basic anesthesia for children less than 5 years. Although many publications could be regarded as anecdotal, the similarities to this survey suggest that the lack of facilities is more generalized than we would like to believe. The real risk of anesthesia in comparison to other major health risks such as human immunodeficiency virus, malaria, tuberculosis and trauma remains undetermined. The critical shortage of manpower remains a barrier to progress. Despite erratic electrical supplies, inconsistent oxygen delivery, paucity of drugs or equipment and on occasion even lack of running water, many provide life-saving anesthesia. Perioperative morbidity and mortality is, however, understandably high by developed world standards.

  7. An attempt to estimate students' workload.

    PubMed

    Pogacnik, M; Juznic, P; Kosorok-Drobnic, M; Pogacnik, A; Cestnik, V; Kogovsek, J; Pestevsek, U; Fernandes, Tito

    2004-01-01

    Following the recent introduction of the European Credit Transfer System (ECTS) into several European university programs, a new interest has developed in determining students' workload. ECTS credits are numerical values describing the student workload required to complete course units; ECTS has the potential to facilitate comparison and create transparency between institutional curricula. ECTS credits are frequently listed alongside institutional credits in course outlines and module summaries. Measuring student workload has been difficult; to a large extent, estimates are based only upon anecdotal and casual information. To gather more systematic information, we asked students at the Veterinary Faculty, University of Ljubljana, to estimate the actual total workload they committed to fulfill their coursework obligations for specific subjects in the veterinary degree program by reporting their attendance at defined contact hours and their estimated time for outside study, including the time required for examinations and other activities. Students also reported the final grades they received for these subjects. The results show that certain courses require much more work than others, independent of credit unit assignment. Generally, the courses with more contact hours tend also to demand more independent work; the best predictor of both actual student workload and student success is the amount of contact time in which they participate. The data failed to show any strong connection between students' total workload and grades they received; rather, they showed some evidence that regular presence at contact hours was the most positive influence on grades. Less frequent presence at lectures tended to indicate less time spent on independent study. It was also found that pre-clinical and clinical courses tended to require more work from students than other, more general subjects. While the present study does not provide conclusive evidence, it does indicate the need for

  8. State of science: mental workload in ergonomics.

    PubMed

    Young, Mark S; Brookhuis, Karel A; Wickens, Christopher D; Hancock, Peter A

    2015-01-01

    Mental workload (MWL) is one of the most widely used concepts in ergonomics and human factors and represents a topic of increasing importance. Since modern technology in many working environments imposes ever more cognitive demands upon operators while physical demands diminish, understanding how MWL impinges on performance is increasingly critical. Yet, MWL is also one of the most nebulous concepts, with numerous definitions and dimensions associated with it. Moreover, MWL research has had a tendency to focus on complex, often safety-critical systems (e.g. transport, process control). Here we provide a general overview of the current state of affairs regarding the understanding, measurement and application of MWL in the design of complex systems over the last three decades. We conclude by discussing contemporary challenges for applied research, such as the interaction between cognitive workload and physical workload, and the quantification of workload 'redlines' which specify when operators are approaching or exceeding their performance tolerances.

  9. Management of obstetric hemorrhage.

    PubMed

    Shevell, Tracy; Malone, Fergal D

    2003-02-01

    A reluctance to proceed with hysterectomy for obstetric hemorrhage may be a more likely cause of preventable death in obstetrics than a lack of surgical or medical skills. Every obstetric unit should have protocols available to deal with hemorrhage and, in addition, have specific guidelines for patients who object to blood transfusions for various reasons. Risk factors for hemorrhage should be identified antenatally, using all possible imaging modalities available, and utilizing multidisciplinary resources whenever possible. Novel strategies for prenatal diagnosis of abnormal placentation include advanced sonography and magnetic resonance imaging. Placement and utilization of arterial catheters for uterine artery embolization is becoming more widespread and new surgical technology such as the argon beam coagulator seems promising. When intra or postpartum hemorrhage is encountered, a familiar protocol for dealing with blood loss should be triggered. Timely hysterectomy should be performed for signs of refractory bleeding. Application of medical and surgical principles combined with recent technologic advances will help the obstetrician avoid disastrous outcomes for both mother and fetus.

  10. Online EEG-Based Workload Adaptation of an Arithmetic Learning Environment.

    PubMed

    Walter, Carina; Rosenstiel, Wolfgang; Bogdan, Martin; Gerjets, Peter; Spüler, Martin

    2017-01-01

    In this paper, we demonstrate a closed-loop EEG-based learning environment, that adapts instructional learning material online, to improve learning success in students during arithmetic learning. The amount of cognitive workload during learning is crucial for successful learning and should be held in the optimal range for each learner. Based on EEG data from 10 subjects, we created a prediction model that estimates the learner's workload to obtain an unobtrusive workload measure. Furthermore, we developed an interactive learning environment that uses the prediction model to estimate the learner's workload online based on the EEG data and adapt the difficulty of the learning material to keep the learner's workload in an optimal range. The EEG-based learning environment was used by 13 subjects to learn arithmetic addition in the octal number system, leading to a significant learning effect. The results suggest that it is feasible to use EEG as an unobtrusive measure of cognitive workload to adapt the learning content. Further it demonstrates that a promptly workload prediction is possible using a generalized prediction model without the need for a user-specific calibration.

  11. Total Laparoscopic Hysterectomy Under Regional Anesthesia.

    PubMed

    Moawad, Nash S; Santamaria Flores, Estefania; Le-Wendling, Linda; Sumner, Martina T; Enneking, F Kayser

    2018-05-07

    Laparoscopic hysterectomies comprise a large proportion of all hysterectomies in the United States. Procedures completed under regional anesthesia pose a number of benefits to patients, but laparoscopic hysterectomies traditionally have been performed under general anesthesia. We describe a case of total laparoscopic hysterectomy under epidural anesthesia with the patient fully awake. A 51-year-old woman with abnormal uterine bleeding underwent an uncomplicated total laparoscopic hysterectomy, bilateral salpingectomy, and excision of endometriosis. The procedure was completed under epidural anesthesia without intravenous sedation or systemic narcotics. Pneumoperitoneum with a pressure of 12 mm Hg and Trendelenburg to 15° allowed for adequate visualization. Anesthesia was achieved with midthoracic and low lumbar epidural catheters. Bilevel positive airway pressure was used for augmentation of respiratory function. With a committed patient, adequate planning, and knowledge of the potential intraoperative complications, regional anesthesia is an option for select women undergoing laparoscopic hysterectomy.

  12. Caudal anesthesia in pediatric surgical practice.

    PubMed

    Rahman, S; Siddiqui, M A; Haque, M; Majumder, S K; Ali, M S; Majid, M A; Hasan, M R

    2006-07-01

    Prospective study was carried out on 100 patients since May 2005 in my private practice and in the department of pediatric surgery of MMCH. Under caudal anesthesia along with or without ketaminie induction and gas inhalation all the patients underwent different surgical procedure namely anorectal surgery (eg. anoplasty, rectal polyp), urogenital surgery (Circumcision, hypospadias, meatotomy), groin surgery (hernia, hydrocele) and foot & leg surgery. Calculated dose schedule of drugs used in anesthesia and volume were maintained. Time of giving anesthesia and time of starting analgesia were recorded. Per-operative and postoperative analgesia were evaluated. Every parent was explained regarding the merit of caudal anesthesia calculated and compared with that of general anesthesia. Application of caudal anesthesia with or without ketamine & diazepam induction can be used safely and cost effectively and may be put into protocol in many of the pediatric surgical practice both in institute and also in private practice.

  13. Physical and mental workloads in professional dance teachers.

    PubMed

    Wanke, Eileen M; Schmidt, Mike; Leslie-Spinks, Jeremy; Fischer, Axel; Groneberg, David A

    2015-03-01

    The aim of this cross-sectional study was to investigate the level of mental and physical workloads in professional dance teachers depending on the trained students' age, technique level, or dance style. A total number of 133 professional dance pedagogues responded to an online cross-sectional questionnaire survey on self-assessment of physical and mental workloads occurring during dance units. The majority of dance teachers estimated their level of physical and mental workload to be almost as high as that of their students, with differences in physical and mental workloads observed depending on dance style, age of students, and technical level. More than 60% of the teachers were convinced that their occupation implies positive effects on their own health in terms of self-realization (78.2%), musculoskeletal system (66.9%), and social relationships (61.7%). Of all respondents, 58.6% stated that their musculoskeletal system was jeopardized by the physically demanding activity. This is followed by the fear of financial insecurity (50.4%). The majority of all dance teachers (males 65.4%, females 63.9%) would like to obtain further education on prevention against or dealing with physical workload. Physical and mental workloads play an important role in dance teaching. Coping with or preventing these loads could be keys to a lifelong, healthy career as a professional dance teacher. Future trials should look at clinical parameters of physical and mental load.

  14. Obstetric training in Emergency Medicine: a needs assessment.

    PubMed

    Janicki, Adam James; MacKuen, Courteney; Hauspurg, Alisse; Cohn, Jamieson

    2016-01-01

    Identification and management of obstetric emergencies is essential in emergency medicine (EM), but exposure to pregnant patients during EM residency training is frequently limited. To date, there is little data describing effective ways to teach residents this material. Current guidelines require completion of 2 weeks of obstetrics or 10 vaginal deliveries, but it is unclear whether this instills competency. We created a 15-item survey evaluating resident confidence and knowledge related to obstetric emergencies. To assess confidence, we asked residents about their exposure and comfort level regarding obstetric emergencies and eight common presentations and procedures. We assessed knowledge via multiple-choice questions addressing common obstetric presentations, pelvic ultrasound image, and cardiotocography interpretation. The survey was distributed to residency programs utilizing the Council of Emergency Medicine Residency Directors (CORD) listserv. The survey was completed by 212 residents, representing 55 of 204 (27%) programs belonging to CORD and 11.2% of 1,896 eligible residents. Fifty-six percent felt they had adequate exposure to obstetric emergencies. The overall comfort level was 2.99 (1-5 scale) and comfort levels of specific presentations and procedures ranged from 2.58 to 3.97; all increased moderately with postgraduate year (PGY) level. Mean overall percentage of items answered correctly on the multiple-choice questions was 58% with no statistical difference by PGY level. Performance on individual questions did not differ by PGY level. The identification and management of obstetric emergencies is the cornerstone of EM. We found preliminary evidence of a concerning lack of resident comfort regarding obstetric conditions and knowledge deficits on core obstetrics topics. EM residents may benefit from educational interventions to increase exposure to these topics.

  15. [YouTube as an information source of spinal anesthesia, epidural anesthesia and combined spinal and epidural anesthesia].

    PubMed

    Tulgar, Serkan; Selvi, Onur; Serifsoy, Talat Ercan; Senturk, Ozgur; Ozer, Zeliha

    Social media as YouTube have become a part of daily life and many studies evaluated health-related YouTube videos. Our aim was to evaluate videos available on YouTube for the conformity to textbook information and their sufficiency as a source for patient information. A search of the YouTube website was performed using the keywords "spinal anesthesia, epidural anesthesia, combined spinal epidural anesthesia". Firstly, 180 videos were evaluated and the characteristics of the video were noted, and the features of the video too were noted if the video was regarding neuraxial anesthesia. Questionnaire 1 (Q1) evaluating the video quality relating to neuraxial anesthesia was designed using a textbook as reference and questionnaire 2 (Q2) was designed for evaluating patient information. After exclusions, 40 videos were included in the study. There was no difference in Q1 or Q2 scores when videos were grouped into 4 quarters according to their appearance order, time since upload or views to length rate (p>0.05). There was no statistical difference between Q1 or Q2 scores for spinal, epidural or combined videos (p>0.05). Videos prepared by a healthcare institute have a higher score in both Questionnaires 1 and 2 (10.87±4.28 vs. 5.84±2.90, p=0.044 and 3.89±5.43 vs. 1.19±3.35, p=0.01 respectively). Videos prepared by institutes, societies, etc. were of higher educational value, but were still very lacking. Videos should be prepared in adherence to available and up-to-date guidelines taking into consideration appropriate step by step explanation of each procedure, patient safety and frequently asked questions. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  16. Relevant Obstetric Factors for Cerebral Palsy: From the Nationwide Obstetric Compensation System in Japan

    PubMed Central

    Hasegawa, Junichi; Toyokawa, Satoshi; Ikenoue, Tsuyomu; Asano, Yuri; Satoh, Shoji; Ikeda, Tomoaki; Ichizuka, Kiyotake; Tamiya, Nanako; Nakai, Akihito; Fujimori, Keiya; Maeda, Tsugio; Masuzaki, Hideaki; Suzuki, Hideaki; Ueda, Shigeru

    2016-01-01

    Objective The aim of this study was to identify the relevant obstetric factors for cerebral palsy (CP) after 33 weeks’ gestation in Japan. Study design This retrospective case cohort study (1:100 cases and controls) used a Japanese national CP registry. Obstetric characteristics and clinical course were compared between CP cases in the Japan Obstetric Compensation System for Cerebral Palsy database and controls in the perinatal database of the Japan Society of Obstetrics and Gynecology born as live singleton infants between 2009 and 2011 with a birth weight ≥ 2,000 g and gestation ≥ 33 weeks. Results One hundred and seventy-five CP cases and 17,475 controls were assessed. Major relevant single factors for CP were placental abnormalities (31%), umbilical cord abnormalities (15%), maternal complications (10%), and neonatal complications (1%). A multivariate regression model demonstrated that obstetric variables associated with CP were acute delivery due to non-reassuring fetal status (relative risk [RR]: 37.182, 95% confidence interval [CI]: 20.028–69.032), uterine rupture (RR: 24.770, 95% CI: 6.006–102.160), placental abruption (RR: 20.891, 95% CI: 11.817–36.934), and preterm labor (RR: 3.153, 95% CI: 2.024–4.911), whereas protective factors were head presentation (RR: 0.199, 95% CI: 0.088–0.450) and elective cesarean section (RR: 0.236, 95% CI: 0.067–0.828). Conclusion CP after 33 weeks’ gestation in the recently reported cases in Japan was strongly associated with acute delivery due to non-reassuring fetal status, uterine rupture, and placental abruption. PMID:26821386

  17. Mental workload prediction based on attentional resource allocation and information processing.

    PubMed

    Xiao, Xu; Wanyan, Xiaoru; Zhuang, Damin

    2015-01-01

    Mental workload is an important component in complex human-machine systems. The limited applicability of empirical workload measures produces the need for workload modeling and prediction methods. In the present study, a mental workload prediction model is built on the basis of attentional resource allocation and information processing to ensure pilots' accuracy and speed in understanding large amounts of flight information on the cockpit display interface. Validation with an empirical study of an abnormal attitude recovery task showed that this model's prediction of mental workload highly correlated with experimental results. This mental workload prediction model provides a new tool for optimizing human factors interface design and reducing human errors.

  18. How Has the Free Obstetric Care Policy Impacted Unmet Obstetric Need in a Rural Health District in Guinea?

    PubMed

    Delamou, Alexandre; Dubourg, Dominique; Beavogui, Abdoul Habib; Delvaux, Thérèse; Kolié, Jacques Seraphin; Barry, Thierno Hamidou; Camara, Bienvenu Salim; Edginton, Mary; Hinderaker, Sven; De Brouwere, Vincent

    2015-01-01

    In 2010, the Ministry of Health (MoH) of Guinea introduced a free emergency obstetric care policy in all the public health facilities of the country. This included antenatal checks, normal delivery and Caesarean section. This study aims at assessing the changes in coverage of obstetric care according to the Unmet Obstetric Need concept before (2008) and after (2012) the implementation of the free emergency obstetric care policy in a rural health district in Guinea. We carried out a descriptive cross-sectional study involving the retrospective review of routine programme data during the period April to June 2014. No statistical difference was observed in women's sociodemographic characteristics and indications (absolute maternal indications versus non-absolute maternal indications) before and after the implementation of the policy. Compared to referrals from health centers of patients, direct admissions at hospital significantly increased from 49% to 66% between 2008 and 2012 (p = 0.001). In rural areas, this increase concerned all maternal complications regardless of their severity, while in urban areas it mainly affected very severe complications. Compared to 2008, there were significantly more Major Obstetric Interventions for Maternal Absolute Indications in 2012 (p < 0.001). Maternal deaths decreased between 2008 and 2012 from 1.5% to 1.1% while neonatal death increased from 12% in 2008 to 15% in 2012. The implementation of the free obstetric care policy led to a significant decrease in unmet obstetric need between 2008 and 2012 in the health district of Kissidougou. However, more research is needed to allow comparisons with other health districts in the country and to analyse the trends.

  19. Physiological Parameter Response to Variation of Mental Workload.

    PubMed

    Marinescu, Adrian Cornelius; Sharples, Sarah; Ritchie, Alastair Campbell; Sánchez López, Tomas; McDowell, Michael; Morvan, Hervé P

    2018-02-01

    To examine the relationship between experienced mental workload and physiological response by noninvasive monitoring of physiological parameters. Previous studies have examined how individual physiological measures respond to changes in mental demand and subjective reports of workload. This study explores the response of multiple physiological parameters and quantifies their added value when estimating the level of demand. The study presented was conducted in laboratory conditions and required participants to perform a visual-motor task that imposed varying levels of demand. The data collected consisted of physiological measurements (heart interbeat intervals, breathing rate, pupil diameter, facial thermography), subjective ratings of workload (Instantaneous Self-Assessment Workload Scale [ISA] and NASA-Task Load Index), and the performance. Facial thermography and pupil diameter were demonstrated to be good candidates for noninvasive workload measurements: For seven out of 10 participants, pupil diameter showed a strong correlation ( R values between .61 and .79 at a significance value of .01) with mean ISA normalized values. Facial thermography measures added on average 47.7% to the amount of variability in task performance explained by a regression model. As with the ISA ratings, the relationship between the physiological measures and performance showed strong interparticipant differences, with some individuals demonstrating a much stronger relationship between workload and performance measures than others. The results presented in this paper demonstrate that physiological and pupil diameter can be used for noninvasive real-time measurement of workload. The methods presented in this article, with current technological capabilities, are better suited for workplaces where the person is seated, offering the possibility of being applied to pilots and air traffic controllers.

  20. Physiological Parameter Response to Variation of Mental Workload

    PubMed Central

    Marinescu, Adrian Cornelius; Sharples, Sarah; Ritchie, Alastair Campbell; Sánchez López, Tomas; McDowell, Michael; Morvan, Hervé P.

    2017-01-01

    Objective: To examine the relationship between experienced mental workload and physiological response by noninvasive monitoring of physiological parameters. Background: Previous studies have examined how individual physiological measures respond to changes in mental demand and subjective reports of workload. This study explores the response of multiple physiological parameters and quantifies their added value when estimating the level of demand. Method: The study presented was conducted in laboratory conditions and required participants to perform a visual-motor task that imposed varying levels of demand. The data collected consisted of physiological measurements (heart interbeat intervals, breathing rate, pupil diameter, facial thermography), subjective ratings of workload (Instantaneous Self-Assessment Workload Scale [ISA] and NASA-Task Load Index), and the performance. Results: Facial thermography and pupil diameter were demonstrated to be good candidates for noninvasive workload measurements: For seven out of 10 participants, pupil diameter showed a strong correlation (R values between .61 and .79 at a significance value of .01) with mean ISA normalized values. Facial thermography measures added on average 47.7% to the amount of variability in task performance explained by a regression model. As with the ISA ratings, the relationship between the physiological measures and performance showed strong interparticipant differences, with some individuals demonstrating a much stronger relationship between workload and performance measures than others. Conclusion: The results presented in this paper demonstrate that physiological and pupil diameter can be used for noninvasive real-time measurement of workload. Application: The methods presented in this article, with current technological capabilities, are better suited for workplaces where the person is seated, offering the possibility of being applied to pilots and air traffic controllers. PMID:28965433

  1. The Current Status and Future of Academic Obstetrics.

    ERIC Educational Resources Information Center

    Bowers, John Z., Ed.; Purcell, Elizabeth F., Ed.

    The state of research in academic obstetrics and its relationship to research in other academic disciplines was addressed in a 1979 conference. Participants included representatives of academic obstetrics, academic pediatrics, and public health. After an introductory discussion by Howard C. Taylor, Jr. on changes in obstetrics in the last 25…

  2. Female family physicians in obstetrics: achieving personal balance.

    PubMed Central

    Carroll, J C; Brown, J B; Reid, A J

    1995-01-01

    OBJECTIVE: To describe the experiences of female family physicians who practise obstetrics in balancing professional obligations with personal and family needs, given the unique challenges that such practice poses for these physicians. DESIGN: Qualitative study. SETTING: Ontario. PARTICIPANTS: A purposefully selected sample of nine female family physicians who met the criteria of being married, having children and currently practising obstetrics. OUTCOME MEASURES: Experiences of female family physicians and their strategies in their personal, family and professional lives that enable them to continue practising obstetrics. RESULTS: All participants continued to practise obstetrics because of the pleasure they derived from it, despite the challenges of balancing the unpredictable demands of obstetrics with their personal and family needs. To continue in obstetrics, they needed to make changes in their lives, either through a gradual, evolutionary process or in response to a critical event. Alterations to work and family arrangements permitted them to meet the challenges and led to increased satisfaction. Changes included making supportive call-group arrangements, limiting work hours and the number of births attended and securing help with household duties. CONCLUSIONS: An in-depth examination, through the use of qualitative methods, showed the reasons why some female family physicians continue to practise obstetrics despite the stressful aspects of doing so. This knowledge may be useful for women who are residents or experienced clinicians and who are considering including obstetrics in their practice. PMID:7497390

  3. Orientations to Academic Workloads at Department Level

    ERIC Educational Resources Information Center

    Wolf, Amanda

    2010-01-01

    Universities confront many challenges in their efforts to manage staff activity with the aid of workload assessment and allocation systems. This article sets out fresh perspectives from an exploratory study designed to uncover patterns of subjective views about various aspects of workloads. Using Q methodology, academic staff in a single…

  4. Rework the workload.

    PubMed

    O'Bryan, Linda; Krueger, Janelle; Lusk, Ruth

    2002-03-01

    Kindred Healthcare, Inc., the nation's largest full-service network of long-term acute care hospitals, initiated a 3-year strategic plan to re-evaluate its workload management system. Here, follow the project's most important and difficult phase--designing and implementing the patient classification system.

  5. Ophthalmologic complications after intraoral local anesthesia.

    PubMed

    von Arx, Thomas; Lozanoff, Scott; Zinkernagel, Martin

    2014-01-01

    The first ophthalmologic complication in conjunction with a dental anesthesia was reported in 1936. The objective of the present study was a detailed analysis of case reports about that topic. After conducting a literature search in PubMed this study analyzed 108 ophthalmologic complications following intraoral local anesthesia in 65 case reports with respect to patient-, anesthesia-, and complication- related factors. The mean age of the patients was 33.8 years and females predominated (72.3%). The most commonly reported complication was diplopia (39.8%), mostly resulting from paralysis of the lateral rectus muscle. Other relatively frequent complications included ptosis (16.7%), mydriasis (14.8%) and amaurosis (13%). Ophthalmologic complications were mainly associated with block anesthesia of the inferior alveolar nerve (45.8%) or the posterior superior alveolar nerve (40.3%). Typically, the ophthalmologic complications in conjunction with intraoral local anesthesia had an immediate to short onset, and disappeared as the anesthesia subsided. The increased number of ophthalmologic complications after intraoral local anesthesia in females may suggest a gender effect. Double vision (diplopia) is the most frequently described complication, which is usually completely reversible like the other reported ophthalmologic complications.

  6. Intraosseous anesthesia with solution injection controlled by a computerized system versus conventional oral anesthesia: A preliminary study

    PubMed Central

    Beneito-Brotons, Rut; Peñarrocha-Oltra, David; Ata-Ali, Javier

    2012-01-01

    Objective: To compare a computerized intraosseous anesthesia system with the conventional oral anesthesia techniques, and analyze the latency and duration of the anesthetic effect and patient preference. Design: A simple-blind prospective study was made between March 2007 and May 2008. Each patient was subjected to two anesthetic techniques: conventional and intraosseous using the Quicksleeper® system (DHT, Cholet, France). A split-mouth design was adopted in which each patient underwent treatment of a tooth with one of the techniques, and treatment of the homologous contralateral tooth with the other technique. The treatments consisted of restorations, endodontic procedures and simple extractions. Results: The study series comprised 12 females and 18 males with a mean age of 36.8 years. The 30 subjects underwent a total of 60 anesthetic procedures. Intraosseous and conventional oral anesthesia caused discomfort during administration in 46.3% and 32.1% of the patients, respectively. The latency was 7.1±2.23 minutes for the conventional technique and 0.48±0.32 for intraosseous anesthesia – the difference being statistically significant. The depth of the anesthetic effect was sufficient to allow the patients to tolerate the dental treatments. The duration of the anesthetic effect in soft tissues was 199.3 minutes with the conventional technique versus only 1.6 minutes with intraosseous anesthesia – the difference between the two techniques being statistically significant. Most of the patients (69.7%) preferred intraosseous anesthesia. Conclusions: The described intraosseous anesthetic system is effective, with a much shorter latency than the conventional technique, sufficient duration of anesthesia to perform the required dental treatments, and with a much lesser soft tissue anesthetic effect. Most of the patients preferred intraosseous anesthesia. Key words:Anesthesia, intraosseous, oral anesthesia, infiltrating, mandibular block, Quicksleeper®. PMID

  7. EEG-based workload estimation across affective contexts

    PubMed Central

    Mühl, Christian; Jeunet, Camille; Lotte, Fabien

    2014-01-01

    Workload estimation from electroencephalographic signals (EEG) offers a highly sensitive tool to adapt the human–computer interaction to the user state. To create systems that reliably work in the complexity of the real world, a robustness against contextual changes (e.g., mood), has to be achieved. To study the resilience of state-of-the-art EEG-based workload classification against stress we devise a novel experimental protocol, in which we manipulated the affective context (stressful/non-stressful) while the participant solved a task with two workload levels. We recorded self-ratings, behavior, and physiology from 24 participants to validate the protocol. We test the capability of different, subject-specific workload classifiers using either frequency-domain, time-domain, or both feature varieties to generalize across contexts. We show that the classifiers are able to transfer between affective contexts, though performance suffers independent of the used feature domain. However, cross-context training is a simple and powerful remedy allowing the extraction of features in all studied feature varieties that are more resilient to task-unrelated variations in signal characteristics. Especially for frequency-domain features, across-context training is leading to a performance comparable to within-context training and testing. We discuss the significance of the result for neurophysiology-based workload detection in particular and for the construction of reliable passive brain–computer interfaces in general. PMID:24971046

  8. Development of techniques for measuring pilot workload

    NASA Technical Reports Server (NTRS)

    Spyker, D. A.; Stackhouse, S. P.; Khalafalla, A. S.; Mclane, R. C.

    1971-01-01

    An objective method of assessing information workload based on physiological measurements was developed. Information workload, or reserve capacity, was measured using a visual discrimination secondary task and subjective rating of task difficulty. The primary task was two axis (pitch and roll) tracking, and the independent variables in this study were aircraft pitch dynamics and wind gust disturbances. The study was structured to provide: (1) a sensitive, nonloading measure of reserve capacity, and (2) an unencumbering reliable measurement of the psychophysiological state. From these, a measured workload index (MWI) and physiological workload index (PWI) were extracted. An important measure of the success of this study was the degree to which the MWI and PWI agreed across the 243 randomly-presented, four-minute trials (9 subjects X 9 tasks X 3 replications). The electrophysiological data collected included vectorcardiogaram, respiration, electromyogram, skin impedance, and electroencephalogram. Special computer programs were created for the analysis of each physiological variable. The digital data base then consisted of 82 physiological features for each of the 243 trials. A prediction of workload based on physiological observations was formulated as a simultaneous least-squares prediction problem. A best subset of 10 features was chosen to predict the three measures of reserve capacity. The cannonical correlation coefficient was .754 with a chi squared value of 91.3 which allows rejection of the null hypothesis with p of .995.

  9. Comparative study between manual injection intraosseous anesthesia and conventional oral anesthesia.

    PubMed

    Peñarrocha-Oltra, D; Ata-Ali, J; Oltra-Moscardó, M-J; Peñarrocha-Diago, M-A; Peñarrocha, M

    2012-03-01

    To compare intraosseous anesthesia (IA) with the conventional oral anesthesia techniques. A simple-blind, prospective clinical study was carried out. Each patient underwent two anesthetic techniques: conventional (local infiltration and locoregional anesthetic block) and intraosseous, for respective dental operations. In order to allow comparison of IA versus conventional anesthesia, the two operations were similar and affected the same two teeth in opposite quadrants. A total of 200 oral anesthetic procedures were carried out in 100 patients. The mean patient age was 28.6±9.92 years. Fifty-five vestibular infiltrations and 45 mandibular blocks were performed. All patients were also subjected to IA. The type of intervention (conservative or endodontic) exerted no significant influence (p=0.58 and p=0.62, respectively). The latency period was 8.52±2.44 minutes for the conventional techniques and 0.89±0.73 minutes for IA - the difference being statistically significant (p<0.05). Regarding patient anesthesia sensation, the infiltrative techniques lasted a maximum of one hour, the inferior alveolar nerve blocks lasted between 1-3 hours, and IA lasted only 2.5 minutes - the differences being statistically significant (p≤0.0000, Φ=0.29). Anesthetic success was recorded in 89% of the conventional procedures and in 78% of the IA. Most patients preferred IA (61%)(p=0.0032). The two anesthetic procedures have been compared for latency, duration of anesthetic effect, anesthetic success rate and patient preference. Intraosseous anesthesia has been shown to be a technique to be taken into account when planning conservative and endodontic treatments.

  10. Obstetric analgesia for vaginal birth in contemporary obstetrics: a survey of the practice of obstetricians in Nigeria

    PubMed Central

    2014-01-01

    Background Contemporary obstetrics in sub-Saharan Africa is yet to meet the analgesic needs of most women during child birth for a satisfactory birth experience and expectedly, obstetricians have a major role to play in achieving this. Methods This was a questionnaire-based, cross-sectional study of 151 obstetricians and gynecologists that attended the 46th Annual General Meeting and Scientific Conference of the Society of Gynaecology and Obstetrics of Nigeria (SOGON) held in Abakaliki, southeast Nigeria in November, 2012. SOGON is the umbrella body that oversees the obstetric and gynecological practice in Nigeria. Data was collated and analyzed with Epi-info statistical software, and conclusions were drawn by means of simple percentages and inferential statistics using Odds Ratio, with P-value < 0.05 at 95% Confidence Interval (CI) taken to be statistically significant. Results Of the 151 participants, males predominated; 110 (72.9%) practiced in government-owned tertiary hospitals in urban locations. Only 74 (49%) offered obstetric analgesia. Among users, only 20 (13.3%) offered obstetric analgesia routinely to parturients, 44 (29.1%) sometimes and 10 (6.6%) on patients’ requests. The commonest analgesia was opioids (41.1%). Among non-users, the commonest reasons adduced were fear of respiratory distress (31.1%), cost (24.7%) and late presentation in labour (15.6%). Conclusion The routine prescription and utilization of obstetric analgesia by obstetricians in Nigeria is still low. Obstetricians are encouraged to step up its use to make childbirth a more fulfilling experience for parturients. PMID:24725280

  11. A model for developing job rotation schedules that eliminate sequential high workloads and minimize between-worker variability in cumulative daily workloads: Application to automotive assembly lines.

    PubMed

    Yoon, Sang-Young; Ko, Jeonghan; Jung, Myung-Chul

    2016-07-01

    The aim of study is to suggest a job rotation schedule by developing a mathematical model in order to reduce cumulative workload from the successive use of the same body region. Workload assessment using rapid entire body assessment (REBA) was performed for the model in three automotive assembly lines of chassis, trim, and finishing to identify which body part exposed to relatively high workloads at workstations. The workloads were incorporated to the model to develop a job rotation schedule. The proposed schedules prevent the exposure to high workloads successively on the same body region and minimized between-worker variance in cumulative daily workload. Whereas some of workers were successively assigned to high workload workstation under no job rotation and serial job rotation. This model would help to reduce the potential for work-related musculoskeletal disorders (WMSDs) without additional cost for engineering work, although it may need more computational time and relative complex job rotation sequences. Copyright © 2016 Elsevier Ltd and The Ergonomics Society. All rights reserved.

  12. Speak Up: Anesthesia and Sedation

    MedlinePlus

    ... anesthesiologist assistant. • Ask the anesthesia professional about the benefits and risks of anesthesia. • Follow instructions for eating, drinking and taking medicines, especially instructions for when not ...

  13. Comparison of workload measures on computer-generated primary flight displays

    NASA Technical Reports Server (NTRS)

    Nataupsky, Mark; Abbott, Terence S.

    1987-01-01

    Four Air Force pilots were used as subjects to assess a battery of subjective and physiological workload measures in a flight simulation environment in which two computer-generated primary flight display configurations were evaluated. A high- and low-workload task was created by manipulating flight path complexity. Both SWAT and the NASA-TLX were shown to be effective in differentiating the high and low workload path conditions. Physiological measures were inconclusive. A battery of workload measures continues to be necessary for an understanding of the data. Based on workload, opinion, and performance data, it is fruitful to pursue research with a primary flight display and a horizontal situation display integrated into a single display.

  14. Comparison of visual evoked potential monitoring during spine surgeries under total intravenous anesthesia versus balanced general anesthesia.

    PubMed

    Uribe, Alberto A; Mendel, Ehud; Peters, Zoe A; Shneker, Bassel F; Abdel-Rasoul, Mahmoud; Bergese, Sergio D

    2017-10-01

    To determine the comparison of its clinical utility and safety profile for visual evoked potential (VEP) monitoring during prone spine surgeries under total intravenous anesthesia (TIVA) versus balanced general anesthesia using the SightSaver™ visual stimulator. The protocol was designed asa pilot, single center, prospective, randomized, and double-arm study. Subjects were randomized to receive either TIVA or balanced general anesthesia. Following induction and intubation, 8 electrodes were placed subcutaneously to collect VEP recordings. The SightSaver™ visual stimulator was placed on the subject's scalp before prone positioning. VEP waveforms were recorded every 30min and assessed by a neurophysiologist throughout the length of surgery. A total of 19 subjects were evaluated and VEP waveforms were successfully collected. TIVA group showed higher amplitude and lower latency than balanced anesthesia. Our data suggested that TIVA is associated with higher VEP amplitude and shorter latencies than balanced general anesthesia; therefore, TIVA could be the most efficient anesthesia regimen for VEP monitoring. The findings help to better understand the effect of different anesthesia regimens on intra-operative VEP monitoring. Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

  15. The reliability and validity of flight task workload ratings

    NASA Technical Reports Server (NTRS)

    Childress, M. E.; Hart, S. G.; Bortolussi, M. R.

    1982-01-01

    Twelve instrument-rated general aviation pilots each flew two scenarios in a motion-base simulator. During each flight, the pilots verbally estimated their workload every three minutes. Following each flight, they again estimated workload for each flight segment and also rated their overall workload, perceived performance, and 13 specific factors on a bipolar scale. The results indicate that time (a priori, inflight, or postflight) of eliciting ratings, period to be covered by the ratings (a specific moment in time or a longer period), type of rating scale, and rating method (verbal, written, or other) may be important variables. Overall workload ratings appear to be predicted by different specific scales depending upon the situation, with activity level the best predictor. Perceived performance seems to bear little relationship to observer-rated performance when pilots rate their overall performance and an observer rates specific behaviors. Perceived workload and performance also seem unrelated.

  16. Voice-stress measure of mental workload

    NASA Technical Reports Server (NTRS)

    Alpert, Murray; Schneider, Sid J.

    1988-01-01

    In a planned experiment, male subjects between the age of 18 and 50 will be required to produce speech while performing various tasks. Analysis of the speech produced should reveal which aspects of voice prosody are associated with increased workloads. Preliminary results with two female subjects suggest a possible trend for voice frequency and amplitude to be higher and the variance of the voice frequency to be lower in the high workload condition.

  17. 21 CFR 868.6700 - Anesthesia stool.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthesia stool. 868.6700 Section 868.6700 Food... DEVICES ANESTHESIOLOGY DEVICES Miscellaneous § 868.6700 Anesthesia stool. (a) Identification. An anesthesia stool is a device intended for use as a stool for the anesthesiologist in the operating room. (b...

  18. 42 CFR 415.178 - Anesthesia services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Anesthesia services. 415.178 Section 415.178 Public..., AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.178 Anesthesia... schedule payment may be made if a physician is involved in a single anesthesia procedure involving an...

  19. 42 CFR 415.178 - Anesthesia services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Anesthesia services. 415.178 Section 415.178 Public..., AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.178 Anesthesia... schedule payment may be made if a physician is involved in a single anesthesia procedure involving an...

  20. 21 CFR 868.6700 - Anesthesia stool.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Anesthesia stool. 868.6700 Section 868.6700 Food... DEVICES ANESTHESIOLOGY DEVICES Miscellaneous § 868.6700 Anesthesia stool. (a) Identification. An anesthesia stool is a device intended for use as a stool for the anesthesiologist in the operating room. (b...

  1. 21 CFR 868.6700 - Anesthesia stool.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Anesthesia stool. 868.6700 Section 868.6700 Food... DEVICES ANESTHESIOLOGY DEVICES Miscellaneous § 868.6700 Anesthesia stool. (a) Identification. An anesthesia stool is a device intended for use as a stool for the anesthesiologist in the operating room. (b...

  2. 21 CFR 868.6700 - Anesthesia stool.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Anesthesia stool. 868.6700 Section 868.6700 Food... DEVICES ANESTHESIOLOGY DEVICES Miscellaneous § 868.6700 Anesthesia stool. (a) Identification. An anesthesia stool is a device intended for use as a stool for the anesthesiologist in the operating room. (b...

  3. 21 CFR 868.6700 - Anesthesia stool.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Anesthesia stool. 868.6700 Section 868.6700 Food... DEVICES ANESTHESIOLOGY DEVICES Miscellaneous § 868.6700 Anesthesia stool. (a) Identification. An anesthesia stool is a device intended for use as a stool for the anesthesiologist in the operating room. (b...

  4. The economic impact of rural family physicians practicing obstetrics.

    PubMed

    Avery, Daniel M; Hooper, Dwight E; McDonald, John T; Love, Michael W; Tucker, Melanie T; Parton, Jason M

    2014-01-01

    The economic impact of a family physician practicing family medicine in rural Alabama is $1,000,000 a year in economic benefit to the community. The economic benefit of those rural family physicians practicing obstetrics has not been studied. This study was designed to determine whether there was any added economic benefit of rural family physicians practicing obstetrics in rural, underserved Alabama. The Alabama Family Practice Rural Health Board has funded the University of Alabama Family Medicine Obstetrics Fellowship since its beginning in 1986. Family medicine obstetrics fellowship graduates who practice obstetrics in rural, underserved areas were sent questionnaires and asked to participate in the study. The questions included the most common types and average annual numbers of obstetrics/gynecological procedures they performed. Ten physicians, or 77% of the graduates asked to participate in the study, returned the questionnaire. Fourteen common obstetrics/gynecological procedures performed by the graduates were identified. A mean of 115 deliveries were performed. The full-time equivalent reduction in family medicine time to practice obstetrics was 20%. A family physician practicing obstetrics in a rural area adds an additional $488,560 in economic benefit to the community in addition to the $1,000,000 from practicing family medicine, producing a total annual benefit of $1,488,560. The investment of $616,385 from the Alabama Family Practice Rural Health Board resulted in a $399 benefit to the community for every dollar invested. The cumulative effect of fellowship graduates practicing both family medicine and obstetrics in rural, underserved areas over the 26 years studied was $246,047,120. © Copyright 2014 by the American Board of Family Medicine.

  5. Workload of Team Leaders and Team Members During a Simulated Sepsis Scenario.

    PubMed

    Tofil, Nancy M; Lin, Yiqun; Zhong, John; Peterson, Dawn Taylor; White, Marjorie Lee; Grant, Vincent; Grant, David J; Gottesman, Ronald; Sudikoff, Stephanie N; Adler, Mark; Marohn, Kimberly; Davidson, Jennifer; Cheng, Adam

    2017-09-01

    Crisis resource management principles dictate appropriate distribution of mental and/or physical workload so as not to overwhelm any one team member. Workload during pediatric emergencies is not well studied. The National Aeronautics and Space Administration-Task Load Index is a multidimensional tool designed to assess workload validated in multiple settings. Low workload is defined as less than 40, moderate 40-60, and greater than 60 signify high workloads. Our hypothesis is that workload among both team leaders and team members is moderate to high during a simulated pediatric sepsis scenario and that team leaders would have a higher workload than team members. Multicenter observational study. Nine pediatric simulation centers (five United States, three Canada, and one United Kingdom). Team leaders and team members during a 12-minute pediatric sepsis scenario. National Aeronautics and Space Administration-Task Load Index. One hundred twenty-seven teams were recruited from nine sites. One hundred twenty-seven team leaders and 253 team members completed the National Aeronautics and Space Administration-Task Load Index. Team leader had significantly higher overall workload than team member (51 ± 11 vs 44 ± 13; p < 0.01). Team leader had higher workloads in all subcategories except in performance where the values were equal and in physical demand where team members were higher than team leaders (29 ± 22 vs 18 ± 16; p < 0.01). The highest category for each group was mental 73 ± 13 for team leader and 60 ± 20 for team member. For team leader, two categories, mental (73 ± 17) and effort (66 ± 16), were high workload, most domains for team member were moderate workload levels. Team leader and team member are under moderate workloads during a pediatric sepsis scenario with team leader under high workloads (> 60) in the mental demand and effort subscales. Team leader average significantly higher workloads. Consideration of decreasing

  6. Effect of time span and task load on pilot mental workload

    NASA Technical Reports Server (NTRS)

    Berg, S. L.; Sheridan, T. B.

    1986-01-01

    Two sets of simulations designed to examine how a pilot's mental workload is affected by continuous manual-control activity versus discrete mental tasks that included the length of time between receiving an assignment and executing it are described. The first experiment evaluated two types of measures: objective performance indicators and subjective ratings. Subjective ratings for the two missions were different, but the objective performance measures were similar. In the second experiments, workload levels were increased and a second performance measure was taken. Mental workload had no influence on either performance-based workload measure. Subjective ratings discriminated among the scenarios and correlated with performance measures for high-workload flights. The number of mental tasks performed did not influence error rates, although high manual workloads did increase errors.

  7. 42 CFR 415.178 - Anesthesia services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Anesthesia services. 415.178 Section 415.178 Public... Anesthesia services. (a) General rule. (1) For services furnished prior to January 1, 2010, an unreduced physician fee schedule payment may be made if a physician is involved in a single anesthesia procedure...

  8. 42 CFR 415.178 - Anesthesia services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Anesthesia services. 415.178 Section 415.178 Public... Anesthesia services. (a) General rule. (1) For services furnished prior to January 1, 2010, an unreduced physician fee schedule payment may be made if a physician is involved in a single anesthesia procedure...

  9. 42 CFR 415.178 - Anesthesia services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Anesthesia services. 415.178 Section 415.178 Public... Anesthesia services. (a) General rule. (1) For services furnished prior to January 1, 2010, an unreduced physician fee schedule payment may be made if a physician is involved in a single anesthesia procedure...

  10. Clinically Enhancing Local Anesthesia Techniques for Endodontic Treatment.

    PubMed

    Bahcall, James; Xie, Qian

    2017-02-01

    Local anesthesia is one of the most important drugs given to patients who undergo endodontic treatment. Yet, clinicians often do not view local anesthetic agents as drugs and, therefore, struggle clinically to consistently achieve profound pulpal anesthesia. To improve the clinical effects of local anesthesia for endodontic treatment, in conjunction with selecting the correct type of local anesthesia, clinicians need to thoroughly understand how the local anesthetic process works and how to objectively test for clinical signs of pulpal anesthesia and integrate supplemental anesthesia when appropriate.

  11. The WFSA Global Anesthesia Workforce Survey.

    PubMed

    Kempthorne, Peter; Morriss, Wayne W; Mellin-Olsen, Jannicke; Gore-Booth, Julian

    2017-09-01

    Safe anesthesia and surgical care are not available when needed for 5 billion of the world's 7 billion people. There are major deficiencies in the specialist surgical workforce in many parts of the world, and specific data on the anesthesia workforce are lacking. The World Federation of Societies of Anaesthesiologists conducted a workforce survey during 2015 and 2016. The aim of the survey was to collect detailed information on physician anesthesia provider (PAP) and non-physician anesthesia provider (NPAP) numbers, distribution, and training. Data were categorized according to World Health Organization regional groups and World Bank income groups. We obtained information for 153 of 197 countries, representing 97.5% of the world's population. There were marked differences in the density of PAPs between World Health Organization regions and between World Bank income groups, ranging from 0 to over 20 PAP per 100,000 population. Seventy-seven countries reported a PAP density of <5, with particularly low densities in the African and South-East Asia regions. NPAPs make up a large part of the global anesthesia workforce, especially in countries with limited resources. Even when NPAPs are included, 70 countries had a total anesthesia provider density of <5 per 100,000. Using current population data, over 136,000 additional PAPs would be needed immediately to achieve a minimum density of 5 per 100,000 population in all countries. The World Federation of Societies of Anaesthesiologists Global Anesthesia Workforce Survey is the most comprehensive study of the global anesthesia workforce to date. It is the first step in a process of ongoing data collection and longitudinal follow-up. The authors recommend an interim goal of at least 5 specialist physician anesthesia providers (anesthesiologists) per 100,000 population. A marked increase in training of PAPs and NPAPs will need to occur if we are to have any hope of achieving safe anesthesia for all by 2030.

  12. Research papers and publications (1981-1987): Workload research program

    NASA Technical Reports Server (NTRS)

    Hart, Sandra G. (Compiler)

    1987-01-01

    An annotated bibliography of the research reports written by participants in NASA's Workload Research Program since 1981 is presented, representing the results of theoretical and applied research conducted at Ames Research Center and at universities and industrial laboratories funded by the program. The major program elements included: 1) developing an understanding of the workload concept; 2) providing valid, reliable, and practical measures of workload; and 3) creating a computer model to predict workload. The goal is to provide workload-related design principles, measures, guidelines, and computational models. The research results are transferred to user groups by establishing close ties with manufacturers, civil and military operators of aerospace systems, and regulatory agencies; publishing scientific articles; participating in and sponsoring workshops and symposia; providing information, guidelines, and computer models; and contributing to the formulation of standards. In addition, the methods and theories developed have been applied to specific operational and design problems at the request of a number of industry and government agencies.

  13. Academic context and perceived mental workload of psychology students.

    PubMed

    Rubio-Valdehita, Susana; López-Higes, Ramón; Díaz-Ramiro, Eva

    2014-01-01

    The excessive workload of university students is an academic stressor. Consequently, it is necessary to evaluate and control the workload in education. This research applies the NASA-TLX scale, as a measure of the workload. The objectives of this study were: (a) to measure the workload levels of a sample of 367 psychology students, (b) to group students according to their positive or negative perception of academic context (AC) and c) to analyze the effects of AC on workload. To assess the perceived AC, we used an ad hoc questionnaire designed according to Demand-Control-Social Support and Effort-Reward Imbalance models. Using cluster analysis, participants were classified into two groups (positive versus negative context). The differences between groups show that a positive AC improves performance (p < .01) and reduces feelings of overload (p < .02), temporal demand (p < .02), and nervousness and frustration (p < .001). Social relationships with peers and teachers, student autonomy and result satisfaction were relevant dimensions of the AC (p < .001 in all cases).

  14. Voice measures of workload in the advanced flight deck: Additional studies

    NASA Technical Reports Server (NTRS)

    Schneider, Sid J.; Alpert, Murray

    1989-01-01

    These studies investigated acoustical analysis of the voice as a measure of workload in individual operators. In the first study, voice samples were recorded from a single operator during high, medium, and low workload conditions. Mean amplitude, frequency, syllable duration, and emphasis all tended to increase as workload increased. In the second study, NASA test pilots performed a laboratory task, and used a flight simulator under differing work conditions. For two of the pilots, high workload in the simulator brought about greater amplitude, peak duration, and stress. In both the laboratory and simulator tasks, high workload tended to be associated with more statistically significant drop-offs in the acoustical measures than were lower workload levels. There was a great deal of intra-subject variability in the acoustical measures. The results suggested that in individual operators, increased workload might be revealed by high initial amplitude and frequency, followed by rapid drop-offs over time.

  15. Foetal Gender and Obstetric Outcome

    PubMed Central

    Schildberger, B.; Leitner, H.

    2016-01-01

    Introduction: Data on specific characteristics based on the gender of the unborn baby and their significance for obstetrics are limited. The aim of this study is to analyse selected parameters of obstetric relevance in the phases pregnancy, birth and postpartum period in dependence on the gender of the foetus. Materials and Methods: The selected study method comprised a retrospective data acquisition and evaluation from the Austrian birth register of the Department of Clinical Epidemiology of Tyrolean State Hospitals. For the analysis all inpatient singleton deliveries in Austria during the period from 2008 to 2013 were taken into account (live and stillbirths n = 444 685). The gender of the baby was correlated with previously defined, obstetrically relevant parameters. Results: In proportions, significantly more premature births and sub partu medical interventions (vaginal and abdominal surgical deliveries. episiotomies) were observed for male foetuses (p < 0.001). The neonatal outcome (5-min Apgar score, umbilical pH value less than 7.1, transfer to a neonatal special unit) is significantly poorer for boys (p < 0.001). Discussion: In view of the vulnerability of male foetuses and infants, further research is needed in order to be able to react appropriately to the differing gender-specific requirements in obstetrics. PMID:27065487

  16. Driver distraction : eye glance analysis and conversation workload.

    DOT National Transportation Integrated Search

    2015-11-01

    The objective of this project was to assess the risk of performing a secondary task while driving a commercial : motor vehicle (CMV). The risk of conversation workload while driving a CMV was also assessed. Conversation : workload is a proxy for cogn...

  17. Dental anesthesia for patients with special needs.

    PubMed

    Wang, Yi-Chia; Lin, I-Hua; Huang, Chi-Hsiang; Fan, Shou-Zen

    2012-09-01

    To offer individualized dental treatment to certain patients who cannot tolerate dental treatment, sedation or general anesthesia is required. The needs could be either medical, mental, or psychological. The most common indications for sedation or general anesthesia are lack of cooperation, multiple morbidities, and pediatric autism. In adults, cognitive impairment and multiple morbidities are most commonly encountered indications. Because of suboptimal home care, incomplete medical history, poor preoperative management, lack of cooperation, and developmental abnormalities, it is a challenge to prepare anesthesia for patients with special needs. The American Society of Anesthesiology (ASA) has proposed guidelines for office-based anesthesia for ambulatory surgery. In patients with ASA physical status IV and V, sedation or general anesthesia for treatment in the dental office is not recommended. The distinction between sedation levels and general anesthesia is not clear. If intravenous general anesthesia without tracheal intubation is chosen for dental procedures, full cooperation between the dentist, dental assistant, and anesthesiologist is needed. Teamwork between the dentist and healthcare provider is key to achieve safe and successful dental treatment under sedation or general anesthesia in the patient with special needs. Copyright © 2012. Published by Elsevier B.V.

  18. Topical anesthesia in phacoemulsification.

    PubMed

    Waheeb, Saad

    2010-09-01

    To evaluate the efficacy of topical anesthesia; topical Benoxinate 0.4% (Oxybuprocaine) and Xylocaine (Lidocaine) gel, in selected cataract patients as an alternative to peribulbar or retrobulbar block anesthesia during cataract surgery. Prospective non-comparative evaluation of patients' and surgeon's satisfaction at the end of the procedure. Three hundred patients (300 eyes) were included in the study. The procedure was explained to patients with details regarding what will happen and what to expect during surgery. All patients received topical anesthesia with Benoxinate 0.4% eye drops and Xylocaine gel 2%. All surgeries were done by the same surgeon using the same machine (updated LEGACY phacoemulsifier, Alcon) and approach (clear corneal incision) and followed by a foldable intraocular lens (IOL) implantation. None of the patients had severe pain during the procedure; only 2% (six of 300) required use of intravenous sedation (Propofol), both the surgeon's and the patients' satisfaction were high. Eye movements and blepharospasm were not significant problems, and no serious complications occurred. Rate of vitreous loss due to posterior capsule tear/rupture was within literature reported range and not different from our previous experience. Topical anesthesia is a satisfactory and safe alternative to retrobulbar and peribulbar anesthesia for clear corneal phacoemulsification and intraocular lens implantation in selected cataract patients in the hands of experienced cataract surgeon.

  19. Topical anesthesia in phacoemulsification

    PubMed Central

    Waheeb, Saad

    2010-01-01

    Purpose: To evaluate the efficacy of topical anesthesia; topical Benoxinate 0.4% (Oxybuprocaine) and Xylocaine (Lidocaine) gel, in selected cataract patients as an alternative to peribulbar or retrobulbar block anesthesia during cataract surgery. Materials and Methods: Prospective non-comparative evaluation of patients’ and surgeon’s satisfaction at the end of the procedure. Three hundred patients (300 eyes) were included in the study. The procedure was explained to patients with details regarding what will happen and what to expect during surgery. All patients received topical anesthesia with Benoxinate 0.4% eye drops and Xylocaine gel 2%. All surgeries were done by the same surgeon using the same machine (updated LEGACY phacoemulsifier, Alcon) and approach (clear corneal incision) and followed by a foldable intraocular lens (IOL) implantation. Results: None of the patients had severe pain during the procedure; only 2% (six of 300) required use of intravenous sedation (Propofol), both the surgeon’s and the patients’ satisfaction were high. Eye movements and blepharospasm were not significant problems, and no serious complications occurred. Rate of vitreous loss due to posterior capsule tear/rupture was within literature reported range and not different from our previous experience. Conclusion: Topical anesthesia is a satisfactory and safe alternative to retrobulbar and peribulbar anesthesia for clear corneal phacoemulsification and intraocular lens implantation in selected cataract patients in the hands of experienced cataract surgeon. PMID:21120050

  20. File-System Workload on a Scientific Multiprocessor

    NASA Technical Reports Server (NTRS)

    Kotz, David; Nieuwejaar, Nils

    1995-01-01

    Many scientific applications have intense computational and I/O requirements. Although multiprocessors have permitted astounding increases in computational performance, the formidable I/O needs of these applications cannot be met by current multiprocessors a their I/O subsystems. To prevent I/O subsystems from forever bottlenecking multiprocessors and limiting the range of feasible applications, new I/O subsystems must be designed. The successful design of computer systems (both hardware and software) depends on a thorough understanding of their intended use. A system designer optimizes the policies and mechanisms for the cases expected to most common in the user's workload. In the case of multiprocessor file systems, however, designers have been forced to build file systems based only on speculation about how they would be used, extrapolating from file-system characterizations of general-purpose workloads on uniprocessor and distributed systems or scientific workloads on vector supercomputers (see sidebar on related work). To help these system designers, in June 1993 we began the Charisma Project, so named because the project sought to characterize 1/0 in scientific multiprocessor applications from a variety of production parallel computing platforms and sites. The Charisma project is unique in recording individual read and write requests-in live, multiprogramming, parallel workloads (rather than from selected or nonparallel applications). In this article, we present the first results from the project: a characterization of the file-system workload an iPSC/860 multiprocessor running production, parallel scientific applications at NASA's Ames Research Center.

  1. Anesthesia for Patients With Liver Disease

    PubMed Central

    Rahimzadeh, Poupak; Safari, Saeid; Faiz, Seyed Hamid Reza; Alavian, Seyed Moayed

    2014-01-01

    Context: Liver plays an important role in metabolism and physiological homeostasis in the body. This organ is unique in its structure and physiology. So it is necessary for an anesthesiologist to be familiar with various hepatic pathophysiologic conditions and consequences of liver dysfunction. Evidence Acquisition: We searched MEDLINE (Pub Med, OVID, MD Consult), SCOPUS and the Cochrane database for the following keywords: liver disease, anesthesia and liver disease, regional anesthesia in liver disease, epidural anesthesia in liver disease and spinal anesthesia in liver disease, for the period of 1966 to 2013. Results: Although different anesthetic regimens are available in modern anesthesia world, but anesthetizing the patients with liver disease is still really tough. Spinal or epidural anesthetic effects on hepatic blood flow and function is not clearly investigated, considering both the anesthetic drug-induced changes and outcomes. Regional anesthesia might be used in patients with advanced liver disease. In these cases lower drug dosages are used, considering the fact that locally administered drugs have less systemic effects. In case of general anesthesia it seems that using inhalation agents (Isoflurane, Desflurane or Sevoflurane), alone or in combination with small doses of fentanyl can be considered as a reasonable regimen. When administering drugs, anesthetist must realize and consider the substantially changed pharmacokinetics of some other anesthetic drugs. Conclusions: Despite the fact that anesthesia in chronic liver disease is a scary and pretty challenging condition for every anesthesiologist, this hazard could be diminished by meticulous attention on optimizing the patient’s condition preoperatively and choosing appropriate anesthetic regimen and drugs in this setting. Although there are paucity of statistics and investigations in this specific group of patients but these little data show that with careful monitoring and considering the above

  2. Sevoflurane anesthesia during acute right ventricular ischemia in pigs preserves cardiac function better than propofol anesthesia.

    PubMed

    Haraldsen, Pernille; Metzsch, Carsten; Lindstedt, Sandra; Algotsson, Lars; Ingemansson, Richard

    2016-09-01

    The intention of the present study was to evaluate possible cardioprotective properties of inhalation anesthesia with sevoflurane. A porcine, open-chest model of right ventricular ischemia was used in 7 pigs receiving inhalation anesthesia with sevoflurane. The model was earlier developed and published by our group, using pigs receiving intravenous anesthesia with propofol. They served as controls. The animals were observed for three hours after the induction of right ventricular ischemia by ligation of the main branches supplying the right ventricular free wall. In the sevoflurane group, the cardiac output recovered 2 hours after the induction of ischemia and intact right ventricular stroke work was observed. In the propofol group, no such recovery occurred. The release of troponin T was significantly lower than in the sevoflurane group. Inhalation anesthesia with sevoflurane seems superior to intravenous anesthesia with propofol in acute right ventricular ischemic dysfunction. © The Author(s) 2016.

  3. General anesthesia versus segmental thoracic or conventional lumbar spinal anesthesia for patients undergoing laparoscopic cholecystectomy.

    PubMed

    Yousef, Gamal T; Lasheen, Ahmed E

    2012-01-01

    Laparoscopic cholecystectomy became the standard surgery for gallstone disease because of causing less postoperative pain, respiratory compromise and early ambulation. This study was designed to compare spinal anesthesia, (segmental thoracic or conventional lumbar) vs the gold standard general anesthesia as three anesthetic techniques for healthy patients scheduled for elective laparoscopic cholecystectomy, evaluating intraoperative parameters, postoperative recovery and analgesia, complications as well as patient and surgeon satisfaction. A total of 90 patients undergoing elective laparoscopic cholecystectomy, between January 2010 and May 2011, were randomized into three equal groups to undergo laparoscopic cholecystectomy with low-pressure CO2 pneumoperitoneum under segmental thoracic (TSA group) or conventional lumbar (LSA group) spinal anesthesia or general anesthesia (GA group). To achieve a T3 sensory level we used (hyperbaric bupivacaine 15 mg, and fentanyl 25 mg at L2/L3) for LSAgroup, and (hyperbaric bupivacaine 7.5 mg, and fentanyl 25 mg at T10/T11) for TSAgroup. Propofol, fentanyl, atracurium, sevoflurane, and tracheal intubation were used for GA group. Intraoperative parameters, postoperative recovery and analgesia, complications as well as patient and surgeon satisfaction were compared between the three groups. All procedures were completed laparoscopically by the allocated method of anesthesia with no anesthetic conversions. The time for the blockade to reach T3 level, intraoperative hypotensive and bradycardic events and vasopressor use were significantly lower in (TSA group) than in (LSA group). Postoperative pain scores as assessed throughout any time, postoperative right shoulder pain and hospital stay was lower for both (TSA group) and (LSA group) compared with (GA group). The higher degree of patients satisfaction scores were recorded in patients under segmental TSA. The present study not only confirmed that both segmental TSA and conventional

  4. General anesthesia versus segmental thoracic or conventional lumbar spinal anesthesia for patients undergoing laparoscopic cholecystectomy

    PubMed Central

    Yousef, Gamal T.; Lasheen, Ahmed E.

    2012-01-01

    Background: Laparoscopic cholecystectomy became the standard surgery for gallstone disease because of causing less postoperative pain, respiratory compromise and early ambulation. Objective: This study was designed to compare spinal anesthesia, (segmental thoracic or conventional lumbar) vs the gold standard general anesthesia as three anesthetic techniques for healthy patients scheduled for elective laparoscopic cholecystectomy, evaluating intraoperative parameters, postoperative recovery and analgesia, complications as well as patient and surgeon satisfaction. Materials and Methods: A total of 90 patients undergoing elective laparoscopic cholecystectomy, between January 2010 and May 2011, were randomized into three equal groups to undergo laparoscopic cholecystectomy with low-pressure CO2 pneumoperitoneum under segmental thoracic (TSA group) or conventional lumbar (LSA group) spinal anesthesia or general anesthesia (GA group). To achieve a T3 sensory level we used (hyperbaric bupivacaine 15 mg, and fentanyl 25 mg at L2/L3) for LSAgroup, and (hyperbaric bupivacaine 7.5 mg, and fentanyl 25 mg at T10/T11) for TSAgroup. Propofol, fentanyl, atracurium, sevoflurane, and tracheal intubation were used for GA group. Intraoperative parameters, postoperative recovery and analgesia, complications as well as patient and surgeon satisfaction were compared between the three groups. Results: All procedures were completed laparoscopically by the allocated method of anesthesia with no anesthetic conversions. The time for the blockade to reach T3 level, intraoperative hypotensive and bradycardic events and vasopressor use were significantly lower in (TSA group) than in (LSA group). Postoperative pain scores as assessed throughout any time, postoperative right shoulder pain and hospital stay was lower for both (TSA group) and (LSA group) compared with (GA group). The higher degree of patients satisfaction scores were recorded in patients under segmental TSA. Conclusion: The present

  5. Using Neural Networks to Explore Air Traffic Controller Workload

    NASA Technical Reports Server (NTRS)

    Martin, Lynne; Kozon, Thomas; Verma, Savita; Lozito, Sandra C.

    2006-01-01

    When a new system, concept, or tool is proposed in the aviation domain, one concern is the impact that this will have on operator workload. As an experience, workload is difficult to measure in a way that will allow comparison of proposed systems with those already in existence. Chatterji and Sridhar (2001) suggested a method by which airspace parameters can be translated into workload ratings, using a neural network. This approach was employed, and modified to accept input from a non-real time airspace simulation model. The following sections describe the preparations and testing work that will enable comparison of a future airspace concept with a current day baseline in terms of workload levels.

  6. Genitourinary Surgical Workload at Deployed U.S. Facilities in Iraq and Afghanistan, 2002-2016.

    PubMed

    Turner, Caryn A; Orman, Jean A; Stockinger, Zsolt T; Hudak, Steven J

    2018-06-13

    Genitourinary surgery constitutes approximately 1.15% of procedures performed for combat injuries. During forward deployment, surgeons usually deploy without urology support. To better understand the training and skills maintenance needs for genitourinary procedures by describing in detail the genitourinary surgical workload during 15 years of combat operations and compare our findings with those from previously published articles. A retrospective analysis of the Department of Defense Trauma Registry (DoDTR) was performed for all Roles 2 and 3 medical treatment facilities in Iraq and Afghanistan, from January 2002 to May 2016. The 177 ICD-9-CM procedure codes identified as genitourinary procedures were grouped into 15 anatomic categories by subject matter experts. Select groups were further subdivided by procedure types. Descriptive analyses were performed and stratified workload percentiles were calculated for the 10th, 50th, and 90th percentiles. Data analysis was performed using Stata Version 14 (College Station, TX, USA). This quality improvement project was deemed exempt from institutional review board review by the U.S. Army Institute of Surgical Research. A total of 3,963 genitourinary surgical procedures were identified, the majority occurring at Role 3 medical treatment facilities (3,512, 88.6%). The most common procedure groups were testis (20.6%), bladder (18.8%), scrotum (17.7%), and kidney (13.5%). The single most common individual procedures performed were unilateral orchiectomy (394, 9.9%), suture of laceration of scrotum and tunica vaginalis (373, 9.4%), nephroureterectomy (360, 9.1%), and other suprapubic cystostomy (268, 6.8%). Of the 77 gynecological procedures, 15 were C-sections. Genitourinary caseload per facility was low, never exceeding nine procedures per month. All deploying surgeons may be required to evaluate, stage, and surgically manage genitourinary, gynecologic, and obstetrical conditions. Surgery on the male genitalia, bladder, and

  7. Obstetrical Forceps

    NASA Technical Reports Server (NTRS)

    2004-01-01

    Marshall inventors Seth Lawson and Stanley Smeltzer display a pair of obstetrical forceps they designed. The forceps, made from composite space-age materials, measure the force applied during instrument-assisted delivery. The new forceps will help medical students get a feel for instrument-assisted deliveries before entering practice.

  8. New horizons in local anesthesia.

    PubMed

    Lackey, A D

    1998-08-01

    The computer-controlled local anesthesia system and the TEA system present 21st-century alternatives to the traditional syringe. The TEA system is a non-invasive form of anesthesia that blocks pain electronically, using the same cellular mechanism as local chemical anesthesia. Targeted electronic anesthesia provides pain control for restorative dental procedures without the use of needles or postoperative discomfort, numbness, and swelling. The computer-assisted system outperforms syringes for traditional injections. This new system generates a precisely controlled anesthetic flow rate that eliminates the need for the operator to use thumb pressure to administer the injection. The lightweight pen-grasp handle results in greater tactile feedback, precision, operator ease, and patient comfort. The greatest advantage may be in the new techniques that it makes available. With these techniques, a dentist can target the teeth to achieve profound pulpal anesthesia, often without the annoying side effects of facial numbness. With this new advanced system in the maxillary arch, the AMSA injection offers clinical advantages over traditional anesthesia techniques, according to Dr. Mark Friedman, whom I consulted with earlier this year. In the mandibular arch, a safe and predictable PDL injection technique may replace the need for an inferior alveolar block in numerous clinical situations. The use of these modified injection techniques can have a positive influence on patient safety, patient comfort, and office productivity. Both of these systems take the fear and anxiety out of dental injections. They offer exciting advanced technology for local pain control. Significantly, if patient stress and anxiety are reduced, the operator immediately benefits. New horizons in local anesthesia offer improved opportunities for patient comfort using computer-controlled local anesthetic systems and TEA.

  9. Topical anesthesia with or without propofol sedation versus retrobulbar/peribulbar anesthesia for cataract extraction: prospective randomized trial.

    PubMed

    Kallio, H; Uusitalo, R J; Maunuksela, E L

    2001-09-01

    To evaluate the feasibility of intravenous sedation in addition to topical anesthesia during cataract extraction. Helsinki University Eye Hospital, Helsinki, Finland. Three hundred seventeen eyes of 291 consecutive patients having cataract surgery were prospectively randomized to receive topical (oxybuprocaine 0.4%, n = 96), combined (topical anesthesia and propofol sedation, n = 107), or retrobulbar/peribulbar (prilocaine 1.5%, n = 114) anesthesia. The intraoperative conditions were judged by the surgeon. A numerical scale (0 to 10) was used to assess the degree of pain during surgery. Outcome measures were the number of complications and adverse events registered perioperatively and 1 week postoperatively as well as Snellen visual acuity. The success of posterior chamber intraocular lens (IOL) implantation through a self-sealing clear corneal incision was 97.9%, 96.3%, and 98.2% in the topical, combined, and retrobulbar/peribulbar groups, respectively. There was no difference among the groups in pain during surgery, frequency of complications, or outcome measures. One week postoperatively, visual acuity was 20/40 or better in 81.7%, 78.5%, and 77.5% of eyes in the topical, combined, and retrobulbar/peribulbar groups, respectively. The surgeon reported significantly fewer difficulties in the retrobulbar/peribulbar group (9.8%) than in the topical (26.0%) (P =.004) or combined (21.0%) (P =.036) groups. Additional sedative/analgesic medication given intraoperatively was required significantly more often in the topical (15.6%) than in the retrobulbar/peribulbar group (2.6%) (P =.002). Patients with bilateral surgery preferred combined anesthesia over retrobulbar/peribulbar anesthesia; however, there was no significant difference in patient acceptance among groups in patients having unilateral surgery. Intravenous propofol sedation added to topical anesthesia did not improve the operative conditions or surgical outcome. Retrobulbar/peribulbar anesthesia ensured the

  10. [Ambulatory anesthesia in pediatric surgery].

    PubMed

    Ben Khalifa, S; Hila, S; Hamzaoui, M; el Cadhi, A; Jlidi, S; Nouira, F; Hellal, Y; Houissa, T; Chaouachi, B

    2000-04-01

    Child is an ideal patient for day care surgery. So more than 60% of paediatric surgery could benefit by ambulatory surgery. Preoperative visit may select patients for ambulatory surgery. Medical exam may lead to choose pre operative screening. The ideal ambulatory anesthesia is locoregional technic or inhalatory one. Tracheal intubation don't contre indicate ambulatory surgery. Recovery of mental abilities following general anesthesia has not the same significance as in adult. Many studies confirm the safety of paediatric outpatients anesthesia.

  11. EEG entropy measures in anesthesia

    PubMed Central

    Liang, Zhenhu; Wang, Yinghua; Sun, Xue; Li, Duan; Voss, Logan J.; Sleigh, Jamie W.; Hagihira, Satoshi; Li, Xiaoli

    2015-01-01

    Highlights: ► Twelve entropy indices were systematically compared in monitoring depth of anesthesia and detecting burst suppression.► Renyi permutation entropy performed best in tracking EEG changes associated with different anesthesia states.► Approximate Entropy and Sample Entropy performed best in detecting burst suppression. Objective: Entropy algorithms have been widely used in analyzing EEG signals during anesthesia. However, a systematic comparison of these entropy algorithms in assessing anesthesia drugs' effect is lacking. In this study, we compare the capability of 12 entropy indices for monitoring depth of anesthesia (DoA) and detecting the burst suppression pattern (BSP), in anesthesia induced by GABAergic agents. Methods: Twelve indices were investigated, namely Response Entropy (RE) and State entropy (SE), three wavelet entropy (WE) measures [Shannon WE (SWE), Tsallis WE (TWE), and Renyi WE (RWE)], Hilbert-Huang spectral entropy (HHSE), approximate entropy (ApEn), sample entropy (SampEn), Fuzzy entropy, and three permutation entropy (PE) measures [Shannon PE (SPE), Tsallis PE (TPE) and Renyi PE (RPE)]. Two EEG data sets from sevoflurane-induced and isoflurane-induced anesthesia respectively were selected to assess the capability of each entropy index in DoA monitoring and BSP detection. To validate the effectiveness of these entropy algorithms, pharmacokinetic/pharmacodynamic (PK/PD) modeling and prediction probability (Pk) analysis were applied. The multifractal detrended fluctuation analysis (MDFA) as a non-entropy measure was compared. Results: All the entropy and MDFA indices could track the changes in EEG pattern during different anesthesia states. Three PE measures outperformed the other entropy indices, with less baseline variability, higher coefficient of determination (R2) and prediction probability, and RPE performed best; ApEn and SampEn discriminated BSP best. Additionally, these entropy measures showed an advantage in computation

  12. Individual differences and subjective workload assessment - Comparing pilots to nonpilots

    NASA Technical Reports Server (NTRS)

    Vidulich, Michael A.; Pandit, Parimal

    1987-01-01

    Results by two groups of subjects, pilots and nonpilots, for two subjective workload assessment techniques (the SWAT and NASA-TLX tests) intended to evaluate individual differences in the perception and reporting of subjective workload are compared with results obtained for several traditional personality tests. The personality tests were found to discriminate between the groups while the workload tests did not. It is concluded that although the workload tests may provide useful information with respect to the interaction between tasks and personality, they are not effective as pure tests of individual differences.

  13. Prevention of altered hemodynamics after spinal anesthesia: A comparison of volume preloading with tetrastarch, succinylated gelatin and ringer lactate solution for the patients undergoing lower segment caesarean section

    PubMed Central

    Mitra, Tapobrata; Das, Anjan; Majumdar, Saikat; Bhattacharyya, Tapas; Mandal, Rahul Deb; Hajra, Bimal Kumar

    2014-01-01

    Background: Spinal anesthesia has replaced general anesthesia in obstetric practice. Hemodynamic instability is a common, but preventable complication of spinal anesthesia. Preloading the circulation with intravenous fluids is considered a safe and effective method of preventing hypotension following spinal anesthesia. We had conducted a study to compare the hemodynamic stability after volume preloading with either Ringer's lactate (RL) or tetrastarch hydroxyethyl starch (HES) or succinylated gelatin (SG) in the patients undergoing cesarean section under spinal anesthesia. Materials and Methods: It was a prospective, double-blinded and randomized controlled study. Ninety six ASA-I healthy, nonlaboring parturients were randomly divided in 3 groups HES, SG, RL (n = 32 each) and received 10 ml/kg HES 130/0.4; 10 ml/kg SG (4% modified fluid gelatin) and 20 ml/kg RL respectively prior to SA scheduled for cesarean section. Heart rate, blood pressure (BP), oxygen saturation was measured. Results: The fall in systolic blood pressure (SBP) (<100 mm Hg) noted among 5 (15.63%), 12 (37.5%) and 14 (43.75%) parturients in groups HES, SG, RL respectively. Vasopressor (phenylephrine) was used to treat hypotension when SBP <90 mm Hg. Both the results and APGAR scores were comparable in all the groups. Lower preloading volume and less intra-operative vasopressor requirement was noted in HES group for maintaining BP though it has no clinical significance. Conclusion: RL which is cheap, physiological and widely available crystalloid can preload effectively and maintain hemodynamic stability well in cesarean section and any remnant hypotension can easily be manageable with vasopressor. PMID:25422601

  14. Comparison of acceptance, preference and efficacy between pressure anesthesia and classical needle infiltration anesthesia for dental restorative procedures in adult patients

    PubMed Central

    Makade, Chetana Sachin; Shenoi, Pratima R; Gunwal, Mohit K

    2014-01-01

    Introduction: Intraoral local anesthesia is essential for delivering dental care. Needless devices have been developed to provide anesthesia without injections. Little controlled research is available on its use in dental restorative procedures in adult patients. The aims of this study were to compare adult patients acceptability and preference for needleless jet injection with classical local infiltration as well as to evaluate the efficacy of the needleless anesthesia. Materials and Methods: Twenty non fearful adults with no previous experience of dental anesthesia were studied using split-mouth design. The first procedure was performed with classical needle infiltration anesthesia. The same amount of anesthetic solution was administered using MADA jet needleless device in a second session one week later, during which a second dental restorative procedure was performed. Patients acceptance was assessed using Universal pain assessment tool while effectiveness was recorded using soft tissue anesthesia and pulpal anesthesia. Patients reported their preference for the anesthetic method at the third visit. The data was evaluated using chi square test and student's t-test. Results: Pressure anesthesia was more accepted and preferred by 70% of the patients than traditional needle anesthesia (20%). Both needle and pressure anesthesia was equally effective for carrying out the dental procedures. Conclusion: Patients experienced significantly less pain and fear (p<0.01) during anesthetic procedure with pressure anesthesia. However, for more invasive procedures needle anesthesia will be more effective. PMID:24778516

  15. The dissociation of subjective measures of mental workload and performance

    NASA Technical Reports Server (NTRS)

    Yeh, Y. H.; Wickens, C. D.

    1984-01-01

    Dissociation between performance and subjective workload measures was investigated in the theoretical framework of the multiple resources model. Subjective measures do not preserve the vector characteristics in the multidimensional space described by the model. A theory of dissociation was proposed to locate the sources that may produce dissociation between the two workload measures. According to the theory, performance is affected by every aspect of processing whereas subjective workload is sensitive to the amount of aggregate resource investment and is dominated by the demands on the perceptual/central resources. The proposed theory was tested in three experiments. Results showed that performance improved but subjective workload was elevated with an increasing amount of resource investment. Furthermore, subjective workload was not as sensitive as was performance to differences in the amount of resource competition between two tasks. The demand on perceptual/central resources was found to be the most salient component of subjective workload. Dissociation occurred when the demand on this component was increased by the number of concurrent tasks or by the number of display elements. However, demands on response resources were weighted in subjective introspection as much as demands on perceptual/central resources. The implications of these results for workload practitioners are described.

  16. LOCAL ANESTHESIA IN IRRADIATED ANIMALS

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Lazovskaya, A.V.

    1964-03-01

    Experiments were conducted on animals subjected to x irradistion. A study was made of the features peculiar to the effect of local anesthetizing agents in various types of anesthesia. As revealed, the effect of decicaine on the cornea of the eye (terminal anesthesia) became intensified during the first hours after the irradiation of the animals (rabbits-- 1000 r) and reduced by the end of the first 24 hr. The initial value of the effect was restored by the third day. The extent of novocaine block of the sensitive conductors (conduction anesthesia) is greater in irradiated animals (frog- 5000 r) thanmore » that in nonirradiated ones. The analgesic effect of anesthetics (novocaine, benzocaine, mesocaine) weakened during infiltration anesthesia administered to the irradiated animals (guinea pigs--350 r). (auth)« less

  17. Quantitative assessment of workload and stressors in clinical radiation oncology.

    PubMed

    Mazur, Lukasz M; Mosaly, Prithima R; Jackson, Marianne; Chang, Sha X; Burkhardt, Katharin Deschesne; Adams, Robert D; Jones, Ellen L; Hoyle, Lesley; Xu, Jing; Rockwell, John; Marks, Lawrence B

    2012-08-01

    Workload level and sources of stressors have been implicated as sources of error in multiple settings. We assessed workload levels and sources of stressors among radiation oncology professionals. Furthermore, we explored the potential association between workload and the frequency of reported radiotherapy incidents by the World Health Organization (WHO). Data collection was aimed at various tasks performed by 21 study participants from different radiation oncology professional subgroups (simulation therapists, radiation therapists, physicists, dosimetrists, and physicians). Workload was assessed using National Aeronautics and Space Administration Task-Load Index (NASA TLX). Sources of stressors were quantified using observational methods and segregated using a standard taxonomy. Comparisons between professional subgroups and tasks were made using analysis of variance ANOVA, multivariate ANOVA, and Duncan test. An association between workload levels (NASA TLX) and the frequency of radiotherapy incidents (WHO incidents) was explored (Pearson correlation test). A total of 173 workload assessments were obtained. Overall, simulation therapists had relatively low workloads (NASA TLX range, 30-36), and physicists had relatively high workloads (NASA TLX range, 51-63). NASA TLX scores for physicians, radiation therapists, and dosimetrists ranged from 40-52. There was marked intertask/professional subgroup variation (P<.0001). Mental demand (P<.001), physical demand (P=.001), and effort (P=.006) significantly differed among professional subgroups. Typically, there were 3-5 stressors per cycle of analyzed tasks with the following distribution: interruptions (41.4%), time factors (17%), technical factors (13.6%), teamwork issues (11.6%), patient factors (9.0%), and environmental factors (7.4%). A positive association between workload and frequency of reported radiotherapy incidents by the WHO was found (r = 0.87, P value=.045). Workload level and sources of stressors vary

  18. Quantitative Assessment of Workload and Stressors in Clinical Radiation Oncology

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Mazur, Lukasz M., E-mail: lukasz_mazur@ncsu.edu; Industrial Extension Service, North Carolina State University, Raleigh, North Carolina; Biomedical Engineering, North Carolina State University, Raleigh, North Carolina

    2012-08-01

    Purpose: Workload level and sources of stressors have been implicated as sources of error in multiple settings. We assessed workload levels and sources of stressors among radiation oncology professionals. Furthermore, we explored the potential association between workload and the frequency of reported radiotherapy incidents by the World Health Organization (WHO). Methods and Materials: Data collection was aimed at various tasks performed by 21 study participants from different radiation oncology professional subgroups (simulation therapists, radiation therapists, physicists, dosimetrists, and physicians). Workload was assessed using National Aeronautics and Space Administration Task-Load Index (NASA TLX). Sources of stressors were quantified using observational methodsmore » and segregated using a standard taxonomy. Comparisons between professional subgroups and tasks were made using analysis of variance ANOVA, multivariate ANOVA, and Duncan test. An association between workload levels (NASA TLX) and the frequency of radiotherapy incidents (WHO incidents) was explored (Pearson correlation test). Results: A total of 173 workload assessments were obtained. Overall, simulation therapists had relatively low workloads (NASA TLX range, 30-36), and physicists had relatively high workloads (NASA TLX range, 51-63). NASA TLX scores for physicians, radiation therapists, and dosimetrists ranged from 40-52. There was marked intertask/professional subgroup variation (P<.0001). Mental demand (P<.001), physical demand (P=.001), and effort (P=.006) significantly differed among professional subgroups. Typically, there were 3-5 stressors per cycle of analyzed tasks with the following distribution: interruptions (41.4%), time factors (17%), technical factors (13.6%), teamwork issues (11.6%), patient factors (9.0%), and environmental factors (7.4%). A positive association between workload and frequency of reported radiotherapy incidents by the WHO was found (r = 0.87, P value=.045

  19. Effects of digital altimetry on pilot workload

    NASA Technical Reports Server (NTRS)

    Harris, R. L., Sr.; Glover, B. J.

    1985-01-01

    A series of VOR-DME instrument landing approaches was flown in the DC-9 full-workload simulator to compare pilot performance, scan behavior, and workload when using a computer-drum-pointer altimeter (CDPA) and a digital altimeter (DA). Six pilots executed two sets of instrument landing approaches, with a CDPA on one set and a DA on the other set. Pilot scanning parameters, flight performance, and subjective opinion data were evaluated. It is found that the processes of gathering information from the CDPA and the DA are different. The DA requires a higher mental workload than the CDPA for a VOR-DME type landing approach. Mental processing of altitude information after transitioning back to the attitude indicator is more evident with the DA than with the CDPA.

  20. Cardiac-Activity Measures for Assessing Airport Ramp-Tower Controller's Workload

    NASA Technical Reports Server (NTRS)

    Hayashi, Miwa; Dulchinos, Victoria

    2016-01-01

    Heart rate (HR) and heart rate variability (HRV) potentially offer objective, continuous, and non-intrusive measures of human-operators mental workload. Such measurement capability is attractive for workload assessment in complex laboratory simulations or safety-critical field testing. The present study compares mean HR and HRV data with self-reported subjective workload ratings collected during a high-fidelity human-in-the-loop simulation of airport ramp traffic control operations, which involve complex cognitive and coordination tasks. Mean HR was found to be weakly sensitive to the workload ratings, while HRV was not sensitive or even contradictory to the assumptions. Until more knowledge on stress response mechanisms of the autonomic nervous system is obtained, it is recommended that these cardiac-activity measures be used with other workload assessment tools, such as subjective measures.

  1. Cardiac-Activity Measures for Assessing Airport Ramp-Tower Controller's Workload

    NASA Technical Reports Server (NTRS)

    Hayashi, Miwa; Dulchinos, Victoria L.

    2016-01-01

    Heart rate (HR) and heart rate variability (HRV) potentially offer objective, continuous, and non-intrusive measures of human-operator's mental workload. Such measurement capability is attractive for workload assessment in complex laboratory simulations or safety-critical field testing. The present study compares mean HR and HRV data with self-reported subjective workload ratings collected during a high-fidelity human-in-the-loop simulation of airport ramp traffic control operations, which involve complex cognitive and coordination tasks. Mean HR was found to be weakly sensitive to the workload ratings, while HRV was not sensitive or even contradictory to the assumptions. Until more knowledge on stress response mechanisms of the autonomic nervous system is obtained, it is recommended that these cardiac-activity measures be used with other workload assessment tools, such as subjective measures.

  2. Psychophysical workload in the operating room: primary surgeon versus assistant.

    PubMed

    Rieger, Annika; Fenger, Sebastian; Neubert, Sebastian; Weippert, Matthias; Kreuzfeld, Steffi; Stoll, Regina

    2015-07-01

    Working in the operating room is characterized by high demands and overall workload of the surgical team. Surgeons often report that they feel more stressed when operating as a primary surgeon than in the function as an assistant which has been confirmed in recent studies. In this study, intra-individual workload was assessed in both intraoperative functions using a multidimensional approach that combined objective and subjective measures in a realistic work setting. Surgeons' intraoperative psychophysiologic workload was assessed through a mobile health system. 25 surgeons agreed to take part in the 24-hour monitoring by giving their written informed consent. The mobile health system contained a sensor electronic module integrated in a chest belt and measuring physiological parameters such as heart rate (HR), breathing rate (BR), and skin temperature. Subjective workload was assessed pre- and postoperatively using an electronic version of the NASA-TLX on a smartphone. The smartphone served as a communication unit and transferred objective and subjective measures to a communication server where data were stored and analyzed. Working as a primary surgeon did not result in higher workload. Neither NASA-TLX ratings nor physiological workload indicators were related to intraoperative function. In contrast, length of surgeries had a significant impact on intraoperative physical demands (p < 0.05; η(2) = 0.283), temporal demands (p < 0.05; η(2) = 0.260), effort (p < 0.05; η(2) = 0.287), and NASA-TLX sum score (p < 0.01; η(2) = 0.287). Intra-individual workload differences do not relate to intraoperative role of surgeons when length of surgery is considered as covariate. An intelligent operating management that considers the length of surgeries by implementing short breaks could contribute to the optimization of intraoperative workload and the preservation of surgeons' health, respectively. The value of mobile health systems for continuous psychophysiologic workload

  3. [Burnout syndrome in medical and obstetric perception of violence].

    PubMed

    Pintado-Cucarella, Sheila; Penagos-Corzo, Julio C; Casas-Arellano, Marco Antonio

    2015-03-01

    Obstetric violence involves a violation of reproductive rights of women during pregnancy, childbirth and postpartum. It has been associated with lack of empathy and emotional discomfort of physicians. To identify the perceptions of obstetric violence and to determine the possible relationship with burnout syndrome. We evaluated 29 physicians whose scope of work relates to obstetrics and gynecology. The evaluation instruments were: a) questionnaire on professional perception that collects demographic information, situations of perceived obstetric violence, major concerns of physicians in their professional work, and includes an scale about level of job satisfaction, b) the Maslach Burnout inventory, and c) Jefferson Scale of Physician Empathy. The most prevalent obstetric violence situations perceived were: medical malpractice and harmful practices (10/29), discrimination (10/29), rude treatment and verbal attacks (11/29). Seventeen participants reported lack of information on obstetric violence and not have tools to cope with this problem. Regarding the burnout syndrome, it was associated with several items of the scale of empathy and with the scale of job satisfaction. This study shows the importance of providing knowledge and tools to deal with obstetric violence and stress management to prevent such situations on medical practices.

  4. Bias in Rating of Rodent Distress during Anesthesia Induction for Anesthesia Compared with Euthanasia.

    PubMed

    Baker, Brittany A; Hickman, Debra L

    2018-03-01

    Selection of an appropriate method of euthanasia involves balancing the wellbeing of the animal during the procedure with the intended use of the animal after death and the physical and psychologic safety of the observer or operator. The recommended practices for anesthesia as compared with euthanasia are very disparate, despite the fact that all chemical methods of euthanasia are anesthetic overdoses. To explain this disparity, this study sought to determine whether perception bias is inherent in the discussion of euthanasia compared with anesthesia. In this study, participants viewed videorecordings of the anesthesia of either 4 rats or 4 mice, from induction to loss of consciousness. Half of the participants were told that they were observing anesthesia; the other half understood that they were observing euthanasia. Participants were asked to rate the distress of the animals by scoring escape behaviors, fear behaviors, respiratory distress, and other distress markers. For mice, the participants generally rated the distress as high when they were told that the mouse was being euthanized, as compared with the participants who were told that the mouse was being anesthetized. For rats, the effect was not as strong, and the distress was generally rated higher when participants were told they were watching anesthesia. Because the interpretation of distress showed bias in both species-even though the bias differed regarding the procedure that interpreted as distressing-this study demonstrates that laboratory animal professionals must consider the influence of potential perception bias when developing policies for euthanasia and anesthesia.

  5. Treatment-seeking behaviour and social status of women with pelvic organ prolapse, 4th-degree obstetric tears, and obstetric fistula in western Uganda.

    PubMed

    Krause, Hannah G; Natukunda, Harriet; Singasi, Isaac; Hicks, Sylvia S W; Goh, Judith T W

    2014-11-01

    This study looks at a trilogy of women's health issues including severe pelvic organ prolapse, unrepaired 4th degree obstetric tears and obstetric fistula, all of which can cause significant suffering in the lives of women and their families. Women undergoing surgery for severe pelvic organ prolapse, unrepaired 4th degree obstetric tears and obstetric fistulae, were interviewed to assess their perceptions of what caused their condition, subsequent impact on their social situation and sexual activity, and whether they had sought treatment previously. One hundred fifty women participated in the survey, including 69 undergoing surgery for genito-urinary fistula, 25 with faecal incontinence only (including 24 women with unrepaired 4th degree obstetric tears and 1 woman with an isolated rectovaginal fistula), and 56 women with severe pelvic organ prolapse. All groups of women were exposed to abandonment by their families with 42 % of women with genito-urinary fistula, 21 % with unrepaired 4th degree obstetric tear, and 25 % of women with severe pelvic organ prolapse rejected by their husbands. Most of the women had actively sought treatment for their condition with no success due to unavailability of treatment or misinformation. This study confirms the social stigma associated with obstetric fistula, however also highlights the social stigma faced by women suffering with severe pelvic organ prolapse and unrepaired 4th degree obstetric tears in western Uganda. There is an urgent need for education and training in obstetric management and pelvic organ prolapse management in such areas of limited resources.

  6. Obstetric team simulation program challenges.

    PubMed

    Bullough, A S; Wagner, S; Boland, T; Waters, T P; Kim, K; Adams, W

    2016-12-01

    To describe the challenges associated with the development and assessment of an obstetric emergency team simulation program. The goal was to develop a hybrid, in-situ and high fidelity obstetric emergency team simulation program that incorporated weekly simulation sessions on the labor and delivery unit, and quarterly, education protected sessions in the simulation center. All simulation sessions were video-recorded and reviewed. Labor and delivery unit and simulation center. Medical staff covering labor and delivery, anesthesiology and obstetric residents and obstetric nurses. Assessments included an on-line knowledge multiple-choice questionnaire about the simulation scenarios. This was completed prior to the initial in-situ simulation session and repeated 3 months later, the Clinical Teamwork Scale with inter-rater reliability, participant confidence surveys and subjective participant satisfaction. A web-based curriculum comprising modules on communication skills, team challenges, and team obstetric emergency scenarios was also developed. Over 4 months, only 6 labor and delivery unit in-situ sessions out of a possible 14 sessions were carried out. Four high-fidelity sessions were performed in 2 quarterly education protected meetings in the simulation center. Information technology difficulties led to the completion of only 18 pre/post web-based multiple-choice questionnaires. These test results showed no significant improvement in raw score performance from pre-test to post-test (P=.27). During Clinical Teamwork Scale live and video assessment, trained raters and program faculty were in agreement only 31% and 28% of the time, respectively (Kendall's W=.31, P<.001 and W=.28, P<.001). Participant confidence surveys overall revealed confidence significantly increased (P<.05), from pre-scenario briefing to after post-scenario debriefing. Program feedback indicates a high level of participant satisfaction and improved confidence yet further program refinement is

  7. CHROMagar Orientation Medium Reduces Urine Culture Workload

    PubMed Central

    Manickam, Kanchana; Karlowsky, James A.; Adam, Heather; Lagacé-Wiens, Philippe R. S.; Rendina, Assunta; Pang, Paulette; Murray, Brenda-Lee

    2013-01-01

    Microbiology laboratories continually strive to streamline and improve their urine culture algorithms because of the high volumes of urine specimens they receive and the modest numbers of those specimens that are ultimately considered clinically significant. In the current study, we quantitatively measured the impact of the introduction of CHROMagar Orientation (CO) medium into routine use in two hospital laboratories and compared it to conventional culture on blood and MacConkey agars. Based on data extracted from our Laboratory Information System from 2006 to 2011, the use of CO medium resulted in a 28% reduction in workload for additional procedures such as Gram stains, subcultures, identification panels, agglutination tests, and biochemical tests. The average number of workload units (one workload unit equals 1 min of hands-on labor) per urine specimen was significantly reduced (P < 0.0001; 95% confidence interval [CI], 0.5326 to 1.047) from 2.67 in 2006 (preimplementation of CO medium) to 1.88 in 2011 (postimplementation of CO medium). We conclude that the use of CO medium streamlined the urine culture process and increased bench throughput by reducing both workload and turnaround time in our laboratories. PMID:23363839

  8. Associations between attending physician workload, teaching effectiveness, and patient safety.

    PubMed

    Wingo, Majken T; Halvorsen, Andrew J; Beckman, Thomas J; Johnson, Matthew G; Reed, Darcy A

    2016-03-01

    Prior studies suggest that high workload among attending physicians may be associated with reduced teaching effectiveness and poor patient outcomes, but these relationships have not been investigated using objective measures of workload and safety. To examine associations between attending workload, teaching effectiveness, and patient safety, hypothesizing that higher workload would be associated with lower teaching effectiveness and negative patient outcomes. We conducted a retrospective study of 69,386 teaching evaluation items submitted by 543 internal medicine residents for 107 attending physicians who supervised inpatient teaching services from July 2, 2005 to July 1, 2011. Attending workload measures included hospital service census, patient length of stay, daily admissions, daily discharges, and concurrent outpatient duties. Teaching effectiveness was measured using residents' evaluations of attendings. Patient outcomes considered were applicable patient safety indicators (PSIs), intensive care unit transfers, cardiopulmonary resuscitation/rapid response team calls, and patient deaths. Mixed linear models and generalized linear regression models were used for statistical analysis. Workload measures of midnight census and daily discharges were associated with lower teaching evaluation scores (both β = -0.026, P < 0.0001). The number of daily admissions was associated with higher teaching scores (β = 0.021, P = 0.001) and increased PSIs (odds ratio = 1.81, P = 0.0001). Several measures of attending physician workload were associated with slightly lower teaching effectiveness, and patient safety may be compromised when teams are managing new admissions. Ongoing efforts by residency programs to optimize the learning environment should include strategies to manage the workload of supervising attendings. © 2016 Society of Hospital Medicine.

  9. Crew procedures and workload of retrofit concepts for microwave landing system

    NASA Technical Reports Server (NTRS)

    Summers, Leland G.; Jonsson, Jon E.

    1989-01-01

    Crew procedures and workload for Microwave Landing Systems (MLS) that could be retrofitted into existing transport aircraft were evaluated. Two MLS receiver concepts were developed. One is capable of capturing a runway centerline and the other is capable of capturing a segmented approach path. Crew procedures were identified and crew task analyses were performed using each concept. Crew workload comparisons were made between the MLS concepts and an ILS baseline using a task-timeline workload model. Workload indexes were obtained for each scenario. The results showed that workload was comparable to the ILS baseline for the MLS centerline capture concept, but significantly higher for the segmented path capture concept.

  10. Accuracy of pulse oximeter perfusion index in thoracic epidural anesthesia under basal general anesthesia.

    PubMed

    Xu, Zifeng; Zhang, Jianhai; Xia, Yunfei; Deng, Xiaoming

    2014-01-01

    To observe the change of PVI after thoracic epidural block on the basis of general anesthesia. In 26 patients undergoing elective upper abdominal operations, changes of SVI, PVI, SVV, PPV and CVP were monitored immediately before and 10 minutes after T8-9 thoracic epidural anesthesia on the basis of general anesthesia. The definition was that patients with ΔSVI greater than 10% belonged to response group to epidural block. Before epidural block, the PVI, SVV and PPV baseline values in patients of response group were significantly higher than those in patients of non-response group. PVI, SVV and PPV after epidural block were significantly higher than immediately before epidural block (P < 0.001). PVI, SVV and PPV baseline values immediately before epidural block were positively correlated with ΔSVI; the correlation coefficients were 0.70, 0.71 and 0.63, respectively, P ≤ 0.001. The optimal critical values for PVI, SVV and PPV to predict response to T8-9 gap epidural block under general anesthesia were 16% (sensitivity 80%, specificity 92%), 13% (sensitivity 90%, specificity 62%) and 12% (sensitivity 90%, specificity 77%), respectively. PVI can be used as a noninvasive indictor to monitor volume change after thoracic epidural block on the basis of general anesthesia.

  11. Spinal anesthesia: an evergreen technique.

    PubMed

    Di Cianni, Simone; Rossi, Maria; Casati, Andrea; Cocco, Caterina; Fanelli, Guido

    2008-04-01

    Spinal anesthesia is a simple technique that provides a deep and fast surgical block through the injection of small doses of local anesthetic solution into the subarachnoid space. The purpose of this review is to provide an overview on recent developments on local anesthetic drugs, side effects, and special techniques of intrathecal anesthesia. Spinal anesthesia can be considered adequately safe, and severe complications are reasonably rare. The cardiovascular effects associated with sympathetic block are more frequent, but successfully treated with volume expansion and administration of vasoactive drugs. It is clear that the total dose of local anesthetic injected into the subarachnoid space is the most important determinant of both therapeutic and unwanted effects of spinal anesthesia. Several studies have also demonstrated the efficacy and safety of using small doses of long acting agents, such as bupivacaine or ropivacaine, to produce an adequately short spinal block in outpatients. Levopivacaine, the pure S(-)-enantiomer of racemic bupivacaine showed a lower risk of cardiovascular and central nervous system (CNS) toxicity than bupivacaine. In the last years we have assisted important changes in the health care organization, with most of the surgical procedures performed on outpatients or on elderly patients with concomitant diseases. This forced us to change the indications and clinical use of intrathecal anesthesia techniques, which have been modified according to the changing needs of surgery. The development of new drugs and special techniques for spinal anesthesia will further improve the clinical use of this old but evergreen technique.

  12. A wavelet transform based method to determine depth of anesthesia to prevent awareness during general anesthesia.

    PubMed

    Mousavi, Seyed Mortaza; Adamoğlu, Ahmet; Demiralp, Tamer; Shayesteh, Mahrokh G

    2014-01-01

    Awareness during general anesthesia for its serious psychological effects on patients and some juristically problems for anesthetists has been an important challenge during past decades. Monitoring depth of anesthesia is a fundamental solution to this problem. The induction of anesthesia alters frequency and mean of amplitudes of the electroencephalogram (EEG), and its phase couplings. We analyzed EEG changes for phase coupling between delta and alpha subbands using a new algorithm for depth of general anesthesia measurement based on complex wavelet transform (CWT) in patients anesthetized by Propofol. Entropy and histogram of modulated signals were calculated by taking bispectral index (BIS) values as reference. Entropies corresponding to different BIS intervals using Mann-Whitney U test showed that they had different continuous distributions. The results demonstrated that there is a phase coupling between 3 and 4 Hz in delta and 8-9 Hz in alpha subbands and these changes are shown better at the channel T 7 of EEG. Moreover, when BIS values increase, the entropy value of modulated signal also increases and vice versa. In addition, measuring phase coupling between delta and alpha subbands of EEG signals through continuous CWT analysis reveals the depth of anesthesia level. As a result, awareness during anesthesia can be prevented.

  13. Intraseptal anesthesia: a review of a relevant injection technique.

    PubMed

    Woodmansey, Karl

    2005-01-01

    Although overshadowed by intraosseous anesthesia and the periodontal ligament injection, intraseptal anesthesia remains a useful local anesthesia technique for general dentists. Intraseptal anesthesia can be employed with safety and efficacy as an alternative to conventional local infiltration or regional nerve block injections. It also can serve as an adjunctive technique when conventional techniques fail to achieve adequate local anesthesia. This article reviews the intraseptal anesthesia technique, including its indications and limitations.

  14. A multicenter study on the appropriateness of hospitalization in obstetric wards: application of Obstetric Appropriateness Evaluation Protocol (Obstetric AEP).

    PubMed

    Mannocci, Alice; Specchia, Maria Lucia; Poppa, Giuseppina; Boccia, Giovanni; Cavallo, Pierpaolo; De Caro, Francesco; Vetrano, Giuseppe; Aleandri, Vincenzo; Capunzo, Mario; Ricciardi, Walter; Boccia, Antonio; Firenze, Alberto; Malvasi, Antonio; La Torre, Giuseppe

    2015-09-01

    The cross-sectional study has been based on the implementation of the Obstetric Appropriateness Evaluation Protocol (OAEP) in seven hospitals to determine inappropriate hospital admissions and days of stay. The outcomes were: inappropriateness of admission and "percentage of inappropriateness" for one hospitalization. A total number of 2196 clinical records were reviewed. The mean percentage of inappropriateness for hospitalization was 22%. The percentage of inappropriateness for the first 10 d of hospitalization peaked in correspondence of the fourth (42%). The logistic regression model on inappropriated admission reported that emergency admission was a protective factor (OR = 0.4) and to be hospitalized in wards with ≥30 beds risk factor (OR = 5.12). The second linear model on "percentage of inappropriateness" showed that inappropriated admission and wards with ≥30 beds increased the percentage (p < 0.001); whereas the admission in Teaching Hospitals was inversely associated (p < 0.001). The present study suggests that the percentage of inappropriate admission depends especially on the inappropriate admission and the large number of beds in obstetric wards. This probably indicates that management of big hospitals, which is very complex, needs improving the processes of support and coordination of health professionals. The OAEP tool seems to be an useful instrument for the decision-makers to monitor and manage the obstetric wards.

  15. A computerized multidimensional measurement of mental workload via handwriting analysis.

    PubMed

    Luria, Gil; Rosenblum, Sara

    2012-06-01

    The goal of this study was to test the effect of mental workload on handwriting behavior and to identify characteristics of low versus high mental workload in handwriting. We hypothesized differences between handwriting under three different load conditions and tried to establish a profile that integrated these indicators. Fifty-six participants wrote three numerical progressions of varying difficulty on a digitizer attached to a computer so that we could evaluate their handwriting behavior. Differences were found in temporal, spatial, and angular velocity handwriting measures, but no significant differences were found for pressure measures. Using data reduction, we identified three clusters of handwriting, two of which differentiated well according to the three mental workload conditions. We concluded that handwriting behavior is affected by mental workload and that each measure provides distinct information, so that they present a comprehensive indicator of mental workload.

  16. Using Psychophysiological Sensors to Assess Mental Workload During Web Browsing.

    PubMed

    Jimenez-Molina, Angel; Retamal, Cristian; Lira, Hernan

    2018-02-03

    Knowledge of the mental workload induced by a Web page is essential for improving users' browsing experience. However, continuously assessing the mental workload during a browsing task is challenging. To address this issue, this paper leverages the correlation between stimuli and physiological responses, which are measured with high-frequency, non-invasive psychophysiological sensors during very short span windows. An experiment was conducted to identify levels of mental workload through the analysis of pupil dilation measured by an eye-tracking sensor. In addition, a method was developed to classify mental workload by appropriately combining different signals (electrodermal activity (EDA), electrocardiogram, photoplethysmo-graphy (PPG), electroencephalogram (EEG), temperature and pupil dilation) obtained with non-invasive psychophysiological sensors. The results show that the Web browsing task involves four levels of mental workload. Also, by combining all the sensors, the efficiency of the classification reaches 93.7%.

  17. Cognitive Workload and Sleep Restriction Interact to Influence Sleep Homeostatic Responses

    PubMed Central

    Goel, Namni; Abe, Takashi; Braun, Marcia E.; Dinges, David F.

    2014-01-01

    Study Objectives: Determine the effects of high versus moderate workload on sleep physiology and neurobehavioral measures, during sleep restriction (SR) and no sleep restriction (NSR) conditions. Design: Ten-night experiment involving cognitive workload and SR manipulations. Setting: Controlled laboratory environment. Participants: Sixty-three healthy adults (mean ± standard deviation: 33.2 ± 8.7 y; 29 females), age 22–50 y. Interventions: Following three baseline 8 h time in bed (TIB) nights, subjects were randomized to one of four conditions: high cognitive workload (HW) + SR; moderate cognitive workload (MW) + SR; HW + NSR; or MW + NSR. SR entailed 5 consecutive nights at 4 h TIB; NSR entailed 5 consecutive nights at 8 h TIB. Subjects received three workload test sessions/day consisting of 15-min preworkload assessments, followed by a 60-min (MW) or 120-min (HW) workload manipulation comprised of visually based cognitive tasks, and concluding with 15-min of postworkload assessments. Experimental nights were followed by two 8-h TIB recovery sleep nights. Polysomnography was collected on baseline night 3, experimental nights 1, 4, and 5, and recovery night 1 using three channels (central, frontal, occipital [C3, Fz, O2]). Measurements and Results: High workload, regardless of sleep duration, increased subjective fatigue and sleepiness (all P < 0.05). In contrast, sleep restriction produced cumulative increases in Psychomotor Vigilance Test (PVT) lapses, fatigue, and sleepiness and decreases in PVT response speed and Maintenance of Wakefulness Test (MWT) sleep onset latencies (all P < 0.05). High workload produced longer sleep onset latencies (P < 0.05, d = 0.63) and less wake after sleep onset (P < 0.05, d = 0.64) than moderate workload. Slow-wave energy—the putative marker of sleep homeostasis—was higher at O2 than C3 only in the HW + SR condition (P < 0.05). Conclusions: High cognitive workload delayed sleep onset, but it also promoted sleep homeostatic

  18. A comparative evaluation of pain and anxiety levels in 2 different anesthesia techniques: locoregional anesthesia using conventional syringe versus intraosseous anesthesia using a computer-controlled system (Quicksleeper).

    PubMed

    Özer, Senem; Yaltirik, Mehmet; Kirli, Irem; Yargic, Ilhan

    2012-11-01

    The aim of this study was to compare anxiety and pain levels during anesthesia and efficacy of Quicksleeper intraosseous (IO) injection system, which delivers computer-controlled IO anesthesia and conventional inferior alveolar nerve block (IANB) in impacted mandibular third molars. Forty subjects with bilateral impacted mandibular third molars randomly received IO injection or conventional IANB at 2 successive appointments. The subjects received 1.8 mL 2% articaine. IO injection has many advantages, such as enabling painless anesthesia with less soft tissue numbness and quick onset of anesthesia as well as lingual and palatal anesthesia with single needle penetration. Although IO injection is a useful technique commonly used during various treatments in dentistry, the duration of injection takes longer than conventional techniques, there is a possibility of obstruction at the needle tip, and, the duration of the anesthetic effect is inadequate for prolonged surgical procedures. Copyright © 2012 Elsevier Inc. All rights reserved.

  19. Emergency preparedness in obstetrics.

    PubMed

    Haeri, Sina; Marcozzi, David

    2015-04-01

    During and after disasters, focus is directed toward meeting the immediate needs of the general population. As a result, the routine health care and the special needs of some vulnerable populations such as pregnant and postpartum women may be overlooked within a resource-limited setting. In the event of hazards such as natural disasters, manmade disasters, and terrorism, knowledge of emergency preparedness strategies is imperative for the pregnant woman and her family, obstetric providers, and hospitals. Individualized plans for the pregnant woman and her family should include knowledge of shelter in place, birth at home, and evacuation. Obstetric providers need to have a personal disaster plan in place that accounts for work responsibilities in case of an emergency and business continuity strategies to continue to provide care to their communities. Hospitals should have a comprehensive emergency preparedness program utilizing an "all hazards" approach to meet the needs of pregnant and postpartum women and other vulnerable populations during disasters. With lessons learned in recent tragedies such as Hurricane Katrina in mind, we hope this review will stimulate emergency preparedness discussions and actions among obstetric providers and attenuate adverse outcomes related to catastrophes in the future.

  20. [Effects of mental workload on work ability in primary and secondary school teachers].

    PubMed

    Xiao, Yuanmei; Li, Weijuan; Ren, Qingfeng; Ren, Xiaohui; Wang, Zhiming; Wang, Mianzhen; Lan, Yajia

    2015-02-01

    To investigate the change pattern of primary and secondary school teachers' work ability with the changes in their mental workload. A total of 901 primary and secondary school teachers were selected by random cluster sampling, and then their mental workload and work ability were assessed by National Aeronautics and Space Administration-Task Load Index (NASA-TLX) and Work Ability Index (WAI) questionnaires, whose reliability and validity had been tested. The effects of their mental workload on the work ability were analyzed. Primary and secondary school teachers' work ability reached the highest level at a certain level of mental workload (55.73< mental workload ≤ 64.10). When their mental workload was lower than the level, their work ability had a positive correlation with the mental workload. Their work ability increased or maintained stable with the increasing mental workload. Moreover, the percentage of teachers with good work ability increased, while that of teachers with moderate work ability decreased. But when their mental workload was higher than the level, their work ability had a negative correlation with the mental workload. Their work ability significantly decreased with the increasing mental workload (P < 0.01). Furthermore, the percentage of teachers with good work ability decreased, while that of teachers with moderate work ability increased (P < 0.001). Too high or low mental workload will result in the decline of primary and secondary school teachers' work ability. Moderate mental workload (55.73∼64.10) will benefit the maintaining and stabilization of their work ability.

  1. Obstetric fistulae in West Africa: patient perspectives.

    PubMed

    Nathan, Lisa M; Rochat, Charles H; Grigorescu, Bogdan; Banks, Erika

    2009-05-01

    The objective of this study is to gain insight into the nature of obstetric fistulae in Africa through patient perspectives. At l'Hôpital Saint Jean de Dieu in Tanguieta, Benin, 37 fistula patients underwent structured interviews about fistula cause, obstacles to medical care, prevention, and reintegration by 2 physicians via interpreters. The majority of participants (43%) thought their fistulae were a result of trauma from the operative delivery. Lack of financial resources (49%) was the most commonly reported obstacle to care, and prenatal care (38%) was most frequently reported as an intervention that may prevent obstetric fistulae. The majority (49%) of the participants requested no further reintegration assistance aside from surgery. Accessible emergency obstetric care is necessary to decrease the burden of obstetric fistulae in Africa. This may be accomplished through increased and improved health care facilities and education of providers and patients.

  2. Intraosseous anesthesia with solution injection controlled by a computerized system versus conventional oral anesthesia: a preliminary study.

    PubMed

    Beneito-Brotons, Rut; Peñarrocha-Oltra, David; Ata-Ali, Javier; Peñarrocha, María

    2012-05-01

    To compare a computerized intraosseous anesthesia system with the conventional oral anesthesia techniques, and analyze the latency and duration of the anesthetic effect and patient preference. A simple-blind prospective study was made between March 2007 and May 2008. Each patient was subjected to two anesthetic techniques: conventional and intraosseous using the Quicksleeper® system (DHT, Cholet, France). A split-mouth design was adopted in which each patient underwent treatment of a tooth with one of the techniques, and treatment of the homologous contralateral tooth with the other technique. The treatments consisted of restorations, endodontic procedures and simple extractions. The study series comprised 12 females and 18 males with a mean age of 36.8 years. The 30 subjects underwent a total of 60 anesthetic procedures. Intraosseous and conventional oral anesthesia caused discomfort during administration in 46.3% and 32.1% of the patients, respectively. The latency was 7.1±2.23 minutes for the conventional technique and 0.48±0.32 for intraosseous anesthesia--the difference being statistically significant. The depth of the anesthetic effect was sufficient to allow the patients to tolerate the dental treatments. The duration of the anesthetic effect in soft tissues was 199.3 minutes with the conventional technique versus only 1.6 minutes with intraosseous anesthesia--the difference between the two techniques being statistically significant. Most of the patients (69.7%) preferred intraosseous anesthesia. The described intraosseous anesthetic system is effective, with a much shorter latency than the conventional technique, sufficient duration of anesthesia to perform the required dental treatments, and with a much lesser soft tissue anesthetic effect. Most of the patients preferred intraosseous anesthesia.

  3. Obstetric acute renal failure 1956-1987.

    PubMed

    Turney, J H; Ellis, C M; Parsons, F M

    1989-06-01

    A total of 142 women with severe acute renal failure (ARF) resulting from obstetric causes was treated by dialysis at a single centre from 1956 to 1987. One-year survival was 78.6%, which compares favourably with other causes of ARF. Abortion, haemorrhage and preclampsia comprised 95% of cases, with survival being best (82.9%) with abortion. Survival was adversely affected by increasing age. Acute cortical necrosis (12.7% of patients) carried 100% mortality after 6 years. Follow-up of survivors showed normal renal function up to 31 years following ARF; 25-year patient survival was 71.6%. Improvements in obstetric care and the disappearance of illegal abortions have resulted in a dramatic decline in the incidence of obstetric ARF.

  4. Novel method of measuring the mental workload of anaesthetists during clinical practice.

    PubMed

    Byrne, A J; Oliver, M; Bodger, O; Barnett, W A; Williams, D; Jones, H; Murphy, A

    2010-12-01

    Cognitive overload has been recognized as a significant cause of error in industries such as aviation and measuring mental workload has become a key method of improving safety. The aim of this study was to pilot the use of a new method of measuring mental workload in the operating theatre using a previously published methodology. The mental workload of the anaesthetists was assessed by measuring their response times to a wireless vibrotactile device and the NASA TLX subjective workload score during routine surgical procedures. Primary task workload was inferred from the phase of anaesthesia. Significantly increased response time was associated with the induction phase of anaesthesia compared with maintenance/emergence, non-consultant grade, and during more complex cases. Increased response was also associated with self-reported mental load, physical load, and frustration. These findings are consistent with periods of increased mental workload and with the findings of other studies using similar techniques. These findings confirm the importance of mental workload to the performance of anaesthetists and suggest that increased mental workload is likely to be a common problem in clinical practice. Although further studies are required, the method described may be useful for the measurement of the mental workload of anaesthetists.

  5. 21 CFR 868.5120 - Anesthesia conduction catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Anesthesia conduction catheter. 868.5120 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5120 Anesthesia conduction catheter. (a) Identification. An anesthesia conduction catheter is a flexible tubular device used to inject...

  6. 21 CFR 868.5120 - Anesthesia conduction catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthesia conduction catheter. 868.5120 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5120 Anesthesia conduction catheter. (a) Identification. An anesthesia conduction catheter is a flexible tubular device used to inject...

  7. 21 CFR 868.5120 - Anesthesia conduction catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Anesthesia conduction catheter. 868.5120 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5120 Anesthesia conduction catheter. (a) Identification. An anesthesia conduction catheter is a flexible tubular device used to inject...

  8. Temperature control can abolish anesthesia-induced tau hyperphosphorylation and partly reverse anesthesia-induced cognitive impairment in old mice.

    PubMed

    Xiao, Haibing; Run, Xiaoqin; Cao, Xu; Su, Ying; Sun, Zhou; Tian, Cheng; Sun, Shenggang; Liang, Zhihou

    2013-11-01

    Anesthesia is related to cognitive impairment and the risk for Alzheimer's disease. Hypothermia during anesthesia can lead to abnormal hyperphosphorylation of tau, which has been speculated to be involved in anesthesia-induced cognitive impairment. The aim of this study was to investigate whether maintenance of the tau phosphorylation level by body temperature control during anesthesia could reverse the cognitive dysfunction in C57BL/6 mice. Eighteen-month-old mice were repeatedly anesthetized during a 2-week period with or without maintenance of body temperature, control mice were treated with normal saline instead of anesthetics. Tau phosphorylation level in mice brain was detected on western blot, and cognitive performance was measured using the Morris water maze (MWM). After anesthesia-induced hypothermia in old mice, tau was hyperphosphorylated and the cognitive performance, measured on MWM, was impaired. When body temperature was controlled during anesthesia, however, the tau hyperphosphorylation was completely avoided, and there was partial recovery in cognitive impairment measured on the MWM. Hyperphosphorylation of tau in the brain after anesthesia is an important event, and it might be, although not solely, responsible for postoperative cognitive decline. © 2013 The Authors. Psychiatry and Clinical Neurosciences © 2013 Japanese Society of Psychiatry and Neurology.

  9. Breastfeeding after Anesthesia: A Review for Anesthesia Providers Regarding the Transfer of Medications into Breast Milk

    PubMed Central

    Cobb, Benjamin; Liu, Renyu; Valentine, Elizabeth; Onuoha, Onyi

    2015-01-01

    Brief Summary Doctors, nurses, and midwives often inform mothers to “pump and dump” their breast milk for 24 hours after receiving anesthesia to avoid passing medications to the infant. This advice, though cautious, is probably outdated. This review highlights the more recent literature regarding common anesthesia medications, their passage into breast milk, and medication effects observed in breastfed infants. We suggest continuing breastfeeding after anesthesia when the mother is awake, alert, and able to hold her infant. We recommend multiple types of medications for pain relief while minimizing sedating medications. Few medications can have sedating effects to the infant, but those medications are specifically outlined. For additional safety, anesthesia providers and patients may screen medications using the National Institute of Health’ LactMed database. PMID:26413558

  10. Breastfeeding after Anesthesia: A Review for Anesthesia Providers Regarding the Transfer of Medications into Breast Milk.

    PubMed

    Cobb, Benjamin; Liu, Renyu; Valentine, Elizabeth; Onuoha, Onyi

    Doctors, nurses, and midwives often inform mothers to "pump and dump" their breast milk for 24 hours after receiving anesthesia to avoid passing medications to the infant. This advice, though cautious, is probably outdated. This review highlights the more recent literature regarding common anesthesia medications, their passage into breast milk, and medication effects observed in breastfed infants. We suggest continuing breastfeeding after anesthesia when the mother is awake, alert, and able to hold her infant. We recommend multiple types of medications for pain relief while minimizing sedating medications. Few medications can have sedating effects to the infant, but those medications are specifically outlined. For additional safety, anesthesia providers and patients may screen medications using the National Institute of Health' LactMed database.

  11. "Time Is Not Enough." Workload in Higher Education: A Student Perspective

    ERIC Educational Resources Information Center

    Kyndt, Eva; Berghmans, Inneke; Dochy, Filip; Bulckens, Lydwin

    2014-01-01

    Students' workload has been recognised as a major factor in the teaching and learning environment. This paper starts by structuring the different conceptualisations of workload described in the scientific literature. Besides the traditional distinction between objective and subjective or perceived workload, a distinction between conceptualisations…

  12. Development of a Methodology for Assessing Aircrew Workloads.

    DTIC Science & Technology

    1981-11-01

    Workload Feasibility Study. .. ...... 52 Subjects. .. .............. ........ 53 Equipment .. ............... ....... 53 Date Analysis ... analysis ; simulation; standard time systems; switching synthetic time systems; task activities; task interference; time study; tracking; workload; work sampl...standard data systems, information content analysis , work sampling and job evaluation. Con- ventional methods were found to be deficient in accounting

  13. [The evolution of vacuum extraction in obstetrics].

    PubMed

    Nikolov, A

    2010-01-01

    Vacuum extraction is one of the methods for assisted vaginal delivery. In this article the evolution of vacuum extraction in obstetrics is been discussed. Historical facts and data from the invention up to state-of-the-art vacuum systems in modern obstetrics are presented.

  14. GPs’ perceptions of workload in England: a qualitative interview study

    PubMed Central

    Croxson, Caroline HD; Ashdown, Helen F; Hobbs, FD Richard

    2017-01-01

    Background GPs report the lowest levels of morale among doctors, job satisfaction is low, and the GP workforce is diminishing. Workload is frequently cited as negatively impacting on commitment to a career in general practice, and many GPs report that their workload is unmanageable. Aim To gather an in-depth understanding of GPs’ perceptions and attitudes towards workload. Design and setting All GPs working within NHS England were eligible. Advertisements were circulated via regional GP e-mail lists and national social media networks in June 2015. Of those GPs who responded, a maximum-variation sample was selected until data saturation was reached. Method Semi-structured, qualitative interviews were conducted. Data were analysed thematically. Results In total, 171 GPs responded, and 34 were included in this study. GPs described an increase in workload over recent years, with current working days being long and intense, raising concerns over the wellbeing of GPs and patients. Full-time partnership was generally not considered to be possible, and many participants felt workload was unsustainable, particularly given the diminishing workforce. Four major themes emerged to explain increased workload: increased patient needs and expectations; a changing relationship between primary and secondary care; bureaucracy and resources; and the balance of workload within a practice. Continuity of care was perceived as being eroded by changes in contracts and working patterns to deal with workload. Conclusion This study highlights the urgent need to address perceived lack of investment and clinical capacity in general practice, and suggests that managing patient expectations around what primary care can deliver, and reducing bureaucracy, have become key issues, at least until capacity issues are resolved. PMID:28093422

  15. GPs' perceptions of workload in England: a qualitative interview study.

    PubMed

    Croxson, Caroline Hd; Ashdown, Helen F; Hobbs, Fd Richard

    2017-02-01

    GPs report the lowest levels of morale among doctors, job satisfaction is low, and the GP workforce is diminishing. Workload is frequently cited as negatively impacting on commitment to a career in general practice, and many GPs report that their workload is unmanageable. To gather an in-depth understanding of GPs' perceptions and attitudes towards workload. All GPs working within NHS England were eligible. Advertisements were circulated via regional GP e-mail lists and national social media networks in June 2015. Of those GPs who responded, a maximum-variation sample was selected until data saturation was reached. Semi-structured, qualitative interviews were conducted. Data were analysed thematically. In total, 171 GPs responded, and 34 were included in this study. GPs described an increase in workload over recent years, with current working days being long and intense, raising concerns over the wellbeing of GPs and patients. Full-time partnership was generally not considered to be possible, and many participants felt workload was unsustainable, particularly given the diminishing workforce. Four major themes emerged to explain increased workload: increased patient needs and expectations; a changing relationship between primary and secondary care; bureaucracy and resources; and the balance of workload within a practice. Continuity of care was perceived as being eroded by changes in contracts and working patterns to deal with workload. This study highlights the urgent need to address perceived lack of investment and clinical capacity in general practice, and suggests that managing patient expectations around what primary care can deliver, and reducing bureaucracy, have become key issues, at least until capacity issues are resolved. © British Journal of General Practice 2017.

  16. Using Psychophysiological Sensors to Assess Mental Workload During Web Browsing

    PubMed Central

    Jimenez-Molina, Angel; Retamal, Cristian; Lira, Hernan

    2018-01-01

    Knowledge of the mental workload induced by a Web page is essential for improving users’ browsing experience. However, continuously assessing the mental workload during a browsing task is challenging. To address this issue, this paper leverages the correlation between stimuli and physiological responses, which are measured with high-frequency, non-invasive psychophysiological sensors during very short span windows. An experiment was conducted to identify levels of mental workload through the analysis of pupil dilation measured by an eye-tracking sensor. In addition, a method was developed to classify mental workload by appropriately combining different signals (electrodermal activity (EDA), electrocardiogram, photoplethysmo-graphy (PPG), electroencephalogram (EEG), temperature and pupil dilation) obtained with non-invasive psychophysiological sensors. The results show that the Web browsing task involves four levels of mental workload. Also, by combining all the sensors, the efficiency of the classification reaches 93.7%. PMID:29401688

  17. Application and Validation of Workload Assessment Techniques

    DTIC Science & Technology

    1993-03-01

    tech ical report documents the process and outcome of meeting this objective. Procedure: A series of eight separate studies was conducted using three...development process . The task analysis and simulation technique was shown to have the capability to track empirical workload ratings. More research is...operator workload during the systems acquisi- tion process , and (b) a pamphlet for the managers of Army systems that describes the need and some procedures

  18. 21 CFR 868.5130 - Anesthesia conduction filter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Anesthesia conduction filter. 868.5130 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5130 Anesthesia conduction filter. (a) Identification. An anesthesia conduction filter is a microporous filter used while administering to a patient...

  19. 21 CFR 868.5130 - Anesthesia conduction filter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthesia conduction filter. 868.5130 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5130 Anesthesia conduction filter. (a) Identification. An anesthesia conduction filter is a microporous filter used while administering to a patient...

  20. 21 CFR 868.5130 - Anesthesia conduction filter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Anesthesia conduction filter. 868.5130 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5130 Anesthesia conduction filter. (a) Identification. An anesthesia conduction filter is a microporous filter used while administering to a patient...

  1. 21 CFR 868.5130 - Anesthesia conduction filter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Anesthesia conduction filter. 868.5130 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5130 Anesthesia conduction filter. (a) Identification. An anesthesia conduction filter is a microporous filter used while administering to a patient...

  2. 21 CFR 868.5130 - Anesthesia conduction filter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Anesthesia conduction filter. 868.5130 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5130 Anesthesia conduction filter. (a) Identification. An anesthesia conduction filter is a microporous filter used while administering to a patient...

  3. [Essential competencies in training in obstetrics].

    PubMed

    Duarte, Sebastião Junior Henrique; Machado, Richardson Miranda

    2016-11-01

    Analyze international reports related to training in obstetrics and present guidelines to help leading educational institutions to develop curriculum guidelines for the teaching of obstetrics and advanced nursing practice in this specialty. A narrative review was conducted of documents from the World Health Organization and the International Confederation of Midwives. The search used the descriptors midwifery and education. All official reports that guide midwife education policies, published from 2009 to 2015 in English and Spanish, and available online, were included. Reports that did not specifically refer to training were excluded. Five reports were selected. Analysis and synthesis of their respective objectives and contents were based on three themes: requirements for professional qualification, continuing education, and guidelines for skilled training in obstetrics, taking into account accepted core competencies for this specialty. Analysis of reports related to training in obstetrics identified that key tasks are being implemented for both educators and midwives. The reports represent a solid basis to develop educational policies that can contribute to universal access and coverage in health and to reducing maternal and neonatal mortality, and potentially can be used to guide international policies.

  4. How the workload impacts on cognitive cooperation: A pilot study.

    PubMed

    Sciaraffa, Nicolina; Borghini, Gianluca; Arico, Pietro; Di Flumeri, Gianluca; Toppi, Jlenia; Colosimo, Alfredo; Bezerianos, Anastatios; Thakor, Nitish V; Babiloni, Fabio

    2017-07-01

    Cooperation degradation can be seen as one of the main causes of human errors. Poor cooperation could arise from aberrant mental processes, such as mental overload, that negatively affect the user's performance. Using different levels of difficulty in a cooperative task, we combined behavioural, subjective and neurophysiological data with the aim to i) quantify the mental workload under which the crew was operating, ii) evaluate the degree of their cooperation, and iii) assess the impact of the workload demands on the cooperation levels. The combination of such data showed that high workload demand impacted significantly on the performance, workload perception, and degree of cooperation.

  5. Hysteroscopic Myomectomy of FIGO Type 2 Leiomyomas Under Local Anesthesia: Bipolar Radiofrequency Needle-Based Release Followed By Electromechanical Morcellation.

    PubMed

    Munro, Malcolm G

    2016-01-01

    To demonstrate a technique designed to expand the capabilities of hysteroscopic intrauterine morcellators to deep type 1 and type 2 lesions. The technique comprises "release" of the tumor using a bipolar radiofrequency needle, followed by dissection and extraction with an electromechanical morcellator, all under local anesthesia. Description of technique using images and video (Canadian Task Force classification Class III). Office uterine procedure and imaging center; academic medical center. Following the administration of local anesthesia and access to the endometrial cavity with a 5.5-mm-o.d. hysteroscopic sheath with a 5 Fr operative channel, a 5 Fr bipolar needle electrode system is used to circumscribe the leiomyoma and enter the pseudocapsule, thereby "releasing" the lesion. Blunt dissection is performed as appropriate and then the system is switched to a hysteroscopic morcellating system (MyoSure; Hologic, Bedford, MA), which is then used to further dissect and remove the target lesion with electromechanical morcellation. The development of intrauterine morcellators has facilitated the performance of hysteroscopic myomectomy, especially under local anesthesia, but the side aperture-based design of the systems limits their use in International Federation of Gynecology and Obstetrics (FIGO) type 1 and 2 tumors, particularly those located at the uterine fundus. This technique, based in part on a previously published technique of leiomyoma release, improves access of the electromechanical morcellator to leiomyomas that previously were inaccessible, and minimizes myometrial trauma by dissecting the tumor via the relatively avascular pseudocapsule. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

  6. Training and testing ERP-BCIs under different mental workload conditions

    NASA Astrophysics Data System (ADS)

    Ke, Yufeng; Wang, Peiyuan; Chen, Yuqian; Gu, Bin; Qi, Hongzhi; Zhou, Peng; Ming, Dong

    2016-02-01

    Objective. As one of the most popular and extensively studied paradigms of brain-computer interfaces (BCIs), event-related potential-based BCIs (ERP-BCIs) are usually built and tested in ideal laboratory settings in most existing studies, with subjects concentrating on stimuli and intentionally avoiding possible distractors. This study is aimed at examining the effect of simultaneous mental activities on ERP-BCIs by manipulating various levels of mental workload during the training and/or testing of an ERP-BCI. Approach. Mental workload was manipulated during the training or testing of a row-column P300-speller to investigate how and to what extent the spelling performance and the ERPs evoked by the oddball stimuli are affected by simultaneous mental workload. Main results. Responses of certain ERP components, temporal-occipital N200 and the late reorienting negativity evoked by the oddball stimuli and the classifiability of ERP features between targets and non-targets decreased with the increase of mental workload encountered by the subject. However, the effect of mental workload on the performance of ERP-BCI was not always negative but depended on the conditions where the ERP-BCI was built and applied. The performance of ERP-BCI built under an ideal lab setting without any irrelevant mental activities declined with the increasing mental workload of the testing data. However, the performance was significantly improved when an ERP-BCI was built under an appropriate mental workload level, compared to that built under speller-only conditions. Significance. The adverse effect of concurrent mental activities may present a challenge for ERP-BCIs trained in ideal lab settings but which are to be used in daily work, especially when users are performing demanding mental processing. On the other hand, the positive effects of the mental workload of the training data suggest that introducing appropriate mental workload during training ERP-BCIs is of potential benefit to the

  7. General anesthesia

    MedlinePlus

    ... Miller's Anesthesia . 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 3. Hernandez A, Sherwood ER. Anesthesiology principles, pain management, and conscious sedation. In: Townsend CM Jr, Beauchamp ...

  8. 21 CFR 868.5150 - Anesthesia conduction needle.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Anesthesia conduction needle. 868.5150 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5150 Anesthesia conduction needle. (a) Identification. An anesthesia conduction needle is a device used to inject local anesthetics into a patient to...

  9. 21 CFR 868.5240 - Anesthesia breathing circuit.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Anesthesia breathing circuit. 868.5240 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5240 Anesthesia breathing circuit. (a) Identification. An anesthesia breathing circuit is a device that is intended to administer medical gases to a...

  10. 21 CFR 868.5140 - Anesthesia conduction kit.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthesia conduction kit. 868.5140 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5140 Anesthesia conduction kit. (a) Identification. An anesthesia conduction kit is a device used to administer to a patient conduction, regional, or...

  11. 21 CFR 868.5150 - Anesthesia conduction needle.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthesia conduction needle. 868.5150 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5150 Anesthesia conduction needle. (a) Identification. An anesthesia conduction needle is a device used to inject local anesthetics into a patient to...

  12. 21 CFR 868.5140 - Anesthesia conduction kit.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Anesthesia conduction kit. 868.5140 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5140 Anesthesia conduction kit. (a) Identification. An anesthesia conduction kit is a device used to administer to a patient conduction, regional, or...

  13. 21 CFR 868.5240 - Anesthesia breathing circuit.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthesia breathing circuit. 868.5240 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5240 Anesthesia breathing circuit. (a) Identification. An anesthesia breathing circuit is a device that is intended to administer medical gases to a...

  14. 21 CFR 868.5140 - Anesthesia conduction kit.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Anesthesia conduction kit. 868.5140 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5140 Anesthesia conduction kit. (a) Identification. An anesthesia conduction kit is a device used to administer to a patient conduction, regional, or...

  15. 21 CFR 868.5150 - Anesthesia conduction needle.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Anesthesia conduction needle. 868.5150 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5150 Anesthesia conduction needle. (a) Identification. An anesthesia conduction needle is a device used to inject local anesthetics into a patient to...

  16. 21 CFR 868.5240 - Anesthesia breathing circuit.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Anesthesia breathing circuit. 868.5240 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5240 Anesthesia breathing circuit. (a) Identification. An anesthesia breathing circuit is a device that is intended to administer medical gases to a...

  17. Simulation Training in Obstetrics and Gynaecology Residency Programs in Canada.

    PubMed

    Sanders, Ari; Wilson, R Douglas

    2015-11-01

    The integration of simulation into residency programs has been slower in obstetrics and gynaecology than in other surgical specialties. The goal of this study was to evaluate the current use of simulation in obstetrics and gynaecology residency programs in Canada. A 19-question survey was developed and distributed to all 16 active and accredited obstetrics and gynaecology residency programs in Canada. The survey was sent to program directors initially, but on occasion was redirected to other faculty members involved in resident education or to senior residents. Survey responses were collected over an 18-month period. Twelve programs responded to the survey (11 complete responses). Eleven programs (92%) reported introducing an obstetrics and gynaecology simulation curriculum into their residency education. All respondents (100%) had access to a simulation centre. Simulation was used to teach various obstetrical and gynaecological skills using different simulation modalities. Barriers to simulation integration were primarily the costs of equipment and space and the need to ensure dedicated time for residents and educators. The majority of programs indicated that it was a priority for them to enhance their simulation curriculum and transition to competency-based resident assessment. Simulation training has increased in obstetrics and gynaecology residency programs. The development of formal simulation curricula for use in obstetrics and gynaecology resident education is in early development. A standardized national simulation curriculum would help facilitate the integration of simulation into obstetrics and gynaecology resident education and aid in the shift to competency-based resident assessment. Obstetrics and gynaecology residency programs need national collaboration (between centres and specialties) to develop a standardized simulation curriculum for use in obstetrics and gynaecology residency programs in Canada.

  18. Experiences of family physicians who practise primary care obstetrics in groups.

    PubMed

    Koppula, Sudha; Brown, Judith B; Jordan, John M

    2011-02-01

    The purpose of this study was to explore the experiences of family physicians in primary care obstetrical groups. Using a qualitative approach, in-depth interviews were conducted with 12 Edmonton family physicians who participated in primary care obstetrical groups. Experiences with respect to several aspects of group obstetrical practice were examined including advantages and challenges of primary care obstetrical groups, provision of patient care by a group, fit with other work commitments, and sustainability of the groups. Study data were audiotaped and transcribed verbatim. Independent and team analysis was iterative and interpretive. Primary care obstetrical groups were found to preserve a family physician's enjoyment of obstetrics and allowed for continuity of care. They afforded work-life balance, allowed for collaboration, and provided support and a social network for group members. Such groups were found to facilitate short-term family physician absences, although long-term absences (such as maternity leaves) were considered challenging. Participants described conflict within primary care obstetrical groups and considered sustainability to be a challenge. Family physicians' continued involvement in obstetrics could be facilitated by their participation in primary care obstetrical groups.

  19. Operator strategies under varying conditions of workload

    NASA Technical Reports Server (NTRS)

    Arnegard, Ruth J.

    1991-01-01

    An attempt was made to operationally define and measure strategic behavior in a complex multiple task environment. The Multi-Attribute Task battery was developed to simulate various aspects of flight and consisted of an auditory communication task, monitoring tasks, a tracking tasks, a resource management task which allowed a wide range of responding patterns, and a scheduling window which allowed operators to predict changes in workload. This battery was validated for its sensitivity to strategic behavior, and baseline measures for each individual task were collected. Twenty-four undergraduate and graduate students then performed the battery for four 64 minute sessions which took place over a period of 2 days. Each subject performed the task battery under four levels of workload, which were presented for equal lengths of time during all four sessions. Results indicated that in general, performance improves as a function of experience with the battery, but that performance decreased as workload level increased. The data also showed that subjects developed strategies for responding to the resource management task which allowed them to manage the high workload levels more efficiently. This particular strategy developed over time but was also associated with errors of complacency. These results are presented along with implications for the aviation field and areas of future research.

  20. [Anesthesia in bronchial asthma].

    PubMed

    Bremerich, D H

    2000-09-01

    Asthma is defined as a chronic inflammatory airway disease in response to a wide variety of provoking stimuli. Characteristic clinical symptoms of asthma are bronchial hyperreactivity, reversible airway obstruction, wheezing and dyspnea. Asthma presents a major public health problem with increasing prevalence rates and severity worldwide. Despite major advances in our understanding of the clinical management of asthmatic patients, it remains a challenging population for anesthesiologists in clinical practice. The anesthesiologist's responsibility starts with the preoperative assessment and evaluation of the pulmonary function. For patients with asthma who currently have no symptoms, the risk of perioperative respiratory complications is extremely low. Therefore, pulmonary function should be optimized preoperatively and airway obstruction should be controlled by using steroids and bronchodilators. Preoperative spirometry is a simple means of assessing presence and severity of airway obstruction as well as the degree of reversibility in response to bronchodilator therapy. An increase of 15% in FEV1 is considered clinically significant. Most asymptomatic persons with asthma can safely undergo general anesthesia with and without endotracheal intubation. Volatile anesthetics are still recommended for general anesthetic techniques. As compared to barbiturates and even ketamine, propofol is considered to be the agent of choice for induction of anesthesia in asthmatics. The use of regional anesthesia does not reduce perioperative respiratory complications in asymptomatic asthmatics, whereas it is advantageous in symptomatic patients. Pregnant asthmatic and parturients undergoing anesthesia are at increased risk, especially if regional anesthetic techniques are not suitable and prostaglandin and its derivates are administered for abortion or operative delivery. Bronchial hyperreactivity associated with asthma is an important risk factor of perioperative bronchospasm. The

  1. Simulation laboratories for training in obstetrics and gynecology.

    PubMed

    Macedonia, Christian R; Gherman, Robert B; Satin, Andrew J

    2003-08-01

    Simulations have been used by the military, airline industry, and our colleagues in other medical specialties to educate, evaluate, and prepare for rare but life-threatening scenarios. Work hour limits for residents in obstetrics and gynecology and decreased patient availability for teaching of students and residents require us to think creatively and practically on how to optimize their education. Medical simulations may address scenarios in clinical practice that are considered important to know or understand. Simulations can take many forms, including computer programs, models or mannequins, virtual reality data immersion caves, and a combination of formats. The purpose of this commentary is to call attention to a potential role for medical simulation in obstetrics and gynecology. We briefly describe an example of how simulation may be incorporated into obstetric and gynecologic residency training. It is our contention that educators in obstetrics and gynecology should be aware of the potential for simulation in education. We hope this commentary will stimulate interest in the field, lead to validation studies, and improve training in and the practice of obstetrics and gynecology.

  2. Surgery for esotropia under topical anesthesia.

    PubMed

    Tejedor, Jaime; Ogallar, Consuelo; Rodríguez, José M

    2010-10-01

    To compare a surgically adjusted dose of strabismus surgery using topical anesthesia in cooperative patients with dosage guidelines adapted to the surgeon's personal technique using sub-Tenon's anesthesia. Randomized, controlled, single-site clinical trial. Sixty patients with nonparalytic, nonrestrictive esotropia who were cooperative for surgery under topical anesthesia. Twenty-eight patients were assigned to topical anesthesia, and 32 patients were assigned to sub-Tenon's anesthesia. Visual acuity, refraction, and deviation angle were determined in all patients preoperatively and postoperatively, and stereoacuity was measured postoperatively. Deviation angle was measured by simultaneous and alternate prism and cover test, and stereoacuity was measured using Randot circles (Stereo Optical Co., Chicago, IL). The amount of surgery under topical anesthesia was adjusted intraoperatively. The amount of surgery used in the 2 treatment groups (measured in millimeters and millimeter/degree of deviation angle) and 6-month motor and stereoacuity outcomes. Patients in the topical group required 3.2 mm less surgery on average than those in the sub-Tenon's group (5.9 and 9.1 mm, respectively; 0.4 and 0.6 mm of recession/degree, respectively) (P<0.01). Motor success (84% and 75%, respectively, P=0.38) and stereoacuity (339.6 and 323.9 arc seconds, respectively, P=0.87) at 6 months were similar in the 2 groups. Topical anesthesia requires a smaller amount of surgery and number of operated muscles to correct esotropia compared with classic surgery guidelines adapted to the surgeon's personal technique. Copyright © 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  3. Pilot Mental Workload with Predictive System Status Information

    NASA Technical Reports Server (NTRS)

    Trujillo, Anna C.

    1998-01-01

    Research has shown a strong pilot preference for predictive information of aircraft system status in the flight deck. However, the mental workload associated with using this predictive information has not been ascertained. The study described here attempted to measure mental workload. In this simulator experiment, three types of predictive information (none, whether a parameter was changing abnormally, and the time for a parameter to reach an alert range) and four initial times to a parameter alert range (1 minute, 5 minutes, 15 minutes, and ETA+45 minutes) were tested to determine their effects on subjects mental workload. Subjective workload ratings increased with increasing predictive information (whether a parameter was changing abnormally or the time for a parameter to reach an alert range). Subjective situation awareness decreased with more predictive information but it became greater with increasing initial times to a parameter alert range. Also, subjective focus changed depending on the type of predictive information. Lastly, skin temperature fluctuated less as the initial time to a parameter alert range increased.

  4. Workload Characterization of a Leadership Class Storage Cluster

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Kim, Youngjae; Gunasekaran, Raghul; Shipman, Galen M

    2010-01-01

    Understanding workload characteristics is critical for optimizing and improving the performance of current systems and software, and architecting new storage systems based on observed workload patterns. In this paper, we characterize the scientific workloads of the world s fastest HPC (High Performance Computing) storage cluster, Spider, at the Oak Ridge Leadership Computing Facility (OLCF). Spider provides an aggregate bandwidth of over 240 GB/s with over 10 petabytes of RAID 6 formatted capacity. OLCFs flagship petascale simulation platform, Jaguar, and other large HPC clusters, in total over 250 thousands compute cores, depend on Spider for their I/O needs. We characterize themore » system utilization, the demands of reads and writes, idle time, and the distribution of read requests to write requests for the storage system observed over a period of 6 months. From this study we develop synthesized workloads and we show that the read and write I/O bandwidth usage as well as the inter-arrival time of requests can be modeled as a Pareto distribution.« less

  5. Student Burnout as a Function of Personality, Social Support, and Workload.

    ERIC Educational Resources Information Center

    Jacobs, Sheri R.; Dodd, David K.

    2003-01-01

    Measures of social support, personality, and workload were related to psychological burnout among 149 college students. High levels of burnout were predicted by negative temperament and subjective workload, but actual workload (academic and vocational) had little to do with burnout. Low levels of burnout were predicted by positive temperament,…

  6. Automation - Changes in cognitive demands and mental workload

    NASA Technical Reports Server (NTRS)

    Tsang, Pamela S.; Johnson, Walter W.

    1987-01-01

    The effect of partial automation on mental workloads in man/machine tasks is investigated experimentally. Subjective workload measures are obtained from six subjects after performance of a task battery comprising two manual (flight-path control, FC, and target acquisition, TA) tasks and one decisionmaking (engine failure, EF) task; the FC task was performed in both a fully manual (altitude and lateral control) mode and in a semiautomated mode (autmatic latitude control). The performance results and subjective evaluations are presented in graphs and characterized in detail. The automation is shown to improve objective performance and lower subjective workload significantly in the combined FC/TA task, but not in the FC task alone or in the FC/EF task.

  7. Predictors of failure of awake regional anesthesia for neonatal hernia repair: data from the General Anesthesia compared to Spinal anesthesia (GAS) study: comparing apnoea and neurodevelopmental outcomes

    PubMed Central

    Frawley, Geoff; Bell, Graham; Disma, Nicola; Withington, Davinia E.; de Graaff, Jurgen C.; Morton, Neil S.; McCann, Mary Ellen; Arnup, Sarah J.; Bagshaw, Oliver; Wolfler, Andrea; Bellinger, David; Davidson, Andrew J.

    2015-01-01

    Background Awake regional anesthesia (RA) is a viable alternative to general anesthesia (GA) for infants undergoing lower abdominal surgery. Benefits include lower incidence of postoperative apnea and avoidance of anesthetic agents that may increase neuroapoptosis and worsen neurocognitive outcomes. The General Anesthesia compared to Spinal anesthesia (GAS) study compares neurodevelopmental outcomes following awake RA or GA in otherwise healthy infants. Our aim was to describe success and failure rates of RA in this study and report factors associated with failure. Methods This was a nested cohort study within a prospective randomized, controlled, observer blind, equivalence trial. Seven hundred twenty two infants ≤ 60 weeks postmenstrual age, scheduled for herniorrhaphy under anesthesia were randomly assigned to receive RA (spinal, caudal epidural or combined spinal caudal anesthetic) or GA with sevoflurane. The data of 339 infants, where spinal or combined spinal caudal anesthetic was attempted, was analyzed. Possible predictors of failure were assessed including: patient factors, technique, experience of site and anesthetist and type of local anesthetic. Results RA was sufficient for the completion of surgery in 83.2% of patients. Spinal anesthesia was successful in 86.9% of cases and combined spinal caudal anesthetic in 76.1%. Thirty four patients required conversion to GA and an additional 23 (6.8%) required brief sedation. Bloody tap on the first attempt at lumbar puncture was the only risk factor significantly associated with block failure (OR = 2.46). Conclusions The failure rate of spinal anesthesia was low. Variability in application of combined spinal caudal anesthetic limited attempts to compare the success of this technique to spinal alone. PMID:26001028

  8. The relationship between physical workload and quality within line-based assembly.

    PubMed

    Ivarsson, Anna; Eek, Frida

    2016-07-01

    Reducing costs and improvement of product quality are considered important to ensure productivity within a company. Quality deviations during production processes and ergonomics have previously shown to be associated. This study explored the relationship between physical workload and real (found during production processes) and potential (need of extra time and assistance to complete tasks) quality deviations in a line-based assembly plant. The physical workload on and the work rotation between 52 workstations were assessed. As the outcome, real and potential quality deviations were studied during 10 weeks. Results show that workstations with higher physical workload had significantly more real deviations compared to lower workload stations. Static work posture had significantly more potential deviations. Rotation between high and low workload was related to fewer quality deviations compared to rotation between only high workload stations. In conclusion, physical ergonomics seems to be related to real and potential quality deviation within line-based assembly. Practitioner Summary: To ensure good productivity in manufacturing industries, it is important to reduce costs and improve product quality. This study shows that high physical workload is associated with quality deviations and need of extra time and assistance to complete tasks within line-based assembly, which can be financially expensive for a company.

  9. Exploring the Utility of Workload Models in Academe: A Pilot Study

    ERIC Educational Resources Information Center

    Boyd, Leanne

    2014-01-01

    The workload of academics in Australia is increasing. Among the potential ramifications of this are work-related stress and burnout. Unions have negotiated workload models in employment agreements as a means of distributing workload in a fair and transparent manner. This qualitative pilot study aimed to explore how academics perceive their current…

  10. Role of intraseptal anesthesia for pain-free dental treatment.

    PubMed

    Gazal, G; Fareed, W M; Zafar, M S

    2016-01-01

    Pain control during the dental procedure is essentials and challenging. A complete efficacious pulp anesthesia has not been attained yet. The regional anesthesia such as inferior alveolar nerve block (IANB) only does not guarantee the effective anesthesia with patients suffering from irreversible pulpitis. This main aim of this review was to discuss various aspects of intraseptal dental anesthesia and its role significance in pain-free treatment in the dental office. In addition, reasons of failure and limitations of this technique have been highlighted. Literature search was conducted for peer-reviewed articles published in English language in last 30 years. Search words such as dental anesthesia, pain control, intraseptal, and nerve block were entered using a web of knowledge and Google scholar databases. Various dental local anesthesia techniques were reviewed. A combination of block anesthesia, buccal infiltration and intraligamentary injection resulted in deep anesthesia (P = 0.003), and higher success rate compared to IANB. For pain-free management of conditions such as irreversible pulpitis, buccal infiltration (4% articaine), and intraosseous injection (2% lidocaine) are better than intraligamentary and IANB injections. Similarly, nerve block is not always effective for pain-free root canal treatment hence, needing supplemental anesthesia. Intraseptal anesthesia is an efficient and effective technique that can be used in maxillary and mandibular adult dentition. This technique is also beneficial when used in conjunction to the regional block or local dental anesthesia.

  11. EFFECTIVE INDICES FOR MONITORING MENTAL WORKLOAD WHILE PERFORMING MULTIPLE TASKS.

    PubMed

    Hsu, Bin-Wei; Wang, Mao-Jiun J; Chen, Chi-Yuan; Chen, Fang

    2015-08-01

    This study identified several physiological indices that can accurately monitor mental workload while participants performed multiple tasks with the strategy of maintaining stable performance and maximizing accuracy. Thirty male participants completed three 10-min. simulated multitasks: MATB (Multi-Attribute Task Battery) with three workload levels. Twenty-five commonly used mental workload measures were collected, including heart rate, 12 HRV (heart rate variability), 10 EEG (electroencephalography) indices (α, β, θ, α/θ, θ/β from O1-O2 and F4-C4), and two subjective measures. Analyses of index sensitivity showed that two EEG indices, θ and α/θ (F4-C4), one time-domain HRV-SDNN (standard deviation of inter-beat intervals), and four frequency-domain HRV: VLF (very low frequency), LF (low frequency), %HF (percentage of high frequency), and LF/HF were sensitive to differentiate high workload. EEG α/θ (F4-C4) and LF/HF were most effective for monitoring high mental workload. LF/HF showed the highest correlations with other physiological indices. EEG α/θ (F4-C4) showed strong correlations with subjective measures across different mental workload levels. Operation strategy would affect the sensitivity of EEG α (F4-C4) and HF.

  12. Single-tooth anesthesia: pressure-sensing technology provides innovative advancement in the field of dental local anesthesia.

    PubMed

    Hochman, Mark N

    2007-04-01

    This article will review standard techniques for intraligamentary injection and describe the technology and technique behind a new single-tooth anesthesia system. This system and technique represents a technological advancement and a greater understanding of intraligamentary anesthesia.

  13. Effect of intraosseous anesthesia on control of hemostasis in pigs.

    PubMed

    Baker, Tyler F; Torabinejad, Mahmoud; Schwartz, Stephen F; Wolf, David

    2009-11-01

    Intraosseous anesthesia is used to deliver anesthetic into cancellous bone adjacent to the root apices. No study has assessed the effect of this anesthetic technique on hemostasis. The purpose of this study was to compare the amount of bleeding from soft tissue and bone in pig jaws after preoperative intraosseous or infiltration anesthesia with 2% lidocaine containing 1:50,000 epinephrine. Twelve pigs were divided into 3 groups. The first group received infiltration anesthesia on one half of the jaw and no anesthesia on the other half. The second group received intraosseous anesthesia on one half of the jaw and no anesthesia on the other half. The third group received infiltration anesthesia on one half of the jaw and intraosseous anesthesia on the second half. Blood was collected during flap reflection to measure the volume of soft tissue bleeding. Osteotomies were then prepared with blood collected from the surgical site to measure the volume of osseous bleeding. The median soft tissue blood loss observed in animals receiving infiltration anesthesia (1.14 mL) was significantly less as compared with animals that received no anesthesia (4.49 mL) or intraosseous anesthesia (2.45 mL). Compared with median hard tissue blood loss observed in animals without anesthesia (1.51 mL), significantly less blood loss was observed in animals receiving either infiltration anesthesia (0.67 mL) or intraosseous anesthesia (0.76 mL). Infiltration anesthesia resulted in significantly less soft tissue bleeding (p = .004) as compared with no anesthesia. Infiltration and intraosseous anesthesia resulted in significantly less osseous bleeding than the use of no anesthetic (p < .001). The volume of blood loss for each animal was shown to be below the maximum safe volume of blood loss for a single procedure.

  14. Barriers to emergency obstetric care services: accounts of survivors of life threatening obstetric complications in Malindi District, Kenya.

    PubMed

    Echoka, Elizabeth; Makokha, Anselimo; Dubourg, Dominique; Kombe, Yeri; Nyandieka, Lillian; Byskov, Jens

    2014-01-01

    Pregnancy-related mortality and morbidity in most low and middle income countries can be reduced through early recognition of complications, prompt access to care and appropriate medical interventions following obstetric emergencies. We used the three delays framework to explore barriers to emergency obstetric care (EmOC) services by women who experienced life threatening obstetric complications in Malindi District, Kenya. A facility-based qualitative study was conducted between November and December 2010. In-depth interviews were conducted with 30 women who experienced obstetric "near miss" at the only public hospital with capacity to provide comprehensive EmOC services in the district. Findings indicate that pregnant women experienced delays in making decision to seek care and in reaching an appropriate care facility. The "first" delay was due to lack of birth preparedness, including failure to identify a health facility for delivery services regardless of antenatal care and to seek care promptly despite recognition of danger signs. The "second" delay was influenced by long distance and inconvenient transport to hospital. These two delays resulted in some women arriving at the hospital too late to save the life of the unborn baby. Delays in making the decision to seek care when obstetric complications occur, combined with delays in reaching the hospital, contribute to ineffective treatment upon arrival at the hospital. Interventions to reduce maternal mortality and morbidity must adequately consider the pre-hospital challenges faced by pregnant women in order to influence decision making towards addressing the three delays.

  15. Using the NASA Task Load Index to Assess Workload in Electronic Medical Records.

    PubMed

    Hudson, Darren; Kushniruk, Andre W; Borycki, Elizabeth M

    2015-01-01

    Electronic medical records (EMRs) has been expected to decrease health professional workload. The NASA Task Load Index has become an important tool for assessing workload in many domains. However, its application in assessing the impact of an EMR on nurse's workload has remained to be explored. In this paper we report the results of a study of workload and we explore the utility of applying the NASA Task Load Index to assess impact of an EMR at the end of its lifecycle on nurses' workload. It was found that mental and temporal demands were the most responsible for the workload. Further work along these lines is recommended.

  16. Measuring Mental Workload: A Performance Battery.

    DTIC Science & Technology

    1987-09-01

    1982). Subjective mental workload. Human Factors, 24, 25-40. Neisser , U ., Novick, R., & Lazar, R. (1963). Searching for ten targets 0...818 MES~A [G MENTAL WORKLOAD: A PERFORMANCE BATTERY( U ) 1/ • i NUN ENGINEERING LAS ABERDEEN PROVING GROUND MO L A MHITAKER ET AL .EP 87 HEL-TH-21-87...UNCLASSIFIED FG 5/9IIEEEEEEIE EhhIEllE~lllEE I.E.E.E I1.2 P e- - ,uIII j .. - - I ,,, 65 -S S p *q 0 0 0 0 0 0 0 0 0 u -; 5 . . ~qqr AD-A187 118

  17. Reprocessing anesthesia instruments and devices.

    PubMed

    Ball, K

    2000-02-01

    Reprocessing anesthesia instruments and devices can often present a challenge for anesthesia providers because anesthesia devices have become more complex, cross-contamination with disease-forming pathogens can occur, and the importance of appropriate reprocessing may not be fully understood. Based on accepted practice recommendations, regulations, and research, reprocessing must be performed by skilled individuals who understand asepsis, cleaning, disinfection, and sterilization principles. This article describes the art of reprocessing and includes highlighted information on recommended practices, Spaulding's classifications, personal protective attire, precleaning, leak testing of flexible endoscopes, device disassembly, cleaning supplies and solutions, cleaning methods, rinsing, reassembly of the device, inspection, disinfection, and sterilization.

  18. Internal consistency and validity of a new physical workload questionnaire

    PubMed Central

    Bot, S; Terwee, C; van der Windt, D A W M; Feleus, A; Bierma-Zeinstra, S; Knol, D; Bouter, L; Dekker, J

    2004-01-01

    Aims: To examine the dimensionality, internal consistency, and construct validity of a new physical workload questionnaire in employees with musculoskeletal complaints. Methods: Factor analysis was applied to the responses in three study populations with musculoskeletal disorders (n = 406, 300, and 557) on 26 items related to physical workload. The internal consistency of the resulting subscales was examined. It was hypothesised that physical workload would vary among different occupational groups. The occupations of all subjects were classified into four groups on the basis of expected workload (heavy physical load; long lasting postures and repetitive movements; both; no physical load). Construct validity of the subscales created was tested by comparing the subscale scores among these occupational groups. Results: The pattern of the factor loadings of items was almost identical for the three study populations. Two interpretable factors were found: items related to heavy physical workload loaded highly on the first factor, and items related to static postures or repetitive work loaded highly on the second factor. The first constructed subscale "heavy physical work" had a Cronbach's α of 0.92 to 0.93 and the second subscale "long lasting postures and repetitive movements", of 0.86 to 0.87. Six of eight hypotheses regarding the construct validity of the subscales were confirmed. Conclusions: The results support the internal structure, internal consistency, and validity of the new physical workload questionnaire. Testing this questionnaire in non-symptomatic employees and comparing its performance with objective assessments of physical workload are important next steps in the validation process. PMID:15550603

  19. Psychophysiological response to cognitive workload during symmetrical, asymmetrical and dual-task walking.

    PubMed

    Knaepen, Kristel; Marusic, Uros; Crea, Simona; Rodríguez Guerrero, Carlos D; Vitiello, Nicola; Pattyn, Nathalie; Mairesse, Olivier; Lefeber, Dirk; Meeusen, Romain

    2015-04-01

    Walking with a lower limb prosthesis comes at a high cognitive workload for amputees, possibly affecting their mobility, safety and independency. A biocooperative prosthesis which is able to reduce the cognitive workload of walking could offer a solution. Therefore, we wanted to investigate whether different levels of cognitive workload can be assessed during symmetrical, asymmetrical and dual-task walking and to identify which parameters are the most sensitive. Twenty-four healthy subjects participated in this study. Cognitive workload was assessed through psychophysiological responses, physical and cognitive performance and subjective ratings. The results showed that breathing frequency and heart rate significantly increased, and heart rate variability significantly decreased with increasing cognitive workload during walking (p<.05). Performance measures (e.g., cadence) only changed under high cognitive workload. As a result, psychophysiological measures are the most sensitive to identify changes in cognitive workload during walking. These parameters reflect the cognitive effort necessary to maintain performance during complex walking and can easily be assessed regardless of the task. This makes them excellent candidates to feed to the control loop of a biocooperative prosthesis in order to detect the cognitive workload. This information can then be used to adapt the robotic assistance to the patient's cognitive abilities. Copyright © 2015 Elsevier B.V. All rights reserved.

  20. Patient transfers in Australia: implications for nursing workload and patient outcomes.

    PubMed

    Blay, Nicole; Duffield, Christine M; Gallagher, Robyn

    2012-04-01

    To discuss the impact of patient transfers on patient outcomes and nursing workload. Many patient transfers are essential and occur in response to patients' clinical changes. However, increasingly within Australia transfers are performed in response to reductions in bed numbers, resulting in 'bed block'. A discussion of the literature related to inpatient transfers, nursing workload and patient safety. Measures to increase patient flow such as short-stay units may result in an increase in patient transfers and nursing workload. Frequent patient transfers may also increase the risk of medication incidents, health-care acquired infections and patient falls. The continuing demand for health care has led to a reactionary bed management system that, in an attempt to accommodate patients, has resulted in increased transfers between wards. This can have a negative effect on nursing workload and affect patient outcomes. High nursing workload is cited as one reason for nurses leaving the profession. Reductions in non-essential transfers may reduce nurse workload, improve patient outcomes and enhance continuity of patient care. © 2011 Blackwell Publishing Ltd.

  1. Caffeine accelerates recovery from general anesthesia

    PubMed Central

    Wang, Qiang; Fong, Robert; Mason, Peggy; Fox, Aaron P.

    2013-01-01

    General anesthetics inhibit neurotransmitter release from both neurons and secretory cells. If inhibition of neurotransmitter release is part of an anesthetic mechanism of action, then drugs that facilitate neurotransmitter release may aid in reversing general anesthesia. Drugs that elevate intracellular cAMP levels are known to facilitate neurotransmitter release. Three cAMP elevating drugs (forskolin, theophylline, and caffeine) were tested; all three drugs reversed the inhibition of neurotransmitter release produced by isoflurane in PC12 cells in vitro. The drugs were tested in isoflurane-anesthetized rats. Animals were injected with either saline or saline containing drug. All three drugs dramatically accelerated recovery from isoflurane anesthesia, but caffeine was most effective. None of the drugs, at the concentrations tested, had significant effects on breathing rates, O2 saturation, heart rate, or blood pressure in anesthetized animals. Caffeine alone was tested on propofol-anesthetized rats where it dramatically accelerated recovery from anesthesia. The ability of caffeine to accelerate recovery from anesthesia for different chemical classes of anesthetics, isoflurane and propofol, opens the possibility that it will do so for all commonly used general anesthetics, although additional studies will be required to determine whether this is in fact the case. Because anesthesia in rodents is thought to be similar to that in humans, these results suggest that caffeine might allow for rapid and uniform emergence from general anesthesia in human patients. PMID:24375022

  2. [Dawning of inhalational anesthesia: a historical perspective.].

    PubMed

    Maia, R Icardo Jakson de Freitas; Fernandes, Cláudia Regina

    2002-11-01

    History, unlike one may imagine, is not something unchangeable and limited to the past. It is adapted according to conveniences of one or other ruling social class. Deliberately or accidentally hidden information, when unveiled may change current concepts, so far taken for granted. So, history, as any other science, is not totally impartial; it suffers influences and interferences of political, religious, economic and cultural thinking. The same is true for anesthesia. Some questions remain unanswered: Why did it take so long for the civilization to control pain? Who did in fact discover Anesthesia? How was the world when Anesthesia was officially discovered? To discuss such questions it is necessary to go back to the History of Anesthesia. This paper addresses the surgical act, pain and anesthesia from the Hellenic culture to the first officially recognized anesthesia, often emphasizing forgotten names and historical peculiarities which have benefited or harmed one or other discoverer. It also focuses on values, culture and scientific developments of the 19th century, correlating them to events that marked the dawning of anesthesia. It would be unfair to attribute the merit of discovering anesthesia to a single person. Historical peculiarities that benefited or harmed one or other researcher cannot be forgotten. Morton was undoubtedly the most favored by the circumstances. He lived in a privileged time and place and has met the most adequate people to his intent. However there is still a question. After all, who is the most important: the father of the idea or who disclosed it? The answer will certainly remain in the field of subjectivity.

  3. Auditing the standard of anaesthesia care in obstetric units.

    PubMed

    Mörch-Siddall, J; Corbitt, N; Bryson, M R

    2001-04-01

    We undertook an audit of 15 obstetric units in the north of England over a 10-month period to ascertain to what extent they conformed to the Obstetric Anaesthetists' Association 'Recommended Minimum Standards for Obstetric Anaesthetic Services' using a quality assurance approach. We demonstrated that all units conformed to the majority of standards but did not conform in at least one major and minor area.

  4. [Variability in nursing workload within Swiss Diagnosis Related Groups].

    PubMed

    Baumberger, Dieter; Bürgin, Reto; Bartholomeyczik, Sabine

    2014-04-01

    Nursing care inputs represent one of the major cost components in the Swiss Diagnosis Related Group (DRG) structure. High and low nursing workloads in individual cases are supposed to balance out via the DRG group. Research results indicating possible problems in this area cannot be reliably extrapolated to SwissDRG. An analysis of nursing workload figures with DRG indicators was carried out in order to decide whether there is a need to develop SwissDRG classification criteria that are specific to nursing care. The case groups were determined with SwissDRG 0.1, and nursing workload with LEP Nursing 2. Robust statistical methods were used. The evaluation of classification accuracy was carried out with R2 as the measurement of variance reduction and the coefficient of homogeneity (CH). To ensure reliable conclusions, statistical tests with bootstrapping methods were performed. The sample included 213 groups with a total of 73930 cases from ten hospitals. The DRG classification was seen to have limited explanatory power for variability in nursing workload inputs, both for all cases (R2 = 0.16) and for inliers (R2 = 0.32). Nursing workload homogeneity was statistically significant unsatisfactory (CH < 0.67) in 123 groups, including 24 groups in which it was significant defective (CH < 0.60). Therefore, there is a high risk of high and low nursing workloads not balancing out in these groups, and, as a result, of financial resources being wrongly allocated. The development of nursing-care-specific SwissDRG classification criteria for improved homogeneity and variance reduction is therefore indicated.

  5. [Evaluation of nurse workload in patients undergoing therapeutic hypothermia].

    PubMed

    Argibay-Lago, Ana; Fernández-Rodríguez, Diego; Ferrer-Sala, Nuria; Prieto-Robles, Cristina; Hernanz-del Río, Alexandre; Castro-Rebollo, Pedro

    2014-01-01

    Therapeutic hypothermia (TH) is recommended to minimize neurological damage in patients surviving sudden cardiac arrest (SCA). There is scarcity of data evaluating the nursing workload in these patients. The objective of the study is to assess the workload of nurses whilst treating patients undergoing TH after SCA. A 43-month prospective-retrospective comparative cohort study was designed. Patients admitted to intensive care unit, for recovered SCA and persistent coma, were included. A comparison was made using the baseline characteristics, medical management, in-hospital mortality, and nursing workload during the first 96hours using the Therapeutic Intervention Scoring System-28 (TISS-28); Nursing Activities Score (NAS); and Nine Equivalents of Nursing Manpower Use Score (NEMS) scales among patients who received TH and those who did not. A total 46 patients were included: 26 in the TH group and 20 in the Non-TH group. Regarding baseline characteristics and management, the TH group presented higher prevalence of smoking habit (69 vs. 25%, p=0.012), out-of-hospital SCA (96 vs. 55%, p<0.001), and the performance of coronary angiography (96 vs. 65%, p=0.014) compared with the non-TH group. No differences were observed in the nursing workload, assessed by TISS 28, NAS or NEMS scales, or in-hospital mortality. In this study performance of TH in SCA survivors is not associated with an increase in nursing workload. The installation of a TH program does not require the use of more nursing resources in terms of workload. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  6. Xenon/remifentanil anesthesia protects against adverse effects of losartan on hemodynamic challenges induced by anesthesia and acute blood loss.

    PubMed

    Francis, Roland C E; Philippi-Höhne, Claudia; Klein, Adrian; Pickerodt, Philipp A; Reyle-Hahn, Matthias S; Boemke, Willehad

    2010-12-01

    The authors aimed to test the hypothesis that xenon anesthesia limits adverse hypotensive effects of losartan during acute hemorrhage. In six conscious unsedated Beagle dogs, the systemic and pulmonary circulation were monitored invasively, and two subsequent 60-min hypotensive challenges were performed by (a) induction (propofol) and maintenance of anesthesia with isoflurane/remifentanil or xenon/remifentanil and by (b) subsequent hemorrhage (20 mL kg⁻¹ within 5 min) from a central vein. The same amount of blood was retransfused 1 h after hemorrhage. Experiments were performed with or without acute angiotensin II receptor subtype 1 blockade by i.v. losartan (100 μg·kg⁻¹·min⁻¹) starting 45 min before induction of anesthesia. Four experiments were performed in each individual dog. Xenon/remifentanil anesthesia provided higher baseline mean arterial blood pressure (85 ± 6 mmHg) than isoflurane/remifentanil anesthesia (67 ± 3 mmHg). In losartan-treated animals, isoflurane/remifentanil caused significant hypotension (42 ± 4 mmHg for isoflurane/remifentanil vs. 71 ± 6 mmHg for xenon/remifentanil). Independent of losartan, hemorrhage did not induce any further reduction of mean arterial blood pressure or cardiac output in either group. Spontaneous hemodynamic recovery was observed in all groups before retransfusion was started. Losartan did not alter the adrenaline, noradrenaline, and vasopressin response to acute hemorrhage. Losartan potentiates hypotension induced by isoflurane/remifentanil anesthesia but does not affect the hemodynamic stability during xenon/remifentanil anesthesia. Losartan does not deteriorate the hemodynamic adaptation to hemorrhage of 20 mL kg⁻¹ during xenon/remifentanil and isoflurane/remifentanil anesthesia. Therefore, xenon/remifentanil anesthesia protects against circulatory side effects of losartan pretreatment and thus may afford safer therapeutic use of losartan during acute hemorrhage.

  7. The psychometrics of mental workload: multiple measures are sensitive but divergent.

    PubMed

    Matthews, Gerald; Reinerman-Jones, Lauren E; Barber, Daniel J; Abich, Julian

    2015-02-01

    A study was run to test the sensitivity of multiple workload indices to the differing cognitive demands of four military monitoring task scenarios and to investigate relationships between indices. Various psychophysiological indices of mental workload exhibit sensitivity to task factors. However, the psychometric properties of multiple indices, including the extent to which they intercorrelate, have not been adequately investigated. One hundred fifty participants performed in four task scenarios based on a simulation of unmanned ground vehicle operation. Scenarios required threat detection and/or change detection. Both single- and dual-task scenarios were used. Workload metrics for each scenario were derived from the electroencephalogram (EEG), electrocardiogram, transcranial Doppler sonography, functional near infrared, and eye tracking. Subjective workload was also assessed. Several metrics showed sensitivity to the differing demands of the four scenarios. Eye fixation duration and the Task Load Index metric derived from EEG were diagnostic of single-versus dual-task performance. Several other metrics differentiated the two single tasks but were less effective in differentiating single- from dual-task performance. Psychometric analyses confirmed the reliability of individual metrics but failed to identify any general workload factor. An analysis of difference scores between low- and high-workload conditions suggested an effort factor defined by heart rate variability and frontal cortex oxygenation. General workload is not well defined psychometrically, although various individual metrics may satisfy conventional criteria for workload assessment. Practitioners should exercise caution in using multiple metrics that may not correspond well, especially at the level of the individual operator.

  8. Role of intraseptal anesthesia for pain-free dental treatment

    PubMed Central

    Gazal, G; Fareed, WM; Zafar, MS

    2016-01-01

    Pain control during the dental procedure is essentials and challenging. A complete efficacious pulp anesthesia has not been attained yet. The regional anesthesia such as inferior alveolar nerve block (IANB) only does not guarantee the effective anesthesia with patients suffering from irreversible pulpitis. This main aim of this review was to discuss various aspects of intraseptal dental anesthesia and its role significance in pain-free treatment in the dental office. In addition, reasons of failure and limitations of this technique have been highlighted. Literature search was conducted for peer-reviewed articles published in English language in last 30 years. Search words such as dental anesthesia, pain control, intraseptal, and nerve block were entered using a web of knowledge and Google scholar databases. Various dental local anesthesia techniques were reviewed. A combination of block anesthesia, buccal infiltration and intraligamentary injection resulted in deep anesthesia (P = 0.003), and higher success rate compared to IANB. For pain-free management of conditions such as irreversible pulpitis, buccal infiltration (4% articaine), and intraosseous injection (2% lidocaine) are better than intraligamentary and IANB injections. Similarly, nerve block is not always effective for pain-free root canal treatment hence, needing supplemental anesthesia. Intraseptal anesthesia is an efficient and effective technique that can be used in maxillary and mandibular adult dentition. This technique is also beneficial when used in conjunction to the regional block or local dental anesthesia. PMID:26955316

  9. Too few staff, too many patients: a qualitative study of the impact on obstetric care providers and on quality of care in Malawi.

    PubMed

    Bradley, Susan; Kamwendo, Francis; Chipeta, Effie; Chimwaza, Wanangwa; de Pinho, Helen; McAuliffe, Eilish

    2015-03-21

    Shortages of staff have a significant and negative impact on maternal outcomes in low-income countries, but the impact on obstetric care providers in these contexts is less well documented. Despite the government of Malawi's efforts to increase the number of human resources for health, maternal mortality rates remain persistently high. Health workers' perceptions of insufficient staff or time to carry out their work can predict key variables concerning motivation and attrition, while the resulting sub-standard care and poor attitudes towards women dissuade women from facility-based delivery. Understanding the situation from the health worker perspective can inform policy options that may contribute to a better working environment for staff and improved quality of care for Malawi's women. A qualitative research design, using critical incident interviews, was used to generate a deep and textured understanding of participants' experiences. Eligible participants had performed at least one of the emergency obstetric care signal functions (a) in the previous three months and had experienced a demotivating critical incident within the same timeframe. Data were analysed using NVivo software. Eighty-four interviews were conducted. Concerns about staff shortages and workload were key factors for over 40% of staff who stated their intention to leave their current post and for nearly two-thirds of the remaining health workers who were interviewed. The main themes emerging were: too few staff, too many patients; lack of clinical officers/doctors; inadequate obstetric skills; undermining performance and professionalism; and physical and psychological consequences for staff. Underlying factors were inflexible scheduling and staff allocations that made it impossible to deliver quality care. This study revealed the difficult circumstances under which maternity staff are operating and the professional and emotional toll this exacts. Systems failures and inadequate human resource

  10. Training and subjective workload in a category search task

    NASA Technical Reports Server (NTRS)

    Vidulich, Michael A.; Pandit, Parimal

    1986-01-01

    This study examined automaticity as a means by which training influences mental workload. Two groups were trained in a category search task. One group received a training paradigm designed to promote the development of automaticity; the other group received a training paradigm designed to prohibit it. Resultant performance data showed the expected improvement as a result of the development of automaticity. Subjective workload assessments mirrored the performance results in most respects. The results supported the position that subjective mental workload assessments may be sensitive to the effect of training when it produces a lower level of cognitive load.

  11. Psychophysiological measures of cognitive workload in laboratory and flight

    NASA Technical Reports Server (NTRS)

    Wilson, Glenn F.; Badeau, Albert

    1993-01-01

    Psychophysiological data have been recorded during different levels of cognitive workload in laboratory and flight settings. Cardiac, eye blink, and brain data have shown meaningful changes as a function of the levels of mental workload. Increased cognitive workload is generally associated with increased heart rates, decreased blink rates and eye closures, and decreased evoked potential amplitudes. However, comparisons of laboratory and flight data show that direct transference of laboratory findings to the flight environment is not possible in many cases. While the laboratory data are valuable, a data base from flight is required so that 'real world' data can be properly interpreted.

  12. Classification Systems for Individual Differences in Multiple-task Performance and Subjective Estimates of Workload

    NASA Technical Reports Server (NTRS)

    Damos, D. L.

    1984-01-01

    Human factors practitioners often are concerned with mental workload in multiple-task situations. Investigations of these situations have demonstrated repeatedly that individuals differ in their subjective estimates of workload. These differences may be attributed in part to individual differences in definitions of workload. However, after allowing for differences in the definition of workload, there are still unexplained individual differences in workload ratings. The relation between individual differences in multiple-task performance, subjective estimates of workload, information processing abilities, and the Type A personality trait were examined.

  13. Event-related potential indices of workload in a single task paradigm

    NASA Technical Reports Server (NTRS)

    Horst, R. L.; Munson, R. C.; Ruchkin, D. S.

    1984-01-01

    Many previous studies of both behavioral and physiological correlates of cognitive workload have burdened subjects with a contrived secondary task in order to assess the workload of a primary task. The present study investigated event-related potential (ERP) indices of workload in a single task paradigm. Subjects monitored changing digital readouts for values that went 'out-of-bounds'. The amplitude of a long-latency positivity in the ERPs elicited by readout changes increased with the number of readouts being monitored. This effect of workload on ERPs is reported, along with plans for additional analyses to address theoretical implications.

  14. [The emergence of obstetrical mechanism: From Lucy to Homo sapiens].

    PubMed

    Frémondière, P; Thollon, L; Marchal, F

    2017-03-01

    The evolutionary history of modern birth mechanism is now a renewed interest in obstetrical papers. The purpose of this work is to review the literature in paleo-obstetrical field. Our analysis focuses on paleo-obstetrical hypothesis, from 1960 to the present day, based on the reconstruction of fossil pelvis. Indeed, these pelvic reconstructions usually provide an opportunity to make an obstetrical assumption in our ancestors. In this analysis, we show that modern birth mechanism takes place during the emergence of our genus 2 million years ago. References are made to human specificities related to obstetrical mechanism: exclusive bipedalism, increase of brain size at birth, metabolic cost of the pregnancy and deep trophoblastic implantation. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  15. Providing intraosseous anesthesia with minimal invasion.

    PubMed

    Giffin, K M

    1994-08-01

    A new variation of intraosseous anesthesia--crestal anesthesia--that is rapid, site-specific and minimally invasive is presented. The technique uses alveolar crest nutrient canals for anesthetic delivery without penetrating either bone or periodontal ligament.

  16. Considerations about our approach to obstetric psychoprophylaxis.

    PubMed

    Cerutti, R; Volpe, B; Sichel, M P; Sandri, M; Sbrignadello, C; Fede, T

    1983-01-01

    Usually the term "obstetric psychoprophylaxis" refers to a specific method or technique. We prefer to consider it as a procedure that involves on one side the woman, the child and its family, and on the other the services entitled to give pre- and post-natal assistance. In order to realize this, a reformation of our methodological parameters and a critical analysis of the results obtained are required. In the courses of obstetric psychoprophylaxis that are held in the Department of Obstetrics and Gynaecology of the University of Padua we take into consideration the following themes: - Methodological approach - Professional training of the staff - Significance of psychosocial culture in the management of the pregnancy by the health services.

  17. Subjective scaling of mental workload in a multi-task environment

    NASA Technical Reports Server (NTRS)

    Daryanian, B.

    1982-01-01

    Those factors in a multi-task environment that contribute to the operators' "sense" of mental workload were identified. The subjective judgment as conscious experience of mental effort was decided to be the appropriate method of measurement. Thurstone's law of comparative judgment was employed in order to construct interval scales of subjective mental workload from paired comparisons data. An experimental paradigm (Simulated Multi-Task Decision-Making Environment) was employed to represent the ideal experimentally controlled environment in which human operators were asked to "attend" to different cases of Tulga's decision making tasks. Through various statistical analyses it was found that, in general, a lower number of tasks-to-be-processed per unit time (a condition associated with longer interarrival times), results in a lower mental workload, a higher consistency of judgments within a subject, a higher degree of agreement among the subjects, and larger distances between the cases on the Thurstone scale of subjective mental workload. The effects of various control variables and their interactions, and the different characteristics of the subjects on the variation of subjective mental workload are demonstrated.

  18. Pathology Consultation on Viscoelastic Studies of Coagulopathic Obstetrical Patients.

    PubMed

    Gehrie, Eric A; Baine, Ian; Booth, Garrett S

    2016-08-01

    In obstetrics, the decision to transfuse blood components has historically been driven by traditional laboratory testing in combination with direct observation of bleeding. The adjunctive use of viscoelastic testing, including thromboelastometry and thromboelastography, has gained increasing acceptance in the clinical domain. We performed a review of the published medical literature by searching the PUBMED database for keywords "viscoelastic" and "obstetric," as well as "viscoelastic" and "postpartum hemorrhage." Additionally, case reports and expert opinion publications that referenced viscoelastic studies in obstetrical patients were evaluated. There is very little high-quality evidence currently published in the medical literature to support the notion that viscoelastic testing obviates the need for traditional coagulation testing or improves mortality resulting from major obstetrical hemorrhage. Additional research is needed to further focus the optimum role of viscoelastic tests in major obstetrical hemorrhage. © American Society for Clinical Pathology, 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  19. Managed care in obstetrics.

    PubMed

    Devoe, L D

    1997-08-01

    Managed care has marched relentlessly through all fields of obstetric care: individual and group practices, proprietary hospitals and academic medical centers, and public health systems. Emphasis on cost containment while preserving high quality has driven the redesign of healthcare delivery. A number of models for providing effective and less expensive obstetric care are now being examined in the USA and abroad. Increased market penetration by managed care will also exert profound and possibly harmful effects on traditional academic teaching institutions. These organizations must adapt to this new environment or face the erosion of physician support and training bases. Ultimately, significant moral and ethical dilemmas will arise when patients' best interests for care are being continually brought into conflict with the physician's need to earn a living.

  20. Workflow interruptions and mental workload in hospital pediatricians: an observational study.

    PubMed

    Weigl, Matthias; Müller, Andreas; Angerer, Peter; Hoffmann, Florian

    2014-09-24

    Pediatricians' workload is increasingly thought to affect pediatricians' quality of work life and patient safety. Workflow interruptions are a frequent stressor in clinical work, impeding clinicians' attention and contributing to clinical malpractice. We aimed to investigate prospective associations of workflow interruptions with multiple dimensions of mental workload in pediatricians during clinical day shifts. In an Academic Children's Hospital a prospective study of 28 full shift observations was conducted among pediatricians providing ward coverage. The prevalence of workflow interruptions was based on expert observation using a validated observation instrument. Concurrently, Pediatricians' workload ratings were assessed with three workload dimensions of the well-validated NASA-Task Load Index: mental demands, effort, and frustration. Observed pediatricians were, on average, disrupted 4.7 times per hour. Most frequent were interruptions by colleagues (30.2%), nursing staff (29.7%), and by telephone/beeper calls (16.3%). Interruption measures were correlated with two workload outcomes of interest: frequent workflow interruptions were related to less cognitive demands, but frequent interruptions were associated with increased frustration. With regard to single sources, interruptions by colleagues showed the strongest associations to workload. The findings provide insights into specific pathways between different types of interruptions and pediatricians' mental workload. These findings suggest further research and yield a number of work and organization re-design suggestions for pediatric care.

  1. Comparison of delayed versus immediate pushing during second stage of labor for nulliparous women with epidural anesthesia.

    PubMed

    Gillesby, Erica; Burns, Suzan; Dempsey, Amy; Kirby, Shirley; Mogensen, Kami; Naylor, Kelly; Petrella, Joann; Vanicelli, Rebecca; Whelan, Breon

    2010-01-01

    To determine if the use of delayed pushing after the onset of the second stage of labor decreases the time of active pushing and decreases maternal fatigue. Randomized clinical trial. Labor and delivery unit of a not-for-profit community hospital. Convenience sample of nulliparous laboring women with epidural anesthesia. Immediate or delayed pushing (2 hours) during the second stage of labor at the time of complete cervical dilatation. The length of pushing, total length of the second stage, and maternal fatigue. A total of 77 women were studied (immediate pushing group=39; delayed pushing=38). The immediate pushing group averaged 94 (± 57) minutes in active pushing, while the delayed pushing group averaged 68 (± 46) minutes, a statistically significant difference (p=.04). No significant differences were found in fatigue scores between the immediate and delayed pushing groups (p>.05). We found that by delaying the onset of active pushing for 2 hours after the beginning of the second stage of labor, the time that nulliparous women with epidural anesthesia spent in active pushing was significantly decreased by 27%. Although the delayed pushing group rested for up to 2 hours, the total time in the second stage of labor averaged only 59 minutes longer than the immediate pushing group. © 2010 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  2. Quantifying the Workload of Subject Bibliographers in Collection Development.

    ERIC Educational Resources Information Center

    Metz, Paul

    1991-01-01

    Discussion of the role of subject bibliographers in collection development activities focuses on an approach developed at Virginia Polytechnic and State Institute to provide a formula for estimating the collection development workload of subject bibliographers. Workload standards and matrix models of organizational structures are discussed, and…

  3. Anesthesia: What to Expect (For Parents)

    MedlinePlus

    ... general — in which your child would be "asleep" regional — when one large area of the body is ... anesthesia or feel the area if local or regional anesthesia was used? Will my child feel pain ...

  4. Respiratory sinus arrhythmia as a measure of cognitive workload.

    PubMed

    Muth, Eric R; Moss, Jason D; Rosopa, Patrick J; Salley, James N; Walker, Alexander D

    2012-01-01

    The current standard for measuring cognitive workload is the NASA Task-load Index (TLX) questionnaire. Although this measure has a high degree of reliability, diagnosticity, and sensitivity, a reliable physiological measure of cognitive workload could provide a non-invasive, objective measure of workload that could be tracked in real or near real-time without interrupting the task. This study investigated changes in respiratory sinus arrhythmia (RSA) during seven different sub-sections of a proposed selection test for Navy aviation and compared them to changes reported on the NASA-TLX. 201 healthy participants performed the seven tasks of the Navy's Performance Based Measure. RSA was measured during each task and the NASA-TLX was administered after each task. Multi-level modeling revealed that RSA significantly predicted NASA-TLX scores. A moderate within-subject correlation was also found between RSA and NASA TLX scores. The findings support the potential development of RSA as a real-time measure of cognitive workload. Copyright © 2011. Published by Elsevier B.V.

  5. Robotic anesthesia: not the realm of science fiction any more.

    PubMed

    Hemmerling, Thomas M; Terrasini, Nora

    2012-12-01

    Robots are present in surgery, to a much lesser extent in the field of anesthesia. The purpose of this review is to show the latest and most important findings in robotic anesthesia. Moreover, this review argues the importance and utility of robots in anesthesia. Over the years, many closed-loop systems have been developed; they were able to control only one or two of the three components of anesthesia: hypnosis, analgesia, or muscle relaxation. McSleepy controls all three components of anesthesia, from induction to emergence of anesthesia. Telemedical applications have not only led to remote monitoring but even to remotely controlled anesthesia, such as transcontinental anesthesia. A new closed-loop system for sedation, called Sedasys, could revolutionize the field of nonoperating room sedation. 'Manual robots' are used to help and replace anesthesiologists performing anesthesia procedures. Specific robots for intubation and nerve blocks have been developed and tested in humans. Robots can improve performance in anesthesia and healthcare. Closed-loop systems are the basis for pharmacological robots. Safe anesthetic care might be delivered through teleanesthesia whenever qualified personnel are not available or need support. Mechanical robots are being developed for anesthesia care.

  6. Clinical relevance in anesthesia journals.

    PubMed

    Lauritsen, Jakob; Møller, Ann M

    2006-04-01

    The purpose of this review is to present the latest knowledge and research on the definition and distribution of clinically relevant articles in anesthesia journals. It will also discuss the importance of the chosen methodology and outcome of articles. In the last few years, more attention has been paid to evidence-based medicine in anesthesia. Several articles on the subject have focused on the need to base clinical decisions on sound research employing both methodological rigor and clinically relevant outcomes. The number of systematic reviews in anesthesia literature is increasing as well as the focus on diminishing the number of surrogate outcomes. It has been shown that the impact factor is not a valid measure of establishing the level of clinical relevance to a journal. This review presents definitions of clinically relevant anesthesia articles. A clinically relevant article employs both methodological rigor and a clinically relevant outcome. The terms methodological rigor and clinical outcomes are fully discussed in the review as well as problems with journal impact factors.

  7. Nurse-patient assignment models considering patient acuity metrics and nurses' perceived workload.

    PubMed

    Sir, Mustafa Y; Dundar, Bayram; Barker Steege, Linsey M; Pasupathy, Kalyan S

    2015-06-01

    Patient classification systems (PCSs) are commonly used in nursing units to assess how many nursing care hours are needed to care for patients. These systems then provide staffing and nurse-patient assignment recommendations for a given patient census based on these acuity scores. Our hypothesis is that such systems do not accurately capture workload and we conduct an experiment to test this hypothesis. Specifically, we conducted a survey study to capture nurses' perception of workload in an inpatient unit. Forty five nurses from oncology and surgery units completed the survey and rated the impact of patient acuity indicators on their perceived workload using a six-point Likert scale. These ratings were used to calculate a workload score for an individual nurse given a set of patient acuity indicators. The approach offers optimization models (prescriptive analytics), which use patient acuity indicators from a commercial PCS as well as a survey-based nurse workload score. The models assign patients to nurses in a balanced manner by distributing acuity scores from the PCS and survey-based perceived workload. Numerical results suggest that the proposed nurse-patient assignment models achieve a balanced assignment and lower overall survey-based perceived workload compared to the assignment based solely on acuity scores from the PCS. This results in an improvement of perceived workload that is upwards of five percent. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. 21 CFR 868.5170 - Laryngotracheal topical anesthesia applicator.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Laryngotracheal topical anesthesia applicator. 868... topical anesthesia applicator. (a) Identification. A laryngotracheal topical anesthesia applicator is a device used to apply topical anesthetics to a patient's laryngotracheal area. (b) Classification. Class...

  9. 21 CFR 868.5170 - Laryngotracheal topical anesthesia applicator.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Laryngotracheal topical anesthesia applicator. 868... topical anesthesia applicator. (a) Identification. A laryngotracheal topical anesthesia applicator is a device used to apply topical anesthetics to a patient's laryngotracheal area. (b) Classification. Class...

  10. 21 CFR 868.5170 - Laryngotracheal topical anesthesia applicator.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Laryngotracheal topical anesthesia applicator. 868... topical anesthesia applicator. (a) Identification. A laryngotracheal topical anesthesia applicator is a device used to apply topical anesthetics to a patient's laryngotracheal area. (b) Classification. Class...

  11. Current obstetrical practice and umbilical cord prolapse.

    PubMed

    Usta, I M; Mercer, B M; Sibai, B M

    1999-01-01

    The aim of this study was to assess the contribution of current obstetrical practice to the occurrence and complications of umbilical cord prolapse. Maternal and neonatal charts of 87 pregnancies complicated by true umbilical cord prolapse during a 5-year period were reviewed. Twin gestation and noncephalic presentations were common features (14 and 41%, respectively). Eighty-nine percent (77) of infants were delivered by cesarean section of which 29% were classical and 88% were primary. The mean gestational age at delivery was 34.0 +/- 6.0 weeks, and the mean birth weight was 2318 +/- 1159 g. Obstetrical intervention preceded 41 (47%) cases (the obstetrical intervention group): amniotomy (9), scalp electrode application (4), intrauterine pressure catheter insertion (6), attempted external cephalic version (7), expectant management of preterm premature rupture of membranes (14), manual rotation of the fetal head (1), and amnioreduction (1). There were 11 perinatal deaths. Thirty-three percent of the infants (32) had a 5-min Apgar score < 7 and 34% had a cord pH < 7.20. Neonatal seizures, intracerebral hemorrhage, necrotizing enterocolitis, hyaline membrane disease, persistent fetal circulation, sepsis, assisted ventilation, and perinatal mortality were comparable in the "obstetrical intervention" and "no-intervention" groups. Most of the neonatal complications occurred in infants < 32 weeks' gestation. We conclude that obstetrical intervention contributes to 47% of umbilical cord prolapse cases; however, it does not increase the associated perinatal morbidity and mortality.

  12. Procedural mishaps with trephine-based intraosseous anesthesia.

    PubMed

    Small, Joel C; Witherspoon, David E; Regan, John D; Hall, Ellen

    2011-01-01

    Failure to achieve profound anesthesia during dental treatment can be a significant problem for dental clinicians, especially for endodontic procedures on teeth in the mandibular arch with irreversible pulpitis. A number of supplemental local anesthesia techniques exist, the most effective of which may be the intraosseous injection. Two cases are presented demonstrating the dangers associated with the use of the intraosseous anesthesia technique. While the technique can provide profound anesthesia in otherwise difficult to anesthetize cases, care must be taken during its administration. Both cases show the damage done to the root and overlying bone by the injudicious use of the trephine. It is incumbent on the clinician to fully consider the anatomy in the area prior to insertion of the trephine. Intraosseous anesthesia techniques are a valuable addition to the clinicians' armamentarium. However careless administration can result in problems of endodontic or periodontal nature that may be difficult to rectify.

  13. Improving operating room productivity via parallel anesthesia processing.

    PubMed

    Brown, Michael J; Subramanian, Arun; Curry, Timothy B; Kor, Daryl J; Moran, Steven L; Rohleder, Thomas R

    2014-01-01

    Parallel processing of regional anesthesia may improve operating room (OR) efficiency in patients undergoes upper extremity surgical procedures. The purpose of this paper is to evaluate whether performing regional anesthesia outside the OR in parallel increases total cases per day, improve efficiency and productivity. Data from all adult patients who underwent regional anesthesia as their primary anesthetic for upper extremity surgery over a one-year period were used to develop a simulation model. The model evaluated pure operating modes of regional anesthesia performed within and outside the OR in a parallel manner. The scenarios were used to evaluate how many surgeries could be completed in a standard work day (555 minutes) and assuming a standard three cases per day, what was the predicted end-of-day time overtime. Modeling results show that parallel processing of regional anesthesia increases the average cases per day for all surgeons included in the study. The average increase was 0.42 surgeries per day. Where it was assumed that three cases per day would be performed by all surgeons, the days going to overtime was reduced by 43 percent with parallel block. The overtime with parallel anesthesia was also projected to be 40 minutes less per day per surgeon. Key limitations include the assumption that all cases used regional anesthesia in the comparisons. Many days may have both regional and general anesthesia. Also, as a case study, single-center research may limit generalizability. Perioperative care providers should consider parallel administration of regional anesthesia where there is a desire to increase daily upper extremity surgical case capacity. Where there are sufficient resources to do parallel anesthesia processing, efficiency and productivity can be significantly improved. Simulation modeling can be an effective tool to show practice change effects at a system-wide level.

  14. All Things Being Equal: Observing Australian Individual Academic Workloads

    ERIC Educational Resources Information Center

    Dobele, Angela; Rundle-Thiele, Sharyn; Kopanidis, Foula; Steel, Marion

    2010-01-01

    The achievement of greater gender equity within Australian universities is a significant issue for both the quality and the strength of Australian higher education. This paper contributes to our knowledge of academic workloads, observing individual workloads in business faculties. A multiple case study method was employed to observe individual…

  15. Measurement, Modeling, and Analysis of a Large-scale Blog Sever Workload

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Jeon, Myeongjae; Hwang, Jeaho; Kim, Youngjae

    2010-01-01

    Despite the growing popularity of Online Social Networks (OSNs), the workload characteristics of OSN servers, such as those hosting blog services, are not well understood. Understanding workload characteristics is important for opti- mizing and improving the performance of current systems and software based on observed trends. Thus, in this paper, we characterize the system workload of the largest blog hosting servers in South Korea, Tistory1. In addition to understanding the system workload of the blog hosting server, we have developed synthesized workloads and obtained the following major findings: (i) the transfer size of non-multimedia files and blog articles can bemore » modeled by a truncated Pareto distribution and a log-normal distribution respectively, and (ii) users accesses to blog articles do not show temporal locality, but they are strongly biased toward those posted along with images or audio.« less

  16. Restriction of oral intake during labor: whither are we bound?

    PubMed

    Sperling, Jeffrey D; Dahlke, Joshua D; Sibai, Baha M

    2016-05-01

    In 1946, Dr Curtis Mendelson suggested that aspiration during general anesthesia for delivery was avoidable by restricting oral intake during labor. This suggestion proved influential, and restriction of oral intake in labor became the norm. These limitations may contribute to fear and feelings of intimidation among parturients. Modern obstetrics, especially in the setting of advances in obstetric anesthesia, does not mirror the clinical landscape of Mendelson; hence, one is left to question if his findings remain relevant or if they should inform current recommendations. The use of general anesthesia at time of cesarean delivery has seen a remarkable decline with increased use of effective neuraxial analgesia as the standard of care in modern obstetric anesthesia. While the American College of Obstetricians and Gynecologists now endorses clear liquids during labor, current recommendations continue to suggest that solid food intake should be avoided. Recent evidence from a systematic review involving 3130 women in active labor suggests that oral intake should not be restricted in women at low risk of complications, given there were no identified benefits or harms of a liberal diet. Aspiration and other adverse maternal outcomes may be unrelated to oral intake in labor and as such, qualitative measures such as patient satisfaction should be paramount. It is time to reassess the impact of oral intake restriction during labor given the minimal risk of aspiration during labor in the setting of modern obstetric anesthesia practices. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Approximate entropy: a new evaluation approach of mental workload under multitask conditions

    NASA Astrophysics Data System (ADS)

    Yao, Lei; Li, Xiaoling; Wang, Wei; Dong, Yuanzhe; Jiang, Ying

    2014-04-01

    There are numerous instruments and an abundance of complex information in the traditional cockpit display-control system, and pilots require a long time to familiarize themselves with the cockpit interface. This can cause accidents when they cope with emergency events, suggesting that it is necessary to evaluate pilot cognitive workload. In order to establish a simplified method to evaluate cognitive workload under a multitask condition. We designed a series of experiments involving different instrument panels and collected electroencephalograms (EEG) from 10 healthy volunteers. The data were classified and analyzed with an approximate entropy (ApEn) signal processing. ApEn increased with increasing experiment difficulty, suggesting that it can be used to evaluate cognitive workload. Our results demonstrate that ApEn can be used as an evaluation criteria of cognitive workload and has good specificity and sensitivity. Moreover, we determined an empirical formula to assess the cognitive workload interval, which can simplify cognitive workload evaluation under multitask conditions.

  18. Cognitive workload modulation through degraded visual stimuli: a single-trial EEG study

    NASA Astrophysics Data System (ADS)

    Yu, K.; Prasad, I.; Mir, H.; Thakor, N.; Al-Nashash, H.

    2015-08-01

    Objective. Our experiments explored the effect of visual stimuli degradation on cognitive workload. Approach. We investigated the subjective assessment, event-related potentials (ERPs) as well as electroencephalogram (EEG) as measures of cognitive workload. Main results. These experiments confirm that degradation of visual stimuli increases cognitive workload as assessed by subjective NASA task load index and confirmed by the observed P300 amplitude attenuation. Furthermore, the single-trial multi-level classification using features extracted from ERPs and EEG is found to be promising. Specifically, the adopted single-trial oscillatory EEG/ERP detection method achieved an average accuracy of 85% for discriminating 4 workload levels. Additionally, we found from the spatial patterns obtained from EEG signals that the frontal parts carry information that can be used for differentiating workload levels. Significance. Our results show that visual stimuli can modulate cognitive workload, and the modulation can be measured by the single trial EEG/ERP detection method.

  19. Effect of time span and task load on pilot mental workload

    NASA Technical Reports Server (NTRS)

    Berg, S. L.; Sheridan, T. B.

    1985-01-01

    Two sets of experiments were run to examine how the mental workload of a pilot might be measured. The effects of continuous manual control activity versus discrete assigned mental tasks (including the length of time between receiving an assignment and executing it) were examined. The first experiment evaluated the strengths and weaknesses of measuring mental workload with an objective perforamance (altitude deviations) and five subjective ratings (activity level, complexity, difficulty, stress, and workload). The second set of experiments built upon the first set by increasing workload intensities and adding another performance measure: airspeed deviation. The results are discussed for both low and high experience pilots.

  20. Spikes in acute workload are associated with increased injury risk in elite cricket fast bowlers.

    PubMed

    Hulin, Billy T; Gabbett, Tim J; Blanch, Peter; Chapman, Paul; Bailey, David; Orchard, John W

    2014-04-01

    To determine if the comparison of acute and chronic workload is associated with increased injury risk in elite cricket fast bowlers. Data were collected from 28 fast bowlers who completed a total of 43 individual seasons over a 6-year period. Workloads were estimated by summarising the total number of balls bowled per week (external workload), and by multiplying the session rating of perceived exertion by the session duration (internal workload). One-week data (acute workload), together with 4-week rolling average data (chronic workload), were calculated for external and internal workloads. The size of the acute workload in relation to the chronic workload provided either a negative or positive training-stress balance. A negative training-stress balance was associated with an increased risk of injury in the week after exposure, for internal workload (relative risk (RR)=2.2 (CI 1.91 to 2.53), p=0.009), and external workload (RR=2.1 (CI 1.81 to 2.44), p=0.01). Fast bowlers with an internal workload training-stress balance of greater than 200% had a RR of injury of 4.5 (CI 3.43 to 5.90, p=0.009) compared with those with a training-stress balance between 50% and 99%. Fast bowlers with an external workload training-stress balance of more than 200% had a RR of injury of 3.3 (CI 1.50 to 7.25, p=0.033) in comparison to fast bowlers with an external workload training-stress balance between 50% and 99%. These findings demonstrate that large increases in acute workload are associated with increased injury risk in elite cricket fast bowlers.

  1. Balancing nurses' workload in hospital wards: study protocol of developing a method to manage workload.

    PubMed

    van den Oetelaar, W F J M; van Stel, H F; van Rhenen, W; Stellato, R K; Grolman, W

    2016-11-10

    Hospitals pursue different goals at the same time: excellent service to their patients, good quality care, operational excellence, retaining employees. This requires a good balance between patient needs and nursing staff. One way to ensure a proper fit between patient needs and nursing staff is to work with a workload management method. In our view, a nursing workload management method needs to have the following characteristics: easy to interpret; limited additional registration; applicable to different types of hospital wards; supported by nurses; covers all activities of nurses and suitable for prospective planning of nursing staff. At present, no such method is available. The research follows several steps to come to a workload management method for staff nurses. First, a list of patient characteristics relevant to care time will be composed by performing a Delphi study among staff nurses. Next, a time study of nurses' activities will be carried out. The 2 can be combined to estimate care time per patient group and estimate the time nurses spend on non-patient-related activities. These 2 estimates can be combined and compared with available nursing resources: this gives an estimate of nurses' workload. The research will take place in an academic hospital in the Netherlands. 6 surgical wards will be included, capacity 15-30 beds. The study protocol was submitted to the Medical Ethical Review Board of the University Medical Center (UMC) Utrecht and received a positive advice, protocol number 14-165/C. This method will be developed in close cooperation with staff nurses and ward management. The strong involvement of the end users will contribute to a broader support of the results. The method we will develop may also be useful for planning purposes; this is a strong advantage compared with existing methods, which tend to focus on retrospective analysis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence

  2. Mentorship in anesthesia.

    PubMed

    Flexman, Alana M; Gelb, Adrian W

    2011-12-01

    This article will provide a review of mentorship in academic medicine. The review will include definitions and an overview of the evidence supporting the benefits, barriers, and structure of mentorship programmes in academic medicine and anesthesia. Finally, we will identify areas of further research. Mentorship in medicine has been increasingly recognized as a core component of training and career advancement in academic medicine. Mentoring provides many benefits to both mentor and mentee and facilitates the growth of academic departments by improving research productivity, faculty career satisfaction, recruitment, and educational performance. Mentorship programmes may be formal or informal and should include some form of mentor education. There are several barriers to successful mentorship including time constraints, limited availability of mentors, gender, minority status, and generational differences. These barriers may be overcome with improved awareness and sensitivity. Further investigation into the prevalence of mentorship and specific needs in our specialty are urgently required. Mentorship has been demonstrated to be an integral part of training and career development in academic medicine and benefits both mentees and mentors. Despite the promotion of mentorship in many academic anesthesia departments, little is published in the available literature supporting mentorship in anesthesia.

  3. The Electric Speaking Practice: A Telephone Workload Study

    PubMed Central

    Westbury, R. C.

    1974-01-01

    The telephone workload in a family practice was studied for two recording periods separated by a 12 month interval. A record was kept of the number of calls, their length, the day of the week on which they were made, to whom they were made, and for what purpose. The telephone practice accounts for about 20 percent of the total practice workload. Calls to the patients and to their representatives were about equally common and account for most of the workload, but a large amount of telephone work is devoted to ‘backing up’ these direct contacts. The use of the telephone for medical purposes saves much time for the patients and much money for the paying agency. A plea is made for intensive study of this aspect of family medicine. PMID:20469032

  4. Subjective workload and individual differences in information processing abilities

    NASA Technical Reports Server (NTRS)

    Damos, D. L.

    1984-01-01

    This paper describes several experiments examining the source of individual differences in the experience of mental workload. Three sources of such differences were examined: information processing abilities, timesharing abilities, and personality traits/behavior patterns. On the whole, there was little evidence that individual differences in information processing abilities or timesharing abilities are related to perceived differences in mental workload. However, individuals with strong Type A coronary prone behavior patterns differed in both single- and multiple-task performance from individuals who showed little evidence of such a pattern. Additionally, individuals with a strong Type A pattern showed some dissociation between objective performance and the experience of mental workload.

  5. Voice measures of workload in the advanced flight deck

    NASA Technical Reports Server (NTRS)

    Schneider, Sid J.; Alpert, Murray; Odonnell, Richard

    1989-01-01

    Voice samples were obtained from 14 male subjects under high and low workload conditions. Acoustical analysis of the voice suggested that high workload conditions can be revealed by their effects on the voice over time. Aircrews in the advanced flight deck will be voicing short, imperative sentences repeatedly. A drop in the energy of the voice, as reflected by reductions in amplitude and frequency over time, and the failure to achieve old amplitude and frequency levels after rest periods, can signal that the workload demands of the situation are straining the speaker. This kind of measurement would be relatively unaffected by individual differences in acoustical measures.

  6. Regional anesthesia practice in China: a survey.

    PubMed

    Huang, Jeffrey; Gao, Huan

    2016-11-01

    Neuraxial anesthesia has been widely used in China. Recently, Chinese anesthesiologists have applied nerve stimulator and ultrasound guidance for peripheral nerve blocks. Nationwide surveys about regional anesthesia practices in China are lacking. We surveyed Chinese anesthesiologists about regional anesthesia techniques, preference, drug selections, complications, and treatments. A survey was sent to all anesthesiologist members by WeChat. The respondents can choose mobile device or desktop to complete the survey. Each IP address is allowed to complete the survey once. A total of 6589 members read invitations. A total of 2654 responses were received with fully completed questionnaires, which represented an overall response rate of 40%. Forty-one percent of the respondents reported that more than 50% of surgeries in their hospitals were done under regional anesthesia. Most of the participants used test dose after epidural catheter insertion. The most common drug for test dose was 3-mL 1.5% lidocaine; 2.6% of the participants reported that they had treated a patient with epidural hematoma after neuraxial anesthesia. Most anesthesiologists (68.2%) performed peripheral nerve blocks as blind procedures based on the knowledge of anatomical landmarks. A majority of hospitals (80%) did not stock Intralipid; 61% of the respondents did not receive peripheral nerve block training. The current survey can serve as a benchmark for future comparisons and evaluation of regional anesthesia practices in China. This survey revealed potential regional anesthesia safety issues in China. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Recurrence of obstetric third-degree and fourth-degree anal sphincter injuries.

    PubMed

    Boggs, Edgar W; Berger, Howard; Urquia, Marcelo; McDermott, Colleen D

    2014-12-01

    To examine outcomes after primary obstetric anal sphincter injuries in a subsequent pregnancy. This was a retrospective analysis of prospectively collated data from a large perinatal database between 2006 and 2010. Primiparous vaginal deliveries with an obstetric anal sphincter injury were identified and tracked to identify their subsequent delivery characteristics and perineal outcomes. A primary obstetric anal sphincter injury occurred in 5.3% of primiparous vaginal deliveries (9,857/186,239); of those patients, 2,093 had a subsequent delivery, and 91.9% delivered vaginally (1,923/2,093). The recurrent obstetric anal sphincter injury rate was also found to be 5.3% (102/1,923). The adjusted odds ratios (ORs) for primary obstetric anal sphincter injuries were significantly increased in large-for-gestational-age neonates for both third-degree laceration (adjusted OR 2.1, 95% confidence interval [CI] 1.9-2.2) and fourth-degree laceration (adjusted OR 2.7, 95% CI 2.3-3.1) and almost all obstetric interventions studied. The adjusted ORs for recurrent obstetric anal sphincter injuries were significant for large-for-gestational-age (25/102, adjusted OR 2.2, 95% CI 1.3-3.6) and instrumental deliveries (15/102, adjusted OR 2.4, 95% CI 1.2-4.6). In this study population, the incidence of recurrent obstetric anal sphincter injuries was similar to that of primary obstetric anal sphincter injuries, and most patients went on to deliver vaginally for subsequent deliveries. The risk of recurrent obstetric anal sphincter injuries was doubled in those who delivered a large-for-gestational-age neonate and in those who had an instrumental delivery.

  8. Role of telephone triage in obstetrics.

    PubMed

    Manning, Nirvana Afsordeh; Magann, Everett F; Rhoads, Sarah J; Ivey, Tesa L; Williams, Donna J

    2012-12-01

    The telephone has become an indispensable method of communication in the practice of obstetrics. The telephone is one of the primary methods by which the patient makes her appointments and contacts her health care provider for advice, reassurance, and referrals. Current methods of telephone triage include personal at the physicians' office, telephone answering services, labor and delivery nurses, and a dedicated telephone triage system using algorithms. Limitations of telephone triage include the inability of the provider to see the patient and receive visual clues from the interaction and the challenges of obtaining a complete history over the telephone. In addition, there are potential safety and legal issues with telephone triage. To date, there is insufficient evidence to either validate or refute the use of a dedicated telephone triage system compared with a traditional system using an answering service or nurses on labor and delivery. Obstetricians and gynecologists, family physicians. After completing this CME activity, physicians should be better able to analyze the scope of variation in telephone triage across health care providers and categorize the components that go into a successful triage system, assess the current scope of research in telephone triage in obstetrics, evaluate potential safety and legal issues with telephone triage in obstetrics, and identify issues that should be addressed in any institution that is using or implementing a system of telephone triage in obstetrics.

  9. Pediatric ambulatory anesthesia.

    PubMed

    August, David A; Everett, Lucinda L

    2014-06-01

    Pediatric patients often undergo anesthesia for ambulatory procedures. This article discusses several common preoperative dilemmas, including whether to postpone anesthesia when a child has an upper respiratory infection, whether to test young women for pregnancy, which children require overnight admission for apnea monitoring, and the effectiveness of nonpharmacological techniques for reducing anxiety. Medication issues covered include the risks of anesthetic agents in children with undiagnosed weakness, the use of remifentanil for tracheal intubation, and perioperative dosing of rectal acetaminophen. The relative merits of caudal and dorsal penile nerve block for pain after circumcision are also discussed. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. Neutron beam irradiation study of workload dependence of SER in a microprocessor

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Michalak, Sarah E; Graves, Todd L; Hong, Ted

    It is known that workloads are an important factor in soft error rates (SER), but it is proving difficult to find differentiating workloads for microprocessors. We have performed neutron beam irradiation studies of a commercial microprocessor under a wide variety of workload conditions from idle, performing no operations, to very busy workloads resembling real HPC, graphics, and business applications. There is evidence that the mean times to first indication of failure, MTFIF defined in Section II, may be different for some of the applications.

  11. Extrapedicular Infiltration Anesthesia as an Improved Method of Local Anesthesia for Unipedicular Percutaneous Vertebroplasty or Percutaneous Kyphoplasty.

    PubMed

    Liu, Liehua; Cheng, Shiming; Lu, Rui; Zhou, Qiang

    2016-01-01

    Aim. This report introduces extrapedicular infiltration anesthesia as an improved method of local anesthesia for unipedicular percutaneous vertebroplasty or percutaneous kyphoplasty. Method. From March 2015 to March 2016, 44 patients (11 males and 33 females) with osteoporotic vertebral compression fractures with a mean age of 71.4 ± 8.8 years (range: 60 to 89) received percutaneous vertebroplasty or percutaneous kyphoplasty. 24 patients were managed with conventional local infiltration anesthesia (CLIA) and 20 patients with both CLIA and extrapedicular infiltration anesthesia (EPIA). Patients evaluated intraoperative pain by means of the visual analogue score and were monitored during the procedure for additional sedative analgesia needs and for adverse nerve root effects. Results. VAS of CLIA + EPIA and CLIA group was 2.5 ± 0.7 and 4.3 ± 1.0, respectively, and there was significant difference ( P = 0.001). In CLIA group, 1 patient required additional sedative analgesia, but in CLIA + EPIA group, no patients required that. In the two groups, no adverse nerve root effects were noted. Summary. Extrapedicular infiltration anesthesia provided good local anesthetic effects without significant complications. This method deserves further consideration for use in unipedicular percutaneous vertebroplasty and percutaneous kyphoplasty.

  12. 21 CFR 884.4900 - Obstetric table and accessories.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Devices § 884.4900 Obstetric table and accessories. (a) Identification. An obstetric table is a device with adjustable sections designed to support a patient in the various positions required during...: patient equipment, support attachments, and cabinets for warming instruments and disposing of wastes. (b...

  13. Publications in anesthesia journals: quality and clinical relevance.

    PubMed

    Lauritsen, Jakob; Moller, Ann M

    2004-11-01

    Clinicians performing evidence-based anesthesia rely on anesthesia journals for clinically relevant information. The objective of this study was to analyze the proportion of clinically relevant articles in five high impact anesthesia journals. We evaluated all articles published in Anesthesiology, Anesthesia & Analgesia, British Journal of Anesthesia, Anesthesia, and Acta Anaesthesiologica Scandinavica from January to June, 2000. Articles were assessed and classified according to type, outcome, and design; 1379 articles consisting of 5468 pages were evaluated and categorized. The most common types of article were animal and laboratory research (31.2%) and randomized clinical trial (20.4%). A clinically relevant article was defined as an article that used a statistically valid method and had a clinically relevant end-point. Altogether 18.6% of the pages had as their subject matter clinically relevant trials. We compared the Journal Impact Factor (a measure of the number of citations per article in a journal) and the proportion of clinically relevant pages and found that they were inversely proportional to each other.

  14. Human interaction with robotic systems: performance and workload evaluations.

    PubMed

    Reinerman-Jones, L; Barber, D J; Szalma, J L; Hancock, P A

    2017-10-01

    We first tested the effect of differing tactile informational forms (i.e. directional cues vs. static cues vs. dynamic cues) on objective performance and perceived workload in a collaborative human-robot task. A second experiment evaluated the influence of task load and informational message type (i.e. single words vs. grouped phrases) on that same collaborative task. In both experiments, the relationship of personal characteristics (attentional control and spatial ability) to performance and workload was also measured. In addition to objective performance and self-report of cognitive load, we evaluated different physiological responses in each experiment. Results showed a performance-workload association for directional cues, message type and task load. EEG measures however, proved generally insensitive to such task load manipulations. Where significant EEG effects were observed, right hemisphere amplitude differences predominated, although unexpectedly these latter relationships were negative. Although EEG measures were partially associated with performance, they appear to possess limited utility as measures of workload in association with tactile displays. Practitioner Summary: As practitioners look to take advantage of innovative tactile displays in complex operational realms like human-robotic interaction, associated performance effects are mediated by cognitive workload. Despite some patterns of association, reliable reflections of operator state can be difficult to discern and employ as the number, complexity and sophistication of these respective measures themselves increase.

  15. Obstetrical emergencies.

    PubMed

    Biddle, D; Macintire, D K

    2000-05-01

    This article discusses different techniques that can be used in the diagnosis and treatment of obstetrical emergencies. Female reproductive emergencies commonly encountered by small animal practitioners include pyometra, dystocia, cesarean section, mastitis, eclampsia, uterine torsion, and uterine prolapse. A thorough knowledge of normal and abnormal reproductive behavior will aid the emergency veterinarian in successfully managing such cases. Timely diagnosis and treatment of these emergencies will often give a good outcome.

  16. Accounts of severe acute obstetric complications in Rural Bangladesh

    PubMed Central

    2011-01-01

    Background As maternal deaths have decreased worldwide, increasing attention has been placed on the study of severe obstetric complications, such as hemorrhage, eclampsia, and obstructed labor, to identify where improvements can be made in maternal health. Though access to medical care is considered to be life-saving during obstetric emergencies, data on the factors associated with health care decision-making during obstetric emergencies are lacking. We aim to describe the health care decision-making process during severe acute obstetric complications among women and their families in rural Bangladesh. Methods Using the pregnancy surveillance infrastructure from a large community trial in northwest rural Bangladesh, we nested a qualitative study to document barriers to timely receipt of medical care for severe obstetric complications. We conducted 40 semi-structured, in-depth interviews with women reporting severe acute obstetric complications and purposively selected for conditions representing the top five most common obstetric complications. The interviews were transcribed and coded to highlight common themes and to develop an overall conceptual model. Results Women attributed their life-threatening experiences to societal and socioeconomic factors that led to delays in seeking timely medical care by decision makers, usually husbands or other male relatives. Despite the dominance of male relatives and husbands in the decision-making process, women who underwent induced abortions made their own decisions about their health care and relied on female relatives for advice. The study shows that non-certified providers such as village doctors and untrained birth attendants were the first-line providers for women in all categories of severe complications. Coordination of transportation and finances was often arranged through mobile phones, and referrals were likely to be provided by village doctors. Conclusions Strategies to increase timely and appropriate care seeking

  17. Accounts of severe acute obstetric complications in rural Bangladesh.

    PubMed

    Sikder, Shegufta S; Labrique, Alain B; Ullah, Barkat; Ali, Hasmot; Rashid, Mahbubur; Mehra, Sucheta; Jahan, Nusrat; Shamim, Abu A; West, Keith P; Christian, Parul

    2011-10-21

    As maternal deaths have decreased worldwide, increasing attention has been placed on the study of severe obstetric complications, such as hemorrhage, eclampsia, and obstructed labor, to identify where improvements can be made in maternal health. Though access to medical care is considered to be life-saving during obstetric emergencies, data on the factors associated with health care decision-making during obstetric emergencies are lacking. We aim to describe the health care decision-making process during severe acute obstetric complications among women and their families in rural Bangladesh. Using the pregnancy surveillance infrastructure from a large community trial in northwest rural Bangladesh, we nested a qualitative study to document barriers to timely receipt of medical care for severe obstetric complications. We conducted 40 semi-structured, in-depth interviews with women reporting severe acute obstetric complications and purposively selected for conditions representing the top five most common obstetric complications. The interviews were transcribed and coded to highlight common themes and to develop an overall conceptual model. Women attributed their life-threatening experiences to societal and socioeconomic factors that led to delays in seeking timely medical care by decision makers, usually husbands or other male relatives. Despite the dominance of male relatives and husbands in the decision-making process, women who underwent induced abortions made their own decisions about their health care and relied on female relatives for advice. The study shows that non-certified providers such as village doctors and untrained birth attendants were the first-line providers for women in all categories of severe complications. Coordination of transportation and finances was often arranged through mobile phones, and referrals were likely to be provided by village doctors. Strategies to increase timely and appropriate care seeking for severe obstetric complications may

  18. Consent for pediatric anesthesia: an observational study.

    PubMed

    Lagana, Zoe; Foster, Andrew; Bibbo, Adriana; Dowling, Kate; Cyna, Allan M

    2012-08-01

    Informed consent prior to anesthesia is an important part of the pediatric pre-anesthetic consultation. This study aimed to observe and identify the number and nature of the anesthesia risks considered and communicated to parents/guardians and children during the pediatric informed consent process on the day of elective surgery. A convenience sample of anesthetists had their pre-anesthesia consultations voice recorded, prior to elective surgery, during a 4-month period at the largest tertiary referral centre for pediatric care in South Australia. A data collection form was used to note baseline demographic data, and voice recording transcripts were independently documented by two researchers and subsequently compared for accuracy regarding the number and nature of risks discussed. Of the 96 voice recordings, 91 (92%) were suitable for the analysis. The five most commonly discussed risks were as follows: nausea and vomiting (36%); sore throat (35%); allergy (29%); hypoxia (25%); and emergence delirium (19%). Twenty-seven pre-anesthetic consultations (30%) were found to have had no discussion of anesthetic risk at all while a further 23 consultations (26%) incorporated general statements inferring that anesthesia carried risks, but with no elaboration about their nature, ramifications or incidence. The median number of risks (IQR) specifically mentioned per consultation was higher, 3 (1) vs 1 (1), P < 0.05, when the consultation was performed by a trainee rather than a consultant anesthetist and when the patient had previous anesthesia experience odds ratio 0.34, 95% CI [0.13, 0.87], P = 0.025. The pediatric anesthesia risk discussion is very variable. Trainees tend to discuss more specific risks than consultants and a patient's previous experience of anesthesia was associated with a more limited discussion of anesthesia risk. © 2011 Blackwell Publishing Ltd.

  19. Mental workload measurement for emergency operating procedures in digital nuclear power plants.

    PubMed

    Gao, Qin; Wang, Yang; Song, Fei; Li, Zhizhong; Dong, Xiaolu

    2013-01-01

    Mental workload is a major consideration for the design of emergency operation procedures (EOPs) in nuclear power plants. Continuous and objective measures are desired. This paper compares seven mental workload measurement methods (pupil size, blink rate, blink duration, heart rate variability, parasympathetic/sympathetic ratio, total power and (Goals, Operations, Methods, and Section Rules)-(Keystroke Level Model) GOMS-KLM-based workload index) with regard to sensitivity, validity and intrusiveness. Eighteen participants performed two computerised EOPs of different complexity levels, and mental workload measures were collected during the experiment. The results show that the blink rate is sensitive to both the difference in the overall task complexity and changes in peak complexity within EOPs, that the error rate is sensitive to the level of arousal and correlate to the step error rate and that blink duration increases over the task period in both low and high complexity EOPs. Cardiac measures were able to distinguish tasks with different overall complexity. The intrusiveness of the physiological instruments is acceptable. Finally, the six physiological measures were integrated using group method of data handling to predict perceived overall mental workload. The study compared seven measures for evaluating the mental workload with emergency operation procedure in nuclear power plants. An experiment with simulated procedures was carried out, and the results show that eye response measures are useful for assessing temporal changes of workload whereas cardiac measures are useful for evaluating the overall workload.

  20. Study of post dural puncture headache with 27G Quincke & Whitacre needles in obstetrics/non obstetrics patients.

    PubMed

    Srivastava, Vibhu; Jindal, Parul; Sharma, J P

    2010-06-01

    The proposed study was carried out in the department of Anaesthesiology, Intensive care & Pain management, Himalayan Institute of Medical Sciences. Swami Rama Nagar, Dehradun. A total of 120 patients of ASA I & II obstetric & non-obstetric undergoing elective/emergency surgery under subarachnoid block were included under the study. To evaluate the frequency of PDPH during spinal anaesthesia using 27 gauge Quincke vs 27G whitacre needle in obstetric/non obstetric patient. In our study patients were in the age group of 15-75 years. Most of the patients in our study belong to ASA Grade I. There was 2%, 1%, 4% and 3% hypotension in-group A, B, C, D respectively. There was 2%, 4% shivering in-group A, C respectively and 1% each in group B, D. In our study failed spinal with 27G Quincke needle was in one case (3.33%) in-group C where successful subarachnoid was performed with a thicken spinal needle 23G Quincke. There was no incidence of PDPH in-group A and D, while 1 (2%) patient in-group B and 2 (4%) in group C. All the three patients were for lower section caesarean section and were young and had undergone more than one attempt to perform spinal block. The headache severity was from mild to moderate and no epidural blood patch was applied.

  1. Anesthesia in a Baird's tapir (Tapirus bairdii).

    PubMed

    Trim, C M; Lamberski, N; Kissel, D I; Quandt, J E

    1998-06-01

    A Baird's tapir (Tapirus bairdii) was satisfactorily immobilized on two occasions with i.m. detomidine (0.065-0.13 mg/kg) and butorphanol (0.13-0.2 mg/kg). On the second occasion, anesthesia was induced by i.v. administration of ketamine (2.2 mg/kg). Twenty minutes later, endotracheal intubation was performed after an additional i.v. injection of ketamine (1.5 mg/kg). Anesthesia was maintained with isoflurane, which provided excellent conditions for radiology and surgery. Anesthesia was associated with hypoxemia when the tapir was allowed to breathe air and with hypoventilation. Mean arterial pressure remained satisfactory. No antagonist drugs were administered, and recovery from anesthesia was rapid and smooth.

  2. Measures of reducing obstetric emergencies hysterectomy incidence.

    PubMed

    Ren, Guo-ping; Wang, Bao-lian; Wang, Yan-hong

    2016-03-01

    To study the obstetric emergency hysterectomy which can reduce the incidence of measures. In maternity of Xinxiang Central Hospital, the total number of deliveries cases has been up to 50,526 in 20 years, of which 48 cases were retrospectively analyzed for the clinical data of Emergency uterine surgery cases. Cases underwent obstetric emergency hysterectomy accounted for 0.095% of total deliveries (48/50 526), in which 11 cases of vaginal delivery, 37 cases of cesarean section. The indications for surgery: 27 cases were cased by placental factors accounted for 56.25%; 14 cases of uterine inertia, accounting for 29.17%; uterine rupture in 4 cases, accounting for 8.33%; 3 cases of coagulopathy, accounting for 6.25%. Where the maternal placental factors hysterectomy is the most common (69.70%, 23/33) and the predominant factor is early maternal uterine inertia (60.00%, 9/15). There are 74.09% (20/27) of patients with placental abnormalities history of previous cesarean section or uterine surgery. The major risk factors leading to obstetric emergency hysterectomy is placental factors. Preventing the occurrence of placental abnormalities planting actively can effectively reduce the rate of obstetric hysterectomy.

  3. Pilot workload and fatigue: A critical survey of concepts and assessment techniques

    NASA Technical Reports Server (NTRS)

    Gartner, W. B.; Murphy, M. R.

    1976-01-01

    The principal unresolved issues in conceptualizing and measuring pilot workload and fatigue are discussed. These issues are seen as limiting the development of more useful working concepts and techniques and their application to systems engineering and management activities. A conceptual analysis of pilot workload and fatigue, an overview and critique of approaches to the assessment of these phenomena, and a discussion of current trends in the management of unwanted workload and fatigue effects are presented. Refinements and innovations in assessment methods are recommended for enhancing the practical significance of workload and fatigue studies.

  4. Topical Drug Formulations for Prolonged Corneal Anesthesia

    PubMed Central

    Wang, Liqiang; Shankarappa, Sahadev A.; Tong, Rong; Ciolino, Joseph B.; Tsui, Jonathan H.; Chiang, Homer H.; Kohane, Daniel S.

    2013-01-01

    Purpose Ocular local anesthetics (OLA’s) currently used in routine clinical practice for corneal anesthesia are short acting and their ability to delay corneal healing makes them unsuitable for long-term use. In this study, we examined the effect on the duration of corneal anesthesia of the site-1 sodium channel blocker tetrodotoxin (TTX), applied with either proparacaine or the chemical permeation enhancer OTAB. The effect of test solutions on corneal healing was also studied. Methods Solutions of TTX, proparacaine, and OTAB, singly or in combination were applied topically to the rat cornea. The blink response, an indirect measure of corneal sensitivity, was recorded using a Cochet-Bonnet esthesiometer, and the duration of corneal anesthesia calculated. The effect of test compounds on the rate of corneal epithelialization was studied in vivo following corneal debridement. Results Combination of TTX and proparacaine resulted in corneal anesthesia that was 8–10 times longer in duration than that from either drug administered alone, while OTAB did not prolong anesthesia. The rate of corneal healing was moderately delayed following co-administration of TTX and proparacaine. Conclusion Co-administration of TTX and proparacaine significantly prolonged corneal anesthesia but in view of delayed corneal re-epithelialization, caution is suggested in use of the combination. PMID:23615270

  5. Assessment of nursing workload in adult psychiatric inpatient units: a scoping review.

    PubMed

    Sousa, C; Seabra, P

    2018-05-16

    No systematic reviews on measurement tools in adult psychiatric inpatient settings exist in the literature, and thus, further research is required on ways to identify approaches to calculate safe nurse staffing levels based on patients' care needs in adult psychiatric inpatient units. To identify instruments that enable an assessment of nursing workload in psychiatric settings. Method A scoping review was conducted. Four studies were identified, with five instruments used to support the calculation of staff needs and workload. All four studies present methodological limitations. Two instruments have already been adapted to this specific context, but validation studies are lacking. The findings indicate that the tools used to evaluate nursing workload in these settings require further development, with the concomitant need for more research to clarify the definition of nursing workload as well as to identify factors with the greatest impact on nursing workload. This review highlights the need to develop tools to assess workload in psychiatric inpatient units that embrace patient-related and non-patient-related activities. The great challenge is to enable a sensitive perception of workload resulting from nurses' psychotherapeutic interventions, an important component of treatment for many patients. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  6. A Procedural Electroencephalogram Simulator for Evaluation of Anesthesia Monitors.

    PubMed

    Petersen, Christian Leth; Görges, Matthias; Massey, Roslyn; Dumont, Guy Albert; Ansermino, J Mark

    2016-11-01

    Recent research and advances in the automation of anesthesia are driving the need to better understand electroencephalogram (EEG)-based anesthesia end points and to test the performance of anesthesia monitors. This effort is currently limited by the need to collect raw EEG data directly from patients. A procedural method to synthesize EEG signals was implemented in a mobile software application. The application is capable of sending the simulated signal to an anesthesia depth of hypnosis monitor. Systematic sweeps of the simulator generate functional monitor response profiles reminiscent of how network analyzers are used to test electronic components. Three commercial anesthesia monitors (Entropy, NeuroSENSE, and BIS) were compared with this new technology, and significant response and feature variations between the monitor models were observed; this includes reproducible, nonmonotonic apparent multistate behavior and significant hysteresis at light levels of anesthesia. Anesthesia monitor response to a procedural simulator can reveal significant differences in internal signal processing algorithms. The ability to synthesize EEG signals at different anesthetic depths potentially provides a new method for systematically testing EEG-based monitors and automated anesthesia systems with all sensor hardware fully operational before human trials.

  7. Physician activity during outpatient visits and subjective workload.

    PubMed

    Calvitti, Alan; Hochheiser, Harry; Ashfaq, Shazia; Bell, Kristin; Chen, Yunan; El Kareh, Robert; Gabuzda, Mark T; Liu, Lin; Mortensen, Sara; Pandey, Braj; Rick, Steven; Street, Richard L; Weibel, Nadir; Weir, Charlene; Agha, Zia

    2017-05-01

    We describe methods for capturing and analyzing EHR use and clinical workflow of physicians during outpatient encounters and relating activity to physicians' self-reported workload. We collected temporally-resolved activity data including audio, video, EHR activity, and eye-gaze along with post-visit assessments of workload. These data are then analyzed through a combination of manual content analysis and computational techniques to temporally align streams, providing a range of process measures of EHR usage, clinical workflow, and physician-patient communication. Data was collected from primary care and specialty clinics at the Veterans Administration San Diego Healthcare System and UCSD Health, who use Electronic Health Record (EHR) platforms, CPRS and Epic, respectively. Grouping visit activity by physician, site, specialty, and patient status enables rank-ordering activity factors by their correlation to physicians' subjective work-load as captured by NASA Task Load Index survey. We developed a coding scheme that enabled us to compare timing studies between CPRS and Epic and extract patient and visit complexity profiles. We identified similar patterns of EHR use and navigation at the 2 sites despite differences in functions, user interfaces and consequent coded representations. Both sites displayed similar proportions of EHR function use and navigation, and distribution of visit length, proportion of time physicians attended to EHRs (gaze), and subjective work-load as measured by the task load survey. We found that visit activity was highly variable across individual physicians, and the observed activity metrics ranged widely as correlates to subjective workload. We discuss implications of our study for methodology, clinical workflow and EHR redesign. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Training improves laparoscopic tasks performance and decreases operator workload.

    PubMed

    Hu, Jesse S L; Lu, Jirong; Tan, Wee Boon; Lomanto, Davide

    2016-05-01

    It has been postulated that increased operator workload during task performance may increase fatigue and surgical errors. The National Aeronautics and Space Administration-Task Load Index (NASA-TLX) is a validated tool for self-assessment for workload. Our study aims to assess the relationship of workload and performance of novices in simulated laparoscopic tasks of different complexity levels before and after training. Forty-seven novices without prior laparoscopic experience were recruited in a trial to investigate whether training improves task performance as well as mental workload. The participants were tested on three standard tasks (ring transfer, precision cutting and intracorporeal suturing) in increasing complexity based on the Fundamentals of Laparoscopic Surgery (FLS) curriculum. Following a period of training and rest, participants were tested again. Test scores were computed from time taken and time penalties for precision errors. Test scores and NASA-TLX scores were recorded pre- and post-training and analysed using paired t tests. One-way repeated measures ANOVA was used to analyse differences in NASA-TLX scores between the three tasks. NASA-TLX score was lowest with ring transfer and highest with intracorporeal suturing. This was statistically significant in both pre-training (p < 0.001) and post-training (p < 0.001). NASA-TLX scores mirror the changes in test scores for the three tasks. Workload scores decreased significantly after training for all three tasks (ring transfer = 2.93, p < 0.001, precision cutting = 3.74, p < 0.001, intracorporeal suturing = 2.98, p < 0.001). NASA-TLX score is an accurate reflection of the complexity of simulated laparoscopic tasks in the FLS curriculum. This also correlates with the relationship of test scores between the three tasks. Simulation training improves both performance score and workload score across the tasks.

  9. Neuraxial and Combined Neuraxial/General Anesthesia Compared to General Anesthesia for Major Truncal and Lower Limb Surgery: A Systematic Review and Meta-analysis.

    PubMed

    Smith, Lauren M; Cozowicz, Crispiana; Uda, Yoshiaki; Memtsoudis, Stavros G; Barrington, Michael J

    2017-12-01

    Neuraxial anesthesia may improve perioperative outcomes when compared to general anesthesia; however, this is controversial. We performed a systematic review and meta-analysis using randomized controlled trials and population-based observational studies identified in MEDLINE, PubMed, and EMBASE from 2010 to May 31, 2016. Studies were included for adult patients undergoing major surgery of the trunk and lower extremity that reported: 30-day mortality (primary outcome), cardiopulmonary morbidity, surgical site infection, thromboembolic events, blood transfusion, and resource use. Perioperative outcomes were compared with general anesthesia for the following subgroups: combined neuraxial-general anesthesia and neuraxial anesthesia alone. Odds ratios (ORs) and 99% confidence intervals (CIs) were calculated to identify the impact of anesthetic technique on outcomes. Twenty-seven observational studies and 11 randomized control trials were identified. This analysis comprises 1,082,965 records from observational studies or databases and 1134 patients from randomized controlled trials. There was no difference in 30-day mortality identified when combined neuraxial-general anesthesia was compared with general anesthesia (OR 0.88; 99% CI, 0.77-1.01), or when neuraxial anesthesia was compared with general anesthesia (OR 0.98; 99% CI, 0.92-1.04). When combined neuraxial-general anesthesia was compared with general anesthesia, combined neuraxial-general anesthesia was associated with a reduced odds of pulmonary complication (OR 0.84; 99% CI, 0.79-0.88), surgical site infection (OR 0.93; 99% CI, 0.88-0.98), blood transfusion (OR 0.90; 99% CI, 0.87-0.93), thromboembolic events (OR 0.84; 99% CI, 0.73-0.98), length of stay (mean difference -0.16 days; 99% CI, -0.17 to -0.15), and intensive care unit admission (OR 0.77; 99% CI, 0.73-0.81). For the combined neuraxial-general anesthesia subgroup, there were increased odds of myocardial infarction (OR 1.18; 99% CI, 1.01-1.37). There was

  10. Pilot Workload Measurement and Experience on Supersonic Cruise Aircraft

    NASA Technical Reports Server (NTRS)

    Rezek, T. W.

    1978-01-01

    Aircraft parameters and physiological parameters most indicative of crew workload were investigated. Recommendations were used to form the basis for a continuing study in which variations of the interval between heart beats are used as a measure of nonphysical workload. Preliminary results are presented and current efforts in further defining this physiological measure are outlined.

  11. Dissociation of performance and subjective measures of workload

    NASA Technical Reports Server (NTRS)

    Yeh, Yei-Yu; Wickens, Christopher D.

    1988-01-01

    A theory is presented to identify sources that produce dissociations between performance and subjective measures of workload. The theory states that performance is determined by (1) amount of resources invested, (2) resource efficiency, and (3) degree of competition for common resources in a multidimensional space described in the multiple-resources model. Subjective perception of workload, multidimensional in nature, increases with greater amounts of resource investment and with greater demands on working memory. Performance and subjective workload measures dissociate when greater resources are invested to improve performance of a resource-limited task; when demands on working memory are increased by time-sharing between concurrent tasks or between display elements; and when performance is sensitive to resource competition and subjective measures are more sensitive to total investment. These dissociation findings and their implications are discussed and directions for future research are suggested.

  12. Canadian anesthesia physician resources: 1996 and beyond.

    PubMed

    Donen, N; King, F; Reid, D; Blackstock, D

    1999-10-01

    To report physician resource information from the 1996 national anesthesia physician and residency programme surveys in Canada. The findings are used to discuss the potential effects on availability of future specialist anesthesia services in Canada. Twenty-six hundred and ninety-three physicians (2,206 specialists, 487 family physicians) providing anesthesia services were surveyed. Information on demographics and patterns of clinical practice were sought. Anesthesia programme directors provided trainee information. Projections of the potential number of practicing anesthesiologists to 2026 were made based on the number of available training positions and age distribution of anesthesiologists. There was a 58.3% response rate to the national survey. Since 1986 there has been a 10% increase in the number of specialist anesthesiologists. Marked regional variations in age distribution and changes in the number of specialist anesthesiologists were noted. Most specialists remain in the region or province of postgraduate training. Sixty percent of specialists were either re-entry trainees or international medical graduates. Changes in anesthesia practice patterns have resulted in 40% of the anesthesiologist's work now occurring outside of the operating room. Anesthesia training positions have decreased by at least 15%. The population of Canada is projected to increase by 33.8% between 1996 and 2026. If current government and position allocation policies continue, it is projected there will be 0% increase in the number of specialist anesthesiologists over the same time period. Changes in anesthesia practices have exacerbated the current shortages of anesthesiologists. These shortages will worsen if the number of, and restrictions to, available residency positions is unchanged.

  13. Improved lower extremity pedaling mechanics in individuals with stroke under maximal workloads.

    PubMed

    Linder, Susan M; Rosenfeldt, Anson B; Bazyk, Andrew S; Koop, Mandy Miller; Ozinga, Sarah; Alberts, Jay L

    2018-05-01

    Background Individuals with stroke present with motor control deficits resulting in the abnormal activation and timing of agonist and antagonist muscles and inefficient movement patterns. The analysis of pedaling biomechanics provides a window into understanding motor control deficits, which vary as a function of workload. Understanding the relationship between workload and motor control is critical when considering exercise prescription during stroke rehabilitation. Objectives To characterize pedaling kinematics and motor control processes under conditions in which workload was systematically increased to an eventual patient-specific maximum. Methods A cohort study was conducted in which 18 individuals with chronic stroke underwent a maximal exertion cardiopulmonary exercise test on a stationary cycle ergometer, during which pedaling torque was continuously recorded. Measures of force production, pedaling symmetry, and pedaling smoothness were obtained. Results Mean Torque increased significantly (p < 0.05) for both legs from initial to terminal workloads. Mean torque Symmetry Index, calculated for down and upstroke portions of the pedaling action, improved from 0.37(0.29) to 0.29(0.35) during downstroke (p = 0.007), and worsened during the upstroke: -0.37(0.38) to -0.62(0.46) (p < 0.001) from initial to terminal workloads. Low Torque Duration improved from initial to terminal workloads, decreasing from 121.1(52.9) to 58.1(39.6) degrees (p < 0.001), respectively. Smoothness of pedaling improved significantly from initial to terminal workloads (p < 0.001). Conclusions Improved pedaling kinematics at terminal workloads indicate that individuals with stroke demonstrate improved motor control with respect to the timing, sequencing, and activation of hemiparetic lower extremity musculature compared to lower workloads. Therapeutic prescription involving higher resistance may be necessary to sufficiently engage and activate the paretic lower extremity.

  14. NASA TLA workload analysis support. Volume 3: FFD autopilot scenario validation data

    NASA Technical Reports Server (NTRS)

    Sundstrom, J. L.

    1980-01-01

    The data used to validate a seven time line analysis of forward flight deck autopilot mode for the pilot and copilot for NASA B737 terminal configured vehicle are presented. Demand workloads are given in two forms: workload histograms and workload summaries (bar graphs). A report showing task length and task interaction is also presented.

  15. Student Workload and Assessment: Strategies to Manage Expectations and Inform Curriculum Development

    ERIC Educational Resources Information Center

    Scully, Glennda; Kerr, Rosemary

    2014-01-01

    This study reports the results of a survey of student study times and perceptions of workload in undergraduate and graduate accounting courses at a large Australian public university. The study was in response to student feedback expressing concerns about workload in courses. The presage factors of student workload and assessment in Biggs' 3P…

  16. [Indications and risk factors for emergency obstetric hysterectomy].

    PubMed

    Nava Flores, Jorge; Paez Angulo, José Antonio; Veloz Martínez, Guadalupe; Sánchez Valle, Verónica; Hernández-Valencia, Marcelino

    2002-06-01

    Emergency obstetric hysterectomy is a procedure that potentially preserves the life and the postpartum bleeding is the direct cause of its indication, the hemorrhage postpartum happens in 1% of obstetric patients. This study was carried out to identify women with potential risk for this event and to prevent this obstetric problem. The most frequent indications for hysterectomy were identified, as well as the sociodemographic characteristic of the patients. The surgical procedure carried out was extra-fascial technique with type Richardson hysterectomy modified; the surgical pieces went to the pathology service, to obtain the histopathological diagnosis. 43 cases of obstetric hysterectomy, were analyzed; the characteristics of this group showed that bigger percentage of this event was more frequent in 31 to 35 years (39.5%), with pregnancies at term (51.1%) in third pregnancies(27.9%), nulliparas (60.4%), with first cesarean section (39.5%), without previous abortions (79.0%). The most frequent obstetric complications were uterine atony and placenta accreta. The cause for uterine atony could be interstitial edema, as well as myometrial hypertrophy, because such histopathological diagnoses were the most common. Odds ratio showed that a patient with cesarean section has 1.16 more probabilities of suffering hysterectomy than a woman with childbirth. This study describes the histological presence of interstitial edema and myometrial hypertrophy as possible causes of uterine atony in the histological study of surgical specimen. This could be related to no response of myometrial to the uterus-tonic effect of oxytocin. Obstetric uterine dysfunction has multifactorial cause. Patients with the characteristics described in this study should be considered as high risk.

  17. Workload and non-contact injury incidence in elite football players competing in European leagues.

    PubMed

    Delecroix, Barthelemy; McCall, Alan; Dawson, Brian; Berthoin, Serge; Dupont, Gregory

    2018-06-02

    The aim of this study was to analyse the relationship between absolute and acute:chronic workload ratios and non-contact injury incidence in professional football players and to assess their predictive ability. Elite football players (n = 130) from five teams competing in European domestic and confederation level competitions were followed during one full competitive season. Non-contact injuries were recorded and using session rate of perceived exertion (s-RPE) internal absolute workload and acute:chronic (A:C) workload ratios (4-weeks, 3-weeks, 2-weeks and week-to-week) were calculated using a rolling days method. The relative risk (RR) of non-contact injury was increased (RR = 1.59, CI95%: 1.18-2.15) when a cumulative 4-week absolute workload was greater than 10629 arbitrary units (AU) in comparison with a workload between 3745 and 10628 AU. When the 3-week absolute workload was more than 8319 AU versus between 2822 and 8318 AU injury risk was also increased (RR= 1.46, CI95% 1.08-1.98). Injury incidence was higher when the 4-week A:C ratio was <0.85 versus >0.85 (RR = 1.31, CI95%: 1.02-1.70) and with a 3-week A:C ratio >1.30 versus <1.30 (RR = 1.37, CI95%: 1.05-1.77). Importantly, none of the A:C workload combinations showed high sensitivity or specificity. In elite European footballers, using internal workload (sRPE) revealed that cumulative workloads over 3 and 4 weeks were associated with injury incidence. Additionally, A:C workloads, using combinations of 2, 3 and 4 weeks as the C workloads were also associated with increased injury risk. No A:C workload combination was appropriate to predict injury.

  18. Cognitive Workload and Psychophysiological Parameters During Multitask Activity in Helicopter Pilots.

    PubMed

    Gaetan, Sophie; Dousset, Erick; Marqueste, Tanguy; Bringoux, Lionel; Bourdin, Christophe; Vercher, Jean-Louis; Besson, Patricia

    2015-12-01

    Helicopter pilots are involved in a complex multitask activity, implying overuse of cognitive resources, which may result in piloting task impairment or in decision-making failure. Studies usually investigate this phenomenon in well-controlled, poorly ecological situations by focusing on the correlation between physiological values and either cognitive workload or emotional state. This study aimed at jointly exploring workload induced by a realistic simulated helicopter flight mission and emotional state, as well as physiological markers. The experiment took place in the helicopter full flight dynamic simulator. Six participants had to fly on two missions. Workload level, skin conductance, RMS-EMG, and emotional state were assessed. Joint analysis of psychological and physiological parameters associated with workload estimation revealed particular dynamics in each of three profiles. 1) Expert pilots showed a slight increase of measured physiological parameters associated with the increase in difficulty level. Workload estimates never reached the highest level and the emotional state for this profile only referred to positive emotions with low emotional intensity. 2) Non-Expert pilots showed increasing physiological values as the perceived workload increased. However, their emotional state referred to either positive or negative emotions, with a greater variability in emotional intensity. 3) Intermediate pilots were similar to Expert pilots regarding emotional states and similar to Non-Expert pilots regarding physiological patterns. Overall, high interindividual variability of these results highlight the complex link between physiological and psychological parameters with workload, and question whether physiology alone could predict a pilot's inability to make the right decision at the right time.

  19. A simplified open gastrostomy under local anesthesia.

    PubMed

    Zickler, R W; Barbagiovanni, J T; Swan, K G

    2001-08-01

    Revision of the standard gastrostomy is often necessary in patients with neuromuscular disorders. These patients pose many anesthetic risks that frequently preclude the use of general anesthesia, intravenous sedation, or endoscopy. Modification of the Stamm gastrostomy enables it to be performed comfortably and readily under local anesthesia. The modification proposed passes the gastrostomy tube through the omentum en route to the abdominal wall. This ensures a seal to the surgical site, eliminates the need for tacking sutures, and allows for a smaller midline incision. These factors greatly reduce the discomfort of the procedure allowing it to be easily accomplished under local anesthesia. This technique of open gastrostomy under local anesthesia has been used in more than 35 patients over the past 10 years with no documented leaks.

  20. Eye Tracking Metrics for Workload Estimation in Flight Deck Operation

    NASA Technical Reports Server (NTRS)

    Ellis, Kyle; Schnell, Thomas

    2010-01-01

    Flight decks of the future are being enhanced through improved avionics that adapt to both aircraft and operator state. Eye tracking allows for non-invasive analysis of pilot eye movements, from which a set of metrics can be derived to effectively and reliably characterize workload. This research identifies eye tracking metrics that correlate to aircraft automation conditions, and identifies the correlation of pilot workload to the same automation conditions. Saccade length was used as an indirect index of pilot workload: Pilots in the fully automated condition were observed to have on average, larger saccadic movements in contrast to the guidance and manual flight conditions. The data set itself also provides a general model of human eye movement behavior and so ostensibly visual attention distribution in the cockpit for approach to land tasks with various levels of automation, by means of the same metrics used for workload algorithm development.

  1. Obstetrical referrals by traditional birth attendants.

    PubMed

    Mustafa, Rozina; Hashmi, Haleema; Mustafa, Rubina

    2012-01-01

    In Pakistan 90% of births are conducted by TBA's. In most cases, TBA's are unable to diagnose the complications and are often unable to take decisions on timely referral. The objective of this study was to determine the prevalence, nature and outcome of life threatening obstetrical conditions in referrals by Traditional Birth Attendants (TBAs). This Observational, Descriptive study was conducted from January to December 2007, in the obstetrical unit of Fatima Hospital, Baqai Medical University, a tertiary care community based hospital. The study included patients referred by TBA's who developed life threatening obstetric conditions (LTOCs). Total 64 patients were referred by TBA's. The prevalence was 7.8%. Out of them, 53 (82.8%) patients admitted with life threatening obstetric conditions. The near-miss morbidities and mortalities were 45 (84.9%) and 8 (15%) respectively. Maternal mortality to Near-miss morbidity ratio was 1:6. Obstructed labour caused near-miss morbidity in 32 (60.3%) patients with no mortality. Postpartum haemorrhage as life threatening condition developed in 16 (30.1%) patients with 10 (18.8%) near-miss morbidities and 6 (11.3%) mortalities. Puerperal sepsis accounted for 1 (1.88%) near-miss morbidity and 2 (3.76%) mortalities. The mortality index for puerperal sepsis is (66.6%) almost double of postpartum haemorrhage (37.5%). Mortality to near miss morbidity ratio is high. Misidentification and late referrals of complicated cases by TBA's were responsible for near-miss morbidities and mortalities.

  2. Interactive Query Processing in Big Data Systems: A Cross Industry Study of MapReduce Workloads

    DTIC Science & Technology

    2012-04-02

    invite cluster operators and the broader data management commu- nity to share additional knowledge about their MapReduce workloads. 9. ACKNOWLEDGMENTS...against real- life production MapReduce workloads. Knowledge of such workloads is currently limited to a handful of technology companies [19, 8, 48, 41...database management insights would benefit from checking workload assumptions against empirical measurements. The broad spectrum of workloads analyzed allows

  3. Are obstetric outcomes affected by female genital mutilation?

    PubMed

    Balachandran, Aswini A; Duvalla, Swapna; Sultan, Abdul H; Thakar, Ranee

    2018-03-01

    Female genital mutilation (FGM) has been associated with adverse obstetric and neonatal outcomes, such as postpartum haemorrhage (PPH), perineal trauma, genital fistulae, obstructed labour and stillbirth. The prevalence of FGM has increased in the UK over the last decade. There are currently no studies available that have explored the obstetric impact of FGM in the UK. The aim of our study was to investigate the obstetric and neonatal outcomes of women with FGM when compared with the general population. We conducted a retrospective case-control study of consecutive pregnant women with FGM over a 5-year period between 1 January 2009 and 31 December 2013. Each woman with FGM was matched for age, ethnicity, parity and gestation with subsequent patients without FGM (control cohort) over the same 5-year period. Outcomes assessed were mode of delivery, duration of labour, estimated blood loss, analgaesia, perineal trauma and foetal outcomes. A total of 242 eligible women (121 FGM, 121 control) were identified for the study. There was a significant increase in the use of episiotomy in the FGM group (p = 0.009) and a significant increase in minor PPH in the control group during caesarean sections (p = 0.0001). There were no differences in all other obstetric and neonatal parameters. In our unit, FGM was not associated with an increased incidence of adverse obstetric and foetal morbidity or mortality.

  4. Psychological Symptoms Among Obstetric Fistula Patients Compared to Gynecology Outpatients in Tanzania

    PubMed Central

    Wilson, Sarah M.; Sikkema, Kathleen J.; Watt, Melissa H.; Masenga, Gileard G.

    2016-01-01

    Background Obstetric fistula is a childbirth injury prevalent in sub-Saharan Africa that causes uncontrollable leaking of urine and/or feces. Research has documented the social and psychological sequelae of obstetric fistula, including mental health dysfunction and social isolation. Purpose This cross-sectional study sought to quantify the psychological symptoms and social support in obstetric fistula patients, compared with a patient population of women without obstetric fistula. Methods Participants were gynecology patients (N = 144) at the Kilimanjaro Christian Medical Center in Moshi, Tanzania, recruited from the Fistula Ward (n = 54) as well as gynecology outpatient clinics (n = 90). Measures included previously validated psychometric questionnaires, administered orally by Tanzanian nurses. Outcome variables were compared between obstetric fistula patients and gynecology outpatients, controlling for background demographic variables and multiple comparisons. Results Compared to gynecology outpatients, obstetric fistula patients reported significantly higher symptoms of depression, posttraumatic stress disorder, somatic complaints, and maladaptive coping. They also reported significantly lower social support. Conclusions Obstetric fistula patients present for repair surgery with more severe psychological distress than gynecology outpatients. In order to address these mental health concerns, clinicians should engage obstetric fistula patients with targeted mental health interventions. PMID:25670025

  5. Obstetric Safety and Quality.

    PubMed

    Pettker, Christian M; Grobman, William A

    2015-07-01

    Obstetric safety and quality is an emerging and important topic not only as a result of the pressures of patient and regulatory expectations, but also because of the genuine interest of caregivers to reduce harm, improve outcomes, and optimize care. Although each seeks to improve care by using scientific approaches beyond human physiology and pathophysiology, patient safety methodologies seek to avoid preventable adverse events, whereas health care quality projects aim to achieve the best possible outcomes. It is well-documented that an increasingly complex medical system controlled by human workers is a circumstance subject to recurrent failure. A safety culture encourages a proactive approach to mitigate failure before, during, and after it occurs. This article highlights the key concepts in health care safety and quality and reviews the background of the quality improvement sciences with particular emphasis on obstetric outcomes and quality measures.

  6. [Distribution and main influential factors of mental workload of middle school teachers in Nanchang City].

    PubMed

    Xiao, Yuanmei; Li, Weijuan; Ren, Qingfeng; Ren, Xiaohui; Wang, Zhiming; Wang, Mianzhen; Lan, Yajia

    2015-01-01

    To investigate the distribution and main influential factors of mental workload of middle school teachers in Nanchang City. A total of 504 middle school teachers were sampled by random cluster sampling from middle schools in Nanchang City, and the mental workload level was assessed with National Aeronautics and Space Administration-Task Load Index (NASA-TLX) which was verified in reliability and validity. The mental workload scores of middle school teachers in Nanchang was approximately normal distribution. The mental workload level of middle school teachers aged 31 -35 years old was the highest. For those no more than 35 years old, there was positive correlation between mental workload and age (r = 0.146, P < 0.05). For those more than 35 years old, the levels of their mental workload had no statistically significant difference. There was a negative correlation between mental workload and educational level(r = -0.172, P < 0.05). The middle school teachers with lower educational level seemed to have a higher mental workload (P < 0.01). The longer a middle school teacher worked per day, the higher the mental workload was. Working hours per day was the most influential factor on mental workload in all influential factors (P < 0.001). Mental workload of middle school teachers was closely related to age, educational level and work hours per day. Working hours per day was the important risk factor of mental workload. Reducing working hours per day, especially reducing it to be no more than 8 hours per day, may be a significant and useful approach alleviating mental workload of middle school teachers in Nanchang City.

  7. Risk in pediatric anesthesia.

    PubMed

    Paterson, Neil; Waterhouse, Peter

    2011-08-01

    Risk in pediatric anesthesia can be conveniently classified as minor or major. Major morbidity includes cardiac arrest, brain damage and death. Minor morbidity can be assessed by clinical audits with small patient samples. Major morbidity is rare. It is best assessed by very large clinical studies and by review of closed malpractice claims. Both minor and major morbidity occur most commonly in infants and children under three, especially those with severe co-morbidities. Knowledge of risk profiles in pediatric anesthesia is a starting point for the reduction of risk. © 2010 Blackwell Publishing Ltd.

  8. Repetitive Pediatric Anesthesia in a Non-Hospital Setting

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Buchsbaum, Jeffrey C., E-mail: jbuchsba@iupui.edu; Indiana University Health Proton Therapy Center, Bloomington, Indiana; McMullen, Kevin P.

    2013-04-01

    Purpose: Repetitive sedation/anesthesia (S/A) for children receiving fractionated radiation therapy requires induction and recovery daily for several weeks. In the vast majority of cases, this is accomplished in an academic center with direct access to pediatric faculty and facilities in case of an emergency. Proton radiation therapy centers are more frequently free-standing facilities at some distance from specialized pediatric care. This poses a potential dilemma in the case of children requiring anesthesia. Methods and Materials: The records of the Indiana University Health Proton Therapy Center were reviewed for patients requiring anesthesia during proton beam therapy (PBT) between June 1, 2008,more » and April 12, 2012. Results: A total of 138 children received daily anesthesia during this period. A median of 30 fractions (range, 1-49) was delivered over a median of 43 days (range, 1-74) for a total of 4045 sedation/anesthesia procedures. Three events (0.0074%) occurred, 1 fall from a gurney during anesthesia recovery and 2 aspiration events requiring emergency department evaluation. All 3 children did well. One aspiration patient needed admission to the hospital and mechanical ventilation support. The other patient returned the next day for treatment without issue. The patient who fell was not injured. No patient required cessation of therapy. Conclusions: This is the largest reported series of repetitive pediatric anesthesia in radiation therapy, and the only available data from the proton environment. Strict adherence to rigorous protocols and a well-trained team can safely deliver daily sedation/anesthesia in free-standing proton centers.« less

  9. Electronic fetal monitoring: family medicine obstetrics.

    PubMed

    Rodney, John R M; Huntley, Benjamin J F; Rodney, Wm Macmillan

    2012-03-01

    Electronic fetal monitoring assesses fetal health during the prenatal and intrapartum process. Intermittent auscultation does not detect key elements of fetal risk, such as beat-to-beat variability. Family medicine obstetric fellowships have contributed new knowledge to this process by articulating a method of analysis that builds on evidence-based recommendations from the American College of Obstetrics and Gynecology as well as the National Institute of Child Health and Development. This article summarizes the development, interpretation, and management of electronic fetal heart rate patterns and tracings. Copyright © 2012 Elsevier Inc. All rights reserved.

  10. [Ophthalmic complications and local anesthesia. Pathophysiology and types of eye complications after intraoral dental anesthesia, and clinical recommendations].

    PubMed

    von Arx, Thomas; Lozanoff, Scott; Zinkernagel, Martin

    2014-01-01

    The present article reviews the different types of ophthalmologic complications following administration of intraoral local anesthesia. Since the first report by Brain in 1936, case reports about that topic have been published regularly in the literature. However, clinical studies evaluating the incidence of ophthalmologic complications after intraoral local anesthesia are rarely available. Previous data point to a frequency ranging from 0.03% to 0.13%. The most frequently described ophthalmologic complications include diplopia (double vision), ptosis (drooping of upper eyelid), and mydriasis (dilatation of pupil). Disorders that rather affect periorbital structures than the eye directly include facial paralysis and periorbital blanching (angiospasm). Diverse pathophysiologic mechanisms and causes have been reported in the literature, with the inadvertent intravascular administration of the local anesthetic considered the primary reason. The agent as well as the vasopressor is transported retrogradely via arteries or veins to the orbit or to periorbital structures (such as the cavernous sinus) with subsequent anesthesia of nerves and paralysis of muscles distant from the oral cavity. In general the ophthalmologic complications begin shortly after administration of the local anesthesia, and disappear once the local anesthesia has subsided.

  11. Social Experiences of Women with Obstetric Fistula Seeking Treatment in Kampala, Uganda.

    PubMed

    Meurice, Marielle; Genadry, Rene; Heimer, Carol; Ruffer, Galya; Kafunjo, Barageine Justus

    Obstetric fistula is a preventable and treatable condition predominately affecting women in low-income countries. Understanding the social context of obstetric fistula may lead to improved prevention and treatment. This study investigated social experiences of women with obstetric fistula seeking treatment at Mulago Hospital in Kampala, Uganda. A descriptive study was conducted among women seeking treatment for obstetric fistula during a surgical camp in July 2011 using a structured questionnaire. Descriptive statistics were computed regarding sociodemographics, obstetric history, and social experience. Fifty-three women participated; 39 (73.58%) leaked urine only. Median age was 29 years (range: 17-58), and most were married or separated. About half (28, 47.9%) experienced a change in their relationship since acquiring obstetric fistula. More than half (27, 50.94%) acquired obstetric fistula during their first delivery, despite almost everyone (50, 94.3%) receiving antenatal care. The median years suffering from obstetric fistula was 1.25. Nearly every participant's social participation changed in at least one setting (51, 96.23%). Most women thought that a baby being too big or having kicked their bladder was the cause of obstetric fistula. Other participants thought health care providers caused the fistula (15, 32.61%; n = 46), with 8 specifying that the bladder was cut during the operation (cesarean section). Knowing someone with obstetric fistula was influential in pursuing treatment. The majority of participants planned to return to family (40, 78.43%; n = 51) and get pregnant after repair (35, 66.04%; n = 53). Study participants experienced substantial changes in their social lives as a result of obstetric fistula, and there were a variety of beliefs regarding the cause. The complex social context is an important component to understanding how to prevent and treat obstetric fistula. Further elucidation of these factors may bolster current efforts in

  12. Domestic violence in the pregnant patient: obstetric and behavioral interventions.

    PubMed

    Mayer, L; Liebschutz, J

    1998-10-01

    Every day, obstetric providers treat patients experiencing domestic violence. Domestic violence can have both dramatic and subtle impacts on maternal and fetal morbidity and mortality. This article enumerates patient risk factors for and obstetric consequences of domestic violence. It describes adaptations to the assessment and treatment of pregnancy complications occurring in the context of domestic violence and presents behavioral interventions that can be performed within existing obstetric care delivery systems. Behavioral interventions include assessments of a patient's readiness for change and her emotional responses to the violence. Obstetric interventions include an assessment of risk of physical harm to a pregnant woman and her fetus from domestic violence. Interviewing techniques include educating the patient about the effects of abuse and, over time, validating a patient's efforts to change. Reliance on a team approach and use of community resources are emphasized. All of these mechanisms enable obstetric providers to assist pregnant women in taking steps to end the abuse.

  13. Unsupervised classification of operator workload from brain signals.

    PubMed

    Schultze-Kraft, Matthias; Dähne, Sven; Gugler, Manfred; Curio, Gabriel; Blankertz, Benjamin

    2016-06-01

    In this study we aimed for the classification of operator workload as it is expected in many real-life workplace environments. We explored brain-signal based workload predictors that differ with respect to the level of label information required for training, including entirely unsupervised approaches. Subjects executed a task on a touch screen that required continuous effort of visual and motor processing with alternating difficulty. We first employed classical approaches for workload state classification that operate on the sensor space of EEG and compared those to the performance of three state-of-the-art spatial filtering methods: common spatial patterns (CSPs) analysis, which requires binary label information; source power co-modulation (SPoC) analysis, which uses the subjects' error rate as a target function; and canonical SPoC (cSPoC) analysis, which solely makes use of cross-frequency power correlations induced by different states of workload and thus represents an unsupervised approach. Finally, we investigated the effects of fusing brain signals and peripheral physiological measures (PPMs) and examined the added value for improving classification performance. Mean classification accuracies of 94%, 92% and 82% were achieved with CSP, SPoC, cSPoC, respectively. These methods outperformed the approaches that did not use spatial filtering and they extracted physiologically plausible components. The performance of the unsupervised cSPoC is significantly increased by augmenting it with PPM features. Our analyses ensured that the signal sources used for classification were of cortical origin and not contaminated with artifacts. Our findings show that workload states can be successfully differentiated from brain signals, even when less and less information from the experimental paradigm is used, thus paving the way for real-world applications in which label information may be noisy or entirely unavailable.

  14. Unsupervised classification of operator workload from brain signals

    NASA Astrophysics Data System (ADS)

    Schultze-Kraft, Matthias; Dähne, Sven; Gugler, Manfred; Curio, Gabriel; Blankertz, Benjamin

    2016-06-01

    Objective. In this study we aimed for the classification of operator workload as it is expected in many real-life workplace environments. We explored brain-signal based workload predictors that differ with respect to the level of label information required for training, including entirely unsupervised approaches. Approach. Subjects executed a task on a touch screen that required continuous effort of visual and motor processing with alternating difficulty. We first employed classical approaches for workload state classification that operate on the sensor space of EEG and compared those to the performance of three state-of-the-art spatial filtering methods: common spatial patterns (CSPs) analysis, which requires binary label information; source power co-modulation (SPoC) analysis, which uses the subjects’ error rate as a target function; and canonical SPoC (cSPoC) analysis, which solely makes use of cross-frequency power correlations induced by different states of workload and thus represents an unsupervised approach. Finally, we investigated the effects of fusing brain signals and peripheral physiological measures (PPMs) and examined the added value for improving classification performance. Main results. Mean classification accuracies of 94%, 92% and 82% were achieved with CSP, SPoC, cSPoC, respectively. These methods outperformed the approaches that did not use spatial filtering and they extracted physiologically plausible components. The performance of the unsupervised cSPoC is significantly increased by augmenting it with PPM features. Significance. Our analyses ensured that the signal sources used for classification were of cortical origin and not contaminated with artifacts. Our findings show that workload states can be successfully differentiated from brain signals, even when less and less information from the experimental paradigm is used, thus paving the way for real-world applications in which label information may be noisy or entirely unavailable.

  15. Prevention in Obstetrics.

    ERIC Educational Resources Information Center

    Children in the Tropics, 1984

    1984-01-01

    The aim of this issue of "Children in the Tropics" is to describe work that may be done by a motivated health team having only the strict minimum of material resources. While not a handbook of obstetrics, this text serves as a reminder of basic information and procedures workers must be able to perform. Following a review of the…

  16. Debriefing decreases mental workload in surgical crisis: A randomized controlled trial.

    PubMed

    Boet, Sylvain; Sharma, Bharat; Pigford, Ashlee-Ann; Hladkowicz, Emily; Rittenhouse, Neil; Grantcharov, Teodor

    2017-05-01

    Mental workload is the amount of mental effort involved in performing a particular task. Crisis situations may increase mental workload, which can subsequently negatively impact operative performance and patient safety. This study aims to measure the impact of learning through debriefing and a systematic approach to crisis on trainees' mental workload in a simulated surgical crisis. Twenty junior surgical residents participated in a high-fidelity, simulated, postoperative crisis in a surgical ward environment (pretest). Participants were randomized to either an instructor-led debriefing, including performance feedback (intervention; n = 10) or no debriefing (control; n = 10). Subjects then immediately managed a second simulated crisis (post-test). Mental workload was assessed in real time during the scenarios using a previously validated, wireless, vibrotactile device. Mental workload was represented by subject response times to the vibrations, which were recorded and analyzed using the Mann-Whitney U test. Participants in the debriefing arm had a significantly reduced median response time in milliseconds (post-test minus pretest -695, quartile range -2,136 to -297) compared to participants in the control arm (42, -1,191 to 763), (between-arm difference P = .049). Debriefing after simulated surgical crisis situations may improve performance by decreasing trainee's mental workload during a subsequent simulated surgical crisis. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Barriers to formal emergency obstetric care services' utilization.

    PubMed

    Essendi, Hildah; Mills, Samuel; Fotso, Jean-Christophe

    2011-06-01

    Access to appropriate health care including skilled birth attendance at delivery and timely referrals to emergency obstetric care services can greatly reduce maternal deaths and disabilities, yet women in sub-Saharan Africa continue to face limited access to skilled delivery services. This study relies on qualitative data collected from residents of two slums in Nairobi, Kenya in 2006 to investigate views surrounding barriers to the uptake of formal obstetric services. Data indicate that slum dwellers prefer formal to informal obstetric services. However, their efforts to utilize formal emergency obstetric care services are constrained by various factors including ineffective health decision making at the family level, inadequate transport facilities to formal care facilities and insecurity at night, high cost of health services, and inhospitable formal service providers and poorly equipped health facilities in the slums. As a result, a majority of slum dwellers opt for delivery services offered by traditional birth attendants (TBAs) who lack essential skills and equipment, thereby increasing the risk of death and disability. Based on these findings, we maintain that urban poor women face barriers to access of formal obstetric services at family, community, and health facility levels, and efforts to reduce maternal morbidity and mortality among the urban poor must tackle the barriers, which operate at these different levels to hinder women's access to formal obstetric care services. We recommend continuous community education on symptoms of complications related to pregnancy and timely referral. A focus on training of health personnel on "public relations" could also restore confidence in the health-care system with this populace. Further, we recommend improving the health facilities in the slums, improving the services provided by TBAs through capacity building as well as involving TBAs in referral processes to make access to services timely. Measures can also be

  18. Teaching primary care obstetrics: insights and recruitment recommendations from family physicians.

    PubMed

    Koppula, Sudha; Brown, Judith B; Jordan, John M

    2014-03-01

    To explore the experiences and recommendations for recruitment of family physicians who practise and teach primary care obstetrics. Qualitative study using in-depth interviews. Six primary care obstetrics groups in Edmonton, Alta, that were involved in teaching family medicine residents in the Department of Family Medicine at the University of Alberta. Twelve family physicians who practised obstetrics in groups. All participants were women, which was reasonably representative of primary care obstetrics providers in Edmonton. Each participant underwent an in-depth interview. The interviews were audiotaped and transcribed verbatim. The investigators independently reviewed the transcripts and then analyzed the transcripts together in an iterative and interpretive manner. Themes identified in this study include lack of confidence in teaching, challenges of having learners, benefits of having learners, and recommendations for recruiting learners to primary care obstetrics. While participants described insecurity and challenges related to teaching, they also identified positive aspects, and offered suggestions for recruiting learners to primary care obstetrics. Despite describing poor confidence as teachers and having challenges with learners, the participants identified positive experiences that sustained their interest in teaching. Supporting these teachers and recruiting more such role models is important to encourage family medicine learners to enter careers such as primary care obstetrics.

  19. Caffeine accelerates recovery from general anesthesia via multiple pathways.

    PubMed

    Fong, Robert; Khokhar, Suhail; Chowdhury, Atif N; Xie, Kelvin G; Wong, Josiah Hiu-Yuen; Fox, Aaron P; Xie, Zheng

    2017-09-01

    Various studies have explored different ways to speed emergence from anesthesia. Previously, we have shown that three drugs that elevate intracellular cAMP (forskolin, theophylline, and caffeine) accelerate emergence from anesthesia in rats. However, our earlier studies left two main questions unanswered. First, were cAMP-elevating drugs effective at all anesthetic concentrations? Second, given that caffeine was the most effective of the drugs tested, why was caffeine more effective than forskolin since both drugs elevate cAMP? In our current study, emergence time from anesthesia was measured in adult rats exposed to 3% isoflurane for 60 min. Caffeine dramatically accelerated emergence from anesthesia, even at the high level of anesthetic employed. Caffeine has multiple actions including blockade of adenosine receptors. We show that the selective A 2a adenosine receptor antagonist preladenant or the intracellular cAMP ([cAMP] i )-elevating drug forskolin, accelerated recovery from anesthesia. When preladenant and forskolin were tested together, the effect on anesthesia recovery time was additive indicating that these drugs operate via different pathways. Furthermore, the combination of preladenant and forskolin was about as effective as caffeine suggesting that both A 2A receptor blockade and [cAMP] i elevation play a role in caffeine's ability to accelerate emergence from anesthesia. Because anesthesia in rodents is thought to be similar to that in humans, these results suggest that caffeine might allow for rapid and uniform emergence from general anesthesia in humans at all anesthetic concentrations and that both the elevation of [cAMP] i and adenosine receptor blockade play a role in this response. NEW & NOTEWORTHY Currently, there is no method to accelerate emergence from anesthesia. Patients "wake" when they clear the anesthetic from their systems. Previously, we have shown that caffeine can accelerate emergence from anesthesia. In this study, we show that

  20. Assessing workload in neuropsychology: An illustration with the Tower of Hanoi test.

    PubMed

    Hardy, David J; Wright, Matthew J

    2018-05-30

    Workload is a common and useful construct in human factors research that has been largely overlooked in other areas of psychology, including neuropsychology, where it could be effectively employed both theoretically and practically. A popular subjective measure of workload, the NASA-Task Load Index (NASA-TLX), is illustrated with a computerized version of the Tower of Hanoi (TOH), a typical neuropsychological test of executive function. Reported workload, especially as an overall measure and also for the Mental Demand and Effort subscales, was greater in the more difficult TOH conditions and was positively correlated with number of moves to complete the TOH as well as completion time. Thus, results support the utility or construct validity of the NASA-TLX in reflecting workload states in the individual as well as various demands of the neuropsychological test (the timing, physical demands, etc.). It is argued that workload can be a useful construct in neuropsychological assessment, providing an additional channel of information on patient status. For instance, what does it mean if test performance for a patient is at a typical level (indicating no deficit) but workload is exceptionally high?

  1. Workloads in Australian emergency departments a descriptive study.

    PubMed

    Lyneham, Joy; Cloughessy, Liz; Martin, Valmai

    2008-07-01

    This study aimed to identify the current workload of clinical nurses, managers and educators in Australian Emergency Departments according to the classification of the department Additionally the relationship of experienced to inexperienced clinical staff was examined. A descriptive research method utilising a survey distributed to 394 Australian Emergency departments with a 21% response rate. Nursing workloads were calculated and a ratio of nurse to patient was established. The ratios included nurse to patient, management and educators to clinical staff. Additionally the percentage of junior to senior clinical staff was also calculated. Across all categories of emergency departments the mean nurse:patient ratios were 1:15 (am shift), 1:7 (pm shift) and 1:4 (night shift). During this period an average of 17.1% of attendances were admitted to hospital. There were 27 staff members for each manager and 23.3 clinical staff for each educator. The percentage of junior staff rostered ranged from 10% to 38%. Emergency nurses cannot work under such pressure as it may compromise the care given to patients and consequently have a negative effect on the nurse personally. However, emergency nurses are dynamically adjusting to the workload. Such conditions as described in this study could give rise to burnout and attrition of experienced emergency nurses as they cannot resolve the conflict between workload and providing quality nursing care.

  2. Parents' satisfaction with pediatric ambulatory anesthesia in northeast of Thailand.

    PubMed

    Boonmak, Suhattaya; Boonmak, Polpun; Pothiruk, Kittawan; Hoontanee, Nattakhan

    2009-12-01

    Study the satisfaction of parents with ambulatory anesthesia and associated factors, including characteristics of the patients and their parents. This was a prospective, descriptive, observation study. The authors included children who were scheduled for ambulatory anesthetic service between birth and 14 years of age and attended at Srinagarind Hospital, Khon Kaen, Thailand. The authors excluded patients whose parents could not be reached by telephone. Before anesthesia, the authors recorded the patients and parents' characteristics, level of information perception (pre-, peri- and post-anesthesia and complications). After anesthesia, the anesthesia technique and any complications were recorded. The day after anesthesia, the authors made phone calls to the patients to record the parents' satisfaction score (viz, of overall, pre-, peri- and post-anesthesia care, and information about the level of patient care at home), and any anesthesia related complications. Ninety-two patients and their parents were included in the present study. Overall parents 'satisfaction with the anesthesia service was 96.7% (i.e., 89/92) (95% CI 90.8-99.3). Parents' satisfaction with pre- and peri-anesthesia care was 100% (95% CI 96.1-100) and 97.9% (95% CI 92.4-99.7), respectively. Parents' satisfaction with the PACU care and information of patient care at home was 96.7% (95% CI 90.8-99.3) and 91.3% (95% CI 83.6-96.2), respectively. Associated factors where parents were dissatisfied included PACU care satisfaction (i.e., relative risk 22.5 (95% CI 3.2-158)) and patient care information at home (i.e., relative risk 13.3 (95% CI 1.3-136.0)). The present study showed a high level of parents' satisfaction. Parents' dissatisfaction associated with PACU care and information about post anesthesia care at home. Additionally information on parents' characteristics provides invaluable data for improving pediatric ambulatory anesthesia in Srinagarind Hospital.

  3. Anesthesia Quality and Patient Safety in China: A Survey.

    PubMed

    Zhu, Bin; Gao, Huan; Zhou, Xiangyong; Huang, Jeffrey

    There has been no nationwide investigation into anesthesia quality and patient safety in China. The authors surveyed Chinese anesthesiologists about anesthesia quality by sending a survey to all anesthesiologist members of the New Youth Anesthesia Forum via WeChat. The respondents could choose to use a mobile device or desktop to complete the survey. The overall response rate was 43%. Intraoperative monitoring: 77.9% of respondents reported that electrocardiogram monitoring was routinely applied for all patients; only 55% of the respondents reported that they routinely used end-tidal carbon dioxide monitoring for their patients under general anesthesia. 10.3% of respondents admitted that they had at least one wrong medicine administration in the past 3 months; 12.4% reported that they had at least one case of cardiac arrest in the past year. This is the first anesthesia quality survey in China. The findings revealed potential anesthesia safety issues in China.

  4. The contribution of multiple pregnancies from overseas fertility treatment to obstetric services in a Western Australian tertiary obstetric hospital.

    PubMed

    Waller, Kylie Anne; Dickinson, Jan E; Hart, Roger J

    2017-08-01

    Increasingly couples are travelling overseas to access assisted reproductive technology, known as cross border reproductive care, although the incidence, pregnancy outcomes and healthcare costs are unknown. To determine obstetric and neonatal outcomes for multiple pregnancies conceived through fertility treatment overseas, and estimate cost of these pregnancies to the health system. Retrospective study of women receiving care for a multiple gestation between July 2013 and June 2015 at Western Australia's sole tertiary obstetric hospital, where conception was by overseas fertility treatment. Obstetric and neonatal outcomes were recorded and cost estimates calculated. Of 11 710 births, 422 were multiple pregnancies. Thirty-seven pregnancies were conceived with fertility treatment, with 11 (29.7%) conceived overseas. Median antenatal clinic attendances, ultrasound examinations, and fetal assessments for the overseas fertility cases were six, 10, and nine, respectively. The gestational age at delivery ranged from 30 to 38 weeks (median 34 + 1). Median neonatal admission duration was 18 days (range 0-47). Cost for obstetric care was estimated between $170 000 and $216 000, and cost of neonatal care was estimated as $810 000, giving a combined total cost of between $980 000 and $1 026 000. At the sole tertiary obstetric centre in WA, approximately one-third of all multiple pregnancies conceived with fertility treatment resulted from treatment overseas. The Australian healthcare cost for these 11 women and their infants exceeded $1 000 000. This study suggests that overseas fertility treatment has a significant health-related cost to the mother and infant, and the local healthcare system. © 2017 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  5. A comprehensive prediction and evaluation method of pilot workload

    PubMed Central

    Feng, Chuanyan; Wanyan, Xiaoru; Yang, Kun; Zhuang, Damin; Wu, Xu

    2018-01-01

    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%. PMID:29710742

  6. A comprehensive prediction and evaluation method of pilot workload.

    PubMed

    Feng, Chuanyan; Wanyan, Xiaoru; Yang, Kun; Zhuang, Damin; Wu, Xu

    2018-01-01

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

  7. Filter bank common spatial patterns in mental workload estimation.

    PubMed

    Arvaneh, Mahnaz; Umilta, Alberto; Robertson, Ian H

    2015-01-01

    EEG-based workload estimation technology provides a real time means of assessing mental workload. Such technology can effectively enhance the performance of the human-machine interaction and the learning process. When designing workload estimation algorithms, a crucial signal processing component is the feature extraction step. Despite several studies on this field, the spatial properties of the EEG signals were mostly neglected. Since EEG inherently has a poor spacial resolution, features extracted individually from each EEG channel may not be sufficiently efficient. This problem becomes more pronounced when we use low-cost but convenient EEG sensors with limited stability which is the case in practical scenarios. To address this issue, in this paper, we introduce a filter bank common spatial patterns algorithm combined with a feature selection method to extract spatio-spectral features discriminating different mental workload levels. To evaluate the proposed algorithm, we carry out a comparative analysis between two representative types of working memory tasks using data recorded from an Emotiv EPOC headset which is a mobile low-cost EEG recording device. The experimental results showed that the proposed spatial filtering algorithm outperformed the state-of-the algorithms in terms of the classification accuracy.

  8. Single-Pilot Workload Management

    NASA Technical Reports Server (NTRS)

    Rogers, Jason; Williams, Kevin; Hackworth, Carla; Burian, Barbara; Pruchnicki, Shawn; Christopher, Bonny; Drechsler, Gena; Silverman, Evan; Runnels, Barry; Mead, Andy

    2013-01-01

    Integrated glass cockpit systems place a heavy cognitive load on pilots (Burian Dismukes, 2007). Researchers from the NASA Ames Flight Cognition Lab and the FAA Flight Deck Human Factors Lab examined task and workload management by single pilots. This poster describes pilot performance regarding programming a reroute while at cruise and meeting a waypoint crossing restriction on the initial descent.

  9. Effect of ramosetron on shivering during spinal anesthesia

    PubMed Central

    Kim, Min Soo; Kim, Dong Won; Woo, Seung-Hoon; Yon, Jun Heum

    2010-01-01

    Background Shivering associated with spinal anesthesia is uncomfortable and may interfere with monitoring. The aim of this study is to evaluate the effect of ramosetron, a serotonin-3 receptor antagonist, on the prevention of shivering during spinal anesthesia. Methods We enrolled 52 patients who were ASA I or II and who had undergone knee arthroscopy under spinal anesthesia. Warmed (37°) lactated Ringer's solution was infused over 15 minutes before spinal anesthesia. Patients were randomly allocated to a control group (group S, N = 26) or study group (group R, N = 26). Spinal anesthesia was performed with a 25-G Quincke-type spinal needle between the lumbar 3-4 interspace with 2.2 ml 0.5% hyperbaric bupivacaine. For patients allocated in groups S and R, 2 ml 0.9% saline and 0.3 mg ramosetron, respectively, was intravenously injected immediately before intrathecal injection at identical times. Shivering and spinal block levels were assessed immediately after the completion of subarachnoid injection, as well as 5, 10, 15, 20, 25, 30, 60, and 120 minutes after spinal anesthesia. Systolic and diastolic blood pressures, heart rate, and peripheral oxygen saturation were also recorded. Core temperatures were measured by tympanic thermometer and recorded before and during spinal anesthesia at 30-minute intervals. Results Shivering was observed in 2 patients in group R and 9 patients in group S (P = 0.038, odds ratio = 6.14, 95% C.I. = 1.08-65.5). The difference in core temperature between the groups was not significant. Conclusions Compared to control, ramosetron is an effective way to prevent shivering during spinal anesthesia. PMID:20498774

  10. Improving Patient Safety in Anesthesia: A Success Story?

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Botney, Richard

    2008-05-01

    Anesthesia is necessary for surgery; however, it does not deliver any direct therapeutic benefit. The risks of anesthesia must therefore be as low as possible. Anesthesiology has been identified as a leader in improving patient safety. Anesthetic mortality has decreased, and in healthy patients can be as low as 1:250,000. Trends in anesthetic morbidity have not been as well defined, but it appears that the risk of injury is decreasing. Studies of error during anesthesia and Closed Claims studies have identified sources of risk and methods to reduce the risks associated with anesthesia. These include changes in technology, such asmore » anesthetic delivery systems and monitors, the application of human factors, the use of simulation, and the establishment of reporting systems. A review of the important events in the past 50 years illustrates the many steps that have contributed to the improvements in anesthesia safety.« less

  11. General anesthesia suppresses normal heart rate variability in humans

    NASA Astrophysics Data System (ADS)

    Matchett, Gerald; Wood, Philip

    2014-06-01

    The human heart normally exhibits robust beat-to-beat heart rate variability (HRV). The loss of this variability is associated with pathology, including disease states such as congestive heart failure (CHF). The effect of general anesthesia on intrinsic HRV is unknown. In this prospective, observational study we enrolled 100 human subjects having elective major surgical procedures under general anesthesia. We recorded continuous heart rate data via continuous electrocardiogram before, during, and after anesthesia, and we assessed HRV of the R-R intervals. We assessed HRV using several common metrics including Detrended Fluctuation Analysis (DFA), Multifractal Analysis, and Multiscale Entropy Analysis. Each of these analyses was done in each of the four clinical phases for each study subject over the course of 24 h: Before anesthesia, during anesthesia, early recovery, and late recovery. On average, we observed a loss of variability on the aforementioned metrics that appeared to correspond to the state of general anesthesia. Following the conclusion of anesthesia, most study subjects appeared to regain their normal HRV, although this did not occur immediately. The resumption of normal HRV was especially delayed on DFA. Qualitatively, the reduction in HRV under anesthesia appears similar to the reduction in HRV observed in CHF. These observations will need to be validated in future studies, and the broader clinical implications of these observations, if any, are unknown.

  12. [Risk management in regional anesthesia: preface and comments].

    PubMed

    Okuda, Yasuhisa

    2011-11-01

    The benefits of regional anesthesia for surgical procedures, when compared with general anesthesia and/or systemic analgesia, include improved postoperative analgesia, an associated decrease in postoperative pain medication use, decreased nausea and vomiting, and quicker recovery and discharge from the hospital. Neurologic complications associated with regional anesthesia are extremely rare. Although rare, these complications may be reduced with new regional techniques such as the use of ultrasound or fluoroscopy, but further detailed research is needed. In regional anesthesia, rare but serious complications make it necessary to always consider the risk-benefit ratio. The articles discuss these issues and give advice on its effective and safe conduct.

  13. Inflight workload assessment: comparison of subjective and physiological measurements.

    PubMed

    Lee, Yung-Hui; Liu, Bor-Shong

    2003-10-01

    Assessment of pilot workload during flight is an important aviation safety consideration. The aim of this study was to assess inflight pilot workload using both physiological and multidimensional subjective-ratings measurements (heart rate and NASA Task Load Index, respectively), comparing relative sensitivity during the four phases of flight: take-off, cruise, approach, and landing. Ten male pilots volunteered to participate in the trials, which took place in a Boeing 747-400 flight simulator. Electrocardiography was performed throughout the test using the portable Cardiovis ECG system. Mean heart rate (HR) and incremental heart rate (delta HR) were considered indices of physiological workload. Peak HR was observed during take-off (83.2 bpm) and landing (88.6 bpm); moreover, delta HR was also greatest (14.2 bpm and 18.8 bpm). The Task Load Index (TLX) scale revealed that mental and performance demands were essential components of workload during flight. In addition, temporal demand was an important component of workload during take-off and physical demand was significant during cruise. Analysis of correlation revealed that the delta HR is significantly related to TLX scores (r = 0.81, n = 40). Management of the individual sources of stress, which tend to become predominant during different flight phases, should be emphasized in periodic recurrent training. For example, a pilot must be trained to cope with the increased temporal stresses associated with take-off. In addition, the recommendations will be concerned with maintaining vigilance, task allocation between pilots, and inflight rest during long-haul cruise.

  14. Designing workload analysis questionnaire to evaluate needs of employees

    NASA Astrophysics Data System (ADS)

    Astuti, Rahmaniyah Dwi; Navi, Muhammad Abdu Haq

    2018-02-01

    Incompatibility between workload with work capacity is one of main problem to make optimal result. In case at the office, there are constraints to determine workload because of non-repetitive works. Employees do work based on the targets set in a working period. At the end of the period is usually performed an evaluation of employees performance to evaluate needs of employees. The aims of this study to design a workload questionnaire tools to evaluate the efficiency level of position as indicator to determine needs of employees based on the Indonesian State Employment Agency Regulation on workload analysis. This research is applied to State-Owned Enterprise PT. X by determining 3 positions as a pilot project. Position A is held by 2 employees, position B is held by 7 employees, and position C is held by 6 employees. From the calculation result, position A has an efficiency level of 1,33 or "very good", position B has an efficiency level of 1.71 or "enough", and position C has an efficiency level of 1.03 or "very good". The application of this tools giving suggestion the needs of employees of position A is 3 people, position B is 5 people, and position C is 6 people. The difference between the number of employees and the calculation result is then analyzed by interviewing the employees to get more data about personal perception. It can be concluded that this workload evaluation tools can be used as an alternative solution to evaluate needs of employees in office.

  15. Investigating Facial Electromyography as an Indicator of Cognitive Workload

    DTIC Science & Technology

    2017-02-22

    Investigating Facial Electromyography as an Indicator of Cognitive Workload 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d...Symposium on Aviation Psychology (ISAP) 9 – 11 May 2017 14. ABSTRACT Facial electromyography (fEMG) is an electromyographic measurement technique... cognitive workload. In the current study, two task-irrelevant facial muscles, corrugator supercilli and lateral frontalis, were monitored in real- time to

  16. Nursing workload in intensive care unit trauma patients: analysis of associated factors.

    PubMed

    Nogueira, Lilia de Souza; Domingues, Cristiane de Alencar; Poggetti, Renato Sérgio; de Sousa, Regina Marcia Cardoso

    2014-01-01

    From the perspective of nurses, trauma patients in the Intensive Care Unit (ICU) demand a high degree of nursing workload due to hemodynamic instability and the severity of trauma injuries. This study aims to identify the factors related to the high nursing workload required for trauma victims admitted to the ICU. This is a prospective, cross-sectional study using descriptive and correlation analyses, conducted with 200 trauma patients admitted to an ICU in the city of São Paulo, Brazil. The nursing workload was measured using the Nursing Activities Score (NAS). The distribution of the NAS values into tertiles led to the identification of two research groups: medium/low workload and high workload. The Chi-square, Fisher's exact, Mann-Whitney and multiple logistic regression tests were utilized for the analyses. The majority of patients were male (82.0%) and suffered blunt trauma (94.5%), with traffic accidents (57.5%) and falls (31.0%) being prevalent. The mean age was 40.7 years (± 18.6) and the mean NAS was 71.3% (± 16.9). Patient gender, the presence of pulmonary failure, the number of injured body regions and the risk of death according to the Simplified Acute Physiology Score II were factors associated with a high degree of nursing workload in the first 24 hours following admission to the ICU. Workload demand was higher in male patients with physiological instability and multiple severe trauma injuries who developed pulmonary failure.

  17. Training of midwives in advanced obstetrics in Liberia.

    PubMed

    Dolo, Obed; Clack, Alice; Gibson, Hannah; Lewis, Naomi; Southall, David P

    2016-05-01

    The shortage of doctors in Liberia limits the provision of comprehensive emergency obstetric and neonatal care. In a pilot project, two midwives were trained in advanced obstetric procedures and in the team approach to the in-hospital provision of advanced maternity care. The training took two years and was led by a Liberian consultant obstetrician with support from international experts. The training took place in CB Dunbar Maternity Hospital. This rural hospital deals with approximately 2000 deliveries annually, many of which present complications. In February 2015 there were just 117 doctors available in Liberia. In the first 18 months of training, the trainees were involved with 236 caesarean sections, 35 manual evacuations of products of conception, 25 manual removals of placentas, 21 vaginal breech deliveries, 14 vacuum deliveries, four repairs of ruptured uteri, the management of four cases of shoulder dystocia, three hysterectomies, two laparotomies for ruptured ectopic pregnancies and numerous obstetric ultrasound examinations. The trainees also managed 41 cases of eclampsia or severe pre-eclampsia, 25 of major postpartum haemorrhage and 21 of shock. Although, initially they only assisted senior doctors, the trainees subsequently progressed from direct to indirect supervision and then to independent management. To compensate for a shortage of doctors able to undertake comprehensive emergency obstetric and neonatal care, experienced midwives can be taught to undertake advanced obstetric care and procedures. Their team work with doctors can be particularly valuable in rural hospitals in resource-poor countries.

  18. Combined spinal and general anesthesia vs general anesthesia for robotic sacrocervicopexy: a randomized controlled trial.

    PubMed

    Segal, Dror; Awad, Nibal; Nasir, Hawash; Mustafa, Susana; Lowenstein, Lior

    2014-03-01

    Gynecologic laparoscopic surgery is frequently accompanied by early postoperative pain. This study assessed the effect of combined general and spinal anesthesia on postoperative pain score, analgesic use, and patient satisfaction following robotic surgeries. This was a randomized controlled trial. Thirty-eight consecutive women who underwent robotic surgeries for pelvic organ prolapse (sacrocolpopexy with or without subtotal hysterectomy) were randomly assigned to receive general anesthesia (control group, n = 20) or combined general with spinal anesthesia (study group, n = 18). Pain scores were assessed at rest and while coughing using a visual analog scale (VAS) 0-10. Dosage of analgesic medication consumption was retrieved from patients' charts. There were no statistically significant differences between the two groups with respect to demographic data and intraoperative hemodynamic parameters. In the postanesthesia care unit (PACU) mean total IV morphine and meperidine dosages were significantly lower for the study than the control group (0.33 vs 7.59 mg, 1.39 vs 27.89 mg, respectively, P < 0.003, <0.001, respectively). In addition, a significantly lower percentage of patients belonging to the study group demanded analgesic medications while in the PACU (33 vs 53 %, P = 0.042). Pain scores in the PACU and during postoperative day 1 were significantly lower in the study group than in the control group (delta VAS 1.9 vs 3.0, P = 0.04). Satisfaction with pain treatment among both patients and nurses was significantly higher in the study group. Reported levels of pain and analgesic use during the first 24 h following robotic gynecologic surgery were significantly lower following general and spinal anesthesia compared to general anesthesia alone.

  19. Toward an Operational Definition of Workload: A Workload Assessment of Aviation Maneuvers

    DTIC Science & Technology

    2010-08-01

    and evaluated by the learner . With practice, the learner moves into the second phase, where optimal strategies are strengthened. The final stage of...The first phase demands a great amount of resources as performance is slow and prone to errors. During this phase, strategies are being formulated...asked to assess mental, physical, visual, aural , and verbal demands of each task. The new assessment is a cost effective method of assessing workload

  20. Estimating pediatric general anesthesia exposure: Quantifying duration and risk.

    PubMed

    Bartels, Devan Darby; McCann, Mary Ellen; Davidson, Andrew J; Polaner, David M; Whitlock, Elizabeth L; Bateman, Brian T

    2018-05-02

    Understanding the duration of pediatric general anesthesia exposure in contemporary practice is important for identifying groups at risk for long general anesthesia exposures and designing trials examining associations between general anesthesia exposure and neurodevelopmental outcomes. We performed a retrospective cohort analysis to estimate pediatric general anesthesia exposure duration during 2010-2015 using the National Anesthesia Clinical Outcomes Registry. A total of 1 548 021 pediatric general anesthetics were included. Median general anesthesia duration was 57 minutes (IQR: 28-86) with 90th percentile 145 minutes. Children aged <1 year had the longest median exposure duration (79 minutes, IQR: 39-119) with 90th percentile 210 minutes, and 13.7% of this very young cohort was exposed for >3 hours. High ASA physical status and care at a university hospital were associated with longer exposure times. While the vast majority (94%) of children undergoing general anesthesia are exposed for <3 hours, certain groups may be at increased risk for longer exposures. These findings may help guide the design of future trials aimed at understanding neurodevelopmental impact of prolonged exposure in these high-risk groups. © 2018 John Wiley & Sons Ltd.