A principled approach to the measurement of situation awareness in commercial aviation

The issue of how to support situation awareness among crews of modern commercial aircraft is becoming especially important with the introduction of automation in the form of sophisticated flight management computers and expert systems designed to assist the crew. In this paper, cognitive theories are discussed that have relevance for the definition and measurement of situation awareness. These theories suggest that comprehension of the flow of events is an active process that is limited by the modularity of attention and memory constraints, but can be enhanced by expert knowledge and strategies. Three implications of this perspective for assessing and improving situation awareness are considered: (1) Scenario variations are proposed that tax awareness by placing demands on attention; (2) Experimental tasks and probes are described for assessing the cognitive processes that underlie situation awareness; and (3) The use of computer-based human performance models to augment the measures of situation awareness derived from performance data is explored. Finally, two potential example applications of the proposed assessment techniques are described, one concerning spatial awareness using wide field of view displays and the other emphasizing fault management in aircraft systems

In-reach specialist nursing teams for residential care homes : uptake of services, impact on care provision and cost-effectiveness

Background: A joint NHS-Local Authority initiative in England designed to provide a dedicated nursing and physiotherapy in-reach team (IRT) to four residential care homes has been evaluated.The IRT supported 131 residents and maintained 15 'virtual' beds for specialist nursing in these care homes. Methods: Data captured prospectively (July 2005 to June 2007) included: numbers of referrals; reason for referral; outcome (e.g. admission to IRT bed, short-term IRT support); length of stay in IRT; prevented hospital admissions; early hospital discharges; avoided nursing home transfers; and detection of unrecognised illnesses. An economic analysis was undertaken. Results: 733 referrals were made during the 2 years (range 0.5 to 13.0 per resident per annum)resulting in a total of 6,528 visits. Two thirds of referrals aimed at maintaining the resident's independence in the care home. According to expert panel assessment, 197 hospital admissions were averted over the period; 20 early discharges facilitated; and 28 resident transfers to a nursing home prevented. Detection of previously unrecognised illnesses accounted for a high number of visits. Investment in IRT equalled £44.38 per resident per week. Savings through reduced hospital admissions, early discharges, delayed transfers to nursing homes, and identification of previously unrecognised illnesses are conservatively estimated to produce a final reduction in care cost of £6.33 per resident per week. A sensitivity analysis indicates this figure might range from a weekly overall saving of £36.90 per resident to a 'worst case' estimate of £2.70 extra expenditure per resident per week. Evaluation early in implementation may underestimate some cost-saving activities and greater savings may emerge over a longer time period. Similarly, IRT costs may reduce over time due to the potential for refinement of team without major loss in effectiveness. Conclusion: Introduction of a specialist nursing in-reach team for residential homes is at least cost neutral and, in all probability, cost saving. Further benefits include development of new skills in the care home workforce and enhanced quality of care. Residents are enabled to stay in familiar surroundings rather than unnecessarily spending time in hospital or being transferred to a higher dependency nursing home setting

Comparing verbal media for alarm handling: Speech versus textual displays

The rise of computers in command and control domains has meant that control operations can be performed via desk-based visual display terminals. This trend has also produced the potential to display information to operators in a variety of formats. Of particular interest has been the use of text-based displays for alarm presentation. There are possible limitations to the use of text for alarm presentation, not least of which is the need for a dedicated alarms display screen (or, at least, a display page). Given the capability of computers to synthesize speech, it is possible that speech-based alarms could generate the same information as text-based displays without the need for dedicated screen space. In this paper an experimental comparison of speech-based and text-based displays for presentation of alarms is reported. The findings show that speech leads to longer response times than text displays, but that it has minimal effect on the efficacy of fault handling. The results are discussed within the alarm initiated activities framework and implications for alarm system design are outlined

Strategies to improve retention in randomised trials: a Cochrane systematic review and meta-analysis

Objective: To quantify the effect of strategies to improve retention in randomised trials.<p></p> Design: Systematic review and meta-analysis.<p></p> Data sources Sources searched: MEDLINE, EMBASE, PsycINFO, DARE, CENTRAL, CINAHL, C2-SPECTR, ERIC, PreMEDLINE, Cochrane Methodology Register, Current Controlled Trials metaRegister, WHO trials platform, Society for Clinical Trials (SCT) conference proceedings and a survey of all UK clinical trial research units.<p></p> Review: methods Included trials were randomised evaluations of strategies to improve retention embedded within host randomised trials. The primary outcome was retention of trial participants. Data from trials were pooled using the fixed-effect model. Subgroup analyses were used to explore the heterogeneity and to determine whether there were any differences in effect by the type of strategy.<p></p> Results: 38 retention trials were identified. Six broad types of strategies were evaluated. Strategies that increased postal questionnaire responses were: adding, that is, giving a monetary incentive (RR 1.18; 95% CI 1.09 to 1.28) and higher valued incentives (RR 1.12; 95% CI 1.04 to 1.22). Offering a monetary incentive, that is, an incentive given on receipt of a completed questionnaire, also increased electronic questionnaire response (RR 1.25; 95% CI 1.14 to 1.38). The evidence for shorter questionnaires (RR 1.04; 95% CI 1.00 to 1.08) and questionnaires relevant to the disease/condition (RR 1.07; 95% CI 1.01 to 1.14) is less clear. On the basis of the results of single trials, the following strategies appeared effective at increasing questionnaire response: recorded delivery of questionnaires (RR 2.08; 95% CI 1.11 to 3.87); a ‘package’ of postal communication strategies (RR 1.43; 95% CI 1.22 to 1.67) and an open trial design (RR 1.37; 95% CI 1.16 to 1.63). There is no good evidence that the following strategies impact on trial response/retention: adding a non-monetary incentive (RR=1.00; 95% CI 0.98 to 1.02); offering a non-monetary incentive (RR=0.99; 95% CI 0.95 to 1.03); ‘enhanced’ letters (RR=1.01; 95% CI 0.97 to 1.05); monetary incentives compared with offering prize draw entry (RR=1.04; 95% CI 0.91 to 1.19); priority postal delivery (RR=1.02; 95% CI 0.95 to 1.09); behavioural motivational strategies (RR=1.08; 95% CI 0.93 to 1.24); additional reminders to participants (RR=1.03; 95% CI 0.99 to 1.06) and questionnaire question order (RR=1.00, 0.97 to 1.02). Also based on single trials, these strategies do not appear effective: a telephone survey compared with a monetary incentive plus questionnaire (RR=1.08; 95% CI 0.94 to 1.24); offering a charity donation (RR=1.02, 95% CI 0.78 to 1.32); sending sites reminders (RR=0.96; 95% CI 0.83 to 1.11); sending questionnaires early (RR=1.10; 95% CI 0.96 to 1.26); longer and clearer questionnaires (RR=1.01, 0.95 to 1.07) and participant case management by trial assistants (RR=1.00; 95% CI 0.97 to 1.04).<p></p> Conclusions: Most of the trials evaluated questionnaire response rather than ways to improve participants return to site for follow-up. Monetary incentives and offers of monetary incentives increase postal and electronic questionnaire response. Some strategies need further evaluation. Application of these results would depend on trial context and follow-up procedures.<p></p&gt

Optometric referrals - how, when and to whom refer a patient?

Els optometristes posseeixen l’equipament i els coneixements necessaris per a proporcionar un examen visual complert i, així detectar la necessitat de derivar a un pacient, si escau. Una derivació optomètrica és la clau per aconseguir un examen ocular complementari, evitar riscos per al pacient i obtenir un diagnòstic complert, per part d’un professional amb coneixements en altres àrees. Un diagnòstic precoç, la tria de proves necessàries i un ràpid tractament són essencials per a prevenir, reduir emergències, minimitzar danys i pèrdues visuals d’una derivació ocular urgent. Un fals positiu és aquell pacient que ha estat inicialment diagnosticat amb una patologia però resulta absent desprès d’una avaluació complementària i extensa. Els optometristes amb poca experiència han de ser curosos perquè són els que tendeixen a generar un major nombre de falsos positius. D’acord amb la precisió i l’adequació de les derivacions optomètriques, cal considerar que, la falta d’informació redueix la efectivitat de moltes derivacions. Quan un optometrista ha de derivar un pacient és necessari escriure un informe de derivació. Aquest, ha d’incloure tota la informació clínica rellevant que permeti entendre el cas derivat. Depenent de a qui vagi dirigida la derivació del pacient, l’informe de derivació haurà de seguir una estructura o una d’altre. Quan arriba el moment d’informar al pacient, una comunicació efectiva és la clau per l’èxit d’un bon desenvolupament del procés. Per concloure, com a professionals, els optometristes tenen un Codi d’Ètics i de Conducta, el qual indica i argumenta pautes, proporcionant solucions per a les necessitats dels pacients i el seu benestar

A Service-Oriented Healthcare Message Alerting Architecture in an Asia Medical Center: A Case Study

This paper illustrates how our development team has used some information technologies to let physicians obtain an instant abnormal laboratory result report for critical patient care services. We have implemented a healthcare message alerting system (HMAS) on a healthcare short message service (HSMS) engine and the distributed healthcare-oriented service environment (DiHOSE) in the National Taiwan University Hospital (NTUH). The HSMS engine has a general interface for all applications which could easily send any kind of alerting messages. Fundamentally, the DiHOSE uses HL7 standard formats to process the information exchange behaviors and can be flexibly extended for reasonable user requirements. The disease surveillance subsystem is an integral part of NTUH new hospital information system which is based on DiHOSE and the disease surveillance subsystem would send alerting messages through the HSMS engine. The latest cell phone message alerting subsystem, a case study, in NTUH proved that the DiHOSE could integrate the user required functions without much work. We concluded that both HSMS and DiHOSE can generalize and extend application demands efficiently