The influence of time of day on handwriting performance and tracking during shift work

Im Rahmen der vorliegenden Studie wurde untersucht, inwieweit die Faktoren Tageszeit und Schichttyp (senso-)motorische Leistungen in einem 3-Schicht-System beeinflussen. Aus Voruntersuchungen ist bekannt, dass Schreib- und Trackingleistungen unter Laborbedingungen einem zirkadianen Rhythmus mit einem Leistungstief gegen 3:00-4:00 Uhr morgens folgen. Im Fokus dieser Studie stand deshalb die Frage, der zeitliche Verlauf dieser Leistungen unter Feldbedingungen verändert: Beeinflusst der Faktor Schicht maßgeblich die (senso-)motorische Leistung oder würden sich auch im Schichtbetrieb ähnliche zeitabhängige Schwankungen wie unter Laborbedingungen ergeben? Als Studienort wurden zwei Industriewerke der Firma Siemens in Berlin ausgewählt, in denen nach einem Wechselschichtsystem mit Morgen, Tag- und Nachtschichten gearbeitet wurde. Von September bis Oktober 2009 wurden Schichtarbeiter von einem Studienteam mit Beteiligung der Doktorandin betreut und während des Schichtbetriebs in 2-Stunden-Zeitintervallen getestet. Die Schreib- und Trackingaufgabe wurde aus methodischen Gründen auf Tablets (“Pocket-PCs“) implementiert. Dadurch konnte gewährleistet werden, dass die Probanden simultan in ihrem realen Arbeitsumfeld getestet wurden. Die Schreibgeschwindigkeit (n=34) war durch den Faktor Schicht und durch die Tageszeit mit einem deutlichen Leistungstief zu Beginn der Morgenschicht um 6:40 Uhr moduliert. Insgesamt war die Geschwindigkeit in der Morgen- und Nachtschicht reduziert. Analog dazu war die Schriftgröße (n=34) durch den Faktor Schicht beeinflusst mit geringster Größe in der Morgenschicht (Minimum: 6:40 Uhr). Für die Trackingaufgabe standen uns weniger Probanden (n=11) zur Verfügung. Es stellte sich heraus, dass die Trackingleistung durch die Tageszeit beeinflusst ist, mit einem Tief um 8:40 Uhr. Diese Ergebnisse zeigen, dass visuo- und feinmotorische Leistungen in einem 3-Schicht-System vor allem zu Beginn der Morgenschicht beeinträchtigt sind. Wir gehen davon aus, dass die geringe Schlafdauer vor der Morgenschicht, die auch im Rahmen dieser Untersuchung erhoben wurde, dabei eine wichtige Rolle spielt. Visuo- und Feinmotorik sind wichtige Fähigkeiten des Menschen, die im Alltag insbesondere beim Umgang mit Objekten und bei der Bedienung von Instrumenten eine Rolle spielen. Es ist naheliegend, dass unsere Daten auch hohe ökonomische Relevanz haben, da diese Leistungen in Produktionsprozessen, in denen Präzision und Effektivität gefragt sind, von potenzieller Bedeutung sind. Darüber hinaus haben Schwankungen der fein- und visuomotorischen Leistung möglicherweise auch bei der Entstehung von Arbeitsunfällen einen Anteil. Die Aufgabe zukünftiger Studien wird deshalb sein, die Zusammenhänge zwischen (Senso-)motorik und Produktionseffektivität beziehungsweise Arbeitsunfällen zu ergründen.The following study investigated (visuo-)motor skills in a rotational shift system. Previous studies under laboratory conditions showed that handwriting and tracking performances followed a circadian rhythm, with a performance minimum at 3:00 or 4:00 in the morning. Therefore, this investigation assessed handwriting and tracking in a real-life setting. We investigated the time of day and shift effects of handwriting kinematics and tracking precision among shiftworkers directly at the work place. The study took place from September to October 2009 in two factory sites of the Siemens AG in Berlin. The employees worked in a three rotational shift system with morning, evening, and night shifts. They attended tests in two-hour intervals during each shift supervised by a study team. We implemented the task on hand-held pocket PCs to allow simultanous tests directly at the work place. Handwriting velocity (n=34) was influenced by the factor shift and time of day with a minimum of performance at the beginning of the morning shift at 06:40. During morning and night shifts handwriting velocity was significantly reduced. Similarly, script size (n=34) was modulated by the factor shift with a performance minimum at 06:40. A smaller group of participants (n=11) performed the tracking task. Here, we found a significant influence of time of day with a performance trough at 8:40 in the morning. In sum, the present field study reports significant modulations of visuomotor and finemotor performances in a rotational shift system. In particular, at the beginning of the morning shift, these performances were impaired. One important factor for these deficits may have been the reduced sleep duration before morning shifts, which we also assessed during the study period Visuomotor and fine motor control play an important role in daily life, in particular during manual object handling. Our data are potentially of economic relevance since these skills are indispensable for accurate and effective production. In addition, deficits of fine motor and visuomotor coordination may also be relevant for work accidents. We suggest for future research to systematically investigate the relationship between fine motor control and production efficiency or accident rates

The influence of time of day on handwriting performance and tracking during shift work

Im Rahmen der vorliegenden Studie wurde untersucht, inwieweit die Faktoren Tageszeit und Schichttyp (senso-)motorische Leistungen in einem 3-Schicht-System beeinflussen. Aus Voruntersuchungen ist bekannt, dass Schreib- und Trackingleistungen unter Laborbedingungen einem zirkadianen Rhythmus mit einem Leistungstief gegen 3:00-4:00 Uhr morgens folgen. Im Fokus dieser Studie stand deshalb die Frage, der zeitliche Verlauf dieser Leistungen unter Feldbedingungen verändert: Beeinflusst der Faktor Schicht maßgeblich die (senso-)motorische Leistung oder würden sich auch im Schichtbetrieb ähnliche zeitabhängige Schwankungen wie unter Laborbedingungen ergeben? Als Studienort wurden zwei Industriewerke der Firma Siemens in Berlin ausgewählt, in denen nach einem Wechselschichtsystem mit Morgen, Tag- und Nachtschichten gearbeitet wurde. Von September bis Oktober 2009 wurden Schichtarbeiter von einem Studienteam mit Beteiligung der Doktorandin betreut und während des Schichtbetriebs in 2-Stunden-Zeitintervallen getestet. Die Schreib- und Trackingaufgabe wurde aus methodischen Gründen auf Tablets (“Pocket-PCs“) implementiert. Dadurch konnte gewährleistet werden, dass die Probanden simultan in ihrem realen Arbeitsumfeld getestet wurden. Die Schreibgeschwindigkeit (n=34) war durch den Faktor Schicht und durch die Tageszeit mit einem deutlichen Leistungstief zu Beginn der Morgenschicht um 6:40 Uhr moduliert. Insgesamt war die Geschwindigkeit in der Morgen- und Nachtschicht reduziert. Analog dazu war die Schriftgröße (n=34) durch den Faktor Schicht beeinflusst mit geringster Größe in der Morgenschicht (Minimum: 6:40 Uhr). Für die Trackingaufgabe standen uns weniger Probanden (n=11) zur Verfügung. Es stellte sich heraus, dass die Trackingleistung durch die Tageszeit beeinflusst ist, mit einem Tief um 8:40 Uhr. Diese Ergebnisse zeigen, dass visuo- und feinmotorische Leistungen in einem 3-Schicht-System vor allem zu Beginn der Morgenschicht beeinträchtigt sind. Wir gehen davon aus, dass die geringe Schlafdauer vor der Morgenschicht, die auch im Rahmen dieser Untersuchung erhoben wurde, dabei eine wichtige Rolle spielt. Visuo- und Feinmotorik sind wichtige Fähigkeiten des Menschen, die im Alltag insbesondere beim Umgang mit Objekten und bei der Bedienung von Instrumenten eine Rolle spielen. Es ist naheliegend, dass unsere Daten auch hohe ökonomische Relevanz haben, da diese Leistungen in Produktionsprozessen, in denen Präzision und Effektivität gefragt sind, von potenzieller Bedeutung sind. Darüber hinaus haben Schwankungen der fein- und visuomotorischen Leistung möglicherweise auch bei der Entstehung von Arbeitsunfällen einen Anteil. Die Aufgabe zukünftiger Studien wird deshalb sein, die Zusammenhänge zwischen (Senso-)motorik und Produktionseffektivität beziehungsweise Arbeitsunfällen zu ergründen.The following study investigated (visuo-)motor skills in a rotational shift system. Previous studies under laboratory conditions showed that handwriting and tracking performances followed a circadian rhythm, with a performance minimum at 3:00 or 4:00 in the morning. Therefore, this investigation assessed handwriting and tracking in a real-life setting. We investigated the time of day and shift effects of handwriting kinematics and tracking precision among shiftworkers directly at the work place. The study took place from September to October 2009 in two factory sites of the Siemens AG in Berlin. The employees worked in a three rotational shift system with morning, evening, and night shifts. They attended tests in two-hour intervals during each shift supervised by a study team. We implemented the task on hand-held pocket PCs to allow simultanous tests directly at the work place. Handwriting velocity (n=34) was influenced by the factor shift and time of day with a minimum of performance at the beginning of the morning shift at 06:40. During morning and night shifts handwriting velocity was significantly reduced. Similarly, script size (n=34) was modulated by the factor shift with a performance minimum at 06:40. A smaller group of participants (n=11) performed the tracking task. Here, we found a significant influence of time of day with a performance trough at 8:40 in the morning. In sum, the present field study reports significant modulations of visuomotor and finemotor performances in a rotational shift system. In particular, at the beginning of the morning shift, these performances were impaired. One important factor for these deficits may have been the reduced sleep duration before morning shifts, which we also assessed during the study period Visuomotor and fine motor control play an important role in daily life, in particular during manual object handling. Our data are potentially of economic relevance since these skills are indispensable for accurate and effective production. In addition, deficits of fine motor and visuomotor coordination may also be relevant for work accidents. We suggest for future research to systematically investigate the relationship between fine motor control and production efficiency or accident rates

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Die COVID-19-Pandemie veränderte nicht die Zahl, aber die Art psychiatrischer Notfälle

Background!#!Due to the demographic change dementia is a common and dramatically increasing reason for medical presentations. In approximately 8% of cases dementia occurs before the age of 65 years. The psychosocial and economic consequences are often severe, particularly in younger patients. Clinicians face major diagnostic challenges. A rapid diagnosis is crucial for patient counselling and management.!##!Objective!#!This review article presents the special features of dementia in younger people, the most important underlying diseases and a rational clinical diagnostic approach.!##!Methods!#!Narrative review. The literature search was carried out in PubMed.!##!Results!#!The differential diagnostic spectrum of dementia in younger people under the age of 65 years is very broad. The most common causes are Alzheimer's disease with typical or atypical clinical presentations and frontotemporal lobar degeneration. The younger the age of onset, the higher the proportion of treatable and potentially reversible causes of dementia.!##!Conclusion!#!The diagnostics of primary neurodegenerative diseases have continuously improved, especially due to the availability of an increasing number of clinical, molecular and imaging biomarkers. Nevertheless, in order to avoid unnecessary and burdensome examinations, the diagnostic work-up of young onset dementia must be hypothesis-driven, i.e. following a precise clinical syndromic classification of the symptoms

Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe

Background Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. Methods The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered with ClinicalTrials.gov, number NCT01878760. Findings Between April 1, 2014, and Jan 31, 2015, 31â127 anaesthetic procedures in 30â874 children with a mean age of 6·35 years (SD 4·50) were included. The incidence of perioperative severe critical events was 5·2% (95% CI 5·0â5·5) with an incidence of respiratory critical events of 3·1% (2·9â3·3). Cardiovascular instability occurred in 1·9% (1·7â2·1), with an immediate poor outcome in 5·4% (3·7â7·5) of these cases. The all-cause 30-day in-hospital mortality rate was 10 in 10â000. This was independent of type of anaesthesia. Age (relative risk 0·88, 95% CI 0·86â0·90; p<0·0001), medical history, and physical condition (1·60, 1·40â1·82; p<0·0001) were the major risk factors for a serious critical event. Multivariate analysis revealed evidence for the beneficial effect of years of experience of the most senior anaesthesia team member (0·99, 0·981â0·997; p<0·0048 for respiratory critical events, and 0·98, 0·97â0·99; p=0·0039 for cardiovascular critical events), rather than the type of health institution or providers. Interpretation This study highlights a relatively high rate of severe critical events during the anaesthesia management of children for surgical or diagnostic procedures in Europe, and a large variability in the practice of paediatric anaesthesia. These findings are substantial enough to warrant attention from national, regional, and specialist societies to target education of anaesthesiologists and their teams and implement strategies for quality improvement in paediatric anaesthesia. Funding European Society of Anaesthesiology

Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe

Background Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. Methods The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered with ClinicalTrials.gov, number NCT01878760. Findings Between April 1, 2014, and Jan 31, 2015, 31 127 anaesthetic procedures in 30 874 children with a mean age of 6.35 years (SD 4.50) were included. The incidence of perioperative severe critical events was 5.2% (95% CI 5.0-5.5) with an incidence of respiratory critical events of 3.1% (2.9-3.3). Cardiovascular instability occurred in 1.9% (1.7-2.1), with an immediate poor outcome in 5.4% (3.7-7.5) of these cases. The all-cause 30-day in-hospital mortality rate was 10 in 10 000. This was independent of type of anaesthesia. Age (relative risk 0.88, 95% CI 0.86-0.90; p<0.0001), medical history, and physical condition (1.60, 1.40-1.82; p<0.0001) were the major risk factors for a serious critical event. Multivariate analysis revealed evidence for the beneficial effect of years of experience of the most senior anaesthesia team member (0.99, 0.981-0.997; p<0.0048 for respiratory critical events, and 0.98, 0.97-0.99; p=0.0039 for cardiovascular critical events), rather than the type of health institution or providers. Interpretation This study highlights a relatively high rate of severe critical events during the anaesthesia management of children for surgical or diagnostic procedures in Europe, and a large variability in the practice of paediatric anaesthesia. These findings are substantial enough to warrant attention from national, regional, and specialist societies to target education of anaesthesiologists and their teams and implement strategies for quality improvement in paediatric anaesthesia