Updating an International Medical Device Standard: A Process for Audible Alarms

Many human factors and ergonomics problems are associated with clinical alarms, usaually referred to as ‘alarm fatigue’. Among these problems is the nature of auditory signals used to attract attention, as these signals are often difficult to learn, easily confusable, and sometimes prone to masking. Symptomatic of this problem is the poor quality of the audible alarms associated with a global medical device safety standard, IEC 60601-1-8. A project aimed at improving and updating these sounds according to best practice is being carried out. This paper charts the progress of this venture and summarizes the results and the published papers which present those results

Recommendation of New Medical Alarms based on Audibility, Identifiability, and Detectability in a Randomized, Simulation-Based Study

Accurate and timely identification of existing audible medical alarms is not adequate in clinical settings. New alarms that are easily heard, quickly identifiable, and discernable from one another are indicated. The "auditory icons" (brief sounds that serve as metaphors for the events they represent) have been proposed as a replacement to the current international standard. The objective was to identify the best performing icons based on audibility and performance in a simulated clinical environment. Three sets of icon alarms were designed using empirical methods. Subjects participated in a series of clinical simulation experiments that examined the audibility, identification accuracy, and response time of each of these icon alarms. A statistical model that combined the outcomes was used to rank the alarms in overall efficacy. We constructed the "best" and "worst" performing sets based on this ranking and prospectively validated these sets in a subsequent experiment with a new subject sample. Experiments were conducted in simulated ICU settings at the University of Miami. Medical trainees were recruited from a convenience sample of nursing students and anesthesia residents at the institution. In Experiment 1 (formative testing), subjects were exposed to one of the three sets of alarms; identical setting and instruments were used throughout. In Experiment 2 (summative testing), subjects were exposed to one of the two sets of alarms, assembled from the best and worst performing alarms from Experiment 1. For each alarm, we determined the minimum sound level to reach audibility threshold in the presence of background clinical noise, identification accuracy (percentage), and response time (seconds). We enrolled 123 medical trainees and professionals for participation (78 with < 6 yr of training). We identified the best performing icon alarms for each category, which matched or exceeded the other candidate alarms in identification accuracy and response time. We propose a set of eight auditory icon alarms that were selected through formative testing and validated through summative testing for adoption by relevant regulatory bodies and medical device manufacturers

Getting Better Hospital Alarm Sounds Into a Global Standard

The reserved set of audible alarm signals embodied within the global medical device safety standard, IEC 60601-1-8, is known to be problematic and in need of updating. The current alarm signals are not only suboptimal, but there is also little evidence beyond learnability (which is known to be poor) that demonstrates their performance in realistic and representative clinical environments. In this article, we describe the process of first designing and then testing potential replacement audible alarm signals for IEC 60601-1-8, starting with the design of several sets of candidate sounds and initial tests on learnability and localizability, followed by testing in simulated clinical environments. We demonstrate that in all tests, the alarm signals selected for further development significantly outperform the current alarm signals. We describe the process of collecting considerably more data on the performance of the new sounds than exists for the current sounds, which ultimately will be of use to end users. We also reflect on the process and practice of working with the relevant committees and other practical issues beyond the science, which also need constant attention if the alarms we have developed are to be included successfully in an updated version of the standard

Brain function assessment in different conscious states

Background: The study of brain functioning is a major challenge in neuroscience fields as human brain has a dynamic and ever changing information processing. Case is worsened with conditions where brain undergoes major changes in so-called different conscious states. Even though the exact definition of consciousness is a hard one, there are certain conditions where the descriptions have reached a consensus. The sleep and the anesthesia are different conditions which are separable from each other and also from wakefulness. The aim of our group has been to tackle the issue of brain functioning with setting up similar research conditions for these three conscious states.Methods: In order to achieve this goal we have designed an auditory stimulation battery with changing conditions to be recorded during a 40 channel EEG polygraph (Nuamps) session. The stimuli (modified mismatch, auditory evoked etc.) have been administered both in the operation room and the sleep lab via Embedded Interactive Stimulus Unit which was developed in our lab. The overall study has provided some results for three domains of consciousness. In order to be able to monitor the changes we have incorporated Bispectral Index Monitoring to both sleep and anesthesia conditions.Results: The first stage results have provided a basic understanding in these altered states such that auditory stimuli have been successfully processed in both light and deep sleep stages. The anesthesia provides a sudden change in brain responsiveness; therefore a dosage dependent anesthetic administration has proved to be useful. The auditory processing was exemplified targeting N1 wave, with a thorough analysis from spectrogram to sLORETA. The frequency components were observed to be shifting throughout the stages. The propofol administration and the deeper sleep stages both resulted in the decreasing of N1 component. The sLORETA revealed similar activity at BA7 in sleep (BIS 70) and target propofol concentration of 1.2 μg/mL.Conclusions: The current study utilized similar stimulation and recording system and incorporated BIS dependent values to validate a common approach to sleep and anesthesia. Accordingly the brain has a complex behavior pattern, dynamically changing its responsiveness in accordance with stimulations and states. © 2010 Ozgoren et al; licensee BioMed Central Ltd

Associations between job demands, perceptions of noise at work and the psychological contract

Despite the widespread interest in the effects of workload on behaviour, there has been little research on the effects of it on attitudes and values in the workplace and life generally. The aim of the present research was to examine associations between noise exposure (which increases workload) and components of the psychological contract (fairness; trust; organisational commitment; work satisfaction; motivation; organisational citizenship; and intention to stay/quit). 166 workers completed a survey measuring components of the psychological contract, perceptions of noise exposure and other job characteristics. Univariate analyses showed that higher noise exposure was associated with a more negative psychological contract. However, adjustment for other job characteristics, both negative (e.g. job demands) and positive (e.g. control and support), removed the significant effects of noise. These results confirm previous research suggesting that psychosocial stressors have greater behavioural effects than components of the physical working environment such as noise

Inotuzumab ozogamicin in pediatric patients with relapsed/refractory acute lymphoblastic leukemia

Although inotuzumab ozogamicin (InO) is recognized as an effective agent in relapsed acute lymphoblastic leukemia (ALL) in adults, data on safety and efficacy in pediatric patients are scarce. We report the use of InO in 51 children with relapsed/ refractory ALL treated in the compassionate use program. In this heavily pretreated cohort, complete remission was achieved in 67% of patients with overt marrow disease. The majority (71%) of responders were negative for minimal residual disease. Responses were observed irrespective of cytogenetic subtype or number or type of prior treatment regimens. InO was welltolerated; grade 3 hepatic transaminitis or hyperbilirubinemia were noted in 6 (12%) and grade 3/4 infections in 11 (22%) patients. No patient developed sinusoidal obstruction syndrome (SOS) during InO therapy; however, 11 of 21 (52%) patients who underwent hematopoietic stem cell transplantation (HSCT) following InO developed SOS. Downregulation of surface CD22 was detected as a possible escape mechanism in three patients who developed a subsequent relapse after InO. We conclude that InO is a well-tolerated, effective therapy for children with relapsed ALL and prospective studies are warranted. Identification of risk factors for developing post-HSCT SOS and strategies to mitigate this risk are ongoing

Effects of perceptions of information overload, noise and environmental demands on wellbeing and academic attainment.

The present research considers components of information overload, which may have a negative impact on wellbeing and academic attainment. 179 university students completed a survey consisting of an information overload scale (IOS) and the wellbeing process questionnaire. Their academic attainment scores were also added to the database. The IOS scale also included questions relating to noise exposure. Both the noise scores and non-noise IOS scores were associated with greater negative wellbeing and lower positive wellbeing. There were no significant effects of noise or IOS scores on academic attainment. Wellbeing is predicted by a number of factors such as exposure to stressors, negative coping, social support and psychological capital. When these established factors were included in the analyses, the effects of noise and other aspects of IOS could be accounted for by exposure to other stressors and were no longer significant predictors of negative or positive wellbeing