Top-Down Processing of Drug Names Can Induce Errors in Discriminating Similar Pseudo-Drug Names by Nurses.

BACKGROUND: One factor that could cause medical errors is confusing medicines with similar names. A previous study showed that nurses who have knowledge about drugs faced difficulty in discriminating a drug name from similar pseudo-drug names. To avoid such errors, finger-pointing and calling (FPC) has been recommended in Japan. OBJECTIVES: The present study had two aims. The first was to determine whether such difficulty was due to top-down processing, rather than bottom-up processing, being applied even for pseudo-names. The other was to investigate whether FPC affected error prevention for similar drug names. METHOD: In two experiments, nurses and non-health care professionals performed a choice reaction time task for drug names and common words, with or without FPC. Error rate and reaction time were analyzed. RESULTS: When drug names were used, nurses showed difficulty discriminating target names from distractors. Furthermore, the error prevention effect of FPC was marginally significant for drug names. However, nurses showed no significant differences when similar drug names were used. There was no significant difference regarding the error rate for words. CONCLUSIONS: Nurses' knowledge of drug names activates top-down processing. As a result, the processing of drug names was not as accurate and quick as that for words for nurses, which caused difficulty in discriminating similar names. FPC may be applicable to reduce confusion errors, possibly by leading individuals to process drug names using bottom-up processing. APPLICATION: The present study advances current knowledge about error tendencies with similar drug names and the effects of FPC on error prevention.

A influência da prática de atividade física no estado de humor de mulheres adultas / The influence of physical activity on the mood of adult women

O objetivo do presente estudo foi comparar os níveis de estado de humor de mulheres adultas praticantes de atividade física regular com os de mulheres adultas sedentárias. Participaram do estudo 57 mulheres (53,36 ± 10,68 anos de idade), divididas em dois grupos: ativas e sedentárias. Utilizou-se um questionário para caracterização da amostra e a Escala de Humor de Brunel (BRUMS). Os resultados do presente estudo demonstraram que as mulheres ativas apresentaram estado de humor positivo, além de apresentaram baixos escores para o estado de humor negativo, quando comparadas aos escores das mulheres sedentárias. Pode-se concluir que a atividade física pode influenciar positivamente o estado de humor.

The aim of this study was to compare mood levels of adult women engaged in regular physical activity with those of sedentary adult women. Fifty-seven women participated in the study (53.36 ± 10.68 years' old), divided into two groups: active and sedentary. A questionnaire was used to characterize the sample, and the Brunel Mood Scale (BRUMS) was also applied. The results demonstrated that active women had a positive mood state in addition to having low scores for negative mood state when compared to the scores of sedentary women. It can be concluded that physical activity can have a positive influence on mood state.

Peripheral nerve blocks for hip fractures in adults.

BACKGROUND: This review was published originally in 1999 and was updated in 2001, 2002, 2009, 2017, and 2020. Updating was deemed necessary due to the high incidence of hip fractures, the large number of official societies providing recommendations on this condition, the possibility that perioperative peripheral nerve blocks (PNBs) may improve patient outcomes, and the major role that PNBs may play in reducing preoperative and postoperative opioid use for analgesia. OBJECTIVES: To compare PNBs used as preoperative analgesia, as postoperative analgesia, or as a supplement to general anaesthesia versus no nerve block (or sham block) for adults with hip fracture. Outcomes were pain on movement at 30 minutes after block placement, acute confusional state, myocardial infarction, chest infection, death, time to first mobilization, and costs of an analgesic regimen for single-injection blocks. We undertook the update to look for new studies and to update the methods to reflect Cochrane standards. SEARCH METHODS: For the updated review, we searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 11), in the Cochrane Library; MEDLINE (Ovid SP, 1966 to November 2019); Embase (Ovid SP, 1974 to November 2019); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCO, 1982 to November 2019), as well as trial registers and reference lists of relevant articles. SELECTION CRITERIA: We included randomized controlled trials (RCTs) assessing use of PNBs compared with no nerve block (or sham block) as part of the care provided for adults 16 years of age and older with hip fracture.  DATA COLLECTION AND ANALYSIS: Two review authors independently screened new trials for inclusion, assessed trial quality using the Cochrane Risk of Bias-2 tool, and extracted data. When appropriate, we pooled results of outcome measures. We rated the certainty of evidence using the GRADE approach. MAIN RESULTS: We included 49 trials (3061 participants; 1553 randomized to PNBs and 1508 to no nerve block (or sham block)). For this update, we added 18 new trials. Trials were published from 1981 to 2020. Trialists followed participants for periods ranging from 5 minutes to 12 months. The average age of participants ranged from 59 to 89 years. People with dementia were often excluded from the included trials. Additional analgesia was available for all participants. Results of 11 trials with 503 participants show that PNBs reduced pain on movement within 30 minutes of block placement (standardized mean difference (SMD) -1.05, 95% confidence interval (CI) -1.25 to -0.86; equivalent to -2.5 on a scale from 0 to 10; high-certainty evidence). Effect size was proportionate to the concentration of local anaesthetic used (P = 0.0003). Based on 13 trials with 1072 participants, PNBs reduce the risk of acute confusional state (risk ratio (RR) 0.67, 95% CI 0.50 to 0.90; number needed to treat for an additional beneficial outcome (NNTB) 12, 95% CI 7 to 47; high-certainty evidence). For myocardial infarction, there were no events in one trial with 31 participants (RR not estimable; low-certainty evidence). From three trials with 131 participants, PNBs probably reduce the risk for chest infection (RR 0.41, 95% CI 0.19 to 0.89; NNTB 7, 95% CI 5 to 72; moderate-certainty evidence). Based on 11 trials with 617 participants, the effects of PNBs on mortality within six months are uncertain due to very serious imprecision (RR 0.87, 95% CI 0.47 to 1.60; low-certainty evidence). From three trials with 208 participants, PNBs likely reduce time to first mobilization (mean difference (MD) -10.80 hours, 95% CI -12.83 to -8.77 hours; moderate-certainty evidence). One trial with 75 participants indicated there may be a small reduction in the cost of analgesic drugs with a single-injection PNB (MD -4.40 euros, 95% CI -4.84 to -3.96 euros; low-certainty evidence). We identified 29 ongoing trials, of which 15 were first posted or at least were last updated after 1 January 2018.  AUTHORS' CONCLUSIONS: PNBs reduce pain on movement within 30 minutes after block placement, risk of acute confusional state, and probably also reduce the risk of chest infection and time to first mobilization. There may be a small reduction in the cost of analgesic drugs for single-injection PNB. We did not find a difference for myocardial infarction and mortality, but the numbers of participants included for these two outcomes were insufficient. Although randomized clinical trials may not be the best way to establish risks associated with an intervention, our review confirms low risks of permanent injury associated with PNBs, as found by others. Some trials are ongoing, but it is unclear whether any further RCTs should be registered, given the benefits found. Good-quality non-randomized trials with appropriate sample size may help to clarify the potential effects of PNBs on myocardial infarction and mortality.

Renin-angiotensin system inhibitors and the severity of coronavirus disease 2019 in Kanagawa, Japan: a retrospective cohort study.

Since the beginning of the coronavirus disease 2019 (COVID-19) outbreak initiated on the Diamond Princess Cruise Ship at Yokohama harbor in February 2020, we have been doing our best to treat COVID-19 patients. In animal experiments, angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II type-1 receptor blockers (ARBs) are reported to suppress the downregulation of angiotensin converting enzyme 2 (ACE2), and they may inhibit the worsening of pathological conditions. We aimed to examine whether preceding use of ACEIs and ARBs affected the clinical manifestations and prognosis of COVID-19 patients. One hundred fifty-one consecutive patients (mean age 60 ± 19 years) with polymerase-chain-reaction proven severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who were admitted to six hospitals in Kanagawa Prefecture, Japan, were analyzed in this multicenter retrospective observational study. Among all COVID-19 patients, in the multiple regression analysis, older age (age ≥ 65 years) was significantly associated with the primary composite outcome (odds ratio (OR) 6.63, 95% confidence interval (CI) 2.28-22.78, P < 0.001), which consisted of (i) in-hospital death, (ii) extracorporeal membrane oxygenation, (iii) mechanical ventilation, including invasive and noninvasive methods, and (iv) admission to the intensive care unit. In COVID-19 patients with hypertension, preceding ACEI/ARB use was significantly associated with a lower occurrence of new-onset or worsening mental confusion (OR 0.06, 95% CI 0.002-0.69, P = 0.02), which was defined by the confusion criterion, which included mild disorientation or hallucination with an estimation of medical history of mental status, after adjustment for age, sex, and diabetes. In conclusion, older age was a significant contributor to a worse prognosis in COVID-19 patients, and ACEIs/ARBs could be beneficial for the prevention of confusion in COVID-19 patients with hypertension.

Effects of walking on sundown syndrome in community-dwelling people with Alzheimer's disease.

BACKGROUND: Sundown syndrome is an important care issue for people with dementia (PwD) and for family caregivers. Walking is a safe and simple physical activity for most PwD, yet no research has explored the effects of different long-term walking periods on sundown syndrome. OBJECTIVES: This study aimed to determine the effects of walking on sundown syndrome, and to identify whether different walking time periods would show different effects on sundown syndrome in community-dwelling people with Alzheimer's disease. METHODS: A quasi-experimental designed study with repeated measurements was conducted. Sixty PwD were recruited and assigned to either the control group or the morning or afternoon walking group according to their caregiver's preference. The participants in the two walking groups completed an average of 120-min walking per week, accompanied by their caregivers. Forty-six achieved the 6-month intervention. Four measurements were taken, one at the pretest and one at weeks 8, 16 and 24. The Chinese version of the Cohen-Mansfield Agitation Inventory, community form (C-CMAI) was used to assess the severity of the sundown syndrome. The generalised estimating equation (GEE) was applied for the longitudinal data analysis. RESULTS: There was a significant change across the study period (p = .048) in the morning walking group, indicating that the score for sundown syndrome decreased when PwD walked in the morning. Considering group effects, compared to the control group, the C-CMAI scores significantly decreased after 16 weeks of walking in the afternoon walking group (p = .001) and after 24 weeks in both the morning and afternoon walking groups (p = .001), indicating that after PwD had walked for 16 weeks, sundown syndrome ameliorated in the afternoon group and continually decreased after 24 weeks in both the morning and afternoon groups. However, there was no significant group difference between the morning and afternoon walking groups during the 24-week walking intervention. CONCLUSIONS: The results indicated that both morning walking and afternoon walking are beneficial for ameliorating the symptoms of sundown syndrome; however, walking in the afternoon may have a faster effect on the symptoms than walking in the morning. Walking is a safe, simple, feasible and effective intervention to benefit individuals with sundown syndrome. IMPLICATIONS FOR PRACTICE: Regularly walking for 30 min a day, four times a week, is beneficial to alleviate sundown syndrome among PwD living in the community. Either morning or afternoon walking is effective for decreasing sundown syndrome, and the longer the walking time, the greater the impact on sundown syndrome.

Spatial Disorientation Survey Among Military Pilots.

BACKGROUND: Spatial disorientation (SD) remains a significant cause of accidents and near accidents. A variety of training methods have been used to assist pilots to anticipate the SD problem. The value of such training in the prevention of disorientation has been difficult to assess.METHODS: To study transfer of SD awareness training, we related reported incidents to the content and frequency of SD awareness training received. The questionnaire was completed by 368 out of 495 pilots; 189 currently flying fixed-wing, and 150 flying rotary-wing aircraft. On average, their age was 38, and they had 2466 flight hours on-type.RESULTS: Respondents gave high ratings for the importance of SD training and their awareness of SD, the latter being one of the training objectives. The amount of SD training received by respondents was positively correlated with ratings for appreciation and importance. Self-rated awareness was positively correlated with the number of reported SD experiences. Although the correlations were below 0.50, the results provide an indication that SD training is effective. In total, respondents reported 5773 SD experiences, 195 of them resulting in a serious risk for flight safety. Narratives of these serious events show that, in many cases, pilots managed their SD by carefully checking the flight instruments, and also by good crew coordination.DISCUSSION: The results of the survey provide some evidence, although based on subjective reports, for transfer of SD training. The results of the SD experiences can be used to improve the SD training in terms of content and frequency.Pennings HJM, Oprins EAPB, Wittenberg H, Houben MMJ, Groen EL. Spatial disorientation survey among military pilots. Aerosp Med Hum Perform. 2020; 91(1):4-10.

Seguridad vial, asma y rinitis: reflexiones / Road safety, asthma and rhinitis: reflections

No disponible

Burst-suppression ratio underestimates absolute duration of electroencephalogram suppression compared with visual analysis of intraoperative electroencephalogram.

BACKGROUND: Machine-generated indices based on quantitative electroencephalography (EEG), such as the patient state index (PSI™) and burst-suppression ratio (BSR), are increasingly being used to monitor intraoperative depth of anaesthesia in the endeavour to improve postoperative neurological outcomes, such as postoperative delirium (POD). However, the accuracy of the BSR compared with direct visualization of the EEG trace with regard to the prediction of POD has not been evaluated previously. METHODS: Forty-one consecutive patients undergoing non-cardiac, non-intracranial surgery with general anaesthesia wore a SedLine ® monitor during surgery and were assessed after surgery for the presence of delirium with the Confusion Assessment Method. The intraoperative EEG was scanned for absolute minutes of EEG suppression and correlated with the incidence of POD. The BSR and PSI™ were compared between patients with and without POD. RESULTS: Visual analysis of the EEG by neurologists and the SedLine ® -generated BSR provided a significantly different distribution of estimated minutes of EEG suppression ( P =0.037). The Sedline ® system markedly underestimated the amount of EEG suppression. The number of minutes of suppression assessed by visual analysis of the EEG was significantly associated with POD ( P =0.039), whereas the minutes based on the BSR generated by SedLine ® were not associated with POD ( P =0.275). CONCLUSIONS: Our findings suggest that SedLine ® (machine)-generated indices might underestimate the minutes of EEG suppression, thereby reducing the sensitivity for detecting patients at risk for POD. Thus, the monitoring of machine-generated BSR and PSI™ might benefit from the addition of a visual tracing of the EEG to achieve a more accurate and real-time guidance of anaesthesia depth monitoring and the ultimate goal, to reduce the risk of POD.

Can an aircraft be piloted via sonification with an acceptable attentional cost? A comparison of blind and sighted pilots.

In the aeronautics field, some authors have suggested that an aircraft's attitude sonification could be used by pilots to cope with spatial disorientation situations. Such a system is currently used by blind pilots to control the attitude of their aircraft. However, given the suspected higher auditory attentional capacities of blind people, the possibility for sighted individuals to use this system remains an open question. For example, its introduction may overload the auditory channel, which may in turn alter the responsiveness of pilots to infrequent but critical auditory warnings. In this study, two groups of pilots (blind versus sighted) performed a simulated flight experiment consisting of successive aircraft maneuvers, on the sole basis of an aircraft sonification. Maneuver difficulty was varied while we assessed flight performance along with subjective and electroencephalographic (EEG) measures of workload. The results showed that both groups of participants reached target-attitudes with a good accuracy. However, more complex maneuvers increased subjective workload and impaired brain responsiveness toward unexpected auditory stimuli as demonstrated by lower N1 and P3 amplitudes. Despite that the EEG signal showed a clear reorganization of the brain in the blind participants (higher alpha power), the brain responsiveness to unexpected auditory stimuli was not significantly different between the two groups. The results suggest that an auditory display might provide useful additional information to spatially disoriented pilots with normal vision. However, its use should be restricted to critical situations and simple recovery or guidance maneuvers.

Postoperative confusion in older adults.

The development of postoperative confusion in older patients is increasingly being recognized as clinically significant because it is becoming more common as the population ages. Postoperative delirium and postoperative cognitive dysfunction differ in time course of development. Risk factors other than age include certain medications as well as anesthesia (both the type and amount used). Postoperative delirium and postoperative cognitive dysfunction appear to increase a patient's risk for developing dementia. Routine preoperative screening may help to identify patients with preexisting cognitive impairment who are at greatest risk for developing postoperative delirium or postoperative cognitive dysfunction.

Decreasing spatial disorientation in care-home settings: How psychology can guide the development of dementia friendly design guidelines.

Alzheimer's disease results in marked declines in navigation skills that are particularly pronounced in unfamiliar environments. However, many people with Alzheimer's disease eventually face the challenge of having to learn their way around unfamiliar environments when moving into assisted living or care-homes. People with Alzheimer's disease would have an easier transition moving to new residences if these larger, and often more institutional, environments were designed to compensate for decreasing orientation skills. However, few existing dementia friendly design guidelines specifically address orientation and wayfinding. Those that do are often based on custom, practice or intuition and not well integrated with psychological and neuroscientific knowledge or navigation research, therefore often remaining unspecific. This paper discusses current dementia friendly design guidelines, reports findings from psychological and neuropsychological experiments on navigation and evaluates their potential for informing design guidelines that decrease spatial disorientation for people with dementia.

Mitigating Simulator Adaptation Syndrome by means of tactile stimulation.

Some drivers experience Simulator Adaptation Syndrome (SAS), a condition in which nausea, disorientation, dizziness, headache, and difficulty focusing, are exhibited when driving in a simulator. To reduce this syndrome, we investigated the efficacy of tactile stimulation (TS) on mitigating Simulator Adaptation Syndrome (SAS) in a driving simulation. Fifteen drivers (eight women; mean age = 24.07 years) participated in this experiment. We compared the total scores of the Simulator Sickness Questionnaire (SSQ) across two stimulation conditions (TS condition and no stimulation condition as a baseline measure). The experimental outcomes revealed that TS seemed to decrease SAS due to attentional distraction from the symptoms and not because of an improvement in balance ability.

Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial.

BACKGROUND: Delirium is a postoperative complication that occurs frequently in patients older than 65 years, and presages adverse outcomes. We investigated whether prophylactic low-dose dexmedetomidine, a highly selective α2 adrenoceptor agonist, could safely decrease the incidence of delirium in elderly patients after non-cardiac surgery. METHODS: We did this randomised, double-blind, placebo-controlled trial in two tertiary-care hospitals in Beijing, China. We enrolled patients aged 65 years or older, who were admitted to intensive care units after non-cardiac surgery, with informed consent. We used a computer-generated randomisation sequence (in a 1:1 ratio) to randomly assign patients to receive either intravenous dexmedetomidine (0·1 µg/kg per h, from intensive care unit admission on the day of surgery until 0800 h on postoperative day 1), or placebo (intravenous normal saline). Participants, care providers, and investigators were all masked to group assignment. The primary endpoint was the incidence of delirium, assessed twice daily with the Confusion Assessment Method for intensive care units during the first 7 postoperative days. Analyses were done by intention-to-treat and safety populations. This study is registered with Chinese Clinical Trial Registry, www.chictr.org.cn, number ChiCTR-TRC-10000802. FINDINGS: Between Aug 17, 2011, and Nov 20, 2013, of 2016 patients assessed, 700 were randomly assigned to receive either placebo (n=350) or dexmedetomidine (n=350). The incidence of postoperative delirium was significantly lower in the dexmedetomidine group (32 [9%] of 350 patients) than in the placebo group (79 [23%] of 350 patients; odds ratio [OR] 0·35, 95% CI 0·22-0·54; p<0·0001). Regarding safety, the incidence of hypertension was higher with placebo (62 [18%] of 350 patients) than with dexmedetomidine (34 [10%] of 350 patients; 0·50, 0·32-0·78; p=0·002). Tachycardia was also higher in patients given placebo (48 [14%] of 350 patients) than in patients given dexmedetomidine (23 [7%] of 350 patients; 0·44, 0·26-0·75; p=0·002). Occurrence of hypotension and bradycardia did not differ between groups. INTERPRETATION: For patients aged over 65 years who are admitted to the intensive care unit after non-cardiac surgery, prophylactic low-dose dexmedetomidine significantly decreases the occurrence of delirium during the first 7 days after surgery. The therapy is safe. FUNDING: Braun Anaesthesia Scientific Research Fund and Wu Jieping Medical Foundation, Beijing, China. Study drugs were manufactured and supplied by Jiangsu Hengrui Medicine Co, Ltd, Jiangsu, China.

New job title blurs boundaries and will confuse the public.

In response to the consultation on the introduction of a nursing associate role (News, February 3), I believe it is ill-advised to include the word 'nurse' in the title, because this necessitates the involvement of the nursing regulator, and will therefore incur costs.

Detection and prediction limits for identifying highly confusable drug names from experimental data.

Confusions between drug names that look and sound alike are common, costly, harmful, and difficult to prevent. One prevention strategy is to screen proposed new drug names for confusability before approving them. Widespread acceptance of preapproval tests of confusability is compromised by the lack of experimental designs and statistical methods to support valid inferences about whether a proposed new name is unacceptably confusing. One way of identifying confusing names is to conduct memory and perception experiments on a set of drug names which would include both the new name and a set of control names (e.g., names already on the market). The experiment would yield an observed error rate for every name. Inferences about the acceptability of the new name can be made by comparing the error rate of the new name to the distribution of error rates of the control names. We describe four memory and perception experiments on drug names, carried out using clinicians as participants. Each experiment included drug names designated as test and control names. We demonstrate how to use a combination of logistic regression, Poisson prediction limits, and highly assured credible intervals to identify and apply a threshold for identifying unacceptably confusing names. Our models show an excellent fit to the data. These experimental designs and analytic methods should be useful in the preapproval testing of proposed new drug names and in similar regulatory scenarios where it is necessary to draw inferences about the comparative safety or effectiveness of new vs. old products.

In-Flight Study of Helmet-Mounted Symbology System Concepts in Degraded Visual Environments.

BACKGROUND: During approach and departure in rotary wing aircraft, a sudden loss of external visual reference precipitates spatial disorientation. METHODS: There were 10 Royal Canadian Air Force (RCAF) Griffon pilots who participated in an in-flight investigation of a 3-dimensional conformal Helmet Display Tracking System (HDTS) and the BrownOut Symbology System (BOSS) aboard an Advanced System Research Aircraft. For each symbology system, pilots performed a two-stage departure followed by a single-stage approach. The presentation order of the two symbology systems was randomized across the pilots. Subjective measurements included situation awareness, mental effort, perceived performance, perceptual cue rating, NASA Task Load Index, and physiological response. Objective performance included aircraft speed, altitude, attitude, and distance from the landing point, control position, and control activity. Repeated measures analysis of variance and planned comparison tests for the subjective and objective responses were performed. RESULTS: For both maneuvers, the HDTS system afforded better situation awareness, lower workload, better perceptual cueing in attitude, horizontal and vertical translation, and lower overall workload index. During the two-stage departure, HDTS achieved less lateral drift from initial takeoff and hover, lower root mean square error (RMSE) in altitude during hover, and lower track error during the acceleration to forward flight. During the single-stage approach, HDTS achieved less error in lateral and longitudinal position offset from the landing point and lower RMSE in heading. DISCUSSION: In both maneuvers, pilots exhibited higher control activity when using HDTS, which suggested that more pertinent information was available to the pilots. Pilots preferred the HDTS system.

[Rethinking the Prescription's Comprehension: an Example of Care Centers for Deaf People]. / Repenser la compréhension de l'ordonnance : l'exemple des soins aux Sourds.

CONTEXT: Since the realization of the difficulties for Deaf people to access care, specific assisting services in french sign language (FSL) and adapted prevention campaigns have developed in France. Illiteracy, a significant problem among Deaf people, makes the comprehension of prescription uncertain. AIM: Exploring and describing the adaptations implemented by professional signers to avoid confusion related to prescription's directions. METHOD: This qualitative study in participant observation listed the different sources of confusion and the adaptations applied on prescriptions on a daily basis by eight practitioners and three intermediators who worked in six care cent ers for Deaf people. Interviews with deaf patients aimed to ascertain the encountered difficulties. These adaptations were presented, for a three-way correlation, during a national meeting attended by professional workers in care centers for Deaf people. They were subjected to a review by all attendees in order to generate a more consensual report. RESULTS: The sources of the identified misunderstandings turned out to be connected with time representation, the use of unknown words or words with double meaning, and the issuing of several documents. To reduce the risk of error, professional signers would use charts, calendars, drawings, replace durations by dates. Some of them requested that the patient would rephrase the understood information. Pros and cons, as well as the pat ient's profile were detailed for each adaptation. CONCLUSION: Even if no method can suppress all risks of confusion, this work leads us to a reflection on alterity through the risk of medicinal errors, on prescription in general, may it be directed to a patient with no particular vulnerability or to a handicapped or illiterate one.

Simulator Study of Helmet-Mounted Symbology System Concepts in Degraded Visual Environments.

BACKGROUND: A sudden loss of external visual cues during critical phases of flight results in spatial disorientation. This is due to undetected horizontal and vertical drift when there is little tolerance for error and correction delay as the helicopter is close to the ground. Three helmet-mounted symbology system concepts were investigated in the simulator as potential solutions for the legacy Griffon helicopters. METHOD: Thirteen Royal Canadian Air Force (RCAF) Griffon pilots were exposed to the Helmet Display Tracking System for Degraded Visual Environments (HDTS), the BrownOut Symbology System (BOSS), and the current RCAF AVS7 symbology system. For each symbology system, the pilot performed a two-stage departure and a single-stage approach. The presentation order of the symbology systems was randomized. Objective performance metrics included aircraft speed, altitude, attitude, and distance from the landing point. Subjective measurements included situation awareness, mental effort, perceived performance, perceptual cue rating, and NASA Task Load Index. Repeated measures analysis of variance and subsequent planned comparison for all the objective and subjective measurements were performed between the AVS7, HDTS, and BOSS. RESULTS: Our results demonstrated that HDTS and BOSS showed general improvement over AVS7 in two-stage departure. However, only HDTS performed significantly better in heading error than AVS7. During the single-stage approach, BOSS performed worse than AVS7 in heading root mean square error, and only HDTS performed significantly better in distance to landing point and approach heading than the others. DISCUSSION: Both the HDTS and BOSS possess their own limitations; however, HDTS is the pilots' preferred flight display.

Symptom trends in the last year of life from 1998 to 2010: a cohort study.

BACKGROUND: Calls for improvement in end-of-life care have focused attention on the management of pain and other troubling symptoms at the end of life. OBJECTIVE: To describe changes in pain intensity and symptom prevalence during the last year of life from 1998 to 2010. DESIGN: Observational study. SETTING: The HRS (Health and Retirement Study), a nationally representative longitudinal survey of community-dwelling U.S. residents aged 51 years or older. PARTICIPANTS: 7204 HRS participants who died while enrolled in the study and their family respondents. MEASUREMENTS: Proxy-reported pain during the last year of life and other symptoms for at least 1 month during the last year of life. Trends in pain intensity and symptom prevalence were analyzed for all decedents and within the categories of sudden death, cancer, congestive heart failure or chronic lung disease, and frailty. RESULTS: Between 1998 and 2010, proxy reports of the prevalence of any pain increased for all decedents from 54.3% (95% CI, 51.6% to 57.1%) to 60.8% (CI, 58.2% to 63.4%), an increase of 11.9% (CI, 3.1% to 21.4%). Reported prevalences of depression and periodic confusion also increased for all decedents by 26.6% (CI, 14.5% to 40.1%) and 31.3% (CI, 18.6% to 45.1%), respectively. Individual symptoms increased in prevalence among specific decedent categories, except in cancer, which showed no significant changes. The prevalence of moderate or severe pain did not change among all decedents or in any specific decedent category. LIMITATION: Use of proxy reports and limited information about some patient and surrogate variables. CONCLUSION: Despite national efforts to improve end-of-life care, proxy reports of pain and other alarming symptoms in the last year of life increased from 1998 to 2010. PRIMARY FUNDING SOURCE: National Institute of Nursing Research.