Sleep Inertia in Aviation.

INTRODUCTION: Sleep inertia is the transition state during which alertness and cognitive performance are temporarily impaired after awakening. Magnitude and time course of sleep inertia are characterized by high individual variability with large differences between the cognitive functions affected. This period of impairment is of concern to pilots, who take sleep or nap periods during on-call work hours or in-flight rest, then need to perform safety-critical tasks soon after waking. This review analyzes literature related to sleep inertia and countermeasures applicable for aviation.METHODS: The large part of scientific literature that focuses on sleep inertia is based on studies in patients with chronic sleep inertia. We analyzed 8 narrative reviews and 64 papers related to acute sleep inertia in healthy subjects.DISCUSSION: Sleep inertia is a multifactorial, complex process, and many different protocols have been conducted, with a low number of subjects, in noncontrolled laboratory designs, with questionnaires or cognitive tests that have not been replicated. Evidence suggests that waking after sleep loss, or from deeper stages of sleep, can exacerbate sleep inertia through complex interactions between awakening and sleep-promoting brain structures. Nevertheless, no meta-analyses are possible and extrapolation to pilots' performances is hypothetical. Studies in real life or simulated operational situations must be conducted to improve the description of the impact of sleep inertia and kinetics on pilots' performances. Taking rest or sleep time remains the main method for pilots to fight against fatigue and related decreases in performance. We propose proactive strategies to mitigate sleep inertia and improve alertness.Sauvet F, Beauchamps V, Cabon P. Sleep inertia in aviation. Aerosp Med Hum Perform. 2024; 95(4):206-213.

Midwifery students' retention of learning after screen-based simulation training on neonatal resuscitation: a pilot study.

Simulation in medical education is widely used to teach both technical and non-technical skills. The use of tools such as screen-based simulation raises the question of their efficiency and the retention rate for knowledge and skills. In this study, we measured midwives' retention of learning after screen-based simulation training on neonatal resuscitation. 14 midwifery students participated in this pilot study. They undertook two screen-based simulation sessions 2 months apart. Measurements included a knowledge quiz, a self-efficacy assessment and two experts' evaluations of the Anaesthetists' Non-Technical Skills (ANTS) and Neonatal Resuscitation Performance Evaluation (NRPE) scoring (non-technical and technical skills, respectively). A demographic survey with open-ended questions on professional experience and learning concluded the study. We showed an improvement in the self-efficacy assessment (p<0.05), the knowledge quiz (p<0.01) and the ANTS evaluation (p<0.0001). However, there was no significant difference in the NRPE score. The students enjoyed the apprenticeship aspect of the screen-based simulation. Repeated exposure to a screen-based simulation on neonatal resuscitation could be advantageous for non-technical skills training, self-confidence and retention of knowledge. This is still a work in progress, undergoing further investigation with more participants and new variables.

Effect of Computer Debriefing on Acquisition and Retention of Learning After Screen-Based Simulation of Neonatal Resuscitation: Randomized Controlled Trial.

BACKGROUND: Debriefing is key in a simulation learning process. OBJECTIVE: This study focuses on the impact of computer debriefing on learning acquisition and retention after a screen-based simulation training on neonatal resuscitation designed for midwifery students. METHODS: Midwifery students participated in 2 screen-based simulation sessions, separated by 2 months, session 1 and session 2. They were randomized in 2 groups. Participants of the debriefing group underwent a computer debriefing focusing on technical skills and nontechnical skills at the end of each scenario, while the control group received no debriefing. In session 1, students participated in 2 scenarios of screen-based simulation on neonatal resuscitation. During session 2, the students participated in a third scenario. The 3 scenarios had an increasing level of difficulty, with the first representing the baseline level. Assessments included a knowledge questionnaire on neonatal resuscitation, a self-efficacy rating, and expert evaluation of technical skills as per the Neonatal Resuscitation Performance Evaluation (NRPE) score and of nontechnical skills as per the Anaesthetists' Non-Technical Skills (ANTS) system. We compared the results of the groups using the Mann-Whitney U test. RESULTS: A total of 28 midwifery students participated in the study. The participants from the debriefing group reached higher ANTS scores than those from the control group during session 1 (13.25 vs 9; U=47.5; P=.02). Their scores remained higher, without statistical difference during session 2 (10 vs 7.75; P=.08). The debriefing group had higher self-efficacy ratings at session 2 (3 vs 2; U=52; P=.02). When comparing the knowledge questionnaires, the significant baseline difference (13 for debriefing group vs 14.5 for control group, P=.05) disappeared at the end of session 1 and in session 2. No difference was found for the assessment of technical skills between the groups or between sessions. CONCLUSIONS: Computer debriefing seems to improve nontechnical skills, self-efficacy, and knowledge when compared to the absence of debriefing during a screen-based simulation. This study confirms the importance of debriefing after screen-based simulation. TRIAL REGISTRATION: ClinicalTrials.gov NCT03844009; https://clinicaltrials.gov/ct2/show/NCT03844009.

Benefits of Screen-Based Postpartum Hemorrhage Simulation on Nontechnical Skills Training: A Randomized Simulation Study.

BACKGROUND: Postpartum hemorrhage (PPH) is the leading cause of maternal death in the world. Nontechnical skills (NTS), such as communication and teamwork, are critical for efficient management of this obstetric emergency. Specific scenarios were designed on a screen-based simulator to train NTS. This study aimed to evaluate the impact of training midwives for NTS with a PPH screen-based simulation. METHODS: A total of 24 midwives participated in the study. They were randomized in 2 groups: the NTS group (n = 12) performed 3 screen-based scenarios designed to train NTS and the control group (n = 12) performed 3 basic scenarios of the screen-based simulation without the NTS training. A structured interview followed the simulation. On the same day, each trainee underwent individually an evaluation on a PPH high-fidelity simulation scenario. Three experts, blinded to the study arm, assessed the NTS with the Anesthetists Non-Technical Skills (ANTS) score. RESULTS: Midwives from the NTS group achieved higher median scores in each dimension of the ANTS score: task management (4 vs. 2/4, P < 0.0001), team working (4 vs. 2/4, P < 0.0001), situation awareness (4 vs. 2.7/4, P < 0.0001), and decision-making (4 vs. 2/4, P < 0.0001). The median value of the total ANTS score was higher in the NTS group than in the control group (15.5 vs. 8/16, P < 0.0001). CONCLUSIONS: Our study highlights that training with a NTS screen-based simulation, with specific scenarios and debriefing, leads to higher midwives' nontechnical skills performance during simulated postpartum hemorrhage.

Electronic pilot-activity monitor: a countermeasure against fatigue on long-haul flights.

BACKGROUND: Previous studies have shown frequent reductions in aircrew alertness during long-haul flights, even during the critical descent phase. Recommended countermeasures include alternation of crew activity with rest, such as cockpit napping. However, a method of monitoring the alertness level of the active and napping pilots should be considered. METHODS: The Electronic Pilot-Activity Monitor (EPAM) continuously monitors the activity of the crew (activity mode) and limits nap duration (timer mode) to prevent sleep inertia effects. The EPAM is currently being validated during actual long-haul flights. To date, we have studied 14 round trips Brussels-New York-Brussels (i.e., 28 flights). Physiological parameters, including electroencephalogram, electrooculogram, and heart rate, were recorded continuously to evaluate the ability of EPAM to detect low alertness phases. RESULTS: We present preliminary results showing that the EPAM can detect some microsleep periods during the flight. However, some microsleeps occurred while the pilot was active. In the timer mode, the EPAM was able to limit sleep duration but some deep sleep was observed. DISCUSSION: These results suggest that additional measures (e.g., eye closure duration) should be included to improve the detection of drowsy periods. In addition, the timer mode should be improved to prevent deep sleep in order to prevent subsequent sleep inertia.

Biological and psychological rhythms: an integrative approach to rhythm disturbances in autistic disorder.

Biological rhythms are crucial phenomena that are perfect examples of the adaptation of organisms to their environment. A considerable amount of work has described different types of biological rhythms (from circadian to ultradian), individual differences in their patterns and the complexity of their regulation. In particular, the regulation and maturation of the sleep-wake cycle have been thoroughly studied. Its desynchronization, both endogenous and exogenous, is now well understood, as are its consequences for cognitive impairments and health problems. From a completely different perspective, psychoanalysts have shown a growing interest in the rhythms of psychic life. This interest extends beyond the original focus of psychoanalysis on dreams and the sleep-wake cycle, incorporating central theoretical and practical psychoanalytic issues related to the core functioning of the psychic life: the rhythmic structures of drive dynamics, intersubjective developmental processes and psychic containment functions. Psychopathological and biological approaches to the study of infantile autism reveal the importance of specific biological and psychological rhythmic disturbances in this disorder. Considering data and hypotheses from both perspectives, this paper proposes an integrative approach to the study of these rhythmic disturbances and offers an etiopathogenic hypothesis based on this integrative approach.

Research and guidelines for implementing Fatigue Risk Management Systems for the French regional airlines.

This paper describes research that aims to provide the overall scientific basis for implementation of a Fatigue Risk Management System (FRMS) for French regional airlines. The current research has evaluated the use of different tools and indicators that would be relevant candidates for integration into the FRMS. For the Fatigue Risk Management component, results show that biomathematical models of fatigue are useful tools to help an airline to prevent fatigue related to roster design and for the management of aircrew planning. The Fatigue Safety assurance includes two monitoring processes that have been evaluated during this research: systematic monitoring and focused monitoring. Systematic monitoring consists of the analysis of existing safety indicators such as Air Safety Reports (ASR) and Flight Data Monitoring (FDM). Results show a significant relationship between the hours of work and the frequency of ASR. Results for the FDM analysis show that some events are significantly related to the fatigue risk associated with the hours of works. Focused monitoring includes a website survey and specific in-flight observations and data collection. Sleep and fatigue measurements have been collected from 115 aircrews over 12-day periods (including rest periods). Before morning duties, results show a significant sleep reduction of up to 40% of the aircrews' usual sleep needs leading to a clear increase of fatigue during flights. From these results, specific guidelines are developed to help the airlines to implement the FRMS and for the airworthiness to oversight the implementation of the FRMS process.

Fatigue risk management: Organizational factors at the regulatory and industry/company level.

This paper focuses on the development of fatigue risk management systems (FRMS) in the transport sector. The evolution of regulatory frameworks is traced, from uni-dimensional hours of service regulations through to frameworks that enable multi-dimensional FRMS. These regulatory changes reflect advances in understanding of human error in the aetiology of accidents, and in fatigue and safety science. Implementation of FRMS shifts the locus of responsibility for safety away from the regulator towards companies and individuals, and requires changes in traditional roles. Organizational, ethnic, and national culture need to be considered. Recent trends in the work environment have potential to adversely affect FRMS, including precarious employment and shortages of skilled labour. Essential components of an FRMS, and examples of FRMS in different transport modes, are described. It is vital that regulators, employer, and employees have an understanding of the causes and consequences of fatigue that is sufficient for them to meet their responsibilities in relation to FRMS. While there is a strong evidence base supporting the principles of FRMS, experience with implementation is more limited. The evidence base for effective implementation will expand, since FRMS is data-driven, and ongoing evaluation is integral. We strongly advocate that experience be shared wherever possible.