Background Driving simulators are a safe alternative to on-road vehicles for studying driving behavior in glaucoma drivers. Visual field (VF) loss severity is associated with higher driving simulator crash risk, though mechanisms explaining this relationship remain unknown. Furthermore, associations between driving behavior and neurocognitive performance in glaucoma are unexplored. Here, we evaluated the hypothesis that VF loss severity and neurocognitive performance interact to influence simulated vehicle control in glaucoma drivers. Methods Glaucoma patients (n = 25) and suspects (n = 18) were recruited into the study. All had > 20/40 corrected visual acuity in each eye and were experienced field takers with at least three stable (reliability > 20%) fields over the last 2 years. Diagnosis of neurological disorder or cognitive impairment were exclusion criteria. Binocular VFs were derived from monocular Humphrey VFs to estimate a binocular VF index (OU-VFI). Montreal Cognitive Assessment (MoCA) was administered to assess global and sub-domain neurocognitive performance. National Eye Institute Visual Function Questionnaire (NEI-VFQ) was administered to assess peripheral vision and driving difficulties sub-scores. Driving performance was evaluated using a driving simulator with a 290° panoramic field of view constructed around a full-sized automotive cab. Vehicle control metrics, such as lateral acceleration variability and steering wheel variability, were calculated from vehicle sensor data while patients drove on a straight two-lane rural road. Linear mixed models were constructed to evaluate associations between driving performance and clinical characteristics. Results Patients were 9.5 years older than suspects (p = 0.015). OU-VFI in the glaucoma group ranged from 24 to 98% (85.6 ± 18.3; M ± SD). OU-VFI (p = .0066) was associated with MoCA total (p = .0066) and visuo-spatial and executive function sub-domain scores (p = .012). During driving simulation, patients showed greater steering wheel variability (p = 0.0001) and lateral acceleration variability (p < .0001) relative to suspects. Greater steering wheel variability was independently associated with OU-VFI (p = .0069), MoCA total scores (p = 0.028), and VFQ driving sub-scores (p = 0.0087), but not age (p = 0.61). Conclusions Poor vehicle control was independently associated with greater VF loss and worse neurocognitive performance, suggesting both factors contribute to information processing models of driving performance in glaucoma. Future research must demonstrate the external validity of current findings to on-road performance in glaucoma.

Aim: Implement ergonomic process improvement within the OR, to decrease incidence of injuries from sharps and needle sticks among the OR teams. Method: A pre and post intervention design was adopted. The number of reported incidents related to needle sticks and sharps over a seven month period prior to the implementation of the ergonomic process improvement(January to July 2014) and over a seven month period following implementation(January to July 2015), were compared. A participatory approach was adopted, for conducting the study and the study team included an ergonomist, surgery educators, two surgeons, operations leader, department manager, team lead, risk manager and two pre-med students functioning as study assistants. Ergonomics training for the prevention of injuries from sharps and needle sticks was developed, which incorporated physical, cognitive and teamwork measures alongside the prevention measures outlined by AORN and evidence based measures identified following a literature review. The Surgery Educator, the Ergonomist and an Attending Surgeon, participated in delivering the ergonomics injury prevention training. The management, including the Team Lead and OR Manager participated in supporting and facilitating the implementation of the injury prevention measures, where possible, such as double gloving; safe passing zones; verbal feedback; silence or task related communications only during critical phases, etc. Results: A significant difference was found in the frequency of the overall sharps and needle stick related incidents over the pre and post implementation time periods of interest(Wilcoxon Signed Rank test - significant at p≤ 0.05 level, where the W-value is 2 and the critical value for W with N=6 is 2). 63.51% decrease in incidence rate was found among the OR staff, and 44.25% decrease in incidence rate was found among students and residents, pre and post implementation. Overall, a 55% decrease was found in the incident rate of events related to sharps and needle sticks among the OR teams(experts and novices combined), over the first seven months of implementing the ergonomic process improvement. Conclusion Within the complex task and team work environments of the operating room in teaching hospitals, ergonomics and human factors fundamentals related to individual task performance, team work and work design could help improve the effectiveness of the safety measures.

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