Development and Evaluation of a Graphical Anesthesia Drug Display

Syroid, Noah; Agutter, James; Drews, Frank A.; Westenskow, Dwayne R.; Albert, Robert; Bermúdez, Julio; Strayer, David L.; Prenzel, Hauke; Loeb, Robert G.; Weinger, Matthew B.

doi:10.1097/00000542-200203000-00010

Cited by 77 publications

(46 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The subjective workload assessment technique and the NASA-task load index evaluate alterations in perceived mental workload, and are utilised during the design process of new technology to assess ergonomic impact (Syroid et al, 2002). Although these systems provide an insight into how an individual reacts to potentially stressful situations, their conclusions are subjective.…”

Section: Introductionmentioning

confidence: 99%

Leukocyte responsiveness, a quantitative assay for subjective mental workload

Shelton-Rayner

Mian²,

Chandler

et al. 2012

International Journal of Industrial Ergonomics

View full text Add to dashboard Cite

Assessing psychological stress and mental workload within work-based scenarios relies heavily upon qualitative, subjective, self-assessment techniques, many of which were originally intended for identifying specific pathological disorders and have reduced sensitivity when evaluating everyday stressors. Quantitative measures involve monitoring changes in the cardiopulmonary system and stress hormone concentration. Although these (e.g. heart rate and blood pressure) provide a basic, reactive indication of the presence of a psychological stressor, many are subject to influence by other bio-mechanisms, or are unable to provide rapid results due to complex laboratory analysis. This study demonstrates how immune responsiveness, known to be influenced by psychological stress, can be used to assess changes in mental workload. Healthy male and female subjects (aged between 26 and 55 years) provided capillary blood samples before and after completing the same, basic, driver-related tasks followed by a simple manoeuvre in two unfamiliar motor vehicles. Using a chemiluminescent technique termed Leukocyte Coping Capacity (LCC), the ability of leukocytes to produce reactive oxygen species in vitro was assessed. Significant post-stressor changes in leukocyte activity were demonstrated between treatment groups. These findings add weight to the proposition that leukocyte activation is a useful quantitative measure of psychological stress and mental loading in humans. This study demonstrates the diagnostic ability of LCC for use during ergonomic evaluation, however the potential industrial applications for this technique are numerous and diverse. KEY WORDSChemiluminescence; Ergonomics; Leukocytes; Mental Workload; Psychological Stress; Reactive Oxygen Species. 3 ABBREVIATIONSHmax-RLU adj , maximum control adjusted leukocyte activity; LCC, leukocyte coping capacity; RLU adj , control adjusted relative light units; T-max, time taken (minutes) to reach maximum control adjusted leukocyte activity; T=5, 10, and 15minutes, control adjusted leukocyte activity at 5, 10, and 15 minutes, respectively, into the 45 minute chemiluminescence sampling protocol. INTRODUCTIONEvaluation of psychological stress -a threat which would not require a physiological response which elicits physiological consequences (Segerstrom and Miller, 2004) relies heavily upon qualitative psychometric measures. Examples include: Present State Examination (Baker et al., 2003), the Brief Symptom Inventory (Brosig et al., 2007;Cuculi et al., 2006;Fellinger et al., 2007;Mansbach et al., 2005), and the BussDurkee Hostility Inventory (Bag et al., 2005). All were primarily designed to identify specific pathologic disorders, and validated using dysfunctional clinical populations with abnormal statistical distributions. Consequently these proved to have limited sensitivity when used to test below intended critical diagnostic thresholds (Lemyre and Tessier, 1988) -such as when investigating psychological and physiological transient laboratory stressors.As psychological...

show abstract

Section: Introductionmentioning

confidence: 99%

Leukocyte responsiveness, a quantitative assay for subjective mental workload

Shelton-Rayner

Mian²,

Chandler

et al. 2012

International Journal of Industrial Ergonomics

View full text Add to dashboard Cite

show abstract

“…A third approach is systems which provide information on drug levels without a control function. This type of device, of which our system is an example, has been shown to lead to less variability in drug dosing and can lead to changes in clinical practice [1,2]. These devices can be overlaid on existing technology at a much lower cost than entirely new systems.…”

Section: Discussionmentioning

confidence: 99%

“…Most systems focus on intravenous agents and many provide information on both plasma and 'effect site' levels, frequently providing a display of the history along with predictions of future levels. Providing this type of feedback to the user may improve control [1,2]. We have developed a similar approach for inhalational agents and our overarching hypothesis is that there is similar value in providing users with both forward prediction and real-time effect site levels for inhalational as for intravenous agents.…”

mentioning

confidence: 99%

The effect of predictive display on the control of step changes in effect site sevoflurane levels*

Kennedy¹,

McKellow²,

French

2010

Anaesthesia

View full text Add to dashboard Cite

SummaryGraphical displays of past and future levels of drugs may be a useful adjunct to manual dosing. We have previously found that a display of predicted future values speeds step changes in end-tidal sevoflurane. In this study anaesthetists made step changes of 0.3% in effect site sevoflurane, with and without the display and as increases and decreases. We analysed 91 changes. When the predictive display was present, users made larger vaporiser dial changes of 3.9% vs 3.1% (95% CI for the difference )1.3% to )0.01%, p = 0.046) reflected in larger end-tidal changes (95% CI for the difference )0.009 vol% to )0.34 vol%, p = 0.06). There was no difference in the speed of change (220 vs 227 s (95% CI for the difference )51 to 32 s)), or in the accuracy of the change. In this study the predictive display influenced the magnitude of the step changes made by anaesthetists but did not affect the speed or overall accuracy of the change. A wide variety of pharmacokinetic ⁄ pharmacodynamic model systems have been developed for use in anaesthesia. Their main aim is to assist drug dosing either in an 'advisory' mode, where model-based drug levels are displayed to the user or, in 'target controlled infusion' (TCI) systems, which directly control drug administration automatically to maintain a given level preset by the user. Most systems focus on intravenous agents and many provide information on both plasma and 'effect site' levels, frequently providing a display of the history along with predictions of future levels. Providing this type of feedback to the user may improve control [1,2]. We have developed a similar approach for inhalational agents and our overarching hypothesis is that there is similar value in providing users with both forward prediction and real-time effect site levels for inhalational as for intravenous agents. These studies have added value with the recent introduction of commercial systems that incorporate some of these functions.We have developed and described a system that uses measured fresh gas flow rates and vaporiser dial settings in conjunction with a model of anaesthetic uptake and distribution [3] to provide forward prediction of end-tidal sevoflurane levels. Trends are displayed of a large number of monitored variables including inspired and expired concentrations of inhalational anaesthetics (Fig. 1). The predictive display rapidly demonstrates the effects of any change in input settings on both end-tidal and effect site levels. Our experience is that this permits the user to choose vaporiser and fresh gas flow settings that rapidly achieve and maintain a desired target without risk of significant overshoot, and our overall aim was to quantify this effect. We have previously shown that anaesthetists made specified changes in end-tidal sevoflurane more rapidly when this display was present but with no effect on the quality of the change [4]. We have now extended this system to include estimates of past and future effect site (C eff ), not just end-tidal, levels of sevoflurane [5]. Forward pre...

show abstract

“…Subjective workload was measured with either the NASA TLX form (9,11,14,17,19,25,26,28,(32)(33)(34)(35)(36)(37), the Borg workload score (20)(21)(22), or other paper-based, unvalidated forms (13,15,23,24,38). The conclusions of these studies suggest that mental workload is reduced by using speech-input records compared to written records (13), with experience (15,21,23,26,27,29,30), using a mixed graphical-numeric interface (11), using drug administration devices that provide feedback (14), with an improved electronic interface (17,37), with the addition of instruction to training, (25) with increased practice (28), and with digital rather than hard-copy x-rays (35).…”

Section: Published Evidencementioning

confidence: 99%

“…The conclusions of these studies suggest that mental workload is reduced by using speech-input records compared to written records (13), with experience (15,21,23,26,27,29,30), using a mixed graphical-numeric interface (11), using drug administration devices that provide feedback (14), with an improved electronic interface (17,37), with the addition of instruction to training, (25) with increased practice (28), and with digital rather than hard-copy x-rays (35). Workload was increased with fatigue (30,31), number of patients seen (30,31,38), dissatisfaction (30,31), poor self-rating of performance (30,31), poor observer rating of performance (30), laparoscopic compared with open surgery (24), during an anesthetic crisis (10), during induction of anesthesia (15,16,(20)(21)(22), with more difficult cases (15,23,26,38), with increased administrative tasks (38), when students are present (22), and when using transesophageal echo during anesthesia (20).…”

Section: Published Evidencementioning

confidence: 99%

Measurement of Mental Workload in Clinical Medicine: A Review Study

Byrne

2011

Anesth Pain

View full text Add to dashboard Cite

A B S T R A C TBackground: Measures of mental workload are now commonly used in industries to identify sources of error and to improve performance. Objectives: This study aimed to review the evidence for the use of this technique within medicine. Patients and Methods:We used search engines and the internet to identify experimental studies that included a measure of mental workload in medical practitioners or trainees/students. Studies that aimed to measure mental "stress" as a disorder, or "productivity" were excluded. Each abstract and then the full paper were appraised prior to inclusion. Results: Thirty-three studies were identified that matched the inclusion criteria. Although these covered a variety of settings, common methods were identifiable. The results support the concept of mental workload measurement as an important factor in medical performance. Conclusions: The limited number of studies and the variety of definitions and measurement techniques used in these studies, make direct comparisons difficult. However, the utility of this methodology in medical education appears to have been established, and guidelines for further research methods are proposed. Please cite this paper as: Implication for health policy/practice/research/medical education:Excessive mental workload is associated with poor performance and error in practice and poor learning in the teaching environment. Strategies to limit workload have been used successfully in other industries and could be applied to medicine.

show abstract

Development and Evaluation of a Graphical Anesthesia Drug Display

Abstract: The drug display altered simulated clinical practice. These results, which will inform the next iteration of designs and evaluations, suggest promise for this approach to drug data visualization.

Cited by 77 publications

References 31 publications

Leukocyte responsiveness, a quantitative assay for subjective mental workload

Leukocyte responsiveness, a quantitative assay for subjective mental workload

The effect of predictive display on the control of step changes in effect site sevoflurane levels*

Measurement of Mental Workload in Clinical Medicine: A Review Study

Contact Info

Product

Resources

About