Airline pilot incapacitation survey.

A survey, replicating one originally conducted by the International Federation of Airline Pilots' Associations (IFALPA) in 1967, was carried out to investigate the aetiology of inflight incapacitation on commercial flight decks. The questionnaire was constructed by IFALPA and distributed worldwide by its member associations. Since response to the questionnaire was voluntary, no control of the sample population was possible. The results indicate that 29% of the 4,345 respondents had been incapacitated at least once. As in 1967, gastro-intestinal symptoms accounted for the majority (58%) of incidents, other main causes being symptoms of nasal and sinus congestion ('blocked' ear and sinus pain), headaches, and faintness or general weakness. Of those who had experienced an incident of incapacitation, 48% claimed that safety was actually, or potentially, affected. However, when all respondents were asked whether they were concerned about safety in the event of incapacitation inflight (excluding take-off and landing), only 25% expressed concern. Slightly more pilots operating in three-man crews (50.5%) thought incapacitation affected the safety of the flight than those operating in two-man crews (45.3%).     

Results and recommendations from the helicopter EMS pilot safety survey 2005

INTRODUCTION: In 2005, the Pilot Safety Study Group (PSSG), consisting of members of the Association of Air Medical Services Research Committee, wrote, distributed, and analyzed a survey of helicopter pilots regarding their knowledge, attitude, and perspectives on safety in the field of air medical transport. METHODS: The Pilot Safety Survey 2005 (PSS2005) was based on another survey--one that was sponsored by Helicopter Association International (HAI) and National EMS Pilots Association (NEMSPA) and administered to pilots in 2001. The PSS2005 pared questions down so that the survey could be completed in 15 minutes on the internet, and the answers were organized in a manner to simplify analysis. An electronic link to the survey was distributed in a non-randomized fashion to HEMS pilots using the mailing lists of various operators and HEMS programs. Questions were clustered into eight groupings of safety, with a majority of responses being categorical, lending themselves to cross-tabulations. RESULTS: The information gathered indicated that Helicopter EMS (HEMS) pilots are very experienced, with the average pilot logging 6,625 flight hours. Collectively, they took responsibility for HEMS accidents; with 92% of total respondents citing "pushing weather minimums" and 82% citing "pilot decision making" as the main reasons for crashes. Crew resource management (CRM) was well appreciated by the pilots; there appeared to be a positive correlation with programs that offer their employees CRM and the pilots' general perspective on safety. The survey was also clear that amongst 40% of the respondents, mission-oriented training needs improvement, and 74% responded that more realistic training in flight simulators would improve safety overall. Finally, 57% of the pilots both desired night vision goggles or devices (NVG/NVD) and believed that their usage would improve safety in the field of air medical transport (55% vs 45%, P = .0025). CONCLUSIONS: Although the recommendations from the PSS2005 are lacking in definite evidence for a decrease in HEMS crashes, we consider the direct input from pilots as critical in the absolute elimination of crashes in Helicopter EMS (Vision Zero). Pilots are, after all, the very ones held responsible for HEMS crashes. Based on these findings, the PSSG hopes that the HEMS community will incorporate the following recommendations into their standard practices. We recommend that all HEMS operators have annual and regular CRM training. We recommend that all HEMS pilots have annual and regular training in realistic flight simulators. Finally, we recommend that all HEMS aircraft be in possession of NVGs, and if this is not possible (eg, light pollution from a highly urbanized region or cost-benefit issues), then to have annual and regular mission-oriented nighttime training.     

2016年我国X射线诊断频度调查的组织和实施

为掌握我国X射线诊断的基本情况及其应用频度与分布，为X射线诊断应用的监督管理提供基础数据，本项目组设计相关调查表并通过预调查进行优化，采用分层配额抽样方法，在全国25省市选择了共557家医疗机构进行基本情况调查，并按照类型、性别、年龄组等分别统计人次数，进行多重线性回归分析估算我国2016年X射线诊断应用频度。估算结果表明，2016年我国10个省份的X射线诊断频度为379~1 228人次/千人口。全国X射线诊断应用发展迅速，与"九五"期间相比明显增加，应进一步加强X射线诊断应用管理。     

Hyperfractionated irradiation of bronchial cancer. Results of a pilot study

The results achieved during recent years in experimental radiotherapy of malignant tumors show more and more the benefit provided by the small individual doses applied in fractionated irradiation. The effects and side effects of a hyperfractionated therapy of the bronchial carcinoma were investigated in a not randomized comparative study. The data of 100 patients were available for evaluation; they showed a tendency to local superiority of hyperfractionated irradiation. The value of hyperfractionation shall be examined in detail in a randomized prospective study.     

Evaluation of critical thinking application in medical ultrasound practice among sonographers in south-eastern Nigeria

PurposeTo investigate the application of critical thinking (CT) in medical ultrasound by sonographers in south-eastern Nigeria as a measure of the quality of practice.MethodsA semi-structured questionnaire based on six elements of CT was distributed to 82 sonographers selected through a simple random sampling. The questionnaire investigated the application of the elements of interpretation, analysis, evaluation, inference, explanation and self-regulation involved in CT by medical sonographers. The data for each respondent were categorized into age, experience and the elements of CT. Statistical analyses were done using mean and Spearman's Rank correlation.ResultsThe overall mean score of the practitioners on all the elements of CT application was 8.65 ± 6.76 against a total of 60. The application of CT did not show any correlation with age or clinical experience using Spearman's Rank correlation (r = −0.017; p > 0.05 and r = −0.086; p > 0.05, respectively).ConclusionsThe results show that there is poor application of CT by medical sonographers in the locality which may impact negatively on the outcome of this diagnostic process. Increase in the number of formal training programmes in sonography and inclusion of CT skills in the curriculum are recommended.     

Agricultural pilot safety in Australia: a survey

Agricultural flying is one of the most hazardous forms of aviation. The incidence of death and injury among agricultural pilots in Australia is over one hundred times the national average for work-related injury. As with most forms of aviation, the pilot's awareness of and attitude toward risk are important factors in accident prevention. However, it is difficult for others to monitor and regulate agricultural flying activity, and responsibility for safety tends to fall largely on the pilot. A 1988 survey of agricultural pilots in Australia, carried out on behalf of the Civil Aviation Authority, showed that: 1) over 50% regularly exceed regulated flying hours; 2) 90% fly on application when tired; 3) there is a systematic relation between accidents and exposure to risk; 4) pilots perceive the main factor contributing to accidents is the pilot. The practical challenge for aviation medicine is to improve occupational safety by assisting pilots to monitor their own capabilities and performance.     

MRI of sarcoidosis patients with musculoskeletal symptoms

OBJECTIVE: Our objective was to determine MRI findings in sarcoidosis patients with musculoskeletal symptoms. CONCLUSION: In sarcoidosis patients with musculoskeletal complaints, MRI reveals marrow and soft-tissue lesions that are occult or underestimated on radiographs. Axial and large-bone lesions may resemble osseous metastases on MRI. Most lesions detected are nonspecific in appearance, except nodular muscle lesions. MRI reveals features suggesting the diagnosis, but with standard protocols, no pathognomonic MRI features were determined.     

The MRI sites functioning in 1987 in France. Results of a survey

A study of the 23 MRI sites functioning in France at the end of 1987 provides an overall view of the organizational and economic aspects of these sites as well as an initial assessment of their activity in terms of the types of equipment used and the institutions, private or public, within which they have been set up.     

Informing angiography patients. Results of a survey and critical comments

100 patients subjected to angiography have been interviewed about their knowledge of the previous diagnostic procedure. The group having cerebral angiography keeps more details and risks in mind than a group having an angiography of the limbs. No patient regards the informed consent as an unnecessary affair and the majority expects to be examined by the informing physician. The radiologist therefore has the opportunity to establish a trustful relationship to the patient and to master his roll as a physician.     

Current practice of lung ultrasonography (LUS) in the diagnosis of pneumothorax: a survey of physician sonographers in Germany

Background

The purpose of this study was to survey the current practice of the use of lung ultrasonography (LUS) in the diagnosis of pneumothorax.

Methods

Physician sonographers, accredited for diagnostic ultrasonography in surgery, anaesthesia and medicine were studied. Questions addressed the frequency of exposure to patients with suspected pneumothorax, frequency of LUS use, preferences regarding technical aspects of LUS examination, assessment of diagnostic accuracy of LUS and involvement in teaching.

Results

Of the respondents, 55.1% used LUS ‘always’ or ‘frequently’ for suspected pneumothorax. Also, 35.5% of physicians rated LUS as ‘always reliable’ in ruling out pneumothorax, and 21.3% of respondents rated LUS as ‘always reliable’ in ruling in pneumothorax. The mode of performing LUS for pneumothorax was highly variable.Statistically significant differences were found regarding the likelihood of LUS usage, the combined use of M-Mode and B-mode scanning and the confidence to exclude pneumothorax based on LUS findings for physicians with frequent exposure to pneumothorax cases.

Conclusions

Physicians'' use of LUS in the diagnosis of pneumothorax is modest. Confidence in diagnostic accuracy is not comprehensive. Further research is required to establish the most efficient way of performing LUS in this scenario to achieve the highest possible diagnostic accuracy and reliable documentation of examination results.     

Percutaneous needle biopsy of musculoskeletal lesions. 1. Effective accuracy and diagnostic utility.

The utility of a diagnostic test depends not only on its accuracy but also on how its results affect clinical management. We reviewed the results of 102 percutaneous needle biopsies to determine the accuracy, effective accuracy, and diagnostic utility of the procedure. We found percutaneous needle biopsy was similarly accurate in identifying suspected metastatic lesions (82%, n = 44), suspected musculoskeletal infections (90%, n = 29), and suspected primary musculoskeletal tumors (83%, n = 29). Effective accuracy, or accuracy discounted for results with limited clinical utility, was highest in identifying suspected metastatic deposits (77%), slightly lower in suspected infections (72%), and lowest in suspected primary tumors (59%). Diagnostic utility (the probability-weighted sum of the utility values of all possible outcomes of a diagnostic test) for identifying metastatic deposits and infections exceeded that for suspected primary tumors. Percutaneous needle biopsy in patients with suspected primary tumors must be performed with the knowledge that, even though technically accurate, such biopsies may be of limited clinical value. Percutaneous needle biopsy of suspected metastatic lesions and suspected infections, on the other hand, offers high accuracy and high diagnostic utility.     

Incidence of work related musculoskeletal disorders in medical dosimetry

Musculoskeletal disorders (MSDs) account for almost 70 million physician office visits per year in the United States and are the most common workplace injuries. These are conditions involving the nerves, tendons, muscles, and supporting structures of the body. Previous studies have concluded that computer users are at high risk of developing work-related musculoskeletal disorders (WRMSDs). As computer users, medical dosimetrists are at risk of developing WRMSDs, yet there is a lack of information regarding the incidence of WRMSDs among medical dosimetrists. The purpose of this study was to determine the incidence of WRMSDs and variables of workstation ergonomics that contribute to the increased risk of WRMSDs in medical dosimetrists. A Qualtrics survey was created to support the 3 research questions guiding this study. The survey was distributed to 2,646 full members of the American Association of Medical Dosimetrists (AAMD), which included only certified medical dosimetrists (CMDs), via email. The distribution of email surveys sent through the AAMD email distribution list resulted in 988 emails opened, for a contact rate of 37% (988/2646). One hundred sixty-four responses were recorded yielding a completion rate of 17% (164/988). Fifty-five percent (90/163) of participants responded that they have experienced WRMSDs. Forty-four percent (289/652) of responses indicated WRMSDs have a slight or moderate interference on work. Sixty-two percent (94/152) of participants felt that their workstations were not ergonomically designed; even greater 68% (104/153) did not feel their workstations were designed for their individually needs. Of those respondents 64% (98/152) would like to see further adaptations made to their workspaces.     

Appendectomy during pregnancy: a survey of two army medical activities.

Acute appendicitis is the most common nonobstetrical surgical condition of the abdomen complicating pregnancy. Appendectomy reportedly is performed during pregnancy once for every 1,500 deliveries. Although the incidence of appendicitis occurring in pregnant women is considered to be the same as in nonpregnant women, the signs and symptoms, and the laboratory findings usually associated with appendicitis in the nonpregnant condition, are frequently unreliable during pregnancy. Using the Computer Diagnostic Data System, we completed a retrospective analysis on all appendectomies performed at two Army Medical Activities (MEDDACs) during a 2-year period. With a representative large Army MEDDAC and a representative medium-sized Army MEDDAC studied, the incidence of appendectomy during pregnancy was the same frequency as in previous reports. The only consistent finding in all pregnant patients who underwent appendectomy was right lower quadrant abdominal pain. Presenting signs and symptoms, clinical evaluations, laboratory findings, and surgical management is discussed. No morbidity or mortality occurred during this study.