Employability assessment of computerized fatigue avoidance tool used with and without actigraphy among naval aircrew

Background

Fatigue Avoidance Scheduling Tool (FAST) is a computerized fatigue prevention tool, which was developed based on a Bio-mathematical model called SAPTE (Sleep, Activity, Performance and Task Effectiveness). Similarly, actigraphy technology is used as a tool for sleep evaluation. This study was an attempt to assess the employability of FAST (both independently and integrated with actigraphy) for detecting operational fatigue by determining the 'Measures for diagnostic accuracy'.

Methods

103 pre-flight medical checks from 51 aircrew were evaluated to detect fatigue both clinically and by using objective measures (FAST and actigraphy integrated FAST). The 'measures of diagnostic accuracy' namely sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio positive (LR +ve), likelihood ratio negative (LR -ve) and Youden's Index were determined and compared.

Results

The diagnostic measures for FAST were: sensitivity (68.4%), specificity (92.8%), PPV (68.4%), NPV (92.8%), LR+ve (9.5), LR-ve (0.34) and Youden's Index (0.61). For actigraphy integrated FAST these values were: sensitivity (84.2%), specificity (96.4%), PPV (94.2%), NPV (94.4%), LR+ve (23.5), LR-ve (0.16) and Youden's Index (0.80).

Conclusion

The increase in sensitivity (from 68.4% to 84.2%), specificity (from 92.8% to 96.4%), PPV (from 68.4% to 94.2%), NPV (92.8% to 94.4%), LR+ve (9.5 to 23.5) and Youden's Index (0.61 to 0.80) indicated that actigraphy integrated FAST is a better screening tool in comparison to the independently employed FAST.

1599 Review of Telephone Consultations for Suspected Head and Neck Cancer Referrals During The COVID-19 Pandemic

Introduction

Pandemic COVID-19 necessitated a transformation in the delivery of healthcare. Telephone consultations were introduced to protect and progressively manage patients with minimal delay. This is a review of the effectiveness of these remote consultations for suspected 2-week wait (2ww) head and neck cancer referrals to a north London NHS teaching hospital Oral and Maxillofacial unit during the first official UK government lockdown from March - July 2020.

Method

Prospective electronic records of 176 consecutive 2ww referrals between March – July 2020 was assessed. Data analysed included initial telephone consultations, subsequent face-to-face (F2F) appointments, if required, the interval from telephone to F2F appointments and histopathological diagnoses.

Results

157 patients (n = 176) received an initial telephone call, of which 127 (80.9%) required a F2F consultation. The number of days between the initial telephone consultation and subsequent F2F assessment ranged from 0 to 141, with a mean of 11 and a median of 1. Notably, 31 patients (24.4%) were seen in person on the same day as their telephone consultation. Biopsies were indicated for 69 patients (54.3%) of which 9 (13.0%) were diagnosed as malignancies.

Conclusions

Whilst protecting patients from a pandemic is utmost, continuing care for non-pandemic conditions must be considered. It is even more important to manage 2ww referrals efficiently. These results indicate the majority of suspected cancer referrals warrant F2F assessment for a confident outcome. Despite reinstated, ongoing social restrictions, 2ww referrals are now being seen exclusively F2F, subject to patient choice. This information is useful for planning and strategizing services in a head and neck OMFS unit.