Abstract P5-13-03: Prospective study of work limitations in breast cancer patients (pts) undergoing curative chemotherapy (CTx)

This abstract was withdrawn by the authors.

Abstract P2-11-15: Development of a web-based survey tool to assess change in breast cancer (BrCa) survivor knowledge after receipt of cancer treatment summary and survivorship care plan (SCP)

Intro: The Institute of Medicine advocates survivorship care plans (SCPs) as tools to improve coordination of care by improving survivor knowledge of follow-up recommendations and future risks. No evidence exists to demonstrate that SCPs impact survivor knowledge of diagnosis, treatment, or future/chronic side effects. Furthermore, there is a lack of information on existing surveys and their ability to assess survivor knowledge regarding these issues, without change over time. The purpose of this research is to report on the development of a survey assessing knowledge of diagnosis, treatment, and side effects in BrCa survivors.

Methods: Using existing literature, two oncologists created 24 questions addressing knowledge of diagnosis, treatment, and side effects. Content experts including breast oncology providers (representing multiple subspecialties), Survey Research Shared Service (SRSS) and patient advocates reviewed and revised the questions. Next, potential questions were administered in a group setting to BrCa survivors to evaluate clarity of instructions and survey wording. The Breast Cancer Knowledge (BreaCK) survey was further revised based on survivor feedback.

For pilot testing, BrCa survivors were recruited from clinic to test BreaCK survey content and clarity. Survey 1 was administered in clinic online. SRSS conducted verbal assessments regarding content after Survey 1. Four weeks later, survivors received Survey 2 via email and answered online. Correct answers were abstracted from the medical record.

Results: Nine subjects completed both surveys. Qualitatively, little intra-subject variation was seen between surveys. Subjects did not feel that the survey was burdensome or intrusive. No subject was able to correctly answer all questions. Final survey adjustments were made based on subject feedback and common incorrect answers encountered when grading the surveys. Specifically, subjects had difficulty understanding “endocrine or hormone therapy.” Furthermore, subjects reported guessing in response to some questions – additional answer categories were added, including “I don't know.”

Conclusion: Survivor knowledge did not change significantly between surveys. This suggests survivor knowledge was not impacted by the survey over the four-week interval. The revised BreaCK survey may be a useful tool for assessing survivor knowledge of diagnosis, treatment and side effects. A larger cohort of BrCa survivors is being recruited, starting Summer 2012, and will be evaluated using the survey.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-11-15.

The Impact of Protocolized Communication during Cardiac Surgery

Background: Communication breakdowns are a common cause of adverse events in high consequence industries. It has become increasingly evident that within healthcare systems that poor communication is the causal factor of a large percentage of sentinel events. Methods: All communication exchanges between surgeon and perfusionist were monitored via observation for 18 cardiovascular surgery cases. Breakdowns were analyzed by stage and type of breakdown and a communication protocol designed based on the breakdowns. The protocol was then implemented, and use of the protocol was then monitored for 16 cardiovascular surgery cases. Results: Breakdowns decreased at each stage of cardiovascular surgery. Specific types of breakdowns decreased dramatically, most by more than half. Conclusions: This study shows that protocolizing communication can have a profound impact on communication breakdowns in the cardiovascular surgery operating theatre.

Human error analysis of commercial aviation accidents: application of the Human Factors Analysis and Classification system (HFACS)

BACKGROUND

The Human Factors Analysis and Classification System (HFACS) is a general human error framework originally developed and tested within the U.S. military as a tool for investigating and analyzing the human causes of aviation accidents. Based on Reason's (1990) model of latent and active failures, HFACS addresses human error at all levels of the system, including the condition of aircrew and organizational factors. The purpose of the present study was to assess the utility of the HFACS framework as an error analysis and classification tool outside the military.

METHODS

The HFACS framework was used to analyze human error data associated with aircrew-related commercial aviation accidents that occurred between January 1990 and December 1996 using database records maintained by the NTSB and the FAA.

RESULTS

Investigators were able to reliably accommodate all the human causal factors associated with the commercial aviation accidents examined in this study using the HFACS system. In addition, the classification of data using HFACS highlighted several critical safety issues in need of intervention research.

CONCLUSION

These results demonstrate that the HFACS framework can be a viable tool for use within the civil aviation arena. However, additional research is needed to examine its applicability to areas outside the flight deck, such as aircraft maintenance and air traffic control domains.

Methamphetamine effects on cognitive processing during extended wakefulness

We examined the effects of both 5- and 10-mg/7O kg body weight of d-methamphetamine HCl on high event rate vigilance and tracking performance in a 13.5-hr sustained-performance session during one night of sleep loss. At 0116 hours participants were administered either a 5 mg/70 kg oral dose of d-methamphetamine (n=10), 10 mg/70 kg d-methamphetamine (n=10), or a placebo (n=10) using standard double-blind procedures. Performance on all measures degraded markedly during the night in the placebo group. Both the 5- and 10-mg methamphetamines treatment reversed an initial decline in d', and reversed increases in nonresponses (lapses) and tracking error within approximately 3 hr of administration. No evidence that amphetamine treatment increased impulsive responding (fast guesses) was observed. The magnitude of the performance effects of the methamphetamine treatments was similar at 3 hr postadministration. However, the effects of the 5-mg dose were shorter-lived, disappearing by the last testing session (6.5 hr postadministration), whereas effects of the 10-mg dose tended to remain throughout testing. Both amphetamine treatments decreased subjective sleepiness during the night and tended to increase subjective sleep latencies during a post-testing sleep period.

Human error and crew resource management failures in Naval aviation mishaps: a review of U.S. Naval Safety Center data, 1990-96

The present study examined the role of human error and crew-resource management (CRM) failures in U.S. Naval aviation mishaps. All tactical jet (TACAIR) and rotary wing Class A flight mishaps between fiscal years 1990-1996 were reviewed. Results indicated that over 75% of both TACAIR and rotary wing mishaps were attributable, at least in part, to some form of human error of which 70% were associated with aircrew human factors. Of these aircrew-related mishaps, approximately 56% involved at least one CRM failure. These percentages are very similar to those observed prior to the implementation of aircrew coordination training (ACT) in the fleet, suggesting that the initial benefits of the program have not persisted and that CRM failures continue to plague Naval aviation. Closer examination of these CRM-related mishaps suggest that the type of flight operations (preflight, routine, emergency) do play a role in the etiology of CRM failures. A larger percentage of CRM failures occurred during non-routine or extremis flight situations when TACAIR mishaps were considered. In contrast, a larger percentage of rotary wing CRM mishaps involved failures that occurred during routine flight operations. These findings illustrate the complex etiology of CRM failures within Naval aviation and support the need for ACT programs tailored to the unique problems faced by specific communities in the fleet.

U.S. naval aviation mishaps, 1977-92: differences between single- and dual-piloted aircraft

The present study examined U.S. Naval aircraft mishap trends between January 1977 and December 1992 using all Class A, B, and C mishaps. Results of this investigation revealed that mishaps attributable to both human error and mechanical/environmental factors have declined steadily over the past 16 years, although mishaps attributed to human error have declined at a much slower rate. For those mishaps attributed to human error, differences were observed between single- and dual-piloted aircraft when phase-of-flight (takeoff, in-flight, landing) and time-of-day were evaluated. For single-piloted aircraft, in-flight mishaps constituted the highest proportion of mishaps during the day ( > 55%), while landing mishaps constituted the highest proportion of mishaps during the evening and night (43-65%). For dual-piloted aircraft, no consistent variation was evident for phase-of-flight and time-of-day. In-flight (approx. 55%) mishaps constituted the highest proportion of mishaps across all times of day, followed by landing (approx. 35%), and takeoff (approx. 10%) mishaps. These data support focused rather than global investigations of aviation mishaps.

The effects of tyrosine on cognitive performance during extended wakefulness

Tyrosine, a large neutral amino acid found in dietary proteins, has received recent attention as a potential treatment for stress. The behavioral effects of tyrosine were examined during an episode of continuous nighttime work involving one night's sleep loss. Subjects performed nine iterations of a battery of performance tasks and mood scales for approximately 13 h, beginning at 1930 and ending at 0820. They remained awake throughout the day on which the experiment began and were awake for more than 24 h by the end of testing. Six hours after the experiment began, one-half of the subjects received 150 mg.kg-1 tyrosine in a split dose while the other half received cornstarch placebo in a double-blind procedure. Tyrosine administration was associated with a significant amelioration of the usual performance decline on a psychomotor task and a significant reduction in lapse probability on a high-event-rate vigilance task. The improvements lasted on the order of 3 h. The results of this study also suggest that tyrosine is a relatively benign treatment at this dose. After further testing with other doses and timing of administration, tyrosine may prove useful in counteracting performance decrements during episodes of sustained work coupled with sleep loss.