Evaluating paediatric dermatology telephone clinics during COVID-19 from a dual clinician and patient perspective: a prospective study.

BACKGROUND: The landscape of dermatology services, already rapidly evolving into an increasingly digital one, has been irretrievably altered by the COVID-19 (SARS-CoV-2) pandemic. Data are needed to assess how best to deliver virtual dermatology services in specific patient subgroups in an era of ongoing social distancing and beyond. Initial studies of teledermatology in paediatric populations suggest that many of the problems experienced in adult telemedicine are more apparent when treating children and come with additional challenges. AIM: To evaluate the efficacy of a virtual paediatric dermatology telephone clinic in comparison to traditional face-to-face (FTF) clinics, both from the clinician and patient/parental perspective. METHODS: We carried out a prospective service evaluation examining a single centre cohort of paediatric dermatology patients managed during the COVID-19 pandemic via a telephone clinic supported by images. The study period covered June-September 2020. Data on outcomes were collected from clinicians and a qualitative patient/parental telephone survey was undertaken separately. A five-point Likert scale was used to assess both satisfaction and levels of agreement regarding whether a telephone clinic was more convenient than an FTF clinic. RESULTS: Of 116 patients included, 24% were new and 76% were follow-up patients, with a mixture of inflammatory dermatoses (75%) and lesions (25%). From the clinician's perspective, most consultations (91%) were successfully completed over the telephone. However, qualitative patient and parent feedback paradoxically illustrated that although nearly all (98%) respondents had no outstanding concerns, 52% felt highly unsatisfied and only 22% agreed that telephone clinics were more convenient. Most (65%) preferred FTF follow-up in the future. Statistical analysis using χ² test showed that among those with established follow-ups, the preference for future consultation type was independent of specific reasons for follow-up. CONCLUSIONS: Our study demonstrates a clear discrepancy between the practical successes of a virtual service from the clinician's perspective compared with the patient/parental perspective. Parental anxiety appears to be less effectively allayed virtually than with FTF. This raises the question of whether there is a role for virtual paediatric telephone clinics in the postpandemic future, which may be better left to patients/parents to decide on an individual basis.

A Synthesis of Subjective Scales Which Assess Worker Fatigue: Building a Simple, Reliable, and Effective Evaluative Instrument

The accurate assessment of operator fatigue has bedeviled ergonomics since before the field was formally constituted. From the archives of the British Industrial Fatigue Research Board in the pre-World-War I era, to Muscio’s (1921) famous inquiry “is a fatigue test possible?’ [1], the question of assessment has been a perpetual challenge. The lack of accurate assessment is allied to a ready recognition that fatigue plays a critical role in many large-scale disasters as well as errors and incidents of less social prominence, but which are nevertheless equally problematic. In recent decades, in our 24-7-365 world, the issue of operator fatigue continues to impact multiple millions of workers around the world;a propensity that the COVID-19 pandemic has only exacerbated. Yet all is not doom and gloom. Most especially in the 21st century, a number of promising methods and techniques have been offered to provide reliable, quantitative values which specify fatigue levels. Very much like the allied concern for workload assessment [2], the three primary methods of assessment concern primary task performance, physiological assessment approaches, and subjective evaluations. The present work is focused on the latter mode, being arguably the most useful for the prospective projection of future fatigue levels. In short, the issue of fatigue is a large and growing one, its assessment is a crucial ergonomic concern, synthesized subjective assessment techniques promise to provide a vital answer. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Why human factors science is demonstrably necessary: historical and evolutionary foundations

We review the theoretical foundation for the need for human factors science. Over the past 2.8 million years, humans and tools have co-evolved. However, in the last century, technology is introduced at a rate that exceeds human evolution. The proliferation of computers and, more recently, robots, introduces new cognitive demands, as the human is required to be a monitor rather than a direct controller. The usage of robots and artificial intelligence is only expected to increase, and the present COVID-19 pandemic may prove to be catalytic in this regard. One way to improve overall system performance is to 'adapt the human to the machine' via task procedures, operator training, operator selection, a Procrustean mandate. Using classic research examples, we demonstrate that Procrustean methods can improve performance only to a limited extent. For a viable future, therefore, technology must adapt to the human, which underwrites the necessity of human factors science. Practitioner Summary: Various research articles have reported that the science of Human Factors is of vital importance in improving human-machine systems. However, what is lacking is a fundamental historical outline of why Human Factors is important. This article provides such a foundation, using arguments ranging from pre-history to post-COVID.

Specifying and Mitigating Thermal Stress Effects on Cognition During Personal Protective Equipment Use.

OBJECTIVE: To report present understanding concerning selected task and environmental factors influencing the changing performance capacity associated with use of personal protective equipment (PPE). BACKGROUND: Much knowledge is available concerning change in complex cognitive capacities under the effects of thermal stress. Our science can inform critical care facilities as to remediation strategies such as work-rest schedules to minimize performance error in highly cognitively demanding circumstances such as intensive care units. METHOD: The present exposition draws from the state-of-the-art understanding concerning thermal stress effects on cognition and workload in complex and demanding tasks. RESULTS: The summation and synthesis of HF/E findings provides important insights into combinatorial effects of forms of stress, typically dealt with only as discrete sources in traditional standards and regulations. The identified interaction between ascending thermal stress and cognitive task demand provides an instance of the plurality of ways HF/E can specify performance limitations in safety-critical circumstances, as witnessed in the current pandemic. CONCLUSION: Accumulated HF/E insights provide systematic ways in which to address and ameliorate the combined forces of physical and cognitive stress on medical personnel constrained to use varying forms of PPE. These principles extend beyond this specific domain to all who are required to work in differential and isolated microclimates. APPLICATION: To minimize the possibility of critical and life-threatening error in intensive care facilities which necessitate PPE use, we need principled work-rest ratio and heat stress mitigation guidance. To promote health, we need to champion healthy work practices in our health workers. HF/E insights can help achieve this important goal.