Syncope in Commercial Pilots and New Regulatory Guidance

INTRODUCTION: Syncope is both incapacitating and unpredictable, presenting a significant challenge in aircrew assessment. Previous UK Civil Aviation Authority (CAA) guidance lacked transparency and relied heavily on specialist in-house cardiology and neurology opinion. A new algorithm was developed which elaborated and formalized the decision-making process. An analysis of its impact on historic cases was undertaken to ensure it aligned with previous certificatory outcomes.METHODS: The medical literature on syncope and the approaches of other national aviation authorities were reviewed to help inform the development of a new algorithm. Using syncope cases in the CAA database, regulatory outcomes generated using the new algorithm were compared with previous decisions in terms of time off from flying (TOF) and Operational Multi-Crew Limitation (OML) duration.RESULTS: There were 40 historic syncope cases (25 existing certificate holders,15 initial applicants) which were reassessed using the new algorithm. The mean TOF for existing pilots using the new algorithm was 7.1 9.8 (mean SD) vs. 4.2 3.5 mo under the old guidance with an OML duration of 21.4 34.9 vs. 24.5 25.2 mo. One less initial applicant experienced a delay to certification. Four cases with underlying pathology were detected using old and new guidance.DISCUSSION: The reassessment of cases showed no statistically significant difference in TOF and OML duration; this is a positive finding from a regulatory perspective, enabling algorithm-led decision-making with less reliance on in-house expertise. A similar approach may be useful in future updates to other areas of regulatory practice.Anderton RA, Mitchell SJ, ONunain SS. Syncope in commercial pilots and new regulatory guidance. Aerosp Med Hum Perform. 2021; 92(8):642649.

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EVIDENCE-BASED MEDICINE IN THE TIMES OF COVID-19: A CROSS-SECTIONAL SURVEY TO UNDERSTAND THE INDIAN PERSPECTIVE

International Journal of Medical Science and Diagnosis Research ◽

10.32553/ijmsdr.v5i5.794 ◽

2021 ◽

Vol 5 (5) ◽

Author(s):

Karan B. Bhanushali ◽

Nikita Gupta ◽

Vinayak Mishra ◽

Heena Asnani

Keyword(s):

Decision Making ◽

Clinical Experience ◽

Evidence Based Medicine ◽

Online Survey ◽

Medical Literature ◽

Evidence Based ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Significant Difference ◽

Based Medicine

Introduction: During the COVID-19 pandemic, there is a tremendous amount of literature published regularly. In a country like India, historically, where there is a paternalistic approach to practicing medicine, there is a lot of hindrance to evidence-based medicine (EBM). Doctors have always weighed one's clinical experience superior over any other form of decision-making. This system of practice has made decision-making difficult for the physicians during this pandemic as COVID-19 is a reasonably new disease entity and the physicians lack enough 'prior experience' dealing with such a situation. Our survey tries to address the common barriers to evidence-based medical practices especially during the COVID-19 pandemic in India. We also try to explore the various source of information used by the doctors. Methods: It is a descriptive cross-sectional survey. The questions were provided in multiple-choice question format. An online survey comprising of 10 questions entitled “Hurdles faced by physicians to assimilate evidence-based guidelines on COVID-19” was made using Google Forms (Google Inc, California, US) and circulated through email to medical practitioners in the Ghatkopar (Mumbai, India) Medical Association's register from 17th June 2020 to 1st September 2020. Results: Our survey collected 213 responses, out of which 80.3% (n=171) of doctors were involved in care, counseling, or management of COVID-19 patients. The most opted primary sources for evidence-based information during this pandemic were teachings of/discussions with medical colleagues (71.4%, n=152), followed by online webinars (59.6%, n= 127) and social media (41.8%, n=89). When questioned about the main obstacles faced by them to obtain evidence-based information, the responses were as follows: Overload of medical literature (53.5%, n=114), limited access to quality resources (40.8%, n=87), unfamiliarity with the bio-statistics analysis (39%, n= 83), difficulty in locating relevant medical literature (38%, n=81), unfamiliarity with the research methodology (37.1%, n=79), lack of time (30%, n=64). Our respondents' perspective concerning EBM attributes: 57.3% (n=122) think evidence-based practice takes their clinical experience into account. 93.4% (n=199) of them have shown an interest in broadening their skills. There was no significant difference between doctors' attitudes with less than 10 years and more than 10 years of experience (chi-square value = 0.857, p = 0.65). Conclusion: Our survey results highlight the balance maintained between evidence-based medicine and experience-based medicine by Indian physicians. They identify the importance of EBM while acknowledging its shortcomings. They realize the significance of developing their repertoire to understand, appraise, and practice EBM. Keywords: EBM, COVID-19

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Indicator of access to medicines in relation to the multiple dimensions of access

Journal of Comparative Effectiveness Research ◽

10.2217/cer-2019-0031 ◽

2019 ◽

Vol 8 (12) ◽

pp. 1027-1041 ◽

Cited By ~ 4

Author(s):

Marina M Garcia ◽

Mariana M Barbosa ◽

Rondineli M Silva ◽

Edna A Reis ◽

Juliana Alvares ◽

...

Keyword(s):

Decision Making ◽

Data Collection ◽

Public Policies ◽

Access To Medicines ◽

Likert Scale ◽

Pharmaceutical Services ◽

Single Indicator ◽

Multiple Dimensions ◽

Significant Difference ◽

The Mean

Aim: Creation of a single indicator of access to medicines. Methods: Data collection was performed with individuals who obtained their medication from either public and/or private pharmacies. A Likert scale was used to measure the importance and satisfaction in relation to various access dimensions. Results: A total of 580 individuals were interviewed. Overall, participants attributed very similar importance scores to the dimensions of access to medicines. The results of the mean score of each dimension showed a statistically significant difference according to the type of pharmacy that the participant visited. Conclusion: This developed indicator will enable a review of access to medicines, making comparisons possible as well as improving decision making about public policies in the field of Pharmaceutical Services.

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Comparison of shared decision making in patients undergoing hemodialysis and peritoneal dialysis for choosing a dialysis modality

BMC Nephrology ◽

10.1186/s12882-021-02269-2 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Sepide Ghodsian ◽

Mansour Ghafourifard ◽

Akram Ghahramanian

Keyword(s):

Decision Making ◽

Peritoneal Dialysis ◽

Shared Decision Making ◽

Early Stage ◽

T Test ◽

Shared Decision ◽

Dialysis Modality ◽

Care Providers ◽

Significant Difference ◽

The Mean

Abstract Background Shared decision making (SDM) is recognized as the gold standard for patient-centered care. This study aimed to assess and compare the SDM among patients undergoing hemodialysis and peritoneal dialysis for choosing a dialysis modality. Methods This is a cross-sectional study that was performed on 300 dialysis patients (218 HD and 82 PD) referred to two Dialysis Centers. Data were collected using demographic information and a 9-item Shared Decision Making Questionnaire (SDM-Q-9). The data were analyzed using ANOVA and independent t-test by SPSS software. Results The mean SDM-Q-9 score in all samples (PD and HD) was 21.94 ± 15.08 (in a possible range of 0 to 45). Results of the independent t-test showed that the mean SDM-Q-9 score in PD patients (33.11 ± 10.08) was higher than HD patients (17.14 ± 74.24) (p < 0.001). The results showed a statistically significant difference in mean SDM-Q-9 score based on patients’ age, educational level, and income (p < 0.05). Conclusion Implementing shared decision making and providing information on RRT should be started in the early stage of CKD. The health care providers should involve patients with CKD and their families in dialysis-related decisions and it should be started in the early stage of CKD.

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Expanding fish productivity in Tasmanian saltmarsh wetlands through tidal reconnection and habitat repair

Marine and Freshwater Research ◽

10.1071/mf17154 ◽

2019 ◽

Vol 70 (1) ◽

pp. 140 ◽

Cited By ~ 4

Author(s):

Vishnu Prahalad ◽

Violet Harrison-Day ◽

Peter McQuillan ◽

Colin Creighton

Keyword(s):

Decision Making ◽

Fish Assemblages ◽

Total Catch ◽

Recreational Fisheries ◽

North West ◽

Initial Investigation ◽

Significant Difference ◽

The Mean ◽

Aid Decision ◽

Fish Productivity

Fish use of coastal saltmarsh wetlands has been documented for many parts of Australia with the notable exception of Tasmania. An initial investigation to examine the diversity, density and patterns of fish use in the Circular Head coast saltmarshes of north-west Tasmania was undertaken. To aid decision making in repair strategies, the effect of saltmarsh condition on fish assemblages was studied using paired sites of predominantly unaltered and altered saltmarshes where levees were present. In all, 851 fish from 11 species were caught in 37 of the 48 pop nets. Three species, Aldrichetta forsteri, Arripis truttaceus and Rhombosolea tapirina, are important to commercial and recreational fisheries and contributed ~20% of the total catch numbers. The mean density of >72 fish per 100m2 is the highest yet reported from Australian studies and indicates that Tasmanian saltmarshes provide higher value habitat for fish compared with elsewhere in Australia, likely due to more frequent and prolonged flooding, and the lack of adjacent mangroves. There was no significant difference in fish assemblages between unaltered and altered marshes. The results suggest that restoring basic saltmarsh structure through tidal reconnection will deliver substantial benefits for fish productivity through habitat expansion.A

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Swallowing difficulties among healthy elderly: prevalence and aetiology

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20180713 ◽

2018 ◽

Vol 4 (2) ◽

pp. 494 ◽

Cited By ~ 1

Author(s):

Fathima Abdul Khader ◽

Gangadhara Somayaji K. S. ◽

Mubeena .

Keyword(s):

The Elderly ◽

Swallowing Disorders ◽

Barium Swallow ◽

Elderly Individuals ◽

Healthy Elderly ◽

Significant Difference ◽

Swallowing Evaluation ◽

Swallowing Difficulties ◽

The Mean ◽

Underlying Pathology

Background: Dysphagia is a common problem among elderly individuals. Very few studies have been done to know the prevalence of dysphagia among healthy elderly individuals. So a study was done to assess the prevalence of swallowing difficulties among healthy elderly individuals and to find out the various causes for it in them. Methods: 259 elderly individuals were screened using the swallowing disturbance questionnaire to assess the prevalence of swallowing disorders. Those individuals with swallowing disorders were further subjected to modified Barium swallow to know the aetiology. Results: Of the 259 elderly individuals screened, 85 were females and 174 were males. The mean age and standard deviation was 66.16±6.233. The prevalence of swallowing difficulties was 20.1%, with no significant difference in the gender wise distribution or age wise distribution. Among the various aetiologies diagnosed, idiopathic cause is the commonest, followed by oesophageal neoplasm (21.1%), and then the achalasia cardia (9.6%). Among oesophageal neoplasm, mid-thoracic esophageal neoplasm (9.6%) is the commonest. Conclusions: Considering the time and cost involved, it is not feasible to subject all elderly for instrumental swallowing evaluation like videofluoroscopy. Hence it would be beneficial to screen the elderly individuals for dysphagia and educate them regarding its importance, as dysphagia can also be associated with serious underlying pathology and complications such as aspiration.

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Incubation Period of COVID-19 From 11545 Patients in Observation Study

10.21203/rs.3.rs-332666/v1 ◽

2021 ◽

Author(s):

Cheng Cheng ◽

Dongdong Zhang ◽

Dejian Dang ◽

Juan Geng ◽

Peiyu Zhu ◽

...

Keyword(s):

Decision Making ◽

Confidence Interval ◽

Incubation Period ◽

Mainland China ◽

Observation Study ◽

Male And Female ◽

Precise Data ◽

Validation Population ◽

Significant Difference ◽

The Mean

Abstract Background The incubation period is a key index of epidemiology in understanding of the spread of infectious diseases and the decision-making of the disease control. However, the incubation period of the emerging COVID-19 is still unclear. Methods Between January 19, 2020 and September 21, 2020, we collected information on 11545 patients in Mainland China outside Hubei. The 218 patients with precise data was validation population. The incubation period was fitted with lognormal model by the coarseDataTools package in R. Results In 11545 patients, the mean incubation period of COVID-19 was 7.1 days (95% Confidence interval [CI], 7.0–7.2). About 5.4% of patients had precise incubation period less than 3 days, 10.2% longer than 14 days, and 2.1% longer than 21 days. There was no statistically significant difference in incubation period between male and female (P = 0.603). It was similar in the 218 patients. The mean accurate incubation period was 6.8 days (6.2–7.4). Of which, 14.7% (32/218) of patients had incubation period less than 3 days, 12.4% (27/218) longer than 14 days, and 0.9% (2/218) longer than 21 days. Conclusions For COVID-19, the mean incubation period is 7.1 days and 10.2% of patients developed disease 14 days after infection, which challenges the current 14-day quarantine strategy.

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Early childhood caries: Are maternal psychosocial factors, decision-making ability, and caries status risk indicators for children in a sub-urban Nigerian population?

BMC Oral Health ◽

10.1186/s12903-020-01324-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Michael Alade ◽

Morenike Oluwatoyin Folayan ◽

Maha El Tantawi ◽

Ayodeji Babatunde Oginni ◽

Abiola A. Adeniyi ◽

...

Keyword(s):

Decision Making ◽

Early Childhood ◽

Psychosocial Factors ◽

Early Childhood Caries ◽

Dental Anxiety ◽

Executive Dysfunction ◽

Risk Indicators ◽

Significant Difference ◽

The Mean ◽

Childhood Caries

Abstract Objective Early childhood caries (ECC) is caries in children below the age of 72 months. The aim of the study was to determine the association of maternal psychosocial factors (general anxiety, dental anxiety, sense of coherence, parenting stress, fatalism, social support, depressive symptoms, and executive dysfunction), decision-making abilities, education, income and caries status with the prevalence and severity of ECC among children resident in Ile-Ife, Nigeria. Methods A dataset of 1549 mother–child (6–71-months-old) dyads collected through examinations and a household survey, using validated psychometric tools to measure the psychosocial factors, were analyzed. The DMFT for the mothers and the dmft for the child were determined. The association between maternal psychosocial factors, education, income, and decision-making ability, the prevalence of maternal caries, and the prevalence of ECC was determined using logistic regression analysis. Results The prevalence of maternal caries was 3.3%, and the mean (standard deviation-SD) DMFT was 0.10 (0.76). The ECC prevalence was 4.3%, and the mean (SD) dmft was 0.13 (0.92). There was no significant difference between the prevalence and severity of maternal caries and ECC by maternal age, education, income, or decision-making abilities. There was also no significant difference in maternal caries, ECC prevalence and ECC severity by maternal psychosocial factors. The only significant association was between the prevalence of caries in the mother and children: children whose mothers had caries were over six times more likely to have ECC than were children with mothers who had no caries (AOR: 6.67; 95% CI 3.23–13.79; p < 0.001). Conclusion The significant association between ECC and maternal caries prevalence suggests that prenatal oral health care for mothers may reduce the risk for ECC.

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Pneumomediastinum: retrospective analysis of 19 cases and an innovation proposal in classification

Egyptian Journal of Bronchology ◽

10.1186/s43168-021-00106-6 ◽

2022 ◽

Vol 16 (1) ◽

Author(s):

Mehmet Çetin ◽

İlteriş Türk ◽

Göktürk Fındık ◽

Koray Aydoğdu ◽

Selim Şakir Erkmen Gülhan ◽

...

Keyword(s):

Younger Adults ◽

Spontaneous Pneumomediastinum ◽

Results Of Treatment ◽

Standard Guideline ◽

Significant Difference ◽

Study Population ◽

The Mean ◽

Underlying Pathology ◽

Standardize Treatment

Abstract Background Guidelines to standardize treatment and follow-up strategies in pneumomediastinum cases are lacking. The aim of the study was to evaluate the etiology in pneumomediastinum cases and the results of treatment and follow-up. Results Nineteen patients with pneumomediastinum who were followed up in our clinic between 2015 and 2020 comprised the study population. Among the patients, 16 (84.2%) were male, and the mean age was 31.15 years. The chief presenting complaints were chest pain and dyspnea. Pneumomediastinum was spontaneous in 15/19 patients (including spontaneous pneumomediastinum with an underlying pathology in 3/15), traumatic in 3/19, and iatrogenic in 1/19. Spontaneous pneumomediastinum without underlying pathology was seen in younger adults (mean age: 23 years). Surgical intervention in traumatic and iatrogenic pneumomediastinum cases was compared with spontaneous cases and no statistically significant difference was observed (p=0.178). The mean hospital stay of all patients was 3.15 days. Only one patient had a recurrence and died, which was later determined to be a secondary spontaneous pneumomediastinum case. Conclusion Pneumomediastinum often occurs with an underlying pathology in advancing age and as spontaneous in younger patients. Therefore, “secondary spontaneous pneumomediastinum” subclass should be evaluated in the classification to facilitate to create a standard guideline and prevent overdiagnosis and overtreatment.

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Impact of the strategy of the six thinking hats in the achievement and decision-making in the teaching methods for third year students in the faculties of education: أثر إستراتيجية القبعات الست في التحصيل واتخاذ القرار في مادة طرائق التدريس لطلبة السنة الثالثة في كليات التربية

المجلة العربية للعلوم ونشر الأبحاث مجلة العلوم التربوية والنفسية ◽

10.26389/ajsrp.y260817 ◽

2017 ◽

Vol 1 (9) ◽

Author(s):

Yasser Khalaf Rashid AlShujairi - Haidar Abdul Karim Mohsen

Keyword(s):

Decision Making ◽

Teaching Methods ◽

Control Group ◽

Normal Manner ◽

Significant Difference ◽

The Mean ◽

The Difference ◽

Faculties Of Education ◽

The Impact ◽

Experimental Group

The objective of the research was to identify the impact of the strategy of the six hats in the achievement and decision-making in the teaching methods for the third year students in the faculties of education. The researchers followed the experimental method in their research, and the number of members of the research sample (70) (35) students studied the strategy of the six hats, the control group and the number of its members (35) students studied in the usual way, and then the researchers between the two groups statistically computed in the variables: In order to achieve the goal of the research, the researchers formulated a set of behavioral objectives for the scientific material that will be studied in the experiment. They then prepared experimental plans for the experimental group in accordance with the strategy of the six hats and according to the usual method of the control group, (50), and a decision-making scale consisting of (41) paragraphs with three alternatives. The net has shown There was a statistically significant difference at the mean level (0.05) among the average scores of the experimental group that studied the strategy of the six hats. It obtained an average of (41,78), compared to the control group studied in the normal manner; In the test of achievement, as well as in the decision-making scale, the experiment obtained an average of (78,30). The control group, which was studied in the usual way, obtained an average of 61,45. The difference in the achievement test and the decision- In the light of the results of the research, the researchers recommended, among other things, the adoption of the strategy of the six hats in the Dries to its impact on the collection and decision-making.

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Vowel Recognition Threshold as a Function of Temporal Segmentations

Journal of Speech and Hearing Research ◽

10.1044/jshr.1304.715 ◽

1970 ◽

Vol 13 (4) ◽

pp. 715-724 ◽

Cited By ~ 6

Author(s):

Richard L. Powell ◽

Oscar Tosi

Keyword(s):

Normal Hearing ◽

Recognition Threshold ◽

Vowel Sound ◽

Significant Difference ◽

The Mean ◽

Vowel Recognition ◽

Temporal Segment

Vowels were segmented into 15 different temporal segments taken from the middle of the vowel and ranging from 4 to 60 msecs, then presented to 6 subjects with normal hearing. The mean temporal-segment recognition threshold of 15 msecs with a range from 9.3 msecs for the /u/ to 27.2 milliseconds for the /a/. Misidenti-fication of vowels was most often confused with the vowel sound adjacent to it on the vowel-hump diagram. There was no significant difference between the cardinal and noncardinal vowels.

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