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Czeisler MÉ, Lane RI, Petrosky E, Wiley JF, Christensen A, Njai R, Weaver MD, Robbins R, Facer-Childs ER, Barger LK, Czeisler CA, Howard ME, Rajaratnam SMW. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic - United States, June 24-30, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1049-1057. [PMID: 32790653 PMCID: PMC7440121 DOI: 10.15585/mmwr.mm6932a1] [Citation(s) in RCA: 1546] [Impact Index Per Article: 386.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Weaver MD, Landrigan CP, Sullivan JP, O'Brien CS, Qadri S, Viyaran N, Wang W, Vetter C, Czeisler CA, Barger LK. The Association Between Resident Physician Work-Hour Regulations and Physician Safety and Health. Am J Med 2020; 133:e343-e354. [PMID: 32061733 PMCID: PMC7469904 DOI: 10.1016/j.amjmed.2019.12.053] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 12/24/2019] [Accepted: 12/28/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND In 2011, the Accreditation Council for Graduate Medical Education (ACGME) instituted a 16-h limit on consecutive hours for first-year resident physicians. We sought to examine the effect of these work-hour regulations on physician safety. METHODS All medical students matched to a US residency program from 2002 to 2007 and 2014 to 2017 were invited to participate in prospective cohort studies. Each month participants reported hours of work, extended duration shifts, and adverse safety outcomes, including motor vehicle crashes, percutaneous injuries, and attentional failures. The incidence of each outcome was compared before and after the 2011 ACGME work-hour limit. Hypotheses were tested using generalized linear models adjusted for potential confounders. RESULTS Of all first-year resident physicians nationwide, 13% participated in the study, with 80,266 monthly reports completed by 15,276 first-year resident physicians. Following implementation of the 16-h 2011 ACGME work-hour limit, the mean number of extended duration (≥24-h) shifts per month decreased from 3.9 to 0.2. The risk of motor vehicle crash decreased 24% (relative risk [RR] 0.76; 0.67-0.85), percutaneous injury risk decreased more than 40% (relative risk 0.54; 0.48-0.61), and the rate of attentional failures was reduced 18% (incidence rate ratio [IRR] 0.82; 0.78-0.86). Extended duration shifts and prolonged weekly work hours were associated with an increased risk of adverse safety outcomes independent of cohort. CONCLUSIONS The 2011 ACGME work-hour limit was associated with meaningful improvements in physician safety and health. Surveillance is needed to monitor the ongoing impact of work hours on physician safety, health, and well-being.
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Affiliation(s)
- Matthew D Weaver
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine, Harvard Medical School, Boston, Mass.
| | - Christopher P Landrigan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine, Harvard Medical School, Boston, Mass; Department of Medicine, Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass
| | - Jason P Sullivan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass
| | - Conor S O'Brien
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass
| | - Salim Qadri
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass
| | - Natalie Viyaran
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass
| | - Wei Wang
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine, Harvard Medical School, Boston, Mass
| | - Céline Vetter
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass; Department of Integrative Physiology, University of Colorado, Boulder
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine, Harvard Medical School, Boston, Mass
| | - Laura K Barger
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine, Harvard Medical School, Boston, Mass
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VoPham T, Weaver MD, Hart JE, Ton M, White E, Newcomb PA. Effect of social distancing on COVID-19 incidence and mortality in the US. medRxiv 2020:2020.06.10.20127589. [PMID: 32587998 PMCID: PMC7310657 DOI: 10.1101/2020.06.10.20127589] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Social distancing policies were implemented in most US states as a containment strategy against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The effectiveness of these policy interventions on morbidity and mortality remains unknown. Our analysis examined the associations between statewide policies and objective measures of social distancing, and objective social distancing and COVID-19 incidence and mortality. We used nationwide, de-identified smartphone GPS data to estimate county-level social distancing. COVID-19 incidence and mortality data were from the Johns Hopkins Coronavirus Resource Center. Generalized linear mixed models were used to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for the association between objective social distancing and COVID-19 incidence and mortality. Stay-at-home orders were associated with a 35% increase in social distancing. Higher social distancing was associated with a 29% reduction in COVID-19 incidence (adjusted IRR 0.71; 95% CI 0.57-0.87) and a 35% reduction in COVID-19 mortality (adjusted IRR 0.65; 95% CI 0.55-0.76). These findings provide evidence to inform ongoing national discussions on the effectiveness of these public health measures and the potential implications of returning to normal social activity.
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Affiliation(s)
- Trang VoPham
- Epidemiology Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Matthew D. Weaver
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Jaime E. Hart
- Channing Division of Network Medicine, Department of Medicine, Brigham and Hospital and Harvard Medical School, Boston, MA
- Exposure, Epidemiology and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Mimi Ton
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Emily White
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA
| | - Polly A. Newcomb
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA
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Robbins R, Weaver MD, Barger LK, Quan SF, Zhivotovsky S, Czeisler CA. 0251 Association Between Sleep Disruption and Workplace Productivity: The Hidden Cost of Caregiving. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Caregiving for older spouses or family members is common with an aging population. The responsibilities caregivers maintain can disrupt sleep, which may present workplace productivity consequences. We sought to test whether caregiving-related sleep disturbance was associated with workplace productivity among adults caring for older spouses and family members.
Methods
Cross-sectional analysis of the 2011 National Study of Caregiving dataset was conducted. The dataset is comprised of family members and unpaid caregivers to older adults in the U.S. (age 65 and above) receiving assistance with self-care, mobility, or household activities. Caregivers reported the frequency of sleep disturbance (“In the last month, how often did caregiving cause your sleep to be interrupted”) from 0 (“never” or “rarely”) to 1 (“some nights”) and 2 (“most nights” or “every night”). Workplace measures included: 1) presenteeism, or the degree to which caregiving affected productivity at work, measured from 1 “not at all” to 10 “very much”; 2) absenteeism, or the proportion of hours missed from work due to caregiving to total hours worked, and 3) productivity loss, or the sum of absenteeism and presenteeism. Generalized linear models examined the relationship between workplace productivity and sleep disturbance, while controlling for relevant covariates, including age, income, education, and self-reported health.
Results
Participants comprised 2,007 caregivers. Mean (SD) age was 63.5 (12.9), and 66.4% of the participants were women (n=1,334). The most common relationship to the older adult was daughter (n=704, 35.1%), followed by spouse/partner (n=422,21.0%), and son (n=310,15.5%). Compared to no “rarely” or “never” experiencing sleep disruption, reporting disruption “most nights” or “every night” was associated with presenteeism (OR=1.2, 95%CI:1.1–1.2), absenteeism (OR=1.1, 95%CI: 1.0–1.1), and total productivity loss (OR=1.22, 95%CI: 1.1 to 1.3).
Conclusion
Caregiving-related sleep disruption is a risk factor for workplace productivity losses, hindering caregivers from professional advancement and further degrading their caregiver capacity. Future study of means for improving sleep among caregivers is warranted.
Support
T32HL007901
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Affiliation(s)
- R Robbins
- Division of Sleep and Circadian Disorders, Boston, MA
| | - M D Weaver
- Division of Sleep and Circadian Disorders, Boston, MA
| | - L K Barger
- Division of Sleep and Circadian Disorders, Boston, MA
| | - S F Quan
- Division of Sleep and Circadian Disorders, Boston, MA
| | | | - C A Czeisler
- Division of Sleep and Circadian Disorders, Boston, MA
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So RJ, Gibney SF, Czeisler ME, Ziporyn PS, Weaver MD, Barger LK, Klerman EB, Quan SF, Czeisler CA. 0977 Engagement in Collegiate Sleep Health Education: A Matter of Timing. Sleep 2019. [DOI: 10.1093/sleep/zsz067.974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | - Pallas Snider Ziporyn
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders and Harvard Medical School, Division of Sleep Medicine, Boston, MA, USA
| | - Matthew D Weaver
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders and Harvard Medical School, Division of Sleep Medicine, Boston, MA, USA
| | - Laura K Barger
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders and Harvard Medical School, Division of Sleep Medicine, Boston, MA, USA
| | - Elizabeth B Klerman
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders and Harvard Medical School, Division of Sleep Medicine, Boston, MA, USA
| | - Stuart F Quan
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders and Harvard Medical School, Division of Sleep Medicine, Boston, MA, USA
| | - Charles A Czeisler
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders and Harvard Medical School, Division of Sleep Medicine, Boston, MA, USA
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*Gibney SF, *Czeisler ME, *Fang K, Clerx EM, Allan JS, Yan A, Lee J, So RJ, Weaver MD, Viyaran N, Qadri S, O'Brien CS, Barger LK, Klerman EB, Czeisler CA. 0633 Prospective Semester-Long Evaluation of College Student Sleep. Sleep 2019. [DOI: 10.1093/sleep/zsz067.631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Matthew D Weaver
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders and Harvard Medical School, Division of Sleep Medicine, Boston, MA, USA
| | - Natalie Viyaran
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders and Harvard Medical School, Division of Sleep Medicine, Boston, MA, USA
| | - Salim Qadri
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders and Harvard Medical School, Division of Sleep Medicine, Boston, MA, USA
| | - Conor S O'Brien
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders and Harvard Medical School, Division of Sleep Medicine, Boston, MA, USA
| | - Laura K Barger
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders and Harvard Medical School, Division of Sleep Medicine, Boston, MA, USA
| | - Elizabeth B Klerman
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders and Harvard Medical School, Division of Sleep Medicine, Boston, MA, USA
| | - Charles A Czeisler
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders and Harvard Medical School, Division of Sleep Medicine, Boston, MA, USA
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Weaver MD, Smith B, O'Brien CS, Viyaran N, Qadri S, Davidson JR, Stenstrom P, Denesle R, Barger LK, Quan SF, Czeisler CA. 0976 The Healthy Sleep Program Quality Improvement Initiative. Sleep 2019. [DOI: 10.1093/sleep/zsz067.973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Matthew D Weaver
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders and Harvard Medical School, Division of Sleep Medicine, Boston, MA, USA
| | - Brad Smith
- Haleo Preventive Health Solutions, Montreal, QC, Canada
| | - Conor S O'Brien
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders and Harvard Medical School, Division of Sleep Medicine, Boston, MA, USA
| | - Natalie Viyaran
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders and Harvard Medical School, Division of Sleep Medicine, Boston, MA, USA
| | - Salim Qadri
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders and Harvard Medical School, Division of Sleep Medicine, Boston, MA, USA
| | | | | | | | - Laura K Barger
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders and Harvard Medical School, Division of Sleep Medicine, Boston, MA, USA
| | - Stuart F Quan
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders and Harvard Medical School, Division of Sleep Medicine, Boston, MA, USA
| | - Charles A Czeisler
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders and Harvard Medical School, Division of Sleep Medicine, Boston, MA, USA
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Weaver MD, Sullivan JP, Qadri S, Viyaran N, O'Brien CS, Landrigan CP, Czeisler CA, Barger LK. 0997 Scheduling Factors Associated With Resident Physician And Patient Safety In More Senior Residents. Sleep 2019. [DOI: 10.1093/sleep/zsz067.994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Matthew D Weaver
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Jason P Sullivan
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
| | - Salim Qadri
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
| | - Natalie Viyaran
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
| | - Conor S O'Brien
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
| | - Christopher P Landrigan
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Laura K Barger
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
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Quan SF, Weaver MD, Barger LK, O'Brien CS, Viyaran N, Qadri S, Czeisler CA. 0996 Interim Findings from a Sleep Health and Wellness Program to Reduce Occupational Burnout. Sleep 2019. [DOI: 10.1093/sleep/zsz067.993] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Stuart F Quan
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders and Harvard Medical School, Division of Sleep Medicine, Boston, MA, USA
| | - Matthew D Weaver
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders and Harvard Medical School, Division of Sleep Medicine, Boston, MA, USA
| | - Laura K Barger
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders and Harvard Medical School, Division of Sleep Medicine, Boston, MA, USA
| | - Conor S O'Brien
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders and Harvard Medical School, Division of Sleep Medicine, Boston, MA, USA
| | - Natalie Viyaran
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders and Harvard Medical School, Division of Sleep Medicine, Boston, MA, USA
| | - Salim Qadri
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders and Harvard Medical School, Division of Sleep Medicine, Boston, MA, USA
| | - Charles A Czeisler
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders and Harvard Medical School, Division of Sleep Medicine, Boston, MA, USA
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Patterson PD, Weaver MD, Markosyan MA, Moore CG, Guyette FX, Doman JM, Sequeira DJ, Werman HA, Swanson D, Hostler D, Lynch J, Templin MA, Rozario NL, Russo L, Hines L, Swecker K, Runyon MS, Buysse DJ. Impact of shift duration on alertness among air-medical emergency care clinician shift workers. Am J Ind Med 2019; 62:325-336. [PMID: 30734328 DOI: 10.1002/ajim.22956] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Greater than half of Emergency Medical Services (EMS) shift workers report fatigue at work and most work long duration shifts. We sought to compare the alertness level of EMS shift workers by shift duration. METHODS We used a multi-site, 14-day prospective observational cohort study design of EMS clinician shift workers at four air-medical EMS organizations. The primary outcome was behavioral alertness as measured by psychomotor vigilance tests (PVT) at the start and end of shifts. We stratified shifts by duration (< 24 h and 24 h), night versus day, and examined the impact of intra-shift napping on PVT performance. RESULTS One hundred and twelve individuals participated. The distribution of shifts <24 h and 24 h with complete data were 54% and 46%, respectively. We detected no differences in PVT performance measures stratified by shift duration (P > 0.05). Performance for selected PVT measures (lapses and false starts) was worse on night shifts compared to day shifts (P < 0.05). Performance also worsened with decreasing time between waking from a nap and the end of shift PVT assessment. CONCLUSIONS Deficits in performance in the air-medical setting may be greatest during night shifts and proximal to waking from an intra-shift nap. Future research should examine alertness and performance throughout air-medical shifts, as well as investigate the timing and duration of intra-shift naps on outcomes.
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Affiliation(s)
- P. Daniel Patterson
- Department of Emergency Medicine; University of Pittsburgh; School of Medicine; Pittsburgh Pennsylvania
- Division of Community Health Services; University of Pittsburgh, School of Health and Rehabilitation Sciences; Pittsburgh Pennsylvania
| | - Matthew D. Weaver
- Harvard Medical School, Division of Sleep Medicine, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology; Brigham and Women's Hospital; Boston Massachusetts
| | - Mark A. Markosyan
- Department of Emergency Medicine; University of Pittsburgh; School of Medicine; Pittsburgh Pennsylvania
- Division of Community Health Services; University of Pittsburgh, School of Health and Rehabilitation Sciences; Pittsburgh Pennsylvania
| | - Charity G. Moore
- Department of Physical Therapy; University of Pittsburgh; School of Health and Rehabilitation Sciences; Pittsburgh Pennsylvania
| | - Frank X. Guyette
- Department of Emergency Medicine; University of Pittsburgh; School of Medicine; Pittsburgh Pennsylvania
| | - Jack M. Doman
- Department of Psychiatry, University of Pittsburgh; School of Medicine; Pittsburgh Pennsylvania
| | - Denisse J. Sequeira
- Department of Emergency Medicine; University of Pittsburgh; School of Medicine; Pittsburgh Pennsylvania
| | | | - Doug Swanson
- Carolinas HealthCare System; Charlotte North Carolina
| | - David Hostler
- Department of Exercise and Nutrition Sciences; The State University of New York; University at Buffalo; Buffalo New York
| | - Joshua Lynch
- MercyFlight of Western New York; Buffalo New York
- Department of Emergency Medicine; Jacobs School of Medicine and Biomedical Sciences; The State University of New York; University at Buffalo; Buffalo New York
| | | | | | - Lindsey Russo
- Department of Exercise and Nutrition Sciences; The State University of New York; University at Buffalo; Buffalo New York
| | | | | | | | - Daniel J. Buysse
- Department of Psychiatry, University of Pittsburgh; School of Medicine; Pittsburgh Pennsylvania
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Weaver MD, Fahrenfort JJ, Belopolsky A, van Gaal S. Independent Neural Activity Patterns for Sensory- and Confidence-Based Information Maintenance during Category-Selective Visual Processing. eNeuro 2019; 6:ENEURO.0268-18.2018. [PMID: 30834301 PMCID: PMC6397950 DOI: 10.1523/eneuro.0268-18.2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/30/2018] [Accepted: 12/16/2018] [Indexed: 11/21/2022] Open
Abstract
Several influential theories of consciousness attempt to explain how, when and where conscious perception arises in the brain. The extent of conscious perception of a stimulus is often probed by asking subjects to provide confidence estimations in their choices in challenging perceptual decision-making tasks. Here, we aimed to dissociate neural patterns of "cognitive" and "sensory" information maintenance by linking category selective visual processes to decision confidence using multivariate decoding techniques on human EEG data. Participants discriminated at-threshold masked face versus house stimuli and reported confidence in their discrimination performance. Three distinct types of category-selective neural activity patterns were observed, dissociable by their timing, scalp topography, relationship with decision confidence, and generalization profile. An early (∼150-200 ms) decoding profile was unrelated to confidence and quickly followed by two distinct decodable patterns of late neural activity (350-500 ms). One pattern was on-diagonal, global and highly related to decision confidence, likely indicating cognitive maintenance of consciously reportable stimulus representations. The other pattern however was off-diagonal, restricted to posterior electrode sites (local), and independent of decision confidence, and therefore may reflect sensory maintenance of category-specific information, possibly operating via recurrent processes within visual cortices. These results highlight that two functionally independent neural processes are operating in parallel, only one of which is related to decision confidence and conscious access.
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Affiliation(s)
- Matthew D. Weaver
- Department of Psychology, University of Amsterdam, Amsterdam 1001 NK, The Netherlands
- Amsterdam Brain and Cognition (ABC), University of Amsterdam, Amsterdam 1001 NK, The Netherlands
- Experimental and Applied Psychology, Vrije Universiteit Amsterdam, Amsterdam 1081 BT, The Netherlands
| | - Johannes J. Fahrenfort
- Department of Psychology, University of Amsterdam, Amsterdam 1001 NK, The Netherlands
- Amsterdam Brain and Cognition (ABC), University of Amsterdam, Amsterdam 1001 NK, The Netherlands
- Experimental and Applied Psychology, Vrije Universiteit Amsterdam, Amsterdam 1081 BT, The Netherlands
| | - Artem Belopolsky
- Experimental and Applied Psychology, Vrije Universiteit Amsterdam, Amsterdam 1081 BT, The Netherlands
| | - Simon van Gaal
- Department of Psychology, University of Amsterdam, Amsterdam 1001 NK, The Netherlands
- Amsterdam Brain and Cognition (ABC), University of Amsterdam, Amsterdam 1001 NK, The Netherlands
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Weaver MD, Barger LK, Malone SK, Anderson LS, Klerman EB. Dose-Dependent Associations Between Sleep Duration and Unsafe Behaviors Among US High School Students. JAMA Pediatr 2018; 172:1187-1189. [PMID: 30285029 PMCID: PMC6366445 DOI: 10.1001/jamapediatrics.2018.2777] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Matthew D. Weaver
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital,Division of Sleep Medicine, Harvard Medical School
| | - Laura K. Barger
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital,Division of Sleep Medicine, Harvard Medical School
| | | | | | - Elizabeth B. Klerman
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital,Division of Sleep Medicine, Harvard Medical School
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Patterson PD, Moore CG, Guyette FX, Doman JM, Weaver MD, Sequeira DJ, Werman HA, Swanson D, Hostler D, Lynch J, Russo L, Hines L, Swecker K, Kroemer AJ, Runyon MS, Buysse DJ. Real-Time Fatigue Mitigation with Air-Medical Personnel: The SleepTrackTXT2 Randomized Trial. PREHOSP EMERG CARE 2018; 23:465-478. [PMID: 30285519 DOI: 10.1080/10903127.2018.1532476] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: The aims of this study were: 1) to determine the short-term impact of the SleepTrackTXT2 intervention on air-medical clinician fatigue during work shifts and 2) determine the longer-term impact on sleep quality over 120 days. Methods: We used a multi-site randomized controlled trial study design with a targeted enrollment of 100 (ClinicalTrials.gov NCT02783027). The intervention was behavioral (non-pharmacological) and participation was scheduled for 120 days. Participation was voluntary. All consented participants answered baseline as well as follow-up surveys. All participants answered text message queries, which assessed self-rated fatigue, sleepiness, concentration, recovery, and hours of sleep. Intervention participants received additional text messages with recommendations for behaviors that can mitigate fatigue. Intervention participants received weekly text messages that promoted sleep. Our analysis was guided by the intent-to-treat principle. For the long-term outcome of interest (sleep quality at 120 days), we used a two-sample t-test on the change in sleep quality to determine the intervention effect. Results: Eighty-three individuals were randomized and 2,828 shifts documented (median shifts per participant =37, IQR 23-49). Seventy-one percent of individuals randomized (n = 59) participated up to the 120-day study period and 52% (n = 43) completed the follow-up survey. Of the 69,530 text messages distributed, participants responded to 61,571 (88.6%). Mean sleep quality at 120 days did not differ from baseline for intervention (p > 0.05) or control group participants (p > 0.05), and did not differ between groups (p > 0.05). There was no change from baseline to 120 days in the proportion with poor sleep quality in either group. Intra-shift fatigue increased (worsened) over the course of 12-hour shifts for participants in both study arms. Fatigue at the end of 12-hour shifts was higher among control group participants than participants in the intervention group (p < 0.05). Pre-shift hours of sleep were often less than 7 hours and did not differ between the groups over time. Conclusions: The SleepTrackTXT2 behavioral intervention showed a positive short-term impact on self-rated fatigue during 12-hour shifts, but did not impact longer duration shifts or have a longer-term impact on sleep quality among air-medical EMS clinicians.
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Szafranski P, Kośmider E, Liu Q, Karolak JA, Currie L, Parkash S, Kahler SG, Roeder E, Littlejohn RO, DeNapoli TS, Shardonofsky FR, Henderson C, Powers G, Poisson V, Bérubé D, Oligny L, Michaud JL, Janssens S, De Coen K, Van Dorpe J, Dheedene A, Harting MT, Weaver MD, Khan AM, Tatevian N, Wambach J, Gibbs KA, Popek E, Gambin A, Stankiewicz P. LINE- and Alu-containing genomic instability hotspot at 16q24.1 associated with recurrent and nonrecurrent CNV deletions causative for ACDMPV. Hum Mutat 2018; 39:1916-1925. [PMID: 30084155 DOI: 10.1002/humu.23608] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 01/20/2023]
Abstract
Transposable elements modify human genome by inserting into new loci or by mediating homology-, microhomology-, or homeology-driven DNA recombination or repair, resulting in genomic structural variation. Alveolar capillary dysplasia with misalignment of pulmonary veins (ACDMPV) is a rare lethal neonatal developmental lung disorder caused by point mutations or copy-number variant (CNV) deletions of FOXF1 or its distant tissue-specific enhancer. Eighty-five percent of 45 ACDMPV-causative CNV deletions, of which junctions have been sequenced, had at least one of their two breakpoints located in a retrotransposon, with more than half of them being Alu elements. We describe a novel ∼35 kb-large genomic instability hotspot at 16q24.1, involving two evolutionarily young LINE-1 (L1) elements, L1PA2 and L1PA3, flanking AluY, two AluSx, AluSx1, and AluJr elements. The occurrence of L1s at this location coincided with the branching out of the Homo-Pan-Gorilla clade, and was preceded by the insertion of AluSx, AluSx1, and AluJr. Our data show that, in addition to mediating recurrent CNVs, L1 and Alu retrotransposons can predispose the human genome to formation of variably sized CNVs, both of clinical and evolutionary relevance. Nonetheless, epigenetic or other genomic features of this locus might also contribute to its increased instability.
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Affiliation(s)
- Przemyslaw Szafranski
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Ewelina Kośmider
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas.,Faculty of Mathematics, Informatics and Mechanics, University of Warsaw, Warsaw, Poland
| | - Qian Liu
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Justyna A Karolak
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas.,Department of Genetics and Pharmaceutical Microbiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Lauren Currie
- Maritime Medical Genetics Service, IWK Health Centre, Halifax, Canada
| | - Sandhya Parkash
- Maritime Medical Genetics Service, IWK Health Centre, Halifax, Canada
| | - Stephen G Kahler
- Section of Genetics and Metabolism, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Elizabeth Roeder
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, San Antonio, Texas
| | | | - Thomas S DeNapoli
- Department of Pathology, Children's Hospital of San Antonio, San Antonio, Texas
| | - Felix R Shardonofsky
- Pediatric Pulmonary Center, Children's Hospital of San Antonio, San Antonio, Texas
| | - Cody Henderson
- Department of Pediatrics, Baylor College of Medicine, San Antonio, Texas.,Neonatal-Perinatal Medicine, Children's Hospital of San Antonio, San Antonio, Texas
| | - George Powers
- Department of Pediatrics, Baylor College of Medicine, San Antonio, Texas.,Neonatal-Perinatal Medicine, Children's Hospital of San Antonio, San Antonio, Texas
| | | | | | | | | | - Sandra Janssens
- Center for Medical Genetics, Ghent University, Ghent, Belgium
| | - Kris De Coen
- Department of Neonatal Intensive Care, Ghent University, Ghent, Belgium
| | - Jo Van Dorpe
- Department of Pathology, Ghent University, Ghent, Belgium
| | | | | | | | - Amir M Khan
- McGovern Medical School at UTHealth, Houston, Texas
| | | | - Jennifer Wambach
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Kathleen A Gibbs
- Children's Hospital of Philadelphia, and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Edwina Popek
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - Anna Gambin
- Faculty of Mathematics, Informatics and Mechanics, University of Warsaw, Warsaw, Poland
| | - Paweł Stankiewicz
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
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65
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Weaver MD, Vetter C, Rajaratnam SMW, O'Brien CS, Qadri S, Benca RM, Rogers AE, Leary EB, Walsh JK, Czeisler CA, Barger LK. Sleep disorders, depression and anxiety are associated with adverse safety outcomes in healthcare workers: A prospective cohort study. J Sleep Res 2018; 27:e12722. [PMID: 30069960 DOI: 10.1111/jsr.12722] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 05/13/2018] [Accepted: 05/25/2018] [Indexed: 11/29/2022]
Abstract
The objective of the study was to determine if sleep disorder, depression or anxiety screening status was associated with safety outcomes in a diverse population of hospital workers. A sample of shift workers at four hospitals participated in a prospective cohort study. Participants were screened for five sleep disorders, depression and anxiety at baseline, then completed prospective monthly surveys for the next 6 months to capture motor vehicle crashes, near-miss crashes, occupational exposures and medical errors. We tested the associations between sleep disorders, depression and anxiety and adverse safety outcomes using incidence rate ratios adjusted for potentially confounding factors in a multivariable negative binomial regression model. Of the 416 hospital workers who participated, two in five (40.9%) screened positive for a sleep disorder and 21.6% screened positive for depression or anxiety. After multivariable adjustment, screening positive for a sleep disorder was associated with 83% increased incidence of adverse safety outcomes. Screening positive for depression or anxiety increased the risk by 63%. Sleep disorders and mood disorders were independently associated with adverse outcomes and contributed additively to risk. Our findings suggest that screening for sleep disorders and mental health screening can help identify individuals who are vulnerable to adverse safety outcomes. Future research should evaluate sleep and mental health screening, evaluation and treatment programmes that may improve safety.
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Affiliation(s)
- Matthew D Weaver
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Céline Vetter
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts.,Broad Institute of Harvard and MIT, Cambridge, Massachusetts
| | - Shantha M W Rajaratnam
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts.,School of Psychology and Psychiatry, Monash University, Clayton, Victoria, Australia
| | - Conor S O'Brien
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts
| | - Salim Qadri
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ruth M Benca
- Department of Psychiatry and Human Behavior, University of California, Irvine, California
| | - Ann E Rogers
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Eileen B Leary
- The Stanford Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Stanford, California
| | - James K Walsh
- Sleep Medicine and Research Center, St Luke's Hospital, St Louis, Missouri
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Laura K Barger
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
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66
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Weaver MD, Sullivan JP, O’Brien CS, Qadri S, Viyaran N, Wang W, Vetter C, Landrigan CP, Czeisler CA, Barger LK. 1045 Effects of Policy Prohibiting Extended Shifts on Patient and Resident Physician Safety. Sleep 2018. [DOI: 10.1093/sleep/zsy061.1044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M D Weaver
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | | | | | - S Qadri
- Brigham and Women’s Hospital, Boston, MA
| | - N Viyaran
- Brigham and Women’s Hospital, Boston, MA
| | - W Wang
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - C Vetter
- University of Colorado, Boulder, CO
| | - C P Landrigan
- Boston Children’s Hospital and Harvard Medical School, Boston, MA
| | - C A Czeisler
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - L K Barger
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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67
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VoPham T, Weaver MD, Vetter C, Hart JE, Tamimi RM, Laden F, Bertrand KA. Circadian Misalignment and Hepatocellular Carcinoma Incidence in the United States. Cancer Epidemiol Biomarkers Prev 2018; 27:719-727. [PMID: 29636342 DOI: 10.1158/1055-9965.epi-17-1052] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/31/2018] [Accepted: 04/05/2018] [Indexed: 12/29/2022] Open
Abstract
Background: Circadian misalignment may increase the risk of developing hepatocellular carcinoma (HCC). The aim of this study was to examine the association between distance from time zone meridian, a proxy for circadian misalignment, and HCC risk in the United States adjusting for known HCC risk factors.Methods: Surveillance, Epidemiology, and End Results (SEER) provided information on 56,347 HCC cases diagnosed between 2000 and 2014 from 16 population-based cancer registries in the United States. Distance from time zone meridian was estimated using the location of each SEER county's Center of Population in a geographic information system. Poisson regression with robust variance estimation was used to calculate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for the association between distance from time zone meridian and HCC risk adjusting for individual-level age at diagnosis, sex, race/ethnicity, year of diagnosis, SEER registry, and county-level prevalence of health conditions, lifestyle factors, shift work occupation, socioeconomic status, and demographic and environmental factors.Results: A 5-degree increase in longitude moving east to west within a time zone was associated with a statistically significant increased risk for HCC (IRR, 1.07; 95% CI, 1.01-1.14, P = 0.03). A statistically significant positive association was observed among those <65 years old, while no association was observed among individuals ≥65 years old (Pfor interaction < 0.01).Conclusions: Circadian misalignment from residing in the western region of a time zone may impact hepatocarcinogenesis.Impact: Circadian misalignment may be an independent risk factor for HCC. Cancer Epidemiol Biomarkers Prev; 27(7); 719-27. ©2018 AACR.
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Affiliation(s)
- Trang VoPham
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. .,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Matthew D Weaver
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Céline Vetter
- Department of Integrative Physiology, University of Colorado, Boulder, Boulder, Colorado.,Broad Institute of Harvard and MIT, Cambridge, Massachusetts
| | - Jaime E Hart
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Rulla M Tamimi
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Francine Laden
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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68
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Patterson PD, Weaver MD, Fabio A, Teasley EM, Renn ML, Curtis BR, Matthews ME, Kroemer AJ, Xun X, Bizhanova Z, Weiss PM, Sequeira DJ, Coppler PJ, Lang ES, Higgins JS. Reliability and Validity of Survey Instruments to Measure Work-Related Fatigue in the Emergency Medical Services Setting: A Systematic Review. PREHOSP EMERG CARE 2018; 22:17-27. [DOI: 10.1080/10903127.2017.1376134] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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69
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Patterson PD, Runyon MS, Higgins JS, Weaver MD, Teasley EM, Kroemer AJ, Matthews ME, Curtis BR, Flickinger KL, Xun X, Bizhanova Z, Weiss PM, Condle JP, Renn ML, Sequeira DJ, Coppler PJ, Lang ES, Martin-Gill C. Shorter Versus Longer Shift Durations to Mitigate Fatigue and Fatigue-Related Risks in Emergency Medical Services Personnel and Related Shift Workers: A Systematic Review. PREHOSP EMERG CARE 2018; 22:28-36. [PMID: 29324079 DOI: 10.1080/10903127.2017.1376135] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND This study comprehensively reviewed the literature on the impact of shorter versus longer shifts on critical and important outcomes for Emergency Medical Services (EMS) personnel and related shift worker groups. METHODS Six databases (e.g., PubMed/MEDLINE) were searched, including one website. This search was guided by a research question developed by an expert panel a priori and registered with the PROSPERO database of systematic reviews (2016:CRD42016040099). The critical outcomes of interest were patient safety and personnel safety. The important outcomes of interest were personnel performance, acute fatigue, sleep and sleep quality, retention/turnover, long-term health, burnout/stress, and cost to system. Screeners worked independently and full-text articles were assessed for relevance. Data abstracted from the retained literature were categorized as favorable, unfavorable, mixed/inconclusive, or no impact toward the shorter shift duration. This research characterized the evidence as very low, low, moderate, or high quality according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. RESULTS The searched yielded n = 21,674 records. Of the 480 full-text articles reviewed, 100 reported comparisons of outcomes of interest by shift duration. We identified 24 different shift duration comparisons, most commonly 8 hours versus 12 hours. No one study reported findings for all 9 outcomes. Two studies reported findings linked to both critical outcomes of patient and personnel safety, 34 reported findings for one of two critical outcomes, and 64 did not report findings for critical outcomes. Fifteen studies were grouped to compare shifts <24 hours versus shifts ≥24 hours. None of the findings for the critical outcomes of patient and personnel safety were categorized as unfavorable toward shorter duration shifts (<24 hours). Nine studies were favorable toward shifts <24 hours for at least one of the 7 important outcomes, while findings from one study were categorized as unfavorable. Evidence quality was low or very low. CONCLUSIONS The quality of existing evidence on the impact of shift duration on fatigue and fatigue-related risks is low or very low. Despite these limitations, this systematic review suggests that for outcomes considered critical or important to EMS personnel, shifts <24 hours in duration are more favorable than shifts ≥24 hours.
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70
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Hughes AM, Patterson PD, Weaver MD, Gregory ME, Sonesh SC, Landsittel DP, Krackhardt D, Hostler D, Lazzara EH, Wang X, Vena JE, Salas E, Yealy DM. Teammate Familiarity, Teamwork, and Risk of Workplace Injury in Emergency Medical Services Teams. J Emerg Nurs 2017; 43:339-346. [DOI: 10.1016/j.jen.2016.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 10/31/2016] [Accepted: 11/22/2016] [Indexed: 10/19/2022]
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71
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Weaver MD, Sullivan JP, Vetter C, Wang W, O’Brien CS, Qadri S, Landrigan CP, Czeisler CA, Barger LK. 1182 WORK HOUR POLICIES ARE ASSOCIATED WITH MEDICAL RESIDENT SLEEP, HEALTH AND WELLNESS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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72
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Barger LK, Wang W, Weaver MD, Sullivan JP, Vetter C, O’Brien C, Qadri S, Landrigan CP, Czeisler CA. 1177 INCREASED RISK OF ADVERSE SAFETY OUTCOMES IN PGY1 RESIDENTS WORKING LONG WORK WEEKS AND ≥16-HOUR SHIFTS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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73
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Weaver MD, Sullivan JP, Vetter C, Wang W, O’Brien CS, Qadri S, Landrigan CP, Czeisler CA, Barger LK. 1183 WORK HOUR POLICIES ARE ASSOCIATED WITH IMPROVED SAFETY AMONG MEDICAL RESIDENTS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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74
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Weaver MD, van Zoest W, Hickey C. A temporal dependency account of attentional inhibition in oculomotor control. Neuroimage 2017; 147:880-894. [DOI: 10.1016/j.neuroimage.2016.11.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/02/2016] [Accepted: 11/05/2016] [Indexed: 10/20/2022] Open
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75
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Weaver MD, Hickey C, van Zoest W. The impact of salience and visual working memory on the monitoring and control of saccadic behavior: An eye-tracking and EEG study. Psychophysiology 2017; 54:544-554. [DOI: 10.1111/psyp.12817] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 11/28/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Matthew D. Weaver
- Center for Mind/Brain Sciences; University of Trento; Rovereto Italy
| | - Clayton Hickey
- Center for Mind/Brain Sciences; University of Trento; Rovereto Italy
| | - Wieske van Zoest
- Center for Mind/Brain Sciences; University of Trento; Rovereto Italy
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Abstract
OBJECTIVES This study sought to estimate charges associated with USA hospital visits for traumatic brain injury (TBI), compare charges from 2006-2010 and evaluate factors associated with higher charges. METHODS The Nationwide Emergency Department Sample database, 2006-2010, was used to estimate charges for emergency department visits and inpatient hospital stays associated with TBI and trends in charges over time were compared. Multivariable linear regression was used to evaluate factors associated with visit charges. RESULTS In 2010, there were $21.4 billion (95% confidence interval (CI) = $17.7-$25.2 billion) in charges for TBI-related admissions, an increase of 22% from 2006. Charges for ED visits resulting in discharge or transfer were $8.2 billion (95% CI = $7.4-$8.9 billion), an increase of 94% from 2006. The proportion of charges for TBI-related visits was disproportionately higher than the proportion of visits for TBI across all years of the study (p < 0.001). Patient age and gender, West region, trauma centre status, non-paediatric hospital designation, metropolitan location and hospital ownership were independently associated with higher charges. CONCLUSIONS There was a substantial charge burden from TBI-related hospital visits and charges increased disproportionately to visit volume. There are patient and hospital factors independently associated with higher charges. These findings, as well as methods to reduce the charge burden and charge disparities, deserve further study.
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Affiliation(s)
- Jennifer R Marin
- a Departments of Pediatrics and Emergency Medicine , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA
| | - Matthew D Weaver
- b Department of Medicine, Division of Sleep Medicine , Harvard Medical School , Boston , MA , USA
| | - Rebekah C Mannix
- c Division of Emergency Medicine , Children's Hospital Boston , Boston , MA , USA
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77
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Weaver MD, Patterson PD, Fabio A, Moore CG, Freiberg MS, Songer TJ. The association between weekly work hours, crew familiarity, and occupational injury and illness in emergency medical services workers. Am J Ind Med 2015; 58:1270-7. [PMID: 26391202 DOI: 10.1002/ajim.22510] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Emergency Medical Services (EMS) workers are shift workers in a high-risk, uncontrolled occupational environment. EMS-worker fatigue has been associated with self-reported injury, but the influence of extended weekly work hours is unknown. METHODS A retrospective cohort study was designed using historical shift schedules and occupational injury and illness reports. Using multilevel models, we examined the association between weekly work hours, crew familiarity, and injury or illness. RESULTS In total, 966,082 shifts and 950 reports across 14 EMS agencies were obtained over a 1-3 year period. Weekly work hours were not associated with occupational injury or illness. Schedule characteristics that yield decreased exposure to occupational hazards, such as part-time work and night work, conferred reduced risk of injury or illness. CONCLUSIONS Extended weekly work hours were not associated with occupational injury or illness. Future work should focus on transient exposures and agency-level characteristics that may contribute to adverse work events.
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Affiliation(s)
- Matthew D. Weaver
- Division of Sleep Medicine; Harvard Medical School; Boston Massachusetts
- Departments of Medicine and Neurology; Brigham and Women's Hospital; Boston Massachusetts
| | - P. Daniel Patterson
- Department of Emergency Medicine; Carolinas HealthCare System Medical Center; Charlotte North Carolina
| | - Anthony Fabio
- Department of Epidemiology, University of Pittsburgh; Graduate School of Public Health; Pittsburgh Pennsylvania
| | - Charity G. Moore
- Carolinas HealthCare System; Dickson Advance Analytics Group; Charlotte North Carolina
| | - Matthew S. Freiberg
- Department of Medicine, Vanderbilt University; School of Medicine; Nashville Tennessee
| | - Thomas J. Songer
- Department of Epidemiology, University of Pittsburgh; Graduate School of Public Health; Pittsburgh Pennsylvania
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78
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Patterson PD, Weaver MD, Landsittel DP, Krackhardt D, Hostler D, Vena JE, Hughes AM, Salas E, Yealy DM. Teammate familiarity and risk of injury in emergency medical services. Emerg Med J 2015; 33:280-5. [PMID: 26614096 DOI: 10.1136/emermed-2015-204964] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 11/06/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We investigated the association between teammate familiarity and workplace injury in the emergency medical services (EMS) setting. METHODS From January 2011 to November 2013, we abstracted a mean of 29 months of shift records and Occupational Safety Health Administration injury logs from 14 EMS organisations with 37 total bases located in four US Census regions. Total teammate familiarity was calculated for each dyad as the total number of times a clinician dyad worked together over the study period. We used negative binomial regression to examine differences in injury incidence rate ratios (IRRs) by familiarity. RESULTS We analysed 715 826 shift records, representing 4197 EMS clinicians and 60 701 unique dyads. We determined the mean shifts per dyad was (5.9, SD 19.7), and quartiles of familiarity were 1 shift worked together over the study period, 2-3 shifts, 4-9 shifts and ≥10 shifts worked together. More than half of all dyads worked one shift together (53.9%, n=32 739), 24.8% of dyads 2-3 shifts, 11.8% worked 4-9 shifts and 9.6% worked ≥10 shifts. The overall incidence rate of injury across all organisations was 17.5 per 100 full-time equivalent (FTE), range 4.7-85.6 per 100 FTE. The raw injury rate was 33.5 per 100 FTEs for dyads with one shift of total familiarity, 14.2 for 2-3 shifts, 8.3 for 4-9 shifts and 0.3 for ≥10 shifts. Negative binomial regression confirmed that dyads with ≥10 shifts had the lowest incidence of injury (IRR 0.03; 95% CI 0.02 to 0.04). CONCLUSIONS Familiarity between teammates varies in the EMS setting, and less familiarity is associated with greater incidence of workplace injury.
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Affiliation(s)
- P Daniel Patterson
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Matthew D Weaver
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Douglas P Landsittel
- Section on Biomarkers and Prediction Modeling, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David Krackhardt
- Heinz School of Public Policy and Management, Tepper School of Business, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - David Hostler
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - John E Vena
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ashley M Hughes
- Institute for Simulation & Training, University of Central Florida, Orlando, Florida, USA
| | - Eduardo Salas
- Department of Psychology, Rice University, Houston, Texas, USA
| | - Donald M Yealy
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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79
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Patterson PD, Buysse DJ, Weaver MD, Doman JM, Moore CG, Suffoletto BP, McManigle KL, Callaway CW, Yealy DM. Real-time fatigue reduction in emergency care clinicians: The SleepTrackTXT randomized trial. Am J Ind Med 2015; 58:1098-113. [PMID: 26305869 DOI: 10.1002/ajim.22503] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND We assessed performance characteristics and impact of a mobile phone text-message intervention for reducing intra-shift fatigue among emergency clinician shift workers. METHODS We used a randomized controlled trial of 100 participants. All participants received text-message assessments at the start, every 4 hr during, and at end of scheduled shifts over a 90-day period. Text-message queries measured self-rated sleepiness, fatigue, and difficulty with concentration. Additional text-messages were sent to intervention participants to promote alertness. A performance measure of interest was compliance with answering text-messages. RESULTS Ninety-nine participants documented 2,621 shifts and responded to 36,073 of 40,947 text-messages (88% compliance rate). Intervention participants reported lower mean fatigue and sleepiness at 4 hr, 8 hr, and at the end of 12 hr shifts compared to controls (P < 0.05). Intervention participants reported better sleep quality at 90-days compared to baseline (P = 0.01). CONCLUSIONS We showed feasibility and short-term efficacy of a text-message based assessment and intervention tool.
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Affiliation(s)
- P. Daniel Patterson
- Department of Emergency Medicine; Carolinas HealthCare System Medical Center; Charlotte North Carolina
| | - Daniel J. Buysse
- Department of Psychiatry; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
| | - Matthew D. Weaver
- Harvard Medical School, Department of Medicine; Division of Sleep Medicine
| | - Jack M. Doman
- Department of Psychiatry; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
| | - Charity G. Moore
- Dickson Advance Analytics Group; Carolinas HealthCare System Medical Center; Charlotte North Carolina
| | - Brian P. Suffoletto
- Department of Emergency Medicine; University of Pittsburgh School of Medicines; Pittsburgh Pennsylvania
| | - Kyle L. McManigle
- Department of Emergency Medicine; University of Pittsburgh School of Medicines; Pittsburgh Pennsylvania
| | - Clifton W. Callaway
- Department of Emergency Medicine; University of Pittsburgh School of Medicines; Pittsburgh Pennsylvania
| | - Donald M. Yealy
- Department of Emergency Medicine; University of Pittsburgh School of Medicines; Pittsburgh Pennsylvania
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Weaver MD, Patterson PD, Fabio A, Moore CG, Freiberg MS, Songer TJ. An observational study of shift length, crew familiarity, and occupational injury and illness in emergency medical services workers. Occup Environ Med 2015; 72:798-804. [PMID: 26371071 DOI: 10.1136/oemed-2015-102966] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 08/06/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Emergency medical services (EMS) clinicians are shift workers deployed in two-person teams. Extended shift duration, workplace fatigue, poor sleep and lack of familiarity with teammates are common in the EMS workforce and may contribute to workplace injury. We sought to examine the relationship between shift length and occupational injury while controlling for relevant shift work and teamwork factors. METHODS We obtained 3 years of shift schedules and occupational injury and illness reports were from 14 large EMS agencies. We abstracted shift length and additional scheduling and team characteristics from shift schedules. We matched occupational injury and illness reports to shift records and used hierarchical logistic regression models to test the relationship between shift length and occupational injury and illness while controlling for teammate familiarity. RESULTS The cohort contained 966,082 shifts, 4382 employees and 950 outcome reports. Risk of occupational injury and illness was lower for shifts ≤8 h in duration (RR 0.70; 95% CI 0.51 to 0.96) compared with shifts >8 and ≤12 h. Relative to shifts >8 and ≤12 h, risk of injury was 60% greater (RR 1.60; 95% CI 1.22 to 2.10) for employees that worked shifts >16 and ≤24 h. CONCLUSIONS Shift length is associated with increased risk of occupational injury and illness in this sample of EMS shift workers.
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Affiliation(s)
- Matthew D Weaver
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - P Daniel Patterson
- Department of Emergency Medicine, Carolinas HealthCare System Medical Center, Charlotte, North Carolina, USA
| | - Anthony Fabio
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Charity G Moore
- Dickson Advance Analytics Group, Carolinas HealthCare System, Charlotte, North Carolina, USA
| | - Matthew S Freiberg
- Department of Medicine, Vanderbilt University, School of Medicine, Nashville, Tennessee, USA
| | - Thomas J Songer
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
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Patterson PD, Klapec SE, Weaver MD, Guyette FX, Platt TE, Buysse DJ. Differences in Paramedic Fatigue before and after Changing from a 24-hour to an 8-hour Shift Schedule: A Case Report. PREHOSP EMERG CARE 2015; 20:132-6. [PMID: 25978152 DOI: 10.3109/10903127.2015.1025158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Emergency medical services (EMS) clinicians often work 24-hour shifts. There is a growing body of literature, with an elevated level of concern among EMS leaders that longer shifts contribute to fatigued workers and negative safety outcomes. However, many questions remain about shift length, fatigue, and outcomes. We describe a case of a 26-year-old male paramedic who switched shift schedules during the midpoint of a randomized trial that addressed fatigue in EMS workers (clinicaltrials.gov identifier: NCT02063737). The participant (case) began the study working full-time with a critical care, advanced life support EMS system that utilized 24-hour shifts. He then transitioned to an EMS system that deploys workers on 8-hour shifts. Per protocol for the randomized trial, the participant completed a battery of sleep health and fatigue surveys at baseline and at the end of 90 days of study. He also reported perceived fatigue, sleepiness, and difficulty with concentration at the beginning, every 4 hours during, and at the end of scheduled shifts, for a total of ten 24-hour shifts and twenty-four 8-hour shifts. We discuss differences in measures taken before and after switching shift schedules, and highlight differences in fatigue, sleepiness, and difficulty with concentration taken at the end of all 34 scheduled shifts stratified by shift duration (24 hours versus 8 hours). Findings from this case report present a unique opportunity to 1) observe and analyze a phenomenon that has not been investigated in great detail in the EMS setting; and 2) address an issue of significance to employers and EMS clinicians alike.
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Patterson PD, Buysse DJ, Weaver MD, Callaway CW, Yealy DM. Recovery between Work Shifts among Emergency Medical Services Clinicians. PREHOSP EMERG CARE 2015; 19:365-75. [DOI: 10.3109/10903127.2014.995847] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Patterson PD, Buysse DJ, Weaver MD, Suffoletto BP, McManigle KL, Callaway CW, Yealy DM. Emergency healthcare worker sleep, fatigue, and alertness behavior survey (SFAB): development and content validation of a survey tool. Accid Anal Prev 2014; 73:399-411. [PMID: 25449415 PMCID: PMC4254576 DOI: 10.1016/j.aap.2014.09.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 08/11/2014] [Accepted: 09/30/2014] [Indexed: 05/08/2023]
Abstract
BACKGROUND Workplace safety is a recognized concern in emergency medical services (EMS). Ambulance crashes are common and injury rates exceed that of the general working public. Fatigue and sleepiness during shift work pose a safety risk for patients and EMS workers. Changing EMS worker behaviors and improving alertness during shift work is hampered by a lack of instruments that reliably and accurately measure multidimensional beliefs and habits that predict alertness behavior. OBJECTIVES We sought to test the reliability and validity of a survey tool (the sleep, fatigue, and alertness behavior survey [SFAB]) designed to identify the cognitions of EMS workers concerning sleep, fatigue, and alertness behaviors during shift work. METHODS We operationalized the integrative model of behavioral prediction (IMBP) and developed a pool of 97 candidate items and sub-items to measure eight domains of the IMBP. Five sleep scientists judged the content validity of each item and a convenience sample of EMS workers completed a paper-based version of the SFAB. We retained items judged content valid by five sleep scientists and performed exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and tests of reliability and internal consistency. We identified a simple factor structure for each scale and calculated means and standard deviations for each item and scale. RESULTS We received 360 completed SFAB surveys from a convenience sample of 800 EMS workers attending two regional continuing education conferences (45% participation rate). Forty-seven candidate items and sub-items/options were removed following content validation, EFA, and CFA testing. Analyses revealed a simple factor structure for seven of eight domains and a final pool of 50 items and sub-items/options. Domains include: attitudes, normative beliefs, knowledge, salience, habits, environmental constraints, and intent. EFA tests of self-efficacy items failed to identify a simple factor structure. We retained two self-efficacy items based on Spearman-Brown correlation of 0.23 (p<0.0001). CONCLUSIONS Measurement of sleep, fatigue, and alertness behavior among EMS workers is challenging. We describe the development and psychometric testing of a survey tool that may be useful in a variety of applications addressing sleep, fatigue, and alertness behavior among EMS workers.
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Affiliation(s)
- P Daniel Patterson
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Daniel J Buysse
- Department of Psychiatry and Clinical Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Matthew D Weaver
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Brian P Suffoletto
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kyle L McManigle
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Clifton W Callaway
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Donald M Yealy
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Marin JR, Weaver MD, Barnato AE, Yabes JG, Yealy DM, Roberts MS. Variation in emergency department head computed tomography use for pediatric head trauma. Acad Emerg Med 2014; 21:987-95. [PMID: 25269579 DOI: 10.1111/acem.12458] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/26/2014] [Accepted: 04/27/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The objectives were to evaluate general emergency department (ED) variation in head computed tomography (CT) use for pediatric head trauma, hospital factors associated with CT use, and recent secular trends in CT utilization for pediatric head trauma. METHODS This was a cross-sectional study of a sample of general EDs in the Nationwide Emergency Department Sample (NEDS; 2006-2010). The authors included visits by patients <19 years of age with International Classification of Diseases, 9th Revision, Clinical Modification, diagnosis codes for head trauma and determined head CT use via Current Procedural Terminology (CPT), Fourth Edition, codes. Crude and risk-adjusted proportions of visits with CT for each hospital were calculated using multilevel mixed effects logistic regression. The association between hospital-level characteristics and head CT were evaluated by constructing multivariable negative binomial regression models. RESULTS There were 324,435 pediatric head trauma visits to 848 EDs in the sample. Median patient age was 8 years (interquartile range [IQR] = 2 to 15 years) and 62% of visits were by males. A minority of patients (0.7%) were severely injured, and only 4.2% were admitted to the hospital. Most EDs (79%) were nonteaching institutions, and 84% were nontrauma centers. Risk-adjusted median CT use was 56.0% (IQR = 46.4% to 64.7%). In multivariate analysis, nontrauma centers were 9% (95% confidence interval [CI] = 4% to 15%) less likely to use head CT for pediatric head trauma patients and among discharged patients, EDs within nonteaching hospitals were 8% more likely to perform CT imaging (95% CI = 2% to 14%). There was no change in CT use from 2006 through 2010 (p = 0.31). CONCLUSIONS There is significant variability among general EDs in CT use for pediatric head trauma, indicating the need for strategies to reduce variation and improve ED imaging practices for this population.
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Affiliation(s)
- Jennifer R Marin
- The Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA; The Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Paoletti D, Weaver MD, Braun C, van Zoest W. Trading off stimulus salience for identity: A cueing approach to disentangle visual selection strategies. Vision Res 2014; 113:116-24. [PMID: 25152318 DOI: 10.1016/j.visres.2014.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 08/03/2014] [Accepted: 08/04/2014] [Indexed: 10/24/2022]
Abstract
Recent studies show that time plays a primary role in determining whether visual selection is influenced by stimulus salience or guided by observers' intentions. Accordingly, when a response is made seems critically important in defining the outcome of selection. The present study investigates whether observers are able to control the timing of selection and regulate the trade-off between stimulus- and goal-driven influences. One experiment was conducted in which participants were asked to make a saccade to the target, a tilted bar embedded in a matrix of vertical lines. An additional distractor, more or less salient than the target, was presented concurrently with the search display. To manipulate when in time the response was given we cued participants before each trial to be either fast or accurate. Participants received periodic feedback regarding performance speed and accuracy. The results showed participants were able to control the timing of selection: the distribution of responses was relatively fast or slow depending on the cue. Performance in the fast-cue condition appeared to be primarily driven by stimulus salience, while in the accurate-cue condition saccades were guided by the search template. Examining the distribution of responses that temporally overlapped between the two cue conditions revealed a main effect of cue. This suggests the cue had an additional benefit to performance independent of the effect of salience. These findings show that although early selection may be constrained by stimulus salience, observers are flexible in guiding the 'when' signal and consequently establishing a trade-off between saliency and identity.
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Affiliation(s)
- Davide Paoletti
- Cimec (Center for Mind/Brain Sciences), University of Trento, Italy.
| | - Matthew D Weaver
- Cimec (Center for Mind/Brain Sciences), University of Trento, Italy
| | - Christoph Braun
- Centre for Integrative Neuroscience, University of Tubingen, Germany
| | - Wieske van Zoest
- Cimec (Center for Mind/Brain Sciences), University of Trento, Italy
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Patterson PD, Moore CG, Weaver MD, Buysse DJ, Suffoletto BP, Callaway CW, Yealy DM. Mobile phone text messaging intervention to improve alertness and reduce sleepiness and fatigue during shiftwork among emergency medicine clinicians: study protocol for the SleepTrackTXT pilot randomized controlled trial. Trials 2014; 15:244. [PMID: 24952387 PMCID: PMC4080698 DOI: 10.1186/1745-6215-15-244] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 06/11/2014] [Indexed: 11/06/2022] Open
Abstract
Background Mental and physical fatigue while at work is common among emergency medical services (EMS) shift workers. Extended shifts (for example 24 hours) and excessive amounts of overtime work increase the likelihood of negative safety outcomes and pose a challenge for EMS fatigue-risk management. Text message-based interventions are a potentially high-impact, low-cost platform for sleep and fatigue assessment and distributing information to workers at risk of negative safety outcomes related to sleep behaviors and fatigue. Methods/Design We will conduct a pilot randomized trial with a convenience sample of adult EMS workers recruited from across the United States using a single study website. Participants will be allocated to one of two possible arms for a 90-day study period. The intervention arm will involve text message assessments of sleepiness, fatigue, and difficulty with concentration at the beginning, during, and end of scheduled shifts. Intervention subjects reporting high levels of sleepiness or fatigue will receive one of four randomly selected intervention messages promoting behavior change during shiftwork. Control subjects will receive assessment only text messages. We aim to determine the performance characteristics of a text messaging tool for the delivery of a sleep and fatigue intervention. We seek to determine if a text messaging program with tailored intervention messages is effective at reducing perceived sleepiness and/or fatigue among emergency medicine clinician shift workers. Additional aims include testing whether a theory-based behavioral intervention, delivered by text message, changes ‘alertness behaviors’. Discussion The SleepTrackTXT pilot trial could provide evidence of compliance and effectiveness that would support rapid widespread expansion in one of two forms: 1) a stand-alone program in the form of a tailored/individualized sleep monitoring and fatigue reduction support service for EMS workers; or 2) an add-on to a multi-component fatigue risk management program led and maintained by employers or by safety and risk management services. Trial Registration Clinicaltrials.gov NCT02063737, Registered on 10 January 2014
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Affiliation(s)
- Paul Daniel Patterson
- Department of Emergency Medicine, School of Medicine, University of Pittsburgh, 3600 Forbes Avenue, Iroquois Bldg, Suite 400A, Pittsburgh, PA, USA.
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Patterson PD, Lave JR, Weaver MD, Guyette FX, Arnold RM, Martin-Gill C, Rittenberger JC, Krackhardt D, Mosesso VN, Roth RN, Wadas RJ, Yealy DM. A comparative assessment of adverse event classification in the out-of-hospital setting. PREHOSP EMERG CARE 2014; 18:495-504. [PMID: 24878451 DOI: 10.3109/10903127.2014.916022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES We sought to test reliability of two approaches to classify adverse events (AEs) associated with helicopter EMS (HEMS) transport. METHODS The first approach for AE classification involved flight nurses and paramedics (RN/Medics) and mid-career emergency physicians (MC-EMPs) independently reviewing 50 randomly selected HEMS medical records. The second approach involved RN/Medics and MC-EMPs meeting as a group to openly discuss 20 additional medical records and reach consensus-based AE decision. We compared all AE decisions to a reference criterion based on the decision of three senior emergency physicians (Sr-EMPs). We designed a study to detect an improvement in agreement (reliability) from fair (kappa = 0.2) to moderate (kappa = 0.5). We calculated sensitivity, specificity, percent agreement, and positive and negative predictive values (PPV/NPV). RESULTS For the independent reviews, the Sr-EMP group identified 26 AEs while individual clinician reviewers identified between 19 and 50 AEs. Agreement on the presence/absence of an AE between Sr-EMPs and three MC-EMPs ranged from κ = 0.20 to κ = 0.25. Agreement between Sr-EMPs and three RN/Medics ranged from κ = 0.11 to κ = 0.19. For the consensus/open-discussion approach, the Sr-EMPs identified 13 AEs, the MC-EMP group identified 18 AEs, and RN/medic group identified 36 AEs. Agreement between Sr-EMPs and MC-EMP group was (κ = 0.30 95%CI -0.12, 0.72), whereas agreement between Sr-EMPs and RN/medic group was (κ = 0.40 95%CI 0.01, 0.79). Agreement between all three groups was fair (κ = 0.33, 95%CI 0.06, 0.66). Percent agreement (58-68%) and NPV (63-76%) was moderately dissimilar between clinicians, while sensitivity (25-80%), specificity (43-97%), and PPV (48-83%) varied. CONCLUSIONS We identified a higher level of agreement/reliability in AE decisions utilizing a consensus-based approach for review rather than independent reviews.
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Affiliation(s)
- Jennifer R Marin
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Matthew D Weaver
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Donald M Yealy
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Rebekah C Mannix
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Weaver MD, Rittenberger JC, Patterson PD, McEntire SJ, Corcos AC, Ziembicki JA, Hostler D. Risk Factors for Hypothermia in EMS-treated Burn Patients. PREHOSP EMERG CARE 2014; 18:335-41. [DOI: 10.3109/10903127.2013.864354] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Patterson PD, Suyama J, Reis SE, Weaver MD, Hostler D. What does it cost to prevent on-duty firefighter cardiac events? A content valid method for calculating costs. Adv Prev Med 2013; 2013:972724. [PMID: 24455288 PMCID: PMC3881339 DOI: 10.1155/2013/972724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 10/29/2013] [Indexed: 11/17/2022] Open
Abstract
Cardiac arrest is a leading cause of mortality among firefighters. We sought to develop a valid method for determining the costs of a workplace prevention program for firefighters. In 2012, we developed a draft framework using human resource accounting and in-depth interviews with experts in the firefighting and insurance industries. The interviews produced a draft cost model with 6 components and 26 subcomponents. In 2013, we randomly sampled 100 fire chiefs out of >7,400 affiliated with the International Association of Fire Chiefs. We used the Content Validity Index (CVI) to identify the content valid components of the draft cost model. This was accomplished by having fire chiefs rate the relevancy of cost components using a 4-point Likert scale (highly relevant to not relevant). We received complete survey data from 65 fire chiefs (65% response rate). We retained 5 components and 21 subcomponents based on CVI scores ≥0.70. The five main components include, (1) investment costs, (2) orientation and training costs, (3) medical and pharmaceutical costs, (4) education and continuing education costs, and (5) maintenance costs. Data from a diverse sample of fire chiefs has produced a content valid method for calculating the cost of a prevention program among firefighters.
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Affiliation(s)
- P. Daniel Patterson
- University of Pittsburgh School of Medicine, Department of Emergency Medicine, 3600 Forbes Avenue, Suite 400A, Pittsburgh, PA 15261, USA
| | - Joe Suyama
- University of Pittsburgh School of Medicine, Department of Emergency Medicine, 3600 Forbes Avenue, Suite 400A, Pittsburgh, PA 15261, USA
| | - Steven E. Reis
- University of Pittsburgh School of Medicine, Department of Emergency Medicine, 3600 Forbes Avenue, Suite 400A, Pittsburgh, PA 15261, USA
| | - Matthew D. Weaver
- University of Pittsburgh School of Medicine, Department of Emergency Medicine, 3600 Forbes Avenue, Suite 400A, Pittsburgh, PA 15261, USA
| | - David Hostler
- University of Pittsburgh School of Medicine, Department of Emergency Medicine, 3600 Forbes Avenue, Suite 400A, Pittsburgh, PA 15261, USA
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Patterson PD, Pfeiffer AJ, Lave JR, Weaver MD, Abebe K, Krackhardt D, Arnold RM, Yealy DM. How familiar are clinician teammates in the emergency department? Emerg Med J 2013; 32:258-62. [PMID: 24351519 DOI: 10.1136/emermed-2013-203199] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Lack of familiarity between teammates is linked to worsened safety in high risk settings. The emergency department (ED) is a high risk healthcare setting where unfamiliar teams are created by diversity in clinician shift schedules and flexibility in clinician movement across the department. We sought to characterise familiarity between clinician teammates in one urban teaching hospital ED over a 22 week study period. METHODS We used a retrospective study design of shift scheduling data to calculate the mean weekly hours of familiarity between teammates at the dyadic level, and the proportion of clinicians with a minimum of 2, 5, 10 and 20 h of familiarity at any given hour during the study period. RESULTS Mean weekly hours of familiarity between ED clinician dyads was 2 h (SD 1.5). At any given hour over the study period, the proportions of clinicians with a minimum of 2, 5, 10 and 20 h of familiarity were 80%, 51%, 27% and 0.8%, respectively. CONCLUSIONS In our study, few clinicians could be described as having a high level of familiarity with teammates. The limited familiarity between ED clinicians identified in this study may be a natural feature of ED care delivery in academic settings. We provide a template for measurement of ED team familiarity.
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Affiliation(s)
- P Daniel Patterson
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anthony J Pfeiffer
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Judith R Lave
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Matthew D Weaver
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kaleab Abebe
- Department of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David Krackhardt
- David A Tepper School of Business, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Robert M Arnold
- Division of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Donald M Yealy
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Johnson TJ, Weaver MD, Borrero S, Davis EM, Myaskovsky L, Zuckerbraun NS, Kraemer KL. Association of race and ethnicity with management of abdominal pain in the emergency department. Pediatrics 2013; 132:e851-8. [PMID: 24062370 PMCID: PMC4074647 DOI: 10.1542/peds.2012-3127] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine if race/ethnicity-based differences exist in the management of pediatric abdominal pain in emergency departments (EDs). METHODS Secondary analysis of data from the 2006-2009 National Hospital Ambulatory Medical Care Survey regarding 2298 visits by patients ≤ 21 years old who presented to EDs with abdominal pain. Main outcomes were documentation of pain score and receipt of any analgesics, analgesics for severe pain (defined as ≥ 7 on a 10-point scale), and narcotic analgesics. Secondary outcomes included diagnostic tests obtained, length of stay (LOS), 72-hour return visits, and admission. RESULTS Of patient visits, 70.1% were female, 52.6% were from non-Hispanic white, 23.5% were from non-Hispanic black, 20.6% were from Hispanic, and 3.3% were from "other" racial/ethnic groups; patients' mean age was 14.5 years. Multivariate logistic regression models adjusting for confounders revealed that non-Hispanic black patients were less likely to receive any analgesic (odds ratio [OR]: 0.61; 95% confidence interval [CI]: 0.43-0.87) or a narcotic analgesic (OR: 0.38; 95% CI: 0.18-0.81) than non-Hispanic white patients (referent group). This finding was also true for non-Hispanic black and "other" race/ethnicity patients with severe pain (ORs [95% CI]: 0.43 [0.22-0.87] and 0.02 [0.00-0.19], respectively). Non-Hispanic black and Hispanic patients were more likely to have a prolonged LOS than non-Hispanic white patients (ORs [95% CI]: 1.68 [1.13-2.51] and 1.64 [1.09-2.47], respectively). No significant race/ethnicity-based disparities were identified in documentation of pain score, use of diagnostic procedures, 72-hour return visits, or hospital admissions. CONCLUSIONS Race/ethnicity-based disparities exist in ED analgesic use and LOS for pediatric abdominal pain. Recognizing these disparities may help investigators eliminate inequalities in care.
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Affiliation(s)
- Tiffani J. Johnson
- Division of Pediatric Emergency Medicine, Children's Hospital of Philadelphia, and,Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | | | - Sonya Borrero
- Division of General Internal Medicine, Department of Medicine, and,Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Esa M. Davis
- Division of General Internal Medicine, Department of Medicine, and
| | - Larissa Myaskovsky
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania;,Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Noel S. Zuckerbraun
- Division of Pediatric Emergency Medicine, Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Kevin L. Kraemer
- Department of Emergency Medicine,,Division of General Internal Medicine, Department of Medicine, and
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Patterson PD, Lave JR, Martin-Gill C, Weaver MD, Wadas RJ, Arnold RM, Roth RN, Mosesso VN, Guyette FX, Rittenberger JC, Yealy DM. Measuring adverse events in helicopter emergency medical services: establishing content validity. PREHOSP EMERG CARE 2013; 18:35-45. [PMID: 24003951 DOI: 10.3109/10903127.2013.818179] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION We sought to create a valid framework for detecting adverse events (AEs) in the high-risk setting of helicopter emergency medical services (HEMS). METHODS We assembled a panel of 10 expert clinicians (n = 6 emergency medicine physicians and n = 4 prehospital nurses and flight paramedics) affiliated with a large multistate HEMS organization in the Northeast US. We used a modified Delphi technique to develop a framework for detecting AEs associated with the treatment of critically ill or injured patients. We used a widely applied measure, the content validity index (CVI), to quantify the validity of the framework's content. RESULTS The expert panel of 10 clinicians reached consensus on a common AE definition and four-step protocol/process for AE detection in HEMS. The consensus-based framework is composed of three main components: (1) a trigger tool, (2) a method for rating proximal cause, and (3) a method for rating AE severity. The CVI findings isolate components of the framework considered content valid. CONCLUSIONS We demonstrate a standardized process for the development of a content-valid framework for AE detection. The framework is a model for the development of a method for AE identification in other settings, including ground-based EMS.
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Affiliation(s)
- P Daniel Patterson
- From the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Guyette FX, Morley JL, Weaver MD, Patterson PD, Hostler D. The effect of shift length on fatigue and cognitive performance in air medical providers. PREHOSP EMERG CARE 2012; 17:23-8. [PMID: 22925035 DOI: 10.3109/10903127.2012.710719] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To employ a battery of previously validated surveys and neuropsychological tests to compare changes in fatigue and cognitive abilities of air medical providers after 12- and 24-hour shifts. METHODS A convenience sample of 34 flight nurses and flight paramedics employed by one air medical service completed the Pittsburgh Sleep Quality Index (PSQI) and the Chalder Fatigue Questionnaire (CFQ) to determine fatigue before and after 12-hour (n = 16) and 24-hour (n = 19) shifts. A battery of neuropsychological tests, including the University of Southern California Repeatable Episodic Memory Test (USC-REMT), Paced Auditory Serial Addition Test (PASAT), Trail Making Test (TMT), and Stroop Color-Word Test were administered before and after the shift to measure changes in cognition. We compared the change in scores stratified by shift length using t-tests, Wilcoxon signed-rank test, and Fisher's exact test. RESULTS Participants in the 12- and 24-hour shift groups were aged 36 ± 8 years (12-hour shifts) and 39 ± 6 years (24-hour shifts) (mean ± standard deviation) and were preponderantly male (62% 12-hour shifts; 63%, 24 hour shifts). The PSQI scores identified 50% of both 12-hour and 24-hour shift subjects as having poor sleep quality. Preshift fatigue was described as a median 2/10 (interquartile range [IQR] = 2-4) and fatigue declined by the end of the shift to a median 1/10 [IQR = 1-2], p = 0.006. Providers averaged 6.8 hours of sleep during 24-hour shifts and 1 hour of sleep during 12-hour shifts. Changes in cognitive scores did not differ between groups. CONCLUSIONS This study identified no changes in cognitive performance following 12- and 24-hour shifts in air medical providers. This suggests that 24-hour shifts in an air medical service with low to moderate utilization do not have a detrimental effect on cognition as measured by this test battery, and are comparable to 12-hour shifts in terms of impact on cognitive function.
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Patterson PD, Weaver MD, Hostler D, Guyette FX, Callaway CW, Yealy DM. The Shift Length, Fatigue, and Safety Conundrum in EMS. PREHOSP EMERG CARE 2012; 16:572-6. [DOI: 10.3109/10903127.2012.704491] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Patterson PD, Weaver MD, Weaver SJ, Rosen MA, Todorova G, Weingart LR, Krackhardt D, Lave JR, Arnold RM, Yealy DM, Salas E. Measuring teamwork and conflict among emergency medical technician personnel. PREHOSP EMERG CARE 2012; 16:98-108. [PMID: 22128909 DOI: 10.3109/10903127.2011.616260] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We sought to develop a reliable and valid tool for measuring teamwork among emergency medical technician (EMT) partnerships. METHODS We adapted existing scales and developed new items to measure components of teamwork. After recruiting a convenience sample of 39 agencies, we tested a 122-item draft survey tool (EMT-TEAMWORK). We performed a series of exploratory factor analyses (EFAs) and confirmatory factor analysis (CFA) to test reliability and construct validity, describing variation in domain and global scores using descriptive statistics. RESULTS We received 687 completed surveys. The EFAs identified a nine-factor solution. We labeled these factors 1) Team Orientation, 2) Team Structure & Leadership, 3) Partner Communication, Team Support, & Monitoring, 4) Partner Trust and Shared Mental Models, 5) Partner Adaptability & Back-Up Behavior, 6) Process Conflict, 7) Strong Task Conflict, 8) Mild Task Conflict, and 9) Interpersonal Conflict. We tested a short-form (30-item SF) and long-form (45-item LF) version. The CFAs determined that both the SF and the LF possess positive psychometric properties of reliability and construct validity. The EMT-TEAMWORK-SF has positive internal consistency properties, with a mean Cronbach's alpha coefficient ≥0.70 across all nine factors (mean = 0.84; minimum = 0.78, maximum = 0.94). The mean Cronbach's alpha coefficient for the EMT-TEAMWORK-LF was 0.87 (minimum = 0.79, maximum = 0.94). There was wide variation in weighted scores across all nine factors and the global score for the SF and LF. Mean scores were lowest for the Team Orientation factor (48.1, standard deviation [SD] 21.5, SF; 49.3, SD 19.8, LF) and highest (more positive) for the Interpersonal Conflict factor (87.7, SD 18.1, for both SF and LF). CONCLUSIONS We developed a reliable and valid survey to evaluate teamwork between EMT partners.
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Affiliation(s)
- P Daniel Patterson
- Department of Emergency Medicine and Center for Emergency Medicine of Western Pennsylvania, Inc., Pennsylvania, USA.
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Abstract
The purpose of this study was to generate national estimates of the prevalence of medically unnecessary emergency medical services (EMS) transports to emergency departments (EDs) over time and to identify characteristics that may be associated with medically unnecessary transports. A previously published algorithm was applied to operationalize medical necessity based on ED diagnosis to 10 years of data from the National Hospital Ambulatory Medical Care Survey. The trend over time was reported using descriptive statistics weighted to produce national estimates. Nationally, the proportion of EMS transports that were medically unnecessary increased from 13% to 17% over the 10-year study period. Individual demographic characteristics, including insurance status, were not predictive of inappropriate utilization. EMS transports for medically unnecessary complaints increased from 1997 to 2007. Our findings from a nationally representative sample highlight the opportunity for alternative patient delivery strategies for select patients seeking EMS services.
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Patterson PD, Weaver MD, Frank RC, Warner CW, Martin-Gill C, Guyette FX, Fairbanks RJ, Hubble MW, Songer TJ, Callaway CW, Kelsey SF, Hostler D. Association between poor sleep, fatigue, and safety outcomes in emergency medical services providers. PREHOSP EMERG CARE 2011; 16:86-97. [PMID: 22023164 DOI: 10.3109/10903127.2011.616261] [Citation(s) in RCA: 135] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the association between poor sleep quality, fatigue, and self-reported safety outcomes among emergency medical services (EMS) workers. METHODS We used convenience sampling of EMS agencies and a cross-sectional survey design. We administered the 19-item Pittsburgh Sleep Quality Index (PSQI), 11-item Chalder Fatigue Questionnaire (CFQ), and 44-item EMS Safety Inventory (EMS-SI) to measure sleep quality, fatigue, and safety outcomes, respectively. We used a consensus process to develop the EMS-SI, which was designed to capture three composite measurements of EMS worker injury, medical errors and adverse events (AEs), and safety-compromising behaviors. We used hierarchical logistic regression to test the association between poor sleep quality, fatigue, and three composite measures of EMS worker safety outcomes. RESULTS We received 547 surveys from 30 EMS agencies (a 35.6% mean agency response rate). The mean PSQI score exceeded the benchmark for poor sleep (6.9, 95% confidence interval [CI] 6.6, 7.2). More than half of the respondents were classified as fatigued (55%, 95% CI 50.7, 59.3). Eighteen percent of the respondents reported an injury (17.8%, 95% CI 13.5, 22.1), 41% reported a medical error or AE (41.1%, 95% CI 36.8, 45.4), and 90% reported a safety-compromising behavior (89.6%, 95% CI 87, 92). After controlling for confounding, we identified 1.9 greater odds of injury (95% CI 1.1, 3.3), 2.2 greater odds of medical error or AE (95% CI 1.4, 3.3), and 3.6 greater odds of safety-compromising behavior (95% CI 1.5, 8.3) among fatigued respondents versus nonfatigued respondents. CONCLUSIONS In this sample of EMS workers, poor sleep quality and fatigue are common. We provide preliminary evidence of an association between sleep quality, fatigue, and safety outcomes.
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Affiliation(s)
- P Daniel Patterson
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA.
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Abstract
BACKGROUND Prior studies have highlighted wide variation in emergency medical services (EMS) workplace safety culture across agencies. OBJECTIVE To determine the association between EMS workplace safety culture scores and patient or provider safety outcomes. METHODS We administered a cross-sectional survey to EMS workers affiliated with a convenience sample of agencies. We recruited these agencies from a national EMS management organization. We used the EMS Safety Attitudes Questionnaire (EMS-SAQ) to measure workplace safety culture and the EMS Safety Inventory (EMS-SI), a tool developed to capture self-reported safety outcomes from EMS workers. The EMS-SAQ provides reliable and valid measures of six domains: safety climate, teamwork climate, perceptions of management, working conditions, stress recognition, and job satisfaction. A panel of medical directors, emergency medical technicians and paramedics, and occupational epidemiologists developed the EMS-SI to measure self-reported injury, medical errors and adverse events, and safety-compromising behaviors. We used hierarchical linear models to evaluate the association between EMS-SAQ scores and EMS-SI safety outcome measures. RESULTS Sixteen percent of all respondents reported experiencing an injury in the past three months, four of every 10 respondents reported an error or adverse event (AE), and 89% reported safety-compromising behaviors. Respondents reporting injury scored lower on five of the six domains of safety culture. Respondents reporting an error or AE scored lower for four of the six domains, while respondents reporting safety-compromising behavior had lower safety culture scores for five of the six domains. CONCLUSIONS Individual EMS worker perceptions of workplace safety culture are associated with composite measures of patient and provider safety outcomes. This study is preliminary evidence of the association between safety culture and patient or provider safety outcomes.
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Affiliation(s)
- Matthew D Weaver
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA
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Patterson PD, Weaver MD, Abebe K, Martin-Gill C, Roth RN, Suyama J, Guyette FX, Rittenberger JC, Krackhardt D, Arnold R, Yealy DM, Lave J. Identification of Adverse Events in Ground Transport Emergency Medical Services. Am J Med Qual 2011; 27:139-46. [DOI: 10.1177/1062860611415515] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Kaleab Abebe
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Ronald N. Roth
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Joseph Suyama
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | | | | | - Robert Arnold
- University of Pittsburgh School of Medicine, Pittsburgh, PA
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