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Bessman SC, Harrison EM, Easterling AP, Snider MN, Preilipper SMM, Glickman GL. Hybrid effectiveness-implementation study of two novel spectrally engineered lighting interventions for shiftworkers on a high-security watchfloor. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2023; 4:zpad051. [PMID: 38084298 PMCID: PMC10710545 DOI: 10.1093/sleepadvances/zpad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/13/2023] [Indexed: 06/26/2024]
Abstract
Shiftwork leads to myriad negative health and safety outcomes. Lighting countermeasures can benefit shiftworkers via physiological effects of light (e.g. alerting, circadian adjustment), and short-wavelength light is the most potent for eliciting those responses; however, limited work indicates it may not be required for alerting. We developed similar-appearing light boxes (correlated color temperature: 3000-3375 K; photopic illuminance: 260-296 lux), enriched (SW+, melanopic EDI: 294 lux) or attenuated (SW-, melanopic EDI: 103 lux) in short-wavelength energy, and implemented them on a high-security watchfloor. Efficacy and feasibility of these two novel lighting interventions were assessed in personnel working 12-hour night shifts (n = 47) in this within-participants, crossover study. For each intervention condition, light boxes were arranged across the front of the watchfloor and illuminated the entire shift; blue-blocking glasses were worn post-shift and before sleep; and sleep masks were used while sleeping. Comparisons between baseline and intervention conditions included alertness, sleep, mood, quality of life (QOL), and implementation measures. On-shift alertness (Karolinska Sleepiness Scale) increased in SW- compared to baseline, while changes in SW+ were more limited. Under SW+, both mood and sleep improved. Psychomotor vigilance task performance did not vary by condition; however, perceived performance and QOL were higher, and reported caffeine consumption and sleep onset latency were lower, under SW-. For both interventions, satisfaction and comfort were high, and fewer symptoms and negative feelings were reported. The addition of spectrally engineered lights to this unique work environment improved sleep, alertness, and mood without compromising visual comfort and satisfaction. This paper is part of the Sleep and Circadian Rhythms: Management of Fatigue in Occupational Settings Collection.
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Affiliation(s)
- Sara C Bessman
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (HJF), Bethesda, USA
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, USA
| | - Elizabeth M Harrison
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (HJF), Bethesda, USA
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, USA
| | - Alexandra P Easterling
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (HJF), Bethesda, USA
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, USA
| | - Michelle N Snider
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (HJF), Bethesda, USA
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, USA
| | - Sebastian M M Preilipper
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (HJF), Bethesda, USA
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, USA
| | - Gena L Glickman
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, USA
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Cushman P, Samuel Scheuller H, Cushman J, Markert RJ. Improving performance on night shift: a study of resident sleep strategies. J Clin Sleep Med 2023; 19:935-940. [PMID: 36710431 PMCID: PMC10152347 DOI: 10.5664/jcsm.10480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/31/2023]
Abstract
STUDY OBJECTIVES To identify sleep strategies of internal medicine residents transitioning to night shift and report their effect on performance. METHODS Residents logged hours of sleep and work starting 3 days prior to the first night shift and continuing through the next 8 days. Cohorts were defined by sleep logs and compared separately by transition strategy, total hours of sleep, amount of sleep occurring at work, weekend sleep schedule, and residency training year. Data from logs were entered into the Fatigue Avoidance Scheduling Tool to measure predicted Performance Effectiveness (PE) during each night shift. RESULTS Twenty-three residents were evaluated. The Sleep Banking transition strategy (n = 2) had higher PE (mean = 88.6%) than all other sleep strategies combined (n = 21, mean = 80.9%; P = .016). Additionally, residents who slept an average of 8-9 hours daily during their week of night shifts had a higher mean PE compared to those who slept < 6 hours (86.8% vs 78.6%; P = .014). CONCLUSIONS Residents who engaged in Sleep Banking prior to the first night shift had higher PE and spent less time above a 0.05% blood alcohol concentration equivalent compared to all other strategies. Similarly, PE and time spent above a 0.05% blood alcohol concentration equivalent improved with increased average hours slept per day during the week of night shifts. Optimizing performance on night shift through the adoption of efficacious sleep strategies is imperative to mitigate patient safety issues that may result from poor alertness and cognitive abilities. CITATION Cushman P, Scheuller HS, Cushman J, Markert RJ. Improving performance on night shift: a study of resident sleep strategies. J Clin Sleep Med. 2023;19(5):935-940.
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Affiliation(s)
- Philip Cushman
- Department of Internal Medicine and Neurology, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
- Wright-Patterson Air Force Base Medical Center, Ohio
| | | | - Jennifer Cushman
- Michigan State University College of Osteopathic Medicine, East Lansing, Michigan
| | - Ronald J. Markert
- Department of Internal Medicine and Neurology, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
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Jung FU, Luppa M, Riedel-Heller SG. [Physician working hours and effects on health, satisfaction and healthcare]. ZENTRALBLATT FUR ARBEITSMEDIZIN, ARBEITSSCHUTZ UND ERGONOMIE 2023; 73:1-7. [PMID: 37361962 PMCID: PMC10141868 DOI: 10.1007/s40664-023-00503-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 06/28/2023]
Abstract
Changes in the working environment with respect to innovative working time models are also increasingly affecting patient care. The number of physicians working part-time, for example, is continuously rising. At the same time, a general increase in chronic diseases and multimorbid conditions as well as the growing shortage of medical staff, leads to more workload and dissatisfaction among this profession. This short overview summarizes the current study situation and associated consequences regarding working hours of physicians and gives a first explorative overview of possible solutions.
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Affiliation(s)
- F. U. Jung
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Ph.-Rosenthal-Str. 55, 04103 Leipzig, Deutschland
| | - M. Luppa
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Ph.-Rosenthal-Str. 55, 04103 Leipzig, Deutschland
| | - S. G. Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Ph.-Rosenthal-Str. 55, 04103 Leipzig, Deutschland
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Chiba T, Hagiwara Y, Hifumi T, Kuroda Y, Ikeda S, Khoujah D, Imaizumi T, Shiga T. Prevalence and Risk Factors of Insomnia and Sleep-aid Use in Emergency Physicians in Japan: Secondary Analysis of a Nationwide Survey. West J Emerg Med 2023; 24:331-339. [PMID: 36976595 PMCID: PMC10047722 DOI: 10.5811/westjem.2022.12.57910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/14/2022] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Emergency physicians (EP) are suspected to have a high prevalence of insomnia and sleep-aid use. Most prior studies about sleep-aid use in EPs have been limited by low response rates. In this study our aim was to investigate the prevalence of insomnia and sleep-aid use among early-career Japanese EPs and assess the factors associated with insomnia and sleep-aid use. METHODS We collected anonymous, voluntary, survey-based data regarding chronic insomnia and sleep-aid use from board-eligible EPs taking the initial Japanese Association of Acute Medicine board certification exam in 2019 and 2020. We describe the prevalence of insomnia and sleep-aid use and analyzed demographic and job-related factors using multivariable logistic regression analysis. RESULTS The response rate was 89.71% (732 of 816). The prevalence of chronic insomnia and sleep-aid use was 24.89% (95% CI 21.78-28.29%) and 23.77% (95% CI 20.69-27.15%), respectively. Factors associated with chronic insomnia were long working hours (odds ratio [OR] 1.02, 1.01-1.03, per one-hour/week), and "stress factor" (OR 1.46, 1.13-1.90). Factors associated with sleep-aid use were male gender (OR 1.71, 1.03-2.86), unmarried status (OR 2.38, 1.39-4.10), and "stress factor" (OR 1.48, 1.13-1.94). The "stress factor" was mostly influenced by stressors in dealing with patients/families and co-workers, concern about medical malpractice, and fatigue. CONCLUSIONS Early-career EPs in Japan have a high prevalence of chronic insomnia and sleep-aid use. Long working hours and stress were associated with chronic insomnia, while male gender, unmarried status, and stress were associated with the use of sleep aids.
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Affiliation(s)
- Takuyo Chiba
- International University of Health and Welfare, Department of Emergency Medicine, Narita, Chiba, Japan
- International University of Health and Welfare, Graduate School of Medicine, Minatoku, Tokyo, Japan
| | - Yusuke Hagiwara
- Tokyo Metropolitan Children's Medical Center, Department of Pediatric Emergency Medicine and Critical Care Medicine, Tokyo, Japan
| | - Toru Hifumi
- St. Luke's International Hospital, Department of Emergency and Critical Care Medicine, Tokyo, Japan
| | | | - Shunya Ikeda
- International University of Health and Welfare, Graduate School of Medicine, Minatoku, Tokyo, Japan
| | - Danya Khoujah
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
- University of Maryland Upper Chesapeake Medical Center, Department of Emergency Medicine, Bel Air, Maryland
| | - Takahiro Imaizumi
- Nagoya University Hospital, Department of Advanced Medicine, Nagoya, Aichi, Japan
| | - Takashi Shiga
- International University of Health and Welfare, Department of Emergency Medicine, Narita, Chiba, Japan
- International University of Health and Welfare, Graduate School of Medicine, Minatoku, Tokyo, Japan
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Hebl JT, Velasco J, McHill AW. Work Around the Clock: How Work Hours Induce Social Jetlag and Sleep Deficiency. Clin Chest Med 2022; 43:249-259. [PMID: 35659023 DOI: 10.1016/j.ccm.2022.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A growing body of evidence has placed an increasing emphasis on how sleep affects health. Not only does insufficient sleep make one subjectively feel worse, but is associated with chronic diseases that are considered epidemics in industrialized nations. This is partly caused by the growing need for prolonged work and social schedules, exemplified by shift work, late-night weekends, and early morning work/school start times (social jetlag). Here, we consider fundamental relationships between the circadian clock and biologic processes and discuss how common practices, such as shift work and social jetlag, contribute to sleep disruption, circadian misalignment, and adverse health outcomes.
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Affiliation(s)
- Joseph T Hebl
- Oregon Health and Sciences University, School of Medicine, 3455 SW US Veterans Hospital Road, Mailcode: SN-ORD, Portland, OR 97239, USA
| | - Josie Velasco
- Sleep, Chronobiology, and Health Laboratory, School of Nursing, Oregon Health & Science University, 3455 SW US Veterans Hospital Road, Mailcode: SN-ORD, Portland, OR 97239, USA; Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, 3455 SW US Veterans Hospital Road, Mailcode: SN-ORD, Portland, OR 97239, USA
| | - Andrew W McHill
- Sleep, Chronobiology, and Health Laboratory, School of Nursing, Oregon Health & Science University, 3455 SW US Veterans Hospital Road, Mailcode: SN-ORD, Portland, OR 97239, USA; Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, 3455 SW US Veterans Hospital Road, Mailcode: SN-ORD, Portland, OR 97239, USA.
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James L, Elkins-Brown N, Wilson M, James SM, Dotson E, Edwards CD, Wintersteen-Arleth L, Stevens K, Butterfield P. The effects of three consecutive 12-hour shifts on cognition, sleepiness, and domains of nursing performance in day and night shift nurses: A quasi-experimental study. Int J Nurs Stud 2021; 123:104041. [PMID: 34411842 DOI: 10.1016/j.ijnurstu.2021.104041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 07/08/2021] [Accepted: 07/10/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Healthcare systems have widely adopted consecutive 12 h day and night shifts for nurses, but the effects of these shifts on cognition, sleepiness, and nursing performance remains understudied. OBJECTIVE To determine the extent of changes in cognition and sleepiness in nurses working three consecutive 12 h shifts, quantify the respective impacts of these changes on different aspects of nursing performance, and investigate individual differences in all measures. DESIGN A quasi-experimental, between-within design collected data from nurses between November 2018 and March 2020. The between-groups component was comprised of day shift nurses vs. night shift nurses, while the within-groups component was comprised of two separate test sessions for each nurse: one immediately following a third consecutive shift (fatigued) and one after three consecutive days off work (rested). SETTING Participants were tested in a northwestern US university's nursing simulation laboratory. PARTICIPANTS A volunteer sample of 94 registered nurses involved in direct patient care working 12 h shifts were recruited from two local hospitals. METHODS Simulated nursing performance was measured in seven separate domains and an aggregate score from the Creighton Competence and Evaluation Inventory, covering both lower- and higher-level constructs like procedural skills, assessment, decision-making, etc. Cognition and sleepiness were assessed through measures of sustained attention, predicted cognitive effectiveness, and subjective sleepiness. RESULTS In our 94 nurses, individual differences in all our measures varied from trivial to extensive. For six domains of performance and the aggregate score there were no significant differences in means across groups or conditions. For the seventh, Communication skills were lower for night nurses than day nurses, but this effect was small. After three consecutive shifts, sustained attention and predicted cognitive effectiveness decreased, and subjective sleepiness increased. Predicted cognitive effectiveness was particularly low for fatigued night nurses relative to other conditions and was positively correlated with Communication while controlling for other predictors. CONCLUSIONS AND RELEVANCE Nurses maintained their levels of performance for all domains after three consecutive shifts. Individual differences in predicted cognitive effectiveness could account for variation in performance by shift type for Communication skills but for no other domain of performance. Communication skills and predicted cognitive effectiveness may interest researchers in the development of fatigue-mitigation strategies for night nurses, but our findings also suggest that more sensitive measures of performance may be necessary to capture other meaningful effects of long, consecutive shifts-if any-on patient care. Tweetable abstract: The effects of three consecutive 12 h shifts on cognition, sleepiness, and domains of nursing performance in day and night shift nurses: A quasi-experimental study.
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Affiliation(s)
- Lois James
- College of Nursing, Washington State University, 412 E. Spokane Falls Blvd, Room 426B, Spokane, WA 99202, USA; Sleep and Performance Research Center, Washington State University, WA, USA.
| | - Nathaniel Elkins-Brown
- College of Nursing, Washington State University, 412 E. Spokane Falls Blvd, Room 426B, Spokane, WA 99202, USA.
| | - Marian Wilson
- College of Nursing, Washington State University, 412 E. Spokane Falls Blvd, Room 426B, Spokane, WA 99202, USA; Sleep and Performance Research Center, Washington State University, WA, USA.
| | - Stephen M James
- College of Nursing, Washington State University, 412 E. Spokane Falls Blvd, Room 426B, Spokane, WA 99202, USA; Sleep and Performance Research Center, Washington State University, WA, USA.
| | - Elizabeth Dotson
- Department of Criminal Justice & Criminology, Washington State University, WA, USA.
| | - Charles D Edwards
- College of Nursing, Washington State University, 412 E. Spokane Falls Blvd, Room 426B, Spokane, WA 99202, USA.
| | - Laura Wintersteen-Arleth
- College of Nursing, Washington State University, 412 E. Spokane Falls Blvd, Room 426B, Spokane, WA 99202, USA.
| | - Kevin Stevens
- College of Nursing, Washington State University, 412 E. Spokane Falls Blvd, Room 426B, Spokane, WA 99202, USA.
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Kentab OY, Ibrahim AAA, Soliman KR, Aljahany M, Alresseeni AI, Algarni AS. Exploring the Prevalence and Patterns of Use of Sleep Aids and Stimulants Among Emergency Physicians and EMS Providers in Saudi Arabia. Open Access Emerg Med 2021; 13:343-353. [PMID: 34349569 PMCID: PMC8327294 DOI: 10.2147/oaem.s310324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/19/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose This study explores the prevalence and patterns of the use of pharmacologic sleep aids and stimulants among Saudi Arabia’s emergency physicians (EPs) and emergency medical services (EMS) providers. Patients and Methods We adopted a descriptive, cross-sectional design. To collect data on the types and frequencies of sleep aids and stimulants used, we distributed a semi-structured, anonymous, web-based questionnaire to registered EPs, paramedics, and emergency medicine technicians (EMTs) in the Saudi Commission for Health Specialties. An internal consistency analysis showed good reliability (Cronbach’s alpha=0.667) of the questionnaire. A subscale analysis confirmed the results—alpha values were 0.720 and 0.618 for the use of sleep aids and stimulants, respectively. Results Males and females represented 81.8% and 18.2%, respectively, of the valid sample of 669 participants. Respondents aged 25–34, 35–44, and 45–55 years represented 51.9%, 32.7%, and 10.2% of the sample, respectively. Results showed that a majority of the respondents (67.1%) used stimulants. Caffeine was the most common stimulant; caffeine and energy drinks were used by 65.9% and 17.2% of the respondents, respectively. Caffeine, energy drinks, nicotine, and ephedrine were used by 65.9%, 17.2%, 18.5%, and 17.3% of the respondents, respectively. The respondents who used at least one sleeping aid and those using only one and two sleeping aids accounted for 36.6%, 15.6%, and 9.7%, respectively. The most common sleeping aids antihistamines and marijuana were used on most days by 13.4% and 13.3% of the respondents, respectively. The average monthly number of night shifts (P = 0.025) significantly influenced sleep aid use. Respondents working in night shifts for 3–5 months or more than 7 days were more likely to use sleeping aids. Conclusion Future research should enhance health workers’ knowledge of the efficacy and safety of these medications and guide strategies to organize and reduce night shift work.
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Affiliation(s)
- Osama Y Kentab
- Emergency Department, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Ahmad AAl Ibrahim
- Emergency Department, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Khaled R Soliman
- Emergency Department, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Muna Aljahany
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Abdulaziz I Alresseeni
- Emergency Department, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Abdulaziz S Algarni
- Emergency Department, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
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Cori JM, Manousakis JE, Koppel S, Ferguson SA, Sargent C, Howard ME, Anderson C. An evaluation and comparison of commercial driver sleepiness detection technology: a rapid review. Physiol Meas 2021; 42. [PMID: 34338222 DOI: 10.1088/1361-6579/abfbb8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/26/2021] [Indexed: 11/11/2022]
Abstract
Objective. Sleepiness-related motor vehicle crashes, caused by lack of sleep or driving during night-time hours, often result in serious injury or fatality. Sleepiness detection technology is rapidly emerging as a sleepiness risk mitigation strategy for drivers. Continuous monitoring technologies assess and alert to driver sleepiness in real-time, while fit for duty technologies provide a single assessment of sleepiness state. The aim of this rapid review was to evaluate and compare sleepiness detection technologies in relation to specifications, cost, target consumer group and validity.Approach. We evaluated a range of sleepiness detection technologies suitable for consumer groups ranging from regular drivers in private vehicles through to work-related drivers within large businesses.Main results. Continuous monitoring technologies typically ranged between $100 and $3000 AUD and had ongoing monthly costs for telematics functionality and manager alerts. Fit for duty technologies had either a one-off purchase cost or a monthly subscription cost. Of concern, the majority of commercial continuous monitoring technologies lacked scientific validation. While some technologies had promising findings in terms of their ability to detect and reduce driver sleepiness, further validation work is required. Field studies that evaluate the sensitivity and specificity of technology alerts under conditions that are regularly experienced by drivers are necessary. Additionally, there is a need for longitudinal naturalistic driving studies to determine whether sleepiness detection technologies actually reduce sleepiness-related crashes or near-crashes.Significance. There is an abundance of sleepiness detection technologies on the market, but a majority lacked validation. There is a need for these technologies and their validation to be regulated by a driver safety body. Otherwise, consumers will base their technology choices on cost and features, rather than the ability to save lives.
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Affiliation(s)
- Jennifer M Cori
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia.,Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.,Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Jessica E Manousakis
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Sjaan Koppel
- Monash University Accident Research Centre, Monash University, Melbourne, Australia
| | - Sally A Ferguson
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Wayville, South Australia, 5034, Australia
| | - Charli Sargent
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Wayville, South Australia, 5034, Australia
| | - Mark E Howard
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia.,Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.,Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Department of Medicine, University of Melbourne, Australia
| | - Clare Anderson
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
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Gatz JD, Gingold DB, Lemkin DL, Wilkerson RG. Association of Resident Shift Length with Procedural Complications. J Emerg Med 2021; 61:189-197. [PMID: 34006422 DOI: 10.1016/j.jemermed.2021.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/02/2021] [Accepted: 02/19/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Training programs for resident physicians struggle to balance the need for clinical experience with the impact of fatigue on patient safety. The length of shifts worked by emergency medicine (EM) residents is likely an important determinant of resident fatigue. OBJECTIVE Assess the impact of a longer clinical shift on procedural competency. METHODS We conducted a retrospective chart review of arterial line placements, central venous catheterizations, tube thoracostomies, endotracheal intubations, and lumbar punctures performed by EM residents working 12-h shifts in the emergency department of an academic medical center over an academic year. We compared complication rates between procedures performed in the first 8 vs. the last 4 h of a 12-h shift. Procedures without complication were defined as successful on first-pass attempt and without a downstream mechanical or medical complication. Multivariable modified Poisson regression was used to simultaneously control for possible confounders affecting procedure success. RESULTS We identified 548 eligible procedures: 307 performed in the first 8 h of a 12-h shift and 241 in the last 4 h. The complication rate across all procedures was higher in the last 4 h of the shift (pooled risk ratio 1.41, 95% confidence interval 1.18-1.67). This effect persisted when adjusting for potential confounders (adjusted risk ratio 1.42, 95% confidence interval 1.19-1.69). CONCLUSION Overall, complication rates of included procedures performed by EM residents were higher during the last 4 vs. first 8 h of a 12-h shift. Training programs should consider the impact of resident fatigue on patient safety when making work schedules.
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Affiliation(s)
- J David Gatz
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Daniel B Gingold
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Daniel L Lemkin
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - R Gentry Wilkerson
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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Harrison EM, Easterling AP, Yablonsky AM, Glickman GL. Sleep-Scheduling Strategies in Hospital Shiftworkers. Nat Sci Sleep 2021; 13:1593-1609. [PMID: 34584475 PMCID: PMC8464337 DOI: 10.2147/nss.s321960] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/24/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Shiftwork causes circadian disruption and results in impaired performance, sleep, and health. Often, individuals on non-standard shifts cannot modify work schedules. At-home sleep schedules are a potentially modifiable point of intervention, yet sleep-scheduling strategies remain relatively understudied. Specifically, the adoption of multiple strategies and the employment of strategies for not only night shifts, but also early starts on days, have yet to be formally examined to our knowledge. We studied how adoption of specific and/or multiple sleep-scheduling strategies for day and night shifts relates to measures of adaptation to shiftwork, self-reported on-shift sleepiness, and individual characteristics (eg, age, chronotype, education in circadian and sleep health). We hypothesized: 1) strategies would differ by shift type, 2) individuals would adopt multiple strategies, 3) strategies better aligned with circadian principles would relate to measures of adaptation, and 4) individual characteristics, such as having dependents, would relate to strategy selection. METHODS A retrospective, online questionnaire (including items from the Survey of Shiftworkers and items related to sleep-scheduling strategies) was administered to both permanent and rotating hospital staff in four wards working 12-h day and/or night shifts (n=89). Additionally, reasons for strategy selection were explored. RESULTS Level of adaptation varied by sleep-scheduling strategy, with the least adaptation for those utilizing the Incomplete Shifter strategies. For night shifts, Night Stay and Switch Sleeper-N strategies were related to lower mid-shift sleepiness. Many night workers reported using strategies that restricted sleep, and most reported using multiple strategies, both of which also related to lower adaptation. Domestic considerations were the most common rationale for strategy selection. Strategies varied by several individual characteristics, including chronotype, dependents, and level of sleep education. DISCUSSION Future work should investigate sleep strategies and circadian interventions to help mitigate the effects of circadian and sleep disruption in hospital staff.
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Affiliation(s)
- Elizabeth M Harrison
- Center for Circadian Biology, University of California San Diego, La Jolla, CA, USA
| | | | | | - Gena L Glickman
- Center for Circadian Biology, University of California San Diego, La Jolla, CA, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Harrison EM, Schmied EA, Easterling AP, Yablonsky AM, Glickman GL. A Hybrid Effectiveness-Implementation Study of a Multi-Component Lighting Intervention for Hospital Shift Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9141. [PMID: 33297521 PMCID: PMC7730086 DOI: 10.3390/ijerph17239141] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/12/2020] [Accepted: 11/25/2020] [Indexed: 12/13/2022]
Abstract
Simple lighting solutions may mitigate the harmful effects of shiftwork. This hybrid effectiveness-implementation study evaluated a multi-component lighting intervention in hospital nurses that included 6500 K architectural lighting in the nurses' station plus optional behavioral components (a lightbox, blueblocker glasses, eyemasks) with instruction about appropriately timed usage. Selective improvements from baseline were observed in on-shift performance, sleep quality, and caffeine consumption in day workers (all p < 0.05); off-shift sleepiness scores improved for night workers (p < 0.05). Further, self-reported measures of quality of life improved for both groups (p < 0.05). Preliminary implementation data from interviews and questionnaires suggest perceived benefits and high acceptability of the intervention.
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Affiliation(s)
- Elizabeth M. Harrison
- Center for Circadian Biology, University of California San Diego, La Jolla, CA 92093, USA; (A.P.E.); (G.L.G.)
- Leidos, Inc., San Diego, CA 92121, USA
- Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, CA 92016, USA;
| | - Emily A. Schmied
- School of Public Health, San Diego State University, San Diego, CA 92182, USA;
| | - Alexandra P. Easterling
- Center for Circadian Biology, University of California San Diego, La Jolla, CA 92093, USA; (A.P.E.); (G.L.G.)
- Leidos, Inc., San Diego, CA 92121, USA
- Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, CA 92016, USA;
| | - Abigail M. Yablonsky
- Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, CA 92016, USA;
- Naval Medical Center, San Diego, CA 92134, USA
| | - Gena L. Glickman
- Center for Circadian Biology, University of California San Diego, La Jolla, CA 92093, USA; (A.P.E.); (G.L.G.)
- Departments of Psychiatry and Neuroscience, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Zhao X, Zhang T, Li B, Yu X, Ma Z, Cao L, Gu Q, Dong C, Jin Y, Fan J, He G. Job-related factors associated with changes in sleep quality among healthcare workers screening for 2019 novel coronavirus infection: a longitudinal study. Sleep Med 2020; 75:21-26. [PMID: 32853914 PMCID: PMC7403128 DOI: 10.1016/j.sleep.2020.07.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/27/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sleep disorders may exacerbate many physical and mental health conditions, causing difficulty function in a healthcare setting. Workers screening for the 2019 novel coronavirus (2019-nCoV) infection have a high risk of not only occupational exposure to the virus but also sleep disorders. However, the job-related factors associated with reduced sleep quality remain unclear. METHODS All healthcare workers temporarily scheduled to screen the 2019-nCoV patients were asked to complete a self-administered questionnaire that included questions on demographics, job-related factors, and sleep quality as assessed using the Pittsburgh Sleep Quality Index (PSQI). Sleep quality was assessed over a one-month follow-up period. RESULTS A total of 116 doctors and 99 nurses were recruited for this study. The total scheduled work time was 14.78 ± 6.69 days during follow-up. Some job-related factors, such as number of work days, years of work experience, and subjective psychological stress, were associated with changes in the PSQI score. During the study, some workers tried out cognitive behavioral therapy (CBT) for sleep disorders using methods that were available online and easily accessible. Adopting online CBT was shown to be associated with scores of components of sleep quality, sleep latency, and sleep disturbance (β = -0.152, P = 0.01; β = -0.175, P = 0.008; and β = -0.158, P = 0.011, respectively). CONCLUSIONS Healthcare workers involved in screening for 2019-nCoV experienced reduced sleep quality, and a reasonable work schedule may help with maintaining sleep quality. In addition, interventions for healthcare workers should target self-help sleep assistance.
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Affiliation(s)
- Xiaolong Zhao
- Department of Otolaryngology Head and Neck Surgery, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, Chengdu, China.
| | - Tong Zhang
- Department of Clinical Laboratory, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bin Li
- Department of Otolaryngology Head and Neck Surgery, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, Chengdu, China
| | - Xiaoxu Yu
- Department of Otolaryngology Head and Neck Surgery, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, Chengdu, China
| | - Zhiyue Ma
- Department of Otolaryngology Head and Neck Surgery, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, Chengdu, China
| | - Luhong Cao
- Department of Otolaryngology Head and Neck Surgery, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, Chengdu, China
| | - Qingjia Gu
- Department of Otolaryngology Head and Neck Surgery, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, Chengdu, China
| | - Chuan Dong
- Department of Otolaryngology Head and Neck Surgery, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, Chengdu, China
| | - Yunhua Jin
- Department of Otolaryngology Head and Neck Surgery, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, Chengdu, China.
| | - Jiangang Fan
- Department of Otolaryngology Head and Neck Surgery, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, Chengdu, China.
| | - Gang He
- Chengdu Tian Fu New District People's Hospital, Chengdu, China
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