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Podda M, Di Martino M, Pata F, Nigri G, Pisanu A, Di Saverio S, Pellino G, Ielpo B. Global disparities in surgeons' workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study. Updates Surg 2024:10.1007/s13304-024-01859-7. [PMID: 38684574 DOI: 10.1007/s13304-024-01859-7] [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: 03/02/2024] [Accepted: 04/10/2024] [Indexed: 05/02/2024]
Abstract
The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI.
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Affiliation(s)
- Mauro Podda
- Department of Surgical Science, Emergency Surgery Unit, Policlinico Universitario "D. Casula", Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, SS 554, Km 4,500, 09042, Cagliari, Monserrato, Italy.
| | - Marcello Di Martino
- Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Francesco Pata
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - Giuseppe Nigri
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Adolfo Pisanu
- Department of Surgical Science, Emergency Surgery Unit, Policlinico Universitario "D. Casula", Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, SS 554, Km 4,500, 09042, Cagliari, Monserrato, Italy
| | - Salomone Di Saverio
- Department of Surgery, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy
| | - Gianluca Pellino
- Department of Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
- Department of Advanced Medical and Surgical Sciences, Universitá degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - Benedetto Ielpo
- Hepatobiliary Surgery Unit, Hospital del Mar, University Pompeu Fabra, Barcelona, Spain
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Ruan A, Flood PD. In Response. Anesth Analg 2023; 136:e42-e43. [PMID: 37205825 DOI: 10.1213/ane.0000000000006474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Affiliation(s)
- Alexandra Ruan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California,
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3
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Windrix C, Vandyck K, Tanaka KA, Butt AL. Night Float Rotations: Continued Questions With Few Answers. Anesth Analg 2023; 136:e41-e42. [PMID: 37205824 DOI: 10.1213/ane.0000000000006473] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Affiliation(s)
- Casey Windrix
- Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma,
| | - Kofi Vandyck
- Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma,
| | - Kenichi A Tanaka
- Department of Surgery and Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Amir L Butt
- Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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4
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Ruan A, Klein A, Jhita P, Hasan-Hill N, Shafer SL, Flood PD. The Effect of Night Float Rotation on Resident Sleep, Activity, and Well-Being. Anesth Analg 2023; 136:701-710. [PMID: 36342844 DOI: 10.1213/ane.0000000000006261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Night float call systems are becoming increasingly common at training programs with the goal of reducing fatigue related to sleep deprivation and sleep disturbance. Previous studies have shown that trainees obtain less sleep during the night float rotation and have decreased sleep efficiency for several days after the rotation. The impact on physical and emotional well-being has not been documented. METHODS Twenty-seven anesthesia residents were enrolled in a study using wearable sleep and activity trackers and National Institutes of Health Patient-Reported Outcome Measurement Information System (NIH PROMIS) surveys for sleep disturbance, fatigue, and positive affect to record data the week before ("baseline"), during ("night float"), and 1 week after ("recovery") their night float rotation. Each subject's data during the night float week and recovery week were compared to his or her own baseline week data using a paired, nonparametric analysis. The primary outcome variable was the change in average daily sleep hours during the night float week compared to the baseline week. Average daily rapid eye movement (REM) sleep, daily steps, and NIH PROMIS scores comparing night float and recovery weeks to baseline week were prespecified secondary outcomes. NIH PROMIS scores range from 0 to 100 with 50 as the national mean and more of the construct having a higher score. RESULTS There was no difference in average daily sleep hours between the night float and the baseline weeks (6.7 [5.9-7.8] vs 6.7 [5.5-7.7] hours, median [interquartile range]; P = .20). Residents had less REM sleep during the night float compared to the baseline weeks (1.1 [0.7-1.5] vs 1.4 [1.1-1.9] hours, P = .002). NIH PROMIS fatigue scores were higher during the night float than the baseline week (58.8 [54.6-65.1] vs 48.6 [46.0-55.1], P = .0004) and did not return to baseline during the recovery week (51.0 [48.6-58.8], P = .029 compared to baseline). Sleep disturbance was not different among the weeks. Positive affect was reduced after night float compared to baseline (39.6 [35.0-43.5] vs 44.8 [40.1-49.6], P = .0009), but returned to baseline during the recovery week (43.6 [39.6-48.2], P = .38). CONCLUSIONS The residents slept the same number of total hours during their night float week but had less REM sleep, were more fatigued, and had less positive affect. All of these resolved to baseline except fatigue, that was still greater than the baseline week. This methodology appears to robustly capture psychophysiological data that might be useful for quality initiatives.
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Affiliation(s)
- Alexandra Ruan
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
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Dragan KE, Nemergut EC. Sleep and Fatigue: And Miles to Go Before We Sleep. Anesth Analg 2023; 136:699-700. [PMID: 36928156 DOI: 10.1213/ane.0000000000006265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- Kristen E Dragan
- From the Department of Anesthesiology, West Virginia University, Morgantown, West Virginia
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Ardizzone E, Lerchbaumer E, Heinzel JC, Winter N, Prahm C, Kolbenschlag J, Daigeler A, Lauer H. Insomnia-A Systematic Review and Comparison of Medical Resident's Average Off-Call Sleep Times. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4180. [PMID: 36901190 PMCID: PMC10002061 DOI: 10.3390/ijerph20054180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/21/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
Sleep deprivation is known to have serious consequences, including a decrease in performance, attention and neurocognitive function. It seems common knowledge that medical residents are routinely sleep deprived, yet there is little objective research recording their average sleep times. To discern whether residents may be suffering from the abovementioned side effects, this review aimed to analyze their average sleep times. Thirty papers recording the average sleep time of medical residents were found via a literature search using the key words "resident" and "sleep". An analysis of the mean sleep times cited therein revealed a range of sleep from 4.2 to 8.6 h per night, the median being 6.2 h. A sub-analysis of papers from the USA showed barely any significant differences in sleep time between the specialties, but the mean sleep times were below 7 h. The only significant difference (p = 0.039) was between the mean sleep times of pediatric and urology residents, with the former achieving less sleep. The comparison of methods for data collection showed no significant difference in the sleep times collected. The results of this analysis imply that residents are regularly sleep deprived and may therefore suffer from the abovementioned consequences.
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Affiliation(s)
- Eve Ardizzone
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany
| | - Emily Lerchbaumer
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany
| | - Johannes C. Heinzel
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany
| | - Natalie Winter
- Department of Neurology, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
| | - Cosima Prahm
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany
| | - Jonas Kolbenschlag
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany
| | - Adrien Daigeler
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany
| | - Henrik Lauer
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany
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Tarrash M, Nelson D, Gabbur N, Goldberg GL. Assessing burnout among Obstetrics & Gynecology residents during night float versus day float in a large academic hospital. BMC MEDICAL EDUCATION 2022; 22:809. [PMID: 36424600 PMCID: PMC9686460 DOI: 10.1186/s12909-022-03897-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The prevalence estimates of burnout among residents vary widely. Resident physicians working overnight have additional stressors and therefore, may be at higher risk of developing burnout. OBJECTIVE To determine the rates of burnout among residents working night rotations versus day rotations. METHODS This is a prospective, cross sectional, survey-based assessment of the prevalence of burnout among Obstetrics and Gynecology (OBGYN) residents on nights versus days rotations conducted at a large academic residency program that spans two separate hospitals in New York. All residents in the residency program were asked to complete the Maslach Burnout Inventory - Human Services Survey for Medical Personnel (MBI-HSS (MP)) after the first rotation of the academic year in 2018, 2019, and 2020. The results for each of the three aspects of the MBI-HSS (MP): emotional exhaustion, depersonalization, and personal accomplishment, were then compared for those on nights versus day rotations using students t-test. RESULTS A total of 76 responses were received, 13 from residents on night rotations and 63 from residents on day rotations with a response rate of 61.8%. Comparing resident responses for a night versus day rotation, the residents averaged a low level of emotional exhaustion (a score of 17 ± 9) on day shift, compared to a moderate level of emotional exhaustion (a score of 18 ± 14) on nights (p = 0.37). Similarly, 55.6% of respondents reports low personal accomplishment on days, compared to 76.9% while on nights. CONCLUSIONS Emotional exhaustion scores were lower for residents on daytime rotations (mean score 17, SD 9), compared to those on nights rotations (mean 18, SD 14). Although there was no difference in depersonalization when comparing the day and night shift, 45% of the responses indicated high levels of depersonalization regardless of the type of shift. These results highlight the need to continue efforts to minimize burnout in medical training.
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Affiliation(s)
- Miriam Tarrash
- Department of Obstetrics & Gynecology, Zucker School of Medicine at Hofstra/Northwell and Northwell Health, New York, USA
| | - David Nelson
- Department of Obstetrics & Gynecology, Zucker School of Medicine at Hofstra/Northwell and Northwell Health, New York, USA
| | - Nagaraj Gabbur
- Department of Obstetrics & Gynecology, Zucker School of Medicine at Hofstra/Northwell and Northwell Health, New York, USA
| | - Gary L Goldberg
- Department of Obstetrics & Gynecology, Zucker School of Medicine at Hofstra/Northwell and Northwell Health, New York, USA.
- Department of Obstetrics & Gynecology LIJ Medical Center, Ob/Gyn Admin Suite Room C221, 270-05 76th Avenue, New Hyde Park, New York, NY, 11040, USA.
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8
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Redinger J, Kabil E, Forkin KT, Kleiman AM, Dunn LK. Resting and Recharging: A Narrative Review of Strategies to Improve Sleep During Residency Training. J Grad Med Educ 2022; 14:420-430. [PMID: 35991104 PMCID: PMC9380640 DOI: 10.4300/jgme-d-21-01035.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/21/2022] [Accepted: 05/31/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Residency involves demanding training with long hours that may cause fatigue and sleep deprivation and adversely impact residents and patients under their care. OBJECTIVE To identify, using a narrative review, evidence-based interventions to reduce the physiologic effects of fatigue and sleep deprivation from overnight and night shift work. METHODS A PubMed literature search was conducted through August 30, 2021, using the terms "resident" and "sleep" in the title or abstract and further narrowed using a third search term. Observational studies, randomized controlled trials, systematic reviews, and meta-analyses of human subjects written and published in English were included. Studies that were not specific to residents or medical interns or did not investigate an intervention were excluded. Additional studies were identified by bibliography review. Due to the heterogeneity of study design and intervention, a narrative review approach was chosen with results categorized into non-pharmacological and pharmacological interventions. RESULTS Initially, 271 articles were identified, which were narrowed to 28 articles with the use of a third search term related to sleep. Bibliography review yielded 4 additional articles. Data on interventions are limited by the heterogeneity of medical specialty, sample size, length of follow-up, and reliance on self-report. Non-pharmacological interventions including strategic scheduling and sleep hygiene may improve sleep and well-being. The available evidence, including randomized controlled trials, to support pharmacological interventions is limited. CONCLUSIONS Non-pharmacological approaches to mitigating fatigue and sleep deprivation have varying effectiveness to improve sleep for residents; however, data for pharmacological interventions is limited.
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Affiliation(s)
- Joyce Redinger
- All authors are with the University of Virginia Health System, Department of Anesthesiology
- Joyce Redinger, MD, is PGY-3 Resident
| | - Emmad Kabil
- All authors are with the University of Virginia Health System, Department of Anesthesiology
- Emmad Kabil, MD, is PGY-4 Resident
| | - Katherine T. Forkin
- All authors are with the University of Virginia Health System, Department of Anesthesiology
- Katherine T. Forkin, MD, is Associate Professor of Anesthesiology
| | - Amanda M. Kleiman
- All authors are with the University of Virginia Health System, Department of Anesthesiology
- Amanda M. Kleiman, MD, is Associate Professor of Anesthesiology
| | - Lauren K. Dunn
- All authors are with the University of Virginia Health System, Department of Anesthesiology
- Lauren K. Dunn, MD, PhD, is Associate Professor of Anesthesiology and Neurological Surgery
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9
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Rigsby RK, Peters EM. Resident-attending discrepancy rates for two consecutive versus nonconsecutive weeks of overnight shifts. Emerg Radiol 2022; 29:819-823. [PMID: 35616766 DOI: 10.1007/s10140-022-02056-y] [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: 03/14/2022] [Accepted: 05/06/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Recent Accreditation Council for Graduate Medical Education policy changes no longer limit the number of consecutive night shifts allowed for trainees. Few studies have examined radiology resident overnight performance over time. This study aimed to compare significant resident-attending discrepancy rates for residents working 2 nonconsecutive versus consecutive weeks of overnight shifts. The authors hypothesized significantly increased week-two discrepancies in the consecutive group. METHODS For 2020, a retrospective analysis of significant overnight resident-attending discrepancy rates over a 24-week period using database searches was performed for residents self-selecting 2 nonconsecutive versus consecutive weeks. The nonconsecutive group typically had a 7-day mix of days off and day shifts between their night shift weeks. Paired and unpaired t tests were performed with p < 0.05 considered significant. RESULTS For the 24 sets of 2 weeks covered by two residents at a time, eight were nonconsecutive and 16 were consecutive. The nonconsecutive group had 75.0% R4 coverage compared to 37.5% for the consecutive group. There were no significant study volume differences between the groups. A total of 27,906 studies (35.3% cross-sectional [CT and MR], 54.9% radiograph plus fluoroscopy, 9.8% US) were performed with 223 discrepancies (0.80%). Overall discrepancies for the nonconsecutive versus consecutive groups were 39/4505 (0.87%) versus 59/9462 (0.62%; p = 0.32) for week one and 46/4732 (1.0%) versus 79/9207 (0.86%; p = 0.60) for week two with no significant differences between the groups by modality. CONCLUSION Residents self-selecting 2 consecutive weeks of overnight shifts do not have increased resident-attending discrepancy rates compared to 2 nonconsecutive weeks.
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Affiliation(s)
- Ryan K Rigsby
- Department of Radiology, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Eric M Peters
- Department of Radiology, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA.
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Aggarwal S, Wisely CE, Gross A, Challa P. Transition to a Night Float System in Ophthalmology Residency: Perceptions of Resident Wellness and Performance. JOURNAL OF ACADEMIC OPHTHALMOLOGY 2022. [DOI: 10.1055/s-0042-1747969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Purpose The purpose of this study is to characterize the influence of a new night float rotation on resident wellness and performance in the Duke University Eye Center Ophthalmology Residency Program.
Methods We analyzed three classes of ophthalmology residents: one class (n = 4) utilized the new night float rotation with no daytime clinical duties, while two senior classes (n = 12) utilized the traditional call system wherein they had daytime and nighttime responsibilities. Residents completed a questionnaire regarding their perceptions of the night float rotation. Supervising attendings (n = 15) were also surveyed about their perceptions of the new rotation.
Results Zero of the four residents on the night float rotation reported burnout compared with 6 of 11 residents in the traditional call system. Most residents supported the adoption of the night float rotation, but this trend was less apparent among fellows and attendings.Most respondents believed the new night float rotation reduced burnout, fatigue, and work hours while increasing time for nonclinical activities. Perceived skills gained while on call were felt to be similar between the two call systems. Fellows and attendings believed residents in the night float system performed similarly or better than residents in the traditional system in indicators such as knowledge and enthusiasm. There was no significant difference in the average number of patient encounters (290.8 ± 30.5 vs. 310.7 ± 25.4, p = 0.163), phone encounters (430.8 ± 20.2 vs. 357.1 ± 90.0, p = 0.068), or average hours worked per week (57.3 ± 4.6 vs. 58.0 ± 5.7 p = 0.797) per resident between night float residents and traditional call residents.
Conclusions This study shows resident support for a night float rotation in ophthalmology residency at Duke, with reductions in burnout and more time for nonclinical activities without affecting perceived clinical performance. We hope this study serves as an impetus for other ophthalmology programs considering a transition to a night float system.
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Affiliation(s)
| | | | - Andrew Gross
- Duke University Eye Center, Durham, North Carolina
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Chen M, Sun J, Chen TZ, Xu DZ, Wan J, Wang Q, Li YG. Loss of nocturnal dipping pattern of skin sympathetic nerve activity during and following an extended-duration work shift in residents in training. J Cardiol 2021; 78:509-516. [PMID: 34275691 DOI: 10.1016/j.jjcc.2021.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/31/2021] [Accepted: 06/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Extended-duration work shifts (EDWSs) might affect the health of physician residents, causing autonomic alteration. Skin sympathetic nerve activity (SKNA) recorded by noninvasive neuro-electrocardiography (neuECG) is used to estimate cardiac sympathetic tone. In this study, we aim to evaluate the impact of EDWSs on nocturnal SKNA assessed in resident doctors. METHODS Twenty-four residents working EDWSs and 12 PhD students not working nightshift schedules were prospectively recruited. The neuECG was performed between 12 am and 6 am for 5 consecutive nights. SKNA was filtered from neuECG recorded signals. The questionnaires regarding work stress and sleep quality, blood pressure, and salivary alpha-amylase and cortisol levels were administered. RESULTS The hours of weekly working and sleep opportunities were similar between residents and students, while residents reported more work stress and worse sleep quality. In residents, SKNA at 6 am (SKNA6am) was significantly higher than SKNA2am during the precall night, revealing a dipping pattern. However, the SKNA dipping disappeared during the on-call night and prominently flattened during the first postcall night, the full recovery of which was delayed until the second postcall nights. The morning blood pressure and salivary alpha-amylase and cortisol levels were similar between the precall and postcall days. In contrast, SKNA in students exhibited a constant dipping profile for all recorded nights. CONCLUSIONS In healthy young adults, SKNA presents a dip night. The SKNA dip is impaired by working a nightshift, with a delayed recovery. The neuECG might serve as a useful tool to detect subclinical autonomic disturbances in shiftworkers.
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Affiliation(s)
- Mu Chen
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Shanghai 200092, China
| | - Jian Sun
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Shanghai 200092, China
| | - Tai-Zhong Chen
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Shanghai 200092, China
| | - Dong-Zhu Xu
- Cardiovascular Division, Institute of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Juyi Wan
- Department of Cardiothoracic Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Qunshan Wang
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Shanghai 200092, China
| | - Yi-Gang Li
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Shanghai 200092, China.
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Kelly-Schuette K, Shaker T, Carroll J, Davis AT, Wright GP, Chung M. A Prospective Observational Study Comparing Effects of Call Schedules on Surgical Resident Sleep and Physical Activity Using the Fitbit. J Grad Med Educ 2021; 13:113-118. [PMID: 33680310 PMCID: PMC7901626 DOI: 10.4300/jgme-d-20-00304.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/02/2020] [Accepted: 09/10/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Surgical residency training has an extended tradition of long hours. Residency programs use a variety of call schedules to combat resident fatigue and sleep deprivation while maintaining adherence to duty hour restrictions. Nonetheless, there is a paucity of data regarding objective measurements of sleep during the different call schedules included in general surgery training. OBJECTIVE The primary objective of this study was to compare the quantity of sleep in 24-hour time frames across all types of shifts worked by general surgery residents at our institution. The secondary objective was to measure activity level in total steps during various time frames. METHODS This prospective observational study was performed between April 4 and August 26, 2018, with general surgery residents. Each resident was assigned a Fitbit Charge 2 to wear during all rotations, including general surgery and subspecialty services. RESULTS Twenty-six out of 31 residents voluntarily participated in the study (84%). In-house call (IHC) had significantly less sleep in a 24-hour time frame than home call and night float (144 vs 283 vs 246 minutes, P < .001 and P < .028). IHC had significantly more steps than home call (11 245 vs 8756 steps, P = .039). The smallest number of steps was obtained when residents were not working (7904 steps). CONCLUSIONS Our data demonstrate that surgical residents on IHC have significantly less sleep compared to all other types of on-call time frames. Residents on IHC have the most steps across all time frames.
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Lunsford-Avery JR, Keller C, Kollins SH, Krystal AD, Jackson L, Engelhard MM. Feasibility and Acceptability of Wearable Sleep Electroencephalogram Device Use in Adolescents: Observational Study. JMIR Mhealth Uhealth 2020; 8:e20590. [PMID: 33001035 PMCID: PMC7563632 DOI: 10.2196/20590] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 02/06/2023] Open
Abstract
Background Adolescence is an important life stage for the development of healthy behaviors, which have a long-lasting impact on health across the lifespan. Sleep undergoes significant changes during adolescence and is linked to physical and psychiatric health; however, sleep is rarely assessed in routine health care settings. Wearable sleep electroencephalogram (EEG) devices may represent user-friendly methods for assessing sleep among adolescents, but no studies to date have examined the feasibility and acceptability of sleep EEG wearables in this age group. Objective The goal of the research was to investigate the feasibility and acceptability of sleep EEG wearable devices among adolescents aged 11 to 17 years. Methods A total of 104 adolescents aged 11 to 17 years participated in 7 days of at-home sleep recording using a self-administered wearable sleep EEG device (Zmachine Insight+, General Sleep Corporation) as well as a wristworn actigraph. Feasibility was assessed as the number of full nights of successful recording completed by adolescents, and acceptability was measured by the wearable acceptability survey for sleep. Feasibility and acceptability were assessed separately for the sleep EEG device and wristworn actigraph. Results A total of 94.2% (98/104) of adolescents successfully recorded at least 1 night of data using the sleep EEG device (mean number of nights 5.42; SD 1.71; median 6, mode 7). A total of 81.6% (84/103) rated the comfort of the device as falling in the comfortable to mildly uncomfortable range while awake. A total of 40.8% (42/103) reported typical sleep while using the device, while 39.8% (41/103) indicated minimal to mild device-related sleep disturbances. A minority (32/104, 30.8%) indicated changes in their sleep position due to device use, and very few (11/103, 10.7%) expressed dissatisfaction with their experience with the device. A similar pattern was observed for the wristworn actigraph device. Conclusions Wearable sleep EEG appears to represent a feasible, acceptable method for sleep assessment among adolescents and may have utility for assessing and treating sleep disturbances at a population level. Future studies with adolescents should evaluate strategies for further improving usability of such devices, assess relationships between sleep EEG–derived metrics and health outcomes, and investigate methods for incorporating data from these devices into emerging digital interventions and applications. Trial Registration ClinicalTrials.gov NCT03843762; https://clinicaltrials.gov/ct2/show/NCT03843762
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Affiliation(s)
- Jessica R Lunsford-Avery
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Casey Keller
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Scott H Kollins
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Andrew D Krystal
- Departments of Psychiatry and Neurology, University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - Leah Jackson
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Matthew M Engelhard
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
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Tsai MH, Urman RD, Adams DC. Overnight call and sleep deprivation – A demand for action. J Clin Anesth 2020; 60:74-75. [DOI: 10.1016/j.jclinane.2019.08.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 08/23/2019] [Indexed: 10/26/2022]
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Thottakam BMVJ, Webster NR, Allen L, Columb MO, Galley HF. Melatonin Is a Feasible, Safe, and Acceptable Intervention in Doctors and Nurses Working Nightshifts: The MIDNIGHT Trial. Front Psychiatry 2020; 11:872. [PMID: 33192634 PMCID: PMC7481467 DOI: 10.3389/fpsyt.2020.00872] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/10/2020] [Indexed: 01/05/2023] Open
Abstract
Nightshift working is associated with sleep deprivation, fatigue and attention/concentration deficits which, in healthcare workers, may impact on patient safety. Clinical staff in the UK routinely work several 12 h nightshifts in a row at about 1-3 month intervals. We investigated the feasibility and acceptability of a crossover trial of melatonin administration in clinical staff working nightshifts with an exploration of effects on sleep measures and attention/concentration tasks. This was a pilot, double-blinded, randomized, placebo-controlled crossover feasibility trial in doctors and nurses working 3 consecutive nightshifts at a tertiary referral hospital in the UK. Twenty five male and female subjects were randomized to receive either 6mg Circadin™ slow release melatonin or placebo before sleep after each consecutive nightshift, followed by a washout period, before crossing over to the other experimental arm. We used actigraphy for objective assessment of sleep parameters. The trial design was feasible and acceptable to participants with negligible side effects, but elevated melatonin levels were prolonged during the active arm (P=0.016). Double digit addition testing, a concentration/attention task, improved with melatonin treatment (P<0.0001). Lapses of vigilance or judgement while doctors or nurses are working nightshifts could impact on patient safety and melatonin may be a useful intervention. This study supports the conclusion that a larger definitive trial of this design is both feasible and safe. Clinical Trial Registration: identifier ISRCTN15529655. https://www.isrctn.com/.
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Affiliation(s)
| | - Nigel R Webster
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom.,Intensive Care Unit, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Lee Allen
- Intensive Care Unit, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Malachy O Columb
- Anaesthesia and Intensive Care Medicine, Manchester University Hospitals NHS Foundation Trust, Wythenshawe, United Kingdom
| | - Helen F Galley
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom.,Intensive Care Unit, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
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