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Asakitogum DA, Nutor JJ, Pozzar R, Hammer M, Alismail S, Kober KM, Miaskowski C. Multidimensional Model of Energy in Patients With Cancer. Semin Oncol Nurs 2024; 40:151644. [PMID: 38692969 DOI: 10.1016/j.soncn.2024.151644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 03/26/2024] [Accepted: 04/05/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVES Evidence suggests that energy is a distinct symptom from fatigue in patients with cancer. The purpose of this paper is to present the Multidimensional Model of Energy in Patients with Cancer (MMEPC) that is based on emerging evidence and to make recommendations for clinical practice and future research. METHODS The literature was reviewed to determine various factors associated with variations in energy in patients with cancer. In addition, some of the emerging evidence in the model is supported by studies of energy in the general population and in patients with other chronic conditions. RESULTS Based on a review of the literature, specific concepts in the MMEPC include: person factors, clinical factors, cancer-related factors, biological factors, factors associated with energy balance, and co-occurring symptoms. The evidence to support the association between each of these factors and variations in energy levels in patients with cancer is described and synthesized. CONCLUSION This article provides emerging evidence on factors that influence variations in energy levels in patients with cancer. While the fundamental biobehavioral and biologic mechanisms that underlie variations in energy levels are not well understood, the model can be used to design pre-clinical and clinical studies of energy in patients with cancer. In addition, while emerging evidence supports the hypothesis that fatigue and energy are distinct symptoms, additional research on common and distinct risk factors and underlying mechanisms is warranted to be able to develop and test precision interventions for one or both symptoms. IMPLICATIONS FOR NURSING PRACTICE The risk factors (eg, being female, sleep quality) associated with variations in energy levels in patients with cancer identified in this paper have important clinical implications. Clinicians can use the identified risk factors to guide their assessments; identify high-risk patients with decrements in energy decrement; and develop targeted energy conservation interventions for the patients.
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Affiliation(s)
| | | | - Rachel Pozzar
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA
| | - Marilyn Hammer
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA
| | | | - Kord M Kober
- School of Nursing, University of California, San Francisco
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco; School of Medicine, University of California, San Francisco
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Martin CV, Joyce-McCoach J, Peddle M, East CE. Sleep deprivation and medication administration errors in registered nurses-A scoping review. J Clin Nurs 2024; 33:859-873. [PMID: 37872866 DOI: 10.1111/jocn.16912] [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: 06/02/2023] [Revised: 08/31/2023] [Accepted: 10/02/2023] [Indexed: 10/25/2023]
Abstract
AIM To explore whether sleep deprivation contributes to medication errors in registered nurses (RNs). BACKGROUND Sleep deprivation is a potential issue for RNs, particularly those who work shifts. Sleep deprivation has been found to have a negative impact on numerous cognitive processes. Nurses administer several medications to patients a day, potentially while sleep deprived-anecdotal reports suggest that this could result in an increased risk of error occurring. DESIGN A scoping review was conducted using the Prisma-ScR extension framework to explore what is known about the effect of RNs' sleep deprivation on medication administration errors. METHODS A search of databases generated 171 results. When inclusion and exclusion criteria were applied, 18 empirical studies were analysed. Studies included retrospective analysis of errors, surveys of perceptions of causes and observational studies. RESULTS Data indicated that RNs consider fatigue, which may be caused by sleep deprivation, to be a contributing factor to medication errors. The search only identified three observer studies, which provided conflicting results as to whether lack of sleep contributes to the error rate. Of the numerous tools used to measure sleep, the Pittsburgh Sleep Quality Index was the most frequently used. CONCLUSION Although RNs anecdotally consider a lack of sleep potentially contributes to medication errors, there is insufficient research to provide robust evidence to confirm this assumption. NO PATIENT OR PUBLIC CONTRIBUTIONS Patient or public contributions were not required for this scoping review. RELEVANCE TO CLINICAL PRACTICE Sleep deprivation is a potential issue for nurses, especially those who work shifts. Poor sleep impacts cognitive processes that potentially could increase errors. Nurses should be aware of the impact sleep may have on patient safety.
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Affiliation(s)
- Christopher Vincent Martin
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Ballarat, Victoria, Australia
| | - Joanne Joyce-McCoach
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Monica Peddle
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
| | - Christine Elizabeth East
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
- Mercy Health, Melbourne, Victoria, Australia
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Wu J, Zhang S, Wu X, Mei W. The effect of off-hours hip surgery on patients' outcomes: a RECORD-compliant retrospective, propensity score-matched cohort study. Minerva Anestesiol 2023; 89:613-624. [PMID: 36700332 DOI: 10.23736/s0375-9393.22.16945-2] [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: 01/27/2023]
Abstract
BACKGROUND Off-hours working may have negative impacts on the performance of clinicians, leading to possible adverse outcomes of patients. We aimed to explore the impact of off-hours hip surgery on early postoperative outcomes. METHODS All patients who underwent hip surgery between January 2015, and December 2020 in our hospital were evaluated in this retrospective cohort study. We measured in-hospital mortality, some postoperative complications, and some intraoperative prognostic indicators. Propensity score matching (PSM) was used to adjust for confounding baseline factors. RESULTS We identified 143 patients in the original cohort. After PSM, 266 patients in the on-hours group were matched with 105 similar patients in the off-hours group. Compared with the on-hours group, the off-hours group had more general anesthesia (81.0% vs. 62.4%; RR, 1.30; 95% CI, 1.14 to 1.48; P=0.001), higher amount of intraoperative CRBC (0 U [0-2] vs. 0 U [0-0]; P=0.032) and FFP transfusion (0 mL [0-150] vs. 0 mL [0-0]; P=0.005), higher dosage of intraoperative sufentanil (24.5±14.5 μg vs. 20.7±13.9 μg; P=0.020), higher incidence of postoperative renal dysfunction (13.3% vs. 6.4%; RR, 2.09; 95% CI, 1.07 to 4.08; P=0.029), hypotension (2.9% vs. 0%; P=0.022), and hypoxemia (3.8% vs. 0.4%; RR, 10.13; 95% CI, 1.15 to 89.61; P=0.024), and higher in-hospital mortality (2.9% vs. 0%; P=0.022). CONCLUSIONS Off-hours hip surgery was associated with adverse early postoperative prognosis, suggesting that more attention should be paid to off-hours hip surgery.
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Affiliation(s)
- Jiayi Wu
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuang Zhang
- Department of Anesthesiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Xi Wu
- Department of Anesthesiology, Tongji Medical College, Xiehe Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Mei
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China -
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Magnavita N, Di Prinzio RR, Meraglia I, Vacca ME, Soave PM, Di Stasio E. Sleep in Residents: A Comparison between Anesthesiology and Occupational Medicine Interns. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2356. [PMID: 36767721 PMCID: PMC9915358 DOI: 10.3390/ijerph20032356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
Sleep deprivation is a significant risk to the health and judgment of physicians. We wanted to investigate whether anesthesiology residents (ARs) who work only one night shift per week have different physical and mental health from occupational medicine residents (OMRs) who do not work at night. A total of 21 ARs and 16 OMRs attending a university general hospital were asked to wear an actigraph to record sleep duration, heart rate and step count and to complete a questionnaire for the assessment of sleep quality, sleepiness, fatigue, occupational stress, anxiety, depression and happiness. ARs had shorter sleep duration than OMRs; on average, they slept 1 h and 20 min less (p < 0.001). ARs also had greater daytime sleepiness, a higher heart rate and lower happiness than OMRs. These results should be interpreted with caution given the cross-sectional nature of the study and the small sample size, but they are an incentive to promote sleep hygiene among residents.
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Affiliation(s)
- Nicola Magnavita
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Woman, Child & Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Reparata Rosa Di Prinzio
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Igor Meraglia
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Maria Eugenia Vacca
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Paolo Maurizio Soave
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Emergency, Anesthesiology and Resuscitation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Enrico Di Stasio
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Diagnostic and Laboratory Medicine, Unity of Chemistry, Biochemistry and Clinical Molecular Biology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics Research, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Scholliers A, Cornelis S, Tosi M, Opsomer T, Shaproski D, Vanlersberghe C, Vanhonacker D, Poelaert J, Goudman L, Moens M. Impact of fatigue on anaesthesia providers: a scoping review. Br J Anaesth 2023; 130:622-635. [PMID: 36697276 DOI: 10.1016/j.bja.2022.12.011] [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: 02/14/2021] [Revised: 09/01/2022] [Accepted: 12/15/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Recently, fatigue has received more attention as a workplace hazard. This scoping review focuses on fatigue in anaesthesia providers. We explore the prevalence of fatigue in anaesthesia providers, and we examine how fatigue impacts their performance. METHODS A literature search was independently conducted from December 2019 through March 2020. The following four databases were consulted: MEDLINE, CINAHL, EMBASE, and PubPsych. Only studies discussing fatigue in anaesthesia providers were eligible. RESULTS The initial database search identified a total of 118 studies, of which 30 studies were included in the review. Eight articles concerned the prevalence of fatigue in anaesthesia providers, whereas 22 explored the impact of fatigue on the performance of anaesthesia providers. Up to 60.8% of anaesthesia providers suffered from severe excessive daytime sleepiness, and fatigue was denoted as a common workplace problem in up to 73.1% of anaesthesia providers. Fatigue had a negative influence on medication errors and vigilance, and it decreased the performance of anaesthesia providers during laboratory psychomotor testing. There was a decrease in non-technical skills (notably communication and teamwork) and worsening mood when fatigued. CONCLUSIONS Based on this scoping review, fatigue is a prevalent a phenomenon that anaesthesia providers cannot ignore. A combination of deterioration in non technical skills, increased medication errors, loss of sustained attention, and psychomotor decline can lead to poorer performance and cause patient harm. Concrete strategies to mitigate fatigue should be developed.
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Affiliation(s)
- Annelies Scholliers
- Department of Anaesthesiology and Perioperative Medicine, University Hospital Brussels (UZ Brussel), Brussels, Belgium.
| | - Stef Cornelis
- Department of Anaesthesiology and Perioperative Medicine, University Hospital Brussels (UZ Brussel), Brussels, Belgium
| | - Maurizio Tosi
- Department of Anaesthesiology and Perioperative Medicine, University Hospital Brussels (UZ Brussel), Brussels, Belgium
| | - Tine Opsomer
- Department of Anaesthesiology and Perioperative Medicine, University Hospital Brussels (UZ Brussel), Brussels, Belgium
| | - David Shaproski
- Department of Anaesthesiology and Perioperative Medicine, University Hospital Brussels (UZ Brussel), Brussels, Belgium
| | - Caroline Vanlersberghe
- Department of Anaesthesiology and Perioperative Medicine, University Hospital Brussels (UZ Brussel), Brussels, Belgium
| | - Domien Vanhonacker
- Department of Anaesthesiology and Perioperative Medicine, University Hospital Brussels (UZ Brussel), Brussels, Belgium
| | - Jan Poelaert
- Department of Anaesthesiology and Perioperative Medicine, University Hospital Brussels (UZ Brussel), Brussels, Belgium
| | - Lisa Goudman
- STIMULUS Research Group, Vrije Universiteit Brussel, Brussels, Belgium; Department of Neurosurgery, University Hospital Brussels (UZ Brussel), Brussels, Belgium; Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium; Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Research Foundation-Flanders (FWO), Brussels, Belgium
| | - Maarten Moens
- STIMULUS Research Group, Vrije Universiteit Brussel, Brussels, Belgium; Department of Neurosurgery, University Hospital Brussels (UZ Brussel), Brussels, Belgium; Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium; Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Radiology, University Hospital Brussels (UZ Brussel), Brussels, Belgium
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Field E, Taylor T. The problem with paradoxes: The hidden costs of fatigue. MEDICAL EDUCATION 2022; 56:967-969. [PMID: 35778864 DOI: 10.1111/medu.14866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Emily Field
- Faculty of Arts and Humanities, Western University, London, Ontario, Canada
| | - Taryn Taylor
- Centre for Education Research & Innovation, Western University, London, Ontario, Canada
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Chen S, Xie Y, Li Y, Fan X, Xing F, Mao Y, Xing N, Wang J, Yang J, Wang Z, Yuan J. Sleep deprivation and recovery sleep affect healthy male resident’s pain sensitivity and oxidative stress markers: The medial prefrontal cortex may play a role in sleep deprivation model. Front Mol Neurosci 2022; 15:937468. [PMID: 36061364 PMCID: PMC9434020 DOI: 10.3389/fnmol.2022.937468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Sleep is essential for the body’s repair and recovery, including supplementation with antioxidants to maintain the balance of the body’s redox state. Changes in sleep patterns have been reported to alter this repair function, leading to changes in disease susceptibility or behavior. Here, we recruited healthy male physicians and measured the extent of the effect of overnight sleep deprivation (SD) and recovery sleep (RS) on nociceptive thresholds and systemic (plasma-derived) redox metabolism, namely, the major antioxidants glutathione (GSH), catalase (CAT), malondialdehyde (MDA), and superoxide dismutase (SOD). Twenty subjects underwent morning measurements before and after overnight total SD and RS. We found that one night of SD can lead to increased nociceptive hypersensitivity and the pain scores of the Numerical Rating Scale (NRS) and that one night of RS can reverse this change. Pre- and post-SD biochemical assays showed an increase in MDA levels and CAT activity and a decrease in GSH levels and SOD activity after overnight SD. Biochemical assays before and after RS showed a partial recovery of MDA levels and a basic recovery of CAT activity to baseline levels. An animal study showed that SD can cause a significant decrease in the paw withdrawal threshold and paw withdrawal latency in rats, and after 4 days of unrestricted sleep, pain thresholds can be restored to normal. We performed proteomics in the rat medial prefrontal cortex (mPFC) and showed that 37 proteins were significantly altered after 6 days of SD. Current findings showed that SD causes nociceptive hyperalgesia and oxidative stress, and RS can restore pain thresholds and repair oxidative stress damage in the body. However, one night of RS is not enough for repairing oxidative stress damage in the human body.
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Affiliation(s)
- Shuhan Chen
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, China
| | - Yanle Xie
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, China
| | - Yize Li
- Department of Anesthesiology, Tianjin Research Institute of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaochong Fan
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, China
| | - Fei Xing
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, China
| | - Yuanyuan Mao
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, China
| | - Na Xing
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, China
| | - Jingping Wang
- Massachusetts General Hospital Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, United States
| | - Jianjun Yang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, China
| | - Zhongyu Wang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, China
- Zhongyu Wang,
| | - Jingjing Yuan
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, China
- *Correspondence: Jingjing Yuan,
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Van Veen M, Lancel M, Şener O, Verkes R, Bouman E, Rutters F. Observational and experimental studies on sleep duration and aggression: A systematic review and meta-analysis. Sleep Med Rev 2022; 64:101661. [DOI: 10.1016/j.smrv.2022.101661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 06/02/2022] [Accepted: 06/05/2022] [Indexed: 10/15/2022]
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Xu L, Yang X, Peng Z, Song T, Wang L, Dai C, Xu M, Shao Y, Lv J. Modafinil ameliorates the decline in pronunciation-related working memory caused by 36-h acute total sleep deprivation: an ERP study. Neurobiol Learn Mem 2022; 192:107625. [DOI: 10.1016/j.nlm.2022.107625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 04/08/2022] [Accepted: 04/25/2022] [Indexed: 01/08/2023]
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Ayoğlu H, Ayoğlu FN. Occupational Risks for Anaesthesiologists and Precautions. Turk J Anaesthesiol Reanim 2021; 49:93-99. [PMID: 33997836 PMCID: PMC8098723 DOI: 10.5152/tjar.2020.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 04/12/2020] [Indexed: 11/29/2022] Open
Abstract
Anaesthesiology is an extremely stressful and risky branch of medicine. New techniques, new procedures, and innovations in anaesthesia increase the responsibilities and obligations of anaesthesiologists day by day. Operating rooms and intensive care units, which are the working environment of anaesthesiologists, are considered to be an unhealthy workplace. Anaesthesiologists are exposed to various potential physical, chemical, biological, ergonomic, and psychosocial risk factors and hazards in their work environments. The occupational risks anaesthesiologists are exposed to threaten their health and may cause their professional performance to decline. This article aimed to raise awareness about the occupational risks, hazards, and precautions in anaesthesiology practice.
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Affiliation(s)
- Hilal Ayoğlu
- Department of Anaesthesiology and Reanimation, Zonguldak Bülent Ecevit University School of Medicine, Zonguldak, Turkey
| | - Ferruh Niyazi Ayoğlu
- Department of Public Health, Zonguldak Bülent Ecevit University School of Medicine, Zonguldak, Turkey
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Maron SZ, Dan J, Gal JS, Neifert SN, Martini ML, Lamb CD, Genadry L, Rothrock RJ, Steinberger J, Rasouli JJ, Caridi JM. Surgical Start Time Is Not Predictive of Microdiscectomy Outcomes. Clin Spine Surg 2021; 34:E107-E111. [PMID: 33633067 DOI: 10.1097/bsd.0000000000001063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/24/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective analysis of clinical data from a single institution. OBJECTIVE The objective of this study was to assess the time of surgery as a possible predictor for outcomes, length of stay, and cost following microdiscectomy. SUMMARY OF BACKGROUND DATA The volume of microdiscectomy procedures has increased year over year, heightening interest in surgical outcomes. Previous investigations have demonstrated an association between time of procedures and clinical outcomes in various surgeries, however, no study has evaluated its influence on microdiscectomy. METHODS Demographic and outcome variables were collected from all patients that underwent a nonemergent microdiscectomy between 2008 and 2016. Patients were divided into 2 cohorts: those receiving surgery before 2 pm were assigned to the early group and those with procedures beginning after 2 pm were assigned to the late group. Outcomes and patient-level characteristics were compared using bivariate, multivariable logistic, and linear regression models. Adjusted length of stay and cost were coprimary outcomes. Secondary outcomes included operative complications, nonhome discharge, postoperative emergency department visits, or readmission rates. RESULTS Of the 1261 consecutive patients who met the inclusion criteria, 792 were assigned to the late group and 469 were assigned to the early group. There were no significant differences in demographics or baseline characteristics between the 2 cohorts. In the unadjusted analysis, mean length of stay was 1.80 (SD=1.82) days for the early group and 2.00 (SD=1.70) days for the late group (P=0.054). Mean direct cost for the early cohort was $5088 (SD=$4212) and $4986 (SD=$2988) for the late cohort (P=0.65). There was no difference in adjusted length of stay or direct cost. No statistically significant differences were found in operative complications, nonhome discharge, postoperative emergency department visits, or readmission rates between the 2 cohorts. CONCLUSION The study findings suggest that early compared with late surgery is not significantly predictive of surgical outcomes following microdiscectomy.
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Affiliation(s)
| | | | - Jonathan S Gal
- Anesthesia, Perioperative and Pain Medicine, Mount Sinai Hospital, New York, NY
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Later Surgical Start Time Is Associated With Longer Length of Stay and Higher Cost in Cervical Spine Surgery. Spine (Phila Pa 1976) 2020; 45:1171-1177. [PMID: 32355143 DOI: 10.1097/brs.0000000000003516] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study of a surgical cohort from a single, large academic institution. OBJECTIVE The aim of this study was to investigate associations between surgical start time, length of stay, cost, perioperative outcomes, and readmission. SUMMARY OF BACKGROUND DATA One retrospective study with a smaller cohort investigated associations between surgical start time and outcomes in spine surgery and found that early start times were correlated with shorter length of stay. No examinations of perioperative outcomes or cost have been performed. METHODS All patients undergoing anterior cervical discectomy and fusion (ACDF) and posterior cervical decompression and fusion (PCDF) were queried from a single institution from January 1, 2008 to November 30, 2016. Patients undergoing surgery that started between 12:00 AM and 6:00 AM were excluded due to their likely emergent nature. Cases starting before and after 2:00 PM were compared on the basis of length of stay and cost as the primary outcomes using multivariable logistic regression. RESULT The patients undergoing ACDF and PCDF were both similar on the basis of comorbidity burden, preoperative diagnosis, and number of segments fused. The patients undergoing ACDF starting after 2 PM had longer LOS values (adjusted difference of 0.65 days; 95% confidence interval [CI]: 0.28-1.03; P = 0.0006) and higher costs of hospitalization (adjusted difference of $1177; 95% CI: $549-$1806; P = 0.0002). Patients undergoing PCDF starting after 2 PM also had longer LOS values (adjusted difference of 1.19 days; 95% CI: 0.46-1.91; P = 0.001) and higher costs of hospitalization (adjusted difference of $2305; 95% CI: $826-$3785; P = 0.002). CONCLUSION Later surgical start time is associated with longer LOS and higher cost. These findings should be further confirmed in the spine surgical literature to investigate surgical start time as a potential cost-saving measure. LEVEL OF EVIDENCE 3.
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Costa C, Mondello S, Micali E, Indelicato G, Licciardello AA, Vitale E, Briguglio G, Teodoro M, Fenga C. Night shift work in resident physicians: does it affect mood states and cognitive levels? J Affect Disord 2020; 272:289-294. [PMID: 32553370 DOI: 10.1016/j.jad.2020.03.139] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 02/12/2020] [Accepted: 03/29/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The effects of night shift work on health status have been widely studied. Night workers seem to smoke more, eat badly and show a low propensity to physical activity. Night work can be associated with an increase in cardiovascular and gastrointestinal disorders, alterations in immune response, diabetes, aging, hormonal imbalance, and premature death; alteration of circadian rhythm is also regarded as a risk factor for breast cancer and neuropsychiatric disorders. Moreover, several studies have highlighted the effects of sleep deprivation on clinical performance, quality of care and personal safety of healthcare personnel. No studies have investigated the effects of night work on Italian resident physicians and compared its effect across specialties. This study aims to assess the prevalence of sleep disorders, possible cognitive impairment and mood states, in relation to night shift work among resident physicians. METHODS 80 resident physicians, attending the postgraduate training into an Hospital located in the South of Italy, were divided into 4 areas (medical, surgical, services and anaesthesia). They were recruited from July 2017 to June 2018 and participated to a survey consisting of 4 questionnaires to investigate the presence of sleep deprivation and sleep quality (Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index), their cognitive status (Mini Mental State examination) and mood profiles (Profile of Mood States, POMS). Analysis of variance was used for comparison of questionnaires scores across specialties. RESULTS Authors reported no sleep deprivation, no sleep disorders and their outcomes, no changes in intellectual efficiency and no cognitive impairment in this population, neither in the areas performing night shifts nor in those involving only day shifts. Mood states measured by POMS showed a borderline level of Anger-Hostility (A) value among the residents of the medical area and services, and an increase slightly beyond the physiological levels of the T-score 50 of Fatigue-Inertia (F) always in the same groups. An increase in the Vigour-Activity (V) value beyond T-score 50 levels was also observed among residents of all the areas considered. CONCLUSIONS Emotional involvement could be attributed to the gap between high professional demand and lack of experience and knowledge among trainees. Tutors should help their students in order to identify earlier changes in the mood. Improvement in the organization of the trainee's activity could reduce the emotional overload.
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Affiliation(s)
- Chiara Costa
- Clinical and Experimental Medicine Department, University of Messina, Messina 98125, Italy
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Occupational Medicine Section, University of Messina, Messina 98125, Italy
| | | | - Giuliano Indelicato
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Occupational Medicine Section, University of Messina, Messina 98125, Italy
| | - Antonino Andrea Licciardello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Occupational Medicine Section, University of Messina, Messina 98125, Italy
| | - Ermanno Vitale
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Occupational Medicine Section, University of Messina, Messina 98125, Italy
| | - Giusi Briguglio
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Occupational Medicine Section, University of Messina, Messina 98125, Italy
| | - Michele Teodoro
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Occupational Medicine Section, University of Messina, Messina 98125, Italy.
| | - Concettina Fenga
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Occupational Medicine Section, University of Messina, Messina 98125, Italy
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Petrut B, Berindan-Neagoe I, Feflea DI, Hogea M, Pasca S, Bujoreanu CE, Bschleipfer T. Mental Fatigue Evaluation of Surgical Teams during a Regular Workday in a High-Volume Tertiary Healthcare Center. Urol Int 2020; 104:301-308. [PMID: 31955166 DOI: 10.1159/000504988] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 11/24/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Considering the complex set of manual and psychological tasks a surgeon has to perform during the day, it is very important to assess the surgeon's fatigability, reaction time, attention, and memory. OBJECTIVE Here, we wanted to determine the mental fatigue status of surgeons and how their abilities are affected through a regular workday. METHODS We included 3 senior urologists and 6 urology residents. In a set period of time, we assessed their fatigue through self-assessed fatigue, Samn-Perelli score, and Karolinska sleepiness scale score. Further, reaction time, attention, and memory correlated with the number of the operations in the day, and total number of operations in that day were assessed. RESULTS As the number of tasks increases, and as the surgeons advance to the end of the workday, they become more fatigued, reaction time ultimately increases, and attention and memory become slightly altered. CONCLUSIONS Complications resulting from the fatigue of surgeons could be serious. Their performance status and skills decrease as they perform more tasks or advance through the day.
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Affiliation(s)
- Bogdan Petrut
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Dragos I Feflea
- Department of Urology, Prof. Dr. Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
| | | | - Sergiu Pasca
- Department of Functional Genomics, Prof. Dr. Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
| | - Cristina E Bujoreanu
- Department of Urology, Prof. Dr. Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania,
| | - Thomas Bschleipfer
- Clinic for Urology, Andrology and Pediatric Urology, Clinics of Nordoberpfalz AG, Weiden, Germany
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Bolin DJ. Sleep Deprivation and Its Contribution to Mood and Performance Deterioration in College Athletes. Curr Sports Med Rep 2019; 18:305-310. [DOI: 10.1249/jsr.0000000000000621] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Decina C, Berke O, van Staaveren N, Baes CF, Widowski TM, Harlander-Matauschek A. An Investigation of Associations Between Management and Feather Damage in Canadian Laying Hens Housed in Furnished Cages. Animals (Basel) 2019; 9:E135. [PMID: 30935154 PMCID: PMC6524406 DOI: 10.3390/ani9040135] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 11/17/2022] Open
Abstract
Feather pecking is a continuous welfare challenge in the housing of egg-laying hens. Canada is currently making the transition from conventional cages to alternative housing systems. However, feather damage (FD) among laying hens due to feather pecking remains a welfare concern. An explorative approach was taken to assess bird, housing, and management associations with FD in Canadian laying hens housed in alternative systems. A questionnaire focused on housing and management practices was administered to 122 laying farms across Canada in autumn of 2017 (response rate of 52.5%), yielding information on a subset of 26 flocks housed in furnished cages. Additionally, a three-point feather cover scoring system was developed to estimate the prevalence of FD. Farmers assessed FD by sampling 50 birds per flock. Linear regression modeling was applied to explain FD as a function of 6 variables (out of an available 54). Of the 6 modeled variables, "increased age", "brown feather colour", "midnight feeding", and "no scratch area" were associated with higher levels of FD at farm level (R² = 0.77). The results indicated that FD resulting from feather pecking is a multifactorial problem, and supported existing evidence that FD increases as birds age. These results also suggested that "feather colour", "midnight feeding", and "access to (or lack of) a scratch area or additional substrate" play a role in FD prevalence in furnished cages.
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Affiliation(s)
- Caitlin Decina
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.
| | - Olaf Berke
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.
| | - Nienke van Staaveren
- Department of Animal Biosciences, Ontario Agricultural College, University of Guelph, Guelph, ON N1G 2W1, Canada.
| | - Christine F Baes
- Department of Animal Biosciences, Ontario Agricultural College, University of Guelph, Guelph, ON N1G 2W1, Canada.
| | - Tina M Widowski
- Department of Animal Biosciences, Ontario Agricultural College, University of Guelph, Guelph, ON N1G 2W1, Canada.
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Song B, Yang Y, Bai W, Li Z, Wan J, Teng X, Shao J, Ji F, Dong H, Zhu J. Effect of physical exercise on young anesthesiologists with on-call-related fatigue. PSYCHOL HEALTH MED 2019; 24:1055-1062. [PMID: 30900471 DOI: 10.1080/13548506.2019.1595681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Bijia Song
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yanchao Yang
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wenya Bai
- Department of Anesthesiology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhen Li
- Department of Anesthesiology, Xijing Hospital of Fourth Military Medical University, Xi’an, China
| | - Jingjie Wan
- Department of Anesthesiology, First Affiliated Hospital of Suzhou University, Suzhou, China
| | - Xiufei Teng
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jianlin Shao
- Department of Anesthesiology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Fuhai Ji
- Department of Anesthesiology, First Affiliated Hospital of Suzhou University, Suzhou, China
| | - Hailong Dong
- Department of Anesthesiology, Xijing Hospital of Fourth Military Medical University, Xi’an, China
| | - Junchao Zhu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
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Walters SJ, Stern C, Stephenson M. Fatigue and measurement of fatigue: a scoping review protocol. ACTA ACUST UNITED AC 2018; 17:261-266. [PMID: 30451709 DOI: 10.11124/jbisrir-2017-003699] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The objectives of this review are to identify and present definitions of fatigue and theoretical, conceptual and mechanistic models of fatigue, and to identify the commonly used instruments that measure fatigue in humans and the settings in which they are used.Specifically, the review questions are.
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Gates M, Wingert A, Featherstone R, Samuels C, Simon C, Dyson MP. Impact of fatigue and insufficient sleep on physician and patient outcomes: a systematic review. BMJ Open 2018; 8:e021967. [PMID: 30244211 PMCID: PMC6157562 DOI: 10.1136/bmjopen-2018-021967] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES For physicians in independent practice, we synthesised evidence on the (1) impacts of insufficient sleep and fatigue on health and performance, and patient safety and (2) effectiveness of interventions targeting insufficient sleep and fatigue. DESIGN We systematically reviewed online literature. After piloting, one reviewer selected studies by title and abstract; full texts were then reviewed in duplicate. One reviewer extracted data; another verified a random 10% sample. Two reviewers assessed risk of bias. We pooled findings via meta-analysis when appropriate or narratively. DATA SOURCES We searched Medline, Embase, PsycINFO, CINAHL and PubMed for published studies in April 2016; Medline was updated in November 2017. We searched Embase for conference proceedings, and hand-searched meeting abstracts, association and foundation websites. ELIGIBILITY CRITERIA FOR SELECTING STUDIES English or French language primary research studies published from 2000 to 2017 examining the effect of fatigue-related or sleep-related exposures or interventions on any outcome among physicians in independent practice and their patients. RESULTS Of 16 154 records identified, we included 47 quantitative studies of variable quality. 28 studies showed associations between fatigue or insufficient sleep and physician health and well-being outcomes. 21 studies showed no association with surgical performance, and mixed findings for psychomotor performance, work performance and medical errors. We pooled data from six cohort studies for patient outcomes. For sleep deprived versus non-sleep deprived surgeons, we found no difference in patient mortality (n=60 436, relative risk (RR) 0.98, 95% CI 0.84 to 1.15, I2=0% (p=0.87)) nor postoperative complications (n=60 201, RR 0.99, 95% CI 0.95 to 1.03, I2=0% (p=0.45)). The findings for intraoperative complications and length of stay were considerably heterogeneous. CONCLUSIONS Fatigue and insufficient sleep may be associated with negative physician health outcomes. Current evidence is inadequate to inform practice recommendations.
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Affiliation(s)
- Michelle Gates
- Alberta Research Centre for Health Evidence (ARCHE), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
| | - Aireen Wingert
- Alberta Research Centre for Health Evidence (ARCHE), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
| | - Robin Featherstone
- Alberta Research Centre for Health Evidence (ARCHE), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
| | - Charles Samuels
- Centre for Sleep and Human Performance, Calgary, Alberta, Canada
| | | | - Michele P Dyson
- Alberta Research Centre for Health Evidence (ARCHE), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
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Grassl N, Nees J, Schramm K, Spratte J, Sohn C, Schott TC, Schott S. A Web-Based Survey Assessing the Attitudes of Health Care Professionals in Germany Toward the Use of Telemedicine in Pregnancy Monitoring: Cross-Sectional Study. JMIR Mhealth Uhealth 2018; 6:e10063. [PMID: 30089606 PMCID: PMC6105866 DOI: 10.2196/10063] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 05/12/2018] [Accepted: 06/18/2018] [Indexed: 01/03/2023] Open
Abstract
Background The demand for fetal monitoring and constant reassurance is high in pregnant women. Consequently, pregnant women use various health apps and are more likely to visit emergency departments due to subjective but nonurgent complaints. However, electronic health (eHealth) and mobile health (mHealth) solutions are rarely used to prevent nonurgent emergency consultations. To implement modern care solutions, a better understanding of the attitudes, fears, and hopes of health care professionals toward eHealth and mHealth is needed. Objective The aim of this study was to investigate the attitudes of health care professionals in obstetrics toward telemedicine. Methods A quantitative Web-based survey on health care professionals in obstetrics in Germany was conducted. The participants included nurses, midwives, and physicians of all age groups and job positions working in hospitals that provide various levels of health care. The questionnaire comprised 24 questions about the characteristics of the study population, views about emergency consultations in obstetrics, attitude toward telemedicine, job satisfaction, and sleeping behavior. Results In total, 244 health care professionals participated in the Web-based survey. In general, health care professionals were skeptical (170/233, 72.9%) about the use of telemedicine in obstetrics; however, 55.8% (130/233) recognized its potential. Moreover, 72% (62/86) of physicians were optimistic in using apps for pregnancy monitoring, whereas 36.1% (47/130) of nonphysicians (P<.001) were not. Significantly, more nonphysicians rejected such developments (75/130, 57.7% rejected) compared with physicians (24/86, 28%; P<.001). We also found that obstetricians with more than 10 years of work-experience are more skeptical; however, approximately 49% (18/37) of them believed that telemedicine could reduce nonurgent emergency consultations, whereas 73.2% (106/145) of obstetricians with less than 5 years of experience (P=.01) thought otherwise. Our survey revealed a high job satisfaction and a prevalence of regular sleeping problems of 45.9% (91/198) among health care professionals in obstetrics. Surprisingly, both job satisfaction and sleeping problems were independent from the number of night shifts per month (P=.77 and P=.99, respectively). Yet, 56.6% (112/198) of the survey participants thought they would be happier with their job if they had to work fewer night shifts per month. Conclusions Our study reveals an ambivalent attitude toward the use of telemedicine among health care professionals in obstetrics in Germany at the moment. Efforts to promote the use of telemedicine should focus on nurses and midwives because these groups are the most skeptical. By contrast, particularly young physicians recognize the potential of apps in patient care and would like to use such technology in pregnancy monitoring.
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Affiliation(s)
- Niklas Grassl
- Department of Gynecology and Obstetrics, University Women's Clinic Heidelberg, Heidelberg, Germany
| | - Juliane Nees
- Department of Gynecology and Obstetrics, University Women's Clinic Heidelberg, Heidelberg, Germany
| | - Katharina Schramm
- Department of Gynecology and Obstetrics, University Women's Clinic Heidelberg, Heidelberg, Germany
| | - Julia Spratte
- Department of Gynecology and Obstetrics, University Women's Clinic Heidelberg, Heidelberg, Germany
| | - Christof Sohn
- Department of Gynecology and Obstetrics, University Women's Clinic Heidelberg, Heidelberg, Germany
| | - Timm C Schott
- Centre of Dentistry, Department of Orthodontics and Orofacial Orthopedics, University of Tuebingen, Tuebingen, Germany
| | - Sarah Schott
- Department of Gynecology and Obstetrics, University Women's Clinic Heidelberg, Heidelberg, Germany
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Stuetzle KV, Pavlin BI, Smith NA, Weston KM. Survey of occupational fatigue in anaesthetists in Australia and New Zealand. Anaesth Intensive Care 2018; 46:414-423. [PMID: 29966116 DOI: 10.1177/0310057x1804600411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Occupational fatigue in anaesthetists is recognised as a patient safety risk. Better understanding of the issues surrounding their fatigue is needed. This study aimed to ascertain the sources and effects of occupational fatigue amongst anaesthetists in Australia and New Zealand. An anonymous online survey was sent to 979 anaesthetists. The response rate was 38.0%. Most participants reported regularly working over 40 hours per week; men reported five more hours per week than women. Stated contributors to fatigue included long work hours, mental strain at work, and personal and family demands. Fatigue-related behaviour was reported more by men (OR [odds ratio]=2.6) and less by respondents reporting eight or more hours of sleep before work (OR=0.6). Reporting at least one instance of less than five hours off between shifts was predictive of falling asleep while administering an anaesthetic (OR=1.6). More data are required to support practices and policies that promote more time off between work periods and increased time for sleep to reduce risk of fatigue.
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Amarouche M, Neville JJ, Deacon S, Kalyal N, Adams N, Cheserem B, Curley D, DeSouza RM, Hafiz F, Jayawardena T, Khetani N, Matthews D, Mustoe S, Okafor S, Padfield O, Rao I, Samir R, Tahir H, Varghese B, Tolias CM. Referrers' point of view on the referral process to neurosurgery and opinions on neurosurgeons: a large-scale regional survey in the UK. BMJ Open 2017; 7:e017495. [PMID: 29180594 PMCID: PMC5719300 DOI: 10.1136/bmjopen-2017-017495] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES There is an increased reliance on online referral systems (ORS) within neurosurgical departments across the UK. Opinions of neurosurgeons on ORS are extensively reported but those of referrers have hardly been sought. Our study aims at ascertaining our referring colleagues' views on our ORS and its impact on patient care, their opinions on neurosurgeons and how to improve our referral process. SETTING 14 district general hospitals and one teaching hospital. PARTICIPANTS 641 healthcare professionals across a range of medical and surgical specialties including doctors of all grades, nurses and physiotherapists. Survey responses were obtained by medical students using a smartphone application. RESULTS Although 92% of respondents were aware of the ORS, 74% would routinely phone the on-call registrar either before or after making referrals online. The majority (44%) believed their call to relate to a life-threatening emergency. 62% of referrers considered the ORS helpful in informing patients' care and 48% had a positive opinion of their interaction with neurosurgical registrars. On ways to improve the ORS, 50% selected email/text confirmation of response sent to referrers and 16% to referring consultants. CONCLUSION Our results confirm that referrers feel that using our ORS positively impacts patient care but that it remains in need of improvement in order to better suit our colleagues' needs when it comes to managing neurosurgical patients. We feel that the promotion of neurosurgical education and mitigation of the effects of adverse workplace human factors are likely to achieve the common goal of neurosurgeons and referrers alike: a high standard in patient care.
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Affiliation(s)
- Meriem Amarouche
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Simon Deacon
- Department of Medicine, King's College London, London, UK
| | - Nida Kalyal
- Department of Medicine, King's College London, London, UK
| | - Nikita Adams
- Department of Medicine, King's College London, London, UK
| | - Beverly Cheserem
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Daniel Curley
- Department of Medicine, King's College London, London, UK
| | - Ruth-Mary DeSouza
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
- Department of Medicine, University College London, London, UK
| | - Fehmi Hafiz
- Department of Medicine, King's College London, London, UK
| | | | - Nishi Khetani
- Department of Medicine, King's College London, London, UK
| | - Diana Matthews
- Department of Medicine, King's College London, London, UK
| | - Sophie Mustoe
- Department of Medicine, King's College London, London, UK
| | - Sabrina Okafor
- Department of Medicine, King's College London, London, UK
| | | | - Ishani Rao
- Department of Medicine, King's College London, London, UK
| | - Reem Samir
- Department of Medicine, King's College London, London, UK
| | - Hyder Tahir
- Department of Medicine, King's College London, London, UK
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Quality organization and risk in anaesthesia: the French perspective. Curr Opin Anaesthesiol 2017; 30:230-235. [PMID: 28118164 DOI: 10.1097/aco.0000000000000432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW Ensuring the quality and safety of anaesthesia in the face of budgetary restrictions and changing demographics is challenging. In France, the environment is regulated by the legislation, and it is often necessary to find solutions that seize opportunities to break with the traditional organization. RECENT FINDINGS Postoperative mortality remains excessively high. The move towards ambulatory care is being adequately integrated into all the stages of patient management in the context of a single therapeutic plan that is mutually agreed upon by all caregivers. The French National Health Authority, which provides certification for healthcare establishments, encourages this 'seamless' approach between private practice and the hospital setting, based on teamwork and interdisciplinary consultation. By daring to break with traditional organizational structures, and by taking account of human factors and staged strategies, it is possible to deliver appropriate care, with a level of quality and safety that meets users' demands. SUMMARY The management of a patient undergoing surgery with anaesthesia is a seamless spectrum from the patient's home to the hospital and back to home. Decision-making must be multidisciplinary. Increased use of ambulatory care, breaks with traditional organizational structures, and efforts to reduce postoperative mortality represents opportunities to improve overall system performance. Demographic and economic constraints are potential threats to be identified.
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Saadat H, Bissonnette B, Tumin D, Raman V, Rice J, Barry N, Tobias J. Effects of partial sleep deprivation on reaction time in anesthesiologists. Paediatr Anaesth 2017; 27:358-362. [PMID: 27900800 DOI: 10.1111/pan.13035] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Fatigue in anesthesiologists may have implications that extend beyond individual well-being. AIM The aim of the present study was to evaluate the impact of sleep deprivation on the reaction time in anesthesiologists either after an overnight call or regular working hours. Moderation of this effect by coping strategies was observed. METHODS Psychomotor vigilance test was used to assess reaction time in 23 anesthesiologists at two time-points: (i) on a regular non-call day and (ii) after a 17-h in-house call. Student's paired t-test was used to compare Psychomotor Vigilance Task data at these two moments. Change score regression was performed to determine the association between coping strategies, assessed using the Coping Strategy Indicator instrument, and decline in reaction time after night call. RESULTS Twenty-one colleagues completed the psychomotor vigilance test measurements after two decided to end their participation for personal reasons. Post-call psychomotor vigilance test mean reaction time decreased by an average of 31.2 ms (95% CI: 0.5, 61.9; P = 0.047) when compared to regular day. Reliance on specific coping mechanisms, indicated by Coping Strategy Indicator scale scores, included problem-solving (28 ± 4), followed by seeking social support (23 ± 5) and avoidance (19 ± 4). The change score regression model (r2 = 0.48) found that greater reliance on avoidance was associated with greater increase in reaction time after night call. CONCLUSION Reaction time increased considerably in anesthesiologists after a night call duty. Greater subjective reliance on avoidance as a coping strategy was associated with greater deterioration in performance.
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Affiliation(s)
- Haleh Saadat
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT, USA
| | - Bruno Bissonnette
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Anesthesia and Critical Care Medicine, The University of Toronto, Toronto, ON, Canada
| | - Dmitry Tumin
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Vidya Raman
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Julie Rice
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - N'Diris Barry
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Joseph Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH, USA
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Heller JA, Kothari R, Lin HM, Levin MA, Weiner M. Surgery Start Time Does Not Impact Outcome in Elective Cardiac Surgery. J Cardiothorac Vasc Anesth 2017; 31:32-36. [DOI: 10.1053/j.jvca.2016.08.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Indexed: 12/28/2022]
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