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Li TP, Slocum S, Sahoo A, Ochuba A, Kolakowski L, Henn Iii RF, Johnson AA, LaPorte DM. Socratic Artificial Intelligence Learning (SAIL): The Role of a Virtual Voice Assistant in Learning Orthopedic Knowledge. JOURNAL OF SURGICAL EDUCATION 2024; 81:1655-1666. [PMID: 39288509 DOI: 10.1016/j.jsurg.2024.08.006] [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: 10/30/2023] [Revised: 08/14/2024] [Accepted: 08/20/2024] [Indexed: 09/19/2024]
Abstract
OBJECTIVE We hypothesized that learning through multiple sensory modalities would improve knowledge recall and recognition in orthopedic surgery residents and medical students. DESIGN We developed a virtual study assistant, named Socratic Artificial Intelligence Learning (SAIL), based on a custom-built natural language processing algorithm. SAIL draws from practice questions approved by the American Board of Orthopaedic Surgery and quizzes users through a conversational, voice-enabled Web interface. We performed a randomized controlled study using a within-subjects, repeated measures design. SETTING Participants first took a pretest to assess their baseline knowledge. They then underwent 10 days of spaced repetition training with practice questions using 3 modalities: oral response, typed response, and multiple-choice. Recall and recognition of the practiced knowledge were assessed via a post-test administered on the first day, first week, and 2 months after the training period. PARTICIPANTS Twenty-four volunteers, who were medical students and orthopedic surgery residents at multiple US medical institutions. RESULTS The oral, typed, and multiple-choice modalities produced similar recall and recognition rates. Although participants preferred using the traditional multiple-choice modality to study for standardized examinations, many were interested in supplementing their study routine with SAIL and believe that SAIL may improve their performance on written and oral examinations. CONCLUSIONS SAIL is not inferior to the multiple-choice modality for learning orthopedic core knowledge. These results indicate that SAIL can be used to supplement traditional study methods. COMPETENCIES: medical knowledge; practice-based learning and improvement.
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Affiliation(s)
- Tuo Peter Li
- Department of Orthopaedic Surgery; The Johns Hopkins University School of Medicine; Baltimore, Maryland
| | - Stewart Slocum
- Department of Computer Science; The Johns Hopkins University Whiting School of Engineering; Baltimore, Maryland; Computer Science and Artificial Intelligence Laboratory; Massachusetts Institute of Technology; Cambridge, Massachusetts
| | - Arpan Sahoo
- Department of Computer Science; The Johns Hopkins University Whiting School of Engineering; Baltimore, Maryland; University of South Florida Morsani College of Medicine; Tampa, Florida
| | - Arinze Ochuba
- Department of Orthopaedic Surgery; The Johns Hopkins University School of Medicine; Baltimore, Maryland
| | - Logan Kolakowski
- Department of Orthopaedic Surgery; University of Maryland School of Medicine; Baltimore, Maryland
| | - Ralph Frank Henn Iii
- Department of Orthopaedic Surgery; University of Maryland School of Medicine; Baltimore, Maryland
| | - Alex A Johnson
- Department of Orthopaedic Surgery; The Johns Hopkins University School of Medicine; Baltimore, Maryland
| | - Dawn M LaPorte
- Department of Orthopaedic Surgery; The Johns Hopkins University School of Medicine; Baltimore, Maryland.
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Shirley ED, Renfro SH, Rocchi VJ. Mental Skills for Orthopaedic Surgery. J Am Acad Orthop Surg 2024; 32:323-330. [PMID: 38373405 DOI: 10.5435/jaaos-d-23-00775] [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: 08/28/2023] [Accepted: 01/14/2024] [Indexed: 02/21/2024] Open
Abstract
Orthopaedic surgery training focuses primarily on the knowledge base and surgical techniques that comprise the fundamental and physical pillars of performance. It also pays much less attention to the mental pillar of performance than does the training of other specialists such as aviators, elite athletes, musicians, and Special Forces operators. However, mental skills optimize the ability to achieve the ideal state during surgery that includes absolute focus with the right amount of confidence and stress. The path to this state begins before surgery with visualization of the surgical steps and potential complications. On the day of surgery, the use of compartmentalization, performance aspirations, performance breathing, and keeping the team focused facilitates achieving and maintaining the proper mental state. Considering the similarities between surgery and other fields of expertise that do emphasize the mental pillar, including this training in orthopaedic residencies, is likely beneficial.
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Affiliation(s)
- Eric D Shirley
- From the Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia
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Feeley AA, Timon C, Feeley IH, Sheehan E. Extended-Duration Work Shifts in Surgical Specialties: A Systematic Review. J Surg Res 2024; 293:525-538. [PMID: 37827031 DOI: 10.1016/j.jss.2023.08.024] [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: 01/09/2023] [Revised: 07/17/2023] [Accepted: 08/31/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION There has been widespread international implementation of duration-hour restrictions to prevent surgical resident burnout and promote patient safety and wellbeing of doctors. A variety of Extended-Duration Work Shifts (EDWS) have been implemented, with a variety of studies examining the effect of shift systems on both surgical performance and the stress response unestablished in the literature. METHODS This was a systematic review evaluating the impact of extended working hours on surgical performance, cognitive impairment, and physiological stress responses. The review used PubMed, Ovid Medline, Embase, and Google Scholar search engines between September and October 2021 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Filters including studies carried out after 2002 and published in the English language were applied. RESULTS In total, 30 studies were included for analysis. General surgery was the most commonly studied rotation, with Neurosurgical, Orthopedic, and ear, nose and throat specialties also included. The majority of studies found no difference or a significant improvement in post-EDWS on simulated performance. EDWS appeared to have the greatest impact on physiological stress markers in junior surgical trainees. CONCLUSIONS Experience appears to confer a protective element in the postcall period, with preservation of skill demonstrated. More experienced clinicians yielded lower levels of physiological markers of stress, although variability in hierarchical workload should be considered. Heterogeneity of findings across physiological, cognitive, and psychomotor assessments highlights the need for robust research on the optimum shift pattern prevents worker burnout and promotes patient safety. Future research to evaluate correlation between stress, on-call workload, and performance in the postcall period is warranted.
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Affiliation(s)
- Aoife A Feeley
- Department of Plastic Surgery, Connolly Hospital Blanchardstown, Dublin, Ireland; School of Medicine, University College Dublin, Belfield, Dublin, Ireland; School of Medicine, Royal College Surgeons Ireland, Dublin, Ireland.
| | - Charlie Timon
- The Walton Centre, Lower Ln, Fazakerley, Liverpool, United Kingdom
| | - Iain H Feeley
- The Walton Centre, Lower Ln, Fazakerley, Liverpool, United Kingdom
| | - Eoin Sheehan
- Department of Surgery, Midland Regional Hospital Tullamore, Tullamore, Co. Offaly, Ireland
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Roizenblatt M, Gehlbach PL, Marin VDG, Roizenblatt A, Saraiva VS, Nakanami MH, Noia LC, Song Watanabe SE, Yasaki ES, Passos RM, Magalhães Junior O, Fernandes RAB, Stefanini FR, Caiado R, Jiramongkolchai K, Farah ME, Belfort R, Maia M. A Polysomnographic Study of Effects of Sleep Deprivation on Novice and Senior Surgeons during Simulated Vitreoretinal Surgery. Ophthalmol Retina 2023; 7:940-947. [PMID: 37164313 DOI: 10.1016/j.oret.2023.05.001] [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: 02/20/2023] [Revised: 04/22/2023] [Accepted: 05/02/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE To assess the impact of a 3-hour polysomnography (PSG)-recorded night of sleep deprivation on next-morning simulated microsurgical skills among vitreoretinal (VR) surgeons with different levels of surgical experience and associate the sleep parameters obtained by PSG with Eyesi-generated performance. DESIGN Self-controlled cohort study. PARTICIPANTS Eleven junior VR surgery fellows with < 2 years of surgical experience and 11 senior surgeons with > 10 years of surgical practice. METHODS Surgical performance was assessed at 7am after a 3-hour sleep-deprived night using the Eyesi simulator and compared with each subject's baseline performance. MAIN OUTCOME MEASURES Changes in Eyesi-generated score (0-700, worst to best), time for task completion (minutes), tremor-specific score (0-100, worst to best), and out-of-tolerance tremor percentage. Polysomnography was recorded during sleep deprivation. RESULTS Novice surgeons had worse simulated surgical performance after sleep deprivation compared with self-controlled baseline dexterity in the total score (559.1 ± 39.3 vs. 593.8 ± 31.7; P = 0.041), time for task completion (13.59 ± 3.87 minutes vs. 10.96 ± 1.95 minutes; P = 0.027), tremor-specific score (53.8 ± 19.7 vs. 70.0 ± 15.3; P = 0.031), and out-of-tolerance tremor (37.7% ± 11.9% vs. 28.0% ± 9.2%; P = 0.031), whereas no performance differences were detected in those parameters among the senior surgeons before and after sleep deprivation (P ≥ 0.05). Time for task completion increased by 26% (P = 0.048) in the post-sleep deprivation simulation sessions for all participants with a high apnea-hypopnea index (AHI) and by 37% (P = 0.008) among surgeons with fragmented sleep compared with those with normal AHI and < 10 arousals per hour, respectively. Fragmented sleep was the only polysomnographic parameter associated with a worse Eyesi-generated score, with a 10% (P = 0.005) decrease the following morning. CONCLUSIONS This study detected impaired simulated surgical dexterity among novice surgeons after acute sleep deprivation, whereas senior surgeons maintained their surgical performance, suggesting that the impact of poor sleep quality on surgical skills is offset by increased experience. When considering the 2 study groups together, sleep fragmentation and AHI were associated with jeopardized surgical performance after sleep deprivation. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Marina Roizenblatt
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil; Vision Institute, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), Universidade Federal de São Paulo, São Paulo, Brazil; The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Peter L Gehlbach
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vitor D G Marin
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Arnaldo Roizenblatt
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Vinicius S Saraiva
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil; Vision Institute, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mauricio H Nakanami
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Luciana C Noia
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sung E Song Watanabe
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Erika S Yasaki
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Renato M Passos
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil; Vision Institute, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | - Rafael Caiado
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Michel E Farah
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil; Vision Institute, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rubens Belfort
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil; Vision Institute, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mauricio Maia
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil; Vision Institute, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), Universidade Federal de São Paulo, São Paulo, Brazil
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Teräs T, Myllyntausta S, Salminen M, Viikari L, Pahkala K, Muranen O, Hutri-Kähönen N, Raitakari O, Rovio S, Stenholm S. The association of previous night's sleep duration with cognitive function among older adults: a pooled analysis of three Finnish cohorts. Eur J Ageing 2023; 20:32. [PMID: 37535149 PMCID: PMC10400735 DOI: 10.1007/s10433-023-00779-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/04/2023] Open
Abstract
STUDY OBJECTIVES Sleep duration has been shown to associate with cognitive function, but little is known about the short-term effect of sleep duration on the previous night. This study examines how usual sleep duration and previous night's sleep duration are associated with cognitive function in older adults. METHODS The study population consisted of 2949 adults aged 59-92 years (mean 72.6, SD 5.7) derived from three Finnish cohorts. Participants' self-reported usual sleep duration was categorized into short (< 7 h, 19%), mid-range (7- < 9 h, 64%), and long (≥ 9 h, 17%). Self-reported sleep duration on the night prior to cognitive testing was categorized into shorter (59%), same (35%), and longer (5.9%) than usual sleep duration. Computerized Cambridge Neuropsychological Test Automated Battery (CANTAB®) was used to assess: (1) learning and memory, (2) working memory, (3) information processing, and (4) reaction time. RESULTS Participants with self-reported long, but not short, usual sleep duration had poorer learning and memory (p = .004), information processing (p = .003), and reaction time (p = .006) when compared to those with mid-range sleep duration. Those who slept more than usually the night prior to cognitive testing had poorer information processing (p = .019) than those sleeping the same as usually, while sleeping less than usually was not associated with cognitive function. CONCLUSIONS This study suggests that while long sleep duration was associated with worse cognitive function, sleeping more than usually the night prior to cognitive testing was only associated with information processing, and sleeping less than usually is not associated with cognitive function.
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Affiliation(s)
- Tea Teräs
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland.
| | - Saana Myllyntausta
- Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland
| | - Marika Salminen
- Welfare Division, City of Turku, Turku, Finland
- Department of General Practice, Faculty of Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Laura Viikari
- Department of Geriatric Medicine, Faculty of Medicine, University of Turku, Turku City Hospital, Turku, Finland
| | - Katja Pahkala
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Paavo Nurmi Centre & Unit for Health and Physical Activity, University of Turku, Turku, Finland
| | - Olli Muranen
- Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland
| | - Nina Hutri-Kähönen
- Department of Pediatrics, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Olli Raitakari
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Suvi Rovio
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Sari Stenholm
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Research Services, Turku University Hospital and University of Turku, Turku, Finland
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Orthopaedic Surgeon Physiological Indicators of Strain as Measured by a Wearable Fitness Device. J Am Acad Orthop Surg 2021; 29:e1378-e1386. [PMID: 33999882 DOI: 10.5435/jaaos-d-21-00078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/21/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Symptoms of stress, depression, and burnout are prevalent in medicine, adversely affecting physician performance. We investigated real-time measurements of physiological strain in orthopaedic resident and faculty surgeon volunteers and identified potential daily stressors. METHODS We performed a prospective blinded cohort pilot study in our academic orthopaedic department. Physicians used a wearable fitness device for 12 weeks to objectively measure heart rate variability (HRV), a documented parameter of overall well-being. Baseline burnout levels were assessed using the Maslach Burnout Inventory questionnaire. Daily surveys inquiring on work responsibilities (clinic, operating room [OR], or "other") were correlated with physiological parameters of strain. Descriptive statistics and linear mixed effects modeling were used to evaluate bivariate relationships. RESULTS Of the 21 participating surgeons, 9 faculty and 12 residents, there was a response rate of 95.2% for the initial burnout survey. Daily surveys were completed for 63.8% (54.9 ± 22.3 days) of the total collection window, and surgeons wore the device for 83.2% of the study (71.6 ± 25.0 days). Residents trended toward lower personal accomplishment and greater psychological detachment on the Maslach Burnout Inventory, with 5 surgeons including 1 faculty surgeon (11.1%) and 4 resident surgeons (33.3%) found to have negatively trending HRV throughout the study period demonstrating higher physiological strain. Time in the OR led to increased next-day HRV (y-intercept = 47.39; B = 4.90; 95% confidence interval, 2.14-7.66; P < 0.001), indicative of lower physiological strain. An increase in device-reported sleep from a surgeon's baseline resulted in a significant increase in next-day HRV (y-intercept = 50.46; B = 0.64; 95% confidence interval, 0.11-1.17; P = 0.02). DISCUSSION Orthopaedic residents, more than faculty, had physiologic findings suggestive of burnout. Time in the OR and increased sleep improved physiological strain parameters. Real-time biometric measurements can identify those at risk of burnout and in need of well-being interventions. LEVEL OF EVIDENCE Level III.
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Does the time of the day affect multiple trauma care in hospitals? A retrospective analysis of data from the TraumaRegister DGU®. BMC Emerg Med 2021; 21:134. [PMID: 34773984 PMCID: PMC8590232 DOI: 10.1186/s12873-021-00525-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/22/2021] [Indexed: 12/01/2022] Open
Abstract
Background Optimal multiple trauma care should be continuously provided during the day and night. Several studies have demonstrated worse outcomes and higher mortality in patients admitted at night. This study involved the analysis of a population of multiple trauma patients admitted at night and a comparison of various indicators of the quality of care at different admission times. Methods Data from 58,939 multiple trauma patients from 2007 to 2017 were analyzed retrospectively. All data were obtained from TraumaRegister DGU®. Patients were grouped by the time of their admission to the trauma center (6.00 am–11.59 am (morning), 12.00 pm–5.59 pm (afternoon), 6.00 pm–11.59 pm (evening), 0.00 am–5.59 am (night)). Incidences, patient demographics, injury patterns, trauma center levels and trauma care times and outcomes were evaluated. Results Fewer patients were admitted during the night (6.00 pm–11.59 pm: 18.8% of the patients, 0.00–5.59 am: 4.6% of the patients) than during the day. Patients who arrived between 0.00 am–5.59 am were younger (49.4 ± 22.8 years) and had a higher injury severity score (ISS) (21.4 ± 11.5) and lower Glasgow Coma Scale (GCS) score (11.6 ± 4.4) than those admitted during the day (12.00 pm–05.59 pm; age: 55.3 ± 21.6 years, ISS: 20.6 ± 11.4, GCS: 12.6 ± 4.0). Time in the trauma department and time to an emergency operation were only marginally different. Time to imaging was slightly prolonged during the night (0.00 am–5.59 am: X-ray 16.2 ± 19.8 min; CT scan 24.3 ± 18.1 min versus 12.00 pm- 5.59 pm: X-ray 15.4 ± 19.7 min; CT scan 22.5 ± 17.8 min), but the delay did not affect the outcome. The outcome was also not affected by level of the trauma center. There was no relevant difference in the Revised Injury Severity Classification II (RISC II) score or mortality rate between patients admitted during the day and at night. There were no differences in RISC II scores or mortality rates according to time period. Admission at night was not a predictor of a higher mortality rate. Conclusion The patient population and injury severity vary between the day and night with regard to age, injury pattern and trauma mechanism. Despite the differences in these factors, arrival at night did not have a negative effect on the outcome.
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Taheri M, Irandoust K. Morning exercise improves cognitive performance decrements induced by partial sleep deprivation in elite athletes. BIOL RHYTHM RES 2020. [DOI: 10.1080/09291016.2019.1576279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Morteza Taheri
- Department of Sports Sciences, Faculty of Social Sciences, Imam Khomeini International University, Qazvin, Iran
| | - Khadijeh Irandoust
- Department of Sports Sciences, Faculty of Social Sciences, Imam Khomeini International University, Qazvin, Iran
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A review of current approaches for evaluating impaired performance in around-the-clock medical professionals. Sleep Med Rev 2019; 46:97-107. [PMID: 31102878 DOI: 10.1016/j.smrv.2019.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 03/19/2019] [Accepted: 04/10/2019] [Indexed: 01/16/2023]
Abstract
The need for data to study the relationship between fatigued healthcare professionals and performance outcomes is evident, however, it is unclear which methodology is most appropriate to provide these insights. To address this issue, we performed a systematic review of relevant articles by searching the MEDLINE, EMBASE, Cochrane, Web of Science, and CINAHL databases. The literature search identified 2960 unique references, of which 82 were identified eligible. The impact on performance was studied on clinical outcomes, medical simulation, neurocognitive performance, sleep quantification and subjective assessment. In general results on performance are conflicting; impairment, no effect, and improvement were found. This review outlines the various methods currently available for assessing fatigue-impaired performance. The contrasting outcomes can be attributed to three main factors: differences in the operationalisation of fatigue, incomplete control data, and the wide variety in the methods used. We recommend the implementation of a clinically applicable tool that can provide uniform data. Until these data become available, caution should be used when developing regulations that can have implications for physicians, education, manpower planning, and ‒ ultimately ‒ patient care.
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Morales J, Yáñez A, Fernández-González L, Montesinos-Magraner L, Marco-Ahulló A, Solana-Tramunt M, Calvete E. Stress and autonomic response to sleep deprivation in medical residents: A comparative cross-sectional study. PLoS One 2019; 14:e0214858. [PMID: 30947295 PMCID: PMC6448892 DOI: 10.1371/journal.pone.0214858] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 03/21/2019] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to evaluate the stress suffered by medical residents as the result of being on call for 24 hours, from a multidimensional approach. Two groups of medical residents selected according to their work shift, participated in the study: one group (n = 40) was sleep-deprived after having been actively on-call for 24 hours, and another contrast group (n = 18) had performed a normal work day and were not sleep-deprived. All participants completed pre-post measures during a 24 h cycle. These were administered on both occasions at 8 am. The measures included HRV, cortisol, cognitive performance and transitory mood. The effect of the group x phase interaction was significant for all variables analysed, indicating that doctors in the 24h on-call shift group showed significant deterioration in all physiological, performance and mood indicators in comparison with the participants in the group not on call. These results suggest the need to review medical on-call systems, in order to reduce the stress load, which has a direct effect on working conditions.
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Affiliation(s)
- Jose Morales
- Faculty of Psychology, Education Sciences and Sport Blanquerna, Ramon Llull University, Barcelona, Spain
- * E-mail:
| | - Alexandre Yáñez
- Faculty of Psychology, Education Sciences and Sport Blanquerna, Ramon Llull University, Barcelona, Spain
| | - Liria Fernández-González
- Department of Personality and Psychological Assessment and Treatment, University of Deusto, Bilbao, Spain
| | | | - Adrià Marco-Ahulló
- Unidad de lesionados medulares, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Mónica Solana-Tramunt
- Faculty of Psychology, Education Sciences and Sport Blanquerna, Ramon Llull University, Barcelona, Spain
| | - Esther Calvete
- Department of Personality and Psychological Assessment and Treatment, University of Deusto, Bilbao, Spain
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Long G, Suqin S, Hu Z, Yan Z, Huixin Y, Tianwang L, Yang Y, Zhenhu W. Analysis of patients' sleep disorder after total knee arthroplasty-A retrospective study. J Orthop Sci 2019; 24:116-120. [PMID: 30146382 DOI: 10.1016/j.jos.2018.07.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/15/2018] [Accepted: 07/27/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Sleep disorder after total knee arthroplasty (TKA) is complex as it greatly differs from patient to patient. Thus, it can be seen that we should further know the detail in sleep disorders following TKA to find well solutions to achieve satisfactory sleep and better recovery. METHODS Between October 2011 and January 2016, 965 patients accepted primary TKA. We reviewed each patient's data. Sleep disorder was evaluated via subjective instruments. The Sleep Questionnaire in the present study is a 12-item instrument that evaluates sleep in terms of three dimensions: sleep quality; disruptive factors; and specific forms. Patients were identified and confirmed as at least 1 kind of sleep disorders according to the Second Edition of the International Classification of Sleep Disorders (ICSD-2). And we compare the clinical characteristics and difference in postoperative recovery of different types of sleep disorders. RESULTS Sleep disturbances persisted approximately 2 months postoperatively. 75.9% patients was classified into primary insomnias, while 24.1% was secondary insomnias. There was the largest number of those who were adjustment sleep disorder. Pains, mental elements, and factors intrinsic to the patients were the most significant causes of insomnia of patients. There were significant differences in VAS pain score (P < 0.001*), active ROM (P < 0.001*) and LOS in hospital (P < 0.001*) among varied forms of insomnias. CONCLUSIONS Our data revealed that adjustment insomnia ranked first. Specifically, the factors affecting sleep quality postoperatively included pains, mental elements, and factors intrinsic to the patients etc. In addition, we found that patients with difficulty in staying asleep and non-restorative sleep has increased pain scores and LOS in hospital with decreased active ROM in comparison to difficulty in falling asleep and too early awakening. Our data may be of a certain benefit to rational use of medication to improve diverse insomnias and to make patients recover better.
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Affiliation(s)
- Gong Long
- Department of Orthopedics, 252 Hospital of Chinese PLA, Baihua East Road, Baoding, Hebei, 071000, China
| | - Sun Suqin
- Shanghai Hospital of Traditional Chinese Medicine, Shanghai, 200071, China
| | - Zhang Hu
- Bai Qiu En Hospital, No. 398 Zhongshan West Road, Shijiazhuang, Hebei, 071001, China
| | - Zhao Yan
- Bai Qiu En Hospital, No. 398 Zhongshan West Road, Shijiazhuang, Hebei, 071001, China
| | - Yao Huixin
- Department of Orthopedics, 252 Hospital of Chinese PLA, Baihua East Road, Baoding, Hebei, 071000, China
| | - Li Tianwang
- Department of Orthopedics, 252 Hospital of Chinese PLA, Baihua East Road, Baoding, Hebei, 071000, China
| | - Yu Yang
- Department of Orthopedics, 252 Hospital of Chinese PLA, Baihua East Road, Baoding, Hebei, 071000, China.
| | - Wang Zhenhu
- Department of Orthopedics, 252 Hospital of Chinese PLA, Baihua East Road, Baoding, Hebei, 071000, China.
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‘After-hours’ non-elective spine surgery is associated with increased perioperative adverse events in a quaternary center. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 28:817-828. [DOI: 10.1007/s00586-018-5848-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
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Iverson A, Stanberry L, Garberich R, Antos A, Sandoval Y, Burke MN, Chavez I, Gössl M, Henry TD, Lips D, Mooney M, Poulose A, Sorajja P, Traverse J, Wang Y, Bradley S, Brilakis ES. Impact of sleep deprivation on the outcomes of percutaneous coronary intervention. Catheter Cardiovasc Interv 2018; 92:1118-1125. [DOI: 10.1002/ccd.27471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 11/14/2017] [Accepted: 12/03/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Ann Iverson
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Larissa Stanberry
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Ross Garberich
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Amber Antos
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Yader Sandoval
- Department of Cardiovascular Medicine; Mayo Clinic; Rochester Minnesota
| | - M. Nicholas Burke
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Ivan Chavez
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Mario Gössl
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Timothy D. Henry
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital; Minneapolis Minnesota
- Cedars Sinai Medical Center; Los Angeles California
| | - Daniel Lips
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Michael Mooney
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Anil Poulose
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Paul Sorajja
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Jay Traverse
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Yale Wang
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Steven Bradley
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Emmanouil S. Brilakis
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital; Minneapolis Minnesota
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Patrick Y, Lee A, Raha O, Pillai K, Gupta S, Sethi S, Mukeshimana F, Gerard L, Moghal MU, Saleh SN, Smith SF, Morrell MJ, Moss J. Effects of sleep deprivation on cognitive and physical performance in university students. Sleep Biol Rhythms 2017; 15:217-225. [PMID: 28680341 PMCID: PMC5489575 DOI: 10.1007/s41105-017-0099-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 03/23/2017] [Indexed: 11/01/2022]
Abstract
Sleep deprivation is common among university students, and has been associated with poor academic performance and physical dysfunction. However, current literature has a narrow focus in regard to domains tested, this study aimed to investigate the effects of a night of sleep deprivation on cognitive and physical performance in students. A randomized controlled crossover study was carried out with 64 participants [58% male (n = 37); 22 ± 4 years old (mean ± SD)]. Participants were randomized into two conditions: normal sleep or one night sleep deprivation. Sleep deprivation was monitored using an online time-stamped questionnaire at 45 min intervals, completed in the participants' homes. The outcomes were cognitive: working memory (Simon game© derivative), executive function (Stroop test); and physical: reaction time (ruler drop testing), lung function (spirometry), rate of perceived exertion, heart rate, and blood pressure during submaximal cardiopulmonary exercise testing. Data were analysed using paired two-tailed T tests and MANOVA. Reaction time and systolic blood pressure post-exercise were significantly increased following sleep deprivation (mean ± SD change: reaction time: 0.15 ± 0.04 s, p = 0.003; systolic BP: 6 ± 17 mmHg, p = 0.012). No significant differences were found in other variables. Reaction time and vascular response to exercise were significantly affected by sleep deprivation in university students, whilst other cognitive and cardiopulmonary measures showed no significant changes. These findings indicate that acute sleep deprivation can have an impact on physical but not cognitive ability in young healthy university students. Further research is needed to identify mechanisms of change and the impact of longer term sleep deprivation in this population.
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Affiliation(s)
- Yusuf Patrick
- Imperial College School of Medicine, Imperial College London, South Kensington Campus, Sir Alexander Fleming Building, London, SW7 2DD UK
| | - Alice Lee
- Imperial College School of Medicine, Imperial College London, South Kensington Campus, Sir Alexander Fleming Building, London, SW7 2DD UK
| | - Oishik Raha
- Imperial College School of Medicine, Imperial College London, South Kensington Campus, Sir Alexander Fleming Building, London, SW7 2DD UK
| | - Kavya Pillai
- Imperial College School of Medicine, Imperial College London, South Kensington Campus, Sir Alexander Fleming Building, London, SW7 2DD UK
| | - Shubham Gupta
- Imperial College School of Medicine, Imperial College London, South Kensington Campus, Sir Alexander Fleming Building, London, SW7 2DD UK
| | - Sonika Sethi
- Imperial College School of Medicine, Imperial College London, South Kensington Campus, Sir Alexander Fleming Building, London, SW7 2DD UK
| | - Felicite Mukeshimana
- Imperial College School of Medicine, Imperial College London, South Kensington Campus, Sir Alexander Fleming Building, London, SW7 2DD UK
| | - Lothaire Gerard
- Imperial College School of Medicine, Imperial College London, South Kensington Campus, Sir Alexander Fleming Building, London, SW7 2DD UK
| | - Mohammad U. Moghal
- Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College London, London, UK
- NIHR Respiratory Disease Biomedical Research Unit, Sleep and Ventilation, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP UK
| | - Sohag N. Saleh
- Faculty of Medicine, Imperial College London, South Kensington Campus, Sir Alexander Fleming Building, London, SW7 2DD UK
| | - Susan F. Smith
- Medical Education Research Unit, Faculty of Medicine, Imperial College London, South Kensington Campus, Sir Alexander Fleming Building, London, SW7 2DD UK
| | - Mary J. Morrell
- Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College London, London, UK
- NIHR Respiratory Disease Biomedical Research Unit, Sleep and Ventilation, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP UK
| | - James Moss
- Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College London, London, UK
- NIHR Respiratory Disease Biomedical Research Unit, Sleep and Ventilation, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP UK
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Smyth P, Maximova K, Jirsch JD. Physicians' attentional performance following a 24-hour observation period: do we need to regulate sleep prior to work? Occup Environ Med 2016; 74:553-557. [DOI: 10.1136/oemed-2015-103489] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 10/09/2016] [Accepted: 10/19/2016] [Indexed: 11/04/2022]
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Abstract
INTRODUCTION To date, no study has reported on the public's opinion of orthopaedic resident duty-hour requirements (DHR). METHODS A survey was administered to people in orthopaedic waiting rooms and at three senior centers. Responses were analyzed to evaluate seven domains: knowledge of duty hours; opinions about duty hours; attitudes regarding shift work; patient safety concerns; and the effects of DHRs on continuity of care, on resident training, and on resident professionalism. RESULTS Respondents felt that fatigue was unsafe and duty hours were beneficial in preventing resident physician fatigue. They supported the idea of residents working in shifts but did not support shifts for attending physicians. However, respondents wanted the same resident to provide continuity of care, even if that violated DHRs. They were supportive of increasing the length of residency to complete training. DHRs were not believed to affect professionalism. Half of the respondents believed that patient opinion should influence policy on this topic. DISCUSSION Orthopaedic patients and those likely to require orthopaedic care have inconsistent opinions regarding DHRs, making it potentially difficult to incorporate their preferences into policy.
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Abstract
OBJECTIVE Baseline, preseason assessment of cognition, symptoms, and balance has been recommended as part of a comprehensive sport concussion management program. We examined the relationship between sleep and baseline test results. We hypothesized that adolescents who slept fewer hours the night before would report more symptoms and perform more poorly on cognitive testing than students who had a full night sleep. DESIGN Cross-sectional observation study. SETTING Preseason concussion testing for high school athletes. PARTICIPANTS A large sample (n = 2928) of student athletes from Maine, USA, between the ages of 13 and 18 years completed preseason testing. Participants with developmental problems, a history of treatment for neurological or psychiatric problems, recent concussion, or 3 or more prior concussions were excluded. ASSESSMENT OF RISK FACTORS Athletes were divided into 4 groups based on their sleep duration the night before testing. MAIN OUTCOME MEASURES Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT; ImPACT Applications, Inc, Pittsburgh, PA) cognitive composite scores and the embedded Post-Concussion Symptom Scale. RESULTS Sleep was not related to any ImPACT cognitive composite score, after covarying for age and controlling for multiple comparisons. In contrast, there were sleep duration, sex, and sleep duration by sex effects on the Post-Concussion Symptom Scale. The effect of sleep duration on symptom reporting was more pronounced in girls. Supplementary analyses suggested that sleep insufficiency was associated with a diverse array of postconcussion-like symptoms. CONCLUSIONS Poor sleep the night before baseline or postinjury testing may be an important confound when assessing postconcussion symptoms. Girls may be more vulnerable to experiencing and reporting symptoms following insufficient sleep. CLINICAL RELEVANCE Clinicians should routinely ask how the athlete slept the night before preseason baseline testing and consider deferring the symptom assessment or later retesting athletes who slept poorly.
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Albergo J, Fernández M, Zaifrani L, Giunta D, Albergo L. ¿Cómo afecta la privación de sueño durante una guardia de 24 horas las funciones cognitivas de los residentes de ortopedia y traumatología? Rev Esp Cir Ortop Traumatol (Engl Ed) 2016; 60:113-8. [DOI: 10.1016/j.recot.2015.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 11/14/2015] [Accepted: 11/22/2015] [Indexed: 11/28/2022] Open
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How does sleep deprivation during 24h on call duty affect the cognitive performance orthopaedic residents? Rev Esp Cir Ortop Traumatol (Engl Ed) 2016. [DOI: 10.1016/j.recote.2015.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Gong L, Wang Z, Fan D. Sleep Quality Effects Recovery After Total Knee Arthroplasty (TKA)--A Randomized, Double-Blind, Controlled Study. J Arthroplasty 2015; 30:1897-901. [PMID: 26344094 DOI: 10.1016/j.arth.2015.02.020] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 02/18/2015] [Accepted: 02/18/2015] [Indexed: 02/01/2023] Open
Abstract
This study examined the effects of sleep quality on early recovery after total knee arthroplasty. A total of 148 patients were randomized 1:1 to receive either zolpidem or placebo for 2 weeks. VAS pain scores (rest, ambulation and night), range of motion (ROM), total amount of opioid analgesics and antiemetics taken, postoperative nausea and vomiting (PONV), sleep efficacy and satisfaction were recorded. It was found that patients taking zolpidem achieved greater improvement in quality of life and reported better satisfaction. Patients in the intervention group had lower pain score and took less antiemetics. Moreover, a significant correlation between sleep quality and ROM was detected. These results demonstrated that improved sleep quality is beneficial to patients' post-TKA recovery.
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Affiliation(s)
- Long Gong
- Department of Orthopedics, Chinese PLA 252 Hospital, Baoding, Hebei, China
| | - ZhenHu Wang
- Department of Orthopedics, Chinese PLA 252 Hospital, Baoding, Hebei, China
| | - Dong Fan
- School of Basic Medical Science, Fudan University, Shanghai, China
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Lauridsen MM, Frøjk J, de Muckadell OBS, Vilstrup H. Opposite effects of sleep deprivation on the continuous reaction times in patients with liver cirrhosis and normal persons. Metab Brain Dis 2014; 29:655-60. [PMID: 25008562 DOI: 10.1007/s11011-014-9583-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 06/27/2014] [Indexed: 02/02/2023]
Abstract
The continuous reaction times (CRT) method describes arousal functions. Reaction time instability in a patient with liver disease indicates covert hepatic encephalopathy (cHE). The effects of sleep deprivation are unknown although cirrhosis patients frequently suffer from sleep disorders. The aim of this study was to determine if sleep deprivation influences the CRT test. Eighteen cirrhosis patients and 27 healthy persons were tested when rested and after one night's sleep deprivation. The patients filled out validated sleep quality questionnaires. Seven patients (38%) had unstable reaction times (a CRTindex < 1.9) compatible with cHE. In these patients, the wakefulness improved or normalized their reaction speed and CRTindex (p = 0.01). There was no change in the other patients' reaction speed or stability. Seven patients (38%) reported poor sleep that was not related to their CRT tests before or after the sleep deprivation. In the healthy participants, the sleep deprivation slowed their reaction times by 11% (p < 0.0001) and in 7 persons (25%) destabilized them. The acute sleep deprivation normalized or improved the reaction time stability of the patients with a CRTindex below 1.9 and had no effect in the patients with a CRTindex above 1.9. There was no relation between reported sleep quality and reaction time results. Thus, in cirrhosis patients, sleep disturbances do not lead to 'falsely' slowed and unstable reaction times. In contrast, the acute sleep deprivation slowed and destabilized the reaction times of the healthy participants. This may have negative consequences for decision-making.
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Abstract
OBJECTIVES There are few studies evaluating the influence of sleep deprivation on endoscopic outcomes. To evaluate the effect of a previous night call on the quality of screening colonoscopies performed the following day. METHODS Average-risk patients undergoing screening colonoscopies were included. Quality metrics were retrospectively compared between two groups of post-call colonoscopies and colonoscopies performed by the same individuals not on call the night before: those performed by gastroenterologists who were only on call the night prior and those performed by gastroenterologists who performed emergent on-call procedures the night prior. RESULTS Between 1 July 2010 and 31 March 2012, 447 colonoscopies were performed by gastroenterologists who were on call only the night prior, 126 colonoscopies were performed by gastroenterologists who had completed on-call emergent procedures the night prior, and 8,734 control colonoscopies were completed. There was a lower percent of patients who were screened with adenomas detected in procedures performed by endoscopists who had performed emergent on-call procedures the night prior compared with the controls (30 vs. 39%, respectively; P=0.043). The mean withdrawal time for these colonoscopies was significantly longer than that for the control procedures (15.5 vs. 14.0 min; P=0.025). For the colonoscopies performed by endoscopists who were on call only the night prior, there was no significant difference in the percent of patients screened with adenomas detected compared with controls (42 vs. 39%, respectively; P=0.136). CONCLUSIONS (1) Despite longer withdrawal times, being on call the night prior and performing an emergent procedure lead to a significant 24% decrease in the adenoma detection rates. (2) It is imperative for screening physicians to be aware of the influence of sleep deprivation on procedural outcomes and to consider altering their practice accordingly.
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