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Camilleri Podesta AM, Redfern N, Abramovich I, Mellin-Olsen J, Oremuš K, Kouki P, Guasch E, Novak-Jankovic V, Sabelnikovs O, Bilotta F, Grigoras I. Fatigue among anaesthesiologists in Europe: Findings from a joint EBA/NASC survey. Eur J Anaesthesiol 2024; 41:24-33. [PMID: 37962409 DOI: 10.1097/eja.0000000000001923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Anaesthesiologists deliver an increasing amount of patient care and often work long hours in operating theatres and intensive care units, with frequent on-calls and insufficient rest in between. In the long term, this will negatively influence mental and physical health and well being. As fatigue becomes more prevalent, this has predictable implications for patient safety and clinical effectiveness. 1. OBJECTIVE This study aimed to evaluate the prevalence, severity, causes and implications of work-related fatigue amongst specialist anaesthesiologists. DESIGN An online survey of specialist anaesthesiologists. PARTICIPANTS The survey was sent to anaesthesiologists in 42 European countries by electronic mail. MAIN OUTCOME MEASURES Responses from a 36-item online survey assessed work-related fatigue and its impact on anaesthesiologists in European countries. RESULTS Work-related fatigue was experienced in 91.6% of the 1508 respondents from 32 European countries. Fatigue was caused by their working patterns, clinical and nonclinical workloads, staffing issues and excessive work hours. Over 70% reported that work-related fatigue negatively impacted on their physical and mental health, emotional well being and safe commuting. Most respondents did not feel supported by their organisation to maintain good health and well being. CONCLUSION Work-related fatigue is a significant and widespread problem amongst anaesthesiologists. More education and increased awareness of fatigue and its adverse effects on patient safety, staff well being and physical and mental health are needed. Departments should ensure that their rotas and job plans comply with the European Working Time Directive (EWTD) and introduce a fatigue risk management system to mitigate the effects of fatigue.
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Affiliation(s)
- Anne Marie Camilleri Podesta
- From the Department of Anaesthesia and Intensive Care, Mater Dei Hospital, Malta (AMCP), the Department of Anaesthesia, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK (NR), Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany (IA), the Department of Anaesthesia and Intensive Care Medicine, Baerum Hospital, Sandvika, Norway (JMO), the Department of Anaesthesiology, AKROMION Special Hospital for Orthopaedic Surgery, Ljudevita Gaja 2,49217 Krapinske Toplice, Croatia (KO), the 6 Department of Anaesthesia, General Hospital Nikaia, Piraeus, Greece (PK), the Department of Anaesthesia and Reanimation. Hospital Universitario La Paz, Madrid, Spain (EG), the Medical Simulation Centre, University Medical Centre Ljubljana, Slovenia (VNJ), the Department of Anaesthesiology and Reanimatology, Riga; Riga Stradins University, Latvia (OS), the Department of Anaesthesiology and Critical Care, Policlinico Umberto I Hospital, La Sapienza University of Rome, Rome, Italy (FB), the Department of Anaesthesiology and Intensive Care, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania (IG)
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Feng S, Davis JA, Chowdhary A, Lomazow W, Yi JS, Huang J, Ding L, Taravati P. The effect of mandatory post-call relief on sleep and wellness in ophthalmology residents. BMC MEDICAL EDUCATION 2023; 23:955. [PMID: 38093220 PMCID: PMC10720055 DOI: 10.1186/s12909-023-04947-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Multiple duty hour reforms have been implemented to optimize resident wellness through increasing opportunities for sleep recovery, but few studies have recorded objectively measured sleep or shown direct sleep and wellness benefits from such interventions. This study seeks to determine whether mandatory post-call relief policies with a partial night float system improved resident sleep, activity, and burnout among ophthalmology residents taking home call. METHODS We conducted a two group cohort study of ophthalmology residents at the University Washington comparing post graduate year-2 (PGY-2) resident sleep, activity, and burnout between the optional post-call relief group from July 1, 2017 to June 30, 2019 to the mandatory post-call relief group from July 1, 2019 to June 30, 2021. RESULTS Of twenty total residents participating in the survey portion, 18 residents participated in the sleep and activity tracking portion of the study, 9 in in the optional post-call relief cohort, and 9 in the mandatory post-call relief cohort. The mandatory post-call relief group recorded longer total sleep on call than the optional post-call relief group (p < 0.001). There was no difference in overnight sleep recorded on call (median 3.4 h), but residents recorded more time napping in the mandatory post-call relief cohort (p < 0.001). There was no significant difference between cohorts in amount of sleep while not on call. Residents in the mandatory post-call relief cohort recorded higher average daily steps, higher exercise time, and lower sedentary time than residents in the optional post-call relief cohort (p < 0.001). They also recorded lower median emotional exhaustion on the Maslach Burnout Inventory and lower stress in the Depression and Anxiety Stress Scale in the mandatory post-call relief cohort (p = 0.008). CONCLUSIONS Implementation of mandatory post-call relief policies with a partial night-float system among PGY-2 residents was associated with more post-call naps with more overall physical activity, lower emotional exhaustion scores, and lower stress scores, despite no changes to overnight sleep on call or total sleep. Although sample size limits interpretation of data, implementation of mandatory post call relief could be considered to improve post-call sleep in programs with home call.
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Affiliation(s)
- Shu Feng
- Department of Ophthalmology, University of Washington School of Medicine, Campus Box 359608, 325 9th Avenue, Seattle, WA, 98104, USA.
| | - John A Davis
- Oregon Health and Sciences University, Casey Eye Institute, Portland, USA
| | - Apoorva Chowdhary
- Department of Ophthalmology, University of Washington School of Medicine, Campus Box 359608, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Whitney Lomazow
- Department of Ophthalmology, University of Washington School of Medicine, Campus Box 359608, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Jonathan S Yi
- University of Miami Health System, Bascom Palmer Eye Institute, Miami, USA
| | - Johnson Huang
- Department of Ophthalmology, University of Washington School of Medicine, Campus Box 359608, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Leona Ding
- Department of Ophthalmology, University of Washington School of Medicine, Campus Box 359608, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Parisa Taravati
- Department of Ophthalmology, University of Washington School of Medicine, Campus Box 359608, 325 9th Avenue, Seattle, WA, 98104, USA
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Babbar S, Williams KB, Cheng AL. Sleep among Obstetrics and Gynecology Trainees: Results from a Yoga-Based Wellness Initiative. Am J Perinatol 2023; 40:181-186. [PMID: 33940640 DOI: 10.1055/s-0041-1728838] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE This study aimed to determine the feasibility of using a wrist-based fitness tracking device to assess sleep among Obstetrics and Gynecology (OBGYN) trainees who engaged in a yoga-based wellness program. We also sought to evaluate the effects of yoga on sleep. STUDY DESIGN A quality improvement initiative consisting of an 8-week wellness program of weekly yoga classes, nutrition, and physical challenges was implemented for OBGYN residents and Maternal-Fetal Medicine fellows. The Polar A370 fitness tracker device was provided and synced to the Polar Flow for Coach program for inclusion. Data obtained included total and restful sleep from each night the device were worn. Pre- and post-assessment of the Pittsburg Sleep Quality Index (PSQI) were compared. Linear mixed models were used to estimate and test the effect of yoga on sleep while controlling for on-call shifts. RESULTS Of the 15 participants who synced their device, 13 (87%) were included for analysis. Sleep data from 572 nights were analyzed. The mean (SD) total sleep was 434.28 (110.03) minutes over the 8 weeks. A minimum of 7 hours (420 minutes) of total sleep occurred 59.3% of the time. After controlling for Friday or Saturday night on-call, those who attended yoga class had a significantly greater total sleep (yoga: 425.14 minutes [41.89], no yoga: 357.33 [43.04] minutes; p = 0.04). There was no significant change in the mean global PSQI score after the program (pre: 5.0 [1.6], post: 5.1 [2.5], p = 0.35). CONCLUSION Wearable fitness monitors provide insight into sleep patterns displayed during training and can serve as a tool to identify those who are sleep deprived and assist in the evaluation of trainee wellness. Training programs are encouraged to provide access to yoga and mindfulness interventions to improve sleep and possibly clinical performance. KEY POINTS · Yoga improves trainee sleep by approximately 60 minutes.. · Total and restful sleep are reduced during night float rotation.. · Trainees obtained 7 hours of sleep approximately 60% of the time..
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Affiliation(s)
- Shilpa Babbar
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Missouri-Kansas City, Children's Mercy Kansas City, Kansas City, Missouri
| | - Karen B Williams
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, Missouri
| | - An-Lin Cheng
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, Missouri
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Silva L, Dias M, Folgado D, Nunes M, Namburi P, Anthony B, Carvalho D, Carvalho M, Edelman E, Gamboa H. Respiratory Inductance Plethysmography to Assess Fatigability during Repetitive Work. SENSORS 2022; 22:s22114247. [PMID: 35684868 PMCID: PMC9185634 DOI: 10.3390/s22114247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022]
Abstract
Cumulative fatigue during repetitive work is associated with occupational risk and productivity reduction. Usually, subjective measures or muscle activity are used for a cumulative evaluation; however, Industry 4.0 wearables allow overcoming the challenges observed in those methods. Thus, the aim of this study is to analyze alterations in respiratory inductance plethysmography (RIP) to measure the asynchrony between thorax and abdomen walls during repetitive work and its relationship with local fatigue. A total of 22 healthy participants (age: 27.0 ± 8.3 yrs; height: 1.72 ± 0.09 m; mass: 63.4 ± 12.9 kg) were recruited to perform a task that includes grabbing, moving, and placing a box in an upper and lower shelf. This task was repeated for 10 min in three trials with a fatigue protocol between them. Significant main effects were found from Baseline trial to the Fatigue trials (p < 0.001) for both RIP correlation and phase synchrony. Similar results were found for the activation amplitude of agonist muscle (p < 0.001), and to the muscle acting mainly as a joint stabilizer (p < 0.001). The latter showed a significant effect in predicting both RIP correlation and phase synchronization. Both RIP correlation and phase synchronization can be used for an overall fatigue assessment during repetitive work.
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Affiliation(s)
- Luís Silva
- Laboratório de Instrumentação, Engenharia Biomédica e Física da Radiação (LIBPhys-UNL), Departamento de Física, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal; (M.D.); (D.F.); (H.G.)
- Correspondence:
| | - Mariana Dias
- Laboratório de Instrumentação, Engenharia Biomédica e Física da Radiação (LIBPhys-UNL), Departamento de Física, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal; (M.D.); (D.F.); (H.G.)
| | - Duarte Folgado
- Laboratório de Instrumentação, Engenharia Biomédica e Física da Radiação (LIBPhys-UNL), Departamento de Física, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal; (M.D.); (D.F.); (H.G.)
- Associação Fraunhofer Portugal Research, Rua Alfredo Allen 455/461, 4200-135 Porto, Portugal;
| | - Maria Nunes
- Associação Fraunhofer Portugal Research, Rua Alfredo Allen 455/461, 4200-135 Porto, Portugal;
| | - Praneeth Namburi
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; (P.N.); (B.A.); (E.E.)
- MIT.nano Immersion Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Brian Anthony
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; (P.N.); (B.A.); (E.E.)
- Device Realization Laboratory, Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Diogo Carvalho
- Faculty of Medicine, Rīga Stradiņš University, 16 Dzirciema iela, LV-1007 Rīga, Latvia;
| | - Miguel Carvalho
- Campus de Azurém, Minho University, 4800-058 Guimarães, Portugal;
| | - Elazer Edelman
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; (P.N.); (B.A.); (E.E.)
- Brigham and Women’s Hospital, Cardiovascular Division, 75 Francis Street, Boston, MA 02115, USA
| | - Hugo Gamboa
- Laboratório de Instrumentação, Engenharia Biomédica e Física da Radiação (LIBPhys-UNL), Departamento de Física, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal; (M.D.); (D.F.); (H.G.)
- Associação Fraunhofer Portugal Research, Rua Alfredo Allen 455/461, 4200-135 Porto, Portugal;
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Nowak K, Łukomska B. The impact of shift work on the well-being and subjective levels of alertness and sleepiness in firefighters and rescue service workers. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2021; 27:1056-1063. [PMID: 34082652 DOI: 10.1080/10803548.2021.1933320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Shift work can be associated with health and sleep problems, which may lead to cognitive impairment. This study investigated the effects of shift work on sleep, health behaviours and cognitive functions of Polish rescue service workers. We tested 18 paramedics working 12-h shifts, 15 firefighters working 24-h shifts and 17 daytime workers. We measured general sleepiness, workload during shifts and the occurrence of health behaviours. Additionally, we measured attention, executive function and subjective alertness. Paramedics showed lower average sleep duration and quality, and fewer health behaviours than firefighters and the control group. However, no differences were found in performance on cognitive tests between the groups and between the measures. The results indicate that the differences in job specificity may contribute to the effects of shift work on the sleep and health of the workers.
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Affiliation(s)
- Kamila Nowak
- Central Institute for Labour Protection - National Research Institute (CIOP-PIB), Poland
| | - Barbara Łukomska
- Central Institute for Labour Protection - National Research Institute (CIOP-PIB), Poland
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The study of visuospatial abilities in trainees: A scoping review and proposed model. Surg Open Sci 2021; 5:25-33. [PMID: 34337374 PMCID: PMC8324459 DOI: 10.1016/j.sopen.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 11/23/2022] Open
Abstract
Background Visuospatial abilities are an important component of technical skill acquisition. Targeted visuospatial ability training may have positive implications for training programs. The development of such interventions requires an adequate understanding of the visuospatial ability processes necessary for surgical and nonsurgical tasks. This scoping review aims to identify the components of visuospatial ability that have been reported in surgical and nonsurgical trainees and determine if there is consensus regarding the language and psychometric measures used, clarifying the elements that may be required to develop interventions that enhance visuospatial ability. Methods A scoping review was designed to identify relevant records from EMBASE and Medline until January 13, 2020. Data were extracted on visuospatial ability terminology, dimensions, instruments, and interventions with results stratified by specialty (surgical, nonsurgical, or mixed). Conference abstracts, opinion pieces, and review studies were excluded. Results Out of 882 total records, 26 were identified that met criteria for inclusion. Surgical specialities were represented in > 90% of results. A total of 16 unique terms were used to describe visuospatial ability and were measured using 34 instruments, of which eight were used more than once. Eighteen different dimensions were identified. A single study explored the effects of a targeted visuospatial ability intervention. Conclusion A wide range of visuospatial ability terms, instruments, and dimensions were identified, suggesting an incomplete understanding of the components most relevant to surgical and nonsurgical tasks. This confusion may be hindering the development of visuospatial ability targeted interventions during residency training. A rigorous methodological model is proposed to help unify the field and guide future research.
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Key Words
- BVMT-R, Brief Visuospatial Memory Test-Revised
- CCT, Cube Comparison Test
- CRT, Card Rotation Test
- MPT, Map Planning Test
- MR, mental rotation
- MRT, Mental Rotation Test
- SO, Spatial Orientation
- SP, spatial planning
- SS, spatial scanning
- VSA, visuospatial ability
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Patterson PD, Weaver MD, Guyette FX, Martin‐Gill C. Should public safety shift workers be allowed to nap while on duty? Am J Ind Med 2020; 63:843-850. [PMID: 32761915 PMCID: PMC7540594 DOI: 10.1002/ajim.23164] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 12/12/2022]
Abstract
Fatigue and sleep deficiency among public safety personnel are threats to wellness, public and personal safety, and workforce retention. Napping strategies may reduce work-related fatigue, improve safety and health, yet in some public safety organizations it is discouraged or prohibited. Our aim with this commentary is to define intra-shift napping, summarize arguments for and against it, and to outline potential applications of this important fatigue mitigation strategy supported by evidence. We focus our discussion on emergency medical services (EMS); a key component of the public safety system, which is comprised of police, fire, and EMS. The personnel who work in EMS stand to benefit from intra-shift napping due to frequent use of extended duration shifts, a high prevalence of personnel working multiple jobs, and evidence showing that greater than half of EMS personnel report severe fatigue, poor sleep quality, inadequate inter-shift recovery, and excessive daytime sleepiness. The benefits of intra-shift napping include decreased sleepiness and fatigue, improved recovery between shifts, decreased anxiety, and reduced feelings of burnout. Intra-shift napping also mitigates alterations in clinician blood pressure associated with disturbed sleep and shift work. The negative consequences of napping include negative public perception, acute performance deficits stemming from sleep inertia, and the potential costs associated with reduced performance. While there are valid arguments against intra-shift napping, we believe that the available scientific evidence favors it as a key component of fatigue mitigation and workplace wellness. We further believe that these arguments extend beyond EMS to all sectors of public safety.
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Affiliation(s)
- P. Daniel Patterson
- Department of Emergency Medicine, School of Medicine University of Pittsburgh Pittsburgh Pennsylvania
- Division of Community Health Services, Emergency Medicine Program, School of Health and Rehabilitation Sciences University of Pittsburgh Pittsburgh Pennsylvania
| | - Matthew D. Weaver
- Division of Sleep and Circadian Disorders Brigham and Women's Hospital Boston Massachusetts
- Division of Sleep Medicine Harvard Medical School Boston Massachusetts
| | - Francis X. Guyette
- Department of Emergency Medicine, School of Medicine University of Pittsburgh Pittsburgh Pennsylvania
| | - Christian Martin‐Gill
- Department of Emergency Medicine, School of Medicine University of Pittsburgh Pittsburgh Pennsylvania
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Sumińska S, Nowak K, Łukomska B, Cygan HB. Cognitive functions of shift workers: paramedics and firefighters - an electroencephalography study. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2020; 27:686-697. [PMID: 32436781 DOI: 10.1080/10803548.2020.1773117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction. Working shifts has a negative impact on employee health and cognitive efficiency. The purpose of this study was to investigate the impact of shift work on cognitive functions - attention and working memory - using both behavioural and electrophysiological measures. Methods. The study was carried out on a group of 34 shift employees (18 paramedics, 16 firefighters) and on 17 day workers. Participants performed the attention network test and the N-back task with two conditions (1-back, 2-back) while the electroencephalography signal was recorded. Results. Observations included a higher amplitude of the P200 potential in paramedics (compared to the control group), a higher amplitude of the P300 potential after work than on a day off and the lowest increase in power in the θ band after the night shift. In firefighters, lower α desynchronization and lower synchronization in the α/β band were observed after a 24-h shift. Paramedics and firefighters had longer reaction times (N-back task). Conclusions. The results suggest that paramedics experience problems with sustained attention. Paramedics process visual stimuli in a different way; after a night shift, performing the tasks required more engagement of cognitive resources. For firefighters, a decrease in visual attention functions and cognitive inhibition was observed.
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Affiliation(s)
- Sylwia Sumińska
- Central Institute for Labour Protection - National Research Institute (CIOP-PIB), Poland
| | - Kamila Nowak
- Central Institute for Labour Protection - National Research Institute (CIOP-PIB), Poland
| | - Barbara Łukomska
- Nencki Institute of Experimental Biology, Polish Academy of Sciences, Poland
| | - Hanna B Cygan
- Bioimaging Research Center, Institute of Physiology and Pathology of Hearing, Poland
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Wilson M, Permito R, English A, Albritton S, Coogle C, Van Dongen HPA. Performance and sleepiness in nurses working 12-h day shifts or night shifts in a community hospital. ACCIDENT; ANALYSIS AND PREVENTION 2019; 126:43-46. [PMID: 28987265 DOI: 10.1016/j.aap.2017.09.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 09/26/2017] [Accepted: 09/28/2017] [Indexed: 05/17/2023]
Abstract
Hospitals are around-the-clock operations and nurses are required to care for patients night and day. The nursing shortage and desire for a more balanced work-to-home life has popularized 12-h shifts for nurses. The present study investigated sleep/wake cycles and fatigue levels in 22 nurses working 12-h shifts, comparing day versus night shifts. Nurses (11day shift and 11 night shift) were recruited from a suburban acute-care medical center. Participants wore a wrist activity monitor and kept a diary to track their sleep/wake cycles for 2 weeks. They also completed a fatigue test battery, which included the Psychomotor Vigilance Test (PVT) and the Karolinska Sleepiness Scale (KSS), at the beginning, middle and end of 4 duty shifts. Daily sleep duration was 7.1h on average. No overall difference in mean daily sleep duration was found between nurses working day shifts versus night shifts. Objective performance on the PVT remained relatively good and stable at the start, middle, and end of duty shifts in day shift workers, but gradually degraded across duty time in night shift workers. Compared to day shift workers, night shift workers also exhibited more performance variability among measurement days and between participants at each testing time point. The same pattern was observed for subjective sleepiness on the KSS. However, congruence between objective and subjective measures of fatigue was poor. Our findings suggest a need for organizations to evaluate practices and policies to mitigate the inevitable fatigue that occurs during long night shifts, in order to improve patient and healthcare worker safety. Examination of alternative shift lengths or sanctioned workplace napping may be strategies to consider.
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Affiliation(s)
- Marian Wilson
- College of Nursing, Washington State University, Spokane, WA, USA.
| | - Regan Permito
- Sleep and Performance Research Center and Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | | | | | | | - Hans P A Van Dongen
- Sleep and Performance Research Center and Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
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Khan OF, Cusano E, Raissouni S, Pabia M, Haeseker J, Bosma N, Ko JJ, Li H, Kumar A, Vickers MM, Tang PA. Immediate-term cognitive impairment following intravenous (IV) chemotherapy: a prospective pre-post design study. BMC Cancer 2019; 19:150. [PMID: 30764801 PMCID: PMC6375158 DOI: 10.1186/s12885-019-5349-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 02/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cognitive impairment is commonly reported in patients receiving chemotherapy, but the acuity of onset is not known. This study utilized the psychomotor vigilance test (PVT) and trail-making test B (TMT-B) to assess cognitive impairment immediately post-chemotherapy. METHODS Patients aged 18-80 years receiving first-line intravenous chemotherapy for any stage of breast or colorectal cancer were eligible. Patient symptoms, peripheral neuropathy and Stanford Sleepiness Scale were assessed. A five-minute PVT and TMT-B were completed on a tablet computer pre-chemotherapy and immediately post-chemotherapy. Using a mixed linear regression model, changes in reciprocal transformed PVT reaction time (mean 1/RT) were assessed. A priori, an increase in median PVT reaction times by > 20 ms (approximating PVT changes with blood alcohol concentrations of 0.04-0.05 g%) was considered clinically relevant. RESULTS One hundred forty-two cancer patients (73 breast, 69 colorectal, median age 55.5 years) were tested. Post-chemotherapy, mean 1/RT values were significantly slowed compared to pre-chemotherapy baseline (p = 0.01). This corresponded to a median PVT reaction time slowed by an average of 12.4 ms. Changes in PVT reaction times were not correlated with age, sex, cancer type, treatment setting, or use of supportive medications. Median post-chemotherapy PVT reaction time slowed by an average of 22.5 ms in breast cancer patients and by 1.6 ms in colorectal cancer patients. Post-chemotherapy median PVT times slowed by > 20 ms in 57 patients (40.1%). Exploratory analyses found no statistically significant association between the primary outcome and self-reported anxiety, fatigue or depression. TMT-B completion speed improved significantly post-chemotherapy (p = 0.03), likely due to test-retest phenomenon. CONCLUSIONS PVT reaction time slowed significantly immediately post-chemotherapy compared to a pre-chemotherapy baseline, and levels of impairment similar to effects of alcohol consumption in other studies was seen in 40% of patients. Further studies assessing functional impact of cognitive impairment on patients immediately after chemotherapy are warranted.
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Affiliation(s)
- Omar F Khan
- Department of Oncology, Cumming School of Medicine, University of Calgary, Tom Baker Cancer Centre, 1331 29 St NW, Calgary, Alberta, T2N 4N2, Canada.
| | - Ellen Cusano
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Mica Pabia
- Department of Oncology, Cumming School of Medicine, University of Calgary, Tom Baker Cancer Centre, 1331 29 St NW, Calgary, Alberta, T2N 4N2, Canada
| | - Johanna Haeseker
- Department of Oncology, Cumming School of Medicine, University of Calgary, Tom Baker Cancer Centre, 1331 29 St NW, Calgary, Alberta, T2N 4N2, Canada
| | - Nicholas Bosma
- Department of Oncology, Cumming School of Medicine, University of Calgary, Tom Baker Cancer Centre, 1331 29 St NW, Calgary, Alberta, T2N 4N2, Canada
| | - Jenny J Ko
- BC Cancer - Abbotsford, Abbotsford, British Columbia, Canada
| | - Haocheng Li
- Department of Mathematics and Statistics, University of Calgary, Calgary, Alberta, Canada
| | - Aalok Kumar
- BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - Michael M Vickers
- Department of Oncology, Ottawa Regional Cancer Centre, Ottawa, Ontario, Canada
| | - Patricia A Tang
- Department of Oncology, Cumming School of Medicine, University of Calgary, Tom Baker Cancer Centre, 1331 29 St NW, Calgary, Alberta, T2N 4N2, Canada
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Alami YZ, Ghanim BT, Zyoud SH. Epworth sleepiness scale in medical residents: quality of sleep and its relationship to quality of life. J Occup Med Toxicol 2018; 13:21. [PMID: 30008792 PMCID: PMC6043987 DOI: 10.1186/s12995-018-0203-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 07/03/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Resident doctors are continuously exposed to prolonged working hours and night shifts, making them susceptible to the many physical, psychological, and cognitive side effects of sleep deprivation, which may affect their quality of life. Therefore, this study aimed to determine the prevalence of sleep penury in resident doctors and to assess the association between self-apprehended sleepiness and quality of life. METHODS A cross-sectional study was carried out in the governmental hospitals in the North of the West Bank between May 2017 and September 2017. Doctors enrolled in residency programmes completed questionnaires about general, sociodemographic, and sleep characteristics. The doctors completed the Arabic Version of the Epworth Sleepiness Scale (ArESS) to assess subjective daytime sleepiness and the RAND 36-item short-form health survey (SF-36) to determine quality of life. RESULTS A total of 101 participants were enrolled. Daytime sleepiness was observed in 37.6% (n = 38) of the participants with an ESS score of ≥10. There was a notable negative correlation between the ESS and quality of health index in the physical composition (r = - 0.351, p < 0.001) demonstrated in the following four subscales: the physical functioning (p < 0.001), role limitations due to physical health (p = 0.045), body pain (p = 0.036), and general health (p < 0.001) components of the SF-36 scale. Females and residents of the centre region had poorer mental quality (p = 0.006 and 0.020, respectively). CONCLUSIONS More than one third of the resident doctors suffer from daytime sleepiness according to the ESS. This was proven to significantly affect several aspects of their quality of life, including physical function and health, body pain, and general health. Sleep deprivation and improvement of quality of life require health promotion actions among medical residents.
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Affiliation(s)
- Yehia Z. Alami
- 0000 0004 0631 5695grid.11942.3fDepartment of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Beesan T. Ghanim
- 0000 0004 0631 5695grid.11942.3fDepartment of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Sa’ed H. Zyoud
- 0000 0004 0631 5695grid.11942.3fPoison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- 0000 0004 0631 5695grid.11942.3fDepartment of Clinical and Community Pharmacy, Department of Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
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Davy J, Göbel M. The effects of extended nap periods on cognitive, physiological and subjective responses under simulated night shift conditions. Chronobiol Int 2017; 35:169-187. [PMID: 29144168 DOI: 10.1080/07420528.2017.1391277] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Extended nap opportunities have been effective in maintaining alertness in the context of extended night shifts (+12 h). However, there is limited evidence of their efficacy during 8-h shifts. Thus, this study explored the effects of extended naps on cognitive, physiological and perceptual responses during four simulated, 8-h night shifts. In a laboratory setting, 32 participants were allocated to one of three conditions. All participants completed four consecutive, 8-h night shifts, with the arrangements differing by condition. The fixed night condition worked from 22h00 to 06h00, while the nap early group worked from 20h00 to 08h00 and napped between 00h00 and 03h20. The nap late group worked from 00h00 to 12h00 and napped between 04h00 and 07h20. Nap length was limited to 3 hours and 20 minutes. Participants performed a simple beading task during each shift, while also completing six to eight test batteries roughly every 2 h. During each shift, six test batteries were completed, in which the following measures were taken. Performance indicators included beading output, eye accommodation time, choice reaction time, visual vigilance, simple reaction time, processing speed and object recognition, working memory, motor response time and tracking performance. Physiological measures included heart rate and tympanic temperature, whereas subjective sleepiness and reported sleep length and quality while outside the laboratory constituted the self reported measures. Both naps reduced subjective sleepiness but did not alter the circadian and homeostatic-related changes in cognitive and physiological measures, relative to the fixed night condition. Additionally, there was evidence of sleep inertia following each nap, which resulted in transient reductions in certain perceptual cognitive performance measures. The present study suggested that there were some benefits associated with including an extended nap during 8-h night shifts. However, the effects of sleep inertia need to be effectively managed to ensure that post-nap alertness and performance is maintained.
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Affiliation(s)
- Jonathan Davy
- a Department of Human Kinetics and Ergonomics , Rhodes University , Grahamstown , South Africa
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Scarella TM, Nelligan J, Roberts J, Boland RJ. Effect of call organization on burnout and quality of life in psychiatry residents. Asian J Psychiatr 2017; 25:27-30. [PMID: 28262169 DOI: 10.1016/j.ajp.2016.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/17/2016] [Accepted: 10/23/2016] [Indexed: 11/17/2022]
Abstract
We aimed to measure the effects of a residency program's mid-year shift from 24-h call to night float on resident burnout and quality of life. At the end of the year, residents who started the year with 24-h call had worse burnout and quality of life, with statistical significance and large effect sizes. Exposure to a twenty-four hour call system, when compared to a full year of night float, may be associated with increased burnout and decreased quality of life, though measuring this effect is not straightforward.
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Affiliation(s)
- Timothy M Scarella
- Brigham and Women's Hospital, Department of Psychiatry, 75 Francis Street, Boston, MA, 02215, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA, 02215 USA.
| | - Julia Nelligan
- Brigham and Women's Hospital, Department of Psychiatry, 75 Francis Street, Boston, MA, 02215, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA, 02215 USA.
| | - Jacqueline Roberts
- Brigham and Women's Hospital, Department of Psychiatry, 75 Francis Street, Boston, MA, 02215, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA, 02215 USA.
| | - Robert J Boland
- Brigham and Women's Hospital, Department of Psychiatry, 75 Francis Street, Boston, MA, 02215, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA, 02215 USA.
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Mahoney B, Holck G, Cappiello E, Liu X, Tsen L. Chronotropic variation in the incidence of unintentional dural puncture in parturients undergoing epidural placement. Int J Obstet Anesth 2015; 24:192-3. [DOI: 10.1016/j.ijoa.2015.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 12/30/2014] [Accepted: 01/03/2015] [Indexed: 11/24/2022]
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Jackson ML, Banks S, Belenky G. Investigation of the effectiveness of a split sleep schedule in sustaining sleep and maintaining performance. Chronobiol Int 2014; 31:1218-30. [DOI: 10.3109/07420528.2014.957305] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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