Anonymous online cognitive behavioral therapy for sleep disorders in shift workers-a study protocol for a randomized controlled trial

Background

Many shift workers suffer from sleep issues, which negatively affect quality of life and performance. Scientifically evaluated, structured programs for prevention and treatment are scarce. We developed an anonymous online cognitive behavioral therapy for insomnia (CBT-I) program. After successful completion of a feasibility study, we now start this prospective, randomized, controlled superiority trial to compare outcomes of two parallel groups, namely an intervention group and a waiting-list control-group. Additionally, we will compare these outcomes to those of a face-to-face CBT-I outpatient sample.

Methods

Collaborating companies will offer our anonymous online intervention to their shift-working employees. Company physicians and counseling services will screen those interested for inclusion and exclusion criteria. Participants will receive access to our online service, where they will complete psychometric assessment and receive random assignment to either the intervention group or the waiting-list control group. Participants and providers will be aware of the group assignment. We aim to allocate at least N = 60 participants to the trial. The intervention consists of psychoeducation, sleep restriction, stimulus control, relaxation techniques, and individual feedback delivered via four e-mail contacts. During the intervention, as well as during the waiting period, participants will fill out weekly sleep diaries. Immediately after completion of the program, the post-intervention assessment takes place. Participants in the control group will be able to participate in the program after all study assessments. To recruit an additional sample, collaborating outpatient sleep clinics will provide six sessions of standard face-to-face CBT-I to an ad hoc sample of shift working patients. We expect both the online and the face-to-face CBT-I interventions to have beneficial effects compared to the control group on the following primary outcomes: self-reported symptoms of depression and insomnia, sleep quality, and daytime sleepiness.

Conclusions

The online intervention allows shift workers to follow a CBT-I program independently of their working schedule and location. Forthcoming results might contribute to further improvement of prevention and therapy of sleep issues in shift workers.

Trial registration

German Clinical Trials Register DRKS DRKS00017777. Registered on 14 January 2020—retrospectively registered.

Effectiveness of an Online CBT-I Intervention and a Face-to-Face Treatment for Shift Work Sleep Disorder: A Comparison of Sleep Diary Data

In western societies, about one in six employees works in shifts. Shiftwork is associated with a number of poor somatic and psychological health outcomes, especially sleep issues. Higher rates of absenteeism and accidents in the workplace are possible consequences. Still, prevention programs and treatment options that are specifically tailored to shift-workers’ needs are rare. We devised a 4-week online cognitive behavioral therapy for insomnia (CBT-I) intervention (n = 21) and compared sleep outcomes to a face-to-face outpatient treatment for shift-workers (n = 12) using a sleep diary and the Epworth Sleepiness Scale (ESS). In the online sample, measures also included the World Health Organization wellbeing questionnaire (WHO-5) and the Insomnia Severity Index (ISI). In the outpatient sample, the Beck Depression Inventory (BDI-II), the Montgomery–Åsberg Depression Rating Scale (MADRS), and the Pittsburgh Sleep Quality Index (PSQI) were administered. Results showed significant improvements in sleep efficiency by 7.2% in the online sample and 7.7% in the outpatient sample. However, no significant difference was found in the rate of improvement in sleep efficiency across four weeks of treatment between the samples. In the online sample, the wellbeing (WHO-5) and insomnia symptoms (ISI) scores were significantly improved following the CBT-I intervention (p < 0.004 and p < 0.002 respectively). In the outpatient sample, symptoms of depression (BDI-II and MADRS scores) and insomnia symptoms (PSQI scores) improved significantly following the CBT-I intervention. In summary, CBT-I significantly improved sleep efficiency in both the online and outpatient samples, in addition to wellbeing, symptoms of insomnia, and depression. The findings of this study demonstrate online CBT-I as a feasible approach for treating insomnia in shift-workers. Future randomized controlled trials are needed.

A pilot study of surgical telementoring for leg fasciotomy

INTRODUCTION

Acute extremity compartment syndrome requires rapid decompression. In remote locations, distance, weather and logistics may delay the evacuation of patients with extremity trauma beyond the desired timeline for compartment release. The aim of this study was to establish the feasibility of performing telementored surgery for leg compartment release and to identify methodological issues relevant for future research.

METHODS

Three anaethetists and one critical care physician were recruited as operators. They were directed to perform a two-incision leg fasciotomy on a Thiel-embalmed cadaver under the guidance of a remotely located orthopaedic surgeon. The operating physician and the surgeon (mentor) were connected through software that allows for real-time supervision and the use of a virtual pointer overlaid onto the surgical field. Two experienced orthopaedic traumatologists independently assessed the adequacy of compartment decompression and the presence of iatrogenic complications.

RESULTS

14 of 16 compartments (in four leg specimens) were felt to have been completely released. The first evaluator considered that the deep posterior compartment was incompletely released in two specimens. The second evaluator considered that the superficial posterior compartment was incompletely released in two specimens. The only complication was a large laceration of the soleus muscle that occurred during a period of blurred video signal attributed to a drop in bandwidth.

CONCLUSIONS

This study suggests that surgical telementoring may enable physicians to safely perform two-incision leg fasciotomy in remote environments. This could improve the chances of limb salvage when compartment syndrome occurs far from surgical care. We found interobserver variation in the assessment of compartment release, which should be considered in the design of future research protocols.

The locked flexible intramedullary humerus nail in pediatric femur and tibia shaft fractures: a feasibility study

There are several options for the treatment of long bone fractures in skeletally immature patients. Surgeon experience, type of fracture, and the possibility of damage to the physeal area dictate individual fracture management patterns. Notably, nail devices have not gained popularity in this patient group. Intramedullary locking nails have become the standard of care in adult patients due to decreased morbidity and mortality. A novel nail has been developed for humeral shaft fractures that uses a lateral starting position to avoid damage to the rotator cuff in humeral fracture fixation. This is possible because of the nail's transient flexibility during insertion. This study illustrates that it is feasible to insert this type of nail through multiple entry portals for both tibial and femoral fracture fixation, without damaging the physeal blood supply or growth areas.

Minimally invasive dynamic hip screw: prospective randomized trial of two techniques of insertion of a standard dynamic fixation device

OBJECTIVE

This study evaluates the safety and outcome of a minimally invasive technique for inserting a standard dynamic hip screw for intertrochanteric fractures.

HYPOTHESIS

The use of standard plate in a minimally invasive technique is both possible and advantageous to patient outcome.

DESIGN AND METHODS

Prospective surgeon-randomized blinded outcome clinical study comparing new technique to conventional technique.

MAIN OUTCOME MEASURE

Pain, operative time and mean hemoglobin drop in percutaneous hip fixation.

RESULTS

The minimally invasive technique had significantly less blood loss (P < 0.001), operative time (P < 0.001) and a trend to less morphine use.

CONCLUSIONS

Minimal invasive technique significantly reduces blood loss and operative time for fixation of intertrochanteric hip fractures without sacrifice of fixation stability or bone healing.

Treatment of complex acetabular fractures through a modified extended iliofemoral approach

OBJECTIVES

To assess the rate of anatomic reconstructions as well as approach-related morbidity and complications in the treatment of complex acetabular fractures through a modified extended iliofemoral approach.

DESIGN

Prospective clinical study.

SETTING

Level I trauma center, University Hospital.

PATIENTS

Inclusion criteria were as follows: (a) associated acetabular fracture or transverse fracture with comminuted roof area stated as not sufficiently reconstructable through a single approach, and (b) age between sixteen and sixty-five years. A total of forty-nine patients with fifty complex acetabular fractures could be included out of the series of ninety-six acetabular fractures treated operatively from August 1992 to February 1996. Open reduction and internal fixation of complex acetabular fractures through the modified extended iliofemoral approach were performed.

RESULTS

In 80 percent of the fifty fractures the reduction was anatomic with a remaining displacement of less than or equal to one millimeter, in eight cases there was a persistent displacement of two millimeters, and two fractures had a poor result with a three-millimeter displacement. Complications included 8 percent loss of reduction, 13 percent heterotopic ossification grade 3, and 4 percent avascular femoral head necrosis. At the two-year follow-up there were 74 percent good or excellent radiographic and clinical results. Two patients had already been reoperated with total hip replacement, and the two patients with femoral head necrosis are currently scheduled for arthroplasty.

CONCLUSIONS

The modified extended iliofemoral approach proved to be appropriate to achieve anatomic reduction in complex acetabular fractures. The high rate of approach-related morbidity has to be considered carefully and may lead to a decreased incidence of extended approaches.

CT scans versus conventional tomography in acute fractures of the odontoid process

Four different radiological diagnostic methods were compared as to their diagnostic relevance in the analysis of odontoid fractures. Thirty-one patients with fresh odontoid fractures were investigated using standard anteroposterior and lateral radiographs, conventional tomography, axial computerized tomography and two-dimensional reconstruction in the sagittal and the coronal planes. As a control, 13 patients without odontoid fractures were examined. The results of the different investigations were correlated with the actual (clinical and/or intra-operative) findings. The coefficients of correlation for the conventional tomography and two-dimensional reconstruction were kappa=0.774 and kappa=0.907, respectively. For conventional radiography and axial computerized tomography (CT), the coefficients were clearly lower, at kappa=0.364 and kappa=0.627, respectively. The less time-consuming CT examination with sagittal and coronal reconstructions is equivalent with respect to diagnostic accuracy and can, therefore, replace conventional tomography in the evaluation fractures.