Sleep and Safety among Healthcare Workers: The Effect of Obstructive Sleep Apnea and Sleep Deprivation on Safety

Occurrence and associated factors of self-reported medical errors among Chinese physicians and nurses: a cross-sectional survey

BACKGROUND

Medical errors (MEs) significantly threaten patient safety globally. This study aimed to explore multidimensional factors associated with self-reported MEs among Chinese physicians and nurses.

METHODS

A cross-sectional online survey using snowball sampling collected 7197 valid responses from Chinese physicians and nurses between October 2020 and April 2022. A self-reported question assessed MEs within the past three months. Sociodemographic characteristics, work-related factors, and mental distress were collected. Data were analyzed using stepwise logistic regression.

RESULTS

1285 (17.9%) physicians and nurses self-reported MEs during the previous 3 months. Factors associated with higher odds of self-reported MEs included male sex (OR: 1.44, 95% CI: 1.23-1.69), physician status (OR: 1.48, 95% CI: 1.26-1.73), history of mental illness (OR: 1.49, 95% CI: 1.16-1.91), longer weekly working hours (OR: 1.20-1.23, 95% CI: 1.03-1.47), workplace violence experience (OR: 1.54-1.75, 95% CI: 1.30-2.17), and dissatisfaction with the medical practice environment (OR: 1.20, 95% CI: 1.05-1.37). Conversely, being married (OR: 0.74, 95% CI: 0.62-0.89), holding a bachelor's degree or higher (OR: 0.82, 95% CI: 0.70-0.97), and having more years of professional practice (OR: 0.96, 95% CI: 0.95-0.97) were associated with lower odds of self-reported MEs. Self-reported MEs were significantly and positively correlated with burnout (OR: 1.40, 95% CI: 1.20-1.62), depressive symptoms (OR: 1.38-1.45, 95% CI: 1.04-1.84), perceived stress (OR: 1.28-1.62, 95% CI: 1.06-2.02), and excessive daytime sleepiness (OR: 1.27-1.46, 95% CI: 1.10-1.79).

CONCLUSIONS

Self-reported MEs are relatively common among Chinese physicians and nurses, and are associated with various factors. Poor workplace conditions and mental distress are linked to an increased risk of MEs. Implementing effective interventions to improve workplace conditions and mental health is crucial for reducing MEs.

A Quantitative Analysis of Work System Factors and Well-Being Among Nurses and Physicians in Rural and Urban Settings During Covid-19 Pandemic

BACKGROUND

The aim of this study was to assess work system factors and nurse and physician well-being across professionals (nurse vs. physician) and geographic locations (rural vs. urban) during COVID-19 pandemic.

METHODS

This study invited nurses and physicians within four hospitals from one large healthcare system to participate: one urban academic medical center and three rural hospitals. We measured work systems factors using the National Academy of Medicine (NAM) framework and the National Institute for Occupational Safety and Health (NIOSH) survey. Wellbeing was measured using the 2-question summative burnout score, Patient Health Questionnaire (PHQ-9) to measure depression, and post-traumatic stress disorder (PTSD) checklist (PCL) to measure PTSD symptoms. Statistical analyses were conducted using Chi-square (for Likert-scale items) and t-tests (for continuous scales) as appropriate. Statistical significance was set at the .05 level, two-tailed.

RESULTS

Overall, our results suggested that nurses and physicians working in the urban settings experience more impeding work system factors and are more burned out, depressed, exhibit more PTSD symptoms, and face greater overall well-being issues, when compared to nurses and physicians working in the rural settings.Conclusions/Applications to Practice:This study examined a comprehensive set of work system factors and well-being measures to better understand differences between rural and urban settings, and nurses compared to physicians. By examining this entire set of measures, we were able to provide a greater insight into the key differences, highlighting opportunities for policy-level contributions to prevent work related impairments from reaching the healthcare workforce.

The Mediating Role of Negative Mood Affect in the Relationship Between Perceived Stress and Vulnerability to Insomnia Among Student Pharmacist Shift Workers

Background

Perceived stress and vulnerability to develop insomnia are closely linked, with negative mood affect playing a key role. Shift workers, particularly student pharmacists juggling academic demands and irregular work schedules, are at heightened risk for stress-related sleep disturbances. While previous studies have explored their direct relationships, limited evidence exists on the dual role of negative mood affect as both a mediator and a non-mediator in these pathways. This study investigates the mediating role of negative mood affect in the relationship between perceived stress and vulnerability to develop insomnia and assesses whether negative mood affect mediates the reverse relationship.

Methods

A cross-sectional study was conducted on 86 student pharmacist shift workers at Notre Dame of Maryland University. Participants completed validated self-report measures, including the Perceived Stress Scale (PSS), the Ford Insomnia Response to Stress Test (FIRST), and the Positive and Negative Affect Schedule (PANAS). Mediation analysis using Hayes' PROCESS macro (Model 4) examined the mediating role of negative mood affect in both pathways. Bias-corrected bootstrapping with 5000 iterations calculated confidence intervals for indirect effects, with significance set at p < 0.05.

Results

Negative mood affect partially mediated the relationship between perceived stress and vulnerability to develop insomnia. Higher stress levels were associated with increased negative mood affect (b = 0.49, SE = 0.05, p < 0.01), which, in turn, was linked to greater insomnia vulnerability (b = 0.39, SE = 0.04, p < 0.01). The indirect effect was significant (b = 0.19, 95% CI [0.06, 0.33]). In contrast, negative mood affect did not mediate the reverse pathway (p = 0.15).

Conclusion

Negative mood affect significantly mediates the relationship between perceived stress and insomnia vulnerability but not the reverse pathway. Interventions targeting emotional regulation may help reduce stress-related sleep disturbances. Longitudinal studies are needed to confirm these findings and refine interventions.

A multimodal approach for sleep apnea detection: SpO2 and force sensitive sensors in a flexible 3D-printed wearable

. The diagnosis of sleep apnea relies on the evaluation of polysomnography (PSG) recordings by experienced health monitoring practitioners. The labor-intensive nature of PSG and it's required complex instrumentation limit its widespread use across the general population. This research inquest offers a wearable health monitoring device in response to these challenges. The device incorporates a custom-fabricated force sensor resistor (FSR) seamlessly integrated with a microcontroller and pulse oximeter (SpO2) within a 3D-printed enclosure. Real-time respiratory and oxygen saturation data are wirelessly transmitted to a web-based interface for comprehensive and automated sleep apnea diagnosis. This prototype provides a comfortable, easy-to-use solution capable of accurate and automated diagnosis of sleep apnea. The sensor is fabricated by spray-coated silver ink finger electrodes, which were characterized by scanning electron microscopy (SEM) and energy dispersive X-ray analysis (EDAX), confirming the presence of high silver content (97.6%) and low oxygen (2.4%), ensuring good electrical conductivity. Additionally, the designed finger electrode was simulated by COMSOL Multiphysics simulations software through repeated trials, suggesting a consistent and direct relationship between applied pressure and voltage output as per the Ohm's law. The sensor's voltage output varied linearly, with force (N) from 0 to 5 V and force (N) from 0 to 40 Newton. The COMSOL simulations uses electrostatic and moving mesh models matched with real-world experimental results further validated the sensor. The minimal non-linearity observed in practical scenarios proves the robustness of the sensor.

Memory-Enhancing and Anxiolytic Effects of the Rose of Jericho on Sleep Deprivation-Related Cognitive and Behavioral Changes

BACKGROUND

Sleep is a crucial physiological phenomenon that enables the body to engage in restoration and rejuvenation. Remarkably, even limited periods of sleep deprivation (SD) can adversely affect cognitive functions such as memory retention, emotional regulation, data processing, and concentration. The Rose of Jericho (RoJ) has been considered more than a plant and has demonstrated potential therapeutic actions in childbirth, respiratory diseases, gastrointestinal disorders, and cancer. The effect of the RoJ on memory, cognition, and behavior has not yet been well-studied.

OBJECTIVES

The present study aimed to investigate the possible therapeutic effects of the RoJ on memory, cognition, behavior, and motor coordination in a rat model of SD.

MATERIALS AND METHODS

Thirty male Wistar albino rats weighing 120-150 g were used in the present study. The rats were acclimatized and trained and then randomly divided into three groups: control (C), sleep-deprived (SD), and SD treated with RoJ (SD+RoJ). Spatial memory and learning were assessed using the Morris Water Maze (MWM) test, while anxiety-related behaviors were evaluated through the Elevated Plus Maze (EPM) test. The rotarod test was used to assess motor coordination.

RESULTS

The study revealed significant behavioral and cognitive performance improvements with the SD+RoJ group across all the tests. In the MWM test, the SD group exhibited a marked increase in test duration (29.5 ± 3.57 sec) and a reduction in average speed (1.9 ± 0.3 cm/s) when compared to the C group (13.41 ± 1.57 sec and 5.9 ± 0.34 cm/s, respectively). Interestingly, the SD+RoJ group significantly reduced test duration (19.75 ± 3.36 sec) and improved rats' speed (6.06 ± 0.27 cm/s) compared to the SD group. The EPM test demonstrated that the SD group spent significantly less time in the open arms (16.2 ± 9.44 sec) than the C group (59.8 ± 3.29 sec). Interestingly, the SD+RoJ group significantly improved the time spent in the open arms (45.8 ± 11.64 sec). Moreover, the SD+RoJ group showed notable improvement in open-arm entries (7 ± 2.39) compared to the SD group (1.6 ± 0.81). In the Rotarod test, the SD group demonstrated a significant decline in latency to fall (44.2 ± 9.5 sec) compared to the C group (228.67 ± 35.44 sec). The SD+RoJ group exhibited a significantly longer falling latency (165 ± 28.77 sec) than the SD group.

CONCLUSION

Treatment with the RoJ alleviated SD-dependent cognitive impairment, anxiety, and decline in motor coordination. Supplementation with the RoJ may offer potential therapeutic benefits, including boosting memory, improving cognition, reducing anxiety and depression, and enhancing motor coordination.

Exploring β-caryophyllene: a non-psychotropic cannabinoid's potential in mitigating cognitive impairment induced by sleep deprivation

Sleep deprivation or sleep loss, a prevalent issue in modern society, is linked to cognitive impairment, leading to heightened risks of errors and accidents. Chronic sleep deprivation affects various cognitive functions, including memory, attention, and decision-making, and is associated with an increased risk of neurodegenerative diseases, cardiovascular issues, and metabolic disorders. This review examines the potential of β-caryophyllene, a dietary non-psychotropic cannabinoid, and FDA-approved flavoring agent, as a therapeutic solution for sleep loss-induced cognitive impairment. It highlights β-caryophyllene's ability to mitigate key contributors to sleep loss-induced cognitive impairment, such as inflammation, oxidative stress, neuronal death, and reduced neuroplasticity, by modulating various signaling pathways, including TLR4/NF-κB/NLRP3, MAPK, Nrf2/HO-1, PI3K/Akt, and cAMP/PKA/CREB. As a naturally occurring, non-psychotropic compound with low toxicity, β-caryophyllene emerges as a promising candidate for further investigation. The review underscores the therapeutic potential of β-caryophyllene for sleep loss-induced cognitive impairment and provides mechanistic insights into its action on crucial pathways, suggesting that β-caryophyllene could be a valuable addition to strategies aimed at combating cognitive impairment and other health issues due to sleep loss.

Impact of innovative technologies on quality and safety in surgery

Technological advancements gradually lead to the revision and transformation of healthcare, training, and research. Surgery is a field of medicine where the collaboration of human resources and the application of innovative technologies could elevate faithfulness and efficiency. The article, exploring the technologies and analyzing them in terms of their reliability, the benefits of performing precision surgeries, the effectiveness in the outcome of surgery with less psychosomatic fatigue, and the improvements in the training process for surgeons, emphasizes the safety and quality that can be achieved. The study was conducted by searching the relevant papers mainly from 2016-2024 using different online databases such as Web of Science, Google Scholar, and PubMed to examine the impact of adopting new technologies in medicine. This paper highlights that the use of innovative technologies in a wide range of surgical procedures could, by adapting interdisciplinary procedures, provide significant results in issues related to safety, quality, reliability, and training.

Astragali radix vesicle-like nanoparticles improve energy metabolism disorders by repairing the intestinal mucosal barrier and regulating amino acid metabolism in sleep-deprived mice

BACKGROUND

Sleep disorder is widespread and involves a variety of intricate factors in its development. Sleep deprivation is a manifestation of sleep disorder, can lead to energy metabolism disturbances, weakened immune system, and compromised body functions. In extreme situations, sleep deprivation can cause organ failure, presenting significant risks to human health.

PURPOSE

This study aimed to investigate the efficacy and mechanisms of Astragalus Radix vesicles-like nanoparticles (AR-VLNs) in counteracting the deleterious effects of sleep deprivation.

METHODS

The ICR mice were divided into control, model, AR-VLNs high dose (equivalent to 20 g/kg crude drug), AR-VLNs low dose (equivalent to 10 g/kg crude drug), AR high dose (equivalent to 20 g/kg crude drug), and AR low dose (equivalent to 10 g/kg crude drug). The REM (rapid eye movement) sleep-deprivation model was established, and evaluations were conducted for motor function, antioxidant capacity, and energy metabolism indices. Moreover, CACO-2 cells damage was induced with lipopolysaccharide to evaluate the repairing ability of AR-VLNs on the intestinal cell mucosa by measuring permeability. Furthermore, metabolomics was employed to elucidate the mechanisms of AR-VLNs action.

RESULTS

AR-VLNs were demonstrated to enhance the motor efficiency and antioxidant capacity in REM sleep-deprived mice, while also minimized pathological damage and restored the integrity of the intestinal mucosal barrier. In vitro experiments indicated the anti-inflammatory effect of AR-VLNs against LPS-induced cell damage. Additionally, metabolomic analysis linked these effects with regulation of the amino acid metabolic pathways. Further confirmation from molecular biology experiments revealed that the protective effects of AR-VLNs against the deleterious effects of REM sleep deprivation were associated with the restoration of the intestinal mucosal barrier and the enhancement of amino acid metabolism.

CONCLUSION

AR-VLNs administration effectively improved energy metabolism disorders in REM sleep deprived mice, by facilitating the repair of the intestinal mucosal barrier and regulating the amino acid metabolism.

Evaluation of Malpractice Fear, Burnout, and Spiritual Well-Being among Physicians in Turkey: A Descriptive Study

This descriptive study was conducted with 406 physicians to evaluate fear of malpractice, burnout and spiritual well-being among physicians in Turkey. In our study, 81.5%, 11.6% and 6.9% of physicians experienced high, medium and low levels of fear of malpractice, emotional burnout, depersonalisation and personal accomplishment, respectively. However, physicians reported high levels of spiritual well-being and harmony with nature, moderate levels of transcendence and anomie. As spiritual well-being and transcendence increased, emotional burnout and depersonalisation decreased and personal accomplishment increased. In addition, as harmony with nature increased, depersonalisation decreased and personal accomplishment increased, and as anomie increased, emotional burnout and depersonalisation increased.

The relationship between workplace justice and self-evaluated nonfatal occupational accidents among healthcare employees in Taiwan: An observational study

The relationship between workplace justice and nonfatal occupational accidents in a single-payer healthcare system has rarely been explored. As countries strive to achieve and sustain universal health coverage, healthcare workers' occupational safety and health require greater concerns. We used the data from a national survey conducted on randomly sampled Taiwanese workers. One hundred forty eight males and 567 females, with a total of 715 healthcare workers aged 20 to 65, were analyzed. The workplace scale consisted of 4 subcomponents, including distributive justice, interpersonal justice, information justice, and procedural justice, and was dichotomized into low and high groups in each dimension. Logistic regression models examined the relationship between workplace justice and self-evaluated occupational accidents among healthcare employees. The prevalence of self-evaluated occupational accidents in healthcare employees was 15.54% and 11.64% for men and women, respectively. After adjusting variables such as sociodemographic variables, physical job demands, shift work status, work contract, and psychological job demands, regression analyses indicated that health employees with lower distributive justice, interpersonal justice, information justice, and procedural justice were significantly associated with self-evaluated occupational accidents both in males and females. Expanding the study to include healthcare systems in different countries could enhance the generalizability of the findings. Offering specific recommendations for policymakers and healthcare administrators to improve workplace justice and reduce occupational accidents.

Association between sleep duration and burnout in healthcare professionals: a cross-sectional survey

Background

Short sleep duration in healthcare professionals is a recurring concern among researchers. On the other hand, the prevalence of burnout in this population group is experiencing exponential growth. Therefore, this study aimed to explore the association between sleep duration and burnout in healthcare professionals.

Methods

This is a cross-sectional study. Data were collected by applying a non-probabilistic convenience sampling, considering a sample of 300 healthcare professionals from the public sector in Peru. The association between variables was explored using multivariate logistic regression. Values of p < 0.05 were considered statistically significant.

Results

The results of the analysis in the crude models revealed that both men and women who slept < 7 h during workdays and days off were 8.33 (95% CI = 2.68-13.99, p = 0.004) and 17.18 (95% CI = 10.50-23.87, p < 0.001) times more likely to have burnout compared to those who reported ≥7 h, respectively. After adjusting for confounding variables, the association remained statistically significant.

Conclusion

The findings of this study underscore the critical importance of sleep duration in the incidence of burnout among healthcare professionals. In the context of the global challenges to the mental and physical health of these professionals, our results highlight the urgent need to implement strategies at the organizational and individual level. This includes promoting a better work-life balance, and effective stress management and improved sleep quality.

Risk of obstructive sleep apnea among health workers: results of a screening in a large Italian University Hospital

PURPOSE

Obstructive sleep apnea (OSA) is a common respiratory sleep disorder, related to increased mortality, poor quality of life, and higher risk of work accidents and injuries. Studies on the risk of OSA (rOSA) among health workers (HW) are scant. The aims of this study were to investigate this issue in a large University Hospital and to assess the effectiveness of a screening program.

METHODS

The STOP-BANG questionnaire (SBQ) was sent via e-mail to the 5031 HW employed at the University Hospital of Verona. HW who completed the SBQ were classified at low, moderate, and high rOSA. HW at high rOSA were invited to undergo nocturnal polygraphy. The determinants of rOSA were studied by non-parametric Kruskal-Wallis test, Pearson's chi-squared, and multinomial logistic model.

RESULTS

Of 5031 HW, 1564 (31.1%) completed the online questionnaire. Responders with low, moderate, and high rOSA were 72.7%, 13.7%, and 13.6%. Male gender, older age, and higher body mass index (BMI) were significant predictors of high rOSA, as expected. Physicians had the lowest probability of being in the high-risk category. Polygraphy was performed in 64 subjects. The positive predictive value of the self-administered SBQ was 68.8% (95%C.I. 55.9-79.8%) but raised to 96.9% (95%C.I. 89.2-99.6%) when re-administered by medical staff.

CONCLUSION

SBQ showed its effectiveness as a screening tool in detecting undiagnosed OSA in HW. Systematic screening for OSA in work settings could allow early diagnosis and treatment, reducing short- and long-term health effects of OSA.

A Scoping Review of Sleep Apnea: Where Do We Stand?

Obstructive sleep apnea (OSA), a condition in which there is a recurrent collapse of the upper airway while sleeping, is a widespread disease affecting 5% to 10% people worldwide. Despite several advances in the treatment modalities for OSA, morbidity and mortality remain a concern. Common symptoms include loud snoring, gasping for air during sleep, morning headache, insomnia, hypersomnia, attention deficits, and irritability. Obese individuals, male gender, older age (65+), family history, smoking, and alcohol consumption are well recognized risk factors of OSA. This condition holds the ability to increase inflammatory cytokines, cause metabolic dysfunction, and increase the sympathetic output, all of which exacerbate OSA due to their effect on the cardiovascular system. In this review, we discuss its brief history, risk factors, complications, treatment modalities, and the role of clinicians in curbing its risk.

Sleep in Residents: A Comparison between Anesthesiology and Occupational Medicine Interns

Sleep deprivation is a significant risk to the health and judgment of physicians. We wanted to investigate whether anesthesiology residents (ARs) who work only one night shift per week have different physical and mental health from occupational medicine residents (OMRs) who do not work at night. A total of 21 ARs and 16 OMRs attending a university general hospital were asked to wear an actigraph to record sleep duration, heart rate and step count and to complete a questionnaire for the assessment of sleep quality, sleepiness, fatigue, occupational stress, anxiety, depression and happiness. ARs had shorter sleep duration than OMRs; on average, they slept 1 h and 20 min less (p < 0.001). ARs also had greater daytime sleepiness, a higher heart rate and lower happiness than OMRs. These results should be interpreted with caution given the cross-sectional nature of the study and the small sample size, but they are an incentive to promote sleep hygiene among residents.