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Almarzouki AF. Impact of on-call shifts on working memory and the role of burnout, sleep, and mental well-being in trainee physicians. Postgrad Med 2024. [PMID: 38656827 DOI: 10.1080/00325481.2024.2347195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/22/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Optimal cognitive functions, including working memory (WM), are crucial to enable trainee physicians to perform and excel in their clinical practice. Several risk factors, including on-call shifts, poor mental health, burnout, and sleep problems, can impair clinical practice in trainee physicians, potentially through cognitive impairment; however, these associations have not been fully explored. OBJECTIVE This study investigated the effect of on-call shifts on WM among trainee physicians and its association with burnout, depression, anxiety, affect, and sleep. MATERIALS AND METHODS This cross-sectional study involved 83 trainee physicians (45% male). We measured demographic and training-related factors including on-call shifts and working hours. We also assessed depressive symptoms (PHQ-9), both state and trait anxiety (STAI total score), burnout (OLBI total score), positive and negative affect scores (PANAS), and sleep disturbances (PSQI total score). WM was evaluated using spatial working memory (SWM) strategy scores that reflected performance and total error counts. RESULTS Trainee physicians with more on-calls per month had significantly worse depressive symptoms, burnout scores, and sleep, as well as more negative affect. While controlling for covariates, being on-call more times per month was significantly associated with worse WM. Worse depressive symptoms and burnout scores were also significantly associated with impaired WM. CONCLUSION Working more on-call shifts is associated with compromised WM. Trainee physicians who experienced more depressive symptoms and burnout had worse WM.
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Affiliation(s)
- Abeer F Almarzouki
- Department of Clinical Physiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Lin PS, Qi WH, Ding CY, An YJ, Yao YT. The Effects of Daytime Variation on Short-term Outcomes of Patients Undergoing Off-Pump Coronary Artery Bypass Grafting. J Cardiothorac Vasc Anesth 2024; 38:931-938. [PMID: 38246822 DOI: 10.1053/j.jvca.2023.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/23/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE To evaluate the effects of time of surgery on the short-term outcomes of patients undergoing off-pump coronary artery bypass grafting (OPCABG). DESIGN A retrospective cohort study. SETTING A single large-volume cardiovascular center. PATIENTS Patients undergoing elective OPCABG between September 2019 and July 2022. INTERVENTIONS Patients were divided into the following 2 groups according to the start time of surgery: morning (AM group, before 11 AM) and afternoon (PM group, after 11 AM). Propensity-score matching (PSM) with a 1:1 matching ratio was used to create comparable cohorts. MEASUREMENTS AND MAIN RESULTS The primary endpoint was the composite incidence of mortality and morbidities during hospitalization. Secondary endpoints included postoperative bleeding and transfusion, mechanical ventilation duration (MVD), and lengths of stay (LOS) in the intensive care unit (ICU) and hospital. From a consecutive series of 1,039 patients, PSM yielded 317 well-matched pairs. There was no difference in the composite incidence of in-hospital mortality and morbidities between the AM and PM groups (16.4% v 17.4%, p = 0.832). However, patients in the PM group were associated with less postoperative blood loss over the first 24 hours (470 v 540 mL, p = 0.002), decreased MVD (14 v 16 hours, p < 0.001), and shorter LOS in ICU (46 v 68 hours, p = 0.002) compared to patients in AM group. CONCLUSIONS The current study suggested a lack of relevance regarding the time of surgery with in-hospital mortality and morbidities in patients undergoing OPCABG.
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Affiliation(s)
- Pei-Shuang Lin
- Department of Cardiovascular Surgery, Fujian Medical University Affiliated First Quanzhou Hospital, Quanzhou, China; Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Wen-Hui Qi
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Anesthesiology, Hengshui People's Hospital, Hengshui, China
| | - Chen-Ying Ding
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Anesthesiology, the First Hospital of Hohhot, Hohhot, China
| | - Yu-Jie An
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Anesthesiology, the Friendship Hospital of Ili Kazakh Autonomous Prefecture, Yining, China
| | - Yun-Tai Yao
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
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Chen-Xu J, Miranda Castilho B, Moura Fernandes B, Silva Gonçalves D, Ferreira A, Gonçalves AC, Ferreira Vieira M, Silva AM, Borges F, Paes Mamede M. Medical residency in Portugal: a cross-sectional study on the working conditions. Front Health Serv 2023; 3:1190357. [PMID: 38116534 PMCID: PMC10728646 DOI: 10.3389/frhs.2023.1190357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 11/07/2023] [Indexed: 12/21/2023]
Abstract
Objectives The current European crisis in human resources in health has opened the debate about working conditions and fair wages. This is the case with Resident doctors, which have faced challenges throughout Europe. In Portugal, they account for about a third of the doctors in the Portuguese National Health Service. No studies to date objectively demonstrate the working conditions and responsibilities undertaken. This study aims to quantify the residents' workload and working conditions. Methods Observational, retrospective cross-sectional study which involved a survey on the clinical and training activity of Portuguese residents, actively working in September 2020. The survey was distributed through e-mail to residents' representatives and directly to those affiliated with the Independent Union of Portuguese Doctors. The descriptive analysis assessed current workload, and logistic regression models analyzed associations with geographical location and residency seniority. Results There were a total of 2,012 participants (19.6% of invited residents). Of the residents giving consultations, 85.3% do so with full autonomy. In the emergency department, 32.1% of the residents work 24 h shifts and 25.1% work shifts without a specialist doctor present. Regarding medical training, 40.8% invest over EUR 1,500 annually. Autonomy in consultations was associated with being a Family Medicine resident (OR 4.219, p < 0.001), being a senior resident (OR 5.143, p < 0.001), and working in the Center (OR 1.685, p = 0.009) and South regions (OR 2.172, p < 0.001). Seniority was also associated with investing over EUR 1,500 in training annually (OR 1.235, p = 0.021). Conclusion Residents work far more than the contracted 40 h week, often on an unpaid basis. They present a high degree of autonomy in their practice, make a very significant personal and financial investment in medical training, with almost no time dedicated to studying during working hours. There is a need to provide better working conditions for health professionals, including residents, for the sake of the sustainability of health systems across Europe.
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Affiliation(s)
- José Chen-Xu
- Unidade de Saúde Pública, Agrupamento de Centros de Saúde Baixo Mondego, Coimbra, Portugal
- Comprehensive Health Research Centre, National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
| | | | - Bruno Moura Fernandes
- Radiology Oncology Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Diana Silva Gonçalves
- Unidade de Saúde Familiar ARS Médica, Agrupamento de Centros de Saúde Loures-Odivelas, Loures, Portugal
| | - André Ferreira
- Medical Oncology Department, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Ana Catarina Gonçalves
- Infectious Diseases Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Maycoll Ferreira Vieira
- Centros de Saúde de Santana e do Caniçal, Serviço de Saúde da Região Autónoma da Madeira, EPERAM, Madeira, Portugal
| | - Andreia M. Silva
- General Surgery Department, Hospital da Horta, EPER, Açores, Portugal
| | - Fábio Borges
- Unidade de Saúde Familiar S. Miguel-O-Anjo, Agrupamento de Centros de Saúde Ave-Famalicão, Famalicão, Portugal
| | - Mónica Paes Mamede
- Anaesthesiology Department, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
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Kim ST, Xia Y, Cho PD, Ho JK, Patel S, Lee C, Ardehali A. Safety and efficacy of delaying lung transplant surgery to a morning start. JTCVS Open 2023; 16:1008-1017. [PMID: 38204689 PMCID: PMC10775029 DOI: 10.1016/j.xjon.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/09/2023] [Accepted: 09/11/2023] [Indexed: 01/12/2024]
Abstract
Objective We aimed to evaluate the safety and efficacy of delaying lung transplantation until morning for donors with cross-clamp times occurring after 1:30 am. Methods All consented adult lung transplant recipients between March 2018 and May 2022 with donor cross-clamp times between 1:30 am and 5 am were enrolled prospectively in this study. Skin incision for enrolled recipients was delayed until 6:30 am (Night group). The control group was identified using a 1:2 logistic propensity score method and included recipients of donors with cross-clamp times occurring at any other time of day (Day group). Short- and medium-term outcomes were examined between groups. The primary endpoint was early mortality (30-day and in-hospital). Results Thirty-four patients were enrolled in the Night group, along with 68 well-matched patients in the Day group. As expected, donors in the Night group had longer cold ischemia times compared to the Day group (344 minutes vs 285 minutes; P < .01). Thirty-day mortality (3% vs 3%; P = .99), grade 3 primary graft dysfunction at 72 hours (8% vs 4%; P = .40), postoperative complications (26% vs 38%; P = .28), and hospital length of stay (15 days vs 14 days; P = .91) were similar in the 2 groups. No significant differences were noted between groups in 3-year survival (70% vs 77%; P = .30) or freedom from chronic lung allograft dysfunction (91% vs 95%; P = .75) at 3 years post-transplantation. The median follow-up was 752.5 days (interquartile range, 487-1048 days). Conclusions Lung transplant recipients with donor cross-clamp times scheduled after 1:30 am may safely have their operations delayed until 6:30 am with acceptable outcomes. Adoption of such a policy in clinically appropriate settings may lead to an alternative workflow and improved team well-being.
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Affiliation(s)
- Samuel T. Kim
- David Geffen School of Medicine, University of California, Los Angeles, Calif
- Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, Calif
| | - Yu Xia
- Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, Calif
| | - Peter D. Cho
- David Geffen School of Medicine, University of California, Los Angeles, Calif
| | - Jonathan K. Ho
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Calif
| | - Swati Patel
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Calif
| | - Christine Lee
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Calif
| | - Abbas Ardehali
- Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, Calif
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Gao Y, Fu X, Hu H, Li T, Yuan L, Zhang J, Wu Y, Wang M, Ke Y, Li X, Hu F, Zhang M, Sun L, Wen H, Guan R, Gao P, Chai W, Zhao Y, Hu D. Impact of shift work on dementia: a systematic review and dose-response meta-analysis. Public Health 2023; 223:80-86. [PMID: 37625271 DOI: 10.1016/j.puhe.2023.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/26/2023] [Accepted: 07/21/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVES Although shift work has been reported as having a link to dementia, evidence remains inconsistent, and a comprehensive dose-response meta-analysis of the association is still lacking. We therefore conducted this meta-analysis to explore the association between shift work and the risk of dementia. STUDY DESIGN Systematic review and dose-response meta-analysis. METHODS PubMed, Embase, and Web of Science databases were systematically searched. Fixed or random-effects models were used to estimate the summary relative risks (RRs) and 95% confidence intervals (95% CIs). Generalized least squares regression was used to estimate dose-response associations, and restricted cubic splines were used to examine possible linear or non-linear associations. RESULTS Five articles (10 studies) with 72,999 participants and 23,067 cases were eventually included in the meta-analysis. The summary RRs and 95% CIs of dementia risk with shift work and night shift work versus daytime work were 1.13 (95% CI: 1.05-1.21, I2 = 46.70%) and 1.13 (95% CI: 1.03-1.24, I2 = 9.20%), respectively. The risk of dementia increased by 1% (RR = 1.01, 95% CI: 1.01-1.02, I2 = 41.3%) with each 1-year increase in the duration of shift work. We found a non-linear dose-response association between the duration of shift work and the risk of dementia (Pnon-linearity = 0.006). Though the shape of the curve was steeper with the duration of shift work <7 years, the increase was more gradual after 7 years. CONCLUSION Our findings suggest that shift work may be a risk factor for future dementia and that controlling the length of shift work is a feasible measure that may contribute to prevent dementia.
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Affiliation(s)
- Y Gao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, People's Republic of China
| | - X Fu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, People's Republic of China
| | - H Hu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, People's Republic of China
| | - T Li
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, People's Republic of China
| | - L Yuan
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, People's Republic of China
| | - J Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, People's Republic of China
| | - Y Wu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, People's Republic of China
| | - M Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, People's Republic of China
| | - Y Ke
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, People's Republic of China
| | - X Li
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, People's Republic of China
| | - F Hu
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Medical School, Shenzhen, Guangdong, 518060, People's Republic of China
| | - M Zhang
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Medical School, Shenzhen, Guangdong, 518060, People's Republic of China
| | - L Sun
- Department of Social Medicine and Health Management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, People's Republic of China
| | - H Wen
- Department of Clinical Medicine, Zhengzhou Shuqing Medical College, 6 Gongming Road, Erqi District, Zhengzhou, Henan, 450064, People's Republic of China
| | - R Guan
- Department of Famarcy, Shenzhen University General Hospital, Shenzhen, Guangdong, 518055, People's Republic of China
| | - P Gao
- Department of Neurology, Shenzhen University General Hospital, Shenzhen, Guangdong, 518055, People's Republic of China
| | - W Chai
- Department of Neurology, Shenzhen University General Hospital, Shenzhen, Guangdong, 518055, People's Republic of China
| | - Y Zhao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, People's Republic of China
| | - D Hu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, People's Republic of China.
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Jørgensen SD, Kidmose P, Mikkelsen K, Blech M, Hemmsen MC, Rank ML, Kjaer TW. Long-term ear-EEG monitoring of sleep - A case study during shift work. J Sleep Res 2023; 32:e13853. [PMID: 36889935 DOI: 10.1111/jsr.13853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/26/2023] [Accepted: 01/26/2023] [Indexed: 03/10/2023]
Abstract
The interest in sleep as a potential clinical biomarker is growing, but the standard method of sleep assessment, polysomnography, is expensive, time consuming, and requires a lot of expert assistance for both set-up and interpretation. To make sleep analysis more available both in research and in the clinic, there is a need for a reliable wearable device for sleep staging. In this case study, we test ear-electroencephalography. A wearable, where electrodes are placed in the outer ear, as a platform for longitudinal at-home recording of sleep. We explore the usability of the ear-electroencephalography in a shift work case with alternating sleep conditions. We find the ear-electroencephalography platform to be reliable both in terms of showing substantial agreement to polysomnography after long-time use (with an overall agreement, using Cohen's kappa, of 0.72) and by being unobtrusive enough to wear during night shift conditions. We find that fractions of non-rapid eye movement sleep and transition probability between sleep stages show great potential as sleep metrics when exploring quantitative differences in sleep architecture between shifting sleep conditions. This study shows that the ear-electroencephalography platform holds great potential as a reliable wearable for quantifying sleep "in the wild", pushing this technology further towards clinical adaptation.
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Affiliation(s)
| | - Preben Kidmose
- Department of Electrical and Computer Engineering, Aarhus University, Aarhus, Denmark
| | - Kaare Mikkelsen
- Department of Electrical and Computer Engineering, Aarhus University, Aarhus, Denmark
| | | | | | | | - Troels Wesenberg Kjaer
- Department of Neurology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
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Debets MPM, Tummers FHMP, Silkens MEWM, Huizinga CRH, Lombarts KMJMH, van der Bogt KEA. Doctors' alertness, contentedness and calmness before and after night shifts: a latent profile analysis. Hum Resour Health 2023; 21:68. [PMID: 37605244 PMCID: PMC10441714 DOI: 10.1186/s12960-023-00855-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND While night shifts are crucial for patient care, they threaten doctors' well-being and performance. Knowledge of how the impact of night shifts differs for doctors is needed to attenuate the adverse effects of night shifts. This study aimed to obtain more precise insight into doctors' feelings surrounding night shift by: identifying profiles based on doctors' alertness, contentedness and calmness scores before and after night shifts (research question (RQ) 1); assessing how doctors' pre- and post-shift profiles change (RQ2); and determining associations of doctors' demographics and shift circumstances with alertness, contentedness and calmness change (RQ3). METHODS Latent Profile Analysis using doctors' pre- and post-shift self-rated alertness, contentedness and calmness scores was employed to identify pre- and post-shift profiles (RQ1). A cross-tabulation revealed pre- and post-shift profile changes (RQ2). Multiple regressions determined associations of demographics (i.e. age, sex, specialty) and night shift circumstances (i.e. hours worked pre-call, hours awake pre-call, shift duration, number of consecutive shifts, total hours of sleep) with alertness, contentedness and calmness change (RQ3). RESULTS In total, 211 doctors participated with a mean age of 39.8 ± 10 years; 47.4% was male. The participants included consultants (46.4%) and trainees (53.6%) of the specialties surgery (64.5%) and obstetrics/gynaecology (35.5%). Three pre-shift (Indifferent, Ready, Engaged) and four post-shift profiles (Lethargic, Tired but satisfied, Excited, Mindful) were found. Most doctors changed from Ready to Tired but satisfied, with alertness reducing most. Age, specialty, sleep, shift duration and the number of consecutive shifts associated with alertness, contentedness and calmness changes. CONCLUSIONS The results provided nuanced insight into doctors' feelings before and after night shifts. Future research may assess whether specific subgroups benefit from tailored interventions.
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Affiliation(s)
- Maarten P M Debets
- Research Group Professional Performance and Compassionate Care, Department of Medical Psychology, Amsterdam University Medical Centres, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Fokkedien H M P Tummers
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Gyneacology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Milou E W M Silkens
- Department of Health Services Research and Management, City University of London, London, United Kingdom
| | - Coen R H Huizinga
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Kiki M J M H Lombarts
- Research Group Professional Performance and Compassionate Care, Department of Medical Psychology, Amsterdam University Medical Centres, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Koen E A van der Bogt
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Surgery, Haaglanden Medical Centre, The Hague, The Netherlands
- University Vascular Centre Leiden, The Hague, The Netherlands
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Morgenstern J, Heitz C, Milne WK. Hot off the press: Sleep and fatigue risk in emergency medicine physicians. Acad Emerg Med 2023; 30:877-879. [PMID: 37099699 DOI: 10.1111/acem.14747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 04/28/2023]
Affiliation(s)
| | - Corey Heitz
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
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Chowdhary A, Davis JA, Ding L, Taravati P, Feng S. Resident Sleep During Traditional Home Call Compared to Night Float. J Acad Ophthalmol (2017) 2023; 15:e204-e208. [PMID: 37744316 PMCID: PMC10513783 DOI: 10.1055/s-0043-1775578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 08/31/2023] [Indexed: 09/26/2023]
Abstract
Purpose This article aims to compare resident sleep while on night float with a traditional home call. Methods We conducted a crossover observational study assessing sleep patterns of seven postgraduate year-2 ophthalmology residents at the University of Washington from 2019 to 2021 using the Fitbit Alta HR device. Overnight call was scheduled from 5 p.m. to 8 a.m. on weekdays, and 8 a.m. to 8 a.m. on weekends. The residency program implemented a partial night float rotation, during which two to three nights of consecutive call were assigned to a resident without other clinical duties. Sleep was recorded using the Fitbit Alta HR for residents while on a 5-week partial night float rotation, on 10-week home call rotations, with postcall relief, and for stretches of seven or more days without call responsibilities. Mixed model regression analysis was used to compare average sleep on home call, night float, and periods without call. Results Sleep data were recorded for a total of 1,015 nights, including 503 nights on home call rotation and 230 nights on night float rotation. Residents slept more during periods away from call compared to either night float or home call rotations ( p < 0.001). Residents experienced increased average overall sleep during 10-week rotations on night float compared to home call ( p = 0.008). While there was no difference in overnight sleep on call between night float and home call ( p = 0.701), residents experienced more sleep overall while on call on night float compared to home call due to more sleep being recorded during postcall naps ( p = 0.016). Conclusion Implementing a night float system can increase resident sleep by allowing for more sleep recovery during time away from clinical duties.
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Affiliation(s)
- Apoorva Chowdhary
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - John A. Davis
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Sciences University, Portland, Oregon
| | - Leona Ding
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Parisa Taravati
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Shu Feng
- Department of Ophthalmology, University of Washington, Seattle, Washington
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Ardizzone E, Lerchbaumer E, Heinzel JC, Winter N, Prahm C, Kolbenschlag J, Daigeler A, Lauer H. Insomnia-A Systematic Review and Comparison of Medical Resident's Average Off-Call Sleep Times. Int J Environ Res Public Health 2023; 20:4180. [PMID: 36901190 PMCID: PMC10002061 DOI: 10.3390/ijerph20054180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/21/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
Sleep deprivation is known to have serious consequences, including a decrease in performance, attention and neurocognitive function. It seems common knowledge that medical residents are routinely sleep deprived, yet there is little objective research recording their average sleep times. To discern whether residents may be suffering from the abovementioned side effects, this review aimed to analyze their average sleep times. Thirty papers recording the average sleep time of medical residents were found via a literature search using the key words "resident" and "sleep". An analysis of the mean sleep times cited therein revealed a range of sleep from 4.2 to 8.6 h per night, the median being 6.2 h. A sub-analysis of papers from the USA showed barely any significant differences in sleep time between the specialties, but the mean sleep times were below 7 h. The only significant difference (p = 0.039) was between the mean sleep times of pediatric and urology residents, with the former achieving less sleep. The comparison of methods for data collection showed no significant difference in the sleep times collected. The results of this analysis imply that residents are regularly sleep deprived and may therefore suffer from the abovementioned consequences.
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Affiliation(s)
- Eve Ardizzone
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany
| | - Emily Lerchbaumer
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany
| | - Johannes C. Heinzel
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany
| | - Natalie Winter
- Department of Neurology, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
| | - Cosima Prahm
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany
| | - Jonas Kolbenschlag
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany
| | - Adrien Daigeler
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany
| | - Henrik Lauer
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany
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11
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Magnavita N, Di Prinzio RR, Meraglia I, Vacca ME, Soave PM, Di Stasio E. Sleep in Residents: A Comparison between Anesthesiology and Occupational Medicine Interns. Int J Environ Res Public Health 2023; 20:2356. [PMID: 36767721 PMCID: PMC9915358 DOI: 10.3390/ijerph20032356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
Sleep deprivation is a significant risk to the health and judgment of physicians. We wanted to investigate whether anesthesiology residents (ARs) who work only one night shift per week have different physical and mental health from occupational medicine residents (OMRs) who do not work at night. A total of 21 ARs and 16 OMRs attending a university general hospital were asked to wear an actigraph to record sleep duration, heart rate and step count and to complete a questionnaire for the assessment of sleep quality, sleepiness, fatigue, occupational stress, anxiety, depression and happiness. ARs had shorter sleep duration than OMRs; on average, they slept 1 h and 20 min less (p < 0.001). ARs also had greater daytime sleepiness, a higher heart rate and lower happiness than OMRs. These results should be interpreted with caution given the cross-sectional nature of the study and the small sample size, but they are an incentive to promote sleep hygiene among residents.
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Affiliation(s)
- Nicola Magnavita
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Woman, Child & Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Reparata Rosa Di Prinzio
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Igor Meraglia
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Maria Eugenia Vacca
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Paolo Maurizio Soave
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Emergency, Anesthesiology and Resuscitation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Enrico Di Stasio
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Diagnostic and Laboratory Medicine, Unity of Chemistry, Biochemistry and Clinical Molecular Biology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics Research, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Sethi PP, Pathania M, Gupta R, Sharma P, Saini LK. Poor quality sleep is associated with greater carotid intima media thickness among otherwise healthy resident doctors. Front Epidemiol 2023; 2:1044111. [PMID: 38455319 PMCID: PMC10910945 DOI: 10.3389/fepid.2022.1044111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/13/2022] [Indexed: 03/09/2024]
Abstract
Background Sleep is important for maintaining the metabolic processes in the body, and hence, disruption in sleep leads to metabolic derangement and accelerated atherosclerosis. The effect of sleep duration on subclinical atherosclerosis has been examined in several studies; however, data regarding sleep quality is lacking. The study aimed to assess the association between sleep quality and carotid intima-media thickness among healthy young doctors. Materials and Methods This was an observational cross-sectional study among 110 healthy young resident doctors. Anthropometric data were recorded and morning fasting venous blood samples were collected to assess fasting blood sugar, lipid profile and glycosylated haemoglobin (HbA1c). Pittsburgh Sleep Quality Index and Berlin questionnaire assessed subjective sleep quality and risk for obstructive sleep apnea, respectively. Carotid ultrasonography was done to detect the intima-media thickness. Results Average age of the participants was 26.45 (±1.43) years, and 51.8% were male. Self-reported poor sleep quality was found in 54.5%. Carotid intima-media thickness (CIMT) was increased among 44.5% of participants. In the multivariate analysis, only poor sleep quality appeared to be associated with higher CIMT (P < 0.001, OR = 7.4; 95% CI = 2.70-20.32). When different components of sleep quality was analyzed through multivariate logistic regression, subjective sleep onset latency (>30 min), sleep efficiency (<85%) and sleep disturbance was found to be associated with the increased CIMT. Conclusion Poor sleep quality, especially prolonged sleep onset latency, poor sleep efficiency, and sleep disturbance are associated with increased carotid intima-media thickness among healthy young adults.
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Affiliation(s)
| | - Monika Pathania
- Department of Internal Medicine, All India Institute of Medical Science, Rishikesh, India
| | - Ravi Gupta
- Department of Psychiatry, All India Institute of Medical Science, Rishikesh, India
| | - Pankaj Sharma
- Department of Radiodiagnosis, All India Institute of Medical Science, Rishikesh, India
| | - Lokesh Kumar Saini
- Department of Pulmonary Medicine, All India Institute of Medical Science, Rishikesh, India
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Tayari H, Mocci R, Haji O, Dugdale AHA. Training satisfaction and well-being among veterinary anaesthesia residents: time for action. Vet Anaesth Analg 2023; 50:9-20. [PMID: 34838435 DOI: 10.1016/j.vaa.2021.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 03/29/2021] [Accepted: 06/02/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To explore the satisfaction and well-being experienced by anaesthesia residents during their training, and to investigate factors that may have influenced their experiences. STUDY DESIGN Cross-sectional online anonymous voluntary survey. SAMPLE POPULATION A total of 150 (of approximately 600 canvassed) former veterinary anaesthesia residents. METHODS Participants were invited to complete an internet-based survey regarding the satisfaction and well-being experienced during their residency. Multiple choice, categorical, dichotomous, Likert-type rating scales and slider questions were used to investigate five domains (demographic, working conditions, educational environment, training satisfaction, well-being). Sampling adequacy, questionnaire reliability and participant responses were investigated by Kaiser-Meyer-Olkin (KMO) indices, Cronbach's α and standard statistical techniques, respectively (p < 0.05). RESULTS The questionnaire demonstrated good sampling adequacy (median KMO index 0.74; range 0.51-0.89) and high item 'reliability' (α = 0.82-0.94). Of the 150 responders, (25% participation rate) 62% were satisfied, 14% were neutral and 24% were dissatisfied with their residency training; 60.6% would do the residency again, 39.3% would not or were unsure. Sex and age did not correlate with training satisfaction (p > 0.05). Salary/stipend was considered inadequate by 70% of responders; 66% received no on-call supplement. Greater supervisory input, a good working environment and extra income when on-call were positively correlated with training satisfaction (p < 0.01). The majority (94.6%) of trainees suffered from at least one medical condition during their residency, with fatigue, sleep disturbance or anxiety reported by > 62%. CONCLUSIONS Although a quarter of responders were dissatisfied with their residency, several modifiable factors were identified, particularly with respect to supervisors' input, working environment and pay, which could inform improvements for future residency programmes. Most trainees experienced negative health impacts; however, this parallels the general situation in both the medical and veterinary professions, which requires greater attention from the supervisors, trainees and colleges.
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Affiliation(s)
- Hamaseh Tayari
- ChesterGates Veterinary Specialists CVS UK (Ltd.), Chester, UK.
| | - Rita Mocci
- ChesterGates Veterinary Specialists CVS UK (Ltd.), Chester, UK
| | - Othamane Haji
- National Institute of Statistic and Applied Economics, (INSEA), Rabat, Morocco
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Li DJ, Wu HC, Chou FHC, Hsu ST, Huang JJ, Hsieh KY, Lin GG, Wu PJ. The social and mental impact on healthcare workers: A comparative and cross-sectional study during two waves of the COVID-19 pandemic in Taiwan. Medicine (Baltimore) 2022; 101:e31316. [PMID: 36281087 PMCID: PMC9592143 DOI: 10.1097/md.0000000000031316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has caused a heavily burden on healthcare workers (HCWs) worldwide. The aim of this study was to compare differences in psychological and social impact between two waves of the pandemic among first- and second-line HCWs in Taiwan. The current study derived data from two cross-sectional surveys conducted in 2020 and 2021. Levels of depression, sleep disturbance, psychological distress, social impact, and demographic variables were collected through self-reported questionnaires. The independent t test was used to compare differences in scores between the first and second wave of the pandemic. Differences between first- and second-line HCWs were also analyzed. A total of 711 HCWs in the first wave and 560 HCWs in the second wave were recruited. For the first- and second-line HCWs, the social impact during the second wave was higher than during the first wave, and they expressed a higher intention to maintain social distancing and were more aware of the pandemic overseas in the second wave. The first-line HCWs had a trend of worse sleep quality during the second wave. In addition, sleep quality was worse in the first-line HCWs than in the second-line HCWs during both waves. The second-line HCWs expressed a greater desire to seek COVID-19-related information than the first-line HCWs during the first wave, and more intended to maintain social distancing during the second wave. Our results show the importance of evaluating the social and mental health burden of HCWs, and especially first-line workers.
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Affiliation(s)
- Dian-Jeng Li
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
- Department of Nursing, Meiho University, Pingtung, Taiwan
| | - Hui-Ching Wu
- Department of Social Work, National Taiwan University, Taipei, Taiwan
| | | | - Su-Ting Hsu
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Joh-Jong Huang
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Medical Humanities and Education, Kaohsiung Medical University, Kaohsiung City, Taiwan
- * Correspondences: Joh-Jong Huang, Department of Health, Kaohsiung City Government, No. 132-1, Kaisyuan 2nd Rd., Lingya District, Kaohsiung 802212, Taiwan (e-mail: )
| | - Kuan-Ying Hsieh
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Guei-Ging Lin
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Pei-Jhen Wu
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
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Wang X, Xing K, He M, He T, Xiang X, Chen T, Zhang L, Li H. Time-restricted feeding is an intervention against excessive dark-phase sleepiness induced by obesogenic diet. Natl Sci Rev 2022; 10:nwac222. [PMID: 36825118 PMCID: PMC9942665 DOI: 10.1093/nsr/nwac222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/05/2022] [Accepted: 10/05/2022] [Indexed: 11/14/2022] Open
Abstract
High-fat diet (HFD)-induced obesity is a growing epidemic and major health concern. While excessive daytime sleepiness (EDS) is a common symptom of HFD-induced obesity, preliminary findings suggest that reduced wakefulness could be improved with time-restricted feeding (TRF). At present, however, the underlying neural mechanisms remain largely unknown. The paraventricular thalamic nucleus (PVT) plays a role in maintaining wakefulness. We found that chronic HFD impaired the activity of PVT neurons. Notably, inactivation of the PVT was sufficient to reduce and fragment wakefulness during the active phase in lean mice, similar to the sleep-wake alterations observed in obese mice with HFD-induced obesity. On the other hand, enhancing PVT neuronal activity consolidated wakefulness in mice with HFD-induced obesity. We observed that the fragmented wakefulness could be eliminated and reversed by TRF. Furthermore, TRF prevented the HFD-induced disruptions on synaptic transmission in the PVT, in a feeding duration-dependent manner. Collectively, our findings demonstrate that ad libitum access to a HFD results in inactivation of the PVT, which is critical to impaired nocturnal wakefulness and increased sleep, while TRF can prevent and reverse diet-induced PVT dysfunction and excessive sleepiness. We establish a link between TRF and neural activity, through which TRF can potentially serve as a lifestyle intervention against diet/obesity-related EDS.
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Affiliation(s)
- Xu Wang
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430074, China,MOE Key Laboratory for Biomedical Photonics, Collaborative Innovation Center for Biomedical Engineering, School of Engineering Sciences, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Keke Xing
- Department of Anatomy, Histology & Embryology, Fourth Military Medical University, Xi’an 710032, China
| | - Mengge He
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430074, China,MOE Key Laboratory for Biomedical Photonics, Collaborative Innovation Center for Biomedical Engineering, School of Engineering Sciences, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Ting He
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430074, China,MOE Key Laboratory for Biomedical Photonics, Collaborative Innovation Center for Biomedical Engineering, School of Engineering Sciences, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Xinkuan Xiang
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430074, China,MOE Key Laboratory for Biomedical Photonics, Collaborative Innovation Center for Biomedical Engineering, School of Engineering Sciences, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Tao Chen
- Department of Anatomy, Histology & Embryology, Fourth Military Medical University, Xi’an 710032, China
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16
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Nagasaki K, Nishizaki Y, Shinozaki T, Kobayashi H, Shimizu T, Okubo T, Yamamoto Y, Konishi R, Tokuda Y. Impact of the resident duty hours on in-training examination score: A nationwide study in Japan. Med Teach 2022; 44:433-440. [PMID: 34818129 DOI: 10.1080/0142159x.2021.2003764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE The relationship between duty hours (DH) and the performance of postgraduate residents is needed to establish appropriate DH limits. This study explores their relationship using the General Medicine In-training Examination (GM-ITE). MATERIALS AND METHODS In this cross-sectional study, GM-ITE examinees of 2019 had participated. We analyzed data from the examination and questionnaire, including DH per week (eight categories). We examined the association between DH and GM-ITE score, using random-intercept linear models with and without adjustments. RESULTS Five thousand five hundred and ninety-three participants (50.7% PGY-1, 31.6% female, 10.0% university hospitals) were included. Mean GM-ITE scores were lower among residents in Category 2 (45-50 h; mean score difference, -1.05; p < 0.001) and Category 4 (55-60 h; -0.63; p = 0.008) compared with residents in Category 5 (60-65 h; Reference). PGY-2 residents in Categories 2-4 had lower GM-ITE scores compared to those in Category 5. University residents in Category 1 and Category 5 showed a large mean difference (-3.43; p = 0.01). CONCLUSIONS DH <60-65 h per week was independently associated with lower resident performance, but more DH did not improve performance. DH of 60-65 h per week may be the optimal balance for a resident's education and well-being.
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Affiliation(s)
- Kazuya Nagasaki
- Department of Internal Medicine, Mito Kyodo General Hospital, University of Tsukuba, Ibaraki, Japan
| | - Yuji Nishizaki
- Division Medical Education, Juntendo University School of Medicine, Tokyo, Japan
| | - Tomohiro Shinozaki
- Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo, Japan
| | - Hiroyuki Kobayashi
- Department of Internal Medicine, Mito Kyodo General Hospital, University of Tsukuba, Ibaraki, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Tomoya Okubo
- Research Division, National Center for University Entrance Examinations, Tokyo, Japan
| | - Yu Yamamoto
- Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Ryota Konishi
- Education Adviser Japan Organization of Occupational Health and Safety, Kanagawa, Japan
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Toubasi AA, Khraisat BR, AbuAnzeh RB, Kalbouneh HM. A cross sectional study: The association between sleeping quality and stress among second and third medical students at the University of Jordan. Int J Psychiatry Med 2022; 57:134-152. [PMID: 33870751 DOI: 10.1177/00912174211011287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Medicine is considered one if not the most stressful educational field. Thus, the aim of this study is to investigate the prevalence of stress and poor sleeping quality among medical students and the association between them. METHOD This cross-sectional study was conducted at the University of Jordan on second- and third-year medical students. The questionnaire consisted of: 1) Demographics; 2) The assessment tools which were Pittsburgh Quality of Sleep Index (PSQI) and Kessler Psychological Distress Status (K10). Binary logistic regression, chi-square and linear regression were used to investigate the association between PSQI, K10, and their determinants. RESULTS The mean for PSQI score was 6.76 ± 3.32. PSQI scores interpretation revealed that 61.7% of the 282 participants of this study were poor sleepers. Logistic regression results showed that only the category of not napping at all from the napping hours variable was significantly associated with sleeping quality. Furthermore, the mean of K10 scores was 24.5 ± 8.5. K10 scores revealed that 66.3% of the participants were stressed. Logistic regression results showed that gender and regular exercise were significantly associated with psychological distress. Additionally, chi-square test, logistic regression and linear regression showed that PSQI was significantly associated with K10 (P <0.01). CONCLUSIONS Stress and poor sleeping quality in medical students at the University of Jordan were highly prevalent and strongly associated. What determined PSQI was daytime napping, and for K10 were regular exercise and gender. Further investigations into stress and sleep quality in the Arabian region are needed.
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Affiliation(s)
- A A Toubasi
- Faculty of Medicine, the University of Jordan, Amman, Jordan
| | - B R Khraisat
- Faculty of Medicine, the University of Jordan, Amman, Jordan
| | - R B AbuAnzeh
- Faculty of Medicine, the University of Jordan, Amman, Jordan
| | - H M Kalbouneh
- Faculty of Medicine, the University of Jordan, Amman, Jordan
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18
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Mendelsohn D. Self in medicine: Determinants of physician well-being and future directions in improving wellness. Med Educ 2022; 56:48-55. [PMID: 34559421 DOI: 10.1111/medu.14671] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 06/13/2023]
Abstract
CONTEXT Medicine, a profession dedicated to the wellness of patients, is struggling with a crisis of physician and trainee wellness. Physicians and trainees are burning out at alarming rates. Historically, medicine has been characterised by challenging working conditions and inattention to physician wellness and self-care. Healthy physicians are better at promoting wellness to their patients, and physicians who are suffering from burnout can deliver compromised patient care. DISCUSSION In recent years, research has increasingly focused on the causes of unwellness among doctors, and a broad range of health determinants have been identified. Studies of interventions for improving trainee and physician wellness have identified individual-focused and organisational approaches that can address the root causes of burnout. Insights from the corporate workplace may help guide interventions. Strategies for addressing physician burnout and improving wellness will involve innovative and multifaceted approaches. Despite a growing emphasis of physician wellness in the literature, implementation of wellness interventions is lagging, and quality improvement methods can address these challenges. CONCLUSION Physician wellness is a shared responsibility among doctors, health care organisations and governing bodies. Addressing burnout and improving physician wellness will require transformational change and the embracement of a culture of wellness in medicine. Quality improvement methods are the next step in identifying effective wellness interventions and the targeted groups of physicians and trainees who will most benefit.
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Affiliation(s)
- Daniel Mendelsohn
- Lions Gate Hospital, Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
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Ye H, Ji M, Wang C, Wang C, Li Y, Chen Y, Cheng L, Li Y, Yang JJ. Integrated Functional Neuroimaging, Monoamine Neurotransmitters, and Behavioral Score on Depressive Tendency in Intensive Care Unit Medical Staffs Induced by Sleep Deprivation After Night Shift Work. Front Psychiatry 2022; 13:848709. [PMID: 35392383 PMCID: PMC8980607 DOI: 10.3389/fpsyt.2022.848709] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Intensive care unit (ICU) medical staffs undergoing sleep deprivation with perennial night shift work were usually at high risk of depression. However, shift work on depression-related resting-state functional magnetic resonance imaging was still not fully understood. The objective of this study was to explore the effects of sleep deprivation in ICU medical staffs after one night of shift work on brain functional connectivity density (FCD) and Hamilton Depression Rating Scale (HAMD) scores. Also, serum neurotransmitter concentrations of serotonin (5-HT) and norepinephrine (NE) were obtained simultaneously. METHODS A total of 21 ICU medical staffs without psychiatric history were recruited. All participants received HAMD score assessment and resting-state functional magnetic resonance imaging scans at two time points: one at rested wakefulness and the other after sleep deprivation (SD) accompanied with one night of shift work. Global FCD, local FCD, and long-range FCD (lrFCD) were used to evaluate spontaneous brain activity in the whole brain. In the meantime, peripheral blood samples were collected for measurement of serum 5-HT and NE levels. All these data were acquired between 7:00 and 8:00 am to limit the influence of biological rhythms. The correlations between the FCD values and HAMD scores and serum levels of neurotransmitters were analyzed concurrently. RESULTS Functional connectivity density mapping manifested that global FCD was decreased in the right medial frontal gyrus and the anterior cingulate gyrus, whereas lrFCD was decreased mainly in the right medial frontal gyrus. Most of these brain areas with FCD differences were components of the default mode network and overlapped with the medial prefrontal cortex. The lrFCD in the medial frontal gyrus showed a negative correlation with HAMD scores after SD. Compared with rested wakefulness, serum levels of 5-HT and NE decreased significantly, whereas HAMD scores were higher after SD within subjects. CONCLUSIONS Our study suggested that sleep deprivation after night shift work can induce depressive tendency in ICU medical staffs, which might be related to alterative medial prefrontal cortex, raised HAMD scores, and varying monoamine neurotransmitters.
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Affiliation(s)
- Haotian Ye
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Muhuo Ji
- Department of Anesthesiology, The Second Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Chaoyan Wang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Cong Wang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying Li
- Department of Anesthesiology, Jiangyin Hospital, Affiliated to Southeast University Medical School, Jiangyin, China
| | - Yuan Chen
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lisha Cheng
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanfei Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jian-Jun Yang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Cleper R, Hertz-Palmor N, Mosheva M, Hasson-Ohayon I, Kaplan R, Kreiss Y, Afek A, Pessach IM, Gothelf D, Gross R. Sleep Difficulties Among COVID-19 Frontline Healthcare Workers. Front Psychiatry 2022; 13:838825. [PMID: 35573372 PMCID: PMC9098971 DOI: 10.3389/fpsyt.2022.838825] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/28/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To identify COVID-19 work-related stressors and experiences associated with sleep difficulties in HCW, and to assess the role of depression and traumatic stress in this association. METHODS A cross-sectional study of HCW using self-report questionnaires, during the first peak of the pandemic in Israel (April 2020), conducted in a large tertiary medical center in Israel. Study population included 189 physicians and nurses working in designated COVID-19 wards and a comparison group of 643 HCW. Mean age of the total sample was 41.7 ± 11.1, 67% were female, 42.1% physicians, with overall mean number of years of professional experience 14.2 ± 20. The exposure was working in COVID-19 wards and related specific stressors and negative experiences. Primary outcome measurement was the Insomnia Severity Index (ISI). Secondary outcomes included the Primary Care-Post Traumatic Stress Disorder Screen (PC-PTSD-5); the Patient Health Questionnaire-9 (PHQ-9) for depression; the anxiety module of the Patient-Reported Outcomes Measurement Information System (PROMIS); Pandemic-Related Stress Factors (PRSF) and witnessing patient suffering and death. RESULTS Compared with non-COVID-19 HCW, COVID-19 HCW were more likely to be male (41.3% vs. 30.7%) and younger (36.91 ± 8.81 vs. 43.14 ± 11.35 years). COVID-19 HCW reported higher prevalence of sleep difficulties: 63% vs. 50.7% in the non-COVID group (OR 1.62, 95% CI 1.15-2.29, p = 0.006), mostly difficulty maintaining sleep: 26.5% vs. 18.5% (OR 1.65, 95% CI 1.11-2.44, p = 0.012). Negative COVID-19 work-related experiences, specifically witnessing patient physical suffering and death, partially explained the association. Although past psychological problems and current depression and PTSD were associated with difficulty maintaining sleep, the main association remained robust also after controlling for those conditions in the full model. CONCLUSION AND RELEVANCE COVID-19 frontline HCW were more likely to report sleep difficulties, mainly difficulty maintaining sleep, as compared with non-COVID-19 HCW working at the same hospital. Negative patient-care related experiences likely mediated the increased probability for those difficulties. Future research is needed to elucidate the long-term trajectories of sleep difficulties among HCW during large scale outbreaks, and to identify risk factors for their persistence.
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Affiliation(s)
- Rony Cleper
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nimrod Hertz-Palmor
- The Chaim Sheba Medical Center, Ramat Gan, Israel.,School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Mariela Mosheva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Chaim Sheba Medical Center, Ramat Gan, Israel
| | | | | | - Yitshak Kreiss
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Arnon Afek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Itai M Pessach
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Doron Gothelf
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Raz Gross
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Chaim Sheba Medical Center, Ramat Gan, Israel
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21
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Slama EM, Batarseh L, Bryan F, Roberts A, Bokhari F, Cunningham SC, Kowdley GC. Wellbeing as Defined by Resident Physicians: A Qualitative Study. Am Surg 2021:31348211065092. [PMID: 34967682 DOI: 10.1177/00031348211065092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The importance of resident wellbeing is increasingly recognized by the ACGME as essential. While prior studies have quantified wellbeing/burnout, few have defined wellbeing from the resident-physician perspective. A REDCap® survey was distributed to residents in various programs, responses were grouped by theme, and data analyzed via chi-square. From 19 institutions, 53/670 responded, from university (34.0%), community (30.2%), and community/university-affiliated (30.2%) programs, mostly surgical (84.9%), followed by medical (9.4%). Wellbeing was defined by mental and spiritual/religious health (33.8%), overall health (23.0%), free time/time management (23.0%), and job/salary satisfaction (18.9%). Proposed changes to traditional training included fewer hours and more schedule flexibility (38.2%), and increased/improved support/feedback (14.7%). Nearly half of the respondents perceived lacking education on career longevity. Wellbeing is paramount to the personal/professional development of residents. Data on resident-defined wellbeing are lacking. The improved understanding of wellbeing defined here can be used to improve residency training programs.
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Affiliation(s)
- Eliza M Slama
- Department of Surgery, 21963Ascension Saint Agnes Hospital, Baltimore, MD, USA
| | - Laith Batarseh
- Department of Surgery, 21963Ascension Saint Agnes Hospital, Baltimore, MD, USA
| | - Francesca Bryan
- Department of Trauma and Burn, 25430Cook County Health, Chicago, IL, USA
| | - Andrew Roberts
- Department of Trauma and Burn, 25430Cook County Health, Chicago, IL, USA
| | - Faran Bokhari
- Department of Trauma and Burn, 25430Cook County Health, Chicago, IL, USA
| | - Steven C Cunningham
- Department of Surgery, 21963Ascension Saint Agnes Hospital, Baltimore, MD, USA
| | - Gopal C Kowdley
- Department of Surgery, 21963Ascension Saint Agnes Hospital, Baltimore, MD, USA
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22
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Durán-Gómez N, Guerrero-Martín J, Pérez-Civantos D, López-Jurado CF, Montanero-Fernández J, Cáceres MC. Night Shift and Decreased Brain Activity of ICU Nurses: A Near-Infrared Spectroscopy Study. Int J Environ Res Public Health 2021; 18:ijerph182211930. [PMID: 34831683 PMCID: PMC8623720 DOI: 10.3390/ijerph182211930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 12/02/2022]
Abstract
Background: Shift working is associated with a profound desynchronization of circadian rhythm and in particular, night-shift work disrupts normal circadian physiology. Sleep deprivation affects the functioning of certain brain areas and thus impairs cognitive performance. The purpose of this study was to investigate the effects of the night shift on cognitive performance and cerebral oxygenation/haemodynamics. Methods: A prospective, observational, comparative, randomized and cross-over study was carried out. A total of 74 intensive care unit nurses in Spain were included in the study. The following variables were measured: sociodemographic, burnout, anxiety, baseline cerebral oxygenation levels on night and day shift using a near-infrared spectroscopy system and cognitive task performance during a verbal fluency task to evaluate the alterations in the prefrontal cortex, assessed as changes in regional saturation index. Results: The average regional saturation index decreased significantly in the night shift (r = 0.560, p < 0.001). The ICU nurses showed a significant decrease in the verbal fluency test on average (8.53 ± 8.49, p < 0.001) and, in general, there was also a significant increase in anxiety score (3.17 ± 7.56, p = 0.001). Conclusions: Sleep deprivation during the night shift was considered to be related to decreased dorsolateral PFC reactivity. After the night shift, the nurses showed a decrease in prefrontal cortex activity and in cognitive performance.
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Affiliation(s)
- Noelia Durán-Gómez
- Departamento de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, 06006 Badajoz, Spain; (J.G.-M.); (C.F.L.-J.); (M.C.C.)
- Correspondence: ; Tel.: +34-92-428-9466
| | - Jorge Guerrero-Martín
- Departamento de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, 06006 Badajoz, Spain; (J.G.-M.); (C.F.L.-J.); (M.C.C.)
| | - Demetrio Pérez-Civantos
- Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, Hospital Universitario de Badajoz, 06006 Badajoz, Spain;
| | - Casimiro Fermín López-Jurado
- Departamento de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, 06006 Badajoz, Spain; (J.G.-M.); (C.F.L.-J.); (M.C.C.)
| | - Jesús Montanero-Fernández
- Departamento de Matemáticas, Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, 06006 Badajoz, Spain;
| | - Macarena C. Cáceres
- Departamento de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, 06006 Badajoz, Spain; (J.G.-M.); (C.F.L.-J.); (M.C.C.)
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Alhamam NM, Buhalim RA, Alsaeed MN, Alfuraikh BF, Aljughaiman MS. Low back pain and its correlations with poor sleep quality among health care providers. J Taibah Univ Med Sci 2021. [PMID: 35140562 PMCID: PMC8801478 DOI: 10.1016/j.jtumed.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/08/2021] [Accepted: 09/01/2021] [Indexed: 11/24/2022] Open
Abstract
Objective Methods Results Conclusion
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24
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Trockel M, Sinsky C, West CP, Dyrbye LN, Tutty M, Carlasare L, Wang H, Shanafelt T. Self-Valuation Challenges in the Culture and Practice of Medicine and Physician Well-being. Mayo Clin Proc 2021; 96:2123-2132. [PMID: 34210511 DOI: 10.1016/j.mayocp.2020.12.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/01/2020] [Accepted: 12/14/2020] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare physicians with workers in other fields on measures of self-valuation (SV) and determine the effect of adjusting for SV on the relationship between being a physician and risk for burnout. PATIENTS AND METHODS A random sample of physicians from the American Medical Association Physician Masterfile and a probability sample from the general US population were used. Data were collected for this cross-sectional study between October 12, 2017 and March 15, 2018. Burnout was indicated by a score of 27 or higher on Emotional Exhaustion or 10 or higher on Depersonalization, using the Maslach Burnout Inventory. Self-valuation was measured with Self-valuation Scale items. RESULTS Physicians (248/832=29.8%) more than workers in other fields (1036/5182=20.0%) "often" or "always" felt more self-condemnation than self-encouragement to learn from the experience when they made a mistake. Physicians (435/832=52.3%) more than workers in other fields (771/5182=14.9%) "often" or "always" put off taking care of their own health due to time pressure. Physicians had greater odds of burnout before (odds ratio [OR], 1.51; 95% CI, 1.30 to 1.76) but not after adjusting for SV responses (OR, 0.93; 95% CI, 0.78 to 1.11). After adjustment for SV, work hours, sex, and age, physicians had lower odds of burnout than workers in other fields (OR, 0.82; 95% CI, 0.68 to 0.99). CONCLUSION Self-valuation is lower in physicians compared with workers in other fields and adjusting for SV eliminated the association between being a physician and higher risk for burnout. Experimental design research is needed to determine whether the association of SV with burnout is causal and the degree to which SV is malleable to intervention at individual, organization, and professional culture levels.
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Affiliation(s)
| | | | | | | | | | | | - Hanhan Wang
- Stanford University School of Medicine, Palo Alto, CA
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25
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Doglikuu BID, Djazayery A, Mirzababaei A, Sajjadi SF, Badruj N, Mirzaei K. Does Interaction between Sleep Quality and Major Dietary Patterns Predicts Depression among Overweight and Obese Women in Iran? Iran J Public Health 2021; 50:1445-1453. [PMID: 34568184 PMCID: PMC8426790 DOI: 10.18502/ijph.v50i7.6635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/12/2020] [Indexed: 12/19/2022]
Abstract
Background: Although major dietary patterns and sleep quality independently affect psychiatric disorders, their interactive association on depression is not clear. This study assesses the independent association of dietary patterns and sleep quality on depression, and also investigates their interactive associations on depression among overweight and obese women in Iran Methods: Cross-sectional study was conducted among 304 participants, age 18 and above in 2018 at Tehran Iran. Usual dietary intake was collected with 174-FFQ. Participants’ biochemical parameters and depression were measured using standard protocol. Major dietary patterns were extracted by factor analysis and grouped into Fruits&Vegetable group (healthy dietary pattern), High Fat diary&Red Meat group (unhealthy dietary pattern) and Crackers&High Energy Drinks group (western dietary patterns). Results: After adjusting for confounders poor sleep was associated with moderate and high depression; AOR (95%CI): 0.41(0.19–0.90) and 0.29(0.13–0.60) respectively. However, healthy dietary patterns (tertiles 2nd and 3rd) interact with sleep for depression; AOR (95%CI): 4.168(1.166–14.992) and 2.966(1.068–8.234) respectively. Unhealthy dietary pattern tertiles 2nd and 3rd interact with sleep for depression; AOR (95%CI): 2.925(1.055–8.113) and 4.216(1.182–15.042) respectively and Western dietary pattern tertile 3rd interacts with sleep for depression; AOR (95%CI): 4.264(1.494–12.169). Conclusion: Sleep deprivation could be associated with depression. However, sleep quality could interacts with dietary patterns to be associate with depression among overweight and obese people.
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Affiliation(s)
- Be-Ikuu Dominic Doglikuu
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, International Campus, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Ministry of Health, Nursing and Midwifery Training College, Twifo Praso, Central Region, Ghana
| | - Abolghassem Djazayery
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Atieh Mirzababaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Seyedeh Forough Sajjadi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Negin Badruj
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Khadijeh Mirzaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Abstract
Stress is one of the major problems globally, associated with poor sleep quality and cognitive dysfunction. Modern society is plagued by sleep disturbances, either due to professional demands or lifestyle or both the aspects, often leading to reduced alertness and compromised mental function, besides the well documented ill effects of disturbed sleep on physiological functions. This pertinent issue needs to be addressed. Yoga is an ancient Indian science, philosophy and way of life. Recently, yoga practice has become increasingly popular worldwide. Yoga practice is an adjunct effective for stress, sleep and associated disorders. There are limited well controlled published studies conducted in this area. We reviewed the available literature including the effect of modern lifestyle in children, adolescents, adults and geriatric population. The role of yoga and meditation in optimizing sleep architecture and cognitive functions leading to optimal brain functioning in normal and diseased state is discussed. We included articles published in English with no fixed time duration for literature search. Literature was searched mainly by using PubMed and Science Direct search engines and critically examined. Studies have revealed positive effects of yoga on sleep and cognitive skills among healthy adults as well as patients of some neurological diseases. Further, on evaluating the published studies, it is concluded that sleep and cognitive functions are optimized by yoga practice, which brings about changes in autonomic function, structural changes, changes in metabolism, neurochemistry and improved functional brain network connectivity in key regions of the brain.
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Affiliation(s)
- Usha Panjwani
- Department of Neurophysiology, Defence Institute of Physiology and Allied Sciences, DRDO, Delhi, India
| | - Sharmila Dudani
- Department of Pathology, Army College of Medical Sciences, Delhi Cantonment, New Delhi, India
| | - Meetu Wadhwa
- Department of Medicine, University of California, San Francisco, California, USA
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Abstract
PURPOSE To explore the prevalence of major anxiety and its associated risk factors in residents in China. METHOD This multicenter, cross-sectional study was conducted from December 2019 to February 2020; 1,343 residents from 8 hospitals in Northeast China were included in the final analysis (effective response rate of 86.48%). Demographic characteristics, dietary habits, life-related factors, work-related factors, and psychological characteristics were collected from participants via a self-reported questionnaire. This questionnaire measured sleep quality, physical activity, anxiety, perceived organizational support, psychological capital, and burnout. Adjusted odds ratios (ORs) and 95% confidence intervals were determined using binary logistic regression. Cutoff values and the area under the curve were calculated for risk factors using receiver operating characteristic curve analysis. RESULTS Of participants, 441 (32.80%) reported anxiety symptoms and 133 (9.90%) reported major anxiety symptoms. Four independent risk factors for major anxiety were identified: poor sleep quality (OR = 1.282, P < .001) and 3 dimensions of burnout: higher emotional exhaustion (OR = 1.085, P < .001), higher depersonalization (OR = 1.064, P = .002), and reduced personal accomplishment (OR = 0.951, P < .001). The optimal cutoff values for these risk factors were 7, 10, 9, and 22 scores, respectively. CONCLUSIONS This study found a considerable prevalence of major anxiety symptoms in residents in China and identified poor sleep quality and higher levels of burnout as having a close association with major anxiety. These findings enrich the existing literature on anxiety and demonstrate a critical need for additional studies that investigate intervention strategies to improve sleep quality and combat burnout, which could improve the mental health of residents.
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Affiliation(s)
- Song Bai
- S. Bai is associate professor, Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qing Chang
- Q. Chang is associate director, Department of Graduate Medical Education, Health Service Center of Liaoning Province, Shenyang, China
| | - Da Yao
- D. Yao is a student, Department of Graduate Medical Education, Health Service Center of Liaoning Province, Shenyang, China
| | - Yixiao Zhang
- Y. Zhang is a resident, Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bin Wu
- B. Wu is director, Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yuhong Zhao
- Y. Zhao is director, Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
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Abstract
Excessive daytime sleepiness (EDS) is a highly prevalent condition that is associated with significant morbidity. The causes of EDS are varied, and include inadequate sleep, sleep disordered breathing, circadian rhythm sleep-wake disorders, and central disorders of hypersomnolence (narcolepsy, idiopathic hypersomnia, and Kleine-Levin syndrome). Additionally, EDS could represent a symptom of an underlying medical or psychiatric disorder. Assessment of EDS includes a thorough sleep, medical, and psychiatric history, targeted clinical examination, and appropriate use of actigraphy to measure sleep duration and sleep-wake patterns, polysomnography to assess for associated conditions such as sleep-related breathing disorders or other factors that might disrupt nighttime sleep, multiple sleep latency testing to ascertain objective sleepiness and diagnose central disorders of hypersomnolence, and measurement of cerebrospinal fluid hypocretin-1 concentration. Treatment of EDS secondary to central disorders of hypersomnolence is primarily pharmacologic with wakefulness-promoting agents such as modafinil, stimulants such as methylphenidate and amphetamines, and newer agents specifically designed to improve wakefulness; behavioral interventions can provide a useful adjunct to pharmacologic treatment. When excessive sleepiness is secondary to other conditions, the treatment should focus on targeting the primary disorder. This review discusses current epidemiology, provides guidance on clinical assessments and testing, and discusses the latest treatment options. For this review, we collated the latest evidence using the search terms excessive sleepiness, hypersomnia, hypersomnolence, treatment from PubMed and MEDLINE and the latest practice parameters from the American Academy of Sleep Medicine.
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Affiliation(s)
- Kriti D Gandhi
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | | | - Michael H Silber
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN
| | - Bhanu Prakash Kolla
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN; Center for Sleep Medicine, Mayo Clinic, Rochester, MN.
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Zhang S, Ring J, Methot M, Zevin B. Medication Errors in Surgery: A Classification Taxonomy and a Pilot Study in Postcall Residents. J Surg Res 2021; 264:402-407. [PMID: 33848839 DOI: 10.1016/j.jss.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/03/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The post-call state in postgraduate medical trainees is associated with impaired decision-making and increased medical errors. An association between post-call state and medication prescription errors for surgery residents is yet to be established. Our objective was to determine whether post-call state is associated with increased proportion of medication prescription errors committed by surgery residents in an academic hospital without a computerized physician order entry (CPOE) system. METHODS This prospective observational study was conducted at a tertiary academic hospital between June 28 and August 31, 2017. It compared the proportion of medication prescription errors committed by surgery residents in their post-call (PC) and no-call (NC) states. A novel taxonomy was developed to classify medication prescription errors. RESULTS Sixteen of twenty-one eligible residents (76%) participated in this study. Self-reported hours of sleep per night was significantly higher in the NC group compared to the PC group (6(4-8) vs 2(0-4) hours, P < 0.01). PC residents committed a significantly higher proportion of medication prescription errors versus NC residents (9.2% vs 3.2%; p=0.04). Decision-making and prescription-writing errors comprised 33% and 67% of errors, respectively. CONCLUSIONS The post-call state in surgery residents is associated with a significantly higher proportion of medication prescription errors in a hospital without a CPOE system. Decision-making and prescription-writing errors could potentially be addressed by additional educational interventions.
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Affiliation(s)
- Shannon Zhang
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Justine Ring
- Division of Plastic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Boris Zevin
- Department of Surgery, Queen's University, Kingston, Ontario, Canada.
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Abstract
This study investigated the risk of insomnia and hypnotics use among emergency physicians. This cross-sectional study recruited physicians working in Taiwanese hospitals in 2015 and the general population as the participants. Data from 1,097 emergency physicians obtained from the National Health Insurance Research Database were grouped into the case group, whereas 14,112 nonemergency physicians and 4,388 people from the general population were categorized into the control groups. This study used logistic regression and conditional logistic regression to compare the risks of insomnia between emergency and nonemergency physicians and between emergency physicians and the general population, respectively. The prevalence of insomnia among emergency physicians, nonemergency physicians and general population was 5.56%, 4.08%, and 1.73%, respectively. Compared with nonemergency physicians and the general population, emergency physicians had a significantly higher risk of insomnia. The proportions of emergency physicians, nonemergency physicians, and general population using hypnotics were 19.96%, 18.24%, and 13.26%, respectively. Among emergency physicians who used hypnotics, 49.77%, 25.57%, and 24.66% used only benzodiazepines, only nonbenzodiazepines, and both benzodiazepines and nonbenzodiazepines, respectively. Nonpharmacological interventions to improve insomnia and reminder of safe use of hypnotics to emergency physicians can serve as references for hospitals in developing health-promoting activities.
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Affiliation(s)
- Yih-Farng Liou
- Department of Internal Medicine, Feng Yuan Hospital, Ministry of Health and Welfare, Taiwan (R.O.C.)
- Institute of Medicine, Chung Shan Medical University, Taiwan (R.O.C.)
| | - Shu-Fen Li
- Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taiwan (R.O.C.)
| | - Chin-Chih Ho
- Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taiwan (R.O.C.)
| | - Mei-Wen Lee
- Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taiwan (R.O.C.)
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Wu Y, Jiang F, Wu S, Liu Y, Tang YL. Sleep duration and satisfaction among physicians in tertiary public hospitals in China: a large sample national survey. J Occup Med Toxicol 2021; 16:8. [PMID: 33663542 PMCID: PMC7934372 DOI: 10.1186/s12995-021-00298-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 02/25/2021] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES To investigate the sleep duration and level of satisfaction among physicians in tertiary public hospitals in China, and to explore associated factors. METHODS A national online cross-sectional survey was conducted. Totally 20,786 physicians from 136 hospitals participated in the survey. Data were collected using an online self-reported questionnaire. Descriptive and logistic regression statistics were performed using the STATA software. RESULTS The mean total sleep duration was 6.37 ± 0.87 h. Of all participants, 61.06% (n = 12,691) reported short sleep duration (less than 7 h per day). 46.97% (n = 9764) were not satisfied with their sleep. An older age and job-related factors (longer working hours per week, specialty including internal medicine, Ob/GYN and emergency medicine, working more night shifts, heavier workload, and working in East China) were significantly associated with reported short sleep duration. CONCLUSIONS The majority of physicians in Chinese public hospitals experienced insufficient sleep duration. Changes are required to improve the wellbeing of physicians and patient outcomes.
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Affiliation(s)
- Yinuo Wu
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Feng Jiang
- Institute of Health Yangtze River Delta, Shanghai Jiao Tong University, 1954 Huashan, Xuhui District, Shanghai, 200030 China
| | - Shichao Wu
- Peking University Shenzhen Hospital, Shenzhen, China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, 5 Dongdan Santiao, Dongcheng District, Beijing, 100730 China
| | - Yi-Lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA USA
- Atlanta VA Medical Center, Decatur, GA USA
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32
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Hajdu SD, Kaesmacher J, Michel P, Sirimarco G, Knebel JF, Bartolini B, Kurmann CC, Puccinelli F, Mosimann PJ, Bonvin C, Arnold M, Niederhäuser J, Eskandari A, Mordasini P, Gralla J, Fischer U, Saliou G. Association of Time of Day When Endovascular Therapy for Stroke Starts and Functional Outcome. Neurology 2021; 96:e1124-e1136. [PMID: 33397770 PMCID: PMC8055343 DOI: 10.1212/wnl.0000000000011449] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/28/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate the association between endovascular therapy (EVT) start time in acute ischemic stroke (AIS) and midterm functional outcome. METHODS This retrospective cohort study included all patients with AIS treated with EVT from 2 stroke center registries from January 2012 to December 2018. The primary outcome was the score on the modified Rankin Scale (mRS) and the utility-weighted mRS (uw-mRS) at 90 days. A proportional odds model was used to calculate the common odds ratio (OR) as a measure of the likelihood that the intervention at a given EVT start time would lead to lower scores on the mRS (shift analysis). RESULTS A total of 1,558 cases were equally allotted into 12 EVT start time periods. The primary outcome favored EVT start times in the morning at 08:00-10:20 and 10:20-11:34 (OR, 0.53; 95% confidence interval [CI], 0.38 to 0.75; p < 0.001; OR, 0.62; 95% CI, 0.44 to 0.87; p = 0.006, respectively), while it disfavored EVT start times at the end of the working day at 15:55-17:15 and 18:55-20:55 (OR, 1.47; 95% CI, 1.03-2.09; p = 0.034; OR, 1.49; 95% CI, 1.03-2.15; p = 0.033). Symptom onset to EVT start time was significantly higher and use of IV tissue plasminogen activator significantly lower between 10:20 and 11:34 (p < 0.004 and p = 0.012, respectively). CONCLUSION EVT for AIS in the morning leads to better midterm functional outcome, while EVT at the end of the work day leads to poorer midterm functional outcome. Difference in baseline factors, standard workflow, and technical efficacy metrics could not be identified as potential mediators of this effect.
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Affiliation(s)
- Steven D Hajdu
- From the Department of Interventional and Diagnostic Radiology (S.D.H., B.B., F.P., G. Saliou), Department of Neurology (P. Michel, G. Sirimarco, A.E.), and Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology, Department of Clinical Neurosciences, EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) (J.-F.K.), Lausanne University Hospital, University of Lausanne; University Institute for Diagnostic, Interventional and Pediatric Radiology (J.K., C.C.K., M.A., U.F.), University Institute for Diagnostic and Interventional Neuroradiology (P.J.M., P. Mordasini, J.G.), University Hospital of Bern, University of Bern; Department of Neurology (C.B.), Sion Hospital; and Department of Neurology (J.N.), Nyon Regional Hospital, Switzerland.
| | - Johannes Kaesmacher
- From the Department of Interventional and Diagnostic Radiology (S.D.H., B.B., F.P., G. Saliou), Department of Neurology (P. Michel, G. Sirimarco, A.E.), and Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology, Department of Clinical Neurosciences, EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) (J.-F.K.), Lausanne University Hospital, University of Lausanne; University Institute for Diagnostic, Interventional and Pediatric Radiology (J.K., C.C.K., M.A., U.F.), University Institute for Diagnostic and Interventional Neuroradiology (P.J.M., P. Mordasini, J.G.), University Hospital of Bern, University of Bern; Department of Neurology (C.B.), Sion Hospital; and Department of Neurology (J.N.), Nyon Regional Hospital, Switzerland
| | - Patrik Michel
- From the Department of Interventional and Diagnostic Radiology (S.D.H., B.B., F.P., G. Saliou), Department of Neurology (P. Michel, G. Sirimarco, A.E.), and Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology, Department of Clinical Neurosciences, EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) (J.-F.K.), Lausanne University Hospital, University of Lausanne; University Institute for Diagnostic, Interventional and Pediatric Radiology (J.K., C.C.K., M.A., U.F.), University Institute for Diagnostic and Interventional Neuroradiology (P.J.M., P. Mordasini, J.G.), University Hospital of Bern, University of Bern; Department of Neurology (C.B.), Sion Hospital; and Department of Neurology (J.N.), Nyon Regional Hospital, Switzerland
| | - Gaia Sirimarco
- From the Department of Interventional and Diagnostic Radiology (S.D.H., B.B., F.P., G. Saliou), Department of Neurology (P. Michel, G. Sirimarco, A.E.), and Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology, Department of Clinical Neurosciences, EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) (J.-F.K.), Lausanne University Hospital, University of Lausanne; University Institute for Diagnostic, Interventional and Pediatric Radiology (J.K., C.C.K., M.A., U.F.), University Institute for Diagnostic and Interventional Neuroradiology (P.J.M., P. Mordasini, J.G.), University Hospital of Bern, University of Bern; Department of Neurology (C.B.), Sion Hospital; and Department of Neurology (J.N.), Nyon Regional Hospital, Switzerland
| | - Jean-Francois Knebel
- From the Department of Interventional and Diagnostic Radiology (S.D.H., B.B., F.P., G. Saliou), Department of Neurology (P. Michel, G. Sirimarco, A.E.), and Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology, Department of Clinical Neurosciences, EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) (J.-F.K.), Lausanne University Hospital, University of Lausanne; University Institute for Diagnostic, Interventional and Pediatric Radiology (J.K., C.C.K., M.A., U.F.), University Institute for Diagnostic and Interventional Neuroradiology (P.J.M., P. Mordasini, J.G.), University Hospital of Bern, University of Bern; Department of Neurology (C.B.), Sion Hospital; and Department of Neurology (J.N.), Nyon Regional Hospital, Switzerland
| | - Bruno Bartolini
- From the Department of Interventional and Diagnostic Radiology (S.D.H., B.B., F.P., G. Saliou), Department of Neurology (P. Michel, G. Sirimarco, A.E.), and Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology, Department of Clinical Neurosciences, EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) (J.-F.K.), Lausanne University Hospital, University of Lausanne; University Institute for Diagnostic, Interventional and Pediatric Radiology (J.K., C.C.K., M.A., U.F.), University Institute for Diagnostic and Interventional Neuroradiology (P.J.M., P. Mordasini, J.G.), University Hospital of Bern, University of Bern; Department of Neurology (C.B.), Sion Hospital; and Department of Neurology (J.N.), Nyon Regional Hospital, Switzerland
| | - Christoph C Kurmann
- From the Department of Interventional and Diagnostic Radiology (S.D.H., B.B., F.P., G. Saliou), Department of Neurology (P. Michel, G. Sirimarco, A.E.), and Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology, Department of Clinical Neurosciences, EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) (J.-F.K.), Lausanne University Hospital, University of Lausanne; University Institute for Diagnostic, Interventional and Pediatric Radiology (J.K., C.C.K., M.A., U.F.), University Institute for Diagnostic and Interventional Neuroradiology (P.J.M., P. Mordasini, J.G.), University Hospital of Bern, University of Bern; Department of Neurology (C.B.), Sion Hospital; and Department of Neurology (J.N.), Nyon Regional Hospital, Switzerland
| | - Francesco Puccinelli
- From the Department of Interventional and Diagnostic Radiology (S.D.H., B.B., F.P., G. Saliou), Department of Neurology (P. Michel, G. Sirimarco, A.E.), and Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology, Department of Clinical Neurosciences, EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) (J.-F.K.), Lausanne University Hospital, University of Lausanne; University Institute for Diagnostic, Interventional and Pediatric Radiology (J.K., C.C.K., M.A., U.F.), University Institute for Diagnostic and Interventional Neuroradiology (P.J.M., P. Mordasini, J.G.), University Hospital of Bern, University of Bern; Department of Neurology (C.B.), Sion Hospital; and Department of Neurology (J.N.), Nyon Regional Hospital, Switzerland
| | - Pascal J Mosimann
- From the Department of Interventional and Diagnostic Radiology (S.D.H., B.B., F.P., G. Saliou), Department of Neurology (P. Michel, G. Sirimarco, A.E.), and Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology, Department of Clinical Neurosciences, EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) (J.-F.K.), Lausanne University Hospital, University of Lausanne; University Institute for Diagnostic, Interventional and Pediatric Radiology (J.K., C.C.K., M.A., U.F.), University Institute for Diagnostic and Interventional Neuroradiology (P.J.M., P. Mordasini, J.G.), University Hospital of Bern, University of Bern; Department of Neurology (C.B.), Sion Hospital; and Department of Neurology (J.N.), Nyon Regional Hospital, Switzerland
| | - Christophe Bonvin
- From the Department of Interventional and Diagnostic Radiology (S.D.H., B.B., F.P., G. Saliou), Department of Neurology (P. Michel, G. Sirimarco, A.E.), and Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology, Department of Clinical Neurosciences, EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) (J.-F.K.), Lausanne University Hospital, University of Lausanne; University Institute for Diagnostic, Interventional and Pediatric Radiology (J.K., C.C.K., M.A., U.F.), University Institute for Diagnostic and Interventional Neuroradiology (P.J.M., P. Mordasini, J.G.), University Hospital of Bern, University of Bern; Department of Neurology (C.B.), Sion Hospital; and Department of Neurology (J.N.), Nyon Regional Hospital, Switzerland
| | - Marcel Arnold
- From the Department of Interventional and Diagnostic Radiology (S.D.H., B.B., F.P., G. Saliou), Department of Neurology (P. Michel, G. Sirimarco, A.E.), and Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology, Department of Clinical Neurosciences, EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) (J.-F.K.), Lausanne University Hospital, University of Lausanne; University Institute for Diagnostic, Interventional and Pediatric Radiology (J.K., C.C.K., M.A., U.F.), University Institute for Diagnostic and Interventional Neuroradiology (P.J.M., P. Mordasini, J.G.), University Hospital of Bern, University of Bern; Department of Neurology (C.B.), Sion Hospital; and Department of Neurology (J.N.), Nyon Regional Hospital, Switzerland
| | - Julien Niederhäuser
- From the Department of Interventional and Diagnostic Radiology (S.D.H., B.B., F.P., G. Saliou), Department of Neurology (P. Michel, G. Sirimarco, A.E.), and Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology, Department of Clinical Neurosciences, EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) (J.-F.K.), Lausanne University Hospital, University of Lausanne; University Institute for Diagnostic, Interventional and Pediatric Radiology (J.K., C.C.K., M.A., U.F.), University Institute for Diagnostic and Interventional Neuroradiology (P.J.M., P. Mordasini, J.G.), University Hospital of Bern, University of Bern; Department of Neurology (C.B.), Sion Hospital; and Department of Neurology (J.N.), Nyon Regional Hospital, Switzerland
| | - Ashraf Eskandari
- From the Department of Interventional and Diagnostic Radiology (S.D.H., B.B., F.P., G. Saliou), Department of Neurology (P. Michel, G. Sirimarco, A.E.), and Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology, Department of Clinical Neurosciences, EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) (J.-F.K.), Lausanne University Hospital, University of Lausanne; University Institute for Diagnostic, Interventional and Pediatric Radiology (J.K., C.C.K., M.A., U.F.), University Institute for Diagnostic and Interventional Neuroradiology (P.J.M., P. Mordasini, J.G.), University Hospital of Bern, University of Bern; Department of Neurology (C.B.), Sion Hospital; and Department of Neurology (J.N.), Nyon Regional Hospital, Switzerland
| | - Pasquale Mordasini
- From the Department of Interventional and Diagnostic Radiology (S.D.H., B.B., F.P., G. Saliou), Department of Neurology (P. Michel, G. Sirimarco, A.E.), and Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology, Department of Clinical Neurosciences, EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) (J.-F.K.), Lausanne University Hospital, University of Lausanne; University Institute for Diagnostic, Interventional and Pediatric Radiology (J.K., C.C.K., M.A., U.F.), University Institute for Diagnostic and Interventional Neuroradiology (P.J.M., P. Mordasini, J.G.), University Hospital of Bern, University of Bern; Department of Neurology (C.B.), Sion Hospital; and Department of Neurology (J.N.), Nyon Regional Hospital, Switzerland
| | - Jan Gralla
- From the Department of Interventional and Diagnostic Radiology (S.D.H., B.B., F.P., G. Saliou), Department of Neurology (P. Michel, G. Sirimarco, A.E.), and Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology, Department of Clinical Neurosciences, EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) (J.-F.K.), Lausanne University Hospital, University of Lausanne; University Institute for Diagnostic, Interventional and Pediatric Radiology (J.K., C.C.K., M.A., U.F.), University Institute for Diagnostic and Interventional Neuroradiology (P.J.M., P. Mordasini, J.G.), University Hospital of Bern, University of Bern; Department of Neurology (C.B.), Sion Hospital; and Department of Neurology (J.N.), Nyon Regional Hospital, Switzerland
| | - Urs Fischer
- From the Department of Interventional and Diagnostic Radiology (S.D.H., B.B., F.P., G. Saliou), Department of Neurology (P. Michel, G. Sirimarco, A.E.), and Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology, Department of Clinical Neurosciences, EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) (J.-F.K.), Lausanne University Hospital, University of Lausanne; University Institute for Diagnostic, Interventional and Pediatric Radiology (J.K., C.C.K., M.A., U.F.), University Institute for Diagnostic and Interventional Neuroradiology (P.J.M., P. Mordasini, J.G.), University Hospital of Bern, University of Bern; Department of Neurology (C.B.), Sion Hospital; and Department of Neurology (J.N.), Nyon Regional Hospital, Switzerland
| | - Guillaume Saliou
- From the Department of Interventional and Diagnostic Radiology (S.D.H., B.B., F.P., G. Saliou), Department of Neurology (P. Michel, G. Sirimarco, A.E.), and Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology, Department of Clinical Neurosciences, EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) (J.-F.K.), Lausanne University Hospital, University of Lausanne; University Institute for Diagnostic, Interventional and Pediatric Radiology (J.K., C.C.K., M.A., U.F.), University Institute for Diagnostic and Interventional Neuroradiology (P.J.M., P. Mordasini, J.G.), University Hospital of Bern, University of Bern; Department of Neurology (C.B.), Sion Hospital; and Department of Neurology (J.N.), Nyon Regional Hospital, Switzerland
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Lee JY, Lee JW, Choi WS, Myong JP. Dose-Response Relationship between Night Work and the Prevalence of Impaired Fasting Glucose: The Korean Worker's Special Health Examination for Night Workers Cohort. Int J Environ Res Public Health 2021; 18:1854. [PMID: 33672896 DOI: 10.3390/ijerph18041854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 12/16/2022]
Abstract
Many studies have been conducted regarding the association between night work and diabetes, but the association between impaired fasting glucose (IFG) and night work is still unclear. The aim of this study was to evaluate this association using the Special Health Examination (SHEW) for Korean night workers. Laboratory, questionnaire, and physical examination data were collected for 80,077 manual workers between 2014 and 2016 from Korea Medical Institute, and associations of the data with IFG were evaluated using a multivariate logistic regression model. The odds ratios for IFG among those who worked night shifts for 2~5 years, 5~12 years, and 12 years or over (ref: <2 years) after adjusting for abdominal obesity were 1.14 (0.90–1.45), 1.41 (1.10–1.81), and 1.75 (1.41–2.19), respectively. A dose–response relationship was identified between the duration of night work and the prevalence of IFG (p for trend <0.05). A dose relationship remained significant when a subgroup of non-obese participants was analyzed. We identified an association and a dose–response relationship between the number of years of night work and IFG. To prevent the development of diabetes in night workers, we suggest that they should be pre-emptively screened and treated from the stage of IFG.
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Kelly-Schuette K, Shaker T, Carroll J, Davis AT, Wright GP, Chung M. A Prospective Observational Study Comparing Effects of Call Schedules on Surgical Resident Sleep and Physical Activity Using the Fitbit. J Grad Med Educ 2021; 13:113-118. [PMID: 33680310 PMCID: PMC7901626 DOI: 10.4300/jgme-d-20-00304.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/02/2020] [Accepted: 09/10/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Surgical residency training has an extended tradition of long hours. Residency programs use a variety of call schedules to combat resident fatigue and sleep deprivation while maintaining adherence to duty hour restrictions. Nonetheless, there is a paucity of data regarding objective measurements of sleep during the different call schedules included in general surgery training. OBJECTIVE The primary objective of this study was to compare the quantity of sleep in 24-hour time frames across all types of shifts worked by general surgery residents at our institution. The secondary objective was to measure activity level in total steps during various time frames. METHODS This prospective observational study was performed between April 4 and August 26, 2018, with general surgery residents. Each resident was assigned a Fitbit Charge 2 to wear during all rotations, including general surgery and subspecialty services. RESULTS Twenty-six out of 31 residents voluntarily participated in the study (84%). In-house call (IHC) had significantly less sleep in a 24-hour time frame than home call and night float (144 vs 283 vs 246 minutes, P < .001 and P < .028). IHC had significantly more steps than home call (11 245 vs 8756 steps, P = .039). The smallest number of steps was obtained when residents were not working (7904 steps). CONCLUSIONS Our data demonstrate that surgical residents on IHC have significantly less sleep compared to all other types of on-call time frames. Residents on IHC have the most steps across all time frames.
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Choshen-Hillel S, Ishqer A, Mahameed F, Reiter J, Gozal D, Gileles-Hillel A, Berger I. Acute and chronic sleep deprivation in residents: Cognition and stress biomarkers. Med Educ 2021; 55:174-184. [PMID: 32697336 PMCID: PMC7854866 DOI: 10.1111/medu.14296] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 06/29/2020] [Accepted: 07/16/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Insufficient sleep affects circadian hormonal profiles and inflammatory markers and may modulate attention, executive functioning and decision-making. Medical professionals and specifically resident physicians, who are involved in long-term nightshift schedules during their post-graduate training, are prone to acute and chronic sleep deprivation and disruption, putting them at risk for making medical errors. The aim of the study was to evaluate the impact of chronic and acute-on-chronic sleep deprivation and disruption among residents on selected physiological and cognitive measures. METHODS Thirty-three medical and surgical residents were evaluated twice - at baseline and after a 26-hour shift. Eighteen young attending physicians who did not engage in nightshift schedules served as controls and were evaluated once. Measures included morning cortisol and high-sensitivity C-reactive protein (hs-CRP), computerised tests of attention and behaviour, the Behaviour Rating Inventory of Executive Function, a risk-taking questionnaire and the Pittsburgh Sleep Quality Index. RESULTS Residents, but not attendings, reported chronic sleep disruption and deprivation. Residents at baseline exhibited reduced morning cortisol levels and elevated hs-CRP levels, compared to attendings. Residents at baseline had impaired global executive function compared to attendings. A nightshift with acute sleep deprivation further reduced residents' executive function. Residents at baseline and after a nightshift demonstrated increased impulsivity and slower processing time than attendings. Residents and attendings did not differ in risk-taking tendencies which were assessed in a separate cohort. CONCLUSIONS In a real-life setting, resident physicians exhibit increased low-grade systemic inflammation (hs-CRP) and impaired HPA-axis function. Their chronic sleep curtailment is associated with greater impulsivity, slower cognitive processing, and impaired executive function. Future research is warranted to understand how improving working schedule by increasing sleep duration may minimise the short-term and potential long-term risks to physicians in training.
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Affiliation(s)
- Shoham Choshen-Hillel
- School of Business Administration and the Federmann Center for the Study of Rationality, Hebrew University of Jerusalem
| | - Ahmad Ishqer
- Pediatric Pulmonary & Sleep Unit, Hadassah-Hebrew University Medical Center
| | - Fadi Mahameed
- Pediatric Pulmonary & Sleep Unit, Hadassah-Hebrew University Medical Center
| | - Joel Reiter
- Pediatric Pulmonary & Sleep Unit, Hadassah-Hebrew University Medical Center
| | - David Gozal
- Department of Child Health, MU Women’s and Children’s Hospital, University of Missouri School of Medicine
| | - Alex Gileles-Hillel
- Pediatric Pulmonary & Sleep Unit, Hadassah-Hebrew University Medical Center
- The Wohl Institute for Translational Medicine, Hadassah-Hebrew University Medical Center
| | - Itai Berger
- Pediatric Neurology; Department of Pediatrics, Assuta-Ashdod University Medical Center
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva
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Weeks KS, Borhart J, Defazio C, Takacs M. The impact of sleep on In-Training Examination (ITE) scores among emergency medicine residents. Am J Emerg Med 2021; 47:299-300. [PMID: 33494960 DOI: 10.1016/j.ajem.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 10/22/2022] Open
Affiliation(s)
- Kristin S Weeks
- Carver College of Medicine of the University of Iowa, Medical Scientist Training Program, Iowa City, Iowa, United States of America.
| | - Joelle Borhart
- Georgetown University Hospital & Washington Hospital Center, Emergency Medicine Department, Washington, DC, United States of America
| | - Christian Defazio
- University of Buffalo, Emergency Medicine Department, Buffalo, NY, United States of America.
| | - Michael Takacs
- University of Iowa Hospitals and Clinics, Emergency Medicine Department, Iowa City, Iowa, United States of America.
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Kolla BP, Coombes BJ, Morgenthaler TI, Mansukhani MP. Increased Patient Safety-Related Incidents Following the Transition into Daylight Savings Time. J Gen Intern Med 2021; 36:51-54. [PMID: 32789617 PMCID: PMC7859153 DOI: 10.1007/s11606-020-06090-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 07/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND "Spring forward," the start of daylight savings time (DST), reduces sleep opportunity by an hour. Insufficient sleep in healthcare workers resulting from the spring forward time change could potentially result in an increase in medical errors. OBJECTIVE We examined the change in reported patient safety-related incidents (SRIs), in the week following the transition into and out of DST over a period of 8 years. DESIGN Observational study SETTING: A US-based large healthcare organization with sites across multiple states MEASUREMENTS: Voluntarily reported SRIs that occurred 7 days prior to and following the spring and fall time changes for years 2010-2017 were ascertained. SRIs likely resulting from human error were identified separately. The changes in the number of SRIs (either all SRIs or SRIs restricted to those likely resulting from human error) from the week before and after the time change (either spring or fall) were modeled using a negative binomial mixed model with a random effect to correct for non-independent observations in consecutive weeks. RESULTS Over the 8-year period, we observed 4.2% (95% CI: - 1.1 to 9.7%; p = 0.12) and 8.8% (95% CI: - 2.5 to 21.5%; p = 0.13) increases in overall SRIs in the 7 days following DST when compared with 7 days prior for spring and fall, respectively. By restricting to SRIs likely resulting from human errors, we observed 18.7% (95% CI: 5.6 to 33.6%; p = 0.004) and 4.9% (95% CI: - 1.3 to 11.5%; p = 0.12) increases for spring and fall, respectively. CONCLUSION Policy makers and healthcare organizations should evaluate delayed start of shifts or other contingency measures to mitigate the increased risk of SRIs during transition to DST in spring.
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Affiliation(s)
- Bhanu Prakash Kolla
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA. .,Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA.
| | | | - Timothy I Morgenthaler
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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Richter K, Peter L, Rodenbeck A, Weess HG, Riedel-Heller SG, Hillemacher T. Shiftwork and Alcohol Consumption: A Systematic Review of the Literature. Eur Addict Res 2021; 27:9-15. [PMID: 32454482 DOI: 10.1159/000507573] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 03/27/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Shiftwork can be a risk factor for a number of different somatic and psychological health conditions, especially sleep disorders. Shiftworkers sleep less than dayworkers, and 20-40% of them suffer from difficulties initiating and maintaining sleep, which result in reduced capacity for work and social life. A common coping strategy might be the use of alcohol, which presents a health and safety hazard as it further impairs sleep quality and exacerbates sleepiness in the workplace. This review aimed to assess the extent of such possible connections. METHODS We performed a systematic search of the scientific literature on shiftwork and alcohol consumption in PubMed, PsycInfo, and Cochrane Library. Only original studies comparing shiftworkers with non-shiftworkers were included. The recommendations of the Preferred Reporting Items of Systematic Reviews and Meta-Analyses were followed. RESULTS Fourteen articles are included in this review. Six studies report some kind of connection between shift- or nightwork and alcohol consumption, especially as a sleep aid. Conflicting or negative results are reported by 3 studies. DISCUSSION Shiftwork, especially working at night and in rotation shifts, is associated with binge drinking disorder in different professions. The reasons for pathological consumption of alcohol can be self-medication of sleep problems or coping with stress and psychosocial problems typical for shiftwork. Nurses aged over 50 years represent one important risk group. These results can be important for preventive programs against sleep disorders, including measures other than drinking alcohol as a sleep aid in the workplace of shiftworkers.
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Affiliation(s)
- Kneginja Richter
- University Clinic for Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, Nuremberg, Germany,
| | - Lukas Peter
- University Clinic for Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Andrea Rodenbeck
- Evangelisches Fachkrankenhaus Göttingen-Weende, Göttingen, Germany
| | - Hans Günter Weess
- Pfalzklinikum Interdisziplinäres Schlafzentrum, Klingenmünster, Germany
| | - Steffi G Riedel-Heller
- Arbeitsmedizin und Public Health (ISAP), Institut für Sozialmedizin, Medizinische Fakultät, Universität Leipzig, Leipzig, Germany
| | - Thomas Hillemacher
- University Clinic for Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, Nuremberg, Germany
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Trockel MT, Menon NK, Rowe SG, Stewart MT, Smith R, Lu M, Kim PK, Quinn MA, Lawrence E, Marchalik D, Farley H, Normand P, Felder M, Dudley JC, Shanafelt TD. Assessment of Physician Sleep and Wellness, Burnout, and Clinically Significant Medical Errors. JAMA Netw Open 2020; 3:e2028111. [PMID: 33284339 DOI: 10.1001/jamanetworkopen.2020.28111] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Sleep-related impairment in physicians is an occupational hazard associated with long and sometimes unpredictable work hours and may contribute to burnout and self-reported clinically significant medical error. OBJECTIVE To assess the associations between sleep-related impairment and occupational wellness indicators in physicians practicing at academic-affiliated medical centers and the association of sleep-related impairment with self-reported clinically significant medical errors, before and after adjusting for burnout. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used physician wellness survey data collected from 11 academic-affiliated medical centers between November 2016 and October 2018. Analysis was completed in January 2020. A total of 19 384 attending physicians and 7257 house staff physicians at participating institutions were invited to complete a wellness survey. The sample of responders was used for this study. EXPOSURES Sleep-related impairment. MAIN OUTCOMES AND MEASURES Association between sleep-related impairment and occupational wellness indicators (ie, work exhaustion, interpersonal disengagement, overall burnout, and professional fulfillment) was hypothesized before data collection. Assessment of the associations of sleep-related impairment and burnout with self-reported clinically significant medical errors (ie, error within the last year resulting in patient harm) was planned after data collection. RESULTS Of all physicians invited to participate in the survey, 7700 of 19 384 attending physicians (40%) and 3695 of 7257 house staff physicians (51%) completed sleep-related impairment items, including 5279 women (46%), 5187 men (46%), and 929 (8%) who self-identified as other gender or elected not to answer. Because of institutional variation in survey domain inclusion, self-reported medical error responses from 7538 physicians were available for analyses. Spearman correlations of sleep-related impairment with interpersonal disengagement (r = 0.51; P < .001), work exhaustion (r = 0.58; P < .001), and overall burnout (r = 0.59; P < .001) were large. Sleep-related impairment correlation with professional fulfillment (r = -0.40; P < .001) was moderate. In a multivariate model adjusted for gender, training status, medical specialty, and burnout level, compared with low sleep-related impairment levels, moderate, high, and very high levels were associated with increased odds of self-reported clinically significant medical error, by 53% (odds ratio, 1.53; 95% CI, 1.12-2.09), 96% (odds ratio, 1.96; 95% CI, 1.46-2.63), and 97% (odds ratio, 1.97; 95% CI, 1.45-2.69), respectively. CONCLUSIONS AND RELEVANCE In this study, sleep-related impairment was associated with increased burnout, decreased professional fulfillment, and increased self-reported clinically significant medical error. Interventions to mitigate sleep-related impairment in physicians are warranted.
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Affiliation(s)
| | - Nikitha K Menon
- Stanford University School of Medicine, Palo Alto, California
| | | | | | - Randall Smith
- Stanford University School of Medicine, Palo Alto, California
| | - Ming Lu
- Stanford University School of Medicine, Palo Alto, California
| | - Peter K Kim
- Physician Affiliate Group of New York, New York, New York
| | | | | | | | | | | | - Mila Felder
- Advocate Christ Medical Center, Oak Lawn, Illinois
| | - Jessica C Dudley
- Brigham and Women's Hospital-Partners HealthCare, Boston, Massachusetts
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Handley SC, Pouppirt N, Zucker E, Coughlin KA, Ades A. Improving the Resident Educational Experience in a Level IV Neonatal/Infant Intensive Care Unit. Pediatr Qual Saf 2020; 5:e352. [PMID: 33134757 PMCID: PMC7591117 DOI: 10.1097/pq9.0000000000000352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 07/23/2020] [Indexed: 11/25/2022] Open
Abstract
Supplemental Digital Content is available in the text. The neonatal/infant intensive care unit (N/IICU) at the Children’s Hospital of Philadelphia is a 98-bed, level IV unit through which second-year pediatric residents rotate monthly. We developed a quality improvement project to improve the resident educational experience using goal setting. Primary objectives were to increase resident educational goal identification to 65% and goal achievement to 85% by June 2017. Secondary objectives were to (1) increase in-person feedback from fellows and/or attendings to 90% by June 2017 and (2) sustain improvements through June 2018.
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Kadour-Peero E, Sagi S, Awad J, Willner I, Bleicher I, Levy E, Gonen R, Vitner D. The impact of nurses' and physicians' shift change on obstetrical outcomes. Arch Gynecol Obstet 2021; 303:653-8. [PMID: 32886235 DOI: 10.1007/s00404-020-05773-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the effect around nurses' shift change and on-call physicians' shift change on obstetrical outcomes. METHODS A retrospective study of women who had an attempt of labor in a single-medical center, January 2006-December 2017. Obstetrical outcomes were compared between the time around nurses' shift change (6:00-8:00, 14:00-16:00, and 22:00-00:00) to the rest of the day, and between the time around on-call physicians' shift change (6:00-8:00, 14:00-16:00) to the rest of the day. RESULTS 32,861 women were included, 7826 deliveries occurred during nurses' shift-change, and 25,035 deliveries occurred during the rest of the day. The groups had similar general and obstetrical characteristics, with no statistical difference in cesarean delivery rate (10% vs. 9.8%, P = 0.45) (Table 1). Nurses' shift change had no measurable effect on obstetrical outcomes, including induction of labor, preterm labor, 5-min-Apgar score and cord pH value, except PPH which was less likely to occur during nurses' shift change period (3.8% vs. 4.4%, P = 0.045) (Table 2). From 32,861 deliveries, 5155 deliveries occurred during on-call physicians' shift-change, and 27,706 deliveries occurred during the rest of the day. Induction\augmentation of labor and epidural analgesia were less likely to happen during on-call physicians' shift change (34.4% vs. 38%, P < 0.0001, 59.6% vs. 61.8%, P = 0.003, respectively) (Table 3). The two groups had similar obstetrical outcomes, without statistical difference in cesarean delivery rate (10% vs. 9.8%, P = 0.63) (Table 4). Table 1 General and obstetric characteristics of women giving birth during the time of nurses shift change versus during the rest of the day Variable Change of nurses shifts (n = 7826) All other hours of the day (n = 25,035) P value Maternal age, y 30.3 ± 5.1 30.2 ± 5.2 0.09 Gestational age at birth (weeks) 39.7 ± 1.09 39.8 ± 1.10 0.55 Nulliparity 2077 (35%) 7067 (37%) 0.01 Induction\augmentation of labor 2905 (37) 9368 (38) 0.62 Epidural analgesia 4746 (61) 15,396 (62) 0.16 Neonatal birth weight, g 3340 ± 422 3330 ± 423 0.06 Data is presented as mean ± S.D or N (%) Table 2 Maternal and neonatal adverse outcomes of women giving birth during the time of nurses shift change versus during the rest of the day Variable (%) Change of nurses shifts (n = 7826) All other hours of the day (n = 25,035) P value Vacuum assisted delivery 615 (7.9) 2002 (8.0) 0.69 Cesarean delivery 788 (10) 2443 (9.8) 0.45 Postpartum hemorrhage 294 (3.8) 1089 (4.4) 0.045 Third- and fourth-degree perineal laceration 106 (1.4) 372 (1.5%) 0.51 5-min Apgar score < 7 39 (0.5) 139 (0.6) 0.65 Umbilical pH < 7.2 170 (23) 580 (23) 0.96 Prolonged second stage 190 (2.5) 559 (2.2) 0.22 Maternal and fetal composite adverse outcome* 1309 (16.7%) 4219 (16.9%) 1.00 Data is presented as N (%) *Maternal and fetal composite adverse outcome was defined as the presence of any of the following: vacuum delivery, CD, prolonged second stage, postpartum hemorrhage, third and fourth degree perineal laceration, 5-min Apgar score < 7 and umbilical cord pH < 7.2 Table 3 General and obstetric characteristics of women giving birth during the time of the on-call physicians shift change versus during the rest of the day Variable Change of physicians shifts (n = 5155) All other hours of the day (n = 27,706) P value Maternal age, years 30.3 ± 5.1 30.2 ± 5.2 0.38 Gestational age at birth (weeks) 39.8 ± 1.09 39.8 ± 1.10 0.95 Nulliparity (%) 1303 (33.4) 7841 (37) < 0.0001 Induction\augmentation of labor (%) 1769 (34.3) 10,504 (38) < 0.0001 Epidural analgesia (%) 3067 (59.6) 17,075 (61.8) 0.003 Neonatal birth weight (gr) 3345 ± 416 3330 ± 424 0.019 Data is presented as mean ± S.D or N (%) Table 4 Maternal and neonatal adverse outcomes of women giving birth during the time of physicians on-call shift change versus during the rest of the day Variable (%) Change of physicians shifts (n = 5155) All other hours of the day (n = 27,706) P value Vacuum assisted delivery 397 (7.7) 2220 (8.0) 0.45 Cesarean delivery 517 (10.0) 2714 (9.8) 0.63 Postpartum hemorrhage 209 (4.1) 1174 (4.3) 0.54 Third- and fourth-degree perineal laceration 67 (1.3) 411 (1.5) 0.31 5-min Apgar score < 7 22 (0.5) 156 (0.6) 0.30 Umbilical pH < 7.2 94 (20.3) 656 (23.3) 0.15 Prolonged second stage 127 (2.5%) 622 (2.3%) 0.36 Maternal and fetal composite adverse outcome* 852 (16.5%) 4676 (16.9%) 1.00 Data is presented as N (%) *Maternal and fetal composite adverse outcome was defined as the presence of any of the following: vacuum delivery, CD, prolonged second stage, postpartum hemorrhage, third and fourth degree perineal laceration, 5-min Apgar score < 7 and umbilical cord pH < 7.2 CONCLUSION: Nurses' shift change and on-call physicians' shift change does not appear to be associated with an increase in adverse maternal or neonatal outcomes.
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Leak RK, Weiner SL, Chandwani MN, Rhodes DC. Long weekend sleep is linked to stronger academic performance in male but not female pharmacy students. Adv Physiol Educ 2020; 44:350-357. [PMID: 32568007 DOI: 10.1152/advan.00005.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Poor sleep hygiene portends loss of physical and mental stamina. Therefore, maintaining a regular sleep/wake schedule on both weekdays and weekends is highly recommended. However, this advice runs contrary to the habits of university students who sleep late on weekends. Pharmacy students at Duquesne University sit for frequent examinations, typically commencing at 7:30 AM, and they complain about mental fatigue. Here, we tested the central hypothesis that longer sleep durations on both weekdays and weekends are linked to stronger academic performance in men and women. Students in their first professional year were administered three surveys to collect data on sleep habits and factors that might influence sleep, such as roommates, long commute times, and sleep interruptions. Grade point averages (GPAs) were collected from the Dean's office, with individual permissions from the students. Longer weekend-but not weekday-sleep durations were significantly correlated with higher cumulative GPAs in men and not in women. Women achieved slightly higher cumulative GPAs than men. Students who fell asleep within 15 min of going to bed had higher professional-phase GPAs than those who fell asleep after an hour or more. Our observations cannot establish causal links, but, given the body of prior evidence on the salutary properties of sleep, men may reap more benefit from recovery sleep on weekends. Rather than recommending that students force themselves awake early on weekends in an attempt to maintain a consistent sleep routine, the real-life habits of students should also be given consideration.
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Affiliation(s)
- Rehana Khan Leak
- Graduate School of Pharmaceutical Sciences, School of Pharmacy, Duquesne University, Pittsburgh, Pennsylvania
| | - Susan L Weiner
- Graduate School of Pharmaceutical Sciences, School of Pharmacy, Duquesne University, Pittsburgh, Pennsylvania
| | - Manisha N Chandwani
- Graduate School of Pharmaceutical Sciences, School of Pharmacy, Duquesne University, Pittsburgh, Pennsylvania
| | - Diane C Rhodes
- School of Pharmacy, Duquesne University, Pittsburgh, Pennsylvania
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Costa C, Mondello S, Micali E, Indelicato G, Licciardello AA, Vitale E, Briguglio G, Teodoro M, Fenga C. Night shift work in resident physicians: does it affect mood states and cognitive levels? J Affect Disord 2020; 272:289-294. [PMID: 32553370 DOI: 10.1016/j.jad.2020.03.139] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 02/12/2020] [Accepted: 03/29/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The effects of night shift work on health status have been widely studied. Night workers seem to smoke more, eat badly and show a low propensity to physical activity. Night work can be associated with an increase in cardiovascular and gastrointestinal disorders, alterations in immune response, diabetes, aging, hormonal imbalance, and premature death; alteration of circadian rhythm is also regarded as a risk factor for breast cancer and neuropsychiatric disorders. Moreover, several studies have highlighted the effects of sleep deprivation on clinical performance, quality of care and personal safety of healthcare personnel. No studies have investigated the effects of night work on Italian resident physicians and compared its effect across specialties. This study aims to assess the prevalence of sleep disorders, possible cognitive impairment and mood states, in relation to night shift work among resident physicians. METHODS 80 resident physicians, attending the postgraduate training into an Hospital located in the South of Italy, were divided into 4 areas (medical, surgical, services and anaesthesia). They were recruited from July 2017 to June 2018 and participated to a survey consisting of 4 questionnaires to investigate the presence of sleep deprivation and sleep quality (Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index), their cognitive status (Mini Mental State examination) and mood profiles (Profile of Mood States, POMS). Analysis of variance was used for comparison of questionnaires scores across specialties. RESULTS Authors reported no sleep deprivation, no sleep disorders and their outcomes, no changes in intellectual efficiency and no cognitive impairment in this population, neither in the areas performing night shifts nor in those involving only day shifts. Mood states measured by POMS showed a borderline level of Anger-Hostility (A) value among the residents of the medical area and services, and an increase slightly beyond the physiological levels of the T-score 50 of Fatigue-Inertia (F) always in the same groups. An increase in the Vigour-Activity (V) value beyond T-score 50 levels was also observed among residents of all the areas considered. CONCLUSIONS Emotional involvement could be attributed to the gap between high professional demand and lack of experience and knowledge among trainees. Tutors should help their students in order to identify earlier changes in the mood. Improvement in the organization of the trainee's activity could reduce the emotional overload.
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Affiliation(s)
- Chiara Costa
- Clinical and Experimental Medicine Department, University of Messina, Messina 98125, Italy
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Occupational Medicine Section, University of Messina, Messina 98125, Italy
| | | | - Giuliano Indelicato
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Occupational Medicine Section, University of Messina, Messina 98125, Italy
| | - Antonino Andrea Licciardello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Occupational Medicine Section, University of Messina, Messina 98125, Italy
| | - Ermanno Vitale
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Occupational Medicine Section, University of Messina, Messina 98125, Italy
| | - Giusi Briguglio
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Occupational Medicine Section, University of Messina, Messina 98125, Italy
| | - Michele Teodoro
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Occupational Medicine Section, University of Messina, Messina 98125, Italy.
| | - Concettina Fenga
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Occupational Medicine Section, University of Messina, Messina 98125, Italy
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Singer-Chang G, Dong F, Seffinger M, Nevins N, Blumer J, Musharbash H, Helf S. Empathy in Medicine Self and Other in Medical Education: Initial Emotional Intelligence Trend Analysis Widens the Lens Around Empathy and Burnout. J Osteopath Med 2020; 120:388-394. [DOI: 10.7556/jaoa.2020.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Context
Integral to emotional intelligence (EI), empathy is frequently studied in medical students. While important, given the implications for patient safety and physician well-being, traits such as self-regard may also affect physician efficacy. Emotional intelligence offers a holistic framework from which to study empathy, allowing it to be explored with coexisting traits and offering opportunities to identify related risk factors.
Objective
To identify trends in osteopathic medical student EI to help mitigate burnout, with specific attention to empathy and self-regard.
Methods
Eight hundred eighty-five students at Western University of Health Sciences College of Osteopathic Medicine of the Pacific from classes 2014-2016 were offered the Emotional Quotient Inventory 2.0 (EQ-i) at the start of school, completion of their second year, and at graduation. Participants completed all 3 inventories, yielding a response rate of 16.3%. Repeated measurement analysis of variance analyses were conducted using SAS software for Windows version 9.3.
Results
A total of 144 students participated. The total EI score shifted from mean (SD) 100.2 (12.4) at baseline to 96.1 (12.8) midway to 96.8 (13.3) at graduation (P=.0161) with significant decreases between baseline and midway (P<.001) and baseline and final administrations (P<.001). Empathy declined from 103 (13.1) to 99.9 (12.7) to 99.6 (12.6) (P=.0481) with significant decreases between baseline and midway (P<.001) and baseline and final administrations (P<.001). Self-regard declined from 98.6 (14.1) to 95.8 (15.1) to 95.5 (14.7) (P=.135) with significant decreases between baseline and midway (P=.0021) and baseline and final administrations (P<.001).
Conclusion
This study's findings support further investigation of potential roles played by EI, empathy, and self-regard in physician burnout.
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Coffyn S, Siengsukon CF. Poor Sleep Hygiene is Associated with Decreased Discrimination and Inattention on Continuous Performance Task in Doctor of Physical Therapy Students: A Cross-sectional Study. ACTA ACUST UNITED AC 2020; 34:160-5. [PMID: 34211256 DOI: 10.1097/jte.0000000000000135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction Reduced sleep quality impairs learning, memory formation, attention, and executive function ability. Poor sleep quality or sleep hygiene has been shown to impair academic performance of undergraduate and medical students. The purpose of this study was to examine the association between sleep quality, sleep hygiene, and cognitive performance in Doctor of Physical Therapy (DPT) students. Methods Fifty DPT students at the University of Kansas Medical Center completed the Pittsburgh Sleep Quality Index (PSQI) and the Sleep Hygiene Index (SHI). Cognitive performance was assessed using the Continuous Performance Test (CPT) which is a test of sustained attention and the Trail-Making Task (TMT) to assess executive functioning. An actigraph was worn for one week to objectively characterize sleep outcomes. Spearman's correlations were performed to assess the association between self-report sleep quality, sleep hygiene, and outcomes on the cognitive tasks. Post-hoc Mann-Whitney and Kruskal-Wallis tests were conducted to examine group differences between sleep outcomes and cognitive performance for demographic variable categories. Results Twenty-three students (46%) reported poor sleep quality, and 27 participants (54%) had objectively-reported poor sleep quality. There was a significant positive correlation between SHI and Detectability (rs= 0.297, p= 0.036) and Omissions (rs=.343, p=0.015). There were group differences between sex and number of pets on the CPT outcomes, and there was a significant group difference between the number of drinks/week categories on the SHI. Discussion and Conclusions About half of the participants were identified as having poor sleep quality. Poorer sleep hygiene was associated with poorer discrimination and inattention, which could potentially impact the students' academic and clinical performance as well as their health and wellbeing. Also, certain demographic variables may modulate the results.
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Leaune E, Ravella N, Vieux M, Poulet E, Chauliac N, Terra JL. Encountering Patient Suicide During Psychiatric Training: An Integrative, Systematic Review. Harv Rev Psychiatry 2019; 27:141-9. [PMID: 31082992 DOI: 10.1097/HRP.0000000000000208] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND/AIM Patient suicide is an adversity that can be considered an "occupational hazard." It has been identified as one of the most stressful adverse events during psychiatric training. The aim of this study was to systematically review the literature assessing the impact of patient suicide on trainees. METHODS We conducted a systematic review on the MEDLINE, Science Direct, Scopus, and Web of Science databases. Studies that reported prevalence of patient suicide, quantitative or qualitative assessment of psychological and professional impacts, coping strategies, and support or educational and postvention programs were deemed eligible for inclusion. RESULTS Of the 1994 articles identified, 22 were included. The literature on the topic was scarce, and the quality of the studies was moderate. No article dealt with nonpsychiatric residents. During their training, 46.4% of psychiatric trainees encountered at least one patient suicide. The traumatic impact was significantly more intense in trainees compared to senior physicians. A negative impact on their professional practice was reported by 17% to 39% of trainees. Formal institutional support for the affected trainees was described as having major shortcomings, and informal support from peers and families was reported as the most helpful response. However, 52% of impacted trainees considered encountering patient suicide a useful and beneficial experience. CONCLUSION The frequent posttraumatic symptoms and the negative professional consequences following patient suicide are worrying phenomena that highlight the need to improve suicide prevention and postvention programs during psychiatric training. Identifying trainees with personal vulnerability factors should be a major concern during the postvention process.
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Gustavsson K, Wierzbicka A, Matuszczyk M, Matuszczyk M, Wichniak A. Sleep among primary care physicians-Association with overtime, night duties and strategies to counteract poor sleep quality. J Sleep Res 2020; 30:e13031. [PMID: 32243038 DOI: 10.1111/jsr.13031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/09/2020] [Accepted: 02/26/2020] [Indexed: 11/29/2022]
Abstract
Physicians belong to the risk group for sleep disorders as a result of work related stress, excessive working time, large amount of on-call duties and shift work. Poor sleep quality of healthcare providers threatens not only their safety, but also the safety of their patients. This study examines if there are any differences in how working either long hours or at night duties relates to self-reported sleep time, sleep quality and daytime sleepiness in primary care physicians. We analyzed data from a survey research of 807 participants. Respondents were divided into four groups based on their reported work hours per week and number of nights on duty per month. Overtime was associated with shorter sleep time and worse subjective sleep quality even when compared with that of participants who work on night duties. All investigated groups of participants reported short sleep latencies which suggests that sleep debt is a common problem in this population. Surprisingly in the case of poor sleep quality participants rarely used recommended methods like regular physical activity or specialist advice. The most frequently reported answer was that they do nothing to improve sleep and every third participants uses hypnotics to do that. These results suggest that primary care physicians despite being at high risk for sleep disorders due to working overtime and at night, pay less attention to their sleep quality and do not use recommended strategies to improve it.
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Affiliation(s)
- Katarzyna Gustavsson
- Department of Clinical Neurophysiology, Sleep Medicine Center, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Aleksandra Wierzbicka
- Department of Clinical Neurophysiology, Sleep Medicine Center, Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | | | - Adam Wichniak
- Department of Clinical Neurophysiology, Sleep Medicine Center, Institute of Psychiatry and Neurology, Warsaw, Poland.,Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
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Chiang TW, Chen SY, Pan YC, Lin YH. Automatic Work-Hours Recorder for Medical Staff (Staff Hours): Mobile App Development. JMIR Mhealth Uhealth 2020; 8:e16063. [PMID: 32130165 PMCID: PMC7064958 DOI: 10.2196/16063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/07/2019] [Accepted: 12/15/2019] [Indexed: 11/13/2022] Open
Abstract
Background There are numerous mobile apps for tracking work hours, but only a few of them record work hours automatically instead of relying on manual logging. No apps have been customized for medical staff, whose work schedules are highly complicated as they have both regular hours and on-call duties. Objective The specific aims of this study were to (1) identify the Staff Hours app users’ GPS-defined work hours, (2) examine the overtime work hours from the app-recorded total work hours and the participants’ self-reported scheduled work hours, and (3) compare these app-recorded total work hours among different occupations. Methods We developed an app, Staff Hours, to automatically calculate a user’s work hours via GPS background data. Users can enter their scheduled hours, including regular hours and on-call duties. The app automatically generates overtime reports by comparing the app-recorded total work hours with the user-defined scheduled hours. A total of 183 volunteers (60 females and 123 males; mean age 32.98 years, SD 6.74) were included in this study. Most of the participants (162/183, 88.5%) were medical staff, and their positions were resident physicians (n=89), visiting staff (n=38), medical students (n=10), registered nurses (n=25), and non–health care professionals (non-HCPs; n=21). Results The total work hours (mean 55.69 hours, SD 21.34) of the 183 participants were significantly higher than their scheduled work hours (mean 50.67 hours, SD 21.44; P=.01). Medical staff had significantly longer total work hours (mean 57.01 hours, SD 21.20) than non-HCPs (mean 45.48 hours, SD 20.08; P=.02). Residents (mean 60.38 hours, SD 18.67) had significantly longer work hours than visiting staff (mean 51.42 hours, SD 20.33; P=.03) and non-HCPs (mean 45.48 hours, SD 20.08; P=.004). Conclusions Staff Hours is the first automatic GPS location–based app designed for medical staff to track work hours and calculate overtime. For medical staff, this app could keep complete and accurate records of work hours in real time, reduce bias, and allow for better complying with labor regulations.
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Affiliation(s)
- Ting-Wei Chiang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
| | - Si-Yu Chen
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
| | - Yuan-Chien Pan
- Department of Psychology, National Taiwan University, Taipei, Taiwan
| | - Yu-Hsuan Lin
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan.,Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
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Chien JW, Chen CY, Lin SH, Lin SW, Lin YH. Cardiac Autonomic Modulation during on-Call Duty under Working Hours Restriction. Int J Environ Res Public Health 2020; 17:E1118. [PMID: 32050580 DOI: 10.3390/ijerph17031118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/05/2020] [Accepted: 02/07/2020] [Indexed: 12/20/2022]
Abstract
Background: Medical residency is a time of high stress and long working hours, which increase the risk of cardiovascular disease. This study aimed to investigate the autonomic modulation of resident physicians throughout the on-call duty cycle. Methods: Spectral analysis of heart rate variability (HRV) was used to compute cardiac parasympathetic modulation (high-frequency power, HF) and cardiac sympathetic modulation (normalized low-frequency power, LF%, and the ratio of LF and HF, LF/HF) of 18 residents for a consecutive 4-day cycle. Results: Male residents show reduced cardiac sympathetic modulation (i.e., higher LF/HF and LF%) than the female interns. Medical residents’ cardiac parasympathetic modulation (i.e., HF) significantly increased on the first and the second post-call day compared with the pre-call day. In contrast, LF% was significantly decreased on the first and the second post-call day compared with the pre-call day. Similarly, LF/HF was significantly decreased on the second post-call day compared with the pre-call day. LF/HF significantly decreased on the first post-call day and on the second post-call day from on-call duty. Conclusion: The guideline that limits workweeks to 80 h and shifts to 28 h resulted in reduced sympathetic modulation and increased parasympathetic modulation during the two days following on-call duty.
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Petrie K, Crawford J, LaMontagne AD, Milner A, Dean J, Veness BG, Christensen H, Harvey SB. Working hours, common mental disorder and suicidal ideation among junior doctors in Australia: a cross-sectional survey. BMJ Open 2020; 10:e033525. [PMID: 31964674 PMCID: PMC7045753 DOI: 10.1136/bmjopen-2019-033525] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/14/2019] [Accepted: 11/26/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Despite concern regarding high rates of mental illness and suicide amongst the medical profession, the link between working hours and doctors' mental health remains unclear. This study examines the relationship between average weekly working hours and junior doctors' (JDs') mental health in Australia. DESIGN AND PARTICIPANTS A randomly selected sample of 42 942 Australian doctors were invited to take part in an anonymous Beyondblue National Mental Health Survey in 2013, of whom 12 252 doctors provided valid data (response rate approximately 27%). The sample of interest comprised 2706 full-time graduate medical trainees in various specialties, at either intern, prevocational or vocational training stage. Consultants and retired doctors were excluded. OUTCOME MEASURES Main outcomes of interest were caseness of common mental disorder (CMD) (assessed using a cut-off of 4 as a threshold on total General Health Questionnaire-28 score), presence of suicidal ideation (SI) (assessed with a single item) and average weekly working hours. Logistic regression modelling was used to account for the impact of age, gender, stage of training, location of work, specialty, marital status and whether JDs had trained outside Australia. RESULTS JDs reported working an average of 50.1 hours per week (SD=13.4). JDs who worked over 55 hours a week were more than twice as likely to report CMD (adjusted OR=2.05; 95% CI 1.62 to 2.59, p<0.001) and SI (adjusted OR=2.00; 95% CI 1.42 to 2.81, p<0.001) compared to those working 40-44 hours per week. CONCLUSIONS Our results show that around one in four JDs are currently working hours that are associated with a doubling of their risk of common mental health problems and SI. These findings suggest that management of working hours represents an important focus for workplaces to improve the mental health of medical trainees.
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Affiliation(s)
- Katherine Petrie
- Black Dog Institute, Randwick, New South Wales, Australia
- Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Anthony D LaMontagne
- School of Health & Social Development, Deakin University, Melbourne, Victoria, Australia
- The McCaughey Centre: VicHealth Centre for the Promotion of Mental Health & Community Wellbeing, Melbourne School of Population Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Allison Milner
- The McCaughey Centre: VicHealth Centre for the Promotion of Mental Health & Community Wellbeing, Melbourne School of Population Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jessica Dean
- St Vincents Hospital Melbourne, Fitzroy, Victoria, Australia
- Beyond Blue, Hawthorn, Victoria, Australia
| | - Benjamin G Veness
- Mental and Addiction Health, Alfred Health, Melbourne, Victoria, Australia
| | - Helen Christensen
- Black Dog Institute, Randwick, New South Wales, Australia
- Medicine, University of New South Wales, Sydney, New South Wales, Australia
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