Resident Sleep During Traditional Home Call Compared to Night Float

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.

Hand Call Practices and Satisfaction: Survey Results From Hand Surgeons in the United States

PURPOSE

To describe current hand call practices in the United States (US) and identify aspects of call practices that lead to surgeon satisfaction.

METHODS

An anonymous survey was administered to practicing members of the American Society for Surgery of the Hand, and responses were filtered to US surgeons taking hand call. Hand call was considered: (A) hand-specific call including replantation or microvascular services or (B) hand-specific call without replantation or microvascular responsibilities. Data were collected pertaining to practices, compensation, assistance, frequency, and satisfaction. Descriptive analyses were performed and regionally subdivided. Pearson correlations were used to determine aspects of a call that influenced surgeon satisfaction.

RESULTS

A total of 662 US hand surgeons from 49 states responded. Among the respondents, 38% (251) participate in replantation or microvascular call, 34% (225) participate in hand-specific call excluding replantation, and 28% (186) do not participate in hand-specific call. Of those practicing hand call (476), 60% take 6 or fewer days of call per month, 62% have assistance with staffing consultations, 65% have assistance with surgical procedures, and 49% are financially incentivized to take call. More than half (51%) reported that they have a protected time for call aside from their elective practice, and 10% of the surgeons reported that they have a dedicated operating room (OR) time after a call to care for cases. Two percent reported that the day following call is free from clinical duties. Only 46% of the surgeons were satisfied with their call schedule, with the top concerns among unsatisfied respondents relating to pay, OR availability, and burnout. The factors correlating to surgeon satisfaction included less frequent call, assistance with performing consultations and surgery, pay for call, and OR availability.

CONCLUSIONS

The majority of US hand surgeons are not satisfied with their current call practices, with frequent concerns relating to pay, OR availability, and burnout.

CLINICAL RELEVANCE

These findings may promote awareness regarding aspects of hand call that correlate with surgeon satisfaction and highlight practice patterns that may reduce burnout.

Reciprocal processes of sensory perception and social bonding: an integrated social-sensory framework of social behavior

Organisms filter the complexity of natural stimuli through their individual sensory and perceptual systems. Such perceptual filtering is particularly important for social stimuli. A shared "social umwelt" allows individuals to respond appropriately to the expected diversity of cues and signals during social interactions. In this way, the behavioral and neurobiological mechanisms of sociality and social bonding cannot be disentangled from perceptual mechanisms and sensory processing. While a degree of embeddedness between social and sensory processes is clear, our dominant theoretical frameworks favor treating the social and sensory processes as distinct. An integrated social-sensory framework has the potential to greatly expand our understanding of the mechanisms underlying individual variation in social bonding and sociality more broadly. Here we leverage what is known about sensory processing and pair bonding in two common study systems with significant species differences in their umwelt (rodent chemosensation and avian acoustic communication). We primarily highlight that (1) communication is essential for pair bond formation and maintenance, (2) the neural circuits underlying perception, communication and social bonding are integrated, and (3) candidate neuromodulatory mechanisms that regulate pair bonding also impact communication and perception. Finally, we propose approaches and frameworks that more fully integrate sensory processing, communication, and social bonding across levels of analysis: behavioral, neurobiological, and genomic. This perspective raises two key questions: (1) how is social bonding shaped by differences in sensory processing?, and (2) to what extent is sensory processing and the saliency of signals shaped by social interactions and emerging relationships?

Relationships Between Sleep, Activity, and Burnout in Ophthalmology Residents

OBJECTIVE

To objectively measure sleep and activity levels and examine their relationship to burnout, depression, anxiety, and stress in ophthalmology residents.

DESIGN

A cohort study of ophthalmology residents at the University of Washington from July 1, 2017 to June 30, 2018.

SETTING

Single-center academic institution.

PARTICIPANTS

Fourteen ophthalmology residents at the University of Washington enrolled between July 1, 2017 and June 30, 2018.

RESULTS

Data were collected from 14 residents, ages 27 to 34. Wrist actigraphy allowed for objective measurement of resident sleep and activity, though adherence to wrist actigraphy usage dropped significantly over time. Residents recorded significantly less sleep on call compared to when they were off call, with mean (SD) 3.6 (2.0) hours on primary call, 5.6 (1.8) hours on secondary call, and 6.7 (1.4) hours off call. Lower average sleep on call was associated with higher emotional exhaustion (r = -0.69, p = 0.04), lower personal accomplishment (r = 0.82, p = 0.007), higher anxiety (r = -0.90, p = 0.001), and higher stress (r = -0.75, p = 0.02). Higher daily activity was associated with higher sense of personal accomplishment (r = 0.57, p = 0.04). Average nightly sleep, average sleep while not on call, and daily sedentary time was not associated with any subset of burnout.

CONCLUSIONS

The association between objectively measured sleep while on call and burnout, depression, and anxiety are consistent with findings from prior studies which relied on subjective measures of sleep. The direction of causality - whether poor sleep caused burnout, burnout caused poor sleep, or both - could not be assessed in the present study. However, these results are consistent with the hypothesis that poor sleep on call contributes to resident burnout and that physical activity may reduce aspects of burnout. The use of wrist actigraphy to objectively measure sleep and activity patterns may help focus and evaluate interventions aimed at decreasing resident burnout.

The Current State of Radiology Call Assistant Triage Programs Among US Radiology Residency Programs

RATIONALE AND OBJECTIVES

Given increasing volume and workflow interruptions in radiology, we sought to identify and characterize radiology call assistant triage (RCAT) programs among US radiology residency programs.

MATERIALS AND METHODS

A survey was created using Qualtrics survey software and emailed to all members of the Association of Program Directors in Radiology listserv. A total of 296 active members belong to this listserv, including program directors and assistant program directors. The survey included questions about the existence and specifics of a call triage assistant program.

RESULTS

Data were obtained from 88 active members of the Association of Program Directors in Radiology (30% response rate). Of those, 20 programs (23%) have an RCAT program. Triage assistant staffing includes nonmedical or clerical staff (60%), medical students (30%), first-year radiology residents (5%), and technologists (5%). All respondents with RCAT programs report satisfaction with their program and plan to continue. A significant majority (75%) have no plans to change, whereas the remaining 25% are considering program expansion and pay increases. Among residency programs without RCAT programs, none reported termination of their triage program. The most common reasons for not having triage assistants include cost, lack of awareness, differing opinions on utility, and the presence of 24/7 attending coverage.

CONCLUSION

Twenty US radiology residency programs report having an RCAT program. All report satisfaction with their program despite different staffing models. RCAT programs may represent an effective measure in limiting interruptions and potentially decreasing interpretative errors made by residents on call.

Hand Surgeons and Orthopedic Trauma Surgeons Call Coverage of Acute Upper Extremity Injuries: Where Should the Line Be Drawn?

BACKGROUND

There is a lack of consensus as to which subspecialty service should cover acute upper extremity injuries in the emergency department (ED). The purpose of the present study is to understand how upper extremity injuries are currently triaged to specialists and to assess the current opinion among hand and orthopedic trauma specialists as to how these injuries should be best triaged based on injury location and severity.

METHODS

The American Association for Hand Surgery (AAHS) membership and Orthopaedic Trauma Association (OTA) membership were surveyed using a 28-item online questionnaire.

RESULTS

A total of 103 responses from the AAHS and 114 responses from the OTA were received. Nearly 50% of the respondents report no formal anatomic line as to how upper extremity injuries are triaged to specialists from the ED. Approximately 57% of the AAHS respondents feel that hand call should begin at the distal radius or proximal, while 71% of the OTA respondents feel that hand call should begin at the radiocarpal joint or distal. There was increasing agreement that more complex injuries be assigned to the hand surgeon.

CONCLUSIONS

There is agreement that proximal to the elbow, the trauma consultant should be called, and distal to the distal radius, the hand consultant should be called. However, there is a lack of agreement as to who should be responsible for call between the elbow and the hand. To optimize patient care, better allocate consultant resources, and minimize conflict between consultants, establishing anatomic guidelines for consultation should be considered.

Do we hear what birds hear in birdsong?

Peter Marler's fascination with richness of birdsong included the notion that birds attended to some acoustic features of birdsong, likely in the time domain, which were inaccessible to human listeners. While a considerable amount is known about hearing and vocal communication in birds, how exactly birds perceive their auditory world still remains somewhat of a mystery. For sure, field and laboratory studies suggest that birds hear the spectral, gross temporal features (i.e. envelope) and perhaps syntax of birdsong much like we do. However, there is also ample anecdotal evidence that birds are consistently more sensitive than humans to at least some aspects of their song. Here we review several psychophysical studies supporting Marler's intuitions that birds have both an exquisite sensitivity to temporal fine structure and may be able to focus their auditory attention on critical acoustic details of their vocalizations. Zebra finches, Taeniopygia guttata, particularly, seem to be extremely sensitive to temporal fine structure in both synthetic stimuli and natural vocalizations. This finding, together with recent research highlighting the complexity of zebra finch vocalizations across contexts, raises interesting questions about what information zebra finches may be communicating in temporal fine structure. Together these findings show there is an acoustic richness in bird vocalizations that is available to birds but likely out of reach for human listeners. Depending on the universality of these findings, it raises questions about how we approach the study of birdsong and whether potentially significant information is routinely being encoded in the temporal fine structure of avian vocal signals.

Nocturnal "humming" vocalizations: adding a piece to the puzzle of giraffe vocal communication

BACKGROUND

Recent research reveals that giraffes (Giraffa camelopardalis sp.) exhibit a socially structured, fission-fusion system. In other species possessing this kind of society, information exchange is important and vocal communication is usually well developed. But is this true for giraffes? Giraffes are known to produce sounds, but there is no evidence that they use vocalizations for communication. Reports on giraffe vocalizations are mainly anecdotal and the missing acoustic descriptions make it difficult to establish a call nomenclature. Despite inconclusive evidence to date, it is widely assumed that giraffes produce infrasonic vocalizations similar to elephants. In order to initiate a more detailed investigation of the vocal communication in giraffes, we collected data of captive individuals during day and night. We particularly focussed on detecting tonal, infrasonic or sustained vocalizations.

FINDINGS

We collected over 947 h of audio material in three European zoos and quantified the spectral and temporal components of acoustic signals to obtain an accurate set of acoustic parameters. Besides the known burst, snorts and grunts, we detected harmonic, sustained and frequency-modulated "humming" vocalizations during night recordings. None of the recorded vocalizations were within the infrasonic range.

CONCLUSIONS

These results show that giraffes do produce vocalizations, which, based on their acoustic structure, might have the potential to function as communicative signals to convey information about the physical and motivational attributes of the caller. The data further reveal that the assumption of infrasonic communication in giraffes needs to be considered with caution and requires further investigations in future studies.

Preserving the educational value of call in a diagnostic radiology residency program

PURPOSE

Our study was designed to determine residents' opinions of the advantages, disadvantages and educational value of a traditional "Tandem Call" (TC) model as compared to night float (NF). Because TC is more representative of adult learning principles and constructivist theory, we hypothesized that resident satisfaction and educational outcomes would demonstrate a preference for, and the educational efficacy of, the TC model.

METHODS

We surveyed all residents in a university-based radiology residency on their opinions of TC and its educational value. Aggregate data from annual Graduate Medical Education Committee institutional surveys (2008-2012) and annual radiology alumni surveys (2009-2012) were reviewed as measures of satisfaction with TC. Performance on the ABR oral exam was a proxy for educational outcome. Quality data for the year of study and prior years in which TC was in effect were reviewed as a measure of patient safety.

RESULTS

The great majority of respondents attributed confidence/competence on call and added value to their education directly to TC. A majority believed that teamwork required for TC facilitated more positive relationships among residents and more peer teaching. Most said that they would not prefer NF. Almost all believed indirect supervision with attending backup aided in developing confidence in performance. Quality data confirmed a low number of discrepancies between preliminary resident and final attending reads.

CONCLUSIONS

TC provides a more consistent call experience throughout residency than NF. TC is valued by residents, facilitates retrieval-based learning and development of independence and efficiency, and parallels essential elements of team-based learning. Quality data suggests that lack of 24-hour attending supervision is not detrimental to patient safety.

Infectious etiologies of childhood leukemia: plausibility and challenges to proof

Infections as well as environmental exposures are proposed determinants of childhood acute lymphoblastic leukemia (ALL), particularly common precursor B-cell ALL (cALL). Lines of investigation test hypotheses that cALL is a rarer result of common infection, that it results from uncommon infection, or that it ensues from abnormal immune development; perhaps it requires a preceding prenatal or early childhood insult. Ideally, studies should document that particular infections precede leukemiA and induce malignant transformation. However, limited detection studies have not directly linked specific human or nonhuman infectious agents with ALL or cALL. Primarily based on surrogate markers of infectious exposure, indirect evidence from ecologic and epidemiologic studies varies widely, but some suggest that infancy or early childhood infectious exposures might protect against childhood ALL or cALL. Several others suggest that maternal infection during pregnancy might increase risk or that certain breast-feeding practices decrease risk. To date, evidence cannot confirm or refute whether at least one infection induces or is a major co-factor for developing ALL or cALL, or perhaps actually protects against disease. Differences in methodology and populations studied may explain some inconsistencies. Other challenges to proof include the likely time lag between infection and diagnosis, the ubiquity of many infections, the influence of age at infection, and the limitations in laboratory assays; small numbers of cases, inaccurate background leukemia rates, and difficulty tracking mobile populations further affect duster investigations. Nevertheless, existing evidence partially supports plausibility and warrants further investigation into potential infectious determinants of ALL and cALL, particularly in the context of multifactorial or complex systems.

Enhancement of cALL immunogenicity by co-culture with a CD154 expressing 293 cell line

Pre-B cell acute lymphoblastic leukaemia (cALL) commonly occurs in young patients and although successful conventional therapies are available (such as cytotoxic drugs and bone marrow transplantation) for a proportion of patients (approximately 30%) these are ultimately unsuccessful. Recurrence of disease is a result of the failure of the immune system to recognize these abnormal cells and down-regulation of crucial molecules required for cognate CD4(+) T cell recognition has been postulated as a means of immune escape. In this study we show that an embryonic kidney cell line (293 cells) transfected with CD154 (40 L.1) are capable of not only maintaining the viability of primary ALL cells in culture but can also up-regulate the expression of a number of crucial molecules involved in antigen recognition. We show that 40 L.1 cell stimulation of primary ALL cell cultures can not only enhance the allogeneic and autologous MLR response to such cells but will also induce CTL effectors which are capable of lysing wild-type autologous ALL cells. It is therefore conceivable that such an approach could be used to generate an active anti-tumour response in patients, following conventional therapy, reducing the incidence of recurrence.