Impact of night-float rotation on sleep,mood, and alertness: the resident's perception

Night-float rotations were designed to alleviate the workload of residents on night call and thereby improve patient safety. However, the impact of the night float on residents is yet to be surveyed. We assessed the impact of the night-float rotation on pediatric residents using an anonymous questionnaire that covered topics, based on recall, about sleep, mood, alertness, adjustment, and others. The study was conducted in a major tertiary pediatric teaching hospital in the United States. Participants were pediatric residents who had completed one or two night-float rotations and were in active training at our teaching hospital at the time of the study. Fifty-two of 60 eligible residents (87%) responded. Sleep duration during the night-float rotation was shorter than during day-shift work in 24 residents (46%), longer in 20 (38%), and unchanged in eight (15%). A higher proportion of residents took longer to fall asleep, had more difficulty falling asleep, had more sleep interruptions, and felt less rested upon awakening. Twenty-four residents (46%) felt that their bodies never adjusted to the night shift. Also, 22 residents (43%) felt moody or depressed in contrast to seven (14%) who felt depressed during the daytime rotation (p=0.0001). Twenty-one residents (41%) felt they were slower in their thinking during the night float than daytime rotations. The results suggest that disturbances of sleep and mood and decreased alertness, typical of night shift, are present in the night-float rotation. Residency programs should monitor closely the impact of the night-float rotation on resident well being and patient safety. The impact of night-shift work should be considered in the design of night-float schedules, and teaching should be provided for residents to learn coping strategies for night-shift work.     

IMPACT OF NIGHT-FLOAT ROTATION ON SLEEP,MOOD, AND ALERTNESS: THE RESIDENT'S PERCEPTION

Night-float rotations were designed to alleviate the workload of residents on night call and thereby improve patient safety. However, the impact of the night float on residents is yet to be surveyed. We assessed the impact of the night-float rotation on pediatric residents using an anonymous questionnaire that covered topics, based on recall, about sleep, mood, alertness, adjustment, and others. The study was conducted in a major tertiary pediatric teaching hospital in the United States. Participants were pediatric residents who had completed one or two night-float rotations and were in active training at our teaching hospital at the time of the study. Fifty-two of 60 eligible residents (87%) responded. Sleep duration during the night-float rotation was shorter than during day-shift work in 24 residents (46%), longer in 20 (38%), and unchanged in eight (15%). A higher proportion of residents took longer to fall asleep, had more difficulty falling asleep, had more sleep interruptions, and felt less rested upon awakening. Twenty-four residents (46%) felt that their bodies never adjusted to the night shift. Also, 22 residents (43%) felt moody or depressed in contrast to seven (14%) who felt depressed during the daytime rotation (p=0.0001). Twenty-one residents (41%) felt they were slower in their thinking during the night float than daytime rotations. The results suggest that disturbances of sleep and mood and decreased alertness, typical of night shift, are present in the night-float rotation. Residency programs should monitor closely the impact of the night-float rotation on resident well being and patient safety. The impact of night-shift work should be considered in the design of night-float schedules, and teaching should be provided for residents to learn coping strategies for night-shift work.     

Can we consider medical residents as shift workers?

Although medical residents are characterized by long working hours, night shifts and high levels of work load, it is unclear if their work schedule can be classified as shift work, or if it has a similar impact on residents' well-being. The present paper compared the profile of complaints about sleep or daytime functioning of medical residents to that of rotating shift workers and day workers, of similar ages. Sixty-one residents (aged: 32.2 +/- 2.2 years), after 2 years of residency, participated in the study. The two control groups with a similar age range (26-40 years) were chosen, and included 94 rotating shift workers and 146 day workers. All subjects completed self-administered questionnaires on their sleep habits, and their sleep-wake cycle was monitored by a wrist-worn actigraph. Ten percent of the residents complained about difficulties falling asleep, 34% complained about morning tiredness, 14% complained about mid-sleep awakening, and 20% about prolonged fatigue. The residents slept significantly less than the day workers, and their sleep efficiency was significantly higher. When examining their subjective complaints profile, residents complained more than day workers and their answers were more similar to those of rotating shift workers, therefore they can be considered to be characterized as shift workers.     

三甲综合性医院住院医师抑郁现状调查及影响因素

目的:调查三甲综合性医院住院医师抑郁现状并分析其影响因素,为提高临床住院医师生活质量及工作效率提供依据。方法:选择三甲综合性医院临床各科室住院医97例为研究对象,调查其性别、年龄、文化程度、婚姻状况等基线资料,采用抑郁自评量表(SDS)对其基线资料进行分析,并采用logistics回归分析住院医师抑郁状态发生的影响因素。结果:97例住院医师SDS评分为(48.99±9.78)分显著高于人群常模(41.85±10.57)分(t=3.212,P0.05),其中抑郁的发生率(35.05%)显著高于正常人群(16.07%)与护士人群(22.55%)(x2=9.437,4.124;P0.05);多因素分析显示,未取得执业医师证书(OR=2.241,P0.05)、不喜欢医生职业(OR=3.722,P0.05)及对工作不满意(OR=7.713,P0.05)是住院医师发生抑郁的危险因素。结论:三甲住院医师的抑郁发生率处于较高水平,未取得执业医师证书、不喜欢医生职业、对工作不满意是住院医师发生抑郁的危险因素。     

Remediation of Contaminated Sediments: A Comparative Analysis of Risks to Residents vs. Remedial Workers

This study weighs the risks to workers of cleaning up a Superfund site against the risks to residents of not cleaning up that site. Risks are measured by the number of deaths and disabilities due to injuries and diseases. We posit a cleanup plan involving 31 occupations and 4,581 person-years of work. We posit 20 hypothetical sites and 99 specific sites with varying numbers of residents and levels of cancer death and cancer disability rates. Depending on the number of residents, and the rates, we find that the risks to workers frequently outweigh the risks to residents. We conclude that risks to workers should be accounted for in EPA judgments regarding whether and how a Superfund site should be cleaned up.     

Fatigue and concerns about quality of care among Ontario interns and residents.

In postgraduate medical training the heavy and irregular workloads are thought to result in fatigue and a potential decrease in the quality of care provided by interns and residents. We investigated these concerns among Ontario interns and residents. Information from 1805 house staff in all specialties and different years of postgraduate education suggested a relation between hours of work, fatigue and concerns about the quality of care.     

Training for fitness: reconsidering the 80-hour work week

The medical literature is replete with articles about the Accreditation Council for Graduate Medical Education's 2003 resident duty hour restrictions. Most of these papers describe creative and thoughtful responses to the new system. However, others express concern that the "80-hour work week" could hamper continuity of care and educational activities. Nevertheless, if fatigue impairs resident learning and medical care quality, then work hour restrictions seem worthwhile. We add our voices to the critics' for additional reasons. Data support that fatigue occurs even with reasonable work schedules, and residents do not reliably use time off from work to rest. Regulated work schedules can interfere with adequate rehearsal of the physical and mental stamina required in certain specialties, yet patients have a right to expect their physicians to be trained in the particular demands of those specialties. Similarly, residents have a right to a realistic understanding of authentic clinical practice. Further, while self-sacrifice need not be routine, trainees should feel that occasional self-sacrifice is appropriate and acceptable for a physician. We reject uniform, arbitrary duty hour limits for all specialties. Rather, we propose that a subspecialty-based system can foster the development of the endurance, skills, and reasoning that patients and colleagues expect.     

Pesticide Risk Perceptions,Knowledge, and Attitudes of Operators,Workers, and Residents: A Review of the Literature

The literature on the risk perceptions, knowledge levels, and attitudes of operators, workers, and residents in relation to non-dietary exposure to agricultural pesticides is reviewed. No literature was identified in relation to bystander exposure. Research has primarily been conducted on participants in developing countries and migrant workers in the United States. For operators and workers, illiteracy, poverty, and a perception that exposure to pesticides is an inevitable part of their work results in limited adoption of safety precautions while using and storing pesticides. As a result, risk communication activities aimed at operator and workers need to take account of the wider socioeconomic and cultural conditions in which workers and operators are working and living. There is less research focused on residents’ and bystanders’ perceptions, attitudes, and behaviors. The lack of European data in general, and residents’ and bystanders’ data in particular, represents a knowledge gap that is pertinent to emerging EU legislation requiring residents’ and bystanders’ inclusion in pesticide risk assessment. This review provides a comprehensive overview that can assist policy-makers, and risk communicators in the development of targeted training and awareness-raising material for operators, workers, bystanders, and residents. Areas for future research are suggested.     

Community response grids: using information technology to help communities respond to bioterror emergencies

Access to accurate and trusted information is vital in preparing for, responding to, and recovering from an emergency. To facilitate response in large-scale emergency situations, Community Response Grids (CRGs) integrate Internet and mobile technologies to enable residents to report information, professional emergency responders to disseminate instructions, and residents to assist one another. CRGs use technology to help residents and professional emergency responders to work together in community response to emergencies, including bioterrorism events. In a time of increased danger from bioterrorist threats, the application of advanced information and communication technologies to community response is vital in confronting such threats. This article describes CRGs, their underlying concepts, development efforts, their relevance to biosecurity and bioterrorism, and future research issues in the use of technology to facilitate community response.     

Dying in hospital: the residents' viewpoint

A survey of residents'' (junior house officers'') experiences and attitudes to the terminal care part of their work in four Glasgow teaching hospitals showed that even a month after starting work one-fifth of the respondents had not actively managed a dying patient. Sixty-four per cent thought that they had received inadequate teaching in terminal care. Depression and anxiety had been the most difficult symptoms encountered. The residents thought that the ward nursing staff contributed much more than their senior medical colleagues to both the medical and psychological aspects of terminal care. The results indicate a need for more undergraduate education in the most relevant areas, such as coping with the psychological problems of dying patients and their relatives. Newly qualified residents require more support from senior medical staff in looking after the terminally ill.     

Modeling the spread of methicillin-resistant Staphylococcus aureus in nursing homes for elderly

Methicillin-resistant Staphylococcus aureus (MRSA) is endemic in many hospital settings, including nursing homes. It is an important nosocomial pathogen that causes mortality and an economic burden to patients, hospitals, and the community. The epidemiology of the bacteria in nursing homes is both hospital- and community-like. Transmission occurs via hands of health care workers (HCWs) and direct contacts among residents during social activities. In this work, mathematical modeling in both deterministic and stochastic frameworks is used to study dissemination of MRSA among residents and HCWs, persistence and prevalence of MRSA in a population, and possible means of controlling the spread of this pathogen in nursing homes. The model predicts that: (i) without strict screening and decolonization of colonized individuals at admission, MRSA may persist; (ii) decolonization of colonized residents, improving hand hygiene in both residents and HCWs, reducing the duration of contamination of HCWs, and decreasing the resident∶staff ratio are possible control strategies; (iii) the mean time that a resident remains susceptible since admission may be prolonged by screening and decolonization treatment in colonized individuals; (iv) in the stochastic framework, the total number of colonized residents varies and may increase when the admission of colonized residents, the duration of colonization, the average number of contacts among residents, or the average number of contacts that each resident requires from HCWs increases; (v) an introduction of a colonized individual into an MRSA-free nursing home has a much higher probability of leading to a major outbreak taking off than an introduction of a contaminated HCW.     

Les résidents et l'enseignement: revue de la littérature.

We reviewed the available data on residents'' teaching role in the clinical setting to develop programs to improve their teaching skills. Articles published from 1966 to 1989 were identified through a computerized search of MEDLINE, and the bibliographies of identified papers were reviewed. Articles directly related to the topic were included and analysed. Taking into account their quality, we extracted data relevant to specific issues. Approximately 15% to 25% of an average work week was spent by residents in different teaching activities. Students acknowledged the importance of their contribution to clinical teaching. Residents benefitted from teaching by increasing their medical knowledge and promoting the development of important attitudes. Insufficient preparation for this task and the numerous practical problems faced by residents may explain their modest performance as teachers. Nevertheless, programs directed to residents might improve the quality of their teaching. We suggest some guidelines for the development of programs to improve their teaching skills and for future research.     

Daily and yearly burnout symptoms in Israeli shift work residents

Burnout is a syndrome of physical and emotional exhaustion that develops among individuals who are open to public demands. In view of their heavy work load and sleep deprivation, we decided to evaluate the impact of long working hours on burnout and psychological status among a sample of residents during the first 2 years of their residency. Seventy-eight residents participated in the study, all residents completed self-administered questionnaires, and their sleep-wake cycle was monitored by a wrist-worn actigraph for a period of 5-7 days. The questionnaires included a short form suitable for Experience Sampling Method (ESM), and a longer background Questionnaire. The results revealed that sleep duration, Work Load and the interaction between them, explain the Negative Mood the day after the night shift. However, positive mood, and fatigue were not affected by sleep duration or workload. In general, after one year of residency, residents become more stressed, less involved in the job, and had a high level of burnout and psychosomatic symptoms. However, after the second year, the burnout symptoms were almost the same as at the beginning except for the level of stress that remained high. Sleep duration was unrelated to the burnout symptoms.     

Clima de aprendizaje y enganche al trabajo del residente clínico: relación con la autodeterminación humana

Introduction:

The learning climate is a factor associated with the clinical resident’s engagement in work activities and the improvement of students’ well-being in the workplace through their self-determination during clinical rotation.

Objective:

To determine the relationship between the learning climate measured with the D-RECT 35 scale and residents’ self-determination and commitment to work using the UWES 17 scale.

Materials and methods:

We conducted a cross-sectional correlational study with residents of surgical medical specialties in clinical rotation at the practice site and who completed the measurement questionnaires.

Results:

We evaluated 188 residents of clinical specialties. The median of the results in the learning climate scale was 3.9/5.0; in the self-determination scale, 4.86/7.0, and in the job engagement scale, 5.0/6.0. The learning climate was considered adequate and a positive relationship was found with self-determination and the residents’ attachment to their activities; these correlations were statistically significant.

Conclusions:

Adequate learning climates are positively related to the ability to engage in work activities and the self-determination of clinical residents as they favor collaborative work and access to supervision generating greater autonomy and more enthusiasm and dedication to assigned activities. This can drive improvements in educational programs in clinical departments and translate into safer patient care.     

Out of work and house and home: Contested youth in an english homeless hostel

Drawing on fieldwork in England, this article considers a group of unemployed teenagers in occasional residence at a hostel for the homeless, examining their attitudes to work, welfare and adulthood. Interactions between the hostel staff and these young people are discussed. Staff and residents are shown to be at odds over how best to make sense of and respond to the problems of homelessness and unemployment. The residents, most of them in their mid to late teens, could be said to be growing up under extremely difficult circumstances, but growing up allthe same. They might even be described as growing up faster than others their age – of necessity. Nevertheless, I suggest that their present difficulties are not always something these young people want to be too grown up about, if they can help it. Out of work and away from home, being young is one of the few things that they have going for them, and it provides them with a way of coping with the problems they face.     

Sociodemographic correlates of breast feeding in Ghana

This study utilizes data from the Ghana Fertility Survey (GFS) (1979-1980) to investigate breast feeding in Ghana and the factors that affect it. Using life table procedures, we found evidence that, when other factors are held constant, older cohorts, women with no schooling, those who work in the agricultural sector, those affiliated with traditional Ghanaian religions, Mole-Dagbanis, rural residents, residents of the Volta, Brong-Ahafo, northern, and upper regions, and low-parity women show longer durations of breast feeding. It is recommended that, along with other fertility reduction measures, prolonged breast feeding among all Ghanaian mothers should be encouraged to help reduce conception and to ensure healthy children.     

Do American Dippers Obtain a Survival Benefit from Altitudinal Migration?

Studies of partial migrants provide an opportunity to assess the cost and benefits of migration. Previous work has demonstrated that sedentary American dippers (residents) have higher annual productivity than altitudinal migrants that move to higher elevations to breed. Here we use a ten-year (30 period) mark-recapture dataset to evaluate whether migrants offset their lower productivity with higher survival during the migration-breeding period when they occupy different habitat, or early and late-winter periods when they coexist with residents. Mark-recapture models provide no evidence that apparent monthly survival of migrants is higher than that of residents at any time of the year. The best-supported model suggests that monthly survival is higher in the migration-breeding period than winter periods. Another well-supported model suggested that residency conferred a survival benefit, and annual apparent survival (calculated from model weighted monthly apparent survival estimates using the Delta method) of residents (0.511 ± 0.038SE) was slightly higher than that of migrants (0.487 ± 0.032). Winter survival of American dippers was influenced by environmental conditions; monthly apparent survival increased as maximum daily flow rates increased and declined as winter temperatures became colder. However, we found no evidence that environmental conditions altered differences in winter survival of residents and migrants. Since migratory American dippers have lower productivity and slightly lower survival than residents our data suggests that partial migration is likely an outcome of competition for limited nest sites at low elevations, with less competitive individuals being forced to migrate to higher elevations in order to breed.     

Mobile patients in an inner London practice.

In an area with the most highly mobile population in Britain 10% of the consultations in one practice were with temporary residents and a further 10% with newly registered patients. We analysed data gathered in 1980 about these two groups and about established patients that included demographic characteristics, the diagnoses made, and the actions taken by the doctors. Temporary residents caused a considerable amount of administration, but they were relatively straightforward to deal with medically and the practice received compensation for the work; with new patients problems were more time consuming, both clinically and administratively, and there was no financial compensation. A practice with a high turnover of its registered patients is at a considerable disadvantage compared with one in a more settled area.