Analysis of the Effects of Day-Time vs. Night-Time Surgery on Renal Transplant Patient Outcomes

Sleep deprivation and disruption of the circadian rhythms could impair individual surgical performance and decision making. For this purpose, this study identified potential confounding factors on surgical renal transplant patient outcomes during day and night. Our retrospective cohort study of 215 adult renal cadaver transplant recipients, of which 132 recipients were allocated in the "day-time" group and 83 recipients in the "night-time" group, primarily stratified the patients into two cohorts, depending on the start time. Within a 24 h operational system, "day-time" was considered as being from 8 a.m. to 8 p.m. and "night-time" from 8 p.m. to 8 a.m.. Primary outcomes examined patient and graft survival after three months and one year. Secondary outcomes included the presence of acute rejection (AR) and delayed graft function (DGF), as well as the rate of postoperative complications. In log-rank testing, "day-time" surgery was associated with a significantly higher risk of patient death (p = 0.003), whereas long-term graft survival was unaffected by the operative time of day. The mean cold ischemia time (CIT), which was 12.4 ± 5.3 h in the "night-time" group, was significantly longer compared to 10.7 ± 3.6 for those during the day (p = 0.01). We observed that "night-time" kidney recipients experienced more wound complications. From our single-centre data, we conclude that night-time kidney transplantation does not increase the risk of adverse events or predispose the patient to a worse outcome. Nevertheless, further research is required to explore the effect of fatigue on nocturnal surgical performance

The Regional Study of Sleep-Related Behaviors of Nurse Anesthetists: Personal and Professional Implications: A Replication Study

Universally, anesthesia providers are expected to be knowledgeable, astutely responding to clinical challenges while maintaining a prolonged vigilance for administration of safe anesthesia and critical care. A fatigued anesthetist is the consequence of cumulative acuity manifesting as decreased motor and cognitive powers. This results in patient harm, impaired judgement, late and inadequate responses to clinical changes, poor communications, and medical errors. With increased expectations and medical-legal claims, anesthesiologists work to provide efficient and timely services, but are rendered sleep deprived themselves. It is the right time to address the issue of the health of anesthesia providers and the profession. The implications of sleep deprivation on patient safety are profound and preventive strategies are essential. The governing bodies of anesthesia providers must ensure mandatory practices to prevent the adverse outcomes of fatigue related errors and patient compromise

Physiological and psychological responses of surgeons and trainees

Performing surgical procedures can increase the physiological stress and mental strain experienced by practicing surgeons and their trainees. This may negatively affect work and learning capacity and quality of patient care by increasing the incidence of burnout, sleep disorders, fatigue and other negative behaviours such as substance abuse. This study aimed to compare the physiological and psychological responses of similar clinical situations between orthopaedic surgeons and their clinical fellows. An observational prospective cohort study was performed in that matter. Our results showed overall increased physiological responses of the fellows during surgery days compared to the clinic days. On the contrary, staff did not show significant variability in their physiological responses between OR and clinic days. Type of procedure and type of approach used for a procedure had a distinct effect on fellows’ physiological responses. Further evaluation including physiological responses during different intraoperative steps might help identify specific stressors present in the working and learning environment

Impact of Sleep and Circadian Disruption on Energy Balance and Diabetes: A Summary of Workshop Discussions

A workshop was held at the National Institute for Diabetes and Digestive and Kidney Diseases with a focus on the impact of sleep and circadian disruption on energy balance and diabetes. The workshop identified a number of key principles for research in this area and a number of specific opportunities. Studies in this area would be facilitated by active collaboration between investigators in sleep/circadian research and investigators in metabolism/diabetes. There is a need to translate the elegant findings from basic research into improving the metabolic health of the American public. There is also a need for investigators studying the impact of sleep/circadian disruption in humans to move beyond measurements of insulin and glucose and conduct more in-depth phenotyping. There is also a need for the assessments of sleep and circadian rhythms as well as assessments for sleep-disordered breathing to be incorporated into all ongoing cohort studies related to diabetes risk. Studies in humans need to complement the elegant short-term laboratory-based human studies of simulated short sleep and shift work etc. with studies in subjects in the general population with these disorders. It is conceivable that chronic adaptations occur, and if so, the mechanisms by which they occur needs to be identified and understood. Particular areas of opportunity that are ready for translation are studies to address whether CPAP treatment of patients with pre-diabetes and obstructive sleep apnea (OSA) prevents or delays the onset of diabetes and whether temporal restricted feeding has the same impact on obesity rates in humans as it does in mice

Impact of Shift Work and Long Working Hours on Worker Cognitive Functions: Current Evidence and Future Research Needs

Particular working conditions and/or organization of working time may cause important sleep disturbances that have been proposed to be predictive of cognitive decline. In this regard, circadian rhythm misalignment induced by exposure to night work or long working hours would be responsible for cognitive impairment. Nevertheless, evidence supporting this correlation is limited and several issues still need to be elucidated. In this regard, we conducted a systematic review to evaluate the association between shift/night work and cognitive impairment and address its main determinants. Information provided by the reviewed studies suggested that night work might have serious immediate negative effects especially on cognitive domains related to attention, memory and response inhibition. Furthermore, cognitive performance would progressively worsen over consecutive night shifts or following exposure to very long work shifts. Otherwise, conflicting results emerged regarding the possible etiological role that night work chronic exposure would have on cognitive impairment. Therefore, circadian rhythm desynchronization, lack of sleep and fatigue resulting from night work may negatively impact worker's cognitive efficiency. However, in light of the considerable methodological variability of the reviewed studies, we proposed to develop a standardized research and evaluation strategy in order to obtain a better and comprehensive understanding of this topic

Taxonomic classification of planning decisions in health care: a review of the state of the art in OR/MS

We provide a structured overview of the typical decisions to be made in resource capacity planning and control in health care, and a review of relevant OR/MS articles for each planning decision. The contribution of this paper is twofold. First, to position the planning decisions, a taxonomy is presented. This taxonomy provides health care managers and OR/MS researchers with a method to identify, break down and classify planning and control decisions. Second, following the taxonomy, for six health care services, we provide an exhaustive specification of planning and control decisions in resource capacity planning and control. For each planning and control decision, we structurally review the key OR/MS articles and the OR/MS methods and techniques that are applied in the literature to support decision making

Sleep and Food Preferences

Short sleep duration is correlated with an increased BMI, but the mechanisms behind this relationship are not fully known. The purpose of this study was to examine the effect of sleep deprivation on dietary intake. Medical residents in good health served as subjects in this crossover study. Twenty adults aged 25 to 48 years completed two testing visits: one sleep deprived (≤ 4 hours of sleep) and one normal (≥ 6 hours of sleep). Food and beverage intake was collected on the days before and after testing by direct observation of breakfast and completion of 24-hour dietary recalls. Sleep deprivation did not significantly affect total energy intake the day after sleep manipulation. Mean energy intake under the sleep deprived condition was 2164.49± 946 calories and 2365.98±844 calories under the normal sleep condition (p=0.57). No differences were seen in macronutrient distribution between the two conditions. There were also no differences in caffeine, fiber, sodium, or sugar intake between the two conditions. In contrast to our expectation, sleep deprivation had no effect on total energy intake or macronutrient distribution. Further research in this area should continue to be conducted as similar studies have found mixed results, and no conclusive statements can be made at this time

Quality of Emergency Care on the Night Shift

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72839/1/j.aem.2005.09.005.pd

A cross-sectional study on prevalence and predictors of burnout among a sample of pharmacists employed in pharmacies in Central Italy

Burnout is defined as an occupational phenomenon linked to chronic workplace stress that has not been successfully managed and included among the factors influencing health status or contact with health services. Although several studies were performed for assessing this phenomenon, there is a lack of data on the prevalence of burnout and associated predictors, due to different definitions of the syndrome and heterogeneity of assessment methods. One of the well-known evidences on burnout is related to the highest risk professions, which include policemen, firemen, teachers, psychologists, medical students, nurses, physicians, and other health professionals, such as pharmacists. Objective. The aims of the present study were to (1) assess the occurrence of burnout syndrome among a sample of pharmacists employed in public and private pharmacies located in Rome province (Latium Region; central Italy); (2) evaluate the role of some potential predictors for the development of the syndrome. Materials and Methods. A questionnaire elaborated ad hoc was administered online to 2,000 members of the Association of Professional Pharmacists of Rome and its province and employed in public or private pharmacies. The questionnaire included the 14-item Shirom-Melamed Burnout Measure (SMBM) tool and questions on demographic characteristics and working conditions. Results. Physical exhaustion was the burnout dimension with the highest score; besides, approximately 11% of the studied pharmacists were categorized as having clinically relevant burnout levels (≥4.40). Several of the investigated variables significantly influenced the single burnout dimensions at the univariate analyses; multivariate analyses demonstrated that alcohol consumption and workplace location have a significant independent role on the overall SMBM index, while working time significantly influences clinically relevant burnout level. Conclusions. The results revealed that pharmacists are at risk of burnout, and thus, it is necessary to perform specific preventive intervention for managing this occupational threat

Vigilance of Certified Registered Nurse Anesthetists

Vigilance of certified registered nurse anesthetists (CRNAs) is an integral component of the care they provide patients under general anesthetic. the practice of CRNas is important as the official seal of the American Association of Nurse Anesthetists (AANA). on the seal, Morpheus, the god of dreams, is shown holding the Lamp of Learning, by the light of which he keeps vigil (Hirter & Van Nest, 1995). as the patients remain unconscious under general anesthesia, CRNas remain the patients\u27 eyes and ears remains responsive to their needs. the CRNa must remain attentive to the patient\u27s needs by continuously monitoring the patient in the operating room and constantly communicating with the operating room staff. Complete focus must be maintained to avoid any mishaps or adverse events. in essence, CRNas must remain focused and vigilant when caring for their patients. the importance of vigilance is essential and undeniable for optimal patient outcomes, but the process has yet to be defined and understood. Fourteen CRNas participated in phone interviews in this study. CRNas practicing in both hospital and ambulatory settings were included. Through data analysis, using constant comparison, a model emerged that explained vigilance in the CRNa process. the core category was Using Senses, and the model had seven subcategories. the categories below reflected stages in the process model. the process begins with the CRNA\u27s care of the patient (Being Alert). This is when the CRNa assumes care of the patient, maintains a high level of alertness, and does not get mentally fatigued. Being alert allows the CRNa to be ready to care for their patients. When CRNas are alert, they are attentive and engaged (Being Attentive and Engaged) in watching over their patients. This allows the CRNa to be constantly aware and pay attention to their patients. Being attentive and engaged allows the CRNa to be focused (Focusing) on every aspect of patient care. Unfortunately, the operating room is a dynamic environment, where distractions, such as music, conversation, and technology can distract clinicians from being engaged in the care of their patients. These distractions can, but do not always, occur. When they do occur, the CRNa redirects their attention and begins to focus, which allows CRNas to use their senses to look, listen, and feel (Looking, Listening, and Touching). Using the senses of looking, listening, and feeling, the CRNa can pick up on events or look for cues that can help continue or improve care by anticipating changes at random intervals during the case. by using their senses and picking up on cues, the CRNa knows what is going on with the patient (Know What Is Happening). the findings of this study have implications for nurse administrators. This theory will be informative and helpful for hospital administrators, as they may want to implement a policy similar to that which the aviation industry developed for pilots reporting for duty. in regards to nursing research, the Institute of Medicine ([IOM], 2003) has used the phenomena of vigilance and surveillance interchangeably, but the processes are not interchangeable. There is a distinction between these two concepts. This study provides a link between the two phenomena. Vigilance is a link to the process of surveillance and studying it will help the researcher expound upon the previous surveillance research in nursing