A mid year comparison study of career satisfaction and emotional states between residents and faculty at one academic medical center

BACKGROUND: The Accreditation Council for Graduate Medical Education's (ACGME) new requirements raise multiple challenges for academic medical centers. We sought to evaluate career satisfaction, emotional states, positive and negative experiences, work hours and sleep among residents and faculty simultaneously in one academic medical center after implementation of the ACGME duty hour requirements. METHODS: Residents and faculty (1330) in the academic health center were asked to participate in a confidential survey; 72% of the residents and 66% of the faculty completed the survey. RESULTS: Compared to residents, faculty had higher levels of satisfaction with career choice, competence, importance and usefulness; lower levels of anxiousness and depression. The most positive experiences for both groups corresponded to strong interpersonal relationships and educational value; most negative experiences to poor interpersonal relationships and issues perceived outside of the physician's control. Approximately 13% of the residents and 14% of the faculty were out of compliance with duty hour requirements. Nearly 5% of faculty reported working more than 100 hours per week. For faculty who worked 24 hour shifts, nearly 60% were out of compliance with the duty-hour requirements. CONCLUSION: Reasons for increased satisfaction with career choice, positive emotional states and experiences for faculty compared to residents are unexplained. Earlier studies from this institution identified similar positive findings among advanced residents compared to more junior residents. Faculty are more frequently at risk for duty-hour violations. If patient safety is of prime importance, faculty, in particular, should be compliant with the duty hour requirements. Perhaps the ACGME should contain faculty work hours as part of its regulatory function

Hughes Abdominal Repair Trial (HART) – Abdominal wall closure techniques to reduce the incidence of incisional hernias: study protocol for a randomised controlled trial

Background Incisional hernias are common complications of midline closure following abdominal surgery and cause significant morbidity, impaired quality of life and increased health care costs. The ‘Hughes Repair’ combines a standard mass closure with a series of horizontal and two vertical mattress sutures within a single suture. This theoretically distributes the load along the incision length as well as across it. There is evidence to suggest that this technique is as effective as mesh repair for the operative management of incisional hernias; however, no trials have compared the Hughes Repair with standard mass closure for the prevention of incisional hernia formation following a midline incision. Methods/design This is a 1:1 randomised controlled trial comparing two suture techniques for the closure of the midline abdominal wound following surgery for colorectal cancer. Full ethical approval has been gained (Wales REC 3, MREC 12/WA/0374). Eight hundred patients will be randomised from approximately 20 general surgical units within the United Kingdom. Patients undergoing open or laparoscopic (more than a 5-cm midline incision) surgery for colorectal cancer, elective or emergency, are eligible. Patients under the age of 18 years, those having mesh inserted or undergoing musculofascial flap closure of the perineal defect in abdominoperineal wound closure, and those unable to give informed consent will be excluded. Patients will be randomised intraoperatively to either the Hughes Repair or standard mass closure. The primary outcome measure is the incidence of incisional hernias at 1 year as assessed by standardised clinical examination. The secondary outcomes include quality of life patient-reported outcome measures, cost-utility analysis, incidence of complete abdominal wound dehiscence and C-POSSUM scores. The incidence of incisional hernia at 1 year, assessed by computerised tomography, will form a tertiary outcome. Discussion A feasibility phase has been completed. The results of the study will be used to inform current and future practice and potentially reduce the risk of incisional hernia formation following midline incisions

Avaliação de campanhas de saúde com ênfase na sífilis congênita: uma revisão sistemática Evaluation of health campaigns with emphasis on congenital syphilis: a systematic review

Campanhas têm sido instrumentos de políticas públicas de saúde, freqüentemente utilizadas no Brasil para esclarecer, motivar ou conseguir o apoio da população e/ou dos profissionais de saúde, em ações relevantes para a saúde pública. Esta revisão procurou levantar subsídios para a avaliação de campanhas de saúde, particularizando-se as metodologias utilizadas, tendo em vista a avaliação de campanhas dirigidas ao controle da sífilis congênita. Os conjuntos de palavras-chave utilizados foram "sífilis congênita + avaliação"; "campanhas de saúde + avaliação" e, "campanha + saúde + avaliação". As bases de dados pesquisadas foram a Medline (Medical Literature Analysis and Retrieval System Online) da National Library of Medicine (EUA), a LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde) e da PAHO (Pan-American Health Organization), no período de 1980 e 2003. Foram incluídos 37 artigos nessa revisão, sendo 15 referentes à sífilis congênita e avaliação e 22 à campanha de saúde e avaliação. A revisão realizada mostrou que existe um espaço a ser preenchido neste campo, principalmente no que se refere à construção metodológica. Apesar da palavra avaliação constar nesses vários artigos, a fundamentação teórica encontrada não foi totalmente condizente com as propostas apresentadas.<br>Campaigns are healthcare public policies means frequently used in Brazil, to educate, motivate or achieve population and/or healthcare professionals in relevant public health actions. This review pursued the gathering of input to assess health campaigns, specifically the methodologies used, focusing on congenital syphilis control campaigns. Keywords used were "congenital syphilis + assessment", "health campaigns + assessment" and, "campaign + health + assessment". Databases surveyed were Medline (Medical Literature Analysis and Retrieval System Online) of National Library of Medicine, LILACS (Latin American and Caribbean Health Sciences) and PAHO (Pan-American Health Organization), from 1980 to 2003. Thirty seven articles in this review, 15 related to congenital syphilis and assessment and 22 to healthcare campaigns and assessment. Review accomplished indicated a gap to be filled in this field specially related to methodology design. Notwithstanding the word "assessment" inclusion in these articles, the theoretical rationale determined was not consistent with the submitted proposals