Inter-hospital comparison of working time allocation among internal medicine residents using time-motion observations: an innovative benchmarking tool

OBJECTIVES The vast majority of residents' working time is spent away from patients. In hospital practice, many factors may influence the resident's working day structure.Using an innovative method, we aimed to compare working time allocation among internal medicine residents using time-motion observations. The first study goal was to describe how the method could be used for inter-hospital comparison. The secondary goal was to learn about specific differences in the resident's working day structure in university and non-university hospital settings. DESIGN Two separate time-motion studies. Trained peer-observers followed the residents during weekday day shifts with a tablet, able to record 22 different activities and corresponding context (with patient, phone, colleague or computer). SETTING Internal medicine residencies at a university (May-July 2015) and a non-university (September-October 2016) community hospital. PARTICIPANTS 28 residents (mean age: 29 years, average postgraduate training: 30 months) at university hospital, 21 residents (mean age: 30 years, average postgraduate training: 17 months) at non-university hospital. OUTCOMES Time spent with patients and time dedicated to activities directly related to patients; description of main differences of time allocation between hospitals. RESULTS Cumulatively 1051 hours of observation (566 (university hospital)+486 (non-university hospital)) and 92 day shifts (49+43) were evaluated. Daily working time was 11.5 versus 11.3 hours. A median daily period of 195 min (IQR 179-211, 27.9%) and 116 min (IQR 98-134, 17.2%) (p<0.001) was dedicated to direct patient care, respectively. CONCLUSIONS We successfully identified differences potentially related to each hospital structure and organisation. Inter-hospital comparisons could help set up interventions aiming to improve workday structure and experience of residents

Cosmogenic nuclides during Isotope Stages 2 and 3

International audienc

Radioisotope dating with the ETHZ-EN-tandem accelerator

During the last three years the ETH-EN-tandem accelerator facility has been adapted for the quantitative determination of the rare isotopes 14C and 10Be in mg samples. The goal of this project is to routinely achieve a 1% accuracy when measuring 14C/12C ratios with a minimum expenditure of human resources and beam time. The concept is similar to that proposed by Purser and Henley (1978). The early evolution of this dating facility was described previously (Suter et al, 1981a,b). This paper is a brief report on the current status of the system and its development

Quality of Life in elderly patients with venous thromboembolism assessed using Patient-Reported Outcome Measures.

BACKGROUND We aimed to evaluate the quality of life (QoL), using Patient-Reported Outcome Measures (PROMs), in elderly patients with venous thromboembolism (VTE) and to explore whether VTE complications (recurrence, bleeding or post thrombotic syndrome) had an impact on later QoL. METHODS We used data from SWITCO65+, a prospective multicenter cohort of patients aged ≥65 years with acute, symptomatic VTE. Primary outcome was change in QoL up to 24 months, assessed using generic (36-Item Short-Form Health Survey [SF-36], with Physical (PCS) and Mental Component Score (MCS) and disease-specific ([VEINES]-QOL, [VEINES-Sym], and [PEmb]-QoL) PROMs. PROMs scores ranged from 0-100 points, higher scores indicating a better QoL. Longitudinal latent class analysis was used to group patients with similar PCS trajectories. Repeated-measures linear regression analyses were used to assess effects of VTE complications on change in QoL scores. RESULTS In 923 patients (median age 75; 54% male), 140 (15%) patients died, 97 (11%) experienced recurrent VTE, and 106 (12%) major bleeding during follow-up. Compared to patients with higher PCS trajectories, patients with lower PCS trajectories were more likely to be older, female, sicker, and less physically active. On average, generic and disease-specific QoL scores improved over time (+11% in PCS, +3% in MCS, +6% in VEINES-QOL and +16% in PEmb-QOL at 3 months). VTE complications was always associated with significantly lower QoL scores (for VTE recurrence: PCS adjusted difference -2.57, 95%CI = -4.47- -0.67). CONCLUSION While QoL following VTE tended to improve over time, patients with VTE-related complications had lower QoL than patients without complications

Quality of life in elderly patients with venous thromboembolism assessed using patient-reported outcome measures

Background: We aimed to evaluate the quality of life (QoL), using patient-reported outcome measures (PROMs), in elderly patients with venous thromboembolism (VTE) and to explore whether VTE complications (recurrence, bleeding, or postthrombotic syndrome) had an impact on later QoL. Methods: We used data from the SWIss venous Thromboembolism COhort of older patients(SWITCO65+), a prospective multicenter cohort of patients aged ≥65 years with acute, symptomatic VTE. Primary outcome was changes in QoL up to 24 months, assessed using generic (36-Item Short-Form Health Survey), with physical (PCS) and mental component score (MCS), and disease-specific (Venous Insufficiency Epidemiological and Economic Study [VEINES]-QoL, [VEINES-Sym], and Pulmonary Embolism QoL) PROMs. PROM scores ranged from 0 to 100 points, higher scores indicating a better QoL. Longitudinal latent class analysis was used to group patients with similar PCS trajectories. Repeated-measures linear regression analyses were used to assess effects of VTE complications on changes in QoL scores. Results: In 923 patients (median age, 75; male, 54%), 140 (15%) patients died, 97 (11%) experienced recurrent VTE, and 106 (12%) major bleeding during follow-up. Compared with patients with higher PCS trajectories, patients with lower PCS trajectories were more likely to be older, female, sicker, and less physically active. On average, generic and disease-specific QoL scores improved over time (+11% in PCS, +3% in MCS, +6% in VEINES QoL, and +16% in Pulmonary Embolism QoL at 3 months). VTE complications were always associated with significantly lower QoL scores (for VTE recurrence: PCS adjusted difference -2.57, 95% CI, -4.47 to -0.67). Conclusion: Although QoL following VTE tended to improve over time, patients with VTE-related complications had lower QoL than patients without complications. Keywords: elderly patients; major bleeding; patient-reported outcome measures; quality of life; venous thromboembolism

Towards personalized antithrombotic management with drugs and devices across the cardiovascular spectrum.

Intravascular thrombus formation and embolization are among the most frequent events leading to a number of cardiovascular conditions with high morbidity and mortality. The underlying causes are stasis of the circulating blood, genetic and acquired coagulation disorders, and reduced antithrombotic or prothrombotic properties of the vascular wall (Virchow's triad). In the venous system, intravascular thrombi can cause venous thrombosis and pulmonary and even peripheral embolism including ischaemic stroke [through a patent foramen ovale (PFO)]. Thrombi in the left atrium and its appendage or ventricle form in the context of atrial fibrillation and infarction, respectively. Furthermore, thrombi can form on native or prosthetic aortic valves, within the aorta (in particular at sites of ulcers, aortic dissection, and abdominal aneurysms), and in cerebral and peripheral arteries causing stroke and critical limb ischaemia, respectively. Finally, thrombotic occlusion may occur in arteries supplying vital organs such the heart, brain, kidney, and extremities. Thrombus formation and embolization can be managed with anticoagulants and devices depending on where they form and embolize and on patient characteristics. Vitamin K antagonists are preferred in patients with mechanical valves, while novel oral anticoagulants are first choice in most other cardiovascular conditions, in particular venous thromboembolism and atrial fibrillation. As anticoagulants are associated with a risk of bleeding, devices such as occluders of a PFO or the left atrial appendage are preferred in patients with an increased bleeding risk. Platelet inhibitors such as aspirin and/or P2Y12 antagonists are preferred in the secondary prevention of coronary artery disease, stroke, and peripheral artery disease either alone or in combination depending on the clinical condition. A differential and personalized use of anticoagulants, platelet inhibitors, and devices is recommended and reviewed in this article

An improved north–south synchronization of ice core records around the 41 kyr 10^{10}Be peak

International audienceUsing new high-resolution 10Be measurements in the NGRIP, EDML and Vostok ice cores, together with previously published data from EDC, we present an improved synchronization between Greenland and Antarctic ice cores during the Laschamp geomagnetic excursion  ∼  41 kyr ago. We estimate the precision of this synchronization to be ±20 years, an order of magnitude better than previous work. We discuss the implications of this new synchronization for making improved estimates of the depth difference between ice and enclosed gas of the same age (Δdepth), difference between age of ice and enclosed gas at the same depth (Δage) in the EDC and EDML ice cores, spectral properties of the 10Be profiles and phasing between Dansgaard–Oeschger-10 (in NGRIP) and AIM-10 (in EDML and EDC)

Multiradionuclide evidence for the solar origin of the cosmic-ray events of AD 774/5 and 993/4

The origin of two large peaks in the atmospheric radiocarbon (C-14) concentration at AD 774/5 and 993/4 is still debated. There is consensus, however, that these features can only be explained by an increase in the atmospheric C-14 production rate due to an extraterrestrial event. Here we provide evidence that these peaks were most likely produced by extreme solar events, based on several new annually resolved Be-10 measurements from both Arctic and Antarctic ice cores. Using ice core Cl-36 data in pair with Be-10, we further show that these solar events were characterized by a very hard energy spectrum with high fluxes of solar protons with energy above 100MeV. These results imply that the larger of the two events (AD 774/5) was at least five times stronger than any instrumentally recorded solar event. Our findings highlight the importance of studying the possibility of severe solar energetic particle events

Risk Profiles and Treatment Patterns in Atrial Fibrillation Patients with Chronic Kidney Disease Receiving or not Receiving Anticoagulation Therapy

Background Patients with atrial fibrillation (AF) and chronic kidney disease (CKD) are at high risk for both thromboembolism and bleeding events. The latter induces a potential reason for withholding oral anticoagulation (OAC) despite an indication for prophylaxis of thromboembolic events