Hospital doctors' workflow interruptions and activities: an observation study

BACKGROUND Interruptions of hospital doctors' workflow are a frequent stressor, eventually jeopardising quality of clinical performance. To enhance the safety of hospital doctors' work, it is necessary to analyse frequency and circumstances of workflow interruptions. AIM To quantify workflow interruptions among hospital doctors, identify frequent sources and relate sources to doctors' concurrent activities. METHODS Within a typical hospital, 32 participant observations of doctors' full work shifts were carried out. Time-motion information was collected on types of workflow interruption and doctors' activities and analysed with logit-linear analyses. RESULTS The frequency of workflow interruptions was high, especially on the intensive care unit and emergency ward. Telephones and bleepers were the most frequently recorded type of work interruption. The combined analysis of doctors' activities and concurrent workflow interruptions revealed that the likelihood of the occurrence of certain types of interruption depended on the tasks being carried out by the doctor. CONCLUSION The present method may be useful for quantifying and distinguishing sources of hospital doctors' workflow interruptions and useful in raising awareness of organisational circumstances

Current Wildland Fire Patterns and Challenges in Europe : A Synthesis of National Perspectives

Changes in climate, land use, and land management impact the occurrence and severity of wildland fires in many parts of the world. This is particularly evident in Europe, where ongoing changes in land use have strongly modified fire patterns over the last decades. Although satellite data by the European Forest Fire Information System provide large-scale wildland fire statistics across European countries, there is still a crucial need to collect and summarize in-depth local analysis and understanding of the wildland fire condition and associated challenges across Europe. This article aims to provide a general overview of the current wildland fire patterns and challenges as perceived by national representatives, supplemented by national fire statistics (2009-2018) across Europe. For each of the 31 countries included, we present a perspective authored by scientists or practitioners from each respective country, representing a wide range of disciplines and cultural backgrounds. The authors were selected from members of the COST Action "Fire and the Earth System: Science & Society" funded by the European Commission with the aim to share knowledge and improve communication about wildland fire. Where relevant, a brief overview of key studies, particular wildland fire challenges a country is facing, and an overview of notable recent fire events are also presented. Key perceived challenges included (1) the lack of consistent and detailed records for wildland fire events, within and across countries, (2) an increase in wildland fires that pose a risk to properties and human life due to high population densities and sprawl into forested regions, and (3) the view that, irrespective of changes in management, climate change is likely to increase the frequency and impact of wildland fires in the coming decades. Addressing challenge (1) will not only be valuable in advancing national and pan-European wildland fire management strategies, but also in evaluating perceptions (2) and (3) against more robust quantitative evidence.Peer reviewe

Participant observation of time allocation, direct patient contact and simultaneous activities in hospital physicians

<p>Abstract</p> <p>Background</p> <p>Hospital physicians' time is a critical resource in medical care. Two aspects are of interest. First, the time spent in direct patient contact – a key principle of effective medical care. Second, simultaneous task performance ('multitasking') which may contribute to medical error, impaired safety behaviour, and stress. There is a call for instruments to assess these aspects. A preliminary study to gain insight into activity patterns, time allocation and simultaneous activities of hospital physicians was carried out. Therefore an observation instrument for time-motion-studies in hospital settings was developed and tested.</p> <p>Methods</p> <p>35 participant observations of internists and surgeons of a German municipal 300-bed hospital were conducted. Complete day shifts of hospital physicians on wards, emergency ward, intensive care unit, and operating room were continuously observed. Assessed variables of interest were time allocation, share of direct patient contact, and simultaneous activities. Inter-rater agreement of Kappa = .71 points to good reliability of the instrument.</p> <p>Results</p> <p>Hospital physicians spent 25.5% of their time at work in direct contact with patients. Most time was allocated to documentation and conversation with colleagues and nursing staff. Physicians performed parallel simultaneous activities for 17–20% of their work time. Communication with patients, documentation, and conversation with colleagues and nursing staff were the most frequently observed simultaneous activities. Applying logit-linear analyses, specific primary activities increase the probability of particular simultaneous activities.</p> <p>Conclusion</p> <p>Patient-related working time in hospitals is limited. The potential detrimental effects of frequently observed simultaneous activities on performance outcomes need further consideration.</p

It’s all about seeing and hearing : the Editors’ and Readers’ Choice Awards 2022

This year marks the inauguration of the annual Editors’ Choice Award and the Readers’ Choice Award, each presented for outstanding original papers and review articles published in the Journal of Comparative Physiology A. The winners of the 2022 Editors’ Choice Award were determined by vote of the Editorial Board for the most highly recommended papers published in Volume 207 in 2021. They are ‘Visual discrimination and resolution in freshwater stingrays (Potamotrygon motoro)’ by Daniel et al. (J Comp Physiol A 207, 43–58, 2021) in the Original Paper category; and ‘Neurophysiology goes wild: from exploring sensory coding in sound proof rooms to natural environments’ by Römer (J Comp Physiol A 207, 303–319, 2021) in the Review Article category. The 2022 Readers’ Choice Award was based on access number of articles published in Volume 206 in 2020, to ensure at least 12-month online presence. It is given to Nicholas et al. for their original paper titled ‘Visual motion sensitivity in descending neurons in the hoverfly’ (J Comp Physiol A 206, 149–163, 2020); and to Schnaitmann et al. for their review article entitled ‘Color vision in insects: insights from Drosophila’ (J Comp Physiol A 206, 183–198, 2020)

Contact chemoreception, magnetic maps, thermoregulation by a superorganism, and, thanks to Einstein, an all-time record : the Editors’ and Readers’ Choice Awards 2023

During the 99 years of its history, the Journal of Comparative Physiology A has published many of the most influential papers in comparative physiology and related disciplines. To celebrate this achievement of the journal’s authors, annual Editors’ Choice Awards and Readers’ Choice Awards are presented. The winners of the 2023 Editors’ Choice Awards are ‘Contact chemoreception in multi‑modal sensing of prey by Octopus’ by Buresch et al. (J Comp Physiol A 208:435–442, 2022) in the Original Paper category; and ‘Magnetic maps in animal navigation’ by Lohmann et al. (J Comp Physiol A 208:41–67, 2022) in the Review/Review-History Article category. The winners of the 2023 Readers’ Choice Awards are ‘Coping with the cold and fighting the heat: thermal homeostasis of a superorganism, the honeybee colony’ by Stabentheiner et al. (J Comp Physiol A 207:337–351; 2021) in the Original Paper category; and ‘Einstein, von Frisch and the honeybee: a historical letter comes to light’ by Dyer et al. (J Comp Physiol A 207:449–456, 2021) in the Review/Review-History category

Fracture Pattern Influences Radial Head Replacement Size Determination Among Experienced Elbow Surgeons

Background: Correct sizing is challenging in radial head replacement and no consensus exists on the implant’s optimal height and width to avoid elbow stiffness and instability. Studies exists, suggesting how to appropriately choose the implant size, but the manner by which the fracture pattern influences the surgeons’ operative choices was not investigated. Methods: The radial heads of four fresh-frozen cadaveric specimens were excised, measured, and fractured to simulate four patterns: three fragments (A); four fragments (B); comminuted (C); comminuted with bone loss (D). Nine examiners were asked to indicate first the maximum diameter of the radial heads with the help of dedicated sizing dishes and then the appropriate implant size with trial implants. Accuracy and precision were determined. A coefficient of variation was calculated and agreement was evaluated with the Bland–Altman method. Results: Accuracy and precision of radial head diameter estimation with dedicated sizing dish were 96.73% and 93.64%, (best pattern, D; worst, C). Accuracy and precision of radial head diameter estimation with trial implants were 99.71% and 90.66% (best pattern, A; worst, D). Frequent modifications occurred between the initial radial head size proposal based on the sizing dish and the radial head size chosen after use of the trial implants (47.2%). Conclusions: Diameter estimation of radial heads with dedicated sizing dishes may be underestimated in comminuted fractures; when bone loss is present, this may lead to an overestimation, especially when using trial implants. Care is essential to determine the optimal size of the implant and to avoid overlenghtening and oversizing, which can be responsible for implant failure. Level of Evidence: Basic Science Study. Clinical Relevance: Knowledge of the manner by which the fracture pattern influences radial head replacement size estimation can help preventing overlenghtening and oversizing during this procedure

Locating the ulnar nerve during elbow arthroscopy using palpation is only accurate proximal to the medial epicondyle

Purpose: Knowledge of ulnar nerve position is of utmost importance to avoid iatrogenic injury in elbow arthroscopy. The aim of this study was to determine how accurate surgeons are in locating the ulnar nerve after fluid extravasation has already occurred, and basing their localization solely on palpation of anatomical landmarks. Methods: Seven cadaveric elbows were used and seven experienced surgeons in elbow arthroscopy participated. An arthroscopic setting was simulated and fluids were pumped into the joint from the posterior compartment for 15 min. For each cadaveric elbow, one surgeon was asked to locate the ulnar nerve solely by palpation of the anatomical landmarks, and subsequently pin the ulnar nerve at two positions: within 5 cm proximal and another within 5 cm distal of a line connecting the medial epicondyle and the tip of the olecranon. Subsequently, the elbows were dissected using a standard medial elbow approach and the distances between the pins and ulnar nerve were measured. Results: The median distance between the ulnar nerve and the proximal pins was 0 mm (range 0–0 mm), and between the ulnar nerve and the distal pins was 2 mm (range 0–10 mm), showing a statistically significant difference (p = 0.009). All seven proximally placed pins (100%) transfixed the ulnar nerve versus two out of seven distally placed pins (29%) (p = 0.021). Conclusions: In a setting simulating an already initiated arthroscopic procedure, the sole palpation of the anatomical landmarks allows experienced elbow surgeons to accurately locate the ulnar nerve only in its course proximal to the medial epicondyle (7/7, 100%), whereas a significantly reduced accuracy is documented when the same surgeons attempt to locate the nerve distal to the medial epicondyle (2/7, 29%; p = 0.021). Current findings support the establishment of a proximal anteromedial portal over a distal anteromedial portal to access the anterior compartment after tissue extravasation has occurred with regard to ulnar nerve safety

A systematic review and characterization of the major and most studied urban soil threats in the European Union

There is an urgent need by the European Union to establish baseline levels for many widespread pollutants and to set out specific levels for these under the Zero pollution action plan. To date, few systematic reviews, superseded by bibliometric analyses, have explored this issue. Even less research has been carried out to compare the efficacy of these two data extraction approaches. This study aims to address these two issues by i) constructing an inventory of the available information on urban soils, highlighting evidence gaps and measuring compliance with the Zero pollution action plan, and by ii) comparing the methods and results of these two data extraction approaches. Through Scopus and Web of Science databases, peer-reviewed articles using the terms urban soil in combination with specific urban soil threats and/or challenges were included. Notably, both approaches retrieved a similar number of initial articles overall, while the bibliometric analysis removed fewer duplicates and excluded fewer articles overall, leaving the total number of articles included in each approach as: 603 articles in the systematic review and 2372 articles in the bibliometric analysis. Nevertheless, both approaches identified the two main urban soil threats and/or challenges to be linked to soil organic carbon and/or heavy metals. This study gives timely input into the Zero pollution action plan and makes recommendations to stakeholders within the urban context

The state of soils in Europe

International audienceThis report delves into the intricate interplay between drivers, pressures and impacts on soil in the 32 Member States of the European Environment Agency (EEA), along with six cooperating countries from the West Balkans, Ukraine and UK, shedding light on the multifaceted challenges facing soil conservation efforts. Our analysis shows the complex interactions among various factors, both anthropogenic and natural, shaping soil degradation processes and their subsequent consequences. We highlight key findings, including the significant impacts of soil degradation on agriculture, ecosystem resilience, water quality, biodiversity, and human health, underscoring the urgent need for comprehensive soil management strategies. Moreover, our examination of citizen science initiatives underlines the importance of engaging the public in soil monitoring and conservation efforts. This work emphasises the policy relevance of promoting sustainable soil governance frameworks, supported by research, innovation, and robust soil monitoring schemes, to safeguard soil health and ensure the long-term resilience of ecosystems

Infective Endocarditis After Transcatheter Versus Surgical Aortic Valve Replacement

Abstract Background Scarce data are available comparing infective endocarditis (IE) following surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). This study aimed to compare the clinical presentation, microbiological profile, management, and outcomes of IE after SAVR versus TAVR. Methods Data were collected from the “Infectious Endocarditis after TAVR International” (enrollment from 2005 to 2020) and the “International Collaboration on Endocarditis” (enrollment from 2000 to 2012) registries. Only patients with an IE affecting the aortic valve prosthesis were included. A 1:1 paired matching approach was used to compare patients with TAVR and SAVR. Results A total of 1688 patients were included. Of them, 602 (35.7%) had a surgical bioprosthesis (SB), 666 (39.5%) a mechanical prosthesis, 70 (4.2%) a homograft, and 350 (20.7%) a transcatheter heart valve. In the SAVR versus TAVR matched population, the rate of new moderate or severe aortic regurgitation was higher in the SB group (43.4% vs 13.5%; P &lt; .001), and fewer vegetations were diagnosed in the SB group (62.5% vs 82%; P &lt; .001). Patients with an SB had a higher rate of perivalvular extension (47.9% vs 27%; P &lt; .001) and Staphylococcus aureus was less common in this group (13.4% vs 22%; P = .033). Despite a higher rate of surgery in patients with SB (44.4% vs 27.3%; P &lt; .001), 1-year mortality was similar (SB: 46.5%; TAVR: 44.8%; log-rank P = .697). Conclusions Clinical presentation, type of causative microorganism, and treatment differed between patients with an IE located on SB compared with TAVR. Despite these differences, both groups exhibited high and similar mortality at 1-year follow-up