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https://www.readbyqxmd.com/read/28720087/resident-perceptions-of-the-impact-of-duty-hour-restrictions-on-resident-attending-interactions-an-exploratory-study
#1
Kristen A Gerjevic, Marcy E Rosenbaum, Manish Suneja
BACKGROUND: The institution of duty hour reforms by the Accreditation Council for Graduate Medical Education in 2003 has created a learning environment where residents are consistently looking for input from attending physicians with regards to balancing duty hour regulations and providing quality patient care. There is a paucity of literature regarding resident perceptions of attending physician actions or attitudes towards work hour restrictions. The purpose of this study was to identify attending physician behaviors that residents perceived as supportive or unsupportive of their compliance with duty hour regulations...
July 18, 2017: BMC Medical Education
https://www.readbyqxmd.com/read/28673883/microsurgical-performance-after-sleep-interruption-a-neurotouch-simulator-study
#2
Alexander Micko, Karoline Knopp, Engelbert Knosp, Stefan Wolfsberger
OBJECTIVE: In times of the ubiquitous debate about doctors' working hour restrictions, it is still questionable if the physician's performance is impaired by high workload and long shifts. In this study we evaluated the impact of sleep interruption on the neurosurgical performance. METHODS: Ten medical students and ten neurosurgical residents were tested on the virtual-reality simulator NeuroTouch by performing the identical microsurgical task, well-rested (baseline test), and after sleep interruption at night (stress test)...
June 30, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28651904/community-based-distribution-of-misoprostol-for-early-abortion-evaluation-of-a-program-along-the-thailand-burma-border
#3
Angel M Foster, Grady Arnott, Margaret Hobstetter
BACKGROUND: Although abortion is legal in Thailand for a number of indications, women from Burma residing in Thailand are rarely able to access safe services. We evaluated the outcomes of a community-based distribution program that provides migrant, refugee, and cross-border women from Burma with evidence-based information about and access to misoprostol for early pregnancy termination. METHODS: After determination of eligibility based on self-report and counseling, trained Network members instructed women to vaginally administer two 800-mcg doses of misoprostol 24 h apart and a third dose one week later, if needed...
June 23, 2017: Contraception
https://www.readbyqxmd.com/read/28638506/efficacy-of-interventions-to-reduce-resident-physician-burnout-a-systematic-review
#4
REVIEW
Kiran R Busireddy, Jonathan A Miller, Kathleen Ellison, Vicky Ren, Rehan Qayyum, Mukta Panda
BACKGROUND: Studies report high burnout prevalence among resident physicians, with little consensus on methods to effectively reduce it. OBJECTIVE: This systematic literature review explores the efficacy of interventions in reducing resident burnout. METHODS: PubMed, Embase, and Web of Science were searched using these key words: burnout and resident, intern, or residency. We excluded review articles, editorials, letters, and non-English-language articles...
June 2017: Journal of Graduate Medical Education
https://www.readbyqxmd.com/read/28633175/the-marshall-family-medicine-residency-twintern-schedule-the-impact-of-an-innovative-hospital-coverage-scheme-on-resident-fatigue
#5
Adam Franks, Stephen M Petrany, Sydnee McElroy, Adam Alley
BACKGROUND AND OBJECTIVES: Work hour restriction has strained the balance between resident service and education. Night Float (NF) rotations are a popular answer to managing this balance but weakens continuity, an essential tenant of family medicine. An innovative short call system for Marshall University's Family Medicine Hospital Service (FMHS), the twINTERN call model, was created in response. We studied the impact of this approach on resident fatigue. METHODS: Anonymous surveys assessed fatigue of the Marshall University's 2013-2014 Family Medicine intern resident class while on NF rotations (ICU, Pediatrics and Surgery) and the twINTERN call...
June 2017: Family Medicine
https://www.readbyqxmd.com/read/28570718/free-flap-reconstruction-monitoring-techniques-and-frequency-in-the-era-of-restricted-resident-work-hours
#6
Urjeet A Patel, David Hernandez, Yelizaveta Shnayder, Mark K Wax, Matthew M Hanasono, Joshua Hornig, Tamer A Ghanem, Matthew Old, Ryan S Jackson, Levi G Ledgerwood, Patrik Pipkorn, Lawrence Lin, Adrian Ong, Joshua B Greene, James Bekeny, Yin Yiu, Salem Noureldine, David X Li, Joel Fontanarosa, Evan Greenbaum, Jeremy M Richmon
Importance: Free flap reconstruction of the head and neck is routinely performed with success rates around 94% to 99% at most institutions. Despite experience and meticulous technique, there is a small but recognized risk of partial or total flap loss in the postoperative setting. Historically, most microvascular surgeons involve resident house staff in flap monitoring protocols, and programs relied heavily on in-house resident physicians to assure timely intervention for compromised flaps...
June 1, 2017: JAMA Otolaryngology—Head & Neck Surgery
https://www.readbyqxmd.com/read/28439356/impact-of-the-2003-acgme-resident-duty-hour-reform-on-hospital-acquired-conditions-a-national-retrospective-analysis
#7
Timothy Wen, Frank J Attenello, Steven Y Cen, Alexander A Khalessi, May Kim-Tenser, Nerses Sanossian, Steven L Giannotta, Arun P Amar, William J Mack
BACKGROUND: The Accreditation Council for Graduate Medical Education reforms in 2003 instituted an 80-hour weekly limit for resident physicians. Critics argue that these restrictions have increased handoffs among residents and the potential for a decline in patient safety. "Never events" hospital-acquired conditions (HACs) are a set of preventable events used as a quality metric in hospital safety analyses. OBJECTIVE: This analysis evaluated post-work hour reform effects on HAC incidence for US hospital inpatients, using the National Inpatient Sample...
April 2017: Journal of Graduate Medical Education
https://www.readbyqxmd.com/read/28375898/virtual-reality-compared-with-bench-top-simulation-in-the-acquisition-of-arthroscopic-skill-a-randomized-controlled-trial
#8
RANDOMIZED CONTROLLED TRIAL
Daniel Banaszek, Daniel You, Justues Chang, Michael Pickell, Daniel Hesse, Wilma M Hopman, Daniel Borschneck, Davide Bardana
BACKGROUND: Work-hour restrictions as set forth by the Accreditation Council for Graduate Medical Education (ACGME) and other governing bodies have forced training programs to seek out new learning tools to accelerate acquisition of both medical skills and knowledge. As a result, competency-based training has become an important part of residency training. The purpose of this study was to directly compare arthroscopic skill acquisition in both high-fidelity and low-fidelity simulator models and to assess skill transfer from either modality to a cadaveric specimen, simulating intraoperative conditions...
April 5, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28375523/how-the-acgme-work-hour-restrictions-have-affected-orthopedic-residents
#9
EDITORIAL
Bryan M Saltzman, Jonathan M Frank
No abstract text is available yet for this article.
January 1, 2017: Orthopedics
https://www.readbyqxmd.com/read/28338438/learning-brain-aneurysm-microsurgical-skills-in-a-human-placenta-model-predictive-validity
#10
Marcelo Magaldi Ribeiro de Oliveira, Carlos Eduardo Ferrarez, Taise Mosso Ramos, Jose Augusto Malheiros, Arthur Nicolato, Carla Jorge Machado, Mauro Tostes Ferreira, Fellype Borges de Oliveira, Cecília Félix Penido Mendes de Sousa, Pollyana Helena Vieira Costa, Sebastiao Gusmao, Giuseppe Lanzino, Rolando Del Maestro
OBJECTIVE Surgery for brain aneurysms is technically demanding. In recent years, the process to learn the technical skills necessary for these challenging procedures has been affected by a decrease in the number of surgical cases available and progressive restrictions on resident training hours. To overcome these limitations, surgical simulators such as cadaver heads and human placenta models have been developed. However, the effectiveness of these models in improving technical skills is unknown. This study assessed concurrent and predictive validity of brain aneurysm surgery simulation in a human placenta model compared with a "live" human brain cadaveric model...
March 24, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28329124/sleep-and-alertness-in-medical-interns-and-residents-an-observational-study-on-the-role-of-extended-shifts
#11
Mathias Basner, David F Dinges, Judy A Shea, Dylan S Small, Jingsan Zhu, Laurie Norton, Adrian J Ecker, Cristina Novak, Lisa M Bellini, Kevin G Volpp
Study Objectives: Fatigue from sleep loss is a risk to physician and patient safety, but objective data on physician sleep and alertness on different duty hour schedules is scarce. This study objectively quantified differences in sleep duration and alertness between medical interns working extended overnight shifts and residents not or rarely working extended overnight shifts. Methods: Sleep-wake activity of 137 interns and 87 PGY-2/3 residents on 2-week Internal Medicine and Oncology rotations was assessed with wrist-actigraphy...
April 1, 2017: Sleep
https://www.readbyqxmd.com/read/28327274/physician-extenders-on-surgical-services-a%C3%A2-systematic-review
#12
REVIEW
Jagdeep Johal, Andrew Dodd
BACKGROUND: With the introduction of resident duty hour restrictions and the resulting in-house trainee shortages, a long-term solution to ensure safe and efficient patient care is needed. One solution is the integration of nurse practitioners (NPs) and physician assistants (PAs) in a variety of health care settings. We sought to examine the use of NPs and PAs on surgical/trauma services and their effect on patient outcomes and resident workload. METHODS: We performed a systematic review of EMBASE, Medline, CINAHL, and the Cochrane Central Register of Controlled Trials...
June 2017: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/28301396/can-hyper-realistic-physical-models-of-peripheral-vessel-exposure-and-fasciotomy-replace-cadavers-for-performance-assessment
#13
Jeremy Holzmacher, Babak Sarani, Adam Puche, Guinevere Granite, Valerie Shalin, Kristy Pugh, William Teeter, Samuel Tisherman, Stacy Shackelford, Colin F Mackenzie
BACKGROUND: Work-hour restrictions have reduced operative experience for residents. The Advanced Surgical Skills for Exposure in Trauma (ASSET) course fills this training gap. Cadaver use has limitations including cost and availability. Hyper-realistic synthetic models may provide an alternative to cadavers. We compared same surgeon performance between synthetic and cadaveric models to determine interchangeability for formative evaluation. METHODS: Forty residents (<4 weeks after ASSET) and 35 faculty (mean, 2...
July 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28212590/the-july-effect-on-maternal-peripartum-complications-before-and-after-resident-duty-hour-reform-a-population-based-retrospective-cohort-study
#14
Ithan D Peltan, Crystal E Brown, Alson K Burke, Eric J Chow, Ali Rowhani-Rahbar, Matthew R Crull
Objective To compare maternal birth complications early versus late in the academic year and to evaluate the impact of resident work hour limitation on the "July effect." Study Design We conducted a retrospective, population-based cohort study of 628,414 singleton births in Washington State from 1987 to 2012 measuring the adjusted risk of maternal peripartum complications early (July/August) versus late (April/May) in the academic year. To control for seasonal outcome variation unrelated to trainees' involvement in care as well as long-term trends in maternal complications unrelated to variation in trainees' effect on outcomes across the academic year, we employed difference-in-differences methods contrasting outcomes at teaching to nonteaching hospitals for deliveries before and after restriction of resident work hours in July 2003...
July 2017: American Journal of Perinatology
https://www.readbyqxmd.com/read/28196195/association-of-otolaryngology-resident-duty-hour-restrictions-with-procedure-specific-outcomes-in-head-and-neck-endocrine-surgery
#15
Aaron Smith, Lauren Braden, Jim Wan, Merry Sebelik
Importance: Graduate medical education has undergone a transformation from traditional long work hours to a restricted plan to allow adequate rest for residents. The initial goal of this restriction is to improve patient outcomes. Objective: To determine whether duty hour restrictions had any impact on surgery-specific outcomes by analyzing complications following thyroid and parathyroid procedures performed before and after duty hour reform. Design, Setting, and Participants: Retrospective cross-sectional analysis of the National Inpatient Sample (NIS)...
June 1, 2017: JAMA Otolaryngology—Head & Neck Surgery
https://www.readbyqxmd.com/read/28185560/inequalities-in-socio-economic-characteristics-and-health-and-wellbeing-of-men-with-and-without-disabilities-a-cross-sectional-analysis-of-the-baseline-wave-of-the-australian-longitudinal-study-on-male-health
#16
Anne M Kavanagh, Zoe Aitken, Eric Emerson, Sash Sahabandu, Allison Milner, Rebecca Bentley, Anthony D LaMontagne, Jane Pirkis, David Studdert
BACKGROUND: Internationally, men with disabilities have higher rates of social and economic disadvantage and poorer health and wellbeing than men without disabilities. No single study has provided comprehensive, population-level information about the magnitude of such differences among adult men using a well-validated instrument to measure disability. METHODS: We analysed baseline data from Ten to Men - an Australian longitudinal study of male health. Ten to Men used a stratified multi-stage cluster random sample design to recruit a national sample of males aged 10 to 55 years residing in private dwellings...
October 31, 2016: BMC Public Health
https://www.readbyqxmd.com/read/28185559/psychosocial-job-quality-mental-health-and-subjective-wellbeing-a-cross-sectional-analysis-of-the-baseline-wave-of-the-australian-longitudinal-study-on-male-health
#17
Anthony D LaMontagne, Allison Milner, Lauren Krnjacki, Marisa Schlichthorst, Anne Kavanagh, Kathryn Page, Jane Pirkis
BACKGROUND: Employment status and working conditions are strong determinants of male health, and are therefore an important focus in the Australian Longitudinal Study on Male Health (Ten to Men). In this paper, we describe key work variables included in Ten to Men, and present analyses relating psychosocial job quality to mental health and subjective wellbeing at baseline. METHODS: A national sample of males aged 10 to 55 years residing in private dwellings was drawn using a stratified multi-stage cluster random sample design...
October 31, 2016: BMC Public Health
https://www.readbyqxmd.com/read/28120274/advanced-gi-surgery-training-a-roadmap-for-the-future-the-white-paper-from-the-ssat-task-force-on-advanced-gi-surgery-training
#18
Matthew M Hutter, Kevin E Behrns, Nathaniel J Soper, Fabrizio Michelassi
There is the need for well-trained advanced GI surgeons. The super specialization seen in academic and large community centers may not be applicable for surgeons practicing in other settings. The pendulum that has been swinging toward narrow specialization is swinging the other way, as many trained subspecialists are having a harder time finding positions after fellowship, and if they do find a position, the majority of their practice can actually be advanced GI surgery and not exclusively their area of focused expertise...
January 24, 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/28118548/the-nasal-fracture-algorithm-a-case-for-protocol-driven-management-to-optimize-care-and-resident-work-hours
#19
Alexander Lanigan, Joshua Lospinoso, Sarah N Bowe, Adrienne M Laury
Since the initiation of resident duty hour restrictions, significant controversy has arisen regarding its impact on surgical resident training. We reviewed a singular facet of the otolaryngology residency experience, nasal bone fracture management, to identify if treatment standardization would improve care and efficiency. For 1 year, otolaryngology consults for isolated nasal fractures were analyzed to assess consultation trends, rate of intervention, and resident work hour utilization. Following a review of the literature, an evidence-based algorithm for management of nasal fractures was developed...
January 1, 2017: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/28118085/the-role-of-simulation-in-surgical-education
#20
Ben Schwab, Eric Hungness, Katherine Ann Barsness, William Craig McGaghie
The current healthcare environment demands optimization of patient outcomes in addition to maximal cost efficiency. Restrictions on resident work hours have placed limitations on the amount of time that trainee physicians can spend on patient care. For the surgery resident, the consequence is less time spent in the operating room under the supervision of a senior surgeon, the cornerstone of Halsted's approach to resident surgeon education. The use of simulation in graduate medical education has gained significant traction as a way to provide trainees with exposure to various techniques and procedures before use on the general patient population...
May 2017: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
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