Median Number Of Hours Research Articles

Normal Cervical Effacement in Term Labor

To estimate the natural history of cervical effacement in labor. This is a retrospective cohort study of term, vertex, singletons who reached 10 cm of cervical dilation from 2010 to 2014. Interval-censored regression was used to estimate the median number of hours between changes in effacement (measured in centimeters of the residual cervix) and to estimate the median effacement at a given cervical dilation. Analysis was stratified by parity and labor type. In total, 7,319 patients were included. Multiparas had faster effacement from 1 cm to complete effacement than nulliparas, but nulliparas were significantly more effaced at each cervical dilation. Patients in spontaneous labor had faster effacement and were significantly more effaced at each centimeter of cervical dilation than those who were induced or augmented. Once active labor was established (>6 cm of cervical dilation), 95% of patients had an effacement of 1 cm or less. By 8 cm of cervical dilation, 50% of all patients were completely effaced. There is a wide range in the normal length of time for the progression of cervical effacement. However, once a patient is in active labor, 95% of patients have effaced to 1 cm or less.

Increased orthogeriatrician involvement in hip fracture care and its impact on mortality in England.

to describe the increase in orthogeriatrician involvement in hip fracture care in England and its association with improvements in time to surgery and mortality. analysis of Hospital Episode Statistics for 196,401 patients presenting with hip fracture to 150 hospitals in England between 1 April 2010 and 28 February 2014, combined with data on orthogeriatrician hours from a national organisational survey. we examined changes in the average number of hours worked by orthogeriatricians in orthopaedic departments per patient with hip fracture, and their potential effect on mortality within 30 days of presentation. The role of prompt surgery (on day of or day after presentation) was explored as a potential confounding factor. Associations were assessed using conditional Poisson regression models with adjustment for patients' sex, age and comorbidity and year, with hospitals treated as fixed effects. between 2010 and 2013, there was an increase of 2.5 hours per patient in the median number of hours worked by orthogeriatricians-from 1.5 to 4.0 hours. An increase of 2.5 hours per patient was associated with a relative reduction in mortality of 3.4% (95% confidence interval 0.9% to 5.9%, P =0.01). This corresponds to an absolute reduction of approximately 0.3%. Higher numbers of orthogeriatrician hours were associated with higher rates of prompt surgery, but were independently associated with lower mortality. in the context of initiatives to improve hip fracture care, we identified statistically significant and robust associations between increased orthogeriatrician hours per patient and reduced 30-day mortality.

Delay in Antibiotic Treatment for UTIs and Renal Scarring

Research Article| October 01 2016 Delay in Antibiotic Treatment for UTIs and Renal Scarring AAP Grand Rounds (2016) 36 (4): 38. https://doi.org/10.1542/gr.36-4-38 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Delay in Antibiotic Treatment for UTIs and Renal Scarring. AAP Grand Rounds October 2016; 36 (4): 38. https://doi.org/10.1542/gr.36-4-38 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: renal scarring, urinary tract infections, fever Source: Shaikh N, Mattoo TK, Keren R, et al. Early antibiotic treatment for pediatric febrile urinary tract infection and renal scarring [published online ahead of print July 25, 2016]. JAMA Pediatr; doi: https://doi.org/10.1001/jamapediatrics.2016.1181 Investigators at multiple institutions conducted a retrospective cohort study of data from 2 previous longitudinal studies (the Randomized Intervention for Children With Vesicoureteral Reflux [RIVUR] trial and the Careful Urinary Tract Infection Evaluation [CUTIE] Study) to determine whether delay in the initiation of antimicrobial treatment for febrile urinary tract infection (UTI) is associated with the occurrence of renal scarring in children. Participants in the RIVUR and CUTIE studies were 2 to 72 months old, presented for their first or second UTI at primary or subspecialty care settings, and were prospectively followed up for 2 years. The RIVUR study enrolled children with vesicoureteral reflux (VUR), while the CUTIE study enrolled children without VUR. Parents of participants in each study were asked at enrollment about the duration of their child’s fever before antimicrobial therapy for the index UTI was started. Children in both studies also received a technetium Tc 99m DMSA renal scan at baseline and at either the 24-month follow-up appointment or several months after being withdrawn from the study due to recurrent UTIs. The primary exposure variable was delay in the initiation of antimicrobial therapy, defined as parent self-reported duration of time between the onset of fever and the start of antimicrobial therapy. The primary outcome was new renal scarring, defined as the presence of areas of photopenia plus contour changes on the follow-up DMSA scan that were not present on the baseline scan. Logistic regression was used to determine the association of delay in initiating antimicrobial therapy and new renal scarring after adjusting for potential confounding variables. Of the 802 participants in the RIVUR and CUTIE studies, 482 were included in analysis. Among included participants, 90% were female, 78% were white, 7% had new renal scarring, and the median number of hours to initiation of antimicrobial therapy was 56.3 hours. Participants with new renal scarring had a significantly longer median time to initiation of antimicrobial therapy than those without new renal scarring (72 vs 48 hours, respectively; P = .003). Older age, Hispanic ethnicity, recurrent UTIs, and bladder and bowel dysfunction were also associated with new renal scarring. The association between delay in the initiation of antibiotic therapy and renal scarring remained statistically significant after adjusting for these other variables. The researchers conclude that there is an association between a delay in the initiation of antibiotic treatment and renal scarring. Dr. Brady has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. This study demonstrated that a delay of >48 hours in initiating antibiotics for a UTI increases the odds of renal scarring. Strengths of this study are its longitudinal follow-up of children for 2 years and its comparison of baseline and late DMSA scans for... You do not currently have access to this content.

OC-11 - Anticoagulation therapy in selected cancer patients at risk of recurrence of venous thromboembolism

Venous thromboembolism (VTE) in cancer patients is an increasingly frequent clinical problem. The overall impact of VTE on cancer patients can be considerable. Targeted patient selection by identifying patients with clinically significant recurrent VTE may have wider health economic benefits whilst reducing patient risk through over-treatment. In the UK, dalteparin is one licensed anticoagulant for the extended treatment and prevention of recurrence of VTE in cancer patients. Rivaroxaban is a highly selective direct Factor Xa inhibitor with oral bioavailability. To assess VTE recurrence in selected cancer patients at risk of recurrence of VTE treated with rivaroxaban or dalteparin. The secondary objectives include safety, acceptability, biomarker identification and health economics. Select-d is a prospective, randomised, open label, multicentre pilot trial comparing dalteparin (200 IU/kg daily subcutaneously for 1 month and 150 IU/kg months 2-6); and rivaroxaban (15mg orally twice daily for 3 weeks and 20mg once daily for 6 months in total) for cancer patients with VTE - symptomatic and incidental pulmonary embolism (P)E or symptomatic lower limb proximal deep vein thrombosis (DVT) - with a second placebo-controlled randomisation (rivaroxaban vs placebo) comparing the duration of therapy (6 vs 12 months) in all patients with PE and those with a DVT who are residual vein thrombosis (RVT) positive. 70% of DVT patients are estimated to be RVT positive after initial treatment. 530 patients are being recruited toprovide reliable estimates of the primary outcome (VTE recurrence rates) to within the 95% confidence interval of 8% assuming VTE rates are 10% at six months. As of 1st December 2015, 264 patients have been recruited from 61 open sites across the UK. Preliminary data indicate that the majority of patients presented with solid tumours (98%), ranging from early or locally advanced (41%) to metastatic disease (57%), and primarily comprising colorectal, lung, and breast malignancies. Only a small number of select-d patients presented with haematological malignancies (2%), which included; leukaemia, myeloma and lymphoma. Over half of the select-d patients had an incidental PE (54%); the remainder had symptomatic PE or DVT (46%). The median number of hours on anticoagulation prior to starting select-d randomised treatment was 48 hours. select-d is the first randomised trial for treatment of VTE, investigating the direct oral anticoagulants vs a low molecular weight heparin in patients with cancer. The results will support optimal treatment for this key patient group and are eagerly awaited.

Laboratory Medicine Education at U.S. Medical Schools: A 2014 Status Report.

To assess the current state of laboratory medicine education at U.S. medical schools. From 2013 to 2014, the authors surveyed the appropriate dean, department chair, or undergraduate education director at each U.S. medical school accredited by the Liaison Committee on Medical Education about the state of laboratory medicine education, curriculum and competency assessment, and barriers to education at his or her institution. The authors used descriptive statistics to analyze the results. The authors received 98 (75%) responses. Eighty-two schools (84%) offered course work in laboratory medicine; 76 (78%) required it. The median number of hours of required course work was 12.5, with 8.0 devoted to lectures and 4.5 to small-group, problem-based learning and/or laboratory sessions. Only 8 schools required training in a clinical setting. Fewer than half reported regular, formal review of the laboratory medicine curriculum. The assessment of students' competency in laboratory medicine was rare (8 schools), and only half of respondents were aware of published curriculum guidelines. Barriers to teaching laboratory medicine included lack of sufficient time in the preclinical curriculum (86; 88%) or clinical curriculum (84; 86%), lack of knowledge of best laboratory practices by residents (70; 72%), lack of student interest (62; 63%), and lack of knowledge by attending physicians (58; 59%). Half of respondents were likely to use a national standardized examination to assess competency in laboratory medicine, if one was available. Significant opportunities exist to improve laboratory medicine education, including in the proper use and interpretation of clinical laboratory testing.

Current pain education within undergraduate medical studies across Europe: Advancing the Provision of Pain Education and Learning (APPEAL) study

ObjectivesUnrelieved pain is a substantial public health concern necessitating improvements in medical education. The Advancing the Provision of Pain Education and Learning (APPEAL) study aimed to determine current levels and...

Oncology pharmacy education and training in the United States Schools of Pharmacy

Objectives(1) To assess the number of hours devoted to oncology education in both the didactic and experiential rotations; (2) to further identify the specific oncology topics that are offered in pathophysiology, pharmacology, and pharmacotherapy; and (3) to delineate activities that are required of students during their experiential activities. MethodsSurveys were sent to Chairs or Associate Chairs of Clinical Departments of 131 pharmacy schools. Qualtrics Survey Software was utilized to administer the survey. ResultsOverall, 62 schools responded for a 47% response rate. All schools reported teaching oncology in the didactic portion of its curriculum and nearly all schools (92%) offered Advanced Pharmacy Practice Experience (APPE) electives in oncology. Most schools (64%) incorporated pharmacotherapy into a block of lectures during a general therapeutics course, while 34% of schools taught it as an individual required course. We found that the median number of hours spent on didactic oncology coursework was 42 hours. The median number of hours spent teaching oncology pathophysiology, pharmacology, and pharmacotherapy was 10, 9, and 20 hours, respectively. About 73% offered fewer than 30 oncology APPE rotation slots to students each year. Schools established more than 15 years ago offered a median of 30 slots compared to 16 slots for schools <7 years old. A median of 15% of students took a required or an elective APPE oncology rotation annually, lasting four to six weeks. With the median school size of 100 students, about 30% of a class was exposed to an oncology experience. ConclusionsThese results expand upon the prior recommendations about the amount of didactics and the types of oncology practice experiences offered to students attending pharmacy school. We recommend that 40 hours of didactics and four to six weeks of experiential rotations be the minimum standard that pharmacy schools provide as oncology education.

Home cervical ripening with dinoprostone gel in nulliparous women with singleton pregnancies.

To evaluate whether home cervical ripening is safe and results in shorter hospital stay. This was a retrospective cohort study of women with singleton pregnancies having induction of labor for postmaturity at a single center between January 2007 and June 2010. Women were offered home cervical ripening with 1 mg dinoprostone gel if they were nulliparous, had uncomplicated singleton pregnancies, and the indication for induction was postmaturity. Nine hundred seven of 1,536 (59.1%) nulliparous women having induction of labor for postmaturity were eligible for home cervical ripening. The median number of hours at home was 11.76 hours (range 0-24.82 hours). There were no cases of birth outside of the hospital, uterine rupture, or significant neonatal morbidity or neonatal death related to home cervical ripening. Eighty-five (5.5%) women who underwent hospital cervical ripening because of maternal preference or social issues formed a hospital cervical ripening comparison group. There was no significant difference in the total number of hours before delivery spent in the hospital between the two groups (26.25; 95% confidence interval [CI] 25.27-27.23 in home cervical ripening group compared with 24.28; 95% CI 22.5-26.0 in the hospital group; P=.26). Clinical outcomes are comparable in nulliparous women who receive a single dose of dinoprostone gel for home cervical ripening compared with those who undergo hospital cervical ripening. However, preadmission home cervical ripening with 1 mg dinoprostone does not decrease the number of hours women spend in the hospital. II.

PA.03 Outcomes of Outpatient Cervical Ripening with 1mg Dinoprostone Gel in Primiparous Singleton Pregnancy: A Cohort Study

AimTo determine the safety and clinical effectiveness of outpatient cervical ripening with Dinoprostone 1 mg.MethodsRetrospective cohort study of women with singleton pregnancies having induction of labour (IOL) for postmaturity at...

Sleep practices among medical students in Pediatrics Department of University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria

Medical students are a population who are at great risk of having bad sleep practice and hygiene due to demanding clinical and academic activities. Poor sleep practices are a disturbing and destabilizing phenomenon. It affects many people and can affect the quality of work, performance and education of medical students. Determining the sleep practices and behaviors could be useful to establish a systematic mental health curriculum in medical schools. The objectives of this study is to describe sleep practices among undergraduate medical students in a Nigerian University. Sleep practices were investigated using a convenience sample of medical students from the University of Nigeria Teaching Hospital Ituku Ozalla, Enugu from October 2012 to February 2013. A total number of participants enrolled were 241 consisting of 150 male and 90 female medical students. However, 222 (response rate: 92.1%) completed and returned the questionnaire. The median number of hours of night sleep on a weekday and weekend were 6 and 7 h respectively. There was a significant correlation between the number of hours of sleep and use of caffeine (Spearman r = -0.148, P < 0.0321). Ninety two (45.3%) had a sleep latency of 10-30 min while 157 (70.7%) woke up 1-2 times/night. Twenty five (11.3%) experience unusual sleep practices such as sleep walking, talking or night terrors. Medical students in our institution have varying degrees of sleeping practice and behavior and this may affect academic performance.

Predictions from harbor porpoise habitat association models are confirmed by long-term passive acoustic monitoring

Survey based habitat association models provide good spatial coverage, but only a snapshot in time of a species' occurrence in a particular area. A habitat association model for harbor porpoises was created using data from five visual surveys of the Moray Firth, Scotland. Its predictions were tested over broader temporal scales using data from static passive acoustic loggers, deployed in two consecutive years. Predictions of relative abundance (individuals per kilometer of survey transect) were obtained for each 4 km × 4 km grid cell, and compared with the median number of hours per day that porpoises were acoustically detected in those cells. There was a significant, but weak, correlation between predicted relative abundance and acoustic estimates of occurrence, but this was stronger when predictions with high standard errors were omitted. When grid cells were grouped into those with low, medium, and high predicted relative abundance, there were similarly significant differences in acoustic detections, indicating that porpoises were acoustically detected more often in cells where the habitat model predicted higher numbers. The integration of acoustic and visual data added value to the interpretation of results from each, allowing validation of patterns in relative abundance recorded during snapshot visual surveys over longer time scales.

Abstract 322: Optimizing Cardiac Catheterization Laboratory Utilization

Background: Optimizing efficient utilization of the catheterization lab is an important concern. Inefficient use of this limited resource increases costs and can compromise patient care. At times of high hospital and specialty care unit census, cath lab throughput is also limited by the availability of recovery beds which may further compromise efficient throughput. At SBUH the cardiac cath lab is staffed from 0630-2300 daily Monday-Friday with an on-call team to provide 7 x 24 hour coverage for STEMI’s. Lab usage was evaluated to determine if this was an efficient and effective use of this limited resource. Methods: All cardiac catheterizations during the period of 10/1/12-12/31/12 were reviewed. The distribution of daily cases, mean and median hours to catheterization by day of the week and median length of stay (ALOS) were determined. Elective outpatient, inpatient, and emergent cases were included. Results: There were a total of 997 cases during this quarter. Average weekday case volume ranged from 13-17 cases/day with the greatest average number of cases performed on Mondays (24% of the weeks cases). Median hours to the cath lab averaged 4.2 hours with the greatest delay on Mondays (5.4 hrs) and Fridays (5.7 hrs). The median number of hours to the cath lab was 31.3 hours with the greatest delay on Fridays (38.5 hrs) and gradually decreasing times from Monday through Thursday with the lowest time delay being on Thursdays (18.9 hrs). The median length of stay averaged 1.11 days, with Mondays patients averaging the longest stays at 1.26 days. There were 45 emergent STEMI cases (5% of the total) during the reviewed period. Conclusions: The marked disparity in mean and median hours reflects a skewed distribution, with many inpatients delayed in going to the CCL. Both median and mean hours were prolonged on Mondays and Fridays along with median length of stay. Further drill down suggested hand-offs, inter-hospital transfer delays, high bed occupancy, and high patient volume contributed to delays on these days. Operator availability, procedure variance, and case mix also contributed to distortions in scheduling and the effective use of lab time. Mid week, Wednesday, was the most efficient day. Block scheduling has since been implemented to better accomodate operators and procedure types within the current staffing constraints. Also as a result of this analysis fewer outpatients are being scheduled on Mondays, changes have been made in ACS protocols, hand-offs, rounding and transfers, and opening the cath lab on a weekend day for inpatients is planned.

Assessing the Impact of a Heparin Induced Thrombocytopenia Recognition and Management Protocol

Abstract 2080Heparin-induced thrombocytopenia (HIT) is an immune mediated adverse reaction to heparin which results in significant patient morbidity. Although guidelines for the management of HIT highlight which patients should receive initial therapy, they fall short of directing decisions regarding continuation of therapy after HIT antibody test results return. Using a multidisciplinary approach, a comprehensive HIT Recognition and Management Protocol was developed. Protocol implementation involved a change in HIT testing from a polyspecific platelet factor 4 (PF4)/heparin ELISA to an IgG-specific PF4/heparin ELISA. The use of automatic send out serotonin release assay (SRA) testing for those with a positive PF4/heparin ELISA optical density between 0.4 and 2 was also implemented. The protocol was initiated on October 15th 2010. The overall goal of this project was to assess the impact of protocol implementation on HIT management.A retrospective observational cohort study using a pre – post design was used. Patients started on direct thrombin inhibitor therapy (DTI) from September 1st 2009- February 28th 2010 for suspected/confirmed HIT composed the pre implementation group while those started on DTI therapy from November 1st 2010 – April 30th 2011 composed the post implementation group. Data extraction involved demographic, clinical, laboratory and pharmacy data. DTI initiation within 12 hours of HIT laboratory testing in patients with an intermediate to high 4Ts score was assessed. Additional endpoints included appropriate discontinuation of DTI therapy defined as discontinuation within 12 hours of a negative PF4/heparin ELISA or within 12 hours of a negative SRA in patients with a positive PF4/heparin ELISA with an optical density below 2. Hours of inappropriate continuation of DTI therapy and appropriate warfarin transition were also assessed. T- test, Chi square and Mann Whitney U were used to analyze data with a level of significance set at p <0.05.A total of 61 patients received DTI therapy for suspected/confirmed HIT in the pre period compared to 46 in the post period. DTI initiation within 12 hours of a PF4/heparin ELISA order for those with an intermediate-high 4T score occurred in 8/31 (25.8%) of pre patients and 24/31 (77.4%) of post patients, p <0.0001. Appropriate discontinuation of DTI therapy after a negative PF4/heparin ELISA occurred in 5/23 (21.7%) of pre patients and 12/26 (46.2%) of post patients, p = 0.07. Total hours of inappropriate continuation of DTI therapy after a negative PF4/heparin ELISA test were 2607.8 hours in the pre and 740.5 hours in the post periods. The median number of hours of inappropriate DTI continuation/patient after a negative PF4/heparin ELISA in the pre versus post periods were 99.6 and 25.1 hours respectively, p=0.04. Appropriate discontinuation of DTI therapy after a negative SRA occurred in 2/13 (15.4%) pre and 2/9 (22.2%) post patients, p =0.12.Seventeen patients in the pre and 10 in the post period were transitioned to warfarin for HIT. Initiation occurred after platelet count recovery to 150 × 109/L in 11/17 (64.7%) of pre and 7/10 (70%) of post patients, p = 0.78. The initial warfarin dose was < 5mg in 15/17 (88.2%) of pre and 10/10 (100%) of post patients, p =0.26. A minimum 5 day overlap of DTI and warfarin therapy occurred in 11/16 (68.8%) pre and 8/9 (88.9%) of post patients, p =0.26.Implementation of the HIT protocol improved the timely initiation of DTI therapy in those with an intermediate-high 4Ts score and was successful in promoting appropriate discontinuation of DTI therapy after a negative PF4/heparin ELISA test. Automatic send out SRA testing did not demonstrate a benefit in promoting discontinuation of therapy in those with a positive PF4/heparin ELISA and a negative SRA. Disclosures:No relevant conflicts of interest to declare.

The nursing and financial implications of laparoscopic colorectal surgery: data from a randomized controlled trial

The issue of cost effectiveness of laparoscopic surgery remains uncertain and its impact on the ward nursing staff is unaddressed. This study investigated these issues using patients from a single centre admitted to a randomized controlled trial. All patients recruited into the Australasian Laparoscopic Colon Cancer Study (ALCCaS) from The Queen Elizabeth Hospital between January 1999 and March 2005 were included in this study. Data relating to hospital cost were collated from the Hospital Patient Costing System. Nursing interventions were calculated in minutes per patient, using the excelcare Software database. Data from 97 patients were analysed (laparoscopy, 53; open surgery, 44). The median number of hours of nursing input per patient was 80 (27.5-907) h in the open surgery group and 58.5 (15-684.5) h in the laparoscopy group. This difference was further increased after exclusion of patients converted from laparoscopy to open surgery. The median total cost of the procedure was AUS $9698/£ 5631 (AUS $3862-90,397) in the open surgery group and AUS $10,951/£ 6219 (AUS$2337-66,237) in the laparoscopy group. These data suggest that laparoscopic colorectal surgery is equivalent in price to open surgery and there may be added benefits in reduced nursing intensity.

Working School Children in a Nigerian Community: Revisiting the Issues

Purpose: The prevalence, risk factors and effects of work on school performance and health consequences of child labour among school children in a rapidly urbanising community in south west Nigeria was assessed. Methods: A descriptive cross-sectional study of 386 Junior Secondary School students was conducted. Questionnaires were used to obtain information on the students&rsquo; socio-demographic characteristics, history of child labour activities, and recent history of illness. The academic records of the students were also reviewed. Results: The prevalence of child labour was 72.5%, the median number of hours spent working per week was 18 hours (range 2- 56 hours). The main reason for working was to augment the family income (37.6%). Child labour was commoner among those: whose mothers were not educated; who had four to eight siblings, and who had a working sibling. Higher proportions of working children had repeated a class and had failed the previous term&rsquo;s examinations. More of the working children reported being ill and injured in the previous term. Conclusion: Child labour is quite common in this area and is associated with negative academic and health outcomes. Multidisciplinary programmes targeted at reducing the practice should be developed.Keywords: Child labour, secondary school students, south west Nigeria

Occupational problems with microscopy in the pathology laboratory

Dear Sir: In the clinical laboratory, many workers spend prolonged periods at microscopy, but there is little appreciation of the range and severity of the work-related problems that may ensue. We administered a questionnaire to assess the magnitude of occupational problems associated with microscope use in the pathology laboratory. Laboratory personnel in Ireland were interviewed through an anonymized questionnaire. Ethical approval for the study was obtained from the St. James's and Federation of Dublin Voluntary Hospitals Ethics Committee. There were 62 respondents with equal numbers of males and females. The response rate was approximately 40%. Personnel were predominately histopathologists or cytopathologists working at consultant level. The majority were less than 50 years of age. Table 1 is a summary of the main results. This study reports a high incidence of visual and musculoskeletal problems (some serious) in the pathology laboratory associated with microscopy use. Three quarters reported episodic musculoskeletal problems involving predominately the neck, back, and shoulder and 20% noted repetitive strain injuries. More than half of those affected required some therapy and 5% had taken sick leave. Visual problems, predominately eye fatigue, were indicated by more than half the respondents. Interestingly quite a significant number of respondents who performed routine microscopy less than the median number of hours per week (20.5h) still reported quite a high incidence of either occupationally associated visual or musculoskeletal problems (39% and 26%, respectively). As expected, there was an increase in the reported visual and musculoskeletal problems once the median number of hours is exceeded (71% and 55%, respectively). Furthermore, the number of years working with a microscope did not have a major impact on the type of occupational injury sustained: Those respondents who worked less than the median number of years (14.5 years) reported a high incidence of either visual or musculoskeletal problems (65% and 32%, respectively) as did those who worked above the median number of years (45% and 42%, respectively). Microscopists should be aware for the potential for work-related illness. Previous studies, involving cytotechnologists and part-time microscopists, have reported similar high rates of neck, shoulder and back pain, eye strain, or headache as a result of working long hours with a conventional light microscope, and related these to the use of non-ergonomic workstations [1–3]. It is interesting that there is little fall in the number reporting occupational injuries compared with the older studies. Although specifics on microscope types was not assessed in the questionnaire, it is likely that newer generation microscopes were in use R. J. Flavin :D. S. O’Briain Department of Histopathology, St. James’s Hospital and Trinity College Dublin, Dublin, Ireland

Dental hygiene students’ part‐time jobs in dental practices in the Netherlands

Many students have paid employment while studying. In the Netherlands, the Individual Health Care Professions Act (IHCP Act) allows dental hygiene students to work under certain conditions in a dental practice. The aim of the study was to determine how many dental hygiene students have part-time job employment in dental practice and which professional tasks they carry out. We also asked the dental hygiene students their opinion of the IHCP Act. All the enrolled dental hygiene students (n = 341) at a School of Health in the Netherlands received a questionnaire by email. The response was 52% (176 students). Of the responding students, 75% had paid employment in addition to their study. A proportion of the students (35%) worked in a dental practice. The median number of hours worked per week was eight. Study year, age and prior education were positively related to working part-time in dental practice. Activities frequently performed were giving oral hygiene instruction, fluoride applications, scaling and root planning, providing chair side assistance and giving local anaesthesia. Although the self-reported knowledge about the IHCP Act was high, almost half of the students expressed the need for more detailed legal information. Many dental hygiene students work in a dental practice, taking over a number of tasks usually performed by the dentist. More information in the dental hygiene curriculum about the requirements of the IHCP Act seems desirable.

Burnout in Medical School Deans: An Uncommon Problem

To assess the burnout level among U.S. and Canadian medical school deans and to study how burnout relates to certain characteristics including hours worked, effectiveness, and support from family and colleagues. Questionnaires were sent in September 2006 to 100 deans who had served at least one year. The questionnaire included 13 questions from the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), which measures three subcomponents of burnout: emotional exhaustion, depersonalization, and personal accomplishment. The response rate was 90%. The median age of participants was 60; the median length of service at the current institution was four years; the median number of hours worked per week was 70.0. Deans most frequently identified school budget deficits, loss of funding, and departure of key faculty as stressors. Whereas only 11% reported being dissatisfied with their positions, 33% reported it was likely they would step down within the next two years. The predominant pattern of MBI-HSS subscale scores in participating deans was moderate emotional exhaustion, moderate depersonalization, and high personal accomplishment. Only 2% of respondents satisfied all three subscale scores for high burnout. Emotional exhaustion was significantly directly associated with work week length and number of weekend days worked and was inversely associated with spousal support, length of service, and age. Despite having an "extreme" job, only 2% of deans exhibited high levels of burnout. A high sense of control and self-efficacy, a supportive family, increasing length of service, and increasing age may be factors which reduce burnout in deans.

The effects of pay and job satisfaction on the labour supply of hospital consultants

There is little evidence about the responsiveness of doctors' labour supply to changes in pay. Given substantial increases in NHS expenditure, new national contracts for hospital doctors and general practitioners that involve increases in pay, and the gradual imposition of a ceiling on hours worked through the European Working Time Directive, knowledge of the size of labour supply elasticities is crucial in examining the effects of these major changes. This paper estimates a modified labour supply model for hospital consultants, using data from a survey of consultants in Scotland. Rigidities in wage setting within the NHS mean that the usual specification of the labour supply model is extended by the inclusion of job quality (job satisfaction) in the equation explaining the optimal number of hours worked. Generalised Method of Moments estimation is used to account for the endogeneity of both earnings and job quality. Our results confirm the importance of pay and non-pay factors on the supply of labour by consultants. The results are sensitive to the exclusion of job quality and show a slight underestimation of the uncompensated earnings elasticity (of 0.09) without controlling for the effect of job quality, and 0.12 when we controlled for job quality. Pay increases in the new contract for consultants will only result in small increases in hours worked. Small and non-significant elasticity estimates at higher quantiles in the distribution of hours suggest that any increases in hours worked are more likely for consultants who work part time. Those currently working above the median number of hours are much less responsive to changes in earnings.

The State of the Clerkship: A Survey of Emergency Medicine Clerkship Directors

An emergency medicine (EM) clerkship can provide a medical student with a unique educational experience. The authors sought to describe the current experiential curriculum of the EM clerkship, along with methods of evaluation, feedback, and grading. A descriptive survey was utilized. Clerkship directors at EM residency programs accredited by the Accreditation Council for Graduate Medical Education completed an online questionnaire. Data were analyzed using descriptive statistics. Ninety-two (70%) of 132 EM clerkship directors completed the survey. Sixty institutions (65%) accepted only fourth-year medical students, and 35% accepted both third- and fourth-year students. The median number of didactic lecture hours provided during each rotation block for students was ten (interquartile range [IQR], 6-16). The average length of a student's clinical shift was eight hours, while the median number of clinical shifts reported per rotation was 15 (IQR, 14-16). The median number of hours worked weekly by a medical student was 40 (IQR, 35-43). Fifty-four EM clerkship directors (59%) incorporated the Accreditation Council for Graduate Medical Education six core competencies into their evaluation process. Seventy-one clerkship directors (77%) used a shift evaluation card to evaluate the clinical performance of medical students. Fifty-four (59%) incorporated an end-of-rotation written examination to determine the final rotation grade for a medical student. Medical students are exposed to a variety of didactic lectures and procedure labs but have similar experiences regarding shift length and work hours. Methods of evaluation of clinical performance vary across clinical sites.