Regular Working Hours Research Articles

When work never ends: How after-hours electronic communication expectations affect job satisfaction through work interference with family and emotional exhaustion

In today’s interconnected and fast-paced work environment, technological advancements have blurred the boundaries between work and personal life. Consequently, employees often find themselves expected to remain available for electronic communication outside regular work hours. While some studies suggest that this aids employees in transitioning between work and home life, it may also hinder their ability to maintain a balance between work and personal life. Thus, drawing on boundary theory and conservation of resources theory, this study examines the impact of after-hours electronic communication expectations (AECE) on job satisfaction through work interference with family and emotional exhaustion. The results of data collected from 300 participants in the textile industry of Pakistan reveal a direct negative impact of AECE on job satisfaction. The results also indicate an indirect effect, wherein AECE influences job satisfaction through a sequential mediation process involving work interference with family, emotional exhaustion, and ultimately, negatively impacts job satisfaction, indicating a cascading effect. The study’s implications for theory and practice, as well as its limitations, are also addressed and discussed.

Challenges of modern work environments and means of overcoming them in the context of psychosocial risk assessments

BackgroundModern work environments constitute an underrepresented part of psychosocial risk assessments at work. Little is known about whether there is an increased stress load at all and what possible improvements could be made in such a case.MethodsModern work environments were assessed in an online questionnaire in 33 companies across a period of more than 4 years. A total of 3431 employees participated in the study. Both quantitative and qualitative data was applied to obtain a differentiated picture.ResultsIncreased stress caused by modern work environments was an issue for around a third of the sample. 31.6% of the participants at least sometimes struggled to balance work and private life. Quite a few of the participants (36.3%) worked sometimes or more outside regular working hours. For 32.4% of participants, the workload has increased due to new technologies, but for 30.4% it has not. The majority (81.4%) feel they can work productively in home offices. The data from 178 completed free text fields on improving modern work environments from the employees’ perspective was analysed. Many named suggestions relate to improvements in time management.ConclusionThis study provides both detailed insights into various aspects of modern work environments and offers solutions to counteract possible negative consequences. Assessing modern work environments in psychosocial risk assessments would be a valuable addition to its completeness.

Factors influencing medical students career intentions in Flanders, Estonia and Hungary: a multivariable analysis.

The career decisions of medical students are pivotal in shaping the future healthcare workforce. In many countries, the number of medical students who choose general practice (GP) as their career is insufficient to meet the needs of the healthcare system. The aim of this study was to describe the factors influencing medical students' career intentions and their preference for a career in GP. A cross-sectional study involving medical students from Flanders (Belgium), Estonia and Hungary. An online questionnaire was used to gather data. Multivariable logistic regression was conducted. Altogether 1601 medical students participated in this study. 18.5% of the participants were interested in GP. Factors related to medical students and the curriculum which predicted the interest in GP were being a woman, being a medical student from Flanders, being a 6th year medical student, coming from a rural area and having GP role models. Students preferring GP named the following factors as important: short and low intensity training program, having long-term and close relationship with patients, continuity of care, regular and flexible working hours and opportunities to achieve work-life balance. This study adds further evidence which characteristics and factors can predict medical students' interest in GP, having GP role models being the most important predictor. Further research into which qualities medical students value in their role models could give us better understanding on how we can support GPs to be better advocates for their specialty and thereby help increase interest in GP.

The Effect of After-Hours Resection on the Outcomes in Patients with High-Grade Gliomas.

The "weekend effect" is the finding that patients presenting for medical care outside of regular working hours tend to have worse outcomes. There is a paucity of literature in the neuro-oncology space exploring this effect. We investigated the extent of resection and complication rates in patients undergoing after-hours high-grade glioma resection. A retrospective review was conducted on patients with high-grade glioma requiring emergent surgery between January 1, 2021, and March 31, 2023. After hours was defined as surgical resection on the weekend and/or evening (>50% of surgical time between 1630 and 0659). These patients were matched to patients undergoing resection during regular working hours. Groups were compared on the basis of the extent of resection, postoperative complications and 6-month mortality rate. A total of 38 patients were included in this study (19 after hours, 19 regular hours). There was no significant difference in age, sex, tumor grade and tumor size between the two groups (all p > 0.05). There was no significant difference in the extent of resection between the groups (p = 0.7442). There was no significant difference in the rate of intraoperative complications, postoperative complications, reoperation and death at 6 months between the groups (all p > 0.05). Estimated blood loss was significantly higher in the regular hours group (p = 0.0278). There was no significant difference in the total operative time (p = 0.0643) and length of stay (p = 0.0601). After-hours high-grade glioma surgery has similar outcomes to regular-hours surgery for lesions not requiring specialized functional mapping.

Remote out-of-hours ultrasound live supervision in pediatrics - improvement of diagnostics and training.

Ultrasound (US) is the preferred imaging modality in pediatrics for diagnostic and therapeutic issues. The absence of radiation and the constant on-site accessibility make it the ideal tool for children. However, despite remarkable technical advances in resolution and applicability, many sophisticated medical questions still require profound expertise on the part of the examiner, thus often hampering fast decisions particularly outside regular working hours. This single-center study, at a university children's hospital evaluated the use of US during emergency service. A four-week documentation period was followed by a subsequent eight-week supervision period with live supervision availability on demand guided by a remote US expert. The demand for expert support, diagnosis, grading of urgency, duration and success of examination, and satisfaction of both examiners were analyzed. 108 patients (mean age 9.7 years) were included. In 38% of cases, US was supervised on demand with a definite diagnosis in 92.6% of cases (25/27). Image quality and technical performance were graded sufficient in 100% of cases. Supervised compared to non-supervised US examinations were prolonged (14.4 min vs. 7.1 min, p<0.001), were more prevalent within the first 24 h in the hospital (70% vs. 56.8%, p=0.06), and were classified more frequently as emergency (22.2% vs. 2.3%; p=0.015). All participants classified the availability of US supervision as decisively helpful. Remote live supervised pediatric US was feasible and effective. It combined timely, high-quality diagnostics even in the case of challenging medical questions with simultaneous US training.

Effectiveness of a policy to reduce non-urgent night-time consultations in out-of-hours services

Abstract Background The utilization of Out-of-Hours General Practice (OOH-GP) services in the Netherlands has been increasing steadily. This has placed significant pressure on triagists and GPs to provide accessible and high-quality care, particularly because of patients with low-urgency health problems, who can wait to visit their GP during regular working hours. To alleviate the strain on OOH services during the night, the “spoed=spoed” policy has been implemented. This policy stipulates that only patients with urgent health problems can consult with a GP during the night (11 p.m. to 8 a.m.). However, it remains unclear whether this policy has effectively reduced consultations during the night. Methods For this study, we used pseudonymised data from electronic health records of 2/3 of Dutch OOH services (catchment area of 12.3 million), from Nivel Primary Care Database, from 2020-2023. We analysed the effects of the policy on contact rates and proportion of high-urgency health problems, by comparing OOH services that did and did not implement the policy, by comparing 6 months before and after implementation and by analysing variances across OOH services. Results Overall, there were no differences in the number or proportion of high-urgency consultations across OOH services that did and did not implement spoed=spoed. In those that did, there were no differences before and after implementation. However, certain OOH services exhibited a decrease in consultation, while also showing a higher proportion high-urgency health problems. Conclusions There is currently no definitive evidence regarding the effectiveness of “spoed=spoed”. However we should learn from the varied effects and experiences in different OOH-services, to facilitate further implementation or adaptation of the policy. Key messages • OOH services can and should learn from each other on what solutions are implemented to lower the care-burden during the night. • Policies aimed at reducing the utilization of OOH serviced should consider the conaxt from the patient, health care provider and organization.

Trends and Changes in Endoscopic Management and Clinical Outcomes of Colonic Diverticular Bleeding during the Coronavirus Disease-2019 Pandemic.

This study evaluated the endoscopic management and clinical outcomes of patients with colonic diverticular bleeding (CDB) during the coronavirus disease 2019 (COVID-19) pandemic. A total of 388 hospitalized patients diagnosed with CDB at two hospitals during (April 2020-March 2023) and before (April 2017-March 2020) the pandemic were enrolled in the study. We performed one-to-one propensity score matching (PSM) on the participants. We analyzed endoscopic management and clinical outcomes before and during the pandemic using a total of 264 patients matched in a PSM analysis. A total of 213 (1.3%) and 172 (1.2%) colonoscopies were performed before and during the pandemic, respectively in patients with CDB (P = 0.70). After PSM, the number of early colonoscopies (63.6% vs. 76.5%, P = 0.03) and colonoscopies performed outside regular working hours (23.8% vs. 47.7%, P < 0.01) was significantly lower during the pandemic than before it. A univariate logistic regression analysis revealed that the risks of rebleeding within 30 days (odds ratio [OR]: 0.81, P = 0.42) and composite outcome (OR: 0.90, P = 0.69) were not increased during the pandemic. During the pandemic, the number of early colonoscopies and colonoscopies performed outside regular working hours decreased; however, this decrease did not influence rebleeding and composite outcome in patients with CDB.

Current status of the working environment of brachytherapy in Japan: a nationwide survey-based analysis focusing on radiotherapy technologists and medical physicists.

Brachytherapy (BT), especially in high dose rate (HDR), has become increasingly complex owing to the use of image-guided techniques and the introduction of advanced applicators. Consequently, radiotherapy technologists and medical physicists (RTMPs) require substantial training to enhance their knowledge and technical skills in image-guided brachytherapy. However, the current status of the RTMP workload, individual abilities and quality control (QC) of BT units in Japan remains unclear. To address this issue, we conducted a questionnaire survey from June to August 2022 in all 837 radiation treatment facilities in Japan involving RTMPs. This survey focused on gynecological cancers treated with HDR-BT (GY-HDR) and permanent prostate implantation using low-dose-rate BT (PR-LDR). The responses revealed that the average working time in the overall process for HDR varied: 120min for intracavitary BT and 180min for intracavitary BT combined with interstitial BT. The QC implementation rate, in accordance with domestic guidelines, was 65% for GY-HDR and 44% for PR-LDR, which was lower than the 69% observed for external beam radiation therapy (EBRT). Additionally, the implementation rate during regular working hours was low. Even among RTMP working in facilities performing BT, the proportion of those able to perform QC for BT units was ~30% for GY-HDR and <20% for PR-LDR, significantly lower than the 80% achieved for EBRT. This study highlights the vulnerabilities of Japan's BT unit QC implementation structure. Addressing these issues requires appropriate training of the RTMP staff to safely perform BT tasks and improvements in practical education and training systems.

Risk factors for mortality in periprosthetic femur fractures about the hip-a retrospective analysis.

Fractures around the hip are known to be an indicator for fragility and are associated with high mortality and various complications. A special type of fractures around the hip are periprosthetic femur fractures (PPF) after Total Hip Arthroplasty (THA). The aim of this study was to investigate the mortality rate associated with PPF after THA and to identify risk factors that may increase it. Consecutive patients (N = 158) who were treated for a PPF after THA in our university hospital between 2010 and 2020 were identified and mortality was assessed using the residential registry. Univariate (Kaplan-Meier-Estimator) and multivariate (Cox-Regression) statistical analysis was performed to identify risk factors influencing mortality. One-year-mortality rate was 23.4% and 2-year mortality was 29.2%. Mortality was significantly influenced by age, gender, treatment, type of comorbidity and time of surgery (p < 0.05). Surgical treatment during regular working hours (8 to 18h) reduced mortality by 53.2% compared to surgery on call (OR: 0.468, 95% CI 0.223, 0.986; p = 0.046). For every year of age, mortality risk increased by 12.9% (OR: 1,129, 95% CI 1.078, 1.182; p < 0.001). The type of fracture according to the Vancouver classification had no influence on mortality (p = 0.179). Plate fixation and conservative treatment were associated with a higher mortality compared to revision arthroplasty (plate: OR 2.8, 95% CI 1.318, 5.998; p = 0.007; conservative: OR 2.5, 95% CI 1.421, 4.507; p = 0.002). Surgical treatment during regular working hours is associated with lower mortality compared to surgery outside these hours. In this retrospective cohort, time to surgery showed no significant impact on all-cause mortality, and revision arthroplasty was associated with lower mortality than conservative treatment or plate fixation. IV (Retrospective cohort study).

The association of physical activity with kidney function risk among adults with long working hours.

Long working hours are likely associated with the decreased of kidney function, while physical activity (PA) was linked to improvements in kidney function. However, whether PA can offset the negative impact of long working hours on kidney function was unclear, which is the focus of this study. A cross-sectional study was conducted. Three approaches were adopted to distinguish the association between long working hours and regular working hours. Moderate to vigorous physical activity (PA) was assessed by a structured questionnaire. eGFR and chronic kidney disease (CKD) or not were utilized to evaluate the kidney function. Linear and logistic regression analyses were conducted to assess the association between weekly working hours, PA, and kidney function. A total of 18,431 adults were enrolled in this study, including 9981 males (54.2%) and 8450 females (45.8%). The average eGFR was (99.54 ± 17.55 mL/min/1.73 m2). The people worked more than 40 h/wk (98.89 ± 17.06 mL/min/1.73 m2) had lower eGFR compared to those worked less than 40 h/wk (99.93 ± 17.83 mL/min/1.73 m2) (p < 0.05). Individuals working longer hours exhibited lower eGFR (β= -0.772, 95% CI: -1.241, -0.303, for > 40 h/wk compared to working ≤ 40 h/wk). Engagement in moderate to vigorous PA was associated with higher eGFR values (β = 1.159, 95% CI: 0.699, 1.619) compared to low PA (< 150 minutes/wk), but this association did not reach statistical significance for the prevalence of CKD. Furthermore, PA was insufficient to reverse the decline of eGFR related to prolonged working hours. Prolonged working hours were associated with a decline in eGFR, while PA was found to have a protective effect on kidney function. However, PA alone may not fully mitigate the negative impact of prolonged working hours on renal health. More robust measures to protect renal function should be implemented to mitigate the damage caused by prolonged working hours.

Patient-centered clinical decision support challenges and opportunities identified from workflow execution models.

To use workflow execution models to highlight new considerations for patient-centered clinical decision support policies (PC CDS), processes, procedures, technology, and expertise required to support new workflows. To generate and refine models, we used (1) targeted literature reviews; (2) key informant interviews with 6 external PC CDS experts; (3) model refinement based on authors' experience; and (4) validation of the models by a 26-member steering committee. We identified 7 major issues that provide significant challenges and opportunities for healthcare systems, researchers, administrators, and health IT and app developers. Overcoming these challenges presents opportunities for new or modified policies, processes, procedures, technology, and expertise to: (1) Ensure patient-generated health data (PGHD), including patient-reported outcomes (PROs), are documented, reviewed, and managed by appropriately trained clinicians, between visits and after regular working hours. (2) Educate patients to use connected medical devices and handle technical issues. (3) Facilitate collection and incorporation of PGHD, PROs, patient preferences, and social determinants of health into existing electronic health records. (4) Troubleshoot erroneous data received from devices. (5) Develop dashboards to display longitudinal patient-reported data. (6) Provide reimbursement to support new models of care. (7) Support patient engagement with remote devices. Several new policies, processes, technologies, and expertise are required to ensure safe and effective implementation and use of PC CDS. As we gain more experience implementing and working with PC CDS, we should be able to begin realizing the long-term positive impact on patient health that the patient-centered movement in healthcare promises.

A survey of United Kingdom intensive care echocardiography provision.

This study, conducted under the oversight of National Health Service Blood & Transplant, aimed to evaluate the current feasibility and implementation of both comprehensive and focused donor echocardiography in United Kingdom Intensive Care Units through a nationwide survey. Responses from 95 hospitals across all 4 UK nations showed each ICU had median 4 (IQR 2, 6) personal with 3 (IQR 2, 5) consultants and 1 (IQR 0, 2) registrar trained in focused echocardiography. A comprehensive echocardiogram can be acquired in 48% (n = 46) of hospitals within 6 h during regular working hours. This percentage drops to 11% (n = 10) outside of regular working hours, with 53% (n = 50) indicating this would require more than 24 h. In the case of focused echocardiogram acquisition, 60% (n = 57) of hospitals can obtain it within 6 h during normal working hours. This figure decreases to 20% (n = 19) outside of regular working hours, with 32% (n = 30) indicating that this would require more than 24 h to obtain. Overall, 98% of responding units (n = 93) have point-of-care ultrasound machines (median 2 (IQR 2, 3) machines per ICU) all equipped with echocardiographic capabilities. However, only 52% (n = 49) of respondents indicated have the ability for remote viewing of echocardiogram images.

Defining the Value of Vascular Surgery Service at a Tertiary Academic Medical Center

BackgroundVascular surgeons play a critical role in the functioning of a healthcare system. As a service line, vascular surgery not only performs its own complex operations but also provides support to other surgical specialties by assisting in the management of vascular-related complications. Previous reports have acknowledged the value of consulting vascular surgeons; however, these studies have primarily been limited to single-center series. In this study, we aim to contribute to the existing literature by sharing our experience and highlighting the financial value of consulting vascular surgeons at a large tertiary academic medical center. MethodsInstitutional electronic medical records were retrospectively queried for all operations performed by vascular surgeons from 2020-2022. Two separate procedural groups were identified. The first group comprised all surgeries where vascular surgery was listed as a co-surgeon for other surgical specialties. The second group comprised all surgeries where vascular surgery was the primary surgeon for service-level cases. Service cases were defined as operations resulting directly from (1) iatrogenic complications from other services, (2) consultations for traumatic injury, or (3) primary surgeon for non-vascular cases. The Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule was used to calculate work relative value units (wRVU) per primary procedure code. ResultsA total of 7821 surgeries were performed with vascular involvement over the study period. Of these, 726 operations (9.3%) were co-surgeon cases requiring intraoperative vascular assistance, from 109 surgeons across all 16 surgical specialties. There was no missing data. The most common specialties requesting vascular assistance included cardiac surgery (n=247, 34.0%), orthopedic surgery (n=152, 20.9%), and neurosurgery (n=131, 18.0%). Total procedural wRVU for co-surgeon cases was 16,220, and total charges exceeded $77.5 million dollars. Vascular surgery served in a primary surgeon role in an additional 154 service-level cases (2.0%) resulting from ten non-surgical services. The most common service-level indication was iatrogenic vascular injury (n=87, 56.4%), and the majority of service-level cases required urgent or emergent surgery (n=123, 79.9%). These procedures generated an additional 2,150 wRVU and $1.1 million dollars in charges for the hospital system. Of all co-surgeon or service-level cases, 19.1% (n=168) occurred after-hours and 10.3% (n=91) occurred on a holiday or weekend. ConclusionVascular surgery is crucial to the operation of all surgical services and many non-surgical service lines within an academic medical center. Apart from providing essential services for primary vascular diseases, the vascular surgery service line offers substantial financial benefits to the healthcare system through its consulting role. A considerable portion of operative consultations are performed under urgent or emergent circumstances, often necessitating surgical intervention outside regular working hours or on holidays/weekends. These findings have significant implications for assessing the value and compensation of vascular surgeons in today's healthcare landscape.

The mixed blessing of work connectivity demands: Self‐regulatory focus as a moderator

SummaryDue to the rapid development of information and communication technologies, employees increasingly feel pressure to engage in work connectivity behavior after regular working hours (WCBA), giving rise to a novel form of job demand known as WCBA demands. This research examined the upside and downside of WCBA demands. Specifically, we defined WCBA demands as stressors that can be appraised by employees as challenges and/or threats. Challenge appraisals are related to job involvement, which in turn leads to job satisfaction and job performance; threat appraisals are related to job‐induced tension, which in turn leads to family dissatisfaction and family incivility. We also examine regulatory focus as a boundary condition underlying the challenge‐threat paradox of WCBA demands. To test the relationships among our hypotheses, we conducted a daily diary survey study of 176 employee‐supervisor‐spouse triads across five consecutive workdays. The findings show that employees with higher levels of promotion focus were more likely to appraise WCBA demands as challenges, which improved their work outcomes via increased job involvement. Employees with higher levels of prevention focus appraised WCBA demands as threats, which undermined their family outcomes via job‐induced tension. Since these findings assume that WCBA demands act as stressors, we conducted a supplemental qualitative study (N = 19) confirming that employees commonly perceive WCBA demands as stressors. The implications for theory and research are discussed.

Hospitalisations Due to Dental Infection: A Retrospective Clinical Audit from an Australian Public Hospital.

The aim of this clinical audit is to evaluate the characteristics of dental infections requiring hospitalisations, which may help improve preventative and management policies. This study retrospectively evaluated the records of patients admitted to the Nepean hospital, Kingswood, New South Wales, Australia, due to dental infections between 2018 and 2019. A total of 102 patients, mostly in their thirties with equal gender distribution, were admitted with dental infections, presenting with pain (100%), swelling (99%), trismus (40.2%), dysphagia (27.4%), fever (21%) [>37 °C], tachycardia (24.8%) and tachypnoea (9.3%). Most patients (68%) presented on weekends, outside regular working hours, and public holidays. A total of 52.5% of patients had taken prior antibiotics. Dental caries, smoking, mental health issues, and illicit drug use were featured strongly. The majority of patients (56.4%) underwent treatment under local anaesthesia. The total length of hospital stay was 271 days (mean 2.7, SD 1.6). Augmentin was the most prescribed antibiotic. Complications were reported in 8.8% of the patients, primarily due to airway compromise. Dental infections leading to hospitalisations continue to be a burden on the healthcare system. A notable finding was that the presentations were primarily on weekends, outside regular working hours, and public holidays, and the majority required dental interventions under local anaesthesia. The provision of on-call emergency dental services may reduce potentially preventable hospitalisations and the length of hospital stay.

Is night emergency laparoscopy a high-risk surgery?

Introduction: Although laparoscopy has become the gold standard for many abdominal emergency pathologies, emergency nighttime laparoscopic surgery is considered high-risk for several reasons, particularly due to limited resources in the operating room during nighttime hours. The primary objective of our study is to evaluate the feasibility and safety of nighttime laparoscopy in the management of non-traumatic acute abdomen. Materials and Methods: Descriptive and prospective, evaluative study conducted between February 2018 and October 2021. Our study included 337 patients undergoing laparoscopic surgery for non-traumatic acute abdominal emergencies. Results: Among the 337 patients, we operated on 211 patients (62.6%) outside of regular working hours (between 4:00 PM and 8:00 AM), of which 189 patients (56.10%) were operated on from 4:00 PM to 12:00 AM, and 22 patients (6.2%) from 12:00 AM to 8:00 AM. The mean operative time was 52.09 ± 24.14 minutes. Perioperative difficulties related to the operated pathology were encountered in 21 cases (9.95%). The overall mean hospital stay was 1 day (range: 7 hours - 4 days). We compared nighttime laparoscopy with daytime laparoscopy and found an advantage in favor of nighttime laparoscopy in reducing hospitalization duration (p value 0.003). Conclusion: Nighttime laparoscopy is feasible and safe.

Influence of Organisational-Level Factors on Delayed Door-to-Balloon Time among Patients with ST-Elevation Myocardial Infarction.

This study aimed to estimate the door-to-balloon (DTB) time and determine the organisational-level factors that influence delayed DTB times among patients with ST-elevation myocardial infarction in Oman. A cross-sectional retrospective study was conducted on all patients who presented to the emergency department at Sultan Qaboos University Hospital and Royal Hospital, Muscat, Oman, and underwent primary percutaneous coronary interventions during 2018-2019. The sample included 426 patients and the median DTB time was 142 minutes. The result of the bivariate logistic regression showed that patients who presented to the emergency department with atypical symptoms were 3 times more likely to have a delayed DTB time, when compared to patients who presented with typical symptoms (odds ratio [OR] = 3.003, 95% confidence interval [CI]: 1.409-6.400; P = 0.004). In addition, patients who presented during off-hours were 2 times more likely to have a delayed DTB time, when compared to patients who presented during regular working hours (OR = 2.291, 95% CI: 1.284-4.087; P = 0.005). To meet the DTB time recommendation, it is important to ensure adequate staffing during both regular and irregular working hours. Results from this study can be used as a baseline for future studies and inform strategies for improving the quality of care.

P.086 The effect of after-hours surgical resection on the outcomes in patients with high grade gliomas

Background: The “weekend effect” is the finding that patients presenting for medical care outside of regular working hours tend to have worse outcomes. There is a paucity of literature in the neuro-oncology space exploring this effect. We investigated the extent of resection and complication rates in patients undergoing after-hours high grade glioma resection. Methods: A retrospective review was conducted on patients with high-grade gliomas requiring emergent surgery between January 2021 to March 2023. After-hours was defined as surgical resection on the weekend and/or evening. These patients were matched to patients undergoing resection during regular working hours. Results: A total of 38 patients were included in this study (19 after-hours, 19 regular hours). There was no significant difference in age, sex, tumor grade, and tumor size between the two groups (all p&gt;0.05). There was no significant difference in the extent of resection between the groups (p=0.7442). There was no significant difference in complications rates, reoperation rates, and death at 6 months (all p&gt;0.05). Estimated blood loss was significantly higher in the regular hours group (p=0.0278). There was no significant difference in the total operative time (p=0.0643) and length of stay (p=0.0601). Conclusions: After-hours high grade glioma surgery is not associated with increased morbidity or mortality.

Implementation of Routine In Situ Simulation in Residency Curriculum Targeting Competency in Technical and Decision-Making Skills

ObjectiveTo describe the development and implementation of a comprehensive in situ simulation-based curriculum for anesthesia residents. DesignThis is a prospective study. SettingThis study was conducted at a university hospital. ParticipantsThis single-center prospective study included all 53 anesthesia residents enrolled in the anesthesia residency program. InterventionsIntroduction of routine high fidelity, in situ simulation program, which incorporates short sessions to train residents in the necessary skill sets and decision-making processes required in the operating room. Measurements and Main ResultsOur team conducted 182 individual 15-minute simulation sessions over three months during regular working hours. All 53 residents in our program actively participated in the simulations. Most residents engaged in at least 3 sessions, with an average participation rate of 3.4 per resident (ranging from 1 to 6 sessions). Residents completed an online anonymous survey, with a response rate of 71.7% (38 out of 53 residents) over the three-month period. The survey aimed to assess their overall impression and perceived contribution of this project to their training. ConclusionOur proposed teaching method can bridge the gap in resident training and enhance their critical reasoning to manage diverse clinical situations they may not experience during their residency.

The potential of the P-graph for optimizing public service processes

AbstractThe European Union set out several directives and standards for governments and local authorities on environmental policy issues in the planning and management of public services. Public service provisioning is subject to both traditional expectations (such as customer-friendliness and efficiency) and new environmental stewardship and sustainability expectations. This paper analyzes public service processes, particularly the university enrolment process. Our analysis used public service models (Service Blueprinting, Business Process Modeling, Process Chain Network) and a mathematical model (P-graph). Our research aims to analyze the university enrolment process and its efficiency, considering sustainability aspects and expectations and identifying the points that can be modified and improved to make it more efficient, sustainable, qualitatively positive, and economical. According to our research, school administrators are overburdened during the enrolment process, often resulting in overtime work and a high turnover ratio. Our results clearly show the high inefficiency of this administrative process, as administrators can only partially meet their expected labor targets during their regular working hours. We found that the university enrolment process can be improved and made more efficient and sustainable. Using the P-graph, we have found the process’s optimal path and resource requirements in a way that was not feasible with previous models. Heartened by these results, we propose introducing and applying the P-graph as a new model to study other public service processes. Graphical abstract