Regular Working Hours Research Articles

A multifaceted approach to wellness in a hematology/oncology fellowship program.

11006 Background: Burnout is widespread among physician trainees and is a growing problem despite increasing awareness. We describe multiple efforts in a single institution’s Hematology/Oncology (HO) fellowship program to help support trainees’ wellness. Methods: A needs assessment was conducted to identify wellness topics and programming important to fellows. Anonymous surveys were distributed to all fellows in Yale’s HO fellowship program at the start of the academic year. Three senior fellows reviewed the results and, with the support of core faculty, designed initiatives to address top priorities. The interventions included off-campus debrief sessions for fellows only, Schwartz Rounds-style discussions during weekday didactic slots, faculty-led didactics on Imposter Syndrome and Perfectionism, and several off-campus, after-hours social activities. A follow-up survey was conducted six months after the initial survey (mid-academic year) to garner feedback. Results: Of the 23 fellows who were sent the initial survey, 17 responded (73.9%). The most requested discussion topics were Perfectionism Traps, Imposter Syndrome, Achieving Happiness/Defining Success at Work, and Myths About Work/Life Balance. Most fellows (76.5%) responded that they would attend off-site debrief sessions if offered. In response to the initial survey, several initiatives were undertaken as described in Methods. The mid-year survey was completed by 16 of 23 fellows (69.6%). Of these 16 respondents, attendance was as follows: 31.3% for after-hours debrief sessions, 75% for Schwartz Rounds-style discussion, 75% for Imposter Syndrome and Perfectionism lecture, and 75% for at least one social activity. The majority of fellows who attended these events reported them to be helpful (range 75-100%). Themes identified from written comments included universal appreciation for wellness programming efforts and a desire for more sessions for group reflection. One fellow noted these activities were “helpful for wellness and fostering a pleasant work environment.” Other fellows noted the Imposter Syndrome discussion “should be mandatory” and “would be helpful earlier in the year.” Several fellows expressed their wellness was linked to clinical workload, and one fellow noted sessions outside of regular work hours are difficult to attend. Conclusions: Structured needs assessment and implementation of wellness programming in a HO training program appeared to be beneficial to the majority of fellows. To our knowledge, this is the first description of comprehensive fellow-directed wellness initiatives in HO training. Continued efforts must be made to better support fellows, including options in location, timing, faculty presence, and optimizing work responsibilities and expectations. Further study is necessary to quantify the impact of these initiatives and to tailor the most effective approach to fellows’ wellness.

Ultrasound-guided hydrostatic reduction of intussusception: comparison of success rates between subspecialized pediatric radiologists and non-pediatric radiologists or radiology residents

Ileocolic intussusception is the most common cause of intestinal obstruction in children under two years of age. Treatment in most cases is radiologically guided reduction. In Slovenia, ultrasound (US)-guided hydrostatic reduction is currently the standard of care. The purpose of this study was to compare the success rate of US-guided hydrostatic reduction when performed by subspecialty-trained pediatric radiologists, non-pediatric radiologists, or radiology residents. We retrospectively analyzed medical records of patients with ileocolic intussusception who underwent US-guided hydrostatic intussusception reduction at University Medical Centre Ljubljana between January 2012 and December 2022 (n = 101). During regular daily working hours, the reduction was performed by pediatric radiologists. After hours (evenings and overnight), pediatric radiologists, non-pediatric radiologists, or radiology residents performed the reduction procedure. Patients were divided into three groups based on the operator performing the procedure. Data was analyzed using the chi-square test. Pediatric radiologists had thirty-seven (75.5%) successful first attempts, non-pediatric radiologists had nineteen (76.0%), and radiology residents had twenty (74.1%). There was no statistically significant difference in the success rate of ileocolic intussusception reduction depending on the operator who performed the procedure (p = 0.98). No perforation was observed in either group during the reduction attempts. Conclusion: Our results demonstrate that US-guided hydrostatic reduction is a reliable and safe procedure that achieves good results even in the hands of less experienced, however appropriately trained, radiologists. The results should encourage more medical centers to consider the implementation of US-guided hydrostatic reduction of ileocolic intussusception.What is Known:• US-guided hydrostatic reduction is a well-established method of treatment for ileocolic intussusception in children.• The results regarding the influence of operator’s experience with the procedure on its success rate are scarce and contradictory.What is New:• US-guided hydrostatic intussusception reduction is a reliable and safe technique that achieves similar success rates when performed by experienced subspecialized pediatric radiologists or less experienced but trained operators such as non-pediatric radiologists and radiology residents.• The implementation of US-guided hydrostatic reduction in general hospitals without subspecialized pediatric radiologists could improve patient care by increasing access to radiologically guided reduction and simultaneously decreasing the time to reduction attempts.

Risk Factors for Postoperative Pulmonary Complications Leading to Increased Morbidity and Mortality in Patients Undergoing Thoracic Surgery for Pleural Empyema

Surgery for pleural empyema carries a high burden of morbidity and mortality. The authors investigated the incidence of postoperative pulmonary complications (PPCs) and their effects on perioperative morbidity and mortality. Patient-specific, preoperative, procedural, and postoperative risk factors for PPCs were analyzed. Retrospective observational study. A single, large university hospital. A total of 250 adult patients were included who underwent thoracic surgery for pleural empyema between January 2017 and December 2021. None. A total of 250 patients with pleural empyema underwent thoracic surgery by video-assisted thoracoscopic surgery (49%; n = 122) or open thoracotomy (51%; n = 128). A proportion (42% [105]) of patients had ≥1 PPCs; 28% (n = 70) had to undergo resurgery; and 10% (n = 25) were re-admitted unexpectedly to the ICU. Preoperative respiratory failure (odds ratio [OR]: 5.8, 95% CI: 2.4-13.1), general anesthesia without regional analgesia techniques (OR: 2.9, 95% CI: 1.4-5.8), open thoracotomy and subsequent resurgery (OR: 3.9, 95% CI 1.5-9.9), surgery outside the regular working hours (OR: 3.1, 95% CI 1.2-8.2), and postoperative sepsis (OR: 2.6, 95% CI 1.1-6.8) were identified as independent risk factors for PPCs. Postoperative pulmonary complications were independent factors for unplanned intensive care unit admission (OR: 10.5, 95% CI 2.1-51 for >1 PPC), death within 360 days (OR: 4.5, 95% CI 2.2-12.3 for ≥2 PPCs), and death within 30 days for ≥1 PPCs (OR: 1.2, 95% CI 1.1-1.3). The incidence of PPCs is a significant risk factor for morbidity and mortality after surgery for pleural empyema. Targeting the risk factors identified in this study could improve patient outcomes.

448 Prescribing of oral antibacterial drugs in primary care out-of-hours services: a scoping review

Abstract Introduction The rapid spread of antimicrobial resistance (AMR), which causes a serious threat to both human health and the global economy, is primarily linked to the overuse and misuse of antibacterial drugs. The AMR crisis is significantly impacted by the use of antibacterial drugs in primary care (1). Within these settings, oral antibacterial drugs are considered one of the most frequently prescribed group of medicines. It has been claimed that within primary care, the proportion of antibacterial drug prescribing is higher outside the regular working hours (out-of-hours (OOH) services) compared to in-hours (IH) services (2). Aim To identify the existing body of literature around oral antibacterial drug prescribing within primary care OOH services. Methods The scoping review was guided by the Joanna Briggs Institute manual and reported in accordance with the PRISMA-ScR. Seven electronic databases (Medline, Embase, Emcare, CINAHL, Scopus, Web of Science, and Cochrane Library) were systematically searched, and the results were screened against pre-defined eligibility criteria. Original and secondary analysis studies that addressed oral antibacterial prescribing in OOH primary care and were published in English were included. Titles and abstracts were independently screened by three reviewers. A pre-piloted extraction form was used to extract relevant data. A narrative synthesis approach was used to summarise the results. Results The initial search yielded 834 records. Upon screening, 28 publications fulfilled the eligibility criteria. Included studies originated from nine high-income countries, with the most frequent being the United Kingdom (six studies, 21.4%) followed by Belgium (five studies, 17.9%). Literature on antibacterial prescribing in OOH services was mostly from quantitative studies (23 studies, 82.14%), with only a few employing a qualitative design (five studies, 17.86%). Different themes and sub-themes were identified across these studies. The majority discussed antibacterial prescribing data in terms of the commonly prescribed medications and/or associated conditions. Eleven studies provided a comparison between IH and OOH settings. Seven studies reported the trends of prescribing over time; of these, three explored prescribing trends before and during COVID-19. The impact of ­intervention implementation on prescribing was investigated in two studies, an educational intervention in one study and the use of an interactive booklet in the other study. Four studies assessed the quality/appropriateness of prescribing either by adherence to guidelines or antibiotic prescribing quality indicators. Limited studies explored prescribing predictors and patients’ expectations and satisfaction with OOH services. In contrast, qualitative studies focussed more on exploring prescribers’ experiences, perspectives, behaviours, and the challenges they face during consultations within OOH settings which may influence their decision-making process. Of these, one study explored why patients consult OOH services and how they communicate their problems. Conclusion This review shows the key areas around oral antibacterial prescribing in primary care OOH services. While there is a satisfactory number of published articles covering various areas within OOH, the use of different approaches to OOH across countries may confound the comparison of practice. A strength of this work is using three reviewers to screen identified records independently. Further research is needed to provide a better understanding of current practice in these settings and how it may be contributing to AMR.

The impact of work pressure and work completion justification on intentional nonmalicious information security policy violation intention

As businesses have had to change how they operate due to the coronavirus pandemic, the need for remote work has risen. With the continuous advancements in technology and increases in typical job demands, employees need to increase their work productivity beyond regular work hours in the office. This type of work environment creates even more opportunities for security breaches due to employees intentionally violating information security policy violations. Although explicitly prohibited by information security policies (ISP), organizations have observed that employees bring critical data out of the office to complete their work responsibilities remotely. Consequently, developing a deeper understanding of how work pressure may influence employees to violate ISPs intentionally is crucial for organizations to protect their critical information better. Based upon the fraud triangle theory, this study proposes the opportunity to copy critical data, work pressure, and work completion justification as the primary motivational factors behind why employees copy critical company data to unsecured storage devices to work at home. A survey was conducted of 207 employees from a marketing research firm. The results suggest that opportunity, work pressure, and work completion justification are positively related to nonmalicious ISP violation intentions. Furthermore, the interaction effect between work completion justification and work pressure on the ISP violation intention is significant and positive. This study provides new insights into our understanding of the roles of work pressure and work completion justification on intentional nonmalicious ISP violation behaviors.

Evaluation of the Effectiveness of the Separate Anesthesia Induction Rooms on Multidisciplinary Work Flow in Operating Rooms.

Operating suites are multidisciplinary units par excellence, and mostly they are the most expensive units in hospitals. Interdisciplinary workflow and efficiency are therefore crucial, which is influenced by floor plans varying from hospital to hospital. Most operating rooms are equipped with adjacent induction rooms, allowing preparation and anesthesia induction of the next patient, while the previous patient is still in the operating room. Parallelizing the working steps is thought to improve turn-over time, thus increasing throughput, number of cases and finally revenue. However, this assumption has never been challenged. We analyzed workflow during regular working hours in an operating suite equipped with a mixture of operating rooms (OR) with next door induction rooms and operating rooms without induction rooms. This allows a direct comparison of both structural elements for efficiency using utilization data over a 24-months period. Both settings were used for gynecological operations. Key result is that induction rooms do not improve perioperative workflow including turn-over time. Instead, ORs without adjacent induction rooms have a significantly shorter turn-over time and OR occupancy duration per case, although surgical time and staffing were similar. Adjacent induction rooms require extra space, funding, and high maintenance costs, but they do not speed up peri-operative processes. Modern anesthetic techniques allow for fast induction of and emergence from anesthesia. Induction rooms adjacent to the OR are no longer needed if general anesthesia without extended monitoring is used for the majority of cases.

Technology-assisted supplemental work: A meta-analysis

Due to the increasing digitalization and connectivity of work, more and more employees engage in technology-assisted supplemental work (TASW). TASW refers to the performance of work-related tasks after regular work hours with the aid of technological tools. Based on a conceptual model of TASW, we present a comprehensive meta-analysis of potential antecedents and outcomes of TASW (K = 89 independent samples, N = 39,085 employees). Results showed that TASW is associated with social normative work context characteristics, such as availability expectations after work (ρ¯ = 0.45), and work characteristics, such as job demands (ρ¯ = 0.32). Associations were also found between TASW and person characteristics, such as work identity (ρ¯ = 0.35) and segmentation preference (ρ¯ = −0.20). Moreover, TASW is related to important employee outcomes, including recovery-related outcomes, such as psychological detachment (ρ¯ = −0.38); well-being outcomes, such as job strain (ρ¯ = 0.12); nonwork-related outcomes, such as work nonwork conflict (ρ¯ = 0.32); as well as attitudinal and performance-related outcomes, such as organizational commitment (ρ¯ = 0.16) and work performance (ρ¯ = 0.27). We also found TASW to be related to certain demographic characteristics, such as male gender (ρ¯ = 0.11) and job-level (ρ¯ = 0.23). Exploratory moderator analyses further revealed that gender moderated the relationship between job demands and TASW, such that the relationship was stronger for samples with a higher percentage of females. We conclude by discussing potential directions for future research to advance the understanding of TASW.

Variation of Liver Transplant Practice and Outcomes During Public Holidays in the United States: Analysis of United Network for Organ Sharing Registry.

We analyzed the United Network for Organ Sharing registry data for 55 200 adult patients who underwent an LT between 2010 and 2019. Patients were grouped according to LT receipt during public holidays ±3 d (n = 7350) and nonholiday periods (n = 47 850). The overall post-LT mortality hazard was analyzed using multivariable Cox regression models. LT recipient characteristics were similar between public holidays and nonholidays. Compared with nonholidays, deceased donors during public holidays had a lower donor risk index (median [interquartile range]: holidays 1.52 [1.29-1.83] versus nonholidays 1.54 [1.31-1.85]; P = 0.001) and shorter cold ischemia time (median [interquartile range]: holidays 5.82 h [4.52-7.22] versus nonholidays 5.91 h [4.62-7.38]; P < 0.001). Propensity score matching 4-to-1 was done to adjust for donor and recipient confounders (n = 33 505); LT receipt during public holidays (n = 6701) was associated with a lower risk of overall mortality (hazard ratio 0.94 [95% confidence interval, 0.86-0.99]; P = 0.046). The number of livers that were not recovered for transplant was higher during public holidays compared with nonholidays (15.4% versus 14.5%, respectively; P = 0.03). Although LT performed during public holidays was associated with improved overall patient survival, liver discard rates were higher during public holidays compared with nonholidays.

Abstract Number: LBA1 Endovascular Thrombectomy vs Best Medical Therapy for Late Presentation Ischaemic Stroke Selected using Non‐Contrast CT

Introduction The efficacy and safety of endovascular thrombectomy (EVT) beyond 6 hours from acute ischaemic stroke (AIS) onset for patients with proximal large vessel occlusion (LVO) selected without CT perfusion or MR imaging is undetermined in routine clinical practice. Methods In this single centre study, we identified consecutive AIS patients with an ICA or M1 MCA segment occlusion who were eligible for EVT based on non‐contrast CT/CT angiography (without CT perfusion or MR imaging) using an Alberta Stroke Program Early CT Score (ASPECTS) of ≥ 6, and an NIHSS score of≥ 6, presenting beyond 6 hours from stroke onset, between January 2018 and March 2022. During the study period, EVT capacity limitations meant EVT‐eligible patients presenting out of regular working hours (between 18.00 and 08.00 on weekdays) or on weekends, consistently received best medical management (BMM). This systemic unavailability of EVT, allows a comparison of EVT and BMM in patients who meet the same inclusion criteria, in which selection based on physician‐related bias is significantly reduced. Functional outcomes (modified Rankin Scale (mRS) at 90 days), symptomatic intracranial haemorrhage (sICH) and mortality at 90 days were compared between patients receiving EVT or BMM following multivariable adjustment for age, sex, baseline stroke severity, ASPECTS, onset‐to‐neuroimaging time, IV thrombolysis, and clot location.Pre‐specified subgroup analyses were performed. Results Among 4802 AIS patients, 150 patients (3.1%) presenting beyond 6‐hours of onset were eligible for EVT: 74 (49%) treated with EVT and 76 (51%) with BMM. Compared to the BMM group, patients treated with EVT had significantly improved functional outcome (mRS) (adjusted common OR = 2.23, 95%CI 1.18‐4.22, p = 0.013), and higher rates of functional independence (mRS≤2; 39.2.% vs 9.2%; aOR = 4.73, 95%CI 1.64‐13.63, p = 0.004). No significant difference was observed between the EVT and BMM groups in the sICH (5.4% vs 2.6%, p = 0.94) or mortality (20.2% vs 47.3%, p = 0.16) rates, respectively. EVT remained effective within the 6–12 hour and &gt;12 hour time window subgroups. No significant treatment interaction was observed in all subgroups. Conclusions In routine clinical practice, of the 3.1% of patients in our AIS population presenting after 6 hours from stroke onset who were deemed eligible for EVT by NCCT/CTA alone, those treated with EVT achieved significantly improved functional outcome, compared to patients treated with BMM only. No significant differences were noted between the two groups with respect to sICH and mortality. While confirmatory randomised trials are awaited, these findings suggest that EVT is effective and safe when performed in AIS patients selected without CTP or MRI beyond 6 hours from stroke onset.

Is Off-Hours ICU Discharge Really the Culprit? Not So Fast!

Off-Hours Intensive Care Unit Transfer Is Associated With Increased Mortality and Failure to RescueThe Annals of Thoracic SurgeryPreviewCardiac postoperative intensive care unit (ICU) beds are a limited resource, and when a patient no longer requires this level of care they are quickly transferred out. We hypothesized that complications and ICU readmission increased when transfer occurred during off-hours compared with regular work hours. Full-Text PDF

Endovascular stroke therapy outside core working hours in a nationwide stroke system

BackgroundEndovascular therapy (EVT) has been established as a major component in the acute treatment of large vessel occlusion stroke. However, it is unclear whether outcome and other treatment-related factors differ...

"Out of office": Availability norms and feeling burned out during the COVID-19 pandemic: The mediating role of autonomy and telepressure.

Digital innovations make it possible to work anywhere and anytime using any kind of device. Given these evolutions, availability norms are emerging at work. These norms specifically refer to the experienced beliefs or expectations from colleagues or superiors to be available for work-related communication after regular work hours. We rely on the Job-Demands Resources Model as we aim to investigate the relationship between these availability norms and burnout symptoms during the COVID-19 pandemic. We first of all study to what extent availability norms are associated with heightened burnout symptoms. Secondly, we study how both a personal demand, namely telepressure, and a job resource, namely autonomy, could offer distinct and relevant explanations for the role these availability norms play in experiencing burnout symptoms. We collected data through a survey study with 229 employees from various organizations in the second half of 2020. The findings indicated that indeed availability norms are significantly associated with more burnout symptoms and that both heightened telepressure and reduced autonomy mediated this relationship. This study contributes to theory and practice as we offer insight into how availability norms at work could be detrimental for the occupational health of employees, which can be taken into account when setting up rules and regulations at work.

Access to General Practitioners during the second year of the COVID-19 pandemic in Portugal: a nationwide survey of doctors

BackgroundThe Portuguese National Health System (NHS) provides universal coverage and near-free health care, but the population has high out-of-pocket expenses and unmet care needs. This suggests impaired accessibility, a key dimension of primary care. The COVID-19 pandemic has further affected access to health care. Understanding General Practitioners’ (GP) experiences during the pandemic is necessary to reconfigure post-pandemic service delivery and to plan for future emergencies. This study aimed to assess accessibility to GPs, from their perspective, evaluating determinants of accessibility during the second pandemic year in Portugal.MethodsAll GPs working in NHS Family Practices in continental Portugal were invited to participate in a survey in 2021. A structured online self-administered anonymous questionnaire was used. Accessibility was assessed through waiting times for consultations and remote contacts and provision of remote access. NHS standards were used to assess waiting times. Descriptive statistics were used to characterize the study sample. Associations between categorical variables were tested using the χ2 statistic and the Student t-test was used to compare means of continuous variables.ResultsA total of 420 GPs were included (7% of the target population). Median weekly working hours was 49.0 h (interquartile range 42.0–56.8), although only 14% reported a contracted weekly schedule over 40 h. Access to in-person consultations and remote contacts was reported by most GPs to occur within NHS time standards. Younger GPs more often reported waiting times over these standards. Most GPs considered that they do not have enough time for non-urgent consultations or for remote contacts with patients.ConclusionsMost GPs reported compliance with standards for waiting times for most in-person consultations and remote contacts, but they do so at the expense of work overload. A persistent excess of regular and unpaid working hours by GPs needs confirmation. If unpaid overtime is necessary to meet the regular demands of work, then workload and specific allocated tasks warrant review. Future research should focus on younger GPs, as they seem vulnerable to restricted accessibility. GPs’ preferences for more in-person care than was feasible during the pandemic must be considered when planning for the post-pandemic reconfiguration of service delivery.

Single- versus two-stage reconstruction in patients with head and neck cancer: What are the benefits?

In head and neck oncology, surgical treatment frequently results in microvascular reconstruction. Oncologic resection followed by immediate reconstruction is often associated with prolonged working and surgical duration, challenging a surgeon’s concentration level and potentially worsening patient outcome. To improve the surgeon’s performance and to reduce risk of potential complications, we implemented a two-stage procedure in patients with head and neck cancer. This study critically analyzed the surgical outcomes, organizational benefits, and investigated job satisfaction among affected health care professionals. A retrospective data analysis of patients who had undergone microvascular reconstruction after oncologic head and neck surgery between 2010 and 2021 included 33 patients (n = 33). Twenty patients underwent single-stage reconstruction (group 1, n = 20) and 13 patients underwent two-stage reconstruction (group 2, n = 13) with 12.2 (± 7.4) days between surgeries. The mean surgical duration, and mean start and end time of the reconstructive surgery component differed significantly (p = 0.002). The mean total complication rate (p = 0.58) did not differ significantly, although a trend toward higher demands for blood products was observed in group 1. There was no significant difference in five-year survival (p = 0.28). A questionnaire on subjective work performance was answered by the affected health care professionals (n = 34) and it revealed that 88% preferred long surgeries to be scheduled first and that 97% work most efficiently in the morning. In conclusion, two-stage reconstruction is a suitable option in selected head and neck cancer patients offering the possibility of optimizing preoperative planning and organization. This may result in regular working hours, reduced surgeon fatigue, and improved job satisfaction without compromising patient outcomes or survival.

Off-Hours Intensive Care Unit Transfer Is Associated With Increased Mortality and Failure to Rescue

BackgroundCardiac postoperative intensive care unit (ICU) beds are a limited resource, and when a patient no longer requires this level of care they are quickly transferred out. We hypothesized that complications and ICU readmission increased when transfer occurred during off-hours compared with regular work hours. MethodsFrom 2010 to 2021, patients who underwent a Society of Thoracic Surgeons index operation at a single center were assigned a group based on their ICU transfer time, defined as when they physically arrived on the acute care floor. Patients were stratified into off-hours vs regular hours by their transfer time. Off-hours was defined as 9 pm to 5 am. Risk-adjusted multivariable logistic regression analyzed the association of ICU readmission, postoperative complications, operative mortality, and failure to rescue by group. ResultsThe cohort included 5951 patients (off-hours n = 292 [4.9%], regular-hours n = 5659 [95.1%]). Patients in the off-hours group had significantly greater odds of risk-adjusted ICU readmission (odds ratio 1.99, 95% CI 1.25-3.04, P < .002) and mortality (odds ratio 3.88, 95% CI 2.27-6.33, P < .001). In the major complications subgroup (Off-hours n = 55, Regular-hours n = 603), Off-hours transfer was associated with increased mortality (failure to rescue) (odds ratio 3.05, 95% CI 1.58-5.69, P = .001). ConclusionsOff-hours ICU to floor transfer was associated with increased postoperative complications, ICU readmission, and mortality, suggesting that the timing of ICU transfer may impact outcomes. This elucidates targets for quality and process improvement for our center and others facing the same resource constraints.

Correlation between Nutritional Intake, Physical Activity, and Occupational Stress with Blood Pressure in Dockworkers at Indonesia Fishing Port

BACKGROUND: Hypertension in the population can result in lost productivity due to an increased risk of premature death and a decline in work productivity. The study on hypertension in workers in Indonesia has primarily focused on formal workers with regular working hours, with little attention paid to informal workers. AIM: This study aims to analyze the correlation between nutritional intake, physical activity, and occupational stress with blood pressure in dockworkers at the fishing port (TPI) Kendal, Indonesia. METHODS: There were 51 male dockworkers recruited. We used a 24-h recall to assess nutritional intake over three non-consecutive days. The physical activity index was measured using the Questionnaire for the Measurement of a Person’s Habitual Physical Activity. Data on occupational stress were obtained through interviews using the Workplace Stress Scale questionnaire. Pearson’s product moment and Spearman’s rank were used to performing a correlation test between variables. RESULTS: The majority of dockworkers had prehypertension (35.3%). There was a correlation between BMI and systolic (p = 0.001; r = 0.554) and diastolic (p = 0.001; r = 0.459) blood pressure. Meanwhile, age was related to systolic blood pressure (p = 0.022; r = 0.320), and cholesterol intake was associated with diastolic blood pressure (p = 0.040; r = 0.289). Blood pressure was not associated with physical activity and occupational stress. CONCLUSION: Dockworkers should reduce sedentary activities and maintain healthy body weight to prevent hypertension.

Use of EEG in neonatal hypoxic-ischemic encephalopathy: A French survey of current practice and perspective for improving health care

ObjectivesControlled therapeutic hypothermia (CTH) is a standard of care in the management of neonatal hypoxic-ischemic encephalopathy HIE in newborns after 36 weeks of gestational age (WGA) in France. The electroencephalogram (EEG) plays a major role in HIE diagnosis and follow-up. We conducted a French national survey on the current use of EEG in newborn undergoing CTH. MethodsBetween July and October 2021, an email survey was sent to the heads of the Neonatal intensive care units (NICUs) in metropolitan and overseas French departments and territories. ResultsOut of 67, 56 (83%) of NICUs responded. All of them performed CTH in children born after 36 WGA with clinical and biological criteria of moderate to severe HIE. 82% of the NICUs used conventional EEG (cEEG) before 6 h of life (H6), prior to CTH being performed, to inform decisions about its use. However, half of the 56 NICUs had limited access after regular working hours. 51 of the 56 centers (91%) used cEEG, either short-lasting or continuous monitoring during cooling, while 5 centers conducted only amplitude EEG (aEEG). Only 4 of 56 centers (7%) used cEEG systematically both prior to CTH and for continuous monitoring under CTH. DiscussionThe use of cEEG in the management of neonatal HIE was widespread in NICUs, but with significant disparities when considering 24-hour access. The introduction of a centralized neurophysiological on-call system grouping several NICUs would be of major interest for most centers which do not have the facility of EEG outside working hours.

Working from Home and Worker Well-being: New Evidence from Germany

The COVID-19 pandemic piqued interest in remote work, but research yields mixed findings on the impact of working from home on workers’ well-being and job attitudes. The authors develop a conceptual distinction between working from home that occurs during regular work hours (replacement work-from-home) and working from home that occurs outside of those hours (extension work-from-home). Using linked establishment-employee survey data from Germany, the authors find that extension work-from-home is associated with lower psychological well-being, higher turnover intentions, and higher work-to-family and family-to-work conflicts. By contrast, replacement work-from-home is associated with better well-being and higher job satisfaction, but higher work-to-family conflict. Extension work-from-home has more negative effects for women’s well-being and work-to-family conflict. This distinction clarifies the conditions under which remote work can have positive consequences for workers and for organizations.

Influence of Fish Handling Practices Onboard Purse Seiners on Quality Parameters of Sardines (Sardina pilchardus) during Cold Storage.

Small pelagic fish are a rich source of high-quality proteins and omega-3 fatty acids, but they are highly perishable due to the activity of microorganisms, endogenous enzymes, and oxidation processes that affect their muscle tissues during storage. This study focused on analyzing the influence of fish handling practices onboard vessels on sensory quality attributes, pH, water holding capacity, TVB-N, proteolytic changes, and lipid oxidation in sardine muscle tissue during cold storage. Experiments were conducted onboard fishing vessels during regular work hours, with added consistency, accounting for similar sardine sizes (physiological and reproductive stages) under similar environmental conditions. Traditional handling practices, e.g., boarding the catch with brail nets and transporting the fish in plastic crates with flake ice, were compared with the use of modified aquaculture pumps for boarding the catch and transporting it in isothermic boxes submerged in ice slurry. Results confirmed significant differences in the parameters among the different fishing vessels, although no significant differences were found between the two methods of fish handling on board the vessels. The study also confirmed a higher rate of lipid oxidation in fish muscle due to physical damage and an increased degree of proteolysis in samples with lower muscle pH values.

Patient, Operator, and Procedural Characteristics of Guidewire Retention as a Complication of Vascular Catheter Insertion.

Pre-specified observational analysis as part of a quality improvement study of consecutive guidewire retention events across a multihospital health system from August 2007 to October 2015. Ten hospitals within the Cleveland Clinic Health System in Ohio, United States. Consecutive all-comers who experienced guidewire retention after vascular catheter insertion. None. Data were manually obtained from the electronic medical records and reviewed for potential contributing factors for guidewire retention, stratified into patient, operator, and procedural characteristics. A total of 24 events were identified. Overall, the median age was 74 years, 58% were males, and the median body mass index was 26.5 kg/m2. A total of 12 (50%) individuals were sedated during the procedure. Most incidents (10 [42%]) occurred in internal jugular venous access sites. The majority of cases (13 [54%]) were performed or supervised by an attending. Among all cases, three (12%) were performed by first-year trainees, seven (29%) by residents, three (12%) by fellows, and four (17%) by certified nurse practitioners. Overall, 16 (67%) events occurred during regular working hours (8 amto 5 pm). In total, 22 (92%) guidewires were inserted nonemergently, with two (8%) during a cardiac arrest. Ultrasound guidance was used in all but one case. Guidewire retention can occur even in the presence of optimal patient, operator, and procedural circumstances, highlighting the need for constant awareness of this risk. Efforts to eliminate this important complication will require attention to issues surrounding the technical performance of the procedure.