Work-hour Restrictions Research Articles

Non-cadaveric spine surgery simulator training in neurosurgical residency

BackgroundSpine surgical training faces increasing challenges due to restricted working hours and greater subspecialization. Modern simulators offer a promising approach to teaching both simple and complex spinal procedures. This study evaluated the acceptance and efficacy of spine simulator training using a lumbar herniated disc model tested by 16 neurosurgical residents (PGY-1-6), and compared 3D and 2D teaching methods. MethodsSixteen residents utilized the Realists RealSpine L4/L5 disc simulator with both microscope and exoscope. A mixed-methods analysis assessed the efficacy and acceptance of the training. Six PGY-1 residents participated in a learning curve study, divided into exoscopic and microscopic cohorts. Each group watched a tutorial in either 3D or 2D, followed by three surgical sessions. Endpoints included surgical progress within 30 minutes and complication rates. Microsurgical skills and mental concepts were evaluated on a numeric Likert Scale. ResultsParticipants rated the simulator training favorably, with a median score of 8/10 across six categories. The learning curve study showed a 30% improvement in microsurgical performance. The completion rate of herniated disc removal increased from 50% at T2 to 100% at T3 and T4. Significant improvement in mental concept was observed (p=0.035), with slightly better consolidation in the exoscope group. Self-assessments revealed significantly improved skills across all participants. ConclusionSpine simulator training was well-received and resulted in improvements in both mental concept and microsurgical performance, with enhanced outcomes in the 3D teaching/exoscope group. This study supports the integration of spine simulators into spine surgical residency, particularly for early-stage training, to improve both cognitive and practical surgical skills.

Enhancing Compliance With Work-Hour Restrictions Through Safety Culture and Leadership in Medical Residencies.

Enhancing Compliance With Work-Hour Restrictions Through Safety Culture and Leadership in Medical Residencies.

Objective alertness, rather than sleep duration, is associated with burnout and depression: A national survey of Japanese physicians.

Approximately 40% of Japanese physicians report working more than 960 hr of overtime annually, with 10% exceeding 1860 hr. To protect their health, annual overtime limits went into effect in 2024. The objective of this study was to investigate associations of self-reported sleep duration with psychological health and objective alertness. This was a cross-sectional National Survey for The Work Style Reform of Long Working Physicians. Physicians self-reported daily sleep duration, burnout (Abbreviated Maslach Burnout Inventory), depression (Center for Epidemiologic Studies Depression Scale) and traffic accidents. Alertness was then evaluated using the brief Psychomotor Vigilance Test. Of 20,382 physicians invited, 1226 completed the survey and brief Psychomotor Vigilance Test. Daily sleep duration was inversely associated with weekly work hours (β = -5.4; 95% confidence interval -6.8 to -4.0, p < 0.0001). Sleep duration < 6 hr and ≥ 8 hr per day was associated with slower responses on the brief Psychomotor Vigilance Test (adjusted p < 0.05). An additional 10 hr worked per week was associated with a 0.40 point (95% confidence interval 0.08-0.72) increase in burnout severity and a 1.7% (95% confidence interval 0.1-3.3%) increase in odds of reporting a traffic accident. Increased brief Psychomotor Vigilance Test lapses, indicating lower alertness, were associated with worse symptoms of depression (β = 0.23 points; 95% confidence interval 0.14-0.31, p < 0.0001) and burnout (β = 0.25 points; 95% confidence interval 0.13-0.36, p < 0.0001). This study emphasizes the importance of sufficient sleep to maintain alertness, and supports limiting work hours for Japanese physicians to protect psychological health. Performance on the brief Psychomotor Vigilance Test may be a useful indicator of psychological health.

Factors influencing the development, recruitment, integration, retention and career development of advanced practice providers in hospital health care teams: a scoping review

BackgroundAdvanced practice providers (APPs), including physician assistants/associates (PAs), nurse practitioners (NPs) and other non-physician roles, have been developed largely to meet changing healthcare demand and increasing workforce shortages. First introduced in primary care in the US, APPs are prevalent in secondary care across different specialty areas in different countries around the world. In this scoping review, we aimed to summarise the factors influencing the development, recruitment, integration, retention and career development of APP roles in hospital health care teams.MethodsWe conducted a scoping review and searched Ovid MEDLINE, Ovid Embase, Ovid Global Health, Ovid PsycINFO and EBSCOhost CINAHL to obtain relevant articles published between Jan 2000 and Apr 2023 that focused on workforce management of APP roles in secondary care. Articles were screened by two reviewers independently. Data from included articles were charted and coded iteratively to summarise factors influencing APP development, recruitment, integration, retention and career development across different health system structural levels (macro-, meso- and micro-level).ResultsWe identified and analysed 273 articles that originated mostly from high-income countries, e.g. the US (n = 115) and the UK (n = 52), and primarily focused on NP (n = 183) and PA (n = 41). At the macro-level, broader workforce supply, national/regional workforce policies such as work-hour restrictions on physicians, APP scope of practice regulations, and views of external collaborators, stakeholders and public representation of APPs influenced organisations’ decisions on developing and managing APP roles. At the meso-level, organisational and departmental characteristics, organisational planning, strategy and policy, availability of resources, local experiences and evidence as well as views and perceptions of local organisational leaders, champions and other departments influenced all stages of APP role management. Lastly at the micro-level, individual APPs’ backgrounds and characteristics, clinical team members’ perceptions, understanding and relationship with APP roles, and patient perceptions and preferences also influenced how APPs are developed, integrated and retained.ConclusionsWe summarised a wide range of factors influencing APP role development and management in secondary care teams. We highlighted the importance for organisations to develop context-specific workforce solutions and strategies with long-term investment, significant resource input and transparent processes to tackle evolving healthcare challenges.

Performance Analysis of District Election Commission Employees

This study employs a qualitative description method to analyze the performance of Sidoarjo District General Election Commission employees, focusing on commissioners and various administrative roles. Utilizing interviews, observation, and documentation, the interactive data analysis model by Miles and Huberman is applied. Findings reveal commendable performance across indicators, yet highlight a notable issue with punctuality. Despite disciplined office hours, employees exhibit lower punctuality during activities and office entry. Limited working hours appear to shape their engagement, with perceived inactivity outside election periods. Various factors impede employee work at the General Election Commission in Sidoarjo Regency. This research contributes valuable insights into electoral administration, emphasizing punctuality and addressing challenges faced by commission employees Highlight : Insights into Employee Punctuality: Reveals significant variations in punctuality during activities and office entry, providing a nuanced understanding of employee behavior. Limited Working Hours Impact: Examines the influence of limited working hours on employee engagement, shedding light on the perceived inactivity outside election periods. Addressing Challenges in Electoral Administration: Highlights key factors hindering the work of General Election Commission employees, offering actionable insights for improving electoral processes. Keywords: Election Commission, Employee Performance, Punctuality, Qualitative Analysis, Challenges

Implementasi Metode Forward Chaining untuk Mendeteksi Defisensi Vitamin Pada Manusia

There are many vitamins such as vitamins A, B, B1, B2, B3, B5, B6, B7, B9, B12, C, D, E, K and various symptoms that are almost similar, making it difficult to identify independently. The challenges associated with vitamin deficiency disorders include long wait times at the doctor's office or during limited working hours, as well as expensive charges. The purpose of the research is to enable the general population to identify and treat vitamin deficiencies in the body by using symptoms as a guide. The research will be conducted online to save costs and provide accessibility from anywhere at any time. In the study, there were 40 symptoms in 14 vitamins which were then applied according to the concept of Forward chaining method, namely IF-THEN rule. When a user enters answers that comply with the rules, the expert system consults with them to diagnose the problem. If the user enters answers that do not conflict with the rules, the system will display the diagnostic results, which include information and remedies for vitamin deficiencies. While literature reviews and nutritionist interviews were used as the data collection strategy, Web-based system implementation used PHP programming language, and MySQL as database media. After conducting validation tests between the system's output and expert data, the system achieved an 87.5% calculation result. It is clear from the test results that this system is operating effectively and appropriately.

Factors Affecting Medical Residents' Decisions to Work After Call.

Accreditation Council for Graduate Medical Education (ACGME) work-hour restrictions (WHRs) are intended to improve patient safety by reducing resident fatigue. Compliance with ACGME WHRs is not universal. The purpose of this study was to identify factors that influence residents' decisions to take a postcall day (PCD) off according to ACGME WHRs. Residents (N = 433) at one university were emailed a link to a survey in 2019. The survey included demographic details and a Discrete Choice Experiment examining influences on resident decisions to take a PCD off. One hundred seventy-five residents (40.4%) responded to the survey; 113 residents (26%) completed the survey. Positive feedback from attending physicians about taking PCDs off in the past had the greatest impact on respondents' decisions to take a PCD off, increasing the probability by 27.3%, followed by chief resident comments about the resident looking tired (16.6% increase), and having never heard their attendings comment about PCDs off as either positive or negative (13.9% increase). Factors that had the largest effect on decreasing the probability of taking a PCD were negative feedback about taking PCDs off (14.3% decrease), continuity of care concerns (10.8% decrease), and whether the resident was looking forward to an assignment (7.9% decrease). The most important influencer of residents' decisions to take a PCD off was related to feedback from their attending physicians, suggesting that compliance with WHRs can be improved by focusing on the residency program's safety culture.

Optimization of Lifeboat Maintenance at MV Dobonsolo

This research was motivated by the maintenance of lifeboats on board, which was less than optimal. It was proven when the Marine Inspector checked the lifeboat on board in the Java Sea on March 20, 2022, after the ship departed from Makassar Port to Tanjung Perak Port, 2 of the 12 lifeboats on board could not be hibobbed, so the ship received Non-Conformity (NC). The purpose of this study is to find out how the implementation of lifeboat maintenance at MV Dobonsolo, the obstacles encountered in carrying out the treatment, and how efforts need to be made to overcome these obstacles. The research method used in the preparation of this thesis is qualitative descriptive by using triangulation (observation, interviews, and documentation) in data collection techniques, as well as using data reduction, data presentation, and conclusion drawing in data analysis techniques. The research found that lifeboat maintenance at MV Dobonsolo was not optimal. The obstacles encountered include a large number of lifeboats, but the maintenance time is less due to the limited daily working hours of the Senior Third Officer, the crew does not understand the lifeboat maintenance procedures, and the unavailability of spare parts on board. Efforts that need to be made include dividing the task of lifeboat maintenance between Senior Third Officer and Junior Third Officer, conducting safety meetings and training the crew regarding the maintenance of lifeboats according to procedures, and asking for spare parts from the company

Local Potential Based-Entrepreneurship Development through Community Service Program

This study aims at investigating the development of local potential-based entrepreneurship through community service (PkM) consisting of several stages including training, production and marketing processes and the constraints experienced. By applying a qualitative analysis in which primary data was collected through interviews, observation, and documentation. The information consists of micro, small and medium enterprises (MSMEs) as well as community leaders at Bindu tourism village, Abian Semal District, Badung Regency-Bali. Data validity using triangulation of sources, methods and theory. Data analysis as an interactive model includes data collection, condensation, presentation and conclusion. The results of the research reveal that the PkM program makes a significant contribution through empowering the tourism village enterprises to produce innovative-creative micro, small and medium scale products. Marketing is done through promotions in various media and market share both at home and abroad. Meanwhile, the constraints experienced the lack of production machines that came from the lack of capital and limited working hours of learning residents.

Analisis Beban Kerja Fisik Dan Mental Bagian Produksi Dengan Menggunakan Metode Cardiovascular Load (CVL) Dan Bourdon Wiersma Di PT. Romi Violeta

A manufacturing company engaged in the furniture industry, specializing in wood, rattan and glass products. Most of the production orders were related to table products, stands and chests, with a total of 15,224 orders for other products. Based on results of direct observation at PT. Romi Violeta from the production process department says that due to the limited working hours, especially as the production orders for tables, shelves, etc. increase every month, the physical and mental strain employees take to meet their production targets. I often complain about. For commodity products. The purpose of the research is to find cases of high physical and mental stress at manufacturing sites with high stress standards such as tables, shelves, and chests of drawers, and to provide suggestions for improving the reduction of physical and mental stress. . Based on an analysis of the results, the mean cardiovascular load (CVL) percentage was found to be 43.902%, indicating that the assessment needs improvement, and the Bourdon Vielsma test speed result was 12.593 seconds with a score of 7. , a body weight score (WS) of 11.5 is included in the adequate group (C). Accuracy is 3.26, score is 8, fair group (CB) weighted score (WS) is 12, constant is 8.185 seconds, score is 5.5, score is . 8 are in the suspicious (R) group.

Burnout Among Psychiatry Residents and One Program's Approach to Creating a Culture of Wellness.

Psychiatry residency training includes unique characteristics that can predispose trainees to burnout, including vicarious traumatization, prevalence of patient suicide and violence in the workplace, and social stigma surrounding mental health. For the purposes of this article, the authors examine these contributing factors and address how psychiatry residency training programs, specifically the Kaiser Permanente Oakland program, are responding to these unique challenges with wellness initiatives. Initiatives to promote wellness at Kaiser Permanente Oakland include a resident and faculty-led wellness committee, work-hour limits, reasonable call schedules, a robust mentorship program, funded social and networking events programs, and comprehensive mental health services.

The Changing Environment in Postgraduate Education in Orthopedic Surgery and Neurosurgery and Its Impact on Technology-Driven Targeted Interventional and Surgical Pain Management: Perspectives from Europe, Latin America, Asia, and The United States.

Personalized care models are dominating modern medicine. These models are rooted in teaching future physicians the skill set to keep up with innovation. In orthopedic surgery and neurosurgery, education is increasingly influenced by augmented reality, simulation, navigation, robotics, and in some cases, artificial intelligence. The postpandemic learning environment has also changed, emphasizing online learning and skill- and competency-based teaching models incorporating clinical and bench-top research. Attempts to improve work-life balance and minimize physician burnout have led to work-hour restrictions in postgraduate training programs. These restrictions have made it particularly challenging for orthopedic and neurosurgery residents to acquire the knowledge and skill set to meet the requirements for certification. The fast-paced flow of information and the rapid implementation of innovation require higher efficiencies in the modern postgraduate training environment. However, what is taught typically lags several years behind. Examples include minimally invasive tissue-sparing techniques through tubular small-bladed retractor systems, robotic and navigation, endoscopic, patient-specific implants made possible by advances in imaging technology and 3D printing, and regenerative strategies. Currently, the traditional roles of mentee and mentor are being redefined. The future orthopedic surgeons and neurosurgeons involved in personalized surgical pain management will need to be versed in several disciplines ranging from bioengineering, basic research, computer, social and health sciences, clinical study, trial design, public health policy development, and economic accountability. Solutions to the fast-paced innovation cycle in orthopedic surgery and neurosurgery include adaptive learning skills to seize opportunities for innovation with execution and implementation by facilitating translational research and clinical program development across traditional boundaries between clinical and nonclinical specialties. Preparing the future generation of surgeons to have the aptitude to keep up with the rapid technological advances is challenging for postgraduate residency programs and accreditation agencies. However, implementing clinical protocol change when the entrepreneur-investigator surgeon substantiates it with high-grade clinical evidence is at the heart of personalized surgical pain management.

The role of safety leadership in nursing management during the pandemic

The role of safety leadership in nursing management during the pandemic

A Comprehensive Umbrella Review for Understanding Burnout in Orthopaedic Surgery

Background: Burnout is characterized by depersonalization, emotional exhaustion, and low personal achievement. Occupational demands can lead to burnout in orthopaedic surgeons, negatively impacting patients and surgeons alike. A high-level overview of burnout is lacking; we therefore aimed to conduct an umbrella review (i.e., review of reviews) summarizing evidence on burnout in orthopaedic surgery, focusing on its rates, associations, prevention, and management.Methods: We searched Ovid Medline, Ovid PsycINFO, EBSCO CINAHL, and CENTRAL from database inception to 16 July 2022, using the terms “orthopaedic surgery,” “burnout,” and “review.” Quality assessments were conducted using the PASS checklist. An article was considered for inclusion if it was a review, summarized evidence on burnout in orthopaedic surgery, and had a full text available to allow for data extraction. We present the results of our review using narrative syntheses.Results: We included eight systematic reviews and eight narrative reviews. We found burnout to be common among orthopaedic surgeons, although reviews reported variable rates, thereby precluding definitive conclusions. Residents were found to be particularly at risk of experiencing burnout, with estimates of one in two being affected. Burnout was found to be positively associated with several personal-related factors, including identifying as a female or as a racial minority, experiencing work-life imbalances, and not having spousal support. It was also associated with work-related factors, including working long hours, having stressful work relationships, and experiencing anxiety about one's clinical competence. Literature on interventions for preventing and managing burnout was limited, although there was some evidence supporting work-hour restrictions for residents.Conclusions: Although burnout is detrimental for orthopaedic surgeons and their patients, high-quality literature in this field is scarce. Future efforts should be dedicated to conducting large-scale, prospective studies to examine burnout rates and associations as well as interventional studies to prevent and manage burnout.Level of Evidence: Level IVKey Concepts•Burnout is a work-related syndrome that negatively impacts orthopaedic surgeons and their patients.•Burnout is common in orthopaedic surgeons, though rates vary considerably between studies, making definitive conclusions difficult to draw.•Orthopaedic surgery residents are particularly at risk of experiencing burnout, with estimates of one in two being affected.•Burnout is positively associated with several personal- and work-related factors.•Research on interventions for preventing and managing burnout is limited and requires additional inquiry.

Review of the Lockdown Regulations’ Impact on Informal Businesses during the COVID-19 Pandemic

Globally, the COVID-19 pandemic lockdown regulations caused enormous changes in all business sectors because many businesses were not allowed to operate. Only a few were regarded as essential businesses, such as pharmacies and grocery shops, and allowed to operate. Lockdown regulations negatively affected the South African informal sector. As a result, it is difficult to provide accurate statistics on the entrepreneurs affected by the COVID-19 pandemic. There are no official statistics from the informal sector. This paper aims to examine how the informal sector was affected by the lockdown down restrictions within South Africa. The paper adopts a systematic review methodology using Google Scholar and Web of Science or Scopes to search for articles on informal entrepreneurship, COVID-19, and South Africa to draw a conclusion from the analysed data. The findings indicated that most of the businesses in the informal sector were negatively affected, including workers because some of them lost their jobs and others did not receive their usual salaries due to limited working hours. There were disruptions in the supply chain and pricing of goods and services, and people could not have sustained their income during the lockdown in South Africa. In conclusion, the informal sector is one of the most vulnerable sectors that lacks access to appropriate risk management structures, and most people live on a hand to mouth basis. COVID-19 has negatively affected the informal sector, mainly through distribution and marketing systems.

COVID-19 certificate as a cutting-edge issue in changing the perception of restaurants' visitors-Illustrations from Serbian urban centers.

As one of the first European cases of the introduction of COVID-19 certificates, the Serbian Government initiated the measure of limited working hours of restaurants for unvaccinated visitors. Due to such actions and frequent bans on working during the pandemic, many restaurants in Serbia had to lay off workers or close. At the end of October 2021, the certificate for entering restaurants and all catering facilities for all the visitors became mandatory. It is interesting to note that earlier findings suggested that some personality characteristics determine the specific behaviors during the pandemic, but there is still a small number of results related to restaurants’ visitors. This study aimed to investigate the predictive strength of the Big Five Factors (BFF) to attitudes toward visits to restaurants in Serbia during the pandemic, depending on the attitudes toward accepting COVID-19 certificates. A survey was conducted on a total sample of 953 visitors of restaurants in three major cities in Serbia. The results of hierarchical regression analysis showed that Openness and Extraversion positively predict attitudes toward visits to facilities during a pandemic, while Conscientiousness and Neuroticism were negative predictors. However, in the second step of hierarchical regression analysis, attitudes toward a COVID-19 certificate as a mediator variable significantly reduced the negative effect of Neuroticism on the attitudes toward visits. It seems that, by obtaining the certificate, the fear of unsafe stays in restaurants can be reduced, and that making decisions about (no) visiting restaurants during the pandemic does not necessarily have to be compromised by emotional lability.

Perceptions of Fatigue and Safety Climate Pertaining to Residency Duty-Hour Restrictions.

Introduction: The Accreditation Council for Graduate Medical Education (ACGME), which sets the standards for residency training, instituted work-hour restrictions in 2003. Our purpose was to assess residents’ perceptions of fatigue and local safety climate specific to these duty-hour restrictions.Methods: All residents (N=433) at one university were emailed a link to a survey in 2019. The survey included demographic details, on-call descriptors, an 18-point climate survey (CS), and the 33-point Chalder Fatigue Questionnaire (CFQ). The CS was adapted from a commonly used safety climate scale and intended to measure the respondent’s perceptions of their program’s attitudes and practices around resident duty-hour compliance. A Pearson correlational analysis was used to determine if there were associations between the variables.Results: Mean CS score was 12.89 (95% confidence interval, CI 12.32-13.46, N=164, 48.5%). Respondents were most likely to disagree with “Residents are told when they are at risk of working beyond ACGME duty-hour restrictions,” where 57 (34.7%) disagreed or strongly disagreed. Mean CFQ score was 16.02 (95% CI 14.87-17.17, N=113, 26.1%). As the CS score improved, CFQ scores decreased indicating an inverse relationship between duty-hour climate and fatigue (r=-0.328, p<0.05). Having a protected post-call day off, and having either the Program Director, Chief Resident, or Senior Resident decide that a resident takes a post-call day off were all associated with higher CS scores. Conclusion: We found that the CS had good internal consistency and evidence of construct validity. An inverse relationship between CS score and fatigue suggests that the level of fatigue is higher among residents in programs where residents perceived that ACGME duty-hour compliance was less important.

Penerapan Metode Dempster Shafer Untuk Diagnosa Penyakit Batu Karang

Rocks or urinary tract stones are small and hard deposits that form in the kidneys, urinary tract and often cause pain when urinating, due to lack of public knowledge about the problem of coral disease, and to find out about this situation, people usually do an examination at the home. Sick or Doctor. However, not everyone can do this, this can be due to insufficient economic factors or long distances to visit the doctor, there are also weaknesses in the limited working hours of the doctor's practice. Therefore, innovations and solutions are needed in these conditions, namely by utilizing computer technology to build an expert system that has the ability as a doctor in making diagnoses. This study aims to create an expert system analysis with the Dempster Shafer method that can help doctors and physician assistants, or the general public in diagnosing coral stone disease. The results of this study indicate that with the analysis of the Dempster Shafer method, more optimal and accurate diagnostic results related to coral disease are available to the general public and can assist in the examination of coral disease.

Concurrent 19. Presentation for: Overcoming COVID challenges in project execution – West Barracouta

Presented on Wednesday 18 May: Session 19 The West Barracouta (BTW) field, one of the largest proven undeveloped gas fields off the south-eastern Australian coast, commenced production in April 2021. The project was developed by Esso-BHP Gippsland Basin Joint Venture (GBJV), a 50–50 JV between ExxonMobil’s subsidiary Esso Australia and BHP Petroleum. The BTW gas field is situated ~6 km south west of the existing Barracouta gas field and platform, the first GBJV platform in Bass Strait. The BTW development involved drilling two subsea production wells, installation of umbilical controls from the existing platform and installation of a ~6 km subsea flowline to connect to existing gas pipeline via a hot tap. The BTW team successfully navigated through engineering, fabrication, testing, mobilisation of an international team and installation of the facilities in a COVID environment. The paper shares insights on how to: manage fabrication impacts with closures and restricted workhours to minimise disruption to the project; complete videoconference Hazid Identification Risk Assessment workshops across different geographical locations; develop and execute methodology for distributed component integrated testing with hardware located in different geographical locations; complete remote inspections, Factory Acceptance Tests (FAT)/verification using videoconference; complete enhanced familiarisation and testing activities at shorebase, prior to offshore installation, given restrictions in overseas travel/access to FAT locations; and safely manage installation personnel to ensure continuity of activities in a COVID environment, e.g. platform, installation vessel and diver COVID requirements. To access the presentation click the link on the right. To read the full paper click here

Sleep Medicine: Its Imperfect Past

Sleep Medicine: Its Imperfect Past