Deborah Parks

Day-night pattern in accidental exposures to blood-borne pathogens among medical students and residents

The purpose of this study was to determine whether the occurrence of accidental blood-borne pathogen exposure incidents in medical students and residents in training varies during the 24h. A retrospective review of reported exposures was conducted in a large urban teaching institution—the University of Texas Health Science Center in Houston—between November 1993 and July 1998. Professional level (year of student or level of resident), time of exposure, means/route of exposure (needle stick, laceration, or splash), and type of medical service were recorded. Analysis of the clock time of the 745 reported blood-borne pathogen exposures showed they occurred more frequently during the day than night. Over the nearly 5-year span, 531 incidents took place between 06:00 and 17:59 in comparison to only 214 between 18:00 and 05:59. To account for the day-night difference in medical student and resident hospital staffing, the data were reexpressed as exposure rates, that is, in terms of the number of events per hour per 1000 medical students and residents. Based on the total number of reported exposures over the almost 5-year span of data collection, the average rate was 40 accidents per hour per 1000 doctors in training during the 12h daytime span (6:00–17:59). It was 50% greater at night (18:00–05:59), with 60 incidents per hour per 1000 doctors in training. The day-night difference in rate of exposures was statistically significant (p<.04). The relative risk ratio for residents and students when working during the day shift compared to working the night shift was 0.67. This means that doctors in training are at a 1.50 higher risk of sustaining a blood-borne pathogen exposure when working nights than when working days. (Chronobiology International, 17(1), 61–70, 2000)

Management of acne vulgaris.

Acne is a chronic and multifactorial skin condition affecting about 80% of persons aged 11 to 30 years, the majority of whom are adolescents (Morelli, 2007, Shamban and Narurkar, 2009, Zaenglein and Thiboutot, 2006). Although acne has no cure and has the potential to cause emotional distress and permanent scarring, proper treatment can control the disease and greatly limit the morbidity. In recent years, acne treatment guidelines have been revised based on a better understanding of acne pathophysiology, and they currently aim to target as many pathogenetic factors as possible. This practice guideline will highlight the most recent treatment guidelines for adolescent acne.