Mary Rose

Effects of Call on Sleep and Mood in Internal Medicine Residents

Residents on call experience decreased total sleep time (TST) and increased dysphoria. This study monitored changes in mood and sleepiness for 3 post-call days. Fifty-two internal medicine residents participated in the study. The residents wore actigraphs for the 4 to 9 days of the study. Each morning resident completed mood scales, a sleepiness scale, and estimated their prior night TST. The residents were on a 1-in-4 schedule. Call decreased subjective- and actigraphy-derived TST to less than 4 hr. During the 3 days post call, mood measures improved. Tension, depression, and anxiety stabilized on the first post-call day following the first night of off-call sleep during which the residents obtained about 7 hr of sleep. Vigor, fatigue, and confusion stabilized on the second post-call day. The Epworth Sleepiness Scale dropped to less than 11 after 1 post-call night and continued to decrease up to 3 post-call days. The effects of call linger past the first recovery night. For these residents, recovery sleep appeared inadequate, and the negative effects of call persisted across succeeding off-call days. Thus, for these residents on a 1-in-4 schedule, call affects their mood for much of the time when off call and potentially their personal and professional interactions during this period as well.

Methods for assessment of health outcomes in children with burn injury: the Multi-Center Benchmarking Study.

BACKGROUND The Multi-Center Benchmarking Study (MCBS) is an innovative program giving a new paradigm for monitoring health outcomes in children and adolescents with burn injuries. METHODS This article presents the methodologies for conducting a multicenter long-term cohort study of 1,140 children and adolescents with small to large burn injuries followed from the acute burn discharge at four burn centers for up to 4 years. The components for this project include a broad and rich range of patient-centered health assessments tailored to children with burn injury, an infrastructure for obtaining relevant clinical data, and patient-centered questionnaire data based on validated Shriners Hospitals for Children/American Burn Association Burn Outcomes Questionnaire (BOQ) and Short-Form Psychosocial Questionnaire, aged 0 years to 18 years. Recovery curves are described for analysis of complex data with repeated measures that are based on mixed models and generalized estimating equations, with adjustments for clinical characteristics. RESULTS Accrual rates are as high as 93%, and follow-up rates of completion are 65%. Recovery curves for selected BOQ domains (upper extremity function, patient compliance, and parental concern) are presented for those children and adolescents aged 5 years to 18 years using the rich cohort of data from the MCBS. Results suggest that the BOQ is sensitive and responsive to capturing differences in the rate and levels of change over time. CONCLUSION The methods implemented in the MCBS are a useful model for conducting large multicenter studies to track the clinical and quality of life of children with burn injuries.

Studies of Fatigue and Human Performance in the Field

Inquiry into fatigue and human performance in the field explore the mechanisms through which performance declines in individuals and groups consequent to fatiguing influences including sleep loss and the circadian timing of sleep. These studies generally examine real-life changes in the industries of transportation and emergency work in order to determine how fatigue is manifested in these environments.

Assessment of Medication and Recreational Drugs Associated with Fatigue

Fatigue is a prevalent condition that increases the risk of errors, contributes to accidents, and impairs quality of life. Causes of fatigue include various medications and recreational agents. With the ever-increasing list of medications approved for managing chronic medical conditions, it can be difficult to ascertain the role of the agents in provoking or exacerbating fatigue. This is especially true when the medical condition for which the agent is prescribed is itself associated with fatigue. A detailed history is a crucial process for establishing the causal relationship between a psychoactive substance and fatigue. The temporal relationship between initiation and/or administration of a medicine and the onset of fatigue represents the most important clue. Sometimes, removal of the presumed agent and close follow-up of a patient is needed to ascertain such a role. With that in mind, there are certain groups of agents that may cause fatigue. In this chapter, we review pharmacological and recreational agents associated with fatigue.

Fatigue: Definitions and Classifications

Classification of types of fatigue is critical to proper identification of strategies which might be employed in proper management of this challenge to the employer as well as the worker. We review in this chapter the common error of confusing fatigue and sleepiness, which, while generated along common neurophysiological pathways, differ in their cause and in optimal management strategies.