scholarly journals Can a tool developed for industry be used to assess fatigue risk in medical rotas? A pilot study of foundation doctors’ rotas in a tertiary centre

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e023470 ◽  
Author(s):  
Elspeth Cumber ◽  
Paul Robert Greig
Keyword(s):  
Relative Risk ◽  
Risk Index ◽  
Health And Safety ◽  
General Medicine ◽  
Secondary Outcome ◽  
Tertiary Centre ◽  
Increased Risk ◽  
Shift Pattern ◽  
Preliminary Study ◽  
The Uk

ObjectivesTo determine the feasibility and ease of using a pre-existing health and safety executive fatigue risk calculator to assess doctors’ rotas.DesignObservational.SettingA large tertiary-referral teaching hospital in the UK.Participants95 anonymised foundation years 1 and 2 rotas in General Medicine, General Surgery and Emergency Medicine covering a 4-month period. All rotas provided by rota coordinators were included and assessed.InterventionsRotas were assessed for two indices: relative risk of fatigue-related errors compared with a ‘2-day, two-night, four-off’ shift pattern and percentage chance of a high score on a standardised sleepiness scale.Primary and secondary outcome measuresFatigue index (percentage chance of a high score on a standardised sleepiness scale) and risk index (relative risk of fatigue-related errors compared with a ‘2-day, two-night, four-off’ shift pattern) of all shifts on all rotas.ResultsNearly half of all shifts demonstrated increased risk of fatigue-related errors and increased probability of high levels of sleepiness. There was significant interspeciality variation in both indices. These results are based on rotas as opposed to ‘work as done’ and are therefore likely to slightly universally underestimate actual fatigue risks.ConclusionsThis preliminary study demonstrates that this tool can be used to compare rotas and guide rota design to minimise risk wherever possible. The calculator guidance clearly states there is no ‘ideal risk’ but that values should be minimised, and a maximum fatigue risk agreed which is deemed acceptable given the nature of work undertaken. This study is intended to demonstrate that fatigue can and should be considered during rota design. We do not suggest that it is used to hold either individuals or organisations to account as there is no evidence for it being used in this way. Further work should assess the practicality of designing medical rotas using this tool to minimise fatigue risk.

scholarly journals Outcomes after cardiac transplantation: a new tertiary centre experience

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
U Ali ◽  
W Pavey ◽  
K Slimani ◽  
C Merry ◽  
R Larbalestier
Keyword(s):  
Renal Failure ◽  
Acute Rejection ◽  
Cardiac Transplantation ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Cardiac Transplant ◽  
Tertiary Centre ◽  
Increased Risk ◽  
The World ◽  
The Mean

Abstract Funding Acknowledgements Type of funding sources: None. Background  Our hospital is one of the most remote transplant centres in the world. We evaluated the short- and long-term outcomes after cardiac transplantation at a new Tertiary Centre hospital in Western Australia. Methods A retrospective study of all patients undergoing cardiac transplantation since February 2015 until November 2020 was conducted. De-identified data was collected using hospital medical records and the ANZSCTS database. Primary outcome measure was mortality at any time point and acute rejection. Secondary outcome measures included new renal failure, post-operative blood product use and readmission rate. Results A total of 59 cardiac transplantations were conducted, with the mean age of recipients being 52 (±15) years and the majority being male (64.4%). Ischaemic cardiomyopathy and dilated cardiomyopathy were the most common indications for transplantation, accounting for 71.2% of all transplants. The mean age of donors was 35.29 (±11.11) years with the majority being male (69.5%). There were no mortalities and acute rejection within 3 months of transplant occurred in 16 (27.1%) patients. New renal failure was the most common complication occurring in 16 (27.1%) patients. After multivariate analysis, donor ischaemia time >200minutes was associated with an increased risk of renal failure (OR 1.2, P = 0.044). Conclusions Over a five-year period at a new cardiac transplant centre in one of the most remote locations of the world, we report no mortalities.

scholarly journals TP8.2.20 Gongs galore: phaleristic study of the relative risk of a healing art related new-year honour

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Katie Mellor ◽  
Arfon GMT Powell ◽  
Osian P James ◽  
David B Robinson ◽  
Richard J Egan ◽  
...  
Keyword(s):  
Public Health ◽  
Relative Risk ◽  
Absolute Risk ◽  
Geographical Location ◽  
General Medicine ◽  
Medical Specialty ◽  
Proportional Representation ◽  
System Bias ◽  
The Uk ◽  
To Receive

Abstract Aims To compare proportional representation of healthcare specialty workers, in receipt of New Year honours (NYHs) and examine system bias. Methods Observational study of recipients of NYHs from 2010 to 2019 within the UK honours system including comparative analysis of proportional representation of the UK medical workforce Absolute risk of receiving a NYH, related to medical specialty, gender, and geographical region. Relative Risk (RR) of receiving an NYH for services to healthcare related to specialty. Results 11 207 NYHs were bestowed, with 368 (3.3%) awarded to healthcare professionals: 212 (57.6%) women, 156 (42.4%) men. The RR of a healthcare professional receiving a NYH was 0.76 (95% CI 0.68 to 0.84, p < 0.001) when compared with the remaining UK workforce. Doctors received most NYHs (n = 181), with Public Health, Clinical Oncology, and General Medicine specialties most likely to be rewarded (RR 20.35 (CI 9.61 to 43.08, p < 0.001), 8.43 (CI 2.70 to 26.30, p < 0.001) and 8.22 (CI 6.22 to 10.86, p < 0.001)) respectively; Anaesthetists received fewest NYHs (RR 0.52 (0.13 to 2.10), p = 0.305). Men were more likely to receive NYHs than women (OR 0.44, 95%CI 0.36 to 0.54; p < 0.001). Two hundred and fifty-four NYHs (69.0%) were bestowed on residents of England (60, 16.3% London), 49 (13.3%) Scotland (p = 0.003), 39 (10.6%) Wales (p < 0.001), and 26 (7.1%) Northern-Ireland (p < 0.001). Conclusions Relative risk of receiving a NYH varied over 150-fold by specialty, two-fold by gender, and three-fold by geographical location. Public Health Physicians are perceived to be the pick of the parade.

Gongs galore: phaleristic study of the relative risk of a healing art related New Year Honour

2021 ◽  
pp. postgradmedj-2020-139368
Author(s):  
Katie Mellor ◽  
Arfon GMT Powell ◽  
Osian P James ◽  
David B Robinson ◽  
Luke Hopkins ◽  
...  
Keyword(s):  
Public Health ◽  
Relative Risk ◽  
Absolute Risk ◽  
Geographical Location ◽  
General Medicine ◽  
Medical Specialty ◽  
Proportional Representation ◽  
System Bias ◽  
The Uk ◽  
To Receive

ObjectivesTo compare proportional representation of healthcare specialty workers, in receipt of New Year Honours (NYHs) and examine system bias.DesignObservational study of UK honours system including comparative analysis of proportional representation of the UK medical workforce.ParticipantsRecipients of NYHs from 2010 to 2019.Main outcome measuresAbsolute risk of receiving an NYH, related to medical specialty, gender and geographical region. Relative risk (RR) of receiving an NYH for services to healthcare related to specialty.Results11 207 NYHs were bestowed, with 368 (3.3%) awarded to healthcare professionals: 212 (57.6%) women, 156 (42.4%) men. The RR of a healthcare professional receiving an NYH was 0.76 (95% CI 0.68 to 0.84, p<0.001) when compared with the remaining UK workforce. Doctors received most NYHs (n=181), with public health, clinical oncology and general medicine specialties most likely to be rewarded (RR 20.35 (95% CI 9.61 to 43.08, p<0.001), 8.43 (95% CI 2.70 to 26.30, p<0.001) and 8.22 (95% CI 6.22 to 10.86, p<0.001)), respectively; anaesthetists received fewest NYHs (RR 0.52 (95% CI 0.13 to 2.10), p=0.305). Men were more likely to receive NYHs than women (OR 0.44, 95% CI 0.36 to 0.54; p<0.001). Two hundred and fifty-four NYHs (69.0%) were bestowed on residents of England (60, 16.3% London), 49 (13.3%) Scotland (p=0.003), 39 (10.6%) Wales (p<0.001) and 26 (7.1%) Northern-Ireland (p<0.001).ConclusionsRelative risk of receiving an NYH varied over 150-fold by specialty, twofold by gender and threefold by geographical location. Public health physicians are perceived to be the pick of the parade.

Policy interventions in health and safety: What works and when--Evidence from the UK

2013 ◽  
Author(s):  
David Hollis ◽  
Stavroula Leka ◽  
Aditya Jain ◽  
Nicholas J. A. Andreou ◽  
Gerard Zwetsloot
Keyword(s):  
Health And Safety ◽  
Policy Interventions ◽  
What Works ◽  
The Uk

Association between Dietary Inflammatory Index and kidney stones in US adults: Data from the NHANES 2007-2016

2021 ◽  
pp. 1-27
Author(s):  
Chichen Zhang ◽  
Shi Qiu ◽  
Haiyang Bian ◽  
Bowen Tian ◽  
Haoyuan Wang ◽  
...  
Keyword(s):  
National Health ◽  
Kidney Stones ◽  
Primary Outcome ◽  
Secondary Outcome ◽  
Nutrition Examination Survey ◽  
Dietary Inflammatory Index ◽  
Inflammatory Index ◽  
Health And Nutrition ◽  
Multivariate Adjustment ◽  
Increased Risk

Abstract Objective: We evaluate the association between the Dietary Inflammatory Index (DII) and kidney stones. Design: We performed a cross-sectional analysis using data from National Health and Nutrition Examination Survey. Dietary intake information was assessed using first 24-HR dietary recall interviews, and the Kidney Conditions was presented by questionnaire. The primary outcome was to investigate the association between DII and incidence of kidney stones, and the secondary outcome was to assess the association between DII and nephrolithiasis recurrence. Setting: The National Health and Nutrition Examination Survey (NHANES), 2007-2016. Participants: The study included 25984 NHANES participants, whose data on DII and kidney stones were available, of whom 2439 reported a history of kidney stones. Results: For the primary outcome, after fully multivariate adjustment, DII score is positively associated with the risk of kidney stones (OR = 1.07; 95% CI: [1.04–1.10]). Then, compared Q4 with Q1, a significant 38% increased likelihood of nephrolithiasis was observed. (OR=1.38; 95% CI: [1.19–1.60]). For the secondary outcome, the multivariate regression analysis showed that DII score is positively correlated with nephrolithiasis recurrence (OR=1.07; 95% CI: [1.00–1.15]). The results noted that higher DII scores (Q3 and Q4) are positively associated with a significant 48% and 61% increased risk of nephrolithiasis recurrence compared with the reference after fully multivariate adjustment. (OR=1.48; 95% CI: [1.07–2.05]; OR=1.61; 95% CI: [1.12–2.31]). Conclusions: Our findings revealed that increased intake of pro-inflammatory diet, as a higher DII score, is correlated with increased odds of kidney stones incidence and recurrence.

scholarly journals Reaffirming health and safety precautionary principles for COVID-19 in the UK

The Lancet ◽  
2021 ◽  
Vol 397 (10271) ◽  
pp. 274
Author(s):  
Raymond M Agius ◽  
Denise Kendrick ◽  
Herb F Sewell ◽  
Marcia Stewart ◽  
John FR Robertson
Keyword(s):  
Health And Safety ◽  
The Uk

scholarly journals Impact of COVID-19 pandemic social restriction measures on people with rheumatic and musculoskeletal diseases in the UK: a mixed-methods study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e048772
Author(s):  
Toby O Smith ◽  
Pippa Belderson ◽  
Jack R Dainty ◽  
Linda Birt ◽  
Karen Durrant ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Qualitative Study ◽  
Online Survey ◽  
Musculoskeletal Diseases ◽  
Community Dwelling ◽  
Secondary Outcome ◽  
Healthcare Provision ◽  
Social Restriction ◽  
The Uk ◽  
The Impact

ObjectivesTo determine the impact of COVID-19 pandemic social restriction measures on people with rheumatic and musculoskeletal diseases (RMDs) and to explore how people adapted to these measures over time.DesignMixed-methods investigation comprising a national online longitudinal survey and embedded qualitative study.SettingUK online survey and interviews with community-dwelling individuals in the East of England.ParticipantsPeople in the UK with RMDs were invited to participate in an online survey. A subsection of respondents were invited to participate in the embedded qualitative study.Primary and secondary outcome measuresThe online survey, completed fortnightly over 10 weeks from April 2020 to August 2020, investigated changes in symptoms, social isolation and loneliness, resilience and optimism. Qualitative interviews were undertaken assessing participant’s perspectives on changes in symptoms, exercising, managing instrumental tasks such a shopping, medication and treatment regimens and how they experienced changes in their social networks.Results703 people with RMDs completed the online survey. These people frequently reported a deterioration in symptoms as a result of COVID-19 pandemic social restrictions (52% reported increase vs 6% reported a decrease). This was significantly worse for those aged 18–60 years compared with older participants (p=0.017). The qualitative findings from 26 individuals with RMDs suggest that the greatest change in daily life was experienced by those in employment. Although some retired people reported reduced opportunity for exercise outside their homes, they did not face the many competing demands experienced by employed people and people with children at home.ConclusionsPeople with RMDs reported a deterioration in symptoms when COVID-19 pandemic social restriction measures were enforced. This was worse for working-aged people. Consideration of this at-risk group, specifically for the promotion of physical activity, changing home-working practices and awareness of healthcare provision is important, as social restrictions continue in the UK.

scholarly journals Socioeconomic Inequalities and Ethnicity Are Associated with a Positive COVID-19 Test among Cancer Patients in the UK Biobank Cohort

Cancers ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1514
Author(s):  
Shing Fung Lee ◽  
Maja Nikšić ◽  
Bernard Rachet ◽  
Maria-Jose Sanchez ◽  
Miguel Angel Luque-Fernandez
Keyword(s):  
Cancer Patients ◽  
Socioeconomic Inequalities ◽  
Uk Biobank ◽  
Incident Cancer ◽  
Increased Risk ◽  
Exposure Variable ◽  
Independent Risk Factors ◽  
The Uk ◽  
Deprived Areas

We explored the role of socioeconomic inequalities in COVID-19 incidence among cancer patients during the first wave of the pandemic. We conducted a case-control study within the UK Biobank cohort linked to the COVID-19 tests results available from 16 March 2020 until 23 August 2020. The main exposure variable was socioeconomic status, assessed using the Townsend Deprivation Index. Among 18,917 participants with an incident malignancy in the UK Biobank cohort, 89 tested positive for COVID-19. The overall COVID-19 incidence was 4.7 cases per 1000 incident cancer patients (95%CI 3.8–5.8). Compared with the least deprived cancer patients, those living in the most deprived areas had an almost three times higher risk of testing positive (RR 2.6, 95%CI 1.1–5.8). Other independent risk factors were ethnic minority background, obesity, unemployment, smoking, and being diagnosed with a haematological cancer for less than five years. A consistent pattern of socioeconomic inequalities in COVID-19 among incident cancer patients in the UK highlights the need to prioritise the cancer patients living in the most deprived areas in vaccination planning. This socio-demographic profiling of vulnerable cancer patients at increased risk of infection can inform prevention strategies and policy improvements for the coming pandemic waves.

scholarly journals SARS-CoV-2 infection in acute pancreatitis increases disease severity and 30-day mortality: COVID PAN collaborative study

Gut ◽  
2021 ◽  
pp. gutjnl-2020-323364
Author(s):  
Sanjay Pandanaboyana ◽  
John Moir ◽  
John S Leeds ◽  
Kofi Oppong ◽  
Aditya Kanwar ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Hospital Stay ◽  
Organ Failure ◽  
Collaborative Study ◽  
Length Of Hospital Stay ◽  
Secondary Outcome ◽  
Icu Admission ◽  
Local Complications ◽  
Persistent Organ Failure ◽  
Increased Risk

ObjectiveThere is emerging evidence that the pancreas may be a target organ of SARS-CoV-2 infection. This aim of this study was to investigate the outcome of patients with acute pancreatitis (AP) and coexistent SARS-CoV-2 infection.DesignA prospective international multicentre cohort study including consecutive patients admitted with AP during the current pandemic was undertaken. Primary outcome measure was severity of AP. Secondary outcome measures were aetiology of AP, intensive care unit (ICU) admission, length of hospital stay, local complications, acute respiratory distress syndrome (ARDS), persistent organ failure and 30-day mortality. Multilevel logistic regression was used to compare the two groups.Results1777 patients with AP were included during the study period from 1 March to 23 July 2020. 149 patients (8.3%) had concomitant SARS-CoV-2 infection. Overall, SARS-CoV-2-positive patients were older male patients and more likely to develop severe AP and ARDS (p<0.001). Unadjusted analysis showed that SARS-CoV-2-positive patients with AP were more likely to require ICU admission (OR 5.21, p<0.001), local complications (OR 2.91, p<0.001), persistent organ failure (OR 7.32, p<0.001), prolonged hospital stay (OR 1.89, p<0.001) and a higher 30-day mortality (OR 6.56, p<0.001). Adjusted analysis showed length of stay (OR 1.32, p<0.001), persistent organ failure (OR 2.77, p<0.003) and 30-day mortality (OR 2.41, p<0.04) were significantly higher in SARS-CoV-2 co-infection.ConclusionPatients with AP and coexistent SARS-CoV-2 infection are at increased risk of severe AP, worse clinical outcomes, prolonged length of hospital stay and high 30-day mortality.

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