scholarly journals 8 General surgical foundation doctor optimisation of daily practice

2019 ◽  
Vol 95 (1130) ◽  
pp. 687.1-687
Author(s):  
Emmanuel Feldano ◽  
Ben Ramasubbu
Keyword(s):  
Structural Changes ◽  
Working Hours ◽  
Daily Practice ◽  
Task Completion ◽  
Junior Doctors ◽  
Daily Routine ◽  
European Working ◽  
Significant Difference ◽  
Working Day ◽  
And Performance

IntroductionTraditionally the role of a surgical foundation year 1 (FY1s) doctors consisted of long working hours, multiple on call shifts and little to rest however, the introduction of European working time directive now means that FY1s are constricted to 48 hours per week on average and various other regulations that junior doctors should abide by yet the same quantity of daily tasks remains the same. In this study we looked at the difficulties FY1s now face in their daily working day and if some of these issues could be resolved by implementing some structural changes.MethodsThe study was conducted in three cycles, each lasting five days (Monday to Friday). Cycle 1 included shadowing of Surgical FY1s on wards for five consecutive days observing daily routine (arrival, lunch and departure time), task completion, communication and handovers. Following this multiple interventions were made to the structure of their daily practice to improve productivity and performance. These improvements were measured in cycle 2 (as the new model was scaffolded into place) and cycle 3 (strictly observed).ResultsIn cycle 1 we observed that 100% of F1s arrived to work on time, there was no set times for lunch and all of the FY1s lunches were interrupted. There was no structure for handovers and 100% of F1s stayed at work beyond there contracted hours. In second cycle, 100% of F1s had lunch between the hours of 12pm-1PM on 3/5 days and 75% on the remaining two days. 75% of F1s had uninterrupted lunches on all 5 days. Morning and afternoon handovers were completed every day. In cycle 3 the results remained as high. There was no significant difference in number of tasks between week 1, 2 and 3.ConclusionThrough the implementation of daily structure and other interventions involving the multidisciplinary team we improved the quality of F1s working day and increased the efficiency of service delivered on the surgical ward.

General surgical foundation doctor: optimisation of daily practice

2020 ◽  
Vol 96 (1136) ◽  
pp. 339-342
Author(s):  
Emmanuel Feldano ◽  
Michael Clark ◽  
Benjamin Ramasubbu
Keyword(s):  
Structural Changes ◽  
Positive Impact ◽  
Daily Practice ◽  
Daily Routine ◽  
Improvement Project ◽  
Surgical Ward ◽  
Significant Difference ◽  
Working Day ◽  
And Performance

IntroductionThe role of a foundation year 1 (FY1) doctor has evolved over the years. Many doctors report significant anxiety and stress during this period. In this Quality Improvement Project, we looked at the difficulties FY1s face in their working day and if these issues could be resolved by implementing some structural changes.MethodsThe project was conducted in three cycles, each lasting 5 days (Monday to Friday), over three consecutive weeks. Week 1 consisted of shadowing of Surgical FY1s on wards observing daily routine (arrival, lunch and departure time), communication and handovers. Following this a number of interventions were made to the structure of their daily practice to improve productivity and performance. These improvements were measured in week 2 (as the new model was scaffolded into place) and week 3 (strictly observed).ResultsThere was no significant difference in number of tasks between week 1, 2 and 3. In week 1, there was no set times for lunch, all of the FY1s lunches were interrupted, there was no structure for handovers and 100% of FY1s stayed at work beyond there contracted hours. In week 2 and 3 there was significant improvement in the number of uninterrupted lunches, amount of time spent beyond contracted hours, number and quality of handovers. The qualitative results collected also suggested positive impact on the working lives of those involved.ConclusionThe implementation of structural changes improved the quality of FY1s working day and increased the efficiency of service delivered on the surgical ward.

scholarly journals AB1088 NAIL PSORIASIS: THE UNDERESTIMATED DISORDER IN PSORIASIS AND PSORIASIS ARTHRITIS. CAN ULTRASOUND AND CAPILLARY MICROSCOPY IN PATIENTS WITH NAIL PSORIASIS SPEED UP OUR DIAGNOSIS AND THERAPY?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1833.2-1833
Author(s):  
B. C. Detlef ◽  
S. El-Nawab-Becker ◽  
M. Toellner ◽  
A. Kleinheinz ◽  
T. Witte
Keyword(s):  
Psoriasis Vulgaris ◽  
Extensor Tendon ◽  
Daily Practice ◽  
Daily Routine ◽  
Nail Psoriasis ◽  
Capillary Microscopy ◽  
Nail Matrix ◽  
Significant Difference ◽  
The Us ◽  
Nail Involvement

Background:Nail psoriasis is an extreme diagnostic and therapeutic challenge and represents an enormous physical and psychological burden for affected patients.50% of patients with psoriasis vulgaris develop nail involvement (NailPso)during the course of their disease. NailPso is the strongest predictor of psoriatic arthritis (PsA). Through the synovio-enthesial concept we have learned that there is an anatomical-pathophysiological relationship between DIP joint, extensor tendon and nail matrix. We have observed in daily practice that hypervascularization (HV) in ultrasound Power Doppler (US-PD)the nail matrix may be a pathognomonic element in its own right. There are no data on this in the literature.Objectives:Is there a difference in the ultrasound PD examination of the DIP joint and nail area and in the capillary microscopy of the corresponding nail fold in patients with psoriasis vulgaris and nail psoriasis versus patients with psoriasis vulgaris without nail psoriasis.Methods:Monocentric prospective study of all consecutive patients with psoriasis vulgaris who have come to a rheumatic practice to clarify a PsA. Inaddition to demographic data, assessments (PASI,DLQI,CASPAR,GEPARD, DAS28, SJ,TJ,FFBH), clinical examination, a standardized ultrasound PD examination and capillary microscopy of the affected fingertips in PsO patients suffering from nail psoriasis was performed as well as corresponding examinations of the 2nd and 3rd finger right in PsO patients without nail involvement.Results:79 patients could be included during the study period. Thereof 25 PsO patients without nail involvement and 44 PsO patients with nail involvement. Since the patients were examined consecutively, the difference results. There was no difference in age, BMI and sex in both groups (Pso and NailPso). The Caspar criteria as classification criteria for a PsA were positive in 65% of the NailPso patients and positive in 50% of all PsO patients without nail infestation. Hypervascularization in the US-PD examination in the area of the nail matrix could be seen significantly more frequently in NailPso compared to non-NagelPso patients. Such a difference did not exist in the HV of the extensor tendons.Capillary microscopy showed a significant difference in the number of torsions/twist capillaries in NailPso compared to Pso patients without NailPso.Hypervascularization of the nail matrix is seen significantly more frequently in patients with psoriasis of the nail than in patients without psoriasis of the nail. Such a difference does not exist in DIP joint -extensor tendon- enthesitis. At the same time, torsions are significantly more frequently seen in capillary microscopy in NailPso than in patients without NailPso.Conclusion:The US-PD examination is a simple and non-invasive procedure which can be performed routinely in daily practice. The hypervascularization of the nail matrix should also make one think of nail psoriasis in the early stage of PsO, in order to be able to start early an appropriate therapy for this very stigmatizing and therapeutically extremely difficult manifestation of PsO. It seems to occur independently of extensor tendon synovitis as an independent manifestation phenomenon.The occurrence of torsions in capillary microscopy >50 % also seems to be groundbreaking for a NagelPso, whereby capillary microscopy is a temporal challenge in daily routine.References:§ The present study (7734-BO-S2018 Ethics Commission of the MHH, Medical School Hannover, Germany) contains parts of the PhD thesis of M.TöllnerDisclosure of Interests:Becker-Capeller Detlef Grant/research support from: Novartis, Speakers bureau: Pfizer, Soham El-Nawab-Becker: None declared, Malo Toellner: None declared, Andreas Kleinheinz: None declared, Torsten Witte: None declared

Factors relating to working hours restriction that have impacted the professional identity of trainees in the last decade

2021 ◽  
Vol 82 (3) ◽  
pp. 1-10
Author(s):  
Soumya Mukherjee ◽  
James Meacock ◽  
Eleanor Kissane ◽  
Debasish Pal
Keyword(s):  
Identity Development ◽  
Professional Identity ◽  
Medical Training ◽  
Working Hours ◽  
Junior Doctors ◽  
Clinical Experiences ◽  
Postgraduate Medical Training ◽  
European Working ◽  
Working Time Directive ◽  
The Impact

Ever-developing changes to the working hours of junior doctors by the European Working Time Directive, the junior doctor contract of 2019 and most recently the COVID-19 pandemic have impacted the professional identity of doctors. There has been little investigation into its influence on the multifaceted aspects of postgraduate medical training, which feeds into how trainees consider themselves professionally and the concept of professional identity or ‘being a doctor’. A review of the medical, socio-political and educational literature reveals that the impact on the professional identity development of trainees is influenced by several perspectives from the trainee, trainer and the public. Gross reduction in working hours has no doubt decreased the raw volume of clinical experiences. However, to counteract this, smarter learning processes have evolved, including narrative reflection, supervised learning events, and a greater awareness of coaching and training among trainers.

scholarly journals Near-misses and Missed Opportunities: Poor Patient Handover In General Surgery

2008 ◽  
Vol 90 (3) ◽  
pp. 96-98 ◽  
Author(s):  
M Tokode ◽  
L Barthelmes ◽  
B O'Riordan
Keyword(s):  
General Surgery ◽  
Working Hours ◽  
Junior Doctors ◽  
Learning Potential ◽  
Missed Opportunities ◽  
Near Misses ◽  
Medical Careers ◽  
European Working ◽  
Working Time Directive ◽  
Patient Handover

Since the introduction of shift systems for junior doctors as part of the European Working Time Directive, different teams of doctors look after patients over the course of a day. This requires ro bust handover mechanisms to pass on inf ormation between differ ent teams of doctors to avoid misses and near-misses in patients' care. Modernising Medical Careers shortens the placements of doctors in foundation programmes in general surgery to four months compared with six-month placements as pre-registration house officers in the past. The reduction in working hours will therefore adv ersely aff ect exposur e and experience of junior doctors in general surg ery unless the learning potential of time spent at work is maximised.

Are patients happy with SCPs operating?

2006 ◽  
Vol 88 (3) ◽  
pp. 101-103 ◽  
Author(s):  
R Moorthy ◽  
J Grainger ◽  
A Scott ◽  
JW Powles ◽  
SG Lattis
Keyword(s):  
New Deal ◽  
Junior Doctors ◽  
Process Of Change ◽  
Out Of Hours ◽  
European Working ◽  
Shift Pattern ◽  
Full Shift ◽  
Working Day ◽  
Working Time Directive ◽  
The New Deal

The traditional model of surgical service is in the process of change. Classically, a consultant surgeon would have the services of an SpR, staff and associate specialist (SAS) and SHO in clinic and theatre. The implementation of the New Deal and the European Working Time Directive has led to a significant reduction in the number of hours worked by junior doctors. Consequently, nearly all SHOs are working a full-shift pattern and most SpRs are moving onto full-shift rotas to ensure out-of-hours service is maintained. This reduction in the number of junior doctors available during the normal working day has increased the development of extended roles for non-medical professionals.

Quinsy trainer

2007 ◽  
Vol 121 (12) ◽  
pp. 1194-1196 ◽  
Author(s):  
J Murphy ◽  
J T Murphy ◽  
A Sama
Keyword(s):  
Low Cost ◽  
Working Hours ◽  
Peritonsillar Abscess ◽  
Junior Doctors ◽  
The European Union ◽  
Simple Method ◽  
The United Kingdom ◽  
Medical Careers ◽  
European Working ◽  
Working Time Directive

AbstractThe implementation of the European Working Time Directive, from the Council of the European Union (93/104/EC), in August 2004 has provoked a change in the working hours of junior doctors in the United Kingdom. With the evolution of the subsequent cross-cover arrangements combined with the modernising of medical careers, training is becoming increasingly important. Here we present a simple method of teaching junior doctors the skills and competencies required to aspirate a peritonsillar abscess or ‘quinsy’. The model is easy to construct, low cost and reusable.

scholarly journals Perceived impact of EWTD on UK doctors

2009 ◽  
Vol 91 (4) ◽  
pp. 132-134 ◽  
Author(s):  
Ryckie G Wade ◽  
James Henderson
Keyword(s):  
Patient Care ◽  
Working Hours ◽  
Working Time ◽  
European Working Time Directive ◽  
Junior Doctors ◽  
European Working ◽  
Perceived Impact ◽  
Working Time Directive ◽  
A Current

Doctors have historically worked long hours to provide patient care but also to gain experience. Over the last decade, working hours have decreased significantly, and the introduction of the European Working Time Directive (EWTD) has formalised this. In August 2009, junior doctors (but not consultants) will be limited to a 48-hour working week (see http://www.dh.gov.uk/en/Managingyourorganisation/Huma nresourcesandtraining/Modernisingworkforceplanninghome/Europeanworkingtimedirective/index.htm). There are concerns at all levels of the profession that doctors will not be adequately trained to function at the standard of a current NHS consultant. Doctors with the least experience make the most errors and familiarity with situations and equipment is directly related to competency.

scholarly journals Weekly working hours for Norwegian hospital doctors since 1994 with special attention to postgraduate training, work–home balance and the European Working Time Directive: a panel study

BMJ Open ◽  
2014 ◽  
Vol 4 (10) ◽  
pp. e005704 ◽  
Author(s):  
Judith Rosta ◽  
Olaf G Aasland
Keyword(s):  
Cultural Values ◽  
Postgraduate Training ◽  
Panel Study ◽  
Working Hours ◽  
Working Time ◽  
European Working Time Directive ◽  
Junior Doctors ◽  
European Working ◽  
Hospital Doctors ◽  
Working Time Directive

ObjectivesTo examine the weekly working hours of Norwegian hospital doctors from 1994 to 2012 with special emphasis on the quality of postgraduate training and work–home balance, and in relation to the requirements of the European Working Time Directive (EWTD).DesignPanel study based on postal questionnaires.SettingNorway.ParticipantsUnbalanced cohort of 1300–1600 doctors in 1994, 1995, 1996, 1997, 2000, 2002, 2004, 2006, 2008, 2010 and 2012.Outcome measuresSelf-reported total weekly working hours and whether 45 weekly working hours are too short, sufficient, or too long to meet the quality requirements of obligatory postgraduate training for junior doctors.ResultsFrom 1994 to 2012, the number of weekly working hours was stable for senior (46–47 h) and junior (45–46 h) hospital doctors. In 2012, significantly more senior (27–35%) than junior (11–20%) doctors reported suboptimal work–home balance, defined as working more than 48 h a week. The majority perceived the present situation with an average of 45 h per week for juniors as sufficient for obligatory postgraduate specialist training, but doctors of higher age (OR 1.04, 95% CI 1.01 to 1.08), senior doctors (1.07, 1.04 to 1.11) and doctors working in surgical specialties (OR 1 vs laboratory medicine 0.03, 0.01 to 0.25, internal medicine 0.31, 0.17 to 0.58, psychiatry 0.12, 0.04 to 0.36, paediatrics 0.36, 0.12 to 1.07, anaesthesiology 0.08, 0.02 to 0.39, gynaecology 0.07, 0.01 to 0.56 and others 0.39, 0.04 to 3.56) were more likely to want the work-week to be longer.ConclusionsThe weekly working hours of Norwegian hospital doctors were always below the EWTD requirements. A significant growth of hospital doctor density over the past two decades, national regulations and cultural values might be important factors. Specialty differences in perception of sufficient training time may call for more flexibility in working time regulations.

Implementation and application of moving average as continuous analytical quality control instrument demonstrated for 24 routine chemistry assays

2017 ◽  
Vol 55 (8) ◽  
pp. 1142-1151 ◽  
Author(s):  
Huub H. van Rossum ◽  
Hans Kemperman
Keyword(s):  
Quality Control ◽  
Moving Average ◽  
Working Hours ◽  
Daily Practice ◽  
Analytical Quality Control ◽  
Analytical Quality ◽  
Simple Method ◽  
Control Instrument ◽  
Significant Difference ◽  
Bias Detection

Abstract Background: General application of a moving average (MA) as continuous analytical quality control (QC) for routine chemistry assays has failed due to lack of a simple method that allows optimization of MAs. A new method was applied to optimize the MA for routine chemistry and was evaluated in daily practice as continuous analytical QC instrument. Methods: MA procedures were optimized using an MA bias detection simulation procedure. Optimization was graphically supported by bias detection curves. Next, all optimal MA procedures that contributed to the quality assurance were run for 100 consecutive days and MA alarms generated during working hours were investigated. Results: Optimized MA procedures were applied for 24 chemistry assays. During this evaluation, 303,871 MA values and 76 MA alarms were generated. Of all alarms, 54 (71%) were generated during office hours. Of these, 41 were further investigated and were caused by ion selective electrode (ISE) failure (1), calibration failure not detected by QC due to improper QC settings (1), possible bias (significant difference with the other analyzer) (10), non-human materials analyzed (2), extreme result(s) of a single patient (2), pre-analytical error (1), no cause identified (20), and no conclusion possible (4). Conclusions: MA was implemented in daily practice as a continuous QC instrument for 24 routine chemistry assays. In our setup when an MA alarm required follow-up, a manageable number of MA alarms was generated that resulted in valuable MA alarms. For the management of MA alarms, several applications/requirements in the MA management software will simplify the use of MA procedures.

scholarly journals Inflammatory Cytokines and Sarcopenia in Iranian Adults-results from SARIR Study

2021 ◽  
Author(s):  
Farzaneh Asoudeh ◽  
Fatemeh Dashti ◽  
Shima Raeesi ◽  
Ramin Heshmat ◽  
Mohammad Bidkhori ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Inflammatory Cytokines ◽  
High Sensitivity ◽  
Inflammatory Biomarkers ◽  
P Value ◽  
Cluster Sampling ◽  
European Working ◽  
Significant Difference ◽  
Hs Crp ◽  
And Performance

Abstract Background Some studies emphasize the effects of inflammatory cytokines in reducing muscle mass and muscle strength and performance. This study aimed to compare pro-inflammatory cytokines in sarcopenic and non-sarcopenic subjects. Method The present study used data from the "Sarcopenia and its Determinants Among Iranian Elders" (SARIR) study. Three hundred men and women aged ≥ 55 years old who lived in the 6th district of Tehran were selected using random cluster sampling. We measured all components by using standard protocols, in addition we defined sarcopenia based on former and new European Working Group on Sarcopenia in Older People (EWGSOP) guidelines. A fasting blood sample was taken from each participant to measure serum high-sensitivity C-reactive protein (hs- CRP), Interleukin 6 (IL-6), and tumor necrosis factor α (TNFα). Results Mean age and body mass index (BMI) of study participants were 66.7 ± 7.7 years and 27.3 ± 4.2 kg/m2, respectively. Thirty-one participants of the present study had the criteria of EWGSOP2-sarcopenia. A statistically significant difference was seen between normal and abnormal groups of muscle strength in hs-CRP (p-value =0.04). Furthermore, we did not observe a remarkable association between inflammatory biomarkers including IL-6, TNF-α and hs-CRP and risk of sarcopenia even after controlling for plausible confounders (OR: 1.15; 95% CI 0.31-4.28, OR 0.68; 95% CI 0.17-2.77 and OR 2.39; 95% CI 0.87-6.55). Conclusion We found that inflammatory biomarkers level was not considerably associated with odds of sarcopenia. Lack of correlation between inflammatory cytokines and sarcopenia could be due to participant’s age and genetic. Future studies are required to confirm these findings.

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