No abstract

Long daytime and overnight shifts remain a major feature of working life for trainees in anaesthesia. Over the past 10 years, there has been an increase in awareness and understanding of the potential effects of fatigue on both the doctor and the patient. The Working Time Regulations (1998) implemented the European Working Time Directive into UK law, and in August 2009 it was applied to junior doctors, reducing the maximum hours worked from an average of 56 per week to 48. Despite this, there is evidence that problems with inadequate rest and fatigue persist. There is no official guidance regarding provision of a minimum standard of rest facilities for doctors in the National Health Service, and the way in which rest is achieved by trainee anaesthetists during their on-call shift depends on rota staffing and workload. We conducted a national survey to assess the incidence and effects of fatigue among the 3772 anaesthetists in training within the UK. We achieved a response rate of 59% (2231/3772 responses), with data from 100% of NHS trusts. Fatigue remains prevalent among junior anaesthetists, with reports that it has effects on physical health (73.6% [95%CI 71.8-75.5]), psychological wellbeing (71.2% [69.2-73.1]) and personal relationships (67.9% [65.9-70.0]). The most problematic factor remains night shift work, with many respondents commenting on the absence of breaks, inadequate rest facilities and 57.0% (55.0-59.1) stating they had experienced an accident or near-miss when travelling home from night shifts. We discuss potential explanations for the results, and present a plan to address the issues raised by this survey, aiming to change the culture around fatigue for the better.

Objective To examine the benefits of compassion practices on two indicators of patient perceptions of care quality—the Hospital Consumer Assessment of Healthcare Providers and systems (HCAHPS) overall hospital rating and likelihood of recommending. Study Setting Two hundred sixty‐nine nonfederal acute care U.S. hospitals. Study Design Cross‐sectional study. Data Collection Surveys collected from top‐level hospital executives. Publicly reported HCAHPS data from October 2012 release. Principal Findings Compassion practices, a measure of the extent to which a hospital rewards compassionate acts and compassionately supports its employees (e.g., compassionate employee awards, pastoral care for employees), is significantly and positively associated with hospital ratings and likelihood of recommending. Conclusions Our findings illustrate the benefits for patients of specific and actionable organizational practices that provide and reinforce compassion.

The purpose of this study was to examine the effects of social influence on responses to acute pain in women and men in a randomized experimental design. Sixty-eight undergraduates (32 women; 36 men) were randomly assigned to perform a cold pressor task either alone or in the presence of a same-sex friend. Expressions of pain were assessed with the short form of the McGill Pain Questionnaire. Overall social support was measured using the Krause social support assessment scale. The presence of a same-sex friend significantly increased pain reports in women, but not in men. Persons who reported high levels of social support on the Krause scale also reported greater cold pressor pain. Results suggest that the presence of a friend can increase pain report to an acute laboratory pain stimulus in women. These findings are consistent with models of social reinforcement in chronic pain syndromes.

There are many confounding factors in assessing the impact of outreach teams in hospitals. This study tentatively concludes that outreach teams may have a favourable impact on mortality rate amongst readmissions to critical care, but more data is needed from multicentre trials.