Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Rest requirements for residents unlikely to improve outcomes in 2 common surgeries

26.07.2010
LA BioMed research provides guidance for medical training requirements

As the Accreditation Council for Graduate Medical Education seeks to improve patient care by further limiting the hours worked by medical residents, the Journal of Surgical Research will published a new study online on Monday reporting that outcomes in two common surgeries – appendectomy and laparoscopic cholecystectomy – were similar among residents who had worked less than 16 hours and those who had worked more than 16 hours.

The research team, led by investigators at Los Angeles Biomedical Research Institute (LA BioMed), concluded that requiring a five-hour rest period at night for surgical residents after 16 hours of work is "unlikely to improve the outcomes for these commonly performed operations."

The researchers reviewed 2,908 laparoscopic cholecystectomies, in which the gall bladder is surgically removed through a small incision in the abdomen, and 1,726 appendectomies to remove patients' appendixes that were performed at Harbor-UCLA Medical Center from July 2003 to March 2009. These are the two most common operations performed by residents, and the two surgical procedures are often performed at night when residents are more likely to have worked a long shift.

The researchers compared outcomes in these two operations when they were performed during the day by surgical residents who had worked less than 16 hours and at night by surgical residents who had worked 16 or more hours. The researchers concluded that "appendectomy and cholecystectomy operations performed at night by less rested and possibly sleep-deprived residents have similar good outcomes compared with those performed during the regular work day."

"In terms of the two most commonly performed operations by surgical trainees, the study suggests that limiting resident shifts to 16 hours of work is unlikely to improve surgical outcomes," said corresponding author Christian de Virgilio, MD, a LA BioMed principal investigator. "Training surgeons takes more time than many other medical disciplines because the residents must learn the craft of surgery along with patient care. By reducing the hours per day available for surgical training, residents would miss out on critical aspects of a patient's care. It will also further increase the costs and length of time to train surgeons. It currently takes 10-15 years after graduating from college to competently train surgeons."

The Accreditation Council for Graduate Medical Education is a private, non-profit council that evaluates and accredits more than 8,800 residency programs in 130 specialties and subspecialties in the United States, affecting more than 110,000 residents. Its 16-member task force charged with reassessing resident training program standards recently proposed a set of draft standards for medical resident education that would reduce duty periods of first-year residents to no more than 16 hours per day and would seek more supervision of first-year residents.

As the residents progress through their training, the task force set no specific limits on hours worked per day but encouraged residents to avoid fatigue by napping or resting during their shifts. The task force recommended the maximum weekly hours of resident training stay the same as the current standard of 80 per week averaged over four weeks.

The study published by the Journal of Surgical Research said the proposed changes in residents' duty hours "have the potential to profoundly affect surgical residency training nationally." It pointed out that limited work hours in Europe have resulted in decreased patient interaction, participation in 30% fewer operations per year, decreased ability to learn from more senior professionals, decreased ability to follow patients through their full clinical course and decreased participation in structured training.

"The accrediting agency should closely examine the data to determine if reducing surgical residents' work hours improves outcomes for surgical patients, and it should carefully consider the effect any reduction in duty hours has on the training of surgeons before adopting any further reductions," said Dr. de Virgilio. "The agency may wish to adopt a different standard for surgical residents, who need more hours on duty to ensure they have adequate time to learn the craft of surgery and follow a patient's care from pre-operation to post-operation."

The task force's standards are open for comment at this time, with final approval set for September and implementation scheduled for July 2011.

About LA BioMed

Founded in 1952, LA BioMed is one of the country's leading nonprofit independent biomedical research institutes. It has more than 150 fulltime and part-time researchers conducting studies into improved treatments and cures for cancer, inherited diseases, infectious diseases, illnesses caused by environmental factors and more. It also educates young scientists and provides community services, including immunization and childhood nutrition programs. LA BioMed is academically affiliated with the David Geffen School of Medicine at UCLA and located on the campus of Harbor-UCLA Medical Center.

Laura Mecoy | EurekAlert!
Further information:
http://www.issuesmanagement.com
http://www.LABioMed.org

More articles from Studies and Analyses:

nachricht A sudden drop in outdoor temperature increases the risk of respiratory infections
11.01.2017 | University of Gothenburg

nachricht Urbanization to convert 300,000 km2 of prime croplands
27.12.2016 | Mercator Research Institute on Global Commons and Climate Change (MCC) gGmbH

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Interfacial Superconductivity: Magnetic and superconducting order revealed simultaneously

Researchers from the University of Hamburg in Germany, in collaboration with colleagues from the University of Aarhus in Denmark, have synthesized a new superconducting material by growing a few layers of an antiferromagnetic transition-metal chalcogenide on a bismuth-based topological insulator, both being non-superconducting materials.

While superconductivity and magnetism are generally believed to be mutually exclusive, surprisingly, in this new material, superconducting correlations...

Im Focus: Studying fundamental particles in materials

Laser-driving of semimetals allows creating novel quasiparticle states within condensed matter systems and switching between different states on ultrafast time scales

Studying properties of fundamental particles in condensed matter systems is a promising approach to quantum field theory. Quasiparticles offer the opportunity...

Im Focus: Designing Architecture with Solar Building Envelopes

Among the general public, solar thermal energy is currently associated with dark blue, rectangular collectors on building roofs. Technologies are needed for aesthetically high quality architecture which offer the architect more room for manoeuvre when it comes to low- and plus-energy buildings. With the “ArKol” project, researchers at Fraunhofer ISE together with partners are currently developing two façade collectors for solar thermal energy generation, which permit a high degree of design flexibility: a strip collector for opaque façade sections and a solar thermal blind for transparent sections. The current state of the two developments will be presented at the BAU 2017 trade fair.

As part of the “ArKol – development of architecturally highly integrated façade collectors with heat pipes” project, Fraunhofer ISE together with its partners...

Im Focus: How to inflate a hardened concrete shell with a weight of 80 t

At TU Wien, an alternative for resource intensive formwork for the construction of concrete domes was developed. It is now used in a test dome for the Austrian Federal Railways Infrastructure (ÖBB Infrastruktur).

Concrete shells are efficient structures, but not very resource efficient. The formwork for the construction of concrete domes alone requires a high amount of...

Im Focus: Bacterial Pac Man molecule snaps at sugar

Many pathogens use certain sugar compounds from their host to help conceal themselves against the immune system. Scientists at the University of Bonn have now, in cooperation with researchers at the University of York in the United Kingdom, analyzed the dynamics of a bacterial molecule that is involved in this process. They demonstrate that the protein grabs onto the sugar molecule with a Pac Man-like chewing motion and holds it until it can be used. Their results could help design therapeutics that could make the protein poorer at grabbing and holding and hence compromise the pathogen in the host. The study has now been published in “Biophysical Journal”.

The cells of the mouth, nose and intestinal mucosa produce large quantities of a chemical called sialic acid. Many bacteria possess a special transport system...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

12V, 48V, high-voltage – trends in E/E automotive architecture

10.01.2017 | Event News

2nd Conference on Non-Textual Information on 10 and 11 May 2017 in Hannover

09.01.2017 | Event News

Nothing will happen without batteries making it happen!

05.01.2017 | Event News

 
Latest News

Water - as the underlying driver of the Earth’s carbon cycle

17.01.2017 | Earth Sciences

Interfacial Superconductivity: Magnetic and superconducting order revealed simultaneously

17.01.2017 | Materials Sciences

Smart homes will “LISTEN” to your voice

17.01.2017 | Architecture and Construction

VideoLinks
B2B-VideoLinks
More VideoLinks >>>