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O objetivo do presente trabalho foi analisar a percepção de securitários brasileiros em relação à compressão da semana de trabalho sob diferentes pontos de vista e correlacioná-la a variáveis sociodemográficas e de momento de carreira. Foi realizada uma pesquisa survey de abordagem mista com aplicação de questionários junto a 240 securitários. A partir de análises estatísticas, assim como análises temáticas, conclui-se que individualmente os participantes tiveram maior concordância sobre os efeitos positivos de uma jornada comprimida, sendo a intensidade do trabalho o principal obstáculo para sua adoção; e alguns gestores possuem uma visão cética sobre os efeitos na produtividade.

Abstract Introduction: Adverse safety outcomes are associated with extended-duration (≥ 24 hour) shifts worked by resident physicians. In 2011 the Accreditation Council for Graduate Medical Education (ACGME) implemented an 80-hour work week (averaged over 4 weeks) and a 16-hour limit on the number of consecutive hours that resident physicians may be scheduled to work in their first postgraduate year (PGY1). We sought to determine if long work weeks and shifts of 16 hours or greater was associated with adverse safety outcomes in PGY1 resident physicians. Methods: Graduating medical students who registered for the National Residency Matching Program were invited to participate in a nationwide survey. From July 2014 to May 2016, residents completed online monthly surveys reporting their work hours, shift lengths, near-crashes and percutaneous injuries. We used linear and generalized linear regression models to estimate the risk of adverse safety outcomes associated with work hours (≤80 and >80 hours/week) and number of shifts that were at least 16 hours (16h; none, 1–4, >4). Age, gender, and BMI were controlled as covariates. Results: 7,345 PGY1 residents completed 46,871 monthly surveys. Compared to those PGY1 residents working ≤80 hours per week with no 16-hour shifts, PGY1 residents working ≤ 80 hours with 1–4 16h shifts had an increased risk of near-crashes (adjusted odds ratio 1.45, 95% CI 1.29–1.61). Residents working ≤ 80 hours with >4 16h shifts had an increased risk of near crashes (1.72, 1.42–2.08). Residents working > 80 hours with 1–4 and > 4 16h shifts had an increased risk of near-crashes (1.89, 1.47–2.42; 2.50, 1.91–3.27) and percutaneous injuries (2.71, 1.79–4.10; 2.49, 1.61–3.86), respectively. Conclusion: PGY1 resident safety is negatively affected by shifts of 16 or more hours, as well as by working >80 hours per week. The ACGME’s current proposal to eliminate the 16-hour consecutive work limit for PGY1 residents could significantly increase the occurrence of adverse safety outcomes in this vulnerable population, and is inconsistent with the ACGME’s stated commitment to the well-being of residents. Support (If Any): National Institute for Occupational Safety and Health R01OH010300.

Abstract Introduction Little is known about the impact of specific rotations on medical residents’ sleep. The purpose of this analysis was to examine the difference in sleep duration and alertness among internal-medicine resident interns during intensive care unit (ICU) compared to general medicine (GM) rotations. Methods This is a secondary report of a randomized non-inferiority trial of 63 United States internal-medicine residency programs. Programs were assigned to either standard duty-hour (80h workweek/16h shifts) or flexible (80h workweek/no shift-length limit) policies. Interns were followed for 2 weeks during either a GM or ICU rotation. The primary outcome was sleep duration/24h (actigraphy). Secondary outcomes were sleepiness (Karolinska Sleepiness Scale [KSS]) and alertness (number of Brief Psychomotor Vigilance Test [PVT-B] lapses). Data were averaged across days (thirteen 24-hour periods). Linear mixed-effect models with random program intercept were used to determine the association between each outcome by rotation, controlling for age, sex, and policy followed. Results N=386 interns were included (mean age 27.9±2.1y, 194 (50.3%) males), with n=261 (67.6%) in GM, and n=125 (32.4%) in ICU. Average sleep duration was 7.00±0.08h and 6.84±0.10h for GM and ICU respectively (p=.09; 95%CI -0.02;0.33h). Percent of days with self-reports of excessive sleepiness were significantly more likely for ICU vs GM from 12am-6am (ICU: 20.2%; GM: 12.5%) and 6am-12pm (ICU: 20.5%; GM: 14.3%). GM had significantly more days with no excessive sleepiness (GM: 40.5%; ICU: 28.1%). Average KSS was 4.8±0.1 for both GM and ICU (p=.60; 95%CI -0.18;0.32). Average number of PVT-B lapses were 5.5±0.5 and 5.7±0.7 for GM and ICU respectively (p=.83; 95%CI -1.48;1.18 lapses). There were no significant differences in PVT-B response speed or false starts between rotations. Conclusion Interns in ICU may experience more excessive sleepiness compared to GM interns, especially in early morning hours. However, sleep duration and alertness were not significantly different between rotations. Support Funded by the National Heart, Lung, and Blood Institute and American Council for Graduate Medical Education

Systematic reviews (SRs) are time and resource intensive, requiring approximately 1 year from protocol registration to submission for publication. Our aim was to describe the process, facilitators, and barriers to completing the first 2-week full SR. We systematically reviewed evidence of the impact of increased fluid intake, on urinary tract infection (UTI) recurrence, in individuals at risk for UTIs. The review was conducted by experienced systematic reviewers with complementary skills (two researcher clinicians, an information specialist, and an epidemiologist), using Systematic Review Automation tools, and blocked off time for the duration of the project. The outcomes were time to complete the SR, time to complete individual SR tasks, facilitators and barriers to progress, and peer reviewer feedback on the SR manuscript. Times to completion were analyzed quantitatively (minutes and calendar days); facilitators and barriers were mapped onto the Theoretical Domains Framework; and peer reviewer feedback was analyzed quantitatively and narratively. The SR was completed in 61 person-hours (9 workdays; 12 calendar days); accepted version of the manuscript required 71 person-hours. Individual SR tasks ranged from 16 person-minutes (deduplication of search results) to 461 person-minutes (data extraction). The least time-consuming SR tasks were obtaining full-texts, searches, citation analysis, data synthesis, and deduplication. The most time-consuming tasks were data extraction, write-up, abstract screening, full-text screening, and risk of bias. Facilitators and barriers mapped onto the following domains: knowledge; skills; memory, attention, and decision process; environmental context and resources; and technology and infrastructure. Two sets of peer reviewer feedback were received on the manuscript: the first included 34 comments requesting changes, 17 changes were made, requiring 173 person-minutes; the second requested 13 changes, and eight were made, requiring 121 person-minutes. A small and experienced systematic reviewer team using Systematic Review Automation tools who have protected time to focus solely on the SR can complete a moderately sized SR in 2 weeks.

Wstęp: Fizjoterapeuci są grupą zawodową narażoną na przeciążenia układu mięśniowo-szkieletowego, które zmniejszają ich wydajność i są najczęstszą przyczyną niezdolności do pracy. Celem niniejszej pracy była ocena progu wrażliwości mięśnia na ból [PPT kPa -1] wśród masażystów po zastosowaniu pneumatycznego stabilizatora zewnętrznego. Materiał i metody: Badaniom poddano dziesięciu fizjoterapeutów w wieku od 26 do 52 lat, pracujących na stanowisku masażysty w wybranych, dolnośląskich ośrodkach rehabilitacji. W trakcie badań oznaczono dwukrotnie PPT, przy użyciu algometru Somedic: po zakończonym 40-godzinnym tygodniu pracy (poniedziałek – piątek) – w piątek, podczas którego osoby badane nie stosowały pneumatycznego stabilizatora zewnętrznego Exonic V.2, oraz po jego zastosowaniu w trakcie kolejnego 40-godzinnego tygodnia pracy również na koniec ostatniego dnia – w piątek. Wyniki: Zauważono istotny statystycznie wzrost wartości średnich PPT zanotowanych w punktach referencyjnych zlokalizowanych po tej samej stronie linii wyrostków kolczystych kręgosłupa, pochodzących z 2 serii pomiarowej w porównaniu z serią 1 (p≤0,05). Zmiany te dodatkowo zostały określone w postaci średnich wartości procentowych, które okazały się wyższe po stronie lewej w porównaniu ze stroną prawą. W zestawieniu zmian procentowych dotyczących odcinka lędźwiowego (L) oraz piersiowego (Th) zanotowano wyższe średnie wartości po stronie prawej w odcinku lędźwiowym oraz po stronie lewej w odcinku piersiowym. Wnioski: Uzyskane wyniki badań uzasadniają zastosowanie zewnętrznego stabilizatora pneumatycznego Exonik V.2 jako narzędzia zmniejszającego bolesność mięśniową mierzoną wartością PPT. Przeprowadzony eksperyment wymaga kontynuacji badań na grupie masażystów o większej liczebności i zbliżonym wieku oraz stażu zawodowym.