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To determine whether postponing daily medical rounds to provide additional preparation time for residents reduces round duration and alters time allocation during rounds, with the hypothesis that increased preparation leads to more efficient rounds without reducing patient contact.
Time and motion study with a before-and-after comparison.
Internal medicine division of Lausanne University Hospital, a Swiss tertiary teaching hospital.
75 residents; 60% women; mean age of 29.6 years and 3.0 years of training.
In 2017, the daily work schedule was reorganised by postponing rounds from 09:00 to 10:00 and moving educational sessions to the afternoon, thereby freeing 90 min to prepare patient cases before rounds.
The primary outcome was the duration of rounds and the proportion thereof spent with patients, using computer systems or in discussion with colleagues. Secondary outcomes included the detailed distribution of resident activities during the officially scheduled round period, particularly time dedicated to supervision, teaching and administrative tasks.
Round duration decreased from 142 min per shift (95% CI 128 to 156) in 2015 to 112 min (95% CI 101 to 124) in 2018 (p=0.001). The proportion of round time spent directly with patients remained stable at 47%. Computer use during rounds decreased from 43% to 32% (p
Postponing rounds to allow more preparation time was associated with shorter, possibly more efficient rounds, reduced computer use in patient presence and increased supervision and teaching.
ISRCTN69703381,
Progressive supranuclear palsy (PSP) is a devastating neurodegenerative disease characterised by cognitive, behavioural and motor problems. Motor symptoms are highly disabling, while cognitive and behavioural changes have a major impact on carer burden, quality of life and prognosis. Apathy and impulsivity are very common, often coexistent in PSP, and negatively predict survival. In preclinical models and other diseases, apathy and impulsivity are associated with noradrenergic deficits, which can be severe in PSP.
Noradrenaline for Progressive Supranuclear Palsy Syndromes trial is a randomised, double-blind, placebo-controlled, crossover design, Phase IIb clinical trial to evaluate the efficacy and safety of oral atomoxetine for the treatment of cognitive and behavioural changes in PSP. Participants receive atomoxetine 40 mg (10 mg/mL oral solution) once daily or a matched placebo solution, in random order, each for 8 weeks. An ‘informant’, who knows the patient with PSP well, is co-recruited to complete some of the trial outcome measures. Participants remain in the trial for 22 weeks after randomisation. The primary objectives are to assess (1) safety and tolerability and (2) efficacy versus placebo on challenging behaviours as reported in a subscale of the Cambridge Behavioural Inventory. Secondary and exploratory measures relate to cognition, the PSP Rating Scale, mood and potential baseline predictors of individual response to atomoxetine computed from imaging, genetic and cognitive measures at baseline.
The trial was approved by the South Central-Oxford B Research Ethics Committee (REC) and the Medicines and Healthcare products Regulatory Agency (REC reference: 20/SC/0416). Dissemination will include publication in peer-reviewed journals, presentations at academic and public conferences and engagement with patients, the public, policymakers and practitioners.
ISRCTN99462035; DOI:
by Janet Poplawski, Tony Montina, Gerlinde A. S. Metz
The developing nervous system displays remarkable plasticity in response to sensory stimulation during critical periods of development. Critical periods may also increase the brain’s vulnerability to adverse experiences. Here we show that early-life stress (ELS) in mice shifts the timing of critical periods in the visual cortex. ELS induced by animal transportation on postnatal day 12 accelerated the opening and closing of the visual cortex critical period along with earlier maturation of visual acuity. Staining of a molecular correlate that marks the end of critical period plasticity revealed premature emergence of inhibitory perineuronal nets (PNNs) following ELS. ELS also drove lasting changes in visual cortex mRNA expression affecting genes linked to psychiatric disease risk, with hemispheric asymmetries favoring the right side. NMR spectroscopy and a metabolomics approach revealed that ELS was accompanied by activated energy metabolism and protein biosynthesis. Thus, ELS may accelerate visual system development, resulting in premature opening and closing of critical period plasticity. Overall, the data suggest that ELS desynchronizes the orchestrated temporal sequence of regional brain development potentially leading to long-term functional deficiencies. These observations provide new insights into a neurodevelopmental expense to adaptative brain plasticity. These findings also suggest that shipment of laboratory animals during vulnerable developmental ages may result in long lasting phenotypes, introducing critical confounds to the experimental design.Este artículo está dividido en tres partes. En primer lugar, a modo de una primera provocación, he señalado tres párrafos, para indicarle de manera general al lector, lo que posiblemente pueda encontrar dentro del contenido de este texto. Lo segundo, presentaré concretamente algunos aspectos conceptuales y metodológicos del abordaje autoetnográfico, entendiendo que esto no es una profundización en el tema, sino simplemente, una segunda provocación, para que lo consideré la o el lector - evaluador (que, para mí serían lo mismo) tomando una postura de lo que está leyendo, y tercero, mostraré un fragmento autoetnográfico propio, para señalar la escritura en autoetnografía iniciada a partir de una epifanía. Este ejercicio narrativo surge a partir de dos momentos concretos pero entrelazados: ser enfermero y ser padre de un hijo con Síndrome de Down.
Women with disabilities are more exposed to violence. The health sector has a key role in all three levels of prevention of violence against women. The objective of this paper was to review the interventions for preventing gender-based violence and reducing its impact on the mental health of women with any form of disability.
Relevant studies were identified through conducting searches in PubMed, Scopus, CINAHL, PsyInfo, Social Services Abstracts, and PILOTS. Two reviewers analyzed and selected studies. A qualitative synthesis was made.
3149 references were obtained, among which eight articles describing nine interventions from the USA and the UK. Most were intended for women with mental/intellectual disability and assessed intimate partner or sexual violence. Only one study showed high methodological quality. They were found to be particularly effective as regards improvement of the skills acquired by participants, but the results as regards improved mental health are not consistent.
Our review shows very little evidence of effective interventions. Further studies are required with higher internal validity and female sample groups with diverse disabilities.
Gender-based violence is a highly prevalent problem for women with disabilities, and in addition to being a public health challenge is a violation of human rights. Health care systems and policymakers should take a key role in all three levels of prevention of violence against women with disabilities. Interventions with longer follow-up times are required. It is also important for interventions to be designed in consultation with people with disabilities.
Se trata de un relato biográfico de un profesional de enfermería con gran experiencia en la atención a pacientes con patologías mentales. Una sólida formación que tal y como relata en un principio fue autodidacta. El profesional manifiesta la necesidad de una formación previa al contacto a nivel sanitario con este tipo de pacientes. En su testimonio muestra su punto de vista respecto a la atención desarrollada a lo largo de los años de su trayectoria profesional, los perjuicios existentes en la sociedad ante estos pacientes y expone las perspectivas de mejora respecto al tema tratado especialmente en el ámbito donde actualmente trabaja una zona rural de Atención primaria de salud. Perteneciente a una asociación de enfermería con gran influencia en la evolución de la profesión enfermera, reflexiona sobre la importancia de la formación continuada y el desarrollo de las especialidades como meta para mejorar la prestación de cuidados.
Se trata de un relato biográfico de un profesional de enfermería con gran experiencia en la atención a pacientes con patologías mentales. Una sólida formación que tal y como relata en un principio fue autodidacta. El profesional manifiesta la necesidad de una formación previa al contacto a nivel sanitario con este tipo de pacientes. En su testimonio muestra su punto de vista respecto a la atención desarrollada a lo largo de los años de su trayectoria profesional, los perjuicios existentes en la sociedad ante estos pacientes y expone las perspectivas de mejora respecto al tema tratado especialmente en el ámbito donde actualmente trabaja una zona rural de Atención primaria de salud. Perteneciente a una asociación de enfermería con gran influencia en la evolución de la profesión enfermera, reflexiona sobre la importancia de la formación continuada y el desarrollo de las especialidades como meta para mejorar la prestación de cuidados.
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