Exercise, diet, and sleep habits of nurses working full-time during the COVID-19 pandemic: An observational study.

BACKGROUND: Healthy diet, exercise, and sleep practices may mitigate stress and prevent illness. However, lifestyle behaviors of acute care nurses working during stressful COVID-19 surges are unclear. PURPOSE: To quantify sleep, diet, and exercise practices of 12-hour acute care nurses working day or night shift during COVID-19-related surges. METHODS: Nurses across 10 hospitals in the United States wore wrist actigraphs and pedometers to quantify sleep and steps and completed electronic diaries documenting diet over 7-days. FINDINGS: Participant average sleep quantity did not meet national recommendations; night shift nurses (n = 23) slept significantly less before on-duty days when compared to day shift nurses (n = 34). Proportionally more night shift nurses did not meet daily step recommendations. Diet quality was low on average among participants. DISCUSSION: Nurses, especially those on night shift, may require resources to support healthy sleep hygiene, physical activity practices, and diet quality to mitigate stressful work environments.

Community-based provision of direct-acting antiviral therapy for hepatitis C: study protocol and challenges of a randomized controlled trial.

BACKGROUND: To achieve the World Health Organization hepatitis C virus (HCV) elimination targets, it is essential to increase access to treatment. Direct-acting antiviral (DAA) treatment can be provided in primary healthcare services (PHCS), improving accessibility, and, potentially, retention in care. Here, we describe our protocol for assessing the effectiveness of providing DAAs in PHCS, and the impact on the HCV care cascade. In addition, we reflect on the challenges of conducting a model of care study during a period of unprecedented change in HCV care and treatment. METHODS: Consenting patients with HCV infection attending 13 PHCS in Australia or New Zealand are randomized to receive DAA treatment at the local tertiary institution (standard care arm), or their PHCS (intervention arm). The primary endpoint is the proportion commenced on DAAs and cured. Treatment providers at the PHCS include: hepatology nurses, primary care practitioners, or, in two sites, a specialist physician. All PHCS offer opioid substitution therapy. DISCUSSION: The Prime Study is the first real-world, randomized, model of care study exploring the impact of community provision of DAA therapy on HCV-treatment uptake and cure. Although the study has faced challenges unique to this period of time characterized by changing treatment and service delivery, the data gained will be of critical importance in shaping health service policy that enables the elimination of HCV. TRIAL REGISTRATION: ClinicalTrials.gov , ID: NCT02555475 . Registered on 15 September 2015.

Residents' perspectives on surgical training and the resident-fellow relationship: comparing residency programs with and without gynecological oncology fellowships.

The effect of a gynecological oncology fellow on obstetrics and gynecology resident education and training is uncertain. The objective is to assess the effect of gynecological oncology fellows on the surgical training of residents in obstetrics and gynecology. Fourth year residents in obstetrics and gynecology in the United States were identified and stratified as to the presence or absence of an oncology fellowship program. Demographics, surgical volume, procedures performed, and self-assessment of surgical proficiency were collected. Responses were compared between residency programs with and without fellowships. Responses were received from 40% of programs. Residents at programs without a fellowship more frequently operated with attendings than did residents at programs with fellows, 91% vs 77%, P= 0.016, and more frequently were responsible for complicated cases, 39% vs 22%, P < 0.0001. Over 90% of residents in both groups reported surgical training as positive and valuable; both groups reported a similar perceived lack of proficiency in radical hysterectomy and lymphadenectomy. Attitudes toward the fellows were generally positive; however, competition for cancer cases was reported by over 66% of residents from programs with fellows. While fellows are often thought of as a detracting factor to residency training, they do not appear to affect the perception of the quality of resident surgical training.

Dependence of the coincidence aperture function of narrow BGO crystals on crystal shape and light encoding schemes.

Although the spatial resolution in positron emission tomography is improved by reducing the crystal width, the resolution becomes increasingly non-uniform towards the edges of the field of view. This is mainly due to penetration of the gamma rays through one or more crystals before detection and the inability of current systems to resolve the depth of interaction within the crystal. This paper compares crystals with straight and pointed tips with and without tungsten septa to determine the effects of pointed tips and septa on spatial resolution and efficiency. Monte Carlo calculations are compared with extensive experimental results obtained from 16 coincidence lines between two four-BGO crystal/dual PMT detector assemblies. The spectral efficiencies for the different combinations are compared. A modest improvement in signal-to-noise ratio at the maximum resolvable frequency is demonstrated when using tungsten septa and pointed crystals. The effects of the optical coding scheme used are discussed and it is shown that most coding schemes cause diminishment of spatial resolution even at the centre of the field of view, resulting from Compton scattering to adjacent crystals.

Automated health testing in a medical group practice. Effects on physician behavior and economic influences.

An automated health testing (AHT) laboratory was introduced into a large medical group practice in January 1970. The impact of AHT was studied by means of a matrix of before and after its introduction and the physicians with high and low volumes of referrals to this service. An epidemiologic data-gathering approach was used to obtain information with minimal interference with normal clinic operation during a 3-year period. Data were obtained from the business office, appointment rosters, AHT laboratory results, and clinic records. AHT was accepted and used more frequently by the general and family practice physicians and internists than by the other physicians in the group practice. After AHT was introduced, the general physicians saw fewer patients but held longer visits, performed more procedures, and ordered fewer tests. On the other hand, the internists saw more patients but held shorter visits, performed more periodic reexaminations, and ordered fewer tests. The study findings indicate that in the short term AHT does not appear to reduce the cost of medical care. However, patients benefited from followup of AHT results; often, this followup resulted in significant newly diagnosed diseases or conditions, treatment, and sometimes surgery.