What makes internal medicine attractive for the millennial generation? A survey of residents in internal medicine in Switzerland.

AIMS: A new generation of physicians, millennials (also known as Generation Y), are entering residency programmes in internal medicine, and these young men and women learn and work in ways that are different from those of past generations. The aim of the present study was to investigate aspects contributing to the attractiveness to young residents of a career in general internal medicine (GIM) compared with medical subspecialties (SUB). METHODS: In a cross-sectional online survey, we included residents working in residency facilities in GIM in German-speaking Switzerland. A total of 1818 junior residents were eligible. We looked for personal preferences, characteristics, and criteria influencing the choice of a career in GIM or SUB. RESULTS: 392 out of 1818 (22%) residents participated in the survey (66% females); they had been in clinical training for 35.5 months on average. 87% of the respondents aspired to a title in GIM, and 29% of these to a SUB title as well. 71% of the women chose GIM and not a SUB vs 58% of the men (p <0.019). GIM residents gave significantly higher ratings to “broad range of expertise,” “flexible work hours” (p = 0.007), “work-life balance”, and “reconciliation of work, family and private life” than residents aiming at a SUB. SUB residents evaluated career-related criteria as significantly more important (p <0.0001). With regard to career motivation, GIM residents and female residents rated extraprofessional concerns significantly higher than SUB residents did (p = 0.019). In contrast, SUB residents showed significantly higher intrinsic motivation than GIM residents (p = 0.025). Only 28.2% of GIM residents had a mentor, compared to 49.6% of SUB residents (p <0.0005). Concerning personal perceptions of the future within the next 5 years, GIM residents attached significantly more importance to part-time work (p = 0.001), whereas SUB residents attached more importance to getting a leading position as a main goal (p = 0.0001). CONCLUSIONS: There are considerable differences between GIM and SUB residents regarding career motivation and their views on working conditions and work-life balance. It is essential to understand the factors that motivate or deter the next generation in order to ensure the attractiveness of the profession of GIM.  .

Blind Intubation through Self-pressurized, Disposable Supraglottic Airway Laryngeal Intubation Masks: An International, Multicenter, Prospective Cohort Study.

BACKGROUND: Supraglottic airway devices commonly are used for securing the airway during general anesthesia. Occasionally, intubation with an endotracheal tube through a supraglottic airway is indicated. Reported success rates for blind intubation range from 15 to 97%. The authors thus investigated as their primary outcome the fraction of patients who could be intubated blindly with an Air-Qsp supraglottic airway device (Mercury Medical, USA). Second, the authors investigated the influence of muscle relaxation on air leakage pressure, predictors for failed blind intubation, and associated complications of using the supraglottic airway device. METHODS: The authors enrolled 1,000 adults having elective surgery with endotracheal intubation. After routine induction of general anesthesia, a supraglottic airway device was inserted and patients were ventilated intermittently. Air leak pressure was measured before and after full muscle relaxation. Up to two blind intubation attempts were performed. RESULTS: The supraglottic airway provided adequate ventilation and oxygenation in 99% of cases. Blind intubation succeeded in 78% of all patients (95% CI, 75 to 81%). However, the success rate was inconsistent among the three centers (P < 0.001): 80% (95% CI, 75 to 85%) at the Institute of Anesthesia and Pain Therapy, Kantonsspital Winterthur, Winterthur, Switzerland; 41% (95% CI, 29 to 53%) at the Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland; and 84% (95% CI, 80 to 88%) at the Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland. Leak pressure before relaxation correlated reasonably well with air leak pressure after relaxation. CONCLUSIONS: The supraglottic airway device reliably provided a good airway and allowed blind intubation in nearly 80% of patients. It is thus a reasonable initial approach to airway control. Muscle relaxation can be used safely when unparalyzed leak pressure is adequate.

Differences in participation and performance trends in age group half and full marathoners.

Recent studies investigated participation and performance trends in age group half marathoners and full marathoners for a single event. The present study investigated participation and performance trends in age group athletes in all half marathons and full marathons held in a single country during a given period of time. Changes in running performance and age of 226,754 half marathoners and 86,419 full marathoners competing in Switzerland between 2000 and 2010 were analyzed using linear regression analyses. The number of half marathoners increased (P < 0.01) from 2000 to 2010 for both men (+231%) and women (+299%). In contrast, the number of male and female full marathoners increased until 2005 only and decreased thereafter. The greatest part of the finishers of both genders was assigned to age group 40-44 years in half marathons (19.5% of finishers) and full marathons (22.0% of finishers). Running performance of female full marathoners improved in age groups 30-34, 35-39, 40-44, 45-49 and 50-54 years. Running performance of male full marathoners improved in age groups 25-29, 30-34, 35-39, 45-49 and 55-59 years. Female half marathoners achieved no change in running times in all age groups. For male half marathoners in age groups 30-34, 40-44 and 50-54 years, running performance declined. In conclusion, during the 2000-2010 period in Switzerland, it appeared that participation in half marathons increased but running performance stabilized. In contrast, participation in full marathons decreased but running performance improved. Further investigations are required to collect complete data for other countries and the investigation of other endurance events in Switzerland.

Participation and performance trends of East-African runners in Swiss half-marathons and marathons held between 2000 and 2010.

BACKGROUND: This study examined the changes in participation, performance and age of East African runners competing in half-marathons and marathons held in Switzerland between 2000 and 2010. METHODS: Race times, sex, age and origin of East African versus Non-African finishers of half-marathon and marathon finishers were analyzed. RESULTS: Across time, the number of Kenyan and Ethiopian finishers remained stable (P > 0.05) while the number of Non-African finishers increased for both women and men in both half-marathons and marathons (P < 0.05). In half-marathons, the top ten African women (71 ± 1.4 min) and top three (62.3 ± 0.6 min) and top ten (62.8 ± 0.4 min) African men were faster than their Non-African counterparts (P < 0.05). In marathons, however, there was no difference in race times between the top three African men (130.0 ± 0.0 min) and women (151.7 ± 2.5 min) compared to Non-African men (129.0 ± 1.0 min) and women (150.7 ± 1.2 min) (P > 0.05). In half-marathons and marathons was no difference in age between the best Non-African and the best African runners (P > 0.05). CONCLUSIONS: During the last decade in Switzerland, the participation of Kenyan and Ethiopian runners in half- and full- marathons remained stable. In marathons there was no difference in age and performance between the top African and the top Non-African runners. Regarding half-marathons, the top African runners were faster but not younger than the top Non-African runners. Future insight should be gained by comparing the present results with participation, performance and age trends for East African runners competing in marathons held in larger countries.

Performance and age of African and non-African runners in half- and full marathons held in Switzerland, 2000-2010.

BACKGROUND: Endurance running performance of African (AF) and non-African (NAF) athletes is investigated, with better performances seen for Africans. To date, no study has compared the age of peak performance between AF and NAF runners. The present research is an analysis of the age and running performance of top AF and NAF athletes, using the hypothesis that AF athletes were younger and faster than NAF athletes. METHODS: Age and performance of male and female AF and NAF athletes in half-marathons and marathons held in Switzerland in 2000-2010 were investigated using single and multilevel hierarchical regression analyses. RESULTS: For half-marathons, male NAF runners were older than male AF runners (P = 0.02; NAF, 31.1 years ± 6.4 years versus AF, 26.2 years ± 4.9 years), and their running time was longer (P = 0.02; NAF, 65.3 minutes ± 1.7 minutes versus AF, 64.1 minutes ± 0.9 minutes). In marathons, differences between NAF and AF male runners in age (NAF, 33.0 years ± 4.8 years versus AF, 28.6 years ± 3.8 years; P < 0.01) and running time (NAF, 139.5 minutes ± 5.6 minutes versus AF, 133.3 minutes ± 2.7 minutes; P < 0.01) were more pronounced. There was no difference in age (NAF, 31.0 years ± 7.0 years versus AF, 26.7 years ± 6.0 years; P > 0.05) or running time (NAF, 75.0 minutes ± 3.7 minutes versus AF, 75.6 minutes ± 5.3 minutes; P > 0.05) between NAF and AF female half-marathoners. For marathoners, NAF women were older than AF female runners (P = 0.03; NAF, 31.6 years ± 4.8 years versus AF, 27.8 years ± 5.3 years), but their running times were similar (NAF, 162.4 minutes ± 7.2 minutes versus AF, 163.0 minutes ± 7.0 minutes; P > 0.05). CONCLUSION: In Switzerland, the best AF male half-marathoners and marathoners were younger and faster than the NAF counterpart runners. In contrast to the results seen in men, AF and NAF female runners had similar performances. Future studies need to investigate performance and age of AF and NAF marathoners in the World Marathon Majors Series.

Cardiac pre-competiton screening in Swiss athletes. Current situation in competitive athletes and short-time assessment of an exemplary local screening program.

AIM OF THE STUDY: In Switzerland, screening concepts for the prevention of sports-associated sudden cardiac death are still insufficiently established in the large group of competitive athletes who are not integrated in an Olympic- or other high-level squad. The aim of the present study was to objectively determine the current situation in this particular group of athletes concerning cardiac pre-competition screening and define specific features of an "ideal" Swiss screening concept. Based on these data, the feasibility and validity was tested by the implementation of an exemplary local screening programme. METHODS: A standardised questionnaire was completed by 1,047 competitive athletes of different ages and gender. The individual, sports-specific profile of an athlete and furthermore, the personal attitude towards and the vision of a "perfect" cardiac screening were assessed. Based on the results, an exemplary local screening programme for competitive athletes was implemented at the "Academic Sports Association Zurich" (ASVZ) in Zurich, Switzerland and evaluated 1 year after its introduction. RESULTS: Only 9% of the 1,047 interviewed competitive athletes (aged 13 to 64 years; median age 22 years, SD = 5.87) had previously undergone a cardiac screening. Only 47% of the interviewed competitive athletes expressed their interest to undergo a cardiac screening at all. Male and older athletes showed a significantly higher acceptance rate for the screening programme than women and younger athletes. All athletes accepted to bear the expenses for the baseline screening programme, adapted to international standards (minimal accepted fee of 60 Swiss Francs). Almost half of the athletes (49.2%) preferred easy accessibility to a sports cardiologist (max. distance of 10 kilometres). The exemplary local screening programme proved to be feasible and successful. However, only 30% of the 102 screened individuals were female and most of the athletes (80%) who made use of the screening had a specific concern or symptom (selection bias). A total of 5 athletes (4.9%) were, at least temporarily, declared as not eligible for competitive sports due to a relevant cardiac pathology. CONCLUSION: The fact that only 9% of the interviewed competitive athletes had previously undergone cardiac screening is alarming, but underlines the necessity and urgency of implementing a cost-effective and adequate screening concept in the enormous group of competitive athletes who are not integrated in an Olympic- or other high-level squad. The need for a certain self-determination and personal responsibility of the athletes should be respected. Therefore, the screening should not be mandatory. However, adequate information about the issue is crucial for an informed decision.