RESUMO
Women have made a place for themselves in sport, but there are still inequalities and specific characteristics compared to men. Puberty is marked by hormonal changes that give the female athlete advantages and disadvantages. She then goes through various periods of life that condition her relationship to her body and her performance. Anatomical and hormonal factors influence certain injuries. Proper management of the menstrual cycle can optimize performance. She is more at risk of nutritional deficiencies or energy deficit. Moreover, she suffers more from a negative body image, aggravated by the pressure of the perfect sportswoman! All of these aspects should be considered when taking care of her and following up regularly, in order to avoid long-term consequences.
La femme s'est fait une place dans le sport, mais il persiste des inégalités et certaines caractéristiques spécifiques par rapport à l'homme. La puberté est marquée par des modifications hormonales conférant à l'athlète féminine des avantages mais aussi des inconvénients. Elle traverse ensuite diverses périodes de vie qui conditionnent sa relation à son corps et ses performances. Des facteurs anatomiques et hormonaux influencent certaines blessures. Une gestion adaptée du cycle menstruel peut optimiser les performances. Elle est plus à risque de carences nutritionnelles ou de déficit énergétique. De plus, elle souffre davantage d'une image négative de son corps, aggravée par la pression de la femme sportive parfaite ! Tous ces aspects sont à considérer lors de sa prise en charge et de son suivi régulier, afin d'éviter des séquelles à long terme.
Assuntos
Esportes , Atletas , Feminino , Humanos , MasculinoRESUMO
OBJECTIVES: The vast majority of residents' working time is spent away from patients. In hospital practice, many factors may influence the resident's working day structure.Using an innovative method, we aimed to compare working time allocation among internal medicine residents using time-motion observations. The first study goal was to describe how the method could be used for inter-hospital comparison. The secondary goal was to learn about specific differences in the resident's working day structure in university and non-university hospital settings. DESIGN: Two separate time-motion studies. Trained peer-observers followed the residents during weekday day shifts with a tablet, able to record 22 different activities and corresponding context (with patient, phone, colleague or computer). SETTING: Internal medicine residencies at a university (May-July 2015) and a non-university (September-October 2016) community hospital. PARTICIPANTS: 28 residents (mean age: 29 years, average postgraduate training: 30 months) at university hospital, 21 residents (mean age: 30 years, average postgraduate training: 17 months) at non-university hospital. OUTCOMES: Time spent with patients and time dedicated to activities directly related to patients; description of main differences of time allocation between hospitals. RESULTS: Cumulatively 1051 hours of observation (566 (university hospital)+486 (non-university hospital)) and 92 day shifts (49+43) were evaluated. Daily working time was 11.5 versus 11.3 hours. A median daily period of 195 min (IQR 179-211, 27.9%) and 116 min (IQR 98-134, 17.2%) (p<0.001) was dedicated to direct patient care, respectively. CONCLUSIONS: We successfully identified differences potentially related to each hospital structure and organisation. Inter-hospital comparisons could help set up interventions aiming to improve workday structure and experience of residents.
Assuntos
Benchmarking/métodos , Medicina Interna/educação , Internato e Residência/estatística & dados numéricos , Assistência ao Paciente/estatística & dados numéricos , Estudos de Tempo e Movimento , Adulto , Feminino , Hospitais Comunitários , Hospitais Universitários , Humanos , MasculinoRESUMO
Adolescent athletes frequently complain of fatigue. Acute fatigue after intense training is physiological and necessary in order to develop capacity and increase performance. However, healthcare practitioners must question persistant fatigue, which causes are multiple, sometimes clear, though mostly multifactorial. A comprehensive and holistic approach is especially required in adolescents, with a complete somatic, psychosocial and athletic history. The role of healthcare professionals is to quickly identify specific signs and complex diagnoses, which can lead to physical and psychological consequences in the long term (overtraining, burnout, abuse, eating disorders). Finally, in a time where overweight and inactivity is rampant in the youth, we must imperatively avoid adolescents dropping out of sports and activity.
La fatigue est un motif de consultation fréquent chez l'athlète adolescent. Une fatigue aiguë après un effort intensif est physiologique, voire même recherchée dans le but d'améliorer les performances. Une fatigue qui s'installe doit interpeller. Les causes sont multiples, parfois bien précises, mais souvent multifactorielles. Une approche holistique est indispensable, surtout chez l'adolescent, avec une anamnèse somatique, psychosociale et sportive détaillée. Le rôle du professionnel de la santé est de détecter au plus vite les premiers signes, certains diagnostics difficiles à poser pouvant avoir de lourdes conséquences physiques et psychiques à long terme (surentraînement, burnout, abus, trouble du comportement alimentaire). En cette ère d'épidémie de surpoids chez les jeunes, l'abandon du sport est à éviter absolument.
Assuntos
Atletas , Fadiga , Esportes , Adolescente , Esgotamento Profissional , Transtornos da Alimentação e da Ingestão de Alimentos , HumanosRESUMO
The hospital internal medicine practice is changing : increasing complexity of patients; implementation of the Electronic Medical Record (EMR); growing volume of medical data and administrative tasks, and limitation of working hours. We quantified the daily tasks of our internal medicine residents. They didn't manage to fulfill their duties in the scheduled time and had to stay after hours ; further, activities indirectly related to patients predominated. Residents spent a daily average of 1.7 hours with patients, 5.2 hours with the computer, and 13 minutes with both. Computer use predominated before 8 am or after 6 pm, while time dedicated to the patient was concentrated in morning during the medical round. Improvements are needed to increase residents' efficiency, and to make them focus on high medical value activities.
La médecine interne hospitalière évolue : patients plus complexes, dossier patient informatisé (DPI), données médicales et tâches administratives grandissantes, limitation des heures de travail. Nous avons quantifié une journée de nos médecins assistants (MA) internistes hospitaliers. Ils n'arrivaient pas à effectuer leur travail dans le temps imparti, restaient au-delà des horaires officiels et les activités indirectement reliées au patient prédominaient. En moyenne, un MA consacrait 1,7 heures/jour aux patients, 5,2 heures à l'ordinateur, et 13 minutes aux deux. L'utilisation de l'ordinateur était supérieure avant 8h00 ou après 18h00, alors que le temps avec le patient prédominait le matin durant la visite. Des solutions sont indispensables pour améliorer l'efficience des MA et concentrer leur temps à des activités à haute valeur médicale.
Assuntos
Medicina Interna , Internato e Residência , Médicos , Hospitais , Humanos , Alocação de RecursosRESUMO
BACKGROUND: Recent implementation of electronic health records (EHR) has dramatically changed medical ward organization. While residents in general internal medicine use EHR systems half of their working time, whether computer usage impacts residents' workflow remains uncertain. We aimed to observe the frequency of task-switches occurring during resident's work and to assess whether computer usage was associated with task-switching. METHODS: In a large Swiss academic university hospital, we conducted, between May 26 and July 24, 2015 a time-motion study to assess how residents in general internal medicine organize their working day. RESULTS: We observed 49 day and 17 evening shifts of 36 residents, amounting to 697 working hours. During day shifts, residents spent 5.4 hours using a computer (mean total working time: 11.6 hours per day). On average, residents switched 15 times per hour from a task to another. Task-switching peaked between 8:00-9:00 and 16:00-17:00. Task-switching was not associated with resident's characteristics and no association was found between task-switching and extra hours (Spearman r = 0.220, p = 0.137 for day and r = 0.483, p = 0.058 for evening shifts). Computer usage occurred more frequently at the beginning or ends of day shifts and was associated with decreased overall task-switching. CONCLUSION: Task-switching occurs very frequently during resident's working day. Despite the fact that residents used a computer half of their working time, computer usage was associated with decreased task-switching. Whether frequent task-switches and computer usage impact the quality of patient care and resident's work must be evaluated in further studies.
Assuntos
Médicos , Padrões de Prática Médica , Computadores , Registros Eletrônicos de Saúde , Feminino , Humanos , Internato e Residência , Masculino , Estudos de Tempo e Movimento , Fluxo de TrabalhoRESUMO
BACKGROUND: Little current evidence documents how internal medicine residents spend their time at work, particularly with regard to the proportions of time spent in direct patient care versus using computers. OBJECTIVE: To describe how residents allocate their time during day and evening hospital shifts. DESIGN: Time and motion study. SETTING: Internal medicine residency at a university hospital in Switzerland, May to July 2015. PARTICIPANTS: 36 internal medicine residents with an average of 29 months of postgraduate training. MEASUREMENTS: Trained observers recorded the residents' activities using a tablet-based application. Twenty-two activities were categorized as directly related to patients, indirectly related to patients, communication, academic, nonmedical tasks, and transition. In addition, the presence of a patient or colleague and use of a computer or telephone during each activity was recorded. RESULTS: Residents were observed for a total of 696.7 hours. Day shifts lasted 11.6 hours (1.6 hours more than scheduled). During these shifts, activities indirectly related to patients accounted for 52.4% of the time, and activities directly related to patients accounted for 28.0%. Residents spent an average of 1.7 hours with patients, 5.2 hours using computers, and 13 minutes doing both. Time spent using a computer was scattered throughout the day, with the heaviest use after 6:00 p.m. LIMITATION: The study involved a small sample from 1 institution. CONCLUSION: At this Swiss teaching hospital, internal medicine residents spent more time at work than scheduled. Activities indirectly related to patients predominated, and about half the workday was spent using a computer. PRIMARY FUNDING SOURCE: Information Technology Department and Department of Internal Medicine of Lausanne University Hospital.
