[The impact of shift work: did hard work ever kill anyone?] / De impact van werken in diensten.

An increasing body of evidence suggests that complaints of fatigue among healthcare staff is widespread and rising, owing to a combination of high work intensity, understaffed workplace and nightshift working. This has been linked to poorer outcomes for patients and to increased risks of injuries for practitioners. Fatiguedecreases performance andphysicalandmentalwellbeing. Moreover, it can lead to sickness absence. What lies behind this culture, behaviour and what are possible solutions to this? A committee called I'm Safe, assigned by the Dutch Association of Anaesthesiology, will address these issues, raise awareness and inform physicians about the impact of shift working. Its aim is to provide tools on where changes can be made in order to create a healthier work environment.

Education, exposure and experience of prehospital teams as quality indicators in regional trauma systems.

OBJECTIVE: Indicators to measure the quality of trauma care may be instrumental in benchmarking and improving trauma systems. This retrospective, observational study investigated whether data on three indicators for competencies of Dutch trauma teams (i.e. education, exposure, experience; agreed upon during a prior Delphi procedure) can be retrieved from existing registrations. The validity and distinctive power of these indicators were explored by analysing available data in four regions. METHODS: Data of all polytrauma patients treated by the Helicopter Emergency Medical Services were collected retrospectively over a 1-year period. During the Delphi procedure, a polytrauma patient was defined as one with a Glasgow Coma Scale of 9 or less or a Paediatric Coma Scale of 9 or less, together with a Revised Trauma Score of 10 or less. Information on education, exposure and experience of the Helicopter Emergency Medical Services physician and nurse were registered for each patient contact. RESULTS: Data on 442 polytrauma patients could be retrieved. Of these, according to the Delphi consensus, 220 were treated by a fully competent team (i.e. both the physician and the nurse fulfilled the three indicators for competency) and 22 patients were treated by a team not fulfilling all three indicators for competency. Across the four regions, patients were treated by teams with significant differences in competencies (P=0.002). CONCLUSION: The quality indicators of education, exposure and experience of prehospital physicians and nurses can be measured reliably, have a high level of usability and have distinctive power.

Bioabsorbable Versus Metallic Screw Fixation for Tibiofibular Syndesmotic Ruptures: A Meta-Analysis.

Ankle fractures with syndesmotic rupture require operative treatment. In most cases, this consists of fixation of the tibiofibular joint with 1 or more screws. Bioabsorbable screws are used for the same purpose but have the advantage that screw removal is unnecessary. The aim of the present study was to compare the results of bioabsorbable and metallic syndesmotic screws. A systematic search was performed in the Ovid MEDLINE electronic database and Google Scholar. Three randomized controlled trials and one comparison study, with 260 patients, were included. The experimental group consisted of patients with syndesmotic injuries treated with bioabsorbable screws versus the control group (patients treated with metallic screws). The primary outcomes were complications and wound infections. No statistically significant difference was demonstrable in the overall number of complications between the 2 groups. In the group of patients with a bioabsorbable screw, 32 of 137 (23.4%) experienced a complication versus 7 of 123 patients (5.7%) with a metallic screw. Data on wound-related complications showed no statistically significant difference, 19.7% versus 5.7%. The average maximum range of motion in both groups was comparable. Bioabsorbable syndesmotic screws and metallic syndesmotic screws were comparable with respect to the incidence of complications and range of motion. However, the absolute number of complications was greater with bioabsorbable screws.

Rerupture rate after early weightbearing in operative versus conservative treatment of Achilles tendon ruptures: a meta-analysis.

Whether Achilles tendon rupture benefits from surgery or conservative treatment remains controversial. Moreover, the outcome can be influenced by the rehabilitation protocol. The goal of the present meta-analysis was to compare the rerupture rate after surgical repair of the Achilles tendon followed by weightbearing within 4 weeks versus conservative treatment with weightbearing within 4 weeks. In addition, a secondary analysis was performed to compare the rerupture rates in patients who started weightbearing after 4 weeks. Seven randomized controlled trials published from 2001 to 2012, with 576 adult patients, were included. The primary outcome measure was the rerupture rate. The secondary outcomes were minor and major complications other than rerupture. In the early weightbearing group, 7 of 182 operatively treated patients (4%) experienced rerupture versus 21 of 176 of the conservatively treated patients (12%). A secondary analysis of the patients treated with late weightbearing showed a rerupture rate of 6% (7 of 108) for operatively treated patients versus 10% (11 of 110) for conservatively treated patients. The differences concerning the rerupture rate in both groups were not statistically significant. No differences were found in the occurrence of minor or major complications after early weightbearing in both patient groups. In conclusion, we found no difference in the rerupture rate between the surgically and nonsurgically treated patients followed by early weightbearing. Weightbearing after 4 weeks also resulted in no differences in the rupture rate in the surgical versus conservatively treated patients. However, surgical treatment was associated with a twofold greater complication rate than conservative treatment.