2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

A meta-analytic investigation of the relationship between the psychological distress of cancer patients and their carers.

ContextConcern exists about the effect of extended resident work hours; however, no study has evaluated training-related performance impairments against an accepted standard of functional impairment.ObjectivesTo compare post-call performance during a heavy call rotation (every fourth or fifth night) to performance with a blood alcohol concentration of 0.04 to 0.05 g% (per 100 mL of blood) during a light call rotation, and to evaluate the association between self-assessed and actual performance.Design, Setting, and ParticipantsA prospective 2-session within-subject study of 34 pediatric residents (18 women and 16 men; mean age, 28.7 years) in an academic medical center conducted between October 2001 and August 2003, who were tested under 4 conditions: light call, light call with alcohol, heavy call, and heavy call with placebo.InterventionsResidents attended a test session during the final week of a light call rotation (non–post-call) and during the final week of a heavy call rotation (post-call). At each session, they underwent a 60-minute test battery (light and heavy call conditions), ingested either alcohol (light call with alcohol condition) or placebo (heavy call with placebo condition), and repeated the test battery. Performance self-evaluations followed each test.Main Outcome MeasuresSustained attention, vigilance, and simulated driving performance measures; and self-report sleepiness, performance, and effort measures.ResultsParticipants achieved the target blood alcohol concentration. Compared with light call, heavy call reaction times were 7% slower (242.5 vs 225.9 milliseconds, P<.001); commission errors were 40% higher (38.2% vs 27.2%, P<.001); and lane variability (7.0 vs 5.5 ft, P<.001) and speed variability (4.1 vs 2.4 mph, P<.001) on the driving simulator were 27% and 71% greater, respectively. Speed variability was 29% greater in heavy call with placebo than light call with alcohol (4.2 vs 3.2 mph, P = .01), and reaction time, lapses, omission errors, and off-roads were not different. Correlation between self-assessed and actual performance under heavy call was significant for commission errors (r = –0.45, P = .01), lane variability (r = –0.76, P<.001), and speed variability (r = –0.71, P<.001), but not for reaction time.ConclusionsPost-call performance impairment during a heavy call rotation is comparable with impairment associated with a 0.04 to 0.05 g% blood alcohol concentration during a light call rotation, as measured by sustained attention, vigilance, and simulated driving tasks. Residents’ ability to judge this impairment may be limited and task-specific.

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Neurobehavioral performance of residents after heavy night call vs after alcohol ingestion.

Cancer survivors' efforts at meaning making may influence the extent to which they successfully make meaning from their experience (i.e., experience posttraumatic growth, find life meaningful, and restore beliefs in a just world), which may, in turn, influence their psychological adjustment. Previous research regarding both meaning making processes and meanings made as determinants of adjustment has shown inconsistent effects, partly because of the lack of clearly articulated theoretical frameworks and problematic research strategies. In a 1-year longitudinal study, the authors distinguished the meaning making process from the outcomes of that process (meanings made), employing specific measures of both. The authors tested pathways through which meaning making efforts led to 3 different meanings made (growth, life meaning, and restored just-world belief) in a sample of 172 young to middle-age adult cancer survivors, and they explored whether those meanings made mediated the effect of meaning making efforts on psychological adjustment. Cross-sectional and longitudinal path models of the meaning making process indicate that meaning making efforts are related to better adjustment through the successful creation of adaptive meanings made from the cancer experience. The authors conclude with clinical implications and suggestions for future research.

Meaning making and psychological adjustment following cancer: The mediating roles of growth, life meaning, and restored just-world beliefs.

The COVID-19 pandemic marks an extraordinary global public health crisis unseen in the last century, with its rapid spread worldwide and associated mortality burden. The longevity of the crisis and disruption to normality is unknown. With COVID-19 set to be a chronic health crisis, clinicians will be required to maintain a state of high alert for an extended period. The support received before and during an incident is likely to influence whether clinicians experience psychological growth or injury. An abundance of information is emerging on disease epidemiology, pathogenesis and infection control prevention. However, literature on interventions for supporting the psychological well-being of healthcare workers during disease outbreaks is limited. This article summarises the available management strategies to increase resilience in healthcare workers during the COVID-19 pandemic and beyond. It focuses on self-care and organisational justice. It highlights various individual as well as organisational strategies. With the success of slowing disease spread in many countries to date, and reduced work-load due to limitations on elective surgery in many institutions, there is more time and opportunity to be pro-active in implementing measures to mitigate or minimise potential adverse psychological effects and improve, restore and preserve the well-being of the workforce now and for years to come. The purpose of this review is to review available literature on strategies for minimising the psychological impact of the COVID-19 pandemic on clinicians and to identify pro-active holistic approaches which may be beneficial for healthcare workers both for the current crisis and into the future.

https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/pdf/10.1111/anae.15180

Resilience strategies to manage psychological distress among healthcare workers during the COVID-19 pandemic: a narrative review.

Purpose.To identify and model the effects of sleep loss and fatigue on resident–physicians’ professional lives and personal well-being.Method.In 2001–02, 149 residents at five U.S. academic health centers and from six specialties (obstetrics–gynecology, emergency medicine, family medicine, i

The effects of sleep loss and fatigue on resident-physicians: a multi-institutional, mixed-method study.

Cancer survivorship is best viewed as a process that continues across the life span. Appraisals of cancer change over time and may not be explicit until long after treatment completion. The current study, using the Lazarus and Folkman (1984) stress-appraisal-coping framework, explored factors related to both a stressful and an irrelevant appraisal of the cancer experience by older long-term survivors. Hierarchical regression analysis investigated the individual and cumulative effects of person factors (survivors' demographic characteristics, beliefs about the effect of cancer on family members) and situation factors (characteristics of cancer) on survivors' appraisals that cancer was a stressful life event. The strongest correlates of the stress appraisal were person factors. A more stressful appraisal was associated with: (1). the belief that diagnosis/treatment caused greater family distress, (2). being younger, and (3). being White. The irrelevant appraisal had a marginally significant correlate in bivariate analysis and was not included in regression analysis. Implications for health-care professionals and patient/family interventions are discussed.

Appraisal of the cancer experience by older long-term survivors

BACKGROUND
Patient activation interventions (PAIs) engage patients in care by promoting increased knowledge, confidence, and/or skills for disease self-management. However, little is known about the impact of these interventions on a wide range of outcomes for adults with type 2 diabetes (DM2), or which of these interventions, if any, have the greatest impact on glycemic control.

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Effectiveness and Safety of Patient Activation Interventions for Adults with Type 2 Diabetes: Systematic Review, Meta-Analysis, and Meta-regression

AIM To better understand the type and range of health issues initiated by patients and providers in 'high-quality' primary-care for adults with diabetes and low socio-economic status (SES). BACKGROUND Although quality of care guidelines are straightforward, diabetes visits in primary care are often more complex than adhering to guidelines, especially in adults with low SES who experience many financial and environmental barriers to good care. METHODS We conducted a qualitative study using direct observation of primary-care diabetes visits at an exemplar safety net practice in 2009-2010. Findings In a mainly African American (93%) low-income population with fair cardiovascular control (mean A1c 7.5%, BP 134/81 mmHg, and low-density lipoprotein cholesterol 100 mg/dL), visits addressed a variety of bio-psychosocial health issues [median: 25 problems/visit (range 13-32)]. Physicians most frequently initiated discussions about chronic diseases, prevention, and health behavior. Patients most frequently initiated discussions about social environment and acute symptoms followed by prevention and health behavior. CONCLUSIONS Primary-care visits by diabetes patients with low SES address a surprising number and diversity of problems. Emerging new models of primary-care delivery and quality measurement should allow adequate time and resources to address the range of tasks necessary for integrating biomedical and psychosocial concerns to improve the health of socio-economically disadvantaged patients.

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Paulette Sage

Papers

The effects of sleep loss and fatigue on resident-physicians: a multi-institutional, mixed-method study.

Appraisal of the cancer experience by older long-term survivors

Effectiveness and Safety of Patient Activation Interventions for Adults with Type 2 Diabetes: Systematic Review, Meta-Analysis, and Meta-regression

No moment wasted: the primary-care visit for adults with diabetes and low socio-economic status.