Showing papers by "North Bristol NHS Trust published in 2006"
TL;DR: Pleural infection differs bacteriologically from pneumonia and requires different treatment, and Antibiotics for community-acquired infection should treat aerobic and anaerobic bacteria.
Abstract: Background: Antibiotic choices for pleural infection are uncertain as its bacteriology is poorly described. Methods: Pleural fluid from 434 pleural infections underwent standard culture and a screen for bacteria by amplification and sequencing of bacterial 16S ribosomal RNA gene. Results: Approximately 50% of community-acquired infections were streptococcal,and20%includedanaerobicbacteria. Approximately 60% of hospital-acquired infections included bacteria frequently resistant to antibiotics (methicillin-resistant Staphylococcus aureus, 25%; Enterobacteriaceae, 18%; Pseudomonasspp., 5%, enterococci, 12%).Mortalitywasincreasedinhospital-acquiredinfection(hospital, 17/36 [47%]; community, 53/304 [17%]; relative risk, 4.24; 95% confidence interval, 2.07–8.69; p 0.00001; 2 ,1d f 17.47) and in gram-negative (10/22 [45%]), S. aureus (15/34 [44%]), or mixed aerobic infections (13/28 [46%]), compared with streptococcal infection (23/137 [17%]) and infection including anaerobic bacteria (10/49 [20%]; p 0.00001, 2 ,4d f 23.35).
290 citations
TL;DR: Improved mechanisms for temperature control are required to prevent potentially deleterious complications of more profound hypothermia and the majority of the cases reviewed demonstrated unintentional overcooling below target temperature.
Abstract: Objectives: Although therapeutic hypothermia for cardiac arrest survivors has been shown to improve neurologically intact survival, optimal methods to ensure controlled induction and maintenance of cooling are not clearly established. Precise temperature control is important to evaluate because unintentional overcooling below the consensus target range of 32–34°C may place the patient at risk for serious complications. We sought to measure the prevalence of overcooling ( 1 hr was identified as follows: 20 of 32 patients (63%) reached temperatures of <32°C, 9 of 32 (28%) reached temperatures of <31°C, and 4 of 32 (13%) reached temperatures of <30°C. Of those with overcooling of <32°C, 6 of 20 (30%) survived to hospital discharge, whereas of those without overcooling, 7 of 12 (58%) survived to hospital discharge (p not significant). Conclusions: The majority of the cases reviewed demonstrated unintentional overcooling below target temperature. Improved mechanisms for temperature control are required to prevent potentially deleterious complications of more profound hypothermia. (Crit Care Med 2006; 34[Suppl.]:S490–S494)
194 citations
TL;DR: Monitoring serum creatinine in patients during the first few weeks after MI may help to identify those who are at highest risk and guide effective long-term therapeutic choices.
Abstract: Baseline renal function is a potent independent risk factor for adverse events after acute myocardial infarction (MI). Worsening renal function (WRF) has been shown to influence outcomes in the heart failure population, but its impact on cardiovascular risk in the post-MI period has not been well defined. For assessment of the prognostic importance of WRF, 2231 patients who had left ventricular dysfunction and were enrolled in the Survival and Ventricular Enlargement (SAVE) trial were studied. Patients were randomly assigned between 3 and 16 d (average 11 d) after acute MI to receive captopril or placebo; those with a serum creatinine of >2.5 mg/dl were excluded from SAVE. WRF was defined as an increase in creatinine of >0.3 mg/dl measured from baseline to 2 wk after randomization. The predictive value of WRF on cardiovascular morbidity and mortality was examined during 42 mo of follow-up. Paired serum creatinine measurements at baseline and 2 wk were available in 1854 patients. WRF occurred in 223 (12.0%) patients and was a stronger predictor of death (hazard ratio [HR] 1.46; 95% confidence interval [CI] 1.05 to 2.02) than baseline creatinine (HR 1.31; 95% CI 1.01 to 1.70). WRF also showed an increased risk for cardiovascular death (HR 1.62; 95% CI 1.14 to 2.30) and the composite end point (HR 1.32; 95% CI 1.03 to 1.70). When stratified by treatment, 104 (5.7%) and 116 (6.4%) patients with WRF in the placebo and captopril groups had no significant association between treatment group and WRF (P = 0.38). The risk for death associated with WRF was HR 1.63 (95% CI 1.05 to 2.52) in the placebo group compared with HR 1.33 (95% CI 0.81 to 2.21) in the captopril group (P = 0.49 for interaction). WRF as early as 2 wk after MI was not uncommon (12.0%) and was associated with increased mortality in patients without renal dysfunction at baseline. Patients who received captopril did not demonstrate more WRF than patients who received placebo. Monitoring serum creatinine in patients during the first few weeks after MI may help to identify those who are at highest risk and guide effective long-term therapeutic choices.
177 citations
TL;DR: The diagnostic process of a suspicious lesion is evidently a 'critical' stage requiring appropriate provision of care to meet patients' psychosocial and information needs if distress is to minimised for the large numbers of patients attending a PLC each year.
Abstract: This study aimed prospectively to investigate psychological distress throughout the diagnostic process in an outpatient pigmented lesion clinic (PLC). Psychological distress was measured at pre clinical diagnosis, post clinical diagnosis, pre histological diagnosis (including a benign follow-up) and post histological diagnosis stages using standard anxiety measurement scales and a study specific measure of satisfaction with care. In total 324 patients undergoing investigation of a suspicious skin lesion consented to take part out of a cohort of 463 patients who attended the PLC in a 6 month period. Using recognised cut-off scores, 27% of women on clinic arrival reported clinically high levels of anxiety, in comparison with 10% of men (p < 0.0001). Patients given an immediate benign post clinical diagnosis reported a reduction in anxiety (p < 0.0001) but patients requiring a biopsy reported elevated levels of anxiety. Approximately, 30% of these biopsy patients reported clinically high levels of anxiety both before and after diagnosis. Patients who received a post histological diagnosis of malignant melanoma also reported the pre histological stage at the clinic as more distressing than waiting for and receiving results (p < 0.01). Patient's quality of life prior to diagnosis was excellent, but emotional functioning (p < 0.05), insomnia (p
79 citations
TL;DR: A chest compression depth of 4-5 cm in adults equates to approximately one-fifth of the AP diameter of the adult chest, which is close to the recommended depth for chest compression during adult cardiopulmonary resuscitation.
78 citations
TL;DR: To determine factors associated with perineal wound complications following abdominoperineal excision of the rectum (APER) for rectal adenocarcinoma and their effects on time to healing.
Abstract: Aim To determine factors associated with perineal wound complications following abdominoperineal excision of the rectum (APER) for rectal adenocarcinoma and their effects on time to healing.
Patients and methods We studied all cases of APER performed in our unit by four consultants over 7 years. Seven out of nine factors considered important in wound healing were analysed using logistic regression and a multivariate model was built to examine interactions. Wound persistence was calculated using the Kaplan–Meier method.
Results Data were available for 94 of 96 patients [male:female, 3:2, median age 72.5 (IQR: 64–78)]. Thirty-nine (41%) patients had 25 Gray, 3-portal, fractionated 5-day short course preoperative radiotherapy (SCPRT). Dukes stages were A (34%), B (26%), C (40%). Perineal wound complications occurred in 44 (47%), 16% of these requiring return to theatre. Local recurrences occurred in 13 (15%). There was no evidence to suggest that either patient gender, age, smoking status, preoperative albumin or haemoglobin level, or T stage were associated with the development of wound complications. The odds of wound complications for a patient who had SCPRT was over 10 times that for a patient who did not have preoperative radiotherapy (odds ratio 10.15, 95% CI: 3.80–27.05, n = 94). Seventy-four per cent of SCPRT and 96% of non-SCPRT wounds had healed by 1 year. Estimated failed wound healing rates at 30 and 90 days were 64% (95% CI: 46–78) and 48% (95% CI: 30–64) in SCPRT patients compared with 23% (95% CI: 12–35) and 9% (95% CI: 3–20) in non-SCPRT patients (log rank test P < 0.0001).
Conclusion Patients who have an APER are over 10 times more likely to have a perineal wound complication if they have SCPRT than not. Two-thirds of these will not have healed by 1 month, half by 3 months and over a quarter will still remain unhealed at 1 year. This has important implications for patient management decisions. Large prospective studies are needed to evaluate the effects of a selective policy for radiotherapy administered to patients requiring APER.
71 citations
TL;DR: Staphylococcus aureus strains from the U.S. SENTRY Antimicrobial Surveillance Program, GISA, and heterogeneous GISA strains were used to compare bactericidal activities of daptomycin and vancomycin using MICs and minimum bactericidal concentrations.
Abstract: Received 2 June 2006/Returned for modification 7 July 2006/Accepted 6 October 2006 Staphylococcus aureus strains from the U.S. SENTRY Antimicrobial Surveillance Program, 2002-2003, glycopeptide-intermediate S. aureus (GISA) strains, and heterogeneous GISA (hGISA) strains were used to compare bactericidal activities of daptomycin and vancomycin using MICs and minimum bactericidal concentrations. Glycopeptide-susceptible S. aureus and hGISA strains were further studied by using time-kill curves. For all isolates, the daptomycin MIC50 and MIC90 are four times lower and the log drops in viable counts at 6 h and 24 h are significantly greater than those for vancomycin.
66 citations
TL;DR: Alongside the classic target organs of the intestine, kidney, bone and parathyroid glands, vitamin D regulates cell growth and maturation in a variety of other tissues, controls other hormonal systems and modulates immunologically mediated processes.
Abstract: The main function of vitamin D is to preserve calcium and phosphate homeostasis, in order to promote skeletal mineralisation. Alongside the classic target organs of the intestine, kidney, bone and parathyroid glands, vitamin D regulates cell growth and maturation in a variety of other tissues, controls other hormonal systems and modulates immunologically mediated processes. The list of cell types with either cytosolic, nuclear or membrane bound vitamin D receptor (VDR) is increasing ( table 1 ) [10] .
46 citations
TL;DR: Dalbavancin showed non-concentration-dependent killing against the three vancomycin-susceptible strains in the range 3-21 mg/L and the vancomYcin-intermediate strain at 15 and 21mg/L, suggesting AUC/MIC could be related to antibacterial effect.
Abstract: Objectives: The antibacterial effect of dalbavancin was studied against Staphylococcus aureus using stepwise declining concentrations designed to model a range of free drug concentrations observed in human serum. Methods: Initial concentrations ranged from 0.6 to 21 mg/L and experiments were conducted over 240 h. Three vancomycin-susceptible and one vancomycin-intermediate strain of S. aureus were used. Results and conclusions: Dalbavancin showed non-concentration-dependent killing against the three vancomycin-susceptible strains in the range 3–21 mg/L and the vancomycin-intermediate strain at 15 and 21 mg/L. AUC/MIC could be related to antibacterial effect. The AUC/MIC for a bacteriostatic effect was 36 at 24 h, 55 at 120 h and 100 at 240 h. A larger AUC/MIC was required to produce a 2 log reduction in counts, being 214 at 24 h, 195 at 120 h and 331 at 240 h.
35 citations
01 Oct 2006
TL;DR: This chapter discusses the malaise of medical manuscripts and guidelines to clearer writing, and some examples rewritten to show how to practice recuperation in the face of illness.
Abstract: Part I. Problem: the illness: 1. Introduction 2. The malaise of medical manuscripts Part II. Solution: Symptomatic relief: 3. Guidelines to clearer writing 4. Is there a better word? 5. Superfluous words 6. Imprecise words and phrases 7. Superfluous phrases 8. Trouble with short words 9. Use of the passive voice 10. Consistency: number and tenses 11. Circumlocution, metaphor and cliche 12. Word order and pronouns 13. Punctuation 14. Constructing sentences 15. Drawing clear graphs Part III. Practice: recuperation: 16. Some examples rewritten 17. Do the experts agree? Appendix: examples to rewrite.
32 citations
TL;DR: Some treatments for prostate cancer avoid this side effect of androgen deprivation therapy and these are discussed, together with treatment strategies to minimise the impact of ADT on bone health.
Abstract: Prostate cancer is often treated with androgen deprivation therapy (ADT). Although this treatment is effective the associated hypogonadism causes accelerated bone loss, osteoporosis and increased fracture risk in men with prostate cancer, even in the absence of bone metastases. In addition to the negative effects of ADT on bone metabolism, men with prostate cancer are at increased risk of osteroporosis due to advanced age, poor nutrition and vitamin D deficiency. Some treatments for prostate cancer avoid this side effect and these are discussed, together with treatment strategies to minimise the impact of ADT on bone health.
TL;DR: Finger rings increase surface bacterial counts and scrubbing reduces these, but if rings are removed before scrubbing, bacterial counts are reduced but remain higher than on adjacent skin or the opposite hand.
TL;DR: The development of an information booklet is described and used to personalise information for all patients and serves, in part, as a record of the key issues discussed during the consultation.
Abstract: INTRODUCTIONIn order to deliver high quality care and empower cancer patients in decision-making, good quality information and communication are essential. We describe the development of an information booklet. PATIENTS AND METHODSA total of 22 colorectal cancer patients (12 male; median age, 72 years, range, 40–86 years) met on 3 occasions. Patients were asked to define their information needs and score them (1–4) according to importance. The information document was written. The second meeting involved feedback on the booklet. The modified booklet was reviewed/approved by the group before submission for local ethics committee approval prior to its distribution to other patients. RESULTSAll participants felt the project a good idea. Essential information included the surgeon's individual morbidity, mortality, survival, recurrence data and details of adjuvant therapies (score = 4). Also important were type of surgery, complications and postoperative recovery (score = 3). Simple anatomical drawings were al...
North Bristol NHS Trust1, Charles University in Prague2, University of Warwick3, Royal United Hospital4, The Catholic University of America5, University Hospitals Birmingham NHS Foundation Trust6, Bielefeld University7, University Hospital Heidelberg8, University Hospital Bonn9, University of Vienna10, University of Mainz11
TL;DR: In this paper, the European Resuscitation Council (ERC) has published a set of leitlinien for the Kreislauf stillstand unter besonderen Umstanden basieren auf dem 2020 International Consensus on Cardiopulmonary RESuscitation Science with Treatment Recommendations.
Abstract: Diese Leitlinien des European Resuscitation Council (ERC) fur den Kreislaufstillstand unter besonderen Umstanden basieren auf dem 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. Dieses Kapitel enthalt Leitlinien zu den Modifikationen der lebensrettenden Basismasnahmen und erweiterten lebensrettenden Masnahmen zur Vorbeugung und Behandlung von Kreislaufstillstanden unter besonderen Umstanden; insbesondere spezielle Ursachen (Hypoxie, Trauma, Anaphylaxie, Sepsis, Hypo‑/Hyperkaliamie und andere Elektrolytstorungen, Hypothermie, Lawinengeschehen, Hyperthermie und maligne Hyperthermie, Lungenembolie, Koronarthrombose, Herzbeuteltamponade, Spannungspneumothorax, Giftstoffe), spezielle Umstande (Operationssaal, Herzchirurgie, Herzkatheterlabor, Dialyseeinheit, Zahnkliniken, Transport wahrend des Flugs, Kreuzfahrtschiffe, Sport, Ertrinken, Grosschadensereignisse) und spezielle Patientengruppen (Asthma und chronisch obstruktive Lungenerkrankung, neurologische Erkrankungen, krankhafte Adipositas, Schwangerschaft).
TL;DR: The need for risk stratification in patients who present with massive pulmonary embolism and PFO is discussed, and it is likely that thrombolysis caused fragments of clot to later break lose and embolise into the cerebral circulation.
TL;DR: There was good agreement on the location of the T5 dermatome, but one in seven anaesthetists were inaccurate by two or more dermatomes, and the knowledge of relevant dermatome levels should be an integral part of obstetric anaesthetic training.
Abstract: The extent of a regional block for Caesarean section must be tested and documented before surgery commences. In recent years a block to 'touch' that includes T5 has increasingly been considered the best predictive test for a pain-free Caesarean section. Our survey examines the consistency with which different anaesthetists identified the location of the T5 dermatome. Seventy-three anaesthetists were asked to mark a point on an anatomical picture to indicate where they would test for T5. Overall there was good agreement on the location of the T5 dermatome, but one in seven anaesthetists were inaccurate by two or more dermatomes. There were no statistically significant differences between the subgroups of senior house officer, specialist registrar and consultant anaesthetists. The knowledge of relevant dermatome levels should be an integral part of obstetric anaesthetic training.
TL;DR: The results suggest that the April 2007 target of a DR of 75% with an FPR of less than 3% is unachievable using current second-trimester maternal serum screening.
Abstract: Background The recommendations of the UK National Screening Committee (NSC) are based on the findings of the Serum, Urine and Ultrasound Screening Study (SURUSS). Our study sought to establish if the SURUSS findings, in terms of detection rates (DR) and false-positive rates (FPR) for various second-trimester marker combinations, could be replicated in a local setting. Methods We investigated the effects of adding inhibin-A and unconjugated oestriol to our existing double test protocol. This retrospective study examined 1000 control pregnancies and 128 affected pregnancies. Results The inhibin-A method was associated with considerable assay drift and very marked within-batch imprecision (intrabatch percent coefficient of variation [CV] = 17%). At a cut-off of 1 in 250, the quadruple test showed a DR of 72%, the triple test 70% and the double test 63%. There were no significant differences between the FPRs for any of the combinations, which were all between 6.6% and 7.0% for a 1 in 250 cut-off. Conclusions In our view, the current inhibin-A assay is unacceptable as a screening marker due to poor assay performance. We have reviewed the NSC benchmark programme outcomes, and would suggest that the 2005 target of a DR of at least 60% with an FPR of less than 5% is achievable using triple testing in the second trimester in conjunction with universal scan dating. Our results suggest that the April 2007 target of a DR of 75% with an FPR of less than 3% is unachievable using current second-trimester maternal serum screening.
TL;DR: The results indicate that decision cut-offs will be influenced by conditions of sample storage prior to IMA analysis, and that these should be stated in detail for each study.
Abstract: Background: Ischaemia-modified albumin (IMA) is being studied as a new marker for reversible ischaemia in patients presenting with possible cardiac chest pain. The conditions under which samples ar...
TL;DR: A sequential assessment of breathing and pulse by healthcare professionals has greater diagnostic accuracy in simulated case scenarios.
TL;DR: A rapid, straightforward HPLC method is reported for the detection of ertapenem in human serum with a broad spectrum of activity and an extended half-life.
Journal Article•
TL;DR: This study investigates cases of so-called "gluten sensitive" neurological syndromes in patients with various idiopathic neuropathologies, detectable anti-gliadin antibodies and HLA-DQ2 or DQ7, and finds no evidence of antiPurkinje cell or anti-neuronal nuclear antibodies.
Abstract: "Gluten sensitive" neurological syndromes (ataxia, peripheral neuropathy, and other conditions) have been hypothesised in patients with various idiopathic neuropathologies, detectable anti-gliadin antibodies and HLA-DQ2 or DQ7. Further investigation of these cases has suggested a high incidence of anti-neuronal antibodies (anti-Purkinje, anti- neuronal nuclear, anti-GAD). This study investigates this contentious area. Over a two-year period, from a local UK population base of two million, seeing over 5000 general neurology referrals per year, we collected 20 cases with idiopathic ataxia, and 32 with idiopathic peripheral neuropathy, and referred them all for blinded antibody testing. 30 adult healthy blood donors, and 7 cases of hereditary ataxia were used as control subjects. Anti-gliadin antibodies (IgG and or IgA) were found in 40% of cases with idiopathic ataxia, 34% with idiopathic peripheral neuropathy, 17% healthy blood donors and 43% with hereditary ataxia. None was positive for antiPurkinje cell or anti-neuronal nuclear antibodies. Only two patients with idiopathic ataxia were positive for antiGAD antibodies (one also being anti-gliadin positive). We were unable to confirm the findings of other groups. First, cases of so-called "gluten sensitive" neurological syndromes were extremely rare in our centre. Second, our idiopathic cases, whether they be gliadin antibody seropositive or not (i.e. "gluten sensitive" or not) were rarely neuronal autoantibody positive.
TL;DR: There remains a need to continue to improve the relationship between the person with type 1 diabetes and the health professional in all areas where this takes place — outpatient clinics, general practice surgeries and hospital wards.
Abstract: Living with type 1 diabetes continues to pose a great challenge for the individual. Health professionals continue to develop interventions aiming to improve self-management.
Focus groups were conducted to explore the experience of living with type 1 diabetes. Participants were asked to describe what they had found helpful. Interactions with health professionals were described as important and very clear ideas regarding supportive and helpful attitudes were described. Participants described their desire to be seen as an individual and not as ‘another diabetic’. They were resentful of judgemental attitudes from health professionals. They wished to be acknowledged as an expert in the management of their diabetes and the ideal health professional was seen as open and listening. Systems such as clinics where there was a lack of continuity or inconsistent advice were deemed to be unhelpful.
There remains a need to continue to improve the relationship between the person with type 1 diabetes and the health professional in all areas where this takes place — outpatient clinics, general practice surgeries and hospital wards. Copyright © 2006 John Wiley & Sons, Ltd.
TL;DR: The US healthcare system provides evidence that spending more on healthcare does not result in better care, but also offers many lessons and surprises on how the quality and safety of healthcare can be improved.
Abstract: The US healthcare system provides evidence that spending more on healthcare does not result in better care, but also offers many lessons and surprises on how the quality and safety of healthcare can be improved. The US Institute of Medicine has clearly articulated what needs to be achieved. A series of US agencies, including the Joint Commission on Accreditation of Healthcare Organizations, the Centers for Medicare and Medicaid Services (CMS), other major players, and the Hospital Quality Alliance, routinely collect and report on numerous measures of the quality and safety of inpatient and outpatient healthcare. Most attention to improving care in the UK has focused on vertically integrated, closed healthcare systems, but the US experience provides additional models from the work of Quality Improvement Organizations and of numerous voluntary organisations that sponsor collaborative improvement.
TL;DR: The evidence for the use of vitamin D and bisphosphonates for the prevention of bone fractures and osteoporosis in elderly patients is reviewed.
Abstract: Fractures are common in elderly subjects, disabling and occasionally fatal. Their incidence increases exponentially with age, with the commonest affected sites being the wrist, vertebrae, hip and humerus. Of these, hip fractures are the most relevant in terms of morbidity and financial cost. The increase in fracture rate with age is believed to result predominantly from age-related increases in the incidence of osteoporosis and falls. This article reviews the evidence for the use of vitamin D and bisphosphonates for the prevention of bone fractures and osteoporosis in elderly patients.
TL;DR: Structured letters are better in orthopaedics because it is easier to access the contents and the structured format disciplines medical staff to address essential information.
Abstract: INTRODUCTIONAccurate written communication is essential in orthopaedic surgery. Incomplete and poorly structured letters can lead to poor knowledge of a patient's diagnosis. MATERIALS AND METHODSStructured and traditional letter formats were compared for speed of reading and preference by general practitioners (GPs), consultants, registrars and out-patient nursing staff. In addition, out-patient clinic letters and notes were analysed and compared for speed of reading and ease of assimilating information and content. RESULTSThere was overwhelming preference for the structured letter format. This style of letter could be read significantly more quickly with information better assimilated and relevant data included more frequently. However, only 26% of letters generated contained a complete set of information sought by GPs and hospital staff. CONCLUSIONSStructured letters are better in orthopaedics because it is easier to access the contents. The structured format disciplines medical staff to address essenti...
TL;DR: The aim of this review is to determine if there is evidence that mobile phones have a detrimental effect on auditory function.
Abstract: Mobile telephones are now an integral part of modern telecommunications. The widespread use of mobile telephones has given rise to concern about the potential influences of electromagnetic fields (EMFs) on human health. The effects of EMFs on human beings are under investigation. Anatomically, the ear is in close proximity to the mobile telephone during use. The effect of mobile phones on auditory function has rarely been studied. The aim of this review is to determine if there is evidence that mobile phones have a detrimental effect on auditory function.
TL;DR: This study demonstrated that in the ‘study population of 194 women requiring vacuum extraction the KIWI Omnicup was associated with a significantly higher failure rate than standard (metal or silastic) cups’, and demonstrated that the Omnicups failure rate did not decrease over the study period.
Journal Article•
TL;DR: Although some people prefer to work these hours, the majority of the individuals who took part in this small study expressed a preference for working during the day.
Abstract: Aim To look at the perceived effects of working unsocial hours Method Six people who worked unsocial hours were sent a questionnaire using open and closed questions, and then interviewed using a semistructured interview technique Qualitative analysis of the transcripts of these interviews was performed using a content analysis approach within a framework Results The analysis revealed that although there were some positive effects of working unsocial hours, there were more negative effects Analysis also demonstrated that all the participants had concerns about working unsocial hours There was agreement from all the participants about the effects of working these hours, except on one point relating to planning where there was a difference of opinion between two people Conclusion While there are some positive effects, the negative effects and concerns relating to working unsocial hours far outweigh them Although some people prefer to work these hours, the majority of the individuals who took part in this small study expressed a preference for working during the day