Possible effects of sleep deprivation and fatigue on the performance and well-being of residents have received little scientific examination until recently. This article is a review of the studies on this topic published since 1970. All those studies that dealt with residents' moods and attitudes demonstrated deleterious effects of sleep deprivation and fatigue. The implications of this finding for patient care deserve exploration. Residents' acuity on performance tests requiring prolonged vigilance tended to deteriorate with acute sleep loss, while their performances on most brief psychomotor tests measuring manual dexterity, reaction times, and short-term recall were not adversely affected. The data presently available suggest that sleep-deprived or fatigued house officers can compensate for sleep loss in crises or other novel situations. However, sleep-deprived residents may be more prone to errors on routine, repetitive tasks and tasks that require sustained vigilance, which form a substantial portion of residents' workload. The authors concur with the recommendation of the Executive Council of the Association of American Medical Colleges that the total working hours for residents should not exceed 80 hours per week averaged over four weeks.
The association between falls, drugs, and diagnoses in elderly residents of a long-term care facility was explored using case-control methodology. The odds of being a faller rather than a control were significant (P less than .01) for those taking antidepressants, sedatives/hypnotics, or vasodilators, and for those with osteoarthritis or depression. When drug/diagnosis subgroups were examined, these same drug classes and diagnoses had high-odds ratios in the largest numbers of subgroups. In general, risk of falling appeared to be more strongly associated with drugs than with diagnoses.
This report describes the basic epidemiologic characteristics of fatal pulmonary embolism as it was recognized in the adult white population of Washington County, Maryland, from 1963 to 1975. Demographic and personal characteristics considered are age, sex, marital status, educational level, adequacy of housing, cigarette smoking, and religious service attendance. There were 316 deaths with pulmonary embolism mentioned on the death certificate during the 12 years of this study. Death was attributed to pulmonary embolism in 55 instances (17%) and to other thromboembolic diseases in 41 cases (13%). Age and educational level were the only sociodemographic variables significantly associated with risk of fatal pulmonary embolism. Mortality rose logarithmically with age up to age 75. Persons with less than 8 years of schooling had the highest rates, but the association with educational level was not linear. There was a suggestion that cigarette smoking was also associated with the certified presence of pulmonary embolism at death. Heart disease and cancer were mentioned on the death certificates of persons dying with pulmonary embolism less often than on death certificates in general, casting doubt on an etiologic association.
For all ages combined, 63 per cent of fatal unintentional poisonings from solids and liquids involve drugs, licit and illicit. In 1978, 1,906 deaths in the United States were ascribed to unintentional poisoning by drugs.2 An observation that such deaths had declined sharply since 1975 led us to review published mortality data for the 1970s. Our preliminary study suggested intriguing similarities between epidemiologic trends in unintentional drug poisoning from 1970-1978* and trends in acute narcotism deaths in several cities,3-8 opiate abuse,5'9-11 and heroin availability and purity:3'6"10"12 all of these phenomena followed U-shaped curves in the first half of the decade, then dropped precipitously to their lowest values in 1978. A more detailed study of mortality data was therefore undertaken. Deaths were subdivided by poisoning agent and by sex, race, and five-year age intervals. Annual mortality rates were calculated using estimates of the appropriate mid-year populations. 13
Young physicians enjoy a considerable mortality advantage over non-physicians of similar age. If the study findings in the death certificate sample are generalizable, at least half of the deaths of young physicians are theoretically preventable (suicides, homicides, and unintentional injuries). Residency program directors should consider how their training programs may affect the likelihood of a young physician's dying from a preventable cause.
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