Allison Thiele, MD PhD

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23 Φεβ 2014 (πριν από 2 χρόνια και 9 μήνες)

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Allison Thiele, MD PhD

University of Saskatchewan College of Medicine

Dept. of Obstetrics, Gynecology & Reproductive Sciences

RQHR Research Day 2013


Commercial truckers


Limits driving to 13h in a 24h period
(Commercial Vehicle Drivers Hours of Service Regulations, Ministry of Justice, Nov 28, 2009)


Pilots


14h work limit in 24h

(Transport Canada)


Marine navigators


Mandatory 10h rest period in 24h

(Transport Canada)



Surgeons

No regulation on work hours


Conflicting evidence regarding effects of
sleep deprivation on physician performance


Negative impact on performance, cognition and
mood
(
Dru

et al, 2007;
Koslowsky

and
Babkoff

1992;
Pilcher

and
Huffcutt

1996)


Simulated laparoscopic skills in residents


↑completion times and errors
(
Eastridge

et al 2003,
Taffinder

et al
1998,
Grantcharov

et al 2001)


Improved economy of motion, ↓time and errors
(
DeMaria

et al 2005)


Performance impairment is equal to BAC of 0.1%

(Dawson and Reid 1997, Williamson and Feyer 2000)


Performance of surgical skills in a sleep
deprived state have been compared to
being legally drunk


However, there are no studies directly comparing
sleep deprivation
vs

intoxication


Most research studies investigating surgical
skills in sleep deprived state are with
residents


To determine if sleep deprivation is
equivalent to being legally drunk in
performance of simulated laparoscopic
surgical skills by staff surgeons


Being sleep deprived is not equivalent to
being legally intoxicated in the performance
of simulated laparoscopic surgical skills


Participants:

nine staff gynecologists with
privileges to perform laparoscopic surgery
in the RQHR and who provided informed
consent


Performance of three tasks:






2

conditions:

Methods


Evaluated for task completion time, # of
errors


Scored according to GOALS criteria


Analysis of data with repeated measures
factorial ANOVA

Sleep deprived

EtOH

Cup
drop

Pass the
rope

Peg
transfer

Sleep deprived

EtOH

Cup
drop

Pass the
rope

Peg
transfer

Efficiency

Depth perception

Bimanual dexterity

Sleep deprived
EtOH

Cup
drop

Pass
the
rope

Peg
transfer

Cup
drop

Pass
the
rope

Peg
transfer

Cup
drop

Pass
the
rope

Peg
transfer

Sleep deprived

EtOH

Cup
drop

Pass the
rope

Peg
transfer


More difficult tasks are harder to perform
regardless of state


Although results were similar for the easier
two tasks, there was a
larger drop in
performance for the hardest task when
intoxicated


Suggests sleep deprivation is not equivalent
to being legally intoxicated
for the
performance of surgical skills in staff
surgeons


Expand research participants to
laparoscopic surgeons of several
specialities


Investigate cognitive abilities in each state


Compare junior vs. senior residents vs. staff
surgeons


Assess performance on
LapMentor

simulation trainer



Co
-
authors: F.
Mohtashami
, E.
Karreman
, J.
Thiel


Dilawri

Simulation Centre


Murray
Schiltz


Spencer Lawton


RQHR Ob/
Gyns


Eastridge
, B.J., Hamilton, E.C., O’Keefe, G.E.,
Rege
, R.V., Valentine, R.J., Jones, D.J.,
Tesfay
, S.
and
Thal
, E.R.. Effect of sleep deprivation on the performance of simulated laparoscopic
surgical skill. The American Journal of Surgery (2003) 186, p169
-
174.


Grantcharov

TP,
Bardram

L,
Funch
-
Jensen P, et al. Laparoscopic performance after one night on
call in a surgical department: prospective study. BMJ 2001;323:1222
-
1223.


Taffinder

NJ, McManus IC,
Gul

Y, et al. Effect of sleep deprivation on surgeons’ dexterity on
laparoscopy simulator. Lancet 1998;352:1191


Dru

M,
Bruge

P, Benoit O, Mason N,
Combes

X,
Margenet

A,
Dhonneur

G, Marty J. Overnight
duty impairs behaviour, awake activity and sleep in medical doctors. European Journal of
Emergency Medicine 2007; 14(4):199
-
203.


Pilcher

JJ,
Huffcutt

AI. Effects of sleep deprivation on performance: a meta
-
analysis. Sleep.
1996 May;19(4):318

326.


Koslowsky

M,
Babkoff

H. Meta
-
analysis of the relationship between total sleep deprivation and
performance.
Chronobiol

Int

1992; 9: 132

136.


DeMaria

EJ, McBride CL, Broderick, TJ, Kaplan BJ. Night call does not impair learning of
laparoscopic skills.
Surg

innov

2005; 12(2):145
-
149.


Dawson D, Reid K. Fatigue, alcohol and performance impairment. Nature 1997;388:235.


Williamson AM, Feyer A
-
M. Moderate sleep deprivation produces impairments in cognitive and
motor performance equivalent to legally prescribed levels of alcohol intoxication.
Occup

Environ Med 2000; 57:649
-
655.