Objective assessment of sleep and alertness in medical house staff and the impact of protected time for sleep

We studied 26 physicians in postgraduate medical training ("house staff") to objectively quantify their sleep, alertness, and psychomotor performance while working on call. This study provided precise data on the extent of sleep deprivation during a typical call night, the workload factors predictive of sleep loss, and the extent to which protected time for sleep within the call night can ameliorate sleep loss and consequent daytime sleepiness. We used ambulatory EEG recording equipment and a standardized computer-based performance test to monitor sleep and alertness over the course of a 36-hour call day. Comparisons were made between interns provided with 4 hours of protected time for sleep by a covering resident ("night-float") and interns without such coverage. As anticipated, we found evidence that hospital interns were severely sleep-deprived, to an extent even greater than prior behavioral observations have suggested. Interns in both conditions spent an average of less than 5 hours (295.4 minutes) in bed attempting to sleep and obtained an average of 3.67 hours (220.1 minutes) of sleep (range 37.4-358.4 minutes). Provision of the night-float for 4 hours did not significantly change total sleep time (TST) (212.8 minutes covered vs. 224.9 minutes uncovered), but sleep efficiency was significantly improved (86.5% vs. 70.3%; p = 0.001). Covered interns also obtained significantly more slow-wave sleep than the uncovered interns (65.4 minutes vs. 51.1 minutes; p = 0.05). However, measures of alertness and performance were not significantly different between the two groups and were only weakly related to TST. These data suggest that significant chronic sleep deprivation is relatively unaffected by sleep obtained in the hospital and that provision of protected time for sleep does not significantly improve TST.     

Approximation of sleep duration and sleep efficiency using actography

The actography is a cost-effective semiobjective method to measure sleep/wake-cycles. This is the reason why the actography should be used first. The actography is after the cost-intensive polysomnography the best method in diagnosis of sleep disorders and monitoring of sleep disorder therapy. Actography over several days allows a precise estimation of total sleep time and sleep efficiency and makes possible an analysis of sleep/wake in natural conditions. The estimation is better if the patient is in high wake body activity and the recording time is longer. The mean values of total sleep time and sleep efficiency from polysomnography and actography are congruent.     

Neuropsychological functioning and determinants of morning alertness in patients with obstructive sleep apnea syndrome

Neuropsychological functioning is reported to be impaired in patients suffering from obstructive sleep apnea syndrome (OSAS). This syndrome is characterized by nocturnal respiratory disturbances, blood oxygen desaturations, sleep fragmentation, and excessive daytime sleepiness. Opinions are divided concerning the exact relationship between the observed cognitive deficits, nocturnal hypoxia, sleep disruption, and impaired daytime alertness. In the present study, morning neuropsychological function of 26 moderate to severe middle-aged sleep apneics is compared to that of 22 primary insomniacs. There were no performance differences on a range of neuropsychological tests among the two patient groups. In addition, the data suggest that morning alertness impairment, which is closely associated with a lack of slow wave sleep (SWS) and rapid eye movement (REM) sleep, is of major importance in inducing poorer cognitive performance in patients with moderate to severe sleep apnea.     

Predicting the effects of leadership training and experience from the contingency model.

Attempts to reconcile previous findings that leadership experience and training very often do not improve group and organizational performance. Experience and training can be viewed as improving the favorableness of the leadership situation. According to F. Fiedler's contingency model, this should increase the performance of low-least preferred coworker (LPC) leaders in very favorable and unfavorable situations, but decrease the performance of high-LPC leaders. It should increase performance of high-LPC leaders in intermediate situations but decrease that of low-LPC leaders. These hypotheses are supported by analyses of data from previous studies. (15 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting the duration of emotional experience: Two experience sampling studies.

The authors present 2 studies to explain the variability in the duration of emotional experience. Participants were asked to report the duration of their fear, anger, joy, gratitude, and sadness episodes on a daily basis. Information was further collected with regard to potential predictor variables at 3 levels: trait predictors, episode predictors, and moment predictors. Discrete-time survival analyses revealed that, for all 5 emotions under study, the higher the importance of the emotion-eliciting situation and the higher the intensity of the emotion at onset, the longer the emotional experience lasts. Moreover, a reappearance, either physically or merely mentally, of the eliciting stimulus during the emotional episode extended the duration of the emotional experience as well. These findings display interesting links with predictions within N. H. Frijda's theory of emotion, with the phenomenon of reinstatement (as studied within the domain of learning psychology), and with the literature on rumination. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting future clinical adjustment from treatment outcome and process variables.

General issues relating to the use of outcome and process data from the treatment of antisocial children to predict future childhood adjustment are examined. For outcome measures, it was assumed that variables based on direct observation of child behavior would provide a better predictor of long-term adjustment than would ratings by participant adults. Long-term adjustment measures consisted of police arrest and out-of-home placement data collected 2 years after treatment termination. Observation data collected at termination predicted future police arrest, but parent and teacher ratings did not. It was also hypothesized that measures of the processes thought to produce the changes in child antisocial behavior would serve as predictors of future adjustment. The data supported this hypothesis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting survival from out-of-hospital cardiac arrest: a graphic model

STUDY OBJECTIVE: To develop a graphic model that describes survival from sudden out-of-hospital cardiac arrest as a function of time intervals to critical prehospital interventions. PARTICIPANTS: From a cardiac arrest surveillance system in place since 1976 in King County, Washington, we selected 1,667 cardiac arrest patients with a high likelihood of survival: they had underlying heart disease, were in ventricular fibrillation, and had arrested before arrival of emergency medical services (EMS) personnel. METHODS: For each patient, we obtained the time intervals from collapse to CPR, to first defibrillatory shock, and to initiation of advanced cardiac life support (ACLS). RESULTS: A multiple linear regression model fitting the data gave the following equation: survival rate = 67%-2.3% per minute to CPR-1.1% per minute to defibrillation-2.1% per minute to ACLS, which was significant at P < .001. The first term, 67%, represents the survival rate if all three interventions were to occur immediately on collapse. Without treatment (CPR, defibrillatory shock, or definitive care), the decline in survival rate is the sum of the three coefficients, or 5.5% per minute. Survival rates predicted by the model for given EMS response times approximated published observed rates for EMS systems in which paramedics respond with or without emergency medical technicians. CONCLUSION: The model is useful in planning community EMS programs, comparing EMS systems, and showing how different arrival times within a system affect survival rate.     

Predicting longitudinal changes in caregiver physical and mental health: A stress process model.

Alzheimer's family caregivers (N?=?122) reported on physical and mental health, as well as stress process variables, at baseline and at a 1-year follow-up. Hierarchical regression analyses of stress process models revealed that increases in primary stressors (e.g., patient self-care and behavioral problems) did not directly affect changes in the mental and physical health outcome variables. However, analyses of models of direct, mediated, and moderated effects revealed that psychosocial resource variables (appraisals, coping responses, and social support) were related to caregiver outcomes over time through several mechanisms. In particular, benign appraisals of stressors, the use of approach coping, and greater levels of social support were associated with more positive caregiver health outcomes over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting the duration of mechanical ventilation. The importance of disease and patient characteristics

STUDY OBJECTIVE: To analyze the determinants of an individual patient's duration of mechanical ventilation and assess interhospital variations for average durations of ventilation. DESIGN: Prospective, multicenter, inception, cohort study. SETTING: Forty-two ICUs at 40 US hospitals. PATIENTS: A total of 5,915 patients undergoing mechanical ventilation on ICU day 1 selected from the acute physiology and chronic health evaluation (APACHE) III database of 17,440 admissions. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Utilizing APACHE III data collected on the 5,915 patients, multivariate regression analysis was performed on selected patients and disease characteristics to determine which variables were significantly associated with the duration of mechanical ventilation. An equation predicting duration of ventilation was then developed using the significant predictor variables and its accuracy was evaluated. Variables significantly associated with duration of ventilation included primary reason for ICU admission, day 1 acute physiology score (APS) of APACHE III, age, prior patient location and hospital length of stay, activity limits due to respiratory disease, serum albumin, respiratory rate, and PaO2/FIo2 measurements. Using an equation derived from these variables, predicted durations of ventilation were then calculated and compared with actual observed durations for each of the 42 ICUs. Average duration of ventilation for the 42 ICUs ranged from 2.6 to 7.9 days, but 60% of this variation was accounted for by differences in patient characteristics. CONCLUSIONS: For patients admitted to the ICU and ventilated on day 1, total duration of ventilation is primarily determined by admitting diagnosis and degree of physiologic derangement as measured by APS. An equation developed using multivariate regression techniques can accurately predict average duration of ventilation for groups of ICU patients, and we believe this equation will be useful for comparing ventilator practices between ICUs, controlling for patient differences in clinical trials of new therapies or weaning techniques, and as a quality improvement mechanism.     

Separating the effects of alertness from the effects of encoding in a pitch-imagery task

This article describes a general approach entitled Wizard of Oz hypnotherapy for use with 8- to 13-year-old children who are generally difficult to treat because of their intermittent inattentive, impulsive, and oppositional characteristics. We have utilized this approach as an adjunct to cognitive-behavioral therapy individually and within a small group format. The Wizard of Oz metaphor is integrated into a hypnotherapy approach designed to facilitate personal problem-solving, improve self-regulation skills, and enhance self-esteem/efficacy. As an adjunct to cognitive-behavioral therapy, this procedure improves the therapeutic alliance, heightens young clients' interest in therapy procedures, and improves overall cooperation with treatment. The therapeutic and hypnotic characteristics that may contribute to this technique's effectiveness are discussed.     

Predicting the effects of leadership training and experience from the contingency model: A clarification.

Clarifies some points that the author's article (see record 1972-27994-001), which presented a new interpretation of leadership training and experience, did not make sufficiently clear, and corrects the various misinterpretations of the findings as well as of the underlying theory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Companionable sleep: Social regulation of sleep and cosleeping in egyptian families.

This exploratory study examined family sleep patterns and quality in a setting of normative napping and cosleeping. Participants were 78 members of 16 families from 2 locales in Egypt (Cairo and a village). Each family member provided a history of sleeping arrangements, 1 week of continuous activity records, and details of each sleep event. Sleep records documented late-onset and dispersed sleep patterns with extensive cosleeping. Of recorded sleep events, 69% involved cosleeping, 24% included more than 1 cosleeper, and only 21% were solitary. Mid-late afternoon napping occurred on 31% of days, and night sleep onsets averaged after midnight. Age and gender structured sleep arrangements and, together with locale, extensively explained sleep behavior (onset, duration, total) and quality. Cosleepers had fewer night arousals, shorter and less variable night sleep duration, and less total sleep. Increased solitary sleep in adolescents and young adults was associated with increased sleep dysregulation, including exaggerated phase shifts in males and more nighttime arousals in females. Where normative, cosleeping may provide psychosensory stimuli that moderate arousal and stabilize sleep. Such moderating features may address important self-regulatory developmental needs during adolescence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Otorhinolaryngologic problems of Wegener's granulomatosis of three months duration]

A case of Wegener's granulomatosis in a 30 years old female was described. The authors have presented the diagnostic difficulties and treatment this rare disease.     

Correlational tests of predictions from a process model of the interview.

We conducted a field study to test eight propositions derived from a process model of the selection interview (Dipboye, 1982; Dipboye & Macan, 1988). According to the model, interviewers' preinterview impressions of an applicant bias the subsequent conduct of the interview and processing of information in the direction of confirming these initial impressions. To test predictions from the model, we surveyed managers and the applicants they interviewed in each of 164 interviews. In support of the model, interviewers' preinterview evaluations were positively related to postinterview evaluations of applicant qualifications and process variables predicted to mediate this relation. Results also supported the model in that interviewers with favorable preinterview impressions were more likely to attribute good interview performances to the applicants' qualifications for the job and poor performances to external factors. Contrary to the model, confidence failed to moderate the above findings, and preinterview impressions were not predictive of applicant reports of interviewers' time spent in questioning. Some possible implications of the model for future research and for improving interview practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting the effects of leadership training and experience from the contingency model: Some remaining problems.

F. F. Fiedler's (see PA, Vol 52:Issue 2) clarifying remarks on using the contingency model to predict effects of leadership training and experience have resolved many of the original article's apparent inconsistencies. Some problems still remain, however, which could seriously impair the usefulness of Fiedler's recommendations. Some of these problems and some possible courses of action are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)