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Ashley Hodge MBA, CCP, FPP Medical University of South Carolina College of Health Professions.
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Transcript of Ashley Hodge MBA, CCP, FPP Medical University of South Carolina College of Health Professions.
The Effect of Sleep Loss and Fatigue on Cardiovascular Perfusion Students: A Mixed Methods Study
Ashley Hodge MBA, CCP, FPPMedical University of South CarolinaCollege of Health Professions
“Nothing seems to bring as much clarity to the function of sleep as spending a night without it.”
-William Killgore
Introduction
“Sleep Loss”
Resident restrictions
Aviation / transportation
History
1896 – Patrick and Gilbert First report of decreased response time
2004- Frey et al. Arithmetic
History
Time-on-task (Lim and Dinges, 2008) Psychomotor vigilance Progressive worsening exacerbated during fatigue Single night of sleep loss
“Wake State Instability” (Doran et al., 2001) Inhibiting neurobiological systems
Individual Differences Age
Fatigue, alcohol and performance impairment
Hand-eye tracking
Performances during sleep deprivation vs. Blood Alcohol Concentration (BAC): 28 hours
17 hours: BAC 0.05%
After 24h wakefulness, corresponded to BAC 0.10%- Legal limit for intoxication
The Effects of Sleep Loss and Fatigue on Resident-Physicians
• 68.9% worked greater than 23 hours
• 17.5% worked continuously over 36 hours
Extended
Work hours
Study
Using a mixed-methods design, the current study aims to determine the effect of acute sleep deprivation on perfusion students, during performance of clinically-relevant tasks utilizing high fidelity simulation.
Study Design
Mixed methods Quantitative
▪High Fidelity Simulation Tasks Qualitative
▪Survey▪Focus Groups
Population
n = 7
Senior Perfusion Students Age: 22-37
Gender: Male: 4 Female: 3
Focus Group
Describe Personal Experiences
“2 cases per day leads to exhaustion”
“I have nodded off while on CPB… could have caused an accident while on CPB”
“Couldn’t remember if I fed my dog”
Concerned about driving home
Sleep loss affects on personal life
“I do not get to see my son”
“I am irritable with my significant other”
“I find myself venting or lashing out at loved ones because of fatigue”
“Chronic Fatigue”
“Weight gain/loss”
Coping Mechanisms
“Sleep all weekend”
“I take naps daily”
“Melatonin / 5 hour energy”
-Room available
Changes
Exam dates
Patient work-ups
End time for
activities
Stanford Sleepiness Scale
Stanford Sleepiness Scale
Baseline 12 hrs 16 hrs 24 hrs0.0
1.0
2.0
3.0
4.0
5.0
6.0
Stanford Sleepiness Scale
Stanford Sleepiness Scale
Epworth Sleepiness Scale (ESS)
Baseline 12 hrs 16 hrs 24 hrs0.0
5.0
10.0
15.0
20.0
25.0
ESS av-erage
ESS Averages vs. Time
Simulation Tasks
Surgeon Protocol
Mock OR
Mock OR
Response Time
Minute 1: Decrease in pO2
Minute 2: Decrease in venous return
Minute 3: Ventricular Fibrillation
Minute 4: Protamine Dosage Calculation
Minute 5: Decrease in MAP
Simulation Sessions
Baseline: 0600
12 hours: 1800
16 hours: 2200
24 hours: 0600 (day 2)
Baseline 12 hrs 16 hrs 24 hrs 0
0.5
1
1.5
2
2.5
3
3.5
Learning Curve
Learning Curve
Response Time
Learning Curve vs. Response Time
Decreased pO2
24 hrs
Poor Venous Return
Ventricular Fibrillation
24 hrs
Drug Calculation
Decreased MAP
Drained Venous Reservoir
Baseline 12 hours 16 hours 24 hours 0
0.5
1
1.5
2
2.5
3
3.5
Number of Oc-curances
Incorrect Drug Calculation
Baseline 12 hours 16 hours 24 hours 0
1
2
3
4
5
6
7
Number of Oc-curances
Conclusions
Sleep loss negatively impacts our participants interpersonal relationships, their health and mental well being and caused irritability in most cases
Over time, the self-assessed alertness decreased
Sleep loss affects performance over time, specifically high functioning cognitive tasks
Study Limitations
Discussion
Inactivity
Student participants
Sample size
Thank You