Management of sleep disorder by preceptors in a family medicine residency program in Calgary, Alberta: a mixed-methods study.

BACKGROUND: Most prescriptions for sedative-hypnotics are written by family physicians. Given the influence of preceptors on residents' prescribing, this study explored how family physician preceptors manage sleeping problems. METHODS: Family physician preceptors affiliated with a postgraduate training program in Alberta were invited to participate in this mixed-methods study, conducted from January to October 2021. It included a quantitative survey of preceptors' attitudes to treatment options for sleep disorder, perceptions of patient expectations and self-efficacy beliefs. Participants indicated their responses on a 5-point Likert scale ranging from "strongly disagree" to "strongly agree." Respondents were then asked whether they were interested in participating in a semistructured qualitative interview that elicited preceptors' management of sleep disorder in response to a series of vignettes. We analyzed the quantitative data using descriptive statistics and the qualitative interviews using thematic analysis. RESULTS: Of the 76 preceptors invited to participate, 47 (62%) completed the survey, and 10 were interviewed. Thirty-two survey respondents (68%) were in academic teaching clinics, and 15 (32%) were from community clinics. The majority of participants (34 [72%]) agreed they had sufficient expertise to use nondrug treatment. Most (43 [91%]) had made efforts to reduce prescribing, and 45 (96%) felt able to support patients empathically when not using sleeping medication. The qualitative data showed that management of sleeping disorder was emotionally challenging. Participants hesitated to prescribe sedatives and reported "exceptions" to prescribing, many of which included indications within guideline recommendations. Participants were reluctant to change a colleague's management. INTERPRETATION: Preceptors were confident using nonpharmacologic management to treat sleep disorder and hesitant to use sedative-hypnotics, presenting legitimate use of sedatives as exceptional behaviour. Acknowledging social norms and affective aspects involved in prescribing may support balanced prescribing of sedative-hypnotics for sleep disorder and reduce physician anxiety.

Spontaneous visceral artery dissections in otherwise normal arteries: Clinical features, management, and outcomes compared with fibromuscular dysplasia.

OBJECTIVE: Visceral artery dissection with otherwise normal-appearing arteries (VADNA), diagnosed on imaging and suggestive of segmental arterial mediolysis, is a poorly understood disease entity. Study objectives were to define the clinical features, management, and outcomes of patients with VADNA compared with patients with fibromuscular dysplasia (FMD). METHODS: In this single-center retrospective cohort study, consecutive patients with a diagnosis of VADNA or FMD evaluated in the Mayo Clinic Gonda Vascular Center (January 1, 2000-April 1, 2017) were identified. Patient demographics, symptom presentation, management, composite adverse arterial events (recurrent arterial dissection, stroke or transient ischemic attack, myocardial infarction, mesenteric or renal infarction, or need for revascularization), and overall survival were compared between VADNA and FMD patients. RESULTS: There were 103 VADNA patients (age [mean ± standard deviation], 51.7 ± 11.0 years; 27.9% female) and 248 FMD controls (49.8 ± 8.9 years; 81.8% female) identified. The most common symptom for VADNA patients was abdominal or flank pain (80.6%). For FMD, chest pain, headache, and dizziness were more frequent presenting complaints. The median follow-up was longer for VADNA patients (42 months; interquartile range, 9-76 months) compared with FMD patients (19 months; interquartile range, 0.6-52 months; P < .001). During this time interval, there were twofold more composite arterial events in the VADNA group compared with the FMD group (17% vs 8.1%; P = .01). This difference was primarily driven by recurrent dissections. All-cause mortality was low and similar for both groups (3.8% vs 0.4%; P = .10). CONCLUSIONS: VADNA patients carry a higher risk of recurrent arterial events compared with those with FMD. This difference was primarily driven by recurrent dissections.

Feasibility and effectiveness of massage therapy for symptom relief in cardiac catheter laboratory staff: a pilot study.

A pilot study was conducted to assess the feasibility and efficacy of massage therapy for cardiac catheterization laboratory staff. Staff members (N = 50) were randomly assigned to 5 or 10 weekly 30-min massages, followed by outcomes assessment. A control group (n = 10) receiving no massage therapy underwent comparable assessment. Visual analog scales, the t test, and the repeated measures model evaluated fatigue, pain, relaxation, stress/anxiety, tension/discomfort, and scheduling ease at baseline, 5 weeks, and 10 weeks. The Aickin separation test was used to assess feasibility of further research. Overall, 90% (337/375) of massage appointments were used. No significant effects were observed, but the Aickin separation test supported further research on massage therapy for fatigue, pain, relaxation, and tension/discomfort. Conducting massage therapy in the workplace is logistically feasible. Larger, longitudinal trials are warranted to better evaluate its effects on staff.

Psychophysiologic responses of invasive cardiologists in an academic catheterization laboratory.

BACKGROUND: This study examined the psychophysiologic responses of invasive cardiologists during cardiac catheterizations. Because occupations are most stressful when one is not in control, the effect of a teaching versus an autonomous role on the psychophysiologic response of invasive cardiologists was investigated. METHODS: The subjects were 9 invasive cardiologists. Psychophysiologic variables such as state anxiety and salivary cortisol levels were measured before and after each invasive cardiologist performed 7 cardiac catheterizations. Heart rate was measured before, during, and after procedures. Three procedures were studied while invasive cardiologists were in the primary operator (autonomous) role with full responsibility and control, whereas 4 were studied while the subjects were in the secondary assistant (teaching) role with full responsibility and no control. RESULTS: There were no significant differences in physiologic arousal (heart rate and salivary cortisol levels) between catheterizations performed in the autonomous role versus those in the teaching role. However, the perceived anxiety scores were higher when in the teaching role versus when in the autonomous role. There were significant differences in psychophysiologic measurements of stress between less experienced cardiologists (out of training < 5 years) and more experienced cardiologists (out of training > 5 years). Less experienced invasive cardiologists had significantly higher trait anxiety (38.4 vs 31.7, P = .001), baseline salivary cortisol levels (0.51 vs 0.33, P = .01), and heart rate change (50.1 vs 27.4 beats/min, P = .001) during procedures compared with more experienced cardiologists. CONCLUSIONS: Although there were no overall differences in the physiologic response to the autonomous and teaching roles, there was a higher perceived state of anxiety when in the teaching role. Less experienced invasive cardiologists had higher psychophysiologic measurements of stress during invasive procedures than did more experienced cardiologists.