Experience from a Singapore tertiary hospital with restructuring of a vascular surgery practice in response to national and institutional policies during the COVID-19 pandemic.

Singapore was one of the first countries to be affected by COVID-19, with the index patient diagnosed on January 23, 2020. For 2 weeks in February, we had the highest number of COVID-19 cases behind China. In this article, we summarize the key national and institutional policies that were implemented in response to COVID-19. We also describe in detail, with relevant data, how our vascular surgery practice has changed because of these policies and COVID-19. We show that with a segregated team model, the vascular surgery unit can still function while reducing risk of cross-contamination. We explain the various strategies adopted to reduce outpatient and inpatient volume. We provide a detailed breakdown of the type of vascular surgical cases that were performed during the COVID-19 pandemic and compare it with preceding months. We discuss our operating room and personal protective equipment protocols in managing a COVID-19 patient and share how we continue surgical training amid the pandemic. We also discuss the challenges we might face in the future as COVID-19 regresses.

Resident Working Hour Restrictions Increased the Workload of the Medical Emergency Team: A Retrospective Observational Study.

BACKGROUND: Restrictions to residents' working hours have been shown to increase the workload of other medical resources; few studies have measured the effects on medical emergency teams (METs). OBJECTIVES: This study evaluated how limiting residents' working hours affected the workload of MET in a pulmonology unit. METHODS: This retrospective observational study analyzed MET activity during periods before and after we limited the working hours of residents in our pulmonary unit to 88 h/wk: Period 1, March 2014 to February 2015; and Period 2, March 2015 to February 2016. Medical emergency team activities, dose (activations/1000 admissions), intensive care unit transfers, and mortality were compared between the two periods for weekdays and for weekends and holidays. RESULTS: There were no significant differences between the two periods in MET dose (85.0 in Period 1 versus 91.3 in Period 2, P = 0.675), intensive care unit transfers (P = 0.828), 30-day mortality (P = 0.701), and 60-day mortality (P = 0.531). However, some activities increased significantly or near significantly in Period 2, including portable echocardiography (P < 0.001), arterial line insertion (P = 0.034), mechanical ventilation (P = 0.063), and fluid therapy (P = 0.220). These increases were greater for weekends and holidays than for weekdays. CONCLUSIONS: Since December 2017, a specific law for improving the training environment and status of residents has been implemented and applied at all hospitals in Korea. This legal restriction to working hours raises concerns regarding other medical personnel and system improvements to ensure patient safety and care continuity.

Sociomedical problems of overwork-related deaths and disorders in Japan.

OBJECTIVES: Cerebrovascular and cardiovascular diseases (CCVDs) and mental disorders, including suicide, are prevalent among overworked individuals in Japan. The 2014 legislation regarding the prevention of overwork-related deaths and disorders has accelerated the research in this field and ultimately the implementation of preventive actions. METHODS: To understand the current problematic situations, the Research Center for Overwork-Related Disorders of the National Institute of Occupational Safety and Health, Japan, conducted analyses of compensated claims for overwork-related CCVDs and mental disorders that were recognized from January 2010 to March 2015. RESULTS: The majority of CCVD cases were the men in their 50s. Transport and postal activities was the highest risk industry. Cerebrovascular cases were higher than cardiovascular ones. Long working hours was the principal factor for CCVDs. The mental disorder cases comprised approximately 70% men and affected younger age groups (peak in the third decade) with various industries at risk. In men, there was an almost equal number of F3 (Mood [affective] disorders) and F4 (Neurotic, stress-related, and somatoform disorders) diagnoses according to the 10th revision of the International Classification of Diseases and Related Health Problems. A larger number of women were diagnosed to have F4. The mental disorder cases were associated not only with long working hours, but also with injuries and disasters as well as interpersonal conflict at work. CONCLUSIONS: Multiple, simultaneous actions need to be made by employees, employers, researchers, and the authorities to achieve the goal of reducing the number of workers suffering from the overwork-related CCVDs and mental disorders.

Massachusetts Voters Reject Nurse Staffing Standards.

Nurses, too, were split on the vote.

Hours of service regulations for professional drivers in continental Latin America.

OBJECTIVES: To describe the hours of service provisions in continental Latin America. DESIGN: Information on regulations of service hours was extracted from either the national transportation authorities or ministries of transportation (or the equivalent institution) from each country. SETTING: Seventeen sovereign countries in continental Latin America (Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Uruguay, Venezuela). PARTICIPANTS: N/A INTERVENTION (IF ANY): N/A MEASUREMENT: Data on (a) limit on work hours, (b) mandatory daily time off (or rest), (c) overall schedule (mandatory weekly time off), and (d) daily breaks were extracted and summarized. RESULTS: Of the 17 countries surveyed, 9 countries have provisions limiting the daily amount of hours of service for professional drivers. Ten have provisions for mandatory daily rest, but only 5 have explicit provisions limiting the number of continuous working days, with mandatory uninterrupted time off >35 hours. Eight countries have provisions for mandatory breaks that limit the hours of continuous driving (ranging from 3 to 5:30 hours). CONCLUSION: Regulations that govern a population with 6 million injuries and over 100,000 deaths per year due to motor vehicle accidents leave important gaps. A minority, 6, of the countries regulated all 3 aspects; daily hours, breaks, and time off, and 3 regulate none of these. The regulations are less precise and restrictive than those in high-income countries, despite the doubled road injury mortality, and likely expose professional drivers and other road users to an increased risk of fatigue-related accidents.

[Occupational health in China, an emerging issue]. / La santé au travail en Chine, une préoccupation naissante.

In Chinese factories, the prevention of occupational illness is inadequate. Public authorities have only recently started to pay attention to the issue. Individual and collective protection measures need to be developed, employees made aware of the issues and controls improved.

[Surgery During Pregnancy - Regulations and Requirements]. / Operieren während der Schwangerschaft ­ Regelungen und Bedarfe.

Due to the marked increase in the numbers of women in medicine, professional and political discussions on equality among doctors are gaining increasing attention. One such issue is "operating during pregnancy". As a result of existing legislation and federal regulations, it has been virtually impossible for pregnant surgeons to continue their surgical work. After approval by the Federal Council or Bundesrat, the revised Maternity Protection Act will come into force on 01.01.2018. It will thereafter be easier for surgeons to operate during pregnancy. The focus will now be on the transformation of workplace practices, in which individual risk assessments of the participating surgeons will be carried out in order to achieve a risk-adapted operation, and thus to prevent premature and unwanted restrictions on the employment of pregnant female surgeons.

[The new methods to define the staffing requirements for doctors,nurses and nurses aides: an example of their implementation in an Italian hospital]. / Le nuove metodologie di valutazione del fabbisognodel personale infermieristico, medico e di supporto: un esempio di applicazione.

. The new methods to define the staffing requirements for doctors, nurses and nurses aides: an example of their implementation in an Italian hospital. The Italian government, after the transposition of European Union legislation on working hours, made a declaration of commitment to increase the number of staff of the National Health Service (NHS). The method for assessing the staffing needs innovates the old one that dated back a few decades. AIM: To implement the method proposed by the Ministry of Health to an Italian hospital and assess its impact on staffing and costs. METHODS: The model was implemented on all the wards, multiplying the minutes of care expected in 2016, dividing the result by 60 to obtain the hours of care, and further dividing by the number of yearly hours of work of a nurse (1418). Same was done for nurses aides. The minutes of care were related to mean weight of the Diagnosis Related Groups of the ward and the results obtained compared to the actual staffing of nurses and nurses aides. The costs of the differences were calculated. RESULTS: The implementation of the model produced an excess of 23 nurses and a scarcity of 95 nurses aides compared to the actual staffing, with an increase of the costs of € 1.828.562,00. CONCLUSIONS: The results obtained and the criticisms received so far show the need of major changes. The data from international studies that associate staffing and patients outcomes and the nurse/patient ratio are macro-indicators already available that may orient choices and investments on the health care professions.

[Work quota setting and man-hour productivity estimation in pathologists]. / Normirovanie truda i otsenka trudozatrat vrachei patologoanatomicheskikh otdelenii.

The paper considers the development and current state of the regulation of work quota setting and remuneration in pathologists. Reasoning from the current staff standards for morbid anatomy departments (units), the authors present a method to calculate the load of pathologists. The essence of the proposed method is demonstrated using a specific example.

Safety and health of professional drivers who drive on Brazilian highways.

Traffic accidents and resulting injuries and deaths have become a global epidemic. In Brazil, most professional drivers, especially truck drivers, face irregular working hours and can be awake for more than 18 hours/day, which reduces their performance and alertness. In this article, we discuss the laws related to Brazilian professional drivers and their current amendments (No. 12,619/2012 and No. 13,103/2015) in relation to working hours at the wheel and rest breaks, which are vital for the quality of life of drivers and society in general. We note that the new law appears to be less efficient than the previous one as it causes insecurity and concern to the users of the transportation system, drivers, and employers. To restrict and reduce accidents, deaths, and injuries in traffic, appropriate legislation is essential, aiming at the safety of workers and users of highways. The law must also benefit the commercial aspect, strengthening the reduction in production and logistics losses. Additionally, traffic education programs are needed, as well as better supervision in relation to total working hours. RESUMO Acidentes de trânsito com consequentes lesões e mortes têm se tornado uma epidemia em nível mundial. No Brasil, a maioria dos motoristas profissionais, sobretudo motoristas de transporte de cargas, enfrenta jornada de trabalho irregular e permanece acordado por mais de 18 horas/dia, o que reduz seu desempenho e estado de alerta. Neste artigo, discutimos as leis dos motoristas profissionais brasileiros e suas alterações vigentes (nº 12.619/2012 e nº 13.103/2015) em relação às horas de trabalho ao volante e a pausas para descanso, imprescindíveis para a qualidade de vida dos motoristas e para a sociedade em geral. Observamos que a nova legislação se mostra menos eficiente que a anterior por causar insegurança e preocupação aos usuários do sistema de transporte, aos próprios motoristas e aos empregadores. Para restringir e reduzir acidentes, mortes e lesões no trânsito, é fundamental uma legislação adequada, que vise à segurança do trabalhador e dos usuários das rodovias. A legislação deve, também, beneficiar o aspecto comercial, que se fortalece pela redução das perdas de produção e logística. Adicionalmente, são necessários programas de educação no trânsito e melhor fiscalização em relação ao tempo total de jornada de trabalho.

Reformas al decreto 1441 del Congreso de la República, Código de Trabajo: decreto No. 007-2017 / Reforms to Decree 1441 of the Congress of the Republic, Labor Code: Decree No. 007-2017

Actualización del Código de trabajo -Decreto No. 1441- Reforma los artículos: 61 literal f); el 269; el 271; adiciona el 271 bis; reforma el 272; el 281; modifica la literal e) y adiciona la literal h) al artículo 292; reforma el artículo 415; crea el artículo 417 y el artículo 418. Contiene 13 Artículos.

Psychological contract breach and employee health: the relevance of unmet obligations for mental and physical health / La ruptura del contrato psicológico de los empleados: la importancia de las obligaciones incumplidas para la salud mental

This study examines the effects of psychological contract breach (PCB) on employee mental and physical health (SF-12) using a sample of 3,870 employees derived from a German longitudinal linked employeremployee study across various industries. Results of multivariate regression models and mediation analysis suggest that PCB affects both the mental and the physical health of employees but is more threatening to employee mental health. In addition, mental health partly mediates the effects of PCB on physical health. Also, the findings of this study show that the relative importance of obligations not met by employers differs according to the specific contents of the psychological contract. In conclusion, the results of this study support the idea that PCB works as a psychosocial stressor at work that represents a crucial risk to employee health (AU)

Este estudio analiza los efectos de la ruptura del contrato psicológico (PCB, según sus siglas en inglés) sobre la salud mental y física (SF-12) de los empleados, utilizando una muestra de 3.870 empleados obtenida de un estudio longitudinal que vincula empleador con empleado en distintas empresas alemanas. Los resultados de los modelos de regresión múltiple y de análisis de mediación indican que la PCB afecta tanto a la salud mental como a la física del empleado, pero es más amenazante para la salud mental. Además, la salud mental modera parcialmente los efectos del PCB en la salud física. Igualmente, los resultados del estudio muestran que la importancia relativa de las obligaciones no cumplidas por parte del empleado varía en función del contenido específico del contrato psicológico. En conclusión, los resultados del estudio avalan la idea de que el PCB funciona como un agente estresante psicosocial en el trabajo, lo que representa un gran riesgo para la salud del empleado (AU)