Browsing by Subject "Outcome Assessment, Health Care"
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Item Single-Center Analysis of the Off-Hour Effect in Cardiogenic Shock Outcomes(2022-12) Harrison, Caroline R.; Berg, Rance E.; Ortega, SterlingThe off-hours effect is a phenomenon where patients admitted during nights and weekends have poorer outcomes than those admitted during weekdays. This observation is often more pronounced in emergent conditions such as cardiogenic shock. Few studies have investigated the presence of an off-hour effect in patients with cardiogenic shock. In my thesis project, I explored the existence of an off-hour effect in 155 cardiogenic shock cases at a major urban hospital by evaluating patient outcomes. Patients admitted during off-hours had higher complication rates (OR=2.66, 95% CI, 1.29 to 5.49; p=0.01). I also found that patients admitted during on-hours waited longer to receive mechanical circulatory support devices after being admitted; however, this did not appear to negatively effect on-hour patient outcomes. While it appears that admission time does influence patient outcomes, the underlying cause for this effect is not yet understood.Item The impact of circadian misalignment on health and wellness in medical students(2020-05) Roig, Christopher A.; Roane, Brandy M.; Cunningham, J. Thomas; Gwirtz, Patricia A.Circadian misalignment, or "social jetlag" refers to a mismatch between the internal circadian clock and external timings (e.g. societal timings) and behaviorally manifests as inappropriately timed sleep/wake cycles or misalignment of sleep patterns with meal timings. Previous literature shows circadian misalignment to contribute to a large number of adverse health outcomes including metabolic changes and disorders, mood disturbance, and decreased daytime functioning. A number of the adverse health outcomes of circadian misalignment, such as depression, suicidality, and burnout are all common within the medical student population. Medical students also tend to exhibit behaviors which promote circadian misalignment, such as staying up late to study, pulling all-nighters for exams, and sleeping in on weekends. Despite these links, very little literature exists regarding the prevalence, manifestations, and effects of circadian misalignment on medical students. This study identifies key behaviors related to circadian misalignment in medical students, as well as identifying negative outcomes associated with these behaviors.