***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : Research evaluating fatigue-induced skills decline has focused on acute sleep deprivation rather than the effects of circadian desynchronization associated with multiple shifts . As a result , the number of consecutive night shifts that residents can safely be on duty without detrimental effects to their technical skills remains unknown . A prospect i ve observational cohort study was conducted to assess the impact of 7 successive night shifts on the technical surgical performance of junior residents . Methods : The interventional strategy included training 21 residents from surgery and allied disciplines on a virtual reality surgical simulator , towards the achievement of preset benchmark scores , followed by 294 technical skills assessment s conducted over 1764 manpower night shift hours . Primary outcomes comprised serial technical skills assessment s on 2 tasks of a virtual reality surgical simulator . Secondary outcomes included assessment s of introspective fatigue , duration of sleep , and prospect i ve recordings of activity ( number of “ calls ” received , steps walked , and patients evaluated ) . Results : Maximal deterioration in performance was observed following the first night shift . Residents took significantly longer to complete the first ( P = 0.002 ) and second tasks ( P = 0.005 ) compared with baseline . They also committed significantly greater numbers of errors ( P = 0.025 ) on the first task assessed . Improved performance was observed across subsequent shifts towards baseline levels . Conclusions : Newly acquired technical surgical skills deteriorate maximally after the first night shift , emphasizing the importance of adequate preparation for night rotas . Performance improvements across successive shifts may be due to ongoing learning or adaptation to chronic fatigue . Further research should focus on assessment s of both technical procedural skills and cognitive abilities to determine the rotas that best minimize errors and maximize patient safety PURPOSE The Accreditation Council for Graduate Medical Education ( ACGME ) work-hour restrictions have prompted many surgical training programs to adopt a night-float resident coverage system ( NF ) . Dissatisfaction with NF prompted us to transition to a rotating junior resident call model ( Q4 ) with 24-hour call shifts at the outset of the 2007 - 2008 academic year . We performed a prospect i ve study to determine the influence of this transition on resident education , morale , and quality of life , as well as on ACGME work rule compliance and American Board of Surgery In-Training Examination ( ABSITE ) scores . METHODS Residents were surveyed after 1 year of NF and again 1 year after the introduction of Q4 .  Responses to a series of statements about the influence of the call model ( NF or Q4 ) on educational opportunities and morale were solicited . The survey used a 5-point Likert response scale ( 1 = complete disagreement to 5 = complete agreement ) . Median values of participant responses were calculated and compared using the Wilcoxon rank-sum test . Compliance with ACGME work rules , ABSITE scores , and operative case logs from the 2006 - 2007 and 2007 - 2008 academic years were also compared . RESULTS Residents were significantly more enthusiastic about Q4 compared with NF , particularly when asked about the influence these systems had on morale ( median response = 4.0 [ Q4 ] compared with 2.0 [ NF ] ; p = 0.001 ) and engagement of residents by the teaching faculty ( median response = 4.0 [ Q4 ] compared with 1.0 [ NF ] ; p = 0.001 ) . Case logs revealed a similar operative experience for first-year residents irrespective of the call schedule ( p = 0.51 ) . Excellent compliance with ACGME work rules was maintained as reflected by the percentage of monthly 80-hour violations per resident months worked ( 3 % [ Q4 ] compared with 0.7 % [ NF ] ) . No difference was observed in the ABSITE scores of first-year residents ( a mean percentile point increase of 1 was found after the introduction of Q4 ) . CONCLUSIONS Educational opportunities , compliance with ACGME work rules , and ABSITE scores can be preserved despite a transition from NF to Q4 .  Residents greatly prefer a rotating call schedule CONTEXT In their first year of postgraduate training , interns commonly work shifts that are longer than 24 hours . Extended- duration work shifts are associated with increased risks of automobile crash , particularly during a commute from work . Interns may be at risk for other occupation-related injuries . OBJECTIVE To assess the relationship between extended work duration and rates of percutaneous injuries in a diverse population of interns in the United States . DESIGN , SETTING , AND PARTICIPANTS National prospect i ve cohort study of 2737 of the estimated 18,447 interns in US postgraduate residency programs from July 2002 through May 2003 . Each month , comprehensive Web-based surveys that asked about work schedules and the occurrence of percutaneous injuries in the previous month were sent to all participants . Case-crossover within-subjects analyses were performed . MAIN OUTCOME MEASURES Comparisons of rates of percutaneous injuries during day work  ( 6:30 am to 5:30 pm ) after working overnight ( extended work ) vs day work that was not preceded by working overnight ( nonextended work ) . We also compared injuries during the nighttime ( 11:30 pm to 7:30 am ) vs the daytime ( 7:30 am to 3:30 pm ) . RESULTS From a total of 17,003 monthly surveys , 498 percutaneous injuries were reported ( 0.029/intern-month ) . In 448 injuries , at least 1 contributing factor was reported . Lapse in concentration and fatigue were the 2 most commonly reported contributing factors ( 64 % and 31 % of injuries , respectively ) . Percutaneous injuries were more frequent during extended work compared with nonextended work ( 1.31/1000 opportunities vs 0.76/1000 opportunities , respectively ; odds ratio [ OR ] , 1.61 ; 95 % confidence interval [ CI ] , 1.46 - 1.78 ) . Extended work injuries occurred after a mean of 29.1 consecutive work hours ; nonextended work injuries occurred after a mean of 6.1 consecutive work hours . Injuries were more frequent during the nighttime than during the daytime ( 1.48/1000 opportunities vs 0.70/1000 opportunities , respectively ; OR , 2.04 ; 95 % CI , 1.98 - 2.11 ) . CONCLUSION Extended work duration and night work were associated with an increased risk of percutaneous injuries in this study population of physicians during their first year of clinical training The stress and long working hours of medical residency have become the basis for controversy over whether current training structures and processes adversely affect residents ' skills and well-being and the quality of patient care . The authors measured cognitive and skills performances of 45 sleep-deprived pediatrics residents by using questions like those on the pediatrics board certification examination and using patient-care tasks that required coordination and dexterity . The residents were r and omly divided into two groups – one stayed awake for 24 hours , the other for 34 hours– and were tested on cognitive and skills performances  before and after sleep deprivation . Sleep deprivation did not have a significant effect on cognitive performance . Of the three skills tested , the residents overall needed more time to perform umbilical artery catheterization , but the group deprived of sleep for 34 hours performed vein cannulation more quickly than the group deprived for 24 hours . Implication s for these findings are discussed in the context of the ongoing controversy over the structure and process of medical education BACKGROUND Although sleep deprivation has been shown to impair neurobehavioral performance , few studies have measured its effects on medical errors . METHODS We conducted a prospect i ve , r and omized study comparing the rates of serious medical errors made by interns while they were working according to a traditional schedule with extended ( 24 hours or more ) work shifts every other shift ( an " every third night " call schedule ) and while they were working according to an intervention schedule that eliminated extended work shifts and reduced the number of hours worked per week . Incidents were identified by means of a multidisciplinary , four-pronged approach that included direct , continuous observation . Two physicians who were unaware of the interns ' schedule assignments independently rated each incident . RESULTS During a total of 2203 patient-days involving 634 admissions , interns made 35.9 percent more serious medical errors during the traditional schedule than during the intervention schedule ( 136.0 vs. 100.1 per 1000 patient-days , P<0.001 ) , including 56.6 percent more nonintercepted serious errors ( P<0.001 ) . The total rate of serious errors on the critical care units was 22.0 percent higher during the traditional schedule than during the intervention schedule ( 193.2 vs. 158.4 per 1000 patient-days , P<0.001 ) . Interns made 20.8 percent more serious medication errors during the traditional schedule than during the intervention schedule ( 99.7 vs. 82.5 per 1000 patient-days , P=0.03 ) . Interns also made 5.6 times as many serious diagnostic errors during the traditional schedule as during the intervention schedule ( 18.6 vs. 3.3 per 1000 patient-days , P<0.001 ) . CONCLUSIONS Interns made substantially more serious medical errors when they worked frequent shifts of 24 hours or more than when they worked shorter shifts . Eliminating extended work shifts and reducing the number of hours interns work per week can reduce serious medical errors in the intensive care unit PURPOSE In response to the Accreditation Council for Graduate Medical Education ( ACGME ) m and ated 80-hour workweek , the night float coverage model was one system created to comply with the work-hour restriction . However , concern has risen as to the operative case volume achieved with this model . The purpose of this study is to determine which system of call ( night float vs traditional rotating call ) provided the senior surgical resident with the greatest surgical case volume while in compliance with the 80-hour workweek . METHODS A nonr and omized sequential study to evaluate the ACGME surgical operative logs ( SOLs ) for surgical chief residents at Memorial University Medical Center ( MUMC ) , which is a level 1 trauma center , from 2006 to 2008 was conducted . The night float system ( NFS ) consisted of a PGY-4 or -5 assigned to in-house general surgery and trauma call from 6:00 pm to 6:00 am Monday through Friday morning and a 24-hour shift from 6:00 am on Sunday to 6:00 am Monday morning . Two months of night call rotations ( nights ) are performed each year per resident with the other 10 months devoted to daytime rotations ( days ) . Conversely , the traditional rotating call schedule ( TCS ) placed each resident on-call every sixth night for a 30-hour period . The TCS required the resident to average approximately 3 weekday and 2 weekend calls per month . The data examined include all cases on the ACGME SOL su bmi tted by each PGY-4 and 5 residents over a 2-year span . Specific design ation of cases between night and day rotations was evaluated while on the NFS , and the total cases volume performed on the NFS and the TCS were analyzed . RESULTS An evaluation of the 2006 - 2007 ( NFS ) year demonstrates an average of 16 cases per month while on nights as compared with 20 cases per month while on day rotations . The caseload on the night rotation was less than day rotations at the PGY-4/5 level . An analysis of the 2006 - 2007 ( NFS ) and 2007 - 2008 ( TCS ) for PGY-4/5 residents revealed an average total caseload of 224 and 276 , respectively . A statistically significant total case difference of 52 cases over the entire year between the 2 systems of call was appreciated . CONCLUSIONS Because of the work-hour restrictions , maximizing surgical education has become a necessity . With the various call systems used throughout general surgery programs , this study specifically compares a traditional 1-in-6 call schedule versus an NFS .  Senior residents lost significant operative experience while operating under an NFS as compared with a TCS . Evidence suggests that the more hours spent by a chief resident during normal operative time elicits more operative experience Forty-two medical residents and interns were studied to evaluate the effect of the stress of medical residency training on-call nights on the hypothalamic-pituitary-adrenal axis . Dexamethasone 1 mg was given at 11:00 p.m. on two separate occasions ; a control ( off-call ) night and on on-call night . Plasma cortisol was measured between 8:00 - 9:00 a.m. the following morning . The number of patient admissions during the on-call night and the number of hours of sleep during both on-call and control nights were recorded . Plasma cortisol decreased to < 138 nmol/l ( < 5 micrograms/dl ) in 41 out of 42 ( 97.6 % ) of the participants following an on-call day and in 40 out of 42 ( 95.2 % ) participants after the control day . The number of hours of sleep during the on-call night was 3.9 + /- 0.29 and during the control night 7.0 + /- 0.11 hours and the number of patient admissions was 3.1 + /- 0.3 . In conclusion General Internal Medicine on-call experience does not produce significant alteration on the hypothalamic-pituitary-adrenal axis Concern is frequently expressed by health care providers and consumers that the work environment of  physicians-in-training  may adversely affect their performance . This article documents the effects of changing from a traditional rotational overnight call schedule for house staff to a schedule design ed to reduce sleep depriv 
    Output:
    
For the limited outcomes measured , most studies supported reducing shift length but did not adequately address the optimal shift duration .