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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_402"
                     title="Minimally Invasive Surgery Takes Toll on MDs, Poll Shows (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/Surgery/GeneralSurgery/tb/18306?impressionId=1265783765615"
                     
      &lt;p&gt;Four out of five surgeons agree: Laparoscopic procedures cause substantial discomfort and pain for the surgeons who perform them.&lt;/p&gt;
&lt;p&gt;More than 80% of surgeons completing an online questionnaire reported pain or stiffness in the hands, neck, back, or legs after performing minimally invasive surgeries, according to Adrian Park, MD, of the University of Maryland Medical Center in Baltimore, and colleagues.&lt;/p&gt;
&lt;p&gt;For most symptoms, the strongest predictor was high case volume, the researchers reported online in the &lt;em&gt;Journal of the American College of Surgeons&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Park and colleagues warned of &quot;an impending epidemic&quot; of occupational injuries among clinicians specializing in minimally invasive surgeries, as such procedures become more common.&lt;/p&gt;
&lt;p&gt;&quot;Now, especially in the face of an impending shortage of general surgeons in the U.S., the last thing that we as a society can afford is surgical careers shortened by occupationally related symptoms and conditions,&quot; they asserted.&lt;/p&gt;
&lt;p&gt;The researchers recommended more research into the ergonomics of laparoscopic surgery, as well as better implementation of existing guidelines meant to reduce injuries associated with the awkward postures and long surgical times often required with these procedures.&lt;/p&gt;
&lt;p&gt;&quot;That research must more clearly and emphatically define the ergonomic impact of minimally invasive surgery on the practicing surgeon (then set about improving it) is now all too painfully clear,&quot; Park and colleagues concluded.&lt;/p&gt;
&lt;p&gt;The researchers invited some 2,000 board-certified members of the Society of American Gastrointestinal and Endoscopic Surgeons (of which Park is currently secretary) to complete the online survey.&lt;/p&gt;
&lt;p&gt;The response rate was 14.4%, with 317 surgeons identified as actively and regularly involved in laparoscopic practices participating.&lt;/p&gt;
&lt;p&gt;Of these, 272 reported experiencing physical symptoms or discomfort that they believed were the result of performing minimally invasive procedures.&lt;/p&gt;
&lt;p&gt;This rate of reported symptoms is markedly higher than that found in earlier studies and surveys, in which the prevalences were in the range of 15% to 60%, Park and colleagues noted.&lt;/p&gt;
&lt;p&gt;They speculated that the current survey, as the most recent, may better reflect the accumulation of injuries over time as surgeons&apos; careers doing minimally invasive surgery have grown longer.&lt;/p&gt;
&lt;p&gt;Fortunately, they found, symptoms were generally not persistent. Only 10.8% of respondents indicated that pain or discomfort continued beyond the immediate aftermath of surgery.&lt;/p&gt;
&lt;p&gt;The largest class of symptoms were those occurring during surgery, with 20.8% of surgeons saying they had symptoms only during procedures and 27.8% reporting symptoms both during and immediately after surgery.&lt;/p&gt;
&lt;p&gt;Another 22.4% indicated that symptoms occurred only immediately after surgery and not persistently.&lt;/p&gt;
&lt;p&gt;About 15% chose &quot;nothing bothers me&quot; in the questionnaire.&lt;/p&gt;
&lt;p&gt;Age appeared to be a factor in the incidence of some complaints, although the pattern was not what might be expected. In particular, hand pain was most common among surgeons younger than 40 and in those older than 60, whereas it was least frequent among surgeons in their 50s.&lt;/p&gt;
&lt;p&gt;Park and colleagues did not report specific hazard ratios or correlation coefficients for case volume as a predictor of symptoms, but they indicated that it was associated with complaints more strongly than other factors such as age, career duration, gender, and height.&lt;/p&gt;
&lt;p&gt;About three-quarters of respondents attributed symptoms to instrument design. Some 40% indicated that operating room table setup and the display monitor location were also contributing factors.&lt;/p&gt;
&lt;p&gt;On the other hand, more than 180 respondents said they had slight or no awareness of published recommendations on surgical ergonomics, such as guidelines published last year in the journal &lt;em&gt;Surgical Endoscopy&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Among those reporting any level of knowledge about the guidelines, only 60% indicated that they had applied it in their practices, Park and colleagues indicated. But more than 90% of surgeons who said they had high awareness of ergonomic guidelines reported putting it to use.&lt;/p&gt;
&lt;p&gt;The researchers said future studies should address other issues not covered adequately in the survey, such as the effects of different monitor positions and instrument designs, as well as whether surgeon discomfort during laparoscopic surgery leads to adverse patient outcomes.&lt;/p&gt;
&lt;p&gt;Park and colleagues also suggested that similar research be conducted on open surgery.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;No external funding for the study was reported.&lt;/p&gt;&lt;p&gt;No potential conflicts of interest were reported.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_422"
                     title="Nurses Often Silent About Workplace Violence (CME/CE)"
                     score="0.012"
                     href="http://www.medpagetoday.com/HospitalBasedMedicine/WorkForce/tb/18335?impressionId=1265783765615"
                     
      The physical and verbal abuse nurses face on the job often goes unreported, according to an Australian survey.&lt;br&gt;
&lt;br&gt;Over the prior year, 52% of nurses in one community hospital said they had been physically assaulted and 69% reported being threatened with violence, according to Rose Chapman, PhD, of the University of Western Australia in Perth, and colleagues.&lt;br&gt;
&lt;br&gt;Verbal abuse was almost universal, being reported by 92% of respondents, the researchers wrote in the February issue of the &lt;em&gt;Journal of Clinical Nursing&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;However, only half mentioned the incidents to senior staff or co-workers, and just 16% filed an official report.&lt;br&gt;
&lt;br&gt;&quot;The reasons for not reporting are many and may include lack of time and management support and the belief that being attacked is &apos;just part of the job,&apos;&quot; they wrote.&lt;br&gt;
&lt;br&gt;The same is true in the U.S., where assaults and under-reporting appear just as common as suggested in the Australian survey, commented Kathleen M. McPhaul, PhD, RN, MPH, of the University of Maryland School of Nursing in Baltimore, who has been involved in such research in the U.S.&lt;br&gt;
&lt;br&gt;A culture change would likely be needed to make a real difference for nurses, Chapman&apos;s group suggested.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;Hospitals would have to ensure that nurses have necessary support, education, encouragement, and time to complete official reports. Nurses who report abuse should get positive feedback from all levels of nursing, they said.&lt;/p&gt;
&lt;p&gt;&quot;If administrators and governments are serious in their intention to reduce workplace violence and provide staff with safe work environments, they should be seen to act on all reported [incidents],&quot; which is rare today, Chapman&apos;s group wrote.&lt;/p&gt;
&lt;p&gt;However, currently there&apos;s no strong lever or incentive to address this kind of workplace abuse since hospitals focus mainly on patient safety as part of accreditation, and national and state workplace safety organizations have little mechanism for monitoring such incidents, McPhaul noted.&lt;/p&gt;
&lt;p&gt;The researchers&apos; survey was intended to reach all 332 nurses working at one nontertiary hospital across all departments  --  emergency, medical, surgical, maternity, pediatric, and mental health.&lt;/p&gt;
&lt;p&gt;The 113 nurses who responded were mainly women in their early 40s who worked part time.&lt;/p&gt;
&lt;p&gt;Among them, about three-quarters reported at least one incident of workplace violence over the preceding 12 months  --  25% said it occurred weekly, 27% said monthly, and for 25% it was rarer, at once every six months. &lt;ul&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Fully 30% of the nurses said they had been involved in an episode involving a weapon  --  often hospital equipment and more rarely a knife or gun.&lt;/p&gt;
&lt;p&gt;The number of total incidents was lowest among nurse midwives, with a mean of 1.67 per year.&lt;/p&gt;
&lt;p&gt;Not surprisingly, the rate was highest among emergency department and mental health staff, who reported an average of 46.43 and 40.39 episodes over 12 months.&lt;/p&gt;
&lt;p&gt;One reason behind the high risk in these two departments may be the &quot;shift to a community-based approach to mental health care and a reduction in mental health beds&quot; such that the same psychiatric patients that assault mental health department nurses are mainstreamed to the emergency department as their point of entry to the hospital, the researchers said.&lt;/p&gt;
&lt;p&gt;However, more years of experience or higher educational qualification didn&apos;t appear to protect nurses. Senior nurse unit managers and clinical nurse specialists actually reported more physical assaults than less senior nurses.&lt;/p&gt;
&lt;p&gt;Age and gender didn&apos;t predict occurrence or type of incident either.&lt;/p&gt;
&lt;p&gt;When nurses did report workplace violence or verbal abuse, it was most often to their immediate manager (29%), other senior nursing staff (14.5%), or to their friends and colleagues (6%).&lt;/p&gt;
&lt;p&gt;Overall, 30% of nurses who responded to the survey gave as their reason for not reporting that workplace violence happens all the time and is simply part of the job.&lt;/p&gt;
&lt;p&gt;Even among those who did make a report of some sort, half said they thought hospital management failed to act on it.&lt;/p&gt;
&lt;p&gt;In fact, when the researchers audited hospital records, they found that 42 official incident reports had been filed by nurses over the prior one year period, nearly always involving injuries.&lt;/p&gt;
&lt;p&gt;In 95% of the cases, the only action taken by the hospital was making staff in the area aware of the incident. No other actions had been documented.&lt;/p&gt;
&lt;p&gt;The researchers cautioned that the voluntary nature and limited scope of the study may have limited generalizability, although the occurrence of violence against nurses is likely similar across developed countries.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The researchers provided no information on conflicts of interest.&lt;/p&gt;&lt;p&gt;McPhaul reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_418"
                     title="Consumer Group Calls for More Sleep for Residents"
                     score="0.011"
                     href="http://www.medpagetoday.com/HospitalBasedMedicine/WorkForce/tb/18332?impressionId=1265783765615"
                     
      &lt;p&gt;WASHINGTON  --  More that a year after the Institute of Medicine (IOM) issued a &lt;a href=&quot;http://www.medpagetoday.com/PracticeManagement/StaffingScheduling/12004&quot; mce_href=&quot;http://www.medpagetoday.com/PracticeManagement/StaffingScheduling/12004&quot; target=&quot;_blank&quot; title=&quot;IOM&amp;#8200;Calls&amp;#8200;for&amp;#8200;Mandatory&amp;#8200;Naps&amp;#8200;and&amp;#8200;Other&amp;#8200;New&amp;#8200;Sleep&amp;#8200;Rules&amp;#8200;for&amp;#8200;Residents&amp;#8200;&quot;&gt;report &lt;/a&gt;calling for mandatory naps for medical residents, the organization responsible for implementing  --  or rejecting  --  the IOM&apos;s controversial recommendation has yet to make a decision.&lt;/p&gt;
&lt;p&gt;The Accreditation Council for Graduate Medical Education (ACGME), which has formed a work safety task force, has said it will release its recommendations on the 2008 report in the upcoming months, collect comments, and schedule a board of directors vote no sooner than fall.&lt;/p&gt;
&lt;p&gt;In the meantime, the consumer advocacy group Public Citizen is trying to rally support behind adoption of the IOM report, which recommends, among other things, that residents take a five-hour nap for every 16 hour shift. Current standards allow residents to work for 30 hours straight.&lt;/p&gt;
&lt;p&gt;The IOM report determined that standards adopted in 2003  --  which mandated a maximum of 80 hours of work a week, when averaged over a four-week period, and no more than 30 hours straight  --  are not easing the problem of overworked and overtired resident physicians.&lt;/p&gt;
&lt;p&gt;As part of its campaign, Public Citizen launched a Web site this week, &lt;a href=&quot;http://www.wakeupdoctor.org&quot; mce_href=&quot;http://www.wakeupdoctor.org&quot; target=&quot;_blank&quot;&gt;www.wakeupdoctor.org&lt;/a&gt;, to promote safer work hours and more supervision for medical residents.&lt;/p&gt;
&lt;p&gt;In a press call Thursday  --  led by Sidney Wolfe, MD, director of Health Programs for Public Citizen  --  physicians and patient advocates said that current work schedules of residents are dangerous and criticized ACGME for failing to have taken any action.&lt;/p&gt;
&lt;p&gt;&quot;Resident physicians find it very hard to concentrate as exhaustion sets in, especially when operating or evaluating patients beyond 16 hours in a single day on a regular basis,&quot; said John Ingle, MD, an ear, nose, and throat surgery resident at the University of New Mexico Health Sciences Center in Albuquerque, N.M. &quot;During times of extreme fatigue, I find myself less compassionate toward my patients and less tolerant of my colleagues.&quot;&lt;/p&gt;
&lt;p&gt;&quot;My body is not made to work 30 hours or more,&quot; said Dan Henderson, a third-year medical student at the University of Connecticut. &quot;If I&apos;m truly going to do no harm as I pledged, I need a system to protect patients against errors caused by my fatigue. If ACGME isn&apos;t willing to do the right thing, hopefully consumers and lawmakers will be ready to step in.&quot;&lt;/p&gt;
&lt;p&gt;A sleep specialist went through a list of the dangers of sleep-deprivation in a medical setting:&lt;/p&gt;
&lt;p&gt;&quot;Resident physicians working 30-hour shifts make 36% more medical errors caring for women in the intensive care unit ... including 460% more serious diagnostic mistakes than those scheduled to work for 16 hours,&quot; said &lt;span&gt;Chuck &lt;span&gt;Czeisler&lt;/span&gt;, MD, of Harvard and Brigham and Women&apos;s Hospital.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&quot;They are 73% more likely to stab themselves with a scalpel or needle,&quot; he said.&lt;/p&gt;
&lt;p&gt;Czeisler cited a survey that found after a year of working &quot;marathon shifts&quot; one in five residents admitted to making a fatigue-related mistake that injured a patient, and one in 20 said they made a fatigue-related mistake that resulted in the death of a patient.&lt;/p&gt;
&lt;p&gt;However, not everyone is sold on those statistics.&lt;/p&gt;
&lt;p&gt;Perry Pugno, MD, a director of a family practice residency program for 20 years, asserted that no definitive study has proven that the 2003 guidelines aren&apos;t working. He said most sleep studies are performed in a lab or in the transportation industry, and questions their applicability to the hospital setting.&lt;/p&gt;
&lt;p&gt;Besides, he said, &quot;Many people come to work in many industries sleep deprived. Restricting the hours of work doesn&apos;t necessarily mean you&apos;re going to get a well-rested person during the period you&apos;re going to be working.&quot;&lt;/p&gt;
&lt;p&gt;He doubts that residents would be willing or able comply with the 2008 IOM recommendation that they take an uninterrupted nap for five hours between every 16 hour shift. It&apos;s nearly impossible to take a nap in the middle of an intense work shift, said Pugno, who is now the director of the Division of Medical Education at the American Academy of Family Physicians.&lt;/p&gt;
&lt;p&gt;As other critics of the IOM report point out, if more residents are forced to work shorter shifts, they will be handing off the care of their patients to another resident, physician, or nurse more often. And medical errors are more likely to occur when the care of the patient is transferred, Pugno said.&lt;/p&gt;
&lt;p&gt;He recently co-authored a paper that presented results from a survey of 265 residency program directors that asked their opinions of the IOM recommendations. More than 60% disagreed or strongly disagreed with them.&lt;/p&gt;
&lt;p&gt;The long hours serve to educate, Pugno said, and to help build intimate doctor-patient relationships that mandatory nap time would sever. He also said that most directors of residency programs are sympathetic to the sleep needs of their residents and schedule shifts accordingly.&lt;/p&gt;
&lt;p&gt;Cost is also a major issue in implementing the IOM recommendations. In the 2008 report, the IOM authors estimated the changes they recommended  --  which also included greater supervision of residents and transportation home for bleary-eyed residents after a long shift  --  would cost $1.7 billion annually.&lt;/p&gt;
&lt;p&gt;&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_228"
                     title="Nurses Should Have a Bigger Leadership Role in Healthcare"
                     score="-0"
                     href="http://www.medpagetoday.com/PracticeManagement/StaffingScheduling/tb/18080?impressionId=1265783765615"
                     
      &lt;p&gt;Opinion leaders across a wide variety of groups think nurses should have more influence in health policy, planning, and management, according to a new Gallup survey.&lt;/p&gt;
&lt;p&gt;Although nurses are viewed as being the most valued source of health information behind physicians, survey respondents rank them as the least likely of healthcare stakeholders  --  including patients  --  to have a great deal of influence in healthcare reform over the next 10 years.&lt;/p&gt;
&lt;p&gt;This despite the fact that among the 1,504 thought leaders in academia, insurance, health services, government, industry, and the corporate world polled, 51% said nurses are very important in reducing medical errors and improving patient safety, and 50% said they are very influential in improving the quality of patient care.&lt;/p&gt;
&lt;p&gt;The major barriers to increased nurse influence, nearly 70% of respondents said, are perceptions that they are lower on the totem pole than physicians when it comes to decision-making and revenue generation.&lt;/p&gt;
&lt;p&gt;When asked what could be done to ensure that nurses take on more leadership responsibility, the first priority, respondents said, was that they make their voices heard  --  56% had said that nursing lacks a single voice in speaking on national issues. More than half of respondents also noted that there was a lack of opportunities for nurses to advance into leadership positions.&lt;/p&gt;
&lt;p&gt;The survey, conducted by Gallup for the Robert Wood Johnson Foundation, examined professional views of nursing, nursing leadership, the future of the industry, and potential barriers to leadership roles for nurses among various healthcare-related groups. It included responses from opinion leaders in academia (276), health services (253), government (253), industry (253), insurance (237), and the corporate world (232).&lt;/p&gt;
&lt;p&gt;Nine out of 10 said nurses should have more influence in increasing the quality of care and reducing medical errors.&lt;/p&gt;
&lt;p&gt;About 85% said they wanted nurses to have more influence in promoting wellness and preventive care, improving efficiency and cost, coordinating care through the healthcare system, and adjusting care to meet an aging population.&lt;/p&gt;
&lt;p&gt;Additionally, 72% thought increased nurse influence would help the healthcare system adapt to the growing change in ethnic, racial, and cultural diversity in patient populations.&lt;/p&gt;
&lt;p&gt;The opinion leaders were also asked whether they feel there is a nursing shortage in the U.S. Just over 80% said Yes and of those, only 2% said it was not a serious problem.&lt;/p&gt;
&lt;p&gt;To blame for the shortage? Respondents cited a stressful/poor work environment (44% see that as a very important reason), not enough openings in nursing schools (40%), and too many nurses leaving the profession (37%). Only 22% cited low pay as very instrumental in causing the shortage.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20090101_19_1578"
                     title="More Sleep for Residents Could Be Costly"
                     score="-0.005"
                     href="http://www.medpagetoday.com/HospitalBasedMedicine/WorkForce/tb/14305?impressionId=1265783765615"
                     
      WASHINGTON, May 20 -- Teaching hospitals would have to spend up to $183 extra per admission to implement Institute of Medicine (IOM) recommendations that residents works fewer hours and get more naps, researchers said. 
              &lt;p&gt; 
              &lt;p&gt;&quot;Hospitals are likely to incur losses under the IOM-recommended changes,&quot; said the authors of a study in the &lt;em&gt;New England Journal of Medicine.&lt;/em&gt;
              &lt;p&gt; 
              &lt;p&gt;The fatigue-reduction strategies outlined in a 2008 IOM report could cost $1.6 billion a year, but it&apos;s not clear whether they would reduce or increase medical errors, said researchers led by Teryl Nuckols, M.D., from the David Geffen School of Medicine at the University of California Los Angeles. 
              &lt;p&gt; 
              &lt;p&gt;The issue of resident fatigue drew national attention in 2003, when the Accreditation Council for Graduate Medical Education (ACGME) mandated that residents work no more than 80 hours per week (averaged over a four-week period), and no more than 30 hours straight. 
              &lt;p&gt; 
              &lt;p&gt;After those rules went into affect, Congress asked the IOM to do a five-year follow-up study on the effects of the ACGME rules. 
              &lt;p&gt; 
              &lt;p&gt;In December 2008 the IOM concluded that the shortened workweek did not reduce fatigue because residents were trying to cram in the same amount of work into less time, and as a result, were severely sleep deprived.  (See &lt;a href=&quot;http://www.medpagetoday.com/PracticeManagement/StaffingScheduling/12004&quot; target=&quot;blank&quot;&gt;IOM Calls for Mandatory Naps and Other New Sleep Rules for Residents&lt;/a&gt;)
              &lt;p&gt; 
              &lt;p&gt;The IOM report called for an uninterrupted, five-hour nap for every 16-hour shift for residents, a reduced workload, increased supervision, and better managed patient hand-offs. 
              &lt;p&gt; 
              &lt;p&gt;In their study of the IOM proposal, researchers estimated labor costs at 1,206 ACGME-accredited teaching hospitals by examining current working patterns. Then, they designed a probability model to compare labor costs of implementing the recommendations with the mortality rate and the costs of preventable medical errors.
              &lt;p&gt; 
              &lt;p&gt;The potential $1.6 billion price tag for implementing the three recommendations depends greatly on the salary of whomever is filling in for an absent or napping resident, the researchers said. 
              &lt;p&gt; 
              &lt;p&gt;If residents do less work, someone has to pick up the slack, and that would most likely be midlevel healthcare providers such as physicians&apos; assistants or nurse practitioners, the IOM report said.
              &lt;p&gt; 
              &lt;p&gt;The cost per major teaching hospital would be $3.2 million per year to pay for midlevel healthcare providers who could take over some duties for the residents, and $3.5 million per year to hire additional residents. 
              &lt;p&gt; 
              &lt;p&gt;Despite the 2003 rules, many residents still spend nine to 24 hours per week on &quot;noneducation tasks that lower-level providers can perform,&quot; according to the &lt;em&gt;NEJM&lt;/em&gt; study. 
              &lt;p&gt; 
              &lt;p&gt;While proponents of the push for less work and more sleep for residents argue that fatigue can lead to workplace errors, studies have yet to pinpoint how many medical errors occur because clinicians didn&apos;t get enough sleep. 
              &lt;p&gt; 
              &lt;p&gt;Two national studies found cutting residents&apos; hours did not lead to higher patient mortality rates, but it didn&apos;t reduce them either.   (See &lt;a href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/6597&quot; target=&quot;blank&quot;&gt;Residents&apos; Shorter Work Hours Don&apos;t Affect Patients&apos; Mortality&lt;/a&gt;)
              &lt;p&gt; 
              &lt;p&gt;The authors of the latest study acknowledge that the effects of the IOM recommendations are unknown.
              &lt;p&gt; 
              &lt;p&gt;In the best-case scenario, they wrote, making sure residents are well-rested and not overworked could reduce errors by 11.3%, the magic number at which the cost of implementing the IOM recommendations would be neutral. 
              &lt;p&gt; 
              &lt;p&gt;But they noted that the additional hand-offs that would occur if residents were given more breaks could actually lead to a 10% increase in errors. 
              &lt;p&gt; 
              &lt;p&gt;Studies have shown hand-offs are linked to adverse events and longer hospital stays, wrote Melvin Blanchard, M.D., Kenneth Polonksy, M.D., of Washington University School of Medicine, and David Meltzer, M.D., Ph.D., of the University of Chicago, in an accompanying editorial that criticized the IOM recommendations. 
              &lt;p&gt; 
              &lt;p&gt;Drs. Blanchard, Meltzer, and Polonsky said effects of the IOM recommendation on resident education must be considered. They said that clinicians who train residents often set an example by showing an &quot;overriding consideration,&quot; for patients. 
              &lt;p&gt; 
              &lt;p&gt;&quot;The proposed system will signify to our trainees that the overriding consideration is the duration of their shift,&quot; the editorialist wrote, adding that it would be a constant &quot;ethical&quot; dilemma to decide to hand-off a patient because an &quot;arbitrary time limit&quot; has been met.  
              &lt;p&gt; 
              &lt;p&gt;The requirement for days off and naps will hinder residents&apos; ability to follow patients through the entire clinical process, they said. 
              &lt;p&gt; 
              &lt;p&gt;The IOM urged &quot;rapid&quot; implementation of the recommendations. 
              &lt;p&gt; 
              &lt;p&gt;&quot;We strongly disagree,&quot; the editorialists said.  
              &lt;p&gt; 
              &lt;p&gt;The ACGME will decide whether to implement the IOM recommendations. The group has commissioned an independent, outside literature review of studies related to duty hours, fatigue and the resident learning environment, said an ACGME spokesperson. 
              &lt;p&gt; 
              &lt;p&gt;The ACGME is also holding a &quot;Duty Hour Congress&quot; in June. 
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt; The study was supported by the IOM, which was on contract for the Agency for Healthcare Research and Quality (AHRQ) The study authors reported no conflicts of interest. 
              &lt;p&gt; 
              &lt;p&gt;Dr. Blanchard reported receiving grant support from Pfizer. Drs. Meltzer and Polonsky reported no conflicts of interest.   &lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
    </recommendedItem>
</recommendedContent>