Random drug testing to reduce the incidence of addiction in anesthesia residents: Preliminary results from one program
ABSTRACT Substance abuse occurs in approximately 1%-2% of anesthesia residents and nearly 80% of programs have had one or more resident (s) with such a problem. Education and control efforts have failed to reduce the frequency of substance abuse. Anesthesia providers have a professional obligation to be drug-free for the well being of their patients. We have instituted a program of preplacement and random urine testing of residents in anesthesiology in an attempt to decrease the incidence of substance abuse. We demonstrate that such a program is feasible, despite logistic and cultural obstacles. Larger multi-institutional studies will be required to determine whether instituting a program of random urine testing decreases the incidence of substance abuse in anesthesiology residents.
Full-textDOI: · Available from: Warren Myron Zapol, Aug 13, 2015
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ABSTRACT: An abstract is unavailable. This article is available as HTML full text and PDF.01/2010; 38(1):91–96. DOI:10.1097/ASA.0b013e3181fe9600
Conference Paper: Rational modeling by pencil-of-functions method[Show abstract] [Hide abstract]
ABSTRACT: Pole-zero modeling of low-pass signals, such as an electromagnetic-scatterer response, is considered in this paper. It is shown by use of pencil-of-functions theorem that (a) the true parameters can be recovered in the ideal case (where the signal is the impulse response of a rational function H(z)), and (b) the parameters are optimal in the generalized least-squares sense when the observed data are corrupted by additive noise or by systematic error. Although the computations are more involved than in all-pole modeling, they are considerably less than those required in iterative schemes of pole-zero modeling. The advantages of the method are demonstrated by simulation example and through application to the electromagnetic response ofa scatterer. The paper also includes very recent and tantalizing results on a new approach to noise correction. In contradistinction with spectral subtraction techniques, where only amplitude information is emphasized (and phase is ignored), we propose a method that (a) estimates the sample variance for the particular data frame, and then performs the subtraction from the Gram matrix.Acoustics, Speech, and Signal Processing, IEEE International Conference on ICASSP '81.; 05/1981
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ABSTRACT: The Institute of Medicine recently concluded that-on average-medical residents make more serious medical errors and have more motor vehicle crashes when they are deprived of sleep. In the interest of public safety, society has required limitations on work hours in many other safety sensitive occupations, including transportation and nuclear power generation. Those who argue in favor of traditional extended duration resident work hours often suggest that there are inter- individual differences in response to acute sleep loss or chronic sleep deprivation, implying that physicians may be more resistant than the average person to the detrimental effects of sleep deprivation on performance, although there is no evidence that physicians are particularly resistant to such effects. Indeed, recent investigations have identified genetic polymorphisms that may convey a relative resistance to the effects of prolonged wakefulness on a subset of the healthy population, although there is no evidence that physicians are over-represented in this cohort. Conversely, there are also genetic polymorphisms, sleep disorders and other inter-individual differences that appear to convey an increased vulnerability to the performance-impairing effects of 24 hours of wakefulness. Given the magnitude of inter-individual differences in the effect of sleep loss on cognitive performance, and the sizeable proportion of the population affected by sleep disorders, hospitals face a number of ethical dilemmas. How should the work hours of physicians be limited to protect patient safety optimally? For example, some have argued that, in contrast to other professions, work schedules that repeatedly induce acute and chronic sleep loss are uniquely essential to the training of physicians. If evidence were to prove this premise to be correct, how should such training be ethically accomplished in the quartile of physicians and surgeons who are most vulnerable to the effects of sleep loss on performance without unacceptably compromising patient safety? Moreover, once it is possible to identify reliably those most vulnerable to the adverse effects of sleep loss on performance, will academic medical centers have an obligation to evaluate the proficiency of both residents and staff physicians under conditions of acute and chronic sleep deprivation? Should work-hour policy limits be modified to ensure that they are not hazardous for the patients of the most vulnerable quartile of physicians, or should the limits be personalized to enable the most resistant quartile to work longer hours? Given that the prevalence of sleep disorders has increased in our society overall, and increases markedly with age, how should fitness for extended duration work hours be monitored over a physician's career? In the spirit of the dictum to do no harm, advances in understanding the medical and genetic basis of inter-individual differences in the performance vulnerability to sleep loss should be incorporated into the development of work-hour policy limits for both physicians and surgeons.Transactions of the American Clinical and Climatological Association 01/2009; 120:249-85.