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Background: Bedtime procrastination, the volitional delay of going to bed without any external circumstances causing the delay, is linked to multiple indicators of inadequate sleep. Intervening to reduce bedtime procrastination may be an important avenue to improve sleep outcomes, yet the phenomenon remains poorly understood in populations at risk for bedtime procrastination. New career starters, those who have graduated from tertiary education and started a new full‐time job within the past 12 months, may be susceptible to problematic bedtime procrastination and are at an opportune time for a 'fresh start' to change behaviour. Aims: The objectives of this study were to understand how bedtime procrastination is experienced and perceived by new career starters, to identify the enablers and barriers to behaviour change in new career starters and to explore themes for future interventions. Materials & Methods: Data were collected through in‐depth semi‐structured interviews with 28 participants. Results: Inductive thematic analysis was used to find seven themes: (1) negative feelings before and during bedtime procrastination; (2) wanting to versus knowing I shouldn't; (3) difficulty falling asleep; (4) influence of automatic processes; (5) consequences of bedtime procrastination; (6) lack of self‐control and (7) technology captures late‐night attention. Participants emphasised the need for me‐time, self‐negotiation to continue procrastinating and knowledge of the value of sleep. Discussion & Conclusion: Findings suggest that bedtime procrastination involves both reflective and automatic cognitive processes. Future interventions would benefit from a dual‐process approach, using cognitive and behavioural techniques to reduce bedtime procrastination. [ABSTRACT FROM AUTHOR]

When on‐call workers wake during the night to perform work duties, they may experience reduced alertness and impaired performance as a result of sleep inertia. After performing their duties, on‐call workers may have the opportunity to return to sleep. Thus, it is important that sleep inertia countermeasures do not affect subsequent sleep. Exercise may be a suitable countermeasure; however, the impact on subsequent sleep is untested. Healthy participants (n = 15) completed three conditions in a counterbalanced order: sedentary, low‐intensity exercise or high‐intensity exercise, performed for 2 min upon awakening. Sleep was recorded 2 hr later using polysomnography, the Karolinska Sleepiness Scale was administered to measure subjective sleepiness, and core body temperature was measured continuously. Results indicate there was no effect of condition on most sleep variables; however, three variables had small differences, with longer total sleep time (p =.006), higher sleep efficiency (p =.006) and shorter N3 latency (p <.001) in the low‐intensity exercise condition. There was no difference in subjective sleepiness (p =.124) or core body temperature (p =.216) 90 min after the exercise intervention. These results indicate that using a short burst of exercise to counteract sleep inertia when woken during the night may be a suitable countermeasure for on‐call workers who not only need to be alert upon waking but also need quality sleep when returning to bed. Future research could include participants of other ages and health statuses to investigate whether the results are generalizable. [ABSTRACT FROM AUTHOR]

Research related to the paramedic workforce is increasing, particularly given the associations with physical and mental health outcomes. However, it is clear that the evidence base to support future paramedic workforce initiatives lacks longitudinal data in cohorts of paramedics. We identify gaps in the epidemiological evidence base for this workforce, and provide insight into the role that prospective cohorts can, and should, play in future research in the paramedic workforce in order to identify health and safety changes over time, and the associations with job requirements, particularly shift work. [ABSTRACT FROM AUTHOR]

Background: Prescribing errors not only impose safety risks, but also delay hospital discharges and adversely affect patient satisfaction. The effect of reducing environmental interruptions on prescribing errors has not been published previously. Aim: The aim of this study was to determine the combined effect of two 'do not disturb' (DND) strategies in decreasing the average number of prescribing errors by reducing distractions during discharge prescription writing. A secondary aim was to assess the effect of the interventions on prescription correction time. Methods: In all, 392 discharge prescriptions from two general medical wards of a teaching hospital were audited over a 10‐week period in a prospective interventional before‐and‐after audit. Clinical pharmacists collected data on the number and type of errors, and time taken to correct errors. DND vests and workstations were made available during the intervention phase. Junior medical officers (JMO) provided daily feedback to the nurse unit managers (NUM) on the number and source of distractions, as well as the use of DND vests and workstations after the intervention. Results: The percentage of error‐free discharge prescriptions increased from 29.7% before to 51.5% after the intervention (p < 0.0001). The mean number of errors per prescription decreased from 1.7 to 1.1 (p < 0.01) in both wards combined. The median time taken to correct erroneous prescriptions did not change significantly. Feedback provided by JMOs showed a marked reduction in interruptions, with 73% stating they were not interrupted at all or just once during prescribing after the intervention, compared with 17% before the intervention. Conclusion: DND strategies decreased the rate of erroneous prescriptions. [ABSTRACT FROM AUTHOR]

The currently assumed aetiology for delayed sleep phase disorder ( DSPD) is a delay of the circadian system. Clinicians have sought to use bright light therapy, exogenous melatonin or chronotherapy to correct the disorder. However, these treatments have achieved unreliable outcomes for DSPD patients and, as such, one suggestion has been that the disorder may be caused by a longer than normal circadian rhythm period length (i.e. tau). The present study investigated this premise using a 78-h ultradian, ultra-short sleep-wake cycle. This constant bedrest routine was used to simulate a series of 1-h long 'days' by alternating 20-min sleep opportunities and 40 min of enforced wakefulness. Thirteen participants were recruited for the study including, six people diagnosed with DSPD according to the International Classification of Sleep Disorders-2 [mean age = 22.0, standard deviation ( SD) = 3.3] and seven good sleepers (mean age = 23.1, SD = 3.9) with normal sleep timing. The DSPD participants' core temperature rhythm tau (mean = 24 h 54 min, SD = 23 min) was significantly longer ( t = −2.33, P = 0.04, Cohen's d = 1.91) than the good sleepers' (mean 24 h 29 min, SD = 16 min). The temperature rhythm of the DSPD participants delayed more rapidly (i.e. >25 min day−1) than the good sleepers'. These findings provide an explanation for the difficulty that DSPD patients have in phase advancing to a more conventional sleep time and their frequent relapse following treatment. The outcomes of this study support a vigorous and continued application of chronobiological and behavioural therapies to entrain DSPD patients to their desired earlier sleep times. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of working consecutive night shifts on sleep time, prior wakefulness, perceived levels of fatigue and psychomotor performance in a group of Australian emergency registrars. Methods: A prospective observational study with a repeated within-subjects component was conducted. Sleep time was determined using sleep diaries and activity monitors. Subjective fatigue levels and reciprocal reaction times were evaluated before and after day and night shifts. Results: A total of 11 registrars participated in the study with 120 shifts analysed. Sleep time was found to be similar during consecutive night and day shifts. The mean number of hours spent awake before the end of a night shift was 14.33. Subjective fatigue scores were worst at the end of a night shift. There was no difference in reciprocal reaction time between the end of night shift and the start of day shift. Conclusions: Registrars sleep a similar amount of time surrounding night and day shifts. Despite reporting the highest levels of fatigue at the end of a night shift, there is no significant difference in reaction times at the end of night shift compared with the beginning of day shift. This correlates with the finding that at the end of night shift the registrars have been awake for less than 16 h, which is the point at which psychomotor performance is expected to decline. [ABSTRACT FROM AUTHOR]

Summary Subjective alertness may provide some insight into reduced performance capacity under conditions suboptimal to neurobehavioural functioning, yet the accuracy of this insight remains unclear. We therefore investigated whether subjective alertness reflects the full extent of neurobehavioural impairment during the biological night when sleep is restricted. Twenty-seven young healthy males were assigned to a standard forced desynchrony (FD) protocol ( n = 13; 9.33 h in bed/28 h day) or a sleep-restricted FD protocol ( n = 14; 4.67 h in bed/28 h day). For both protocols, subjective alertness and neurobehavioural performance were measured using a visual analogue scale (VAS) and the psychomotor vigilance task (PVT), respectively; both measures were given at various combinations of prior wake and circadian phase (biological night versus biological day). Scores on both measures were standardized within individuals against their respective baseline average and standard deviation. We found that PVT performance and VAS rating deviated from their respective baseline to a similar extent during the standard protocol, yet a greater deviation was observed for PVT performance than VAS rating during the sleep-restricted protocol. The discrepancy between the two measures during the sleep-restricted protocol was particularly prominent during the biological night compared with the biological day. Thus, subjective alertness did not reflect the full extent of performance impairment when sleep was restricted, particularly during the biological night. Given that subjective alertness is often the only available information upon which performance capacity is assessed, our results suggest that sleep-restricted individuals are likely to under-estimate neurobehavioural impairment, particularly during the biological night. [ABSTRACT FROM AUTHOR]

Rate of recovery of daytime performance and sleepiness following moderate and severe sleep deprivation (SD) was examined when recovery opportunity was either augmented or restricted. Thirty healthy non-smokers, aged 18–33 years, participated in one of three conditions: moderate SD with augmented (9-h) recovery opportunities, moderate SD with restricted (6-h) recovery opportunities, or severe SD with augmented recovery opportunities. Each participant attended the laboratory for 8–9 consecutive nights: an adaptation and baseline night (23:00–08:00 hours), one or two night(s) of wakefulness, and five consecutive recovery sleep opportunities (23:00–08:00 hours or 02:00–08:00 hours). On each experimental day, psychomotor vigilance performance (PVT) and subjective sleepiness (SSS) were assessed at two-hourly intervals, and MSLTs were performed at 1000h. PSG data was collected for each sleep period. For all groups, PVT performance significantly deteriorated during the period of wakefulness, and sleepiness significantly increased. Significant differences were observed between the groups during the recovery phase. Following moderate SD, response speed, lapses and SSS returned to baseline after one 9-h sleep opportunity, while sleep latencies required two 9-h opportunities. When the recovery opportunity was restricted to six hours, neither PVT performance nor sleepiness recovered, but stabilised at below-baseline levels. Following severe SD, sleepiness recovered after one (SSS) or two (physiological) 9-h sleep opportunities, however PVT performance remained significantly below baseline for the entire recovery period. These results suggest that the mechanisms underlying the recovery process may be more complicated than previously thought, and that we may have underestimated the impact of sleep loss and/or the restorative value of subsequent sleep. [ABSTRACT FROM AUTHOR]

Summary: On‐call work is used to manage around the clock working requirements in a variety of industries. Often, tasks that must be performed while on‐call are highly important, difficult and/or stressful by nature and, as such, may impact the level of anxiety that is experienced by on‐call workers. Heightened anxiety is associated with poor sleep, which affects next‐day cognitive performance. Twenty‐four male participants (20–35 years old) spent an adaptation, a control and two counterbalanced on‐call nights in a time‐isolated sleep laboratory. On one of the on‐call nights they were told that they would be required to do a speech upon waking (high‐stress condition), whereas on the other night they were instructed that they would be required to read to themselves (low‐stress condition). Pre‐bed anxiety was measured by the State Trait Anxiety Inventory form x‐1, and polysomnography and quantitative electroencephalogram analyses were used to investigate sleep. Performance was assessed across each day using the 10‐min psychomotor vigilance task (09:30 hours, 12:00 hours, 14:30 hours, 17:00 hours). The results indicated that participants experienced no significant changes in pre‐bed anxiety or sleep between conditions. However, performance on the psychomotor vigilance task was best in the high‐stress condition, possibly as a result of heightened physiological arousal caused by performing the stressful task that morning. This suggests that performing a high‐stress task may be protective of cognitive performance to some degree when sleep is not disrupted. [ABSTRACT FROM AUTHOR]

The article presents a peer-reviewed report about the concept of medical intern orientation. This report is an innovative approach to medical education in the U.S. In this context, an overview of the importance of orientation programs is highlighted. It has been believed that through the 2005 interns and their educators, the authors developed the survey list to construct a set of systems-based tasks that interns should perform competently.