aedes
aedes t1_j1zr8nj wrote
Reply to comment by Fellainis_Elbows in How do shifts work on really long medical operations? by TerjiD
You might think I was referring to some of the NEJM papers that came out around 2018 comparing standard to “flexible” scheduling?
I was more talking about the older papers that came out in the first decade of the 2000s when duty hour restrictions first came into place... which compared old-school scheduling to duty-hour restrictions and found no difference in patient outcomes (or occasionally worse patient outcomes with restrictions in some of the surgical literature).
aedes t1_j1zanp5 wrote
To add to what others have said, and to make this more generalizable outside of just medicine...
Swapping out people who have been working a long time for fresh people is limited by two factors:
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The availability of fresh people. There are often alternate nurses available for a very long case. In some situations there may simply not be another surgeon available. This is part of the responsibility that comes from being in positions of leadership, or having a very specialized knowledge base and skill set. In times of “crises,” you may be working absurdly long hours for a very long time.
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Transitioning to a fresh team is associated with its own risks. The fresh team will be less familiar with what’s going on, and miscommunications about the situation may occur during the transition. A critical event that happens during the transition may also be disastrous due to unclear individual responsibilities and communication flow.
There have been scientific studies on patient outcomes with physicians working either very long shifts, or shorter shifts but with more “signovers” of care happening. There was no improvement in patient outcomes with shorter working hours, presumably because of the risks that occur due to care transitions.
Balancing the above points is something that must be done in many situations, not just medicine.
How does the military decide when to switch out troops in a war zone?
How should government deal with decision making during a prolonged and intense period of time?
Etc.
aedes t1_j7wnkhn wrote
Reply to According to a study on 12,211 patients, aspirin is just as effective at preventing blood clots as low molecular weight heparin, but it costs less and is easier to administer by giuliomagnifico
Non-inferior is not “just as effective.” That would require an equivalence study to conclude, rather than a non-inferiority study.
Rather, a positive non-inferiority like this best interpreted as “aspirin is tolerably close to low-molecular weight heparin.”
Where the researchers have defined what “tolerably close” means. It could very well be 10% worse than low-molecular weight heparin. But if the non-inferiority margin was set to 15%, the study would conclude that aspirin was non-inferior.
You can’t interpret non-inferiority study results without knowing the non-inferiority margin and how it was derived and if it seems to be a reasonable amount or not.