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[BMJ圣诞专刊]:Q热—避免说出“安静”一词的迷信说法作为应对机制:一项随机对照非劣效研究
2020年01月16日 时讯速递, 进展交流 暂无评论

Research Christmas 2019: Let it Be

Q fever—the superstition of avoiding the word “quiet” as a coping mechanism: randomised controlled non-inferiority trial

Charlotte R Brookfield, Patrick P J Phillips, Robert J Shorten

BMJ 2019; 367: l6446 doi: https://doi.org/10.1136/bmj.l6446 (Published 18 December 2019)

Objective 目的

To determine the validity of the superstition that utterance of the word “quiet” in a clinical setting increases workload.

确定在临床情况下说出“安静”一词能够增加工作量这一迷信说法的真实性。

Design 试验设计

Prospective randomised controlled non-inferiority study.

前瞻随机对照非劣效研究

Setting 场景

Microbiology department of a large teaching hospital in Lancashire, UK.

英国Lancashire一所大型教学医院的微生物学科

Participants 研究对象

Two members of the medical microbiology team carried out the duty work on any given week day and an on-call team member on any weekend day. 29 days were assigned in which staff were to say “Today will be a quiet day” and 32 days were assigned in which staff were to refrain from saying the word “quiet” in any context.

在每个工作日医学微生物学团队的2名成员负责值班,周末由一名成员值班。在29天值班人员说“今天将是非常安静的一天”,在另外32天,在任何情况下都限制值班人员说出“安静”这个词。

Interventions 干预措施

Each day was randomly allocated to either saying “Today will be a quiet day” (intervention group) or refraining from saying the word “quiet” (control group) in any context.

将每天随机分为或者说“今天将是非常安静的一天”(干预组)或在任何情况下限制说出“安静”一词(对照组)

Main outcome measures 主要预后指标

The primary outcome was mean overall workload: a composite of number of clinically related telephone calls, clinically significant results, or validated results processed by the duty medical microbiology team during a 24 hour period referred to collectively as “clinical episodes.” A difference of 30 clinical episodes was considered as the margin of non-inferiority. Secondary outcomes included the individual components of the primary outcome.

主要预后指标为平均总工作量:即包括24小时内接听临床相关电话数量,有临床意义的结果,或由值班微生物学团队进行的结果验证等,统称为“临床事件”。将临床事件数目相差30次作为非劣效边界值。次要预后指标包括主要预后终点的各项事件。

Results 结果

Workload was measured each day over a 61 day period (1 May to 30 June 2019). A mean 139.0 clinical episodes occurred on control days compared with 144.9 on days when the experimental intervention was uttered, a difference of 5.9 (95% confidence interval−12.9 to 24.7). The upper bound was less than the specified margin of 30, providing evidence for non-inferiority. No evidence of a difference in workload was found between interventions with any of the four components, whether considering unadjusted or adjusted analyses, or looking at the subgroups of week days or weekends.

在61天内(5月1日至6月30日)每日测定工作量。对照日内平均发生139.0次临床事件,试验日内平均为144.9次临床事件,差异为5.9次(95% 可信区间−12.9 to 24.7)。上限低于预设提示非劣效的边界值 30次。无论未校正抑或校正分析,或针对工作日及周末进行亚组分析,均没有证据显示两组间4项临床结局的工作量存在任何差异。

Conclusions 结论

The study findings refute the long held superstition that utterance of the word “quiet” impacts on clinical workload, and therefore it should not be avoided. In the era of considerable staff shortages and increased work related stress, doctors should look to other methods to increase resilience and protect their wellbeing and mental health.

试验结果拒绝长期以来的迷信说法,即说出“安静”一词能够影响临床工作量,因此需要避免这样做。在人员短缺且工作压力日益增加的现实情况下,医生应当寻求其他方法增加,并保护身体及精神健康

Trial registration 试验注册

Lancashire Teaching Hospitals NHS Foundation Trust’s research department SE-259.

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