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Schubert DUC, Serfaty FM, Cunha MR, Oigman W, Tarvainen MP, Neves MF. Heart rate variability and perception of mental stress among medical students and residents at an emergency department. Am J Emerg Med 2024; 78:12-17. [PMID: 38181540 DOI: 10.1016/j.ajem.2023.12.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/14/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND When Medical Residents (MR) and Medical Students (MS) are assigned to the demanding environment of an Emergency they inevitably encounter stress. The aims of this study are to measure short-term heart rate variability (HRV) before and after shifts, estimate perceived stress levels, and assess the recovery patterns after their shifts. METHODS We assessed HRV parameters in MS and MR using the wristband physiological monitor Polar® Verify Sense before and after day (DS) and night shifts (NS). Perceived stress levels were evaluated using the simplified State Trait Anxiety Inventory (STAI-S6) and the Subjective Units of Distress Scale. RESULTS This study included 60 participants of which 55% were female with a mean age of 26 years. MS presented significant reduction in sympathetic nervous system index after DS [0.68 (0.01-2.42) vs -0.22 (-0.75-1.13), p < 0.01] and NS [0.87 (-0.28-1.45) vs 0.06 (-0.70-1.04), p < 0.01], while MR maintained the same levels of sympathetic activity [DS: 1.17 (0.04 -2.88) vs 0.93 (0.50-1.41), p = 0.14; NS: 1.37 (0.76-2.21) vs 1.29 (0.35-2.18), p = 0.40]. Psychological data from STAI-S6 showed statistically significant differences when comparing before and after DS in both groups, with more perceived stress after than before DS (MS: 12 ± 4 vs 14 ± 4, p = 0.04; MR: 14 ± 4 vs 16 ± 4, p = 0.04), which was not observed at NS (MS: 12 ± 3 vs 12 ± 3, p = 0.84; MR: 15 ± 3 vs 15 ± 4, p = 0.40). CONCLUSIONS Short-term HRV recordings before and after day or night shifts among MR and MS revealed heightened sympathetic activity preceding each shift, with a more sustained increase observed in the MR population and more perceived stress after day shifts in both groups.
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Affiliation(s)
| | - Fabiano Marcel Serfaty
- Department of Clinical Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Michelle Rabello Cunha
- Department of Clinical Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Institute of Nutrition, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Wille Oigman
- Department of Clinical Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mika P Tarvainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Mario Fritsch Neves
- Department of Clinical Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Voltmer E, Rosta J, Köslich-Strumann S, Goetz K. Job satisfaction and work stress among physicians in Norway and Germany-A cross-sectional study. PLoS One 2024; 19:e0296703. [PMID: 38181025 PMCID: PMC10769063 DOI: 10.1371/journal.pone.0296703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 12/17/2023] [Indexed: 01/07/2024] Open
Abstract
PURPOSE Physicians' health and wellbeing are important albeit often neglected quality indicators of health care systems. The aims of the study were to compare job satisfaction and work stress among doctors in Germany and Norway, and to identify predictors for job satisfaction. METHODS All active physicians in Schleswig-Holstein, Germany (N = 13,304) and a nationwide sample of Norwegian physicians (N = 2,316) were surveyed in a cross-sectional design in 2021. Response rates of German and Norwegian physicians were n = 4,385 (33%) and n = 1,639 (70.8%), respectively. In addition to age, sex, and work-hours, the main outcome measures were the validated Job Satisfaction Scale (JSS) and the short form of the Effort-Reward Imbalance Questionnaire (ERI). RESULTS There were significant differences between Norwegian and German physicians in job satisfaction but with small effect sizes. All effort scores of German physicians were significantly higher and four of seven reward scores significantly lower than for their Norwegian colleagues. The proportion of German physicians in the state of a gratification crisis was significantly higher (67%) than in their Norwegian colleagues (53%). In both countries, physicians with a gratification crisis scored significantly lower on all items of job satisfaction. There were only minor gender differences in job satisfaction and effort-reward balance. Age, effort, and reward accounted for 46% of the explained variance of job satisfaction. CONCLUSIONS Lower job satisfaction and reward in some areas and higher perceived effort of physicians in Germany than in Norway are still in favor of Norwegian working conditions, but the differences seem to diminish. The high proportions of gratification crises in both countries warrants appropriate measures for prevention and health promotion.
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Affiliation(s)
- Edgar Voltmer
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Judith Rosta
- Institute for Studies of the Medical Profession, Oslo, Norway
| | | | - Katja Goetz
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Lübeck, Germany
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Li H, Upreti T, Do V, Dance E, Lewis M, Jacobson R, Goldberg A. Measuring wellbeing: A scoping review of metrics and studies measuring medical student wellbeing across multiple timepoints. MEDICAL TEACHER 2024; 46:82-101. [PMID: 37405740 DOI: 10.1080/0142159x.2023.2231625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
PURPOSE Studies have demonstrated poor mental health in medical students. However, there is wide variation in study design and metric use, impairing comparability. The authors aimed to examine the metrics and methods used to measure medical student wellbeing across multiple timepoints and identify where guidance is necessary. METHODS Five databases were searched between May and June 2021 for studies using survey-based metrics among medical students at multiple timepoints. Screening and data extraction were done independently by two reviewers. Data regarding the manuscript, methodology, and metrics were analyzed. RESULTS 221 studies were included, with 109 observational and 112 interventional studies. There were limited studies (15.4%) focused on clinical students. Stress management interventions were the most common (40.2%). Few (3.57%) interventional studies followed participants longer than 12 months, and 38.4% had no control group. There were 140 unique metrics measuring 13 constructs. 52.1% of metrics were used only once. CONCLUSIONS Unique guidance is needed to address gaps in study design as well as unique challenges surrounding medical student wellbeing surveys. Metric use is highly variable and future research is necessary to identify metrics specifically validated in medical student samples that reflect the diversity of today's students.
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Affiliation(s)
- Henry Li
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Tushar Upreti
- Max Rady College of Medicine, Faculty of Health Sciences, University of Manitoba Rady, Winnipeg, Canada
| | - Victor Do
- Department of Pediatrics, Faculty of Medicine, University of Toronto Temerty, Toronto, Canada
| | - Erica Dance
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Melanie Lewis
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Ryan Jacobson
- Office of Advocacy and Wellbeing, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Aviva Goldberg
- Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba Rady, Winnipeg, Canada
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El Dabbah NA, Elhadi YAM. High levels of burnout among health professionals treating COVID-19 patients in two Nile basin countries with limited resources. Sci Rep 2023; 13:6455. [PMID: 37081113 PMCID: PMC10116483 DOI: 10.1038/s41598-023-33399-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/12/2023] [Indexed: 04/22/2023] Open
Abstract
Burnout syndrome is a real cause for concern in African health facilities. Healthcare professionals (HCPs) burnout is considered a great public health problem and especially during pandemics as several physical and emotional stressors on this population can lead to increased burnout. This study aimed to investigate the frequency and associated factors of occupational burnout among HCPs working at COVID-19 isolation facilities in Egypt and Sudan. This is important to summarize lessons learned and inform relevant interventions for future pandemic responses. A cross-sectional survey was conducted among frontline HCPs from May 2021 to July 2021. An online, anonymous, self-administered questionnaire was used for data collection. Occupational burnout was estimated using the Oldenburg Burnout Inventory. A total of 362 HCPs participated in the study and were equally recruited from Egypt (181) and Sudan (181) with a mean age of (31.84 ± 8.32) years. More than half of HCPs were females (60%) and physicians (58.3%). Most HCPs included in the study had high levels of work disengagement (75.4%) and emotional exhaustion (98.6%). Burnout syndrome was present in 75% of the HCPs with 77% among Egyptian HCPs and 71% among Sudanese HCPs. Multivariate logistic regression was used to determine predictors of burnout, working hours per week were the parameters associated with burnout syndrome among Egyptian HCPs; while for Sudanese HCPs, these were age and number of days off. The study revealed a high level of burnout syndrome among HCPs working at COVID-19 isolation facilities in both Egypt and Sudan. Appropriate actions should be taken to preserve the mental health status of HCPs through the establishment of effective and efficient coping strategies.
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Affiliation(s)
- Noha Ahmed El Dabbah
- Department of Health Administration and Behavioral Sciences High Institute of Public Health, Alexandria University, Alexandria, Egypt.
| | - Yasir Ahmed Mohammed Elhadi
- Department of Health Administration and Behavioral Sciences High Institute of Public Health, Alexandria University, Alexandria, Egypt
- Department of Public Health, Medical Research Office, Sudanese Medical Research Association, Khartoum, Sudan
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Cildoz M, Ibarra A, Mallor F. Acuity-based rotational patient-to-physician assignment in an emergency department using electronic health records in triage. Health Informatics J 2023; 29:14604582231167430. [PMID: 37068379 DOI: 10.1177/14604582231167430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Emergency department (ED) operational metrics generated by a new acuity-based rotational patient-to-physician assignment (ARPA) algorithm are compared with those obtained with a simple rotational patient assignment (SRPA) system aimed only at an equitable patient distribution. The new ARPA method theoretically guarantees that no two physicians' assigned patient loads can differ by more than one, either partially (by acuity levels) or in total; whereas SRPA guarantees only the latter. The performance of the ARPA method was assessed in practice in the ED of the main public hospital (Hospital Compound of Navarra) in the region of Navarre in Spain. This ED attends over 140 000 patients every year. Data analysis was conducted on 9,063 ED patients in the SRPA cohort, and 8,892 ED patients in the ARPA cohort. The metrics of interest are related both to patient access to healthcare and physician workload distribution: patient length of stay; arrival-to-provider time; ratio of patients exceeding the APT target threshold; and range of assigned patients across physicians by priority levels. The transition from SRPA to ARPA is associated with improvements in all ED operational metrics. This research demonstrates that ARPA is a simple and useful strategy for redesigning front-end ED processes.
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Affiliation(s)
- Marta Cildoz
- Institute of Smart Cities, Public University of Navarre, Pamplona, Spain
| | | | - Fermin Mallor
- Institute of Smart Cities, Public University of Navarre, Pamplona, Spain
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Chambers CNL, Frampton CMA. Burnout, stress and intentions to leave work in New Zealand psychiatrists; a mixed methods cross sectional study. BMC Psychiatry 2022; 22:380. [PMID: 35668372 PMCID: PMC9169591 DOI: 10.1186/s12888-022-03980-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/06/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Demand for mental health services in New Zealand and internationally is growing. Little is known about how psychiatrists are faring in this environment. This study aimed to investigate wellbeing of psychiatrists working in the public health system in New Zealand, identify the main risk factors for work-related stress, gauge perceptions of how workload has changed over time, assess job satisfaction and whether individuals intend or desire to leave their work. METHODS Psychiatrists working in New Zealand who were also members of the Association of Salaried Medical Specialists were invited to participate in an online survey. Main outcome measures were degree of burnout and stress experienced at work. Supplementary measures included perceived workplace demands and levels of support. Predictor variables included perceptions of changes to workloads over time, degree of job satisfaction and intentions to leave work. Logistic regression assessed characteristics associated with burnout and job satisfaction as well as intentions to leave work. Free text comments were analysed thematically alongside quantitative trends. RESULTS 368/526 responded (70% response rate). 34.6% met the criteria for burnout and 35.3% scored with high work stress. There were no significant patterns of association with demographic variables but significant correlation with all but one predictor variable; having experienced a change to the demands of the on-call workload. 45% agreed they would leave their current job if able and 87% disagreed that they are working in a well-resourced mental health service. Respondents emphasised the impact of growing workloads and expressed concerns about their ability to provide optimal care in these circumstances. CONCLUSIONS High burnout appears to affect one in three psychiatrists in New Zealand. Many attribute their feelings of burnout to demand for their services. These findings may assist with better workforce planning for psychiatry and emphasises potential consequences of demand for and poor resourcing of mental health services for the retention and wellbeing of doctors in psychiatry worldwide.
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Affiliation(s)
- Charlotte N. L. Chambers
- Director, Policy and Research, Association of Salaried Medical Specialists, PO Box 10763, Wellington, 6143 New Zealand
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Blanchard J, Li Y, Bentley SK, Lall MD, Messman AM, Liu YT, Diercks DB, Merritt‐Recchia R, Sorge R, Warchol JM, Greene C, Griffith J, Manfredi RA, McCarthy M. The perceived work environment and well-being: A survey of emergency health care workers during the COVID-19 pandemic. Acad Emerg Med 2022; 29:851-861. [PMID: 35531649 PMCID: PMC9347760 DOI: 10.1111/acem.14519] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/26/2022] [Accepted: 05/05/2022] [Indexed: 12/21/2022]
Abstract
Background During the COVID‐19 pandemic, health care provider well‐being was affected by various challenges in the work environment. The purpose of this study was to evaluate the relationship between the perceived work environment and mental well‐being of a sample of emergency physicians (EPs), emergency medicine (EM) nurses, and emergency medical services (EMS) providers during the pandemic. Methods We surveyed attending EPs, resident EPs, EM nurses, and EMS providers from 10 academic sites across the United States. We used latent class analysis (LCA) to estimate the effect of the perceived work environment on screening positive for depression/anxiety and burnout controlling for respondent characteristics. We tested possible predictors in the multivariate regression models and included the predictors that were significant in the final model. Results Our final sample included 701 emergency health care workers. Almost 23% of respondents screened positive for depression/anxiety and 39.7% for burnout. Nurses were significantly more likely to screen positive for depression/anxiety (adjusted odds ratio [aOR] 2.04, 95% confidence interval [CI] 1.11–3.86) and burnout (aOR 2.05, 95% CI 1.22–3.49) compared to attendings. The LCA analysis identified four subgroups of our respondents that differed in their responses to the work environment questions. These groups were identified as Work Environment Risk Group 1, an overall good work environment; Risk Group 2, inadequate resources; Risk Group 3, lack of perceived organizational support; and Risk Group 4, an overall poor work environment. Participants in the two groups who perceived their work conditions as most adverse were significantly more likely to screen positive for depression/anxiety (aOR 1.89, 95% CI 1.05–3.42; and aOR 2.04, 95% CI 1.14–3.66) compared to participants working in environments perceived as less adverse. Conclusions We found a strong association between a perceived adverse working environment and poor mental health, particularly when organizational support was deemed inadequate. Targeted strategies to promote better perceptions of the workplace are needed.
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Affiliation(s)
- Janice Blanchard
- Department of Emergency Medicine George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Yixuan Li
- Department of Health Policy, Milken Institute School of Public Health George Washington University Washington District of Columbia USA
| | - Suzanne K. Bentley
- Departments of Emergency Medicine & Medical Education Icahn School of Medicine at Mount Sinai, New York City Health+Hospitals/Elmhurst New York New York USA
| | - Michelle D. Lall
- Department of Emergency Medicine Emory University School of Medicine Atlanta Georgia USA
| | - Anne M. Messman
- Department of Emergency Medicine Wayne State University School of Medicine, University Health Center–6G Detroit Michigan USA
| | - Yiju Teresa Liu
- Department of Emergency Medicine David Geffen School of Medicine at UCLA, Harbor–UCLA Medical Center Torrance California USA
| | | | - Rory Merritt‐Recchia
- Department of Emergency Medicine Alpert Medical School of Brown University Providence Rhode Island USA
| | - Randy Sorge
- Department of Emergency Medicine Louisiana State University Spirit of Charity Emergency Medicine Residency Program New Orleans Louisiana USA
| | - Jordan M. Warchol
- Department of Emergency Medicine University of Nebraska Medical Center Omaha Nebraska USA
| | - Christopher Greene
- Department of Emergency Medicine University of Alabama at Birmingham Birmingham Alabama USA
| | - James Griffith
- Department of Psychiatry George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Rita A. Manfredi
- Department of Emergency Medicine George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Melissa McCarthy
- Departments of Health Policy and Emergency Medicine, Milken Institute School of Public Health George Washington University Washington District of Columbia USA
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Yung J, Kim B. Promoting intern wellness within a psychiatry residency training program: A process of regular check-ins by chief residents. EDUCATION FOR HEALTH (ABINGDON, ENGLAND) 2021; 34:113-117. [PMID: 35488659 DOI: 10.4103/efh.efh_354_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Wellness in residency is increasingly considered a vital part of medical training. Yet to be widely explored are efforts that focus particularly on 1st-year residents (i.e., interns), who likely experience unique professional changes. We developed and implemented, within a psychiatry residency training program, a process of individualized wellness check-ins with interns by chief residents throughout an academic year. METHODS At the beginning of the academic year, a one-page baseline questionnaire was completed by interns anticipating how the chief residents can best support them. During check-ins, the chief residents asked about interns' residency experiences and wellness. The check-ins were conducted at frequencies requested by each intern. Chief residents sought open verbal feedback from the interns, and more structured feedback was collected 6 months into the academic year, using a brief four-question mid-year questionnaire. RESULTS Check-ins were conducted with all eight interns in the program. Baseline questionnaire responses indicated interns' preferences for more mentorship, communication across the program, and socialization. Regular check-ins started at intern-desired frequencies, and their content was guided by individual interns' questionnaire responses. Feedback from interns shaped the frequency/content of subsequent check-ins. DISCUSSION This regular check-in process is an early attempt to explicitly delineate what chief residents can do to support intern wellness. This process can be adapted to meet specific individual/program needs. Further work is warranted to rigorously (i) examine measurable impact of the process on intern wellness and (ii) compare the impact to those of other emerging practices that use regular check-ins to target intern wellness.
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Affiliation(s)
- Jaimie Yung
- Harvard South Shore Psychiatry Residency Training Program, VA Boston Healthcare System; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Bo Kim
- Harvard South Shore Psychiatry Residency Training Program, VA Boston Healthcare System; Department of Psychiatry, Harvard Medical School; Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
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Nishi M, Yamano M, Matoba S. Prediction of well-being and insight into work-life integration among physicians using machine learning approach. PLoS One 2021; 16:e0254795. [PMID: 34265012 PMCID: PMC8282024 DOI: 10.1371/journal.pone.0254795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 07/03/2021] [Indexed: 11/19/2022] Open
Abstract
There has been increasing interest in examining physician well-being and its predictive factors. However, few studies have revealed the characteristics associated with physician well-being and work-life integration using a machine learning approach. To investigate predictive factors of well-being and obtain insights into work-life integration, the survey was conducted by letter mail in a sample of Japanese physicians. A total of 422 responses were collected from 846 physicians. The mean age was 47.9 years, males constituted 83.3% of the physicians, and 88.6% were considered to be well. The most accurate machine learning model showed a mean area under the curve of 0.72. The mean permutation importance of career satisfaction, work hours per week, existence of family support, gender, and existence of power harassment were 0.057, 0.022, 0.009, 0.01, and 0.006, respectively. Using a machine learning model, physician well-being could be predicted. It seems to be influenced by multiple factors, such as career satisfaction, work hours per week, family support, gender, and power harassment. Career satisfaction has the highest impact, while long work hours have a negative effect on well-being. These findings support the need for organizational interventions to promote physician well-being and improve the quality of medical care.
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Affiliation(s)
- Masahiro Nishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Cardiovascular Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Michiyo Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Pyo J, Ock M, Park B, Kim NE, Choi EJ, Park H, Ahn HS. Meaning and Status of Health-related Quality of Life Recognized by Medical Professionals: a Qualitative Study. J Korean Med Sci 2021; 36:e20. [PMID: 33463094 PMCID: PMC7813583 DOI: 10.3346/jkms.2021.36.e20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 11/01/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Medical professionals must maintain their health to provide quality medical care to patients safely. However, the health-related quality of life of medical professionals is a complex issue that currently lacks a standardized evaluation approach. Therefore, the purpose of this study was to identify their perceptions of the health-related quality of life of medical professionals and explore ways to measure their quality of life as accurately. METHODS This study explored the subjective health status and well-being of Korean medical professionals by conducting three focus group discussions (FGDs) with 12 physicians and 6 nurses (November to December 2019). In the FGD, we elicited participants' opinions on existing health-related quality of life measurement tools. Also, we analyzed transcribed data through content analysis. RESULTS Participants in this study noted the ambiguity in the current definitions of health provided by the World Health Organization. They shared various problems of their health, mainly concerning fatigue and sleep disorders due to their work pattern. Also, participants shared anxiety, burden, and fear of negative consequences due to the complexity of their work. Participants voiced the necessity of a questionnaire on health-related quality of life that reflects the working lives of medical professionals. CONCLUSION Medical professionals in Korea were mainly criticizing about health-related quality of life problems caused by their work characteristics. The results of this study will provide valuable information for future health-related quality of life surveys targeting medical professionals in Korea, and also help to determine the method for monitoring the health-related quality of life for health professionals. In addition, the aspects and items identified by medical professionals as important for their health-related quality of life may be used as a basis for developing a new health-related quality of life measurement tools for medical professionals.
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Affiliation(s)
- Jeehee Pyo
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
- Department of Preventive Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Minsu Ock
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea.
| | - Bohyun Park
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Nam Eun Kim
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Eun Jeong Choi
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Hyesook Park
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, Korea.
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
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Lo C, Yu J, Görges M, Matava C. Anesthesia in the modern world of apps and technology: Implications and impact on wellness. Paediatr Anaesth 2021; 31:31-38. [PMID: 33119935 DOI: 10.1111/pan.14051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 02/01/2023]
Abstract
Recent decades have seen an unprecedented leap in digital innovation, with far-reaching implications in healthcare. Anesthesiologists have historically championed the adoption of new technologies. However, the rapid evolution of these technologies has outpaced attempts at studying their potential impact on healthcare providers' well-being. This document introduces several categories of workplace technologies commonly encountered by the anesthesiologist. We examine examples of novel technology and the impact of these digital interventions on the anesthesiologist's well-being. We also review popular personalized technology aimed at improving wellness and the impact on well-being examined. Finally, technology acceptance models are introduced to improve technology adoption, which, when appropriately applied, may minimize the negative impacts of technology on anesthesiologists' well-being. Incorporating quantitative, serial assessments of well-being as part of technology implementation are proposed as a future direction for examining the wellness impact of technology on anesthesiologists.
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Affiliation(s)
- Calvin Lo
- Department of Anesthesiology and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Julie Yu
- Department of Anesthesiology and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Matthias Görges
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada.,Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Clyde Matava
- Department of Anesthesiology and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Mariani R, Renzi A, Di Trani M, Trabucchi G, Danskin K, Tambelli R. The Impact of Coping Strategies and Perceived Family Support on Depressive and Anxious Symptomatology During the Coronavirus Pandemic (COVID-19) Lockdown. Front Psychiatry 2020; 11:587724. [PMID: 33281647 PMCID: PMC7691226 DOI: 10.3389/fpsyt.2020.587724] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/12/2020] [Indexed: 12/28/2022] Open
Abstract
The coronavirus pandemic represents a severe global crisis, affecting physical, and psychological health. Lockdown rules imposed to counteract the rapid growth of COVID-19, mainly social restrictions, have represented a risk factor for developing depressive and anxious symptoms. The research aims are to explore the effect of coping strategies and perceived social support on depressive and anxious symptomatology during the COVID-19 pandemic. Ninety-six healthy people (46 males, mean age = 39.3; SD = 16.6) completed through on-line platform: Socio-demographic questionnaire, Coping Inventory for Stressful Situations (CISS), Multidimensional Scale of Perceived Social Support (MSPSS) and Symptom Checklist-90-Revised (SCL-90-R), 3 weeks after the imposition of lockdown restrictions. SCL-90-R Depression scores showed significant positive correlation with CISS Emotion (r = 0.85; p = 0.001) and Avoidant (r = 0.34; p = 0.018), a significant negative correlation with MSPSS Family support (r = -0.43; p = 0.003). SCL-90-R Anxiety scores showed a significant positive correlation with CISS Emotion (r = 0.72; p = 0.001) and Avoidant (r = 0.35; p = 0.016). No significant correlations between both CISS Emotion and Avoidant scales with social support emerged. Two Multiple Linear Regression analysis were performed using, respectively, SCL-90-R Depression and Anxiety scores as dependent variables, and the CISS and MSPSS scales, age, and gender as predictors. The first regression model (R 2 = 0.78; adjusted R 2 = 0.75) revealed CISS Emotion (β = 0.83; p = 0.001) and MSPSS Family support (β = -0.24; p = 0.004) had a predictive effect on SCL-90-R Depression scores. The second regression model (R 2 = 0.52; adjusted R 2 = 0.472) revealed that only CISS Emotion (β = 0.71; p = 0.001) predicted the SCL-90-R Anxiety scores. In conclusion, during the COVID-19 pandemic lockdowns, coping focus on emotions seemed to increase anxious and depressive symptoms, probably due to the uncontrollable nature of the stressful event and the high emotional response. Family support which reduces the sense of loneliness had an exclusive role in mitigating depressive symptoms. These results highlight the importance of promoting psychological strategies to improve emotional regulation skills, reducing isolation from family, to prevent mood symptomatology in healthy citizens during large-scale health crises.
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Affiliation(s)
- Rachele Mariani
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Alessia Renzi
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Michela Di Trani
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Kerri Danskin
- Princeton Psychological Services, Princeton, NJ, United States
| | - Renata Tambelli
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
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13
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Berardo L, Gerges C, Wright J, Stout A, Shah H, Papanastassiou A, Kimmell K. Assessment of burnout prevention and wellness programs for US-based neurosurgical faculty and residents: a systematic review of the literature. J Neurosurg 2020; 135:392-400. [PMID: 33126213 DOI: 10.3171/2020.6.jns201531] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Neurosurgeon burnout is a serious and prevalent issue that has been shown to impact professionalism, physician health, and patient outcomes. Interventions targeting physician burnout primarily focus on improving physician wellness. Many academic neurosurgery programs have established wellness curricula to combat burnout and improve wellness. No official recommendations exist for establishing a wellness program that effectively targets sources of burnout. The aim of this review was to examine measures of burnout and report objective results of wellness interventions for neurosurgical faculty and residents. METHODS Two systematic literature reviews were performed in parallel, in accordance with PRISMA 2009 guidelines. Following removal of duplicates, a query of PubMed/MEDLINE, Scopus, Ovid, Cochrane, and EMBASE databases yielded 134 resident-related articles and 208 faculty-related articles for abstract screening. After abstract screening, 17 articles with a primary focus of resident wellness and 10 with a focus on faculty wellness met criteria for full-text screening. Of the total 27 screened articles, 9 (6 resident, 2 faculty, 1 both resident and faculty) met criteria and were included in the final analysis. Article quality was assessed using the Joanna Briggs Institute critical appraisal tools for cohort studies. RESULTS Included studies reported burnout rates for neurosurgery residents of 30%-67%. Work-life imbalance, imbalance of duties, inadequate operative exposure, and hostile faculty were contributors to burnout. The 2 included studies reported burnout rates for neurosurgery faculty members of 27% and 56.7%. Psychosocial stressors, relational stressors, and financial uncertainty were generally associated with increased feelings of burnout. Of the 4 studies reporting on outcomes of wellness initiatives included in this review, 3 reported a positive impact of the wellness interventions and 1 study reported no significant improvement after implementing a wellness initiative. CONCLUSIONS Burnout among neurosurgical faculty and residents is prevalent and permeates the daily lives of neurosurgeons, negatively affecting patient outcomes, career satisfaction, and quality of life. Many neurosurgery programs have instituted wellness programs to combat burnout, but few have published evidence of improvement after implementation. While studies have shown that residents and faculty recognize the importance of wellness and look favorably on such initiatives, very few studies have reported objective outcomes.
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Affiliation(s)
- Laura Berardo
- 1School of Medicine, University of Texas at San Antonio, Texas
| | - Christina Gerges
- 2School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - James Wright
- 2School of Medicine, Case Western Reserve University, Cleveland, Ohio
- 3Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Amber Stout
- 3Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Hamid Shah
- 4Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Kristopher Kimmell
- 6Department of Neurosurgery, Rochester Regional Health and University of Rochester Medical Center, Rochester, New York
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14
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Heinze K, Suwanabol PA, Vitous CA, Abrahamse P, Gibson K, Lansing B, Mody L. A Survey of Patient Perspectives on Approach to Health Care: Focus on Physician Competency and Compassion. J Patient Exp 2020; 7:1044-1053. [PMID: 33457544 PMCID: PMC7786646 DOI: 10.1177/2374373520968447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We conducted a cross-sectional, survey study of 764 volunteers to gain insight into patients’ perceptions of physician qualities of compassion and competence. Among 651 (85% response rate) survey participants, mean age was 52.4 (SD 21.4) years, 70.8% (n = 458) were female, and 84% (n = 539) identified as white. Predictors of compassion over competence included female gender (adjusted odds ratio [aOR] = 1.4, 95% CI: 1.04-1.89) and whether the respondent had a personal connection to the vignette (aOR = 1.24, 95% CI: 1.0-1.53). Thematic analysis demonstrated that preferences were influenced by: (a) explicit beliefs regarding the value of physician compassion and physician competence; (b) impact of emotional and mental health on medical experiences; (c) the type and frequency of health care exposure; and (d) perceived role of the physician in various clinical vignettes. Patients had wide-ranging, complex opinions on the qualities they valued in their physicians. These findings suggest that patients are engaged and can provide critical thoughtful feedback on the practice and delivery of health care.
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Affiliation(s)
- Kevin Heinze
- Department of Ophthalmology & Visual Sciences, University of Illinois, Chicago, IL, USA
| | - Pasithorn A Suwanabol
- Department of Surgery, University of Michigan, MI, USA.,Center for Healthcare Outcomes and Policy, University of Michigan, MI, USA
| | - C Ann Vitous
- Center for Healthcare Outcomes and Policy, University of Michigan, MI, USA
| | - Paul Abrahamse
- Department of Biostatistics, University of Michigan, MI, USA
| | - Kristen Gibson
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, MI, USA
| | - Bonnie Lansing
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, MI, USA
| | - Lona Mody
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, MI, USA.,Geriatrics Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, MI, USA
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15
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Ng APP, Chin WY, Wan EYF, Chen J, Lau CS. Prevalence and severity of burnout in Hong Kong doctors up to 20 years post-graduation: a cross-sectional study. BMJ Open 2020; 10:e040178. [PMID: 33109674 PMCID: PMC7592302 DOI: 10.1136/bmjopen-2020-040178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To estimate the prevalence and severity of burnout and explore the factors associated with burnout among Hong Kong medical graduates up to 20 years post-graduation. DESIGN Cross-sectional survey. SETTING Hong Kong. PARTICIPANTS Doctors who graduated from the University of Hong Kong between 1995 and 2014. PRIMARY AND SECONDARY OUTCOME MEASURES Burnout as measured by the Copenhagen Burnout Inventory (CBI), alcohol consumption as measured by the Alcohol Use Disorders Identification Test Version C, lifestyle behaviours (hours of sleep and work, exercise, smoking, substance use), career satisfaction and sociodemographic characteristics were obtained using paper or online questionnaires. RESULTS Response rate was 30.9% (496/1607). Prevalence of CBI burnout was 63.1% (personal), 55.9% (work-related) and 35.4% (patient-related). The mean CBI subscale scores were 57.4±21.4 (personal), 48.9±7.4 (work-related) and 41.5±21.8 (client-related). Factors associated with personal and patient-related burnout included age (coeff -0.437, 95% CI -0.779 to -0.095 and coeff -0.596, 95% CI -0.965 to -0.228, respectively), practice setting (coeff -5.759, 95% CI -10.665 to -0.853 and coeff -5.317, 95% CI -10.602 to -0.032, respectively) and regular exercise (coeff -6.855, 95% CI -11.102 to -2.608 and coeff -6.769, 95% CI -11.333 to -2.205, respectively). Gender (coeff 5.1, 95% CI 1.382 to 8.818), average hours of sleep per night (coeff -5.200, 95% CI -7.139 to -3.262) and work hours per week (coeff 0.226, 95% CI 0.099 to 0.353) were associated with personal burnout only. No factors were significantly associated with work-related burnout. CONCLUSION Burnout is highly prevalent among Hong Kong medical graduates. Younger doctors, women and those working in the public sector appear to be at higher risk for burnout and may benefit from targeted interventions. Policymakers and healthcare authorities should consider measures to help reduce burnout by enabling adequate sleep, reducing work hours and encouraging exercise.
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Affiliation(s)
- Amy Pui Pui Ng
- Department of Family Medicine and Primary Care, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, China
| | - Weng Yee Chin
- Department of Family Medicine and Primary Care, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, China
- Institute of Medical and Health Sciences Education, University of Hong Kong, Hong Kong, China
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, China
- Department of Pharmacology and Pharmacy, University of Hong Kong, Hong Kong, China
| | - Julie Chen
- Department of Family Medicine and Primary Care, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, China
- Institute of Medical and Health Sciences Education, University of Hong Kong, Hong Kong, China
| | - Chak Sing Lau
- Department of Medicine, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, China
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16
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Gaeta TJ. Need for a holistic approach to reducing burnout and promoting well-being. J Am Coll Emerg Physicians Open 2020; 1:1050-1051. [PMID: 33145556 PMCID: PMC7593492 DOI: 10.1002/emp2.12111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/01/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Theodore J. Gaeta
- Department of Emergency MedicineNewYork‐Presbyterian Brooklyn Methodist HospitalBrooklynNew YorkUSA
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17
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Yaffee AQ, Peacock E, Seitz R, Hughes G, Haun P, Ross M, Moran TP, Pendley A, Terry N, Wright DW. Preparedness, Adaptation, and Innovation: Approach to the COVID-19 Pandemic at a Decentralized, Quaternary Care Department of Emergency Medicine. West J Emerg Med 2020; 21:63-70. [PMID: 33052812 PMCID: PMC7673894 DOI: 10.5811/westjem.2020.8.48624] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/19/2020] [Indexed: 01/17/2023] Open
Abstract
The COVID-19 pandemic has required healthcare systems to be creative and adaptable in response to an unprecedented crisis. Below we describe how we prepared for and adapted to this pandemic at our decentralized, quaternary-care department of emergency medicine, with specific recommendations from our experience. We discuss our longstanding history of institutional preparedness, as well as adaptations in triage, staffing, workflow, and communications. We also discuss innovation through working with industry on solutions in personal protective equipment, as well as telemedicine and methods for improving morale. These preparedness and response solutions and recommendations may be useful moving forward as we transition between response and recovery in this pandemic as well as future pandemics.
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Affiliation(s)
- Anna Q Yaffee
- Emory University, Department of Emergency Medicine, Atlanta, Georgia
| | - Elizabeth Peacock
- Emory University, Department of Emergency Medicine, Atlanta, Georgia
| | - Roslyn Seitz
- Emory University, Department of Emergency Medicine, Atlanta, Georgia
| | - George Hughes
- Emory University, Department of Emergency Medicine, Atlanta, Georgia
| | - Philip Haun
- Emory University, Department of Emergency Medicine, Atlanta, Georgia
| | - Michael Ross
- Emory University, Department of Emergency Medicine, Atlanta, Georgia
| | - Tim P Moran
- Emory University, Department of Emergency Medicine, Atlanta, Georgia
| | - Andrew Pendley
- Emory University, Department of Emergency Medicine, Atlanta, Georgia
| | - Nataisia Terry
- Emory University, Department of Emergency Medicine, Atlanta, Georgia
| | - David W Wright
- Emory University, Department of Emergency Medicine, Atlanta, Georgia
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18
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Carmassi C, Bertelloni CA, Avella MT, Cremone I, Massimetti E, Corsi M, Dell'Osso L. PTSD and Burnout are Related to Lifetime Mood Spectrum in Emergency Healthcare Operator. Clin Pract Epidemiol Ment Health 2020; 16:165-173. [PMID: 32874191 PMCID: PMC7431684 DOI: 10.2174/1745017902016010165] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/21/2020] [Accepted: 06/28/2020] [Indexed: 11/27/2022]
Abstract
Background: PTSD and burnout are frequent conditions among emergency healthcare personnel because exposed to repeated traumatic working experiences. Increasing evidence suggests high comorbidity between PTSD and mood symptoms, particularly depression, although the real nature of this relationship still remains unclear. The purpose of this study was to investigate the relationship between PTSD, burnout and lifetime mood spectrum, assessed by a specific scale, among health-care professionals of a major University Hospital in Italy. Methods: N=110 Emergency Unit workers of the Azienda Ospedaliero-Universitaria Pisana (Pisa, Italy) were assessed by the TALS-SR, MOODS-SR lifetime version and the ProQOL R-IV. Results: Approximately 60% of participants met at least one PTSD symptom criterion (criterion B, 63.4%; criterion C, 40.2%; criterion D 29.3%; criterion E, 26.8%), according to DSM-5 diagnosis. Almost sixteen percent of the sample reported a full symptomatic DSM-5 PTSD (work-related) diagnosis, and these showed significantly higher scores in all MOODS-SR depressive domains, as well as in the rhythmicity domain, compared with workers without PTSD. Further, mood-depressive and cognition-depressive MOODS-SR domains resulted to be predictive for PTSD. Significant correlations emerged between either PTSD diagnosis and criteria or ProQOL subscales and all the MOOD-SR domains. Conclusion: A significant association emerged among PTSD, burnout and lifetime MOOD Spectrum, particularly the depressive component, in emergency health care operators, suggesting this population should be considered at-risk and undergo regular screenings for depression and PTSD.
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Affiliation(s)
- Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Maria Teresa Avella
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ivan Cremone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Enrico Massimetti
- ASST, Bergamo Ovest, SSD Servizio Psichiatrico diagnosi e cura, Treviglio, Italy
| | - Martina Corsi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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19
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Hettle D, Sutherland K, Miles E, Allanby L, Bakewell Z, Davies D, Dhonye Y, Handford V, Upton R, Vilenchik V, Wood R. Cross-skilling training to support medical redeployment in the COVID-19 pandemic. Future Healthc J 2020; 7:e41-e44. [PMID: 33094252 DOI: 10.7861/fhj.2020-0049] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
During the response to the COVID-19 pandemic, doctors will be redeployed into roles with which they are unfamiliar. Adequate training must be provided to reacquaint doctors with medical ward practice, supporting psychological wellbeing and patient safety. Here we describe a cross-skilling programme in North Bristol NHS Trust designed to address colleague anxiety and support wellbeing during redeployment.
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20
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Stehman CR, Clark RL, Purpura A, Kellogg AR. Wellness: Combating Burnout and Its Consequences in Emergency Medicine. West J Emerg Med 2020; 21:555-565. [PMID: 32421501 PMCID: PMC7234720 DOI: 10.5811/westjem.2020.1.40971] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/10/2020] [Indexed: 12/12/2022] Open
Abstract
Medicine recognizes burnout as a threat to quality patient care and physician quality of life. This issue exists throughout medicine but is notably prevalent in emergency medicine (EM). Because the concept of "wellness" lacks a clear definition, attempts at ameliorating burnout that focus on achieving wellness make success difficult to achieve and measure. Recent work within the wellness literature suggests that the end goal should be to achieve a culture of wellness by addressing all aspects of the physician's environment. A review of the available literature on burnout and wellness interventions in all medical specialties reveals that interventions focusing on individual physicians have varying levels of success. Efforts to compare these interventions are hampered by a lack of consistent endpoints. Studies with consistent endpoints do not demonstrate clear benefits of achieving them because improving scores on various scales may not equate to improvement in quality of care or physician quality of life. Successful interventions have uncertain, long-term effects. Outside of EM, the most successful interventions focus on changes to systems rather than to individual physicians. Within EM, the number of well-structured interventions that have been studied is limited. Future work to achieve the desired culture of wellness within EM requires establishment of a consistent endpoint that serves as a surrogate for clinical significance, addressing contributors to burnout at all levels, and integrating successful interventions into the fabric of EM.
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Affiliation(s)
- Christine R Stehman
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - Ryan L Clark
- University of Massachusetts Medical School - Baystate Health, Department of Emergency Medicine, Springfield, Massachusetts
| | - Andrea Purpura
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - Adam R Kellogg
- University of Massachusetts Medical School - Baystate Health, Department of Emergency Medicine, Springfield, Massachusetts
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21
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Sikora RD, Manfredi RA, Chung A, Kaplan JA, Tyo CJ, Akhtar S. Wellness for the Future: Cultural and Systems-based Challenges and Solutions. Acad Emerg Med 2020; 27:317-332. [PMID: 32037678 DOI: 10.1111/acem.13937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/13/2020] [Accepted: 01/30/2020] [Indexed: 12/30/2022]
Abstract
The goal of the 2019 Society for Academic Emergency Medicine Consensus Conference was to explore the current cultural and systemic issues in emergency medicine that impact the individual well-being of every emergency physician and to make recommendations for future study. Burnout is epidemic in emergency medicine. Physician wellness is required to enhance patient clinical outcomes as well as to ensure professional satisfaction and longevity. For conference preparation, a consensus steering committee was created, and a decision was made to use the groundbreaking model of the National Academy of Medicine's "Factors Affecting Clinician Well-Being and Resilience" to further identify areas of needed study. On May 14, 2019, the Wellness Consensus Conference was attended by over 50 faculty physicians from across the United States. These attendees discussed key concepts and prior research presented by content experts. Groups of participants engaged in crowdsourcing techniques to consolidate ideas derived from those discussions. These consensus concepts were recorded and are presented within this article. A repetitive theme noted at the conference was the overwhelming effect of the system and organization factors on individual physician well-being. The concept of ongoing assessment of professional fulfillment over the life span of the emergency physician was felt to be crucial in guiding wellness and resilience interventions in a timely manner. Examining ways to enable physicians to flourish rather than experience burnout are strong future directions for study.
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Affiliation(s)
- Rosanna D. Sikora
- Department of Emergency Medicine West Virginia University Morgantown WV
| | | | | | - Jay A. Kaplan
- University Medical Center New Orleans New Orleans LA
| | | | - Saadia Akhtar
- and Icahn School of Medicine at Mount Sinai New York NY
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22
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Aggarwal A, Lazarow F, Anzai Y, Elsayed M, Ghobadi C, Dandan OA, Griffith B, Straus CM, Kadom N. Maximizing Value While Volumes are Increasing. Curr Probl Diagn Radiol 2020; 50:451-453. [PMID: 32222265 DOI: 10.1067/j.cpradiol.2020.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/09/2020] [Accepted: 02/25/2020] [Indexed: 01/04/2023]
Abstract
Radiologists are facing ever increasing volumes while trying to provide value-based care. There are several drivers of increasing volumes: increasing population size, aging population, increased utilization, gaps in evidence-based care, changes in the provider workforce, defensive medicine, and increasing case complexity. Higher volumes result in increased cognitive and systemic errors and contribute to radiologist fatigue and burnout. We discuss several strategies for mitigating high volumes including abbreviated MRI protocols, 24/7 radiologist coverage, reading room assistants, and other strategies to tackle radiologist burnout.
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Affiliation(s)
| | - Frances Lazarow
- Department of Radiology, Eastern Virginia Medical School, Norfolk, VA
| | - Yoshimi Anzai
- Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, UT
| | - Mohammad Elsayed
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Comeron Ghobadi
- Department of Radiology, The University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Omran Al Dandan
- Department of Radiology, Imam Abdulrahman Bin Faisal University College of Medicine, Dammam, Saudi Arabia
| | - Brent Griffith
- Department of Radiology, Henry Ford Health System, Detroit, MI
| | - Christopher M Straus
- Department of Radiology, The University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Nadja Kadom
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
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23
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Abstract
Diabetes educators can be challenged by therapeutic inertia, as has been documented with other health care providers. There are many contributing factors related to the educators themselves, their patients, and the health care system in which they operate. To address this potentially significant barrier to quality patient care, diabetes educators can adopt numerous strategies to maximize their impact and address the factors contributing to therapeutic inertia in their practices.
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Affiliation(s)
- Carla Cox
- Mountain Vista Medicine, South Jordan, UT
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24
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Kaczor EE, Carreiro S, Stapp J, Chapman B, Indic P. Objective Measurement of Physician Stress in the Emergency Department Using a Wearable Sensor. PROCEEDINGS OF THE ... ANNUAL HAWAII INTERNATIONAL CONFERENCE ON SYSTEM SCIENCES. ANNUAL HAWAII INTERNATIONAL CONFERENCE ON SYSTEM SCIENCES 2020; 2020:3729-3738. [PMID: 32015695 PMCID: PMC6996921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Physician stress, and resultant consequences such as burnout, have become increasingly recognized pervasive problems, particularly within the specialty of Emergency Medicine. Stress is difficult to measure objectively, and research predominantly relies on self-reported measures. The present study aims to characterize digital biomarkers of stress as detected by a wearable sensor among Emergency Medicine physicians. Physiologic data were continuously collected using a wearable sensor during clinical work in the emergency department, and participants were asked to self-identify episodes of stress. Machine learning algorithms were used to classify self-reported episodes of stress. Comparing baseline sensor data to data in the 20-minute period preceding self-reported stress episodes demonstrated the highest prediction accuracy for stress. With further study, detection of stress via wearable sensors could be used to facilitate evidence-based stress research and just-in-time interventions for emergency physicians and other high-stress professionals.
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Affiliation(s)
- Eric E Kaczor
- Department of Emergency Medicine, Division of Medical Toxicology, University of Massachusetts, Medical School, Worcester, MA
| | - Stephanie Carreiro
- Department of Emergency Medicine, Division of Medical Toxicology, University of Massachusetts Medical, School, Worcester, MA
| | - Joshua Stapp
- Department of Electrical Engineering, University of Texas at Tyler, Tyler, TX
| | - Brittany Chapman
- Department of Emergency Medicine, Division of Medical Toxicology, University of Massachusetts Medical School, Worcester, MA
| | - Premananda Indic
- Department of Electrical Engineering, University of Texas at Tyler, Tyler, TX
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25
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Boettcher C, Sommer G, Peitzsch M, Zimmer KP, Eisenhofer G, Wudy SA. Differential Responses of Urinary Epinephrine and Norepinephrine to 24-h Shift-Work Stressor in Physicians. Front Endocrinol (Lausanne) 2020; 11:572461. [PMID: 33071978 PMCID: PMC7538665 DOI: 10.3389/fendo.2020.572461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/18/2020] [Indexed: 01/13/2023] Open
Abstract
Multiple stressors, including 24-h-shifts characterise the working environment of physicians, influencing well-being, health and performance. We aimed to evaluate the effect of the stressor 24-h-shift on the adrenal medullary and sympathoneural system in physicians with the hypothesis that shift work might have different impacts on both systems. Twenty-two physicians collected two 12-h-urine samples ("daytime" and "nighttime") during a 24-h shift ("on-duty") and on a free weekend ("off-duty"), respectively. Urinary excretion rates per m2 body surface area were assessed for the catecholamines epinephrine, norepinephrine and their respective free O-methylated metabolites metanephrine and normetanephrine by LC-MS/MS-analysis. The stressor provoked differential responses of epinephrine and norepinephrine. Epinephrine excretion rates showed significant increases from off to on duty. The largest proportional change (off-duty to on-duty) for epinephrine was observed for nighttime (205%), the increase for daytime was 84%. An increase in norepinephrine from off to on duty was only visible for nighttime collections. For the catecholamine metabolites, normetanephrine paralleled norepinephrine and exhibited an increase in excretion from off to on duty during nighttime collections of 53% whereas there was no change during daytime collections (3%). In conclusion: Whilst the 24-h-shift-work stressor in physicians activates the sympatho-adrenomedullary system, represented by epinephrine, the sympathoneural response through norepinephrine reflects mainly an ambulatory position during working hours.
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Affiliation(s)
- Claudia Boettcher
- University Children's Hospital, Paediatric Endocrinology & Diabetology, University of Berne, Berne, Switzerland
- Division of Paediatric Endocrinology & Diabetology, Department of General Paediatrics and Neonatology, Centre of Child and Adolescent Medicine, Justus Liebig University Giessen, Giessen, Germany
- *Correspondence: Claudia Boettcher
| | - Grit Sommer
- University Children's Hospital, Paediatric Endocrinology & Diabetology, University of Berne, Berne, Switzerland
| | - Mirko Peitzsch
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Klaus-Peter Zimmer
- Department of General Paediatrics and Neonatology, Centre of Child and Adolescent Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - Graeme Eisenhofer
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Stefan A. Wudy
- Division of Paediatric Endocrinology & Diabetology, Department of General Paediatrics and Neonatology, Centre of Child and Adolescent Medicine, Justus Liebig University Giessen, Giessen, Germany
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Comp GB, Sharkey M. ED Stories: An Online Emergency Medicine Residency Community Building and Wellness Initiative. Cureus 2019; 11:e5405. [PMID: 31632859 PMCID: PMC6795368 DOI: 10.7759/cureus.5405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The "ED Stories" project is a novel method for promoting individual wellness and interpersonal relationships on a virtual platform in an emergency medicine residency program. We engaged multiple individuals across all levels of medical training on a virtual platform to facilitate discussion regarding difficult situations, patient interactions, and tips on how to succeed in challenge circumstances in the future. The platform was outlined as a "safe space," free of judgment and criticism. We engaged 54 participants with a culmination of 131 interactions; there were 14 original posts with a total of 22 comments. We believe that this virtual platform allowed for safe discussion of difficult concepts related to our jobs and served as an outlet to promote physician wellness and reduce burnout in the future.
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Affiliation(s)
| | - Meenal Sharkey
- Emergency Medicine, OhioHealth Doctors Hospital, Columbus, USA
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