Harmonized definition of occupational burnout: A systematic review, semantic analysis, and Delphi consensus in 29 countries

Objective:

A consensual definition of occupational burnout is currently lacking. We aimed to harmonize the definition of occupational burnout as a health outcome in medical research and reach a consensus on this definition within the Network on the Coordination and Harmonisation of European Occupational Cohorts (OMEGA-NET).

Methods:

First, we performed a systematic review in MEDLINE, PsycINFO and Embase (January 1990 to August 2018) and a semantic analysis of the available definitions. We used the definitions of burnout and burnout-related concepts from the Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT) to formulate a consistent harmonized definition of the concept. Second, we sought to obtain the Delphi consensus on the proposed definition.

Results:

We identified 88 unique definitions of burnout and assigned each of them to 1 of the 11 original definitions. The semantic analysis yielded a first proposal, further reformulated according to SNOMED-CT and the panelists’ comments as follows: “In a worker, occupational burnout or occupational physical AND emotional exhaustion stateis an exhaustion due to prolonged exposure to work-related problems”. A panel of 50 experts (researchers and healthcare professionals with an interest for occupational burnout) reached consensus on this proposal at the second round of the Delphi, with 82% of experts agreeing on it.

Conclusion:

This study resulted in a harmonized definition of occupational burnout approved by experts from 29 countries within OMEGA-NET. Future research should address the reproducibility of the Delphi consensus in a larger panel of experts, representing more countries, and examine the practicability of the definition.

Gait analysis in patients with a preformed articulated knee spacer

Two-stage revision is one of the most widely accepted procedures to eradicate infection and restore function in infected knee prosthesis; while the use of an articulated spacers is advocated by many as a means to preserve function between stages, no data are available regarding gait parameters after spacer implant. The aim of present study was to assess and compare the gait parameters of patients with articulated knee spacers with a normal reference population and with the sound limb. Computerised gait analysis, was performed 8 to 14 weeks after the infected knee prosthesis had been removed and a preformed, articulated, knee spacer had been implanted, in 10 consecutive patients. Kinematic data show a mean gait velocity reduction of 70% and a decrease of the range of motion of the operated knee of 59%, compared with controls. While ground reaction forces were only slightly reduced, frontal and sagittal moments and calculated powers around the affected knees were near zero or zero. Our findings point out the ability of a preformed articulated spacer to preserve, although reduced, the normal gait parameters and joint range of motion and the capacity of the human body to provide useful postural modifications, even in the absence of the proprioceptive input from a normal knee or from a traditional total knee replacement.

Telethermographic findings after uncomplicated and septic total knee replacement

Thermal imaging with infrared thermography is a noninvasive approach to monitoring surgical site healing and detecting septic complications. The aim of this study was to set reference values for telethermographic patterns of wound healing after total knee replacement (TKR) not complicated by infection and to compare them against thermograms from patients with knee prosthesis infection. Forty consecutive patients operated for TKR underwent telethermography of the operated and the contralateral knee before and up to 12 months after uncomplicated surgery. The imaging data sets were then compared against those obtained starting 8 months after TKR in 15 other patients with diagnosed periprosthetic infection. Presurgical assessment thermograms showed no difference between the affected and the healthy knees. At assessment 3 days postoperative, the temperature of the operated knee had increased markedly, with a peak differential temperature (operated minus non-operated knee joint temperature) of 3.4±0.7°C; measurement at 90 days after surgery showed a return to baseline knee joint temperature in the patients with uncomplicated surgery. In the patients with septic complications, the mean differential temperature was 1.6±0.6°C (range, 1.1-2.5°C). Thermal imaging showed a measurable, reproducible telethermographic pattern of surgical site healing in patients with uncomplicated TKR and an elevated mean differential temperature >1.0°C in those with persistent prosthesis infection.