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Thakore NL, Lan M, Winkel AF, Vieira DL, Kang SK. Best Practices: Burnout Is More Than Binary. AJR Am J Roentgenol 2024. [PMID: 39016454 DOI: 10.2214/ajr.24.31111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
Burnout among radiologists is increasingly prevalent, with potential for substantial negative impact on physician well-being, care delivery, and health outcomes. To evaluate this phenomenon using reliable and accurate means, validated quantitative instruments are essential. Variation in measurement can contribute to wide-ranging findings. This article evaluates radiologist burnout rates globally and dimensions of burnout as reported using different validated instruments and provide guidance on best practices to characterize burnout. Fifty-seven studies between 1990 and 2023 were included in a systematic review, and 43 studies were included in a meta-analysis of burnout prevalence using random effects models. Reported burnout ranged from 5% to 85%. With the Maslach Burnout Inventory (MBI), burnout prevalence varied significantly depending on instrument version. Among MBI subcategories, the prevalence of emotional exhaustion was 54% (95% CI, 45-63%), depersonalization was 52% (95% CI, 41-63%), and low personal accomplishment was 36% (95% CI, 27-47%). Other validated burnout instruments showed less heterogeneous results; studies using the Stanford Professional Fulfillment Index yielded burnout prevalence of 39% (95% CI, 34-45%), whereas the Validated Single-Item instrument yielded 34% (95% CI, 29-39%). Standardized instruments for prevalence alongside multidimensional profiles capturing experiences may better characterize radiologist burnout, including change over time.
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Affiliation(s)
| | - Michael Lan
- NYU Grossman School of Medicine, New York, NY
| | | | - Dorice L Vieira
- Health Sciences Library, NYU Grossman School of Medicine, New York, NY
| | - Stella K Kang
- Associate Professor, Department of Radiology, NYU Langone Health, New York, NY
- Department of Population Health, NYU Langone Health, New York, NY
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2
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Azour L, Goldin JG, Kruskal JB. Radiologist and Radiology Practice Wellbeing: A Report of the 2023 ARRS Wellness Summit. Acad Radiol 2024; 31:250-260. [PMID: 37718125 DOI: 10.1016/j.acra.2023.08.025] [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: 07/24/2023] [Revised: 08/14/2023] [Accepted: 08/19/2023] [Indexed: 09/19/2023]
Abstract
In April 2023, the first American Roentgen Ray Society (ARRS) Wellness Summit was held in Honolulu, Hawaii. The Summit was a communal call to action bringing together professionals from the field of radiology to critically review our current state of wellness and reimagine the role of radiology and radiologists to further wellbeing. The in-person and virtual Summit was available free-of-cost to all meeting registrants and included 12 sessions with 44 invited moderators and panelists. The Summit aimed to move beyond simply rehashing the repeated issues and offering theoretical solutions, and instead focus on intentional practice evolution, identifying implementable strategies so that we as a field can start to walk our wellness talk. Here, we first summarize the thematic discussions from the 2023 ARRS Wellness Summit, and second, share several strategic action items that emerged.
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Affiliation(s)
- Lea Azour
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA.
| | - Jonathan G Goldin
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jonathan B Kruskal
- Department of Radiology, Harvard-Beth Israel Deaconess Medical Center, Boston, MA
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3
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Marchand WR, Sullivan-Sakaeda L, Lackner R, Taplin D, Nazarenko E. A replication study of a psychotherapy incorporating horses resiliency intervention for healthcare workers. Complement Ther Med 2023; 76:102965. [PMID: 37473927 DOI: 10.1016/j.ctim.2023.102965] [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: 04/18/2023] [Revised: 06/16/2023] [Accepted: 07/17/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVES The first aim of this pilot observational study was to replicate a previous study of a resiliency psychotherapy incorporating horses (PIH) intervention for healthcare workers. The second aim was to address some gaps in the literature regarding equine-assisted services more broadly. DESIGN Prospective open trial. SETTING A large healthcare system and a community equine facility INTERVENTION: A single-session four-hour intervention that focused on participants resilience. MAIN OUTCOME MEASURES Safety, feasibility, and utilization were assessed, and psychological instruments were administered. Instruments utilized were the Positive and Negative Affect Scale the Acceptance and Action Questionnaire II, and the Conner-Davidson Resiliency Scale. RESULTS Thirty-eight subjects participated in the study, the majority of which were female (71.1 %). The age group with the most representation included those ranging from age 25-34. The intervention was safe but underutilized. Participation was associated with improved psychological flexibility (PF), and positive affect, as well as reduction in negative affect pre- to post-intervention. There was no change in resiliency and there were no associations between improvements in affect and PF. CONCLUSIONS Resiliency PIH interventions for healthcare workers can be utilized safely and likely result in short-term psychological benefits for participants. Future randomized controlled investigations are warranted, and these studies should implement methods to maximize utilization. Additionally, this study and the literature suggest that enhanced affect and PF are likely important EAS outcomes across a variety of interventions. These constructs should be investigated with more rigorous studies including comparisons of interventions with and without a psychotherapy component.
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Affiliation(s)
- William R Marchand
- VISN 19 Whole Health Flagship site, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA; Department of Psychiatry, University of Utah, 501 Chipeta Way, Salt Lake City, UT 84108, USA; Department of Animal, Dairy and Veterinary Sciences, Utah State University, 4815 Old Main Hill, Logan, UT 84322, USA.
| | | | - Ryan Lackner
- VISN 19 Whole Health Flagship site, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA
| | - Dylan Taplin
- VISN 19 Whole Health Flagship site, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA
| | - Elena Nazarenko
- VISN 19 Whole Health Flagship site, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA
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Gabelloni M, Faggioni L, Fusco R, De Muzio F, Danti G, Grassi F, Grassi R, Palumbo P, Bruno F, Borgheresi A, Bruno A, Catalano O, Gandolfo N, Giovagnoni A, Miele V, Barile A, Granata V. Exploring Radiologists' Burnout in the COVID-19 Era: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3350. [PMID: 36834044 PMCID: PMC9966123 DOI: 10.3390/ijerph20043350] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/03/2023] [Accepted: 02/12/2023] [Indexed: 06/18/2023]
Abstract
Since its beginning in March 2020, the COVID-19 pandemic has claimed an exceptionally high number of victims and brought significant disruption to the personal and professional lives of millions of people worldwide. Among medical specialists, radiologists have found themselves at the forefront of the crisis due to the pivotal role of imaging in the diagnostic and interventional management of COVID-19 pneumonia and its complications. Because of the disruptive changes related to the COVID-19 outbreak, a proportion of radiologists have faced burnout to several degrees, resulting in detrimental effects on their working activities and overall wellbeing. This paper aims to provide an overview of the literature exploring the issue of radiologists' burnout in the COVID-19 era.
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Affiliation(s)
- Michela Gabelloni
- Nuclear Medicine Unit, Department of Translational Research, University of Pisa, 56126 Pisa, Italy
| | - Lorenzo Faggioni
- Academic Radiology, Department of Translational Research, University of Pisa, 56126 Pisa, Italy
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
| | - Federica De Muzio
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy
| | - Ginevra Danti
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
- Italian Society of Medical and Interventional Radiology, SIRM Foundation, 20122 Milan, Italy
| | - Francesca Grassi
- Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Roberta Grassi
- Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Pierpaolo Palumbo
- Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, Department of Diagnostic Imaging, 67100 L’Aquila, Italy
| | - Federico Bruno
- Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, Department of Diagnostic Imaging, 67100 L’Aquila, Italy
| | - Alessandra Borgheresi
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, 60126 Ancona, Italy
- Department of Clinical, Special and Dental Sciences, Università Politecnica delle Marche, 60126 Ancona, Italy
| | - Alessandra Bruno
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, 60126 Ancona, Italy
- Department of Clinical, Special and Dental Sciences, Università Politecnica delle Marche, 60126 Ancona, Italy
| | - Orlando Catalano
- Department of Radiology, Istituto Diagnostico Varelli, 80126 Naples, Italy
| | - Nicoletta Gandolfo
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, 16149 Genoa, Italy
| | - Andrea Giovagnoni
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, 60126 Ancona, Italy
- Department of Clinical, Special and Dental Sciences, Università Politecnica delle Marche, 60126 Ancona, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
- Italian Society of Medical and Interventional Radiology, SIRM Foundation, 20122 Milan, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
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Burnout Is the Symptom, Moral Injury Is the Cause: The Need for Systems-Level Changes in Radiology. AJR Am J Roentgenol 2023; 220:297-298. [PMID: 35920709 DOI: 10.2214/ajr.22.28027] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Burnout. Wellness. Resiliency. Self-care. These buzzwords have become commonplace and the topics of articles, webinars, and lectures in medicine. Opinions vary about the most effective initiatives to optimize radiologist wellness and mitigate burnout. Despite ongoing efforts, burnout continues to grow. Although individual-directed interventions play a role, the greater leverage lies with practice- and organization-led initiatives.
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Bredella MA, Volkov BB, Doyle JM. Training and cultivating the translational science workforce: Responses of Clinical and Translational Science Awards program hubs to the COVID-19 pandemic. Clin Transl Sci 2023; 16:43-49. [PMID: 36448246 PMCID: PMC9841297 DOI: 10.1111/cts.13437] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/28/2022] [Accepted: 10/07/2022] [Indexed: 12/05/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has dramatically changed our lives and the delivery of healthcare. The pandemic also led to widespread disruption in the research activities and training of pre-doctoral, post-doctoral, and early career faculty researchers. This mini-review uses the Local Adaptive Capacity Framework to describe successful practices, challenges, and lessons learned on how Clinical and Translational Science Award (CTSA) hubs have used their expertise, resources, and collaborations to advance clinical and translational science research and workforce development while facing and adapting to a pandemic. Data for this mini-review were taken from the scientific literature (23 articles) and the Research Performance Progress Reports of 50 unique CTSA hubs (40 TL1 and 50 KL2 awards). Institutions responded in innovative ways to the disruption of the COVID-19 pandemic. Electronic and virtual platforms were used to overcome challenges related to physical distancing, laboratory closures, and travel bans. The importance of mentorship and well-being led to the creation of new virtual programs to expand mentoring and networking beyond the home institution and to promote well-being and resilience. These solutions to translational workforce development can be implemented to address future public health emergencies.
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Affiliation(s)
- Miriam A. Bredella
- Massachusetts General Hospital and Harvard Catalyst, The Harvard Clinical and Translational Science CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Boris B. Volkov
- University of Minnesota Clinical and Translational Science InstituteMinneapolisMinnesotaUSA
- Division of Epidemiology and Community Health, Institute for Health InformaticsUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Jamie M. Doyle
- Division of Clinical Innovation, National Center for Advancing Translational SciencesNational Institutes of HealthBethesdaMarylandUSA
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Cooke EA, Awan OA. Beyond the Gray Scale: Using the Arts to Elevate our Work in Radiology. Acad Radiol 2022; 29:1449-1451. [PMID: 35907642 DOI: 10.1016/j.acra.2021.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 10/16/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Erin A Cooke
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Omer A Awan
- Associate Vice Chair of Education, University of Maryland School of Medicine, 655 W Baltimore Street, Baltimore, MD 21201.
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Horowitz JM, Choe MJ, Dienes K, Cameron KA, Agarwal G, Yaghmai V, Carr JC. Team Approach to Improving Radiologist Wellness: A Case-Based Methodology. Curr Probl Diagn Radiol 2022; 51:806-812. [PMID: 35365374 PMCID: PMC9356970 DOI: 10.1067/j.cpradiol.2022.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/08/2022] [Accepted: 02/27/2022] [Indexed: 09/03/2023]
Abstract
Radiologist wellness is important on an individual and group/institutional level and helps to promote a strong and healthy working environment, which can improve radiologist retention and engagement. This paper will discuss case examples of radiologist wellness improvements in a single academic institution over a 3-year period using the DMAIC (Define, Measure, Analyze, Improve, and Control) model. Leveraging this framework led to the implementation of reading room assistants, reduction in work-related injuries by improvements in ergonomics, and the formation of a faculty mentorship program.
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Affiliation(s)
- Jeanne M Horowitz
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Michael J Choe
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Katelyn Dienes
- Director, Project Management Office, Northwestern Memorial Health Care, Chicago, IL
| | - Kenzie A Cameron
- Division of General Internal Medicine and Geriatrics / Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Gaurava Agarwal
- Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Vahid Yaghmai
- Department of Radiological Sciences, University of California, Irvine, UCI Health, Dept of Radiology, University of California Irvine, Orange, CA
| | - James C Carr
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
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9
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Marchand WR, Sullivan-Sakaeda L. A pilot observational study of a psychotherapy incorporating equines resiliency intervention for staff at a large medical center. Complement Ther Clin Pract 2022; 49:101660. [PMID: 35988323 DOI: 10.1016/j.ctcp.2022.101660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 06/12/2022] [Accepted: 08/10/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND and purpose: Stress and burnout among healthcare workers are significant public health concerns. The primary aim of this pilot study was to conduct preliminary assessments of safety, feasibility, and participant satisfaction with a psychotherapy incorporating equines (PIE)-based resiliency intervention for healthcare workers. The overarching goal was to lay the groundwork for future, more rigorous investigations. Lastly, a very preliminary assessment of using the Acceptance and Action Questionnaire II (AAQII) to assess for changes in psychological flexibility (PF) associated with PIE was conducted. MATERIALS AND METHODS Thirty-seven staff members from a medical center participated in a 4-h PIE-based resiliency retreat. Pre- and post-intervention instruments were utilized to assess participants' self-perception of physical and psychological health (PROMIS Global Short Form) and enjoyment of (Physical Activity Enjoyment Scale) and satisfaction with (Client Satisfaction Questionnaire) the intervention, as well as changes in PF (AAQII). RESULTS There were no adverse effects on participants, staff, or equines. Preliminary results suggested that the intervention was perceived as enjoyable by participants. However, the intervention was not fully utilized. Finally, there was a significant (p = 0.02) pre-to post-intervention change in AAQII scores. CONCLUSION This study provides a foundation for future rigorous studies of PIE-based resiliency interventions for medical staff. Given the limitations of this pilot work, firm conclusions cannot be drawn regarding safety and feasibility. However, the preliminary results suggest that future studies of this intervention are warranted and that the AAQII may be a useful instrument to assess for possible changes in PF.
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Affiliation(s)
- William R Marchand
- VISN 19 Whole Health Flagship Site, Located at VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT, 84148, USA; Department of Psychiatry, University of Utah, 501 Chipeta Way, Salt Lake City, UT, 84108, USA; Department of Animal, Dairy and Veterinary Sciences, Utah State University, 0500 Old Main Hill, Logan, UT, 84322, USA.
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10
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Systematic Review of Mind–Body Modalities to Manage the Mental Health of Healthcare Workers during the COVID-19 Era. Healthcare (Basel) 2022; 10:healthcare10061027. [PMID: 35742076 PMCID: PMC9222815 DOI: 10.3390/healthcare10061027] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/28/2022] [Accepted: 05/31/2022] [Indexed: 12/12/2022] Open
Abstract
Healthcare workers (HCWs) have suffered physical and psychological threats since the beginning of the coronavirus disease 2019 (COVID-19) pandemic. Mind-body modalities (MBMs) can reduce the long-term adverse health effects associated with COVID-specific chronic stress. This systematic review aims to investigate the role of MBMs in managing the mental health of HCWs during the COVID-19 pandemic. A comprehensive search was conducted using 6 electronic databases, resulting in 18 clinical studies from 2019 to September 2021. Meta-analysis showed that MBMs significantly improved the perceived stress of HCWs (standardized mean difference, −0.37; 95% confidence intervals, −0.53 to −0.21). In addition, some MBMs had significant positive effects on psychological trauma, burnout, insomnia, anxiety, depression, self-compassion, mindfulness, quality of life, resilience, and well-being, but not psychological trauma and self-efficacy of HCWs. This review provides data supporting the potential of some MBMs to improve the mental health of HCWs during COVID-19. However, owing to poor methodological quality and heterogeneity of interventions and outcomes of the included studies, further high-quality clinical trials are needed on this topic in the future.
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Volkov BB, Ragon B, Doyle JM, Bredella MA. Adaptive capacity and preparedness of Clinical and Translational Science Award Program hubs: Overview of an environmental scan. J Clin Transl Sci 2022; 7:e31. [PMID: 36845304 PMCID: PMC9947610 DOI: 10.1017/cts.2022.400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/06/2022] [Accepted: 05/06/2022] [Indexed: 11/06/2022] Open
Abstract
The ability of research networks and individual institutions to effectively and efficiently prepare, respond, and adapt to emergent challenges is essential for the biomedical research enterprise. At the beginning of 2021, a special Working Group was formed by individuals in the Clinical and Translational Science Award (CTSA) consortium and approved by the CTSA Steering Committee to explore "Adaptive Capacity and Preparedness (AC&P) of CTSA Hubs." The AC&P Working Group took a pragmatic Environmental Scan (E-Scan) approach of utilizing the diverse data that had been collected through existing mechanisms. The Local Adaptive Capacity framework was adapted to illustrate the interconnectedness of CTSA programs and services, while exposing how the demands of the pandemic forced them to quickly pivot and adapt. This paper presents a synopsis of the themes and lessons learned that emerged from individual sections of the E-Scan. Lessons learned from this study may improve our understanding of adaptive capacity and preparedness at different levels, as well as help strengthen the core service models, strategies, and foster innovation in clinical and translational science research.
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Affiliation(s)
- Boris B. Volkov
- University of Minnesota Clinical and Translational Science Institute, Minneapolis, MN, USA
- Institute for Health Informatics, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Bart Ragon
- integrated Translational Health Research Institute of Virginia, University of Virginia, Charlottesville, VA, USA
| | - Jamie Mihoko Doyle
- Division of Clinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Miriam A. Bredella
- Massachusetts General Hospital and Harvard Catalyst, The Harvard Clinical and Translational Science Center, Harvard Medical School, Boston, MA, USA
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12
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Schaefer PW, Borondy Kitts A. Introduction to the Wellness Issue. J Am Coll Radiol 2021; 18:637-638. [PMID: 33958080 DOI: 10.1016/j.jacr.2021.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Pamela W Schaefer
- Professor, Vice Chair, Post Graduate Education and Fellowship Training; Clinical Director of MRI; Interim Director of Neuroradiology; Neuroradiology Fellowship Director, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts.
| | - Andrea Borondy Kitts
- Lung Cancer and Patient Advocate, Consultant Rescue Lung, Rescue Life Society, COO, Prosumer Health, Jupiter, Florida
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