Burnout among doctors in China through 2018: A protocol of systematic review and meta-analysis

Prevalence and factors associated with burnout syndrome in Peruvian health professionals before the COVID-19 pandemic: A systematic review

Introduction

Burnout syndrome (BS) is a prevalent occupational health problem in health professionals. To describe the prevalence and factors associated with BS in Peruvian health professionals.

Method

A systematic review and meta-analysis were performed. The key terms "burnout" and "professional exhaustion" were used with words related to Peru. The databases consulted were LILACS/Virtual Health Library, Medline/PubMed, Science Direct, EBSCO, Scopus, SciELO, and RENATI-SUNEDU; articles published between January 2000 to December 2020 were considered for inclusion. Methodological quality was evaluated using the Newcastle-Ottawa scale.

Results

Thirty studies were identified (8 scientific articles and 22 graduate theses). The median sample size was 78, with an interquartile range of 50-110. A meta-analysis was performed to calculate a dichotomic prevalence of burnout syndrome in health professionals of 25 % (95%CI: 9 %-45 %; I2 = 97.14 %; 5 studies). Also, our meta-analysis estimated the overall prevalence of mild burnout (27 %; 95%CI: 16%-41 %; I2 = 96.50 %), moderate burnout (48 %; 95%CI: 32%-65 %; I2 = 97.54 %), and severe burnout (17 %; 95%CI: 10%-24 %; I2 = 92.13 %; 18 studies). We present meta-analyses by region, profession, hospital area, and by dimension of the Maslach Burnout Inventory. Overall, the studies presented adequate levels of quality in 96.7 % of the included studies (n = 29). In addition, our narrative review of factors associated with BS and its three dimensions identified that different studies find associations with labor, socio-demographic, individual, and out-of-work factors.

Conclusions

There is a higher prevalence of moderate BS in Peruvian health professionals at MINSA and EsSalud hospitals in Peru, with severity differing by region of Peru, type of profession, work area, and dimensions of BS.

Standard ophthalmology residency training in China: an evaluation of resident satisfaction on training program in Guangdong Province

BACKGROUND

National standardized training for resident doctors (STRD) in mainland China has been formally established since 2014 as a kind of postgraduate education. The purpose of this survey was to assess the satisfaction of the training residents in Guangdong Province on the ophthalmology STRD program after a duration of 5 years.

METHOD

A 48-item survey was sent to all postgraduate ophthalmology residents from bases in Guangdong Province to inquire about their attitude towards the program. The survey contained questions about demographic and work-related information, job satisfaction, psychological resilience, and job performance. All responses were verified, and invalid questionnaires were excluded. Statistical analyses were performed using SPSS software version 22.0 (SPSS, Inc., Chicago, IL). Multiple logistic regression analysis was used to evaluate the factors (demographic information, working environment, clinical exposure, supervision and hands-on training opportunities, and involvement in academic activities) impacting the overall satisfaction. P < 0.05 was considered statistically significant.

RESULTS

A total of 471/635 (74.17%) valid questionnaires were returned from all the STRD bases of Guangdong Province, which included 38 hospitals. 60.3% of the respondents reported overall satisfaction with their training. The satisfaction with operative teaching (60.7%) was slightly lower than the other settings of teaching experience (above 65%). Meanwhile, the satisfaction on different secessions of operative experience was all below 70%, of which in the areas of cornea and orbit were 55.42% and 57.53%, respectively. Some potential factors were found to affect general satisfaction, including the training grade, marriage, working time, income level, the doctor-patient relationship, family members working as doctors, the time proportion spent on writing medical documents during clinical work, and the frequency of attending academic meetings. Improvement was observed in both performing and reporting clinical examinations in the last year of training in comparison to the first year. Finally, 82.8% of the residents acknowledged this training was helpful for future clinical work. The first five career preferences for residents were cataract (67.1%), refractive surgery (42.3%), vitreo-retina (36.5%), optometry (28.7%), and oculoplastic (27.2%).

CONCLUSION

Ophthalmology residents in Guangdong Province expressed comparable satisfaction with the STRD program. To further improve satisfaction, factors such as resident subsidy, harmonious marriage, the patient-doctor relationship, and chances of attending academic conferences should be emphasized.

The Application of Enhanced Recovery After Surgery for Gastrectomy and Colorectal Resection: A Systematic Review and Meta-Analysis

Purpose: Enhanced recovery after surgery (ERAS) protocols not only positively affect gastrointestinal surgery outcomes but may also increase the risk of some complications. This meta-analysis was conducted to assess the impact of ERAS on the recovery and complications following gastrointestinal surgery. Materials and Methods: Studies published before December 2022 were retrieved from the following databases, EMBASE, PubMed, Cochrane Library, and Web of Science, without limitations of language or race. The endpoints included lung infection, surgical site infection, postoperative ileus, length of hospitalization, urinary tract infection, readmission, anastomotic leakage, and C-reactive protein serum levels. Results: A total of 23 studies were included. The results of the meta-analysis revealed that there was a decrease in incidence of the lung infection (risk ratio = 0.46, 95% confidence interval 0.27-0.74, P = .002) and postoperative length of hospitalization (P < .00001). However, ERAS protocol groups had higher readmission rates, nausea, and vomiting. There was no significant difference in the incidence of anastomotic leakage, ileus, surgical site infection, and urinary tract infection between the experimental and control groups. Conclusions: ERAS protocols can reduce the risk of postoperative lung infections, shorten hospital stays, and expedite patient recovery. Furthermore, ERAS protocols are not associated with serious complications following gastrointestinal surgeries.

Burnout among doctors in China through 2020: A systematic review and meta-analysis

Objective

To analyze surveys measuring the prevalence of burnout among Chinese doctors and reveal the overall prevalence, characteristics, timeline, and factors related to burnout.

Methods

A comprehensive search was conducted on China National Knowledge Infrastructure, WANFANG, PubMed, EMBASE, PsycINFO and Cochrane Library databases from their inception to 28 February 2021. Random-effects meta-analyses, meta-regression and planned subgroup analyses were performed, and the standardized mean difference was adopted for comparisons between subgroups. Egger’s and Begg’s tests were performed to evaluate publication bias. Heterogeneity across the studies was tested using the I² statistic. The study protocol was registered on PROSPERO (CRD42018104249).

Results

In total, 3,210 records were reviewed; 64 studies including 48,638 Chinese doctors were eligible for meta-analysis. The prevalence of burnout increased continuously from 2008 to 2017 and decreased significantly from 2018 to 2020, a little increase from 2020 to 2021. The overall prevalence of burnout was 75.48% (95% CI, 69.20 to 81.26; I² = 99.23%, P < 0.001), and high burnout was 9.37% (95% CI, 4.91 to 15.05, I² = 98.88%, P < 0.001). The prevalence of emotional exhaustion was 48.64% (95% CI, 38.73 to 58.59; I² = 99.53%, P < 0.001), depersonalization was 54.67% (95% CI, 46.95 to 62.27; I² = 99.20%, P < 0.001), and reduced personal accomplishment was 66.53% (95% CI, 58.13 to 74.44; I² = 99.37%, P < 0.001). Gender, marriage, professional title and specialty all influenced burnout.

Conclusions

The results showed that the total prevalence of doctor burnout in China is very high. The prevalence of burnout varies by location. Gender, marital status and professional title all affect burnout scores.

Teamwork quality and health workers burnout nexus: a new insight from canonical correlation analysis

BACKGROUND

Burnout is evidenced to have  adverse effect on the well-being of health workers. Although several risk factors of burnout have been found, only a hand full of studies have examined the role of teamwork quality. This study therefore sought to explore the relationship between the sub-dimensions of burnout and teamwork quality.

METHOD

This is an empirical study involving health workers who have practising certificate from the National Health Commission of the People's Republic of China. Relying on the study's target population, a sample of 939 healthworkers complied to partake in the survey. Data were obtained from the administration of a well-structured electronic questionnaire containing the Maslach Burnout Inventory together with Healthy and Resilient Organization (HERO) scales correspondingly. The scales were then analysed using the canonical correlation approach (CCA).

RESULTS

The results unveiled a statistically significant correlation between teamwork quality and health worker burnout indicating that teamwork quality and burnout are canonically correlated. Further, examination on the relationship existing between the dimensions of teamwork quality and burnout unveiled that with the exception of personal accomplishment and teamwork dedication, teamwork quality sub-scales (teamwork vigour and teamwork absorption) were negatively related to emotional exhaustion and depersonalization as sub-scales of burnout, respectively.

CONCLUSION

The study concluded that, surge in teamwork quality leads to reduced emotional exhaustion and reduced depersonalization while simultaneously increasing professional accomplishment. Therefore, this study presents a solid foundation for decreasing burnout syndrome in healthcare that can be implemented by successfully increasing levels of teamwork quality.

Validation of the Chinese Version of the Coronary Artery Disease Education Questionnaire - Short Version: A Tool to Evaluate Knowledge of Cardiac Rehabilitation Components

Background:

Patient education is the first step in implementing a cardiac rehabilitation (CR) program and a powerful tool for promoting behavioral changes in cardiac patients. In China, the clinical workload is so heavy that a short and reliable tool for assessing disease-related knowledge is needed for targeted patient education.

Objective:

The aim of this study was to translate, adapt and validate the Chinese version of the Coronary Artery Disease Education Questionnaire – Short Version (CADE-Q SV).

Methods:

The CADE-Q SV was translated to simplified Chinese and culturally adapted to the Chinese context. The translated version was reviewed by a committee of seven experts in cardiovascular disease, and the content validity of the questionnaire was established. The psychometric properties of the questionnaire were analyzed considering the responses of 240 CR patients. The Kuder-Richardson-20 (KR-20) coefficient and Cronbach’s alpha were used to assess internal consistency. The intraclass correlation coefficient (ICC) was used to assess test-retest reliability. The criterion-related validity was evaluated by determining whether there were differences in the total scores of patients with different educational levels. Confirmatory factor analysis (CFA) was used to assess the factor structure.

Results:

Three items from the original version were adapted to reflect Chinese culture. The content validity index was 0.94. The KR-20 score was 0.856. All ICC values were > 0.70. The knowledge scores of patients with different educational levels were significantly different, indicating that the criterion-related validity of the Chinese CADE-Q-SV was acceptable. CFA validated the five-factor structure of the Chinese CADE-Q-SV.

Conclusion:

The Chinese CADE-Q SV questionnaire has good reliability and validity. This short, efficient tool can be completed quickly, assess disease-related knowledge in cardiovascular patients and serve as a reference for individualized patient education in China. It can also be used to evaluate the effectiveness of CR-related patient education interventions.

Evaluating the Relationship Between Burnout Levels and Compassion Fatigue, Emotional Intelligence, and Communication Skills of Organ Transplant Coordinators

AIM

The aim was to determine the effects of compassion fatigue, emotional intelligence levels, and communication skills of organ transplant coordinators on burnout.

METHODS

This descriptive correlational study included 104 organ transplant coordinators. Data were collected via a survey that consisted of demographic information, the Copenhagen Burnout Inventory, the Emotional Intelligence Scale, and the Compassion Fatigue Scale.

FINDINGS

A positive relationship was reported between burnout (mean, 39.42 [SD, 19.54]) and compassion fatigue (mean, 2.26 [SD, 0.86]) measurements of the organ transplant coordinators (r = 0.432) and a negative and significant relationship existed between burnout and emotional intelligence (mean, 3.53 [SD, 0.58]) measurements (r = -0.372). However, no correlation was found between communication skills (mean, 4.27 [SD, 0.52]) and burnout (r = -0.184; P > .05) except a negative correlation with client-related burnout measurements (r = -0.222; P < .05). As a result of the 2-step regression analysis, the regression-squared value predicted the joint effect of compassion fatigue and emotional intelligence on burnout (R² = .285).

CONCLUSIONS

Organ transplant coordinators reported moderate levels of burnout and compassion fatigue and high levels of emotional intelligence and communication skills. Compassion fatigue caused burnout, while emotional intelligence decreased. Additionally, transplant coordinators' communication skills were related to client-related burnout.

Mental health status of Chinese physicians working in intensive care unit

PURPOSE

Physicians working in intensive care unit (ICU) are prone to suffer from mental health problems, but there are still very limited data of mental health status of ICU physicians in China. Therefore, this study was to investigate their psychological status.

MATERIALS AND METHODS

ICU physicians were contacted electronically and asked to complete the Symptom Check-list 90 (SCL-90) for Chinese from December 13 to December 14 in 2018. A total of 1749 valid questionnaires were collected. Fifteen potential relevant factors that could affect the mental health status of ICU physicians were also analyzed by multivariate logistic regression.

RESULTS

The total mean score of SCL-90 for surveyed subjects was 175.49 ± 65.79. Near half of the respondents were identified with psychological symptoms. The pooled estimates of all the nine factors, including somatization, obsession-compulsion, interpersonal-sensitivity, depression, anxiety, hostility, phobic anxiety, and paranoid ideation among ICU physicians, were significantly higher than those in the general population (P < 0.001). Multivariate analysis revealed that education, title, working hours per week, frequency of night shift were risk factors for psychological symptoms.

CONCLUSIONS

The situation of psychological health of ICU physicians in China is worrying, and it is urgent to take some effective measures to improve their mental health.

Changes in Chinese patch testing practices over 13 years: Updated cross-sectional survey and possible international implications

BACKGROUND

Patch testing, the standard method for diagnosing allergic contact dermatitis, has been utilized for over 30 years in China. A 2006 survey found that patch testing was widespread among Chinese dermatologists, but the practice and perceptions were unsatisfactory.

OBJECTIVE

To evaluate the current situation of patch testing practice and perception, we resurveyed Chinese dermatologists.

METHODS

A cross-sectional survey of Chinese dermatologists was conducted by electronic questionnaires at the 15th National Congress of Dermatology in November 2019.

RESULTS

There were 2199 valid questionnaires collected. About 75% of dermatologists performed patch testing; the majority (59.2%) utilized the baseline (standard) allergen series made in China; others used TRUE Test or the Chemotechnique Diagnostics series, a greater share compared with 2006. Most (92.8%) performed only one single reading, more than 2006. About two-thirds offered patient education after patch testing, but only 27% were executed by trained dermatologists. Dermatologists from regional hospitals more likely performed patch testing and had better perception of patch testing. The majority (88.1%) had received patch testing training, which however did not significantly improve dermatologists' perception.

CONCLUSIONS

There was an insignificant improvement in practice and perception of dermatologists compared with 2006. Further education and studies should be conducted. Similar surveys in other countries would be of interest.