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Ghasemi V, Kiani Z, Alizadeh S, Roozbeh N, Mehrnoush V, MohammadSouri B, Saniee N, Shahrour W, Banaei M. Prevalence of stress urinary incontinence and urge urinary incontinence in multiples sclerosis patients: a systematic review and meta-analysis. Neurol Sci 2024; 45:4197-4210. [PMID: 38710988 DOI: 10.1007/s10072-024-07570-0] [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: 12/06/2023] [Accepted: 04/26/2024] [Indexed: 05/08/2024]
Abstract
Urinary incontinence (UI), encompassing stress urinary incontinence (SUI) and urge urinary incontinence (UUI), is a prevalent and debilitating condition in patients with multiple sclerosis (MS), profoundly impacting their quality of life. This systematic review and meta-analysis aimed to elucidate the worldwide prevalence rates of SUI and UUI among MS patients. This study was conducted by examining observational studies published between 2000 and 2023. An exhaustive literature search was conducted across databases such as PubMed, MEDLINE, Web of Science, Scopus, ProQuest, and Google Scholar. The Meta-prop method facilitated pooled prevalence estimation of UUI and SUI, while Egger tests assessed publication bias. In total, 27 studies with 15,052 participants were included in the meta-analysis. The findings revealed a high random effect pooled prevalence of UUI at 41.02% (95% Confidence Interval [CI]: 30.57-51.89; I2 = 99%, p < 0.001) and SUI at 25.67% (95% CI: 19.30-32.58%; I2 = 94.9%, P < 0.001). Additionally, the pooled prevalence of mixed urinary incontinence (MUI) was reported at 18.81% (95% CI: 7.55-33.48; I2:95.44%, p < 0.001). The high heterogeneity observed suggests variable prevalence across populations and highlights the intricate nature of UI in MS. These findings underscore the critical need for dedicated supportive, therapeutic, and rehabilitative interventions to manage this common complaint in MS patients effectively.
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Affiliation(s)
- Vida Ghasemi
- Asadabad School of Medical Sciences, Asadabad, Iran
| | - Zahra Kiani
- Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shiva Alizadeh
- Department of Midwifery & Reproductive Health, Zeynab School of Nursing & Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Nasibeh Roozbeh
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Vahid Mehrnoush
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Behzad MohammadSouri
- Urology and Nephrology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Nadia Saniee
- Asadabad School of Medical Sciences, Asadabad, Iran
| | - Walid Shahrour
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Mojdeh Banaei
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
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Kosydar-Bochenek J, Religa D, Iwanicka K, Szczupak M, Krupa-Nurcek S. Burnout among Polish paramedics: insights from the Oldenburg Burnout Inventory. Front Public Health 2024; 12:1444833. [PMID: 39165774 PMCID: PMC11333246 DOI: 10.3389/fpubh.2024.1444833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 07/29/2024] [Indexed: 08/22/2024] Open
Abstract
Introduction Emergency medical services rely heavily on paramedics who, as frontline responders, face unique stressors that can potentially lead to burnout. This pilot study utilizes the Oldenburg Burnout Inventory (OLBI) to assess burnout levels among Polish paramedics. The aim is to contribute to the understanding of burnout in this specific professional context and identify key factors influencing burnout dimensions. Future research will build on these preliminary findings. Materials and methods A cross-sectional study was conducted from March 01 to April 30, 2023, utilizing an online survey accessible to Polish paramedics. The OLBI, a validated tool, was employed to measure burnout, focusing on two dimensions: exhaustion and withdrawal of involvement. Results Among the 147 participating paramedics, the majority were male (65.99%). Paramedics exhibited burnout symptoms across both dimensions measured by The Oldenburg Burnout Inventory scale (OLBI), with an average level for lack of commitment recorded at 20.09, an average level for exhaustion at 20.60. The study revealed that 41.5% of paramedics experienced low burnout, 44.9% reported moderate burnout, and 13.6% faced high burnout risks. Analysis showed that women experienced significantly higher levels of exhaustion compared to men (p = 0.01). Conclusion This pilot study provides valuable initial insights into burnout among Polish paramedics. The OLBI's two-factor structure, evaluating exhaustion and disengagement, proved reliable and valid in this context. The prevalence of burnout, with over 60% of paramedics experiencing moderate to high levels, highlights the urgency of addressing burnout in this profession. Future research will be essential to explore the underlying causes and develop targeted interventions. Practical implications Understanding the factors contributing to burnout among paramedics is crucial for developing targeted interventions. Strategies should focus on stress management training, organizational support, and well-being initiatives. Addressing gender-specific differences in burnout experiences is essential for tailoring interventions effectively. Proactive psychological support mechanisms and optimized working conditions can enhance paramedics' overall well-being, ensuring their continued effectiveness in providing emergency medical services.
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Affiliation(s)
- Justyna Kosydar-Bochenek
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszów, Rzeszów, Poland
| | - Dorota Religa
- Deputy Head of Division for Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, Stockholm, Sweden
| | - Kamila Iwanicka
- Students of the Innovative Research in Emergency Medicine Student Club at the University of Rzeszów, Rzeszów, Poland
| | - Mateusz Szczupak
- Department of Anesthesiology and Intensive Care, Copernicus Hospital, Gdańsk, Poland
| | - Sabina Krupa-Nurcek
- Department of Surgery, Institute of Medical Sciences, Medical College of Rzeszów University, Rzeszów, Poland
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Newton J, Smith ADAC. Developing emotional preparedness and mental resilience through high-fidelity simulation: a 'bridge too far' for institutions teaching major trauma management and mass-casualty medicine? BMC MEDICAL EDUCATION 2024; 24:544. [PMID: 38750542 PMCID: PMC11097583 DOI: 10.1186/s12909-024-05526-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/06/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Clinical acumen represents only part of being adequately equipped to attend a major incident. The emotive sights, sounds and smells of these dynamic environments are all-encompassing experiences, and responders must also be armed with the emotional preparedness to perform their clinical or managerial duties effectively, as well as the mental resilience to facilitate professional continuance. Despite this, limited training and a sparsity of evidence exists to guide developments within this domain. Historically, major incident training has focused on clinical theory acquisition, but irrespective of how comprehensive the learning materials, they are of little consequence if tandem steps to cultivate mental resilience and emotional preparedness are absent. High-Fidelity Simulation (HFS) has a growing reputation as an effective means of bridging important gaps between theory and practice. This pilot study aimed to measure student's self-reported perception of their readiness to respond to a major incident following a large-scale HFS. METHODS Quantitative data was obtained from a sample of 108 students undertaking paramedic science, physician associate studies and adult nursing degree programmes. A bespoke questionnaire was developed to measure self-reported clinical acumen, mental and emotional preparedness. RESULTS 91% of students agreed the combination of theoretical training and HFS provided made them feel clinically prepared to attend a real major incident; 86% agreed this experience had developed their mental resilience and 90% agreed that they felt emotionally prepared to attend a major incident. CONCLUSION Within this pilot study, the blend of theoretical training and HFS contributed to self-reported clinical acumen, mental and emotional preparation, in learners training to work in disaster environments or emergency medicine settings.
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Affiliation(s)
- Jon Newton
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK.
| | - Andrew D A C Smith
- Mathematics and Statistics Research Group, University of the West of England, Bristol, UK
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Schwartz M, Berkowitz J, McCann-Pineo M. Understanding the Role of Empathy and Gender on EMS Clinician Occupational Stress and Mental Health Outcomes. PREHOSP EMERG CARE 2024; 28:635-645. [PMID: 38359401 DOI: 10.1080/10903127.2024.2319139] [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: 08/18/2023] [Accepted: 02/08/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Emergency Medical Service (EMS) clinicians experience high levels of occupational stress due to long hours, short staffing, and patient deaths, among other factors. While gender has been partially examined, little is known regarding the role of empathy on occupational stress and mental health (MH) outcomes among EMS clinicians. Therefore, the current study examines the moderating role of empathy and, separately, gender on associations between occupational stress and mental health. METHODS A cross-sectional examination of EMS clinician occupational and personal wellbeing was conducted via an anonymous, electronic survey. Information on clinician demographics, and validated measures of occupational stress, burnout, and MH outcomes were collected. Empathy was assessed using the Toronto Empathy Scale (TEQ). Descriptive/bivariate statistics were conducted for variables of interest. Separate multivariable regression models evaluated associations between occupational stress and mental health outcomes. Empathy and gender were examined as potential moderators using interactions. RESULTS A total of 568 EMS clinicians completed the survey. High levels of mental health difficulties were reported (34.0% anxiety, 29.2% depression, 48.6% burnout). Increased occupational stress was associated with increased anxiety (OR =1.08, 95% CI 1.05-1.10), depression (OR = 1.09, 95% CI 1.06-1.10), and burnout (OR = 1.10, 95% CI 1.07-1.12). No moderation analyses were significant. Greater resilience was associated with lower depression, anxiety, and burnout. CONCLUSION EMS clinicians, much like other first responders, experience considerable occupational stress, of which is associated with mental health difficulties and burnout. Findings underscore the need for intervention programs aimed at reducing the impact of occupational stress and the promotion of resilience. Continuing to understand the full scope of EMS mental health, including the role of resilience, is imperative, particularly in light of future public emergencies.
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Affiliation(s)
| | - Jonathan Berkowitz
- Northwell, New Hyde Park, New York, USA
- Department of Emergency Medicine, Northshore University Hospital, Manhasset, New York, USA
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Molly McCann-Pineo
- Northwell, New Hyde Park, New York, USA
- Department of Emergency Medicine, Northshore University Hospital, Manhasset, New York, USA
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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Ivánkovits L, Kazinczi C, Kocsis K, Stankovic M, Koday Z, Pető Z, Töreki A. A simplified measure of burnout symptoms among paramedics - an exploratory analysis of a Hungarian sample. BMC Psychol 2024; 12:37. [PMID: 38238830 PMCID: PMC10797803 DOI: 10.1186/s40359-024-01518-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/02/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Burnout is still one of the leading mental health problems. According to research results over the past decades, healthcare workers, including paramedics, are considered a high-risk group. In concordance with these results, the available resources need to prioritize monitoring paramedics' mental health. METHODS In our study, we investigated whether the available test batteries measuring burnout could be reduced while maintaining their effectiveness. We reduced the 21-item Burnout Measurement and the 8-item version of the Psychosomatic Symptom Scale using the data of 727 Hungarian paramedics. We selected the top four items of the questionnaires that were significantly correlated with the original Burnout Measure Index and the Psychosomatic Scale Index. The classification efficiency of the shortened list of items was based on the initial risk categories of the Burnout Measure and its sensitivity was analyzed using Binary Logistic regression and ROC curves. We then used Two-Step Cluster Analysis to test the ability of the shortened Burnout Measure Index to develop new risk categories. The reliability indicators were also explored. RESULTS The results show that the Burnout Measurement can be reduced to 4 items with a classification efficiency of 93.5% in determining the level of burnout. The 5-item reduction of the Psychosomatic Symptom Scale can classify subjects to the appropriate intervention level for burnout with an efficiency of 81.6%. The ROC analysis suggests that the shortened questionnaires have an excellent separative ability to discriminate between the initial risk groups. Three new risk categories were also identified as a result of the cluster analysis. CONCLUSION The shortened scales may be proven effective in resource management, which could significantly quicken the assessment of burnout in the future. The abbreviated scale is also suitable for classifying subjects into risk categories. However, further research is needed to see whether the shortened scales can be used as a diagnostic tool.
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Affiliation(s)
- László Ivánkovits
- Department of Emergency Medicine, University of Szeged, 6, Semmelweis Street, Szeged, 6725, Hungary
| | - Csaba Kazinczi
- Department of Neurology, University of Szeged, 6, Semmelweis Street, Szeged, 6725, Hungary
- Department of Clinical Psychology, Semmelweis University, 25, Üllői Street, Budapest, 1091, Hungary
| | - Krisztián Kocsis
- Department of Radiology, University of Szeged, 6, Semmelweis street, Szeged, 6725, Hungary.
| | - Mona Stankovic
- Department of Emergency Medicine, University of Szeged, 6, Semmelweis Street, Szeged, 6725, Hungary
| | - Zsuzsanna Koday
- Eötvös Lóránd Univesity, Egyetem tér 1-3, Budapest, 1053, Hungary
| | - Zoltán Pető
- Department of Emergency Medicine, University of Szeged, 6, Semmelweis Street, Szeged, 6725, Hungary
| | - Annamária Töreki
- Department of Emergency Medicine, University of Szeged, 6, Semmelweis Street, Szeged, 6725, Hungary
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Haruna J, Uemura S, Taguchi Y, Muranaka S, Niiyama S, Inamura H, Sawamoto K, Mizuno H, Narimatsu E. Influence of work and family environment on burnout among emergency medical technicians. Clin Exp Emerg Med 2023; 10:287-295. [PMID: 36796782 PMCID: PMC10579723 DOI: 10.15441/ceem.22.389] [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: 10/23/2022] [Revised: 01/09/2023] [Accepted: 01/31/2023] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVE Burnout among emergency medical technicians is a serious problem affecting delivery of quality emergency medical services. Although the repetitive nature of the job and lower education level requirements for technicians have been reported as risk factors, little is known about the influence of burden of responsibility, degree of supervisor support, and home environment on burnout among emergency medical technicians. This study aimed to test the hypothesis that burden of responsibility, degree of supervisor support, and home environment increase burnout probability. METHODS A web-based survey was conducted among emergency medical technicians in Hokkaido, Japan from July 26, 2021 to September 13, 2021. A total of 21 facilities were randomly selected from 42 fire stations. Prevalence of burnout was measured using the Maslach Burnout-Human Services Survey Inventory (MBI-HSS). Burden of responsibility was measured using a visual analog scale. Occupational background was also measured. Supervisor support was measured using the Brief Job Stress Questionnaire (BJSQ). Family-work negative spillover was measured using the Japanese version of Survey Work-Home Interaction-NijmeGen (SWING). The cutoff value for burnout syndrome was defined as emotional exhaustion≥27 and/or depersonalization≥10. RESULTS A total of 700 survey respondents were included, and 27 surveys with missing data were excluded. The suspected burnout frequency was 25.6%. Covariates were adjusted using multilevel logistic regression model analysis. Low supervisor support (odds ratio, 1.421; 95% confidence interval, 1.136-1.406; P<0.001) and high family-work negative spillover (odds ratio, 1.264; 95% confidence interval, 1.285-1.571; P<0.001) were independent factors associated with higher probability of burnout. CONCLUSION This study indicated that focusing on improvement of supervisor support for emergency medical technicians and creating supportive home environments may assist in reducing burnout frequency.
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Affiliation(s)
- Junpei Haruna
- Department of Emergency Medical Services, Life Flight and Disaster Medicine, Sapporo Medical University, Sapporo, Japan
- Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Shuji Uemura
- Department of Emergency Medical Services, Life Flight and Disaster Medicine, Sapporo Medical University, Sapporo, Japan
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yukiko Taguchi
- Department of Emergency Medical Services, Life Flight and Disaster Medicine, Sapporo Medical University, Sapporo, Japan
- Department of Nursing, Sapporo Medical University School of Health Sciences, Sapporo, Japan
| | - Saori Muranaka
- Department of Emergency Medical Services, Life Flight and Disaster Medicine, Sapporo Medical University, Sapporo, Japan
- Department of Advanced Critical Care and Emergency Center, Sapporo Medical University Hospital, Sapporo, Japan
| | - Sachi Niiyama
- Department of Emergency Medical Services, Life Flight and Disaster Medicine, Sapporo Medical University, Sapporo, Japan
- Department of Advanced Critical Care and Emergency Center, Sapporo Medical University Hospital, Sapporo, Japan
| | - Hirotoshi Inamura
- Department of Emergency Medical Services, Life Flight and Disaster Medicine, Sapporo Medical University, Sapporo, Japan
- Department of Hospital Pharmacy, Sapporo Medical University Hospital, Sapporo, Japan
| | - Keigo Sawamoto
- Department of Emergency Medical Services, Life Flight and Disaster Medicine, Sapporo Medical University, Sapporo, Japan
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hirotoshi Mizuno
- Department of Emergency Medical Services, Life Flight and Disaster Medicine, Sapporo Medical University, Sapporo, Japan
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Eichi Narimatsu
- Department of Emergency Medical Services, Life Flight and Disaster Medicine, Sapporo Medical University, Sapporo, Japan
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
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Duffee B, Willis DB. Paramedic perspectives of job stress: Qualitative analysis of high-stress, high-stakes emergency medical situations. Soc Sci Med 2023; 333:116177. [PMID: 37595422 DOI: 10.1016/j.socscimed.2023.116177] [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: 03/02/2023] [Revised: 05/24/2023] [Accepted: 08/12/2023] [Indexed: 08/20/2023]
Abstract
The time from when an ambulance paramedic receives the 911 alarm notification until they have determined the differential diagnosis of a patient is highly stressful. During this time, there is a high demand placed on the paramedic, and they have a low level of control. Recent advances in prehospital care that place more responsibility on paramedics have exacerbated this high-stress phenomenon. Twenty paramedics from across the United States were interviewed and evaluated using descriptive phenomenology to better understand one of the most stressful moments of high-stakes decision-making that paramedics regularly face. Using descriptive phenomenology, we identified six categories in the paramedics' interview responses: pressure, overwhelm, emotional extremes (with sub-categories of adrenaline rush and time-dilation), dissociation, multi-tasking, and disconnect. This analysis of the paramedic's lived experience of this high-stress, high-stakes phenomenon provides insight into how paramedics experience the unique stress of this phenomenon. This understanding is key to elucidating the effects of this acute stress that may impact the judgment and, ultimately, the care performed by the paramedic. Both early- and late-career paramedics from thirteen different states in all regions of the United States were interviewed. Further qualitative data from paramedics from a diverse range of regions and backgrounds are essential to identify ways in which to ameliorate the negative effects of acute stress experienced by paramedics. Addressing such issues will reduce turnover and burnout among paramedics.
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Affiliation(s)
- Bram Duffee
- Institute for Social Innovation Research Fellow, Fielding Graduate University, 2020 De La Vina Street, Santa Barbara, CA, 93105, USA.
| | - David Blake Willis
- Professor of Anthropology and Education Faculty, School of Leadership Studies, Fielding Graduate University, 2020 De La Vina Street, Santa Barbara, CA, 93105, USA
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Lu DW, Shin J, Wan C, Rea TD, Crowe RP, Meischke HW, Counts CR. Burnout and Workplace Incivility Among Emergency Medical Services Practitioners: A Preliminary Report. PREHOSP EMERG CARE 2023; 27:413-417. [PMID: 36749661 DOI: 10.1080/10903127.2023.2175088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Burnout has detrimental consequences for health care organizations, clinicians, and the quality of care that patients receive. Prior work suggests that workplace incivility (negative interpersonal acts) contributes to burnout. While workplace incivility is linked to EMS practitioner job dissatisfaction, absenteeism, and planned attrition, the relationship between workplace incivility and burnout has not been evaluated among EMS practitioners. This study aimed to characterize the prevalence and association of burnout and workplace incivility among EMS practitioners. METHODS A cross-sectional survey of EMS personnel in King County, Washington was performed in January to March of 2021 with burnout as the primary outcome and workplace incivility as a secondary outcome. Multivariable logistic regression was used to evaluate associations between outcomes and EMS practitioner factors that included age, sex, race/ethnicity, years of EMS experience, and current job role. RESULTS 835 completed surveys were received (response rate 25%). The prevalence of burnout was 39.2%. Women were more likely to have burnout than men (59.3% vs. 33.7%, aOR 2.2, 95% CI 1.3-3.7). Workplace incivility was experienced weekly by 32.1% of respondents, with women more likely to experience incivility compared to men (41.9% vs. 27.2%, aOR 2.0, 95% CI 1.2-3.3). Respondents who experienced frequent workplace incivility were more likely to have burnout than those who did not experience frequent incivility (61.9% vs. 38.1%, OR 4.0, 95% CI 3.0-5.5). CONCLUSIONS The prevalence of burnout and workplace incivility were concerning among EMS practitioners, with women more likely to experience both compared to men. EMS practitioners who experienced frequent workplace incivility were also more likely to have burnout than those who did not experience frequent incivility.
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Affiliation(s)
- Dave W Lu
- Department of Emergency Medicine, University of Washington, Seattle, Washington
| | - Jenny Shin
- Emergency Medical Services Division, Public Health Seattle and King County, Seattle, Washington
| | - Christopher Wan
- University of Washington School of Medicine, Seattle, Washington
| | - Thomas D Rea
- Department of Medicine, Division of General Internal Medicine, University of Washington, Seattle, Washington
| | | | - Hendrika W Meischke
- Department of Health Systems and Population Health, Hans Rosling Center for Population Health, University of Washington, Seattle, Washington
| | - Catherine R Counts
- Department of Emergency Medicine, University of Washington, Seattle, Washington
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Patterson PD, Martin SE, Brassil BN, Hsiao WH, Weaver MD, Okerman TS, Seitz SN, Patterson CG, Robinson K. The Emergency Medical Services Sleep Health Study: A cluster-randomized trial. Sleep Health 2023; 9:64-76. [PMID: 36372657 DOI: 10.1016/j.sleh.2022.09.013] [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: 10/21/2021] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Greater than half of emergency medical services (EMS) clinician shift workers report poor sleep, fatigue, and inadequate recovery between shifts. We hypothesized that EMS clinicians randomized to receive tailored sleep health education would have improved sleep quality and less fatigue compared to wait-list controls after 3 months. METHODS We used a cluster-randomized, 2-arm, wait-list control study design (clinicaltrials.gov identifier: NCT04218279). Recruitment of EMS agencies (clusters) was nationwide. Our study was powered at 88% to detect a 0.4 standard deviation difference in sleep quality with 20 agencies per arm and a minimum of 10 individuals per agency. The primary outcome was measured using the Pittsburgh Sleep Quality Index (PSQI) at 3-month follow-up. Our intervention was accessible in an online, asynchronous format and comprised of 10 brief education modules that address fatigue mitigation topics prescribed by the American College of Occupational Environmental Medicine. RESULTS In total, 36 EMS agencies and 678 individuals enrolled. Attrition at 3 months did not differ by study group (Intervention = 17.4% vs. Wait-list control = 18.2%; p = .37). Intention-to-treat analyses detected no differences in PSQI and fatigue scores at 3 months. Per protocol analyses showed the greater the number of education modules viewed, the greater the improvement in sleep quality and the greater the reduction in fatigue (p < .05). CONCLUSIONS While intention-to-treat analyses revealed no differences in sleep quality or fatigue at 3 months, per protocol findings identified select groups of EMS clinician shift workers who may benefit from sleep health education. Our findings may inform fatigue risk management programs.
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Affiliation(s)
- P Daniel Patterson
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania, USA; University of Pittsburgh, School of Health and Rehabilitation Sciences, Division of Community Health Services, Emergency Medicine Program, Pittsburgh, Pennsylvania, USA.
| | - Sarah E Martin
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania, USA
| | - Bridget N Brassil
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania, USA
| | - Wei-Hsin Hsiao
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania, USA
| | - Matthew D Weaver
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Boston, Massachusetts, USA; Harvard Medical School, Division of Sleep Medicine, Boston, Massachusetts, USA
| | - Tiffany S Okerman
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania, USA
| | - Staci N Seitz
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania, USA
| | - Charity G Patterson
- University of Pittsburgh, School of Health and Rehabilitation Sciences, Department of Physical Therapy, Pittsburgh, Pennsylvania, USA
| | - Kathy Robinson
- National Association of State EMS Officials (NASEMSO), Falls Church, Virginia, USA
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Herttuainen A, Nordquist H. Recent Paramedic Graduates' Chronic Stress Adds Intentions to Leave the Profession: A Pilot Study Utilizing a Web-Based Survey. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231210706. [PMID: 38014634 PMCID: PMC10685760 DOI: 10.1177/00469580231210706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/23/2023] [Accepted: 10/10/2023] [Indexed: 11/29/2023]
Abstract
Paramedics have mentally and physically demanding jobs, and chronic stress is not uncommon. Recently graduated paramedics, in particular, have been identified as needing support in their early careers. This pilot study examined chronic stress experienced by recent graduate paramedics and their intentions to leave the paramedic profession. Finnish paramedics encompass qualifications to work in various nursing sectors. This pilot study was a cross-sectional survey study among Finnish paramedics who graduated less than 3 years ago and who were currently working in prehospital EMS (n = 152). They evaluated chronic organizational and operational stressors on the Emergency Medical Services Chronic Stress Questionnaire with 20 statements. Two structured questions related to the intention to leave the paramedic profession. Three summary scales were formed. The differences in stress by the intention to leave were reported descriptively and the differences were tested with Mann-Whitney U test. The influence of potential predictors of the intention to leave prehospital EMS work or the nursing sector completely were explored with a forward stepwise logistic regression model. Those who intended to leave prehospital EMS work (25%, n = 35/152) or to leave the nursing sector completely (33%, n = 50/152) experienced higher levels of stress than those without such intentions. Stress related to organizational inequity and leadership challenges was the strongest and stress related to social, health, and personal impacts was the second strongest predictor of the intention to leave. Reducing chronic stress might be important in terms of paramedic retention. Several further study needs are addressed.
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Affiliation(s)
| | - Hilla Nordquist
- South-Eastern Finland University of Applied Sciences, Kotka, Finland
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McIntyre K. Leadership emotion: how leaders influence employee wellbeing and performance in the disaster and emergency management context. JANUARY 2023 2023. [DOI: 10.47389/38.1.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Leaders play a unique role in the disaster management context as they address the safety needs of communities and manage the complexities of the response and recovery task. Leaders who effectively navigate the challenges of leading in this unique context bring hope and positivity, uniting the efforts of community and government to address the needs of those seeking safety and support. Positive affect is one aspect of effective leadership that receives considerable attention in the academic literature but has, as yet, received little attention in the disaster and emergency management area. This paper draws on contemporary literature on the understanding of positive affect in leadership, bringing together the limited current literature in the area of leader affect in the emergency management context and identifying a significant gap. It calls for a research focus on positive affect in the unique context of disaster and emergency management and consideration of the implications for wellbeing and performance.
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Affiliation(s)
- Katie McIntyre
- University of the Sunshine Coast, Sippy Downs, Queensland
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12
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Brown JA, Watson E, Rogers T. Hospital security guard's well-being and repeated exposure to personal threats in the workplace: a qualitative study in an Australian hospital. INTERNATIONAL JOURNAL OF WORKPLACE HEALTH MANAGEMENT 2022. [DOI: 10.1108/ijwhm-01-2022-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis study aimed to understand the effect of repeated exposure to personal threats on hospital security guards' well-being.Design/methodology/approachA single site, qualitative study using a convenience sampling approach to recruit hospital security guards who attend code black (staff, patient or visitor exposed to a personal threat) calls.FindingsFive interviews were held with eight hospital security guards. Seven of the eight participants were male. Seven were Caucasian. All had extensive experience in the industry. Six consistent themes emerged from the data covering well-being, coping and support; concerns about physical safety; compassion and compassion fatigue; effective communication is crucial; role/s; and training and equipment.Research limitations/implicationsThis study used a convenient sampling approach to recruit security guards from one acute hospital in Australia, limiting the applicability of the findings to other contexts. Although the majority of hospital security guards were interviewed, the format of interviews varied between one-to-one interviews and focus groups, based on the availability of guards to participate and attend.Practical implicationsWe recommend that the role of the hospital security guard in Code black situations is documented in policy and practice documents, and articulated in multidisciplinary aggression management training. There should be clear statements on the importance of strong communication and clinical leadership in code black situations. Hospital security guards should attend Mental Health First Aid training, which teaches on and off the job coping strategies. There is a need for debriefing and consideration should be given to supporting “time-out”. Hospital security guards require education on infection control and the risks associated with blood and body fluids.Originality/valueHospital security guards play an important role in the safety of patients and staff in code black situations. When they are well supported, they experience high levels of job satisfaction and are able to maintain their compassion towards people who are aggressive and violent towards them. However, repeated exposure to code black situations has the potential to erode the well-being of hospital security guards.
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The effectiveness of psychological interventions for reducing PTSD and psychological distress in first responders: A systematic review and meta-analysis. PLoS One 2022; 17:e0272732. [PMID: 36001612 PMCID: PMC9401173 DOI: 10.1371/journal.pone.0272732] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 07/25/2022] [Indexed: 11/21/2022] Open
Abstract
Background First responders are faced with stressful and traumatic events in their work that may affect their psychological health. The current review examined the effectiveness of psychological interventions to treat posttraumatic stress disorder (PTSD), anxiety, depression, stress and burnout in first responders. Methods Four databases were searched to identify controlled studies that examined the efficacy of psychological interventions to reduce PTSD symptoms (primary outcome) in first responders (including firefighters, police/law enforcement officers, search and rescue personnel, emergency and paramedics teams). Secondary outcomes were anxiety, depression, burnout, and stress. Results 15 studies were identified, including 10 studies that measured PTSD, 7 studies for anxiety, 10 studies for depression, 7 studies for stress and 1 for burnout. Interventions were associated with a significant reduction in PTSD (SDM = -0.86; 95% CI = -1.34 –- 0.39), depression (SDM = -0.63; 95% CI = -0.94 –-0.32), and anxiety (SDM = -0.38; 95% CI = -0.71 –-0.05) but not stress (SDM = -0.13; 95% CI = -0.51–0.25). CBT-based and clinician-delivered interventions were associated with significantly greater reductions in PTSD than other types of interventions and non-clinician interventions, but no differences were found for depression. There was evidence of moderate to high risk of bias across all studies. Conclusions Psychological interventions are effective in reducing PTSD, depression and anxiety symptoms but not stress in first responders. Further research is needed using high quality randomised designs over longer periods of follow-up.
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Price JAB, Ogunade AO, Fletcher AJ, Ricciardelli R, Anderson GS, Cramm H, Carleton RN. Peer Support for Public Safety Personnel in Canada: Towards a Typology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095013. [PMID: 35564405 PMCID: PMC9104081 DOI: 10.3390/ijerph19095013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022]
Abstract
Public safety personnel (PSP) are frequently exposed to potentially psychologically traumatic events (PPTEs) which can impact mental health. To help mitigate the negative effects of PPTEs, PSP commonly rely on peer support. Peer support generally refers to a wide variety of mental health resources that offer social or emotional assistance to a peer, and in some cases professional assistance. Despite the use of and demand for peer support, there is relatively little empirical evidence regarding effectiveness. The evidence gaps regarding peer support effectiveness may be due, in part, to inadequate guidelines and standards of practice that are publicly supported by a consensus among peer support providers. The current study was designed to explore the current conceptualization and implementation of peer support among Canadian PSP using a document analysis. The results indicate that peer support can be conceptualized via three models (i.e., peer-enabled, peer-led, peer-partnership) and implemented via two delivery methods (i.e., program, service). The research team proposed a novel diagram towards a typology of peer support to highlight the diversity in peer support conceptualization and implementation and provide a foundation for the development of mutually agreed-upon language and a shared framework. Overall, the current study can help inform peer support resources within and beyond PSP communities.
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Affiliation(s)
- Jill A. B. Price
- Department of Psychology, University of Regina, Regina, SK S4S 0A2, Canada; (A.O.O.); (R.N.C.)
- Correspondence:
| | - Adeyemi O. Ogunade
- Department of Psychology, University of Regina, Regina, SK S4S 0A2, Canada; (A.O.O.); (R.N.C.)
| | - Amber J. Fletcher
- Department of Sociology and Social Studies, University of Regina, Regina, SK S4S 0A2, Canada;
| | | | - Gregory S. Anderson
- Faculty of Science, Thompson Rivers University, Kamloops, BC V2C 0C8, Canada;
| | - Heidi Cramm
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON K7L 3N6, Canada;
| | - R. Nicholas Carleton
- Department of Psychology, University of Regina, Regina, SK S4S 0A2, Canada; (A.O.O.); (R.N.C.)
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Mental Disorder Symptoms and the Relationship with Resilience among Paramedics in a Single Canadian Site. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084879. [PMID: 35457746 PMCID: PMC9030944 DOI: 10.3390/ijerph19084879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 02/04/2023]
Abstract
There is growing recognition in research and policy of a mental health crisis among Canada’s paramedics; however, despite this, epidemiological surveillance of the problem is in its infancy. Just weeks before the emergence of the COVID-19 pandemic, we surveyed paramedics from a single, large, urban paramedic service in Ontario, Canada to assess for symptom clusters consistent with post-traumatic stress disorder (PTSD), major depressive disorder, and generalized anxiety disorder and to identify potential risk factors for each. In total, we received 589 completed surveys (97% completion rate) and found that 11% screened positive for PTSD, 15% screened positive for major depressive disorder, and 15% screened positive for generalized anxiety disorder, with one in four active-duty paramedics screening positive for any of the three as recently as February 2020. In adjusted analyses, the risk of a positive screen varied as a function of employment classification, gender, self-reported resilience, and previous experience as a member of the service’s peer support team. Our findings support the position that paramedics screen positive for mental disorders at high rates—a problem likely to have worsened since the onset of the COVID-19 pandemic. We echo the calls of researchers and policymakers for urgent action to support paramedic mental health in Canada.
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Witczak-Błoszyk K, Krysińska K, Andriessen K, Stańdo J, Czabański A. Work-Related Suicide Exposure, Occupational Burnout, and Coping in Emergency Medical Services Personnel in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1156. [PMID: 35162179 PMCID: PMC8835152 DOI: 10.3390/ijerph19031156] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 02/04/2023]
Abstract
Work-related suicide exposure may significantly contribute to the risk of burnout in first responders. This study assessed the exposure to suicide, burnout, and coping mechanisms in emergency medical services in Poland, including psychosocial determinants, such as age, gender, and access to psychological support. The level of burnout was assessed using the Link Burnout Questionnaire (LBQ), and coping was measured using the Coping Inventory for Stressful Situations (CISS). Data were analysed using a series of variance analyses and a partial least squares structural equation modelling. The study showed that 98% of emergency medical services personnel reported work-related suicide exposure. The LBQ score indicated symptoms of burnout, in particular relational deterioration, and the CISS showed low levels of emotion-oriented coping. Physicians reported higher levels of psycho-physical exhaustion than paramedics and nurses. Access to psychological support in the workplace was related to lower levels of burnout. Emergency medical services personnel are frequently exposed to suicide, which may be related to the risk of occupational burnout, and coping strategies used in this occupational group are often not optimal. Preventive measures, such as training emergency medical services personnel in regard to effective coping strategies, are needed, and personnel should be encouraged to access mental health services and supports.
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Affiliation(s)
| | - Karolina Krysińska
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia;
| | - Karl Andriessen
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia;
| | - Jacek Stańdo
- Lodz University of Technology, 90-137 Łódź, Poland;
| | - Adam Czabański
- Department of Social Sciences, Jacob of Paradies University, 66-400 Gorzów Wielkopolski, Poland;
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Ericsson CR, Nordquist H, Lindström V, Rudman A. Finnish paramedics' professional quality of life and associations with assignment experiences and defusing use - a cross-sectional study. BMC Public Health 2021; 21:1789. [PMID: 34610798 PMCID: PMC8490964 DOI: 10.1186/s12889-021-11851-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/22/2021] [Indexed: 12/04/2022] Open
Abstract
Background Paramedics experience traumatic events and social emergencies during assignments while also being subjected to verbal and physical threats. Consequently, they are at risk for burnout and secondary traumatic stress, factors inherent to professional quality of life. Defusing and peer-support potentially decrease such symptoms; however, perceived defusing needs and use are not always balanced. Our aim was to explore Finnish paramedics’ professional quality of life, using the Professional Quality of Life Scale, with associations to EMS assignment experiences as well as formal and informal defusing need and use over a 12-month period. Methods A quantitative study of 257 Finnish paramedics using a cross-sectional design. Study outcomes were secondary traumatic stress (STS), compassion satisfaction (CS), and burnout (BO) scores using the modified 9-item Short Professional Quality of Life scale (ProQOL). Likert-type scales were used to collect participants’ recollections of assignment experiences and defusing from a 12-month period. Associations were explored using Spearman’s correlation coefficients. Results Short ProQOL score medians were STS 4.00 (IQR 3), BO 6.00 (IQR 3) and CS 13.00 (IQR 3). STS and BO correlated to experiences of social emergencies and traumatic events while BO correlated to experiences of threat situations (r = 0.206, p = .001). Paramedics perceived a need for defusing in general associated with STS (r = 0.178, p < .001) and participated in informal defusing. Participation in defusing of any form did not associate with ProQOL scores. Conclusions Finnish paramedics’ more frequent experiences of social emergencies, traumatic events, and paramedic-directed threat situations were associated with higher levels of STS and BO. STS was also associated with paramedics’ increased need for defusing and use of informal peer defusing, although neither STS, BO or CS scores associated to any defusing form. Managing paramedics STS and BO, while fostering CS, could therefore be a future research focus. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11851-0.
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Affiliation(s)
- Christoffer R Ericsson
- Faculty of Medicine, University of Helsinki, Helsinki, Finland. .,Department of Healthcare, Arcada University of Applied Sciences, Jan Magnus Janssons plats 1, 00560, Helsinki, Finland.
| | - Hilla Nordquist
- South-Eastern Finland University of Applied Sciences, Kotka, Finland
| | - Veronica Lindström
- Department of Neurobiology, Care Sciences and Society, Section of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Ann Rudman
- Department of Health and Welfare, Dalarna University, Falun, Sweden
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Roberts R, Wong A, Jenkins S, Neher A, Sutton C, O'Meara P, Frost M, Bamberry L, Dwivedi A. Mental health and well-being impacts of COVID-19 on rural paramedics, police, community nurses and child protection workers. Aust J Rural Health 2021; 29:753-767. [PMID: 34586704 PMCID: PMC8653026 DOI: 10.1111/ajr.12804] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 08/18/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To investigate the impact of COVID-19 on the mental health and well-being of rural paramedics, police, community nursing and child protection staff. METHOD An online survey was distributed to investigate the sources of stress and support across individual, task and organisational domains. SETTING AND PARTICIPANTS The survey was completed by 1542 paramedics, police, community nurses and child protection workers from all states and territories of Australia. This study describes the data for the 632 rural participants. MAIN OUTCOME MEASURES The main measures of well-being were the Public Health Questionnaire (PHQ9), the Generalised Anxiety Disorder (GAD7), the Maslach Burnout Inventory (MBI), workplace engagement, intention to quit and COVID-19-related stress. RESULTS The mean depression and anxiety scores were 8.2 (PHQ9) and 6.8 (GAD7). This is 2-3 times that found in the general community. Over half (56.1%) of respondents showed high emotional exhaustion (burnout). The emotional exhaustion, depersonalisation and personal accomplishment mean scores were 28.5, 9.3 and 34.2, respectively. The strongest associations with burnout and psychological distress were workload, provision of practical support, training and organisational communication. A significant proportion of respondents were seriously considering quitting (27.4%) or looking for a new job with a different employer (28.5%) in the next 12 months. CONCLUSIONS COVID-19 has increased the workload and stress on rural front-line community staff. The major sources of stress were related to organisations' responses to COVID-19 and not COVID-19 per se. The data suggest the most effective mental health interventions are practical and preventive, such as firstly ensuring fair and reasonable workloads.
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Affiliation(s)
| | - Alfred Wong
- Charles Sturt University, Bathurst, NSW, Australia
| | | | - Alain Neher
- Charles Sturt University, Bathurst, NSW, Australia
| | - Clare Sutton
- Charles Sturt University, Bathurst, NSW, Australia
| | | | - Mark Frost
- Charles Sturt University, Bathurst, NSW, Australia
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Chen YH, Tsai CF, Yeh CJ, Jong GP. Is burnout a mediating factor between sharps injury and work-related factors or musculoskeletal pain? World J Clin Cases 2021; 9:7391-7404. [PMID: 34616806 PMCID: PMC8464475 DOI: 10.12998/wjcc.v9.i25.7391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/01/2021] [Accepted: 07/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Burnout, musculoskeletal pain, and sharps injuries (SIs) affect medical workers.
AIM To establish a model between SIs, burnout, and the risk factors to assess the extent to which burnout affects SIs.
METHODS This questionnaire was used for an observational and cross-sectional study, which was based on members at a hospital affiliated with a medical university in Taichung, Taiwan, in 2020. The valid responses constituted 68.5% (1734 of 2531). The items were drawn from the Nordic Musculoskeletal Questionnaire and Copenhagen burnout inventory and concerned work experience, occupational category, presence of chronic diseases, sleep duration, overtime work, and work schedule. Factor analysis, chi-square test, Fisher exact test, Multiple linear, logistic regression and Sobel test were conducted. The present analyses were performed using SAS Enterprise Guide 6.1 software (SAS Institute Inc., Cary, NC, United States), and significance was set at P < 0.05.
RESULTS Personal and work-related burnout ranks, sex, work experience ranks, occupational groups, drinking in the past month, sleep duration per day, presence of chronic diseases, overtime work ranks, and work schedule were associated with SIs. Frequent upper limb and lower limb pain (pain occurring every day or once a week) determined to be related to SIs. High personal burnout (> Q3) and high work-related burnout (> Q3) mediated the relationship between SIs and frequent lower limb pain. Similarly, frequent lower limb pain mediated the relationship of SIs with high personal and high work-related burnout. High personal and high work-related burnout mediated the relationships of SIs with overtime work and irregular shift work. The mediating model provides strong evidence of an association between mental health and SIs.
CONCLUSION Burnout was determined to contribute to SIs occurrence; specifically, it mediated the relationships of SIs with frequent musculoskeletal pain, overtime work, and irregular shift work.
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Affiliation(s)
- Yong-Hsin Chen
- Department of Public Health, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Occupational Safety and Health, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Chin-Feng Tsai
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Chih-Jung Yeh
- Department of Public Health, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Gwo-Ping Jong
- Department of Internal Medicine, Chung Shan Medical University Hospital and Chung Shan Medical University, Taichung 40201, Taiwan
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Peters SE, Sorensen G, Katz JN, Gundersen DA, Wagner GR. Thriving from Work: Conceptualization and Measurement. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7196. [PMID: 34281131 PMCID: PMC8296939 DOI: 10.3390/ijerph18137196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/21/2021] [Accepted: 06/29/2021] [Indexed: 11/16/2022]
Abstract
Work is a major contributor to our health and well-being. Workers' thriving is directly influenced by their job design, work environment and organization. The purpose of this report is to describe the qualitative methods used to develop the candidate items for a novel measure of Thriving from Work through a multi-step iterative process including: a literature review, workshop, interviews with experts, and cognitive testing of the candidate items. Through this process, we defined Thriving from Work as the state of positive mental, physical, and social functioning in which workers' experiences of their work and working conditions enable them to thrive in their overall lives, contributing to their ability to achieve their full potential in their work, home, and community. Thriving from Work was conceptualized into 37 attributes across seven dimensions: psychological, emotional, social, work-life integration, basic needs, experience of work, and health. We ultimately identified, developed and/or modified 87 candidate questionnaire items mapped to these attributes that performed well in cognitive testing in demographically and occupationally diverse workers. The Thriving from Work Questionnaire will be subjected to psychometric testing and item reduction in future studies. Individual items demonstrated face validity and good cognitive response properties and may be used independently from the questionnaire.
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Affiliation(s)
- Susan E. Peters
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
| | - Glorian Sorensen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
- Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Jeffrey N. Katz
- Departments of Orthopedic Surgery and Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA;
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Daniel A. Gundersen
- Survey and Qualitative Methods Core, Division of Population Health, Dana-Farber Cancer Institute, Boston, MA 02215, USA;
| | - Gregory R. Wagner
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
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Roth K, Baier N, Busse R, Henschke C. Arbeitszufriedenheit und Burnout in der präklinischen Notfallversorgung. Notf Rett Med 2021. [DOI: 10.1007/s10049-021-00881-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Zusammenfassung
Hintergrund
Einsätze unter unterschiedlichen und erschwerten Bedingungen können Burnout-Werte für Mitarbeiter im Rettungsdienst erhöhen. Zufriedenheit am Arbeitsplatz wird als Faktor gesehen, der im Zusammenhang mit erhöhten Burnout-Werten steht.
Ziel der Arbeit
Ziele waren die Untersuchung der Arbeitszufriedenheit und des Burnout-Syndroms bei nichtärztlichen Mitarbeitern im Rettungsdienst sowie die Analyse des Zusammenhangs zwischen hohen Burnout-Werten und Faktoren der Zufriedenheit.
Material und Methoden
Mittels eines Onlinefragebogens wurden Mitarbeiter zu Arbeitszufriedenheit und Aspekten, die das Erleben des Burnouts messen, befragt. Einer deskriptiven Auswertung folgte eine Zusammenhangsanalyse zwischen Arbeitszufriedenheit und einzelnen Burnout-Dimensionen (emotionale Erschöpfung [EE] und Depersonalisierung [DP]) mittels binärer logistischer Regressionen.
Ergebnisse
In die Analyse wurden 1082 Fragebögen einbezogen. Die Majorität der Studienteilnehmer war männlich, jünger als 40 Jahre und in Vollzeit tätig. In den Dimensionen EE und DP wiesen 26,2 % bzw. 40,0 % der Befragten hohe Burnout-Werte auf. Zwischen 17,7 % und 75,9 % der Befragten waren mit einzelnen Aspekten des Arbeitsplatzes unzufrieden (z. B. Flexibilität des Dienstplans, Fortbildungsurlaub, Gehalt, beruflicher Status). Die Zufriedenheit mit dem beruflichen Status und der Berufswahl ist signifikant mit niedrigeren Burnout-Werten in den Dimensionen EE und DP assoziiert.
Diskussion
Die Ergebnisse zeigen die Notwendigkeit einer Verbesserung der Arbeitsbedingungen. Die negative Assoziation zwischen der Zufriedenheit mit dem beruflichen Status sowie der Berufswahl und Burnout-Werten sollte die Diskussion über Strategien zur Anerkennung der Berufe aus gesellschaftlicher Sicht noch stärker anstoßen.
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Zare S, Mohammadi dameneh M, Esmaeili R, Kazemi R, Naseri S, Panahi D. Occupational stress assessment of health care workers (HCWs) facing COVID-19 patients in Kerman province hospitals in Iran. Heliyon 2021; 7:e07035. [PMID: 33997362 PMCID: PMC8112293 DOI: 10.1016/j.heliyon.2021.e07035] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/11/2021] [Accepted: 05/06/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The health care workers (HCWs) at the frontline of fighting COVID-19 are at higher risk for mental health problems, including stress, anxiety, depression, and insomnia. This study aimed at assess the status of occupational stress in the three occupational groups of nurses, physicians and hospital cleaning crew facing COVID-19 patients in hospitals of Kerman province in Iran. METHODOLOGY This cross-sectional descriptive analytical study was performed on 290 medical staffs including nurses, physicians and cleaning crew facing COVID-19 patients working in different hospitals in Iran in 2020. Demographic information form and occupational Stress Questionnaire (HSE tool indicator) were used to collect data. The health and safety executive (HSE) questionnaire has 35 questions and 7 areas, which was developed in the 1990s by the UK Health and Safety Institute to measure occupational stress. RESULTS The mean score of total dimensions among HCWs was 2.93. Communications, Manager support, Changes and Demand factors with scores of 2.76, 2.77, 2.83 and 2.87 had the greatest impact on participants' stress levels, respectively. Also, Colleague support factor with a score of 3.38 had the least effect on stress levels. Also, according to the results, 87% of nurses, 79% of cleaning crew and 67% of physicians had a partial to high levels of stress that, on average, 77.5% of the HCWs participating in this study had at least a small amount of stress. CONCLUSIONS The mean stress score among the participants of the present study was between high stress level and moderate stress level. Factors such as communications, manager support, change and demand had the greatest impact on employee stress levels. Therefore, by improving the communication between people working in hospitals, increasing managers' support for staff, and reducing workplace demands such as reducing workload and improving workplace environment, the stress level of staff in hospitals during the outbreak of COVID-19 can be reduced.
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Affiliation(s)
- Sajad Zare
- Department of Occupational Health Engineering and Safety at Work, Faculty of Public Health, Kerman University of Medical Sciences, Kerman, Iran
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Moslem Mohammadi dameneh
- Department of Occupational Health Engineering and Safety at Work, Faculty of Public Health, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - Reza Esmaeili
- Department of Occupational Health Engineering and Safety at Work, Faculty of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Reza Kazemi
- Department of Ergonomics, Faculty of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sahar Naseri
- Department of Ergonomics, Faculty of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davoud Panahi
- Department of Occupational Health and Safety, Faculty of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Peifer C, Hagemann V, Claus M, Larra MF, Aust F, Kühn M, Owczarek M, Bröde P, Pacharra M, Steffens H, Watzl C, Wascher E, Capellino S. Low self-reported stress despite immune-physiological changes in paramedics during rescue operations. EXCLI JOURNAL 2021; 20:792-811. [PMID: 33907542 PMCID: PMC8073856 DOI: 10.17179/excli2021-3617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/07/2021] [Indexed: 11/18/2022]
Abstract
Despite the high stress levels, paramedics seem to ignore or even negate the stress. This can be detrimental and lead to stress-related diseases. Therefore, we investigated the divergence between physiological and psychological stress responses of paramedics. Participants were 16 paramedics and 17 white-collar workers. We assessed psychological stress parameters, cortisol awakening response (CAR), and quantified immune parameters. In paramedics, electrocardiogram (ECG) was measured during one complete 24-hour shift. Our results revealed that CAR was higher in paramedics compared to controls. An alteration of immune parameters was observed even during days of free time. Also, ECG recordings showed acute stress in paramedics during rescue situations. Questionnaires revealed that rescue-service specific stressors affect psychological outcomes. However, paramedics reported significantly less mental stress and higher levels of depersonalization than controls. Taken together, our results suggest higher stress in paramedics compared to controls. However, paramedics negate their daily stress. Our findings underline therefore the importance to develop stress-management interventions for paramedics including sensitization for their stress reactions.
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Affiliation(s)
- Corinna Peifer
- University of Lübeck, Department of Psychology, Lübeck, Germany
| | - Vera Hagemann
- University of Bremen, Faculty of Business Studies and Economics, Bremen, Germany
| | - Maren Claus
- Leibniz Research Centre for Working Environment and Human Factors (IfADo), Department of Immunology, Dortmund, Germany
| | - Mauro F. Larra
- IfADo- Leibniz Research Centre for Working Environment and Human Factors (IfADo), Department of Ergonomics, Dortmund, Germany
| | - Fabienne Aust
- University of Lübeck, Department of Psychology, Lübeck, Germany
- Ruhr University Bochum, Faculty of Psychology, Bochum, Germany
| | - Marvin Kühn
- Ruhr University Bochum, Faculty of Psychology, Bochum, Germany
| | - Monika Owczarek
- Ruhr University Bochum, Faculty of Psychology, Bochum, Germany
| | - Peter Bröde
- Leibniz Research Centre for Working Environment and Human Factors (IfADo), Department of Immunology, Dortmund, Germany
| | - Marlene Pacharra
- IfADo- Leibniz Research Centre for Working Environment and Human Factors (IfADo), Department of Ergonomics, Dortmund, Germany
- MSH Medical School Hamburg, University of Applied Sciences and Medical University, Hamburg, Germany
| | | | - Carsten Watzl
- Leibniz Research Centre for Working Environment and Human Factors (IfADo), Department of Immunology, Dortmund, Germany
| | - Edmund Wascher
- IfADo- Leibniz Research Centre for Working Environment and Human Factors (IfADo), Department of Ergonomics, Dortmund, Germany
| | - Silvia Capellino
- Leibniz Research Centre for Working Environment and Human Factors (IfADo), Department of Immunology, Dortmund, Germany
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Chirico F, Crescenzo P, Sacco A, Riccò M, Ripa S, Nucera G, Magnavita N. Prevalence of burnout syndrome among Italian volunteers of the Red Cross: a cross-sectional study. INDUSTRIAL HEALTH 2021; 59:117-127. [PMID: 33473066 PMCID: PMC8010165 DOI: 10.2486/indhealth.2020-0246] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 01/14/2021] [Indexed: 06/01/2023]
Abstract
Burnout syndrome (BOS) is a work-related constellation of symptoms characterized by emotional exhaustion, depersonalization, and personal accomplishment. A cross-sectional survey was performed to study the prevalence of BOS among a randomly selected sample of 280 Italian Red Cross volunteers. A socio-demographic questionnaire and the Maslach Burnout Inventory (MBI)-HSS were used to collect data. 241 volunteers participated (response rate: 86.1%). A significant proportion of the workers had BOS subscale scores in the highest tertile: emotional exhaustion 8.0%, depersonalization 35.9% and perceived lack of accomplishment 23.5%, respectively. Volunteers in emergency care reported higher levels of emotional exhaustion (p=0.004) and depersonalization (p=0.001), and lower level of personal accomplishment (p=0.042) than volunteers engaged in non-healthcare social and administrative duties. These findings support the opportunity of a set of administrative, organizational and individual preventive interventions for emergency volunteers' mental health.
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Affiliation(s)
- Francesco Chirico
- Post-graduate School of Occupational Health, Università Cattolica del Sacro Cuore, Italy
- Health Service Department, State Police, Ministry of Interior, Italy
| | - Pietro Crescenzo
- Italian Red Cross Voluntary Military Corp, Psychological Activities Unit (NAP), Ministry of Defense, Italy
| | - Angelo Sacco
- Post-graduate School of Occupational Health, Università Cattolica del Sacro Cuore, Italy
- Local Healthcare Unit Roma 2, Italy
| | - Matteo Riccò
- Dipartimento di Prevenzione, AUSL-IRCCS di Reggio Emilia, Italy
| | | | - Gabriella Nucera
- Department of Emergency, Fatebenefratelli Hospital, ASST Fatebenefratelli and Sacco, Italy
| | - Nicola Magnavita
- Post-graduate School of Occupational Health, Università Cattolica del Sacro Cuore, Italy
- Department of Woman/Child & Public Health, Fondazione Policlinico A. Gemelli IRCCS, Italy
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Koppmann A, Cantillano V, Alessandri C. DISTRÉS MORAL Y BURNOUT EN EL PERSONAL DE SALUD DURANTE LA CRISIS POR COVID-19. REVISTA MÉDICA CLÍNICA LAS CONDES 2021. [PMCID: PMC7849543 DOI: 10.1016/j.rmclc.2020.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
El presente artículo revisa los principales aspectos relativos al concepto de distrés moral y burnout en el personal sanitario, los factores de riesgo general y específicos propios de la actual emergencia sanitaria, los instrumentos de evaluación disponibles, así como las principales estrategias y recomendaciones de prevención y manejo del cuadro.
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Montgomery AP, Azuero A, Baernholdt M, Loan LA, Miltner RS, Qu H, Raju D, Patrician PA. Nurse Burnout Predicts Self-Reported Medication Administration Errors in Acute Care Hospitals. J Healthc Qual 2021; 43:13-23. [PMID: 33394839 DOI: 10.1097/jhq.0000000000000274] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Every one out of 10 nurses reported suffering from high levels of burnout worldwide. It is unclear if burnout affects job performance, and in turn, impairs patient safety, including medication safety. The purpose of this study is to determine whether nurse burnout predicts self-reported medication administration errors (MAEs). METHODS A cross-sectional study using electronic surveys was conducted from July 2018 through January 2019, using the Copenhagen Burnout Inventory. Staff registered nurses (N = 928) in acute care Alabama hospitals (N = 42) were included in this study. Descriptive statistics, correlational, and multilevel mixed-modeling analyses were examined. RESULTS All burnout dimensions (Personal, Work-related, and Client-related Burnout) were significantly correlated with age (r = -0.17 to -0.21), years in nursing (r = -0.10 to -0.17), years of hospital work (r = -0.07 to -0.10), and work environment (r = -0.24 to -0.57). The average number of self-reported MAEs in the last 3 months was 2.13. Each burnout dimension was a statistically significant predictor of self-reported MAEs (p < .05). CONCLUSIONS Nurse burnout is a significant factor in predicting MAEs. This study provides important baseline data for actionable interventions to improve nursing care delivery, and ultimately health care, for Alabamians.
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Kuo FL, Yang PH, Hsu HT, Su CY, Chen CH, Yeh IJ, Wu YH, Chen LC. Survey on perceived work stress and its influencing factors among hospital staff during the COVID-19 pandemic in Taiwan. Kaohsiung J Med Sci 2020; 36:944-952. [PMID: 32815248 PMCID: PMC7461417 DOI: 10.1002/kjm2.12294] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/04/2020] [Accepted: 07/23/2020] [Indexed: 12/20/2022] Open
Abstract
This study aimed to investigate the perceived work stress and its influencing factors among hospital staff during the novel coronavirus (COVID‐19) pandemic in Taiwan. A web‐based survey was conducted at one medical center and two regional hospitals in southern Taiwan, targeting physicians, nurses, medical examiners, and administrators. The questionnaire included items on the demographic characteristics of hospital staff and a scale to assess stress among healthcare workers caring for patients with a highly infectious disease. A total of 752 valid questionnaires were collected. The hospital staff reported a moderate level of stress and nurses had a highest level of stress compared to staff in the other three occupational categories. The five highest stress scores were observed for the items “rough and cracked hands due to frequent hand washing and disinfectant use,” “inconvenience in using the toilet at work,” “restrictions on eating and drinking at work,” “fear of transmitting the disease to relatives and friends,” and “fear of being infected with COVID‐19.” Discomfort caused by protective equipment was the major stressor for the participants, followed by burden of caring for patients. Among participants who experienced severe stress (n = 129), work stress was higher among those with rather than without minor children. The present findings may serve as a reference for future monitoring of hospital staff's workload, and may aid the provision of support and interventions.
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Affiliation(s)
- Fang-Li Kuo
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Pei-Hsuan Yang
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,School of Nursing, Fooyin University, Kaohsiung, Taiwan
| | - Hsin-Tien Hsu
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Che-Yu Su
- Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chun-Hsien Chen
- Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - I-Jeng Yeh
- Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yen-Hung Wu
- Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Li-Chin Chen
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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28
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Khasne RW, Dhakulkar BS, Mahajan HC, Kulkarni AP. Burnout among Healthcare Workers during COVID-19 Pandemic in India: Results of a Questionnaire-based Survey. Indian J Crit Care Med 2020; 24:664-671. [PMID: 33024372 PMCID: PMC7519601 DOI: 10.5005/jp-journals-10071-23518] [Citation(s) in RCA: 145] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Burnout, a state of physical and emotional exhaustion, in healthcare workers (HCWs) is a major concern. The prevalence of burnout, due to COVID-19 pandemic in India, is unknown. We therefore conducted this survey. Materials and methods A questionnaire-based survey using Copenhagen Burnout Inventory was carried out among HCWs looking after COVID-19 patients. Questionnaire was sent to the HCWs, using WhatsApp Messenger, and voluntary participation was sought. We received responses from 2026 HCWs. Burnout was assessed in personal, work, and client-related (COVID-19 pandemic-related) domains. Burnout was defined at a cut-off score of 50 for each domain. Results The prevalence of personal burnout was 44.6% (903), work-related burn-out was only 26.9% (544), while greater than half of the respondents (1,069, 52.8%) had pandemic-related burnout. Younger respondents (21-30 years) had higher personal and work-related burnout. The prevalence of personal and work-related burnout was significantly (p < 0.01) higher among females. The doctors were 1.64 times, and the support staff were 5 times more likely to experience pandemic-related burnout. Conclusion There is a significant prevalence of burnout during the COVID-19 pandemic among HCWs, in particular, doctors and support staff. Female respondents had higher prevalence. We suggest that the management should be proactive and supportive in improving working conditions and providing assurance to the HCWs. The long-term effects of the current pandemic need to be assessed later. How to cite this article Khasne RW, Dhakulkar BS, Mahajan HC, Kulkarni AP. Burnout among Healthcare Workers during COVID-19 Pandemic in India: Results of a Questionnaire-based Survey. Indian J Crit Care Med 2020;24(8):664-671.
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Affiliation(s)
- Ruchira W Khasne
- Department of Critical Care Medicine, Ashoka Medicover Hospital, Wadala, Nashik, Maharashtra, India
| | - Bhagyashree S Dhakulkar
- Department of Critical Care Medicine, Ashoka Medicover Hospital, Wadala, Nashik, Maharashtra, India
| | - Hitendra C Mahajan
- Department of Anesthesiology, Ashoka Medicover Hospital, Wadala, Nashik, Maharashtra, India
| | - Atul P Kulkarni
- Division of Critical Care Medicine, Department of Anesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Parel (E), Mumbai, Maharashtra, India
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