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Budden AK, Song S, Henry A, Wakefield CE, Abbott JA. Surgeon reported measures of stress and anxiety prior to and after elective gynecological surgery. Acta Obstet Gynecol Scand 2024; 103:360-367. [PMID: 38053225 PMCID: PMC10823402 DOI: 10.1111/aogs.14728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/23/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION Performing surgical procedures is a recognized source of stress for surgeons. Vocational stress is an important contributor to performance, patient care, and burnout with dispositional and environmental factors contributing. Accurately assessing surgeon stress is critical to measuring effectiveness of stress reduction programs. The primary aim was to identify differences between surgeons' self-reported anticipated stress and anxiety prior to gynecological surgery, compared with their recollection of experienced stress and anxiety during surgery. Secondary aims assessed any differences by level of training, surgical type, and surgeon role. MATERIAL AND METHODS Attending and resident gynecologists performing routine elective surgeries completed a visual analog scale (VAS) assessing perceived stress and the State-Trait Anxiety Inventory (STAI) prior to and immediately after completing 161 elective surgeries including total laparoscopic hysterectomy, laparoscopic excision of moderate-severe endometriosis, or hysteroscopic myomectomy. RESULTS Eight attending gynecologists and nine residents participated. Residents commenced as primary surgeon in 62/90 (69%) procedures. Stress experienced during surgery was greater than anticipated in 92/161 (57%) surgery episodes (mean VAS increase: 3.9; 95% CI: 1.1-6.8, p = 0.009). State anxiety was greater than anticipated in 99/161 (62%) episodes (mean state anxiety increase: 4.4; 95% CI: 3.0-5.8, p < 0.001). Greater preprocedural anticipatory stress and anxiety was observed in residents vs. attending gynecologists (VAS 51.9 vs. 22.8, p < 0.001; state anxiety 38.3 vs. 28.1, p < 0.001) and in primary vs. assistant surgeons (VAS 47.2 vs. 29.9, p < 0.001; state anxiety 36.9 vs. 28.3, p < 0.001). Intraoperative stress and anxiety were greater in primary surgeons (VAS 50.4 vs. 30.5, p < 0.001; anxiety 41.3 vs. 32.5, p < 0.001) and residents (VAS 43.4 vs. 31.7, p < 0.001; anxiety 53.5 vs. 33.7, p < 0.001) compared with assistants and attending gynecologists. Perceived stress and anxiety were positively correlated at both timepoints (r = 0.68, p < 0.001; r = 0.82, p < 0.001). CONCLUSIONS When asked to reflect on stress experienced during surgery, our data show that stress during surgery is greater than anticipated for many surgical episodes. Self-reported stress symptoms commence prior to surgery and are more commonly reported by surgeons operating as primary surgeon and by those in training. Future research should focus on determinants of presurgical stress and examine when stressors become inhibitory to performance.
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Affiliation(s)
- Aaron K. Budden
- School of Clinical MedicineUNSWSydneyNew South WalesAustralia
- Gynecology Research and Clinical Excellence (GRACE)Royal Hospital for WomenSydneyNew South WalesAustralia
| | - Sophia Song
- School of Clinical MedicineUNSWSydneyNew South WalesAustralia
- Gynecology Research and Clinical Excellence (GRACE)Royal Hospital for WomenSydneyNew South WalesAustralia
| | - Amanda Henry
- School of Clinical MedicineUNSWSydneyNew South WalesAustralia
- Department of Women's and Children's HealthSt George HospitalSydneyNew South WalesAustralia
| | - Claire E. Wakefield
- School of Clinical MedicineUNSWSydneyNew South WalesAustralia
- Kids Cancer CenterSydney Children's HospitalSydneyNew South WalesAustralia
| | - Jason A. Abbott
- School of Clinical MedicineUNSWSydneyNew South WalesAustralia
- Gynecology Research and Clinical Excellence (GRACE)Royal Hospital for WomenSydneyNew South WalesAustralia
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Xu S, Arnetz JE, Arnetz BB. Applying machine learning to explore the association between biological stress and near misses in emergency medicine residents. PLoS One 2022; 17:e0264957. [PMID: 35259166 PMCID: PMC8903283 DOI: 10.1371/journal.pone.0264957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 02/19/2022] [Indexed: 01/22/2023] Open
Abstract
Physician stress is associated with near misses and adverse medical events. However, little is known about physiological mechanisms linking stress to such events. We explored the utility of machine learning to determine whether the catabolic stress hormone cortisol and the anabolic, anti-stress hormone dehydroepiandrosterone sulfate (DHEA-S), as well as the cortisol to DHEA-S ratio relate to near misses in emergency medicine residents during active duty in a trauma 1 emergency department. Compared to statistical models better suited for inference, machine learning models allow for prediction in situations that have not yet occurred, and thus better suited for clinical applications. This exploratory study used multiple machine learning models to determine possible relationships between biomarkers and near misses. Of the various models tested, support vector machine with radial bias function kernels and support vector machine with linear kernels performed the best, with training accuracies of 85% and 79% respectively. When evaluated on a test dataset, both models had prediction accuracies of around 80%. The pre-shift cortisol to DHEA-S ratio was shown to be the most important predictor in interpretable models tested. Results suggest that interventions that help emergency room physicians relax before they begin their shift could reduce risk of errors and improve patient and physician outcomes. This pilot demonstrates promising results regarding using machine learning to better understand the stress biology of near misses. Future studies should use larger groups and relate these variables to information in electronic medical records, such as objective and patient-reported quality measures.
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Affiliation(s)
- Sonnet Xu
- Troy High School, Troy, Michigan, United States of America
- * E-mail:
| | - Judith E. Arnetz
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, United States of America
| | - Bengt B. Arnetz
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, United States of America
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Mansoori JN, Clark BJ, Havranek EP, Douglas IS. The Impact of Choice Architecture on Sepsis Fluid Resuscitation Decisions: An Exploratory Survey-Based Study. MDM Policy Pract 2022; 7:23814683221099454. [PMID: 35592271 PMCID: PMC9112319 DOI: 10.1177/23814683221099454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background Discordance with well-known sepsis resuscitation guidelines is often
attributed to rational assessments of patients at the point of care.
Conversely, we sought to explore the impact of choice architecture (i.e.,
the environment, manner, and behavioral psychology within which options are
presented and decisions are made) on decisions to prescribe
guideline-discordant fluid volumes. Design We conducted an electronic, survey-based study using a septic shock clinical
vignette. Physicians from multiple specialties and training levels at an
academic tertiary-care hospital and academic safety-net hospital were
randomized to distinct answer sets: control (6 fluid options), time
constraint (6 fluid options with a 10-s limit to answer), or choice overload
(25 fluid options). The primary outcome was discordance with Surviving
Sepsis Campaign fluid resuscitation guidelines. We also measured response
times and examined the relationship between each choice architecture
intervention group, response time, and guideline discordance. Results A total of 189 of 624 (30.3%) physicians completed the survey. Time spent
answering the vignette was reduced in time constraint (9.5 s, interquartile
range [IQR] 7.3 s to 10.0 s, P < 0.001) and increased in
choice overload (56.8 s, IQR 35.9 s to 86.7 s, P <
0.001) groups compared with control (28.3 s, IQR 20.0 s to 44.6 s). In
contrast, the relative risk of guideline discordance was higher in time
constraint (2.07, 1.33 to 3.23, P = 0.001) and lower in
choice overload (0.75, 0.60, to 0.95, P =0.02) groups.
After controlling for time spent reading the vignette, the overall odds of
choosing guideline-discordant fluid volumes were reduced for every
additional second spent answering the vignette (OR 0.98, 0.97, to 0.99,
P < 0.001). Conclusions Choice architecture may affect fluid resuscitation decisions in sepsis
regardless of patient conditions, warranting further investigation in
real-world contexts. These effects should be considered when implementing
practice guidelines. Highlights
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Affiliation(s)
- Jason N. Mansoori
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Denver Health Medical Center, Denver, CO, USA
| | - Brendan J. Clark
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Edward P. Havranek
- Division of Cardiology, Department of Medicine, Denver, CO, USA
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ivor S. Douglas
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Denver Health Medical Center, Denver, CO, USA
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Workplace Cognitive Failure among Nurses during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910394. [PMID: 34639695 PMCID: PMC8508323 DOI: 10.3390/ijerph181910394] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 12/20/2022]
Abstract
Numerous studies provide evidence of the physical and emotional strain experienced by nurses during the COVID-19 pandemic. However, little is known regarding the impact of this occupational strain on nurses’ cognitive function at work. The aim of this study was to identify factors associated with workplace cognitive failure in a sample of U.S. nurses during the COVID-19 pandemic. An online questionnaire was administered in May 2020 to Michigan nurses statewide via three nursing organizations (n = 695 respondents). Path analysis was conducted to test the parallel effects of frequency of contact with COVID patients and personal protective equipment (PPE) supply on workplace cognitive failure scores. Mediation effects of stress, sleep quality, secondary trauma, and work-related exhaustion were examined for each exposure. Results revealed significant indirect effects of all mediators except sleep quality of contact with COVID patients (cumulative indirect effect = 1.30, z = 6.33, p < 0.001) and PPE (cumulative indirect effect = −2.10, z = −5.22, p < 0.001) on cognitive failure. However, 58% of the PPE effect was direct. To reduce the risk of cognitive failure, healthcare organizations need to provide nurses with protective equipment and work environments that allow nurses to strengthen their resilience to extreme working conditions.
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Roskos SE, Fitzpatrick L, Arnetz B, Arnetz J, Shrotriya S, Hengstebeck E. Complex patients' effect on family physicians: high cognitive load and negative emotional impact. Fam Pract 2021; 38:454-459. [PMID: 33367637 DOI: 10.1093/fampra/cmaa137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Complex patients present an increasing challenge to the health care system and family physicians play an important role in their care. As part of a larger project exploring family physicians' perceptions of complex patients, we sought to understand how complex patients affect family physicians and if these effects might be related to physician burnout. METHODS We conducted a qualitative study involving interviews with family physicians from various practice settings. We invited the physicians to choose three of their patients between the ages of 18 and 64 whom they considered to have complex medical problems and to have access to their medical records during a telephone interview using a semi-structured interview guide. Interviews were audio-recorded, professionally transcribed and coded. Using qualitative analytical software, research team members worked together to analyse the interview data and determine emerging themes. RESULTS Eleven family physicians participated in the interviews and described 29 unique complex patients, including challenges and effects on them personally. Analysis of the available 10 family physicians' interviews revealed two themes related to complexity's impact on physicians: (i) high cognitive load and (ii) negative emotional impact. CONCLUSION Although preliminary, this study offers a previously unconsidered understanding of drivers of physician burnout, including high cognitive load and negative emotional impact on family physicians created by caring for complex patients. Interventions to improve health care, including addressing physician wellness and burnout, should include the provision of resources to assist them with decreasing cognitive load and negative emotional impact when caring for complex patients.
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Affiliation(s)
- Steven E Roskos
- Department of Family Medicine, Michigan State University, East Lansing, MI, USA.,Department of Family Medicine, Sparrow Hospital, Lansing, MI, USA
| | - Laurie Fitzpatrick
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, MI, USA
| | - Bengt Arnetz
- Department of Family Medicine, Michigan State University, East Lansing, MI, USA.,Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Judy Arnetz
- Department of Family Medicine, Michigan State University, East Lansing, MI, USA
| | - Shiva Shrotriya
- Department of Medicine, Michigan State University, East Lansing, MI, USA
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Cognitive biases, environmental, patient and personal factors associated with critical care decision making: A scoping review. J Crit Care 2021; 64:144-153. [PMID: 33906103 DOI: 10.1016/j.jcrc.2021.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/31/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Cognitive biases and factors affecting decision making in critical care can potentially lead to life-threatening errors. We aimed to examine the existing evidence on the influence of cognitive biases and factors on decision making in critical care. MATERIALS AND METHODS We conducted a scoping review by searching MEDLINE for articles from 2004 to November 2020. We included studies conducted in physicians that described cognitive biases or factors associated with decision making. During the study process we decided on the method to summarize the evidence, and based on the obtained studies a descriptive summary of findings was the best fit. RESULTS Thirty heterogenous studies were included. Four main biases or factors were observed, e.g. cognitive biases, personal factors, environmental factors, and patient factors. Six (20%) studies reported biases associated with decision making comprising omission-, status quo-, implicit-, explicit-, outcome-, and overconfidence bias. Nineteen (63%) studies described personal factors, twenty-two (73%) studies described environmental factors, and sixteen (53%) studies described patient factors. CONCLUSIONS The current evidence on cognitive biases and factors is heterogenous, but shows they influence clinical decision. Future studies should investigate the prevalence of cognitive biases and factors in clinical practice and their impact on clinical outcomes.
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Bortolotto I, de Brum APS, Guecheva TN, de Souza LM, de Paula-Ramos ALL, Trindade C, Consiglio AR. DNA damage, salivary cortisol levels, and cognitive parameters in a nursing team. MUTATION RESEARCH-GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2021; 861-862:503300. [PMID: 33551101 DOI: 10.1016/j.mrgentox.2020.503300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
In a cross-sectional study of women in a nursing team at a university hospital in southern Brazil, we studied DNA damage, salivary cortisol levels, and cognition. DNA damage was measured in blood leukocytes with the comet assay and the micronucleus test. Salivary cortisol levels were determined upon waking, 30 min later, and at bedtime. Cognition was evaluated according to the Stroop, Digit span and Word span tests. Cortisol levels on waking up were associated negatively with the number of years the employee worked at the institution and positively with the DNA damage in comet assay. Cognitive scores were lower when the cortisol levels were low at awakening and high at bedtime; and were associated positively with educational level. Cortisol status may influence overall health as well as essential work skills, such as attention.
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Affiliation(s)
- Iranez Bortolotto
- Programa de Pós-Graduação em Enfermagem, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Departamento de Biofísica, Instituto de Biociências, Universidade Federal do Rio Grande do Sul (UFRGS), RS, Brazil
| | - Ana Paula Scherer de Brum
- Programa de Pós-Graduação em Enfermagem, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Universidade do Oeste de Santa Catarina (UNOESC), SC, Brazil
| | - Temenouga Nikolova Guecheva
- Departamento de Biofísica, Instituto de Biociências, Universidade Federal do Rio Grande do Sul (UFRGS), RS, Brazil
| | - Larissa Milano de Souza
- Departamento de Biofísica, Instituto de Biociências, Universidade Federal do Rio Grande do Sul (UFRGS), RS, Brazil
| | - Ana Ligia Lia de Paula-Ramos
- Departamento de Biofísica, Instituto de Biociências, Universidade Federal do Rio Grande do Sul (UFRGS), RS, Brazil
| | - Cristiano Trindade
- Departamento de Biofísica, Instituto de Biociências, Universidade Federal do Rio Grande do Sul (UFRGS), RS, Brazil; Facultad de Ciencias Básicas y Biomédicas, Universidad Simón Bolívar, Barranquilla, Colombia.
| | - Angelica Rosat Consiglio
- Programa de Pós-Graduação em Enfermagem, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Departamento de Biofísica, Instituto de Biociências, Universidade Federal do Rio Grande do Sul (UFRGS), RS, Brazil.
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Janicki AJ, Frisch SO, Patterson PD, Brown A, Frisch A. Emergency Medicine Residents Experience Acute Stress While Working in the Emergency Department. West J Emerg Med 2020; 22:94-100. [PMID: 33439813 PMCID: PMC7806330 DOI: 10.5811/westjem.2020.10.47641] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 10/28/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Acute stress may impair cognitive performance and multitasking, both vital in the practice of emergency medicine (EM). Previous research has demonstrated that board-certified emergency physicians experience physiologic stress while working clinically. We sought to determine whether EM residents have a similar stress response, and hypothesized that residents experience acute stress while working clinically. METHODS We performed a prospective observational study of physiologic stress including heart rate (HR), heart rate variability (HRV), and subjective stress in EM residents during clinical shifts in the emergency department. HR and HRV were measured via 3-lead Holter monitors and compared to baseline data obtained during weekly educational didactics. Subjective stress was assessed before and after clinical shifts via a Likert-scale questionnaire and written comments. RESULTS We enrolled 21 residents and acquired data from 40 shifts. Residents experienced an increase in mean HR of eight beats per minute (P < 0.001) and decrease in HRV of 53.9 milliseconds (P = 0.005) while working clinically. Subjective stress increased during clinical work (P <0.001). HRV was negatively correlated with subjective stress, but this did not reach statistical significance (P = 0.09). CONCLUSION EM residents experience acute subjective and physiologic stress while working clinically. HR, HRV, and self-reported stress are feasible indicators to assess the acute stress response during residency training. These findings should be studied in a larger, more diverse cohort of residents and efforts made to identify characteristics that contribute to acute stress and to elicit targeted educational interventions to mitigate the acute stress response.
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Affiliation(s)
- Adam J Janicki
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania
| | - Stephanie O Frisch
- University of Pittsburgh, School of Nursing, Department of Acute and Tertiary Care, Pittsburgh, Pennsylvania
| | - P Daniel Patterson
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania
| | - Aaron Brown
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania
| | - Adam Frisch
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania
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Nurse Work Environment and Stress Biomarkers: Possible Implications for Patient Outcomes. J Occup Environ Med 2020; 61:676-681. [PMID: 31205209 DOI: 10.1097/jom.0000000000001642] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To examine associations between nurse work environment, serum biomarkers, and patient outcomes in a large hospital. METHODS A work environment questionnaire was administered in 2017 to the total sample of nurses in a Midwestern hospital. A subsample of nurses (n = 83) provided blood samples. Correlation analyses examined associations between work environment ratings, biomarkers (dehydroepiandrosterone-sulphate [DHEA-S] and interleukin-6 [IL-6]), and unit-level patient outcomes. RESULTS Work stress was negatively correlated with DHEA-S (r = -0.23) and positively correlated with IL-6 (r = 0.31; P < 0.05). Psychological safety (r = 0.22) and competence development (r = 0.25) were both positively correlated with DHEA-S (P < 0.05). DHEA-S was negatively correlated with central line-associated bloodstream infections (rho = -0.61; P < 0.05). CONCLUSIONS Work environment-associated physiological mechanisms might adversely impact patient safety, in addition to nurse health.
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Toyokuni Y, Ishimaru T, Honno K, Kubo T, Matsuda S, Fujino Y. Near-miss incidents owing to fatigue and irregular lifestyles in ambulance personnel. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2020; 77:46-50. [PMID: 33208030 DOI: 10.1080/19338244.2020.1842312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We aimed to investigate the association between fatigue and near-miss incidents and between irregular lifestyles and fatigue in ambulance personnel. In this cross-sectional study, we used a self-administered questionnaire and ambulance dispatch records during November 2017. We performed multiple logistic regression; in total, 254 ambulance staff were eligible for inclusion in the analysis. The adjusted odds of near-miss incidents were 3.19 times higher for participants with higher fatigue than for those with normal fatigue, with statistical significance. Fatigue was significantly associated with the monthly number of ambulance dispatches, office working hours, mealtimes, daytime napping hours, and napping hours during a night shift. In this study, we demonstrated a positive association between fatigue and near-miss incidents among ambulance personnel. Additionally, our results suggest that irregular lifestyles are a root cause of fatigue in ambulance personnel.
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Affiliation(s)
- Yoshiki Toyokuni
- Department of Public Health, School of Medicine, University of Occupational and Environmental Health, Japan,Kitakyushu, Japan
| | - Tomohiro Ishimaru
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan,Kitakyushu, Japan
| | - Katsumi Honno
- Department of Public Health, School of Medicine, University of Occupational and Environmental Health, Japan,Kitakyushu, Japan
| | - Tatsuhiko Kubo
- Department of Public Health and Health Policy, Graduate School of Biomedical and Health Sciences, Hiroshima University,Hiroshima, Japan
| | - Shinya Matsuda
- Department of Public Health, School of Medicine, University of Occupational and Environmental Health, Japan,Kitakyushu, Japan
| | - Yoshihisa Fujino
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan,Kitakyushu, Japan
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Arnetz BB, Templin TN, Jen KLC, Sudan S, Arnetz JE. Lifestyle and psychosocial factors associated with maintenance of normal body mass index in college students: a cross sectional study. BMC Res Notes 2020; 13:516. [PMID: 33168065 PMCID: PMC7653865 DOI: 10.1186/s13104-020-05362-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/27/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The purpose of this study was to identify lifestyle and psychosocial factors associated with maintenance of normal body mass index (BMI, 18.5-24.9 kg/m2). Undergraduate students (n = 2781; 7.1% response rate) at a Big Ten university responded to a survey in 2018. BMI was calculated from the reported weight and height at the time of the survey and upon entering the university. Logistic regression analyses examined lifestyle and psychosocial health factors associated with maintenance of normal BMI by academic year. RESULTS Current BMI was within normal range for 68.8% of freshmen and 60.6% of seniors. Never consuming fast food was a significant predictor for maintaining normal BMI in sophomores (OR 3.78; 95% CI 1.61, 8.88; p < 0.01) and juniors (OR 7.82; 95% CI 2.14, 28.65; p < 0.01). In seniors, better psychosocial health (OR 1.40; 95% CI 1.12, 1.76; p < 0.01) was the only significant predictor for maintaining one's normal freshman BMI category. Among those within the normal BMI range upon entering the university, psychosocial health (OR 1.31; 95% CI 1.10, 1.55; p < 0.01) was the only predictor of retaining one's absolute BMI within ± 3% as a senior. Prospective studies are needed to better understand the interaction between environment, behavior, and psychological health involved in retaining normal weight.
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Affiliation(s)
- Bengt B Arnetz
- Department of Family Medicine, College of Human Medicine, Michigan State University, 15 Michigan Street NE, Grand Rapids, MI, 49503, USA.
| | | | - K-L Catherine Jen
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI, USA
| | - Sukhesh Sudan
- Department of Family Medicine, College of Human Medicine, Michigan State University, 15 Michigan Street NE, Grand Rapids, MI, 49503, USA
| | - Judith E Arnetz
- Department of Family Medicine, College of Human Medicine, Michigan State University, 15 Michigan Street NE, Grand Rapids, MI, 49503, USA
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Chang TP, Azen C, Sherman JM. Physiological Stress Markers Following Resuscitations Remain Elevated Throughout Physician Shift Hours. Acad Emerg Med 2020; 27:510-513. [PMID: 32282983 DOI: 10.1111/acem.13982] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/05/2020] [Accepted: 03/27/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Todd P. Chang
- From the Division of Emergency Medicine Children's Hospital Los Angeles Los Angeles CA
- Keck School of Medicine University of Southern California Los Angeles CA
| | - Colleen Azen
- Keck School of Medicine University of Southern California Los Angeles CA
- the Southern California Center for Translational Science Institute Los Angeles CA
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Ishimaru T, Kubo T, Honno K, Toyokuni Y, Fujino Y. Near misses and presenteeism among paramedics. Occup Med (Lond) 2019; 69:593-597. [PMID: 31206581 DOI: 10.1093/occmed/kqz076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Paramedics need to be in good physical health to be able to respond to emergencies. We hypothesized that near misses by paramedics and unanticipated incidents that cause no harm may be associated with presenteeism during emergency rescues. AIMS To examine the association between presenteeism and near misses among paramedics. METHODS A cross-sectional study was conducted among 254 paramedics using a self-administered questionnaire. Presenteeism was measured using the work functioning impairment scale (WFun). RESULTS Twelve per cent of respondents experienced high work function impairment indicating presenteeism. The rate of near-miss experiences steadily increased with increasing work function impairment among paramedics (WFun score category: middle, odds ratio (OR) 3.62, 95% confidence interval (CI) 1.62-8.11; high, OR 4.36, 95% CI 1.37-13.84; very high, OR 8.62, 95% CI 2.09-35.48). CONCLUSIONS This study demonstrated a positive relationship between impaired work function indicating presenteeism and near misses among paramedics. This suggests that presenteeism may be associated with errors that have the potential to cause serious accidents. Improved access to treatment for frequent health problems may reduce the number of incidents among paramedics.
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Affiliation(s)
- T Ishimaru
- Department of Health Management, Nishinihon Occupational Health Service Center, Kitakyushu, Japan.,Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - T Kubo
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - K Honno
- Department of Public Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Y Toyokuni
- Department of Public Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Y Fujino
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
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14
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Acute provider stress in high stakes medical care: Implications for trauma surgeons. J Trauma Acute Care Surg 2019; 88:440-445. [DOI: 10.1097/ta.0000000000002565] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Sudan S, Lewalski P, Arnetz J, Vanschagen J, Arnetz B. The association between attendings' feedback and residents' reporting of near-misses. BMC Res Notes 2019; 12:355. [PMID: 31234930 PMCID: PMC6591858 DOI: 10.1186/s13104-019-4395-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 06/18/2019] [Indexed: 11/26/2022] Open
Abstract
Objective Accreditation Council for Graduate Medical Education’s Clinical Learning Environment Review report suggests that residents in clinical learning environments underreport their near-misses, an indicator of patient safety. Furthermore, when the residents report these events, they receive little feedback from their attendings. Although, various studies emphasize the importance of feedback given to the residents, the association between feedback and patient safety has not been explored. This study was conducted in 28 emergency medicine residents in a level 1 trauma center. A recent study in the same cohort found that residents’ stress biomarker levels and patient acuity were positively related to their near-misses reports. The current study hypothesizes that residents that receive constructive feedback on their performance from their attendings would report more near-misses. Results Linear regression was used to determine whether ratings of attendings’ feedback predicted residents’ reports of near-misses. Feedback was positively related to residents’ near-misses reports even after controlling for patient acuity and stress biomarker levels. This may be due to the residents becoming more aware of what a near miss is or it may also be that constructive feedback encourages them to report more near-misses as they may view this as a learning opportunity.
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Affiliation(s)
- Sukhesh Sudan
- Department of Family Medicine, Michigan State University, College of Human Medicine, 15 Michigan St. NE, Grand Rapids, MI, 49503, USA.
| | - Philip Lewalski
- Department of Emergency Medicine, Wayne State University, Detroit, MI, USA
| | - Judy Arnetz
- Department of Family Medicine, Michigan State University, College of Human Medicine, 15 Michigan St. NE, Grand Rapids, MI, 49503, USA
| | - John Vanschagen
- Department of Family Medicine, Michigan State University, College of Human Medicine, 15 Michigan St. NE, Grand Rapids, MI, 49503, USA
| | - Bengt Arnetz
- Department of Family Medicine, Michigan State University, College of Human Medicine, 15 Michigan St. NE, Grand Rapids, MI, 49503, USA
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Comparisons of Stress Physiology of Providers in Real-Life Resuscitations and Virtual Reality–Simulated Resuscitations. ACTA ACUST UNITED AC 2019; 14:104-112. [DOI: 10.1097/sih.0000000000000356] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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