Work stress and burnout among emergency physicians: a systematic review of last 10 years of research

AIM OF THE STUDY

First, to provide a synthesis and analysis of available scientific literature regarding the level of work stress and burnout among emergency physicians. Second, to identify the effect of the specific work situation-related factors.

METHODS

A systematic search was performed in NCBI PubMed and Embase. Comparative primary studies, both systematic review and cross-sectional, quantifying burnout in emergency physicians were included. Only studies published between 2011 and 2022 were retained. Synonym sets were compiled for the search key for 'burnout & stress', 'emergency', 'physician' and 'burnout & posttraumatic stress disorder'.

RESULTS

Thirty-five papers were retained for further research. Emergency physicians scored significantly higher for all dimensions of burnout compared to other healthcare professions. Significant correlations for burnout were found with work characteristic and organizational factors. Critical incidents and aggression were identified as the most important acute work characteristics and organizational factors impacting emergency physician's mental wellbeing including the development of posttraumatic stress disorder. Moreover, personal factors such as age, personality, and coping strategies also play an important role in the development of burnout as well as work-related trauma.

CONCLUSION

Available studies show that emergency physicians report higher scores of emotional exhaustion and depersonalization when compared to other healthcare professionals. Work characteristics contribute to this, but work-related traumatic incidents and aggression are important determinants. Personal characteristics such as age, personality type D, previous experiences and coping strategies seem to be determining factors likewise. Emergency physicians showed a high risk for developing burnout and work stress-related problems.

Attitudes towards following meat, vegetarian and vegan diets: an examination of the role of ambivalence

Vegetarianism within the U.K. is growing in popularity, with the current estimate of 7% of the population eating a vegetarian diet. This study examined differences between the attitudes and beliefs of four dietary groups (meat eaters, meat avoiders, vegetarians and vegans) and the extent to which attitudes influenced intentions to follow each diet. In addition, the role of attitudinal ambivalence as a moderator variable was examined. Completed questionnaires were obtained from 111 respondents (25 meat eaters, 26 meat avoiders, 34 vegetarians, 26 vegans). In general, predictions were supported, in that respondents displayed most positive attitudes and beliefs towards their own diets, and most negative attitudes and beliefs towards the diet most different form their own. Regression analyses showed that, as predicted by the Theory of Planned Behaviour, attitudes, subjective norm and perceived behavioural control were significant predictors of intention to follow each diet (apart from the vegetarian diet, where subjective norm was non-significant). In each case, attitudinal ambivalence was found to moderate the attitude-intention relationship, such that attitudes were found to be stronger predictors at lower levels of ambivalence. The results not only highlight the extent to which such alternative diets are an interesting focus for psychological research, but also lend further support to the argument that ambivalence in an important influence on attitude strength.

Developing occupational standards: a learning disabilities project

Occupational standards are often seen as cumbersome and inappropriate to a vocational curriculum such as nursing. However, the term fitness for practice is once more being used to focus the minds of educationalists and practitioners in healthcare delivery on the goal in preparing practitioners for the future. The project reported here was guided jointly by staff from a higher education institution and an NHS trust and involved practitioners in designing occupational standards with a view to using them in practice and incorporating them into the preregistration curriculum. The pivotal structure in this process was the focus group which, with tenacity and commitment, designed, developed and structured standards which were realistic and relevant to healthcare delivery.

An Escherichia coli plasmid vector system for high-level production and purification of heterologous peptides fused to active chloramphenicol acetyltransferase

A very small plasmid vector system is described for construction and high-level production of C-terminal chloramphenicol acetyltransferase (CAT) fusion proteins in Escherichia coli. The only functional elements of the plasmid are a minimal region of the ColE1 origin of DNA replication and the Tn9 cat gene, both under control of a tac promoter. Since C-terminal fusion to CAT does not interfere with chloramphenicol (Cm) resistance, plasmids are maintained under Cm selection. Because of its small size (1392 bp), the system is especially convenient for building and expression of synthetic genes and gene fragments. This concept was utilized to generate a fusion with a synthetic gene encoding the multiple-epitope fragment from the rubella virus E1 membrane protein. Affinity-purified fusion proteins were obtained in mg amounts from 100-ml batches of culture fluid, and incorporated as a specific antigen in a rubella immunoglobulin G enzyme-linked immunosorbent assay.

A general method for routine sequencing of cloned DNA fragments using commercial dye primers and its application in sequence analysis of Toxoplasma gondii RH genome fragments

A generally applicable approach for amplification and subsequent sequencing using commercially available dye primers is described. The polymerase chain reaction primers, one of which is biotinylated, are tagged at their 5' end with sequences of commercial sequencing primers. After purification and strand separation on streptavidin-coated magnetic beads, both strands are sequenced automatically on an Applied Biosystems 373A DNA sequencer using the appropriate standard dye-labeled sequencing primers. This approach is demonstrated on PstI and MnlI DNA fragments from Toxoplasma gondii RH cloned in the in-house developed derivatives of vector pJRtac99.