JOBSTRESS: Biomarkes Of Job STRess In Emergency Senior Physicians - Detection of Stressful Events
Study Details
Study Description
Brief Summary
Emergency medicine is a unique specialty focusing on a breadth of acute care, on demand . Shift work is also a fundamental component of emergency medicine, and is associated with chronic stress, including stress at work. Consequently, stress may lead to symptoms of mental exhaustion, physical fatigue, detachment from work, and feelings of diminished competence . Emergency physicians (EPs) are exposed to a complex interplay between stress (life-and-death emergencies - a defining characteristic of their job), sleep deprivation, and fatigue due to repeated changes in, and duration of shifts. Work-related exhaustion can lead to various physical and psychological symptoms, and also may be associated with delayed decision-making . The combined effects of stress and fatigue can impact on job performance, often resulting in otherwise preventable medical errors. Moreover, prolonged stress may expose EPs to a higher risk of multiple diseases, predominantly systemic inflammation and coronary heart disease. All these contribute to the premature departure of EPs to other specialties. Furthermore, low HRV has been associated with stress, burnout, and is linked with an increased risk of cardiovascular diseases.
This project proposes to evaluate if life-and-death emergencies or specific situations will induce abrupt changes in HRV among emergency physicians. Moreover, we would like to compare reactions between being an actor (EPs) and being a spectator. We will further assess the role of expertise and habituation to stressful emergency situations between two untrained external observers
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
The JOBSTRESS protocol was designed to provide a better understanding of the association between specific situations (ie: life and death emergencies) and breaks in the variability of the heart rate. Each emergency physician participates in the study four times. A night shift from 6:30 p.m to 8:30 a.m (14 hours) which will be compared with a day shift, as a control, from 8:30 a.m to 6:30 p.m, 16 hours following the night shift and 14 hours following the day shift. Emergency physicians will be accompanied by a medical externship student and by a student in psychology.
Statistical analysis will be performed using Stata software (version 13; Stata-Corp, College Station, Tex., USA). All statistical tests will be bilateral and a p <0.05 will be considered significant. Qualitative variables will be described in terms of numbers and proportions. Quantitative variables will be described in terms of numbers, average, median, standard deviation, and range. Graphic representations will be complete presentations of results. We process multivariate physiological series (HR, HRV, SC, wrist motion, respiratory rate) in order to build a stress index. For such multivariate physiological series, we first use change point analysis on each univariate series in order to get clusters with constant parameters, then we use classification algorithm on the constant parameters obtained in first step in order to obtain different classes corresponding to different levels of stress. Eventually, we obtain at each time the level of stress and can compare it to the environmental conditions.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Emergency physicians actors during the work |
Behavioral: Comparison of biomarkers of stress
Emergency will be followed during a night shift and the rest day et during a day shift and the rest day. They will be observed by a student (psychology student or medical externship student). We will assess the role of expertise and habituation to stressful emergency situations between two untrained external observers
|
| Experimental: medical externship student spectator during the emergency physician work |
Behavioral: Comparison of biomarkers of stress
Emergency will be followed during a night shift and the rest day et during a day shift and the rest day. They will be observed by a student (psychology student or medical externship student). We will assess the role of expertise and habituation to stressful emergency situations between two untrained external observers
|
| Experimental: psychology student spectator during the emergency physician work |
Behavioral: Comparison of biomarkers of stress
Emergency will be followed during a night shift and the rest day et during a day shift and the rest day. They will be observed by a student (psychology student or medical externship student). We will assess the role of expertise and habituation to stressful emergency situations between two untrained external observers
|
Outcome Measures
Primary Outcome Measures
- heart rate variability at night work [during 38 hours night 1]
measure of abrupt changes in HRV signals during 38 hours
- heart rate variability at night work [during 38 hours night 2]
measure of abrupt changes in HRV signals during 38 hours
- heart rate variability at day work [during 24 hours day 1]
measure of abrupt changes in HRV signals during 24 hours
- heart rate variability at day work [during 24 hours day 2]
measure of abrupt changes in HRV signals during 24 hours
Secondary Outcome Measures
- Stress [10 hours before the night 1 procedure]
measure of stress using VAS
- Stress [10 hours before the night 2 procedure]
measure of stress using VAS
- fatigue [10 hours before the night 1 procedure]
measure of fatigue using VAS
- fatigue [10 hours before the night 2 procedure]
measure of fatigue using VAS
- Stress [baseline of the night 1 procedure]
measure of stress using VAS
- Stress [baseline of the night 2 procedure]
measure of stress using VAS
- Fatigue [baseline of the night 1 procedure]
measure of Fatigue using VAS
- Fatigue [baseline of the night 2 procedure]
measure of Fatigue using VAS
- Stress [at the end of the night 1 procedure]
measure of stress using VAS
- Fatigue [at the end of the night 2 procedure]
measure of Fatigue using VAS
- Stress [10 hours after the end of the night 1 procedure]
measure of stress using VAS
- Stress [10 hours after the end of the night 2 procedure]
measure of stress using VAS
- Fatigue [10 hours after the end of the night 1 procedure]
measure of Fatigue using VAS
- Fatigue [10 hours after the end of the night 2 procedure]
measure of Fatigue using VAS
- Stress [24 hours after the end of the night 1 procedure]
measure of stress using VAS
- Stress [24 hours after the end of the night 2 procedure]
measure of stress using VAS
- Fatigue [24 hours after the end of the night 1 procedure]
measure of Fatigue using VAS
- Fatigue [24 hours after the end of the night 2 procedure]
measure of Fatigue using VAS
- Stress [baseline of the day 1 procedure]
measure of stress using VAS
- Stress [baseline of the day 2 procedure]
measure of stress using VAS
- Fatigue [baseline of the day 1 procedure]
measure of Fatigue using VAS
- Fatigue [baseline of the day 2 procedure]
measure of Fatigue using VAS
- Stress [end of the day 1 procedure]
measure of stress using VAS
- Fatigue [end of the day 2 procedure]
measure of Fatigue using VAS
- Stress [14 hours after the end of the day 1 procedure]
measure of stress using VAS
- Stress [14 hours after the end of the day 2 procedure]
measure of stress using VAS
- Fatigue [14 hours after the end of the day 1 procedure]
measure of Fatigue using VAS
- Fatigue [14 hours after the end of the day 2 procedure]
measure of Fatigue using VAS
- Saliva biomarkers cortisol [10 hours before the beginning of the night 1 procedure]
measur of Cortisol
- Saliva biomarkers cortisol [10 hours before the beginning of the night 2 procedure]
measur of Cortisol
- Saliva biomarkers cortisol [baseline of night 1 procedure]
measur of Cortisol
- Saliva biomarkers cortisol [baseline of night 2 procedure]
measur of Cortisol
- Saliva biomarkers cortisol [end of the night 1 procedure]
measur of Cortisol
- Saliva biomarkers cortisol [end of the night 2 procedure]
measur of Cortisol
- Saliva biomarkers cortisol [10 hours after the end of the night 1 procedure]
measur of Cortisol
- Saliva biomarkers cortisol [10 hours after the end of the night 2 procedure]
measur of Cortisol
- Saliva biomarkers cortisol [24 hours after the end of the night 1 procedure]
measur of Cortisol
- Saliva biomarkers cortisol [24 hours after the end of the night 2 procedure]
measur of Cortisol
- Saliva biomarkers cortisol [baseline of the day 1 procedure]
measur of Cortisol
- Saliva biomarkers cortisol [baseline of the day 2 procedure]
measur of Cortisol
- Saliva biomarkers cortisol [end of the day 1 procedure]
measure of Cortisol
- Saliva biomarkers cortisol [end of the day 2 procedure]
measure of Cortisol
- Saliva biomarkers cortisol [14 hours after the end of the day 1 procedure]
measure of Cortisol
- Saliva biomarkers cortisol [14 hours after the end of the day 2 procedure]
measure of Cortisol
- Saliva biomarkers DHEAS [10 hours before the beginning of the night 1 procedure]
measure of DHEAS
- Saliva biomarkers DHEAS [10 hours before the beginning of the night 2 procedure]
measure of DHEAS
- Saliva biomarkers DHEAS [baseline of the night 1 procedure]
measure of DHEAS
- Saliva biomarkers DHEAS [baseline of the night 2 procedure]
measure of DHEAS
- Saliva biomarkers DHEAS [end of the night 1 procedure]
measure of DHEAS
- Saliva biomarkers DHEAS [end of the night 2 procedure]
measure of DHEAS
- Saliva DHEAS [10 hours after the end of the night 1 procedure]
measure of DHEAS
- Saliva DHEAS [10 hours after the end of the night 2 procedure]
measure of DHEAS
- Saliva biomarkers DHEAS [24 hours after the end of the night 1 procedure]
measure of DHEAS
- Saliva biomarkers DHEAS [24 hours after the end of the night 2 procedure]
measure of DHEAS
- Saliva biomarkers DHEAS [baseline of the day 1 procedure]
measure of DHEAS
- Saliva biomarkers DHEAS [baseline of the day 2 procedure]
measure of DHEAS
- Saliva biomarkers DHEAS [14 hours after the end of the day 1 procedure]
measure of DHEAS
- Saliva biomarkers DHEAS [14 hours after the end of the day 2 procedure]
measure of DHEAS
- Saliva biomarkers lgAs [10 hours before the beginning of the night 1 procedure]
measure of lgAs
- Saliva biomarkers lgAs [10 hours before the beginning of the night 2 procedure]
measure of lgAs
- Saliva biomarkers lgAs [baseline of the night 1 procedure]
measure of lgAs
- Saliva biomarkers lgAs [baseline of the night 2 procedure]
measure of lgAs
- Saliva biomarkers lgAs [end of the night 1 procedure]
measure of lgAs
- Saliva biomarkers lgAs [end of the night 2 procedure]
measure of lgAs
- Saliva biomarkers lgAs [10 hours after the end of the night 1 procedure]
measure of lgAs
- Saliva biomarkers lgAs [10 hours after the end of the night 2 procedure]
measure of lgAs
- Saliva biomarkers lgAs [24 hours after the end of the night 1 procedure]
measure of lgAs
- Saliva biomarkers lgAs [24 hours after the end of the night 2 procedure]
measure of lgAs
- Saliva biomarkers lgAs [baseline of the day 1 procedure]
measure of lgAs
- Saliva biomarkers lgAs [baseline of the day 2 procedure]
measure of lgAs
- Saliva biomarkers lgAs [end of the day 1 procedure]
measure of lgAs
- Saliva biomarkers lgAs [end of the day 2 procedure]
measure of lgAs
- Saliva biomarkers lgAs [14 hours after the end of the day 1 procedure]
measure of lgAs
- Saliva biomarkers lgAs [14 hours after the end of the day 2 procedure]
measure of lgAs
- blood samples full blood count [end of night 1 procedure]
: measure of full blood count
- blood samples full blood count [end of night 2 procedure]
: measure of full blood count
- blood samples full blood count [baseline of day 1 procedure]
: measure of full blood count
- blood samples full blood count [baseline of day 2 procedure]
: measure of full blood count
- blood samples HbA1c, [end of night 1 procedure]
: measure of HbA1c,
- blood samples HbA1c, [end of night 2 procedure]
: measure of HbA1c,
- blood samples HbA1c [baseline of day 1 procedure]
: measure of HbA1c
- blood samples HbA1c [baseline of day 2 procedure]
: measure of HbA1c
- blood samples HDLc and LDL-cholesterol [end of the night 1 procedure]
: measure of HDLc and LDL-cholesterol
- blood samples HDLc and LDL-cholesterol [end of the night 2 procedure]
: measure of HDLc and LDL-cholesterol
- blood samples HDLc and LDL-cholesterol [baseline of the day 1 procedure]
: measure of HDLc and LDL-cholesterol
- blood samples HDLc and LDL-cholesterol [baseline of the day 2 procedure]
: measure of HDLc and LDL-cholesterol
- blood samples TG [end of the night 1 procedure]
: measure of TG
- blood samples TG [end of the night 2 procedure]
: measure of TG
- blood samples TG [baseline of the day 1 procedure]
: measure of TG
- blood samples TG [baseline of the day 2 procedure]
: measure of TG
- blood samples Cortisol [end of the night 1 procedure]
: measure of Cortisol
- blood samples Cortisol [end of the night 2 procedure]
: measure of Cortisol
- blood samples Cortisol [baseline of the day 1 procedure]
: measure of Cortisol
- blood samples Cortisol [baseline of the day 2 procedure]
: measure of Cortisol
- blood samples DHEAS [end of the night 1 procedure]
: measure of DHEAS
- blood samples DHEAS [end of the night 2 procedure]
: measure of DHEAS
- blood samples DHEAS [baseline of the day 1 procedure]
: measure of DHEAS
- blood samples DHEAS [baseline of the day 2 procedure]
: measure of DHEAS
- blood samples vitamine D [end of the night 1 procedure]
: measure of vitamine D
- blood samples vitamine D [end of the night 2 procedure]
: measure of vitamine D
- blood samples vitamine D [baseline of the day 1 procedure]
: measure of vitamine D
- blood samples vitamine D [baseline of the day 2 procedure]
: measure of vitamine D
- blood samples BDNF [end of the night 1 procedure]
: measure of BDNF
- blood samples BDNF [end of the night 2 procedure]
: measure of BDNF
- blood samples BDNF [baseline of the day 1 procedure]
: measure of BDNF
- blood samples BDNF [baseline of the day 2 procedure]
: measure of BDNF
- blood samples proinflammatory cytokines [end of the night 1 procedure]
: measure of proinflammatory cytokines
- blood samples proinflammatory cytokines [end of the night 2 procedure]
: measure of proinflammatory cytokines
- blood samples proinflammatory cytokines [baseline of the day 1 procedure]
: measure of proinflammatory cytokines
- blood samples proinflammatory cytokines [baseline of the day 2 procedure]
: measure of proinflammatory cytokines
- blood samples telomeres lengh [end of the night 1 procedure]
: measure of telomeres lengh
- blood samples telomeres lengh [end of the night 2 procedure]
: measure of telomeres lengh
- blood samples telomeres lengh [baseline of the day 1 procedure]
: measure of telomeres lengh
- blood samples telomeres lengh [baseline of the day 2 procedure]
: measure of telomeres lengh
- Mindfulness [day 1]
Mindfulness is assessed by the Freiburg Mindfulness Inventory-14 (FMI) composed by a 4-point Likert scale ranging from 1 (strongly disagree) to 4 (strongly agree)
- Burnout [day 1]
Burnout is assessed by the Maslach Burn-out Inventory (MBI) composed by 22 items and a 7-point scale ranging from "never" to "every day".
- Depression [day 1]
depression is assessed by the Hospital Anxiety and Depression scale (HAD) composed by 7 items and a 4-point scale from "never" to "always".
- Anxiety [day 1]
Anxiety is assessed by the the Hospital Anxiety and Depression scale (HAD) composed by 7 items and a 4-point scale from "never" to "always" and by the State-Trait Anxiety Inventory (STAI) composed by two dimensions, state anxiety and trait anxiety, both evaluated with a 20-items questionnaire on a 4-point scale from "never" to "always".
- General health [day 1]
general health is assessed by the short form 36 health survey (SF36) composed by 36 items
- quality of life [day 1]
quality of life is assessed by a brief multidimensional life satisfaction scale
- Personal resources [day 1]
measure of trait perception of workplace stress (ICPH)
- Lifestyle [day 1]
Assessing factors regarding lifestyle are related to smoking, alcohol, coffee, food intake (questionnaires), and physical activity (Recent Physical Activity Questionnaire).
- Physical activity [day 1]
Physical activity is assessed by the Recent Physical Activity Questionnaire (RPAQ)
- Life and occupational events [day 1]
Assessing factors regarding death of patients or death of a loved one by questionnaire.
- Sick leave [day 1]
assessing sick leave by the number of absence days the previous 6 months using a questionnaire
- Clinical measurements height [day 1]
measure of height
- Clinical measurements weight [day 1]
measure of weight
- Clinical measurements waist circumference [day 1]
measure of waist circumference
- diastolic blood pressure [baseline of night 1 procedure]
measure of diastolic blood pressure
- diastolic blood pressure [baseline of night 2 procedure]
measure of diastolic blood pressure
- systolic blood pressure [baseline of night 1 procedure]
measure of systolic blood pressure
- systolic blood pressure [baseline of night 2 procedure]
measure of systolic blood pressure
- diastolic blood pressure [end of night 1 procedure]
measure of diastolic blood pressure
- diastolic blood pressure [end of night 2 procedure]
measure of diastolic blood pressure
- systolic blood pressure [end of night 1 procedure]
measure of systolic blood pressure
- systolic blood pressure [end of night 2 procedure]
measure of systolic blood pressure
- diastolic blood pressure [baseline of day 1 procedure]
measure of disatolic blood pressure
- diastolic blood pressure [baseline of day 2 procedure]
measure of disatolic blood pressure
- systolic blood pressure [baseline of day 1 procedure]
measure of systolic blood pressure
- systolic blood pressure [baseline of day 2 procedure]
measure of systolic blood pressure
- diastolic blood pressure [end of day 1 procedure]
measure of disatolic blood pressure
- diastolic blood pressure [end of day 2 procedure]
measure of disatolic blood pressure
- systolic blood pressure [end of day 1 procedure]
measure of systolic blood pressure
- systolic blood pressure [end of day 2 procedure]
measure of systolic blood pressure
- skin conductance [during 38 hours of night 1 procedure]
measure of the skin conductance
- skin conductance [during 38 hours of night 2 procedure]
measure of the skin conductance
- skin conductance [during 24 hours of day 1 procedure]
measure of the skin conductance
- skin conductance [during 24 hours of day 2 procedure]
measure of the skin conductance
- Genetic factors ACE [end of the night 1 procedure]
measure of the polymorphism of angiotensin converting enzyme inhibitors (ACE
- Genetic factors ACE [end of the night 2 procedure]
measure of the polymorphism of angiotensin converting enzyme inhibitors (ACE
- Genetic factors ACE [baseline of the day 1 procedure]
measure of the polymorphism of angiotensin converting enzyme inhibitors (ACE
- Genetic factors ACE [baseline of the day 2 procedure]
measure of the polymorphism of angiotensin converting enzyme inhibitors (ACE
- Genetic factors (5-HTT) [end of the night 1 procedure]
measure of the polymorphism of the serotonin transporter (5-HTT)
- Genetic factors (5-HTT) [end of the night 2 procedure]
measure of the polymorphism of the serotonin transporter (5-HTT)
- Genetic factors (5-HTT) [baseline of the day 1 procedure]
measure of the polymorphism of the serotonin transporter (5-HTT)
- Genetic factors (5-HTT) [baseline of the day 2 procedure]
measure of the polymorphism of the serotonin transporter (5-HTT)
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Emergency physicians from the emergency department of CHU Clermont-Ferrand will be accompanied by a medical externship student and by a student in psychology.
-
Ability to give a written informed consent.
Exclusion Criteria:
- Participant refusal to participate
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Chu Clermont Ferrand | Clermont-Ferrand | France | 63003 |
Sponsors and Collaborators
- University Hospital, Clermont-Ferrand
Investigators
- Principal Investigator: Frédéric Dutheil, University Hospital, Clermont-Ferrand
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- RBHP 2019 DUTHEIL 2
- 2019-A02961-56