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European Journal of Radiology Open Dec 2023Burnout among physicians has a prevalence rate exceeding 50%. The radiology department is not immune to the burnout epidemic. Understanding and addressing burnout among... (Review)
Review
RATIONALE AND OBJECTIVES
Burnout among physicians has a prevalence rate exceeding 50%. The radiology department is not immune to the burnout epidemic. Understanding and addressing burnout among radiologists has been a subject of recent interest. Thus, our study aims to systematically review studies reporting the prevalence of burnout in physicians in the radiology department while providing an overview of the factors associated with burnout among radiologists.
MATERIALS AND METHODS
The search was conducted from inception until November 13th, 2022, in PubMed, Embase, Education Resources Information Center, PsycINFO, and psycArticles. Studies reporting the prevalence of burnout or any subdimensions among radiology physicians, including residents, fellows, consultants, and attendings, were included. Data on study characteristics and estimates of burnout syndrome or any of its subdimensions were collected and summarized.
RESULTS
After screening 6379 studies, 23 studies from seven countries were eligible. The number of participants ranged from 26 to 460 (median, 162; interquartile range, 91-264). In all, 18 studies (78.3%) employed a form of the Maslach Burnout Inventory. In comparison, four studies (17.4%) used the Stanford Professional Fulfillment Index, and one study (4.3%) used a single-item measure derived from the Zero Burnout Program survey. Overall burnout prevalence estimates were reported by 14 studies (60.9%) and varied from 33% to 88%. High burnout prevalence estimates were reported by only five studies (21.7%) and ranged from 5% to 62%. Emotional exhaustion and depersonalization prevalence estimates were reported by 16 studies (69.6%) and ranged from 11%-100% and 4%-97%, respectively. Furthermore, 15 studies (65.2%) reported low personal accomplishment prevalence, ranging from 14.7% to 84%. There were at least seven definitions for overall burnout and high burnout among the included studies, and there was high heterogeneity among the cutoff scores used for the burnout subdimensions.
CONCLUSION
Burnout in radiology is increasing globally, with prevalence estimates reaching 88% and 62% for overall and high burnout, respectively. A myriad of factors has been identified as contributing to the increased prevalence. Our data demonstrated significant variability in burnout prevalence estimates among radiologists and major disparities in burnout criteria, instrument tools, and study quality.
PubMed: 37920681
DOI: 10.1016/j.ejro.2023.100530 -
Frontiers in Oncology 2023Variation in stage at diagnosis of childhood cancers (CC) may explain differences in survival rates observed across geographical regions. The BENCHISTA project aims to...
INTRODUCTION
Variation in stage at diagnosis of childhood cancers (CC) may explain differences in survival rates observed across geographical regions. The BENCHISTA project aims to understand these differences and to encourage the application of the Toronto Staging Guidelines (TG) by Population-Based Cancer Registries (PBCRs) to the most common solid paediatric cancers.
METHODS
PBCRs within and outside Europe were invited to participate and identify all cases of Neuroblastoma, Wilms Tumour, Medulloblastoma, Ewing Sarcoma, Rhabdomyosarcoma and Osteosarcoma diagnosed in a consecutive three-year period (2014-2017) and apply TG at diagnosis. Other non-stage prognostic factors, treatment, progression/recurrence, and cause of death information were collected as optional variables. A minimum of three-year follow-up was required. To standardise TG application by PBCRs, on-line workshops led by six tumour-specific clinical experts were held. To understand the role of data availability and quality, a survey focused on data collection/sharing processes and a quality assurance exercise were generated. To support data harmonization and query resolution a dedicated email and a question-and-answers bank were created.
RESULTS
67 PBCRs from 28 countries participated and provided a maximally de-personalized, patient-level dataset. For 26 PBCRs, data format and ethical approval obtained by the two sponsoring institutions (UCL and INT) was sufficient for data sharing. 41 participating PBCRs required a Data Transfer Agreement (DTA) to comply with data protection regulations. Due to heterogeneity found in legal aspects, 18 months were spent on finalizing the DTA. The data collection survey was answered by 68 respondents from 63 PBCRs; 44% of them confirmed the ability to re-consult a clinician in cases where stage ascertainment was difficult/uncertain. Of the total participating PBCRs, 75% completed the staging quality assurance exercise, with a median correct answer proportion of 92% [range: 70% (rhabdomyosarcoma) to 100% (Wilms tumour)].
CONCLUSION
Differences in interpretation and processes required to harmonize general data protection regulations across countries were encountered causing delays in data transfer. Despite challenges, the BENCHISTA Project has established a large collaboration between PBCRs and clinicians to collect detailed and standardised TG at a population-level enhancing the understanding of the reasons for variation in overall survival rates for CC, stimulate research and improve national/regional child health plans.
PubMed: 37675230
DOI: 10.3389/fonc.2023.1232451 -
Revista Brasileira de Medicina Do... 2023Characterized by high levels of emotional exhaustion and depersonalization and reduced professional accomplishment, burnout syndrome has been a major cause of psychic...
INTRODUCTION
Characterized by high levels of emotional exhaustion and depersonalization and reduced professional accomplishment, burnout syndrome has been a major cause of psychic illness in nursing workers, with a serious impact on the quality of services and on patient safety.
OBJECTIVES
To analyze the correlation between organizational climate, job satisfaction, and burnout in nursing workers.
METHODS
This is a cross-sectional study with a sample of 534 Brazilian nursing workers. We used the Organizational Climate Scale for Health Organizations, the Job Satisfaction Questionnaire (S20/23), and the Maslach Burnout Inventory. An analytical descriptive analysis of the data was performed using relative and absolute frequencies, mean, standard deviation, minimum, maximum, and correlation test between the variables.
RESULTS
Organizational climate and job satisfaction were evaluated as regular. With regard to burnout, moderate levels of emotional exhaustion, low levels of depersonalization, and high levels of professional accomplishment were observed. A strong positive correlation was found between job satisfaction and organizational climate; in addition to a moderate negative correlation between emotional exhaustion and both organizational climate and job satisfaction, and a moderate negative correlation between depersonalization and job satisfaction.
CONCLUSIONS
Organizational climate and job satisfaction had a negative correlation with burnout dimensions, representing possible protective factors.
PubMed: 38313086
DOI: 10.47626/1679-4435-2022-867 -
Nature Communications Oct 2023Ketamine commonly and rapidly induces dissociative and other altered states of consciousness (ASCs) in humans. However, the neural mechanisms that contribute to these... (Randomized Controlled Trial)
Randomized Controlled Trial
Ketamine commonly and rapidly induces dissociative and other altered states of consciousness (ASCs) in humans. However, the neural mechanisms that contribute to these experiences remain unknown. We used functional neuroimaging to engage key regions of the brain's affective circuits during acute ketamine-induced ASCs within a randomized, multi-modal, placebo-controlled design examining placebo, 0.05 mg/kg ketamine, and 0.5 mg/kg ketamine in nonclinical adult participants (NCT03475277). Licensed clinicians monitored infusions for safety. Linear mixed effects models, analysis of variance, t-tests, and mediation models were used for statistical analyses. Our design enabled us to test our pre-specified primary and secondary endpoints, which were met: effects of ketamine across dose conditions on (1) emotional task-evoked brain activity, and (2) sub-components of dissociation and other ASCs. With this design, we also could disentangle which ketamine-induced affective brain states are dependent upon specific aspects of ASCs. Differently valenced ketamine-induced ASCs mediated opposing effects on right anterior insula activity. Participants experiencing relatively higher depersonalization induced by 0.5 mg/kg of ketamine showed relief from negative brain states (reduced task-evoked right anterior insula activity, 0.39 SD). In contrast, participants experiencing dissociative amnesia showed an exacerbation of insula activity (0.32 SD). These results in nonclinical participants may shed light on the mechanisms by which specific dissociative states predict response to ketamine in depressed individuals.
Topics: Adult; Humans; Brain; Consciousness; Emotions; Ketamine
PubMed: 37857620
DOI: 10.1038/s41467-023-42141-5 -
Medical Education Online Dec 2023Mental wellbeing issues among medical students are common, and their relationship to medical professionalism is debated. Few studies have attempted to link such issues... (Review)
Review
BACKGROUND
Mental wellbeing issues among medical students are common, and their relationship to medical professionalism is debated. Few studies have attempted to link such issues with undergraduate medical education. This review aimed to advance the knowledge on this matter by exploring the relationship between mental wellbeing and medical professionalism in undergraduate medical education.
METHODS
We collected the literature about mental wellbeing and medical professionalism (published from 1 January 1986 to 31 March 2021) from the Web of Science, PubMed, Scopus and ScienceDirect databases using the search terms 'mental wellbeing' and 'medical professionalism'.We included all peer-reviewed articles in which mental wellbeing and medical professionalism in the undergraduate medical education context were the central topics regardless of the age range, nationality, race and gender of the participants.
RESULTS
From the 13,076 Iinitially found articles, 16 were included. These 16 articles were from nine countries in four different continents, which all together helped us find answer to our research question using extracted points relating to the main study themes (mental wellbeing and medical professionalism). Under theme 1 (mental wellbeing), six subthemes emerged: burnout, stress, depression, disappointment, depersonalisation and conscientiousness. Theme 2 (medical professionalism), on the other hand, had five subthemes: empathy, academic performance, compassion, unprofessional behaviour and professionalism. A significant inverse association was found between empathy and burnout. Academic performance was also related to burnout. At the same time, empathy was found to have a varied association with stress. Moreover, compassion was found to alleviate burnout and nurture professional gratification.
CONCLUSION
The medical professionalism attributes were found to deteriorate as the mental wellbeing issues grow. This can harm medical students' overall health, current learning abilities and future attitudes towards their patients. Explicit primary research is thus required to examine and intervene in the cause-effect relationship between medical professionalism and mental wellbeing.
Topics: Humans; Burnout, Professional; Emotions; Empathy; Mental Health; Professionalism; Students, Medical; Stress, Psychological
PubMed: 36621960
DOI: 10.1080/10872981.2023.2165892 -
International Journal of Environmental... Aug 2023Informal caregivers (ICs) of cancer patients play a crucial role in health care. Several of the challenges they face can affect their quality of life (QoL). This...
Informal caregivers (ICs) of cancer patients play a crucial role in health care. Several of the challenges they face can affect their quality of life (QoL). This cross-sectional study explored role of burnout and caregiving satisfaction in their relationship to QoL. Portuguese ICs of adult cancer patients ( = 92) answered a sociodemographic and caregiving questionnaire, the WHOQOL-SRPB BREF, assessing physical, psychological, social, environmental, and spiritual QoL domains; the Maslach Burnout Interview, assessing the dimensions of depersonalization, emotional exhaustion, and personal accomplishment; and a Visual Analogic Scale on caregiving satisfaction. We tested correlations and a parallel mediation model for each domain of QoL, considering burnout dimensions as possible mediators between satisfaction and QoL domains. Our results show that satisfaction, burnout dimensions, and almost all QoL domains are correlated. Together, burnout dimensions seem to mediate the relationship between caregiving satisfaction and psychological, environmental, and spiritual QoL. Satisfaction had a significant indirect effect solely through emotional exhaustion on psychological QoL (β = 1.615, 95% BCI [0.590; 2.849]), environmental QoL (β = 0.904, 95% BCI [0.164; 1.876]), and spiritual QoL (β = 0.816, 95% BCI [0.019; 1.792]). It seems essential for mental health professionals to address these dimensions when providing support to an IC.
Topics: Adult; Humans; Caregivers; Quality of Life; Cross-Sectional Studies; Burnout, Psychological; Health Personnel
PubMed: 37623163
DOI: 10.3390/ijerph20166577 -
Frontiers in Psychology 2023This paper presents a critical comparison between two phenomenological accounts of schizophrenic experience: on the one side, Blankenburg's seminal work on the basal... (Review)
Review
This paper presents a critical comparison between two phenomenological accounts of schizophrenic experience: on the one side, Blankenburg's seminal work on the basal disturbance () of schizophrenia as loss of natural self-evidence (); on the other side, Tatossian's insight, briefly elaborated in a lecture presented in Heidelberg in 1994 and largely forgotten by the relevant literature. Whereas the former mainly develops an reading of schizophrenia, the latter suggests an understanding. Indeed, for Blankenburg, schizophrenic experience can be broadly characterized as a progressive impoverishment of our rootedness in the social world, leading to derealization and depersonalization. In this respect, Tatossian takes schizophrenic autism not as the effect of a loss of originary sociality but as the result of a deeper disproportion. For Tatossian, schizophrenia is characterized, ultimately, by a basic self-disorder or alteration that consists in the breakdown of the twofold dimension of transcendental subjectivity, encompassing both constituting consciousness and phenomenologizing onlooker. In this sense, his interpretation of schizophrenic disorders is closer to the ipseity-disturbance model. I show that while Blankenburg and Tatossian share a dialectical understanding of schizophrenia by pointing to basic modifications of the "transcendental organization" of experience, their divergence originates from a different reading of the phenomenological epoché. Except for the clinical perspective, the point of contention between Blankenburg and Tatossian seems to concern their use of internal resources of the Husserlian phenomenology. By presenting the philosophical presuppositions of their analyses, I discuss two key figures of phenomenological psychopathology by showing how their debate on the meaning of schizophrenic experience can be reframed by looking at the relationship between transcendental subjectivity and intersubjectivity in Husserl's phenomenology.
PubMed: 37484111
DOI: 10.3389/fpsyg.2023.1214474 -
Frontiers in Psychology 2023Philosophers maintain that touch confers a sense of reality or grounding to perceptual experience. In touching oneself, one is simultaneously both subject and object of...
Philosophers maintain that touch confers a sense of reality or grounding to perceptual experience. In touching oneself, one is simultaneously both subject and object of touch, a template for experiencing oneself as subject and object of intentions, feelings, and motivations, or intersubjectivity. Here, I explore a form of self-touch carefully documented by Winnicott in observing how the infant engages the transitional object. I compare the processes of self-loss in transitional states, including absorption in art, empathic immersion, drug-induced ego dissolution, and depersonalization. I use examples drawn from Rodin, Dante, and the Beatles; research correlating neurophysiological findings with aspects of self-representation; predictive processing-based models; Hohwy's concepts of minimal and narrative self; Clark's notion of the extended mind; and phenomenological perspectives on touch, to postulate a role for self-touch in the pre-reflective sense of mine-ness, or grounding, in transitional states.
PubMed: 37533722
DOI: 10.3389/fpsyg.2023.1097402 -
Brain Sciences Jul 2023Fear extinction is the basis of exposure therapies for posttraumatic stress disorder (PTSD), but half of patients do not improve. Predicting fear extinction in...
Fear extinction is the basis of exposure therapies for posttraumatic stress disorder (PTSD), but half of patients do not improve. Predicting fear extinction in individuals with PTSD may inform personalized exposure therapy development. The participants were 125 trauma-exposed adults (96 female) with a range of PTSD symptoms. Electromyography, electrocardiogram, and skin conductance were recorded at baseline, during dark-enhanced startle, and during fear conditioning and extinction. Using a cross-validated, hold-out sample prediction approach, three penalized regressions and conventional ordinary least squares were trained to predict fear-potentiated startle during extinction using 50 predictor variables (5 clinical, 24 self-reported, and 21 physiological). The predictors, selected by penalized regression algorithms, were included in multivariable regression analyses, while univariate regressions assessed individual predictors. All the penalized regressions outperformed OLS in prediction accuracy and generalizability, as indexed by the lower mean squared error in the training and holdout subsamples. During early extinction, the consistent predictors across all the modeling approaches included dark-enhanced startle, the depersonalization and derealization subscale of the dissociative experiences scale, and the PTSD hyperarousal symptom score. These findings offer novel insights into the modeling approaches and patient characteristics that may reliably predict fear extinction in PTSD. Penalized regression shows promise for identifying symptom-related variables to enhance the predictive modeling accuracy in clinical research.
PubMed: 37626488
DOI: 10.3390/brainsci13081131 -
Brain Sciences Aug 2023Pesticides are chemicals used in agricultural fields for the prevention or destruction of pests. Inappropriate use of these substances, as well as handling them without... (Review)
Review
Pesticides are chemicals used in agricultural fields for the prevention or destruction of pests. Inappropriate use of these substances, as well as handling them without using personal protective equipment, may result in serious health problems such as neurodegenerative diseases and mental disorders. Previous studies have demonstrated the adverse effects of pesticides on brain function. However, some researchers have associated pesticide poisoning with the development of disorders such as dissociative amnesia, multiple personality disorders, and depersonalization disorder. The objective of this work was to perform a bibliographic review of the relationship between pesticide poisoning and the development of dissociative disorders. Previous studies suggest that the duration of pesticide exposure is a major determinant in the development of dissociative diseases and disorders. The information obtained in this review suggests that there is no specific relationship between dissociative disorders and pesticide poisoning. However, these results point to associating the most representative symptoms of dissociative disorder (such as amnesia and memory loss) with pesticide exposure. Based on the bibliographic search, possible mechanisms of action were suggested in an attempt to explain a possible association between exposure to pesticides and the appearance of dissociative disorders.
PubMed: 37626550
DOI: 10.3390/brainsci13081194