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 and assess the role of expertise and habituation to stressful emergency situations.
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 two 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. Emergency physicians will be accompanied by a medical externship student. 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 Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
SCREENING
Masking
NONE
Enrollment
48
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 medical externship student. We will assess the role of expertise and habituation to stressful emergency situations.
Chu Clermont Ferrand
Clermont-Ferrand, France
heart rate variability at night work
measure of abrupt changes in HRV signals during 14 hours
Time frame: from 18:30 to 8:30, during the 14 hours of the night shift
heart rate variability at day work
measure of abrupt changes in HRV signals during 10 hours
Time frame: from 8:30 to 18:30, during the 10 hours of the day shift
Stress
measure of stress using VAS
Time frame: 18:30, baseline of the night shift
Fatigue
measure of Fatigue using VAS
Time frame: at 18:30, baseline of the night shift
Stress
measure of stress using VAS
Time frame: at 8h30, at the end of the night shift
Fatigue
measure of Fatigue using VAS
Time frame: at 8:30, at the end of the night shift
Stress
measure of stress using VAS
Time frame: at 8:30, 24 hours after the end of night shift
Fatigue
measure of Fatigue using VAS
Time frame: at 8:30, 24 hours after the end of night shift
Fatigue
measure of Fatigue using VAS
Time frame: at 18:30, 24 hours after the end of day shift
Stress
measure of stress using VAS
Time frame: at 18:30, 24 hours after the end of day shift
Stress
measure of stress using VAS
Time frame: at 8:30, baseline of the day shift
Fatigue
measure of Fatigue using VAS
Time frame: at 8:30, baseline of the day shift
Stress
measure of stress using VAS
Time frame: at 18:30, end of the day shift
Fatigue
measure of Fatigue using VAS
Time frame: at 18:30, end of the day shift
Saliva biomarkers cortisol
measure of Cortisol
Time frame: at 18:30, baseline of the night shift
Saliva biomarkers cortisol
measure of Cortisol
Time frame: at 8:30, at the end of the night shift
Saliva biomarkers cortisol
measure of Cortisol
Time frame: at 8:30, baseline of the day shift
Saliva biomarkers cortisol
measure of Cortisol
Time frame: at 18:30, end of the day shift
Saliva biomarkers DHEAS
measure of DHEAS
Time frame: at 18:30, baseline of the night shift
Saliva biomarkers DHEAS
measure of DHEAS
Time frame: at 8:30, at the end of the night shift
Saliva biomarkers DHEAS
measure of DHEAS
Time frame: at 8:30, baseline of the day shift
Saliva biomarkers DHEAS
measure of DHEAS
Time frame: at 18:30, end of the day shift
Saliva biomarkers lgAs
measure of lgAs
Time frame: at 18:30, baseline of the night shift
Saliva biomarkers lgAs
measure of lgAs
Time frame: at 8:30, at the end of the night shift
Saliva biomarkers lgAs
measure of lgAs
Time frame: at 8:30, baseline of the day shift
Saliva biomarkers lgAs
measure of lgAs
Time frame: at 18:30, end of the day shift
blood samples full blood count
measure of full blood count
Time frame: at 8:30, at the end of the night shift
blood samples full blood count
measure of full blood count
Time frame: at 8:30, baseline of the day shift
blood samples HbA1c,
measure of HbA1c
Time frame: at 8:30, at the end of the night shift
blood samples HbA1c,
measure of HbA1c
Time frame: at 8:30, baseline of the day shift
blood samples HDLc and LDL-cholesterol
measure of HDLc and LDL-cholesterol
Time frame: at 8:30, at the end of the night shift
blood samples HDLc and LDL-cholesterol
measure of HDLc and LDL-cholesterol
Time frame: at 8:30, baseline of the day shift
blood samples TG
measure of TG
Time frame: at 8:30, at the end of the night shift
blood samples TG
measure of TG
Time frame: at 8:30, baseline of the day shift
blood samples Cortisol
measure of Cortisol
Time frame: at 8:30, at the end of the night shift
blood samples Cortisol
measure of Cortisol
Time frame: at 8:30, baseline of the day shift
blood samples DHEAS
measure of DHEAS
Time frame: at 8:30, at the end of the night shift
blood samples DHEAS
measure of DHEAS
Time frame: at 8:30, baseline of the day shift
blood samples vitamine D
measure of vitamine D
Time frame: at 8:30, at the end of the night shift
blood samples vitamine D
measure of vitamine D
Time frame: at 8:30, baseline of the day shift
blood samples BDNF
measure of BDNF
Time frame: at 8:30, at the end of the night shift
blood samples BDNF
measure of BDNF
Time frame: at 8:30, baseline of the day shift
blood samples proinflammatory cytokines
measure of proinflammatory cytokines
Time frame: at 8:30, at the end of the night shift
blood samples proinflammatory cytokines
measure of proinflammatory cytokines
Time frame: at 8:30, baseline of the day shift
blood samples telomeres lengh
measure of telomeres lengh
Time frame: at 8:30, at the end of the night shift
blood samples telomeres lengh
measure of telomeres lengh
Time frame: at 8:30, baseline of the day shift
Burnout
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".
Time frame: day 1
Depression
depression is assessed by the Hospital Anxiety and Depression scale (HAD) composed by 7 items and a 4-point scale from "never" to "always".
Time frame: day 1
Anxiety
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".
Time frame: day 1
Life satisfaction
quality of life is assessed by a brief multidimensional life satisfaction scale (BMLSS)
Time frame: day 1
Lifestyle
Assessing factors regarding lifestyle are related to smoking, alcohol, coffee, food intake (questionnaires), and physical activity (Recent Physical Activity Questionnaire).
Time frame: day 1
Life and occupational events
Assessing factors regarding death of patients or death of a loved one by questionnaire.
Time frame: day 1
Sick leave
assessing sick leave by the number of absence days the previous 6 months using a questionnaire
Time frame: day 1
Clinical measurements height
measure of height
Time frame: day 1
Clinical measurements weight
measure of weight
Time frame: day 1
diastolic blood pressure
measure of diastolic blood pressure
Time frame: at 18:30, baseline of the night shift
systolic blood pressure
measure of systolic blood pressure
Time frame: at 18:30, baseline of the night shift
diastolic blood pressure
measure of diastolic blood pressure
Time frame: at 8:30, at the end of the night shift
systolic blood pressure
measure of systolic blood pressure
Time frame: at 8:30, at the end of the night shift
diastolic blood pressure
measure of disatolic blood pressure
Time frame: at 8:30, baseline of the day shift
systolic blood pressure
measure of systolic blood pressure
Time frame: at 8:30, baseline of the day shift
diastolic blood pressure
measure of disatolic blood pressure
Time frame: at 18:30, end of day shift
systolic blood pressure
measure of systolic blood pressure
Time frame: at 18:30, end of day shift
skin conductance
measure of the skin conductance
Time frame: from 18:30 to 8:30, during the 14 hours of night shift
skin conductance
measure of the skin conductance
Time frame: from 8:30 to 18:30, during the 10 hours of day shift
Genetic factors ACE
measure of the polymorphism of angiotensin converting enzyme inhibitors (ACE
Time frame: at 8:30, end of the night shift
Genetic factors ACE
measure of the polymorphism of angiotensin converting enzyme inhibitors (ACE
Time frame: at 8:30, baseline of the day shift
Genetic factors (5-HTT)
measure of the polymorphism of the serotonin transporter (5-HTT)
Time frame: at 8:30, end of the night shift
Genetic factors (5-HTT)
measure of the polymorphism of the serotonin transporter (5-HTT)
Time frame: at 8:30, baseline of the day shift
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