Biomarkes Of Job STRess In Emergency Senior Physicians - Detection of Stressful Events
- Conditions
- Heart Rate Variability
- Interventions
- Behavioral: Comparison of biomarkers of stress
- Registration Number
- NCT04334083
- Lead Sponsor
- University Hospital, Clermont-Ferrand
- 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 and assess the role of expertise and habituation to stressful emergency situations.
- 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 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.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 48
- Emergency physicians from the emergency department of CHU Clermont-Ferrand will be accompanied by a medical externship student.
- Ability to give a written informed consent.
- Participant refusal to participate
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Emergency physicians Comparison of biomarkers of stress actors during the work medical externship student Comparison of biomarkers of stress spectator during the emergency physician work
- Primary Outcome Measures
Name Time Method heart rate variability at night work from 18:30 to 8:30, during the 14 hours of the night shift measure of abrupt changes in HRV signals during 14 hours
heart rate variability at day work from 8:30 to 18:30, during the 10 hours of the day shift measure of abrupt changes in HRV signals during 10 hours
- Secondary Outcome Measures
Name Time Method Stress at 18:30, end of the day shift measure of stress using VAS
Clinical measurements weight day 1 measure of weight
Clinical measurements height day 1 measure of height
Fatigue at 18:30, end of the day shift measure of Fatigue using VAS
Saliva biomarkers DHEAS at 18:30, end of the day shift measure of DHEAS
blood samples TG at 8:30, baseline of the day shift measure of TG
blood samples DHEAS at 8:30, baseline of the day shift measure of DHEAS
blood samples BDNF at 8:30, baseline of the day shift measure of BDNF
blood samples proinflammatory cytokines at 8:30, baseline of the day shift measure of proinflammatory cytokines
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".
Sick leave day 1 assessing sick leave by the number of absence days the previous 6 months using a questionnaire
blood samples HDLc and LDL-cholesterol at 8:30, baseline of the day shift measure of HDLc and LDL-cholesterol
blood samples Cortisol at 8:30, baseline of the day shift measure of Cortisol
blood samples vitamine D at 8:30, baseline of the day shift measure of vitamine D
Saliva biomarkers cortisol at 18:30, end of the day shift measure of Cortisol
blood samples full blood count at 8:30, baseline of the day shift measure of full blood count
blood samples HbA1c, at 8:30, baseline of the day shift measure of HbA1c
Saliva biomarkers lgAs at 18:30, end of the day shift measure of lgAs
blood samples telomeres lengh at 8:30, baseline of the day shift measure of telomeres lengh
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".
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".
systolic blood pressure at 18:30, end of day shift measure of systolic blood pressure
Life satisfaction day 1 quality of life is assessed by a brief multidimensional life satisfaction scale (BMLSS)
Lifestyle day 1 Assessing factors regarding lifestyle are related to smoking, alcohol, coffee, food intake (questionnaires), and physical activity (Recent Physical Activity Questionnaire).
Life and occupational events day 1 Assessing factors regarding death of patients or death of a loved one by questionnaire.
diastolic blood pressure at 18:30, end of day shift measure of disatolic blood pressure
skin conductance from 8:30 to 18:30, during the 10 hours of day shift measure of the skin conductance
Genetic factors ACE at 8:30, baseline of the day shift measure of the polymorphism of angiotensin converting enzyme inhibitors (ACE
Genetic factors (5-HTT) at 8:30, baseline of the day shift measure of the polymorphism of the serotonin transporter (5-HTT)
Trial Locations
- Locations (1)
Chu Clermont Ferrand
🇫🇷Clermont-Ferrand, France