Personalised yoga for burnout and traumatic stress in junior doctors.

OBJECTIVES: Junior doctors are frequently exposed to occupational and traumatic stress, sometimes with tragic consequences. Mindfulness-based and fitness interventions are increasingly used to mitigate this, but have not been compared.We conducted a randomised, controlled pilot trial to assess the feasibility, acceptability and effectiveness of these interventions in junior doctors. METHODS: We randomised participants (n=21) to weekly 1-hour sessions of personalised, trauma-informed yoga (n=10), with a 4-hour workshop, and eHealth homework; or group-format fitness (n=8) in an existing wellness programme, MDOK. Burnout, traumatic stress and suicidality were measured at baseline and 8 weeks. RESULTS: Both interventions reduced burnout, and yoga increased compassion satisfaction within group on the Professional Quality of Life scale, without difference between groups on this measure.Personalised yoga significantly reduced depersonalisation (z=-1.99, p=0.05) compared with group fitness on the Maslach Burnout Inventory (MBI-HSS (MP)) and showed greater flexibility changes. Both interventions increased MBI Personal Accomplishment, with no changes in other self-report psychological or physiological metrics, including breath-counting.Participants doing one-to-one yoga rated it more highly overall (p=0.02) than group fitness, and reported it comparatively more beneficial for mental (p=0.01) and physical health (p=0.05). Face-to-face weekly sessions were 100% attended in yoga, but only 45% in fitness. CONCLUSION: In this pilot trial, both yoga and fitness improved burnout, but trauma-informed yoga reduced depersonalisation in junior doctors more than group-format fitness. One-to-one yoga was better adhered than fitness, but was more resource intensive. Junior doctors need larger-scale comparative research of the effectiveness and implementation of individual, organisational and systemic mental health interventions. TRIAL REGISTRATION NUMBER: ANZCTR 12618001467224.

A cross-sectional study investigating the associations of person-organisation and person-group fit with staff outcomes in mental healthcare.

OBJECTIVES: Organisational and workplace cultures are fundamental determinants of health systems performance; through better understanding of the dimensions of culture there is the potential to influence them, and subsequently improve safety and quality of care, as well as the experiences of both patients and staff. One promising conceptual framework for studying culture in healthcare is person-environment (P-E) fit. Comprising person-organisational (P-O) and person-group (P-G) components, P-E fit is defined as the extent to which individuals are compatible with their work environment. The aim of this study was to examine the associations of P-O and P-G fit with staff outcomes in mental healthcare. SETTING AND PARTICIPANTS: Participants (n=213) were staff and volunteers at 31 primary mental health facilities across six states of Australia. PRIMARY AND SECONDARY OUTCOME MEASURES: Staff outcomes, comprising burnout (depersonalisation and emotional exhaustion), job satisfaction and work stress. DESIGN: A multidimensional survey tool was used to measure P-O and P-G fit, and staff outcomes. Multiple regression analyses were used to test the associations between fit and outcome measures. RESULTS: The regression analyses indicated that, based on a Bonferroni adjusted alpha value of α=00417, P-O fit accounted for 36.6% of the variability in satisfaction (F=8.951, p≤0.001); 27.7% in emotional exhaustion (F=6.766, p≤0.001); 32.8% in depersonalisation (F=8.646, p≤0.001); and 23.5% in work stress (F=5.439, p≤0.001). The P-G fit results were less conclusive, with P-G fit accounting for 15.8% of the variability in satisfaction (F=4.184, p≤0.001); 10.0% in emotional exhaustion (F=2.488, p=0.014); 28.6% in depersonalisation (F=8.945, p≤0.001); and 10.4% in work stress (F=2.590, p=0.032). There was no statistically significant increase in the variability accounted for when the interaction term of P-O and P-G fit was added to the regression. CONCLUSIONS: The findings highlight that staff's perception of their workplace and organisational culture can have implications for staff well-being.

Relationship of Training in Acupuncture to Physician Burnout.

BACKGROUND: Physician burnout is an ongoing problem that affects both physician wellbeing and patient care. Burnout is characterized by emotional exhaustion and depersonalization. Studies have explored ways to prevent and alleviate burnout. Receiving training in acupuncture may reduce physician burnout. OBJECTIVE: The purpose of this study is to determine if acupuncture training is associated with less patient depersonalization and less emotional exhaustion among physicians. METHODS: These self-reported data were collected from a cross-sectional survey of family physicians at the Uniformed Services Academy of Family Physicians 2017 conference. Physicians answered questions regarding their level of acupuncture training as well as questions about burnout (depersonalization and emotional exhaustion). RESULTS: The overall response rate was 66% (325/492). Of these, 233 cases provided complete datasets. In a model controlling for years' practice and clinical pace, acupuncture training was significantly associated with decreased depersonalization, F (1, 194) = 5.82, P < .05. CONCLUSION: Study data show an association between decreased physician depersonalization and acupuncture training, suggesting acupuncture training may be a helpful strategy to reduce family physicians' depersonalization of patients.

The impact of Balint work on alexithymia, perceived stress, perceived social support and burnout among physicians working in palliative care: a longitudinal study.

OBJECTIVES: Physicians working with palliative patients have a substantial risk of emotional exhaustion because of their daily confrontation with suffering and death. Common concerns include alexithymia, high stress, low perceived social support and a greater burnout risk. This longitudinal study aimed to evaluate the effectiveness of Balint training in preventing the development of these symptoms in these medical professionals. MATERIAL AND METHODS: The design of the study was longitudinal. A group of 69 physicians working with palliative patients from 5 county hospitals in Romania (33 men, 36 women) participated in the study. Out of them, 31 joined and systematically attended a local Balint group whereas the others did not participate in such a group, either during the study or previously. They were given, both at the beginning (2015) and at the end of the study (2017), 4 psychometric instruments assessing alexithymia (Bagby's Toronto Alexithymia Scale), perceived stress (Cohen and Williamson's Perceived Stress Scale), social support (Duke-UNC Functional Social Support Questionnaire) and burnout (Maslach Burnout Inventory). A split-plot ANOVA analysis was used for evaluating the significance of Balint groups participation, with gender and age considered as auxiliary variables. RESULTS: In the study group, Balint training significantly improved the scores of global burnout (F(1, 64) = 25.104, p < 0.0001), 2 of its components (emotional exhaustion (F(1, 64) = 18.390, p < 0.0001) and depersonalization (F(1, 64) = 10.957, p < 0.002), alexithymia (F(1, 64) = 3.461, p < 0.0001) and perceived social support (F(1, 64) = 57.883, p < 0.0001), but not the scores of perceived stress and low personal accomplishment. Gender had an additional contribution in decreasing alexithymia (F(1, 64) = 7.436, p < 0.009) and increasing perceived social support (F(1, 64) = 15.426, p < 0.0001), with higher effects in men. CONCLUSIONS: This study points to the potential usefulness of Balint training in addressing alexithymia and burnout, and in improving perceived social support among physicians working with palliative patients. As the Balint method is easily understood and does not require special investments, it could represent a cost-effective instrument of addressing job-related psychological risks. Int J Occup Med Environ Health. 2019;32(1):53-63.

¿Cuál es la relación entre el síndrome de burnout, el sentido de la vida y el proyecto de vida laboral en los médicos residentes?: una perspectiva logoterapéutica / What is the relationship between burnout syndrome, the meaning of life and the project of working life in resident physicians ?: a logotherapeutic perspective

Introducción: el síndrome de burnout (BO) suele afectar a médicos residentes, debido al estrés laboral crónico. Desde un marco logoterapéutico, la pérdida de un sentido de la vida (SV) es el denominador más común de todas las formas de perturbación emocional, y el BO podría enmarcarse dentro de un proyecto de vida laboral (PVL) con enrolamiento enajenante. El objetivo principal del trabajo es evaluar la relación entre el BO, el SV y el PVL, en los programas de residencia del Hospital Italiano de Buenos Aires. Población y métodos: se evaluaron residentes de 6 programas de residencia del Hospital Italiano de Buenos Aires, a través de un cuestionario. El BO se midió con el "Maslach Burnout Inventory" (MBI). El SV se midió con el "Purpose in Life Test" (PIL Test). El PVL se midió con la Escala de PVL de la Dra. Isabel Pérez Jáuregui. Resultados: participaron 104 residentes. El 28,8% de los evaluados mostraron BO, el 18,3% falta de SV y el 30,8% un PVL inauténtico con sobreadaptación. Tanto la falta de SV como el PVL inauténtico con sobreadaptación se asociaron en forma estadísticamente significativa con BO (p < 0,01), y la presencia de cualquiera de estas alteraciones aumentó en casi 18 veces (odds ratio [OR] crudo) la probabilidad de presentar el síndrome. Los OR ajustados de falta de SV (6,28) y PVL inauténtico (9,57) para la presencia de BO continuaron siendo estadísticamente significativos. Por último, en esta investigación pudimos determinar que las subescalas del MBI agotamiento y despersonalización se correlacionaron negativamente con el PIL Test (r=-0,41 y r=-0,53, respectivamente) y la Escala de PVL (r=-0,45 y r=-0,42, respectivamente), mientras que la subescala de realización se correlacionó positivamente en forma significativa con estas dos últimas (r=0,63 y r=0,61, respectivamente). Conclusiones: se encontró una relación estadísticamente significativa entre BO, falta de SV y PVL inauténtico, en la residencia. (AU)

Introduction: The Burnout Syndrome (BO) usually affects medical residents because they are exposed to chronic labour stress. From a logotherapeutic view, the loss of meaning and purpose in life (ML) is the common denominator of all types of emotional distress, and the BO could belong to an altered labour life project (LLP) with overadaptation. The objective of this study was to evaluate the relationship between the BO, the ML, and the LLP, in residency programs at a university hospital. Population and methods: residents from six programs at Hospital Italiano de Buenos Aires were evaluated. The BO was measured with the Maslach Burnout Inventory (MBI). The ML was measured with the Purpose in Life Test (Pil Test). The LLP was measured with the LLP Scale created by Doctor Isabel Pérez Jáuregui. Results: one hundred and four residents participated. Out of the evaluated residentes, 28.8% showed BO. The loss of ML was observed in 18.3%, and an altered LLP with overadaptation affected the 30.8% of the sample. Loss of ML and altered LLP with overadaptation were associated in a statistically significant way with BO (p<0.01), and the presence of any of this alterations increased the odds ratio almost 18 times to suffer BO. The adjusted odds ratio of loss of ML (6.28) and altered LLP (9.57) to suffer BO, were also statistically significant. Finally, a negative correlation was observed between exhaustion and despersonalization (MBI) and the Pil Test (r=-0.41 and r=-0.53, respectively) and the LLP Scale (r=-0.45 and r=-0.42, respectively), while a positive significant correlation was observed between the personal accomplishment (MBI) and the Pil Test and LLP Scale (r=0.63 and r=0.61, respectively). Conclusions: in the residency, we found a statistically significant relationship between BO, loss of ML and altered LLP. (AU)

Is Balint training associated with the reduced burnout among primary health care doctors?

The aim of our study was to examine whether the participation in Balint group is associated with the reducing burnout syndrome among primary health care doctors. This investigation was conducted on a population of 210 doctors employed in primary health centers in Belgrade. Out of 210 doctors, 70 have completed Balint training for a period of at least 1 year, whereas 140 doctors have never attended this training (the Non-Balint group). The level of burnout among physicians was assessed with the Serbian translation of the original 22-item version of the Maslach Burnout Inventory - Human Services Survey which defines burnout in relation to emotional exhaustion, depersonalization and personal accomplishment. We found that 45.0% of the Non-Balint participants and 7.1% of the Balint-trained participants responded with symptoms of high level of emotional exhaustion, with a statistically significant difference (p < 0.001). In relation to depersonalization, 20% of the Non-Balint subjects were highly depersonalized compared to 4.4% of the Balint-trained subjects, with a statistically significant difference (p < 0.001). Regarding the personal accomplishment, 21.4% of the Non-Balint subjects and 7.1% of the Balint-trained subjects had a perception of low personal accomplishment, with a statistical significance (p < 0.001). In the multiple ordinal logistic model, with emotional exhaustion as a dependent variable, statistically significant predictor was female gender (OR = 2.51; p = 0.021), while Balint training was obtained as a protective factor (OR = 0.12; p < 0.001). Non-specialists were detected as a risk factor for depersonalization (OR = 2.14; p = 0.026) while Balint group was found as a protective factor (OR = 0.10; p < 0.001), according to the multiple ordinal logistic regression analysis. Regarding the reduced personal accomplishment, our results indicated that nonspecialists were at risk for this subdimension (OR = 2.09; p = 0.025), whereas Balint participants were protected (OR = 0.18; p < 0.001). Participation in Balint groups is associated with the reduced burnout syndrome among primary health care doctors.

Estudio de prevalencia sobre el síndrome de Burnout o Desgaste Profesional en los Cirujanos Ortopédicos de Andalucía / Prevalence study on burnout syndrome or Professional Burnout in Andalusia Orthopaedic Surgeons

Objetivo: Determinar la incidencia de desgaste profesional en los cirujanos ortopédicos de Andalucía en el año 2014. Determinar la posible asociación con una serie de factores sociodemográficos y laborales así como conocer las razones a las que los profesionales lo atribuyen y las medidas que propondrían para paliarlo. Material y método: Se diseña un estudio transversal descriptivo entre los 450 cirujanos ortopédicos de Andalucía, socios de la SATO y que tenían facilitada una dirección de email en dicha sociedad. Se envía a través de un enlace de Google Drive, anónimo que constaba de 3 partes: el cuestionario Maslach Burn Out Inventory para medir el grado de burnout, una serie de variables sociodemográficas y laborales y una última parte que constaba de preguntas abiertas sobre lo más negativo de su servicio, lo más positivo y lo que cambiarían para mejorar. Como criterio de inclusión se daba el tener el título de Especialista en Cirugía Ortopédica y Traumatología, estar en activo ejerciendo en la Comunidad Autónoma Andaluza y estar en activo. Resultados: Contestaron la encuesta 106 especialistas (23,5%), hombres el 83% y mujeres el 17%, el mayor grupo se encontraba entre los 30 y los 55 años (55%). El 86% se encontraban casados o con pareja estable y solo el 27% no tenía ningún hijo. El 68% tenían un contrato laboral estable bien con estatutarios del SAS o como laboral indefinido de las Agencias Públicas. El 38% realizaba entre 5-10 guardias al mes ya sea de presencia o de 1º localizado. El 29% presentaba un alto nivel de Burnout y en sus tres dimensiones el 41,5% presentaban un alta nivel de cansancio emocional, el 48,9% un alto nivel de despersonalización y el 37,2% presentaban un bajo nivel de realización personal. El trabajar cerca del lugar de residencia (p=0,018), el tener guardias de presencia física (p=0,007) y el trabajar en una Agencia Pública (p=0,03) se relaciona con un mayor nivel de desgaste profesional. Como factores subjetivos por parte de los encuestados de este desgaste resaltaban la presión asistencial (19,2%), la mala relación sueldo/responsabilidad (17,3%) y el poco reconocimiento del trabajo desempeñado tanto por la administración como por los usuarios (12,5%). El 77% volverían continuarían trabajando de Traumatólogos pero cambiarían el Hospital donde trabajan y solo el 4% estaría dispuesto a cambiar de especialidad con tal de continuar en el mismo centro de trabajo. Conclusiones: El nivel de desgaste profesional de los Traumatólogos de Andalucía en 2014 es moderado y similar al estudio realizado entre los Traumatólogos españoles en 2005 a pesar de estar atravesando por un momento socioeconómico más delicado que en esa fecha. Existe un mayor nivel de desgaste profesional entre los profesionales que viven cerca de su lugar de trabajo, en los que trabajan en las Agencias Públicas y en los que hacen guardias de presencia. Sin embargo no existe relación entre el desgaste profesional y la edad, sexo, tipo de contrato ni número de guardias. El 77% de los profesionales cambiaría de Hospital pero no de especialidad médica

Objective: To determine the incidence of burnout in orthopedic surgeons of Andalusia in 2014. To determine the possible association between burnout and a number of sociodemographic and occupational factors and to know the reasons argued and the measures proposed to alleviate it. Material and methods: A transversal descriptive study was designed. A test was electronically sent to all orthopaedic surgeons working in Andalusia that were members of the Andalusian orthopaedic society (SATO). The test consisted of Maslach burn inventory, some demographic data and some proposals for better well being during work. Inclusion criteria were to be a licensed orthopaedic surgeon, to work in Andalusia and to be active (not retired). Results: Answers were received from 106 specialists (23.5%), 83% men and 17% women, the largest group was between 30 and 55 years (55%). 86% were married or in a stable relationship and only 27% had no son. 68% had a stable employment contract statutory well with SAS or permanent employment with Public Agencies. 38% performed 5-10 on call full-day working activities per month. 29% had a high level of burnout and in its three dimensions 41.5% had a high level of emotional exhaustion, 48.9% a high level of depersonalization and 37.2% had a low level of personal fulfillment . The work near the place of residence (p = 0.018), to have on-call full-day working physically present (p = 0.007) and work on a Public Agency (p = 0.03) were associated with a higher level of burnout. As subjective factors for this burnout, respondents emphasized the workload (19.2%), poor relationship salary / liability (17.3%) and little recognition of the work performed by both the employer and by users (12.5%). 77% would continue working but would change the Hospital where they work and only 4% were willing to change their specialty with such proceeding in the same workplace. Conclusions: The level of burnout of orthopaedic surgeons of Andalusia in 2014 is moderate and similar to a previous study among Spanish Orthopedists performed in 2005, despite being having a poorer socioeconomic scenario. There is a higher level of burnout among professionals who live near their workplace, work in Public Agencies and have on-call full-day working activities. However there is no relationship between burnout and age, sex, type of contract and number of days on-call per month. 77% of professionals would change Hospital but not medical specialty

[Out-of-body experience as possible seizure symptom in a patient with a right parietal lesion]. / "Out-of-body experience" als mögliches Anfallssymptom bei einem Patienten mit rechtsparietaler Läsion.

Out-of-body experiences are reported in a variety of diseases and physiologic conditions. We report a 44-year-old patient with epigastric auras, psychomotor and grand mal seizures, and paroxysmal experiences during which he believed to have left his body and seen himself from the outside. Electroencephalography showed a right temporal and right parietal seizure pattern on several occasions, and a lesion in the right parietal lobe was detected by cranial magnetic resonance imaging. Histological examination showed a pleomorphic xanthoastrocytoma. Following extirpation of the lesion, the patient has been seizure-free for 5 years.

Esquizofrenia y subjetividad / Schizophrenia and subjectivity

Existe actualmente cierto interés por las denominadas en la esquizofrenia. A lo largo de la historia de esta patología estos fenómenos han tomado forma a través de conceptos como despersonalización-desrealización, automatismo mental, trastornos del yo y autismo. Los autores se proponen revisar dichos síndromes y su asentamiento en el paradigma de la subjetividad entendida como autoconciencia, así como los límites que dicho paradigma encierra. Se concluye tratando de encuadrar este proceso dentro del asunto más amplio de una psicopatología concebida como técnica de producción de inteligibilidad (AU)

Recently, the group of symptoms known as of schizophrenia has raised a grouping interest. These phenomena have been shaped through concepts like depersonalization-derealization, mental automatism, disorders of the self and autism. The authors propose to review these syndromes, as well as their relationship with subjectivity understood as consciousness of the self (or self-awareness) and the shortcomings due to such a relationship. To finish, we will provide some hints into psychopathology understood as a technique of production of intelligibility which will hopefully help to provide a better grasp of the process describe above (AU)

Helping your patients overcome dental phobia.

Dental phobias stem from various sources and can lead to strongly conditioned fear responses. The following are the most common origins of dental fear: Previously painful or negative experiences during visits to a dentist's office. A severe discomfort with feeling vulnerable and/or out of control in a dental situation. A sense of embarrassment from dental neglect and fear of ridicule and/or belittlement. Scary anecdotes of negative dental experiences from family and friends. Negative, menacing portrayals of dentists in movies, television, newspapers, and magazines. A sense of depersonalization in the dental process, intensified by today's necessity for the use of barrier precautions, such as masks, latex gloves, and shields. A general fear of the unknown. Once you recognize the possible sources of your patients' fears, you will be in a much better position to help them identify and overcome their particular brand of dental phobia.

Examining a stress-coping model of burnout and depression in extension agents.

Occupational stressors, coping strategies, and burnout and depression were examined in extension agents. Results indicated that a significant proportion of extension agents (range = 9.8%-51%) reported burnout symptoms above established cut-off scores for the burnout subscales, but fewer than 3% of the sample reported significant symptoms on all 3 dimensions of burnout. Depressive symptoms based on established cut-off scores were noted in approximately 26% of the sample. Stepwise multiple regression indicated that extension agents who used an emotion-oriented coping strategy were more likely to (a) display high levels of depression, emotional exhaustion, and depersonalization and (b) exhibit low levels of personal accomplishment. Furthermore, task-oriented coping strategies were found to be negatively associated with the 3 dimensions of burnout. Implications for interventional programming to reduce the symptoms of burnout are discussed.