Biomarkes Of Job STRess In Emergency Senior Physicians - Detection of Stressful Events
Condition: Heart Rate Variability
MeSH terms: Emergencies; Occupational Stress
Study type: Interventional

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.
    

Intervention name(s): Comparison of biomarkers of stress
Intervention type(s): Behavioral
Intervention description(s): 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.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Screening
Keywords: Heart rate variability; stress; cortisol