Biomarkes Of Job STRess In Emergency Senior Physicians - Detection of Stressful Events

Study Overview
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Brief Summary
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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
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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.

Official Title
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Biomarkers Of Job STRess In Emergency Senior Physicians - Detection of Stressful Events

Conditions
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Heart Rate Variability

Intervention / Treatment
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* Behavioral: Comparison of biomarkers of stress


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 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. Exclusion Criteria: Participant refusal to participate

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Screening
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Emergency physicians<br>actors during the work | Behavioral: Comparison of biomarkers of stress<br>* 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.<br>|
| Experimental: medical externship student<br>spectator during the emergency physician work | Behavioral: Comparison of biomarkers of stress<br>* 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.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| heart rate variability at night work | measure of abrupt changes in HRV signals during 14 hours | 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 | from 8:30 to 18:30, during the 10 hours of the day shift | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Stress | measure of stress using VAS | 18:30, baseline of the night shift | 
| Fatigue | measure of Fatigue using VAS | at 18:30, baseline of the night shift | 
| Stress | measure of stress using VAS | at 8h30, at the end of the night shift | 
| Fatigue | measure of Fatigue using VAS | at 8:30, at the end of the night shift | 
| Stress | measure of stress using VAS | at 8:30, 24 hours after the end of night shift | 
| Fatigue | measure of Fatigue using VAS | at 8:30, 24 hours after the end of night shift | 
| Fatigue | measure of Fatigue using VAS | at 18:30, 24 hours after the end of day shift | 
| Stress | measure of stress using VAS | at 18:30, 24 hours after the end of day shift | 
| Stress | measure of stress using VAS | at 8:30, baseline of the day shift | 
| Fatigue | measure of Fatigue using VAS | at 8:30, baseline of the day shift | 
| Stress | measure of stress using VAS | at 18:30, end of the day shift | 
| Fatigue | measure of Fatigue using VAS | at 18:30, end of the day shift | 
| Saliva biomarkers cortisol | measure of Cortisol | at 18:30, baseline of the night shift | 
| Saliva biomarkers cortisol | measure of Cortisol | at 8:30, at the end of the night shift | 
| Saliva biomarkers cortisol | measure of Cortisol | at 8:30, baseline of the day shift | 
| Saliva biomarkers cortisol | measure of Cortisol | at 18:30, end of the day shift | 
| Saliva biomarkers DHEAS | measure of DHEAS | at 18:30, baseline of the night shift | 
| Saliva biomarkers DHEAS | measure of DHEAS | at 8:30, at the end of the night shift | 
| Saliva biomarkers DHEAS | measure of DHEAS | at 8:30, baseline of the day shift | 
| Saliva biomarkers DHEAS | measure of DHEAS | at 18:30, end of the day shift | 
| Saliva biomarkers lgAs | measure of lgAs | at 18:30, baseline of the night shift | 
| Saliva biomarkers lgAs | measure of lgAs | at 8:30, at the end of the night shift | 
| Saliva biomarkers lgAs | measure of lgAs | at 8:30, baseline of the day shift | 
| Saliva biomarkers lgAs | measure of lgAs | at 18:30, end of the day shift | 
| blood samples full blood count | measure of full blood count | at 8:30, at the end of the night shift | 
| blood samples full blood count | measure of full blood count | at 8:30, baseline of the day shift | 
| blood samples HbA1c, | measure of HbA1c | at 8:30, at the end of the night shift | 
| blood samples HbA1c, | measure of HbA1c | at 8:30, baseline of the day shift | 
| blood samples HDLc and LDL-cholesterol | measure of HDLc and LDL-cholesterol | at 8:30, at the end of the night shift | 
| blood samples HDLc and LDL-cholesterol | measure of HDLc and LDL-cholesterol | at 8:30, baseline of the day shift | 
| blood samples TG | measure of TG | at 8:30, at the end of the night shift | 
| blood samples TG | measure of TG | at 8:30, baseline of the day shift | 
| blood samples Cortisol | measure of Cortisol | at 8:30, at the end of the night shift | 
| blood samples Cortisol | measure of Cortisol | at 8:30, baseline of the day shift | 
| blood samples DHEAS | measure of DHEAS | at 8:30, at the end of the night shift | 
| blood samples DHEAS | measure of DHEAS | at 8:30, baseline of the day shift | 
| blood samples vitamine D | measure of vitamine D | at 8:30, at the end of the night shift | 
| blood samples vitamine D | measure of vitamine D | at 8:30, baseline of the day shift | 
| blood samples BDNF | measure of BDNF | at 8:30, at the end of the night shift | 
| blood samples BDNF | measure of BDNF | at 8:30, baseline of the day shift | 
| blood samples proinflammatory cytokines | measure of proinflammatory cytokines | at 8:30, at the end of the night shift | 
| blood samples proinflammatory cytokines | measure of proinflammatory cytokines | at 8:30, baseline of the day shift | 
| blood samples telomeres lengh | measure of telomeres lengh | at 8:30, at the end of the night shift | 
| blood samples telomeres lengh | measure of telomeres lengh | 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. | 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. | 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. | day 1 | 
| Life satisfaction | quality of life is assessed by a brief multidimensional life satisfaction scale (BMLSS) | day 1 | 
| Lifestyle | Assessing factors regarding lifestyle are related to smoking, alcohol, coffee, food intake (questionnaires), and physical activity (Recent Physical Activity Questionnaire). | day 1 | 
| Life and occupational events | Assessing factors regarding death of patients or death of a loved one by questionnaire. | day 1 | 
| Sick leave | assessing sick leave by the number of absence days the previous 6 months using a questionnaire | day 1 | 
| Clinical measurements height | measure of height | day 1 | 
| Clinical measurements weight | measure of weight | day 1 | 
| diastolic blood pressure | measure of diastolic blood pressure | at 18:30, baseline of the night shift | 
| systolic blood pressure | measure of systolic blood pressure | at 18:30, baseline of the night shift | 
| diastolic blood pressure | measure of diastolic blood pressure | at 8:30, at the end of the night shift | 
| systolic blood pressure | measure of systolic blood pressure | at 8:30, at the end of the night shift | 
| diastolic blood pressure | measure of disatolic blood pressure | at 8:30, baseline of the day shift | 
| systolic blood pressure | measure of systolic blood pressure | at 8:30, baseline of the day shift | 
| diastolic blood pressure | measure of disatolic blood pressure | at 18:30, end of day shift | 
| systolic blood pressure | measure of systolic blood pressure | at 18:30, end of day shift | 
| skin conductance | measure of the skin conductance | from 18:30 to 8:30, during the 14 hours of night shift | 
| skin conductance | measure of the skin conductance | 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 | at 8:30, end of the night shift | 
| Genetic factors ACE | measure of the polymorphism of angiotensin converting enzyme inhibitors (ACE | at 8:30, baseline of the day shift | 
| Genetic factors (5-HTT) | measure of the polymorphism of the serotonin transporter (5-HTT) | at 8:30, end of the night shift | 
| Genetic factors (5-HTT) | measure of the polymorphism of the serotonin transporter (5-HTT) | at 8:30, baseline of the day shift | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Heart rate variability, stress, cortisol