High Rates Of Burnout Research Articles

The Association of Psychotherapy With Burnout, Depression, and Measures of Well-Being in Residents and Fellows: A Pilot Study.

Resident physicians experience high rates of burnout and depression but rarely prioritize their well-being or seek mental health care. The Accreditation Council for Graduate Medical Education mandated that training programs prioritize resident wellness and emotional and mental health to ensure readily available and accessible mental health care. To help meet that requirement and circumvent barriers to accessing care, the University of California San Diego Healer Education Assessment & Referral (HEAR) Program offers residents and fellows short-term therapy for coping with challenges that threaten their well-being. This report describes the results of a pilot study designed to evaluate the feasibility and effectiveness of the HEAR Program's resident therapy program. The cohort included residents and fellows who completed at least 1 postbaseline assessment from January to May 2022. Measures of fulfillment, burnout, self-compassion, quality of life, depression, and suicidal ideation were assessed and compared before and up to 12 weeks after enrollment. Of the 39 residents who consented to participation, 30 completed at least 1 postbaseline assessment. Most outcomes improved after therapy, with significant increases in fulfillment (mean [SE] coefficient, 0.24 [0.08]; z score, 2.86; P = .004), self-compassion (mean [SE] coefficient, 0.37 [0.07]; z score, 5.72; P < .001), and quality of life ( P < .001) and significant reductions in burnout (Stanford burnout scale: mean [SE] coefficient, -0.27 [0.07]; z score, -4.01; P < .001; single-item burnout scale: mean [SE] coefficient, -0.34 [0.08]; z score, -4.37; P < .001) and depression severity (mean [SE] coefficient, -1.08 [0.25]; z score, -4.36; P < .001). This pilot study noted improvements in fulfillment, compassion, quality of life, and function, as well as reductions in burnout and depression severity, among resident physicians. Future studies in larger cohorts are needed to validate these findings and inform further optimization of this program.

Trauma Informed Care for Nursing Action Bachelor of Science in Nursing Course.

Nurses commonly experience psychological trauma with high risk for a host of mental health concerns such as suicide, depression, anxiety, and substance use disorders, as well as high rates of burnout and moral injury. Despite rigorous academic preparation, baccalaureate nursing education curricula lack content on the widespread effects of trauma. Using a trauma informed care (TIC) model, an innovative course called Trauma Informed Care for Nursing Action (TIC4NA) was created. This course allows students to safely explore the profession of nursing to transform their learning about trauma related to patient care, the nursing community, and society. TIC curriculum delivery offers supportive strategies to mitigate negative outcomes during nursing school. This content could have positive effects on nurse and nursing student retention as well as mitigating a barrage of negative outcomes for individual nurses and the nursing profession. [J Nurs Educ. 2024;63(4):233-240.].

Group peer mentoring is effective for different demographic groups of biomedical research faculty: A controlled trial.

Improved mentoring of midcareer researchers in medical schools has been identified as an important potential avenue for addressing low vitality and high burnout rates in faculty, and the scarcity of both underrepresented minority (URM) faculty and women in biomedical research. To address the need for widescale effective mentoring, we sought to determine whether a group peer mentoring intervention (C-Change Mentoring and Leadership Institute) for early midcareer research faculty was effective for different demographic groups in a controlled trial. Thirty-five diverse early midcareer faculty and 70 propensity-matched (PM) control subjects matched to intervention subjects on a) study inclusion criteria; b) gender, race, and ethnicity, degree, rank, years of experience, publications, grants; and c) pretest survey outcome variables, participated in the intervention. The C-Change Participant Survey assessed vitality, self-efficacy in career advancement, research success, mentoring others, valuing diversity, cognitive empathy, and anti-sexism/anti-racism skills at pretest and intervention completion. Analysis using multiple regression models included outcome pretest values and indicator variables for intervention, gender, URM status, and MD vs. PhD. Hypotheses regarding differential effectiveness of the intervention by demographic group were tested by including cross-product terms between the demographic indicator variables and the intervention indicator. Missing data were addressed using chained equations to create 100 data sets. The intervention participants had significantly higher (favorable) scores than PM controls for: self-assessed change in vitality; self-efficacy for career advancement, research, and mentoring others; cognitive empathy; and anti-sexism/racism skills. The benefits of the intervention were nearly identical across: gender, URM vs non-URM faculty, and degree MD/PhD, except vitality significantly increased for non-URM subjects, and not for URM faculty. Self-assessed change in vitality increased for URM and non-URM. The intervention worked successfully for enhancing vitality, self-efficacy and cross-cultural engagement across different demographic groups of biomedical research faculty.

Reducing Burnout, Suicide &amp; Wellbeing among Healthcare Professionals:

Recently the lack of well-being, higher rates of burnout and reports of suicide in healthcare professionals have become an area of concern for organisations. Physician and nurse suicides are a worry and subject of increasing ‘professional and public health interest. Despite good resources to help others, healthcare workers are sacrificing their well-being. Moreover, systemic barriers by organisational culture and policy are often preventing self-care or help-seeking actions.

Medical educational study burnout and job satisfaction among general practitioners and occupational physicians during the COVID-19 epidemic

In this narrative review, general practitioners and occupational physicians (GPOPs) are compared in terms of their burnout and job satisfaction. The studies used show an immediate link between burnout and a lack of job satisfaction. However, it is unclear which of these two factors, which will apparently need to be researched and discovered through more research, influences the growth of the other one. High burnout and low satisfaction rates arise because of intrapersonal variables, factors related to the workplace, and factors related to the dynamics of the workplace environment. There is a remarkable rise in burnout among GPOPs during the COVID-19 pandemic. It is critical psychological interventions be made to address burnout and boost job satisfaction levels as it has a detrimental impact and adverse effect on the medical working environment.

Violence against healthcare professionals in intensive care units: a systematic review and meta-analysis of frequency, risk factors, interventions, and preventive measures

BackgroundTo assess the frequency, risk factors, consequences, and prevention of violence against healthcare workers in intensive care units.MethodsPubMed, Scopus, Google Scholar, EMBASE, Cochrane, and Web of Science were searched for studies on violence against healthcare workers in adult intensive care units. Risk factors, patient characteristics, and implications for healthcare workers were collected. Study quality, bias, and level of evidence were assessed using established tools.ResultsSeventy-five studies with 139,533 healthcare workers from 32 countries were included. The overall median frequency of violence was 51% (IQR 37–75%). Up to 97% of healthcare workers experienced verbal violence, and up to 82% were victims of physical violence. Meta-analysis of frequency revealed an average frequency of 31% (95% CI 22–41%) for physical violence, 57% for verbal violence (95% CI 48–66%), and 12% for sexual violence (95% CI 4–23%). Heterogeneity was high according to the I2 statistics. Patients were the most common perpetrators (median 56%), followed by visitors (median 22%). Twenty-two studies reported increased risk ratios of up to 2.3 or odds ratios of up to 22.9 for healthcare workers in the ICU compared to other healthcare workers. Risk factors for experiencing violence included young age, less work experience, and being a nurse. Patients who exhibited violent behavior were often male, older, and physically impaired by drugs. Violence was underreported in up to 80% of cases and associated with higher burnout rates, increased anxiety, and higher turnover intentions. Overall the level of evidence was low.ConclusionsWorkplace violence is frequent and underreported in intensive care units, with potential serious consequences for healthcare workers, calling for heightened awareness, screening, and preventive measures. The potential risk factors for violence should be further investigated.Systematic review registration: The protocol for this review was registered with Prospero on January 15, 2023 (ID CRD42023388449).

Predictors of Job Satisfaction and Association with Psychological Distress Among Academic Medicine Faculty in Kazakhstan.

The growing concern for the faculty's well-being is allied with the emotionally demanding nature of teaching, which has an adverse effect on physical and mental health. There is abundant evidence that academic medicine faculty are subjected to high rates of dissatisfaction, distress, burnout, and turnover among medical educators. This study is dedicated to the exploration of the association between job satisfaction and psychological distress among academic medicine faculty in Kazakhstan. The observational cross-sectional study was conducted among medical educators in Kazakhstan between 1 October and 25 December. The survey was completed by 715 representatives of academic medicine staff. The sample size was calculated by Epi Info Sample Size Calculator, version 7.0. Multinomial logistic regression analysis using the forced entry procedure was applied to identify the factors associated with job satisfaction. The prevalence of job satisfaction, depression, anxiety, and stress was 19.2%, 40.6%, 41.3%, and 53%, respectively. Three variables were significantly associated with job satisfaction: having a partner (AOR=0.79; 95% CI 0.38-1.659), having work experience of 5-10 years (AOR=0.32; 95% CI 0.14-0.74), and holding a Ph.D. degree (AOR=0.40; 95% CI 0.18-0.91). Job satisfaction was significantly associated with depression (p=0.005) and stress (p<0.001). Compared to previous research in this area, our findings reported a higher prevalence of psychological distress and dissatisfaction. Potential reason for higher rates of dissatisfaction may be the global disruption due to COVID-19 pandemic.

Burnout in Neurosurgery

Burnout is a pervasive psychosocial syndrome that manifests as a chronic response to interpersonal stressors encountered in the occupational setting. Neurosurgeons exhibit a high prevalence rate of burnout, ranging from 33% to 67%. The primary objective of this study is to examine the prevalence of Burnout syndrome within the neurosurgical community and identify the contributing factors. A prospective observational study was conducted utilizing an anonymous survey format, incorporating the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) questionnaire. Additional inquiries were made regarding demographic characteristics, occupational factors, lifestyle choices, and the Hospital Anxiety and Depression Scale (HADS) questionnaire. The survey was disseminated between March 23rd, 2023, and April 4th, 2023, utilizing the email registries of the Spanish Society of Neurosurgery (SENEC) and the Latin American Federation of Neurosurgical Societies (FLANC). Descriptive analysis was performed, comparing responses between participants with and without burnout syndrome using cross-tabulation and the Chi-square test to assess the presence of dependency. A total of 282 neurosurgeons completed the survey. The sample comprised 30.1% females and 69.9% males, with a median age within the 30-40 range. Among the surveyed neurosurgeons, 66.7% exhibited a prevalence of burnout, while 23.4% met the criteria for defined burnout. Significantly higher rates of burnout syndrome were observed among residents, specifically those in their fifth year of residency, as well as those whose departments perform a moderate range of surgeries (500-1000), participating in on-call duties, lacking regular physical exercise (at least twice a week), engaging infrequently in social activities with friends, lacking extracurricular hobbies, and obtaining scores exceeding 10 points in any of the HADS subscales. Burnout syndrome affects nearly a quarter of the neurosurgical specialists included in this study. Moreover, a distinct profile associated with defined burnout among neurosurgeons emerges, encompassing characteristics such as being a fifth-year resident, belongs to departments with a moderate number of surgeries, with few extra-occupational distractions and exhibiting symptoms of depression or anxiety.

Do physicians need tragic optimism?

In 2016, as a trainee doctor, I wrote a paper on changing the culture of medicine. I felt the medical system was broken back then, and it seems even less functional now, with higher rates of burnout, dropout and staff shortages nationally. As a result of a lack of resources, it feels impossible to provide the care to our communities expected of us, making our work challenging and disheartening. Until all stakeholders acknowledge the systemic issues faced by our workforce, service outcomes and physician well-being may not improve. We need to collaborate and innovate to reform the healthcare system taking a multifaceted, evidence-based approach, implementing an appropriate balance of systemic change and interventions to support individual well-being. As we collectively work towards these changes, tragic optimism may spur physicians to develop meaning and purpose despite the inevitable challenges. This may serve as the motivation and fuel required to survive and sustain our practice but also thrive working in careers of value.

Abstract WP114: Texas Stroke Program Assessment: Infrastructure, Turnover, and Burnout Implications

Introduction: Unlike state designation for trauma centers, there are no Texas State rules on certain infrastructure requirements for stroke designation and independent stroke center accreditation. To assess the current state of program manager impact, a Texas Stroke Program Survey was administered. Hypothesis: Lack of requirements results in overburdened programs, high turnover, poor mentorship, and burnout. Methods: Electronic survey contained program assessment with link to validated instrument (MBI-HSS), administered by Mind Garden Inc, to assess burnout, well-being, and work-related dimensions for medical personnel. Of the 181 Texas designated stroke facilities, 98% were contacted with each site having one anonymous senior program staff member complete the survey. Results: Survey responses were 105 among which 78 completed MBI-HSS (26% CSC, 1% TCS, 59.6% PSC, 17.3% ASRH). Respondents: 66.7% stroke coordinators, 23.8% stroke program managers/directors, and 9.5% identified as other. Majority (41%) were in current role for 1-2 yrs (19% &lt;1 yr, 20% 3-5 yrs, 13.3% 6-9 yrs, 6.7% &gt; 10 yrs) and 42.9% did not consider resigning. Over 5 yr period, 49.5% reported 2 or more turnovers of their position (none 26.7%, once 21.9%, twice 20%, &gt; twice 29.5%, new role 1.9%). Majority (57.1%) reported serving more than one major role at facility. Reported 67.3% had dedicated stroke coordinators and 49% data collectors. Only 53.3% reported adequate resources and 15.2% felt program was priority with sufficient hospital support. Role on-boarding was reported by 16.2% and 61.9% reported no mentorship. MBI-HSS revealed 74.4% had burnout profile of ineffective, overextended, or burnout. Conclusion: Survey demonstrates variability in infrastructure, reduced support and mentorship, high rates of turnover and burnout in Texas stroke programs. Nearly all respondents (91.4%) felt requirements for infrastructure and support for stroke program development and growth were needed.

Frequency of Burnout and its Factors among Nurses Working at Tertiary Care Hospital Lahore

Nurses experience a high rate of burnout, which may be attributed to the physically and mentally exhausting profession. Consequently, it leads to a decrease in the quality of care. Objectives: The present study was employed to determine the frequency of burnout and its contributing factors among nurses. Methods: A cross-sectional study was conducted at the Mayo Hospital, Lahore. Both male and female nurses and at least one year of job experience were included in the study. Nurses who were working in management posts were excluded from the study. A self-administered, pre-tested, and validated questionnaire “Copenhagen Burnout Inventory” was used to assess burnout. Results: Most of the nurses reported moderate levels of personal, professional, and client-related burnout. Gender was significantly and negatively associated with emotional burnout (β -.182; p=0.004), and rotation of duty was also found to be significantly and negatively related to personal burnout (β -0.271; p˂0.01) among nurses. Similarly, work-related burnout, gender (β -0.198; p=0.002), and rotation (β -0.175 p=0.006) were found to be negatively and significantly associated with burnout, while duty shift was significantly positively (β=0.169; p=0.010) related to work-related burnout. Age was positively associated (β=0.096; p=0.029) with client-related burnout, while residence (β -0.17; p=0.022, and rotation (β -0.617; p=0.004) were found to be negatively and significantly associated with client-related burnout. Conclusions: A high frequency of burnout was recorded among study participants. The long duty shifts and rotations had a significant impact on nurses' burnout in the present study.

Evaluating Systemic Burnout in Medical Oncology Through a National Oncology Mentorship Program.

Mentorship has a positive influence on trainee skills and well-being. A 2022 Pilot Mentorship Program in New South Wales involving 40 participants revealed high burnout rates in Medical Oncology trainees. As part of an Australia-wide inaugural National Oncology Mentorship Program in 2023 (NOMP23), a national survey was undertaken to assess the prevalence of burnout, anxiety, depression, professional fulfilment, and drivers of distress in the Australian medical oncology workforce. NOMP23 is a 1-year prospective cohort study that recruited medical oncology trainees and consultants using e-mail correspondence between February and March 2023. Each participant completed a baseline survey which included the Maslach Burnout Index (MBI), Stanford Professional Fulfilment Index, and Patient Health Questionnaire-4 for anxiety and depression. One hundred and twelve participants (56 mentors, 56 mentees) were enrolled in NOMP23, of which 86 (77%) completed the baseline survey. MBI results at baseline demonstrated that 77% of consultants and 82% of trainees experienced burnout in the past 12 months. Professional fulfilment was noted to be <5% in our cohort. Screening rates of anxiety and depression in trainees were 32% and 16%, respectively, compared with 7% and 2% for consultants. When assessing reasons for workplace stress, two thirds stated that heavy patient load contributed to stress, while almost three quarters attributed a heavy administrative load. Lack of supervision was a key stressor for trainees (39%), as was lack of support from the training college (58%). Trainees and consultant medical oncologists demonstrate high rates of burnout and low professional fulfilment. The NOMP23 program has identified a number of key stress factors driving burnout and demonstrated concerning levels of anxiety and depression. Ongoing mentorship and other well-being initiatives are needed to address these issues.

Burnout in emergency department personnel—A continuing concern post pandemic

AbstractIntroductionHigh incidences of burnout has been reported amongst emergency department (ED) personnel during the COVID‐19 pandemic. Emerging from the pandemic, organisational support for psychological health may dwindle and become secondary to economic priorities. We aimed to ascertain the level of burnout within ED staff at our hospital, identify professional groups, which were more vulnerable and domains, which contributed most towards burnout.MethodsWe conducted a cross‐sectional study approximately 8 months after major moves to remove COVID‐19 restrictions in Singapore. Data was collected via a self‐administered survey employing the Copenhagen Burnout Inventory (CBI). Demographics, occupational details, work satisfaction and motivation to stay in the job were also collected and analysed.ResultsA total of 115 ED staff participated. Overall CBI score was 62.3 ± 22.0. Scores for personal, work‐related and client burnout were 64.9 ± 23.2, 61.6 ± 23.1 and 60.4 ± 26.1, respectively. A total of 44.5% had to take medical leave because of burnout. Nurses had higher overall CBI scores than doctors (67.5 ± 20.5 vs. 54.6 ± 23.0, p = 0.01). Those who were satisfied with their present job had lower overall CBI scores compared to those not satisfied (42.7 ± 17.9 vs. 84.0 ± 14.4, p &lt; 0.001). Overall CBI scores were also lower in those motivated compared with those not motivated to continue in their current job (50.1 ± 16.3 vs. 79.0 ± 15.1, p &lt; 0.001).ConclusionED staff continue to record high rates of burnout as we transit out of the pandemic. Accompanying rates of medical leave and low levels of motivation to remain in the job are serious occupational health concerns. Factors contributing to burnout in at risk groups such as nurses should be further analysed. High mean CBI scores in the personal and work domains indicate that related factors contribute most towards burnout and interventions should be focused accordingly.

Mindfulness Based Interventions for Surgeons: A Scoping Review.

To review the evidence on mindfulness-based interventions (MBIs) for surgeons. Healthcare professionals have alarmingly high rates of burnout, yet little is known about psychological factors that support resilience. MBIs, which involve codified training in specific skills such as self-awareness, emotional regulation, and perspective-taking, have shown benefit to professionals in high stress environments, but have had limited implementation in the healthcare workplace and in surgery. To our knowledge, there has not been a scoping review of MBIs in surgery to date. We conducted a scoping review of the evidence for the feasibility and effectiveness of MBIs for surgeons, including evidence on interventions that explicitly train mindfulness, which spans multiple cohorts and settings, utilizing different methodologies and outcome measures. This scoping review yielded 24 studies, including two mixed method/qualitative studies, nine randomized control trials, three non-randomized interventional studies, and eight single-arm interventional studies. We find that MBIs in surgery 1) are feasible in surgical contexts, with implementation science providing insights on sustainability; 2) increase mindfulness, 3) improve well-being in terms of burnout and both psychological and neurophysiological measures of stress, and 4) enhance performance as measured in executive function, surgical skills, and communication skills. These conclusions are supported by psychometric measures, observations of technical skills, and neurophysiological evidence. Future directions include studying MBIs in larger and more diverse populations, and iteratively tailoring mindfulness-based interventions to other healthcare contexts.

Australian regional cancer nurses’ experiences of burnout during 2019–2021

BackgroundCancer nurses are known to experience high rates of burnout. Despite cancer nurses being critical to providing care for people in rural and remote areas, there is limited research exploring the unique challenges and job demands experienced by regional cancer nurses, and the job demands which may act to buffer these stressors. AimThis study aims to identify antecedents of burnout among Victorian regional cancer nurses over a two-year period, by examining the job demands and resources prevalent in their work. We will build on existing literature by identifying specific job resources that can ameliorate job demands experienced by regional cancer nurses. MethodsA qualitative case study with participants located in regional Victoria, Australia was employed. Semi-structured interviews were conducted both prior to and during the COVID-19 pandemic. FindingsPatient aggression, emotional demands, unsupportive peers and management, and resource constrained work environments were reported as distinct job demands; while job significance, supportive peers and leadership, and connection to community were reported as job resources. ConclusionIn regional settings, patient aggression, workforce shortages, hazardous work environments and inconsistent digitisation of patient management systems are common characteristics of under-resourced workplaces. Despite these challenges, participants reported a strong desire to remain in the profession, mostly due to their commitment to their communities. Supportive peers and colleagues were also reported as an important job resource, particularly during the pandemic. Summaryof relevance Problem or issueCancer nurses in rural and regional areas experience unique job demands. There is limited existing literature on the stressors experienced by regional cancer nurses resulting from these job demands. What is already knownCancer nurses require specialised knowledge and skills to undertake emotionally demanding work. Nurses providing care to people with cancer in regional areas experience the additional pressure of dual relationships with patients, because of living and working in close-knit communities. What this paper addsThis study identifies the unique job demands experienced by cancer nurses in regional areas of Victoria, Australia. The findings identify several site-specific demands characteristic of an under resourced workplace, including the inconsistent digitalisation of medical records are new. Positive job factors that enable regional cancer nurses to manage their roles in a highly demanding work environment were attributed to the culture of rural communities. Understanding the importance of local culture to retention provides healthcare leaders with insights to improve staff health and wellbeing through increasing local engagement and connection, and buffer challenges associated with burnout in cancer nurses practicing in regional areas of Victoria.

Evaluating a Scribe Program in Reducing Provider Burnout

Burnout causes decreased job satisfaction, mental health issues, and leads to poor patient care. A large contributor is the electronic health record. Primary care providers from a medical group completed the Professional Fulfillment and Burnout Index survey showing high rates of burnout, and a scribe program was initiated. This quality improvement project evaluated the scribe program and its effects on burnout, documentation burden, and productivity for primary care physicians and nurse practitioners. Most participants had burnout. After using scribes, most had improved work-life balance. The scribe program was an important resource to prevent burnout related to the electronic health record.

The benefits, barriers and facilitators of mentoring programs for first-year doctors: A systematic review.

The transition from medical student to first-year doctor is notoriously difficult, yielding a high rate of transition failure, burn-out and mental health deterioration. Doctors in this cohort experience unique challenges during this time, which manifest through performance gaps, issues of professional identity, new occupational pressures, and cultural expectations. Mentoring programs are commonly utilised in the medical profession to foster personal and professional development and improve psychosocial well-being and career satisfaction. However, there exist no systematic reviews examining the use of mentorship specifically for the first-year doctor cohort, given the unique transition challenges faced by this vulnerable group. Due to their transition difficulties, evaluate the research on mentorship specifically for first-year doctors, and identify the emerging themes that can inform the benefits to this group, the barriers that impede program implementation and the facilitators that contribute to successful mentorship programs for this cohort. The PEO (population, exposure outcome) framework was adopted to develop the research inquiry, after which, a systematic review was conducted, adhering to PRISMA guidelines. The search strategy was conducted with assistance from an experienced university librarian. Screening and selection were completed independently against inclusion/exclusion criteria, by two reviewers. The methodological quality of included studies was assessed using Joanna Briggs critical appraisal instruments. Data sources used included Web of Science Medline, Ebsco Cinahl Plus, Scopus, Web of Science Core Collection and Ovid Journals. Search parameters were restricted to English language and peer-reviewed; date range was unobstructed up to 26 August 2022. A total of 4137 articles were retrieved, with 13 considered to have met full inclusion criteria. An integrative review synthesis identified three major themes; benefits of mentoring for first-year doctors, intrinsic and extrinsic barriers to mentoring programs and facilitating factors that improve successful program implementation. First-year doctors report untenable and highly strenuous working conditions, that result in poor mental health and high attrition rates. Formalised, near-peer, tier mosaic mentoring programs provide significant psychosocial and career benefits to this cohort specifically, bridge the training gap from medical student to first-year doctor and ameliorate patterns of intergenerational bullying, hierarchy and emotional inhibition. However, mentorship is inextricably interrelated to societal-cultural considerations of identity. Mentorship alone cannot overcome endemic cultural challenges within medicine without broader systemic change; however, programs are a valuable option towards positive support for first-year doctors.

Coping with disruptive patients: Perspectives of primary care employees.

The impact of patient aggression on primary health care employees is underexplored, yet imperative to address, given high rates of burnout. We qualitatively explore perceptions of patient aggression among staff in women's health primary care at the Veterans Health Administration (VA). Our objective is to identify coping strategies that staf devised in response to aggressive behavior. We conducted semi-structured interviews with 60 VA women's health primary care employees in 2021 and 2022. Informed by the Job Demands-Resources theoretical model, we used rapid qualitative analysis to identify themes related to patient aggression and employee coping strategies. Disruptive behaviors reported by participants included verbal and physical aggression. Staff cited disruptive patient behavior as emotionally draining and perceived a lack of consequences for low-level aggression. Respondents used coping strategies in response to patient aggression at three time points: before, during, and after a negative interaction. At each point, support from team members emerged as a dominant coping mechanism, as well as rapport-building with patients. Patient aggression can negatively impact the work experiences of primary care employees. At VA, women's health primary care staff have devised multiple strategies to cope with these interactions. However, the ability to effectively prevent and manage patient aggression is limited by the lack of meaningful repercussions for aggression at the organizational level, which has important implications for employee well-being and retention. Retention of women's health employees in VA is critical given the need for a highly specialized workforce to address the complex health needs of women veterans.

Robust optimization of a radiotherapy pretreatment preparation workflow

Objective. Increasing cancer incidence, staff shortage and high burnout rate among radiation oncologists, medical physicists and radiation technicians are putting many departments under strain. Operations research (OR) tools could optimize radiotherapy processes, however, clinical implementation of OR-tools in radiotherapy is scarce since most investigated optimization methods lack robustness against patient-to-patient variation in duration of tasks. By combining OR-tools, a method was developed that optimized deployment of radiotherapy resources by generating robust pretreatment preparation schedules that balance the expected average patient preparation time (F mean) with the risk of working overtime (RoO). The method was evaluated for various settings of an one-stop shop (OSS) outpatient clinic for palliative radiotherapy. Approach. The OSS at our institute sees, scans and treats 3–5 patients within one day. The OSS pretreatment preparation workflow consists of a fixed sequence of tasks, which was manually optimized for radiation oncologist and CT availability. To find more optimal sequences, with shorter F mean and lower RoO, a genetic algorithm was developed which regards these sequences as DNA-strands. The genetic algorithm applied natural selection principles to produce new sequences. A decoder translated sequences to schedules to find the conflicting fitness parameters F mean and RoO. For every generation, fitness of sequences was determined by the distance to the estimated Pareto front of F mean and RoO. Experiments were run in various OSS-settings. Main results. According to our approach, the expected F mean of the current clinical schedule could be reduced with 37%, without increasing RoO. Additional experiments provided insights in trade-offs between F mean, RoO, working shift length, number of patients treated on a single day and staff composition. Significance. Our approach demonstrated that OR-tools could optimize radiotherapy resources by robust pretreatment workflow scheduling. The results strongly support further exploration of scheduling optimization for treatment preparation also outside a one-stop shop or radiotherapy setting.

Study on radiation characteristics of coal fired boiler changing with burnout rate

The burnout rate is an important parameter in the combustion of pulverized coal. During the process of pulverized coal burnout, its radiation characteristics and the entire coal-fired boiler vary with the burnout rate, which is a very complex process and current research is not clear enough. This study proposes a new single particle pulverized coal burnout model, which incorporates pore volume correction to fit the density ratio and diameter ratio of multiple coal types with varying burnout rates as the theoretical basis. Using Mie theory, Jiaozuo coal particles are calculated average absorption and scattering efficiency in the band of 0.39 ∼ 16 μm, which is used as the basis for correcting particle emissivity and scattering factor. Then, through user defined function (UDF) in the simulation software, the particle radiation characteristics are modified from the original constants of 0.9 and 0.6 to linear and polynomial models that vary with the burnout rate. Not only do the spatial distribution rules of the coal-fired boilers radiation characteristics with the burnout rate of the furnace be obtained, but also the temperature distribution of the furnace under different particle radiation characteristics models is compared. The results show that the pulverized coal burnout model is consistent with the experimental results in literatures. High burnout rate corresponds to low mass concentration of furnace particles, and low absorption and scattering coefficients. Using the above model to calculate the particle emissivity and scattering factor that vary with the burnout rate, after UDF embedding, the error between the simulation results and the on-site cross-sectional temperature and thermal imaging detection decreases from 4.81 % to 2.59 %, reflecting the high accuracy and rationality of the burnout model and particle radiation characteristic correction method.