Work stress and burnout among emergency physicians: a systematic review of last 10 years of research.

AIM OF THE STUDY: First, to provide a synthesis and analysis of available scientific literature regarding the level of work stress and burnout among emergency physicians. Second, to identify the effect of the specific work situation-related factors. METHODS: A systematic search was performed in NCBI PubMed and Embase. Comparative primary studies, both systematic review and cross-sectional, quantifying burnout in emergency physicians were included. Only studies published between 2011 and 2022 were retained. Synonym sets were compiled for the search key for 'burnout & stress', 'emergency', 'physician' and 'burnout & posttraumatic stress disorder'. RESULTS: Thirty-five papers were retained for further research. Emergency physicians scored significantly higher for all dimensions of burnout compared to other healthcare professions. Significant correlations for burnout were found with work characteristic and organizational factors. Critical incidents and aggression were identified as the most important acute work characteristics and organizational factors impacting emergency physician's mental wellbeing including the development of posttraumatic stress disorder. Moreover, personal factors such as age, personality, and coping strategies also play an important role in the development of burnout as well as work-related trauma. CONCLUSION: Available studies show that emergency physicians report higher scores of emotional exhaustion and depersonalization when compared to other healthcare professionals. Work characteristics contribute to this, but work-related traumatic incidents and aggression are important determinants. Personal characteristics such as age, personality type D, previous experiences and coping strategies seem to be determining factors likewise. Emergency physicians showed a high risk for developing burnout and work stress-related problems.

Sarcoidosis-like disease with pulmonary infestation, meningoencephalitis and transverse myelitis after sigmoid cancer treatment.

We present the case of a 40-year-old male with recent history of moderately differentiated invasive adenocarcinoma of the sigmoid in whom both respiratory and neurological disease developed simultaneously, mimicking diffuse metastatic disease. The broad differential diagnosis and pitfalls (both diagnostic and therapeutic) are described. Pulmonary sarcoidosis as well as neurosarcoidosis occur very rarely after solid cancers.

Motor neuron disease features in a patient with neuroborreliosis and a cervical anterior horn lesion.

A variety of neurological syndromes has been described in neuroborreliosis: cranial nerve palsies, radiculopathy, axonal neuropathy, stroke, parkinsonism, transverse myelitis, supranuclear palsy, Guillain-Barré syndrome, ... We report a case of neuroborreliosis with cervical myelitis presenting clinically as a lower motor neuron syndrome of the upper and lower limbs with proximal and distal pareses and atrophies as well as bulbar dysarthria and dysphagia. During the course of the disease the patient developed the clinical picture of a meningoencephalitis. After initiating ceftriaxone treatment the patient showed a complete recovery. In endemic regions for Lyme disease, in all neurological syndromes neuroborreliosis has to be excluded.

An unusual case of 4-aminopyridine toxicity in a multiple sclerosis patient: epileptic disorder or toxic encephalopathy?

We report the case of a 45-year old female multiple sclerosis patient, who accidentally was overdosed with 4-aminopyridine which resulted in dystonic, choreathetoid type abnormal movements in the four limbs, motoric distress, confusion and opisthotonus. There is little known about 4-aminopyridine toxicity. There are only a few reported cases ranging from mild paresthesias to tonic-clonic seizures. 4-aminopyridine enhances neuronal conduction at neuromuscular synapses and is indicated in the treatment of selected neurological disorders including multiple sclerosis (MS) and myasthenia gravis, among others.

[Fever of unknown origin caused by anaplasmosis]. / Koorts van onbekende oorsprong, met als oorzaak anaplasmose.

A 74-year-old man in good clinical condition presented with complaints of recurrent fever up to 38 degrees C and diffuse thoracic pain, both present for several weeks. Antibiotic therapy did not result in disappearance of the symptoms. Except for a picture of chronic inflammation and a positive Anaplasma IgM antibody titre, serology yielded no indication ofthe diagnosis. Further investigation, including imaging, showed no convincing cause. 'Anaplasma infection' remained the working diagnosis. One month after hospitalisation, the patient was free of fever without any type of therapy. Control blood tests revealed seroconversion to Anaplasma IgG antibodies, constituting serological evidence of a recent infection. The prevalence ofanaplasmosis is increasing. Mice are the principal reservoir for the intracellular bacteria and the infection is transmitted by ticks. In case of fever of unknown origin, since the transmission takes place in the same manner, one should consider both Borrelia and an infection with Anaplasma.

Vocal cord immobilisation in diffuse idiopathic skeletal hyperostosis (DISH).

Advanced forms of diffuse idiopathic skeletal hyperostosis or Forestier's disease can induce dysphagia and significant respiratory symptoms such as hoarseness, dyspnea, snoring and laryngeal stridor. Severe respiratory distress is very rare. Two identical cases of chronic respiratory distress due to bilateral vocal cord adduction-fixation in conjunction with skeletal pathology in the cervical area are presented. The clinical, diagnostic and therapeutic work-up and the prognostic outcome of the laryngeal pathology are discussed.

A rule for early outcome classification of out-of-hospital cardiac arrest patients presenting with ventricular fibrillation.

The aim of the study was to develop a scoring system for outcome classification at the start of prehospital first tier resuscitation for patients with cardiac arrest from ventricular fibrillation (VF). We studied a consecutive sample of 100 out-of-hospital cardiac arrest patients, presenting with VF of presumed cardiac etiology on arrival of the first tier (in a two-tiered urban Emergency Medical Services system). The number of patients discharged was 29 ('survivors') and 71 died ('non-survivors'). The electrocardiography (ECG) tracings recorded during resuscitation using a semi-automatic defibrillator were retrospectively analysed. For each patient, VF amplitude in mV (VF_a) and the number of base-line crossings per second (VF_blc) were calculated. Fisher's linear discriminant analysis was applied to discriminate between survivors and non-survivors using the variables VF_a, VF_blc and age. Patients were classed as potential survivors or non-survivors using a survival index = 0.6*(VF_a) + 0.4*(VF_blc)-4.0. If for a given patient the survival index is < 0, he is classified in the non-survivor group, if the survival index is > 0, he is classified in the survivor group. Using this index 79% of the survivors and 70% of the non-survivors could be classified correctly. Adding age to the formula increased the correct classification of survivors to 86 and 73% for the non-survivors. The survival index provides a research tool for the discrimination between potential survivors and non-survivors, which opens the possibility for the development of alternative treatment protocols in cardiac arrest.

An image analysis study of vastus lateralis muscle fibers in malignant hyperthermia susceptible patients.

We studied the correlation between the in vitro contracture test (IVCT) performed in malignant hyperthermia (MH) and the muscle fiber type composition in 29 human vastus lateralis (VL) biopsy samples (from 12 women and 17 men) using a semiautomated image analyzer. Relative number, lesser diameter, global area, and spatial distribution of the muscle fibers were measured. In these and in 26 additional VL muscle biopsy samples of patients with other myopathies, we compared our morphometric data with the observations made by the pathologist. Among the MH group, type 1 fibers were larger in both malignant hyperthermia susceptible (MHS) men and women reaching statistical significance only in the latter. The relative number and global area were unchanged. In MHS patients relative number and global area of type 2A fibers were smaller. No changes in the parameters of type 2B fibers were found. In a minority of sections (14%) clustering was observed. Sex-related alterations in type 2 fiber characteristics were found between MHS patients. However, our findings do not clearly point towards a syndrome-induced alteration of size, number, global area, or distribution of type 1, 2A, and 2B muscle fibers in VL of MH patients. By morphometric analysis, we found several additional biopsy samples that met the interpretation of "abnormal" size and number of muscle fibers in human malignant hyperthermia than were reported by the pathologist.

Discordant light microscopic, electron microscopic, and in vitro contracture study findings in a family with central core disease.

We report a family that was referred to our laboratory after a fatal malignant hyperthermia (MH) accident during general anesthesia. Postmortem study of different muscles of the proband pointed retrospectively to the presence of central core disease (CCD). Of the 8 family members investigated by histology and in vitro contracture testing (IVCT) 5 were found to be MH-susceptible. Neurological examination was completely normal. Histologically, these 5 patients showed a highly variable proportion (6-89%) of cores in type 1 fibers on light microscopy. In 3 patients definite central cores were found, in 1 patient multicore disease was diagnosed, and 1 patients presented with a mixed central/paracentral form. Electron microscopy could detect cores in only 4 out of 5 patients. These results demonstrate the difficulty to diagnose central or multicore disease and suggest that mixed forms within the same family may occur. The one histologically dubious patient in this family shows that the most sensitive test for the diagnosis of this myopathy might be the IVCT.