@Article{info:doi/10.2196/67111,
author="Khairat, Saif
and Morelli, Jennifer
and Liao, Wan-Ting
and Aucoin, Julia
and Edson, S. Barbara
and Jones, B. Cheryl",
title="Association of Virtual Nurses' Workflow and Cognitive Fatigue During Inpatient Encounters: Cross-Sectional Study",
journal="JMIR Hum Factors",
year="2025",
month="Apr",
day="22",
volume="12",
pages="e67111",
keywords="virtual nursing",
keywords="telemedicine",
keywords="cognitive fatigue",
keywords="eye-tracking technology",
keywords="eye tracking",
keywords="eye",
keywords="nursing",
keywords="virtual",
keywords="cross-sectional study",
keywords="workflow",
keywords="inpatient",
keywords="fatigue",
keywords="pupil size",
keywords="pupil",
keywords="tracking",
keywords="USA",
keywords="United States",
keywords="design",
keywords="cognitive",
keywords="virtual care",
keywords="nurse",
keywords="delivery model",
keywords="technology",
keywords="communication",
keywords="EHR",
keywords="electronic health record",
keywords="virtual nurse",
abstract="Background: The virtual nursing delivery model enables the provision of expert nursing care from a remote location, using technology such as audio and video communication, remote monitoring devices, and access to electronic health records. Virtual nurses spend an extensive amount of time on computers to provide care, and little is known about how this workflow may affect and contribute to cognitive fatigue. Objective: This study aimed to use eye tracking technology and pupil size variation to determine instances of virtual nurse cognitive fatigue during their typical workflow. Methods: This study examined the virtual nursing workflow by recording and analyzing virtual nurse encounters using eye tracking. This cross-sectional study was conducted during regular 12-hour shifts at a major Southeastern health center in the United States. Results: The study found that 75\% (22/29) of virtual nursing encounters demonstrated a first fatigue instance at 9.8 minutes during patient discharges and at 11.9 minutes during patient admissions. Conclusions: This study provides valuable insights into virtual nursing workflow design and how it may impact the cognitive fatigue levels of nurses providing inpatient virtual care. ",
doi="10.2196/67111",
url="https://humanfactors.jmir.org/2025/1/e67111"
}


@Article{info:doi/10.2196/70640,
author="Li Jung, Lu
and Chou, Chin Pei
and Wu, Yu-Hua",
title="Limited Moderating Effect of Podcast Listening on Work Stress and Emotional Exhaustion Among Nurses During the COVID-19 Pandemic: Cross-Sectional Study",
journal="JMIR Nursing",
year="2025",
month="Apr",
day="16",
volume="8",
pages="e70640",
keywords="work stress",
keywords="emotional exhaustion",
keywords="podcasts",
keywords="nurses",
keywords="COVID-19",
keywords="mental health",
abstract="Background: The COVID-19 pandemic placed unprecedented pressure on health care systems worldwide, significantly impacting frontline health care workers, especially nurses. These professionals faced considerable psychological stress from caring for patients with COVID-19 and the fear of spreading the virus to their families. Studies report that more than 60\% (132/220) of nurses experience anxiety, depression, and emotional exhaustion, which adversely affect their mental health and the quality of care they provide. Objective: This study aimed to investigate the relationship between work-related stress and emotional exhaustion among nurses and to assess whether listening to podcasts moderates this association. Methods: A cross-sectional online survey was conducted between March 1, 2023, and March 31, 2023. A total of 271 clinical nurses, aged 20 years to 65 years, were recruited for the study. Participants were divided into 2 groups: experimental group consisting of regular podcast listeners (n=173) and control group comprising nonlisteners (n=98). Ethical approval for this study was obtained from the local ethics committee (IRB number YGHIRB20230421B). Validated scales were used to measure work stress, emotional dissonance, and emotional exhaustion. Data analysis included descriptive statistics, independent t tests, and structural equation modeling to examine the relationships between variables. Results: No statistically significant differences were found between the experimental and control groups in terms of overall work stress (mean difference=--0.09, 95\% CI --0.31 to 0.13; P=.42) or emotional exhaustion (mean difference=0.07, 95\% CI --0.15 to 0.29; P=.53). Emotional dissonance emerged as a significant predictor of emotional exhaustion in both the experimental ($\beta$=0.476, P<.001) and control ($\beta$=0.321, P=.01) groups. Nurses reporting higher workloads had significantly higher emotional exhaustion levels (experimental group: $\beta$=0.302, P<.001; control group: $\beta$=0.327, P=.002). Podcast listening demonstrated only a slight, nonsignificant moderating effect. Conclusions: Although podcasts alone may not significantly reduce work stress or emotional exhaustion among nurses, there was a potential, albeit limited, moderating effect of podcasts on emotional well-being. They could serve as a supplementary tool for emotional support. However, broader and more comprehensive interventions are required to address the underlying causes of stress and emotional exhaustion in this population. More in-depth exploration and recommendations are possible by analyzing the content and patterns of listening. Further research is needed to examine the long-term benefits of integrating podcasts with other digital tools for holistic stress management in health care settings. ",
doi="10.2196/70640",
url="https://nursing.jmir.org/2025/1/e70640",
url="http://www.ncbi.nlm.nih.gov/pubmed/40159623"
}


@Article{info:doi/10.2196/67190,
author="Zhang, Zheyuan
and Sun, Sijin
and Moradbakhti, Laura
and Hall, Andrew
and Mougenot, Celine
and Chen, Juan
and Calvo, A. Rafael",
title="Health Care Professionals' Engagement With Digital Mental Health Interventions in the United Kingdom and China: Mixed Methods Study on Engagement Factors and Design Implications",
journal="JMIR Ment Health",
year="2025",
month="Apr",
day="4",
volume="12",
pages="e67190",
keywords="burnout",
keywords="digital mental health interventions",
keywords="engagement",
keywords="eHealth",
keywords="design",
keywords="health care professional",
keywords="health care workers",
keywords="United Kingdom",
keywords="UK",
keywords="China",
keywords="Chinese",
keywords="occupational stress",
keywords="mixed-methods",
keywords="stigma",
keywords="well-being",
keywords="mental health",
keywords="digital health",
keywords="occupational health",
abstract="Background: Mental health issues like occupational stress and burnout, compounded with the after-effects of COVID-19, have affected health care professionals (HCPs) around the world. Digital mental health interventions (DMHIs) can be accessible and effective in supporting well-being among HCPs. However, low engagement rates of DMHIs are frequently reported, limiting the potential effectiveness. More evidence is needed to reveal the factors that impact HCPs' decision to adopt and engage with DMHIs. Objective: This study aims to explore HCPs' motivation to engage with DMHIs and identify key factors affecting their engagement. Amongst these, we include cultural factors impacting DMHI perception and engagement among HCPs. Methods: We used a mixed method approach, with a cross-sectional survey (n=438) and semistructured interviews (n=25) with HCPs from the United Kingdom and China. Participants were recruited from one major public hospital in each country. Results: Our results demonstrated a generally low engagement rate with DMHIs among HCPs from the 2 countries. Several key factors that affect DMHI engagement were identified, including belonging to underrepresented cultural and ethnic groups, limited mental health knowledge, low perceived need, lack of time, needs for relevance and personal-based support, and cultural elements like self-stigma. The results support recommendations for DMHIs for HCPs. Conclusions: Although DMHIs can be an ideal alternative mental health support for HCPs, engagement rates among HCPs in China and the United Kingdom are still low due to multiple factors and barriers. More research is needed to develop and evaluate tailored DMHIs with unique designs and content that HCPs can engage from various cultural backgrounds. ",
doi="10.2196/67190",
url="https://mental.jmir.org/2025/1/e67190"
}


@Article{info:doi/10.2196/66338,
author="Keefe, M. Janice
and McCloskey, Rose
and Hodgins, J. Marilyn
and McArthur, Caitlin
and MacKenzie, Adrian
and Weeks, E. Lori
and Estabrooks, A. Carole",
title="Examining Quality of Work Life in Atlantic Canadian Long-Term Care Homes: Protocol for a Cross-Sectional Survey Study",
journal="JMIR Res Protoc",
year="2025",
month="Mar",
day="31",
volume="14",
pages="e66338",
keywords="residential long-term care",
keywords="care staff",
keywords="Atlantic Canada",
keywords="quality of work life",
keywords="work environment",
keywords="health and well-being",
abstract="Background: The Canadian long-term care (LTC) workforce cares for increasingly complex residents. With greater care needs come greater demands. Despite this, LTC staffing and resources are largely unchanged and underresearched over the last decade. The Atlantic provinces are home to the oldest population in Canada, indicating a high need for LTC. The health and well-being of the LTC workforce are critical components of care quality, yet only in Western Canada are such data routinely and systematically collected. Translating Research in Elder Care is a 2-decade research program studying the LTC work environment and has found strong links between the working conditions of LTC staff and resident outcomes. We draw upon their success to generate the evidence needed to understand, support, and manage the LTC workforce in Canada's four Atlantic provinces. Objective: This study aims (1) to assess the quality of work life among staff in LTC homes in Atlantic Canada; (2) to examine the effects of the work environment on the quality of work life; and (3) to build capacity for research in the LTC sector in Atlantic Canada among knowledge users, researchers, and trainees. The objective of this paper is to describe the approach needed to examine the quality of work life and health of care staff in LTC homes. Methods: Stratified random sampling will be used to recruit homes in Atlantic Canada. The sampling frame was designed to recruit 25\% of the LTC homes in each of the 4 provinces with proportional representation by size; ownership model; and, if applicable, region or language. Key outcome variables include measures of mental health and well-being, quality of work life, intention to leave, workplace context, and missed or rushed care. Primary data will be obtained through structured interviews with care aides and web-based surveys from registered nurses, licensed practical nurses, managers, and allied health providers. Eligible participants were from an LTC home with at least 25 residents, 90\% of whom were aged 65 years or older, and had worked in the home for at least 3 months. Multivariate analyses include regression analysis for explaining predictors of quality of work-life outcomes and multilevel modeling for more complex relationships of staff outcomes by provinces and LTC home characteristics. Results: Data collection and cleaning are complete as of October 2024 (N=2305). Care aides (n=1338), nurses (n=724), allied health providers (n=154), and managers (n=89) from 53 homes make up the sample. Data analysis is ongoing. Initially, individual reports will present descriptive data for each participating LTC home. Concurrent analysis is planned for publication in peer-reviewed journals. Conclusions: This peer-reviewed research protocol lays the foundation for a comprehensive analysis of the effects of the work environment on the quality of work life of LTC staff in Atlantic Canada. International Registered Report Identifier (IRRID): DERR1-10.2196/66338 ",
doi="10.2196/66338",
url="https://www.researchprotocols.org/2025/1/e66338"
}


@Article{info:doi/10.2196/70982,
author="Amirabdolahian, Saeed
and Pare, Guy
and Tams, Stefan",
title="Digital Wellness Programs in the Workplace: Meta-Review",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="14",
volume="27",
pages="e70982",
keywords="digital wellness programs",
keywords="corporate wellness",
keywords="health interventions",
keywords="efficacy",
keywords="acceptability",
keywords="meta-review",
keywords="mHealth",
keywords="eHealth",
abstract="Background: Corporate wellness programs are increasingly using digital technologies to promote employee health. Digital wellness programs (DWPs) refer to initiatives that deliver health interventions through digital tools. Despite a growing body of evidence on DWPs, the literature remains fragmented across multiple health domains. Objective: This study aims to provide a comprehensive synthesis of existing research on the efficacy (eg, impact on employee's physical health, mental well-being, behavioral changes, and absenteeism) and acceptability (eg, engagement, perceived usefulness, and adoption) of employer-provided DWPs. Specifically, we aim to map the extent, range, and nature of research on this topic; summarize key findings; identify gaps; and facilitate knowledge dissemination. Methods: We conducted a meta-review of studies published between 2000 and 2023. We adopted a database-driven search approach, including the MEDLINE, PsycINFO, ProQuest Central, and Web of Science Core Collection databases. The inclusion criteria consisted of (1) review articles; (2) publications in English, French, or German; (3) studies reporting on digital health interventions implemented in organizations; (4) studies reporting on nonclinical or preclinical employee populations; and (5) studies assessing the efficacy and acceptability of employer-provided DWPs. We performed a descriptive numerical summary and thematic analysis of the included studies. Results: Out of 593 nonduplicate studies screened, 29 met the inclusion criteria. The most investigated health domains included mental health (n=19), physical activity (n=8), weight management (n=6), unhealthy behavior change (n=4), and sleep management (n=2). In total, 24 reviews focused on the efficacy of DWPs, primarily in relation to health-related outcomes (eg, stress and weight), while fewer reviews addressed organization-related outcomes (eg, burnout and absenteeism). Four reviews explored the mechanisms of action, and 3 assessed the acceptability of DWPs using various measures. Overall, the findings support the efficacy and acceptability of DWPs, although significant gaps persist, particularly regarding the durability of outcomes, the role of technology, and the causal mechanisms underlying behavioral change. Conclusions: While DWPs show promise across a variety of health domains, several aspects of their effectiveness remain underexplored. Practitioners should capitalize on existing evidence of successful DWPs while acknowledging the limitations in the literature. ",
doi="10.2196/70982",
url="https://www.jmir.org/2025/1/e70982"
}


@Article{info:doi/10.2196/59913,
author="Lenker, Puzino Kristina
and Felix, L. Laura
and Cichy, Sarah
and Lehman, Erik
and Logan, M. Jeanne
and Murray, Michael
and Kraschnewski, L. Jennifer",
title="Using the Community Resilience Model and Project ECHO to Build Resiliency in Direct Support Professionals: Protocol for a Longitudinal Survey",
journal="JMIR Res Protoc",
year="2025",
month="Mar",
day="6",
volume="14",
pages="e59913",
keywords="neurodiversity",
keywords="community resilience model",
keywords="Project ECHO",
keywords="direct support professionals",
keywords="autism",
keywords="telementoring",
keywords="methods and feasibility",
keywords="resiliency",
keywords="intellectual disabilities",
keywords="ASD",
keywords="autism spectrum disorder",
keywords="DSP",
keywords="supportive care",
keywords="community resilience",
keywords="burnout",
keywords="resilience",
keywords="neurodivergent client",
keywords="neurodevelopmental disorders",
keywords="evidence-based knowledge",
abstract="Background: Individuals with intellectual disabilities or autism spectrum disorder (ID/A) sometimes require supportive services from direct support professionals (DSPs). The supportive care provided to individuals with ID/A by DSPs can vary from assistance with daily living activities to navigating society. The COVID-19 pandemic not only exacerbated poor outcomes for individuals with ID/A but also for DSPs, who report experiencing burnout in the aftermath of the pandemic. DSPs are critical to providing much-needed support to individuals with ID/A. Objective: The goal of this study is to evaluate the impact of the community resilience model on DSP burnout and neurodivergent client outcomes using the Project ECHO (Extension for Community Healthcare Outcomes) telementoring platform as a dissemination tool. Methods: This protocol leverages community resilience theory and telementoring through the Project ECHO model to foster resilience in DSPs and their neurodiverse client population. ECHO participants' resilience behaviors will be evaluated via surveys including the Connor Davison Resilience Scale and the WHO-5 Well-Being Index. These surveys will be administered preprogram, at the end of the 8-week ECHO program, and 90 days after the ECHO program's completion. Pre-post relationships will be assessed using generalized estimating equations. The main outcomes will be self-reported changes in knowledge, self-efficacy, and resilience. Results: All ECHO program cohorts and follow-up data collection have concluded, with 131 survey participants. The project team is currently analyzing and interpreting the data. We anticipate having all data analyzed and interpreted by February 2025. Conclusions: DSPs provide critical services to individuals with ID/A. By providing skills in resiliency via the ECHO model, participants will be able to apply resiliency to their own professional lives while fostering resilience within their neurodiverse client base, leading to increased positive outcomes for both groups. International Registered Report Identifier (IRRID): DERR1-10.2196/59913 ",
doi="10.2196/59913",
url="https://www.researchprotocols.org/2025/1/e59913",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053792"
}


@Article{info:doi/10.2196/62782,
author="Nomeikaite, Auguste
and Gelezelyte, Odeta
and B{\"o}ttche, Maria
and Andersson, Gerhard
and Kazlauskas, Evaldas",
title="Role of Tailored Timing and Frequency Prompts on the Efficacy of an Internet-Delivered Stress Recovery Intervention for Health Care Workers: Randomized Controlled Trial",
journal="JMIR Ment Health",
year="2025",
month="Jan",
day="28",
volume="12",
pages="e62782",
keywords="internet interventions",
keywords="mental health",
keywords="stress",
keywords="health care workers",
keywords="short message service",
keywords="cognitive behavioral therapy",
keywords="internet-delivered cognitive behavioral therapy",
keywords="psychotherapy",
keywords="randomized",
keywords="controlled trial",
keywords="engagement",
keywords="SMSl worker",
keywords="usage",
keywords="occupational health",
keywords="provider",
keywords="prompt",
keywords="message",
abstract="Background: Prompts offer a promising strategy to promote client engagement in internet-delivered cognitive behavioral therapy (ICBT). However, if the prompts do not meet the needs of clients, they can potentially be more obtrusive rather than helpful. Objective: The aim of this study was to test if prompts tailored based on timing and frequency, aligned with preintervention goal setting, can increase usage and the efficacy of a therapist-supported ICBT stress recovery intervention for health care workers. Methods: The 2-arm randomized controlled trial included 87 health care workers (99\% female, aged 19-68 years: mean 39.61, SD 11.49): 43 in the standard intervention group and 44 in the tailored prompts group. The primary outcome measure was the Recovery Experiences Questionnaire, and the secondary outcomes were the Perceived Stress Scale-4, the Patient Health Questionnaire-4, and the World Health Organization-5 Well-Being Index. The self-report data were collected before the intervention (September 2022), postintervention (October 2022), and 6-month follow-up (May 2023). Results: The results showed that tailored prompts, although appreciated by the majority (39/40, 98\%), did not improve intervention usage indicators, such as the number of logins (t85=--0.91; P=.36), modules opened (t83.57=--1.47; P=.15), modules completed (t85=--0.71; P=.48), exercises completed (t85=--1.05; P=.30), or the time spent using the program ($\chi$22=1.1; P=.57). Similarly, tailored prompts did not increase the effects of the intervention in terms of stress recovery skills (Cohen d ranging from 0.31 to 0.85), perceived stress (d=--0.08; --0.70), depression (d=--0.11; --0.38), anxiety (d=--0.32; --0.64), or psychological well-being (d=0.26; 0.46). In addition, the standard intervention group showed greater long-term stress recovery effects than the group using the internet-delivered intervention supplemented by tailored prompts ($\beta$=--0.24, P=.03). Conclusions: Although the study confirmed the efficacy of the program, the merits of tailored prompts in ICBT for stress recovery were not supported. Future research is needed to test the effects of the stress recovery intervention supplemented by goal setting and tailored prompts. Trial Registration: ClinicalTrials.gov NCT05553210; https://clinicaltrials.gov/study/NCT05553210 ",
doi="10.2196/62782",
url="https://mental.jmir.org/2025/1/e62782"
}


@Article{info:doi/10.2196/63197,
author="Antico, Lia
and Brewer, Judson",
title="Digital Mindfulness Training for Burnout Reduction in Physicians: Clinician-Driven Approach",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="24",
volume="9",
pages="e63197",
keywords="burnout",
keywords="anxiety",
keywords="empathy fatigue",
keywords="physician",
keywords="mindfulness",
keywords="digital therapeutics",
keywords="app",
keywords="smartphone",
keywords="podcast",
keywords="compassion",
keywords="health care provider",
keywords="training",
keywords="physician burnout",
keywords="cynicism",
keywords="efficacy",
keywords="treatment",
keywords="meditation",
keywords="chronic",
keywords="workplace stress",
keywords="digital health",
keywords="mHealth",
keywords="mobile phone",
abstract="Background: Physician burnout is widespread in health care systems, with harmful consequences on physicians, patients, and health care organizations. Mindfulness training (MT) has proven effective in reducing burnout; however, its time-consuming requirements often pose challenges for physicians who are already struggling with their busy schedules. Objective: This study aimed to design a short and pragmatic digital MT program with input from clinicians specifically to address burnout and to test its efficacy in physicians. Methods: Two separate nonrandomized pilot studies were conducted. In the first study, 27 physicians received the digital MT in a podcast format, while in the second study, 29 physicians and nurse practitioners accessed the same training through a free app-based platform. The main outcome measure was cynicism, one dimension of burnout. The secondary outcome measures were emotional exhaustion (the second dimension of burnout), anxiety, depression, intolerance of uncertainty, empathy (personal distress, perspective taking, and empathic concern subscales), self-compassion, and mindfulness (nonreactivity and nonjudgment subscales). In the second study, worry, sleep disturbances, and difficulties in emotion regulation were also measured. Changes in outcomes were assessed using self-report questionnaires administered before and after the treatment and 1 month later as follow-up. Results: Both studies showed that MT decreased cynicism (posttreatment: 33\% reduction; P?.04; r?0.41 and follow-up: 33\% reduction; P?.04; r?0.45), while improvements in emotional exhaustion were observed solely in the first study (25\% reduction, P=.02, r=.50 at posttreatment; 25\% reduction, P=.008, r=.62 at follow-up). There were also significant reductions in anxiety (P?.01, r?0.49 at posttreatment; P?.01, r?0.54 at follow-up), intolerance of uncertainty (P?.03, r?.57 at posttreatment; P<.001, r?0.66 at follow-up), and personal distress (P=.03, r=0.43 at posttreatment; P=.03, r=0.46 at follow-up), while increases in self-compassion (P?.02, r?0.50 at posttreatment; P?.006, r?0.59 at follow-up) and mindfulness (nonreactivity: P?.001, r?0.69 at posttreatment; P?.004, r?0.58 at follow-up; nonjudgment: P?.009, r?0.50 at posttreatment; P?.03, r?0.60 at follow-up). In addition, the second study reported significant decreases in worry (P=.04, r=0.40 at posttreatment; P=.006, r=0.58 at follow-up), sleep disturbances (P=.04, r=0.42 at posttreatment; P=.01, r=0.53 at follow-up), and difficulties in emotion regulation (P=.005, r=0.54 at posttreatment; P<.001, r=0.70 at follow-up). However, no changes were observed over time for depression or perspective taking and empathic concern. Finally, both studies revealed significant positive correlations between burnout and anxiety (cynicism: r?0.38; P?.04; emotional exhaustion: r?0.58; P?.001). Conclusions: To our knowledge, this research is the first where clinicians were involved in designing an intervention targeting burnout. These findings suggest that this digital MT serves as a viable and effective tool for alleviating burnout and anxiety among physicians. Trial Registration: ClinicalTrials.gov NCT06145425; https://clinicaltrials.gov/study/NCT06145425 ",
doi="10.2196/63197",
url="https://formative.jmir.org/2025/1/e63197"
}


@Article{info:doi/10.2196/50852,
author="Bienefeld, Nadine
and Keller, Emanuela
and Grote, Gudela",
title="AI Interventions to Alleviate Healthcare Shortages and Enhance Work Conditions in Critical Care: Qualitative Analysis",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="13",
volume="27",
pages="e50852",
keywords="artificial intelligence",
keywords="AI",
keywords="work design",
keywords="sociotechnical system",
keywords="work",
keywords="job",
keywords="occupational health",
keywords="sociotechnical",
keywords="new work",
keywords="future of work",
keywords="satisfaction",
keywords="health care professionals",
keywords="intensive care",
keywords="ICU",
keywords="stress mitigation",
keywords="worker",
keywords="employee",
keywords="stress",
keywords="health care professional",
keywords="overburdened",
keywords="burden",
keywords="burnout",
keywords="autonomy",
keywords="competence",
keywords="flexible",
keywords="task",
keywords="workplace",
keywords="hospital",
abstract="Background: The escalating global scarcity of skilled health care professionals is a critical concern, further exacerbated by rising stress levels and clinician burnout rates. Artificial intelligence (AI) has surfaced as a potential resource to alleviate these challenges. Nevertheless, it is not taken for granted that AI will inevitably augment human performance, as ill-designed systems may inadvertently impose new burdens on health care workers, and implementation may be challenging. An in-depth understanding of how AI can effectively enhance rather than impair work conditions is therefore needed. Objective: This research investigates the efficacy of AI in alleviating stress and enriching work conditions, using intensive care units (ICUs) as a case study. Through a sociotechnical system lens, we delineate how AI systems, tasks, and responsibilities of ICU nurses and physicians can be co-designed to foster motivating, resilient, and health-promoting work. Methods: We use the sociotechnical system framework COMPASS (Complementary Analysis of Sociotechnical Systems) to assess 5 job characteristics: autonomy, skill diversity, flexibility, problem-solving opportunities, and task variety. The qualitative analysis is underpinned by extensive workplace observation in 6 ICUs (approximately 559 nurses and physicians), structured interviews with work unit leaders (n=12), and a comparative analysis of data science experts' and clinicians' evaluation of the optimal levels of human-AI teaming. Results: The results indicate that AI holds the potential to positively impact work conditions for ICU nurses and physicians in four key areas. First, autonomy is vital for stress reduction, motivation, and performance improvement. AI systems that ensure transparency, predictability, and human control can reinforce or amplify autonomy. Second, AI can encourage skill diversity and competence development, thus empowering clinicians to broaden their skills, increase the polyvalence of tasks across professional boundaries, and improve interprofessional cooperation. However, careful consideration is required to avoid the deskilling of experienced professionals. Third, AI automation can expand flexibility by relieving clinicians from administrative duties, thereby concentrating their efforts on patient care. Remote monitoring and improved scheduling can help integrate work with other life domains. Fourth, while AI may reduce problem-solving opportunities in certain areas, it can open new pathways, particularly for nurses. Finally, task identity and variety are essential job characteristics for intrinsic motivation and worker engagement but could be compromised depending on how AI tools are designed and implemented. Conclusions: This study demonstrates AI's capacity to mitigate stress and improve work conditions for ICU nurses and physicians, thereby contributing to resolving health care staffing shortages. AI solutions that are thoughtfully designed in line with the principles for good work design can enhance intrinsic motivation, learning, and worker well-being, thus providing strategic value for hospital management, policy makers, and health care professionals alike. ",
doi="10.2196/50852",
url="https://www.jmir.org/2025/1/e50852"
}


@Article{info:doi/10.2196/51101,
author="Burrell, Joanna
and Baker, Felicity
and Bennion, Russell Matthew",
title="Resilience Training Web App for National Health Service Keyworkers: Pilot Usability Study",
journal="JMIR Med Educ",
year="2025",
month="Jan",
day="6",
volume="11",
pages="e51101",
keywords="resilience",
keywords="workplace stress",
keywords="National Health Service",
keywords="NHS keyworker",
keywords="digital learning",
keywords="digital health",
keywords="usability",
keywords="feasibility",
keywords="mental health",
keywords="pilot study",
keywords="learning",
keywords="training",
keywords="exercise",
keywords="primary care provider",
keywords="health care professional",
keywords="occupational health",
keywords="worker",
keywords="hospital",
keywords="emergency",
keywords="survey",
keywords="questionnaire",
keywords="mobile phone",
abstract="Background: It is well established that frontline health care staff are particularly at risk of stress. Resilience is important to help staff to manage daily challenges and to protect against burnout. Objective: This study aimed to assess the usability and user perceptions of a resilience training web app developed to support health care keyworkers in understanding their own stress response and to help them put into place strategies to manage stress and to build resilience. Methods: Nurses (n=7) and other keyworkers (n=1), the target users for the resilience training web app, participated in the usability evaluation. Participants completed a pretraining questionnaire capturing basic demographic information and then used the training before completing a posttraining feedback questionnaire exploring the impact and usability of the web app. Results: From a sample of 8 keyworkers, 6 (75\%) rated their current role as ``sometimes'' stressful. All 8 (100\%) keyworkers found the training easy to understand, and 5 of 7 (71\%) agreed that the training increased their understanding of both stress and resilience. Further, 6 of 8 (75\%) agreed that the resilience model had helped them to understand what resilience is. Many of the keyworkers (6/8, 75\%) agreed that the content was relevant to them. Furthermore, 6 of 8 (75\%) agreed that they were likely to act to develop their resilience following completion of the training. Conclusions: This study tested the usability of a web app for resilience training specifically targeting National Health Service keyworkers. This work preceded a larger scale usability study, and it is hoped this study will help guide other studies to develop similar programs in clinical settings. ",
doi="10.2196/51101",
url="https://mededu.jmir.org/2025/1/e51101"
}


@Article{info:doi/10.2196/58037,
author="Pei, Tao
and Ding, Yinan
and Tang, Jinsong
and Liao, Yanhui",
title="Evaluating the Effectiveness of a Multimodal Psychotherapy Training Program for Medical Students in China: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2025",
month="Jan",
day="3",
volume="14",
pages="e58037",
keywords="multimodal teaching",
keywords="psychotherapy training",
keywords="Chinese medical students",
keywords="randomized controlled trial",
abstract="Background: Psychotherapy is central to the treatment of mental disorders, highlighting the importance of medical students and residents developing competencies in this area. Chinese medical residents have expressed a strong need for psychotherapy training, yet they are generally dissatisfied with the current offerings. This paper presents the protocol for an evidence-based, well-structured psychotherapy teaching program aimed at medical students and residents. Objective: This study involves a randomized controlled trial of a 2-day multimodal intensive educational intervention designed to evaluate the effectiveness of a new psychotherapy teaching program for medical students and residents in China. The primary outcomes include participants' knowledge and utilization of psychotherapy, training program acceptability, self-reported self-efficacy, and motivation to apply psychotherapy. Methods: This 2-arm randomized controlled trial was conducted at Sir Run Run Shaw Hospital. The study aimed to recruit approximately 160 medical students and residents, with about 80 participants in the intervention group and 80 in the control group. Both groups completed a baseline survey before participation, reporting their psychotherapy knowledge, utilization of psychotherapy, self-efficacy, and self-motivation. The intervention group received a 2-day multimodal intensive educational intervention (supervision-based online teaching), while the waitlist control group did not receive any intervention during this period. Both groups were followed up for 8 weeks, completing the same survey administered at baseline. At the end of the study, the control group received the intervention. The primary outcome measure was the change in trainees' psychotherapy knowledge before and after the intervention training. Secondary outcome measures included changes in the trainees' utilization of psychotherapy, self-reported self-efficacy, and self-reported motivation for psychotherapy. Additionally, training program acceptability was assessed. Analysis of covariance was used to analyze the primary outcomes. Pearson correlations and regression analysis explored factors associated with the knowledge score at baseline. The secondary outcomes, including participants' psychotherapy utilization, confidence, and motivation, were analyzed using the same methods as for knowledge. All tests were 2-tailed, with a significance level set at P<.05. Results: A total of 160 participants were recruited and randomized between January 4 and 12, 2024. Baseline assessments were conducted from January 28 to February 1, 2024. The psychotherapy training program for the intervention group took place on February 3 and 4, 2024. Posttraining assessments were conducted starting April 1, 2024. Due to withdrawals, incomplete surveys, and data loss, we had a total of 113 participants: 57 in the intervention group and 56 in the control group. The amount of data varied across measures. The data analysis was finished in August 2024. Conclusions: This study aims to evaluate the effectiveness of the multimodal psychotherapy training program for medical students in China. If this brief, cognitive behavioral therapy--based psychotherapy skill training proves effective, the potential mental health impact of its nationwide expansion could be significant. Trial Registration: ClinicalTrials.gov NCT06258460; https://clinicaltrials.gov/ct2/show/NCT06258460 International Registered Report Identifier (IRRID): DERR1-10.2196/58037 ",
doi="10.2196/58037",
url="https://www.researchprotocols.org/2025/1/e58037",
url="http://www.ncbi.nlm.nih.gov/pubmed/39752191"
}


@Article{info:doi/10.2196/59093,
author="Zhang, Lin
and Huang, Shuang
and Liu, Sha
and Huang, Yuanxiu
and Chen, Shan
and Hu, Jinsong
and Xu, Mingzhong",
title="Effectiveness of an Internet-Based Acceptance and Commitment Therapy Intervention for Reducing Psychological Distress in Health Care Professionals: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="18",
volume="26",
pages="e59093",
keywords="acceptance and commitment therapy",
keywords="internet-based intervention",
keywords="stress",
keywords="anxiety",
keywords="depression",
keywords="burnout",
keywords="health care professionals",
keywords="randomized controlled trial",
abstract="Background: Psychological distress is prevalent among health care professionals and can lead to poor-quality patient care. Internet-based acceptance and commitment therapy (iACT) is a promising intervention for improving mental health due to its low cost and easy access. However, there is limited evidence of its effectiveness in reducing health care professionals' psychological distress. Objective: This study aims to examine the effects of iACT on psychological distress (stress, anxiety, and depression) among health care professionals in China. Methods: From October 2022 to February 2023, a total of 108 health care professionals were recruited via WeChat and randomized into a 6-week iACT intervention program with therapist support (n=54) or waitlist control group (n=54). The intervention included 21 self-guided sessions combining teaching videos, mindfulness practices, and journal writing, followed by 7 live conferences to share experiences and discuss questions, all conducted via WeChat. Primary outcomes (stress, anxiety, and depression) and secondary outcomes (burnout and psychological flexibility) were collected using the Sojump platform, the most popular web-based survey platform in China. Generalized estimating equations were used to compare the outcomes between groups and assess the effects of group, time, and group-by-time interaction. Subgroup and sensitive analyses were performed to test the robustness of our findings across various groups. Results: Among the 108 health care professionals, 68 (63\%) completed the follow-up assessment at week 10, including 35 (64.8\%) in the iACT group and 33 (61.1\%) in the waitlist control group. Of the 54 participants in the iACT group, all attended at least 2 sessions, and 25 attended all 28 sessions. On average, participants attended 20 (71\%) sessions. The iACT group showed significant improvement in the Depression Anxiety and Stress Scales-21 total score (d=0.82, 95\% CI 0.39-1.26), and the effects were sustained for 4 weeks after the intervention (d=1.08, 95\% CI 0.57-1.59). Compared to the control group, the iACT group showed significantly lower scores in burnout at week 6 (d=1.42, 95\% CI 0.95-1.89) and week 10 (d=1.52, 95\% CI 0.98-2.06). The iACT group showed significantly higher psychological flexibility at week 6 (d=1.23, 95\% CI 0.77-1.69) and week 10 (d=1.15, 95\% CI 0.64-1.66). Conclusions: The iACT effectively decreased health care professionals' psychological distress and burnout and improved their psychological flexibility. Our findings provide implications and guidance for the development and broad implementation of iACT in health care settings to improve the mental health of health care professionals. Trial Registration: Chinese Clinical Trial Register ChiCTR2400093584; https://tinyurl.com/38werwsk ",
doi="10.2196/59093",
url="https://www.jmir.org/2024/1/e59093",
url="http://www.ncbi.nlm.nih.gov/pubmed/39693127"
}


@Article{info:doi/10.2196/59927,
author="Xie, Yao
and Fadahunsi, Philip Kayode
and Flynn, Paul
and Taylor-Robinson, Simon
and Gallagher, Joseph
and Cullen, Walter
and O'Donoghue, John",
title="Barriers and Facilitators of International Health Care Students' Well-Being in Higher Education: Protocol for a Systematic Integrative Review",
journal="JMIR Res Protoc",
year="2024",
month="Dec",
day="11",
volume="13",
pages="e59927",
keywords="integrative review",
keywords="higher education",
keywords="international students",
keywords="educational migrants",
keywords="barriers",
keywords="facilitators",
keywords="well-being",
keywords="mixed methods synthesis",
keywords="health care students",
keywords="health care education",
abstract="Background: International health care students encounter unique hurdles as they pursue education in foreign countries. These challenges, stemming from adjustment to new cultural environments and stressful academic programs, significantly impact their well-being. Understanding the barriers and facilitators experienced by international health care students is crucial for ensuring their successful integration into academic and professional spheres. Most existing reviews focus on specific populations or disciplines, thus limiting their generalizability. Objective: This systematic integrative review aims to provide a comprehensive understanding of barriers and facilitators of international health care students' well-being in higher education. Methods: The protocol follows the Joanna Briggs Institute's guidance for a mixed methods systematic review. The main information sources will include PubMed, Scopus, Web of Science, and EBSCOhost, supplemented with manual reference search and citation tracking using Google Scholar. The study selection will be done independently by 2 reviewers based on predetermined eligibility criteria. The study population will consist of international higher education students enrolled in human health--related disciplines including medicine, pharmacy, nursing, and allied health care fields. Qualitative and quantitative data relating to barriers and facilitators of international health care students' well-being will be extracted using a customized data extraction template in Covidence review management software. Quantitative data will be ``qualitized'' and integrated with qualitative data using a convergent integrated approach, as described in the Joanna Briggs Institute's guidance. The integrated data will then be synthesized using a thematic analysis approach to provide a comprehensive understanding of barriers and facilitators of international health care students' well-being. Results: The initial literature search yielded 2408 papers from the selected databases. The findings of this review will be presented in a narrative format, supported by visualizations such as tables and diagrams. The review is expected to be completed by December 2024. Conclusions: This systematic integrative review will identify barriers and facilitators of international health care students' well-being in higher education. The findings could inform the development of targeted interventions and support initiatives in higher education institutions globally, with the ultimate goal of enhancing the well-being as well as the academic and professional success of international health care students. Trial Registration: PROSPERO CRD42024372785; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42024372785 International Registered Report Identifier (IRRID): PRR1-10.2196/59927 ",
doi="10.2196/59927",
url="https://www.researchprotocols.org/2024/1/e59927"
}


@Article{info:doi/10.2196/52817,
author="Nadav, Janna
and Kaihlanen, Anu-Marja
and Kujala, Sari
and Keskim{\"a}ki, Ilmo
and Viitanen, Johanna
and Salovaara, Samuel
and Saukkonen, Petra
and V{\"a}nsk{\"a}, Jukka
and Vehko, Tuulikki
and Heponiemi, Tarja",
title="Factors Contributing to Successful Information System Implementation and Employee Well-Being in Health Care and Social Welfare Professionals: Comparative Cross-Sectional Study",
journal="JMIR Med Inform",
year="2024",
month="Nov",
day="21",
volume="12",
pages="e52817",
keywords="implementation",
keywords="health information systems",
keywords="client information systems",
keywords="stress",
keywords="healthcare professionals",
keywords="social welfare professionals",
keywords="clinician well-being",
keywords="workplace stress",
abstract="Background: The integration of information systems in health care and social welfare organizations has brought significant changes in patient and client care. This integration is expected to offer numerous benefits, but simultaneously the implementation of health information systems and client information systems can also introduce added stress due to the increased time and effort required by professionals. Objective: This study aimed to examine whether professional groups and the factors that contribute to successful implementation (participation in information systems development and satisfaction with software providers' development work) are associated with the well-being of health care and social welfare professionals. Methods: Data were obtained from 3 national cross-sectional surveys (n=9240), which were carried out among Finnish health care and social welfare professionals (registered nurses, physicians, and social welfare professionals) in 2020?2021. Self-rated stress and stress related to information systems were used as indicators of well-being. Analyses were conducted using linear and logistic regression analysis. Results: Registered nurses were more likely to experience self-rated stress than physicians (odds ratio [OR] --0.47; P>.001) and social welfare professionals (OR --0.68; P<.001). They also had a higher likelihood of stress related to information systems than physicians (b=--.11; P<.001). Stress related to information systems was less prevalent among professionals who did not participate in information systems development work (b=--.14; P<.001). Higher satisfaction with software providers' development work was associated with a lower likelihood of self-rated stress (OR --0.23; P<.001) and stress related to information systems (b=--.36 P<.001). When comparing the professional groups, we found that physicians who were satisfied with software providers' development work had a significantly lower likelihood of stress related to information systems (b=--.12; P<.001) compared with registered nurses and social welfare professionals. Conclusions: Organizations can enhance the well-being of professionals and improve the successful implementation of information systems by actively soliciting and incorporating professional feedback, dedicating time for information systems development, fostering collaboration with software providers, and addressing the unique needs of different professional groups. ",
doi="10.2196/52817",
url="https://medinform.jmir.org/2024/1/e52817"
}


@Article{info:doi/10.2196/55562,
author="Kubickova, Veronika
and Steel, Craig
and Moulds, L. Michelle
and Kanstrup, Marie
and Beer, Sally
and Darwent, Melanie
and Keating, Liza
and Holmes, A. Emily
and Iyadurai, Lalitha",
title="Reducing the Number of Intrusive Memories of Work-Related Traumatic Events in Frontline Health Care Staff During the COVID-19 Pandemic: Case Series",
journal="JMIR Hum Factors",
year="2024",
month="Nov",
day="18",
volume="11",
pages="e55562",
keywords="intrusive memories",
keywords="digital intervention",
keywords="psychological trauma",
keywords="remote delivery",
keywords="health care staff",
keywords="COVID-19",
keywords="case series",
abstract="Background: Frontline health care staff are frequently exposed to traumatic events as part of their work. Although this study commenced before the emergence of COVID-19, levels of exposure were heightened by the pandemic. Many health care staff members report intrusive memories of such events, which can elicit distress, affect functioning, and be associated with posttraumatic stress disorder symptoms in the long term. We need evidence-based interventions that are brief, preventative, nonstigmatizing, suitable for the working lives of frontline health care staff, and effective for repeated trauma exposure. A brief, guided imagery-competing task intervention involving a trauma reminder cue and Tetris gameplay may hold promise in this regard, given evidence that it can prevent and reduce the number of intrusive memories following trauma across various settings. Objective: This case series aims to investigate the impact of a brief imagery-competing task intervention on the number of intrusive memories, general functioning, and symptoms of posttraumatic stress, anxiety, and depression, and examine the feasibility and acceptability of the intervention for UK National Health Service frontline health care staff. The intervention was delivered with guidance from a clinical psychologist. Methods: We recruited 12 clinical staff from the UK National Health Service, specifically from emergency departments, the intensive care unit, and the ambulance service. We evaluated the intervention using an AB single-case experimental design, where the baseline (A) was the monitoring-only phase and the postintervention (B) period was the time after the intervention was first administered. Methods were adapted once the COVID-19 pandemic began. Results: There was a decrease (59\%) in the mean number of intrusive memories per day from baseline (mean 1.29, SD 0.94) to postintervention (mean 0.54, SD 0.51). There was a statistically significant reduction in the number of intrusive memories from baseline to postintervention, as shown by an aggregated omnibus analysis with a small effect size ($\tau$-U=--0.38; P<.001). Depression, anxiety, and posttraumatic stress symptoms all significantly reduced from preintervention to postintervention. Participants also reported improvements in functioning based on both quantitative and qualitative measures. The intervention was feasible to deliver and rated as acceptable by participants. Conclusions: These preliminary findings suggest that this brief therapist-guided imagery-competing task intervention offers a potential approach to mitigating the impact of work-related traumatic events in frontline health care staff, both during a pandemic and beyond. Randomized controlled trials will be an important next step. ",
doi="10.2196/55562",
url="https://humanfactors.jmir.org/2024/1/e55562"
}


@Article{info:doi/10.2196/64125,
author="Carrillo, Irene
and Skoumalov{\'a}, Ivana
and Bruus, Ireen
and Klemm, Victoria
and Guerra-Paiva, Sofia
and Kne?evi{\'c}, Bojana
and Jankauskiene, Augustina
and Jocic, Dragana
and Tella, Susanna
and Buttigieg, C. Sandra
and Srulovici, Einav
and Madarasov{\'a} Geckov{\'a}, Andrea
and P{\~o}lluste, Kaja
and Strametz, Reinhard
and Sousa, Paulo
and Odalovic, Marina
and Mira, Joaqu{\'i}n Jos{\'e}",
title="Psychological Safety Competency Training During the Clinical Internship From the Perspective of Health Care Trainee Mentors in 11 Pan-European Countries: Mixed Methods Observational Study",
journal="JMIR Med Educ",
year="2024",
month="Oct",
day="7",
volume="10",
pages="e64125",
keywords="psychological safety",
keywords="speaking up",
keywords="professional competence",
keywords="patient safety",
keywords="education",
keywords="adverse event",
abstract="Background: In the field of research, psychological safety has been widely recognized as a contributing factor to improving the quality of care and patient safety. However, its consideration in the curricula and traineeship pathways of residents and health care students is scarce. Objective: This study aims to determine the extent to which health care trainees acquire psychological safety competencies during their internships in clinical settings and identify what measures can be taken to promote their learning. Methods: A mixed methods observational study based on a consensus conference and an open-ended survey among a sample of health care trainee mentors from health care institutions in a pan-European context was conducted. First, we administered an ad hoc questionnaire to assess the perceived degree of acquisition or implementation and significance of competencies (knowledge, attitudes, and skills) and institutional interventions in psychological safety. Second, we asked mentors to propose measures to foster among trainees those competencies that, in the first phase of the study, obtained an average acquisition score of <3.4 (scale of 1-5). A content analysis of the information collected was carried out, and the spontaneity of each category and theme was determined. Results: In total, 173 mentors from 11 pan-European countries completed the first questionnaire (response rate: 173/256, 67.6\%), of which 63 (36.4\%) participated in the second consultation. The competencies with the lowest acquisition level were related to warning a professional that their behavior posed a risk to the patient, managing their possible bad reaction, and offering support to a colleague who becomes a second victim. The mentors' proposals for improvement of this competency gap referred to training in communication skills and patient safety, safety culture, work climate, individual attitudes, a reference person for trainees, formal incorporation into the curricula of health care degrees and specialization pathways, specific systems and mechanisms to give trainees a voice, institutional risk management, regulations, guidelines and standards, supervision, and resources to support trainees. In terms of teaching methodology, the mentors recommended innovative strategies, many of them based on technological tools or solutions, including videos, seminars, lectures, workshops, simulation learning or role-playing with or without professional actors, case studies, videos with practical demonstrations or model situations, panel discussions, clinical sessions for joint analysis of patient safety incidents, and debriefings to set and discuss lessons learned. Conclusions: This study sought to promote psychological safety competencies as a formal part of the training of future health care professionals, facilitating the translation of international guidelines into practice and clinical settings in the pan-European context. ",
doi="10.2196/64125",
url="https://mededu.jmir.org/2024/1/e64125",
url="http://www.ncbi.nlm.nih.gov/pubmed/39374073"
}


@Article{info:doi/10.2196/49505,
author="Puah, Shermain
and Pua, Yee Ching
and Shi, Jing
and Lim, Mui Sok",
title="The Effectiveness of a Digital Mental Fitness Program (Positive Intelligence) on Perceived Stress, Self-Compassion, and Ruminative Thinking of Occupational Therapy Undergraduate Students: Longitudinal Study",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="7",
volume="26",
pages="e49505",
keywords="mental health",
keywords="students",
keywords="digital wellness",
keywords="mobile health (mHealth)",
keywords="perceived stress",
keywords="self-compassion",
keywords="rumination",
abstract="Background: Health care students often endure numerous stressors throughout their undergraduate education that can have lasting negative effects on their mental well-being. Positive Intelligence (PQ) is a digital mental fitness program designed to enhance self-mastery and help individuals reach their potential by strengthening various ``mental muscles.'' Objective: This study aims to evaluate the effectiveness of a 6-week app-delivered PQ program in reducing perceived stress, increasing self-compassion, and decreasing rumination tendencies among health care undergraduates. We hypothesized that students would show reductions in perceived stress, increases in self-compassion, and decreases in rumination tendencies by the end of the PQ program, compared with their preprogram scores. We adopted an exploratory approach for the 5-month follow-up due to the limited research consensus on the sustained effects of app-based programs over varying periods. Methods: The PQ program includes weekly hour-long videos, weekly group meetings, and daily 15-minute app-guided practices. Participants were first-year students from the occupational therapy program at a university in Singapore. Participants completed surveys measuring self-compassion, perceived stress, and rumination levels before and after the PQ program, and again at a 5-month follow-up. Data were analyzed using repeated measures ANOVA to assess differences across the pretest, immediate posttest, and follow-up posttest. Results: Out of 87 students enrolled in the study, the final sample consisted of 64 students (n=47, 73\%, female; mean age 23 years, SD 5.06 years) with complete data. At the end of the 6 weeks, students exhibited significant increases in self-compassion (before the intervention: mean 3.07, SD 0.35; after the intervention: mean 3.34, SD 0.35; P<.001) and reductions in rumination tendencies (before the intervention: mean 3.57, SD 0.40; after the intervention: mean 3.27, SD 0.34; P<.001). However, no significant change in perceived stress levels was observed (before the intervention: 2.99, SD 0.14; after the intervention: mean 2.97, SD 0.16; P=.50). These effects were not influenced by the daily app-based practice of PQ exercises, and there were no sustained effects on self-compassion (mean 3.17, SD 0.27; P=.09) or rumination tendencies (mean 3.42, SD 0.38; P=.06) at the 5-month follow-up. Additionally, there was a significant increase in perceived stress at follow-up (mean 3.17, SD 0.21; P<.001) compared with pre- and postintervention levels. Conclusions: The PQ program did not directly alter stress perceptions but may have reframed students' automatic negative thought processes, increased their awareness of self-sabotaging behaviors, and enhanced their self-compassion while reducing ruminative thinking. These findings highlight the importance of self-awareness for students' well-being. Students can benefit from practices such as mindfulness and peer discussions to enhance self-compassion and reduce rumination. Educators trained in the PQ program can foster a supportive environment that encourages self-compassion, challenges negative self-talk, and helps students manage stress. ",
doi="10.2196/49505",
url="https://www.jmir.org/2024/1/e49505",
url="http://www.ncbi.nlm.nih.gov/pubmed/39374067"
}


@Article{info:doi/10.2196/55921,
author="Vomhof, Markus
and Bau, Tabea Jessica
and H{\"u}ter, Pia
and Stehl, Stefan
and Haastert, Burkhard
and Loerbroks, Adrian
and Icks, Andrea
and Calo, Teresa Stella
and Schuster, Luca
and Pischke, R. Claudia
and Kairies-Schwarz, Nadja
and Angerer, Peter
and Apolin{\'a}rio-Hagen, Jennifer",
title="Preferences Regarding Information Strategies for Digital Mental Health Interventions Among Medical Students: Discrete Choice Experiment",
journal="JMIR Form Res",
year="2024",
month="Oct",
day="4",
volume="8",
pages="e55921",
keywords="preferences",
keywords="digital mental health",
keywords="medical students",
keywords="innovation diffusion",
keywords="technology acceptance",
keywords="health information",
abstract="Background: Digital mental health interventions (DMHIs) are capable of closing gaps in the prevention and therapy of common mental disorders. Despite their proven effectiveness and approval for prescription, use rates remain low. The reasons include a lack of familiarity and knowledge as well as lasting concerns. Medical students were shown to have a comparatively higher risk for common mental disorders and are thus an important target group for raising awareness about DMHIs. At best, knowledge is already imparted during medical school using context-sensitive information strategies. Yet, little is known about medical students' information preferences regarding DMHIs. Objective: This study aims to explore information preferences for DMHIs for personal use among medical students in Germany. Methods: A discrete choice experiment was conducted, which was developed using an exploratory sequential mixed methods research approach. In total, 5 attributes (ie, source, delivery mode, timing, recommendation, and quality criteria), each with 3 to 4 levels, were identified using formative research. Data were analyzed using logistic regression models to estimate preference weights and the relative importance of attributes. To identify subgroups of students varying in information preferences, we additionally performed a latent class analysis. Results: Of 309 participants, 231 (74.8\%) with reliable data were included in the main analysis (women: 217/309, 70.2\%; age: mean 24.1, SD 4.0 y). Overall, the conditional logit model revealed that medical students preferred to receive information about DMHIs from the student council and favored being informed via social media early (ie, during their preclinic phase or their freshman week). Recommendations from other students or health professionals were preferred over recommendations from other users or no recommendations at all. Information about the scientific evidence base was the preferred quality criterion. Overall, the timing of information was the most relevant attribute (32.6\%). Latent class analysis revealed 2 distinct subgroups. Class 1 preferred to receive extensive information about DMHIs in a seminar, while class 2 wanted to be informed digitally (via email or social media) and as early as possible in their studies. Conclusions: Medical students reported specific needs and preferences regarding DMHI information provided in medical school. Overall, the timing of information (early in medical education) was considered more important than the information source or delivery mode, which should be prioritized by decision makers (eg, members of faculties of medicine, universities, and ministries of education). Study findings suggest general and subgroup-specific information strategies, which could be implemented in a stepped approach. Easily accessible digital information may promote students' interest in DMHIs in the first step that might lead to further information-seeking behavior and the attendance of seminars about DMHIs in the second step. ",
doi="10.2196/55921",
url="https://formative.jmir.org/2024/1/e55921",
url="http://www.ncbi.nlm.nih.gov/pubmed/39365652"
}


@Article{info:doi/10.2196/58692,
author="Abdullah Sharin, Ili
and Jinah, Norehan
and Bakit, Pangie
and Adnan, Khirman Izzuan
and Zakaria, Haniza Nor
and Mohmad, Shazwani
and Ahmad Subki, Zubaidah Siti
and Zakaria, Nursyahda
and Lee, Yun Kun",
title="Psychoeducational Burnout Intervention for Nurses: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2024",
month="Sep",
day="30",
volume="13",
pages="e58692",
keywords="burnout intervention",
keywords="burnout",
keywords="psychoeducation",
keywords="nurse",
keywords="systematic review",
keywords="protocol",
keywords="evidence-based intervention",
keywords="effectiveness",
keywords="psychoeducational intervention",
keywords="mental health.",
abstract="Background: Nurses face high levels of stress and emotional exhaustion due to heavy workloads and demanding work environments. Prolonged exposure to these stressors predisposes nurses to burnout, which can adversely affect patient care. Addressing burnout among nurses requires a multifaceted approach, involving both personal and organizational strategies. While organizational strategies target systemic workplace issues, personal interventions are often favored for their ease of implementation, immediate benefits, and empowerment of health care workers through stress management and resilience-building. Prioritizing evidence-based interventions to mitigate burnout among nurses is crucial for managing occupational stress and promoting well-being. Person-directed psychoeducation is an effective personal intervention strategy used to equip nurses with the appropriate knowledge and skills to handle stressors, thereby safeguarding their mental health and ensuring high-quality patient care. Objective: This protocol proposes a systematic review that aims to identify and assess the effectiveness of person-directed psychoeducational interventions for nurses. The review aims to pinpoint effective interventions that can be implemented to manage burnout and support the mental health of nurses. Methods: This systematic review will follow the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. In total of 5 electronic databases (PubMed-MEDLINE, EBSCOhost, Ovid MEDLINE, Scopus, and ScienceDirect) will be searched for studies published between January 1, 2014, and December 31, 2023. The search will encompass 3 main keywords: ``nurses,'' ``burnout intervention,'' and ``burnout.'' Predefined eligibility criteria will guide the screening process. Data will be extracted to address the objectives of the review. The risk of bias for each study will be assessed using Joanna Briggs Institute Critical Appraisal Tools. Results: Preliminary searches have been initiated since February 2024, with the review expected to be completed by June 2024. The expected results will include a comprehensive list of psychoeducational interventions and their effectiveness in reducing burnout among nurses. The review will highlight interventions that demonstrate significant impact in published studies from various countries. Conclusions: Given the rising prevalence of burnout among nurses and its detrimental effects on individuals and health care organizations, the findings from this systematic review are expected to inform health care policy and practice. By evaluating different interventions, it will provide insights into the most effective strategies, contributing to evidence-based practices that support nurses' mental health and well-being. The findings can support stakeholders in developing and implementing targeted strategies to combat nurse burnout, ultimately enhancing the quality of patient care and health care delivery. In addition, the findings will also offer valuable information for researchers, guiding future practice and research in this area. Trial Registration: PROSPERO CRD42024505762; https://tinyurl.com/4p84dk3d International Registered Report Identifier (IRRID): DERR1-10.2196/58692 ",
doi="10.2196/58692",
url="https://www.researchprotocols.org/2024/1/e58692"
}


@Article{info:doi/10.2196/49387,
author="MacNeill, Luke A.
and MacNeill, Lillian
and Luke, Alison
and Doucet, Shelley",
title="Health Professionals' Views on the Use of Conversational Agents for Health Care: Qualitative Descriptive Study",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="25",
volume="26",
pages="e49387",
keywords="conversational agents",
keywords="chatbots",
keywords="health care",
keywords="health professionals",
keywords="health personnel",
keywords="qualitative",
keywords="interview",
abstract="Background: In recent years, there has been an increase in the use of conversational agents for health promotion and service delivery. To date, health professionals' views on the use of this technology have received limited attention in the literature. Objective: The purpose of this study was to gain a better understanding of how health professionals view the use of conversational agents for health care. Methods: Physicians, nurses, and regulated mental health professionals were recruited using various web-based methods. Participants were interviewed individually using the Zoom (Zoom Video Communications, Inc) videoconferencing platform. Interview questions focused on the potential benefits and risks of using conversational agents for health care, as well as the best way to integrate conversational agents into the health care system. Interviews were transcribed verbatim and uploaded to NVivo (version 12; QSR International, Inc) for thematic analysis. Results: A total of 24 health professionals participated in the study (19 women, 5 men; mean age 42.75, SD 10.71 years). Participants said that the use of conversational agents for health care could have certain benefits, such as greater access to care for patients or clients and workload support for health professionals. They also discussed potential drawbacks, such as an added burden on health professionals (eg, program familiarization) and the limited capabilities of these programs. Participants said that conversational agents could be used for routine or basic tasks, such as screening and assessment, providing information and education, and supporting individuals between appointments. They also said that health professionals should have some oversight in terms of the development and implementation of these programs. Conclusions: The results of this study provide insight into health professionals' views on the use of conversational agents for health care, particularly in terms of the benefits and drawbacks of these programs and how they should be integrated into the health care system. These collective findings offer useful information and guidance to stakeholders who have an interest in the development and implementation of this technology. ",
doi="10.2196/49387",
url="https://www.jmir.org/2024/1/e49387",
url="http://www.ncbi.nlm.nih.gov/pubmed/39320936"
}


@Article{info:doi/10.2196/58288,
author="Lai, Lauren
and Sanatkar, Samineh
and Mackinnon, Andrew
and Deady, Mark
and Petrie, Katherine
and Lipscomb, Rosie
and Counson, Isabelle
and Francis-Taylor, Rohan
and Dean, Kimberlie
and Harvey, Samuel",
title="Testing the Effectiveness of a Mobile Smartphone App Designed to Improve the Mental Health of Junior Physicians: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Sep",
day="19",
volume="13",
pages="e58288",
keywords="junior physicians",
keywords="digital mental health",
keywords="smartphone app",
keywords="depression",
keywords="mobile phone",
abstract="Background: Shift (Black Dog Institute) is the first mobile health smartphone app?created to support the mental health of junior physicians. Junior physicians experience demanding work conditions, leading to high levels of psychological distress and burnout. However, they are often concerned about the potential career impacts of seeking mental health support. The confidentiality and ease of access of digital interventions may be particularly suited to address these concerns. The Shift app provides therapeutic and psychoeducational content and strategies contextualized for the specific needs of physicians in training. App content includes information on mental health, help seeking, mindfulness, and common workplace-related concerns of junior physicians. Objective: This study aims to test, at scale, the effectiveness of Shift among junior physicians working in Australia using a randomized controlled trial design. The primary aim is to examine whether junior physicians using Shift experience a reduction in depressive symptoms compared with a waitlist control group. The secondary aim is to examine whether the app intervention group experiences improvements in anxiety, work and social functioning, help seeking, quality of life, and burnout compared with the control group. Methods: A total of 778 junior physicians were recruited over the internet through government and nongovernment medical organizations across Australia, as well as through paid social media advertisements. They were randomly allocated to one of 2 groups: (1) the intervention group, who were asked to use the Shift app for a period of 30 days, or?(2) the waitlist control group, who were placed on a waitlist and were asked to use the app after 3 months.?Participants completed psychometric measures for self-assessing mental health and wellbeing outcomes, with assessments occurring at baseline, 1 month after completing the baseline period, and 3 months after completing the baseline period. Participants in the waitlist control group were asked to complete an additional web-based questionnaire 1 month after receiving access to the app or 4 months after completing the baseline survey. Participants took part in the study on the internet; the study was completely automated. Results: The study was funded from November 2022 to December 2024 by the New South Wales Ministry of Health. Data collection for the study occurred between January and August 2024, with 780 participants enrolling in the study during this time. Data analysis is underway; the effectiveness of the intervention will be estimated on an intention-to-treat basis using a mixed-model, repeated measures analysis. Results are expected to be submitted for publication in 2025. Conclusions: To the best of our knowledge, this is the first randomized controlled trial to examine the effectiveness of a mobile health smartphone app specifically designed to support the mental health of junior physicians. Trial Registration: Australia and New Zealand Clinical Trials Registry ACTRN12623000664640; https://tinyurl.com/7xt24dhk International Registered Report Identifier (IRRID): DERR1-10.2196/58288 ",
doi="10.2196/58288",
url="https://www.researchprotocols.org/2024/1/e58288"
}


@Article{info:doi/10.2196/44368,
author="Shalaby, Reham
and Agyapong, Belinda
and Dias, Raquel
and Obuobi-Donkor, Gloria
and Adu, K. Medard
and Spicer, Sharron
and Yanchar, L. Natalie
and Agyapong, O. Vincent I.",
title="Psychological Health and Wellness and the Impact of a Supportive Text Messaging Program (Wellness4MDs) Among Physicians and Medical Learners in Canada: Protocol for a Longitudinal Study",
journal="JMIR Res Protoc",
year="2024",
month="Sep",
day="16",
volume="13",
pages="e44368",
keywords="wellness",
keywords="doctors",
keywords="Canada",
keywords="depression",
keywords="burnout",
keywords="anxiety",
keywords="supportive text messages",
keywords="eHealth",
abstract="Background: Burnout, anxiety, and depression continue to affect physicians, postgraduate medical trainees, and medical students globally and in Canada particularly after the COVID-19 pandemic. Objective: The primary goal of this project is to design, implement, monitor, and evaluate a daily supportive SMS text messaging program (Wellness4MDs, Global Psychological e-Health Foundation). The program aims to reduce the prevalence and severity of burnout, anxiety, and depression symptoms among physicians, postgraduate medical trainees, and medical students in Canada. Methods: This longitudinal study represents a multistakeholder, mixed methods, multiyear implementation science project. Project evaluation will be conducted through a quantitative prospective longitudinal approach using a paired sample comparison, a naturalistic cross-sectional controlled design, and satisfaction surveys. Prevalence estimates for psychological problems would be based on baseline data from self-completed validated rating scales. Additional data will be collected at designated time points for paired comparison. Outcome measures will be assessed using standardized rating scales, including the Maslach Burnout Inventory for burnout symptoms, the 9-item Patient Health Questionnaire for depression symptoms, the 7-item Generalized Anxiety Disorder scale for anxiety symptoms, and the World Health Organization--Five Well-Being Index. Results: The project launched in the last quarter of 2023, and program evaluation results will become available within 36 months. The Wellness4MDs program is expected to reduce the prevalence and severity of psychological problems among physicians in Canada and achieve high subscriber satisfaction. Conclusions: The results from the Wellness4MDs project evaluation will provide key information regarding the effectiveness of daily supportive SMS text messages and links to mental health resources on these mental health parameters in Canadian physicians, postgraduate trainees, and medical students. Information will be useful for informing policy and decision-making concerning psychological interventions for physicians in Canada. International Registered Report Identifier (IRRID): PRR1-10.2196/44368 ",
doi="10.2196/44368",
url="https://www.researchprotocols.org/2024/1/e44368"
}


@Article{info:doi/10.2196/54005,
author="De la Cruz-Torralva, Kelly
and Escobar-Agreda, Stefan
and Riega L{\'o}pez, Pedro
and Amaro, James
and Reategui-Rivera, Mahony C.
and Rojas-Mezarina, Leonardo",
title="Assessment of a Pilot Program for Remote Support on Mental Health for Young Physicians in Rural Settings in Peru: Mixed Methods Study",
journal="JMIR Form Res",
year="2024",
month="Sep",
day="10",
volume="8",
pages="e54005",
keywords="telemedicine",
keywords="screening",
keywords="treatment",
keywords="mental health",
keywords="suicide",
keywords="depression",
keywords="anxiety",
keywords="alcoholism",
keywords="physicians",
keywords="rural areas",
keywords="Peru",
abstract="Background: Telemedicine-based interventions show promise in addressing mental health issues among rural populations, yet evidence regarding their impact among the health care workforce in these contexts remains limited. Objective: This study aimed to evaluate the characteristics and the responses and perceptions of recently graduated physicians who work in rural areas of Peru as part of the Servicio Rural Urbano Marginal en Salud (Rural-Urban Marginal Health Service [SERUMS], in Spanish) toward a telehealth intervention to provide remote orientation and accompaniment in mental health. Methods: A mixed methods study was carried out involving physicians who graduated from the Universidad Nacional Mayor de San Marcos and participated in the Mental Health Accompaniment Program (MHAP) from August 2022 to February 2023. This program included the assessment of mental health conditions via online forms, the dissemination of informational materials through a website, and, for those with moderate or high levels of mental health issues, the provision of personalized follow-up by trained personnel. Quantitative analysis explored the mental health issues identified among physicians, while qualitative analysis, using semistructured interviews, examined their perceptions of the services provided. Results: Of 75 physicians initially enrolled to the MHAP, 30 (41.6\%) opted to undergo assessment and use the services. The average age of the participants was 26.8 (SD 1.9) years, with 17 (56.7\%) being female. About 11 (36.7\%) reported have current or previous mental health issues, 17 (56.7\%) indicating some level of depression, 14 (46.7\%) indicated some level of anxiety, 5 (16.6\%) presenting a suicidal risk, and 2 (6.7\%) attempted suicide during the program. Physicians who did not use the program services reported a lack of advertising and related information, reliance on personal mental health resources, or neglect of symptoms. Those who used the program expressed a positive perception regarding the services, including evaluation and follow-up, although some faced challenges accessing the website. Conclusions: The MHAP has been effective in identifying and managing mental health problems among SERUMS physicians in rural Peru, although it faced challenges related to access and participation. The importance of mental health interventions in this context is highlighted, with recommendations to improve accessibility and promote self-care among participants. ",
doi="10.2196/54005",
url="https://formative.jmir.org/2024/1/e54005"
}


@Article{info:doi/10.2196/57384,
author="Aggarwal, Sumit
and Simmy, Simmy
and Mahajan, Nupur
and Nigam, Kuldeep",
title="Challenges Experienced by Health Care Workers During Service Delivery in the Geographically Challenging Terrains of North-East India: Study Involving a Thematic Analysis",
journal="JMIR Form Res",
year="2024",
month="Sep",
day="10",
volume="8",
pages="e57384",
keywords="challenges",
keywords="thematic analysis",
keywords="infrastructure",
keywords="communication",
keywords="supply distribution",
keywords="resilience",
keywords="adaptability",
keywords="vaccination awareness",
keywords="innovative solutions",
abstract="Background: The public health landscape in North-East India is marked by the foundational principle of equitable health care provision, a critical endeavor considering the region's intricate geography and proximity to international borders. Health care workers grapple with challenges, such as treacherous routes, limited infrastructure, and diverse cultural nuances, when delivering essential medical services. Despite improvements since the National Rural Health Mission in 2005, challenges persist, prompting a study to identify health care workers' challenges and alternative strategies in Manipur and Nagaland. Objective: This study aims to document the challenges experienced by health care workers during service delivery in the geographically challenging terrains of North-East India. Methods: This study is part of the i-DRONE (Indian Council of Medical Research's Drone Response and Outreach for North East) project, which aims to assess the feasibility of drone-mediated vaccine and medical delivery. This study addresses the secondary objective of the i-DRONE project. In-depth interviews of 29 health care workers were conducted using semistructured questionnaires in 5 districts (Mokokchung and Tuensang in Nagaland, and Imphal West, Bishnupur, and Churachandpur in Manipur). Nineteen health facilities, including primary health care centers, community health centers, and district hospitals, were selected. The study considered all levels of health care professionals who were in active employment for the past 6 months without a significant vacation and those who were engaged in ground-level implementation, policy, and maintenance activities. Data were recorded, transcribed, and translated, and subsequently, codes, themes, and subthemes were developed using NVivo 14 (QSR International) for thematic analysis. Results: Five themes were generated from the data: (1) general challenges (challenges due to being an international borderline district, human resource constraints, logistical challenges for medical supply, infrastructural issues, and transportation challenges); (2) challenges during the COVID-19 pandemic (increased workload, lack of diagnostic centers, mental health challenges and family issues, routine health care facilities affected, stigma and fear of infection, and vaccine hesitancy and misinformation); (3) perception and awareness regarding COVID-19 vaccination; (4) alternative actions or strategies adopted by health care workers to address the challenges; and (5) suggestions provided by health care workers. Health care workers demonstrated adaptability by overcoming these challenges and provided suggestions for addressing these challenges in the future. Conclusions: Health care workers in Manipur and Nagaland have shown remarkable resilience in the face of numerous challenges exacerbated by the pandemic. Despite infrastructural limitations, communication barriers, and inadequate medical supply distribution in remote areas, they have demonstrated adaptability through innovative solutions like efficient data management, vaccination awareness campaigns, and leveraging technology for improved care delivery. The findings are pertinent for not only health care practitioners and policymakers but also the broader scientific and public health communities. However, the findings may have limited generalizability beyond Manipur and Nagaland. ",
doi="10.2196/57384",
url="https://formative.jmir.org/2024/1/e57384",
url="http://www.ncbi.nlm.nih.gov/pubmed/39255009"
}


@Article{info:doi/10.2196/50071,
author="Watanabe, Kazuhiro
and Tran, Thu Thuy Thi
and Sripo, Narisara
and Sakuraya, Asuka
and Imamura, Kotaro
and Boonyamalik, Plernpit
and Sasaki, Natsu
and Tienthong, Thanate
and Asaoka, Hiroki
and Iida, Mako
and Nguyen, Thuy Quynh
and Nguyen, Thi Nga
and Vu, Thai Son
and Ngo, Thi Thuy
and Luyen, Thi Tham
and Nguyen, Duc Long
and Nguyen, Viet Nga Thi
and Nguyen, Thanh Binh
and Matsuyama, Yutaka
and Takemura, Yukie
and Nishi, Daisuke
and Tsutsumi, Akizumi
and Nguyen, Thanh Huong
and Kaewboonchoo, Orawan
and Kawakami, Norito",
title="Effectiveness of a Smartphone-Based Stress Management Program for Depression in Hospital Nurses During COVID-19 in Vietnam and Thailand: 2-Arm Parallel-Group Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="30",
volume="26",
pages="e50071",
keywords="digital mental health intervention",
keywords="unguided program",
keywords="universal prevention",
keywords="health care workers",
keywords="nurses",
keywords="COVID-19",
keywords="depression",
keywords="mobile phone",
abstract="Background: During the COVID-19 pandemic, health care professionals experienced high levels of depression. However, extant research has not highlighted effective internet-based psychological interventions to improve the mental health in this population during the pandemic. It remains unclear whether self-guided, internet-based cognitive behavioral therapy (iCBT) programs are effective in improving the mental health of health care workers during the COVID-19 pandemic. Objective: The aim of this study was to evaluate the effectiveness of a smartphone-based iCBT stress management program for reducing the depression experienced by nurses in Vietnam and Thailand. Methods: From March to April 2022, a 2-arm, parallel-group randomized controlled trial was implemented. One arm offered a 7-week self-guided iCBT program, and the other offered treatment as usual as a control arm. Full-time nurses were recruited from 6 hospitals: 2 hospitals in Vietnam and 4 hospitals in Thailand. The primary outcome of this program was the severity of depression measured by the Depression Anxiety Stress Scale-21 items. Follow-up surveys were conducted to measure the change in depression severity at 3 months (July-August 2022) and at 6 months (October-November 2022) after baseline. Mixed modeling for repeated measures was used to test the effects of the intervention compared with the control for the follow-up. Results: A total of 1203 nurses were included in this study: 602 in the intervention group and 601 in the control group. The follow-up rate at 3 and 6 months ranged from 85.7\% (515/601) to 87.5\% (527/602). The completion rate for the program was 68.1\% (410/602). The group difference in depression was significant at the 3-month follow-up (coefficient=--0.92, 95\% CI --1.66 to --0.18; P=.02) and nonsignificant at the 6-month follow-up (coefficient=--0.33, 95\% CI --1.11 to 0.45; P=.41). The estimated effect sizes were --0.15 and --0.06 at the 3- and 6-month follow-ups, respectively. Conclusions: Our study shows that the smartphone-based iCBT program was effective in reducing depression at the 3-month follow-up among hospital nurses in Vietnam and Thailand during the COVID-19 pandemic. However, the effect size was small, and therefore, these results may not be clinically meaningful. Trial Registration: UMIN Clinical Trials Registry UMIN000044145; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr\_view.cgi?recptno=R000050128 International Registered Report Identifier (IRRID): RR2-10.20944/preprints202303.0450.v1 ",
doi="10.2196/50071",
url="https://www.jmir.org/2024/1/e50071"
}


@Article{info:doi/10.2196/45422,
author="Liu, Wenhua
and Wang, Quan
and Zheng, Danli
and Mei, Junhua
and Lu, Jiajia
and Chen, Guohua
and Wang, Wei
and Ding, Fengfei",
title="The Effects of a Complex Interactive Multimodal Intervention on Personalized Stress Management Among Health Care Workers in China: Nonrandomized Controlled Study",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="12",
volume="26",
pages="e45422",
keywords="multimodal intervention",
keywords="stress management",
keywords="health care workers",
keywords="perceived stress",
keywords="autonomic nervous system",
keywords="stress",
keywords="management",
keywords="mental health",
keywords="engagement",
keywords="human support",
keywords="physiological stress",
keywords="psychological stress",
keywords="social network",
keywords="mobile phone",
abstract="Background: Health care workers (HCWs) frequently face multiple stressors at work, particularly those working night shifts. HCWs who have experienced distress may find it difficult to adopt stress management approaches, even if they are aware of the effects of stress and coping processes. Therefore, an individualized intervention may be required to assist distressed HCWs in bridging the ``knowledge-practice'' gap in stress management and effectively alleviating stress symptoms. Objective: The main objective of this research was to compare the effects of a complex interactive multimodal intervention (CIMI) to self-guided stress management interventions on stress symptoms of distressed HCWs, as measured by physiological (heart rate variability), psychological (perceived stress, mental distress, and subjective happiness), and sleep disorder (fatigue and sleepiness) indicators. Methods: We conducted a nonrandomized, controlled study in 2 Chinese general hospitals. The participants in this study were 245 HCWs who fulfilled at least 1 of the 3 dimensions on the Depression, Anxiety, and Stress Scale. All eligible individuals were required to complete a questionnaire and wear a 24-hour Holter device to determine the physiological signs of stress as indexed by heart rate variability at both baseline and after the intervention. The CIMI group received a 12-week online intervention with 4 components---mobile stress management instruction, a web-based WeChat social network, personalized feedback, and a nurse coach, whereas the control group simply received a self-guided intervention. Results: After a 12-week intervention, the Perceived Stress Scale (PSS) scores reduced significantly in the CIMI group (mean difference [MD] --5.31, 95\% CI --6.26 to --4.37; P<.001) compared to the baseline levels. The changes in PSS scores before and after the intervention exhibited a significant difference between the CIMI and control groups (d=--0.64; MD --4.03, 95\% CI --5.91 to --2.14; P<.001), and the effect was medium. In terms of physiological measures, both the control group (MD --9.56, 95\% CI --16.9 to --2.2; P=.01) and the CIMI group (MD --8.45, 95\% CI --12.68 to --4.22; P<.001) demonstrated a significant decrease in the standard deviation of normal-to-normal intervals (SDNN) within the normal clinical range; however, there were no significant differences between the 2 groups (d=0.03; MD 1.11, 95\% CI --7.38 to 9.59; P=.80). Conclusions: The CIMI was an effective intervention for improving sleep disorders, as well as parts of the psychological stress measures in distressed HCWs. The findings provide objective evidence for developing a mobile stress management intervention that is adaptable and accessible to distressed HCWs, but its long-term effects should be investigated in future research. Trial Registration: ClinicalTrials.gov NCT05239065; https://clinicaltrials.gov/ct2/show/NCT05239065 ",
doi="10.2196/45422",
url="https://www.jmir.org/2024/1/e45422"
}


@Article{info:doi/10.2196/50253,
author="Barac, Milica
and Scaletty, Samantha
and Hassett, C. Leslie
and Stillwell, Ashley
and Croarkin, E. Paul
and Chauhan, Mohit
and Chesak, Sherry
and Bobo, V. William
and Athreya, P. Arjun
and Dyrbye, N. Liselotte",
title="Wearable Technologies for Detecting Burnout and Well-Being in Health Care Professionals: Scoping Review",
journal="J Med Internet Res",
year="2024",
month="Jun",
day="25",
volume="26",
pages="e50253",
keywords="wearable",
keywords="healthcare professionals",
keywords="burnout",
keywords="digital health",
keywords="mental health",
abstract="Background: The occupational burnout epidemic is a growing issue, and in the United States, up to 60\% of medical students, residents, physicians, and registered nurses experience symptoms. Wearable technologies may provide an opportunity to predict the onset of burnout and other forms of distress using physiological markers. Objective: This study aims to identify physiological biomarkers of burnout, and establish what gaps are currently present in the use of wearable technologies for burnout prediction among health care professionals (HCPs). Methods: A comprehensive search of several databases was performed on June 7, 2022. No date limits were set for the search. The databases were Ovid: MEDLINE(R), Embase, Healthstar, APA PsycInfo, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science Core Collection via Clarivate Analytics, Scopus via Elsevier, EBSCOhost: Academic Search Premier, CINAHL with Full Text, and Business Source Premier. Studies observing anxiety, burnout, stress, and depression using a wearable device worn by an HCP were included, with HCP defined as medical students, residents, physicians, and nurses. Bias was assessed using the Newcastle Ottawa Quality Assessment Form for Cohort Studies. Results: The initial search yielded 505 papers, from which 10 (1.95\%) studies were included in this review. The majority (n=9) used wrist-worn biosensors and described observational cohort studies (n=8), with a low risk of bias. While no physiological measures were reliably associated with burnout or anxiety, step count and time in bed were associated with depressive symptoms, and heart rate and heart rate variability were associated with acute stress. Studies were limited with long-term observations (eg, ?12 months) and large sample sizes, with limited integration of wearable data with system-level information (eg, acuity) to predict burnout. Reporting standards were also insufficient, particularly in device adherence and sampling frequency used for physiological measurements. Conclusions: With wearables offering promise for digital health assessments of human functioning, it is possible to see wearables as a frontier for predicting burnout. Future digital health studies exploring the utility of wearable technologies for burnout prediction should address the limitations of data standardization and strategies to improve adherence and inclusivity in study participation. ",
doi="10.2196/50253",
url="https://www.jmir.org/2024/1/e50253",
url="http://www.ncbi.nlm.nih.gov/pubmed/38916948"
}


@Article{info:doi/10.2196/54029,
author="Cho, Aram
and Cha, Chiyoung
and Baek, Gumhee",
title="Development of an Artificial Intelligence--Based Tailored Mobile Intervention for Nurse Burnout: Single-Arm Trial",
journal="J Med Internet Res",
year="2024",
month="Jun",
day="21",
volume="26",
pages="e54029",
keywords="artificial intelligence",
keywords="burnout",
keywords="mobile app",
keywords="nurses",
keywords="nurse",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="applications",
keywords="usability",
keywords="satisfaction",
keywords="effectiveness",
keywords="tailored",
keywords="mind-body",
keywords="meditation",
keywords="mindfulness",
keywords="ACT",
keywords="algorithm",
keywords="algorithms",
keywords="occupational health",
keywords="digital health",
keywords="recommender",
keywords="optimization",
keywords="acceptance and commitment therapy",
keywords="job",
keywords="worker",
keywords="workers",
keywords="stress",
keywords="employee",
keywords="employees",
abstract="Background: Nurse burnout leads to an increase in turnover, which is a serious problem in the health care system. Although there is ample evidence of nurse burnout, interventions developed in previous studies were general and did not consider specific burnout dimensions and individual characteristics. Objective: The objectives of this study were to develop and optimize the first tailored mobile intervention for nurse burnout, which recommends programs based on artificial intelligence (AI) algorithms, and to test its usability, effectiveness, and satisfaction. Methods: In this study, an AI-based mobile intervention, Nurse Healing Space, was developed to provide tailored programs for nurse burnout. The 4-week program included mindfulness meditation, laughter therapy, storytelling, reflective writing, and acceptance and commitment therapy. The AI algorithm recommended one of these programs to participants by calculating similarity through a pretest consisting of participants' demographics, research variables, and burnout dimension scores measured with the Copenhagen Burnout Inventory. After completing a 4-week program, burnout, job stress, stress response using the Stress Response Inventory Modified Form, the usability of the app, coping strategy by the coping strategy indicator, and program satisfaction (1: very dissatisfied; 5: very satisfied) were measured. The AI recognized the recommended program as effective if the user's burnout score reduced after the 2-week program and updated the algorithm accordingly. After a pilot test (n=10), AI optimization was performed (n=300). A paired 2-tailed t test, ANOVA, and the Spearman correlation were used to test the effect of the intervention and algorithm optimization. Results: Nurse Healing Space was implemented as a mobile app equipped with a system that recommended 1 program out of 4 based on similarity between users through AI. The AI algorithm worked well in matching the program recommended to participants who were most similar using valid data. Users were satisfied with the convenience and visual quality but were dissatisfied with the absence of notifications and inability to customize the program. The overall usability score of the app was 3.4 out of 5 points. Nurses' burnout scores decreased significantly after the completion of the first 2-week program (t=7.012; P<.001) and reduced further after the second 2-week program (t=2.811; P=.01). After completing the Nurse Healing Space program, job stress (t=6.765; P<.001) and stress responses (t=5.864; P<.001) decreased significantly. During the second 2-week program, the burnout level reduced in the order of participation (r=--0.138; P=.04). User satisfaction increased for both the first (F=3.493; P=.03) and second programs (F=3.911; P=.02). Conclusions: This program effectively reduced burnout, job stress, and stress responses. Nurse managers were able to prevent nurses from resigning and maintain the quality of medical services using this AI-based program to provide tailored interventions for nurse burnout. Thus, this app could improve qualitative health care, increase employee satisfaction, reduce costs, and ultimately improve the efficiency of the health care system. ",
doi="10.2196/54029",
url="https://www.jmir.org/2024/1/e54029"
}


@Article{info:doi/10.2196/49581,
author="Wekenborg, Katharina Magdalena
and F{\"o}rster, Katharina
and Schweden, Florian
and Weidemann, Robin
and Bechtolsheim, von Felix
and Kirschbaum, Clemens
and Weitz, J{\"u}rgen
and Ditzen, Beate",
title="Differences in Physicians' Ratings of Work Stressors and Resources Associated With Digital Transformation: Cross-Sectional Study",
journal="J Med Internet Res",
year="2024",
month="Jun",
day="17",
volume="26",
pages="e49581",
keywords="physicians",
keywords="digital transformation",
keywords="chronic stress",
keywords="hair cortisol concentration",
keywords="work stressors",
keywords="work resources",
abstract="Background: The emergence of the COVID-19 pandemic rapidly accelerated the need and implementation of digital innovations, especially in medicine. Objective: To gain a better understanding of the stress associated with digital transformation in physicians, this study aims to identify working conditions that are stress relevant for physicians and differ in dependence on digital transformation. In addition, we examined the potential role of individual characteristics (ie, age, gender, and actual implementation of a digital innovation within the last 3 years) in digitalization-associated differences in these working conditions. Methods: Cross-sectional web-based questionnaire data of 268 physicians (mean age 40.9, SD 12.3 y; n=150, 56\% women) in Germany were analyzed. Physicians rated their chronic stress level and 11 relevant working conditions (ie, work stressors such as time pressure and work resources such as influence on sequence) both before and after either a fictional or real implementation of a relevant digital transformation at their workplace. In addition, a subsample of individuals (60; n=33, 55\% women) submitted self-collected hair samples for cortisol analysis. Results: The stress relevance of the selected working conditions was confirmed by significant correlations with self-rated chronic stress and hair cortisol levels (hair F) within the sample, all of them in the expected direction (P values between .01 and <.001). Multilevel modeling revealed significant differences associated with digital transformation in the rating of 8 (73\%) out of 11 working conditions. More precisely, digital transformation was associated with potentially stress-enhancing effects in 6 working conditions (ie, influence on procedures and complexity of tasks) and stress-reducing effects in 2 other working conditions (ie, perceived workload and time pressure). Younger individuals, women, and individuals whose workplaces have implemented digital innovations tended to perceive digitalization-related differences in working conditions as rather stress-reducing. Conclusions: Our study lays the foundation for future hypothesis-based longitudinal research by identifying those working conditions that are stress relevant for physicians and prone to differ as a function of digital transformation and individual characteristics. ",
doi="10.2196/49581",
url="https://www.jmir.org/2024/1/e49581",
url="http://www.ncbi.nlm.nih.gov/pubmed/38885014"
}


@Article{info:doi/10.2196/54811,
author="Wu, Yuxuan
and Wu, Mingyue
and Wang, Changyu
and Lin, Jie
and Liu, Jialin
and Liu, Siru",
title="Evaluating the Prevalence of Burnout Among Health Care Professionals Related to Electronic Health Record Use: Systematic Review and Meta-Analysis",
journal="JMIR Med Inform",
year="2024",
month="Jun",
day="12",
volume="12",
pages="e54811",
keywords="clinical decision support system",
keywords="electronic health record",
keywords="electronic medical record",
keywords="health information technology",
keywords="alert fatigue",
keywords="burnout",
keywords="health care professionals",
keywords="health care service",
keywords="EHR",
keywords="systematic review",
keywords="meta-analysis",
keywords="health information system",
keywords="clinician burnout",
keywords="health informatics",
abstract="Background: Burnout among health care professionals is a significant concern, with detrimental effects on health care service quality and patient outcomes. The use of the electronic health record (EHR) system has been identified as a significant contributor to burnout among health care professionals. Objective: This systematic review and meta-analysis aims to assess the prevalence of burnout among health care professionals associated with the use of the EHR system, thereby providing evidence to improve health information systems and develop strategies to measure and mitigate burnout. Methods: We conducted a comprehensive search of the PubMed, Embase, and Web of Science databases for English-language peer-reviewed articles published between January 1, 2009, and December 31, 2022. Two independent reviewers applied inclusion and exclusion criteria, and study quality was assessed using the Joanna Briggs Institute checklist and the Newcastle-Ottawa Scale. Meta-analyses were performed using R (version 4.1.3; R Foundation for Statistical Computing), with EndNote X7 (Clarivate) for reference management. Results: The review included 32 cross-sectional studies and 5 case-control studies with a total of 66,556 participants, mainly physicians and registered nurses. The pooled prevalence of burnout among health care professionals in cross-sectional studies was 40.4\% (95\% CI 37.5\%-43.2\%). Case-control studies indicated a higher likelihood of burnout among health care professionals who spent more time on EHR-related tasks outside work (odds ratio 2.43, 95\% CI 2.31-2.57). Conclusions: The findings highlight the association between the increased use of the EHR system and burnout among health care professionals. Potential solutions include optimizing EHR systems, implementing automated dictation or note-taking, employing scribes to reduce documentation burden, and leveraging artificial intelligence to enhance EHR system efficiency and reduce the risk of burnout. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021281173; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42021281173 ",
doi="10.2196/54811",
url="https://medinform.jmir.org/2024/1/e54811",
url="http://www.ncbi.nlm.nih.gov/pubmed/38865188"
}


@Article{info:doi/10.2196/49450,
author="Li, Weicong
and Tang, Maggie Liyaning
and Montayre, Jed
and Harris, B. Celia
and West, Sancia
and Antoniou, Mark",
title="Investigating Health and Well-Being Challenges Faced by an Aging Workforce in the Construction and Nursing Industries: Computational Linguistic Analysis of Twitter Data",
journal="J Med Internet Res",
year="2024",
month="Jun",
day="5",
volume="26",
pages="e49450",
keywords="social media",
keywords="construction",
keywords="nursing",
keywords="aging",
keywords="health and well-being",
keywords="Twitter",
abstract="Background: Construction and nursing are critical industries. Although both careers involve physically and mentally demanding work, the risks to workers during the COVID-19 pandemic are not well understood. Nurses (both younger and older) are more likely to experience the ill effects of burnout and stress than construction workers, likely due to accelerated work demands and increased pressure on nurses during the COVID-19 pandemic. In this study, we analyzed a large social media data set using advanced natural language processing techniques to explore indicators of the mental status of workers across both industries before and during the COVID-19 pandemic. Objective: This social media analysis aims to fill a knowledge gap by comparing the tweets of younger and older construction workers and nurses to obtain insights into any potential risks to their mental health due to work health and safety issues. Methods: We analyzed 1,505,638 tweets published on Twitter (subsequently rebranded as X) by younger and older (aged <45 vs >45 years) construction workers and nurses. The study period spanned 54 months, from January 2018 to June 2022, which equates to approximately 27 months before and 27 months after the World Health Organization declared COVID-19 a global pandemic on March 11, 2020. The tweets were analyzed using big data analytics and computational linguistic analyses. Results: Text analyses revealed that nurses made greater use of hashtags and keywords (both monograms and bigrams) associated with burnout, health issues, and mental health compared to construction workers. The COVID-19 pandemic had a pronounced effect on nurses' tweets, and this was especially noticeable in younger nurses. Tweets about health and well-being contained more first-person singular pronouns and affect words, and health-related tweets contained more affect words. Sentiment analyses revealed that, overall, nurses had a higher proportion of positive sentiment in their tweets than construction workers. However, this changed markedly during the COVID-19 pandemic. Since early 2020, sentiment switched, and negative sentiment dominated the tweets of nurses. No such crossover was observed in the tweets of construction workers. Conclusions: The social media analysis revealed that younger nurses had language use patterns consistent with someone experiencing the ill effects of burnout and stress. Older construction workers had more negative sentiments than younger workers, who were more focused on communicating about social and recreational activities rather than work matters. More broadly, these findings demonstrate the utility of large data sets enabled by social media to understand the well-being of target populations, especially during times of rapid societal change. ",
doi="10.2196/49450",
url="https://www.jmir.org/2024/1/e49450",
url="http://www.ncbi.nlm.nih.gov/pubmed/38838308"
}


@Article{info:doi/10.2196/56267,
author="Bieri, Stefan Jannic
and Ikae, Catherine
and Souissi, Ben Souhir
and M{\"u}ller, J{\"o}rg Thomas
and Schlunegger, Charlotte Margarithe
and Golz, Christoph",
title="Natural Language Processing for Work-Related Stress Detection Among Health Professionals: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2024",
month="May",
day="15",
volume="13",
pages="e56267",
keywords="health professionals",
keywords="natural language processing",
keywords="text-mining",
keywords="work-related stress",
keywords="healthcare",
keywords="occupational well-being",
keywords="automatic detection",
keywords="scoping review protocol",
keywords="methodology",
keywords="synthesis",
abstract="Background: There is an urgent need worldwide for qualified health professionals. High attrition rates among health professionals, combined with a predicted rise in life expectancy, further emphasize the need for additional health professionals. Work-related stress is a major concern among health professionals, affecting both the well-being of health professionals and the quality of patient care. Objective: This scoping review aims to identify processes and methods for the automatic detection of work-related stress among health professionals using natural language processing (NLP) and text mining techniques. Methods: This review follows Joanna Briggs Institute Methodology and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The inclusion criteria for this scoping review encompass studies involving health professionals using NLP for work-related stress detection while excluding studies involving other professions or children. The review focuses on various aspects, including NLP applications for stress detection, criteria for stress identification, technical aspects of NLP, and implications of stress detection through NLP. Studies within health care settings using diverse NLP techniques are considered, including experimental and observational designs, aiming to provide a comprehensive understanding of NLP's role in detecting stress among health professionals. Studies published in English, German, or French from 2013 to present will be considered. The databases to be searched include MEDLINE (via PubMed), CINAHL, PubMed, Cochrane, ACM Digital Library, and IEEE Xplore. Sources of unpublished studies and gray literature to be searched will include ProQuest Dissertations \& Theses and OpenGrey. Two reviewers will independently retrieve full-text studies and extract data. The collected data will be organized in tables, graphs, and a qualitative narrative summary. This review will use tables and graphs to present data on studies' distribution by year, country, activity field, and research methods. Results synthesis involves identifying, grouping, and categorizing. The final scoping review will include a narrative written report detailing the search and study selection process, a visual representation using a PRISMA-ScR flow diagram, and a discussion of implications for practice and research. Results: We anticipate the outcomes will be presented in a systematic scoping review by June 2024. Conclusions: This review fills a literature gap by identifying automated work-related stress detection among health professionals using NLP and text mining, providing insights on an innovative approach, and identifying research needs for further systematic reviews. Despite promising outcomes, acknowledging limitations in the reviewed studies, including methodological constraints, sample biases, and potential oversight, is crucial to refining methodologies and advancing automatic stress detection among health professionals. International Registered Report Identifier (IRRID): PRR1-10.2196/56267 ",
doi="10.2196/56267",
url="https://www.researchprotocols.org/2024/1/e56267",
url="http://www.ncbi.nlm.nih.gov/pubmed/38749026"
}


@Article{info:doi/10.2196/54180,
author="Martin, Josh
and Rueda, Alice
and Lee, Hee Gyu
and Tassone, K. Vanessa
and Park, Haley
and Ivanov, Martin
and Darnell, C. Benjamin
and Beavers, Lindsay
and Campbell, M. Douglas
and Nguyen, Binh
and Torres, Andrei
and Jung, Hyejung
and Lou, Wendy
and Nazarov, Anthony
and Ashbaugh, Andrea
and Kapralos, Bill
and Litz, Brett
and Jetly, Rakesh
and Dubrowski, Adam
and Strudwick, Gillian
and Krishnan, Sridhar
and Bhat, Venkat",
title="Digital Interventions to Understand and Mitigate Stress Response: Protocol for Process and Content Evaluation of a Cohort Study",
journal="JMIR Res Protoc",
year="2024",
month="May",
day="6",
volume="13",
pages="e54180",
keywords="web-based platform",
keywords="stress",
keywords="distress",
keywords="moral distress",
keywords="wearable",
keywords="oura ring",
keywords="virtual reality",
keywords="VR",
keywords="COVID-19",
keywords="nursing",
keywords="digital health implementation",
abstract="Background: Staffing and resource shortages, especially during the COVID-19 pandemic, have increased stress levels among health care workers. Many health care workers have reported feeling unable to maintain the quality of care expected within their profession, which, at times, may lead to moral distress and moral injury. Currently, interventions for moral distress and moral injury are limited. Objective: This study has the following aims: (1) to characterize and reduce stress and moral distress related to decision-making in morally complex situations using a virtual reality (VR) scenario and a didactic intervention; (2) to identify features contributing to mental health outcomes using wearable, physiological, and self-reported questionnaire data; and (3) to create a personal digital phenotype profile that characterizes stress and moral distress at the individual level. Methods: This will be a single cohort, pre- and posttest study of 100 nursing professionals in Ontario, Canada. Participants will undergo a VR simulation that requires them to make morally complex decisions related to patient care, which will be administered before and after an educational video on techniques to mitigate distress. During the VR session, participants will complete questionnaires measuring their distress and moral distress, and physiological data (electrocardiogram, electrodermal activity, plethysmography, and respiration) will be collected to assess their stress response. In a subsequent 12-week follow-up period, participants will complete regular assessments measuring clinical outcomes, including distress, moral distress, anxiety, depression, and loneliness. A wearable device will also be used to collect continuous data for 2 weeks before, throughout, and for 12 weeks after the VR session. A pre-post comparison will be conducted to analyze the effects of the VR intervention, and machine learning will be used to create a personal digital phenotype profile for each participant using the physiological, wearable, and self-reported data. Finally, thematic analysis of post-VR debriefing sessions and exit interviews will examine reoccurring codes and overarching themes expressed across participants' experiences. Results: The study was funded in 2022 and received research ethics board approval in April 2023. The study is ongoing. Conclusions: It is expected that the VR scenario will elicit stress and moral distress. Additionally, the didactic intervention is anticipated to improve understanding of and decrease feelings of stress and moral distress. Models of digital phenotypes developed and integrated with wearables could allow for the prediction of risk and the assessment of treatment responses in individuals experiencing moral distress in real-time and naturalistic contexts. This paradigm could also be used in other populations prone to moral distress and injury, such as military and public safety personnel. Trial Registration: ClinicalTrials.gov NCT05923398; https://clinicaltrials.gov/study/NCT05923398 International Registered Report Identifier (IRRID): DERR1-10.2196/54180 ",
doi="10.2196/54180",
url="https://www.researchprotocols.org/2024/1/e54180",
url="http://www.ncbi.nlm.nih.gov/pubmed/38709554"
}


@Article{info:doi/10.2196/55499,
author="Asgari, Elham
and Kaur, Japsimar
and Nuredini, Gani
and Balloch, Jasmine
and Taylor, M. Andrew
and Sebire, Neil
and Robinson, Robert
and Peters, Catherine
and Sridharan, Shankar
and Pimenta, Dominic",
title="Impact of Electronic Health Record Use on Cognitive Load and Burnout Among Clinicians: Narrative Review",
journal="JMIR Med Inform",
year="2024",
month="Apr",
day="12",
volume="12",
pages="e55499",
keywords="electronic health record",
keywords="cognitive load",
keywords="burnout",
keywords="technology",
keywords="clinician",
doi="10.2196/55499",
url="https://medinform.jmir.org/2024/1/e55499",
url="http://www.ncbi.nlm.nih.gov/pubmed/38607672"
}


@Article{info:doi/10.2196/49772,
author="Mincarone, Pierpaolo
and Bodini, Antonella
and Tumolo, Rosaria Maria
and Sabina, Saverio
and Colella, Riccardo
and Mannini, Linda
and Sabato, Eugenio
and Leo, Giacomo Carlo",
title="Association Between Physical Activity and the Risk of Burnout in Health Care Workers: Systematic Review",
journal="JMIR Public Health Surveill",
year="2024",
month="Mar",
day="18",
volume="10",
pages="e49772",
keywords="burnout",
keywords="Maslach Burnout Inventory",
keywords="MBI",
keywords="Copenhagen Burnout Inventory",
keywords="CBI",
keywords="Professional Fulfillment Index",
keywords="PFI",
keywords="physical activity",
keywords="health care workers",
keywords="public health policy",
abstract="Background: Burnout is a multidimensional psychological syndrome that arises from chronic workplace stress. Health care workers (HCWs), who operate in physically and emotionally exhausting work contexts, constitute a vulnerable group. This, coupled with its subsequent impact on patients and public economic resources, makes burnout a significant public health concern. Various self-care practices have been suggested to have a positive effect on burnout among HCWs. Of these, physical activity stands out for its ability to combine psychological, physiological, and biochemical mechanisms. In fact, it promotes psychological detachment from work and increases self-efficacy by inhibiting neurotransmitters and neuromodulators, increasing endorphin levels, enhancing mitochondrial function, and attenuating the hypothalamic pituitary-adrenal axis response to stress. Objective: Our objective was to conduct a systematic review of the evidence on the association between physical activity and burnout among HCWs. Methods: We considered HCWs, physical activity, and burnout, framing them as population, exposure, and outcome, respectively. We searched APA PsycArticles, MEDLINE, and Scopus until July 2022. We extracted relevant data on study design, methods to measure exposure and outcome, and statistical approaches. Results: Our analysis encompassed 21 independent studies. Although 10\% (2/21) of the studies explicitly focused on physical activity, the remaining investigations were exploratory in nature and examined various predictors, including physical activity. The most commonly used questionnaire was the Maslach Burnout Inventory. Owing to the heterogeneity in definitions and cutoffs used, the reported prevalence of burnout varied widely, ranging from 7\% to 83\%. Heterogeneity was also observed in the measurement tools used to assess physical activity, with objective measures rarely used. In total, 14\% (3/21) of the studies used structured questionnaires to assess different types of exercise, whereas most studies (18/21, 86\%) only recorded the attainment of a benchmark or reported the frequency, intensity, or duration of exercise. The reported prevalence of physically active HCWs ranged from 44\% to 87\%. The analyses, through a variety of inferential approaches, indicated that physical activity is often associated with a reduced risk of burnout, particularly in the domains of emotional exhaustion and depersonalization. Furthermore, we compiled and classified a list of factors associated with burnout. Conclusions: Our comprehensive overview of studies investigating the association between physical activity and burnout in HCWs revealed significant heterogeneity in definitions, measurements, and analyses adopted in the literature. To address this issue, it is crucial to adopt a clear definition of physical activity and make thoughtful choices regarding measurement tools and methodologies for data analysis. Our considerations regarding the measurement of burnout and the comprehensive list of associated factors have the potential to improve future studies aimed at informing decision-makers, thus laying the foundation for more effective management measures to address burnout. ",
doi="10.2196/49772",
url="https://publichealth.jmir.org/2024/1/e49772",
url="http://www.ncbi.nlm.nih.gov/pubmed/38498040"
}


@Article{info:doi/10.2196/49467,
author="Jaiswal, Satish
and Purpura, R. Suzanna
and Manchanda, K. James
and Nan, Jason
and Azeez, Nihal
and Ramanathan, Dhakshin
and Mishra, Jyoti",
title="Design and Implementation of a Brief Digital Mindfulness and Compassion Training App for Health Care Professionals: Cluster Randomized Controlled Trial",
journal="JMIR Ment Health",
year="2024",
month="Jan",
day="22",
volume="11",
pages="e49467",
keywords="compassion",
keywords="digital app",
keywords="digital health",
keywords="digital intervention",
keywords="digital mental health",
keywords="digital mindfulness",
keywords="EEG",
keywords="health workers",
keywords="healthcare professionals",
keywords="mindfulness",
keywords="neuroplasticity",
keywords="physicians",
keywords="training",
abstract="Background: Several studies show that intense work schedules make health care professionals particularly vulnerable to emotional exhaustion and burnout. Objective: In this scenario, promoting self-compassion and mindfulness may be beneficial for well-being. Notably, scalable, digital app--based methods may have the potential to enhance self-compassion and mindfulness in health care professionals. Methods: In this study, we designed and implemented a scalable, digital app--based, brief mindfulness and compassion training program called ``WellMind'' for health care professionals. A total of 22 adult participants completed up to 60 sessions of WellMind training, 5-10 minutes in duration each, over 3 months. Participants completed behavioral assessments measuring self-compassion and mindfulness at baseline (preintervention), 3 months (postintervention), and 6 months (follow-up). In order to control for practice effects on the repeat assessments and calculate effect sizes, we also studied a no-contact control group of 21 health care professionals who only completed the repeated assessments but were not provided any training. Additionally, we evaluated pre- and postintervention neural activity in core brain networks using electroencephalography source imaging as an objective neurophysiological training outcome. Results: Findings showed a post- versus preintervention increase in self-compassion (Cohen d=0.57; P=.007) and state-mindfulness (d=0.52; P=.02) only in the WellMind training group, with improvements in self-compassion sustained at follow-up (d=0.8; P=.01). Additionally, WellMind training durations correlated with the magnitude of improvement in self-compassion across human participants ($\rho$=0.52; P=.01). Training-related neurophysiological results revealed plasticity specific to the default mode network (DMN) that is implicated in mind-wandering and rumination, with DMN network suppression selectively observed at the postintervention time point in the WellMind group (d=--0.87; P=.03). We also found that improvement in self-compassion was directly related to the extent of DMN suppression ($\rho$=--0.368; P=.04). Conclusions: Overall, promising behavioral and neurophysiological findings from this first study demonstrate the benefits of brief digital mindfulness and compassion training for health care professionals and compel the scale-up of the digital intervention. Trial Registration: Trial Registration:   International Standard Randomized Controlled Trial Number Registry ISRCTN94766568, https://www.isrctn.com/ISRCTN94766568 ",
doi="10.2196/49467",
url="https://mental.jmir.org/2024/1/e49467",
url="http://www.ncbi.nlm.nih.gov/pubmed/38252479"
}


@Article{info:doi/10.2196/42813,
author="Espinola, W. Caroline
and Nguyen, Binh
and Torres, Andrei
and Sim, Walter
and Rueda, Alice
and Beavers, Lindsay
and Campbell, M. Douglas
and Jung, Hyejung
and Lou, Wendy
and Kapralos, Bill
and Peter, Elizabeth
and Dubrowski, Adam
and Krishnan, Sridhar
and Bhat, Venkat",
title="Digital Interventions for Stress Among Frontline Health Care Workers: Results From a Pilot Feasibility Cohort Trial",
journal="JMIR Serious Games",
year="2024",
month="Jan",
day="9",
volume="12",
pages="e42813",
keywords="virtual reality",
keywords="simulation",
keywords="mobile app",
keywords="stress",
keywords="moral distress",
keywords="moral injury",
keywords="COVID-19",
keywords="mobile phone",
abstract="Background: The COVID-19 pandemic has challenged the mental health of health care workers, increasing the rates of stress, moral distress (MD), and moral injury (MI). Virtual reality (VR) is a useful tool for studying MD and MI because it can effectively elicit psychophysiological responses, is customizable, and permits the controlled study of participants in real time. Objective: This study aims to investigate the feasibility of using an intervention comprising a VR scenario and an educational video to examine MD among health care workers during the COVID-19 pandemic and to use our mobile app for longitudinal monitoring of stress, MD, and MI after the intervention. Methods: We recruited 15 participants for a compound intervention consisting of a VR scenario followed by an educational video and a repetition of the VR scenario. The scenario portrayed a morally challenging situation related to a shortage of life-saving equipment. Physiological signals and scores of the Moral Injury Outcome Scale (MIOS) and Perceived Stress Scale (PSS) were collected. Participants underwent a debriefing session to provide their impressions of the intervention, and content analysis was performed on the sessions. Participants were also instructed to use a mobile app for 8 weeks after the intervention to monitor stress, MD, and mental health symptoms. We conducted Wilcoxon signed rank tests on the PSS and MIOS scores to investigate whether the VR scenario could induce stress and MD. We also evaluated user experience and the sense of presence after the intervention through semi--open-ended feedback and the Igroup Presence Questionnaire, respectively. Qualitative feedback was summarized and categorized to offer an experiential perspective. Results: All participants completed the intervention. Mean pre- and postintervention scores were respectively 10.4 (SD 9.9) and 13.5 (SD 9.1) for the MIOS and 17.3 (SD 7.5) and 19.1 (SD 8.1) for the PSS. Statistical analyses revealed no significant pre- to postintervention difference in the MIOS and PSS scores (P=.11 and P=.22, respectively), suggesting that the experiment did not acutely induce significant levels of stress or MD. However, content analysis revealed feelings of guilt, shame, and betrayal, which relate to the experience of MD. On the basis of the Igroup Presence Questionnaire results, the VR scenario achieved an above-average degree of overall presence, spatial presence, and involvement, and slightly below-average realism. Of the 15 participants, 8 (53\%) did not answer symptom surveys on the mobile app. Conclusions: Our study demonstrated VR to be a feasible method to simulate morally challenging situations and elicit genuine responses associated with MD with high acceptability and tolerability. Future research could better define the efficacy of VR in examining stress, MD, and MI both acutely and in the longer term. An improved participant strategy for mobile data capture is needed for future studies. Trial Registration: ClinicalTrails.gov NCT05001542; https://clinicaltrials.gov/study/NCT05001542 International Registered Report Identifier (IRRID): RR2-10.2196/32240 ",
doi="10.2196/42813",
url="https://games.jmir.org/2024/1/e42813",
url="http://www.ncbi.nlm.nih.gov/pubmed/38194247"
}


@Article{info:doi/10.2196/50357,
author="Wosny, Marie
and Strasser, Maria Livia
and Hastings, Janna",
title="Experience of Health Care Professionals Using Digital Tools in the Hospital: Qualitative Systematic Review",
journal="JMIR Hum Factors",
year="2023",
month="Oct",
day="17",
volume="10",
pages="e50357",
keywords="health information technology",
keywords="electronic health record",
keywords="electronic medical records",
keywords="clinical decision support",
keywords="health care professionals",
keywords="burnout",
keywords="qualitative research",
abstract="Background: The digitalization of health care has many potential benefits, but it may also negatively impact health care professionals' well-being. Burnout can, in part, result from inefficient work processes related to the suboptimal implementation and use of health information technologies. Although strategies to reduce stress and mitigate clinician burnout typically involve individual-based interventions, emerging evidence suggests that improving the experience of using health information technologies can have a notable impact. Objective: The aim of this systematic review was to collect evidence of the benefits and challenges associated with the use of digital tools in hospital settings with a particular focus on the experiences of health care professionals using these tools. Methods: We conducted a systematic literature review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to explore the experience of health care professionals with digital tools in hospital settings. Using a rigorous selection process to ensure the methodological quality and validity of the study results, we included qualitative studies with distinct data that described the experiences of physicians and nurses. A panel of 3 independent researchers performed iterative data analysis and identified thematic constructs. Results: Of the 1175 unique primary studies, we identified 17 (1.45\%) publications that focused on health care professionals' experiences with various digital tools in their day-to-day practice. Of the 17 studies, 10 (59\%) focused on clinical decision support tools, followed by 6 (35\%) studies focusing on electronic health records and 1 (6\%) on a remote patient-monitoring tool. We propose a theoretical framework for understanding the complex interplay between the use of digital tools, experience, and outcomes. We identified 6 constructs that encompass the positive and negative experiences of health care professionals when using digital tools, along with moderators and outcomes. Positive experiences included feeling confident, responsible, and satisfied, whereas negative experiences included frustration, feeling overwhelmed, and feeling frightened. Positive moderators that may reinforce the use of digital tools included sufficient training and adequate workflow integration, whereas negative moderators comprised unfavorable social structures and the lack of training. Positive outcomes included improved patient care and increased workflow efficiency, whereas negative outcomes included increased workload, increased safety risks, and issues with information quality. Conclusions: Although positive and negative outcomes and moderators that may affect the use of digital tools were commonly reported, the experiences of health care professionals, such as their thoughts and emotions, were less frequently discussed. On the basis of this finding, this study highlights the need for further research specifically targeting experiences as an important mediator of clinician well-being. It also emphasizes the importance of considering differences in the nature of specific tools as well as the profession and role of individual users. Trial Registration: PROSPERO CRD42023393883; https://tinyurl.com/2htpzzxj ",
doi="10.2196/50357",
url="https://humanfactors.jmir.org/2023/1/e50357",
url="http://www.ncbi.nlm.nih.gov/pubmed/37847535"
}


@Article{info:doi/10.2196/45664,
author="Hummel, Svenja
and Michelsen, Ina
and Zafar, Ali
and Moritz, Steffen
and Benoy, Charles
and Lemogne, C{\'e}dric
and Almeida, Rosa
and Losada, Raquel
and Ribeiro, Oscar
and Frisardi, Vincenza
and Tarricone, Ilaria
and Ferrari, Silvia
and Dechent, Frieder
and Huber, G. Christian
and Weidt, Steffi
and Mayer, Gwendolyn
and Schultz, Jobst-Hendrik",
title="Unmet Psychosocial Needs of Health Care Professionals in Europe During the COVID-19 Pandemic: Mixed Methods Approach",
journal="JMIR Public Health Surveill",
year="2023",
month="Sep",
day="6",
volume="9",
pages="e45664",
keywords="COVID-19",
keywords="mental health",
keywords="health care professionals",
keywords="health care workers",
keywords="pandemic preparedness",
keywords="mixed methods",
keywords="coping",
keywords="stressors",
keywords="psychosocial",
abstract="Background: The COVID-19 pandemic severely affected everyday life and working conditions for most Europeans, particularly health care professionals (HCPs). Over the past 3 years, various policies have been implemented in various European countries. Studies have reported on the worsening of mental health, work-related stress, and helpful coping strategies. However, having a closer look is still necessary to gain more information on the psychosocial stressors and unmet needs of HCPs as well as nonmedical staff. Objective: This study aimed to obtain quantitative information on job-related stressors of physicians and nurses and the coping strategies of HCPs and nonmedical staff at 2 periods of the COVID-19 pandemic. By further analyzing qualitative comments, we wanted to gain more information on the psychosocial stressors and unmet needs of HCPs as well as nonmedical staff on different levels of experience. Methods: A cross-sectional survey was conducted at 2 time points during the COVID-19 pandemic in several European countries. The first study period (T1) lasted between April 1 and June 20, 2020, and the second study period (T2) lasted between November 25, 2021, and February 28, 2022. On a quantitative level, we used a questionnaire on stressors for physicians and nurses and a questionnaire on coping strategies for HCPs and nonmedical staff. Quantitative data were descriptively analyzed for mean values and differences in stressors and coping strategies. Qualitative data of free-text boxes of HCPs and nonmedical staff were analyzed via thematic analysis to explore the experiences of the individuals. Results: T1 comprised 609 participants, and T2 comprised 1398 participants. Overall, 296 participants made 438 qualitative comments. The uncertainty about when the pandemic would be controlled (T1: mean 2.28, SD 0.85; T2: mean 2.08, SD 0.90) and the fear of infecting the family (T1: mean 2.26, SD 0.98; T2: mean 2.02, SD 1.02) were the most severe stressors identified by physicians and nurses in both periods. Overall, the use of protective measures (T1: mean 2.66, SD 0.60; T2: mean 2.66, SD 0.60) and acquiring information about COVID-19 (T1: mean 2.29, SD 0.82; T2: mean 1.99, SD 0.89) were identified as the most common coping strategies for the entire study population. Using thematic analysis, we identified 8 themes of personal experiences on the micro, meso, and macro levels. Measures, working conditions, feelings and emotions, and social climate were frequently mentioned topics of the participants. In T1, feelings of isolation and uncertainty were prominent. In T2, feelings of exhaustion were expressed and vaccination was frequently discussed. Moreover, unmet psychosocial needs were identified. Conclusions: There is a need for improvement in pandemic preparedness. Targeted vocational education measures and setting up of web-based mental health support could be useful to bridge gaps in psychosocial support needs in future crises. ",
doi="10.2196/45664",
url="https://publichealth.jmir.org/2023/1/e45664",
url="http://www.ncbi.nlm.nih.gov/pubmed/37672320"
}


@Article{info:doi/10.2196/44195,
author="Soares, Pontes Juliana
and Lopes, Hor{\'a}cio Rayssa
and Mendon{\c{c}}a, Souza Paula Beatriz de
and Silva, Vieira C{\'i}cera Renata Diniz
and Rodrigues, Martins Cl{\'a}udia Cristiane Filgueira
and Castro, de Janete Lima",
title="Use of the Maslach Burnout Inventory Among Public Health Care Professionals: Scoping Review",
journal="JMIR Ment Health",
year="2023",
month="Jul",
day="21",
volume="10",
pages="e44195",
keywords="burnout professional",
keywords="burnout",
keywords="health care professional",
keywords="health personnel",
keywords="health professionals",
keywords="Maslach Burnout Inventory",
keywords="mental health",
keywords="occupational health",
keywords="public health services",
keywords="public health",
keywords="workplace stress",
abstract="Background: Work can be considered a source of living, well-being, and socioeconomic development. When the work environment negatively influences individuals, it may trigger emotional disturbances, behavioral problems, chronic stress conditions, and illnesses such as burnout syndrome (BS). Recently, studies on BS have increased and placed a special focus on health care professionals. The prevalence of BS among health professionals is associated with their chronic exposure to human hardship and long working hours without proper rest. These factors have contributed to greater stress and high physical and emotional exhaustion levels. Objective: This study aims to identify and map studies using the Maslach Burnout Inventory (MBI) scale to identify burnout syndrome in health professionals working in public health services. Methods: This scoping review was developed based on the Joanna Briggs Institute (JBI) Reviewers Manual and reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A total of 6 databases were searched to identify relevant studies: Embase, LILACS, MEDLINE or PubMed, PsycInfo, Scopus, and Web of Science. Gray literature was consulted on ProQuest Dissertations and Theses Global, Google Scholar, Brazilian Digital Library of Theses and Dissertations, and Open Access Theses and Dissertations. Additionally, the reference lists were searched to retrieve studies not previously selected. The steps followed in this study were proposed by Arskey and O'Malley and Levac, Colquhoun, and O'Brien: identification of research questions, identification of potential studies, study selection, data extraction and imputation, data analyses and interpretation, and consultation with stakeholders. The detailed methodology was published in a protocol. Results: A total of 55 articles were identified after screening for eligibility criteria, published between 1999 and 2021 in 32 countries. Most reports were published in Brazil, Spain, and China. A total of 22 versions of the MBI were identified, presenting different items, scores, and cutoff points. The included studies had recommendations and implications for clinical practice. The consultation with stakeholders allowed knowledge translation for those interested in BS. Conclusions: Studies mostly included physicians (34/55, 61.8\%) and nurses (24/55, 43.6\%), and the original version of MBI was predominantly used. Divergences in BS classification were highlighted, which may be related to MBI cross-cultural adaptations and applications in other countries. This study contributes to the advancement of research regarding burnout syndrome as an occupational illness since it has harmful consequences for workers, health care services, and the quality of care provided to the population. ",
doi="10.2196/44195",
url="https://mental.jmir.org/2023/1/e44195",
url="http://www.ncbi.nlm.nih.gov/pubmed/37477960"
}


@Article{info:doi/10.2196/42317,
author="de Miquel, Carlota
and Moneta, Victoria Maria
and Weber, Silvana
and Lorenz, Christopher
and Olaya, Beatriz
and Haro, Maria Josep",
title="The Mediating Role of General and Cognitive Stress on the Effect of an App-Based Intervention on Productivity Measures in Workers: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2023",
month="Jul",
day="3",
volume="25",
pages="e42317",
keywords="e-mental health intervention",
keywords="work",
keywords="absenteeism",
keywords="presenteeism",
keywords="stress",
keywords="mediation",
abstract="Background: Loss of productivity is a result of absence from work (absenteeism) or of working with limitations due to illness (presenteeism). Recently, occupational mental health interventions have increasingly been delivered in digital format, as this is thought to be more convenient, flexible, easily accessible, and anonymous. However, the effectiveness of electronic mental health (e-mental health) interventions in the workplace to improve presenteeism and absenteeism remains unknown, and could be potentially mediated by psychological variables such as stress levels. Objective: The aim of this study was to determine the effectiveness of an e-mental health intervention to reduce absenteeism and presenteeism in employees, as well as to investigate the mediating role of stress in this effect. Methods: Employees of six companies in two countries participated in a randomized controlled trial (n=210 in the intervention group and n=322 in the waitlist control group). Participants in the intervention group could use the Kelaa Mental Resilience app for 4 weeks. All participants were asked to complete assessments at baseline, during the intervention, postintervention, and at a 2-week follow-up. Absenteeism and presenteeism were assessed by means of the Work Productivity and Activity Impairment Questionnaire: General Health, while general and cognitive stress were assessed through the Copenhagen Psychosocial Questionnaire-Revised Version. Regression and mediation analyses were performed to evaluate the effect of the Kelaa Mental Resilience app on presenteeism and absenteeism. Results: The intervention did not have a direct effect on presenteeism or absenteeism, neither at postintervention nor at follow-up. Nevertheless, general stress significantly mediated the intervention effect on presenteeism (P=.005) but not on absenteeism (P=.92), and cognitive stress mediated the effect of the intervention on both presenteeism (P<.001) and absenteeism (P=.02) right after the intervention. At the 2-week follow-up, the mediating effect of cognitive stress on presenteeism was significant (P=.04), although this was not the case for its mediating effect on absenteeism (P=.36). Additionally, at the 2-week follow-up, general stress did not mediate the intervention effect on presenteeism (P=.25) or on absenteeism (P=.72). Conclusions: While no direct effect of the e-mental health intervention on productivity was found in this study, our findings suggest that stress reduction could mediate the effect of the intervention on presenteeism and absenteeism. As such, e-mental health interventions that address stress in employees might also indirectly reduce presenteeism and absenteeism in these employees. However, due to study limitations such as an overrepresentation of female participants in the sample and a high proportion of attrition, these results should be interpreted with caution. Future research is needed to better understand the mechanisms of interventions on productivity in the workplace. Trial Registration: ClinicalTrials.gov NCT05924542; https://clinicaltrials.gov/study/NCT05924542 ",
doi="10.2196/42317",
url="https://www.jmir.org/2023/1/e42317",
url="http://www.ncbi.nlm.nih.gov/pubmed/37399056"
}


@Article{info:doi/10.2196/47629,
author="Meese, A. Katherine
and Boitet, M. Laurence
and Sweeney, L. Katherine
and Nassetta, Lauren
and Mugavero, Michael
and Hidalgo, Bertha
and Reamey, Rebecca
and Rogers, A. David",
title="Still Exhausted: The Role of Residual Caregiving Fatigue on Women in Medicine and Science Across the Pipeline",
journal="J Med Internet Res",
year="2023",
month="Jun",
day="14",
volume="25",
pages="e47629",
keywords="caregiving",
keywords="women in medicine",
keywords="exhaustion",
keywords="childcare",
keywords="burden",
keywords="burnout",
keywords="stress",
keywords="caregiver",
keywords="women",
keywords="professional",
keywords="child",
keywords="eldercare",
keywords="elderly",
keywords="older adults",
keywords="older adult",
keywords="gerontology",
keywords="family care",
keywords="informal care",
keywords="unpaid care",
keywords="survey",
doi="10.2196/47629",
url="https://www.jmir.org/2023/1/e47629",
url="http://www.ncbi.nlm.nih.gov/pubmed/37314842"
}


@Article{info:doi/10.2196/42566,
author="Ditton, Elizabeth
and Knott, Brendon
and Hodyl, Nicolette
and Horton, Graeme
and Oldmeadow, Christopher
and Walker, Rohan Frederick
and Nilsson, Michael",
title="Evaluation of an App-Delivered Psychological Flexibility Skill Training Intervention for Medical Student Burnout and Well-being: Randomized Controlled Trial",
journal="JMIR Ment Health",
year="2023",
month="Feb",
day="6",
volume="10",
pages="e42566",
keywords="burnout",
keywords="psychological",
keywords="burnout interventions",
keywords="well-being",
keywords="medicine",
keywords="medical student",
keywords="digital intervention",
keywords="app-delivered intervention",
keywords="individualized intervention",
keywords="randomized controlled trial",
keywords="RCT",
keywords="randomized",
keywords="Acceptance and Commitment Training",
keywords="stress",
keywords="mobile health",
keywords="mHealth",
keywords="mobile phone",
abstract="Background: Physician burnout is a common problem, with onset frequently occurring during undergraduate education. Early intervention strategies that train medical students in psychological flexibility skills could support well-being and mitigate burnout risks associated with unmodifiable career stressors. There is a need for randomized controlled trials to assess effectiveness. As psychological flexibility varies contextually and among individuals, tailoring interventions may improve outcomes. Smartphone apps can facilitate individualization and accessibility, and the evaluation of this approach is an identified research priority. Objective: This study aimed to evaluate the effectiveness of a stand-alone app--delivered Acceptance and Commitment Training intervention for improving medical students' self-reported burnout, well-being, psychological flexibility, and psychological distress outcomes. We aimed to explore whether an individualized app would demonstrate benefits over a nonindividualized version. Methods: This parallel randomized controlled trial was conducted with a sample of medical students from 2 Australian universities (N=143). Participants were randomly allocated to 1 of 3 intervention arms (individualized, nonindividualized, and waitlist) using a 1:1:1 allocation ratio. Individualized and nonindividualized participants were blinded to group allocation. The 5-week intervention included an introductory module (stage 1) and on-demand access to short skill training activities (stage 2), which students accessed at their own pace. Stage 2 was either nonindividualized or individualized to meet students' identified psychological flexibility training needs. Results: The mean differences in change from baseline between the intervention groups and the waitlist group were not statistically significant for burnout outcomes: exhaustion (primary; individualized: ?0.52, 95\% CI ?3.70 to 2.65, P=.75; nonindividualized: 1.60, 95\% CI ?1.84 to 5.03, P=.37), cynicism (individualized: ?1.26, 95\% CI ?4.46 to 1.94, P=.44; nonindividualized: 1.00, 95\% CI ?2.45 to 4.46, P=.57), and academic efficacy (individualized: 0.94, 95\% CI ?0.90 to 2.79, P=.32; nonindividualized: 2.02, 95\% CI 0.02-4.03, P=.05). Following the intervention, the individualized group demonstrated improved psychological flexibility (0.50, 95\% CI 0.12-0.89; P=.01), reduced inflexibility (0.48, 95\% CI ?0.92 to ?0.04; P=.04), and reduced stress (?6.89, 95\% CI ?12.01 to 5.99; P=.01), and the nonindividualized group demonstrated improved well-being (6.46, 95\% CI 0.49-12.42; P=.04) and stress (?6.36, 95\% CI ?11.90 to ?0.83; P=.03) compared with waitlist participants. Between-group differences for the individualized and nonindividualized arms were not statistically significant. High attrition (75/143, 52.4\%) was observed. Conclusions: This trial provides early support for the potential benefits of Acceptance and Commitment Training for medical student well-being and psychological outcomes and demonstrates that psychological flexibility and inflexibility can be trained using a smartphone app. Although postintervention burnout outcomes were not statistically significant, improvements in secondary outcomes could indicate early risk mitigation. Replication studies with larger samples and longer-term follow-up are required, and future research should focus on improving implementation frameworks to increase engagement and optimize individualization methods. Trial Registration: Australian New Zealand Clinical Trials Registry 12621000911897; https://tinyurl.com/2p92cwrw International Registered Report Identifier (IRRID): RR2-10.2196/32992 ",
doi="10.2196/42566",
url="https://mental.jmir.org/2023/1/e42566",
url="http://www.ncbi.nlm.nih.gov/pubmed/36745486"
}


@Article{info:doi/10.2196/42338,
author="Soares, Pontes Juliana
and Lopes, Horacio Rayssa
and Mendon{\c{c}}a, Souza Paula Beatriz de
and Silva, Vieira C{\'i}cera Renata Diniz
and Rodrigues, Martins Cl{\'a}udia Cristiane Filgueira
and Castro, de Janete Lima",
title="Use of the Maslach Burnout Inventory Among Public Health Care Professionals: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2022",
month="Nov",
day="1",
volume="11",
number="11",
pages="e42338",
keywords="health care personnel",
keywords="health care workers",
keywords="public health services",
keywords="Maslach burnout inventory",
keywords="burnout, health care professional",
keywords="workplace stress",
keywords="mental health",
keywords="occupational health",
keywords="psychological well-being",
keywords="policymaker",
abstract="Background: Burnout syndrome is a chronic response to stressors in the workplace. It is characterized by emotional exhaustion and physical and mental burnout and may lead to high employee turnover, work absenteeism, and increased occupational accidents. Most studies use the Maslach Burnout Inventory (MBI) to identify burnout and implement preventive actions and treatments. Objective: This study presents a scoping review protocol to identify and map studies that used MBI to assess burnout syndrome in health care professionals working in public health services. Methods: This scoping review protocol follows the Joanna Briggs Institute reviewers' manual, and this protocol consists of 6 stages: identifying the research question, identifying relevant studies, study selection, data extraction and coding, analysis and interpretation of results, and consultation with stakeholders. We will conduct searches in Embase, LILACS, PubMed/MEDLINE, PsycINFO, Scopus, Web of Science databases, and gray literature. The main research question is as follows: how is MBI used to identify burnout syndrome in health care professionals working in public health services? Inclusion criteria will comprise qualitative and quantitative studies using MBI to identify burnout syndrome in health care professionals working in public health services and no restrictions in language and publication dates. Data will be extracted using a spreadsheet adapted from the Joanna Briggs Institute model. Quantitative and qualitative data will be analyzed using descriptive statistics and thematic analysis, respectively. The consultation with stakeholders will be essential for increasing the knowledge about MBI, identifying new evidence, and developing future strategies to guide public policies preventing burnout syndrome in health care professionals working in public services. Results: This protocol will guide a scoping review to identify and map studies that used MBI to identify burnout syndrome in health care professionals working in public health services. The results of this review may be useful to public health care professionals, managers, policymakers, and the general population because these findings will help understand the validated, translated, and adapted versions of MBI and domains, number of items, Likert scales, and cutoff points or the latent profile analysis most used in the literature. Furthermore, possible research gaps may be identified to guide future studies. All information regarding the stages of the scoping review favor its transparency and allow it to be methodologically replicated according to the principles of open science, thereby reducing the risk of bias and data duplication. Conclusions: This study may reveal the multiplicity of scales described in the literature and the different forms of assessing burnout syndrome in health care professionals. This study may help to standardize the assessment of burnout syndrome in health care professionals working in public health services and contribute to the discussion and knowledge dissemination about burnout syndrome and mental health in this population. International Registered Report Identifier (IRRID): DERR1-10.2196/42338 ",
doi="10.2196/42338",
url="https://www.researchprotocols.org/2022/11/e42338",
url="http://www.ncbi.nlm.nih.gov/pubmed/36318252"
}


@Article{info:doi/10.2196/38926,
author="Mesk{\'o}, Bertalan",
title="COVID-19's Impact on Digital Health Adoption: The Growing Gap Between a Technological and a Cultural Transformation",
journal="JMIR Hum Factors",
year="2022",
month="Sep",
day="19",
volume="9",
number="3",
pages="e38926",
keywords="COVID-19",
keywords="digital health",
keywords="future",
keywords="cultural transformation",
keywords="medical information",
keywords="technology adoption",
keywords="health care",
keywords="physician burnout",
keywords="burnout",
doi="10.2196/38926",
url="https://humanfactors.jmir.org/2022/3/e38926",
url="http://www.ncbi.nlm.nih.gov/pubmed/36121692"
}


@Article{info:doi/10.2196/34230,
author="Henshall, Catherine
and Ostinelli, Edoardo
and Harvey, Jade
and Davey, Zoe
and Aghanenu, Bemigho
and Cipriani, Andrea
and Attenburrow, Mary-Jane",
title="Examining the Effectiveness of Web-Based Interventions to Enhance Resilience in Health Care Professionals: Systematic Review",
journal="JMIR Med Educ",
year="2022",
month="Sep",
day="6",
volume="8",
number="3",
pages="e34230",
keywords="resilience",
keywords="health care professionals",
keywords="depression",
keywords="psychological stress",
keywords="internet",
keywords="mental health",
abstract="Background: Internationally, the impact of continued exposure to workplace environmental and psychological stressors on health care professionals' mental health is associated with increased depression, substance misuse, sleep disorders, and posttraumatic stress. This can lead to staff burnout, poor quality health care, and reduced patient safety outcomes. Strategies to improve the psychological health and well-being of health care staff have been highlighted as a critical priority worldwide. The concept of resilience for health care professionals as a tool for negotiating workplace adversity has gained increasing prominence. Objective: This systematic review aims to examine the effectiveness of web-based interventions to enhance resilience in health care professionals. Methods: We searched the PubMed, CINAHL, PsycINFO, and Ovid SP databases for relevant records published after 1990 until July 2021. We included studies that focused on internet-delivered interventions aiming at enhancing resilience. Study quality was assessed with the Risk of Bias 2 tool for randomized controlled trial designs and Joanna Briggs Institute critical appraisal tool for other study designs. The protocol was registered on PROSPERO (International Prospective Register of Systematic Reviews; CRD42021253190). PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Results: A total of 8 studies, conducted between 2014 and 2020 and involving 1573 health care workers, were included in the review. In total, 4 randomized controlled trial designs and 4 pre- and postdesign studies were conducted across a range of international settings and health care disciplines. All of these studies aimed to evaluate the impact of web-based interventions on resilience or related symptoms in health care professionals involved in patient-facing care. Interventions included various web-based formats and therapeutic approaches over variable time frames. One randomized controlled trial directly measured resilience, whereas the remaining 3 used proxy measures to measure psychological concepts linked to resilience. Three pretest and posttest studies directly measured resilience, whereas the fourth study used a proxy resilience measure. Owing to the heterogeneity of outcome measures and intervention designs, meta-analysis was not possible, and qualitative data synthesis was undertaken. All studies found that resilience or proxy resilience levels were enhanced in health care workers following the implementation of web-based interventions. The overall risk of bias of all 8 studies was low. Conclusions: The findings indicate that web-based interventions designed to enhance resilience may be effective in clinical practice settings and have the potential to provide support to frontline staff experiencing prolonged workplace stress across a range of health care professional groups. However, the heterogeneity of included studies means that findings should be interpreted with caution; more web-based interventions need rigorous testing to further develop the evidence base. Trial Registration: PROSPERO CRD42021253190; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=253190 ",
doi="10.2196/34230",
url="https://mededu.jmir.org/2022/3/e34230",
url="http://www.ncbi.nlm.nih.gov/pubmed/36066962"
}


@Article{info:doi/10.2196/37015,
author="Srikesavan, Cynthia
and Davey, Zoe
and Cipriani, Andrea
and Henshall, Catherine",
title="Resilience Enhancement Online Training for Nurses (REsOluTioN): Protocol for a Pilot Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Aug",
day="3",
volume="11",
number="8",
pages="e37015",
keywords="online training",
keywords="nurses",
keywords="resilience",
keywords="mental well-being",
keywords="pilot trial",
keywords="COVID-19",
keywords="nursing",
keywords="mental health",
keywords="health care staff",
keywords="psychological health",
keywords="online health",
keywords="resilience training",
keywords="health care setting",
abstract="Background: Globally, nurses are facing increased pressure to provide high-quality complex patient care within environments with scarce resources in terms of staffing, infrastructure, or financial reward. The strain and demand on the psychological health and well-being of nurses during COVID-19 has been substantial, with many experiencing burnout; as such, interventions to enhance resilience within the workplace are required. A face-to-face resilience enhancement training program for nurses that was effective in improving resilience levels was translated into a 4-week online training program, Resilience Enhancement Online Training for Nurses (REsOluTioN), to enable greater accessibility for nurses. Objective: This study aims to compare levels of resilience, psychological health, and well-being in nurses before and after the online resilience training compared to a wait list control group. It will also explore participants' engagement with the trial and their acceptability of the online training. Methods: This is a two-arm, parallel, randomized controlled trial with a 6-week follow-up period. Up to 100 registered nonagency nurses working at a National Health Service hospital trust in South England will be recruited. Four cohorts will run, and participants will be randomized into a wait list control group or to REsOluTioN. Pre- and postonline surveys will collect study outcome measure data. In the REsOluTioN arm, data will be collected on the perceived usefulness of the online training via an online survey. Institutional and health research authority approvals have been obtained. Results: REsOluTioN will aim to empower nurses to maintain and enhance their resilience while working under challenging clinical conditions. The online training will be interactive with input from mentors, health care leaders, and peers to promote engagement and enhanced communication, and will create a forum where nurses can express their views and concerns, without hierarchical infrastructures inhibiting them. This can increase self-knowledge and learning around workplace resilience coping strategies and provide a safe space to validate feelings through mentorship and peer support. Findings will be reported in accordance with the CONSORT (Consolidated Standards of Reporting Trials) guidelines. The trial is now finished and was conducted between August 2021 and May 2022. Conclusions: The REsOluTioN trial will enable preliminary data to be gathered to indicate the online training's effectiveness in enhancing nurses' resilience in the workplace, with the potential for larger scale follow-up studies to identify its value to nurses working across a range of health care settings. Trial Registration: ClinicalTrials.gov NCT05074563; https://clinicaltrials.gov/ct2/show/NCT05074563 International Registered Report Identifier (IRRID): DERR1-10.2196/37015 ",
doi="10.2196/37015",
url="https://www.researchprotocols.org/2022/8/e37015",
url="http://www.ncbi.nlm.nih.gov/pubmed/35862692"
}


@Article{info:doi/10.2196/37195,
author="Sch{\"o}nfeld, Simone
and Rathmer, Ines
and Michaelsen, M. Maren
and Hoetger, Cosima
and Onescheit, Miriam
and Lange, Silke
and Werdecker, Lena
and Esch, Tobias",
title="Effects of a Mindfulness Intervention Comprising an App, Web-Based Workshops, and a Workbook on Perceived Stress Among Nurses and Nursing Trainees: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Aug",
day="2",
volume="11",
number="8",
pages="e37195",
keywords="nurses",
keywords="nursing trainee",
keywords="nursing student",
keywords="acute care",
keywords="inpatient",
keywords="health promotion",
keywords="mindfulness",
keywords="mobile",
keywords="web-based",
keywords="stress",
keywords="mobile phone",
abstract="Background: Previous research has found digitally supported mindfulness interventions to be effective when used for stress management among workers in high-stress occupations. Findings on digitally supported mindfulness interventions among nurses working in acute inpatient care settings are heterogeneous, lack long-term follow-up, and do not assess adherence and acceptability. Objective: This study aimed to investigate the effectiveness and efficacy of a digitally supported mindfulness intervention designed to improve health- and work-related outcomes among nurses and nursing trainees working in acute inpatient care settings. Methods: We will conduct a multicenter randomized controlled trial using a wait-list control group design. Randomization will be stratified by hospital and job status (nurse or nursing trainee). Recruitment will take place on the web and offline during the working hours of nurses and nursing trainees. The intervention group will receive a digitally supported mindfulness intervention, which will comprise an app, 2 web-based workshops, and a workbook, whereas the wait-list control group will be scheduled to receive the same intervention 14 weeks later. The 2 web-based workshops will be led by a certified mindfulness-based stress reduction trainer. Nurses will use the app and the workbook independently. Self-report web-based surveys will be conducted on the web at baseline, at 10 weeks after allocation, at 24 weeks after allocation, and at 38 weeks after allocation. Outcomes of interest will include perceived stress (primary outcome), health- and work-related variables, and variables related to adherence and acceptability of the digitally supported mindfulness intervention. We will perform intention-to-treat and per-protocol analyses. Results: Data collection will be completed by the beginning of August 2022. Data analyses will be completed by December 2022. Conclusions: Our study design, including long-term follow-up and the investigation of variables related to adherence and acceptability, will ensure rigorous evaluation of effectiveness and efficacy. Relative to costly in-person intervention efforts, this program may present a cost-effective and potentially highly scalable alternative. Findings regarding effectiveness, efficacy, adherence, and acceptability will inform stakeholders' decisions regarding the implementation of similar interventions to promote the well-being of nurses and nursing trainees, which may, in turn, alleviate detrimental stress-related outcomes (eg, burnout) because of work-related demands. Trial Registration: German Clinical Trials Register DRKS00025997; https://tinyurl.com/433cas7u International Registered Report Identifier (IRRID): DERR1-10.2196/37195 ",
doi="10.2196/37195",
url="https://www.researchprotocols.org/2022/8/e37195",
url="http://www.ncbi.nlm.nih.gov/pubmed/35916708"
}


@Article{info:doi/10.2196/34979,
author="Leung, I. Tiffany
and Kuhn, Tobias
and Dumontier, Michel",
title="Representing Physician Suicide Claims as Nanopublications: Proof-of-Concept Study Creating Claim Networks",
journal="JMIRx Med",
year="2022",
month="Jul",
day="1",
volume="3",
number="3",
pages="e34979",
keywords="physician suicide",
keywords="suicide",
keywords="suicide prevention",
keywords="physician well-being",
keywords="physician mental health",
keywords="nanopublication",
keywords="physician",
keywords="doctor",
keywords="mental health",
keywords="semantic publishing",
keywords="bibliometrics",
keywords="claim network",
keywords="information distortion",
keywords="misinformation",
abstract="Background: In the poorly studied field of physician suicide, various factors can contribute to misinformation or information distortion, which in turn can influence evidence-based policies and prevention of suicide in this unique population. Objective: The aim of this paper is to use nanopublications as a scientific publishing approach to establish a citation network of claims in peer-reviewed publications about the rate of suicide among US physicians. Methods: A list of articles from a previously published scoping literature review on physician suicide was used to identify those articles that commented on or investigated suicidal behaviors of physician populations, including students, postgraduate trainees, and practicing physicians. The included articles were from peer-reviewed publications and asserted a claim about the annual rate of physician suicide. Manual data extraction was performed to collect article (or resource) type, title, authors, digital object identifier or URI, publication year, claim (about annual physician suicide rate), data of last access of the article (eg, for a webpage), and citations supporting the claim. Additional articles, websites, or other links were only added to the set of claims if they were cited by a peer-reviewed article already included in the data set. A nanopublication was created for each article or resource using Nanobench with an investigator-developed literature-based claim nanopublication template. Results: A set of 49 claims concerning the rate of US physician suicide was represented as nanopublications. Analysis of the claim network revealed that (1) the network is not fully connected, (2) no single primary source of the claim could be identified, and (3) all end-point citations had a claim with no further citation, had no apparent claim, or could not be accessed to verify the claim. The nanopublication strategy also enabled the capture of variant claims published on a website. Conclusions: Nanopublications remain to be adopted in broader scientific publishing in medicine, especially in publishing about physician mental health and suicide. This proof-of-concept study highlights an opportunity for more coordinated research efforts in the subject of physician suicide. Our work integrates these various claims and enables the verification of nonauthoritative assertions, thereby better equipping researchers to advance evidence-based knowledge and to make informed statements in the advocacy of physician suicide prevention. Representing physician suicide rate claims as nanopublications can be extended and improved in future work. ",
doi="10.2196/34979",
url="https://med.jmirx.org/2022/3/e34979",
url="http://www.ncbi.nlm.nih.gov/pubmed/27725715"
}


@Article{info:doi/10.2196/35083,
author="Ewais, Tatjana
and Hunt, Georgia
and Munro, Jonathan
and Pun, Paul
and Hogan, Christy
and William, Leeroy
and Teodorczuk, Andrew",
title="Schwartz Rounds for Staff in an Australian Tertiary Hospital: Protocol for a Pilot Uncontrolled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Apr",
day="27",
volume="11",
number="4",
pages="e35083",
keywords="Schwartz Rounds",
keywords="compassionate care",
keywords="health care staff well-being",
abstract="Background: Schwartz Rounds are a unique, organization-wide interdisciplinary intervention aimed at enhancing staff well-being, compassionate care, teamwork, and organizational culture in health care settings. They provide a safe space wherein both clinical and nonclinical health staff can connect and share their experiences about the social and emotional aspects of health care. Objective: Although Schwartz Rounds have been assessed and widely implemented in the United States and United Kingdom, they are yet to be formally evaluated in Australian health care settings. The purpose of this study is to evaluate the feasibility and impact of Schwartz Rounds on staff well-being, compassionate care, and organizational culture, in a tertiary metropolitan hospital in Brisbane, Australia. Methods: This mixed methods repeated measures pilot study will recruit 24 participants in 2 groups from 2 departments, the intensive care unit and the gastroenterology department. Participants from each group will take part in 3 unit-based Schwartz Rounds. Primary outcomes will include the study and intervention feasibility measures, while secondary outcomes will include scores on the Maslach Burnout Inventory--Human Services Survey, the Schwartz Centre Compassionate Care Scale, and the Culture of Care Barometer. Primary and secondary outcomes will be collected at baseline, after the Rounds, and 3-month follow-up. Two focus groups will be held approximately 2 months after completion of the Schwartz Rounds. Descriptive statistics, paired t tests, chi-square tests, and analysis of variance will be used to compare quantitative data across time points and groups. Qualitative data from focus groups and free-text survey questions will be analyzed using an inductive thematic analysis approach. Results: The study was approved by the Mater Hospital Human Research Ethics Committee (reference number: HREC/MML/71868) and recruitment commenced in July 2021; study completion is anticipated by May 2022. Conclusions: The study will contribute to the assessment of feasibility and preliminary efficacy of the Schwartz Rounds in a tertiary Australian hospital during the COVID-19 pandemic. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621001473853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382769\&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/35083 ",
doi="10.2196/35083",
url="https://www.researchprotocols.org/2022/4/e35083",
url="http://www.ncbi.nlm.nih.gov/pubmed/35475785"
}


@Article{info:doi/10.2196/30680,
author="Obuobi-Donkor, Gloria
and Eboreime, Ejemai
and Bond, Jennifer
and Phung, Natalie
and Eyben, Scarlett
and Hayward, Jake
and Zhang, Yanbo
and MacMaster, Frank
and Clelland, Steven
and Greiner, Russell
and Jones, Chelsea
and Cao, Bo
and Br{\'e}mault-Phillips, Suzette
and Wells, Kristopher
and Li, Xin-Min
and Hilario, Carla
and Greenshaw, J. Andrew
and Agyapong, Opoku Vincent Israel",
title="An E--Mental Health Solution to Prevent and Manage Posttraumatic Stress Injuries Among First Responders in Alberta: Protocol for the Implementation and Evaluation of Text Messaging Services (Text4PTSI and Text4Wellbeing)",
journal="JMIR Res Protoc",
year="2022",
month="Apr",
day="25",
volume="11",
number="4",
pages="e30680",
keywords="posttraumatic stress injury",
keywords="first responders",
keywords="messaging",
keywords="mobile phone",
keywords="text-based intervention",
keywords="Text4PTSI",
keywords="Text4Wellbeing",
abstract="Background: First responders are confronted with traumatic events in their work that has a substantial toll on their psychological health and may contribute to or result in posttraumatic stress injuries (PTSIs) for many responders. Persons with a PTSI usually seek management therapies. Evidence indicates that digital delivery of these therapies is an innovative, efficient, and effective way to improve PTSI symptoms as an adjunct to in-person delivery. Objective: This project aims to implement and provide accessible, convenient, and economical SMS text messaging services, known as Text4PTSI and Text4Wellbeing, to first responders in Alberta, Canada; to prevent and improve the symptoms of PTSI among first responders; and to improve their overall quality of life. We will evaluate posttraumatic symptoms and the impact of Text4PTSI and Text4Wellbeing on stress, anxiety, and depression in relation to the correspondents' demographic backgrounds. Methods: First responders who subscribe to Text4PTSI or Text4Wellbeing receive daily supportive and psychoeducational SMS text messages for 6 months. The SMS text messages are preprogrammed into an online software program that delivers messages to subscribers. Baseline and follow-up data are collected through online questionnaires using validated scales at enrollment, 6 weeks, 12 weeks, and 24 weeks (end point). In-depth interviews will be conducted to assess satisfaction with the text-based intervention. Results: We hypothesize that participants who enroll in this program will have improved PTSI symptoms; increased or improved quality of life; and significant reduction in associated stress, depression, and anxiety symptoms, among other psychological concerns. Improvement will be determined in comparison to established baseline parameters. Conclusions: This research will be beneficial for practitioners and will inform policy-making and decision-making regarding psychological interventions for PTSI. Lessons from this study will inform the scale-up of the intervention, a cost-effective, zero contact therapeutic option to manage PTSI. International Registered Report Identifier (IRRID): PRR1-10.2196/30680 ",
doi="10.2196/30680",
url="https://www.researchprotocols.org/2022/4/e30680",
url="http://www.ncbi.nlm.nih.gov/pubmed/35468094"
}


@Article{info:doi/10.2196/36702,
author="Broetje, Sylvia
and Bauer, F. Georg
and Jenny, J. Gregor",
title="Acceptance of an Internet-Based Team Development Tool Aimed at Improving Work-Related Well-being in Nurses: Cross-sectional Study",
journal="JMIR Nursing",
year="2022",
month="Apr",
day="22",
volume="5",
number="1",
pages="e36702",
keywords="digital intervention",
keywords="eHealth",
keywords="nurses",
keywords="online intervention",
keywords="organizational health",
keywords="technology acceptance",
keywords="UTAUT",
keywords="workplace health promotion",
keywords="mHealth",
abstract="Background: Workplace health interventions can produce beneficial health- and business-related outcomes. However, such interventions have traditionally focused on lifestyle behaviors of individuals, mostly not considering the role of working conditions. The wecoach intervention is an internet-based tool that combines both a digital and a participatory team development approach aimed at addressing critical job demands and resources as key aspects of health-promoting working conditions. Nursing staff are particularly affected by challenging working conditions and could potentially benefit greatly. Understanding the acceptance of novel workplace health promotion approaches is a critical precursor to their successful implementation and use. Objective: This study aims to examine the factors influencing the acceptance of a digitally supported team development tool among nurse managers. Methods: A sample of 32 nurse managers from 3 German-speaking countries tested wecoach and completed our online questionnaire. Hypotheses were based on the unified theory of acceptance and use of technology (UTAUT) and the organizational health development (OHD) model and were tested using multiple regression analyses. Results: Our analyses found that merely capacities on the team level (CapTeam) significantly contributed to the acceptance of wecoach, although only after the other variables were excluded in the stepwise multiple regression analysis. The UTAUT predictors were unable to add significant variance explanation beyond that, and their inclusion masked the contribution of CapTeam. Conclusions: For the acceptance of a digitally supported participatory tool, the fit with the team, its culture, and its motivation are of critical importance, while aspects proposed by traditional acceptance models, such as the UTAUT, may not be applicable. ",
doi="10.2196/36702",
url="https://nursing.jmir.org/2022/1/e36702",
url="http://www.ncbi.nlm.nih.gov/pubmed/35452403"
}


@Article{info:doi/10.2196/36200,
author="Kruse, Scott Clemens
and Mileski, Michael
and Dray, Gevin
and Johnson, Zakia
and Shaw, Cameron
and Shirodkar, Harsha",
title="Physician Burnout and the Electronic Health Record Leading Up to and During the First Year of COVID-19: Systematic Review",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="31",
volume="24",
number="3",
pages="e36200",
keywords="electronic health record",
keywords="physician burnout",
keywords="quality improvement",
keywords="psychiatry",
keywords="medical informatics",
keywords="COVID-19",
keywords="pandemic",
keywords="health informatic",
keywords="health care",
keywords="health care professional",
keywords="health care infrastructure",
keywords="health care system",
keywords="mental health",
keywords="cognitive fatigue",
abstract="Background: Physician burnout was first documented in 1974, and the electronic health record (EHR) has been known to contribute to the symptoms of physician burnout. Authors pondered the extent of this effect, recognizing the increased use of telemedicine during the first year of COVID-19. Objective: The aim of this review was to objectively analyze the literature over the last 5 years for empirical evidence of burnout incident to the EHR and to identify barriers to, facilitators to, and associated patient satisfaction with using the EHR to improve symptoms of burnout. Methods: No human participants were involved in this review; however, 100\% of participants in studies analyzed were adult physicians. We queried 4 research databases and 1 targeted journal for studies commensurate with the objective statement from January 1, 2016 through January 31, 2021 (n=25). Results: The hours spent in documentation and workflow are responsible for the sense of loss of autonomy, lack of work-life balance, lack of control of one's schedule, cognitive fatigue, a general loss of autonomy, and poor relationships with colleagues. Researchers have identified training, local customization of templates and workflow, and the use of scribes as strategies to alleviate the administrative burden of the EHR and decrease symptoms of burnout. Conclusions: The solutions provided in the literature only addressed 2 of the 3 factors (workflow and documentation time) but not the third factor (usability). Practitioners and administrators should focus on the former 2 factors because they are within their sphere of control. EHR vendors should focus on empirical evidence to identify and improve the usability features with the greatest impact. Researchers should design experiments to explore solutions that address all 3 factors of the EHR that contribute to burnout. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020201820; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=201820 International Registered Report Identifier (IRRID): RR2-10.2196/15490 ",
doi="10.2196/36200",
url="https://www.jmir.org/2022/3/e36200",
url="http://www.ncbi.nlm.nih.gov/pubmed/35120019"
}


@Article{info:doi/10.2196/35280,
author="Sato, Christa
and Adumattah, Anita
and Abulencia, Krisel Maria
and Garcellano, Dennis Peter
and Li, Tai-Wai Alan
and Fung, Kenneth
and Poon, Kwong-Lai Maurice
and Vahabi, Mandana
and Wong, Pui-Hing Josephine",
title="COVID-19 Mental Health Stressors of Health Care Providers in the Pandemic Acceptance and Commitment to Empowerment Response (PACER) Intervention: Qualitative Study",
journal="JMIR Form Res",
year="2022",
month="Mar",
day="22",
volume="6",
number="3",
pages="e35280",
keywords="COVID-19",
keywords="COVID-19 in Canada",
keywords="health care providers",
keywords="pandemic stressors",
keywords="health impact",
keywords="caregiving roles",
keywords="situational identities",
keywords="emotional labor",
keywords="hero discourse",
keywords="social ecological framework",
abstract="Background: Since the pandemic, more Canadians have reported poorer mental health. A vital group experiencing a high level of stressors consists of health care providers (HCPs) caring for COVID-19 patients, carrying out public health responses, or working with vulnerable populations. The mental health of HCPs is negatively affected by the pandemic, not only at work but also at home and in the community. Intersecting stressors at multiple levels contribute to HCPs' experiences of fatigue, insomnia, anxiety, depression, and posttraumatic stress symptoms. Objective: The aim of this qualitative study was to explore the pandemic stressors experienced by HCPs at work, at home, and in the community before participating in the Pandemic Acceptance and Commitment to Empowerment Response (PACER) online intervention. Methods: Informed by a social ecological approach, we used a qualitative reflective approach to engage 74 HCPs in diverse roles. Data were collected during the first 2 waves of the COVID-19 pandemic (June 2020 to February 2021) in Canada. Results: Informed by a social ecological framework, 5 overarching themes were identified in our thematic analysis: (1) personal level stressors that highlight HCPs' identities and responsibilities beyond the workplace; (2) interpersonal level stressors from disrupted social relationships; (3) organizational stressors that contributed to unsettled workplaces and moral distress; (4) community and societal stressors attributed to vicarious trauma and emotional labor; and (5) the multilevel and cumulative impacts of COVID-19 stressors on HCPs' health. Conclusions: COVID-19 is not merely a communicable disease but also a social and political phenomenon that intensifies the effects of social inequities. Current understanding of pandemic stressors affecting HCPs is largely partial in nature. Although workplace stressors of HCPs are real and intense, they need to be explored and understood in the context of stressors that exist in other domains of HCPs' lives such as family and community to ensure these experiences are not being silenced by the ``hero'' discourses or overshadowed by professional demands. ",
doi="10.2196/35280",
url="https://formative.jmir.org/2022/3/e35280",
url="http://www.ncbi.nlm.nih.gov/pubmed/35138256"
}


@Article{info:doi/10.2196/34601,
author="Coleshill, James Matthew
and Baldwin, Peter
and Black, Melissa
and Newby, Jill
and Shrestha, Tanya
and Haffar, Sam
and Mills, Llewellyn
and Stensel, Andrew
and Cockayne, Nicole
and Tennant, Jon
and Harvey, Samuel
and Christensen, Helen",
title="The Essential Network (TEN): Protocol for an Implementation Study of a Digital-First Mental Health Solution for Australian Health Care Workers During COVID-19",
journal="JMIR Res Protoc",
year="2022",
month="Mar",
day="9",
volume="11",
number="3",
pages="e34601",
keywords="blended care",
keywords="mental health",
keywords="burnout",
keywords="health care workers",
keywords="COVID-19",
keywords="health care service",
keywords="health service",
abstract="Background: The COVID-19 pandemic has placed health care workers (HCWs) under severe stress, compounded by barriers to seeking mental health support among HCWs. The Essential Network (TEN) is a blend of digital and person-to-person (blended care) mental health support services for HCWs, funded by the Australian Federal Department of Health as part of their national COVID-19 response strategy. TEN is designed as both a preventative measure and treatment for common mental health problems faced by HCWs. New blended services need to demonstrate improvements in mental health symptoms and test acceptability in their target audience, as well as review implementation strategies to improve engagement. Objective: The primary objective of this implementation study is to design and test an implementation strategy to improve uptake of TEN. The secondary objectives are examining the acceptability of TEN among HCWs, changes in mental health outcomes associated with the use of TEN, and reductions in mental health stigma among HCWs following the use of TEN. Methods: The implementation study contains 3 components: (1) a consultation study with up to 39 stakeholders or researchers with implementation experience to design an implementation strategy, (1) a longitudinal observational study of at least 105 HCWs to examine the acceptability of TEN and the effectiveness of TEN at 1 and 6 months in improving mental health (as assessed by the Distress Questionnaire [DQ-5], Patient Health Questionnaire [PHQ-9], Generalized Anxiety Disorder [GAD-7], Oldenburg Burnout Inventory [OBI-16], and Work and Social Adjustment Scale [WSAS]) and reducing mental health stigma (the Endorsed and Anticipated Stigma Inventory [EASI]), and (3) an implementation study where TEN service uptake analytics will be examined for 3 months before and after the introduction of the implementation strategy. Results: The implementation strategy, designed with input from the consultation and observational studies, is expected to lead to an increased number of unique visits to the TEN website in the 3 months following the introduction of the implementation strategy. The observational study is expected to observe high service acceptability. Moderate improvements to general mental health (DQ-5, WSAS) and a reduction in workplace- and treatment-related mental health stigma (EASI) between the baseline and 1-month time points are expected. Conclusions: TEN is a first-of-a-kind blended mental health service available to Australian HCWs. The results of this project have the potential to inform the implementation and development of blended care mental health services, as well as how such services can be effectively implemented during a crisis. International Registered Report Identifier (IRRID): DERR1-10.2196/34601 ",
doi="10.2196/34601",
url="https://www.researchprotocols.org/2022/3/e34601",
url="http://www.ncbi.nlm.nih.gov/pubmed/35148269"
}


@Article{info:doi/10.2196/32800,
author="Tajirian, Tania
and Jankowicz, Damian
and Lo, Brian
and Sequeira, Lydia
and Strudwick, Gillian
and Almilaji, Khaled
and Stergiopoulos, Vicky",
title="Tackling the Burden of Electronic Health Record Use Among Physicians in a Mental Health Setting: Physician Engagement Strategy",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="8",
volume="24",
number="3",
pages="e32800",
keywords="burnout",
keywords="organizational strategy",
keywords="electronic health record use",
keywords="clinical informatics",
keywords="medical informatics",
doi="10.2196/32800",
url="https://www.jmir.org/2022/3/e32800",
url="http://www.ncbi.nlm.nih.gov/pubmed/35258473"
}


@Article{info:doi/10.2196/35558,
author="Simpson, Naomi
and Steen, Mary
and Vernon, Rachael
and Briley, Annette
and Wepa, Dianne",
title="Developing Conflict Resolution Strategies and Building Resilient Midwifery Students: Protocol for a Mixed Methods Research Study",
journal="JMIR Res Protoc",
year="2022",
month="Feb",
day="18",
volume="11",
number="2",
pages="e35558",
keywords="midwifery students",
keywords="workplace",
keywords="bullying",
keywords="violence",
keywords="conflict",
keywords="abuse",
keywords="resilience",
abstract="Background: Workplace bullying and violence (WBV) are well-documented issues in the midwifery profession. Negative workplace culture, conflict, and bullying are the most common forms of workplace violence experienced by midwives. Workplace violence increases the risk of midwives experiencing burnout, compassion fatigue, psychological trauma, poor mental health, absenteeism, loss of passion for the midwifery profession, job dissatisfaction, and poor job retention. Midwifery students describe workplace violence in the form of physical, emotional, or verbal abuse, and bullying. Therefore, there is a justification to develop conflict resolution strategies and resilience in midwifery students prior to graduation. Objective: Our aim is to develop and facilitate a bespoke education program for South Australian midwifery students to enable them to develop skills in conflict resolution, build resilience, and identify self-care strategies. Methods: This study will undertake a preparatory phase summarizing the body of literature on midwifery students' knowledge, understanding, and experiences of WBV. Following this, a 3-phase sequential mixed methods research design study will be undertaken. In Phase 1, quantitative data will be collected via a semistructured questionnaire and a validated conflict measurement tool, before and after attending an education workshop, and will be analyzed using descriptive and inferential statistics. Results from Phase 1 will inform and guide the development of an interview schedule for Phase 2. In Phase 2, qualitative data will be gathered by facilitating one-to-one interviews and a thematic analysis will be undertaken to gain a deeper understanding of midwifery students' experiences of WBV. In Phase 3, data integration using triangulation will be undertaken and meta-inferences will be developed via the integration of results and findings from Phases 1 and 2. Results: The preparatory phase will commence in October 2021. Phase 1 will commence in 2022 with analysis of pre- and posteducation results anticipated to be completed by December 2022. Phase 2 will be developed from findings of the preparatory phase and results of Phase 1. An interpretation of verbatim interview transcripts is estimated to be undertaken by April 2023. Phase 3 of the study is expected to commence in May 2023, and this will involve the analysis of collective evidence gathered from Phases 1 and 2. The anticipated completion date for the study is December 2023. Conclusions: The outcomes of this research will provide insights into the prevalence and impact of WBV experienced by midwifery students. The findings of the research will report on levels of knowledge, skills, and confidence, and will assess the impact of a bespoke conflict resolution and resilience education workshop for midwifery students in managing WBV. International Registered Report Identifier (IRRID): PRR1-10.2196/35558 ",
doi="10.2196/35558",
url="https://www.researchprotocols.org/2022/2/e35558",
url="http://www.ncbi.nlm.nih.gov/pubmed/34995202"
}


@Article{info:doi/10.2196/32992,
author="Ditton, Elizabeth
and Knott, Brendon
and Hodyl, Nicolette
and Horton, Graeme
and Walker, Rohan Frederick
and Nilsson, Michael",
title="Assessing the Efficacy of an Individualized Psychological Flexibility Skills Training Intervention App for Medical Student Burnout and Well-being: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Feb",
day="4",
volume="11",
number="2",
pages="e32992",
keywords="burnout",
keywords="psychological",
keywords="burnout interventions",
keywords="psychological flexibility",
keywords="digital intervention",
keywords="individualized intervention",
keywords="acceptance and commitment therapy",
keywords="medical students",
keywords="well-being",
keywords="mobile phone",
abstract="Background: Medical student burnout is a prevalent problem with adverse long-term outcomes. Incorporating psychological resource-building interventions into comprehensive burnout prevention approaches during medical training is an identified priority among educators. These interventions could reduce burnout risk by buffering students against nonmodifiable career stressors. However, there is a need for rigorous investigation into optimal intervention targets and methods. Psychological flexibility (PF) is an adaptive behavioral skill set that has demonstrated relationships with medical student burnout and well-being. More broadly, there is evidence that PF mediates burnout and well-being outcomes and may be a protective factor. Efficacy studies assessing the benefits of interventions targeting PF among medical students are needed. Research also supports the need to establish optimal methods for increasing intervention efficacy in the context of individual differences in burnout and PF by using individualized approaches. Objective: This study aims to assess whether an app-delivered PF intervention (Acceptance and Commitment Training) reduces burnout and improves well-being among medical students. We will examine whether changes in burnout and well-being are mediated by changes in PF. The potential benefits of an individualized version of the app versus those of a nonindividualized version will also be evaluated. Methods: In this 3-arm, parallel, randomized controlled study, a sample of medical students will be randomly allocated to 1 of 3 intervention arms (individualized, nonindividualized, and waiting list) by using a 1:1:1 allocation ratio. Participants in the individualized and nonindividualized intervention arms will have 5 weeks to access the app, which includes a PF concepts training session (stage 1) and access to short PF skill activities on demand (stage 2). Stage 2 will be either individualized to meet participants' identified PF training needs at each log-in or nonindividualized. Results: Burnout, well-being, and PF will be assessed at baseline and after the intervention. Quantitative analyses will include descriptive and inferential statistics. We hypothesize that the Acceptance and Commitment Training intervention app will be effective in improving burnout and well-being and that changes in these outcomes will be mediated by changes in PF. We further hypothesize that participants in the individualized intervention group will demonstrate greater improvements in burnout and well-being outcomes than those in the nonindividualized group. Conclusions: The findings of this study could guide the development of burnout prevention and well-being initiatives for medical students. Identifying PF as a mediating process would provide support for the delivery of preventive intervention programs that train individuals to strengthen this psychological resource before burnout symptoms emerge. This would be an important step in addressing and potentially offsetting the significant costs of burnout among medical students and physicians. Demonstrating the superiority of an individualized version of the app over a nonindividualized version would have implications for enhancing intervention precision and efficacy by using scalable interventions. Trial Registration: Australian New Zealand Clinical Trials Registry ANZCTR 12621000911897; https://www.anzctr.org.au/ACTRN12621000911897.aspx International Registered Report Identifier (IRRID): PRR1-10.2196/32992 ",
doi="10.2196/32992",
url="https://www.researchprotocols.org/2022/2/e32992",
url="http://www.ncbi.nlm.nih.gov/pubmed/35119378"
}


@Article{info:doi/10.2196/35274,
author="Yalamanchili, Bhavya
and Donelle, Lorie
and Jurado, Leo-Felix
and Fera, Joseph
and Basch, H. Corey",
title="Investigating \#covidnurse Messages on TikTok: Descriptive Study",
journal="JMIR Nursing",
year="2022",
month="Jan",
day="14",
volume="5",
number="1",
pages="e35274",
keywords="COVID-19 pandemic",
keywords="nurse",
keywords="burnout",
keywords="social media",
keywords="stress",
keywords="TikTok",
keywords="nursing",
keywords="COVID-19",
keywords="pandemic",
keywords="social support",
keywords="digital peer support",
keywords="health communication",
keywords="peer support",
abstract="Background: During a time of high stress and decreased social interaction, nurses have turned to social media platforms like TikTok as an outlet for expression, entertainment, and communication. Objective: The purpose of this cross-sectional content analysis study is to describe the content of videos with the hashtag \#covidnurse on TikTok, which included 100 videos in the English language. Methods: At the time of the study, this hashtag had 116.9 million views. Each video was coded for content-related to what nurses encountered and were feeling during the COVID-19 pandemic. Results: Combined, the 100 videos sampled received 47,056,700 views; 76,856 comments; and 5,996,676 likes. There were 4 content categories that appeared in a majority (>50) of the videos: 83 showed the individual as a nurse, 72 showed the individual in professional attire, 58 mentioned/suggested stress, 55 used music, and 53 mentioned/suggested frustration. Those that mentioned stress and those that mentioned frustration received less than 50\% of the total views (n=21,726,800, 46.17\% and n=16,326,300,  34.69\%, respectively). Although not a majority, 49 of the 100 videos mentioned the importance of nursing. These videos garnered 37.41\% (n=17,606,000) of the total views, 34.82\% (n=26,759) of the total comments, and 23.85\% (n=1,430,213) of the total likes. So, despite nearly half of the total videos mentioning how important nurses are, these videos received less than half of the total views, comments, and likes. Conclusions: Social media and increasingly video-related online messaging such as TikTok are important platforms for social networking, social support, entertainment, and education on diverse topics, including health in general and COVID-19 specifically. This presents an opportunity for future research to assess the utility of the TikTok platform for meaningful engagement and health communication on important public health issues. ",
doi="10.2196/35274",
url="https://nursing.jmir.org/2022/1/e35274",
url="http://www.ncbi.nlm.nih.gov/pubmed/35029536"
}


@Article{info:doi/10.2196/30640,
author="Chaudhry, Moalla Beenish
and Islam, Ashraful
and Matthieu, Monica",
title="Toward Designs of Workplace Stress Management Mobile Apps for Frontline Health Workers During the COVID-19 Pandemic and Beyond: Mixed Methods Qualitative Study",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="13",
volume="6",
number="1",
pages="e30640",
keywords="mental health",
keywords="stress",
keywords="mHealth",
keywords="frontline health worker",
keywords="design requirements",
keywords="pandemic",
keywords="COVID-19",
keywords="design",
keywords="intervention",
keywords="burnout",
keywords="perspective",
keywords="need",
keywords="user design",
abstract="Background: In recent years, mobile apps have been developed to prevent burnout, promote anxiety management, and provide health education to workers in various workplace settings. However, there remains a paucity of such apps for frontline health workers (FHWs), even though FHWs are the most susceptible to stress due to the nature of their jobs. Objective: The goal of this study was to provide suggestions for designing stress management apps to address workplace stressors of FHWs based on the understanding of their needs from FHWs' own perspectives and theories of stress. Methods: A mixed methods qualitative study was conducted. Using a variety of search strings, we first collected 41 relevant web-based news articles published between December 2019 and May 2020 through the Google search engine. We then conducted a cross-sectional survey with 20 FHWs. Two researchers independently conducted qualitative analysis of all the collected data using a deductive followed by an inductive approach. Results: Prevailing uncertainty and fear of contracting the infection was causing stress among FHWs. Moral injury associated with seeing patients die from lack of care and lack of experience in handling various circumstances were other sources of stress. FHWs mentioned 4 coping strategies. Quick coping strategies such as walking away from stressful situations, entertainment, and exercise were the most common ways to mitigate the impact of stress at work. Peer support and counseling services were other popular methods. Building resilience and driving oneself forward using internal motivation were also meaningful ways of overcoming stressful situations. Time constraints and limited management support prevented FHWs from engaging in stress management activities. Conclusions: Our study identified stressors, coping strategies, and challenges with applying coping strategies that can guide the design of stress management apps for FHWs. Given that the pandemic is ongoing and health care crises continue, FHWs remain a vulnerable population in need of attention. ",
doi="10.2196/30640",
url="https://formative.jmir.org/2022/1/e30640",
url="http://www.ncbi.nlm.nih.gov/pubmed/34806985"
}


@Article{info:doi/10.2196/34372,
author="Steen, Mary
and Othman, Etman Shwikar Mahmoud
and Briley, Annette
and Vernon, Rachael
and Hutchinson, Steven
and Dyer, Susan",
title="Self-compassion Education for Health Professionals (Nurses and Midwives): Protocol for a Sequential Explanatory Mixed Methods Study",
journal="JMIR Res Protoc",
year="2022",
month="Jan",
day="13",
volume="11",
number="1",
pages="e34372",
keywords="self-compassion",
keywords="mixed methods research",
keywords="study protocol",
keywords="health professionals",
keywords="nurses",
keywords="midwives",
abstract="Background: A few recent studies have reported that having the ability to provide self-compassion can reduce health professionals' levels of anxiety and stress, the risk of compassion fatigue, and burnout, and it can generally improve their well-being. Therefore, there is evidence to support further research into the investigation and exploration of self-compassion education and training for health professionals. Objective: This study aims to increase the knowledge and understanding of self-compassion and how this may enhance the health and well-being of health professionals. Methods: The proposed research study will adopt a sequential explanatory mixed methods design. This study will be conducted in 3 phases. Phase 1 will use a pre-educational self-compassion questionnaire (web-based survey) to collect data from participants at 3 time points (before, immediately after, and after follow-up at 6-8 weeks) after they have attended a self-compassion education and training program. Phase 2 will use an interview schedule to explore the participants' views and experiences through a follow-up focus group or individual interview. Finally, phase 3 will include data integration and dissemination of key findings and recommendations. Results: This study was approved by the Women's and Children's Health Network Human Research Ethics Committee and the Human Research Ethics Committee at the University of South Australia on June 26, 2021 (ID: 204,074). A scoping review was conducted to inform this research study (focusing on nurses and midwives). The preparatory phase was completed in April 2021. Phase 1 is expected to be completed by June 2022 and phase 2 will commence in July 2022. Conclusions: The key findings from the data integration for this research project will provide in-depth details and insights to broaden the discussion about self-compassion and its influence on health professionals' health and well-being. Health professionals (nurses and midwives) may benefit from self-compassion education and training programs to improve their health and well-being. International Registered Report Identifier (IRRID): PRR1-10.2196/34372 ",
doi="10.2196/34372",
url="https://www.researchprotocols.org/2022/1/e34372",
url="http://www.ncbi.nlm.nih.gov/pubmed/34848389"
}


@Article{info:doi/10.2196/32017,
author="Dederichs, Melina
and Nitsch, Jan Felix
and Apolin{\'a}rio-Hagen, Jennifer",
title="Piloting an Innovative Concept of e--Mental Health and mHealth Workshops With Medical Students Using a Participatory Co-design Approach and App Prototyping: Case Study",
journal="JMIR Med Educ",
year="2022",
month="Jan",
day="10",
volume="8",
number="1",
pages="e32017",
keywords="participatory design",
keywords="co-design",
keywords="mHealth",
keywords="medical student",
keywords="eHealth",
keywords="medical education",
keywords="mental health",
keywords="mobile phone",
abstract="Background: Medical students show low levels of e--mental health literacy. Moreover, there is a high prevalence of common mental illnesses among medical students. Mobile health (mHealth) apps can be used to maintain and promote medical students' well-being. To date, the potential of mHealth apps for promoting mental health among medical students is largely untapped because they seem to lack familiarity with mHealth. In addition, little is known about medical students' preferences regarding mHealth apps for mental health promotion. There is a need for guidance on how to promote competence-based learning on mHealth apps in medical education. Objective: The aim of this case study is to pilot an innovative concept for an educative workshop following a participatory co-design approach and to explore medical students' preferences and ideas for mHealth apps through the design of a hypothetical prototype. Methods: We conducted a face-to-face co-design workshop within an elective subject with 26 participants enrolled at a medical school in Germany on 5 consecutive days in early March 2020. The aim of the workshop was to apply the knowledge acquired from the lessons on e--mental health and mHealth app development. Activities during the workshop included group work, plenary discussions, storyboarding, developing personas (prototypical users), and designing prototypes of mHealth apps. The workshop was documented in written and digitalized form with the students' permission. Results: The participants' feedback suggests that the co-design workshop was well-received. The medical students presented a variety of ideas for the design of mHealth apps. Among the common themes that all groups highlighted in their prototypes were personalization, data security, and the importance of scientific evaluation. Conclusions: Overall, this case study indicates the feasibility and acceptance of a participatory design workshop for medical students. The students made suggestions for improvements at future workshops (eg, use of free prototype software, shift to e-learning, and more time for group work). Our results can be (and have already been) used as a starting point for future co-design workshops to promote competence-based collaborative learning on digital health topics in medical education. ",
doi="10.2196/32017",
url="https://mededu.jmir.org/2022/1/e32017",
url="http://www.ncbi.nlm.nih.gov/pubmed/35006085"
}


@Article{info:doi/10.2196/27096,
author="Heponiemi, Tarja
and Gluschkoff, Kia
and Vehko, Tuulikki
and Kaihlanen, Anu-Marja
and Saranto, Kaija
and Nissinen, Sari
and Nadav, Janna
and Kujala, Sari",
title="Electronic Health Record Implementations and Insufficient Training Endanger Nurses' Well-being: Cross-sectional Survey Study",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="23",
volume="23",
number="12",
pages="e27096",
keywords="electronic health records",
keywords="implementation",
keywords="information systems",
keywords="training",
keywords="stress",
keywords="cognitive failures",
keywords="time pressure",
keywords="registered nurses",
abstract="Background: High expectations have been set for the implementations of health information systems (HIS) in health care. However, nurses have been dissatisfied after implementations of HIS. In particular, poorly functioning electronic health records (EHRs) have been found to induce stress and cognitive workload. Moreover, the need to learn new systems may require considerable effort from nurses. Thus, EHR implementations may have an effect on the well-being of nurses. Objective: This study aimed to examine the associations of EHR-to-EHR implementations and the sufficiency of related training with perceived stress related to information systems (SRIS), time pressure, and cognitive failures among registered nurses. Moreover, we examined the moderating effect of the employment sector (hospital, primary care, social services, and others) on these associations. Methods: This study was a cross-sectional survey study of 3610 registered Finnish nurses in 2020. EHR implementation was measured by assessing whether the work unit of each respondent had implemented or will implement a new EHR (1) within the last 6 months, (2) within the last 12 months, (3) in the next 12 months, and (4) at no point within the last 12 months or in the forthcoming 12 months. The associations were examined using analyses of covariance adjusted for age, gender, and employment sector. Results: The highest levels of SRIS (adjusted mean 4.07, SE 0.05) and time pressure (adjusted mean 4.55, SE 0.06) were observed among those who had experienced an EHR implementation within the last 6 months. The lowest levels of SRIS (adjusted mean 3.26, SE 0.04), time pressure (adjusted mean 4.41, SE 0.05), and cognitive failures (adjusted mean 1.84, SE 0.02) were observed among those who did not experience any completed or forthcoming implementations within 12 months. Nurses who perceived that they had received sufficient implementation-related training experienced less SRIS (F1=153.40, P<.001), time pressure (F1=80.95, P<.001), and cognitive failures (F1=34.96, P<.001) than those who had received insufficient training. Recent implementations and insufficient training were especially strongly associated with high levels of SRIS in hospitals. Conclusions: EHR implementations and insufficient training related to these implementations may endanger the well-being of nurses and even lead to errors. Thus, it is extremely important for organizations to offer comprehensive training before, during, and after implementations. Moreover, easy-to-use systems that allow transition periods, a re-engineering approach, and user involvement may be beneficial to nurses in the implementation process. Training and other improvements would be especially important in hospitals. ",
doi="10.2196/27096",
url="https://www.jmir.org/2021/12/e27096",
url="http://www.ncbi.nlm.nih.gov/pubmed/34941546"
}


@Article{info:doi/10.2196/32165,
author="Goodday, M. Sarah
and Karlin, Emma
and Alfarano, Alexandria
and Brooks, Alexa
and Chapman, Carol
and Desille, Rachelle
and Rangwala, Shazia
and Karlin, R. Daniel
and Emami, Hoora
and Woods, Fugate Nancy
and Boch, Adrien
and Foschini, Luca
and Wildman, Mackenzie
and Cormack, Francesca
and Taptiklis, Nick
and Pratap, Abhishek
and Ghassemi, Marzyeh
and Goldenberg, Anna
and Nagaraj, Sujay
and Walsh, Elaine
and 
and Friend, Stephen",
title="An Alternative to the Light Touch Digital Health Remote Study: The Stress and Recovery in Frontline COVID-19 Health Care Workers Study",
journal="JMIR Form Res",
year="2021",
month="Dec",
day="10",
volume="5",
number="12",
pages="e32165",
keywords="stress",
keywords="wearable",
keywords="digital health",
keywords="frontline",
keywords="COVID-19",
keywords="health care worker",
keywords="alternative",
keywords="design",
keywords="app",
keywords="assessment",
keywords="sensor",
keywords="engagement",
keywords="support",
keywords="knowledge",
abstract="Background: Several app-based studies share similar characteristics of a light touch approach that recruit, enroll, and onboard via a smartphone app and attempt to minimize burden through low-friction active study tasks while emphasizing the collection of passive data with minimal human contact. However, engagement is a common challenge across these studies, reporting low retention and adherence. Objective: This study aims to describe an alternative to a light touch digital health study that involved a participant-centric design including high friction app-based assessments, semicontinuous passive data from wearable sensors, and a digital engagement strategy centered on providing knowledge and support to participants. Methods: The Stress and Recovery in Frontline COVID-19 Health Care Workers Study included US frontline health care workers followed between May and November 2020. The study comprised 3 main components: (1) active and passive assessments of stress and symptoms from a smartphone app, (2) objective measured assessments of acute stress from wearable sensors, and (3) a participant codriven engagement strategy that centered on providing knowledge and support to participants. The daily participant time commitment was an average of 10 to 15 minutes. Retention and adherence are described both quantitatively and qualitatively. Results: A total of 365 participants enrolled and started the study, and 81.0\% (n=297) of them completed the study for a total study duration of 4 months. Average wearable sensor use was 90.6\% days of total study duration. App-based daily, weekly, and every other week surveys were completed on average 69.18\%, 68.37\%, and 72.86\% of the time, respectively. Conclusions: This study found evidence for the feasibility and acceptability of a participant-centric digital health study approach that involved building trust with participants and providing support through regular phone check-ins. In addition to high retention and adherence, the collection of large volumes of objective measured data alongside contextual self-reported subjective data was able to be collected, which is often missing from light touch digital health studies. Trial Registration: ClinicalTrials.gov NCT04713111; https://clinicaltrials.gov/ct2/show/NCT04713111 ",
doi="10.2196/32165",
url="https://formative.jmir.org/2021/12/e32165",
url="http://www.ncbi.nlm.nih.gov/pubmed/34726607"
}


@Article{info:doi/10.2196/31358,
author="Koren, Ainat
and Alam, Ul Mohammad Arif
and Koneru, Sravani
and DeVito, Alexa
and Abdallah, Lisa
and Liu, Benyuan",
title="Nursing Perspectives on the Impacts of COVID-19: Social Media Content Analysis",
journal="JMIR Form Res",
year="2021",
month="Dec",
day="10",
volume="5",
number="12",
pages="e31358",
keywords="mental health",
keywords="information retrieval",
keywords="coronavirus",
keywords="COVID-19",
keywords="nursing",
keywords="nurses",
keywords="health care workers",
keywords="pandemic",
keywords="impact",
keywords="social media analytics",
abstract="Background: Nurses are at the forefront of the COVID-19 pandemic. During the pandemic, nurses have faced an elevated risk of exposure and have experienced the hazards related to a novel virus. While being heralded as lifesaving heroes on the front lines of the pandemic, nurses have experienced more physical, mental, and psychosocial problems as a consequence of the COVID-19 outbreak. Social media discussions by nursing professionals participating in publicly formed Facebook groups constitute a valuable resource that offers longitudinal insights. Objective: This study aimed to explore how COVID-19 impacted nurses through capturing public sentiments expressed by nurses on a social media discussion platform and how these sentiments changed over time. Methods: We collected over 110,993 Facebook discussion posts and comments in an open COVID-19 group for nurses from March 2020 until the end of November 2020. Scraping of deidentified offline HTML tags on social media posts and comments was performed. Using subject-matter expert opinions and social media analytics (ie, topic modeling, information retrieval, and sentiment analysis), we performed a human-in-a-loop analysis of nursing professionals' key perspectives to identify trends of the COVID-19 impact among at-risk nursing communities. We further investigated the key insights of the trends of the nursing professionals' perspectives by detecting temporal changes of comments related to emotional effects, feelings of frustration, impacts of isolation, shortage of safety equipment, and frequency of safety equipment uses. Anonymous quotes were highlighted to add context to the data. Results: We determined that COVID-19 impacted nurses' physical, mental, and psychosocial health as expressed in the form of emotional distress, anger, anxiety, frustration, loneliness, and isolation. Major topics discussed by nurses were related to work during a pandemic, misinformation spread by the media, improper personal protective equipment (PPE), PPE side effects, the effects of testing positive for COVID-19, and lost days of work related to illness. Conclusions: Public Facebook nursing groups are venues for nurses to express their experiences, opinions, and concerns and can offer researchers an important insight into understanding the COVID-19 impact on health care workers. ",
doi="10.2196/31358",
url="https://formative.jmir.org/2021/12/e31358",
url="http://www.ncbi.nlm.nih.gov/pubmed/34623957"
}


@Article{info:doi/10.2196/26370,
author="Counson, Isabelle
and Bartholomew, Alexandra
and Crawford, Joanna
and Petrie, Katherine
and Basarkod, Geetanjali
and Moynihan, Victoria
and Pires, Josie
and Cohen, Rachel
and Glozier, Nicholas
and Harvey, Samuel
and Sanatkar, Samineh",
title="Development of the Shift Smartphone App to Support the Emotional Well-Being of Junior Physicians: Design of a Prototype and Results of Usability and Acceptability Testing",
journal="JMIR Form Res",
year="2021",
month="Dec",
day="2",
volume="5",
number="12",
pages="e26370",
keywords="digital mental health",
keywords="mHealth apps",
keywords="help-seeking",
keywords="junior physicians",
keywords="co-design",
keywords="user-centered design",
keywords="mobile phone",
abstract="Background: Junior physicians report higher levels of psychological distress than senior doctors and report several barriers to seeking professional mental health support, including concerns about confidentiality and career progression. Mobile health (mHealth) apps may be utilized to help overcome these barriers to assist the emotional well-being of this population and encourage help-seeking. Objective: This study describes the development and pilot trial of the Shift mHealth app to provide an unobtrusive avenue for junior physicians to seek information about, and help for, well-being and mental health concerns, which is sensitive to workplace settings. Methods: A 4-phase iterative development process was undertaken to create the content and features of Shift involving junior physicians using the principles of user-centered design. These 4 phases were---needs assessment, on the basis of interviews with 12 junior physicians; prototype development with user experience feedback from 2 junior physicians; evaluation, consisting of a pilot trial with 22 junior physicians to assess the usability and acceptability of the initial prototype; and redesign, including user experience workshops with 51 junior physicians. Results: Qualitative results informed the content and design of Shift to ensure that the app was tailored to junior physicians' needs. The Shift app prototype contained cognitive behavioral, mindfulness, value-based actions, and psychoeducational modules, as well as a tracking function that visualized patterns of daily variations in mood and health behaviors. Pilot-testing revealed possible issues with the organization of the app content, which were addressed through a thorough restructuring and redesign of Shift with the help of junior physicians across 3 user experience workshops. Conclusions: This study demonstrates the importance of ongoing end user involvement in the creation of a specialized mHealth app for a unique working population experiencing profession-specific stressors and barriers to help-seeking. The development and pilot trial of this novel Shift mHealth app are the first steps in addressing the mental health and support-seeking needs of junior physicians, although further research is required to validate its effectiveness and appropriateness on a larger scale. ",
doi="10.2196/26370",
url="https://formative.jmir.org/2021/12/e26370",
url="http://www.ncbi.nlm.nih.gov/pubmed/34860662"
}


@Article{info:doi/10.2196/23789,
author="Steinkamp, Jackson
and Sharma, Abhinav
and Bala, Wasif
and Kantrowitz, J. Jacob",
title="A Fully Collaborative, Noteless Electronic Medical Record Designed to Minimize Information Chaos: Software Design and Feasibility Study",
journal="JMIR Form Res",
year="2021",
month="Nov",
day="9",
volume="5",
number="11",
pages="e23789",
keywords="electronic medical records",
keywords="clinical notes",
keywords="information chaos",
keywords="information overload",
keywords="clinician burnout",
keywords="software design",
keywords="problem-oriented medical record",
keywords="medical records",
keywords="electronic records",
keywords="documentation",
keywords="clinical",
keywords="software",
abstract="Background: Clinicians spend large amounts of their workday using electronic medical records (EMRs). Poorly designed documentation systems contribute to the proliferation of out-of-date information, increased time spent on medical records, clinician burnout, and medical errors. Beyond software interfaces, examining the underlying paradigms and organizational structures for clinical information may provide insights into ways to improve documentation systems. In particular, our attachment to the note as the major organizational unit for storing unstructured medical data may be a cause of many of the problems with modern clinical documentation. Notes, as currently understood, systematically incentivize information duplication and information scattering, both within a single clinician's notes over time and across multiple clinicians' notes. Therefore, it is worthwhile to explore alternative paradigms for unstructured data organization. Objective: The aim of this study is to demonstrate the feasibility of building an EMR that does not use notes as the core organizational unit for unstructured data and which is designed specifically to disincentivize information duplication and information scattering. Methods: We used specific design principles to minimize the incentive for users to duplicate and scatter information. By default, the majority of a patient's medical history remains the same over time, so users should not have to redocument that information. Clinicians on different teams or services mostly share the same medical information, so all data should be collaboratively shared across teams and services (while still allowing for disagreement and nuance). In all cases where a clinician must state that information has remained the same, they should be able to attest to the information without redocumenting it. We designed and built a web-based EMR based on these design principles. Results: We built a medical documentation system that does not use notes and instead treats the chart as a single, dynamically updating, and fully collaborative workspace. All information is organized by clinical topic or problem. Version history functionality is used to enable granular tracking of changes over time. Our system is highly customizable to individual workflows and enables each individual user to decide which data should be structured and which should be unstructured, enabling individuals to leverage the advantages of structured templating and clinical decision support as desired without requiring programming knowledge. The system is designed to facilitate real-time, fully collaborative documentation and communication among multiple clinicians. Conclusions: We demonstrated the feasibility of building a non--note-based, fully collaborative EMR system. Our attachment to the note as the only possible atomic unit of unstructured medical data should be reevaluated, and alternative models should be considered. ",
doi="10.2196/23789",
url="https://formative.jmir.org/2021/11/e23789",
url="http://www.ncbi.nlm.nih.gov/pubmed/34751651"
}


@Article{info:doi/10.2196/29896,
author="Joshi, Megha
and Shah, Aangi
and Trivedi, Bhavi
and Trivedi, Jaahnavee
and Patel, Viral
and Parghi, Devam
and Thakkar, Manini
and Barot, Kanan
and Jadawala, Vivek",
title="Psychosocial and Behavioral Effects of the COVID-19 Pandemic in the Indian Population: Protocol for a Cross-sectional Study",
journal="JMIR Res Protoc",
year="2021",
month="Nov",
day="5",
volume="10",
number="11",
pages="e29896",
keywords="COVID-19",
keywords="mental health",
keywords="India",
keywords="lockdown",
keywords="isolation",
keywords="social isolation",
keywords="behavior",
keywords="psychology",
keywords="psychosocial effects",
abstract="Background: During the year 2020, the COVID-19 pandemic spread from China to the rest of the world, which prompted the world to implement a widespread mandated quarantine or social isolation. The impending uncertainty of the pandemic must have resulted in a variety of widespread mental health maladies. There has been documentation in the literature about a lot of these in small populations of the world but limited studies have been conducted in India, leading to limited evidence in the literature. Objective: The main objective of our study is to investigate the mental health effects that the COVID-19 pandemic has had on the general population in India both quantitatively and qualitatively. These results will help contribute to reducing the knowledge gap that is recognized in the literature, which is the result of the unprecedented and novel nature of the pandemic. Methods: We designed and validated our own questionnaire and used the method of circulating the questionnaire via WhatsApp (Facebook Inc). WhatsApp is a social media app that is very popularly used in India; hence, it turned out to be an effective medium for gathering pilot data. We analyzed the pilot data and used them to validate the questionnaire. This was done with the expertise of our mentor, Nilima Shah, MD (psychiatry). We gathered pilot data on 545 subjects and used the results to determine the changes that were needed for the questionnaire while simultaneously validating the questionnaire. Results: The study protocol was approved in September 2020 by the institutional review board at Vadilal Sarabhai General Hospital, Ahmedabad, Gujarat, India. Conclusions: The following preliminary assumptions can be made about the study based on the pilot data: the majority of the survey respondents were male (289/545, 53\%), most of them were educated and employed as health care workers (199/545, 36.5\%). The majority of the responders were self-employed (185/545, 33.9\%), single (297/545, 54.5\%), and stayed with their families (427/541, 79\%) for the lockdown, which helped them psychologically. Findings that are specific to mental health have been elaborated upon in the manuscript. It is evident from the data collected in previous literature that the pandemic has had significant detrimental effects on the mental health of a vast proportion of the Indian population. International Registered Report Identifier (IRRID): DERR1-10.2196/29896 ",
doi="10.2196/29896",
url="https://www.researchprotocols.org/2021/11/e29896",
url="http://www.ncbi.nlm.nih.gov/pubmed/34519652"
}


@Article{info:doi/10.2196/31408,
author="Golz, Christoph
and Peter, Anne Karin
and M{\"u}ller, J{\"o}rg Thomas
and Mutschler, Jochen
and Zwakhalen, G. Sandra M.
and Hahn, Sabine",
title="Technostress and Digital Competence Among Health Professionals in Swiss Psychiatric Hospitals: Cross-sectional Study",
journal="JMIR Ment Health",
year="2021",
month="Nov",
day="4",
volume="8",
number="11",
pages="e31408",
keywords="technostress",
keywords="digital competence",
keywords="psychiatry",
keywords="health professionals",
keywords="multiple regression",
abstract="Background: Psychiatric hospitals are becoming increasingly digitized because of the disruptive rise in technical possibilities. This digitization leads to new tasks and demands for health professionals, which can have an impact on technostress. It is unclear whether digital competence reduces technostress and how technostress affects health professionals' mental and physical health. Objective: This study aims to assess the association between digital competence and technostress, considering individual characteristics and the association between technostress and long-term consequences for health professionals. Methods: Cross-sectional data from 3 Swiss psychiatric hospitals were analyzed using multiple linear regression. The dependent variables for the models were digital competence, technostress, and long-term consequences (intention to leave the organization or the profession, burnout symptoms, job satisfaction, general health status, quality of sleep, headaches, and work ability). One model was calculated for each long-term consequence. The mean scores for technostress and digital competence could range between 0 (fully disagree) and 4 (fully agree), where a high value for technostress indicated high technostress and a high value for digital competence indicated high digital competence. Results: The sample comprised 493 health professionals in psychiatric hospitals. They rated their technostress as moderate (mean 1.30, SD 0.55) and their digital competence as high (mean 2.89, SD 0.73). Digital competence was found to be significantly associated with technostress ($\beta$=?.20; P<.001). Among the individual characteristics, age ($\beta$=.004; P=.03) and profession were significantly associated with both digital competence and technostress. Technostress is a relevant predictor of burnout symptoms ($\beta$=10.32; P<.001), job satisfaction ($\beta$=?6.08; P<.001), intention to leave the profession ($\beta$=4.53; P=.002), organization ($\beta$=7.68; P<.001), general health status ($\beta$=?4.47; P<.001), quality of sleep ($\beta$=?5.87; P<.001), headaches ($\beta$=6.58; P<.001), and work ability ($\beta$=?1.40; P<.001). Conclusions: Physicians and nurses who have more interaction with digital technologies rate their technostress higher and their digital competence lower than those in other professions. Health professionals with low interaction with digital technologies appear to overestimate their digital competence. With increasing digitization in psychiatric hospitals, an increase in the relevance of this topic is expected. Educational organizations and psychiatric hospitals should proactively promote the digital competence of health professionals to manage expected disruptive changes. ",
doi="10.2196/31408",
url="https://mental.jmir.org/2021/11/e31408",
url="http://www.ncbi.nlm.nih.gov/pubmed/34734840"
}


@Article{info:doi/10.2196/30217,
author="Elyashar, Aviad
and Plochotnikov, Ilia
and Cohen, Idan-Chaim
and Puzis, Rami
and Cohen, Odeya",
title="The State of Mind of Health Care Professionals in Light of the COVID-19 Pandemic: Text Analysis Study of Twitter Discourses",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="22",
volume="23",
number="10",
pages="e30217",
keywords="health care professionals",
keywords="Twitter",
keywords="COVID-19",
keywords="topic analysis",
keywords="emotion analysis",
keywords="sentiment analysis",
keywords="social media",
keywords="machine learning",
keywords="active learning",
abstract="Background: The COVID-19 pandemic has affected populations worldwide, with extreme health, economic, social, and political implications. Health care professionals (HCPs) are at the core of pandemic response and are among the most crucial factors in maintaining coping capacities. Yet, they are also vulnerable to mental health effects caused by managing a long-lasting emergency with a lack of resources and under complicated personal concerns. However, there are a lack of longitudinal studies that investigate the HCP population. Objective: The aim of this study was to analyze the state of mind of HCPs as expressed in online discussions published on Twitter in light of the COVID-19 pandemic, from the onset of the pandemic until the end of 2020. Methods: The population for this study was selected from followers of a few hundred Twitter accounts of health care organizations and common HCP points of interest. We used active learning, a process that iteratively uses machine learning and manual data labeling, to select the large-scale population of Twitter accounts maintained by English-speaking HCPs, focusing on individuals rather than official organizations. We analyzed the topics and emotions in their discourses during 2020. The topic distributions were obtained using the latent Dirichlet allocation algorithm. We defined a measure of topic cohesion and described the most cohesive topics. The emotions expressed in tweets during 2020 were compared to those in 2019. Finally, the emotion intensities were cross-correlated with the pandemic waves to explore possible associations between the pandemic development and emotional response. Results: We analyzed the timelines of 53,063 Twitter profiles, 90\% of which were maintained by individual HCPs. Professional topics accounted for 44.5\% of tweets by HCPs from January 1, 2019, to December 6, 2020. Events such as the pandemic waves, US elections, or the George Floyd case affected the HCPs' discourse. The levels of joy and sadness exceeded their minimal and maximal values from 2019, respectively, 80\% of the time (P=.001). Most interestingly, fear preceded the pandemic waves, in terms of the differences in confirmed cases, by 2 weeks with a Spearman correlation coefficient of $\rho$(47 pairs)=0.340 (P=.03). Conclusions: Analyses of longitudinal data over the year 2020 revealed that a large fraction of HCP discourse is directly related to professional content, including the increase in the volume of discussions following the pandemic waves. The changes in emotional patterns (ie, decrease in joy and increase in sadness, fear, and disgust) during the year 2020 may indicate the utmost importance in providing emotional support for HCPs to prevent fatigue, burnout, and mental health disorders during the postpandemic period. The increase in fear 2 weeks in advance of pandemic waves indicates that HCPs are in a position, and with adequate qualifications, to anticipate pandemic development, and could serve as a bottom-up pathway for expressing morbidity and clinical situations to health agencies. ",
doi="10.2196/30217",
url="https://www.jmir.org/2021/10/e30217",
url="http://www.ncbi.nlm.nih.gov/pubmed/34550899"
}


@Article{info:doi/10.2196/28088,
author="Corr{\^e}a, Pires Roberta
and Castro, Carla Helena
and Quaresma, Salom{\~a}o Bruna Maria Castro
and Stephens, Soares Paulo Roberto
and Araujo-Jorge, Cremonini Tania
and Ferreira, Rodrigues Roberto",
title="Perceptions and Feelings of Brazilian Health Care Professionals Regarding the Effects of COVID-19: Cross-sectional Web-Based Survey",
journal="JMIR Form Res",
year="2021",
month="Oct",
day="22",
volume="5",
number="10",
pages="e28088",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="health professionals",
keywords="Brazil",
keywords="pandemic",
keywords="mental health",
keywords="health planning",
abstract="Background: The importance of health professionals has been recognized in COVID-19 pandemic--affected countries, especially in those such as Brazil, which is one of the top 3 countries that have been affected in the world. However, the workers' perception of the stress and the changes that the pandemic has caused in their lives vary according to the conditions offered by these affected countries, including salaries, individual protection equipment, and psychological support. Objective: The purpose of this study was to identify the perceptions of Brazilian health workers regarding the COVID-19 pandemic impact on their lives, including possible self-contamination and mental health. Methods: This cross-sectional web-based survey was conducted in Brazil by applying a 32-item questionnaire, including multiple-choice questions by using the Google Forms electronic assessment. This study was designed to capture spontaneous perceptions from health professionals. All questions were mandatory and divided into 2 blocks with different proposals: personal profile and COVID-19 pandemic impact. Results: We interviewed Brazilian health professionals from all 5 Brazilian regions (N=1376). Our study revealed that 1 in 5 (23\%) complained about inadequate personal protective equipment, including face shields (234/1376, 17.0\%), masks (206/1376, 14.9\%), and laboratory coats (138/1376, 10.0\%), whereas 1 in 4 health professionals did not have enough information to protect themselves from the coronavirus disease. These professionals had anxiety due to COVID-19 (604/1376, 43.9\%), difficulties in sleep (593/1376, 43.1\%), and concentrating on work (453/1376, 32.9\%). Almost one-third experienced traumatic situations at work (385/1376, 28.0\%), which may have led to negative feelings of fear of COVID-19 and sadness. Despite this situation, there was hope and empathy among their positive feelings. The survey also showed that 1 in 5 acquired COVID-19 with the most classic and minor symptoms, including headache (274/315, 87.0\%), body pain (231/315, 73.3\%), tiredness (228/315, 72.4\%), and loss of taste and smell (208/315, 66.0\%). Some of their negative feelings were higher than those of noninfected professionals (fear of COVID-19, 243/315, 77.1\% vs 509/1061, 48.0\%; impotence, 142/315, 45.1\% vs 297/1061, 28.0\%; and fault, 38/315, 12.1\% vs 567/1061, 53.4\%, respectively). Another worrying outcome was that 61.3\% (193/315) reported acquiring an infection while working at a health facility and as expected, most of the respondents felt affected (344/1376, 25.0\%) or very affected (619/1376, 45.0\%) by the COVID-19. Conclusions: In Brazil, the health professionals were exposed to a stressful situation and to the risk of self-contamination---conditions that can spell future psychological problems for these workers. Our survey findings showed that the psychological support for this group should be included in the future health planning of Brazil and of other hugely affected countries to assure a good mental health condition for the medical teams in the near future. ",
doi="10.2196/28088",
url="https://formative.jmir.org/2021/10/e28088",
url="http://www.ncbi.nlm.nih.gov/pubmed/34519656"
}


@Article{info:doi/10.2196/24208,
author="Smith, L. Jeremy
and Allen, W. Jason
and Haack, I. Carla
and Wehrmeyer, L. Kathryn
and Alden, G. Kayley
and Lund, B. Maha
and Mascaro, S. Jennifer",
title="Impact of App-Delivered Mindfulness Meditation on Functional Connectivity, Mental Health, and Sleep Disturbances Among Physician Assistant Students: Randomized, Wait-list Controlled Pilot Study",
journal="JMIR Form Res",
year="2021",
month="Oct",
day="19",
volume="5",
number="10",
pages="e24208",
keywords="mindfulness",
keywords="meditation",
keywords="resting state",
keywords="fMRI",
keywords="connectivity",
keywords="mobile phone",
abstract="Background: Health care provider and trainee burnout results in substantial national and institutional costs and profound social effects. Identifying effective solutions and interventions to cultivate resilience among health care trainees is critical. Although less is known about the mental health needs of physician assistants (PAs) or PA students, accumulating research indicates that they experience similarly alarming rates of burnout, depression, and emotional exhaustion. Mobile app--delivered mindfulness meditation may be an effective part of salubrious programming to bolster long-term resilience and health among PA students. Objective: This study aims to examine the impact of app-delivered mindfulness meditation on self-reported mental health symptoms among PA students. A secondary aim is to investigate changes in brain connectivity to identify neurobiological changes related to changes in mental health symptoms. Methods: We recruited PA students enrolled in their third semester of PA school and used a longitudinal, randomized, wait-list--controlled design. Participants randomized to the mindfulness group were provided 1-year subscriptions to the 10\% Happier app, a consumer-based meditation app, and asked to practice every day for 8 weeks. Before randomization and again after completion of the 8-week program, all participants completed resting-state functional magnetic resonance imaging as well as self-report assessments of burnout, depression, anxiety, and sleep impairment. App use was acquired as a measure of mindfulness practice time. Results: PA students randomized to the mindfulness group reported improvements in sleep impairment compared with those randomized to the wait-list control group ($\eta$p2=0.42; P=.01). Sleep impairment decreased significantly in the mindfulness group (19\% reduction; P=.006) but not in the control group (1\% reduction; P=.71). There were no other significant changes in mental health for those randomized to app-delivered mindfulness. Across all students, changes in sleep impairment were associated with increased resting-state functional connectivity between the medial prefrontal cortex (a component of the default mode network) and the superior temporal gyrus, as well as between areas important for working memory. Changes in connectivity predicted categorical conversion from impaired to nonimpaired sleep in the mindfulness group. Conclusions: This pilot study is the first to examine app-based mindfulness for PA students' mental health and investigate the impact of mindfulness on PA students' brain function. These findings suggest that app-delivered mindfulness may be an effective tool to improve sleep dysfunction and that it may be an important part of the programming necessary to reduce the epidemic of suffering among health profession trainees. ",
doi="10.2196/24208",
url="https://formative.jmir.org/2021/10/e24208",
url="http://www.ncbi.nlm.nih.gov/pubmed/34665153"
}


@Article{info:doi/10.2196/30757,
author="Kaufmann, G. Peter
and Havens, S. Donna
and Mensinger, L. Janell
and Bradley, K. Patricia
and Brom, M. Heather
and Copel, C. Linda
and Costello, Alexander
and D'Annunzio, Christine
and Dean Durning, Jennifer
and Maldonado, Linda
and Barrow McKenzie, Ann
and Smeltzer, C. Suzanne
and Yost, Jennifer
and ",
title="The COVID-19 Study of Healthcare and Support Personnel (CHAMPS): Protocol for a Longitudinal Observational Study",
journal="JMIR Res Protoc",
year="2021",
month="Oct",
day="7",
volume="10",
number="10",
pages="e30757",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="stress",
keywords="depression",
keywords="anxiety",
keywords="sleep",
keywords="social support",
keywords="resilience",
keywords="mental health",
keywords="physical health",
abstract="Background: Early in the development of the COVID-19 pandemic, it was evident that health care workers, first responders, and other essential workers would face significant stress and workplace demands related to equipment shortages and rapidly growing infections in the general population. Although the effects of other sources of stress on health have been documented, the effects of these unique conditions of the COVID-19 pandemic on the long-term health and well-being of the health care workforce are not known. Objective: The COVID-19 Study of Healthcare and Support Personnel (CHAMPS) was designed to document early and longitudinal effects of the pandemic on the mental and physical health of essential workers engaged in health care. We will investigate mediators and moderators of these effects and evaluate the influence of exposure to stress, including morbidity and mortality, over time. We will also examine the effect of protective factors and resilience on health outcomes. Methods: The study cohort is a convenience sample recruited nationally through communities, professional organizations, networks, social media, and snowball sampling. Recruitment took place for 13 months to obtain an estimated sample of 2762 adults who provided self-reported information administered on the web through structured questionnaires about their work environment, mental and physical health, and psychosocial factors. Follow-up questionnaires will be administered after 6 months and annually thereafter to ascertain changes in health, well-being, and lifestyle. Participants who consented to be recontacted form the longitudinal cohort and the CHAMPS Registry may be contacted to ascertain their interest in ancillary studies for which they may be eligible. Results: The study was approved by the Institutional Review Board and launched in May 2020, with grants from Travere Therapeutics Inc, McKesson Corporation, anonymous donors, and internal funding from the M. Louise Fitzpatrick College of Nursing at Villanova University.  Recruitment ended in June 2021 after enrolling 2762 participants, 1534 of whom agreed to participate in the longitudinal study and the registry as well as to be contacted about eligibility for future studies. Conclusions: The CHAMPS Study and Registry will enable the acquisition of detailed data on the effects of extended psychosocial and workplace stress on morbidity and mortality and serve as a platform for ancillary studies related to the COVID-19 pandemic. Trial Registration: ClinicalTrials.gov NCT04370821; https://clinicaltrials.gov/ct2/show/NCT04370821 International Registered Report Identifier (IRRID): DERR1-10.2196/30757 ",
doi="10.2196/30757",
url="https://www.researchprotocols.org/2021/10/e30757",
url="http://www.ncbi.nlm.nih.gov/pubmed/34582354"
}


@Article{info:doi/10.2196/28623,
author="Wu, Andrew
and Radhakrishnan, Varsha
and Targan, Elizabeth
and Scarella, M. Timothy
and Torous, John
and Hill, P. Kevin",
title="Self-Reported Preferences for Help-Seeking and Barriers to Using Mental Health Supports Among Internal Medicine Residents: Exploratory Use of an Econometric Best-Worst Scaling Framework for Gathering Physician Wellness Preferences",
journal="JMIR Med Educ",
year="2021",
month="Oct",
day="6",
volume="7",
number="4",
pages="e28623",
keywords="residency program",
keywords="choice",
keywords="burnout",
keywords="wellness",
abstract="Background: Burnout interventions are limited by low use. Understanding resident physician preferences for burnout interventions may increase utilization and improve the assessment of these interventions. Objective: This study aims to use an econometric best-worst scaling (BWS) framework to survey internal medicine resident physicians to establish help-seeking preferences for burnout and barriers to using wellness supports by quantifying selections for 7 wellness support options and 7 barriers. Methods: Internal medicine resident physicians at our institution completed an anonymous web-based BWS survey during the 2020-2021 academic year. This cross-sectional study was analyzed with multinomial logistic regression and latent class modeling to determine the relative rank ordering of factors for seeking support for burnout and barriers to using wellness supports. Analysis of variance with Tukey honest significant difference posthoc test was used to analyze differences in mean utility scores representing choice for barriers and support options. Results: Of the 163 invited residents, 77 (47.2\% response rate) completed the survey. Top-ranking factors for seeking wellness supports included seeking informal peer support (best: 71\%; worst: 0.6\%) and support from friends and family (best: 70\%; worst: 1.6\%). Top-ranking barriers to seeking counseling included time (best: 75\%; worst: 5\%) and money (best: 35\%; worst: 21\%). Conclusions: Overall, our findings suggest that low utilization of formal mental health support is reflective of resident preferences to seek help informally and that increasing utilization will require addressing pragmatic barriers of time and cost. Assessing physician preferences for wellness-related initiatives may contribute to understanding the low utilization of formal mental health services among physicians, which can be determined using a BWS framework. ",
doi="10.2196/28623",
url="https://mededu.jmir.org/2021/4/e28623",
url="http://www.ncbi.nlm.nih.gov/pubmed/34612838"
}


@Article{info:doi/10.2196/28731,
author="de Vries, Herman
and Kamphuis, Wim
and Oldenhuis, Hilbrand
and van der Schans, Cees
and Sanderman, Robbert",
title="Moderation of the Stressor-Strain Process in Interns by Heart Rate Variability Measured With a Wearable and Smartphone App: Within-Subject Design Using Continuous Monitoring",
journal="JMIR Cardio",
year="2021",
month="Oct",
day="4",
volume="5",
number="2",
pages="e28731",
keywords="stress",
keywords="strain",
keywords="burnout",
keywords="resilience",
keywords="heart rate variability",
keywords="sleep",
keywords="wearables",
keywords="digital health",
keywords="sensors",
keywords="ecological momentary assessment",
keywords="mobile phone",
abstract="Background: The emergence of smartphones and wearable sensor technologies enables easy and unobtrusive monitoring of physiological and psychological data related to an individual's resilience. Heart rate variability (HRV) is a promising biomarker for resilience based on between-subject population studies, but observational studies that apply a within-subject design and use wearable sensors in order to observe HRV in a naturalistic real-life context are needed. Objective: This study aims to explore whether resting HRV and total sleep time (TST) are indicative and predictive of the within-day accumulation of the negative consequences of stress and mental exhaustion. The tested hypotheses are that demands are positively associated with stress and resting HRV buffers against this association, stress is positively associated with mental exhaustion and resting HRV buffers against this association, stress negatively impacts subsequent-night TST, and previous-evening mental exhaustion negatively impacts resting HRV, while previous-night TST buffers against this association. Methods: In total, 26 interns used consumer-available wearables (Fitbit Charge 2 and Polar H7), a consumer-available smartphone app (Elite HRV), and an ecological momentary assessment smartphone app to collect resilience-related data on resting HRV, TST, and perceived demands, stress, and mental exhaustion on a daily basis for 15 weeks. Results: Multiple linear regression analysis of within-subject standardized data collected on 2379 unique person-days showed that having a high resting HRV buffered against the positive association between demands and stress (hypothesis 1) and between stress and mental exhaustion (hypothesis 2). Stress did not affect TST (hypothesis 3). Finally, mental exhaustion negatively predicted resting HRV in the subsequent morning but TST did not buffer against this (hypothesis 4). Conclusions: To our knowledge, this study provides first evidence that having a low within-subject resting HRV may be both indicative and predictive of the short-term accumulation of the negative effects of stress and mental exhaustion, potentially forming a negative feedback loop. If these findings can be replicated and expanded upon in future studies, they may contribute to the development of automated resilience interventions that monitor daily resting HRV and aim to provide users with an early warning signal when a negative feedback loop forms, to prevent the negative impact of stress on long-term health outcomes. ",
doi="10.2196/28731",
url="https://cardio.jmir.org/2021/2/e28731",
url="http://www.ncbi.nlm.nih.gov/pubmed/34319877"
}


@Article{info:doi/10.2196/32663,
author="Liu, W. Jenny J.
and Nazarov, Anthony
and Plouffe, A. Rachel
and Forchuk, A. Callista
and Deda, Erisa
and Gargala, Dominic
and Le, Tri
and Bourret-Gheysen, Jesse
and Soares, Vanessa
and Nouri, S. Maede
and Hosseiny, Fardous
and Smith, Patrick
and Roth, Maya
and MacDougall, G. Arlene
and Marlborough, Michelle
and Jetly, Rakesh
and Heber, Alexandra
and Albuquerque, Joy
and Lanius, Ruth
and Balderson, Ken
and Dupuis, Gabrielle
and Mehta, Viraj
and Richardson, Don J.",
title="Exploring the Well-being of Health Care Workers During the COVID-19 Pandemic: Protocol for a Prospective Longitudinal Study",
journal="JMIR Res Protoc",
year="2021",
month="Sep",
day="27",
volume="10",
number="9",
pages="e32663",
keywords="COVID-19",
keywords="health care worker",
keywords="pandemic",
keywords="mental health",
keywords="wellbeing",
keywords="survey",
keywords="design",
keywords="longitudinal",
keywords="prospective",
keywords="protocol",
keywords="challenge",
keywords="impact",
keywords="distress",
keywords="perception",
abstract="Background: Health care workers (HCWs) have experienced several stressors associated with the COVID-19 pandemic. Structural stressors, including extended work hours, redeployment, and changes in organizational mandates, often intersect with interpersonal and personal stressors, such as caring for those with COVID-19 infections; worrying about infection of self, family, and loved ones; working despite shortages of personal protective equipment; and encountering various difficult moral-ethical dilemmas. Objective: The paper describes the protocol for a longitudinal study seeking to capture the unique experiences, challenges, and changes faced by HCWs during the COVID-19 pandemic. The study seeks to explore the impact of COVID-19 on the mental well-being of HCWs with a particular focus on moral distress, perceptions of and satisfaction with delivery of care, and how changes in work structure are tolerated among HCWs providing clinical services. Methods: A prospective longitudinal design is employed to assess HCWs' experiences across domains of mental health (depression, anxiety, posttraumatic stress, and well-being), moral distress and moral reasoning, work-related changes and telehealth, organizational responses to COVID-19 concerns, and experiences with COVID-19 infections to self and to others. We recruited HCWs from across Canada through convenience snowball sampling to participate in either a short-form or long-form web-based survey at baseline. Respondents to the baseline survey are invited to complete a follow-up survey every 3 months, for a total of 18 months. Results: A total of 1926 participants completed baseline surveys between June 26 and December 31, 2020, and 1859 participants provided their emails to contact them to participate in follow-up surveys. As of July 2021, data collection is ongoing, with participants nearing the 6- or 9-month follow-up periods depending on their initial time of self-enrollment. Conclusions: This protocol describes a study that will provide unique insights into the immediate and longitudinal impact of the COVID-19 pandemic on the dimensions of mental health, moral distress, health care delivery, and workplace environment of HCWs. The feasibility and acceptability of implementing a short-form and long-form survey on participant engagement and data retention will also be discussed. International Registered Report Identifier (IRRID): DERR1-10.2196/32663 ",
doi="10.2196/32663",
url="https://www.researchprotocols.org/2021/9/e32663",
url="http://www.ncbi.nlm.nih.gov/pubmed/34477557"
}


@Article{info:doi/10.2196/29374,
author="Mohan, Vishnu
and Garrison, Cort
and Gold, A. Jeffrey",
title="Using a New Model of Electronic Health Record Training to Reduce Physician Burnout: A Plan for Action",
journal="JMIR Med Inform",
year="2021",
month="Sep",
day="20",
volume="9",
number="9",
pages="e29374",
keywords="electronic health records",
keywords="clinician burnout",
keywords="EHR training",
keywords="clinician wellness",
keywords="after-hours EHR use",
keywords="EHR",
keywords="patient data",
keywords="burnout",
keywords="simulation",
keywords="efficiency",
keywords="optimization",
keywords="well-being",
doi="10.2196/29374",
url="https://medinform.jmir.org/2021/9/e29374",
url="http://www.ncbi.nlm.nih.gov/pubmed/34325400"
}


@Article{info:doi/10.2196/31295,
author="Hirten, P. Robert
and Danieletto, Matteo
and Tomalin, Lewis
and Choi, Hyewon Katie
and Zweig, Micol
and Golden, Eddye
and Kaur, Sparshdeep
and Helmus, Drew
and Biello, Anthony
and Pyzik, Renata
and Calcagno, Claudia
and Freeman, Robert
and Sands, E. Bruce
and Charney, Dennis
and Bottinger, P. Erwin
and Murrough, W. James
and Keefer, Laurie
and Suarez-Farinas, Mayte
and Nadkarni, N. Girish
and Fayad, A. Zahi",
title="Factors Associated With Longitudinal Psychological and Physiological Stress in Health Care Workers During the COVID-19 Pandemic: Observational Study Using Apple Watch Data",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="13",
volume="23",
number="9",
pages="e31295",
keywords="wearable device",
keywords="COVID-19",
keywords="stress",
keywords="heart rate variability",
keywords="psychological",
keywords="psychology",
keywords="physiology",
keywords="mental health",
keywords="health care worker",
keywords="observational",
keywords="app",
keywords="heart rate",
keywords="nervous system",
keywords="resilience",
keywords="emotion",
keywords="support",
keywords="quality of life",
abstract="Background: The COVID-19 pandemic has resulted in a high degree of psychological distress among health care workers (HCWs). There is a need to characterize which HCWs are at an increased risk of developing psychological effects from the pandemic. Given the differences in the response of individuals to stress, an analysis of both the perceived and physiological consequences of stressors can provide a comprehensive evaluation of its impact. Objective: This study aimed to determine characteristics associated with longitudinal perceived stress in HCWs and to assess whether changes in heart rate variability (HRV), a marker of autonomic nervous system function, are associated with features protective against longitudinal stress. Methods: HCWs across 7 hospitals in New York City, NY, were prospectively followed in an ongoing observational digital study using the custom Warrior Watch Study app. Participants wore an Apple Watch for the duration of the study to measure HRV throughout the follow-up period. Surveys measuring perceived stress, resilience, emotional support, quality of life, and optimism were collected at baseline and longitudinally. Results: A total of 361 participants (mean age 36.8, SD 10.1 years; female: n=246, 69.3\%) were enrolled. Multivariate analysis found New York City's COVID-19 case count to be associated with increased longitudinal stress (P=.008). Baseline emotional support, quality of life, and resilience were associated with decreased longitudinal stress (P<.001). A significant reduction in stress during the 4-week period after COVID-19 diagnosis was observed in the highest tertial of emotional support (P=.03) and resilience (P=.006). Participants in the highest tertial of baseline emotional support and resilience had a significantly different circadian pattern of longitudinally collected HRV compared to subjects in the low or medium tertial. Conclusions: High resilience, emotional support, and quality of life place HCWs at reduced risk of longitudinal perceived stress and have a distinct physiological stress profile. Our findings support the use of these characteristics to identify HCWs at risk of the psychological and physiological stress effects of the pandemic. ",
doi="10.2196/31295",
url="https://www.jmir.org/2021/9/e31295",
url="http://www.ncbi.nlm.nih.gov/pubmed/34379602"
}


@Article{info:doi/10.2196/31211,
author="Fung, Po-Lun Kenneth
and Vahabi, Mandana
and Moosapoor, Masoomeh
and Akbarian, Abdolreza
and Jing-Wen Liu, Jenny
and Wong, Pui-Hing Josephine",
title="Implementation of an Internet-Based Acceptance and Commitment Therapy for Promoting Mental Health Among Migrant Live-in Caregivers in Canada: Protocol",
journal="JMIR Res Protoc",
year="2021",
month="Sep",
day="13",
volume="10",
number="9",
pages="e31211",
keywords="migrant live-in caregiver",
keywords="women",
keywords="mental health",
keywords="acceptance commitment therapy",
keywords="resiliency",
keywords="empowerment",
abstract="Background: Psychological distress, isolation, feelings of powerlessness, and limited social support are realities faced by temporary migrant live-in caregivers in Canada. Furthermore, they experience multiple barriers in accessing mental health services due to their long work hours, limited knowledge of health resources, precarious employment, and immigration status. Objective: The Women Empowerment - Caregiver Acceptance \& Resilience E-Learning (WE2CARE) project is a pilot intervention research project that aims to promote the mental well-being and resiliency of migrant live-in caregivers. The objectives include exploring the effectiveness of this program in achieving the following: (1) reducing psychological distress (depression, anxiety, and stress); (2) promoting committed actions of self-care; and (3) building mutual support social networks. Further, participants' satisfaction with the intervention and their perceived barriers to and facilitators of practicing the self-care strategies embedded in WE2CARE will be examined. Methods: A total of 36 live-in caregivers residing in the Greater Toronto Area will be recruited and randomly assigned to either the intervention or waitlist control group. The intervention group will receive a 6-week web-based psychosocial intervention that will be based on Acceptance and Commitment Therapy (ACT). Standardized self-reported surveys will be administered online preintervention, postintervention, and at 6 weeks postintervention to assess mental distress (Depression, Anxiety and Stress Scale), psychological flexibility (Acceptance and Action Questionnaire), mindfulness (Cognitive and Affective Mindfulness Scale -- Revised), and resilience (Multi-System Model of Resilience Inventory). In addition, two focus groups will be held with a subset of participants to explore their feedback on the utility of the WE2CARE program. Results: WE2CARE was funded in January 2019 for a year. The protocol was approved by the research ethics boards of Ryerson University (REB 2019-036) and the University of Toronto (RIS37623) in February and May 2019, respectively. Data collection started upon ethics approval and was completed by May 2020. A total of 29 caregivers completed the study and 20 participated in the focus groups. Data analyses are in progress and results will be published in 2021. Conclusions: WE2CARE could be a promising approach to reducing stress, promoting resilience, and providing a virtual space for peer emotional support and collaborative learning among socially isolated and marginalized women. The results of this pilot study will inform the adaptation of an ACT-based psychological intervention for online delivery and determine its utility in promoting mental health among disadvantaged and vulnerable populations. International Registered Report Identifier (IRRID): DERR1-10.2196/31211 ",
doi="10.2196/31211",
url="https://www.researchprotocols.org/2021/9/e31211",
url="http://www.ncbi.nlm.nih.gov/pubmed/34515642"
}


@Article{info:doi/10.2196/29582,
author="Kim, Jin Yun
and Qian, Linchao
and Aslam, Shahzad Muhammad",
title="Cyberbullying Among Traditional and Complementary Medicine Practitioners in the Workplace: Protocol for a Cross-sectional Descriptive Study",
journal="JMIR Res Protoc",
year="2021",
month="Aug",
day="12",
volume="10",
number="8",
pages="e29582",
keywords="cyberbullying",
keywords="traditional medicine",
keywords="workplace",
keywords="practitioners",
keywords="medical professional",
abstract="Background: Cyberbullying is becoming prevalent among health care professionals and may cause a variety of mental health issues. Traditional and complementary medicine practitioners remain an important pillar of the health care system in Malaysia. Objective: This paper presents a study protocol for an online survey (Cyberbullying Among Traditional and Complementary Medicine Practitioner [TCMPs]) that will collect the first nationwide representative data on cyberbullying behavior among traditional and complementary medicine practitioners in Malaysia. The objectives of the survey are to (1) evaluate the cyberbullying behavior among traditional and complementary medicine practitioners in Malaysia, (2) identify sociodemographic and social factors related to cyberbullying, and (3) evaluate the association between cyberbullying behavior, sociodemographic, and social factors. Methods: A snowball sampling strategy will be applied. Traditional and complementary medicine practitioners who are permanent Malaysian residents will be randomly selected and invited to participate in the survey (N=1023). Cyberbullying behavior will be measured using the Cyberbullying Behavior Questionnaire (CBQ). Data on the following items will be collected: work-related bullying, person-related bullying, aggressively worded messages, distortion of messages, sending offensive photos/videos, hacking computers or sending a virus or rude message, and threatening messages about personal life or family members. We will also collect data on participants' sociodemographic characteristics, social factors, and substance abuse behavior. Results: This cross-sectional descriptive study was registered with Research Registry (Unique Identifying Number 6216; November 05, 2020). This research work (substudy) is planned under a phase 1 study approved by the Research Management Centre, Xiamen University Malaysia. This substudy has been approved by the Research Ethics Committee of Xiamen University Malaysia (REC-2011.01). The cross-sectional survey will be conducted from July 01, 2021, to June 30, 2022. Data preparation and statistical analyses are planned from January 2022 onward. Conclusions: The current research can contribute to identify the prevalence of workplace cyberbullying among Malaysian traditional and complementary medicine practitioners. The results will help government stakeholders, health professionals, and education professionals to understand the psychological well-being of Malaysian traditional and complementary medicine practitioners. Trial Registration: Research Registry Unique Identifying Number 6216; https://tinyurl.com/3rsmxs7u International Registered Report Identifier (IRRID): PRR1-10.2196/29582 ",
doi="10.2196/29582",
url="https://www.researchprotocols.org/2021/8/e29582",
url="http://www.ncbi.nlm.nih.gov/pubmed/34387559"
}


@Article{info:doi/10.2196/29126,
author="Kremer, Lisanne
and Lipprandt, Myriam
and R{\"o}hrig, Rainer
and Breil, Bernhard",
title="Examining the Mental Workload Associated With Digital Health Technologies in Health Care: Protocol for a Systematic Review Focusing on Assessment Methods",
journal="JMIR Res Protoc",
year="2021",
month="Aug",
day="3",
volume="10",
number="8",
pages="e29126",
keywords="mental workload",
keywords="cognitive load",
keywords="assessment",
keywords="healthcare workers",
keywords="health information system",
keywords="digital health technology",
keywords="health care professionals",
keywords="stress",
keywords="eyetracking",
abstract="Background: The workload in health care is high; physicians and nurses report high stress levels due to a demanding environment where they often have to perform multiple tasks simultaneously. As a result, mental health issues among health care professionals (HCPs) are on the rise and the prevalence of errors in their daily tasks could increase. Processes of demographic change are partly responsible for even higher stress levels among HCPs. The digitization of patient care is intended to counteract these processes. However, it remains unclear whether these health information systems (HIS) and digital health technologies (DHT) support the HCPs and relieve stress, or if they represent a further burden. The mental construct that describes this burden of technologies is mental workload (MWL). Work in the clinic can be viewed as working in safety-critical environments. Particularly in this sensitive setting, the measurement methods of MWL are relevant, mainly due to their strongly differing levels of intrusiveness and sensitivity. The method of eye tracking could be a useful way to measure MWL directly in the field. Objective: The systematic review aims to address the following questions: (1) In which manner do DHT contribute to the overall MWL of HCPs? (2) Can we observe a direct or indirect effect of DHT on MWL? (3) Which aspects or factors of DHT contribute to an increase in MWL? (4) Which methods/assessments are applied to measure MWL related to HIS/DHT? (5) What role does eye tracking/pupillometry play in the context of measuring MWL? (6) Which outcomes are being assessed via eye tracking? Methods: Following the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) statement, we will conduct a systematic review. Based on the research questions, we define keywords that we then combine in search terms. The review follows the following steps: literature search, article selection, data extraction, risk of bias assessment, data analysis, and data synthesis. Results: We expect results as well as a finalization of the review in the summer of 2021. Conclusions: This review will evaluate the impact of DHT on the MWL of HCPs. In addition, assessment methods of MWL in the context of digital technologies will be systematically analyzed. Trial Registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42021233271; https://www.crd.york.ac.uk/PROSPERO/display\_record.php?ID=CRD42021233271 International Registered Report Identifier (IRRID): DERR1-10.2196/29126 ",
doi="10.2196/29126",
url="https://www.researchprotocols.org/2021/8/e29126",
url="http://www.ncbi.nlm.nih.gov/pubmed/34342590"
}


@Article{info:doi/10.2196/23516,
author="Pimentel, B. Camilla
and Clark, Valerie
and Baughman, W. Amy
and Berlowitz, R. Dan
and Davila, Heather
and Mills, L. Whitney
and Mohr, C. David
and Sullivan, L. Jennifer
and Hartmann, W. Christine",
title="Health Care Providers and the Public Reporting of Nursing Home Quality in the United States Department of Veterans Affairs: Protocol for a Mixed Methods Pilot Study",
journal="JMIR Res Protoc",
year="2021",
month="Jul",
day="21",
volume="10",
number="7",
pages="e23516",
keywords="nursing homes",
keywords="public reporting",
keywords="quality",
abstract="Background: In June 2018, the United States Department of Veterans Affairs (VA) began the public reporting of its 134 Community Living Centers' (CLCs) overall quality by using a 5-star rating system based on data from the national quality measures captured in CLC Compare. Given the private sector's positive experience with report cards, this is a seminal moment for stimulating measurable quality improvements in CLCs. However, the public reporting of CLC Compare data raises substantial and immediate implications for CLCs. The report cards, for example, facilitate comparisons between CLCs and community nursing homes in which CLCs generally fare worse. This may lead to staff anxiety and potentially unintended consequences. Additionally, CLC Compare is designed to spur improvement, yet the motivating aspects of the report cards are unknown. Understanding staff attitudes and early responses is a critical first step in building the capacity for public reporting to spur quality.  Objective: We will adapt an existing community nursing home public reporting survey to reveal important leverage points and support CLCs' quality improvement efforts. Our work will be grounded in a conceptual framework of strategic orientation. We have 2 aims. First, we will qualitatively examine CLC staff reactions to CLC Compare. Second, we will adapt and expand upon an extant community nursing home survey to capture a broad range of responses and then pilot the adapted survey in CLCs. Methods: We will conduct interviews with staff at 3 CLCs (1 1-star CLC, 1 3-star CLC, and 1 5-star CLC) to identify staff actions taken in response to their CLCs' public data; staff's commitment to or difficulties with using CLC Compare; and factors that motivate staff to improve CLC quality. We will integrate these findings with our conceptual framework to adapt and expand a community nursing home survey to the current CLC environment. We will conduct cognitive interviews with staff in 1 CLC to refine survey items. We will then pilot the survey in 6 CLCs (2 1-star CLCs, 2 3-star CLCs, and 2 5-star CLCs) to assess the survey's feasibility, acceptability, and preliminary psychometric properties.  Results: We will develop a brief survey for use in a future national administration to identify system-wide responses to CLC Compare; evaluate the impact of CLC Compare on veterans' clinical outcomes and satisfaction; and develop, test, and disseminate interventions to support the meaningful use of CLC Compare for quality improvement.  Conclusions: The knowledge gained from this pilot study and from future work will help VA refine how CLC Compare is used, ensure that CLC staff understand and are motivated to use its quality data, and implement concrete actions to improve clinical quality. The products from this pilot study will also facilitate studies on the effects of public reporting in other critical VA clinical areas. International Registered Report Identifier (IRRID): DERR1-10.2196/23516 ",
doi="10.2196/23516",
url="https://www.researchprotocols.org/2021/7/e23516",
url="http://www.ncbi.nlm.nih.gov/pubmed/34287218"
}


@Article{info:doi/10.2196/26817,
author="Tawfik, S. Daniel
and Sinha, Amrita
and Bayati, Mohsen
and Adair, C. Kathryn
and Shanafelt, D. Tait
and Sexton, Bryan J.
and Profit, Jochen",
title="Frustration With Technology and its Relation to Emotional Exhaustion Among Health Care Workers: Cross-sectional Observational Study",
journal="J Med Internet Res",
year="2021",
month="Jul",
day="6",
volume="23",
number="7",
pages="e26817",
keywords="frustration with technology",
keywords="emotional exhaustion",
keywords="professional burnout",
keywords="work-life integration",
keywords="biomedical technology",
keywords="work-life balance",
keywords="user-centered design",
keywords="electronic health records",
keywords="medical informatics applications",
keywords="health information systems",
abstract="Background: New technology adoption is common in health care, but it may elicit frustration if end users are not sufficiently considered in their design or trained in their use. These frustrations may contribute to burnout. Objective: This study aimed to evaluate and quantify health care workers' frustration with technology and its relationship with emotional exhaustion, after controlling for measures of work-life integration that may indicate excessive job demands. Methods: This was a cross-sectional, observational study of health care workers across 31 Michigan hospitals. We used the Safety, Communication, Operational Reliability, and Engagement (SCORE) survey to measure work-life integration and emotional exhaustion among the survey respondents. We used mixed-effects hierarchical linear regression to evaluate the relationship among frustration with technology, other components of work-life integration, and emotional exhaustion, with adjustment for unit and health care worker characteristics. Results: Of 15,505 respondents, 5065 (32.7\%) reported that they experienced frustration with technology on at least 3-5 days per week. Frustration with technology was associated with higher scores for the composite Emotional Exhaustion scale (r=0.35, P<.001) and each individual item on the Emotional Exhaustion scale (r=0.29-0.36, P<.001 for all). Each 10-point increase in the frustration with technology score was associated with a 1.2-point increase (95\% CI 1.1-1.4) in emotional exhaustion (both measured on 100-point scales), after adjustment for other work-life integration items and unit and health care worker characteristics. Conclusions: This study found that frustration with technology and several other markers of work-life integration are independently associated with emotional exhaustion among health care workers. Frustration with technology is common but not ubiquitous among health care workers, and it is one of several work-life integration factors associated with emotional exhaustion. Minimizing frustration with health care technology may be an effective approach in reducing burnout among health care workers. ",
doi="10.2196/26817",
url="https://www.jmir.org/2021/7/e26817",
url="http://www.ncbi.nlm.nih.gov/pubmed/34255674"
}


@Article{info:doi/10.2196/22075,
author="Ye, Jiancheng",
title="Advancing Mental Health and Psychological Support for Health Care Workers Using Digital Technologies and Platforms",
journal="JMIR Form Res",
year="2021",
month="Jun",
day="30",
volume="5",
number="6",
pages="e22075",
keywords="mental health",
keywords="health care workers",
keywords="health informatics",
keywords="digital intervention",
keywords="health technology",
keywords="mobile health",
keywords="COVID-19",
abstract="Background: The COVID-19 pandemic is a global public health crisis that has not only endangered the lives of patients but also resulted in increased psychological issues among medical professionals, especially frontline health care workers. As the crisis caused by the pandemic shifts from acute to protracted, attention should be paid to the devastating impacts on health care workers' mental health and social well-being. Digital technologies are being harnessed to support the responses to the pandemic, which provide opportunities to advance mental health and psychological support for health care workers. Objective: The aim of this study is to develop a framework to describe and organize the psychological and mental health issues that health care workers are facing during the COVID-19 pandemic. Based on the framework, this study also proposes interventions from digital health perspectives that health care workers can leverage during and after the pandemic. Methods: The psychological problems and mental health issues that health care workers have encountered during the COVID-19 pandemic were reviewed and analyzed based on the proposed MEET (Mental Health, Environment, Event, and Technology) framework, which also demonstrated the interactions among mental health, digital interventions, and social support. Results: Health care workers are facing increased risk of experiencing mental health issues due to the COVID-19 pandemic, including burnout, fear, worry, distress, pressure, anxiety, and depression. These negative emotional stressors may cause psychological problems for health care workers and affect their physical and mental health. Digital technologies and platforms are playing pivotal roles in mitigating psychological issues and providing effective support. The proposed framework enabled a better understanding of how to mitigate the psychological effects during the pandemic, recover from associated experiences, and provide comprehensive institutional and societal infrastructures for the well-being of health care workers. Conclusions: The COVID-19 pandemic presents unprecedented challenges due to its prolonged uncertainty, immediate threat to patient safety, and evolving professional demands. It is urgent to protect the mental health and strengthen the psychological resilience of health care workers. Given that the pandemic is expected to exist for a long time, caring for mental health has become a ``new normal'' that needs a strengthened multisector collaboration to facilitate support and reduce health disparities. The proposed MEET framework could provide structured guidelines for further studies on how technology interacts with mental and psychological health for different populations. ",
doi="10.2196/22075",
url="https://formative.jmir.org/2021/6/e22075",
url="http://www.ncbi.nlm.nih.gov/pubmed/34106874"
}


@Article{info:doi/10.2196/24312,
author="Ferreira, S{\'o}nia
and Sousa, Machado Mafalda
and Moreira, Silva Pedro
and Sousa, Nuno
and Pic{\'o}-P{\'e}rez, Maria
and Morgado, Pedro",
title="A Wake-up Call for Burnout in Portuguese Physicians During the COVID-19 Outbreak: National Survey Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Jun",
day="9",
volume="7",
number="6",
pages="e24312",
keywords="COVID-19",
keywords="anxiety",
keywords="coronavirus",
keywords="depression",
keywords="frontline",
keywords="health care professionals",
keywords="health care staff",
keywords="obsessive compulsive disorder",
keywords="SARS-CoV-2",
keywords="stress",
abstract="Background: The COVID-19 outbreak has imposed physical and psychological pressure on health care professionals, including frontline physicians. Hence, evaluating the mental health status of physicians during the current pandemic is important to define future preventive guidelines among health care stakeholders. Objective: In this study, we intended to study alterations in the mental health status of Portuguese physicians working at the frontline during the COVID-19 pandemic and potential sociodemographic factors influencing their mental health status. Methods: A nationwide survey was conducted during May 4-25, 2020, to infer differences in mental health status (depression, anxiety, stress, and obsessive compulsive symptoms) between Portuguese physicians working at the frontline during the COVID-19 pandemic and other nonfrontline physicians. A representative sample of 420 participants stratified by age, sex, and the geographic region was analyzed (200 frontline and 220 nonfrontline participants). Moreover, we explored the influence of several sociodemographic factors on mental health variables including age, sex, living conditions, and household composition. Results: Our results show that being female ($\beta$=1.1; t=2.5; P=.01) and working at the frontline ($\beta$=1.4; t=2.9; P=.004) are potential risk factors for stress. In contrast, having a house with green space was a potentially beneficial factor for stress ($\beta$=--1.5; t=--2.5; P=.01) and anxiety ($\beta$=--1.1; t=--2.4; P=.02). Conclusions: It is important to apply protective mental health measures for physicians to avoid the long-term effects of stress, such as burnout. ",
doi="10.2196/24312",
url="https://publichealth.jmir.org/2021/6/e24312",
url="http://www.ncbi.nlm.nih.gov/pubmed/33630744"
}


@Article{info:doi/10.2196/25259,
author="Zhao, Lina
and Sznajder, Kristin
and Cheng, Dan
and Wang, Shimeng
and Cui, Can
and Yang, Xiaoshi",
title="Coping Styles for Mediating the Effect of Resilience on Depression Among Medical Students in Web-Based Classes During the COVID-19 Pandemic: Cross-sectional Questionnaire Study",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="7",
volume="23",
number="6",
pages="e25259",
keywords="resilience",
keywords="coping styles",
keywords="depression",
keywords="medical students",
keywords="COVID-19",
keywords="coping",
keywords="mediation",
keywords="web-based education",
keywords="e-learning",
keywords="smartphone",
keywords="cross-sectional",
abstract="Background: Due to strict, nationwide, comprehensive COVID-19 protective measures, including home quarantine, all Chinese medical students began taking web-based classes beginning in the spring semester of 2020. Home quarantine, web-based classes, and the stress surrounding the COVID-19 pandemic may have triggered an increased incidence of mental health problems among medical students. Although there have been increasing amounts of literature on depression among medical students, studies focusing on positive psychological resources, such as resilience during the COVID-19 pandemic, still need to be expanded. Objective: This study aims to assess depression among medical students who are taking web-based classes during the COVID-19 pandemic and to investigate the role of coping styles as mediators between resilience and depression. Methods: A cross-sectional study of 666 medical students involving stratified sampling in Shenyang, Liaoning Province, China, was completed between March 20 and April 10, 2020. The participants responded to a self-administered, smartphone-based questionnaire, which included the Patient Health Questionnaire-9, Simplified Coping Style Questionnaire, and Ego Resilience 89 Scale. Hierarchical linear regression and structural equation modeling were used in this study. Results: The prevalence of depression among the participants was 9.6\% (64/666) in this study. The regression analysis revealed that grade (the year in which the medical student was in training) (P=.013), how well students adapted to web-based classes (P<.001), their levels of resilience (P=.04), and their coping styles were independent predictors for depression (P<.001). Resilience and positive coping styles were negatively related to depression (resilience: P=.04; positive coping styles: P<.001), and negative coping styles were positively related to depression (P<.001). The structural equation modeling analysis showed that the effect of resilience on depression was partially mediated by coping styles (P=.007). Conclusions: In this study, it was found that the prevalence of depression was slightly low and coping styles mediated the association between resilience and depression among medical students during the COVID-19 pandemic. These findings have significant implications for future studies. Future studies and interventions should aim to improve resilience and promote positive coping styles. ",
doi="10.2196/25259",
url="https://www.jmir.org/2021/6/e25259",
url="http://www.ncbi.nlm.nih.gov/pubmed/34033579"
}


@Article{info:doi/10.2196/28497,
author="Esmaeilzadeh, Pouyan
and Mirzaei, Tala",
title="Using Electronic Health Records to Mitigate Workplace Burnout Among Clinicians During the COVID-19 Pandemic: Field Study in Iran",
journal="JMIR Med Inform",
year="2021",
month="Jun",
day="3",
volume="9",
number="6",
pages="e28497",
keywords="COVID-19",
keywords="pandemic",
keywords="clinician burnout",
keywords="electronic health record",
keywords="health information technologies",
keywords="hospital intervention",
abstract="Background: The COVID-19 pandemic spread worldwide in 2020. Notably, in the countries dealing with massive casualties, clinicians have worked in new conditions characterized by a heavy workload and a high risk of being infected. The issue of clinician burnout during the pandemic has attracted considerable attention in health care research. Electronic health records (EHRs) provide health care workers with several features to meet a health system's clinical needs. Objective: We aim to examine how the use of EHR features affects the burnout of clinicians working in hospitals that have special wards for confirmed COVID-19 cases. Methods: Using an online survey, we collected data from 368 physicians, physician assistants, and nurses working in six hospitals that have implemented EHRs in the city of Tehran in Iran. We used logistic regression to assess the association between burnout and awareness of EHR features, EHR system usability, concerns about COVID-19, technology solutions, hospital technology interventions, hospital preparedness, and professional efficacy adjusted for demographic and practice characteristics. Results: The primary outcome of our study was self-reported burnout during the COVID-19 pandemic. Of the 368 respondents, 36\% (n=134) reported having at least one symptom of burnout. Participants indicated that the leading cause of EHR-related stress is inadequate training for using technology (n=159, 43\%), followed by having less face-to-face time with patients (n=140, 38\%). Positive perceptions about the EHR's ease of use were associated with lower odds of burnout symptoms. More interventions, such as clear communication of regulations; transparency in policies, expectations, and goals regarding the use of technology in the clinical workflow; and hospital preparedness to cope with the challenges of the pandemic, were associated with lower odds of burnout. Conclusions: The use of EHR applications, hospital pandemic preparation programs, and transparent technology-related policies and procedures throughout the epidemic can be substantial mitigators of technology-based stress and clinician burnout. Hospitals will then be better positioned to devise or modify technology-related policies and procedures to support physicians' and nurses' well-being during the COVID-19 pandemic. Training programs, transparency in communications of regulations, and developing a clear channel for informing clinicians of changes in policies may help reduce burnout symptoms among physicians and nurses during a pandemic. Providing easily accessible mentorship through teleconsultation and 24-hour available information technology support may also help to mitigate the odds of burnout. ",
doi="10.2196/28497",
url="https://medinform.jmir.org/2021/6/e28497",
url="http://www.ncbi.nlm.nih.gov/pubmed/34033578"
}


@Article{info:doi/10.2196/27473,
author="Singh, Laura
and Kanstrup, Marie
and Depa, Katherine
and Falk, Ann-Charlotte
and Lindstr{\"o}m, Veronica
and Dahl, Oili
and G{\"o}ransson, E. Katarina
and Rudman, Ann
and Holmes, A. Emily",
title="Digitalizing a Brief Intervention to Reduce Intrusive Memories of Psychological Trauma for Health Care Staff Working During COVID-19: Exploratory Pilot Study With Nurses",
journal="JMIR Form Res",
year="2021",
month="May",
day="26",
volume="5",
number="5",
pages="e27473",
keywords="intrusive memories",
keywords="psychological trauma",
keywords="prevention",
keywords="pilot trial",
keywords="COVID-19",
keywords="digital intervention",
keywords="remote delivery",
keywords="cognitive science",
keywords="person-based approach",
keywords="mixed methods",
keywords="co-design",
keywords="health care staff",
abstract="Background: The COVID-19 pandemic has accelerated the worldwide need for simple remotely delivered (digital) scalable interventions that can also be used preventatively to protect the mental health of health care staff exposed to psychologically traumatic events during their COVID-19--related work. We have developed a brief behavioral intervention that aims to reduce the number of intrusive memories of traumatic events but has only been delivered face-to-face so far. After digitalizing the intervention materials, the intervention was delivered digitally to target users (health care staff) for the first time. The adaption for staff's working context in a hospital setting used a co-design approach. Objective: The aims of this mixed method exploratory pilot study with health care staff who experienced working in the pandemic were to pilot the intervention that we have digitalized (for remote delivery and with remote support) and adapted for this target population (health care staff working clinically during a pandemic) to explore its ability to reduce the number of intrusive memories of traumatic events and improve related symptoms (eg, posttraumatic stress) and participant's perception of their functioning, and to explore the feasibility and acceptability of both the digitalized intervention and digitalized data collection. Methods: We worked closely with target users with lived experience of working clinically during the COVID-19 pandemic in a hospital context (registered nurses who experienced intrusive memories from traumatic events at work; N=3). We used a mixed method design and exploratory quantitative and qualitative analysis. Results: After completing the digitalized intervention once with remote researcher support (approximately 25 minutes) and a brief follow-up check-in, participants learned to use the intervention independently. All 3 participants reported zero intrusive memories during week 5 (primary outcome: 100\% digital data capture). Prior to study inclusion,  two or more intrusions in the week were reported preintervention (assessed retrospectively). There was a general pattern of symptom reduction and improvement in perceived functioning (eg, concentration) at follow-up. The digitalized intervention and data collection were perceived as feasible and rated as acceptable (eg, all 3 participants would recommend it to a colleague). Participants were positive toward the digital intervention as a useful tool that could readily be incorporated into work life and repeated in the face of ongoing or repeated trauma exposure. Conclusions: The intervention when delivered remotely and adapted for this population during the pandemic was well received by participants. Since it could be tailored around work and daily life and used preventatively, the intervention may hold promise for health care staff pending future evaluations of efficacy. Limitations include the small sample size, lack of daily intrusion frequency data in the week before the intervention, and lack of a control condition. Following this co-design process in adapting and improving intervention delivery and evaluation, the next step is to investigate the efficacy of the digitalized intervention in a randomized controlled trial. ",
doi="10.2196/27473",
url="https://formative.jmir.org/2021/5/e27473",
url="http://www.ncbi.nlm.nih.gov/pubmed/33886490"
}


@Article{info:doi/10.2196/27331,
author="Stewart, H. Nancy
and Koza, Anya
and Dhaon, Serena
and Shoushtari, Christiana
and Martinez, Maylyn
and Arora, M. Vineet",
title="Sleep Disturbances in Frontline Health Care Workers During the COVID-19 Pandemic: Social Media Survey Study",
journal="J Med Internet Res",
year="2021",
month="May",
day="19",
volume="23",
number="5",
pages="e27331",
keywords="social media",
keywords="sleep disorders",
keywords="frontline health care workers",
keywords="burnout",
keywords="insomnia",
keywords="sleep",
keywords="health care worker",
keywords="stress",
keywords="survey",
keywords="demographic",
keywords="outcome",
keywords="COVID-19",
abstract="Background: During the COVID-19 pandemic, health care workers are sharing their challenges, including sleep disturbances, on social media; however, no study has evaluated sleep in predominantly US frontline health care workers during the COVID-19 pandemic. Objective: The aim of this study was to assess sleep among a sample of predominantly US frontline health care workers during the COVID-19 pandemic using validated measures through a survey distributed on social media. Methods: A self-selection survey was distributed on Facebook, Twitter, and Instagram for 16 days (August 31 to September 15, 2020), targeting health care workers who were clinically active during the COVID-19 pandemic. Study participants completed the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI), and they reported their demographic and career information. Poor sleep quality was defined as a PSQI score ?5. Moderate-to-severe insomnia was defined as an ISI score >14. The Mini-Z Burnout Survey was used to measure burnout. Multivariate logistic regression tested associations between demographics, career characteristics, and sleep outcomes. Results: A total of 963 surveys were completed. Participants were predominantly White (894/963, 92.8\%), female (707/963, 73.4\%), aged 30-49 years (692/963, 71.9\%), and physicians (620/963, 64.4\%). Mean sleep duration was 6.1 hours (SD 1.2). Nearly 96\% (920/963, 95.5\%) of participants reported poor sleep (PSQI). One-third (288/963, 30\%) reported moderate or severe insomnia. Many participants (554/910, 60.9\%) experienced sleep disruptions due to device use or had nightmares at least once per week (420/929, 45.2\%). Over 50\% (525/932, 56.3\%) reported burnout. In multivariable logistic regressions, nonphysician (odds ratio [OR] 2.4, 95\% CI 1.7-3.4), caring for patients with COVID-19 (OR 1.8, 95\% CI 1.2-2.8), Hispanic ethnicity (OR 2.2, 95\% CI 1.4-3.5), female sex (OR 1.6, 95\% CI 1.1-2.4), and having a sleep disorder (OR 4.3, 95\% CI 2.7-6.9) were associated with increased odds of insomnia. In open-ended comments (n=310), poor sleep was mapped to four categories: children and family, work demands, personal health, and pandemic-related sleep disturbances. Conclusions: During the COVID-19 pandemic, nearly all the frontline health care workers surveyed on social media reported poor sleep, over one-third reported insomnia, and over half reported burnout. Many also reported sleep disruptions due to device use and nightmares. Sleep interventions for frontline health care workers are urgently needed. ",
doi="10.2196/27331",
url="https://www.jmir.org/2021/5/e27331",
url="http://www.ncbi.nlm.nih.gov/pubmed/33875414"
}


@Article{info:doi/10.2196/27039,
author="Fiol-DeRoque, Ant{\`o}nia Maria
and Serrano-Ripoll, Jes{\'u}s Maria
and Jim{\'e}nez, Rafael
and Zamanillo-Campos, Roc{\'i}o
and Y{\'a}{\~n}ez-Juan, Mar{\'i}a Aina
and Bennasar-Veny, Miquel
and Leiva, Alfonso
and Gervilla, Elena
and Garc{\'i}a-Buades, Esther M.
and Garc{\'i}a-Toro, Mauro
and Alonso-Coello, Pablo
and Pastor-Moreno, Guadalupe
and Ruiz-P{\'e}rez, Isabel
and Sitges, Carolina
and Garc{\'i}a-Campayo, Javier
and Llobera-C{\'a}naves, Joan
and Ricci-Cabello, Ignacio",
title="A Mobile Phone--Based Intervention to Reduce Mental Health Problems in Health Care Workers During the COVID-19 Pandemic (PsyCovidApp): Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="May",
day="18",
volume="9",
number="5",
pages="e27039",
keywords="COVID-19",
keywords="randomized controlled trial",
keywords="mental health",
keywords="health care workers",
keywords="mHealth",
keywords="app",
abstract="Background: The global health emergency generated by the COVID-19 pandemic is posing an unprecedented challenge to health care workers, who are facing heavy workloads under psychologically difficult situations. Mental mobile Health (mHealth) interventions are now being widely deployed due to their attractive implementation features, despite the lack of evidence about their efficacy in this specific population and context. Objective: The aim of this trial is to evaluate the effectiveness of a psychoeducational, mindfulness-based mHealth intervention to reduce mental health problems in health care workers during the COVID-19 pandemic. Methods: We conducted a blinded, parallel-group, controlled trial in Spain. Health care workers providing face-to-face health care to patients with COVID-19 were randomly assigned (1:1) to receive the PsyCovidApp intervention (an app targeting emotional skills, healthy lifestyle behavior, burnout, and social support) or a control app (general recommendations about mental health care) for 2 weeks. The participants were blinded to their group allocation. Data were collected telephonically at baseline and after 2 weeks by trained health psychologists. The primary outcome was a composite of depression, anxiety, and stress (overall score on the Depression Anxiety Stress Scale-21 [DASS-21]). Secondary outcomes were insomnia (Insomnia Severity Index), burnout (Maslach Burnout Inventory Human Services Survey), posttraumatic stress (Davidson Trauma Scale), self-efficacy (General Self-Efficacy Scale), and DASS-21 individual scale scores. Differences between groups were analyzed using general linear modeling according to an intention-to-treat protocol. Additionally, we measured the usability of the PsyCovidApp (System Usability Scale). The outcome data collectors and trial statisticians were unaware of the treatment allocation. Results: Between May 14 and July 25, 2020, 482 health care workers were recruited and randomly assigned to PsyCovidApp (n=248) or the control app (n=234). At 2 weeks, complete outcome data were available for 436/482 participants (90.5\%). No significant differences were observed between the groups at 2 weeks in the primary outcome (standardized mean difference --0.04; 95\% CI --0.11 to 0.04; P=.15) or in the other outcomes. In our prespecified subgroup analyses, we observed significant improvements among health care workers consuming psychotropic medications (n=79) in the primary outcome (--0.29; 95\% CI --0.48 to --0.09; P=.004), and in posttraumatic stress, insomnia, anxiety, and stress. Similarly, among health care workers receiving psychotherapy (n=43), we observed improvements in the primary outcome (--0.25; 95\% CI --0.49 to --0.02; P=.02), and in insomnia, anxiety, and stress. The mean usability score of PsyCovidApp was high (87.21/100, SD 12.65). After the trial, 208/221 participants in the intervention group (94.1\%) asked to regain access to PsyCovidApp, indicating high acceptability. Conclusions: In health care workers assisting patients with COVID-19 in Spain, PsyCovidApp, compared with a control app, reduced mental health problems at 2 weeks only among health care workers receiving psychotherapy or psychotropic medications. Trial Registration: ClinicalTrials.gov NCT04393818; https://clinicaltrials.gov/ct2/show/NCT04393818. ",
doi="10.2196/27039",
url="https://mhealth.jmir.org/2021/5/e27039",
url="http://www.ncbi.nlm.nih.gov/pubmed/33909587"
}


@Article{info:doi/10.2196/27963,
author="Pereira, Filipa
and Querido, Isabel Ana
and Bieri, Marion
and Verloo, Henk
and Laranjeira, Ant{\'o}nio Carlos",
title="Presenteeism Among Nurses in Switzerland and Portugal and Its Impact on Patient Safety and Quality of Care: Protocol for a Qualitative Study",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="13",
volume="10",
number="5",
pages="e27963",
keywords="healthcare",
keywords="nurses",
keywords="predictors",
keywords="presenteeism",
keywords="quality of care",
keywords="frontline",
keywords="managers",
keywords="Portugal",
keywords="Switzerland",
keywords="patient safety",
keywords="patients",
keywords="safety",
keywords="stress",
keywords="emotion",
keywords="knowledge transfer",
keywords="acute care",
keywords="long-term care",
abstract="Background: Nurses dispense direct care in a wide variety of settings and are considered the backbone of the health care system. They often work long hours, face emotional stress, and are at a high risk of psychosocial and somatic illnesses. Nurses sometimes fall sick but work regardless, leading to presenteeism and subsequent risks to quality of care and patient safety due to the increased likelihood of patients falling, medication errors, and staff-to-patient disease transmission. Objective: This study aims to understand presenteeism among frontline nurses and nurse managers in acute, primary, and long-term health care settings and to contribute to the development of future interventional studies and recommendations. Methods: A qualitative study based on online focus group discussions will explore the perceptions of, attitudes to, and experiences with presenteeism among frontline nurses and nurse managers. Using a pilot-tested interview guide, 8 focus group discussions will involve nurses working in acute care hospitals, primary care settings, and long-term residential care facilities in Switzerland's French-speaking region and Portugal's Center region. The data collected will be examined using a content analysis approach via NVivo 12 QSR International software. Results: The University of Applied Sciences and Arts Western Switzerland's School of Health Sciences and the Polytechnic of Leiria's School of Health Sciences in Portugal have both approved funding for the study. The research protocol has been approved by ethics committees in both countries. Study recruitment commenced in February 2021. The results of the data analysis are expected by September 2021. Conclusions: This present study aims to gain more insight into the dilemmas facing nurses as a result of all causes of presenteeism among frontline nurses and nurse managers in different health care settings. The researchers will prepare manuscripts on the study's findings, publish them in relevant peer-reviewed journals, exhibit them in poster presentations, and give oral presentations at appropriate academic and nonscientific conferences. Regarding further knowledge transfer, researchers will engage with stakeholders to craft messages focused on the needs of nurses and nurse managers and on disseminating our research findings to deal with the issue of nursing presenteeism. International Registered Report Identifier (IRRID): PRR1-10.2196/27963 ",
doi="10.2196/27963",
url="https://www.researchprotocols.org/2021/5/e27963",
url="http://www.ncbi.nlm.nih.gov/pubmed/33983134"
}


@Article{info:doi/10.2196/26590,
author="Golden, A. Eddye
and Zweig, Micol
and Danieletto, Matteo
and Landell, Kyle
and Nadkarni, Girish
and Bottinger, Erwin
and Katz, Lindsay
and Somarriba, Ricardo
and Sharma, Vansh
and Katz, L. Craig
and Marin, B. Deborah
and DePierro, Jonathan
and Charney, S. Dennis",
title="A Resilience-Building App to Support the Mental Health of Health Care Workers in the COVID-19 Era: Design Process, Distribution, and Evaluation",
journal="JMIR Form Res",
year="2021",
month="May",
day="5",
volume="5",
number="5",
pages="e26590",
keywords="mHealth",
keywords="resilience",
keywords="mental health",
keywords="COVID-19",
keywords="HCWs",
keywords="digital health",
keywords="health app",
keywords="mental health platform",
keywords="mobile phone",
abstract="Background: The COVID-19 pandemic has resulted in increased strain on health care systems and negative psychological effects on health care workers (HCWs). This is anticipated to result in long-term negative mental health effects on the population, with HCWs representing a particularly vulnerable group. The scope of the COVID-19 pandemic necessitates the development of a scalable mental health platform to provide services to large numbers of at-risk or affected individuals. The Mount Sinai Health System in New York City was at the epicenter of the pandemic in the United States. Objective: The Center for Stress, Resilience, and Personal Growth (CSRPG) was created to address the current and anticipated psychological impact of the pandemic on the HCWs in the health system. The mission of the Center is to support the resilience and mental health of employees through educational offerings, outreach, and clinical care. Our aim was to build a mobile app to support the newly founded Center in its mission. Methods: We built the app as a standalone digital platform that hosts a suite of tools that users can interact with on a daily basis. With consideration for the Center's aims, we determined the overall vision, initiatives, and goals for the Wellness Hub app, followed by specific milestone tasks and deliverables for development. We defined the app's primary features based on the mental health assessment and needs of HCWs. Feature definition was informed by the results of a resilience survey widely distributed to Mount Sinai HCWs and by the resources offered at CSRPG, including workshop content. Results: We launched our app over the course of two phases, the first phase being a ``soft'' launch and the second being a broader launch to all of Mount Sinai. Of the 231 HCWs who downloaded the app, 173 (74.9\%) completed our baseline assessment of all mental health screeners in the app. Results from the baseline assessment show that more than half of the users demonstrate a need for support in at least one psychological area. As of 3 months after the Phase 2 launch, approximately 55\% of users re-entered the app after their first opening to explore additional features, with an average of 4 app openings per person. Conclusions: To address the mental health needs of HCWs during the COVID-19 pandemic, the Wellness Hub app was built and deployed throughout the Mount Sinai Health System. To our knowledge, this is the first resilience app of its kind. The Wellness Hub app is a promising proof of concept, with room to grow, for those who wish to build a secure mobile health app to support their employees, communities, or others in managing and improving mental and physical well-being. It is a novel tool offering mental health support broadly. ",
doi="10.2196/26590",
url="https://formative.jmir.org/2021/5/e26590",
url="http://www.ncbi.nlm.nih.gov/pubmed/33872189"
}


@Article{info:doi/10.2196/24014,
author="Akbar, Fatema
and Mark, Gloria
and Prausnitz, Stephanie
and Warton, Margaret E.
and East, A. Jeffrey
and Moeller, F. Mark
and Reed, E. Mary
and Lieu, A. Tracy",
title="Physician Stress During Electronic Health Record Inbox Work: In Situ Measurement With Wearable Sensors",
journal="JMIR Med Inform",
year="2021",
month="Apr",
day="28",
volume="9",
number="4",
pages="e24014",
keywords="electronic health records",
keywords="stress",
keywords="wearables",
keywords="HRV",
keywords="inbox",
keywords="EHR alerts",
keywords="after-hours work",
keywords="electronic mail",
keywords="physician well-being",
keywords="Inbasket",
abstract="Background: Increased work through electronic health record (EHR) messaging is frequently cited as a factor of physician burnout. However, studies to date have relied on anecdotal or self-reported measures, which limit the ability to match EHR use patterns with continuous stress patterns throughout the day. Objective: The aim of this study is to collect EHR use and physiologic stress data through unobtrusive means that provide objective and continuous measures, cluster distinct patterns of EHR inbox work, identify physicians' daily physiologic stress patterns, and evaluate the association between EHR inbox work patterns and physician physiologic stress. Methods: Physicians were recruited from 5 medical centers. Participants (N=47) were given wrist-worn devices (Garmin Vivosmart 3) with heart rate sensors to wear for 7 days. The devices measured physiological stress throughout the day based on heart rate variability (HRV). Perceived stress was also measured with self-reports through experience sampling and a one-time survey. From the EHR system logs, the time attributed to different activities was quantified. By using a clustering algorithm, distinct inbox work patterns were identified and their associated stress measures were compared. The effects of EHR use on physician stress were examined using a generalized linear mixed effects model. Results: Physicians spent an average of 1.08 hours doing EHR inbox work out of an average total EHR time of 3.5 hours. Patient messages accounted for most of the inbox work time (mean 37\%, SD 11\%). A total of 3 patterns of inbox work emerged: inbox work mostly outside work hours, inbox work mostly during work hours, and inbox work extending after hours that were mostly contiguous to work hours. Across these 3 groups, physiologic stress patterns showed 3 periods in which stress increased: in the first hour of work, early in the afternoon, and in the evening. Physicians in group 1 had the longest average stress duration during work hours (80 out of 243 min of valid HRV data; P=.02), as measured by physiological sensors. Inbox work duration, the rate of EHR window switching (moving from one screen to another), the proportion of inbox work done outside of work hours, inbox work batching, and the day of the week were each independently associated with daily stress duration (marginal R2=15\%). Individual-level random effects were significant and explained most of the variation in stress (conditional R2=98\%). Conclusions: This study is among the first to demonstrate associations between electronic inbox work and physiological stress. We identified 3 potentially modifiable factors associated with stress: EHR window switching, inbox work duration, and inbox work outside work hours. Organizations seeking to reduce physician stress may consider system-based changes to reduce EHR window switching or inbox work duration or the incorporation of inbox management time into work hours. ",
doi="10.2196/24014",
url="https://medinform.jmir.org/2021/4/e24014",
url="http://www.ncbi.nlm.nih.gov/pubmed/33908888"
}


@Article{info:doi/10.2196/23311,
author="Wang, Zhicheng
and Lin, Leesa
and Guo, Yan
and Xiong, Huayi
and Tang, Kun",
title="The Uncounted Casualties of a Hidden COVID-19 Epidemic in China: Cross-sectional Study on Deaths Related to Overwork",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="20",
volume="23",
number="4",
pages="e23311",
keywords="nonpharmaceutical interventions",
keywords="on-duty deaths",
keywords="COVID-19",
keywords="overwork death",
keywords="crowdsourced data",
keywords="intervention",
keywords="mortality",
keywords="casualty",
keywords="cross-sectional",
keywords="overwork",
keywords="stress",
abstract="Background: During the COVID-19 response, nonclinical essential workers usually worked overtime and experienced significant work stress, which subsequently increased their risk of mortality due to cardiovascular diseases, stroke, and pre-existing conditions. Deaths on duty, including deaths due to overwork, during the COVID-19 response were usually reported on web-based platforms for public recognition and solidarity. Although no official statistics are available for these casualties, a list of on-duty deaths has been made publicly available on the web by crowdsourcing. Objective: This study aims to understand the trends and characteristics of deaths related to overwork among the frontline nonclinical essential workers participating in nonpharmaceutical interventions during the first wave of COVID-19 in China. Methods: Based on a web-based crowdsourced list of deaths on duty during the first wave of the COVID-19 response in China, we manually verified all overwork-related death records against the full-text web reports from credible sources. After excluding deaths caused by COVID-19 infection and accidents, a total of 340 deaths related to overwork among nonclinical essential workers were attributed to combatting the COVID-19 crisis. We coded the key characteristics of the deceased workers, including sex, age at death, location, causes of death, date of incidence, date of death, containment duties, working area, and occupation. The temporal and spatial correlations between deaths from overwork and COVID-19 cases in China were also examined using Pearson correlation coefficient. Results: From January 20 to April 26, 2020, at least 340 nonclinical frontline workers in China were reported to have died as a result of overwork while combatting COVID-19. The weekly overwork mortality was positively correlated with weekly COVID-19 cases (r=0.79, P<.001). Two-thirds of deceased workers (230/340, 67.6\%) were under 55 years old, and two major causes of deaths related to overwork were cardiovascular diseases (138/340, 40.6\%) and cerebrovascular diseases (73/340, 21.5\%). Outside of Hubei province, there were almost 2.5 times as many deaths caused by COVID-19--related overwork (308/340, 90.6\%) than by COVID-19 itself (n=120). Conclusions: The high number of deaths related to overwork among nonclinical essential workers at the frontline of the COVID-19 epidemic is alarming. Policies for occupational health protection against work hazards should therefore be prioritized and enforced. ",
doi="10.2196/23311",
url="https://www.jmir.org/2021/4/e23311",
url="http://www.ncbi.nlm.nih.gov/pubmed/33822735"
}


@Article{info:doi/10.2196/24617,
author="Calderaro, Cerqueira D{\'e}bora
and Kahlow, Stadler Barbara
and Munhoz, Ara{\'u}jo Gabriela
and Dias, Basualto Samuel Elias
and Lopes, Ziroldo Jo{\~a}o Vitor
and Borges, Rizzo Aline
and Mariz, Ata{\'i}de Henrique De
and Gomes, Poti Kirla Wagner
and Valadares, Azevedo Lilian David De
and Ara{\'u}jo, Costa Nafice
and Ribeiro, Euz{\'e}bio Sandra Lucia
and Kakehasi, Maria Adriana
and Reis, Gomides Ana Paula Monteiro
and Marques, Cl{\'a}udia
and Reis-Neto, Torres Edgard
and Paiva, Santos Eduardo Dos
and Pileggi, Salviato Gecilmara
and Ferreira, Aparecida Gilda
and Provenza, Roberto Jos{\'e}
and Mota, Henrique Licia Maria
and Xavier, Machado Ricardo
and Teodoro, Martins Maycoln Le{\^o}ni
and Pinheiro, Medeiros Marcelo De
and ",
title="Effects of Participating in a Research Project During the COVID-19 Pandemic on Medical Students' Educational Routines and Mental Health: Protocol for a Web-Based Survey Study",
journal="JMIR Res Protoc",
year="2021",
month="Apr",
day="9",
volume="10",
number="4",
pages="e24617",
keywords="SARS-CoV-2",
keywords="COVID-19",
keywords="medical education",
keywords="observational",
keywords="cross-sectional",
keywords="case-control study",
keywords="voluntary",
keywords="mental health",
keywords="rheumatic disease",
keywords="medical student",
keywords="protocol",
keywords="survey",
abstract="Background: The COVID-19 pandemic has resulted in social isolation, which has a potential negative impact on the educational routines (eg, the suspension of face-to-face appointments) and mental health of medical students. The Mario Pinotti II (MPII) study is a 24-week observational study that conducted scheduled telephone calls every 2 weeks to verify the occurrence of COVID-19 in patients with rheumatic diseases on chronic hydroxychloroquine therapy (from March 29, 2020, to September 30, 2020). The effects of voluntarily participating in a research project (ie, one that involves interactions via telephone contact with patients, professors, rheumatologists, and colleagues) on the daily lives and mental health of medical students requires evaluation. Objective: As medical students are professionals in training and have a high level of responsibility in terms of handling the emotional and physical aspects of several diseases, this study aims to evaluate the impacts of the COVID-19 pandemic and participation in the MPII study on the educational routines and mental health of medical students. Methods: A web-based survey was carried out to perform a cross-sectional comparative assessment of medical students who participated in the MPII study and their colleagues who were not involved in the MPII study. Participants from both groups were matched based on sex, age, and medical school. The web questionnaire was developed by a panel composed of graduate medical students, rheumatologists, medical school professors, and a psychology professor. The questionnaire included details on demographic and life habits data and evaluated participants' impressions of the MPII study and the impact of the COVID-19 pandemic on their educational routines and medical training. In addition, depression, anxiety, and stress were evaluated using the Brazilian version of the Depression, Anxiety, and Stress Scale (DASS)-21, and currently, the DASS-21 scores are grouped as those that indicate a low, moderate, or high risk of mental distress. This project was approved by the Federal University of S{\~a}o Paulo Ethics Committee (CAAE: 34034620.0.0000.5505). Results: Data were collected from both medical student groups from July 20 to August 31, 2020. Data extraction was completed in September 2020. The data analysis is ongoing. We expect the results to be published in the first semester of 2021. Conclusions: This study will provide insight into the effects of participating in a research project on depression, anxiety, and stress, which will be determined by applying the DASS-21 to a large sample of Brazilian undergraduate medical students. We will also evaluate the impact of the COVID-19 pandemic on medical students' educational routines and medical training. International Registered Report Identifier (IRRID): DERR1-10.2196/24617 ",
doi="10.2196/24617",
url="https://www.researchprotocols.org/2021/4/e24617",
url="http://www.ncbi.nlm.nih.gov/pubmed/33735094"
}


@Article{info:doi/10.2196/21917,
author="Javanmard, Mitra
and Steen, Mary
and Vernon, Rachael",
title="Influence of Self-Compassion on the Health of Midwives and Nurses: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2021",
month="Mar",
day="31",
volume="10",
number="3",
pages="e21917",
keywords="self-compassion",
keywords="self-worth",
keywords="self-appreciation",
keywords="self-kindness",
keywords="midwives",
keywords="nurses",
abstract="Background: Self-compassion is recognized to have a positive effect upon a person's health. However, the influence of self-compassion on the health of midwives and nurses is less well understood. Midwives and nurses often work in highly demanding environments and situations, and are exposed to multiple work-based stressors simultaneously. Stressors such as a demanding clinical workload, high acuity, missing breaks, working more than their contracted hours, insufficient resources and staff, and poor patient outcomes can lead to midwives and nurses feeling physically exhausted and at increased risk of poor mental health. Self-compassion may act as a protective factor, assisting midwives and nurses to remain healthy. Objective: This scoping review will provide an overview of the evidence base relating to the influence of self-compassion on the health of midwives and nurses. Methods: The purpose of a scoping review is to comprehensively and systematically review the literature and identify key evidence or gaps. The search strategy for this protocol includes electronic databases such as Medline, Embase, Emcare, PsycInfo, Joanna Briggs Institute, Cochrane Library, and Scopus. Grey literature sources will be also searched, including ProQuest Central, internet search engines (Google Scholar), and manually searched key journals and reference lists of relevant articles. This scoping review will be undertaken in seven stages, guided by established scoping review methods and reporting guidelines: (1) identifying the research questions; (2) identifying relevant studies; (3) selecting the studies; (4) charting the data; (5) collating, summarizing, and reporting the results; (6) consulting; and (7) dissemination of knowledge. Data will be abstracted and presented using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist and explanation by three independent researchers. Results: A preliminary search conducted in Medline (OVID) retrieved 194 results. Completion of the review is expected in December 2020 and will be published in early 2021. Conclusions: To our knowledge, this will be the first scoping review of evidence-based literature relating to the influence of self-compassion on the health of midwives and nurses. It is anticipated that this analysis of the literature will contribute to understanding how midwives and nurses may use self-compassion in a proactive way to reduce work-based stressors such as burnout, stress, and compassion fatigue. Furthermore, the findings may inform educational needs with implications for clinical practice. International Registered Report Identifier (IRRID): PRR1-10.2196/21917 ",
doi="10.2196/21917",
url="https://www.researchprotocols.org/2021/3/e21917",
url="http://www.ncbi.nlm.nih.gov/pubmed/33787500"
}


@Article{info:doi/10.2196/25148,
author="Otokiti, Umar Ahmed
and Craven, K. Catherine
and Shetreat-Klein, Avniel
and Cohen, Stacey
and Darrow, Bruce",
title="Beyond Getting Rid of Stupid Stuff in the Electronic Health Record (Beyond-GROSS): Protocol for a User-Centered, Mixed-Method Intervention to Improve the Electronic Health Record System",
journal="JMIR Res Protoc",
year="2021",
month="Mar",
day="16",
volume="10",
number="3",
pages="e25148",
keywords="electronic health records",
keywords="burnout, psychological",
keywords="user-centered design",
keywords="usability",
keywords="EHR optimization",
abstract="Background: Up to 60\% of health care providers experience one or more symptoms of burnout. Perceived clinician burden resulting in burnout arises from factors such as electronic health record (EHR) usability or lack thereof, perceived loss of autonomy, and documentation burden leading to less clinical time with patients. Burnout can have detrimental effects on health care quality and contributes to increased medical errors, decreased patient satisfaction, substance use, workforce attrition, and suicide. Objective: This project aims to improve the user-centered design of the EHR by obtaining direct input from clinicians about deficiencies. Fixing identified deficiencies via user-centered design has the potential to improve usability, thereby increasing satisfaction by reducing EHR-induced burnout. Methods: Quantitative and qualitative data will be obtained from clinician EHR users. The input will be received through a form built in a REDCap database via a link embedded in the home page of the EHR. The REDCap data will be analyzed in 2 main dimensions, based on nature of the input, what section of the EHR is affected, and what is required to fix the issue(s). Identified issues will be escalated to relevant stakeholders responsible for rectifying the problems identified. Data analysis, project evaluation, and lessons learned from the evaluation will be incorporated in a Plan-Do-Study-Act (PDSA) manner every 4-6 weeks. Results: The pilot phase of the study began in October 2020 in the Gastroenterology Division at Mount Sinai Hospital, New York City, NY, which includes 39 physicians and 15 nurses. The pilot is expected to run over a 4-6--month period. The results of the REDCap data analysis will be reported within 1 month of completing the pilot phase. We will analyze the nature of requests received and the impact of rectified issues on the clinician EHR user. We expect that the results will reveal which sections of the EHR have the highest deficiencies while also highlighting issues about workflow difficulties. Perceived impact of the project on provider engagement, patient safety, and workflow efficiency will also be captured by evaluation survey and other qualitative methods where possible. Conclusions: The project aims to improve user-centered design of the EHR by soliciting direct input from clinician EHR users. The ultimate goal is to improve efficiency, reduce EHR inefficiencies with the possibility of improving staff engagement, and lessen EHR-induced clinician burnout. Our project implementation includes using informatics expertise to achieve the desired state of a learning health system as recommended by the National Academy of Medicine as we facilitate feedback loops and rapid cycles of improvement. International Registered Report Identifier (IRRID): PRR1-10.2196/25148 ",
doi="10.2196/25148",
url="https://www.researchprotocols.org/2021/3/e25148",
url="http://www.ncbi.nlm.nih.gov/pubmed/33724202"
}


@Article{info:doi/10.2196/27107,
author="Mira, Joaquin Jose
and Cobos, Angel
and Mart{\'i}nez Garc{\'i}a, Olga
and Bueno Dom{\'i}nguez, Jos{\'e} Mar{\'i}a
and Astier-Pe{\~n}a, Pilar Mar{\'i}a
and P{\'e}rez P{\'e}rez, Pastora
and Carrillo, Irene
and Guilabert, Mercedes
and Perez-Jover, Virtudes
and Fernandez, Cesar
and Vicente, Asuncion Mar{\'i}a
and Lahera-Martin, Matilde
and Silvestre Busto, Carmen
and Lorenzo Mart{\'i}nez, Susana
and Sanchez Martinez, Ascension
and Martin-Delgado, Jimmy
and Mula, Aurora
and Marco-Gomez, Barbara
and Abad Bouzan, Cristina
and Aibar-Remon, Carlos
and Aranaz-Andres, Jesus
and ",
title="An Acute Stress Scale for Health Care Professionals Caring for Patients With COVID-19: Validation Study",
journal="JMIR Form Res",
year="2021",
month="Mar",
day="9",
volume="5",
number="3",
pages="e27107",
keywords="SARS-CoV-2 virus",
keywords="COVID-19 outbreak",
keywords="medical staff",
keywords="acute stress",
keywords="moral injury",
keywords="posttraumatic stress",
keywords="COVID-19",
abstract="Background: The COVID-19 pandemic has affected the response capacity of the health care workforce, and health care professionals have been experiencing acute stress reactions since the beginning of the pandemic. In Spain, the first wave was particularly severe among the population and health care professionals, many of whom were infected. These professionals required initial psychological supports that were gradual and in line with their conditions. Objective: In the early days of the pandemic in Spain (March 2020), this study aimed to design and validate a scale to measure acute stress experienced by the health care workforce during the care of patients with COVID-19: the Self-applied Acute Stress Scale (EASE). Methods: Item development, scale development, and scale evaluation were considered. Qualitative research was conducted to produce the initial pool of items, assure their legibility, and assess the validity of the content. Internal consistency was calculated using Cronbach $\alpha$ and McDonald $\omega$. Confirmatory factor analysis and the Mann-Whitney-Wilcoxon test were used to assess construct validity. Linear regression was applied to assess criterion validity. Back-translation methodology was used to translate the scale into Portuguese and English. Results: A total of 228 health professionals from the Spanish public health system responded to the 10 items of the EASE scale. Internal consistency was .87 (McDonald $\omega$). Goodness-of-fit indices confirmed a two-factor structure, explaining 55\% of the variance. As expected, the highest level of stress was found among professionals working in health services where a higher number of deaths from COVID-19 occurred (P<.05). Conclusions: The EASE scale was shown to have adequate metric properties regarding consistency and construct validity. The EASE scale could be used to determine the levels of acute stress among the health care workforce in order to give them proportional support according to their needs during emergency conditions, such as the COVID-19 pandemic. ",
doi="10.2196/27107",
url="https://formative.jmir.org/2021/3/e27107",
url="http://www.ncbi.nlm.nih.gov/pubmed/33687343"
}


@Article{info:doi/10.2196/26168,
author="Lewis, Matthew
and Palmer, J. Victoria
and Kotevski, Aneta
and Densley, Konstancja
and O'Donnell, L. Meaghan
and Johnson, Caroline
and Wohlgezogen, Franz
and Gray, Kathleen
and Robins-Browne, Kate
and Burchill, Luke",
title="Rapid Design and Delivery of an Experience-Based Co-designed Mobile App to Support the Mental Health Needs of Health Care Workers Affected by the COVID-19 Pandemic: Impact Evaluation Protocol",
journal="JMIR Res Protoc",
year="2021",
month="Mar",
day="9",
volume="10",
number="3",
pages="e26168",
keywords="mental health",
keywords="mobile applications",
keywords="COVID-19",
keywords="health personnel",
keywords="experience-based co-design",
keywords="impact",
keywords="evaluation",
keywords="digital interventions",
keywords="app",
keywords="intervention",
keywords="health care worker",
keywords="design",
keywords="delivery",
keywords="support",
abstract="Background: The COVID-19 pandemic has highlighted the importance of health care workers' mental health and well-being for the successful function of the health care system. Few targeted digital tools exist to support the mental health of hospital-based health care workers, and none of them appear to have been led and co-designed by health care workers. Objective: RMHive is being led and developed by health care workers using experience-based co-design (EBCD) processes as a mobile app to support the mental health challenges posed by the COVID-19 pandemic to health care workers. We present a protocol for the impact evaluation for the rapid design and delivery of the RMHive mobile app. Methods: The impact evaluation will adopt a mixed methods design. Qualitative data from photo interviews undertaken with up to 30 health care workers and semistructured interviews conducted with up to 30 governance stakeholders will be integrated with qualitative and quantitative user analytics data and user-generated demographic and mental health data entered into the app. Analyses will address three evaluation questions related to engagement with the mobile app, implementation and integration of the app, and the impact of the app on individual mental health outcomes. The design and development will be described using the Mobile Health Evidence Reporting and Assessment guidelines. Implementation of the app will be evaluated using normalization process theory to analyze qualitative data from interviews combined with text and video analysis from the semistructured interviews. Mental health impacts will be assessed using the total score of the 4-item Patient Health Questionnaire (PHQ4) and subscale scores for the 2-item Patient Health Questionnaire for depression and the 2-item Generalized Anxiety Scale for anxiety. The PHQ4 will be completed at baseline and at 14 and 28 days. Results: The anticipated average use period of the app is 30 days. The rapid design will occur over four months using EBCD to collect qualitative data and develop app content. The impact evaluation will monitor outcome data for up to 12 weeks following hospital-wide release of the minimal viable product release. The study received funding and ethics approvals in June 2020. Outcome data is expected to be available in March 2021, and the impact evaluation is expected to be published mid-2021. Conclusions: The impact evaluation will examine the rapid design, development, and implementation of the RMHive app and its impact on mental health outcomes for health care workers. Findings from the impact evaluation will provide guidance for the integration of EBCD in rapid design and implementation processes. The evaluation will also inform future development and rollout of the app to support the mental health needs of hospital-based health care workers more widely. International Registered Report Identifier (IRRID): DERR1-10.2196/26168 ",
doi="10.2196/26168",
url="https://www.researchprotocols.org/2021/3/e26168",
url="http://www.ncbi.nlm.nih.gov/pubmed/33635823"
}


@Article{info:doi/10.2196/20445,
author="Sasaki, Natsu
and Imamura, Kotaro
and Tran, Thu Thuy Thi
and Nguyen, Thanh Huong
and Kuribayashi, Kazuto
and Sakuraya, Asuka
and Bui, Minh Thu
and Nguyen, Thuy Quynh
and Nguyen, Thi Nga
and Nguyen, Huong Giang Thi
and Zhang, Weibin Melvyn
and Minas, Harry
and Sekiya, Yuki
and Watanabe, Kazuhiro
and Tsutsumi, Akizumi
and Shimazu, Akihito
and Kawakami, Norito",
title="Effects of Smartphone-Based Stress Management on Improving Work Engagement Among Nurses in Vietnam: Secondary Analysis of a Three-Arm Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Feb",
day="23",
volume="23",
number="2",
pages="e20445",
keywords="stress management",
keywords="mental health",
keywords="occupational health",
keywords="digital health",
keywords="workplace",
keywords="LMICs",
keywords="South-East Asia",
keywords="health care professionals",
abstract="Background: Work engagement is important for employee well-being and work performance. However, no intervention study has investigated the effect of an eMental Health intervention on work engagement among workers in low- and middle-income countries (LMICs). Objective: The aim of the study was to examine the effects of a newly developed smartphone-based stress management program (ABC Stress Management) on improving work engagement among hospital nurses in Vietnam, an LMIC. Methods: Full-time registered nurses (n=949) were randomly assigned to one of 2 intervention groups or a control group. The intervention groups were a 6-week, 6-lesson program offering basic cognitive behavioral therapy (CBT-based stress management skills), provided in either free-choice (program A) or fixed order (program B). Work engagement was assessed at baseline and 3-month and 7-month follow-ups in each of the 3 groups. Results: The scores of work engagement in both intervention groups improved from baseline to 3-month follow-up, and then decreased at the 7-month follow-up, while the score steadily increased from baseline to 7-month follow-up in the control group. Program B showed a significant intervention effect on improving work engagement at the 3-month follow-up (P=.049) with a small effect size (Cohen d= 0.16; 95\% CI 0.001 to 0.43]). Program A showed nonsignificant trend (d=0.13; 95\% CI --0.014 to 0.41; P=.07) toward improved engagement at 3 months. Neither program achieved effectiveness at the 7-month follow-up. Conclusions: The study demonstrated that a fixed order (program B) delivery of a smartphone-based stress management program was effective in improving work engagement in nurses in Vietnam. However, the effect was small and only temporary. Further improvement of this program is required to achieve a greater effect size and more sustained, longer lasting impact on work engagement. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000033139; tinyurl.com/55gxo253 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-025138 ",
doi="10.2196/20445",
url="https://www.jmir.org/2021/2/e20445",
url="http://www.ncbi.nlm.nih.gov/pubmed/33620328"
}


@Article{info:doi/10.2196/22939,
author="Tao, Shiqiang
and Lhatoo, Samden
and Hampson, Johnson
and Cui, Licong
and Zhang, Guo-Qiang",
title="A Bespoke Electronic Health Record for Epilepsy Care (EpiToMe): Development and Qualitative Evaluation",
journal="J Med Internet Res",
year="2021",
month="Feb",
day="12",
volume="23",
number="2",
pages="e22939",
keywords="specialty-specific EHR",
keywords="physician-centered design",
keywords="clinical workflow",
keywords="patient care management",
keywords="clinical care documentation",
keywords="physician burnout",
keywords="interoperability",
abstract="Background: While electronic health records (EHR) bring various benefits to health care, EHR systems are often criticized as cumbersome to use, failing to fulfill the promise of improved health care delivery with little more than a means of meeting regulatory and billing requirements. EHR has also been recognized as one of the contributing factors for physician burnout. Objective: Specialty-specific EHR systems have been suggested as an alternative approach that can potentially address challenges associated with general-purpose EHRs. We introduce the Epilepsy Tracking and optimized Management engine (EpiToMe), an exemplar bespoke EHR system for epilepsy care. EpiToMe uses an agile, physician-centered development strategy to optimize clinical workflow and patient care documentation. We present the design and implementation of EpiToMe and report the initial feedback on its utility for physician burnout. Methods: Using collaborative, asynchronous data capturing interfaces anchored to a domain ontology, EpiToMe distributes reporting and documentation workload among technicians, clinical fellows, and attending physicians. Results of documentation are transmitted to the parent EHR to meet patient care requirements with a push of a button. An HL7 (version 2.3) messaging engine exchanges information between EpiToMe and the parent EHR to optimize clinical workflow tasks without redundant data entry. EpiToMe also provides live, interactive patient tracking interfaces to ease the burden of care management. Results: Since February 2019, 15,417 electroencephalogram reports, 2635 Epilepsy Monitoring Unit daily reports, and 1369 Epilepsy Monitoring Unit phase reports have been completed in EpiToMe for 6593 unique patients. A 10-question survey was completed by 11 (among 16 invited) senior clinical attending physicians. Consensus was found that EpiToMe eased the burden of care documentation for patient management, a contributing factor to physician burnout. Conclusions: EpiToMe offers an exemplar bespoke EHR system developed using a physician-centered design and latest advancements in information technology. The bespoke approach has the potential to ease the burden of care management in epilepsy. This approach is applicable to other clinical specialties. ",
doi="10.2196/22939",
url="http://www.jmir.org/2021/2/e22939/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33576745"
}


@Article{info:doi/10.2196/23125,
author="Ni, Jie
and Wang, Fang
and Liu, Yihai
and Wu, Mingyue
and Jiang, Yan
and Zhou, Yujie
and Sha, Dujuan",
title="Psychological Impact of the COVID-19 Pandemic on Chinese Health Care Workers: Cross-Sectional Survey Study",
journal="JMIR Ment Health",
year="2021",
month="Jan",
day="20",
volume="8",
number="1",
pages="e23125",
keywords="2019-nCoV",
keywords="COVID-19",
keywords="frontline clinician",
keywords="medical students",
keywords="psychology",
abstract="Background: The outbreak of COVID-19 has dominated headlines worldwide. The number of infections has continued to rise and had reached 30,000 worldwide at the time this paper was written. Because of the high risk of nosocomial transmission, medical health care workers may be experiencing substantial psychological stress. This descriptive study aimed to identify psychosocial effects on hospital staff associated with working in a hospital environment during the COVID-19 outbreak. Objective: Our survey participants included 57 frontline clinicians working at Wuhan First Hospital and 157 medical students working at Jiangsu Provincial People's Hospital during the COVID-19 outbreak. The questionnaire we adopted included questions regarding the participants' personal well-being, sociodemographic characteristics, and psychological status. Methods: 57 frontline clinicians working in Wuhan First Hospital and 157 medical training students working in Jiangsu Provincial Peoples Hospital during this outbreak participated in our survey. The questionnaire we adopted included questions regarding the participants' personal well-being, sociodemographic characteristics and the psychological status. Results: The COVID-19 outbreak had psychological impacts both on formal workers and medical students. The psychological effects included sleep disorders, anxiety, and depression. There was no significant difference between the group of formal workers and medical students (P=.85), and more than 50\% (30/54, 56\%, vs. 83/157, 52.9\%) of the respondents reported pandemic-related mental disorders. Conclusions: Our study indicates that the high risk of SARS-CoV-2 exposure caused substantial psychological stress among health care workers. This finding emphasizes the need to promote psychological crisis intervention for medical personnel during this epidemic. ",
doi="10.2196/23125",
url="http://mental.jmir.org/2021/1/e23125/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33341754"
}


@Article{info:doi/10.2196/17598,
author="Liu, Lisa
and Woo, P. Benjamin K.",
title="Twitter as a Mental Health Support System for Students and Professionals in the Medical Field",
journal="JMIR Med Educ",
year="2021",
month="Jan",
day="19",
volume="7",
number="1",
pages="e17598",
keywords="Twitter",
keywords="social media",
keywords="mental health",
keywords="health professionals",
keywords="community",
keywords="social support",
keywords="depression",
keywords="physician suicide",
doi="10.2196/17598",
url="http://mededu.jmir.org/2021/1/e17598/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33464210"
}


@Article{info:doi/10.2196/24298,
author="Pinho, Lucena Rebeca Da N{\'o}brega
and Costa, Ferreira Thais
and Silva, Miranda Nayane
and Barros-Areal, F. Adriana
and Salles, Mattos Andr{\'e} De
and Oliveira, Pedrosa Andrea
and Rassi, Carlos
and Valero, Brero Caroline Elizabeth
and Gomes, Martins Ciro
and Mendon{\c{c}}a-Silva, Dayde
and Oliveira, Fernando
and Jochims, Isadora
and Ranulfo, Ivan
and Neves, Seixas Juliana De Brito
and Oliveira, Lucas
and Dantas, Nogueira Maria
and Rosal, Marta
and Soares, Mayra
and Kurizky, Patr{\'i}cia
and Peterle, Uliana Viviane
and Faro, Furtado Yasmin
and Gomides, Paula Ana
and da Mota, Licia
and Albuquerque, Cleandro
and Simaan, Kozak Cezar
and Amado, M. Veronica",
title="Mental Health and Burnout Syndrome Among Postgraduate Students in Medical and Multidisciplinary Residencies During the COVID-19 Pandemic in Brazil: Protocol for a Prospective Cohort Study",
journal="JMIR Res Protoc",
year="2021",
month="Jan",
day="19",
volume="10",
number="1",
pages="e24298",
keywords="burnout syndrome",
keywords="medical residency",
keywords="multidisciplinary residency",
keywords="COVID-19",
keywords="mental health",
keywords="burnout",
keywords="stress",
keywords="anxiety",
keywords="prospective",
keywords="cohort",
keywords="health care professional",
keywords="medical student",
abstract="Background: The COVID-19 pandemic has led to high levels of physical, psychological, and social stress among health care professionals, including postgraduate students in medical and multidisciplinary residencies. This stress is associated with the intense fear of occupational exposure to SARS-CoV-2, the virus known to cause COVID-19. These professionals are at risk of developing physical and mental illnesses not only due to the infection but also due to prolonged exposure to multidimensional stress and continued work overload. Objective: This study aims to evaluate the prevalence of symptoms suggestive of mental disorders and burnout syndrome and determine the risk factors for burnout among postgraduate students in medical and multidisciplinary residencies in Brazil during the COVID-19 pandemic. Methods: For this prospective cohort study with parallel groups, participants were recruited between July and September 2020 to achieve a sample size of at least 1144 participants. Research instruments such as Depression, Anxiety, and Stress Scale; Patient Health Questionnaire; Brief Resilient Coping Scale; and Oldenburg Burnout Inventory will be used to collect data. Data will be collected in 2 waves: the first wave will include data related to sample characterization and psychosocial evaluation, and the second wave will be launched 12 weeks later and will include an evaluation of the incidence of burnout as well as correlations with the potential predictive factors collected in the first wave. Additionally, we will collect data regarding participants' withdrawal from work. Results: The recruitment took place from July 29 to September 5, 2020. Data analyses for this phase is already in progress. The second phase of the study is also in progress. The final data collection began on December 1, 2020, and it will be completed by December 31, 2020. Conclusions: We believe the findings of this study will help evaluate the impact of the COVID-19 pandemic on the mental health conditions of health professionals in Brazil as well as contribute to the planning and implementation of appropriate measures that can alleviate these mental health challenges. International Registered Report Identifier (IRRID): DERR1-10.2196/24298 ",
doi="10.2196/24298",
url="https://www.researchprotocols.org/2021/1/e24298",
url="http://www.ncbi.nlm.nih.gov/pubmed/33290246"
}


@Article{info:doi/10.2196/24983,
author="Hummel, Svenja
and Oetjen, Neele
and Du, Junfeng
and Posenato, Elisabetta
and Resende de Almeida, Maria Rosa
and Losada, Raquel
and Ribeiro, Oscar
and Frisardi, Vincenza
and Hopper, Louise
and Rashid, Asarnusch
and Nasser, Habib
and K{\"o}nig, Alexandra
and Rudofsky, Gottfried
and Weidt, Steffi
and Zafar, Ali
and Gronewold, Nadine
and Mayer, Gwendolyn
and Schultz, Jobst-Hendrik",
title="Mental Health Among Medical Professionals During the COVID-19 Pandemic in Eight European Countries: Cross-sectional Survey Study",
journal="J Med Internet Res",
year="2021",
month="Jan",
day="18",
volume="23",
number="1",
pages="e24983",
keywords="mental health",
keywords="COVID-19",
keywords="Europe",
keywords="medical professionals",
keywords="stress",
keywords="depression",
keywords="anxiety",
keywords="coping",
keywords="stressors",
abstract="Background: The death toll of COVID-19 topped 170,000 in Europe by the end of May 2020. COVID-19 has caused an immense psychological burden on the population, especially among doctors and nurses who are faced with high infection risks and increased workload. Objective: The aim of this study was to compare the mental health of medical professionals with nonmedical professionals in different European countries during the COVID-19 pandemic. We hypothesized that medical professionals, particularly those exposed to COVID-19 at work, would have higher levels of depression, anxiety, and stress. We also aimed to determine their main stressors and most frequently used coping strategies during the crisis. Methods: A cross-sectional online survey was conducted during peak COVID-19 months in 8 European countries. The questionnaire included demographic data and inquired whether the participants were exposed to COVID-19 at work or not. Mental health was assessed via the Depression Anxiety Stress Scales32 (23.53)--21 (DASS-21). A 12-item checklist on preferred coping strategies and another 23-item questionnaire on major stressors were completed by medical professionals. Results: The sample (N=609) consisted of 189 doctors, 165 nurses, and 255 nonmedical professionals. Participants from France and the United Kingdom reported experiencing severe/extremely severe depression, anxiety, and stress more often compared to those from the other countries. Nonmedical professionals had significantly higher scores for depression and anxiety. Among medical professionals, no significant link was reported between direct contact with patients with COVID-19 at work and anxiety, depression, or stress. ``Uncertainty about when the epidemic will be under control'' caused the most amount of stress for health care professionals while ``taking protective measures'' was the most frequently used coping strategy among all participants. Conclusions: COVID-19 poses a major challenge to the mental health of working professionals as a considerable proportion of our participants showed high values for depression, anxiety, and stress. Even though medical professionals exhibited less mental stress than nonmedical professionals, sufficient help should be offered to all occupational groups with an emphasis on effective coping strategies. ",
doi="10.2196/24983",
url="http://www.jmir.org/2021/1/e24983/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33411670"
}


@Article{info:doi/10.2196/21445,
author="Smoktunowicz, Ewelina
and Lesnierowska, Magdalena
and Carlbring, Per
and Andersson, Gerhard
and Cieslak, Roman",
title="Resource-Based Internet Intervention (Med-Stress) to Improve Well-Being Among Medical Professionals: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Jan",
day="11",
volume="23",
number="1",
pages="e21445",
keywords="well-being",
keywords="job stress",
keywords="internet intervention",
keywords="self-efficacy",
keywords="perceived social support",
keywords="medical professionals",
abstract="Background: Medical professionals are exposed to multiple and often excessive demands in their work environment. Low-intensity internet interventions allow them to benefit from psychological support even when institutional help is not available. Focusing on enhancing psychological resources---self-efficacy and perceived social support---makes an intervention relevant for various occupations within the medical profession. Previously, these resources were found to operate both individually or sequentially with self-efficacy either preceding social support (cultivation process) or following it (enabling process). Objective: The objective of this randomized controlled trial is to compare the efficacy of 4 variants of Med-Stress, a self-guided internet intervention that aims to improve the multifaceted well-being of medical professionals. Methods: This study was conducted before the COVID-19 pandemic. Participants (N=1240) were recruited mainly via media campaigns and social media targeted ads. They were assigned to 1 of the following 4 groups: experimental condition reflecting the cultivation process, experimental condition reflecting the enabling process, active comparator enhancing only self-efficacy, and active comparator enhancing only perceived social support. Outcomes included 5 facets of well-being: job stress, job burnout, work engagement, depression, and job-related traumatic stress. Measurements were taken on the web at baseline (time 1), immediately after intervention (time 2), and at a 6-month follow-up (time 3). To analyze the data, linear mixed effects models were used on the intention-to-treat sample. The trial was partially blinded as the information about the duration of the trial, which was different for experimental and control conditions, was public. Results: At time 2, job stress was lower in the condition reflecting the cultivation process than in the one enhancing social support only (d=?0.21), and at time 3, participants in that experimental condition reported the lowest job stress when compared with all 3 remaining study groups (ds between ?0.24 and ?0.41). For job-related traumatic stress, we found a significant difference between study groups only at time 3: stress was lower in the experimental condition in which self-efficacy was enhanced first than in the active comparator enhancing solely social support (d=?0.24). The same result was found for work engagement (d=?0.20), which means that it was lower in exactly the same condition that was found beneficial for stress relief. There were no differences between study conditions for burnout and depression neither at time 2 nor at time 3. There was a high dropout in the study (1023/1240, 82.50\% at posttest), reflecting the pragmatic nature of this trial. Conclusions: The Med-Stress internet intervention improves some components of well-being---most notably job stress---when activities are completed in a specific sequence. The decrease in work engagement could support the notion of dark side of this phenomenon, but further research is needed. Trial Registration: ClinicalTrials.gov NCT03475290; https://clinicaltrials.gov/ct2/show/NCT03475290 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3401-9 ",
doi="10.2196/21445",
url="https://www.jmir.org/2021/1/e21445",
url="http://www.ncbi.nlm.nih.gov/pubmed/33427674"
}


@Article{info:doi/10.2196/24206,
author="Gupta, Bhawna
and Sharma, Vyom
and Kumar, Narinder
and Mahajan, Akanksha",
title="Anxiety and Sleep Disturbances Among Health Care Workers During the COVID-19 Pandemic in India: Cross-Sectional Online Survey",
journal="JMIR Public Health Surveill",
year="2020",
month="Dec",
day="22",
volume="6",
number="4",
pages="e24206",
keywords="occupational epidemiology",
keywords="anxiety",
keywords="GAD-7",
keywords="sleep quality",
keywords="health care worker",
keywords="pandemic",
keywords="COVID-19",
keywords="online survey",
keywords="sleep",
keywords="mental health, personal protective equipment",
abstract="Background: The COVID-19 pandemic caused by SARS-CoV-2 has become a serious concern among the global medical community and has resulted in an unprecedented psychological impact on health care workers, who were already working under stressful conditions. Objective: In this study, we aimed to evaluate and measure the effects of the COVID-19 pandemic on the anxiety levels and sleep quality among health care workers in India, as well as to determine how the unavailability of personal protective equipment affects their willingness to provide patient-related care. Methods: We conducted an online cross-sectional study using piloted, structured questionnaires with self-reported responses from 368 volunteer male and female health care workers in India. Study participants were identified through social networking platforms such as Facebook and WhatsApp. The survey evaluated the participants' degree of signs and symptoms of anxiety and sleep quality based on the 7-item Generalized Anxiety Disorder (GAD-7) scale and single-item Sleep Quality Scale, respectively. Information on the availability of personal protective equipment was collected based on responses to relevant survey questions. Results: The majority of health care workers (126/368, 34.2\%) were in the age group 45-60 years, and 52.2\% (192/368) were doctors. Severe anxiety (ie, GAD-7 score >10) was observed among 7.3\% (27/368) health care workers, whereas moderate, mild, and minimal anxiety was observed among 12.5\% (46/368), 29.3\% (108/368), and 50.8\% (187/368) health care workers, respectively. Moreover, 31.5\% (116/368) of the health care workers had poor-to-fair sleep quality (ie, scores <6). Univariate analysis showed female gender and inadequate availability of personal protective equipment was significantly associated with higher anxiety levels (P=.01 for both). Sleep disturbance was significantly associated with age <30 years (P=.04) and inadequate personal protective equipment (P<.001). Multivariable analysis showed that poorer quality of sleep was associated with higher anxiety levels (P<.001). Conclusions: The COVID-19 pandemic has potentially caused significant levels of anxiety and sleep disturbances among health care workers, particularly associated with the female gender, younger age group, and inadequate availability of personal protective equipment. These factors put health care workers at constant risk of contracting the infection themselves or transmitting it to their families. Early identification of at-risk health care workers and implementation of situation-tailored mitigation measures could help alleviate the risk of long-term, serious psychological sequelae as well as reduce current anxiety levels among health care workers. ",
doi="10.2196/24206",
url="https://publichealth.jmir.org/2020/4/e24206",
url="http://www.ncbi.nlm.nih.gov/pubmed/33284784"
}


@Article{info:doi/10.2196/23382,
author="Melnick, R. Edward
and Harry, Elizabeth
and Sinsky, A. Christine
and Dyrbye, N. Liselotte
and Wang, Hanhan
and Trockel, Todd Mickey
and West, P. Colin
and Shanafelt, Tait",
title="Perceived Electronic Health Record Usability as a Predictor of Task Load and Burnout Among US Physicians: Mediation Analysis",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="22",
volume="22",
number="12",
pages="e23382",
keywords="electronic health record",
keywords="EHR",
keywords="usability",
keywords="cognitive load",
keywords="System Usability Scale",
keywords="physician task load",
keywords="NASA Task Load Index",
keywords="physician",
keywords="burnout",
keywords="stress",
abstract="Background: Electronic health record (EHR) usability and physician task load both contribute to physician professional burnout. The association between perceived EHR usability and workload has not previously been studied at a national level. Better understanding these interactions could give further information as to the drivers of extraneous task load. Objective: This study aimed to determine the relationship between physician-perceived EHR usability and workload by specialty and evaluate for associations with professional burnout. Methods: A secondary analysis of a cross-sectional survey of US physicians from all specialties was conducted from October 2017 to March 2018. Among the 1250 physicians invited to respond to the subsurvey analyzed here, 848 (67.8\%) completed it. EHR usability was assessed with the System Usability Scale (SUS; range: 0-100). Provider task load (PTL) was assessed using the mental demand, physical demand, temporal demand, and effort required subscales of the National Aeronautics and Space Administration Task Load Index (range: 0-400). Burnout was measured using the Maslach Burnout Inventory. Results: The mean scores were 46.1 (SD 22.1) for SUS and 262.5 (SD 71.7) for PTL. On multivariable analysis adjusting for age, gender, relationship status, medical specialty, practice setting, hours worked per week, and number of nights on call per week, physician-rated EHR usability was associated with PTL, with each 1-point increase in SUS score (indicating more favorable) associated with a 0.57-point decrease in PTL score (P<.001). On mediation analysis, higher SUS score was associated with lower PTL score, which was associated with lower odds of burnout. Conclusions: A strong association was observed between EHR usability and workload among US physicians, with more favorable usability associated with less workload. Both outcomes were associated with the odds of burnout, with task load acting as a mediator between EHR usability and burnout. Improving EHR usability while decreasing task load has the potential to allow practicing physicians more working memory for medical decision making and patient communication. ",
doi="10.2196/23382",
url="http://www.jmir.org/2020/12/e23382/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33289493"
}


@Article{info:doi/10.2196/18345,
author="Zivin, Kara
and Kononowech, Jennifer
and Boden, Matthew
and Abraham, Kristen
and Harrod, Molly
and Sripada, K. Rebecca
and Kales, C. Helen
and Garcia, A. Hector
and Pfeiffer, Paul",
title="Predictors and Consequences of Veterans Affairs Mental Health Provider Burnout: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2020",
month="Dec",
day="21",
volume="9",
number="12",
pages="e18345",
keywords="burnout",
keywords="mental health providers",
keywords="patient outcomes",
keywords="provider experience",
keywords="mental health",
keywords="veterans",
abstract="Background: In the Veterans Health Administration (VHA), mental health providers (MHPs) report the second highest level of burnout after primary care physicians. Burnout is defined as increased emotional exhaustion and depersonalization and decreased sense of personal accomplishment at work. Objective: This study aims to characterize variation in MHP burnout by VHA facility over time, identifying workplace characteristics and practices of high-performing facilities. Methods: Using both qualitative and quantitative methods, we will evaluate factors that influence MHP burnout and their effects on patient outcomes. We will compile annual survey data on workplace conditions and annual staffing as well as productivity data to assess same and subsequent year provider and patient outcomes reflecting provider and patient experiences. We will conduct interviews with mental health leadership at the facility level and with frontline MHPs sampled based on our quantitative findings. We will present our findings to an expert panel of operational partners, Veterans Affairs clinicians, administrators, policy leaders, and experts in burnout. We will reengage with facilities that participated in the earlier qualitative interviews and will hold focus groups that share results based on our quantitative and qualitative work combined with input from our expert panel. We will broadly disseminate these findings to support the development of actionable policies and approaches to addressing MHP burnout. Results: This study will assist in developing and testing interventions to improve MHP burnout and employee engagement. Our work will contribute to improvements within VHA and will generate insights for health care delivery, informing efforts to address burnout. Conclusions: This is the first comprehensive, longitudinal, national, mixed methods study that incorporates different types of MHPs. It will engage MHP leadership and frontline providers in understanding facilitators and barriers to effectively address burnout. International Registered Report Identifier (IRRID): PRR1-10.2196/18345 ",
doi="10.2196/18345",
url="http://www.researchprotocols.org/2020/12/e18345/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33346737"
}


@Article{info:doi/10.2196/24240,
author="Du, Junfeng
and Mayer, Gwendolyn
and Hummel, Svenja
and Oetjen, Neele
and Gronewold, Nadine
and Zafar, Ali
and Schultz, Jobst-Hendrik",
title="Mental Health Burden in Different Professions During the Final Stage of the COVID-19 Lockdown in China: Cross-sectional Survey Study",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="2",
volume="22",
number="12",
pages="e24240",
keywords="mental health",
keywords="COVID-19",
keywords="China",
keywords="depression",
keywords="anxiety",
keywords="lockdown",
keywords="coping strategies",
keywords="stressors",
keywords="stress",
keywords="doctors",
keywords="nurses",
keywords="students",
keywords="media consumption",
keywords="WeChat",
abstract="Background: COVID-19 resulted in considerable mental health burden in the Chinese general population and among health care workers at the beginning and peak of the pandemic. However, little is known about potentially vulnerable groups during the final stage of the lockdown. Objective: The aim of this survey study was to assess the mental health burden of different professions in China in order to find vulnerable groups, possible influencing factors, and successful ways of coping during the last 4 weeks of the lockdown in Hubei Province. Methods: A cross-sectional online survey asked participants about current residence, daily working hours, exposure to COVID-19 at work, and media preferences. We used a shortened version of the Depression, Anxiety and Stress Scale (DASS-21) to assess mental health. Further assessments included perceived stress (Simplified Chinese version of the 14-item Perceived Stress Scale), coping strategies for all participants, and specific stressors for health care workers. We followed the reporting guidelines of the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement for observational studies. Results: The sample (N=687) consisted of 158 doctors, 221 nurses, 24 other medical staff, 43 students, 60 teachers/government staff, 135 economy staff, 26 workers/farmers, and 20 professions designated under the ``other'' category. We found increased depression (n=123, 17.9\%), anxiety (n=208, 30.3\%), and stress (n=94, 13.7\%) in our sample. Professions that were vulnerable to depression were other medical staff and students. Doctors, nurses, and students were vulnerable to anxiety; and other medical staff, students, and economy staff were vulnerable to stress. Coping strategies were reduced to three factors: active, mental, and emotional. Being female and emotional coping were independently associated with depression, anxiety, or stress. Applying active coping strategies showed lower odds for anxiety while mental coping strategies showed lower odds for depression, anxiety, and stress. Age, being inside a lockdown area, exposure to COVID-19 at work, and having a high workload (8-12 hours per day) were not associated with depression, anxiety, or stress. WeChat was the preferred way of staying informed across all groups. Conclusions: By the end of the lockdown, a considerable part of the Chinese population showed increased levels of depression and anxiety. Students and other medical staff were the most affected, while economy staff were highly stressed. Doctors and nurses need support regarding potential anxiety disorders. Future work should focus on longitudinal results of the pandemic and develop targeted preventive measures. ",
doi="10.2196/24240",
url="https://www.jmir.org/2020/12/e24240",
url="http://www.ncbi.nlm.nih.gov/pubmed/33197231"
}


@Article{info:doi/10.2196/22408,
author="Mrklas, Kelly
and Shalaby, Reham
and Hrabok, Marianne
and Gusnowski, April
and Vuong, Wesley
and Surood, Shireen
and Urichuk, Liana
and Li, Daniel
and Li, Xin-Min
and Greenshaw, James Andrew
and Agyapong, Opoku Vincent Israel",
title="Prevalence of Perceived Stress, Anxiety, Depression, and Obsessive-Compulsive Symptoms in Health Care Workers and Other Workers in Alberta During the COVID-19 Pandemic: Cross-Sectional Survey",
journal="JMIR Ment Health",
year="2020",
month="Sep",
day="25",
volume="7",
number="9",
pages="e22408",
keywords="health care worker",
keywords="COVID-19",
keywords="pandemic",
keywords="mental health",
keywords="depression",
keywords="anxiety",
keywords="stress",
keywords="obsessive compulsive",
abstract="Background: During pandemics, effective containment and mitigation measures may also negatively influence psychological stability. As knowledge about COVID-19 rapidly evolves, global implementation of containment and mitigation measures has varied greatly, with impacts to mental wellness. Assessing the impact of COVID-19 on the mental health needs of health care workers and other workers may help mitigate mental health impacts and secure sustained delivery of health care and other essential goods and services. Objective: This study assessed the self-reported prevalence of stress, anxiety, depression, and obsessive-compulsive symptoms in health care workers and other workers seeking support through Text4Hope, an evidence-based SMS text messaging service supporting the mental health of residents of Alberta, Canada, during the COVID-19 pandemic. Methods: An online cross-sectional survey gathered demographic (age, gender, ethnicity, education, relationship, housing and employment status, employment type, and isolation status) and clinical characteristics using validated tools (self-reported stress, anxiety, depression, and contamination/hand hygiene obsessive-compulsive symptoms). Descriptive statistics and chi-square analysis were used to compare the clinical characteristics of health care workers and other workers. Post hoc analysis was conducted on variables with >3 response categories using adjusted residuals. Logistic regression determined associations between worker type and likelihood of self-reported symptoms of moderate or high stress, generalized anxiety disorder, and major depressive disorder, while controlling for other variables. Results: Overall, 8267 surveys were submitted by 44,992 Text4Hope subscribers (19.39\%). Of these, 5990 respondents were employed (72.5\%), 958 (11.6\%) were unemployed, 454 (5.5\%) were students, 559 (6.8\%) were retired, 234 (2.8\%) selected ``other,'' and 72 (0.9\%) did not indicate their employment status. Most employed survey respondents were female (n=4621, 86.2\%). In the general sample, the 6-week prevalence rates for moderate or high stress, anxiety, and depression symptoms were 85.6\%, 47.0\%, and 44.0\%, respectively. Self-reported symptoms of moderate or high stress, anxiety, and depression were all statistically significantly higher in other workers than in health care workers (P<.001). Other workers reported higher obsessive-compulsive symptoms (worry about contamination and compulsive handwashing behavior) after the onset of the pandemic (P<.001), while health care worker symptoms were statistically significantly higher before and during the COVID-19 pandemic (P<.001). This finding should be interpreted with caution, as it is unclear the extent to which the adaptive behavior of health care workers or the other workers might be misclassified by validated tools during a pandemic. Conclusions: Assessing symptoms of prevalent stress, anxiety, depression, and obsessive-compulsive behavior in health care workers and other workers may enhance our understanding of COVID-19 mental health needs. Research is needed to understand more fully the relationship between worker type, outbreak phase, and mental health changes over time, as well as the utility of validated tools in health care workers and other workers during pandemics. Our findings underscore the importance of anticipating and mitigating the mental health effects of pandemics using integrated implementation strategies. Finally, we demonstrate the ease of safely and rapidly assessing mental health needs using an SMS text messaging platform during a pandemic. International Registered Report Identifier (IRRID): RR2-10.2196/19292 ",
doi="10.2196/22408",
url="http://mental.jmir.org/2020/9/e22408/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32915764"
}


@Article{info:doi/10.2196/21366,
author="Evanoff, A. Bradley
and Strickland, R. Jaime
and Dale, Marie Ann
and Hayibor, Lisa
and Page, Emily
and Duncan, G. Jennifer
and Kannampallil, Thomas
and Gray, L. Diana",
title="Work-Related and Personal Factors Associated With Mental Well-Being During the COVID-19 Response: Survey of Health Care and Other Workers",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="25",
volume="22",
number="8",
pages="e21366",
keywords="COVID-19",
keywords="coronavirus",
keywords="pandemic",
keywords="mental health",
keywords="health care workers",
keywords="remote work",
keywords="worker well-being",
keywords="occupational health",
abstract="Background: The response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has created an unprecedented disruption in work conditions. This study describes the mental health and well-being of workers both with and without clinical exposure to patients with coronavirus disease (COVID-19). Objective: The aim of this study is to measure the prevalence of stress, anxiety, depression, work exhaustion, burnout, and decreased well-being among faculty and staff at a university and academic medical center during the SARS-CoV-2 pandemic and describe work-related and personal factors associated with their mental health and well-being. Methods: All faculty, staff, and postdoctoral fellows of a university, including its medical school, were invited in April 2020 to complete an online questionnaire measuring stress, anxiety, depression, work exhaustion, burnout, and decreased well-being. We examined associations between these outcomes and factors including work in high-risk clinical settings and family/home stressors. Results: There were 5550 respondents (overall response rate of 34.3\%). Overall, 34\% of faculty and 14\% of staff (n=915) were providing clinical care, while 61\% of faculty and 77\% of staff were working from home. Among all workers, anxiety (prevalence ratio 1.37, 95\% CI 1.09-1.73), depression (prevalence ratio 1.28, 95\% CI 1.03-1.59), and high work exhaustion (prevalence ratio 1.24, 95\% CI 1.13-1.36) were independently associated with community or clinical exposure to COVID-19. Poor family-supportive behaviors by supervisors were also associated with these outcomes (prevalence ratio 1.40, 95\% CI 1.21-1.62; prevalence ratio 1.69, 95\% CI 1.48-1.92; and prevalence ratio 1.54, 95\% CI 1.44-1.64, respectively). Age <40 years and a greater number of family/home stressors were also associated with these poorer outcomes. Among the subset of clinicians, caring for patients with COVID-19 and working in high-risk clinical settings were additional risk factors. Conclusions: Our findings suggest that the pandemic has had negative effects on the mental health and well-being of both clinical and nonclinical employees. Mitigating exposure to COVID-19 and increasing supervisor support are modifiable risk factors that may protect mental health and well-being for all workers. ",
doi="10.2196/21366",
url="http://www.jmir.org/2020/8/e21366/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32763891"
}


@Article{info:doi/10.2196/19500,
author="Jukic, Tomislav
and Ihan, Alojz
and Petek {\vS}ter, Marija
and Strojnik, Vojko
and Stubljar, David
and Starc, Andrej",
title="Adherence of Female Health Care Workers to the Use a Web-Based Tool for Improving and Modifying Lifestyle: Prospective Target Group Pilot Study",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="14",
volume="22",
number="8",
pages="e19500",
keywords="mHealth",
keywords="eHealth",
keywords="health care workers",
keywords="occupational stress",
keywords="burnout",
keywords="adherence",
keywords="web-based tool",
abstract="Background: Health care professionals are exposed to the psychological and physiological effects of stress, which is a well-known risk factor for various mental and physical health problems. Objective: The aims of this study were to assess the adherence of female health care workers to use a web-based tool for improving and modifying lifestyle and to identify the potential factors influencing their adherence. Methods: A prospective, observational study was performed. A total of 80 female health care workers (physicians and gradated nurses) from 2 university medical centers and female members of a family medicine society participated. Participants completed a questionnaire that inquired about their basic demographic data and physical fitness. Physical fitness was assessed by the Rockport Fitness Walking Test. Adherence to a web-based application (24@life) was followed for 3 months and the number of log-ins into the application was counted. Results: The study was conducted from March to October 2019. Significantly high workload has been detected in all groups (P<.05), except in the general practitioner with normal workload group. The graduated nurse working in the surgery room group showed chronic stress with elevated S-cortisol levels (>690 nmol/L); activated cellular immune system with elevated concentrations of lymphocytes (reference 1.1-2.5 {\texttimes} 109 cells/L), CD3 cells (reference 0.7-1.9 {\texttimes} 109 cells/L), CD8 cells (reference 0.2-0.7 {\texttimes} 109 cells/L), and HLA-DR/CD3 cells (reference 0.04-0.2 {\texttimes} 109 cells/L); and the worst quality of sleep (mean 2.8 [SD 1.2]). Only 32 of 80 participants (40\%) were adherent to the web-based application. Participants most frequently viewed web pages on areas of physical activity (497 times) and nutrition (332 times). No factors or participant's characteristics such as weight (odds ratio [OR] 1.026, 95\% CI 0.977-1.078), BMI (OR 0.993, 95\% CI 0.834-1.184), age (OR 0.970, 95\% CI 0.910-1.034), or stress level (OR 0.997, 95\% CI 0.995-1.000) were identified to affect the adherence rates. Conclusions: Female health care workers exposed to high workload did not find the web-based application useful for improving and modifying their lifestyle. Therefore, other strategies that might help health care workers facing stress and improve their lifestyle should be identified. ",
doi="10.2196/19500",
url="https://www.jmir.org/2020/8/e19500",
url="http://www.ncbi.nlm.nih.gov/pubmed/32687475"
}


@Article{info:doi/10.2196/17857,
author="Yan, Yu-Hua
and Chien, Tsair-Wei
and Yeh, Yu-Tsen
and Chou, Willy
and Hsing, Shu-Chen",
title="An App for Classifying Personal Mental Illness at Workplace Using Fit Statistics and Convolutional Neural Networks: Survey-Based Quantitative Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="31",
volume="8",
number="7",
pages="e17857",
keywords="respiratory therapist",
keywords="ELMI app",
keywords="Rasch analysis",
keywords="convolutional neural network",
keywords="mental health",
keywords="mobile phone",
abstract="Background: Mental illness (MI) is common among those who work in health care settings. Whether MI is related to employees' mental status at work is yet to be determined. An MI app is developed and proposed to help employees assess their mental status in the hope of detecting MI at an earlier stage. Objective: This study aims to build a model using convolutional neural networks (CNNs) and fit statistics based on 2 aspects of measures and outfit mean square errors for the automatic detection and classification of personal MI at the workplace using the emotional labor and mental health (ELMH) questionnaire, so as to equip the staff in assessing and understanding their own mental status with an app on their mobile device. Methods: We recruited 352 respiratory therapists (RTs) working in Taiwan medical centers and regional hospitals to fill out the 44-item ELMH questionnaire in March 2019. The exploratory factor analysis (EFA), Rasch analysis, and CNN were used as unsupervised and supervised learnings for (1) dividing RTs into 4 classes (ie, MI, false MI, health, and false health) and (2) building an ELMH predictive model to estimate 108 parameters of the CNN model. We calculated the prediction accuracy rate and created an app for classifying MI for RTs at the workplace as a web-based assessment. Results: We observed that (1) 8 domains in ELMH were retained by EFA, (2) 4 types of mental health (n=6, 63, 265, and 18 located in 4 quadrants) were classified using the Rasch analysis, (3) the 44-item model yields a higher accuracy rate (0.92), and (4) an MI app available for RTs predicting MI was successfully developed and demonstrated in this study. Conclusions: The 44-item model with 108 parameters was estimated by using CNN to improve the accuracy of mental health for RTs. An MI app developed to help RTs self-detect work-related MI at an early stage should be made more available and viable in the future. ",
doi="10.2196/17857",
url="https://mhealth.jmir.org/2020/7/e17857",
url="http://www.ncbi.nlm.nih.gov/pubmed/32735232"
}


@Article{info:doi/10.2196/19126,
author="Sbaffi, Laura
and Walton, James
and Blenkinsopp, John
and Walton, Graham",
title="Information Overload in Emergency Medicine Physicians: A Multisite Case Study Exploring the Causes, Impact, and Solutions in Four North England National Health Service Trusts",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="27",
volume="22",
number="7",
pages="e19126",
keywords="emergency medicine",
keywords="information overload",
keywords="physicians",
keywords="national health care system",
abstract="Background: Information overload is affecting modern society now more than ever because of the wide and increasing distribution of digital technologies. Social media, emails, and online communications among others infuse a sense of urgency as information must be read, produced, and exchanged almost instantaneously. Emergency medicine is a medical specialty that is particularly affected by information overload with consequences on patient care that are difficult to quantify and address. Understanding the current causes of medical information overload, their impact on patient care, and strategies to handle the inflow of constant information is crucial to alleviating stress and anxiety that is already crippling the profession. Objective: This study aims to identify and evaluate the main causes and sources of medical information overload, as experienced by emergency medicine physicians in selected National Health Service (NHS) trusts in the United Kingdom. Methods: This study used a quantitative, survey-based data collection approach including close- and open-ended questions. A web-based survey was distributed to emergency physicians to assess the impact of medical information overload on their jobs. In total, 101 valid responses were collected from 4 NHS trusts in north England. Descriptive statistics, principal component analysis, independent sample two-tailed t tests, and one-way between-group analysis of variance with post hoc tests were performed on the data. Open-ended questions were analyzed using thematic analysis to identify key topics. Results: The vast majority of respondents agreed that information overload is a serious issue in emergency medicine, and it increases with time. The always available culture (mean 5.40, SD 1.56), email handling (mean 4.86, SD 1.80), and multidisciplinary communications (mean 4.51, SD 1.61) are the 3 main reasons leading to information overload. Due to this, emergency physicians experience guideline fatigue, stress and tension, longer working hours, and impaired decision making, among other issues. Aspects of information overload are also reported to have different impacts on physicians depending on demographic factors such as age, years spent in emergency medicine, and level of employment. Conclusions: There is a serious concern regarding information overload in emergency medicine. Participants identified a considerable number of daily causes affecting their job, particularly the traditional culture of emergency departments being always available on the ward, exacerbated by email and other forms of communication necessary to maintain optimal, evidence-based practice standards. However, not all information is unwelcome, as physicians also need to stay updated with the latest guidelines on conditions and treatment, and communicate with larger medical teams to provide quality care. ",
doi="10.2196/19126",
url="http://www.jmir.org/2020/7/e19126/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32716313"
}


@Article{info:doi/10.2196/19274,
author="Tajirian, Tania
and Stergiopoulos, Vicky
and Strudwick, Gillian
and Sequeira, Lydia
and Sanches, Marcos
and Kemp, Jessica
and Ramamoorthi, Karishini
and Zhang, Timothy
and Jankowicz, Damian",
title="The Influence of Electronic Health Record Use on Physician Burnout: Cross-Sectional Survey",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="15",
volume="22",
number="7",
pages="e19274",
keywords="electronic health record",
keywords="physician",
keywords="burnout",
keywords="psychiatry",
keywords="medical informatics",
abstract="Background: Physician burnout has a direct impact on the delivery of high-quality health care, with health information technology tools such as electronic health records (EHRs) adding to the burden of practice inefficiencies. Objective: The aim of this study was to determine the extent of burnout among physicians and learners (residents and fellows); identify significant EHR-related contributors of physician burnout; and explore the differences between physicians and learners with regard to EHR-related factors such as time spent in EHR, documentation styles, proficiency, training, and perceived usefulness. In addition, the study aimed to address gaps in the EHR-related burnout research methodologies by determining physicians' patterns of EHR use through usage logs. Methods: This study used a cross-sectional survey methodology and a review of administrative data for back-end log measures of survey respondents' EHR use, which was conducted at a large Canadian academic mental health hospital. Chi-square and Fisher exact tests were used to examine the association of EHR-related factors with general physician burnout. The survey was sent out to 474 individuals between May and June 2019, including physicians (n=407), residents (n=53), and fellows (n=14), and we measured physician burnout and perceptions of EHR stressors (along with demographic and practice characteristics). Results: Our survey included 208 respondents, including physicians (n=176) and learners (n=32). The response rate was 43.2\% for physicians (full-time: 156/208, 75.0\%; part-time: 20/199, 10.1\%), and 48\% (32/67) for learners. A total of 25.6\% (45/176) of practicing physicians and 19\% (6/32) of learners reported having one or more symptoms of burnout, and 74.5\% (155/208) of all respondents who reported burnout symptoms identified the EHR as a contributor. Lower satisfaction and higher frustration with the EHRs were significantly associated with perceptions of EHR contributing toward burnout. Physicians' and learners' experiences with the EHR, gathered through open-ended survey responses, identified challenges around the intuitiveness and usability of the technology as well as workflow issues. Metrics gathered from back-end usage logs demonstrated a 13.6-min overestimation in time spent on EHRs per patient and a 5.63-hour overestimation of after-hours EHR time, when compared with self-reported survey data. Conclusions: This study suggests that the use of EHRs is a perceived contributor to physician burnout. There should be a focus on combating physician burnout by reducing the unnecessary administrative burdens of EHRs through efficient implementation of systems and effective postimplementation strategies. ",
doi="10.2196/19274",
url="https://www.jmir.org/2020/7/e19274",
url="http://www.ncbi.nlm.nih.gov/pubmed/32673234"
}


@Article{info:doi/10.2196/13996,
author="Khairat, Saif
and Xi, Lin
and Liu, Songzi
and Shrestha, Shilpa
and Austin, Charles",
title="Understanding the Association Between Electronic Health Record Satisfaction and the Well-Being of Nurses: Survey Study",
journal="JMIR Nursing",
year="2020",
month="Jun",
day="23",
volume="3",
number="1",
pages="e13996",
keywords="electronic health record",
keywords="nursing",
keywords="satisfaction",
keywords="critical care",
abstract="Background: Intensive care unit (ICU) nurses experience high levels of burnout related to the high-stress environment. Management of electronic health records (EHR) is a contributing factor to physician burnout. However, limited research has established the relationship between the nurse's well-being and EHR use. Objective: The objective of this study was to examine the association between EHR use and the well-being of nurses. Methods: We surveyed registered nurses employed at a major Southeastern medical center in the United States about their demographics, experience with EHRs, satisfaction with EHRs, and elements of well-being. The correlation between subgroup demographics and survey questions was examined using Kendall and Fisher tests. Results: A total of 113 ICU registered nurses responded to the survey, of which 93 (82.3\%) were females. The population had a mean age of 35.18 years (SD 10.65). A significant association was found between satisfaction and well-being scores, where higher EHR satisfaction was associated with higher self-reported well-being (correlation 0.35, P<.001). Nurses who were unhappy with the time spent in EHR use compared with direct patient care reported higher levels of stress (P<.001) and isolation (P=.009). Older nurses reported higher dissatisfaction with the amount of time spent on EHR tasks related to direct patient care compared to younger nurses (P<.001). Conclusions: Although nurses reported acceptable satisfaction scores with EHR use, deeper analysis suggests that EHR indirectly affects the well-being of nurses. These findings strongly indicate that lower EHR satisfaction can impact the well-being of nurses. More research is needed to optimize the nurse-EHR experience through more user-centered design approaches. ",
doi="10.2196/13996",
url="https://nursing.jmir.org/2020/1/e13996/",
url="http://www.ncbi.nlm.nih.gov/pubmed/34345776"
}


@Article{info:doi/10.2196/13294,
author="Duan, Guimin
and Liao, Xin
and Yu, Weiping
and Li, Guihua",
title="Classification and Prediction of Violence Against Chinese Medical Staff on the Sina Microblog Based on a Self-Organizing Map: Quantitative Study",
journal="J Med Internet Res",
year="2020",
month="May",
day="26",
volume="22",
number="5",
pages="e13294",
keywords="workplace violence",
keywords="medical staff",
keywords="social media",
abstract="Background: For the last decade, doctor-patient contradiction in China has remained prominent, and workplace violence toward medical staff still occurs frequently. However, little is known about the types and laws of propagation of violence against medical staff online. Objective: By using a self-organizing map (SOM), we aimed to explore the microblog propagation law for violent incidents in China that involve medical staff, to classify the types of incidents and provide a basis for rapidly and accurately predicting trends in public opinion and developing corresponding measures to improve the relationship between doctors and patients. Methods: For this study, we selected 60 cases of violent incidents in China involving medical staff that led to heated discussions on the Sina microblog from 2011 to 2018, searched the web data of the microblog using crawler software, recorded the amount of new tweets every 2 hours, and used the SOM neural network to cluster the number of tweets. Polynomial and exponential functions in MATLAB software were applied to predict and analyze the data. Results: Trends in the propagation of online public opinion regarding the violent incidents were categorized into 8 types: bluff, waterfall, zigzag, steep, abrupt, wave, steep slope, and long slope. The communications exhibited different characteristics. The prediction effect of 4 types of incidents (ie, bluff, waterfall, zigzag, and steep slope) was good and accorded with actual spreading trends. Conclusions: Our study found that the more serious the consequences of a violent incident, such as a serious injury or death, the more attention it drew on the microblog, the faster was its propagation speed, and the longer was its duration. In these cases, the propagation types were mostly steep slope, long slope, and zigzag. In addition, the more serious the consequences of a violent incident, the higher popularity it exhibited on the microblog. The popularity within a week was significantly higher for acts resulting from patients' dissatisfaction with treatments than for acts resulting from nontherapeutic incidents. ",
doi="10.2196/13294",
url="http://www.jmir.org/2020/5/e13294/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32348253"
}


@Article{info:doi/10.2196/16528,
author="Lee, Yi-Lien
and Chou, Willy
and Chien, Tsair-Wei
and Chou, Po-Hsin
and Yeh, Yu-Tsen
and Lee, Huan-Fang",
title="An App Developed for Detecting Nurse Burnouts Using the Convolutional Neural Networks in Microsoft Excel: Population-Based Questionnaire Study",
journal="JMIR Med Inform",
year="2020",
month="May",
day="7",
volume="8",
number="5",
pages="e16528",
keywords="nurse burnout",
keywords="MBI-HSS Chinese version",
keywords="receiver operating characteristic curve",
keywords="convolutional neural network",
keywords="Lz person fit statistic",
abstract="Background: Burnout (BO), a critical syndrome particularly for nurses in health care settings, substantially affects their physical and psychological status, the institute's well-being, and indirectly, patient outcomes. However, objectively classifying BO levels has not been defined and noticed in the literature. Objective: The aim of this study is to build a model using the convolutional neural network (CNN) to develop an app for automatic detection and classification of nurse BO using the Maslach Burnout Inventory--Human Services Survey (MBI-HSS) to help assess nurse BO at an earlier stage. Methods: We recruited 1002 nurses working in a medical center in Taiwan to complete the Chinese version of the 20-item MBI-HSS in August 2016. The k-mean and CNN were used as unsupervised and supervised learnings for dividing nurses into two classes (n=531 and n=471 of suspicious BO+ and BO?, respectively) and building a BO predictive model to estimate 38 parameters. Data were separated into training and testing sets in a proportion 70\%:30\%, and the former was used to predict the latter. We calculated the sensitivity, specificity, and receiver operating characteristic curve (area under the curve) across studies for comparison. An app predicting respondent BO was developed involving the model's 38 estimated parameters for a website assessment. Results: We observed that (1) the 20-item model yields a higher accuracy rate (0.95) with an area under the curve of 0.97 (95\% CI 0.94-0.95) based on the 1002 cases, (2) the scheme named matching personal response to adapt for the correct classification in model drives the prior model's predictive accuracy at 100\%, (3) the 700-case training set with 0.96 accuracy predicts the 302-case testing set reaching an accuracy of 0.91, and (4) an available MBI-HSS app for nurses predicting BO was successfully developed and demonstrated in this study. Conclusions: The 20-item model with the 38 parameters estimated by using CNN for improving the accuracy of nurse BO has been particularly demonstrated in Excel (Microsoft Corp). An app developed for helping nurses to self-assess job BO at an early stage is required for application in the future. ",
doi="10.2196/16528",
url="https://medinform.jmir.org/2020/5/e16528",
url="http://www.ncbi.nlm.nih.gov/pubmed/32379050"
}


@Article{info:doi/10.2196/16285,
author="Kim, Esther
and Mallett, Robert
and Hrabok, Marianne
and Yang, Alicia Yajing
and Moreau, Chantal
and Nwachukwu, Izu
and Kravtsenyuk, Maryana
and Abba-Aji, Adam
and Li, Daniel
and Agyapong, O. Vincent I.",
title="Reducing Burnout and Promoting Health and Wellness Among Medical Students, Residents, and Physicians in Alberta: Protocol for a Cross-Sectional Questionnaire Study",
journal="JMIR Res Protoc",
year="2020",
month="Apr",
day="17",
volume="9",
number="4",
pages="e16285",
keywords="burnout, psychological",
keywords="wellness",
keywords="resilience",
keywords="burnout measures",
keywords="burnout interventions",
keywords="delivery of health care",
keywords="medicine",
keywords="work life balance",
abstract="Background: Burnout is an increasingly common and insidious phenomenon experienced by workers in many different fields, although it is of particular concern among physicians and trainees due to the nature of their work. It is estimated that one-third of practicing physicians will experience burnout during their career, and this rate is expected to continue to increase. Burnout has significant implications, as it has been identified as a contributor to increased medical errors, decreased patient satisfaction, substance use, workforce attrition, and suicide. Objective: This study will evaluate the prevalence and impact of burnout on physicians, residents, and medical students in Alberta. Methods: Quantitative and qualitative data collected through self-administered, anonymous, online questionnaires will be used in this cross-sectional provincial study design. Data collection tools were developed based on published literature and questions from previously validated instruments. The tools capture relevant demographic information, mental health status, and rates of burnout, as well as factors contributing to both burnout and resilience among respondents. We anticipate a sample size of 777 medical students, 959 residents, and 1961 physicians to represent the respective ratios of trainees and practicing physicians in the province of Alberta. Results: Study recruitment will begin in September 2020, with 4 weeks of data collection. The results of this study are anticipated within 12 months from the end of data collection. It is expected that the results will provide an overview of the prevalence of burnout among those training and working in medicine in Alberta, identify contributors to burnout, and help develop interventions aimed at reducing burnout. Conclusions: This study's aim is to examine burnout prevalence and contributing factors among medical trainees and physicians in Alberta. It is expected that the results will identify and examine individual and organizational practices that contribute to burnout and help develop strategies and interventions focused on mitigating burnout and its sequelae. International Registered Report Identifier (IRRID): PRR1-10.2196/16285 ",
doi="10.2196/16285",
url="http://www.researchprotocols.org/2020/4/e16285/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32301742"
}


@Article{info:doi/10.2196/15608,
author="Roy, Alexandra
and Druker, Susan
and Hoge, A. Elizabeth
and Brewer, A. Judson",
title="Physician Anxiety and Burnout: Symptom Correlates and a Prospective Pilot Study of App-Delivered Mindfulness Training",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="1",
volume="8",
number="4",
pages="e15608",
keywords="anxiety",
keywords="burnout",
keywords="mindfulness",
keywords="app",
keywords="mHealth",
keywords="physician",
keywords="smartphone",
keywords="digital therapeutics",
abstract="Background: Physician burnout is on the rise, yet little is known about its relationship to anxiety. Mindfulness-based stress reduction has demonstrated decreases in anxiety, yet physicians have reported reluctance to engage in it due to significant time commitments. Objective: The aims of this study are to assess whether app-based mindfulness training can reduce anxiety in physicians and to explore if anxiety and burnout are correlated, thus leading to a reduction in both anxiety and burnout. Methods: This was a nonrandomized pilot study comprised of 34 physicians who worked in a large US health care network and reported having anxiety. The intervention was an app-based mindfulness program. The main outcome measure was anxiety, measured by the Generalized Anxiety Disorder-7 (GAD-7). The secondary outcome measures assessed burnout: cynicism and emotional exhaustion items from the Maslach Burnout Inventory. Results: GAD-7 scores decreased significantly at posttreatment (1 month after treatment initiation, 48\% reduction, P<.001) and at the 3-month follow-up (57\% reduction, P<.001). There was a significant correlation between anxiety and burnout (cynicism: r=.43; P=.01; emotional exhaustion: r=.71; P<.001). There was also a significant decrease in cynicism (50\% reduction, P=.003 at posttreatment; 50\% reduction, P=.009 at follow-up) and emotional exhaustion at both time points (20\% reduction, P<.001 at posttreatment; 20\% reduction, P=.003 at follow-up). Conclusions: This pilot study is the first to test an app-based mindfulness training program targeted at reducing anxiety with physicians and to demonstrate that in physicians, anxiety is correlated with burnout. These findings suggest that this may be an effective tool to reduce anxiety and burnout in physicians. Trial Registration: ClinicalTrials.gov NCT04137081; https://www.clinicaltrials.gov/ct2/show/NCT04137081 ",
doi="10.2196/15608",
url="https://mhealth.jmir.org/2020/4/e15608",
url="http://www.ncbi.nlm.nih.gov/pubmed/32234708"
}


@Article{info:doi/10.2196/14238,
author="Maswadi, Nizar
and Khader, S. Yousef
and Abu Slaih, Ahmad",
title="Perceived Stress Among Resident Doctors in Jordanian Teaching Hospitals: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2019",
month="Oct",
day="2",
volume="5",
number="4",
pages="e14238",
keywords="psychology",
keywords="physicians",
keywords="teaching hospitals",
keywords="Jordan",
abstract="Background: Medical residents in Jordanian hospitals are involved in many clinical and nonclinical tasks that expose them to various stress factors. High stress and burnout have the potential to negatively impact work performance and patient care, including medication errors, suboptimal care, clinical errors, and patient dissatisfaction. Objective: This study aimed to determine the perceived stress among medical residents in Jordanian hospitals and its associated risk factors. Methods: A cross-sectional study was conducted among residents in Jordanian hospitals. A cluster sample of 5 hospitals with residency programs was selected from different health sectors. All residents who were working in the selected hospitals were invited to participate in this study, during the period from April to July 2017. A total of 555 residents agreed to participate in this study, giving a response rate of 84\%. The perceived stress scale (PSS) was used for assessment. Results: A total of 398 male and 157 female residents were included in this study. The mean PSS score in this study was 21.6; 73\% (405/555) of the residents had moderate level of stress, and 18\% (100/555) had high level of stress. About 6.7\% (37/555) of the residents had hypertension, 2.7\% (15/555) had diabetes, 3.2\% (18/555) had heart disease, and 8.5\% (47/555) were anemic. 233 (42\%) respondents complained of back pain, and 161 (29\%) of the respondents complained of insomnia. Stress was associated with higher workload, sleep deprivation, and dissatisfaction in the relationship with colleagues, with income, and with the program. In multivariate analysis, the following factors were significantly associated with stress: female gender, dissatisfaction with working environment, and facing work-related, academic, and family stressors. Conclusions: The majority of medical residents in Jordanian hospitals felt nervous and stressed. Conducting stress management programs during residency and improving the work environment are strongly recommended. ",
doi="10.2196/14238",
url="https://publichealth.jmir.org/2019/4/e14238",
url="http://www.ncbi.nlm.nih.gov/pubmed/31579024"
}


@Article{info:doi/10.2196/13909,
author="Peters, Andrew Gregory
and Wong, L. Matthew
and Joseph, W. Joshua
and Sanchez, D. Leon",
title="Pulse Rate Variability in Emergency Physicians During Shifts: Pilot Cross-Sectional Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Oct",
day="2",
volume="7",
number="10",
pages="e13909",
keywords="emergency medicine",
keywords="burnout",
keywords="photoplethysmography",
keywords="emergency physicians",
keywords="physician wellness",
keywords="stress",
keywords="heart rate variability",
keywords="pulse rate variability",
abstract="Background: The high prevalence of physician burnout, particularly in emergency medicine, has garnered national attention in recent years. Objective means of measuring stress while at work can facilitate research into stress reduction interventions, and wearable photoplethysmography (PPG) technology has been proposed as a potential solution. However, the use of low-burden wearable biosensors to study training and clinical practice among emergency physicians (EP) remains untested. Objective: This pilot study aimed to (1) determine the feasibility of recording on-shift photoplethysmographic data from EP, (2) assess the quality of these data, and (3) calculate standard pulse rate variability (PRV) metrics from the acquired dataset and examine patterns in these variables over the course of an academic year. Methods: A total of 21 EP wore PPG biosensors on their wrists during clinical work in the emergency department during a 9-hour shift. Recordings were collected during the first quarter of the academic year, then again during the fourth quarter of the same year for comparison. The overall rate of usable data collection per time was computed. Standard pulse rate (PR) and PRV metrics from these two time points were calculated and entered into Student t tests. Results: More than 400 hours of data were entered into these analyses. Interpretable data were captured during 8.54\% of the total recording time overall. In the fourth quarter of the academic year compared with the first quarter, there was no significant difference in median PR (75.8 vs 76.8; P=.57), mean R-R interval (0.81 vs 0.80; P=.32), SD of R-R interval (0.11 vs 0.11; P=.93), root mean square of successive difference of R-R interval (0.81 vs 0.80; P=.96), low-frequency power (3.5{\texttimes}103 vs 3.4{\texttimes}103; P=.79), high-frequency power (8.5{\texttimes}103 vs 8.3{\texttimes}103; P=.91), or low-frequency to high-frequency ratio (0.42 vs 0.41; P=.43), respectively. Power estimates for each of these tests exceeded .90. A secondary analysis of the resident-only subgroup similarly showed no significant differences over time, despite power estimates greater than .80. Conclusions: Although the use of PPG biosensors to record real-time physiological data from EP while providing clinical care seems operationally feasible, this study fails to support the notion that such an approach can efficiently provide reliable estimates of metrics of interest. No significant differences in PR or PRV metrics were found at the end of the year compared with the beginning. Although these methods may offer useful applications to other domains, it may currently have limited utility in the contexts of physician training and wellness. ",
doi="10.2196/13909",
url="https://mhealth.jmir.org/2019/10/e13909",
url="http://www.ncbi.nlm.nih.gov/pubmed/31579017"
}