The Prevalence of Burnout and Depression and Their Association With Adherence to Safety and Practice Standards: A Survey of United States Anesthesiology Trainees.

The Prevalence of Burnout and Depression and Their Association with Adherence to Safety and Practice Standards: A Survey of United States Anesthesiology Trainees.

Anesth Analg. 2013 May 17;
de Oliveira GS, Chang R, Fitzgerald PC, Almeida MD, Castro-Alves LS, Ahmad S, McCarthy RJ

BACKGROUND:The prevalence of burnout and depression in anesthesiology residents has not been determined. It is also unknown whether anesthesiology resident burnout/depression may affect patient care and safety. The primary objective of this study was to determine the prevalence of burnout and depression in anesthesiology residents in the United States. We hypothesized that residents at high risk of burnout and/or depression would report more medical errors as well as a lower rate of following principles identified as the best practice of anesthesiology.METHODS:A cross-sectional survey was sent to 2773 anesthesiology residents in the United States. The questionnaire was divided into 5 parts examining trainees’ demographic factors, burnout (Maslach Burnout Inventory), depression (Harvard depression scale), 10 questions designed to evaluate best practice of anesthesiology, and 7 questions evaluating self-reported errors. Best practices and self-reported error rates were compared among subjects with a high risk of burnout only, high risk of depression only, high risk of burnout and depression, and low risk of burnout and depression. Pairwise comparisons were considered significant at P < 0.004 and confidence intervals (CIs) reported at 99.6%.RESULTS:There were 1508 (54%) resident responds. High burnout risk was found in 41% (575 of 1417) of respondents. Working >70 hours per week, having >5 drinks per week, and female gender were associated with increased burnout risk. Twenty-two percent (298 of 1384) screened positive for depression. Working >70 hours of work per week, smoking, female gender, and having >5 drinks per week were associated with increased depression risk. Two hundred forty (17%) respondents scored at high risk of burnout and depression, 321 (23%) at high risk of burnout, 58 (4%) at high risk of depression only, and 764 (56%) at low risk of burnout or depression. Median best practice scores (maximum = 30) for residents at high risk of burnout (difference -2; 99.6% CI, -1 to -2; P < 0.001) or high risk of burnout and depression (difference -4; 99.6% CI, -3 to -6; P < 0.001) were lower than scores of residents at low risk for burnout or depression. Thirty-three percent of respondents with high burnout and depression risk reported multiple medication errors in the last year compared with 0.7% of the lower-risk responders (P < 0.001).CONCLUSION:Burnout, depression, and suicidal ideation are very prevalent in anesthesiology residents. In addition to effects on the health of anesthesiology trainees, burnout and depression may also affect patient care and safety. HubMed – depression

Depression and Risk of Stroke in Midaged Women: A Prospective Longitudinal Study.

Stroke. 2013 May 16;
Jackson CA, Mishra GD

BACKGROUND AND PURPOSE: Depression is known to increase stroke risk. Although limited, there is some evidence for age differences, with a suggestion for a stronger association in younger groups. We investigated the effect of depression on stroke incidence in a large cohort of midaged women. METHODS: We included 10 547 women without a history of stroke aged 47 to 52 years from the Australian Longitudinal Study on Women’s Health, surveyed every 3 years from 1998 to 2010. Depression was defined at each survey using the Center for Epidemiological Studies Depression Scale (shortened version) and antidepressant use in the past month. Stroke was ascertained through self-report and mortality data. We determined the association between depression and stroke at the subsequent survey, using generalized estimating equation analysis, adjusting for time-varying covariates. RESULTS: At each survey, ?24% were defined as having depression. During follow-up, 177 strokes occurred. Depression was associated with a >2-fold increased odds of stroke (odds ratio, 2.41; 95% confidence interval, 1.78-3.27), which attenuated after adjusting for age, socioeconomic status, lifestyle, and physiological factors (odds ratio, 1.94; 95% confidence interval, 1.37-2.74). Findings were robust to sensitivity analyses addressing methodological issues, including definition of depression, antidepressant use, and missing covariate data. CONCLUSIONS: Depression is a strong risk factor for stroke in midaged women, with the association partially explained by lifestyle and physiological factors. Further studies of midaged and older women from the same population are needed to confirm whether depression is particularly important in younger women and to inform targeted intervention approaches. HubMed – depression

Effect-site concentration of remifentanil to prevent cough after laryngomicrosurgery.

Laryngoscope. 2013 May 20;
Chang CH, Lee JW, Choi JR, Shim YH

Objective: The aim of this study was to discover the optimal effect-site concentration of remifentanil for cough prevention that does not delay awakening or cause respiratory depression during emergence from anesthesia with propofol and remifentanil in laryngomicrosurgery patients. Study design: Prospective, randomized, controlled trial. Methods: One hundred five patients were randomly assigned to maintain an effect-site concentration (Ce) of remifentanil at a predetermined value of 1 (R1), 1.5 (R1.5), and 2 (R2) ng/ml during emergence. The incidence and grade (0, no coughing; 1, single cough; 2, > one episode non-sustained coughing; 3, sustained and repetitive coughing with head lift) of cough, emergence time, blood pressure (MAP), heart rate (HR), spontaneous respiratory rate (RR), oxygen saturation and postoperative nausea and vomiting (PONV) were recorded during emergence and recovery. Results: The total number of patients with coughing during emergence was lower in groups R1.5 and R2 than in group R1. The cough grade during tracheal extubation was lower in groups R 1.5 and R2 than in group R1. In group R2, emergence time was longer and PACU score was lower than groups R1 and R1.5. Also in group R2, transient hypoventilation and PONV were more frequent compared to R1. There were no differences in MAP and HR among the three groups during emergence and recovery. Conclusion: Maintenance of remifentanil at Ce 1.5 and 2 ng/ml suppressed coughing without serious adverse events during emergence from anesthesia with propofol and remifentanil in patients undergoing laryngomicrosurgery. HubMed – depression