The impact of mindfulness-based interventions on doctors’ well-being and performance: A systematic review

The well-being of doctors is at risk, as evidenced by high burnout rates amongst doctors around the world. Alarmingly, burned-out doctors are more likely to exhibit low levels of professionalism and provide suboptimal patient care. Research suggests that burnout and the well-being of doctors can be improved by mindfulness-based interventions (MBIs). Furthermore, MBIs may improve doctors’ performance (eg in empathy). However, there are no published systematic reviews that clarify the effects of MBIs on doctor well-being or performance to inform future research and professional development programmes. We therefore systematically reviewed and narratively synthesised findings on the impacts of MBIs on doctors’ well-being and performance.

We searched PubMed and PsycINFO from inception to 9 May 2018 and independently reviewed studies investigating the effects of MBIs on doctor wellbeing or performance. We systematically extracted data and assessed study quality according to the Medical Education Research Study Quality Instrument (MERSQI), and narratively reported study findings.

We retrieved a total of 934 articles, of which 24 studies met our criteria; these included randomised, (un)controlled or qualitative studies of average quality. Effects varied across MBIs with different training contents or formats: MBIs including essential mindfulness training elements, or employing group-based training, mostly showed positive effects on the well-being or performance of doctors across different educational and hospital settings. Doctors perceived both benefits (enhanced self- and otherunderstanding) and challenges (time limitations and feasibility) associated with MBIs. Findings were subject to the methodological limitations of studies (eg the use of selfselected participants, lack of placebo interventions, use of self-reported outcomes).

This review indicates that doctors can perceive positive impacts of MBIs on their well-being and performance. However, the evidence was subject to methodological limitations and does not yet support the standardisation of MBIs in professional development programmes. Rather, health care organisations could consider including group-based MBIs as voluntary modules for doctors with specific well-being needs or ambitions regarding professional development.

The full article can be downloaded below.  

Physician Burnout, Resilience, and Patient Experience in a Community Practice: Correlations and the Central Role of Activation

Clinician burnout and patient experience are important issues that are often considered separately. New measures of resilience may influence both. We explored relationships among clinician resilience, burnout, and patient experience. Analysis included 490 physicians who completed surveys measuring burnout and resilience (decompression and activation) and had at least 30 patient experience surveys available for analysis. Burnout was measured with 2 items from the Maslach Burnout Inventory (MBI) which were part of the organization’s ongoing measurement of clinician experience. Resilience was measured with 8 items from 2 Press Ganey validated subscales related to clinicians’ ability to decompress from work and their experience of feeling of activation and connection to purpose while at work. Clinicians reporting more frequent symptoms of burnout based on the MBI items reported less ability to decompress (r for individual measures ranged from .183 to .475, P < .01) and less feeling of activation (r for individual measures ranged from .116 to .401, P < .01). Individual elements of decompression and activation were significantly associated with patient experience. In terms of activation, feeling that one’s work makes a difference (r ranged from .121 to .159, P < .05) and believing one’s work to be meaningful (r ranged from .102 to .135, P < .05) were positively associated with patient experience with their care provider. However, elements of decompression such as being able to free one’s mind from work (r ranged from .092 to .119, P < .05) and being able to disconnect from work communications such as e-mails (r ranged from .094 to .130, P < .05) were negatively associated with patient experience with their care providers. Patient and provider experience are intertwined in that clinician resilience is associated with both burnout and patient experience, but individual mechanisms of resilience may be beneficial for the clinician but not for the patient.

The full article can be downloaded below.  

Commentary: Two Threats to Precision Medicine Equity

In January 2015, President Barack Obama unveiled the “Precision Medicine Initiative,” a nationwide research effort to help bring an effective, preventive, and therapeutic approach to medicine. The purpose of the initiative is to bring a precise understanding of the genetic and environmental determinants of disease into clinical settings across the United States. The announcement was coupled with $216 million provided in the President’s proposed budget for a million-person national research cohort including public and private partnerships with academic medical centers, researchers, foundations, privacy experts, medical ethicists, and medical product innovators. The Initiative promises to expand the use of precision medicine in cancer research and modernize regulatory approval processes for genome sequencing technologies. In response, Congress passed the 21st Century Cures Act in December 2016, authorizing a total of $1.5 billion over 10 years for the program. Although the Precision Medicine Initiative heralds great promise for the future of disease treatment and eradication, its implementation and development must be carefully guided to ensure that the millions of federal dollars expended will be spent equitably. This commentary discusses two key threats to the Precision Medicine Initiative’s ability to proceed in a manner consistent with the United States Constitutional requirement that the federal government shall not “deny to any person . . . the equal protection of the laws.” In short, this commentary sounds two cautionary notes, in order to advance precision medicine equity. First, achieving precision medicine equity will require scientists and clinicians to fulfill their intellectual, moral, and indeed legal duty to work against abusive uses of precision medicine science to advance distorted views of racial group variation.

Precision medicine scientists must decisively denounce and distinguish this Initiative from the pseudo-science of eugenics – the immoral and deadly pseudo-science that gave racist and nationalist ideologies what Troy Duster called a “halo of legitimacy” during the first half of the 20th century. Second, to combat the social threat to precision medicine, scientists must incorporate a comprehensive, ecological understanding of the fundamental social and environmental determinants of health outcomes in all research. Only then will the Precision Medicine Initiative live up to its potential to improve and indeed transform health care delivery for all patients, regardless of race, color, or national origin.

The full commentary can be downloaded below.  

Can Precision Medicine Reduce the Burden of Diabetes?

Precision medicine is a new health care concept intended to hasten progress toward individualized treatment and, in so doing, to improve everyone’s opportunity to enjoy good health. Yet, this concept pays scant attention to opportunities for change in the social determinants that are the major drivers of health. Precision medicine research is likely to generate improvements in medical care but may have the unintended consequence of worsening existing disparities in health care access. For prevention, precision medicine emphasizes comprehensive risk prediction and individual efforts to accomplish risk reduction. The application of the precision medicine vision to type 2 diabetes, a growing threat to population health, fails to acknowledge collective responsibility for a health-promoting society.

The full article can be downloaded below.  

Precision dosing to avoid adverse drug reactions

Adverse drug reactions (ADRs) have traditionally been managed by trial and error, adjusting drug and dose selection reactively following patient harm. With an improved understanding of ADRs, and the patient characteristics that increase susceptibility, precision medicine technologies enable a proactive approach to ADRs and support clinicians to change prescribing accordingly. This commentary revisits the famous pharmacology–toxicology continuum first postulated by Paracelsus 500years ago and explains why precision dosing is needed to help avoid ADRs in modern clinical practice. Strategies on how to improve precision dosing are given, including more research to establish better precision dosing targets in the cases of greatest need, easier access to dosing instructions via e-prescribing, improved monitoring of patients with novel biomarkers of drug response, and further application of model-informed precision dosing.

The full commentary can be downloaded below.  

Full noncontact laser ultrasound: first human data

Full noncontact laser ultrasound (LUS) imaging has several distinct advantages over current medical ultrasound (US) technologies: elimination of the coupling mediums (gel/water), operator-independent image quality, improved repeatability, and volumetric imaging. Current light-based ultrasound utilizing tissue-penetrating photoacoustics (PA) generally uses traditional piezoelectric transducers in contact with the imaged tissue or carries an optical fiber detector close to the imaging site. Unlike PA, the LUS design presented here minimizes the optical penetration and specifically restricts optical-to-acoustic energy transduction at the tissue surface, maximizing the generated acoustic source amplitude. With an appropriate optical design and interferometry, any exposed tissue surfaces can become viable acoustic sources and detectors. LUS operates analogously to conventional ultrasound but uses light instead of piezoelectric elements. Here, we present full noncontact LUS results, imaging targets at ~5 cm depths and at a meterscale standoff from the target surface. Experimental results demonstrating volumetric imaging and the first LUS images on humans are presented, all at eye- and skin-safe optical exposure levels. The progression of LUS imaging from tissue-mimicking phantoms, to excised animal tissue, to humans in vivo is shown, with validation from conventional ultrasound images. The LUS system design insights and results presented here inspire further LUS development and are a significant step toward the clinical implementation of LUS.

The full article can be downloaded below.  

To make advanced therapies, we need to industrialize personalization

It’s encouraging to see biopharma manufacturing, logistics, transport, and other partners in the cell- and gene-therapy ecosystem coming together in new ways to ensure the successful and reliable delivery of advanced therapies for individual patients. But much more evolution is needed to provide sustainable patient access to advanced therapies.

The full STAT article can be viewed at this link.  

Speech Emotion Detection using IoT based Deep Learning for Health Care

Human emotions are essential to recognize the behavior and state of mind of a person. Emotion detection through speech signals has started to receive more attention lately. This paper proposes the method for detecting human emotions using speech signals and its implementation in realtime using the Internet of Things (IoT) based deep learning for the care of older adults in nursing homes. The research has two main contributions. First, we have implemented a real-time system based on audio IoT, where we have recorded human voice and predicted emotions via deep learning. Secondly, for advance classification, we have designed a model using data normalization and data augmentation techniques. Finally, we have created an integrated deep learning model, called Speech Emotion Detection (SED), using a 2D convolutional neural networks (CNN). The best accuracy that was reported by our method was approximately 95%, which outperformed all state-of-the-art approaches. We have further extended to apply the SED model to a live audio sentiment analysis system with IoT technologies for the care of older adults in nursing homes.

The full article can be viewed at this link.  

Long Term Care: Navigating The Decade Ahead

We’re days away from entering what the World Health Organization proclaimed to be “the Decade of Healthy Ageing.” Health systems around the world, however, are woefully underequipped to provide the care that healthy aging requires.

From 2020 to 2030, the pressure will be on for national governments, policymakers, and healthcare providers to redress the scarcity of resources available to the elderly and the people who care for them. High on any country’s list of priorities should be the research, development, and funding of robust long term care systems. Within thirty years, the number of older adults in need of long term care is expected to reach 277 million globally. Of these, millions—27 million, to be exact—will be living in the United States. 

To build long term care systems with the sole purpose of purveying end of life supports and services is not enough—not nearly. For these systems to be accessible, affordable, and equitable to all, they must discard a notion of health overdetermined by illness and treatment in favor of one befitting the full complexity of the person.

The full article can be viewed at this link.  

The Association Between Perceived Electronic Health Record Usability and Professional Burnout Among US Physicians

The usability of current EHRs as assessed by US physicians using a standardized metric of technology usability is markedly lower than for most other technologies and falls into the grade category of F. A strong dose-response relationship between EHR usability and risk for burnout among physicians was observed. Given the association between EHR usability and physician burnout, improving EHR usability may be an important approach to help reduce health care professional burnout.

The full article can be downloaded below.