Artificial Intelligence in a Smartwatch for Atrial Fibrillation

An interesting study by Perez et al in NEJM found some very interesting things:

1. A large number of people opted-in to be part of the study (over 400K)
2. In about 4 months, about 0.5% participants were noted to have irregular heart rate – a relatively small percentage than one would expect.
3. Of the people who returned 7-day monitoring after being notified of irregular heart beat, about one-third had atrial fibrillation. This is a significant number of atrial fibrillation in otherwise asymptomatic individuals.

The study highlights several important things, some noted above. However, what it does not tell us if the use of smartwatch to identify atrial fibrillation in otherwise healthy people results in improved health outcomes or not. A future study should be able to evaluate this question. For now, at least we know we can depend on smartwatch to identify atrial fibrillation.

Burnout among Nurses

Dyrbye et al conducted a national survey of the US nurses (response rate 26.2%) and found that 35.3% had burnout symptoms. Interestingly, 30.7% of the respondents also had symptoms of depression. Quite interestingly, authors found that nurses who had higher burnout were more likely to have been absent 1 or more days during the last month and had poor work-performance.

Critique: Authors need to be commended for conducting a national study of nurses. However, this study has the same issue that we find in other burnout literature; person who is burnout is also the one who determines if they have poor performance or not. At least theoretically, one would assume that a person who is burnout will look more negatively towards themselves and their work than a person who is not burned out; we would expect a high correlation between the two. On the other hand, a study in which nurses’ superiors could have been asked to comment on performance would have generated more reliable data, however, such study would have been quite expensive requiring significant external funding.

Burnout in Healthcare–A systems approach

Interesting and thought-provoking analytical piece by Montgomery et al which correctly points out that the responsibility of mitigating burnout lies with the institution and that the practice of putting the responsibility on healthcare workers should be abandoned. Currently, most places try to focus on the healthcare worker – asking them to take better care of themselves, be resilient, cope with stressors on their own, etc. They propose the following:

1. Provider burnout should be added to the current assessment of healthcare quality
2. Burnout should be assessed at the departmental/unit level (and I would add that it should be measured at least annually).
3. Development of health workplaces should be a major goal
4. Key questions concerning research and practice should not be coming from researchers alone.

Personally, I do believe that there are not enough researchers examining the interventions needed to address burnout. There is lack of funding from national funding agencies and from locally from institutions.

Some Recent Physician Burnout Literature

An abstract, presented at the the annual meeting and published in the Journal of American College of Surgeons’ supplement examined relationship between burnout and involvement of surgeons in medical device development/innovation.

As is often found in medical students across the world, New Zealand’s medical students also appear to have high levels of burnout. Farrell et al surveyed one of the two medical school in New Zealand and found that the prevalence of exhaustion was 77% while of disengagement was 68%. Another proof that burnout in medical profession is a worldwide phenomenon.

A study examined burnout among Egyptian ICU physicians and found interesting results. The level of exhaustion was 38.8%, somewhat better than generally found in the West. However, the level of depersonalization was 70.1%. This is really surprising; do Egyptian physicians really feel that much disconnected or disengaged from their patients?