Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.
Harvard Medical School, Boston, MA, United States.
JMIR Mhealth Uhealth. 2019 Oct 2;7(10):e13909. doi: 10.2196/13909.
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.
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.
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.
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 (3.5×103 vs 3.4×103; P=.79), high-frequency power (8.5×103 vs 8.3×103; 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.
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.
近年来，医生倦怠症的高发率，尤其是在急诊医学领域，引起了全国的关注。客观的工作压力衡量手段可以促进压力减轻干预措施的研究，而可穿戴光电容积脉搏波（PPG）技术已被提出作为一种潜在的解决方案。然而，使用低负担的可穿戴生物传感器来研究急诊医生（EP）的培训和临床实践仍有待检验。
本初步研究旨在：（1）确定从 EP 记录轮班期间光电容积脉搏波数据的可行性，（2）评估这些数据的质量，以及（3）从获取的数据集计算标准脉搏率变异性（PRV）指标，并检查整个学年这些变量的变化模式。
共有 21 名 EP 在急诊科临床工作期间，在手腕上佩戴 PPG 生物传感器，时长 9 小时。在学术年的第一季度和第四季度分别采集记录进行比较。计算每个时间段内可收集数据的总比例。计算这两个时间点的标准脉搏率（PR）和 PRV 指标，并进行学生 t 检验。
这些分析共输入了 400 多个小时的数据。总体上，可解释数据仅占总记录时间的 8.54%。与第一季度相比，在学术年的第四季度，中位数 PR（75.8 与 76.8；P=.57）、平均 R-R 间隔（0.81 与 0.80；P=.32）、R-R 间隔标准差（0.11 与 0.11；P=.93）、连续 R-R 间隔均方根差（0.81 与 0.80；P=.96）、低频功率（3.5×103 与 3.4×103；P=.79）、高频功率（8.5×103 与 8.3×103；P=.91）或低频到高频的比值（0.42 与 0.41；P=.43）均无显著差异。这些测试的功率估计值均大于.90。对仅住院医师亚组的二次分析也显示，尽管功率估计值大于.80，但随时间无显著差异。
尽管使用 PPG 生物传感器在提供临床护理的同时记录 EP 的实时生理数据在操作上似乎可行，但本研究未能支持这种方法可以有效地提供感兴趣的指标的可靠估计的观点。与年初相比，年末 PR 或 PRV 指标无显著差异。尽管这些方法可能在其他领域有有用的应用，但在医生培训和健康领域可能目前具有有限的实用性。
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