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<article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:ali="http://www.niso.org/schemas/ali/1.0/" article-type="research-article" dtd-version="1.2" xml:lang="en"><front><journal-meta><journal-id journal-id-type="publisher-id">Russian Medicine</journal-id><journal-title-group><journal-title xml:lang="en">Russian Medicine</journal-title><trans-title-group xml:lang="ru"><trans-title>Российский медицинский журнал</trans-title></trans-title-group></journal-title-group><issn publication-format="print">0869-2106</issn><issn publication-format="electronic">2412-9100</issn><publisher><publisher-name xml:lang="en">Eco-Vector</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">624424</article-id><article-id pub-id-type="doi">10.17816/medjrf624424</article-id><article-categories><subj-group subj-group-type="toc-heading" xml:lang="en"><subject>Original Research Articles</subject></subj-group><subj-group subj-group-type="toc-heading" xml:lang="ru"><subject>Оригинальные исследования</subject></subj-group><subj-group subj-group-type="article-type"><subject>Research Article</subject></subj-group></article-categories><title-group><article-title xml:lang="en">Prevalence of signs of professional burnout among medical workers involved in providing medical care for circulatory system diseases</article-title><trans-title-group xml:lang="ru"><trans-title>Распространённость признаков профессионального выгорания среди медицинских работников, участвующих в оказании высокотехнологичной помощи при лечении болезней системы кровообращения, и способы его профилактики</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-2279-3307</contrib-id><contrib-id contrib-id-type="spin">3972-2791</contrib-id><name-alternatives><name xml:lang="en"><surname>Artamonova</surname><given-names>Galina V.</given-names></name><name xml:lang="ru"><surname>Артамонова</surname><given-names>Галина Владимировна</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>MD, Dr. Sci. (Medicine), professor</p></bio><bio xml:lang="ru"><p>д-р мед. наук, профессор</p></bio><email>popsan@kemcardio.ru</email><xref ref-type="aff" rid="aff2"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-5162-0029</contrib-id><contrib-id contrib-id-type="spin">4652-0570</contrib-id><name-alternatives><name xml:lang="en"><surname>Popsuiko</surname><given-names>Artem N.</given-names></name><name xml:lang="ru"><surname>Попсуйко</surname><given-names>Артем Николаевич</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>Cand. Sci. (Philosophy)</p></bio><bio xml:lang="ru"><p>канд. филос. наук</p></bio><email>popsan@kemcardio.ru</email><xref ref-type="aff" rid="aff2"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-5521-4653</contrib-id><contrib-id contrib-id-type="spin">7252-5646</contrib-id><name-alternatives><name xml:lang="en"><surname>Agienko</surname><given-names>Alena S.</given-names></name><name xml:lang="ru"><surname>Агиенко</surname><given-names>Алена Сергеевна</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><email>agieas@kemcardio.ru</email><xref ref-type="aff" rid="aff2"/></contrib></contrib-group><aff-alternatives id="aff1"><aff><institution xml:lang="en">Research Institute for Complex Issues of Cardiovascular Diseases</institution></aff><aff><institution xml:lang="ru">Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний</institution></aff><aff><institution xml:lang="kk"></institution></aff><aff><institution xml:lang="pt"></institution></aff><aff><institution xml:lang="zh"></institution></aff></aff-alternatives><aff-alternatives id="aff2"><aff><institution xml:lang="en">Research Institute for Complex Issues of Cardiovascular Diseases</institution></aff><aff><institution xml:lang="ru">Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний</institution></aff></aff-alternatives><pub-date date-type="preprint" iso-8601-date="2024-04-20" publication-format="electronic"><day>20</day><month>04</month><year>2024</year></pub-date><pub-date date-type="pub" iso-8601-date="2024-05-17" publication-format="electronic"><day>17</day><month>05</month><year>2024</year></pub-date><volume>30</volume><issue>2</issue><issue-title xml:lang="en"/><issue-title xml:lang="ru"/><fpage>132</fpage><lpage>141</lpage><history><date date-type="received" iso-8601-date="2023-12-11"><day>11</day><month>12</month><year>2023</year></date><date date-type="accepted" iso-8601-date="2024-04-08"><day>08</day><month>04</month><year>2024</year></date></history><permissions><copyright-statement xml:lang="en">Copyright ©; 2024, Eco-Vector</copyright-statement><copyright-statement xml:lang="ru">Copyright ©; 2024, Эко-Вектор</copyright-statement><copyright-year>2024</copyright-year><copyright-holder xml:lang="en">Eco-Vector</copyright-holder><copyright-holder xml:lang="ru">Эко-Вектор</copyright-holder><ali:free_to_read xmlns:ali="http://www.niso.org/schemas/ali/1.0/" start_date="2027-05-17"/><license><ali:license_ref xmlns:ali="http://www.niso.org/schemas/ali/1.0/">https://creativecommons.org/licenses/by-nc-nd/4.0/</ali:license_ref></license></permissions><self-uri xlink:href="https://medjrf.com/0869-2106/article/view/624424">https://medjrf.com/0869-2106/article/view/624424</self-uri><abstract xml:lang="en"><p><italic>BACKGROUND:</italic> Among 13 thousand doctors interviewed in 2021, 42% displayed signs of professional burnout. This phenomenon negatively affects the frequency of repeated hospitalizations, the number of adverse events, and increased employee turnover. However, studies concerning burnout in doctors are rare and do not focus on specialists who provide medical care for patients with circulatory system diseases (CSD).</p> <p><italic>AIM:</italic> was to assess the level of burnout in medical workers involved in the provision of medical care for patients with CSD and to explore staff perceptions of its prevention.</p> <p><italic>MATERIALS AND METHODS:</italic> A sociological survey (based on the standardized Maslach Burnout Inventory questionnaire) was conducted among medical personnel (women represented the majority of the sample — 76%, men — 24%). The sample is represented by doctors (<italic>n</italic>=89), nursing staff and auxillary nurses (NSAN) (<italic>n</italic>=128). The mean age for the whole group of respondents was 40.7±0.7, professional experience lasted 12.0±0.6 years. Standard methods of descriptive statistics were used for the data analysis. The age characteristics of the group had no significant differences by professional categories. Doctors had 39.0±1.2 years (min — 24, max — 63), NSAN had 41.0±0.6 years (min — 19, max — 67). Professional experience lasted differed doctors 39.0±1.2 years, in NSAN — 12.3±0.8. Men were characterized by a mean age of 36.7±1.6 years and professional experience lasted 10.0±1.2 years and women 42.0±0.7 years and 12.6±0.7 years, respectively. The character of distribution of quantitative data in the presented study was analyzed using the Kolmogorov–Smirnov and Shapiro–Wilk criterion.</p> <p><italic>RESULTS:</italic> 80.2% of respondents presented with a high level of reduced professional accomplishments (RPA), 53.4% — a moderate average level of depersonalization. The emotional exhaustion was similar in all respondents, although average level of emotional exhaustion was the most prevalent (39.6%). 43.8% of doctors had an average level of emotional exhaustion, which is higher compared with NSAN — 37.5%. Clinical and paraclinical units are associated with a medium level of emotional exhaustion and a high RPA. At the same time, paraclinical units are characterized by a medium level of depersonalization, in contrast to clinical units, which are found to have a high level of this factor. According to the respondents, possible measures to prevent emotional burnout should include a set of measures including, rational distribution of responsibilities within departments, workload among the staff, as well as the formation of special skills to overcome stressful situations and optimization of activities with the help of digital solutions (support system for medical decisions, etc.).</p> <p><italic>CONCLUSION:</italic> Working as medical staff and providing medical care for patients with CSD is strongly associated with a high level of reduced professional accomplishments (80.2% of respondents). Proper measures for the prevention of emotional burnout should primarily include organizational solutions focused on optimizing internal processes in medical staff’ work. According to the respondents, among the measures aimed at the prevention of emotional burnout, the most demanded may be: rational distribution of responsibilities within departments, workload among staff, as well as the formation of special skills to overcome stressful situations and optimization of activities with the help of digital solutions (medical decision support system, etc.).</p></abstract><trans-abstract xml:lang="ru"><p><italic>Обоснование.</italic> Среди 13 тыс. американских врачей, опрошенных в 2021 году, у 42% выявлено профессиональное выгорание. Данное явление влияет на увеличение частоты повторных госпитализаций и числа нежелательных событий, усиливает текучесть кадров. Однако исследования, изучающие выгорание у врачей, немногочисленны и не охватывают специалистов, оказывающих высокотехнологичную медицинскую помощь при лечении болезней системы кровообращения (БСК).</p> <p><italic>Цель исследования</italic> — оценить текущий уровень профессионального выгорания медицинских работников, участвующих в оказании высокотехнологичной медицинской помощи при БСК, и изучить мнение сотрудников о мерах его профилактики.</p> <p><italic>Материалы и методы.</italic> Проведён социологический опрос медицинского персонала (76% женщин и 24% мужчин) на основе стандартизированного опросника Maslach Burnout Inventory. Выборка представлена врачами (<italic>n</italic>=89), младшим и средним медицинским персоналом (МиСМП) (<italic>n</italic>=128). Средний возраст в целом по группе респондентов составил 40,7±0,7 года, стаж — 12,0±0,6 года. Возрастные характеристики исследуемых не имели существенных отличий по профессиональным категориям: врачи — 39,0±1,2 года (min — 24, max — 63), МиСМП — 41,0±0,6 года (min — 19, max — 67). Распределение по стажу характеризовалось бόльшими отличиями: врачи — 39,0±1,2 года, МиСМП — 12,3±0,8 года. Средний возраст мужчин составил 36,7±1,6 года, стаж — 10,0±1,2 года; женщин — 42,0±0,7 и 12,6±0,7 года соответственно. Для анализа данных применяли стандартные методы описательной статистики. Характер распределения количественных данных в представленном исследовании анализировали с помощью критерия Колмогорова–Смирнова и Шапиро–Уилка.</p> <p><italic>Результаты.</italic> У 80,2% респондентов выявлен высокий уровень редукции профессиональных достижений (РПД), у 53,4% — средний уровень деперсонализации. Распределение по уровням эмоционального истощения выглядит равномерным за некоторым преимуществом среднего уровня (39,6%). У 43,8% врачей проявляется средней уровень эмоционального истощения, что выше, чем у МиСМП (37,5%). Клинические и параклинические подразделения ассоциируются со средним уровнем эмоционального истощения и высоким РПД. Одновременно параклинические подразделения характеризуются средним уровнем деперсонализации в отличие от клинических подразделений, у которых выявлен высокий уровень данного фактора. По мнению респондентов, возможные меры профилактики профессионального выгорания должны включать комплекс мероприятий: рациональное распределение обязанностей внутри подразделений, равномерное распределение нагрузки среди персонала, формирование специальных навыков преодоления стрессовых ситуаций, оптимизацию деятельности при помощи цифровых решений (система поддержки врачебных решений и пр.).</p> <p><italic>Заключение.</italic> Деятельность медицинского персонала, оказывающего высокотехнологичную медицинскую помощь при БСК, сопряжена в большей степени (80,2% респондентов) с высоким уровнем РПД. По мнению респондентов, необходим комплекс мер, направленных на профилактику профессионального выгорания, который включает рациональное распределение обязанностей и нагрузки, а также формирование специальных навыков преодоления стрессовых ситуаций. Кроме того, необходима оптимизация деятельности при помощи цифровых решений.</p></trans-abstract><kwd-group xml:lang="en"><kwd>occupational stress</kwd><kwd>work engagement</kwd><kwd>professional burnout</kwd><kwd>Maslach Burnout Inventory</kwd></kwd-group><kwd-group xml:lang="ru"><kwd>профессиональный стресс</kwd><kwd>вовлечённость в работу</kwd><kwd>профессиональное выгорание</kwd><kwd>Maslach Burnout Inventory</kwd></kwd-group><funding-group><award-group><funding-source><institution-wrap><institution xml:lang="ru">Правительство РФ</institution></institution-wrap><institution-wrap><institution xml:lang="en">Government of the Russian Federation</institution></institution-wrap></funding-source><award-id>122012000364-5</award-id></award-group></funding-group></article-meta></front><body></body><back><ref-list><ref id="B1"><label>1.</label><citation-alternatives><mixed-citation xml:lang="en">https://www.vademec.ru/ [Internet]. Medscape: 47% of US doctors experienced burnout in 2021 [cited: 2023 Jul 6]. Available from: https://www.vademec.ru/news/2022/01/28/medscape-v-2021-godu-47-vrachey-v-ssha-ispytali-emotsionalnoe-vygoranie/ (In Russ).</mixed-citation><mixed-citation xml:lang="ru">https://www.vademec.ru/ [интернет]. Medscape: в 2021 году 47% врачей в США испытали эмоциональное выгорание. Режим доступа: https://www.vademec.ru/news/2022/01/28/medscape-v-2021-godu-47-vrachey-v-ssha-ispytali-emotsionalnoe-vygoranie/ Дата обращения: 06.07.2023.</mixed-citation></citation-alternatives></ref><ref id="B2"><label>2.</label><citation-alternatives><mixed-citation xml:lang="en">Coleman DM, Money SR, Meltzer AJ, et al. Vascular surgeon wellness and burnout: a report from the Society for Vascular Surgery Wellness Task Force. J Vasc Surg. 2021;73(6):1841–1850.e3. doi: 10.1016/j.jvs.2020.10.065</mixed-citation><mixed-citation xml:lang="ru">Coleman D.M., Money S.R., Meltzer A.J., et al. Vascular surgeon wellness and burnout: a report from the Society for Vascular Surgery Wellness Task Force // J Vasc Surg. 2021. Vol. 73, N 6. P. 1841–1850.e3. doi: 10.1016/j.jvs.2020.10.065</mixed-citation></citation-alternatives></ref><ref id="B3"><label>3.</label><citation-alternatives><mixed-citation xml:lang="en">Chow OS, Sudarshan M, Maxfield MW, et al. National survey of burnout and distress among cardiothoracic surgery trainees. Ann Thorac Surg. 2021;111(6):2066–2071. doi: 10.1016/j.athoracsur.2020.06.062</mixed-citation><mixed-citation xml:lang="ru">Chow O.S., Sudarshan M., Maxfield M.W., et al. National survey of burnout and distress among cardiothoracic surgery trainees // Ann Thorac Surg. 2021. Vol. 111, N 6. P. 2066–2071. doi: 10.1016/j.athoracsur.2020.06.062</mixed-citation></citation-alternatives></ref><ref id="B4"><label>4.</label><citation-alternatives><mixed-citation xml:lang="en">West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, consequences and solutions. J Intern Med. 2018;283(6):516–529. doi: 10.1111/joim.12752</mixed-citation><mixed-citation xml:lang="ru">West C.P., Dyrbye L.N., Shanafelt T.D. Physician burnout: contributors, consequences and solutions // J Intern Med. 2018. Vol. 283, N 6. P. 516–529. doi: 10.1111/joim.12752</mixed-citation></citation-alternatives></ref><ref id="B5"><label>5.</label><citation-alternatives><mixed-citation xml:lang="en">Neplyueva GA, Soloveva AE, Krovopolenova SD, et al. Prevalence of professional burnout among practicing cardiologists in the constituent entities of the Russian Federation. Russian Journal of Cardiology. 2023;28(1S):16–26. EDN: TABKJG doi: 10.15829/1560-4071-2023-5320</mixed-citation><mixed-citation xml:lang="ru">Неплюева Г.А., Соловьева А.Е., Кривополенова С.Д., и др. Распространенность синдрома профессионального выгорания среди практикующих кардиологов в субъектах Российской Федерации // Российский кардиологический журнал. 2023. Т. 28, № 1S. С. 16–26. EDN: TABKJG doi: 10.15829/1560-4071-2023-5320</mixed-citation></citation-alternatives></ref><ref id="B6"><label>6.</label><citation-alternatives><mixed-citation xml:lang="en">Ibraev SА, Zharylkassyn ZZ, Оtаrоv ЕZ, Ismailov CU. Modern aspects of occupational risk among persons of mental labor (the literature review). Mezhdunarodnyj zhurnal prikladnyh i fundamental’nyh issledovanij. 2017;(3-1):62–65. EDN: YHGOML</mixed-citation><mixed-citation xml:lang="ru">Ибраев С.А., Жарылкасын Ж.Ж., Отаров Е.Ж., Исмаилов Ч.У. Современные аспекты профессионального риска у лиц умственного труда (обзор литературы) // Международный журнал прикладных и фундаментальных исследований. 2017. № 3-1. С. 62–65. EDN: YHGOML</mixed-citation></citation-alternatives></ref><ref id="B7"><label>7.</label><citation-alternatives><mixed-citation xml:lang="en">Galikeeva A, Idrisova G, Stepanov E, et al. Factors affecting health of the working population. Social Aspects of Population Health. 2022;68(2):3. EDN: HQTUBD doi: 10.21045/2071-5021-2021-68-2-3</mixed-citation><mixed-citation xml:lang="ru">Галикеева А.Ш., Идрисова Г.Б., Степанов Е.Г., и др. Факторы формирования здоровья работающего населения // Социальные аспекты здоровья населения. 2022. Т. 68, № 2. С. 3. EDN: HQTUBD doi: 10.21045/2071-5021-2021-68-2-3</mixed-citation></citation-alternatives></ref><ref id="B8"><label>8.</label><citation-alternatives><mixed-citation xml:lang="en">Nesyn VV, Nesyn SV. Burnout of health professionals. Online scientific &amp; educational bulletin zdorove i obrazovanie v xxi veke. 2019;21(6):19–23. EDN: TNQWGS doi: 10.26787/nydha-2226-7417-2019-21-6-19-23</mixed-citation><mixed-citation xml:lang="ru">Несын В.В., Несына С.В. Эмоциональное выгорание врачей // Электронный научно-образовательный вестник Здоровье и образование в XXI веке. 2019. Т. 21, № 6. С. 19–23. EDN: TNQWGS doi: 10.26787/nydha-2226-7417-2019-21-6-19-23</mixed-citation></citation-alternatives></ref><ref id="B9"><label>9.</label><citation-alternatives><mixed-citation xml:lang="en">Rubin B, Goldfarb R, Satele D, Graham L. Burnout and distress among nurses in a cardiovascular centre of a quaternary hospital network: a cross-sectional survey. CMAJ Open. 2021;9(1):E19–E28. doi: 10.9778/cmajo.20200058</mixed-citation><mixed-citation xml:lang="ru">Rubin B., Goldfarb R., Satele D., Graham L. Burnout and distress among nurses in a cardiovascular centre of a quaternary hospital network: a cross-sectional survey // CMAJ Open. 2021. Vol. 9, N 1. P. E19–E28. doi: 10.9778/cmajo.20200058</mixed-citation></citation-alternatives></ref><ref id="B10"><label>10.</label><citation-alternatives><mixed-citation xml:lang="en">Dyrbye LN, Satele D, Sloan J, Shanafelt TD. Utility of a brief screening tool to identify physicians in distress. J Gen Intern Med. 2013;28(3):421–427. doi: 10.1007/s11606-012-2252-9</mixed-citation><mixed-citation xml:lang="ru">Dyrbye L.N., Satele D., Sloan J., Shanafelt T.D. Utility of a brief screening tool to identify physicians in distress // J Gen Intern Med. 2013. Vol. 28, N 3. P. 421–427. doi: 10.1007/s11606-012-2252-9</mixed-citation></citation-alternatives></ref><ref id="B11"><label>11.</label><citation-alternatives><mixed-citation xml:lang="en">Menon NK, Shanafelt TD, Sinsky CA, et al. Association of physician burnout with suicidal ideation and medical errors. JAMA Netw Open. 2020;3(12):e2028780. doi: 10.1001/jamanetworkopen.2020.28780</mixed-citation><mixed-citation xml:lang="ru">Menon N.K., Shanafelt T.D., Sinsky C.A., et al. Association of physician burnout with suicidal ideation and medical errors // JAMA Netw Open. 2020. Vol. 3, N 12. P. e2028780. doi: 10.1001/jamanetworkopen.2020.28780</mixed-citation></citation-alternatives></ref><ref id="B12"><label>12.</label><citation-alternatives><mixed-citation xml:lang="en">Riley MR, Mohr DC, Waddimba AC. The reliability and validity of three-item screening measures for burnout: evidence from group-employed health care practitioners in upstate New York. Stress Health. 2018;34(1):187–193. doi: 10.1002/smi.2762</mixed-citation><mixed-citation xml:lang="ru">Riley M.R., Mohr D.C., Waddimba A.C. The reliability and validity of three-item screening measures for burnout: evidence from group-employed health care practitioners in upstate New York // Stress Health. 2018. Vol. 34, N 1. P. 187–193. doi: 10.1002/smi.2762</mixed-citation></citation-alternatives></ref><ref id="B13"><label>13.</label><citation-alternatives><mixed-citation xml:lang="en">Vasilieva LN, Ksenofontova AG. Prevalence of burnout syndrome among doctors. Zdravookhranenie Chuvashii. 2020;(1):10–16. EDN: ABLFFO doi: 10.25589/GIDUV.2020.45.52.001</mixed-citation><mixed-citation xml:lang="ru">Васильева Л.Н., Ксенофонтова А.Г. Распространенность синдрома эмоционального выгорания среди врачей // Здравоохранение Чувашии. 2020. № 1. С. 10–16. EDN: ABLFFO doi: 10.25589/GIDUV.2020.45.52.001</mixed-citation></citation-alternatives></ref><ref id="B14"><label>14.</label><citation-alternatives><mixed-citation xml:lang="en">Shanafelt TD, Sloan JA, Habermann TM. The well-being of physicians. Am J Med. 2003;114(6):513–519. doi: 10.1016/s0002-9343(03)00117-7</mixed-citation><mixed-citation xml:lang="ru">Shanafelt T.D., Sloan J.A., Habermann T.M. The well-being of physicians // Am J Med. 2003. Vol. 114, N 6. P. 513–519. doi: 10.1016/s0002-9343(03)00117-7</mixed-citation></citation-alternatives></ref><ref id="B15"><label>15.</label><citation-alternatives><mixed-citation xml:lang="en">Romani M, Ashkar K. Burnout among physicians. Libyan J Med. 2014;9(1):23556. doi: 10.3402/ljm.v9.23556</mixed-citation><mixed-citation xml:lang="ru">Romani M., Ashkar K. Burnout among physicians // Libyan J Med. 2014. Vol. 9, N 1. P. 23556. doi: 10.3402/ljm.v9.23556</mixed-citation></citation-alternatives></ref><ref id="B16"><label>16.</label><citation-alternatives><mixed-citation xml:lang="en">Mikalauskas A, Širvinskas E, Marchertienė I, et al. Burnout among Lithuanian cardiac surgeons and cardiac anesthesiologists. Medicina (Kaunas). 2012;48(9):478–484. doi: 10.3390/medicina48090071</mixed-citation><mixed-citation xml:lang="ru">Mikalauskas A., Širvinskas E., Marchertienė I., et al. Burnout among Lithuanian cardiac surgeons and cardiac anesthesiologists // Medicina (Kaunas). 2012. Vol. 48, N 9. P. 478–484. doi: 10.3390/medicina48090071</mixed-citation></citation-alternatives></ref><ref id="B17"><label>17.</label><citation-alternatives><mixed-citation xml:lang="en">Patel RS, Sekhri S, Bhimanadham NN, et al. A review on strategies to manage physician burnout. Cureus. 2019;11(6):e4805. doi: 10.7759/cureus.4805</mixed-citation><mixed-citation xml:lang="ru">Patel R.S., Sekhri S., Bhimanadham N.N., et al. A review on strategies to manage physician burnout // Cureus. 2019. Vol. 11, N 6. P. e4805. doi: 10.7759/cureus.4805</mixed-citation></citation-alternatives></ref><ref id="B18"><label>18.</label><citation-alternatives><mixed-citation xml:lang="en">Murashkin MS, Sharshakova TM. Burnout syndrome in the professional work of doctors. Health and Ecology Issues. 2020;(2):119–123. EDN: ARNKAG</mixed-citation><mixed-citation xml:lang="ru">Мурашкин М.С., Шаршакова Т.М. Синдром эмоционального выгорания в профессиональной деятельности врачей // Проблемы здоровья и экологии. 2020. № 2. С. 119–123. EDN: ARNKAG</mixed-citation></citation-alternatives></ref><ref id="B19"><label>19.</label><citation-alternatives><mixed-citation xml:lang="en">Nikushina MM. Emotional burnout in doctor’s practice: how to bring down the “flame”? StatusPraesens. Pediatrija i neonatologija. 2020;(3-4):23–31. (In Russ). EDN: PSDUDK</mixed-citation><mixed-citation xml:lang="ru">Никушина М.М. Эмоциональное выгорание в практике врача: как сбить «пламя»? // StatusPraesens. Педиатрия и неонатология. 2020. № 3-4. С. 23–31. EDN: PSDUDK</mixed-citation></citation-alternatives></ref></ref-list></back></article>
