***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Purpose Staff behaviours to optimise patient safety may be influenced by burnout , depression and strength of the safety culture . We evaluated whether burnout , symptoms of depression and safety culture affected the frequency of medical errors and adverse events ( selected using Delphi techniques ) in ICUs . Methods Prospect i ve , observational , multicentre ( 31 ICUs ) study from August 2009 to December 2011 . Results Burnout , depression symptoms and safety culture were evaluated using the Maslach Burnout Inventory ( MBI ) , CES-Depression scale and Safety Attitudes Question naire , respectively . Of 1,988 staff members , 1,534 ( 77.2 % ) participated . Frequencies of medical errors and adverse events were 804.5/1,000 and 167.4/1,000 patient-days , respectively . Burnout prevalence was 3 or 40 % depending on the definition ( severe emotional exhaustion , depersonalisation and low personal accomplishment ; or MBI score greater than −9 ) . Depression symptoms were identified in 62/330 ( 18.8 % ) physicians and 188/1,204 ( 15.6 % ) nurses/nursing assistants . Median safety culture score was 60.7/100 [ 56.8–64.7 ] in physicians and 57.5/100 [ 52.4–61.9 ] in nurses/nursing assistants . Depression symptoms were an independent risk factor for medical errors . Burnout was not associated with medical errors . The safety culture score had a limited influence on medical errors . Other independent risk factors for medical errors or adverse events were related to ICU organisation ( 40 % of ICU staff off work on the previous day ) , staff ( specific safety training ) and patients ( workload ) . One-on-one training of junior physicians during duties and existence of a hospital risk-management unit were associated with lower risks . Conclusions The frequency of selected medical errors in ICUs was high and was increased when staff members had symptoms of depression The presence of hope has been found to influence an individual 's ability to cope with stressful situations . The objective of this study is to evaluate the relationship between medical errors , hope and burnout among practicing physicians using vali date d metrics . Prospect i ve cohort study was conducted among hospital based physicians practicing in Japan ( N = 836 ) . Measures included the  vali  date  d Burnout Scale , self- assessment of medical errors and Herth Hope Index ( HHI ) . The main outcome measure was the frequency of self-perceived medical errors , and Poisson regression analysis was used to evaluate the association between hope and medical error . A total of 361 errors were reported in 836 physician-years . We observed a significant association between hope and self-report of medical errors . Compared with the lowest tertile category of HHI , incidence rate ratios ( IRRs ) of self-perceived medical errors of physicians in the highest category were 0.44 ( 95%CI , 0.34 to 0.58 ) and 0.54 ( 95%CI , 0.42 to 0.70 ) respectively , for the 2nd and 3rd tertile . In stratified analysis by hope score , among physicians with a low hope score , those who experienced higher burnout reported higher incidence of errors ; physicians with high hope scores did not report high incidences of errors , even if they experienced high burnout . Self-perceived medical errors showed a strong association with physicians ' hope , and hope modified the association between physicians ' burnout and self-perceived medical errors AIMS We examined the impact of workplace relationships ( perceived organizational support , supervisor-nurse relationships and teamwork ) on the engagement , well-being , organizational commitment and turnover intentions of nurses working in Australian and USA hospitals . BACKGROUND In a global context of nurse shortages , knowledge about factors impacting nurse retention is urgently sought . We postulated , using the Social Exchange Theory , that nurses '  turnover intentions would be affected by several factors and especially their relationships at work . DESIGN Based on the literature review , data were collected via a self-report survey to test the hypotheses . METHODS A self-report survey was used to gather data in 2010 - 2012 from 510 r and omly chosen nurses from Australian hospitals and 718 nurses from US hospitals . A multi-group structural equation modelling analysis identified significant paths and compared the impact between countries . RESULTS The findings indicate that this model was more effective in predicting the correlations between variables for nurses in Australia compared with the USA . Most paths predicted were confirmed for Australia , except for the impact of teamwork on organizational commitment and turnover , plus the impact of engagement on turnover . In contrast , none of the paths related to supervisor-subordinate relationships was significant for the USA ; neither were the paths from teamwork to organizational commitment or turnover . CONCLUSION Our findings suggest that well-being is a predictor of turnover intentions , meaning that healthcare managers need to consider nurses ' well-being in everyday decision-making , especially in the cost-cutting paradigm that pervades healthcare provision in nearly every country . This is important because nurses are in short supply and this situation will continue to worsen , because many countries have an ageing population RATIONALE The stressful work environment of ICUs can lead to burnout . Burnout can impact on the welfare and performance of caregivers , and may lead them to resign their job . The shortage of ICU caregivers is becoming a real threat for health care leaders . OBJECTIVES To investigate the factors associated with burnout on a national level in order to determine potential important factors . METHODS Prospect i ve , multicenter , observational survey of all caregivers from 74 of the 92 Swiss ICUs , measuring the prevalence of burnout among the caregivers and the pre-specified center- , patient- and caregiver-related factors influencing its prevalence . MEASUREMENTS AND MAIN RESULTS Out of the 4322 question naires distributed from March 2006 to April 2007 , 3052 ( 71 % ) were returned , with a response rate of 72 % by center , 69 % from nurse-assistants , 73 % from nurses and 69 % from physicians . A high proportion of female nurses among the team was associated with a decreased individual risk of high burnout ( OR 0.98 , 95 % CI:0.97 - 0.99 for every % ) . The caregiver-related factors associated with a high risk of burnout were being a nurse-assistant , being a male , having no children and being under 40 years old . CONCLUSIONS The findings of this study seem to open a new frontier concerning burnout in ICUs , highlighting the importance of team composition . Our results should be confirmed in a prospect i ve multicenter , multinational study . Whether our results can be exported to other medical setting s where team-working is pivotal remains to be investigated CONTEXT Medical errors are associated with feelings of distress in physicians , but little is known about the magnitude and direction of these associations . OBJECTIVE To assess the frequency of self-perceived medical errors among resident physicians and to determine the association of self-perceived medical errors with resident quality of life , burnout , depression , and empathy using vali date d metrics . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve longitudinal cohort study of categorical and preliminary internal medicine residents at Mayo Clinic Rochester . Data were provided by 184 ( 84 % ) of 219 eligible residents . Participants began training in the 2003 - 2004 , 2004 - 2005 , and 2005 - 2006 academic years and completed surveys quarterly through May 2006 . Surveys included self- assessment of medical errors and linear analog scale assessment of quality of life every 3 months , and the Maslach Burnout Inventory ( depersonalization , emotional exhaustion , and personal accomplishment ) , Interpersonal Reactivity Index , and a vali date d depression screening tool every 6 months . MAIN OUTCOME MEASURES Frequency of self-perceived medical errors was recorded . Associations of an error with quality of life , burnout , empathy , and symptoms of depression were determined using generalized estimating equations for repeated measures . RESULTS Thirty-four percent of participants reported making at least 1 major medical error during the study period . Making a medical error in the previous 3 months was reported by a mean of 14.7 % of participants at each quarter . Self-perceived medical errors were associated with a subsequent decrease in quality of life ( P = .02 ) and worsened measures in all domains of burnout ( P = .002 for each ) . Self-perceived errors were associated with an odds ratio of screening positive for depression at the subsequent time point of 3.29 ( 95 % confidence interval , 1.90 - 5.64 ) . In addition , increased burnout in all domains and reduced empathy were associated with increased odds of self-perceived error in the following 3 months ( P=.001 , P<.001 , and P=.02 for depersonalization , emotional exhaustion , and lower personal accomplishment , respectively ; P=.02 and P=.01 for emotive and cognitive empathy , respectively ) . CONCLUSIONS Self-perceived medical errors are common among internal medicine residents and are associated with substantial subsequent personal distress . Personal distress and decreased empathy are also associated with increased odds of future self-perceived errors , suggesting that perceived errors and distress may be related in a reciprocal cycle PURPOSE To investigate if differences in antecedents of severe and nonsevere medication errors exist . DESIGN A longitudinal study of 6 months of data from 279 nursing units in 146 r and omly selected hospitals in the United States ( US ) . METHODS Antecedents of severe and nonsevere medication errors included  work environment factors ( work dynamics and RN hours )  ,  team factors ( communication with physicians and nurses ' expertise ) ,  person factors ( nurses ' education and experience ) ,  patient factors  ( age , health status , and previous hospitalization ) , and medication-related support services . Generalized estimating equations with a negative binomial distribution were used with nursing units as the unit of analysis . FINDINGS None of the antecedents allowed predicting both types of medication errors . Nurses ' expertise had a negative and medication-related support services had a positive association with nonsevere medication errors . Nurses ' educational level had a significant nonlinear relationship with severe medication errors only : As the percentage of unit BSN-prepared nurses increased , severe medication errors decreased until the percentage of BSN-prepared nurses reached 54 % . In contrast , RN experience had a statistically significant relationship with nonsevere medication errors only and nursing units with more experienced nurses reported more nonsevere medication errors . CONCLUSIONS Severe and nonsevere medication errors might have different antecedents . CLINICAL RELEVANCE Error prevention and management strategies should be targeted to specific types of medication errors for best results AIM Whether mental stress negatively impacts team performance during  cardio-pulmonary resuscitation ( CPR )  remains controversial ; this may partly be explained by differences in stress measures used in previous studies . Our aim was to compare self-reported , biochemical and physiological stress measures in regard to CPR performance . METHODS This prospect i ve , observational study was conducted at the simulator center of the University Hospital Basel , Switzerl and .  Self-reported ( feeling stressed and overwhelmed [ stress/overload  ] )  , biochemical ( plasma cortisol ) and physiological ( heart rate , heart rate variability ) stress measures  were assessed in 28 residents ( teams of 2 ) before , during and after resuscitation .  Team performance was defined as time to start CPR and h and s-on time during the first 180 s. RESULTS At baseline , significant negative correlations of heart rate variability with stress/overload and heart rate , as well as positive correlations of heart rate and cortisol were found . During resuscitation , self-reported , biochemical and physiological stress measures did not correlate significantly . There was no association of baseline stress measures with performance . During CPR , stress/overload was significantly associated with time to start CPR ( regression coefficient 12.01 ( 95 % CI 0.65 , 23.36 ) , p=0.04 ) , while heart rate was negatively associated with time to start CPR ( regression coefficient -0.78 ( 95 % CI -1.44 , -0.11 ) , p=0.027 ) and positively with h and s-on time ( regression coefficient 2.22 ( 95 % CI 0.53 , 3.92 ) , p=0.015 ) . CONCLUSIONS  Self-reported stress ( stress/overload ) was the only predictor for low CPR performance . Biochemical measures showed no association , and physiological measures ( heart rate ) showed an inverse association , which may be due to physical activity , limiting its value as a mental stress marker in this acute setting The influence of teammates ' shared mental models on team processes and performance was tested using 56 undergraduate dyads who " flew " a series of missions on a personal-computer-based flight-combat simulation .  The authors both conceptually and empirically distinguished between teammates ' task- and team-based mental models and indexed their convergence or " sharedness " using individually completed paired-comparisons matrices analyzed using a network-based algorithm . The results illustrated that both shared-team- and task-based mental models related positively to subsequent team process and performance . Furthermore , team processes fully mediated the relationship between mental model convergence and team effectiveness . Results are discussed in terms of the role of shared cognitions in team effectiveness and the applicability of different interventions design ed to achieve such convergence Patient care in hospital setting s requires coordinated team performance . Studies in other industries show that successful teams adapt their coordination processes to the situational task requirements . This prospect i ve field study aim ed to test a new observation system and investigate patterns of adaptive coordination within operating room teams . A trained observer recorded coordination activities during  
    Output:
    
We found support for the existence of independent associations between teamwork , clinician occupational well-being and patient safety .