<?xml version="1.0" encoding="ISO-8859-1"?><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">
<front>
<journal-meta>
<journal-id>2524-177X</journal-id>
<journal-title><![CDATA[Revista médica del Hospital General de México]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. med. Hosp. Gen. Méx.]]></abbrev-journal-title>
<issn>2524-177X</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Médica del Hospital General de México A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2524-177X2020000100026</article-id>
<article-id pub-id-type="doi">10.24875/hgmx.19000026</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Burnout syndrome in surgeons, surgery residents, and medical students: Prevalence and associated factors]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Revilla-Pacheco]]></surname>
<given-names><![CDATA[Francisco]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rodriguez-Salgado]]></surname>
<given-names><![CDATA[Pamela]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Manrique-Guzman]]></surname>
<given-names><![CDATA[Salvador]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Herrada-Pineda]]></surname>
<given-names><![CDATA[Tenoch]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Llaca-Garcia]]></surname>
<given-names><![CDATA[Elvira]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,The American British Cowdray Medical Center Centro Neurológico ]]></institution>
<addr-line><![CDATA[ State of Mexico]]></addr-line>
<country>Mexico</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad Anáhuac Facultad de Bioética ]]></institution>
<addr-line><![CDATA[ State of Mexico]]></addr-line>
<country>Mexico</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>03</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>03</month>
<year>2020</year>
</pub-date>
<volume>83</volume>
<numero>1</numero>
<fpage>26</fpage>
<lpage>32</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S2524-177X2020000100026&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S2524-177X2020000100026&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S2524-177X2020000100026&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[ Objective: The aim of the study was to determine the burnout syndrome's prevalence in surgeons, surgery residents and medical students in a private institution using the Maslach Burnout Inventory and to analyze associated factors related to the presence of this syndrome.  Materials and methods: Once approved by the Ethics and Research Committee from our Institution, the Maslach Burnout Inventory was used to identify the presence of burnout syndrome in a sample of 72 physicians at the surgery service. The diagnosis of burnout syndrome was defined as the association of a high level of emotional exhaustion and depersonalization with a low level of professional achievement. Its prevalence was determined and an analysis of demographic factors and bioethical training was performed. The relationship of these factors was examined concerning the syndrome's presence or absence, using Fisher's exact test, Chi-square, and Mann-Whitney U-test. Finally, a logistic univariate and multivariate regression analysis applied.  Results: A 65% (Confidence interval 95% 54-76) burnout syndrome global prevalence was found. The prevalence found in medical students was 67%, in surgery residents 76%, and in surgeons 45.5%. Statistical significance was found between the absence of the syndrome and bioethics training (p = 0.000), presence of burnout syndrome, age (higher risk in young people, p = 0.020), and working hours per week (higher risk in subjects with higher workload p = 0.034). No statistical relationship was observed between the burnout syndrome and the gender or the medical position.  Conclusions: High burnout syndrome prevalence was found in the medical population from the department of surgery at our institution. This study suggests that the proper knowledge of bioethical aspects in the practice of medicine is a cardinal element that protects against the development of burnout syndrome. The present study points toward an appropriate bioethics training as a preventive factor of the burnout syndrome.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Burnout syndrome]]></kwd>
<kwd lng="en"><![CDATA[Maslach burnout inventory]]></kwd>
<kwd lng="en"><![CDATA[Bioethics]]></kwd>
<kwd lng="en"><![CDATA[Stress]]></kwd>
<kwd lng="en"><![CDATA[Surgery]]></kwd>
<kwd lng="en"><![CDATA[Surgeons]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Maslach]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Schaufeli]]></surname>
<given-names><![CDATA[WB]]></given-names>
</name>
<name>
<surname><![CDATA[Leiter]]></surname>
<given-names><![CDATA[MP]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Job burnout]]></article-title>
<source><![CDATA[Annu Rev Psychol]]></source>
<year>2001</year>
<volume>52</volume>
<page-range>397-422</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Squiers]]></surname>
<given-names><![CDATA[JJ]]></given-names>
</name>
<name>
<surname><![CDATA[Lobdell]]></surname>
<given-names><![CDATA[KW]]></given-names>
</name>
<name>
<surname><![CDATA[Fann]]></surname>
<given-names><![CDATA[JI]]></given-names>
</name>
<name>
<surname><![CDATA[DiMaio]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Physician burnout:are we treating the symptoms instead of the disease?]]></article-title>
<source><![CDATA[Ann Thorac Surg]]></source>
<year>2017</year>
<volume>104</volume>
<page-range>1117-22</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Steinmeier]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Rachinger]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Kaus]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Ganslandt]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
<name>
<surname><![CDATA[Huk]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
<name>
<surname><![CDATA[Fahlbusch]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Factors influencing the application accuracy of neuronavigation systems]]></article-title>
<source><![CDATA[Stereotact Funct Neurosurg]]></source>
<year>2000</year>
<volume>75</volume>
<page-range>188-202</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Shanafelt]]></surname>
<given-names><![CDATA[TD]]></given-names>
</name>
<name>
<surname><![CDATA[Sloan]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
<name>
<surname><![CDATA[Habermann]]></surname>
<given-names><![CDATA[TM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The well-being of physicians]]></article-title>
<source><![CDATA[Am J Med]]></source>
<year>2003</year>
<volume>114</volume>
<page-range>513-9</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Dyrbye]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Shanafelt]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Timbros]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Timbros-Kemper]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
</person-group>
<collab>Protecting and Promoting the Well-being of Surgeons</collab>
<source><![CDATA[Basics of Surgery]]></source>
<year>2007</year>
<page-range>177-84</page-range><publisher-loc><![CDATA[Maarssen ]]></publisher-loc>
<publisher-name><![CDATA[Elsevier Gezondheidzorg]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Green]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Duthie]]></surname>
<given-names><![CDATA[HL]]></given-names>
</name>
<name>
<surname><![CDATA[Young]]></surname>
<given-names><![CDATA[HL]]></given-names>
</name>
<name>
<surname><![CDATA[Peters]]></surname>
<given-names><![CDATA[TJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Stress in surgeons]]></article-title>
<source><![CDATA[Br J Surg]]></source>
<year>1990</year>
<volume>77</volume>
<page-range>1154-8</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kent]]></surname>
<given-names><![CDATA[GG]]></given-names>
</name>
<name>
<surname><![CDATA[Johnson]]></surname>
<given-names><![CDATA[AG]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Conflicting demands in surgical practice]]></article-title>
<source><![CDATA[Ann R Coll Surg. Engl]]></source>
<year>1995</year>
<volume>77</volume>
<page-range>235-8</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Shanafelt]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A career in surgical oncology:finding meaning, balance, and personal satisfaction]]></article-title>
<source><![CDATA[Ann Surg Oncol]]></source>
<year>2008</year>
<volume>15</volume>
<page-range>400-6</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Campbell Jr]]></surname>
<given-names><![CDATA[DA]]></given-names>
</name>
<name>
<surname><![CDATA[Sonnad]]></surname>
<given-names><![CDATA[SS]]></given-names>
</name>
<name>
<surname><![CDATA[Eckhauser]]></surname>
<given-names><![CDATA[FE]]></given-names>
</name>
<name>
<surname><![CDATA[Campbell]]></surname>
<given-names><![CDATA[KK]]></given-names>
</name>
<name>
<surname><![CDATA[Greenfield]]></surname>
<given-names><![CDATA[LJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Burnout among American surgeons]]></article-title>
<source><![CDATA[Surgery]]></source>
<year>2001</year>
<volume>130</volume>
<page-range>696-702</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Harms]]></surname>
<given-names><![CDATA[BA]]></given-names>
</name>
<name>
<surname><![CDATA[Heise]]></surname>
<given-names><![CDATA[CP]]></given-names>
</name>
<name>
<surname><![CDATA[Gould]]></surname>
<given-names><![CDATA[JC]]></given-names>
</name>
<name>
<surname><![CDATA[Starling]]></surname>
<given-names><![CDATA[JR]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A 25-year single institution analysis of health, practice, and fate of general surgeons]]></article-title>
<source><![CDATA[Ann Surg]]></source>
<year>2005</year>
<volume>242</volume>
<page-range>520-6</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kuerer]]></surname>
<given-names><![CDATA[HM]]></given-names>
</name>
<name>
<surname><![CDATA[Eberlein]]></surname>
<given-names><![CDATA[TJ]]></given-names>
</name>
<name>
<surname><![CDATA[Pollock]]></surname>
<given-names><![CDATA[RE]]></given-names>
</name>
<name>
<surname><![CDATA[Huschka]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Baile]]></surname>
<given-names><![CDATA[WF]]></given-names>
</name>
<name>
<surname><![CDATA[Morrow]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Career satisfaction, practice patterns and burnout among surgical oncologists:report on the quality of life of members of the Society of Surgical Oncology]]></article-title>
<source><![CDATA[Ann Surg Oncol]]></source>
<year>2007</year>
<volume>14</volume>
<page-range>3043-53</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Shanafelt]]></surname>
<given-names><![CDATA[TD]]></given-names>
</name>
<name>
<surname><![CDATA[Bradley]]></surname>
<given-names><![CDATA[KA]]></given-names>
</name>
<name>
<surname><![CDATA[Wipf]]></surname>
<given-names><![CDATA[JE]]></given-names>
</name>
<name>
<surname><![CDATA[Back]]></surname>
<given-names><![CDATA[AL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Burnout and self-reported patient care in an internal medicine residency program]]></article-title>
<source><![CDATA[Ann Intern Med]]></source>
<year>2002</year>
<volume>136</volume>
<page-range>358-67</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Shanafelt]]></surname>
<given-names><![CDATA[TD]]></given-names>
</name>
<name>
<surname><![CDATA[Balch]]></surname>
<given-names><![CDATA[CM]]></given-names>
</name>
<name>
<surname><![CDATA[Bechamps]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Russell]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Dyrbye]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Satele]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Burnout and medical errors among American surgeons]]></article-title>
<source><![CDATA[Ann Surg]]></source>
<year>2010</year>
<volume>251</volume>
<page-range>995-1000</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[West]]></surname>
<given-names><![CDATA[CP]]></given-names>
</name>
<name>
<surname><![CDATA[Huschka]]></surname>
<given-names><![CDATA[MM]]></given-names>
</name>
<name>
<surname><![CDATA[Novotny]]></surname>
<given-names><![CDATA[PJ]]></given-names>
</name>
<name>
<surname><![CDATA[Sloan]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
<name>
<surname><![CDATA[Kolars]]></surname>
<given-names><![CDATA[JC]]></given-names>
</name>
<name>
<surname><![CDATA[Habermann]]></surname>
<given-names><![CDATA[TM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Association of perceived medical errors with resident distress and empathy:a prospective longitudinal study]]></article-title>
<source><![CDATA[JAMA]]></source>
<year>2006</year>
<volume>296</volume>
<page-range>1071-8</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Firth-Cozens]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Greenhalgh]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Doctors'perceptions of the links between stress and lowered clinical care]]></article-title>
<source><![CDATA[Soc Sci Med]]></source>
<year>1997</year>
<volume>44</volume>
<page-range>1017-22</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Meier]]></surname>
<given-names><![CDATA[DE]]></given-names>
</name>
<name>
<surname><![CDATA[Back]]></surname>
<given-names><![CDATA[AL]]></given-names>
</name>
<name>
<surname><![CDATA[Morrison]]></surname>
<given-names><![CDATA[RS]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The inner life of physicians and care of the seriously ill]]></article-title>
<source><![CDATA[JAMA]]></source>
<year>2001</year>
<volume>286</volume>
<page-range>3007-14</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[van Mol]]></surname>
<given-names><![CDATA[MM]]></given-names>
</name>
<name>
<surname><![CDATA[Kompanje]]></surname>
<given-names><![CDATA[EJ]]></given-names>
</name>
<name>
<surname><![CDATA[Benoit]]></surname>
<given-names><![CDATA[DD]]></given-names>
</name>
<name>
<surname><![CDATA[Bakker]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Nijkamp]]></surname>
<given-names><![CDATA[MD]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The prevalence of compassion fatigue and burnout among healthcare professionals in intensive care units:a systematic review]]></article-title>
<source><![CDATA[PLoS One]]></source>
<year>2015</year>
<volume>10</volume>
</nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Spickard Jr]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Gabbe SG, Christensen JF. Mid-career burnout in generalist and specialist physicians]]></article-title>
<source><![CDATA[JAMA]]></source>
<year>2002</year>
<volume>288</volume>
<page-range>1447-50</page-range></nlm-citation>
</ref>
<ref id="B19">
<label>19</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Shanafelt]]></surname>
<given-names><![CDATA[TD]]></given-names>
</name>
<name>
<surname><![CDATA[Novotny]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Johnson]]></surname>
<given-names><![CDATA[ME]]></given-names>
</name>
<name>
<surname><![CDATA[Zhao]]></surname>
<given-names><![CDATA[X]]></given-names>
</name>
<name>
<surname><![CDATA[Steensma]]></surname>
<given-names><![CDATA[DP]]></given-names>
</name>
<name>
<surname><![CDATA[Lacy]]></surname>
<given-names><![CDATA[MQ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The well-being and personal wellness promotion strategies of medical oncologists in the North Central Cancer Treatment Group]]></article-title>
<source><![CDATA[Oncology]]></source>
<year>2005</year>
<volume>68</volume>
<page-range>23-32</page-range></nlm-citation>
</ref>
<ref id="B20">
<label>20</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Shanafelt]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Chung]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[White]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Lyckholm]]></surname>
<given-names><![CDATA[LJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Shaping your career to maximize personal satisfaction in the practice of oncology]]></article-title>
<source><![CDATA[J Clin Oncol]]></source>
<year>2006</year>
<volume>24</volume>
<page-range>4020-6</page-range></nlm-citation>
</ref>
<ref id="B21">
<label>21</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Balch]]></surname>
<given-names><![CDATA[CM]]></given-names>
</name>
<name>
<surname><![CDATA[Shanafelt]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Combating stress and burnout in surgical practice:a review]]></article-title>
<source><![CDATA[Thorac Surg Clin]]></source>
<year>2011</year>
<volume>21</volume>
<page-range>417-30</page-range></nlm-citation>
</ref>
<ref id="B22">
<label>22</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[McCullough]]></surname>
<given-names><![CDATA[LB]]></given-names>
</name>
<name>
<surname><![CDATA[Jones]]></surname>
<given-names><![CDATA[JW]]></given-names>
</name>
<name>
<surname><![CDATA[Brody]]></surname>
<given-names><![CDATA[BA]]></given-names>
</name>
</person-group>
<source><![CDATA[Surgical Ethics]]></source>
<year>1998</year>
<publisher-loc><![CDATA[New York ]]></publisher-loc>
<publisher-name><![CDATA[Oxford University Press]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B23">
<label>23</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ford]]></surname>
<given-names><![CDATA[PJ]]></given-names>
</name>
<name>
<surname><![CDATA[DeMarco]]></surname>
<given-names><![CDATA[JP]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Brains, ethics, and elective surgeries:emerging ethics consultation]]></article-title>
<source><![CDATA[Ethics Med]]></source>
<year>2007</year>
<volume>23</volume>
<page-range>39</page-range></nlm-citation>
</ref>
<ref id="B24">
<label>24</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Breen]]></surname>
<given-names><![CDATA[KJ]]></given-names>
</name>
</person-group>
<source><![CDATA[Ethics, Law, and Medical Practice]]></source>
<year>1997</year>
<publisher-loc><![CDATA[St Leonards ]]></publisher-loc>
<publisher-name><![CDATA[Allen and Unwin]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B25">
<label>25</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Pearson]]></surname>
<given-names><![CDATA[SD]]></given-names>
</name>
<name>
<surname><![CDATA[Sabin]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Emanuel]]></surname>
<given-names><![CDATA[EJ]]></given-names>
</name>
</person-group>
<source><![CDATA[No Margin, No Mission:Health Care Organizations and the Quest for Ethical Excellence]]></source>
<year>2003</year>
<publisher-loc><![CDATA[New York ]]></publisher-loc>
<publisher-name><![CDATA[Oxford University Press]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B26">
<label>26</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Dyrbye]]></surname>
<given-names><![CDATA[LN]]></given-names>
</name>
<name>
<surname><![CDATA[Thomas]]></surname>
<given-names><![CDATA[MR]]></given-names>
</name>
<name>
<surname><![CDATA[Huschka]]></surname>
<given-names><![CDATA[MM]]></given-names>
</name>
<name>
<surname><![CDATA[Lawson]]></surname>
<given-names><![CDATA[KL]]></given-names>
</name>
<name>
<surname><![CDATA[Novotny]]></surname>
<given-names><![CDATA[PJ]]></given-names>
</name>
<name>
<surname><![CDATA[Sloan]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A multicenter study of burnout, depression, and quality of life in minority and nonminority US medical students]]></article-title>
<source><![CDATA[Mayo Clin Proc]]></source>
<year>2006</year>
<volume>81</volume>
<page-range>1435-42</page-range></nlm-citation>
</ref>
<ref id="B27">
<label>27</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Shanafelt]]></surname>
<given-names><![CDATA[TD]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Finding meaning, balance, and personal satisfaction in the practice of oncology]]></article-title>
<source><![CDATA[J Support Oncol]]></source>
<year>2005</year>
<volume>3</volume>
<page-range>157-62</page-range></nlm-citation>
</ref>
<ref id="B28">
<label>28</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Maslach]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Jackson]]></surname>
<given-names><![CDATA[SE]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The measurement of experienced burnout]]></article-title>
<source><![CDATA[J Organ Behav]]></source>
<year>1981</year>
<volume>2</volume>
<page-range>99-113</page-range></nlm-citation>
</ref>
<ref id="B29">
<label>29</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Maslach]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Jackson]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Leiter]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<collab>The Maslach Burnout Inventory</collab>
<source><![CDATA[All Versions of the MBI, and the Manual, are Now Available at Mind Garden]]></source>
<year>1996</year>
<publisher-loc><![CDATA[Palo Alto, CA ]]></publisher-loc>
<publisher-name><![CDATA[Consulting Psychologists Press]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B30">
<label>30</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Seisdedos]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
</person-group>
<source><![CDATA[MBI Inventario Burnout de Maslach]]></source>
<year>1997</year>
<publisher-loc><![CDATA[Madrid ]]></publisher-loc>
<publisher-name><![CDATA[TEA Ediciones]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B31">
<label>31</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Fumis]]></surname>
<given-names><![CDATA[RR]]></given-names>
</name>
<name>
<surname><![CDATA[Junqueira Amarante]]></surname>
<given-names><![CDATA[GA]]></given-names>
</name>
<name>
<surname><![CDATA[de Fátima Nascimento]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Vieira Junior]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Moral distress and its contribution to the development of burnout syndrome among critical care providers]]></article-title>
<source><![CDATA[Ann Intensive Care]]></source>
<year>2017</year>
<volume>7</volume>
<page-range>71</page-range></nlm-citation>
</ref>
<ref id="B32">
<label>32</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Meltzer]]></surname>
<given-names><![CDATA[LS]]></given-names>
</name>
<name>
<surname><![CDATA[Huckabay]]></surname>
<given-names><![CDATA[LM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Critical care nurses'perceptions of futile care and its effect on burnout]]></article-title>
<source><![CDATA[Am J Crit Care]]></source>
<year>2004</year>
<volume>13</volume>
<page-range>202-8</page-range></nlm-citation>
</ref>
<ref id="B33">
<label>33</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Epstein]]></surname>
<given-names><![CDATA[EG]]></given-names>
</name>
<name>
<surname><![CDATA[Hamric]]></surname>
<given-names><![CDATA[AB]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Moral distress, moral residue, and the crescendo effect]]></article-title>
<source><![CDATA[J Clin Ethics]]></source>
<year>2009</year>
<volume>20</volume>
<page-range>330-42</page-range></nlm-citation>
</ref>
<ref id="B34">
<label>34</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Rushton]]></surname>
<given-names><![CDATA[CH]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Defining and addressing moral distress:tools for critical care nursing leaders]]></article-title>
<source><![CDATA[AACN Adv Crit Care]]></source>
<year>2006</year>
<volume>17</volume>
<page-range>161-8</page-range></nlm-citation>
</ref>
<ref id="B35">
<label>35</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Corley]]></surname>
<given-names><![CDATA[MC]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Nurse moral distress:a proposed theory and research agenda]]></article-title>
<source><![CDATA[Nurs Ethics]]></source>
<year>2002</year>
<volume>9</volume>
<page-range>636-50</page-range></nlm-citation>
</ref>
<ref id="B36">
<label>36</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Elpern]]></surname>
<given-names><![CDATA[EH]]></given-names>
</name>
<name>
<surname><![CDATA[Covert]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Kleinpell]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Moral distress of staff nurses in a medical intensive care unit]]></article-title>
<source><![CDATA[Am J Crit Care]]></source>
<year>2005</year>
<volume>14</volume>
<page-range>523-30</page-range></nlm-citation>
</ref>
<ref id="B37">
<label>37</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Shoorideh]]></surname>
<given-names><![CDATA[FA]]></given-names>
</name>
<name>
<surname><![CDATA[Ashktorab]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Yaghmaei]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Alavi Majd]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Relationship between ICU nurses'moral distress with burnout and anticipated turnover]]></article-title>
<source><![CDATA[Nurs Ethics]]></source>
<year>2015</year>
<volume>22</volume>
<page-range>64-76</page-range></nlm-citation>
</ref>
<ref id="B38">
<label>38</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Teixeira]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Ribeiro]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
<name>
<surname><![CDATA[Fonseca]]></surname>
<given-names><![CDATA[AM]]></given-names>
</name>
<name>
<surname><![CDATA[Carvalho]]></surname>
<given-names><![CDATA[AS]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Burnout in intensive care units-a consideration of the possible prevalence and frequency of new risk factors:a descriptive correlational multicentre study]]></article-title>
<source><![CDATA[BMC Anesthesiol]]></source>
<year>2013</year>
<volume>13</volume>
<page-range>38</page-range></nlm-citation>
</ref>
<ref id="B39">
<label>39</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lichtenstein]]></surname>
<given-names><![CDATA[RL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The job satisfaction and retention of physicians in organized settings:a literature review]]></article-title>
<source><![CDATA[Med Care Rev]]></source>
<year>1984</year>
<volume>41</volume>
<page-range>139-79</page-range></nlm-citation>
</ref>
<ref id="B40">
<label>40</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ramirez]]></surname>
<given-names><![CDATA[AJ]]></given-names>
</name>
<name>
<surname><![CDATA[Graham]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Richards]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<name>
<surname><![CDATA[Cull]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Gregory]]></surname>
<given-names><![CDATA[WM]]></given-names>
</name>
<name>
<surname><![CDATA[Leaning]]></surname>
<given-names><![CDATA[MS]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Burnout and psychiatric disorder among cancer clinicians]]></article-title>
<source><![CDATA[Br J Cancer]]></source>
<year>1995</year>
<volume>71</volume>
<page-range>1263-9</page-range></nlm-citation>
</ref>
<ref id="B41">
<label>41</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Linzitto]]></surname>
<given-names><![CDATA[JP]]></given-names>
</name>
<name>
<surname><![CDATA[Grance]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Health professionals'quality of life in relation to end of life care]]></article-title>
<source><![CDATA[Curr Opin Support Palliat Care]]></source>
<year>2017</year>
<volume>11</volume>
<page-range>306-9</page-range></nlm-citation>
</ref>
<ref id="B42">
<label>42</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Tateno]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Jovanovi&#263;]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Beezhold]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Uehara-Aoyama]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Umene-Nakano]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
<name>
<surname><![CDATA[Nakamae]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Suicidal ideation and burnout among psychiatric trainees in Japan]]></article-title>
<source><![CDATA[Early Interv Psychiatry]]></source>
<year>2018</year>
<volume>12</volume>
<page-range>935-7</page-range></nlm-citation>
</ref>
<ref id="B43">
<label>43</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Owczarek]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Wojtowicz]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Paw&#322;owski]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
<name>
<surname><![CDATA[Bia&#322;oszewski]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Burnout syndrome among physiotherapists]]></article-title>
<source><![CDATA[Wiad Lek]]></source>
<year>2017</year>
<volume>70</volume>
<page-range>537-42</page-range></nlm-citation>
</ref>
<ref id="B44">
<label>44</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Embriaco]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Papazian]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Kentish-Barnes]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Pochard]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Azoulay]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Burnout syndrome among critical care healthcare workers]]></article-title>
<source><![CDATA[Curr Opin Crit Care]]></source>
<year>2007</year>
<volume>13</volume>
<page-range>482-8</page-range></nlm-citation>
</ref>
<ref id="B45">
<label>45</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Martins Pereira]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Teixeira]]></surname>
<given-names><![CDATA[CM]]></given-names>
</name>
<name>
<surname><![CDATA[Carvalho]]></surname>
<given-names><![CDATA[AS]]></given-names>
</name>
<name>
<surname><![CDATA[Hernández-Marrero]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Compared to palliative care, working in intensive care more than doubles the chances of burnout:results from a nationwide comparative study]]></article-title>
<collab>InPalIn</collab>
<source><![CDATA[PLoS One]]></source>
<year>2016</year>
<volume>11</volume>
</nlm-citation>
</ref>
<ref id="B46">
<label>46</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bruce]]></surname>
<given-names><![CDATA[CR]]></given-names>
</name>
<name>
<surname><![CDATA[Miller]]></surname>
<given-names><![CDATA[SM]]></given-names>
</name>
<name>
<surname><![CDATA[Zimmerman]]></surname>
<given-names><![CDATA[JL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A qualitative study exploring moral distress in the ICU team:the importance of unit functionality and intrateam dynamics]]></article-title>
<source><![CDATA[Crit Care Med]]></source>
<year>2015</year>
<volume>43</volume>
<page-range>823-31</page-range></nlm-citation>
</ref>
<ref id="B47">
<label>47</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wilson]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<name>
<surname><![CDATA[Goettemoeller]]></surname>
<given-names><![CDATA[DM]]></given-names>
</name>
<name>
<surname><![CDATA[Bevan]]></surname>
<given-names><![CDATA[NA]]></given-names>
</name>
<name>
<surname><![CDATA[McCord]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Moral distress:levels, coping and preferred interventions in critical care and transitional care nurses]]></article-title>
<source><![CDATA[J Clin Nurs]]></source>
<year>2013</year>
<volume>22</volume>
<page-range>1455-66</page-range></nlm-citation>
</ref>
<ref id="B48">
<label>48</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Houston]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Casanova]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<name>
<surname><![CDATA[Leveille]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Schmidt]]></surname>
<given-names><![CDATA[KL]]></given-names>
</name>
<name>
<surname><![CDATA[Barnes]]></surname>
<given-names><![CDATA[SA]]></given-names>
</name>
<name>
<surname><![CDATA[Trungale]]></surname>
<given-names><![CDATA[KR]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The intensity and frequency of moral distress among different healthcare disciplines]]></article-title>
<source><![CDATA[J Clin Ethics]]></source>
<year>2013</year>
<volume>24</volume>
<page-range>98-112</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
