{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T16:37:54Z","timestamp":1787503074944,"version":"build-2736575974"},"reference-count":16,"publisher":"BMJ","license":[{"start":{"date-parts":[[2019,12,18]],"date-time":"2019-12-18T00:00:00Z","timestamp":1576627200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"abstract":"Abstract<\/jats:title>\n \n Objective<\/jats:title>\n To determine the validity of the superstition that utterance of the word \u201cquiet\u201d in a clinical setting increases workload.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Prospective randomised controlled non-inferiority study.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Microbiology department of a large teaching hospital in Lancashire, UK.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n Two members of the medical microbiology team carried out the duty work on any given week day and an on-call team member on any weekend day. 29 days were assigned in which staff were to say \u201cToday will be a quiet day\u201d and 32 days were assigned in which staff were to refrain from saying the word \u201cquiet\u201d in any context.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Each day was randomly allocated to either saying \u201cToday will be a quiet day\u201d (intervention group) or refraining from saying the word \u201cquiet\u201d (control group) in any context.<\/jats:p>\n <\/jats:sec>\n \n Main outcome measures<\/jats:title>\n The primary outcome was mean overall workload: a composite of number of clinically related telephone calls, clinically significant results, or validated results processed by the duty medical microbiology team during a 24 hour period referred to collectively as \u201cclinical episodes.\u201d A difference of 30 clinical episodes was considered as the margin of non-inferiority. Secondary outcomes included the individual components of the primary outcome.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Workload was measured each day over a 61 day period (1 May to 30 June 2019). A mean 139.0 clinical episodes occurred on control days compared with 144.9 on days when the experimental intervention was uttered, a difference of 5.9 (95% confidence interval\u221212.9 to 24.7). The upper bound was less than the specified margin of 30, providing evidence for non-inferiority. No evidence of a difference in workload was found between interventions with any of the four components, whether considering unadjusted or adjusted analyses, or looking at the subgroups of week days or weekends.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The study findings refute the long held superstition that utterance of the word \u201cquiet\u201d impacts on clinical workload, and therefore it should not be avoided. In the era of considerable staff shortages and increased work related stress, doctors should look to other methods to increase resilience and protect their wellbeing and mental health.<\/jats:p>\n <\/jats:sec>\n \n Trial registration<\/jats:title>\n Lancashire Teaching Hospitals NHS Foundation Trust\u2019s research department SE-259.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmj.l6446","type":"journal-article","created":{"date-parts":[[2019,12,18]],"date-time":"2019-12-18T10:24:11Z","timestamp":1576664651000},"page":"l6446","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Q fever\u2014the superstition of avoiding the word \u201cquiet\u201d as a coping mechanism: randomised controlled non-inferiority trial"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6493-2574","authenticated-orcid":false,"given":"Charlotte R","family":"Brookfield","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6336-7024","authenticated-orcid":false,"given":"Patrick P J","family":"Phillips","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J","family":"Shorten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,12,18]]},"reference":[{"key":"key20191222000120_ref1","unstructured":"Bj\u00f6rk, It\u2019s Oh So Quiet [cover version]. 1995."},{"key":"key20191222000120_ref2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b1286"},{"key":"key20191222000120_ref3","volume-title":"This is going to hurt: Secret Diaries of a junior doctor.","author":"Kay","year":"2017"},{"key":"key20191222000120_ref4","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(98)70214-8"},{"key":"key20191222000120_ref5","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0167480"},{"key":"key20191222000120_ref6","doi-asserted-by":"publisher","DOI":"10.1308\/rcsbull.2017.133"},{"key":"key20191222000120_ref7","unstructured":"icmje.org. International Committee of Medical Journal Editors; Clinical Trials Registration [cited July 2019].www.icmje.org\/about-icmje\/faqs\/clinical-trials-registration\/"},{"key":"key20191222000120_ref8","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e7586"},{"key":"key20191222000120_ref9","doi-asserted-by":"publisher","DOI":"10.1080\/03610928308828586"},{"key":"key20191222000120_ref10","unstructured":"gov.uk. PHE: Public Health England, English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) Report 2018. [cited July 2019]. https:\/\/webarchive.nationalarchives.gov.uk\/20191003132022\/www.gov.uk\/government\/publications\/english-surveillance-programme-antimicrobial-utilisation-and-resistance-espaur-report"},{"key":"key20191222000120_ref11","unstructured":"Tackling antimicrobial resistance 2019 to 2024: The UK's 5-year national action plan. January 2019. [cited July 2019]. https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/784894\/UK_AMR_5_year_national_action_plan.pdf"},{"key":"key20191222000120_ref12","unstructured":"European Centre for Disease Prevention and Control. Point prevalence survey of healthcare associated infections and antimicrobial use in European acute care hospitals. Stockholm: ECDC; 2013. [cited July 2019]. https:\/\/ecdc.europa.eu\/sites\/portal\/files\/media\/en\/publications\/Publications\/healthcare-associated-infections-antimicrobial-use-PPS.pdf"},{"key":"key20191222000120_ref13","unstructured":"National Institute for Health and Care Excellence: Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use. NICE guideline [NG15] August 2015."},{"key":"key20191222000120_ref14","unstructured":"Royal College of Pathologists. Workforce Planning Overview 2017. [cited July 2019]. www.rcpath.org\/profession\/workforce-planning\/our-workforce-research\/workforce-annual-report-2018.html"},{"key":"key20191222000120_ref15","unstructured":"The Heath Foundation, Kings Fund and Nuffield Health: The healthcare workforce in England: Make or Break? November 2018. [cited July 2019]. www.kingsfund.org.uk\/publications\/health-care-workforce-england"},{"key":"key20191222000120_ref16","unstructured":"Royal College of Physicians Underfunded. Underdoctored. OverStretched. The NHS in 2016. September 2016. [cited July 2019]. www.rcplondon.ac.uk\/guidelines-policy\/underfunded-underdoctored-overstretched-nhs-2016"}],"updated-by":[{"DOI":"10.1136\/bmj.m452","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2020,2,11]],"date-time":"2020-02-11T00:00:00Z","timestamp":1581379200000}}],"container-title":["BMJ"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bmj.l6446","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmj.l6446","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,9,25]],"date-time":"2020-09-25T23:52:41Z","timestamp":1601077961000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.bmj.com\/lookup\/doi\/10.1136\/bmj.l6446"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12,18]]},"references-count":16,"alternative-id":["10.1136\/bmj.l6446"],"URL":"https:\/\/doi.org\/10.1136\/bmj.l6446","relation":{},"ISSN":["1756-1833"],"issn-type":[{"value":"1756-1833","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,12,18]]}}}