{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T16:43:35Z","timestamp":1794501815377,"version":"4.9.1"},"reference-count":50,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"unspecified","delay-in-days":26,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Mayo Clinic Health System Administrative and Research Office"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,2,11]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Burnout among healthcare professionals remains a critical public health issue linked to impaired cognition, emotional exhaustion and diminished clinical performance. Structured breathing practices have demonstrated promise in improving autonomic regulation and cerebral oxygenation, yet their feasibility, acceptability and implementation in real-world healthcare settings remain underexplored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This single-arm pilot feasibility trial aims to evaluate the feasibility, acceptability and implementation appropriateness of a structured breathing-based intervention for healthcare professionals across community-based Mayo Clinic Health System (MCHS) sites. Secondary objectives include assessing usability and engagement with the mobile breathing platform, while exploratory analyses will describe magnitude of variability and feasibility of collecting psychological and cerebral haemodynamic measures. This study will commence in November 2025 and is expected to be completed by June 2026.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>A total of 40 clinicians (MD\/DO\/MBBS\/PA) and nurses reporting moderate or greater burnout will be enrolled across four MCHS sites. Participants will complete a 4-month structured breathing programme delivered primarily online, supported by a mobile application for practice tracking. Assessments will occur at baseline, 2 months and 4 months, with functional near-infrared spectroscopy (fNIRS) measures of cerebral oxygenation collected at baseline and 4 months in a population subset. Primary outcomes include (1) recruitment yield, retention and adherence rates; (2) acceptability and participant satisfaction (survey and qualitative feedback); and (3) implementation appropriateness measured by the Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM) and Feasibility of Intervention Measure (FIM). Secondary outcomes include digital engagement and usability through mobile analytics and the System Usability Scale. Exploratory outcomes are psychological indicators (burnout, depression, anxiety, perceived stress, sleep, fatigue, professional fulfilment and resilience) and physiological endpoints (fNIRS). Analyses will be descriptive, summarising feasibility metrics with 95% CIs. Progression criteria (recruitment\u226575%, retention\u226580%, adherence\u226570%, AIM\/IAM\/FIM\u22654.0) will determine readiness for a definitive hybrid effectiveness\u2013implementation trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The study is approved by the Mayo Clinic Institutional Review Board (IRB # 25-009320). All participants will provide informed consent. Study procedures ensure confidentiality, cultural sensitivity and participant safety. Data will be securely stored in REDCap and disseminated through peer-reviewed publications and scientific conference<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT07218458\">NCT07218458<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-113105","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T14:40:35Z","timestamp":1772203235000},"page":"e113105","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Evaluation of a structured breathing-based intervention to reduce burnout and enhance mental well-being among healthcare professionals in community-based practice settings: study protocol for a single-arm pilot feasibility trial"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct07218458","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct07218458","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1084-2469","authenticated-orcid":false,"given":"Pravesh","family":"Sharma","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Psychology, Mayo Clinic, Eau Claire, Wisconsin, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rowa","family":"Osman","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marin","family":"Nycklemoe","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle M","family":"Boos","sequence":"additional","affiliation":[{"name":"Clinical Research, Mayo Clinic Health System in Eau Claire, Eau Claire, Wisconsin, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Crystal M","family":"Murphy","sequence":"additional","affiliation":[{"name":"Clinical Research, Mayo Clinic Health System in Eau Claire, Eau Claire, Wisconsin, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn","family":"Flock","sequence":"additional","affiliation":[{"name":"Clinical Research, Mayo Clinic Health System in Eau Claire, Eau Claire, Wisconsin, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David N","family":"Jacobson","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seokbeen","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jody L","family":"Nation","sequence":"additional","affiliation":[{"name":"Employee Assistance Program, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa A","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Nursing, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina","family":"Schuldt","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Mayo Clinic, Eau Claire, Wisconsin, USA"},{"name":"Mayo Clinic Health System Employee Well-being, Mayo Clinic, Eau Claire, Wisconsin, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul H","family":"Min","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"key":"2026062610414620000_16.2.e113105.1","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1016\/j.mayocp.2020.12.027","article-title":"Physician Distress and Burnout: The Neurobiological Perspective","volume":"96","author":"Arnsten","year":"2021","journal-title":"Mayo Clin Proc"},{"key":"2026062610414620000_16.2.e113105.2","unstructured":"Association AM . 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