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The Cochrane Database of Systematic... Feb 2017Clinical research affecting how doctors practice medicine is increasingly sponsored by companies that make drugs and medical devices. Previous systematic reviews have... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Clinical research affecting how doctors practice medicine is increasingly sponsored by companies that make drugs and medical devices. Previous systematic reviews have found that pharmaceutical-industry sponsored studies are more often favorable to the sponsor's product compared with studies with other sources of sponsorship. A similar association between sponsorship and outcomes have been found for device studies, but the body of evidence is not as strong as for sponsorship of drug studies. This review is an update of a previous Cochrane review and includes empirical studies on the association between sponsorship and research outcome.
OBJECTIVES
To investigate whether industry sponsored drug and device studies have more favorable outcomes and differ in risk of bias, compared with studies having other sources of sponsorship.
SEARCH METHODS
In this update we searched MEDLINE (2010 to February 2015), Embase (2010 to February 2015), the Cochrane Methodology Register (2015, Issue 2) and Web of Science (June 2015). In addition, we searched reference lists of included papers, previous systematic reviews and author files.
SELECTION CRITERIA
Cross-sectional studies, cohort studies, systematic reviews and meta-analyses that quantitatively compared primary research studies of drugs or medical devices sponsored by industry with studies with other sources of sponsorship. We had no language restrictions.
DATA COLLECTION AND ANALYSIS
Two assessors screened abstracts and identified and included relevant papers. Two assessors extracted data, and we contacted authors of included papers for additional unpublished data. Outcomes included favorable results, favorable conclusions, effect size, risk of bias and whether the conclusions agreed with the study results. Two assessors assessed risk of bias of included papers. We calculated pooled risk ratios (RR) for dichotomous data (with 95% confidence intervals (CIs)).
MAIN RESULTS
Twenty-seven new papers were included in this update and in total the review contains 75 included papers. Industry sponsored studies more often had favorable efficacy results, RR: 1.27 (95% CI: 1.17 to 1.37) (25 papers) (moderate quality evidence), similar harms results RR: 1.37 (95% CI: 0.64 to 2.93) (four papers) (very low quality evidence) and more often favorable conclusions RR: 1.34 (95% CI: 1.19 to 1.51) (29 papers) (low quality evidence) compared with non-industry sponsored studies. Nineteen papers reported on sponsorship and efficacy effect size, but could not be pooled due to differences in their reporting of data and the results were heterogeneous. We did not find a difference between drug and device studies in the association between sponsorship and conclusions (test for interaction, P = 0.98) (four papers). Comparing industry and non-industry sponsored studies, we did not find a difference in risk of bias from sequence generation, allocation concealment, follow-up and selective outcome reporting. However, industry sponsored studies more often had low risk of bias from blinding, RR: 1.25 (95% CI: 1.05 to 1.50) (13 papers), compared with non-industry sponsored studies. In industry sponsored studies, there was less agreement between the results and the conclusions than in non-industry sponsored studies, RR: 0.83 (95% CI: 0.70 to 0.98) (six papers).
AUTHORS' CONCLUSIONS
Sponsorship of drug and device studies by the manufacturing company leads to more favorable efficacy results and conclusions than sponsorship by other sources. Our analyses suggest the existence of an industry bias that cannot be explained by standard 'Risk of bias' assessments.
Topics: Conflict of Interest; Data Interpretation, Statistical; Drug Industry; Equipment and Supplies; Industry; Publication Bias; Research Report; Research Support as Topic; Treatment Outcome
PubMed: 28207928
DOI: 10.1002/14651858.MR000033.pub3 -
Journal of Nursing Management Oct 2022To investigate the outcomes and the effect sizes of ethical leadership in nursing practice. (Meta-Analysis)
Meta-Analysis Review
AIM
To investigate the outcomes and the effect sizes of ethical leadership in nursing practice.
BACKGROUND
Many meta-analysis of ethical leadership have been conducted in other fields, but there are none for the effects of ethical leadership of nurse leaders and should be investigated.
EVALUATION
For a systematic literature review, we searched PubMed, EMBASE, the Cochrane Library, CINAHL, OVID, Web of Science and Korean databases for studies published in Korean or English. We used Comprehensive Meta-Analysis (CMA) 2.0 and R 3.6.2 for the meta-analysis.
KEY ISSUES
We divided the outcomes of ethical leadership into three categories and investigated the effect sizes: subordinates' perceptions of their leaders (ES = 0.65), subordinates' ethical behaviours (ES = 0.04) and job or organisational outcomes (ES = 0.45). In addition, we identified 14 outcome variables, and transformational leadership showed the greatest effect size (ES = 0.77) among them.
CONCLUSION
This study confirmed the positive effects of ethical nursing leadership on individual nurses' perceptions about their leaders, their jobs and organisations.
IMPLICATIONS FOR NURSING MANAGEMENT
Nursing organisations and nurse administrators should make efforts to highlight ethical leadership of nurse leaders to improve outcomes of organisational performance including individual nurses' perceptions about their leaders, their jobs and organisations.
Topics: Humans; Leadership; Ethics, Nursing; Nurse Administrators; Morals
PubMed: 35761760
DOI: 10.1111/jonm.13726 -
Philosophy, Ethics, and Humanities in... Nov 2022Moral distress is one of the most important problems that nurses face in their care of patients. Various studies have reported the frequency and severity of moral... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Moral distress is one of the most important problems that nurses face in their care of patients. Various studies have reported the frequency and severity of moral distress in nurses. However, to date, a comprehensive study that shows the results of these research across the world was not found, therefore due to the importance of this issue, its role in the health of nurses and patients, and the lack of general statistics about it worldwide, the present study was conducted to determine the frequency and severity of moral distress in nurses through a systematic review and meta-analysis.
METHODS
In this review study, searching national and international databases of SID, MagIran, IranMedex, IranDoc, Google Scholar, Embase, ScienceDirect, Scopus, CINHAL, PubMed, and Web of Science (WoS) between 2005 and February 2020 were extracted. The random-effects model was used for analysis, and the heterogeneity of studies with the I index was investigated. Data were analyzed using Comprehensive Meta-Analysis (Version 2).
RESULTS
The frequency of moral distress in 9 articles with a sample size of 1576 persons was 1.7 ± 0.5 from (0-4), in 13 articles with a sample size of 1870 persons, 3.07 ± 0.1 from (0-5), in 6 articles with a sample size of 1316 persons, 3.2 ± 0.29 from (0-6), in 18 articles with a sample size of 1959 persons, 4.6 ± 0.518 from (1-7) and in 35 articles with a sample size of 3718 persons, 81.1 ± 4.6 from (216-30), and the severity of moral distress in 4 articles with a sample size of 1116 persons, 1.7 ± 0.37 from (0-4), in 5 articles with a sample size of 1282 persons, 2.6 ± 0.28 from (0-5), in 5 articles with a sample size of 944 persons, 3.9 ± 0.63 from (0-6) and in 8 articles with a sample size of 901 persons was 82.3 ± 5.4 (0-216).
CONCLUSION
The results of this study showed that the frequency and severity of moral distress in nurses are high and are a serious problem in nurses. Therefore, policymakers in this field should consider its role in the health of nurses and patients.
Topics: Humans; Morals
PubMed: 36348378
DOI: 10.1186/s13010-022-00126-0 -
Cancer NursingWeighing implications of multiple intensive cancer-directed therapies over time, oncology nurses are more prone to intrinsic distress compared to nurses in non-oncologic... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Weighing implications of multiple intensive cancer-directed therapies over time, oncology nurses are more prone to intrinsic distress compared to nurses in non-oncologic settings. This vulnerability may give rise to moral distress. Yet, little is known about moral distress experiences of oncology nurses.
OBJECTIVE
This systematic review and meta-analysis examined the frequency and intensity of moral distress among oncology nurses with an exploratory focus on nurse-level and work-related characteristics.
METHODS
We conducted a systematic search of 7 electronic databases (2000-2020) supplemented by hand-search strategy. Means and standard deviations of moral distress scores in the included studies were extracted and pooled in our meta-analysis.
RESULTS
Our sample of 8 cross-sectional studies consisting of 2686 participants with 1654 oncology nurses met criteria for inclusion. A random-effects model was used in our meta-analysis given considerable heterogeneity. Our results suggest that moral distress was of low to moderate frequency, but of high intensity. Moral distress among oncology nurses was a significant predictor for burnout, provider communication, decisions surrounding end-of-life care, work conditions (eg, patient assignment, type of unit), and inability to provide compassionate care.
CONCLUSION
Moral distress in oncology nurses is associated with burnout syndrome, compassion fatigue, and secondary traumatic stress syndrome, all of which are linked to poor patient care and outcomes. Robust psychological well-being is critical in minimizing unintended consequences of moral distress.
IMPLICATIONS FOR PRACTICE
Oncology nurses are at high risk for moral distress due to the nature of their work. Future studies should examine the prevalence among oncology nurses to help inform targeted interventions.
Topics: Humans; Stress, Psychological; Oncology Nursing; Cross-Sectional Studies; Burnout, Professional; Neoplasms; Morals; Surveys and Questionnaires
PubMed: 35283474
DOI: 10.1097/NCC.0000000000001075 -
Nursing Ethics 2023Moral distress (MD) is well-documented within the nursing literature and occurs when constraints prevent a correct course of action from being implemented. The measured... (Review)
Review
Moral distress (MD) is well-documented within the nursing literature and occurs when constraints prevent a correct course of action from being implemented. The measured frequency of MD has increased among nurses over recent years, especially since the COVID-19 Pandemic. MD is less understood among nurse leaders than other populations of nurses. A qualitative systematic review was conducted with the aim to synthesize the experiences of MD among nurse leaders. This review involved a search of three databases (Medline, CINAHL, and APA PsychINFO) which resulted in the retrieval of 303 articles. PRISMA review criteria guided authors during the article review and selection process. Following the review, six articles were identified meeting review criteria and quality was assessed using the Critical Appraisal Skills Programme (CASP) Checklist for qualitative studies. No ethical review was required for this systematic review. The six studies included in this review originated from the United States, Brazil, Turkey, and Iran. Leadership roles ranged from unit-based leadership to executive leadership. Assigned quality scores based upon CASP criteria ranged from 6 to 9 (moderate to high quality). Three analytical themes emerged from the synthesis: (1) moral distress is consuming; (2) constrained by the system; and (3) adapt to overcome. The unique contributors of MD among nurse leaders include the leadership role itself and challenges navigating moral situations as they arise. The nurse leader perspective should be considered in the development of future MD interventions.
Topics: Humans; Pandemics; Nursing Care; Leadership; Qualitative Research; Morals
PubMed: 37845832
DOI: 10.1177/09697330231191279 -
International Nursing Review Dec 2022To summarize the findings from literature regarding the prevalence of plagiarism and its various types, knowledge, and attitudes of students toward plagiarism, factors... (Meta-Analysis)
Meta-Analysis Review
AIM
To summarize the findings from literature regarding the prevalence of plagiarism and its various types, knowledge, and attitudes of students toward plagiarism, factors associated with plagiarism, and the applied interventions to decrease the incidence of plagiarism.
BACKGROUND
Plagiarism is a major form of academic dishonesty practiced by students at all educational levels.
INTRODUCTION
Academic dishonesty was defined as any unauthorized help that adds to students' formal academic performance. These dishonest behaviors can be categorized as falsifying information, hiding errors, collaborating with colleagues when not allowed, and plagiarism.
METHODS
Systematic search of databases was conducted in September 2021 to identify studies that discussed plagiarism in nursing studies. We included 31 studies in this systematic review and meta-analysis, with a total of 9,175 nursing students. The analysis was conducted using RevMan software.
RESULTS
Plagiarism was the most frequent academic misconduct among nursing students (practiced by 55.3%). Paraphrasing without referencing was the most practiced form (39.53%), while submitting others' work without acknowledgment was the least one (9.61%). Most students were aware of the concept of plagiarism (80.8%) and had positive ethical attitudes toward it (88.26%). Plagiarism was negatively associated with age, parenting, and completing semester credits. However, it was positively correlated with average grades and liberal educators. Plagiarism was a significant predictor of clinical misconduct.
DISCUSSION
A gap in the students' knowledge and skills were noticed. These gaps may be contributing to the high occurrence of plagiaristic acts, besides the unethical attitudes.
CONCLUSION
Plagiarism is a serious academic misconduct practice that can be associated with subsequent clinical misconduct. There is a need to fill the knowledge and skills gap, and to set effective policies.
IMPLICATION FOR NURSING AND HEALTH POLICY
In their attempts to eliminate plagiarism, nurse educators are encouraged to provide effective educational training and practical tasks, in order to fill the gaps in knowledge and skills. Additionally, implementing clear and effective punishment policies would prevent intentional plagiaristic acts. This would aid in introducing qualified nurses accountable for the health of patients.
Topics: Humans; Plagiarism; Students, Nursing; Faculty, Nursing; Morals
PubMed: 35397177
DOI: 10.1111/inr.12755 -
Critical Care Medicine Sep 2020To provide a concise review of data and literature pertaining to the etiologies of conflict in the ICU, as well as current approaches to conflict management.
OBJECTIVES
To provide a concise review of data and literature pertaining to the etiologies of conflict in the ICU, as well as current approaches to conflict management.
DATA SOURCES
Detailed search strategy using PubMed and OVID Medline for English language articles describing conflict in the ICU as well as prevention and management strategies.
STUDY SELECTION
Descriptive and interventional studies addressing conflict, bioethics, clinical ethics consultation, palliative care medicine, conflict management, and conflict mediation in critical care.
DATA EXTRACTION
Relevant descriptions or studies were reviewed, and the following aspects of each manuscript were identified, abstracted, and analyzed: setting, study population, aims, methods, results, and relevant implications for critical care practice and training.
DATA SYNTHESIS
Conflict frequently erupts in the ICU between patients and families and care teams, as well as within and between care teams. Conflict engenders a host of untoward consequences for patients, families, clinicians, and facilities rendering abrogating conflict a key priority for all. Conflict etiologies are diverse but understood in terms of a framework of triggers. Identifying and de-escalating conflict before it become intractable is a preferred approach. Approaches to conflict management include utilizing clinical ethics consultation, and palliative care medicine clinicians. Conflict Management is a new technique that all ICU clinicians may use to identify and manage conflict. Entrenched conflict appears to benefit from Bioethics Mediation, an approach that uses a neutral, unaligned mediator to guide parties to a mutually acceptable resolution.
CONCLUSIONS
Conflict commonly occurs in the ICU around difficult and complex decision-making. Patients, families, clinicians, and institutions suffer undesirable consequences resulting from conflict, establishing conflict prevention and resolution as key priorities. A variety of approaches may successfully identify, manage, and prevent conflict including techniques that are utilizable by all team members in support of clinical excellence.
Topics: Critical Care; Dissent and Disputes; Ethics, Medical; Group Processes; Humans; Intensive Care Units; Negotiating; Palliative Care; Patient Care Team
PubMed: 32618689
DOI: 10.1097/CCM.0000000000004440 -
Environmental Science and Pollution... Nov 2023Energy companies are in the spotlight regarding the environmental pressure to address the current environmental issues by initiating the sets of social responsibilities.... (Review)
Review
Energy companies are in the spotlight regarding the environmental pressure to address the current environmental issues by initiating the sets of social responsibilities. Energy sector companies are actively adopting Corporate Social Responsibility (CSR) practices to address the increased pressure and enablement to manage and prevent the risks of environmental impact at the same time concentrating on the economic growth. The current study provides a systematic literature review identifying CSR initiative measures towards sustainability and proposes a framework of CSR measurements in the energy sector. The framework combines the Search, Appraisal, Synthesis, and Analysis (SALSA) method together with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and PSALSAR (Protocol, Search, Appraisal, Synthesis, Analysis and Report). Moreover, for setting the research scope, PICOC (Population, Intervention, Comparison, Outcome, and Context) is applied. As a result, eleven CSR measures for the energy sector were identified. The measurements were classified into 4 pillars: environmental pillar, stakeholder communication and external image, financial pillar, and organizational pillar. The environmental impact and GHG reduction align with the ecological modernization theories. Green energy innovations find theoretical resonance in the diffusion of innovation theories. Stakeholder engagement and branding link to the stakeholder theory, while financial performance, to the shareholder value theories. Occupational health and safety theory support the employee safety and corporate culture considerations. These measures, selected through theoretical lenses and systematic review, contribute to shaping a sustainable energy landscape. Furthermore, the research results were discussed, and the future research agenda together with policy recommendations were provided.
Topics: Occupational Health; Organizations; Social Responsibility; Organizational Culture
PubMed: 37798520
DOI: 10.1007/s11356-023-30131-5 -
The British Journal of Psychiatry : the... Jun 2018Many people confront potentially morally injurious experiences (PMIEs) in the course of their work which can violate deeply held moral values or beliefs, putting them at... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Many people confront potentially morally injurious experiences (PMIEs) in the course of their work which can violate deeply held moral values or beliefs, putting them at risk for psychological difficulties (e.g. post-traumatic stress disorder (PTSD), depression, etc.).AimsWe aimed to assess the effect of moral injury on mental health outcomes.
METHOD
We conducted a systematic review and meta-analysis to assess the association between work-related PMIEs and mental health disorders. Studies were independently assessed for methodological quality and potential moderator variables, including participant age, gender and PMIE factors, were also examined.
RESULTS
Thirteen studies were included, representing 6373 participants. PMIEs accounted for 9.4% of the variance in PTSD, 5.2% of the variance in depression and 2.0% of the variance in suicidality. PMIEs were associated with more symptoms of anxiety and behavioural problems (e.g. hostility), although this relationship was not consistently significant. Moderator analyses indicated that methodological factors (e.g. PMIE measurement tool), demographic characteristics and PMIE variables (e.g. military v. non-military context) did not affect the association between a PMIE and mental health outcomes.
CONCLUSIONS
Most studies examined occupational PMIEs in military samples and additional studies investigating the effect of PMIEs on civilians are needed. Given the limited number of high-quality studies available, only tentative conclusions about the association between exposure to PMIEs and mental health disorders can be made.Declaration of interestNone.
Topics: Depressive Disorder; Humans; Military Personnel; Morals; Occupational Diseases; Stress Disorders, Post-Traumatic; Suicide
PubMed: 29786495
DOI: 10.1192/bjp.2018.55 -
Applied Nursing Research : ANR Feb 2024Nurses face various ethical conflicts when taking care of patients, and such conflicts require moral courage. This systematic review was conducted with the aim of...
BACKGROUND
Nurses face various ethical conflicts when taking care of patients, and such conflicts require moral courage. This systematic review was conducted with the aim of investigating moral courage and its related factors among nurses.
METHODS
To find related studies, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The PubMed, Web of Science, Google Scholar, Scopus, Embase and Science Direct databases were searched using keywords such as Courage, Moral Courage, and Nurses, and no lower time limit was imposed when conducting the searches. The identified studies were published between January 2000 and March 2023. Quality of articles was assessed using the STROBE checklist.
RESULTS
The pooled sample size for the 19 included studies was 7863. All studies were observational and cross-sectional. The results showed that three categories of factors most related to moral courage are individual, moral, and factors related to the organization. Underlying factors of each category are also provided within this paper.
CONCLUSION
Moral courage is an integral part of nursing, which as a profession, is becoming even more challenging with the advancement of science and technology. Therefore, there is a need for nurses and especially nursing managers to be considerate of factors affecting moral courage of nurses, with a view to strengthening the positive factors and reducing the negative impacts.
Topics: Humans; Courage; Cross-Sectional Studies; Ethics, Nursing; Morals; Nurses
PubMed: 38490799
DOI: 10.1016/j.apnr.2024.151768