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Systematic review of interventions to improve the psychological well-being of general practitioners.BMC Family Practice Mar 2016The health of doctors who work in primary care is threatened by workforce and workload issues. There is a need to find and appraise ways in which to protect their mental... (Review)
Review
BACKGROUND
The health of doctors who work in primary care is threatened by workforce and workload issues. There is a need to find and appraise ways in which to protect their mental health, including how to achieve the broader, positive outcome of well-being. Our primary outcome was to evaluate systematically the research evidence regarding the effectiveness of interventions designed to improve General Practitioner (GP) well-being across two continua; psychopathology (mental ill-health focus) and 'languishing to flourishing' (positive mental health focus). In addition we explored the extent to which developments in well-being research may be integrated within existing approaches to design an intervention that will promote mental health and prevent mental illness among these doctors.
METHODS
Medline, Embase, Cinahl, PsychINFO, Cochrane Register of Trials and Web of Science were searched from inception to January 2015 for studies where General Practitioners and synonyms were the primary participants. Eligible interventions included mental ill-health prevention strategies (e.g. promotion of early help-seeking) and mental health promotion programmes (e.g. targeting the development of protective factors at individual and organizational levels). A control group was the minimum design requirement for study inclusion and primary outcomes had to be assessed by validated measures of well-being or mental ill-health. Titles and abstracts were assessed independently by two reviewers with 99% agreement and full papers were appraised critically using validated tools.
RESULTS
Only four studies (with a total of 997 GPs) from 5392 titles met inclusion criteria. The studies reported statistically significant improvement in self-reported mental ill-health. Two interventions used cognitive-behavioural techniques, one was mindfulness-based and one fed-back GHQ scores and self-help information.
CONCLUSION
There is an urgent need for high quality, controlled studies in GP well-being. Research on improving GP well-being is limited by focusing mainly on stressors and not giving systematic attention to the development of positive mental health.
Topics: General Practitioners; Health Promotion; Humans; Mental Health; Occupational Health
PubMed: 27009060
DOI: 10.1186/s12875-016-0431-1 -
BMJ Open Jun 2015To determine the cost-effectiveness of nurse practitioners delivering primary and specialised ambulatory care. (Review)
Review
OBJECTIVE
To determine the cost-effectiveness of nurse practitioners delivering primary and specialised ambulatory care.
DESIGN
A systematic review of randomised controlled trials reported since 1980.
DATA SOURCES
10 electronic bibliographic databases, handsearches, contact with authors, bibliographies and websites.
INCLUDED STUDIES
Randomised controlled trials that evaluated nurse practitioners in alternative and complementary ambulatory care roles and reported health system outcomes.
RESULTS
11 trials were included. In four trials of alternative provider ambulatory primary care roles, nurse practitioners were equivalent to physicians in all but seven patient outcomes favouring nurse practitioner care and in all but four health system outcomes, one favouring nurse practitioner care and three favouring physician care. In a meta-analysis of two studies (2689 patients) with minimal heterogeneity and high-quality evidence, nurse practitioner care resulted in lower mean health services costs per consultation (mean difference: -€6.41; 95% CI -€9.28 to -€3.55; p<0.0001) (2006 euros). In two trials of alternative provider specialised ambulatory care roles, nurse practitioners were equivalent to physicians in all but three patient outcomes and one health system outcome favouring nurse practitioner care. In five trials of complementary provider specialised ambulatory care roles, 16 patient/provider outcomes favouring nurse practitioner plus usual care, and 16 were equivalent. Two health system outcomes favoured nurse practitioner plus usual care, four favoured usual care and 14 were equivalent. Four studies of complementary specialised ambulatory care compared costs, but only one assessed costs and outcomes jointly.
CONCLUSIONS
Nurse practitioners in alternative provider ambulatory primary care roles have equivalent or better patient outcomes than comparators and are potentially cost-saving. Evidence for their cost-effectiveness in alternative provider specialised ambulatory care roles is promising, but limited by the few studies. While some evidence indicates nurse practitioners in complementary specialised ambulatory care roles improve patient outcomes, their cost-effectiveness requires further study.
Topics: Ambulatory Care; Cost-Benefit Analysis; Humans; Nurse Practitioners; Primary Care Nursing
PubMed: 26056121
DOI: 10.1136/bmjopen-2014-007167 -
Public Understanding of Science... Jul 2024Given the importance of public engagement in governments' adoption of artificial intelligence systems, artificial intelligence researchers and practitioners spend little...
Given the importance of public engagement in governments' adoption of artificial intelligence systems, artificial intelligence researchers and practitioners spend little time reflecting on who those publics are. Classifying publics affects assumptions and affordances attributed to the publics' ability to contribute to policy or knowledge production. Further complicating definitions are the publics' role in artificial intelligence production and optimization. Our structured analysis of the corpus used a mixed method, where algorithmic generation of search terms allowed us to examine approximately 2500 articles and provided the foundation to conduct an extensive systematic literature review of approximately 100 documents. Results show the multiplicity of ways publics are framed, by examining and revealing the different semantic nuances, affordances, political and expertise lenses, and, finally, a lack of definitions. We conclude that categorizing publics represents an act of power, politics, and truth-seeking in artificial intelligence.
Topics: Artificial Intelligence; Community Participation; Public Opinion; Politics; Humans
PubMed: 38282355
DOI: 10.1177/09636625231219853 -
BMJ Open Aug 2023People with pulmonary hypertension (PH) are not routinely referred for exercise rehabilitation despite the potential for reducing breathlessness and improving quality of...
Development of a complex exercise rehabilitation intervention for people with pulmonary hypertension: the supervised pulmonary hypertension exercise rehabilitation (SPHERe) trial.
BACKGROUND
People with pulmonary hypertension (PH) are not routinely referred for exercise rehabilitation despite the potential for reducing breathlessness and improving quality of life. We describe the development of a supervised pulmonary hypertension exercise rehabilitation (SPHERe) programme for people with PH.
METHODS
Development was completed in three phases: (1) systematic review, (2) stakeholder engagement with consensus from patients and experts and (3) prepilot intervention acceptability testing. We completed systematic reviews to identify international cardiopulmonary rehabilitation guidance and trials of exercise-based interventions for people with PH. Evidence from systematic reviews and stakeholder consensus shaped the SPHERe intervention, including addition of individual behavioural support sessions to promote exercise adherence. The draft SPHERe intervention was ratified through discussions with multidisciplinary professionals and people living with PH. We acceptability tested the centre-based intervention with eight participants in a prepilot development phase which identified a number of condition-specific issues relating to safety and fear avoidance of activity. Comprehensive intervention practitioner training manuals were produced to ensure standardised delivery. Participant workbooks were developed and piloted. Trial recruitment began in January 2020 but was subsequently suspended in March 2020 further to COVID-19 pandemic 'lockdowns'. In response to the pandemic, we undertook further development work to redesign the intervention to be suitable for exclusively home-based online delivery. Recruitment to the revised protocol began in June 2021.
DISCUSSION
The final SPHERe intervention incorporated weekly home-based online group exercise and behavioural support 'coaching' sessions supervised by trained practitioners, with a personalised home exercise plan and the optional loan of a stationary exercise bike. The intervention was fully manualised with clear pathways for assessment and individualised exercise prescription. The clinical and cost-effectiveness of the SPHERe online rehabilitation intervention is currently being tested in a UK multicentre randomised controlled trial.
TRIAL REGISTRATION NUMBER
ISCRTN10608766.
Topics: Humans; Communicable Disease Control; COVID-19; Exercise Therapy; Hypertension, Pulmonary; Pandemics; Quality of Life
PubMed: 37536964
DOI: 10.1136/bmjopen-2022-066053 -
Frontiers in Medicine 2023When physicians and nurses are looking at the same patient, they may not see the same picture. If assuming that the clinical reasoning of both professions is alike and... (Review)
Review
When physicians and nurses are looking at the same patient, they may not see the same picture. If assuming that the clinical reasoning of both professions is alike and ignoring possible differences, aspects essential for care can be overlooked. Understanding the multifaceted concept of clinical reasoning of both professions may provide insight into the nature and purpose of their practices and benefit patient care, education and research. We aimed to identify, compare and contrast the documented features of clinical reasoning of physicians and nurses through the lens of layered analysis and to conduct a simultaneous concept analysis. The protocol of this systematic integrative review was published doi: 10.1136/bmjopen-2021-049862. A comprehensive search was performed in four databases (PubMed, CINAHL, Psychinfo, and Web of Science) from 30th March 2020 to 27th May 2020. A total of 69 Empirical and theoretical journal articles about clinical reasoning of practitioners were included: 27 nursing, 37 medical, and five combining both perspectives. Two reviewers screened the identified papers for eligibility and assessed the quality of the methodologically diverse articles. We used an onion model, based on three layers: Philosophy, Principles, and Techniques to extract and organize the data. Commonalities and differences were identified on professional paradigms, theories, intentions, content, antecedents, attributes, outcomes, and contextual factors. The detected philosophical differences were located on a care-cure and subjective-objective continuum. We observed four principle contrasts: a broad or narrow focus, consideration of the patient as such or of the patient and his relatives, hypotheses to explain or to understand, and argumentation based on causality or association. In the technical layer a difference in the professional concepts of diagnosis and the degree of patient involvement in the reasoning process were perceived. Clinical reasoning can be analysed by breaking it down into layers, and the onion model resulted in detailed features. Subsequently insight was obtained in the differences between nursing and medical reasoning. The origin of these differences is in the philosophical layer (professional paradigms, intentions). This review can be used as a first step toward gaining a better understanding and collaboration in patient care, education and research across the nursing and medical professions.
PubMed: 36936242
DOI: 10.3389/fmed.2023.1017783 -
Journal of Child Health Care : For... Apr 2024Adolescents face issues regarding physical health, mental health, sexual health, drug and alcohol problems, stress, and peer pressure. Little is known about adolescents'... (Review)
Review
Adolescents face issues regarding physical health, mental health, sexual health, drug and alcohol problems, stress, and peer pressure. Little is known about adolescents' help-seeking behaviours in relation to health concerns. The general practitioner (GP) is usually the first point of contact for adolescents. The aim of this systematic review was to identify, describe, and summarize evidence on barriers and enablers experienced by adolescents when accessing GP-led primary care services. Systematic searches using four electronic databases (PsycINFO, MEDLINE, CINAHL, and SocINDEX) were conducted and the quality of the included studies was appraised. Six studies were included in this review. Findings indicate that barriers to GP access relate to trust, confidentiality, privacy, and communication. Adolescents also reported barriers such as transport, cost, and lack of information. Adolescents reported enablers being services that are sensitive to their needs, healthcare professionals who understand them, and services that are flexible regarding out of hours access. Listening to and acting on the voice of adolescents is important to developing youth-friendly services.
PubMed: 38629615
DOI: 10.1177/13674935241239837 -
Addiction (Abingdon, England) Jan 2023To compare the effectiveness of practitioner versus digitally delivered interventions for reducing hazardous and harmful alcohol consumption. (Meta-Analysis)
Meta-Analysis Review
Practitioner and digitally delivered interventions for reducing hazardous and harmful alcohol consumption in people not seeking alcohol treatment: a systematic review and network meta-analysis.
AIM
To compare the effectiveness of practitioner versus digitally delivered interventions for reducing hazardous and harmful alcohol consumption.
DESIGN
Systematic review and network meta-analysis comprising comprehensive search for randomised controlled trials, robust screening and selection methods and appraisal with the Cochrane Risk of Bias tool. Network meta-analyses were conducted in Stata using random effects, frequentist models. The confidence in network meta-analysis (CINeMA) tool was used to assess confidence in effect sizes.
SETTING
Online or community or health settings where the intervention was immediately accessible without referral.
PARTICIPANTS
Non treatment-seeking hazardous or harmful drinkers.
MEASUREMENTS
Primary outcome was mean difference in alcohol consumption (g/wk); secondary outcome was number of single high intensity drinking episodes. Baseline consumption was analysed as a covariate.
FINDINGS
Of 201 included trials (94 753 participants), 152 reported a consumption outcome that could be converted to grams/week; 104 reported number of single high intensity drinking episodes. At 1 and 6 months, practitioner delivered interventions reduced consumption more than digitally delivered interventions (1 month: -23 g/wk (95% CI, -43 to -2); 6 months: -14 g/wk [95% CI, -25 to -3]). At 12 months there was no evidence of difference between practitioner and digitally delivered interventions (-6 g/wk [95% CI, -24 to 12]). There was no evidence of a difference in single high intensity drinking episodes between practitioner and digitally delivered interventions at any time point. Effect sizes were small, but could impact across a population with relatively high prevalence of hazardous and harmful drinking. Heterogeneity was a concern. Some inconsistency was indicated at 1 and 6 months, but little evidence was apparent at 12 months.
CONCLUSION
Practitioner delivered interventions for reducing hazardous and harmful alcohol consumption are more effective than digitally delivered interventions up to 6 months; at 12 months there is no evidence of a difference.
Topics: Humans; Alcohol Drinking; Network Meta-Analysis; Alcoholism; Ethanol; Mass Screening
PubMed: 35815387
DOI: 10.1111/add.15999 -
Clinical Child and Family Psychology... Mar 2023Parental mental illness is a major international public health concern given its implications for whole families, including children. Family-focused practice (FFP), an... (Meta-Analysis)
Meta-Analysis Review
Parental mental illness is a major international public health concern given its implications for whole families, including children. Family-focused practice (FFP), an approach that emphasises a "whole-family" approach to care, provides an opportunity to mitigate the significant risks associated with parental mental health difficulties. The positive benefits associated with FFP have led to a shift in policy and practice towards prioritising FFP within adult mental health services. However, evidence suggests that FFP remains scarce and is not routine. Research has identified the important role of practitioners in facilitating FFP. The current review identified, synthesised and appraised the international qualitative literature examining adult mental health practitioners' implementation experiences of FFP. It aimed to provide an evidence-informed account of practitioner experiences of FFP delivery and to identify key recommendations to enhance future FFP outcomes in AMHS. Ovid Medline, PsycInfo, CINAHL plus, EMBASE and Web of Science Core Collection were searched systematically, in line with PRISMA guidance, up to January 2022. The Critical Appraisal Skills Programme (CASP) was used to undertake the quality appraisal prior to a thematic synthesis being conducted. The review was registered on PROSPERO. Nineteen papers, spanning 17 years of research with 469 practitioners, were included. Three main themes and 14 subthemes were developed, representing different aspects of practitioner experiences of FFP delivery. Practitioners' approach to FFP was variable and influenced by their beliefs about FFP, perceived roles and responsibilities, competence, service setting, and personal parenting status. Practitioners engaged in a balancing act to maintain a dual focus on their service-users and their children, to navigate powerful emotions, and consider multiple perspectives in a biomedical organisational structure that advocates individualised treatment. Although working together unified teams, a greater need for external interagency collaboration was identified. The use of strength-based approaches with clients and dedicated staff resources, within clear guidelines and frameworks, was reported to be necessary to maximise FFP delivery. This review proposes a complex FFP dynamic whereby practitioners engage in a constant balancing act between FFP stakeholders to achieve meaningful FFP outcomes for service-users and their families. Service recommendations are provided.
Topics: Adult; Humans; Mental Disorders; Mental Health Services; Parenting; Parents
PubMed: 36318397
DOI: 10.1007/s10567-022-00418-z -
Nutrients Apr 2022Healthy dietary intake and physical activity reduce the risk of non-communicable diseases. This systematic review and meta-analysis aimed to examine the effect of... (Meta-Analysis)
Meta-Analysis Review
Impact of Nutrition and Physical Activity Interventions Provided by Nutrition and Exercise Practitioners for the Adult General Population: A Systematic Review and Meta-Analysis.
Healthy dietary intake and physical activity reduce the risk of non-communicable diseases. This systematic review and meta-analysis aimed to examine the effect of interventions including both nutrition and physical activity provided by nutrition and exercise practitioners for adults in the general population (those without diagnosed disease). The MEDLINE, CINAHL, Cochrane Central, Cochrane Database of Systematic Reviews and SportDiscus databases were searched for randomized controlled trials (RCTs) published from 2010 until April 2021. Outcomes included physical activity, fruit and vegetable intake, waist circumference, percent weight loss, quality of life (QoL) and adverse events. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods were used to synthesize and grade evidence. Meta-analyses were stratified according to participant health status. The database search identified 11,205 articles, and 31 RCTs were included. Interventions increased physical activity amount [standardized mean difference (SMD) (95% CI): 0.25 (0.08, 0.43)] (low certainty evidence); increased vegetable intake [SMD (95% CI): 0.14 (0.05, 0.23)] (moderate certainty evidence); reduced waist circumference [MD (95% CI): -2.16 cm (-2.96, -1.36)] (high certainty evidence); and increased likelihood of achieving 5% weight loss for adults with overweight and obesity [relative risk (95% CI): 2.37 (1.76, 3.19)] (high certainty evidence). Very low and low certainty evidence described little-to-no effect on QoL or adverse events. Nutrition and exercise practitioners play key roles in facilitating positive lifestyle behaviors to reduce cardiometabolic disease risk in adults.
Topics: Adult; Exercise; Humans; Life Style; Overweight; Quality of Life; Weight Loss
PubMed: 35565696
DOI: 10.3390/nu14091729 -
Research in Social & Administrative... Feb 2023The use of competency-based education (CBE) worldwide is increasing and has been advocated for by key reports in health professional education. Recent developments,... (Review)
Review
BACKGROUND
The use of competency-based education (CBE) worldwide is increasing and has been advocated for by key reports in health professional education. Recent developments, including the first global competency framework for pharmacists published by the International Pharmaceutical Federation (FIP) in 2012, can help facilitate CBE adoption. However, adopting CBE is complex and involves various features and stages of development.
OBJECTIVE
This systematic review examines pharmacy education and training to identify features of CBE-related approaches currently in use worldwide to develop a picture of contemporary CBE-related activity in pharmacy for the purpose of guiding future development.
METHOD
Scopus, Web of Science, Medline, Embase, and ERIC electronic databases were searched to identify relevant literature. Studies associated with CBE or training of pharmacy practitioners and related postgraduate or undergraduate students were included. Studies were limited to those published in English from 2010 to 2021. Two authors performed the screening and selection of studies, and a 3rd author resolved any discrepancies. The review followed PRSIMA guidelines and was registered with PROSPERO under CRD42022296424. The findings were analysed using an inductive approach and presented descriptively.
RESULTS
Twenty-eight studies were included in the review, all of which originate from high-income countries, spanning a range of educational levels and research designs. A total of 20 features and 21 supporting components were identified and categorised, connected to those previously identified in the closely linked medical literature, and categorised into 6 overarching themes: design, teaching and learning, feedback and assessment, faculty, resources, and internal and external factors. A collective understanding of the concept of competency, in combination with a shared vision between education, regulation, and practice, underpins successful application of the CBE approach.
CONCLUSIONS
This review summarises common features of CBE across the globe which can be used to guide further developments in pharmacy education. Mutual consensus on the design and delivery of CBE features ensures that the intended learning outcomes are in alignment with the learner's experience and congruent with the realities of pharmacy practice.
Topics: Humans; Competency-Based Education; Students; Curriculum; Educational Status; Education, Pharmacy; Pharmacy; Students, Pharmacy
PubMed: 36272964
DOI: 10.1016/j.sapharm.2022.09.013