-
Sports Medicine (Auckland, N.Z.) Dec 2013Medial tibial stress syndrome (MTSS) is a common exercise-induced leg injury among athletes and military personnel. Several treatment options have been described in the... (Review)
Review
BACKGROUND
Medial tibial stress syndrome (MTSS) is a common exercise-induced leg injury among athletes and military personnel. Several treatment options have been described in the literature, but it remains unclear which treatment is most effective.
OBJECTIVE
The objective of this systematic review was to assess the effectiveness of any intervention in the treatment of MTSS.
STUDY SELECTION
Published or non-published studies, reporting randomized or non-randomized controlled trials of any treatment in subjects with MTSS were eligible for inclusion. Treatments were assessed for effects on pain, time to recovery or global perceived effect.
DATA SOURCES
Computerized bibliographic databases (MEDLINE, CENTRAL, EMBASE, CINAHL, PEDro and SPORTDiscus) and trial registries were searched for relevant reports, from their inception to 1 June 2012. Grey literature was searched for additional relevant reports.
STUDY APPRAISAL
The Cochrane Risk of Bias Tool was used to appraise study quality of randomized clinical trials (RCTs) whereas the Newcastle Ottawa Scale was used to appraise non-randomized trials. The 'levels of evidence', according to the Oxford Centre for Evidence-Based Medicine, addressed the impact of the assessed trials. Two reviewers independently performed the search for articles, study selection, data extraction and appraised methodological quality.
RESULTS
Eleven trials were included in this systematic review. All RCTs revealed a high risk of bias (Level 3 of evidence). Both non-randomized clinical trials were found to be of poor quality (Level 4 of evidence). RCTs, studying the effect of a lower leg brace versus no lower leg brace, and iontophoresis versus phonophoresis, were pooled using a fixed-effects model. No significant differences were found for lower leg braces (standardized mean difference [SMD] -0.06; 95 % CI -0.44 to 0.32, p = 0.76), or iontophoresis (SMD 0.09; 95 % CI -0.50 to 0.68, p = 0.76). Iontophoresis, phonophoresis, ice massage, ultrasound therapy, periosteal pecking and extracorporeal shockwave therapy (ESWT) could be effective in treating MTSS when compared with control (Level 3 to 4 of evidence). Low-energy laser treatment, stretching and strengthening exercises, sports compression stockings, lower leg braces and pulsed electromagnetic fields have not been proven to be effective in treating MTSS (level 3 of evidence).
CONCLUSION
None of the studies are sufficiently free from methodological bias to recommend any of the treatments investigated. Of those examined, ESWT appears to have the most promise.
Topics: Evidence-Based Medicine; Humans; Medial Tibial Stress Syndrome; Pain Management; Treatment Outcome
PubMed: 23979968
DOI: 10.1007/s40279-013-0087-0 -
International Journal of Nursing Studies May 2019Nursing shortages have profoundly impacted hospitals and consequently increased financial expenditure, resulting in work overload, thus augmenting nurses' stress and...
BACKGROUND
Nursing shortages have profoundly impacted hospitals and consequently increased financial expenditure, resulting in work overload, thus augmenting nurses' stress and burnout levels. Studies have found that resilience helps nurses reduce the effects of stress and burnout. However, the factors associated with nurse resilience are yet to be determined.
OBJECTIVES
This systematic review aims to identify the associated personal and work-related factors of nurse resilience.
DESIGN
This systematic review has been registered in the international prospective register of systematic reviews (Registered Number: CRD 42018094080). Results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol.
DATA SOURCES
The systematic search was undertaken between March and April 2018 in five databases: CINAHL Plus, MEDLINE (Ovid), PsycINFO, EMBASE, and Scopus. The searched terms combined in each database were: resilience, hardiness, work, employ, occupation, job, and nursing.
REVIEW METHODS
Full-text English articles published between 2000 and 2018 were included. Studies were also included if they involved: (1) nurses who provided direct patient care, (2) resilience and its associated factors, (3) an empirical quantitative study, and (4) a quality assessment grade of 'good' or 'fair'. Two authors carried out the study eligibility and quality assessment independently. A narrative synthesis was utilised following the Job Demands-Resources model to identify the factors of job demands and resources, which were associated with nurse resilience.
RESULTS
A total of 38 articles met the criteria and were systematically reviewed and narratively synthesised. Various resilience scales utilised in these studies made it unfeasible to synthesise the evidence using a meta-analysis. Inconsistencies exist when examining personal and work-related factors. Job demands (stress, burnout, posttraumatic stress disorder, and workplace bullying) were negatively associated with resilience, while job resources (coping skills, self-efficacy, social support, job satisfaction, job retention, and general wellbeing) were positively related to resilience. Using a quality assessment tool, 23 studies were rated as 'Good', 15 were assessed as 'Fair', and 20 were found to have a risk of bias.
CONCLUSIONS
Understanding nurse resilience can proactively help nurses identify or prevent potential problems, thus fostering job resources and ultimately achieving personal and professional growth. Increased nurse resilience can help nurses reduce emotional exhaustion, increase work engagement, and enhance function when facing workplace challenges. This can assist nurses to establish strategies to deal with adversity and attenuate the effects of job demands. Further research is needed to explore nurse resilience and develop a consistent instrument for measuring resilience.
Topics: Adaptation, Psychological; Attitude of Health Personnel; Burnout, Professional; Humans; Job Satisfaction; Nursing Staff, Hospital; Resilience, Psychological; Workload
PubMed: 30925279
DOI: 10.1016/j.ijnurstu.2019.02.014 -
PloS One 2021Does time management work? We conducted a meta-analysis to assess the impact of time management on performance and well-being. Results show that time management is... (Meta-Analysis)
Meta-Analysis
Does time management work? We conducted a meta-analysis to assess the impact of time management on performance and well-being. Results show that time management is moderately related to job performance, academic achievement, and wellbeing. Time management also shows a moderate, negative relationship with distress. Interestingly, individual differences and contextual factors have a much weaker association with time management, with the notable exception of conscientiousness. The extremely weak correlation with gender was unexpected: women seem to manage time better than men, but the difference is very slight. Further, we found that the link between time management and job performance seems to increase over the years: time management is more likely to get people a positive performance review at work today than in the early 1990s. The link between time management and gender, too, seems to intensify: women's time management scores have been on the rise for the past few decades. We also note that time management seems to enhance wellbeing-in particular, life satisfaction-to a greater extent than it does performance. This challenges the common perception that time management first and foremost enhances work performance, and that wellbeing is simply a byproduct.
Topics: Adult; Female; Humans; Job Satisfaction; Male; Stress, Psychological; Time Management
PubMed: 33428644
DOI: 10.1371/journal.pone.0245066 -
Diseases of the Colon and Rectum Jun 2017Physician burnout in the United States has reached epidemic proportions and is rising rapidly, although burnout in other occupations is stable. Its negative impact is... (Review)
Review
BACKGROUND
Physician burnout in the United States has reached epidemic proportions and is rising rapidly, although burnout in other occupations is stable. Its negative impact is far reaching and includes harm to the burned-out physician, as well as patients, coworkers, family members, close friends, and healthcare organizations.
OBJECTIVE
The purpose of this review is to provide an accurate, current summary of what is known about physician burnout and to develop a framework to reverse its current negative impact, decrease its prevalence, and implement effective organizational and personal interventions.
DATA SOURCES
I completed a comprehensive MEDLINE search of the medical literature from January 1, 2000, through December 28, 2016, related to medical student and physician burnout, stress, depression, suicide ideation, suicide, resiliency, wellness, and well-being. In addition, I selectively reviewed secondary articles, books addressing the relevant issues, and oral presentations at national professional meetings since 2013.
STUDY SELECTION
Healthcare organizations within the United States were studied.
RESULTS
The literature review is presented in 5 sections covering the basics of defining and measuring burnout; its impact, incidence, and causes; and interventions and remediation strategies.
CONCLUSIONS
All US medical students, physicians in training, and practicing physicians are at significant risk of burnout. Its prevalence now exceeds 50%. Burnout is the unintended net result of multiple, highly disruptive changes in society at large, the medical profession, and the healthcare system. Both individual and organizational strategies have been only partially successful in mitigating burnout and in developing resiliency and well-being among physicians. Two highly effective strategies are aligning personal and organizational values and enabling physicians to devote 20% of their work activities to the part of their medical practice that is especially meaningful to them. More research is needed.
Topics: Burnout, Professional; Delivery of Health Care; Humans; Incidence; Medical Errors; Near Miss, Healthcare; Personnel Turnover; Physicians; Professional Autonomy; Stress, Psychological; Suicide; United States; Workload; Workplace
PubMed: 28481850
DOI: 10.1097/DCR.0000000000000844 -
BMJ (Clinical Research Ed.) Dec 2020To evaluate evidence from randomised controlled trials and non-randomised controlled trials on the effectiveness of hospital clowns for a range of symptom clusters in...
OBJECTIVE
To evaluate evidence from randomised controlled trials and non-randomised controlled trials on the effectiveness of hospital clowns for a range of symptom clusters in children and adolescents admitted to hospital with acute and chronic conditions.
DESIGN
Systematic review of randomised and non-randomised controlled trials.
DATA SOURCES
Medline, ISI of Knowledge, Cochrane Central Register of Controlled Trials, Science Direct, Scopus, American Psychological Association PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Latin American and Caribbean Health Sciences Literature.
STUDY SELECTION
Randomised and non-randomised controlled trials were peer reviewed using the following eligibility criteria: children and adolescents who were admitted to hospital for acute conditions or chronic disorders, studies comparing use of hospital clowns with standard care, and studies evaluating the effect of hospital clowns on symptom management of inpatient children and adolescents as a primary outcome.
DATA EXTRACTION AND SYNTHESIS
Two investigators independently screened studies, extracted data, and appraised the risk of bias. Methodological appraisal was assessed by two investigators independently using the Jadad scale, the revised Cochrane risk-of-bias tool for randomised controlled trials (RoB 2), and the risk of bias in non-randomised studies (ROBINS-I) tool for non-randomised controlled trials.
RESULTS
24 studies (n=1612) met the inclusion criteria for data extraction and analysis. Most studies were randomised controlled trials (n=13). Anxiety was the most frequently analysed symptom (n=13), followed by pain (n=9), psychological and emotional responses and perceived wellbeing (n=4), stress (n=4), cancer related fatigue (n=3), and crying (n=2). Five studies used biomarkers, mainly cortisol, to assess stress or fatigue outcome following hospital clowns. Most of the randomised controlled trials (n=11; 85%) were rated as showing some concerns, and two trials were rated with a high risk of bias. Most non-randomised controlled trials (n=6; 55%) were rated with a moderate risk of bias according to ROBINS-I tool. Studies showed that children and adolescents who were in the presence of hospital clowns, either with or without a parent present, reported significantly less anxiety during a range of medical procedures, as well as improved psychological adjustment (P<0.05). Three studies that evaluated chronic conditions showed favourable results for the intervention of hospital clowns with significant reduction in stress, fatigue, pain, and distress (P<0.05).
CONCLUSIONS
These findings suggest that the presence of hospital clowns during medical procedures, induction of anaesthesia in the preoperative room, and as part of routine care for chronic conditions might be a beneficial strategy to manage some symptom clusters. Furthermore, hospital clowns might help improve psychological wellbeing in admitted children and adolescents with acute and chronic disorders, compared with those who received only standard care.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42018107099.
Topics: Acute Disease; Anxiety; Child; Child, Hospitalized; Chronic Disease; Fatigue; Humans; Laughter Therapy; Non-Randomized Controlled Trials as Topic; Pain Management; Randomized Controlled Trials as Topic; Stress, Psychological
PubMed: 33328164
DOI: 10.1136/bmj.m4290 -
European Review For Medical and... May 2019Medication administration accounts for 40% of the nursing clinical activity in hospitals and nurses play a central role in granting the patient safety, as they are... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Medication administration accounts for 40% of the nursing clinical activity in hospitals and nurses play a central role in granting the patient safety, as they are directly responsible for the patient care. This review aims at analyzing the correlation between the clinical risk management and the occurrence of medication errors and the effects of the shift work (such as excessive fatigue and sleep deprivation after a shift in hospital) on inpatient nurses.
MATERIALS AND METHODS
This paper adheres to the relevant EQUATOR guidelines. A systematic review was conducted according to the PRISMA statement and pertinent articles were selected based on inclusion criteria and quality assessment factors. Two reviewers searched the bibliographic databases PubMed, Scopus, Cochrane, CINAHL to collect all the available articles in English and Italian issued between 1992 and August 2017.
RESULTS
The reviewers analyzed 19 of the 723 initially extracted references, as they focused on the impact of workload, shifts and sleep deprivation on the probability of making medication errors.
CONCLUSIONS
The main reasons behind medication errors are stress, fatigue, increased workload, night shifts, nurse staffing ratio and workflow interruptions. These factors can have a significant negative impact on the health and the performance of the employees. It is desirable to extend and deepen the research to identify appropriate measures to minimize medication errors.
Topics: Humans; Medication Errors; Nurses; Patient Safety; Shift Work Schedule; Work Schedule Tolerance; Workload
PubMed: 31173328
DOI: 10.26355/eurrev_201905_17963 -
Drug Safety Nov 2013Underlying systems factors have been seen to be crucial contributors to the occurrence of medication errors. By understanding the causes of these errors, the most... (Review)
Review
BACKGROUND
Underlying systems factors have been seen to be crucial contributors to the occurrence of medication errors. By understanding the causes of these errors, the most appropriate interventions can be designed and implemented to minimise their occurrence.
OBJECTIVE
This study aimed to systematically review and appraise empirical evidence relating to the causes of medication administration errors (MAEs) in hospital settings.
DATA SOURCES
Nine electronic databases (MEDLINE, EMBASE, International Pharmaceutical Abstracts, ASSIA, PsycINFO, British Nursing Index, CINAHL, Health Management Information Consortium and Social Science Citations Index) were searched between 1985 and May 2013.
STUDY SELECTION
Inclusion and exclusion criteria were applied to identify eligible publications through title analysis followed by abstract and then full text examination. English language publications reporting empirical data on causes of MAEs were included. Reference lists of included articles and relevant review papers were hand searched for additional studies. Studies were excluded if they did not report data on specific MAEs, used accounts from individuals not directly involved in the MAE concerned or were presented as conference abstracts with insufficient detail.
DATA APPRAISAL AND SYNTHESIS METHODS
A total of 54 unique studies were included. Causes of MAEs were categorised according to Reason's model of accident causation. Studies were assessed to determine relevance to the research question and how likely the results were to reflect the potential underlying causes of MAEs based on the method(s) used.
RESULTS
Slips and lapses were the most commonly reported unsafe acts, followed by knowledge-based mistakes and deliberate violations. Error-provoking conditions influencing administration errors included inadequate written communication (prescriptions, documentation, transcription), problems with medicines supply and storage (pharmacy dispensing errors and ward stock management), high perceived workload, problems with ward-based equipment (access, functionality), patient factors (availability, acuity), staff health status (fatigue, stress) and interruptions/distractions during drug administration. Few studies sought to determine the causes of intravenous MAEs. A number of latent pathway conditions were less well explored, including local working culture and high-level managerial decisions. Causes were often described superficially; this may be related to the use of quantitative surveys and observation methods in many studies, limited use of established error causation frameworks to analyse data and a predominant focus on issues other than the causes of MAEs among studies.
LIMITATIONS
As only English language publications were included, some relevant studies may have been missed.
CONCLUSIONS
Limited evidence from studies included in this systematic review suggests that MAEs are influenced by multiple systems factors, but if and how these arise and interconnect to lead to errors remains to be fully determined. Further research with a theoretical focus is needed to investigate the MAE causation pathway, with an emphasis on ensuring interventions designed to minimise MAEs target recognised underlying causes of errors to maximise their impact.
Topics: Data Collection; Databases, Factual; Drug Prescriptions; Hospitals, Teaching; Humans; Medication Errors; Models, Theoretical; Patient Care Team; Pharmaceutical Preparations; Quality Assurance, Health Care; Workload
PubMed: 23975331
DOI: 10.1007/s40264-013-0090-2 -
Journal of Nursing Management Jul 2013Our aim was to describe the findings of a systematic review of studies that examine the relationship between nursing leadership practices and patient outcomes. (Review)
Review
AIM
Our aim was to describe the findings of a systematic review of studies that examine the relationship between nursing leadership practices and patient outcomes.
BACKGROUND
As healthcare faces an economic downturn, stressful work environments, upcoming retirements of leaders and projected workforce shortages, implementing strategies to ensure effective leadership and optimal patient outcomes are paramount. However, a gap still exists in what is known about the association between nursing leadership and patient outcomes.
METHODS
Published English-only research articles that examined leadership practices of nurses in formal leadership positions and patient outcomes were selected from eight online bibliographic databases. Quality assessments, data extraction and analysis were completed on all included studies.
RESULTS
A total of 20 studies satisfied our inclusion criteria and were retained. Current evidence suggests relationships between positive relational leadership styles and higher patient satisfaction and lower patient mortality, medication errors, restraint use and hospital-acquired infections.
CONCLUSIONS
The findings document evidence of a positive relationship between relational leadership and a variety of patient outcomes, although future testing of leadership models that examine the mechanisms of influence on outcomes is warranted.
IMPLICATIONS FOR NURSING MANAGEMENT
Efforts by organisations and individuals to develop transformational and relational leadership reinforces organisational strategies to improve patient outcomes.
Topics: Health Facility Environment; Humans; Leadership; Nurse Administrators; Nursing; Nursing Administration Research; Organizational Objectives; Outcome Assessment, Health Care; Patient Satisfaction; Workplace
PubMed: 23865924
DOI: 10.1111/jonm.12116 -
CA: a Cancer Journal For Clinicians May 2016Answer questions and earn CME/CNE The American Cancer Society Head and Neck Cancer Survivorship Care Guideline was developed to assist primary care clinicians and other... (Review)
Review
Answer questions and earn CME/CNE The American Cancer Society Head and Neck Cancer Survivorship Care Guideline was developed to assist primary care clinicians and other health practitioners with the care of head and neck cancer survivors, including monitoring for recurrence, screening for second primary cancers, assessment and management of long-term and late effects, health promotion, and care coordination. A systematic review of the literature was conducted using PubMed through April 2015, and a multidisciplinary expert workgroup with expertise in primary care, dentistry, surgical oncology, medical oncology, radiation oncology, clinical psychology, speech-language pathology, physical medicine and rehabilitation, the patient perspective, and nursing was assembled. While the guideline is based on a systematic review of the current literature, most evidence is not sufficient to warrant a strong recommendation. Therefore, recommendations should be viewed as consensus-based management strategies for assisting patients with physical and psychosocial effects of head and neck cancer and its treatment. CA Cancer J Clin 2016;66:203-239. © 2016 American Cancer Society.
Topics: Accessory Nerve Diseases; Aftercare; American Cancer Society; Anxiety; Bursitis; Deglutition Disorders; Dental Care; Dental Caries; Depression; Disease Management; Dystonia; Fatigue; Gastroesophageal Reflux; Head and Neck Neoplasms; Health Promotion; Humans; Hypothyroidism; Lymphedema; Neck Muscles; Osteonecrosis; Periodontitis; Peripheral Nervous System Diseases; Respiratory Aspiration; Sleep Apnea Syndromes; Sleep Wake Disorders; Stress, Psychological; Survivors; Taste Disorders; Trismus; Vestibular Neuronitis; Voice Disorders; Xerostomia
PubMed: 27002678
DOI: 10.3322/caac.21343 -
BMC Health Services Research Dec 2017Nurses leaving their jobs and the profession are an issue of international concern, with supply-demand gaps for nurses reported to be widening. There is a large body of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Nurses leaving their jobs and the profession are an issue of international concern, with supply-demand gaps for nurses reported to be widening. There is a large body of existing literature, much of which is already in review form. In order to advance the usefulness of the literature for nurse and human resource managers, we undertook an overview (review of systematic reviews). The aim of the overview was to identify high quality evidence of the determinants and consequences of turnover in adult nursing.
METHODS
Reviews were identified which were published between 1990 and January 2015 in English using electronic databases (the Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, Applied Social Sciences Index and Abstracts, CINAHL plus and SCOPUS) and forward searching. All stages of the review were conducted in parallel by two reviewers. Reviews were quality appraised using the Assessment of Multiple Systematic Reviews and their findings narratively synthesised.
RESULTS
Nine reviews were included. We found that the current evidence is incomplete and has a number of important limitations. However, a body of moderate quality review evidence does exist giving a picture of multiple determinants of turnover in adult nursing, with - at the individual level - nurse stress and dissatisfaction being important factors and -at the organisational level - managerial style and supervisory support factors holding most weight. The consequences of turnover are only described in economic terms, but are considered significant.
CONCLUSIONS
In making a quality assessment of the review as well as considering the quality of the included primary studies and specificity in the outcomes they measure, the overview found that the evidence is not as definitive as previously presented from individual reviews. Further research is required, of rigorous research design, whether quantitative or qualitative, particularly against the outcome of actual turnover as opposed to intention to leave.
TRIAL REGISTRATION
PROSPERO Registration 17 March 2015: CRD42015017613 .
Topics: Adult; Female; Humans; Intention; Interpersonal Relations; Job Satisfaction; Leadership; Male; Motivation; Nursing Staff; Organizational Culture; Personnel Turnover; Power, Psychological; Review Literature as Topic; Salaries and Fringe Benefits; Workload
PubMed: 29246221
DOI: 10.1186/s12913-017-2707-0