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Cancer Journal (Sudbury, Mass.) 2019This narrative review provides an overview of the scope of psychosocial distress and stress in cancer patients and survivors and the potential negative consequences of... (Review)
Review
This narrative review provides an overview of the scope of psychosocial distress and stress in cancer patients and survivors and the potential negative consequences of untreated symptoms. Evidence-based interventions to treat these symptoms are reviewed, beginning with a summary of published clinical practice guidelines, followed by more detailed reviews of the specific integrative interventions with the largest empirical support: cognitive-behavioral stress management, yoga, mindfulness-based interventions, and massage. We also comment on use of natural health products because of their popularity. Finally, we conclude with recommendations to improve the quality of research in integrative interventions for stress management.
Topics: Cancer Survivors; Disease Management; Evidence-Based Practice; Humans; Integrative Oncology; Mind-Body Therapies; Neoplasms; Practice Guidelines as Topic; Stress, Psychological; Yoga
PubMed: 31567460
DOI: 10.1097/PPO.0000000000000395 -
PM & R : the Journal of Injury,... Mar 2016Stress fractures are common overuse injuries in athletes. They occur during periods of increased training without adequate rest, disrupting normal bone reparative... (Review)
Review
Stress fractures are common overuse injuries in athletes. They occur during periods of increased training without adequate rest, disrupting normal bone reparative mechanisms. There are a host of intrinsic and extrinsic factors, including biochemical and biomechanical, that put athletes at risk. In most stress fractures, the diagnosis is primarily clinical, with imaging indicated at times, and management focused on symptom-free relative rest with advancement of activity as tolerated. Overall, stress fractures in athletes have an excellent prognosis for return to sport, with little risk of complication. There is a subset of injuries that have a greater risk of fracture progression, delayed healing, and nonunion and are generally more challenging to treat with nonoperative care. Specific locations of high-risk stress fracture include the femoral neck (tension side), patella, anterior tibia, medial malleolus, talus, tarsal navicular, proximal fifth metatarsal, and great toe sesamoids. These sites share a characteristic region of high tensile load and low blood flow. High-risk stress fractures require a more aggressive approach to evaluation, with imaging often necessary, to confirm early and accurate diagnosis and initiate immediate treatment. Treatment consists of nonweight-bearing immobilization, often with a prolonged period away from sport, and a more methodic and careful reintroduction to athletic activity. These stress fractures may require surgical intervention. A high index of suspicion is essential to avoid delayed diagnosis and optimize outcomes in this subset of stress fractures.
Topics: Athletes; Athletic Injuries; Disease Management; Fractures, Stress; Humans
PubMed: 26972260
DOI: 10.1016/j.pmrj.2015.09.019 -
Clinical & Experimental Optometry Jan 2019Digital eye strain, an emerging public health issue, is a condition characterised by visual disturbance and/or ocular discomfort related to the use of digital devices... (Review)
Review
Digital eye strain, an emerging public health issue, is a condition characterised by visual disturbance and/or ocular discomfort related to the use of digital devices and resulting from a range of stresses on the ocular environment. This review aims to provide an overview of the extensive literature on digital eye strain research with particular reference to the clinical management of symptoms. As many as 90 per cent of digital device users experience symptoms of digital eye strain. Many studies suggest that the following factors are associated with digital eye strain: uncorrected refractive error (including presbyopia), accommodative and vergence anomalies, altered blinking pattern (reduced rate and incomplete blinking), excessive exposure to intense light, closer working distance, and smaller font size. Since a symptom may be caused by one or more factors, a holistic approach should be adopted. The following management strategies have been suggested: (i) appropriate correction of refractive error, including astigmatism and presbyopia; (ii) management of vergence anomalies, with the aim of inducing or leaving a small amount of heterophoria (~1.5 Exo); (iii) blinking exercise/training to maintain normal blinking pattern; (iv) use of lubricating eye drops (artificial tears) to help alleviate dry eye-related symptoms; (v) contact lenses with enhanced comfort, particularly at end-of-day and in challenging environments; (vi) prescription of colour filters in all vision correction options, especially blue light-absorbing filters; and (vii) management of accommodative anomalies. Prevention is the main strategy for management of digital eye strain, which involves: (i) ensuring an ergonomic work environment and practice (through patient education and the implementation of ergonomic workplace policies); and (ii) visual examination and eye care to treat visual disorders. Special consideration is needed for people at a high risk of digital eye strain, such as computer workers and contact lens wearers.
Topics: Asthenopia; Computer Systems; Disease Management; Humans; Vision Disorders
PubMed: 29797453
DOI: 10.1111/cxo.12798 -
Heart Failure Clinics Jul 2020The key to understanding hemodynamics in heart failure (HF) is the relation between elevated left ventricular (LV) filling pressure and cardiac output. Some patients... (Review)
Review
The key to understanding hemodynamics in heart failure (HF) is the relation between elevated left ventricular (LV) filling pressure and cardiac output. Some patients show abnormal response to stress in the relationship between LV filling pressure and cardiac output. In patients with preserved diastolic function, cardiac output can be increased without significantly elevated filling pressure during stress. In patients with HF, as long as the Frank-Starling mechanism operates effectively, cardiac output can increase while acquiring elevated filling pressure. In patients with decompensated HF, hemodynamic stress will lead to a much greater elevation in filling pressure and pulmonary venous hypertension.
Topics: Cardiac Output; Disease Management; Echocardiography, Stress; Heart Failure; Hemodynamics; Humans
PubMed: 32503757
DOI: 10.1016/j.hfc.2020.02.001 -
British Journal of Nursing (Mark Allen... Jan 2017Conflict is a consistent and unavoidable issue within healthcare teams. Despite training of nurse leaders and managers around areas of conflict resolution, the problem...
Conflict is a consistent and unavoidable issue within healthcare teams. Despite training of nurse leaders and managers around areas of conflict resolution, the problem of staff relations, stress, sickness and retention remain. Conflict arises from issues with interpersonal relationships, change and poor leadership. New members of staff entering an already established healthcare team should be supported and integrated, to encourage mutual role respect between all team members and establish positive working relationships, in order to maximise patient care. This paper explores the concept of conflict, the importance of addressing causes of conflict, effective management, and the relevance of positive approaches to conflict resolution. Good leadership, nurturing positive team dynamics and communication, encourages shared problem solving and acceptance of change. Furthermore mutual respect fosters a more positive working environment for those in healthcare teams. As conflict has direct implications for patients, positive resolution is essential, to promote safe and effective delivery of care, whilst encouraging therapeutic relationships between colleagues and managers.
Topics: Attitude of Health Personnel; Humans; Interprofessional Relations; Leadership; Morale; Negotiating; Nurse Administrators; Nurse's Role; Organizational Culture; Patient Care Team; United Kingdom; Workplace
PubMed: 28132555
DOI: 10.12968/bjon.2017.26.2.100 -
Journal of Clinical Nursing Apr 2018To appraise and synthesise empirical studies examining sources of occupational stress and ways of coping utilised by nurse managers when dealing with stress. (Review)
Review
AIMS AND OBJECTIVES
To appraise and synthesise empirical studies examining sources of occupational stress and ways of coping utilised by nurse managers when dealing with stress.
BACKGROUND
The Nurse Manager's role is challenging yet draining and stressful and has adverse consequences on an individual's overall health and well-being, patients' outcomes and organisational productivity. Considerable research has been carried out; however, an updated and broader perspective on this critical organisational issue has not been performed.
DESIGN
An integrative review.
METHODS
Five databases (Cumulative Index to Nursing and Allied Health Literature, SCOPUS, PubMed, PsychINFO and MEDLINE) were searched to identify relevant articles. Search terms and MeSH terms included: "charge nurse," "coping," "coping strategy," "coping style," "psychological adaptation," "psychological stress," "stressors," "nurse manager" and "unit manager." Twenty-two articles were included in this review. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines.
RESULTS
Four themes were identified: moderate stress levels, common sources of stress, ways of coping and the impact of nurses' characteristics on stress.
CONCLUSIONS
Nurse managers experienced moderate levels of stress mainly from heavy workloads, lack of resources and financial responsibilities. Enhancing social support and promoting job control were seen as important in reducing work stress and its related consequences. Additional studies using a more rigorous method and a larger sample size preferably in multicultural settings would shed more light on this topic.
RELEVANCE TO CLINICAL PRACTICE
Hospital and nurse administrators play an important role in promoting supportive structures for daily professional practice for nurse managers through staffing, organisational resources, support services, leadership and stress management training.
Topics: Adaptation, Psychological; Humans; Leadership; Nurse Administrators; Occupational Stress; Resilience, Psychological
PubMed: 29148110
DOI: 10.1111/jocn.14165 -
Occupational Medicine (Oxford, England) Mar 2020The UK Health and Safety Executive's Stress Management Competency Framework and associated questionnaire, the Stress Management Competency Indicator Tool (SMCIT),...
BACKGROUND
The UK Health and Safety Executive's Stress Management Competency Framework and associated questionnaire, the Stress Management Competency Indicator Tool (SMCIT), address line managers' behaviours across four competency areas. The application in policing remains unexplored.
AIMS
This study profiled English police officers' perception of their line managers' competencies in the framework areas. The odds of experiencing poor mental wellbeing and work attitudes associated with having a line manager with a development need on each competency area were tested.
METHODS
Two hundred and sixty-three police officers completed a survey comprising the SMCIT and measures of psychological distress, resilience and work engagement. Bivariate correlations were calculated to identify patterns of relationships between variables. Binary logistic regression analyses tested the odds of psychological distress caseness, low resilience and low work engagement being associated with officers' perception of their line manager having a development need on the SMCIT criteria.
RESULTS
Approximately half the participants reported their line manager had a development need on the 'Managing and Communicating Existing and Future Work', 'Managing the Individual Within the Team' and 'Reasoning and Managing Difficult Situations' competencies, and one quarter on the 'Respectful and Responsible: Managing Emotions and Having Integrity' competency. Officers' rating of their line manager having a development need on the four competency areas was associated with up to four-fold elevated odds of each undesirable state.
CONCLUSIONS
The framework competency areas are relevant to English policing and offer a basis for stress reduction interventions targeted at line managers' behaviours.
Topics: Adult; England; Female; Humans; Male; Mental Health; Middle Aged; Occupational Stress; Police; Resilience, Psychological; Stress, Psychological; Surveys and Questionnaires; Work Engagement; Workplace
PubMed: 31774917
DOI: 10.1093/occmed/kqz143 -
The Canadian Journal of Cardiology Jan 2017The Canadian Cardiovascular Society Guidelines Committee and key Canadian opinion leaders believed there was a need for up to date guidelines that used the Grading of... (Review)
Review
The Canadian Cardiovascular Society Guidelines Committee and key Canadian opinion leaders believed there was a need for up to date guidelines that used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of evidence assessment for patients who undergo noncardiac surgery. Strong recommendations included: 1) measuring brain natriuretic peptide (BNP) or N-terminal fragment of proBNP (NT-proBNP) before surgery to enhance perioperative cardiac risk estimation in patients who are 65 years of age or older, are 45-64 years of age with significant cardiovascular disease, or have a Revised Cardiac Risk Index score ≥ 1; 2) against performing preoperative resting echocardiography, coronary computed tomography angiography, exercise or cardiopulmonary exercise testing, or pharmacological stress echocardiography or radionuclide imaging to enhance perioperative cardiac risk estimation; 3) against the initiation or continuation of acetylsalicylic acid for the prevention of perioperative cardiac events, except in patients with a recent coronary artery stent or who will undergo carotid endarterectomy; 4) against α agonist or β-blocker initiation within 24 hours before surgery; 5) withholding angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker starting 24 hours before surgery; 6) facilitating smoking cessation before surgery; 7) measuring daily troponin for 48 to 72 hours after surgery in patients with an elevated NT-proBNP/BNP measurement before surgery or if there is no NT-proBNP/BNP measurement before surgery, in those who have a Revised Cardiac Risk Index score ≥1, age 45-64 years with significant cardiovascular disease, or age 65 years or older; and 8) initiating of long-term acetylsalicylic acid and statin therapy in patients who suffer myocardial injury/infarction after surgery.
Topics: Canada; Cardiology; Cardiovascular Diseases; Disease Management; Humans; Perioperative Period; Practice Guidelines as Topic; Risk Assessment; Societies, Medical; Surgical Procedures, Operative
PubMed: 27865641
DOI: 10.1016/j.cjca.2016.09.008 -
Gut Aug 2019The objectives of this review on 'leaky gut' for clinicians are to discuss the components of the intestinal barrier, the diverse measurements of intestinal permeability,... (Review)
Review
The objectives of this review on 'leaky gut' for clinicians are to discuss the components of the intestinal barrier, the diverse measurements of intestinal permeability, their perturbation in non-inflammatory 'stressed states' and the impact of treatment with dietary factors. Information on 'healthy' or 'leaky' gut in the public domain requires confirmation before endorsing dietary exclusions, replacement with non-irritating foods (such as fermented foods) or use of supplements to repair the damage. The intestinal barrier includes surface mucus, epithelial layer and immune defences. Epithelial permeability results from increased paracellular transport, apoptosis or transcellular permeability. Barrier function can be tested in vivo using orally administered probe molecules or in vitro using mucosal biopsies from humans, exposing the colonic mucosa from rats or mice or cell layers to extracts of colonic mucosa or stool from human patients. Assessment of intestinal barrier requires measurements beyond the epithelial layer. 'Stress' disorders such as endurance exercise, non-steroidal anti-inflammatory drugs administration, pregnancy and surfactants (such as bile acids and dietary factors such as emulsifiers) increase permeability. Dietary factors can reverse intestinal leakiness and mucosal damage in the 'stress' disorders. Whereas inflammatory or ulcerating intestinal diseases result in leaky gut, no such disease can be cured by simply normalising intestinal barrier function. It is still unproven that restoring barrier function can ameliorate clinical manifestations in GI or systemic diseases. Clinicians should be aware of the potential of barrier dysfunction in GI diseases and of the barrier as a target for future therapy.
Topics: Disease Management; Gastrointestinal Diseases; Humans; Intestinal Mucosa; Permeability
PubMed: 31076401
DOI: 10.1136/gutjnl-2019-318427 -
Journal of the American Geriatrics... Apr 2014Noncognitive neuropsychiatric symptoms (NPS) of dementia (aggression, agitation, depression, anxiety, delusions, hallucinations, apathy, disinhibition) affect... (Review)
Review
Noncognitive neuropsychiatric symptoms (NPS) of dementia (aggression, agitation, depression, anxiety, delusions, hallucinations, apathy, disinhibition) affect individuals with dementia nearly universally across dementia stages and etiologies. NPS are associated with poor outcomes for individuals with dementia and caregivers, including excess morbidity and mortality, greater healthcare use, and earlier nursing home placement, as well as caregiver stress, depression, and difficulty with employment. Although the Food and Drug Administration has not approved pharmacotherapy for NPS, psychotropic medications are frequently used to manage these symptoms, but in the few cases of proven pharmacological efficacy, significant risk of adverse effects may offset benefits. There is evidence of efficacy and limited potential for adverse effects of nonpharmacological treatments, typically considered first line, but their uptake as preferred treatments remains inadequate in real-world clinical settings. Thus, the field currently finds itself in a predicament in terms of management of these difficult symptoms. It was in this context that the University of Michigan Program for Positive Aging, working in collaboration with the Johns Hopkins Alzheimer's Disease Research Center and Center for Innovative Care in Aging sponsored and convened a multidisciplinary expert panel in Detroit, Michigan, in fall 2011 with three objectives: to define critical elements of care for NPS in dementia; to construct an approach describing the sequential and iterative steps of managing NPS in real-world clinical settings that can be used as a basis for integrating nonpharmacological and pharmacological approaches; and to discuss how the approach generated could be implemented in research and clinical care.
Topics: Behavior Therapy; Crisis Intervention; Dementia; Disease Management; Expert Testimony; Humans; Neuropsychological Tests; Practice Guidelines as Topic; Severity of Illness Index
PubMed: 24635665
DOI: 10.1111/jgs.12730