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International Journal of Environmental... Oct 2021Nursing is considered to be an at-risk profession of burnout due to daily exposure to difficult situations such as death and pain care. In addition, some units such as... (Meta-Analysis)
Meta-Analysis Review
Nursing is considered to be an at-risk profession of burnout due to daily exposure to difficult situations such as death and pain care. In addition, some units such as the intensive care unit (ICU), can be stressful due to high levels of morbidity and mortality and ethical dilemmas. Burnout causes a deterioration in quality of care, increasing the risk of mortality in patients due to poor performance and errors in the healthcare environment. The aim of this study was to analyse the levels, prevalence and related factors of burnout in ICU nurses. A systematic review and meta-analysis were carried out in the Medline, Scopus and CINAHL databases. Fifteen articles were found for the systematic review and four for the meta-analysis. With a sample of = 1986 nurses, the meta-analytic estimate prevalence for high emotional exhaustion was 31% (95% CI, 8-59%), for high depersonalization was 18% (95% CI, 8-30%), and for low personal accomplishment was 46% (95% CI, 20-74%). Within the dimensions of burnout, emotional exhaustion had a significant relationship with depression and personality factors. Both sociodemographic factors (being younger, single marital status, and having less professional experience in ICU) and working conditions (workload and working longer hours) influence the risk of burnout syndrome.
Topics: Burnout, Professional; Burnout, Psychological; Humans; Intensive Care Units; Nurses; Prevalence; Risk Factors
PubMed: 34769948
DOI: 10.3390/ijerph182111432 -
Journal of Advanced Nursing Aug 2021To examine the nurses' burnout and associated risk factors during the COVID-19 pandemic. (Meta-Analysis)
Meta-Analysis Review
AIMS
To examine the nurses' burnout and associated risk factors during the COVID-19 pandemic.
DESIGN
We followed the Cochrane criteria and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for this systematic review and meta-analysis.
DATA SOURCES
PubMed, Scopus, ProQuest, Cochrane COVID-19 registry, CINAHL and pre-print services (medRχiv and PsyArXiv) were searched from January 1 to November 15, 2020 and we removed duplicates.
REVIEW METHODS
We applied a random effect model to estimate pooled effects since the heterogeneity between results was very high.
RESULTS
Sixteen studies, including 18,935 nurses met the inclusion criteria. The overall prevalence of emotional exhaustion was 34.1%, of depersonalization was 12.6% and of lack of personal accomplishment was 15.2%. The main risk factors that increased nurses' burnout were the following: younger age, decreased social support, low family and colleagues readiness to cope with COVID-19 outbreak, increased perceived threat of Covid-19, longer working time in quarantine areas, working in a high-risk environment, working in hospitals with inadequate and insufficient material and human resources, increased workload and lower level of specialized training regarding COVID-19.
CONCLUSION
Nurses experience high levels of burnout during the COVID-19 pandemic, while several sociodemographic, social and occupational factors affect this burnout.
IMPACT
We found that burnout among nurses is a crucial issue during the COVID-19 pandemic. There is an urgent need to prepare nurses to cope better with COVID-19 pandemic. Identification of risk factors for burnout could be a significant weapon giving nurses and health care systems the ability to response in a better way against the following COVID-19 waves in the near future.
Topics: Burnout, Professional; Burnout, Psychological; COVID-19; Humans; Nurses; Pandemics; Risk Factors; SARS-CoV-2
PubMed: 33764561
DOI: 10.1111/jan.14839 -
JAMA Psychiatry Dec 2022Whether ketamine is as effective as electroconvulsive therapy (ECT) among patients with major depressive episode remains unknown. (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Whether ketamine is as effective as electroconvulsive therapy (ECT) among patients with major depressive episode remains unknown.
OBJECTIVE
To systematically review and meta-analyze data about clinical efficacy and safety for ketamine and ECT in patients with major depressive episode.
DATA SOURCES
PubMed, MEDLINE, Cochrane Library, and Embase were systematically searched using Medical Subject Headings (MeSH) terms and text keywords from database inception through April 19, 2022, with no language limits. Two authors also manually and independently searched all relevant studies in US and European clinical trial registries and Google Scholar.
STUDY SELECTION
Included were studies that involved (1) a diagnosis of depression using standardized diagnostic criteria, (2) intervention/comparator groups consisting of ECT and ketamine, and (3) depressive symptoms as an efficacy outcome using standardized measures.
DATA EXTRACTION AND SYNTHESIS
Data extraction was completed independently by 2 extractors and cross-checked for errors. Hedges g standardized mean differences (SMDs) were used for improvement in depressive symptoms. SMDs with corresponding 95% CIs were estimated using fixed- or random-effects models. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed.
MAIN OUTCOMES AND MEASURES
Efficacy outcomes included depression severity, cognition, and memory performance. Safety outcomes included serious adverse events (eg, suicide attempts and deaths) and other adverse events.
RESULTS
Six clinical trials comprising 340 patients (n = 162 for ECT and n = 178 for ketamine) were included in the review. Six of 6 studies enrolled patients who were eligible to receive ECT, 6 studies were conducted in inpatient settings, and 5 studies were randomized clinical trials. The overall pooled SMD for depression symptoms for ECT when compared with ketamine was -0.69 (95% CI, -0.89 to -0.48; Cochran Q, P = .15; I2 = 39%), suggesting an efficacy advantage for ECT compared with ketamine for depression severity. Significant differences were not observed between groups for studies that assessed cognition/memory or serious adverse events. Both ketamine and ECT had unique adverse effect profiles (ie, ketamine: lower risks for headache and muscle pain; ECT: lower risks for blurred vision, vertigo, diplopia/nystagmus, and transient dissociative/depersonalization symptoms). Limitations included low to moderate methodological quality and underpowered study designs.
CONCLUSIONS AND RELEVANCE
Findings from this systematic review and meta-analysis suggest that ECT may be superior to ketamine for improving depression severity in the acute phase, but treatment options should be individualized and patient-centered.
Topics: Humans; Electroconvulsive Therapy; Ketamine; Depressive Disorder, Major; Suicide, Attempted; Randomized Controlled Trials as Topic
PubMed: 36260324
DOI: 10.1001/jamapsychiatry.2022.3352 -
JAMA Sep 2018Burnout is a self-reported job-related syndrome increasingly recognized as a critical factor affecting physicians and their patients. An accurate estimate of burnout... (Review)
Review
IMPORTANCE
Burnout is a self-reported job-related syndrome increasingly recognized as a critical factor affecting physicians and their patients. An accurate estimate of burnout prevalence among physicians would have important health policy implications, but the overall prevalence is unknown.
OBJECTIVE
To characterize the methods used to assess burnout and provide an estimate of the prevalence of physician burnout.
DATA SOURCES AND STUDY SELECTION
Systematic search of EMBASE, ERIC, MEDLINE/PubMed, psycARTICLES, and psycINFO for studies on the prevalence of burnout in practicing physicians (ie, excluding physicians in training) published before June 1, 2018.
DATA EXTRACTION AND SYNTHESIS
Burnout prevalence and study characteristics were extracted independently by 3 investigators. Although meta-analytic pooling was planned, variation in study designs and burnout ascertainment methods, as well as statistical heterogeneity, made quantitative pooling inappropriate. Therefore, studies were summarized descriptively and assessed qualitatively.
MAIN OUTCOMES AND MEASURES
Point or period prevalence of burnout assessed by questionnaire.
RESULTS
Burnout prevalence data were extracted from 182 studies involving 109 628 individuals in 45 countries published between 1991 and 2018. In all, 85.7% (156/182) of studies used a version of the Maslach Burnout Inventory (MBI) to assess burnout. Studies variably reported prevalence estimates of overall burnout or burnout subcomponents: 67.0% (122/182) on overall burnout, 72.0% (131/182) on emotional exhaustion, 68.1% (124/182) on depersonalization, and 63.2% (115/182) on low personal accomplishment. Studies used at least 142 unique definitions for meeting overall burnout or burnout subscale criteria, indicating substantial disagreement in the literature on what constituted burnout. Studies variably defined burnout based on predefined cutoff scores or sample quantiles and used markedly different cutoff definitions. Among studies using instruments based on the MBI, there were at least 47 distinct definitions of overall burnout prevalence and 29, 26, and 26 definitions of emotional exhaustion, depersonalization, and low personal accomplishment prevalence, respectively. Overall burnout prevalence ranged from 0% to 80.5%. Emotional exhaustion, depersonalization, and low personal accomplishment prevalence ranged from 0% to 86.2%, 0% to 89.9%, and 0% to 87.1%, respectively. Because of inconsistencies in definitions of and assessment methods for burnout across studies, associations between burnout and sex, age, geography, time, specialty, and depressive symptoms could not be reliably determined.
CONCLUSIONS AND RELEVANCE
In this systematic review, there was substantial variability in prevalence estimates of burnout among practicing physicians and marked variation in burnout definitions, assessment methods, and study quality. These findings preclude definitive conclusions about the prevalence of burnout and highlight the importance of developing a consensus definition of burnout and of standardizing measurement tools to assess the effects of chronic occupational stress on physicians.
Topics: Burnout, Professional; Compassion Fatigue; Depersonalization; Humans; Job Satisfaction; Physicians; Prevalence; Surveys and Questionnaires
PubMed: 30326495
DOI: 10.1001/jama.2018.12777 -
PloS One 2018Burnout is a psychological syndrome that is very common among medical residents. It consists of emotional exhaustion (EE), depersonalization (DP) and reduced personal... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Burnout is a psychological syndrome that is very common among medical residents. It consists of emotional exhaustion (EE), depersonalization (DP) and reduced personal accomplishment (PA).
OBJECTIVE
To estimate burnout among different medical residency specialties.
METHODS
A systematic review with meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of bibliographic databases and grey literature was conducted, from inception to March 2018. The following databases were accessed: Embase, PubMed, Web of Science, Google Scholar and Scopus, and 3,575 studies were found. Methodological quality was evaluated by Agency for Healthcare Research and Quality Methodology Checklist for Cross-Sectional/Prevalence Study. In the final analysis, 26 papers were included. Their references were checked for additional studies, but none were included.
RESULTS
4,664 medical residents were included. High DP, EE and low PA proportions were compared. Specialties were distributed into three groups of different levels of burnout prevalence: general surgery, anesthesiology, obstetrics/gynecology and orthopedics (40.8%); internal medicine, plastic surgery and pediatrics (30.0%); and otolaryngology and neurology (15.4%). Overall burnout prevalence found for all specialties was 35.7%.
CONCLUSION
The prevalence of burnout syndrome was significantly higher among surgical/urgency residencies than in clinical specialties.
PROSPERO REGISTRATION
CRD42018090270.
Topics: Burnout, Psychological; Depersonalization; Humans; Internal Medicine; Internship and Residency; Physicians; Prevalence; Specialties, Surgical
PubMed: 30418984
DOI: 10.1371/journal.pone.0206840 -
The Cochrane Database of Systematic... Nov 2023A panic attack is a discrete period of fear or anxiety that has a rapid onset and reaches a peak within 10 minutes. The main symptoms involve bodily systems, such as... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
A panic attack is a discrete period of fear or anxiety that has a rapid onset and reaches a peak within 10 minutes. The main symptoms involve bodily systems, such as racing heart, chest pain, sweating, shaking, dizziness, flushing, churning stomach, faintness and breathlessness. Other recognised panic attack symptoms involve fearful cognitions, such as the fear of collapse, going mad or dying, and derealisation (the sensation that the world is unreal). Panic disorder is common in the general population with a prevalence of 1% to 4%. The treatment of panic disorder includes psychological and pharmacological interventions, including antidepressants and benzodiazepines.
OBJECTIVES
To compare, via network meta-analysis, individual drugs (antidepressants and benzodiazepines) or placebo in terms of efficacy and acceptability in the acute treatment of panic disorder, with or without agoraphobia. To rank individual active drugs for panic disorder (antidepressants, benzodiazepines and placebo) according to their effectiveness and acceptability. To rank drug classes for panic disorder (selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), mono-amine oxidase inhibitors (MAOIs) and benzodiazepines (BDZs) and placebo) according to their effectiveness and acceptability. To explore heterogeneity and inconsistency between direct and indirect evidence in a network meta-analysis.
SEARCH METHODS
We searched the Cochrane Common Mental Disorders Specialised Register, CENTRAL, CDSR, MEDLINE, Ovid Embase and PsycINFO to 26 May 2022.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) of people aged 18 years or older of either sex and any ethnicity with clinically diagnosed panic disorder, with or without agoraphobia. We included trials that compared the effectiveness of antidepressants and benzodiazepines with each other or with a placebo.
DATA COLLECTION AND ANALYSIS
Two authors independently screened titles/abstracts and full texts, extracted data and assessed risk of bias. We analysed dichotomous data and continuous data as risk ratios (RRs), mean differences (MD) or standardised mean differences (SMD): response to treatment (i.e. substantial improvement from baseline as defined by the original investigators: dichotomous outcome), total number of dropouts due to any reason (as a proxy measure of treatment acceptability: dichotomous outcome), remission (i.e. satisfactory end state as defined by global judgement of the original investigators: dichotomous outcome), panic symptom scales and global judgement (continuous outcome), frequency of panic attacks (as recorded, for example, by a panic diary; continuous outcome), agoraphobia (dichotomous outcome). We assessed the certainty of evidence using threshold analyses.
MAIN RESULTS
Overall, we included 70 trials in this review. Sample sizes ranged between 5 and 445 participants in each arm, and the total sample size per study ranged from 10 to 1168. Thirty-five studies included sample sizes of over 100 participants. There is evidence from 48 RCTs (N = 10,118) that most medications are more effective in the response outcome than placebo. In particular, diazepam, alprazolam, clonazepam, paroxetine, venlafaxine, clomipramine, fluoxetine and adinazolam showed the strongest effect, with diazepam, alprazolam and clonazepam ranking as the most effective. We found heterogeneity in most of the comparisons, but our threshold analyses suggest that this is unlikely to impact the findings of the network meta-analysis. Results from 64 RCTs (N = 12,310) suggest that most medications are associated with either a reduced or similar risk of dropouts to placebo. Alprazolam and diazepam were associated with a lower dropout rate compared to placebo and were ranked as the most tolerated of all the medications examined. Thirty-two RCTs (N = 8569) were included in the remission outcome. Most medications were more effective than placebo, namely desipramine, fluoxetine, clonazepam, diazepam, fluvoxamine, imipramine, venlafaxine and paroxetine, and their effects were clinically meaningful. Amongst these medications, desipramine and alprazolam were ranked highest. Thirty-five RCTs (N = 8826) are included in the continuous outcome reduction in panic scale scores. Brofaromine, clonazepam and reboxetine had the strongest reductions in panic symptoms compared to placebo, but results were based on either one trial or very small trials. Forty-one RCTs (N = 7853) are included in the frequency of panic attack outcome. Only clonazepam and alprazolam showed a strong reduction in the frequency of panic attacks compared to placebo, and were ranked highest. Twenty-six RCTs (N = 7044) provided data for agoraphobia. The strongest reductions in agoraphobia symptoms were found for citalopram, reboxetine, escitalopram, clomipramine and diazepam, compared to placebo. For the pooled intervention classes, we examined the two primary outcomes (response and dropout). The classes of medication were: SSRIs, SNRIs, TCAs, MAOIs and BDZs. For the response outcome, all classes of medications examined were more effective than placebo. TCAs as a class ranked as the most effective, followed by BDZs and MAOIs. SSRIs as a class ranked fifth on average, while SNRIs were ranked lowest. When we compared classes of medication with each other for the response outcome, we found no difference between classes. Comparisons between MAOIs and TCAs and between BDZs and TCAs also suggested no differences between these medications, but the results were imprecise. For the dropout outcome, BDZs were the only class associated with a lower dropout compared to placebo and were ranked first in terms of tolerability. The other classes did not show any difference in dropouts compared to placebo. In terms of ranking, TCAs are on average second to BDZs, followed by SNRIs, then by SSRIs and lastly by MAOIs. BDZs were associated with lower dropout rates compared to SSRIs, SNRIs and TCAs. The quality of the studies comparing antidepressants with placebo was moderate, while the quality of the studies comparing BDZs with placebo and antidepressants was low.
AUTHORS' CONCLUSIONS
In terms of efficacy, SSRIs, SNRIs (venlafaxine), TCAs, MAOIs and BDZs may be effective, with little difference between classes. However, it is important to note that the reliability of these findings may be limited due to the overall low quality of the studies, with all having unclear or high risk of bias across multiple domains. Within classes, some differences emerged. For example, amongst the SSRIs paroxetine and fluoxetine seem to have stronger evidence of efficacy than sertraline. Benzodiazepines appear to have a small but significant advantage in terms of tolerability (incidence of dropouts) over other classes.
Topics: Adult; Humans; Panic Disorder; Selective Serotonin Reuptake Inhibitors; Paroxetine; Fluoxetine; Venlafaxine Hydrochloride; Serotonin and Noradrenaline Reuptake Inhibitors; Alprazolam; Clomipramine; Reboxetine; Clonazepam; Desipramine; Network Meta-Analysis; Antidepressive Agents; Antidepressive Agents, Tricyclic; Benzodiazepines; Diazepam
PubMed: 38014714
DOI: 10.1002/14651858.CD012729.pub3 -
International Journal of Environmental... Oct 2021Physician's burnout has been recognized as an increasing and significant work-related syndrome, described by the combination of emotional exhaustion (EE) and... (Review)
Review
Physician's burnout has been recognized as an increasing and significant work-related syndrome, described by the combination of emotional exhaustion (EE) and depersonalization (D), together with low personal accomplishment (PA). It has many negative consequences on personal, organizational, and patient care levels. This systematic review aimed to analyze research articles where psychological interventions with elements of mindfulness (PIMs) were used to support physicians in order to reduce burnout and foster empathy and well-being. Systematic searches were conducted in May 2019, within six electronic databases PubMed, EBSCOhost MEDLINE, PsycArticles, Cochrane Library, JSTOR, and Slovenian national library information system. Different combinations of boolean operators were used-mindfulness, empathy, medicine/family medicine/general practice/primary care, burnout, doctors/physicians, intervention, and support group. Additional articles were manually searched from the reference list of the included articles. Studies with other healthcare professionals (not physicians and residents) and/or medical students, and those where PIMs were applied for educational or patient's treatment purposes were excluded. Of 1194 studies identified, 786 screened and 139 assessed for eligibility, there were 18 studies included in this review. Regardless of a specific type of PIMs applied, results, in general, demonstrate a positive impact on empathy, well-being, and reduction in burnout in participating physicians. Compared with other recent systematic reviews, this is unique due to a broader selection of psychological interventions and emphasis on a sustained effect measurement. Given the pandemic of COVID-19, it is of utmost importance that this review includes also interventions based on modern information technologies (mobile apps) and can be used as an awareness-raising material for physicians providing information about feasible and easily accessible interventions for effective burnout prevention and/or reduction. Future research should upgrade self-reported data with objective psychological measures and address the question of which intervention offers more benefits to physicians.
Topics: Burnout, Professional; Burnout, Psychological; COVID-19; Empathy; Humans; Mindfulness; Physicians; Psychosocial Intervention; SARS-CoV-2
PubMed: 34769700
DOI: 10.3390/ijerph182111181 -
BMC Family Practice May 2018burnout syndrome is a significant problem in nursing professionals. Although, the unit where nurses work may influence burnout development. Nurses that work in primary... (Meta-Analysis)
Meta-Analysis
BACKGROUND
burnout syndrome is a significant problem in nursing professionals. Although, the unit where nurses work may influence burnout development. Nurses that work in primary care units may be at higher risk of burnout. The aim of the study was to estimate the prevalence of emotional exhaustion, depersonalization and low personal accomplishment in primary care nurses.
METHODS
We performed a meta-analysis. We searched Pubmed, CINAHL, Scopus, Scielo, Proquest, CUIDEN and LILACS databases up to September 2017 to identify cross-sectional studies assessing primary care nurses' burnout with the Maslach Burnout Inventory were included. The search was done in September 2017.
RESULTS
After the search process, n = 8 studies were included in the meta-analysis, representing a total sample of n = 1110 primary care nurses. High emotional exhaustion prevalence was 28% (95% Confidence Interval = 22-34%), high depersonalization was 15% (95% Confidence Interval = 9-23%) and 31% (95% Confidence Interval = 6-66%) for low personal accomplishment.
CONCLUSIONS
Problems such as emotional exhaustion and low personal accomplishment are very common among primary care nurses, while depersonalization is less prevalent. Primary care nurses are a burnout risk group.
Topics: Burnout, Professional; Community Health Nursing; Compassion Fatigue; Humans; Job Satisfaction; Nurses; Prevalence; Primary Care Nursing
PubMed: 29747579
DOI: 10.1186/s12875-018-0748-z -
International Journal of Environmental... Oct 2020Palliative care nurses are exposed to hard situations, death, and duel feelings in their daily practice. These, and other work stressors, can favor burnout development.... (Meta-Analysis)
Meta-Analysis
Palliative care nurses are exposed to hard situations, death, and duel feelings in their daily practice. These, and other work stressors, can favor burnout development. Thus, it is important to analyze the prevalence and risk factors of burnout in palliative care nurses and estimate its prevalence. A systematic review and meta-analysis was done with quantitative primary studies. = 15 studies were included with = 6 studies including information for the meta-analysis. The meta-analytic prevalence estimation of emotional exhaustion was 24% (95% CI 16-34%), for depersonalization was 30% (95% CI 18-44%) and for low personal accomplishment was 28% with a sample of = 693 palliative care nurses. The main variables related with burnout are occupational variables followed by psychological variables. Some interventions to improve working conditions of palliative care nurses should be implemented to reduce burnout.
Topics: Adult; Burnout, Professional; Female; Humans; Male; Middle Aged; Nurses; Palliative Care; Prevalence; Quality of Life
PubMed: 33096682
DOI: 10.3390/ijerph17207672 -
Scientific Reports Jul 2023Sporadic evidence exists for burnout interventions in terms of types, dosage, duration, and assessment of burnout among clinical nurses. This study aimed to evaluate... (Meta-Analysis)
Meta-Analysis
Sporadic evidence exists for burnout interventions in terms of types, dosage, duration, and assessment of burnout among clinical nurses. This study aimed to evaluate burnout interventions for clinical nurses. Seven English databases and two Korean databases were searched to retrieve intervention studies on burnout and its dimensions between 2011 and 2020.check Thirty articles were included in the systematic review, 24 of them for meta-analysis. Face-to-face mindfulness group intervention was the most common intervention approach. When burnout was measured as a single concept, interventions were found to alleviate burnout when measured by the ProQoL (n = 8, standardized mean difference [SMD] = - 0.654, confidence interval [CI] = - 1.584, 0.277, p < 0.01, I = 94.8%) and the MBI (n = 5, SMD = - 0.707, CI = - 1.829, 0.414, p < 0.01, I = 87.5%). The meta-analysis of 11 articles that viewed burnout as three dimensions revealed that interventions could reduce emotional exhaustion (SMD = - 0.752, CI = - 1.044, - 0.460, p < 0.01, I = 68.3%) and depersonalization (SMD = - 0.822, CI = - 1.088, - 0.557, p < 0.01, I = 60.0%) but could not improve low personal accomplishment. Clinical nurses' burnout can be alleviated through interventions. Evidence supported reducing emotional exhaustion and depersonalization but did not support low personal accomplishment.
Topics: Humans; Burnout, Professional; Emotions; Mindfulness; Achievement; Nurses
PubMed: 37414811
DOI: 10.1038/s41598-023-38169-8