To determine whether there is an association between healthcare professionals' wellbeing and burnout, with patient safety.
Systematic research review.
PsychInfo (1806 to July 2015), Medline (1946 to ...July 2015), Embase (1947 to July 2015) and Scopus (1823 to July 2015) were searched, along with reference lists of eligible articles.
Quantitative, empirical studies that included i) either a measure of wellbeing or burnout, and ii) patient safety, in healthcare staff populations.
Forty-six studies were identified. Sixteen out of the 27 studies that measured wellbeing found a significant correlation between poor wellbeing and worse patient safety, with six additional studies finding an association with some but not all scales used, and one study finding a significant association but in the opposite direction to the majority of studies. Twenty-one out of the 30 studies that measured burnout found a significant association between burnout and patient safety, whilst a further four studies found an association between one or more (but not all) subscales of the burnout measures employed, and patient safety.
Poor wellbeing and moderate to high levels of burnout are associated, in the majority of studies reviewed, with poor patient safety outcomes such as medical errors, however the lack of prospective studies reduces the ability to determine causality. Further prospective studies, research in primary care, conducted within the UK, and a clearer definition of healthcare staff wellbeing are needed.
This review illustrates the need for healthcare organisations to consider improving employees' mental health as well as creating safer work environments when planning interventions to improve patient safety.
PROSPERO registration number: CRD42015023340.
The cumulative science linking stress to negative health outcomes is vast. Stress can affect health directly, through autonomic and neuroendocrine responses, but also indirectly, through changes in ...health behaviors. In this review, we present a brief overview of (
a
) why we should be interested in stress in the context of health; (
b
) the stress response and allostatic load; (
c
) some of the key biological mechanisms through which stress impacts health, such as by influencing hypothalamic-pituitary-adrenal axis regulation and cortisol dynamics, the autonomic nervous system, and gene expression; and (
d
) evidence of the clinical relevance of stress, exemplified through the risk of infectious diseases. The studies reviewed in this article confirm that stress has an impact on multiple biological systems. Future work ought to consider further the importance of early-life adversity and continue to explore how different biological systems interact in the context of stress and health processes.
The steroid hormone ecdysone is the central regulator of insect developmental transitions. Recent new advances in our understanding of ecdysone action have relied heavily on the application of ...Drosophila melanogaster molecular genetic tools to study insect metamorphosis. In this review, we focus on three major aspects of Drosophila ecdysone biology: (a) factors that regulate the timing of ecdysone release, (b) molecular basis of stage- and tissue-specific responses to ecdysone, and (c) feedback regulation and coordination of ecdysone signaling.
An engaging and reflective look at how austerity and the billionaire class paved the way for Trump's presidency, the rise of the "alt-right," and the caging of migrants children and adults in ...detention centers across the country. For all of the energy that the far right has demonstrated-and for all of the support that they receive from institutional conservatives in the GOP and affiliated organizations-the United States is experiencing an upsurge in left-wing social movements unlike any other in the past half-century, with roots not in the Democratic Party but Occupy Wall Street and Black Lives Matter. Drawing on his original reporting as well as archival research, O'Connor investigates how the capitalist class and the radical right mobilize racism to defend their interests, while focusing on one of the most pressing issues of our time: immigration.
Fatigue is one of the most common and debilitating cancer symptoms, and is associated with impaired quality of life. The exact pathophysiology of cancer-related fatigue (CRF) is poorly understood, ...but in any individual, it is likely multifactorial and involves inter-related cytokine, muscular, neurotransmitter, and neuroendocrine changes. Underlying CRF mechanisms proposed include central and peripheral hypotheses. Central mechanisms include hypotheses about cytokine dysregulation, hypothalamic-pituitary-adrenal-axis disruption, circadian rhythm disruption, serotonin, and vagal afferent nerve function while peripheral mechanisms include hypotheses about adenosine triphosphate and muscle contractile properties. Currently, these hypotheses are largely based on evidence from other conditions in which fatigue is characteristic. The purpose of this article is to provide a narrative review of the literature and present the current controversies in the pathophysiology of CRF, particularly in relation to central and peripheral hypotheses for CRF. An understanding of pathophysiology may facilitate direct and simple therapeutic interventions for those with cancer.
Recent observations with the Chandra X-ray telescope continue to detect X-ray emission from the transient GW170817. In a total exposure of 96.6 ks, performed between 2020 March 9 and 16 (935–942 d ...after the merger), a total of 8 photons are measured at the source position, corresponding to a significance of ≈5σ. Radio monitoring with the Australian Telescope Compact Array (ATCA) shows instead that the source has faded below our detection threshold (<33 μJy, 3σ). By assuming a constant spectral index of β = 0.585, we derive an unabsorbed X-ray flux of ≈1.4 × 10−15 erg cm−2 s−1, higher than earlier predictions, yet still consistent with a simple structured jet model. We discuss possible scenarios that could account for prolonged emission in X-rays. The current data set appears consistent both with energy injection by a long-lived central engine and with the onset of a kilonova afterglow, arising from the interaction of the sub-relativistic merger ejecta with the surrounding medium. Long-term monitoring of this source will be essential to test these different models.
First responders are faced with stressful and traumatic events in their work that may affect their psychological health. The current review examined the effectiveness of psychological interventions ...to treat posttraumatic stress disorder (PTSD), anxiety, depression, stress and burnout in first responders. Four databases were searched to identify controlled studies that examined the efficacy of psychological interventions to reduce PTSD symptoms (primary outcome) in first responders (including firefighters, police/law enforcement officers, search and rescue personnel, emergency and paramedics teams). Secondary outcomes were anxiety, depression, burnout, and stress. 15 studies were identified, including 10 studies that measured PTSD, 7 studies for anxiety, 10 studies for depression, 7 studies for stress and 1 for burnout. Interventions were associated with a significant reduction in PTSD (SDM = -0.86; 95% CI = -1.34 -- 0.39), depression (SDM = -0.63; 95% CI = -0.94 --0.32), and anxiety (SDM = -0.38; 95% CI = -0.71 --0.05) but not stress (SDM = -0.13; 95% CI = -0.51-0.25). CBT-based and clinician-delivered interventions were associated with significantly greater reductions in PTSD than other types of interventions and non-clinician interventions, but no differences were found for depression. There was evidence of moderate to high risk of bias across all studies. Psychological interventions are effective in reducing PTSD, depression and anxiety symptoms but not stress in first responders. Further research is needed using high quality randomised designs over longer periods of follow-up.
Gamma-ray bursts (GRBs) are flashes of high-energy radiation arising from energetic cosmic explosions. Bursts of long (greater than two seconds) duration are produced by the core-collapse of massive ...stars
, and those of short (less than two seconds) duration by the merger of compact objects, such as two neutron stars
. A third class of events with hybrid high-energy properties was identified
, but never conclusively linked to a stellar progenitor. The lack of bright supernovae rules out typical core-collapse explosions
, but their distance scales prevent sensitive searches for direct signatures of a progenitor system. Only tentative evidence for a kilonova has been presented
. Here we report observations of the exceptionally bright GRB 211211A, which classify it as a hybrid event and constrain its distance scale to only 346 megaparsecs. Our measurements indicate that its lower-energy (from ultraviolet to near-infrared) counterpart is powered by a luminous (approximately 10
erg per second) kilonova possibly formed in the ejecta of a compact object merger.
Abstract A number of different treatments for neuropathic pain have been studied, but the literature is sizable, rapidly evolving, and lacks important information about practical aspects of patient ...management. Under the auspices of the International Association for the Study of Pain (IASP) Neuropathic Pain Special Interest Group (NeuPSIG), a consensus process was used to develop evidence-based guidelines for the pharmacologic management of neuropathic pain that take into account clinical efficacy, adverse effects, impact on health-related quality of life, convenience, and costs. On the basis of randomized clinical trials, medications recommended as first-line treatments for neuropathic pain included certain antidepressants (i.e., tricyclic antidepressants and dual reuptake inhibitors of both serotonin and norepinephrine), calcium channel α2 -δ ligands (i.e., gabapentin and pregabalin), and topical lidocaine. Opioid analgesics and tramadol were recommended as second-line treatments that can be considered for first-line use in selected clinical circumstances. Other medications that generally would be used as third-line treatments include certain other antidepressant and antiepileptic medications, topical capsaicin, mexiletine, and N -methyl- d -aspartate receptor antagonists. Two other national and international associations recently published pharmacologic treatment guidelines for neuropathic pain, which are summarized and contrasted with the NeuPSIG recommendations. Recent guidelines for the use of neurostimulation for the treatment of neuropathic pain also are summarized. For all treatments for neuropathic pain, long-term studies, head-to-head comparisons, and studies of treatment combinations are a priority for future research.
Objective
To investigate the effects of Image Biomarker Standardisation Initiative (IBSI) compliance, harmonisation of calculation settings and platform version on the statistical reliability of ...radiomic features and their corresponding ability to predict clinical outcome.
Methods
The statistical reliability of radiomic features was assessed retrospectively in three clinical datasets (patient numbers: 108 head and neck cancer, 37 small-cell lung cancer, 47 non-small-cell lung cancer). Features were calculated using four platforms (PyRadiomics, LIFEx, CERR and IBEX). PyRadiomics, LIFEx and CERR are IBSI-compliant, whereas IBEX is not. The effects of IBSI compliance, user-defined calculation settings and platform version were assessed by calculating intraclass correlation coefficients and confidence intervals. The influence of platform choice on the relationship between radiomic biomarkers and survival was evaluated using univariable cox regression in the largest dataset.
Results
The reliability of radiomic features calculated by the different software platforms was only excellent (ICC > 0.9) for 4/17 radiomic features when comparing all four platforms. Reliability improved to ICC > 0.9 for 15/17 radiomic features when analysis was restricted to the three IBSI-compliant platforms. Failure to harmonise calculation settings resulted in poor reliability, even across the IBSI-compliant platforms. Software platform version also had a marked effect on feature reliability in CERR and LIFEx. Features identified as having significant relationship to survival varied between platforms, as did the direction of hazard ratios.
Conclusion
IBSI compliance, user-defined calculation settings and choice of platform version all influence the statistical reliability and corresponding performance of prognostic models in radiomics.
Key Points
• Reliability of radiomic features varies between feature calculation platforms and with choice of software version.
• Image Biomarker Standardisation Initiative (IBSI) compliance improves reliability of radiomic features across platforms, but only when calculation settings are harmonised.
• IBSI compliance, user-defined calculation settings and choice of platform version collectively affect the prognostic value of features.
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