P92 Power dynamics in healthcare teams – a barrier to team effectiveness and patient safety: A systematic review

Abstract Introduction Hierarchies in healthcare teams are pervasive and widely acknowledged as impacting on working cultures. This review explores the impact of power dynamics in multidisciplinary healthcare teams on patient safety and team effectiveness. Methods A systematic review was conducted using five academic databases (PubMed, CINAHL, PsycInfo, Cochrane Library, Embase) between January 2010-2020. Potentially relevant articles were selected based on title and abstract review, followed by full text review, data extraction and data appraisal. Consistent with PRISMA guidelines, two researchers independently carried out all stages, from data screening to quality appraisal. A narrative synthesis was conducted. Results The databases searches yielded a total of 869 studies. 28 studies met the eligibility criteria and were included in the synthesis. Of these, 20 articles associated power dynamics with team effectiveness and 19 linked power dynamics to patient safety outcomes. Hierarchical power dynamics inhibit team communication and speaking up behaviours, which impacts team effectiveness and patient safety. Barriers to speaking up include workplace policies; respect for seniors’ experience; time pressures; feelings of intimidation and powerlessness; fears of reprisal and repercussions; perceived poor self-efficacy; lack of confidence and role clarity. Conclusion Hierarchies and power dynamics have a profoundly negative effect on patient safety and team effectiveness through their negative impact on communication and speaking up behaviours. Whilst hierarchies cannot be abolished, to improve team communication and collaboration, healthcare organisations and training programmes should consider initiatives that break down silos and promote an inclusive approach to patient care. Initiatives that target the practice of collective leadership and an open and supportive work environment have been shown to improve communication and team effectiveness. Theme: Cross-disciplinary research

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High-Fat Ketogenic Diets and Physical Performance: A Systematic Review

Advances in Nutrition ◽

10.1093/advances/nmaa101 ◽

2020 ◽

Cited By ~ 1

Author(s):

Nancy E Murphy ◽

Christopher T Carrigan ◽

Lee M Margolis

Keyword(s):

Systematic Review ◽

Physical Performance ◽

Performance Test ◽

Negative Impact ◽

Performance Outcomes ◽

Cochrane Library ◽

Time To Exhaustion ◽

High Fat ◽

Ketogenic Diets ◽

The Impact

ABSTRACT Use of high-fat, ketogenic diets (KDs) to support physical performance has grown in popularity over recent years. While these diets enhance fat and reduce carbohydrate oxidation during exercise, the impact of a KD on physical performance remains controversial. The objective of this work was to assess the effect of KDs on physical performance compared with mixed macronutrient diets [control (CON)]. A systematic review of the literature was conducted using PubMed and Cochrane Library databases. Randomized and nonrandomized studies were included if participants were healthy (free of chronic disease), nonobese [BMI (kg/m2) <30], trained or untrained men or women consuming KD (<50 g carbohydrate/d or serum or whole-blood β-hydroxybutyrate >0.5 mmol/L) compared with CON (fat, 12–38% of total energy intake) diets for ≥14 d, followed by a physical performance test. Seventeen studies (10 parallel, 7 crossover) with 29 performance (13 endurance, 16 power or strength) outcomes were identified. Of the 13 endurance-type performance outcomes, 3 (1 time trial, 2 time-to-exhaustion) reported lower and 10 (4 time trials, 6 time-to-exhaustion) reported no difference in performance between the KD compared with CON. Of the 16 power or strength performance outcomes, 3 (1 power, 2 strength) reported lower, 11 (4 power, 7 strength) no difference, and 2 (power) enhanced performance in the KD compared with the CON. Risk of bias identified some concern of bias primarily due to studies allowing participants to self-select diet intervention groups and the inability to blind participants to the study intervention. Overall, the majority of null results across studies suggest that a KD does not have a positive or negative impact on physical performance compared with a CON diet. However, discordant results between studies may be due to multiple factors, such as the duration consuming study diets, training status, performance test, and sex differences, which will be discussed in this systematic review.

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Impact of the communication and patient hand-off tool SBAR on patient safety: a systematic review

BMJ Open ◽

10.1136/bmjopen-2018-022202 ◽

2018 ◽

Vol 8 (8) ◽

pp. e022202 ◽

Cited By ~ 35

Author(s):

Martin Müller ◽

Jonas Jürgens ◽

Marcus Redaèlli ◽

Karsten Klingberg ◽

Wolf E Hautz ◽

...

Keyword(s):

Systematic Review ◽

Patient Safety ◽

Adverse Events ◽

Patient Outcomes ◽

Cochrane Library ◽

Secondary Outcome ◽

Communication Tool ◽

Clinical Routine ◽

Wide Range ◽

The Impact

ObjectivesCommunication breakdown is one of the main causes of adverse events in clinical routine, particularly in handover situations. The communication tool SBAR (situation, background, assessment and recommendation) was developed to increase handover quality and is widely assumed to increase patient safety. The objective of this review is to summarise the impact of the implementation of SBAR on patient safety.DesignA systematic review of articles published on SBAR was performed in PUBMED, EMBASE, CINAHL, Cochrane Library and PsycINFO in January 2017. All original research articles on SBAR fulfilling the following eligibility criteria were included: (1) SBAR was implemented into clinical routine, (2) the investigation of SBAR was the primary objective and (3) at least one patient outcome was reported.SettingA wide range of settings within primary and secondary care and nursing homes.ParticipantsA variety of heath professionals including nurses and physicians.Primary and secondary outcome measuresAspects of patient safety (patient outcomes) defined as the occurrence or incidence of adverse events.ResultsEight studies with a before–after design and three controlled clinical trials performed in different clinical settings met the inclusion criteria. The objectives of the studies were to improve team communication, patient hand-offs and communication in telephone calls from nurses to physicians. The studies were heterogeneous with regard to study characteristics, especially patient outcomes. In total, 26 different patient outcomes were measured, of which eight were reported to be significantly improved. Eleven were described as improved but no further statistical tests were reported, and six outcomes did not change significantly. Only one study reported a descriptive reduction in patient outcomes.ConclusionsThis review found moderate evidence for improved patient safety through SBAR implementation, especially when used to structure communication over the phone. However, there is a lack of high-quality research on this widely used communication tool.Trial registrationnone

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The impact of exogenous nitric oxide during cardiopulmonary bypass for cardiac surgery

Perfusion ◽

10.1177/02676591211014821 ◽

2021 ◽

pp. 026765912110148

Author(s):

Joseph Mc Loughlin ◽

Lorraine Browne ◽

John Hinchion

Keyword(s):

Nitric Oxide ◽

Systematic Review ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Troponin I ◽

Length Of Hospital Stay ◽

Cochrane Library ◽

High Quality Research ◽

Low Cardiac Output Syndrome ◽

The Impact

Objectives: Cardiac surgery using cardiopulmonary bypass frequently provokes a systemic inflammatory response syndrome. This can lead to the development of low cardiac output syndrome (LCOS). Both of these can affect morbidity and mortality. This study is a systematic review of the impact of gaseous nitric oxide (gNO), delivered via the cardiopulmonary bypass (CPB) circuit during cardiac surgery, on post-operative outcomes. It aims to summarise the evidence available, to assess the effectiveness of gNO via the CPB circuit on outcomes, and highlight areas of further research needed to develop this hypothesis. Methods: A comprehensive search of Pubmed, Embase, Web of Science and the Cochrane Library was performed in May 2020. Only randomised control trials (RCTs) were considered. Results: Three studies were identified with a total of 274 patients. There was variation in the outcomes measures used across the studies. These studies demonstrate there is evidence that this intervention may contribute towards cardioprotection. Significant reductions in cardiac troponin I (cTnI) levels and lower vasoactive inotrope scores were seen in intervention groups. A high degree of heterogeneity between the studies exists. Meta-analysis of the duration of mechanical ventilation, length of ICU stay and length of hospital stay showed no significant differences. Conclusion: This systematic review explored the findings of three pilot RCTs. Overall the hypothesis that NO delivered via the CPB circuit can provide cardioprotection has been supported by this study. There remains a significant gap in the evidence, further high-quality research is required in both the adult and paediatric populations.

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Is the use of contraceptives associated with periodontal diseases? A systematic review and meta-analyses

BMC Women s Health ◽

10.1186/s12905-021-01180-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Micaele Maria Lopes Castro ◽

Maria Karolina Martins Ferreira ◽

Iasmin Encaua Essashika Prazeres ◽

Paula Beatriz de Oliveira Nunes ◽

Marcela Baraúna Magno ◽

...

Keyword(s):

Systematic Review ◽

Quantitative Analysis ◽

Periodontal Diseases ◽

Hormonal Contraceptive ◽

Cochrane Library ◽

Hormonal Contraceptives ◽

Clinical Parameters ◽

Significant Difference ◽

Meta Analyses ◽

The Impact

Abstract Background Previous studies indicated an impact of hormonal contraceptive use on oral health. This systematic review aimed to investigate the evidence supporting the impact of the use of hormonal contraceptives and periodontal diseases. Methods This study is based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and based on the PECO acrostic. Inclusion criteria comprised observational studies including women (P), which evaluated hormonal contraceptive users (E) and hormonal contraceptive non-users (C), to verify the association between this hormonal therapy and the periodontal diseases (O). Searches were performed on 5 databases: PubMed, Scopus, Web of Science, Cochrane Library, LILACS and grey literature (OpenGrey and Google Scholar). After the selection process, the included studies were evaluated qualitatively. Moreover, quantitative data were analyzed in two meta-analyses for clinical attachment loss (CAL) and probing depth (PD). Finally, the level of certainty was measured with the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) tool between periodontal clinical parameters. Results 18 articles were eligible for the qualitative synthesis and 7 of them were selected for quantitative analysis. Hence, 15 of the eligible articles reported an association between the use of hormonal contraceptives and severity of periodontal disease. However, 6 articles demonstrated high risk of bias and were excluded from quantitative synthesis. The meta-analysis showed a statistically significant difference for CAL (MD 0.24 [0.09, 0.40]; p = 0.002), but in PD (MD 0.05 [− 0.05, 0.15]; p = 0.33) such difference was not identified. A very low level of evidence was found between the clinical parameters. Conclusions The use of hormonal contraceptives may be associated to severity of periodontal diseases. However, the quantitative analysis points to an inconclusive outcome due to the high level of heterogeneity. The association is biologically plausible, however additional studies are warranted to better elucidate the clinical significance of this possible association.

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Impact of Treatment for Nasal Cavity Disorders on Sleep Quality: Systematic Review and Meta-analysis

Otolaryngology ◽

10.1177/01945998211029527 ◽

2021 ◽

pp. 019459982110295

Author(s):

Jacob Fried ◽

Erick Yuen ◽

Kathy Zhang ◽

Andraia Li ◽

Nicholas R. Rowan ◽

...

Keyword(s):

Systematic Review ◽

Sleep Quality ◽

Nasal Obstruction ◽

Meta Analysis ◽

Mean Difference ◽

Cochrane Library ◽

Life Questionnaire ◽

Subjective Sleep Quality ◽

Subjective Sleep ◽

The Impact

Objective To determine the impact of treatment for patients with nasal obstruction secondary to allergic rhinitis (AR) and nasal septal deviation (NSD) on sleep quality. Data Sources Primary studies were identified though PubMed, Scopus, Cochrane Library, and Web of Science. Review Methods A systematic review was performed by querying databases for articles published through August 2020. Studies were included that reported on objective sleep parameters (apnea-hypopnea index) and sinonasal and sleep-specific patient-reported outcome measures: Rhinoconjunctivitis Quality of Life Questionnaire, Nasal Obstruction Symptom Evaluation, Epworth Sleepiness Scale (EpSS), and Pittsburgh Sleep Quality Index (PSQI). Results The database search yielded 1414 unique articles, of which 28 AR and 7 NSD studies were utilized for meta-analysis. A total of 9037 patients (8515 with AR, 522 with NSD) were identified with a mean age of 35.0 years (35.3 for AR, 34.0 for NSD). Treatment for AR and NSD significantly improved subjective sleep quality. For AR, the EpSS mean difference was −1.5 (95% CI, –2.4 to –0.5; P = .002) and for the PSQI, –1.7 (95% CI, –2.1 to –1.2; P < .00001). For NSD, the EpSS mean difference was −3.2 (95% CI, –4.2 to –2.2; P < .00001) and for the PSQI, –3.4 (95% CI, –6.1 to –0.6; P = .02). Conclusion Subjective sleep quality significantly improved following treatment for AR and NSD. There were insufficient data to demonstrate that objective metrics of sleep quality similarly improved.

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Efficacy of hydrofibre dressing following total joint arthroplasty: a meta-analysis of randomised controlled trials

Hip International ◽

10.1177/11207000211012669 ◽

2021 ◽

pp. 112070002110126

Author(s):

Raman Mundi ◽

Harman Chaudhry ◽

Seper Ekhtiari ◽

Prabjit Ajrawat ◽

Daniel M Tushinski ◽

...

Keyword(s):

Systematic Review ◽

Total Joint Arthroplasty ◽

Meta Analysis ◽

Joint Infection ◽

The United States ◽

Joint Arthroplasty ◽

Cochrane Library ◽

Controlled Trials ◽

Observable Effect ◽

The Impact

Introduction: In the United States, over 1,000,000 total joint arthroplasty (TJA) surgeries are performed annually and has been forecasted that this number will exceed 4,000,000 by the year 2030. Many different types of dressing exist for use in TJA surgery, and it is unclear if any of the newer, hydrofibre dressings are superior to traditional dressings at reducing rates of infections or improving wound healing. Thus, the aim of this systematic review and meta-analysis was to assess the impact of hydrofiber dressings on reducing complications. Methods: A systematic review and meta-analysis was performed using the online databases MEDLINE and the Cochrane Library. Randomized controlled trials (RCTs) comparing hydrofibre dressings to a standard dressing were included. Summary measures are reported as odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs). Our primary outcome was prosthetic joint infection (PJI). Secondary outcomes included blisters, dressing changes and wound irritation. Results: 5 RCTs were included. Hydrofibre dressing had no observable effect on PJI or wound irritation (OR 0.53; 95% CI, 0.14–1.98; p = 0.35). Hydrofibre dressings reduced the rate of blisters (OR 0.36; 95% CI, 0.14–0.90; p = 0.03) and number of dressing changes (MD -1.89; 95% CI, -2.68 to -1.11). Conclusions: In conclusion, evidence suggests hydrofibre dressings have no observable effect on PJI and wound irritation. Evidence for reduction in blisters and number of dressings is modest given wide CIs and biased trial methodologies. Use of hydrofibre dressings should be considered inconclusive for mitigating major complications in light of current best evidence.

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The Use of Seton as a Bridge to Definitive Ligation of the Intersphincteric Fistula Tract Procedure for Fistula-in-ano: A Systematic Review and Meta-analysis

Journal of Coloproctology ◽

10.1055/s-0041-1730039 ◽

2021 ◽

Author(s):

Carlos Placer-Galán ◽

Jose Mª Enriquez-Navascués ◽

Tania Pastor-Bonel ◽

Ignacio Aguirre-Allende ◽

Yolanda Saralegui-Ansorena

Keyword(s):

Systematic Review ◽

Anal Fistula ◽

Meta Analysis ◽

Fistula Tract ◽

Cochrane Library ◽

Fistula In Ano ◽

Intersphincteric Fistula ◽

The Impact ◽

Seton Placement ◽

Primary Healing

Abstract Background There is still controversy over the usefulness of seton placement prior to the ligation of the intersphincteric fistula tract (LIFT) surgery in the management of anal fistula. Objective To evaluate the impact of preoperative seton placement on the outcomes of LIFT surgery for the management of fistula-in-ano. Design systematic review and meta-analysis. Data Sources A search was performed on the MEDLINE (PubMed), EMBASE, Scopus, Web of Science, Cochrane Library and Google Scholar databases. Study Selection Original studies without language restriction reporting the primary healing rates with and without seton placement as a bridge to definitive LIFT surgery were included. Intervention The intervention assessed was the LIFT with and without prior seton placement. Main Outcome Measures The main outcome was defined as the primary healing rate with and without the use of seton as a bridge to definitive LIFT surgery. Results Ten studies met the criteria for systematic review, all retrospective, with a pooled study population of 772 patients. There were no significant differences in the percentages of recurrence between patients with and without seton placement (odds ratio [OR] 1.02; 95% confidence interval [CI] 0.73–1.43: p = 0.35). The I2 value was 9%, which shows the homogeneity of the results among the analyzed studies. The 10 included studies demonstrated a weighted average overall recurrence of 38% (interquartile range [IQR] 27–42.7%), recurrence with the use of seton was 40% (IQR 26.6–51.2%), and without its use, the recurrence rate was 51.3% (IQR 31.3–51.3%) Limitations The levels of evidence found in the available literature were relatively fair, as indicated after qualitative evaluation using the Newcastle-Ottawa scale and the Attitude Heading Reference System (AHRS) evidence levels. Conclusions Our meta-analysis suggests that the placement of seton as a bridge treatment prior to LIFT surgery does not significantly improve long-term anal fistula healing outcomes. Ligation of the intersphincteric fistula tract surgery can be performed safely and effectively with no previous seton placement.International prospective register of systematic reviews—PROSPERO registration number: CDR42020149173.

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Risk of nodal disease in patients with MRI-detected extramural vascular invasion in rectal cancer: a systematic review and meta-analysis

Tumori Journal ◽

10.1177/0300891620975867 ◽

2020 ◽

pp. 030089162097586

Author(s):

Pratik Tripathi ◽

Zhen Li ◽

Yaqi Shen ◽

Xuemei Hu ◽

Daoyu Hu

Keyword(s):

Systematic Review ◽

Rectal Cancer ◽

Lymph Node ◽

Vascular Invasion ◽

Literature Search ◽

Meta Analysis ◽

Adjuvant Chemoradiotherapy ◽

Cochrane Library ◽

Nodal Disease ◽

The Impact

Background: The impact of magnetic resonance imaging–detected extramural vascular invasion (mrEMVI) in distant metastasis is well known but its correlation with prevalence of lymph node metastasis is less studied. The aim of this systematic review and meta-analysis was to assess the prevalence of nodal disease in mrEMVI–positive and negative cases in rectal cancer. Methods: Following guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic literature search in PubMed, Web of Science, Cochrane Library, and EMBase was carried out to identify relevant studies published up to May 2019. Results: Our literature search generated 10 studies (863 and 1212 mrEMVI–positive and negative patients, respectively). The two groups (mrEMVI–positive and negative) were significantly different in terms of nodal disease status (odds ratio [OR] 3.15; 95% confidence interval [CI] 2.12–4.67; p < 0.001). The prevalence of nodal disease was 75.90% vs 52.56% in the positive mrEMVI vs negative mrEMVI group, respectively ( p < 0.001). The prevalence of positive lymph node in positive mrEMVI patients treated with neoadjuvant/adjuvant chemoradiotherapy (nCRT/CRT) (OR 2.47; 95% CI 1.65–3.69; p < 0.001) was less compared with the patients who underwent surgery alone (OR 6.25; 95% CI 3.74–10.44; p < 0.001). Conclusion: The probability of positive lymph nodes in cases of positive mrEMVI is distinctly greater compared with negative cases in rectal cancer. Positive mrEMVI indicates risk of nodal disease prevalence increased by threefold in rectal cancer.

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Impact of economic and financial crimes on economic growth in emerging and developing countries

Journal of Financial Crime ◽

10.1108/jfc-10-2018-0112 ◽

2019 ◽

Vol 26 (3) ◽

pp. 910-920 ◽

Cited By ~ 1

Author(s):

Sani Abubakar Saddiq ◽

Abu Sufian Abu Bakar

Keyword(s):

Systematic Review ◽

Developing Countries ◽

Negative Impact ◽

Meta Analysis ◽

Eligibility Criteria ◽

Content Type ◽

Research Reporting ◽

Financial Crimes ◽

Emerging And Developing Countries ◽

The Impact

Purpose The purpose of the study is to investigate the impact of economic and financial crimes on the economies of emerging and developing countries. Design/methodology/approach Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines and meta-analysis of economics research reporting guidelines were used to conduct a quantitative synthesis of empirical evidence on the impact of economic and financial crimes in developing and emerging countries. Findings A total of 103 studies were searched, out of which 6 met the selection/eligibility criteria of this systematic review. The six selected studies indicated that economic and financial crimes have a negative impact in emerging and developing countries. Originality/value To the best knowledge of the authors, no published systematic review of the impact of economic and financial crimes in developing countries has been conducted to date.

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Ageing, limb-loss and military veterans: a systematic review of the literature

Ageing and Society ◽

10.1017/s0144686x18000119 ◽

2018 ◽

Vol 39 (8) ◽

pp. 1582-1610 ◽

Cited By ~ 4

Author(s):

NICK CADDICK ◽

HELEN CULLEN ◽

AMANDA CLARKE ◽

MATT FOSSEY ◽

MICHAEL HILL ◽

...

Keyword(s):

Systematic Review ◽

Health Care ◽

Military Service ◽

Military Veterans ◽

Limb Loss ◽

Cochrane Library ◽

Term Care ◽

Long Term Impact ◽

The Impact

ABSTRACTThe impact of losing a limb in military service extends well beyond initial recovery and rehabilitation, with long-term consequences and challenges requiring health-care commitments across the lifecourse. This paper presents a systematic review of the current state of knowledge regarding the long-term impact of ageing and limb-loss in military veterans. Key databases were systematically searched including: ASSIA, CINAHL, Cochrane Library, Medline, Web of Science, PsycArticles/PsychInfo, ProQuest Psychology and ProQuest Sociology Journals, and SPORTSDiscus. Empirical studies which focused on the long-term impact of limb-loss and/or health-care requirements in veterans were included. The search process revealed 30 papers relevant for inclusion. These papers focused broadly on four themes: (a) long-term health outcomes, prosthetics use and quality of life; (b) long-term psycho-social adaptation and coping with limb-loss; (c) disability and identity; and (d) estimating the long-term costs of care and prosthetic provision. Findings present a compelling case for ensuring the long-term care needs and costs of rehabilitation for older limbless veterans are met. A dearth of information on the lived experience of limb-loss and the needs of veterans’ families calls for further research to address these important issues.

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