Conflict resolution in anaesthesia: systematic review

BackgroundConflict is a significant and recurrent problem in most modern healthcare systems. Given its ubiquity, effective techniques to manage or resolve conflict safely are required.ObjectiveThis review focuses on conflict resolution interventions for improvement of patient safety through understanding and applying/teaching conflict resolution skills that critically depend on communication and improvement of staff members’ ability to voice their concerns.MethodsWe used the Population-Intervention-Comparator-Outcome model to outline our methodology. Relevant English language sources for both published and unpublished papers up to February 2018 were sourced across five electronic databases: the Cochrane Library, EMBASE, MEDLINE, SCOPUS and Web of Science.ResultsAfter removal of duplicates, 1485 studies were screened. Six articles met the inclusion criteria with a total sample size of 286 healthcare worker participants. Three training programmes were identified among the included studies: (A) crisis resource management training; (B) the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) training; and (C) the two-challenge rule (a component of TeamSTEPPS), and two studies manipulating wider team behaviours. Outcomes reported included participant reaction and observer rating of conflict resolution, speaking up or advocacy-inquiry behaviours. Study results were inconsistent in showing benefits of interventions.ConclusionThe evidence for training to improve conflict resolution in the clinical environment is sparse. Novel methods that seek to influence wider team behaviours may complement traditional interventions directed at individuals.

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Social, Organizational, and Technological Factors Impacting Clinicians’ Adoption of Mobile Health Tools: A Systematic Literature Review (Preprint)

10.2196/preprints.15935 ◽

2019 ◽

Cited By ~ 2

Author(s):

Christine Jacob ◽

Antonio Sanchez-Vazquez ◽

Chris Ivory

Keyword(s):

Mobile Health ◽

English Language ◽

Organizational Factors ◽

Evidence Base ◽

Ease Of Use ◽

Cochrane Library ◽

User Engagement ◽

Technological Factors ◽

Study Results ◽

Social Organizational

BACKGROUND There is a growing body of evidence highlighting the potential of Mobile Health in reducing healthcare costs, enhancing access, and improving the quality of patient care. However, user acceptance and adoption are key prerequisites to harness this potential, hence, a deeper understanding of the factors impacting this adoption is crucial for its success. OBJECTIVE The aim of this review is to systematically explore relevant published literature in order to synthesize the current understanding of the factors impacting clinicians’ adoption of mHealth tools, not only from a technology perspective but also from social and organizational perspectives. METHODS A structured search was carried out of Medline PubMed, the Cochrane Library, and SAGE database for studies published between January 2008 and July 2018 in the English language; yielding 4993 results, of which 171 met the inclusion criteria. RESULTS The technological factors impacting clinicians’ adoption of mobile health were categorized into 8 key themes: Usefulness, Ease of use, Design, Compatibility, Technical issues, content, Personalization and convenience. These were in turn divided into 14 sub-themes altogether. Social and organizational factors were much more prevalent and were categorized into 8 key themes: Workflow related, Patient related, Policy and regulations, Culture or attitude or social influence, Monetary factors, Evidence base, Awareness, and User engagement. These were in turn divided into 41 sub-themes, highlighting the importance of considering these factors when addressing potential barriers to mHealth adoption and how to overcome them. CONCLUSIONS The study results can help inform mHealth providers and policy makers regarding the key factors impacting mHealth adoption, guiding them into making educated decisions to foster this adoption and harness the potential benefits. CLINICALTRIAL NA

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

BJS Open ◽

10.1093/bjsopen/zrab032.091 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

Emma Kearns ◽

Zuneera Khurshid ◽

Sabrina Anjara ◽

Aoife De Brún ◽

Brendan Rowan ◽

...

Keyword(s):

Systematic Review ◽

Patient Safety ◽

Team Effectiveness ◽

Negative Impact ◽

Cochrane Library ◽

Power Dynamics ◽

Team Communication ◽

Speaking Up ◽

Healthcare Teams ◽

The Impact

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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N-Acetyl cysteine in rodenticide poisoning: A systematic review and meta-analysis

Current Reviews in Clinical and Experimental Pharmacology ◽

10.2174/2772432816666210825102726 ◽

2021 ◽

Vol 16 ◽

Author(s):

Muhammed Rashid ◽

Viji Pulikkel Chandran ◽

Sreedharan Nair ◽

Deepa Sudalai Muthu ◽

Jemima Pappuraj ◽

...

Keyword(s):

English Language ◽

Retrospective Studies ◽

Meta Analysis ◽

Treated Group ◽

Pooled Analysis ◽

Cochrane Library ◽

Language Studies ◽

Study Results ◽

Clinical Benefits ◽

Acetyl Cysteine

Background: Treatment with N-Acetyl cysteine (NAC) in rodenticide poisoning has not been well established due to mixed study results and insufficient evidence. This review aimed to summarize the clinical benefits of NAC in the management of rodenticide poisoning. Method: This review follows the PICOS framework and the PRISMA guidelines. PubMed/MEDLINE, Scopus, and the Cochrane library were searched to identify the published literature from inception to September 2020, and a reference search was performed for additional relevant studies. The English language studies addressing the use of NAC in rodenticide poisoning were considered for the review. We considered all experimental and observational studies due to the insufficient number of interventional studies. Results: Ten studies (two RCTs, four observational, and four descriptive) out of 2,178 studies with 492 participants were considered for the review. Only six studies (two RCTs, one prospective, and three retrospective studies) reported recovery and mortality rates. Pooled results of RCTs (n=2) showed a significant recovery rate (Odds Ratio [OR]:3.97; 95% Confidence Interval [CI]:1.69-9.30), whereas summary estimates of prospective and retrospective studies recorded a non-significant effect. Meta-analysis of RCTs (OR: 0.25; 95% CI: 0.11-0.59; n=2) and retrospective studies (OR: 0.34; 95% CI: 0.15-0.78; n=3) showed a significant reduction in mortality, whereas pooled analysis of prospective studies recorded a non-significant effect. A significant reduction in intubation or ventilation (OR: 0.25; 95% CI: 0.11-0.60; 2 RCTs) and a non-significant (P=0.41) difference in duration of hospitalization was observed with NAC when compared to the non-NAC treated group. The quality of the included studies appeared to be moderate to high. Conclusion: Our findings indicate that NAC showed better survival and lower mortality rate when compared to a non-NAC treated group; hence NAC can be considered for the management of rodenticide poisoning.

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Social, Organizational, and Technological Factors Impacting Clinicians’ Adoption of Mobile Health Tools: Systematic Literature Review

JMIR mhealth and uhealth ◽

10.2196/15935 ◽

2020 ◽

Vol 8 (2) ◽

pp. e15935 ◽

Cited By ~ 16

Author(s):

Christine Jacob ◽

Antonio Sanchez-Vazquez ◽

Chris Ivory

Keyword(s):

Mobile Health ◽

English Language ◽

Meta Analysis ◽

Organizational Factors ◽

Evidence Base ◽

Ease Of Use ◽

Cochrane Library ◽

User Engagement ◽

Technological Factors ◽

Study Results

Background There is a growing body of evidence highlighting the potential of mobile health (mHealth) in reducing health care costs, enhancing access, and improving the quality of patient care. However, user acceptance and adoption are key prerequisites to harness this potential; hence, a deeper understanding of the factors impacting this adoption is crucial for its success. Objective The aim of this review was to systematically explore relevant published literature to synthesize the current understanding of the factors impacting clinicians’ adoption of mHealth tools, not only from a technological perspective but also from social and organizational perspectives. Methods A structured search was carried out of MEDLINE, PubMed, the Cochrane Library, and the SAGE database for studies published between January 2008 and July 2018 in the English language, yielding 4993 results, of which 171 met the inclusion criteria. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines and the Cochrane handbook were followed to ensure a systematic process. Results The technological factors impacting clinicians’ adoption of mHealth tools were categorized into eight key themes: usefulness, ease of use, design, compatibility, technical issues, content, personalization, and convenience, which were in turn divided into 14 subthemes altogether. Social and organizational factors were much more prevalent and were categorized into eight key themes: workflow related, patient related, policy and regulations, culture or attitude or social influence, monetary factors, evidence base, awareness, and user engagement. These were divided into 41 subthemes, highlighting the importance of considering these factors when addressing potential barriers to mHealth adoption and how to overcome them. Conclusions The study results can help inform mHealth providers and policymakers regarding the key factors impacting mHealth adoption, guiding them into making educated decisions to foster this adoption and harness the potential benefits.

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Sensory Phenomena in Obsessive-Compulsive Disorder and Tic Disorders: A Review of the Literature

CNS Spectrums ◽

10.1017/s1092852900016606 ◽

2008 ◽

Vol 13 (5) ◽

pp. 425-432 ◽

Cited By ~ 91

Author(s):

Helena da Silva Prado ◽

Maria Conceição do Rosário ◽

Jennifer Lee ◽

Ana G. Hounie ◽

Roseli G. Shavitt ◽

...

Keyword(s):

Obsessive Compulsive Disorder ◽

English Language ◽

Cochrane Library ◽

Subjective Experiences ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

English Language Literature ◽

Study Results ◽

Language Literature ◽

Just Right

ABSTRACTIntroduction:A variety of subjective experiences have been reported to be associated with the symptom expression of obsessive-compulsive disorder (OCD) and Tourette syndrome (TS). First described in TS patients, these subjective experiences have been defined in different ways. There is no consensus in the literature on how to best define subjective experiences. This lack of consensus may hinder the understanding of study results and prevents the possibility of including them in the search for etiological factors associated with OCD and TS.Methods:The objective of this article was to review the descriptions of subjective experiences in the English-language literature from 1980–2007. This meta-analytic review was carried out using the English-language literature from 1980–2007 available on MEDLINE, PsyclNFO, and the Cochrane Library databases using the following search terms: premonitory urges, sensory tics, “just-right” perceptions, sensory phenomena, sensory experiences, incompleteness, “not just-right” phenomena, obsessive-compulsive disorder and TS, including OCD and/or TS, in all combination searches. We also searched for the references cited in each article previously found that referred to the aforementioned terms. Thirtyone articles were included in the study.Results:Subjective experiences, in particular, the sensory phenomena, were important phenotypic variables in the characterization of the tic-related OCD subtype and were more frequent in the early-onset OCD subtype. There is a paucity of studies using structured interviews to assess sensory phenomena, their epidemiology and the etiological mechanisms associated with sensory phenomena.Conclusion:The current review provides some evidence that sensory phenomena can be useful to identify more homogenous subgroups of OCD and TS patients and should be included as important phenotypic variables in future clinical, genetic, neuroimaging, and treatment-response studies.

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In situ simulation as a tool for patient safety: a systematic review identifying how it is used and its effectiveness

BMJ Simulation and Technology Enhanced Learning ◽

10.1136/bmjstel-2015-000065 ◽

2015 ◽

Vol 1 (3) ◽

pp. 103-110 ◽

Cited By ~ 18

Author(s):

Graham Fent ◽

James Blythe ◽

Omer Farooq ◽

Makani Purva

Keyword(s):

Patient Safety ◽

Clinical Skills ◽

Real Life ◽

Interdisciplinary Teams ◽

Cochrane Library ◽

Future Research ◽

Clinical Environment ◽

In Situ Simulation ◽

Safety Outcomes

BackgroundIn situ simulation is an emerging technique involving interdisciplinary teams working through simulated scenarios which replicate events encountered in healthcare institutions, particularly those which are either low frequency or associated with high risk to patients. Since it takes place in the clinical environment, it is ideally suited to improving patient safety outcomes.ObjectiveTo identify and appraise all studies assessing contribution of in situ simulation to patient safety, identify gaps in knowledge and areas for future research, as well as suggesting strategies for maximising its impact on patient safety within an institution.Study selectionThree electronic databases (MEDLINE, PubMed and EMBASE) as well as the Cochrane Library were searched for articles relating to patient safety outcomes in in situ simulation. In addition a subject expert was approached to suggest any additional articles not identified by electronic searches. A total of 1795 abstracts were identified and screened, 35 full articles assessed for eligibility for inclusion and a total of 18 full articles included in the review after unsuitable articles were excluded.ConclusionsIn situ simulation can improve real-life patient safety outcomes, with 2 studies demonstrating improved morbidity and mortality outcomes following initiation of in situ simulation. There is good evidence to suggest that its implementation leads to improved clinical skills, teamwork and observed behaviours. Additionally, it is ideally suited to detecting latent safety errors (errors identified within a scenario which, if they had occurred in real life, could have led to a degree of harm occurring to a patient).

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Efficacy of compression stockings in preventing post-thrombotic syndrome in patients with deep venous thrombosis: a systematic review and metaanalysis

VASA ◽

10.1024/0301-1526/a000508 ◽

2016 ◽

Vol 45 (2) ◽

pp. 141-147 ◽

Cited By ~ 7

Author(s):

Jakob Martin Burgstaller ◽

Johann Steurer ◽

Ulrike Held ◽

Beatrice Amann-Vesti

Keyword(s):

Systematic Review ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Cochrane Library ◽

Compression Stockings ◽

Post Thrombotic Syndrome ◽

Study Results ◽

Preventive Efficacy ◽

One Year ◽

The Cochrane Library

Abstract. Background: Here, we update an earlier systematic review on the preventive efficacy of active compression stockings in patients with diagnosed proximal deep venous thrombosis (DVT) by including the results of recently published trials. The aims are to synthesize the results of the original studies, and to identify details to explain heterogeneous results. Methods: We searched the Cochrane Library, PubMed, Scopus, and Medline for original studies that compared the preventive efficacy of active compression stockings with placebo or no compression stockings in patients with diagnosed proximal DVT. Only randomized controlled trials (RCTs) were included. Results: Five eligible RCTs with a total of 1393 patients (sample sizes ranged from 47 to 803 patients) were included. In three RCTs, patients started to wear compression stockings, placebo stockings or no stockings within the first three weeks after the diagnosis of DVT. The results of two RCTs indicate a statistically significant reduction in post-thrombotic syndrome (PTS) of 50% or more after two or more years. The result of one RCT shows no preventive effect of compression stockings at all. Due to the heterogeneity of the study results, we refrained from pooling the results of the RCTs. In a further RCT, randomization to groups with and without compression stockings took place six months after the diagnosis of DVT, and in another RCT, only patients with the absence of PTS one year after the diagnosis of DVT were analyzed. One RCT revealed a significant reduction in symptoms, whereas another RCT failed to show any benefit of using compression stockings. Conclusions: At this time, it does not seem to be justifiable to entirely abandon the recommendations regarding compression stockings to prevent PTS in patients with DVT. There is evidence favoring compression stockings, but there is also evidence showing no benefit of compression stockings.

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On South Sudan, in English. Review of the Books by Peter Martell “First Raise A Flag: How South Sudan Won the Longest War but Lost the Peace” and John Young “South Sudan’s Civil War: Violence, Insurgency and Failed Peacemaking”

10.31132/2412-5717-2020-51-2-109-115 ◽

2020 ◽

pp. 109-115

Author(s):

Anna Sharova

Keyword(s):

Conflict Resolution ◽

Civil War ◽

English Language ◽

South Sudan ◽

International Governance ◽

Refugee Camps ◽

Graham Greene ◽

The Future ◽

Independent Country ◽

Spot Analysis

Anna Sharova reviews two recent books separately published by two English language authors – P. Martell and J. Young. The books are very different in style and mood. While P. Martell presents an excellent example of British journalist prose in the style of his elder compatriots Somerset Maugham and Graham Greene, who did their reporting and writing from exotic countries during fateful periods of history, J. Young offers a more academic, though no less ‘on the spot’ analysis of the situation in the youngest independent country of Africa. J. Young’s considers two possible approaches to conflict resolution as possible outcomes: non-intervention cum continuation of the war, or the introduction of international governance. P. Martell comes up with a disappointing prediction about the future of South Sudan. The war will go on, the famine will return, and the threat of genocide will not disappear. People will continue to flee the country, and refugee camps will grow. New warring groups will appear, new murders will be committed. Neighbouring states will not stop competing for influence and resources. New peacekeepers will arrive. Warlords will be accused of crimes, but, as before, they will escape punishment, while some will be promoted.

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Accuracy of Pulse Oximetry in the Presence of Fetal Hemoglobin—A Systematic Review

Children ◽

10.3390/children8050361 ◽

2021 ◽

Vol 8 (5) ◽

pp. 361

Author(s):

Ena Pritišanac ◽

Berndt Urlesberger ◽

Bernhard Schwaberger ◽

Gerhard Pichler

Keyword(s):

Pulse Oximetry ◽

Neonatal Intensive Care ◽

English Language ◽

Arterial Oxygen Saturation ◽

Fetal Hemoglobin ◽

Arterial Oxygen ◽

Cochrane Library ◽

Preterm Neonates ◽

Neonatal Blood ◽

The Impact

Continuous monitoring of arterial oxygen saturation by pulse oximetry (SpO2) is the main method to guide respiratory and oxygen support in neonates during postnatal stabilization and after admission to neonatal intensive care unit. The accuracy of these devices is therefore crucial. The presence of fetal hemoglobin (HbF) in neonatal blood might affect SpO2 readings. We performed a systematic qualitative review to investigate the impact of HbF on SpO2 accuracy in neonates. PubMed/Medline, Embase, Cumulative Index to Nursing & Allied Health database (CINAHL) and Cochrane library databases were searched from inception to January 2021 for human studies in the English language, which compared arterial oxygen saturations (SaO2) from neonatal blood with SpO2 readings and included HbF measurements in their reports. Ten observational studies were included. Eight studies reported SpO2-SaO2 bias that ranged from −3.6%, standard deviation (SD) 2.3%, to +4.2% (SD 2.4). However, it remains unclear to what extent this depends on HbF. Five studies showed that an increase in HbF changes the relation of partial oxygen pressure (paO2) to SpO2, which is physiologically explained by the leftward shift in oxygen dissociation curve. It is important to be aware of this shift when treating a neonate, especially for the lower SpO2 limits in preterm neonates to avoid undetected hypoxia.

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The Rheumatology Drugs for COVID-19 Management: Which and When?

Journal of Clinical Medicine ◽

10.3390/jcm10040783 ◽

2021 ◽

Vol 10 (4) ◽

pp. 783

Author(s):

Fabiola Atzeni ◽

Ignazio Francesco Masala ◽

Javier Rodríguez-Carrio ◽

Roberto Ríos-Garcés ◽

Elisabetta Gerratana ◽

...

Keyword(s):

English Language ◽

Multidisciplinary Approach ◽

Intravenous Immunoglobulins ◽

Cochrane Library ◽

Immunomodulatory Drugs ◽

Antiviral Therapies ◽

Tnf Α ◽

Large Heterogeneity ◽

Necrosis Factor ◽

Game Changer

Introduction: While waiting for the development of specific antiviral therapies and vaccines to effectively neutralize the SARS-CoV2, a relevant therapeutic strategy is to counteract the hyperinflammatory status, characterized by an increase mainly of interleukin (IL)-1β, IL-2, IL-6, IL-7, IL-8, and tumor necrosis factor (TNF)-α, which hallmarks the most severe clinical cases. ‘Repurposing’ immunomodulatory drugs and applying clinical management approved for rheumatic diseases represents a game-changer option. In this article, we will review the drugs that have indication in patients with COVID-19, including corticosteroids, antimalarials, anti-TNF, anti-IL-1, anti-IL-6, baricitinib, intravenous immunoglobulins, and colchicine. The PubMed, Medline, and Cochrane Library databases were searched for English-language papers concerning COVID-19 treatment published between January 2020 and October 2020. Results were summarized as a narrative review due to large heterogeneity among studies. In the absence of specific treatments, the use of immunomodulatory drugs could be advisable in severe COVID-19 patients, but clinical outcomes are still suboptimal. An early detection and treatment of the complications combined with a multidisciplinary approach could allow a better recovery of these patients.

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