Medical Burnout

2022 ◽  
pp. 184-194
Author(s):  
Diogo Franco Santos ◽  
Ana Rita Branco Silva ◽  
Maria do Rosário Novo ◽  
Cristina Vaz de Almeida
Keyword(s):  
Emotional Exhaustion ◽  
Health Personnel ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Well Being ◽  
Workplace Stress ◽  
Inadequate Response ◽  
Professional Lives ◽  
Professional Efficacy ◽  
Mesh Terms

The WHO defines burnout as an inadequate response to chronic workplace stress, with emotional exhaustion, depersonalization, and reduced professional efficacy. Its growing incidence among physicians may adversely affect their personal and professional lives. Mindfulness aims to reach a state of consciousness in which one's attention is purposefully focused on the present. This chapter uses a narrative review of articles published between 2015 and 2019, with the MeSH terms “Burnout,” “Professional,” “Mindfulness,” and “Health Personnel.” Sixty-six articles were obtained, of which one meta-analysis, two systematic reviews, and two randomized clinical trials (RCT) met the inclusion criteria. All studies showed some degree of burnout improvement, more statistically significant as regards emotional exhaustion. One RCT also showed a reduction in heart rate. Available evidence suggests that mindfulness may improve physicians' well-being, mental health, and resilience, asserting itself as a possible coping strategy for burnout, namely regarding emotional exhaustion.

scholarly journals Efficacy of Modern Diabetes Treatments- Dpp-4i, Sglt-2i, Glp-1ra- in White and Asian Patients With Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Author(s):  
Sushrima Gan1 ◽  
Adem Y Dawed ◽  
Louise A Donnelly ◽  
ATN Nair ◽  
Colin NA Palmer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Randomized Clinical Trials ◽  
Data Extraction ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Glucose Lowering ◽  
Asian Ethnicity ◽  
Mesh Terms ◽  
Oral Agents ◽  
The Impact

<b><i><u>Background and Purpose:</u></i></b>The pathophysiology of Type 2 diabetes differs markedly by ethnicity. A systematic review and meta-analysis was conducted to assess the impact of ethnicity on the glucose lowering efficacy of the newer oral agents, SGLT-2is, GLP-1RAs and DPP-4is, using evidence from randomized clinical trials (RCTs). <p><b><i><u>Data Sources:</u></i></b>A literature search was conducted in PubMed of all randomized, placebo-controlled trials of DPP-4 inhibitors, SGLT-2 inhibitors and GLP-1RA. The search strategy was developed based on medical subject sub-headings (MeSH) terms and keywords.</p> <p><b><i><u>Study selection :</u></i></b> 64 studies qualified for meta-analysis after full-text review based on pre-defined inclusion and exclusion criteria. RCTs with at least 50 patients in each arm; >70% of population from Asian or White group; duration>=24 weeks; published up to March 2019 were selected for systematic review and meta-analysis.</p> <p><b><i><u>Data extraction:</u></i></b>Data extraction was done for aggregated study-level data , by two independent researchers. Absolute changes in HbA1c (%) from baseline to 24 weeks between the drug and placebo was considered as the primary endpoint of the study.</p> <p><b><i><u>Data synthesis: </u></i></b>Change in HbA1c was evaluated by computing mean differences (MDs) and 95% confidence intervals (CI) between treatment and placebo arms. </p> <p><b><i><u>Limitations: </u></i></b> Study is based on summarized data and could not be separated based on East Asians and South Asians.</p> <p><b><i><u>Conclusion : </u></i></b>The glucose lowering efficacy of SGLT-2i, and to a lesser extent DPP-4i, was greater in studies of predominantly Asian ethnicity compared to studies of predominantly white ethnicity. There was no difference seen by ethnicity for GLP-1RA.</p>

scholarly journals Efficacy of Modern Diabetes Treatments- Dpp-4i, Sglt-2i, Glp-1ra- in White and Asian Patients With Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Author(s):  
Sushrima Gan1 ◽  
Adem Y Dawed ◽  
Louise A Donnelly ◽  
ATN Nair ◽  
Colin NA Palmer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Randomized Clinical Trials ◽  
Data Extraction ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Glucose Lowering ◽  
Asian Ethnicity ◽  
Mesh Terms ◽  
Oral Agents ◽  
The Impact

<b><i><u>Background and Purpose:</u></i></b>The pathophysiology of Type 2 diabetes differs markedly by ethnicity. A systematic review and meta-analysis was conducted to assess the impact of ethnicity on the glucose lowering efficacy of the newer oral agents, SGLT-2is, GLP-1RAs and DPP-4is, using evidence from randomized clinical trials (RCTs). <p><b><i><u>Data Sources:</u></i></b>A literature search was conducted in PubMed of all randomized, placebo-controlled trials of DPP-4 inhibitors, SGLT-2 inhibitors and GLP-1RA. The search strategy was developed based on medical subject sub-headings (MeSH) terms and keywords.</p> <p><b><i><u>Study selection :</u></i></b> 64 studies qualified for meta-analysis after full-text review based on pre-defined inclusion and exclusion criteria. RCTs with at least 50 patients in each arm; >70% of population from Asian or White group; duration>=24 weeks; published up to March 2019 were selected for systematic review and meta-analysis.</p> <p><b><i><u>Data extraction:</u></i></b>Data extraction was done for aggregated study-level data , by two independent researchers. Absolute changes in HbA1c (%) from baseline to 24 weeks between the drug and placebo was considered as the primary endpoint of the study.</p> <p><b><i><u>Data synthesis: </u></i></b>Change in HbA1c was evaluated by computing mean differences (MDs) and 95% confidence intervals (CI) between treatment and placebo arms. </p> <p><b><i><u>Limitations: </u></i></b> Study is based on summarized data and could not be separated based on East Asians and South Asians.</p> <p><b><i><u>Conclusion : </u></i></b>The glucose lowering efficacy of SGLT-2i, and to a lesser extent DPP-4i, was greater in studies of predominantly Asian ethnicity compared to studies of predominantly white ethnicity. There was no difference seen by ethnicity for GLP-1RA.</p>

Meta-analysis and Approach of the Real Impact of Anorexigenic Drugs in the Obesity in Humans: The Last Five Years of the Randomized Studies

2020 ◽  
Vol 16 (7) ◽  
pp. 750-758
Author(s):  
Ana Valéria Garcia Ramirez ◽  
Durval Ribas Filho ◽  
Idiberto José Zotarelli Filho
Keyword(s):  
Weight Loss ◽  
Young People ◽  
Weight Reduction ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Public Health Problem ◽  
P Value ◽  
Randomized Studies ◽  
Mesh Terms ◽  
The Mean

Introduction: Obesity shows a multifactorial disease and presents a serious public health problem, with an alarming epidemic character. According to NHANES (National Health and Nutrition Examination Survey) from 2015 to 2016, 39.6% of American adults and 18.5% of young people were obese and 7.7% of adults and 5.6% of young people had severe obesity. Brazil ranks fifth in the world ranking, with about 18 million people reaching up to 70 million overweight individuals. Despite shortterm weight loss with diet and exercise, weight regain continues to be a concern. Anti-obesity drugs, such as Sibutramine (SIB), Phentermine (PHEN), Fenproporex (FEN), Mazindol (MAZ), Amfepramone (AMFE) and Orlistat (ORL) may play a role in weight reduction in patients whose condition is refractory to non- and maintenance of weight loss. Objective: A systematic review followed by meta-analysis of randomized clinical trials over the past five years to explore the efficacy and safety of anorexigenic drugs for weight reduction and consequent treatment of obesity. Methods: The search strategy in MEDLINE / Pubmed, Web of Science, ScienceDirect Journals (Elsevier), Scopus (Elsevier), OneFile (Gale) is as follows : - search for mesh terms (Sibutramine, Phentermine, Fenproporex, Mazindol, Amfepramone , Orlistat, Weight loss, Safety), and the use of booleans "and" between mesh terms and "or" among historical findings. Results: It was observed that in the last five years of randomized studies no significant general complications were found, with only 5.7%. The mean overall weight loss was 6.18 (± 2.8) kg in the mean time of 12 months. The overall success rate among these drugs was 80.18%. The p-value values did not present a significant statistical difference, being p <0.05 within each drug group analyzed, for both weight and success rates. Conclusion: The scientific findings of randomized studies on the use of anorexigenic drugs to treat obesity have shown safety and efficiency in the last five years, with a reasonable weight loss and no significant complications.

scholarly journals Hydroxychloroquine Versus COVID-19: A Rapid Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Amir Shamshirian ◽  
Amirhossein Hessami ◽  
Keyvan Heydari ◽  
Reza Alizadeh-Navaei ◽  
Mohammad Ali Ebrahimzadeh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mortality Rate ◽  
Adverse Effects ◽  
Comparative Studies ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Sensitivity Analyses ◽  
Cochrane Library ◽  
Control Group ◽  
Mesh Terms

AbstractBackgroundCoronavirus Disease 2019 (COVID-19) has become a major global issue with rising the number of infected individuals and mortality in recent months. Among all therapeutic approaches, arguments have raised about hydroxychloroquine (HCQ) efficacy in the treatment of COVID-19. We aimed to overcome the controversies regarding the effectiveness of hydroxychloroquine in the treatment of COVID-19, using a systematic review and meta-analysis.MethodsA systematic search was performed in PubMed, Scopus, Embase, Cochrane Library, Web of Science, Google Scholar and medRxiv pre-print database using all available MeSH terms for COVID-19 and hydroxychloroquine. Two authors selected and assessed the quality of studies independently using related checklists. Data have been extracted from included studies and analyzed using CMA v. 2.2.064. heterogeneity was also assessed using the I-squared test. We also conducted different sensitivity analyses to examine the effect of studies that greatly influence the results.ResultsOut of 14 studies entered into our systematic review, 12 studies including seven comparative studies with control group and five observational studies containing 3,428 participants have entered into the study. The results of the meta-analysis on comparative studies indicated no significant clinical effectiveness (negative in RT-PCR evaluation) for HCQ regimen in the treatment of COVID-19 in comparison to control group (RR: 1.04, 95% CI, 0.83-1.31). The same result was observed for the combination of HCQ+azithromycin (RR: 2.15, 95% CI, 0.31-14.77). Approximately 1.7 times higher mortality rate was observed among the HCQ regimen group in comparison to control group (RR: 1.73, 95% CI, 1.06-2.81), which was not related to the age differences according to meta-regression analysis (P=0.305). No substantial difference was observed for disease exacerbation (RR: 1.87, 95% CI, 0.28-12.36) between HCQ group and controls. Also, radiological findings significantly improved in the HCQ group (OR: 0.32, 95% CI, 0.11-0.98). Odds of known HCQ adverse effects (diarrhea, vomiting, blurred vision, rash, headache, etc.) occurred in the HCQ regimen group was approximately 3.5 times of control group (OR: 3.55, 95% CI, 1.61-7.82), but no substantial differences were found regarding intubation odds between HCQ group and control group (OR: 2.11, 95% CI, 0.31-14.03).ConclusionThis systematic review and meta-analysis not only indicated no clinical benefits regarding HCQ treatment with/without azithromycin for COVID-19 patients, but the higher mortality rate and frequency of known HCQ adverse effects were observed for the HCQ regimen group. However, due to that most of the studies were non-randomized and results were not homogenous, selection bias was unavoidable and further large randomized clinical trials following comprehensive meta-analysis should be taken into account in order to achieve more reliable findings.

scholarly journals Levels of Burnout and Risk Factors in Medical Area Nurses: A Meta-Analytic Study

2018 ◽  
Vol 15 (12) ◽  
pp. 2800 ◽  
Author(s):  
Jesús Molina-Praena ◽  
Lucia Ramirez-Baena ◽  
José Gómez-Urquiza ◽  
Gustavo Cañadas ◽  
Emilia De la Fuente ◽  
...  
Keyword(s):  
Emotional Exhaustion ◽  
Prevalence Rate ◽  
Meta Analysis ◽  
Well Being ◽  
Personal Accomplishment ◽  
Level Of Evidence ◽  
Scientific Databases ◽  
Medical Area ◽  
Research Findings ◽  
Double Blinded

Research findings concerning burnout prevalence rate among nurses from the medical area are contradictory. The aim of this study was to analyse associated factors, to determine nurse burnout levels and to meta-analyse the prevalence rate of each burnout dimension. A systematic review, with meta-analysis, was conducted in February 2018, consulting the next scientific databases: PubMed, CUIDEN, CINAHL, Scopus, LILACS, PsycINFO and ProQuest Health & Medical Complete. In total, 38 articles were extracted, using a double-blinded procedure. The studies were classified by the level of evidence and degrees of recommendation. The 63.15% (n = 24) of the studies used the MBI. High emotional exhaustion was found in the 31% of the nurses, 24% of high depersonalisation and low personal accomplishment was found in the 38%. Factors related to burnout included professional experience, psychological factors and marital status. High emotional exhaustion prevalence rates, high depersonalisation and inadequate personal accomplishment are present among medical area nurses. The risk profile could be a single nurse, with multiple employments, who suffers work overload and with relatively little experience in this field. The problem addressed in this study influence the quality of care provided, on patients’ well-being and on the occupational health of nurses.

scholarly journals Adverse childhood experience and adult persistent pain and disability: protocol for a systematic review and meta-analysis

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
André Bussières ◽  
Jan Hartvigsen ◽  
Manuela L. Ferreira ◽  
Paulo H. Ferreira ◽  
Mark J. Hancock ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Childhood Experiences ◽  
Emotional Abuse ◽  
Meta Analysis ◽  
Well Being ◽  
Persistent Pain ◽  
Eligibility Criteria ◽  
Childhood Experiences ◽  
Mesh Terms ◽  
Adverse Childhood

Abstract Background A growing body of research highlights the pervasive harms of adverse childhood experiences (ACEs) on health throughout the life-course. However, findings from prior reviews and recent longitudinal studies investigating the association between types of ACEs and persistent pain have yielded inconsistent findings in the strength and direction of associations. The purpose of this review is to appraise and summarize evidence on the relationship between ACEs and persistent pain and disability outcomes in adulthood. The specific aims are (1) to determine whether there is a relationship between exposure to ACE and persistent pain and disability in adults and (2) to determine whether unique and cumulative ACEs exposures (number and type) increase the risk of developing persistent pain and disability in adulthood. Method A systematic review and meta-analysis of observational studies will be conducted. Our eligibility criteria are defined following a PECOS approach: population, adults with persistent (≥ 3 months) musculoskeletal and somatoform painful disorders exposed to single or cumulative direct ACEs alone (i.e., physical, sexual, emotional abuse or neglect) or in combination to indirect types of ACE (e.g., parental death, exposure to domestic violence) in the first 18 years of life; comparators, unexposed individuals; outcomes, measurements for persistent pain (≥ 3 months) and disability using discrete and/or continuous measures; and settings, general population, primary care. A comprehensive search of MEDLINE (Ovid) and nine other pertinent databases was conducted from inception to 29 August 2019 using a combination of key words and MeSh terms (the search will be updated prior to conducting the analyses). Pairs of reviewers will independently screen records and full text articles, and a third reviewer will be consulted in cases of disagreement. Data will be extracted using Endnote and Covidence and a meta-analysis will be conducted using Review Manager (RevMan) Version 5.3. The Scottish Intercollegiate Guidelines Network (SIGN) and the Joanna Briggs Institute (JBI) checklists will be used to assess the quality of the included studies. If heterogeneity is high, the findings will be presented in narrative form. Discussion The present review will help consolidate knowledge on persistent pain and disability by evaluating whether frequency and type of adverse childhood experiences produces the most harm. Findings may help inform practitioners and policy-makers who endeavor to prevent and/or mitigate the consequences of ACEs and promote healthy development and well-being of children, youth, and families. Systematic review registration PROSPERO CRD42020150230

scholarly journals Do we need still more trials on T4 and T3 combination therapy in hypothyroidism?

2009 ◽  
Vol 161 (6) ◽  
pp. 955-959 ◽  
Author(s):  
Wilmar M Wiersinga
Keyword(s):  
Clinical Trials ◽  
Combination Therapy ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Well Being ◽  
Once Daily ◽  
Serum Free ◽  
Physiological Serum ◽  
Levothyroxine Replacement ◽  
Hypothyroid Patients

Approximately 10% of hypothyroid patients are dissatisfied with the outcome of levothyroxine replacement. It is unlikely that slight over- or under-treatment with thyroxine (T4) explains remaining complaints. Meta-analysis of randomized clinical trials shows no advantage of T4/tri-iodothyronine (T3) combination therapy over T4 monotherapy. However, each of these trials can be criticized, and none is perfect: most of them failed to mimic the physiological ratio of serum free T4 (FT4) to free T3 (FT3) concentrations. Development of a sustained-release T3 preparation given as a single nighttime dose (together with levothyroxine once daily) might maintain physiological serum FT4–FT3 ratio's throughout 24 h. Genetic polymorphisms in deiodinase 2 and thyroid hormone transporters have been associated with well-being, fatigue, depression, and greater improvement on combination therapy. Future trials should target carriers of these polymorphisms to see whether they do better on T4/T3 combination therapy than on T4 monotherapy.

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