International Journal of Evidence-Based Healthcare最新文献

Aim: The current study aimed to assess the suitability of the Work Organisation Assessment Questionnaire (WOAQ) for use in the healthcare sector, specifically for community nurses and paramedics. Community nurses and paramedics work in complex environments and are exposed to a range of psychosocial hazards linked with the development of musculoskeletal and mental health disorders. To reduce the incidence of these disorders, assessment and then control of psychosocial hazards is required. WOAQ addresses this need through an employee survey to identify key hazards, with the responses used to underpin a participative development of solutions.

Method: Using a bifactor model, the WOAQ and five nested factors were cross validated using a sample of 1255 community nurses and paramedics using data collected in 2011 and 2012.

Results: The results of metric invariance testing demonstrated that the WOAQ is a valid tool across health organizations. Full invariance testing at mean constructs level also showed strong support of validity of the 'general score' of the WOAQ. However, minor mean differences were found between two nested factors (workload issues and the relationships with the coworkers).

Conclusion: The WOAQ is a valid assessment tool for application within the nursing and paramedic settings. Practical implications for these findings in healthcare settings are discussed.

Aim: Previous studies, some dating back several decades, have recommended that the use of plain abdominal radiography should be curbed, particularly with the growth of more accurate imaging modalities. However, evidence from referral data suggests that plain abdominal radiography continues to be a commonly requested examination. The aim of this review was to explore the gap between evidence and practice by re-examining the evidence using a robust methodology, investigating the diagnostic accuracy of plain abdominal radiography.

Methods: Studies were identified from electronic databases and reference lists. Eligible studies provided data as to the sensitivity and specificity of plain abdominal radiography for either acute abdominal pain (Group A) or suspected intestinal obstruction (Group B). Version 2 of the Quality Assessment of Diagnostic Accuracy Studies was used to assess the quality of studies and hierarchical summary receiver operator characteristic curves and coupled forest plots were generated.

Results: Four studies evaluated plain abdominal radiography for acute abdominal pain (Group A) and 10 for suspected intestinal obstruction (Group B). Two studies investigated both presentations and were included in both groups. Methodological quality of studies was moderately high, though incorporation bias was a common limitation. Sensitivity for Group A studies ranged from 30 to 46%, with specificity from 75 to 88%. For Group B, the range of sensitivity was 48 to 96% and specificity from 50 to 100%.

Conclusion: The results suggest that use of plain abdominal radiography could be substantially reduced, particularly for patients with undifferentiated acute abdominal pain. While some guidelines exist, there is sound argument for clinical decision rules for abdominal imaging to inform evidence-based clinical decision-making and radiology referrals.

Aim: To investigate the content and face validity of a patient-reported outcome measure used by Australian physiotherapists in the assessment of inflammatory conditions of the lactating breast.

Methods: Sixty one experts representing 'women who previously had inflammatory conditions of the lactating breast' (48%), 'clinicians' (38%) and 'academics' (8%) interested in women's health and 7% unidentified participants were invited to complete a three round Delphi study.

Results: Ninety five percent of participants agreed that overall, the patient-reported outcome measure was appropriate for use in assessing and treating inflammatory conditions of the lactating breast. The item 'impact' was added to ensure the appropriate assessment of functional aspects of daily life. The item terminology used in the patient-reported outcome measure was simplified to 'pain', 'redness', 'hardness/tightness', 'temperature of affected area', 'sickness/wellness' and 'affected area. A clinician script was developed to ensure the patient-reported outcome measure has utility and consistency regardless of the experience of the women presenting with inflammatory conditions of the lactating breast or the clinician.

Conclusion: The resultant Breast Inflammatory Symptom Severity Index (BISSI) is a patient-reported outcome measure for use in the diagnosis and monitoring of clinical changes of symptoms associated with inflammatory conditions of the lactating breast including engorgement, blocked ducts and mastitis. It utilizes person-centred language and assesses symptoms considered important to both patient and clinician. The development of the clinician script facilitates utility regardless of the experience of either the woman with the inflammatory condition or the treating clinician.

Aim: Incomplete reporting of interventions in randomized controlled trials (RCTs) may hinder the replicability of studies and thus lead to adverse clinical outcomes for patients. Currently, little is known about the completeness of intervention reporting in neurology clinical trials. This study's primary objective was to determine the completeness of intervention reporting in neurology RCTs, as measured by the Template for Intervention Description and Replication (TIDieR) checklist. The secondary objectives of this study were to compare the completeness of intervention reporting before and after TIDieR publication and to evaluate factors associated with intervention reporting.

Methods: We conducted a cross-sectional, pilot-tested, double-blind investigation of 141 neurology RCTs to determine the completeness of intervention reporting in neurology.

Results: Overall, the average number of TIDieR checklist items that reached completion per study was 7.4 out of 12 (61.7%). We found no increase in intervention reporting following the publication of TIDieR (P = 0.35). Our generalized estimating equation analysis found that poorer TIDieR adherence was associated with trials lacking a trial registration (P = 0.03).

Conclusion: Our findings showed that on average, authors reported only 61.7% of items on the TIDieR checklist. These findings have significant implications, because incomplete reporting may hinder the replicability of studies and thus negatively affect clinical outcomes for patients.

Aim: These are turbulent times for hospitals, patients, and nurses. Nurse turnover is a global issue across all specialties but are exacerbated in medical-surgical areas where high nurse-patient ratios, use of point-of-care technologies, and stressful working conditions require sufficient numbers of highly trained nurses. These workload factors are further exaggerated by the current nursing shortage. The current nursing shortage crisis makes nursing job conditions more important than ever to examine. Despite heavy emphasis on promoting healthy work environments, job satisfaction, and retention of nurses working in intensive care and emergency room settings, limited research is available about the workload perception, burnout, and intent to leave among medical-surgical nurses. This study aimed to describe the relationships between workload perception, burnout, and intent to leave among medical-surgical nurses at two teaching hospitals in Southeastern United States.

Methods: A survey design and convenience sampling method was used. A sample of 58 medical-surgical staff nurses participated in the study. A 42-item questionnaire composed of a demographic survey, Individual Workload Perception Scale, and Maslach Burnout Inventory Scale were used. Simple descriptive statistics, Pearson's product-moment correlations, and multiple regression analysis procedures were used to analyze the data.

Results: More than half of the respondents reported high workloads and intentions to leave their current position. The overall burnout level for the sample was moderate to high. Moderate-to-strong intercorrelations were found between workload perception and intent to leave (r = 0.513, P < 0.0001), burnout and intent to leave (r = -0.435, P < 0.0006), and workload perception and burnout (r = -0.588, P < 0.0001). Workload perception and burnout among medical-surgical nurses both factored significantly on the intent to leave a current job (P < 0.05).

Conclusion: The current study provides new insights about the relationships between workload perception, burnout, and intent to leave among medical-surgical nurses. The findings indicate the higher the nurses' workload perception, the more likely they will leave their current job. Nurse managers should consider these findings when developing strategies to improve the work environment and nurse retention. Additional research is needed to gain more insight into the causality among workload perception, burnout, and intent to leave a current job among medical-surgical nurses.