BackgroundThe effect of a multi-faceted handoff strategy in a high volume internal medicine inpatient setting on process and patient outcomes has not been clearly established. We set out to determine if a multi-faceted handoff intervention consisting of education, standardized handoff procedures, including fixed time and location for face-to-face handoff would result in improved rates of handoff compared with usual practice. We also evaluated resident satisfaction, health resource utilization and clinical outcomes.MethodsThis was a cluster randomized controlled trial in a large academic tertiary care center with 18 inpatient internal medicine ward teams from January-April 2013. We randomized nine inpatient teams to an intervention where they received an education session standardizing who and how to handoff patients, with practice and feedback from facilitators. The control group of 9 teams continued usual non-standardized handoffs. The primary process outcome was the rate of patients handed over per 1000 patient nights. Other process outcomes included perceptions of inadequate handoff by overnight physicians, resource utilization overnight and hospital length of stay. Clinical outcomes included medical errors, frequency of patients requiring higher level of care overnight, and in-hospital mortality.ResultsThe intervention group demonstrated a significant increase in the rate of patients handed over to the overnight physician (62.90/1000 person-nights vs. 46.86/1000 person-nights, p = 0.002). There was no significant difference in other process outcomes except resource utilization was increased in the intervention group (26.35/1000 person-days vs. 17.57/1000 person-days, p-value = 0.01). There was no significant difference between groups in medical errors (4.8% vs. 4.1%), need for higher level of care or in hospital mortality. Limitations include a dependence of accurate record keeping by the overnight physician, the possibility of cross-contamination in the handoff process, analysis at the cluster level and an overall low number of clinical events.ConclusionsImplementation of a multi-faceted resident handoff intervention did not result in a significant improvement in patient safety although did improve number of patients handed off. Novel methods to improve handoff need to be explored.Trial registrationRegistered at ClinicalTrials.gov: NCT01796756.
In order to evaluate the effectiveness of interventions for Background: osteoarthritis of the wrist in adults we performed a systematic review and meta-analysis.The MEDLINE and EMBASE via OVID, CINAHL and Methods: SPORTDiscus via EBSCO databases were searched from inception to 25 April 2018.All randomised controlled clinical trials (RCTs) and any prospective studies of adults with wrist osteoarthritis investigating any intervention with a comparator were included. Data were extracted and checked for accuracy and completeness by pairs of reviewers. Primary outcomes were pain and function. Comparative treatment effects were analysed by random effects at all time points.Three RCTs were identified for inclusion after screening and all Results: had a high risk of bias. Two compared proximal row carpectomy (PRC) with four corner fusion (4CF) for post-traumatic osteoarthritis, while the other compared leather with commercial wrist splints in patients with chronic wrist pain, of which a small group had wrist osteoarthritis.There is no prospective study comparing operative to Conclusion: non-operative treatment for wrist osteoarthritis, while there is a paucity of prospective studies assessing the effectiveness of both non-operative and operative interventions. Further research is necessary in order to better define which patients benefit from which specific interventions.The review protocol was registered with PROSPERO under Registration: the registration number . CRD42018094799
Background: In order to evaluate the effectiveness of interventions for osteoarthritis of the wrist in adults we performed a systematic review and meta-analysis. Methods: The MEDLINE and EMBASE via OVID, CINAHL and SPORTDiscus via EBSCO databases were searched from inception to 25 th April 2018.All randomised controlled clinical trials (RCTs) and any prospective studies of adults with wrist osteoarthritis investigating any intervention with a comparator were included. Data were extracted and checked for accuracy and completeness by pairs of reviewers. Primary outcomes were pain and function. Comparative treatment effects were analysed by random effects at all time points. Results: Three RCTs were identified for inclusion after screening and all had a high risk of bias. Two compared proximal row carpectomy (PRC) with four corner fusion (4CF) for post-traumatic osteoarthritis, while the other compared leather with commercial wrist splints in patients with chronic wrist pain, of which a small group had wrist osteoarthritis. Conclusion: There is no prospective study comparing operative to non-operative treatment for wrist osteoarthritis, while there is a paucity of prospective studies assessing the effectiveness of both non-operative and operative interventions. Further research is necessary in order to better define which patients benefit from which specific interventions. Registration: The review protocol was registered with PROSPERO under the registration number CRD42018094799.
The iHAND score had moderate ability to predict which patients required assessment overnight, while MEWS score and current gestalt approach correlated poorly, suggesting the iHAND score may help prioritisation of patients likely to be seen overnight for handover.
Mindfulness broadly describes an open and receptive awareness of current experience that involves the self-regulation of attention, keeping it focussed on the present moment in order to develop greater awareness and recognition of mental events. Research has shown that dispositional mindfulness is positively associated with measures of psychological well-being, including workrelated measures such as job satisfaction, work engagement, and work-family balance. Furthermore, mindfulness-based interventions (MBIs) delivered to employees have been found to decrease perceived stress, burnout, and depression, and to improve life satisfaction, mood, and sleep quality.The current project extends that body of research by investigating the effects of mindfulness on a range of workplace outcomes that have previously received little empirical investigation, including co-worker relationship quality, innovative behaviours, resistance to change, and engagement and thriving at work. The current research also proposed and investigated a number of mechanisms to explain the effects of mindfulness on these workplace outcomes. Specifically, the proposal drew on previous research suggesting that mindfulness leads to more adaptive functioning and greater selfregulation by increasing cognitive flexibility, positive reappraisal, and positive affect.An initial cross-sectional study of 184 office workers found that dispositional mindfulness was associated with all five workplace outcomes, and that the association with each was fully mediated by one or more of the three proposed mechanisms. Specifically, mindfulness was associated with co-worker relationship quality and thriving at work via positive reappraisal and positive affect, whereas it was associated with innovative behaviours and less resistance to change via cognitive flexibility alone. On the other hand, cognitive flexibility, positive reappraisal, and positive affect all mediated the association between mindfulness and work engagement.A follow-up study found that a 4-week workplace MBI delivered to 131 employees, including office workers, school teachers, cleaners, and senior executives, improved self-reports of mindfulness, positive reappraisal, and negative affect. An additional novel finding was that the MBI reduced dispositional resistance to change. The study also found an unexpected decrease in innovative behaviours following the intervention, but this result may have been an artefact of the measure that was used. No significant pre-post changes were found in the other measures.The current project also investigated the mechanisms of change during the workplace MBI by looking at the correlations between changes in different measures, and by analysing weekly changes during the intervention. Results indicated that decreases in resistance to change correlated with increases in mindfulness, suggesting that mindfulness may have mediated that improvement.iii In contrast, improvements in reappraisal and reductions in negative affect and innovative behaviours were not correla...
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