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This article explores the repercussions of workplace bullying on nurses and the health-care profession as a whole. I discuss the nature of workplace bullying and draw upon prior studies to explore some of the barriers that prevent witnesses to bullying from intervening, as well as barriers faced by targets in taking action to stop the bullying. As overt forms of resistance are often not feasible in situations where nurses occupy subordinate positions to their bullies, I propose that cognitive reappraisal can be an effective coping strategy, and situate this perspective within the research on humour, hope and optimism.
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Adaptação Psicológica , Bullying , Cognição , Senso de Humor e Humor como Assunto , Humanos , Local de TrabalhoRESUMO
Duration of overall survival in patients with cancer has lengthened due to earlier detection and improved treatments. However, these improvements have created challenges in assessing the impact of newer treatments, particularly those used early in the treatment pathway. As overall survival remains most decision-makers' preferred primary endpoint, therapeutic innovations may take a long time to be introduced into clinical practice. Moreover, it is difficult to extrapolate findings to heterogeneous populations and address the concerns of patients wishing to evaluate everyday quality and extension of life. There is growing interest in the use of surrogate or interim endpoints to demonstrate robust treatment effects sooner than is possible with measurement of overall survival. It is hoped that they could speed up patients' access to new drugs, combinations, and sequences, and inform treatment decision-making. However, while surrogate endpoints have been used by regulators for drug approvals, this has occurred on a case-by-case basis. Evidence standards are yet to be clearly defined for acceptability in health technology appraisals or to shape clinical practice. This article considers the relevance of the use of surrogate endpoints in cancer in the UK context, and explores whether collection and analysis of real-world UK data and evidence might contribute to validation.
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INTRODUCTION: Adolescent depression screening is recommended starting at age 12 years, but younger children experience depression as well. Our objective was to determine whether screening for depression at age 11 years yields similar results to screening at age 12 years. METHODS: We conducted a retrospective chart review of 1000 11- and 12-year-olds in multiple pediatric offices of a large-group practice associated with a health maintenance organization in Southern California. All offices used a multistage depression screening process during well-child visits using the Patient Health Questionnaire for Adolescents, the global depression inquiry within a parent questionnaire, a chart-based review of mental health history, and brief patient/parent interview informed by the first 3 elements. RESULTS: The 11- and 12-year-old cohorts had similar completion rates for the Patient Health Questionnaire for Adolescents (99.2% vs 97.8%, P = 0.06), with similar mean total Patient Health Questionnaire for Adolescents scores (2.12 vs 2.22, P = 0.48). There was no significant difference for positive screenings determined by the pediatrician (12.0% vs 16.0%, P = 0.07), but parents of 12-year-olds were more likely have concerns for their child's mood (6.8% vs 10.5%, P = 0.04). There were similar percentages of referrals (6.2% vs 8.8%, P = 0.12), beneficial conversations related to depression and anxiety, (4.5% vs 4.8%, P = 0.85), and new mental health diagnoses (2.0% vs 2.3%, P = 0.79). DISCUSSION: The process, results, and outcomes of screenings are similar for 11- and 12-year-olds, with a tendency toward more positive findings in 12-year-olds. CONCLUSION: Multistage depression screening in 11-year-olds can be applied successfully in clinical practice, with most cases identifying youths without a prior mental health diagnosis.
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Ansiedade , Depressão , Adolescente , Criança , Depressão/diagnóstico , Depressão/epidemiologia , Humanos , Programas de Rastreamento , Saúde Mental , Estudos Retrospectivos , Inquéritos e QuestionáriosRESUMO
Aim: Estimate the 3-year budget impact in England from 2016/17 of improving nonvalvular atrial fibrillation management in high-risk stroke patients. Materials & methods: The Academic Health Science Network's AF Business Case Model was used to identify detection, protection (risk assessment and treatment initiation) and perfection (optimized treatment) gaps and to project the budget impact of closing these. Results: Closing all gaps over 3 years could prevent 27,550 strokes. Overall, perfection gap savings were £136,650,962 and protection gap savings were £58,146,171. Detection by screening in year one could cost £149,048,676, but with stroke-prevention savings would be £47,081,047 at 3 years. Thus, total potential savings were £194,797,133 and the cost-adjusted budget impact was £147,716,086. Conclusion: The detection and perfection gaps are key areas for investment.
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Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Orçamentos , Redução de Custos , Acidente Vascular Cerebral/prevenção & controle , Fibrilação Atrial/economia , Inglaterra , Humanos , Programas de Rastreamento , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/economiaRESUMO
OBJECTIVE: The "Bow-tie" optimal pathway discovery analysis uses large clinical event datasets to map clinical pathways and to visualize risks (improvement opportunities) before, and outcomes after, a specific clinical event. This proof-of-concept study assesses the use of NHS Hospital Episode Statistics (HES) in England as a potential clinical event dataset for this pathway discovery analysis approach. MATERIALS AND METHODS: A metaheuristic optimization algorithm was used to perform the "bow-tie" analysis on HES event log data for sepsis (ICD-10 A40/A41) in 2016. Analysis of hospital episodes across inpatient and outpatient departments was performed for the period 730 days before and 365 days after the index sepsis hospitalization event. RESULTS: HES data captured a sepsis event for 76 523 individuals (>13 years), relating to 580 000 coded events (across 220 sepsis and non-sepsis event classes). The "bow-tie" analysis identified several diagnoses that most frequently preceded hospitalization for sepsis, in line with the expectation that sepsis most frequently occurs in vulnerable populations. A diagnosis of pneumonia (5 290 patients) and urinary tract infections (UTIs; 2 057 patients) most often preceded the sepsis event, with recurrent UTIs acting as a potential indicative risk factor for sepsis. DISCUSSION: This proof-of-concept study demonstrates that a "bow-tie" pathway discovery analysis of the HES database can be undertaken and provides clinical insights that, with further study, could help improve the identification and management of sepsis. The algorithm can now be more widely applied to HES data to undertake targeted clinical pathway analysis across multiple healthcare conditions.
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There are 3 main theories used to explain the functions of humor: (1) the relief theory, (2) the incongruity theory, and (3) the superiority theory. While these theories focus on the specific role that humor plays for people in situations such as dealing with misfortune, making sense of rule violations, and bonding with others, we propose that underlying each of these theories are the physiological benefits of laughter. We draw on findings from empirical studies on laughter to demonstrate that these physiological benefits occur regardless of the theory that is used to explain the humor function. Findings from these studies have important implications for nurse practitioners working in hospice settings, long-term care facilities, nursing homes, and hospitals.
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Terapia do Riso , Riso/fisiologia , Estresse Psicológico/terapia , Senso de Humor e Humor como Assunto , HumanosRESUMO
BACKGROUND: The National Health Service (NHS) is faced with increasing cost pressures that make the efficient use of resources paramount. Irritable bowel syndrome (IBS) places a large burden on the NHS as it has been estimated that at least 12% of the UK population is affected. However, poor clinical coding makes accurate assessment of this burden challenging. OBJECTIVE: To calculate primary-care prescribing and both hospital outpatient and admission costs associated with the management of IBS in England. DESIGN AND MAIN OUTCOME MEASURES: Hospital Episode Statistics data for 2012-2013 for all clinical commissioning groups in England were analysed to calculate the tariff cost of IBS. Prescribing analysis and cost tabulation (PACT) data for this period were also analysed. RESULTS: In 2012-2013, there were 1â 219â 961 outpatient attendances in gastroenterology and colorectal surgery specialties. Despite this, only 1982 patients were recorded with IBS-specific codes, with a total estimated tariff cost of £812â 336. In addition, 28â 849 patients were recorded with IBS-related symptom codes at a cost of £11â 002â 874. In 2011-2012, there were 658â 698 diagnostic lower gastrointestinal endoscopies at a tariff cost of £16â 967â 670 4. Of these, 323â 752 (49%) had no further follow-up in secondary care over the subsequent 12â months. PACT data indicated that £44â 977â 959 and £25â 582â 752, respectively, were spent on selected laxatives and antispasmodics commonly used to treat IBS in primary care. CONCLUSIONS: Better diagnosing, through improved clinical coding and standardisation of diagnostic criteria, is required to more accurately assess the true burden and allow optimal management of IBS.
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The Royal Flying Doctor Service (RFDS) of Australia was founded in 1928 by the Reverend John Flynn to deliver health services to the people of the Australian Outback. In this unique environment the RFDS Queensland Section provides both Primary Health Care and Aeromedical services to rural and remote communities throughout Queensland. It provides health services from a hub and spoke model and its clinicians work very closely with other health service providers, such as Queensland Heath, within the communities it visits. Currently, the RFDS' health records are both paper and electronic and clinicians duplicate much of patient information and data between RFDS and non-RFDS health records. Introduction of an off-the-shelf electronic medical record (EMR) would not meet the RFDS' clinical and organisational needs because of complexity, the multidisciplinary nature of the teams and the lack of communication technology in the communities the RFDS visits. This article defines the vision for a health information system designed to meet the requirements of the RFDS, and describes its implementation throughout RFDS Queensland using the PRINCE2 project management methodology.
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There are 3 main theories used to explain the functions of humor: (1) the relief theory, (2) the incongruity theory, and (3) the superiority theory. Though these theories focus on the specific role that humor plays for people in situations such as dealing with misfortune, making sense of rule violations, and bonding with others, we propose that underlying each of these theories are the physiological benefits of laughter. We draw on findings from empirical studies on laughter to demonstrate that these physiological benefits occur regardless of the theory that is used to explain the humor function.