Leadership Effectiveness in Healthcare Settings: A Systematic Review and Meta-Analysis of Cross-Sectional and Before-After Studies

To work efficiently in healthcare organizations and optimize resources, team members should agree with their leader's decisions critically. However, nowadays, little evidence is available in the literature. This systematic review and meta-analysis has assessed the effectiveness of leadership interventions in improving healthcare outcomes such as performance and guidelines adherence. Overall, the search strategies retrieved 3,155 records, and 21 of them were included in the meta-analysis. Two databases were used for manuscript research: PubMed and Scopus. On 16th December 2019 the researchers searched for articles published in the English language from 2015 to 2019. Considering the study designs, the pooled leadership effectiveness was 14.0% (95%CI 10.0-18.0%) in before-after studies, whereas the correlation coefficient between leadership interventions and healthcare outcomes was 0.22 (95%CI 0.15-0.28) in the cross-sectional studies. The multi-regression analysis in the cross-sectional studies showed a higher leadership effectiveness in South America (beta = 0.56; 95%CI 0.13, 0.99), in private hospitals (beta = 0.60; 95%CI 0.14, 1.06), and in medical specialty (beta = 0.28; 95%CI 0.02, 0.54). These results encourage the improvement of leadership culture to increase performance and guideline adherence in healthcare settings. To reach this purpose, it would be useful to introduce a leadership curriculum following undergraduate medical courses

A systematic review of how studies describe educational interventions for evidence-based practice:Stage 1 of the development of a reporting guideline

Abstract Background The aim of this systematic review was to identify which information is included when reporting educational interventions used to facilitate foundational skills and knowledge of evidence-based practice (EBP) training for health professionals. This systematic review comprised the first stage in the three stage development process for a reporting guideline for educational interventions for EBP. Methods The review question was ‘What information has been reported when describing educational interventions targeting foundational evidence-based practice knowledge and skills?’ MEDLINE, Academic Search Premier, ERIC, CINAHL, Scopus, Embase, Informit health, Cochrane Library and Web of Science databases were searched from inception until October - December 2011. Randomised and non-randomised controlled trials reporting original data on educational interventions specific to developing foundational knowledge and skills of evidence-based practice were included. Studies were not appraised for methodological bias, however, reporting frequency and item commonality were compared between a random selection of studies included in the systematic review and a random selection of studies excluded as they were not controlled trials. Twenty-five data items were extracted by two independent reviewers (consistency > 90%). Results Sixty-one studies met the inclusion criteria (n = 29 randomised, n = 32 non-randomised). The most consistently reported items were the learner’s stage of training, professional discipline and the evaluation methods used (100%). The least consistently reported items were the instructor(s) previous teaching experience (n = 8, 13%), and student effort outside face to face contact (n = 1, 2%). Conclusion This systematic review demonstrates inconsistencies in describing educational interventions for EBP in randomised and non-randomised trials. To enable educational interventions to be replicable and comparable, improvements in the reporting for educational interventions for EBP are required. In the absence of a specific reporting guideline, there are a range of items which are reported with variable frequency. Identifying the important items for describing educational interventions for facilitating foundational knowledge and skills in EBP remains to be determined. The findings of this systematic review will be used to inform the next stage in the development of a reporting guideline for educational interventions for EBP

Triage Process in Emergency Departments: an Indonesian Study

Background: Triage process has rapidly developed in some countries in the last three decades in order to respond to the demand for emergency services by growing population and emergency health needs. However, this development does not appear to match in Indonesian hospitals. The triage process in Indonesia remains obscure.Purpose: This study aimed to describe triage process in Indonesia from a range of different perspectives.Methods: The research design of this study was descriptive qualitative using semistructured interviews of 12 policy makers or persons responsible from 5 different organizations which informed triage practice in Indonesia. The data were analyzed using a three step content analysis.Results: The result produced 3 themes. First, four steps of triage process ranging from receiving to prioritizing were reported as the triaging procedures in Indonesia which were almost similar to the International literature except for a re-triage step. Second,primary and secondary triage processes were also applied in all emergency departments in Indonesia. Last, no prolonged waiting time in Indonesia could be assumed whether the triage process was effective and efficient or it was only a quick process of sorting to rapidly increase the number of patients in the treatment rooms. Out of the themes, the result also indicated that the involvement of nurses in health policy development inIndonesia needed supportConclusion: Triage process in Indonesia still needs improvements. Patient\u27s re-triage and evaluating secondary triage should be given more frameworks in the future. An effective and efficient triage process in Indonesia will best manage the number of patients in the treatment rooms and therefore further observational researches on patterns and trends are needed. Moreover, including the role of nurses as policy makers in the curriculum of nursing undergraduate and post-graduate degrees would give nurses the evidence to seek out policy making positions in the futur

Educating the educators: Incorporating bioinformatics into biological science education in Malaysia

Bioinformatics can be defined as a fusion of computational and biological sciences. The urgency to process and analyse the deluge of data created by proteomics and genomics studies has caused bioinformatics to gain prominence and importance. However, its multidisciplinary nature has created a unique demand for specialist trained in both biology and computing. In this review, we described the components that constitute the bioinformatics field and distinctive education criteria that are required to produce individuals with bioinformatics training. This paper will also provide an introduction and overview of bioinformatics in Malaysia. The existing bioinformatics scenario in Malaysia was surveyed to gauge its advancement and to plan for future bioinformatics education strategies. For comparison, we surveyed methods and strategies used in education by other countries so that lessons can be learnt to further improve the implementation of bioinformatics in Malaysia. It is believed that accurate and sufficient steerage from the academia and industry will enable Malaysia to produce quality bioinformaticians in the future

Comparison of the Knowledge in Core Policies of Essential Drug List Among Medical Practitioners and Medical Students in Galle, Sri Lanka

Selection of the best and safest medicine should be one of the national economic policies in a country for good health care services. Introduction of detailed module in rational use of medicine (RUM) to pharmacology syllabus needed prior analysis of the existing knowledge among health care workers. Therefore we assessed the knowledge and attitudes of essential drug list (EDL) on medical practitioners (MPs) and medical students (MSs). Forty two MPs and 120 MSs from hospital and Faculty of Medicine were given a pretested structured questionnaire related to core policies of EDL, contents, criteria for selection and time frame for revision in RUM. Our study showed that only 29% of MPs were confident about their knowledge in EDL and 17% of them had marked it as don’t know. Study was expanded for quantitative analysis of the knowledge on the core policies of EDL on them. Knowledge on contents, criteria for selection and the time frame for revision of EDL were 63%, 83% and 17% in MPs. Of MSs, 87% had sound knowledge in core contents, 32% in criteria for selection and only 50% of MSs were aware about the correct time frame of revision of EDL. Knowledge in contents of EDL was higher in MSs (87%) than MPs(63&). MPs were not aware about EDL preparing criteria such as inclusion of generic names, common ailment, majority ailments of the people (59%, 56% and 56% respectively). In contrast, MSs had > 93% of the knowledge in all three areas. However MSs had poorer knowledge (32%) in criteria for selection of EDL than MPs (83%). Knowledge in time frame for revision of EDL was 17% in MPs and 50% in MSs. We found that MPs in the service were not convinced about their knowledge in EDL. Deficiency was significant in the core contents of the EDL preparation. Therefore we suggest that MPs need repetitive in-service training programme for practicing of RUM in the national health facilities. We need to reiterative programme in the core curriculum regarding the criteria for EDL selection. Though MSs had good knowledge in content of EDL, they are poor in criteria for selection and time frame for revision

Undergraduate medical textbooks do not provide adequate information on intravenous fluid therapy: a systematic survey and suggestions for improvement

<b>Background</b><p></p> Inappropriate prescribing of intravenous (IV) fluid, particularly 0.9% sodium chloride, causes post-operative complications. Fluid prescription is often left to junior medical staff and is frequently poorly managed. One reason for poor intravenous fluid prescribing practices could be inadequate coverage of this topic in the textbooks that are used.<p></p> <b>Methods</b><p></p> We formulated a comprehensive set of topics, related to important common clinical situations involving IV fluid therapy, (routine fluid replacement, fluid loss, fluids overload) to assess the adequacy of textbooks in common use. We assessed 29 medical textbooks widely available to students in the UK, scoring the presence of information provided by each book on each of the topics. The scores indicated how fully the topics were considered: not at all, partly, and adequately. No attempt was made to judge the quality of the information, because there is no consensus on these topics.<p></p> <b>Results</b><p></p> The maximum score that a book could achieve was 52. Three of the topics we chose were not considered by any of the books. Discounting these topics as “too esoteric”, the maximum possible score became 46. One textbook gained a score of 45, but the general score was poor (median 11, quartiles 4, 21). In particular, coverage of routine postoperative management was inadequate.<p></p> <b>Conclusions</b><p></p> Textbooks for undergraduates cover the topic of intravenous therapy badly, which may partly explain the poor knowledge and performance of junior doctors in this important field. Systematic revision of current textbooks might improve knowledge and practice by junior doctors. Careful definition of the remit and content of textbooks should be applied more widely to ensure quality and “fitness for purpose”, and avoid omission of vital knowledge