Disclosure of researcher allegiance in meta-analyses and randomised controlled trials of psychotherapy: a systematic appraisal

Psychotherapy research may suffer from factors such as a researchers own therapy allegiance. The aim of this study was to evaluate if researcher allegiance (RA) was reported in meta-analyses and randomised controlled trials (RCTs) of psychotherapeutic treatments.Systematic approach using meta-analyses of different types of psychotherapies.Medline, PsycINFO and Cochrane Database of Systematic Reviews.We evaluated meta-analyses of RCTs regarding various types of psychotherapies. Meta-analyses were eligible if they included at least one RCT with RA and they were published in journals in Medline, PsycINFO and Cochrane Database of Systematic Reviews with an impact factor larger than 5.We identified 146 eligible meta-analyses that synthesised data from a total of 1198 unique RCTs. Only 25 of the meta-analyses (17.2%) reported allegiance and only 6 (4.1%) used a proper method to control its effect. Of the 1198 eligible primary RCTs, 793 (66.3%) were allegiant. Authors in 25 of these 793 RCTs (3.2%) reported their allegiance while only one study (0.2%) controlled for its effect.The vast majority among a group of published meta-analyses and RCTs of psychotherapeutic treatments seldom reported and evaluated the allegiance effect. The results of the present study highlight a major lack of this information in meta-analyses and their included studies, though meta-analyses perform slightly better than RCTs. Stringent guidelines should be adopted by journals in order to improve reporting and attenuate possible effects of RA in future research

Self-rated health, work characteristics and health related behaviours among nurses in Greece: a cross sectional study

BACKGROUND: Previous studies on self-rated health among nurses have indicated an association of low job satisfaction and stress in relation to poor self-rated health. The relationship between self rated health and the specific work characteristics and health related behaviours of nurses to our knowledge have not been adequately studied. OBJECTIVE: To investigate the health profile of nurses working in hospitals in North West Greece and to examine the associations between self rated health (SRH) and health related behaviours and work characteristics in this group of hospital employees. METHODS: A self-administered questionnaire was distributed to a random sample of 443 nurses working in all the hospitals in North West Greece. Regression analysis was used to examine the relationship of health related behaviours and work characteristics with self rated health among the nurses. RESULTS: A total of 353 responded to the questionnaire (response rate 80%) of which 311 (88%) were female and 42 (12%) male. The mean age (standard deviation) of the respondents was 36 years (5.6) and their mean years of working as nurses were 13.5 years (5.9). Almost half of the nurses' smoked, and about one third were overweight or obese. About 58% (206) of the nurses reported having poor health while 42% (147) reported having good health. Self-rated health was independently associated with gender, effort to avoid fatty foods and physical activity, according to multiple logistic regression analysis. CONCLUSION: The population studied presented a relatively poor health profile, and a high proportion of poor SRH. Though female gender and effort to avoid fatty foods were associated with poor SRH, and exercise and white meat consumption with good SRH, specific work characteristics were not associated with SRH

Students' perceptions of the educational environment in a Greek Dental School, as measured by DREEM

Aim: The aim of this study was to estimate the dental students perceptions of their educational environment and to identify any differences related both to their gender and semester of studies. Materials and methods: The translated and validated in Greek Dundee Ready Education Environment Measure (DREEM) questionnaire was distributed to all 2ndto 5th-year students of the Athens Dental School. The questionnaire consisted of 50 statements organised in five subscales (perceptions of learning, teachers, atmosphere, academic self-perceptions and social self-perceptions). Internal validity was checked with Cronbach alpha. Confirmatory factor analysis (CFA) was performed under the same conditions as the original inventory. Mean statement, subscale and overall scores were calculated and given as percentages. Results: The response rate was 64%. Overall Cronbach alpha was 0.93 (excellent). CFA produced five meaningful subscales, not matching the original ones. The overall DREEM mean score was 56%. Gender did not influence the findings. The students’ perceptions of the educational environment with the exception of the academic selfperceptions were more positive in the pre-clinical years. Statistically significant differences were revealed only for the ‘learning’ subscale between the 3rd-and the 4th-year students. Seventy-eight percent of the statements were in the positive side. The lowest scores were related to students’ stress, tiredness and lack of appropriate feedback from the teachers, and the highest were related to accommodation, school friends and perceptions that they feel socially comfortable in class. Conclusions: Students’ perceptions of the educational environment were reasonably positive, with no gender difference. However, some weaknesses were identified, particularly in the clinical years. Further research is needed to clarify appropriate interventions

If you could change one thing in your school, what would this be? 469 suggestions of 429 medical graduates

OBJECTIVE The I CAN! questionnaire is an instrument for measuring the outcomes of medical curricula, based mainly on the Tuning project. The questionnaire is under construction and validation. It consists of 105 closed questions and the open question "if you could change one thing in your school, what would this be?". This paper presents the responses of medical graduates to this open question. METHOD The questionnaire was distributed to the graduates of six medical schools in Greece during the summer and autumn 2009 graduation periods, and to residents and specialist doctors during a primary health care conference in Greece (5.2.2010). The responses to the open question were grouped into categories and subcategories according to their conceptual content, and their frequency was calculated. RESULTS Questionnaires were collected from 408 new graduates of six medical schools (357 and 51 during the summer and autumn graduations, respectively): 45% male, 55% female; from Athens 148 (48% of its graduates), Thrace 38 (81%), Ioannina 12 (17%), Crete 32 (47%), and Thessaly 31 (100%). In addition, 21 questionnaires were collected from residents and specialist doctors. A total of 469 changes were proposed, related mainly to the curriculum (212) and teachers (215), and fewer to other elements of the educational environment (42). The suggestions included: increase in practical exercises (129) and clinical experience (8), introduction of practical subjects (21), exclusion of highly specialized subjects (12), changes in the timetable (6), the way of teaching (108), the method of student assessment (62), and the attitude (31) and selection (14) of the teachers. Only a few suggested changes were related to students' issues (10) and the administration of their school (30). CONCLUSIONS The majority of suggestions of the medical graduates recommended curriculum reform and a student-centered attitude from the teachers. The findings of this study, which are similar to those previously derived from students (80% preclinical) from the same medical schools, support the precept that changes in the medical curricula in Greece are essential, and may provide the impetus for immediate action by the medical faculties. © Athens Medical Society

I CAN! A graduate self-completion questionnaire for evaluating medical curriculum outcomes: How to use it, and preliminary findings on Greek medical education outcomes

Objective Although valid instruments are available for measuring the educational environment during the 6-year period of undergraduate medical study, there was no tool for measuring the end-product of the medical curriculum, i.e. the abilities of the "medical graduate". The I CAN! questionnaire, based on the tuning-medicine project, is an instrument designed to measure this. The construction and validation of the questionnaire Greek, and graduates' answers to the open question "if you could change one thing in your school, what would this be?" have been described elsewhere. The aim of this paper was to present how of the instrument works and the responses of medical graduates to its closed questions. METHOD The I CAN! questionnaire consists of 104 randomly arranged closed questions, based on the tuning-medicine level-two learning outcomes for undergraduate medical education in Europe, organized into 16 level-one outcomes, 12 for medical competencies and 4 for professionalism. The questionnaire was distributed to the graduates of Greek medical schools during the summer and autumn 2009 graduation. Their responses were coded (disagree absolutely=0, disagree=20, disagree moderately=40, agree moderately=60, agree=80, agree absolutely=100). The mean question, level-one outcomes and overall scores were calculated, and interpreted as: <50 very poor, 50-60.9 poor, 61-70.9 fairly poor, 71-78.9 fairly good, 79-88.9 good, 89-100 very good. Results Completed questionnaires were provided by 408 graduates of 6 medical schools, representing 55% of the total graduate population: 45% male, 55% female. They were graduates of the Universities of: Athens 148 (48% of graduates), Thessaloniki 147 (71%), Thrace 38 (81%), Ioannina 12 (17%), Crete 32 (47%), and Thessaly 31 (100%). On average they self-assessed their overall ability at 74% (i.e., in the "moderately good" interpretation zone), their ability to prescribe drugs 65% and to apply evidence-based medicine 68%, being a global doctor 80% and possessing professional atributes 83%. They considered themselves weaker in specific areas: Carrying out blood transfusion (37%), requesting autopsy (52%), administering intravenous therapy and using infusion devices (55%), completing correctly a death certificate (57%), matching appropriate drugs and other treatment to the clinical context (58%), and using diagnostic and therapeutic options available through other health professions (59%). They reported strength in: messuring blood pressure (96%), carrying out electrocardiography (92%), will to succeed (92%), maintaining confidentiality (91%), recognizing their own limits and asking for help (88%). Conclusions The I CAN! self-assessment questionnaire can identify the perceived strengths and weaknesses of medical graduates, offering the basis for implementation of a SWOT analysis (strengths, weaknesses, opportunities, threats) and evidence-based educational policy. Medical schools could use the instrument to monitor progress towards competence of tomorrow's doctors, and to assess effectiveness of policy changes. If all European medical schools were to use it on every graduate cohort, a time series database could be created to serve administrative, research and other purposes. © Athens Medical Society