The effect of job demand-control-social support model on nurses’ job satisfaction in specialized teaching hospitals, Ethiopia

Background: The job demand-control- social support model has been widely studied in western countries but has not been theoretically addressed on health workers of sub-Saharan African countries. Therefore, this study investigates the relationship between Job Demand-Control-Support Model and job satisfaction in specialized teaching hospitals in Ethiopia.Method: A cross-sectional survey was conducted from September 2014 to May 2015 in three public specialized teaching hospitals in Ethiopia. Among 1371 nurses, 360 were selected as sample. Data was collected using Job Content Questionnaire and Job Satisfaction Survey Questionnaire. After the data was collected, it was analyzed using SPSS version16.0 statistical software. The results were analyzed using of descriptive statistics followed by inferential statistics on the variables.Results: The result revealed that control variables (gender, age, educational qualification, and work experience) accounted for a significant increment explaining 2.1 percent of the variance in job satisfaction. Job demand and social support together explained 24.5 percent of job satisfaction. Job demand(β=-0.152; p<0.01) had significant but negative relationship with job satisfaction and social support (β=0.458; p<0.01) had significant and positive relationship with job satisfaction. On the other hand, job control (β=0.042; p>0.05) did not have a significant relationship with job satisfaction. Furthermore, there was no straight three- way interaction effect among job demand, job control and social support (β=0.05, p>0.05).Conclusion: Job demand and social support are related to nurses’ job satisfaction, but job control neither related to nor moderated the relationship between job demands and job satisfaction. Furthermore, there was no joint three-way interaction effect among job demand, job control and social support.Key words: Job Demand, Job Control, Social Support, Nurses, Public, Hospital, Ethiopi

Recruitment to randomised controlled trials with children

Recruitment to randomised controlled trials is known to be difficult. Poor recruitment has several adverse consequences. It affects the validity of study findings, is a common cause of trial extensions and may result in premature termination of trials, which is a huge loss in terms of invested funds, resources and lost knowledge. Non-completion or delayed completion of studies maintains the uncertainty about the efficacy and safety of interventions, thereby delaying or preventing the use of effective interventions and prolonging the use of ineffective or potentially harmful treatments. Recruitment of children to randomised controlled trials is thought to be more challenging due to the vulnerability of the population and the fact that consent is provided by another person usually parents. This thesis aims to review the recruitment performance, i.e. comparison of achieved to anticipated recruitment, of randomised controlled trials with children and identify the factors associated with good or poor recruitment. We undertook a pilot systematic review of recruitment and retention in randomised controlled trials with children, in published literature, and found that few studies report recruitment information but those that do, report very high rates of percentage total recruitment achieved (%TR) and consent. It was not possible to obtain unbiased estimates of recruitment performance and consent rate due to the likelihood of selective reporting and/or non-publication of trials with unsuccessful recruitment. We subsequently conducted a review of recruitment of children to randomised controlled trials in the National Institute of Health Research (NIHR) Clinical Research Network (CRN) portfolio and found that under-recruitment and delayed recruitment are common problems in paediatric trials. Having a trial manager or coordinator was found to be significantly associated with successful recruitment. Other factors such as being an IMP (Investigational Medicinal Product) vs. non-IMP trial, trial of acute vs. chronic illness, having CTU (Clinical Trials Unit) involvement, pilot/feasibility study and additional trial demands had no statistically significant association with recruitment success. Since recruitment to a clinical trial can be affected by a number of internal and external factors, we conducted a survey with the clinical teams of a multi-centre randomised controlled trial with children, the MAGNETIC trial, to understand the various facilitators and barriers to recruitment. In order to identify the facilitators and barriers to recruitment and establish the recruitment experience of clinical teams in a systematic manner, we developed an evidence based recruitment survey tool. The survey tool is an online questionnaire that presents a comprehensive evidence based list of facilitators and barriers and free text space for responders to record the strategies applied to overcome these barriers and suggestions for change in organisation of trials to boost recruitment. The survey of clinical teams recruiting to the MAGNETIC trial found that a motivated clinical team with effective communication skills, effective coordination between study team members at site and between sites and CTU, trial management support, research experience of PI, presence of a research nurse and availability of a designated research team were imperative for trial recruitment success. Heavy clinical workload, shift patterns of work, lack of trained staff particularly out of hours, GCP training, local clinical arrangements and parental anxiety about the safety of experimental treatment were recognised as important barriers to recruitment. A trial specific barrier was difficulty faced by the clinicians in seeking consent from the parents of an acutely ill child in the emergency setting and suggestions were made for consideration of deferred consent. We concluded that recruitment to randomised controlled trials with children is challenging and poor recruitment and recruitment delays are a common problem. Reporting of recruitment and consent in paediatric trials is poor and needs improvement. Presence of a dedicated trial manager is significantly associated with successful recruitment and the various generic and trial specific facilitators and barriers to recruitment that have been identified can be used by trialists in planning and conducting future clinical trials with children

Inflammatory fibroid polyp (Vanek's tumour), an unusual large polyp of the jejunum: a case report

We report the case of a 46-year-old man who presented with recurrent episodes of severe upper abdominal pain over a period of three months. A computerized tomography scan of his abdomen demonstrated a large non-obstructing jejunal mass. He underwent laparotomy and resection of a 13.5 cm tumour from the distal jejunum. Histopathological examination confirmed a large inflammatory fibroid polyp of the jejunum. The clinical presentation and microscopic features are discussed

A survey of facilitators and barriers to recruitment to the MAGNETIC trial

Background Recruitment to randomised controlled trials with children is challenging. It is imperative to understand the factors that boost or hinder recruitment of children to clinical trials. We conducted a survey of facilitators and barriers to recruitment to the MAGNETIC trial, using a previously developed web-based tool. Methods MAGNETIC is a multicentre randomised trial of nebulised magnesium in acute severe asthma, recruiting 508 children from 30 UK sites. Recruiters were asked to grade a list of factors from –3 to +3 depending on whether the factor was perceived as a strong, intermediate or weak barrier (–3 to –1) or facilitator (+1 to + 3), and using (0) if it was thought to be not applicable. Free text responses were invited on strategies applied to counter the identified barriers. Results The commonly identified facilitators were motivation and experience of study teams, effective communication and coordination between teams at site and between sites and the Clinical Trials Unit, the presence of designated research nurses, good trial management, clinical trial publicity, simple inclusion criteria, effective communication with parents and presentation of trial information in a simple and clear manner. The commonly identified barriers were heavy clinical workload, shift patterns of work, Good Clinical Practice (GCP) training, inadequate number of trained staff, time and setting of consent seeking, non-availability of research staff out of hours and parents' concerns about their child taking an experimental medicine. Having a designated research nurse, arranging GCP training and trial-related training sessions for staff were the most commonly reported interventions. Conclusions This study highlights important generic and trial-specific facilitators and barriers to recruitment to a paediatric trial in the acute setting and provides information on the recruitment strategies or interventions that were applied to overcome these barriers. This information can be very useful in informing the design and conduct of future clinical trials with children, particularly in the acute or emergency setting

Patient-reported outcome measures used in patients with primary sclerosing cholangitis: a systematic review

Abstract Background Primary Sclerosing Cholangitis (PSC) is a rare chronic, cholestatic liver condition in which patients can experience a range of debilitating symptoms. Patient reported outcome measures (PROMs) could provide a valuable insight into the impact of PSC on patient quality of life and symptoms. A previous review has been conducted on the quality of life instruments used in liver transplant recipients. However, there has been no comprehensive review evaluating PROM use or measurement properties in PSC patients’ to-date. The aim of the systematic review was to: (a) To identify and categorise which PROMs are currently being used in research involving the PSC population (b) To investigate the measurement properties of PROMs used in PSC. Methods A systematic review of Medline, EMBASE and CINAHL, from inception to February 2018, was undertaken. The methodological quality of included studies was assessed using the Consensus-based Standards for selection of health Measurement Instruments (COSMIN) checklist. Results Thirty-seven studies were identified, which included 36 different PROMs. Seven PROMs were generic, 10 disease-specific, 17 symptom-specific measures and 2 measures on dietary intake. The most common PROMs were the Short form-36 (SF-36) (n = 15) and Chronic liver disease questionnaire (CLDQ) (n = 6). Only three studies evaluated measurement properties, two studies evaluated the National Institute of Diabetes Digestive and Kidney Diseases Liver Transplant (NIDDK-QA) and one study evaluated the PSC PRO; however, according to the COSMIN guidelines, methodological quality was poor for the NIDDK-QA studies and fair for the PSC PRO study. Conclusion A wide variety of PROMs have been used to assess health-related quality of life and symptom burden in patients with PSC; however only two measures (NIDDK-QA and PSC PRO) have been formally validated in this population. The newly developed PSC PRO requires further validation in PSC patients with diverse demographics, comorbidities and at different stages of disease; however this is a promising new measure with which to assess the impact of PSC on patient quality of life and symptoms

Recruitment to randomised controlled trials with children

Recruitment to randomised controlled trials is known to be difficult. Poor recruitment has several adverse consequences. It affects the validity of study findings, is a common cause of trial extensions and may result in premature termination of trials, which is a huge loss in terms of invested funds, resources and lost knowledge. Non-completion or delayed completion of studies maintains the uncertainty about the efficacy and safety of interventions, thereby delaying or preventing the use of effective interventions and prolonging the use of ineffective or potentially harmful treatments. Recruitment of children to randomised controlled trials is thought to be more challenging due to the vulnerability of the population and the fact that consent is provided by another person usually parents. This thesis aims to review the recruitment performance, i.e. comparison of achieved to anticipated recruitment, of randomised controlled trials with children and identify the factors associated with good or poor recruitment. We undertook a pilot systematic review of recruitment and retention in randomised controlled trials with children, in published literature, and found that few studies report recruitment information but those that do, report very high rates of percentage total recruitment achieved (%TR) and consent. It was not possible to obtain unbiased estimates of recruitment performance and consent rate due to the likelihood of selective reporting and/or non-publication of trials with unsuccessful recruitment. We subsequently conducted a review of recruitment of children to randomised controlled trials in the National Institute of Health Research (NIHR) Clinical Research Network (CRN) portfolio and found that under-recruitment and delayed recruitment are common problems in paediatric trials. Having a trial manager or coordinator was found to be significantly associated with successful recruitment. Other factors such as being an IMP (Investigational Medicinal Product) vs. non-IMP trial, trial of acute vs. chronic illness, having CTU (Clinical Trials Unit) involvement, pilot/feasibility study and additional trial demands had no statistically significant association with recruitment success. Since recruitment to a clinical trial can be affected by a number of internal and external factors, we conducted a survey with the clinical teams of a multi-centre randomised controlled trial with children, the MAGNETIC trial, to understand the various facilitators and barriers to recruitment. In order to identify the facilitators and barriers to recruitment and establish the recruitment experience of clinical teams in a systematic manner, we developed an evidence based recruitment survey tool. The survey tool is an online questionnaire that presents a comprehensive evidence based list of facilitators and barriers and free text space for responders to record the strategies applied to overcome these barriers and suggestions for change in organisation of trials to boost recruitment. The survey of clinical teams recruiting to the MAGNETIC trial found that a motivated clinical team with effective communication skills, effective coordination between study team members at site and between sites and CTU, trial management support, research experience of PI, presence of a research nurse and availability of a designated research team were imperative for trial recruitment success. Heavy clinical workload, shift patterns of work, lack of trained staff particularly out of hours, GCP training, local clinical arrangements and parental anxiety about the safety of experimental treatment were recognised as important barriers to recruitment. A trial specific barrier was difficulty faced by the clinicians in seeking consent from the parents of an acutely ill child in the emergency setting and suggestions were made for consideration of deferred consent. We concluded that recruitment to randomised controlled trials with children is challenging and poor recruitment and recruitment delays are a common problem. Reporting of recruitment and consent in paediatric trials is poor and needs improvement. Presence of a dedicated trial manager is significantly associated with successful recruitment and the various generic and trial specific facilitators and barriers to recruitment that have been identified can be used by trialists in planning and conducting future clinical trials with children

A new method of assessing anal sphincter integrity using inverted vectormanometry

PURPOSE: Vectorgraphy as an integrated mapping of radial pressure profiles of the anal canal has been used to attempt identification of pressure-related defects with doubtful reliability since vectorgraphs bear no resemblance to endoanal ultrasound scans at similar levels in the anal canal. This study aimed to devise a technique to enable vectorgraphy to be more representative of sphincter function and integrity. METHODS: Vectormanometry was performed in 50 patients with anorectal disorders using an Arndorfer pneumohydraulic system. "Normal" three-dimensional manometric images of each 0.5 cm of the anal sphincter were computer-generated by plotting anal pi sures at rest and during squeeze radially around a central zero axis. The graphs were replotted with zero at the periphery and maximal anal pressure at the center. Both this ("inverted") and "normal" vectorgraphs were compared with endoanal ultrasound images at similar levels, assessing both internal and external anal sphincters. RESULTS: Standard vectormanometry produced excellent pictures of pressures throughout the anal canal; the anatomy however bore no resemblance to the pictures produced by endoanal ultrasound. The inverted vectographs showed a much better correlation with endoanal ultrasound at each 0.5-mm level of the anal canal, for both squeeze pressure graphs and external sphincter correlations and for resting pressure graphs and internal sphincter correlations. CONCLUSIONS: Accurate assessment of sphincter integrity is not possible when interpreting the vectormanometry graphs in the current format; however, inverted vectorgraphy gives good correlations with endoanal ultrasound and provides combined functional (pressure measurement) and anatomic (three-dimensional profile) information regarding the anal canal