Development of burnout over time and the causal order of the three dimensions of burnout among male and female GPs. A three-wave panel study

<p>Abstract</p> <p>Background</p> <p>A good understanding of the aetiology and development of burnout facilitates its early recognition, prevention and treatment. Since the prevalence and onset of this health problem is thought to differ between men and women, sex must be taken into account. This study aims to assess the prevalence and development of burnout among General Practitioners (GPs). In this population the prevalence of burnout is high.</p> <p>Methods</p> <p>We performed a three-wave longitudinal study (2002, 2004, 2006) in a random sample of Dutch GPs. Data were collected by means of self-report questionnaires including the Maslach Burnout Inventory. Our final sample consisted of 212 GPs of which 128 were male. Data were analyzed by means of SPSS and LISREL.</p> <p>Results</p> <p>Results indicate that about 20% of the GPs is clinically burned out (but still working). For both sexes, burnout decreased after the first wave, but increased again after the second wave. The prevalence of depersonalization is higher among men. With regard to the process of burnout we found that for men burnout is triggered by depersonalization and by emotional exhaustion for women.</p> <p>Conclusions</p> <p>As regards the developmental process of burnout, we found evidence for the fact that the aetiological process of burnout, that is the causal order of the three burnout dimensions, differs between men and women. These sex differences should be taken into account in vocational training and policy development, especially since general practice is feminizing rapidly.</p

Review of methods used by chiropractors to determine the site for applying manipulation

Background: With the development of increasing evidence for the use of manipulation in the management of musculoskeletal conditions, there is growing interest in identifying the appropriate indications for care. Recently, attempts have been made to develop clinical prediction rules, however the validity of these clinical prediction rules remains unclear and their impact on care delivery has yet to be established. The current study was designed to evaluate the literature on the validity and reliability of the more common methods used by doctors of chiropractic to inform the choice of the site at which to apply spinal manipulation. Methods: Structured searches were conducted in Medline, PubMed, CINAHL and ICL, supported by hand searches of archives, to identify studies of the diagnostic reliability and validity of common methods used to identify the site of treatment application. To be included, studies were to present original data from studies of human subjects and be designed to address the region or location of care delivery. Only English language manuscripts from peer-reviewed journals were included. The quality of evidence was ranked using QUADAS for validity and QAREL for reliability, as appropriate. Data were extracted and synthesized, and were evaluated in terms of strength of evidence and the degree to which the evidence was favourable for clinical use of the method under investigation. Results: A total of 2594 titles were screened from which 201 articles met all inclusion criteria. The spectrum of manuscript quality was quite broad, as was the degree to which the evidence favoured clinical application of the diagnostic methods reviewed. The most convincing favourable evidence was for methods which confirmed or provoked pain at a specific spinal segmental level or region. There was also high quality evidence supporting the use, with limitations, of static and motion palpation, and measures of leg length inequality. Evidence of mixed quality supported the use, with limitations, of postural evaluation. The evidence was unclear on the applicability of measures of stiffness and the use of spinal x-rays. The evidence was of mixed quality, but unfavourable for the use of manual muscle testing, skin conductance, surface electromyography and skin temperature measurement. Conclusions: A considerable range of methods is in use for determining where in the spine to administer spinal manipulation. The currently published evidence falls across a spectrum ranging from strongly favourable to strongly unfavourable in regard to using these methods. In general, the stronger and more favourable evidence is for those procedures which take a direct measure of the presumptive site of care– methods involving pain provocation upon palpation or localized tissue examination. Procedures which involve some indirect assessment for identifying the manipulable lesion of the spine–such as skin conductance or thermography–tend not to be supported by the available evidence.https://doi.org/10.1186/2045-709X-21-3

Is prevention of sports injuries a realistic goal? A four-year prospective investigation of sports injuries among physical education students.

Is prevention of sports injuries a realistic goal? A four-year prospective investigation of sports injuries among physical education students. Twellaar M, Verstappen FT, Huson A. Department of Movement Sciences, University of Limburg, Maastricht, The Netherlands. To assess the reliability of injury registration and to determine the incidence of injury in intramural (program of the institution) and extramural (leisure time) sports activities, we prospectively recorded information on sports injuries for 4 years in a group of 136 physical education students. Registration forms were completed every 3 weeks, and data on medical consultations were recorded. During the last year, we asked 59 students to recall all injuries sustained to establish the reliability of retrospective injury registration. In the prospective study, 525 sports injuries were recorded: 58% during intramural activities and 42% during extramural. The incident rate per 1000 hours of intramural activities (1.26) was significantly lower than that for extramural activities (1.77). A gradual decline in response rate from 98.4% the 1st year to 87.7% in the final year indicated a decreasing compliance during the study period. Eighteen percent of all injuries with recorded medical consultations were not reported by the students. At the retrospective injury registration in the final year of the study, students had forgotten 54% of the recorded injuries and 50 injuries (20% of all recorded injuries) were mentioned that had not been recorded during the previous years. We conclude that, even in a well-supervised population, prospective injury registration is not complete, and the reliability of retrospective injury registration is even poorer

Physical fitness and sports skills in relation to sports injuries. A four-year prospective investigation of sports injuries among physical education students.

In order to study the relationship between physical fitness/sport-specific skills and sports injuries 136 physical education students were studied during their 4-years of training in a prospective investigation. Physical fitness was measured every year using a battery of fitness tests, and the performance marks of a number of sports scored at the exams of the academy were used as parameters for the sport-specific skills. Sports injuries were recorded every 3 weeks on standard forms. Relative risk ratios were calculated between the tertile groups good, average and poor for all variables of physical fitness and sport-specific skills. Injury-proneness was defined for all and for acute and chronic injuries separately near the median number of injuries sustained. In only 6 out of 126 computed relative risks was a significant difference found. Discriminant analysis revealed an explanation of 16%, 14% and 11% of the variance for respectively all, acute and chronic injuries, at which 5 or 6 variables in varying combination were included. From our findings it may be concluded that physical fitness and sport-specific skills have little impact on sports injuries for the following two main reasons. Firstly, subjects at risk for sports injuries participate per definition in sports activities and have consequently developed their fitness and skills compared to the sedentary population. Thus, the range in physical fitness or sports skills in the population at risk is relatively small (physical education students belong to the 7th-10th decile in fitness test scores within a general college student population) and therefore an effect is hard to show. Secondly, the total number of sports injuries is very small and moreover, it should be distributed over several categories for analysis. The favourable advantages of using physical education students to study intrinsic risk factors (comparable and varied sports program, excellent compliance) appeared to be insufficient to compensate for drawbacks of selection

Postoperative abdominal adhesions and bowel obstruction. A survey among Dutch general practitioners

Background : There is increasing interest among specialists in the complications after abdominal surgery due to adhesions. Objective: Exploration of experiences, attitudes and expectations of general practitioners concerning bowel obstruction and postoperative abdominal adhesions. Methods : In October 2012 a postal questionnaire was sent to a random sample of 800 Dutch GPs. Results: The response rate was 45%, 24% (n = 190) filled out the questionnaire completely, 12% (n = 99) had no experience with the subject and 7% (n = 57) had no time to respond. A history of abdominal surgery does play a part in more than 80% of GP's differential diagnosis of abdominal complaints. Seventy-five per cent consider some types of surgery to induce more adhesions. Eighty-five per cent ponder the differentiation between adhesion related complaints and IBS as clear, however difficult (78%) in specific patients. Intestinal transit problems likely due to adhesions are treated with extra fluid (n = 64), more fibres (n = 85) and laxatives (n = 153). Referral to a specialist for adhesiolysis is rarely considered (11%). Forty per cent of the GPs would refer a patient with abdominal pain and suspected adhesions. Seventy-six per cent denote knowledge gaps and low experience in the treatment of intestinal transit problems. Some (n = 23) indicate the need for information about adhesions and obstruction through CME papers. Conclusion: Respondents are well equipped to deal with abdominal complaints and intestinal transit problems due to postoperative adhesions. Some indicate the need for information about adhesions and prevention of obstruction through CME papers

'To use or not to use': a qualitative study to evaluate experiences of healthcare providers and patients with the assessment of burden of COPD (ABC) tool

Contains fulltext : 165922.pdf (publisher's version ) (Open Access)In the management of chronic conditions, such as chronic obstructive pulmonary disease (COPD), there is a shift from doctor-driven care to patient-centred integrated care with active involvement of and self-management by the patient. A recently developed tool, the assessment of burden of COPD (ABC) tool, can be used in this transition to facilitate self-management support and shared decision-making. We performed a qualitative study, in which we collected and analysed the data using the methods of conventional content analyses. We performed in-depth interviews consisting of mainly open questions. Fifteen healthcare providers and 21 patients were interviewed who had worked with the ABC tool in daily care. In general, participants responded positively to the tool. Healthcare providers felt the visual representation provided was effective and comprehensible for patients and provided them with insight into their disease, a finding that patients confirmed. If patients were allowed to choose between a consultation with or without the ABC tool, the majority would prefer using the tool: it provides them with an overview and insight, which makes it easier to discuss all relevant topics related to COPD. The tool can provide structure in consultations, and is compatible with the concepts of 'motivational interviewing' and 'individualised care-planning'. Suggestions for improvement related to content and layout. So far, the tool has only been available as a stand-alone online program, that is not connected to the electronic medical record systems. It was therefore suggested that the tool be integrated into the systems to enhance its usability and its uptake by healthcare providers

Effectiveness of the Assessment of Burden of COPD (ABC) tool on health-related quality of life in patients with COPD: a cluster randomised controlled trial in primary and hospital care

Contains fulltext : 165996.pdf (publisher's version ) (Open Access)OBJECTIVE: Assessing the effectiveness of the Assessment of Burden of COPD (ABC) tool on disease-specific quality of life in patients with chronic obstructive pulmonary disease (COPD) measured with the St. George's Respiratory Questionnaire (SGRQ), compared with usual care. METHODS: A pragmatic cluster randomised controlled trial, in 39 Dutch primary care practices and 17 hospitals, with 357 patients with COPD (postbronchodilator FEV1/FVC ratio /=40 years, who could understand and read the Dutch language. Healthcare providers were randomly assigned to the intervention or control group. The intervention group applied the ABC tool, which consists of a short validated questionnaire assessing the experienced burden of COPD, objective COPD parameter (eg, lung function) and a treatment algorithm including a visual display and treatment advice. The control group provided usual care. Researchers were blinded to group allocation during analyses. Primary outcome was the number of patients with a clinically relevant improvement in SGRQ score between baseline and 18-month follow-up. Secondary outcomes were the COPD Assessment Test (CAT) and the Patient Assessment of Chronic Illness Care (PACIC; a measurement of perceived quality of care). RESULTS: At 18-month follow-up, 34% of the 146 patients from 27 healthcare providers in the intervention group showed a clinically relevant improvement in the SGRQ, compared with 22% of the 148 patients from 29 healthcare providers in the control group (OR 1.85, 95% CI 1.08 to 3.16). No difference was found on the CAT (-0.26 points (scores ranging from 0 to 40); 95% CI -1.52 to 0.99). The PACIC showed a higher improvement in the intervention group (0.32 points (scores ranging from 1 to 5); 95% CI 0.14 to 0.50). CONCLUSIONS: This study showed that use of the ABC tool may increase quality of life and perceived quality of care. TRIAL REGISTRATION NUMBER: NTR3788; Results