Job Satisfaction and Chronic Stress of General Practitioners and Their Teams: Baseline Data of a Cluster-Randomised Trial (IMPROVEjob)

Background: A high prevalence of poor job satisfaction and high chronic stress is documented for general practitioners (GPs) and non-physician practice staff from various countries. The reasons are multifactorial and include deficits in leadership, communication and workflows. This publicly funded study evaluates the effectiveness of the newly developed participatory, interdisciplinary, and multimodal IMPROVEjob intervention on improving job satisfaction among GPs and practice personnel. Here, we report the baseline characteristics of the participating GPs and practice assistants, focusing on job satisfaction and perceived chronic stress. Methods: The IMPROVEjob study was performed as a cluster-randomised, controlled trial (cRCT) with German GP practices in the North Rhine Region. The IMPROVEjob intervention comprised two leadership workshops (one for practice leaders only; a second for leaders and practice assistants), a toolbox with supplemental printed and online material, and a nine-month implementation phase supported by IMPROVEjob facilitators. The intervention addressed issues of leadership, communication, and work processes. During study nurse visits, participants completed questionnaires at baseline and after nine months follow up. The primary outcome was the change in job satisfaction as measured by the respective scale of the validated German version of the Copenhagen Psychosocial Questionnaire (German COPSOQ, version 2018). Perceived chronic stress was measured using the Trier Inventory of Chronic Stress (TICS- SSCS). Results: Recruitment of 60 practices was successful: 21 were solo, 39 were group practices. At baseline, n = 84 practice owners, n = 28 employed physicians and n = 254 practice assistants were included. The mean age of all participants was 44.4 (SD = 12.8). At baseline, the job satisfaction score in the total sample was 74.19 of 100 (±14.45) and the perceived chronic stress score was 19.04 of 48 (±8.78). Practice assistants had a significantly lower job satisfaction than practice owners (p < 0.05) and employed physicians (p < 0.05). In the regression analysis, perceived chronic stress was negatively associated with job satisfaction (b= -0.606, SE b = 0.082, p < 0.001, ICC = 0.10). Discussion: The degree of job satisfaction was similar to those in other medical professionals published in studies, while perceived chronic stress was markedly higher compared to the general German population. These findings confirm the need for interventions to improve psychological wellbeing in GP practice personnel

Olfactory Ensheathing Cell Transplantation in Experimental Spinal Cord Injury:Effect size and Reporting Bias of 62 Experimental Treatments: A Systematic Review and Meta-Analysis

Olfactory ensheathing cell (OEC) transplantation is a candidate cellular treatment approach for human spinal cord injury (SCI) due to their unique regenerative potential and autologous origin. The objective of this study was, through a meta-epidemiologic approach, (i) to assess the efficacy of OEC transplantation on locomotor recovery after traumatic experimental SCI and (ii) to estimate the likelihood of reporting bias and/or missing data. A study protocol was finalized before data collection. Embedded into a systematic review and meta-analysis, we conducted a literature research of databases including PubMed, EMBASE, and ISI Web of Science from 1949/01 to 2014/10 with no language restrictions, screened by two independent investigators. Studies were included if they assessed neurobehavioral improvement after traumatic experimental SCI, administrated no combined interventions, and reported the number of animals in the treatment and control group. Individual effect sizes were pooled using a random effects model. Details regarding the study design were extracted and impact of these on locomotor outcome was assessed by meta-regression. Missing data (reporting bias) was determined by Egger regression and Funnel-plotting. The primary study outcome assessed was improvement in locomotor function at the final time point of measurement. We included 49 studies (62 experiments, 1,164 animals) in the final analysis. The overall improvement in locomotor function after OEC transplantation, measured using the Basso, Beattie, and Bresnahan (BBB) score, was 20.3% (95% CI 17.8-29.5). One missing study was imputed by trim and fill analysis, suggesting only slight publication bias and reducing the overall effect to a 19.2% improvement of locomotor activity. Dose-response ratio supports neurobiological plausibility. Studies were assessed using a 9-point item quality score, resulting in a median score of 5 (interquartile range [IQR] 3-5). In conclusion, OEC transplantation exerts considerable beneficial effects on neurobehavioral recovery after traumatic experimental SCI. Publication bias was minimal and affirms the translational potential of efficacy, but safety cannot be adequately assessed. The data justify OECs as a cellular substrate to develop and optimize minimally invasive and safe cellular transplantation paradigms for the lesioned spinal cord embedded into state-of-the-art Phase I/II clinical trial design studies for human SCI

Visual Exploration of Media Transparency for Data Journalists: Problem Characterization and Abstraction

Abstract Today, journalists increasingly deal with complex, large, and heterogeneous datasets and, thus, face challenges in integration, wrangling, analysis, and reporting these data. Besides, the lack of money, time, and skills influence their journalistic work. Information visualization and visual analytics offer possibilities to support data journalists. This paper contributes to an overview of a possible characterization and abstraction of certain aspects of data-driven journalism in Austria. A case study was conducted based on the dataset of media transparency in Austria. We conducted four semistructured interviews with Austrian data journalists, as well as an exploratory data analysis of the media transparency dataset. To categorize our findings we used Munzner´s analytical framework and the Data-User-Task Design Triangle by Miksch and Aigner

Assessment of publication bias.

<p>(A) Funnel plot displays the precision plotted against the effect size. When considering the Funnel plot without any imputation from the trim and fill method (black dots only), the analysed 62 experiments indicate an overall effect size (ES) of 20.3%. When applying the trim and fill method to detect possible missing experiments based on the funnel plot’s asymmetry, the overall effect size results in a reduced effect size of 19.2%. One imputation was done, indicating a possibly missing experiment (red dot). (B) Egger regression illustrates the precision (one divided by the standard error of the mean) plotted against effect size divided by the standard error of the mean. Egger regression line does not intersect the origin, indicating possibly underlying publication bias. (C) “Traffic light” colored funnel plot adds two layers of information in the context of study quality. The circle sizes represent the number of animals in the individual experiment and the dot colors reflect the individual points on the quality score. The “traffic light” funnel plot demonstrates that studies with higher quality scores (≥5; green dots) relate closer to the corrected calculated effect size, although the stratification did not account for significance heterogeneity (Quality score ≥5: 18.7 [95%CI 10.6–26.7]; <5: 22.1 [10.3–33.9]). However, the “traffic light” funnel plot also identified a cluster of studies reporting high study quality likely to further correct the observed effect size below the adjusted effect size of the trim-and-filled funnel plot.</p

Study selection.

<p>(A) Interventional preclinical OEC transplantation studies analyzing effects on locomotor recovery after SCI. (B) Effect size in percent according to rank; black dots represent studies applying the Basso, Beattie, and Bresnahan (BBB) score for neurobehavioral outcome assessment, and white dots indicate studies using other scores. The vertical error bars represent the 95% CI of individual studies, and the horizontal gray bar represents 95% CI of all analyzed studies (overall effect size 23.6 [95% CI 17.8–29.5]). (C) Meta-regression demonstrating the effect size for studies reporting motor outcome by open field BBB testing is comparatively lower when compared with other scores (e.g., Tarlov scale).</p

Autologous olfactory ensheathing cell (OEC) transplantation.

<p>OECs are extracted from a. the olfactory bulb or b. the olfactory mucosa (left side). After cell propagation, OECs are transplanted on the injured spinal cord (right side). OECs are transplanted either to the lesion core or rostral/caudal parenchymal areas juxtaposed to the lesion site after acute, subacute, or beginning chronic time frames after SCI in varying concentrations and dosages. With their unique ability to reorganise the glial scar and guide regenerating axons from the peripheral to the central nervous system (reviewed recently [<a href="http://www.plosbiology.org/article/info:doi/10.1371/journal.pbio.1002468#pbio.1002468.ref006" target="_blank">6</a>]), OECs are being regarded as a promising cellular approach for SCI treatment. Intramedullary OEC transplantation in proximity to the injured spinal cord site may facilitate regenerating fibres to overcome molecular axonal outgrowth inhibitors surrounding the forming scar and promote functional outcome improvement. There is heterogeneity in morphology, antigen expression, and function in OECs derived from olfactory mucosa versus olfactory bulb [<a href="http://www.plosbiology.org/article/info:doi/10.1371/journal.pbio.1002468#pbio.1002468.ref015" target="_blank">15</a>,<a href="http://www.plosbiology.org/article/info:doi/10.1371/journal.pbio.1002468#pbio.1002468.ref016" target="_blank">16</a>].</p

Higher Work-Privacy Conflict and Lower Job Satisfaction in GP Leaders and Practice Assistants Working Full-Time Compared to Part-Time: Results of the IMPROVEjob Study

Background: Work-privacy conflict (WPC) has become an important issue for medical professionals. The cluster-randomized controlled IMPROVEjob study aimed at improving job satisfaction (primary outcome), with additional outcomes such as examining the work-privacy conflict in German general practice personnel. Using baseline data of this study, the relationship between work-privacy conflict and job satisfaction (JS) was analyzed. In addition, factors associated with higher WPC were identified. Methods: At baseline, 366 participants (general practitioners (GPs) in leadership positions, employed general practitioners, and practice assistants) from 60 German practices completed a questionnaire addressing socio-demographic data and job characteristics. Standardized scales from the German version of the COPSOQ III requested data concerning job satisfaction and work-privacy conflict. Both scores range from 0 (lowest) to 100 (highest). Multilevel analysis accounted for the clustered data. Statistical analyses were performed using IBM SPSS and RStudio software, with a significance level set at p &lt; 0.05. Results: Job satisfaction was 77.16 (mean value; SD = 14.30) among GPs in leadership positions (n = 84), 79.61 (SD = 12.85) in employed GPs (n = 28), and 72.58 (SD = 14.42) in practice assistants (n = 254). Mean values for the WPC-scale were higher for professionals with more responsibilities: GPs in leadership positions scored highest with 64.03 (SD = 29.96), followed by employed physicians (M = 45.54, SD =30.28), and practice assistants (M = 32.67, SD = 27.41). General practitioners and practice assistants working full-time reported significantly higher work-privacy conflict than those working part-time (p &lt; 0.05). In a multilevel analysis, work-privacy conflict was significantly associated with job satisfaction (p &lt; 0.001). A multiple regression analysis identified working hours, as well as and being a practice owner or an employed physician as factors significantly influencing WPC. Discussion: WPC was high among general practice leaders and practice personnel working full-time. Future interventions to support practice personnel should focus on reducing WPC, as there is good evidence of its effects on job satisfaction

180° view on general practitioners’ leadership skills: practice-level comparisons of leader and staff assessments using data from the cluster-randomised controlled IMPROVEjob study

Objectives Strong primary care leaders are needed to assure high quality services for patient populations. This study analysed general practitioners’ (GP) leadership skills comparing practice-level self and staff assessments based on the full range of leadership model and the leader-member exchange (LMX).Setting The questionnaire survey was conducted among German general practice leaders and their staff participating in the IMPROVEjob trial.Participants The study population comprised 60 German general practices with 366 participants: 84 GP practice leaders and 282 employees (28 physicians and 254 practice assistants).Primary and secondary outcome measures Leadership skills of the practice leaders were measured using the Integrative Leadership Questionnaire (German Fragebogen für integrative Führung) and the LMX-7 questionnaire. Leaders rated themselves and practice staff rated their leaders. The data was analysed by paired mean comparisons on the practice level.Results For most leadership dimensions, practice leaders rated themselves higher than their employees rated them. Differences were found for transformational leadership (p&lt;0.001, d=0.41), especially for the dimensions ‘innovation’ (p&lt;0.001, d=0.69) and ‘individuality focus’ (p&lt;0.001, d=0.50). For transactional leadership, the dimension ‘goal setting’ differed significantly (p&lt;0.01, d=0.30) but not the other dimensions. Scores for negative leadership were low and showed no differences between leaders and employees. Interestingly, employed physicians’ rated their practice leaders higher on the two transformational (‘performance development’, ‘providing a vision’) and all transactional dimensions. The LMX-7 scale showed high quality relationships between leaders and employees.Conclusions This 180° analysis of GPs’ leadership skills with self and employee ratings indicated good relationships. There is a potential to improve leadership regarding goal-setting, innovation and focusing on individual team members. These results allow for the development of targeted interventions.Trial registration number German Clinical Trials Register, DRKS00012677. Registered 16 October 2019