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Carolyn Chew-Graham

Bio: Carolyn Chew-Graham is an academic researcher from Keele University. The author has contributed to research in topics: Health care & Mental health. The author has an hindex of 59, co-authored 376 publications receiving 13343 citations. Previous affiliations of Carolyn Chew-Graham include St George's Hospital & St George’s University Hospitals NHS Foundation Trust.


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Journal ArticleDOI
TL;DR: The SPIDER tool would not be recommended due to the risk of not identifying relevant papers, but has potential due to its greater specificity, while the PICO tool is recommended for a fully comprehensive search but the PICOS tool where time and resources are limited.
Abstract: Qualitative systematic reviews are increasing in popularity in evidence based health care. Difficulties have been reported in conducting literature searches of qualitative research using the PICO search tool. An alternative search tool, entitled SPIDER, was recently developed for more effective searching of qualitative research, but remained untested beyond its development team. In this article we tested the ‘SPIDER’ search tool in a systematic narrative review of qualitative literature investigating the health care experiences of people with Multiple Sclerosis. Identical search terms were combined into the PICO or SPIDER search tool and compared across Ovid MEDLINE, Ovid EMBASE and EBSCO CINAHL Plus databases. In addition, we added to this method by comparing initial SPIDER and PICO tools to a modified version of PICO with added qualitative search terms (PICOS). Results showed a greater number of hits from the PICO searches, in comparison to the SPIDER searches, with greater sensitivity. SPIDER searches showed greatest specificity for every database. The modified PICO demonstrated equal or higher sensitivity than SPIDER searches, and equal or lower specificity than SPIDER searches. The modified PICO demonstrated lower sensitivity and greater specificity than PICO searches. The recommendations for practice are therefore to use the PICO tool for a fully comprehensive search but the PICOS tool where time and resources are limited. Based on these limited findings the SPIDER tool would not be recommended due to the risk of not identifying relevant papers, but has potential due to its greater specificity.

1,011 citations

Journal ArticleDOI
TL;DR: Evidence from this meta-analysis suggests that recent intervention programs for burnout in physicians were associated with small benefits that may be boosted by adoption of organization-directed approaches, providing support for the view that burnout is a problem of the whole health care organization, rather than individuals.
Abstract: Importance Burnout is prevalent in physicians and can have a negative influence on performance, career continuation, and patient care. Existing evidence does not allow clear recommendations for the management of burnout in physicians. Objective To evaluate the effectiveness of interventions to reduce burnout in physicians and whether different types of interventions (physician-directed or organization-directed interventions), physician characteristics (length of experience), and health care setting characteristics (primary or secondary care) were associated with improved effects. Data Sources MEDLINE, Embase, PsycINFO, CINAHL, and Cochrane Register of Controlled Trials were searched from inception to May 31, 2016. The reference lists of eligible studies and other relevant systematic reviews were hand searched. Study Selection Randomized clinical trials and controlled before-after studies of interventions targeting burnout in physicians. Data Extraction and Synthesis Two independent reviewers extracted data and assessed the risk of bias. The main meta-analysis was followed by a number of prespecified subgroup and sensitivity analyses. All analyses were performed using random-effects models and heterogeneity was quantified. Main Outcomes and Measures The core outcome was burnout scores focused on emotional exhaustion, reported as standardized mean differences and their 95% confidence intervals. Results Twenty independent comparisons from 19 studies were included in the meta-analysis (n = 1550 physicians; mean [SD] age, 40.3 [9.5] years; 49% male). Interventions were associated with small significant reductions in burnout (standardized mean difference [SMD] = −0.29; 95% CI, −0.42 to −0.16; equal to a drop of 3 points on the emotional exhaustion domain of the Maslach Burnout Inventory above change in the controls). Subgroup analyses suggested significantly improved effects for organization-directed interventions (SMD = −0.45; 95% CI, −0.62 to −0.28) compared with physician-directed interventions (SMD = −0.18; 95% CI, −0.32 to −0.03). Interventions delivered in experienced physicians and in primary care were associated with higher effects compared with interventions delivered in inexperienced physicians and in secondary care, but these differences were not significant. The results were not influenced by the risk of bias ratings. Conclusions and Relevance Evidence from this meta-analysis suggests that recent intervention programs for burnout in physicians were associated with small benefits that may be boosted by adoption of organization-directed approaches. This finding provides support for the view that burnout is a problem of the whole health care organization, rather than individuals.

855 citations

Journal ArticleDOI
TL;DR: This meta-analysis provides evidence that physician burnout may jeopardize patient care; reversal of this risk has to be viewed as a fundamental health care policy goal across the globe.
Abstract: Importance Physician burnout has taken the form of an epidemic that may affect core domains of health care delivery, including patient safety, quality of care, and patient satisfaction However, this evidence has not been systematically quantified Objective To examine whether physician burnout is associated with an increased risk of patient safety incidents, suboptimal care outcomes due to low professionalism, and lower patient satisfaction Data Sources MEDLINE, EMBASE, PsycInfo, and CINAHL databases were searched until October 22, 2017, using combinations of the key termsphysicians,burnout, andpatient care Detailed standardized searches with no language restriction were undertaken The reference lists of eligible studies and other relevant systematic reviews were hand-searched Study Selection Quantitative observational studies Data Extraction and Synthesis Two independent reviewers were involved The main meta-analysis was followed by subgroup and sensitivity analyses All analyses were performed using random-effects models Formal tests for heterogeneity (I2) and publication bias were performed Main Outcomes and Measures The core outcomes were the quantitative associations between burnout and patient safety, professionalism, and patient satisfaction reported as odds ratios (ORs) with their 95% CIs Results Of the 5234 records identified, 47 studies on 42 473 physicians (25 059 [590%] men; median age, 38 years [range, 27-53 years]) were included in the meta-analysis Physician burnout was associated with an increased risk of patient safety incidents (OR, 196; 95% CI, 159-240), poorer quality of care due to low professionalism (OR, 231; 95% CI, 187-285), and reduced patient satisfaction (OR, 228; 95% CI, 142-368) The heterogeneity was high and the study quality was low to moderate The links between burnout and low professionalism were larger in residents and early-career (≤5 years post residency) physicians compared with middle- and late-career physicians (CohenQ = 727;P = 003) The reporting method of patient safety incidents and professionalism (physician-reported vs system-recorded) significantly influenced the main results (CohenQ = 814;P = 007) Conclusions and Relevance This meta-analysis provides evidence that physician burnout may jeopardize patient care; reversal of this risk has to be viewed as a fundamental health care policy goal across the globe Health care organizations are encouraged to invest in efforts to improve physician wellness, particularly for early-career physicians The methods of recording patient care quality and safety outcomes require improvements to concisely capture the outcome of burnout on the performance of health care organizations

694 citations

Journal ArticleDOI
TL;DR: Preeclampsia is associated with a 4-fold increase in future incident heart failure and a 2-fold increased risk in coronary heart disease, stroke, and death because of coronary heart or cardiovascular disease.
Abstract: Background—Preeclampsia is a pregnancy-specific disorder resulting in hypertension and multiorgan dysfunction. There is growing evidence that these effects persist after pregnancy. We aimed to syst...

612 citations

Journal ArticleDOI
TL;DR: This work has shown that there is a resistance within the profession to help‐seeking and an ad hoc approach to dealing with stress and distress in doctors.
Abstract: BACKGROUND: Medical education is reported to be demanding and stressful and previous work with doctors suggests that there is a resistance within the profession to help-seeking and an ad hoc approach to dealing with stress and distress. AIM: To explore the attitudes of medical students at the University of Manchester, UK to the causes of stress and to examine their views on help-seeking. STUDY DESIGN: A qualitative study using semistructured interviews, with analysis of the data using the technique of constant comparison. METHODS: Medical students at the University of Manchester were invited to participate in the study. Sampling made the research representative of medical students in terms of gender, ethnicity and UK/overseas students. Semistructured interviews, with open questions, were conducted and audio-taped with consent. The tapes were transcribed verbatim. The schedule was revised in the light of the emerging themes. RESULTS: Medical students recognised that studying medicine contributes to stress, as experienced in their undergraduate careers. Students reported that perceptions of stigma associated with mental illness, including stress, were prevalent in the student body and were perceived to continue throughout the medical profession. Avoidance of appropriate help-seeking behaviour starts early and is linked to perceived norms which dictate that experiencing a mental health problem may be viewed as a form of weakness and has implications for subsequent successful career progression. CONCLUSION: The preparation of medical students for life as doctors involves more than facilitation of the acquisition of knowledge and skills, so that new doctors can conform to the principals of professional conduct. Support and mentoring are required so that stress can be identified early and dealt with appropriately

474 citations


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01 Jan 2016
TL;DR: The using multivariate statistics is universally compatible with any devices to read, allowing you to get the most less latency time to download any of the authors' books like this one.
Abstract: Thank you for downloading using multivariate statistics. As you may know, people have look hundreds times for their favorite novels like this using multivariate statistics, but end up in infectious downloads. Rather than reading a good book with a cup of tea in the afternoon, instead they juggled with some harmful bugs inside their laptop. using multivariate statistics is available in our digital library an online access to it is set as public so you can download it instantly. Our books collection saves in multiple locations, allowing you to get the most less latency time to download any of our books like this one. Merely said, the using multivariate statistics is universally compatible with any devices to read.

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TL;DR: In this paper, Imagined communities: Reflections on the origin and spread of nationalism are discussed. And the history of European ideas: Vol. 21, No. 5, pp. 721-722.

13,842 citations

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TL;DR: Reading a book as this basics of qualitative research grounded theory procedures and techniques and other references can enrich your life quality.

13,415 citations

01 Jan 2014
TL;DR: These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care.
Abstract: XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

9,618 citations