Background Growing evidence attests to the efficacy of mindfulness-based interventions(MBIs),but their effectiveness for healthcare workers remains uncertain.Aims To evaluate the evidence for MBIs in improving healthc...Background Growing evidence attests to the efficacy of mindfulness-based interventions(MBIs),but their effectiveness for healthcare workers remains uncertain.Aims To evaluate the evidence for MBIs in improving healthcare workers’psychological well-being.Methods A systematic literature search was conducted on Medline,Embase,Cumulative Index for Nursing and Allied Health Literature,PsycINFO and Cochrane Central Register of Controlled Trials up to 31 August 2022 using the keywords‘healthcare worker’,‘doctor’,‘nurse’,‘allied health’,‘mindfulness’,‘wellness’,‘workshop’and‘program’.Randomised controlled trials with a defined MBI focusing on healthcare workers and quantitative outcome measures related to subjective or psychological well-being were eligible for inclusion.R V.4.0.3 was used for data analysis,with the standardised mean difference as the primary outcome,employing DerSimonian and Laird’s random effects model.Grading of Recommendations,Assessment,Development and Evaluation framework was used to evaluate the quality of evidence.Cochrane’s Risk of Bias 2 tool was used to assess the risk of bias in the included studies.Results A total of 27 studies with 2506 participants were included,mostly from the USA,involving various healthcare professions.MBIs such as stress reduction programmes,apps,meditation and training showed small to large effects on anxiety,burnout,stress,depression,psychological distress and job strain outcomes of the participants.Positive effects were also seen in self-compassion,empathy,mindfulness and well-being.However,long-term outcomes(1 month or longer postintervention)varied,and the effects were not consistently sustained.Conclusions MBIs offer short-term benefits in reducing stress-related symptoms in healthcare workers.The review also highlights limitations such as intervention heterogeneity,reduced power in specific subgroup analyses and variable study quality.展开更多
BACKGROUND Hepatic resection(HR)results in an inflammatory response that can be modified by perioperative steroid administration.However,it remains to be determined if this response's attenuation translates to a r...BACKGROUND Hepatic resection(HR)results in an inflammatory response that can be modified by perioperative steroid administration.However,it remains to be determined if this response's attenuation translates to a reduction in complications.AIM To evaluate if perioperative administration of steroids reduces complications following HR.METHODS A systematic review of randomized controlled trials(RCTs)was conducted on PubMed,Embase,and Cochrane Central Register of Controlled Trials to evaluate the effect of perioperative steroid(compared to placebo or no intervention)use in patients undergoing HR.Clinical outcomes were extracted,and meta-analysis was performed.RESULTS 8 RCTs including 590 patients were included.Perioperative steroid administration was associated with significant reduction in postoperative complications[odds ratios:0.58;95%confidence intervals(CI):0.35-0.97,P=0.04].There was also improvement in biochemical and inflammatory markers,including serum bilirubin on postoperative day 1[MD:-0.27;95%CI:(-0.47,-0.06),P=0.01],Creactive protein on postoperative day 3[MD:-4.89;95%CI:(-5.83,-3.95),P<0.001],and interleukin-6 on postoperative day 1[MD:-54.84;95%CI:(-63.91,-45.76),P<0.001].CONCLUSION Perioperative steroids administration in HR may reduce overall complications,postoperative bilirubin,and inflammation.Further studies are needed to determine the optimal dose and duration and patient selection.展开更多
BACKGROUND Heel pain is a common orthopaedic complaint,and if left untreated can be a source of chronic morbidity.Accurate diagnosis can be challenging,owing to the complex anatomy and multiple pain generators present...BACKGROUND Heel pain is a common orthopaedic complaint,and if left untreated can be a source of chronic morbidity.Accurate diagnosis can be challenging,owing to the complex anatomy and multiple pain generators present in the foot.We aim to share our clinical experience managing an unusual case of chronic heel pain secondary to osteochondroma.CASE SUMMARY A 41-year-old obese male who works as a porter presented with a long-standing history of left plantar heel pain.He was assessed to have point tenderness over the plantar insertion of the calcaneus as well as a positive Silfverski?ld test.He was treated for plantar fasciitis and tight gastrocnemius but failed conservative therapies as well as surgical intervention.Magnetic resonance imaging revealed the presence of a pedunculated bony protrusion over the plantar aspect of the calcaneus.The decision was made for excision of the osteochondroma,and the patient has been pain-free since.CONCLUSION Osteochondromas are rarely symptomatic in skeletally mature patients.While most are benign with a very low risk of malignant transformation,surgical excision can yield excellent results and significant pain relief in symptomatic patients.展开更多
文摘Background Growing evidence attests to the efficacy of mindfulness-based interventions(MBIs),but their effectiveness for healthcare workers remains uncertain.Aims To evaluate the evidence for MBIs in improving healthcare workers’psychological well-being.Methods A systematic literature search was conducted on Medline,Embase,Cumulative Index for Nursing and Allied Health Literature,PsycINFO and Cochrane Central Register of Controlled Trials up to 31 August 2022 using the keywords‘healthcare worker’,‘doctor’,‘nurse’,‘allied health’,‘mindfulness’,‘wellness’,‘workshop’and‘program’.Randomised controlled trials with a defined MBI focusing on healthcare workers and quantitative outcome measures related to subjective or psychological well-being were eligible for inclusion.R V.4.0.3 was used for data analysis,with the standardised mean difference as the primary outcome,employing DerSimonian and Laird’s random effects model.Grading of Recommendations,Assessment,Development and Evaluation framework was used to evaluate the quality of evidence.Cochrane’s Risk of Bias 2 tool was used to assess the risk of bias in the included studies.Results A total of 27 studies with 2506 participants were included,mostly from the USA,involving various healthcare professions.MBIs such as stress reduction programmes,apps,meditation and training showed small to large effects on anxiety,burnout,stress,depression,psychological distress and job strain outcomes of the participants.Positive effects were also seen in self-compassion,empathy,mindfulness and well-being.However,long-term outcomes(1 month or longer postintervention)varied,and the effects were not consistently sustained.Conclusions MBIs offer short-term benefits in reducing stress-related symptoms in healthcare workers.The review also highlights limitations such as intervention heterogeneity,reduced power in specific subgroup analyses and variable study quality.
文摘BACKGROUND Hepatic resection(HR)results in an inflammatory response that can be modified by perioperative steroid administration.However,it remains to be determined if this response's attenuation translates to a reduction in complications.AIM To evaluate if perioperative administration of steroids reduces complications following HR.METHODS A systematic review of randomized controlled trials(RCTs)was conducted on PubMed,Embase,and Cochrane Central Register of Controlled Trials to evaluate the effect of perioperative steroid(compared to placebo or no intervention)use in patients undergoing HR.Clinical outcomes were extracted,and meta-analysis was performed.RESULTS 8 RCTs including 590 patients were included.Perioperative steroid administration was associated with significant reduction in postoperative complications[odds ratios:0.58;95%confidence intervals(CI):0.35-0.97,P=0.04].There was also improvement in biochemical and inflammatory markers,including serum bilirubin on postoperative day 1[MD:-0.27;95%CI:(-0.47,-0.06),P=0.01],Creactive protein on postoperative day 3[MD:-4.89;95%CI:(-5.83,-3.95),P<0.001],and interleukin-6 on postoperative day 1[MD:-54.84;95%CI:(-63.91,-45.76),P<0.001].CONCLUSION Perioperative steroids administration in HR may reduce overall complications,postoperative bilirubin,and inflammation.Further studies are needed to determine the optimal dose and duration and patient selection.
文摘BACKGROUND Heel pain is a common orthopaedic complaint,and if left untreated can be a source of chronic morbidity.Accurate diagnosis can be challenging,owing to the complex anatomy and multiple pain generators present in the foot.We aim to share our clinical experience managing an unusual case of chronic heel pain secondary to osteochondroma.CASE SUMMARY A 41-year-old obese male who works as a porter presented with a long-standing history of left plantar heel pain.He was assessed to have point tenderness over the plantar insertion of the calcaneus as well as a positive Silfverski?ld test.He was treated for plantar fasciitis and tight gastrocnemius but failed conservative therapies as well as surgical intervention.Magnetic resonance imaging revealed the presence of a pedunculated bony protrusion over the plantar aspect of the calcaneus.The decision was made for excision of the osteochondroma,and the patient has been pain-free since.CONCLUSION Osteochondromas are rarely symptomatic in skeletally mature patients.While most are benign with a very low risk of malignant transformation,surgical excision can yield excellent results and significant pain relief in symptomatic patients.
