Systematic review of interventions to improve the psychological well-being of general practitioners

BACKGROUND: The health of doctors who work in primary care is threatened by workforce and workload issues. There is a need to find and appraise ways in which to protect their mental health, including how to achieve the broader, positive outcome of well-being. Our primary outcome was to evaluate systematically the research evidence regarding the effectiveness of interventions designed to improve General Practitioner (GP) well-being across two continua; psychopathology (mental ill-health focus) and 'languishing to flourishing' (positive mental health focus). In addition we explored the extent to which developments in well-being research may be integrated within existing approaches to design an intervention that will promote mental health and prevent mental illness among these doctors.

METHODS: Medline, Embase, Cinahl, PsychINFO, Cochrane Register of Trials and Web of Science were searched from inception to January 2015 for studies where General Practitioners and synonyms were the primary participants. Eligible interventions included mental ill-health prevention strategies (e.g. promotion of early help-seeking) and mental health promotion programmes (e.g. targeting the development of protective factors at individual and organizational levels). A control group was the minimum design requirement for study inclusion and primary outcomes had to be assessed by validated measures of well-being or mental ill-health. Titles and abstracts were assessed independently by two reviewers with 99 % agreement and full papers were appraised critically using validated tools.

RESULTS: Only four studies (with a total of 997 GPs) from 5392 titles met inclusion criteria. The studies reported statistically significant improvement in self-reported mental ill-health. Two interventions used cognitive-behavioural techniques, one was mindfulness-based and one fed-back GHQ scores and self-help information.

CONCLUSION: There is an urgent need for high quality, controlled studies in GP well-being. Research on improving GP well-being is limited by focusing mainly on stressors and not giving systematic attention to the development of positive mental health.

Do Cochrane summaries help student midwives understand the findings of Cochrane systematic reviews: the BRIEF randomised trial

BACKGROUND: Abstracts and plain language summaries (PLS) are often the first, and sometimes the only, point of contact between readers and systematic reviews. It is important to identify how these summaries are used and to know the impact of different elements, including the authors' conclusions. The trial aims to assess whether (a) the abstract or the PLS of a Cochrane Review is a better aid for midwifery students in assessing the evidence, (b) inclusion of authors' conclusions helps them and (c) there is an interaction between the type of summary and the presence or absence of the conclusions.

METHODS: Eight hundred thirteen midwifery students from nine universities in the UK and Ireland were recruited to this 2 × 2 factorial trial (abstract versus PLS, conclusions versus no conclusions). They were randomly allocated to one of four groups and asked to recall knowledge after reading one of four summary formats of two Cochrane Reviews, one with clear findings and one with uncertain findings. The primary outcome was the proportion of students who identified the appropriate statement to describe the main findings of the two reviews as assessed by an expert panel.

RESULTS: There was no statistically significant difference in correct response between the abstract and PLS groups in the clear finding example (abstract, 59.6 %; PLS, 64.2 %; risk difference 4.6 %; CI -0.2 to 11.3) or the uncertain finding example (42.7 %, 39.3 %, -3.4 %, -10.1 to 3.4). There was no significant difference between the conclusion and no conclusion groups in the example with clear findings (conclusions, 63.3 %; no conclusions, 60.5 %; 2.8 %; -3.9 to 9.5), but there was a significant difference in the example with uncertain findings (44.7 %; 37.3 %; 7.3 %; 0.6 to 14.1, p = 0.03). PLS without conclusions in the uncertain finding review had the lowest proportion of correct responses (32.5 %). Prior knowledge and belief predicted student response to the clear finding review, while years of midwifery education predicted response to the uncertain finding review.

CONCLUSIONS: Abstracts with and without conclusions generated similar student responses. PLS with conclusions gave similar results to abstracts with and without conclusions. Removing the conclusions from a PLS with uncertain findings led to more problems with interpretation.

The effect of statins on intraocular pressure and on the incidence and progression of glaucoma: A Systematic Review and Meta-analysis

Purpose: We conducted a systematic review and meta-analysis of observational studies to evaluate the effect of oral statins on intraocular pressure (IOP) and the incidence and progression of glaucoma. Methods: This was a systematic review of the literature and meta-analysis. Searches of PubMed/Medline and Embase were conducted to include all types of studies. Gray literature abstracts were also considered for inclusion. Last search date was February 2016. Risk of bias was assessed using the Newcastle-Ottawa scale independently by two reviewers. Odds ratios (OR) or hazard ratios (HR) and 95% confidence intervals (CI) were extracted from each study. Pooled ORs for incidence of glaucoma were calculated using a random-effects model. Results: We identified seven cohort studies, three case–control studies, and one cross-sectional study with a total number of 583,615 participants. No randomized controlled trials were retrieved. Pooled ORs demonstrated a statistically significant association between short-term statin use (≤2 years) and reduced incidence of glaucoma (OR 0.96, 95%CI 0.94, 0.99). Pooled ORs of long-term statin use (>2 years) did not demonstrate statistically significant reduction in incidence of glaucoma (OR 0.70, 95%CI 0.46, 1.06). There was inconsistent evidence for the protective effect of statins against the progression of glaucoma, although there was no standard definition for progression across studies. There was no significant difference in IOP associated with statin use. Conclusions: Short-term statin use is associated with a reduced incidence of glaucoma. The effect of statins on glaucoma progression and IOP is uncertain.

The Promise of Peace:Revisiting the Northern Irish Model

The Northern Ireland peace process is often eulogized as a successful model of conflict transformation. Although the process exhibited many of the problems that beset other societies seeking to move from conflict to a negotiated peace (including disagreements over the functioning of institutions and the meanings of cultural symbols, unresolved issues relating to the effects of political violence on victims and survivors and society at large; and the residual presence of violent and political ‘spoiler’ groups), the resilience of political dialogue has proven remarkable.
This collection revisits the promise of ‘a truly historic opportunity for a new beginning’ a decade and a half on from the signing of the Belfast/Good Friday Agreement in 1998. The book will bring together academics from across a number of disciplines, including management and organizational behaviour, law, politics, sociology, archaeology and literature.

The different contributions aim to assess what impact it has made in the legal, policy, and institutional areas it specifically targeted: political reform, human rights and equality provision, working through legacies of the past (including police reform, prisoner release and victims' rights) and the building of new relationships within the island of Ireland and between Ireland and Britain. With the emergence of first-time voters who had no direct experience of the violence the book explores what the Agreement offers for future generations.

The book is the culmination of a 12-month research project sponsored by the British Academy and Leverhulme that addressed the following aspects of the peace process:
Peace walls: The euphemistically named peace walls remain one of the most visible reminders of Northern Ireland’s divisions and they are famously the only material manifestations of the conflict that have grown in number and extent since the 1998 Agreement. They were originally placed between antagonistic neighbouring communities – often at their request – at times of heightened tensions. Research under this theme explored the lack of ongoing engagement with their continuing presences, evolving meanings and impact on the communities that reside beside them needs to be overtly addressed.
Cultural division: Cultural differences have often been seen as lying at the heart of the ‘Irish problem’. Despite this, art and artists have increasingly been seen as having the potential to develop new discourses. Research explored the following questions: What role can the arts play in re-imagining the spaces opened up by the promises of the 1998 Agreement? What implication does the confrontation with the legacies of conflict have for artistic practices? What impact do the arts have on constructions of identity, on narratives of history, and on electoral politics?
Institutional transformation: This strand of research explored the significance of the process of organizational change which followed the establishment of the 1998 on political and other public policy institutions such as the police and prison services. It suggested that the experience and lessons learned from such periods of transition have much to contribute to how Northern Ireland begins to address political polarization in other areas of public service infrastructure, chiefly around the sectarian monoliths of education and housing.
Working through the past: ‘Legacy’ issues have gained increasing prominence since 1998: issues to do with public symbolism (particularly relating to the flying of flags and parading), defining victimhood, securing victims’ rights, recovery of the ‘disappeared’, reintegrating ex- prisoners back into society, and the possibilities for truth recovery and reconciliation have all acquired salient and emotive force. Although the 1998 Agreement promised to ‘honour the dead’ through a ‘new beginning’, it is increasingly unclear as to whether an agreed narrative about the past is possible – or even worthwhile pursuing. Research under this theme looked at the complex relationship between memory, commemoration and violence; how commemorative events are performed, organized, policed and represented. It also addressed the fraught issue of how to come to terms with Northern Ireland’s divided and bloodied past.

The editors are in the process of guiding contributors to adapt their papers, which were presented to a series of workshops on the above themes, to the purposes of the book. In particular, the contributors will be guided to focus on the related aims of assessing the extent of change that has occurred and providing an assessment of what remains to be done. To that end, contributors are asked to engage directly with the questions that close the ‘Introduction’, namely: To what extent has the ‘promise’ of the 1998 Agreement been fulfilled? To what extent has the 1998 Agreement given rise to forms of exclusion? To what extent has the 1998 Agreement shaped new forms of debate, dispute and engagement? In the absence of that guidance having been sent out yet, the outlines below are, for the time being, the abstracts of their original papers.