Latest Articles
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Meta Analysis
Job satisfaction and turnover among nurses: integrating research findings across studies.
A meta-analytic study investigated the causal relationships among job satisfaction, behavioral intentions, and nurse turnover behavior. A theoretical model was proposed in which behavioral intentions were viewed as a direct antecedent to turnover behavior. ⋯ The results of the modifier analysis suggested that effect sizes are fairly robust to differences in study designs, response rates, and methods of measuring job satisfaction, but the manner in which behavioral intentions were operationalized appeared to moderate the relationship between behavioral intentions and turnover and job satisfaction. Of variables related to nursing job satisfaction, work content and work environment had a stronger relationship with job satisfaction than economic or individual difference variables.
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The safety of naproxen sodium for over-the-counter use was evaluated based on 48 randomized, double-blind, placebo-controlled clinical trials that evaluated naproxen/naproxen sodium (NAP) for indications appropriate to, and under, conditions common to, nonprescription analgesics. Of the 48 studies, 27 were single-dose studies and 21 were multiple-dose studies of 1 to 10 days' duration; 19 studies included ibuprofen and 9 included acetaminophen. A total of 4138 patients received naproxen or naproxen sodium (3589 patients received naproxen 187.5 to 400 mg and 549 received naproxen sodium 220 to 440 mg), 2423 received placebo, 1574 received ibuprofen (200 or 400 mg), and 671 received acetaminophen (500 to 1000 mg). ⋯ Across all 48 studies, 83% of both the NAP- and placebo-treated patients reported no adverse events. The incidence rates were similar between NAP and placebo, with headache (4.8% NAP, 6.4% placebo), nausea (3.4% NAP, 3.1% placebo), and somnolence (2.7% NAP, 1.9% placebo) the most commonly reported events. Rates of adverse events with NAP, ibuprofen, and acetaminophen were similar.
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J. Neurol. Neurosurg. Psychiatr. · Jul 1995
Meta AnalysisDexamethasone treatment for acute bacterial meningitis: how strong is the evidence for routine use?
A methodological appraisal of the published randomised controlled trials on the use of dexamethasone as an adjunct treatment in acute bacterial meningitis was carried out to examine whether the available evidence is strong enough to support the routine use of the drug. Studies were eligible for inclusion if they were published in indexed journals after 1966, written in English, and were randomised controlled trials with dexamethasone as adjunct to antimicrobials in patients with acute bacterial meningitis. All studies were extracted and their adherence to eight methodological principles was graded as adequate, inadequate, or unclear. ⋯ It is concluded that the available evidence is not strong enough to support a routine use of dexamethasone in acute bacterial meningitis. Further research is needed to determine the effect of a policy to use dexamethasone early in the management of suspected acute bacterial meningitis. Future studies should adopt a pragmatic approach, be methodologically rigorous, and meticulously measure the risk as well as the benefit of this policy.
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Critical care medicine · Jul 1995
Meta AnalysisSteroid controversy in sepsis and septic shock: a meta-analysis.
The use of corticosteroids in patients with sepsis or septic shock has been controversial for many decades. Clinical studies have reported beneficial, as well as negative results. We conducted a meta-analysis to assess the clinical evidence and to evaluate treatment effects in specific subgroups of patients. ⋯ No overall beneficial effect of corticosteroids in patients with septic shock was observed; however, there is some evidence for a positive effect in patients with Gram-negative septicemia.
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This review provides meta-analytic data of studies aiming at improved treatment of deep vein thrombosis and pulmonary embolism. The introduction of low molecular weight heparin has considerably ameliorated the initial treatment of deep vein thrombosis, and should now be regarded as the treatment of choice for most patients with deep vein thrombosis. Oral anticoagulant treatment is presently considered safe and effective for the long-term treatment of venous thromboembolism, provided that the INR is maintained at 2.0-3.0. ⋯ Studies determining the efficacy and safety of low molecular weight heparin in this condition deserve priority. Thrombolytic therapy should be restricted to patients with massive pulmonary embolism, unless safer methods of thrombolysis have been developed. Surgical embolectomy and catheter fragmentation of emboli seem alternative options but deserve further investigations.