Maike van Niekerk, PhD

All Publications

• Proactive integrated consultation-liaison psychiatry and time spent in hospital by older medical inpatients in England (The HOME Study): a multicentre, parallel-group, randomised controlled trial The Lancet Psychiatry Sharpe and Walker (shared 1st author), M., van Niekerk (second author), M., Toynbee, M., Magill, N., Frost, C., White, I. R., Walker, S., Duarte, A., Owens, C., Dickens, C., Price, A., The HOME Study Team 2024

  View details for DOI 10.1016/S2215-0366(24)00188-3

• Strengthening the Pipeline: Promoting Diversity into Orthopedic Surgery. Clinics in sports medicine van Niekerk, M., O'Mara, A., Kha, S., Zhou, J., McAdams, T. A., Ladd, A., Shea, K., Frick, S., Maloney, W. J., Chu, C. R. 2024; 43 (2): 253-270

  Abstract

  The United States is a nation of diverse racial and ethnic origins. Athletes represent the full spectrum of the nation's population. However, the orthopedic surgeons who serve as team physicians are Caucasian and male with staggeringly few exceptions. This manuscript provides an overview of the current status and barriers to diversity among orthopedic team physicians, along with strategies to address the issue. Specifically, pipeline initiatives implemented at one academic medical school and orthopedic surgery department are summarized as potential models that can be further developed by other institutions to enhance diversity in orthopedic surgery.

  View details for DOI 10.1016/j.csm.2023.07.007

  View details for PubMedID 38383108

• The use of hinged elbow orthosis following surgical management of terrible triad injuries of the elbow. European journal of orthopaedic surgery & traumatology : orthopedie traumatologie Cruz, J. P., Salazar, B., van Niekerk, M., Finlay, A. K., Van Rysselberghe, N. L., Goodnough, L. H., Bishop, J. A., Gardner, M. J. 2024

  Abstract

  To determine outcomes following surgical management of terrible triad injuries in patients treated with and without a hinged elbow orthosis (HEO) in the post-operative setting.This study was a retrospective review of 41 patients who underwent surgical treatment of terrible triad injuries including radial head fracture, coronoid fracture, and ulnohumeral dislocation between 2008 and 2023 with at least 10-week follow-up.Nineteen patients were treated post-operatively without HEO, and 22 patients were treated with HEO. There were no differences in range of motion (ROM) between patients treated with and without HEO in final flexion-extension arc (118.4° no HEO, 114.6° HEO, p = 0.59) or pronation-supination arc (147.8° no HEO, 141.4° HEO, p = 0.27). Five patients treated without HEO and one patient treated with HEO returned to the operating room for stiffness (26%, 5%, p = 0.08). QuickDASH scores were similar between groups (p = 0.69).This study found no difference in post-operative ROM, complications, or QuickDASH scores in patients treated post-operatively with or without HEO. Based on these results, we cannot determine whether the use of HEO adds additional stability to the elbow while initiating ROM exercises post-operatively.

  View details for DOI 10.1007/s00590-024-03843-8

  View details for PubMedID 38403660

  View details for PubMedCentralID 6583215

• Patient and medical unit staff experiences of proactive and integrated consultation-liaison psychiatry in The HOME Study: a qualitative investigation Journal of the Academy of Consultation-Liaison Psychiatry Sharpe, M., Toynbee, M., van Niekerk, M., Bold, R., Walker, J. 2024
• “Therapy Deserts” – A Call to Action to Address Inequitable Access to Therapy Services Among Pediatric Patients JPOSNA van Niekerk, M., Harbacheck, K., Obilo , C., Liu , T., Weisman , A., Johnson , A., Magaña , S., Balakrishnan , K., Cook , K., Shea , K. 2024; 7

  View details for DOI 10.1016/j.jposna.2024.100040

• Connecting Underrepresented Medical Students to Resources and Role Models In Orthopaedic Surgery: A Virtual Diversity, Equity, Inclusion and Accessibility Summit Under Review Debopadhaya, S., Saker, C., van Niekerk, M., Agarwal, A. R., Zhao, A., Shea, K., Mulcahey, M. K., MSOS DEIA Committee 2024
• Proactive and integrated consultation-liaison psychiatry for older medical inpatients: A mixed methods description of training, care provided and clinician experience in the HOME study General Hospital Psychiatry Sharpe, M., Toynbee, M., van Niekerk, M., Solomons, L., Owens, C., Price, A., Yousif, M., Palmer, A., Clay, F., Berk, G., Burns, J., Hill, L., Harris, J., Bajorek, T., Sirois-Giguere, G., Magill, N., Aitken, P., Dickens, C., Walker, J. 2024
• Student-Athletes' Deteriorating Mental Health During COVID-19: Recommendations on Proactive Strategies for Addressing Unique Mental Health Needs. Journal of pediatric psychology Cheng, M., van Niekerk, M., Biviano, G. 2023

  Abstract

  High school and college student-athletes face unique stressors that can negatively impact their mental health, which were exacerbated by the COVID-19 pandemic. Although mental health issues are prevalent in athletic communities, there often remains stigma around mental health and reluctance to seek psychological support. Physical injury can be the cause or the result of the psychological struggles that athletes face-holistic care for the adolescent athlete population must incorporate both elements. Pediatric psychologists, allied healthcare professionals, sports organizations, academic institutions, coaches, caregivers, and student-athletes themselves all play an active role in shaping the mental health of student-athletes and are therefore responsible for creating a culture that prioritizes mental and physical wellness. This paper aims to provide clear recommendations for the various stakeholders on how to address the unique mental health needs of student-athletes. The recommendations presented are based on a review of existing literature in the field and on-the-ground experience working with student-athletes during the COVID-19 pandemic. There are several key interventions highlighted in this paper, including changing the athletic community's culture to prioritize the holistic well-being of athletes, as well as proactively offering mental health education, resources, and programming for student-athletes, with a particular emphasis on health equity to meet the needs of students most at risk. Commitment from pediatric psychologists and allied healthcare professionals, sports organizations, academic institutions, coaches, caregivers, and student-athletes will maximize the likelihood of improving student-athletes' psychological well-being.

  View details for DOI 10.1093/jpepsy/jsad071

  View details for PubMedID 37816146

• A Step-by-Step Guide to Understanding and Conducting Quality Improvement Initiatives in Orthopaedic Surgery JPOSNA van Niekerk, M., Shea, K., Samora, J., Jones, K., Brighton, B., Pinney, S., Tileston, K. 2023; 5 (1)

  View details for DOI 10.55275/JPOSNA-2023-631

• Psychological aspects of return to sport for the female athlete Arthroscopy, Sports Medicine, and Rehabilitation van Niekerk, M., Matzkin , E., Christino , M. 2023

  View details for DOI 10.1016/j.asmr.2023.04.021

• System-Level Interventions for Addressing Burnout and Improving Professional Wellness for Orthopedic Surgeons JPOSNA van Niekerk, M., Tileston, K., Bouchard , M., Atanda , A., Goldstein , R., Gantsoudes , G., Carter , C., Christino , M. 2023; 5 (1)

  View details for DOI 10.55275/JPOSNA-2023-620

• A Comprehensive Umbrella Review for Understanding Burnout in Orthopaedic Surgery JPOSNA van Niekerk , M., Tileston , K., Bouchard, M., Christino, M., Goldstein, R., Gantsoudes , G., Carter , C., Atanda , A. 2023; 5 (1)

  View details for DOI 10.55275/JPOSNA-2023-619

• POSNA Safe Surgery Program (PSSP): First-Year Results Implementing Quality Metrics JPOSNA Tileston, K., van Niekerk, M., Vitale, M., Cho, R., Brighton, B., Tippabhatla, A., Rohde, M., Shea, K. 2023
• Effectiveness of psychosocial interventions for pediatric patients with scoliosis: a systematic review World Journal of Pediatric Surgery van Niekerk, M., Richey, A., Vorhies, J., Wong, C., Tileston, K. 2023; 6 (e000513)

  View details for DOI 10.1136/wjps-2022-000513

• The Prevalence of Psychiatric Disorders in General Hospital Inpatients: A Systematic Umbrella Review. Journal of the Academy of Consultation-Liaison Psychiatry van Niekerk, M., Walker, J., Hobbs, H., Magill, N., Toynbee, M., Steward, B., Harriss, E., Sharpe, M. 2022

  Abstract

  To inform the future development of Consultation-Liaison (C-L) Psychiatry services we need accurate information on the prevalence of psychiatric disorders in the general hospital inpatient setting. Systematic reviews have summarized the literature on specific aspects of this broad topic, but there has been no high-level overview that aggregates their findings and identifies gaps in the relevant literature. We therefore aimed to produce a comprehensive overview of the field, summarizing the research literature on the prevalence of psychiatric disorders (that is, interview-based psychiatric diagnoses) in general hospital inpatients. We did this using a systematic umbrella review (systematic review of systematic reviews), which is the best and most efficient method for summarizing a broad area of research.We searched Ovid Medline, Ovid Embase, Ovid PsycINFO, EBSCO CINAHL and Scopus from database inception to September 2021 for systematic reviews that provided a pooled prevalence estimate, or prevalence range, for interview-diagnosed psychiatric disorders in general hospital inpatients. Two reviewers independently assessed articles and extracted data. The review is registered with PROSPERO, number CRD42019125574.We screened 11,728 articles and included ten systematic reviews in our umbrella review. We were able to extract pooled prevalence estimates from these as follows: major depression 12% to 20%; any anxiety disorder 8%; generalized anxiety disorder 5%; panic disorder 3%; delirium 15%. We were only able to extract a prevalence range for dementia, which was 3% to 63%. We found no systematic reviews from which we could extract prevalence data for the other psychiatric disorders that we included in our searches, indicating important gaps. From these data we estimated that approximately one-third of inpatients has a psychiatric disorder.Psychiatric disorders are very common in general hospital inpatients. Whilst the planning of C-L Psychiatry services will benefit from more research on the prevalence of each of the full range of disorders encountered in the inpatient setting, our findings indicate that we already know enough to justify increased and more population-based service provision.

  View details for DOI 10.1016/j.jaclp.2022.04.004

  View details for PubMedID 35491011

• PASS: A checklist for assessing the quality of systematic reviews of prevalence studies General Hospital Psychiatry Walker, J., Hobbs, H., Magill, N., van Niekerk, M., Sharpe, M. 2022: 133-134

  View details for DOI 10.1016/j.genhosppsych.2022.01.003

• Patients Who Return to Sport After Primary Anterior Cruciate Ligament Reconstruction Have Significantly Higher Psychological Readiness: A Systematic Review and Meta-analysis of 3744 Patients Am J Sports Med Xiao, M., van Niekerk, M., Trivedi, N., Hwang, C., Sherman, S., Safran, M., Abrams, G. 2022

  View details for DOI 10.1177/03635465221102420

• World mental health report: Transforming mental health for all World Health Organization, 1. World Health Organization. 2022
• Framework for collaborative action on tuberculosis and comorbidities WHO Global TB Programme, 1. World Health Organization. Geneva. 2022 1-88
• Letter to the editor: Improving Biopsychosocial Care for Adolescents with Scoliosis “A systematic scoping review and textual narrative synthesis of the qualitative evidence related to adolescent idiopathic scoliosis”   International Journal of Orthopaedic and Trauma Nursing van Niekerk, M., Tileston, K. 2022

  View details for DOI 10.1016/j.ijotn.2022.100961

• 'Do not attempt cardiopulmonary resuscitation' (DNACPR)-difficulty in discussions with older medical inpatients and their families: a survey of hospital doctors. BMJ supportive & palliative care Walker, J., Burke, K., Magill, N., van Niekerk, M., Wanat, M., Hobbs, H., Rocroi, I., Frost, C., Sharpe, M. 2021

  Abstract

  To determine, for doctors looking after older medical inpatients: (1) how difficult they find discussions about 'do not attempt cardiopulmonary resuscitation' (DNACPR); (2) whether difficulty is associated with doctors' personal and professional characteristics; (3) how frequently DNACPR discussions are made more difficult by practical issues and by doctors' uncertainties.Survey of hospital doctors working on the acute medical wards of a UK NHS teaching hospital.171/200 (86%) of eligible doctors participated. 165 had experience of DNACPR discussions with older inpatients and/or their families and were included in our analysis. 'Difficulty' (defined as finding discussions 'fairly difficult' or 'difficult') was experienced by 52/165 (32%) for discussions with patients and 60/165 (36%) for discussions with families. Doctors with specific training in DNACPR discussions were less likely to have difficulty in discussions with patients. Older, more experienced doctors were less likely to have difficulty in discussions with families. Lack of time and place, and uncertainty about prognosis were the most frequently reported causes of difficulty.Many doctors have difficulty in DNACPR discussions. Training needs to include managing discussions with families, as well as with patients, and doctors need time and space to deliver this important part of their job.

  View details for DOI 10.1136/bmjspcare-2021-003151

  View details for PubMedID 34261766

• The effectiveness of inpatient consultation-liaison psychiatry service models: A systematic review of randomized trials GENERAL HOSPITAL PSYCHIATRY Toynbee, M., Walker, J., Clay, F., Hollands, L., van Niekerk, M., Harriss, E., Sharpe, M. 2021; 71: 11-19

  Abstract

  To systematically review randomized trials of the effectiveness of inpatient Consultation-Liaison (C-L) Psychiatry service models in improving patient outcomes, reducing length of hospital stay and decreasing healthcare costs.We searched databases including Ovid Medline, Ovid Embase, Ovid PsycINFO and EBSCO CINAHL for relevant trials. Two independent reviewers assessed articles and extracted data. The review is registered with PROSPERO, number CRD42019120827.Eight trials were eligible for inclusion. All had methodological limitations and all were published more than ten years ago. None reported clear evidence that the C-L Psychiatry service model evaluated was more effective than usual medical care alone. All the service models tested focused on providing a consultation for patients identified by screening. Clinical heterogeneity precluded meta-analysis.Whilst we found no evidence that any of the inpatient C-L Psychiatry service models evaluated is effective, the sparseness of the literature and its methodological limitations preclude strong conclusions. The trials do, however, suggest that purely consultation-based service models may not be effective. A new generation of robust clinical trials of a wider range of C-L Psychiatry service models is now required to inform future service developments.

  View details for DOI 10.1016/j.genhosppsych.2021.04.003

  View details for Web of Science ID 000668955100002

  View details for PubMedID 33906098

• Major Depression and Survival in People With Cancer PSYCHOSOMATIC MEDICINE Walker, J., Mulick, A., Magill, N., Symeonides, S., Gourley, C., Burke, K., Belot, A., Quartagno, M., van Niekerk, M., Toynbee, M., Frost, C., Sharpe, M. 2021; 83 (5): 410-416

  Abstract

  The question of whether depression is associated with worse survival in people with cancer remains unanswered because of methodological criticism of the published research on the topic. We aimed to study the association in a large methodologically robust study.We analyzed data on 20,582 patients with breast, colorectal, gynecological, lung, and prostate cancers who had attended cancer outpatient clinics in Scotland, United Kingdom. Patients had completed two-stage screening for major depression as part of their cancer care. These data on depression status were linked to demographic, cancer, and subsequent mortality data from national databases. We estimated the association of major depression with survival for each cancer using Cox regression. We adjusted for potential confounders and interactions between potentially time-varying confounders and the interval between cancer diagnosis and depression screening, and used multiple imputation for missing depression and confounder data. We pooled the cancer-specific results using fixed-effects meta-analysis.Major depression was associated with worse survival for all cancers, with similar adjusted hazard ratios (HRs): breast cancer (HR = 1.42, 95% confidence interval [CI] = 1.15-1.75), colorectal cancer (HR = 1.47, 95% CI = 1.11-1.94), gynecological cancer (HR = 1.36, 95% CI = 1.08-1.71), lung cancer (HR = 1.39, 95% CI = 1.24-1.56), and prostate cancer (HR = 1.76, 95% CI = 1.08-2.85). The pooled HR was 1.41 (95% CI = 1.29-1.54, p < .001, I2 = 0%). These findings were not materially different when we only considered the deaths (90%) that were attributed to cancer.Major depression is associated with worse survival in patients with common cancers. The mechanisms of this association and the clinical implications require further study.

  View details for DOI 10.1097/PSY.0000000000000942

  View details for Web of Science ID 000669432500002

  View details for PubMedID 33938501

• The prevalence of anxiety in general hospital inpatients: A systematic review and meta-analysis General Hospital Psychiatry Walker, J., van Niekerk (joint first author), M., Hobbs, H., Toynbee, M., Magill, N., Bold, R., Hampsey, E., Harriss, E., Frost, C., Sharpe, M. 2021; 72: 131-140

  View details for DOI 10.1016/j.genhosppsych.2021.08.004

• Different independent associations of depression and anxiety with survival in patients with cancer JOURNAL OF PSYCHOSOMATIC RESEARCH Walker, J., Magill, N., Mulick, A., Symeonides, S., Gourley, C., Toynbee, M., van Niekerk, M., Burke, K., Quartagno, M., Frost, C., Sharpe, M. 2020; 138: 110218

  Abstract

  Depression and anxiety have both been reported to predict worse subsequent survival in people with cancer. However, depression and anxiety are mutually associated and we lack understanding of their independent associations with survival. We therefore aimed to investigate these in a large sample of patients with common cancers.We analysed data on 19,966 patients with common cancers (breast, colorectal, gynaecological, lung and prostate) who had attended specialist NHS outpatient clinics in Scotland, UK. Hospital Anxiety and Depression Scale (HADS) data were linked with demographic, cancer and mortality data. We estimated the independent associations of depression (HADS depression score) and anxiety (HADS anxiety score) with survival by fitting (separately for each cancer) Cox proportional hazards models which incorporated cubic splines to allow for non-linear associations. We also adjusted for potential confounders.The median time from HADS completion to death or censoring was 1.9 years. Greater depression was found to be strongly associated with worse survival from all cancers. When adjusted for anxiety, this association remained in males and increased in females. Greater anxiety was also associated with worse survival in nearly all cancers. However, when adjusted for depression, the association of anxiety with worse survival was lost. In females the association reversed direction so that greater anxiety was associated with better survival.Although often considered together as aspects of 'emotional distress', depression and anxiety have different independent associations with survival in patients with cancer and should therefore be considered separately.

  View details for DOI 10.1016/j.jpsychores.2020.110218

  View details for Web of Science ID 000579175500002

  View details for PubMedID 32911441

• The HOME Study: Statistical and economic analysis plan for a randomised controlled trial comparing the addition of Proactive Psychological Medicine to usual care, with usual care alone, on the time spent in hospital by older acute hospital inpatients TRIALS Magill, N., White, I. R., Walker, J., Burke, K., Toynbee, M., van Niekerk, M., Yang, F., Walker, S., Sculpher, M., Sharpe, M., Frost, C. 2020; 21 (1): 373

  Abstract

  Prolonged acute hospital stays are a problem for older people and for health services. Failure to effectively manage the psychological and social aspects of illness is an important cause of prolonged hospital stay. Proactive Psychological Medicine (PPM) is a new way of providing psychiatry services to medical wards which is proactive, focussed, intensive and integrated with medical care. The primary aim of PPM is to reduce the time older people spend in hospital because of unmanaged psychological and social problems. The HOME Study will test the effectiveness and cost-effectiveness of PPM.The study is a two-arm, parallel-group, randomised, controlled superiority trial with linked health economic analysis and an embedded process evaluation. The target population is people aged 65 years and older admitted to acute hospitals. Participants will be randomly allocated to either usual care plus PPM or usual care alone. The primary outcome is the number of days spent as an inpatient in a general hospital in the month following randomisation. Secondary outcomes include quality of life, cognitive function, independent functioning, symptoms of anxiety and depression, and experience of hospital stay. The cost-effectiveness of usual care plus PPM compared with usual care alone will be assessed using quality-adjusted life-years as an outcome as well as costs from the NHS perspective.This update to the published trial protocol gives a detailed plan of the statistical and economic analysis of The HOME Study.ISRCTN registry, ISRCTN86120296. Registered on 3 January 2018.

  View details for DOI 10.1186/s13063-020-04256-8

  View details for Web of Science ID 000533404800002

  View details for PubMedID 32366328

  View details for PubMedCentralID PMC7197124

• The HOME Study: study protocol for a randomised controlled trial comparing the addition of Proactive Psychological Medicine to usual care, with usual care alone, on the time spent in hospital by older acute hospital inpatients TRIALS Walker, J., Burke, K., Toynbee, M., van Niekerk, M., Frost, C., Magill, N., Walker, S., Sculpher, M., White, I. R., Sharpe, M. 2019; 20 (1): 483

  Abstract

  Prolonged acute hospital stays are a major problem for older people and for health services. Failure to effectively manage the psychological and social aspects of illness is an important cause of prolonged hospital stays. Proactive Psychological Medicine (PPM) is a new way of providing psychiatry services to medical wards. PPM is proactive, focussed, intensive and integrated with medical care. A major aim of PPM is to reduce the time older people spend in hospital because of unmanaged psychological and social problems. The HOME Study will test the effectiveness and cost-effectiveness of PPM.A two-arm parallel-group randomised controlled superiority trial, with a linked health economic analysis and an embedded process evaluation, will be conducted at three sites. A total of 3588 participants will be recruited and randomised to usual care or usual care plus PPM. The primary outcome is the number of days spent as an inpatient in a general hospital in the month (30 days) post-randomisation. Secondary outcomes for each participant (measured at 1 and 3 months) include quality of life, independent functioning, symptoms of anxiety and depression, cognitive function, and their experience of the hospital stay.The trial has been designed to produce findings that are generalisable to all older medical inpatients (including those with cognitive impairment). It will provide information on the effectiveness and cost-effectiveness of PPM, which we hope will be of value to patients, clinicians, managers and service planners.ISRCTN86120296 . Registered on 3 January 2018.

  View details for DOI 10.1186/s13063-019-3502-5

  View details for Web of Science ID 000479240500002

  View details for PubMedID 31391073

  View details for PubMedCentralID PMC6686488

• Risk for psychological distress among cancer patients with a familial history of Indian Residential School attendance: Results from the 2008-10 First Nations Regional Health Survey van Niekerk, M., Bombay Amy 2017: 3-195

  View details for DOI 10.1002/pon.4272