Journal of evaluation in clinical practice最新文献

{"title":"The Effect of Hydrotherapy Application on Pain During Birth and Postpartum Fatigue and Comfort","authors":"Zeynep Cambaz,&nbsp;Ayça Şolt Kırca","doi":"10.1111/jep.70060","DOIUrl":"https://doi.org/10.1111/jep.70060","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The aim of this study is to investigate the effect of hydrotherapy applied during labour on pain felt at birth, postpartum fatigue and comfort, and person-centred maternity care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The sample of this randomized controlled experimental study consisted of 80 pregnant women (40 in the experimental group and 40 in the control group) who would give a birth for the second time. The experimental group was given a shower twice with water at 32°C–37°C in the desired position for 20 min when the dilation was 4–5 cm and 6–8 cm. The control group was given routine care. Data were collected with a descriptive information form and the Visual Analogue Scale (VAS) before the birth and with the Visual Analogue Scale for Fatigue (VASF), the Postpartum Comfort Scale (PCS), and the Person-Centred Maternity Care Scale (PCMCS) following the birth. Pearson's <i>χ</i>² test, independent samples <i>t</i>-test and Mann–Whitney <i>U</i> test were used to analyze the data, and the confidence interval was evaluated at <i>p</i> &lt; 0.05.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The labour times, VAS values and VASF scores of the hydrotherapy group were significantly lower than those of the control group (VAS: 6.98 ± 1.46; 9.45 ± 0.68; VASF: 59.43 ± 36.33; 76.47 ± 26.91, respectively). The hydrotherapy group had significantly higher 1st- and 5th-minute Apgar scores, postpartum comfort scores and PCMCS scores than the control group (PCS: 138.4 ± 15.62; 135.35 ± 10.84; PCMCS: 59.35 ± 5.32; 58.55 ± 4.11, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>It was determined that hydrotherapy application shortened labour time, had a positive effect on newborn Apgar scores, relieved pain felt during birth, reduced postpartum fatigue, increased postpartum comfort and had a positive effect on person-centred maternal care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70060","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the Reimbursement Process for New Drugs: A Case Study of a Two-Waiver System in South Korea","authors":"Seung-Rae Yu","doi":"10.1111/jep.70074","DOIUrl":"https://doi.org/10.1111/jep.70074","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To empirically analyse the case of a newly introduced system in Korea to improve the process of drug reimbursement to investigate the application of the waiver system to economic evaluations and pricing negotiations, to examine the characteristics and inclusion outcomes of drugs subject to this system and to derive implications for improving patient access and financial sustainability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A drug data set was compiled using data from the Ministry of Health and Welfare (MoHW) and public institutions. Additional information on pharmaceutical companies and indications was obtained from the Korea Food and Drug Administration (KFDA). Descriptive statistics were used to summarise variable distributions. Chi-squared tests and multivariate logistic regression analyses, including interaction terms, were performed to determine differences before and after the implementation of the waiver system and their relevance to negotiation outcomes. Statistical analysis was performed using SPSS version 27.0 with a significance level of 0.05.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 2007 to 2022, a total of 785 new drugs have been introduced. In Korea, the waiver system includes two types: a price negotiation waiver primarily for non-orphan and non-cancer drugs and an economic evaluation waiver designed for orphan and cancer drugs with significant clinical needs. Drugs listed in three or fewer countries were significantly more likely to utilise the price negotiation waiver system due to pricing disadvantages associated with limited international registration. Since the introduction of the two waiver systems, there has been a notable increase in negotiation agreement rates for orphan and cancer drugs, a trend supported by regression analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study demonstrates how Korea's two-waiver system streamlined the reimbursement process, improving access to orphan and cancer drugs while ensuring financial sustainability. The system's eligibility criteria effectively balance the needs of noncritical and critical diseases, ensuring equitable access while maintaining fiscal responsibility. These findings have important institutional implications for improving patient access to medicines while effectively managing financial expenditure.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70074","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Relationship Between Inertia Levels and Tendency to Medical Errors Among Nurses in Paediatric Clinics","authors":"Veysel Can,&nbsp;Mehmet Bulduk,&nbsp;Abdullah Adıyaman","doi":"10.1111/jep.70069","DOIUrl":"https://doi.org/10.1111/jep.70069","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to evaluate the relationship between the inertia levels of nurses working in paediatric clinics and their tendency to make medical errors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This descriptive study was conducted between April 2023 and June 2023 with nurses working in the paediatric clinics of a training and research hospital in a province in eastern Turkey. The Descriptive Information Form, Inertia Scale (IS) and Nursing Tendency to Medical Errors Scale (NTMSE) were used as data collection tools. The entire population was targeted without using a sampling method, and the study was completed with 221 nurses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the nurses, 52.9% were between 26 and 33 years of age, and 52.0% were female. Additionally, 66.1% were single, 50.7% had an income less than their expenses, and 77.8% held a bachelor's degree. Inertia was significantly associated with age, marital status, income level, professional experience, duration of work and medical error training, while it was found to be lower among nurses who followed scientific publications (<i>p</i> &lt; 0.05). However, there was no statistical correlation between the mean total score of the NTMSE and the descriptive characteristics (<i>p</i> &gt; 0.05). An association was found between age and the falls subscale of the NTMSE, while nurses working in paediatric units exhibited higher malpractice tendencies in the falls, patient monitoring, and material safety subscales (<i>p</i> &lt; 0.05). No statistically significant correlation was found between the IS and NTMSE (<i>p</i> &gt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The study determined that the inertia levels of nurses working in paediatric clinics were moderate and their tendency to make medical errors was low. Regular training programmes and professional development activities should be planned to reduce inertia levels and enhance professional performance. Additionally, improving the working conditions of nurses and strengthening supportive monitoring mechanisms are essential to prevent medical errors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty Focus: Empowering Rural Health With Advanced Nurse Practitioners: A Discussion Paper","authors":"Maria Betts,&nbsp;Deirdre Harkin","doi":"10.1111/jep.70075","DOIUrl":"https://doi.org/10.1111/jep.70075","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Frailty is a multidimensional condition with symptoms relating to falls, immobility, incontinence, impaired memory and medication side-effects. With increasing numbers of frailty, particularly in rural areas, healthcare systems are being challenged globally. Moreover, frailty may be more common in rural communities as a consequence of transportation issues, limited access to healthcare services and health promotion activities. Advanced Nurse Practitioners are ideally placed to undertake comprehensive geriatric assessments and identify frailly syndromes.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aims&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Explore the function of the Advanced Nurse Practitioner in managing people living with frailty in rural areas, drawing on a review of current guidelines, literature, and practice, considering public health agendas and evidence-based practice.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Design&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Discussion paper.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Key Learnings&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Frailty is linked to poorer health outcomes, an excessive use of health resources and decreased quality of life. Incorporating Advanced Nurse Practitioners into integrated models of care and health improvement strategies, can improve patient outcomes.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Using advanced clinical and decision-making skills, Advanced Nurse practitioners deliver evidence-based care to improve patient safety and health outcomes. Creating partnerships to enhance the provision of healthcare, they are focused on frailty prevention, detection and providing support to develop co-produced management plans to address individual needs. The Advanced Nurse Practitioner has the ability to practice autonomously within an expanded scope of clinical practice, making them the ideal professional to support people living with frailty in rural areas.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Impact for Nursing&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;When thinking about future strategies for advanced practice, it is important to acknowledge the lack of regulation, roles in nursing, inadequate title protection, role variability, and different educational requirements. Organisations need to consider the enablers and barriers of Advanced Nurse Practitioners fulfilling their duties. Advanced Nurse practitioners are guided by public health agendas to improve the population health of those in rural areas.&lt;/p&gt;\u0000 ","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70075","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"‘Doing the Right Things’ First and Then ‘Doing Things Right’","authors":"James A. Marcum","doi":"10.1111/jep.70079","DOIUrl":"https://doi.org/10.1111/jep.70079","url":null,"abstract":"&lt;p&gt;Modern medicine is facing a crisis with respect to providing the quality of healthcare patients seek or need, especially for chronic diseases such as cancer and diabetes. Sturmberg and Mercuri offer an insightful solution to this crisis with a shift in perspective. Invoking the management guru, Peter Drucker [&lt;span&gt;1&lt;/span&gt;], they argue that the necessary shift in perspective is from ‘Doing things right’ to ‘Doing the right things’ first. In other words, medicine needs to shift to a perspective that includes the context in which the patient is embedded, from one that often ignores or excludes the patient's context and thereby fails to deliver the healthcare that the patient really requires. The shift not only has an impact on medical research but also on clinical practice. Indeed, the patient's lived context or lifeworld is important with respect to providing the healthcare patients seek or need.&lt;/p&gt;&lt;p&gt;Sturmberg and Mercuri also invoke the mathematician, David Sumpter [&lt;span&gt;2&lt;/span&gt;], and his four ways of thinking to implement the paradigmatic shift from ‘Doing things right’ to ‘Doing the right things’ first. According to Sumpter, the first way of thinking is statistical by which the individual patient is defined in terms of the collective average. The next is interactive thinking, which explicates collective interactions simply with respect to a single linear cause and effect. The third is chaotic thinking in which the randomness and disorder of events are factored into the cognitive equations and calculations. The final is complex thinking, which, according to Sturmberg and Mercuri, is ‘more focused on introspection and self-reflection…about finding the stories which help us to better understand ourselves, as well as those around us’ (p. 9). Their goal for contemporary medicine, then, is to shift from statistical and interactive thinking that only considers the average and a linear cause and effect in terms of ‘Doing things right’ to complex and chaotic thinking that embeds the components within a multilayered and multifactorial context or story including the ethical with respect to ‘Doing the right things’ first.&lt;/p&gt;&lt;p&gt;Besides Sumpter, Sturmberg and colleagues [&lt;span&gt;3, 4&lt;/span&gt;] have also drawn on another management guru, David Snowden, and the Cynefin framework to address multilayered and multifactorial contexts [&lt;span&gt;5, 6&lt;/span&gt;], which is relevant to Sturmberg and Mercuri's current project. The Cynefin framework consists of four domains for making decisions: clear, complicated, complex and chaotic. The clear domain pertains to knowing the relevant factors involved in a decision, while the complicated domain involves several unknown factors but still a robust decision is possible. Both complex and chaotic domains contain a majority of unknown factors or unknowable factors, respectively, such that decisions are often difficult and questionable but still need to be made. The relevance for the Cynefin framework for Sturmberg and Mercuri's","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70079","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Clinical Indicators of Acute Deterioration and Morbidity and Mortality in the Residential Aged Care Population: A Retrospective Cohort Study of Routinely Collected Health Data","authors":"Julie Frances Daltrey,&nbsp;Michal Kathleen Boyd,&nbsp;Vanessa Burholt,&nbsp;Heather McLeod,&nbsp;W. U. Zhenqiang,&nbsp;Katherine Bloomfield,&nbsp;Jacqualine Robinson","doi":"10.1111/jep.70068","DOIUrl":"https://doi.org/10.1111/jep.70068","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The timely identification of acute deterioration in people living in residential aged care is critical to reducing rates of resident morbidity and mortality. However, residents often present with atypical or nonspecific presentations that make this difficult. This study aimed to quantify the strength of the relationship between the indicators acute deterioration reported in the literature and morbidity and mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A retrospective cohort study using routinely collected health data. A single dependant acute deterioration variable (emergency department presentation or hospital admission or death within 7 days of the last completed international resident assessment instrument long-term care facility (interRAI-LTCF) assessment) was correlated with indicators of acute deterioration reported in the literature and available in interRAI-LTCF. Univariate and multivariate logistic regression analysis evaluated this association.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Nine variables were independently associated with acute deterioration. These were being ‘largely asleep or unresponsive’ odds ratio (OR): 7.95, 95% CI: 4.72–13.39, <i>p</i> &lt; 0.001, ‘easily distracted’ (OR: 1.78, 95% CI: 1.28–2.49, <i>p</i> &lt; 0.001), eating ‘one or fewer meals a day’ (OR: 2.13, 95% CI: 1.67–2.73, <i>p</i> &lt; 0.001), reduced activities of daily living (OR: 2.06, 95% CI: 1.11–3.82, <i>p</i> = 0.02) inability to complete toilet transfer (OR: 1.95, 95% CI: 1.24–3.03, <i>p</i> = 0.004), ‘dyspnoea; at rest’ (OR: 1.81, 95% CI: 1.32–2.49, <i>p</i> &lt; 0.001), ‘two or more falls in 30 days’ (OR: 1.53, 95% CI: 1.15–2.03, <i>p</i> = 0.003), peripheral oedema (OR: 1.37, 95 CI: 1.07–1.77, <i>p</i> = 0.014) and daily pain (OR: 1.37, 95% CI: 1.05–1.77, <i>p</i> = 0.019).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Presenting with one of nine variables made residents between 1.4 and 8 times more likely to be experiencing acute deterioration than others living in the facility. The monitoring the resident for these variables by healthcare assistants could support the timely identification of acute deterioration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>Not applicable.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Virtual Multidisciplinary Team Meeting Model for Adult Patients on Haemodialysis: A Qualitative Study","authors":"Qiumian Wang,&nbsp;Yangama Jokwiro,&nbsp;Edward Zimbudzi","doi":"10.1111/jep.70071","DOIUrl":"https://doi.org/10.1111/jep.70071","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>During the COVID-19 pandemic, face-to-face multidisciplinary team meetings evolved to virtual platforms. Healthcare professionals' experiences of virtual multidisciplinary team meetings is unknown, and it is not clear whether virtual meetings are a feasible long-term alternative in the post pandemic era.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To explore the experiences and perceptions of members of the multidisciplinary team managing people with kidney disease regarding virtual meetings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Semi-structured interviews were conducted. Maximal variation sampling was used to ensure adequate representation by gender and professional roles. All interviews were audiotaped and transcribed verbatim, before being analysed by two researchers independently using the Theoretical Domains Framework. A third researcher was then referred to for resolving any disagreements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Members of the nephrology multidisciplinary team meeting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>Health professionals' experiences and perspectives of virtual multidisciplinary team meetings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the nine participants interviewed, six were females and the majority were nurses. Most of the participants were aged 30–40 years. Three main themes emerged within the three primary domains: impact on staff and patient outcomes; limited technological skills, and opportunities for improvement. From the four intermediate domains, another four themes were captured: professional responsibility; impact on engagement; barriers to participation; and desire to provide optimal patient care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Healthcare professionals of a single centre nephrology care team reported that virtual multidisciplinary meetings overcame geographic barriers and infection control restrictions, and offered possibilities for broader inclusivity. However, strategies are needed to overcome technological issues, improve participants' skills to navigate technology, and optimize active participation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70071","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Guideline Development Processes: Integrating Evidence Estimation and Decision-Analytical Frameworks","authors":"Benjamin Djulbegovic,&nbsp;Iztok Hozo,&nbsp;Ilkka Kunnamo,&nbsp;Gordon Guyatt","doi":"10.1111/jep.70051","DOIUrl":"https://doi.org/10.1111/jep.70051","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Rationale, Aims and Objectives&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Despite using state-of-the-art methodologies like Grades of Recommendation, Assessment, Development and Evaluation (GRADE), current guideline development frameworks still rely heavily on panellists' &lt;i&gt;intuitive&lt;/i&gt; integration of evidence related to the benefits and harms/burdens of health interventions. This leads to the ‘black-box’ and ‘integration’ problems, highlighting the lack of transparency in guideline decision-making. Combined with humans' limited capacity to process the large volumes of information presented in Summary of Findings (SoF) tables—the primary output of systematic reviews that underpin guideline recommendations—this reliance on non-explicit processes raises concerns about the trustworthiness of clinical practice guidelines.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;SoF tables provide the best available evidence, derived from frequentist or Bayesian estimation frameworks. Decision analysis, which integrates both types of estimates but considers intervention consequences, is the only analytical approach that combines multiple outcomes (benefits, harms and costs) into a single metric to support decision-making. Such analysis seeks to identify the optimal decision by balancing harms, benefits and uncertainties. This paper leverages the PICO format (Population, Intervention, Comparison(s), Outcome) as a conceptual basis for deriving SoF tables. Subsequently, we propose a solution to GRADE's “black-box” and “integration” problems by matching PICO-based SoF with decision models.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We succeeded in connecting the PICO framework to simple decision-analytical models, restricted to time frames supported by empirically verifiable evidence, to calculate which competing intervention offers the greatest benefit (net differences in expected utility; ΔEU). The single metric [ΔEU] enabled a simple, transparent and easy-to-understand assessment of the superiority of competing management strategies across multiple outcomes (considering both benefits and harms), addressing the ‘black-box’ and ‘integration’ problems. Completing a SoF-based decision model takes about 10 min. Not surprisingly, the recommendations based on ΔEU may differ from the intuitive recommendations of panels.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We propose that incorporating the straightforward and transparent modelling into guideline panels' decision-making processes will enhance their intuitive judgements, resulting in more trustworthy recommendations. Give","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70051","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thirty-Five Years of General Practice Payment and Administration in England","authors":"Richard A. Young","doi":"10.1111/jep.70064","DOIUrl":"https://doi.org/10.1111/jep.70064","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Fee-for-service payment is commonly blamed for problems in the US healthcare system, including the current and projected shortage of primary care physicians. Britain's National Health Service (NHS) general practitioner (GP) workforce has been paid mostly by capitation since the creation of the NHS, which leads many US observers to conclude that capitation will solve many primary care problems.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>To compile and synthesize information about GP payment and administration from publicly-avalailable sources.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a compilation of 30+ years of articles I accumulated about GPs and the NHS supplemented by Google Scholar, NHS websites, and similar searches to close information gaps; as well as two trips to directly observe UK GPs care for their patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty five years of cycles of scarce resources have impacted the GP workforce and scope of practice. There has never been a golden age of support for GPs. GPs have worked under a series of unfunded or under-funded mandates and have been tasked with responsibilities that more appropriately should have been handled by policy makers. The net result is that the scope of practice of GPs has gradually eroded. The years 2002–2009 were probably the most GP-friendly with the best population outcomes, when GPs were given additional resources and were empowered to positively affect other aspects of their local healthcare system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The British GP experience shows that it is too easy for politicians to add more work responsibilities to physicians paid by capitation without seriously examining and supporting the GP workforce to achieve the desired goals, which has led some UK GPs to recently propose fee-for-service payment. Administering and paying for GP services through the lens of complex adaptive systems management, with adequate resources, will likely result in a more effective and sustainable GP workforce.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregnant Women's Breast Milk and Breastfeeding Myths and Associated Factors: A Case of Refugee and Non-Refugee Women","authors":"Ayça Şolt Kırca,&nbsp;Elif Dağli,&nbsp;Seçil Hür","doi":"10.1111/jep.70059","DOIUrl":"https://doi.org/10.1111/jep.70059","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study was conducted to determine the prevalence of breast milk and breastfeeding myths during pregnancy among Turkish, Turkish–Romani, and Syrian pregnant women and compare the similarities and differences between the countries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Study Design</h3>\u0000 \u0000 <p>The sample of the study consisted of 330 pregnant women who presented to a hospital. Data were collected with a ‘Descriptive Information Form’ and ‘Breast Milk and Breastfeeding Myths Form’ developed by the researchers. The Breast Milk and Breastfeeding Myths Form consists of items expressing common beliefs about breast milk and breastfeeding, and each item is evaluated with one of the following three options: ‘yes,’ ‘no,’ and ‘no idea.’ The forms were applied face to face to the pregnant women who came to the outpatient clinic. The data were evaluated on the SPSS (14.0) software package, and chi-square and advanced analyses were used for the statistical analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Turkish, Turkish-Romani, and Syrian pregnant women who made up the study sample had similar socio-demographic characteristics. It was determined that there were intercultural differences in 28 out of 30 myths evaluated by Turkish, Turkish-Romani, and Syrian mothers regarding breast milk and breastfeeding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>It was determined that Turkish pregnant women had different myths about breast milk and breastfeeding from Syrian and Turkish-Romani pregnant women. It can be said that false beliefs and attitudes about breast milk and breastfeeding are common.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 2","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70059","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}