Journal of evaluation in clinical practice最新文献

{"title":"From Management to Symbiosis: A Five-Layered Model of Negative Capability in Primary Care.","authors":"Takao Wakabayashi, Hiroshi Mihara","doi":"10.1111/jep.70620","DOIUrl":"10.1111/jep.70620","url":null,"abstract":"<p><strong>Rationale: </strong>Modern medicine has traditionally emphasised certainty, which may contribute to intolerance of uncertainty, physician burnout, and premature diagnostic closure. In recent years, the concept of 'Negative Capability' (NC) has emerged as a novel perspective to address this challenge.</p><p><strong>Aims and objectives: </strong>This study aimed to explore the perspectives of general practitioners (GPs) on the multi-layered roles of NC across individual cognition, the physician-patient relationship, and team dynamics, thereby developing a conceptual framework for clinical practice.</p><p><strong>Method: </strong>We conducted a qualitative study using a hermeneutic phenomenological approach in Japan. Focus group interviews were held with a total of 12 participant-sessions (comprising 11 unique general practitioners and an academic philosopher specialising in NC, including one clinician who participated iteratively across sessions to enrich data depth). The verbatim data were analysed manually using the Steps for Coding and Theorisation (SCAT) method, ensuring credibility through continuous peer debriefing and member checking.</p><p><strong>Results: </strong>Clinical NC was conceptualised as five interconnected layers: (1) structural limitations of the medical paradigm, (2) individual transformation, (3) cultivation within a secure base, (4) joint engagement with uncertainty, and (5) inheritance of clinical philosophy. NC functions as an internal 'mental cane' for physicians, supporting a shift from managing uncertainty to remaining with it.</p><p><strong>Conclusion: </strong>This perspective reframes clinical uncertainty from an individual cognitive burden to a shared relational space, alleviating the pressure to prematurely resolve it. This multi-layered approach provides a sustainable philosophy for primary care, supporting clinician well-being and helping clinicians move from rapid resolution towards more meaningful engagement with patients by relational care in complex clinical environments.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 6","pages":"e70620"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039235","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":"Self, Others and Context: Reframing Clinical Reasoning as a Socio-Cognitive Practice.","authors":"Thierry Pelaccia, Peter Wyer, Jonathan Sherbino, Geoff Norman","doi":"10.1111/jep.70619","DOIUrl":"10.1111/jep.70619","url":null,"abstract":"<p><strong>Rationale, aims and objectives: </strong>Clinical reasoning is often studied as if it occurred inside the clinician's head. Yet, in practice, clinicians think, decide and act through constant interaction with patients, colleagues, technologies, routines and local constraints. This article challenges predominantly individual and decontextualised accounts of clinical reasoning and reframes reasoning as a situated socio-cognitive practice. We aim to show how explicit and tacit knowledge interact with the social, material and organizational environments in which clinical practice unfolds.</p><p><strong>Methods: </strong>We develop a conceptual synthesis drawing on research in clinical reasoning, situated and distributed cognition, ecological psychology, workplace learning and knowledge translation. Tacit knowledge, particularly know-how and know-who, is used as a bridge between individual cognitive processes and the healthcare ecosystem. Distributed cognition, affordances, communities of practice and mindlines are mobilised as complementary analytical lenses.</p><p><strong>Results: </strong>This synthesis conceptualises clinical reasoning as an emergent capability arising from interactions among Self, Others and Context. Expertise depends not only on what clinicians know, but also on their ability to perceive what matters, mobilise the right resources, judge whom to trust, and adapt action to the situation at hand. This perspective helps explain why expert performance may deteriorate across unfamiliar settings and why artificial intelligence should be understood not as a substitute for reasoning, but as a cognitive artefact whose value depends on clinicians' capacity to critically interpret and contextualise its outputs. It also highlights the importance of authentic participation, cognitive apprenticeship and socially supported reflection in developing clinical expertise.</p><p><strong>Conclusions: </strong>Clinical reasoning is neither an isolated mental process nor a simple response to context. It is an accomplishment distributed across clinicians, other people, artefacts and environments. Reframing it in this way shifts attention from how clinicians think in isolation to how reasoning actually works in practice, with important implications for clinical work, education, artificial intelligence and research.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 6","pages":"e70619"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039203","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":"Implementation of Models of Service Delivery Designed for the Management of People With Hip and/or Knee Osteoarthritis in Primary Care: A Scoping Review Protocol.","authors":"Alexandre Moniz, Maiara Moreto, Julian Perelman, Eduardo Brazete Cruz, Marta Moreira Marques","doi":"10.1111/jep.70587","DOIUrl":"10.1111/jep.70587","url":null,"abstract":"<p><strong>Rationale: </strong>Hip and Knee Osteoarthritis (HKOA) is a growing public health challenge, associated with high disability and socioeconomic burden. Current literature indicates that care provided to people with HKOA does not follow evidence-based recommendations, is sub-optimal, reactive, and fragmented. This suggests the need to develop structured approaches to guarantee high-value care and ensure the sustainability of healthcare systems. Models of Service Delivery (MoSD), that is, how a model of care should be adapted and implemented in a local setting or health service at an operational level, have been increasingly recognised as a potential solution to overcome this existing gap. However, the reporting on MoSD for the management of HKOA remains limited.</p><p><strong>Aims and objectives: </strong>Therefore, this scoping review aims to map the existing literature on the development and implementation of MoSD for the management of HKOA in primary care, exploring how these models are organised and implemented in real-world settings.</p><p><strong>Methods: </strong>This scoping review will be developed according to the Joanna Briggs Institute guidance and follow the PCC framework for the establishment of the eligibility criteria-Population (people with HKOA), Concept (MoSD for the management of HKOA), Context (primary care). A detailed search will be conducted in several health sciences (i.e., PubMed, CINAHL, EMBASE, CENTRAL, PsycINFO, Scopus and Web of Science) and grey literature (i.e., Bielefeld academic search engine and MedNar Search Engine) databases. Studies with quantitative, qualitative or mixed-methods methodology published since 2000 will be considered for inclusion. Two researchers will independently perform screening of titles/abstracts and full texts, followed by data charting. Finally, the charted data will be analysed through a deductive content analysis and presented in graphic, diagrammatic or tabular form, accompanied by a narrative summary.</p><p><strong>Conclusion: </strong>This scoping review may have important implications for HKOA care, providing a comprehensive overview of how care is currently organised and delivered. It will also highlight key opportunities and gaps in available primary care-based MoSD and inform their future design and implementation.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 6","pages":"e70587"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912325","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":"Clinical Decision-Making and Guideline Alignment Among Brazilian Physical Therapists: Evidence From Standardized Carpal Tunnel Syndrome Vignettes","authors":"Luciane Fernanda Rodrigues Martinho Fernandes,&nbsp;Brenda Thaís Alves Cardoso,&nbsp;Darlisson Bueno Paranhos,&nbsp;Vítor Hugo Mendes Castro,&nbsp;Amanda Avelar de Resende,&nbsp;Paula Regina Mendes da Silva Serrão","doi":"10.1111/jep.70575","DOIUrl":"https://doi.org/10.1111/jep.70575","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Clinical practice guidelines (CPGs) are intended to support evidence-based clinical decision-making. However, the extent to which physical therapists' clinical decisions align with guideline recommendations remains uncertain, particularly in Brazil.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the alignment of Brazilian physical therapists' clinical decisions with recommendations from CTS clinical practice guidelines and to examine whether general evidence-based practice (EBP) knowledge, self-reported guideline use, and condition-specific guideline knowledge are associated with this alignment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional study was conducted using an online questionnaire comprising two clinical vignettes representing mild and moderate CTS. Participants selected assessment and treatment strategies, which were scored using a weighted guideline-alignment system based on the strength of the supporting evidence. Scores were expressed as percentages. Between-group comparisons were performed using Welch's independent <i>t</i>-tests, and effect sizes were estimated using Cohen's d.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 282 physical therapists were included. Overall alignment with guideline recommendations was low (mean 46.2%, SD 10.7), with similarly low scores for assessment (45.9% ± 14.5) and intervention (46.5% ± 11.7). No significant associations were observed between guideline alignment and any of the investigated variables (all <i>p</i> &gt; 0.05). Effect sizes were uniformly small. All participants selected at least one non-recommended intervention, and 66.7% selected at least one non-recommended assessment procedure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Clinical decisions made by Brazilian physical therapists showed limited alignment with CTS clinical practice guideline recommendations. General EBP knowledge, self-reported guideline use, and condition-specific guideline knowledge were not significantly associated with guideline alignment, and all observed effect sizes were small. These findings suggest that improving guideline implementation requires addressing factors beyond individual knowledge and highlight the importance of behavioural, organizational, and contextual determinants of clinical decision-making.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70575","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860132","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":"Frameworks for Measuring Factors Associated With Healthcare Providers' Performance: A Scoping Review","authors":"Khalid Alkhurayji,&nbsp;Saja A. Alrayes,&nbsp;Arwa Alumran","doi":"10.1111/jep.70566","DOIUrl":"https://doi.org/10.1111/jep.70566","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Healthcare providers are influenced by several factors that affect their performance. However, no such work has been presented to organise or clarify this growing body of literature.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim and Objectives</h3>\u0000 \u0000 <p>This study aimed to identify frameworks for measuring factors affecting healthcare providers' performance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extensions for Scoping Reviews (PRISMA-ScR). This review was guided by the Population, Concept, and Context framework recommended by the Joanna Briggs Institute (JBI). Searches were conducted in several databases and search engines, including PubMed, Web of Science, and Google Scholar. We included research articles of any design. A standardised data sheet was used for data extraction by each reviewer. The data extracted from the studies were related to the details of frameworks (name, country of origin, dimensions, indicator used, and setting of framework). The analysis of this review included variables from the framework details using ranges, medians, and counts, as appropriate. Furthermore, various interpretations of the results were presented in narrative form.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We found 17 frameworks for measuring HCPP in terms of domains, subdomains, indicators, and depth of detail. Asia accounted for the majority of framework origins (70%). Most frameworks were published around 2020 (88.23%). The domains of the frameworks varied from 2 to 8, with a median score of 5. The findings were synthesised into 8-categories covering aspects related to feedback, work environment, motivation, performance, well-being, organisation, work-life interface, and personal attributes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The results of this review provide useful resources for the government, health institutes, and hospitals to inform them of the factors that affect the HCPP—specifically, choosing a framework that is systematically relevant to their institutions' contexts and settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860133","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":"The Relationship Between Loneliness and Geriatric Feelings of Burdensomeness in Hospitalized Older Adults","authors":"Hüsna Ceylan,&nbsp;Adeviye Aydin","doi":"10.1111/jep.70585","DOIUrl":"https://doi.org/10.1111/jep.70585","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to examine the relationship between loneliness and geriatric feelings of burdensomeness in hospitalized older adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study was conducted with 337 older adults hospitalized in a province in Türkiye. Data were collected through face-to-face interviews between April and July 2025 using the Sociodemographic Information Form, the Loneliness Scale for Older Adults, and the Geriatric Feelings of burdensomeness Scale. Data analysis included descriptive statistics (mean, standard deviation, minimum, and maximum), Pearson correlation analysis, and simple linear regression analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean score on the Loneliness Scale for Older Adults was 10.40 ± 6.31, indicating an acceptable level of loneliness, while the mean score on the Geriatric Feelings of burdensomeness Scale was 55.38 ± 22.57, reflecting a below-average level of burden. A positive, moderate, and statistically significant relationship was found between loneliness and geriatric feelings of burdensomeness (<i>r</i>: 0.529; <i>p</i> &lt; 0.05). Loneliness explained 28% of the variance in geriatric feelings of burdensomeness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The findings indicate that increased loneliness among hospitalized older adults is associated with heightened geriatric feelings of burdensomeness. In this context, providing psychological assessment and care services for hospitalized older adults with medical conditions through a holistic nursing approach within the scope of Consultation-Liaison Psychiatric Nursing may support mental well-being. In particular, it is recommended to implement empowerment programs aimed at reducing loneliness and perceived burden and to conduct qualitative studies that allow for an in-depth exploration of hospitalization experiences.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860130","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":"Phenomenology of a Biographical Disruption: Delirium in the Critically Ill Patient","authors":"A. Canabal-Berlanga,&nbsp;C. Alvargonzález,&nbsp;B. Abad,&nbsp;E. Rosas","doi":"10.1111/jep.70583","DOIUrl":"https://doi.org/10.1111/jep.70583","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Delirium in the Intensive Care Unit (ICU) is an acute neurocognitive syndrome affecting up to 80% of patients on mechanical ventilation. While traditionally defined by biomedical criteria (DSM-5), these metrics often overlook the profound ontological rupture and subjective alienation experienced by the patient.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>This study aims to integrate clinical evidence with phenomenological reflection to evaluate how delirium alters patient identity and to define the resulting ethical responsibilities for the clinical team.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>An interdisciplinary conceptual analysis was conducted, merging pathophysiological data and clinical meta-analyses with philosophical frameworks, including the phenomenology of perception, narrative identity and the ethics of vulnerability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Delirium suspends the ‘intentional arc’, leading to a collapse of the lived world, fragmented temporality and distorted otherness. Subphenotypes like hypoactive delirium often result in ‘epistemic injustice’ by silencing the patient's subjective testimony. Post-Intensive Care Syndrome (PICS) is identified as a ‘biographical disruption’ and a wound to selfhood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Clinical evaluation must transcend pathophysiology to include ‘narrative competence’, enabling the reconstruction of the patient's fractured history. Bioethics should shift from abstract rational autonomy toward a model of ‘relational autonomy’ grounded in vulnerability.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860071","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":"The Digital Transformation of Rehabilitation Medicine: A Narrative Review of Artificial Intelligence Innovations, Clinical Integration, and Future Paradigms","authors":"Hao Wu,&nbsp;Yali Yang,&nbsp;Li Wang,&nbsp;Hao Su,&nbsp;Xiaobing Li","doi":"10.1111/jep.70580","DOIUrl":"https://doi.org/10.1111/jep.70580","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Traditional rehabilitation medicine, primarily dependent on qualitative clinical assessment and static therapeutic protocols, faces significant challenges in scalability, objectivity, and dynamic adaptability. The integration of Artificial Intelligence (AI) is catalyzing a paradigm shift from “experience-driven” to “data-driven” precision rehabilitation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This narrative review delineates the current landscape of AI innovations in rehabilitation, evaluates their clinical integration across the patient lifecycle, and identifies the socio-technical barriers to widespread adoption.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We narratively synthesized recent advancements in four foundational technological pillars: Computer Vision (CV) for markerless motion capture, Reinforcement Learning (RL) for intention-aware robotics, Digital Twins (DT) for prognostic simulation, and Explainable AI (XAI) for clinical decision support.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our analysis reveals that AI-driven models enhance rehabilitative efficiency by providing highly objective functional assessments, demonstrating high accuracy in specific controlled validation datasets. Clinical evidence suggests that AI-integrated interventions can potentially reduce certain motor recovery cycles by up to 20%–30% through real-time assist-as-needed (AAN) paradigms. Furthermore, the deployment of AI-mediated remote monitoring and virtual assistants has demonstrated up to a 25% relative improvement in patient adherence post-discharge based on selected pilot studies, effectively bridging the “rehabilitation gap” between hospital and home.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>While AI offers transformative potential for personalized and accessible care, its maturation depends on overcoming challenges related to data heterogeneity, algorithmic “black-box” distrust, and systemic interoperability. We propose a multidisciplinary roadmap to establish unified regulatory frameworks and standardized APIs. Ultimately, the transition to AI-augmented rehabilitation is highly promising for achieving equitable and evidence-based functional recovery in the era of digital medicine.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860131","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":"Association Between Discharge Destination and Excess Length of Stay in Heart Failure-Related Admissions: A Retrospective Single-Centre Study","authors":"Deepti Singh,&nbsp;Kellas Cameron","doi":"10.1111/jep.70563","DOIUrl":"https://doi.org/10.1111/jep.70563","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Hospital readmissions and excess inpatient length of stay remain important clinical and organisational concerns in cardiovascular care. Although discharge destination has been linked to postacute utilisation and spending, less is known about whether discharge destination is associated with inpatient days exceeding diagnosis-related expected stay.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>This study examined whether discharge destination was associated with excess length of stay above diagnosis-related expected stay among heart failure-related admissions and whether those additional inpatient days were associated with lower 30-day readmission.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We conducted a retrospective observational study of administrative admissions recorded between August 2016 and October 2017 at a large academic urban teaching hospital. The primary outcome was excess length of stay, defined as max (length of stay—CMS geometric mean length of stay, 0). The primary explanatory variable was discharge destination, grouped as home, skilled nursing, other facility or discontinued care. Multivariable regression models estimated adjusted associations with excess length of stay, and a secondary generalised estimating equation model assessed 30-day readmission.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The final analytic sample included 1076 admissions from 743 unique patients. Mean excess length of stay was 2.47 days, and 24.3% of admissions were followed by a 30-day readmission. In adjusted models, discharge to skilled nursing was associated with 1.46 additional excess days versus home discharge (95% CI: 0.68–2.23; <i>p</i> &lt; 0.001), while discharge to other facility settings was associated with 1.67 additional excess days (95% CI: 0.29–3.04; <i>p</i> = 0.017). Findings were directionally similar in sensitivity analyses. Excess stay was not associated with lower 30-day readmission, and nonhome discharge categories were not associated with lower readmission odds.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this single-site observational sample, nonhome discharge, especially skilled nursing placement, was associated with longer stays above DRG-benchmarked expectations without lower short-term readmission. These findings may reflect greater discharge complexity and local postacute transition constraints, although the study did not directly measure the mechanisms underlying prolonged hospitalisation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 5","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148784686","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":"Empowering Collaboration With Patients: Healthcare Staff's Perspectives on Conditions for Shared Decision-Making in Swedish Psychiatric Care","authors":"Charlotte Cederborg,&nbsp;Märta Sund Levander,&nbsp;Berit M. Gustafsson","doi":"10.1111/jep.70562","DOIUrl":"10.1111/jep.70562","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Rationale&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Shared decision-making (SDM) is advocated in psychiatric care to facilitate patients' engagement in treatment discussions about their own care. However, applying SDM in practice involves more than simply referring to an advocated method. It is therefore interesting to study healthcare professionals' perceptions and experiences of the conditions necessary for patients to truly participate in SDM.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aim&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To explore healthcare staff's experiences of patient involvement in psychiatric care, paying particular attention to perceived prerequisites, barriers and strategies relevant to shared decision-making.&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;This was an exploratory qualitative study, utilising an inductive approach. Twenty-eight psychiatric care professionals (21 women and 7 men; nurses (10), nurse's assistants (7), psychologists (2), psychotherapists/therapists (6), psychiatrists (1), junior doctors (1) and peer support (1)) participated in focus group interviews. Data was analysed using conventional content analysis, deriving coding categories directly from the transcripts without the influence of prior theoretical frameworks.&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;Four main categories emerged: &lt;i&gt;care relationship&lt;/i&gt;, &lt;i&gt;patient resources&lt;/i&gt;, &lt;i&gt;organization&lt;/i&gt; and &lt;i&gt;strategies in patient meetings&lt;/i&gt;. Staff emphasised &lt;i&gt;time&lt;/i&gt; as an overarching factor, which affected all the main categories. Trust, openness and mutual respect in the care relationship facilitate collaboration and patient involvement. Staff highlighted personalised care that aligns with patients' resource needs and values, supported by professionalism and transparency in communication. Beyond relational factors, organizational challenges—including time constraints and resource limitations—were barriers to patient involvement in SDM. Strategies such as motivational interviewing, documentation in patient records and care plans, and multidisciplinary teamwork were identified as facilitators.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Overall, the study illustrates that staff work towards a good care relationship to strengthen patients' engagement in SDM in psychiatric care. To truly apply patient involvement and SDM in practice, organizational support is needed, in the form of more time, more available resources and clearer care structures. In addition, organizational aspects, such as ","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 5","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13492985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794095","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}