Journal of evaluation in clinical practice最新文献

{"title":"Implementation of Clinical Pharmacy Services in Primary Health Care: A Scoping Review","authors":"João Pedro Vasconcelos Paolinelli,&nbsp;Taiana de Alencar,&nbsp;Kérilin Stancine Santos Rocha,&nbsp;Mariana Linhares Pereira,&nbsp;Genival Araujo dos Santos Júnior","doi":"10.1111/jep.70285","DOIUrl":"10.1111/jep.70285","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>The implementation of Clinical Pharmacy Services in healthcare systems is multifactorial and complex. Some studies summarize the implementation research of these services in both outpatient and inpatient contexts. However, the literature lacks a comprehensive synthesis to understand how the implementation process occurs in Primary Health Care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To map, at an international level, the studies on the implementation of Clinical Pharmacy Services in Primary Health Care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>This scoping review followed the recommendations of the JBI Manual for Evidence Synthesis for Scoping Reviews. A systematic search was conducted in May 2023 across six electronic databases, grey literature, and the references of the selected studies. Original studies that described the implementation process of Clinical Pharmacy Services in Primary Health Care were eligible for inclusion. Two researchers independently assessed the studies based on eligibility criteria and extracted data from the selected articles. Data were presented descriptively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 97 studies were included, with 85.6% (<i>n</i> = 83) conducted in developed countries. A significant emphasis was observed on qualitative and mixed-methods research, accounting for 46.4% (<i>n</i> = 45) of the studies. Only 22.7% (<i>n</i> = 22) of the studies utilized theoretical models as research guides, while 96.9% (<i>n</i> = 94), did not report on the implementation phase. Comprehensive Medication Management (36.8%, <i>n</i> = 35) was the most cited type of service. The most assessed implementation outcome was feasibility, at 73.2% (<i>n</i> = 71). A total of 47.4% (<i>n</i> = 46) assessed outcomes related to the implemented service, which included clinical, economic, and/or humanistic aspects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study revealed numerous publications on the implementation of clinical services provided by pharmacists in primary care. These findings can guide future research on the implementation of these services and highlight the need for developing and underdeveloped countries to explore this topic further.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70285","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137881","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 Depression and Mother–Infant Attachment in the Postpartum Period: The Case of Somalia","authors":"Handan Özcan,&nbsp;Ayşe Çuvadar,&nbsp;Adow Nur Sharif,&nbsp;Naimo Mahdi Sheikh Ibrahim","doi":"10.1111/jep.70282","DOIUrl":"10.1111/jep.70282","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study evaluated postpartum depression levels among mothers in Somalia and examined its impact on mother-infant attachment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This descriptive correlational study was conducted at a training and research hospital in Mogadishu, involving a sample of 178 postpartum women. Data were collected using a “Personal Information Form” for demographics, the “Beck Depression Inventory” to measure depression levels, and the “Maternal Attachment Inventory” for maternal attachment characteristics. Statistical analysis using SPSS 26 software indicated significance at <i>p</i> &lt; 0.05.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The results revealed moderate depression symptoms and low maternal attachment levels among the participants. Higher depression and attachment scores were observed among university graduates, employees, and those with planned pregnancies (<i>p</i> &lt; 0.05). Furthermore, a weak positive relationship existed between the Beck Depression Inventory and the Maternal Attachment Inventory scores (<i>r</i> = 0.282, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The results suggest the importance of recognizing and intervening in postpartum depression early, with a focus on identifying contributing factors and emphasizing the need for targeted counseling to enhance maternal attachment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137858","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":"Evaluation of Potentially Inappropriate Prescriptions Among the Geriatric Population in Tabuk, Saudi Arabia via the STOPP/START Criteria, Version 3: A Multicentric Study","authors":"Kousalya Prabahar","doi":"10.1111/jep.70279","DOIUrl":"https://doi.org/10.1111/jep.70279","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Older populations are prone to various chronic diseases and takes polypharmacy, which can lead to potentially inappropriate medications (PIMs), causing several complications. This research aimed to estimate PIMs and potential prescribing omissions (PPOs) in older adults via the STOPP/START criteria, version 3.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicentric retrospective observational study was executed among subjects aged ≥ 65 years, who were hospitalized at two Ministry hospitals from July 2023 to June 2024. The medicines of the geriatric population were assessed for PIMs/PPOs via the STOPP/START criteria, version 3. The data were scrutinized via SPPSS 27. Descriptive statistics were performed for qualitative and quantitative data. Multinomial logistic regression was applied to evaluate the effects of sex, age, comorbidities and medicines on PIMs and PPOs. Multiple linear regression analysis was conducted to evaluate potential multicollinearity among the predictors associated with PIMs and PPOs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 385 subjects were included in this study. The participants' mean age was 75.7 ± 8.76 years and 50.13% were male. Among the study population, 48.83% had potentially inappropriate prescriptions, 37.66% with PIMs and 20.52% with PPOs. In total, 190 PIMs and 108 PPOs were identified, and the most frequently prescribed PIM was calcium channel blockers (20%). Comorbidities were significantly associated with PIMs and PPOs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Overall, 48.83% of the prescriptions were potentially inappropriate. The percentage of PIMs/PPOs is lower in our population than in previous versions of the STOPP/START criteria. However, scheduled audits should be performed to keep the PIMs/PPOs at the lowest range. A comprehensive list of medications that are appropriate or inappropriate for use in older adults should be established, and prescribers should consult this list before prescribing to help prevent potentially inappropriate prescriptions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145101956","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":"Impact of Care Delivered in Nondesignated Areas on Older Patients Admitted With Hip Fractures: A Quality Improvement Initiative","authors":"Joan Solomon,&nbsp;Ashna Ameer,&nbsp;Vahida Chopda,&nbsp;Radcliffe Lisk,&nbsp;Keefai Yeong,&nbsp;Jay Acharya,&nbsp;Jonathan Robin,&nbsp;Christopher H. Fry,&nbsp;Thang S. Han","doi":"10.1111/jep.70276","DOIUrl":"https://doi.org/10.1111/jep.70276","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although testimonies of devastating impacts of care delivered in nondesignated hospital areas (corridor care) are mounting, there is a paucity of quantitative data. This study aimed to assess the associations between: (1) care in nondesignated areas and key performance indicators (KPIs), including ward moves and length of stay (LOS); and (2) between KPIs and mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from this cross-sectional study were derived from the National Hip Fracture Database audit programme (a quality-improvement initiative commissioned by the Healthcare Quality Improvement Partnership, NHS England). In total, 508 patients (65% women) consecutively admitted with hip fractures (January 2024–January 2025) were included. The duration (h:min) of care in nondesignated areas was categorised by tertiles (&lt; 1:20; 1:20–4:20; &gt; 4:20). Associations between variables were determined by logistic regression, presented as odds ratios (OR) and 95% confidence intervals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients cared for in nondesignated areas (11%) and bed care patients (89%) had similar clinical characteristics (median age = 85.5 years). Care in nondesignated areas varied inversely with seasonal average local temperatures: 10.7% in summer (22.5°C), 19.6% autumn (15.9°C), 44.6% winter (8.6°C), and 25.0% spring (14.9°C), which was more discernible than the corresponding distribution of bed care: 21.2%, 23.7%, 25.9% and 29.2%. Compared with bed care patients, those cared for in nondesignated areas for ≥ 1 h:20 min were associated with ≥ 3 ward moves: OR = 4.02 (1.61–10.06). LOS on orthogeriatric wards for bed care patients was 13.4 days, and care in nondesignated areas &gt; 4 h:20 min was 17.2 days, which increased to 19.7 days for all patients cared for in nondesignated areas with ≥ 3 ward moves. In turn, higher in-hospital mortality was associated with multiple ward moves: OR = 2.63 (1.23–5.66) and prolonged LOS: OR = 3.23 (1.53–6.81).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The impact of care delivered in nondesignated areas exposed by KPIs is consistent with testimonies from patients and NHS staff. This evidence serves as a stimulus to take urgent action to abolish care in nondesignated areas.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70276","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102279","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":"Volunteer Outreach and Predictive Modeling: Rapid Randomized Quality Improvement Project for New Patient Attendance in a Primary Care Safety-Net","authors":"Kevin Chen,&nbsp;Khera Bailey,&nbsp;Simon Nemytov,&nbsp;Kenan Katranji,&nbsp;Michael Bouton,&nbsp;Andrew B. Wallach,&nbsp;Hannah B. Jackson","doi":"10.1111/jep.70278","DOIUrl":"https://doi.org/10.1111/jep.70278","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;Nonattendance at new patient appointments leads to missed opportunities for engagement in care, lost revenue, and suboptimal resource utilization.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To assess the effectiveness of outreach calls to new patients, prioritized by a no-show predictive algorithm and conducted by volunteers, on visit attendance.&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;Rapid randomized quality improvement project.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Participants&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Patients with new patient appointments at an urban safety-net adult primary care clinic scheduled to occur between August 1, 2024 and September 30, 2024.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Intervention&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Estimated probability of visit no-show for patients was calculated using a predictive algorithm embedded in the electronic health record and used to sort lists of patients with upcoming appointments. Every other patient received an outreach call from a trained volunteer within 3 business days of their appointment plus usual automated reminder messages versus usual automated reminder messages alone.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Main Measures&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;New patient visit attendance compared between intervention and control groups. We conducted subgroup analyses of attendance by visit modality (in-person vs. telehealth), preferred language, and quartile of predicted no-show probability.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Key Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Patients in the intervention group (&lt;i&gt;n&lt;/i&gt; = 281) had higher visit attendance than those in the control group (&lt;i&gt;n&lt;/i&gt; = 280): 68.0% versus 54.1% (&lt;i&gt;p&lt;/i&gt; &lt; 0.01). There was a significant difference in attendance for in-person (70.7% vs. 51.7%; &lt;i&gt;p&lt;/i&gt; &lt; 0.01) but not telehealth (60.6% vs. 61.2%; &lt;i&gt;p&lt;/i&gt; = 0.94) visits. Patients who preferred English had the biggest increase in attendance (17.2%; &lt;i&gt;p&lt;/i&gt; &lt; 0.01). Patients in the second and third quartiles of predicted no-show probability (31%–38% and 39%–45% predicted probability) had the biggest increases in attendance (22.2% [&lt;i&gt;p&lt;/i&gt; = 0.01] and 15.4% [&lt;i&gt;p&lt;/i&gt; = 0.05]).&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;Outreach calls for new patients, prioritized by a no-show predictive algorithm and conducted by volunteers, can be a feasible and effective approach to improving visit attend","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102282","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":"Maximising Value in Healthcare Systems by Putting the Patient at the Centre – Systemic Design Considerations","authors":"Joachim Sturmberg,&nbsp;Saadi Taher","doi":"10.1111/jep.70270","DOIUrl":"https://doi.org/10.1111/jep.70270","url":null,"abstract":"<p>Value-based healthcare addresses inefficiencies, rising costs, and inconsistent quality by prioritising patient outcomes relative to costs. Despite broad support, its definition and implementation remain unclear. This perspective proposes a systemic, person-centred approach that aligns stakeholders around shared values. We examine frameworks like Berwick's ‘Triple Aim’ and Porter's patient-centred model, and integrat Sir Muir Gray's moral dimension for a holistic perspective. Achieving an effective system requires committed leadership, bottom-up redesign integrating all care levels, and cross-sector collaboration to align policies with sustainable health improvements. Context-sensitive metrics are essential to balancing patient-centred and economic value.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70270","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102281","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":"Factors Influencing the Adoption of Shared Decision Making for Antibiotic Treatments in Developing Countries: A Systematic Review of Physicians and Patients' Perspectives","authors":"Gashaw Enbiyale Kasse,&nbsp;Suzanne M. Cosh,&nbsp;Judy Humphries,&nbsp;Md Shahidul Islam","doi":"10.1111/jep.70281","DOIUrl":"https://doi.org/10.1111/jep.70281","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;Shared decision-making is a decision-making process that involves both patients and their healthcare providers and can serve as a framework to reduce inappropriate antibiotic prescribing, thereby helping to control antibiotic resistance. However, little is known about the factors that influence the adoption of shared decision-making for antibiotic prescription in developing countries.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objectives&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The objective of this review is to identify factors influencing the adoption of shared decision-making for antibiotic prescription from both physicians' and patients' perspectives in developing countries.&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;We searched four electronic databases, Web of Science, Scopus, PubMed and ProQuest Health and Medicine, from 3 July 2023 to August 20, 2023. Studies were included if they assessed factors influencing the practice of shared decision-making during antibiotics prescription from physicians' or patients' perspectives in developing countries. The included studies were published in English and used quantitative, qualitative or mixed-method designs, spanning 2010 and 2023. The quality of the included articles was assessed using the Mixed Method Appraisal Tool (MMAT) version 2018, and data extraction from selected articles was performed by the first author and co-authors. Narrative synthesis was used to synthesis the qualitative result and incorporate quantitative data.&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;Initially, a total of 2120 studies were identified. After evaluating the inclusion criteria, 24 were included in the final analysis. The main factors that influence the adoption of shared decision-making (SDM) in developing countries are time constraints, misunderstanding of shared decision-making, cultural and socioeconomic influence, power dynamics differences (hierarchical relationship between physicians and patients), patients' preference and agreement with shared decision-making, and availability of resources. Additionally, the quality of the relationship between patients and physicians plays a key role in influencing the practice of shared decision-making.&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;The findings highlight the importance of interventions aimed at both physicians and patients, such as education and training programs focused on shared decision-making for antibiotic prescription. However, further study is required to develop effective strategies that promote the adoption of shared decision-making practices while","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145101993","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":"Enhancing Adolescent Asthma Control and Self-Efficacy: A Decision Tree Analysis of a Mobile Health Application in a Randomized Controlled Trial","authors":"Nimet Karataş,&nbsp;Ayşegül İşler,&nbsp;Ayşen Bingöl","doi":"10.1111/jep.70266","DOIUrl":"https://doi.org/10.1111/jep.70266","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>To evaluate the efficacy of YoungAsthma, a nurse-led, web-based mHealth intervention on asthma control and self-efficacy among adolescents with asthma utilizing decision tree analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Asthma is a prevalent chronic condition in pediatric populations, necessitating sustained management for optimal disease control.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A randomized controlled clinical trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Fifty-four eligible adolescents were randomly assigned to either the intervention group (YoungAsthma + Usual care, <i>n </i>= 27) or the control group (Usual care, <i>n</i> = 27) for 4 weeks. Primary outcomes—asthma control and self-efficacy—were assessed using the Information Form, Asthma Control Test, Self-Efficacy Scale for Children and Adolescents with Asthma. Statistical analyses included Fisher's exact test, chi-square test, Wilcoxon signed-rank test, Mann-Whitney U test, and Intention-to-Treat (ITT) analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-eight participants completed the study (11% dropout per group). The intervention group exhibited a greater improvement in asthma control than the control group. While both groups showed increased self-efficacy, the intervention group's improvement was significantly higher. Decision tree analysis identified key predictors, indicating that lower scores were associated with a higher likelihood of remaining in the control group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Nurse-led, technology-supported interventions significantly enhance asthma control and self-efficacy in adolescents. Decision tree analysis provided valuable insights into key factors influencing asthma control and self-efficacy improvements, identifying subgroups that benefited most from the intervention. Interdisciplinary collaboration facilitated a user-centered approach grounded in Bandura's Self-Efficacy Theory, offering a data-driven framework for personalized asthma management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Relevance to Clinical Practice</h3>\u0000 \u0000 <p>Decision tree analysis aids in identifying patients who would benefit most, enabling precision-targeted interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Reporting Method</h3>\u0000 \u0000 <p>This study was conducted","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022163","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 Impact of Social Network Interruption on Depression in the Elderly With Chronic Diseases: A Longitudinal Study in China","authors":"Tong Shi,&nbsp;Zongshun Chen,&nbsp;Chaoping Pan,&nbsp;Shikang Deng,&nbsp;Junfeng Jiang,&nbsp;Peigang Wang","doi":"10.1111/jep.70263","DOIUrl":"https://doi.org/10.1111/jep.70263","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Social support can have health benefits but may also pose risks for the elderly, particularly those facing conflicts and network disruptions. Understanding the short and long-term mental health effects, especially in elderly individuals with chronic illnesses, is crucial due to global depression concerns. Yet, research is limited, with gaps in exploring different social disruption scenarios and lacking comprehensive multi-period data analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a longitudinal study using 2016 and 2018 China Longitudinal Aging Social Survey (CLASS) data. Our study included 5476 and 7138 participants aged 60−90 with chronic illnesses, 4730 participating in both years. We analysed relationships using depression scores, social network disruption and social adaptation. Ordinary least squares explored short and long-term effects, and propensity score matching examined causal inferences, including gender and urban-rural differences. We also explored the social adaptation's mediating role.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Disrupted social networks significantly increased short and long-term depression (<i>β </i>= 0.984, <i>p </i>&lt; 0.001; <i>β </i>= 0.337, <i>p </i>&lt; 0.01). However, after propensity score matching, only short-term impacts persisted (ATT = 0.981−1.045, <i>p </i>&lt; 0.001). Factors like death and conflicts had short-term impacts, milder in females (0.673 points) than in males (1.285 points). Both urban and rural participants experienced increased depression. Social adaptation explained 14.1% of the mediation effect.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Disrupted social networks heightened short-term depression in elderly individuals with chronic illnesses, with varying gender and location effects. Robust social adaptability facilitated new connections, reducing depression. Implications include emphasizing rapid network recovery and enhancing adaptability for mental health support in aging populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022165","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":"Beyond Barriers and Facilitators: A Qualitative Study of the Interests Driving Physician-Led Innovation","authors":"Miriam Wiersma,&nbsp;Ian Kerridge,&nbsp;Wendy Lipworth","doi":"10.1111/jep.70274","DOIUrl":"https://doi.org/10.1111/jep.70274","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Clinical innovation—where physicians develop and use novel interventions that differ significantly from standard practice and that have not been shown to be sufficiently safe or effective for regular use in healthcare systems—has the potential to transform patient care and drive medical advancement. However, it is not without risk.</p>\u0000 \u0000 <p>It is important, therefore, that policymakers and healthcare institutions develop strategies to encourage responsible clinical innovation. For these strategies to be effective, they need to be based on a comprehensive understanding of the factors driving physicians' development and use of innovative interventions. While research has provided important insights into contextual barriers and facilitators, individual factors, particularly physicians' interests, remain underexplored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>The aims of this qualitative study were to investigate the factors that drive and deter clinical innovation in diverse medical specialties and to examine whether these factors differ significantly between specialties.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Thirty-one semi-structured interviews were conducted with Australian physicians from surgery, reproductive medicine, and cancer care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Physicians' interests (e.g., obligations to patients and personal financial concerns) were perceived to play an important role in driving their use of innovative interventions, along with individual traits and contextual factors. There were also significant differences between specialties—with fertility specialists and surgeons more strongly emphasizing financial and commercial interests as key drivers of clinical innovation than oncologists.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings suggest that while addressing structural barriers to clinical innovation at the health system level remains important, policymakers must also give attention to the diverse interests of physician-innovators. Understanding these interests, the ways in which they align and conflict, and which are most prominent across different specialties, will enable policymakers and healthcare institutions to develop targeted strategies to encourage physician-led innovation and ensure it is responsible.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70274","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022095","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}