Journal of evaluation in clinical practice最新文献

{"title":"Redefining Representativeness of a Sample in Causal Terms","authors":"Michał Sikorski,&nbsp;Alexander Gebharter,&nbsp;Barbara Osimani","doi":"10.1111/jep.70137","DOIUrl":"https://doi.org/10.1111/jep.70137","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Despite its crucial role, sample representativeness remains a controversial topic in the methodology of medical science. There is an ongoing debate not only about how best to define and ensure the representativeness of a sample (e.g., Rudolph et al. 2023; Porta 2016), but also about whether representativeness is worth pursuing at all (e.g., Rothman et al. 2013).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>Our aim is to construct a formalised, precise, and practical conceptualisation of sample representativeness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We employ the established framework of causal Bayesian networks to develop such a conceptualisation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We propose a precise formal definition of sample representativeness that translates into clear and actionable methodological guidance. Additionally, we provide examples and a checklist to illustrate the application of the proposed conceptualisation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We believe that the presented definition will facilitate further discussion of the issue of representativeness and prove useful to scientists in practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 4","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70137","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144339465","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":"Intravenous Medication Administration Errors in Hospitalised Patients: An Updated Systematic Review","authors":"Sutha Rajakumar,&nbsp;Retha Rajah,&nbsp;Subramaniam Thanimalai,&nbsp;Fadzlin binti Mohd Mokhtar,&nbsp;Dinesh Sangarran Ramachandram","doi":"10.1111/jep.70167","DOIUrl":"https://doi.org/10.1111/jep.70167","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Administering intravenous (IV) drugs carries a high risk of adverse effects due to their direct entry into circulation. Identifying the prevalence and types of IV administration errors and the drugs involved is crucial for implementing effective interventions to reduce such errors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This systematic review aimed to examine and synthesise the available articles on medication errors involving IV administration in hospitalised patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive search was conducted using electronic databases, including PubMed, Ovid Medline, and CINAHL. The search was performed without time limitation up to July 2023. However, only articles published in English and human subjects were included. The quality of the studies was appraised using the Newcastle-Ottawa quality assessment scale (NOS). This systematic review was registered with PROSPERO (CRD42023469352).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Result</h3>\u0000 \u0000 <p>Database searches yielded 2177 articles; after duplicate removal, 1717 underwent title and abstract screening, and 23 were included after full-text review. The studies were from 12 countries, and the multicentre study included countries from Europe, Africa, the Americas, Asia, and Australia. The majority of the studies were conducted in either teaching hospitals (<i>n</i> = 11) or university-affiliated hospitals (<i>n</i> = 7), with most involving direct observation (<i>n</i> = 21). IV administration errors exhibit a broad prevalence range of 5.0%−62.9%, involving various types such as wrong diluent, dose, route, rate, technique, omission, and timing. Studies lack uniformity in reporting, with some not specifying prevalence. The highest prevalence of specific errors varies across settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our review highlights that IV medication error rates vary based on study design, setting, and population. Standardised definitions, reporting procedures, and reliable tracking methods are needed. Human factors, system issues, and environmental stressors influence medication errors. Future research must improve our understanding and address these factors to enhance patient safety and healthcare quality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 4","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70167","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144339529","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":"The Inescapable Specificities of Psychiatry Across Research, Clinical Practice, and Medical Education","authors":"Diogo Telles Correia","doi":"10.1111/jep.70165","DOIUrl":"https://doi.org/10.1111/jep.70165","url":null,"abstract":"<div>\u0000 \u0000 <p>There is increasing evidence that psychiatric disorders have a complex causality, with components belonging to different paradigms and levels of abstraction. They are thus constructs determined by a complex and not yet fully understood interaction between biological and psychosocial factors. As a result, the classification of mental disorders is based on the presentation of symptom clusters and their progression over time and the classification of psychopathological symptoms follows a logical framework based on their mode of presentation and not on causal factors. On the other hand, psychiatric concepts are hybrid, depending not only on biology but also on psychosocial components. The study of their definition, their current meaning, the various sub-concepts they encompass, the connection between different concepts, and the evolution of concepts over time is carried out through conceptual analysis. Poorly understood and defined concepts regarding their structure and components lead to false empirical questions and poorly chosen scientific methodologies, yielding results of questionable validity. In this article, these issues are explored in detail, and a comparison is established between common medical disorders and psychiatric disorders. It is also argued that they should be considered in all research conducted in psychiatry, as well as in clinical practice and medical education in psychiatry.</p>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 4","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144264434","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":"Correction to “Medical Narrative Ability and Humanistic Care Ability of Chinese Clinical Nurses: The Mediating Role of Empathy Ability”","authors":"","doi":"10.1111/jep.70103","DOIUrl":"https://doi.org/10.1111/jep.70103","url":null,"abstract":"<p>Y. Yu, X. Wan, C. Sun, et al., “Medical Narrative Ability and Humanistic Care Ability of Chinese Clinical Nurses: The Mediating Role of Empathy Ability,” <i>Journal of Evaluation in Clinical Practice</i> 31 (2025): e14046. https://doi.org/10.1111/jep.14046.</p><p>In paragraph 4 of the ‘Variables and measures’ section, the text ‘The Chinese version of JSE-HP^[40] is to evaluate the empathy ability of medical staff. The Cronbach's <i>α</i> of the scale is 0.750. The split-half coefficient is 0.771, and the test-retest reliability is 0.659. It consists of 20 items and three dimensions: opinion selection (10 items), emotional care (7 items), and perspective-taking (3 items). Likert 7-level scoring method is adopted for all of them, ranging from completely disagree to completely agree with 1–7 points respectively. The reverse scoring scale consists of 10 reverse questions with scores ranging from 20 to 140. The higher the score, the stronger the empathy ability of the nurse. This scale demonstrates good reliability and validity, and has been extensively utilized within medical and nursing communities. In this study, the Cronbach's <i>α</i> of this scale was 0.903.’ was incorrect. This should have read: ‘The Chinese version of JSE-HP^[40] is used to evaluate the empathy ability of medical staff. The Cronbach's <i>α</i> of the scale is 0.750. The split-half coefficient is 0.771, and the test-retest reliability is 0.659. It consists of 20 items and three dimensions: opinion selection (10 items), emotional care (7 items), and perspective-taking (3 items). A 7-point Likert scale is used, ranging from 1 (completely disagree) to 7 (completely agree). The scale includes 10 reverse-scored items, with total scores ranging from 20 to 140, where higher scores indicate stronger empathy ability. This scale demonstrates good reliability and validity and has been widely applied in medical and nursing communities. In this study, the Cronbach's <i>α</i> of this scale was 0.903. The JSE-HP was used in this study with permission from Thomas Jefferson University. To enhance its applicability and accuracy within the Chinese cultural context, slight adjustments were made to the item order during the cross-cultural adaptation process. These modifications were intended to better align with the linguistic and contextual nuances of empathy expression in Chinese medical practice. This adjustment aligns with the principle of “experiential equivalence” ensuring that respondents could better comprehend the questionnaire, thereby improving response accuracy and reliability^[56].’</p><p>We apologize for this error.</p><p>Additional Reference:</p><p>[56] F. Guillemin, C. Bombardier, and D. Beaton, “Cross-Cultural Adaptation of Health-Related Quality of Life Measures: Literature Review and Proposed Guidelines,” <i>Journal of Clinical Epidemiology</i> 46, no. 12 (1993): 1417–1432.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 4","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70103","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144264430","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 Trial Informativeness: A Rapid Review of Global Research on How to Ensure Trials Are Useful","authors":"Sarah R. Prowse,&nbsp;Shaun Treweek,&nbsp;Miriam Brazzelli,&nbsp;Hanne Bruhn","doi":"10.1111/jep.70147","DOIUrl":"https://doi.org/10.1111/jep.70147","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Randomised controlled trials are considered the ‘gold standard’ in clinical research and decision-making. However, many trials have significant flaws that current review processes fail to identify early enough for corrections to be made. Flaws in trial design, conduct and reporting ultimately lead to research waste. This rapid review provides insights from global research aimed at improving trial ‘informativeness’ as described by Zarin and colleagues.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A rapid review was conducted with a focus on research addressing trial design processes that might improve informativeness aligned with one or more of the five key conditions outlined by Zarin and colleagues: 1) Importance, 2) Design, 3) Feasibility, 4) Integrity and 5) Reporting. A further thematic analysis was conducted using NVivo 12.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The final review includes 42 texts. Of the 27 recommended processes or actions to improve trial informativeness, most were relevant to the second condition of trial design (2) Design; 44%). A key recommendation was the use of ‘tools’ to enhance trial informativeness. A total of 23 tools were identified across the conditions of 1) Importance (17%), 2) Design (74%) and 5) Reporting (9%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This review highlights how a better understanding of design processes that lead to informative trials can reduce or eliminate research waste. Further research is needed on how these processes can better support pre-funding peer review, which would also increase the likelihood of producing informative trials.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 4","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70147","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144264433","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":"Are Canadian Clinical Practice Guidelines Accounting for Adults With Multiple Chronic Diseases? A Systematic Review","authors":"Olivia L. Tseng,&nbsp;Shanjot Brar,&nbsp;Martin Dawes,&nbsp;Hetesh Ranchod,&nbsp;Diane Lacaille,&nbsp;Victoria C.H. Su,&nbsp;Craig Mitton","doi":"10.1111/jep.70143","DOIUrl":"https://doi.org/10.1111/jep.70143","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Recommendations that are equipped with essential and adequate information promote adherence and support evidence-informed decision-making, which are crucial attributes of patient-centered care when caring for patients with multiple coexisting health conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>To systematically evaluate the content of recommendations of Clinical Practice Guidelines in Canada.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We searched PubMed, MEDLINE, Embase, and professional organization websites to identify 18 Canadian guidelines addressing 14 diseases prevalent in adults with multimorbidity in nonhospital settings. Two reviewers independently appraised the included guidelines using the international AGREE II tool, extracted 2,509 recommendations and assessed each recommendation to determine the presence of primary health outcomes, as well as secondary demographics and the number of involved diseases. We stratified the findings by potential modifiers: level of evidence (LOE) and type of recommendations (e.g., screening and diagnosis).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Half of the guidelines were high-quality, with all domains scoring 50% or higher. The format and definitions of LOE were found to be heterogeneous. A significant portion focused on a single disease (72%), did not include any demographic information (72), or missed health outcomes (66%). Health outcomes were more frequently addressed in pharmacological (17.6%) and Nonpharmacological (14.5%) management recommendations than in screening (0.7%) and diagnosis (1.1%) recommendations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>There is significant variation in guidelines. For health professionals such as primary care whose patients have multiple conditions, this variation is unacceptable. A centralized guideline development agency would reduce inconsistencies in formatting among guidelines, promoting adherence. Recommendations equipped with adequate information are pivotal in supporting patient-centered care through evidence-informed decision-making.</p>\u0000 \u0000 <p><b>PROSPERO registration</b>: CRD42020105261.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 4","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70143","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144244798","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":"The Effect of Using of Social Media on Smoking Cessation Stages and Processes Among Health Care Providers","authors":"Ahmad A. Aljarrah,&nbsp;Debra C. Wallace,&nbsp;Audai Hayajneh,&nbsp;Cindy Bacon,&nbsp;Stephanie Pickett","doi":"10.1111/jep.70158","DOIUrl":"https://doi.org/10.1111/jep.70158","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In recent years, social media has become a promising tool for promoting health behavior change among young adults globally. The widespread use of social media among health care providers presents a unique opportunity to deliver tailored cessation support and information. Despite the high prevalence of smoking in this group, there's a lack of research on the effectiveness of social media-based interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>“The study employed a quasi-experimental single group pretest-posttest design using Facebook as the intervention platform, guided by the Transtheoretical Model”. The study included 103 health care provider recruited from a middle eastern hospitals who volunteered to participate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The majority of participants began smoking before age 18, with family smoking prevalent in the sample. All participants were in the precontemplation stage before the intervention. Post-intervention, over 77% progressed to a higher stage of change. The processes of change (POC) scores increased by an average of 2.23 units, with a mean difference of 1.26 (95% CI = 0.934–1.599), indicating a strong association between POC changes and stage progression. This suggests the intervention's effectiveness in supporting smoking cessation efforts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The use of social media to quit smoking among health care providers was very effective in improving the transitional stages of change. Therefore, it is essential to use social media to help this group to quit smoking as well as to conduct future studies using a more diverse range of participants.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 4","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144244908","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":"Addressing Changing Healthcare Needs: A Realist-Inspired Review of Innovative Rehabilitation Care Models","authors":"Catherine M. Giroux,&nbsp;Damien Contandriopoulos,&nbsp;André Bussières,&nbsp;Sara Ahmed,&nbsp;Lori Letts,&nbsp;Jill Boruff,&nbsp;Lisa Starr,&nbsp;Aliki Thomas","doi":"10.1111/jep.70144","DOIUrl":"https://doi.org/10.1111/jep.70144","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale/Objectives</h3>\u0000 \u0000 <p>Canadian healthcare is facing an aging population, an increasing prevalence of chronic disease and related disability, and rising healthcare costs. Integrating innovative rehabilitation models of care may help bolster health systems by shifting to a longer-term approach to addressing health and wellbeing. However, little is known about how these care models may look and what is needed to ensure their effective operationalization in practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This realist-inspired narrative review explored how, when, and in what circumstances innovative models of care have been successfully implemented and sustained in rehabilitation. The peer-reviewed and grey literature was searched and subsequently screened by title, abstract, and full text. Data extracted from included articles focused on identifying contexts, mechanisms, and outcomes. A numerical analysis of quantitative data and a conventional content analysis of qualitative abstractions was conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-six documents published between 2014 and 2021 were uncovered predominantly from Australia and Canada. Overall, for new care models to be successfully implemented and sustained, they need to: (1) have clearly articulated goals, (2) have access to short- and long-term funding, (3) align with key legislative changes to optimise buy-in, (4) take a multidisciplinary approach that is supported by management, and (5) include educational and outreach strategies that can be implemented amongst all interested parties.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The heterogeneity of studies and limitations in their reporting precluded the identification of context-mechanism-outcome configurations typically found in realist reviews. Future implementation research should draw on relevant reporting guidelines to report their findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 4","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70144","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144244840","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":"Inter-Practice Variability in General Practice Consultations With Older Patients: A Cross-Sectional Analysis of the Registrar Clinical Encounters in Training Study","authors":"Adele Kincses,&nbsp;Alexandria Turner,&nbsp;Alison Fielding,&nbsp;Amanda Tapley,&nbsp;Andrew Davey,&nbsp;Dominica Moad,&nbsp;Elizabeth Holliday,&nbsp;Jason Dizon,&nbsp;Mieke van Driel,&nbsp;Parker Magin","doi":"10.1111/jep.70139","DOIUrl":"https://doi.org/10.1111/jep.70139","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>General practice is central to older patient care provision. For GP registrars (specialist GPs in training), exposure to older patients is also vital for developing chronic disease and multimorbidity management skills. However, registrars see fewer older patients, and are less engaged with older patient care, than established GPs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>This study aimed to assess inter-practice variability in the proportion of older patients seen by Australian GP registrars during training.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Cross-sectional analysis from the ReCEnT study of GP registrars' clinical experiences (2010–2023). The outcome was consultation with older (65+ years) patients. Inter-practice variability was assessed with Intraclass Correlation Coefficient (ICC) and Median Odds Ratio (MOR). Outcome variance attributable to practice was estimated within the Bayesian modelling framework using a mixed-effects logistic regression with cross-classified random effects for registrar and practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The analysis included 4643 registrars across 978 practices. 19% (129,659/688,281) of consultations were with older patients. The ICC was 0.15 (95% Credible Interval (CrI) [0.14, 0.17]) in a model with a random effect for practice; and, in a model adjusted for time/registrar/patient/practice variables, 0.10 (CrI [0.09, 0.11]). These values (comparable with, or higher than, reported for other general practice variables), indicate registrars' older patient clinical exposure is dependent upon the practice(s) trained in. The MOR was 2.08 (CrI [(2.00, 2.16]); and, adjusted, 1.81 (CrI [1.76, 1.87). By randomly changing practice location, the odds of a registrar's consultation being with an older patient thus approximately doubles (or, alternatively, halves) on average.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The practice itself is the greatest determinant in registrars' exposure to older patients. Practice-level interventions are essential to improve registrars' in-training older patient care experience.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 4","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144244797","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":"Patient Voices in Pharmacovigilance: Understanding Adverse Drug Reactions Through Consumer Narratives","authors":"Shatavisa Mukherjee,&nbsp;Siddhartha Roy,&nbsp;Nikhil Era","doi":"10.1111/jep.70164","DOIUrl":"https://doi.org/10.1111/jep.70164","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Adverse drug reactions (ADRs) are unintended and harmful responses to medications. Although clinicians and researchers often focus on the clinical aspects and prevention of ADRs, consumers—the patients themselves—experience and interpret these events in personal, social, and cultural contexts. Understanding consumers' perspectives on ADRs is essential to improving communication, therapeutic decision-making, and patient safety strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to explore consumers' views and experiences of ADRs, including their perceptions of risk, attribution of causes, and the impact on medication adherence and trust in healthcare providers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A qualitative research design was employed. Purposive sampling was used to recruit adult participants who had experienced at least one ADR or were caregivers of someone with an ADR experience. Four focus group discussions (FGDs) were conducted (<i>n</i> = 28). A semi-structured discussion guide elicited participants' personal accounts and interpretations of ADRs. Data were transcribed verbatim and analyzed using thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Six major themes emerged: (1) Understanding and Knowledge of ADRs, (2) Severity and Impact on Daily Life, (3) Trust and Communication with Healthcare Providers, (4) Self-Medication Practices and ADR Risk, (5) Emotional and Psychological Responses, and (6) Recommendations for Improved ADR Awareness and Reporting. Participants expressed anxiety about the unpredictability of ADRs, citing both mild and severe reactions. Many shared difficulties with navigating information sources, feeling that healthcare professionals sometimes minimized or overlooked their concerns. The emotional toll of ADRs ranged from worry and frustration to lowered trust in medical recommendations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Consumers' experiences of ADRs are deeply personal, often influenced by prior knowledge, trust in healthcare providers, and the perceived severity of reactions. Patient-centered communication strategies, clearer information on risks and benefits, and robust ADR reporting mechanisms are recommended to empower consumers and enhance medication safety. Understanding the consumer perspective is pivotal for healthcare policy and practice to reduce the burden of preventable ADRs and to improve patient-centered care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 4","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144244912","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}