Journal of evaluation in clinical practice最新文献

{"title":"AppRaise: Software for Quantifying Evidence Uncertainty in Systematic Reviews Using a Posterior Mixture Model","authors":"Conrad Kabali","doi":"10.1111/jep.70272","DOIUrl":"https://doi.org/10.1111/jep.70272","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Systematic reviews are essential for evidence-based healthcare decision-making. While it is relatively straightforward to quantitatively assess random errors in systematic reviews, as these are typically reported in primary studies, the assessment of biases often remains narrative. Primary studies seldom provide quantitative estimates of biases and their uncertainties, resulting in systematic reviews rarely including such measurements. Additionally, evidence appraisers often face time constraints and technical challenges that prevent them from conducting quantitative bias assessments themselves. Given that multiple biases and random errors collectively skew the point estimate from the truth, it is important to incorporate comprehensive quantitative methods of uncertainty in systematic reviews. These methods should integrate random errors and biases into a unified measure of uncertainty and be easily accessible to evidence appraisers, preferably through user-friendly software.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>To address this need, we propose a posterior mixture model and introduce <span>AppRaise</span>, a free, web-based interactive software designed to implement this approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We showcase its application through a health technology assessment (HTA) report on the effectiveness of continuous glucose monitoring in reducing A1c levels among individuals with type 1 diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Applying the <span>AppRaise</span> software to the HTA report revealed a high level of certainty (86% probability) that continuous glucose monitoring would, on average, result in a reduction in A1c levels compared with self-monitoring of blood glucose among Ontarians with type 1 diabetes. These findings were similar to other quantitative bias-adjusted approaches in systematic reviews.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p><span>AppRaise</span> can be utilized as a standalone tool or as a complement to validate the quality of evidence assessed using qualitative-based scoring methods. This approach is also useful for assessing the sensitivity of parameter estimates to potential biases introduced by primary studies.</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":"145022164","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":"Current Trends and Future Directions of Statistical Methods in Medical Research: A Scientometric Analysis","authors":"Fatma Yardibi,&nbsp;Chaomei Chen,&nbsp;Cagdas Hakan Aladag,&nbsp;Ozkan Kose","doi":"10.1111/jep.70257","DOIUrl":"https://doi.org/10.1111/jep.70257","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objective</h3>\u0000 \u0000 <p>The field of medical statistics has experienced significant advancements driven by integrating innovative statistical methodologies. This study aims to conduct a comprehensive analysis to explore current trends, influential research areas, and future directions in medical statistics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This paper maps the evolution of statistical methods used in medical research based on 4,919 relevant publications retrieved from the Web of Science. High-frequency keywords and citation metrics were analyzed to identify research hotspots. A dual-map overlay and document co-citation analysis were performed using CiteSpace to uncover thematic clusters and track knowledge flow between disciplines. Additionally, network metrics, such as betweenness centrality and sigma, were employed to quantify the influence and novelty of publications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Results identified a strong interdisciplinary exchange between medical statistics and fields such as health, nursing, molecular biology, and computer science, with clinical trials, survival analysis, and predictive modeling emerging as central themes. The influence of artificial intelligence (AI), machine learning (ML), and deep learning (DL) is growing substantially, particularly in areas such as diagnostic imaging, epidemiology, and treatment prediction, highlighting a shift towards more complex, data-driven methodologies. While traditional statistical techniques, such as survival analysis and regression, remain vital, emerging technologies are reshaping research approaches, fostering collaboration, and advancing the field's capabilities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Future research will likely focus on overcoming challenges related to data privacy, ethical considerations, and the need for continued biostatistics education in healthcare. This study offers a roadmap for ongoing research and highlights opportunities for future interdisciplinary collaborations to address the complexities of modern medical data analysis. This scientometrics study reveals the evolution of statistical methods used in medical research over time, evaluates frequently cited models and thematic changes, and provides implications that can enhance evidence-based decision-making processes regarding methodological choices that guide contemporary clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012477","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":"Should We Routinely Take Chest X-Rays Before Surgery? A Systematic Scoping Review of Clinical Recommendations Using the Appraisal of Guidelines for Research and Evaluation–Recommendations Excellence (AGREE-REX) Instrument","authors":"Ting-Ju Wu,&nbsp;Kee-Hsin Chen,&nbsp;Yi-No Kang,&nbsp;Khanh Dinh Hoang,&nbsp;Hsin-Chih Fang,&nbsp;Chiehfeng Chen","doi":"10.1111/jep.70265","DOIUrl":"https://doi.org/10.1111/jep.70265","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;Chest radiography is often performed preoperatively as a common diagnostic tool. However, chest radiography carries the risk of radiation exposure. Given the uncertainty surrounding the utility of preoperative chest radiographs, physicians require systematically developed recommendations. This systematic review assesses the quality and consistency of guideline recommendations for the timing and indications of preoperative chest radiography to make appropriate decisions.&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;The guideline recommendations on the management of the preoperative chest radiography, August 2024, were retrieved. All the reviewed recommendations were in English. Four reviewers independently assessed the quality of recommendations by using the Appraisal of Guidelines for Research and Evaluation–Recommendations Excellence (AGREE-REX) instrument, which contained three main domains (clinical applicability, values and preferences, and implementability), and their reported evidence was evaluated.&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;Ten eligible recommendations were included. Six and four of the recommendations were of high and moderate quality according to AGREE-REX instrument, respectively. Overall, these guideline statements demonstrated significantly higher quality in the implementability domain (median 5.62, IQR 5.03 to 5.97), followed by the domain of value and preference (median 5.34, IQR 4.45 to 5.48) and the clinical applicability domain (median 4.96, IQR 4.27 to 5.15). Most recommendations on the preoperative chest radiograph were relatively consistent. The overall Krippendorff′s alpha value of 0.824 indicates generally satisfactory agreement and reliable ratings. Although none of the 10 recommendations advocate for routine preoperative chest radiographs, they indicate specific clinical circumstances and patient populations in which such testing may be warranted.&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;Routine chest radiography before surgery is generally not recommended, except in specific circumstances, as follows: (1) age &gt; 70 years, (2) cardiac or thoracic clinical symptoms or a medical history, (3) surgery involving the chest, (4) ASA levels III to VI, and (5) work environments that may expose individuals to harmful particles. However, the final decision regarding preoperative chest radiographs should remain flexible, should be based on individual patient characteristics, the physician′s expertise, and consultation with other health-care professionals.&lt;/p&gt;\u0000 \u0000 &lt;p&gt;&lt;b&gt;Clinical Trial Registration.&lt;/b&gt; Name of the registry: PROS","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012480","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":"A Reflective Verbalization Strategy to Trigger Alternative Diagnostic Hypotheses","authors":"Sho Isoda,&nbsp;Taro Shimizu,&nbsp;Tadayuki Hashimoto,&nbsp;Fumio Shimada,&nbsp;Miwa Misawa,&nbsp;Tomio Suzuki","doi":"10.1111/jep.70267","DOIUrl":"https://doi.org/10.1111/jep.70267","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Physicians sometimes encounter various types of gut feelings (GFs) during clinical diagnosis. The type of GF addressed in this paper refers to the intuitive sense that the generated hypothesis might be incorrect. An appropriate diagnosis cannot be obtained unless these GFs are articulated and inventive solutions are devised. Thus, the method of articulating GFs is critical.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>The current study proposes reflective verbalization (RV) to help healthcare professionals capitalize on their GF. In cognitive psychology, RV is the process of verbalizing one's thoughts and feelings through metacognition, to promote deeper understanding and insight problem-solving. When applied to clinical reasoning, RV can help doctors verbalize their GFs, refining their diagnostic hypotheses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>To address GFs systematically using RV, we introduce the DATES approach, comprising five perspectives: Degree, Abandoned, Time course, Excess, and Shortage. Each perspective prompts physicians to compare their patient's information against typical illness scripts, ensuring no detail is omitted or overlooked.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results and Conclusion</h3>\u0000 \u0000 <p>The tool also aids physicians in considering possible differential diagnoses for one or more of these elements. This guiding tool may aid physicians in overcoming biases, including confirmation and anchoring biases, thus improving diagnostic accuracy. This tool is useful for healthcare professionals who wish to improve their clinical reasoning and decision-making abilities, particularly when they encounter inexplicable contradictions in their diagnostic hypotheses.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70267","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012481","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":"Artificial General Intelligence and Its Threat to Public Health","authors":"Richard C. Armitage","doi":"10.1111/jep.70269","DOIUrl":"https://doi.org/10.1111/jep.70269","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Artificial intelligence (AI) is increasingly applied across healthcare and public health, with evidence of benefits including enhanced diagnostics, predictive modelling, operational efficiency, medical education, and disease surveillance.However, potential harms – such as algorithmic bias, unsafe recommendations, misinformation, privacy risks, and sycophantic reinforcement – pose challenges to safe implementation.Far less attention has been directed to the public health threats posed by artificial general intelligence (AGI), a hypothetical form of AI with human-level or greater cognitive capacities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This article explores the benefits and harms of current AI systems, introduces AGI and its distinguishing features, and examines the threats AGI could pose to public health and humanity's survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Unlike ‘narrow’ AI, AGI could autonomously learn, generalise across domains, and self-improve, potentially achieving superintelligence with unpredictable behaviours.AGI threatens public health through two broad categories: (1) misuse, where adversaries deploy AGI for cyberattacks, disinformation campaigns, or to develop chemical, biological, radiological, and nuclear (CBRN) weapons; and (2) misalignment, where poorly aligned AGI pursues goals in harmful ways, leading to loss of human control, erosion of autonomy, and potentially existential risk.The population-level consequences include widespread unemployment, reduced trust in health systems, catastrophic biological threats, and risks to human survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Healthcare and public health professionals have a critical role in framing AGI risks as health threats, building coalitions akin to historic movements against nuclear war, and collaborating with AI researchers, ethicists, and policymakers.Leveraging their expertise, trust, and global networks, these professionals can help ensure that AI development prioritises human wellbeing and safeguards humanity's future.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70269","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012213","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":"Development, Evaluation, and Implementation of Guideline Adaptation and Its Frameworks: A Meta-Epidemiological Study of English-Language Guidelines","authors":"Yuan Zhang,&nbsp;Shu Wang,&nbsp;Zhixuan Wen,&nbsp;Yueming Yang,&nbsp;Yuxuan Zhang,&nbsp;Yixiong Geng,&nbsp;Yaguang Peng,&nbsp;Yali Liu","doi":"10.1111/jep.70261","DOIUrl":"https://doi.org/10.1111/jep.70261","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Guideline adaptation refers to the process of modifying or tailoring existing clinical practice guidelines (CPGs) in addressing local health system needs, improving the relevance of recommendations, and overcoming barriers like resource constraints. However, limited information is known about the current development, evaluation, and implementation of guideline adaptation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study aims to evaluate the methodological quality, utilization, and implementation of English-language adapted CPGs and compare frameworks used for adaptation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This meta-epidemiological study systematically searched and included adapted CPGs and original CPGs in English to the end of 2022 by applying the two most widely used adaptation frameworks, ADAPTE and GRADE-ADOLOPMENT. Their characteristics, utilization, and implementation were analyzed, the completeness of the adaptation steps was assessed via quality evaluation, and the two adaptation frameworks were compared in exploring their advantages, limitations, and suitable applicable situations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 30 adapted CPGs were included, and 75 original CPGs were identified. Most of the adapted and original CPGs were developed by developed countries/regions and had close connections, covering a wide range of populations and fields. However, resource-limited countries/regions participate less in guideline adaptation, requiring additional consideration. The adapted CPGs that applied the ADAPTE and GRADE-ADOLOPMENT frameworks had insufficient adaptation quality, with mean reporting rates of 64.7% and 78.6%, respectively. Comparisons of the adaptation methods revealed several key gaps, such as rigor, conciseness, efficiency, and transparency, and the advantages of applying guideline adaptation in resource-limited areas have not been fully revealed, indicating the need for a future unified adaptation framework that considers the advantages and limitations of current methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Several shortcomings in the methodological quality of current adapted CPGs were identified, alerting appraisals before applying their recommendations; and key gaps existed regarding available guideline adaptation methods, requiring a future unified framework to be developed. Further research should examine non-English guidelines to enhance the global applicability of these findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012216","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":"Standardising Traditional Chinese Medicine Decoction Rooms: Current Challenges and Proposed Solutions for Medical Institutions","authors":"Lin Shi,&nbsp;Jian-Kun Wu","doi":"10.1111/jep.70240","DOIUrl":"https://doi.org/10.1111/jep.70240","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To analyse current supervision methods and problems in traditional Chinese medicine (TCM) decoction rooms in medical institutions and to propose feasible methods of quality control.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study is a literature review. Literature related to TCM decoction was obtained from the PubMed, CNKI and Web of Science databases. Studies published between 2010 and 2024 were retrieved using ‘traditional Chinese medicine decoction’ as the search term. The collected research findings were then summarised and analysed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This study identified the following problems in TCM decoction rooms: (1) the equipment and facilities are not ideal, (2) staff-implemented processes are not standardised and (3) the management system is flawed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Recommendations</h3>\u0000 \u0000 <p>In view of the above problems, the following recommendations for decoction rooms are proposed: (1) a safe and hygienic environment should be developed; (2) equipment and facilities should be improved; (3) staff training should be strengthened and staff quality improved and (4) management should be enhanced.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012210","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":"Health: A Critique of Clinicians' Views and a Transgressive Model Based on Imagination","authors":"Alexandra Pârvan","doi":"10.1111/jep.70247","DOIUrl":"https://doi.org/10.1111/jep.70247","url":null,"abstract":"<div>\u0000 \u0000 <p>In its first part, the article offers a critique of current definitions of health advanced in medical scholarship. It identifies and discusses their major problematic themes (e.g., wholeness, balance, adaptation, activity), and how these are also relevant for the dominant, professional understanding of <i>mental</i> health. Patient reports are used throughout to illustrate both the argument against the normative type of health that is proposed and operated with in clinical contexts, and, in the second part of the article, the model put forth as a solution. The latter is called ‘transgressiveʼ because it is based on transgressing normative boundaries that are culturally and professionally set in place to establish discrete and value-charged identities for medically relevant realities—such as ‘diseaseʼ, ‘bodyʼ, ‘personʼ, ‘healthʼ—and that are not facilitating either clinical or patient work conducive to lived, personal health. New concepts are introduced (‘autobiologyʼ, ‘health-diversityʼ, ‘poietic injusticeʼ) to argue for: health as a personal creation, a position of diversity about health processes or states, and the importance of training the imagination in the clinical professions. The transgressive model of health is intended as a conceptual tool for practical, clinical application by healthcare practitioners.</p>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012478","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":"Community Pharmacy Service for Patients With Inhaled Medications: A Multi-Perspective Observation and Assessment Under Routine Conditions","authors":"Ann-Christin Kroenert,&nbsp;Lucas Freyberg,&nbsp;Claudia Sehmisch,&nbsp;Sebastian Michael,&nbsp;Thilo Bertsche","doi":"10.1111/jep.70271","DOIUrl":"https://doi.org/10.1111/jep.70271","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Outcome studies have shown the benefits of inhalation consultations. Therefore, the service of inhalation consultations from pharmacists has been implemented in guidelines. Recently, this service became reimbursable for German community pharmacies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>We aimed to investigate how this service is performed under routine conditions to actually achieve the proven benefits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We evaluated the reimbursed inhalation service under routine conditions in community pharmacies in Saxony, Germany. An external trained monitor observed routine services and documented predefined handling errors in patients' inhalation demonstrations. Besides, the monitor checked which contents of predefined checklists were addressed. After the consultations, patients and pharmaceutical staff were asked about the pervious service via a questionnaire.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We analysed 48 reimbursed inhalation services in 13 different community pharmacies. Most consultations were on metered dose inhalers and dry powder inhalers, with 42% (20/48) each. We observed a median of <i>n</i> = 2 handling errors per patient (Q25: 1; Q75: 3). On average, 77% of those two errors were addressed by the pharmaceutical staff during the following consultation (95% confidence interval [69%; 86%]; minimum: 0%; maximum: 100%). Overall, patients' contentment with the service was very high (overall median: 5), while pharmaceutical staff's contentment was high (overall median: 4). There was no correlation between duration and unaddressed errors (<i>r</i> = 0.16; <i>p</i> = 0.35) or patients' contentment (<i>r</i> = 0.19; <i>p</i> = 0.26).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Handling errors in patients' inhalation technique were common but mostly recognized and addressed by the pharmaceutical staff during the reimbursed inhalation service. Patients' contentment with the service was high to very high, and they were usually more content with the service than the pharmaceutical staff.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70271","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012211","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 Outcomes for Traumatised Health and Social Care Staff Through the Implementation of a Trauma Pathway Within an NHS Staff Support Service: A Case Study","authors":"Ekaterina Yurtaeva,&nbsp;Emma Groves","doi":"10.1111/jep.70262","DOIUrl":"https://doi.org/10.1111/jep.70262","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Health and care professionals experience Post Traumatic Stress Disorder (PTSD) at higher rates than the general population with occupational trauma being as prevalent as is personal trauma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>The aim of this case study was to demonstrate the trauma-informed model of care implemented as part of the trauma pathway within the Humber and North Yorkshire (HNY) Resilience Hub.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We use a case study methodology to illustrate how the pathway supported a member of healthcare staff who struggled with symptoms of PTSD due to personal trauma and was unable to access support via other mental health services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results and Conclusion</h3>\u0000 \u0000 <p>We conclude that more services are needed to support health and care staff with psychological difficulties in a trauma-informed and psychologically safe way.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012214","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}