Journal of evaluation in clinical practice最新文献

{"title":"Psychometric Evaluation of the Icelandic Version of the Modified Dynamic Gait Index for Community-Dwelling Older Adults With Balance Impairments","authors":"Solveig A. Arnadottir,&nbsp;Ragnar F. Gustafsson,&nbsp;Nina D. Oskarsdottir,&nbsp;Holmfridur H. Sigurdardottir,&nbsp;Atli Agustsson","doi":"10.1111/jep.14262","DOIUrl":"10.1111/jep.14262","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Optimal mobility is crucial for healthy aging, particularly among older adults with balance impairments. This research examines the psychometric properties of the modified Dynamic Gait Index (mDGI) translated into Icelandic, highlighting its suitability for evaluating mobility in this demographic group and within the context of healthy aging. Addressing the scarcity of international psychometric research on the mDGI, this study contributes to the translation of geriatric outcome measures into different languages, enhancing clinical applications and international research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To assess the reliability and validity of the mDGI among Icelandic older adults experiencing balance impairments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This methodological study included 30 participants, aged 67–91 years, receiving outpatient physical therapy for balance impairments. The participants completed two mDGI assessments 4–7 days apart, and additional assessments using the 10-meter walking test (10MWT), Timed Up and Go (TUG), Activities-specific Balance Confidence (ABC) scale, and Short Form Health Survey (SF-36) subscales. Analysis included evaluating the mDGI's total scale and subscales' reliability and validity using Intraclass Correlation Coefficient (<i>ICC</i>_3,1), Standard Error of Measurement (<i>SEM</i>), Cronbach's alpha, and Spearman's rho.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mDGI demonstrated high relative reliability (<i>ICC</i>_3,1 = 0.95 for total mDGI; 0.73–0.92 for all subscales) and strong absolute reliability (<i>SEM</i> for total mDGI = 1.32; two subscales = 1.17–1.43). Internal consistency was robust (alpha for total mDGI = 0.9; two subscales = 0.86–0.89). Construct validity was confirmed by mDGI's correlations with 10MWT, TUG, and SF-36 social and physical functioning subscales. No floor or ceiling effects were observed in mDGI total scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The Icelandic version of the mDGI provides reliable and valid measures for evaluating balance and gait in older adults with balance impairments. Its sound psychometric properties support its use in similar demographic settings globally, providing a reliable tool for geriatric care practitioners and researchers worldwide.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807420","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 Learning Approaches Among Physiotherapy Students in Haryana: A Cross-Sectional Study","authors":"Pooja,&nbsp;Megha Gakhar,&nbsp;Bhawna Verma,&nbsp;Vinay Jagga","doi":"10.1111/jep.14253","DOIUrl":"10.1111/jep.14253","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Understanding students' learning approach, modifying teaching methods, curriculum and material accordingly is essential to deliver quality education. Knowing more about the learning approaches assists in upgrading the profession's quality for continuous professional development.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The cross-sectional study was carried out among physiotherapy students studying in physiotherapy colleges affiliated with the same university. The Approaches and Study Skills Inventory for Students questionnaire was used to evaluate learning approaches in both preclinical and clinical students. Data were analysed using the IBM Statistical Package SPSS 27. Statistical significance was set at <i>p</i> &lt; 0.05.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 250 participants with a mean age of 21.09 + 1.93 years, 129 (51.6%) in the preclinical group and 121 (48.4%) in the clinical group participated in the study. 67 (26.7%) of the students were male, while 183 (72.9%) were females. The vast majority of participants (97.6%) adopt a deep approach to learning, while only a small fraction (2.0%) use a surface approach, with the strategic approach being rarely used (0.4%). No significant difference was observed between the males and females, and students of different colleges under the same university.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The predominant approach is the deep learning approach reflecting active learning. This may indicate that curriculum and strategies of teaching are employed over physiotherapy students to promote quality learning. Also, the teaching preferences varies between two group of physiotherapy students. Thus, this will also assist physiotherapy educators in planning and delivering learning activities according to learners by knowing their preferences.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791977","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 Community-Based Mental Health Services in the Framework of SWOT Analysis From the Perspective of Health Providers and Service Recipients: A Case Study","authors":"Sercan Mansuroğlu,&nbsp;Özge Eri̇ş Davut","doi":"10.1111/jep.14247","DOIUrl":"https://doi.org/10.1111/jep.14247","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study is a case study that aims to evaluate community-based mental health services from the perspective of health providers and service recipients through SWOT analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This qualitative case study was conducted through in-depth interviews with five healthcare providers providing services in a community mental health centre and five individuals with severe mental disorders receiving services. The data were analysed by content analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>As a result of the content analysis of the data, subthemes were identified under the main themes of strengths, weaknesses, opportunities and threats. For service recipients; under the theme of strengths, the subthemes of multidimensional support systems and treatment adherence, and under the theme of weaknesses, the subthemes of insufficient physical environment and insufficient attention were identified. Under the theme of opportunities, the subthemes of awareness, self-confidence, employment/financial gain, sharing/socialization and problem solving were identified, while under the theme of threats, the subthemes of economic constraints and feeling uncomfortable were revealed. For health providers; under the theme of strengths, the subthemes of holistic approach, early intervention and stigma prevention, under the theme of weaknesses, the subthemes of lack of resources, lack of standards, unqualified team members, inadequate professional/in-service trainings were revealed. Under the theme of opportunities, the subthemes of autonomous working environment, support systems and aids, and training programmes were identified, while under the theme of threats, the subthemes of economic constraints, stigma exposure, political deficiencies, staff reluctance/burnout, negative perceptions about the centre, and gettıng complacent were identified.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Community-based mental health services contain strengths, weaknesses, opportunities and threats according to the views of both health providers and service recipients, and the views of the groups overlap with each other within the supply-demand mechanism. It can be said that the effectiveness of community-based mental health services will increase by preventing threats by improving weaknesses and increasing the visibility of opportunities by recognizing strengths.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762429","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":"Implications of Large Language Models for Clinical Practice: Ethical Analysis Through the Principlism Framework","authors":"Richard C. Armitage","doi":"10.1111/jep.14250","DOIUrl":"https://doi.org/10.1111/jep.14250","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The potential applications of large language models (LLMs)—a form of generative artificial intelligence (AI)—in medicine and health care are being increasingly explored by medical practitioners and health care researchers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This paper considers the ethical implications of LLMs for medical practitioners in their delivery of clinical care through the ethical framework of principlism.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>It finds that, regarding beneficence, LLMs can improve patient outcomes through supporting administrative tasks that surround patient care, and by directly informing clinical care. Simultaneously, LLMs can cause patient harm through various mechanisms, meaning non-maleficence would prevent their deployment in the absence of sufficient risk mitigation. Regarding autonomy, medical practitioners must inform patients if their medical care will be influenced by LLMs for their consent to be informed, and alternative care uninfluenced by LLMs must be available for patients who withhold such consent. Finally, regarding justice, LLMs could promote the standardisation of care within individual medical practitioners by mitigating any biases harboured by those practitioners and by protecting against human factors, while also up-skilling existing medical practitioners in low-resource settings to reduce global health disparities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Accordingly, this paper finds a strong case for the incorporation of LLMs into clinical practice and, if their risk of patient harm is sufficiently mitigated, this incorporation might be ethically required, at least according to principlism.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.14250","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762427","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":"Optimising Outpatient Registration System Implementation Using Critical Path Method: A Case Study","authors":"Dan Hong","doi":"10.1111/jep.14254","DOIUrl":"https://doi.org/10.1111/jep.14254","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Today, hospital information systems (HISs) play an irreplaceable role in hospital management. At present, HIS construction projects in many hospitals have faced the setback of ‘project quagmire’ to varying degrees. The critical path method (CPM) mainly aims to find the critical path, thus managing project progress.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To explore the importance and practical application of the CPM to the management of HIS project schedules.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study used the construction project of a hospital's outpatient registration subsystem as an example. CPM was used to determine the critical path. The time and workload required for the project were calculated using the forward and backward extrapolation methods. The earliest start time and earliest completion time as well as the latest start time and latest completion time of each task could be calculated using the forward and backward extrapolation methods. The path with the longest construction period was determined to be the critical path, and the unit speed rate of each activity was calculated on this basis. Then, the time schedule of the outpatient registration subsystem was compressed and the project schedule optimised.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Path 3 [outpatient registration demand analysis (A)—basic data preparation (C)—subsystem test (F)—simulation test (G)] was determined to be the critical path according to the construction period, and the task time was compressed on this basis. Considering many factors, the time of the subsystem test task (F) was reduced from 7 weeks to 4 weeks. The total cost was saved by 1000 yuan, which not only ensured the progress ahead but also saved the overall cost.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The CPM could effectively measure the completion and deviation of each stage of the registration system project, which provided an effective guarantee for the subsequent schedule compression to ensure that the project was completed as scheduled and was of sufficient quality. However, all conditions had to be considered comprehensively; doing otherwise would lead to increased risks and costs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762430","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":"Measurement of Physical Activity Divided Into Inside and Outside the Home in People With Parkinson's Disease: A Feasibility Study","authors":"Yuichi Hirakawa,&nbsp;Hiroaki Sakurai,&nbsp;Kazuya Takeda,&nbsp;Soichiro Koyama,&nbsp;Masanobu Iwai,&nbsp;Ikuo Motoya,&nbsp;Yoshikiyo Kanada,&nbsp;Nobutoshi Kawamura,&nbsp;Mami Kawamura,&nbsp;Shigeo Tanabe","doi":"10.1111/jep.14251","DOIUrl":"https://doi.org/10.1111/jep.14251","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>In people with Parkinson's disease (PD), quantitative assessment of activities inside and outside the home is crucial for planning effective rehabilitation tailored to a person's living conditions and characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>We examined the feasibility of combining a physical activity metre and a daily activity diary for people with PD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Physical activity was evaluated using a triaxial accelerometer and recorded in a daily activity diary by the participant. The feasibility outcome was the data adoption rate, which was the physical activity rate calculated from the activity metre wearing time and the missing times from the daily activity diary.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results and Conclusion</h3>\u0000 \u0000 <p>Of the 10 participants, nine had a complete data set (adoption rate 90%). The mean physical activity metre wearing time was 14.12 ± 2.26 h/day, with a mean missing time of 25.7 ± 18.1 min/day in the daily activity diary. Combining a physical activity metre and a daily activity diary is feasible in people with PD, particularly when planning rehabilitation protocols to enhance daily physical activity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142724215","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 Implementing Virtual Diabetes Group Visits on Staff and Provider Wellbeing, Job Satisfaction, and Burnout: A Mixed Methods Analysis","authors":"Rohan Moghe,&nbsp;Mengqi Zhu,&nbsp;Erin Staab,&nbsp;Daisy Nuñez,&nbsp;Sana Basheer,&nbsp;Wen Wan,&nbsp;Amanda Campbell,&nbsp;Michael Quinn,&nbsp;Cynthia T. Schaefer,&nbsp;Arshiya A. Baig","doi":"10.1111/jep.14238","DOIUrl":"https://doi.org/10.1111/jep.14238","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Rationale&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Few have assessed the impact of group visits (GVs), or shared medical appointments, on community health centre (CHC) staff and provider burnout, wellness, and job satisfaction.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aims and Objectives&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This study assesses the impact of diabetes GV implementation on staff and provider morale and burnout.&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;It is a pre-post study from a larger cluster randomised trial. Two cohorts of providers and staff from 13 Midwestern CHC clinics implemented in-person (&lt;i&gt;N&lt;/i&gt; = 39) and virtual (&lt;i&gt;N&lt;/i&gt; = 31) GVs for adults with diabetes. Semi-structured interviews (post-implementation) and surveys (pre and post-implementation) were conducted with staff and providers in both cohorts to assess changes in burnout, staff morale, and job satisfaction, along with reported benefits and burdens of GVs. Thematic analysis of interview transcripts and significance testing for survey data was then performed.&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;Interview data came from the in-person cohort (&lt;i&gt;N&lt;/i&gt; = 15) and the virtual cohort (&lt;i&gt;N&lt;/i&gt; = 19). Survey data were collected from a total of 70 respondents from the in-person (&lt;i&gt;N&lt;/i&gt; = 39) and virtual (&lt;i&gt;N&lt;/i&gt; = 31) cohorts. Key results include reported improved relationships with colleagues (‘&lt;i&gt;it has made our professional relationships stronger and I feel more comfortable talking about other things, as well’&lt;/i&gt;.), strengthened connections with patients (&lt;i&gt;‘We were able to help patients on a deeper level and provide more detail and one-on-one care’&lt;/i&gt;.), and individual reward (&lt;i&gt;‘Morale has increased. They're contributing and doing something positive for the patients’&lt;/i&gt;.). When asked about in-person versus virtual GVs, respondents noted they preferred in-person care but appreciated the flexibility virtual care afforded. Survey results revealed improved job satisfaction in the 2018 cohort and improved morale in the 2020 cohort, as well as perceived benefits including increased interprofessional collaboration and increased connection to patients.&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;Implementation of GVs in the CHC setting impacted key areas of burnout, including relationships, job attachment, and feelings of meaningful contribution in the workplace among providers and staff. Future clinic-based implementation studies may consider measuring staff and provider well-being as part of th","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.14238","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142724182","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 of Machine Learning Algorithms for Identifying Patients With Limited Health Literacy","authors":"Dylan Koole,&nbsp;Oscar Shen,&nbsp;Amanda Lans,&nbsp;Tom M. de Groot,&nbsp;J. J. Verlaan,&nbsp;J. H. Schwab","doi":"10.1111/jep.14248","DOIUrl":"10.1111/jep.14248","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Rationale&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Limited health literacy (HL) leads to poor health outcomes, psychological stress, and misutilization of medical resources. Although interventions aimed at improving HL may be effective, identifying patients at risk of limited HL in the clinical workflow is challenging. With machine learning (ML) algorithms based on readily available data, healthcare professionals would be enabled to incorporate HL screening without the need for administering in-person HL screening tools.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aims and Objectives&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Develop ML algorithms to identify patients at risk for limited HL in spine patients.&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;Between December 2021 and February 2023, consecutive English-speaking patients over the age of 18 and new to an urban academic outpatient spine clinic were approached for participation in a cross-sectional survey study. HL was assessed using the Newest Vital Sign and the scores were divided into limited (0–3) and adequate (4–6) HL. Additional patient characteristics were extracted through a sociodemographic survey and electronic health records. Subsequently, feature selection was performed by random forest algorithms with recursive feature selection and five ML models (stochastic gradient boosting, random forest, Bayes point machine, elastic-net penalized logistic regression, support vector machine) were developed to predict limited HL.&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;Seven hundred and fifty-three patients were included for model development, of whom 259 (34.4%) had limited HL. Variables identified for predicting limited HL were age, Area Deprivation Index-national, Social Vulnerability Index, insurance category, Body Mass Index, race, college education, and employment status. The Elastic-Net Penalized Logistic Regression algorithm achieved the best performance with a c-statistic of 0.766, calibration slope/intercept of 1.044/−0.037, and Brier score of 0.179.&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;Elastic-Net Penalized Logistic Regression had the best performance when compared with other ML algorithms with a c-statistic of 0.766, calibration slope/intercept of 1.044/−0.037, and a Brier score of 0.179. Over one-third of patients presenting to an outpatient spine center were found to have limited HL. While this algorithm is far from being used in clinical practice, ML algorithms offer a potential opportunity for identifying patients at ","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11582738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686990","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 Associated With Junior Nurses Ability to Recognise and Respond to Clinical Deterioration: A Cross-Sectional Study in Tertiary Hospitals in Malawi","authors":"Christina Chipeta,&nbsp;Peng Lingli,&nbsp;Musa Nget,&nbsp;Chifundo Benedicto Thamala","doi":"10.1111/jep.14243","DOIUrl":"https://doi.org/10.1111/jep.14243","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Recognising and responding swiftly to patient deterioration is critical for preventing adverse events. Junior nurses play a vital role in identifying the signs of clinical deterioration and initiating interventions. No prior studies have assessed junior nurses’ abilities to manage clinical deterioration in Malawi.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to assess junior nurses’ ability to recognise and respond to clinical deterioration in Malawian tertiary hospitals and identify associated factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The institutional based cross-section study design was used which included 322 junior nurses across all departments of four tertiary hospitals in Malawi (November–December 2023). Data collection utilised a questionnaire for clinical deterioration recognition and response ability in junior nurses. Chi-square, Fisher's exact, and logistic regression tests were used for data analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Junior nurses achieved a median score of 71 with an interquartile range of 68–75 on the clinical deterioration questionnaire. According to the study, nurses with more work experience, those who worked in intensive care units, and those who participated in discussions about clinical deterioration had better scores. In contrast, nurses with less than 1 year of experience were 5.5 times more likely to struggle with recognising and responding to clinical deterioration than those with 5 years of experience (<i>OR</i>: 5.506, <i>p</i> = 007). Additionally, working in the paediatric department decreased junior nurses’ ability to recognise and respond to clinical deterioration six times compared to working in the intensive care unit (OR: 6.068, <i>p</i> = 0.018). Furthermore, junior nurses who had never engaged in discussions related to clinical deterioration had a seven times higher likelihood of poor ability to recognise and respond to clinical deterioration (OR = 6.954, <i>p</i> = 0.005).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study highlights the need for specialised training programmes related to clinical deterioration that incorporate active learning, such as clinical scenarios and practical applications, along with mentorship initiatives to enhance junior nurses’ skills and confidence in recognising and responding to clinical deterioration.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674136","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":"Unseen Heroes: Exploring the Impact of Schizophrenia Caregiving on Families","authors":"Ghinasha Chaudhary,&nbsp;Alia Asmat","doi":"10.1111/jep.14246","DOIUrl":"10.1111/jep.14246","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Schizophrenia is a complex mental health disorder that not only affects the individual diagnosed but also has profound implications for their families and caregivers. This paper aims to shed light on the emotional, social and practical challenges faced by caregivers, as well as the coping mechanisms they employ to navigate the complexities of caregiving.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Through semi-structured interviews with caregivers of patients with schizophrenia, thematic analysis was employed to uncover the initial reactions, dynamics, daily life impact and coping skills.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thematic analysis of caregiver interviews reveals dominant themes including the emotional rollercoaster of caregiving, fostering fulfilling lives for loved ones with schizophrenia, the balancing act of caregiving responsibilities and the importance of social support networks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Caregivers often experience a wide range of emotions, from love and empathy to frustration and helplessness, as they navigate the challenges of supporting their loved ones with schizophrenia. Additionally, caregivers may face stigma, social isolation and financial strain, further complicating their caregiving journey.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675916","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}