Journal of evaluation in clinical practice最新文献

{"title":"The Contingent Payoff of Transparency: The Mediating Roles of Citizen Participation and Enforcement in Health Service Delivery Improvement","authors":"Samuel Atiku,&nbsp;Alfred Okoh,&nbsp;Olufisayo Olakotan","doi":"10.1111/jep.70401","DOIUrl":"10.1111/jep.70401","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>How transparency reforms affect frontline health service delivery remains uncertain. Research presents a transparency paradox, where some studies report service improvements when transparency is combined with oversight, while others find minimal impact on outcomes such as staff absence or medicine availability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This article addresses the conditions under which transparency improves health services. We argue that inconsistent findings stem from construct slippage, where distinct reforms are grouped together. We propose an unbundled conceptualisation distinguishing three types: Passive Transparency (information only disclosure), VOICE Interventions (disclosure plus citizen participation), and TEETH Interventions (disclosure linked to credible sanctions).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a scoping review of studies from 2000 to 2025 following PRISMA guidelines. Database searches yielded 6636 records, resulting in 49 included experimental, quasi experimental, and observational studies. Each intervention was coded as Passive Transparency, VOICE or TEETH based on its actual components rather than author labels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The evidence shows that Passive Transparency alone rarely shifts health service outcomes, though it can modestly increase citizen knowledge. Interventions that combine disclosure with empowered VOICE mechanisms show more consistent gains, such as large mortality reductions found in Uganda and Malawi. Similarly, TEETH interventions with credible enforcement, such as centralised drug procurement, produced large price reductions. Where enforcement was weak, transparency had little effect.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The impact of transparency on health service delivery is conditional rather than automatic. The transparency paradox is largely resolved when interventions are unbundled. Transparency functions as a diagnostic input whose effectiveness depends on being coupled with functional accountability arrangements: either empowered citizen VOICE or credible state TEETH.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 2","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147389458","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":"Enhancing the Clinical Feasibility of Morita Therapy in China Through the Integration of ACT and DBT: A Theoretical Framework and Implementation Protocol","authors":"Wang Ge,&nbsp;Tian Yumei,&nbsp;Jia Xiaoni,&nbsp;Wang Zhao","doi":"10.1111/jep.70400","DOIUrl":"10.1111/jep.70400","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This study aims to address the challenge of high dropout rates during the absolute bed rest period of Morita therapy in clinical practice in China. It explores the integration of Acceptance and Commitment Therapy (ACT) and Dialectical Behaviour Therapy (DBT) theory and techniques to enhance the operability and completion rate of this critical phase, while preserving the core therapeutic mechanisms of Morita therapy.&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 research examines the common ground between Morita therapy, ACT, and DBT in core concepts such as acceptance, action orientation, and psychological flexibility, as well as their potential shared biological mechanisms (e.g., modulating the default mode network, facilitating prediction error learning, and promoting neuroplasticity). By reviewing the current state of clinical practice in China, it analyses the underlying causes of implementation difficulties during the absolute bed rest period (e.g., patient psychological characteristics, socio-cultural background, and healthcare system constraints). A structured operational framework is proposed, integrating specific ACT and DBT techniques – such as cognitive defusion, mindfulness, values clarification, and distress tolerance skills – into the different stages of the absolute bed rest period.&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;The integrated framework provides patients with operable, structured skill-based support during the absolute bed rest period. It facilitates the progressive development of awareness, enhances acceptance capacity, improves distress tolerance, and fosters a connection with personal values. This framework not only has the potential to reduce dropout rates but also deepens patients' understanding and practice of the Morita therapy philosophy of ‘accepting reality as it is.’ It offers a new theoretical foundation and practical pathway for the effective implementation of Morita therapy within the Chinese cultural context.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The integration of ACT and DBT techniques shows promise in enhancing the clinical feasibility and patient completion rate of the absolute bed rest period in Morita therapy. It achieves this by adapting to the psychological characteristics and socio-cultural realities of Chinese patients while preserving core therapeutic mechanisms, such as facilitating ‘sudden insight’ and awakening life energy. Future directions include the development of a structured operational manual and validation of its efficacy through randomised controlled trials, thereby promoting the deeper integration and applica","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 2","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147389472","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 Framework to Decipher and Report Implementation Strategies and Pragmatic Attributes of Trial Design Domains From Pre-Implementation Studies Identified From a Systematic Review: A Methodological Study","authors":"Rahma Ajja,&nbsp;Vidhya Suresh,&nbsp;Sean Wang,&nbsp;Adrianna Elashker,&nbsp;Catalina Ordorica,&nbsp;Hayden B. Bosworth,&nbsp;Justin B. Moore,&nbsp;Brittany N. Rudd,&nbsp;Yashashwi Pokharel","doi":"10.1111/jep.70403","DOIUrl":"10.1111/jep.70403","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Telemedicine has strong potential to improve hypertension management, yet its uptake into routine care remains limited. Implementation strategies (IS) enhance evidence-based intervention (EBI) use. Identifying IS used in pre-implementation trials and understanding whether these trials are explanatory or pragmatic can inform the expedited translation of EBI. Despite the availability of tools to evaluate trial design and report IS, clinical researchers often face challenges in systematically describing IS from pre-implementation studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using the Pragmatic Implementation Strategy Reporting tool (PISRT), we describe a step-by-step approach to retrospectively report IS from 13 telemedicine trials of hypertension management identified from a systematic review. For each trial, we also mapped nine trial design domains along efficacy to effectiveness spectrum using the PRagmatic Explanatory Continuum Indicator Summary–2 (PRECIS–2) tool. Three clinical researchers new to implementation science underwent short training on implementation science methods including the Expert Recommendation for Implementation Change (ERIC) project, supervised by a fourth clinical researcher with working implementation science knowledge. The clinical researchers clarified important implementation science concepts, terminologies, PRECIS–2 domains and data harmonizing approaches across trials guided by published literature, lectures and group discussions during pilot coding sessions. After individual data extraction, the clinical researchers met to select and operationalize IS and trial design domains along the efficacy to effectiveness spectrum using consensus achieved through group discussions. We partnered with two implementation science experts to refine our approach and elaborated each ERIC IS by providing relevant examples in implementing IS in telemedicine management of hypertension intervention. We also defined intervention components for each trial to help distinguish EBI from IS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>We describe a practical manual for systematically reporting IS and attributes of trial designs from efficacy and effectiveness telemedicine trials for hypertension management. We provide a step-by-step approach to support clinical researchers in reporting IS and assessing the readiness of trials evaluating an EBI for real-world use. Future work should evaluate the effectiveness of our methods, including implementation science experts evaluating any discordance with our IS reporting.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 2","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147390301","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":"Nursing Care Behaviours and Challenges Faced During Truth-Telling: A Phenomenological Study","authors":"Ayşegül Yıldız İçigen,&nbsp;Elif Zeynep Meti̇n Gemici","doi":"10.1111/jep.70396","DOIUrl":"10.1111/jep.70396","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The process of truth-telling in nursing, particularly in the fields of oncology and intensive care, is a critical yet complex process that encompasses ethical principles, effective communication and emotional support. It involves significant challenges during the transmission of difficult information to both patients and their families.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to examine the care behaviours of nurses working in oncology and intensive care units during truth-telling and to identify the challenges they experience in this process.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study was conducted using the phenomenological design. Sixteen nurses from different hospitals in Türkiye were selected through purposive sampling. Maximum variation sampling was utilized to ensure the widest possible diversity among participants. In-depth interviews were used for data collection, and the data were analysed using the traditional descriptive phenomenological approach. The study adhered to the COREQ checklist for qualitative research reporting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study was conducted with 16 nurses from various age groups working in oncology and intensive care clinics of different hospitals in Türkiye. Study data were analysed, and three themes were elicited: the first thing that comes to the Light of Truth, the Language of Care and the Thorn of the Rose.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>It was determined that nurses used care behaviours, such as understanding the individual during truth-telling, empathic listening to give spiritual support, showing respect, establishing open communication, answering questions, relieving concerns, showing a friendly approach and therapeutic touch. Coping with the emotional responses of patients-relatives/the family and their own emotions during truth-telling was the most challenging situation for nurses.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 2","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147389521","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":"Will Medical Schools Train AI Tutors to Teach by Humiliation?","authors":"Bilal Irfan,&nbsp;Roberto Daniel Sirvent","doi":"10.1111/jep.70414","DOIUrl":"10.1111/jep.70414","url":null,"abstract":"&lt;p&gt;The rapid integration of artificial intelligence into clinical and educational workflows invites a familiar warning from digital health: any system may only be as good as the data and practices that shape it. That axiom is usually applied to diagnostic algorithms and decision support, but it also belongs in the classroom. If educational models are trained on the habits, signals, and outcomes that dominate medical schooling, they will likely reproduce not only content but pedagogy. One entrenched practice in clinical training is teaching by humiliation, a pattern of public shaming, belittlement, and staged embarrassment used to compel performance [&lt;span&gt;1&lt;/span&gt;]. When an approach is both prevalent and rationalized as effective, it may be legible to data collection and optimization routines as a norm to emulate. The result could be a generation of AI tutors that encode humiliation as a feature rather than a flaw.&lt;/p&gt;&lt;p&gt;Recent work on AI tutoring shows the promise and the peril. Investigators designed an AI tutor around what they considered pedagogical best practices, including active learning, cognitive load management, growth mindset, scaffolding, and timely feedback [&lt;span&gt;2&lt;/span&gt;]. The intervention outperformed in-class active learning. This is encouraging, yet it also raises a basic question for medical education: who decides what counts as a best practice, and what evidence base feeds that designation. Much of contemporary educational technology remains steeped in behaviorist assumptions that privilege extrinsic motivators, rigid outcome alignment, and compliance with summative assessment regimes. If training corpora and telemetry reward rapid fact retrieval, error avoidance, and test performance, AI tutors will optimize for those signals. They may neglect curiosity, conceptual integration, and clinical judgment under uncertainty, which are the very capacities that matter at the bedside.&lt;/p&gt;&lt;p&gt;Medical education's relationship with humiliation is well documented. This has included high rates of belittlement, public put-downs, and disparaging responses to student questions [&lt;span&gt;3, 4&lt;/span&gt;]. Qualitative studies show how yelling and derision have been normalized to the point that learners struggle to label them as mistreatment [&lt;span&gt;5&lt;/span&gt;]. This culture is not reducible to loud voices. It also expresses itself through silence, facial cues of disdain, and the choreography of clinical rounds where a wrong answer becomes a spectacle. If AI tutors learn from this environment, they may not need to shout to humiliate. They can deploy leaderboards, streaks, and punitive hints that rank students against peers and convert error into social exposure [&lt;span&gt;6&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Gamified platforms are often marketed as engines of engagement, but they frequently trade intrinsic motivation for points, badges, and hierarchical comparison. Leaderboards and competitive scoring introduce a persistent public record that quietly extends teaching by humiliatio","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 2","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147389507","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":"Tobacco Use Among University Students: Perceived Health Risks and Behavioral Change After COVID-19","authors":"Hadeel J. Dabour,&nbsp;Nesrin N. Abu-Baker,&nbsp;Ahlam S. Alnatour,&nbsp;Mohammed AlBashtawy","doi":"10.1111/jep.70399","DOIUrl":"10.1111/jep.70399","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>One of the most serious threats to public health is the tobacco epidemic. That's because smoking cigarettes could significantly raise the morbidity and mortality rates of infectious diseases, such as COVID-19 infection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study aimed to assess the perceived health risks, behavioral change, and predictive factors of university students who were tobacco users during the COVID-19 pandemic in Jordan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional design was conducted using a convenience sample of 370 university students in Amman. A self-reported questionnaire was distributed between August 2022 and October 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The most commonly used types of tobacco among university students were regular cigarettes (65.4%), water-pipes (47.8%), and e-cigarettes (41.1%). In response to the COVID-19 pandemic, 28.1% of participants reported that they attempted quitting, and 6.5% actually stopped using tobacco. Also, 84% of the students believed that smoking negatively impacts their health, and 34% agreed that smoking increases the risk of contracting COVID-19 and its severity. Being male or medical student significantly predicted higher mean score of behavioral change or perceived health risks (<i>p</i> ≤ 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Public health professionals and policymakers should enhance students' awareness about the health consequences of all types of smoking and increase access to smoking cessation programs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 2","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147365436","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":"Cost-Reduction Strategies and Patient Care Quality: Insights From Hospital Leaders","authors":"Abdul-Monim Batiha","doi":"10.1111/jep.70351","DOIUrl":"10.1111/jep.70351","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hospitals in middle-income countries such as Jordan face increasing pressure to reduce operational costs while maintaining high standards of patient care. Although global strategies like value-based care, digital health transformation, and Lean process improvements have shown success in wealthier nations, their implementation and outcomes in resource-constrained settings remain underexplored. This study investigates cost-reduction strategies led by hospital leadership in Jordan and evaluates their impact on financial sustainability and patient care quality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A qualitative descriptive study was conducted from January to March 2024 in public and private hospitals across urban and semi-urban areas of Jordan. Twenty-five senior hospital leaders, including chief executive officers and financial directors, were recruited through purposive sampling. Data were collected through semi-structured interviews and analyzed thematically using qualitative analysis software. A pragmatic inquiry framework guided the design and interpretation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thematic analysis revealed eight key strategies, including digital health system adoption, transition to value-based care, Lean process redesign, workforce optimization, and improved supply chain management. Outcomes included a thirty percent reduction in documentation errors, a reduction of one and a half days in average patient length of stay, and a twenty percent decrease in medical supply costs. Importantly, these positive outcomes emerged despite persistent challenges such as limited government support, technological barriers, and workforce inefficiencies—highlighting that strong leadership, interdepartmental collaboration, and data-informed decision-making were essential to overcoming systemic constraints.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Leadership-driven strategies can effectively reduce costs and improve care quality in hospitals operating under resource constraints. The interplay between achieved outcomes and existing challenges underscores the importance of policy support, investment in digital infrastructure, and sustained leadership engagement for achieving scalable and sustainable improvements.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 2","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147365419","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":"Reclaiming Pharmacovigilance: Bridging the Evidence–Practice Gap in Psychopharmacology","authors":"Carlos De las Cuevas","doi":"10.1111/jep.70402","DOIUrl":"10.1111/jep.70402","url":null,"abstract":"&lt;p&gt;More than three decades after the introduction of so-called ‘atypical’ antipsychotics, psychiatry faces an uncomfortable paradox: the scientific evidence underpinning psychopharmacology has never been stronger, yet clinical practice remains strikingly conservative. We possess detailed knowledge of comparative efficacy, adverse-effect profiles, and long-term outcomes—supported by registries, pharmacovigilance data and meta-analyses—yet prescribing habits continue to be shaped more by convenience, institutional inertia, and regulatory burden than by science itself.&lt;/p&gt;&lt;p&gt;This tension between knowledge and practice defines what may be termed a crisis of psychopharmacology. The evidence base continues to expand, while clinical implementation stagnates. Few areas illustrate this more clearly than treatment-resistant schizophrenia (TRS) and the growing cardiometabolic and cardiac burden associated with widely used antipsychotics.&lt;/p&gt;&lt;p&gt;Clozapine remains the only antipsychotic with robust, replicated evidence of superiority in TRS, consistently reducing relapse, hospitalisation, and suicide risk [&lt;span&gt;1&lt;/span&gt;]. Nevertheless, it remains profoundly underused worldwide. The TRRIP consensus guidelines explicitly recommend clozapine as the third-line treatment after two adequate antipsychotic trials, yet large registry studies continue to show long delays in initiation and frequent discontinuation at subtherapeutic doses [&lt;span&gt;2, 3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The reasons are well known: bureaucratic monitoring requirements, clinician apprehension, and organisational disincentives. The result is a paradoxical situation in which the only medication proven to reduce mortality in schizophrenia [&lt;span&gt;4&lt;/span&gt;] is the least prescribed for those who most need it. Instead, antipsychotic polypharmacy—often involving high-dose combinations of SGAs—has become a surrogate for evidence-based escalation, despite data demonstrating higher mortality risk and no clear efficacy advantage [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The introduction of SGAs was originally heralded as a revolution in tolerability and safety. Yet, over time, a substantial body of evidence has documented their cumulative metabolic and cardiovascular burden. Weight gain, dyslipidaemia, insulin resistance, hypertension, and QTc prolongation are not merely side effects—they are major contributors to the 10–20-year reduction in life expectancy observed in severe mental illness [&lt;span&gt;6&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The cardiometabolic risk associated with clozapine and olanzapine is particularly well documented, while ziprasidone and amisulpride have been linked to QTc prolongation and arrhythmic events [&lt;span&gt;7&lt;/span&gt;]. Despite this knowledge, routine metabolic and ECG monitoring remains inconsistent. In many health systems, lipid profiles, glucose levels, or ECGs are not obtained at the recommended intervals—an omission that would be unacceptable in any other branch of medicine.&lt;/p&gt;&lt;p&gt;Recent nationwide cohort studies have underscored the c","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 2","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12964518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147365448","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":"Implementing Genomic Medicine in Primary Care: A Convergent Mixed Method Case Study","authors":"Emory W. Heffernan,&nbsp;Kristine R. Hearld,&nbsp;Irene P. Moss,&nbsp;Kelly M. East,&nbsp;Irfan M. Asif,&nbsp;Whitley V. Kelley,&nbsp;Erin W. Delaney,&nbsp;Greg M. Cooper,&nbsp;Bruce R. Korf,&nbsp;Nita A. Limdi,&nbsp;Larry R. Hearld","doi":"10.1111/jep.70397","DOIUrl":"10.1111/jep.70397","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Despite the growing interest in implementing genomic medicine into primary care, numerous barriers persist. Herein we present formative work conducted at three primary care clinics to identify barriers to implementation as part of a state-funded genomic medicine initiative.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A convergent mixed-methods case study was conducted across three family practice clinics participating in the Alabama Genomic Health Initiative. Quantitative, cross-sectional surveys evaluated clinic personnel attitudes, implementation climate, and feasibility. Additionally, qualitative, semi-structured interviews examined clinic personnel's perceptions of genomic medicine implementation into routine care, identified barriers to this integration, and investigated strategies for overcoming these barriers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Respondents exhibited positive attitudes towards genomic medicine while voicing concerns regarding time constraints, technological integration, lack of actionable results for certain patients, and inadequate implementation knowledge. Although the primary care climate was generally supportive of change, it was less conducive to the specific implementation of genomic medicine. External facilitators and educational resources were identified as critical for successful implementation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Despite primary care personnel acknowledging the preventive and diagnostic value of genomic medicine, the effective integration of this practice requires practical solutions to barriers such as resource limitations and specialized training needs, indicating that enhanced infrastructure and focused educational initiatives could facilitate its implementation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 2","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12955339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147344442","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":"Effectiveness of Health Literacy Interventions for Blood Pressure Control, Medication Adherence, and Self-Efficacy In Older Adults With Hypertension: A Systematic Review and Meta-Analysis.","authors":"Jinxia Yu, Naiyang Shi, Jin Zhao, Fuxian Li, Jiayu Wang, Mincong Jin, Hui Jin","doi":"10.1111/jep.70419","DOIUrl":"https://doi.org/10.1111/jep.70419","url":null,"abstract":"<p><p>This systematic review and meta-analysis contributes to the Journal's focus on clinical care improvement and evidence-based medicine by evaluating the global evidence for a scalable, person-centred intervention-health literacy-in the management of hypertension among older adults.</p><p><strong>Background: </strong>Health literacy (HL) is the ability to access, understand, and apply health information to make informed decisions. However, evidence regarding the comprehensive effects of HL interventions on multiple outcomes in older adults with hypertension remains unclear.</p><p><strong>Aims: </strong>This study aimed to evaluate the effectiveness of HL interventions for improving systolic blood pressure (SBP), diastolic blood pressure (DBP), medication adherence, and self-efficacy in older adults with hypertension.</p><p><strong>Methods: </strong>We searched PubMed, Web of Science, Scopus, Embase, the Cochrane Library, and CINAHL from inception to June 2025 for relevant randomized controlled trials (RCTs). Study quality was assessed using the Cochrane RoB 2.0 tool. Pooled mean differences (MD) and standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated using random-effects models. Subgroup and sensitivity analyses were conducted.</p><p><strong>Results: </strong>Forty-two RCTs (9,332 participants) were included; 25 studies (59.5%) had a low risk of bias. Meta-analysis revealed that HL interventions significantly reduced SBP (MD: -6.90 mmHg; 95% CI: -8.51 to -5.29; p < 0.01) and DBP (MD: -3.03 mmHg; 95% CI: -4.12 to -1.94; p < 0.01), and improved medication adherence (SMD: 0.69; 95% CI: 0.26 to 1.12; p < 0.01) and self-efficacy (SMD: 0.35; 95% CI: 0.10 to 0.60; p < 0.01). Greater benefits were observed in trials conducted in Eurasian regions and those emphasizing active participant engagement.</p><p><strong>Conclusions: </strong>HL interventions are effective in improving SBP and DBP control, medication adherence, and self‑efficacy among older adults with hypertension. The findings support the integration of structured, participatory HL strategies into routine geriatric hypertension management.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 2","pages":"e70419"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147520673","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}