Journal of evaluation in clinical practice最新文献

{"title":"Service Improvement Needs an Understanding of Complex Environments: Causal Diagrams Help Elucidate Causes and Patient Safety Implications of Failure to Collect Vital Signs at Triage","authors":"Gillian E. Francis,&nbsp;Mark Leaning,&nbsp;Barbara Cleaver,&nbsp;Gianni Turcato,&nbsp;Arian Zaboli","doi":"10.1111/jep.70195","DOIUrl":"https://doi.org/10.1111/jep.70195","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Triage frequently fails to identify critically ill patients and needs improved methods. Limited understanding, or errors in multivariable models are likely to impede progress in service improvement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>(1) to reveal a complex web of potential causal pathways stemming from nurses' decisions at triage and patient flow. (2) to add to the understanding of, and research methodology for triage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Secondary data analysis of records from a 91 month convenience sample of all patients attending a general Emergency Department (ED) was used to pose new questions about the functioning of triage systems. A conceptual model of the impact of patient flow on triage decisions and subsequent events was developed. Directed Acyclic Graphs (DAGs) were constructed to assist in the understanding of results and future research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Analysis showed a pivotal role for collection of vital signs data with far-reaching and surprisingly marked consequences. The response of triage nurses to time pressure revealed a complex ‘web’ of interactions and some unexpected findings. Safety and outcomes for patients were measurably affected and even the risky decisions some patients took to leave ED were influenced.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Triage is failing patients, ED staff and hospitals in complex ways and needs improvement. DAGs are useful for preventing mistakes in statistical analyses and improving research studies. By combining these with informal diagrams we hope to bridge communication barriers, since improving quality of care needs a multidisciplinary effort. Implications for the profession and patient care are outlined.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 5","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144573332","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 SHARE Model of Trauma Recovery: Addressing Silence, Honor, Attachment, Relational Trauma, and Embodied Memory in Collectivist Cultures","authors":"Anam Nawaz Malik,&nbsp;Shazia Hassan","doi":"10.1111/jep.70200","DOIUrl":"https://doi.org/10.1111/jep.70200","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Global trauma recovery frameworks have predominantly emerged from Western cultural paradigms, emphasizing individualism, open expression, and cognitive reframing. These approaches often fail to account for the sociocultural realities of collectivist, honor-based societies, where silence, relational boundaries, and communal identity fundamentally shape the trauma experience.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This paper introduces the SHARE Model of Trauma Recovery, a culturally grounded conceptual framework that responds to this gap by centering five core constructs: Silence, Honor, Attachment, Relational Trauma, and Embodied Memory.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Developed through critical synthesis of neurobiological theories (e.g., Polyvagal Theory), feminist psychology, and cross-cultural trauma literature, the SHARE model addresses how cultural scripts, familial loyalty, and suppressed emotion inhibit traditional recovery pathways.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Each element of the model reflects a culturally embedded barrier and potential access point for healing within non-Western contexts, particularly among women and survivors of violence in patriarchal, collectivist societies. The SHARE model redefines trauma recovery as a relational, embodied, and culturally mediated process, extending beyond Western diagnostic categories to include silence as survival, honor as constraint, and attachment as both wounding and healing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Clinical implications, therapeutic applications, and avenues for future empirical testing are discussed. This model offers a critical step toward equitable, culturally responsive trauma care and sets a foundation for transforming global trauma theory and practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 5","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144573335","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":"Artificial Intelligence in Healthcare: A Scoping Review of Medical Professionals' Acceptance and Institutional Challenges in Implementation","authors":"Latifun Nesa,&nbsp;Moustaq Karim Khan Rony,&nbsp;Sharmin Chowdhury,&nbsp;Most. Baby Naznin,&nbsp;Kanika Halder,&nbsp;Mst. Husne Ara,&nbsp;Nurun Naher Akter,&nbsp;Kobory Mankhin,&nbsp;Jinat Mohasana Shabnur,&nbsp;Jahangir Alam,&nbsp;Mst. Rina Parvin,&nbsp;Daifallah M. Alrazeeni,&nbsp;Fazila Akter","doi":"10.1111/jep.70170","DOIUrl":"https://doi.org/10.1111/jep.70170","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Artificial intelligence (AI) is transforming healthcare at a fast pace, showing promising potential to enhance medical diagnosis, inform treatment strategies, and support patient care. These advancements have the potential to improve clinical outcomes, streamline workflows, and reduce errors. However, comprehending the level of acceptance among medical professionals and the institutional challenges involved in implementing AI is essential.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This scoping review aimed to identify the acceptance of AI among medical professionals and to identify the institutional barriers that impede its widespread implementation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A scoping review methodology was applied to analyze studies published between 2015 and 2025. The review included peer-reviewed articles focusing on medical professionals' perspectives on AI adoption, including factors like acceptance, attitudes, benefits, and challenges. Key databases such as PubMed, Scopus, and IEEE Xplore were searched to ensure comprehensive coverage of relevant research. Data were extracted and categorized into themes related to AI acceptance, barriers, and institutional challenges.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Two major themes emerged: (1) medical professionals' acceptance of AI and (2) institutional challenges to implementation. AI tools used in diagnostic imaging, administrative support, and natural language processing were generally well accepted due to perceived efficiency and accuracy. Conversely, predictive models and clinical decision support systems received cautious responses, primarily due to concerns about interpretability, trust, and autonomy. Institutional barriers included limited infrastructure, lack of integration with existing health records, financial constraints, inadequate training opportunities, and regulatory ambiguities regarding liability, privacy, and fairness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While AI holds transformative potential for healthcare, its successful adoption requires addressing both human and systemic factors. Enhancing AI literacy, investing in infrastructure, and developing clear regulatory guidelines are critical to overcoming resistance and enabling meaningful integration.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 4","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514633","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":"Examining the Relationship Between Basic Nursing Skills, Hand Function, and Anxiety Levels in First-Year Nursing Students: A Correlational Study","authors":"Yılmaz Coşkun Ela,&nbsp;Yalçın Irmak Aylin,&nbsp;Şendir Merdiye","doi":"10.1111/jep.70191","DOIUrl":"https://doi.org/10.1111/jep.70191","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The aim of this study was to determine the relationship between basic nursing skills, hand functions and anxiety levels of nursing students.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>It is vital that basic nursing skills are achieved in the fastest and most accurate way in nursing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>This study was conducted with cross-sectional correlational design.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The sample of study consisted of freshman nursing students (<i>N </i>= 123). The data were obtained by ‘Student Information Form’, ‘State-Trait Anxiety Inventory’, ‘Basic Nursing Skills Forms’ and ‘Hand Skill Test’. Descriptive statistics and Pearson's correlation coefficient were used to analyse the data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean age of the students was 19.24 ± 1.31 years and 69.9% were female. 76% (<i>n </i>= 95) of them had not experienced any nursing skill before. The students' scores of basic nursing skills were above average. State and Trait Anxiety Inventory total scores were 44.71 ± 6.57 and 39.78 ± 9.82, respectively. 93.6% (<i>n</i> = 117) of the students had right dominant hand. Significant low-to-moderate correlations were found between left hand fine motor skill score and nasogastric drug administration skill (<i>r</i> = 0.197), both hand fine motor skill scores and blood collection skill (<i>r</i> = 0.191), assembly fine motor skill score and sterile glove wearing (<i>r</i> = 0.200), and subcutaneous injection skill (<i>r</i> = 0.277). However, no significant correlation was found between hand function and anxiety levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this study, a relationship was found between hand function and some basic skills. It is recommended that hand skills of nursing students should be evaluated multidimensionally with different measurement tools and similar studies should be planned in groups at different levels of nursing education and in larger samples.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 4","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70191","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514680","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":"Prevalence of CAC Scoring in Patients With Known Coronary Artery Disease: A Cohort Study on Choosing Wisely","authors":"Sarah J. Murphy,&nbsp;David E. Winchester","doi":"10.1111/jep.70185","DOIUrl":"https://doi.org/10.1111/jep.70185","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Coronary artery calcium (CAC) scoring plays a role in risk assessment for presence of atherosclerotic coronary heart disease (CHD). Among patients with known CHD, CAC has little or no value. Performing CAC on CHD patients is discouraged by ACC/AHA guidelines and the Choosing Wisely campaign. The extent to which this occurs in clinical practice is not well described.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We evaluated all UF Health patients since 2011 with known CHD who later underwent CAC scoring. We used our Integrated Data Repository to identify the cohort based on International Classification of Diseases and Current Procedural Terminology codes. Data from patient demographics, past medical history, CAC scoring results, ordering provider information and subsequent clinical management were recorded into a custom REDCap database for qualitative analysis. No prespecified statistical plan was performed as the investigation was intended as descriptive.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Upon reviewing all patients with known CHD, we found only 19 instances over 12 years where CAC scoring was ordered. Among these, 14 were men and 5 were women. A large percentage had a past medical history of DM (9, 47.4%) and hypertension (15, 78.9%) with a subclinical CHD diagnosis (17, 89.5%). Statin therapy was already initiated for 13 (68.4%). Most of the CAC scoring tests were ordered by cardiology attendings (10, 52.6%), and the justification most frequently provided was for risk stratification in patients with known CHD. Often (78.9%), there was no significant change in patient management or a slight alteration in medication therapy. One case resulted in percutaneous intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CAC scoring was rarely ordered among patients with known CHD over a 12-year span. Professional society efforts towards encouraging high-value care may wish to consider more high-impact recommendations in the future.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 4","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514636","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":"Childhood Burn Injuries: Impact of Context on Prevention","authors":"Godpower Chinedu Michael","doi":"10.1111/jep.70181","DOIUrl":"https://doi.org/10.1111/jep.70181","url":null,"abstract":"","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 4","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514635","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":"Serial Living Solid Organ Donation: An Ethical Analysis","authors":"Richard C. Armitage","doi":"10.1111/jep.70192","DOIUrl":"https://doi.org/10.1111/jep.70192","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>It is possible in many countries to not only become a living solid organ donor, but to become a serial living solid organ donor, a process in which an individual subsequently donates a liver lobe after donating a kidney, or vice versa. The major ethical issues that surround uncompensated living single solid organ donation (the doctor's duties to respect autonomy, of beneficence, and of non-maleficence) have been well described, and this process is generally considered ethically permissible if the donor has sufficient health, and if their decision is voluntary, fully informed, and made in the absence of coercion. However, the landscape of ethical issues pertaining to serial living solid organ donation has so far gone unexamined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This paper conducts an ethical analysis, using the ethical framework of Principlism, of the ethical issues that surround serial living solid organ donation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Serial living solid organ donation not only repeats the ethical issues that pertain to single organ donation, but also compounds some of them. Respect for autonomy in serial donation is challenged by uncertainty of the long-term risks of serial donation, and serial donors potentially face an increased risk of coercion from those in need of an organ and other third parties. The removal of a second healthy organ in serial donation poses greater risk to non-maleficence than single organ donation because the enduring effects of the previous surgery increase surgical risk. The effect of serial donation on beneficence is currently unknown. Serial donation also generates the potentially novel ethical issue of the donation being motivated by pathological altruism (the act thereby being inspired by selfish concerns), which threatens autonomy, non-maleficence, and beneficence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Research is required to understand the long-term risks to physical health and psychological wellbeing of serial donation to promote autonomy, non-maleficence, and beneficence. Additionally, the understanding of pathological altruism as a motivating factor for living organ donation should be increased, and the psychological assessment of potential living donors should be vigilant to detect this motivation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 4","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70192","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514681","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 a Comprehensive Tool to Assess Rigor When Evaluating Quality Improvement Projects","authors":"Kathryn Kynoch,&nbsp;Mary-Anne Ramis,&nbsp;Caroline de Moel-Mandel,&nbsp;Ritin Fernandez,&nbsp;Hanan Khalil","doi":"10.1111/jep.70193","DOIUrl":"https://doi.org/10.1111/jep.70193","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The aim of this study was to develop a pragmatic domain-based tool to Comprehensively Assess Rigor when Evaluating Quality Improvement projects (CARE-QI) that can be used by health professionals, researchers, or academics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>An expert panel was recruited to provide consensus on the tool. The development of the CARE-QI instrument followed a three-stage methodology. Firstly, a scoping review was used to identify potential items for inclusion. Secondly, using these items, a draft version of the tool was developed by the researchers and finally a Delphi survey was initiated to reach consensus on the final items. Two rounds of surveys were required where participants rated their level of agreement with each item on a Likert scale from 1 not important to 5 very important. The final version was sent out in the third round. Participants could provide free text comments on the tool during all rounds.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 40 experts participated in the first round of the Delphi survey. Members consisted of international multi-disciplinary healthcare professionals including clinicians and researchers with an interest in quality improvement and evidence implementation. The final CARE-QI tool consists of 13 items within four-domains: problem and design, context, intervention and implementation, and evaluation and sustainability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A pragmatic domains-based tool has been developed, in collaboration with experts within the field, to comprehensively assess rigor when evaluating different types of clinical quality improvement projects. Further testing will confirm validity and reliability of the items within the tool.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 4","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70193","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514731","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 Affecting Survival in Older Patients on Enteral Nutritional Support","authors":"Tuğba Önder,&nbsp;Çağatay Çavuşoğlu,&nbsp;Ebru Öztürk,&nbsp;Funda Yıldırım Borazan,&nbsp;Berna Göker","doi":"10.1111/jep.70168","DOIUrl":"https://doi.org/10.1111/jep.70168","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The effects of clinical and laboratory characteristics on survival outcomes in older patients receiving enteral nutrition (EN) support are unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analysed the effects of clinical characteristics, comprehensive geriatric assessment scores and duration of nutritional support use on the survival outcomes of older patients who received enteral nutritional support in our Geriatrics Clinic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three hundred and thirty-nine patients were analysed, of whom 211 (62.2%) were female. The median age was 81 years (range: 65−102). Oral nutritional support was given to 321 (94.7%) patients, and 18 (5.3%) were given nutritional support via percutaneous endoscopic gastrostomy (PEG). The median MNA-SF, ADLs, IADL, MMTs and GDS-SF scores were 8 (1−14), 5 (0−6), 4 (0−8), 22 (0−30) and 5 (0−15), respectively. Male sex (HR = 2.403, 95% CI = 1.355−4.273; <i>p</i> = 0.003), older age [75−84 vs. 65−74 years; HR = 2.960, 95% CI = 1.010–8.677; <i>p</i> = 0.048 and &gt; 85 versus 65−74 years; HR = 5.504, 95% CI = 1.854−16.335; <i>p</i> = 0.002], higher LDH (HR = 1.004, 95% CI = 1.002−1.006; <i>p</i> &lt; 0.001), lower IADL score (HR = 1.215, 95% CI = 1.102–1.336; <i>p</i> &lt; 0.001) and shorter ENS duration (HR = 1.269, 95% CI = 1.122−1.436; <i>p</i> &lt; 0.001) were associated with worse survival. With a 1-month reduction in the enteral feeding period, the risk of death in the 5th month increased by 1.215 times, and the risk of death in the 10th month increased by 1.171 times; this effect diminished over time. The median survival of patients on nutritional support via PEG was 12 ± 2.9 months (range 6.2−17.7). The 1-year survival rate in the PEG group was 50%, and the 3-year survival rate was 12%. In the ONS group, the 1-year survival rate was 78%, and the 3-year survival rate was 55%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our results suggest that male sex, older age, high LDH levels, low IADL scores and shorter ENS duration may be associated with adverse survival outcomes in older patients receiving EN support.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 4","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514732","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":"Usability Challenges in Electronic Health Records: Impact on Documentation Burden and Clinical Workflow: A Scoping Review","authors":"Olufisayo Olakotan,&nbsp;Ray Samuriwo,&nbsp;Hadiza Ismaila,&nbsp;Samuel Atiku","doi":"10.1111/jep.70189","DOIUrl":"https://doi.org/10.1111/jep.70189","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The adoption of Electronic Health Records (EHRs) has become integral to today's healthcare by supporting preventive care; however, it often imposes significant documentation burdens that disrupt workflows. These challenges may stem from usability issues driven by system or interface design flaws that result in the misalignment of EHR with clinical workflows, increasing clinicians' cognitive load. This study aims to identify and analyze the usability issues contributing to documentation burdens and subsequently lead to workflow disruptions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The scoping review employed the methodology developed by Levac. Three databases, namely PubMed, Scopus, and Ovid MEDLINE, were searched to identify relevant studies published in English between 2007 and 2024. Handsearching of key journals was also conducted to ensure comprehensive coverage of the literature. All findings were reported according to PRISMA guidelines for scoping reviews.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 2387 identified records, only 28 studies met the inclusion criteria, employing qualitative, mixed methods as well as time-motion studies. The studies noted that clinicians frequently experienced significant workflow disruptions caused by poorly designed interfaces, which led to task-switching, excessive and prolonged screen navigation, and fragmented critical information across EHR. These challenges often necessitated workarounds, such as duplicating documentation and using external tools, further increasing the risk of data entry errors and prolonging documentation times.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study findings highlight the critical need for improved EHR design that minimises workflow disruptions associated with documentation burden. Addressing these challenges requires human factors approach that streamlines information retrieval, optimizes interface usability, and eliminates unnecessary task complexity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 4","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70189","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514976","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}