Evaluation & the Health Professions最新文献

Currently there is little guidance on the power considerations for the multiple-group (controlled) interrupted time series design (MG-ITSA). In this study, simulations estimated power based on the number of time periods, the number of control units, when the treatment is introduced, and the degree of autocorrelation. The measures of effect were the difference in differences (DID) in level and the DID in trend. Power was evaluated at three different effect sizes. Higher power was generally associated with longer studies, more control units, larger effect sizes, and decreasing autocorrelation. Introducing the treatment at the halfway point in the study typically produced higher power than elsewhere for DID in trend. DID in level required fewer time periods to achieve the desired power than the DID in trend. The results show that to increase power, a researcher can increase the number of control units, increase the number of time periods, utilize the DID in level as the measure of effect, and maximize the effect size. Autocorrelation cannot be readily manipulated, and therefore must be accounted for in the time series regression model. Health researchers must consider the many factors highlighted here that uniquely affect power when determining the most efficient way to conduct an MG-ITSA study.

The interaction of multidimensional person, environment, task, and performance factors requires advanced analytic approaches to understand livability among older adults. This study examined the predictive value of the Livability Scale (LS) for residential satisfaction using multiple machine learning algorithms in adults aged 65 and above. Six models-logistic regression, decision tree, random forest, gradient boosting, support vector machine, and an ensemble model-were compared to determine which best captured the LS complex structure. The random forest demonstrated the strongest performance (F1 = 0.74, AUC = 0.78) with consistent generalization in k-fold cross-validation (M = 0.68), providing balanced sensitivity (0.60) and specificity (0.90). Model comparison also revealed meaningful differences: SVM showed heightened sensitivity to satisfaction, correctly detecting a larger number of satisfied cases but with increased false positives, whereas GBM minimized false positives, indicating higher specificity but lower sensitivity. Feature-importance analysis identified cultural facilities, residential affordability, activities and events, parks, structural safety, and cleanliness as key contributors to predictions. Overall, the findings emphasize the value of machine learning in uncovering non-linear patterns in livability data and demonstrate the potential of algorithmic diversity to guide evidence-based residential interventions for older adults.

The Multidimensional Psychological Flexibility Inventory (MPFI) is a complex self-report measurement tool designed to assess Acceptance and Commitment Therapy's (ACT) Hexaflex model components of psychological flexibility and inflexibility. There is a lack of literature on the invariance of the MPFI and its discriminant validity in relationship to second-wave therapy concepts such negative automatic thoughts. In this study, we present a Romanian adaptation and validation of the MPFI performed on a sample of 1109 participants from the general population. The results indicated an adequate fit to the data of the original MPFI factor model, high internal consistency levels, the ability to be invariant across levels of gender and age, and supported the MPFI's convergent, and discriminant. Some theory incongruent correlations emerged between MPFI dimensions and acceptance and experiential avoidance that suggest the need for further refinement of the MPFI. We discuss this unexpected correlation in relationship to explanatory factors such as the COVID lockdown context, personality, and age. Altogether, our results indicate that the Romanian version of the MPFI is a psychometrically sound instrument that can be used to study the Hexaflex ACT model and to evaluate psychological flexibility and inflexibility and their sub-processes in practice.

The Strengthening Families Program (SFP) has recognized value in preventing criminality and drug use in adolescents from underprivileged backgrounds. The objective of this study was to measure the effects of a 14-week version of this program targeting adolescents 12-16 years old in two medium-sized Quebec municipalities, using a repeated-measure design. The study participants were: 1) an intervention group, consisting of 71 adolescents and 61 parents who participated in the SFP between January 2018 and December 2019; and 2) a comparison group, consisting of 57 adolescents and 56 parents. Multivariate longitudinal regression indicates that the SFP reinforces some protective factors, such as the parent-child relation, as well as some key dimensions of family strengths. However, no effect was observed on parenting practices or adolescents' social behaviour. The differences between the intervention and control groups, the clinical significance of the results, and challenges of evaluating the SFP are discussed.

This study investigates the effectiveness of a continuous nursing model in the postoperative rehabilitation of patients with lower extremity varicose veins. Using a randomised controlled trial design, we compared the outcomes of patients receiving continuous nursing care with those receiving routine care. The study included 120 patients divided equally into control and experimental groups. Outcomes were measured in terms of rehabilitation quality (wound healing time, lower extremity functional scale scores, complication rates) and quality of life (QoL). Significant improvements were seen in the experimental group across multiple measures, including faster wound healing (p < .05), better functional recovery (p < .01) and higher QoL scores (p < .01). These findings suggest that implementing a continuous nursing model can significantly enhance the postoperative rehabilitation and overall well-being of patients with lower extremity varicose veins.

Persons in substance use disorders (SUD) treatment report a high prevalence of tobacco use. Often neglected in SUD treatment, some recent state-level policies mandated screening and offering tobacco use treatment or referral. We interviewed 85 providers from 68 SUD treatment facilities across 20 US states, assessed providers' estimates of tobacco use prevalence in their facilities, their perceptions on types of nicotine-containing products used by their service users, tobacco policies that were implemented at their facilities, and whether treatment (counseling or pharmacologic treatment) was offered. Prevalence estimates replicate prior findings; however, the variability of the types of nicotine-containing products used was greater than what has been reported in prior studies (cigarettes, e-cigarettes, and modern oral nicotine products). According to providers, 44 (64.7%) of the facilities offered tobacco cessation treatment, and 49 (72.1%) offered FDA-approved pharmacologic adjuncts. Treatment centers in our sample in states mandating assessment/treatment of tobacco use were relatively less likely to offer tobacco cessation treatment (52.8% vs. 78.1%), whereas facilities that accepted insurance as a payment option were more likely to provide these services (77.6% vs. 31.6%). These data suggest that policy mandates may be less effective than financial incentives at promoting tobacco use cessation in SUD facilities.

With the evolution of healthcare, the demand for medical services is rising. Nurses, facing high workloads and job indispensability, are at risk of presenteeism due to health issues, which impairs their focus and productivity. Nursing is a high-risk, high-stress profession, and compared to other medical personnel, nurses are more susceptible to presenteeism. Presenteeism can have severe consequences for nursing staff, the quality of care, and healthcare institutions. Although previous studies have explored the prevalence of presenteeism among nurses, there are variations in reported data due to differences in regions and assessment tools, and there is a scarcity of meta-analyses specifically addressing the prevalence of presenteeism among Chinese nurses. The study systematically assesses the incidence rate of presenteeism among nurses and evaluates the impact of various factors, including gender, marital status, department, professional title, position, education level, and employment relationship, on the incidence rate of presenteeism. Systematic review and meta-analysis. The following databases were searched: China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database, China Biomedical Literature Database (CBM), PubMed, Web of Science, Embase, CINAHL, and PsycINFO. The search covered all literature published before June 15, 2024. Researchers independently conducted all literature screening, quality assessment, and data extraction and analysis. The average scores and standard deviations of the Chinese version of the Health and Productivity Loss (SPS-6) scale were pooled using Stata 14.0 with a random-effects meta-analysis. Finally, subgroup analysis was employed to explore the sources of heterogeneity between studies. In this systematic review and meta-analysis, a total of 26 studies were included, involving 12,366 clinical nurses from China. Our findings indicate that the overall average score for absenteeism was 16.48 (95% CI: 15.64-17.32). Furthermore, subgroup analysis revealed that female nurses, married nurses, those with the title of nurse practitioner, clinical nurses, those with a secondary vocational education, contract nurses, and nurses from the ICU had higher presenteeism scores. The level of presenteeism among clinical nurses in China is moderate. Female nurses, married nurses, those with the title of nurse practitioner, clinical nurses, nurses with a secondary vocational education, contract nurses, and those from the ICU exhibit more pronounced presenteeism. These findings may provide a theoretical basis for hospital managers to address and manage presenteeism. PROSPERO number: CRD42024557555.

This study investigates the mediating effect of emotional labour on role stress and silence behaviour among nurses in a women-children special hospital to provide theoretical support and practical guidance for nursing management. A cross-sectional design was used. Data were collected from a grade-A tertiary women-children special hospital used convenience sampling. A path analysis of the relationships among emotional labour, role stress and silence behaviour was conducted using structural equation modelling (SEM).Statistical analysis of data and construction of SEM were conducted using the General Information Questionnaire, Role Stressors Scale, Emotional Labour Scale and Silence Behaviour Scale as survey tools along with SPSS 22.0 and AMOS 24.0 software. A total of 1,145 valid questionnaires were recovered, with an effective recovery rate of 98.5%. The respondents' scores for role stress, emotional labour and silence behaviour were 35.49 ± 4.47, 40.67 ± 5.49 and 10.14 ± 3.79, respectively. Pearson's correlation analysis revealed a positive correlation between emotional labour and role stress and silence behaviour. The SEM analysis showed that emotional labour was a mediator for role stress. Emotional labour functions as a mediator between role stress and silence behaviour among nurses in the women-children special hospital. As such, nursing managers must take nurses' emotional management skills seriously to reduce their role stress.

Psychosocial factors such as organizational cynicism and work motivation are associated with clinical outcomes, along with the knowledge and skills of medical professionals. Oncology surgeons, in particular, represent a critical group in terms of patient safety and mortality due to the high-risk surgical environment. The study aims to examine the association of organizational cynicism, work motivation, and professional and demographic characteristics of oncology surgeons with patient mortality. Face-to-face interviews were conducted with 107 surgeons practicing in Türkiye to collect data. A cross-sectional, descriptive approach was selected as the research design. The study followed the STROBE checklist for observational research. The Multidimensional Work Motivation Scale (MWMS) and the Organizational Cynicism Scale (OCS) were used as measurement tools. To predict patient mortality rate, negative binomial regression analysis was used. Increased cognitive cynicism (IRR = 1.033, p < .001) and identified regulation (IRR = 1.188, p < .001) were associated with higher patient mortality rate. Contrastingly, increased intrinsic motivation (IRR = 0.944, p < .001) was associated with decreased mortality rate. Furthermore, gender and managerial position were associated with clinical outcomes as control variables. Reducing organizational cynicism and supporting autonomous motivation may inform strategic approaches to strengthening patient safety.

Clinical innovation by doctors involves the development and use of interventions that have not been formally evaluated according to the usual standards of evidence-based medicine. While the distinction between research and innovation has been discussed theoretically, little is known about how doctors working in different specialty areas define and understand clinical innovation and how they distinguish it from other related practices. In order to address this gap, this qualitative interview study explored how doctors from diverse specialties defined and understood clinical innovation. Thirty-one semi-structured interviews were conducted with Australian doctors from surgery, reproductive medicine, and cancer care. While participants defined clinical innovation in similar ways, they also identified several morally and clinically salient characteristics that distinguish different types of innovation. Based on these findings, we developed a multidisciplinary governance model for clinical innovation that accounts for its diversity and complexity. This governance model offers clear guidance for determining what types of oversight are most appropriate for different types of clinical innovation. Its benefits include that it can be applied across diverse medical specialties and used alongside existing models, such as those used to identify clinical innovation.