Evaluation & the Health Professions最新文献

This study aimed to examine the factorial structure of the Jefferson Scale of Empathy-Medical student version (JSE-S) and assess items' discriminatory ability at higher and lower empathy levels in medical student populations from different countries and languages. JSE-S datasets were retrieved from previous studies of 4113 first- and/or second-year medical students from Switzerland, Portugal, Italy, Brazil, France, Spain, New Zealand, UK, Ireland, Mexico, and Peru. Parallel principal component analyses and item response theory were applied. Excluding item 18, the Compassionate Care subscale emerged in five samples (Switzerland, Portugal, Italy, France and UK/Ireland), Perspective Taking in three (Switzerland, Portugal and UK/Ireland) and Walking in Patient's Shoes in five (Switzerland, Portugal, Spain, UK/Ireland and Mexico/Peru). All subscales had items providing overlapping information. The JSE-S subscales had reliable high test performance at low empathy levels, while when the JSE-S increased, the standard error also increased. There was no consistent support across countries for the JSE-S three-factorial structure. Items provided redundant information and discriminatory power decreased when aiming to differentiate students at high empathy levels. A JSE-S revision to improve cross-cultural comparability, results' generalizability and validity should focus on suppressing or reformulating items that cannot differentiate medical students' empathy.

This study evaluated the effect of preoperative ocular fixation training on patients undergoing pterygium surgery. Before pterygium excision, patients were trained to perform eye position fixation training, which is beneficial for surgeons performing microsurgery. The study analysed the effectiveness of preoperative eye position fixation training in patients with pterygium by randomised controlled experimental design. The number of occurrences of self-turning, operation time, self-rating depression scale scores and self-rating anxiety scale scores of the experimental group (EG) were lower than those of the control group (CG). The recurrence rate and the incidence of conjunctival tear and conjunctival suture loosening in the EG were significantly lower than those in the CG. The use of eye fixation training prior to pterygium surgery can facilitate the activities of the surgeon, reduce the operation time, reduce the occurrence of complications and reduce the recurrence rate after the operation. Eye fixation training is worthy of application in patients with pterygium.

Indigenous governance of health care has increasingly been advocated among Indigenous peoples in many countries. However, there is limited research that has empirically examined its benefits. In 2020/21, we conducted a survey of 2113 Indigenous Wayuu individuals in Colombia who received services from the Indigenous Wayuu led health care insurance organization Anas Wayuu and its network of service providers, and Wayuu individuals who received services from non-Indigenous health insurance organizations. We compared their health care utilization and perception of quality of care. A main finding of the study was that Anas Wayuu enrollees were more than twice as likely to access health care than enrollees from non-Indigenous health insurance organizations, even when controlling for the demographic and health characteristics. The study provided compelling evidence suggesting that Anas Wayuu, being an Indigenous led health organization improves access to, and quality of care, among Indigenous health service recipients.

Self-regulated learning (SRL) plays a pivotal role in medical education. There is a pressing need for a meta-analytical review to comprehensively evaluate the effect sizes of SRL strategies across diverse learning outcomes and levels of medical trainees. A meta-analysis was executed by searching five databases and resulted in 61 studies that met our inclusion criteria. A three-level meta-analysis was performed to examine the association between SRL strategies and various levels of learning outcomes (i.e., affective, cognitive, and behavioral learning outcomes). Moderator analyses were conducted using meta-regression, considering factors such as types of learning outcomes, training levels, SRL subscales, and quality of the studies. The analysis yielded an average effect size of .212, using Pearson's correlation coefficient, demonstrating a positive and significant association between SRL strategies and overall learning outcomes. Although our moderator analyses indicated that SRL subscales and study quality did not significantly influence the relationship between SRL strategies and learning outcomes, SRL strategies had a more pronounced effect on affective outcomes than on test scores, behavioral outcomes, and mental health outcomes. In addition, the association between SRL strategies and learning outcomes were significantly higher among the clerkship phase of undergraduate medical education than the pre-clerkship phase.

Role modelling is important in developing professionalism with a need for reliable, evidence-based tools to assess professionalism in the learning environment (LE). The Learning Environment for Professionalism (LEP) survey is brief, anonymous and balanced assessing medical trainees' and attendings' positive and negative professionalism behaviours that can be tracked longitudinally and identify problem areas in the LE. Seven training programs agreed to facilitate administration of the LEP survey at four hospitals in Ottawa, Canada. The survey was carried out iteratively between 2013 and 2020. A total of 3783 LE ratings of training programs and hospitals were assessed longitudinally using univariate linear regression. A Bonferroni corrected p-value of ≤.0045 was used to account for multiple comparisons. Positive professional behaviours were observed across time with some of the negative behaviors having improved. A negative signal was found, with attendings appearing to be treating patients unfairly because of their financial status, ethnic background, sexual or religious preferences. Applying LEP survey longitudinally across diverse training programs and institutions is feasible and may assist programs to identify areas requiring attention and acknowledging areas of exemplary professionalism. Continuous monitoring of LE to meet requirements of accrediting bodies can also be considered an important quality improvement metric.

This systematic review provides an overview of the unique challenges allied health professions face in the translation and implementation of evidence into practice, which remain relatively under reported and uninformed by a theoretical basis of behaviour change. MEDLINE, EMBASE, CINAHL and Scopus databases from 2010 to 2022 were searched for primary study designs resulting in 21 articles included in this review (PROSPERO: 2022 CRD42022314996). Allied health disciplines reported in the review were mainly from occupational therapy, physiotherapy, dietetics, and speech pathology. The most frequently reported implementation determinants across the Theoretical Domains Framework were identified as 'environmental context and resources', and 'knowledge'. The results also identified a greater influence of 'social influences' and 'beliefs about consequences' in implementation. Implementing evidence into clinical practice is a multifaceted, complex process, and the use of the Theoretical Domains Framework provided a systematic approach to understanding the drivers behind the target behaviours. However, there is a paucity of studies across the allied health professions that describe implementation strategies used and their impact. Many of the studies focused on implementation by the individual clinician rather than the role organizations can play in the translation of evidence into practice.

Contribution Analysis (CA) is a promising theory-based evaluation approach for complex interventions, yet its application in health interventions remains largely unexplored. To bridge this gap, we conducted a scoping review to examine the extent of such applications and the methodologies, strengths, and limitations of this approach in health programming. Our comprehensive search strategy was developed and used in 15 databases to identify peer-reviewed articles from 1999 to 2023 that focused on using CA to evaluate health interventions. We then implemented rigorous double- and triple-screening processes for abstracts and full-text papers, respectively. Data were extracted and narratively summarized. Our review found seven relevant studies, which showed that CA has been employed in health promotion programs, health policies, and targeted health issues such as nutrition, cardiovascular disease, substance misuse, and suicide prevention. The studies identified strengths of using CA, including its flexible impact evaluation approach, capacity to inform decision-making, and potential to enhance understanding of health programs and policies. However, challenges such as how to determine suitable evidence levels and how to best manage resource intensity were also identified. The limited number of studies indicates that CA is still a novel approach, whereas the variation in the reporting of the studies suggests that this approach could benefit from more standardized methods and detailed stakeholder engagement strategies.

The aim of this scoping review is to outline the existing landscape of how real patients participate in the workplace-based assessment of trainees across diverse healthcare professions. In 2019-2020, the authors searched MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, and Web of Science databases for studies that included descriptions of experiences whereby patients received care from a health professional trainee and participated in workplace-based assessments of that trainee. Full-text articles published in English from 2009 to 2020 were included in the search. Of the 8770 studies screened; 77 full-text articles were included. Analysis showed that strategies for patient participation in workplace-based assessment varied widely. Aspects studied ranged from validation of an assessment tool to evaluation of the impact of an educational intervention on trainees' performance. Assessment of patient satisfaction was the most common approach to patient involvement. The majority of studies were conducted in North America and in the context of physician training. Formal patient participation in the assessment of health professional trainees appears heterogeneous across health professions. Gaps in the literature are evident; therefore, this review points to an inclusive approach to workplace-based assessment to ensure patient feedback of the trainees who care for them is represented.

We aimed to calculate disability-adjusted life expectancy (DALE) for Korean older adults based on their sex, educational attainment, and residential region across their cognitive status. We included 3,854 participants (aged 65-91 years) from the Korean Longitudinal Study of Aging's seventh survey data. The participant's cognitive function status (normal, moderately impaired, or severely impaired) was determined based on cognitive examination and physical function independence, which was used to calculate their DALE. Females with normal cognition had higher DALE (7.60 years, Standard Deviation (SD) = 3.88) than males (6.76, SD = 3.40); however, both sexes had comparable DALE for cognitive impairment. In contrast, the DALE values increased with higher educational achievements. Regarding residential areas, the DALE value for participants with normal cognition and moderate impairment was the highest among urban dwellers, while DALE for participants with severely impaired cognitive function was highest among rural dwellers; however, there were no statistically significant differences based on residential conditions. Our findings suggest that demographic characteristics should be considered when developing health policies and treatment strategies to meet the needs of the aging population in Korea.

Surgical prehabilitation aims to optimise patients' physiological reserves to better withstand the stress of surgery, reduce the risk of postoperative complications, and promote a faster and optimal recovery. The purpose of this commentary is to outline the key aspects of prehabilitation before surgery for cancer which seem to impact its effectiveness and wider implementation. Particular attention is paid to the role and integration of resistance training programmes as a key component of multimodal prehabilitation for patients with cancer. We firstly analyse some of the barriers currently hindering the implementation of prehabilitation programmes in the National Health Service (United Kingdom). Later, we describe essential aspects of resistance training design, such as exercise modality and order execution, volume and intensity, rest periods between sets or exercises, and workout frequency. Furthermore, we propose a methodology to use the perception of effort to control patients' progression during a prehabilitation programme.