Journal of evaluation in clinical practice最新文献

Rationale, aims, and objectives: The previous studies demonstrated that the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, a leading method for evaluating the certainty (quality) of scientific evidence (CoE), cannot reliably differentiate between various levels of CoE when the objective is to accurately assess the magnitude of the treatment effect. An estimated effect size is a function of multiple factors, including the true underlying treatment effect, biases, and other nonlinear factors that affect the estimate in different directions. We postulate that non-weighted, simple linear tallying can provide more accurate estimates of the probability of a true estimate of treatment effects as a function of CoE.

Methods: We reasoned that stable treatment effect estimates over time indicate truthfulness. We compared odds ratios (ORs) from meta-analyses (MAs) before and after updates, hypothesising that a ratio of odds ratios (ROR) equal to 1 will be more commonly observed in higher versus lower CoE. We used a subset of a previously analysed data set consisting of 82 Cochrane pairs of MAs in which CoE has not changed with the updated MA. If the linear model is valid, we would expect a decrease in the number of ROR = 1 cases as we move from high to moderate, low, and very low CoE.

Results: We found a linear relationship between the probability of a potentially 'true' estimate of treatment effects as a function of CoE (assuming a 10% ROR error margin) (R² = 1; p = 0.001). The probability of potentially 'true' estimates decreases by 21% (95% CI: 18%-24%) for each drop in the rating of CoE. A linear relationship with a 5% ROR error margin was less clear, likely due to a smaller sample size. Still, higher CoE showed a significantly greater probability of 'true' effects (53%) compared to non-high (i.e., moderate, low, or very low) CoE (25%); p = 0.032.

Conclusion: This study confirmed linear relationship between CoE and the probability of potentially 'true' estimates. We found that the probability of potentially "true" estimates decreases by about 20% for each drop in CoE (from about 80% for high to 55% for moderate to 35% to low and 15% to very low CoE).

Rationale: Misinformation can lead to adverse outcomes on the health beliefs and behaviors of individuals. Therefore, health literacy skills are needed as a central competency to recognize the trustfulness of health-related knowledge in any resources. To ensure this, a time-efficient, skill-oriented psychometric tools are needed to measure the comprehensive general health literacy level of communities.

Aims and objectives: This research was conducted to evaluate the psychometric properties of the 12-item Health Literacy Survey-Europe (HLS₁₉-Q12) regarding Turkish culture.

Method: A methodological design was adopted. The population consisted of adult individuals registered to two family health centers in Ankara. The sample was determined based on 5-10 times the number of scale items rule (n_total = 192). A questionnaire and Health Literacy Survey-Europe-Q12 were used to collect data. Language, content and construct validities and internal consistency reliability tests were performed through IBM-SPSS 25.0 and AMOS 24.0 programs. The content validity was determined via the Davis technique. The construct validity was examined by exploratory (EFA) (n₁ = 120) and confirmatory factor analysis (CFA) (n₂ = 72). Internal consistency was evaluated using Cronbach's alpha coefficient. Time invariance was evaluated by test-retest method (n_retest = 32) 4 weeks later.

Results: The mean age was 30.17 ± 10.37 (min. 18-max. 61). The Kaiser-Meyer Olkin test result was 0.898, and the Bartlett's Test of Sphericity result was 604.889 (p < 0.001). The model-fit indices showed good fit. The difference between the first and the second measurements was statistically insignificant (t = -1.659, p = 0.107). The Cronbach's alpha was 0.88.

Conclusions: The HLS₁₉-Q12-TR was a valid and reliable measurement tool in determining the health literacy level of the Turkish adult population. As one of the social determinants of health, easy measurement and generating a general health literacy map of the population is considered a necessity.

Aim: To investigate the effect of preadmission education given to laparoscopic sleeve gastrectomy patients on preoperative and postoperative anxiety, postoperative pain, and patient vital signs.

Methods: The study was designed as randomized, controlled, experimental, and single-blind. This study was conducted with 68 patients who met the inclusion criteria and underwent laparoscopic sleeve gastrectomy in the general surgery clinic of a university hospital between December 2022 and October 2023. Data were collected using the 'Perioperative Form,' 'Visual Analog Scale,' and 'State Anxiety Scale I-II.' Intervention group patients were informed and educated about the surgical process in the outpatient clinic. The anxiety levels of all patients were determined with the State Anxiety Scale the day before surgery. In the postoperative period, vital signs (once), anxiety (on the first day after surgery), and pain levels (eight times during 48 h) were measured.

Results: In the analysis between the groups, the difference between the duration of postoperative hospital stay (p = 0.007), pain (p = 0.000 for all measured), and anxiety levels (p = 0.000) was statistically significant. There were also significant differences in the diastolic blood pressure (p = 0.007), body temperature (p = 0.000), and saturation values (p = 0.000). Patients' readiness level for surgery was the most influential factor in postoperative pain levels (p = 0.000).

Conclusion: The education given to the patients before hospitalization decreased preoperative and postoperative anxiety levels, postoperative hospital stay and pain levels, and positively affected diastolic blood pressure, body temperature and saturation levels. One-to-one education given to patients in the outpatient clinic also contributes positively to their readiness for surgery. This study provides valuable evidence to the wider global clinical community by demonstrating the important benefits of preadmission education for patients undergoing bariatric surgery. Implementation of similar educational interventions in diverse healthcare settings worldwide may lead to increased postoperative recovery and improved overall patient well-being after bariatric surgery.

Rationale: Antibiotic prescription, its nature and its duration are a very common decision-making situation in primary care practice. Clinical practice guidelines (CPGs) are regularly emitted by various organisations on this topic.

Aims and objectives: Our goal is to run a quality appraisal of the current French guidelines, for the most common primary care infectious pathologies.

Method: We collected all primary care CPGs that are currently prevailing in France through a systematic review of the french website Antibioclic®. For each of these guidelines, a quality assessment was run by 3 independent reviewers, by means of the Appraisal of Guidelines for REsearch & Evaluation II instrument. The main outcome was a 'reliability score', defined as the sum of the scores in domains 'rigour of development' and 'editorial independence'. To be considered 'reliable', the CPG had to reach a 60% threshold in these two domains. Secondary outcomes were as follows: global quality score of CPGs, number and ratio of CPGs for which a systematic review has been conducted during its conception.

Results: Over the 43 CPGs that have been assessed, none reached the 60%-threshold as to the reliability score. Only one CPG (2.33%) gets an over-60% quality assessment in the domain of rigour of development (D3), whereas three CPGs (6.98%) reach this threshold in the domain of editorial independence (D6). One CPG (2.33%) met the quality threshold of 60% as to overall assessment. Rigour of development and editorial independence are the domains that obtained the lowest average score, respectively, 11% and 21%. Overall assessment received an average score of 29%. A systematic review of the literature was mentioned for 10 CPGs (23.26%).

Conclusion: There is a lack of quality in the development process of the current French guidelines in primary care infectiology. This process should be reconsidered, with higher insistence as to its quality.

Rationale: Meta-analysis, a powerful technique for combining effect estimates from multiple studies, enhances statistical power and precision. However, its adoption can be hindered by challenges in statistical interpretation and the complexity of specialized software. MetaXL, a freely available Microsoft Excel add-in, aims to mitigate these barriers by providing comprehensive support and facilitating seamless integration of meta-analytical results into research publications.

Aims and objectives: This tutorial illustrates the practical application of MetaXL for synthesizing meta-analytical evidence, with a focus on common effect sizes and their presentation.

Method: This paper reintroduce MetaXL's functions and provide concise explanations of common effect sizes employed in meta-analysis. The tutorial delves into fundamental concepts such as the selection of appropriate effect sizes for pooling and the choice of meta-analytical models. Eight illustrative examples are presented, incorporating diverse effect sizes and data formats, including scenarios involving incidence rate ratios, weighted and standardized mean differences, hazard ratios, and prevalence. Additionally, key concepts in network meta-analysis are discussed, along with their implementation in MetaXL. MetaXL provides convenient access to data formatting templates tailored to various data types and effect sizes encountered in included studies.

Results and conclusion: This tutorial offers researchers, particularly those with limited resources, detailed explanations and insights into commonly used methodologies for pooling effect sizes. Furthermore, it introduces the new Excel functions that comes with the MetaXL add-in. Accurate population of this function and adherence to the correct format are essential to ensure error-free analyzes.

Aim: This study was conducted to determine the effect of nurses' attitudes towards evidence-based practices on individualised nursing care.

Methods: This study is a cross-sectional descriptive trial. The descriptive analysis included 200 clinical nurses working in a private hospital between April and September 2022. Data were collected with a personal information form, Individualised Care Scale (A-Nurse Version), and Evidence-Based Nursing Attitude Questionnaire. The relationship between the scales and effect was examined by Pearson correlation and linear regression analyses. T-test, one-way analysis of variance (ANOVA), and post hoc (Tukey, LSD) analysis were used in the statistical analysis of nurses according to their descriptive characteristics. This study has adhered to the STROBE checklist for reporting.

Results: They had high mean scores on Individualised Care Scale total (3.68 ± 1.25) and from Clinical Situation (3.78 ± 1.30) and Decisional Control (3.82 ± 1.35) subscales and average score from the Personal Life (3.32 ± 1.29) subscale. Their mean score from the Evidence-Based Nursing Attitude Questionnaire was average (47.64 ± 10.99). There was a positive moderate (r = 0.50, p = 0.000 < 0.05) significant correlation between the scales.

Conclusion: Positive attitude towards evidence-based nursing practices positively affects individualised care. Variables such as professional experience positively affect nurses' attitudes towards evidence-based nursing. A positive and significant relationship was found between nurses' attitudes towards evidence-based practice and their attitudes towards individualised care.

Objective: To construct a decision support tool for determining venous access in chemotherapy of breast cancer.

Methods: A decision support tool for determining venous access was developed through semi-structured interviews, literature analysis, expert inquiry, and user adaptation. The subjects of the study were breast cancer patients with chemotherapy who planned to have deep vein catheterization in a Grade IIIA hospital in Nanjing from August to December 2023. The enrolled patients were then divided into the control group and the intervention group, with 44 cases in each group. The control group received routine pre-catheterization interviews, while the intervention group used the decision support tool on this basis. Further comparison was conducted on the willingness of and actual participation in decision-making, decisional conflict, decision-making satisfaction, and decision regret between the two groups using t-test and chi-square test.

Results: This study constructed a decision support tool for determining venous access in chemotherapy of breast cancer, including 8 primary indicators and 40 secondary indicators. The intervention group actually participated in treatment decisions more than the control group, and the intervention group was more willing to participate in treatment decisions (p < 0.05). Furthermore, the intervention group had significantly higher degrees of actual participation in decision-making and satisfaction with decision-making compared to the control group (p < 0.05); while the former group had significantly lower decisional conflict, decision regret at 1 month and 3 months after discharge than those in the latter group (p < 0.05).

Conclusion: The decision support tool for determining venous access in chemotherapy of breast cancer is scientific and practical to promote patient participation in decision-making, reduce decisional conflicts, improve decision-making quality, and achieve joint decision-making between doctors and patients.

Introduction: This paper uses pragmatic feminist poststructuralism to explore how ethical theory is applied to singing voice rehabilitation by specialist singing teachers.

Methods: A critical literature review examines the relationship between traditional and feminist ethical theories and their potential impact on practice. Themes have been extracted from the literature to create an intersectional feminist poststructural analysis framework, facilitating a document analysis of the foundations of three policy documents currently available to singing voice rehabilitation specialists. Poststructural deconstructivism was applied to thematic analysis to consider the impact of ethical theories on policy and practice.

Findings: Policies we found to be rooted in traditional enlightenment ethics, with a focus on hyper-rationality, androcentrism and legalism. Person-centred care ethics was found to be lacking in all documents. Contrary to best-practice recommendations documents failed to provided practical guidelines for practitioners.

Conclusion: Findings indicate adopting an intersectional feminist ethical policy could improve existing documents via a move from legislation and authority towards care and reflexivity.

Rationale, aims, and objective: Breastfeeding provides optimal nutrition for infants, and health literacy significantly influences breastfeeding rates. This study aimed to develop a tool to assess the breastfeeding health literacy levels of pregnant women.

Methods: This methodologically structured study was conducted with 590 pregnant women who visited the pregnancy follow-up clinic between January and April 2024 and met the sampling criteria. Data were collected using a participant form and the Health Literacy Scale for Breastfeeding for Pregnant Women (BFHLS). To assess the BFHLS validity, the content validity index (CVI) and factor analysis were used, while the reliability was evaluated using the test-retest method, item-total score correlation, and Cronbach's alpha reliability coefficient.

Results: The BFHLS for pregnant women is structured into four dimensions, comprising 25 items. To assess the scale's stability, test-retest measurements were conducted with a minimum interval of 2 weeks, revealing no significant difference in mean scores (p > 0.05). The CVI for each item was 99%. The corrected item-total correlations ranged from 0.48 to 0.92, and Cronbach's alpha value was determined to be 0.96.

Conclusion: The BFHLS developed for pregnant women is a valid and reliable tool. Higher scores on the scale indicate a greater level of breastfeeding health literacy in pregnant women. This scale can effectively be used to assess the breastfeeding health literacy levels of pregnant women.

Background: Recovery from depression constitutes a long journey that is understood as a unique and multifaceted process encompassing various dimensions. To understand what constitutes recovery from depression and to develop greater insights into the unique dimensions of the recovery journey, the study of recovery memoirs is essential.

Method: This article performs a dimensional analysis on six Indian first-hand accounts of recovery from depression collected in Amrita Tripathi and Arpita Anand's Real Stories of Dealing with Depression to examine the journeys toward healing and the uniqueness of the recovery processes. Through the dimensional analysis, four core dimensions of recovery from depression-Problems, Social Supports, Position of Recovery and Functionality-are identified. The process of recovery, consisting of understanding the problems (causes) through sensed adversities (sensed effects), making use of received social supports to transform oneself, finding out the position of recovery, and lastly, functioning peacefully for living, corresponds to the four dimensions of recovery. Drawing on Herbert Blumer's theory of social interactionism, the article examines how different individuals interpret their experiences of depression in unique ways and develop distinctive recovery strategies.

Discussion: The identified dimensions of recovery correspond to the need for unique approaches to recovery articulated by each of the narrators. The selected narratives reveal that the problems are unique, and for each of the unique problems, there has to be a distinctive support mechanism. The recovery narratives are centred around the unique problems wherein the individuals attempt to understand what happened to them and why it happened.

Conclusion: The article concludes by suggesting that healthcare practitioners can utilise the dimensions and the subdimensions as a lead to understand fully how their clients conceptualise their problems and try to understand how each client defines the recovery itself.