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Translation, Cross-Cultural Adaptation and Validation of the Karaduman Chewing Performance Scale for the Italian Paediatric Population
IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-12-20 DOI: 10.1111/jep.14283
Francesca Pizza, Marco Tofani, Giorgia Biondo, Carolina Giordani, Cristiana Murgioni, Massimiliano Raponi, Gessica Della Bella, Antonella Cerchiari

Background

Chewing is a fundamental motor activity, but there is no specific assessment tool in Italian for paediatric rehabilitation. The Karaduman Chewing Performance Scale (KCPS) is a performance-based assessment tool that allow to classify chewing performance in childhood.

Objective

To translate, culturally adapt and assess reliability, criterion validity and cross-cultural validity of the KCPS into Italian in a paediatric population.

Methods

Following international guidelines, the KCPS was translated and culturally adapted into Italian. Inter-rater reliability was measured using the intraclass correlation coefficient (ICC), the criterion validity using the Pearson correlation coefficient comparing KCPS score with the Paediatric Screening-Priority Evaluation Dysphagia (PS-PED), and cross-cultural validity was examined across diagnostic groups.

Results

The study included 165 children with a mean age of 6.33 with different health conditions, namely autism spectrum disorder, cerebral palsy and genetic syndromes. The analysis revealed that KCPS was reliable measure with a ICC 0.93, and a moderate positive linear correlation with the PS-PED (Pearson 0.48) was found. In each diagnostic group, chewing performance disorders were found, highlighting specific characteristics.

Conclusions

Despite limited sample in reliability analysis and the need of exploring the relationship with chewing abilities and severity of diseases, the KCPS was found a reliable and valid tool for determining the level of chewing performance in paediatric population. Now Italian clinicians can use it with more confidence in their clinical practice and research.

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引用次数: 0
AttributeRank: An Algorithm for Attribute Ranking in Clinical Variable Selection
IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-12-20 DOI: 10.1111/jep.14257
Donald Douglas Atsa'am, Ruth Wario, Pakiso Khomokhoana

Background

Risk difference is a valuable measure of association in epidemiology and healthcare which has the potential to be used in medical and clinical variable selection.

Objective

In this study, an attribute ranking algorithm, called AttributeRank, was developed to facilitate variable selection from clinical data sets.

Methods

The algorithm computes the risk difference between a predictor and the response variable to determine the level of importance of a predictor. The performance of the algorithm was compared with some existing variable selection algorithms using five clinical data sets on neonatal birthweight, bacterial survival after treatment, myocardial infarction, breast cancer, and diabetes.

Results

The variable subsets selected by AttributeRank yielded the highest average classification accuracy across the data sets, compared to Fisher score, Pearson's correlation, variable importance function, and Chi-Square.

Conclusion

AttributeRank proved to be more valuable in attribute ranking of clinical data sets compared to the existing algorithms and should be implemented in a user-friendly application in future research.

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引用次数: 0
The 6-Item Self-Efficacy Scale in Chronic Disease Management in Women With Endometriosis: A Turkish Validity and Reliability Study
IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-12-20 DOI: 10.1111/jep.14282
Hamide Arslan Tarus, Nurdan Demirci

Objective

This study aimed to adapt the 6-Item Self-Efficacy Scale for Chronic Disease Management (SEMDC-6S) to women with endometriosis in the Turkish population and to evaluate its validity and reliability.

Methods

This methodological study comprised of 200 women with endometriosis. The construct validity of the scale was tested using the confirmatory factor analysis methods. The reliability of the scale was tested using Cronbach's alpha coefficient, item-total score correlations and test-retest reliability analysis.

Results

It was determined that the SEMDC-6S consisted of six items and one subscale. In the confirmatory factor analysis, the fit index values of the scale were found to be acceptable. The intraclass correlation coefficient of test–retest reliability was 0.95, and Cronbach's alpha coefficient was 0.76.

Conclusion

The Turkish version of the SEMDC-6S is a valid and reliable tool for assessing the self-efficacy of women with endometriosis.

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引用次数: 0
The Effect of Lean Hospital Practices on Nurses' Direct Care Activities: Time and Motion Study
IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-12-19 DOI: 10.1111/jep.14278
Zibel Koc, Sule Ecevit Alpar

Background

This study investigates the effects of lean management practices on nurses' direct patient care activities and the interruptions they encounter in healthcare settings. The literature indicates that lean management enhances efficiency and improves patient care. Increased nursing time per patient correlates with better outcomes; however, rising patient loads and frequent interruptions hinder nurses' ability to deliver effective care, jeopardising patient safety. Addressing these inefficiencies is essential, given nurses' critical role in ensuring quality care.

Method

Using a single-centre, observational, pre-post time and motion design alongside participatory action research from August 2019 to July 2022, the study included three phases: a survey assessing nurses' views on problem-solving and lean management; observations identifying nurses' activities and interruptions; and focus group discussions. The results presented here are from the observation phase, with 34 nurses from surgical, internal medicine, and mixed services participating. Quantitative variables were expressed as means, standard deviations, and significance was assessed at a 95% confidence interval (p < 0.05).

Results

Observations in 2019 (324 h) and 2022 (314 h) revealed that nurses dedicated a significant portion of their time to direct patient care, which increased post-lean implementation (surgical: 50.67%, internal: 50.09%, mixed: 44.38%). Waste rates decreased by 35.81%, and documentation time decreased by 23.55%. Overall interruptions also decreased significantly (p < 0.05).

Conclusion

Lean management effectively reduces waste and improves direct patient care time, enhancing patient safety and care quality. Continuous improvement initiatives in nursing practices are essential for success.

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引用次数: 0
Cross-Cultural Adaptation and Content Validation of the Yonsei Lifestyle Profile for Older Adults in the United States
IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-12-19 DOI: 10.1111/jep.14281
Yeonju Jin, Young-Myoung Lim, Ickpyo Hong

Rationale

As the global population ages, there is a growing need for tools to assess lifestyle factors that impact the health and quality of life of older adults. The Yonsei Lifestyle Profile (YLP), originally developed in South Korea, is a comprehensive tool for evaluating key lifestyle domains. However, cultural and linguistic differences between countries necessitate the adaptation of such tools for use in diverse populations. This study addresses the gap by developing an English version of the YLP (YLP-E) for older adults in the United States.

Aims and Objectives

As the global population continues to age, maintaining and improving the health and quality of life of older adults has become increasingly important. This study aimed to develop a YLP-E, a cross-cultural adaptation of the Korean version of the YLP, that can be used for older American adults.

Method

The Delphi method was used to consult expert panels regarding the cultural and linguistic appropriateness of the translation. The translation process involved a two-way translation–back-translation procedure and iterative revisions based on expert feedback.

Results and Conclusions

The final YLP-E tool, which incorporated feedback on linguistic and cultural adequacy, consisted of 3 lifestyle domains (physical activity, activity participation and nutrition) with 62 items. The second round improved the content validity, with the linguistic content validity ratio (CVR) and cultural CVR reaching 0.86 and 0.94, respectively. The YLP-E is a valuable tool for comprehensively assessing and monitoring the lifestyle of older American adults and holds promise for further refinement and validation across diverse demographic settings. Future research needs to focus on utilizing the YLP-E to develop personalized interventions aimed at improving the health and quality of life of older adults and evaluating the tool's efficacy in promoting healthy aging.

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引用次数: 0
Effect of Excess Mortality on Longevity During the COVID-19 Pandemic in South Asia
IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-12-19 DOI: 10.1111/jep.14258
Ahbab Mohammad Fazle Rabbi, Hafiz T. A. Khan

Background

Throughout the twentieth century and beyond, a global trend of declining mortality rates and an increase in life expectancies was noted until the onset of the coronavirus disease 2019 (COVID-19) pandemic. A reduction in life expectancies was observed in most countries, including South Asia, during 2020 and 2021 due to the excess mortality caused by the pandemic.

Objective

This study aims to examine the change in life expectancy in selected South Asian countries and the relative change in age- and sex-specific mortality rates over time due to the COVID-19 pandemic. In addition to that, we further examined the effect of a pandemic on a short-term forecast of life expectancy.

Data and Methods

Estimated age- and sex-specific mortality rates of seven South Asian countries were utilised from the 2022 revision of the World Population Prospects (WPP 2022). Changes in life expectancies are estimated using standard life table estimation techniques. To estimate the relative change in age- and sex-specific mortality levels and change in mortality forecasts as a result of the pandemic, we applied the Lee-Carter method.

Results

The application of the Lee–Carter model revealed age- and sex-specific variations in mortality improvements, reflecting heightened mortality rates within the region. This decline in mortality improvement is highly observed for both sexes in Pakistan, followed by India and Bangladesh. Populations exhibiting slower rates of improvement throughout their lifespan demonstrated minimal alterations attributable to the pandemic's impact. Comparative life expectancy forecasts indicate a slower rise in post-pandemic life expectancy at birth and in remaining life expectancies at older ages among most of these populations.

Conclusion

These findings highlight the pandemic's profound impact on mortality dynamics, emphasising the need for targeted interventions to mitigate its long-term effects on population health and longevity.

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引用次数: 0
Unravelling Education Needs for Clinical Practice Guideline Development: A Survey Performed in the Netherlands
IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-12-19 DOI: 10.1111/jep.14274
Chloé A. de Mortier, Mirthe J. Klein Haneveld, Daniëlle M. L. Verstegen, Ghislaine A. P. G. van Mastrigt, Aggie T. G. Paulus, Silvia M. A. A. Evers, Dunja H. H. Dreesens, Marian H. J. M. Majoie

Objective

The development of clinical practice guidelines (CPG) has evolved into a rigorous and complex process. There is a need for training of CPG developers including methodologists, panel members and patient representatives. This study explored the educational needs and experiences of CPG developers, with specific attention to the patient perspective and economic considerations.

Study Design and Setting

An anonymised mixed-method survey was distributed among CPG developers and panel members in the Netherlands. The survey, developed in collaboration with Dutch CPG development organisations and patient organisations, aimed to capture insights into the developers' roles, training needs, and the incorporation of economic considerations and patient perspectives in CPG development. Data analysis involved qualitative content analysis and descriptive quantitative analysis.

Results

A total of 271 responses were analysed. Respondents described role-specific tasks and tasks overlapping between roles. Experience, guidance, and training influenced the respondents' feeling of preparedness for their tasks. Respondents expressed the need for content-related training, including CPG development methodology. They also raised the importance of process-related topics in training, such as the inclusion of different perspectives and responsibilities during CPG development. About half of the respondents (46%) indicated that economic considerations were included in their CPGs, however, there was no uniformity in approach. The patient perspective was included by 89% of the respondents, also in varying manners. Overall, respondents underscored the importance of both topics in CPG development (training) to ensure a future-proof healthcare system.

Conclusion

This study underscores the importance of tailored CPG development training programmes addressing the specific competencies required for the different roles in CPG development. Thereby, recognising a holistic approach encompassing both content- and process-related aspects. Addressing economic considerations and the patient perspective in training will contribute to CPGs that support a patient-centred and sustainable healthcare system.

{"title":"Unravelling Education Needs for Clinical Practice Guideline Development: A Survey Performed in the Netherlands","authors":"Chloé A. de Mortier,&nbsp;Mirthe J. Klein Haneveld,&nbsp;Daniëlle M. L. Verstegen,&nbsp;Ghislaine A. P. G. van Mastrigt,&nbsp;Aggie T. G. Paulus,&nbsp;Silvia M. A. A. Evers,&nbsp;Dunja H. H. Dreesens,&nbsp;Marian H. J. M. Majoie","doi":"10.1111/jep.14274","DOIUrl":"10.1111/jep.14274","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The development of clinical practice guidelines (CPG) has evolved into a rigorous and complex process. There is a need for training of CPG developers including methodologists, panel members and patient representatives. This study explored the educational needs and experiences of CPG developers, with specific attention to the patient perspective and economic considerations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design and Setting</h3>\u0000 \u0000 <p>An anonymised mixed-method survey was distributed among CPG developers and panel members in the Netherlands. The survey, developed in collaboration with Dutch CPG development organisations and patient organisations, aimed to capture insights into the developers' roles, training needs, and the incorporation of economic considerations and patient perspectives in CPG development. Data analysis involved qualitative content analysis and descriptive quantitative analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 271 responses were analysed. Respondents described role-specific tasks and tasks overlapping between roles. Experience, guidance, and training influenced the respondents' feeling of preparedness for their tasks. Respondents expressed the need for content-related training, including CPG development methodology. They also raised the importance of process-related topics in training, such as the inclusion of different perspectives and responsibilities during CPG development. About half of the respondents (46%) indicated that economic considerations were included in their CPGs, however, there was no uniformity in approach. The patient perspective was included by 89% of the respondents, also in varying manners. Overall, respondents underscored the importance of both topics in CPG development (training) to ensure a future-proof healthcare system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study underscores the importance of tailored CPG development training programmes addressing the specific competencies required for the different roles in CPG development. Thereby, recognising a holistic approach encompassing both content- and process-related aspects. Addressing economic considerations and the patient perspective in training will contribute to CPGs that support a patient-centred and sustainable healthcare system.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.14274","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854265","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}
引用次数: 0
Practical Study on the Participation of Clinical Pharmacists in Multi-Disciplinary Teams Dealing With Nutrition Intervention Management in Ovarian Cancer
IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-12-16 DOI: 10.1111/jep.14260
Yanmo Yang, Qinxuan Li, Mi Zhou

Objective

This study aimed to explore the role of clinical pharmacists in guiding nutritional treatment in a multi-disciplinary team for patients with ovarian cancer (OC) and the significance of pharmaceutical nutritional intervention in overall management and drug administration.

Methods

Fifty-nine patients with OC in our gynaecological oncology ward were retrospectively investigated. The patients were divided into a conventional therapy (CT) group (n = 30) and a pharmaceutical management (PM) group (n = 29) according to different nutritional therapies received. Nutritional monitoring indicators and clinical response indicators were used to evaluate the intervention effect. Serum albumin (ALB), haemoglobin (HGB) and prealbumin (PAB) levels at admission and discharge, exhaust time, time to return to a normal diet, time to first postoperative chemotherapy and length of hospital stay were measured.

Results

The PAB and ALB indicators in the PM group returned to the admission levels; the difference between the two groups was statistically significant (p < 0.05). There was no significant difference in HGB levels between the two groups (p > 0.05). The time to flatus, time to return to normal diet and time to first postoperative chemotherapy in the PM group were significantly shorter than those in the CT group, and the differences had statistical significance (p < 0.05). Patients in the PM group had a significantly shorter hospital stay than those in the CT group (12.5 ± 3.2 days vs 16.8 ± 4.1 days; p = 0.022).

Conclusion

Nutritional treatment management by clinical pharmacists plays a key role in the antitumour treatment of patients with OC, effectively improving their nutritional status and thus promoting rapid postoperative recovery.

研究目的本研究旨在探讨临床药师在多学科团队中指导卵巢癌(OC)患者营养治疗的作用,以及药物营养干预在整体管理和用药方面的意义:我们对妇科肿瘤病房的 59 名卵巢癌患者进行了回顾性调查。根据患者接受的不同营养疗法,将其分为常规治疗(CT)组(30 人)和药物治疗(PM)组(29 人)。营养监测指标和临床反应指标用于评估干预效果。对入院和出院时的血清白蛋白(ALB)、血红蛋白(HGB)和前白蛋白(PAB)水平、排气时间、恢复正常饮食时间、首次术后化疗时间和住院时间进行了测量:结果:PM 组的 PAB 和 ALB 指标恢复到入院时的水平;两组之间的差异有统计学意义(P 0.05)。PM组的排气时间、恢复正常饮食时间和术后首次化疗时间明显短于CT组,差异有统计学意义(P 结论:PM组的营养治疗管理与CT组相比具有明显优势:临床药师的营养治疗管理在 OC 患者的抗肿瘤治疗中发挥着关键作用,可有效改善患者的营养状况,从而促进术后快速康复。
{"title":"Practical Study on the Participation of Clinical Pharmacists in Multi-Disciplinary Teams Dealing With Nutrition Intervention Management in Ovarian Cancer","authors":"Yanmo Yang,&nbsp;Qinxuan Li,&nbsp;Mi Zhou","doi":"10.1111/jep.14260","DOIUrl":"10.1111/jep.14260","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to explore the role of clinical pharmacists in guiding nutritional treatment in a multi-disciplinary team for patients with ovarian cancer (OC) and the significance of pharmaceutical nutritional intervention in overall management and drug administration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Fifty-nine patients with OC in our gynaecological oncology ward were retrospectively investigated. The patients were divided into a conventional therapy (CT) group (<i>n</i> = 30) and a pharmaceutical management (PM) group (<i>n</i> = 29) according to different nutritional therapies received. Nutritional monitoring indicators and clinical response indicators were used to evaluate the intervention effect. Serum albumin (ALB), haemoglobin (HGB) and prealbumin (PAB) levels at admission and discharge, exhaust time, time to return to a normal diet, time to first postoperative chemotherapy and length of hospital stay were measured.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The PAB and ALB indicators in the PM group returned to the admission levels; the difference between the two groups was statistically significant (<i>p</i> &lt; 0.05). There was no significant difference in HGB levels between the two groups (<i>p</i> &gt; 0.05). The time to flatus, time to return to normal diet and time to first postoperative chemotherapy in the PM group were significantly shorter than those in the CT group, and the differences had statistical significance (<i>p</i> &lt; 0.05). Patients in the PM group had a significantly shorter hospital stay than those in the CT group (12.5 ± 3.2 days vs 16.8 ± 4.1 days; <i>p</i> = 0.022).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Nutritional treatment management by clinical pharmacists plays a key role in the antitumour treatment of patients with OC, effectively improving their nutritional status and thus promoting rapid postoperative recovery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828872","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}
引用次数: 0
Development and Content Analysis Protocol for Evaluating Artificial Intelligence in Drug-Related Information
IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-12-16 DOI: 10.1111/jep.14276
Dantony Castro Barros de Donato, Guilherme José Aguilar, Lucas Gaspar Ribeiro, Luiz Ricardo Albano dos Santos, Luana Michelly Aparecida Costa dos Santos, Wilbert Dener Lemos Costa, Alan Maicon de Oliveira

Introduction

Artificial intelligence (AI) has significant transformative potential across various sectors, particularly in health care. This study aims to develop a protocol for the content analysis of a method designed to assess AI applications in drug-related information, specifically focusing on contraindications, adverse reactions, and drug interactions. By addressing existing challenges, this preliminary research seeks to enhance the safe and reliable integration of AI into healthcare practices.

Methods

A study protocol was developed for the creation of the method, followed by an initial content analysis conducted by an expert panel. The method was established in phases: (1) Analysis of drug-related databases and form development; (2) AI configuration; (3) Expert panel review and initial validation.

Results

In Phase 1, the Micromedex, UpToDate, and Medscape databases were reviewed to establish terminology and classifications related to contraindications, adverse reactions, and drug interactions, resulting in the development of a questionnaire for the AI. Phase 2 involved configuring the Gemini AI tool to enhance response specificity. In Phase 3, AI responses to 30 questions were validated by an expert panel, yielding a 76.7% agreement rate for appropriateness, while 23.3% were deemed inappropriate, particularly concerning contraindicated drug interactions.

Conclusion

This preliminary study demonstrates the potential for using an AI-powered tool to standardize drug-related information retrieval, particularly for contraindications and adverse reactions. While AI responses were generally appropriate, improvements are needed in identifying contraindicated drug interactions. Further research with larger datasets and broader evaluations is required to enhance AI's reliability in healthcare settings.

导言:人工智能(AI)在各行各业都具有巨大的变革潜力,尤其是在医疗保健领域。本研究旨在为评估人工智能在药物相关信息中应用的方法制定内容分析协议,尤其侧重于禁忌症、不良反应和药物相互作用。通过应对现有挑战,这项初步研究旨在加强将人工智能安全可靠地融入医疗保健实践:方法:为创建该方法制定了研究方案,随后由专家小组进行了初步内容分析。该方法分阶段制定:(1)分析药物相关数据库并开发表格;(2)人工智能配置;(3)专家小组审查和初步验证:在第 1 阶段,对 Micromedex、UpToDate 和 Medscape 数据库进行了审查,以确定与禁忌症、不良反应和药物相互作用相关的术语和分类,从而为人工智能开发了一份问卷。第二阶段包括配置 Gemini AI 工具,以提高回复的特异性。在第 3 阶段,专家小组对 30 个问题的人工智能回答进行了验证,结果显示 76.7% 的回答是恰当的,而 23.3% 的回答被认为是不恰当的,尤其是在禁忌药物相互作用方面:这项初步研究证明了使用人工智能驱动的工具来规范药物相关信息检索的潜力,尤其是在禁忌症和不良反应方面。虽然人工智能的反应总体上是适当的,但在识别药物相互作用禁忌方面还需要改进。要提高人工智能在医疗环境中的可靠性,还需要对更大的数据集和更广泛的评估进行进一步研究。
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引用次数: 0
When Health Care Needs a Centre, When It Doesn't, and Why It Matters
IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-12-16 DOI: 10.1111/jep.14271
Stephen Buetow

This paper examines the concept of centredness in health care, with a particular focus on person-centred care. While the principle of centring care is widely accepted, the concept of a ‘centre’ remains ambiguous, complicating its implementation. The paper defines centredness, questions the necessity of a central focus and explores alternative models. It suggests that while centredness has helped to address historical imbalances, it risks oversimplification, reducing care to a binary structure of centre and periphery. It also excludes non-persons and lacks cultural sensitivity. Alternative frameworks, such as distributed care, shift away from a singular focus toward a more dynamic, networked approach. Distributed care offers flexibility and inclusivity, but it raises challenges about coordination and the potential emergence of a new implicit centre: distribution itself. Hybrid models combining elements of centred and distributed care offer a path forward. Empirical research is needed to compare these approaches, with the aim of developing more responsive and adaptable systems to address diverse and complex needs for health care.

本文探讨了医疗保健中 "以人为本 "的概念,尤其关注以人为本的医疗保健。虽然以护理为中心的原则已被广泛接受,但 "中心 "的概念仍然模糊不清,使其实施变得更加复杂。本文对 "以人为本 "进行了定义,质疑了 "以人为本 "的必要性,并探讨了其他模式。论文认为,虽然中心化有助于解决历史上的不平衡问题,但也存在过度简化的风险,有可能将护理工作简化为中心和边缘的二元结构。它还排斥非个体,缺乏文化敏感性。其他框架,如分布式护理,则从单一关注点转向更具活力的网络化方法。分布式护理具有灵活性和包容性,但也带来了协调方面的挑战,以及可能出现新的隐性中心:分布式本身。结合中心护理和分布式护理元素的混合模式提供了一条前进的道路。需要开展实证研究,对这些方法进行比较,以开发反应更快、适应性更强的系统,满足多样化和复杂的医疗保健需求。
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引用次数: 0
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Journal of evaluation in clinical practice
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