Journal of evaluation in clinical practice最新文献_第10页

Association Does Not Mean Causation, When Observational Data Were Misinterpreted as Causal: The Observational Interpretation Fallacy 当观测数据被误解为因果关系时，关联并不意味着因果关系：观测解释谬误。

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2024-12-29 DOI: 10.1111/jep.14288

Filippo D'Amico, Marilena Marmiere, Martina Fonti, Mariarita Battaglia, Alessandro Belletti

Background

The differentiation between association and causation is a significant challenge in medical research, often further complicated by cognitive biases that erroneously interpret coincidental observational data as indicative of causality. Such misinterpretations can lead to misguided clinical guidelines and healthcare practice, potentially endangering patient safety and leading to inefficient use of resources.

Methods

We conducted an extensive search of PubMed, Cochrane, and Embase databases up to March 2024, identifying circumstances where associations from observational studies were incorrectly deemed causal. These instances led to changes in clinical practice, embodying what we have termed the ‘observational interpretation fallacy’.

Results

Our search identified 16 notable cases where observational study-derived associations, initially thought to influence clinical practices and guidelines positively, were later contradicted by findings from randomised controlled trials or further studies, necessitating significant revisions in clinical practice.

Conclusion

In many cases, misinterpretation of observational finding negatively affecting patient care and public health policies. Addressing and rectifying the observational interpretation fallacy is crucial for the progression of medical research and the maintenance of safe and effective clinical practice. It is imperative for health policymakers, clinicians, and the lay public to critically assess research outcomes and make health-related decisions based on a foundation of evidence-based medicine. This approach ensures the alignment of medical practices with the most current and robust scientific evidence, safeguarding patient welfare and optimising resource allocation.

背景：区分关联和因果关系是医学研究中的一个重大挑战，往往因错误地将巧合的观察数据解释为因果关系的指示性的认知偏差而进一步复杂化。这种误解可能导致误导的临床指导方针和医疗保健实践，潜在地危及患者安全并导致资源的低效使用。方法：我们对PubMed、Cochrane和Embase数据库进行了广泛的检索，直到2024年3月，确定观察性研究的关联被错误地视为因果关系的情况。这些例子导致了临床实践的变化，体现了我们所说的“观察解释谬误”。结果：我们的研究确定了16个值得注意的病例，其中观察性研究衍生的关联最初被认为对临床实践和指南有积极影响，后来与随机对照试验或进一步研究的结果相矛盾，需要对临床实践进行重大修改。结论：在许多情况下，对观察结果的误解会对患者护理和公共卫生政策产生负面影响。解决和纠正观察解释谬误对于医学研究的进展和维持安全有效的临床实践至关重要。卫生政策制定者、临床医生和普通公众必须严格评估研究成果，并在循证医学的基础上做出与健康相关的决定。这种方法确保医疗实践与最新和最可靠的科学证据保持一致，保障患者福利并优化资源分配。

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引用次数: 0

Illnesses Associated With Increased Length of Stay for Individuals Experiencing Homelessness: A Retrospective Cohort Study of Emergency Department Visits and Hospitalisations 与无家可归者住院时间延长相关的疾病：急诊科就诊和住院的回顾性队列研究

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2024-12-29 DOI: 10.1111/jep.14236

S. Monty Ghosh, Khokan C. Sikdar, Adetola Koleade, Jordan Ross, William Rioux, Eddy S. Lang, Geoff Messier, Robert Tanguay, Stephen E. Congly, Stephanie Van den Berg, Karen L. Tang

Background

Individuals experiencing homelessness (IEH) tend to have increased length of stay (LOS) in acute care settings, which negatively impacts health care costs and resource utilisation. It is unclear however, what specific factors account for this increased LOS. This study attempts to define which diagnoses most impact LOS for IEH and if there are differences based on their demographics.

Methods

A retrospective cohort study was conducted looking at ICD-10 diagnosis codes and LOS for patients identified as IEH seen in Emergency Departments (ED) and also for those admitted to hospital. Data were stratified based on diagnosis, gender, and age. Statistical analysis was conducted to determine which ICD-10 diagnoses were significantly associated with increased ED and inpatient LOS for IEH compared to housed individuals.

Results

Homelessness was associated with increased LOS regardless of gender or age group. The absolute mean difference of LOS between IEH and housed individuals was 1.62 h [95% CI 1.49–1.75] in the ED and 3.02 days [95% CI 2.42–3.62] for inpatients. Males age 18–24 years spent on average 7.12 more days in hospital, and females aged 25–34 spent 7.32 more days in hospital compared to their housed counterparts. Thirty-one diagnoses were associated with increased LOS in EDs for IEH compared to their housed counterparts; maternity concerns and coronary artery disease were associated with significantly increased inpatient LOS.

Conclusion

Homelessness significantly increases the LOS of individuals within both ED and inpatient settings. We have identified several diagnoses that are associated with increased LOS in IE; these should inform the prioritisation and development of targeted interventions to improve the health of IEH.

背景：经历无家可归（IEH）的个人往往在急性护理机构的停留时间（LOS）更长，这对医疗保健成本和资源利用产生负面影响。然而，目前尚不清楚是什么具体因素导致了LOS的增加。本研究试图确定哪些诊断对IEH的LOS影响最大，以及是否存在基于人口统计学的差异。方法：进行了一项回顾性队列研究，研究了在急诊科（ED）和住院的确诊为IEH的患者的ICD-10诊断代码和LOS。根据诊断、性别和年龄对数据进行分层。进行了统计分析，以确定哪些ICD-10诊断与IEH住院患者的ED和LOS增加显著相关。结果：无论性别或年龄组，无家可归与LOS增加有关。IEH和住院患者LOS的绝对平均差异在ED组为1.62 h [95% CI 1.49-1.75]，在住院组为3.02 d [95% CI 2.42-3.62]。18-24岁的男性平均住院天数比住在家里的男性多7.12天，25-34岁的女性平均住院天数比住在家里的女性多7.32天。与住院者相比，31例诊断与IEH急诊科的LOS增加有关；产妇担忧和冠状动脉疾病与住院患者LOS显著增加相关。结论：无家可归显著增加了急诊科和住院病人的LOS。我们已经确定了几种与IE中LOS增加相关的诊断；这些应为确定优先次序和制定有针对性的干预措施提供信息，以改善IEH的健康。

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引用次数: 0

Lack of Prescription Drug Benefit Knowledge and Problems Paying Medical Bills Among Medicare Beneficiaries 医疗保险受益人处方药福利知识的缺乏与医疗费用支付问题。

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2024-12-29 DOI: 10.1111/jep.14290

McKayla Massey, Kathryn Litten, Samuel D. Towne Jr., Vasiliki Beleri, Chanhyun Park, Boon Peng Ng

Aims and Objectives

Approximately 50% of Americans report having low health insurance literacy, leading to uncertainty when choosing their insurance coverage to best meet their healthcare needs. Therefore, we aimed to evaluate the association between lack of prescription drug benefit knowledge and problems paying medical bills among Medicare beneficiaries.

Methods

We analysed the 2021 Medicare Current Beneficiary Survey Public Use File of 5586 Medicare beneficiaries aged ≥ 65 years. The binary dependent variable was whether beneficiaries had problems paying medical bills in the past year. The categorical independent variable was how much beneficiaries knew about the Medicare prescription drug benefit. A survey-weighted multivariable logit model, adjusted for covariates (e.g., socio-demographics, comorbidities, private insurance coverage, and satisfaction with out-of-pocket costs), was conducted to examine the association between the independent variable and problems paying medical bills.

Results

Approximately 4.3% of study beneficiaries (~2.0 million beneficiaries) reported problems paying medical bills. Of those without and with problems paying medical bills, 27.7% and 39.6%, respectively, reported knowing little/almost nothing about prescription drug benefits. Beneficiaries aged 65–74 years (marginal effect [ME] = 2.1%, p < 0.01), with comorbidities (e.g., ≥ 4 conditions, ME = 3.8%, p < 0.001), dissatisfaction with out-of-pocket costs (ME = 10.1%, p < 0.001), without private insurance (e.g., employer-sponsored insurance, ME = 2.5%, p < 0.01), or with little/almost no knowledge of prescription drug benefits (ME = 1.9%, p < 0.05) were more likely to report problems paying medical bills compared to their counterparts.

Conclusion

Tailored programmes aimed at improving beneficiaries' knowledge of prescription drug benefits, reducing out-of-pocket costs and preventing comorbidities may be considered for the at-risk population to address the problem.

目的和目标：大约50%的美国人报告说他们的健康保险知识水平较低，这导致他们在选择保险范围以最好地满足他们的医疗保健需求时不确定。因此，我们旨在评估缺乏处方药福利知识与医疗保险受益人支付医疗费用问题之间的关系。方法：对5586名年龄≥65岁的医疗保险受益人的2021年医疗保险现行受益人调查公共使用档案进行分析。二元因变量是受益人在过去一年中是否有支付医疗费用的问题。分类自变量是受益人对医疗保险处方药福利的了解程度。采用调查加权的多变量logit模型，对协变量（如社会人口统计学、合并症、私人保险覆盖范围和自付费用满意度）进行调整，以检验自变量与支付医疗费用问题之间的关联。结果：大约4.3%的研究受益人（约200万受益人）报告在支付医疗费用方面存在问题。在支付医药费没有问题和有问题的人中，分别有27.7%和39.6%的人表示对处方药的好处知之甚少或几乎一无所知。结论：针对高危人群，可考虑制定针对性的方案，提高受益人对处方药福利的了解，降低自付费用，预防合并症，以解决问题。

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引用次数: 0

On Lateness: The Ethics of Running Behind Schedule in General Practice 论迟到：全科医学中落后于计划的伦理问题。

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2024-12-23 DOI: 10.1111/jep.14293

Richard C. Armitage

Introduction

GPs, at least in the United Kingdom, often run behind schedule in their clinics. This lateness is an inherently ethical problem due to the negative consequences it generates.

Methods

The paper outlines these negative consequences, attempts to classify the major reasons for such lateness, explores the ethical status of each of these reasons, and offers suggestions for how the negative consequences might be managed.

Findings and Discussion

The major reasons for lateness can be classified as GP-related, patient-related, and third party-related. The major negative consequences of lateness in general practice might be classified as the potential disturbance to quality and safe care, the dissatisfaction of and inconvenience to subsequent patients, and the disruption of timely care. These negative consequences must be burdened by some party—either the patient who is related to the reason for the lateness, or other patients who are not. While a strict equality approach to managing such lateness does not consider patients’ clinical needs, GPs compensating by actively ‘catching up’ in their clinics threatens quality and safety of care. The paper argues for minimising the negative consequences of lateness for all parties, while simultaneously promoting equity with regard to patients’ clinical needs. The ethical status of each major reason for lateness in general practice is explored, and suggestions are offered for how each might be managed to minimise the negative consequences and promote equity.

导读：至少在英国，全科医生经常在他们的诊所落后于计划。这种迟到本身就是一个道德问题，因为它会产生负面后果。方法：本文概述了这些负面后果，试图对这些迟到的主要原因进行分类，探讨了这些原因中的每一个的伦理地位，并提出了如何管理负面后果的建议。发现与讨论：迟到的主要原因可分为gp相关、患者相关和第三方相关。在全科实践中，迟到的主要负面后果可能被归类为对质量和安全护理的潜在干扰，对后续患者的不满和不便，以及及时护理的中断。这些负面后果必须由某些人来承担——要么是与迟到原因有关的病人，要么是与迟到原因无关的其他病人。虽然管理这种迟到的严格平等方法没有考虑到患者的临床需求，但全科医生通过积极地“赶上”他们的诊所来补偿，会威胁到护理的质量和安全。本文主张尽量减少迟到对各方的负面影响，同时促进患者临床需求方面的公平。探讨了在一般实践中迟到的每个主要原因的道德地位，并就如何管理每个原因提供了建议，以尽量减少负面后果并促进公平。

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引用次数: 0

Translation, Cross-Cultural Adaptation and Validation of the Karaduman Chewing Performance Scale for the Italian Paediatric Population 意大利儿童卡拉杜曼咀嚼行为量表的翻译、跨文化适应和验证。

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

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.

背景：咀嚼是一种基本的运动活动，但在意大利没有专门的评估工具用于儿科康复。Karaduman咀嚼表现量表（KCPS）是一种基于表现的评估工具，可以对儿童的咀嚼表现进行分类。目的：翻译，文化适应和评估信度，标准效度和跨文化效度的KCPS成意大利语的儿科人群。方法：遵循国际指南，将KCPS翻译成意大利语并进行文化改编。使用类内相关系数（ICC）测量评分者间信度，使用Pearson相关系数比较KCPS评分与儿科筛查-优先评估吞咽困难（PS-PED）的标准效度，并检查诊断组间的跨文化效度。结果：本研究共纳入165名儿童，平均年龄6.33岁，分别为自闭症谱系障碍、脑瘫和遗传综合征。分析显示，KCPS是可靠的测量方法，其ICC为0.93，与PS-PED呈正相关（Pearson为0.48）。在每个诊断组中，发现了咀嚼行为障碍，突出了特定的特征。结论：尽管可靠性分析样本有限，需要探索咀嚼能力和疾病严重程度之间的关系，但KCPS是确定儿科人群咀嚼能力水平的可靠有效工具。现在，意大利的临床医生可以在临床实践和研究中更有信心地使用它。

{"title":"Translation, Cross-Cultural Adaptation and Validation of the Karaduman Chewing Performance Scale for the Italian Paediatric Population","authors":"Francesca Pizza, Marco Tofani, Giorgia Biondo, Carolina Giordani, Cristiana Murgioni, Massimiliano Raponi, Gessica Della Bella, Antonella Cerchiari","doi":"10.1111/jep.14283","DOIUrl":"10.1111/jep.14283","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To translate, culturally adapt and assess reliability, criterion validity and cross-cultural validity of the KCPS into Italian in a paediatric population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864373","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

AttributeRank: An Algorithm for Attribute Ranking in Clinical Variable Selection AttributeRank：一种临床变量选择中的属性排序算法。

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

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.

背景：风险差异是流行病学和卫生保健相关性的一种有价值的测量方法，有可能用于医学和临床变量的选择。目的：在本研究中，开发了一种称为AttributeRank的属性排序算法，以方便从临床数据集中选择变量。方法：该算法计算预测变量与响应变量之间的风险差，以确定预测变量的重要程度。采用新生儿出生体重、治疗后细菌存活率、心肌梗死、乳腺癌和糖尿病5个临床数据集，与现有的一些变量选择算法进行性能比较。结果：与Fisher评分、Pearson相关、变量重要性函数和卡方相比，AttributeRank选择的变量子集在数据集中产生了最高的平均分类精度。结论：与现有算法相比，AttributeRank在临床数据集属性排序方面更有价值，应在未来的研究中以用户友好的方式应用。

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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 子宫内膜异位症妇女慢性疾病管理的6项自我效能量表：土耳其效度和信度研究

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

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.

目的：本研究旨在将6项慢性疾病管理自我效能量表（SEMDC-6S）应用于土耳其人群中子宫内膜异位症女性，并评估其效度和信度。方法：对200例子宫内膜异位症患者进行方法学研究。采用验证性因子分析方法对量表的结构效度进行检验。量表的信度采用Cronbach’s alpha系数、项目总分相关性和重测信度分析进行检验。结果：SEMDC-6S量表由6个条目和1个分量表组成。在验证性因子分析中，发现量表的拟合指标值是可以接受的。重测信度的类内相关系数为0.95,Cronbach’s alpha系数为0.76。结论：土耳其版SEMDC-6S是评估子宫内膜异位症患者自我效能感的有效和可靠的工具。

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引用次数: 0

The Effect of Lean Hospital Practices on Nurses' Direct Care Activities: Time and Motion Study 精益医院实践对护士直接护理活动的影响：时间与动作研究。

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

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.

背景：本研究调查了精益管理实践对护士直接病人护理活动的影响，以及他们在医疗保健环境中遇到的中断。文献表明，精益管理提高了效率，改善了病人的护理。每位患者护理时间的增加与更好的结果相关；然而，不断增加的患者负荷和频繁的中断阻碍了护士提供有效护理的能力，危及患者安全。鉴于护士在确保高质量护理方面的关键作用，解决这些低效率问题至关重要。方法：2019年8月至2022年7月，采用单中心、观察性、岗前时间和运动设计以及参与式行动研究，研究包括三个阶段：调查评估护士对问题解决和精益管理的看法；观察护士的活动和中断；焦点小组讨论。本文介绍的结果来自观察阶段，共有34名来自外科、内科和混合服务部门的护士参与。结果：2019年（324 h）和2022年（314 h）的观察显示，护士将很大一部分时间用于指导患者护理，这增加了精益后的实施（手术：50.67%，内部：50.09%，混合：44.38%）。浪费率降低了35.81%，记录时间减少了23.55%。结论：精益管理有效地减少了浪费，提高了患者的直接护理时间，提高了患者的安全和护理质量。护理实践的持续改进是成功的关键。

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引用次数: 0

Effect of Excess Mortality on Longevity During the COVID-19 Pandemic in South Asia 南亚COVID-19大流行期间死亡率过高对寿命的影响

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

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.

背景：在整个二十世纪及以后，直到2019年冠状病毒病（COVID-19）大流行爆发之前，人们注意到死亡率下降和预期寿命延长的全球趋势。在2020年和2021年期间，包括南亚在内的大多数国家的预期寿命都有所缩短，原因是该流行病造成的死亡率过高。目的：本研究旨在研究选定南亚国家的预期寿命变化以及因COVID-19大流行而导致的年龄和性别死亡率随时间的相对变化。除此之外，我们进一步研究了流行病对预期寿命短期预测的影响。数据和方法：7个南亚国家按年龄和性别分列的估计死亡率来自2022年修订的《世界人口展望》（WPP 2022）。使用标准寿命表估计技术估计预期寿命的变化。为了估计大流行导致的年龄和性别死亡率水平的相对变化以及死亡率预测的变化，我们采用了Lee-Carter方法。结果：李-卡特模型的应用揭示了死亡率改善的年龄和性别差异，反映了该地区死亡率的上升。在巴基斯坦，男女死亡率都明显下降，其次是印度和孟加拉国。在整个生命周期中表现出较慢改善速度的人群表明，受大流行影响的变化最小。相对预期寿命预测表明，在大多数这些人口中，大流行后出生时预期寿命和老年时剩余预期寿命的上升速度较慢。结论：这些发现突出了该流行病对死亡率动态的深刻影响，强调需要采取有针对性的干预措施，以减轻其对人口健康和寿命的长期影响。

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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 美国老年人延世生活方式概况的跨文化适应和内容验证。

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

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.

理由：随着全球人口老龄化，越来越需要工具来评估影响老年人健康和生活质量的生活方式因素。延世生活方式概况（YLP）最初在韩国开发，是评估关键生活方式领域的综合工具。但是，由于各国之间的文化和语言差异，需要对这些工具进行调整，以便在不同的人口中使用。本研究通过开发美国老年人YLP （YLP- e）的英文版本来解决这一差距。宗旨和目标：随着全球人口继续老龄化，保持和改善老年人的健康和生活质量变得越来越重要。本研究旨在开发YLP- e，这是韩国版YLP的跨文化改编，可用于美国老年人。方法：采用德尔菲法对翻译的文化和语言适宜性进行专家咨询。翻译过程包括双向翻译-反翻译过程和基于专家反馈的迭代修订。结果和结论：最终的YLP-E工具纳入了对语言和文化充分性的反馈，包括3个生活方式领域（体育活动、活动参与和营养），共有62个项目。第二轮提高了内容效度，语言内容效度比（CVR）和文化内容效度比分别达到0.86和0.94。YLP-E是全面评估和监测美国老年人生活方式的有价值的工具，并有望在不同的人口环境中进一步完善和验证。未来的研究需要集中在利用YLP-E开发个性化干预措施，旨在改善老年人的健康和生活质量，并评估该工具在促进健康老龄化方面的功效。

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