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

Lace Index: Predict the High-Risk of 30-Days Readmission of Patients With Acute Myocardial Infarction: National Health Insurance Claims Data 2011–2020 蕾丝指数：预测急性心肌梗死患者30天再入院的高风险：2011-2020年国民健康保险索赔数据。

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2025-09-30 DOI: 10.1111/jep.70289

Vasuki Rajaguru, Whiejong Han, Suk-Yong Jang, Jaeyong Shin, Sang Gyu Lee, Tae Hyun Kim

Background

Readmission following acute myocardial infarction (AMI) poses significant challenges to health systems and patient outcomes. The LACE index, a composite of Length of stay, Acuity of admission, Comorbidities, and Emergency department visits, is widely used for readmission prediction. However, its performance in large-scale, real-world Korean cohorts remains understudied.

Objective

This study aimed to validate the predictive performance of the LACE index for 30-day readmissions in AMI patients using a nationally representative Korean cohort.

Methods

This retrospective cohort study analyzed data from the Korean National Health Insurance Service Sample (NHISS) database from 2011 to 2020. A total of 609,640 adult patients hospitalized for AMI were included. The LACE index was calculated for each patient, and 30-day readmissions were identified. Logistic regression was used to estimate odds ratios (ORs) for readmission. Model discrimination was assessed using ROC curve analysis and C-statistics. Subgroup and survival analyses were performed by age, LACE score, and comorbidity burden.

Results

Among 609,640 AMI patients, 205 (0.034%) experienced 30-day readmission. Patients with a LACE score of ≥ 10 had significantly higher odds of readmission (OR = 2.65; 95% CI: 1.68–4.19, p < 0.001) compared to those with scores 0–4. Middle-aged adults (35–64 years) also showed elevated readmission risk (OR = 3.42; 95% CI: 1.74–6.73, p < 0.001), while older adults (≥ 65 years) did not have significantly different risk. The LACE index showed moderate discriminatory performance (C-statistics = 0.71). Kaplan–Meier survival curves demonstrated significantly lower 30-day survival among patients with LACE ≥ 10.

Conclusions

Study findings suggest the LACE index is a useful tool for predicting 30-day readmissions among AMI patients in Korea. Its simplicity and moderate accuracy support its application in clinical and policy-level risk stratification strategies. Future prospective studies should refine prediction models by incorporating additional clinical variables.

背景：急性心肌梗死（AMI）后再入院对卫生系统和患者预后构成重大挑战。LACE指数是住院时间、入院锐度、合并症和急诊科就诊次数的综合指数，被广泛用于再入院预测。然而，它在大规模、真实的韩国队列中的表现仍有待研究。目的：本研究旨在通过具有全国代表性的韩国队列验证LACE指数对AMI患者30天再入院的预测性能。方法：本回顾性队列研究分析了2011年至2020年韩国国民健康保险服务样本（NHISS）数据库中的数据。共纳入609,640名因急性心肌梗死住院的成年患者。计算每位患者的LACE指数，并确定30天再入院。使用逻辑回归估计再入院的优势比（or）。采用ROC曲线分析和c统计量评估模型判别性。根据年龄、LACE评分和合并症负担进行亚组和生存分析。结果：609,640例AMI患者中，205例（0.034%）30天再入院。LACE评分≥10的患者再入院的几率明显更高（OR = 2.65; 95% CI: 1.68-4.19, p）结论：研究结果表明，LACE指数是预测韩国AMI患者30天再入院的有用工具。它的简单性和适度的准确性支持其在临床和政策层面的风险分层策略的应用。未来的前瞻性研究应通过纳入其他临床变量来完善预测模型。

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引用次数: 0

Implementation of Clinical Pharmacy Services in Primary Health Care: A Scoping Review 初级卫生保健中临床药学服务的实施：范围审查。

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2025-09-25 DOI: 10.1111/jep.70285

João Pedro Vasconcelos Paolinelli, Taiana de Alencar, Kérilin Stancine Santos Rocha, Mariana Linhares Pereira, Genival Araujo dos Santos Júnior

Rationale

The implementation of Clinical Pharmacy Services in healthcare systems is multifactorial and complex. Some studies summarize the implementation research of these services in both outpatient and inpatient contexts. However, the literature lacks a comprehensive synthesis to understand how the implementation process occurs in Primary Health Care.

Aim

To map, at an international level, the studies on the implementation of Clinical Pharmacy Services in Primary Health Care.

Method

This scoping review followed the recommendations of the JBI Manual for Evidence Synthesis for Scoping Reviews. A systematic search was conducted in May 2023 across six electronic databases, grey literature, and the references of the selected studies. Original studies that described the implementation process of Clinical Pharmacy Services in Primary Health Care were eligible for inclusion. Two researchers independently assessed the studies based on eligibility criteria and extracted data from the selected articles. Data were presented descriptively.

Results

A total of 97 studies were included, with 85.6% (n = 83) conducted in developed countries. A significant emphasis was observed on qualitative and mixed-methods research, accounting for 46.4% (n = 45) of the studies. Only 22.7% (n = 22) of the studies utilized theoretical models as research guides, while 96.9% (n = 94), did not report on the implementation phase. Comprehensive Medication Management (36.8%, n = 35) was the most cited type of service. The most assessed implementation outcome was feasibility, at 73.2% (n = 71). A total of 47.4% (n = 46) assessed outcomes related to the implemented service, which included clinical, economic, and/or humanistic aspects.

Conclusion

This study revealed numerous publications on the implementation of clinical services provided by pharmacists in primary care. These findings can guide future research on the implementation of these services and highlight the need for developing and underdeveloped countries to explore this topic further.

理由：临床药学服务在卫生保健系统的实施是多因素和复杂的。一些研究总结了这些服务在门诊和住院情况下的实施研究。然而，文献缺乏一个全面的综合，以了解实施过程如何发生在初级卫生保健。目的：在国际范围内对初级卫生保健中临床药学服务的实施情况进行研究。方法：该范围综述遵循JBI范围综述证据综合手册的建议。我们于2023年5月对6个电子数据库、灰色文献和所选研究的参考文献进行了系统检索。描述初级卫生保健中临床药学服务实施过程的原始研究符合纳入条件。两名研究人员根据入选标准独立评估研究，并从选定的文章中提取数据。数据以描述性方式呈现。结果：共纳入97项研究，85.6% （n = 83）来自发达国家。定性和混合方法研究占研究总数的46.4% （n = 45）。只有22.7% （n = 22）的研究使用理论模型作为研究指导，而96.9% （n = 94）的研究没有报告实施阶段。综合用药管理（36.8%,n = 35）是被引用最多的服务类型。评估最多的实施结果是可行性，占73.2% （n = 71）。共有47.4% （n = 46）评估了与实施服务相关的结果，包括临床、经济和/或人文方面。结论：本研究揭示了大量关于初级保健中药剂师提供的临床服务实施的出版物。这些发现可以指导未来关于这些服务实施的研究，并强调发展中国家和不发达国家进一步探索这一主题的必要性。

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引用次数: 0

Evaluation of Depression and Mother–Infant Attachment in the Postpartum Period: The Case of Somalia 产后抑郁与母婴依恋的评价：以索马里为例。

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2025-09-25 DOI: 10.1111/jep.70282

Handan Özcan, Ayşe Çuvadar, Adow Nur Sharif, Naimo Mahdi Sheikh Ibrahim

Aim

This study evaluated postpartum depression levels among mothers in Somalia and examined its impact on mother-infant attachment.

Methods

This descriptive correlational study was conducted at a training and research hospital in Mogadishu, involving a sample of 178 postpartum women. Data were collected using a “Personal Information Form” for demographics, the “Beck Depression Inventory” to measure depression levels, and the “Maternal Attachment Inventory” for maternal attachment characteristics. Statistical analysis using SPSS 26 software indicated significance at p < 0.05.

Results

The results revealed moderate depression symptoms and low maternal attachment levels among the participants. Higher depression and attachment scores were observed among university graduates, employees, and those with planned pregnancies (p < 0.05). Furthermore, a weak positive relationship existed between the Beck Depression Inventory and the Maternal Attachment Inventory scores (r = 0.282, p < 0.001).

Conclusion

The results suggest the importance of recognizing and intervening in postpartum depression early, with a focus on identifying contributing factors and emphasizing the need for targeted counseling to enhance maternal attachment.

目的：本研究评估了索马里母亲的产后抑郁水平，并考察了其对母婴依恋的影响。方法：本描述性相关研究在摩加迪沙的一家培训和研究医院进行，涉及178名产后妇女的样本。数据收集采用“个人信息表”进行人口统计，“贝克抑郁量表”测量抑郁水平，“母亲依恋量表”测量母亲依恋特征。采用SPSS 26软件进行统计学分析，p为显著性。结果：被试抑郁症状为中度，母亲依恋水平较低。结论：研究结果提示早期识别和干预产后抑郁的重要性，重点是识别导致产后抑郁的因素，并强调有针对性的咨询，以增强母亲的依恋。

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引用次数: 0

Evaluation of Potentially Inappropriate Prescriptions Among the Geriatric Population in Tabuk, Saudi Arabia via the STOPP/START Criteria, Version 3: A Multicentric Study 通过STOPP/START标准评估沙特阿拉伯Tabuk老年人群中可能不适当的处方，版本3：一项多中心研究

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2025-09-21 DOI: 10.1111/jep.70279

Kousalya Prabahar

Background

Older populations are prone to various chronic diseases and takes polypharmacy, which can lead to potentially inappropriate medications (PIMs), causing several complications. This research aimed to estimate PIMs and potential prescribing omissions (PPOs) in older adults via the STOPP/START criteria, version 3.

Methods

This multicentric retrospective observational study was executed among subjects aged ≥ 65 years, who were hospitalized at two Ministry hospitals from July 2023 to June 2024. The medicines of the geriatric population were assessed for PIMs/PPOs via the STOPP/START criteria, version 3. The data were scrutinized via SPPSS 27. Descriptive statistics were performed for qualitative and quantitative data. Multinomial logistic regression was applied to evaluate the effects of sex, age, comorbidities and medicines on PIMs and PPOs. Multiple linear regression analysis was conducted to evaluate potential multicollinearity among the predictors associated with PIMs and PPOs.

Results

In total, 385 subjects were included in this study. The participants' mean age was 75.7 ± 8.76 years and 50.13% were male. Among the study population, 48.83% had potentially inappropriate prescriptions, 37.66% with PIMs and 20.52% with PPOs. In total, 190 PIMs and 108 PPOs were identified, and the most frequently prescribed PIM was calcium channel blockers (20%). Comorbidities were significantly associated with PIMs and PPOs.

Conclusion

Overall, 48.83% of the prescriptions were potentially inappropriate. The percentage of PIMs/PPOs is lower in our population than in previous versions of the STOPP/START criteria. However, scheduled audits should be performed to keep the PIMs/PPOs at the lowest range. A comprehensive list of medications that are appropriate or inappropriate for use in older adults should be established, and prescribers should consult this list before prescribing to help prevent potentially inappropriate prescriptions.

年龄较大的人群容易患各种慢性疾病并服用多种药物，这可能导致潜在的不适当药物（PIMs），导致多种并发症。本研究旨在通过STOPP/START标准，版本3来估计老年人的pim和潜在处方遗漏（PPOs）。方法对2023年7月至2024年6月在两所部属医院住院的年龄≥65岁的患者进行多中心回顾性观察性研究。通过STOPP/START标准第3版对老年人群的药物进行PIMs/PPOs评估。通过SPPSS 27对数据进行了仔细检查。对定性和定量数据进行描述性统计。采用多项logistic回归评价性别、年龄、合并症和药物对PIMs和PPOs的影响。采用多元线性回归分析评估与PIMs和PPOs相关的预测因子之间可能存在多重共线性关系。结果本研究共纳入385名受试者。参与者平均年龄为75.7±8.76岁，男性占50.13%。在研究人群中，有潜在不当处方的占48.83%，pim占37.66%，PPOs占20.52%。总共鉴定出190例PIM和108例PPOs，最常用的PIM是钙通道阻滞剂（20%）。合并症与PIMs和PPOs显著相关。结论总体而言，48.83%的处方存在潜在不适宜处方。在我们的人口中，pim / ppo的百分比比以前版本的STOPP/START标准要低。但是，应该执行计划审计，以将pim / ppo保持在最低范围内。应建立适合或不适合老年人使用的综合药物清单，开处方者应在开处方前查阅该清单，以帮助预防可能不适当的处方。

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引用次数: 0

Impact of Care Delivered in Nondesignated Areas on Older Patients Admitted With Hip Fractures: A Quality Improvement Initiative 在非指定区域提供护理对老年髋部骨折患者入院的影响：一项质量改进倡议

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2025-09-21 DOI: 10.1111/jep.70276

Joan Solomon, Ashna Ameer, Vahida Chopda, Radcliffe Lisk, Keefai Yeong, Jay Acharya, Jonathan Robin, Christopher H. Fry, Thang S. Han

Background

Although testimonies of devastating impacts of care delivered in nondesignated hospital areas (corridor care) are mounting, there is a paucity of quantitative data. This study aimed to assess the associations between: (1) care in nondesignated areas and key performance indicators (KPIs), including ward moves and length of stay (LOS); and (2) between KPIs and mortality.

Methods

Data from this cross-sectional study were derived from the National Hip Fracture Database audit programme (a quality-improvement initiative commissioned by the Healthcare Quality Improvement Partnership, NHS England). In total, 508 patients (65% women) consecutively admitted with hip fractures (January 2024–January 2025) were included. The duration (h:min) of care in nondesignated areas was categorised by tertiles (< 1:20; 1:20–4:20; > 4:20). Associations between variables were determined by logistic regression, presented as odds ratios (OR) and 95% confidence intervals.

Results

Patients cared for in nondesignated areas (11%) and bed care patients (89%) had similar clinical characteristics (median age = 85.5 years). Care in nondesignated areas varied inversely with seasonal average local temperatures: 10.7% in summer (22.5°C), 19.6% autumn (15.9°C), 44.6% winter (8.6°C), and 25.0% spring (14.9°C), which was more discernible than the corresponding distribution of bed care: 21.2%, 23.7%, 25.9% and 29.2%. Compared with bed care patients, those cared for in nondesignated areas for ≥ 1 h:20 min were associated with ≥ 3 ward moves: OR = 4.02 (1.61–10.06). LOS on orthogeriatric wards for bed care patients was 13.4 days, and care in nondesignated areas > 4 h:20 min was 17.2 days, which increased to 19.7 days for all patients cared for in nondesignated areas with ≥ 3 ward moves. In turn, higher in-hospital mortality was associated with multiple ward moves: OR = 2.63 (1.23–5.66) and prolonged LOS: OR = 3.23 (1.53–6.81).

Conclusions

The impact of care delivered in nondesignated areas exposed by KPIs is consistent with testimonies from patients and NHS staff. This evidence serves as a stimulus to take urgent action to abolish care in nondesignated areas.

背景：虽然关于在非指定医院区域（走廊护理）提供护理的破坏性影响的证词越来越多，但缺乏定量数据。本研究旨在评估：(1)非指定区域的护理与关键绩效指标（kpi）之间的关系，包括病房移动和住院时间（LOS）；(2) kpi与死亡率之间的关系。方法本横断面研究的数据来源于国家髋部骨折数据库审计项目（由英国国民健康服务体系医疗质量改进伙伴关系委托的一项质量改进倡议）。共纳入508例髋部骨折患者（65%为女性）（2024年1月至2025年1月）。在非指定区域的护理时间（h:min）按tiles （< 1:20; 1:20 - 4:20; > 4:20）进行分类。变量之间的关联通过逻辑回归确定，以比值比（OR）和95%置信区间表示。结果非指定区域护理患者（11%）与卧床护理患者（89%）临床特征相似（中位年龄= 85.5岁）。非指定区域护理与当地季节平均气温呈负相关，夏季10.7%(22.5°C)，秋季19.6%(15.9°C)，冬季44.6%(8.6°C)，春季25.0%(14.9°C)，与床上护理的相应分布（21.2%,23.7%，25.9%和29.2%）相比更具可辨性。与卧床护理患者相比，非指定区域护理时间≥1小时20分钟的患者转病房次数≥3次：OR = 4.02（1.61-10.06）。住院患者在骨科病房的住院时间为13.4天，非指定区域4小时20分钟护理时间为17.2天，所有非指定区域≥3次病房转移患者的住院时间均增加至19.7天。反过来，较高的住院死亡率与多次病房移动相关：OR = 2.63（1.23-5.66）和延长的LOS: OR = 3.23（1.53-6.81）。结论kpi所暴露的非指定地区的护理效果与患者和NHS工作人员的证词一致。这一证据有助于采取紧急行动，取消非指定地区的护理。

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引用次数: 0

Volunteer Outreach and Predictive Modeling: Rapid Randomized Quality Improvement Project for New Patient Attendance in a Primary Care Safety-Net 志愿者拓展和预测模型：初级保健安全网中新患者就诊的快速随机质量改进项目

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2025-09-21 DOI: 10.1111/jep.70278

Kevin Chen, Khera Bailey, Simon Nemytov, Kenan Katranji, Michael Bouton, Andrew B. Wallach, Hannah B. Jackson

Background

Nonattendance at new patient appointments leads to missed opportunities for engagement in care, lost revenue, and suboptimal resource utilization.

Objective

To assess the effectiveness of outreach calls to new patients, prioritized by a no-show predictive algorithm and conducted by volunteers, on visit attendance.

Design

Rapid randomized quality improvement project.

Participants

Patients with new patient appointments at an urban safety-net adult primary care clinic scheduled to occur between August 1, 2024 and September 30, 2024.

Intervention

Estimated probability of visit no-show for patients was calculated using a predictive algorithm embedded in the electronic health record and used to sort lists of patients with upcoming appointments. Every other patient received an outreach call from a trained volunteer within 3 business days of their appointment plus usual automated reminder messages versus usual automated reminder messages alone.

Main Measures

New patient visit attendance compared between intervention and control groups. We conducted subgroup analyses of attendance by visit modality (in-person vs. telehealth), preferred language, and quartile of predicted no-show probability.

Key Results

Patients in the intervention group (n = 281) had higher visit attendance than those in the control group (n = 280): 68.0% versus 54.1% (p < 0.01). There was a significant difference in attendance for in-person (70.7% vs. 51.7%; p < 0.01) but not telehealth (60.6% vs. 61.2%; p = 0.94) visits. Patients who preferred English had the biggest increase in attendance (17.2%; p < 0.01). Patients in the second and third quartiles of predicted no-show probability (31%–38% and 39%–45% predicted probability) had the biggest increases in attendance (22.2% [p = 0.01] and 15.4% [p = 0.05]).

Conclusions

Outreach calls for new patients, prioritized by a no-show predictive algorithm and conducted by volunteers, can be a feasible and effective approach to improving visit attend

背景：新患者预约不出席导致错过参与护理的机会、收入损失和资源利用不理想。目的评估对新患者外展电话的有效性，该外展电话采用未到预测算法进行优先排序，并由志愿者进行。设计快速随机质量改进项目。在2024年8月1日至2024年9月30日期间在城市安全网成人初级保健诊所预约新患者的患者。干预措施使用嵌入在电子健康记录中的预测算法计算患者未赴约的估计概率，并用于对即将预约的患者列表进行排序。其他每位患者在预约后的3个工作日内，都会收到一位训练有素的志愿者打来的外展电话，再加上常规的自动提醒信息，而不是常规的自动提醒信息。主要措施干预组与对照组新患者就诊率比较。我们通过访问方式（面对面与远程医疗）、首选语言和预测缺席概率的四分位数对出勤进行了亚组分析。干预组（n = 281）患者的访诊出勤率高于对照组（n = 280）： 68.0%比54.1% （p < 0.01）。现场就诊的出勤率有显著差异（70.7% vs. 51.7%; p < 0.01），但远程医疗就诊的出勤率无显著差异（60.6% vs. 61.2%; p = 0.94）。偏爱英语的患者出勤率增加最多（17.2%;p < 0.01）。预测缺席概率的第二和第三四分位数（预测概率分别为31%-38%和39%-45%）患者的出勤率增幅最大（分别为22.2% [p = 0.01]和15.4% [p = 0.05]）。结论对新患者进行外展呼吁，采用无就诊预测算法进行优先排序，并由志愿者进行，是一种有针对性地提高出勤率的可行而有效的方法。需要进一步调查以了解如何更好地支持非英语偏好患者和远程医疗预约患者。

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引用次数: 0

Maximising Value in Healthcare Systems by Putting the Patient at the Centre – Systemic Design Considerations 以病人为中心实现医疗保健系统价值最大化——系统设计考虑

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2025-09-21 DOI: 10.1111/jep.70270

Joachim Sturmberg, Saadi Taher

Value-based healthcare addresses inefficiencies, rising costs, and inconsistent quality by prioritising patient outcomes relative to costs. Despite broad support, its definition and implementation remain unclear. This perspective proposes a systemic, person-centred approach that aligns stakeholders around shared values. We examine frameworks like Berwick's ‘Triple Aim’ and Porter's patient-centred model, and integrat Sir Muir Gray's moral dimension for a holistic perspective. Achieving an effective system requires committed leadership, bottom-up redesign integrating all care levels, and cross-sector collaboration to align policies with sustainable health improvements. Context-sensitive metrics are essential to balancing patient-centred and economic value.

基于价值的医疗保健通过优先考虑患者的结果而不是成本，解决了效率低下、成本上升和质量不一致的问题。尽管得到广泛支持，但其定义和实施仍不明确。这种观点提出了一种系统的、以人为本的方法，使利益相关者围绕共同的价值观保持一致。我们研究了像贝里克的“三重目标”和波特的以病人为中心的模型这样的框架，并将缪尔·格雷爵士的道德维度整合为一个整体的视角。实现有效的系统需要坚定的领导，自下而上的重新设计，整合所有护理水平，以及跨部门合作，使政策与可持续的卫生改善相一致。上下文敏感的指标对于平衡以患者为中心的价值和经济价值至关重要。

引用次数: 0

Factors Influencing the Adoption of Shared Decision Making for Antibiotic Treatments in Developing Countries: A Systematic Review of Physicians and Patients' Perspectives 影响发展中国家抗生素治疗采用共同决策的因素：对医生和患者观点的系统回顾

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2025-09-21 DOI: 10.1111/jep.70281

Gashaw Enbiyale Kasse, Suzanne M. Cosh, Judy Humphries, Md Shahidul Islam

<div> <section> <h3> Background</h3> <p>Shared decision-making is a decision-making process that involves both patients and their healthcare providers and can serve as a framework to reduce inappropriate antibiotic prescribing, thereby helping to control antibiotic resistance. However, little is known about the factors that influence the adoption of shared decision-making for antibiotic prescription in developing countries.</p> </section> <section> <h3> Objectives</h3> <p>The objective of this review is to identify factors influencing the adoption of shared decision-making for antibiotic prescription from both physicians' and patients' perspectives in developing countries.</p> </section> <section> <h3> Methods</h3> <p>We searched four electronic databases, Web of Science, Scopus, PubMed and ProQuest Health and Medicine, from 3 July 2023 to August 20, 2023. Studies were included if they assessed factors influencing the practice of shared decision-making during antibiotics prescription from physicians' or patients' perspectives in developing countries. The included studies were published in English and used quantitative, qualitative or mixed-method designs, spanning 2010 and 2023. The quality of the included articles was assessed using the Mixed Method Appraisal Tool (MMAT) version 2018, and data extraction from selected articles was performed by the first author and co-authors. Narrative synthesis was used to synthesis the qualitative result and incorporate quantitative data.</p> </section> <section> <h3> Results</h3> <p>Initially, a total of 2120 studies were identified. After evaluating the inclusion criteria, 24 were included in the final analysis. The main factors that influence the adoption of shared decision-making (SDM) in developing countries are time constraints, misunderstanding of shared decision-making, cultural and socioeconomic influence, power dynamics differences (hierarchical relationship between physicians and patients), patients' preference and agreement with shared decision-making, and availability of resources. Additionally, the quality of the relationship between patients and physicians plays a key role in influencing the practice of shared decision-making.</p> </section> <section> <h3> Conclusion</h3> <p>The findings highlight the importance of interventions aimed at both physicians and patients, such as education and training programs focused on shared decision-making for antibiotic prescription. However, further study is required to develop effective strategies that promote the adoption of shared decision-making practices while

共同决策是一个涉及患者及其医疗保健提供者的决策过程，可以作为减少不适当抗生素处方的框架，从而有助于控制抗生素耐药性。然而，对于影响发展中国家采用抗生素处方共同决策的因素知之甚少。本综述的目的是从发展中国家的医生和患者的角度确定影响抗生素处方共同决策的因素。方法检索Web of Science、Scopus、PubMed和ProQuest Health and Medicine 4个电子数据库，检索时间为2023年7月3日至2023年8月20日。如果研究从发展中国家医生或患者的角度评估影响抗生素处方共同决策实践的因素，则纳入研究。纳入的研究以英语发表，采用定量、定性或混合方法设计，时间跨度为2010年至2023年。使用混合方法评估工具（MMAT） 2018版对纳入文章的质量进行评估，并由第一作者和共同作者从所选文章中提取数据。采用叙事综合法对定性结果进行综合，并纳入定量数据。最初，共确定了2120项研究。经评估纳入标准后，24例纳入最终分析。影响发展中国家采用共同决策（SDM）的主要因素是时间限制、对共同决策的误解、文化和社会经济影响、权力动态差异（医生和患者之间的等级关系）、患者对共同决策的偏好和同意，以及资源的可用性。此外，患者和医生之间关系的质量在影响共同决策的实践中起着关键作用。研究结果强调了针对医生和患者的干预措施的重要性，例如关注抗生素处方共同决策的教育和培训计划。然而，需要进一步研究，以制定有效的战略，促进采用共同决策实践，同时考虑到环境因素的作用。

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引用次数: 0

Enhancing Adolescent Asthma Control and Self-Efficacy: A Decision Tree Analysis of a Mobile Health Application in a Randomized Controlled Trial 增强青少年哮喘控制和自我效能：一项随机对照试验中移动健康应用程序的决策树分析

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2025-09-10 DOI: 10.1111/jep.70266

Nimet Karataş, Ayşegül İşler, Ayşen Bingöl

Aims and Objectives

To evaluate the efficacy of YoungAsthma, a nurse-led, web-based mHealth intervention on asthma control and self-efficacy among adolescents with asthma utilizing decision tree analysis.

Background

Asthma is a prevalent chronic condition in pediatric populations, necessitating sustained management for optimal disease control.

Design

A randomized controlled clinical trial.

Methods

Fifty-four eligible adolescents were randomly assigned to either the intervention group (YoungAsthma + Usual care, n = 27) or the control group (Usual care, n = 27) for 4 weeks. Primary outcomes—asthma control and self-efficacy—were assessed using the Information Form, Asthma Control Test, Self-Efficacy Scale for Children and Adolescents with Asthma. Statistical analyses included Fisher's exact test, chi-square test, Wilcoxon signed-rank test, Mann-Whitney U test, and Intention-to-Treat (ITT) analysis.

Results

Forty-eight participants completed the study (11% dropout per group). The intervention group exhibited a greater improvement in asthma control than the control group. While both groups showed increased self-efficacy, the intervention group's improvement was significantly higher. Decision tree analysis identified key predictors, indicating that lower scores were associated with a higher likelihood of remaining in the control group.

Conclusions

Nurse-led, technology-supported interventions significantly enhance asthma control and self-efficacy in adolescents. Decision tree analysis provided valuable insights into key factors influencing asthma control and self-efficacy improvements, identifying subgroups that benefited most from the intervention. Interdisciplinary collaboration facilitated a user-centered approach grounded in Bandura's Self-Efficacy Theory, offering a data-driven framework for personalized asthma management.

Relevance to Clinical Practice

Decision tree analysis aids in identifying patients who would benefit most, enabling precision-targeted interventions.

Reporting Method

This study was conducted

目的和目的利用决策树分析评估YoungAsthma的有效性，这是一项护士主导的基于网络的移动健康干预，对哮喘青少年的哮喘控制和自我效能感进行干预。背景：哮喘是儿科人群中一种常见的慢性疾病，需要持续的治疗以达到最佳的疾病控制。设计随机对照临床试验。方法将54名符合条件的青少年随机分为干预组（YoungAsthma +常规护理组，n = 27）和对照组（常规护理组，n = 27），为期4周。主要结局-哮喘控制和自我效能-评估使用信息表，哮喘控制测试，自我效能量表儿童和青少年哮喘。统计分析包括Fisher精确检验、卡方检验、Wilcoxon符号秩检验、Mann-Whitney U检验和意向治疗（Intention-to-Treat， ITT）分析。结果48名参与者完成了研究（每组11%的人退出）。干预组在哮喘控制方面比对照组有更大的改善。虽然两组的自我效能都有所提高，但干预组的改善程度明显更高。决策树分析确定了关键的预测因素，表明得分越低，留在对照组的可能性越大。结论护士主导、技术支持的干预措施可显著提高青少年哮喘控制和自我效能感。决策树分析为影响哮喘控制和自我效能改善的关键因素提供了有价值的见解，确定了从干预中获益最多的亚组。跨学科合作促进了基于Bandura自我效能理论的以用户为中心的方法，为个性化哮喘管理提供了数据驱动的框架。与临床实践的相关性决策树分析有助于确定哪些患者将受益最多，从而实现精确的靶向干预。报告方法本研究按照报告试验的统一标准和移动健康证据报告和评估指南进行。临床试验注册号临床试验。首次招聘日期：2020年12月。https://register.clinicaltrials.gov/prs/beta/studies/S000AJ5B00000102/recordSummary。

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引用次数: 0

The Impact of Social Network Interruption on Depression in the Elderly With Chronic Diseases: A Longitudinal Study in China 社会网络中断对中国老年慢性病患者抑郁的影响：一项纵向研究

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2025-09-10 DOI: 10.1111/jep.70263

Tong Shi, Zongshun Chen, Chaoping Pan, Shikang Deng, Junfeng Jiang, Peigang Wang

Background

Social support can have health benefits but may also pose risks for the elderly, particularly those facing conflicts and network disruptions. Understanding the short and long-term mental health effects, especially in elderly individuals with chronic illnesses, is crucial due to global depression concerns. Yet, research is limited, with gaps in exploring different social disruption scenarios and lacking comprehensive multi-period data analysis.

Methods

We conducted a longitudinal study using 2016 and 2018 China Longitudinal Aging Social Survey (CLASS) data. Our study included 5476 and 7138 participants aged 60−90 with chronic illnesses, 4730 participating in both years. We analysed relationships using depression scores, social network disruption and social adaptation. Ordinary least squares explored short and long-term effects, and propensity score matching examined causal inferences, including gender and urban-rural differences. We also explored the social adaptation's mediating role.

Results

Disrupted social networks significantly increased short and long-term depression (β = 0.984, p < 0.001; β = 0.337, p < 0.01). However, after propensity score matching, only short-term impacts persisted (ATT = 0.981−1.045, p < 0.001). Factors like death and conflicts had short-term impacts, milder in females (0.673 points) than in males (1.285 points). Both urban and rural participants experienced increased depression. Social adaptation explained 14.1% of the mediation effect.

Conclusions

Disrupted social networks heightened short-term depression in elderly individuals with chronic illnesses, with varying gender and location effects. Robust social adaptability facilitated new connections, reducing depression. Implications include emphasizing rapid network recovery and enhancing adaptability for mental health support in aging populations.

社会支持可以带来健康益处，但也可能给老年人，特别是那些面临冲突和网络中断的老年人带来风险。由于全球对抑郁症的担忧，了解抑郁症对心理健康的短期和长期影响，尤其是对患有慢性疾病的老年人的影响，至关重要。然而，研究有限，在探索不同的社会混乱情景方面存在空白，缺乏全面的多时期数据分析。方法采用2016年和2018年中国纵向老龄化社会调查（CLASS）数据进行纵向研究。我们的研究包括5476和7138名年龄在60 - 90岁之间的慢性疾病患者，其中4730人在两年内都参加了研究。我们使用抑郁评分、社会网络破坏和社会适应来分析关系。普通最小二乘法研究短期和长期影响，倾向得分匹配研究因果关系，包括性别和城乡差异。我们还探讨了社会适应的中介作用。结果社交网络中断显著增加短期和长期抑郁（β = 0.984, p < 0.001; β = 0.337, p < 0.01）。然而，在倾向评分匹配后，只有短期影响持续存在（ATT = 0.981−1.045,p < 0.001）。死亡和冲突等因素的短期影响，女性（0.673分）比男性（1.285分）轻微。城市和农村的参与者都经历了更多的抑郁。社会适应解释了14.1%的中介效应。结论：社会网络中断会加剧老年慢性病患者的短期抑郁，其影响存在性别和地域差异。强大的社会适应能力促进了新的联系，减少了抑郁。其意义包括强调快速网络恢复和增强老年人心理健康支持的适应性。

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