Journal of evaluation in clinical practice最新文献

Background: Although guidelines focus predominantly on individual diseases, some dedicated guidelines and recommendations exist for common combinations of comorbidities. Using diabetes, coronary heart disease (CHD) and stroke as an example, we aimed to assess the current status and quality of such guidelines.

Methods: We systematically searched literature databases, Google, guideline platforms, and websites of relevant organizations. We included guidelines published between 2020 and 2024 that addressed at least two of the following diseases: diabetes, CHD, and stroke; and included drug therapy interventions. We extracted the recommendations on drug therapy and sources of the supporting evidence, and assessed the quality of the guidelines using AGREE II and RIGHT with the help of a large language model based tool.

Results: We identified 82 guidelines: 64 focused on one disease with recommendations on comorbidities, and 18 specifically addressed a combination of diseases. China was the most frequent country of origin (n = 50, 61.0%). The methodological and reporting quality of these guidelines was moderate on average. For most guidelines (n = 54, 65.9%), the primary focus was on diabetes. We grouped the recommended drug therapies for patients with combinations of these diseases into four main categories: anti-diabetic therapy, antihypertensive therapy, lipid-lowering therapy, and anticoagulant therapy. Most recommendations were supported by RCTs, but only a third of the guidelines referred to studies done in multimorbid patients.

Conclusion: Most recommendations related to multimorbidity were found in guidelines focusing on a single target disease, and supporting evidence from multimorbid patients was rare. More primary evidence from multimorbid patients is needed.

Objective: The clinical profiles of child victims admitted to hospitals following earthquakes, as well as the characteristics associated with hospital stay, are important. This study aimed to analyze the clinical outcomes of pediatric victims admitted following a sudden earthquake to enhance preparedness for accessing essential health services to reduce losses in future disasters.

Methods: Among 2158 patients referred to the pediatric emergency department (PED), 356 children followed at our tertiary inpatient clinic were included. Demographics, surgical interventions, and the presence of life-threatening conditions like crush syndrome and fasciotomy/amputation were investigated. Crush syndrome was defined as clinical and laboratory evidence of muscle injury accompanied by systemic complications odds ratios (OR) with 95% confidence intervals (CI) were calculated.

Results: Among the patients, 56.5% were male. The median length of hospital stay was 4 days (range: 1-120). The most common injury mechanism was entrapment under rubble, and the lower extremities were the most frequently affected injury site. Compartment syndrome developed in 31.7% of patients, and 2.8% underwent amputation. Crush syndrome was identified in 75.3% of hospitalized patients and was significantly more common among children admitted on the second day or later after the earthquake. Elevated creatine phosphokinase (CPK) levels significantly increased the likelihood of developing crush syndrome (OR: 61.7, 95% CI) and the need for fasciotomy (OR: 16.9, 95% CI). Fasciotomy was required in 28.9% of patients. Dehydration was associated with an increased risk of fasciotomy (OR: 7.2) and amputation (OR: 5.4). Elevated levels of myoglobin, uric acid, blood urea nitrogen/creatinine, and aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were significantly associated with crush syndrome and fasciotomy (p < 0.001).

Conclusion: The high burden of crush-related complications in pediatric earthquake victims underscores the need for pediatric-specific trauma protocols in disaster settings. Early identification of risk factors and rapid intervention may reduce severe outcomes such as fasciotomy, renal failure, and amputation.

Clinical variation (a.k.a. medical practice variation) describes how patient care and outcomes differ across patients, providers, hospitals, geographic regions or other dimensions. By understanding clinical variation in patient care or outcomes that cannot be explained by patient differences, researchers and health systems can (1) highlight overuse, underuse, inefficiencies or inequities impacting patient care, (2) identify the level (e.g., patient, provider, hospital) contributing the most variation and (3) interrogate the reasons that explain the observed variation. Numerous methods exist to understand clinical variation; however, these are not well identified or characterized in the existing body of health services research literature. We aim to provide non-technical methodological guidance to researchers interested in describing and quantifying clinical variation by characterizing and comparing methods suited to this task. We present several plots to display clinical variation, including point and jitter plots, scatterplots, caterpillar plots, box plots and funnel plots. While most plots simply visualize the variation, funnel plots can characterize whether the variation is larger than expected after adjusting for relevant clinical factors that might reasonably explain clinical variation, such as case-mix. We present several basic statistical approaches to measure clinical variation, including variance, standard deviation, coefficient of variation, systematic coefficient of variation and interquartile range. Further, we describe multilevel models that measure clinical variation beyond its magnitude, including the level(s) at which variation occurs and the level-specific factors that explain the variation. We describe several statistics that quantify the clinical variation that exists in a multilevel model, such as the intraclass correlation coefficient and median odds, risk, rate and hazard ratios. We discuss key considerations when describing and quantifying clinical variation, including the appropriate measurement of patient care and outcomes, the factors explaining variation and whether it is warranted and what interventions might help reduce the variation. The objective of this review is to provide an overview of techniques to consider when describing clinical variation, serving as a resource for those examining clinical variation.

Rationale: Guidelines are statements or recommendations that help interest-holders make decisions about clinical care or health policy. Engaging a wide range of interest-holders, such as patients, providers, policymakers and members of the public in the guideline development process can help ensure that guidelines are fit-for-purpose. The MuSE Consortium is developing guidance for the engagement of interest-holders throughout the guideline development process in the form of an extension of the Guidelines International Network (GIN)-McMaster Guideline Development Checklist (GDC).

Aims and objectives: The objective of this study is to identify principles and strategies to promote interest-holder engagement across the guideline development enterprise.

Methods: We conducted interviews with 43 individuals from 10 different interest-holder groups and 15 different countries. We used a framework analysis to thematically analyze findings and identify principles and strategies relevant for engaged guideline development.

Results: Guideline development initiatives may better engage interest-holders by shifting from vertical to horizontal power structures, emphasizing collaboration and shared decision-making. We identified a need for epistemic justice, promoting fairness and equality in knowledge production and validation, particularly for patients and members of the public. Representation is a crucial key issue, necessitating diverse perspectives in guideline development groups. Strategies include involving interest-holders early and meaningfully in the guideline development process through governance, setting clear expectations and timelines, and providing fair compensation. Dissemination activities should extend beyond academic publications, empowering all interest-holders to contribute to activities such as presentations, educational sessions, or social media campaigns. While engagement is desirable, limitations may arise in emergency contexts or resource-constrained settings.

Conclusions: Guideline developers may need to make pragmatic decisions as to who they engage in guideline development and how. Capacity strengthening in low- and middle-income countries may help address current disparities in engagement in guideline development. Future research should explore issues around representativeness of interest-holders.

Aim: This study aims to assess the relationship between altruism and the level of missed nursing care among nurses working in Intensive Care Units (ICU).

Design: The study was descriptive and correlational.

Methods: This study was conducted between 15 January and 15 June 2025 with 210 ICU nurses working in two public hospitals. Data were collected using the "Nurse Demographic Information Form", the "Altruism Scale" and the "Missed Nursing Care Survey (MISSCARE)". Data analysis included descriptive statistics, Independent Student's t test, One-Way ANOVA, and Pearson correlation analysis.

Results: The nurses' mean age was 29.30 ± 5.23 years, with 72.4% being female and 80.0% holding a bachelor's degree. It was found that 78.6% of the participants experienced delays in providing patient care due to material shortages and high workload, while 97.1% reported delivering care with an altruistic approach. A significant, moderate, and negative correlation was identified between the altruism scale and the amount of missed nursing care (MISSCARE A) (r = -0.389, p < 0.001).

Patient or public contribution: A higher level of altruism among ICU nurses appears to contribute to a lower incidence of missed nursing care. The correlation between missed nursing care and altruism underscores the importance of altruistic attitudes in patient care. However, the high significance of the reasons for missed nursing care highlights issues related to working conditions in ICU settings. To enable altruistic nurses to provide high-quality care without disruptions, healthcare policies should prioritize improving working conditions, adjusting staffing levels, and addressing medical supply shortages.