Journal of evaluation in clinical practice最新文献

Background: The process of truth-telling in nursing, particularly in the fields of oncology and intensive care, is a critical yet complex process that encompasses ethical principles, effective communication and emotional support. It involves significant challenges during the transmission of difficult information to both patients and their families.

Objective: This study aimed to examine the care behaviours of nurses working in oncology and intensive care units during truth-telling and to identify the challenges they experience in this process.

Methods: This study was conducted using the phenomenological design. Sixteen nurses from different hospitals in Türkiye were selected through purposive sampling. Maximum variation sampling was utilized to ensure the widest possible diversity among participants. In-depth interviews were used for data collection, and the data were analysed using the traditional descriptive phenomenological approach. The study adhered to the COREQ checklist for qualitative research reporting.

Results: The study was conducted with 16 nurses from various age groups working in oncology and intensive care clinics of different hospitals in Türkiye. Study data were analysed, and three themes were elicited: the first thing that comes to the Light of Truth, the Language of Care and the Thorn of the Rose.

Conclusion: It was determined that nurses used care behaviours, such as understanding the individual during truth-telling, empathic listening to give spiritual support, showing respect, establishing open communication, answering questions, relieving concerns, showing a friendly approach and therapeutic touch. Coping with the emotional responses of patients-relatives/the family and their own emotions during truth-telling was the most challenging situation for nurses.

Rationale: Breastfeeding is recognized as a cornerstone of maternal and child health, yet health professionals frequently report insufficient knowledge to provide effective support. Strengthening the evaluation of educational outcomes in health professions training is therefore essential to improve clinical practice and patient care. This study aimed to develop and validate the Breastfeeding Knowledge Scale (BKS), a tool to assess breastfeeding-related knowledge among health professions students in Brazil.

Methods: This study followed COSMIN guidelines. Concept elicitation was conducted through workshops with experts and students to identify relevant domains of breastfeeding knowledge. A pilot study, including cognitive interviews with students, evaluated the comprehensibility and comprehensiveness of items. Content validity was assessed with both students and a multidisciplinary panel of professionals using the content validity index (CVI) and content validity coefficient (CVC), complemented by qualitative feedback. Psychometric testing included exploratory factor analysis (EFA) to evaluate structural validity and guide item reduction, followed by assessment of internal consistency with Cronbach's ⍺, calculated only after confirming the unidimensionality of each subscale.

Results: The concept elicitation process yielded five thematic clusters that were reorganized into three broader domains: Biological aspects of lactation, Policy and Sociocultural Context and Clinical Management (including complementary feeding). After iterative refinement and EFA, the instrument was reduced to 40 items. The final version was administered to 143 students. Internal consistency was excellent for the overall scale (Cronbach's ⍺ = 0.910) and strong for each domain (biological = 0.810; policy and sociocultural context = 0.790; clinical management = 0.796). These results supported both structural validity and reliability of the BKS.

Conclusions: The BKS is a valid and reliable instrument for evaluating breastfeeding-related competencies in health professions students. By providing a comprehensive and psychometrically sound measure, it enables rigorous evaluation of training adequacy, supports curriculum improvement and ultimately contributes to strengthening clinical practice and breastfeeding outcomes.

Objectives: Hyperbaric Oxygen Therapy (HBOT), which provides treatment of chronic wounds and damaged tissues by inhaling pure oxygen under high pressure, serves both in centres and as portable oxygen chambers. During HBOT treatment, it is possible for the patient to experience an accident caused by oxygen and pressure. In this context, especially the use of portable oxygen chambers is quite risky and requires a high level of technical knowledge. Today, YouTube is a platform that contains a lot of useful or useless information and is used by millions of people at the same time. The information contained in these contents uploaded on YouTube without any control or filtering can reach anyone with internet access. In this context, the aim of this study is to evaluate the characteristics, quality and reliability of the content uploaded on YouTube for portable oxygen chambers.

Methods: The study was cross-sectional and searches were performed on the YouTube platform with five keywords. The analysed videos were evaluated by two experienced researchers in terms of the accuracy of the information contained, the parameters of the video, upload date, duration, number of views, likes and comments. Video quality was assessed using the Global Quality Scale (GQS), reliability was assessed using the modified DISCERN (Mdıscern), information accuracy, information flow, quality and precision of the videos were assessed using the Video Information and Quality Index (VIQI) Scale, and transparency was assessed using the Journal of American Medical Association Benchmark criteria (JAMA).

Results: In this study, 45 portable Hyperbaric Oxygen Therapy (HBOT) videos on the YouTube platform were evaluated for quality and reliability. Only 31% of the videos were classified as high quality, while the majority of the remaining videos were of medium (40%) and low (29%) quality. The mean scores of M-Discern and VIQI were 3.1 and 3.3, respectively, and 58% of the content had low reliability according to JAMA criteria. The quality and credibility levels of physician- and academic-generated videos were statistically significantly higher (p < 0.05) compared to content produced by independent users and marketers. A weak but significant relationship was found between GQS and number of views (r = 0.29, p = 0.04).

Conclusion: This study revealed that portable HBOT content on YouTube is largely inadequate in terms of information quality and reliability. It is of great importance that content on digital platforms on health-related topics is prepared by professionals and supported by scientific references.

Aim: To investigate the relation between moral foundations and patient-centered care in health professionals who work in the delivery room and in the rooming-in.

Design: Single-center quantitative survey study.

Methods: This survey was conducted in a Brazilian maternity ward. The Moral Foundations Questionnaire (MFQ-20) and the Care in Dialogue Competence Scale (CDCS) were administered to health professionals working in the delivery room and rooming-in areas. Analysis included descriptive statistics and Spearman correlations. Data were analyzed using Stata version 19.0.

Results: A total of 80 health professionals were included, and the median age was 34 years (IQR: 28.5-44). Cronbach's alpha of the MFQ-20 was 0.8480, and CDCS was 0.8499. In the MFQ-20, fairness and care were the domains with the highest median, and in the CDCS, communication and dialogue with the patient. MFQ-20 and CDCS were correlated (0.54; p < 0.001). Purity presented the highest domain-specific correlation with CDCS (0.48; p < 0.0001).

Conclusion: In this maternity ward, health professionals' moral foundations are correlated with patient-centered care. Although fairness and care were the MFQ-20 domains with the highest medians, purity was the domain most strongly correlated to CDCS.

Impact: Clinical practice requires health professionals to use moral dimensions that are part of their individual essence, and this can correlate with patient-centered care, a dimension of quality care.

Patient or public contribution: These results contribute to a better understanding of the relations between moral foundations and patient-centered care in neonatology. By highlighting moral motivations strongly associated with patient-centered care, we can strengthen it.

Background: All evidence-based medical decisions rely on the assumption that the evidence being used is applicable to current populations. To date, the age of evidence is not typically measured nor reported in systematic reviews.

Methods: We sought to develop a method to quantify the age of evidence for medical interventions, using statins and sodium-glucose co-transporter protein 2 (SGLT-2) inhibitors as exemplars, which may facilitate evaluating its potential outdatedness. We conducted a retrospective cross-sectional study of all Cochrane reviews evaluating the effects of these drugs on cardiovascular disease (CVD) management up to August 2024, summarising the evidence and calculating the lag in time between patient enrolment in trials and current decision-making (August 2024).

Results: We identified 57 Cochrane reviews on statins, with 9 (15.8%) meeting our criteria, and 6 reviews on SGLT-2 inhibitors, with 2 (33.3%) being eligible. The 9 statin reviews include 153 different trials, enrolling participants from 1988 to 2017, spanning 28 years. The 2 SGLT-2 inhibitor reviews involve 67 trials from 2008 to 2021, spanning 13 years. The median age of evidence for statins is 24.1 years, compared to 8.6 years for SGLT-2 inhibitors. Among the statin review topics, evidence was most robust for statins in the context of primary prevention of CVD.

Conclusions: Our findings highlight the potential outdatedness of long-established treatments like statins and suggest that reporting the age of evidence in systematic reviews may facilitate outdatedness assessments. We propose that future Cochrane reviews report the age of evidence, as this could significantly enhance the decision-making process in evidence-based medicine.

Rationale, aims, and objectives: Shared decision making (SDM) is widely endorsed in clinical guidelines, yet clinicians may not use it consistently across different clinical problems. This study explores how SDM is influenced by the clinical topic under discussion.

Methods: Using unannounced standardized patients (USPs), we observed how resident physicians engaged in SDM during new patient visits involving both gastroesophageal reflux disease (GERD) and smoking cessation. Audio recordings were evaluated using the validated Observer OPTION-5 tool.

Results: SDM scores were significantly higher in smoking cessation discussions than in GERD management. Residents more frequently integrated patient preferences when discussing smoking but gave more information when managing GERD.

Conclusions: Residents appeared to adjust their SDM behaviors based on topic, suggesting context-dependent application. Educational interventions should address this variability and promote balanced use of SDM across routine and behaviorally complex decisions.

Rationale: Empathy in healthcare benefits patients and practitioners, yet system-level barriers inhibit empathy. The barriers include burnout-inducing administrative workloads, burdensome protocols, lack of wellbeing spaces, un-empathic leadership, and not emphasising empathy as an institutional value. A workshop aimed at enhancing empathic systems was successfully delivered in Canada but has not been tested in the UK National Health Service (NHS) setting.

Aims and objectives: This study aimed to test the feasibility of an empathic systems workshop within the UK.

Method: We conducted an interprofessional workshop with stakeholders from an emergency department (ED). We used a modified nominal group technique to prioritise actions that enhance empathy in the ED. Satisfaction with the workshop and confidence that the workshop would lead to positive change were measured on a 10-point Likert scale.

Results: Twenty-eight participants representing the following stakeholder groups attended the workshop: medical consultants, nurses, and porters. The group agreed to generate an improved wellbeing plan and to implement an effective secondary triage system. Seventy-three percent (73%) rated their satisfaction with the workshop as eight or higher out of ten, and 63% reported being confident that the workshop would lead to improvements in system empathy. A doctor strike limited the range of stakeholders who were able to attend, and long-term follow up was not conducted.

Conclusion: Participants in a UK setting were satisfied with a previously developed system empathy workshop, were able to prioritise changes that would improve system empathy, and were confident that the changes would be effective.

Rationale, aims and objectives: Pharmacogenetics is considered a promising method to improve pharmacotherapy, yet its implementation in clinical practice is hampered, limiting its potential benefits to the public. Previously, its uptake has been investigated within a variety of healthcare professional groups. Commonly cited barriers by prescribing physicians are lack of knowledge and insurance coverage. An important occupational group who may support physicians due to their expert knowledge are pharmacists. However, they have been understudied in research on pharmacogenetics implementation thus far. Therefore, we investigated the experience and attitudes of pharmacists regarding pharmacogenetics using an online questionnaire.

Method: Using Qualtrics software, an online survey was distributed nationally from April 1st to December 1st 2024. Respondents were recruited during a national conference organized by the Dutch pharmacy residents, through email-invites, and via newsletters of national pharmacist-associations.

Results: In total, data of n = 281 respondents were analyzed in the study, the majority of which were working professionals (±15.8 years of experience). Although only 44.4% had ever requested a pharmacogenetic test, 88.6% of respondents had experience with test result interpretation. Cost, lack of reimbursement through insurance, and lack of availability of pharmacogenetic guidelines including clinical evidence, were found as key barriers. Importantly, respondents generally felt confident regarding their own pharmacogenetics-related knowledge and skills, while maintaining caution in situations where pharmacogenetic evidence is limited.

Conclusion: Successful adoption of pharmacogenetics in practice may benefit from interprofessional collaboration, expanding the pharmacogenetics evidence base, and prioritizing pharmacogenetics in updated health policy.

Background: Artificial intelligence (AI) is increasingly embedded in healthcare businesses, promoted for its ability to enhance efficiency, reduce costs and optimize workflows. However, the intersection of profit-driven priorities with patient-centred values presents significant ethical and professional challenges for nurses, who serve as the frontline mediators between technology and patients.

Aim: This study aimed to explore nurses lived experiences of AI integration in healthcare businesses, focusing on how they navigate tensions between institutional efficiency and their professional commitment to patient-centred care.

Methods: An interpretive phenomenological design was employed to capture the depth of nurses' perspectives. Data were collected between May and June 2025 through 26 semi-structured interviews and 1 focus group with 7 nurses, yielding a total of 33 participants from AI-integrated private hospitals. Transcripts were analyzed thematically, with trustworthiness ensured through member validation, audit trails and reflexive journaling.

Results: Four overarching themes emerged. Nurses reported emotional and ethical conflicts when AI recommendations contradicted clinical judgement, often leading to moral distress. Business imperatives were perceived to prioritize efficiency over individualized care, with nurses excluded from decision-making about AI adoption. Many participants expressed anxiety over role displacement and a diminishing sense of autonomy, although some redefined their professional identity as technology navigators. Inadequate training and lack of institutional support further amplified challenges, leaving nurses underprepared to manage AI tools effectively.

Conclusion: While AI offers organizational advantages, its integration without inclusive planning and adequate training risks undermining holistic nursing practice. Strengthening institutional support, valuing nurses' input and balancing efficiency with empathy are essential to align technological innovation with compassionate, patient-centred care.