Journal of evaluation in clinical practice最新文献

Rationale: Practice context is known to influence the deployment of competencies. The COVID-19 pandemic created a major disruption in many practice contexts. The objective was to understand the lived experience of rehabilitation clinicians during a major disruption of their practice context, namely, the COVID-19 pandemic.

Methods: We used a longitudinal phenomenological design. Eligible clinicians were occupational therapists (OT), physical therapists (PT), physiotherapy technologists (Phys T.), speech-language pathologists (S-LP) and audiologists (AUD), working in the same rehabilitation workplace for at least 2 years before March 2020 (the pandemic). Clinicians who were reassigned to roles outside the field of rehabilitation were excluded. We conducted individual online interviews using a guide developed by the team with expertise and knowledge of the phenomenon. An interpretative phenomenological analysis was carried out. Results were discussed until the research team reached a consensus.

Results: A total of 32 clinicians participated in the study (12 OT, 5 PT, 5 Phys T., 7 S-LP, 3 AUD), working with a variety of clienteles and work settings, for an average of 11.7 ± 7.6 years in the same practice setting. A wide range of emotions (e.g. anger, sadness, guilt, fear, pride) reflected clinicians' experience during disruption. Professional expertise was perceived as being enhanced by disruption as clinicians stepped out of their comfort zone; this encouraged reflective practice and a recognition of the need to be more explicit about their decision-making process. Collaboration with colleagues was perceived as key for effective coping and deployment of adaptative expertise.

Conclusions: A disruption in the practice context may have positive effects on professional expertise through the mobilization of reflective practice.

Purpose: The stress of conscience occurs in stressful situations that are often encountered in healthcare, leading to an uncomfortable conscience in healthcare workers. They may not be able to control their emotions and feel burnout. Therefore, the aim of this study is to evaluate the effect of stress of conscience on burnout in healthcare workers.

Methods: This cross-sectional study was performed with 602 healthcare workers between November 2020 and January 2021 in Turkey. Data were collected using a sociodemographic form, Stress of Conscience Scale, and Maslach Burnout Inventory.

Results: A positive and high-level relationship was found between the stress of conscience and burnout (r = 0.603, p < 0.001). The stress of conscience accounted for 36% of burnout. Also, female healthcare workers have high stress of conscience and burnout scores.

Conclusion: This study is important in terms of realising the stress and burnout of healthcare workers and for health managers to recognise the stress types of their workers. The increase in the level of burnout of healthcare workers is associated with their stress of conscience. Using the results of this study, national and international consensus can be obtained to reduce the impact of the stress of conscience on healthcare workers.

Peter Drucker pointed out an important distinction between 'doing things right' and 'doing the right thing', which recognised that all problems are embedded in a context and thus can only be understood within their unique contextual setting. Contemporary research practices in clinical medicine often regards contextual factors as potential confounders that will bias effect estimates and thus must be avoided. However rigorous, research devoid of context ultimately deprives users of understanding of the support factors that make research transferable to policy decisions or managing care of individual patients-it stands in the way of 'doing the right thing' in 'real life' settings. Appreciating that all problems are embedded in a greater context means that one should not ignore their interconnected and interdependent systemic nature, that is, every variable is simultaneously dependent and independent. This is the reason for the cascading effects and feedback loops witnessed in disease progression and policy efforts. We discuss the need for researchers to a-priori consider the context of their research question as well as the structural relationships of the variables under investigation, which in turn provides the basis for choosing the most appropriate research design. We have a moral imperative to first 'do the right thing'-ask questions that address the contextual needs of our patients, and then to 'do it right'-choose the best research method to answer this contextually framed need. Only then will our research efforts have meaningful and lasting impacts on patient care.

Rationale: The change of IgG of COVID-19 vaccine was thought to be an effect of diet quality or daily habits.

Aims and objectives: This study aimed to correlate diet quality and healthy living factors with serum IgG response in the blood.

Methods: Participants were selected from volunteers who had their first vaccination and did not have COVID-19 disease (Male = 21 Female = 40). Serum IgG levels were measured on average (avg) 28 days after the COVID-19 vaccine. Information was obtained directly from the participants by questionnaire method (Food consumption record, frequency of food consumption, Diet Quality Index [(DQI], etc.).

Results: A significant difference was observed in the IgG levels of the second measurement of age (young/middle) and gender (male/female) (p < 0.05). A significant difference was found in the first measurement of serum IgG levels and IgG avgs of those with medium diet quality and those who did not drink alcohol (p < 0.05). When the IgG2/1 ratio was examined between alcohol users and nonalcohol, a significant increase was observed about two times in non-alcohol users (p = 0.039). There is a positive significant moderate strength relationship between the second measurements of IgG and anthropometric measurements and the first, second, and avg measurements of IgG with DQI. It was found that there was a negative significant medium-strength relationship between individuals' amount of alcohol consumption and IgG avg (r = -0.535, p = 0.009).

Conclusions: Medium diet quality has been seen to affect antibody levels positively. At the same time, it is thought that alcohol use negatively affects serum IgG antibody response in the long term. Other than that, there was shown to be a correlation between IgG levels and DQI.

Background: Anemia due to malnutrition may develop as a result of iron, folate and vitamin B12 deficiencies. This situation poses a higher risk of morbidity and mortality in the geriatric population than in other age groups. Therefore, early diagnosis of anemia and early initiation of treatment is very important. This study aims to predict the diagnosis of anemia with using machine learning (ML) methods in geriatric patients followed in an outpatient clinic.

Methods: In line with the purpose of the study, anemia classification was made by analysing patients' hemogram and biochemistry blood values and medical data such as malnutrition, physical and cognitive activity scores with ML methods.

Results: In our data set consisting of 438 patient observations, the most successful ML algorithm was the J48 algorithm with 97.77% accuracy. In the continuation of the study, the predictive performance of anemia was investigated by excluding blood values and selecting only attributes consisting of malnutrition and physical activity scores. In this case, the most successful prediction was obtained with the Random Forest algorithm with 85.39% accuracy.

Conclusions: The study showed that anemia can be predicted with high accuracy in geriatric patients without hemogram data. Additionally, our geriatric data set was shared with researchers for future research. Thus, it has contributed to the literature by opening a new path for studies on subjects such as comparing classification performances with new methodologies or predicting different diseases in geriatric patients.

Rationale: In clinical and research settings, the validity and reliability of measurement instruments are crucial for reliable results. Current methods for computing validation metrics like Aiken's coefficients are often complex and error-prone, highlighting the need for a standardized computational tool to simplify and enhance this process.

Aims and objectives: The objective of this study was to develop AikenCalc, a tool created to automate the calculation of Aiken coefficients. This tool provides a quantitative method for examining the validity and reliability of consensus among expert judges.

Method: AikenCalc was developed with Shiny app, an R library that allows an easy-to-use interface and improved computational efficiency. It was validated using a convergence method by comparing the manual calculations with those obtained using AikenCalc. Additionally, to examine usability and interface, six experts evaluated their experience using AikenCalc and provided improvement feedback.

Results: AikenCalc demonstrated good convergent validity, closely aligning with the results obtained manually, and the six experts gave favorable ratings regarding the usability and interface of AikenCalc. Finally, it was shown that AikenCalc significantly reduced the time required for calculations, thanks to its user-friendly interface.

Conclusion: AikenCalc represents a significant improvement in the validation of measurement instruments by automating and simplifying the calculation of Aiken's coefficients through a Shiny web application. Additionally, it fills a knowledge gap, as there is currently no similar calculator available in the field of research.

Rationale, aims, and objectives: Medical device-integrated electronic medical records (MDI-EMR) pose significant challenges in ensuring effective usage, data security and patient safety. The complexities of MDI-EMR necessitate applying various security mechanisms to safeguard against cyber threats. Therefore, we evaluated cyber threats to MDI-EMR and the effectiveness of applied security controls using a proposed framework from sociotechnical and risk assessment perspectives.

Method: We conducted a qualitative case study evaluation in a general hospital in Saudi Arabia using interviews, observation, and document analysis from the perspectives of major MDI-EMR stakeholders, including healthcare providers, IT professionals and cybersecurity specialists.

Results: The results showed the interplay among physical, technical and administrative security controls that maintained a secure posture of MDI-EMR. The effectiveness of security controls is highly influenced by the staff's cybersecurity awareness and training. The perceived effectiveness of security controls varied among users, with some expressing satisfaction with the ease of use and reliability, while others highlighting challenges such as password complexity and access procedures. Understanding these diverse perspectives is crucial for tailoring security measures to meet the needs of different stakeholders effectively.

Conclusion: Collaboration among the key stakeholders is crucial for implementing security controls for MDI-EMR. Balancing security measures with usability concerns is essential, as highlighted by challenges in implementing technical controls. A comprehensive approach encompassing physical, technical and administrative controls, continuous education and awareness initiatives are significant to empower staff in recognising and mitigating cyber threats effectively to safeguard medical data and ensure the integrity of healthcare systems.