Arwa Khaled, Ahmad M. Alhajoj, Khalid Orayj, Bandar Alqahtani, Wafa Alshahrani, Jaiydaa Asiri
Introduction
Mental health disorders are widely recognised as significant challenges for university students globally. Participation in extracurricular activities has been associated with reduced psychological stress and improved overall well-being among university students.
Objectives
This study aims to investigate whether participation in extracurricular activities has a measurable impact on depression, anxiety, and stress among pharmacy students at King Khalid University.
Methods
A cross-sectional study was conducted among 220 pharmacy students. Data encompassed demographics, DASS-21 scores, prior mental health diagnoses, and detailed participation in extracurricular activities (type, frequency, hours per week). Analytical methods included t-tests, ANOVA, regression modelling.
Results
Clinically significant symptoms were common: 38% depression, 52% anxiety, 35% stress. While 79% reported extracurricular involvement (primarily volunteering, social, cultural, and sports activities), no statistically significant difference in DASS-21 scores between participants and non-participants (p > 0.05 for all subscales). Even the type and frequency of activities failed to confer a meaningful protective effect. Female gender and prior mental health diagnoses emerged as the strongest, independent predictors of higher psychological distress.
Conclusions
Involvement in the extracurricular activities, as currently structured, does not significantly impact depression, anxiety, or stress scores among pharmacy students at King Khalid University. Despite widespread participation, high psychological distress persists, especially among female students and those with prior diagnoses. These findings suggest the need for targeted, quality-focused mental health interventions beyond simply encouraging extracurricular activity.
{"title":"Extracurricular Activities and Mental Health: Insights From Pharmacy Students in Saudi Arabia","authors":"Arwa Khaled, Ahmad M. Alhajoj, Khalid Orayj, Bandar Alqahtani, Wafa Alshahrani, Jaiydaa Asiri","doi":"10.1111/jep.70348","DOIUrl":"10.1111/jep.70348","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Mental health disorders are widely recognised as significant challenges for university students globally. Participation in extracurricular activities has been associated with reduced psychological stress and improved overall well-being among university students.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aims to investigate whether participation in extracurricular activities has a measurable impact on depression, anxiety, and stress among pharmacy students at King Khalid University.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional study was conducted among 220 pharmacy students. Data encompassed demographics, DASS-21 scores, prior mental health diagnoses, and detailed participation in extracurricular activities (type, frequency, hours per week). Analytical methods included <i>t</i>-tests, ANOVA, regression modelling.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Clinically significant symptoms were common: 38% depression, 52% anxiety, 35% stress. While 79% reported extracurricular involvement (primarily volunteering, social, cultural, and sports activities), no statistically significant difference in DASS-21 scores between participants and non-participants (<i>p</i> > 0.05 for all subscales). Even the type and frequency of activities failed to confer a meaningful protective effect. Female gender and prior mental health diagnoses emerged as the strongest, independent predictors of higher psychological distress.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Involvement in the extracurricular activities, as currently structured, does not significantly impact depression, anxiety, or stress scores among pharmacy students at King Khalid University. Despite widespread participation, high psychological distress persists, especially among female students and those with prior diagnoses. These findings suggest the need for targeted, quality-focused mental health interventions beyond simply encouraging extracurricular activity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933690","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}
{"title":"Is Consent Truly ‘Informed’? Addressing the Challenges and Pitfalls in Counselling Patients for Medical Interventions","authors":"Isaac K. S. Ng","doi":"10.1111/jep.70354","DOIUrl":"10.1111/jep.70354","url":null,"abstract":"","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933716","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}
This meta-research study mapped systematic reviews on photobiomodulation (PBM), encompassing low-level laser therapy (LLLT) and light-emitting diode (LED) modalities, to evaluate whether protocols were registered, whether published reviews adhered to and updated their PROSPERO records, and whether topic redundancy occurred across reviews.
Methods
Comprehensive searches were conducted in MEDLINE (via PubMed) and Epistemonikos on June 2, 2025. Data were extracted on protocol registration, registry type, update status on PROSPERO, deviations between registered protocols and published reviews, topic redundancy, and the use of certainty of evidence assessment tools.
Results
A total of 285 systematic reviews (with and without meta-analysis) published between 1999 and 2025 were included, of which approximately 40% addressed dentistry and orofacial dysfunctions. Among these, 129 reviews (45%) had a registered protocol, with 125 (96.9%) on the PROSPERO platform and four (3.1%) on other registries, including INPLASY and the Open Science Framework. Despite publication, 72% (90/125) of PROSPERO records remained classified as “ongoing,” reflecting limited updates to the registry status. Deviations between registered and published protocols occurred in 22.4% (29/129) of reviews, mainly involving unplanned outcomes, modifications in search strategies, or changes in analytical methods. Redundancy was frequent, with multiple reviews addressing identical or highly similar clinical questions, such as 20 reviews on orthodontic treatment and 18 on temporomandibular dysfunction. Assessment of the certainty of the evidence was also limited, with only 18.5% (53/285) of reviews applying the GRADE approach, which was reported exclusively in reviews with meta-analysis.
Conclusion
These findings highlight low adherence to protocol registration recommendations, limited status updating, and high levels of duplication, combined with infrequent assessment of evidence certainty. Strengthening prospective registration and transparent reporting is essential to ensure that systematic reviews on PBM provide trustworthy, reproducible evidence to guide clinical decision-making and inform healthcare policy. The study protocol is available at https://osf.io/9vknf/.
{"title":"Adherence to Protocol Registration Among Systematic Reviews on Photobiomodulation: A Meta-Research Study","authors":"Giovanna Marcilio Santos, Giullia Carvalho Mangas Lopes, Kamilla Mayr Martins Sá, Giulia Almirón da Rocha Soares, Marcela Letícia Leal Gonçalves, Sandra Kalil Bussadori, Elaine Marcílio Santos, Ana Luiza Cabrera Martimbianco","doi":"10.1111/jep.70346","DOIUrl":"10.1111/jep.70346","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>This meta-research study mapped systematic reviews on photobiomodulation (PBM), encompassing low-level laser therapy (LLLT) and light-emitting diode (LED) modalities, to evaluate whether protocols were registered, whether published reviews adhered to and updated their PROSPERO records, and whether topic redundancy occurred across reviews.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Comprehensive searches were conducted in MEDLINE (via PubMed) and Epistemonikos on June 2, 2025. Data were extracted on protocol registration, registry type, update status on PROSPERO, deviations between registered protocols and published reviews, topic redundancy, and the use of certainty of evidence assessment tools.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 285 systematic reviews (with and without meta-analysis) published between 1999 and 2025 were included, of which approximately 40% addressed dentistry and orofacial dysfunctions. Among these, 129 reviews (45%) had a registered protocol, with 125 (96.9%) on the PROSPERO platform and four (3.1%) on other registries, including INPLASY and the Open Science Framework. Despite publication, 72% (90/125) of PROSPERO records remained classified as “ongoing,” reflecting limited updates to the registry status. Deviations between registered and published protocols occurred in 22.4% (29/129) of reviews, mainly involving unplanned outcomes, modifications in search strategies, or changes in analytical methods. Redundancy was frequent, with multiple reviews addressing identical or highly similar clinical questions, such as 20 reviews on orthodontic treatment and 18 on temporomandibular dysfunction. Assessment of the certainty of the evidence was also limited, with only 18.5% (53/285) of reviews applying the GRADE approach, which was reported exclusively in reviews with meta-analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These findings highlight low adherence to protocol registration recommendations, limited status updating, and high levels of duplication, combined with infrequent assessment of evidence certainty. Strengthening prospective registration and transparent reporting is essential to ensure that systematic reviews on PBM provide trustworthy, reproducible evidence to guide clinical decision-making and inform healthcare policy. The study protocol is available at https://osf.io/9vknf/.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70346","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Juan Manuel Martínez-Ripoll, Marta García-Domingo, Yolanda M. De la Fuente Robles
Background and Aims
Epidermolysis bullosa is a rare genetic disorder causing extreme mucocutaneous fragility, requiring specialized, multidisciplinary care. Integrating palliative care into Epidermolysis bullosa management has proven beneficial in symptom control and psychosocial support. The aim of this study was to analyze the interdisciplinary intervention of the Dermatology Service and the Palliative Care and Complex Chronic Patient Team at Sant Joan de Déu Hospital in pediatric patients with Recessive Dystrophic Epidermolysis Bullosa.
Methods
A descriptive qualitative design was used to explore the experiences of parents of children with Recessive Dystrophic Epidermolysis Bullosa and healthcare professionals at Sant Joan de Déu Hospital. Internal protocols were analyzed and open online surveys were conducted. Families were recruited through purposive sampling with DEBRA España's support, while healthcare professionals were invited from the Dermatology Service and the Palliative Care and Complex Chronic Patient Team.
Results
The joint interdisciplinary intervention between the Dermatology Service and the Palliative Care and Complex Chronic Patient Team at SJDH, grounded in a palliative care approach, provides holistic and continuous support to patients and their families from birth throughout the entire life course. It incorporates spiritual care and community coordination, fosters autonomy and social inclusion, and aligns with international best practices established by specialized centers such as EB House Austria. This model stands as a replicable benchmark for the care of individuals with EB.
Conclusions
This qualitative study suggests that an interdisciplinary care model, grounded in palliative care and implemented from an early stage in a sustained manner, improves the quality of life of pediatric patients with RDEB and their families. The coordination between clinical and psychosocial teams, together with person-centered care, enhances family autonomy, promotes inclusion and addresses the comprehensive needs across the life course.
{"title":"Interdisciplinary Approach in Pediatric Patients With Recessive Dystrophic Epidermolysis Bullosa: Experience From the Dermatology Service and the Palliative Care and Complex Chronic Patient Team at Sant Joan de Déu Hospital (Barcelona, Spain)","authors":"Juan Manuel Martínez-Ripoll, Marta García-Domingo, Yolanda M. De la Fuente Robles","doi":"10.1111/jep.70345","DOIUrl":"10.1111/jep.70345","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Epidermolysis bullosa is a rare genetic disorder causing extreme mucocutaneous fragility, requiring specialized, multidisciplinary care. Integrating palliative care into Epidermolysis bullosa management has proven beneficial in symptom control and psychosocial support. The aim of this study was to analyze the interdisciplinary intervention of the Dermatology Service and the Palliative Care and Complex Chronic Patient Team at Sant Joan de Déu Hospital in pediatric patients with Recessive Dystrophic Epidermolysis Bullosa.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A descriptive qualitative design was used to explore the experiences of parents of children with Recessive Dystrophic Epidermolysis Bullosa and healthcare professionals at Sant Joan de Déu Hospital. Internal protocols were analyzed and open online surveys were conducted. Families were recruited through purposive sampling with DEBRA España's support, while healthcare professionals were invited from the Dermatology Service and the Palliative Care and Complex Chronic Patient Team.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The joint interdisciplinary intervention between the Dermatology Service and the Palliative Care and Complex Chronic Patient Team at SJDH, grounded in a palliative care approach, provides holistic and continuous support to patients and their families from birth throughout the entire life course. It incorporates spiritual care and community coordination, fosters autonomy and social inclusion, and aligns with international best practices established by specialized centers such as EB House Austria. This model stands as a replicable benchmark for the care of individuals with EB.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This qualitative study suggests that an interdisciplinary care model, grounded in palliative care and implemented from an early stage in a sustained manner, improves the quality of life of pediatric patients with RDEB and their families. The coordination between clinical and psychosocial teams, together with person-centered care, enhances family autonomy, promotes inclusion and addresses the comprehensive needs across the life course.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70345","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Naoki Kakudate, Yoko Yokoyama, Elaine Pereira da Silva Tagliaferro, Futoshi Sumida, Yuki Matsumoto, Valeria V. Gordan, Gregg H. Gilbert
Aims and Objectives
The study aimed to explore how dentists in different countries prioritize strategies to address the evidence–practice gap (EPG). The objectives were to (1) evaluate and compare the priority of strategies to improve the evidence-practice gap (EPG) among Japanese and Brazilian dentists, and (2) analyze the association between the self-reported EPG and improvement strategies.
Methods
A cross-sectional study with two rounds of web-based questionnaires was administered to 136 dentists in Japan and 110 in Brazil. The self-reported EPG was assessed using three items related to minimal intervention dentistry (MID) via a mixed-methods approach with qualitative and quantitative assessments. Participants quantitatively prioritized EPG improvement strategies based on items derived from a qualitative content analysis. Logistic regression examined the association between the self-reported EPG and these stated improvement strategies.
Results
Seven EPG improvement strategies were identified from the qualitative content analysis. The highest priority selected by dentists in Japan was ‘Review the insurance system and reimbursement to enable the practice of evidence-based dentistry’ (65%). In Brazil, the highest priority was ‘Encourage dental research that is useful to clinical practice and disseminate its findings’ (74%). The second-highest priority in both countries was ‘Enhance continuing education programs to enable dentists to practice evidence-based dentistry’ (49% in Japan and 65% in Brazil). Logistic regression showed that in Japan, ‘Review the insurance system and reimbursement to enable the practice of evidence-based dentistry’ and in Brazil, ‘Develop and disseminate easy-to-understand clinical practice guidelines’ were significantly associated with the self-reported EPG among these same respondents (p < 0.05).
Conclusions
This mixed-methods study identified seven strategies to improve the EPG in Japan and Brazil. Improving the insurance system and reimbursement in Japan, and developing and disseminating clear clinical practice guidelines in Brazil, may effectively bridge the EPG. Enhancing continuing education was the second-highest priority in both countries.
{"title":"Comparison of Self-Reported Evidence-Practice Gap Improvement Strategies Among Japanese and Brazilian Dentists","authors":"Naoki Kakudate, Yoko Yokoyama, Elaine Pereira da Silva Tagliaferro, Futoshi Sumida, Yuki Matsumoto, Valeria V. Gordan, Gregg H. Gilbert","doi":"10.1111/jep.70355","DOIUrl":"10.1111/jep.70355","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>The study aimed to explore how dentists in different countries prioritize strategies to address the evidence–practice gap (EPG). The objectives were to (1) evaluate and compare the priority of strategies to improve the evidence-practice gap (EPG) among Japanese and Brazilian dentists, and (2) analyze the association between the self-reported EPG and improvement strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional study with two rounds of web-based questionnaires was administered to 136 dentists in Japan and 110 in Brazil. The self-reported EPG was assessed using three items related to minimal intervention dentistry (MID) via a mixed-methods approach with qualitative and quantitative assessments. Participants quantitatively prioritized EPG improvement strategies based on items derived from a qualitative content analysis. Logistic regression examined the association between the self-reported EPG and these stated improvement strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seven EPG improvement strategies were identified from the qualitative content analysis. The highest priority selected by dentists in Japan was ‘Review the insurance system and reimbursement to enable the practice of evidence-based dentistry’ (65%). In Brazil, the highest priority was ‘Encourage dental research that is useful to clinical practice and disseminate its findings’ (74%). The second-highest priority in both countries was ‘Enhance continuing education programs to enable dentists to practice evidence-based dentistry’ (49% in Japan and 65% in Brazil). Logistic regression showed that in Japan, ‘Review the insurance system and reimbursement to enable the practice of evidence-based dentistry’ and in Brazil, ‘Develop and disseminate easy-to-understand clinical practice guidelines’ were significantly associated with the self-reported EPG among these same respondents (<i>p</i> < 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This mixed-methods study identified seven strategies to improve the EPG in Japan and Brazil. Improving the insurance system and reimbursement in Japan, and developing and disseminating clear clinical practice guidelines in Brazil, may effectively bridge the EPG. Enhancing continuing education was the second-highest priority in both countries.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933723","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}
Even given identical information, patients and healthcare professionals may appropriately make conflicting decisions.
Aims and Objectives
Introduce the concept of mutual two-person, as opposed to individual, decision making.
Method
Present operational definition of shared decision making based on two-person decision theory demonstrate how to identify a shared decision, distinguish between a shared decision and some other commonly used approaches, and report the results of computer simulations that demonstrate the patterns of mutual satisfaction of various decision approached given common information.
Results
Shared decision making yields more mutually stable and satisfactory treatment decisions than do other approaches and have the additional advantage of achieving fewer morally questionable outcomes.
Conclusion
In addition to shared information, shared decisions are superior to those made independently by patients or healthcare professionals.
{"title":"Shared Decision Making or Sharing Information?","authors":"David W. Chambers","doi":"10.1111/jep.70352","DOIUrl":"10.1111/jep.70352","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Even given identical information, patients and healthcare professionals may appropriately make conflicting decisions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>Introduce the concept of mutual two-person, as opposed to individual, decision making.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Present operational definition of shared decision making based on two-person decision theory demonstrate how to identify a shared decision, distinguish between a shared decision and some other commonly used approaches, and report the results of computer simulations that demonstrate the patterns of mutual satisfaction of various decision approached given common information.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Shared decision making yields more mutually stable and satisfactory treatment decisions than do other approaches and have the additional advantage of achieving fewer morally questionable outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In addition to shared information, shared decisions are superior to those made independently by patients or healthcare professionals.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933718","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}
{"title":"Comment on “The Correlation between the Level of Commitment to Ethical Values and Moral Sensitivity of Associate Degree Students”","authors":"Amnuay Kleebayoon, Viroj Wiwanitkit","doi":"10.1111/jep.70327","DOIUrl":"10.1111/jep.70327","url":null,"abstract":"","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933688","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}
‘Desirable difficulties’, a concept that originated in the cognitive psychology literature, are practices that tend to impede initial learning but that promote long-term retention and transfer of knowledge and skills. Educators in the health professions have been enjoined to employ and integrate desirable difficulties in their classroom and clinical teaching practice, with assurances that they ‘work’. But how do they work? Insights into the mechanisms of desirably difficult practices may enrich the practice of educators and provide impetus for further research into how and when such practices might be effectively deployed in health professions education.
Aim
In this paper, I review the evidence from the cognitive psychology and educational literatures not only for evidence of the effectiveness and boundary conditions of the desirable difficulties, but for their proposed mechanisms. I also review reports on how these practices have been deployed and investigated within health professions education.
Results
Desirable difficulties for which there is ample robust evidence across fields and disciplines are formative testing, or assessment-for-learning as opposed to assessment-of-learning, interleaved or mixed practice, or problem-solving, distributed or spaced practice, and various productive failure approaches. These practices are hypothesised to have various cognitive, meta-cognitive, motivational and affective mechanisms at the level of the individual. Within the health professions education literature, there is some evidence of lack of clarity as to how these practices are defined and as to their theoretical underpinnings.
Conclusions
While there is ample evidence supporting the efficacy of desirable difficulties, it is crucial to approach their implementation with caution. Greater perceived difficulty or disfluency should not be conflated uncritically with greater educational benefit. Lack of clarity as to what is, and what is not, a desirably difficult practice has been evident in published health professions education literature. Educators and researchers alike should have a clear understanding of the definitions and theoretical bases of desirable difficulties to advance practice and theory.
{"title":"Why Desirable Difficulties ‘Work’: A Review of the Evidence From Cognitive and Educational Psychology and Some Caveats for the Health Professions Education Field","authors":"Sally Binks","doi":"10.1111/jep.70349","DOIUrl":"10.1111/jep.70349","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>‘Desirable difficulties’, a concept that originated in the cognitive psychology literature, are practices that tend to impede initial learning but that promote long-term retention and transfer of knowledge and skills. Educators in the health professions have been enjoined to employ and integrate <i>desirable difficulties</i> in their classroom and clinical teaching practice, with assurances that they ‘work’. But how do they work? Insights into the mechanisms of desirably difficult practices may enrich the practice of educators and provide impetus for further research into how and when such practices might be effectively deployed in health professions education.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>In this paper, I review the evidence from the cognitive psychology and educational literatures not only for evidence of the effectiveness and boundary conditions of the desirable difficulties, but for their proposed mechanisms. I also review reports on how these practices have been deployed and investigated within health professions education.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Desirable difficulties for which there is ample robust evidence across fields and disciplines are formative testing, or assessment-for-learning as opposed to assessment-of-learning, interleaved or mixed practice, or problem-solving, distributed or spaced practice, and various productive failure approaches. These practices are hypothesised to have various cognitive, meta-cognitive, motivational and affective mechanisms at the level of the individual. Within the health professions education literature, there is some evidence of lack of clarity as to how these practices are defined and as to their theoretical underpinnings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While there is ample evidence supporting the efficacy of desirable difficulties, it is crucial to approach their implementation with caution. Greater perceived difficulty or disfluency should not be conflated uncritically with greater educational benefit. Lack of clarity as to what is, and what is not, a desirably difficult practice has been evident in published health professions education literature. Educators and researchers alike should have a clear understanding of the definitions and theoretical bases of desirable difficulties to advance practice and theory.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933745","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}
Sebastian Sabadis, Roswell F. Childs, Jodi L. Young, Chad E. Cook
Rationale
Patient expectations are a key component of the shared decision-making process and have been found to be associated with treatment outcomes. However, there are concerns about the published research on patient expectations, including heterogeneity of the studies, variability, ceiling effect, and lack of validity of the measuring tools.
Aims and Objectives
This prospective, longitudinal cohort study investigated whether initial patient expectations for physical therapy, measured by the Expectation for Treatment Scale (ETS), could predict PROMIS physical function (PF) and pain interference (PI) scores at six and 12 weeks in patients with musculoskeletal conditions. A secondary aim was to determine the explanatory power of patient expectations on these outcomes.
Methods
This study followed a prospective cohort design. Participants aged 18–89 years with any musculoskeletal condition, receiving outpatient physical therapy within the Bellin Health System were recruited from January 2024 to July 2024. Data collected included demographics, health information, ETS scores at baseline, and PROMIS PF and PI scores at baseline, six and 12 weeks. Statistical analysis included descriptive statistics, uni- and multivariable quantile regression, and multiple imputations to handle missing data.
Results
The ETS was a significant predictor of both PROMIS PF (p < 0.001) and PROMIS PI (p < 0.001) at 12 weeks, but not at 6 weeks. The multivariable models showed medium explanatory power, with pseudo R² values of 0.28 for PF and 0.15 for PI at 12 weeks.
Conclusion
In this cohort, a patient's baseline expectations score is a positive and significant predictor of long-term (12-week) PF and PI-related outcomes in musculoskeletal conditions. Pseudo R2 was higher for physical function than for pain interference, indicating higher explanatory power of the model for 12-week PF. These findings suggest clinicians can use patient expectations to help better predict and potentially improve patient outcomes.
理由：患者期望是共同决策过程的关键组成部分，并且已发现与治疗结果相关。然而，对已发表的关于患者期望的研究存在担忧，包括研究的异质性、可变性、上限效应和测量工具的有效性不足。目的和目的：这项前瞻性、纵向队列研究调查了通过治疗预期量表（ETS）测量的初始患者对物理治疗的期望是否可以预测肌肉骨骼疾病患者在6周和12周时的PROMIS身体功能（PF）和疼痛干扰（PI）评分。第二个目的是确定患者对这些结果的期望的解释力。方法：采用前瞻性队列设计。参与者年龄在18-89岁，患有任何肌肉骨骼疾病，在2024年1月至2024年7月在Bellin卫生系统接受门诊物理治疗。收集的数据包括人口统计数据、健康信息、基线时ETS得分、基线、第6周和第12周时PROMIS PF和PI得分。统计分析包括描述性统计，单变量和多变量分位数回归，以及处理缺失数据的多重输入。结果：ETS是12周时PROMIS PF （p < 0.001）和PROMIS PI （p < 0.001）的显著预测因子，但不是6周时的预测因子。多变量模型具有中等解释力，12周时PF和PI的伪R²值分别为0.28和0.15。结论：在该队列中，患者的基线期望评分是肌肉骨骼疾病长期（12周）PF和pi相关结果的积极且显著的预测因子。与疼痛干扰相比，身体功能的伪R2更高，表明模型对12周PF的解释力更高。这些发现表明临床医生可以使用患者期望来帮助更好地预测和潜在地改善患者的预后。
{"title":"Patient Expectations as Predictors: Understanding Patient-Reported Outcomes in Musculoskeletal Conditions","authors":"Sebastian Sabadis, Roswell F. Childs, Jodi L. Young, Chad E. Cook","doi":"10.1111/jep.70343","DOIUrl":"10.1111/jep.70343","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Patient expectations are a key component of the shared decision-making process and have been found to be associated with treatment outcomes. However, there are concerns about the published research on patient expectations, including heterogeneity of the studies, variability, ceiling effect, and lack of validity of the measuring tools.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>This prospective, longitudinal cohort study investigated whether initial patient expectations for physical therapy, measured by the Expectation for Treatment Scale (ETS), could predict PROMIS physical function (PF) and pain interference (PI) scores at six and 12 weeks in patients with musculoskeletal conditions. A secondary aim was to determine the explanatory power of patient expectations on these outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study followed a prospective cohort design. Participants aged 18–89 years with any musculoskeletal condition, receiving outpatient physical therapy within the Bellin Health System were recruited from January 2024 to July 2024. Data collected included demographics, health information, ETS scores at baseline, and PROMIS PF and PI scores at baseline, six and 12 weeks. Statistical analysis included descriptive statistics, uni- and multivariable quantile regression, and multiple imputations to handle missing data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The ETS was a significant predictor of both PROMIS PF (<i>p</i> < 0.001) and PROMIS PI (<i>p</i> < 0.001) at 12 weeks, but not at 6 weeks. The multivariable models showed medium explanatory power, with pseudo R² values of 0.28 for PF and 0.15 for PI at 12 weeks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this cohort, a patient's baseline expectations score is a positive and significant predictor of long-term (12-week) PF and PI-related outcomes in musculoskeletal conditions. Pseudo R<sup>2</sup> was higher for physical function than for pain interference, indicating higher explanatory power of the model for 12-week PF. These findings suggest clinicians can use patient expectations to help better predict and potentially improve patient outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145850225","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}
The global prevalence rate of glaucoma blindness is extremely high and is a leading cause of irreversible blindness. Despite many advancements in treatment, evaluating glaucoma blindness remains challenging due to the long time required for its development and the combined use of treatment modalities.
Aims and Objectives
To evaluate the effectiveness of various treatment modalities in preventing glaucoma-related blindness using a 5-year retrospective study from a tertiary care hospital in Thailand.
Methods
A retrospective, cross-sectional study was conducted on 1031 glaucoma patients diagnosed between October 2017 and September 2022. Patients with advanced pterygium, corneal opacity, or macular degeneration were excluded. Data on demographics, clinical characteristics, and treatment modalities (medications, phacoemulsification with intraocular lens implantation [PE with IOL], laser iridotomy [LI], and trabeculectomy) were analyzed. Blindness was defined according to WHO criteria. Multivariate logistic regression assessed associations between blindness and risk factors.
Results
Of the 1031 patients, 21.0% experienced blindness. Secondary glaucoma (SG) had the highest blindness rate (33.5%) compared to primary open-angle glaucoma (POAG, 19.0%) and primary angle-closure glaucoma (PACG, 19.9%). Multimodal interventions significantly reduced blindness in POAG (adjusted OR: 0.57; 95% CI: 0.38–0.87; p = 0.027), but no significant benefit was observed in PACG or SG. PE with IOL showed the lowest blindness rate (14.9%), while trabeculectomy had the highest (47.2%). Treatment initiation within 5 years of diagnosis did not significantly affect blindness rates.
Conclusion
Multimodal interventions effectively reduce blindness in POAG but not in PACG or SG. Future studies should explore the impact of adherence, IOP fluctuation, and secondary glaucoma etiology on outcomes to optimize treatment strategies.
理由：青光眼失明的全球患病率非常高，是不可逆失明的主要原因。尽管治疗取得了许多进步，但由于青光眼的发展和综合使用治疗方式需要很长时间，因此评估青光眼失明仍然具有挑战性。目的和目的：通过泰国一家三级医院的5年回顾性研究，评估各种治疗方式在预防青光眼相关性失明方面的有效性。方法：对2017年10月至2022年9月诊断的1031例青光眼患者进行回顾性横断面研究。排除了晚期翼状胬肉、角膜混浊或黄斑变性患者。统计数据、临床特征和治疗方式（药物、超声乳化人工晶状体植入术[PE with IOL]、激光虹膜切开术[LI]和小梁切除术）进行分析。根据世卫组织的标准定义失明。多因素logistic回归评估失明与危险因素之间的关系。结果：1031例患者中，21.0%出现失明。继发性青光眼致盲率（33.5%）高于原发性开角型青光眼（POAG, 19.0%）和原发性闭角型青光眼（PACG, 19.9%）。多模式干预显著降低了POAG的失明（校正OR: 0.57; 95% CI: 0.38-0.87; p = 0.027），但在PACG或SG中未观察到显著的益处。人工晶状体置换术致盲率最低（14.9%），而小梁切除术致盲率最高（47.2%）。诊断后5年内开始治疗对失明率没有显著影响。结论：多模式干预能有效降低POAG患者的失明，而对PACG和SG患者的失明无显著影响。未来的研究应探讨依从性、IOP波动和继发性青光眼病因对结果的影响，以优化治疗策略。
{"title":"Retrospective Analysis of Intervention Effectiveness in Preventing Glaucoma Blindness in a Tertiary Care Setting","authors":"Thetthar Kanthar, Pasitpon Vatcharavongvan, Vanida Prasert","doi":"10.1111/jep.70341","DOIUrl":"10.1111/jep.70341","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>The global prevalence rate of glaucoma blindness is extremely high and is a leading cause of irreversible blindness. Despite many advancements in treatment, evaluating glaucoma blindness remains challenging due to the long time required for its development and the combined use of treatment modalities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>To evaluate the effectiveness of various treatment modalities in preventing glaucoma-related blindness using a 5-year retrospective study from a tertiary care hospital in Thailand.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective, cross-sectional study was conducted on 1031 glaucoma patients diagnosed between October 2017 and September 2022. Patients with advanced pterygium, corneal opacity, or macular degeneration were excluded. Data on demographics, clinical characteristics, and treatment modalities (medications, phacoemulsification with intraocular lens implantation [PE with IOL], laser iridotomy [LI], and trabeculectomy) were analyzed. Blindness was defined according to WHO criteria. Multivariate logistic regression assessed associations between blindness and risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 1031 patients, 21.0% experienced blindness. Secondary glaucoma (SG) had the highest blindness rate (33.5%) compared to primary open-angle glaucoma (POAG, 19.0%) and primary angle-closure glaucoma (PACG, 19.9%). Multimodal interventions significantly reduced blindness in POAG (adjusted OR: 0.57; 95% CI: 0.38–0.87; <i>p</i> = 0.027), but no significant benefit was observed in PACG or SG. PE with IOL showed the lowest blindness rate (14.9%), while trabeculectomy had the highest (47.2%). Treatment initiation within 5 years of diagnosis did not significantly affect blindness rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Multimodal interventions effectively reduce blindness in POAG but not in PACG or SG. Future studies should explore the impact of adherence, IOP fluctuation, and secondary glaucoma etiology on outcomes to optimize treatment strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145850262","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}
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