3D Magnetic Resonance Imaging (3D-MRI) analysis of brain tumours is an important tool for gathering information needed for diagnosis and disease therapy planning. However, during the brain tumor segmentation process existing techniques have segmentation error while identifying tumor location and extended tumor regions due to improper extraction of initial contour points and overlapping tissue intensity distributions.
Methods
Hence a novel Duo-step optimised Pyramidal SegNet has been proposed in which multiscale contrast convolutional attention module improve contrast and the tumor edge has been extracted based on location and tumor extension using Duo-step darning needle optimisation that set initial contour points and pyramidal level set segmentation with ancillary Sobel edge operator extract the tumour region from all 2D MRI image slices without having overlapped tissue intensity distributions thereby effectively minimises segmentation error. Furthermore, during the classification of segmented tumor region based on its type, irregular planimetric volume and low interrater concordance of multivariate brain tumors reduce the detection rate due to neglecting the extraction of contextual and symmetric features. Hence 3D brain Unified NN has been proposed in which adaptive multi-layer deep unified encoder module extract 3D contextual and symmetric features by measuring the difference from the observed region and contralateral region and the multivariate brain tumors are classified with boosted Sparse Categorical Cross entropy loss calculation to demonstrate high detection rate.
Results and Conclusion
The results obtained for the BraTS2020 and Brain Tumor Detection 2020 data sets showed that the proposed model outperforms existing techniques with excellent precision of 97%, 97.5%, recall of 99%, 97.8%, and accuracy of 95.7%, 98.4%, respectively.
{"title":"Multivariate Brain Tumor Detection in 3D-MRI Images Using Optimised Segmentation and Unified Classification Model","authors":"V. Anitha","doi":"10.1111/jep.14229","DOIUrl":"https://doi.org/10.1111/jep.14229","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>3D Magnetic Resonance Imaging (3D-MRI) analysis of brain tumours is an important tool for gathering information needed for diagnosis and disease therapy planning. However, during the brain tumor segmentation process existing techniques have segmentation error while identifying tumor location and extended tumor regions due to improper extraction of initial contour points and overlapping tissue intensity distributions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Hence a novel Duo-step optimised Pyramidal SegNet has been proposed in which multiscale contrast convolutional attention module improve contrast and the tumor edge has been extracted based on location and tumor extension using Duo-step darning needle optimisation that set initial contour points and pyramidal level set segmentation with ancillary Sobel edge operator extract the tumour region from all 2D MRI image slices without having overlapped tissue intensity distributions thereby effectively minimises segmentation error. Furthermore, during the classification of segmented tumor region based on its type, irregular planimetric volume and low interrater concordance of multivariate brain tumors reduce the detection rate due to neglecting the extraction of contextual and symmetric features. Hence 3D brain Unified NN has been proposed in which adaptive multi-layer deep unified encoder module extract 3D contextual and symmetric features by measuring the difference from the observed region and contralateral region and the multivariate brain tumors are classified with boosted Sparse Categorical Cross entropy loss calculation to demonstrate high detection rate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results and Conclusion</h3>\u0000 \u0000 <p>The results obtained for the BraTS2020 and Brain Tumor Detection 2020 data sets showed that the proposed model outperforms existing techniques with excellent precision of 97%, 97.5%, recall of 99%, 97.8%, and accuracy of 95.7%, 98.4%, respectively.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674135","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}
Healthcare systems are facing unprecedented need to respond to an ever-evolving context of providing safe person-centred care to its citizens and staff. This transformation requires a rethink of healthcare leadership. Systems leaders are critical for culture change; to support safe patient care, facilitate innovation, build person-centred teams, and develop a collaborative workforce. Education has been considered the panacea for leadership growth with current models closely connected to qualifications, distinct courses and micro-credentialing. Yet systems leaders need skills, capacities and experience which augment interprofessional teams to work and innovate in ways which are creative, satisfying and sustaining. These leaders facilitate interprofessional partnerships vertically and horizontally within an organisation. One such role is the Multi Professional Consultant Practitioner, who are expert practitioners and embedded researchers, with a strategic whole system approach, and value all voices toward improving patient and staff experience. This role has been predominantly developed within the United Kingdom. However, a global model would translate this role within health systems more broadly. Potential exists for integrated expertise to enable quality care across the system to meet the needs of their local communities. With this in mind, this scoping review aimed at exploring the Multi Professional Consultant Practitioner role-what it is and how it contributes to system transformation.
{"title":"Multi Professional Consultant Practice—What Is it and How Does the Role Contribute Systems Transformation?","authors":"Jacqueline Peet, Rebekkah Middleton","doi":"10.1111/jep.14235","DOIUrl":"https://doi.org/10.1111/jep.14235","url":null,"abstract":"<div>\u0000 \u0000 <p>Healthcare systems are facing unprecedented need to respond to an ever-evolving context of providing safe person-centred care to its citizens and staff. This transformation requires a rethink of healthcare leadership. Systems leaders are critical for culture change; to support safe patient care, facilitate innovation, build person-centred teams, and develop a collaborative workforce. Education has been considered the panacea for leadership growth with current models closely connected to qualifications, distinct courses and micro-credentialing. Yet systems leaders need skills, capacities and experience which augment interprofessional teams to work and innovate in ways which are creative, satisfying and sustaining. These leaders facilitate interprofessional partnerships vertically and horizontally within an organisation. One such role is the Multi Professional Consultant Practitioner, who are expert practitioners and embedded researchers, with a strategic whole system approach, and value all voices toward improving patient and staff experience. This role has been predominantly developed within the United Kingdom. However, a global model would translate this role within health systems more broadly. Potential exists for integrated expertise to enable quality care across the system to meet the needs of their local communities. With this in mind, this scoping review aimed at exploring the Multi Professional Consultant Practitioner role-what it is and how it contributes to system transformation.</p>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674133","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}
Nashwa Masnoon PhD, Sarita Lo MClinPharm, Melissa Baysari PhD, Alexandra Bennett PhD, Andrew J. McLachlan PhD, Fiona Blyth PhD, Mai Duong MPhil, Sarah N. Hilmer PhD
<div> <section> <h3> Rationale</h3> <p>The Drug Burden Index (DBI) measures exposure to anticholinergic and sedative drugs, which are associated with harm in older adults. To facilitate deprescribing in older Australian inpatients, we piloted an intervention bundle integrating the DBI in Electronic Medical Records, clinician deprescribing guides, consumer information leaflets and a stewardship pharmacist.</p> </section> <section> <h3> Objectives</h3> <p>To understand (i) hospital clinician experiences of using the bundle and (ii) consumer (patient and carer) and General Practitioner (GP) experiences of in-hospital deprescribing, following bundle implementation.</p> </section> <section> <h3> Methods</h3> <p>Hospital clinicians from target services (General and Geriatric Medicine) at an Australian metropolitan tertiary-referral hospital, were invited to complete surveys, including the System Usability Scale (SUS), and interviews. Patients aged ≥75 years with high DBI (DBI ≥1) were admitted to target services, and their carers, received interview invitations. Consenting patients’ GPs received surveys. Qualitative data was thematically analysed. Hospital clinician interviews were mapped to the Human Organisation Technology-fit Framework. Patient interviews were mapped to an adaptation of the National Health Service Patient Experience Framework.</p> </section> <section> <h3> Results</h3> <p>Seventeen hospital clinicians (<i>n</i> = 15 medical, <i>n</i> = 2 pharmacists) and four GPs completed surveys. Eight hospital clinicians (<i>n</i> = 7 medical, <i>n</i> = 1 pharmacist), seven patients and two carers completed interviews. Hospital clinicians reported good usability (SUS score 71.5 ± 12.5). Most themes were around system use and user satisfaction. They reported the intervention was useful for medication review, identified challenges from pre-existing heavy workload and suggested further integration into workflows. Patients and carers reported themes around information, communication and education. Patients reported feeling better or no different post-deprescribing. Patients, carers and GPs described poor communication regarding in-hospital medication changes and their rationale.</p> </section> <section> <h3> Conclusions</h3> <p>The intervention was well accepted by hospital clinicians. The bundle requires further integration into workflows for sustainability and assessment of generalisability in other health services. Given patients, carers and GPs reported poor medication-related communication, future interventions may target this.</p> </sec
{"title":"Consumer and multidisciplinary clinician experiences after implementation of the Drug Burden Index intervention bundle to facilitate deprescribing in older inpatients: A mixed method study","authors":"Nashwa Masnoon PhD, Sarita Lo MClinPharm, Melissa Baysari PhD, Alexandra Bennett PhD, Andrew J. McLachlan PhD, Fiona Blyth PhD, Mai Duong MPhil, Sarah N. Hilmer PhD","doi":"10.1111/jep.14220","DOIUrl":"https://doi.org/10.1111/jep.14220","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>The Drug Burden Index (DBI) measures exposure to anticholinergic and sedative drugs, which are associated with harm in older adults. To facilitate deprescribing in older Australian inpatients, we piloted an intervention bundle integrating the DBI in Electronic Medical Records, clinician deprescribing guides, consumer information leaflets and a stewardship pharmacist.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To understand (i) hospital clinician experiences of using the bundle and (ii) consumer (patient and carer) and General Practitioner (GP) experiences of in-hospital deprescribing, following bundle implementation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Hospital clinicians from target services (General and Geriatric Medicine) at an Australian metropolitan tertiary-referral hospital, were invited to complete surveys, including the System Usability Scale (SUS), and interviews. Patients aged ≥75 years with high DBI (DBI ≥1) were admitted to target services, and their carers, received interview invitations. Consenting patients’ GPs received surveys. Qualitative data was thematically analysed. Hospital clinician interviews were mapped to the Human Organisation Technology-fit Framework. Patient interviews were mapped to an adaptation of the National Health Service Patient Experience Framework.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventeen hospital clinicians (<i>n</i> = 15 medical, <i>n</i> = 2 pharmacists) and four GPs completed surveys. Eight hospital clinicians (<i>n</i> = 7 medical, <i>n</i> = 1 pharmacist), seven patients and two carers completed interviews. Hospital clinicians reported good usability (SUS score 71.5 ± 12.5). Most themes were around system use and user satisfaction. They reported the intervention was useful for medication review, identified challenges from pre-existing heavy workload and suggested further integration into workflows. Patients and carers reported themes around information, communication and education. Patients reported feeling better or no different post-deprescribing. Patients, carers and GPs described poor communication regarding in-hospital medication changes and their rationale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The intervention was well accepted by hospital clinicians. The bundle requires further integration into workflows for sustainability and assessment of generalisability in other health services. Given patients, carers and GPs reported poor medication-related communication, future interventions may target this.</p>\u0000 </sec","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674138","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}
Cancer patients experience substantial psychological distress which causes the reduction of the quality of life. However, the risk of psychological distress has not been well predicted especially in young- and middle-aged gynaecological cancer patients. This study aimed to develop a prediction model for psychological distress in young- and middle-aged gynaecological cancer patients using the artificial neural network (ANN).
Methods
A cross-sectional study of young- and middle-aged gynaecological cancer patients (n = 368) was conducted between March and December 2022. We used the univariate analysis to determine the factors affecting psychological distress. ANN was used for psychological distress prediction in young- and middle-aged gynaecological cancer patients. Also, a traditional logistic regression (LR) model was constructed for comparison. The area under the receiver's operating characteristic curve (AUC) was used to evaluate the model's predictive performance.
Results
ANN and LR showed that self-efficacy, economic income and sleep duration were the top risk variables for psychological distress in young- and middle-aged gynaecological cancer patients. The AUC of the ANN was 0.977, the sensitivity was 94.83% and the specificity was 86.44%, whereas logistic regression's were 0.920, 85.57% and 82.76%, respectively.
Conclusion
Compared with the LR model, the ANN model shows obvious superiority across all assessment index outcomes, and it may be used as a decision-support tool for early identification of young- and middle-aged gynaecological cancer patients suffering from psychological distress.
{"title":"Constructing a Predictive Model for Psychological Distress of Young- and Middle-Aged Gynaecological Cancer Patients","authors":"Yitong Qu, Yinan Zhang, Xueying Zhou, Linan Wang, Xinran Zhu, Shimei Jin, Shumei Zhuang","doi":"10.1111/jep.14244","DOIUrl":"https://doi.org/10.1111/jep.14244","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cancer patients experience substantial psychological distress which causes the reduction of the quality of life. However, the risk of psychological distress has not been well predicted especially in young- and middle-aged gynaecological cancer patients. This study aimed to develop a prediction model for psychological distress in young- and middle-aged gynaecological cancer patients using the artificial neural network (ANN).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional study of young- and middle-aged gynaecological cancer patients (<i>n</i> = 368) was conducted between March and December 2022. We used the univariate analysis to determine the factors affecting psychological distress. ANN was used for psychological distress prediction in young- and middle-aged gynaecological cancer patients. Also, a traditional logistic regression (LR) model was constructed for comparison. The area under the receiver's operating characteristic curve (AUC) was used to evaluate the model's predictive performance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>ANN and LR showed that self-efficacy, economic income and sleep duration were the top risk variables for psychological distress in young- and middle-aged gynaecological cancer patients. The AUC of the ANN was 0.977, the sensitivity was 94.83% and the specificity was 86.44%, whereas logistic regression's were 0.920, 85.57% and 82.76%, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Compared with the LR model, the ANN model shows obvious superiority across all assessment index outcomes, and it may be used as a decision-support tool for early identification of young- and middle-aged gynaecological cancer patients suffering from psychological distress.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674146","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}
Emerging digital technologies are accelerating the transition of healthcare services from traditional in-person settings to virtual platforms. As a result, digital literacy is becoming essential for individuals to effectively engage with these services. However, inadequate digital literacy poses a significant barrier to both accessing and utilising virtual healthcare, potentially widening existing health disparities.
Aims and Objectives
This protocol outlines the approach for systematically reviewing and synthesising the existing literature on the influence of digital literacy on accessing and utilising virtual healthcare services.
Methods
A comprehensive literature search will be conducted across five databases: Web of Science, Medline, Scopus, CINAHL and IEEE Xplore, covering publications from 2014 to 2024. The review will include all age cohorts and demographics, focusing on studies that examine digital literacy and measures of access to and utilisation of virtual healthcare services. Two independent reviewers will screen studies using pre-determined search strategies for inclusion.
Conclusion
Findings from this study will provide valuable insights into the challenges and facilitators of digital literacy in engaging with virtual healthcare services. This review will also offer evidence-based recommendations to optimise digital health interventions and promote inclusive, equitable healthcare delivery.
{"title":"Assessing the Role of Digital Literacy in Accessing and Utilising Virtual Healthcare Services: A Systematic Review Protocol","authors":"Caitlin Hung, Tarun Reddy Katapally","doi":"10.1111/jep.14245","DOIUrl":"https://doi.org/10.1111/jep.14245","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Emerging digital technologies are accelerating the transition of healthcare services from traditional in-person settings to virtual platforms. As a result, digital literacy is becoming essential for individuals to effectively engage with these services. However, inadequate digital literacy poses a significant barrier to both accessing and utilising virtual healthcare, potentially widening existing health disparities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>This protocol outlines the approach for systematically reviewing and synthesising the existing literature on the influence of digital literacy on accessing and utilising virtual healthcare services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive literature search will be conducted across five databases: Web of Science, Medline, Scopus, CINAHL and IEEE Xplore, covering publications from 2014 to 2024. The review will include all age cohorts and demographics, focusing on studies that examine digital literacy and measures of access to and utilisation of virtual healthcare services. Two independent reviewers will screen studies using pre-determined search strategies for inclusion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Findings from this study will provide valuable insights into the challenges and facilitators of digital literacy in engaging with virtual healthcare services. This review will also offer evidence-based recommendations to optimise digital health interventions and promote inclusive, equitable healthcare delivery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.14245","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674132","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}
Tessa Kolar MSc, Courtney B. Cook MSc, CGC, Anthony Cooper MBChB, FRCSC, Tom Blydt-Hansen MDCM, FRCPC, Mary B. Connolly FRCP, MBBCH, Cyrus Boelman MD, Harpreet Chhina PhD, Anita Datta MD, Michelle Demos MD, FRCPC, Kyla J. Hildebrand MD, FRCPC, Kathryn Selby MBBCH, FRCPC, Ye Shen MPH, Scott E. Wenderfer MD, PhD, GenCOUNSEL Study, Alison M. Elliott PhD, CGC
Background
Family-centred care (FCC) emphasizes a partnership approach to care between healthcare providers (HCPs), patients, and families. FCC provides significant benefits to both children and families; however, challenges exist in implementing FCC into practice. This study aimed to explore HCPs' FCC behaviours in multidisciplinary specialty clinics at a tertiary pediatric health care center in Canada.
Methods
A demographic survey and the Measure of Processes of Care for Service Providers (MPOC-SP) questionnaire was administered to HCPs in five specialty clinics: orthopaedics, neurology, multi-organ transplant, immunology, and nephrology. Survey data were summarized using descriptive statistics. The association between possible predictor variables (ethnicity, gender, years in clinical practice) and MPOC-SP scores were analysed by analysis of variance (ANOVA) followed by post-hoc Tukey's test. Differences in scores across professional disciplines were analysed by multivariate analysis of variance (MANOVA) followed by ANOVA. Items rated lower (1–4 out of 7 by >33% of participants) were identified as potential areas for improvement.
Results
HCPs (N = 77) from all five clinics rated the MPOC-SP domain ‘Treating People Respectfully’ the highest (mean 6.00 ± 0.59) and ‘Providing General Information’ the lowest (mean 4.56 ± 1.27). HCPs with 5–10 years of experience had higher scores across all domains compared to HCPs with <5 years and >10 years of experience. There were no significant differences in scores based on ethnicity, gender, and professional discipline. Items rated lower (1–4 out of 7 by >33% of participants) involved providing general information and emotional support to families.
Conclusions
Providing general information and emotional support to patients and families are areas for improvement for all specialty clinics surveyed. Given genetic counsellors (GCs) expertise in education and counselling, GC integration in these clinics is one way in which FCC can be improved. Our study also shows that years of work experience influences HCPs' capacity to provide FCC.
{"title":"Evaluating family-centred care at BC Children's Hospital: Healthcare providers' perspectives","authors":"Tessa Kolar MSc, Courtney B. Cook MSc, CGC, Anthony Cooper MBChB, FRCSC, Tom Blydt-Hansen MDCM, FRCPC, Mary B. Connolly FRCP, MBBCH, Cyrus Boelman MD, Harpreet Chhina PhD, Anita Datta MD, Michelle Demos MD, FRCPC, Kyla J. Hildebrand MD, FRCPC, Kathryn Selby MBBCH, FRCPC, Ye Shen MPH, Scott E. Wenderfer MD, PhD, GenCOUNSEL Study, Alison M. Elliott PhD, CGC","doi":"10.1111/jep.14187","DOIUrl":"https://doi.org/10.1111/jep.14187","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Family-centred care (FCC) emphasizes a partnership approach to care between healthcare providers (HCPs), patients, and families. FCC provides significant benefits to both children and families; however, challenges exist in implementing FCC into practice. This study aimed to explore HCPs' FCC behaviours in multidisciplinary specialty clinics at a tertiary pediatric health care center in Canada.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A demographic survey and the Measure of Processes of Care for Service Providers (MPOC-SP) questionnaire was administered to HCPs in five specialty clinics: orthopaedics, neurology, multi-organ transplant, immunology, and nephrology. Survey data were summarized using descriptive statistics. The association between possible predictor variables (ethnicity, gender, years in clinical practice) and MPOC-SP scores were analysed by analysis of variance (ANOVA) followed by post-hoc Tukey's test. Differences in scores across professional disciplines were analysed by multivariate analysis of variance (MANOVA) followed by ANOVA. Items rated lower (1–4 out of 7 by >33% of participants) were identified as potential areas for improvement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>HCPs (<i>N</i> = 77) from all five clinics rated the MPOC-SP domain ‘Treating People Respectfully’ the highest (mean 6.00 ± 0.59) and ‘Providing General Information’ the lowest (mean 4.56 ± 1.27). HCPs with 5–10 years of experience had higher scores across all domains compared to HCPs with <5 years and >10 years of experience. There were no significant differences in scores based on ethnicity, gender, and professional discipline. Items rated lower (1–4 out of 7 by >33% of participants) involved providing general information and emotional support to families.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Providing general information and emotional support to patients and families are areas for improvement for all specialty clinics surveyed. Given genetic counsellors (GCs) expertise in education and counselling, GC integration in these clinics is one way in which FCC can be improved. Our study also shows that years of work experience influences HCPs' capacity to provide FCC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.14187","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674137","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}
Rationale: Awareness of their standing relative to best practices motivates primary healthcare (PHC) teams to improve their practices. However, gathering the data necessary to create such a portrait is a challenge. An effective way to support the improvement of the practices of PHC teams is to simplify the availability of data portraying aspects of their practices that might need improvement. Timely access is one of the foremost challenges of PHC. Yet, very few tools supporting reflections on the implementation of best practices to improve access are available to PHC teams.
Aims and objectives: To develop an online reflective tool that evaluates the state of a PHC team member's advanced access practice and formulates customized recommendations for improvement.
Methods: This sequential multimethod study was informed by a literature review and an expert panel composed of researchers, patients, provincial and local decision-makers, and PHC clinical and administrative staff in the province of Quebec, Canada. Consensus was reached on the content of the questionnaire and the prioritization of the recommendations.
Results: No reflective tool on advanced access practices was found in the literature review. Grey literature was used to create an initial version of the questionnaire. This version was revised and enriched through consultation phases with the expert panel. Then, five iterations of the tool were tested with 169 PHC team members, which led to the conception of two distinct versions: one for clinical staff and one for administrative agents responsible for appointment booking. The final versions of the reflective tool are available online in both English and French.
Conclusion: This reflective tool provides a portrait of PHC team members' advanced access practices as well as an automated report that contains personalized and prioritized recommendations for improvement. Further developments are necessary for its optimal use among PHC professionals other than physicians and nurse practitioners.
{"title":"Reflective Tool on Advanced Access to Support Primary Healthcare Teams: Development and Validation of an Online Questionnaire.","authors":"Isabelle Gaboury, Mylaine Breton, Christine Beaulieu, Marianne Renard, Maxime Sasseville, Lara Maillet, Catherine Hudon, Isabel Rodrigues, Sabina Abou Malham, Arnaud Duhoux, Jeannie Haggerty","doi":"10.1111/jep.14232","DOIUrl":"https://doi.org/10.1111/jep.14232","url":null,"abstract":"<p><strong>Rationale: </strong>Awareness of their standing relative to best practices motivates primary healthcare (PHC) teams to improve their practices. However, gathering the data necessary to create such a portrait is a challenge. An effective way to support the improvement of the practices of PHC teams is to simplify the availability of data portraying aspects of their practices that might need improvement. Timely access is one of the foremost challenges of PHC. Yet, very few tools supporting reflections on the implementation of best practices to improve access are available to PHC teams.</p><p><strong>Aims and objectives: </strong>To develop an online reflective tool that evaluates the state of a PHC team member's advanced access practice and formulates customized recommendations for improvement.</p><p><strong>Methods: </strong>This sequential multimethod study was informed by a literature review and an expert panel composed of researchers, patients, provincial and local decision-makers, and PHC clinical and administrative staff in the province of Quebec, Canada. Consensus was reached on the content of the questionnaire and the prioritization of the recommendations.</p><p><strong>Results: </strong>No reflective tool on advanced access practices was found in the literature review. Grey literature was used to create an initial version of the questionnaire. This version was revised and enriched through consultation phases with the expert panel. Then, five iterations of the tool were tested with 169 PHC team members, which led to the conception of two distinct versions: one for clinical staff and one for administrative agents responsible for appointment booking. The final versions of the reflective tool are available online in both English and French.</p><p><strong>Conclusion: </strong>This reflective tool provides a portrait of PHC team members' advanced access practices as well as an automated report that contains personalized and prioritized recommendations for improvement. Further developments are necessary for its optimal use among PHC professionals other than physicians and nurse practitioners.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621920","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}
Background: Medical humanities education is an integral component of medical education. However, the current landscape of research on medical humanities education remains incomplete. The purpose of this study is to identify the trends in research on medical humanities education and provide a global overview of the field by analysing various aspects such as sources, authors, literature, and keywords. The aim is to offer insights and recommendations for the future development of medical humanities education.
Methods: This research utilised bibliometric tools such as VOSviewer, CiteSpace, SciMAT, and the R software package biblioshiny to analyse literature sources, authors, documents, and keywords. This systematic review methodology allowed for a comprehensive examination of the field. Additionally, the study investigated international collaborations and scientific outputs, shedding light on the global landscape of medical humanities education research.
Results: The study included a total of 403 articles published between January 1980 and December 2023 from the Web of Science (WoS) database. The field of medical humanities education experienced an annual growth rate of 9.08% in literature output from 1980 to 2023, indicating its increasing prominence and scholarly interest over time. The research topics within this field have evolved in response to societal and medical developments. Core research themes that have consistently garnered attention from researchers include empathy, ethics, and narrative medicine, reflecting their significance and ongoing relevance in the field.
Conclusion: These shifts in research hotspots signify the dynamic nature of the field, adapting to evolving contexts and emerging research domains. By embracing cross-cultural perspectives and fostering interdisciplinary collaborations, stakeholders in medical humanities education can collectively enrich the field, promote inclusivity, and enhance the overall educational experience for healthcare professionals.
{"title":"Mapping the Landscape of Medical Humanities Education: Trends and Insights.","authors":"Yunxia Hong, Chao Song, Zhongquan Jiang, Wen Zhang","doi":"10.1111/jep.14239","DOIUrl":"https://doi.org/10.1111/jep.14239","url":null,"abstract":"<p><strong>Background: </strong>Medical humanities education is an integral component of medical education. However, the current landscape of research on medical humanities education remains incomplete. The purpose of this study is to identify the trends in research on medical humanities education and provide a global overview of the field by analysing various aspects such as sources, authors, literature, and keywords. The aim is to offer insights and recommendations for the future development of medical humanities education.</p><p><strong>Methods: </strong>This research utilised bibliometric tools such as VOSviewer, CiteSpace, SciMAT, and the R software package biblioshiny to analyse literature sources, authors, documents, and keywords. This systematic review methodology allowed for a comprehensive examination of the field. Additionally, the study investigated international collaborations and scientific outputs, shedding light on the global landscape of medical humanities education research.</p><p><strong>Results: </strong>The study included a total of 403 articles published between January 1980 and December 2023 from the Web of Science (WoS) database. The field of medical humanities education experienced an annual growth rate of 9.08% in literature output from 1980 to 2023, indicating its increasing prominence and scholarly interest over time. The research topics within this field have evolved in response to societal and medical developments. Core research themes that have consistently garnered attention from researchers include empathy, ethics, and narrative medicine, reflecting their significance and ongoing relevance in the field.</p><p><strong>Conclusion: </strong>These shifts in research hotspots signify the dynamic nature of the field, adapting to evolving contexts and emerging research domains. By embracing cross-cultural perspectives and fostering interdisciplinary collaborations, stakeholders in medical humanities education can collectively enrich the field, promote inclusivity, and enhance the overall educational experience for healthcare professionals.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621890","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}
Alexandra Crew, Claire Reidy, Helene-Mari van der Westhuizen, Mackenzie Graham
Introduction: Diabetic retinopathy is one of the leading causes of avoidable blindness among adults globally, and screening programmes can enable early diagnosis and prevention of progression. Artificial intelligence (AI) diagnostic solutions have been developed to diagnose diabetic retinopathy. The aim of this review is to identify ethical concerns related to AI-enabled diabetic retinopathy diagnostics and enable future research to explore these issues further.
Methods: This is a narrative review that uses thematic analysis methods to develop key findings. We searched two databases, PubMed and Scopus, for papers focused on the intersection of AI, diagnostics, ethics, and diabetic retinopathy and conducted a citation search. Primary research articles published in English between 1 January 2013 and 14 June 2024 were included. From the 1878 papers that were screened, nine papers met inclusion and exclusion criteria and were selected for analysis.
Results: We found that existing literature highlights ensuring patient data has appropriate protection and ownership, that bias in algorithm training data is minimised, informed patient decision-making is encouraged, and negative consequences in the context of clinical practice are mitigated.
Conclusions: While the technical developments in AI-enabled diabetic retinopathy diagnostics receive the bulk of the research focus, we found that insufficient attention is paid to how this technology is accessed equitably in different settings and which safeguards are needed against exploitative practices. Such ethical issues merit additional exploration and practical problem-solving through primary research. AI-enabled diabetic retinopathy screening has the potential to enable screening at a scale that was previously not possible and could contribute to reducing preventable blindness. It will only achieve this if ethical issues are emphasised, understood, and addressed throughout the translation of this technology to clinical practice.
{"title":"A Narrative Review of Ethical Issues in the Use of Artificial Intelligence Enabled Diagnostics for Diabetic Retinopathy.","authors":"Alexandra Crew, Claire Reidy, Helene-Mari van der Westhuizen, Mackenzie Graham","doi":"10.1111/jep.14237","DOIUrl":"https://doi.org/10.1111/jep.14237","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetic retinopathy is one of the leading causes of avoidable blindness among adults globally, and screening programmes can enable early diagnosis and prevention of progression. Artificial intelligence (AI) diagnostic solutions have been developed to diagnose diabetic retinopathy. The aim of this review is to identify ethical concerns related to AI-enabled diabetic retinopathy diagnostics and enable future research to explore these issues further.</p><p><strong>Methods: </strong>This is a narrative review that uses thematic analysis methods to develop key findings. We searched two databases, PubMed and Scopus, for papers focused on the intersection of AI, diagnostics, ethics, and diabetic retinopathy and conducted a citation search. Primary research articles published in English between 1 January 2013 and 14 June 2024 were included. From the 1878 papers that were screened, nine papers met inclusion and exclusion criteria and were selected for analysis.</p><p><strong>Results: </strong>We found that existing literature highlights ensuring patient data has appropriate protection and ownership, that bias in algorithm training data is minimised, informed patient decision-making is encouraged, and negative consequences in the context of clinical practice are mitigated.</p><p><strong>Conclusions: </strong>While the technical developments in AI-enabled diabetic retinopathy diagnostics receive the bulk of the research focus, we found that insufficient attention is paid to how this technology is accessed equitably in different settings and which safeguards are needed against exploitative practices. Such ethical issues merit additional exploration and practical problem-solving through primary research. AI-enabled diabetic retinopathy screening has the potential to enable screening at a scale that was previously not possible and could contribute to reducing preventable blindness. It will only achieve this if ethical issues are emphasised, understood, and addressed throughout the translation of this technology to clinical practice.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621874","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}
Background: Spanish community pharmacy has been incorporating some methods and approaches in the evaluation and improvement of quality, with the ISO 9001 standard being the most used reference. The experience of a community pharmacy in Spain is presented. The pharmacy implemented a management system based on the ISO 9001 standard in 2020, using the Deming cycle with the aim of enhancing the quality of pharmaceutical care. The results obtained in the processes over the following 2 years are also presented.
Methods: The ISO 9001 standard was reviewed to ensure compliance. The Quality Management System control documentation was updated and included the following documents: quality manual, process map, operational processes and procedures, quality indicators and incident records. The pharmacy has planned and implemented a process of monitoring, measurement, analysis of results and continuous improvement for operational, strategic and support processes during the time period of the study. The main operational processes were associated with a set of indicators which permitted to know the results obtained, analyse deviations and implement improvements. The planning and development of the project encompassed approximately 1 year and involved several key stages: (1) diagnosis and assessment of quality situation, (2) analysis of processes, (3) preparation of documentation, (4) implementation of the Quality Management System, (5) internal audit, (6) monitoring of activities and continuous improvement, (7) follow-up audit by the certifying body, (8) obtaining the ISO 9001:2015 quality certificate.
Results: The planned schedule was adhered and the documents were successfully drafted. In total, eight operational processes, nine support processes and six strategic processes were reviewed and included in the Quality Management System. Twenty indicators were established to monitor and analyse the performance of these processes. During audits, deviations in the system or nonconformances were identified and analysed. In the first year of system implementation, five nonconformances were identified, decreasing to two in the subsequent two periods. In 2020, three improvement actions were implemented with the objective of: (1) implementing a medication reconciliation service, (2) developing a medication dose adjustment service for polymedicated patients, and (3) implementing a service to measure and improve inhalation technique in patients using inhalers.
Conclusions: The implementation of a methodology based on the ISO 9001 standard has facilitated: (1) Integrating process management as a regular working methodology, (2) A focus on the continuous improvement of services, (3) Achieving recognition of the staff efforts and involvement.
背景：西班牙社区药房在质量评估和改进方面采用了一些方法和途径，其中最常用的参考标准是 ISO 9001 标准。本文介绍了西班牙一家社区药房的经验。该药房于 2020 年实施了以 ISO 9001 标准为基础的管理系统，采用戴明循环方法，旨在提高药品护理质量。此外，还介绍了在随后两年的过程中取得的成果：方法：对 ISO 9001 标准进行审查，以确保符合标准。对质量管理体系控制文件进行了更新，包括以下文件：质量手册、流程图、操作流程和程序、质量指标和事故记录。在研究期间，药房对运营、战略和支持流程进行了规划，并实施了监测、测量、结果分析和持续改进流程。主要业务流程与一系列指标相关联，通过这些指标可以了解所取得的成果、分析偏差并实施改进。项目的规划和开发历时约一年，涉及几个关键阶段：(1) 质量状况诊断和评估，(2) 流程分析，(3) 文件编制，(4) 质量管理体系的实施，(5) 内部审核，(6) 活动监控和持续改进，(7) 认证机构的后续审核，(8) 获得 ISO 9001:2015 质量证书：结果：按照计划进度，成功起草了文件。总共审查了 8 个业务流程、9 个支持流程和 6 个战略流程，并将其纳入质量管理体系。为监测和分析这些过程的绩效，制定了 20 项指标。在审核过程中，发现并分析了系统中的偏差或不符合项。在系统实施的第一年，发现了 5 个不符合项，在随后的两个阶段减少到 2 个。2020 年，实施了三项改进行动，目标是：(1) 实施药物对账服务，(2) 为多药病人开发药物剂量调整服务，(3) 实施一项服务，测量并改进使用吸入器病人的吸入技术：结论：实施基于 ISO 9001 标准的方法有助于：(1) 将流程管理作为常规工作方法，(2) 注重服务的持续改进，(3) 员工的努力和参与得到认可。
{"title":"Quality Management in Spanish Community Pharmacy: Implementation of ISO 9001.","authors":"Damià Barris Blundell, Nuria García-Agua Soler","doi":"10.1111/jep.14240","DOIUrl":"https://doi.org/10.1111/jep.14240","url":null,"abstract":"<p><strong>Background: </strong>Spanish community pharmacy has been incorporating some methods and approaches in the evaluation and improvement of quality, with the ISO 9001 standard being the most used reference. The experience of a community pharmacy in Spain is presented. The pharmacy implemented a management system based on the ISO 9001 standard in 2020, using the Deming cycle with the aim of enhancing the quality of pharmaceutical care. The results obtained in the processes over the following 2 years are also presented.</p><p><strong>Methods: </strong>The ISO 9001 standard was reviewed to ensure compliance. The Quality Management System control documentation was updated and included the following documents: quality manual, process map, operational processes and procedures, quality indicators and incident records. The pharmacy has planned and implemented a process of monitoring, measurement, analysis of results and continuous improvement for operational, strategic and support processes during the time period of the study. The main operational processes were associated with a set of indicators which permitted to know the results obtained, analyse deviations and implement improvements. The planning and development of the project encompassed approximately 1 year and involved several key stages: (1) diagnosis and assessment of quality situation, (2) analysis of processes, (3) preparation of documentation, (4) implementation of the Quality Management System, (5) internal audit, (6) monitoring of activities and continuous improvement, (7) follow-up audit by the certifying body, (8) obtaining the ISO 9001:2015 quality certificate.</p><p><strong>Results: </strong>The planned schedule was adhered and the documents were successfully drafted. In total, eight operational processes, nine support processes and six strategic processes were reviewed and included in the Quality Management System. Twenty indicators were established to monitor and analyse the performance of these processes. During audits, deviations in the system or nonconformances were identified and analysed. In the first year of system implementation, five nonconformances were identified, decreasing to two in the subsequent two periods. In 2020, three improvement actions were implemented with the objective of: (1) implementing a medication reconciliation service, (2) developing a medication dose adjustment service for polymedicated patients, and (3) implementing a service to measure and improve inhalation technique in patients using inhalers.</p><p><strong>Conclusions: </strong>The implementation of a methodology based on the ISO 9001 standard has facilitated: (1) Integrating process management as a regular working methodology, (2) A focus on the continuous improvement of services, (3) Achieving recognition of the staff efforts and involvement.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621909","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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