Journal of evaluation in clinical practice最新文献_第4页

Facilitators and Barriers of Implementation of Clinical Pharmacy Services in County Hospitals Based on CFIR: A Qualitative Study 基于CFIR的县级医院临床药学服务实施的促进因素与障碍：一项定性研究

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2026-01-09 DOI: 10.1111/jep.70357

Jie Xiao, Shuting Huang, Lei Chen, Qing Wang, Ying Wang, Wenzheng Xie, Ting Liu, Ke Sai, Ping Xu

Introduction

Clinical pharmacy services comprise a range of patient-centered, systematic care activities delivered by pharmacists, aiming to optimize medication use and improve patient outcomes. Despite growing recognition of the role of clinical pharmacy in medication safety, there is limited comprehensive analysis of barriers or actionable strategies, especially in under-resourced areas. This study aims to explore the state of implementation of clinical pharmacy practice, to elucidate the influencing factors and associated strategies.

Methods

Data were collected through quantitative surveys, participant observation, and semi-structured interviews. Data collection and analysis were guided by the Consolidated Framework for Implementation Research (CFIR). Directed content analysis was used to code the data and identify factors influencing clinical pharmacy services. Implementation strategies were developed using the CFIR-ERIC matching tool.

Results

Case studies were conducted in six county hospitals, with a total of 64 interviewees. We identified 25 facilitators and 21 barriers across five CFIR domains, with 15 distinguishing constructs between well and poorly performing centers. Our findings highlighted the critical role of local condition, policies and laws, external support, standardized appraisal systems, leadership, available resources, staffing and performance-linked incentives in sustaining service quality. Our analysis also proposed 8 tailored strategies to support sustainable implementation. The main distinguishing constructs between well and poorly performing implementation centers included outer setting, inner setting, individuals and implementation process.

Conclusions

The implementation and sustainability of clinical pharmacy services are still limited by factors such as inadequate resources, inappropriate regulatory frameworks, lack of leadership, and insufficient competency of pharmacists. Corresponding implementation strategies should be adopted to promote the development of clinical pharmacy services, and the professional development of clinical pharmacists, especially in under-resourced areas.

Clinical Trial Registration

N/A.

临床药学服务包括一系列以患者为中心，由药剂师提供的系统护理活动，旨在优化药物使用和改善患者预后。尽管人们越来越认识到临床药学在用药安全中的作用，但对障碍或可操作策略的综合分析有限，特别是在资源不足的地区。本研究旨在探讨临床药学实践的实施状况，阐明其影响因素及相关策略。方法：采用定量调查、参与观察、半结构化访谈等方法收集资料。数据收集和分析以实施研究综合框架（CFIR）为指导。采用定向内容分析对数据进行编码，识别影响临床药学服务的因素。使用cfr - eric匹配工具制定了实施策略。结果：在6个县医院进行了个案研究，共有64名受访者。我们在五个CFIR领域中确定了25个促进因素和21个障碍，并在表现良好和表现不佳的中心之间建立了15个区分结构。我们的研究结果强调了当地条件、政策和法律、外部支持、标准化评估系统、领导、可用资源、人员配备和与绩效挂钩的激励措施在维持服务质量方面的关键作用。我们的分析还提出了8项量身定制的战略，以支持可持续实施。绩效较好的实施中心与绩效较差的主要区分结构包括外部环境、内部环境、个体和实施过程。结论：临床药学服务的实施和可持续性仍然受到资源不足、监管框架不合理、缺乏领导和药师能力不足等因素的制约。应采取相应的实施策略，促进临床药学服务的发展，促进临床药师的专业发展，特别是在资源匮乏地区。临床试验注册：无。

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引用次数: 0

The Moderating Effect of Physical Activity in the Relationship Between Eco-Anxiety and Premenstrual Syndrome 体力活动在生态焦虑与经前综合征关系中的调节作用。

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2026-01-09 DOI: 10.1111/jep.70364

Ayça Balmumcu, Hakan Öztürk, Nazan Öztürk, Ayden Çoban

Background

Ecological anxiety related to climate change is thought to be a risk factor for premenstrual syndrome (PMS). Regular physical activity can effectively reduce both physical and psychological symptoms associated with PMS. This study was conducted to examine the moderating effect of physical activity on the relationship between climate change-related eco-anxiety and PMS.

Methods

This cross-sectional and correlational study was conducted between February and March 2025 on 635 female students studying in health-related departments of a university. Personal information form, PMS scale, eco-anxiety scale and International Physical Activity Questionnaire-Short form were used to collect data.

Results

The prevalence of PMS was 87.7% and the median score on the Eco-anxiety scale was 13. The direct effect of eco-anxiety on PMS was positive and statistically significant (β = 0.606, p < 0.001). The direct effect of physical activity on PMS was negative and statistically significant (β = −0.067, p = 0.029).

Conclusion

The results of this study suggest that eco-anxiety levels affect PMS symptoms and that physical activity has a modulatory effect on the relationship between eco-anxiety and PMS. Psychosocial interventions aimed at reducing eco-anxiety and lifestyle changes that promote physical activity should be considered in interventions to manage premenstrual syndrome. It is important that women's health nurses and midwives, who have an important role in protecting and promoting women's health, consider eco-anxiety in their interventions.

背景：气候变化相关的生态焦虑被认为是经前综合征（PMS）的危险因素。有规律的体育活动可以有效地减少经前症候群相关的生理和心理症状。本研究旨在探讨体力活动对气候变化相关生态焦虑与经前症候群之间的调节作用。方法：于2025年2 - 3月对某高校卫生系635名女学生进行横断面及相关研究。采用个人信息表、经前症候群量表、生态焦虑量表和国际体育活动问卷-短表进行数据收集。结果：经前综合症患病率为87.7%，生态焦虑量表得分中位数为13分。生态焦虑对经前症候群的直接影响为正且有统计学意义（β = 0.606, p）。结论：生态焦虑水平影响经前症候群的症状，体力活动对生态焦虑与经前症候群的关系具有调节作用。在管理经前综合症的干预措施中，应考虑旨在减少生态焦虑和改变生活方式以促进身体活动的社会心理干预措施。重要的是，在保护和促进妇女健康方面发挥重要作用的妇女保健护士和助产士在其干预措施中考虑到生态焦虑。

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引用次数: 0

Extracurricular Activities and Mental Health: Insights From Pharmacy Students in Saudi Arabia 课外活动与心理健康：来自沙特阿拉伯药学学生的见解。

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2026-01-08 DOI: 10.1111/jep.70348

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.

心理健康障碍被广泛认为是全球大学生面临的重大挑战。在大学生中，参加课外活动与减少心理压力和提高整体幸福感有关。目的：本研究旨在探讨参与课外活动是否对哈立德国王大学药学专业学生的抑郁、焦虑和压力有可测量的影响。方法：对220名药学专业学生进行横断面调查。数据包括人口统计、DASS-21分数、之前的心理健康诊断和详细的课外活动参与情况（类型、频率、每周小时数）。分析方法包括t检验、方差分析、回归模型。结果：临床显著症状常见：抑郁38%，焦虑52%，应激35%。虽然79%的人报告了课外活动（主要是志愿者、社会、文化和体育活动），但参与者和非参与者在DASS-21得分上没有统计学上的显著差异（所有子量表的p < 0.05）。即使是活动的类型和频率也不能产生有意义的保护作用。女性性别和先前的心理健康诊断是最强烈的、独立的心理困扰预测因素。结论：参与课外活动，按照目前的结构，对哈立德国王大学药学专业学生的抑郁、焦虑或压力得分没有显著影响。尽管广泛参与，但高度的心理困扰仍然存在，尤其是在女学生和有前科的学生中。这些发现表明，除了简单地鼓励课外活动外，还需要有针对性的、注重质量的心理健康干预措施。

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引用次数: 0

Is Consent Truly ‘Informed’? Addressing the Challenges and Pitfalls in Counselling Patients for Medical Interventions 同意真的是“知情的”吗？解决的挑战和陷阱，在咨询病人的医疗干预。

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2026-01-08 DOI: 10.1111/jep.70354

Isaac K. S. Ng

引用次数: 0

Adherence to Protocol Registration Among Systematic Reviews on Photobiomodulation: A Meta-Research Study 在光生物调节的系统综述中遵守方案注册：一项元研究。

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2026-01-08 DOI: 10.1111/jep.70346

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

Aims and Objectives

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/.

目的和目的：本荟萃研究绘制了光生物调节（PBM）的系统综述，包括低水平激光治疗（LLLT）和发光二极管（LED）模式，以评估方案是否注册，已发表的综述是否遵守并更新了其PROSPERO记录，以及综述之间是否发生主题冗余。方法：于2025年6月2日在MEDLINE（通过PubMed）和Epistemonikos中进行综合检索。提取的数据包括方案注册、注册类型、PROSPERO上的更新状态、注册方案与已发表综述之间的偏差、主题冗余以及证据评估工具的确定性。结果：1999年至2025年间共发表了285篇系统综述（有或没有荟萃分析），其中约40%涉及牙科和口腔面部功能障碍。其中，129篇评论（45%）有注册的协议，125篇（96.9%）在PROSPERO平台上，4篇（3.1%）在其他注册，包括INPLASY和开放科学框架。尽管已发布，72%（90/125）的普洛斯彼罗记录仍被归类为“正在进行”，反映了登记状态的有限更新。22.4%（29/129）的综述出现注册方案与已发表方案之间的偏差，主要涉及意外结果、检索策略的修改或分析方法的改变。重复是常见的，有多个综述针对相同或高度相似的临床问题，如20篇关于正畸治疗的综述和18篇关于颞下颌功能障碍的综述。对证据确定性的评估也很有限，只有18.5%（53/285）的综述采用了GRADE方法，这仅在meta分析的综述中报道。结论：这些发现突出了方案注册建议的依从性低，状态更新有限，重复程度高，以及证据确定性评估不频繁。加强前瞻性登记和透明报告对于确保对PBM的系统审查提供可信的、可重复的证据来指导临床决策和告知医疗保健政策至关重要。研究方案可在https://osf.io/9vknf/上获得。

{"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}

引用次数: 0

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) 隐性营养不良大疱性表皮松解症儿科患者的跨学科治疗方法：来自圣琼德达姆苏医院（西班牙巴塞罗那）皮肤科服务和姑息治疗和复杂慢性患者团队的经验。

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2026-01-08 DOI: 10.1111/jep.70345

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.

背景和目的：大疱性表皮松解症是一种罕见的遗传性疾病，引起皮肤粘膜脆弱，需要专业的多学科治疗。将姑息治疗纳入大疱性表皮松解症治疗已被证明对症状控制和社会心理支持有益。本研究的目的是分析圣琼德达姆苏医院皮肤科和姑息治疗和复杂慢性患者小组对隐性营养不良大疱性表皮松解症儿童患者的跨学科干预。方法：采用描述性定性设计，探讨圣琼德达姆苏医院隐性营养不良大疱性表皮松解症患儿家长及医护人员的治疗经历。对内部协议进行了分析，并进行了公开的在线调查。在DEBRA España的支持下，通过有目的的抽样招募了家庭，同时从皮肤病服务和姑息治疗和复杂慢性患者团队邀请了医疗保健专业人员。结果：SJDH皮肤科与姑息治疗和复杂慢性患者团队之间的联合跨学科干预，以姑息治疗方法为基础，为患者及其家属提供从出生到整个生命过程的全面和持续的支持。它结合了精神关怀和社区协调，促进自治和社会包容，并与奥地利EB House等专业中心建立的国际最佳实践保持一致。这一模式为EB患者的护理提供了可复制的基准。结论：本定性研究表明，以姑息治疗为基础，从早期阶段持续实施的跨学科护理模式，可提高RDEB患儿及其家庭的生活质量。临床和社会心理团队之间的协调，加上以人为本的护理，增强了家庭自主权，促进了包容，并解决了整个生命过程中的综合需求。

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引用次数: 0

Comparison of Self-Reported Evidence-Practice Gap Improvement Strategies Among Japanese and Brazilian Dentists 日本和巴西牙医自我报告证据-实践差距改善策略的比较。

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2026-01-08 DOI: 10.1111/jep.70355

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.

目的和目的：本研究旨在探讨不同国家的牙医如何优先考虑解决证据-实践差距（EPG）的策略。目的是(1)评价和比较日本和巴西牙医改善证据-实践差距（EPG）策略的优先级；(2)分析自我报告的EPG与改善策略之间的关系。方法：采用横断面研究方法，对日本136名牙医和巴西110名牙医进行两轮网络问卷调查。自我报告的EPG通过定性和定量评估的混合方法，使用与最小干预牙科（MID）相关的三个项目进行评估。参与者根据定性内容分析得出的项目对EPG改进策略进行定量优先排序。逻辑回归检验了自我报告的EPG与这些陈述的改善策略之间的关系。结果：通过定性内容分析，确定了7种EPG改进策略。日本牙医选择的最高优先级是“审查保险制度和报销，以实现循证牙科的实践”（65%）。在巴西，最优先考虑的是“鼓励对临床实践有用的牙科研究并传播其发现”（74%）。这两个国家的第二优先事项是“加强继续教育项目，使牙医能够实践循证牙科”（日本为49%，巴西为65%）。Logistic回归显示，在日本，“审查保险制度和报销，以实现循证牙科的实践”和在巴西，“制定和传播易于理解的临床实践指南”与这些受访者中自我报告的EPG显著相关(p结论：该混合方法研究确定了改善日本和巴西EPG的七种策略。在日本改善保险制度和报销，在巴西制定和传播明确的临床实践指南，可以有效地弥合EPG。加强继续教育是两国的第二优先事项。

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引用次数: 0

Shared Decision Making or Sharing Information? 共享决策还是共享信息？

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2026-01-08 DOI: 10.1111/jep.70352

David W. Chambers

Rationale

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.

基本原理：即使提供相同的信息，患者和医疗保健专业人员也可能适当地做出相互矛盾的决定。目的和目标：引入两个人共同决策的概念，而不是个人决策。方法：基于二人决策理论给出了共享决策的操作定义，演示了如何识别共享决策，区分共享决策和其他常用方法，并报告了计算机模拟的结果，该结果展示了给定共同信息的各种决策方法的相互满足模式。结果：与其他方法相比，共享决策产生了更稳定和令人满意的治疗决策，并且具有实现更少道德问题结果的额外优势。结论：除了共享信息外，共享决策优于患者或医护人员独立做出的决策。

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引用次数: 0

Comment on “The Correlation between the Level of Commitment to Ethical Values and Moral Sensitivity of Associate Degree Students” 评《副学士学位学生伦理价值观承诺水平与道德敏感性的关系》

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2026-01-08 DOI: 10.1111/jep.70327

Amnuay Kleebayoon, Viroj Wiwanitkit

引用次数: 0

Why Desirable Difficulties ‘Work’: A Review of the Evidence From Cognitive and Educational Psychology and Some Caveats for the Health Professions Education Field 为什么理想的困难“起作用”：来自认知和教育心理学的证据综述以及卫生专业教育领域的一些注意事项。

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2026-01-08 DOI: 10.1111/jep.70349

Sally Binks

Background

‘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.

背景：“理想困难”是一个起源于认知心理学文献的概念，指的是那些倾向于阻碍初始学习，但却能促进知识和技能长期保留和转移的实践。已要求卫生专业的教育工作者在课堂和临床教学实践中使用和整合适当的困难，并保证这些困难“有效”。但它们是如何工作的呢？对困难做法机制的深入了解可以丰富教育工作者的实践，并为进一步研究如何以及何时在卫生专业教育中有效地采用这些做法提供动力。目的：在本文中，我回顾了认知心理学和教育文献的证据，不仅为证据的有效性和边界条件的理想困难，而且为他们提出的机制。我还审查了关于如何在卫生专业教育中部署和调查这些做法的报告。结果：在各个领域和学科中，有足够的有力证据表明，理想的困难是形成性测试，或与学习评估相对的学习评估，交错或混合实践，或解决问题，分布或间隔实践，以及各种生产性失败方法。这些实践被假设在个体层面上具有各种认知、元认知、动机和情感机制。在卫生专业教育文献中，有一些证据表明，这些实践是如何定义的，以及它们的理论基础是缺乏明确的。结论：虽然有充分的证据支持理想困难的有效性，但谨慎对待其实施至关重要。更大的感知困难或不流利不应该不加批判地与更大的教育效益混为一谈。在已出版的卫生专业教育文献中，缺乏对什么是什么不是的明确认识，这是一种令人满意的困难实践。教育工作者和研究人员都应该对理想困难的定义和理论基础有一个清晰的认识，以推动实践和理论的发展。

{"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}

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