Journal of evaluation in clinical practice最新文献

Background: The selection of patients who are going to be admitted to an emergency department observation unit (EDOU) is essential for the good management of these units, intended fundamentally to avoid unnecessary hospitalization of patients. This is especially important when dealing with older patients. It would be important to know what factors are associated with discharge home and to have a clinical predictive scale that appropriately selects older patients who are going to be admitted to an EDOU.

Methods: A retrospective cross-sectional study was conducted of all patients ≥65 years of age assisted in 48 Spanish Emergency Departments for 7 consecutive days and were admitted to the EDOU. Demographics-functional, vital signs data and initial laboratory results were analyzed to investigate its association with discharge home and develop and validate a prediction model for discharge home from EDOU. Multivariable logistic regression was performed to develop a prediction model, and a scoring system was created.

Results: Among 5457 patients admitted to the EDOU from the emergency room, 2508 (46%) patients were discharged home, and 2949 (54%) were admitted to the hospital. Five variables were strongly associated with discharge home: the absence of fever (adjusted OR: 3.61, 95% CI:1.53-8.54), Glasgow Coma Scale score of 15 points (2.80, 1.63-4.82), absence of tachypnea (2.51, 1.74-3.64) or leukocytosis (2.07, 1.70-2.52) and oxygen saturation >94% (2.00, 1.64-2.43). The final model achieved an area under the receiver operating characteristic curve of 0.648 (IC95% = 0.627-0.668) in the development cohort and 0.635 (0.614-0.656) in the validation cohort.

Conclusions: There are factors associated with a greater probability of discharge home of older patients admitted to EDOUs. Prediction at the individual level remains elusive, as the best model obtained in this study did not have sufficient validity to be applied in the clinical setting.

Objective: Liver transplant recipients are at a high risk of infection during the first month. Therefore, it is crucial to implement isolation measures correctly to prevent the spread of nosocomial infections. Evidence-based practices and proper implementation of isolation measures can significantly reduce morbidity and mortality. The study aimed to investigate the impact of nurses' attitudes towards evidence-based nursing on their compliance with isolation measures.

Methods: This is a descriptive study conducted between October 2023 and January 2024, with the participation of 137 nurses working in the organ transplant clinics of a university hospital in Turkey. Data was collected using a participant introduction form, the attitudes towards evidence-based nursing scale, and the compliance with isolation measures scale.

Results: The mean total score for the scale of attitudes towards evidence-based nursing among nurses was 55.95 ± 10.43 (15-75). Similarly, the mean total score for the scale of compliance with isolation measures was 71.44 ± 13.53 (18-90). Both scores were above the middle level. The study found a moderately significant positive correlation between attitudes towards evidence-based nursing and compliance with isolation measures (r: 0.670, p: 0.000). The regression model showed that the attitude towards evidence-based nursing explained 44.9% of the positivity towards isolation measures (R² = 0.449).

Conclusions: The study found a positive correlation between nurses' positive attitudes towards evidence-based nursing and their compliance with isolation precautions when caring for liver transplant patients. This highlights the significance of evidence-based nursing in patient care and the importance of adhering to isolation measures to prevent nosocomial infections.

Rationale, aims and objectives: Psychometrics of the Chinese Life Attitude Self-rating Questionnaire for Breast Cancer (LASQ-BC) has not yet been conducted in a larger sample of women with breast cancer. This study aimed to examine the reliability, validity, and sensitivity of the LASQ-BC in Chinese mainland female breast cancer patients.

Method: This is a cross-sectional study. Reliability was determined by Cronbach's α and Guttman split-half coefficient. Convergent and discriminant validity were evaluated via item-subscale and item-total score correlations. Factorial validity was estimated using a principal component analysis with varimax rotation. Sensitivity was identified via Cohen's effect size (ES) and an independent sample t-test between the new and recurrent cases. Multiple linear regression analysis was used to further examine sensitivity of the LASQ-BC under the influence of newly diagnosed breast cancer (yes vs. no).

Results: A total of 429 patients completed the questionnaire. Cronbach's α of the LASQ-BC was 0.96, ranging from 0.86 to 0.92 for the four subscales (i.e., choice and responsibility, life meaning, benevolence, and life experiences). The Guttman split-half coefficient was 0.90. The hypothesised item-subscale and item-total score correlations were higher than the critical value of 0.50. Four factors were extracted from the 23 items, explaining 69.29% of the total variance. Eligible ES (range: 0.38-0.48) was found in the four subscales and total score between the new and recurrent cases (independent sample t-test), and under the influence of newly diagnosed breast cancer (yes vs. no; multiple linear regression analysis).

Conclusion: The Chinese LASQ-BC has acceptable reliability, validity, and sensitivity in women with breast cancer of mainland China. It can be used to female breast cancer patients as an invaluable metric and a crucial instrument for assessing and discerning those grappling with a suboptimal life attitude, and in gauging the efficacy of psychological interventions tailored to enhance this perspective.

Rationale: Self-measured blood pressure (SMBP) monitoring is crucial for hypertension management, yet its adoption, particularly among disadvantaged populations, remains low. 'Love Your Heart' is a quality improvement program providing free standard SMBP devices to hypertensive patients, aiming to enhance adoption and assess its impact on blood pressure control.

Aims and objectives: This study evaluates the 'Love Your Heart' program's implementation success through assessing adoption rates and exploring changes in systolic blood pressure (SBP) among participants. We aim to understand factors influencing adoption and potential benefits of SMBP monitoring in a diverse, socially disadvantaged patient population.

Methods: We retrospectively evaluated the 'Love Your Heart' program using electronic health records (EHR) at a primary care site in Chicago. Adult patients with hypertension were enroled in the 6-month program, which included education sessions and free SMBP devices. Adoption was measured by participation in program components, and changes in SBP were analysed based on adoption status. Statistical analyses were conducted using SAS software, adhering to STROBE reporting guidelines.

Results: Of 621 eligible patients, 104 participated, with 83 included in the evaluation. Despite all participants receiving free SMBP devices, adoption rates were modest, with only 7% sharing readings with the care team. However, patients who received device instructions demonstrated greater decreases in SBP compared to those who did not. Although not statistically significant, clinically meaningful decreases in SBP were observed among adopters.

Conclusion: The 'Love Your Heart' program highlights the challenges of promoting SMBP monitoring among disadvantaged patient populations. While providing free devices addresses access barriers, low reporting to the care team suggests the need for further support mechanisms. Future research should explore strategies to enhance SMBP adoption and integration into clinical care, particularly in settings lacking automated data transmission systems.

Background: At-risk infants are predisposed to major and minor neurodevelopmental disorders due to various biological and environmental factors.

Objective: This study aimed to investigate the relationship between gross motor maturation from 1 to 18 months and gross motor performance in the preschool period, as well as the risk of developmental coordination disorder (DCD) in at-risk infants, referred to the Family Counselling Center of the Turkish Spastic Children's Foundation (FCCTSCF) between 2014 and 2016.

Methods: Fifty-seven children who had their gross motor maturation assessed between 1 and 18 months at the FCCTSCF were re-evaluated in the preschool period. The Alberta Infant Motor Scale (AIMS) was used to evaluate gross motor maturation between 1 and 18 months. In contrast, the Gross Motor Function Measure-88 and the Developmental Coordination Disorder Questionnaire were used to assess gross motor performance in the preschool period.

Results: Of the at-risk infants included in the study, 45.6% were evaluated as having typical development, 21% were identified as having cerebral palsy (CP), and 33.3% were determined to be at risk for DCD. Children with CP and those at risk for DCD were found to have lower percentile ranks on the past AIMS test compared to the healthy group (p = 0.001). A significant positive correlation was found between the Alberta Infant Motor Scale and the Gross Motor Function Measure-88 (p = 0.014).

Conclusion: In the clinical follow-up of at-risk infants, those who scored low on AIMS should be monitored for future risk of DCD and minor disorders, even if major neurological issues such as cerebral palsy are not detected.