Peter J. Hahn, Daniel Y. Johnson, Joanne Wang, Carly Lusk, Samantha Allen, Fabiana S. Araújo, Daniel Yohanna, Erin M. Staab, Neda Laiteerapong
Rationale
Over 30% of adults in the United States have symptoms of depressive or anxiety disorders. The majority of these patients are treated only in primary care and have suboptimal outcomes. The Collaborative Care Model (CoCM) is designed to address this problem.
Aims and Objectives
This study evaluated the implementation and effectiveness of CoCM at an urban academic medical center primary care clinic.
Methods
Retrospective chart review and analysis informed by the RE-AIM framework.
Results
Across 148 patients, mean PHQ-9 scores decreased by 4.8 (SD, 5.8, p < 0.001) and GAD-7 scores decreased by 5.6 (SD, 5.7, p < 0.001). Overall adoption rate was 36% and differed between attending physicians/APNs (50%) and residents (32%). Implementation showed fidelity to measurement-based care, but only 40% of cases were reviewed with the psychiatrist.
Conclusion
A real-world CoCM can improve symptoms of depression and anxiety for adults; however, trainee adoption and adherence to psychiatric case reviews may merit special attention.
{"title":"Evaluating the Real-World Implementation and Effectiveness of a Collaborative Care Model for Adults with Depression and Anxiety at an Urban, Academic Hospital","authors":"Peter J. Hahn, Daniel Y. Johnson, Joanne Wang, Carly Lusk, Samantha Allen, Fabiana S. Araújo, Daniel Yohanna, Erin M. Staab, Neda Laiteerapong","doi":"10.1111/jep.70332","DOIUrl":"10.1111/jep.70332","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Over 30% of adults in the United States have symptoms of depressive or anxiety disorders. The majority of these patients are treated only in primary care and have suboptimal outcomes. The Collaborative Care Model (CoCM) is designed to address this problem.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>This study evaluated the implementation and effectiveness of CoCM at an urban academic medical center primary care clinic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective chart review and analysis informed by the RE-AIM framework.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Across 148 patients, mean PHQ-9 scores decreased by 4.8 (SD, 5.8, <i>p</i> < 0.001) and GAD-7 scores decreased by 5.6 (SD, 5.7, <i>p</i> < 0.001). Overall adoption rate was 36% and differed between attending physicians/APNs (50%) and residents (32%). Implementation showed fidelity to measurement-based care, but only 40% of cases were reviewed with the psychiatrist.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A real-world CoCM can improve symptoms of depression and anxiety for adults; however, trainee adoption and adherence to psychiatric case reviews may merit special attention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145654485","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}
Conversation Club is a community-based intervention developed to support social and conversation skills in both neurodiverse and neurotypical children who may need additional support in these areas. The purpose of this preliminary evaluation is to examine the efficacy of Conversation Club delivered in the local setting.
Methods
This mixed-methods case study involved a child-caregiver dyad. Pre-post intervention data were collected through interview and battery of tests assessing social skills (e.g., Social Skills Improvement System; Social Responsiveness Scale).
Results
Both the child and caregiver shared that they were satisfied with Conversation Club and felt that the child benefitted from the curriculum. Results also indicated that the child made a reliable change on both self- and caregiver-measures of social and conversation skills, but results were mixed for behaviour indices. Interestingly, the child rated their social skills as average before and after intervention, compared to elevated social impairments perceived by the caregiver at both time points.
Conclusion
An overall strength of this case study was to include the perspective of the child participant, in addition to the caregiver report, to evaluate the social validity and acceptance of the intervention for teaching conversation skills.
{"title":"Child and Caregiver Perspectives on Conversation Club Therapy: A Case Study","authors":"Theresa Pham, Boomerang Health Group","doi":"10.1111/jep.70337","DOIUrl":"10.1111/jep.70337","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale, Aims and Objectives</h3>\u0000 \u0000 <p>Conversation Club is a community-based intervention developed to support social and conversation skills in both neurodiverse and neurotypical children who may need additional support in these areas. The purpose of this preliminary evaluation is to examine the efficacy of Conversation Club delivered in the local setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This mixed-methods case study involved a child-caregiver dyad. Pre-post intervention data were collected through interview and battery of tests assessing social skills (e.g., Social Skills Improvement System; Social Responsiveness Scale).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both the child and caregiver shared that they were satisfied with Conversation Club and felt that the child benefitted from the curriculum. Results also indicated that the child made a reliable change on both self- and caregiver-measures of social and conversation skills, but results were mixed for behaviour indices. Interestingly, the child rated their social skills as average before and after intervention, compared to elevated social impairments perceived by the caregiver at both time points.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>An overall strength of this case study was to include the perspective of the child participant, in addition to the caregiver report, to evaluate the social validity and acceptance of the intervention for teaching conversation skills.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12670064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145654496","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}
The American College of Radiology (ACR) Appropriateness Criteria (AC) were designed to guide evidence-based imaging decisions. Increasingly, however, insurers and electronic health record–embedded clinical decision support (CDS) systems use these criteria to determine coverage, shifting their role from clinical guide to gatekeeping tool. This commentary examines the disconnect between policy and practice, driven by low physician awareness, educational gaps, and difficulty navigating the criteria. When applied rigidly, particularly in insurance reimbursement, these shortcomings risk deepening diagnostic inequities. The example of breast cancer screening for patients with dense breast tissue illustrates how restrictive application can limit access to higher-sensitivity imaging and exacerbate disparities. We argue that guidelines should guide, not govern, and that insurer reliance must be paired with physician training, transparent methodology, and adaptability. Policy reform, expanded coverage mandates, and integration of AC education into medical training are needed to align guidelines with both clinical realities and patient needs.
{"title":"Appropriateness Criteria, Insurance Policies, and the Erosion of Clinical Judgement","authors":"Jacob Duncan","doi":"10.1111/jep.70329","DOIUrl":"https://doi.org/10.1111/jep.70329","url":null,"abstract":"<div>\u0000 \u0000 <p>The American College of Radiology (ACR) Appropriateness Criteria (AC) were designed to guide evidence-based imaging decisions. Increasingly, however, insurers and electronic health record–embedded clinical decision support (CDS) systems use these criteria to determine coverage, shifting their role from clinical guide to gatekeeping tool. This commentary examines the disconnect between policy and practice, driven by low physician awareness, educational gaps, and difficulty navigating the criteria. When applied rigidly, particularly in insurance reimbursement, these shortcomings risk deepening diagnostic inequities. The example of breast cancer screening for patients with dense breast tissue illustrates how restrictive application can limit access to higher-sensitivity imaging and exacerbate disparities. We argue that guidelines should guide, not govern, and that insurer reliance must be paired with physician training, transparent methodology, and adaptability. Policy reform, expanded coverage mandates, and integration of AC education into medical training are needed to align guidelines with both clinical realities and patient needs.</p>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145619308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The Intolerance of Uncertainty Scale (IUS-12) is widely used in both clinical and community studies. Due to the length and inconsistent factor structure of the IUS-12, an abbreviated version consisting of five items (IUS-5) has been proposed. However, no study has examined its psychometric properties aside from the preliminary work by its developers. The current study investigated the factor structure of the IUS-5 as well as its reliability and validity.
Method
A sample of 315 nurses completed an online self-report questionnaire during the COVID-19 pandemic.
Results
Confirmatory factor analysis of the IUS-5 suggested a deletion of one item. The final analysis supported a one-factor solution on the remaining four items (IUS-4) with a McDonald's omega of 0.77. The validity of IUS-4 was assessed by testing its positive and negative correlations with existing related and contrary measures, respectively. Further, the validity of the IUS-4 was supported through known-group validation.
Conclusions
This is the first psychometric assessment of the IUS-5 measure of intolerance of uncertainty in a sample of nurses. Results from the current study supported a shorter measure of four items. However, more work needs to be conducted to examine the IUS-4 and IUS-5 in samples of healthcare providers with different cultural and linguistic backgrounds.
{"title":"Psychometric Properties of Intolerance of Uncertainty Scale (IUS-5) in a Sample of Nurses: A Methodological Study","authors":"Faryal Khamis, Abdallah Badahdah, Nasser Aloud","doi":"10.1111/jep.70320","DOIUrl":"https://doi.org/10.1111/jep.70320","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objective</h3>\u0000 \u0000 <p>The Intolerance of Uncertainty Scale (IUS-12) is widely used in both clinical and community studies. Due to the length and inconsistent factor structure of the IUS-12, an abbreviated version consisting of five items (IUS-5) has been proposed. However, no study has examined its psychometric properties aside from the preliminary work by its developers. The current study investigated the factor structure of the IUS-5 as well as its reliability and validity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A sample of 315 nurses completed an online self-report questionnaire during the COVID-19 pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Confirmatory factor analysis of the IUS-5 suggested a deletion of one item. The final analysis supported a one-factor solution on the remaining four items (IUS-4) with a McDonald's omega of 0.77. The validity of IUS-4 was assessed by testing its positive and negative correlations with existing related and contrary measures, respectively. Further, the validity of the IUS-4 was supported through known-group validation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This is the first psychometric assessment of the IUS-5 measure of intolerance of uncertainty in a sample of nurses. Results from the current study supported a shorter measure of four items. However, more work needs to be conducted to examine the IUS-4 and IUS-5 in samples of healthcare providers with different cultural and linguistic backgrounds.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145619309","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}
Lara Joana Santos Caxico-Vieira, Elindayane Vieira de Souza, Maria Amélia Joyce da Silva Moura, Rafaella de Oliveira Santos Silva, Alessandra Rezende Mesquita, Tácio de Mendonça Lima, Divaldo Pereira de Lyra Jr.
Introduction
Assessing health service quality, particularly through indicators, is essential for improvement and accountability. However, the literature lacks a comprehensive analysis of how drug dispensing quality is measured.
Objective
This scoping review protocol aims to identify the validated indicators used to assess the quality of drug dispensing in community pharmacies.
Methods
A scoping review will follow the JBI Reviewer's Manual and PRISMA-ScR guidelines. An electronic search will be conducted in MEDLINE (PubMed), Embase, Scopus, Web of Science and LILACS, using search terms related to “quality indicators, health care”, “dispensing” and “community pharmacies”, along with their synonyms. Study selection and data extraction will be performed independently by two reviewers, disagreements will be resolved by a third. Findings will be synthesized narratively.
Conclusion
This study will identify and critically analyze quality indicators for drug dispensing in community pharmacies, bridging fragmented practices with evidence-based standards to guide safer, more effective pharmaceutical care.
评估保健服务质量，特别是通过指标，对改进和问责至关重要。然而，文献缺乏对如何测量药品调剂质量的全面分析。目的本范围审查方案旨在确定可用于评估社区药房药品调剂质量的有效指标。方法根据JBI审稿人手册和PRISMA-ScR指南进行范围审查。将在MEDLINE （PubMed）、Embase、Scopus、Web of Science和LILACS中进行电子搜索，使用与“质量指标、卫生保健”、“配药”和“社区药房”及其同义词相关的搜索词。研究选择和数据提取将由两位审稿人独立完成，分歧将由第三位审稿人解决。研究结果将以叙述的方式进行综合。结论本研究将识别并批判性地分析社区药房药品调剂的质量指标，将支离破碎的做法与循证标准联系起来，指导更安全、更有效的药学服务。
{"title":"Quality Indicators for Drug Dispensing in Community Pharmacies: A Scoping Review Protocol","authors":"Lara Joana Santos Caxico-Vieira, Elindayane Vieira de Souza, Maria Amélia Joyce da Silva Moura, Rafaella de Oliveira Santos Silva, Alessandra Rezende Mesquita, Tácio de Mendonça Lima, Divaldo Pereira de Lyra Jr.","doi":"10.1111/jep.70333","DOIUrl":"https://doi.org/10.1111/jep.70333","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Assessing health service quality, particularly through indicators, is essential for improvement and accountability. However, the literature lacks a comprehensive analysis of how drug dispensing quality is measured.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This scoping review protocol aims to identify the validated indicators used to assess the quality of drug dispensing in community pharmacies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A scoping review will follow the JBI Reviewer's Manual and PRISMA-ScR guidelines. An electronic search will be conducted in MEDLINE (PubMed), Embase, Scopus, Web of Science and LILACS, using search terms related to “quality indicators, health care”, “dispensing” and “community pharmacies”, along with their synonyms. Study selection and data extraction will be performed independently by two reviewers, disagreements will be resolved by a third. Findings will be synthesized narratively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study will identify and critically analyze quality indicators for drug dispensing in community pharmacies, bridging fragmented practices with evidence-based standards to guide safer, more effective pharmaceutical care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70333","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145619261","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}
This study aimed to evaluate the effect of an interprofessional patient safety training programme on students' attitudes and interprofessional collaboration.
Methods
A quasi-experimental study with a nonequivalent control group was conducted at Shahid Rahnemoon Hospital, affiliated with Shahid Sadoughi University of Medical Sciences. Seventy students participated in the 2023–2024 internship courses, with 35 students in each group. Participants were assigned to two groups using cluster randomization based on their internal medicine rotation schedule. The intervention group received interprofessional education, while the control group received uniprofessional training. The intervention group engaged in case-based learning within mixed medical and nursing teams; the control group completed the same activities in separate uniprofessional groups. Two self-report questionnaires assessed attitudes towards patient safety and professionalism, as well as performance in interprofessional collaboration. Assessments occurred before the intervention, 1 month after, and 3 months after. Data analysis included descriptive and inferential statistics, specifically independent t tests, repeated measures ANOVA, and χ2 tests, all conducted at a 95% confidence interval using SPSS version 26.
Results
The study revealed a significant difference in both attitude (F = 19.4, p < 0.0001, η² = 0.28) and performance (F = 4.53, p = 0.013, η² = 0.060) across the three assessments.
Conclusion
The findings demonstrate that interprofessional training improved students' attitudes and produced a moderate effect on performance. Sustained performance improvement may require longitudinal training. Future research should account for cultural factors and the structure of educational and healthcare systems.
本研究旨在评估跨专业患者安全培训计划对学生态度和跨专业合作的影响。方法在Shahid Sadoughi医科大学附属的Shahid Rahnemoon医院进行非等效对照组的准实验研究。70名学生参加了2023-2024年的实习课程，每组35名。根据其内科轮换时间表，采用聚类随机法将参与者分为两组。干预组接受跨专业培训，对照组接受非专业培训。干预组在混合医疗和护理团队中进行基于案例的学习；对照组在不同的非专业小组中完成相同的活动。两份自我报告问卷评估了对患者安全和专业精神的态度，以及在跨专业合作中的表现。评估分别在干预前、干预后1个月和干预后3个月进行。数据分析包括描述性统计和推断性统计，特别是独立t检验、重复测量方差分析和χ2检验，均使用SPSS version 26以95%置信区间进行。结果三种评估方法在态度（F = 19.4, p < 0.0001, η²= 0.28）和工作表现（F = 4.53, p = 0.013, η²= 0.060）上存在显著差异。结论跨专业训练改善了学生的态度，并对成绩产生了适度的影响。持续的绩效改进可能需要纵向培训。未来的研究应该考虑文化因素以及教育和医疗系统的结构。
{"title":"Interprofessional Patient Safety Education: Assessing Students' Interprofessional Collaboration, Attitudes Towards Safety and Professionalism","authors":"Samaneh Mirzaei, Fatemeh Keshmiri, Mohsen Gholinataj Jelodar, Mandana Shirazi","doi":"10.1111/jep.70319","DOIUrl":"https://doi.org/10.1111/jep.70319","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>This study aimed to evaluate the effect of an interprofessional patient safety training programme on students' attitudes and interprofessional collaboration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A quasi-experimental study with a nonequivalent control group was conducted at Shahid Rahnemoon Hospital, affiliated with Shahid Sadoughi University of Medical Sciences. Seventy students participated in the 2023–2024 internship courses, with 35 students in each group. Participants were assigned to two groups using cluster randomization based on their internal medicine rotation schedule. The intervention group received interprofessional education, while the control group received uniprofessional training. The intervention group engaged in case-based learning within mixed medical and nursing teams; the control group completed the same activities in separate uniprofessional groups. Two self-report questionnaires assessed attitudes towards patient safety and professionalism, as well as performance in interprofessional collaboration. Assessments occurred before the intervention, 1 month after, and 3 months after. Data analysis included descriptive and inferential statistics, specifically independent <i>t</i> tests, repeated measures ANOVA, and <i>χ</i><sup>2</sup> tests, all conducted at a 95% confidence interval using SPSS version 26.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study revealed a significant difference in both attitude (<i>F</i> = 19.4, <i>p</i> < 0.0001, <i>η</i>² = 0.28) and performance (<i>F</i> = 4.53, <i>p</i> = 0.013, <i>η</i>² = 0.060) across the three assessments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The findings demonstrate that interprofessional training improved students' attitudes and produced a moderate effect on performance. Sustained performance improvement may require longitudinal training. Future research should account for cultural factors and the structure of educational and healthcare systems.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145619307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This cross-sectional study aims to investigate the differences between parents and nurses in perceived educational support for pediatric postoperative pain management. It is hypothesized that there is significant difference between the participants that leads to insufficient control of pain.
Methods
Parents of children undergoing major surgery and surgical nurses were invited to respond to the electronic questionnaires. The prioritization of specific information, children's postoperative pain experience, the preferred method for receiving or providing educational support and participants' satisfaction with the educational support was investigated.
Results
We included 214 participants, including 50 surgical nurses and 164 parents. How to evaluate pain severity in child was rated as the most import information in parents, while it was how to command PCAP in nurses. Significant differences were detected in the importance scores of the following: (1) indication of PCAP [4.5 (2–5) vs. 5 (2–5), p = 0.0241], (2) how to evaluate pain severity in the child [4.5 (1–5) vs. 5 (3–5), p = 0.0482], and (3) target of postoperative pain management [4.5 (2–5) vs. 5 (3–5), p = 0.0130]. There was significantly difference in the preferred method to receive/provide educational support between nurses and parents (p = 0.0100). Parents were significantly less satisfied with the educational support [5 (2–5) vs. 4 (1–5), p = 0.0316]. The pain score at both movement and rest at 24, 48 and 72 h was significantly decreased over time, 6 (5–7), 5 (4–6), 4 (3–4) with p < 0.0001, < 0.0001 and 0.0004 and 3 (3–4), 3 (2–3), 2 (2–3) with p = 0.0010, < 0.0001 and 0.1002, respectively. The median (IQR) press number at 24, 48 and 72 h were 0 (0–1), 1 (0–2) and 1 (1–3), with no significant differences.
Conclusions
Despite the use of PCAP, children experienced moderate postoperative pain owing to low parental engagement. Differences between parents and surgical nurses in the prioritization of specific information may result in insufficient educational support. Further studies are warranted to evaluate the effectiveness of educational programs that address parents' concerns to improve the postoperative pain management in pediatric population.
{"title":"Differences Between Parents and Nurses in Perceived Educational Support for Pediatric Postoperative Pain Management","authors":"Yuanye Hu, Yun Shi","doi":"10.1111/jep.70338","DOIUrl":"https://doi.org/10.1111/jep.70338","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This cross-sectional study aims to investigate the differences between parents and nurses in perceived educational support for pediatric postoperative pain management. It is hypothesized that there is significant difference between the participants that leads to insufficient control of pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Parents of children undergoing major surgery and surgical nurses were invited to respond to the electronic questionnaires. The prioritization of specific information, children's postoperative pain experience, the preferred method for receiving or providing educational support and participants' satisfaction with the educational support was investigated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 214 participants, including 50 surgical nurses and 164 parents. How to evaluate pain severity in child was rated as the most import information in parents, while it was how to command PCAP in nurses. Significant differences were detected in the importance scores of the following: (1) indication of PCAP [4.5 (2–5) vs. 5 (2–5), <i>p</i> = 0.0241], (2) how to evaluate pain severity in the child [4.5 (1–5) vs. 5 (3–5), <i>p</i> = 0.0482], and (3) target of postoperative pain management [4.5 (2–5) vs. 5 (3–5), <i>p</i> = 0.0130]. There was significantly difference in the preferred method to receive/provide educational support between nurses and parents (<i>p</i> = 0.0100). Parents were significantly less satisfied with the educational support [5 (2–5) vs. 4 (1–5), <i>p</i> = 0.0316]. The pain score at both movement and rest at 24, 48 and 72 h was significantly decreased over time, 6 (5–7), 5 (4–6), 4 (3–4) with <i>p</i> < 0.0001, < 0.0001 and 0.0004 and 3 (3–4), 3 (2–3), 2 (2–3) with <i>p</i> = 0.0010, < 0.0001 and 0.1002, respectively. The median (IQR) press number at 24, 48 and 72 h were 0 (0–1), 1 (0–2) and 1 (1–3), with no significant differences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite the use of PCAP, children experienced moderate postoperative pain owing to low parental engagement. Differences between parents and surgical nurses in the prioritization of specific information may result in insufficient educational support. Further studies are warranted to evaluate the effectiveness of educational programs that address parents' concerns to improve the postoperative pain management in pediatric population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145626385","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}
Uncertainty comes in many kinds, is ubiquitous in all parts of clinical work, and is burdensome to physicians, patients, proxies and policy makers. Moreover, it leads to a range of adverse responses such as excessive testing and interventions, overdiagnosis and overtreatment. While the technical aspects of uncertainty are widely accounted for, the burdens of uncertainty need closer scrutiny.
Aims and Objectives
The aim of this article is to investigate the complex burden of uncertainty for clinicians: as health professionals, carers for patients, and human beings facing the unknown.
Method
A conceptual analysis is applied introducing a case to illustrate the diverse aspects of uncertainty reviewed in the literature.
Results
We identify six types of burdens of uncertainty: cognitive, emotional, behavioural, social, moral and existential and show how they play out for clinicians in clinical care for their patients, as health professionals, as caregivers and human beings. Moreover, we suggest specific strategies for bearing these various types of burdens of uncertainty in all roles.
Conclusion
Bearing the burdens of uncertainty is crucial for professional integrity, well-being, and communication with patients, but also for improving the quality, safety, efficiency and sustainability of healthcare.
{"title":"Bearing the Burdens of Medical Uncertainty","authors":"Bjørn Hofmann, Paul K. J. Han","doi":"10.1111/jep.70323","DOIUrl":"https://doi.org/10.1111/jep.70323","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Uncertainty comes in many kinds, is ubiquitous in all parts of clinical work, and is burdensome to physicians, patients, proxies and policy makers. Moreover, it leads to a range of adverse responses such as excessive testing and interventions, overdiagnosis and overtreatment. While the technical aspects of uncertainty are widely accounted for, the burdens of uncertainty need closer scrutiny.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>The aim of this article is to investigate the complex burden of uncertainty for clinicians: as health professionals, carers for patients, and human beings facing the unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A conceptual analysis is applied introducing a case to illustrate the diverse aspects of uncertainty reviewed in the literature.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identify six types of burdens of uncertainty: cognitive, emotional, behavioural, social, moral and existential and show how they play out for clinicians in clinical care for their patients, as health professionals, as caregivers and human beings. Moreover, we suggest specific strategies for bearing these various types of burdens of uncertainty in all roles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Bearing the burdens of uncertainty is crucial for professional integrity, well-being, and communication with patients, but also for improving the quality, safety, efficiency and sustainability of healthcare.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145619093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study developed, implemented, and evaluated the effectiveness of a holistic nursing program based on 24 h Holter monitoring for patients undergoing coronary angiography, aiming to improve nursing quality and reduce the incidence of coronary complications during the perioperative period.
Methods
Eighty patients who underwent coronary angiography from Jan 2023 to Dec 2023 were randomly divided into a study group and a control group. The control group received routine care, while the experimental group received targeted holistic care based on dynamic electrocardiogram monitoring.
Results
The score of nursing quality in the experimental group was significantly higher than the control group (p ＜ 0.05), and the incidence of complications in the experimental group was significantly lower than the control group (P ＜ 0.05). the two groups were comparable.
Conclusion
The overall nursing based on 24 h dynamic electrocardiogram monitoring can significantly improve the nursing quality of coronary angiography and reduce the occurrence of complications.
{"title":"A Holistic Nursing Programme Based on 24 h Holter Monitoring for Coronary Angiography Patients in the Perioperative Period","authors":"Ting Liu, ShuangJiao Xu, Pingping Wang","doi":"10.1111/jep.70326","DOIUrl":"https://doi.org/10.1111/jep.70326","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study developed, implemented, and evaluated the effectiveness of a holistic nursing program based on 24 h Holter monitoring for patients undergoing coronary angiography, aiming to improve nursing quality and reduce the incidence of coronary complications during the perioperative period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Eighty patients who underwent coronary angiography from Jan 2023 to Dec 2023 were randomly divided into a study group and a control group. The control group received routine care, while the experimental group received targeted holistic care based on dynamic electrocardiogram monitoring.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The score of nursing quality in the experimental group was significantly higher than the control group (<i>p</i> ＜ 0.05), and the incidence of complications in the experimental group was significantly lower than the control group (<i>P</i> ＜ 0.05). the two groups were comparable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The overall nursing based on 24 h dynamic electrocardiogram monitoring can significantly improve the nursing quality of coronary angiography and reduce the occurrence of complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70326","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145619092","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}
Tiffany R. Martinez, Antoinette M. Schoenthaler, Devin M. Mann, Hayley Belli, Harris R. Bearnot, Ian Lustbader, Saul Blecker
Background
Medication nonadherence is a common issue among patients with hypertension. Healthcare professionals often overlook medication nonadherence due to limited tools, time constraints, and competing demands. Integrating pharmacy medication fill data into electronic health records (EHRs) presents an opportunity to enhance medication adherence measurement and monitoring in real-time. This study identified facilitators and barriers to addressing adherence to antihypertensive medications by Medical Assistants (MAs), Registered Nurses (RNs), and Primary Care Providers (PCPs) in primary care settings.
Methods
We conducted a qualitative study with, 15 healthcare professionals (5 MAs, 5 RNs, and 5 PCPs) caring for patients with hypertension. Semi-structured interviews, guided by the Consolidated Framework for Implementation Research (CFIR), explored barriers and facilitators related to screening and addressing medication non-adherence during primary care clinical encounters. Thematic analysis and deductive coding were used to analyze the data.
Results
Four major themes emerged: motivation, work infrastructure, capability, and opportunity. MAs and PCPs were motivated to discuss medication adherence and build relationships. Capability varied; RNs were confident in their counseling skills based on their training and patient trust, and PCPs described adherence counseling as part of their role, particularly through motivational interviewing. Work infrastructure presented structural hurdles due to RN workflow limitations and MA role constraints. Opportunity to address non-adherence were constrained by tight schedules and competing clinical demands during brief visits.
Conclusions
RNs and PCPs felt capable in their ability to address medication adherence but cited time and competing demands as significant barriers; conversely, MAs reported motivation but were limited by their role. These findings suggest opportunities for effective management of medication adherence in practice settings through a more coordinated strategy across multiple healthcare professionals.
{"title":"Healthcare Professionals' Perspectives on Addressing Patients' Medication Adherence in Primary Care Settings","authors":"Tiffany R. Martinez, Antoinette M. Schoenthaler, Devin M. Mann, Hayley Belli, Harris R. Bearnot, Ian Lustbader, Saul Blecker","doi":"10.1111/jep.70322","DOIUrl":"https://doi.org/10.1111/jep.70322","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Medication nonadherence is a common issue among patients with hypertension. Healthcare professionals often overlook medication nonadherence due to limited tools, time constraints, and competing demands. Integrating pharmacy medication fill data into electronic health records (EHRs) presents an opportunity to enhance medication adherence measurement and monitoring in real-time. This study identified facilitators and barriers to addressing adherence to antihypertensive medications by Medical Assistants (MAs), Registered Nurses (RNs), and Primary Care Providers (PCPs) in primary care settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a qualitative study with, 15 healthcare professionals (5 MAs, 5 RNs, and 5 PCPs) caring for patients with hypertension. Semi-structured interviews, guided by the Consolidated Framework for Implementation Research (CFIR), explored barriers and facilitators related to screening and addressing medication non-adherence during primary care clinical encounters. Thematic analysis and deductive coding were used to analyze the data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four major themes emerged: motivation, work infrastructure, capability, and opportunity. MAs and PCPs were motivated to discuss medication adherence and build relationships. Capability varied; RNs were confident in their counseling skills based on their training and patient trust, and PCPs described adherence counseling as part of their role, particularly through motivational interviewing. Work infrastructure presented structural hurdles due to RN workflow limitations and MA role constraints. Opportunity to address non-adherence were constrained by tight schedules and competing clinical demands during brief visits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>RNs and PCPs felt capable in their ability to address medication adherence but cited time and competing demands as significant barriers; conversely, MAs reported motivation but were limited by their role. These findings suggest opportunities for effective management of medication adherence in practice settings through a more coordinated strategy across multiple healthcare professionals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov; NCT05349422; https://clinicaltrials.gov/ct2/show/NCT05349422.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145619041","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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