Journal of evaluation in clinical practice最新文献

Background: Nongovernment medical institutions have gradually become a significant part of China's healthcare system, with a growing numbers of staff. However, the current status of anesthesiology staff in these institutions is unclear. To gain insight into this situation and to compare it with public hospitals, the national anesthesia professional committee of the Chinese Nongovernment Medical Institutions Association (CNMIA) designed and conducted the national cross-sectional survey.

Methods: We conducted a national cross-sectional study to investigate the occupational and health status of anesthesiology staff in Nongovernment medical institutions. Additional questions were included for the directors of the anesthesiology department to understand their work stress and the reasons for employee turnover. The electronic questionnaire was created using Questionnaire Star and distributed by Anesthesia Professional Committee of the CNMIA through the QR code links and WeChat.

Results: A total of 1111 questionnaires were collected, including 989 from anesthesiologists and 122 from nurse anesthetists. The overall job satisfaction score (MSQ) was 75.57 ± 12.32 and the average fatigue score (MFI-20) was 49.10 ± 10.90. High-risk factors for severe fatigue included being aged 31-40, holding a middle title, frequently working night shifts, having long working hours, and participating surgeries classified as ASA III or higher. The most common disease reported was difficulty falling asleep/insomnia. Multivariate logistic regression analysis showed that men (OR = 0.662, 95% CI: 0.482-0.909, p < 0.05), those with a bachelor's degree (OR = 2.152, 95% CI: 1.186-3.903, p < 0.05), individuals with heavy workloads (OR = 2.999, 95% CI: 1.493-6.024, p < 0.01), poor health (OR = 4.280, 95% CI: 1.216-15.057, p < 0.05), and high MFI-20 scores (OR = 1.085, 95% CI: 1.067-1.103, p < 0.001) were more likely to suffer from insomnia. Directors identified medical quality and safety management as their main source of stress and low income as the primary reason for employee resignation.

Conclusions: Nongovernment medical institutions have fewer employees, similar workloads, relatively low job stress and higher job satisfaction compared to public hospitals. Low income and difficulty falling asleep/insomnia are significant issues that require attention.

Objective: To apply the Ottawa Model of Research Use to translate the Guidelines for the Prevention and Control of Vascular Catheter-Associated Bloodstream Infections.

Methods: The Ottawa model of research use is used to provide a framework and guidance. This study was organized by the Nursing Department of the Affiliated Hospital of Hebei Engineering University, and the Intravenous Therapy Group was responsible for the implementation of the study. The hospital's intravenous therapy administrators, members of the sedation team, and specialist nurses will be organized to evaluate the importance, exactness, and clinical practicability of 34 entries. Twelve clinical departments and IV therapy clinics with a high number of central venous catheters were used as sites for translating evidence from this project. The evidence-based team assessed the practice environment, potential practitioners, and clinical status of clinical translation of evidence through symposia, review of relevant systems, operational procedures, on-site inspections, and questionnaires. They compare evidence with existing processes and decide on change strategies.

Results: Before and after the application of the evidence, there was a significant increase in the knowledge, belief, and behavior of healthcare workers on CLABSI prevention and control, especially in the acquisition of related knowledge (χ² = 26.648 p < 0.001). The associated implementation rate was also significantly improved, with a significant decrease in CLABSI incidence from 0.29 per 1000 to 0.11 per 1000 (χ² = 8.625 p = 0.004). The assessment of the integration of issues showed that 8 aspects, including workflow, knowledge mastery, monitoring reports, and aseptic operations, do not meet the qualified standards.

Conclusion: Through this clinical change, a perfect prevention and control system has been established, and the level of knowledge, belief, and behavior of medical staff in preventing CLABSI has been improved, while the incidence of CLABSI has been reduced.

Medicine is a compound field composed of science and art. The (necessary) degree to which the latter is involved opens medicine, in particular, to the introduction of ideas which do not, by their very nature, submit to confirmation or confutation as do the various methods of traditional science. This paper explores several ways in which a Lysenkoistic ideology can be interjected into medicine changing the manner in which it interacts with both patients and society. Simply, when ideology supersedes evidence the edifice of Western Medicine comes under direct threat. The exploration of this emerging ideological transition in medicine, and science more broadly, is of critical importance to determine the most salutary path forward.

Aim: The purpose is to develop a care package for the prevention of medical device-related pressure injuries using the Delphi Method.

Design: The study is a methodological.

Method: The care package was developed using the Delphi Method, a consensus-based technique. Two expert groups were selected to develop the care package to prevent medical device-related pressure injuries. The invitation letter and the questionnaire consisting of two questions were sent to the relevant experts via email and completed in three rounds after receiving responses. The scores from the experts were uploaded to the SPSS 25.0 software package. The range (R) was calculated as R = Q3-Q1. The differences (R) between the quartiles were examined. Items with R < 1.2 were accepted as having reached a consensus.

Results: As a result of the evaluation, it was organized as 83 items. As a result of the analysis of the scores of the second round of the Delphi Method, the range values of each item were examined. In the third round of the Delphi Method, it was found that consensus was reached in the third round on items 18, 29, and 56, on which consensus could not be reached in the second round, and the care package was accepted with 83 items.

Conclusion: An 83-item care package was created to prevent medical device-related pressure injuries in children.

Background: Patients suffering from multidrug/rifampicin resistant tuberculosis (MDR/RR-TB) are treated for prolonged periods with a complex regimen comprised of relatively less effective and more toxic anti-TB drugs, consequently resulting in high incidence of adverse events (AEs).

Study aim: The current study evaluates the incidence, types, management and predictors of AEs, and their impact on treatment outcomes in MDR/RR-TB patients receiving all oral treatment regimens.

Study design: A total of 242 eligible MDR/RR-TB patients treated at two different study sites from June 2019 to December 2021 were included in this study.

Measures and outcomes: Patients' sociodemographic, microbiological, clinical characteristics, reported AEs and treatment outcomes were retrospectively abstracted from their medical records. Chi-square, and Fisher exact tests (wherever applicable) were used to find the association between the variable and the occurrence of AEs.

Results: Majority of the patients were suffered from MDR-TB (71.9%) and were treated with longer treatment regimen (77.7%). Overall 206/242 patients (85%) experienced at least one AE during their treatment. Gastrointestinal disturbance was the most common AE (49.6%), followed by arthralgia (49.2%), psychiatric disturbances (39.3%), dermatological reactions (27.7%), body/headache (24.8%) and hyperuricemia (19%). Due to AEs, treatment modification was noted in 55 (22.72%) patients. Level of modification in the treatment regimen was higher in optic neuritis (100%) followed by neuropathies (80%) and myelosuppression (59%). Similarly, hepatotoxicity was the most serious AE in which the whole treatment regimen was terminated in 27% of patients. Furthermore, the results revealed that only patients' education status had statistically significant association with the incidence of AEs (p = 0.02). The treatment success rate was 80.6% whereas the ratio of died and LTFU patients were 15.3% and 4.1% respectively. Although patients who experienced AEs were more likely to develop successful treatment outcomes (82%) than their counterparts (72.2%), though this difference was not statistically significant.

Conclusion: Although AEs were highly present in the current cohort, but they were successfully managed mostly by nonpharmacological interventions or symptomatic treatment. Besides, the incidence of AEs did not have a negative impact on treatment outcomes. High-risk patients for AEs must receive special attention and enhanced clinical management.

Objectives: Appropriate insulin injection technique can help to enhance positive clinical outcomes in insulin-treated patients. This cross-sectional survey was undertaken to assess the present state of injection technique practices of patients administering insulin and the incidence of local complications associated with insulin injection.

Methods: This cross-sectional study was conducted at 11 tertiary hospitals in Xi'an City. A total of 1370 patients with diabetes were enroled in the survey. Each patient was asked questions on the Injection Technique questionnaire, demonstrated insulin injection on an injection training pad and had their injection sites inspected by a nurse.

Results: About 98% of participants were type 2 diabetic patients. The 5 mm length needles were used by 640 (46.71%) patients. Around 1286 participants reused pen needles. Only one-third of patients rotate the injection sites. Around 901 patients had ecchymosis at injection sites, 43 participants suffered rash and or pruritus and 661 patients had lipohypertrophy. About 2.99% of patients reported having infection at the injection sites. Most patients (72.55%) occasionally felt pain when injecting insulin. The results of the multivariable logistict analysis showed that gender (male), needle length, priming the pen before injections and correct site rotation were negatively associated with the incidence of injection site ecchymosis. Lower incidence of lipohypertrophy was associated with needle length 4 mm, needle length 6 mm, single use of pen needles, priming the pen before injections and correct site rotation. Higher incidence of injection site infection was related to not disinfecting injection sites before each injection.

Conclusions: Despite some improvements detected in some aspects of patients' insulin injection practice in recent years, a large gap still exists between insulin injection guidelines and patients' actual injection behaviour. Injection-related complications at injection sites are still considerably common among our study population. Patients' education regarding insulin injection technique should be conducted repeatedly and regularly to make sure patients' compliance to injection guidelines.

Background/aims: Thromboembolism (TE) notably increase morbidity and mortality among inflammatory bowel disease (IBD) patients. Despite ECCO's 2024 guidelines advocating routine anticoagulant prophylaxis, its application in Asia remains inconsistent due to a lack of regional studies. This research investigates the incidence and predictors of TE during IBD-related hospitalizations in Taiwan, aiming to improve prevention strategies.

Materials and methods: Our retrospective cohort study included 282 adult IBD patients, accounting for 515 flare-up related hospitalizations at Linkou Chang Gung Memorial Hospital from January 2001 to March 2024. Patients were classified into two groups based on the occurrence of TE.

Results: The incidence of TE was 1.55%. The TE group had significantly lower body weight, body mass index (BMI), hemoglobin and albumin levels but higher rate of sepsis and concurrent autoimmune diseases compared to the non-TE group. Multivariate analysis indicated that concurrent autoimmune diseases and hypoalbuminemia were independent predictors of TE. The optimal serum albumin cutoff was established at 3.01 g/dL, with sensitivities and specificities of 87.5% and 77.3%, respectively.

Conclusions: This pioneering Asian study identifies concurrent autoimmune diseases and low serum albumin as key predictors of TE in hospitalized IBD patients. We recommend targeted anticoagulant prophylaxis for IBD patients with these risk factors, especially when serum albumin falls below 3.01 g/dL.

Rationale: This service evaluation details the process of introducing Single Session Therapy (SST) with families to a Child and Adolescent Mental Health Service in the United Kingdom. SST is a model of short-term psychotherapy intervention which can be applied to family contexts to provide timely mental health support.

Aims and objectives: This service evaluation had two objectives: (1) Review the existing evidence base and literature for SST. (2) Evaluate the implementation of a new SST treatment pathway in CAMHS, including patient experiences and satisfaction with the service.

Method: SQUIRE Guidelines are used to report on this new knowledge of healthcare. This evaluation used qualitative methods to evaluate the impact of the new service. The team also used existing frameworks within the Trust, namely discharge data, which is collected routinely as part of service evaluation.

Results: This evaluation suggests positive support for this model, and that many families appreciate and value the opportunity to build on strengths and work toward their goals as families. This project outcome appears to support some of Talmon's (1990) findings that the most commonly attended number of sessions is one, and that of those who attended only one session, many perceived the session as useful. Waiting times for our service are extremely long. The pace and structure around goals and solutions could feel both galvanising, as some reported, but others felt it was an insufficient response to the severity of their difficulties.

Conclusion: More high-quality research is needed before judgments can be made around the cost-effectiveness or efficacy of SST over existing approaches in the United Kingdom. While implementing SST should not be used to justify reduction in existing interventions, it offers a positive additional service for young people experiencing mental health difficulties and their families.