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“Both the Training and the Coffee Afterwards Mattered a Lot”—Factors of Importance in a Complex Intervention After Acute Hospitalization: Perspectives of Older Adults With Frailty “训练和之后的咖啡都很重要”——急性住院后复杂干预的重要因素:虚弱老年人的观点
IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-11-27 DOI: 10.1111/jep.70321
Rikke Larsen Rasmussen, Laurine Nilsson, Mette Holst, Morten Villumsen, Jane Andreasen

Rationale

Older adults with frailty often face functional decline and limitations in doing everyday activities after being discharged from acute hospital admission affecting their health and quality of life. However, engaging them in training interventions can be challenging.

Aims and Objectives

The aim of this study was to evaluate a combined training, nutrition, and social intervention from the perspective of newly discharged older adults with frailty participating in the intervention.

Methods

Semi-structured interviews were conducted with 14 participants of whom 10 were interviewed twice. Data were analyzed using a theory-based evaluation approach using a CIMO (Context–Intervention–Mechanism–Outcome) framework, followed by subsequent analysis of key elements.

Results

The study found that a skilled and person-centered physiotherapist was crucial to making strength training feasible for participants, resulting in adherence and effort in training, although continuation after the intervention was challenged by different aspects such as geography and social factors. Including goal setting and test results could potentially be relevant motivational tools, but goal setting was not implemented well, according to the experiences of the participants. The social part of the intervention was important for encouraging participation and the well-being of participants, as groups were cohesive, and participants were accepting of each other. Participants did not recall the nutritional intervention very well, and it seemingly only had a small impact.

Conclusion

The physiotherapist's approach was essential for ensuring compliance and motivation for strength training for the older adults with frailty. Furthermore, fostering social cohesion within training groups could be important for promoting compliance and participant well-being. Factors influencing the continuation of training should be considered to ensure its long-term sustainability. Further research is warranted on incorporating nutritional guidance to enhance the impact of interventions for newly discharged older adults with frailty.

老年虚弱患者在急性住院出院后往往面临功能下降和日常活动限制,影响他们的健康和生活质量。然而,让他们参与培训干预可能具有挑战性。目的和目的本研究的目的是从参与干预的新出院虚弱老年人的角度评估联合训练,营养和社会干预。方法对14名被试进行半结构化访谈,其中10人进行两次访谈。数据分析采用基于理论的评估方法,采用CIMO(背景-干预-机制-结果)框架,随后对关键要素进行分析。结果研究发现,尽管干预后的持续受到地理和社会因素等不同方面的挑战,但熟练且以人为本的物理治疗师对于使参与者的力量训练可行至关重要,从而导致训练的坚持和努力。包括目标设定和测试结果可能是潜在的相关激励工具,但根据参与者的经验,目标设定并没有很好地实施。干预的社会部分对于鼓励参与者的参与和参与者的福祉很重要,因为群体是有凝聚力的,参与者是相互接受的。参与者对营养干预的回忆不太好,而且似乎只有很小的影响。结论物理治疗师的方法对于确保老年人虚弱的力量训练的依从性和动力至关重要。此外,培养培训团体内部的社会凝聚力对于促进遵守和参与者福祉可能很重要。应考虑影响培训继续进行的因素,以确保其长期可持续性。进一步的研究需要纳入营养指导,以增强干预措施对新出院的虚弱老年人的影响。
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引用次数: 0
Risk of Bias Assessment of Randomized Controlled Trials: From the 1994 Cochrane Collaboration Toolkit to ROBUST-RCT 随机对照试验的偏倚风险评估:从1994 Cochrane协作工具包到ROBUST-RCT
IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-11-27 DOI: 10.1111/jep.70328
Rafael Leite Pacheco, Rachel Riera
<p>In March 1994, the Cochrane Collaboration issued its inaugural formal guidance on the methodology for conducting and updating systematic reviews, presented as a section within the Cochrane Collaboration toolkit. This section, titled ‘Section VI: Preparing and Maintaining Systematic Reviews’, offered directives for assessing the methodological quality of randomized controlled trials incorporated into the reviews. It drew upon a prior study by Moher et al. [<span>1</span>], which systematically appraised scales and checklists devised to evaluate trial quality, including the Jadad scale [<span>2</span>]. The authors concluded that none of the existing scales at that time could be recommended without concerns.</p><p>The newly proposed framework for assessing methodological quality rested on four bias domains, termed ‘categories’ within the document: selection, performance, exclusion, and detection. The selective reporting of significant results was also noted as a criterion that might prove pertinent in certain contexts, though it was not considered as a fundamental domain.</p><p>The evaluation system delineated three possible ratings for the overall risk of bias: low, moderate, or high. Review authors were tasked with determining whether the trials fulfilled valid criteria across all domains (signifying a trial with a low risk of bias), whether some criteria were only partially satisfied (indicating a moderate risk), or whether one or more criteria remained unmet (denoting a high risk of bias).</p><p>This underscores that the necessity of striking a balance between complexity and methodological rigour was already a matter of concern.</p><p>In October 1996, Section VI was revised and reissued as a standalone publication, henceforth titled the Cochrane Collaboration Handbook. This third edition emphasizes the importance of critically appraising studies, shifting away from the earlier terminology of methodological quality assessment.</p><p>The principal recommendation retained the same four bias domains: selection, performance, attrition, and detection. The domain formerly designated as exclusion bias was renamed as attrition bias. The evaluation framework preserved its established logic for classifying the overall risk of bias as low, moderate, or high.</p><p>In 1999, the Cochrane Handbook was refined into its fourth version, preserving the recommendations for trial assessment with no substantial alterations. The fourth version of the handbook had some minor updates, including changes to its name in different versions. For example, version 4.2.1 [<span>3</span>] was named ‘Cochrane Reviwers' Handbook’ while version 4.2.6 [<span>4</span>] was named ‘Cochrane Handbook for Systematic Reviews of Interventions’, a designation that endures in the present version.</p><p>In the 11th volume of the Cochrane Collaboration Methods Groups Newsletter, released in June 2007, Julian Higgins and Douglas Altman foreshadowed the principal attributes of an innovative
1994年3月,Cochrane Collaboration发布了其首份正式指南,内容是关于进行和更新系统评价的方法,作为Cochrane Collaboration工具包中的一个部分。本节题为“第六节:准备和维护系统评价”,为评价纳入评价的随机对照试验的方法学质量提供了指导。它借鉴了Moher等人先前的一项研究[1],该研究系统地评估了用于评估试验质量的量表和清单,包括Jadad量表[1]。作者的结论是,当时没有一个现有的比额表可以毫无顾虑地推荐。新提出的评估方法学质量的框架基于四个偏倚域,在文件中称为“类别”:选择、性能、排除和检测。有选择性地报告重要结果也被认为是在某些情况下可能证明是相关的标准,尽管它不被认为是一个基本领域。评估系统为总体偏倚风险划分了三个可能的等级:低、中、高。综述作者的任务是确定试验是否满足所有领域的有效标准(表明试验具有低偏倚风险),是否某些标准仅部分满足(表明中等风险),或者是否有一个或多个标准未满足(表示高偏倚风险)。这突出表明,在复杂性和方法严谨性之间取得平衡的必要性已经是一个令人关切的问题。1996年10月,第六部分被修订并作为独立出版物重新发行,从此命名为《Cochrane协作手册》。这第三版强调了批判性评估研究的重要性,从方法论质量评估的早期术语转移。主要建议保留了相同的四个偏置域:选择、性能、损耗和检测。以前被指定为排除偏差的领域被重新命名为损耗偏差。评估框架保留了将总体偏倚风险划分为低、中、高的既定逻辑。1999年,《科克伦手册》修订为第四版,保留了对试验评估的建议,没有实质性的改变。该手册的第四版有一些小的更新,包括在不同版本中更改了其名称。例如,版本4.2.1[3]被命名为“Cochrane评审员手册”,而版本4.2.6[4]被命名为“Cochrane干预措施系统评价手册”,这一名称在当前版本中仍然存在。在2007年6月发布的Cochrane协作方法组通讯的第11卷中,Julian Higgins和Douglas Altman预示了一种创新工具的主要属性,该工具从2005年到2007年一直处于开发阶段,专门用于评估随机对照试验中的偏倚风险。通过这种新颖的工具,作者确定了偏倚风险与方法质量构成一个不同的概念。新工具被设计为包含六个领域:序列生成、分配隐藏、参与者、人员和结果的盲化、不完整的结果数据、选择性结果报告和其他偏倚来源。评估系统将以领域特定的判断为特征,将其分类为高、低或未知风险。中度的中间分类被取消,取而代之的是未知风险的正式名称。2008年2月,Cochrane手册更新到第五版[5]。这个新版本纳入了这个工具,当时被称为“Cochrane风险偏倚工具”。初步版本采用了一个术语变化,将“未知的偏倚风险”改为“不明确的偏倚风险”。这个版本的Cochrane偏倚风险工具的特点是直接的问题,可以用简单的“是”或“否”来回答,以评估每个领域的偏倚风险。例如,第一个领域的评估问题是“足够的序列生成?”,这将支持“是”或“否”的回答。2011年3月,Cochrane手册更新到5.1[6]版本。在这个版本中,“参与者/人员/结果的盲化”领域被分为两个领域:“参与者和人员的盲化”(表现偏差)和“结果评估的盲化”(检测偏差)。Cochrane协作的偏倚风险工具于2011年正式发表在《英国医学杂志》上。该手稿还提出了一种方法,用于制定试验中每个结果的偏倚风险总结评估,建立每个结果的总体评估。 总体评估将表示为:(i)“所有关键领域的偏倚风险低”,这意味着“如果存在偏倚,不太可能严重影响结果”;(ii)“所有关键领域的偏倚风险低或不明确”,即“存在对结果产生一些怀疑的偏倚风险”;(iii)“偏倚可能严重影响结果”,意思是“在一个或多个关键领域存在较高的偏倚风险”。在其发表之后,几项元研究发现了使用[8]工具的问题。这些研究分析了Cochrane综述的样本,发现审稿人之间对判断[8]的一致性较差,得出总体判断[9]的方法不一致,并且该工具在所有领域的应用不足[10-14]。在非cochrane系统评价中也观察到类似的问题。2019年7月,第六版《Cochrane手册》引入了一种更新的偏倚风险工具,即Cochrane偏倚风险工具2.0 (RoB 2.0),与原始版本[16]相比,该工具进行了重大修改。RoB 2.0包括五个领域:(i)随机化过程引起的偏倚,(ii)偏离预期干预措施引起的偏倚,(iii)缺失结果数据引起的偏倚,(iv)测量结果的偏倚,以及(v)报告结果选择的偏倚。域“其他偏见”被删除。虽然这些领域是相关的,但它们并不完全反映原始工具。例如,领域“报告结果的选择偏差”并没有解决由于选择性不报告结果而导致的偏差,而这是在原始工具的“选择性结果报告”领域中考虑的。另一个例子是在“随机化过程产生的偏差”领域纳入了对基线差异的考虑,这通常是在原始版本的“其他偏差”领域中解决的。RoB 2.0还重新引入了过去的两个值得注意的特性。第一种是中间判断,以前称为“中度风险”,现在称为“一些关注”。“因此,每个领域现在都可以得到三种判断中的一种:高偏见风险、一些担忧或低偏见风险。”第二个特征涉及重新引入信号问题。每个领域都是在一个信号问题框架内进行评估的,这些问题可以回答为“是”、“可能是”、“可能不是”、“不是”或“没有信息”。新版本还根据兴趣效应的性质区分了偏见风险,特别是区分了分配干预的影响和坚持干预的影响。由于这些影响的性质不同,判断可能会有所不同。RoB 2.0为评估每个评估结果的总体偏倚风险提供了一个清晰的框架。它还为信号问题的潜在响应提供了复杂的算法,从而为每个域的判断提供信息。RoB 2.0在发布后不久就在实现中遇到了挑战。这篇评论的作者参加了在爱丁堡举行的第25届Cochrane学术研讨会上的RoB 2.0研讨会,在那里,即使经过2小时的激烈讨论,观众也无法就如何接近第一领域达成共识。早期调查显示,在Cochrane评价[17]和非Cochrane评价[18]中,该工具的依从性较低,评分者间可靠性较差[19],使用不充分[18]。许多人将执行速度缓慢归因于评估过程的复杂性显著增加[b]。2025年3月,GRADE工作组的作者发布了一个名为ROBUST-RCT[21]的新工具,旨在评估随机对照试验的偏倚风险。开发一种新工具的主要理由是要求简单和实用,在以前的工具中,为了方法论的严谨性而牺牲了这一点。ROBUST-RCT包括六个核心领域:随机序列生成、分配隐藏、参与者盲化、医疗保健提供者盲化、结果评估者盲化和未包括在分析中的结果数据。对每个领域的判断有四种可能的结果:低、可能低、可能高或绝对高。对于大多数领域,得出每个判断的过程与2008年Cochrane偏差风险工具的早期版本非常相似。通过回答一些简单的问题来做出判断,例如“分配顺序是否充分生成?”和“分配是否被充分隐瞒?”ROBUST-RCT还包括可选的领域,如果认为相关,审稿人可以选择纳入。其中一个可选领域与选择性结果报告有关,而其他项目与Cochrane协作工具第一版中的“其他偏见”领域的评估部分重叠。我们相信,ROBUST-RCT将更快地被科学界接受,因为它解决了导致RoB 2高度复杂性的
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引用次数: 0
Prevalence and Associated Factors of Burnout Among Obstetrics and Gynecology Nurses: A Cross-Sectional Analysis 妇产科护士职业倦怠的患病率及相关因素:横断面分析。
IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-11-18 DOI: 10.1111/jep.70315
Yali Chen, Jingjing Cai

Background

Job burnout significantly impacts the quality and safety of clinical nursing care. Given the unique demands of obstetric and gynecological (OB/GYN) nursing, addressing burnout in this workforce is critical for safeguarding both nurse well-being and patient outcomes. This study aimed to investigate the prevalence of job burnout and identify its contributing factors among OB/GYN nurses, with the goal of providing evidence-based guidance for clinical nurse management and healthcare policy.

Methods

A cross-sectional survey was conducted with nurses in the OB/GYN department of our hospital between July 1 and August 31, 2024. The Nursing Burnout Scale (validated previously for nursing populations) was used to assess burnout levels, and multiple linear regression analysis was applied to identify potential influencing factors.

Results

A total of 116 OB/GYN nurses participated. The mean job burnout score was 158.64 ± 16.07, which corresponds to a moderate level of burnout based on the scale's established criteria. Correlation analysis showed significant associations between burnout scores and educational level (r = 0.558), number of children (r = 0.527), professional title (r = 0.604), years of nursing experience (r = 0.622), and average monthly income (r = 0.606) (all p < 0.05). Multiple linear regression further confirmed these variables as significant predictors of job burnout (all p < 0.05).

Conclusion

OB/GYN nurses in this study experience moderate levels of job burnout, influenced by multiple personal and professional factors. These findings support the need for targeted interventions—such as tailored support programs for nurses with varying experience or family structures—and highlight the value of using such data to inform hospital management strategies and healthcare policies aimed at reducing burnout and enhancing nursing care quality and safety.

背景:工作倦怠对临床护理质量和安全有显著影响。鉴于产科和妇科(OB/GYN)护理的独特需求,解决这一劳动力的职业倦怠对于保障护士福祉和患者预后至关重要。本研究旨在调查妇产科护士工作倦怠的患病率,并找出影响因素,旨在为临床护理管理和医疗保健政策提供循证指导。方法:对2024年7月1日至8月31日在我院妇产科工作的护士进行横断面调查。采用护理倦怠量表(之前针对护理人群进行了验证)评估护理倦怠水平,并采用多元线性回归分析确定潜在影响因素。结果:共116名妇产科护士参与。工作倦怠平均得分为158.64±16.07分,根据量表制定的标准,工作倦怠处于中等水平。相关分析显示,职业倦怠得分与受教育程度(r = 0.558)、子女数量(r = 0.527)、职称(r = 0.604)、护理年限(r = 0.622)、月平均收入(r = 0.606)存在显著相关(均为p)。结论:本研究中妇产科护士存在中等程度的职业倦怠,受个人因素和专业因素的多重影响。这些发现支持了有针对性的干预措施的必要性,例如针对不同经验或家庭结构的护士量身定制的支持计划,并强调了利用这些数据为医院管理策略和医疗保健政策提供信息的价值,这些策略和政策旨在减少倦怠,提高护理质量和安全性。
{"title":"Prevalence and Associated Factors of Burnout Among Obstetrics and Gynecology Nurses: A Cross-Sectional Analysis","authors":"Yali Chen,&nbsp;Jingjing Cai","doi":"10.1111/jep.70315","DOIUrl":"10.1111/jep.70315","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Job burnout significantly impacts the quality and safety of clinical nursing care. Given the unique demands of obstetric and gynecological (OB/GYN) nursing, addressing burnout in this workforce is critical for safeguarding both nurse well-being and patient outcomes. This study aimed to investigate the prevalence of job burnout and identify its contributing factors among OB/GYN nurses, with the goal of providing evidence-based guidance for clinical nurse management and healthcare policy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional survey was conducted with nurses in the OB/GYN department of our hospital between July 1 and August 31, 2024. The Nursing Burnout Scale (validated previously for nursing populations) was used to assess burnout levels, and multiple linear regression analysis was applied to identify potential influencing factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 116 OB/GYN nurses participated. The mean job burnout score was 158.64 ± 16.07, which corresponds to a moderate level of burnout based on the scale's established criteria. Correlation analysis showed significant associations between burnout scores and educational level (r = 0.558), number of children (r = 0.527), professional title (r = 0.604), years of nursing experience (r = 0.622), and average monthly income (r = 0.606) (all <i>p</i> &lt; 0.05). Multiple linear regression further confirmed these variables as significant predictors of job burnout (all <i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>OB/GYN nurses in this study experience moderate levels of job burnout, influenced by multiple personal and professional factors. These findings support the need for targeted interventions—such as tailored support programs for nurses with varying experience or family structures—and highlight the value of using such data to inform hospital management strategies and healthcare policies aimed at reducing burnout and enhancing nursing care quality and safety.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145549564","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}
引用次数: 0
Toward More Precise Health Care Through Relational Mapping 通过关系映射实现更精确的医疗保健。
IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-11-18 DOI: 10.1111/jep.70308
Stephen Buetow

Precision health seeks to personalize care by accounting for individual variation but is too often reduced to ‘personalized biological’ interventions. This reductionism overlooks the existential and psychosocial dimensions of health. To address this gap, this paper introduces the relatome as a conceptual framework that systematically and comprehensively records relational patterns, including how patients build trust, prefer to receive information, and approach decision-making. By extending precision health into the relational domain, the relatome makes care more precise in guiding patient experience and treatment effectiveness. As a transferable component of the patient's clinical record, it also helps providers coordinate understanding across systems and settings, preserving psychosocial insights often lost during care transitions. Unlike static genetic data, these relational patterns are updated based on patient feedback and provider observations. Realizing the potential of the relatome requires addressing five sets of implementation challenges: conceptual and epistemic, technical and infrastructural, continuity and system design, equity and participation, and evaluation and investment.

精准医疗寻求通过考虑个体差异来实现个性化护理,但往往被简化为“个性化生物”干预。这种还原论忽视了健康的存在和社会心理层面。为了解决这一差距,本文介绍了关系组作为一个概念框架,系统地、全面地记录关系模式,包括患者如何建立信任、更愿意接受信息和接近决策。通过将精准健康扩展到关系领域,关系组使护理在指导患者体验和治疗效果方面更加精确。作为患者临床记录的可转移组成部分,它还有助于提供者协调跨系统和环境的理解,保留在护理过渡期间经常丢失的心理社会见解。与静态遗传数据不同,这些关系模式是基于患者反馈和提供者观察而更新的。实现关系的潜力需要解决五组执行挑战:概念和认识、技术和基础结构、连续性和系统设计、公平和参与、评价和投资。
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引用次数: 0
Midwives' Views and Experiences of Practice to Delivered in Water: A Qualitative Study 助产士对水中分娩的看法和实践经验:一项定性研究。
IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-11-18 DOI: 10.1111/jep.70318
Buse Nur Kisa, Resmiye Ozdilek

Background

This study aimed to reveal the experiences of midwives who assisted women giving birth water.

Method

A phenomenological design, which is one of the qualitative research methods, was used in the study that was conducted with freelance midwives between June and August 2023. The sample of the study consisted of 14 midwives who met the inclusion criteria and agreed to participate in the research. Data were collected face to face using a ‘Descriptive Information Form’ and a ‘Semi-Structured Interview Form’ and were analysed using the thematic analysis method and the MAXQDA Analytics Pro2020 software.

Discussion

Midwives' narratives about water birth were grouped under three themes: water birth process, water birth team, and evaluation of water birth. The eight categories that made up these themes were conveniences, difficulties, characteristics of the team, equipment used during birth, difficulties in using the equipment, prenatal preparation, midwives' self-evaluations, and views about pregnant women's experiences.

Conclusion

According to this study, midwives talked more about the category of convenience than difficulties regarding the water birth process. It was determined that all midwives repeated the code of comforting the pregnant woman, which is in the convenience category under the theme of the water birth process. The most frequently stated difficulty was ensuring that the water was kept as clean as possible. Midwives reported that they most frequently observed that pregnant women gave birth more easily in water.

背景:本研究旨在揭示助产士协助妇女分娩水的经验。方法:采用质性研究方法之一的现象学设计,于2023年6 - 8月对自由职业助产士进行研究。该研究的样本包括14名符合纳入标准并同意参与研究的助产士。使用“描述性信息表”和“半结构化访谈表”面对面收集数据,并使用主题分析方法和MAXQDA Analytics Pro2020软件进行分析。讨论:助产士对水中分娩的叙述分为三个主题:水中分娩过程、水中分娩团队和水中分娩评估。组成这些主题的8个类别分别是便利、困难、团队特点、分娩时使用的设备、使用设备的困难、产前准备、助产士的自我评价和对孕妇经历的看法。结论:根据本研究,助产士对水中分娩的方便程度多于困难程度。确定所有助产士都重复了在水中分娩过程主题下方便类别的孕妇安慰守则。最常提到的困难是确保水尽可能保持干净。助产士报告说,她们最常观察到孕妇在水中分娩更容易。
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引用次数: 0
Lessons From the COVID-19 Pandemic: The Role of Interventions in Relieving Mental Stress 2019冠状病毒病大流行的教训:干预措施在缓解精神压力中的作用。
IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-11-12 DOI: 10.1111/jep.70317
Raaj Tiagi

Background

The COVID-19 pandemic has significantly impacted healthcare workers’ mental health worldwide. Although increased stress, anxiety, and burnout are well documented, there is limited evidence on the effectiveness of workplace interventions such as infection prevention and control (IPC) and personal protective equipment (PPE) training in mitigating these effects.

Aim

To examine the association between IPC training, PPE training, and consistent adherence to safety protocols with self-reported mental health outcomes among healthcare workers in Canada during the COVID-19 pandemic.

Methods

This study analyzed data from 12,727 healthcare workers who responded to a 2021 Statistics Canada crowdsource survey. Logistic regression models assessed the relationship between mental health status (same/better vs worse compared to pre-pandemic) and three predictors: sufficient IPC training, sufficient PPE training, and consistent protocol adherence, controlling for demographic and occupational factors.

Results

Adequate IPC and PPE training, along with consistent adherence to protocols, were significantly associated with better self-reported mental health outcomes across healthcare worker groups. Regional differences and survey design limitations affecting generalizability are acknowledged.

Conclusions

Basic workplace interventions such as IPC and PPE training and adherence to safety protocols may help protect healthcare workers’ mental health during public health crises. Policymakers should prioritize these feasible, low-cost measures to mitigate pandemic-related psychological distress.

背景:2019冠状病毒病大流行严重影响了全球医护人员的心理健康。尽管压力、焦虑和倦怠的增加有充分的记录,但关于工作场所干预措施(如感染预防和控制(IPC)和个人防护装备(PPE)培训)在减轻这些影响方面的有效性的证据有限。目的:研究COVID-19大流行期间加拿大卫生保健工作者的IPC培训、PPE培训和一贯遵守安全规程与自我报告的心理健康结果之间的关系。方法:本研究分析了参与2021年加拿大统计局众包调查的12727名医护人员的数据。逻辑回归模型评估了精神健康状况(与大流行前相比相同/更好或更差)与三个预测因素之间的关系:充分的IPC培训、充分的个人防护装备培训和一贯的协议遵守情况,控制了人口和职业因素。结果:充分的IPC和PPE培训,以及一贯遵守协议,与卫生保健工作者群体更好的自我报告心理健康结果显着相关。区域差异和调查设计限制影响了概括性。结论:基本的工作场所干预措施,如IPC和PPE培训以及遵守安全规程,可能有助于在公共卫生危机期间保护卫生工作者的心理健康。决策者应优先考虑这些可行的低成本措施,以减轻与大流行有关的心理困扰。
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引用次数: 0
Response to Armitage: Reconsidering the Ethical Landscape of AI-Generated Clinical Documentation 对Armitage的回应:重新考虑人工智能生成的临床文件的伦理景观。
IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-11-12 DOI: 10.1111/jep.70313
Q. Wilton Sun, Jennifer E. Miller, Sarah C. Hull
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引用次数: 0
Clinical Outcomes and Guideline Adherence in Distal Radial Fractures with Associated Carpal Dislocations: A Service Evaluation 桡骨远端骨折伴腕关节脱位的临床疗效和指南依从性:一项服务评估。
IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-11-12 DOI: 10.1111/jep.70312
Bea Duric, Benjamin Flowers, Karlo Jagic, Katie Zuo, Sundas Butt

Background

Carpal dislocations are rare but serious injuries, sometimes occurring in isolation or in association with distal radial fractures. These complex injuries carry high risks of long-term dysfunction and require timely and standardised management. In 2017, the British Orthopaedic Association (BOA) and British Society for Surgery of the Hand (BSSH) published consensus guidelines to address wide variations in care and outcomes. This audit evaluated adherence to BOA/BSSH guidance at a tertiary trauma centre.

Methods

80 patients with extra-articular distal radial fractures and carpal dislocations were retrospectively identified (October 2022–March 2023). A structured checklist based on BOA/BSSH recommendations was applied, focusing on documentation, anaesthesia, timing of surgery, immobilisation, and Postoperative care.

Results

Mean age was 38.2 (±13.7) years, and 76/80 (95.0%) patients underwent surgical management. Only 4/37 (10.8%) patients with available anaesthesia data received intravenous regional anaesthesia as recommended. Mean immobilisation time was 8.2 (±2.6) weeks, exceeding the 4-week standard. Surgery within 1 week occurred in 34/76 (44.7%). No cases documented a neurovascular assessment. At 6 months, 22/80 (27.5%) reported ongoing stiffness and 40/80 (50.0%) required hand therapy.

Conclusion

Adherence to BOA/BSSH guidelines was poor, particularly for anaesthesia choice, immobilisation duration, and surgical timing. This may have contributed to mediocre outcomes. As current standards are primarily designed for DRFs rather than CDs, their direct application to these complex cases should be interpreted cautiously. Nonetheless, improved documentation, anaesthesia practice, and adherence to early mobilisation protocols represent clear opportunities for service improvement.

背景:腕关节脱位是一种罕见但严重的损伤,有时单独发生或合并桡骨远端骨折。这些复杂的损伤具有长期功能障碍的高风险,需要及时和标准化的管理。2017年,英国骨科协会(BOA)和英国手部外科学会(BSSH)发布了共识指南,以解决护理和结果的广泛差异。该审核评估了三级创伤中心对BOA/BSSH指导的依从性。方法:回顾性分析关节外桡骨远端骨折合并腕关节脱位患者80例(2022年10月- 2023年3月)。应用了基于BOA/BSSH建议的结构化清单,重点是文件、麻醉、手术时机、固定和术后护理。结果:平均年龄38.2(±13.7)岁,76/80(95.0%)患者接受手术治疗。只有4/37(10.8%)有麻醉资料的患者接受了推荐的静脉区域麻醉。平均固定时间为8.2(±2.6)周,超过4周标准。1周内手术34/76(44.7%)。没有病例记录神经血管评估。6个月时,22/80(27.5%)报告持续僵硬,40/80(50.0%)需要手部治疗。结论:BOA/BSSH指南的依从性较差,特别是在麻醉选择、固定时间和手术时机方面。这可能是导致结果平庸的原因之一。由于目前的标准主要是为drf而不是cd设计的,因此应谨慎解释它们对这些复杂情况的直接应用。尽管如此,改进的文件、麻醉实践和对早期动员协议的遵守为改善服务提供了明显的机会。
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引用次数: 0
Pregnant Women's Breast Milk and Breastfeeding Myths and Associated Factors: A Case of Refugee and Non-Refugee Women 孕妇的母乳和母乳喂养的神话和相关因素:一个案例的难民和非难民妇女。
IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-11-12 DOI: 10.1111/jep.70314
Meryem Erat Nergiz, Siddika Songul Yalcin
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引用次数: 0
Physicians' Attitudes Toward Defensive Medicine and Medical Errors in Palliative Care: A Cross-Sectional Study 姑息治疗中医生对防御性医学和医疗差错的态度:一项横断面研究。
IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-11-12 DOI: 10.1111/jep.70316
Ardacan Uyğur, Abdullah Ozan Polat, Okcan Basat

Rationale

Medical errors represent a major issue for healthcare professionals. Although they may not always cause direct harm to patients, timely reporting of such errors is an important step in improving safety and reducing malpractice risk. As the number of these lawsuits rises, physicians often resort to defensive medicine practices.

Aims and Objectives

The aim of this study is to evaluate the attitudes, behaviours and knowledge levels of physicians working in palliative care services with resprect to defensive medicine.

Method

This multicenter, cross-sectional and analytical study, 110 physicians working in the Palliative Care Service participated in the study between 01.10.2023 and 31.10.2023. Demographic information, defensive medicine attitude scale and medical error attitude scale were applied to the participants.

Results

Sixty-two of the participants were female and 48 were male. Based on the data, 5.5% of the participants had a moderate, 64.5% had a high, and 30.0% had a very high level of defensive medicine attitudes. Resident physicians rated their defensive medicine attitude with higher scores than specialist physicians. In addition, physicians with less than 5 years of experience have higher positive defensive medicine scores. There is a significant relationship between age and the medical error attitude scale score. Most of the participants received palliative care training, but they stated that they did not have sufficient knowledge about defensive medicine.

Conclusion

Although the defensive medicine scores of the participants are high, additional training is necessary to close the gaps in knowledge. There is also a promising situation in terms of medical error awareness.

基本原理:医疗差错是医疗保健专业人员面临的主要问题。尽管它们可能并不总是对患者造成直接伤害,但及时报告此类错误是提高安全性和降低医疗事故风险的重要一步。随着此类诉讼的增多,医生们往往采取防御性的医疗措施。目的和目的:本研究的目的是评估的态度,行为和知识水平的医生工作在姑息治疗服务相对于防御性医学。方法:本研究为多中心、横断面、分析性研究,于2023年10月1日至2023年10月31日期间共有110名姑息治疗服务部门的医生参与。采用人口统计学资料、防御性医疗态度量表和医疗差错态度量表对被试进行问卷调查。结果:参与者中女性62人,男性48人。数据显示,5.5%的受访者防御性医学态度为中等水平,64.5%为高水平,30.0%为非常高水平。住院医师的防御性医学态度评分高于专科医师。此外,经验不足5年的医生有较高的积极防御医学得分。年龄与医疗差错态度量表得分有显著相关。大多数参与者接受了姑息治疗培训,但他们表示他们没有足够的防御性医学知识。结论:虽然参与者的防御医学得分较高,但需要额外的培训来弥补知识差距。在医疗错误意识方面也有一个很好的情况。
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引用次数: 0
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Journal of evaluation in clinical practice
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