Journal of evaluation in clinical practice最新文献

Background: Responses to experimental pain have suggested central and peripheral sensitisation in adult patients with sickle cell disease (SCD). Recent studies have proposed an algometry-derived dynamic measure of pain sensitisation, slowly repeated evoked pain (SREP), which is useful in the discrimination of painful conditions related to central sensitisation. Pain and fatigue are two symptoms that affect the general functioning of patients with SCD most significantly, however, research about experimental dynamic pain measures and their relation to the main symptoms of SCD (pain and fatigue) is still scarce.

Objective: This preliminary study aimed to test the utility of the SREP protocol for detecting pain sensitisation in patients with SCD, and to evaluate the associations of pain sensitisation, pain threshold, and pain tolerance with the main clinical symptoms of SCD, pain and fatigue.

Methods: Twenty-two female outpatients with SCD and 20 healthy women participated. Pain threshold, pain tolerance, and pain sensitisation were assessed by algometry in the fingernail. Clinical pain, fatigue, anxiety, depression and pain catastrophizing were evaluated.

Results: No group differences were found in pain threshold and tolerance. However, using the SREP protocol, pain sensitisation was greater in patients than in healthy participants, even after controlling for psychological variables and body mass index. Pain threshold and tolerance were inversely associated with fatigue levels in the SCD group, with pain tolerance being the main predictor.

Conclusions: Pain threshold and tolerance did not discriminate between patients and healthy individuals, but were useful for predicting fatigue severity in SCD. The SREP protocol provides a useful dynamic measure of pain for the discrimination and detection of enhanced pain sensitisation in patients with SCD, which could contribute to more personalised pain evaluations and treatment for these patients.

Rationale: Patient participation should encapsulate the individual's resources and needs, though such standards remain rationed for people living with a long-term health concern like kidney failure.

Aims: To illustrate what patient participation signified to patients and staff in kidney care, and whether an agreed or disagreed conceptualisation occurred over time, evaluating the influence of two study-specific interventions to facilitate more person-centred participation.

Method: By convergent mixed methods design across 9 units in Sweden, we repeated the following data collection at 3 time points over 18 months: semistructured interviews with patients and staff (n = 72), and structured reviews for accounts of participation in patient records (n = 240). Data were subjected to content analysis and descriptive statistics, respectively. The outcomes were appraised for changes over time besides the interventions to enhance attention to patients' participation: a clinical tool and guidance distributed to management, and additional local support, respectively.

Results: Both patients and staff described patient participation as a comprehension of the disease and its management in everyday life. Yet, patients accentuated participation as one's experiences being recognised, and mutual knowledge exchange. Instead, staff emphasised the patients managing their treatment. The health records primarily represented what staff do to support their notion of patient participation. No influence of the interventions was noted, but what signified patient participation was maintained over time.

Conclusion: Both patients and staff stress the importance of patient participation, although they focus on different elements. Further person-centred conduct warrants a shared conceptualisation and strategies addressing and scaffolding patients' preferences and means.

Rationale: College students represent a unique demographic group as they are adults no longer under direct parental care, yet often lack the institutional health support available to more established members of society, which can lead to their health needs being neglected, despite their substantial contributions to blood donation. The objective of this study is to shed light on the health status of college students in Hefei, with a specific focus on transfusion-transmitted diseases. Based on the detailed data analysis, the implementation of some constructive strategies will play a good warning role in improving clinical blood safety and promoting better health monitoring of this population in the future.

Aims & objectives: The study aims to achieve two main objectives: On the one hand, to deepen our understanding of college students' participation in blood donation activities. On the other hand, to propose effective strategies for increasing youth involvement. Additionally, such research aims to afford recommendations for ensuring the safety of clinical blood supplies. Although the strategies and suggestions presented are speculative, they are grounded in the logical analysis of data and relevant theoretical frameworks. Therefore, these recommendations serve as a basis for potential future testing and implementation.

Method: The evaluation process for blood samples at the Hefei Blood Bank involves thorough serological testing for hepatitis B and C, HIV, and Treponema pallidum using both Enzyme-Linked Immunosorbent Assay (ELISA) and Nucleic Acid Testing (NAT). HIV reactive samples were further confirmed using Western Blot techniques at an external specialized laboratory. To ensure accuracy, each sample was tested with reagents from two different manufacturers. Moreover, any initially reactive sample was retested with the same reagent to eliminate potential false positives. In cases of conflicting results, alternative reagent kits are utilized for further confirmatory tests. Only samples that consistently show reactive results in consecutive tests are considered positive confirmation samples.

Results & conclusion: Upon analysis of the data set, it was found that out of the total 663,105 donors, 177,089 (26.7%) were identified as college students, with the remaining 486,016 categorized as noncollege students. Our study demonstrated a notably lower prevalence of blood-transmitted infections among college students (0.48%) in contrast to the wider donor population (1.23%), underscoring their potential as safe blood donors. To uphold this level of safety and protect public health, it is crucial to increase disease prevention awareness and advocate for responsible donation practices within this specific demographic. Strengthening confidentiality protocols and expanding education on safe sexual behaviors in university settings are vital actions to cultivate an environ

Rationale: Hospitalization may be a valuable chance for the detection of unknown and uncontrolled diabetes mellitus (DM). There is a screening tool at our hospital: in case of high inpatient plasma glucose level, an A1c value is added if no available from the last 3 months.

Aims and objectives: Our objective was to analyse the population with A1c ≥ 9% detected through this system from 2021 to 2023.

Materials and methods: A retrospective study was performed. Three thousand five hundred seventy-two patients were screened. We studied 243 patients with A1c ≥ 9%.

Results: Fourty-eight patients (19.8%) had unknown DM. The Endocrinology department was consulted in 39 cases (16%). In most of the cases (51%), there was not a mention in the discharge report, nor changes in the usual treatment (65.4%). Ninety patients (37%) improved A1c. Most of the ones that improved (58.9%) had a correct follow-up, compared with those who did not (23.5%) (p < 0.01).

Conclusions: Measurement of A1c during hospitalization can help us to diagnose unknown or poorly controlled DM. Therapeutic inertia and delayed diagnosis are two problems associated to DM that are confirmed by our data.

Background: The shift of treatment of paediatric cancer patients to include more care at home puts a lot of pressure on health care professionals (HCPs) to prepare and train parents on safe and correct drug handling at home. Parents must take in and understand the information presented to them while coping with their own fear related to their child's cancer diagnosis. In Sweden, parents are expected to handle and manipulate oral anticancer drugs (OADs) in the home setting. There is however a lack of a standardized method to inform and educate parents on how to handle OADs in a correct way at home.

Aim: To describe parents' experiences of handling OADs at home after participating in an educational intervention.

Method: Educational intervention in the present study aimed to improve parents' knowledge in key concepts that is, handling OADs at home by using information presented in different forms. Fifteen parents to 12 children with cancer were recruited from a paediatric oncology ward in Sweden to participate in an interview. The interviews were transcribed verbatim and subjected to qualitative content analysis.

Results: Parents' experiences are presented in categories: Relieved stress, Awareness of own exposure, Facilitated my everyday life, Parents need continued support individually. The educational intervention resulted in both positive and negative feelings, increased awareness of drug exposure and correct drug handling at home. Practical training and information presented in different ways facilitated the process of drug handling. To handle the drug correctly at home parents requested to be trained and informed in the beginning of their child's oral drug treatment. In addition, parents requested to be individually approached by HCP to get answers to questions and concerns.

Conclusions: This educational intervention study shows promising results for the method used by HCPs to inform and educate parents on complicated topics such as handling OADs at home.

Background: Visitation has a positive effect on patients and families, yet, it can disrupt intensive care unit (ICU) care and increase the risk of patient infections, which previously favoured face-to-face visits. The coronavirus disease 2019 (COVID-19) pandemic has raised the importance of virtual visits and led to their widespread adoption globally, there are still many implementation barriers that need to be improved. Therefore, this review aimed to explore the use of ICU virtual visit technology during the COVID-19 pandemic and the barriers and facilitators of virtual visits to improve virtual visits in ICUs.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, six databases (CINAHL, China National Knowledge Infrastructure [CNKI], PubMed, Cochrane, VIP and Wang Fang databases) were searched for empirical studies published between 1 January 2020 and 22 October 2023. Studies that investigated and reported barriers to and facilitators of implementing virtual visits in ICUs during the COVID-19 pandemic were included. Evidence from the included studies was identified and thematically analysed using Thomas and Harden's three-step approach. Study quality was appraised with the Mixed-Methods Appraisal Tool.

Results: A total of 6770 references were screened, of which 35 studies met the inclusion criteria after a full-text review. Eight main barriers to virtual visits use were identified: technical difficulties; insufficient resources; lack of physical presence and nonverbal information; low technical literacy; differences in families' perceptions of visual cues; privacy and ethics issues; inequitable access and use of virtual visit technology; and lack of advance preparation. Four facilitating factors of virtual visit use were identified: providing multidimensional professional support; strengthening coordination services; understanding the preferences of patients and their families; and enhancing privacy and security protection. In the quality appraisal of 35 studies, 12 studies were rated as low, five as medium and 18 as high methodological quality.

Conclusion: This review identified key facilitating factors and barriers to ICU virtual visits, which can foster the development of infrastructure, virtual visiting workflows, guidelines, policies and visiting systems to improve ICU virtual visiting services. Further studies are necessary to identify potential solutions to the identified barriers.

Objectives: This study aims to determine the awareness levels and factors affecting it, along with prevalent misconceptions about Steatotic Liver Disease (SLD) among participants with high-risk indicators.

Methods: A questionnaire with open-ended questions was utilized. Participants were recruited from two general internal medicine outpatient clinics, focusing on those with high-risk indicators for SLD. Data collection involved a questionnaire covering demographic information, self-reported clinical conditions, and open-ended questions about SLD awareness. Key focus areas included misconceptions, thematic awareness, and the relationship between awareness and educational attainment.

Results: The study involved 228 participants, predominantly female (70.4%), with an average age of 53.8 years. Only 33.7% showed a comprehensive understanding of all aspects of SLD. However, 90.4% provided some accurate information, though often limited or incomplete. Higher education and awareness of SLD risks were key predictors of better understanding. The logistic regression model, with an accuracy of 0.76 and recall of 0.84, found higher education inversely related to low awareness. Common misconceptions highlighted included the belief that polypharmacy or certain medications cause SLD, fatigue as an effect, and increased water intake as a treatment. Notably, seven patients mentioned artichoke consumption as a potential treatment.

Conclusion: The findings highlight the gap between comprehensive and partial awareness of SLD among high-risk individuals. Educational level and informed understanding of SLD risks are crucial for improving awareness, emphasizing the need for specialized educational efforts and risk communication to high-risk patients.

Background: Tackling client absenteeism in primary and secondary care settings is crucial to ensure the continuity of care for individuals, families and communities, as well as preventing waste of resources within healthcare systems.

Methodology: This article is an integrative review to identify advancements in health technologies that address client absenteeism in primary and secondary care. The databases Medical Literature and Retrieval System Online (MEDLINE/PubMed®), Scientific Electronic Library Online and Virtual Health Library were consulted. The inclusion criteria were as follows: full papers, published between 2013 and 2023, in English, Portuguese or Spanish. The descriptors used were the following: patients, mobile applications, health services management, absenteeism and primary care, and secondary care. Eleven articles published from 2014 to 2021 were included.

Results: Most articles were identified in the MEDLINE/PUBMED database, employed a randomized controlled trial methodology (36.36%), and were published between 2019 and 2021 (90.0%) in English (63.7%). The applications had managerial, assistive and/or educational purposes. In addition to absenteeism control, these applications strived to promote client engagement with health services, increase health literacy and tackle structural barriers to care, such as language barriers.

Conclusion: Efforts are needed to ensure that providers receive training to educate clients on the applications. Moreover, community-based participatory studies to ensure the feasibility of applications are warranted.

Background: Outcome monitoring can support the delivery of quality service that meets the needs of clients, clinicians and services. However, few studies have examined client or staff perspectives on the design and implementation of outcomes monitoring within a service. Implementation of outcomes monitoring requires understanding the preferences and expectations of relevant stakeholders.

Objective: Informed by the Consolidated Framework for Implementation Research, this study aimed to investigate the preferences and priorities of relevant staff, clients and family members to inform the design and implementation of an effective outcomes monitoring system in the context of a mental health service for military veterans and their families.

Method: Twenty-nine staff participated across five online focus groups, including clinical staff, peer workers, policy staff and supervisors. Ten clients participated in online or telephone semi-structured interviews. Thematic analysis was used to develop themes from the data.

Results: Clients and staff agreed that outcomes monitoring should cover more than symptoms, particularly by incorporating functional outcomes. Assessing mental health over time was considered a valuable tool for supporting treatment processes and providing actionable information. Challenges identified by clients and staff included the need for efficient processes, ensuring measures are relevant and acceptable, and maintaining client privacy. The ability to personalise data collection and have a streamlined, responsive system were key attributes of a quality outcomes monitoring framework.

Conclusions: Findings suggest that an effective outcome monitoring framework should be client-led, tailored to the individual's needs, and provide feedback on progress. Outcomes monitoring should also be efficient, accessible and allow for safe information sharing.