Journal of evaluation in clinical practice最新文献

英文中文

The Role of Traditional Chinese Medicine Health Management Model in Improving the Quality of Clinical Nursing Services 中医健康管理模式在提高临床护理服务质量中的作用

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2025-11-02 DOI: 10.1111/jep.70301

Desheng Li, Min Zhou, Hongmei Zhang, Lulu Zheng

Objective

To explore the role of the traditional Chinese medicine (TCM) health management model in improving the quality of clinical nursing services.

Methods

The respiratory department of a tertiary hospital began constructing and applying the TCM health management model in 2020. Taking this as the time node, the study was divided into two stages: between February and October 2019 (pre-implementation phase) and between April and December 2020 (post-implementation phase). A total of 300 patients were selected from those admitted during the post-implementation phase as the post-implementation group; another 300 patients were selected from those admitted during the pre-implementation phase as the pre-implementation group. Nursing management quality indicators, nursing service quality scores and patient satisfaction were compared and analysed between the two groups. Sensitivity analyses were conducted to adjust for potential time-related confounders.

Results

Compared with the pre-implementation group, the incidence of adverse events in the post-implementation group was significantly reduced (3.33% vs. 8.67%, p < 0.05), the qualified rate of nursing documents increased to 98.33% (vs. 89.33%, p < 0.05) and the service response time was shortened to 5.2 ± 1.3 min (vs. 9.8 ± 2.1, p < 0.05). Regarding nursing service quality, the scores for guidance service, health education, triage nursing, medication management and risk control increased to 90.55 ± 4.18, 91.48 ± 4.29, 90.82 ± 3.97, 90.17 ± 4.49 and 91.65 ± 4.50 points, respectively (all p < 0.05). For patient satisfaction scores, service situation, treatment environment and treatment experience increased to 90.51 ± 4.71, 90.69 ± 4.78 and 90.29 ± 4.12 points, respectively (all p < 0.05).

Conclusion

Within the context of this single-centre quasi-experimental study, the TCM health management model showed potential in optimising nursing processes and improving selected quality indicators in the respiratory department. However, these findings require validation through multicentre randomised controlled trials before broader implementation can be recommended.

Relevance to Clinical Practice

This study offers preliminary insights into integrating traditional medicine approaches with modern nursing practices, although further research is needed to establish broader applicability, particula

目的探讨中医健康管理模式在提高临床护理服务质量中的作用。方法某三级医院呼吸科于2020年开始构建和应用中医健康管理模式。以此为时间节点，将研究分为两个阶段：2019年2月至10月（实施前阶段）和2020年4月至12月（实施后阶段）。从实施后阶段入院患者中选取300例患者作为实施后组；另外从预实施阶段入院的患者中选择300例作为预实施组。比较分析两组护理管理质量指标、护理服务质量评分及患者满意度。进行敏感性分析以调整潜在的时间相关混杂因素。结果与实施前组相比，实施后组不良事件发生率显著降低（3.33% vs. 8.67%, p < 0.05），护理文件合格率提高至98.33% (89.33%,p < 0.05)，服务响应时间缩短至5.2±1.3 min （p < 0.05）。护理服务质量方面，指导服务、健康教育、分诊护理、用药管理、风险控制得分分别提高至90.55±4.18分、91.48±4.29分、90.82±3.97分、90.17±4.49分、91.65±4.50分（p均为0.05）。在患者满意度得分方面，服务状况、治疗环境和治疗体验分别提高到90.51±4.71分、90.69±4.78分和90.29±4.12分（p均为0.05）。结论在本单中心准实验研究的背景下，中医健康管理模式在优化护理流程和提高呼吸科选定的质量指标方面显示出潜力。然而，在推荐更广泛的实施之前，这些发现需要通过多中心随机对照试验进行验证。这项研究为传统医学方法与现代护理实践的结合提供了初步的见解，尽管需要进一步的研究来建立更广泛的适用性，特别是在国际环境中。

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引用次数: 0

Correction to “Implementation of Clinical Pharmacy Services in Primary Health Care: A Scoping Review” 更正“初级卫生保健中临床药学服务的实施：范围审查”。

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2025-11-02 DOI: 10.1111/jep.70307

Paolinelli, J.P.V., de Alencar, T., Rocha, K.S.S., Pereira, M.L. and dos Santos Júnior, G.A. (2025), Implementation of Clinical Pharmacy Services in Primary Health Care: A Scoping Review. Journal of Evaluation in Clinical Practice, 31: e70285. https://doi.org/10.1111/jep.70285.

The graduate program in the affiliation for Kérilin Stancine Santos Rocha is incorrect:

²Laboratory of Innovation for Healthcare (Linc). Postgraduate Program in Pharmaceutical Assistance (PPGASFAR), Federal University of Espírito Santo, Vitória, ES, Brazil

The correct affiliation should be:

²Laboratory of Innovation for Healthcare (Linc). Graduate Program in Pharmaceutical Services and Policies (PPGASFAR), Federal University of Espírito Santo, Vitória, ES, Brazil

We apologize for this error.

Paolinelli, j.p.v., de Alencar， T., Rocha, k.s.s., Pereira， M.L.和dos Santos Júnior， G.A.(2025)，初级卫生保健中临床药学服务的实施：范围审查。临床临床评价杂志，31(1):70 - 85。https://doi.org/10.1111/jep.70285.The在ksamriin stanine Santos Rocha附属机构的研究生项目是不正确的：2医疗保健创新实验室（Linc）。药物援助研究生课程（PPGASFAR）， Espírito Santo联邦大学，Vitória， ES，巴西正确的隶属关系应该是：2创新医疗实验室（Linc）。医药服务与政策研究生课程（PPGASFAR），联邦大学Espírito Santo， Vitória， ES， brazil我们为这个错误道歉。

引用次数: 0

Evidence-Based Summary on Medication Adherence Management for Adult Tuberculosis Patients With Multi-Dimensional Strategies and Practice Framework 基于证据的成人结核病患者药物依从性管理多维策略与实践框架综述。

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2025-10-27 DOI: 10.1111/jep.70280

Fanghui Xie, Rong Yao, Li Liang, Chuntao Wu, Yinping Hu, Yan Zhou, Min Huang, Jinxia Du, Xia Zhao, Bin Wan, Shengfang Xia

Objective

This study aims to systematically retrieve, evaluate and synthesize the best evidence for medication adherence management in adult tuberculosis (TB) patients, providing an evidence-based foundation for optimizing clinical practice.

Methods

Evidence-based questions were formulated using the PIPOST model. Following the ‘6S’ model, 19 Chinese and international databases (BMJ Best Practice, WHO, Cochrane Library, etc.), guidelines and professional association websites were searched from their inception to March 2025, using keywords such as tuberculosis, TB, medication adherence and drug adherence. Clinical guidelines, systematic reviews and manuals were included. Four researchers independently assessed the quality of the literature using AGREE II, AMSTAR and the Johns Hopkins Nursing Evidence-Based Practice Manual tools. Extracted evidence was classified, summarized and graded using the JBI Evidence-Based Healthcare Center's evidence hierarchy system (2014).

Results

Fourteen publications were included (five systematic reviews, six guidelines, three manuals), yielding 25 pieces of evidence across four dimensions: healthcare services, medication adherence supervision, adverse drug reaction management and patient social support. Key evidence included: Providing patient-centred care (Level 1 evidence); delivering health education and counselling throughout treatment (Level 1); implementing directly observed therapy (DOT) and digital health technologies (Level 1); prioritizing adverse drug reaction management (Level 4); strengthening social support systems (Level 1).

Conclusion

This study integrates a multidimensional intervention framework to systematize adherence management in adult TB patients. However, clinical implementation must consider regional resources, cultural differences and individual patient needs. Future research should focus on three priorities: (1) scaling digital technologies; (2) developing adverse reaction early-warning systems; and (3) exploring cost-effective interventions.

目的：系统检索、评价和综合成人结核病患者药物依从性管理的最佳证据，为优化临床实践提供循证依据。方法：采用PIPOST模型编制循证问题。按照“6S”模式，检索了19个国内外数据库（BMJ Best Practice、WHO、Cochrane Library等）、指南和专业协会网站，从其成立到2025年3月，使用关键词如结核病、TB、药物依从性和药物依从性。包括临床指南、系统评价和手册。四名研究人员使用AGREE II、AMSTAR和约翰霍普金斯护理循证实践手册工具独立评估文献的质量。使用JBI循证医疗保健中心的证据层次系统（2014）对提取的证据进行分类、汇总和分级。结果：纳入14篇出版物（5篇系统综述，6篇指南，3本手册），在卫生保健服务、药物依从性监督、药物不良反应管理和患者社会支持四个方面提供了25条证据。主要证据包括：提供以患者为中心的护理（一级证据）；在整个治疗过程中提供健康教育和咨询（第1级）；实施直接观察治疗（DOT）和数字卫生技术（1级）；优先考虑药物不良反应管理（4级）；加强社会支持系统（第1级）。结论：本研究整合了一个多维干预框架，使成人结核病患者的依从性管理系统化。然而，临床实施必须考虑地区资源、文化差异和患者个体需求。未来的研究重点应集中在三个方面：(1)数字技术的规模化；(2)建立不良反应预警系统；(3)探索具有成本效益的干预措施。

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引用次数: 0

‘Indeed, I Was Afraid. But I See Now I Shouldn't Have’: Voices of Vaccine-Accepting Parents About MMR Vaccination 25 Years After Wakefield's Autism Fallacy “的确，我很害怕。但我现在看到我不应该”：在韦克菲尔德的自闭症谬论25年后，接受疫苗的父母对MMR疫苗接种的声音。

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2025-10-23 DOI: 10.1111/jep.70302

Isidora Andric, Branko Beronja, Biljana Lukic, Teodora Bubnjevic, Milan Boskovic, Marija Milanovic, Jelena Dotlic, Marija Milic, Natasa Maksimovic, Tatjana Gazibara

Rationale and Aim

Over the past two decades several measles outbreaks occurred in Serbia with 15 fatal outcomes because the measles-mumps-rubella (MMR) vaccine coverage is low. The study purpose was to explore the attitudes of parents of vaccinated children towards the MMR vaccine.

Methods

This qualitative research was conducted on 40 parents of MMR vaccinated children aged 1–8 years throughout Serbia. Purposive sampling with maximum variation was used. Parents were interviewed while attending regular paediatric check-ups at the primary health centres. Participant selection was finalised when thematic saturation was achieved. Qualitative content analysis was applied.

Results

On average, parents were 36 ± 6 years old. The data were classified according to these themes: (1) General attitudes towards vaccination, (2) Sources of information about the MMR vaccine, (3) Interactions with health care workers, (4) Fear of MMR vaccination and (5) Perceived adverse effects associated with the MMR vaccination. The majority of parents expressed positive attitudes about vaccines in general and was accepting of MMR vaccination. Most parents explained that discussion with the paediatrician about the MMR vaccine was crucial in the process of accepting vaccination. Although one-half of parents were not afraid of the MMR vaccine, the other half of parents were still unable to completely let go of fear that something bad can happen to their child, despite the evidence.

Conclusion

The vast majority of parents support MMR vaccination. However, many parents of MMR vaccinated children still expressed lingering fear of adverse effects despite knowing that MMR-autism link was rejected.

理由和目的：在过去二十年中，由于麻疹-腮腺炎-风疹（MMR）疫苗覆盖率低，塞尔维亚发生了几次麻疹暴发，造成15人死亡。本研究的目的是探讨接种过MMR疫苗的儿童家长对MMR疫苗的态度。方法：本定性研究对塞尔维亚全国接种MMR疫苗的40名1-8岁儿童的父母进行了研究。采用最大变异的有目的抽样。在初级保健中心接受定期儿科检查时，对父母进行了访谈。当主题达到饱和时，参与者的选择就完成了。采用定性含量分析。结果：父母平均年龄36±6岁。数据根据以下主题进行分类：(1)对疫苗接种的一般态度，(2)关于MMR疫苗的信息来源，(3)与卫生保健工作者的互动，(4)对MMR疫苗接种的恐惧和(5)与MMR疫苗接种相关的感知不良反应。大多数家长对疫苗总体上持积极态度，并接受MMR疫苗接种。大多数家长解释说，在接受疫苗接种的过程中，与儿科医生讨论MMR疫苗是至关重要的。虽然有一半的父母不害怕MMR疫苗，但另一半的父母仍然无法完全摆脱对孩子可能发生坏事的恐惧，尽管有证据。结论：绝大多数家长支持MMR疫苗接种。然而，许多接种了MMR疫苗的孩子的父母仍然表达了对不良反应的挥之不去的恐惧，尽管他们知道MMR与自闭症的联系被拒绝了。

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引用次数: 0

Health Literacy Levels and Predictors Among Hospitalized Patients With Chronic Diseases 慢性疾病住院患者健康素养水平及预测因素

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2025-10-23 DOI: 10.1111/jep.70305

Elif Okur, Yağmur Akbal Demirci, Nesrin Nural

Objectives

The study investigated the health literacy levels and predictors of hospitalized patients with chronic diseases.

Methods

This descriptive and cross-sectional study was conducted with 128 hospitalized patients with chronic diseases between January 2024 and June 2024 in the internal medicine clinics of a public hospital in a province of Turkey. The data were collected using the “Participant Information Form”, the “Charlson Comorbidity Index” and the “Turkish Health Literacy Scale-32 (THLS-32)”.

Results

The lowest health literacy score was found in chronic renal failure patients (24.82 ± 11.94), and the highest in COPD/asthma patients (32.10 ± 10.75). A significant correlation was observed between the variables of age, duration of chronic disease (years), number of medications used, frequency of visiting a healthcare institution, and frequency of hospitalization for the past year and the health literacy score (Adjusted R² = 0.314, F = 12.350, p < 0.05). Age and frequency of hospitalization were found to be significant predictors of the health literacy score (p < 0.05).

Conclusions

This study revealed that more than half of individuals with chronic diseases have inadequate/problematic/limited health literacy. Approximately one-fourth of individuals with chronic diseases had inadequate health literacy. In addition, the health literacy level was low in older patients, had a high frequency of visits to health care institutions, had a high frequency of hospitalization, had a high frequency of emergency unit visits, had a long duration of chronic disease (years), had a high number of medications, and had a high number of comorbid diseases for the past year. Health education should be provided to patients frequently visiting the hospital to improve their health status.

目的：探讨慢性疾病住院患者健康素养水平及其预测因素。方法：对土耳其某省一家公立医院内科门诊2024年1月至2024年6月住院的128例慢性疾病患者进行描述性和横断面研究。使用“参与者信息表”、“Charlson共病指数”和“土耳其健康素养量表-32 （THLS-32）”收集数据。结果：慢性肾功能衰竭患者健康素养评分最低（24.82±11.94），COPD/哮喘患者健康素养评分最高（32.10±10.75）。年龄、慢性病病程（年）、用药次数、就诊次数、过去一年住院次数等变量与健康素养评分存在显著相关（调整后R2 = 0.314, F = 12.350, p）。结论：超过一半的慢性疾病患者健康素养不足/问题/有限。大约四分之一的慢性病患者缺乏卫生知识。此外，老年患者的卫生素养水平较低，到保健机构就诊的频率高，住院的频率高，急诊就诊的频率高，慢性疾病持续时间长（年），服用药物的数量多，过去一年中患有合并症的疾病的数量多。对经常到医院就诊的病人进行健康教育，改善其健康状况。

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引用次数: 0

Understanding and Managing Confounders, Mediators and Colliders in Research 理解和管理研究中的混杂因素、中介因素和碰撞因素。

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2025-10-21 DOI: 10.1111/jep.70298

Ahtisham Younas, Shahzad Inayat

Rationale

Researchers often make causal inferences about relationships among variables and constructs. However, third-variable effects may obscure the relationship among studied variables. Third-variable effects generally include confounders and mediators, but recently there has been an emerging discussion on colliders.

Aim

To provide a concise introduction of confounders, colliders, and mediators for health researchers and outline strategies for minimising the impact of confounders, colliders and mediators in quantitative research.

Methods

Methodological literature from biostatistics textbooks, methodology papers, and methodological reviews published in nursing, health, psychological and behavioural sciences.

Conclusions

Understanding third-variable effects is crucial to conducting rigorous research and drawing valid causal inferences from research data. Health researchers should embrace both theory and model-based thinking as a foundational element of their methodology. This involves explicitly theorising the underlying causal structures before data collection and analysis using Directed Acyclic Graphs which are useful for visually representing hypothesised causal pathways and their relationships with potential third variables.

理论基础：研究人员经常对变量和构念之间的关系作出因果推论。然而，第三变量效应可能会模糊所研究变量之间的关系。第三变量效应通常包括混杂因子和中介因子，但最近出现了关于碰撞因子的讨论。目的：为卫生研究人员提供混杂因素、碰撞因素和中介因素的简明介绍，并概述在定量研究中尽量减少混杂因素、碰撞因素和中介因素影响的策略。方法：方法文献来源于生物统计学教科书、方法学论文和发表在护理、健康、心理和行为科学领域的方法学综述。结论：了解第三变量效应对于开展严谨的研究和从研究数据中得出有效的因果推论至关重要。卫生研究人员应将理论和基于模型的思维作为其方法论的基本要素。这包括在数据收集和分析之前，使用有向无环图明确地理论化潜在的因果结构，这对于可视化地表示假设的因果路径及其与潜在第三变量的关系很有用。

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引用次数: 0

There Is No Dilemma: The Issue of Female Genital Reinfibulation in High-Income Countries Need Not be Revisited 没有困境：高收入国家的女性生殖器再植问题不需要重新讨论

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2025-10-18 DOI: 10.1111/jep.70303

Richard C. Armitage

<p>According to the World Health Organisation, female genital mutilation (FGM) comprises all procedures that involve the partial or total removal of external female genitalia or other injury to the female genital organs for nonmedical reasons [<span>1</span>]. The same classification describes Type III FGM—often referred to as infibulation—as the narrowing of the vaginal orifice through the creation of a covering seal formed by cutting and apposition of the labia minora and/or the labia majora, with or without excision of the clitoris [<span>1</span>].</p><p>Defibulation is the anterior midline vulval incision of the infibulation scar performed prenatally or at the time of delivery. While it restores sufficient access to the female reproductive tract, defibulation does not reinstate physical or emotional normality [<span>2</span>]. Reinfibulation is the subsequent resuturing of the incised infibulation scar tissue after delivery [<span>2</span>]. Approximately 13 million women have undergone infibulation globally, and an estimated 6.5–10.4 million women are likely to have been reinfibulated worldwide [<span>2</span>].</p><p>The prevalence of FGM is highly concentrated in a band of countries from the Atlantic coast to the Horn of Africa [<span>3</span>], and reinfibulation is most prevalent in countries where Type III FGM is the most practiced type, including Somalia (98%–100%), Sudan (82%), Djibouti (50%), and Eritrea (34%) [<span>1</span>]. While offering no medical benefits, reinfibulation returns women who have been defibulated to an infibulated state and subjects them once again to its accompanying harms. The process is associated with, among other risks, localised infection or abscess formation, sepsis, haemorrhage, shock, acute urinary retention, and contraction of hepatitis and/or HIV [<span>4</span>], while the infibulated state is associated with a plethora of gynaecological and obstetric complications [<span>4, 5</span>].</p><p>In their recent Correspondence in <i>The Lancet</i>, Bonavina and colleagues lament the unlawful status of reinfibulation in high-income countries as ‘potentially depriving [women] of their choice’, and claim there exists an ethical dilemma between preserving the ability of women to choose reinfibulation and protecting them against its harmful consequences [<span>6</span>]. The article contains multiple ethical problems, which I addressed in a reply submitted to the <i>The Lancet</i>. The reply was rejected by the editorial board, and my subsequent request for the board′s reasoning behind its decision was not granted. I shall, therefore, rebut the article here instead.</p><p>In their article, Bonavina and colleagues presume that the women who ‘choose’ reinfibulation simply exercise their autonomy in doing so. This reflects a superficial understanding of autonomy that conflates mere expression of preference with genuine autonomous choice. Autonomy, properly conceived, requires not only the capacity to express pref

根据世界卫生组织的定义，切割女性生殖器官包括因非医疗原因部分或全部切除女性外生殖器或对女性生殖器官造成其他伤害的所有程序[b]。同样的分类也适用于III型女性生殖器切割——通常被称为“插入”——在切除或不切除阴蒂的情况下，通过切割和放置小阴唇和/或大阴唇形成覆盖密封，使阴道口变窄。除管术是指在产前或分娩时在外阴前中线切口处进行的除管术。虽然它恢复了足够的女性生殖道通道，但它并不能恢复身体或情感的正常。再插管是指分娩后切开的插管瘢痕组织的后续重建。全球约有1300万妇女接受过插管，估计全世界有650万至1040万妇女可能再次接受过插管。女性生殖器切割的流行高度集中在从大西洋沿岸到非洲之角的一组国家[b]，在第三类女性生殖器切割最为盛行的国家，包括索马里（98%-100%）、苏丹（82%）、吉布提（50%）和厄立特里亚（34%）[b]。虽然没有医疗上的好处，但再插管会使已经被插管的妇女回到插管状态，并使她们再次遭受随之而来的伤害。除其他风险外，该过程与局部感染或脓肿形成、败血症、出血、休克、急性尿潴留以及肝炎和/或艾滋病毒bbb的收缩有关，而窒息状态与大量妇产科并发症有关[4,5]。在他们最近在《柳叶刀》杂志上的通信中，Bonavina及其同事哀叹高收入国家的再注射非法地位“潜在地剥夺了[妇女]的选择”，并声称在保留妇女选择再注射的能力和保护她们免受其有害后果之间存在道德困境[10]。这篇文章包含了多个伦理问题，我在给《柳叶刀》的回复中提到了这些问题。我的回复被编辑委员会拒绝了，我随后要求委员会解释其决定背后的原因，但没有得到批准。因此，我将在这里反驳这篇文章。在他们的文章中，博纳维纳和同事们认为，“选择”再注射的女性只是在这样做时行使了她们的自主权。这反映了对自主权的肤浅理解，即把单纯的偏好表达与真正的自主选择混为一谈。正确理解的自治不仅需要表达偏好的能力，而且需要真正独立自决的必要条件，特别是没有不适当的压力、恳求或胁迫。除了这种自愿之外，真正的自主还需要有关决策及其后果的充分信息，以及完全理解决策的认知能力。此外，自主性的关系解释认为，有意义的自主性需要支持性的社会条件，如认可、关怀和非压迫性的关系，这些条件使个人能够发展必要的心理和社会能力，以实现真正的自决[10]。当检查女性对再灌注的“选择”时，这些条件中的每一个都可能受到损害。首先，在这种情况下，自主选择的信息要求很少得到满足。接受再植手术的妇女往往对相关的医疗风险缺乏全面的了解，特别是因为切割女性生殖器的受害者几乎都是未成年人。此外，“选择”经常发生在由传统叙事主导的信息环境中，这些叙事将再灌注呈现为正常、必要或不可避免的bb0。其次，“选择”再植的妇女是否有必要的自愿和自由选择其他方式（再次强调，特别是因为女性生殖器切割的受害者几乎都是未成年人），包括在她们及其文化习俗和社会规范迁移的高收入国家，这一点还远不清楚。相反，自愿性要求从根本上被强制性的社会结构所妥协，而这些“选择”就发生在这种社会结构中。值得注意的是，Bonavina和同事们自己也承认，社区成员，特别是“年长的女性同行”，在“决定进行再插管”的压力下，受到手术会提高男性性快感的信念的影响。”[6]。即使我们承认妇女的再插管请求可以是自主的，这也不会确立执行该程序的医疗义务。这是因为自主只是多个伦理原则中的一个，这些原则往往彼此之间存在紧张关系，其中最值得注意的是在这种情况下的非恶意，[7,8]它警告人们不要在没有相应医疗效益的情况下进行造成重大伤害的手术。例如，一个潜在的肾脏捐赠者的自主决定可能会因为不可接受的手术风险而在道德上被否决，而医生没有道德义务尊重我自主要求切除健康右臂的要求。此外，不能要求医生采取他们认为不道德的行动，如果他们这样做，就会违反他们的诚信，即使病人自主地要求他们这样做。伦理原则是要平衡的，没有什么是神圣不可侵犯的，包括自治在内。再灌注造成的极端伤害使其远远超出了道德实践的界限，尽管有自主权。Bonavina和他的同事似乎提出了一种文化相对主义的论点，他们认为禁止再强制政策代表了文化帝国主义（“禁止再强制政策可能被视为一种机制，通过这种机制，国家可以加强其文化、意识形态和价值观，将其作为社会秩序的权力工具，并成为全球人权的默认标准。”）”)[6]。这一论点未能区分对文化多样性的容忍和对有害习俗的容忍。有系统地伤害和使妇女处于从属地位的文化习俗不能仅仅以妇女的传统地位来要求道德保护。此外，几乎所有高收入国家都认可的人权框架为身体完整和性别平等确立了超越文化界限的普遍标准。这些标准承认，有些做法，无论其文化来源如何，都与人类尊严不相容，不能通过诉诸文化真实性来维持。阴道灌封和所有其他形式的女性生殖器切割都完全属于这一类。因此，Bonavina及其同事所指出的明显的伦理困境根本不存在。相反，像所有形式的女性生殖器切割一样，再植入手术在道德上是站不住脚的，高收入国家必须坚持“禁止再植入手术”的政策，以保护弱势妇女。虽然作者将此类政策视为“国家强化其文化、意识形态和价值观的一种机制”，但从道德上讲，任何国家的文化、意识形态和价值观中拒绝这种野蛮行为的元素都是值得称赞的。作者声明无利益冲突。

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引用次数: 0

AI Anxiety: A Web of Science-Based Bibliometric Analysis 人工智能焦虑：基于科学的文献计量分析网络。

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2025-10-16 DOI: 10.1111/jep.70296

Betul Akalin, Furkan Alp, Birkan Tapan, Mehmet Besir Demirbas

Aim

Artificial Intelligence Anxiety (AI Anxiety) refers to the apprehension and distrust individuals may feel in response to the rapid development and integration of artificial intelligence into various aspects of life. These emotions are often driven by concerns about AI's potential implications in domains such as employment, security, privacy, and human interaction. This study aims to conduct a comprehensive bibliometric analysis of the scientific literature on ‘AI Anxiety’ published between 2011 and 2024.

Methods

A total of 80 articles indexed in the Web of Science (WoS) Core Collection database were analysed. The study evaluated parameters including the most cited publications, annual distribution of research, contributing countries, leading publishers, main research domains, and keyword trends. Network analyses involving coauthorship, author citations, institutional citations, and country-level citations were conducted using VOSviewer software.

Results

The findings indicate a notable increase in AI Anxiety-related studies, particularly between 2021 and 2024. Highly cited articles include works by Youn (2021) and Wang (2022). The United States emerged as the leading contributor, followed by China and Türkiye. Prominent publishers were Elsevier, Springer Nature, and Taylor & Francis. In the coauthorship network, authors such as Merlo and Johnson occupied central positions. Frequently used keywords included ‘Artificial Intelligence’, ‘AI Anxiety’, ‘Technology Acceptance Model’, and ‘Trust’. Country citation analysis revealed that the United States and China occupied central roles with strong citation linkages to other countries.

Conclusion

The study highlights the growing scholarly interest in the psychological and societal implications of artificial intelligence. It also provides a roadmap for future research directions by identifying key contributors, collaborative patterns, and thematic trends within the field of AI Anxiety.

目的：人工智能焦虑（Artificial Intelligence Anxiety，简称AI Anxiety）是指人们对人工智能的快速发展和融入生活的方方面面所产生的恐惧和不信任。这些情绪通常是由对人工智能在就业、安全、隐私和人际互动等领域的潜在影响的担忧所驱动的。本研究旨在对2011年至2024年间发表的关于“人工智能焦虑”的科学文献进行全面的文献计量分析。方法：对Web of Science (WoS) Core Collection数据库收录的80篇文献进行分析。该研究评估的参数包括被引用次数最多的出版物、研究的年度分布、贡献国、主要出版商、主要研究领域和关键词趋势。使用VOSviewer软件进行网络分析，包括合著者、作者引用、机构引用和国家级引用。结果：研究结果表明，与人工智能焦虑相关的研究显著增加，尤其是在2021年至2024年之间。高被引文章包括Youn（2021）和Wang（2022）的作品。美国成为最大的贡献国，其次是中国和俄罗斯。著名的出版商有爱思唯尔、施普林格Nature和Taylor & Francis。在合著者网络中，Merlo和Johnson等作者占据了中心位置。常用的关键词包括“人工智能”、“人工智能焦虑”、“技术接受模型”和“信任”。国家引文分析显示，美国和中国占据中心地位，与其他国家的引文联系较强。结论：这项研究突出了人工智能的心理和社会影响日益增长的学术兴趣。它还通过确定人工智能焦虑领域的关键贡献者、协作模式和主题趋势，为未来的研究方向提供了路线图。

{"title":"AI Anxiety: A Web of Science-Based Bibliometric Analysis","authors":"Betul Akalin, Furkan Alp, Birkan Tapan, Mehmet Besir Demirbas","doi":"10.1111/jep.70296","DOIUrl":"10.1111/jep.70296","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Artificial Intelligence Anxiety (AI Anxiety) refers to the apprehension and distrust individuals may feel in response to the rapid development and integration of artificial intelligence into various aspects of life. These emotions are often driven by concerns about AI's potential implications in domains such as employment, security, privacy, and human interaction. This study aims to conduct a comprehensive bibliometric analysis of the scientific literature on ‘AI Anxiety’ published between 2011 and 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 80 articles indexed in the Web of Science (WoS) Core Collection database were analysed. The study evaluated parameters including the most cited publications, annual distribution of research, contributing countries, leading publishers, main research domains, and keyword trends. Network analyses involving coauthorship, author citations, institutional citations, and country-level citations were conducted using VOSviewer software.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The findings indicate a notable increase in AI Anxiety-related studies, particularly between 2021 and 2024. Highly cited articles include works by Youn (2021) and Wang (2022). The United States emerged as the leading contributor, followed by China and Türkiye. Prominent publishers were Elsevier, Springer Nature, and Taylor & Francis. In the coauthorship network, authors such as Merlo and Johnson occupied central positions. Frequently used keywords included ‘Artificial Intelligence’, ‘AI Anxiety’, ‘Technology Acceptance Model’, and ‘Trust’. Country citation analysis revealed that the United States and China occupied central roles with strong citation linkages to other countries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The study highlights the growing scholarly interest in the psychological and societal implications of artificial intelligence. It also provides a roadmap for future research directions by identifying key contributors, collaborative patterns, and thematic trends within the field of AI Anxiety.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 7","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145301400","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

Factors Influencing Readiness for Hospital Discharge Among Patients With Schizophrenia: A Cross-Sectional Study 影响精神分裂症患者出院准备的因素：一项横断面研究。

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2025-10-14 DOI: 10.1111/jep.70277

Aliane Uwera, Qingqing Yang, Shumin Zhang, Jie Shi, Min Gao, Meizhi Li, Jianjian Wang, Zhanchou Zhang, Li He, Lulu Lu, Qiongni Chen

Rationale

Schizophrenia is a severe disabling disease associated with disease relapse and a high readmission rate after hospital discharge. Readiness for hospital discharge plays a crucial role in patients transitioning from the hospital to the community, as well as in improving post-discharge outcomes. However, previous studies have predominantly focused on personal characteristics, social support, and nurses' guidance during discharge, while disease-related factors and ward environment factors have been overlooked.

Objectives

To assess the current status and factors influencing readiness for hospital discharge among patients with schizophrenia.

Method

390 patients and 14 head nurses of psychiatric wards from six tertiary hospitals in China completed the questionnaire from July 2023 to January 2024. Data was analysed using descriptive statistics, t-tests, ANOVA, Pearson correlation, and multiple linear regression. This study was reported using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist.

Results

The mean score of readiness for hospital discharge among patients with schizophrenia was high (102.63 ± 15.69). The quality of discharge teaching, schizophrenia self-management, perceived social support, and other factors affecting the ability to control symptoms such as stigma and family conflicts significantly influenced readiness for hospital discharge, explained by 47.50% of the total variation in the model.

Conclusion

The current study has revealed a high level of readiness for hospital discharge, schizophrenia self-management, perceived social support, and quality of discharge teaching among patients with schizophrenia. In addition, the quality of discharge teaching, self-management, social support, and other reasons affecting the ability to control symptoms were the key factors influencing readiness for hospital discharge among patients with schizophrenia. Therefore, personalised hospital discharge preparation for patients with schizophrenia throughout their hospitalisation period is needed for effective community reintegration.

理由：精神分裂症是一种与疾病复发和出院后再入院率高相关的严重致残疾病。出院准备在患者从医院转到社区以及改善出院后结果方面起着至关重要的作用。然而，以往的研究主要集中在个人特征、社会支持、护士出院指导等方面，忽视了疾病相关因素和病房环境因素。目的：了解精神分裂症患者出院准备的现状及影响因素。方法：于2023年7月至2024年1月，对全国6所三级医院的390名患者和14名精神科病区护士长进行问卷调查。数据分析采用描述性统计、t检验、方差分析、Pearson相关和多元线性回归。本研究采用加强流行病学观察性研究报告（STROBE）检查表进行报告。结果：精神分裂症患者平均出院准备得分较高（102.63±15.69）。出院教学的质量、精神分裂症自我管理、感知到的社会支持以及其他影响控制症状（如耻辱和家庭冲突）能力的因素显著影响出院准备程度，解释了模型中47.50%的总变异。结论：目前的研究表明，精神分裂症患者的出院准备程度、精神分裂症自我管理、感知社会支持和出院教学质量较高。此外，出院教学质量、自我管理、社会支持等影响症状控制能力的因素是影响精神分裂症患者出院准备的关键因素。因此，需要在整个住院期间为精神分裂症患者进行个性化的出院准备，以便有效地重新融入社区。

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引用次数: 0

Reframing EHR Policy in China: Towards Balanced Implementation and Ethical Foundations 重构中国电子健康档案政策：走向平衡实施与伦理基础。

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice

Pub Date : 2025-10-14 DOI: 10.1111/jep.70273

Shuyuan Chen, Wenhao Huang, Yan Xu, Jie Yang

Objective

Electronic Health Record (EHR) systems are a core component of healthcare informatization, playing a crucial role in the development of digital and smart healthcare. This study utilizes policy tool theory to analyse policies related to China's EHR system. By gaining a deep understanding of the mechanisms of policy impact, we believe we can better guide the development direction of EHR systems, optimize resource allocation, and improve system effectiveness and efficiency. Ultimately, this will make a substantial contribution to the construction of healthcare informatization.

Methods

The research employs Christopher Hood's ʻNATOʼ model of policy tools to construct a three-dimensional analytical framework. A total of 427 relevant policy documents were retrieved and screened from the PKULAW.COM and WWW.GOV.COM databases. NVivo 14 software was used for text mining and quantitative analysis.

Results

The study reveals that authority tools (36.88%) dominate across most policy objectives, particularly in improving healthcare quality and promoting technological innovation. Nodality tools (27.90%) also demonstrate significant influence in enhancing healthcare quality and fostering technological innovation. Organization tools (21.75%) reflect governmental efforts in institutional development and organizational coordination. While economic tools (13.48%) show a lower overall frequency of use, they are applied relatively more in objectives related to rational resource allocation.

Conclusion

Recommendations include optimizing the government's role and balancing the use of authority tools; refining the policy objective system with increased attention to ethical issues; and strengthening the synergistic application of policy tools to enhance policy implementation effectiveness.

目的：电子病历（Electronic Health Record， EHR）系统是医疗信息化的核心组成部分，对数字化、智慧医疗的发展起着至关重要的作用。本研究运用政策工具理论对中国电子病历制度相关政策进行分析。通过深入了解政策影响机制，我们相信可以更好地引导电子病历系统的发展方向，优化资源配置，提高系统的有效性和效率。最终，这将为医疗信息化建设做出实质性贡献。方法：采用Christopher Hood的“NATO”政策工具模型构建三维分析框架。从PKULAW.COM和WWW.GOV.COM数据库共检索和筛选了427份相关政策文件。使用NVivo 14软件进行文本挖掘和定量分析。结果：研究表明，权威工具（36.88%）在大多数政策目标中占主导地位，特别是在提高医疗质量和促进技术创新方面。结节性工具（27.90%）在提高医疗质量和促进技术创新方面也显示出显著的影响。组织工具（21.75%）反映了政府在制度发展和组织协调方面的努力。虽然经济工具（13.48%）的总体使用频率较低，但相对而言，它们更多地应用于与合理资源配置相关的目标。结论：建议优化政府角色，平衡使用权威工具；完善政策目标体系，加强对伦理问题的关注；加强政策工具的协同运用，提高政策执行效果。

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引用次数: 0

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