{"title":"Pregnant Women's Breast Milk and Breastfeeding Myths and Associated Factors: A Case of Refugee and Non-Refugee Women","authors":"Meryem Erat Nergiz, Siddika Songul Yalcin","doi":"10.1111/jep.70314","DOIUrl":"10.1111/jep.70314","url":null,"abstract":"","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145504672","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}
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.
{"title":"Physicians' Attitudes Toward Defensive Medicine and Medical Errors in Palliative Care: A Cross-Sectional Study","authors":"Ardacan Uyğur, Abdullah Ozan Polat, Okcan Basat","doi":"10.1111/jep.70316","DOIUrl":"10.1111/jep.70316","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145504979","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}
<p>A rare psychologist can be an expert in all areas of psychological practices. After recognising this fact, regulatory Colleges in many Western countries have segregated licenses into subspecialties, such as Child, Geriatric, Educational, Addiction, Military, Clinical, Organisational, or Neuropsychology. The negative outcome of such segregated licensing has emerged as a shortage of Specialists in Psychology (SP), who have a license to conduct psychological evaluations of specific demographic groups. For example, only Child Psychologists can perform evaluations of children, but there is a long waiting list for a Child Psychologist in many regions. In 2022, the APA reported that only 4% of Psychologists have licenses to work with children and adolescents (Abramson, 2022). This shortage is even more noticeable in cases when the SP should know specific language to understand the client.</p><p>Such cases are rare, but to ensure inclusivity and quality of care for all members of the public, psychologists should have Plan B-s to handle them. We can base these Plan B-s on the inter-disciplinary cooperation—similar to the permission to assist in medical emergencies for doctors regardless of their sub-specialities. Otherwise, with the recent surge in refugees, veterans and relocations of people avoiding war conflicts, as well as the ageing of populations, a significant number of people are at risk of not having timely evaluation and quality care simply because they can't find SPs speaking their language. The purpose of the EDR format is to serve exclusively in such complex EDR cases and to assist the information transfer from an EDR client in distress to needed services, including the informational assistance of non-clients in the referral to a needed SP. This might reduce the SP's time for psychological assessment, including time for information gathering and summarising facts, translations, file review and optional highlighting of possible correspondence of behaviour to DSM/ICD descriptors (Figure 1).</p><p>An EDR can be prepared as an extensive attachment to the client-family referrals to SPs. Normally, referral letters mention the concerns or symptoms only briefly. Any parallels between more specific DSM/ICD categories and observed or cited (from reviewed documents) behaviour can be viewed as an attempt to give a diagnosis to non-clients by a non-SP psychologist, violating the conditions of a license. This is not a trivial matter, as there are currently several cases where regulatory Colleges of Psychologists penalise Psychologists for documenting information about non-clients (clients' relatives) in distress who were desperately but unsuccessfully looking for a psychologist. Psychologists who were treating these clients knew the family and their situation well, spoke their language. Still, their hands were tied in helping the clients' relatives since they didn't have SP licenses related to this demographic group.</p><p>It is important, therefore, to
{"title":"Evidence-Documenting Reports as a Plan-B in Urgent/Complex Cases of Psychological Practice","authors":"Irina Trofimova","doi":"10.1111/jep.70311","DOIUrl":"https://doi.org/10.1111/jep.70311","url":null,"abstract":"<p>A rare psychologist can be an expert in all areas of psychological practices. After recognising this fact, regulatory Colleges in many Western countries have segregated licenses into subspecialties, such as Child, Geriatric, Educational, Addiction, Military, Clinical, Organisational, or Neuropsychology. The negative outcome of such segregated licensing has emerged as a shortage of Specialists in Psychology (SP), who have a license to conduct psychological evaluations of specific demographic groups. For example, only Child Psychologists can perform evaluations of children, but there is a long waiting list for a Child Psychologist in many regions. In 2022, the APA reported that only 4% of Psychologists have licenses to work with children and adolescents (Abramson, 2022). This shortage is even more noticeable in cases when the SP should know specific language to understand the client.</p><p>Such cases are rare, but to ensure inclusivity and quality of care for all members of the public, psychologists should have Plan B-s to handle them. We can base these Plan B-s on the inter-disciplinary cooperation—similar to the permission to assist in medical emergencies for doctors regardless of their sub-specialities. Otherwise, with the recent surge in refugees, veterans and relocations of people avoiding war conflicts, as well as the ageing of populations, a significant number of people are at risk of not having timely evaluation and quality care simply because they can't find SPs speaking their language. The purpose of the EDR format is to serve exclusively in such complex EDR cases and to assist the information transfer from an EDR client in distress to needed services, including the informational assistance of non-clients in the referral to a needed SP. This might reduce the SP's time for psychological assessment, including time for information gathering and summarising facts, translations, file review and optional highlighting of possible correspondence of behaviour to DSM/ICD descriptors (Figure 1).</p><p>An EDR can be prepared as an extensive attachment to the client-family referrals to SPs. Normally, referral letters mention the concerns or symptoms only briefly. Any parallels between more specific DSM/ICD categories and observed or cited (from reviewed documents) behaviour can be viewed as an attempt to give a diagnosis to non-clients by a non-SP psychologist, violating the conditions of a license. This is not a trivial matter, as there are currently several cases where regulatory Colleges of Psychologists penalise Psychologists for documenting information about non-clients (clients' relatives) in distress who were desperately but unsuccessfully looking for a psychologist. Psychologists who were treating these clients knew the family and their situation well, spoke their language. Still, their hands were tied in helping the clients' relatives since they didn't have SP licenses related to this demographic group.</p><p>It is important, therefore, to","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70311","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Skin cancer is a significant public health problem; it is one of the most commonly occurring cancers worldwide and imposes a high economic burden on society.
Aims and Objectives
This study aimed to elucidate the key factors affecting the cost of skin cancer in patients residing in southern Iran.
Methods
A comprehensive list of cost-affecting factors for skin cancer was developed through a scoping review of relevant literature from multiple databases (PubMed, ProQuest, Scopus, ISI Web of Science, SID, and Magiran), supplemented by expert input from skin cancer specialists. Subsequently, the data about 216 skin cancer patients selected randomly were collected between March 2020 and March 2022. The factors affecting the costs of skin cancer were determined using SPSS 13.0 software through statistical tests and multiple regression analysis.
Results
Multiple linear regression analysis identified mortality (p < 0.001), inpatient days (p < 0.001), and skin cancer type (p = 0.056) as key cost drivers. Mortality had the strongest impact, increasing costs by $78,249 per case (95% CI: ±$12,433), followed by each additional inpatient day ($4884 ± $845). Melanoma cases incurred $3727 higher costs than non-melanoma cases.
Conclusions
In conclusion, mortality, cancer type, and inpatient days were key cost drivers in skin cancer management. To mitigate these, we recommend nationwide high-risk screening, hospitalization reduction strategies, and prevention programs. Targeted mortality reduction requires early detection initiatives and public education on warning signs.
皮肤癌是一个重大的公共卫生问题；它是世界上最常见的癌症之一，给社会带来了沉重的经济负担。目的和目的本研究旨在阐明影响居住在伊朗南部的皮肤癌患者费用的关键因素。方法通过对多个数据库（PubMed、ProQuest、Scopus、ISI Web of Science、SID和Magiran）的相关文献进行范围审查，并辅以皮肤癌专家的意见，制定出一份全面的皮肤癌成本影响因素清单。随后，在2020年3月至2022年3月期间，随机抽取216名皮肤癌患者的数据。采用SPSS 13.0软件进行统计检验和多元回归分析，确定影响皮肤癌成本的因素。结果多元线性回归分析发现死亡率（p < 0.001）、住院天数（p < 0.001）和皮肤癌类型（p = 0.056）是主要的成本驱动因素。死亡率的影响最大，每例增加78,249美元的费用（95% CI：±12,433美元），其次是每增加一个住院日（4884±845美元）。黑色素瘤病例的费用比非黑色素瘤病例高出3727美元。结论死亡率、肿瘤类型和住院天数是皮肤癌治疗的主要成本驱动因素。为了减轻这些，我们建议在全国范围内进行高风险筛查，减少住院治疗策略和预防计划。有针对性地降低死亡率需要采取早期发现行动，并就预警信号开展公众教育。
{"title":"Factors Affecting the Costs of Skin Cancer Patients: A Study in Southern Iran","authors":"Faride Sadat Jalali, Mozhgan Seif, Abdosaleh Jafari, Khosro Keshavarz, Ramin Ravangard","doi":"10.1111/jep.70300","DOIUrl":"https://doi.org/10.1111/jep.70300","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Skin cancer is a significant public health problem; it is one of the most commonly occurring cancers worldwide and imposes a high economic burden on society.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>This study aimed to elucidate the key factors affecting the cost of skin cancer in patients residing in southern Iran.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive list of cost-affecting factors for skin cancer was developed through a scoping review of relevant literature from multiple databases (PubMed, ProQuest, Scopus, ISI Web of Science, SID, and Magiran), supplemented by expert input from skin cancer specialists. Subsequently, the data about 216 skin cancer patients selected randomly were collected between March 2020 and March 2022. The factors affecting the costs of skin cancer were determined using SPSS 13.0 software through statistical tests and multiple regression analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Multiple linear regression analysis identified mortality (<i>p</i> < 0.001), inpatient days (<i>p</i> < 0.001), and skin cancer type (<i>p</i> = 0.056) as key cost drivers. Mortality had the strongest impact, increasing costs by $78,249 per case (95% CI: ±$12,433), followed by each additional inpatient day ($4884 ± $845). Melanoma cases incurred $3727 higher costs than non-melanoma cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In conclusion, mortality, cancer type, and inpatient days were key cost drivers in skin cancer management. To mitigate these, we recommend nationwide high-risk screening, hospitalization reduction strategies, and prevention programs. Targeted mortality reduction requires early detection initiatives and public education on warning signs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420632","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}
L. J. Zimmermann, A. Weaver, M. Gottlieb, K. Pallok, D. Thompson, D. A. Ansell, K. E. Niehaus, G. Walker
Rationale
Nearly half of American adults live with high blood pressure, of whom three-quarters do not have their blood pressure under adequate control. Many challenges exist in assessing blood pressure control, including in-clinic measurement biases and physiologic variability, limiting the ability to appropriately guide therapeutic changes.
Aims and Objectives
This study's objective was to compare blood pressure (BP) variability in-clinic and at-home using a BP monitoring app.
Methods
This retrospective, observational study compared in-clinic BP measurements to at-home BP measurements recorded via a mobile application from April 2024 to May 2025. BP variability was assessed, comparing standard deviations (SD), control status (adequately controlled: systolic BP < 140 mmHg and diastolic BP < 90 mmHg), and both within-day and within-week timeframe fluctuations.
Results
Among 304 patients with sufficient in-clinic data, the mean SD value for in-clinic systolic BP was 12.6 mmHg. Comparing at-home readings 2, 4, and 6 weeks before an in-clinic appointment for 207, 229, and 243 patients with sufficient data, 71.5%, 72.1%, and 72.8% of in-clinic measurements differed by more than 5 mmHg from average at-home systolic BP, and 30.1%, 29.8%, and 29.8% indicated a different hypertension control status, respectively. For patients with at-home readings, the mean systolic BP SD for 288 patients within the same day was 8.8 mmHg. Over 2, 4, and 6 week timeframes, mean SD increased to 10.5, 10.9, and 11.1 mmHg for 322, 329, and 336 patients with sufficient readings, respectively.
Conclusion
Reliance on single in-clinic BP measurements for hypertension management can be inaccurate due to significant variability over time. In addition to impacting treatment decisions, this may impact HEDIS metrics and Medicare Advantage Star ratings, which heavily influence healthcare revenue and quality perception. Findings indicate at-home BP monitoring can result in a meaningfully different BP control rate, emphasizing a role for at-home monitoring to enhance BP measurement reliability.
{"title":"Blood Pressure Variability Between In-Clinic and At-Home Measurements: Implications for Care Quality Assessment","authors":"L. J. Zimmermann, A. Weaver, M. Gottlieb, K. Pallok, D. Thompson, D. A. Ansell, K. E. Niehaus, G. Walker","doi":"10.1111/jep.70299","DOIUrl":"https://doi.org/10.1111/jep.70299","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Nearly half of American adults live with high blood pressure, of whom three-quarters do not have their blood pressure under adequate control. Many challenges exist in assessing blood pressure control, including in-clinic measurement biases and physiologic variability, limiting the ability to appropriately guide therapeutic changes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>This study's objective was to compare blood pressure (BP) variability in-clinic and at-home using a BP monitoring app.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective, observational study compared in-clinic BP measurements to at-home BP measurements recorded via a mobile application from April 2024 to May 2025. BP variability was assessed, comparing standard deviations (SD), control status (adequately controlled: systolic BP < 140 mmHg and diastolic BP < 90 mmHg), and both within-day and within-week timeframe fluctuations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 304 patients with sufficient in-clinic data, the mean SD value for in-clinic systolic BP was 12.6 mmHg. Comparing at-home readings 2, 4, and 6 weeks before an in-clinic appointment for 207, 229, and 243 patients with sufficient data, 71.5%, 72.1%, and 72.8% of in-clinic measurements differed by more than 5 mmHg from average at-home systolic BP, and 30.1%, 29.8%, and 29.8% indicated a different hypertension control status, respectively. For patients with at-home readings, the mean systolic BP SD for 288 patients within the same day was 8.8 mmHg. Over 2, 4, and 6 week timeframes, mean SD increased to 10.5, 10.9, and 11.1 mmHg for 322, 329, and 336 patients with sufficient readings, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Reliance on single in-clinic BP measurements for hypertension management can be inaccurate due to significant variability over time. In addition to impacting treatment decisions, this may impact HEDIS metrics and Medicare Advantage Star ratings, which heavily influence healthcare revenue and quality perception. Findings indicate at-home BP monitoring can result in a meaningfully different BP control rate, emphasizing a role for at-home monitoring to enhance BP measurement reliability.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420642","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}
Marjan Shahbazi, Mehdi Alizadeh Zarei, Afsoon Hassani Mehraban, Samaneh Karamali Esmaili, Fatemeh Shahbazi
Background
With the rise of globalisation, the demand for reliable and valid measurement tools that can be applied across diverse languages and cultures has become increasingly crucial. This situation requires the translation and adaptation of assessment instruments before they can be effectively used in new contexts.
Objective
This umbrella review aimed to synthesise and critically evaluate existing methods for translating and culturally adapting self-report health instruments.
Methods
A comprehensive search was performed in PubMed, CINAHL, and the Cochrane Library for reviews published between January 2000 and April 2025. Two independent reviewers screened the titles, abstracts, and full texts using predefined inclusion and exclusion criteria. Data were extracted and categorised into translation and cultural adaptation processes. The methodological quality of included reviews was appraised using the AMSTAR tool.
Results
Nineteen reviews were included, identifying 46 distinct methods for translation and cultural adaptation. Considerable variation was observed regarding the number of steps, use of forward and back translation, expert committee involvement, and pre-testing with target populations. Only 10 methods fully implemented all essential steps recommended by quality evaluation checklists such as DuBay & Watson.
Conclusion
This umbrella review provides the first quantitative critique of translation and cultural adaptation methods for self-report instruments. Findings highlight the absence of a single ‘gold standard’ but support the adoption of structured, multistep approaches that integrate expert committee review and cognitive testing to ensure linguistic accuracy and cultural appropriateness.
{"title":"An Umbrella Review of Various Methods for Translating and Culturally Adapting Self-Reported Health Instruments","authors":"Marjan Shahbazi, Mehdi Alizadeh Zarei, Afsoon Hassani Mehraban, Samaneh Karamali Esmaili, Fatemeh Shahbazi","doi":"10.1111/jep.70287","DOIUrl":"https://doi.org/10.1111/jep.70287","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>With the rise of globalisation, the demand for reliable and valid measurement tools that can be applied across diverse languages and cultures has become increasingly crucial. This situation requires the translation and adaptation of assessment instruments before they can be effectively used in new contexts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This umbrella review aimed to synthesise and critically evaluate existing methods for translating and culturally adapting self-report health instruments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive search was performed in PubMed, CINAHL, and the Cochrane Library for reviews published between January 2000 and April 2025. Two independent reviewers screened the titles, abstracts, and full texts using predefined inclusion and exclusion criteria. Data were extracted and categorised into translation and cultural adaptation processes. The methodological quality of included reviews was appraised using the AMSTAR tool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Nineteen reviews were included, identifying 46 distinct methods for translation and cultural adaptation. Considerable variation was observed regarding the number of steps, use of forward and back translation, expert committee involvement, and pre-testing with target populations. Only 10 methods fully implemented all essential steps recommended by quality evaluation checklists such as DuBay & Watson.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This umbrella review provides the first quantitative critique of translation and cultural adaptation methods for self-report instruments. Findings highlight the absence of a single ‘gold standard’ but support the adoption of structured, multistep approaches that integrate expert committee review and cognitive testing to ensure linguistic accuracy and cultural appropriateness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420643","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}
Ramazan Cihad Yilmaz, Alper Percin, Dilan Demirtas Karaoba, Busra Candiri
Aims and Objectives
This study aimed to investigate the metaphorical perceptions of the students of the Department of Physiotherapy and Rehabilitation regarding exercise.
Methods
The study was designed as a phenomenological case study, following the qualitative research method; it included 180 students from the Department of Physiotherapy and Rehabilitation. The students were asked to complete the sentence, “Exercise is like…; because…” to gain insight into their perception of exercise.
Results
Students produced 180 metaphors, which were grouped into 13 different categories. Students most frequently compared exercise to the notions of water, reading, therapy, air, and medicine. The categories with the highest number of metaphors included “happiness and soothing,” “psychological impact,” “labour, care, and continuity,” and “valuable.” The metaphors suggested by the students of the Department of Physiotherapy and Rehabilitation toward exercise were positive; however, they defined exercise as a challenging activity that requires effort and continuity.
Conclusion
Most students included in the study used positive metaphors about exercise. A few students expressed negative sentiments. Investigating the perceptions of physiotherapy students on exercise beginning from their school years can provide a reference for adopting a better quality and holistic exercise approach, including teaching about and training on exercise, thereby enhancing their future role in developing exercise prescriptions and improving exercise adherence.
{"title":"A Review of Physiotherapy and Rehabilitation Students' Metaphorical Perceptions of Exercise","authors":"Ramazan Cihad Yilmaz, Alper Percin, Dilan Demirtas Karaoba, Busra Candiri","doi":"10.1111/jep.70306","DOIUrl":"https://doi.org/10.1111/jep.70306","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>This study aimed to investigate the metaphorical perceptions of the students of the Department of Physiotherapy and Rehabilitation regarding exercise.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study was designed as a phenomenological case study, following the qualitative research method; it included 180 students from the Department of Physiotherapy and Rehabilitation. The students were asked to complete the sentence, “Exercise is like…; because…” to gain insight into their perception of exercise.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Students produced 180 metaphors, which were grouped into 13 different categories. Students most frequently compared exercise to the notions of water, reading, therapy, air, and medicine. The categories with the highest number of metaphors included “happiness and soothing,” “psychological impact,” “labour, care, and continuity,” and “valuable.” The metaphors suggested by the students of the Department of Physiotherapy and Rehabilitation toward exercise were positive; however, they defined exercise as a challenging activity that requires effort and continuity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Most students included in the study used positive metaphors about exercise. A few students expressed negative sentiments. Investigating the perceptions of physiotherapy students on exercise beginning from their school years can provide a reference for adopting a better quality and holistic exercise approach, including teaching about and training on exercise, thereby enhancing their future role in developing exercise prescriptions and improving exercise adherence.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This cross-sectional study aims to compare the accuracy, precision and clarity of responses to dental implant questions from three artificial intelligence (AI) models: ChatGPT (OpenAI, GPT-4), Gemini (Google) and MedGebra.
Materials and Methods
56 questions from an EAO patient guide were used and responses from each AI system were evaluated independently by two oral surgery specialists using a four-point Likert scale for correctness, precision and clarity.
Results
ChatGPT consistently scored highest especially in clarity with perfect marks from both evaluators. Gemini ranked lower in accuracy and precision but exhibited similar clarity. MedGebra received the lowest ratings on all criteria. Though consistency generally remained excellent, the inter-rater reliability study revealed some variance in agreement levels between two examiners.
Conclusion
ChatGPT and Gemini provided more accurate and informative responses on dental implants questions compared to MedGebra. According to the findings of the present study AI chatbots have potential for enhancing patient education on dental implants but professional oversight is crucial for ensuring accuracy and reliability. The study highlights the promising and potential benefits of large language models (LLMs) in dental patient education.
{"title":"Evaluation of Artificial Intelligence Conversational Models in Providing Information on Dental Implants: A Comparative Analysis of ChatGPT, Gemini and MedGebra","authors":"Georgios Kofos, Anastasia Fardi, Theodoros Lillis, Fotopoulos Ioannis, Nickolaos Dabarakis","doi":"10.1111/jep.70304","DOIUrl":"https://doi.org/10.1111/jep.70304","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>This cross-sectional study aims to compare the accuracy, precision and clarity of responses to dental implant questions from three artificial intelligence (AI) models: ChatGPT (OpenAI, GPT-4), Gemini (Google) and MedGebra.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>56 questions from an EAO patient guide were used and responses from each AI system were evaluated independently by two oral surgery specialists using a four-point Likert scale for correctness, precision and clarity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>ChatGPT consistently scored highest especially in clarity with perfect marks from both evaluators. Gemini ranked lower in accuracy and precision but exhibited similar clarity. MedGebra received the lowest ratings on all criteria. Though consistency generally remained excellent, the inter-rater reliability study revealed some variance in agreement levels between two examiners.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ChatGPT and Gemini provided more accurate and informative responses on dental implants questions compared to MedGebra. According to the findings of the present study AI chatbots have potential for enhancing patient education on dental implants but professional oversight is crucial for ensuring accuracy and reliability. The study highlights the promising and potential benefits of large language models (LLMs) in dental patient education.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70304","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In the early weeks of the pandemic year 2020, health agencies were slow to warn of the potential for a global health emergency while scientists waited for ‘sufficient’ evidence of human-to-human transmission of the new coronavirus. There were further delays and confusion in issuing guidance because of uncertainty about the most important routes of exposure. A 2021 international expert panel review of COVID-19 pandemic response concluded: ‘The bias of the current system of pandemic alert is towards inaction—steps may only be taken if the weight of evidence requires them. This bias should be reversed—precautionary action should be taken on a presumptive basis, unless evidence shows it is not necessary’. To implement this recommendation, health agencies should incorporate the concept of precaution into their methods for rapidly and transparently reaching policy decisions. In this article, we summarise the historical development of precautionary policy frameworks, and present 4 key components. First, take action if potential risks are large, even when the science is uncertain. This corresponds to the common sense idea of ‘better safe than sorry’. Second, consider the burden of proof required before choosing among alternative actions. Third, ensure that the full range of potential solutions is considered by broadly defining the problem and consulting all relevant scientific fields. Finally, increase public participation so that all relevant perspectives are included, and the chances of public buy-in are increased. Drawing lessons from past applications and missed opportunities, we propose steps that health agencies could take to incorporate precaution into a pragmatic approach to using science for pandemic preparedness and response. The risk of another pandemic from the highly pathogenic avian influenza A (H5N1) virus underscores the urgency of this new approach.
{"title":"Science for Pandemic Preparedness: A Precautionary Framework","authors":"David Kriebel, Rok Ho Kim, Trisha Greenhalgh","doi":"10.1111/jep.70309","DOIUrl":"https://doi.org/10.1111/jep.70309","url":null,"abstract":"<p>In the early weeks of the pandemic year 2020, health agencies were slow to warn of the potential for a global health emergency while scientists waited for ‘sufficient’ evidence of human-to-human transmission of the new coronavirus. There were further delays and confusion in issuing guidance because of uncertainty about the most important routes of exposure. A 2021 international expert panel review of COVID-19 pandemic response concluded: ‘The bias of the current system of pandemic alert is towards inaction—steps may only be taken if the weight of evidence requires them. This bias should be reversed—precautionary action should be taken on a presumptive basis, unless evidence shows it is not necessary’. To implement this recommendation, health agencies should incorporate the concept of precaution into their methods for rapidly and transparently reaching policy decisions. In this article, we summarise the historical development of precautionary policy frameworks, and present 4 key components. First, take action if potential risks are large, even when the science is uncertain. This corresponds to the common sense idea of ‘better safe than sorry’. Second, consider the burden of proof required before choosing among alternative actions. Third, ensure that the full range of potential solutions is considered by broadly defining the problem and consulting all relevant scientific fields. Finally, increase public participation so that all relevant perspectives are included, and the chances of public buy-in are increased. Drawing lessons from past applications and missed opportunities, we propose steps that health agencies could take to incorporate precaution into a pragmatic approach to using science for pandemic preparedness and response. The risk of another pandemic from the highly pathogenic avian influenza A (H5N1) virus underscores the urgency of this new approach.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70309","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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。
{"title":"The Role of Traditional Chinese Medicine Health Management Model in Improving the Quality of Clinical Nursing Services","authors":"Desheng Li, Min Zhou, Hongmei Zhang, Lulu Zheng","doi":"10.1111/jep.70301","DOIUrl":"https://doi.org/10.1111/jep.70301","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To explore the role of the traditional Chinese medicine (TCM) health management model in improving the quality of clinical nursing services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared with the pre-implementation group, the incidence of adverse events in the post-implementation group was significantly reduced (3.33% vs. 8.67%, <i>p</i> < 0.05), the qualified rate of nursing documents increased to 98.33% (vs. 89.33%, <i>p</i> < 0.05) and the service response time was shortened to 5.2 ± 1.3 min (vs. 9.8 ± 2.1, <i>p</i> < 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 <i>p</i> < 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 <i>p</i> < 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Relevance to Clinical Practice</h3>\u0000 \u0000 <p>This study offers preliminary insights into integrating traditional medicine approaches with modern nursing practices, although further research is needed to establish broader applicability, particula","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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