Journal of evaluation in clinical practice最新文献

Rationale: Allied Health Primary Contact Clinic (AHPCC) models of care are increasingly used to manage growing demands on health service capacity. There is a critical need for new models of care to demonstrate value, however comprehensive evaluation of AHPCCs, including use of metrics frameworks like the Moretto framework, have been slow to uptake, and the reasons for this are unclear.

Aims and objectives: To understand current evaluation practices as mapped to the Moretto framework, and explore clinician attitudes to the process of service evaluation across a variety of AHPCC models implemented within a metropolitan health service in Queensland, Australia.

Method: A convergent mixed methods approach was used. Data were collected in 2022 using a quantitative presurvey, followed by a qualitative descriptive interview with AHPCC lead clinicians. Thirty AHPCCs were eligible, and all potential participants who provided consent were included. Descriptive statistics and thematic analysis were used for quantitative and qualitative data respectively, then merged and reported jointly.

Results: Twenty-three clinicians representing 22 different AHPCCs participated. AHPCC models were found to be complex and varied. Evaluation practices were variable across AHPCCs, although more than half collected most of the Moretto framework measures. Quality of life and resource use measures were least commonly collected. Themes regarding participants' experience of AHPCCs evaluation were that: Evaluation is complex and challenging; Evaluation is important; and Evaluation needs to be enabled.

Conclusion: For health services to fully understand the value of their AHPCC services and direct their limited resources appropriately, evaluation activity needs to be better valued and enabled at a local, statewide and national level. Strategies should include protected time, funding, administrative support, leadership support, access to mentorship, development of structures which enable collaborative evaluation at a state-wide (or broader) level, and a shared understanding of value and core areas for measurement across stakeholders.

Objective: Climate change is thought to have possible effects on changes in the menstruation process, which covers an important period of time in women's lives. Our study aimed to determine the impact of climate change anxiety on premenstrual syndrome (PMS) in women of reproductive age.

Methods: This is a cross-sectional study. The research was conducted online using various digital platforms between December 2023 and February 2024. This study was conducted on 456 women of reproductive age. The Personal Information Form, PMS Scale and Eco-Anxiety Scale were used for the data collection. The level of statistical significance was set at p < 0.05.

Results: The prevalence of PMS was 44.7%. The average score for the Eco-Anxiety Scale was 27.28 ± 6.44. A significant majority of participants (81.4%) stated that climate change would affect women's health, and 81.1% thought that they were affected by climate change. The Eco-Anxiety Scale scores were higher in women with PMS (p < 0.05). The results of the binary logistic regression analysis showed that being affected by climate change (odds ratio [OR] = 2.109, 95% confidence interval [CI] = 1.045-4.259, p = 0.035), age at menarche (OR = 1.249, 95% Cl = 1.073-1.453, p = 0.004) and Eco-Anxiety Scale scores were significant predictors of PMS (OR = 0.828, 95% Cl = 0.791-0.867, p < 0.001).

Conclusion: The results of our study showed that women with PMS had higher Eco-Anxiety Scale scores. Given the global effects of climate change, it is important to investigate its effects as a risk factor for the emergence of PMS. Furthermore, women's healthcare providers play an important and beneficial role in adapting to a changing climate; these efforts will have long-term impacts.

Background: At present, there is no specific teaching method for doctor-patient communication for oncology residents. This study combined BOPPPS (bridge-in, learning objective, pretest, participatory learning, posttest, and summary) teaching model and SBAR (situation-background-assessment-recommendation) communication model to try a new teaching and assessment model of doctor-patient communication, aiming to explore and improve the teaching method of doctor-patient communication for oncology residents.

Methods: Ninety residents were randomly divided into two groups: the experimental group (n = 45) was trained with the BOPPPS teaching model combined with the SBAR communication model, the routine teaching method was adopted in the control group (n = 45). Indicators of assessment included doctor-patient communication skills, satisfaction with teaching, and patient satisfaction.

Results: The scores for doctor-patient communication ability were significantly better in experimental group than control group (p < 0.05). The degree of satisfaction degree (very satisfied + satisfied) of the experimental group were higher than control group (p < 0.05). The overall teaching satisfaction of the experimental group was 100.00%, the control group was 77.78%, p < 0.001. Patients' satisfaction with the residents in the experimental group (93.3%) was significantly higher than control group (80.0%), p = 0.043.

Conclusion: The application of the BOPPPS combined with the SBAR can effectively enhance residents' doctor-patient communication ability and improve teaching satisfaction and patient satisfaction. This new model can effectively improve resident physician‒patient communication ability, which is worth actively promoting in clinical teaching work.

Aims: This study aimed to examine the effect of the hand hygiene education on middle school students' behavioral scores related to hand hygiene practices.

Design: The research adheres to a quasi-experimental design suitable for the pre-test Posttest model with a control group.

Methods: The population of the study consists of a total of 1159 students, comprising 5th, 6th, 7th, and 8th graders. During the first semester of the 2021-2022 academic year, face-to-face education was conducted at a middle school located in Ankara. Two face-to-face training sessions were conducted to increase awareness of hand hygiene.

Results: The groups indicate homogeneity in terms of demographic characteristics. The mean hand hygiene behavior score was 56.45 ± 8.03 before the education in the intervention group, which increased to 59.79 ± 7.62 after the education. In the control group, the mean score was 55.98 ± 7.89 before the education and 57.15 ± 7.63 after the education. It was found that after the educational program, there was a statistically significant increase in hand hygiene behavior scores of the groups.

Conclusion: The research findings indicate a beneficial impact of hand hygiene education on students' average behavioral scores.

Impact: To foster lasting behavioral changes from a young age, it is advisable to implement hygiene education in schools periodically, including targeted interventions for middle school students.

Background: The World Health Organization Surgical Safety Checklist (SSC), now used by healthcare providers worldwide, has proved to be useful in the improvement of patients' health through the reduction of mortality and morbidity after surgery. In the Emilia-Romagna region in Italy the SSC is accompanied by a document that registers any non-conformity (NC) identified during SSC completion. This study aimed to investigate the association between surgical complications and checklist compliance, in terms of incompleteness and presence of NCs, using data from the Modena Local Health Unit (LHU).

Methods: We used data from surgeries performed in the Modena LHU between 2018 and 2022, with their SSC and related NC document. We estimated relative risks (RRs) of complications fitting three modified Poisson regression models. Model 1 included checklist incompleteness and NC presence, Model 2 adjusted Model 1 for patients' sex and age group, and Model 3 adjusted Model 2 for the other potential confounders. We also performed a sensitivity analysis estimating the same three models including death outcomes as complications.

Results: We found an increased risk of complications for both checklist incompleteness (unadjusted RR [uRR]= 2.04; 95% confidence interval [CI]: 1.17 to 3.54) and presence of NCs (uRR = 2.35; 95% CI: 1.71 to 3.22). Results were consistent after adjustment and in the sensitivity analysis.

Conclusions: Improving checklist compliance can reduce the risk of surgical complications. In particular, NCs are a risk factor that must be further investigated to better understand their relationship with complications. We believe that NCs data recording is helpful for both researchers in the scope of surgical complications, and healthcare professionals in the operating room.

Aim: The current study aimed to assess the effect of interprofessional education on participants' self-efficacy perception of interprofessional communication at different levels of a healthcare system (relationships in the interpersonal, interprofessional, and administration levels).

Design: This is a sequential explanatory mixed-method study.

Method: Learners include surgical residents, surgical technology nurses, and anesthesia nurses (n = 130) who participated in the intervention and control groups. The quasi-experimental study was conducted in the first step. The educational strategy was interprofessional education and the main teaching method was case-based learning. The self-efficacy perception of the participants was assessed by a 26-item questionnaire before and 1 month after the intervention. The descriptive tests (mean, SD, percentage), student t-tests, and ANOVA were analyzed. The participants' experiences were explored through semi-structured interviews. Qualitative content was analyzed by Lundman and Graneheim's approach.

Results: The results showed that the scores of the learners in the intervention group (4.05 ± 0.31) improved significantly compared to the control group (3.35 ± 0.37) (p = 0.0001). In the present study, the experiences of the participants were categorized into a theme "explicit and implicit confrontations with perceived distrust in the system" which includes two categories "failure to internalize professionalism among team members" and "dominance of a paternalistic culture within the health care system".

Conclusion: The results showed the positive impact of interprofessional education interventions on participants' self-efficacy perception of interprofessional communication. The results showed that interprofessional education, with the participation of different professionals and managers at different levels of a healthcare system, improved the participants' perception of self-efficacy regarding interprofessional communication. The results showed the improvement in the participants' communication with team members and managers required to solve the perceived explicit and implicit confrontations in the surgical departments.

Implications for the profession: The implementation of an interprofessional education strategy focused on interprofessional professionalism and collaboration principles in clinical activities, formal and informal education in the surgical department is recommended.

Rationale, aims and objectives: With absence of a cure, the mainstay of management for patients with motor neurone disease (MND) is holistic supportive care and symptom control. Non-invasive ventilation (NIV) can provide relief from distressing dyspnoea which often accompanies progressive respiratory muscle weakness. Some patients using NIV will become dependent on it, with a small proportion of these patients going on to request withdrawal. Despite being legal in the UK, elective withdrawal of NIV can be emotionally and ethically challenging for the staff involved. To guide the process of symptom-controlled withdrawal, in 2015 the Association for Palliative Medicine (APM) released clinical guidance. The aim of this study is to explore the experiences of the multi-disciplinary team (MDT) involved in elective withdrawal of NIV in an MND cohort following the publication of this guidance.

Method: A qualitative, semi-structured interview study of eight NHS qualified staff members (three Doctors, four Nurses, one Allied Health Professional). Clinicians were asked questions relating to their experiences of the withdrawals. After full transcription, data was analysed thematically.

Results: Four main themes were identified, offering insight into how the withdrawals affected staff's well-being and summarised via an 'enablers and barriers' model. The setting was important, as was the depth and longevity of the clinician's investment in the patient. Positive influences on staff's well-being arose from the sense of fulfilling the patient's wishes, good teamwork, presence of an experienced clinician and awareness of the APM (2015) Guidance. Conversely, barriers to well-being were expressed through the unpredictability of each scenario, moral and ethical uncertainties, external pressures on time, mismatched expectations, poor communication and the emotional intensity of the act.

Conclusion: Elective withdrawal is highly emotive, simultaneously positively and negatively influencing staff well-being. By addressing the potential mitigating factors, the overall impact on staff's mental health and well-being maybe improved and thus, subsequently, patient care.