Evidence-based practice (EBP) is crucial for appropriate, effective, and affordable care. Despite EBP education, barriers like low self-efficacy and outcome expectancy limit nurses' engagement in EBP. Reliable scales are essential to evaluate interventions aimed at improving self-efficacy and outcome expectancy in EBP. The English Self-efficacy and Outcome Expectancy in EBP scales are psychometrically sound.

To describe the translation, construct validity and internal consistency of the Dutch Self-efficacy and Outcome Expectancy in EBP Scales.

The scales were translated forward and backward, piloted for comprehensibility and completeness and then administered among Dutch nurses and nursing students.

Pilot testing confirmed comprehensibility, completeness, and relevance of the items. Confirmatory factor analysis (CFA) (n = 769) tested a second-order model for the Self-efficacy scale (Comparative Fit Index (CFI)=0.96, Tucker-Lewis Index (TLI)=0.95, Root Mean Square Error of Approximation (RMSEA)=0.06, Standardized Root Mean Residual (SRMR)=0.04) and a single-factor model for the Outcome Expectancy Scale (CFI=0.99, TLI=0.99, RMSEA=0.06, SRMR=0.01). Chi-squared tests remained significant. Hypothesis testing confirmed construct validity of the Self-efficacy (r = 0.77) and Outcome Expectancy Scale (r = 0.74). Both scales exhibited high internal consistency with McDonald's Omega and Cronbach's Alpha values above 0.95.

Both scales exhibit theoretical soundness and positive fit indices. Significant chi-square tests and high correlations between weighted and unweighted scores support using unweighted scores over utilizing the estimated model to calculate weighted scores.

Construct validity and internal consistency of the Dutch Self-efficacy and Outcome Expectancy in EBP Scales are good. Future research should prioritize responsiveness and test-retest reliability.

Pancreatic cancer is a highly invasive malignant tumor with a complex pathogenesis that makes early diagnosis challenging. The potential association between Helicobacter pylori infection and pancreatic cancer risk has been noted; however, the available results are still highly divergent. The aim of the present study was to systematically evaluate the association between different types of H. pylori infection and pancreatic cancer risk as well as to explore the possible causes. A systematic search was conducted using the PubMed, Embase and Cochrane Library databases up to August 2023. The literature quality was evaluated using the Newcastle-Ottawa Scale. All studies that met the criteria were included in the overall meta-analysis to calculate the odds ratios (ORs) and corresponding 95% confidence intervals (CIs). In addition, subgroup analyses were performed based on factors such as diagnostic criteria for H. pylori infection, study region, type of study design and CagA status. The effect of publication bias on the quantitative synthesis results was assessed using the trim-and-fill analysis, and sensitivity analyses were used to verify the robustness of the quantitative synthesis results. A total of 17 studies involving 67,910 participants, including 64,372 controls and 3,538 patients with pancreatic cancer, were included in the present study. The overall analysis showed that no significant association was observed between H. pylori infection and pancreatic cancer risk (OR, 1.15; 95% CI, 0.93-1.41). Further subgroup analyses, which did not consider the effects of study quality, diagnostic criteria, geographical distribution and the type of study design, did not produce new findings that contradicted the results of the overall analysis. CagA+ H. pylori infection did not significantly affect the risk of pancreatic cancer (OR, 0.95; 95% CI, 0.78-1.16), whereas CagA- H. pylori infection may be a possible risk factor for pancreatic cancer (OR, 1.24; 95% CI, 1.004-1.541). The H. pylori infection did not significantly increase the risk of pancreatic cancer. However, it is noteworthy that CagA- H. pylori infection could be a potential factor that elevated the risk of pancreatic cancer.

The purpose of this study was to explore how 'quality' is understood for traumatic brain injury (TBI) rehabilitation from the perspectives of the rehabilitation recipients, their families and the providing clinicians.

A participatory study using a mixed-methods, triangulation design.

The study involved 1. a systematic literature search; 2. Individual semi-structured interviews with people with TBI and/or their caregivers and TBI rehabilitation clinicians, and 3. an online consensus process.

22 participants (7 people with TBI, 8 caregivers, 7 clinicians) participated in individual interviews. Their transcribed data were coded into broad categories via in-depth reflexive, thematic analysis; these categories were then mapped to 13 quality domains extracted from the literature. The emergent themes were then presented to the individuals, via an electronic consensus tool in two rounds. This resulted in 12 prioritized domains of quality that encompass service features, staff qualities and effectiveness.

These evidence-informed and consensus-agreed indicators for quality may help guide both the provision and evaluation of TBI rehabilitation, that is valued and meaningful.

Evidence-based practice (EBP) integrates clinical expertise, patient preferences, and research evidence to guide healthcare decisions. Despite its global importance, research on EBP competencies among Palestinian nursing students remains limited. This study aims to explicitly assess EBP competency levels; knowledge, attitudes, and skills, while identifying key predictors and barriers affecting EBP integration.

A cross-sectional study was conducted with 273 nursing students from Palestine Ahliya University using the validated Evidence-Based Practice Competence Questionnaire (EBP-COQ). Data were analyzed using descriptive statistics, Pearson correlation, and multiple linear regression.

Participants exhibited moderate evidence-based practice (EBP) competency, with an overall score of 59.4% (mean = 74.3/125). Domain-specific scores revealed knowledge (58%), attitudes (62%), and skills (58%) at comparable levels. Multiple linear regression identified academic progression (fourth-year status: β = 5.982, p < 0.001) and self-directed learning (papers read monthly: β = 3.133, p < 0.001) as strong predictors of higher competency. Notably, prior EBP training showed a significant negative correlation with competency (r = -0.492, p < 0.001), raising concerns about the quality and effectiveness of existing training programs.

This study provides the first systematic assessment of EBP competency among Palestinian nursing students. While academic progression and self-directed learning enhance competency, concerns over the quality of EBP training programs require urgent attention. The findings underscore the need for curriculum reforms, structured mentorship, and improved access to research resources to enhance EBP integration into nursing education and practice in Palestine.

Not applicable.

Much infectious disease research focuses on the interaction of microorganisms and drugs in the laboratory, assuming biological activity of inhibiting organism growth in vitro directly translates to improving patient outcomes in the clinic. Yet in vitro testing does not consider the important role of the human immune system in causing and response to disease. Research shows that patient outcomes are still suboptimal even with disease due to organisms that maintain in vitro susceptibility to currently available drugs. Resources and discussions have focused on "antimicrobial resistance" yet the majority of deaths are with susceptible organisms. Studies of new interventions do not address the questions that patients and clinicians in practice ask in order to improve patient outcomes regardless of causative pathogen in patients who would receive the drugs in the real-world setting. Research in infectious diseases should shift to refocus on improving patient outcomes. This would result in changes in the research questions evaluated, the types of patients enrolled, the comparisons made, the interventions studied, the outcomes evaluated, and the types of statistical evaluations used. In turn this would provide patients and clinicians with better evidence for patient care and justify payment for new interventions.

Employing a mixed-methods approach, this study: (a) scoped the literature for desirable characteristics of online learning environments; (b) analyzed and compared the available online systematic review and meta-analysis (SR/MA) courses; and (c) proposed an outline for a model online systematic review SR/MA course that is aligned with PRISMA principles, and (d) charted learning outcomes, module contents, interactive elements, feedback and module assessment, and course evaluation of the proposed course. The findings highlight the many distinctive aspects and design of the proposed model course, including its comprehensiveness, alignment with PRISMA principles, self-pace and self-direction, with high interactivity levels, augmented by the expert trainer guidance ('human' factor), and individualized feedback, and its conclusion with the incorporation of the learners in virtual research teams undertaking real SR/MA. The proposed model course integrates principles of problem-based learning, where in addition to the provided resources (interactive assignments and video tutorials), trainees will be actively conducting their own real SR/MA as part of the course, while receiving expert feedback to enhance learning outcomes. Assignments' scores will be used to evaluate the learners' proficiency levels, and to pinpoint strengths and areas requiring enhancement. Overall, the proposed model course stands out as an innovative initiative in online SR/MA training, offering a valuable and comprehensive online learner-centered, expert-guided, 'hands-on' educational approach to SR/MA training. This sets a benchmark for future online courses in research synthesis methodology within health, medical, surgical and related fields.

Psychological resilience refers to maintaining or regaining psychological well-being after experiencing adversity, trauma, or stress. There is evidence suggesting that cognitive behavioral therapy (CBT) can significantly enhance an individual's coping skills. However, the overall effectiveness of CBT on resilience among cancer patients remains unclear. Therefore, this study systematically evaluated the impact of CBT on resilience among cancer patients.

The PubMed, PsycINFO, Cochrane Library, CINAHL, and Embase databases were searched using keywords. Two researchers independently conducted a rigorous evaluation of the quality of the evidence using the GRADE system and independently performed data extraction. A meta-analysis was conducted to calculate the experimental group's effect size and to explore the effects of CBT on enhancing resilience.

Thirteen randomized controlled trials (RCTs) were included in this meta-analysis. The effect of CBT on increasing resilience among cancer patients was small but significant immediately after the intervention (g = 1.211; p < 0.001). The results showed that CBT delivered via mobile devices was more effective than face-to-face CBT (β = 0.284; P = 0.012). Additionally, group CBT also outperformed individual CBT (β = 0.181; P = 0.042). Furthermore, CBT was more effective among patients with existing tumors (β = 0.285; P = 0.037). The evidence regarding the effects of CBT on resilience was found to be of moderate strength.

The results of this study indicate CBT can improve resilience among cancer patients. These findings underscore the importance of considering delivery methods and formats when implementing CBT interventions, with mobile device delivery and group formats resulting in better outcomes. The positive effects of CBT on patients with existing tumors highlight the importance of delivering this therapy in specific clinical contexts. Overall, this study provided moderately strong evidence that CBT is a valuable tool for enhancing resilience among cancer patients.

CRD42021256841.

The necessity for explainability of artificial intelligence technologies in medical applications has been widely discussed and heavily debated within the literature. This paper comprises a systematized review of the arguments supporting and opposing this purported necessity. Both sides of the debate within the literature are quoted to synthesize discourse on common recurring themes and subsequently critically analyze and respond to it. While the use of autonomous black box algorithms is compellingly discouraged, the same cannot be said for the whole of medical artificial intelligence technologies that lack explainability. We contribute novel comparisons of unexplainable clinical artificial intelligence tools, diagnosis of idiopathy, and diagnoses by exclusion, to analyze implications on patient autonomy and informed consent. Applying a novel approach using comparisons with clinical practice guidelines, we contest the claim that lack of explainability compromises clinician due diligence and undermines epistemological responsibility. We find it problematic that many arguments in favour of the practical, ethical, or legal necessity of clinical artificial intelligence explainability conflate the use of unexplainable AI with automated decision making, or equate the use of clinical artificial intelligence with the exclusive use of clinical artificial intelligence.

The purpose of this study was to explore the experiences of individuals with persistent nonspecific neck pain who used immersive virtual reality (VR) serious games at home for 2 weeks.

In this descriptive qualitative study, semi-structured one-on-one interviews were conducted at the participant's home after the 2-week period. Interviews were analyzed using qualitative content analysis. Sample size was determined using the information power concept (where "information power" refers to the amount of relevant information the sample provides for addressing the research question).

Eleven adults with continuous or recurrent nonspecific neck pain participated in the study. Three main categories were identified. The first revolves around the home environment, revealing that participants had mixed perceptions about being at home, yet held a positive perspective on the utilization of immersive VR in that setting. The second pertains to immersive VR as a novel technology, indicating its overall comfort, user-friendliness, and varying degrees of immersion and presence experienced by the participants. The third focuses on exercising in immersive VR, drawing comparisons with conventional exercises, exploring the facilitators and barriers to usage, and addressing various aspects of integrating this technology into rehabilitation.

Immersive VR was deemed comfortable for almost all participants and easy to use. Participants found exercising in immersive VR motivating and enjoyable, compared to conventional exercises. The home environment proved suitable for using immersive VR, though challenges included autonomy and reduced human contact. Participants highlighted facilitators and barriers in using immersive VR serious games, as well as immersive VR's rehabilitation potential. They also underscored the crucial role of physical therapists for guidance, remote supervision, and personalized treatment.

These findings could help clinicians to better understand the experiences of individuals with persistent nonspecific neck pain when using immersive VR, as well as its use at home. This understanding can improve patient care and optimize the effectiveness of immersive VR as a treatment method.

Evidence-based practice (EBP) results in high-quality care and decreases unwarranted variation in practice.

Few performance criteria related to EBP are included in physical therapy clinical education (CE) performance measures, despite EBP requirements in Doctor of Physical Therapy education. The purpose of this study was to develop EBP-specific competencies that may be used for Doctor of Physical Therapy students for use throughout CE.

Thirteen subject matter experts (SME) participated in this study.

Subject matter experts were asked to rank each core EBP competency, from a previously described framework, using a 3-point Likert scale, which included "Not Essential," "Essential," and "Not Sure." A consensus of 70% or greater for the "Essential" rating advanced the competency to the final Delphi round, whereas a consensus of 70% or greater for the "Not Essential" rating was required for competency elimination. Subject matter experts voted to either "Accept" or "Modify" the competencies that had reached the inclusion consensus threshold. All competencies that reached consensus for inclusion after all 3 rounds were included in the final EBP Domain of Competence.

Consensus was achieved in round one for 38% ( n = 26) of items. In round 2, a consensus was achieved for 20% ( n = 8) of items. Of the items remaining after rounds 1 and 2, 6 overarching competencies were identified, and all remaining items served as descriptions and specifications in the final EBP Domain of Competence.

The 6 competencies developed from this study constitute the EBP Domain of Competence and may be used throughout CE to assess students' EBP competency in clinical practice.

Reflective practice is viewed as a theoretical and pedagogical concept in higher education having several diverse approaches and interpretations. The most important aspect of reflective practice is that it is a necessary quality assurance aspect of higher education which should occur recurrently and at different stages of the program. It usually entails an evaluation of advanced instructions which has become the norm in an educational setting, in order to improve the learning outcomes. Reflective practice must therefore be seen as a tool which allows continuous improvement, modifications, and changes to educational approaches, which include theoretical and clinical assessment strategies. Academics in prosthetic dentistry at a research-led university reflected on their current assessment strategies used in the senior undergraduate dental program as part of a quality assurance process and its global comparability. This paper aims to share and explain the importance of reviewing assessment strategies in higher education, especially in such a clinical program using reflective practice as a framework. Different assessment strategies used over a 5-year period are explored and their different structures, expectations, and appropriateness for a clinical program are reported from the literature. The concerns were addressed in a cyclical manner within this framework, and Blooms and blueprinting implemented where appropriate. We conclude that without a validated definition and framework for regular reflective practices, and guidelines to modify the included assessment strategies, the quality assurance within a competency-based dental program may be compromised.

To investigate evidence-based practices and examine the influence of individual and social system factors on evidence-based practices among nurses in general hospitals.

Evidence-based practice is essential for improving healthcare quality. However, a challenge for nursing worldwide is nurses' limited use of evidence-based practices. It is crucial to determine the individual and social system factors affecting nurses' use of evidence-based practices.

This study employs a multi-institutional cross-sectional design.

With a multistage random sampling method, 336 registered nurses were recruited from 17 general hospitals in the Republic of the Union of Myanmar. Data were collected through a seven-part questionnaire, including the Evidence-Based Practice Implementation Scale and individual and social system factors. Data were analyzed using descriptive statistics and multiple linear regression.

Nurses in general hospitals perceived low levels of evidence-based practices. Individual factors, such as perceived barriers (p < .001), knowledge (p < .001) and attitudes (p = .001), were related to EBP as well as social system factors, including the work environment (p < .001) which influence nurses' practice, explaining 34% variance among nurses.

Nurses perceived the work environment as the most influencing factor related to evidence-based practices. Individual characteristics, including perceived knowledge, attitudes and barriers, were critical factors in performing evidence-based practices in Myanmar.

Nurse administrators and policymakers can develop strategies and interventions for improving knowledge, attitudes and work environment towards evidence-based practice. Minimizing the barriers to evidence-based practice will promote evidence-based practices in Myanmar general hospitals.

In addressing the individual and social system factors influencing the evidence-based practices of nurses, this study contributes to enhancing healthcare quality and outcomes.

This study adhered to the STROBE checklist.

There was no patient or public contribution.

Clinical and epidemiological research is indispensable for improvements in evidence-based healthcare and health outcomes, but it also leaves important gaps in our understanding of health and illness. Qualitative research has been increasingly recognized as a key to addressing some of these gaps, using both exploratory (to gain a more complete and in-depth understanding of problems) and explanatory (to explain quantitative results) approaches. By finding out 'what's going on' and bringing people's stories to light, qualitative research is widely advocated as crucial in enhancing patient-centered research and healthcare. To date, most clinicians, clinical researchers and epidemiologists are relatively unfamiliar with and untrained in qualitative research-a type of research that, compared with quantitative research, requires different research skills and uses a different jargon, type of reasoning, and methods. This article aims to equip them with the basic knowledge necessary to appraise and design qualitative research. Specifically, we provide a comprehensive overview of (i) what qualitative research is, including various examples of qualitative research questions and explanations of the contrasting properties of quantitative and qualitative research; (ii) what constitutes the added value of qualitative research in the clinical and epidemiological context, illustrated using numerous research studies conducted within nephrology; and (iii) practical guidelines for designing qualitative research within this context, including a self-developed checklist containing essential information to include in qualitative research protocols. In doing so, we hope to enrich clinical and epidemiological research with complementary qualitative evidence-amongst others, invaluable insights into patients' lived experiences and perceptions-and thereby greatly enhance patient-centered research and evidence-based healthcare.

We examined four potential challenges for the implementation of the European Union (EU) Regulation 2021/2282 on Health Technology Assessment (EU HTAR): interaction with the European Medicines Agency (EMA), expert input, the interface of European health technology assessment (EU HTA) joint procedures with those within Member States, and the management of conflict of interest. This research aims to explore how to address these challenges in a balanced manner and prioritise key actions for effective collaboration in the context of the EU HTA.

The methodology included a pre-convention survey among relevant stakeholders as well as working groups and the plenary ranking of discussion outcomes at the European Access Academy (EAA) Spring Convention 2024.

In the survey, 65.5% of respondents indicated that experts are currently not sufficiently included in the upcoming joint scientific consultations and clinical assessments; only 37.9% suggested that the EU HTA joint procedures would accelerate national appraisal decision-making, and 58.6% believed that the principles of 'transparency' and 'competency' are balanced in the EU HTA position on conflict of interest. The top priority action points identified in the working groups were the involvement of the best available expertise, the early and inclusive involvement of experts, strengthened early scientific dialogue, and the fostering of the political willingness/financial support of EU Member States to increase capacities.

The key topics identified were an approach to conflict of interest that balances transparency obligations and the need for expertise, strengthens the involvement of clinical and patient experts, intensifies early interaction between the EMA and EU HTA, and increases the involvement of the EU Member States.

Randomized controlled trials (RCTs) can produce valid estimates of the benefits and harms of therapeutic interventions. However, incomplete reporting can undermine the validity of their conclusions. Reporting guidelines, such as SPIRIT for protocols and CONSORT for results, have been developed to improve transparency in RCT publications. In this study, we report a corpus of 200 RCT publications, named SPIRIT-CONSORT-TM, annotated for transparency. We used a comprehensive data model that includes 83 items from SPIRIT and CONSORT checklists for annotation. Inter-annotator agreement was calculated for 30 pairs. The dataset includes 26,613 sentences annotated with checklist items and 4,231 terms. We also trained natural language processing (NLP) models that automatically identify these items in publications. The sentence classification model achieved 0.742 micro-F1 score (0.865 at the article level). The term extraction model yielded 0.545 and 0.663 micro-F1 score in strict and lenient evaluation, respectively. The corpus serves as a benchmark to train models that assist stakeholders of clinical research in maintaining high reporting standards and synthesizing information on study rigor and conduct.

The aim of this study was to explore women's experience of menopause care after breast cancer in the UK.

This study is a thematic analysis of free-text comments in an online survey that asked women about their experience of menopause care after breast cancer. A coding framework was used that mapped comments to eight domains of patient experience (deductive analysis). An inductive approach was used to identify subthemes within each of the eight domains.

A total of 1,195 women completed the survey. Two hundred twenty-six women (18.9%) left free-text comments in response to questions about shared decision making and patient experience. Most were White (96.9%), university educated (52.6%), and aged 41 to 60 years at breast cancer diagnosis (81.8%). The menopausal symptom burden was high (96.5%, 87.6%, and 75.7% reported physical, psychological, and genitourinary symptoms, respectively). Lack of involvement in shared decision making was the dominant theme (n = 120, 53%), followed by issues concerning access to menopause care (n = 65, 29%). Lack of information, communication issues, and feeling unsupported were prevalent themes/subthemes. Twenty women (9%) reported a lack of courtesy and respect in their interactions with healthcare professionals.

In this study, women's experience of menopause-related breast cancer aftercare was poor. Larger studies are needed to qualitatively explore the experience, unmet needs, and expectations of all breast cancer survivors including women from more deprived and ethnic minority groups.

Recent investigations of recovery from alcohol use disorder (AUD) have distinguished subgroups of high and low functioning recovery in data from randomized controlled trials of behavioral treatments for AUD. Analyses considered various indicators of alcohol use, life satisfaction, and psychosocial functioning, and identified four recovery profiles from AUD three years following treatment.

The present study integrates these profiles into a two-part machine learning framework, using recursive partitioning and random forests to distinguish a) clinical cut-points across 28 end-of-treatment biopsychosocial measurements that are predictive of high or low functioning recovery three years after treatment; and b) a rank-ordered list of the most salient variables for predicting individual membership in the high-functioning recovery sub-groups.

This secondary data analysis includes individuals (n = 809; 29.7% female) in the outpatient arm of Project MATCH who completed the end-of-treatment assessment and three-year follow-up batteries.

Recursive partitioning found individuals with low depressive symptoms and less than 25% drinking days were more likely to be in a high functioning recovery profile (68%), whereas those with at least mild depressive symptoms and low purpose in life were more likely to be in a low functioning recovery profile (70%). Random forests identified purpose in life, social functioning, and depressive symptoms as the best predictors of recovery profiles.

Recovery profiles are best predicted by variables often considered of secondary interest. We demonstrate the utility of two machine learning approaches, highlighting how random forests can overcome recursive partitioning limitations.

Cost of novel medications has increased worldwide, causing financial toxicity to heart failure patients. Patients can discuss medication costs with clinicians to manage financial burden, but such discussion can be uncommon. This study seeked to investigate the experiences and preferences of heart failure patients in Singapore regarding medication cost discussions to develop effective strategies to encourage such conversations.

Participants were recruited from a hospital outpatient heart failure clinic in 2022 to participate in a qualitative survey containing open-ended questions. Inclusion criteria were patients aged 21 years and above, diagnosed with heart failure, and capable of comprehending English. There were no exclusion criteria. Conventional content analysis was performed on collected responses.

Among forty-eight heart failure patients (median age: 63.5 years, 43.8% male, 72.9% Chinese) who participated, most (93.8%) wanted to discuss medication costs with clinicians for reasons such as concern over affordability, taking ownership of health, making informed decisions, minimizing inconvenience, and obtaining tailored cost information. Affordability of medications was a concern for patients but only 8.3% of patients actually had regular cost discussions with clinicians in the past year. Patients mentioned a lack of initiative from the clinicians, limited cost awareness, and time constraints as reasons why cost conversations did not happen.

Outpatient heart failure patients in Singapore desire to discuss medication costs with clinicians but few participants reported having such conversations. Barriers hindering cost discussions have to be addressed to ensure patients make an informed medication decision with minimal financial burden.

Healthcare decisions evaluate treatment risks and benefits, using a shared decision-making process between patient and clinician. Healthcare workers (HCWs) offer treatments based on condition specific evidence and expert knowledge. The patient evaluates treatment choices from their individual perception of how helpful or harmful treatment might be. This is a "risk-taking" decision. Those in a disorder of consciousness (DOC) have unreliable or absent awareness. They cannot participate in the risk-taking decisional process outlined above. Instead, family members and HCWs evaluate the options and determine how much risk is acceptable. We propose this is a distinctly different decisional process called "risk-making," and that for those in a DOC it is influenced by multiple poorly understood factors. The different ways that decisions are made on their behalf may be negatively impacting their healthcare and creating a distributive justice need. A "risk-making" theory of DOC healthcare decision-making was developed via narrative literature review. It aims to explicate the realities of DOC decision-making practices, and surface rarely discussed assumptions and social factors possibly impacting DOC healthcare for discussion and future exploration.

Internists must respond to increasingly complex clinical scenarios in a context of progressively increasing life expectancy, techno-scientific development and accelerated demographic and sociocultural changes. Ethical reflection is a useful tool to resolve and prevent value conflicts, which are frequent in clinical practice. The ethical training of internists contributes to professional excellence and can be oriented at two complementary levels: 1) development of skills in all internists for the management of "clinical microethics", which allow the integration of the techno-scientific aspects of medicine in a satisfactory clinical relationship at a human level; 2) specialization for internists who are experts in bioethics, to lead ethics committees (and other consulting models) in a more local setting and participate in bioethical debates and the development of normative ethics in a more general setting.

Evidence-based medicine (EBM) plays a critical role in improving clinical decision-making and patient outcomes. We aimed to determine the knowledge, practice, and facilitating factors of EBM and the associated factors of EBM knowledge and practice among Malaysian doctors.

A cross-sectional study with a nationwide online survey was conducted from June to November 2022 among Malaysian doctors. The survey assessed doctors' knowledge (K), practice (P), and facilitating factors (F) for EBM (collectively referred to as KPF) using the preexisting validated Evidence-Based Medicine Questionnaire (EBMQ). Higher scores indicated better knowledge, practice, and facilitating factors for EBM implementation. The KPF percentage scores were categorised into high (> 80%), moderate (60-79%), and low (< 59%). The Pearson correlation coefficient was used to assess the correlation between knowledge, practice, and facilitating factors. The differences in knowledge and practice scores by gender, designation, workplace, work sector, EBM workshop participation, research experience, publication, and level of facilitating factors after adjusting for years of service were analysed using multi-factorial multivariate analysis of covariance (MANCOVA).

Among 409 doctors, 53.8% of doctors had a moderate level of knowledge, while about two-thirds demonstrated a higher level of practice (67.2%) and a moderate level of facilitating factors (67.0%). About 18% and 12% of doctors had low levels of knowledge and facilitating factors, respectively. Only 0.5% had low EBM practice. A positive and significant correlation among knowledge, practice, and facilitator scores was noted (P < 0.001). Doctors with prior research experience, high facilitating factors, and EBM workshops attendance had higher EBM knowledge scores (all P < 0.001). Specialists (P = 0.029) and doctors with high facilitating factors (P < 0.001) had higher EBM practice scores.

Malaysian doctors reported a high level of EBM practice despite moderate knowledge and facilitating factors. This suggests a strong willingness to integrate EBM into clinical practice. EBM workshops may help doctors gain further knowledge. Stakeholders should address the barriers that exist at the individual, institutional, and health system levels to strengthen the implementation of EBM.

The birth process involves biopsychosocial aspects, the identification of which has been little researched. This systematic review aims to identify biopsychosocial aspects of interventions during physiological birth in first-time mothers and to assess the effectiveness of these interventions on birth outcomes.A systematic guideline search resulted in the definition of a physiological birth of first-time mothers with a singleton from the cephalic position at 37+0 to 42+0 weeks' gestation. A systematic literature search assessed intervention studies for evidence quality using the GRADE methodology. Structured content analysis according to Mayring was used to identify biopsychosocial aspects.18 bio-organic, psychological and sociological aspects were identified from 20 studies. The quality of evidence was mostly low to very low due to inadequate reporting of fetal and maternal outcomes and characteristics. Moderate confidence was shown for midwifery care and aromatherapy in increasing spontaneous labor, and transcutaneous electrical nerve stimulation in improving satisfaction, subjective pain perception and APGAR score. Identified biopsychosocial aspects enable a multidimensional assessment of physiological birth and could lead to a biopsychosocial care model. Insufficient quality of evidence does not allow the derivation of specific interventions. Studies in obstetrics should use defined endpoints and characteristics to improve the quality of evidence.

Establishing a causation relationship between treatments and patient outcomes is of essential importance for researchers to guide clinical decision-making with rigorous scientific evidence. Despite the fact that randomized controlled trials are widely regarded as the gold standard for identifying causal relationships, they are not without its generalizability and ethical constraints. Observational studies employing causal inference methods have emerged as a valuable alternative to exploring causal relationships.

In this tutorial, we provide a succinct yet insightful guide about identifying causal relationships using observational studies, with a specific emphasis on research in the field of neurosurgery.

We first emphasize the importance of clearly defining causal questions and conceptualizing target trial emulation. The limitations of the classic causation framework proposed by Bradford Hill are then discussed. Following this, we introduce one of the modern frameworks of causal inference, which centers around the potential outcome framework and directed acyclic graphs. We present the obstacles presented by confounding and selection bias when attempting to establish causal relationships with observational data within this framework.

To provide a comprehensive overview, we present a summary of efficient causal inference methods that can address these challenges, along with a simulation example to illustrate these techniques.

Mobile health (mHealth) technologies offer potential benefits for enhancing pregnancy care through timely information and personalized support. Yet, various barriers limit their adoption among pregnant women. This study explored the perspectives of Iranian pregnant women and healthcare stakeholders on the barriers and facilitators influencing mHealth utilization in pregnancy care.

A qualitative content analysis was conducted involving 21 participants including 14 pregnant women and seven healthcare stakeholders (including two obstetricians, two midwives, two medical informatics specialists, and one sociologist), who recruited via purposive sampling from hospitals affiliated with Mashhad University of Medical Sciences and private clinics in Northeast Iran from May to December 2023. Data were collected through semi-structured, in-depth interviews and analyzed using Hsieh and Shannon's (2005) conventional content analysis approach. Trustworthiness was ensured through triangulation, researcher's prolonged engagement, peer debriefing, member check, and audit trial.

The main theme, "Barriers and facilitators for mhealth utilization in pregnancy care," encompassed four key categories including (1) Digital ecosystem challenges highlighting structural issues like inadequate infrastructure, economic constraints, cultural adaptation gaps, interface complexity, and data security concerns, (2) Healthcare system implementation barriers including integration issues, low digital literacy, and a lack of continuity with traditional healthcare practices, (3) User empowerment and engagement revealing that mHealth can enhance access to information, promote autonomy, and provide personalized support, and (4) Integration of mHealth in the Healthcare system demonstrating the transformative potential of mHealth for improving maternal health monitoring, communication, and evidence-based care strategies.

Addressing digital, financial, and cultural barriers while enhancing usability and user autonomy could significantly improve healthcare access and equity for pregnant women in Iran. Policymakers should prioritize scalable and culturally sensitive mHealth interventions to maximize these benefits across diverse communities.

Moves toward integration of Artificial Intelligence (AI), particularly deep learning and generative AI-based technologies, into the domains of healthcare and public health have recently intensified, with a growing body of literature tackling the ethico-political implications of this. This paper considers the interwoven epistemic, sociopolitical and technical ramifications of healthcare-AI entanglements, examining how AI materialities shape emergence of particular modes of healthcare organization, governance and roles, and reflecting on how to embed participatory engagement within these entanglements. We discuss the implications of socio-technical entanglements between AI and Evidence-Based Medicine (EBM) for equitable development and governance of health AI. AI applications invariably center on the domains of medical knowledge and practice that are amenable to computational workings. This, in turn, intensifies the prioritization of these medical domains and furthers the assumptions which support the development of AI, a move which decontextualizes the qualitative nuances and complexities of healthcare while simultaneously advancing infrastructure to support these medical domains. We sketch the material and ideological reconfiguration of healthcare which is being shaped by the move toward embedding health AI assemblages in real-world contexts. We then consider the implications of this, how AI might be best employed in healthcare, and how to tackle the algorithmic injustices which become reproduced within health AI assemblages.

The long-term outcomes of percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG) in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel disease remain debated.

The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry was used to analyse 57 097 revascularized patients with NSTEMI with multivessel disease in Sweden from January 2005 to June 2022. The primary endpoint was all-cause mortality, encompassing both in-hospital and long-term mortality; the secondary endpoints included myocardial infarction (MI), stroke, new revascularization, and heart failure. Multilevel logistic regression with follow-up time as a log-transformed offset variable and double-robust adjustment with the instrumental variable method were applied to control for known and unknown confounders.

Percutaneous coronary intervention was the primary therapy in 42 190 (73.9%) patients, while 14 907 (26.1%) received CABG. Percutaneous coronary intervention patients were generally older with more prior cardiovascular events, whereas CABG patients had higher incidences of diabetes, hypertension, left main and three-vessel disease, and reduced ejection fraction. Over a median follow-up of 7.1 years, PCI was associated with higher risks of death [adjusted odds ratio (aOR) 1.67; 95% confidence interval (CI) 1.54-1.81] and MI (aOR 1.51; 95% CI 1.41-1.62) but there was no significant difference in stroke. Repeat revascularization was three times more likely to PCI (aOR 3.01; 95% CI 2.57-3.51), while heart failure risk was 15% higher (aOR 1.15; 95% CI 1.07-1.25). Coronary artery bypass grafting provided longer survival within 15 years, especially in patients under 70 years of age, with left main disease or left ventricular dysfunction, though this benefit diminished over shorter time horizons.

Coronary artery bypass grafting is associated with lower risks of mortality, MI, repeat revascularization, and heart failure in patients with NSTEMI, particularly in high-risk subgroups. However, its survival benefit lessens with shorter life expectancy.

The European CORE-MD consortium (Coordinating Research and Evidence for Medical Devices) proposes a score for medical devices incorporating artificial intelligence or machine learning algorithms. Its domains are summarised as valid clinical association, technical performance, and clinical performance. High scores indicate that extensive clinical investigations should be undertaken before regulatory approval, whereas lower scores indicate devices for which less pre-market clinical evaluation may be balanced by more post-market evidence.

Proximal phalangeal fractures are common yet challenging due to their inherent instability.

This study presents a case for patient-centered care and a nonsurgical management pathway.

Case report.

M, a 56-year-old male, sustained a comminuted oblique proximal phalanx fracture to his left nondominant small finger while playing football. Five days post injury, the fracture was reduced with local anesthetic and manipulation (LAMP). The injury was managed conservatively with a full-time hand-based orthosis with metacarpophalangeal joint flexion, and buddy taping. One week later, the fracture had lost reduction and significantly displaced. Instead of converting to surgery, a further LAMP (LAMP2) was performed, and conservative management continued. Outcomes were collected at baseline, 6, 12, and 15 weeks, and 10 months following LAMP2.

By 12 weeks, M had a full range of motion, minimal pain, no difficulty with personal daily activities, and resumed full manual labor work duties and gym workouts. Quality of life was reported as high from 6 weeks. M was extremely satisfied.

Conservative management of an initially unstable proximal phalanx reduced by LAMP, with a second LAMP one week later, demonstrated excellent outcomes and could be a possible management pathway for similar patients.

Chronic Kidney Disease (CKD) is a global health concern and is frequently underdiagnosed due to its subtle initial symptoms, contributing to increasing morbidity and mortality. A comprehensive understanding of CKD comorbidities could lead to the identification of risk-groups, more effective treatment and improved patient outcomes. Our research presents a two-fold objective: developing an effective machine learning (ML) workflow for text classification and entity relation extraction and assembling a broad list of diseases influencing CKD development and progression.

We analysed 39,680 abstracts with CKD in the title from the Embase library. Abstracts about a disease affecting CKD development and/or progression were selected by multiple ML classifiers trained on a human-labelled sample. The best classifier was further trained with active learning. Disease names in question were extracted from the selected abstracts using a novel entity relation extraction methodology. The resulting disease list and their corresponding abstracts were manually checked and a final disease list was created.

The SVM model gave the best results and was chosen for further training with active learning. This optimised ML workflow enabled us to discern 68 comorbidities across 15 ICD-10 disease groups contributing to CKD progression or development. The reading of the ML-selected abstracts showed that some diseases have direct causal effect on CKD, while others, like schizophrenia, has indirect causal effect on CKD.

These findings have the potential to guide future CKD investigations, by facilitating the inclusion of a broader array of comorbidities in CKD prognostic models. Ultimately, our study enhances understanding of prognostic comorbidities and supports clinical practice by enabling improved patient monitoring, preventive strategies, and early detection for individuals at higher CKD development or progression risk.

Evidence-based medicine (EBM) is a fundamental element of modern surgical practice. However, its integration into surgical training remains challenging. Through a scoping review, this study mapped existing evidence on the practice of EBM in surgery, focusing on knowledge, attitudes, barriers, and curricula.

The literature was systematically searched through 3 databases and 2 registers. Fifty articles published over a 22-year period (2001-2023) were identified based on predefined eligibility criteria. These were reviewed using Arksey and O'Malley's methodological framework. The review was checked against the PRISMA 2018 checklist for scoping reviews.

There is evidence of awareness and appreciation of EBM principles among surgeons and surgical trainees. However, the understanding of EBM terminology is varied. Attitudes toward EBM were predominantly positive yet reliance on clinical experience over evidence-based guidelines was noted. Key barriers to EBM practice included time constraints, lack of structured training, and methodological challenges in surgical research. The review highlighted the lack of validated competency assessment tools and the need for structured EBM curricula. Various educational strategies, such as journal clubs and courses, were found to improve EBM knowledge, albeit with limited evidence on long-term practice change.

This scoping review underscores the need for a more detailed understanding of stakeholder views of EBM in surgical practice, the development, implementation, and assessment of educational interventions in this field, and tailored strategies to assess EBM competency in surgery.

It is unclear which educational interventions effectively improve healthcare professionals' information literacy.

We aimed to evaluate the effectiveness of educational interventions for improving the formulation of answerable clinical questions and the search skills of healthcare professionals.

We followed the Cochrane methodology and reported according to the PRISMA statement. The following databases from inception to November 2022: MEDLINE, Cochrane CENTRAL, EMBASE, Web of Science, CINAHL, and Google Scholar search engine, were searched. Randomised controlled trials and crossover trials on any educational interventions were included. Studies on search tools that are obsolete were excluded.

Ten studies that mainly compared the effectiveness of lectures and bedside education to lectures or no intervention for searching of PubMed and/or MEDLINE, were included. There was evidence for improved attitude towards the intervention favouring lecture with self-directed learning over lecture, bedside education, and computer-assisted self-directed learning (RR: 1.14; 95% CI 1.06-1.23; N = 2 studies; 1064 participants; I2 = 0%; moderate certainty evidence). There were limited findings on the knowledge, skills, satisfaction, and behaviour outcomes.

Future research should include a wider set of outcomes, be reported better and explore the use of digital technology for delivery of educational interventions. Further research should entail well-designed trials with relevant outcomes evaluating novel digital-based educational interventions.

Peter Drucker pointed out an important distinction between 'doing things right' and 'doing the right thing', which recognised that all problems are embedded in a context and thus can only be understood within their unique contextual setting. Contemporary research practices in clinical medicine often regards contextual factors as potential confounders that will bias effect estimates and thus must be avoided. However rigorous, research devoid of context ultimately deprives users of understanding of the support factors that make research transferable to policy decisions or managing care of individual patients-it stands in the way of 'doing the right thing' in 'real life' settings. Appreciating that all problems are embedded in a greater context means that one should not ignore their interconnected and interdependent systemic nature, that is, every variable is simultaneously dependent and independent. This is the reason for the cascading effects and feedback loops witnessed in disease progression and policy efforts. We discuss the need for researchers to a-priori consider the context of their research question as well as the structural relationships of the variables under investigation, which in turn provides the basis for choosing the most appropriate research design. We have a moral imperative to first 'do the right thing'-ask questions that address the contextual needs of our patients, and then to 'do it right'-choose the best research method to answer this contextually framed need. Only then will our research efforts have meaningful and lasting impacts on patient care.

Information from indocyanine green (ICG) lymphography (ICG-L) can be used to guide an individual's lymphedema therapy plan. However, the mechanisms for this clinical translation are not well described. This study proposes a novel clinical decision support tool for translating ICG-L findings into individualized lymphedema therapy plans and describes subsequent changes in plan features of manual lymphatic drainage and compression.

This before-after study compared specific therapy plan features before and after ICG-L for participants with limb lymphedema. After participants had undergone ICG-L, the individuals' ICG-L findings were translated into an ICG-L-informed therapy plan using a novel clinical decision support tool, ICG-TRANSLATE. A predetermined coding tree was used to identify changes in elements of manual lymphatic drainage and compression therapy plan recommendations.

Following the application of the ICG-TRANSLATE decision support tool, 100% (n = 25) of participants had a change in manual lymphatic drainage recommendations, including elements of terminal nodes, pathway, and technique. Additionally, 88% (n = 22) had a change in compression recommendations, which was most commonly a change in garment limb coverage.

ICG-L findings informed changes to traditional lymphedema therapy plan modalities of manual lymphatic drainage and compression. Whether this change to individual therapy recommendations translates into improved lymphedema outcomes requires further investigation.

A clinical decision support tool may assist practitioners in translating ICG-L findings into individualized lymphedema therapy plans for people with lymphedema. Further exploration is necessary to determine if the management changes derived through ICG-L-informed therapy plans improve outcomes for people with lymphedema.

The growing burden of cancer, with its costly and difficult to endure therapies, underscores the urgent need for individualized care that enhances patients' quality of life. Effective individualized treatment planning requires collaboration between healthcare professionals and patients (and their relatives), focusing on patients' personal values and preferences through shared decision-making. In practice, oncology care predominantly follows clinical guidelines, which, while reducing practice variation, may not account for individual patient differences in health status and preferences. Moreover, guidelines often emphasize medical endpoints such as disease-free survival, overlooking quality of life and treatment burden considerations crucial to many patients. This can result in unfitting treatment choices and decisional regret. The Integrated Oncological Decision-making Model (IODM) addresses these challenges by incorporating three essential domains for treatment decision-making: medical treatment options, patient goals and preferences, and general health status. The IODM aims to integrate these domains into the decision-making process, ensuring that treatment plans are tailored to individual patient needs. Initial implementation of the IODM is shown promising results, with a significant proportion of patients receiving less invasive, more appropriate treatments without compromising survival outcomes. The IODM has demonstrated its potential to facilitate patient-centred care, reduce unnecessary treatments, and improve patient outcomes. Continued implementation and evaluation of the IODM across various oncological settings are essential to refine the model and ensure its integration into routine clinical practice, ultimately enhancing the quality and effectiveness of cancer care.

The understanding of responses to traumatic events has been greatly influenced by the introduction of the diagnosis of post-traumatic stress disorder (PTSD). In this paper we review the initial versions of the diagnostic criteria for this condition and the associated epidemiological findings, including sociocultural differences. We consider evidence for post-traumatic reactions occurring in multiple contexts not previously defined as traumatic, and the implications that these observations have for the diagnosis. More recent developments such as the DSM-5 dissociative subtype and the ICD-11 diagnosis of complex PTSD are reviewed, adding to evidence that there are several distinct PTSD phenotypes. We describe the psychological foundations of PTSD, involving disturbances to memory as well as to identity. A broader focus on identity may be able to accommodate group and communal influences on the experience of trauma and PTSD, as well as the impact of resource loss. We then summarize current evidence concerning the biological foundations of PTSD, with a particular focus on genetic and neuroimaging studies. Whereas progress in prevention has been disappointing, there is now an extensive evidence supporting the efficacy of a variety of psychological treatments for established PTSD, including trauma-focused interventions - such as trauma-focused cognitive behavior therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR) - and non-trauma-focused therapies, which also include some emerging identity-based approaches such as present-centered and compassion-focused therapies. Additionally, there are promising interventions that are neither psychological nor pharmacological, or that combine a pharmacological and a psychological approach, such as 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy. We review advances in the priority areas of adapting interventions in resource-limited settings and across cultural contexts, and of community-based approaches. We conclude by identifying future directions for work on trauma and mental health.

A multifaceted and interactive teaching approach is recommended for achieving proficiency in evidence-based practice, with critical thinking considered vital for connecting theory and practice. In this context, we advocate the strategic use of health claims in media to promote critical thinking and provide an accessible entry point to evidence-based practice for early-stage university healthcare students.

We conducted a convergent mixed methods study, including a cross-sectional survey with structured and open-ended questions as well as focus group interviews, at the Faculty of Health Sciences, Oslo Metropolitan University, during the 2020-2021 academic year. Participants were bachelor's students in bioengineering, physiotherapy, social education, and occupational therapy. We employed a blended learning approach, combining digital learning resources, teaching in critical assessment of health claims and evidence-based practice, and a concurrent group exam assignment centered around health news. The outcome measures included students' experiences integrating health claims into evidence-based practice teaching and their experiences with teaching approaches, including the group exam.

Out of 446 participants, 136 (30.5%) responded to the structured questions in the survey. In response to the open-ended questions within the survey, 109 (80.1%) of the respondents shared positive experiences about the course, while 98 (72%) suggested improvements. Additionally, 25 students participated in focus group interviews. Synthesizing the results, we found that students viewed the inclusion of health claim assessment as a useful entry point for learning evidence-based practice. In addition, both the blended learning design and the group exam were identified as contributors to a positive perception of learning outcomes from the course.

Integrating critical reflection on media health claims into evidence-based practice education, alongside a blended learning approach and a group exam, may be beneficial for educating bachelor's healthcare students. However, further rigorous study designs are needed to assess the effect of the course on learning outcomes.

DOI 10.5281/zenodo.6985449.

People with chronic kidney disease are at increased risk of thrombotic and bleeding episodes making anticoagulant treatment decisions challenging. Currently, there are no support tools for people with chronic kidney disease regarding anticoagulant therapy decisions. This work aimed to co-produce materials to support shared-decision making when considering anticoagulant use in advanced chronic kidney disease.

Focus groups were undertaken to explore the views of people with kidney disease towards anticoagulant prescribing. Data was thematically analysed based on Makoul and Clayman's model of shared-decision making. Co-production methods were used to develop a question prompt list based on themes from the focus groups in conjunction with people with kidney disease over three meetings.

A question prompt list, to be used by patients when initiated on anticoagulant therapy, was co-produced. These questions were based upon participants' experiences of the various stages of shared-decision making within the context of anticoagulant use in advanced chronic kidney disease. Of particular importance to participants was the individualised discussion around treatment risks and follow up arrangements.

Shared-decision making is important when initiating medication to ensure the best outcomes for patients, yet it can be difficult to engage in shared-decision making without prompts or guidance. This co-produced question prompt list could be included as part of national guideline to support shared-decision making for anticoagulant initiation in patients with advanced chronic kidney disease.

Suhexiang (SHX) pill is widely used for treating acute ischemic stroke (AIS). Experimental and randomized controlled trials suggested that SHX pill was beneficial for patients with AIS. However, the effectiveness of SHX pill in real-world practice setting remains unclear. It is of great importance to investigate the effectiveness and safety of SHX pill in patients with acute ischemic stroke in real-world clinical practice with long-term follow-up.

The Suhexiang pill for acute ischemic stroke in Real-world Practice Setting (SUNRISE) is a multicenter, prospective, product-specific, observational study designed to provide insight into the administration of SHX pill for patients with AIS in the real-world clinical practice setting, with an initial sample size of 1000. Eligible patients treated with SHX pill within seven days of AIS onset will be consecutively included in this registry. The primary outcome is the proportion of patients independent at 3 months after stroke onset defined by an mRS score of 0, 1, or 2.

The findings of the SUNRISE registry will not only provide insights into the characteristics of patients who may benefit from SHX treatment, but also may enable the individualized treatment decision-making of SHX pill in real-world practice setting.

This study was registered with the ClinicalTrials.gov (URL: https://clinicaltrials.gov/ , Unique identifier: NCT05833932).

The purpose of this article is to design and introduce the SQUARE-IT approach to help scientists and clinicians in research to align important research problems with the objectives, the appropriate clinical research questions to be answered, and the research hypotheses to be investigated in medical and therapeutic specialties. Research ideas can be generated primarily through simple methods such as brainstorming and mind mapping. However, transforming ideas into a valid research question is not as easy as it may seem, as the mere presence of an idea does not guarantee that the researcher has already uncovered existing knowledge on a particular topic or identified the actual research problem. Therefore, the SQUARE-IT items are developed, described, and critically discussed with reference to the scientific literature. They ask whether the identified research problem is 'Specific', 'Quantifiable', 'Usable', 'Accurate', 'Restricted', 'Eligible', 'Investigable', and 'Timely'. Before formulating the focused clinical question, SQUARE-IT can be used as a preparatory step to enable researchers to organize the relevant information that has been explored to date and to assess whether additional information is needed, thereby identifying current research gaps. In addition, it should facilitate the effectiveness and efficiency of evidence-based practice to ensure high quality patient care. Using SQUARE-IT as a framework, further elaboration of the approach and addition of other aspects are warranted to advance the discussion and improve methods of evidence-based practice in medical and therapeutic specialties for quality improvement of patient care.