Validation of short version of evidence-based practice instruments among nurses in clinical practice:Evidence-based practice beliefs,implementation,and organizational culture

Objective:The objective of the study is to validate the short version of evidence-based practice(EBP)instruments among nurses in clinical practice.Methods:An institutional-based cross-sectional research design was used and a stratified sampling technique to select 285 nurse clinicians.The study utilized a structured questionnaire comprising of demographic data from the participants and three validated scales:the shortened versions of the EBP Beliefs Scale,the EBP Implementation Scale,and the Organizational Culture and Readiness for System-Wide Integration of Evidence-Based Practice(OCRSIEP)survey.With the use of descriptive statistics,the data were analyzed and presented in frequencies and percentages,while inter-item correlation coefficient(ICC)and the Kaiser-Meyer-Olkin measure of sampling adequacy were used to confirm the validity of using factor analysis.Results:Findings revealed the mean scores of the EBP Beliefs Scale ranged from 1.50 to 1.61,EBP Implementation Scale ranged from 1.84 to 1.94,and the OCRSIEP Scale ranged from 1.93 to 2.19.All the three shortened scales accordingly had good internal reliability,29.30±9.93 out of 80 for the EBP Beliefs Scale,19.56±7.37 out of 72 for the EBP Implementation Scale,and 66.32±20.35 out of 125 for the OCRSIEP Scale.Conclusion:This study has generated a valid Short Version of EBP reliable instrument that is psychometrically robust that can be used by nurses and clinicians to evaluate EBP in clinical settings since the results presented as a whole confirmed the high reliability and factorial validity.

Factors influencing the continuity of evidence-based practice in perioperative airway management for elderly patients with fractures:A qualitative study

BACKGROUND More and more evidence-based practices are emerging,but researchers mostly focus on short-term effects,resulting in evidence-based practices not being applied in the clinic in the long term.In this study,we took the evidence-based practice of perioperative airway management in elderly fracture patients as an example and adopted a descriptive phenomenological approach to understand the influencing factors of its sustainability to provide a reference basis for promoting the continuity of evidence-based practice in the clinic.AIM To explore factors influencing the persistence of evidence-based practice in perioperative airway management in elderly patients with fractures.METHODS This study was qualitative research.Nine nurses who implemented evidencebased practice in the orthopedic ward of a tertiary comprehensive hospital in Shanghai from September 2023 to October 2023 were selected using purposive sampling as research subjects.Semi-structured interviews were conducted with them,and the data were analyzed using the Colaizzi phenomenological analysis method based on the three dimensions and ten factors of the NHS sustainability model.RESULTS Three main themes and ten subthemes were identified:Process aspects(benefits to patients,benefits to nurses,lack of follow-up,complex processes);staff aspects(insufficient human resources,inadequate training and education,lack of leadership support);and organizational environment aspects(inadequate infrastructure,poor patient compliance,poor doctor cooperation).CONCLUSION Human resources,training and education,leadership support,infrastructure,and patient-physician collaboration are important factors influencing the sustainability of evidence-based practice for perioperative airway management in older patients with fractures.

Virtual reality:The bridge between medical education and clinical practice

After perusing the paper by Kim et al,I discovered that this is an interesting manuscript and a successful study.Virtual reality(VR)is an emerging and promising technology employed in the domain of medical practice and medical education over the past decade.In the era of big data,VR is constantly progressing in the fields of medical education and clinical diagnosis and treatment.As a novel scientific and technological tool,VR not only overcomes multiple limitations of the traditional medical teaching mode but also reduces the reliance on personnel and equipment.VR can simulate the real clinical situation,stimulate the enthusiasm of young doctors and nurses for clinical study,and simultaneously safeguard and promote medical safety and doctor-patient harmony.Favorable outcomes have been attained in clinical teaching and diagnosis and treatment activities.While enhancing the training conditions of medical cosmetics and elevating the level of clinical practice and teaching,the risks resulting from improper clinical diagnosis and treatment have been circumvented.All of this is evident and comprehensible.

Research on the development methodology for clinical practice guidelines for organic integration of traditional Chinese medicine and Western medicine

Integrated traditional Chinese medicine(TCM)and Western medicine(WM)is a new medical science grounded in the knowledge bases of both TCM and WM,which then forms a unique modern medical system in China.Integrated TCM and WM has a long history in China,and has made important achievements in the process of clinical diagnosis and treatment.However,the methodological defects in currently published clinical practice guidelines(CPGs)limit its development.The organic integration of TCM and WM is a deeper integration of TCM and WM.To realize the progression of"integration"to"organic integration",a targeted and standardized guideline development methodology is needed.Therefore,the purpose of this study is to establish a standardized development procedure for clinical practice guidelines for the organic integration of TCM and WM to promote the systematic integration of TCM and WM research results into clinical practice guidelines in order to achieve optimal results as the whole is greater than the sum of the parts.

Levels of evidence and grades of recommendation supporting European society for medical oncology clinical practice guidelines

Background:The European Society for Medical Oncology(ESMO)guidelines are among the most comprehensive and widely used clinical practice guidelines(CPGs)globally.However,the level of scientific evidence supporting ESMO CPG recommendations has not been systematically investigated.This study assessed ESMO CPG levels of evidence(LOE)and grades of recommendations(GOR),as well as their trends over time across various cancer settings.Methods:We manually extracted every recommendation with the Infectious Diseases Society of America(IDSA)classification from each CPG.We examined the distribution of LOE and GOR in all available ESMO CPG guidelines across different topics and cancer types.Results:Among the 1,823 recommendations in the current CPG,30%were classified as LOEⅠ,and 43%were classified as GOR A.Overall,there was a slight decrease in LOEⅠ(−2%)and an increase in the proportion of GOR A(+1%)in the current CPG compared to previous versions.The proportion of GOR A recommendations based on higher levels of evidence such as randomized trials(LOEⅠ–Ⅱ)shows a decrease(71%vs.63%,p=0.009)while recommendations based on lower levels of evidence(LOEⅢ–Ⅴ)show an increase(29%vs.37%,p=0.01)between previous and current version.In the current versions,the highest proportion of LOEⅠ(42%)was found in recommendations related to pharmacotherapy,while the highest proportion of GOR A recommendations was found in the areas of pathology(50%)and diagnostic(50%)recommendations.Significant variability in LOEⅠand GOR A recommendations and their changes over time was observed across different cancer types.Conclusion:One-third of the current ESMO CPG recommendations are supported by the highest level of evidence.More well-designed randomized clinical trials are needed to increase the proportion of LOEⅠand GOR A recommendations,ultimately leading to improved outcomes for cancer patients.

Machine learning applications in healthcare clinical practice and research

Machine learning(ML)is a type of artificial intelligence that assists computers in the acquisition of knowledge through data analysis,thus creating machines that can complete tasks otherwise requiring human intelligence.Among its various applications,it has proven groundbreaking in healthcare as well,both in clinical practice and research.In this editorial,we succinctly introduce ML applications and present a study,featured in the latest issue of the World Journal of Clinical Cases.The authors of this study conducted an analysis using both multiple linear regression(MLR)and ML methods to investigate the significant factors that may impact the estimated glomerular filtration rate in healthy women with and without non-alcoholic fatty liver disease(NAFLD).Their results implicated age as the most important determining factor in both groups,followed by lactic dehydrogenase,uric acid,forced expiratory volume in one second,and albumin.In addition,for the NAFLD-group,the 5th and 6th most important impact factors were thyroid-stimulating hormone and systolic blood pressure,as compared to plasma calcium and body fat for the NAFLD+group.However,the study's distinctive contribution lies in its adoption of ML methodologies,showcasing their superiority over traditional statistical approaches(herein MLR),thereby highlighting the potential of ML to represent an invaluable advanced adjunct tool in clinical practice and research.

Diagnosis and Management of Biliary Strictures after Deceased-Donor Liver Transplantation Based on Clinical Practice

Biliary complications are still the main complications for liver transplantation recipients. Biliary strictures comprise the major part of all biliary complications after deceased-donor liver transplantation (LT). Biliary strictures following LT are divided into anastomotic strictures (AS) and non-anastomotic strictures (NAS). A Limitation of current published researches is that most studies aren’t based on clinical practice. The aim of this review is to summarize risk factors, clinical presentation, diagnosis and management in post-LT biliary strictures.

Evidence-Based Nursing Practice of Reducing Immune-Related Skin Toxicity of Tumor Patients Guided by Sensitive Indicators

Purpose research on nursing sensitive indicators in tumor Patients application effect in immune-related skin toxicity management. Method select our hospital April to June, 202360 cases patients with immune therapy settings as the control group. August-October, 2023 60 cases the patients treated with immune therapy were the experimental group. The control group adopted regular nursing methods, while the experimental group sensitive Indicators, evidence-based give preventive care. The social situation, psychological state, physical function, quality of life score, incidence of skin toxicity caused by immune checkpoint inhibitors, moderate and above of the two groups of patients were compared. Incidence of skin toxicity. Result: experience group SAS score, SDS score higher than the control group, the difference was statistically significant (P < 0.05);The incidence of skin toxic reactions caused by immune checkpoint inhibitors and the incidence of moderate and above skin toxic reactions in the experimental group are lower than those in the control group, and the difference is statistically significant (P < 0.05). Conclusion: sensitive indicator guidance evidence-based preventive care can reduce the degree of immune-related skin toxicity, improve the psychological state and quality of life of tumor patients treated with immune therapy and reduce the incidence of adverse reactions, improve nursing quality and patient satisfaction.

Trust in Clinical Practice: A Systematic Review

Background: The aim of this study is to gain a better understanding of the true importance of trust in clinical practice by looking at how it is formed, how it affects clinical practice, and how to improve it. Methods: Using the PRISMA-ScR checklist, a review of the literature was performed to identify research evaluating the importance of trust in the doctor-patient relationship. After thorough screening and removal of duplicates, 21 articles were used in the literature review. Results: The classifying themes that emerged in the selected articles were What Makes Trust and Effects of Trust. The theme of What Makes Trust garnered two subthemes as well: Impact of Doctor-Patient Relationship on Trust and Impact of Shared Decision-Making on Trust. Further to that, the overarching themes found were slightly more specific. They were Traits of Trust, Mistrust and Barriers to Trust, Positive Effects of Trust and the Effects of a Lack of Trust. We found that the best way to improve trust was to improve communication between the patient and the doctor. Additionally, we found that the biggest barrier to a trusting doctor patient relationship was a stigmatised condition, followed by a perception of a financially-motivated doctor. Finally, we found that a lack of trust can prevent patients from seeking and receiving proper treatment. Conclusions: With a better understanding of how trust is built and the extent of the role it plays in clinical practice, we hope that this growing knowledge can improve the practice of many doctors in the future. It is certain that more research needs to be done in this area, especially focusing on vulnerable and stigmatised populations such as chronic pain patients.

Necessary prerequisites for evidence-based practice:results of investigating nurses'informatics competency and information literacy skills

This study aimed to evaluate the correlation between nursing informatics(NI)competency and information literacy skills for evidencebased practice(EBP)among intensive care nurses.This cross-sectional study was conducted on 184 nurses working in intensive care units(ICUs).The study data were collected through demographic information,Nursing Informatics Competency Assessment Tool(NICAT),and information literacy skills for EBP questionnaires.The intensive care nurses received competent and low-moderate levels for the total scores of NI competency and information literacy skills,respectively.They received a moderate score for the use of different information resources but a low score for information searching skills,different search features,and knowledge about search operators,and only 31.5%of the nurses selected the most appropriate statement.NI competency and related subscales had a significant direct bidirectional correlation with information literacy skills for EBP and its subscales(P<0.05).Nurses require a high level of NI competency and information literacy for EBP to obtain up-to-date information and provide better care and decision-making.Health planners and policymakers should develop interventions to enhance NI competency and information literacy skills among nurses and motivate them to use EBP in clinical settings.

Study on the Methodology of Developing Evidence-Based Clinical Practice Guidelines of Chinese Medicine

At present, evidence-based clinical practice guideline （EBCPG） is the main mode of developing clinical practice guidelines （CPGs） in the world, but in China, most of CPGs of Chinese medicine （CM） are still guidelines based on expert consensus. The objective of this study is to construct initially the methodology of developing EBCPGs of CM and to promote the development of standardization of CM. Based on the development of ＂Guideline for Diagnosis and Treatment of Common Pediatric Diseases in CM＂, the methodology of developing EBCPG of CM was explored by analyzing the pertinent literature and considering the characteristics of CM. In this study, the key problem was to put forward the suggestion and strategies. However, due to the methodology study of developing EBCPG of CM is still in the initial stage, there are still some problems which need further study.

Analysis of the History and Current Situation of the Development of General Practice Teaching Clinics in China

A summary of the exploration of the teaching mode of the general practice teaching clinic, a summary of the deficiencies of the teaching clinic and a summary of the significance of the establishment of the general practice teaching clinic are presented with a view to promoting the development of general practice and cultivating more excellent successors in general practice.

Assessing the Quality of the First Batch of Evidence-Based Clinical Practice Guidelines in Traditional Chinese Medicine

Objective: To assess the quality of the first batch of Chinese evidence-based clinical practice guidelines (CPGs) in Traditional Chinese Medicine (TCM) using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. Methods: Evidence-based CPGs in TCM supported by the World Health Organization Western Pacific Regional Office (WHO/WPRO) and whose development was organized by the China Academy of Chinese Medical Sciences were identified and manually retrieved. CPGs were assessed using the AGREE instrument, and the data in each CPG were analyzed in terms of the six domains in the AGREE instrument: scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, applicability, and editorial independence. Results: Twenty-eight CPGs were identified, of which 26 were included in the study. The AGREE instrument rated the 26 CPGs in terms of the six domains. The assessment results showed the following average scores: for editorial independence, 84.16%; for rigor of development, 80.95%; for scope and purpose, 79.96%; for clarity and presentation, 70.88%; for stakeholder involvement, 61.28%; for applicability, the average score was only 27.09%. In summary, nine CPGs were rated as "strongly recommended", six as "recommended with provision or alternation", and 11 as "unsure". Conclusion: Most of the first batch of Chinese evidence-based CPGs in TCM had significant shortcomings in applicability. It is suggested that special attention be paid to enhancing the quality of applicability when developing evidence-based CPGs in TCM.

China Association of Acupuncture–Moxibustion Evidence-based clinical practice guideline of acupuncture and moxibustion: Primary dysmenorrhea

Dysmenorrhea refers to periodic abdominal pain,or radiating to lumbosacral region.For the severe case,it is intolerable,combined with nausea and vomiting sometimes.This disease is commonly seen in unmarried young women.Epidemiological studies have shown that dysmenorrhea is the most common gynecological disease,especially in young women[1].Acupuncture and moxibustion have a long history in the treatm ent of primary dysmenorrhea(hereinafter referred to as PD),and compared with medication,the advantages are presented in the treatment.Entrusted by the Standardization Working Committee of China Association for Acupuncture and Moxibustion(CAAM),Department of Acupuncture and Moxibustion,Dongzhimen Hospital,Beijing University of Traditional Chinese Medicine has undertaken the drafting of Evidence-Based Clinical Practice Guideline of Acupuncture and Moxibustion:Primary Dysmenorrhea(hereinafter referred to as the Guideline).The Guideline was issued in 2014 by CAAM.It summarizes the research achievements in acupuncture-moxibustion treatm ent for dysmenorrhea in recent decades and is intended to standardize the clinical regimen of treatm ent with acupuncture and moxibustion so as to improve the clinical effect.

Obstacles in employing evidence-based practice by nurses in their clinical settings: a descriptive study

Objective: The challenge of employing evidence-based practice (EBP) is multifarious and varied. Nursing interventions supported by research evidence have been exposed to progress positive patient outcomes, while its implementation is faced with various obstacles. This study aimed to identify obstacles in employing EBP by nurses in their clinical settings. Methods: This descriptive design study was conducted at Benha University Hospital with a convenient sample of 154 nurses. Two tools were utilized: (Ⅰ) sociodemographic data sheet, which included sociodemographic characteristics of the participants, and (Ⅱ) interview scale, which contained two parts: (1) obstacles scale, which contained obstacles that impede nurses from the utilization of EBP, and (2) questions to rank the three greatest obstacles in employing EBP by nurses. Results: The greatest EBP obstacle ranked by nurses was the organizational limitations (90.9%), followed by research quality (86.9%) and research accessibility (51.0%), while individual characteristics (35.9%) were ranked as the least obstacle. There was a significant statistical correlation between organizational limitations, research quality as well accessibility-related obstacles and nurses' age, level of education, as well their years of work experience (P<0.05). Conclusions: Findings of this study showed series of obstacles in employing EBP by nurses in their clinical settings, stressing the call for expansion of nurses' capabilities related to EBP utilization in patients' care.

Clinical practice guideline dissemination and a new approach using Haddon matrix as a conceptual framework of evidence-based implementation strategies

To err is human. Clinical practice guidelines （CPGs） are often not followed and lead to adverse outcomes. The issue on implementation of CPG is complex. A review of CPG implementation is done to identify the barriers and enablers. For the first time, a fishbone diagram is used to delineate the root-causes. And Haddon matrix is applied to help understand the complexity of evidence-based implementation （EBI） strategies.

An Exploration of Perceived Barriers to Evidence-Based Practice among Physiotherapy Students during Clinical Placement—A Descriptive Cross-Sectional Study

Introduction: Teaching evidence-based practice (EBP) has become part of the standard curriculum for health care students and professionals. Teaching EBP skills should be emphasized in entry level physiotherapy education as physiotherapists are expected to practice in an evidence-based way. Identifying barriers to the application of EBP in clinical placement plays an important role in developing physiotherapy programs. The present study aimed to explore physiotherapy students’ perceived barriers toward the use of EBP during their clinical placements. Methods: A cross-sectional study was conducted among third-year physiotherapy students at the Faculty of Health Sciences University of Ljubljana, Slovenia. Participants were asked to complete a self-reported questionnaire that was developed by the researcher based on previously developed surveys. The analyses applied included descriptive statistics and calculation of frequencies, percentages, means and standard deviations of the participating students’ scores. Results: Fifty final-year undergraduate students with a mean age of 23.7 (±4.3, range 23 - 27) years participated in the study. Majority of participants reported lack of formal training, poor ability to critically appraise research evidence, insufficient time, their clinical supervisors, or other therapists not using EBP when treating patients as barriers towards practicing EBP. Conclusions: Physiotherapy students face many challenges in terms of training, organizational, and personal barriers toward the use of EBP during clinical placement. Lack of formal training, lack of research skills, insufficient time and their clinical supervisors or other therapists not using EBP when treating patients, emerged as top barriers. This fact underlines the importance of teaching students EBP skills, which would enable them to use EBP when working with patients.

Investigation on the Clinical Readiness of Nurses’Evidence-Based Practice in a 3A-Level General Hospital in Beijing

Objective:To understand the evidence-based practice readiness of developing evidence application projects in a 3A-level general hospital in Beijing,to identify barriers to evidence-based practice and to promote the successful application of evidence.Methods:All the clinical nurses who were going to participate in the application units of the evidence-based practice project were selected as the survey objects,and the self-made“Basic Information Questionnaire”and“Clinical Readiness to Evidence-based Nursing Assessment(CREBNA)”were used to conduct the survey.The total amounts and subscales were calculated.The factors that influence the score of the total scale were scored and analyzed.Results:The CREBNA total score was(119.87±19.18),the evidence subscale score was(47.94±8.54),the organizational environmental subscale score was(36.09±6.11),and the facilitator subscale score was(35.83±7.56).Univariate analysis showed that the total score of the scale was related to years of work,scientific research experience,knowledge of evidence-based care,and participation in evidence-based practice.Conclusion:The current evidence-based practice preparation situation is good.It is feasible to carry out evidence-based practice activities in the hospital.The follow-up development plan should be made based on the corresponding obstacle factors.

Nurses’ and midwives’ participation and utilization of health-related research in Kenya: Implications for evidence-based practice

Objective To assess the level of participation of nurses and midwives in health-related research,determine the status of utilization of research to inform nursing and midwifery practice in Kenya,and explore perspectives of nurses and midwives about strategies to empower nurses/midwives to engage in health research in Kenya.Methods Data were extracted from online survey responses of 156 nurse and midwife educators,practitioners,and managers/administrators.SPSS version 26 was used to analyze quantitative data;qualitative data were analyzed using Excel to organize data into categories.Results Over one-third of participants reported ever publishing research(37.2%,58/156).Participants reported using knowledge gained in nursing school to guide practice most frequently(n=148).Utilization of research findings to guide practice was reported by 80.3%(110/137)of participants.Strategies to enhance participation in the research included research training,research forums,policy reforms,and emphasis on research in curricula.Conclusions There is need to intensify and prioritize proposed strategies to empower nurses/midwives to engage in health research.

Perspectives and clinical practices of optometrists in Saudi Arabia concerning myopia in children

AIM:To investigate the practice patterns of optometrists in Saudi Arabia regarding myopia management.METHODS:An internet-based survey was distributed to all practicing optometrists in Saudi Arabia(n=1886).The survey contained questions related to 1)demographics,2)knowledge about myopia and its associated complications,3)current clinical care,4)type and frequency of myopia treatment prescribed,and 5)potential barriers limiting treatment adoption.RESULTS:The completed surveys were collected from 171 optometrists(9.06%response rate,60%male).Knowledge regarding myopia-associated complications was prevalent but somewhat inaccurate among the respondents.Cycloplegic refraction at initial visit was used by 59%of the respondents.The cover test was the most reported binocular vision test(83%),and 38%of optometrists did not perform any ocular biometrics.Twothirds prescribed single-vision spectacles for children with myopia.Increased time spent outdoors was selected by 80%of the practitioners who prescribed myopia control treatment as the primary approach.Insufficient support and lack of clinical experience in providing myopia treatment were reported as the most important factors limiting the adoption of myopia management strategies.CONCLUSION:The current optometric practices in Saudi Arabia require further investigation.Optometrists appear to be somewhat aware of myopia and the associated risks.However,most evidence-based myopia treatments are not being locally adopted,primarily because of lack of support,lack of experience,and limited availability.