Evidence-based Framework Research Articles

Central Role of Hypertension in HIV Comorbidity Networks: A Population-Based Study of Age and Sex-Specific Patterns in Southwest China.

The increasing life expectancy among people living with HIV (PLWH) has transformed HIV management into chronic disease care. This transformation has introduced complex patterns of comorbidities that challenge current health care approaches. A deeper understanding of the interactions between these conditions and their distribution across demographic groups remains essential for optimizing care. This study analyzed electronic health records of 13 884 adult people living with HIV in Luzhou, China (2001-2022). Network analysis identified central comorbidities and their interactions. Hierarchical clustering revealed disease patterns, while time series analysis tracked temporal trends. A nomogram-based prediction model underwent development and validation using bootstrap resampling. The analysis identified comorbidities in 34.58% of the cohort. Network analysis revealed hypertension as the most central condition (Strength: 0.30, Betweenness: 82, Closeness: 0.0007), followed by metabolic disorders and peripheral vascular diseases. Four distinct comorbidity clusters emerged, with infectious and metabolic diseases forming the core cluster. Demographic patterns showed that younger, female, and homosexual people living with HIV exhibited patterns dominated by neoplasms and sexually transmitted diseases, contrasting with cardiovascular-metabolic patterns in older, male, and heterosexual individuals. Age >50 years (odds ratio, 2.220 [95% CI, 2.024-2.436]) and male sex (odds ratio, 1.145 [95% CI, 1.053-1.246]) emerged as significant predictors of comorbidity risk. The prediction model demonstrated acceptable calibration (χ2=13.784, P=0.088) and discrimination (AUC, 0.666 [95% CI, 0.657-0.675]). The findings establish hypertension as a central node in HIV comorbidity networks, with patterns varying by demographic characteristics. This evidence-based framework supports the development of targeted screening strategies and personalized interventions focused on central network conditions.

Skin reflectance changes in Kenyan neonates during the first month of life: an observational study.

The study documents significant changes in skin pigmentation among Kenyan newborns over their first month of life, with significant decreases in reflectance at wavelengths critical for transcutaneous diagnostic devices. This research provides the first quantitative documentation of optical-light characteristics in African newborn skin using Individual Typology Angle (ITA), demonstrating significant darkening as infant skin matures. By establishing baseline ITA values and developmental changes in African newborns, this study creates an evidence-based framework for designing future inclusive clinical trials for transcutaneous diagnostic devices that account for both skin tone diversity and age-related changes.

Optimizing efficiency in Tanzanian public hospitals through improved productivity and resource utilization

Efficient healthcare delivery is crucial for achieving optimal health outcomes, particularly in developing countries facing resource allocation challenges. This study evaluates regional healthcare efficiency in Tanzania using Data Envelopment Analysis (DEA) with data from 2017 to 2021, employing both Constant Returns to Scale (CRS) and Variable Returns to Scale (VRS) methods and analyzing productivity trends through the Malmquist Productivity Index (MPI). The results indicate an average scale efficiency of 56.8%, with Dar es Salaam, Morogoro, Kilimanjaro, Arusha, and Tanga achieving full efficiency, while Ruvuma (26.7%) and Mtwara (28%) were the least efficient, highlighting significant regional disparities. CRS technical efficiency averaged 48.5%, implying a 51.5% input savings potential, while VRS technical efficiency averaged 82.3%, suggesting a 17.7% input savings potential. Additionally, only 19.23% of regions were efficient under CRS, and 30.77% under VRS. The MPI results showed that low technical change, with an average of 0.822, was a key driver of inefficiency despite a 2.063 average pure efficiency change, indicating poor technological progress. Further analysis of returns to scale found that 69.24% of regions operated under Increasing Returns to Scale (IRS), suggesting underutilization of resources, while 11.53% experienced Decreasing Returns to Scale (DRS), signaling inefficiencies from overextension. Recommendations to address these inefficiencies include targeted resource redistribution, improving healthcare worker conditions, staff capacity building, health information system integration, performance-based incentives, and fostering public–private partnerships to enhance service delivery and efficiency. Additionally, evidence-based decision-making frameworks and strong performance monitoring systems should guide reforms, promoting a more equitable and efficient healthcare system in Tanzania and many other developing countries.

Evaluating coastal agroecological dynamics using Landsat-derived vegetation and environmental indices embedded in Decision Support System and Monitoring Tools: insights from Guyana towards achieving SDGs

Coastal agroecological zones are vital for ensuring ecological stability, food security, and economic resilience. However, these zones face escalating threats from climate change, including salinity intrusion, vegetation degradation, and disruptions to hydrological processes. This study evaluates the dynamics of vegetation health, soil salinity, and water availability within Guyana’s coastal agroecological zones using multi-temporal Landsat 8 imagery, spectral indices such as the Enhanced Vegetation Index (EVI), Modified Soil-Adjusted Vegetation Index (MSAVI), Normalized Difference Salinity Index (NDSI), and Normalized Difference Water Index (NDWI), and a customised Decision Support System (DSS) for environmental monitoring and planning. Spanning 2015–2023, the sample application analysis focuses on the Mahaica-Berbice region (Region 5) of Guyana, a critical rice-farming area, to identify spatial and temporal trends, assess climate impacts on biogeochemical cycles, and provide actionable insights. This study integrates Google Earth Engine (GEE) for scalable geospatial analysis and a DSS that synthesises environmental indices into interactive, actionable formats for policymakers. The DSS offers an innovative platform for monitoring agroecological dynamics, identifying vulnerable zones, and guiding adaptive management strategies. Results reveal substantial annual variations in vegetation health, salinity, and water content, emphasising climate-induced vulnerabilities and their implications for carbon and nitrogen cycling. These findings emphasise the importance of sustainable resource management strategies and reinforce resilience against climate-induced challenges. The study directly supports the United Nations Sustainable Development Goals (SDGs), including SDG 2 (Zero Hunger) by advancing sustainable agriculture, SDG 13 (Climate Action) by fostering adaptive climate strategies, and SDG 15 (Life on Land) by promoting biodiversity conservation and ecosystem health. By combining remote sensing, DSS innovation, and environmental monitoring tools, this research offers a replicable, evidence-based framework to balance development and ecological sustainability in vulnerable coastal landscapes. It demonstrates the critical role of integrated technologies in shaping climate-resilient futures. Clinical trial registration: Not applicable.

International Consensus on Reporting Anastomotic Leaks After Colorectal Cancer Surgery: The CoReAL Reporting Framework.

Anastomotic leak frequently complicates colorectal anastomoses with high morbidity and mortality. The substantial variability in published leak rates reflects the lack of consistency in reporting variables that may impact the occurrence, management, short and long-term outcomes of patients. The Consensus for Reporting of colorectal Anastomotic Leaks is an international collaborative that developed a standardized evidence-based framework for reporting key variables related to the entire episode of colorectal anastomotic leak in cancer patients. Along the preoperative, intraoperative, short- and long-term postoperative phases of a left-sided colorectal anastomotic leak, key questions regarding all potentially relevant variables were formulated. A literature review was conducted to generate evidence-based statements in response to these questions. Statements that reached consensus, together with input from patients' experience and experts' opinion, were incorporated into the framework as reporting elements. Modified Delphi methodology, including online voting and an in-person consensus meeting, was used to generate consensus statements based on the literature review, and to develop the reporting framework. An international panel of 32 colorectal surgeons with expertise in the field of colorectal anastomotic leaks, representing 6 surgical societies, along with radiologists, research collaborators, patients, healthcare economists and surgical trial methodologists. Evidence-based statements and reporting elements with >70% agreement were included. Consensus among experts was achieved on 33 evidence-based statements and 43 reporting elements for the CoReAL framework. The reporting elements encompassed evidence-based statements (27), patient perspectives (7), as well as expert opinion (9). Sampling did not represent all regions in the world. Because of the paucity of evidence for some topics, evidence-based statements were primarily based on moderate to low level of evidence. This international consensus provides an evidence-based standardized framework for reporting of key variables related to a colorectal anastomotic leak following oncologic resection. See Video Abstract.

Professional identity formation in sports teachers: a multifactorial analysis

Introduction: The modern sports education system is undergoing a significant transformation due to global changes in sports and new requirements for the training of young athletes. Objective: This study aims to identify key factors influencing the professional identity of teachers working with young athletes, including their personal sports experience, continuous professional development (internships, courses, competitions), institutional specifics, and student achievement levels. Methodology: A mixed-method cross-sectional study, with a quantitative emphasis, was conducted using an adapted Coach Identity Development Scale. The scale assessed six components: social and personal development, social recognition, life coaching, training, success, and motivation. A supplementary questionnaire collected demographic and professional data. Results: The results show the significant influence of the factors on forming teachers' professional identities and create the basis for a comprehensive analysis of their interaction. Discussion: Practical implications include recommendations for differentiated teacher training programs emphasizing life coaching competencies, institutional support structures, and evidence-based professional development frameworks aligned with international coaching standards. Conclusions: Professional identity formation is driven by experiential, institutional, and developmental factors, necessitating differentiated training, systemic reforms and longitudinal research.

A Contextual Analysis of Factors Influencing Employee Performance in the Public Sector

This study examines key drivers of employee performance in Bahrain's public sector, thereby addressing a significant research gap concerning the understanding of culture-based and technologically influenced factors that affect performance in public sector organizations. A mixed-method approach was employed, involving a systematic literature review of 108 peer-reviewed studies, 22 expert interviews, and 23 participants divided into four focus group discussions (FGDs) of 4–6 individuals each. A thematic analysis of these qualitative data was conducted using NVivo, achieving high inter-coder reliability (Cohen's kappa of 0.83 for interviews; 0.86 for FGDs). This process identified 46 distinct drivers of employee performance, with leadership, digital competence, hybrid work models, motivation, and organizational culture emerging as dominant themes. The findings offer practical insights for human resources policy and performance management, providing an evidence-based framework to enhance employee performance in Bahrain's public sector.

Lived Experience of Men with Prostate Cancer in Ireland: A Qualitative Descriptive Study.

Prostate cancer is recognised as the second most common diagnosed cancer in men and remains a significant global public health concern. In Ireland, the incidence of prostate cancer continues to rise, with approximately 1 in 6 men being diagnosed in their lifetime. Men's experiences with prostate cancer are complex, necessitating further research into the factors influencing diagnosis and treatment. Therefore, this study aims to explore men's experiences with prostate cancer, emphasising the interplay between screening, diagnosis, and the lived experiences of those affected. A qualitative descriptive study was conducted among men with prostate cancer in Ireland. Using a purposive sampling (n = 11) were interviewed with data saturation guiding sample size determination. A semi-structured interview guide was used for data collection either face-to-face or via Microsoft Teams and phone calls. Data were analysed using Braune and Clarke's thematic analysis approach after transcription, with NVivo 12.0 software supporting analysis. Thematic analysis identified five themes: systemic obstacle in timely cancer detection, the role of efficient system in cancer care, emotional resilience in cancer recovery, redefining normalcy post treatment and harnessing specialised support network in coping strategies. These themes were examined through the lens of the Biopsychosocial Model to understand their interconnected nature and impact on patient experiences. This study highlights the complex factors affecting prostate cancer patients' experiences, emphasizing the need for a patient-centred approach, addressing systemic disparities, and promoting multidisciplinary care. It suggests implementing evidence-based survivorship care frameworks to improve quality of life for survivors, with future research exploring long-term effects of integrated care models.

Generative artificial intelligence 5: reflective practice

Reflective practice is a foundational element of paramedicine, introduced during education and reinforced through professional standards set by the Health and Care Professions Council (HCPC). Generative artificial intelligence (Gen AI) presents a novel tool to support reflective practice in both formal CPD activities and informal self-reflection. Through prompt engineering, users can deepen the quality and insight of their reflection, while critically analysing the tool's output can enhance understanding of professional value, decision-making and personal growth. This article explores established and emerging models of reflective practice – including both evidence-based and practice-informed frameworks – and evaluates how Gen AI can be used to scaffold reflection across experience levels. The use of Gen AI is recommended with critical awareness, ensuring users uphold confidentiality, consider bias and align with the ethical and professional standards of regulatory bodies.

Development of Evidence-Based Guidelines for the Integration of Generative AI in University Education Through a Multidisciplinary, Consensus-Based Approach.

The introduction highlights the transformative impact of generative artificial intelligence (GenAI) on higher education (HE), emphasising its potential to enhance student learning and instructor efficiency while also addressing significant challenges such as accuracy, privacy, and ethical concerns. By exploring the benefits and risks of AI integration, the introduction underscores the urgent need for evidence-based, inclusive, and adaptable frameworks to guide universities in leveraging GenAI responsibly and effectively in academic environments. This paper presents a comprehensive process for developing cross-disciplinary and consensus-based guidelines, based on the latest evidence for the integration of GenAI at European University Cyprus (EUC). In response to the rapid adoption of AI tools such as LLMs in HE, a task group at EUC created a structured framework to guide the ethical and effective use of GenAI in academia, one that was intended to be flexible enough to incorporate new developments and not infringe on instructors' academic freedoms, while also addressing ethical and practical concerns. The framework development was informed by extensive literature reviews and consultations. Key pillars of the framework include: addressing the risks and opportunities presented by GenAI; promoting transparent communication; ensuring responsible use by students and educators; safeguarding academic integrity. The guidelines emphasise the balance between, on the one hand, leveraging AI to enhance educational experiences, and, on the other maintaining critical thinking and originality. The framework also includes practical recommendations for AI usage, classroom integration, and policy formulation, ensuring that AI augments rather than replaces human judgement in educational settings. The iterative development process, including the use of GenAI tools for refining the guidelines, illustrates a hands-on approach to AI adoption in HE, and the resulting guidelines may serve as a model for other higher education institutions (HEIs) aiming to integrate AI tools while upholding educational quality and ethical standards.

Development of a graded management program for patients with diabetic foot ulcers based on the triangle model: A Delphi study.

Development of a graded management program for patients with diabetic foot ulcers based on the triangle model: A Delphi study.

Making Strategy a Priority: Overcoming Barriers to Dedicated Strategic Thinking Time

This article examines why strategic planning, despite its recognized importance, frequently receives inadequate attention in organizations. Drawing from management research, it identifies three primary barriers: leadership's daily operational demands crowding out long-term thinking, stakeholder pressure for short-term results discouraging future-focused investments, and the abstract nature of traditional strategic planning making implementation challenging. The authors provide practical solutions for each obstacle, including dedicated time-blocking techniques for strategic thinking, realignment of incentive structures to reward long-term perspectives, and methods to ground abstract strategies in concrete action plans with clear ownership. Through case examples across healthcare, technology, and other sectors, the article offers an evidence-based framework for elevating strategic planning from a neglected afterthought to an integrated organizational priority that balances visionary thinking with operational execution.

Workplace violence as a crisis: Using O'Rourke's theory as a framework to foster role clarity and professional role commitment.

Workplace violence as a crisis: Using O'Rourke's theory as a framework to foster role clarity and professional role commitment.

Developing Indigenous-Centered Healing, Health, and Wellness Frameworks to Strengthen Indigenous Health Systems, Decolonize Public Health, and Achieve Health Equity.

Over the past 20 years, national and global health initiatives have increasingly used resources, implemented tools, and proposed policies to change the social determinants of health contributing to health inequities. The World Health Organization and the US Centers for Disease Prevention and Control have applied their evidence-based frameworks to these efforts. Yet, for tribal nations and Indigenous communities in the United States, these frameworks' relevance and applicability are limited. The disproportionate impact of the COVID-19 pandemic (e.g., incidence and mortality rates) highlighted Indigenous epistemologies and realities (e.g., tribal sovereignty, strained state-tribal health systems) that were either missing or did not conceptually fit in these social determinants of health frameworks. We describe findings from the 2018 to 2024 Indigenous Social Determinants of Health Project completed by Seven Directions, an Indigenous public health institute. We propose constructs for Indigenous healing, health, and wellness frameworks developed by and for tribal nations and Indigenous communities. Practitioners and policymakers may use these tailored frameworks in collaboration across sectors (e.g., public health, social services, behavioral health) to align systems for transformational change, decolonize public health, and achieve health equity. (Am J Public Health. 2025;115(5):726-731. https://doi.org/10.2105/AJPH.2024.307958).

Invasive treatment of chronic coronary syndrome

The 2024 guidelines of the European Society of Cardiology for the treatment of chronic coronary syndrome provide a comprehensive overview covering prevention, diagnostics, as well as pharmacological and invasive therapies. Based on the latest scientific evidence, the guidelines for myocardial revascularization, valid since 2018, have been updated, and treatment recommendations have been adjusted accordingly. Myocardial revascularization, as an adjunct to optimal pharmacological therapy, remains a key treatment strategy for symptom relief, as well as for improving quality of life and long-term clinical outcomes in patients with chronic coronary syndrome. The decision between percutaneous coronary intervention and coronary artery bypass surgery depends on the anatomical complexity and functional severity of coronary artery disease, as well as comorbidities, patient preferences, and expectations. A careful risk-benefit assessment and an individualized treatment approach are essential to ensure optimal care for each patient. The current guidelines provide an evidence-based framework for this complex decision-making process.

Bridging the gap: How content engineers and designers can collaborate for accessible UI

This article explores the critical intersection between content platform engineers and designers, highlighting effective collaboration strategies for creating accessible user interfaces. The disconnect between technical implementation and visual design frequently leads to accessibility barriers that impact users with disabilities. By establishing shared understanding of accessibility standards, implementing cross-functional education, integrating workflows, and utilizing proper implementation techniques, teams can overcome these barriers while maintaining brand consistency. The piece presents evidence-based frameworks for measuring collaboration effectiveness and emphasizes the importance of organizational support through executive sponsorship, resource allocation, training opportunities, and recognition systems. Through practical examples including a form component case study, the article demonstrates how bridging disciplinary divides results in digital experiences that are both accessible and aesthetically compelling, serving the needs of all users regardless of ability.

The comprehensibility and feasibility of the modified brief pain inventory and fear of pain questionnaire adapted for children and young people with cerebral palsy.

To test the comprehensibility and feasibility of the modified brief pain inventory (mBPI) and Fear of Pain Questionnaire for Children short-form (FOPQ-C-SF) adapted for children and young people with cerebral palsy (CP), with diverse cognitive and communication abilities. Improving assessment of pain interference (mBPI) and pain-related fear (FOPQ-C-SF) in CP can enhance quality of life by increasing access to under-utilised interventions targeting pain-related physical disability and mental health. A convergent mixed methods approach was used. Twenty-two people (5-30 years) with CP completed the adapted mBPI and FOPQ-C-SF in a cognitive interview, administered by pen/paper or TalkingMats®, an evidence-based visual communication framework. Cognitive interviewing approaches were adapted to optimise participation and expression for diverse cognitive and communication abilities. Quantitative data were analysed to report tool administration times, overall completion rates and communication effectiveness. Qualitative data were analysed by content analysis to determine further changes required to the tools. Median administration times were 6.2min (IQR = 5.3-7.6) for mBPI and 4.1min (IQR = 2.7-4.9) for FOPQ-C-SF. All completed the mBPI. Three did not complete the FOPQ-C-SF due to fatigue, challenging behaviour and parent recommendation. Ten minor changes were identified. The adapted mBPI and FOPQ-C-SF are likely comprehensible and feasible for children and young people with CP, including those with diverse cognitive and communication abilities. It is likely most children and young people with CP can effectively communicate responses to both tools. The adapted tools will now undergo further psychometric testing, prior to becoming freely available for clinical and research use.

The Negative Footprint Illusion: Why Our 'Green' Choices Might Not Be So Green?

The Negative Footprint Illusion (NFI) is a cognitive bias that leads individuals to falsely assume that adding an environmentally friendly product or behavior reduces the overall environmental impact. This illusion distorts sustainability assessments, as people rely on averaging bias, compensatory green beliefs (CGB), framing effects, and quantity insensitivity instead of objectively evaluating total environmental impact. This review examines NFI as a cognitive barrier to sustainable nutrition, exploring its underlying mechanisms and their role in shaping environmental decision-making. Empirical evidence highlights how individuals miscalculate their carbon footprint, particularly in food consumption and energy-related decisions and how perceptual biases reinforce this illusion. Addressing these biases through strategic sustainability communication and evidence-based decision-making frameworks is crucial for fostering truly sustainable consumption behaviors.

Toward an evidence-based framework for training students’ collaborative problem-solving skills: Introducing and testing the PEER model.

Toward an evidence-based framework for training students’ collaborative problem-solving skills: Introducing and testing the PEER model.

Supplemental Material for Toward an Evidence-Based Framework for Training Students’ Collaborative Problem-Solving Skills: Introducing and Testing the PEER Model

Supplemental Material for Toward an Evidence-Based Framework for Training Students’ Collaborative Problem-Solving Skills: Introducing and Testing the PEER Model