Journal of evaluation in clinical practice最新文献

{"title":"The Brazilian Version of the Visual CARE 5Q: Instrument Translation and Cultural Adaptation","authors":"Amanda Piovani Monteiro,&nbsp;Daniel Ferreira Dahdah,&nbsp;Regina Helena Vitale Torkomian Joaquim,&nbsp;Cristina Ortiz Sobrinho Valete","doi":"10.1111/jep.70663","DOIUrl":"10.1111/jep.70663","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To translate and cross-culturally adapt the Visual CARE 5Q for use with Brazilian children.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A methodological cross-sectional study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Portuguese translation and adaptation of the original Visual CARE 5Q. We followed five standardised steps: translation, synthesis, back-translation, expert evaluation, and pilot testing. Ten expert judges and 25 hospitalised children aged 7−11 years participated in the study. Content validity was assessed using the Content Validity Index (CVI). Semantic, idiomatic, conceptual, and cultural equivalence were evaluated. Reliability was assessed using internal consistency, evaluated with Cronbach's alpha. The one-factor structure was evaluated by exploratory factor analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Adjustments for better comprehensiveness were necessary for items 1 and 5. All items reached full agreement after adjustments. Equivalence was adequate. Children evaluated the Visual CARE 5Q Brazilian version positively. The instrument demonstrated a unidimensional structure, consistent with the original version, and acceptable internal consistency (<i>α</i> = 0.73).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>After translation and cultural adaptation, the Visual CARE 5Q Brazilian version is applicable as a tool to assess hospitalised children's perception of clinical empathy in Brazil, contributing to the advancement of quality and child-centered care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Impact</h3>\u0000 \u0000 <p>Evaluating children's perceived empathy during hospitalisation requires the use of instruments adapted to each country's reality and qualifies pediatric healthcare.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patient or Public Contribution</h3>\u0000 \u0000 <p>These results contribute to clinical practice by providing an instrument to evaluate perceived empathy among pediatric patients in Brazil.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70663","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When Risk Scores Become Trajectories: Interpreting Change After Model Updating","authors":"Henry Bair","doi":"10.1111/jep.70654","DOIUrl":"10.1111/jep.70654","url":null,"abstract":"","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tragic Competence: A Third Structure in Physician Distress","authors":"Jörg Strobel","doi":"10.1111/jep.70611","DOIUrl":"https://doi.org/10.1111/jep.70611","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Rationale&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Physician distress is conventionally described as burnout and addressed through resilience, or as moral injury and addressed through systemic reform. Both frameworks assume that distress follows from a known right action being blocked or a value betrayed. Some of the distress of clinical work has a third structure: clinicians are sometimes troubled not because a value has been lost but because several legitimate goods make claims that cannot all be met, so a defensible choice may still leave a genuine good unrealised. Neither existing framework names this structure, and medicine has no vocabulary for the remainder it leaves.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aims and Objectives&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To distinguish this third structure from burnout, moral distress and moral injury; to establish the sense in which such situations are properly called tragic; to name and define the capacity that allows them to be carried; and to identify the personal and structural conditions on which that capacity depends.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Method&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Conceptual analysis. The argument draws on the philosophical literature on moral dilemmas and moral remainder, principally Marcus, Williams, Gowans, Hursthouse, Tessman, Nussbaum and MacIntyre, and reads it against the empirical and professional literature on clinician distress.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Situations in which genuine goods conflict are tragic in the technical sense that literature has established, a structural claim about conflicting goods rather than about catastrophe or flawed character. What sustains a clinician through them is a developable capacity here called &lt;i&gt;tragic competence&lt;/i&gt;: the ability to choose among competing goods, register any remainder honestly, and remain a recognisable self in the carrying. Its failure modes are collapse and armour, the latter suggesting that some of what burnout instruments measure as depersonalisation is a defence against tragic awareness rather than fatigue. Whether the capacity holds depends jointly on a personal condition and a structural one, the clinician's agency over the conditions of care. The claim is contributory, not exclusive: conflict among goods is general to moral life, unevenly distributed across clinical specialties, and operates alongside the recognised drivers of distress. What is distinctive is not medicine's exposure to this structure but its unpreparedness for it.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 ","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70611","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149099766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of a Clinical Script for Medicine Dispensing","authors":"Sabrina Oliveira Campos de França,&nbsp;Audinei de Sousa Moura,&nbsp;Noêmia Urruth Leão Tavares,&nbsp;Tiago Marques dos Reis,&nbsp;Débora Santos Lula Barros,&nbsp;Rodrigo Fonseca Lima,&nbsp;Rafael Santos Santana","doi":"10.1111/jep.70642","DOIUrl":"https://doi.org/10.1111/jep.70642","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Pharmaceutical dispensing constitutes a fundamental clinical activity for promoting the rational use of medicines and patient safety. However, the lack of structured and validated instruments can contribute to non-standardised practices, impacting the quality of care and the effectiveness of the interventions performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To develop and validate the content of a clinical guide to support pharmaceutical dispensing practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A two-stage methodological study. Initially, the structure of the guide was draughted based on a dispensing algorithm described in the literature and adapted through a focus group comprising 14 professionals, including pharmacists and expert researchers. In the second stage, the content was validated using the Delphi Technique. The items were evaluated for representativeness, clarity, objectivity and precision, and the Content Validity Index (CVI) was calculated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the first round, most items presented a satisfactory CVI, with point adjustments needed in two sections of the guide. The main suggestions involved greater organization into a checklist format and language simplification to favour practical applicability. After the adjustments, the second round achieved full consensus among the experts, confirming the instrument's validity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The participatory construction process and the Delphi Technique contributed to the refinement of the guide. Incorporating the experts' suggestions reinforced the importance of usability and standardization as key elements for dispensing support tools. The instrument shows potential to qualify care, reduce practice variability, and support the pharmacist's clinical reasoning. The guide demonstrated content validity and consensus among experts, proving to be a structured tool applicable to pharmaceutical dispensing practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70642","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149099764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Epidemiology-Constrained Framework for Mechanistic Hypothesis Restriction and Prioritization in Complex Disease","authors":"Uri Gabbay","doi":"10.1111/jep.70638","DOIUrl":"https://doi.org/10.1111/jep.70638","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Rationale&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Many chronic diseases remain mechanistically unresolved despite major advances in molecular biology, systems biology and high-throughput biomedical investigation. Disorders such as autoimmune disease, neurodegeneration and chronic inflammatory syndromes frequently exhibit prolonged latency, developmental susceptibility windows, heterogeneous phenotypes and multiscale biological interaction that limit direct experimental reconstruction of initiating causal events. Under such conditions, causal interpretation may proceed without sufficient inferential constraint, contributing to fragmentation between molecular association and coherent causal explanation.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aims and Objectives&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To propose an epidemiology-constrained framework for restricting and prioritising mechanistic hypotheses in complex chronic disease when direct experimental access to disease initiation is limited.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This conceptual framework was developed through a purposive conceptual synthesis of recurring epidemiologic structures and established inferential approaches relevant to complex chronic disease. The literature was organised across predefined conceptual domains, including temporality, sex distribution, geographic and migration patterns, multimorbidity, protective exposures, life-course epidemiology, causal inference, triangulation and systems epidemiology. Multiple sclerosis and Parkinson's disease were selected as illustrative examples because they exhibit several characteristics central to the framework, including prolonged latency, environmental modulation, heterogeneous phenotypes and limited experimental accessibility to initiating events.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Within the proposed model, structured epidemiologic observations, including sex distribution, geographic gradients, migration effects, age-of-onset patterns, multimorbidity networks and protective exposures, are first evaluated for reproducibility, bias, temporality and alternative explanations and are then treated as candidate constraints on competing mechanistic models. These constraints restrict and prioritise, rather than establish mechanistic hypotheses. Temporality and multimorbidity are incorporated as inferential filters that help distinguish antecedent causal processes from downstream consequences and treatment-related effects. Application to multiple sclerosis and Parkinson's disease illustrates how convergent population-level observations may narrow mechanistic hypothesi","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70638","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149099516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Very Important Person (VIP) Syndrome: Psychological Illusion or Real Surgical Risk? A Propensity Score-Matched Cohort Study of Robot-Assisted Radical Prostatectomy With a Surgeon Survey","authors":"Taeyoung Park,&nbsp;Hyemi Lee,&nbsp;Tae Beom Kim,&nbsp;Kyung Jin Chung,&nbsp;Chang Hee Kim,&nbsp;Kwang Taek Kim,&nbsp;Il Woo Park","doi":"10.1111/jep.70655","DOIUrl":"https://doi.org/10.1111/jep.70655","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale, Aims and Objectives</h3>\u0000 \u0000 <p>Special treatment of very important persons (VIPs) is widely believed to cause deviation from standard care and worse outcomes, but has rarely been tested objectively, especially in surgery. We examined whether VIP status is associated with worse outcomes after robot-assisted radical prostatectomy and the burden surgeons report when operating on such patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>In a single-centre retrospective study, 75 patients flagged as VIP among 571 men undergoing robot-assisted radical prostatectomy for non-metastatic prostate cancer were matched 1:4 to 300 controls by a propensity score from eight covariates, with exact matching on surgeon (analytic cohort, 375). Perioperative outcomes, complications, and readmission were compared, and six surgeons completed an exploratory eight-item burden survey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After matching, covariates were well balanced (all standardised mean differences below 0.10 except operative year, 0.130). Surgical and complication outcomes showed no difference (complications: risk difference +8.0 points, 95% confidence interval −2.0 to +18.0). The exception was inpatient antibiotic days, longer in VIPs by 0.87 days (95% confidence interval +0.17 to +1.57), though concentrated in one surgeon and non-significant once that surgeon was excluded (interaction <i>p</i> &lt; 0.001). Surgeons reported higher cognitive strain and a greater defensive-prescribing impulse, yet their reported intent and actual prescribing correlated only weakly and non-significantly.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>VIP status was not associated with worse objective outcomes, but a few surgeons prolonged antibiotics defensively without clear benefit, while their reported burden stayed high, dissociating perception from outcome. Maintaining standard, protocol-based care and antimicrobial stewardship for every patient is the safe and equitable response; the small sample limits precision.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149100318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emotional Blunting During Antidepressant Treatment: Implications for Clinical Decision-Making and Patient-Centred Care","authors":"Carlos De las Cuevas","doi":"10.1111/jep.70604","DOIUrl":"https://doi.org/10.1111/jep.70604","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Emotional blunting is frequently reported during antidepressant treatment but remains conceptually underdefined. Reduced emotional reactivity and affective intensity may represent therapeutic benefit, an adverse effect, residual depressive symptomatology, or a context-dependent combination of these possibilities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>To clarify the phenomenology and clinical significance of antidepressant-associated emotional blunting, distinguish it from residual depression, anhedonia, and apathy, and consider its implications for long-term prescribing, shared decision-making, and patient-centred care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Evidence from phenomenological and qualitative accounts, survey-based and clinical studies, neurobiological research, patient-reported outcome literature, and relevant ethical and clinical guidance was narratively integrated to examine the prevalence, mechanisms, subjective meanings, and management of emotional blunting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Emotional blunting is reported by a substantial proportion of antidepressant-treated patients, although estimates vary because of differences in definitions, instruments, populations, and study designs. Evidence suggests that serotonergic antidepressants may dampen the processing of both rewarding and aversive stimuli, but medication effects cannot always be clearly separated from residual illness. Patients' appraisals are heterogeneous: emotional attenuation may be experienced as protective or acceptable during acute treatment yet burdensome, alienating, or inconsistent with personal recovery during maintenance treatment. Misclassification may lead to inappropriate dose escalation, unnecessary continuation, or premature discontinuation. Clinical responses should therefore be individualised and may include maintaining treatment, dose reduction, switching, psychological or psychosocial interventions, or planned discontinuation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Emotional blunting is best understood as a therapeutically ambivalent, patient-reported outcome whose significance varies with illness phase, treatment goals, perceived benefits, and individual values. Systematic enquiry and shared decision-making can support more clinically appropriate and person-centred antidepressant care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70604","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149099514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Unseen Burden in Midwifery: Associations Between Workplace Violence, PTSD Symptoms, and Professional Quality of Life","authors":"Recep Yücel,&nbsp;Şebnem Yücel,&nbsp;Hacer Alan Dikmen,&nbsp;Havva Tokgöz Kekeç","doi":"10.1111/jep.70639","DOIUrl":"https://doi.org/10.1111/jep.70639","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study aimed to examine the associations between exposure to physical and verbal workplace violence and post-traumatic stress disorder (PTSD) symptoms as well as professional quality of life among midwives.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Descriptive and correlational study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A descriptive and correlational study was conducted with 341 midwives working in public healthcare institutions in Turkey between February and June 2024. Data were collected online using the Personal Information Form, the PTSD Brief Scale, and the Professional Quality of Life Scale. Independent samples t-tests and linear regression analyses were performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the participants, 22.9% reported exposure to physical violence and 85.0% to verbal violence in the workplace. Exposure to verbal violence was significantly associated with higher PTSD symptom levels (<i>p</i> = 0.004), whereas physical violence was not (<i>p</i> = 0.082). Both physical (<i>p</i> = 0.046) and verbal violence (<i>p</i> = 0.049) were significantly associated with higher compassion satisfaction. Regression analysis showed that verbal violence explained 2.1% of the variance in PTSD symptoms (Adjusted <i>R</i>² = 0.021), while physical and verbal violence together explained 1.9% of the variance in compassion satisfaction (Adjusted <i>R</i>² = 0.019).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Workplace violence against midwives is highly prevalent and is associated with variations in psychological well-being and professional quality of life. Due to the cross-sectional correlational design, causal relationships cannot be established. Nevertheless, these findings highlight the importance of institutional strategies, respectful workplace policies, and supportive interventions to address workplace violence and promote midwives' mental health and professional well-being.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149099515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guideline Adherence and Variability in AI-Assisted Surgical Decision-Making for Low Back Pain","authors":"Yiğit Önaloğlu","doi":"10.1111/jep.70630","DOIUrl":"https://doi.org/10.1111/jep.70630","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Surgical decision-making in low back pain requires balancing diagnostic uncertainty, asymmetric risk and guideline adherence, particularly when distinguishing non-specific conditions from pathologies warranting timely surgical referral. As large language models (LLMs) are increasingly considered as decision-support tools, their reliability in guideline-concordant surgical triage requires systematic evaluation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess and compare the performance of two LLMs (GPT and Gemini) in guideline-adherent surgical decision-making across a range of lumbar spine presentations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This comparative cross-sectional study was conducted between January and February 2026. Sixty standardised clinical scenarios representing non-specific low back pain, lumbar disc herniation with radiculopathy, lumbar spinal stenosis, and red-flag emergency conditions were developed. Guideline-based management decisions served as the reference standard. Both models were queried using an identical fixed prompt to determine diagnosis, management strategy, and urgency. Sensitivity, specificity, overall accuracy, and area under the receiver operating characteristic (ROC) curve (AUC) were calculated. Discriminative performance was compared using the DeLong test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both models demonstrated high adherence in clearly defined emergency scenarios. GPT showed higher sensitivity for identifying surgical indications than Gemini (95.8% versus 75%), while specificity was 100% for both. Overall accuracy was 98.3% for GPT and 90% for Gemini. ROC analysis confirmed superior discriminative performance for GPT (AUC 0.99 versus 0.88; <i>p</i> &lt; 0.05). Differences were primarily observed in non-emergent surgical cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LLMs demonstrated strong alignment with guideline-based management in unambiguous scenarios, but variability emerged in sensitivity for non-emergent surgical indications. These findings underscore the importance of structured validation when integrating AI-assisted tools into clinical decision-making pathways.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149099513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Individual in Medicine: Why Anomalies Matter","authors":"J. Hansen","doi":"10.1111/jep.70640","DOIUrl":"https://doi.org/10.1111/jep.70640","url":null,"abstract":"<div>\u0000 \u0000 <p>Modern medicine relies on standardisation and population-level guidance to protect the public, yet these same structures can unintentionally filter out the anomalous cases that advance scientific understanding. This article argues that anomalies function as epistemic signals—early indicators of where current knowledge is incomplete—but are routinely lost through systemic pressures. Four mechanisms illustrate this pattern: time constraints that prevent clinicians from connecting atypical findings; diagnostic frameworks that act as epistemic filters when applied rigidly; evolving medical categories that reclassify cases only after definitions shift; and research designs that exclude patients who fall outside methodological requirements. Together, these mechanisms create an environment in which rare reactions and unusual presentations are screened out before they can contribute to clinical insight. The article proposes a parallel, low-friction pathway for forwarding atypical cases to interdisciplinary groups, allowing medicine to reclaim information currently lost at the margins. Creating such epistemic space would help clinicians feel that their observations matter and would restore a core scientific principle: progress begins with the unexpected.</p>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149099339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}