Journal of evaluation in clinical practice最新文献

{"title":"Examining the Relationships Between Organisational Arrogance, Organisational Silence, and Psychological Safety: An Application on Healthcare Employees","authors":"Mustafa Filiz,&nbsp;Yalçın Karagöz,&nbsp;Yusuf Karaşin","doi":"10.1111/jep.70645","DOIUrl":"10.1111/jep.70645","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study aims to examine the relationships between Organisational Arrogance (OA), Psychological Safety (PS), and Organisational Silence (OS) among healthcare employees, and to determine whether these variables differ according to demographic characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>The study was conducted with 439 healthcare employees working in primary, secondary, and tertiary healthcare institutions across different regions of Türkiy. Data were collected through an online survey consisting of the OS Scale, OA Scale, and PS Scale. The structural validity of the scales was tested using Confirmatory Factor Analysis (CFA) via AMOS. Descriptive statistics, independent samples <i>t</i>-tests, ANOVA, and correlation analyses were performed using IBM SPSS Statistics. Normality assumptions were assessed based on skewness and kurtosis values.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The findings revealed that OA is negatively and significantly associated with PS (<i>r</i> = −0.313, <i>p</i> &lt; 0.001) and positively associated with OS (<i>r</i> = 0.344, <i>p</i> &lt; 0.001). Additionally, PS is negatively associated with OS (<i>r</i> = −0.294, <i>p</i> &lt; 0.001). Demographic analyses indicated that only gender produced a significant difference in OA, with female employees reporting higher levels than males, while no significant differences were found for PS and OS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The results suggest that OA may contribute to decreasing PS and increasing OS. Enhancing PS within organisations may help reduce silent behaviours and promote open communication.</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":"149110796","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":"When the Algorithm Speaks First: Trust, Reliance and the Reconstruction of Clinical Metacognition","authors":"Joel Hanhart,&nbsp;Anat Zohar","doi":"10.1111/jep.70652","DOIUrl":"https://doi.org/10.1111/jep.70652","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aims of the Journal Addressed&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This paper addresses three of the aims of the Journal: clinical decision making, health philosophy and person-centred healthcare. Retinal imaging serves as the analytic case. The question at issue, what epistemic attitude a clinician may properly hold towards an algorithmic output issued for an individual patient, arises in every discipline and every health system in which such systems are deployed, and the argument is tested throughout against systems that read no images.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Rationale, Aims and Objectives&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Diagnostic artificial intelligence increasingly delivers a conclusion before the clinician has formed one, and medical education has responded by adding modules on the critical appraisal of algorithmic output. Such curricula rest upon two unsound foundations: they extend a form of metacognitive instruction shown not to improve diagnostic accuracy and they ask clinicians to cultivate an attitude whose defining feature is the relaxation of validation. This paper establishes what epistemic attitude a clinician may hold towards an algorithmic output and derives the form that clinical metacognition must take in consequence.&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;Conceptual analysis, drawing upon the philosophy of trust and epistemic dependence, the cognitive science of clinical reasoning and empirical studies of artificial intelligence in clinical practice. Retinal medicine serves as the analytic case, chosen because it is the domain in which the position under contest is strongest; the argument is tested throughout against systems that process no images.&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;Trust and reliance are distinct attitudes. On the account adopted here, to trust a medical algorithm is to rely upon it while relaxing the monitoring of the conditions that make it reliable; trust is reliance from which validation has been withdrawn. Regulatory clearance, institutional adoption and published performance supply legitimate grounds for trusting the assemblage that produces a system, yet none of them, singly or together, warrants reliance upon its output for an individual patient. Three asymmetries separate algorithmic from human epistemic dependence: the algorithm can be neither interrogated nor held to account; its errors fall on whole classes of patients at once; and its warrant holds of a population while the decision is owed to a person. The metacognition this situation demands is knowledge, not disposition, and stands untouched by the ev","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.70652","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149099340","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":"Beyond Primum Non Nocere: Therapeutic Injury, Comparative Harm Management, and the Ethics of Modern Medicine","authors":"Boris Nikolic","doi":"10.1111/jep.70643","DOIUrl":"https://doi.org/10.1111/jep.70643","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale, Aims and Objective</h3>\u0000 \u0000 <p>The maxim primum non nocere (“first, do no harm”) remains emblematic of medical ethics, yet much of modern therapeutics accepts foreseeable and sometimes near-certain injury in pursuit of benefit: surgery injures tissue, chemotherapy produces systemic toxicity, and ablation and embolization achieve their effect through controlled destruction. This paper asks how such therapeutic injury is to be ethically understood, and whether non-maleficence still describes the operative morality of clinical practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>The paper proceeds by critical conceptual and ethical analysis rather than empirical study, situating the question within the literature that has sought to refine non-maleficence—principlism, the doctrine of double effect, proportionality reasoning, threshold deontology, and the ethics of risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Contemporary medicine is argued to operate not through literal non-maleficence but through comparative harm management: the selection among competing, foreseeable harms under uncertainty. A distinct and growing class of interventions produces injury that is not a side effect but the therapeutic mechanism itself, a case the inherited frameworks address only obliquely. Comparative harm management is shown to describe the architecture of clinical decision-making rather than to add a further criterion of justification such as proportionality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Non-maleficence retains a regulative and cautionary value but no longer describes the operational morality of modern medicine. The physician is best understood not as a guarantor of freedom from harm but as a steward of proportionate therapeutic injury under conditions of uncertainty, vulnerability, and competing obligations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70643","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149099715","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":"Beyond Autonomy: Ethical Considerations of AI in Substitute Decision-Making for Incapacitated Patients","authors":"Alberto Boretti","doi":"10.1111/jep.70661","DOIUrl":"https://doi.org/10.1111/jep.70661","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The integration of artificial intelligence (AI) into healthcare offers significant potential for enhancing patient care, particularly for incapacitated patients unable to communicate their preferences. Advanced AI systems, such as Personalized Patient Preference Predictors (P4), are increasingly proposed as tools to assist in substitute decision-making, yet their ethical implications remain underexamined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This paper critically examines the ethical implications of employing AI-driven preference prediction systems in substitute decision-making for incapacitated patients. It evaluates these systems through the ethical principles of autonomy, beneficence, non-maleficence, and justice, and proposes a framework for their ethically sound integration into clinical practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The analysis draws on principled ethical reasoning to interrogate key challenges posed by P4 systems, including the distinction between probabilistic preference inference and genuine autonomy, the risk of algorithmic paternalism even in personalized models, and the subtle manifestations of bias within highly individualized datasets.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The analysis reveals that while P4 systems may augment preference prediction, they cannot fully capture the relational, contextual, and value-laden nature of authentic patient preferences. Algorithmic paternalism and latent bias remain salient risks, even in highly personalized models. These findings underscore the indispensability of human surrogates in contextualizing AI-generated data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>AI should function as a decision-support tool that augments, rather than replaces, the holistic judgment of human surrogates. An ethical framework integrating AI predictions within a model of relational autonomy is proposed. Key recommendations include maintaining meaningful human oversight, developing transparent and interpretable AI, and establishing a robust regulatory framework to ensure ethically sound and patient-centered care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149099716","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":"Physician Factors Associated With Burnout During System-Wide Electronic Health Record Implementation: A Prospective Repeated Cross-Sectional Study of Acute and Post-Acute Care Physicians","authors":"Yerin R. Lee,&nbsp;Louise Harris,&nbsp;Peter Rossos,&nbsp;Lucas B. Chartier,&nbsp;Maxim Ben-Yakov","doi":"10.1111/jep.70648","DOIUrl":"https://doi.org/10.1111/jep.70648","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 burnout is a major concern, particularly during periods of large-scale institutional change such as electronic health record (EHR) implementation.&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 examine associations of burnout with physician age, clinical experience, and after-hours documentation burden (‘pyjama time’) among acute and post-acute care physicians undergoing EHR implementation, and secondarily to evaluate changes in burnout across three phases of EHR implementation (Pre-Implementation, Post-Implementation, Post-Optimisation).&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;We conducted anonymous electronic surveys of acute and post-acute care attending physicians at a tertiary academic health system in Toronto, Canada across three phases of EHR implementation. Burnout was assessed using the Maslach Burnout Inventory Human Services Survey–Medical Personnel (MBI-HSS-MP). Univariable and multivariable logistic regression analyses identified factors associated with high emotional exhaustion, high depersonalisation, and low personal accomplishment.&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;We collected 306 responses in Pre-Implementation, 248 in Post-Implementation, and 214 in Post-Optimisation. Overall burnout levels remained stable across implementation phases (&lt;i&gt;p&lt;/i&gt; ≥ 0.05). Physician age ≥ 65 years was independently protective across all burnout domains (adjusted odds ratio [aOR] 0.33-0.49; &lt;i&gt;p&lt;/i&gt; &lt; 0.01). Physicians with &gt; 20 years in practice were less likely to report high depersonalisation (OR 0.39; &lt;i&gt;p&lt;/i&gt; &lt; 0.01) or low personal accomplishment (OR 0.54; &lt;i&gt;p&lt;/i&gt; = 0.01). Increasing pyjama time was associated with higher odds of emotional exhaustion on univariable analysis (OR 1.06 per hour; &lt;i&gt;p&lt;/i&gt; &lt; 0.03) and remained independently associated with depersonalisation after adjustment (aOR 1.07; &lt;i&gt;p&lt;/i&gt; = 0.02). Documentation burden peaked in the Post-Implementation phase (mean pyjama time 381.6 min/day), with higher depersonalisation observed on univariable analysis (OR 1.51; &lt;i&gt;p&lt;/i&gt; &lt; 0.02), although this association attenuated after adjustment.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;In this three-phase study, after-hours documentation burden was strongly associated with depersonalisation, while physician age ≥ 65 years consistently protected against burnout. Although overall burnout levels remained stable across implementation phase","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70648","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149099713","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":"Algorithmic Deservingness: Accountability and Oversight in AI-Mediated Access to Healthcare","authors":"Stjepan Škudar","doi":"10.1111/jep.70637","DOIUrl":"https://doi.org/10.1111/jep.70637","url":null,"abstract":"","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149099911","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 One-Per-Thousand Effect: Rare Catastrophic Events, Hindsight, and Defensive Medicine in Modern Obstetrics","authors":"Antonio Ragusa","doi":"10.1111/jep.70629","DOIUrl":"https://doi.org/10.1111/jep.70629","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale, Aims, and Objectives</h3>\u0000 \u0000 <p>Rare catastrophic obstetric outcomes are uncommon in high-income settings but may exert an influence on clinical practice that is disproportionate to their epidemiological frequency. This paper proposes the one-per-thousand effect, a conceptual framework describing how exceptional adverse events may progressively influence clinical judgement, organisational behaviour, and intervention thresholds. Although developed in obstetrics, the framework addresses broader questions of clinical decision-making under uncertainty, patient safety, and healthcare evaluation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A conceptual analysis was undertaken by integrating evidence and theory from obstetrics, cognitive psychology, patient safety, human factors, and defensive medicine. The framework examines how organisational memory, availability effects, hindsight and outcome bias, asymmetric accountability, and anticipation of blame may interact to shape clinical behaviour following rare catastrophic events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The proposed model suggests that severe but infrequent adverse outcomes may produce organisational effects that extend beyond the individual case. Through reinforcing cognitive and organisational mechanisms, isolated catastrophes may progressively lower intervention thresholds, increase intervention rates and expose a much larger population to intervention-related harms. The framework distinguishes targeted learning from identifiable failures and broader behavioural adaptation driven primarily by exceptional events rather than by proportionate evidence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The one-per-thousand effect offers a conceptual explanation for how rare catastrophic events may reshape routine clinical practice through organisational learning processes operating under uncertainty. By distinguishing proportionate learning from defensive adaptation, the framework provides a basis for strengthening clinical governance through prospective sequential review, just culture, structured professional support, and no-fault compensation. Although illustrated in obstetrics, the proposed model may be applicable to other high-risk healthcare settings in which rare adverse outcomes exert disproportionate organisational influence.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149099714","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":"Perceptions of Healthcare Professionals on Clinical Debriefing Structured by The Talk Method","authors":"Jéssica Santos Oliveira Targino,&nbsp;Antônio Alves da Silva Neto,&nbsp;Wanderley de Lima Pereira,&nbsp;Marlon Natan Baracho de Oliveira,&nbsp;Rodrigo Guimarães dos Santos Almeida,&nbsp;Raphael Raniere de Oliveira Costa","doi":"10.1111/jep.70641","DOIUrl":"https://doi.org/10.1111/jep.70641","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aim&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To understand healthcare professionals' perceptions regarding the application of the Debriefing TALK method in clinical practice, with emphasis on interprofessional communication and patient safety.&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;A qualitative action research study conducted with 12 healthcare professionals from secondary care in the Northeast region of Brazil. The educational intervention included dialogic lectures, communication skills training, clinical simulation, and structured debriefing sessions using the TALK method. Qualitative data were analyzed using the Collective Subject Discourse method, while quantitative data were analyzed using descriptive statistics. The study followed COREQ recommendations.&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;The TALK method functioned as a structuring device for reflective practice, promoting the reorganization of interprofessional interactions and reframing communication failures as opportunities for learning. Participants reported improvements in communication, team integration, and care planning, as well as the promotion of a psychologically safe and non-punitive environment. Reported barriers included time constraints, workload burden, variable engagement, and limited institutional support.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The TALK Debriefing method proved feasible and well accepted, showing potential to enhance clinical practice through structured reflection, meaningful learning, and strengthened interprofessional communication, contributing to patient safety in real-world care contexts.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Implications for Practice&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The findings suggest that the TALK method may support reflective and communication-centered practices in healthcare services, strengthening interprofessional collaboration and patient safety culture.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Impact&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This study advances knowledge on structured debriefing in real clinical settings, highlighting the TALK method as a pedagogical and organizational strategy capable of transforming communication failures into opportunities for collective learning and practice improvement.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Reporting Method&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Reported according to CO","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70641","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149099915","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":"Assessing the Carbon Footprint of Haemophilia B Gene Therapy: A Framework for Environmental Health Technology Assessment","authors":"Manuel Rodriguez Lopez,&nbsp;María Teresa Alvarez Román,&nbsp;Michael Calviño Suarez,&nbsp;Ramiro José Nuñez Vázquez,&nbsp;Carmen Albo Lopez","doi":"10.1111/jep.70649","DOIUrl":"https://doi.org/10.1111/jep.70649","url":null,"abstract":"","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149099914","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":"CALME: A Cognitive Loop for Ethical Deliberation During Clinical Action","authors":"Nina Cadeau Comte","doi":"10.1111/jep.70633","DOIUrl":"https://doi.org/10.1111/jep.70633","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale, Aims and Objectives</h3>\u0000 \u0000 <p>Most established approaches to clinical ethics support deliberation before or after care, through processes such as informed consent, institutional guidance, ethics consultation and retrospective case review. Yet ethically significant decisions often arise during clinical action, when clinicians must respond under time pressure, manage competing technical demands and navigate asymmetries of knowledge and power. Although the literature on everyday ethics shows that routine practice is ethically dense, it does not provide a compact reasoning structure designed for use as care unfolds. This article develops such a structure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method (Conceptual)</h3>\u0000 \u0000 <p>The framework was developed through conceptual analysis of the temporal and cognitive conditions of decision-making during clinical action. Five bodies of scholarship informed its design: reflective practice, the logic of care, everyday ethics, cognitive load theory, and naturalistic decision-making. Three hypothetical clinical cases were used to examine its internal coherence and illustrate how it could be applied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>CALME is a five-component cognitive loop: Context, Appraisal, Limits, Margin of manoeuvre and Evaluation. Its compact structure is designed to limit the effort required to search among possible actions, with the aim of preserving working memory for ethical attention. The Limits component makes competence, ethical justification, the patient's wishes and institutional constraints explicit. Margin of manoeuvre narrows the available actions to four categories: continue, adapt, defer or stop. Evaluation then returns the clinician to Context, allowing the loop to be repeated as action changes the situation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In a form simple enough to remember and practical enough to use at the bedside, CALME gives explicit structure to ethical decision-making during clinical encounters. It offers clinicians what the everyday-ethics literature has not yet provided: not simply another account of the ethical density of routine practice, but a usable format for the reasoning that such density requires.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149099913","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}