Journal of evaluation in clinical practice最新文献

{"title":"Statistical Complexity Is Outpacing Peer Review","authors":"Michal Ordak","doi":"10.1111/jep.70613","DOIUrl":"10.1111/jep.70613","url":null,"abstract":"","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008666","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":"From Evidence to Value: Integrating Evidence-Based Medicine, Patient Safety, Quality Improvement, Learning Health Systems, and Value-Based Healthcare","authors":"Takehiro Okabayashi,&nbsp;Ryo Inada,&nbsp;Toshi Imai,&nbsp;Kazuhide Ozaki,&nbsp;Kazutoshi Hayashi","doi":"10.1111/jep.70605","DOIUrl":"10.1111/jep.70605","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Evidence-Based Medicine (EBM) has strengthened clinical decision-making, but evidence alone cannot ensure that care is delivered safely, consistently, or in a manner that produces outcomes meaningful to patients. Patient safety, Quality Improvement (QI), Learning Health Systems (LHS), and Value-Based Healthcare (VBHC) have emerged to address these limitations. Understanding their relationships is important for healthcare systems seeking improvement and patient-centred care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>To examine the historical development and conceptual relationships among EBM, patient safety, QI, LHS, and VBHC, and to propose an integrated framework for understanding their complementary roles in healthcare quality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A narrative review was conducted using PubMed as a database, supplemented by reference-list searching. Literature published from approximately 1990 to June 2026 was considered. Searches combined terms related to EBM, patient safety, QI, LHS, VBHC, implementation science, systems thinking, shared decision-making, quality of care, and healthcare transformation. Landmark publications, conceptual papers, guidelines, consensus statements, systematic reviews, and original studies were narratively synthesized.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The review identifies a Five-Stage Evolution Framework: EBM establishes what works; patient safety addresses how effective care can be delivered safely; QI enables reliable and continuous improvement; LHS creates feedback loops that allow healthcare systems to learn from routine clinical practice; and VBHC evaluates whether these efforts generate outcomes that matter to patients relative to the resources required. These paradigms are complementary rather than competing approaches. Their integration also requires systems thinking, data literacy, interprofessional collaboration, shared decision-making, and attention to patient values and equity. Challenges include the evidence-to-practice gap, organizational barriers, data quality, algorithmic bias, privacy, and the difficulty of measuring individualized value.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Modern healthcare should move beyond isolated quality initiatives toward an integrated system that generates evidence, delivers care safely, continuously learns and improves, and creates meaningful value for patients. The proposed framework is conceptual and requires empirical evaluation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975876","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":"Analysis of Nursing Service Quality Gaps and Improvement Strategies in VIP General Wards Based on Patient-Reported Outcomes","authors":"Xueyan Luo,&nbsp;Jianying Li,&nbsp;Xi Liu,&nbsp;Jiaying Liang,&nbsp;Xiaoxian He","doi":"10.1111/jep.70599","DOIUrl":"10.1111/jep.70599","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;In the context of patient-centered healthcare, VIP wards are becoming increasingly common due to their commitment to an excellent service experience. This study aimed to investigate the associations between nursing service quality, patient-reported health status, and patient satisfaction in VIP wards.&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;A single-center retrospective cross-sectional secondary analysis was conducted from January 2025 to March 2026, involving 266 discharged patients from the VIP general ward of a tertiary hospital in China. All primary study outcomes were patient-reported. The five-dimensional service quality (SERVQUAL) scale was used to assess nursing service quality gaps, the patient-reported outcomes measurement information system 29-item profile (PROMIS-29) scale was used to evaluate patient-reported outcomes (PROs), and overall satisfaction, along with socio-demographic information, was collected. Data were analyzed using descriptive statistics, analysis of variance, correlation analysis, and multiple linear regression.&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;Among 266 participants, a significant gap existed between patients' expectations and perceptions of nursing service (overall gap score: −0.45 ± 0.61), with the largest gap found in assurance (−0.63 ± 0.85; paired Cohen's &lt;i&gt;d&lt;/i&gt;_&lt;i&gt;z&lt;/i&gt; = −0.74), indicating a moderate-to-large standardized discrepancy. Patients reported lower physical function and higher anxiety, fatigue, and sleep disturbance than the general population reference. Patients who opted for the VIP payment package reported significantly smaller gaps in reliability, responsiveness, and assurance than patients using other payment methods, but no significant differences were found among the three payment groups across the seven PROMIS-29 domains or pain intensity. Multiple regression analysis revealed that the empathy deficit (&lt;i&gt;β&lt;/i&gt; = −0.447, 95% CI −0.562 to −0.333, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and anxiety level (&lt;i&gt;β&lt;/i&gt; = −0.299, 95% CI −0.424 to −0.174, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) had the largest standardized coefficients; the reliability deficit (&lt;i&gt;β&lt;/i&gt; = −0.226, 95% CI −0.347 to −0.106, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and sleep disturbance (&lt;i&gt;β&lt;/i&gt; = −0.124, 95% CI −0.223 to −0.024, &lt;i&gt;p&lt;/i&gt; = 0.015) were also significant, whereas the remaining candidate variables were not. Importance-performance analysis (IPA) identified four high-importance, low-performance items including ‘Individualized attention’, ‘Sufficient nursing knowledge’, ‘Nurses willingness to help’, and ‘Patient safety’, as priority areas for improvement.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977124","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":"Communicative Rationality and Clinical Decision-Making: A Habermasian Perspective on the Doctor–Patient Relationship","authors":"Antonio da Silva Menezes Jr.","doi":"10.1111/jep.70555","DOIUrl":"10.1111/jep.70555","url":null,"abstract":"<p>Clinical encounters are where biomedical knowledge, institutional norms, and patients' lived experiences meet. Yet, modern healthcare structures these encounters through documentation, performance measures, and digital tools. These systems prioritise efficiency and measurable outcomes, often creating barriers to authentic dialogue between clinicians and patients. This tension raises philosophical questions about what conditions are necessary for meaningful clinical interactions. This article analyses the doctor–patient relationship using Jürgen Habermas' theory of communicative action. It argues that the key dynamic in clinical consultation is the negotiation of validity claims: truth (biomedical facts), normative rightness (institutional obligations), and sincerity (subjective experience). On this basis, the article proposes a conceptual model that characterises consultation as the interaction among three domains – biomedical facts, institutional norms, and patients' lived experience – summarised as ‘Facts, Norms, and Lives.’ The analysis studies how modern healthcare pressures shift clinical communication from dialogue aimed at mutual understanding to interaction driven by instrumental goals. The article argues that communicative methods – such as narrative competence and collaborative decision-making – not only restore deliberative legitimacy in clinical encounters, but additionally reinforce the normative foundations of medical practice by conceptualising the consultation as a communicative structure.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963434","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 Evaluation of Clinician and Informatician Perspectives on Medication Harm Risk Prediction Tools for Use in a Tertiary Hospital Setting","authors":"Jonathan Yong Jie Lam,&nbsp;Michael Barras,&nbsp;Ian A. Scott,&nbsp;Ahmad Abdel-Hafez,&nbsp;Nazanin Falconer","doi":"10.1111/jep.70592","DOIUrl":"10.1111/jep.70592","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Risk prediction tools (RPTs) use clinical data to estimate the likelihood of adverse events such as medication harm and institute preventive strategies. However, their adoption in hospitals can be limited by implementation challenges, workflow integration barriers, and technical constraints.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to determine clinicians' and informaticians' perspectives on the requirements, factors influencing adoption of digital RPTs for medication harm in hospitals, and to identify effective implementation strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Semi-structured interviews were conducted with clinicians and informaticians in three Australian digital hospitals within the Metro South Hospital and Health Service in 2025. Themes were inductively identified and deductively mapped to the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-two interviews were conducted with six doctors, eleven pharmacists, and five informaticians. Five themes were identified, reflecting key influences on the implementation of digital RPTs in hospitals, including clinician trust, perceived utility, and organisational readiness. Desired features such as automation, feedback functionality, and workflow compatibility were seen as essential to adoption. While enablers included comprehensive feedback mechanisms and adequate resource planning, barriers included poor integration with existing systems and uncertainty around tool reliability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Stakeholders recognised the value of digital RPTs in supporting medication safety. Understanding their perceptions and experiences is necessary for addressing barriers and enhancing tool acceptability. This study highlighted desirable tool features and organisational factors that influence successful implementation. These findings can inform strategies for effective implementation, adoption, and sustained use of RPTs in hospital settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963455","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":"Underdiagnosis of Health: A Key Driver of Overdiagnosis of Disease","authors":"Bjørn Hofmann","doi":"10.1111/jep.70603","DOIUrl":"10.1111/jep.70603","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In reducing medical overactivity and healthcare waste, there is much focus on reducing overdiagnosis of disease. Surprisingly, there is little attention on the underdiagnosis of health.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This article investigates how avoiding underdiagnosis of health can reduce medical overactivity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Conceptual analysis drawing philosophy of medicine and medical ethics is used to address five specific research questions: 1) What is health? 2) What is underdiagnosis? 3) What is underdiagnosis of health? 4) What is the relationship between underdiagnosis of health and overdiagnosis (of disease)? 5) What are the implications of the answers to questions 1–4?</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Underdiagnosis of health is contingent on the concept of health, e.g. health as wellbeing, capability, homeostasis, well-functioning, sense of coherence, resilience, and ability to realize vital goals. Underdiagnosis is reconceptualized as an epistemic omission that applies as much to health as to disease. On this basis, four types of underdiagnosis of health are identified, three of which are inherently related to overdiagnosis of disease. Unlike overdiagnosis, which is primarily detectable at the population level, underdiagnosis of health can often be identified at the level of the individual clinical encounter. Given the asymmetry of aversion—where omissions are often judged more harshly than commissions—there may be a stronger moral appeal to avoid underdiagnosis of health than to avoid overdiagnosis of disease. However, there are conceptual and practical challenges associated with underdiagnosis of health.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>While acknowledging the many challenges with the concept, focusing on underdiagnosis of health may be a fruitful strategy to mitigate medical overactivity including overdiagnosis of disease.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963418","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":"Reconceptualizing Clinical Priority as Relational Influence: Derivation of Drawing Reasoning From a Sequential Programme of Research","authors":"Alessandra Milani,&nbsp;Eliana Misurelli,&nbsp;Ketti Mazzocco","doi":"10.1111/jep.70602","DOIUrl":"10.1111/jep.70602","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Determining which patient problem requires attention first is a continuous cognitive task with direct consequences for patient safety. Despite its centrality, clinical prioritization remains conceptually underdeveloped. Organizational models frame it as protocol-driven; experiential models assume it improves with clinical exposure. Neither addresses the specific cognitive challenge that prioritization poses when patients present with multiple interacting conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>To reconceptualize clinical prioritization as a distinct cognitive task requiring relational integration under uncertainty, and to derive drawing reasoning, a structured visual method designed to support this process, from a three-study sequential programme of research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Conceptual development through sequential derivation. Three linked studies provided inputs: a theoretical integration combining complexity science, psychoneuroendocrinoimmunology, dual-process theory, and the Theory of Event Coding; a qualitative study documenting how clinicians define priority (<i>N</i> = 104); and an experimental study identifying cognitive biases and accuracy collapse when clinical data conflicted with expectations (<i>N</i> = 130). Cross-study findings were synthesized to produce definitions, an operationalized method, and testable propositions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The programme produced two conceptual outputs and one methodological output. Systemic priority is defined as the variable exerting the strongest relational influence within the patient's clinical configuration. Iterative reasoning is specified as a safety-critical cognitive operation whose interruption is empirically linked to systematic errors in prioritization. Drawing reasoning translates these outputs into a three-phase method, variable elicitation, relational mapping, and priority identification with conflict check, that directly targets the cognitive vulnerabilities documented experimentally.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Clinical prioritization under complexity is a distinct cognitive task that is not reducible to urgency ranking or accumulated experience. Drawing reasoning provides a teachable and testable method warranting empirical evaluation, particularly in chronic, multimorbid, and educational contexts.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963437","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 Relationship Between Nurses' Approaches to Ethical Issues and Their Attitudes Towards Principles of Ethics: A Descriptive, Correlational Research Design","authors":"Pervin Sahiner","doi":"10.1111/jep.70610","DOIUrl":"10.1111/jep.70610","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Nurses are likely to encounter many ethical issues in their practice. Ethical principles provide an important framework for considering ethical issues in nursing practice. The study was designed to examine the relationship between nurses' approaches to ethical issues and their attitudes toward ethical principles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This descriptive and cross-sectional study was conducted with nurses at a university hospital between 1 October 2023, and 28 January 2024. A total of 220 nurses who met the study criteria participated in the study. Data were collected using a Descriptive Characteristics Form, the Ethical Issues Approach Scale, and the Ethical Principles Attitude Scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The nurses' median scores on the Ethical Principles Attitude Scale and the Ethical Issues Approach Scale were 61.00 (53.00–67.00) and 23.00 (19.00–29.00), respectively. The findings revealed a statistically significant, low positive correlation between nurses' attitudes toward ethical principles and their approaches to ethical issues (r = 0.273, <i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study found a weak but statistically significant positive correlation between nurses' attitudes toward ethical principles and their approaches to ethical issues. Because lower scores on the Ethical Principles Attitude Scale indicate more favourable attitudes, the finding suggests that stronger approaches to ethical issues were associated with less favourable attitudes toward ethical principles. This inverse association should be interpreted cautiously because the correlation was weak and the cross-sectional design does not allow causal inference.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963368","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":"Count Backwards From Ten: Epistemic Injustice and the Patient as Expert in the Operating Theatre","authors":"Olivia Massard,&nbsp;Marie Kratzer","doi":"10.1111/jep.70609","DOIUrl":"10.1111/jep.70609","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>The figure of the ‘patient as expert’ has reshaped how medicine understands the knowing subject, yet its influence stops at the door of the operating theatre. Perioperative medicine, which comprises the preoperative clinic, the anaesthetic room and the surgical table, is at once the most instrument-saturated arena in clinical practice and the one in which the patient is most completely translated into a body and a stream of numbers before being rendered, by design, unconscious and mute.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>To examine the operating theatre as the limit case of the patient-as-expert debate; to distinguish the physiological silencing of anaesthesia, which is a clinical necessity rather than an injustice, from the epistemic injustice that surrounds it; and to translate this analysis into a concrete, testable programme for epistemic justice in perioperative care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A conceptual and philosophical analysis, drawing on Fricker's account of testimonial and hermeneutical injustice, Dotson's analysis of silencing, the phenomenology of illness developed by Toombs, Leder, Carel and Svenaeus, and Foucault's account of the medical gaze, together with the person-centred care, capability and philosophical-health literatures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We show how the theatre's gaze and its production pressures conspire to make the patient's testimony hard to hear; that general anaesthesia abolishes, for a time, the lived body from which patient knowledge is drawn, so raising rather than lowering the stakes of gathering that knowledge before the silence and crediting it after; that the several mechanisms at work, testimonial and hermeneutical injustice, structural silencing, production pressure and the authority of the anaesthetic record, must be told apart; and that accidental awareness is the emblem of the perioperative economy of credibility. Throughout, the patient is treated not only as a source of clinically useful information but as an interpreting and valuing person whose standing is what is finally at stake.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The operating theatre is the sharpest and most instructive test case for taking the patient seriously as a knower. We propose a concrete, testable programme for epistemic justice in perioperative care, continuous with the specialty's existing safety culture.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963409","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":"Validation of an AI-Assisted Framework for Systematic Bias Assessment in Observational Studies","authors":"Mahyar Etminan,&nbsp;Ramin Rezaeianzadeh,&nbsp;Antonios Douros","doi":"10.1111/jep.70593","DOIUrl":"10.1111/jep.70593","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>The rapid expansion of medical literature has led to variability and contradictions in study findings, making it increasingly difficult to distinguish meaningful signals from noise. Much of this variability arises from methodological limitations, including confounding, selection bias, and reverse causation. Although artificial intelligence (AI)-assisted tools exist for risk-of-bias assessment, most are designed for systematic reviews and are not tailored to identifying epidemiologic biases in observational studies. Structured, scalable approaches are needed to evaluate validity in real-world evidence research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>To develop and validate EpiVise, an AI-assisted, expert-informed, rule-based framework for identifying major sources of bias in pharmacoepidemiologic studies and to assess its agreement with expert epidemiologist evaluations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Recently published pharmacoepidemiologic studies from high-impact journals (post- July 2025) were independently evaluated by EpiVise and two expert epidemiologists across predefined bias domains, including measured confounding, confounding by indication, selection bias, immortal time bias, and disease latency bias. Agreement was assessed using weighted kappa statistics. In addition, synthetic study scenarios with predefined embedded biases were constructed to evaluate framework performance under controlled conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among published studies (10 studies; 60 ratings), agreement between EpiVise and expert assessments was substantial (weighted κ = 0.75; 95% confidence interval [CI], 0.63–0.87). Twelve ratings (20.0%) were discordant, all limited to adjacent categories. In synthetic scenarios (10 studies; 50 ratings), agreement was also substantial, with 40 of 50 ratings concordant (80.0%) and a weighted κ of 0.72 (95% CI, 0.61–0.83).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>EpiVise demonstrated substantial agreement with expert epidemiologist assessments in both published and synthetic study evaluations. As a scalable and reproducible framework for identifying common epidemiologic biases, EpiVise may enhance evidence appraisal, peer review, and clinical or regulatory decision-making. Further validation across broader study designs and therapeutic areas is warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919957","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}