Journal of evaluation in clinical practice
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McHugh and Walker introduced a model of knowledge to demonstrate that EBM is a form of scientism that ignores important sources of knowledge thereby impairing the practice of medicine. We study the development of this model and explore additional applications. ⋯ Priority should be given to Upshur et al for the development of a model that has far-reaching application to medical epistemology. It is shown that all four of the types of evidence considered-qualitative/personal, qualitative/general, quantitative/general, and quantitative/personal-are required to adequately characterize epistemology in medical research and practice.
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To establish an enhanced Youden's index with net benefit, as a scientific method for optimal-threshold determination in shared decision making. ⋯ The enhanced Youden's index can establish the optimal-thresholds from the perspective of maximization of patients' net benefit and provide a quantifiable method for shared decision making.
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The benefits for shared decision-making (SDM) in delivery of high-quality and personalized care are undisputed, but what is it about the dynamics of the delivery room that leads some to doubt that true SDM is possible? How difficult can it be to establish SDM as the norm when caring for a woman in labour? The discussion around SDM, autonomy, and rationality is timely and highly relevant to wider practice. ⋯ The recent UN report advocating a human rights-based approach to end mistreatment and violence against women in reproductive health services has a particular focus on childbirth and obstetric violence. This paper contributes to the recognition of obstetric violence as a human rights violation. It offers conceptual tools to diagnose the impact of gender stereotypes during childbirth and to eliminate women's discrimination in the field of reproductive health.
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In this article, we evaluate and compare the frailties of two different standards of disclosure of information regarding the risks of medical procedures applied in recent judicial decisions in the United Kingdom. As an alternative, we present the tenets and philosophical grounds of an agency model of consent and a person-based standard of disclosure. ⋯ We conclude that in order to know how to obtain valid informed consent, doctors need to engage in real conversations with their patients, revealing as much information as they, taken as real persons, need to be part of a genuine shared and respectful decision-making process.
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The foundationalist and anti-foundationalist conceptions of medical knowledge have been at loggerheads for decades. Evidence-based medicine (EBM), the most prominent form of foundationalism, has attained wide appeal and acceptance among authorities. It proposes that evidence is the "base" upon which all clinical decisions should be grounded. ⋯ In this paper, I provide a survey of the foundationalist and anti-foundationalist debate in medicine and defend anti-foundationalism on the basis that foundationalist approaches are anachronistic, and in the case of evidence-based medicine ultimately confuses inputs (evidence) for consideration in making a judgement with outputs (conclusions). I further propose that virtue ethics is inseparable from anti-foundationalism and conclude that the current infatuation with EBM implies something rather troubling; that physicians cannot be trusted to utilize their extensive training and skills to make reasonable decisions in the best interests of their patients. If this is in fact true, it suggests a crisis in virtue amongst medical professionals.