Journal of evaluation in clinical practice
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One of the criticisms of the operational/diagnostic criteria, generalised since DSM-III, has been that they were shaped solely to achieve the best inter-peer reliability with no considerations for validity. This does not fully reflect reality since throughout the development of the criteria, there was an effort to define and fulfil some validity requirements. However, despite several attempts to create alternative diagnostic systems, there is still a widespread misunderstanding of the epistemological foundations that support this paradigm. ⋯ On the epistemological basis of these operational criteria (OC) the influence of Hempel has been widely discussed. However, the group from St. Louis and, also the DSM-III editors, never openly acknowledged his role and his contribution and revealed other influences such as other medical specialties (that used and validated several OC in the diagnosis of their diseases). On the other hand, contrary to what has often been mentioned there has been a continuous attempt to validate the OC since their conception. In the implementation and development of the operational paradigm, a more instrumental trend was followed, focused on utility, but with successive attempts to achieve realistic validity by searching for biological or psychological causality. The methodologies were initially expert-driven and gradually more data-driven and included some variables external to the construct itself, such as familial aggregation, diagnostic consistency over time, prognostic and other psychometric measures.
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Charters and Heitman have recently argued that epidemic status is lost once the disease becomes 'accepted into people's daily lives and routines, becoming endemic-domesticated-and accepted'. This is a normativist, subjectivist approach to epidemic classification; that is, it is both value-laden, and dependent on the attitudes of the population. In this article, we argue for an alternative approach: a value-dependent realist account of epidemic-status. ⋯ To frame the argument we draw from complexity theory, arguing that human populations can be viewed as complex systems, and epidemic-status as an emergent property of a complex system. We propose aggregating the normative standards relevant to labeling a disease as an epidemic, and use this as our indicator for both the beginning, and the end of epidemics. An epidemic ends, we argue, once the burden of disease drops below an objective but distinctly normative 'epidemic threshold'.
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The evidentiary standards and epistemic models of clinical care, especially those of evidence-based medicine, are dissimilar to those used in philosophy and examination of how the two systems intersect may help clinicians make more informed treatment decisions. ⋯ We find that the medical establishment should embrace ethical evaluation as intrinsic to medical practice and that medical training and treatment guidelines should reflect this reality. Patients deserve clarity and transparency about how physicians make determinations about their treatment, and physicians should be prepared to offer explanations for those decisions.
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Since non-directed (altruistic) kidney donors do not stand to benefit from the lengthening and strengthening of a relationship that they intrinsically value, their donations are considered to constitute the most altruistic variety of living kidney donation. ⋯ Accordingly, the expected value of becoming a living kidney donor is likely to be positive, meaning the act of doing so may be considered akin to the taking out of an insurance policy. In the context of non-directed (altruistic) kidney donation, this may diminish the extent to which such a donation is considered altruistic.