Journal of evaluation in clinical practice
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A significant proportion of somatic symptoms remain, at present, medically unexplained. These symptoms are common, can affect any part of the body, and can result in a wide range of outcomes-from a minor, transient inconvenience to severe, chronic disability-but medical testing reveals no observable pathology. This paper explores two first-person accounts of so-called 'medically unexplained' illness: one that is published in a memoir, and the other produced during a semi-structured interview. ⋯ I claim that patients living with so-called 'medically unexplained' illnesses suffer a double burden. They endure both somatic and social suffering-not only their symptoms, but also disrespectful, traumatic and shame-inducing experiences of healthcare systems. I conclude with a reflection on the urgent need for changes in clinical training that could improve the quality of life for these patients, even in the absence of an explanation, treatment or cure for their symptoms.
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Exercise interventions and policies are widely prescribed in both sport and healthcare. Research investigating exercise interventions and policies is generally conducted using an Evidence-Based framework, placing an emphasis on evidence gathered from randomised controlled trials (RCTs). ⋯ The article argues that evidence from mechanistic studies ought to be considered alongside evidence from RCTs because: as RCTs investigating exercise interventions tend to be of low quality, mechanistic studies ought to be used to reinforce the evidence base; further, evidence from mechanistic studies is highly useful for both questions of extrapolation and implementation. This article argues for this on theoretical grounds, and also draws on a number of case studies.
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ICD-11's diagnostic definition possesses conceptual lacunae and normative implications calling for further attention. ⋯ At least with present day medical and scientific knowledge, a complete characterization of the AN phenotype cannot be achieved without reference to psychological states of motivation. And more research, not only clinical, genetic and neurobiological but also conceptual and ethical, will be required to resolve the challenges presented by AN.
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Some have questioned the extent of medical intervention at the end of people's lives, arguing that we often intervene in the dying process in ways which are harmful, inappropriate, or undignified. In this paper, I argue that over-treatment of dying is a function of the way in which clinicians manage epistemic risk-the risk of being wrong. When making any scientific decision-whether making inferences from empirical data, or determining a plan for medical treatment-there is always a degree of uncertainty: in other words, there is always a possibility we make the wrong decision. ⋯ Having outlined where and how epistemic risk arises in end-of-life care, I turn my attention to the values and norms which shape clinicians' management of epistemic risk. I highlight how societal attitudes towards death, the medicalisation of dying, and the practice of defensive medicine all contribute to clinicians erring on one side of epistemic caution, minimising the risk that they miss or fail to treat illness. By applying the concept of epistemic risk to end-of-life care, I offer a novel lens through which to view medical decision-making in dying patients.
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Bias is an ambiguous term, defined in different ways. In conventional usage, it indicates unwarranted prejudice. However, in health research, the notion that bias is invariably bad is biased. ⋯ Thus, health researchers need to bring their biases to consciousness. A dialectical approach can then engage the biases as conversational partners to innovate health policy that is informed by principles including transparency, good faith and tolerance. Less critical than whether researchers are biased is whose interests their bias serves given their positionality and role.