ObjectiveTo investigate the association of pre-existing migraine in patients hospitalised and who recovered from severe acute respiratory syndrome coronavirus 2 infection with the presence of post-coronavirus disease symptoms.BackgroundNo study has investigated the role of migraine as a risk factor for development of post-COVID symptoms.MethodsA case-control study including individuals hospitalised during the first wave of the pandemic was conducted. Patients with confirmed previous diagnosis of migraine were considered cases. Two age- and sex-matched individuals without a history of (...) headache per case were also recruited as controls. Hospitalisation/clinical data were collected from hospital medical records. Patients were scheduled for a telephone interview. A list of post-COVID symptoms was systematically evaluated, but participants were invited to freely report any symptom. The Hospital Anxiety and Depression Scale and the Pittsburgh Sleep Quality Index were used to assess anxiety/depressive symptoms and sleep quality. Multivariable conditional logistic regression models were constructed.ResultsOverall, 57 patients with confirmed diagnosis of migraine and 144 non-migraine controls who had recovered from COVID-19 were assessed at 7.3 months after hospital discharge. The number of post-COVID symptoms in the migraine group was significantly greater than in the non-migraine group. Fatigue was significantly more prevalent in the migraine group. However, no between-groups difference in the prevalence of headache as a post-COVID symptom was detected.ConclusionPatients with a history of migraine who recovered from COVID-19 exhibited more long-term fatigue as post-COVID sequelae than those without migraine. Some of the pathophysiological changes associated with migraine could predispose to the occurrence of post-COVID symptoms. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:How I Hate You, CancerClaire YarMigraine. That’s what we thought. They run in my family, so why not? My beautiful, bright, extroverted ten–year–old daughter’s neurological exam was unremarkable, but she had a bad headache and was vomiting in the early morning hours. Migraine didn’t seem that much of a stretch. Our savvy pediatrician had a gut feeling that it was more than a migraine and sent her (...) for an MRI.We had not even left the children’s hospital before I received a voicemail to call our pediatrician. When I returned the call, on our way to pick up Ellie’s younger brother from school and already running late I heard the words that no parent wants to hear, “I have bad news. We found a brain tumor and it’s rather large”. This conversation would turn our lives into a frenzy of fear and leave unanswered (unanswerable?) questions. I was told to bring her to the ER where we would be met by a neurosurgeon and oncologist. I could not process this information. My initial fears were too scary to utter. Was she going to die? Do children survive brain surgery “intact”? Is it operable? Oncologist = scary cancer, doesn’t it? Did we do something to cause it? What if our insurance doesn’t cover the best treatment?Clinging to the life I knew before—needing to stay in the “before,” not even pulling the car over, I reached backwards, held Ellie’s leg and spoke the words out loud for the first time. That’s what a brain tumor diagnosis does to your family. It breaks up time into “before” and “after”. Her reaction was a terrified wail and then, oddly, hysterical laughter. Is that what shock looks like? My own reaction to the call was of stunned silence. The sound of my heartbeat and the blood rushing in my ears meant I could not ask the questions I had in that moment.Ellie has always been exceptional. She is a bright light in any room. At only ten–years–old, she spoke like a teenager; had the vocabulary of an adult. Never again would I be able to take this for granted. In every waking moment that our lives were unoccupied with the practicalities of a brain tumor diagnosis, the questions I couldn’t think of or say out loud during that terrible phone call continually flooded my thoughts. Your child’s brain is everything after all; it’s what makes them “them.”An avid horse rider, she had been off her favorite horse’s back for a few weeks saying that the bouncing hurt her neck. I had kept her off school for several days, but we had seen marked improvement in [End Page E12] the day or two leading up to that devastating D–Day of diagnosis, and she had been back at school doing well. Only a week before, Ellie had been dancing at a party with friends. How could she have a brain tumor?We rushed home and hurriedly packed our bags for “at least a week”—and I recall that life seemed to be both in slow motion and traveling at the speed of light. I desperately wanted to turn the clock back to the innocence we had known a few hours before. This was way too much news to hear in one day. Even when I heard the diagnosis, I was surprised that we would have to go to the hospital that day. Now! Don’t people get time to process or plan and get second opinions? We had no time to tell family and friends or ask for help. We didn’t have the luxury of time. Time is another thing I no longer take for granted.Upon arrival at the large children’s hospital we felt as if we were given so much information, but looking back, I now know that these angels are trained in giving parents only what they can handle—in tiny pieces, nibble by nibble. You don’t (can’t) hear half of it anyway. Our families live far from us, and trying to gather and figure out... (shrink)

Headache disorders can be considered as the predominant neurological condition. In the field of neurological diseases, migraine was estimated to cost a total of €27 billion per year for the loss through reduced work productivity in the European Community. Medical data and information in turn provide knowledge based on which physicians make scientific decisions for diagnosis and treatments. It is, therefore, very useful to create diagnostic tools to help physicians make better decisions. This paper is focused on a (...) new hybrid clustering system combining analytic hierarchy process and weighted fuzzy c-means clustering method for diagnosing children with primary headache disorder. The proposed three-stage hybrid diagnosing system is tested on data set collected from hospitalized children in the Clinical Centre of Vojvodina, Novi Sad, Serbia. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:My Gratifying Testimonial of My Extended Warranties of LifeDanette RaginMy name is Danette Ragin. I am a 2-time kidney recipient who has been diagnosed with ESRD (End Stage Renal Disease). Both transplants were performed in Baltimore, Maryland. I am also a 3-time Donor Family Member and the proud Mom of a living donor.I received the first kidney from a deceased donor on June 22, 2008. The donor was traveling (...) thru Maryland with her family on vacation and experienced heart complications. My second kidney was donated to me by my youngest daughter Angel on December 20. 2016. I am thankful to God for both of my extended warranties. I’d like to share a little about my journey with you.Around the year 2002, I started seeing my PCP (Primary Care Physician) for terrible migraine headaches, which on occasions lasted for weeks. After several tests, she expressed her concerns. I had been spilling protein in my urine and my kidney function was showing some abnormalities. My PCP sent me to see a neurologist after several failed attempts to gain some type of reprieve from the nerve-racking headaches. My nephrologist confirmed my PCP’s diagnosis, and I had visits with the nephrologist every 6 months until they noticed a substantial change.“Ah, Mrs. Ragin, you’re in the beginning stage of End Stage Renal Disease”. Boom! (That hit me like a ton of bricks.) “Umm, you mean I have kidney failure! No! Not me. I’ve worked in dialysis. That can’t happen to me!”Of course, I was in complete denial. Both my PCP and nephrologist were very supportive mentally, physically, emotionally, and even spiritually. This information was so devastatingly painful that I started working harder and longer. I turned into a Superwoman with my family, work, and church. I was trying to drown out the fact that my health was being compromised, refusing to believe this could happen to me. I started to slow down in my daily functions, my appetite decreased, and I lost weight as a result. I thought that my weight loss was bringing my “Sexy Back,” only to realize that I am not exempt from sickness. My nephrologist assured me of a possible solution. He advised me to have my name placed on the waitlist of one of the transplant centers in Maryland.In October 2006, I had surgery to have an A/V fistula placed in my left arm to prepare for possible dialysis treatments in the future. In January 2007, I went to be evaluated for a kidney transplant. I was given 6 weeks to complete all required tests to secure a place on the transplant waiting list. Determination allowed me to complete all tests within 2 weeks.In April 2007, I was approved to be placed on the transplant list. In October, I had a PDC (Peritoneal Dialysis Catheter) placed in my abdomen so that I could dialyze myself at home. I loved it but it didn’t love me. It was removed in January 2008. Right afterward, I received my first unsuccessful call to be transplanted. (The kidneys were cystic and could not be used.) “Bummer.” I also received another call in April 2008 (Easter Sunday). Those kidneys were [End Page 134] at another hospital in Maryland, so if the waiting patient at their facility refused the kidney, I would be next in line. The patient accepted the donation. It wasn’t my turn yet.In the meantime, I had already started hemo-dialysis in mid-March 2008. On Saturday, June 21, 2008, while enjoying the weekend with my family, I received a call around 2:30 p.m. My youngest daughter and I were out shopping. We were in a crowded store that was going out of business, and I felt my phone vibrate. I noticed a slightly familiar number. I stepped out of the store to retrieve the call.“Mrs Ragin...Me: Yes.“Danette Ragin...Me: Yes.“We are calling from the University with an organ offer for you!”I told them they had me at the sight of the first few digits of the phone number they were calling from!In June... (shrink)

Clinical decisionmaking includes reasoning from prescientific or scientific theories, reasoning from uncontrolled or controlled experience, and reasoning based on empathic understanding and moral beliefe. The development of contemporary clinical thinking is discussed, and it is found that successive generations of medical practitioners have had different views of the rationality and relative importance of these modes of reasoning: that which is considered rational by one generation of doctors is sometimes denounced by the next. The author's book, Rational Diagnosis and Treatment (...) , which is an example of clinical thinking in the 1960s and early 70s, is used to illustrate one particular view of clinical decisionmaking. Keywords: rational, clinical decisionmaking, biological theory, controlled clinical studies, empathic understanding, ethical reasoning CiteULike Connotea Del.icio.us What's this? (shrink)

ABSTRACTMedical diagnosis is sometimes used by critical realists and others as an exemplar of a form of inference across time in which a current empirical observation points backwards to the conditions of its emergence and forwards to a possible future outcome or progression. Accordingly, its practice warrants critical exploration to confirm its legitimacy as a philosophical reference point. The strengths and weakness of the exemplar are appraised using case brief case studies. The limitations of medical diagnosis are discussed (...) in the wider context of the sociology of medical knowledge, the social determinants of ill-health and the role of commercial interests in shaping diagnostic practice. The conclusion is cautious, not nihilistic. Diachronic inference in medicine, as in other disciplines working in and with open systems, can be respected for its advantages to humanity. However, this brings with it the perennial caution of epistemic humility and a needed tolerance of uncertainty.. (shrink)

A diagnostic process is an investigative process that takes a clinical picture as input and outputs a diagnosis. We propose a method for distinguishing diagnoses that are warranted from those that are not, based on the cognitive processes of which they are the outputs. Processes designed and vetted to reliably produce correct diagnoses will output what we shall call ‘warranted diagnoses’. The latter are diagnoses that should be trusted even if they later turn out to have been wrong. Our (...) work is based on the recently developed Cognitive Process Ontology and further develops the Ontology of General Medical Science. It also has applications in fields such as intelligence, forensics, and predictive maintenance, all of which rely on vetted processes designed to secure the reliability of their outputs. (shrink)

Now in its fourth edition, Rational Diagnosis and Treatment: Evidence-Based Clinical Decision - Making is a unique book to look at evidence-based medicine and the difficulty of applying evidence from group studies to individual patients._ The book analyses the successive stages of the decision process and deals with topics such as the examination of the patient,_the reliability of clinical data, the logic of diagnosis, the fallacies of uncontrolled therapeutic experience and the need for randomised clinical trials and meta-analyses. (...) It is the main theme of the book that, whenever possible, clinical decisions must be based on the evidence from clinical research, but the authors also explain the pitfalls of such research and the problems involved in applying evidence from groups of patients to the individual patient._ For this new edition, the sections on placebo and meta-analysis and on alternative medicine have been thoroughly updated, and there is more focus on insufficient reporting of harms of interventions. The sections on different research designs describe advantages and limitations, and the increased medicalisation and the effects of cancer screening on health people are noted. A section on academic freedom when clinicians collaborate with industry and ghost authors is added._ This essential reference work integrates the science and statistical approach of evidence-based medicine with the art and humanism of medical practice; distinguishing between data, sets of data, knowledge and wisdom, and their application. Such an intellectually challenging book is ideal for both medical students and doctors who require theoretical and practical clinical skills to help ensure that they apply theory in practice. (shrink)

The aim of this essay is to elaborate philosophical and ethical underpinnings of posthumous diagnosis of famous historical figures based on literary and artistic products, or commonly called retrospective diagnosis. It discusses ontological and epistemic challenges raised in the humanities and social sciences, and attempts to systematically reply to their criticisms from the viewpoint of clinical medicine, philosophy of medicine, particularly the ontology of disease and the epistemology of diagnosis, and medical ethics. The ontological challenge focuses on (...) the doubt about the persistence of a disease over historical time, whereas the epistemic challenge disputes the inaccessibility of scientific verification of a diagnosis in the past. I argue that the critics are in error in conflating the taxonomy of disease and the act of diagnosing a patient. Medical diagnosis is fundamentally a hypothesis-construction and an explanatory device that can be generated under various degrees of uncertainty and limited amount of information. It is not an apodictic judgment as the critics presuppose, but a probabilistic judgment with varying degrees of plausibility under uncertainty. In order to avoid this confusion, I propose that retrospective diagnosis of a historical figure be syndromic without identifying underlying disease, unless there is justifiable reason for such specification. Moreover it should be evaluated not only from the viewpoint of medical science but also in a larger context of the scholarship of the humanities and social sciences by its overall plausibility and consistency. On the other hand, I will endorse their concerns regarding the ethics and professionalism of retrospective diagnosis, and call for the need for situating such a diagnosis in an interdisciplinary scope and the context of the scholarship of the historical figure. I will then enumerate several important caveats for interdisciplinary retrospective diagnosis using an example of the retrospective diagnosis of Socrates for his life-long intermittent neurologic symptoms. Finally, I will situate the present argument in a larger context of the major debate among the historians of medicine and paleopathologists, and discuss the similarities and differences. (shrink)

1. GENERAL The term "diagnostics" refers to the general theory of diagnosis, not to the study of specific diagnoses but to their general framework. It borrows from different sciences and from different philosophies. Traditionally, the general framework of diagnostics was not distinguished from the framework of medicine. It was not taught in special courses in any systematic way; it was not accorded special attention: students absorbed it intuitively. There is almost no comprehensive study of diagnostics. The instruction in (...) class='Hi'>diagnosis provided in medical schools is exclusively specific. Clinical instruction includes (in addition to vital background information, such as anatomy and physiology) specific instruction in nosology, the theory and classification of diseases, and this includes information on diagnoses and prognoses of diverse diseases. What is the cause of the neglect of diagnostics, and of its integrated teaching? The main cause may be the prevalence of the view of diagnostics as part-and parcel of nosology. In this book nosology is taken as a given, autonomous field of study, which invites almost no comments; we shall freely borrow from it a few important general theses and a few examples. We attempt to integrate here three studies: ll of the way nosology is used in the diagnostic process; of the diagnostic process as a branch of applied ethics; ~ of the diagnostic process as a branch of social science and social technology. (shrink)

Current symptom-based DSM and ICD diagnostic criteria for mental disorders are prone to yielding false positives because they ignore the context of symptoms. This is often seen as a benign flaw because problems of living and emotional suffering, even if not true disorders, may benefit from support and treatment. However, diagnosis of a disorder in our society has many ramifications not only for treatment choice but for broader social reactions to the diagnosed individual. In particular, mental disorders impose a (...) sick role on individuals and place a burden upon them to change; thus, disorders decrease the level of respect and acceptance generally accorded to those with even annoying normal variations in traits and features. Thus, minimizing false positives is important to a pluralistic society. The harmful dysfunction analysis of disorder is used to diagnose the sources of likely false positives, and propose potential remedies to the current weaknesses in the validity of diagnostic criteria. (shrink)

Definitive diagnosis of malaria requires the demonstration through laboratory tests of the presence within the patient of malaria parasites or their components. Since malaria parasites can be present even in the absence of malaria manifestations, and since symptoms of malaria can be manifested even in the absence of malaria parasites, malaria diagnosis raises important issues for the adequate understanding of disease, etiology and diagnosis. One approach to the resolution of these issues adopts a realist view, according to (...) which the needed clarifications will be derived from a careful representation of the entities on the side of the patient which form the ultimate truthmakers for clinical statements. We here address a challenge to this realist approach relating to the diagnosis of malaria, and show how this challenge can be resolved by appeal to Basic Formal Ontology (BFO) and to the Ontology for General Medical Science (OGMS) constructed in its terms. (shrink)

In this chapter, our focus is the role played by notions of rationality in the diagnosis of mental disorders, and in the practice of overriding patient autonomy in psychiatry. We describe and evaluate different hypotheses concerning the relationship between rationality and diagnosis, raising questions about what features underpin psychiatric categories. These questions reinforce widely held concerns about the use of diagnosis as a justification for overriding autonomy, which have motivated a shift to mental incapacity as an alternative (...) justification. However, this approach too has recently been criticized from a mental disability rights perspective. Our analysis of the relationship between mental capacity and rationality is used to illuminate these concerns, and to investigate further the relationship between rationality and psychiatric diagnosis. (shrink)

In clinical medicine, a diagnosis can offer an explanation of a patient's symptoms by specifying the pathology that is causing them. Diagnoses in psychiatry are also sometimes presented in clinical texts as if they pick out pathological processes that cause sets of symptoms. However, current evidence suggests the possibility that many diagnostic categories in psychiatry are highly causally heterogeneous. For example, major depressive disorder may not be associated with a single type of underlying pathological process, but with a range (...) of different causal pathways, each involving complex interactions of various biological, psychological, and social factors. This paper explores the implications of causal heterogeneity for whether psychiatric diagnoses can be said to serve causal explanatory roles in clinical practice. I argue that while they may fall short of picking out a specific cause of the patient's symptoms, they can nonetheless supply different sorts of clinically relevant causal information. In particular, I suggest that some psychiatric diagnoses provide negative information that rules out certain causes, some provide approximate or disjunctive information about the range of possible causal processes, and some provide causal information about the relations between the symptoms themselves. (shrink)

BackgroundPrevious studies suggested a circadian variation of migraine attack onset, although, with contradictory results – possibly because of the existence of migraine subgroups with different circadian attack onset peaks. Migraine is primarily a brain disorder, and if the diversity in daily distribution of migraine attack onset reflects an important aspect of migraine, it may also associate with interictal brain activity. Our goal was to assess brain activity differences in episodic migraine subgroups who were classified (...) according to their typical circadian peak of attack onset.MethodsTwo fMRI studies were conducted with migraine without aura patients (n= 31 in Study 1,n= 48 in Study 2). Among them, three subgroups emerged with typical Morning, Evening, and Varying start of attack onset. Whole brain activity was compared between the groups in an implicit emotional processing fMRI task, comparing fearful, sad, and happy facial stimuli to neutral ones.ResultsIn both studies, significantly increased neural activation was detected to fearful (but not sad or happy) faces. In Study 1, the Evening start group showed increased activation compared to the Morning start group in regions involved in emotional, self-referential (left posterior cingulate gyrus, right precuneus), pain (including left middle cingulate, left postcentral, left supramarginal gyri, right Rolandic operculum) and sensory (including bilateral superior temporal gyrus, right Heschl’s gyrus) processing. While in Study 2, the Morning start group showed increased activation compared to the Varying start group at a nominally significant level in regions with pain (right precentral gyrus, right supplementary motor area) and sensory processing (bilateral paracentral lobule) functions.ConclusionOur fMRI studies suggest that different circadian attack onset peaks are associated with interictal brain activity differences indicating heterogeneity within migraine patients and alterations in sensitivity to threatening fearful stimuli. Circadian variation of migraine attack onset may be an important characteristic to address in future studies and migraine prophylaxis. (shrink)

With the development of artificial intelligence technologies, it is possible to use computer to read digital medical images. Because Alzheimer’s disease has the characteristics of high incidence and high disability, it has attracted the attention of many scholars, and its diagnosis and treatment have gradually become a hot topic. In this paper, a multimodal diagnosis method for AD based on three-dimensional shufflenet and principal component analysis network is proposed. First, the data on structural magnetic resonance imaging and functional (...) magnetic resonance imaging are preprocessed to remove the influence resulting from the differences in image size and shape of different individuals, head movement, noise, and so on. Then, the original two-dimensional ShuffleNet is developed three-dimensional, which is more suitable for 3D sMRI data to extract the features. In addition, the PCANet network is applied to the brain function connection analysis, and the features on fMRI data are obtained. Next, kernel canonical correlation analysis is used to fuse the features coming from sMRI and fMRI, respectively. Finally, a good classification effect is obtained through the support vector machines method classifier, which proves the feasibility and effectiveness of the proposed method. (shrink)

Diagnosis of dementia in primary care is both difficult and important. The recommendations by several authors to improve the diagnosis of dementia by general practitioners are important, but insufficient. It is argued that perhaps the disease concept in itself is a cause of confusion for clinicians. Primary care physicians need an adapted procedure, gradually leading to the final diagnosis of dementia. It has to be a stepwise labelling strategy, using global descriptions and non-disease specific labels in the (...) beginning, ending up with well-defined disease criteria. In this process, there is circularity: previous diagnoses have to be kept in mind because symptoms and signs may gradually change during the progression of the disease, leading to reconsideration of previous deleted options. To frame this properly, the primary care physician needs to adopt a broad frail elderly geriatric concept. Implementation of this concept not only helps the diagnostic process, but also stimulates the care for dementing patients and their caregivers. Relevant arguments for early diagnostic involvement of primary care physicians can be put forward on condition that a new concept, adapted procedures and adapted instruments are used. (shrink)

In The Anticipatory Corpse, Jeffrey Bishop claims that modern medicine has lost formal and final causality as the dead body has become epistemologically normative, and that a singular focus on efficient and material causality has thoroughly distorted modern medical practice. Bishop implies that the renewal of medicine will require its housing in alternate social spaces. This essay critiques both Bishop’s diagnosis and therapy by arguing, first, that alternate social imaginaries, though perhaps marginalized, are already present within the practice of (...) medicine. And second, the essay argues that alternate social imaginaries in medicine can be reclaimed not through separatist communities but in the re-narration of conceptually underdetermined practices. Given Bishop’s invitation for theology to engage medicine, this essay then draws from theologian Dietrich Bonhoeffer for the kind of diagnosis and therapy currently needed, concluding with a contemporary example of how an alternate social imaginary is being instantiated in modern medicine. (shrink)

Migraine is a chronic and idiopathic disorder leading to cognitive and affective problems. However, the neural basis of migraine without aura is still unclear. In this study, dynamic amplitude of low-frequency fluctuations analyses were performed in 21 patients with migraine without aura and 21 gender- and age-matched healthy controls to identify the voxel-level abnormal functional dynamics. Significantly decreased dALFF in the bilateral anterior insula, bilateral lateral orbitofrontal cortex, bilateral medial prefrontal cortex, bilateral anterior cingulate cortex, and left (...) middle frontal cortex were found in patients with migraine without aura. The dALFF values in the anterior cingulate cortex were negatively correlated with pain intensity, i.e., visual analog scale. Finally, support vector machine was used to classify patients with migraine without aura from healthy controls and achieved an accuracy of 83.33%, sensitivity of 90.48%, and specificity of 76.19%. Our findings provide the evidence that migraine influences the brain functional activity dynamics and reveal the neural basis for migraine, which could facilitate understanding the neuropathology of migraine and future treatment. (shrink)

Definitive diagnosis of malaria requires the demonstration through laboratory tests of the presence within the patient of malaria parasites or their components. Since malaria parasites can be present even in the absence of malaria manifestations, and since symptoms of malaria can be manifested even in the absence of malaria parasites, malaria diagnosis raises important issues for the adequate understanding of disease, etiology and diagnosis. One approach to the resolution of these issues adopts a realist view, according to (...) which the needed clarifications will be derived from a careful representation of the entities on the side of the patient which form the ultimate truthmakers for clinical statements. We here address a challenge to this realist approach relating to the diagnosis of malaria, and show how this challenge can be resolved by appeal to Basic Formal Ontology (BFO) and to the Ontology for General Medical Science (OGMS) constructed in its terms. (shrink)

The public, mental health consumers, as well as mental health practitioners wonder about what kinds of values mental health professionals hold, and what kinds of values influence psychiatric diagnosis. Are mental disorders socio-political, practical, or scientific concepts? Is psychiatric diagnosis value-neutral? What role does the fundamental philosophical question "How should I live?" play in mental health care? In his carefully nuanced and exhaustively referenced monograph, psychiatrist and philosopher of psychiatry John Z. Sadler describes the manifold kinds of values (...) and value judgements involved in psychiatric diagnosis and classification systems like the DSM. Professor Sadler takes the reader on a fascinating conceptual tour of the inner workings of psychiatric diagnosis, considering the role of science, culture, sexuality, politics, gender, technology, human nature, patienthood, and professions in building his vision of a more humane psychiatric diagnostic process. (shrink)

The objective of the paper is to implement and validate diagnosis in the medical field via refined neutrosophic fuzzy logic (RNFL). As such, we have proposed a Max-Min composition (MMC) method in RNFL. This method deals with the diagnosis under certain constraints like uncertainty and indeterminacy. Further, we have considered the diagnosis problems to validate the sensitivity analysis of the novel multi attribute decision-making technique. Finally, we gave the graphical representations and compared the obtained results with other (...) existing measures in refined neutrosophic fuzzy sets. (shrink)

Diagnosis theory reasons about incomplete knowledge and only considers the past. It distinguishes between violations and non-violations. Qualitative decision theory reasons about decision variables and considers the future. It distinguishes between fulfilled goals and unfulfilled goals. In this paper we formalize normative diagnoses and decisions in the special purpose formalism DIO(DE)2 as well as in extensions of the preference-based deontic logic PDL. The DIagnostic and DEcision-theoretic framework for DEontic reasoning DIO(DE)2 formalizes reasoning about violations and fulfillments, and is used (...) to characterize the distinction between normative diagnosis theory and (qualitative) decision theory. The extension of the preference-based deontic logic PDL shows how normative diagnostic and decision-theoretic reasoning — i.e. reasoning about violations and fulfillments — can be formalized as an extension of deontic reasoning. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hypatia 16.3 (2001) 172-176 [Access article in PDF] Book Review Diagnosis: Difference: The Moral Authority of Medicine Diagnosis: Difference: The Moral Authority of Medicine. By Abby L. Wilkerson. Ithaca: Cornell University Press, 1998. In this compact volume, Abby Wilkerson makes several important contributions to the burgeoning literature of feminist (bio)ethics by providing substantive arguments in support of some of the key intuitive beliefs that are central to (...) much feminist bioethics thinking. Most centrally, she carefully fleshes out a feminist case for re-framing traditional bioethics approaches to the relation between health and justice. Particularly valuable is her richly detailed argument establishing the importance of bringing to the realm of health and health care Iris Marion Young's (1990) important insight that justice involves far more than questions of distribution.At the same time, Wilkerson demonstrates another major feminist tenet: that ethics and epistemology are intimately related. This connection is developed [End Page 172] through a second major theme in which she systematically tracks medicine's tendency to extend its accepted epistemic authority over physical ailments into a general authority over many other aspects of life. She documents examples of medicine's success in leveraging its scientific knowledge about certain aspects of the body into a broader ideological vision through which it claims epistemic authority in the personal and moral realm. By making explicit the gaps between medical knowledge and moral knowledge, she is able to challenge the moral authority and social power that are now granted to medical experts.While these arguments are important, they are not the whole story of the book, for its message is as much about process in bioethics as it is about conclusions. Wilkerson insists that the specific perspective of the theorist affects her/his reasoning. She demonstrates the importance of this fact by using her own distinct position as a bisexual woman to make visible the implicit acceptance and perpetuation of several ideological norms by those in dominant positions in both medicine and bioethics. The central method of the book is what she calls "material-semiotic." It involves the assumption that all human experience is mediated by culture, and the body (specifically the medicalized body) must be recognized as a political site subject to a variety of social values. We must, therefore, attend to the cultural meanings of health and illness and explore the ways that society labels and responds to these conditions. This requires investigation of the specific bodily (material) effects of these meanings in both individual and social experience.The book begins with the epistemological frame of the argument in which Wilkerson claims that medicine is deeply infected by the values and biases of the dominant culture, including its tendencies towards sexist, racist, classist, homophobic, and ablist attitudes. She explores ways in which medical theory and practice stigmatize bodily experiences common to women (in gynecology, obstetrics, and the treatment of victims of sexual or domestic violence). Medicalizing so many aspects of women's experience has the effect of obscuring women's subjective experiences and replacing them with medicine's normative perspectives of appropriate psychological norms. Moreover, the norm of femaleness promoted is a heterosexual, middle class, white variety such that other forms of social difference (e.g., non-white, non-heterosexual) must then also be medicalized and stigmatized; that is, the medical model requires explanations of difference that render pathological most variations on the privileged norm. Hence, alternative sexualities, like differences in class, abilities, race, and gender are interpreted through a medical lens that is thoroughly value-laden. In such ways, the epistemological authority granted to medicine is conflated into an unjustified form of moral authority. Although similar biases are common to every powerful social institution in the United States, they are especially pernicious within medicine because of the enormous influence it exerts in shaping knowledge about the nature of difference between social [End Page 173] groups. This immense social power may be directed towards reducing inequalities and promoting social justice, but, all too often, it is used to convey beliefs and norms that serve the interests of the privileged.Wilkerson's criticism is not reserved... (shrink)

In this paper I present an argument in favour of a parental duty to use preimplantation genetic diagnosis (PGD). I argue that if embryos created in vitro were able to decide for themselves in a rational manner, they would sometimes choose PGD as a method of selection. Couples, therefore, should respect their hypothetical choices on a principle similar to that of patient autonomy. My thesis shows that no matter which moral doctrine couples subscribe to, they ought to conduct the (...) PGD procedure in the situations when it is impossible to implant all of the created embryos and if there is a significant risk for giving birth to a child with a serious condition. (shrink)

Psychiatric diagnoses are increasingly seen as viable categories around which self and social identities might be drawn. This introduces a new pressure on the “boundary problem” for psychiatry: when members of the public request diagnoses to affirm their self-identities how should we draw the line between mental disorder and normality? If psychiatrists have the authority to recognize and diagnose mental disorder, how can roles as diagnosers and gate-keepers be balanced in a post-stigma era of mental health care? Focusing on the (...) disorder identified would-be patient who would not attract the diagnosis they seek were they not to seek it, this essay explores what it means to have an identity bound to a psychiatric diagnosis and considers a framework for psychiatrists to negotiate clinical encounters that involve the seeking of identity affirming diagnoses. (shrink)

: A fascinating criticism of abortion occasioned by prenatal diagnosis of potentially disabling traits is that the complex of test-and-abortion sends a morally disparaging message to people living with disabilities. I have argued that available versions of this "expressivist" argument are inadequate on two grounds. The most fundamental is that, considered as a practice, abortions prompted by prenatal testing are not semantically well-behaved enough to send any particular message; they do not function as signs in a rule-governed symbol system. (...) Further, even granting, for the sake of argument, the expressive power of testing and aborting, it would not be possible, contra the argument's proponents, to distinguish between abortions undertaken because of beliefs about the disabling conditions the fetus might face as a child and abortions undertaken for many other possible reasons--e.g., because of the poverty the fetus would face or the increase in family size that the birth of a new child would occasion. Here, I respond to criticisms of those arguments, and propose and defend another: the expressivist argument cannot, in general, distinguish successfully between abortion and therapy as modalities for responding to disabilities. (shrink)

Patient centred diagnosis is best practised through shared decision making; an iterative dialogue between doctor and patient, whichrespects a patient’s needs, values, preferences, and circumstances. -/- Shared decision making for diagnostic situations differs fundamentally from that for treatment decisions. This has important implications when considering its practical application. -/- The nature of dialogue should be tailored to the specific diagnostic decision; scenarios with higher stakes or uncertainty usually require more detailed conversations.

The purpose of this paper is to offer a diagnosis and a resolution to generality problem. I state the generality problem and suggest a distinction between criteria of relevance and what I call a theory of determination. The generality problem may concern either of these. While plausible criteria of relevance would be convenient for the externalist, he does not need them. I discuss various theories of determination, and argue that no existing theory of determination is plausible. This provides a (...) case for the no determination view: there are no facts that determine relevant types. This is the diagnosis of the generality problem. The externalist, however, may embrace the no determination view. This is what provides a resolution to the generality problem. (shrink)

In this paper I argue that ethics and evidence are intricately intertwined within the clinical practice of differential diagnosis. Too often, when a disease is difficult to diagnose, a physician will dismiss it as being “not real” or “all in the patient’s head.” This is both an ethical and an evidential problem. In the paper my aim is two-fold. First, via the examination of two case studies (late-stage Lyme disease and Addison’s disease), I try to elucidate why this kind (...) of dismissal takes place. Then, I propose a potential solution to the problem. I argue that instead of dismissing a patient’s illness as “not real,” physicians ought to exercise a compassionate suspension of judgment when a diagnosis cannot be immediately made. I argue that suspending judgment has methodological, epistemic, and ethical virtues and therefore should always be preferred to patient dismissal in the clinical setting. (shrink)

Diagnosis theory reasons about incomplete knowledge and only considers the past. It distinguishes between violations and non-violations. Qualitative decision theory reasons about decision variables and considers the future. It distinguishes between fulfilled goals and unfulfilled goals. In this paper we formalize normative diagnoses and decisions in the special purpose formalism DIO2 as well as in extensions of the preference-based deontic logic PDL. The DIagnostic and DEcision-theoretic framework for DEontic reasoning DIO2 formalizes reasoning about violations and fulfillments, and is used (...) to characterize the distinction between normative diagnosis theory and decision theory. The extension of the preference-based deontic logic PDL shows how normative diagnostic and decision-theoretic reasoning — i.e. reasoning about violations and fulfillments — can be formalized as an extension of deontic reasoning. (shrink)

This essay argues that making a diagnosis in medicine is essentially a hermeneutic enterprise, one in which interpretation skills play a major part in understanding a disease. The clinical encounter is an event comprised of two voices; one is the voice of science which is grounded in empiricism, the other is that of human experience, which is grounded in story-telling and the interpretation of those stories.Using two voices, one from the Diagnostic and Statistical Manual of Mental Disorders-III-Revised, which describes (...) alcohol abuse and alcohol dependence, and the other, that of Claire, a character in Edward Albee's play, A Delicate Balance, who is conversing with her brother-in-law, Tobias, I apply principles from Hans-Georg Gadamer's hermeneutics to the clinical diagnostic process. The essay will demonstrate that we overlook an enormous amount of information about alcoholism by an overreliance on objective data and that our hope for understanding alcoholics is in listening to their voices, and sharing the interpretation of their experiences with them. (shrink)

Complaints about the state of medical care are increasing in today s India; whether it s unnecessary investigations, botched operations or expensive, sometimes even harmful, medication. But while the unease is widespread, few outside the profession understand the extent to which the medical system is being distorted. Dr Arun Gadre and Dr Abhay Shukla have gathered evidence from seventy-eight practising doctors, in both the private and public medical sectors, to expose the ways in which vulnerable patients are exploited by a (...) system that promotes unscrupulous medical practices. At a time when the medical sector is growing rapidly, especially in urban areas, with the proliferation of multi-specialty hospitals and the adoption of ever-more sophisticated technologies, rational and ethical medical care is becoming increasingly rare. Honest doctors feel under siege, professional bodies meant to regulate the medical sector fail to do so, and the influence of the powerful pharmaceutical industry becomes even more pervasive. Drawing on the frank and courageous statements of these seventy-eight doctors dismayed at the state of their profession, Dissenting Diagnosis lays bare the corruption afflicting the medical sector in India and sets out solutions for a healthier future. (shrink)

The dark house.--The cell.--The endocrine glands.--Human types.--The brain and central nervous system.--Medical psychology.--Different paths to truth.--Consciousness.--The Vedânta.--Yoga.--Higher states of consciousness.--Religion.--Buddhism.--Christ and Buddha.--The church.--Mystical Christianity.--'If there had been a candle ... '--Bibliography (p. [251]-255).

The Diagnosis Confirmation Model includes a dual-pricing mechanism designed to support value-based pricing of novel antibiotics while improving the alignment of financial incentives with their optimal use in patients at high risk of drug-resistant infections. DCM is a market-based model and complementary to delinked models. Policymakers interested in stimulating antibiotic innovation could consider tailoring the DCM to their reimbursement systems and incorporating it into the suite of incentives to improve the economics of antibiotics.

This target article considers the ethical implications of providing prenatal diagnosis (PND) and antenatal screening services to detect fetal abnormalities in jurisdictions that prohibit abortion for these conditions. This unusual health policy context is common in the Latin American region. Congenital conditions are often untreated or under-treated in developing countries due to limited health resources, leading many women/couples to prefer termination of affected pregnancies. Three potential harms derive from the provision of PND in the absence of legal and safe (...) abortion for these conditions: psychological distress, unjust distribution of burdens between socio-economic classes, and financial burdens for families and society. We present Iran as a comparative case study where recognition of these ethical issues has led to the liberalization of abortion laws for fetuses with thalassemia. We argue that physicians, geneticists and policymakers have an ethical and professional duty of care to advocate for change in order to ameliorate these harms. (shrink)

Two versions of the argument that prenatal diagnosis discriminates against the disabled are distinguished and analysed. Both are shown to be inadequate, but some valid concerns about the social effects of prenatal diagnosis are highlighted.

In this resource for educators, Harold F. Burks offers a comprehensive guide to the evaluation techniques and intervention strategies that have worked with many school children experiencing problems. Thus, Diagnosis and Remediation Practices for Troubled School Children attempts to: clarify the understanding of observed, unwanted child behavior symptoms ; investigate with educators and parents—and sometimes children—the possible causal factors that antedate these behavior manifestations; create in cooperation with parents and school personnel, innovative intervention techniques to help children learn accepted (...) behavior patterns. (shrink)

The War on Terror has exposed deep problems within contemporary political practice. It has demonstrated the moral fragility of liberal democracy. Much critical literature on the topic is devoted to uncovering the sources of this fragility. In this paper, we accept the general thrust of much of this literature, but turn our attention to the practical upshot of the criticism. A common feature of the literature is that, when it comes to offering remedies of the problems it identifies, what is (...) offered is ‘diagnosis without treatment’. The negation of a problem is regarded as a solution. For example, if the problem is that the USA is not acting as a good international citizen, the solution is that it begins to act as such. This is like a doctor diagnosing gout and recommending to the patient that they reduce the level of uric acid in their big toe. We argue that diagnosis without treatment is endemic in literature on the War on Terror and the ills of liberal democracy. We divide this literature into five categories and examine representative works in each. At the end of the paper, we describe what is required to avoid offering yet more diagnosis without treatment. (shrink)