Tracing Uncertainties in New Prognostics of Consciousness

Uncertainty is a basic condition of medicine - in research, in the clinic and in the intersection between the two domains. Prognostics is in its very nature an attempt to address and manage the uncertainty of the future. New technologies are continuously developed in order to make prognostics more precise and hence make the future more predictable. However, such technologies may not always serve to decrease uncertainty, but rather enhance or introduce new uncertainties, and thereby open other futures than those imagined. Our study follows an interdisciplinary Danish research group currently seeking to advance methods of neuroimaging in prognostics for unresponsive patients with uncertain consciousness due to anoxic brain injury after an out-of-hospital cardiac arrest. Applying an interdisciplinary approach combining ethnographic methods and philosophical analysis we trace the experience of uncertainty in this context of tool development at the intersection of scientific and clinical reasoning around disorders of consciousness. Specifically, we employ and develop the three-dimensional framework of uncertainty developed by Han, Klein and Arora (2011). We identify salient uncertainties from the perspective of the researchers and show how these lead to different uncertainties experienced by the clinicians. Additionally, we show that while ambiguity may be the source of different kinds of uncertainty, the context determines the nature of the source. Our investigation has a descriptive and theoretical focus, however, uncovering these details may serve as a basis for normative discussions of strategies for uncertainty management, as well as evidence evaluation in research and the clinic in the future.&nbsp

Viral etnografi

I denne artikel beskriver vi, hvordan den antropologiske komponent af „HOPE – How Democracies Cope with COVID-19: A Data-Driven Approach“ har arbejdet etnografisk under covid-19-epidemien i Danmark. Artiklen illustrerer, hvordan coronavirus’ ustabilitet fordrede en kontinuerlig gentænkning af det etnografiske feltarbejde. Coronakrisen skabte en akut situation, hvor forudgående viden og forbindelser til en divers række felter blev centrale for indsamlingen af data om befolkningen i Danmarks oplevelser med Sars-CoV-2. Samtidig med at være objekt for den antropologiske undersøgelse var coronavirus definerende for de metodiske muligheder, idet risikoen for smitte samt restriktioner ansporede til brugen af virtuelle interviews, hurtige graf-elicitationer og indsamling af data fra Facebook. Vi argumenterer for, at mens den etnografiske natur af den enkelte metode varierer, er de samlet og i kombination med teamets personlige erfaringer med livet under coronakrisen og den antropologiske refleksion og teoretisering med til at frembringe en kvasietnografi, der åbner for centrale etnografiske indsigter om coronakrisens sociale konsekvenser. Endvidere argumenterer vi for vigtigheden af metodisk fleksibilitet, hvis etnografisk viden skal spille en rolle i håndteringen af situationer som coronakrisen

Does size really matter? A multisite study assessing the latent structure of the proposed ICD-11 and DSM-5 diagnostic criteria for PTSD

Background: Researchers and clinicians within the field of trauma have to choose between different diagnostic descriptions of posttraumatic stress disorder (PTSD) in the DSM-5 and the proposed ICD-11. Several studies support different competing models of the PTSD structure according to both diagnostic systems; however, findings show that the choice of diagnostic systems can affect the estimated prevalence rates. Objectives: The present study aimed to investigate the potential impact of using a large (i.e. the DSM-5) compared to a small (i.e. the ICD-11) diagnostic description of PTSD. In other words, does the size of PTSD really matter? Methods: The aim was investigated by examining differences in diagnostic rates between the two diagnostic systems and independently examining the model fit of the competing DSM-5 and ICD-11 models of PTSD across three trauma samples: university students (N = 4213), chronic pain patients (N = 573), and military personnel (N = 118). Results: Diagnostic rates of PTSD were significantly lower according to the proposed ICD-11 criteria in the university sample, but no significant differences were found for chronic pain patients and military personnel. The proposed ICD-11 three-factor model provided the best fit of the tested ICD-11 models across all samples, whereas the DSM-5 seven-factor Hybrid model provided the best fit in the university and pain samples, and the DSM-5 six-factor Anhedonia model provided the best fit in the military sample of the tested DSM-5 models. Conclusions: The advantages and disadvantages of using a broad or narrow set of symptoms for PTSD can be debated, however, this study demonstrated that choice of diagnostic system may influence the estimated PTSD rates both qualitatively and quantitatively. In the current described diagnostic criteria only the ICD-11 model can reflect the configuration of symptoms satisfactorily. Thus, size does matter when assessing PTSD