Pathology and Research
Jeremy R. Jass in Understanding Pathology, 2020
How do the specific attributes of the discipline of anatomical pathology lend themselves to the advance of medical research? The most general contribution has been to the systematic classification of disease known as nosology. This process begins with the arrangement of the many thousands of known diseases into logical groupings, rather like the phylogenetic classification of species of animals and plants. Diseases may be grouped according to the usual age, sex or race of affected subjects, by the part of the body that is most severely affected, or by the type of treatment that would be employed. Although such classifications might have some use, they all fail to place diseases within distinct, non-overlapping boundaries. To achieve a more meaningful approach to nosology, it is necessary to look at the fundamental nature of a disease, specifically the mechanisms underlying its causation (aetiology) and evolution (pathogenesis).
The Problems of Nosology in Alcoholism Treatment and Research
Edith S. Lisansky Gomberg in Current Issues in Alcohol/Drug Studies, 2019
To begin, it is important to review the purpose of any nosology applied to a clinical problem. In most cases, this purpose is twofold. First, the nosology should, in naming a type or sub-type of a general clinical syndrome, describe or define a natural history associated with that type or nosology alone. By so doing, the nosological description, based on empirical data, offers a baseline of the natural course of an illness or a condition against which efforts to treat may be measured. It follows that any useful nosology should be based on empirical observation of an illness course. Such observations are best done using prospectively applied measures of a clinical population studied over the usual course of the illness. This is true whether one is studying diabetes, cancer, or alcoholism. Prospective studies in the latter condition are especially difficult owing to the extreme length of the natural course of the illness, varying from a few years to as many as twenty or more. This approach to nosology assumes a “disease model,” one facet of which is the natural decline as the disease progresses.
Family Systems and Chronic Illness: A Typological Model
Froma Walsh, Carol Anderson in Chronic Disorders and the Family, 2014
Before proposing a solution, let us examine the origins of the problem more closely. The great variability of chronic illnesses and their changing nature over time have presented a vexing problem to psychosocial investigators who have attempted to identify the most salient psychosocial variables relevant to disease course or treatment compliance. Recent reviews of the psychosocial modifiers of stress emphasize a variety of methodological and conceptual weaknesses (Elliot & Eisdorfer, 1982; Kasl, 1982; Weiss et al., 1981). The difficulty originates when social scientists or psychotherapists accept a disease classification that is based on purely biological criteria that are clustered in ways to meet the needs of medicine. This nosology fits the world of anatomy, physiology, biochemistry, microbiology, physical diagnosis, pharmacology, surgery, etc. From a traditional medical point of view, the diagnosis of a specific illness is of primary concern because it dictates subsequent treatment planning. One can argue that the problem of psychosocial research in physical illness suffers as much from a blind acceptance of this unshakable model of medicine as from its own shortcomings. We hinder progress in clarifying the relationship of psychosocial factors to disease course if we limit ourselves to a biological framework that categorizes information to diagnose and treat illness from a biological perspective.
Commentary: statistical analysis of 2 × 2 tables in biomarker studies 1) the four ‘indices of test validity’
Published in Biomarkers, 2022
David Paul Lovell
The test statistics produced for assessing tests performance are referred to by some as diagnostic accuracy statistics or performance indices (Rautaharju et al. 1976). Feinstein (2002) referred to them as nosologic indices. Nosology is the classification, arrangement, or catalogue of diseases. An endpoint (or an index or attribute) is called a condition (also called an ‘event’ or ‘target’ event). Endpoints can be nominal/ordinal/binary, or quantitative/interval-scaled. In the case of a binary endpoint, it is, often, called either positive or negative. Endpoints in some tests can be polychotomous (i.e. multilevel and have more than two categories) but these will not be discussed here (but see Arias and Sangrador 2017). In practice, no test is likely to be 100% accurate. The size of the performance indices is, therefore, important and their evaluation requires careful interpretation.
Classification of Seasonal Hyperacute Panuveitis (SHAPU)
Published in Ocular Immunology and Inflammation, 2022
Ranju Kharel Sitaula, Anadi Khatri, Pratap Karki, Sagun Narayan Joshi, Haramaya Gurung, Eliya Shrestha, Indraman Maharjan, Ananda K Sharma, Madan Prasad Upadhyay
Literature illustrates that the nosology was started for the classification of diseases before the fifteenth century but professional nosology involving the coding of diseases as per diagnosis had only started expanding dramatically in the last half of the twentieth century.6 Now in the twenty-first century, electronic records and the growing promise of automated nosology have not just made the disease classification easier but also assisted in proper documentation of the disease – aiding clinicians, researchers, and scientists to have an in-depth knowledge about its outbreaks, incidence, and prevalence. Thus, we aim to contribute in the ophthalmic nosology by purposing a classification criteria for SHAPU. The classification is suggested on the background of prolonged experience of this entity by investigators (SRG) who have dedicated years of research on this topic – including the first clinician and ophthalmologist who coined the term SHAPU, more than 46 years ago and is also considered the father of SHAPU (Professor Madan Prasad Upadhyay).5 We hope this classification will help in effective planning and evaluation of this ocular emergency condition and deliver the appropriate and reliable information for timely management and prevention of complications.
Interdisciplinary approach to chronic pain management
Published in Postgraduate Medicine, 2020
Alexey Danilov, Andrey Danilov, Alexander Barulin, Olga Kurushina, Nina Latysheva
Since, according to modern concepts, a person is an integral multi-factor system, it is almost impossible to imagine a pathology that in isolation affects the interests of only one medical specialty. At the same time, the exponential growth of highly specialized knowledge sometimes prevents doctors of various fields from reaching understanding and consensus in the management of the patient. Often a situation arises when doctors of different specialties use different terms in the description of the same processes, sometimes they use inconsistent models of pathophysiological processes and different methods of pharmacological correction of the same syndrome. So, even in the medical care standards and clinical guidelines for doctors of different specialties, various, sometimes anti-directional, approaches to the same nosology are described. This leads to polypharmacy, drug conflicts and a complete misunderstanding of the patient as to what recommendations to follow. And pain syndromes, especially chronic pain syndromes, can be one of the brightest examples of the changing treatment paradigms today [1].
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