The clinical picture, creating diagnostic constructs, and causation

2019 ◽  
pp. 53-69
Author(s):  
Ahmed Samei Huda
Keyword(s):  
Clinical Picture ◽  
Clinical Utility ◽  
Individual Factors ◽  
Common Elements ◽  
Medical Conditions ◽  
Scientific Validity ◽  
Causative Factors ◽  
Framework Conditions ◽  
Diagnostic Investigations

The clinical picture is the doctor’s interpretation based on what has happened to the patient and symptoms, signs, and results of investigations that are available to her. It is created by the interaction of causative factors as well as multiple cultural, interactive, and individual factors. The doctor matches the patient’s clinical picture with the diagnostic construct and the most common elements of an attached clinical picture. Diagnostic constructs based on similarity with the clinical picture may have clinical utility by accumulating information about likely outcomes and responses to treatments. Diagnostic constructs based on common mechanisms (such as changes in structure or processes) and/or causes have greater scientific validity and allow more reliable diagnostic investigations and better prospects of developing superior treatments. Most medical conditions are caused by a combination of causative factors. Proving a factor is causative is complex. One of the best known methods is Austen Hill’s framework. Conditions occur due to combinations of causes, characteristics, and contexts.

The nature of diagnostic constructs

2019 ◽  
pp. 34-52
Author(s):  
Ahmed Samei Huda
Keyword(s):  
Clinical Picture ◽  
Clinical Utility ◽  
Healthcare Professionals ◽  
Clear Cut

Classification is essential in medicine to help doctors acquire, learn, and recall clinically useful information about problems coming to healthcare professionals’ attention. There problems include both essentialist diagnostic constructs (where all examples share a quality and are distinct from other constructs) and nominalist diagnostic constructs (used to describe clinically useful concepts not necessarily separate from other constructs). Diagnostic constructs may be recognized using defined criteria and/or as prototypical examples. They are based on similarities in clinical picture, mechanisms/processes, and/or causes. They may be used to identify clinically important situations, diseases/clear-cut syndromes, spectrums of health, illness(es)/and condition(s), injuries, and other situations of interest to healthcare professionals. Thresholds established on the basis of clinical utility (e.g. level of distress or risk of complications) may be used to define conditions. Care must be taken to guard against over-medicalization of problems or situations.

Depression and Anxiety in Patients Undergoing Diagnostic Investigations for Head and Neck Cancers

1986 ◽  
Vol 149 (4) ◽  
pp. 491-493 ◽  
Author(s):  
A. D. M. Davies ◽  
C. Davies ◽  
M. C. Delpo
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Clinical Picture ◽  
Depression And Anxiety ◽  
Head And Neck Oncology ◽  
Self Assessment ◽  
Diagnostic Biopsy ◽  
Oncology Unit ◽  
Assessment Scales ◽  
Diagnostic Investigations

Patients attending a regional head and neck Oncology Unit were assessed for depression and anxiety (using the Leeds self-assessment scales) before diagnostic biopsy investigations. At the time of the assessments, neither patients nor investigators knew the biopsy results. Patients whose biopsies subsequently proved positive (showing the presence of a tumour) had significantly higher depression scores than those whose biopsies were negative. Differences in mean anxiety scores did not differ between groups. It is suggested that depression is part of the clinical picture of head and neck cancer.

Criticism of psychiatric diagnosis

2019 ◽  
pp. 89-104
Author(s):  
Ahmed Samei Huda
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Clinical Utility ◽  
Clinical Decision Making ◽  
Mental Health Problems ◽  
Medical Model ◽  
Clinical Decision ◽  
Negative Consequences ◽  
Causative Factors ◽  
Medical Diagnostic

Criticisms of psychiatric diagnostic constructs from a clinical/scientific view have been made on several points: reliability, such as how often two clinicians agree on the same diagnosis; validity, such as clear separation between diagnostic constructs or presence of objective validators; utility, such as predicting outcomes and treatment responses; implying an inaccurate conception of mental health problems as diseases that also minimizes the influence of social causative factors, high rates of co-occurrence, and association with negative consequences such as stigma. Many psychiatric diagnostic constructs lack validity but often have clinical utility. This clinical utility depends on how the clinician works therefore psychiatric diagnostic constructs are well suited to the medical model but may have little utility for other mental health professionals who work differently or for researchers testing hypotheses. Diagnostic constructs have utility for administrative purposes. The criticisms can be used to generate a set of questions to evaluate psychiatric diagnostic constructs. Psychiatric diagnostic constructs are best compared with general medical diagnostic constructs because they are used for similar purposes in clinical decision-making. A comparison will be made to see if there is no overlap, some overlap, or near total overlap between general medical and psychiatric diagnostic constructs.

Exercise and Cognitive Function: Increased Fitness Improves Cognition in Older Adults and Those with Chronic Medical Conditions

2016 ◽  
Vol 5 (2) ◽  
pp. 21-27
Author(s):  
Andrew Fedor ◽  
Fawn Walter ◽  
Joel W. Hughes ◽  
John Gunstad
Keyword(s):  
Older Adults ◽  
Cognitive Function ◽  
Cognitive Functioning ◽  
Clinical Utility ◽  
Regular Exercise ◽  
Chronic Medical Conditions ◽  
Medical Conditions ◽  
Future Studies ◽  
Neurological Outcomes ◽  
Positive Effects

Cognitive functioning may be preserved or improved through exercise. Both acute and regular exercise have positive effects on cognition, particularly on measures of attention, executive functioning, and memory. Improving fitness may be especially beneficial to cognitive function in older adults and persons with chronic medical conditions. Future studies should identify the mechanisms for these benefits and seek to determine the clinical utility of routinely recommending exercise to promote better neurological outcomes.

Rethinking Categories and Dimensions in the DSM

2020 ◽  
Vol 45 (6) ◽  
pp. 663-682
Author(s):  
James Phillips
Keyword(s):  
Clinical Utility ◽  
William James ◽  
Scientific Validity ◽  
Diagnostic Categories ◽  
Natural Categories ◽  
Practical Effect ◽  
Probabilistic Character ◽  
Philosophical Pragmatism

Abstract This paper addresses the role of categories and dimensions in the classification of psychopathology. While psychopathology does not sort itself out neatly into natural categories, we do find rough, symptom-based groupings that, through refinement, become diagnostic categories. Given that these categories suffer from comorbidity, uncertain boundaries, and excessive “unspecified disorder” diagnoses, there has been a move toward refining the diagnoses with dimensional measures. The paper traces efforts both to improve the diagnostic categories with validators that allow at least partial validity and to introduce dimensional measures into the diagnostic manual. Drawing from the philosophical pragmatism of Charles Sanders Peirce, William James, and John Dewey, which emphasizes the practical, effect-sensitive consequences of a theory along with an emphasis on empirical evidence and the progressive, probabilistic character of knowledge, the paper argues that these efforts must be guided both by scientific validity and clinical utility.

scholarly journals Walking on common ground: a cross-disciplinary scoping review on the clinical utility of digital mobility outcomes

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Ashley Polhemus ◽  
Laura Delgado Ortiz ◽  
Gavin Brittain ◽  
Nikolaos Chynkiamis ◽  
Francesca Salis ◽  
...  
Keyword(s):  
Scoping Review ◽  
Gait Speed ◽  
Clinical Utility ◽  
Common Ground ◽  
Ecological Validity ◽  
Step Length ◽  
Step Count ◽  
Chronic Obstructive ◽  
Medical Conditions ◽  
Clinical Measures

AbstractPhysical mobility is essential to health, and patients often rate it as a high-priority clinical outcome. Digital mobility outcomes (DMOs), such as real-world gait speed or step count, show promise as clinical measures in many medical conditions. However, current research is nascent and fragmented by discipline. This scoping review maps existing evidence on the clinical utility of DMOs, identifying commonalities across traditional disciplinary divides. In November 2019, 11 databases were searched for records investigating the validity and responsiveness of 34 DMOs in four diverse medical conditions (Parkinson’s disease, multiple sclerosis, chronic obstructive pulmonary disease, hip fracture). Searches yielded 19,672 unique records. After screening, 855 records representing 775 studies were included and charted in systematic maps. Studies frequently investigated gait speed (70.4% of studies), step length (30.7%), cadence (21.4%), and daily step count (20.7%). They studied differences between healthy and pathological gait (36.4%), associations between DMOs and clinical measures (48.8%) or outcomes (4.3%), and responsiveness to interventions (26.8%). Gait speed, step length, cadence, step time and step count exhibited consistent evidence of validity and responsiveness in multiple conditions, although the evidence was inconsistent or lacking for other DMOs. If DMOs are to be adopted as mainstream tools, further work is needed to establish their predictive validity, responsiveness, and ecological validity. Cross-disciplinary efforts to align methodology and validate DMOs may facilitate their adoption into clinical practice.

Review and analysis of therapeutic methods dedicated to retained primitive reflexes

2020 ◽  
Vol LXXXI (4) ◽  
pp. 283-292
Author(s):  
Paulina Krzeszewska ◽  
Emilia Mikołajewska
Keyword(s):  
Clinical Picture ◽  
Scientific Validity ◽  
Therapeutic Method ◽  
Primitive Reflexes ◽  
Therapeutic Procedures

An increasing interest in the topic of retained primitive reflexes in children has been observed in recent years. There is greater awareness of the occurrence and consequences of the aforementioned reflexive reactions among specialists and parents, and the number of the therapy forms offered is growing. However, these forms are often at variance with the current research on the clinical picture of persistent reflexes or on the results of therapeutic procedures undertaken. The popularity of a given therapeutic method is not always proportional to its scientific validity. The aim of this article is to review and analyze therapeutic methods dedicated to retained primitive reflexes.

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