Proposed Terms

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From: Barry Smith [1] Sent: Sunday, August 31, 2008 8:07 PM Subject: comments on diseases, signs and symptoms?

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Diseases, Signs and Symptoms: Draft List of Proposed Definitions Richard Scheuermann, Werner Ceusters, Barry Smith

We use ‘abnormal’ to designate those bodily structures, processes or qualities which are associated to a significant degree with pain and other feelings of illness or with enhanced morbidity (the threshold degree of significance being determined by the community of clinicians).

Homeostasis =def. The events transpiring within the body fall within the range which allows bodily functioning to be sustained, and the bodily mechanisms for restoring values within the interior of this range are unimpaired.

Pathological Process =def. A biological process in a human being that is of a type standardly classified by the community of clinicians as abnormal.

Acute Pathological Process =def. A pathological process beginning with a deviation from and terminating with a return to normal homeostasis.

Disorder =def. The physical result of a change in some part of the patient that is associated with a pathological process.

Acute Disorder =def. The physical result of a change in some part of the patient that is associated with an acute pathological process.

Chronic Pathological Process =def. A pathological process that results in an adaptation on the part of the patient to a level of abnormal homeostasis.

Chronic Disorder =def. The physical result of a change in some part of the patient that is associated, absent intervention, with a chronic pathological process.

Progressive Pathological Process =def. A pathological process that begins with a deviation from homeostasis and which continues to deviate in such a way as to preclude the re-establishment of homeostasis.

Progressive Disorder =def. The physical result of a change in the patient that is associated, absent intervention, with a progressive pathological process.

Physical Examination =def. A sequence of acts of observing and measuring the physical responses of a patient on the part of a physician occurring in the context of a clinical encounter.

Sign =def. A process or quality that is observed in a physical examination and is hypothesized by the clinician as a manifestion of a disorder.

Symptom =def. A quality of the patient that is observed and can be observed only by the patient and is of the type that can be hypothesized by the patient as a manifestion of a disorder.

Laboratory Test =def. A laboratory assay that is used to test a hypothesis about a given patient, and has input: a specimen derived from the patient, and output: a certain result which represents a quality of that patient.

Laboratory Test Result =def. A representation of a quality of a specimen that is the output of a laboratory test.

Finding =def. The result of either a laboratory test or a patient self-assessment (representation, by the clinician, of a symptom as reported by the patient, in the form of an assertion that this patient has this symptom) or a clinical examination (representation, by the clinician, of a sign, in the form of an assertion that this patient manifests this sign).

Clinical Phenotype =def. A constellation of those qualities associated with a disease at each stage of its development.

Clinical Picture A representation of a clinical phenotype inferred from the constellation of findings available to the clinician about a given a patient at any given stage.

Diagnosis =def. The result of an interpretive process which has input: a clinical picture of a given patient and conclusion: an assertion of the form ‘this patient has disease or disorder such and such’.

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From: Richard H. Scheuermann , Ph.D. [2] Sent: Monday, September 01, 2008 3:59 PM Subject: Signs Symptoms and Findings Workshop: Definitions Proposed for Discussion

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Signs, Symptoms and Findings: Draft List of Definitions Proposed for Discussion

01 September 2008

We use ‘bodily feature’ to designate biological qualities, processes or structures of an organism such as blond hair, coughing, swelling.

We use ‘clinically normal’ to designate bodily features of a human being that are typically not associated with pain or other feelings of illness, with dysfunction, or with other indications of enhanced morbidity.

We use ‘homeostasis’ to designate the state in which the bodily processes of the organism are regulated in such a way as to (1) maintain bodily features within a certain homeostatic range and (2) respond successfully to departures from this range caused by external influences. During homeostasis the organism continually assesses its current state to determine if its bodily features fall within this range.

Homeostatic Range =def. The range of types of bodily features whose maintenance is continuously sought by an organism in the state of homeostasis.

Normal Homeostasis =def. Homeostasis of a type that is clinically normal for a human being of a given type and age in a given environment.

Abnormal Homeostasis =def. Homeostasis of a type that is not normal.

Disorder =def. A bodily structure in a human being that is clinically abnormal.

Etiological Process =def. A biological process in a human being that leads to a disorder.

Pathological Process =def. A biological process in a human being that is caused by a disorder.

Acute Pathological Process =def. A pathological process terminating with a resolution of the disorder and a return to normal homeostasis.

Acute Disorder =def. A disorder that leads to an acute pathological process.

Chronic Pathological Process =def. A pathological process that results from an adaptation on the part of the patient to a level of abnormal homeostasis.

Chronic Disorder =def. A disorder that, in the absence of intervention, would typically lead to a chronic pathological process.

Progressive Pathological Process =def. A pathological process that deviates increasingly from homeostasis in such a way that the re-establishment of homeostasis is precluded.

Progressive Disorder =def. A disorder that, in the absence of intervention, would lead to a progressive pathological process.

Physical Examination =def. A sequence of acts of observing eliciting responses, and measuring the bodily features of a patient, occurring in the context of a clinical encounter.

Sign =def. A bodily feature of the patent that is observed in a physical examination and is hypothesized by the clinician to be a disorder or a manifestation of a disorder.

Symptom =def. A quality of the patient that is observed and can be observed only by the patient and is of the type that can be hypothesized by the patient as a manifestation of a disorder.

Laboratory Test =def. A laboratory assay that has as input a specimen derived from the patient, and as output a result that represents a quality of the patient.

Laboratory Finding =def. The representation of a quality of a patient that is the output of a laboratory test.

Clinical Finding =def. A representation of a bodily feature of a patient that is recorded by a clinician because the feature is hypothesized to be of clinical significance.

Clinical Phenotype =def. A constellation of those types of bodily features that are associated with a disorder at each stage of its development.

Clinical Picture =def. A representation of a clinical phenotype as instantiated in a given patient that is inferred from the constellation of laboratory and clinical findings available to the clinician about a given a patient at any given stage.

Diagnosis =def. The conclusion of an interpretive process that has as input a clinical picture of a given patient and as output an assertion to the effect that the patient has a disorder of such and such a type.