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The privileged status of prestigious terminology: impact of "medicalese" on clinical judgments.

PURPOSE: Health professionals frequently use medical terminology like dyspnea or nasopharyngitis. These two studies examine how the use of medical terms affects the judgments of seriousness, prevalence, and disease; and diagnostic judgments. METHOD: In study 1, a survey containing the names of 22 diseases with either a medical or lay description was completed by 47 undergraduate psychology students and 25 medical students, who were asked to judge seriousness, prevalence, and how "disease-like" it was. In study 2, undergraduate students learned four "pseudopsychiatry" conditions, each with four associated features. Features were presented in lay or medical versions. They were then tested with 18 new cases with two medical features from one condition and two lay terms from the other. RESULTS: In study 1, the medical students rated conditions as more disease-like, more serious, and less prevalent than did the psychology students. Medical descriptions were seen as significantly less common and somewhat more serious and more disease-like. In study 2, the participants rated the condition with medical features consistently more likely than the alternative, regardless of training condition. CONCLUSIONS: The specific words used to describe a feature or condition can have an impact on judgments of likelihood of disease, and, to a lesser extent, judgments of seriousness.

Diagnosis↗

Primary bone tumors of the spine. Terminology and surgical staging.

Appropriate application of an oncologic staging system is required to evaluate the relationship among histologic types, management, and outcome of primary bone tumors. A commonly accepted terminology for surgical procedures and for definition of tumor extent is needed for surgical planning and clinical reviews. The principles of the Enneking system for classifying stages of tumors are emphasized and applied to the spine using a practical approach for surgical staging.

Chondrosarcoma↗

Glossary of evidence-based orthopaedic terminology.

As surgeons incorporate the philosophy of evidence-based orthopaedics into patient care, they need to become familiar with common terminology. A glossary of commonly used terms encountered among evidence-based orthopaedic practitioners is presented.

Epidemiologic Research Design↗

Evaluation and management codes: from current procedural terminology through relative update commission to Center for Medicare and Medicaid Services.

BACKGROUND: Physicians should have a working knowledge of the process by which patient care codes are created and subsequently assigned values. The Society of Critical Care Medicine has representatives on the national committees that focus on code creation and definition and on assignment of relative value units. In addition, a better understanding of documentation requirements and the audit process will facilitate improved compliance and minimize liability. DISCUSSION: The authors discuss the current procedural terminology (CPT) process for defining care codes and the relative update commission (RUC) process for assigning values to those codes, with each code assigned a separate value in three separate categories. Steps for managing any concern or dispute about billing, denials, or an audit are subsequently addressed. Tenets of proper documentation are discussed, and some future developments are identified that are likely to affect critical care. CONCLUSION: Knowledge of the procedures by which care codes are defined and valued is necessary for using these codes properly, as well as for addressing needs unmet by existing codes. Preventing audits is the best approach to proper coding and billing, and documentation is key.

Centers for Medicare and Medicaid Services, U.S.↗

The terminology problem for T cells: a discussion paper.

The school of thought that owes allegiance to Ludwig Wittgenstein teaches that language conditions perceptions. When we use the term 'cytotoxic T lymphocyte' or 'helper T cell' we tend to orientate our own thinking processes, and those of listeners or readers, down particular paths. Part of the problem is that we are often describing cell populations by functions that may either be a property of only a proportion of those that are being assayed, or are simply inferred from the expression of various cell-surface markers. The consequence can be a measure of confusion that might be avoided if we could communicate with greater clarity. Is it possible to achieve a better terminology that will be accepted generally? The following are some examples of why there may be some value in thinking about this.

Hypersensitivity, Delayed↗

Telemedicine and terminology: different needs of context information.

Traditionally, communication between healthcare providers, including the provision of physicians with information and knowledge, works quite well because there are implicitly common conventions and assumptions in the collaboration of all involved actors. The basic prerequisite of the communication process between humans is a mutual agreement on syntax and semantics of oral and written language, i.e., of the medical sublanguage. With telemedicine, i.e., the use of telecommunication and informatics in medicine, this prerequisite is no longer sufficient. First, various professionals from different clinical communities, characterized by specialty, nationality, school, etc., share the management of the patient's health. Second, electronically communicated information is more and more intended for processing by computer applications rather than for direct interpretation by human users. Third, the interconnection of distributed heterogeneous software systems in medicine raises the issue of semantic interoperability, especially the problem of data integration. A faithful communication in such a scenario must be based on explicit assumptions "behind" a message. Interpreting an usually highly context-dependent utterance demands for mechanisms on a pragmatic level in natural language processing. The need for additional processing and integration of the transferred data by the receiving system demands for standardization and mediation, taking into consideration contextual knowledge that cannot entirely be explained and processed with linguistic and terminological approaches. This paper describes different categories of contexts and also different needs of applications concerning "context awareness."

Telemedicine↗

Immunohistochemical detection of the membrane and fluid-phase terminal complement complexes C5b-9(m) and SC5b-9. Consequences for interpretation and terminology.

Activation of the terminal pathway of complement on a membrane results in the generation of the membrane-damaging terminal C5b-9(m) complement complex, whereas the non-lytic water-soluble SC5b-9 complex is formed when complement is activated in the fluid phase. Both forms of the terminal complement complex (TCC) can be immunohistochemically detected, but not distinguished, by antibodies recognizing neoantigens in the complexes. By means of monoclonal antibodies against C9 neoantigens and against the S-protein, it was demonstrated that deposits of the TCC in tissue sections may be either in the form of C5b-9(m) or SC5b-9. The consequences of this for the interpretation of the histochemical data and the terminology of the two complexes are discussed.

Adult↗

Terminology and classification of colorectal adenocarcinoma: the Australian clinico-pathological staging system.

A new system--the Australian Clinico-pathological Staging (ACPS) System--is proposed for the reporting of cases of colorectal adenocarcinoma. It utilizes all information available--clinical, operative and pathological--before a stage is allotted. This contrasts with Dukes' classification which is based solely on the pathological examination of the resected specimen. The ACPS has a special category 'D' for incurable cancer--those with a locally advanced irremovable tumour or with distant metastases. This method requires co-operation between clinician and pathologist and the use of precise terminology with strict adherence to definitions. The validity of the system is tested by analysing the survival pattern of 709 patients from Concord Hospital according to the ACPS and Dukes' system.

Adenocarcinoma↗

Standardization of terminology in meta-analysis: a proposal for working definitions.

In this paper we present a brief overview of the growing concern to standardize definitions and terminology in meta-analysis. This tool has become inescapable in both drug research and therapeutic evaluation. The performed and published meta-analyses are increasing, as well as the variation in the meaning of the terms used in meta-analysis. In the second part of the paper we propose glossary of the most common terms used in reports of meta-analyses. The glossary has been written by only one group of scientists, the definitions are therefore proposed to the scientific community as working definitions, to be subject to reactions from leaders in meta-analysis.

Clinical Trials as Topic↗

The concept of "reversible" dementia. How nonreliable terminology may impair effective treatment.

Although good clinical and research information continually appears in the dementia literature, there is the disconcerting sense that, in some areas, a lack of clarity and rigor exists regarding terminology. Although definitions in the field of dementia initially seem reasonably straightforward, specific problem areas exist. This multidisciplinary field encompasses a variety of physician specialists, as well as other diverse professionals and brings not only the benefit of a rich mix of backgrounds, but also provides a medium for potential misunderstanding due to miscommunication. The variety of definitions of dementia, and especially the label, "reversible dementia," exemplifies this problem. Disease-specific dementias, pseudodementia, and delirium are three clinical situations that may or may not be classified as "reversible dementias," depending on individual training, custom, and jargon. Use of the term "reversible dementia" may cause misunderstanding and inefficiency and benefits neither patient nor caregiver. It is suggested that the term be replaced. Further, all diagnostic labels should be clearly understood and explained. Emphasis must be placed on promoting the fact that all patients with cognitive/functional decline, no matter how defined or what the cause, are eminently treatable individuals.

Aged↗

Developing a subject-derived terminology to describe perceptions of chemicals in foods.

Risk perception may be influenced by a number of factors, such as unfamiliarity, lack of control, perceived consequences, and hazards being seen as catastrophic and having risk for future generations. Risk perception researchers have typically used such investigator-selected characteristics to assess hazards. In the first study reported here, the repertory grid method was used to elicit the terminology that subjects (n = 30) use to distinguish between 30 different chemicals. The data were submitted to generalized Procrustes analysis. The first principal axis of the resulting consensus plot separated the chemicals ranging from "poisonous or toxic," "harmful or dangerous," and "sounds negative" at one end, to "positive effect on health," "often present in food nowadays," and "sounds positive" at the other end. The second principal axis ranged from "familiar with or knowledge of" and "chemical" to "natural." A second study (n = 226) was carried out to look at the general validity of the results of the repertory grid interviews using a fixed questionnaire. The data were submitted to principal components analysis and internal preference mapping. The first principal component ranged from "safe" and "healthy" at one end, to "poisonous" and "harmful" at the other end. The chemicals also separated in terms of "familiar," "chemical," and "natural." All three methods of data collection and analysis yield essentially similar results.

Attitude↗

Comparison of nursing interventions classification and current procedural terminology codes for categorizing nursing activities.

PURPOSE: To compare the frequency with which nursing activity terms could be categorized using Nursing Interventions Classification (NIC) and Current Procedural Terminology (CPT) codes. DESIGN: Descriptive. The sample was 201 patients with AIDS hospitalized 1989-1992 for pneumocystis carinii pneumonia in three US medical centers. METHODS: Nursing activity terms (n = 21,366) were collected from patient interviews, nurse interviews, intershift reports, and patient records, then were categorized using NIC and CPT codes. RESULTS: Nursing activity terms were categorized into 80 NIC interventions across 22 classes and into 15 CPT codes. All terms in the data set were classifiable using the NIC system and the majority (60%) of the terms were classified into 14 NIC intervention categories; 6% of the terms were classifiable by CPT codes. The most frequently used CPT code was "pulse oximetry." Significantly (p < .0001) greater numbers of nursing activity terms could be categorized in the NIC system compared to the CPT system. CONCLUSIONS: Findings provide evidence that NIC is superior to CPT for categorizing nursing activities in this study's population. The findings support the importance of discipline-specific classifications for categorization of health care interventions. Nursing-specific intervention classification systems such as NIC, the Omaha System, and the Home Health Care Classification are essential to defining the contribution of nursing to both quality and cost outcomes.

Adult↗

Behavior of the contractile vacuole of Tetrahymena pyriformis W: a redescription with comments on the terminology.

The behavior of the contractile vacuole of Tetrahymena pyriformis W has been recorded and analyzed quantitatively by cinephotography. The vacuole fills in a stepwise fashion by the confluence of ampullae which appear regularly at the beginning of systole and whose membranes are continuous with that of the contractile vacuole throughout the cycle. The vacuole may subsequently fill slowly by a means not discernible by light microscopy. The vacuole rounds up at the beginning of systole and shortly thereafter the ampullae reappear around the perimeter of the vacuole. They are expanded by fluid forced into them from the vacuole. Round-up and the mode of growth of the ampullae indicate that the contractile vacuole is truly contractile. Expulsion occurs soon after the appearance of the ampullae and terminates the cycle. Contraction is initiated at regular intervals by a timing mechanism which is independent of the size of the vacuole. Suitable terminology to describe the structure and behavior of the contractile vacuole is discussed.

Animals↗

So-called calcifying odontogenic cyst: review and discussion on the terminology and classification.

The so-called calcifying odontogenic cyst (COC) shows extensive diversity in its clinico-histopathological appearances and biological behaviour. Because of this diversity, there has been confusion and disagreement on the terminology and classification of this lesion. The attempts at classification of COC may be divided into two concepts. The first concept is the "monistic" one that all COCs are neoplastic in nature, even though the majority are cystic in architecture and appear to be non-neoplastic. The second is the "dualistic" concept that COC contains two entities: a cyst and a neoplasm. Although the World Health Organization (WHO) classified COC as an odontogenic tumour in 1992 based on the former concept, current thinking favors strongly the latter one. In this article, several previous classifications of COC in the literature are discussed and a new simple classification scheme based on the "dualistic" concept is proposed.

Biology↗

An assessment of the terminology used by diplomates and students to describe the character of equine mitral and aortic valve regurgitant murmurs: correlations with the physical properties of the sounds.

Twenty students and 16 diplomates listened to 7 recordings made from 7 horses with either aortic (n = 3) or mitral valve (n = 4) regurgitant murmurs. A total of 30 different terms were used to describe the character of these murmurs. However, only 4 terms were used in a repeatable and consistent manner. Most people described the character of a given mitral or aortic valve murmur with 1 or 2 terms. Diplomates drew from a pool of terms that was about half the size of that used by students--8.1 +/- 2.0 terms for diplomats (mean +/- 1 SD) versus 13.1 +/- 1.8 terms for students (P > .001). Only blowing, honking, buzzing, and musical were markedly associated with the recording played. Frequency analysis of the murmurs allowed them to be classified as containing harmonics (n = 4) or not containing harmonics (n = 3). Blowing was used to describe murmurs without harmonics on 39 of 48 occasions and corresponds to the term noisy used in some older descriptions of equine murmurs. Honking, musical, and buzzing were markedly associated with murmurs that contained harmonics; these terms were used 23, 13, and 12 of a possible 64 times, respectively. The frequency of buzzing and honking murmurs (72.7 +/- 9.3 and 88.4 +/- 46.3 Hz, respectively) was markedly lower than that of musical murmurs (156.8 +/- 81.1 Hz) (all P values < .01). Honking murmurs (0.392 +/- 0.092 seconds) were shorter than those described as buzzing or musical (0.496 +/- 0.205 and 0.504 +/- 0.116 seconds, respectively). The data suggest that the terminology for the character of aortic and mitral regurgitant murmurs should be restricted to 4 terms: blowing, honking, buzzing, and musical. Honking, buzzing, and musical describe murmurs with a peak dominant frequency and harmonics; blowing describes murmurs without a peak frequency. Effective communication could be enhanced by playing examples of reference sounds when these terms are taught so that nomenclature is used more uniformly.

Animals↗

Standardised terminology for the description and analysis of equine locomotion.

Terminology for the analysis of equine locomotion is reviewed and the most appropriate terms selected for use by research workers in this field. Each cycle of limb movement comprises a stance phase, when the hoof is in contact with the ground, alternating with a swing phase. The stance phase is subdivided at the mid-stance position into an initial decelerative phase followed by a propulsive phase. When the stance phases of different limbs occur concurrently, the term overlap refers to the duration of simultaneous ground contact. Single support is the term used to describe the phase when the limb is in its stance phase unaided by any other limb. A gait consists of a limb coordination pattern repeated at each stride. The start and finish of the stride must be designated as a prerequisite to the determination of stride length, stride duration and stride frequency. In asymmetrical gaits, such as the gallop, the stride as a whole will have a stride stance phase, when one or more limbs are in contact with the ground, and a suspension phase. In symmetrical gaits, such as the trot and pace, the stride consists of left and right stance phases and suspension phases. Advanced placement and advanced lift off measure the time between ground placement and lift off respectively of consecutive limbs. The line of motion indicates the progressive movement of the centre of gravity in the X-Y plane. Measurements in th Y-Z plane, such as line gait and overcrossing, describe the ground placement of the hooves relative to the line of motion. Diagonal width is the distance between diagonal limb pairs in this plane.

Animals↗

Emergency medicine terminology in the United Kingdom--time to follow the trend?

OBJECTIVE: To determine the frequency of use of the terms "accident and emergency" and "emergency medicine" and their derivatives in original articles in the Journal of Accident and Emergency Medicine. METHODS: Hand search of all articles in the Journal of Accident and Emergency Medicine from September 1995 to July 2000, categorising the first use of terminology in each original article to describe the specialty, its departments, or their staff into either accident and emergency or emergency medicine groups. RESULTS: There is a clear trend towards increasing use of the terms emergency medicine, emergency physician and emergency department, with decreasing use of the terms accident and emergency medicine, accident and emergency department and accident and emergency doctor, although the latter group still constitutes the majority. CONCLUSION: The use of emergency medicine to describe the specialty in the United Kingdom is increasing, although this may reflect the Journal's growing international standing. This trend should be taken into account in the debate over the specialty's name in this country.

Accidents↗

What constitutes a histological confirmation of cancer? A survey of terminology interpretation in two English regions.

AIMS: To compare interpretation by cancer registries and histopathologists of phrases that might confirm a diagnosis of cancer. METHODS: One hundred and thirty one consultant pathologists were sent a questionnaire containing 37 phrases used in pathology reports, including those indicating cancer and those not. Pathologists were asked to indicate whether each phrase confirmed the disease, ruled it out, or was uncertain, together with a subjective estimate of how frequently they used the phrase. RESULTS: There was a 58% response rate with similar interpretation between regions. There were some differences in frequency of use. At least 50% of respondents considered 12 terms as confirmatory (for nine the lower 95% confidence limit was greater than 66%). CONCLUSIONS: The registry should consider ignoring four of the 13 terms currently regarded as confirmatory. Terminology used in pathology reports should be standardised across registries. Registries and coding departments should use empirical evidence to assess which phrases confirm a diagnosis.

Communication↗