Keeping a clinical distinction exact while editing
Many clinical words carry a distinction that a near synonym erases: a sign against a symptom, a laboratory finding against what a patient experiences, an acute condition against a long-term treatment, a cause against its study, relapse against refractory, a drug's salt against sodium, mortality against a mortality rate, and an endpoint against a date. Editing clinical wording keeps each distinction as it was meant.
Signs, symptoms and laboratory findings
Symptoms, or complaints, are experienced by patients, whereas signs are observed by clinicians or through tests. Marked rises in CK are signs of statin-induced myopathy, and myalgia that cannot be attributed to physical exertion may be a symptom of evolving statin-induced rhabdomyolysis. Ipsilateral pupil dilation should not be called a symptom of elevated intracranial pressure or cerebral oedema after stroke, nor myalgia a sign of incipient rhabdomyolysis.
A patient with a dose-limiting toxicity is preferable to a patient who experiences one, because whether the patient experiences it is subjective. A dose-limiting toxicity defined by laboratory values, such as an absolute neutrophil count below 1500/mm³ or a white blood cell count below 3 × 10⁹/L, can be argued to be a change an individual does not directly experience, since clinical laboratory tests would be unnecessary if individuals could perceive it.
Words for a condition
Acute and chronic describe diseases or conditions, not treatments: a treatment may be long-term but not chronic, and urgent but not acute. In at least two major disorders acute has a specific physiological definition that its meaning of short-term does not completely cover. An acute abdomen is severe abdominal pain within 24 hours that has an unclear aetiology, with a differential diagnosis that includes abdominal aortic aneurysm, appendicitis, pyelonephritis, pancreatitis, cholecystitis, diverticulitis, ovarian torsion, ectopic pregnancy and ischaemia, and acute coronary syndromes are cardiovascular conditions associated with acute myocardial ischaemia, including 12-lead electrocardiographic ST-segment-elevation myocardial infarction. In some cases acute peritonitis, which results from infection of the peritoneal lining of the abdominal cavity, is more precise than acute abdomen.
Accident may be imprecise or misleading, since what is usually meant is injury, trauma, a shooting or a collision. Cerebrovascular accident should not be used for stroke, because stroke is preventable and not an accident, and cerebrovascular incident (CVI) is preferred.
Type 2 diabetes, with mellitus at first mention only, is preferable to non-insulin-dependent diabetes mellitus, which defines the condition by what it is not.
Menopause, or the climacteric, the cessation of menses, is a time of life and not a medical condition. Signs and symptoms are associated with the virtual cessation of oestrogen output, and a manageable postmenopausal syndrome, including acute hot flushes and vaginal atrophy, is arguable. But the case for menopause or post-menopause as a medical condition is not persuasive, and the same goes for partial androgen deficiency of the ageing male. Each of these expressions is, on its face, potentially judgemental, refers to populations rather than individual patients, and may spuriously suggest a need to replenish deficient levels of the reproductive hormone.
Aetiology is not cause: aetiology is the study or overall perspective on causes, so sneezing has a complex aetiology, but antigen-induced irritation of the mucous membranes lining the nose and throat is not its aetiology.
An epidemic is a condition that affects many people in a defined area and is temporary or time-limited, and a pandemic spans more than one geographical region, such as a continent. Some journal peer reviewers object to statements such as the growing diabetes epidemic, which is not a true epidemic, and in most evidence-based study reports the two words should be restricted to their infectious-disease contexts.
Relapse and refractory
Medical dictionaries define a relapse as the return of a disease after its apparent cessation, or its return in a new attack after an interval of improvement, and medical and general dictionaries define refractory as resistant to treatment, one giving intractable as a synonym. A migraine may seem at first to be refractory to the many standard treatments, and a patient may relapse into a coma. A condition, not a patient, may be refractory to treatment. Amenable to treatment is an antonym of refractory to treatment.
In writing on oncology products, relapsed and refractory are sometimes used almost interchangeably. Their meanings are so disparate that one usage columnist is dismayed when they are used synonymously or interchangeably.
Drugs, regimens and treatment groups
Salt is not sodium. A regimen should include both the drug and its dosage, with the route and frequency of administration. Regimens, not patients, are switched or altered. Only the active-treatment group is treated, and the control group receives placebo or usual care.
Severity and doses
Mild-to-moderate is not mild or moderate, and it should be used only to imply a continuum. Minimum effective dose is so misleading that one almost needs to rethink it to fathom what its users intend, and minimum dose effective is its substitute.
Outcomes and study periods
Mortality is 100%, since death is inevitable, so no medication or other intervention can reduce mortality, though it may reduce premature mortality or mortality over a certain time span. So only a mortality rate, mortality over some time interval or an age-standardised mortality rate should be reported.
Endpoint chiefly signifies an outcome measure, so calling a study's completion date its endpoint distracts by that connotation, and the period a study ran is better stated by its dates, from the first patient enrolled to the last patient's follow-up visit.