Re: [Gnumed-devel] Clinicians: indications, again

[Karsten Hilbert]

On Thu, Jun 17, 2010 at 10:58:54AM -0700, Jim Busser wrote:

> Maybe I have a different meaning for indications. To me, an indication is not 
> a purpose but rather a situation that justifies to do something.
> 

> A patient has an aortic aneurysm and a possibility of a
> surgical repair. Surgery achieves a repair, but the repair
> is not the indication...

Agreed.

> the repair is the outcome. The
> indication is not even just the existence of the aneurysm,

very true

> it should be e.g. aneurysm >5cm

Hm, not really IMO. Shouldn't the indication be

holistically / ISDM:

 "patient decides to undergo surgery after considering options"

while medico-scientifically (pending patient consent !):

 "surgery is indicated in that it promises the greatest benefit"

?

Along those lines the vaccination indiation is

 "vaccination against X is indicated to prevent undesired effects from 
suffering X"

> So back to vaccinations, the "indication" for pneumovax is not the intended 
> outcome of immunization.

In a way it is a negative indication:

 "indication" for, say, pneumovax is "*prevention* of undesired outcomes of 
pneumococus infection"

> The indication should be
> 
>       hyposplenism
>       chronic lung disease

Exactly :-)   The indication for pneumovax is *prevention*
of what you listed (or rather "decision of patient to
attempt prevention of ...")

And then, one could aggregate your list into "pneumococcus
infection" or, shorter "pneumococcus" :-)

> etc ... or do I misunderstand the table, and is the table
> supposed to include some yet-to-be-added columns that are
> *themselves* to hold the "indications" which will indicate
> the use of the vaccine (and maybe the first column should
> have a different label)?

No, that table is used to link vaccines ("vaccine" as in
"drug") to (against) what they are given for.

I do appreciate your concern on precision but also maintain
that this is "pragmatically correct" in the sense of typical
clinical use, no ?

I do, however, also stay open to good reasoning and
suggestions for improvement - as always :-)

Karsten
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