diagnosis

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diagnosis,

determination of the nature of a disease or ailment. A clinical diagnosis is based on the medical history and physical examination of the patient: it may be confirmed with X-Rays, CAT Scans (Computerized Axial Tomography), MRI (Magnetic Resonance Imaging), and other laboratory tests. Diagnosis by physical examination includes ascertaining temperature, pulse, and blood pressure and involves the use of palpation, to detect enlarged organs and other abnormalities; tapping, to delineate some of the internal organs; and listening, to interpret sounds from organs such as the heart and lungs. Instruments that facilitate physical examination include the sphygmomanometer for blood pressure; the stethoscopestethoscope
[Gr.,=chest viewer], instrument that enables the physican to hear the sounds made by the heart, the lungs, and various other organs. The earliest stethoscope, devised by the French physician R. T. H. Laënnec in the early 19th cent.
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 for listening to the heart and lungs; the ophthalmoscopeophthalmoscope
, instrument used for examining the inner structure of the eye. The device was invented by the German physiologist H. L. F. von Helmholtz in 1851. His model consisted of three plates of glass pressed together and mounted on a handle at a 45° angle.
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 to examine the inner eye; and the laryngoscope and bronchoscopebronchoscope
, long, tubular instrument with a light at the tip that is inserted through the windpipe and bronchial tubes to examine these structures. By passing other instruments through it, foreign bodies and obstructions can be removed and tissue or secretions may be removed
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 to view the larynx, windpipe, and other air passages. Recent innovations in electronics have made it possible for any of these devices to be fitted with video cameras and lights, so that the interior of the body can be viewed on video monitors and recorded on videotape for future reference. In diagnostic tests, the blood, urine, tissues, and other excretions and secretions of the body are examined for evidence of chemical imbalance, cellular change, and the presence of pathogenic organisms. Exploratory surgery and the insertion of visual equipment through a small incision (e.g., laparoscopy and arthroscopy) may be used to assist in diagnosis.

Diagnosis

 

in medicine, the process of identifying a disease and designating it with accepted medical terminology— that is, making a diagnosis. The science of the methods of making a diagnosis is called diagnostics.

Diagnosis is based on the thorough and systematic study of a patient that includes (1) anamnesis—purposeful questioning concerning the complaints, history of the condition, and history of the life of the patient, (2) physical examination (inspection, palpation, percussion, auscultation), testing of visual and auditory acuity and reflexes with special devices, testing of the range of movements in the joints, and so forth; (3) analysis of the results of laboratory tests of blood and various excretions (feces, urine, sputum, pus, and so forth); X-ray examinations: graphic methods—recording on paper or film the movements of the heart (cardiography), blood vessels (sphygmography), and so forth; electrodiagnostic studies (electrocardiography, electroencephalography, and so forth); endoscopy—inspection of the interior of certain organs (for example, the stomach and urinary bladder) using special optical instruments; biopsy—the study of small pieces of tissue excised from the patient or of material obtained by puncturing bone marrow and lymph nodes with a special needle. In certain diseases, important diagnostic data are obtained with radioactive isotopes (radioisotopic diagnosis). Bacteriological and serological (using serum) methods are very important in diagnosing infectious and allergic diseases. In order to make a diagnosis in difficult cases, physicians sometimes resort to an exploratory operation, so that they may examine and study local changes directly.

In order to identify a disease, it is generally necessary to find a fairly large number of symptoms and combinations of symptoms and to determine their intensity. Since different diseases may share the same symptoms (for example, headache, fever, vomiting), differential diagnosis is used. The starting point is usually the selection of the most characteristic, prominent, and positively known (pathognomonic) symptom. The disease is compared with others that show a similar symptom. Less commonly, the diagnosis is made by excluding similar diseases.

To avoid the errors caused by insufficient medical experience, especially in diagnosing rare diseases, attempts were made starting in the 1950’s to make diagnoses with the help of computers, using symptoms (detected by the physician) whose significance in various diseases was calculated beforehand. Development of this approach (cybernetic medicine) is impeded by the difficulties encountered in evaluating symptoms quantitatively and by the imperfect classification of diseases.

In making a diagnosis, the physician attempts to find the cause of the disease and its accompanying diseases and complications and to assess the severity of the functional disorders (functional diagnosis). He also takes into account the particular physiological characteristics of the patient. Thus, a diagnosis must reflect the characteristics that distinguish a given patient from other patients with the same disease. An early, accurate, and maximally concrete diagnosis facilitates well-considered and efficacious therapy and often makes it possible to forecast possible variations in the course of the disease.

A pathologicoanatomical diagnosis is made post-mortem by a specialist (pathological anatomist) who bases his diagnosis on the study of the findings of the autopsy and on the chemical and microscopic analysis of tissues in comparison with the results of studies made while the patient was living. Pathologicoanatomical diagnosis is of value is finding and analyzing inaccuracies in diagnoses made during life; it is also used in forensic medicine.

REFERENCES

Osipov, I. N., and P. V. Kopnin. Osnovnye voprosy teorii diagnoza, 2nd ed. Tomsk, 1962.
Metodicheskie problemy diagnostiki Moscow, 1965. (Collection of articles.)
Brodman, K. “Postanovka diagnoza pri pomoshchi vychislitel’noi mashiny.” In Elektronika i kibernetika v biologii i meditsine. Moscow, 1963. Page 361. (Translated from English.)
Diagnosis in veterinary medicine is divided into general and special diagnosis. The objective of the former is preliminary familiarization with the sick animal (anamnesis); determination of its external appearance; study of the skin, integuments, subcutaneous tissue, superficial lymph nodes, and visible mucosae; and measurement of the body temperature. Special diagnosis involves an examination of the internal organs, blood, urine, gastrointestinal contents, cerebrospinal fluid, and so forth. Inspection, palpation, percussion, probing, catheterization, roentgenoscopic and graphic studies (roentgenoscopy, roentgenography, sphygmography, electrocardiography, and so forth) are among the clinical methods used. Diagnostic allergic tests (tuber-culinization, malleinization, and so forth) are used extensively to diagnose infectious and parasitic diseases. Bioassays (inoculation of living tissues and live animals) are necessary in diagnosing a number of infectious diseases (for example, anthrax, brucellosis, tuberculosis, botulism, and tularemia).

REFERENCE

Klinicheskaia diagnostika vnutrennikh boleznei sel’skokhoziaistvennykh zhivotnykh, 2nd ed. Edited by V. I. Zaitsev. Moscow, 1964.

V. I. ZAITSEV

diagnosis

[‚dī·əg′nō·səs]
(computer science)
The process of locating and explaining detectable errors in a computer routine or hardware component.
(medicine)
Identification of a disease from its signs and symptoms.
(systematics)
In taxonomic study, a statement of the characters that distinguish a taxon from coordinate taxa.

diagnosis

1. Med
a. the identification of diseases by the examination of symptoms and signs and by other investigations
b. an opinion or conclusion so reached
2. Biology a detailed description of an organism, esp a plant, for the purpose of classification
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English, J.T., Sharfstein, S.S., Scherl, D.J., et al.: Diagnosis-Related Groups and General Hospital Psychiatry: The APA Study.
The plan suggests that savings of FF30 billion could be made by replacing the global budget by a system of payment on the basis of diagnosis-related groups (DRG).
Keywords: Healthcare, Fee-for-service (FFS), Pay-for-performance (P4P), Quality Improvement, Diagnosis-Related Groups (DRGs), Capitation, Electronic Medical Record (EMR), Health Information Technology (HIT)
Payment systems and considerations of case mix--Are diagnosis-related groups applicable in Japan?
Under Medicare's inpatient prospective payment system (IPPS), hospitals generally receive fixed payments for hospital stays based on diagnosis-related groups (DRG), a system that classifies stays by patient diagnosis and procedures.
Officials at the Centers for Medicare and Medicaid Services are replacing 9 current cardiovascular diagnosis-related groups (DRGs) commonly billed by specialty hospitals with 12 new DRGs that the agency says will better recognize the severity of illness of the patient.
The Centers for Medicare and Medicaid Services (CMS), if directed by the Medicare Payment Advisory Committee (MedPAC), could create a new series of procedure-specific diagnosis-related groups (DRGs) for transplants performed on patients with complicating conditions, just as it already does for many other surgical procedures.
As of October 1998, if a hospital inpatient is treated for 1 of 10 specific diagnosis-related groups (DRGs) and then discharged to a non-PPS setting, the patient is considered a transfer patient.
This information was produced by another hospital in Syracuse, New York for a clinical pathway addressing adult pneumonia (Diagnosis-Related Groups 89 and 90).
Health plans are collecting data to "profile" the physicians with whom they contract.[4] So far, most have not paid much attention to utilization of resources.[5] Some are starting to use relative value systems, to reflect use of resources, and case mix indices, to get at complexity.[6] When physicians fail to adjust for case mix in their practices, they risk being miscategorized as overutilizers[7] This further indicates how essential it is for physicians and hospitals to understand and apply case mix indices, diagnosis-related groups and resource-based relative value systems.
Background: With the rising incidence as well as the medical expenditure among patients with unstable angina pectoris, the research aimed to investigate the inpatient medical expenditure through the combination of diagnosis-related groups (DRGs) among patients with unstable angina pectoris in a Grade A tertiary hospital to conduct the referential standards of medical costs for the diagnosis.