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Reply to: Acuity versus acuteness of illness
EDITORIAL CORRESPONDENCE
Acuity versus acuteness of illness To the Editor: I am writing to express a concern about the misuse of the word
acuity in both the title and text of an article in the January issue of the JOURNAL: "Acuity Scores as Predictors of Cost-related Outcomes of Neonatal Intensive Care." 1 Stedman's Medical Dictionary defines acuity as "sharpness, clearness, distinctness."21 do not think this is the sense of the word the authors intended. For years, intensivists have used the word to mean "acuteness or severity of illness" as a sort of shorthand medical slang. In the proper context, its meaning is clear, but it is still not correct usage. I am disappointed that the authors would use this term in an article for publication and that the editorial staff did not catch this error and insist that it be corrected before publication.
Paul Kaplowitz, MD Department of Pediatrics MCV Hospitals Virginia Commonwealth University Richmond, VA 23298-0140 9/35/65761 REFERENCES 1. Kotagal UR, Perlstein PH, Atherton HD, Donovan EF. Acuity scores as predictors of cost-related outcomes of neonatal intensive care. J PEDIATR 1995;126:88-93. 2. Hensyl WR, ed. Stedman's medical dictionary. 25th ed. Baltimore: Williams & Wilkins, 1990:22.
Reply To the Editor: My colleagues and I agree that the word acuity refers to clarity or clearness. In Miller Keane Encyclopedia Dictionary of Medicine, Nursing and Allied Health, 1 in addition to the above definition, the authors define "the degree of acuity of illness" as one way in which the word acuity is used. In McGraw-Hill's Essential Dictionary of Health Care, the word acuity is defined as "a keenness of sensory perception, as of hearing or perceptiveness of mind," and "nursing jargon--requirement for nursing care," synonymous with "nursing intensity." In the purest sense we completely agree that this latter definition is a stretch of the meaning of the word acuity and that it has moved into the medical text as a shorthand medical slang to mean acuteness of illness. Finally, in the Oxford English Dictionary acuity is also defined in relation to a disease, "the disease may at any time take on the characteristics of virulence and acuity. ''3 Thank you for raising this very interesting point.
Uma R. Kotagal, MD Department of Pediatrics University of Cincinnati Medical Center Children's Hospital Medical Center Cincinnati, OH 45267-0541 9/35/65762
The Journal of Pediatrics
REFERENCES 1. Miller Keane. Encyclopedia of medicine, nursing and allied health. 5th ed. Philadelphia: WB Saunders, 1992:23. 2. Essential dictionary of health care. New York: McGraw-Hill, 1988:114. 3. Oxford English dictionary. Oxford, United Kingdom: Oxford University Press, 1933:97.
Reply Mea culpa, mea culpa. Our thanks to Dr. Kaplowitz for calling attention to our failure to defend our language against the further inroads of clinical jargon. As contributors to THE JoLr~AL know, we do battle the misuse of parameter, the use of nouns as verbs, and the introduction of unnecessary neologisms. This latest misdemeanor (alas, there have been others) will be a stimulus to increased vigilance. Let us hope that the new editor will do better.
Joseph M. Garfunkel, MD Editor 9•35/65763
Home medical care for children To the Editor: I read with interest the article on pediatric home care by Goldberg et al. (J PEDIATR 1994;125:686-90) and agree thoroughly with their conclusions regarding the importance of physician involvement in this area. I was puzzled, however, by the fact that they did not make use of a long line of literature on pediatric involvement in home care programs and their evaluation, as well as training issues. They did not cite even the seminal article in this area by my colleague, Dr. Ruth E. K. Stein, that appeared in THE JOCP,NAL more than 15 years ago (Stein REK. Pediatric home care: an ambulatory special care unit. J PED~ArR 1978;92:495-9). Some of the work of Aday and associates cited by Goldberg et al. (their references 4 and 5) was a direct outgrowth of the earlier evaluation of pediatric home care by Dr. Stein and her research team, and used the instruments developed by Dr. Stein and associates. I was part of the consultant panel on the Aday study to maximize continuity between the two studies on these very issues. I raise these issues to point out that the case by Goldberg et al. is stronger than they depicted. A more inclusive view of the pediattic home care model Would show that physician involvement is not a recent development in the home care field. Pediatricians have been an early and continuing source of leadership on pediatric home care models and evaluation for many years.
Dorothy Jones Jessop, PhD Medical and Health Research Association of New York City, Inc. New York, NY 10013-2988 9•35•64043
August 1995
33 1
Acuity versus acuteness of illness To the Editor: I am writing to express a concern about the misuse of the word
acuity in both the title and text of an article in the January issue of the JOURNAL: "Acuity Scores as Predictors of Cost-related Outcomes of Neonatal Intensive Care." 1 Stedman's Medical Dictionary defines acuity as "sharpness, clearness, distinctness."21 do not think this is the sense of the word the authors intended. For years, intensivists have used the word to mean "acuteness or severity of illness" as a sort of shorthand medical slang. In the proper context, its meaning is clear, but it is still not correct usage. I am disappointed that the authors would use this term in an article for publication and that the editorial staff did not catch this error and insist that it be corrected before publication.
Paul Kaplowitz, MD Department of Pediatrics MCV Hospitals Virginia Commonwealth University Richmond, VA 23298-0140 9/35/65761 REFERENCES 1. Kotagal UR, Perlstein PH, Atherton HD, Donovan EF. Acuity scores as predictors of cost-related outcomes of neonatal intensive care. J PEDIATR 1995;126:88-93. 2. Hensyl WR, ed. Stedman's medical dictionary. 25th ed. Baltimore: Williams & Wilkins, 1990:22.
Reply To the Editor: My colleagues and I agree that the word acuity refers to clarity or clearness. In Miller Keane Encyclopedia Dictionary of Medicine, Nursing and Allied Health, 1 in addition to the above definition, the authors define "the degree of acuity of illness" as one way in which the word acuity is used. In McGraw-Hill's Essential Dictionary of Health Care, the word acuity is defined as "a keenness of sensory perception, as of hearing or perceptiveness of mind," and "nursing jargon--requirement for nursing care," synonymous with "nursing intensity." In the purest sense we completely agree that this latter definition is a stretch of the meaning of the word acuity and that it has moved into the medical text as a shorthand medical slang to mean acuteness of illness. Finally, in the Oxford English Dictionary acuity is also defined in relation to a disease, "the disease may at any time take on the characteristics of virulence and acuity. ''3 Thank you for raising this very interesting point.
Uma R. Kotagal, MD Department of Pediatrics University of Cincinnati Medical Center Children's Hospital Medical Center Cincinnati, OH 45267-0541 9/35/65762
The Journal of Pediatrics
REFERENCES 1. Miller Keane. Encyclopedia of medicine, nursing and allied health. 5th ed. Philadelphia: WB Saunders, 1992:23. 2. Essential dictionary of health care. New York: McGraw-Hill, 1988:114. 3. Oxford English dictionary. Oxford, United Kingdom: Oxford University Press, 1933:97.
Reply Mea culpa, mea culpa. Our thanks to Dr. Kaplowitz for calling attention to our failure to defend our language against the further inroads of clinical jargon. As contributors to THE JoLr~AL know, we do battle the misuse of parameter, the use of nouns as verbs, and the introduction of unnecessary neologisms. This latest misdemeanor (alas, there have been others) will be a stimulus to increased vigilance. Let us hope that the new editor will do better.
Joseph M. Garfunkel, MD Editor 9•35/65763
Home medical care for children To the Editor: I read with interest the article on pediatric home care by Goldberg et al. (J PEDIATR 1994;125:686-90) and agree thoroughly with their conclusions regarding the importance of physician involvement in this area. I was puzzled, however, by the fact that they did not make use of a long line of literature on pediatric involvement in home care programs and their evaluation, as well as training issues. They did not cite even the seminal article in this area by my colleague, Dr. Ruth E. K. Stein, that appeared in THE JOCP,NAL more than 15 years ago (Stein REK. Pediatric home care: an ambulatory special care unit. J PED~ArR 1978;92:495-9). Some of the work of Aday and associates cited by Goldberg et al. (their references 4 and 5) was a direct outgrowth of the earlier evaluation of pediatric home care by Dr. Stein and her research team, and used the instruments developed by Dr. Stein and associates. I was part of the consultant panel on the Aday study to maximize continuity between the two studies on these very issues. I raise these issues to point out that the case by Goldberg et al. is stronger than they depicted. A more inclusive view of the pediattic home care model Would show that physician involvement is not a recent development in the home care field. Pediatricians have been an early and continuing source of leadership on pediatric home care models and evaluation for many years.
Dorothy Jones Jessop, PhD Medical and Health Research Association of New York City, Inc. New York, NY 10013-2988 9•35•64043
August 1995
33 1