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Case definitions integrating empiric and consensus perspectives

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By L. A. Jason et al.

Abstract

BACKGROUND: There has been considerable controversy regarding how to name and define the illnesses known as myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS). The IOM report has proposed a new clinical criteria and name for this illness, but aspects of these recommendations have been scrutinized by patients and scientists.

PURPOSE: It is possible that both empiric and consensus approaches could be used to help settle some of these diagnostic challenges. Using patient samples collected in the United States, Great Britain, and Norway (N=556), the current study attempted to categorize patients using more general as well as more restricted case definitions.

RESULTS: Overall, the outcomes suggest that there might be four groupings of patients, with the broadest category involving those with chronic fatigue (N=62), defined by 6 or more months of fatigue which can be cannot be explained by medical or psychiatric conditions. A second category involves those patients that have chronic fatigue that can be explained by a medical or psychiatric condition (N=47). A third category involves more specific criteria that have been posited both by the IOM report, a Canadian Clinical Case criteria, a ME-ICC criteria and a more empiric approach. These efforts have specified domains of substantial reductions of activity, post-exertional malaise, neurocognitive impairment, and sleep dysfunction (N=346). Patients with these characteristics were more functionally impaired than those meeting just chronic fatigue criteria, p < .05. Finally, those meeting even more restrictive ME criteria proposed by Ramsay, identified a smaller and even more impaired group, p < .05.

DISCUSSION: The advantages of using such empirical and consensus approaches to develop reliable classification and diagnostic efforts are discussed.

Source: Jason LA, McManimen S, Sunnquist M, Brown A, Furst J, Newton JL, Strand EB. Case definitions integrating empiric and consensus perspectives. Fatigue. 2016;4(1):1-23. Epub 2016 Jan 19.

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One thought on “Case definitions integrating empiric and consensus perspectives”

  1. jadam914 says:

    First patient category is created by the worst of the watered-down and unaccepted definitions by true experts. The second patient category is non-existent by even most, unscientific and unreasonable case definitions. Both in my opinion are counterproductive, useless, and muddy the waters. There’s some debate that the 3rd and 4th categories are one in the same, a subclass of the other or a parallel disease. These categories are derived from expert accepted case definitions.The Chronic Fatigue Label must be severed from both the third and fourth categories because of the destructive and trivializing nature of the name.

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