CHAPTER 1

CONCEPTS OF HEALTH AND DISEASE

LESSON 1: HEALTH AND DISEASE

HEALTH

The World Health Organization (WHO) in 1948 defined health as a “state of complete
physical, mental, and social well-being and not merely the absence of disease and infirmity.”
Although ideal for many people, this was an unrealistic goal. At the World Health Assembly in
1977, representatives of the member governments of WHO agreed that their goal was to have
all citizens of the world reach a level of health by the year 2000 that allows them to live a
socially and economically productive life.10 The U.S. Department of Health and Human Services
in Healthy People 2010 described the determinants of health as an interaction between an
individual’s biology and behavior, physical and social environments, government policies and
interventions, and access to quality health care.

HEALTH AND DISEASE AS STATES OF ADAPTATION

The ability of the body to adapt both physically and psychologically to the many stresses
that occur in both health and disease is affected by a number of factors, including age, health
status, psychosocial resources, and the rapidity with which the need to adapt occurs. Generally
speaking, adaptation affects the whole person. When adapting to stresses that are threats to
health, the body uses those behaviors that are the most efficient and effective. It does not use
long-term mechanisms when short-term adaptation is sufficient. The increase in heart rate that
accompanies a febrile illness is a temporary response designed to deliver additional oxygen to
tissues during the short period that the elevated temperature increases metabolic needs.
Adaptation is further affected by the availability of adaptive responses and the ability of the
body to select the most appropriate response. The ability to adapt is dependent on the
availability of adaptive responses—the greater number of available responses, the more
effective is the capacity to adapt.

DISEASE
The term pathophysiology, may be defined as the physiology of altered health. The term
combines the words pathology and physiology. Pathology (from the Greek pathos, meaning
“disease”) deals with the study of the structural and functional changes in cells, tissues, and
organs of the body that cause or are caused by disease. Physiology deals with the functions of
the human body. Thus, pathophysiology deals not only with the cellular and organ changes that
occur with disease but also with the effects that these changes have on total body function.
Pathophysiology also focuses on the mechanisms of the underlying disease and provides the
background for preventive as well as therapeutic health care measures and practices.
A disease has been defined as any deviation from or interruption of the normal structure
or function of a part, organ, or system of the body that is manifested by a characteristic set of
symptoms or signs. The aspects of the disease process include the etiology, pathogenesis,
morphologic changes, clinical manifestations, diagnosis, and clinical course.
The World Health Organization includes physical, mental, and social well-being in its definition
of health. A state of health is difficult to define because the genetic differences among
individuals as well as the many variations in life experiences and environmental influences
create a variable base. The context in which health is measured is also a consideration. A one
who is blind can be in good general health. Injury or surgery may create a temporary
impairment in a specific area, but the person’s overall health status is not altered.
Homeostasis is the maintenance of a relatively stable internal environment regardless of
external changes. Disease develops when significant changes occur in the body, leading to a
state in which homeostasis cannot be maintained without intervention. Under normal conditions
homeostasis is maintained within the body with regard to factors such as blood pressure, body
temperature, and fluid balance. As frequent minor changes occur in the body, the compensation
mechanisms respond, and homeostasis is quickly restored. Usually the individual is not aware of
these changes or the compensations taking place. Steps to Health (Table 1.1) are
recommended to prevent disease.

Table 1.1. Seven Steps to Health

1. Be a nonsmoker and avoid second-hand smoke.

2. Eat 5 to 10 servings of vegetables and fruit a day. Choose high-fiber, lower-fat foods. If you drink
alcohol, limit your intake to one to two drinks a day.
3. Be physically active on a regular basis. This will also help you to maintain a healthy body weight.
4. Protect yourself and your family from the sun.
5. Follow cancer screening guidelines.
6. Visit your doctor or dentist if you notice any change in your normal state of health.
7. Follow health and safety instructions at home and at work when using, storing, and disposing of
hazardous materials.

CONCEPT AND SCOPE OF PATHOPHYSIOLOGY

Pathophysiology involves the study of functional or physiologic changes in the body that
result from disease processes. This subject builds on knowledge of the normal structure and
function of the human body. Disease development and the associated changes to normal
anatomy or physiology may be obvious or may be hidden with its quiet beginning at the cellular
level. As such, pathophysiology includes some aspects of pathology, the laboratory study of cell
and tissue changes associated with disease.
Pathophysiology is, therefore, based on a loss of or a change in normal structure and
function. This basis also saves relearning many facts. Many disorders affecting a particular
system or organ—for example, the liver— display a set of common signs and symptoms directly
related to that organ’s normal structure and function. For example, when the liver is damaged,
many clotting factors cannot be produced; therefore, excessive bleeding results. Jaundice, a
yellow color in the skin, is another sign of liver disease, resulting from the liver’s inability to
excrete bilirubin. Also, basic pathophysiologic concepts related to the causative factors of a
disease, such as the processes of inflammation or infection, are common to many diseases.
Inflammation in the liver causes swelling of the tissue and stretching of the liver capsule,
resulting in pain, as does inflammation of the kidneys. This cause and effect relationship,
defined by signs and symptoms, facilitates the study of a specific disease.
Prevention of disease has become a primary focus in health care. The known causes of
and factors predisposing to specific diseases are being used in the development of more
effective preventive programs, and it is important to continue efforts to detect additional
significant factors and gather data to further decrease the incidence of certain diseases. The
Centers for Disease Control and Prevention in the United States have a significant role in
collection of data about all types of disease and provide evidence-based recommendations for
prevention. Prevention includes activities such as maintaining routine vaccination programs and
encouraging participation in screening programs such as blood pressure clinics and vision
screening.
While studying pathophysiology, one becomes aware of the complexity of many
diseases, the difficulties encountered in diagnosis and treatment, and the possible implications
arising from a list of signs and symptoms or a prognosis. Sophisticated and expensive
diagnostic tests are now available. The availability of these tests, however, also depends on the
geographic location of individuals, including their access to large, well-equipped medical
facilities. More limited resources may restrict the number of diagnostic tests available to an
individual, or a long waiting period may be necessary before testing and treatment are
available. When one understands the pathophysiology, comprehension of the manifestations
and potential complications of a disease, and its treatment, the pathophysiology of a disease,
comprehension of its manifestations and potential complications, and its treatment, usually
follow. A solid knowledge base enables health care professionals to meet these increased
demands with appropriate information.

Etiology
The causes of disease are known as etiologic factors. Among the recognized etiologic
agents are biologic agents (e.g., bacteria, viruses), physical forces ( e.g., trauma, burns,
radiation), chemical agents (e.g., poisons, alcohol), and nutritional excesses or deficits. Most
disease-causing agents are nonspecific, and many different agents can cause disease of a single
organ. For example, lung disease can result from trauma, infection, exposure to physical and
chemical agents, or neoplasia. With severe lung involvement, each of these agents has the
potential to cause respiratory failure. On the other hand, a single agent or traumatic event can
lead to disease of a number of organs or systems. For example, severe circulatory shock can
cause multi-organ failure. Although a disease agent can affect more than a single organ, and a
number of disease agents can affect the same organ, most disease states do not have a single
cause. Instead, most diseases are multifactorial in origin. This is particularly true of diseases
such as cancer, heart disease, and diabetes. The multiple factors that predispose to a particular
disease often are referred to as risk factors.
One way to view the factors that cause disease is to group them into categories
according to whether they were present at birth or acquired later in life. Congenital conditions
are defects that are present at birth, although they may not be evident until later in life.
Congenital malformation may be caused by genetic influences, environmental factors ( e.g., viral
infections in the mother, maternal drug use, irradiation, or intrauterine crowding), or a
combination of genetic and environmental factors. Not all genetic disorders are evident at birth.
Many genetic disorders, such as familial hypercholesterolemia and polycystic kidney disease,
take years to develop. Acquired defects are those that are caused by events that occur after
birth. These include injury, exposure to infectious agents, inadequate nutrition, lack of oxygen,
inappropriate immune responses, and neoplasia. Many diseases are thought to be the result of
a genetic predisposition and an environmental event or events that serve as a trigger to initiate
disease development.

Pathogenesis
Pathogenesis is the sequence of cellular and tissue events that take place from the time
of initial contact with an etiologic agent until the ultimate expression of a disease. Etiology
describes what sets the disease process in motion, and pathogenesis, how the disease process
evolves. Although the two terms often are used interchangeably, their meanings are quite
different. For example, atherosclerosis often is cited as the cause or etiology of coronary heart
disease. In reality, the progression from fatty streak to the occlusive vessel lesion seen in
persons with coronary heart disease represents the pathogenesis of the disorder. The true
etiology of atherosclerosis remains largely uncertain.

Morphology
Morphology refers to the fundamental structure or form of cells or tissues. Morphologic
changes are concerned with both the gross anatomic and microscopic changes that are
characteristic of a disease. Histology deals with the study of the cells and extracellular matrix of
body tissues. The most common method used in the study of tissues is the preparation of
histologic sections that can be studied with the aid of a microscope. Because tissues and organs
usually are too thick to be examined under a microscope, they must be sectioned to obtain thin,
translucent sections. Histologic sections play an important role in the diagnosis of many types of
cancer. A lesion represents a pathologic or traumatic discontinuity of a body organ or tissue.
Descriptions of lesion size and characteristics often can be obtained through the use of
radiographs, ultrasonography, and other imaging methods. Lesions also may be sampled by
biopsy and the tissue samples subjected to histologic study.

Clinical Manifestations
Disease can be manifested in a number of ways. Sometimes, the condition produces
manifestations, such as fever, that make it evident that the person is sick. Other diseases are
silent at the onset and are detected during examination for other purposes or after the disease
are far advanced.
Signs and symptoms are terms used to describe the structural and functional changes
that accompany a disease. A symptom is a subjective complaint that is noted by the person
with a disorder, whereas a sign is a manifestation that is noted by an observer. Pain, difficulty
in breathing, and dizziness are symptoms of a disease. An elevated temperature, a swollen
extremity, and changes in pupil size are objective signs that can be observed by someone other
than the person with the disease. Signs and symptoms may be related to the primary disorder,
or they may represent the body’s attempt to compensate for the altered function caused by the
pathologic condition.

Diagnosis
A diagnosis is the designation as to the nature or cause of a health problem ( e.g.,
bacterial pneumonia or hemorrhagic stroke). The diagnostic process usually requires a careful
history and physical examination. The history is used to obtain a person’s account of his or her
symptoms, their progression, and the factors that contribute to a diagnosis. The physical
examination is done to observe for signs of altered body structure or function. The development
of a diagnosis involves weighing competing possibilities and selecting the most likely one from
among the conditions that might be responsible for the person’s clinical presentation. The
clinical probability of a given disease in a person of a given age, sex, race, lifestyle, and locality
often is influential in arriving at a presumptive diagnosis. Laboratory tests, radiologic studies,
CT scans, and other tests often are used to confirm a diagnosis.

Normality
An important factor when interpreting diagnostic test results is the determination of
whether they are normal or abnormal. Is a blood count above normal, within the normal range,
or below normal? Normality usually determines whether further tests are needed or if
interventions are necessary. What is termed a normal value for a laboratory test is established
statistically from test results obtained from a selected sample of people. The normal values
refer to the 95% distribution (mean plus or minus two standard deviations of test results for the
reference population. The normal values for some laboratory tests are adjusted for sex or age.
For example, the normal hemoglobin range for women is 12.0 to 16.0 g/dL and for men, 14.0
to 17.4 g/dL.15 Serum creatinine level often is adjusted for age in the elderly, and normal
values for serum phosphate differ between adults and children.

Reliability, Validity, Sensitivity, Specificity, and Predictive Value.

The quality of data on which a diagnosis is based may be judged for its reliability, validity,
sensitivity, specificity, and predictive value. Reliability refers to the extent to which an
observation, if repeated, gives the same result. A poorly calibrated blood pressure machine may
give inconsistent measurements of blood pressure, particularly of pressures in either the high or
low range. Reliability also depends on the persons making the measurements. For example,
blood pressure measurements may vary from one observer to another because of the technique
that is used (e.g., different observers may deflate the cuff at a different rate, thus obtaining
different values), the way the numbers on the manometer are read, or differences in hearing
acuity. Validity refers to the extent to which a measurement tool measures what it is intended
to measure. This often is assessed by comparing a measurement method with the best possible
method of measure that is available. For example, the validity of blood pressure measurements
obtained by a sphygmomanometer might be compared with those obtained by intraarterial
measurements. Measures of sensitivity and specificity are concerned with determining how well
the test or observation identifies people with the disease and people without the disease.
Sensitivity refers to the proportion of people with a disease who are positive for that disease on
a given test or observation (called a true-positive result). Specificity refers to the proportion of
people without the disease who are negative on a given test or observation (called a true-
negative result). A test that is 95% specific correctly identifies 95 of 100 normal people. The
other 5% are false-positive results. A false-positive test result, particularly for conditions such
as human immunodeficiency virus (HIV) infection, can be unduly stressful for the person being
tested. In the case of HIV testing, a positive result on the initial antibody test is followed up
with a more sensitive test. On the other hand, false-negative test results in conditions such as
cancer can delay diagnosis and jeopardize the outcome of treatment. Predictive value is the
extent to which an observation or test result is able to predict the presence of a given disease
or condition. A positive predictive value refers to the proportion of true-positive results that
occurs in a given population. In a group of women found to have “suspect breast nodules” in a
cancer-screening program, the proportion later determined to have breast cancer would
constitute the positive predictive value. A negative predictive value refers to the true-negative
observations in a population. In a screening test for breast cancer, the negative predictive value
represents the proportion of women without suspect nodules who do not have breast cancer.
Although predictive values rely in part on sensitivity and specificity, they depend more heavily
on the prevalence of the condition in the population. Despite unchanging sensitivity and
specificity, the positive predictive value of an observation rises with prevalence, whereas the
negative predictive value falls.

Clinical Course
The clinical course describes the evolution of a disease. A disease can have an acute,
subacute, or chronic course. An acute disorder is one that is relatively severe, but self-limiting.
Chronic disease implies a continuous, long-term process. A chronic disease can run a
continuous course, or it can present with exacerbations (aggravation of symptoms and severity
of the disease) and remissions (a period during which there is a lessening of severity and a
decrease in symptoms). Subacute disease is intermediate or between acute and chronic: it is
not as severe as an acute disease and not as prolonged as a chronic disease.
The spectrum of disease severity for infectious diseases such as hepatitis B can range
from preclinical to persistent chronic infection. During the preclinical stage, the disease is not
clinically evident but is destined to progress to clinical disease. As with hepatitis B, it is possible
to transmit the virus during the preclinical stage. Subclinical disease is not clinically apparent
and is not destined to become clinically apparent. It is diagnosed with antibody or culture tests.
Most cases of tuberculosis are not clinically apparent, and evidence of their presence is
established by skin tests.
Clinical disease is manifested by signs and symptoms. A persistent chronic infectious disease
persists for years, sometimes for life. Carrier status refers to an individual who harbors an
organism but is not infected, as evidenced by antibody response or clinical manifestations. This
person still can infect others. Carrier status may be of limited duration, or it may be chronic,
lasting for months or years.

LESSON 2: PERSPECTIVES ON HEALTH AND DISEASE IN POPULATIONS

The health of individuals is closely linked to the health of the community and to the
population it encompasses. The ability to traverse continents in a matter of hours has
opened the world to issues of populations at a global level. Diseases that once were confined to
local areas of the world now pose a threat to populations throughout the world. As we move
through the twenty-first century, we are continually reminded that the health care system and
the services it delivers are targeted to particular populations.
Managed care systems are focused on a population-based approach to planning,
delivering, providing, and evaluating health care. The focus of health care also has begun to
emerge as a partnership in which individuals are asked to assume greater responsibility for their
own health.

EPIDEMIOLOGY AND PATTERNS OF DISEASE

Epidemiology is the study of disease in populations. It was initially developed to explain
the spread of infectious diseases during epidemics and has emerged as a science to study risk
factors for multifactorial diseases, such as heart disease and cancer. Epidemiology looks for
patterns, such as age, race, dietary habits, lifestyle, or geographic location of persons affected
with a particular disorder. In contrast to biomedical researchers, who seek to elucidate the
mechanisms of disease production, epidemiologists are more concerned with whether
something happens than how it happens.
Much of our knowledge about disease comes from epidemiologic studies. Epidemiologic
methods are used to determine how a disease is spread, how to control it, how to prevent it,
and how to eliminate it. Epidemiologic methods also are used to study the natural history of
disease, to evaluate new preventative and treatment strategies, to explore the impact of
different patterns of health care delivery, and to predict future health care needs. As such,
epidemiologic studies serve as a basis for clinical decision making, allocation of health care
dollars, and development of policies related to public health issues.
 Prevalence and Incidence
Measures of disease frequency are an
important aspect of epidemiology. They establish a
means for predicting what diseases are present in
a population and provide an indication of the rate
at which they are increasing or decreasing. A
disease case can be either an existing case or the
number of new episodes of a particular illness that
is diagnosed within a given period. Incidence is the
number of new cases arising in a population during
a specified time. It is determined by dividing the
number of new cases of a disease by the
population at risk for development of the disease
during the same period.

Prevalence is the number of people in a

population who have a particular disease at a given point in time or period. It is determined by
dividing the existing number of cases by the population at risk for development of the disorder
during the same period. Incidence and prevalence rates always are reported as proportions
(e.g., cases per 100 or cases per 100,000).

Morbidity and Mortality

Morbidity and mortality statistics provide information about the functional effects
(morbidity) and death producing (mortality) characteristics of a disease. These statistics are
useful in terms of anticipating health care needs, planning of public education programs,
directing health research efforts, and allocating health care dollars.
Mortality or death statistics provide information about the trends in the health of a
population. In most countries, people are legally required to record certain facts such as age,
sex, and cause of death on a death certificate. Internationally agreed classification procedures
(the International Classification of Diseases by the WHO) are used for coding the cause of
death, and the data are expressed as death rates. Crude mortality rates ( i.e., number of deaths
in a given period) do not account for age, sex, race, socioeconomic status, and other factors.
For this reason, mortality often is expressed as death rates for a specific population, such as the
infant mortality rate. Mortality also can be described in terms of the leading causes of death
according to age, sex, race, and ethnicity. Among all persons 65 years of age and older, the five
leading causes of death in the United States are heart disease, cancer, stroke, chronic
obstructive lung disease, and pneumonia and influenza. In 1997, for example, diabetes was the
third leading cause of death among American Indians 65 years of age and older, the fourth
leading cause of death among older Hispanic and black persons, and the sixth leading cause of
death among older white persons and Asian Americans.
Morbidity describes the effects an illness has on a person’s life. Many diseases, such as
arthritis, have low death rates but have a significant impact on a person’s life. Morbidity is
concerned not only with the occurrence or incidence of a disease but also with persistence and
the long-term consequences of the disease.
DETERMINATION OF RISK FACTORS
Conditions suspected of contributing to the development of a disease are called risk
factors. They may be inherent to the person (high blood pressure or overweight) or external
(smoking or drinking alcohol). There are different types of studies used to determine risk
factors, including cross-sectional studies, case-control studies, and cohort studies.
Cross-sectional studies use the simultaneous collection of information necessary for
classification of exposure and outcome status. They can be used to compare the prevalence of
a disease in those with the factor (or exposure) with the prevalence of a disease in those who
are unexposed to the factor, such as the prevalence of coronary heart disease in smokers and
nonsmokers. Case-control studies are designed to compare persons known to have the
outcome of interest (cases) and those known not to have the outcome of interest ( control).
Information on exposures or characteristics of interest is then collected from persons in both
groups. For example, the characteristics of maternal alcohol consumption in infants born with
fetal alcohol syndrome (cases) can be compared with those in infants born without the
syndrome (control). A cohort is a group of persons who were born at approximately the same
time or share some characteristics of interest. Persons enrolled in a cohort study (also called a
longitudinal study) are followed over a period to observe some health outcome. A cohort may
consist of a single group of persons chosen because they have or have not been exposed to
suspected risk factors; two groups specifically selected because one has been exposed and the
other has not; or a single exposed group in which the results are compared with the general
population. The Framingham Study, which examined the characteristics of people who would
later experience coronary heart disease, and the Nurses’ Health Study, which initially explored
the relationship between oral contraceptives and breast cancer, are two well-known cohort
studies.

NATURAL HISTORY
The natural history of disease refers to the progression and projected outcome of a
disease without medical intervention. By studying the patterns of a disease over time in
populations, epidemiologists can better understand its natural history. A knowledge of the
natural history can be used to determine disease outcome, establish priorities for
health care services, determine the effects of screening and early detection programs on
disease outcome, and compare the results of new treatments with the expected outcome
without treatment.
Prognosis refers to the probable outcome and prospect of recovery from a disease. It
can be designated as chances for full recovery, possibility of complications, or anticipated
survival time. Prognosis often is presented in relation to treatment options—that is, the
expected outcomes or chances for survival with or without a certain type of treatment. The
prognosis associated with a given type of treatment usually is presented along with the risk
associated with the treatment.

LESSON 3: LEVELS OF PREVENTION

Basically, leading a healthy life contributes to the prevention of disease. There are three
fundamental types of prevention: primary prevention, secondary prevention, and tertiary
prevention (Table 1.2). Primary prevention is directed at keeping disease from occurring by
removing all risk factors. Immunizations are examples of primary prevention. Secondary
prevention detects disease early when it is still asymptomatic and treatment measures can
affect a cure. The use of a Papanicolaou (Pap) smear for early detection of cervical cancer is an
example of secondary prevention. Tertiary prevention is directed at clinical interventions that
prevent further deterioration or reduce the complications of a disease once it has been
diagnosed. An example is the use of specific medications to reduce the risk for death in persons
who have had a heart attack. Tertiary prevention measures also include measures to limit
physical impairment and social consequences of an illness.
Primary prevention often is accomplished outside the health care system. Chlorination
and fluoridation of water supplies and laws that mandate seat belt use are examples of
community-wide primary prevention. There are fewer community-wide efforts directed at
secondary prevention, and those that are available usually do not involve the entire community.
Examples include breast self-examination education programs and blood pressure screening
programs. Nevertheless, many health care clinics are becoming increasingly devoted to primary
and secondary prevention through such activities as prenatal and well-child care,
immunizations, lifestyle counseling, and screening for early disease detection or risk factors.
There are many fewer tertiary prevention efforts outside the health care system.

Table 1.2. Primary, Secondary, and Tertiary Prevention

Primary Prevention

- The goal is to protect healthy people from developing a disease or experiencing an injury in the
first place. For example:
1. Education about good nutrition, the importance of regular exercise, and the dangers of
tobacco, alcohol, and other drugs.
2. Education and legislation about proper seat belt and helmet use
3. Regular exams and screening tests to monitor risk factors for illness
4. Immunization against infectious disease
5. Controlling potential hazards at home and in the workplace
Secondary Prevention

- These interventions happen after an illness or serious risk factors have already been diagnosed.
The goal is to halt or slow the progress of disease (if possible) in its earliest stages; in the case of
injury, goals include limiting long-term disability and preventing reinjury. For example:
1. Telling people to take daily, low-dose aspirin to prevent a first or second heart attack or
stroke
2. Recommending regular exams and screening tests in people with known risk factors for
illness
3. Providing suitably modified work for injured workers
Tertiary Prevention

- This phase focuses on helping people manage complicated, long-term health problems such as
diabetes, heart disease, cancer, and chronic musculoskeletal pain. The goals include preventing
further physical deterioration and maximizing quality of life. For example:
1. Cardiac or stroke rehabilitation programs
2. Chronic pain management programs
3. Patient support groups

EVIDENCE-BASED PRACTICE AND PRACTICE GUIDELINES

Evidence-based practice and evidence-based practice guidelines have recently gained
popularity with clinicians, public health practitioners, health care organizations, and the public
as a means of improving the quality and efficiency of health care. Their development has been
prompted, at least in part, by the enormous amounts of published information about diagnostic
and treatment measures for various disease conditions as well as demands for better and more
cost-effective health care.
Evidence-based practice has been defined as “the conscientious, explicit, and judicious
use of current best evidence in making decisions about the care of individual patients.” It is
based on the integration of the individual expertise of the practitioner with the best external
clinical evidence from systematic research. The term clinical expertise implies the proficiency
and judgment that individual clinicians gain through clinical experience and clinical practice. The
best external clinical evidence relies on the identification of clinically relevant research, often
from the basic sciences, but especially from patient-centered clinical studies that focus on the
accuracy and precision of diagnostic tests and methods, the power of prognostic indicators, and
the effectiveness and safety of therapeutic, rehabilitative, and preventive regimens.
Clinical practice guidelines are systematically developed statements intended to inform
practitioners and clients in making decisions about health care for specific clinical
circumstances. They not only should review various outcomes but also must weigh various
outcomes, both positive and negative, and make recommendations.
Guidelines are different from systematic reviews. They can take the form of algorithms, which
are step-by-step methods for solving a problem, written directives for care, or a combination
thereof. The development of evidence-based practice guidelines often uses methods such as
meta-analysis to combine evidence from different studies to produce a more precise estimate of
the accuracy of a diagnostic method or the effects of an intervention method. It also requires
review: by practitioners with expertise in clinical content, who can verify the completeness of
the literature review and ensure clinical sensibility; by experts in guideline development who
can examine the method by which the guideline was developed; and by potential users of the
guideline. Once developed, practice guidelines must be continually reviewed and changed to
keep pace with new research findings and with new diagnostic and treatment methods. For
example, the Guidelines for the Prevention, Evaluation, and Treatment of High Blood Pressure,
first developed in 1972 by the Joint National Committee, have been revised seven times, and
the Guidelines for the Diagnosis and Management of Asthma, first developed in 1991 by the
Expert Panel, have undergone three revisions. Evidence-based practice guidelines, which are
intended to direct client care, are also important in directing research into the best methods of
diagnosing and treating specific health problems. This is because health care providers use the
same criteria for diagnosing the extent and severity of a particular condition such as
hypertension and because they use the same protocols for treatment.

Prepared by:
AMIEL F. REYES

REFERENCES:

Textbooks:

Pathophysiology Concepts of Altered Health States by Carol Mattson Porth,

Other References:

1. Pathophysiology, 6th edition by Jacquelyn L. Banasik and Lee-Ellen C. Copstead.

2019
2. Pathophysiology for the Health Professions, 3rd edition by Barbara E. Gould.2007
3. Color Atlas of Pathophysiology by Stefan Silbernagl and Florian Lang. 2000
4. Pathophysiology Made Incredibly Easy!, 5th edition by Wolter Luwer and Lipincott
Williams and Wilkins. 2013

Websites:

1. http://www.pathophys.org
2. https://www.imedpub.com/scholarly/pathophysiology-journals-articles-ppts-
list.php
3. https://www.edx.org/learn/pathophysiology
4. http://www.youtube.com