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PubMed2005

A developmental and genetic classification for malformations of cortical development.

Increasing recognition of malformations of cortical development and continuing improvements in imaging techniques, molecular biologic techniques, and knowledge of mechanisms of brain development have resulted in continual improvement of the understanding of these disorders. The authors propose a revised classification based on the stage of development (cell proliferation, neuronal migration, cortical organization) at which cortical development was first affected. The categories are based on known developmental steps, known pathologic features, known genetics (when possible), and, when necessary, neuroimaging features. In those cases in which the precise developmental and genetic features are uncertain, classification is based on known relationships among the genetics, pathologic features, and neuroimaging features. The major change since the prior classification has been a shift to using genotype, rather than phenotype, as the basis for classifying disorders wherever the genotype-phenotype relationship is adequately understood. Other substantial changes include more detailed classification of congenital microcephalies, particularly those in which the genes have been mapped or identified, and revised classification of congenital muscular dystrophies and polymicrogyrias. Information on genetic testing is also included. This classification allows a better conceptual understanding of the disorders, and the use of neuroimaging characteristics allows it to be applied to all patients without necessitating brain biopsy, as in pathology-based classifications.

Cerebral Cortex↗

PubMed1991

A retrospective comparison between different stage classifications for nasopharyngeal carcinoma.

From 1984 to 1987, 659 patients with untreated nasopharyngeal carcinoma (NPC) were investigated by computed tomography of the nasopharynx and skull base, and fibreoptic nasopharyngoscopy. Thirty-one patients presenting with distant metastasis were treated palliatively; 628 were treated with intent to cure. Prospective staging was performed for the Ho's classification but since all T- and N-stage data required for staging according to the Huang's, the Changsha and the UICC classifications were recorded and stored in a computer database, retrospective staging according to these classifications could be accurately performed. Ho's classification was concluded to be the best in view of highly significant differences between the overall stages in survival and between N-stages in distant metastasis. The number of prognostically distinct overall stages and N-stages was greatest for Ho's classification. Huang's T-stage classification was superior, however, because it emphasized the significant adverse effect on local tumour control of cranial nerve(s) palsy (Tn) and intracranial tumour extension (Tc). Changsha and UICC classifications were demonstrably less powerful in predicting NPC prognosis. Multiple sites of involvement within the nasopharynx by NPC had no adverse influence on local tumour control. The grouping together of both soft-tissue and skull-base lesions into Changsha's T3 has been shown to be unjustified because of significant differences in local failure.

Humans↗

PubMedDate not supplied

Classification of pressure sores: 1.

It is anticipated that the forthcoming national clinical guidelines for the prevention and management of pressure sores will attempt to clarify pressure sore classification. There are many classification systems available, but to date not one has emerged as all-encompassing. A classification system has to be sufficiently detailed to allow accurate assessment of pressure sores. So far this has been difficult to achieve, particularly for pressure sores that do not involve a break in the skin. The assessment forms the basis upon which the patient's care will be planned. There are ethical, legal and financial implications if the assessment is unable to reflect accurately the true nature of the patient's pressure sore. Nurses have attempted to integrate pressure sore classification into the holistic patient assessment process. Their attempts are often thwarted by the limitations of the classification systems currently available. As a result a patient's pressure sore is allocated a classification in which the criteria chosen are nearest to the visual description of the sore, but do not accurately represent the true extent of tissue damage. This article, the first of two parts, highlights the problems of patient assessment and the limitations of current classification systems.

Humans↗

PubMed2003

Are "accidental" gun deaths as rare as they seem? A comparison of medical examiner manner of death coding with an intent-based classification approach.

OBJECTIVES: Unintentional firearm death is often considered a nearly negligible proportion of overall gun death. These rates are based on medical examiner (ME) and coroner death classifications, which affect derived epidemiologic data and subsequent prevention measures. The aim of this study was to compare the proportion of pediatric unintentional gun deaths in Miami-Dade County based on manner of death coding by the ME with an intent-based classification of child gun deaths. METHODS: ME and police records for all pediatric firearm fatalities in Miami-Dade County from 1994 to 1998 were reviewed. The ME's assignment of manner of death as homicide, suicide, or accident was compared with an intent-based classification of intentional homicide, intentional suicide, and unintentional firearm death based on expressed or implied evidence of intent to harm. RESULTS: There were 123 pediatric firearm deaths in Miami-Dade County from 1994 to 1998. A significant difference between ME coding and the intent-based classification was found for homicide (94 vs 78) but not for suicide. A significant difference was also found between the ME's coding for "accident" and the investigator's classification of "unintentional" firearm death (4 vs 26). CONCLUSIONS: The incidence of unintentional pediatric firearm deaths is significantly underreported by the Miami-Dade County ME when the classification of "accidental" firearm death is used. Reviewing the manner of death classification criteria or establishing an intent code on official death documentation is recommended. Furthermore, clinicians should be aware that the true incidence of unintentional gun death may be higher than that reported as accidental.

Accidents↗

PubMed1991

[Analysis of information on health: 1893-1993, one hundred years since the International Classification of Diseases].

The analysis of mortality by cause, as well as of morbidity, calls for an instrument that groups the diseases according to common characteristics, that is to say, a classification of diseases. The WHO International Classification of Diseases, in its Ninth Revision, is currently in use. This classification first appeared in 1893; its Tenth Revision is being proposed for 1993. This present paper describes the origins of this international classification, making special references to John Graunt, William Farr and Jacques Bertillon as well as describing the evolution that has occurred through its successive revisions. Initially it was a classification that included only causes of death. After the Sixth Revision included all the diseases and causes of medical consultations, thus allowing its use in morbidity. For the tenth and later revisions, a "family" of classifications is proposed, for a great variety of uses in health services, administration and epidemiology. Some critical observations on the current international classification of diseases are also presented.

Adult↗

PubMedDate not supplied

[Use of the disease family classification in epidemiology and health related problems].

This paper describes the evolution of disease frequency statistics and techniques used to present them. Beginning in the 17th century were the first specific references to causes of death and proceeding practically until the mid-20th century as mortality statistics by causes, the instrument for a methodical description of diseases was classification of causes of death. From the latter half of the 20th century on, in addition to mortality statistics by cause, morbidity statistics became routine, with the adoption of disease classification and no longer only classification by cause of death. More recently, classification has been adapted to medical specialties, resulting in what has been termed "disease family classification", including classification of the consequences of diseases, with statistics on disability. Disease classification, both for mortality and morbidity, fostered the development of various types of epidemiological studies (both descriptive and analytical) that expanded knowledge on health.

Cause of Death↗

PubMedDate not supplied

[Distal radius fractures: consistency of the classifications].

OBJECTIVE: The purpose of this study was to determine the intra-observer and interobserver reproducibility of Frykman, AO and Universal classifications for the fractures of the distal radius. METHODS: In this study, 40 radiographs of fractures of the distal radius were selected and classifed by orthopedists of different centers and levels of experience, determining the intra-observer and interobserver reproducibility of the classifications using Kappa statistic method. RESULTS: The medium intra-observer concordance observed was moderate to Frykman and Universal classifications and light to the AO system. The medium interobserver reproducibility was light in the two readings to Frykman and Universal classifications and despicable in the second reading of the AO classification. CONCLUSION: All the classifications used presented questionable interobserver reproducibility compromising the use of the three evaluated systems.

Humans↗

PubMed2026

Automated Classification of Lymphoma Subtypes From Histopathological Images Using a U-Net Deep Learning Model: Comparative Evaluation Study.

BACKGROUND: Accurate classification and grading of lymphoma subtypes are essential for treatment planning. Traditional diagnostic methods face challenges of subjectivity and inefficiency, highlighting the need for automated solutions based on deep learning techniques. OBJECTIVE: This study aimed to investigate the application of deep learning technology, specifically the U-Net model, in classifying and grading lymphoma subtypes to enhance diagnostic precision and efficiency. METHODS: In this study, the U-Net model was used as the primary tool for image segmentation integrated with attention mechanisms and residual networks for feature extraction and classification. A total of 620 high-quality histopathological images representing 3 major lymphoma subtypes were collected from The Cancer Genome Atlas and the Cancer Imaging Archive. All images underwent standardized preprocessing, including Gaussian filtering for noise reduction, histogram equalization, and normalization. Data augmentation techniques such as rotation, flipping, and scaling were applied to improve the model's generalization capability. The dataset was divided into training (70%), validation (15%), and test (15%) subsets. Five-fold cross-validation was used to assess model robustness. Performance was benchmarked against mainstream convolutional neural network architectures, including fully convolutional network, SegNet, and DeepLabv3+. RESULTS: The U-Net model achieved high segmentation accuracy, effectively delineating lesion regions and improving the quality of input for classification and grading. The incorporation of attention mechanisms further improved the model's ability to extract key features, whereas the residual structure of the residual network enhanced classification accuracy for complex images. In the test set (N=1250), the proposed fusion model achieved an accuracy of 92% (1150/1250), a sensitivity of 91.04% (1138/1250), a specificity of 89.04% (1113/1250), and an F1-score of 90% (1125/1250) for the classification of the 3 lymphoma subtypes, with an area under the receiver operating characteristic curve of 0.95 (95% CI 0.93-0.97). The high sensitivity and specificity of the model indicate strong clinical applicability, particularly as an assistive diagnostic tool. CONCLUSIONS: Deep learning techniques based on the U-Net architecture offer considerable advantages in the automated classification and grading of lymphoma subtypes. The proposed model significantly improved diagnostic accuracy and accelerated pathological evaluation, providing efficient and precise support for clinical decision-making. Future work may focus on enhancing model robustness through integration with advanced algorithms and validating performance across multicenter clinical datasets. The model also holds promise for deployment in digital pathology platforms and artificial intelligence-assisted diagnostic workflows, improving screening efficiency and promoting consistency in pathological classification.

Humans↗

PubMedDate not supplied

[ATC and EphMRA classifications: evolution from 1996 to 2003 and comparative analysis].

In their daily practice, health practitioners use one or more pharmacotherapeutic classifications. This diversity of classifications impairs the exchange of drug information, while the use of international or European classifications facilitates this diffusion. The "Hospital National Center of Drugs Information" (CNHIM) has integrated ATC (Anatomical Therapeutic Chemical) and EphMRA (European Pharmaceutical Marketing Research Association) classifications into its "Thériaque" database and has given the ATC official status in France by publishing a French translation. The objective of this article was to analyse the evolution of these two classification systems between 1996 and 2003, and to compare their allocations (of codes) with those for the drugs present in Thériaque in January 2002. The ATC comprises 14 principal groups and five levels of hierarchy, while the EphMRA comprises 16 principal groups and three to four levels. In Thériaque, the ATC is linked to active substances and drugs, and the EphMRA to drugs. Data-processing requests have made it possible to make a comparative analysis. Each year, the two classification systems evolve in terms of addition, suppression, modification and subdivision. Two principal differences are evident in the allocations in Thériaque (class EphMRA K "Hospital solutions" versus class ATC B "Blood and blood forming organ"; class EphMRA T "Diagnostic agents" versus class ATC V "Various"). Classifications evolve in parallel or independently, and although they are closely related to one another, they retain their specificities in terms of structure and uses.

Drug Information Services↗

PubMed2004

Proposal of a classification system for patients with neck pain.

It is likely that patients with neck pain are not a homogeneous group, but, instead, consist of a variety of subgroups, each of which may benefit from a specific intervention matched to the patient's signs and symptoms. Studies to date have largely failed to account for this possibility, which may compromise the statistical power of research and ultimately fail to provide guidance for clinical decision making. Classification provides a means of breaking down a larger entity into more homogeneous subgroups of patients, based on examination data. Classification can guide the determination of a patient's prognosis, and the selection of the most appropriate intervention strategy. Classification has received considerable attention in the management of patients with low back pain, and evidence is emerging regarding its benefits. There has been considerably less effort made towards examining classification as it pertains to patients with neck pain. The purpose of this clinical commentary is to examine the current literature and to propose a classification system for patients with neck pain, based on the overall goal of treatment. The approach is based on published evidence when possible and is also informed by clinical experience and expert opinion. Classification decisions are based on the integration of data from a variety of information from the history and physical examination. The end result of the classification process is to determine the treatment approach believed to be most likely to maximize the clinical outcome for an individual patient with neck pain.

Decision Making↗

PubMed1986

International classification of primary care.

"Health for all by year 2000" was the subject of the WHO Conference at Alma-Ata in 1978. It was evident that good primary care was a requirement to reach this goal. However, knowledge about this was scanty, and the instrument, an acceptable classification for analyses of primary care, was lacking. Since 1978 a WHO Working Party on Classifications of Primary Care has been working on a Reason for Encounter Classification. A RFEC test form was produced. In 1983 a feasibility study was conducted in nine countries: Australia, Barbados, Brazil, Hungary, Malaysia, The Netherlands, Norway, the Philippines, and the USA. The results of this were changing the original proposal very much. In addition, the WONCA/WHO Classification of Health Problems in Primary Care was included in the final version. In 1984 this final version was accepted by WONCA Classification Committee. This is called ICPC = The International Classification of Primary Care. ICPC is biaxial with the chapters of organ/organ systems along the one axis, in addition of three chapters: General, Mental, and Social problems. The other axis comprises seven components: Complaints, Process and Diagnosis. An alphanumeric code is used. The feasibility study of RFEC comprised ten test sites, and 138 primary care professionals recorded a total of 100 452 reasons for encounter. The English version of the RFEC was translated into five other languages, and these versions were used during the study. ICPC is a comprehensive, simple and practicable classification which can be used in medical records and in different areas of primary care research.

Diagnosis↗

PubMed2003

Reconsidering the classification of schizophrenia and manic depressive illness--a critical analysis and new conceptual model.

The idea of 'disease entity' in psychiatry and the nosologic map of insanity with the distinction between dementia praecox (schizophrenia since Bleuler 1911) and manic depressive insanity, originally developed by Emil Kraepelin (1986), is an important landmark in the history of psychiatry (Jablensky 1995). This classification, however, has been vigorously debated throughout the years, and new evidence emerging from epidemiological, clinical, genetic and biological research demonstrates that the two nosological categories have distinct features as well as share many similarities in their risk factors, genetic predisposition, brain pathology, neurophysiology, clinical phenomenology and response to treatment, thus raising questions about the validity of the categorical classification of psychoses. In this paper we examine some of the similarities and differences between schizophrenia and bipolar illness emerging from recent biological and clinical research and attempt to clarify major inherent logical contradictions in the application of the 'disease' model of psychiatric diagnosis to the categorical classification of schizophrenia and bipolar illness. Then we examine how similar predicaments have been resolved in other natural classification systems, namely the biological classification of species and the periodic table of the elements. Finally we propose a hypothetical conceptual approach to the classification of psychoses that has been greatly informed by the organizing principle underlying the periodic table of the elements, and is distinct from the 'disease' model of psychiatric classification.

Bipolar Disorder↗

PubMed1997

Poor reproducibility of classification of proximal humeral fractures. Additional CT of minor value.

Fractures of the proximal humerus can be described using the Neer and AO fracture classifications. To assess the reproducibility and reliability of these classifications, we investigated 26 proximal humeral fractures with both plain radiographs and CT. 5 specialists in orthopedic surgery and 5 specialists in radiology independently classified all radiographs on 2 occasions. There was a moderate agreement between the observers when using the Neer classification, but only a fair agreement with the AO classification. The Neer system had a kappa value of 0.42 and the AO had a value of 0.31 in the first assessment. In the second assessment the kappa values were 0.45 and 0.30, respectively. Intraobserver reproducibility was slight to almost perfect agreement with Neer (kappa range 0.20-0.85) and slight to moderate agreement with AO (kappa range 0.16-0.60). The observers most familiar with shoulder fracture radiographs and shoulder fracture treatment were more consistent in their classifications. We conclude that even with CT, the fracture classifications of Neer and AO have a low consistency. Neither classification system is reproducible enough to allow comparisons of different studies.

Humans↗

PubMed1996

The validity of classification for the clinical presentation of intracranial dural arteriovenous fistulas.

A number of classification schemes for intracranial dural arteriovenous fistulas (AVFs) have been published that claim to predict which lesions will present in a benign or aggressive fashion based on radiological anatomy. We have tested the validity of two proposed classification schemes for the first time in a large single-institution study. A series of 102 intracranial dural AVFs in 98 patients assessed at a single institution was analyzed. All patients were classified according to two grading scales: the more descriptive schema of Cognard, et al. (Cognard) and that recently proposed by Borden, et al. (Borden). According to the Borden classification, 55 patients were Type I, 18 Type II, and 29 Type III. Using the Cognard classification, 40 patients were Type I, 15 Type IIA, eight Type IIB, 10 Type IIA+B, 13 Type III, 12 Type IV, and four Type V. Intracranial hemorrhage (ICH) or nonhemorrhagic neurological deficit was considered an aggressive presenting clinical feature. A total of 16 (16%) of 102 intracranial dural AVFs presented with hemorrhage. Eleven of these hemorrhages (69%) occurred in either anterior cranial fossa or tentorial lesions. When analyzed according to the Borden classification, none (0%) of 55 Type I intracranial dural AVFs, two (11%) of 18 Type II, and 14 (48%) of 29 Type III intracranial dural AVFs presented with hemorrhage (p < 0.0001). After exclusion of visual or cranial nerve deficits that were clearly related to cavernous sinus intracranial dural AVFs, nonhemorrhagic neurological deficits were a feature of presentation in one (2%) of 55 Type I, five (28%) of 18 Type II, and nine (31%) of 29 Type III patients (p < 0.0001). When combined, an aggressive clinical presentation (ICH or nonhemorrhagic neurological deficit) was seen most commonly in intracranial dural AVFs located in the tentorium (11 (79%) of 14) and the anterior cranial fossa (three (75%) of four), but this simply reflected the number of higher grade lesions in these locations. Aggressive clinical presentation strongly correlated with Borden types: one (2%) of 55 Type I, seven (39%) of 18 Type II, and 23 (79%) of 29 Type III patients (p < 0.0001). A similar correlation with aggressive presentation was seen with the Cognard classification: none (0%) of 40 Type I, one (7%) of 15 Type IIA, three (38%) of eight Type IIB, four (40%) of 10 Type IIA+B, nine (69%) of 13 Type III, 10 (83%) of 12 Type IV, and four (100%) of four Type V (p < 0.0001). No location is immune from harboring lesions capable of an aggressive presentation. Location itself only raises the index of suspicion for dangerous venous anatomy in some intracranial dural AVFs. The configuration of venous anatomy as reflected by both the Cognard and Borden classifications strongly predicts intracranial dural AVFs that will present with ICH or nonhemorrhagic neurological deficit.

Adolescent↗

PubMed2004

Validity of using a panoramic radiograph for initial dental classification of Army recruits.

OBJECTIVE: The objective of this study was to examine the validity of classifying Initial Entry Training (IET) soldiers into dental fitness classification 2 or 3 based solely on examining panoramic radiographs. MATERIALS AND METHODS: The dental readiness classification, derived from a clinical screening examination versus a panoramic radiological examination, was compared for 1,050 Fort Sill Basic Training recruits during a 1-month period. The dentist who reviewed the panoramic radiograph and determined a dental classification was blinded to the earlier dental classification from the clinical examination. The Spearman's rank order correlation test was used to determine if a statistically significant correlation existed between classifications based on the clinical examination versus classification by review of the panoramic radiograph alone. RESULTS: The project identified that 18% (n = 186) and 23.7% (n = 249) of the sample population had at least one class 3 condition identified from the clinical screening examination and the panoramic radiograph review, respectively. Of the 186 dental fitness category 3 conditions identified from the routine dental screening, 81.7% (152) of them were also identified from the review of the panoramic radiograph. Spearman's rank order correlation test statistic was 0.633 for a p < 0.001, indicating a statistically significant correlation in the identification of IET soldiers with class 3 conditions using a screening examination with a review of the panoramic radiograph. CONCLUSIONS: The findings of this study suggest that panoramic radiograph review can identify IET soldiers with dental fitness category 3 conditions and implies that a policy change may be prudent to allow this type of initial classification.

Data Interpretation, Statistical↗

PubMed1999

Salt-sensitivity classification in normotensive adults.

The objectives of this study were to assess the reliability, sensitivity and specificity of salt-sensitivity classification in normotensive adults and to determine the predictive power of four clinical indices for salt-sensitivity. A total of 66 healthy, normotensive, free-living adults were administered 11-day salt-sensitivity diagnostic dietary salt challenges on two occasions to permit assessment of classification test-retest reliability. An oral glucose tolerance test, an acute saline loading test, gustatory testing and determination of salivary flow and sodium concentration were carried out to assess (by correlation analysis) their predictive power for salt-sensitivity. Following these procedures, 21 participants followed a reduced-sodium diet for 4 months, during which blood pressure was monitored monthly to allow evaluation of salt-sensitivity classification sensitivity and specificity. Regression was used to develop a predictive model for salt-sensitivity. Salt-sensitivity classification was not highly reliable (kappa-value=0.38), sensitive (0.73) or specific (0.60). No single index was highly predictive of classification status, but a model composed of five indices accounted for 92% of the variance in blood pressure response to acute salt challenge. The dietary salt challenge procedure used here for salt-sensitivity classification of normotensive adults had low test-retest reliability. While a battery of easily measured attributes may facilitate rapid salt-sensitivity classification, such a diagnosis provides only limited insight regarding blood pressure responsiveness to chronic dietary salt restriction in normotensive adults.

Adult↗

PubMed1999

[Validity of different classifications of unstable angina].

The classification of the unstable angina syndrome has represented one of the main objectives of the cardiologists in the two last decades. The ambiguous definition of this syndrome has led to the phenomenon that numerous classifications have been achieved, based especially in the different clinical presentations of this syndrome, that are neither clearly matched with a different physiopathology nor with the prognosis. On the other hand, the validation of the majority of the classifications have been attempted through studies of selected populations with an insufficient number of patients in a syndrome with a wide spectrum of clinical presentation, pathophysiology and prognosis. On this basis, the existing classifications do not fully satisfy the scientific community, which is confirmed by the periodical appearance of new proposals. In our setting, the classifications which are most applied are those of the Spanish Society of Cardiology and Braunwald's Classification. Both offer the usefulness of their simplicity, since they only consider clinical aspects, but sustain the previously mentioned inconveniences. A more practical classification could possibly be based exclusively on physiopathological or prognostic characteristics, which allow a more adequate management of these patients.

Angina, Unstable↗

PubMed1998

Intervention classifications for nursing practice and the ICNP: cultural considerations for Korean nurses.

There are several intervention classifications for nursing practice. Yet, their relevancy and clarity for international use has not been evaluated. Thus, the paper presents a review of 4 major nursing intervention classifications (Saba's Home Health Care Classifications, Omaha's Intervention Scheme, Grobe's Nursing Intervention Lexicon & Taxonomy, and the International Classification for Nursing Practice) for Korean nursing practice. A simple comparison procedure utilized to determine the relevancy and clarity of each overall scheme and specific elements. The findings showed that general concepts for the top level of all the classifications were both relevant and clear. However, specific elements of lower levels became less clear and relevant because of the lack of definitions and cultural differences. In particular, interventions related to psycho-social and environmental components appeared to be either unclear or non-relevant for Korean nursing practice while interventions related to physiological components were found to be very relevant and clear. In conclusion, multiple levels of hierarchical intervention schemes and the absence of definitions impede clarity of intervention classifications. In addition, for international use, an intervention classification needs to be sensitive to cultural relevancy in its elements.

Evaluation Studies as Topic↗