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PubMed2006

Comparison of the Moorfields classification using confocal scanning laser ophthalmoscopy and subjective optic disc classification in detecting glaucoma in blacks and whites.

OBJECTIVE: To compare the diagnostic accuracy of the Moorfields regression classification (MRC) and subjective optic disc evaluation in discriminating early to moderate glaucomatous from nonglaucomatous eyes. DESIGN: Cross-sectional observational study. PARTICIPANTS: Two hundred thirty-three patients with glaucoma and 216 normal subjects were included in the analysis. Racial groups were defined by self-description. METHODS: All subjects underwent confocal scanning laser ophthalmoscopy, stereophotography, and standard perimetry. Glaucoma was defined by visual field defect alone and confirmed with a second visual field test. Stereo photographs were graded as either normal or glaucomatous appearing in a masked fashion by 2 independent graders and adjudicated by a third grader in cases of disagreement. Mean disc area was compared between patients correctly and incorrectly diagnosed with either technique. MAIN OUTCOME MEASURES: Sensitivity and specificity of MRC and subjective evaluation of stereophotographs in the detection of glaucomatous visual field loss. RESULTS: With the MRC, the sensitivity and specificity were higher using the 95% cutoff than using the 99.9% cutoff. Classification based on subjective photo assessment had a greater agreement with the diagnosis of glaucoma than the MRC for blacks (MRC, sensitivity = 62.5%, specificity = 93.2%; Photo, sensitivity = 76.5%, specificity = 91.5%) and whites (MRC, sensitivity = 67.0%, specificity = 92.2%; photo, sensitivity = 78.4%, specificity = 91.9%). Disc area was significantly larger in patients incorrectly diagnosed with the MRC (P = 0.0289). CONCLUSIONS: Subjective optic disc grading by glaucoma specialists outperformed the MRC with the HRT II in both black and white subjects. Both subjective and objective diagnostic methods were associated with similar sensitivity and specificity between racial groups. The MRC was more likely to provide an incorrect diagnosis in subjects with larger optic discs.

Black or African American↗

PubMed1990

WHO International Histological Classification of Tumours. Tentative Histological Classification of Salivary Gland Tumours.

The principles of the proposed modified WHO Histological Typing of Salivary Gland Tumours are based on the following: 1) The classification of tumours is oriented to the routine work of the practicing surgical pathologists, those who do not see tumours of the salivary glands very often. The inclusion of rare, but clearly defined tumour entities should be helpful to surgical pathologists consulting with clinical specialists. 2) The different types of carcinomas must be distinguished not only by precise histopathological definitions, but also considering differences in prognosis and treatment. For example, the polymorphous low-grade adenocarcinoma and the epithelial-myoepithelial carcinoma are characterized by a relatively good prognosis in contrast to the salivary duct carcinoma. 3) Special points of discussion are: subclassification and grading of carcinomas (e.g. acinic cell carcinoma, mucoepidermoid carcinoma and adenoid cystic carcinoma), the classification of basal cell tumours (basal cell adenoma, basal cell carcinoma, solid type of adenoid cystic carcinoma), malignant tumours in pleomorphic adenomas and the differential diagnosis between primary tumours and metastases.

Adenocarcinoma↗

PubMed1987

Classification of myositis. Correlations between morphological and clinical classifications of inflammatory muscle disease.

Insufficient clinical data given to pathologists often hamper the differentiation of inflammatory muscle diseases. Thus we proved the value of a classification based only upon morphological criteria. Among 160 biopsies with myositic pattern (4.9% of a series of 3264 muscle biopsies) we could distinguish the following groups: Interstitial inflammation with only few fibre necroses (17.6%), predominance of fibre necroses with few inflammatory infiltrates (38.1%), small vessel vasculitis (20.0%), arteritis (13.1%), granulomatous myositis (8.8%) and polymorphonuclear leukocytic infiltrates (2.6%). This classification is compared with the used clinical diagnoses. Some special morphological aspects (histometric and immunocytologic examinations, tissue calcification, inclusion bodies, neurogenic atrophies) are analysed and so are some clinical peculiarities (e.g. malignoma-association, differentiation of mixed connective tissue syndrome, drug-induced reactions). The diagnostic value of purely morphologic criteria is restricted. For better diagnostic work a great number of clinical informations is required. Nevertheless, certain morphological patterns give important directions, e.g. to occult malignoma.

Adult↗

PubMed1992

Angle classification revisited 2: a modified Angle classification.

Edward Angle, in his classification of malocclusions, appears to have made Class I a range of abnormality, not a point of ideal occlusion. Current goals of orthodontic treatment, however, strive for the designation "Class I occlusion" to be synonymous with the point of ideal intermeshing and not a broad range. If contemporary orthodontists are to continue to use Class I as a goal, then it is appropriate that Dr. Angle's century-old classification, be modified to be more precise.

Humans↗

PubMedDate not supplied

Random forest: a classification and regression tool for compound classification and QSAR modeling.

A new classification and regression tool, Random Forest, is introduced and investigated for predicting a compound's quantitative or categorical biological activity based on a quantitative description of the compound's molecular structure. Random Forest is an ensemble of unpruned classification or regression trees created by using bootstrap samples of the training data and random feature selection in tree induction. Prediction is made by aggregating (majority vote or averaging) the predictions of the ensemble. We built predictive models for six cheminformatics data sets. Our analysis demonstrates that Random Forest is a powerful tool capable of delivering performance that is among the most accurate methods to date. We also present three additional features of Random Forest: built-in performance assessment, a measure of relative importance of descriptors, and a measure of compound similarity that is weighted by the relative importance of descriptors. It is the combination of relatively high prediction accuracy and its collection of desired features that makes Random Forest uniquely suited for modeling in cheminformatics.

Journal Article↗

PubMed2003

Diagnostic classification of organic psychiatric disorders after aneurysmal subarachnoid hemorrhage: a comparison between ICD-10, DSM-IV and the Lindqvist & Malmgren classification system.

OBJECTIVE: There is no universally accepted consensus for organic psychiatric disorders (OPDs) between the two major classifications, ICD-10 and DSM-IV. The aim was to compare the coverage of these systems with the Lindqvist & Malmgren (LM) classification system for organic psychiatry. METHOD: Organic psychiatric disorders were diagnosed according to ICD-10, DSM-IV, and the LM system in 119 patients 12 months after surgery as a result of aneurysmal subarachnoid hemorrhage. RESULTS: Among 35 patients with astheno-emotional (AE) disorder (LM system), 83% (95% CI: 67-92%) had mild cognitive disorder (MCD) according to ICD-10 clinical descriptions and diagnostic guidelines (CDDG), 49% (95% CI: 33-64%) had MCD according to ICD-10 diagnostic criteria for research (DCR), and 34% (95% CI: 21-51%) had mild neurocognitive disorder according to DSM-IV. The coverage for other OPDs did not differ between the systems. CONCLUSION: The coverage for AE disorder (LM system) was significantly higher than the corresponding diagnoses of the ICD-10 and DSM-IV systems. Modifications of the latter systems are suggested.

Adult↗

PubMed1991

Classification of benign breast disorders. The ANDI classification based on physiological processes within the normal breast.

Terminology in benign breast conditions has been confused by multiplicity of terms which do not relate accurately to clinical or histological patterns. Further confusion arises because terminology is not based on sound concepts of pathogenesis. The ANDI classification has been put forward as a nomenclature based on pathogenesis to replace the division of benign breast disorders into 'normal' and 'disease'. It recognizes that a spectrum exists for most conditions which extends from normal, through mild abnormality--'aberrations'--to disease. This classification allows precise definition of an individual patient problem in terms of pathogenesis, histology and clinical implications. It has proved helpful in deciding rational clinical management and in teaching the significance of benign breast disorders.

Adenofibroma↗

PubMed1998

Implementation and evaluation of Nursing Interventions Classification and Nursing Outcomes Classification in a patient education plan.

Nursing Interventions Classification (NIC) and Nursing Outcomes Classification (NOC) are recognized examples of standardized nursing languages used to describe the contribution nursing makes to patient care. Columbus Regional Hospital nursing leadership recognized the need to use standardized nursing interventions and nursing-sensitive patient outcomes to describe the unique contribution nursing makes to patient education. In collaboration with the University of Iowa, NIC/NOC languages were implemented in the development of a patient education plan for a clinical pathway population.

Critical Pathways↗

PubMed1989

The development of a disease classification system, based on the International Classification of Diseases, for use by neurologists.

Effective planning and evaluation of medical services is only possible if appropriate and reliable information is available. Diagnoses of patients seen are essential data. The epidemiological value of standard, reliable diagnostic data could also be considerable. The International Classification of Diseases (ICD) is the only system currently available which provides a common basis of classification for general statistical use. A booklet, using ICD codes, for classifying in-patients and out-patients seen by neurologists has been developed. It is simple and easy to use, affords the necessary economy of time, and should result in uniformity of coding. Reliability studies confirm that inaccuracies occur when patients' diagnoses are coded retrospectively from their medical files, even when observers are medically trained. It is recommended that doctors should accept personal responsibility for coding patients' diagnoses at the time of consultation or discharge from hospital.

Diagnosis, Differential↗

PubMed1977

Diagnosis, definition and classification in chronic generalized respiratory disorder. A proposal to come to a manageable clinical classification system in the human being. An answer to the stimulating report of the ACCP-ATS joint committee on pulmonary nomenclature.

It appears that the definition of a syndrome is to a large extent determined by the approach of the researcher. Particular emphasis is given to the very great interest of a classification as meticulous as possible, using all relevant clinical data not only as snapshots, but also over the longest possible observation period. Such a classification of carefully followed individual cases may contribute essentially to the identification of syndromes and to the detection of pathomechanisms and pathogenesis.

Chronic Disease↗

PubMed1998

Variability in the classification of radiographs using the 1980 International Labor Organization Classification for Pneumoconioses.

This study describes the extent of agreement in classification of chest radiographs using the International Labor Organization (ILO) classification among six readers from the United States and Canada. A set of 119 radiographs was created and read by three Canadian and three US readers. The two ratings of interest were profusion (scored from 0/- to 3/+) and pleural abnormalities consistent with pneumoconiosis (scored with the ILO system, then collapsed into a yes/no). We used a number of approaches to evaluate interreader agreement on profusion and pleural changes, determining concordance, observed agreement, kappa statistic, and a new measure to approximate sensitivity and specificity. This study found that five of six readers had good fair to good agreement for pleural findings and for profusion as a dichotomous variable (> or = 1/0 vs < or = 0/1) using the kappa statistic, while a sixth reader had poor agreement. We found that concordance, expressed as percent agreement, was higher for normal radiographs than for ones that showed disease, and describe the use of the kappa statistic to control for this finding. This analysis adds to the existing literature with the use of the kappa statistic, and by presenting a new measure for "underreading" and "overreading" tendencies.

Humans↗

PubMed2003

Establishing competency in the use of North American Nursing Diagnosis Association, Nursing Outcomes Classification, and Nursing Interventions Classification terminology.

The purpose of this study was to evaluate a 16-hour intervention designed to build clinician competency in the use of North American Nursing Diagnosis Association (NANDA), Nursing Outcome Classification (NOC), and Nursing Interventions Classification (NIC) (hereinafter: N3) among nurses with limited N3 knowledge. Each of 19 pairs of nurses independently selected N3 terms and rated the outcomes applicable to an actual patient for a specified time. A pair-through discussion then created a single consensus patient profile of the applicable terms. Before discussion, pairs agreed on 46% of the NANDA diagnoses, 30% of the NOC outcomes, and 20% of the NIC interventions selected. Eighty-nine percent of NOC label pair ratings were within 1 point. Building competency in N3 requires consistent use in written and oral communication with peers across time. Inter-rater reliabilities (IRRs) for NOC label ratings support previous findings.

Clinical Competence↗

PubMed1992

Asthma classification by pathophysiology and IgE-mediated allergic reaction: new concepts for classification of asthma.

Bronchial asthma was classified by the pathophysiology and by the mechanism of onset of the disease. Forty asthmatics who had serum IgE levels lower than 200 IU/ml were evaluated by two classification methods. 1. In asthma classified by a score based on clinical findings and examinations, the characteristics of the findings and examination results were compared among three asthma types, i.e., Ia. simple broncho-constriction type, Ib. bronchoconstriction+hypersecretion type, and II. bronchiolar obstruction type. Type Ib patients, in addition to manifesting hypersecretion, had a significantly higher proportion of eosinophils in the bronchoalveolar lavage (BAL) fluid compared to other asthma types. Significantly decreased values for ventilatory parameters and an increased proportion of BAL neutrophils were found in type II compared with other asthma types. 2. In a new classification by mechanism of onset, asthma was classified into three types according to the degree of participation of IgE-mediated reactions associated with specific IgE antibodies and serum levels of total IgE: asthma induced by definite IgE-mediated reaction (atopic asthma), possible IgE-mediated reactions (asthma), and asthma induced by non-IgE-mediated reaction (asthma syndrome).

Adolescent↗

PubMed2001

A comparison of two diabetic foot ulcer classification systems: the Wagner and the University of Texas wound classification systems.

OBJECTIVE: In this study the following two ulcer classification systems were applied to new foot ulcers to compare them as predictors of outcome: the Wagner (grade) and the University of Texas (LT) (grade and stage) wound classification systems. RESEARCH DESIGN AND METHODS: Ulcer size, appearance, clinical evidence of infection, ischemia, and neuropathy at presentation were recorded, and patients were followed up until healing or for 6 months. RESULTS: Of 194 patients with new foot ulcers, 67.0% were neuropathic, 26.3% were neuroischemic, 1.0% were ischemic, and 5.7% had no identified underlying factors. Median (interquartile range [IQR]) ulcer size at presentation was 1.5 cm2 (0.6-4.0). Lower-limb amputations were performed for 15% of ulcers, whereas 65% healed [median (IQR) healing time 5 (3-10) weeks] and 16% were not healed at study termination; 4% of patients died. Wagner grade (P < 0.0001), and UT grade (P < 0.0001) and stage (P < 0.001) showed positive trends with increased number of amputations. For UT stage, the risk of amputation increased with infection both alone (odds ratio [OR] = 11.1, P < 0.0001) and in combination with ischemia (OR = 14.7, P < 0.0001), but not significantly with ischemia alone (OR = 4.6, P = 0.09). Healing times were not significantly different for each grade of the Wagner (P = 0.1) or the UT system (P = 0.07), but there was a significant stepwise increase in healing time with each stage of the UT system (P < 0.05), and stage predicted healing (P < 0.05). CONCLUSIONS: Increasing stage, regardless of grade, is associated with increased risk of amputation and prolonged ulcer healing time. The UT system's inclusion of stage makes it a better predictor of outcome.

Adult↗

PubMed1986

The classification of malignant melanoma, its histological reporting and registration: a revision of the 1972 Sydney classification.

A group of pathologists with an interest in malignant melanoma met in Sydney in 1982 to update the classification of melanoma formulated in Sydney in 1972. The group recommended that malignant melanoma be classified as follows: malignant melanoma with an adjacent component of superficial spreading type, malignant melanoma with an adjacent component of lentigo maligna type, malignant melanoma with an adjacent component of acral lentiginous type, malignant melanoma with an adjacent component of mucosal lentiginous type, malignant melanoma with no adjacent component, malignant melanoma of unclassifiable histogenetic type. The data recorded in the surgical pathology report should include: diagnosis of primary malignant melanoma, histogenetic classification, presence/absence of ulceration, micrometer-measured thickness, microanatomical level, mitotic rate/mm2, presence/absence of vascular invasion, presence/absence of regression, completeness of resection. The recommendations for the examination of specimens and the recording of data for research purposes and for tumour registries are described.

Biopsy↗

PubMed1982

Morphologic classification of non-Hodgkin's lymphoma. I. Retrospective analysis using the Kiel classification.

In a retrospective analysis of 334 cases of non-Hodgkin's lymphoma observed between 1969 and 1978, 250 cases could be classified according to the Kiel classification. Clinicopathologic correlation was analysed for these latter cases. Irrespective of the morphologic appearance, all cases initially in stage I showed an excellent prognosis after radiation therapy alone, whereas the prognosis for stage II was similar to stages III and IV. For stages II-IV, 3 major prognostic groups with significantly differing survival curves were identified. The median survival times were one, 3 and more than 7 years, respectively. The pathologic and clinical significance of the Kiel classification is discussed.

Adult↗

PubMedDate not supplied

An introduction to the concepts and classifications of the international classification of impairments, disabilities, and handicaps.

This paper aims to introduce the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) and to set the scene for the forthcoming revision process. The consequences of diseases and disorders at the level of the body (impairment), the person (disability), and the person as a social being (handicap) are defined and described. Bearing in mind some of the controversies and confusions which have become apparent in attempts to apply the ICIDH since its publication in 1980, the distinctions between the different concepts are explored: namely, impairment--disability; impairment--functional limitation--disability; and between disability--handicap. The nature of the classification schemes for these concepts is described, together with some implications for methods of assessment. Finally, the contribution the ICIDH has made, and its potential uses are briefly reviewed.

Persons with Disabilities↗

PubMed1996

Classification of peripheral T-cell lymphomas: cytogenetic findings support the updated Kiel classification.

The cytogenetic findings in peripheral T-cell lymphomas enabled us to distinguish not only between low and high grade peripheral T-cell lymphomas (PTL) but also between different morphologically defined subtypes. High grade lymphomas exhibited a higher frequency of aberrant clones, polyploid chromosome numbers, a higher complexity of aberrant clones and a lower proportion of normal metaphases than low grade PTL. Moreover, deletions in 6q, trisomies of 7q and monosomy 13 or changes of 13q14 were significantly more frequent in high grade than in low grade PTL. Translocation t(2;5)(p23;q35) was only seen in large cell anaplastic lymphoma. T-CLL/T-PLL was associated with the simultaneous presence of inversion inv(14)(q11q32.l) and trisomy 8q, mostly due to i(8q)(q10). Trisomy 3 was a characteristic chromosome aberration of lymphoepithelioid lymphoma, AILD-type T-cell lymphoma and T-zone lymphoma. In contrast to the other low grade PTL, AILD-type T-ceIl lymphoma and cutaneous T-cell lymphoma showed a high frequency of unrelated clones. In summary, the cytogenetic findings paralleled the histopathologic classification according to the updated Kiel classification and support the value of the distinction of the different morphologically defined entities.

Chromosome Aberrations↗