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At least 595 records · Page 33Linked to original sources
PubMed1998

Classification and low back pain: a review of the literature and critical analysis of selected systems.

Classification systems for patients with low back pain have become more abundant in the literature since the mid-1980s. Some classification systems are designed to determine the most appropriate treatment, some are designed to aid in prognosis, and others are designed to identify pathology. Still other classification systems categorize patients into homogeneous groups based on selected variables. The purpose of this review is to describe and critically evaluate low back pain classification systems. Several classification systems were summarized and examined. Four classification systems that were judged to be the most commonly cited and most relevant to physical therapists were critiqued using a more thorough systematic approach. The analysis suggests that future research should address the usefulness of existing classification systems as well as the development of new classification systems designed using commonly accepted measurement principles.

Humans↗
PubMed1999

An update on the classification of endometriosis.

The challenge of creating a satisfactory classification of endometriosis remains to be answered. The ability of the current classification schemes to predict pregnancy outcome or to aid in the management of pelvic pain is recognized to be inadequate. Further revisions of the current classification scheme are anticipated as the understanding of how endometriosis contributes to infertility and pelvic pain evolves. In any revision of the classification system, use of empirically derived weights and breakpoints to define disease stages based on outcome data in larger clinical trials should be attempted. It is also possible that additional factors such as CA-125 level or lesion characteristics may be shown to play an important role in prognosis. If so, these will need to be accounted for in the classification scheme. Careful and consistent use of the recommendations of the American Society for Reproductive Medicine classification of endometriosis subcommittee should allow for collection of data for use in further revisions. It is quite possible that a classification scheme that is designed to predict outcome with respect to pregnancy may be totally inadequate in assessing patients who have endometriosis and pelvic pain. Factors found to be important in the assessment of pelvic pain may be different from those involved with the pathophysiology of endometriosis and infertility. The AFS form suggested for use in the management of endometriosis in the presence of pelvic pain allows for recording of variables such as depth of invasion, histology, as well as documenting adjunct investigations and preoperative physical findings. Such prospective data collection and review in large centers may provide a large clinical base from which to derive empirical point scores and breakpoints in a classification scheme.

Endometriosis↗
PubMedDate not supplied

Improving tissue classification in MRI: a three-dimensional multispectral discriminant analysis method with automated training class selection.

PURPOSE: To improve the reliability, accuracy, and computational efficiency of tissue classification with multispectral sequences [T1, T2, and proton density (PD)], we developed an automated method for identifying training classes to be used in a discriminant function analysis. We compared it with a supervised operator-dependent method, evaluating its reliability and validity. We also developed a fuzzy (continuous) classification to correct for partial voluming. METHOD: Images were obtained on a 1.5 T GE Signa MR scanner using three pulse sequences that were co-registered. Training classes for the discriminant analysis were obtained in two ways. The operator-dependent method involved defining circular ROIs containing 5-15 voxels that represented "pure" samples of gray matter (GM), white matter (WM), and cerebrospinal fluid (CSF), using a total of 150-300 voxels for each tissue type. The automated method involved selecting a large number of samples of brain tissue with sufficiently low variance and randomly placed throughout the brain ("plugs"), partitioning these samples into GM, WM, and CSF, and minimizing the amount of variance within each partition of samples to optimize its "purity." The purity of the plug was estimated by calculating the variance of 8 voxels in all modalities (T1, T2, and PD). We also compared "sharp" (discrete) measurements (which classified tissue only as GM, WM, or CSF) and "fuzzy" (continuous) measurements (which corrected for partial voluming by weighting the classification based on the mixture of tissue types in each voxel). RESULTS: Reliability was compared for the operator-dependent and automated methods as well as for the fuzzy versus sharp classification. The automated sharp classifications consistently had the highest interrater and intrarater reliability. Validity was assessed in three ways: reproducibility of measurements when the same individuals were scanned on multiple occasions, sensitivity of the method to detecting changes associated with aging, and agreement between the automated segmentation values and those produced through expert manual segmentation. The sharp automated classification emerged as slightly superior to the other three methods according to each of these validators. Its reproducibility index (intraclass r) was 0.97, 0.98, and 0.98 for total CSF, total GM, and total WM, respectively. Its correlations with age were 0.54, -0.61, and -0.53, respectively. Its percent agreement with the expert manually segmented tissue for the three tissue types was 93, 90, and 94%, respectively. CONCLUSION: Automated identification of training classes for discriminant analysis was clearly superior to a method that required operator intervention. A sharp (discrete) classification into three tissue types was also slightly superior to one that used "fuzzy" classification to produce continuous measurements to correct for partial voluming. This multispectral automated discriminant analysis method produces a computationally efficient, reliable, and valid method for classifying brain tissue into GM, WM, and CSF. It corrects some of the problems with reliability and computational inefficiency previously observed for operator-dependent approaches to segmentation.

Adult↗
PubMed1998

Effects of binary decision making on the classification of fractures of the ankle.

OBJECTIVE: To evaluate the effect of binary decision making on interobserver reliability in the classification of fractures of the ankle. DESIGN: Radiographic review study. PATIENTS/PARTICIPANTS: Observers: two PGY-2 orthopaedic residents, two PGY-5 residents, and two orthopaedic attending surgeons. INTERVENTION: Radiographs of fifty ankle fractures were classified. Each observer classified the radiographs by using the original AO/ASIF system and its recent binary modification. MAIN OUTCOME MEASUREMENTS: Interobserver reliability was assessed by using a kappa coefficient and compared for the two classification methods. RESULTS: The mean kappa value for interobserver reliability for type only and for type and group classification when using the original AO/ASIF system was 0.77 and 0.61, respectively. Using binary decision making, the mean kappa values for type only and for type and group were 0.78 and 0.62, respectively. There was no statistically significant difference in reliability between the original and binary classification systems. CONCLUSION: The interobserver reliability of both the original AO/ASIF classification system and its binary modification is substantial. The results of the present study, however, cast doubt on the effectiveness of binary decision making in improving interobserver reliability in the classification of fractures. To our knowledge, this study is the first to compare the original AO/ASIF classification system with its binary modification. Additional study of other fractures may help elucidate the effectiveness of binary decision making in improving interobserver reliability in the classification of all fractures.

Ankle Injuries↗
PubMed2000

The use of a classification approach to identify subgroups of patients with acute low back pain. Interrater reliability and short-term treatment outcomes.

STUDY DESIGN: A prospective, consecutive, cohort study of patients with acute low back pain classified into subgroups based on examination data and treated with a specific treatment approach. OBJECTIVE: To calculated the interrater reliability of a classification system, and to compare initial patient characteristics and outcomes of physical therapy treatment when a classification approach is used. SUMMARY OF BACKGROUND DATA: Classification of patients with low back pain into homogeneous subgroups has been identified as a research priority. Identifying relevant subgroups of patients could improve clinical outcomes and research efficiency. METHODS: Consecutive patients referred to physical therapy for treatment of acute low back pain were evaluated and classified into one of four subgroups (immobilization, mobilization, specific exercise, or traction) before treatment. Physical therapy treatment was based on the patient's classification. The classifications were compared for initial patient characteristics, frequency and duration of physical therapy, and improvement in Oswestry scores. RESULTS: In this study, 120 patients were evaluated and classified. Analysis of interrater reliability showed a kappa value of 0.56. Differences were found among the classifications for age, initial Oswestry score, history of low back pain, symptom distribution, and average change in Oswestry score with treatment. CONCLUSIONS: Reaching a consensus regarding relevant patient subgroups requires data on the reliability and validity of existing classification systems. Further work is required to validate improvement in treatment outcomes using a classification approach.

Acute Disease↗
PubMed2002

Classification of age-related changes in lumbar intervertebral discs: 2002 Volvo Award in basic science.

STUDY DESIGN: A histologic study on age-related changes of the human lumbar intervertebral disc was conducted. OBJECTIVES: To investigate comprehensively age-related temporospatial histologic changes in human lumbar intervertebral disc, and to develop a practicable and reliable classification system for age-related histologic disc alteration. SUMMARY OF THE BACKGROUND DATA: No comprehensive microscopic analysis of age-related disc changes is available. There is no conceptual morphologic framework for classifying age-related disc changes as a reference basis for more sophisticated molecular biologic analyses of the causative factors of disc aging or premature aging (degeneration). METHODS: A total of 180 complete sagittal lumbar motion segment slices obtained from 44 deceased individuals (fetal to 88 years of age) were analyzed with regard to 11 histologic variables for the intervertebral disc and endplate, respectively. In addition, 30 surgical specimens (3 regions each) were investigated with regard to five histologic variables. Based on the semiquantitative analyses of 20,250 histologic variable assessments, a classification system was developed and tested in terms of validity, practicability, and reliability. The classification system was applied to cadaveric and surgical disc specimens not included in the development of the classification system, and the scores were assessed by two additional independent raters. RESULTS: A semiquantitative analyses provided clear histologic evidence for the detrimental effect of a diminished blood supply on the endplate, resulting in the tissue breakdown beginning in the nucleus pulposus and starting in the second life decade. Significant temporospatial variations in the presence and abundance of histologic disc alterations were observed across levels, regions, macroscopic degeneration grades, and age groups. A practicable classification system for age-related histologic disc alterations was developed, resulting in moderate to excellent reliability (kappa values, 0.49-0.98) depending on the histologic variable. Application of the classification system to cadaveric and surgical specimens demonstrated a significant correlation with age ( < 0.0001) and macroscopic grade of degeneration ( < 0001). However, substantial data scatter caution against reliance on traditional macroscopic disc grading and favor a histology-based classification system as a reference standard. CONCLUSIONS: Histologic disc alterations can reliably be graded based on the proposed classification system providing a morphologic framework for more sophisticated molecular biologic analyses of factors leading to age-related disc changes. Diminished blood supply to the intervertebral disc in the first half of the second life decade appears to initiate tissue breakdown.

Adolescent↗
PubMedDate not supplied

The importance of surgeons' experience on intraobserver and interobserver reliability of classifications used for Perthes disease.

The objective of this study was to evaluate the percentage agreement and intraobserver and interobserver reliability for the Catterall, Salter-Thompson, Herring, and Stulberg classification systems, with special reference to the experience of surgeons. AP and frog-leg radiographs of 10 patients were evaluated by 18 reviewers with three levels of experience on two occasions. Each patient had three sets of radiographs of different stages of disease (initial stage, fragmentation phase, and healed phase). The interobserver percentage agreement rates were 28% for residents, 42% for senior surgeons, and 51% for pediatric orthopaedists for the Catterall classification in the initial stage; 63%, 46%, and 68% for the Salter-Thompson classification; 44%, 44%, and 61% for the Herring classification; and 34%, 37%, and 43% for the Stulberg classification at skeletal maturity. The Catterall, Herring, and Salter-Thompson classifications have a learning curve, and pediatric orthopaedists have better intra- and interobserver reliability. The Stulberg classification system when used at skeletal maturity consistently gave the best results for intraobserver and interobserver reliability for residents, senior surgeons, and pediatric orthopaedists. These results suggest that although the reliability of these classification systems improves with the experience of the observer, inter- and intraobserver error is generally high even among experienced pediatric orthopaedists.

Clinical Competence↗
PubMedDate not supplied

Development and validation of the AO pediatric comprehensive classification of long bone fractures by the Pediatric Expert Group of the AO Foundation in collaboration with AO Clinical Investigation and Documentation and the International Association for Pediatric Traumatology.

A series of four agreement studies (classification sessions) were conducted to support the development and validation of a comprehensive pediatric long bone fracture classification system. This system follows the principle of the Müller-AO classification for long bones in adults and integrates most relevant existing pediatric classification systems. The diagnosis includes the distinction between epiphyseal (E), metaphyseal (M), or diaphyseal (D) fractures, as well as identification of child-specific features. This article describes the proposed system in some detail. Digital standard preoperative anteroposterior and lateral radiographs from 267 consecutive pediatric patients (<16 years old and open physis) with single fractures of the distal humerus, radius, or tibia were collected at a single university children's hospital. Fractures were classified independently by five experienced pediatric surgeons. The classification process was assessed for reliability using the kappa coefficient and accuracy using latent class modeling separately for each bone for bone type, and separately for each bone type for child codes. At the last classification session, kappa values for E-M-D and child code classifications were mostly above 0.90, and accuracy estimates were between 75% and 100% for different surgeons, types, and bones. Disagreement and misclassification of fractures were overall very low; hence, experienced and trained surgeons can classify pediatric long bone fractures using the proposed system with high accuracy based on standard radiographic views. The authors encourage wide consultation and further evaluation of this proposed pediatric long bone classification system with a larger number of future users with different training before being used for documentation and clinical studies.

Adolescent↗
PubMed2005

New concepts on the pathogenesis and classification of spondylolisthesis.

STUDY DESIGN: A review of the literature in the English language pertaining to the pathogenesis and classification of spondylolisthesis. OBJECTIVE: To review the morphology and biomechanics of the lumbosacral junction as it relates to spondylolisthesis. To present contemporary theories of the development and progression of spondylolisthesis and an etiology-based classification system. SUMMARY OF BACKGROUND DATA: The proper treatment of spondylolisthesis is dependent on recognizing the type of slip and its natural history. Although a number of clinical and radiographic features have been identified as risk factors, their role as primary causative factors or secondary adaptive changes is not clear. In particular, confusion persists over the classification of slips with "isthmic defects." The early identification of spondylolisthesis that will progress to a high grade without intervention remains elusive. METHODS: A review of English language literature regarding the pathogenesis and classification of spondylolisthesis. RESULTS.: Current literature suggests that spinopelvic parameters, in addition to the morphology and biomechanics of the lumbosacral junction, play a causative role in the development of spondylolisthesis. Progression of developmental slips may be due to growth deficiencies of the anterosuperior sacrum, analogous to Blount's disease at the knee. The Marchetti-Bartolozzi classification system emphasizes the distinction between developmental dysplastic slips and acquired laminar stress fractures, both of which may have isthmic defects. These two types of spondylolisthesis have significantly different natural histories, suggesting the need for different treatment strategies. The Marchetti-Bartolozzi system also allows for the classification of postsurgical, pathologic, and degenerative forms of spondylolisthesis. CONCLUSIONS: The morphology of the lumbosacral junction resists high shear and compressive forces. The loss of the posterior restraint through an incompetent bony hook may result in the forward displacement of one vertebra on the subjacent vertebra. The spinopelvic parameters, such as pelvic incidence, may be greater determinants of development and progression than previously appreciated. The Marchetti-Bartolozzi classification system is applicable to all forms of lumbar spondylolisthesis,and seems to be clinically relevant in terms of treatment decisions. Their system emphasizes the distinction between developmental spondylolisthesis with lysis and acquired spondylitic spondylolisthesis, which have been included together in previous classification systems and caused confusion over natural history and treatment. Developmental slips have a greater propensity toward progression, which may be secondary to growth deficiencies of the upper sacrum. Further study is required to confirm these observations.

Disease Progression↗
PubMed2005

A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status.

STUDY DESIGN: A new proposed classification system for thoracolumbar (TL) spine injuries, including injury severity assessment, designed to assist in clinical management. OBJECTIVE: To devise a practical, yet comprehensive, classification system for TL injuries that assists in clinical decision-making in terms of the need for operative versus nonoperative care and surgical treatment approach in unstable injury patterns. SUMMARY OF BACKGROUND DATA: The most appropriate classification of traumatic TL spine injuries remains controversial. Systems currently in use can be cumbersome and difficult to apply. None of the published classification schemata is constructed to aid with decisions in clinical management. METHODS: Clinical spine trauma specialists from a variety of institutions around the world were canvassed with respect to information they deemed pivotal in the communication of TL spine trauma and the clinical decision-making process. Traditional injury patterns were reviewed and reconsidered in light of these essential characteristics. An initial validation process to determine the reliability and validity of an earlier version of this system was also undertaken. RESULTS: A new classification system called the Thoracolumbar Injury Classification and Severity Score (TLICS) was devised based on three injury characteristics: 1) morphology of injury determined by radiographic appearance, 2) integrity of the posterior ligamentous complex, and 3) neurologic status of the patient. A composite injury severity score was calculated from these characteristics stratifying patients into surgical and nonsurgical treatment groups. Finally, a methodology was developed to determine the optimum operative approach for surgical injury patterns. CONCLUSIONS: Although there will always be limitations to any cataloging system, the TLICS reflects accepted features cited in the literature important in predicting spinal stability, future deformity, and progressive neurologic compromise. This classification system is intended to be easy to apply and to facilitate clinical decision-making as a practical alternative to cumbersome classification systems already in use. The TLICS may improve communication between spine trauma physicians and the education of residents and fellows. Further studies are underway to determine the reliability and validity of this tool.

Humans↗
PubMed2006

Reliability of radiological classifications used in Legg-Calve-Perthes disease.

Radiological assessment is a valuable tool in the assessment, management and prognostication of Perthes disease. Radiological assessment, however, is not an easy task and all classification systems used in Perthes disease have some degree of interrater and intrarater variabilities. In the past, there were some isolated studies to find the reliability of the classifications used in Perthes disease. In this study, we comprehensively studied three most commonly used radiological classifications (Salter-Thompson, lateral pillar and Catterall). We had 44 patients' radiographs (anteroposterior and lateral) taken in the fragmentation stage, and two experienced observers assessed and classified the radiographs on two separate occasions. In this study, we found that the average interrater reliability of the Salter-Thompson, lateral pillar and Catterall classifications was 0.163 (0.08-0.236), 0.722 (0.581-0.824) and 0.433 (0.280-0.546), respectively. The intrarater reliability was 0.313 and 0.699 for the Salter-Thompson, 0.707 and 0.658 for the lateral pillar and 0.38 and 0.577 for the Catterall classifications. Further, we tried to determine the possible reason for the low reliability associated with the Catterall classification. We think that the quantitative method of lateral pillar has better intrarater and interrater reliabilities than other classification systems, and the reliability of the Catterall classification can be significantly improved if some radiological parameters such as metaphyseal reaction and identification of the junction of involved to uninvolved region can be optimized.

Humans↗
PubMed2004

Detection of skin cancer by classification of Raman spectra.

Skin lesion classification based on in vitro Raman spectroscopy is approached using a nonlinear neural network classifier. The classification framework is probabilistic and highly automated. The framework includes a feature extraction for Raman spectra and a fully adaptive and robust feedforward neural network classifier. Moreover, classification rules learned by the neural network may be extracted and evaluated for reproducibility, making it possible to explain the class assignment. The classification performance for the present data set, involving 222 cases and five lesion types, was 80.5%+/-5.3% correct classification of malignant melanoma, which is similar to that of trained dermatologists based on visual inspection. The skin cancer basal cell carcinoma has a classification rate of 95.8%+/-2.7%, which is excellent. The overall classification rate of skin lesions is 94.8%+/-3.0%. Spectral regions, which are important for network classification, are demonstrated to reproduce. Small distinctive bands in the spectrum, corresponding to specific lipids and proteins, are shown to hold the discriminating information which the network uses to diagnose skin lesions.

Artificial Intelligence↗
PubMed2005

A wrapper-based approach to image segmentation and classification.

The traditional processing flow of segmentation followed by classification in computer vision assumes that the segmentation is able to successfully extract the object of interest from the background image. It is extremely difficult to obtain a reliable segmentation without any prior knowledge about the object that is being extracted from the scene. This is further complicated by the lack of any clearly defined metrics for evaluating the quality of segmentation or for comparing segmentation algorithms. We propose a method of segmentation that addresses both of these issues, by using the object classification subsystem as an integral part of the segmentation. This will provide contextual information regarding the objects to be segmented, as well as allow us to use the probability of correct classification as a metric to determine the quality of the segmentation. We view traditional segmentation as a filter operating on the image that is independent of the classifier, much like the filter methods for feature selection. We propose a new paradigm for segmentation and classification that follows the wrapper methods of feature selection. Our method wraps the segmentation and classification together, and uses the classification accuracy as the metric to determine the best segmentation. By using shape as the classification feature, we are able to develop a segmentation algorithm that relaxes the requirement that the object of interest to be segmented must be homogeneous in some low-level image parameter, such as texture, color, or grayscale. This represents an improvement over other segmentation methods that have used classification information only to modify the segmenter parameters, since these algorithms still require an underlying homogeneity in some parameter space. Rather than considering our method as, yet, another segmentation algorithm, we propose that our wrapper method can be considered as an image segmentation framework, within which existing image segmentation algorithms may be executed. We show the performance of our proposed wrapper-based segmenter on real-world and complex images of automotive vehicle occupants for the purpose of recognizing infants on the passenger seat and disabling the vehicle airbag. This is an interesting application for testing the robustness of our approach, due to the complexity of the images, and, consequently, we believe the algorithm will be suitable for many other real-world applications.

Algorithms↗
PubMed2002

Feature selection for the classification of movements from single movement-related potentials.

Classification of movement-related potentials recorded from the scalp to their corresponding limb is a crucial task in brain-computer interfaces based on such potentials. Many features can be extracted from raw electroencephalographic signals to be used for classification, but the utilization of irrelevant or superfluous features is detrimental to the performance of classification algorithms. It is, therefore, necessary to select a small number of relevant features for the classification task. This paper demonstrates the use of two feature selection methods to choose a small number (10-20) of relevant features from a bank containing upward of 1000 features. One method is based on information theory and the other on the use of genetic algorithms. We show that the former is poorly suited for the aforementioned classification task and discuss the probable reasons for this. However, using a genetic algorithm on data recorded from five subjects we demonstrate that it is possible to differentiate between the movements of two limbs with a classification accuracy of 87% using as little as 10 features without subject training. With the addition of a simple coding scheme, this method can be applied to multiple limb classification and a 63% classification accuracy rate can be reached when attempting to distinguish between three limbs.

Adult↗
PubMed2004

Specific epileptic syndromes are rare even in tertiary epilepsy centers: a patient-oriented approach to epilepsy classification.

PURPOSE: To assess the practicability and reliability of a five-dimensional patient-oriented epilepsy classification and to compare it with the International League Against Epilepsy (ILAE) classification of epilepsy and epileptic syndromes. The dimensions consist of the epileptogenic zone, semiologic seizure type(s), etiology, related medical conditions, and seizure frequency. METHODS: The 185 epilepsy patients (94 adults, 91 children, aged 18 years or younger) were randomly selected from the database of a tertiary epilepsy center and the general neurological department of a metropolitan hospital (28 adults). The charts were reviewed independently by two investigators and classified according to both the ILAE and the patient-oriented classification. Interrater reliability was assessed, and a final consensus among all investigators was established. RESULTS: Only four (4%) adults and 19 (21%) children were diagnosed with a specific epilepsy syndrome of the ILAE classification. All other patients were in unspecific categories. The patient-oriented classification revealed that 64 adults and 56 children had focal epilepsy. In an additional 34 adults and 45 children, the epileptogenic zone could be localized to a certain brain region, and in 14 adults and five children, the epileptogenic zone could be lateralized. Fourteen adults and 21 children had generalized epilepsy. In 16 adults and 14 children, it remained unclear whether the epilepsy was focal or generalized. Generalized simple motor seizures were found in 66 adults and 52 children, representing the most frequent seizure type. Etiology could be determined in 40 adults and 45 children. Hippocampal sclerosis was the most frequent etiology in adults (10%), and cortical dysplasia (9%), in children. Seven adults and 31 children had at least daily seizures. Seventeen adults and 26 children had rare or no seizures at their last documented contact. The most frequent related medical conditions were psychiatric disorders and mental retardation. Interrater agreement was high (kappa values of 0.8 to 0.9) for both the patient-oriented and the ILAE classification. CONCLUSIONS: Specific epilepsy syndromes included in the current ILAE classification are rare even in a tertiary epilepsy center. Most patients are included in unspecific categories that provide only incomplete information. In contrast, all of the patients could be classified by the five-dimensional patient-oriented classification, providing all essential information for the management of the patients with a high degree of interrater reliability.

Adolescent↗
PubMed1998

A proposal for a new histological classification scheme for predicting short-term tumor recurrence and death in patients with invasive ductal carcinoma of the breast.

Tumor recurrence rate (TRR) and mortality rate (MR) of invasive ductal carcinoma (IDC) of the breast in short-term follow-up are relatively low. Nevertheless, it is extremely important to identify patients at risk of early recurrence or death after surgery. The aim of this study was to establish a new histological prognostic classification scheme for IDC in order accurately to predict the short-term outcome. The following histological parameters were analyzed in 201 IDCs: 1) tumor size, 2) structural atypia, 3) nuclear atypia, 4) number of mitotic figures, 5) fibrotic focus (FF), 6) vascular invasion, 7) tumor necrosis, 8) skin invasion, 9) muscle invasion, 10) nodal status and 11) extramammary fat invasion. Multivariate analysis showed that nuclear atypia, presence of FF, and the invasive length of fat invasion (ILFI) were the most important histological parameters correlated with TRR or MR of IDCs. Accordingly, a new histological classification based on nuclear atypia, FF and ILFI (Nucleus-Fibrotic focus-Fat invasion, NFF) was devised. Comparative studies were performed with the following existing prognostic classifications: 1) histological grade, 2) modified Scarff-Bloom-Richardson histological grade, 3) prognostic index and 4) pathological TNM (pTNM) stage classifications. Patient grouping defined by NFF classification significantly correlated with tumor recurrence or death of IDCs in all cases, cases at stages I and II, those without lymph node metastasis and those who were estrogen receptor (ER)-positive after adjustment for the other four classifications, using multivariate analysis. NFF classification appeared superior to existing prognostic classifications for the accurate prediction of the short-term outcome for patients with IDCs in low risk groups.

Adipose Tissue↗
PubMed2004

Inter-rater reliability of the EPUAP pressure ulcer classification system using photographs.

BACKGROUND: Many classification systems for grading pressure ulcers are discussed in the literature. Correct identification and classification of a pressure ulcer is important for accurate reporting of the magnitude of the problem, and for timely prevention. The reliability of pressure ulcer classification systems has rarely been tested. AIMS AND OBJECTIVES: The purpose of this paper is to examine the inter-rater reliability of classifying pressure ulcers according to the European Pressure Ulcer Advisory Panel classification system when using pressure ulcer photographs. DESIGN: Survey was among pressure ulcer experts. METHODS: Fifty-six photographs were presented to 44 pressure ulcer experts. The experts classified the lesions as normal skin, blanchable erythema, pressure ulcer (four grades) or incontinence lesion. Inter-rater reliability was calculated. RESULTS: The multirater-Kappa for the entire group of experts was 0.80 (P < 0.001). Various groups of experts obtained comparable results. Differences in classifications are mainly limited to 1 degree of difference. Incontinence lesions are most often confused with grade 2 (blisters) and grade 3 pressure ulcers (superficial pressure ulcers). CONCLUSIONS: The inter-rater reliability of the European Pressure Ulcer Advisory Panel classification appears to be good for the assessment of photographs by experts. The difference between an incontinence lesion and a blister or a superficial pressure ulcer does not always seem clear. RELEVANCE TO CLINICAL PRACTICE: The ability to determine correctly whether a lesion is a pressure ulcer lesion is important to assess the effectiveness of preventive measures. In addition, the ability to make a correct distinction between pressure ulcers and incontinence lesions is important as they require different preventive measures. A faulty classification leads to mistaken measures and negative results. Photographs can be used as a practice instrument to learn to discern pressure ulcers from incontinence lesions and to get to know the different grades of pressure ulcers. The Pressure Ulcer Classification software package has been developed to facilitate learning.

Adult↗
PubMed1999

A new epileptic seizure classification based exclusively on ictal semiology.

Historically, seizure semiology was the main feature in the differential diagnosis of epileptic syndromes. With the development of clinical EEG, the definition of electroclinical complexes became an essential tool to define epileptic syndromes, particularly focal epileptic syndromes. Modern advances in diagnostic technology, particularly in neuroimaging and molecular biology, now permit better definitions of epileptic syndromes. At the same time detailed studies showed that there does not necessarily exist a one-to-one relationship between epileptic seizures or electroclinical complexes and epileptic syndromes. These developments call for the reintroduction of an epileptic seizure classification based exclusively on clinical semiology, similar to the seizure classifications which were used by neurologists before the introduction of the modern diagnostic methods. This classification of epileptic seizures should always be complemented by an epileptic syndrome classification based on all the available clinical information (clinical history, neurological exam, ictal semiology, EEG, anatomical and functional neuroimaging, etc.). Such an approach is more consistent with mainstream clinical neurology and would avoid the current confusion between the classification of epileptic seizures (which in the International Seizure Classification is actually a classification of electroclinical complexes) and the classification of epileptic syndromes.

Electroencephalography↗