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PubMed1991

Antiarrhythmic drug classifications. A critical appraisal of their history, present status, and clinical relevance.

Classifications of antiarrhythmic drugs have developed because of a need to organize the large number of agents available according to pharmacological properties of clinical relevance. The current classification is a hybrid of classification systems developed in the early 1970s. It subdivides drugs according to 4 major pharmacological actions: (a) depression of phase 0 sodium current; (b) antagonism of adrenergic effects on the heart; (c) prolongation of of action potential duration; and (d) calcium channel blockade. Further subdivision of sodium channel blockers is based on the kinetics of sodium channel blockade and drug effects on action potential duration. A critical analysis of selected aspects of the clinical actions of antiarrhythmic drugs indicates the value of the current classification, as well as some limitations in its ability to separate drugs into distinct groups with characteristic clinical properties. The strengths of the current classification are due to the clinical importance of the pharmacological properties on which it is based. These results in electrophysiological actions, indications, and adverse effects that are typical for each group of drugs. The limitations of the current system relate to the propensity of individual drugs to have actions of more than one class simultaneously, the way that the various actions of a given drug are dependent on concentration, rate, and tissue type, and to problems in subclass definition. Some of these shortcomings could be alleviated by returning to the concept, originally put forward by Singh and Vaughan Williams, of classes of drug action rather than classes of drug per se. This approach would be pharmacologically more realistic than trying to assign each antiarrhythmic agent to a single unique class, would be better able to incorporate the complexities of drug action, and would potentially be more flexible. The wide use of antiarrhythmic drug classifications attests to their value, and suggests that they are likely to continue to be important in the future.

Anti-Arrhythmia Agents↗
PubMed2005

Reassessment of the classification of the severity in idiopathic pulmonary fibrosis using SF-36 questionnaire.

OBJECTIVE: To investigate whether or not the newly revised classification of the severity of idiopathic interstitial pneumonia (IIP) is appropriate with respect to quality of life (QOL). METHODS: The association between the subscale of Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and pulmonary function or serum marker was analyzed using Pearson's correlation coefficient. The association between the subscale of SF-36 and the previous or newly revised classification of the severity of IIP was analyzed using Spearman's rank correlation test. PATIENTS: Forty patients with idiopathic pulmonary fibrosis (IPF) were enrolled. RESULTS: The mean deviation value scores for 7 items, excluding bodily pain (BP) in SF-36 were below the national reference values. % vital capacity (VC) was correlated with the 7 items excluding BP. However, neither serum LDH nor KL-6 values were correlated with any item in SF-36. According to the new or previous classification of the severity, severity was correlated with physical function, limitation of role functioning related physical problems and general health (GH); the correlation coefficient with the new one was slightly higher than the previous one. Based on these results, we established a unique draft on the classification of the severity. %VC <70% was added as an item for the newly revised classification in our draft. In our draft, there was rank correlation between the 7 items, excluding BP, in SF-36 and severity. CONCLUSION: With respect to QOL, the newly revised classification of the severity of IIP was not satisfactory, but the hypoxemia during exercise in patients with resting PaO(2) >80 Torr and reduction of VC were found to be important factors.

Aged↗
PubMed1983

Reproducibility of mammographic classifications.

Wolfe's mammographic classification and a percentage classification are statistically evaluated for inter- and intraobserver bias and agreement by seven mammographers with a set of 200 xeromammograms. The results demonstrate significant bias and disagreement with both methods, raising questions about the clinical limitations of these or other mammographic classifications. However, about 90% of the percentage classifications of pairs of readers are within adjacent categories. This suggests that (1) more experience with precisely defined classifications and protocols, (2) the development and application of readily available instructional materials, and (3) studies to identify and evaluate sources of variation in such classifications may eventually lead to acceptable levels of reproducibility.

Breast Neoplasms↗
PubMed1997

The classification of diabetes by clinical and C-peptide criteria. A prospective population-based study.

OBJECTIVE: To evaluate both the concordance in the classification of diabetes by clinical and C-peptide criteria and, prospectively, the consistency of the classification by C-peptide. RESEARCH DESIGN AND METHODS: Individuals with diabetes who were enlisted in the prospective epidemiological study of diabetic neuropathy (Rochester Diabetic Neuropathy Study [RDNS]) were classified clinically by National Diabetes Data Group (NDDG) criteria to IDDM and NIDDM at entry to the study. In addition, C-peptide response to 1 mg glucagon was measured at entry for the classification to IDDM (basal C-peptide, < 0.17 pmol/ml; increment above basal, < 0.07 pmol/ml) and NIDDM (all other responses) and for concordance with the clinical classification made. The consistency of the C-peptide response was assessed every 2 years for up to 8 years. RESULTS: Among 346 individuals with diabetes, 84 were classified as IDDM and 262 as NIDDM by clinical algorithm. COncordance with the C-peptide response occurred in 89% of the patients and remained consistent during 8 years of follow-up. Among the 37 patients with discordant clinical and C-peptide classification, those considered clinically to have NIDDM had a consistent IDDM C-peptide response during follow-up, and most of those considered to have IDDM clinically eventually showed an IDDM C-peptide response during follow-up. CONCLUSIONS: Clinical criteria for the classification of diabetes are highly correlated with the assessment of insulin secretory reserve. A small number of individuals considered to have NIDDM clinically or by C-peptide have or develop an IDDM peptide response.

Adolescent↗
PubMed2004

The interrater reliability among physical therapists newly trained in a classification system for acute low back pain.

STUDY DESIGN: A prospective methodological interrater reliability study. OBJECTIVES: To calculate the interrater reliability among clinicians newly trained in a classification system for acute low back pain and to determine the level of agreement at key junctures within the classification algorithm. BACKGROUND: The utility of a classification system for patients with low back pain depends on its reliability and generalizability. To be practical, clinicians must be able to apply the system after a reasonable amount of training. Identifying key points in the classification algorithm where disagreement occurs can lead to better operational definitions. METHODS: Four physical therapists read an article and attended a 1-day training session in the classification system. Randomly paired therapists classified patients referred for treatment of acute low back pain and noted decisions at key junctures in the system algorithm. RESULTS: Forty-five patients were classified. Repeated examinations did not increase the patient's pain (P>.05). For 3 out of the 4 therapists, the interrater reliability showed a kappa value of 0.45. The fourth therapist, excluded from the overall analysis, exhibited a bias towards the immobilization classification. Among the 3 therapists, major disagreement occurred with the determination of symmetry with trunk side bending and the effects of repeated movements. CONCLUSIONS: Three out of 4 clinicians newly trained in the system showed moderate reliability. The reliability was slight when the fourth therapist was included. Refinement of the operational definitions and criteria for determining lumbar capsular patterns are needed. One day of training is probably not adequate for all therapists, especially for those biased towards specific low back pain syndromes.

Adult↗
PubMed1999

Tenderness classification of beef: III. Effect of the interaction between end point temperature and tenderness on Warner-Bratzler shear force of beef longissimus.

The objectives of this experiment were to determine 1) whether end point temperature interacts with tenderness to affect Warner-Bratzler shear force of beef longissimus and 2) if so, what impact that interaction would have on tenderness classification. Warner-Bratzler shear force was determined on longissimus thoracis cooked to either 60, 70, or 80 degrees C after 3 and 14 d of aging from carcasses of 100 steers and heifers. Warner-Bratzler shear force values (3- and 14-d aged steaks pooled) for steaks cooked to 70 degrees C were used to create five tenderness classes. The interaction of tenderness class and end point temperature was significant (P < .05). The increase in Warner-Bratzler shear force as end point temperature increased was greater (P < .05) for less-tender longissimus than more-tender longissimus (Tenderness Class 5 = 5.1, 7.2, and 8.5 kg and Tenderness Class 1 = 2.4, 3.1, and 3.7 kg, respectively, for 60, 70, and 80 degrees C). The slopes of the regressions of Warner-Bratzler shear force of longissimus cooked to 60 or 80 degrees C against Warner-Bratzler shear force of longissimus cooked to 70 degrees C were different (P < .05), providing additional evidence for this interaction. Correlations of Warner-Bratzler shear force of longissimus cooked to 60 or 80 degrees C with Warner-Bratzler shear force of longissimus cooked to 70 degrees C were .90 and .86, respectively. One effect of the interaction of tenderness with end point temperature on tenderness classification was to increase (P < .01) the advantage in shear force of a "Tender" class of beef over "Commodity" beef as end point temperature increased (.24 vs .42 vs .60 kg at 14 d for 60, 70, and 80 degrees C, respectively). When aged 14 d and cooked to 80 degrees C, "Commodity" steaks were six times more likely (P < .01) than "Tender" steaks to have shear force values > or = 5 kg (24 vs 4%). The end point temperature used to conduct tenderness classification did not affect classification accuracy, as long as the criterion for "Tender" was adjusted accordingly. However, cooking steaks to a greater end point temperature than was used for classification may reduce classification accuracy. The beef industry could alleviate the detrimental effects on palatability of consumers cooking beef to elevated degrees of doneness by identifying and marketing "Tender" longissimus.

Animal Husbandry↗
PubMed1978

Classification of lymphomas.

Malignant lymphomas are neoplasms of cells of the lymphoreticular or immune system. Classification of these neoplasms has long been controversial and confusing. In recent years, considerable progress has been made in establishing useful and prognostically significant classifications of lymphomas. Currently, lymphomas may be divided into two main groups: Hodgkin's disease and non-Hodgkin's lymphomas. The Rye classification of Hodgkin's disease is now widely accepted and used throughout most of the world. In contrast, considerable conflict exists about the schemes of non-Hodgkin's lymphomas. The traditional classifications of non-Hodgkin's lymphomas currently used by most pathologists are based purely on morphologic grounds, and, despite the fact that they may be conceptually incorrect, they have often been shown to be useful for clinicopathologic studies. New or modern but yet untested schemes based not only on morphologic criteria, but also on recent immunologic techniques, have been proposed. This work will review the classifications of Hodgkin's disease and the non-Hodgkin's lymphomas, emphasizing the currently used schemes, describe the major modern classifications of lymphomas, and discuss and illustrate the subclasses of lymphomas and the differential diagnoses of the various types of lymphomas from nonlymphomatous proliferations which may mimic them.

Diagnosis, Differential↗
PubMed1992

Prognostic value of the histologic classification of peripheral T-cell lymphoma: a clinico-pathologic study of 71 HTLV-1 negative cases.

The histologic and clinical features of 71 cases of peripheral T-cell lymphoma (PTCL) have been studied. All patients were HTLV-1 negative. The T-cell phenotype was demonstrated by immunohistochemistry on cryostat sections (41 cases) and paraffin-embedded sections (30 cases). All cases were histologically classified according to the updated Kiel classification of non-Hodgkin's lymphoma (low and high-grade) and according to a Working Formulation (WF)-based classification (predominantly small cells, mixed small and large cells, and predominantly large cells). Most cases were in the high-grade group according to both classifications. The prognostic value of these two classifications was comparatively assessed. The analysis of the actuarial survival curves showed that, by using the updated Kiel classification, low-grade PTCL had a survival probability higher than high-grade PTCL although the difference was not statistically significant. Similar results were obtained when the WF-based classification was applied: furthermore, actuarial survival curves of mixed small and large cell PTCL, and of large cell PTCL were rather similar, thus indicating that differentiating these two categories has a limited prognostic value.

Adolescent↗
PubMed1982

The "urge to classify" the narcotic addict: a review of psychiatric classification. I.

Attempts to classify drug addicts are divided into three main groups: (1) psychiatric classifications, (2) psychological classifications, and (3) classifications by pattern of abuse. An extensive literature review of the psychiatric classifications of narcotic addicts suggests that there is no one diagnosis that fits all narcotic addicts and that the importance of psychopathology in drug addiction has been exaggerated. It is concluded that theoretical psychiatric classifications of narcotic addicts have failed to stimulate empirical research and that empirical classifications have not demonstrated their utility for treatment and prognosis.

Humans↗
PubMed1984

The "urge to classify" the narcotic addict: a review of psychiatric classification. II.

Attempts to classify drug addicts are divided into three main groups: (1) psychiatric classifications, (2) psychosocial classifications, and (3) classifications by pattern of abuse. An extensive literature review of the psychiatric classifications of narcotic addicts suggests that there is no one diagnosis that fits all narcotic addicts and that the importance of psychopathology in drug addiction has been exaggerated. It is concluded that theoretical psychiatric classifications of narcotic addicts have failed to stimulate empirical research and that empirical classifications have not demonstrated their utility for treatment and prognosis.

Humans↗
PubMed1999

3D-radiographic analysis does not improve the Neer and AO classifications of proximal humeral fractures.

The Neer and AO fracture classifications for fractures of the proximal humerus have shown poor reproducibility based on plain radiography. We wanted to investigate whether the addition of 3-dimensional (3D) reconstructions would increase the reproducibility of classification. 7 observers independently classified 24 fractures of the proximal humerus using both plain radiographs, CT and 3D and the classification was repeated 2 months later. There was a moderate interobserver agreement when using the Neer classification, but only a fair agreement with the AO classification. The Neer system had a mean kappa value of 0.44 and the AO had a value of 0.32 for the first assessment. In the second assessment, the mean kappa values were 0.49 and 0.34, respectively. Intraobserver reproducibility was fair to substantial agreement for Neer (kappa range 0.27-0.73) and for AO (kappa range 0.29-0.74). In conclusion, the addition of CT and 3D to plain radiographs did not improve the reproducibility of the classifications of Neer and AO of the proximal humerus.

Humans↗
PubMedDate not supplied

Investigation of a severity-based classification of mood and anxiety symptoms in primary care patients.

BACKGROUND: Current Diagnostic and Statistical Manual of Mental Disorders (DSM) classifications describe spectrums of symptoms that define mood and anxiety disorders. These DSM classifications have been applied to primary care populations to establish the frequency of these disorders in primary care. DSM classifications, however, might not adequately describe the underlying or natural groupings of mood and anxiety symptoms in primary care. This study explores common clusters of mood and anxiety symptoms and their severity while exploring the degree of cluster congruency with current DSM classification schemes. We also evaluate how well the groupings derived from these different classifying methods explain differences in patients' health-related quality of life. METHODS: Study design was cross-sectional, using a sample of 1333 adult primary care patients attending a university-based family medicine clinic. We applied cluster analysis to responses on a 15-item instrument measuring symptoms of mood and anxiety and their severity. We used the PRIME-MD to determine the presence of DSM-III-R disorders. The SF-36 Health Survey was used to assess health-related quality of life. RESULTS: Cluster analysis produced four groups of patients different from groupings based on the DSM. These four groups differed from each other on sociodemographic indicators, health-related quality of life, and frequency of DSM disorders. Cluster membership was associated in three of four clusters with a clinically significant and progressive decrease in mental and physical health functioning as measured by the SF-36 Health Survey. This decline was independent of the presence of a DSM diagnosis. CONCLUSIONS: A primary care classification scheme for mood and anxiety symptoms that includes severity appears to provide more useful information than traditional DSM classifications of disorders.

Adult↗
PubMed2005

Classification tool for the systematic histological assessment of hepatocellular carcinoma, macroregenerative nodules, and dysplastic nodules in cirrhotic liver.

AIM: To design a classification tool for the histological assessment of hepatocellular carcinoma (HCC), dysplastic nodules (DN), and macroregenerative nodules (MRN) in cirrhotic liver. METHODS: Two hundred and twelve hepatocellular nodules (106 HCC; 74 MRN; 32 DN) were assessed systematically, quantitatively, and semiquantitatively as appropriate for 10 histological features that have been described as helpful in distinguishing small HCC, DN, and MRN in cirrhotic livers. The data were analyzed by multiple correspondence analysis (MCA). RESULTS: MCA distributed HCC, DN, and MRN as defined by traditional histological evaluation as well as the individual histological variables, in a "malignancy scale". Based on the MCA data representation, we created a classification tool, which categorizes an individual nodular lesion as MRN, DN, or HCC based on the balance of all histological features (i.e., vascular invasion, capsular invasion, tumor necrosis, tumor heterogeneity, reticulin loss, capillarization of sinusoids, trabecular thickness, nuclear atypia, and mitotic activity). The classification tool classified most (83%) of a validation set of 47 nodules in the same way as the routine histological assessment. No discrepancies were present for DN and MRN between the routine histological assignment and the classification tool. Of 25 HCC assigned by routine assessment in the validation set, 8 were assigned to the DN category by the classification tool. CONCLUSION: We have designed a classification tool for the histological assessment of HCC and its putative precursors in cirrhotic liver. Application of this tool systematically records histological features of diagnostic importance in the evaluation of small HCC.

Carcinoma, Hepatocellular↗
PubMed1995

Visual-auditory interaction in speeded classification: role of stimulus difference.

An experiment examined cross-modal interference and congruence in speeded classification: Subjects had to identify compound (visual-auditory) stimuli as either low or high in spatial position (visual judgment) or low or high in pitch (auditory judgment), in 16 conditions, each of which combined one of four possible pairs of tones, varying in frequency difference, with one of four possible pairs of dots, varying in positional difference. Both classification by position and classification by pitch revealed Garner interference (poorer performance than baseline, with orthogonal variation in the irrelevant dimension) and congruence effects (better performance with congruent than with incongruent stimulus combinations), but pitch classification showed more. Furthermore, the size of the pitch difference strongly affected classification by pitch and less strongly affected classification by position, but the size of the position difference affected neither. The findings are consistent with the view that Garner interference and congruence effects are closely related, perhaps arising from a common source, and suggest that the asymmetries could depend in part on the degree of dimensional overlap between stimuli and responses.

Adult↗
PubMed1995

Classification of leprosy cases under field conditions in Bangladesh. II. Reliability of clinical criteria.

In 2 non-governmental organization projects 244 new leprosy patients in Bangladesh were classified in the field according to clinical criteria i.e. number of skin lesions and number of enlarged nerves. Comparison of these classification results with the results of skin smears and biopsies yielded a sensitivity (for detection of a MB case) of 92.1%, but the 'unconfirmed MB rate' amounted to 52.6%. In order to improve the reliability of the operational classification, several additional clinical criteria were investigated. It was found that neither the presence of anaesthesia in the skin lesions nor the presence of grade 2 disabilities or peripheral anaesthesia or voluntary muscle testing (VMT) impairment contributed to an improved classification. Counting the number of body areas showing signs of leprosy, which had proven very useful in other programmes, did not result in a more reliable classification in the 2 projects in Bangladesh. The presence of clinical signs of lepromatous leprosy, more specifically nodules or diffuse infiltration, could be a useful addition to the classification criteria. If the sensitivity must remain higher than 90%, the lowest 'unconfirmed MB rate' obtainable in Bangladesh, using clinical criteria only, is 46.4%, for a sensitivity of 91.0%. However, the inclusion of skin-smear results in the classification criteria could improve the sensitivity to 96.6% and lower the 'unconfirmed MB rate' to 40.3%. A reduction in MB overclassification will result in more efficient and more cost-effective leprosy control programmes.

Bacteriological Techniques↗
PubMed1994

[TNM classification].

Stage classification of cancer is a method for objectively describing the status of a tumor. For more than 30 years, the TNM classification system was applied on various kind of malignant neoplasms, whose basic principles were: 1) applicability to all anatomic sites; 2) independence from treatment, and 3) susceptibility to further modification on the basis of information supplied by surgery and histopathological description. Thus far, TNM classification system has made a great contribution to 1) aid the clinician in the planning of treatment; 2) give some indication of prognosis; 3) assist in evaluation of the results of treatment; 4) facilitate the exchange of information between treatment centers; 5) contribute to the continuing investigation of human cancer. However, the publication of the fourth edition of the TNM classification has caused great consternation to urologists because of lack of logic for its complete revision. In this review analyses were done on the changes in the TNM classification of the genitourinary tumors described in the 3rd, 4th and 4th revision. Discussion was also made in relation to the TNM systems and classification systems in the general rules for clinical and pathological studies on urological malignancy of Japanese Urological Association.

Humans↗
PubMedDate not supplied

[The adaptive classification of the dynamic spectral patterns in the human EEG].

The classification technique of single spectra based on a matrix of intercorrelation between these spectra and the fixed set of standard spectral patterns (SP) has been put forward. Including in the classification technique a special procedure for automatic adaptation of the standard SP to given EEG records makes it possible to reduce the number of unclassified single spectra to a minimum (6-10%), which we can ignore during comparative analysis of the EEG classification profiles. Using the universal set of standard SP makes it possible to compare the results of classification of different EEG records. The results of the analysis of classification profiles of human multichannel EEG during performance of the memory task on perception of visual images are described in the paper. It has been shown that both the total EEG reorganization associated with the alpha rhythm blockade during eyes opening and less noticeable EEG shifts accompanying changes in the stages of cognitive activity are underlain by a rather differentiated transformations of relative contributions of each type of the SP into the total power spectrum. It has been revealed that a relatively small part (15-20%) of the elementary EEG segments participates in the reorganization of the EEG classification profile.

Adaptation, Physiological↗
PubMed2000

Femoral bone loss in total hip arthroplasty: classification and preoperative planning.

A single comprehensive classification system that can adequately describe all types of bone loss associated with hip arthroplasty should become a standard for reporting purposes. There is a need for a critical appraisal of the classification systems currently in use and, through a consensus, for development of a system that will permit comparison between the reported results of different techniques. Although no one classification system is ideal, the one proposed by the AAOS Committee on the Hip is the most comprehensive and the most consistently used. It addresses not only revision total hip arthroplasty but also primary hip replacement. It also addresses other conditions related to problems with the bone stock, such as those resulting from a previous hip arthrodesis on the acetabular side and femoral stenosis and malalignment on the femoral side. The only drawback to this classification system is its complexity; however, the problem of acetabular and femoral bone loss is of sufficient complexity and variety that a simple classification system, although ideal, cannot be comprehensive. Regardless of the absence of a common language and a comprehensive classification system that is applicable to all types of reconstructions, it is clear that femoral bone loss is a problem that will continue to challenge orthopaedic surgeons. It is only by careful and methodical analysis of patients who have femoral bone loss and by meticulous attention being paid to detail in preoperative evaluation and investigation, surgical planning, and the recording of outcomes that we will be able to improve our treatment of this difficult problem.

Arthroplasty, Replacement, Hip↗