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Leprosy classification for use in control programs.

Some classifications of Leprosy currently in use are reviewed and the difficulties of their application in field work are analysed. While it is recognized the scientific value of these classifications in order to identify precisely the clinical, bacteriological, histological and immunological aspects of the disease, an alternative simplified classification is suggested, to be used in control programmes. In this classification clinical forms that require the same public health action are put together. Thus, clinical forms are reduced to three basic groups. The clinical and laboratory criteria which define each group are presented, as well as the correlation between this simplified classification and the classic one.

Humans↗

A statistically based method for identifying hospital classification criteria.

The development of valid classification criteria for U.S. hospitals. A number of bills recently introduced in the U.S. Congress call for the linkage of classification criteria to cost limits for hospitals. Such proposals have not indicated how the classification criteria should be validated or tested.A research project was therefore undertaken to determine whether 87 large community hospitals could be classified into interpretable and reproducible homogenous groups. By means of an automatic interaction detector (AID), a set of unique classification criteria were identified. These included residency and internship education programs, medical school affiliation, renal dialysis, and organ bank facilities. Application of the criteria to 1970 and 1971 data for the 87 hospitals resulted in five reproducible and stable groups of hospitals. The criteria were validated by several tests involving different types of cost comparisons and ratios.The research results indicate that an AID-based classification structure is a feasible model for grouping or classifying large hospitals for comparative purposes. Only a small number of variables are necessary to classify large hospitals, and the criteria do not need to be overly complex. Many of the variables traditionally used may be omitted.

Economics, Hospital↗

Immunological classification of high grade non-Hodgkin's lymphomas (NHL) in children.

The immunological classification of 28 high grade non-Hodgkin's lymphomas (NHL) in children was shown. The morphological classification was based on Working Formulation, the immunological classification--on acute lymphoblastic leukemia subtypes. The phenotypes were assayed cytofluorometrically with monoclonal antibodies and compared to ontogenic stages in B and T cell development. Small non-cleaved cell lymphoma (Burkitt's type) was seen in 13 patients, lymphoblastic lymphoma in 12 patients, low differentiated in 3 patients. Immunological classification showed B-lymphocyte origin of blast cells in 15 patients including 11 small non-cleaved Burkitt's lymphoma (mature B and cALL phenotype), 3 undifferentiated cases (pro-B and mature B cell) and 1 case of lymphoblastic lymphoma (cALL type). T-cell origin of blast cells was demonstrated in 13 patients. The immunological classification used routinely was helpful in selection of patients with unfavourable prognosis. The more precise description of blast cells was valuable for better adjustment of therapy and better prognosis.

Adolescent↗

A case-mix classification system for long-term care facilities.

The resident assessment and associated classification model inherent in any case-mix classification system are particularly germane to nursing. Resource Utilization Groups-Version III (RUG-III) illustrates how a case-mix classification system for long-term care nursing facilities is designed and constructed. Understanding the RUG-III classification system can assist nurses in evaluating other classification systems that may be adopted by Medicaid programs. Nurses provide a crucial perspective in forming and informing healthcare policy associated with nursing home payment and quality.

Diagnosis-Related Groups↗

[Nomenclature and classification of membrane receptors and their subtypes].

Present rapid growth of information about receptors for endogenous ligands and drugs requires changes in definitions, nomenclature and classifications of receptors and their subtypes. Receptors are defined as such membrane structures for which we have sufficiently reliable characterization of their structure, transducing mechanisms (mediation of intracellular effects), and selectively acting drugs (operational criterion). This characterization is based on the integrated approach to classification that relies on all three essential criteria. The current classification of membrane receptors is organized by International Union of Pharmacology Committee on Receptor Nomenclature and Drug Classification (NC-IUPHAR). Their conclusions about receptor classifications are regularly published in pharmacological journals and in special publications. List of presently known membrane receptors and their subtypes is provided in this review.

Receptors, Cell Surface↗

Risk stratification in unstable angina. Prospective validation of the Braunwald classification.

OBJECTIVES: To validate the Braunwald classification of unstable angina as a predictor of in-hospital cardiac complications; to determine which factors of the Braunwald classification contributed significantly to this prediction; and to devise a method of combining these predictive factors into an overall odds ratio for complications. DESIGN: A validation cohort of consecutive patients followed prospectively for in-hospital cardiac complications including myocardial infarction and death. SETTING: A community-based academic medical center. PATIENTS: A total of 393 patients admitted consecutively to the coronary care and intermediate care units with unstable angina. MAIN OUTCOME MEASURES: Major cardiac complications including death, myocardial infarction, congestive heart failure, cardiogenic shock, and severe ventricular dysrhythmias. RESULTS: Multiple logistic regression analysis identified four clinical factors used in the Braunwald classification that predicted the in-hospital occurrence of major cardiac complications: (1) myocardial infarction within less than 14 days (odds ratio [OR], 5.72; 95% confidence interval [CI], 1.92 to 16.97); (2) need for intravenous nitroglycerin (OR, 2.33; 95% CI, 1.31 to 4.17); (3) lack of beta-blocker or calcium channel blocker prior to admission (OR, 3.83; 95% CI, 1.55 to 9.42); and (4) baseline ST depression (OR, 2.81; 95% CI, 1.45 to 5.47). Two other clinical factors, diabetes and age, were also significant predictors. Validation of this model using parametric and nonparametric bootstrap techniques revealed excellent agreement between the CIs for adjusted ORs derived from the multiple logistic regression and those derived from the bootstrap. CONCLUSIONS: The classification of unstable angina proposed by Braunwald includes four factors that predict risk of major in-hospital cardiac complications. Specific factors used in this classification can be combined with diabetes and age to better stratify risk of major cardiac complications in this disorder using a simpler model.

Age Factors↗

[Prognostic evaluation of the classification of distal radius fractures].

Authors give historical review of different classifications in the cases of distal radial fractures. They give analysis on advantage and disadvantage of three different classifications, based on 633 cases, according to the practical applicability, to the expected outcome and to the way of treatment. According to the analysis the Older classification gives good prognosis, but the Frykman classification is without any practical importance. The AO classification is prognostically more or less satisfactory.

Colles' Fracture↗

Histologic classification and immunophenotyping of canine non-Hodgkin's lymphomas: unexpected high frequency of T cell lymphomas with B cell morphology.

Using three different classification schemes (Rappaport, the Working Formulation, and the Kiel classification), 116 canine malignant lymphomas were classified histologically. The number of lymphomas with a completely follicular growth pattern was low (14.9%). The majority of the lymphomas (50.8%) had a diffuse type of architecture, while 34.3% were diffuse with some nodularity. In the Rappaport scheme, 69.3% of the canine lymphomas were classified as histiocytic lymphomas, but these consisted of a group of tumors with different morphologic and immunologic cell types. The Working Formulation and the Kiel classification could be applied to differentiate the canine lymphomas cytomorphologically. In both the Working Formulation and the Kiel classification, only a minority of lymphomas (16.4 and 12.0%, respectively) were low-grade malignant lymphomas. Large cell or centroblastic lymphomas were the most frequently encountered in the Working Formulation or the Kiel classification, respectively. Immunophenotyping of 95 lymphomas was performed with the aid of a panel of monoclonal and polyclonal antibodies. The majority of the lymphomas were of B cell origin (58.9%) while three were classified as non-B/non-T cell lymphomas. Contrary to the distribution pattern of human non-Hodgkin's lymphoma (NHL) in western countries, there was a high percentage of T cell lymphomas (37.9%) in the canine. However, the phenotype could not be predicted by the morphologic characteristics alone.

Animals↗

Classification of hazardous materials by oral, dermal, and inhalational toxicities.

Currently, no toxicity classification system exists in any formal sense for dermal and inhalational toxicities (the main routes of exposure in occupational environments), and, different criteria are used by regulatory agencies in the classification of toxicity by these routes. Therefore, a comparison of the acute toxicity information available for 582 chemicals with exposure standards was made with a view to establishing such a toxicity classification system. By sorting data on the basis of oral toxicity values, and dividing these values into toxicity classes (such as slightly toxic, very toxic, supertoxic), a strong correlation was found to exist between oral and dermal toxicity values, and oral and inhalational toxicity values. Indeed, overlap across toxicity classes was very small, and in most cases, clear demarcations existed. A toxicity classification system is proposed from these data. This classification system is based on a comparison of actual toxicity data, and is a true reflection of the interrelationships between oral, dermal, and inhalational toxicities.

Administration, Inhalation↗

[Anterior commissure in the spreading of the glottic cancer: classification, prognosis and therapy].

Laryngeal tumors involving anterior commissure have a particularly aggressive behaviour. Prognosis and therapy of these tumors is quite different depending on the type and the extension of commissural involvement. In spite of these considerations, present TNM classifications (UICC/AJCC) of laryngeal tumors do not consider anterior commissure in the spreading of glottic cancer. To obviate this problem, Fini-Storchi (1993) proposed an anatomic-oncological definition of anterior commissure (AC) and, on it, a classification (additional to TNM system) of AC involvement (AC1-AC2-AC3). We marginally modified Fini-Storchi classificative criteria and, according to them, we performed e re-classification of laryngeal tumors with anterior commissure involvement, we observed in our Department between 1977 and 1991 (255 cases). In particular we treated 190 AC1 (74.5%), 40 AC2 (15.6%), 25 AC3 (9.8%). For each AC category, different therapeutical options are presented and discussed. Long term results (minimum follow-up: 38 months) are evaluated and efficacy of AC classification is checked.

Adult↗

The Read clinical classification and its use in plastic surgery.

The recording of medical data has developed from crude non-specific classifications to complex systems tailor-made for individual practices. The development of the Read Clinical Classification has produced a complex classification which is user friendly and covers the whole of medicine. The classification allows unique medical concepts to be assigned preferred descriptive terms, each of which has a unique identifying code. The system allows very specific data to be recorded by using strings of linked codes. The development of the classification has led to an improvement in the way data for plastic surgery can be recorded. This paper outlines the principles used in the development of the terms for plastic surgery, and how they may be used in the future.

Abstracting and Indexing↗

[The classification of anomalies of the maxillodental system].

Since the known classifications of maxillodental abnormalities are either not up-to-date or essentially differ from the WHO classification, the authors suggest a working scheme for classification of maxillodental abnormalities, that is based on the international classification of diseases. All the principal disorders of the maxillodental system structure are taken into consideration in the suggested scheme, that is, in fact, a clinico-morphologic and therefore pathogenetic classification.

Humans↗

Comparison of functional and medical assessment in the classification of persons with spinal cord injury.

For many reasons, persons with spinal cord injury (SCI) are classified according to a set of guidelines in which the term classification refers to a numeric value based on some selection of motor, sensory, and/or functional tests. The resulting classification is used as a means of quantifying the extent of neurological injury. Scales that focus on neurological injury (in the acute phase) differ from those that focus on functional ability (in the chronic phase). The relationship among these scales in grouping persons with SCI has not been ascertained. The purpose of the present study was to compare several classification systems within the same group of spinal cord injured subjects. Thirty subjects with traumatic SCI were classified by the same examiner and grouped according to three classification systems: 1) the American Spinal Injury Association (ASIA) Scale; 2) the Bracken Scale; and, 3) the wheelchair basketball (BB) Sports Test. Calculation of Spearman's Rho correlation coefficients showed positive associations between the ASIA Scale and BB Sports Test (0.81). The Bracken Scale showed a negative correlation with the ASIA system (-0.66) and the BB Sports Test (-0.48). Of the three classification systems, the ASIA Scale showed the greatest discrimination in grouping subjects with SCI in both mixed (complete and incomplete), as well as incomplete injuries. It was clear that these three systems could result in different patterns of subject grouping and thus might affect the outcome of the clinical research studies.

Activities of Daily Living↗

Classifications and epidemiologic considerations of epileptic seizures and epilepsy.

The manifestations of epileptic disorders are widely known to be extremely protean. Classifying the disorders is a way of achieving a common understanding of the terminology used in identifying seizure disorders in the clinical or research settings. Two International Classifications have been developed, namely the International Classification of Epileptic Seizures and the International Classification of Epilepsy and Epileptic Syndromes. The first divides epileptic seizures into two major categories: partial and generalized. Partial epileptic seizures are further classified according to the impairment or the preservation of consciousness into simple partial and complex partial seizures. Either condition may secondarily generalize into tonic-clonic seizures. Under the International Classification, epilepsy and epileptic syndromes are initially classified according to their corresponding types of seizures into localization-related and generalized disorders. Each disorder is further classified according to the relationship to etiologic or predisposing factors into symptomatic, cryptogenic, or idiopathic types. The classifications undoubtedly will be further revised as more is learned about epileptic disorders with advances in electrophysiology, neuroimaging techniques, and molecular genetics. An overview of the epidemiology of epileptic disorders shows that, contrary to the popular belief, they are primarily disorders of childhood; age-specific incidence rates of first unprovoked seizure and of epilepsy are highest in the elderly. An appreciation of the epidemiology of seizure disorders is essential in their clinical and laboratory evaluation.

Adolescent↗

[1984-1994: ten years of skin flaps. Improvements and conceptual developments. Development of vascular concepts, classification and clinical concepts].

After a brief review of definitions and semantics, the author recalls the state of the art before 1984 concerning arterial and venous cutaneous blood supply. Studies and concepts published since 1984 include those of Nakajima, who distinguished six types of cutaneous arteries, Gumener, who emphasized the vascular entity represented by the subcutaneous connective tissue, and Taylor. This author, after many studies on the whole body, defined forty arterial and venous cutaneous territories, border-arteries and veins oscillating at the borders of these territories, as well as a number of neurovascular entities (neurocutaneous arteries and veins). In terms of haemodynamics, the concepts of anatomical, haemodynamic and potential arterial cutaneous territories, the concepts of arteriosome and venotome and the concept of low venous pressure zones are analysed. These anatomical and concepts haemodynamic are the basis for the feasibility and reliability of the various cutaneous, musculocutaneous and fasciocutaneous flaps. A number of classifications for these various flaps have been proposed since 1984: a theoretical classification (Kunert's), classifications according to vascular systematization, including Nakajima's classification, and many others. The author proposes a practical classification which should allow a better understanding and better national and international exchange. In parallel, the design and indications of various types of flaps have also advanced since 1984. Skin flaps without a systematized blood supply do not correspond to random flaps. Musculocutaneous flaps have advanced in three directions: partial muscular harvesting when the objective of the flap is essentially cover, an increase of the skin flap surface area; substitution, in certain anatomical regions, of the concept of fasciocutaneous flap for that of musculocutaneous flap, particularly in thoracolumbar and anterior thoracic regions. The author notes the progress in fasciocutaneous flaps: distal pedicle leg flaps, development of decreased cutaneous morbidity resulting in fasciosubcutaneous flaps and proximal or distal fascial (or fascio-adipose) pedicle fasciocutaneous island flaps, progress of normal flow or reverse flow island septocutaneous flaps on the main vessels of the limbs towards to similar types of island flaps on secondary vessels, especially in peri-articular sites. The other clinical concepts analysed include grafted fascial flaps, grafted adipose and fascioadipose flaps, neurocutaneous flaps, "tailormade" flaps and chimeric flaps. This progress in vascular and clinical concepts of skin cover flaps over the last ten years is illustrated by many examples of skin cover, particularly involving the posterior aspect of the heel.

Female↗

[Classification of mood disorders in adults].

The two main classifications of mood disorders currently used are the American system, DSM, the fourth edition of which came out in 1994, and the International Classification of Diseases, the tenth edition of which was published in 1993. These classifications are based on the following broad principles: simple description with no hypothetical aetio-pathogenic discussion, distinction between the various clinical forms in accordance with variety and intensity of symptoms, co-existence of other more or less serious somatic disorders, individual identification of bipolar forms, etc. The key changes made in the classification of mood disorders between the revised version of DSMIII published in 1987 and DSM-IV published in 1994 suggest that a greater degree of concordance in diagnosis between different practitioners may be expected in future. In addition, certain changes such as the therapeutic decision-trees will most likely have an impact on practice. In this way, further details are added to the clinical criteria of duration or description of the clinical features seen, thereby allowing a clearer distinction to be made between normality and the onset of the pathology in question. Regarding bipolar disorders, the general organisation of the classification and the terminology used have been extensively revised, with the distinction between types I and II becoming official. Furthermore, differentiation between certain aspects of depression emphasises the frequency of certain clinical particularities, either in the onset or during the course of these disorders. This is true of melancholic, catatonic and atypical features specifiers (i.e. with mood reactivity and interpersonal rejection sensitivity), post-partum onset specifier, seasonal pattern specifier and rapid-cycling specifier. Finally, a certain number of specifications are proposed allowing the postulation of notions of complete or partial cure between episodes in case of recurrence.

Adult↗

Comparison of quantitative methods to assess hepatic function: Pugh's classification, indocyanine green, antipyrine, and dextromethorphan.

STUDY OBJECTIVES: To compare three quantitative metabolic markers used to assess hepatic function, indocyanine green (ICG), a high-extraction marker; antipyrine, a low-extraction marker; and dextromethorphan, a P-450IID6 marker, with the clinically used Pugh's classification. DESIGN: Comparison of 12 healthy controls with 12 age- and sex-matched patients with different degrees of liver disease. SETTING: Research center in a university-affiliated teaching hospital. PATIENTS: The 12 patients had different degrees of liver disease: 4 mild (Pugh's score 6 or 7); 4 moderate (Pugh's score 8 or 9); and 4 severe (Pugh's score > or = 10). Each level had an equal number of men and women subjects. MEASUREMENTS AND MAIN RESULTS: Clearance of ICG detected mild alterations in hepatic function as efficiently as it did for moderate and severe impairment, but it lacked the specificity to distinguish among the classification groups. In contrast, antipyrine was effective in identifying moderate and severe hepatic impairment; however, its clearance was not reduced in mild liver disease. Pugh's classification appears to be a clinically useful method of assessing the global degree of hepatic impairment in patients with chronic disease, and there was a significant correlation between it and antipyrine clearance (r = 0.67, p = 0.0003) and ICG clearance (r = 0.86, p = 0.0001). Four of eight patients with a Pugh's score greater than 8 had a dextromethorphan metabolic ratio expression reflective of a poor metabolizer phenotype based on 0- to 4-hour urine collection, but only two of those eight patients were classified as poor metabolizers based on 4- to 12-hour urine collection. These percentages of poor metabolizers are substantially higher than for historical controls (8.5-10.4%) and most likely reflect a decrease in the P-450IID6 functional ability with progression of liver disease. However, due to small sample size and lack of knowledge of the patients' genotypes, these data are only suggestive. CONCLUSION: Pugh's classification appears to be a reliable indicator of the degree of chronic liver disease and could be employed as a drug development research classification tool; however, it does not replace quantitative metabolic markers, especially isozyme-specific markers.

Adult↗

Empirically derived classification of coagulation disorders in 224 patients.

BACKGROUND: It is not known whether the current molecular classification of blood coagulation disorders into severe (0-1%), moderate (1-5%) and mild (5-40% factor activity remaining) corresponds to the actual clinical situation or is in the patients best interest. METHODS: A questionnaire-based study of 244 patients. Principal factor analysis was used to create a set of variables for classification, which was performed using K-means algorithm. The main variables were use of prophylactic treatment during the last five years and during the last 12 months, home treatment, bleeding, surgery, antibody inhibitors, use of cold medication, pain, use of analgesics, functional disability and physical activity level. RESULTS: The first five variables of the main outcome measures loaded to a factor reflecting bleeding (bleeding factor) and the last four to a pain factor; both factors produced a 3-cluster solution with severe, moderate and mild bleeding or pain. Overlap between the molecular, bleeding and pain classifications was not extensive. Only 16% of 81 patients with severe coagulation factor deficiency had severe musculoskeletal pain and disability. Furthermore, only 28.6% of the patients with severe von Willebrand's disease actually had a severe bleeding disorder. CONCLUSIONS: Molecular classification does not correlate very well with the severity of disease as reflected in bleeding and pain. This is due to better prognosis for patients on modern medical management. Appropriate patient classification is a basis for defining and managing patients' clinical problems.

Adolescent↗