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At least 19 recordsLinked to original sources
PubMed2000

EORTC classification for primary cutaneous lymphomas: a comparison with the R.E.A.L. Classification and the proposed WHO Classification.

Primary cutaneous lymphomas differ significantly from their nodal equivalents in clinical behaviour and prognosis, and often require a different therapeutic approach. Since currently used classification systems for non-Hodgkin lymphomas do not or insufficiently recognize the special character of these lymphomas, primary cutaneous lymphomas are not uncommonly diagnosed incorrectly, and/or treated inappropriately with unnecessarily aggressive therapies. For that reason the Cutaneous Lymphoma Group of the European Organization for Research and Treatment of Cancer (EORTC) has recently proposed a separate classification for the group of primary cutaneous lymphomas. The EORTC Classification is consistently based on a combination of clinical, histological, immunophenotypical and genetic criteria, and includes well-defined and recognizable disease entities. It contains a limited number of cutaneous T-cell lymphomas and cutaneous B-cell lymphomas, which comprise more than 95% of all primary cutaneous lymphomas. The clinical significance of this classification has been validated by long-term follow-up data of more than 800 patients with a primary cutaneous lymphoma. The basic principles of the EORTC Classification will be presented, and current controversies between the EORTC Classification on the one hand, and the R.E.A.L. Classification and the proposed WHO Classification on the other will be discussed.

Europe↗
PubMed2002

Cross-mapping the ICNP with NANDA, HHCC, Omaha System and NIC for unified nursing language system development. International Classification for Nursing Practice. International Council of Nurses. North American Nursing Diagnosis Association. Home Health Care Classification. Nursing Interventions Classification.

Nursing language plays an important role in describing and defining nursing phenomena and nursing actions. There are numerous vocabularies describing nursing diagnoses, interventions and outcomes in nursing. However, the lack of a standardized unified nursing language is considered a problem for further development of the discipline of nursing. In an effort to unify the nursing languages, the International Council of Nurses (ICN) has proposed the International Classification for Nursing Practice (ICNP) as a unified nursing language system. The purpose of this study was to evaluate the inclusiveness and expressiveness of the ICNP terms by cross-mapping them with the existing nursing terminologies, specifically the North American Nursing Diagnosis Association (NANDA) taxonomy I, the Omaha System, the Home Health Care Classification (HHCC) and the Nursing Interventions Classification (NIC). Nine hundred and seventy-four terms from these four classifications were cross-mapped with the ICNP terms. This was performed in accordance with the Guidelines for Composing a Nursing Diagnosis and Guidelines for Composing a Nursing Intervention, which were suggested by the ICNP development team. An expert group verified the results. The ICNP Phenomena Classification described 87.5% of the NANDA diagnoses, 89.7% of the HHCC diagnoses and 72.7% of the Omaha System problem classification scheme. The ICNP Action Classification described 79.4% of the NIC interventions, 80.6% of the HHCC interventions and 71.4% of the Omaha System intervention scheme. The results of this study suggest that the ICNP has a sound starting structure for a unified nursing language system and can be used to describe most of the existing terminologies. Recommendations for the addition of terms to the ICNP are provided.

International Council of Nurses↗
PubMed1983

Morphological classification of non-Hodgkin malignant lymphoma. II. Comparison between Rappaport's classification and the Kiel classification.

In a retrospective survey of 334 cases of non-Hodgkin lymphoma (NHL), 250 cases could be classified according to both Rappaport's classification and the Kiel classification. All patients initially in stage I had an excellent prognosis irrespective of histology, whereas patients in stages II, III and IV had a worse prognosis that did not significantly differ between stages. Rappaport's classification could separate stages II-IV into 2 different prognostic groups, one favourable and one unfavourable group. According to the Kiel classification, 3 prognostic groups - favourable, intermediate and unfavourable - were found. The survival rate for favourable Rappaport fell in between favourable-Kiel and intermediate-Kiel. Both subgroups within favourable-Rappaport (nodular lymphomas and diffuse well differentiated lymphomas) could actually be subdivided by the Kiel classification into one group with a more truly favourable behaviour and one with an intermediate behaviour. The extent of follicularity among nodular lymphomas and the presence of plasmacytoid differentiation among the small lymphocytic lymphomas were found to be of prognostic importance. In conclusion, we found that the Kiel classification separated the more indolent lymphomas better than Rappaport's classification. No preference was found concerning the high grade lymphomas.

Actuarial Analysis↗
PubMedDate not supplied

The need for new and short lists of classifications in health care. A proposed management classification for primary health care services: the 4-P classification.

In this paper we analyse the development of the International Classification of Diseases (ICD) and other World Health Organizations (WHO) classification families. We identify their limitations in supporting the managerial process of primary care and the supply of relevant information, especially for developing countries and present the alternative of using unified shorter lists in primary care and hospitals that can be adapted to suit the country's needs. The study presents a new comprehensive classification for primary care encounters (4-P Classification), which gathers together, on a single form, information on providers, place of encounter, problem-oriented diagnoses and procedure provided. The proposed classification can be easily coded and collated by health providers, with minimal paperwork; alternatively, a sample of the encounter forms can be collated and analysed at central or regional statistical units, using personal or microcomputers.

Developing Countries↗
PubMed1999

[Worldwide consensus: the way from the KIEL classification to the REAL classification to the WHO classification].

The history of lymphoma classification has been long and controversial. However, within the last thirty years much has been learned about the biology of lymphoma. The concept of classifying malignant lymphoma according to the (proposed) normal counterpart was developed in the KIEL classification. In 1994, the so-called revised European/American lymphoma classification was published as a consensus of pathologists from both sides of the Atlantic. Its clinical significance was proven in the International Lymphoma Classification Project. The upcoming WHO-Classification is based on the principle to define disease entities that can be recognized by the pathologists and are of clinical relevance. Within these entities, histopathological variants and clinical subtypes are described, which may or may not bear prognostic relevance. Prognostic factors can be defined within an entity, on a clinical, morphological, immunohistochemical or genetic basis.

Diagnosis, Differential↗
PubMedDate not supplied

[Clinical classification of laryngeal carcinoma. Critique of existing classifications and proposal of a new working classification].

Clinical classification of cancer of the larynx is an intriguing problem that has not been yet solved by the several proposals followed on during thirty years. The main disagreement deals with their aims that have become strictly prognostic, with no egard for therapeutic indications in individual cases. Apart from this aspect, the prognostic factors taken into account even by the last drawing (TNM UICC 1987) seem too rough to allow a correct statistical comparison among the different therapeutic modalities that can be applied to each clinical situation. This lack becomes exceedingly relevant when controlled therapeutic trials are to be planned, comparing radiotherapy with the various types of surgical procedure. A careful critical review of the successive clinical classifications (UICC, AJC) is made and a new descriptive working classification (CLM) is proposed. It aims first of all at a more rational organization of the main prognostic factors to be considered for all locations and stages, with no radical distortion of the last TNM UICC staging system, some details excepted. Afterwards each stage is subdivided into substages according to the presence or absence of those prognostic factors of known influence on applicability and outcome of all various therapeutic modalities, with particular emphasis to some pending problems. CLM classification makes it possible to set up homogeneous groups of cases on which every type of prospective or retrospective comparison of different treatments can be made. Advantages of the CLM working classification are: no need for further modification; possibility of giving information, after appropriate check, about therapeutic indications; possibility of moving quickly and simply subcategories of cases with similar prognosis from CLM to TNM.

Humans↗
PubMed1998

[Reproducibility and prognostic value of histopathological classifications of malignant lymphomas. Prolegomena for the 1st international classification proposed by WHO. Group of the non-Hodgkin's Malignant Lymphoma Classification Project].

Different histopathologic classifications have been used in the study of malignant lymphomas. The clinical relevance (reproducibility, prognostic value) has not been precisely studied. The "non-Hodgkin's lymphoma classification project" has been organized to study a cohort of 1,403 cases in 9 sites around the world consisting of consecutive patients seen between 1988 and 1990 in order to have a good follow-up. The reproducibility of the up-dated Kiel and the ILSG (REAL) classifications between the 5 visiting expert hematopathologists was pretty good, at least 85% for the majority of the entities. According to survival curves, the lymphomas can be stratified in 4 different groups. Comparison with the international prognostic index demonstrate that for therapeutic strategy both histopathology and index should be used. The results bring a good support to the project of the WHO to propose the first international classification of lymphomas based on both forme classifications.

Age Factors↗
PubMed1985

Classification of non-Hodgkin's lymphomas. Reproducibility of major classification systems. NCI non-Hodgkin's Classification Project Writing Committee.

An international, multi-institutional, clinical, pathologic study of 1175 cases of non-Hodgkin's lymphoma sponsored by the National Cancer Institute has offered a unique opportunity to investigate issues of reproducibility and agreement in pathologic classification. Teams of experienced hematopathologists reviewed all 1175 cases, with the "experts" utilizing their own classification system and the experienced panelists utilizing all six of the histopathologic classification systems. The fact that 20% of the slides were randomly repeated for a second interpretation allowed assessment of the reproducibility of any one given pathologist. In addition, the agreement between and among pathologists was evaluated. Results of this retrospective study showed that both experts and panelists were able to identify follicular (nodular) or other indolent lymphomas with 95% probability of concurrence between initial and later interpretations. Moreover, individual pathologists agreed with others in identifying and classifying these follicular features with approximately 90% probability of agreement. The reproducibility for individual pathologists, based on the 20% of cases that were randomly repeated, varied from a probability 0.53 to 0.93. Comparisons of intersystem predictability demonstrated that no one system predicted for any of the other systems within any major degree of reliability. This inability to "translate" from one system to another is thought to be a reflection of the problems of both interpathologist agreement and intrapathologist reproducibility. Flaws in study design are discussed and the usage of the working formulation of non-Hodgkin's lymphomas, in addition to classification by traditional schemas, is strongly encouraged.

Bone Marrow↗
PubMed1984

[Histological classification and prognosis of mammary cancer-histological classification devised by the Japan Mammary Cancer Society and WHO classification].

Between 1966 and 1977, 427 patients with mammary cancer underwent surgery at the Shikoku Cancer Center Hospital. Using these subjects, the histological classification devised by the Japan Mammary Cancer Society was compared with the WHO classification. Since the WHO classification places 80.4% of all cases into the category of invasive duct carcinoma, the significance of the histological classification as a factor in predicting prognosis is reduced. Thus, some other subclassification is needed for practical application. We classified invasive duct carcinoma according to cellular atypism (CAT), structural atypism (SAT) and infiltration mode (INF), and examined their relationship to the 5-year survival rate; there was a positive correlation.

Breast Neoplasms↗
PubMed1997

The Danish National Health Classification system--Nursing Interventions Classification--a part of a common Danish Health Care Classification.

The Danish Nursing Intervention Classification is the first national nursing intervention classification. Because of the official status of the project it is to be a national standard. It will thus be possible for the system to be in general use nation-wide, which is a necessary condition for an efficient communication in the health care sector in Denmark.

Classification↗
PubMed1995

A classification manager for compositional concept systems exemplarily shown by the AO/ASIF classification of fractures of long bones.

Conventional classification and coding systems represent concept systems by strict hierarchical enumeration and are supported by meaningful codes. Compositional classification is a means for representing concept systems by semantic descriptions. Classification is based on the structure of concept descriptions and explicit hierarchical relationships between their constituents. A classification manager will be presented which is based on the BERNWARD model [1]. BERNWARD is a conceptual graphs formalism and allows the constrained composition of concept descriptions by primitive concepts and roles. It stresses the distinction between generic and partitive relations. Concept descriptions can be classified on the basis of structural criteria for subsumption and part-whole relation. The capabilities of the model, compared to the principles of conventional classification and coding systems, will be exemplified by the AO/ASIF classification of fractures of long bones [2]. This classification is based on 2 axes: topography (long bone and segment) and morphology (type, group, subgroup and quality). It consists of the enumeration of all relevant fractures of long bones which are represented by a compositional meaningful code and by a line drawing. In the demonstrated system, the composition of fracture descriptions is supported by lists of terms and by graphics. The interactive selection of concepts from the space of concepts defined by the implemented classifications is supported by combining the following strategies: entering terms, selecting graphics, adding relevant characteristics to a concept selected before, and navigating through various hierarchies e.g.,generic or partitive hierarchies. These strategies are controlled by different types of compositional restrictions which are: role restrictions, hierarchical restrictions, and coordination restrictions. Role restrictions constrain the addition of specializing characteristics to elements of concept descriptions e.g., the possible complexities of fractures are simple, wedge, and multifragmented. Hierarchical restrictions constrain the generic or partitive refinement of concept elements. For example, every long bone can have the segment "proximal metaphyseal," but only tibia/fibula can have the region "malleolar." Coordination restrictions constrain the coordination of concepts e.g., a frontal fracture of the capitellum can affect the trochlea. Therefore, it is allowed to define a frontal fracture of capitellum and trochlea. Medical observations can be documented by association of selected concepts e.g., a fracture of radius and ulna can be associated to the patient Mr. X. The tools implemented for interactive selection of concepts can be used to rescan documented cases. In contrast to common classification systems, a case can be selected by combining different criteria in BERNWARD. It is possible to look for all female patients with a complex fracture of a long bone of the left upper extremity or to look for all bifocal fractures of the forearm with a wedge fracture of the radius. There is no problem to add new knowledge to the classification manager in the form of another classification. A new classification can be built by using elements of old ones e.g., the classification of the human skeleton is also useful for the AO/ASIF classification. Therefore, parts of classifications can be stored on and loaded from the disk by the demonstrated system. he user environment does not have to be changed to document a different area of medicine because of the conceptual representation of medical knowledge in BERNWARD. The user front-end can be used for all classifications e.g., a relational DBMS for Apple Macintosh systems. Some recursive functions are implemented in a linked Prolog system for effective computation of formal relations between concepts.

Computer Graphics↗
PubMed2000

Lymphoma classification--from controversy to consensus: the R.E.A.L. and WHO Classification of lymphoid neoplasms.

BACKGROUND: Controversy in lymphoma classification dates back to the first attempts to formulate such classifications. Over the years, much of this controversy arose from the assumption that there had to be a single guiding principle--a 'gold standard'--for classification, and from the existence of multiple different classifications. DESIGN: The International Lymphoma Study Group (I.L.S.G.) developed a consensus list of lymphoid neoplasms, which was published in 1994 as the 'Revised European-American Classification of Lymphoid Neoplasms' (R.E.A.L.). The classification is based on the principle that a classification is a list of 'real' disease entities, which are defined by a combination of morphology, immunophenotype, genetic features, and clinical features. The relative importance of each of these features varies among diseases, and there is no one 'gold standard'. In some tumors morphology is paramount, in others it is immunophenotype, a specific genetic abnormality, or clinical features. An international study of 1300 patients, supported by the San Salvatore Foundation, was conducted to determine whether the R.E.A.L. Classification could be used by expert pathologists and had clinical relevance. Since 1995, the European Association of Pathologists (EAHP) and the Society for Hematopathology (SH) have been developing a new World Health Organization (WHO) Classification of hematologic malignancies, using an updated R.E.A.L. Classification for lymphomas and applying the principles of the R.E.A.L. Classification to myeloid and histiocytic neoplasms. A Clinical Advisory Committee (CAC) was formed to ensure that the WHO Classification will be useful to clinicians. RESULTS: The International Lymphoma Study showed that the R.E.A.L. Classification could be used by pathologists, with inter-observer reproducibility better than for other classifications (> 85%). Immunophenotyping was helpful in some diagnoses, but not required for many others. New entities not specifically recognized in the Working Formulation accounted for 27% of the cases. Diseases that would have been lumped together as 'low grade' or 'intermediate/high grade' in the Working Formulation showed marked differences in survival, confirming that they need to be treated as distinct entities. Clinical features such as the International Prognostic Index were also important in determining patient outcome. The WHO Clinical Advisory Committee concluded that clinical groupings of lymphoid neoplasms was neither necessary nor desirable. Patient treatment is determined by the specific type of lymphoma, with the addition of grade within the tumor type, if applicable, and clinical prognostic factors such as the International Prognostic Index (IPI). CONCLUSIONS: The experience of developing the WHO Classification has produced a new and existing degree of cooperation and communication between oncologists and pathologists from around the world, which should facilitate progress in the understanding and treatment of hematologic malignancies.

Decision Making↗
PubMedDate not supplied

Urothelial neoplasia of the urinary bladder--comparison of interobserver variability for WHO Classification 1972 with WHO/ISUP Consensus Classification 1998.

BACKGROUND: Classification of urothelial bladder tumours is an important factor in the treatment and prognosis of these lesions. Over the years many classifications have been proposed for this purpose. The objective of this study was to classify urothelial neoplasms of the urinary bladder using the latest WHO/ISUP Consensus Classification 1998 and WHO Classification 1972 and compare the two regarding interobserver variability. METHODS: This study included 100 consecutive biopsy specimens of urothelial neoplasms of the urinary bladder diagnosed at the department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi. These were classified according to WHO Classification 1972 and WHO/ISUP Consensus Classification 1998 by 2 groups of pathologists independently. The tumour categories for WHO classification 1972; papilloma, and transitional cell carcinoma (TCC) grades I, II and III were compared with the WHO/ISUP Consensus Classification entities of papilloma, papillary neoplasm of low malignant potential, low grade and high grade papillary carcinomas. Kappa statistics were used to evaluate interobserver variability. Chi square test was used to calculate significance. RESULTS: There was agreement on 80 tumours between the two groups of histopathologists when using WHO classification 1972 while there was agreement on 95 tumours using WHO/ISUP consensus classification. The value of Kappa for WHO Classification was 0.68 (good agreement) whereas for WHO/ISUP Consensus Classification it was 0.91 (excellent agreement). The difference between the two systems was statistically significant (p<0,001). Kappa values were less for benign and borderline lesions using both systems. CONCLUSIONS: WHO/ISUP Consensus Classification 1998 showed less interobserver variability than WHO Classification 1972 in the evaluation of bladder tumours. It was found easier to apply by both groups. There was less agreement on the benign and borderline lesions using both the classifications.

Carcinoma, Papillary↗
PubMed2004

Legg-Calve-Perthes disease. Part I: Classification of radiographs with use of the modified lateral pillar and Stulberg classifications.

BACKGROUND: Accurate and reliable radiographic classifications of the relative severity and outcome of Legg-Calve-Perthes disease are essential in the study of that disease. As part of a prospective multicenter study, we sought to define more clearly the lateral pillar classification of severity and the Stulberg classification of outcome; we sought especially to define the borderlines between classification groups. METHODS: We performed interobserver and intraobserver trials of the lateral pillar and Stulberg classifications using sets of twenty radiographs chosen from a prospective study of 345 hips. To establish reliable definitions of the lateral pillar classification, we added a new, intermediate group termed the B/C border group, which includes femoral heads with a thin or poorly ossified lateral pillar and those with a loss of exactly 50% of the original height of the lateral pillar. The resulting classification consists of four groups: A, B, B/C border, and C. In our application of the classification system of Stulberg et al., we defined a class-II femoral head as round and fitting within 2 mm of a circle on both anteroposterior and frog-leg lateral radiographs. We defined a Stulberg class-III femoral head as out of round by more than 2 mm on either view and a Stulberg class-IV femoral head as one with at least 1 cm of flattening of the weight-bearing articular surface. To assess interobserver and intraobserver agreement, we performed two trials of each classification with six orthopaedic surgeons reviewing twenty radiographs or pairs of radiographs. RESULTS: In the first trial of the lateral pillar classification, there was 81% agreement per radiograph and the average weighted kappa was 0.71. In the second trial, there was 85% agreement per radiograph and the weighted kappa averaged 0.79. Intraobserver reliability testing showed a 77% match between Trials 1 and 2, an average weighted kappa of 0.81, and an average generalizability coefficient of 0.91. In Trial 1 of the Stulberg classification, there was 91% agreement per radiograph and an average weighted kappa of 0.82. In Trial 2, there was 92% agreement per radiograph and an average weighted kappa of 0.82. Intraobserver reliability testing showed an 89% match between Trials 1 and 2, an average weighted kappa value of 0.88, and an average generalizability coefficient of 0.92. CONCLUSIONS: The interobserver and intraobserver trials of these classifications produced kappa values and generalizability coefficients in the excellent range. The modified lateral pillar classification and the redefined Stulberg classification are sufficiently reliable and accurate for use in studies of Legg-Calve-Perthes disease.

Adolescent↗
PubMed2004

Comparative evaluation of gastric carcinoma staging: Japanese classification versus new american joint committee on cancer/international union against cancer classification.

BACKGROUND: The TNM and Japanese classifications of regional lymph node spread (N categories) for gastric cancer differ, whereas the classifications of local extent (T categories) are identical. This study was designed to compare these staging systems and devise a more rational system for gastric carcinoma. METHODS: A series of 1244 patients with gastric cancer were enrolled in the study. Survival rates were evaluated to clarify which aspects of each staging system (feasibility, reproducibility, and accuracy of prognostic stratification) were superior. RESULTS: The TNM and Japanese classification systems differ in their categorizations of lymph node spread. A significant difference in survival rate was observed in lymph node metastasis classified as N1 and N2 by the Japanese classification and then subclassified by the TNM classification, although there was no significant difference in the survival in cases of lymph node metastasis classified by TNM into pN1 and pN2 and then subclassified by the Japanese classification. Among patients with M1 metastasis (number 16 a2 and b1 in Japanese classification) in the TNM classification, there was a significant difference in survival. A new classification that included the para-aortic lymph nodes (number 16 a2 and b1) as regional lymph nodes within the TNM classification provided homogeneity and an improvement in staging. CONCLUSIONS: TNM classification was more rational and homogenous than Japanese classification. New classification could lead to worldwide uniformity in the description of patients and make possible uniform interinstitutional comparisons of surgical results.

Analysis of Variance↗
PubMed2000

Cutaneous lymphomas: a proposal for a unified approach to classification using the R.E.A.L./WHO Classification.

BACKGROUND: The classification of cutaneous lymphomas has been controversial. The EORTC has proposed that conventional classification schemes are not suitable for cutaneous lymphomas, and that a unique classification system is required. DESIGN: The authors review the suitability of the R.E.A.L. Classification for cutaneous lymphomas, and compare it with the newly proposed EORTC system. The principles of the R.E.A.L. Classification have been adopted by the WHO committees for the classification of hematopoietic and lymphoid neoplasms. Each disease is defined as a distinct entity based on an integration of morphology, immunophenotypic and genetic features, clinical presentation and course, and normal cellular counterpart. If either primary or secondary involvement of the skin is a constant factor, this aspect is considered integral to disease definition. RESULTS: Organ-specific classification schemes may impede the recognition of common features of diseases involving multiple anatomic sites. For example, cutaneous marginal zone B-cell lymphomas (formerly designated cutaneous immunocytomas) mirror the features of MALT lymphomas in other anatomic sites. While the EORTC Classification for cutaneous lymphomas attempts to emphasize certain aspects of these neoplasms of importance to dermatologists, the use of multiple classification systems is a step backward, and may lead to confusion among hematologists/oncologists, and dermatologists. Nevertheless, cutaneous lymphomas often have a more indolent natural history than nodal lymphomas, and may require different therapeutic approaches. Clinical features are an important prognostic factor and should be utilized in guiding therapy. For cutaneous lymphomas the presence or absence of systemic spread is particularly important. Additionally, the site of origin is often important in the definition of disease entities. CONCLUSIONS: Organ-specific classification schemes, such as the EORTC Classification for cutaneous lymphomas, are not required, and indeed may impede the recognition of common features of diseases involving multiple anatomic sites. A common classification system, such as the R.E.A.L./WHO Classification, should be utilized for all lymphomas, regardless of the site of origin.

Europe↗
PubMed2005

Using a multidisciplinary classification in nursing: the International Classification of Functioning Disability and Health.

AIM: This paper reports a study to explore systematically the usefulness of the International Classification of Functioning, Disability and Health to nurses giving patient care. BACKGROUND: The International Classification of Functioning, Disability and Health has a history of more than 20 years. Although this World Health Organization classification offers multidisciplinary use, nurses are not familiar with it. METHODS: Applications of the International Classification for nursing practice were developed and evaluated in a multi-centre project, composed of a series of 10 projects in a variety of settings. These applications were a variety of tools, such as assessment forms, care plans and transfer forms. The study used information from 653 patients, 469 nurses and 178 others (International Classification experts; other professionals with whom nurses communicate or discuss patient data). FINDINGS: Large sections of the International Classification were used in the 10 projects, revealing a predominant focus on body functions (53% of all three-digit codes and corresponding terms used). Although large sections of the Classification were useful in practice applications, some items were identified that could be added, improved or described with more detail. Positive remarks made by nurses referred to the scope of the International Classification, which encouraged assessing beyond a patient's functional impairments. CONCLUSIONS: The International Classification of Functioning, Disability and Health can be a useful tool in classifying and communicating aspects of patient functioning by nurses. A level of moderate detail within the Classification (three-digit level) seems appropriate for most nursing purposes. Our results on items that could be added or improved can serve as input in future revisions of the Classification. Future use of the International Classification should be encouraged, because of its relevance to nursing and its potential for multidisciplinary use in patient care.

Activities of Daily Living↗
PubMed2002

Histologic classification of thymic epithelial tumors: comparison of established classification schemes.

The object of our multicenter retrospective study was to compare the new histologic World Health Organization (WHO) classification and the classical histologic Bernatz classification in terms of interobserver agreement and prognostic importance. The influence of coexisting diseases was also analyzed using the Charlson score. We evaluated 218 patients from 5 different hospitals who were treated between 1967 and 1998. The statistical methods of analysis included Kaplan-Meier estimates of survival curves and the application of Cox proportional hazards models to identify sets of prognostic factors for survival. Interobserver agreement was assessed by kappa coefficients. For both WHO and Bernatz classifications, interobserver agreement was good (weighted kappa > 0.87). However, the subdiversification of the "bioactive" WHO subgroup (B1, B2, B3) resulted in an interobserver agreement of only 0.49 within this group. In multivariable models, both the WHO classification and the Bernatz classification including carcinomas showed similar prognostic capabilities. The B3 type in the WHO classification and the predominantly epithelial type in the Bernatz classification had an intermediate prognostic ranking in comparison with the carcinomas and with the other subgroups. For both classifications, further simplification and subclassification into 3 subgroups led to classes with good discriminative power in respect to survival. In addition, very good interobserver agreement was observed in the simplified classifications. Comorbidity, sex, age of the patient and lymphofollicular hyperplasia had no major influence on overall survival. Both classifications showed similar prognostic power. Interobserver agreement of the type B subgroups was only moderate. By simplification of the classifications, subgroups with distinct survival could be identified.

Adolescent↗