scholarly journals RELIABILITY OF A NOVEL KOCHER CLASSIFICATION FOR OSTEOCHONDRITIS DISSECANS

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0026
Author(s):  
Stephen T. Mathew ◽  
Laura A. Lins ◽  
Patricia Miller ◽  
Mininder S. Kocher
Keyword(s):  
Osteochondritis Dissecans ◽  
Classification System ◽  
Treatment Decision ◽  
Classification Systems ◽  
Disease Classification ◽  
Interrater Agreement ◽  
The Novel ◽  
Treatment Decision Making ◽  
The Stability ◽  
Different Characteristics

Background: Current radiographic classification systems for osteochondritis dissecans (OCD) of the knee utilize different characteristics of lesions to rate the stability and severity of disease. Classification systems such as Hefti and Nelson are widely used as the current standards for radiographic imaging and arthroscopic evaluation is the gold standard to assess stability. The purpose of this study was to compare the reliability of this new method with that of older, more established methods, as the first step in establishing its validity and clinical utility. Methods: One hundred twenty-four standardized knee MRIs of established patients with knee OCD were pre-selected to capture the spectrum of lesion types both regarding progression and location of the lesion. Each of the MRIs were classified independently by 2 readers into the Kocher, Hefti, and Nelson classification systems and a random sample was re-reviewed by one rater 6 weeks after initial review. The inter-rater and intra-rater agreement was evaluated by estimating Krippendorff’s alpha. Results: 108 knees were classified by the Kocher, Hefti, and Nelson classification systems, as 16 of the studies had an absence of the appropriate imaging sequences necessary. There were no differences in agreement across classification systems. Krippedorf’s alpha for interrater agreement was 0.51 (CI 0.33-0.66) for the Hefti classification, 0.50 (0.34-0.64) for the Nelson classification, and 0.49 (0.32-0.65) for the Kocher classification. The intrarater agreement was 0.88 (0.75-0.97) for the Hefti classification, 0.94 (0.86-0.99) for the Nelson classification and 0.98 (0.94-1.00) for the Kocher classification system. Conclusions: The novel Kocher classification for knee OCD had almost perfect intrarater agreement and moderate interrater agreement, consistent with well-established classification systems. This new classification system would be simpler with only three categories, whereas the Hefti (five) and Nelson (four) sysems had more. This simpler classification system could be widely applicable because the results could more accurately drive clinical treatment decision making for clinicians.

Yoruba Disease Classifications for Planning in Health Care

1983 ◽  
Vol 4 (2) ◽  
pp. 117-122 ◽  
Author(s):  
William R. Brieger ◽  
Jayashree Ramakrishna ◽  
Joshua D. Adeniyi
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Classification System ◽  
Training Programs ◽  
Classification Systems ◽  
Disease Classification ◽  
General Point ◽  
Primary Health ◽  
Illness And Disease ◽  
Point Of Departure

An understanding of local concepts of illness and disease that underlie disease classification systems is essential for designing culturally relevant training programs in primary health care. Prior to training personnel in primary health care in Idere, Nigeria, residents were interviewed revealing that two main groups of disease exist. Generally, arun is serious, chronic and contagious, while aisan represents temporary indispositions. When given seventeen conditions to classify, respondents clearly demarked five as arun and five as aisan while the remainder fell in a grey area in between. Ironically, malaria which is a dangerous disease to young children, was classified as aisan. The disease classification system is being used as a general point of departure for discussion during training. Concerning training on the specific diseases, appropriate ideas are reinforced while others are modified all within the context of the local classification system.

scholarly journals Classification and treatment of endothermal heat-induced thrombosis: Recommendations from the American Venous Forum and the Society for Vascular Surgery This Practice Guidelines document has been co-published in Phlebology [DOI: 10.1177/0268355520953759] and Journal of Vascular Surgery: Venous and Lymphatic Disorders [DOI: 10.1016/j.jvsv.2020.06.008]. The publications are identical except for minor stylistic and spelling differences in keeping with each journal’s style. The contribution has been published under a Attribution-Non Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0), (https://creativecommons.org/licenses/by-nc-nd/4.0/).

2020 ◽  
pp. 026835552095375
Author(s):  
Lowell S. Kabnick ◽  
Mikel Sadek ◽  
Haraldur Bjarnason ◽  
Dawn M. Coleman ◽  
Ellen D. Dillavou ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Classification System ◽  
Treatment Guidelines ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Duplex Ultrasound ◽  
Classification Systems ◽  
The Body ◽  
The Novel

The American Venous Forum (AVF) and the Society for Vascular Surgery set forth these guidelines for the management of endothermal heat-induced thrombosis (EHIT). The guidelines serve to compile the body of literature on EHIT and to put forth evidence-based recommendations. The guidelines are divided into the following categories: classification of EHIT, risk factors and prevention, and treatment of EHIT. One major feature is to standardize the reporting under one classification system. The Kabnick and Lawrence classification systems are now combined into the AVF EHIT classification system. The novel classification system affords standardization in reporting but also allows continued combined evaluation with the current body of literature. Recommendations codify the use of duplex ultrasound for the diagnosis of EHIT. Risk factor assessments and methods of prevention including mechanical prophylaxis, chemical prophylaxis, and ablation distance are discussed. Treatment guidelines are tailored to the AVF EHIT class (ie, I, II, III, IV). Reference is made to the use of surveillance, antiplatelet therapy, and anticoagulants as deemed indicated, and the recommendations incorporate the use of the novel direct oral anticoagulants. Last, EHIT management as it relates to the great and small saphenous veins is discussed.

scholarly journals Identification of Multi-omics Biomarkers and Construction of the Novel Prognostic Model for Hepatocellular Carcinoma

2022 ◽  
Author(s):  
Xiaokai Yan ◽  
Chiying Xiao ◽  
Kunyan Yue ◽  
Min Chen ◽  
Hang Zhou ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Prognostic Model ◽  
Treatment Decision ◽  
Prognostic Models ◽  
Prognostic Indicators ◽  
The Novel ◽  
Decision Curve Analysis ◽  
Treatment Decision Making ◽  
Assessment And Treatment ◽  
Cox Analysis

Abstract Genome changes play a crucial role in carcinogenesis, and many biomarkers can be used as effective prognostic indicators in various tumours. Although previous studies have constructed many predictive models for hepatocellular carcinoma (HCC) based on molecular signatures, the performance is unsatisfactory. To fill this shortcoming, we hope to build a more accurate predictive model to guide prognostic assessments of HCC. We use the TCGA to identify crucial biomarkers and construct single-omic prognostic models through difference analysis, univariate Cox, and LASSO/stepwise Cox analysis. The performances of single-omic models were evaluated and validated through survival analysis, Harrell’s concordance index (C-index), and receiver operating characteristic (ROC) curve. A multi-omics model was built and evaluated by decision curve analysis (DCA), C-index, and ROC analysis. Multiple mRNAs, lncRNAs, miRNAs, CNV genes, and SNPs were significantly associated with the prognosis of HCC. Five single-omic models were constructed, and the mRNA and lncRNA models showed good performance with c-indexes over 0.70. The multi-omics model presented a quite predictive solid ability with a c-index over 0.80. In this study, we identified many biomarkers that may help study underlying carcinogenesis mechanisms in HCC. In addition, we constructed multiple single-omic models and an integrated multi-omics model that may provide practical and reliable guides for prognosis assessment and treatment decision-making.

scholarly journals Ankle Fracture Stability-based Classification

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0034
Author(s):  
James Michelson ◽  
John Delaney
Keyword(s):  
Classification System ◽  
Ankle Fracture ◽  
Area Under The Curve ◽  
Positive Outcome ◽  
Classification Systems ◽  
Ankle Fractures ◽  
Kappa Statistics ◽  
Pathologic Fractures ◽  
The Stability ◽  
Excellent Reproducibility

Category: Trauma Introduction/Purpose: Rotational ankle fractures are common in orthopaedic surgery, however existing classification systems are mostly descriptive in nature and do not explicitly guide surgical decision-making. A Stability-Based classification was developed recently to provide a more prognostic classification. The purpose of this study was to compare the reproducibility of existing ankle fracture classifications, and determine the ability of the Stability-Based classification to predict clinical treatment. Methods: One hundred ninety-three consecutive ankle fractures treated at our institution were retrospectively analyzed. Rotational type injury patterns in patients >18 years old were included. None of the subjects were clinically treated or evaluated by the study authors. The fractures were treated by attending physicians who were unaware of the Stability-Based classification system. Pathologic fractures were excluded. Three observers classified injury radiographs using the Lauge-Hansen, Weber/AO, and Stability-Based classifications systems. Reproducibility (inter-observer variation) of each classification system was calculated using kappa statistics. Prognostic values were evaluated by calculating the area under the curve (AUC) for the ROC curves (using surgery as the positive outcome) for each classification. Results: The Stability-Based classification was showed the excellent reproducibility (kappa .938, 95% CI .921-.952), along with the Weber/AO classification (kappa .97, 95% CI .961-.976), while the Lauge-Hansen had the lowest reproducibility (kappa .74, 95%CI .664-.795). The AUC for the three classifications were .883 (95%CI .852-.914), .626 (95%CI .576-.675), and .698 (95%CI .641-.755), respectively (Figure 1). The AUC was significantly better for the Stability-Based classification compared to the other 2 classifications (p<.001). Conclusion: The AO/Weber classification had excellent reproducibility, but did not predict the need for surgical stabilization accurately. In contrast, the Stability-Based classification system was both highly reproducible (kappa .938) with excellent prognostic ability to identify patients who got surgery (AUC .883). Furthermore, there were no patients who were classified as stable who failed non-operative treatment. The Stability-Based classification was found to have superior prognostic capacity compared to both the Lauge-Hansen and AO/Weber classification systems. This extends earlier studies by showing the reproducibility of the Stability-Based classification system and directly demonstrating its prognostic superiority to other classification systems.

scholarly journals Clinical staging models: From general medicine to mental disorders

2017 ◽  
Vol 23 (5) ◽  
pp. 292-299 ◽  
Author(s):  
Jan Scott ◽  
Chantal Henry
Keyword(s):  
Mental Disorders ◽  
General Medicine ◽  
Bipolar Disorders ◽  
Treatment Decision ◽  
Classification Systems ◽  
Clinical Staging ◽  
Treatment Decision Making ◽  
High Benefit ◽  
Staging Model ◽  
Age Range

SummaryRevisions of international classification systems for mental disorders have focused on improving the reliability of diagnostic criteria. However, the uncertain validity of the current diagnostic categories means that they do not always fulfil their key purposes, namely to guide treatment and predict outcomes. This is especially true when traditional diagnostic approaches are applied to adolescents and young adults with emerging illnesses. A clinical staging model, similar to those used in general medicine, could improve diagnosis in psychiatry and aid treatment decision-making, especially if applied to individuals aged about 15–25 years, which is the peak age range for the onset of severe mental disorders. Staging models may offer a new framework for the development of interventions with high benefit and low risk, and for research into neurobiological and psychosocial risk factors. However, this approach is not without controversy: some experts oppose its introduction, some argue that it represents a transdiagnostic model, and some suggest it is only viable if disorder-specific models are used.Learning Objectives• Gain awareness of some limitations of current approaches to psychiatric diagnosis• Review the basic principles of clinical staging models used in general medicine• Understand current research on the use of staging models in psychiatry, and attempts to apply these models to bipolar disorders

Classification and diagnosis of headache disorders

2020 ◽  
pp. 3-11
Author(s):  
Jes Olesen ◽  
Richard B. Lipton
Keyword(s):  
Clinical Practice ◽  
Classification System ◽  
Diagnostic Category ◽  
Classification Systems ◽  
Disease Classification ◽  
Headache Disorders

Disease classification systems delineate a group of related disorders and provide operational rules for defining the boundaries among them. Diagnosis refers to the assignment of a particular individual to a particular diagnostic category. A robust disease classification system provides a framework for standardizing diagnosis, studying epidemiology, predicting prognosis, assessing treatment, and implementing therapy in practice. Disease classification is therefore crucial for both clinical practice and research.

Novel Arthroscopic Classification of Osteochondritis Dissecans of the Knee

2016 ◽  
Vol 44 (7) ◽  
pp. 1694-1698 ◽  
Author(s):  
James L. Carey ◽  
Eric J. Wall ◽  
Nathan L. Grimm ◽  
Theodore J. Ganley ◽  
Eric W. Edmonds ◽  
...  
Keyword(s):  
Osteochondritis Dissecans ◽  
Classification System ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Intraobserver Reliability ◽  
Classification Systems ◽  
Future Research ◽  
Multicenter Studies ◽  
Level Of Evidence ◽  
Surgical Evaluation

Background: Several systems have been proposed for classifying osteochondritis dissecans (OCD) of the knee during surgical evaluation. No single classification includes mutually exclusive categories that capture all of the salient features of stability, chondral fissuring, and fragment detachment. Furthermore, no study has assessed the reliability of these classification systems. Purpose: To determine the intra- and interobserver reliability of a novel, comprehensive arthroscopic classification system with mutually exclusive OCD lesion types. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: The Research in OsteoChondritis of the Knee (ROCK) study group developed a classification system for arthroscopic evaluation of OCD of the knee that includes 6 arthroscopic categories—3 immobile types and 3 mobile types. To optimize comprehensibility and applicability, each was developed with a memorable name, a brief description, a line diagram corresponding to the archetypal arthroscopic appearance, and an arthroscopic photograph depicting this archetype. Thirty representative arthroscopic videos were evaluated by 10 orthopaedic surgeon raters, who classified each lesion. After 4 weeks, the raters again classified the OCD lesions depicted in the 30 videos in a new, randomly selected order. Reliability was assessed via the intraclass correlation coefficient (ICC). Results: The interobserver reliability of this novel arthroscopy classification was estimated by an ICC of 0.94 (95% CI, 0.91-0.97) for the first round and 0.95 (95% CI, 0.93-0.98) for the second round. According to the standards for the magnitude of the reliability coefficient of Altman, these ICCs indicate that interobserver reliability was very good. The intraobserver reliability was estimated by an ICC of 0.96 (95% CI, 0.95-0.97), which indicates that the intraobserver reliability was similarly very good. Conclusion: The ROCK OCD knee arthroscopy classification system demonstrated excellent intra- and interobserver reliability. In light of this reliability, this classification system may be used clinically and to facilitate future research, including multicenter studies for OCD.

Patient Involvement in Treatment Decision Making Can Help or Hinder Placebo Analgesia

2014 ◽  
Vol 222 (3) ◽  
pp. 165-170 ◽  
Author(s):  
Andrew L. Geers ◽  
Jason P. Rose ◽  
Stephanie L. Fowler ◽  
Jill A. Brown
Keyword(s):  
Patient Involvement ◽  
Cold Water ◽  
Prior Experience ◽  
Water Immersion ◽  
Treatment Decision ◽  
Cold Water Immersion ◽  
Not Given ◽  
Placebo Analgesia ◽  
Treatment Decision Making ◽  
Immersion Experience

Experiments have found that choosing between placebo analgesics can reduce pain more than being assigned a placebo analgesic. Because earlier research has shown prior experience moderates choice effects in other contexts, we tested whether prior experience with a pain stimulus moderates this placebo-choice association. Before a cold water pain task, participants were either told that an inert cream would reduce their pain or they were not told this information. Additionally, participants chose between one of two inert creams for the task or they were not given choice. Importantly, we also measured prior experience with cold water immersion. Individuals with prior cold water immersion experience tended to display greater placebo analgesia when given choice, whereas participants without this experience tended to display greater placebo analgesia without choice. Prior stimulus experience appears to moderate the effect of choice on placebo analgesia.

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