Clinical, Aetiological, Anatomical and Pathological Classification (Ceap): Gold Standard and Limits

2012 ◽  
Vol 27 (1_suppl) ◽  
pp. 114-118 ◽  
Author(s):  
E Rabe ◽  
F Pannier
Keyword(s):  
Gold Standard ◽  
Varicose Veins ◽  
Clinical Signs ◽  
Consensus Conference ◽  
Scientific Publications ◽  
Consensus Document ◽  
Venous Diseases ◽  
Ceap Classification ◽  
Definition Of

The first CEAP (clinical, aetiological, anatomical and pathological elements) consensus document was published after a consensus conference of the American Venous Forum, held at the sixth annual meeting of the AVF in February 1994 in Maui, Hawaii. In the following years the CEAP classification was published in many international journals and books which has led to widespread international use of the CEAP classification since 1995. The aim of this paper is to review the benefits and limits of CEAP from the available literature. In an actual Medline analysis with the keywords ‘CEAP’ and ‘venous insufficiency’, 266 publications using the CEAP classification in venous diseases are available. The CEAP classification was accepted in the venous community and used in scientific publications, but in most of the cases only the clinical classification was used. Limitations of the first version including a lack of clear definition of clinical signs led to a revised version. The CEAP classification is the gold standard of classification of chronic venous disorders today. Nevertheless for proper use some facts have to be taken into account: the CEAP classification is not a severity classification, C2 summarizes all kinds of varicose veins, in C3 it may be difficult to separate venous and other reasons for oedema, and corona phlebectatica is not included in the classification. Further revisions of the CEAP classification may help to overcome the still-existing deficits.

Clinical Diagnostic Accuracy of Early/Advanced Parkinson Disease: Updated Clinicopathologic Study

2020 ◽  
pp. 10.1212/CPJ.0000000000001016
Author(s):  
Charles H. Adler ◽  
Thomas G. Beach ◽  
Nan Zhang ◽  
Holly A. Shill ◽  
Erika Driver-Dunckley ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Clinical Diagnosis ◽  
Gold Standard ◽  
Disease Duration ◽  
Clinical Signs ◽  
Confidence Levels ◽  
Clinicopathologic Study ◽  
Clinical Diagnostic ◽  
Neuropathological Diagnosis

AbstractObjectives:Update data for diagnostic accuracy of a clinical diagnosis of Parkinson’s disease (PD) using neuropathological diagnosis as the gold standard.Methods:Data from the Arizona Study of Aging and Neurodegenerative Disorders (AZSAND) was used to determine the predictive value of a clinical PD diagnosis. Two clinical diagnostic confidence levels were used, Possible PD (PossPD, never treated or not responsive) and Probable PD (ProbPD, 2/3 cardinal clinical signs + responsive to dopaminergic medications). Neuropathological diagnosis was the gold standard.Results:Based on first visit to AZSAND, 15/54 (27.8%) PossPD cases and 138/163 (84.7%) ProbPD had confirmed PD. PD was confirmed in 24/34 (70.6%) ProbPD with <5 yrs and 114/128 (89.1%) with >5 yrs disease duration. Using the consensus final clinical diagnosis following death, 161/187 (86.1%) ProbPD had neuropathologically confirmed PD. Diagnostic accuracy for ProbPD improved if included motor fluctuations, dyskinesias, and hyposmia, and hyposmia for PossPD.Conclusions:This updated study confirmed lower clinical diagnostic accuracy for elderly, untreated or poorly responsive PossPD participants and for ProbPD with <5 yr disease duration, even when medication responsive. Caution continues to be needed when interpreting clinical studies of PD, especially studies of early disease, that do not have autopsy confirmation.Classification of Evidence:This study provides Class II evidence that a clinical diagnosis of probable PD at first visit identifies patients who will have pathologically confirmed PD with a sensitivity of 82.6% and specificity of 86.0%.

scholarly journals Managerial innovations: Approach to definition and classification

2020 ◽  
Vol 19 (4) ◽  
pp. 493-519
Author(s):  
Yaroslav D. Sovetkin ◽  
Keyword(s):  
General Concept ◽  
Business Community ◽  
Scientific Publications ◽  
Bibliographic Analysis ◽  
New Approach ◽  
Citation Indexes ◽  
Definition Of ◽  
The Relationship ◽  
Managerial Innovation

Managerial innovations have become the topic of interest for many scholars, but this concept remains underdeveloped and poorly managed among the academy and business community in Russia. This paper offers the composition of approach to definition and classifi cation of managerial innovations, formed on the basis of exploration of the concept “managerial innovation” evolution, and estimation of the relationship with a more general concept “innovation”. The suggested composition of approach is based on the three-stage bibliographic analysis of scientific literature. In course of the bibliographic research, scientific articles were selected according to the key words, period of publication and citation index. 140 scientific publications were identified and collected for the period from 1975 to 2019 covering citation indexes from 0 to 12 476 by Web of Science citation database and from 4 to 2 185 by Scopus database. On the basis of the conducted bibliographic research, the author introduces his definition of innovation and managerial innovation and explains the connection between them. Within the conducted research different approaches to classification of managerial innovations were studied and on their basis a new approach to classification of managerial innovations was proposed. The findings can be useful for different avenues of further research regarding managerial innovations.

scholarly journals Classification of Partially Regular Microreliefs Formed on the End Surfaces of Rotary Bodies

2020 ◽  
pp. 129-135
Author(s):  
Volodymyr Dzyura ◽  
Keyword(s):  
Mutual Arrangement ◽  
Relative Area ◽  
Scientific Publications ◽  
New Class ◽  
Lack Of Information ◽  
Dimensional Parameters ◽  
Definition Of ◽  
First Time ◽  
Rotating Bodies

The aim of the article is to classify partially regular microreliefs that are formed on the end surfaces of rotating bodies. The article analyzes the known classifications of regular microreliefs in scientific publications and regulations. The parameters by which regular microreliefs are classified and their characteristics are analyzed. The lack of information on the classification of partially regular microreliefs formed on the end surfaces of rotating bodies as a new class of microreliefs has been established. The proposed classification reveals a set of options for the implementation of partially regular microreliefs formed on the end surfaces of bodies of rotation and their characteristics. For the first time the classification of partially regular microreliefs that are formed on the end surfaces of rotating bodies is offered, carried out on the basis of features of kinematics of technological process. It c can be a basis for creation of their mathematical models and definition of the relative area of vibro-rolling. Signs of classification are proposed to take: methods of forming a partially regular microrelief; the shape of the centerline of continuous regular micro-irregularities; mutual arrangement of adjacent grooves; mutual placement of axial lines of continuous regular micro-inequalities; groove shapes. Each of these features is divided into certain sub-features, which consist of the corresponding characteristics, which are expressed by the elements of the mode of vibration rolling, the dimensional parameters of the elements of the grooves, their mutual placement. For the first time, analytical dependences were obtained to determine the parameter of partially regular microreliefs classification formed on the end surfaces of rotating bodies by the nature of the change in the radii of the axial lines and their axial steps.

scholarly journals Essential Fundamentals of Armed Violence through the Prism of the Phenomenon of Social Violence

2020 ◽  
Vol 23 (1-2) ◽  
pp. 93-101
Author(s):  
Anton Bader
Keyword(s):  
Social Relations ◽  
Social Life ◽  
Social Evolution ◽  
Scientific Publications ◽  
Human Environment ◽  
Social Violence ◽  
Armed Violence ◽  
Definition Of ◽  
Radical Form

The article comprehensively examines the social sources of armed violence, as one of the important phenomena in the development of humanity. Based on the analysis of works by leading Ukrainian and foreign scientists, the author considers the essence of the phenomenon of armed violence in the context of the development of social violence. In particular, a significant number of scientific papers have been analyzed, in which certain aspects of the topic chosen for research are disclosed, the main approaches and concepts that have developed in the process of studying this issue are identified and characterized.The complex characteristic of the basic concepts that studied in the article is presented. The term "social violence" the author understands as the application by one class or another of a social group of various forms of coercion, up to armed influence, against other classes and social groups in order to obtain or maintain economic and political dominance, to gain these or those rights or privileges. Accordingly, armed violence is interpreted as a way to achieve the goals using weapons. The author agrees with the opinion of a significant number of scientists regarding the definition of armed violence as a radical form of the use of social violence.As a result of the research, the author has come to the conclusion that violence has been characteristic of the human environment since its occurrence. As most scholars have noted, since the emergence of social relations, violence, including armed violence, has been one of the most important ways to achieve the goals of controlling and asserting dominance in other members of social communities. Armed violence is the most radical form of achievement of the aforementioned goal. As a form of social interaction, as noted by psychologists, armed violence is the result of the transformation of animal instincts that, in the course of social evolution, have evolved into one of the specific forms of struggle for domination within complex human communities. This is the main scientific value of the articles analyzed in the article.At the same time, as the analysis of the researched works has shown, the further classification of the types of armed violence according to the spheres of its application in social life and its varieties, according to the tasks, which are realized in the process of its use, needs further consideration. The article assumes that the most important criterion for the classification of violence is the use of weapons in this process. It is noted that no one can doubt that armed violence is violence. It is suggested to consider the main goal of most unarmed forms of social violence − the prevention of armed forms of confrontation. These aspects will be addressed in future scientific publications

Early morning oedema in patients with primary varicose veins without trophic changes

VASA ◽  
2016 ◽  
Vol 45 (6) ◽  
pp. 491-495 ◽  
Author(s):  
Didier Rastel ◽  
François-André Allaert
Keyword(s):  
Varicose Veins ◽  
Clinical Signs ◽  
Time Lapse ◽  
Early Morning ◽  
Epidemiological Studies ◽  
Control Group ◽  
Trophic Changes ◽  
Primary Varicose Veins ◽  
Ceap Classification ◽  
Consultation Time

Abstract. Background: Chronic lower limb oedema is one of the complications of superficial or deep chronic venous disorders. It is ranked as “C3”on the CEAP classification. In epidemiological studies, the recognition of oedema is mainly based on clinical signs, and oedema is more easily detected in the second part of the day when it becomes evident. We addressed the question whether oedema is already present in the morning in patients suffering of primary varicose veins without trophic changes. Patients and methods: In total, 101 patients with primary varicose veins (C2 and/or C3 stage of the CEAP classification) and 122 controls were enrolled as they appeared in our centre. The consultation time was no later than 6 hours after the patient had woken up. Oedema was detected by pitting test and ultrasound. Results: The mean consultation time lapse was 3.7 ± 1.2 hours after waking-up. Oedema was more frequent in the group of primary varicose veins without trophic changes (36 % compared to 14 % in the control group; p < 0.01). Oedema was mainly detected by ultrasound and far less so by the pitting test. Conclusions: Patients with varicose veins have morning oedema more frequently than patients without varicosis and at a higher rate than in epidemiological studies.

CEAP-classes and symptoms in people with varicose veins

Phlebologie ◽  
2005 ◽  
Vol 34 (06) ◽  
pp. 305-309
Author(s):  
C. Ose ◽  
G. Rudofsky ◽  
J. Roesener ◽  
H. Hirche ◽  
K. Kroeger
Keyword(s):  
Odds Ratio ◽  
Varicose Veins ◽  
Clinical Signs ◽  
Clinical Findings ◽  
Venous Disease ◽  
Muscle Cramps ◽  
Restless Legs ◽  
Class 1 ◽  
Ceap Classification ◽  
Reticular Veins

SummaryIndividual symptoms of patients with varicose veins are not considered in the CEAP-classification. Method: We analysed how far people with CEAP class 1 and 2 differ in their symptoms from people without varicose veins in the Duesseldorf/ Essen civil servants study recruiting 9935 employees. All volunteers were asked to fill out a questionnaire and were clinically examined. Primarily the clinical findings were documented adapted to the Basel Study and later modified according to the CEAP classification: 64% class 0 (no visible or palpable clinical signs of venous disease), 27% class 1 (small cutaneous veins and/or reticular veins) and 9 class 2 (varicose veins). Results: Leg swelling and muscle cramps during night were the most frequent symptoms in both classes. Statistically the frequency of symptoms in volunteers classified as CEAP class 1 respectively 2 were different from volunteers showing CEAP class 0 but were not different from each other. Grouping the symptoms restless legs, itching and cramps and calculating odds ratios for none of these showed significant results. Especially in women suffering from CEAP class 2 a significant small odds ratio of 0.5 (95%CI: 0.4–0.6) indicated that women rid of all these three symptoms had less frequently a varicosis disease. Conclusion: It can be assumed that the clinical differentiation into CEAP classes also differentiates groups of people with different symptoms.

scholarly journals Evaluation of gastric emptying by means of scintigra-phy using different test meals

2019 ◽  
Vol 7 (2A) ◽  
Author(s):  
Viviana Montoya ◽  
Viviane Parisitto ◽  
Mateus Fontes ◽  
Luiz Gonzaga ◽  
Luciene Das Graças ◽  
...  
Keyword(s):  
Gastric Emptying ◽  
Gold Standard ◽  
Delayed Gastric Emptying ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Mechanical Obstruction ◽  
Standard Meal ◽  
Solid Foods ◽  
Gastric Emptying Time

Gastroparesis is a disorder characterized by symptoms and evidence of delayed gastric emptying (GE) in the absence of mechanical obstruction. Scintigraphy has been considered a "gold standard" for measuring Gastric Emptying Time (GET) and retention percentage of radio-labeled food, after four hours of ingestion. To obtain the images, it is recommended, worldwide, the use of the Tougas diet (255kcal) as a standard meal. The objective of this study was to compare the GET and the percentage of retention in the time of 4 h, obtained by scintigraphy using the Tougas diet (255 kcal) and the proposed diet (319 kcal). Thirty patients, both genders, aged 23 to 76 years,  were selected, they presenting clinical symptoms suggestive of gastroparesis. These parameters were measured for the same patient, but in different days. The results showed that the diet fat content used to obtain EG of solid foods by scintigraphy did not influence the retention percentage results after 4 hours of ingestion of the radiolabeled food. However, the time of two hours is an important parameter to be observed in the result of this examination. In addition, the data suggest that the proposed diet may be more efficient for the classification of the severity of EG delay in patients with clinical signs suggestive of gastroparesis. 

Criminal Law Analysis of Iatrogenic Crimes and Practice of Applying the Norms of Criminal Law, Providing Responsibility for their Commission

2020 ◽  
Vol 2 (3) ◽  
pp. 33-61
Author(s):  
R. B. Ivanchenko ◽  
◽  
V. A. Zaryaev
Keyword(s):  
Criminal Law ◽  
Medical Errors ◽  
Criminal Code ◽  
Professional Activity ◽  
Scientific Publications ◽  
Expert Opinions ◽  
General Scientific ◽  
Definition Of ◽  
The Right

Introduction. Caring for the health of citizens is the most important task of any state, and the article 41 of the Constitution of Russia directly establishes the right of everyone to protection of health and medical care. Despite the noble and humane mission that medical workers are called upon to carry out, helping people and saving their lives, the problem of medical errors (iatrogenic) leading to tragic consequences has clearly indicated its presence recently. The high public danger of such phenomena causes the need for their criminal law assessment. The problems that arise in this case are connected, first of all, with a diverse understanding of the essence of medical errors and iatrogenic crimes, the lack of uniformity in the application of the criminal law establishing liability for their commission. Theoretical Basis. Methods. The article is based on the analysis of Russian and foreign criminal, administrative, civil legislation, court sentences and decisions, scientific publications in Russian and foreign publications. In addition, expert opinions, doctrinal ideas and opinions on the topics of this work were used. In the process of preparing the article, a number of general scientific and private scientific research methods were used. Results. The article discusses issues related to the specifics of the criminal law assessment of acts committed by medical workers in the process of professional activity. The positions of specialists are given regarding the definition of this specific group of crimes, the author’s vision is formulated on the classification of specific socially dangerous acts as “iatrogenic”. The current legislation in the field of health care is examined, which makes it possible to concretize the terminology used in the articles of the Russian Criminal Code providing liability for iatrogenic crimes. The judicial-investigative practice of applying the indicated norms of the criminal law is analyzed, the problems of qualification of such acts are revealed. Discussion and Conclusion. In conclusion, the authors differentiate such concepts as “medical error”, “accident”, “iatrogenic crime”, determine that the deliberate commission of an iatrogenic crime should be assessed either according to the rules on the circumstances that exclude the criminal act, or as a general criminal act; designate a circle of crimes defined as “iatrogenic”; come to the conclusion that the solution to the problem of counteraction to iatrogenic crimes cannot be associated with the intensification or expansion of criminal repression.

scholarly journals Nomenclature for kidney function and disease—executive summary and glossary from a Kidney Disease: Improving Global Outcomes (KDIGO) consensus conference

2020 ◽  
Vol 41 (48) ◽  
pp. 4592-4598
Author(s):  
Andrew S Levey ◽  
Kai-Uwe Eckardt ◽  
Nijsje M Dorman ◽  
Stacy L Christiansen ◽  
Michael Cheung ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Kidney Function ◽  
English Language ◽  
Kidney Diseases ◽  
Public Awareness ◽  
Kidney Injury ◽  
Consensus Conference ◽  
Scientific Publications ◽  
Executive Summary

Abstract The worldwide burden of kidney disease is rising, but public awareness remains limited, underscoring the need for more effective communication by stakeholders in the kidney health community. Despite this need for clarity, the nomenclature for describing kidney function and disease lacks uniformity. In June 2019, Kidney Disease: Improving Global Outcomes (KDIGO) convened a consensus conference with the goal of standardizing and refining the nomenclature used in the English language to describe kidney function and disease, and of developing a glossary that could be used by journals in scientific publications. Guiding principles of the conference were that the revised nomenclature should be patient-centred, precise, and consistent with nomenclature used in the KDIGO guidelines. Conference attendees reached general consensus on the following recommendations: (i) to use ‘kidney’ rather than ‘renal’ or ‘nephro’ when referring to kidney disease and kidney function; (ii) to use ‘kidney failure’ with appropriate descriptions of the presence or absence of symptoms, signs, and treatment rather than ‘end-stage’ kidney disease; (iii) to use the KDIGO definition and classification of acute kidney diseases and disorders (AKD) and acute kidney injury (AKI) rather than alternative descriptions to define and classify the severity of AKD and AKI; (iv) to use the KDIGO definition and classification of chronic kidney disease (CKD) rather than alternative descriptions to define and classify the severity of CKD; and (v) to use specific kidney measures, such as albuminuria or decreased glomerular filtration rate, rather than ‘abnormal or reduced kidney function’ to describe alterations in kidney structure and function. A proposed five-part glossary contains specific items for which there was general agreement. Conference attendees acknowledged limitations of the recommendations and glossary but considered that standardizing scientific nomenclature is essential for improving communication.

scholarly journals Clinical study of asymptomatic deep vein thrombosis in patients with varicose veins of lower extremities

2019 ◽  
Vol 6 (10) ◽  
pp. 3548
Author(s):  
Basavarajappa M. ◽  
Anantharaju G. S. ◽  
Deepak G.
Keyword(s):  
Deep Vein Thrombosis ◽  
Varicose Veins ◽  
Strong Association ◽  
Medical Science ◽  
Clinical Signs ◽  
Lower Limbs ◽  
Research Centre ◽  
Vein Thrombosis ◽  
Ceap Classification ◽  
Deep Vein

Background: The main aim is to study the association between asymptomatic deep vein thrombosis (DVT) in patients with varicose veins in different gender and age groups. Secondly, to study the risk of developing DVT in patients having superficial venous thrombophlebitis (SVT) with varicose veins and finally to study the clinical correlation of clinical, etiological, anatomical and pathological (CEAP) classification with DVT in patients with varicose veins.Methods: Patients presenting to department of General surgery at SS Institute of Medical Science and Research Centre during the period from June 2017 to June 2019 with varicose veins of lower limbs and without clinical signs of DVT were included in this study. Patients were categorised according to CEAP classification. All patients were subjected to duplex scanning of lower limbs to look for presence of SVT and DVT.Results: In our study, 73% patients were males and 27% patients were females. Maximum patients were in age group of 40-60 years.16 patients had DVT, 38 patients had SVT, 166 patients belonged to C2 and 56 patients belonged to CEAP class C3 and beyond.Conclusions: There is a strong association between varicose veins and asymptomatic DVT .The presence of SVT is not a risk factor for concomitant DVT in varicose vein patients. Clinical presentation with C3 or more CEAP grade is one of the potential risk factors for concomitant DVT in vari­cose vein patients.

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