Causal analysis of fetal death in high-risk pregnancies

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Mónica Aguinaga ◽  
Yolotzin Valdespino ◽  
Daniela Medina ◽  
Salvador Espino y Sosa ◽  
Rosalba Sevilla ◽  
...  
Keyword(s):  
High Risk ◽  
Fetal Death ◽  
Causal Analysis ◽  
Classification Systems ◽  
Premature Labor ◽  
Fetal Autopsy ◽  
International Statistical Classification ◽  
Level 3 ◽  
Possible Cause

Abstract Objectives To determine the causes of fetal death among the stillbirths using two classification systems from 22 weeks of gestation in a period of three years in high-risk pregnancies. This is a retrospective observational study. Methods The National Institute of Perinatal Health in Mexico City is a Level 3 care referral center attending high-risk pregnancies from throughout the country. The population consisted of patients with fetal death during a three-year period. Between January 2016 and December 2018, all stillbirths were examined in the Pathology Department by a pathologist and a medical geneticist. Stillbirth was defined as a fetal death occurring after 22 weeks of gestation. Results Main outcome measures: Causal analysis of fetal death using the International Statistical Classification of Disease and Related Health Problems-Perinatal Mortality (ICD-PM) and initial causes of fetal death (INCODE) classification systems. A total of 297 stillborn neonates were studied. The distribution of gestational age in antepartum stillbirths (55.2%) showed a bimodal curve, 36% occurred between 24 and 27 weeks and 32% between 32 and 36 weeks. In comparison, the majority (86%) of intrapartum deaths (44.8%) were less than 28 weeks of gestation. Of the 273 women enrolled, 93 (34%) consented to a complete fetal autopsy. The INCODE system showed a present cause in 42%, a possible cause in 54% and a probable cause in 93% of patients. Conclusions The principal causes of antepartum death were fetal abnormalities and pathologic placental conditions and the principal causes of intrapartum death were complications of pregnancy which caused a premature labor and infections.

scholarly journals Classification of stillbirths is an ongoing dilemma

2016 ◽  
Vol 44 (7) ◽  
Author(s):  
Luigi Nappi ◽  
Federica Trezza ◽  
Pantaleo Bufo ◽  
Irene Riezzo ◽  
Emanuela Turillazzi ◽  
...  
Keyword(s):  
Causes Of Death ◽  
Fetal Death ◽  
Classification Systems ◽  
World Health ◽  
Fetal Autopsy ◽  
Unexplained Death ◽  
Gynecology And Obstetrics ◽  
Associated Conditions ◽  
Health Organization

AbstractAim:To compare different classification systems in a cohort of stillbirths undergoing a comprehensive workup; to establish whether a particular classification system is most suitable and useful in determining cause of death, purporting the lowest percentage of unexplained death.Methods:Cases of stillbirth at gestational age 22–41 weeks occurring at the Department of Gynecology and Obstetrics of Foggia University during a 4 year period were collected. The World Health Organization (WHO) diagnosis of stillbirth was used. All the data collection was based on the recommendations of an Italian diagnostic workup for stillbirth. Two expert obstetricians reviewed all cases and classified causes according to five classification systems.Results:Relevant Condition at Death (ReCoDe) and Causes Of Death and Associated Conditions (CODAC) classification systems performed best in retaining information. The ReCoDe system provided the lowest rate of unexplained stillbirth (14%) compared to de Galan-Roosen (16%), CODAC (16%), Tulip (18%), Wigglesworth (62%).Conclusion:Classification of stillbirth is influenced by the multiplicity of possible causes and factors related to fetal death. Fetal autopsy, placental histology and cytogenetic analysis are strongly recommended to have a complete diagnostic evaluation. Commonly employed classification systems performed differently in our experience, the most satisfactory being the ReCoDe. Given the rate of “unexplained” cases, none can be considered optimal and further efforts are necessary to work out a clinically useful system.

Die Wirksamkeit eines Frühinterventionsprogramms für Jugendliche mit Computerspiel- und Internetabhängigkeit: Mittelfristige Effekte der PROTECT+ Studie

2020 ◽  
Vol 48 (1) ◽  
pp. 3-14 ◽  
Author(s):  
Carolin Szász-Janocha ◽  
Eva Vonderlin ◽  
Katajun Lindenberg
Keyword(s):  
Internet Use ◽  
Health Problems ◽  
Reliable Change Index ◽  
Gaming Disorder ◽  
Statistical Classification ◽  
Reliable Change ◽  
Classification Of Diseases ◽  
International Statistical Classification

Zusammenfassung. Fragestellung: Das junge Störungsbild der Computerspiel- und Internetabhängigkeit hat in den vergangenen Jahren in der Forschung zunehmend an Aufmerksamkeit gewonnen. Durch die Aufnahme der „Gaming Disorder“ in die ICD-11 (International Statistical Classification of Diseases and Related Health Problems) wurde die Notwendigkeit von evidenzbasierten und wirksamen Interventionen avanciert. PROTECT+ ist ein kognitiv-verhaltenstherapeutisches Gruppentherapieprogramm für Jugendliche mit Symptomen der Computerspiel- und Internetabhängigkeit. Die vorliegende Studie zielt auf die Evaluation der mittelfristigen Effekte nach 4 Monaten ab. Methodik: N = 54 Patientinnen und Patienten im Alter von 9 bis 19 Jahren (M = 13.48; SD = 1.72) nahmen an der Frühinterventionsstudie zwischen April 2016 und Dezember 2017 in Heidelberg teil. Die Symptomschwere wurde zu Beginn, zum Abschluss der Gruppentherapie sowie nach 4 Monaten anhand von standardisierten Diagnostikinstrumenten erfasst. Ergebnisse: Mehrebenenanalysen zeigten eine signifikante Reduktion der Symptomschwere anhand der Computerspielabhängigkeitsskala (CSAS) nach 4 Monaten. Im Selbstbeurteilungsbogen zeigte sich ein kleiner Effekt (d = 0.35), im Elternurteil ein mittlerer Effekt (d = 0.77). Der Reliable Change Index, der anhand der Compulsive Internet Use Scale (CIUS) berechnet wurde, deutete auf eine starke Heterogenität im individuellen Symptomverlauf hin. Die Patientinnen und Patienten bewerteten das Programm zu beiden Follow-Up-Messzeitpunkten mit einer hohen Zufriedenheit. Schlussfolgerungen: Die vorliegende Arbeit stellt international eine der wenigen Studien dar, die eine Reduktion der Symptome von Computerspiel- und Internetabhängigkeit im Jugendalter über 4 Monate belegen konnte.

scholarly journals Classification of Post-Fire Responses of Woody Plants to include Pyrophobic Communities

Fire ◽  
2020 ◽  
Vol 3 (2) ◽  
pp. 15 ◽  
Author(s):  
Lynda D. Prior ◽  
David M. J. S. Bowman
Keyword(s):  
Woody Plants ◽  
Seed Banks ◽  
Classification Systems ◽  
Woody Vegetation ◽  
General Category ◽  
Conifer Species ◽  
Soil Seed Banks ◽  
Obligate Seeder ◽  
In Fire

Developing standardised classification of post-fire responses is essential for globally consistent comparisons of woody vegetation communities. Existing classification systems are based on responses of species growing in fire-prone environments. To accommodate species that occur in rarely burnt environments, we have suggested some important points of clarification to earlier schemes categorizing post-fire responses. We have illustrated this approach using several Australasian conifer species as examples of pyrophobic species. In particular, we suggest using the term “obligate seeder” for the general category of plants that rely on seed to reproduce, and qualifying this to “post-fire obligate seeder” for the narrower category of species with populations that recover from canopy fire only by seeding; the species are typically fire-cued, with large aerial or soil seed banks that germinate profusely following a fire, and grow and reproduce rapidly in order to renew the seed bank before the next fire.

scholarly journals Interobserver agreement of the Paris and simplified classifications of superficial colonic lesions: a Western study

2021 ◽  
Vol 09 (03) ◽  
pp. E388-E394
Author(s):  
Francesco Cocomazzi ◽  
Marco Gentile ◽  
Francesco Perri ◽  
Antonio Merla ◽  
Fabrizio Bossa ◽  
...  
Keyword(s):  
Interobserver Agreement ◽  
Classification Systems ◽  
Sensitivity Analyses ◽  
Size Estimation ◽  
Rater Agreement ◽  
Staff Members ◽  
Video Clips ◽  
Paris Classification ◽  
Level Of Agreement

Abstract Background and study aims The Paris classification of superficial colonic lesions has been widely adopted, but a simplified description that subgroups the shape into pedunculated, sessile/flat and depressed lesions has been proposed recently. The aim of this study was to evaluate the accuracy and inter-rater agreement among 13 Western endoscopists for the two classification systems. Methods Seventy video clips of superficial colonic lesions were classified according to the two classifications, and their size estimated. The interobserver agreement for each classification was assessed using both Cohen k and AC1 statistics. Accuracy was taken as the concordance between the standard morphology definition and that made by participants. Sensitivity analyses investigated agreement between trainees (T) and staff members (SM), simple or mixed lesions, distinct lesion phenotypes, and for laterally spreading tumors (LSTs). Results Overall, the interobserver agreement for the Paris classification was substantial (κ = 0.61; AC1 = 0.66), with 79.3 % accuracy. Between SM and T, the values were superimposable. For size estimation, the agreement was 0.48 by the κ-value, and 0.50 by AC1. For single or mixed lesions, κ-values were 0.60 and 0.43, respectively; corresponding AC1 values were 0.68 and 0.57. Evaluating the several different polyp subtypes separately, agreement differed significantly when analyzed by the k-statistics (0.08–0.12) or the AC1 statistics (0.59–0.71). Analyses of LSTs provided a κ-value of 0.50 and an AC1 score of 0.62, with 77.6 % accuracy. The simplified classification outperformed the Paris classification: κ = 0.68, AC1 = 0.82, accuracy = 91.6 %. Conclusions Agreement is often measured with Cohen’s κ, but we documented higher levels of agreement when analyzed with the AC1 statistic. The level of agreement was substantial for the Paris classification, and almost perfect for the simplified system.

scholarly journals 905 How to prioritise patients and safely resume elective surgery during the Covid-19 pandemic

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
H Subbiah Ponniah ◽  
M Ahmed ◽  
T Edwards ◽  
J Cobb ◽  
E Dean ◽  
...  
Keyword(s):  
Patient Safety ◽  
High Risk ◽  
Orthopaedic Surgery ◽  
Elective Surgery ◽  
Paediatric Patients ◽  
Level 3 ◽  
Level 1 ◽  
Surgical Unit

Abstract Introduction There are now over 2.5 million NHS patients awaiting elective surgery, with the most in orthopaedics. We present an algorithm and results for safely and equitably restarting surgery at COVID-light sites. Method An MDT applied the COVID-19 Algorithm for Resuming Elective Surgery (CARES) on 1169 patients awaiting elective orthopaedic surgery. It assessed safety, procedural efficacy, and biopsychosocial factors, to prioritise patients. They were assigned to five categories and underwent surgery at one of three COVID-light sites (1. access to HDU/ITU/Paediatrics/specialist equipment, 2. an NHS elective surgical unit and 3. a private elective surgical unit). Results 21 ‘Urgent’ patients received expedited care; 118 were Level 1/2; 222 were Level 3; 808 were Level 4. In 6 weeks, 355 surgeries were performed, with Urgent and Level 1/2 cases performed soonest (mean 18 days, p < 0.001). 33 high-risk/complex/paediatric patients had surgery at Site 1 and the rest at Sites 2 and 3. No patients contracted COVID-19 within 2 weeks of surgery. Conclusions We validated a widely generalisable model to facilitate resumption of elective surgery in COVID-light sites. It enabled surgery for patients in most suffering, undergoing the most efficacious procedures and/or at highest risk of deterioration, without compromising patient-safety.

scholarly journals Reliability of the classification of cartilage and labral injuries during hip arthroscopy

2020 ◽  
Vol 7 (3) ◽  
pp. 448-457
Author(s):  
Stephanie W Mayer ◽  
Tobias R Fauser ◽  
Robert G Marx ◽  
Anil S Ranawat ◽  
Bryan T Kelly ◽  
...  
Keyword(s):  
Femoral Head ◽  
Transition Zone ◽  
Central Compartment ◽  
Classification Systems ◽  
Cartilage Injury ◽  
Intraobserver Agreement ◽  
Acetabular Cartilage ◽  
Femoral Head Cartilage ◽  
Labral Tears

Abstract To determine interobserver and intraobserver reliabilities of the combination of classification systems, including the Beck and acetabular labral articular disruption (ALAD) systems for transition zone cartilage, the Outerbridge system for acetabular and femoral head cartilage, and the Beck system for labral tears. Additionally, we sought to determine interobserver and intraobserver agreements in the location of injury to labrum and cartilage. Three fellowship trained surgeons reviewed 30 standardized videos of the central compartment with one surgeon re-evaluating the videos. Labral pathology, transition zone cartilage and acetabular cartilage were classified using the Beck, Beck and ALAD systems, and Outerbridge system, respectively. The location of labral tears and transition zone cartilage injury was assessed using a clock face system, and acetabular cartilage injury using a five-zone system. Intra- and interobserver reliabilities are reported as Gwet’s agreement coefficients. Interobserver and intraobserver agreement on the location of acetabular cartilage lesions was highest in superior and anterior zones (0.814–0.914). Outerbridge interobserver and intraobserver agreement was >0.90 in most zones of the acetabular cartilage. Interobserver and intraobserver agreement on location of transition zone lesions was 0.844–0.944. The Beck and ALAD classifications showed similar interobserver and intraobserver agreement for transition zone cartilage injury. The Beck classification of labral tears was 0.745 and 0.562 for interobserver and intraobserver agreements, respectively. The Outerbridge classification had almost perfect interobserver and intraobserver agreement in classifying chondral injury of the true acetabular cartilage and femoral head. The Beck and ALAD classifications both showed moderate to substantial interobserver and intraobserver reliabilities for transition zone cartilage injury. The Beck system for classification of labral tears showed substantial agreement among observers and moderate intraobserver agreement. Interobserver agreement on location of labral tears was highest in the region where most tears occur and became lower at the anterior and posterior extents of this region. The available classification systems can be used for documentation regarding intra-articular pathology. However, continued development of a concise and highly reproducible classification system would improve communication.

scholarly journals Application of MRI for the Diagnosis of Neoplasms

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Ewa Bejer-Oleńska ◽  
Michael Thoene ◽  
Andrzej Włodarczyk ◽  
Joanna Wojtkiewicz
Keyword(s):  
Benign Neoplasms ◽  
Young Males ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Mri Scans ◽  
International Statistical Classification ◽  
The Central Nervous System ◽  
Spss Software ◽  
The Brain

Aim. The aim of the study was to determine the most commonly diagnosed neoplasms in the MRI scanned patient population and indicate correlations based on the descriptive variables. Methods. The SPSS software was used to determine the incidence of neoplasms within the specific diagnoses based on the descriptive variables of the studied population. Over a five year period, 791 patients and 839 MRI scans were identified in neoplasm category (C00-D48 according to the International Statistical Classification of Diseases and Related Health Problems ICD-10). Results. More women (56%) than men (44%) represented C00-D48. Three categories of neoplasms were recorded. Furthermore, benign neoplasms were the most numerous, diagnosed mainly in patients in the fifth decade of life, and included benign neoplasms of the brain and other parts of the central nervous system. Conclusions. Males ≤ 30 years of age with neoplasms had three times higher MRI scans rate than females of the same age group; even though females had much higher scans rate in every other category. The young males are more often selected for these scans if a neoplasm is suspected. Finally, the number of MRI-diagnosed neoplasms showed a linear annual increase.

Prospects for the classification of mental disorders of children and adolescents

2008 ◽  
Vol 23 (7) ◽  
pp. 481-485 ◽  
Author(s):  
M.H. Schmidt ◽  
J. Sinzig
Keyword(s):  
Mental Disorders ◽  
Children And Adolescents ◽  
Classification Systems ◽  
General Question ◽  
Specific Information ◽  
Specific Symptom ◽  
Trade Offs ◽  
Dimensional Classification ◽  
Dsm V

AbstractSuggestions for classification of mental disorders of children and adolescents in DSM-V and ICD-11 have been made, which differ strongly from the current descriptive approach of dimensional classification.These suggestions even comprise a dichotomized system for health care as well as for scientific purposes.Nevertheless it is obvious that we are far behind an “etiological” classification, so that trade-offs have necessarily to be made in DSM-V and ICD-11.Appropriate proposals concern the strict separation of disorders that are typical for children and adolescents as well as for adults.Furthermore a differentiation of diagnosis for infants, toddlers and preschool children is required in both classification systems. As far as it is relevant for treatment, combined diagnosis in DSM-V and subthreshold diagnosis as well as coding-possibilities for findings in molecular biology should be permitted.As personality disorders should only be diagnosed after the age of 16, it is recommended to dimensionally classify personality traits that are pathognomonic for specific symptom patterns and of prognostic relevance.DSM-V and ICD-11 should allow age-specific information on axis-IV. The article discusses the general question of how relational disorders respectively disturbances should be classified and include furthermore special recommendations concerning ICD and DSM categories.

CLASSIFICATION SYSTEMS FOR ADOLESCENT AND ADULT SCOLIOSIS

Neurosurgery ◽  
2008 ◽  
Vol 63 (suppl_3) ◽  
pp. A16-A24 ◽  
Author(s):  
Justin S. Smith ◽  
Christopher I. Shaffrey ◽  
Charles Kuntz ◽  
Praveen V. Mummaneni
Keyword(s):  
Health Care Providers ◽  
Research Society ◽  
Classification Systems ◽  
Adult Scoliosis ◽  
Care Providers ◽  
Classification Schemes ◽  
Scoliosis Research Society ◽  
Adult Degenerative Scoliosis ◽  
Spinal Abnormality

ABSTRACT OBJECTIVE To review current classification systems for adolescent and adult scoliosis. METHODS The literature was reviewed in reference to scoliosis classification systems for adolescent and adult scoliosis. RESULTS There are multiple classification systems for scoliosis. Classification of scoliosis is dependent on patient age, spinal abnormality, scoliotic curve, and global spinal alignment. To date, classification systems have focused predominantly on adolescent idiopathic scoliosis or adult/degenerative scoliosis; a single classification system evaluating scoliotic deformities of different ages and spinal abnormalities has not been identified. CONCLUSION The importance of scoliosis classification schemes lies in their ability to standardize communication among health care providers. With regard to the classification of adolescent scoliosis, the Lenke system has addressed many of the significant limitations of the King system and is now the standard classification scheme. Classification schemes for adult scoliosis have been reported only recently, and each offers specific advantages (the simple pathogenesis-based system of Aebi, the strong clinical relevance of the Schwab system, and the richly descriptive Scoliosis Research Society system). This article highlights the salient features of currently used scoliosis classification systems.

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