scholarly journals Examining Diagnostic Options and Classification Systems Available for Endometriosis

2021 ◽  
pp. 60-71
Author(s):  
Debabrata Ghosh ◽  
Jayasree Sengupta
Keyword(s):  
Healthcare Providers ◽  
Scoring Systems ◽  
Classification Systems ◽  
Sample Collection ◽  
Clinical Imaging ◽  
Recent Recommendation ◽  
Staging Systems ◽  
Diagnostic Values ◽  
American Society ◽  
Histological Confirmation

Introduction: Endometriosis is characterised by the presence of endometrium-like tissue outside the uterus, and is often associated with chronic pelvic pain, infertility, and compromised quality of life. Development of reliable methods of early diagnosis, staging, and classification of endometriosis would allow for restriction of disease progression by its early detection and strategising towards its early treatment and management. Diagnostic options: Typically, diagnosis and staging of endometriosis include a history and physical examination followed by clinical, imaging, and laparoscopic findings. Surgical inspection of lesions at laparoscopy with histological confirmation remains the most reliable procedure towards the detection of endometriosis and its classification. Although there are many putative peripheral biomarkers having potential diagnostic values for endometriosis, further studies are necessary for their validation. Classification systems: Based on anatomical, clinical, imaging, and several pathophysiological findings, various classifications and staging systems of endometriosis, e.g., revised American Society for Reproductive Medicine (rASRM), ENZIAN, Endometriosis Fertility Index (EFI) and Foci–Ovarian endometrioma–Adhesion–Tubal endometriosis–Inflammation (FOATI) scoring systems, have so far been postulated. However, there is no fool-proof diagnostic and classification approach available for the disease due to the general failure of current systems to reflect reproducible correlation with the major symptoms of endometriosis. Conclusion: A ‘toolbox approach’, using all the available diagnostic and classification systems maximising the information available to healthcare providers and females, is a recent recommendation. Development of collaborative research networks for the harmonisation of patient information, biological sample collection, and its storage, and that of methodological and analytical tools in a wider patient base is necessary to discover reliable leads for future diagnostic options and a classification system for endometriosis.

Estrogen Receptor Classification for Hepatocellular Carcinoma: Comparison With Clinical Staging Systems

2003 ◽  
Vol 21 (3) ◽  
pp. 441-446 ◽  
Author(s):  
Erica Villa ◽  
Alessandra Colantoni ◽  
Calogero Cammà ◽  
Antonella Grottola ◽  
Paola Buttafoco ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Estrogen Receptor ◽  
Multivariate Analysis ◽  
Classification System ◽  
Scoring System ◽  
Scoring Systems ◽  
Classification Systems ◽  
Clinical Staging ◽  
Therapeutic Decisions ◽  
Staging Systems

Purpose: Several scoring systems to evaluate patients with hepatocellular carcinoma (HCC) exist. A good scoring system should provide information on prognosis and guide therapeutic decisions. The presence of variant liver estrogen receptor (ER) transcripts in the tumor has been shown to be the strongest negative predictor of survival in HCC. The aim of this study was to compare the predictive value of the commonly applied clinical scoring systems for survival of patients with HCC with that of the evaluation of ER in patients with HCC (molecular scoring system). Materials and Methods: HCC was staged according to the Okuda classification, Barcelona Clinic Liver Cancer classification, Italian classification system (CLIP), French classification, and ER status in 96 patients. Analysis of survival was performed according to the Kaplan-Maier test and was made for each classification system and ER. A comparison between classifications was made by univariate and multivariate analysis. Results: Among the clinical classification systems, only the CLIP was able to identify patient populations with good, intermediate, and poor prognosis. On multivariate analysis, ER classification was shown to be the best predictive classification for survival of patients with HCC (P <.0001). This difference was the result of a better allocation of patients with ominous prognosis (variant ER) having nevertheless good clinical score. Conclusion: The evaluation of the presence of wild-type or variant ER transcripts in the tumor is the best predictor of survival in patients with HCC. Its accuracy in discriminating patients with good or unfavorable prognosis is significantly greater than that of the commonly used scoring systems for the staging of HCC.

scholarly journals Myelodysplastic syndrome: classification and prognostic systems

2011 ◽  
pp. 25-33
Author(s):  
Rosangela Invernizzi ◽  
Agnese Filocco
Keyword(s):  
Clinical Information ◽  
Scoring Systems ◽  
Classification Systems ◽  
World Health ◽  
Individual Risk ◽  
Information Classification ◽  
Definition Of ◽  
Health Organization ◽  
The Individual ◽  
Prognostic Scoring Systems

Myelodysplastic syndromes (MDS) are acquired clonal disorders of hematopoiesis, that are characterized most frequently by normocellular or hypercellular bone marrow specimens, and maturation that is morphologically and functionally dysplastic. MDS constitute a complex hematological problem: differences in disease presentation, progression and outcome have made it necessary to use classification systems to improve diagnosis, prognostication and treatment selection. On the basis of new scientific and clinical information, classification and prognostic systems have recently been updated and minimal diagnostic criteria forMDS have been proposed by expert panels. In addition, in the last few years our ability to define the prognosis of the individual patient with MDS has improved. In this paper World Health Organization (WHO) classification refinements and recent prognostic scoring systems for the definition of individual risk are highlighted and current criteria are discussed. The recommendations should facilitate diagnostic and prognostic evaluations in MDS and selection of patients for new effective targeted therapies.

scholarly journals Recent progress of prognostic biomarkers and risk scoring systems in chronic lymphocytic leukemia

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Xiaoya Yun ◽  
Ya Zhang ◽  
Xin Wang
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Tp53 Mutation ◽  
Scoring Systems ◽  
Lymphocytic Leukemia ◽  
Prognostic Biomarkers ◽  
Novel Agents ◽  
Prognostic Models ◽  
Predictive Values ◽  
Mutation Status ◽  
Staging Systems

Abstract Chronic lymphocytic leukemia (CLL) is the most prevalent adult leukemia with high heterogeneity in the western world. Thus, investigators identified a number of prognostic biomarkers and scoring systems to guide treatment decisions and validated them in the context of immunochemotherapy. A better understanding of prognostic biomarkers, including serum markers, flow cytometry outcomes, IGHV mutation status, microRNAs, chromosome aberrations and gene mutations, have contributed to prognosis in CLL. Del17p/ TP53 mutation, NOTCH1 mutation, CD49d, IGHV mutation status, complex karyotypes and microRNAs were reported to be of predictive values to guide clinical decisions. Based on the biomarkers above, classic prognostic models, such as the Rai and Binet staging systems, MDACC nomogram, GCLLSG model and CLL-IPI, were developed to improve risk stratification and tailor treatment intensity. Considering the presence of novel agents, many investigators validated the conventional prognostic biomarkers in the setting of novel agents and only TP53 mutation status/del 17p and CD49d expression were reported to be of prognostic value. Whether other prognostic indicators and models can be used in the context of novel agents, further studies are required.

Cultural Engagement in Clinical Ethics: A Model for Ethics Consultation

2001 ◽  
Vol 10 (1) ◽  
pp. 16-33 ◽  
Author(s):  
MICHELE A. CARTER ◽  
CRAIG M. KLUGMAN
Keyword(s):  
Health Beliefs ◽  
Clinical Ethics ◽  
Core Competencies ◽  
Healthcare Providers ◽  
Health Sector ◽  
Ethics Consultation ◽  
Health Care Ethics ◽  
Theoretical Concepts ◽  
Medical Needs ◽  
American Society

In the rapidly evolving healthcare environment, perhaps no role is in greater flux and redefinition than that of the clinical bioethicist. The discussion of ethics consultation in the bioethics literature has moved from an ambiguous concern regarding its proper place in the clinical milieu to the more provocative question of which methods and theories should best characterize the intellectual and practical work it claims to do. The American Society for Bioethics and Humanities addressed these concerns in its 1998 report, Core Competencies for Health Care Ethics Consultation. The report tries to answer the question as to what disciplinary training, background experience, and levels of knowledge in ethics the clinical ethics consultant should have, and what specific skills and character traits the clinical ethics consultant should cultivate. In addition to acquiring knowledge of common bioethical issues, theoretical concepts in ethical theory and moral reasoning, and health-related law and policy, the report also recommends that ethics consultants demonstrate knowledge of the health beliefs and perspectives of patients and healthcare providers. In our opinion, this recommendation underscores a crucial aspect of the practice of ethics consultation in the increasingly multicultural settings of healthcare institutions. Clearly, the dynamic of American life and culture is permeated with diversity and variety as new groups suffuse their own beliefs and faith perspectives into the health sector. New immigrant groups force society to question traditional healthcare practices and to accommodate changing medical needs.

Attitudes of Healthcare Professionals toward Patient Counseling on Drug-Nutrient Interactions

1994 ◽  
Vol 28 (5) ◽  
pp. 576-580 ◽  
Author(s):  
Mary E. Teresi ◽  
Douglas E. Morgan
Keyword(s):  
Enteral Nutrition ◽  
Healthcare Professionals ◽  
Healthcare Providers ◽  
Mail Survey ◽  
Instructional Materials ◽  
Patient Counseling ◽  
Disease States ◽  
Mailing Lists ◽  
Advantageous Position ◽  
American Society

OBJECTIVE: To evaluate the attitudes of healthcare providers on drug—nutrient interaction (DNI) counseling. DESIGN: A mail survey. SETTING: Random sample of healthcare providers with interest in nutrition, practicing in Iowa or Nebraska. METHODS: A 48-item questionnaire was constructed on the basis of a review of DNI literature. The survey was sent to 100 pharmacists, 50 registered dietitians, 25 registered nurses, and 25 physicians identified from culled mailing lists of the American Society of Parenteral and Enteral Nutrition and the Iowa Nebraska Society of Parenteral and Enteral Nutrition. Assessed variables included the amount of DNI counseling provided, who is in the best position to provide DNI counseling, and what information should be included in instructional materials on DNIs for patients. Data were entered into a relational database for evaluation and comparison. RESULTS: The usable response rate was 49.5 percent (n=99): 49 pharmacists, 29 dietitians, 18 nurses, and 3 physicians. Only 12 respondents provided DNI counseling in >50 percent of patient interactions. Seventy-one respondents (72 percent) felt pharmacists were in the best position to discuss DNIs with patients. More than half of the respondents felt a new DNI pamphlet should be developed to replace an existing Food and Drug Administrationsponsored pamphlet. Although 70 percent felt the new pamphlet should be organized according to specific drugs, many felt the format should also include specific populations and disease states. Eighty-six percent indicated that a chart on ONIs geared toward healthcare professionals would be useful. CONCLUSIONS: Patient-oriented resources should be developed to enhance DNI counseling. Pharmacists are in a uniquely advantageous position to provide DNI counseling.

Definitions, classification, epidemiology, and risk factors of acute kidney injury

2018 ◽  
Author(s):  
Eric A. J. Hoste ◽  
John A. Kellum ◽  
Norbert Lameire
Keyword(s):  
Acute Kidney Injury ◽  
Medical Literature ◽  
Kidney Injury ◽  
Staging System ◽  
Acute Kidney Injury Network ◽  
Classification Systems ◽  
Clinical Settings ◽  
Binary Descriptor ◽  
Staging Systems ◽  
Definition Of

The lack of a precise biochemical definition of acute kidney injury (AKI) resulted in at least 35 definitions in the medical literature, which gave rise to a wide variation in reported incidence and clinical significance of AKI, impeded a meaningful comparison of studies.The first part of this chapter describes and discusses different definitions and classification systems of AKI. Patient outcome and the need for renal replacement therapy are directly related to the severity of AKI, an observation that supports the use of a categorical staging system rather than a simple binary descriptor. The severity of AKI is commonly characterized using the relative changes in serum creatinine and urine output. Recently introduced staging systems including the RIFLE classification and the Acute Kidney Injury Network (AKIN) use these relatively simple and readily available parameters allowing the assignment of individual patients to different AKI stages. More recently, a Kidney Disease: Improving Global Outcomes (KDIGO) workgroup developed a consensus-based AKI staging system drawing elements of both RIFLE and AKIN. The potential pitfalls and limitations of the proposed definitions and classifications are briefly described.The second part of the chapter describes the epidemiology of AKI in different clinical settings; the intensive care unit (ICU), the hospitalized population, and the community. The different spectrum of AKI in the emerging countries is discussed and the most important causes and aetiologies of the major clinical types of AKI, prerenal, renal, and post-renal are summarized in table form. Finally the patient survival and renal functional outcome of AKI are briefly discussed

Elderly patients undergoing cystectomy, comparing preoperative American Society of Anesthesiology and Eastern Cooperative Oncology Group scores and operative approaches

2019 ◽  
Vol 86 (4) ◽  
pp. 183-188 ◽  
Author(s):  
Christopher Martin ◽  
Jeremy M West ◽  
Salvatore Palermo ◽  
Darshan P Patel ◽  
Angela P Presson ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Eastern Cooperative Oncology Group ◽  
Scoring Systems ◽  
Partial Cystectomy ◽  
Complication Rates ◽  
Oncology Group ◽  
Muscle Invasive Bladder Cancer ◽  
Grade 3 ◽  
American Society ◽  
Muscle Invasive

Objective: To evaluate preoperative scoring systems and operative management and their relation to complications in patients older than 75 years undergoing cystectomy at two academic institutions. Methods: In total, 212 patients aged 75–95 years with muscle invasive bladder cancer underwent cystectomy at the University of Utah and Central Hospital of Bolzano, Italy. The rates of Grade 3 Clavien-Dindo complications and above in radical cystectomy patients (n = 199) were compared using Eastern Cooperative Oncology Group Scores and American Society of Anesthesiologists Physical Status Classification. The rates of Grade 3 Clavien-Dindo complications and above were also compared by urinary diversion type. Logistic regression was used to control for source institution. Results: In total, 199 cases were included in the primary analysis. Neither of the preoperative scoring systems were predictive for identification of radical cystectomy patients with ⩾Grade 3 Clavien-Dindo complications. In secondary analysis (n = 212, including partial cystectomy), none of the urinary diversion types associated with radical cystectomy had a significantly different rate of complications. However, partial cystectomy (n = 13) had a significantly lower rate of complications. Conclusion: Complication rates among elderly patients undergoing cystectomy for muscle invasive bladder cancer were very high. For patients who are approved for surgery after the history and physical exam, none of our objective metrics adequately predicted operative risk. A unique diversion procedure described by the Bolzano group, uretero-ureterocutaneostomy, had equivalent complication rates to the more common diversion procedures. It also appears based on outcomes in this cohort that partial cystectomy is a particularly favorable option within the elderly population in terms of perioperative morbidity.

scholarly journals Contemporary Treatment Strategy for Spinal Metastasis: The “LMNOP” System

2011 ◽  
Vol 38 (3) ◽  
pp. 396-403 ◽  
Author(s):  
Gillian R. Paton ◽  
Evan Frangou ◽  
Daryl R. Fourney
Keyword(s):  
Spinal Metastasis ◽  
Scoring Systems ◽  
Management Plan ◽  
Classification Systems ◽  
Mechanical Instability ◽  
Key Factors ◽  
Management Options ◽  
Prior Therapy ◽  
Wide Range ◽  
Choice Of Treatment

The choice of treatment for spinal metastasis is complex because (1) it depends on several inter-related clinical and radiologic factors, and (2) a wide range of management options has evolved in recent years. While radiation therapy and surgery remain the cornerstones of treatment, radiosurgery and percutaneous vertebral augmentation have also established a role. Classification systems have been developed to aid in the decision-making process, and each has different strengths and weaknesses. The comprehensive scoring systems developed to date provide an estimate of life expectancy, but do not provide much advice on the choice of treatment. We propose a new decision model that describes the key factors in formulating the management plan, while recognizing that the care of each patient remains highly individualized. The system also incorporates the latest changes in technology. The LMNOP system evaluates the number of spinal Levels involved and the Location of disease in the spine (L), Mechanical instability (M), Neurology (N), Oncology (O), Patient fitness, Prognosis and response to Prior therapy (P).

A Retrospective Population-Based Comparison of HER2 Immunohistochemistry and Fluorescence In Situ Hybridization in Breast Carcinomas: Impact of 2007 American Society of Clinical Oncology/ College of American Pathologists Criteria

2013 ◽  
Vol 138 (2) ◽  
pp. 213-219 ◽  
Author(s):  
Kurt A. Schalper ◽  
Sudha Kumar ◽  
Pei Hui ◽  
David L. Rimm ◽  
Peter Gershkovich
Keyword(s):  
In Situ Hybridization ◽  
Fluorescence In Situ Hybridization ◽  
Clinical Oncology ◽  
Scoring Systems ◽  
Population Based ◽  
Breast Carcinomas ◽  
Her2 Testing ◽  
Invasive Breast Carcinomas ◽  
American Society

Context.—In 2007 the American Society of Clinical Oncology/College of American Pathologists made new recommendations for HER2 testing and redefined HER2 positivity. Objective.—To analyze results from simultaneous HER2 testing with immunohistochemistry and fluorescence in situ hybridization (FISH) in 2590 invasive breast carcinomas between 2002 and 2010, using 2 scoring systems. Design.—Cases from between 2002 and 2006 were scored by using original US Food and Drug Administration criteria (N = 1138) and those from between 2007 and 2010 were evaluated according to American Society of Clinical Oncology/College of American Pathologists criteria (N = 1452). Concordance between testing methods and clinicopathologic associations were determined. Results.—Overall concordance between immunohistochemistry/FISH in the 9-year period was 96.2% (κ = 0.82), and positive concordance was lower. After 2007, the proportion of HER2/neu-positive and HER2/neu-negative cases was not significantly changed when using immunohistochemistry (10.5% versus 8.9%, P = .22 and 69.4% versus 63%, P = .13, respectively), but the number of equivocal cases was higher (19.9% versus 28%, P &lt; .001). While the proportion of negative cases by FISH remained unchanged after 2007 (86.5% versus 88.2%, P = .76), the number of positive cases was lower (13.4% versus 9.2%, P &lt; .001). In addition, 38 cases (2.6%) were FISH equivocal, 16 of which were also equivocal by immunohistochemistry. Overall, immunohistochemistry/FISH concordance was 95.9% between 2002 and 2006 (κ = 0.82) and 96.4% after 2007 (κ = 0.82). However, an approximately 13% lower positive assay concordance was noted in the last period. Conclusions.—Application of American Society of Clinical Oncology/College of American Pathologists recommendations is associated with comparable overall immunohistochemistry/FISH concordance, reduced positive concordance, and increased equivocal results.

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