The revised burn diagram and its effect on diagnosis-related group coding.

PubMed

Turner, D G; Berger, N; Weiland, A P; Jordan, M H

1996-01-01

Diagnosis-related group (DRG) codes for burn injuries are defined by thresholds of the percentage of total body surface area and depth of burns, and by whether surgery, debridement, or grafting or both occurred. This prospective study was designed to determine whether periodic revisions of the burn diagram resulted in more accurate assignment of the International Classification of Diseases and DRG codes. The admission burn diagrams were revised after admission and after each surgical procedure. All areas grafted (deep second-and third-degree burns) were diagrammed as "third-degree," after the current convention that both are biologically the same and require grafting. The multiple diagrams from 82 charts were analyzed to determine the disparities in the percentage of total body surface area burn and the percentage of body surface area third-degree burn. The revised diagrams differed from the admission diagrams in 96.5% of the cases. In 77% of the cases, the revised diagram correctly depicted the percentage of body surface area third-degree burn as confirmed intraoperatively. In 7.3% of the cases, diagram revision changed the DRG code. Documenting wound evolution in this manner allows more accurate assignment of the International Classification of Diseases and DRG codes, assuring optimal reimbursement under the prospective payment system.

[The internationalization of the nursing profession in Taiwan].

PubMed

Chuang, Hsiao-Ling; Wang, Cheng-Ching; Kuo, Pi-Chao

2011-06-01

Globalization, nursing manpower migration, and the multinational nature of the medical industry have increased the level of internationalization in Taiwan's nursing profession. In nursing practice, competencies for the general nursing list (Taiwan version) and ICNP (International Classification for Nursing Practice) have been clinically tested and revised. In academic nursing, significant effort is invested toward achieving the three general objectives of internationalized teaching, internationalized campuses, and international academic exchanges. We should further test and revise Taiwan's competencies for the general nursing list, and the ICNP should be continually tested and revised. Additionally, nursing personnel should strengthen foreign language competencies, appreciate different nursing practice cultures, participate in international exchange activities, and place increasing emphasis on international cooperation in research and nursing education accreditation. Such should further enhance and strengthen international cooperation, which should further encourage internationalization in the domestic nursing profession.

A System for Supporting Development and Update of the International Classification of Health Interventions (ICHI).

PubMed

Donada, Marc; Della Mea, Vincenzo; Cumerlato, Megan; Rankin, Nicole; Madden, Richard

2018-01-01

The International Classification of Health Interventions (ICHI) is a member of the WHO Family of International Classifications, being developed to provide a common tool for reporting and analysing health interventions for statistical purposes. A web-based platform for classification development and update has been specifically developed to support the initial development step and then, after final approval, the continuous revision and update of the classification. The platform provides features for classification editing, versioning, comment management and URI identifiers. During the last 12 months it has been used for developing the ICHI Beta version, replacing the previous process based on the exchange of Excel files. At November 2017, 90 users have provided input to the development of the classification, which has resulted in 2913 comments and 2971 changes in the classification, since June 2017. Further work includes the development of an URI API for machine to machine communication, following the model established for ICD-11.

The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part A: Renal, Penile, and Testicular Tumours.

PubMed

Moch, Holger; Cubilla, Antonio L; Humphrey, Peter A; Reuter, Victor E; Ulbright, Thomas M

2016-07-01

The fourth edition of the World Health Organization (WHO) classification of urogenital tumours (WHO "blue book"), published in 2016, contains significant revisions. These revisions were performed after consideration by a large international group of pathologists with special expertise in this area. A subgroup of these persons met at the WHO Consensus Conference in Zurich, Switzerland, in 2015 to finalize the revisions. This review summarizes the most significant differences between the newly published classification and the prior version for renal, penile, and testicular tumours. Newly recognized epithelial renal tumours are hereditary leiomyomatosis and renal cell carcinoma (RCC) syndrome-associated RCC, succinate dehydrogenase-deficient RCC, tubulocystic RCC, acquired cystic disease-associated RCC, and clear cell papillary RCC. The WHO/International Society of Urological Pathology renal tumour grading system was recommended, and the definition of renal papillary adenoma was modified. The new WHO classification of penile squamous cell carcinomas is based on the presence of human papillomavirus and defines histologic subtypes accordingly. Germ cell neoplasia in situ (GCNIS) of the testis is the WHO-recommended term for precursor lesions of invasive germ cell tumours, and testicular germ cell tumours are now separated into two fundamentally different groups: those derived from GCNIS and those unrelated to GCNIS. Spermatocytic seminoma has been designated as a spermatocytic tumour and placed within the group of non-GCNIS-related tumours in the 2016 WHO classification. The 2016 World Health Organization (WHO) classification contains new renal tumour entities. The classification of penile squamous cell carcinomas is based on the presence of human papillomavirus. Germ cell neoplasia in situ of the testis is the WHO-recommended term for precursor lesions of invasive germ cell tumours. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Management of A Rare Case of Communicating Internal-External Inflammatory Resorption.

PubMed

Arora, Suraj; Gill, Gurdeep Singh; Saluja, Priyanka; Setia, Vikas

2015-05-01

The present case describes the successful management of a rare case of communicating internal-external resorption in which both internal and external resorption seem to develop independent of each other. The case report highlights the importance of correct diagnosis and need of revision of classification system of resorptive defects.

Management of A Rare Case of Communicating Internal-External Inflammatory Resorption

PubMed Central

Arora, Suraj; Saluja, Priyanka; Setia, Vikas

2015-01-01

The present case describes the successful management of a rare case of communicating internal-external resorption in which both internal and external resorption seem to develop independent of each other. The case report highlights the importance of correct diagnosis and need of revision of classification system of resorptive defects. PMID:26155588

International Standards for Neurological Classification of Spinal Cord Injury: cases with classification challenges.

PubMed

Kirshblum, S C; Biering-Sorensen, F; Betz, R; Burns, S; Donovan, W; Graves, D E; Johansen, M; Jones, L; Mulcahey, M J; Rodriguez, G M; Schmidt-Read, M; Steeves, J D; Tansey, K; Waring, W

2014-03-01

The International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) is routinely used to determine the levels of injury and to classify the severity of the injury. Questions are often posed to the International Standards Committee of the American Spinal Injury Association regarding the classification. The committee felt that disseminating some of the challenging questions posed, as well as the responses, would be of benefit for professionals utilizing the ISNCSCI. Case scenarios that were submitted to the committee are presented with the responses as well as the thought processes considered by the committee members. The importance of this documentation is to clarify some points as well as update the SCI community regarding possible revisions that will be needed in the future based upon some rules that require clarification.

The road to 11th edition of the International Classification of Diseases: trajectories of scientific consensus and contested science in the classification of intellectual disability/intellectual developmental disorders.

PubMed

Salvador-Carulla, Luis; Bertelli, Marco; Martinez-Leal, Rafael

2018-03-01

To increase the expert knowledge-base on intellectual developmental disorders (IDDs) by investigating the typology trajectories of consensus formation in the classification systems up to the 11th edition of the International Classification of Diseases (ICD-11). This expert review combines an analysis of key recent literature and the revision of the consensus formation and contestation in the expert committees contributing to the classification systems since the 1950s. Historically two main approaches have contributed to the development of this knowledge-base: a neurodevelopmental-clinical approach and a psychoeducational-social approach. These approaches show a complex interaction throughout the history of IDD and have had a diverse influence on its classification. Although in theory Diagnostic and Statistical Manual (DSM)-5 and ICD adhere to the neurodevelopmental-clinical model, the new definition in the ICD-11 follows a restrictive normality approach to intellectual quotient and to the measurement of adaptive behaviour. On the contrary DSM-5 is closer to the recommendations made by the WHO 'Working Group on Mental Retardation' for ICD-11 for an integrative approach. A cyclical pattern of consensus formation has been identified in IDD. The revision of the three major classification systems in the last decade has increased the terminological and conceptual variability and the overall scientific contestation on IDD.

[The informational support of statistical observation related to children disability].

PubMed

Son, I M; Polikarpov, A V; Ogrizko, E V; Golubeva, T Yu

2016-01-01

Within the framework of the Convention on rights of the disabled the revision is specified concerning criteria of identification of disability of children and reformation of system of medical social expertise according international standards of indices of health and indices related to health. In connection with it, it is important to consider the relationship between alterations in forms of the Federal statistical monitoring in the part of registration of disabled children in the Russian Federation and classification of health indices and indices related to health applied at identification of disability. The article presents analysis of relationship between alterations in forms of the Federal statistical monitoring in the part of registration of disabled children in the Russian Federation and applied classifications used at identification of disability (International classification of impairments, disabilities and handicap (ICDH), international classification of functioning, disability and health (ICF), international classification of functioning, disability and health, version for children and youth (ICF-CY). The intersectorial interaction is considered within the framework of statistics of children disability.

The DSM-5: Classification and criteria changes.

PubMed

Regier, Darrel A; Kuhl, Emily A; Kupfer, David J

2013-06-01

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) marks the first significant revision of the publication since the DSM-IV in 1994. Changes to the DSM were largely informed by advancements in neuroscience, clinical and public health need, and identified problems with the classification system and criteria put forth in the DSM-IV. Much of the decision-making was also driven by a desire to ensure better alignment with the International Classification of Diseases and its upcoming 11th edition (ICD-11). In this paper, we describe select revisions in the DSM-5, with an emphasis on changes projected to have the greatest clinical impact and those that demonstrate efforts to enhance international compatibility, including integration of cultural context with diagnostic criteria and changes that facilitate DSM-ICD harmonization. It is anticipated that this collaborative spirit between the American Psychiatric Association (APA) and the World Health Organization (WHO) will continue as the DSM-5 is updated further, bringing the field of psychiatry even closer to a singular, cohesive nosology. Copyright © 2013 World Psychiatric Association.

Importance of Proper Utilization of International Classification of Diseases 10th Revision and Clinical Documentation in Modern Payment Models.

PubMed

Nichols, Joseph C; Osmani, Feroz A; Sayeed, Yousuf

2016-05-01

Health care payment models are changing rapidly, and the measurement of outcomes and costs is increasing. With the implementation of International Classification of Diseases 10th revision (ICD-10) codes, providers now have the ability to introduce a precise array of diagnoses for their patients. More specific diagnostic codes do not eliminate the potential for vague application, as was seen with the utility of ICD-9. Complete, accurate, and consistent data that reflect the risk, severity, and complexity of care are becoming critically important in this new environment. Orthopedic specialty organizations must be actively involved in influencing the definition of value and risk in the patient population. Now is the time to use the ICD-10 diagnostic codes to improve the management of patient conditions in data. Copyright © 2016 Elsevier Inc. All rights reserved.

Global classification and coding of hypersensitivity diseases - An EAACI - WAO survey, strategic paper and review.

PubMed

Demoly, P; Tanno, L K; Akdis, C A; Lau, S; Calderon, M A; Santos, A F; Sanchez-Borges, M; Rosenwasser, L J; Pawankar, R; Papadopoulos, N G

2014-05-01

Hypersensitivity diseases are not adequately coded in the International Coding of Diseases (ICD)-10 resulting in misclassification, leading to low visibility of these conditions and general accuracy of official statistics. To call attention to the inadequacy of the ICD-10 in relation to allergic and hypersensitivity diseases and to contribute to improvements to be made in the forthcoming revision of ICD, a web-based global survey of healthcare professionals' attitudes toward allergic disorders classification was proposed to the members of European Academy of Allergy and Clinical Immunology (EAACI) (individuals) and World Allergy Organization (WAO) (representative responding on behalf of the national society), launched via internet and circulated for 6 week. As a result, we had 612 members of 144 countries from all six World Health Organization (WHO) global regions who answered the survey. ICD-10 is the most used classification worldwide, but it was not considered appropriate in clinical practice by the majority of participants. The majority indicated the EAACI-WAO classification as being easier and more accurate in the daily practice. They saw the need for a diagnostic system useful for nonallergists and endorsed the possibility of a global, cross-culturally applicable classification system of allergic disorders. This first and most broadly international survey ever conducted of health professionals' attitudes toward allergic disorders classification supports the need to update the current classifications of allergic diseases and can be useful to the WHO in improving the clinical utility of the classification and its global acceptability for the revised ICD-11. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Proposals for Paraphilic Disorders in the International Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11).

PubMed

Krueger, Richard B; Reed, Geoffrey M; First, Michael B; Marais, Adele; Kismodi, Eszter; Briken, Peer

2017-07-01

The World Health Organization is currently developing the 11th revision of the International Classifications of Diseases and Related Health Problems (ICD-11), with approval of the ICD-11 by the World Health Assembly anticipated in 2018. The Working Group on the Classification of Sexual Disorders and Sexual Health (WGSDSH) was created and charged with reviewing and making recommendations for categories related to sexuality that are contained in the chapter of Mental and Behavioural Disorders in ICD-10 (World Health Organization 1992a). Among these categories was the ICD-10 grouping F65, Disorders of sexual preference, which describes conditions now widely referred to as Paraphilic Disorders. This article reviews the evidence base, rationale, and recommendations for the proposed revisions in this area for ICD-11 and compares them with DSM-5. The WGSDSH recommended that the grouping, Disorders of sexual preference, be renamed to Paraphilic Disorders and be limited to disorders that involve sexual arousal patterns that focus on non-consenting others or are associated with substantial distress or direct risk of injury or death. Consistent with this framework, the WGSDSH also recommended that the ICD-10 categories of Fetishism, Fetishistic Transvestism, and Sadomasochism be removed from the classification and new categories of Coercive Sexual Sadism Disorder, Frotteuristic Disorder, Other Paraphilic Disorder Involving Non-Consenting Individuals, and Other Paraphilic Disorder Involving Solitary Behaviour or Consenting Individuals be added. The WGSDSH's proposals for Paraphilic Disorders in ICD-11 are based on the WHO's role as a global public health agency and the ICD's function as a public health reporting tool.

The Molecular Pathology of Myelodysplastic Syndrome.

PubMed

Haferlach, Torsten

2018-05-23

The diagnosis and classification of myelodysplastic syndromes (MDS) are based on cytomorphology and cytogenetics (WHO classification). Prognosis is best defined by the Revised International Prognostic Scoring System (IPSS-R). In recent years, an increasing number of molecular aberrations have been discovered. They are already included in the classification (e.g., SF3B1) and, more importantly, have emerged as valuable markers for better classification, particularly for defining risk groups. Mutations in genes such as SF3B1 and IDH1/2 have already had an impact on targeted treatment approaches in MDS. © 2018 S. Karger AG, Basel.

International Headache Society classification: new proposals about chronic headache.

PubMed

Manzoni, G C; Torelli, P

2003-05-01

In the International Headache Society (IHS) classification of 1988, chronic daily headache (CDH) forms are not exhaustively categorized. The forthcoming revision of the classification will include a number of CDH forms that had been reported prior to 1988 or have been identified after that date. In particular, chronic migraine will be added to the classification as a complication of migraine, provided that use of symptomatic drugs does not exceed 10 days per month. In addition to chronic cluster headache and chronic paroxysmal hemicrania, short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) and hemicrania continua will be comprised among CDH forms with short-lived attacks. Hypnic headache will be included in Group 4 ("Other primary headaches"). No additions will be made to the new IHS classification for forms such as new daily persistent headache (NDPH) and cervicogenic headache as proposed by Sjaastad.

The new ILAE report on terminology and concepts for organization of epileptic seizures: a clinician's critical view and contribution.

PubMed

Panayiotopoulos, Chrysostomos P

2011-12-01

The International League Against Epilepsy (ILAE) standardized classification and terminology for "epileptic seizures" of 1981 and "epilepsies and epileptic syndromes" of 1989 provide a fundamental framework for organizing and differentiating the epilepsies. However, a revision of these classifications is mandated by recent major technologic and scientific advances. Since 1997, the relevant ILAE Commissions have made significant efforts to achieve better and internationally uniform classifications as reflected in their reports of 2001, 2006, and 2010. Their initial aim to construct a "new scientific classification from application of methods used in biology that determines separate species and natural classes" proved elusive and, therefore, the last Commission in their report of 2010 confined their revisions to "new terminology and concepts" instead of "proposing a new classification (in the sense of organization) of epilepsies." It is unfortunate that most of the proposals in this report are modified interpretations and nomenclature of previous ILAE classifications; new terms are not better than the old ones, and recent advances have not been incorporated. Hence, the new ILAE report met with considerable protest from several expert epileptologists. This critical review refers mainly to the epileptic seizures, the classification of which may be an easier and less controversial task in the ILAE revisions. A revised classification should incorporate advanced knowledge of seizure pathophysiology, and clinical, interictal, and ictal manifestations. Such an attempt was made and detailed in the 2006 report of the ILAE Classification Core Group. However, these changes were largely discarded in the new ILAE report of 2010, without justification. This is inexplicable considering that the scientific advances that were available to the two Commissions were the same or had improved between 2006 and 2010. Of major concern is that "No specific classification is recommended for focal seizures which should be described according to their manifestations." Such a proposition defies the essence and the principle of any classification that requires an organization and a common language for communication. Free text descriptions are fine in a manual of differential diagnosis but not as a classification system. Another striking weakness is that even the accepted types of epileptic seizure are listed by name only, without defining them. The result is avoidable confusion. Furthermore, the report fails to consider reflex epileptic seizures. Status epilepticus is the most conspicuous omission despite immense advances of our understanding of it and its relevance on the classification. It appears that the new ILAE report does not fulfill its intent to improve the previous classifications and it may be premature to submit anything similar to this for approval by the ILAE General Assembly. The ILAE Commission could benefit by asking experts in basic and clinical science to provide a concise statement in their field of expertise as, for example, what are focal, myoclonic, or absence seizures, and their subtypes, their manifestations, and their possible pathophysiology. Areas of certainties and uncertainties, agreements and disagreements should be identified and stated clearly, with documentation of the reasons for it. Probably this is the only way forward for a truly scientific, sound, and clinically meaningful organizational system for the epileptic seizures and the epilepsies. Wiley Periodicals, Inc. © 2011 International League Against Epilepsy.

Proposals for new standardized general diagnostic criteria for the secondary headaches.

PubMed

Olesen, J; Steiner, T; Bousser, M-G; Diener, H-C; Dodick, D; First, M B; Goadsby, P J; Göbel, H; Lainez, M J A; Lipton, R B; Nappi, G; Sakai, F; Schoenen, J; Silberstein, S D

2009-12-01

Headache classification is a dynamic process through clinical testing and re-testing of current and proposed criteria. After publication of the second edition of the International Classification of Headache Disorders (ICHD-II), need arose for revisions in the classification of medication overuse headache and chronic migraine. These changes made apparent a further need for broader revisions to the standard formulation of diagnostic criteria for the secondary headaches. Currently, the fourth criterion makes impossible the definitive diagnosis of a secondary headache until the underlying cause has resolved or been cured or greatly ameliorated by therapy, at which time the headache may no longer be present. Given that the main purpose of diagnostic criteria is to enable a diagnosis at the onset of a disease in order to guide treatment, this is unhelpful in clinical practice. In the present paper we propose maintaining a standard approach to the secondary headaches using a set of four criteria A, B, C and D, but we construct these so that the requirement for resolution or successful treatment is removed. The proposal for general diagnostic criteria for the secondary headaches will be entered into the internet-based version of the appendix of ICHD-II. During 2009 the Classification Committee will apply the general criteria to all the specific types of secondary headaches. These, and other changes, will be included in a revision of the entire classification entitled ICHD-IIR, expected to be published in 2010. ICHD-IIR will be printed and posted on the website and will be the official classification of the International Headache Society. Unfortunately, it will be necessary to translate ICHD-IIR into the many languages of the world, but the good news is that no major changes to the headache classification are then foreseen for the next 10 years. Until the printing of ICHD-IIR, the printed ICHD-II criteria remain in place for all other purposes. We issue a plea to the headache community to use and study these proposed general criteria for the secondary headaches in order to provide more evidence for their utility-before their incorporation in the main body of the classification.

42 CFR 424.3 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... means International Classification of Diseases, Ninth Revision, Clinical Modification. Nonparticipating hospital means a hospital that does not have in effect a provider agreement to participate in Medicare. Participating hospital means a hospital that has in effect a provider agreement to participate in Medicare. [53...

[Theory of toxic classification of traditional Chinese medicine and recommendations for revision of China pharmacopeia (volume 1)].

PubMed

Zhao, Junning; Ye, Zuguang

2012-08-01

Toxic classification of traditional Chinese medicine, as a contribution of traditional Chinese medicine (TCM) to the recognition of medicinal toxicity and rational use of medicinal materials by Chinese people, is now a great issue related to safe medication, sustainable development and internationalization of Chinese medicine. In this article, the origination and development of toxic classification theory was summarized and analyzed. Because toxic classification is an urgent issue related to TCM industrialization, modernization and internationalization, this article made a systematic analysis on the nature and connotation of toxic classification as well as risk control for TCM industry due to the medicinal toxicity. Based on the toxic studies, this article made some recommendations on toxic classification of Chinese medicinal materials for the revision of China Pharmacopeia (volume 1). From the aspect of scientific research, a new technical guideline for research on toxic classification of Chinese medicine should be formulated based on new biological toxicity test technology such as Microtox and ADME/Tox, because the present classification of acute toxicity of mice/rats can not met the modern development of Chinese medicine any more. The evaluation system and technical SOP of TCM toxic classification should also be established, and they should well balance TCM features, superiority and international requirements. From the aspect of medicine management, list of toxic medicines and their risk classification should be further improved by competent government according to scientific research. In China Pharmacopeia (volume I), such descriptions of strong toxicity, toxicity or mild toxicity should be abandoned when describing medicine nature and flavor. This revision might help promote TCM sustainable development and internationalization, and enhance the competitive capacity of Chinese medicine in both domestic and international market. However, description of strong toxicity, toxicity or mild toxicity might be used when making cautions for the medicine, stating that the description is based on Chinese classic works. In this way, TCM traditional theory might be inherited and features of Chinese medicine maintained and reflected. Besides, modern findings should be added to the cautions, including dose-response relationship, toxic mechanism, and toxic elements. The traditional toxic descriptions and modern findings, as a whole, can make the caution clear and scientific, and then promote safe medication and TCM modernization and internationalization.

Participant action research with bedside nurses to identify NANDA-International, Nursing Interventions Classification, and Nursing Outcomes Classification categories for hospitalized persons with diabetes.

PubMed

Minthorn, Crista; Lunney, Margaret

2012-05-01

Experienced bedside nurses identified 14 nursing diagnoses, 78 interventions, and 76 health outcomes for hospitalized persons with diabetes. Using these terms, the nursing department revised the standards of care and the electronic health record. Nurses' engagement in generating knowledge translated to increased interest in research. This methodology is recommended for other agencies. Copyright © 2012 Elsevier Inc. All rights reserved.

Mental and behavioural disorders in the ICD-11: concepts, methodologies, and current status.

PubMed

Gaebel, Wolfgang; Zielasek, Jürgen; Reed, Geoffrey M

2017-04-30

This review provides an overview of the concepts, methods and current status of the development of the Eleventh Revision of the Mental and Behavioural Disorders chapter of the International Classification of Diseases and Related Health Problems (ICD-11) by the World Health Organization (WHO). Given the global use of the current version (ICD-10) for a wide range of applications in clinical practice and health statistics, a major aim of the development process for ICD-11 has been to increase the utility of the classification system. Expert working groups with responsibility for specific disorder groupings first suggested a set of revised diagnostic guidelines. Then surveys were performed to obtain suggestions for revisions from practicing health professionals. A completely revised structure for the classification of mental and behavioural disorders was developed and major revisions were suggested, for example, for schizophrenia and other primary psychotic disorders, substance use disorders, affective disorders and personality disorders. A new category of "gaming disorder" has been proposed and conditions related to sexual health and gender identity will be classified separately from mental disorders. An ICD-11 beta draft is freely available on the internet and public comments are invited. Field studies of the revised diagnostic guidelines are in process to obtain additional information about necessary improvements. A tabulated crosswalk from previous ICD-10 to then ICD-11 criteria will be necessary to ascertain the continuity of diagnoses for epidemiological and other statistical purposes. The final version of ICD-11 is currently scheduled for release by the World Health Assembly in 2018.

76 FR 32933 - International Standard-Setting Activities

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-07

... or re-evaluation by JECFA. Proposed amendments to the Risk Analysis Principles for CCRVDF for comments and consideration at the next session. Proposed revision of Risk Analysis Principles Applied by... the Classification of Foods and Animal Feeds: Tree Nuts, Herbs and Spices. Draft Principle and...

Categorization of allergic disorders in the new World Health Organization International Classification of Diseases.

PubMed

Tanno, Luciana Kase; Calderon, Moises A; Goldberg, Bruce J; Akdis, Cezmi A; Papadopoulos, Nikolaos G; Demoly, Pascal

2014-01-01

Although efforts to improve the classification of hypersensitivity/allergic diseases have been made, they have not been considered a top-level category in the International Classification of Diseases (ICD)-10 and still are not in the ICD-11 beta phase linearization. ICD-10 is the most used classification system by the allergy community worldwide but it is not considered as appropriate for clinical practice. The Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) on the other hand contains a tightly integrated classification of hypersensitivity/allergic disorders based on the EAACI/WAO nomenclature and the World Health Organization (WHO) may plan to align ICD-11 with SNOMED CT so that they share a common ontological basis. With the aim of actively supporting the ongoing ICD-11 revision and the optimal practice of Allergology, we performed a careful comparison of ICD-10 and 11 beta phase linearization codes to identify gaps, areas of regression in allergy coding and possibly reach solutions, in collaboration with committees in charge of the ICD-11 revision. We have found a significant degree of misclassification of terms in the allergy-related hierarchies. This stems not only from unclear definitions of these conditions but also the use of common names that falsely imply allergy. The lack of understanding of the immune mechanisms underlying some of the conditions contributes to the difficulty in classification. More than providing data to support specific changes into the ongoing linearization, these results highlight the need for either a new chapter entitled Hypersensitivity/Allergic Disorders as in SNOMED CT or a high level structure in the Immunology chapter in order to make classification more appropriate and usable.

[Generalized anxiety disorder, now and the future: a perspective to the DSM-5].

PubMed

Otsubo, Tempei

2012-01-01

Generalized, persistent, and free-floating anxiety was first described by Freud in 1894. The diagnostic term generalized anxiety disorder (GAD) was not in classification systems until the publication of the diagnostic and statistical manual for mental disorders, third edition (DSM-III) in 1980. Initially considered as a residual category to be used when no other diagnosis could be made, it is not accepted that GAD represents a distinct diagnostic category yet. Since 1980, revisions to the diagnostic criteria for GAD in the DSM-III-R, DSM-IV and DSM-5 classifications have slightly redefined this disorder. The classification is fluid. The duration criterion has increased to 6 months in DSM-IV, but decreased to 3 months in DSM-5. This article reviews the development of diagnostic criteria for defining GAD from Freud to DSM-5 and compares the DSM-5 criterion with DSM-IV and the tenth revision of the International Classification of Disease. The impact of the changes in diagnostic criteria on research into GAD, and on diagnosis, differential diagnosis, will be discussed.

Performance of the Delirium Rating Scale-Revised-98 Against Different Delirium Diagnostic Criteria in a Population With a High Prevalence of Dementia.

PubMed

Sepulveda, Esteban; Franco, José G; Trzepacz, Paula T; Gaviria, Ana M; Viñuelas, Eva; Palma, José; Ferré, Gisela; Grau, Imma; Vilella, Elisabet

2015-01-01

Delirium diagnosis in elderly is often complicated by underlying dementia. We evaluated performance of the Delirium Rating Scale-Revised-98 (DRS-R98) in patients with high dementia prevalence and also assessed concordance among past and current diagnostic criteria for delirium. Cross-sectional analysis of newly admitted patients to a skilled nursing facility over 6 months, who were rated within 24-48 hours after admission. Interview for Diagnostic and Statistical Manual of Mental Disorders, 3rd edition-R (DSM)-III-R, DSM-IV, DSM-5, and International Classification of Diseases 10th edition delirium ratings, administration of the DRS-R98, and assessment of dementia using the Informant Questionnaire on Cognitive Decline in the Elderly were independently performed by 3 researchers. Discriminant analyses (receiver operating characteristics curves) were used to study DRS-R98 accuracy against different diagnostic criteria. Hanley and McNeil test compared the area under the curve for DRS-R98's discriminant performance for all diagnostic criteria. Dementia was present in 85/125 (68.0%) subjects, and 36/125 (28.8%) met criteria for delirium by at least 1 classification system, whereas only 19/36 (52.8%) did by all. DSM-III-R diagnosed the most as delirious (27.2%), followed by DSM-5 (24.8%), DSM-IV-TR (22.4%), and International Classification of Diseases 10th edition (16%). DRS-R98 had the highest AUC when discriminating DSM-III-R delirium (92.9%), followed by DSM-IV (92.4%), DSM-5 (91%), and International Classification of Diseases 10th edition (90.5%), without statistical differences among them. The best DRS-R98 cutoff score was ≥14.5 for all diagnostic systems except International Classification of Diseases 10th edition (≥15.5). There is a low concordance across diagnostic systems for identification of delirium. The DRS-R98 performs well despite differences across classification systems perhaps because it broadly assesses phenomenology, even in this population with a high prevalence of dementia. Copyright © 2015 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

77 FR 68891 - Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, DME Face-to...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-16

... Area ICD International Classification of Diseases IMRT Intensity Modulated Radiation Therapy IOM... Stereotactic body radiation therapy SGR Sustainable growth rate TC Technical component TIN Tax identification... Clinical Lab Fee Schedule, which is unaffected by the misvalued code initiative. Radiation therapy centers...

Optimizing research in symptomatic uterine fibroids with development of a computable phenotype for use with electronic health records.

PubMed

Hoffman, Sarah R; Vines, Anissa I; Halladay, Jacqueline R; Pfaff, Emily; Schiff, Lauren; Westreich, Daniel; Sundaresan, Aditi; Johnson, La-Shell; Nicholson, Wanda K

2018-06-01

Women with symptomatic uterine fibroids can report a myriad of symptoms, including pain, bleeding, infertility, and psychosocial sequelae. Optimizing fibroid research requires the ability to enroll populations of women with image-confirmed symptomatic uterine fibroids. Our objective was to develop an electronic health record-based algorithm to identify women with symptomatic uterine fibroids for a comparative effectiveness study of medical or surgical treatments on quality-of-life measures. Using an iterative process and text-mining techniques, an effective computable phenotype algorithm, composed of demographics, and clinical and laboratory characteristics, was developed with reasonable performance. Such algorithms provide a feasible, efficient way to identify populations of women with symptomatic uterine fibroids for the conduct of large traditional or pragmatic trials and observational comparative effectiveness studies. Symptomatic uterine fibroids, due to menorrhagia, pelvic pain, bulk symptoms, or infertility, are a source of substantial morbidity for reproductive-age women. Comparing Treatment Options for Uterine Fibroids is a multisite registry study to compare the effectiveness of hormonal or surgical fibroid treatments on women's perceptions of their quality of life. Electronic health record-based algorithms are able to identify large numbers of women with fibroids, but additional work is needed to develop electronic health record algorithms that can identify women with symptomatic fibroids to optimize fibroid research. We sought to develop an efficient electronic health record-based algorithm that can identify women with symptomatic uterine fibroids in a large health care system for recruitment into large-scale observational and interventional research in fibroid management. We developed and assessed the accuracy of 3 algorithms to identify patients with symptomatic fibroids using an iterative approach. The data source was the Carolina Data Warehouse for Health, a repository for the health system's electronic health record data. In addition to International Classification of Diseases, Ninth Revision diagnosis and procedure codes and clinical characteristics, text data-mining software was used to derive information from imaging reports to confirm the presence of uterine fibroids. Results of each algorithm were compared with expert manual review to calculate the positive predictive values for each algorithm. Algorithm 1 was composed of the following criteria: (1) age 18-54 years; (2) either ≥1 International Classification of Diseases, Ninth Revision diagnosis codes for uterine fibroids or mention of fibroids using text-mined key words in imaging records or documents; and (3) no International Classification of Diseases, Ninth Revision or Current Procedural Terminology codes for hysterectomy and no reported history of hysterectomy. The positive predictive value was 47% (95% confidence interval 39-56%). Algorithm 2 required ≥2 International Classification of Diseases, Ninth Revision diagnosis codes for fibroids and positive text-mined key words and had a positive predictive value of 65% (95% confidence interval 50-79%). In algorithm 3, further refinements included ≥2 International Classification of Diseases, Ninth Revision diagnosis codes for fibroids on separate outpatient visit dates, the exclusion of women who had a positive pregnancy test within 3 months of their fibroid-related visit, and exclusion of incidentally detected fibroids during prenatal or emergency department visits. Algorithm 3 achieved a positive predictive value of 76% (95% confidence interval 71-81%). An electronic health record-based algorithm is capable of identifying cases of symptomatic uterine fibroids with moderate positive predictive value and may be an efficient approach for large-scale study recruitment. Copyright © 2018 Elsevier Inc. All rights reserved.

What is generalized anxiety disorder?

PubMed

Rickels, K; Rynn, M A

2001-01-01

Generalized, persistent, and free-floating anxiety was first described by Freud in 1894, although the diagnostic term generalized anxiety disorder (GAD) was not included in classification systems until 1980 (Diagnostic and Statistical Manual for Mental Disorders, Third Edition [DSM-III]). Initially considered a residual category to be used when no other diagnosis could be made, it is now widely accepted that GAD represents a distinct diagnostic category. Since 1980, revisions to the diagnostic criteria for GAD in the DSM-III-R and DSM-IV classifications have markedly redefined this disorder, increasing the duration criterion to 6 months and increasing the emphasis on worry and psychic symptoms. This article reviews the development of the diagnostic criteria for defining GAD from Freud to DSM-IV and compares the DSM-IV criteria with the criteria set forth in the tenth revision of the International Classification of Diseases. The impact of the changes in diagnostic criteria on research into GAD, and on diagnosis, differential diagnosis, and treatment of GAD, will be discussed.

76 FR 60388 - Revision of Cotton Futures Classification Procedures

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-29

...-005] RIN 0581-AD16 Revision of Cotton Futures Classification Procedures AGENCY: Agricultural Marketing... update the procedures for cotton futures quality classification services by using Smith-Doxey classification data in the cotton futures classification process. In addition, references to a separate and...

77 FR 5379 - Revision of Cotton Futures Classification Procedures

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-03

... 0581-AD16 Revision of Cotton Futures Classification Procedures AGENCY: Agricultural Marketing Service... for cotton futures quality classification services by using Smith-Doxey classification data in the cotton futures classification process. In addition, references to a separate and optional review of...

Proposed declassification of disease categories related to sexual orientation in the International Statistical Classification of Diseases and Related Health Problems (ICD-11).

PubMed

Cochran, Susan D; Drescher, Jack; Kismödi, Eszter; Giami, Alain; García-Moreno, Claudia; Atalla, Elham; Marais, Adele; Vieira, Elisabeth Meloni; Reed, Geoffrey M

2014-09-01

The World Health Organization is developing the 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11), planned for publication in 2017. The Working Group on the Classification of Sexual Disorders and Sexual Health was charged with reviewing and making recommendations on disease categories related to sexuality in the chapter on mental and behavioural disorders in the 10th revision (ICD-10), published in 1990. This chapter includes categories for diagnoses based primarily on sexual orientation even though ICD-10 states that sexual orientation alone is not a disorder. This article reviews the scientific evidence and clinical rationale for continuing to include these categories in the ICD. A review of the evidence published since 1990 found little scientific interest in these categories. In addition, the Working Group found no evidence that they are clinically useful: they neither contribute to health service delivery or treatment selection nor provide essential information for public health surveillance. Moreover, use of these categories may create unnecessary harm by delaying accurate diagnosis and treatment. The Working Group recommends that these categories be deleted entirely from ICD-11. Health concerns related to sexual orientation can be better addressed using other ICD categories.

Proposed declassification of disease categories related to sexual orientation in the International Statistical Classification of Diseases and Related Health Problems (ICD-11)

PubMed Central

Drescher, Jack; Kismödi, Eszter; Giami, Alain; García-Moreno, Claudia; Atalla, Elham; Marais, Adele; Vieira, Elisabeth Meloni; Reed, Geoffrey M

2014-01-01

Abstract The World Health Organization is developing the 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11), planned for publication in 2017. The Working Group on the Classification of Sexual Disorders and Sexual Health was charged with reviewing and making recommendations on disease categories related to sexuality in the chapter on mental and behavioural disorders in the 10th revision (ICD-10), published in 1990. This chapter includes categories for diagnoses based primarily on sexual orientation even though ICD-10 states that sexual orientation alone is not a disorder. This article reviews the scientific evidence and clinical rationale for continuing to include these categories in the ICD. A review of the evidence published since 1990 found little scientific interest in these categories. In addition, the Working Group found no evidence that they are clinically useful: they neither contribute to health service delivery or treatment selection nor provide essential information for public health surveillance. Moreover, use of these categories may create unnecessary harm by delaying accurate diagnosis and treatment. The Working Group recommends that these categories be deleted entirely from ICD-11. Health concerns related to sexual orientation can be better addressed using other ICD categories. PMID:25378758

Annotation and Classification of Argumentative Writing Revisions

ERIC Educational Resources Information Center

Zhang, Fan; Litman, Diane

2015-01-01

This paper explores the annotation and classification of students' revision behaviors in argumentative writing. A sentence-level revision schema is proposed to capture why and how students make revisions. Based on the proposed schema, a small corpus of student essays and revisions was annotated. Studies show that manual annotation is reliable with…

[Changes of 2015 WHO Histological Classification of Lung Cancer 
and the Clinical Significance].

PubMed

Yang, Xin; Lin, Dongmei

2016-06-20

Due in part to remarkable advances over the past decade in our understanding of lung cancer, particularly in area of medical oncology, molecular biology, and radiology, there is a pressing need for a revised classification, based not on pathology alone, but rather on an integrated multidisciplinary approach to classification of lung cancer. The 2015 World Health Organization (WHO) Classification of Tumors of the Lung, Pleura, Thymus and Heart has just been published with numerous important changes from the 2004 WHO classification. The revised classification has been greatly improved in helping advance the field, increasing the impact of research, improving patient care and assisting in predicting outcome. The most significant changes will be summarized in this paper as follows: (1) main changes of lung adenocarcinoma as proposed by the 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) classification, (2) reclassifying squamous cell carcinomas into keratinizing, nonkeratinizing, and basaloid subtypes with the nonkeratinizing tumors requiring immunohistochemistry proof of squamous differentiation, (3) restricting the diagnosis of large cell carcinoma only to resected tumors that lack any clear morphologic or immunohistochemical differentiation with reclassification of the remaining former large cell carcinoma subtypes into different categories, (4) grouping of neuroendocrine tumors together in one category, (5) and the current viewpoint of histologic grading of lung cancer.

The ICD diagnoses of fetishism and sadomasochism.

PubMed

Reiersøl, Odd; Skeid, Svein

2006-01-01

In this article we discuss psychiatric diagnoses of sexual deviation as they appear in the International Classification of Diseases (ICD-10), the internationally accepted classification and diagnostic system of the World Health Organization (WHO). Namely, we discuss the background of three diagnostic categories: Fetishism (F65.0), Fetishistic Transvestism (F65.1), and Sadomasochism (F65.5). Pertinent background issues regarding the above categories are followed by a critique of the usefulness of diagnosing these phenomena today. Specifically, we argue that Fetishism, Fetishistic Transvestism, and Sadomasochism, also labeled Paraphilia or perversion, should not be considered illnesses. Finally, we present the efforts of an initiative known as ReviseF65, which was established in 1997, to abolish these diagnoses.

Knee Pain and Mobility Impairments: Meniscal and Articular Cartilage Lesions Revision 2018.

PubMed

Logerstedt, David S; Scalzitti, David A; Bennell, Kim L; Hinman, Rana S; Silvers-Granelli, Holly; Ebert, Jay; Hambly, Karen; Carey, James L; Snyder-Mackler, Lynn; Axe, Michael J; McDonough, Christine M

2018-02-01

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to meniscus and articular cartilage lesions. J Orthop Sports Phys Ther. 2018;48(2):A1-A50. doi:10.2519/jospt.2018.0301.

Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2018.

PubMed

Martin, Robroy L; Chimenti, Ruth; Cuddeford, Tyler; Houck, Jeff; Matheson, J W; McDonough, Christine M; Paulseth, Stephen; Wukich, Dane K; Carcia, Christopher R

2018-05-01

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to midportion Achilles tendinopathy. J Orthop Sports Phys Ther 2018;48(5):A1-A38. doi:10.2519/jospt.2018.0302.

Radiographic Prevalence of Femoroacetabular Impingement in a Young Population with Hip Complaints Is High

DTIC Science & Technology

2010-01-27

Sciatica 724.3 Abnormality of gait 781.2 ICD-9 = International Classification of Diseases, 9th Revision; NOS = not otherwise specified. Volume 468, Number...the patients were not considered in our analysis, specifically diagnoses such as sacroiliitis or sciatica , in which clinical symptoms may not be

The New Solar System

ERIC Educational Resources Information Center

Wilkinson, John

2009-01-01

Since 2006, the details of bodies making up our solar system have been revised. This was largely as a result of new discoveries of a number of planet-like objects beyond the orbit of Pluto. The International Astronomical Union redefined what constituted a planet and established two new classifications--dwarf planets and plutoids. As a result, the…

Identification of ICD Codes Suggestive of Child Maltreatment

ERIC Educational Resources Information Center

Schnitzer, Patricia G.; Slusher, Paula L.; Kruse, Robin L.; Tarleton, Molly M.

2011-01-01

Objective: In order to be reimbursed for the care they provide, hospitals in the United States are required to use a standard system to code all discharge diagnoses: the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9). Although ICD-9 codes specific for child maltreatment exist, they do not identify all…

Three Diagnostic Systems for Autism: DSM-III, DSM-III-R, and ICD-10.

ERIC Educational Resources Information Center

Volkmar, Fred R.; And Others

1992-01-01

This paper compared clinicians' diagnosis and DSM-III (Diagnostic and Statistical Manual), DSM-III-R (Revised), and ICD-10 (International Classification of Diseases) diagnoses of 52 individuals with autism and 62 nonautistic, developmentally disordered individuals. The DSM-III-R system overdiagnosed the presence of autism, and ICD-10 closely…

77 FR 54663 - Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-05

...This final rule adopts the standard for a national unique health plan identifier (HPID) and establishes requirements for the implementation of the HPID. In addition, it adopts a data element that will serve as an other entity identifier (OEID), or an identifier for entities that are not health plans, health care providers, or individuals, but that need to be identified in standard transactions. This final rule also specifies the circumstances under which an organization covered health care provider must require certain noncovered individual health care providers who are prescribers to obtain and disclose a National Provider Identifier (NPI). Lastly, this final rule changes the compliance date for the International Classification of Diseases, 10th Revision, Clinical Modification (ICD- 10-CM) for diagnosis coding, including the Official ICD-10-CM Guidelines for Coding and Reporting, and the International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) for inpatient hospital procedure coding, including the Official ICD-10-PCS Guidelines for Coding and Reporting, from October 1, 2013 to October 1, 2014.

Steps through the revision process of reproductive health sections of ICD-11.

PubMed

Chou, Doris; Tunçalp, Özge; Hotamisligil, Selen; Norman, Jane; Say, Lale; Volkmer, Björn; Pattinson, Bob; Rooney, Cleo; Serour, Gamal; de Mouzon, Jacques; Gardosi, Jason; Thueroff, Joachim; Mark, Morgan; D'Hooghe, Thomas

2012-01-01

In 2007, the WHO initiated an organizational structure for the 11th revision of the International Classification of Diseases (ICD). Effective deployment of ICD-derived tools facilitates the use and collection of health information in a variety of resource settings, promoting quantitatively informed decisions. They also facilitate comparison of disease incidence and outcomes between different countries and different health care systems around the world. The Department of Reproductive Health and Research (RHR) coordinates the revision of chapters 14 (diseases of the genitourinary system), 15 (pregnancy, childbirth, and puerperium), and 16 (conditions originating in the perinatal period). RHR convened a technical advisory group (TAG), the Genito-Urinary Reproductive Medicine (GURM) TAG, for the ICD revision. The TAG's work reflects the collective understanding of sexual and reproductive health and is now available for review within the ICD-11 revision process. Copyright © 2012 S. Karger AG, Basel.

42 CFR 412.517 - Revision of LTC-DRG group classifications and weighting factors.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Revision of LTC-DRG group classifications and... classifications and weighting factors. (a) CMS adjusts the classifications and weighting factors annually to... the LTC-DRG classifications and recalibration of the weighting factors described in paragraph (a) of...

42 CFR 412.517 - Revision of LTC-DRG group classifications and weighting factors.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Revision of LTC-DRG group classifications and... classifications and weighting factors. (a) CMS adjusts the classifications and weighting factors annually to... the LTC-DRG classifications and recalibration of the weighting factors described in paragraph (a) of...

Between DSM and ICD: Paraphilias and the Transformation of Sexual Norms.

PubMed

Giami, Alain

2015-07-01

The simultaneous revision of the two major international classifications of disease, the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases, serves as an opportunity to observe the dynamic processes through which social norms of sexuality are constructed and are subject to change in relation to social, political, and historical context. This article argues that the classifications of sexual disorders, which define pathological aspects of "sexually arousing fantasies, sexual urges or behaviors" are representations of contemporary sexual norms, gender identifications, and gender relations. It aims to demonstrate how changes in the medical treatment of sexual perversions/paraphilias passed, over the course of the 20th century, from a model of pathologization (and sometimes criminalization) of non-reproductive sexual behaviors to a model that reflects and privileges sexual well-being and responsibility, and pathologizes the absence or the limitation of consent in sexual relations.

Predictive Validity of ICD-11 PTSD as Measured by the Impact of Event Scale-Revised: A 15-Year Prospective Study of Political Prisoners.

PubMed

Hyland, Philip; Brewin, Chris R; Maercker, Andreas

2017-04-01

The 11 th edition of the International Classification of Diseases (ICD-11; World Health Organization, 2017) proposes a model of posttraumatic stress disorder (PTSD) that includes 6 symptoms. This study assessed the ability of a classification-independent measure of posttraumatic stress symptoms, the Impact of Event Scale-Revised (Weiss & Marmar, 1996), to capture the ICD-11 model of PTSD. The current study also provided the first assessment of the predictive validity of ICD-11 PTSD. Former East German political prisoners were assessed in 1994 (N = 144) and in 2008-2009 (N = 88) on numerous psychological variables using self-report measures. Of the participants, 48.2% and 36.8% met probable diagnosis for ICD-11 PTSD at the first and second assessments, respectively. Confirmatory factor analysis supported the factorial validity of the 3-factor ICD-11 model of PTSD, as represented by items selected from the Impact of Event Scale-Revised. Hierarchical multiple regression analysis demonstrated that, controlling for sex, the symptom clusters of ICD-11 PTSD (reexperiencing, avoidance, and sense of threat) significantly contributed to the explanation of depression (R 2 = .17), quality of life (R 2 = .21), internalized anger (R 2 = .10), externalized anger (R 2 = .12), hatred of perpetrators (R 2 = .15), dysfunctional disclosure (R 2 = .27), and social acknowledgment as a victim (R 2 = .12) across the 15-year study period. Current findings add support for the factorial and predictive validity of ICD-11 PTSD within a unique cohort of political prisoners. Copyright © 2017 International Society for Traumatic Stress Studies.

Evaluation of surveillance methods for staphylococcal toxic shock syndrome.

PubMed

Lesher, Lindsey; Devries, Aaron; Danila, Richard; Lynfield, Ruth

2009-05-01

We compared passive surveillance and International Classification of Diseases, 9th Revision, codes for completeness of staphylococcal toxic shock syndrome (TSS) surveillance in the Minneapolis-St. Paul area, Minnesota, USA. TSS-specific codes identified 55% of cases compared with 30% by passive surveillance and were more sensitive (p = 0.0005, McNemar chi2 12.25).

Evaluation of Surveillance Methods for Staphylococcal Toxic Shock Syndrome

PubMed Central

DeVries, Aaron; Danila, Richard; Lynfield, Ruth

2009-01-01

We compared passive surveillance and International Classification of Diseases, 9th Revision, codes for completeness of staphylococcal toxic shock syndrome (TSS) surveillance in the Minneapolis–St. Paul area, Minnesota, USA. TSS-specific codes identified 55% of cases compared with 30% by passive surveillance and were more sensitive (p = 0.0005, McNemar χ2 12.25). PMID:19402965

Validation of the international labour office digitized standard images for recognition and classification of radiographs of pneumoconiosis.

PubMed

Halldin, Cara N; Petsonk, Edward L; Laney, A Scott

2014-03-01

Chest radiographs are recommended for prevention and detection of pneumoconiosis. In 2011, the International Labour Office (ILO) released a revision of the International Classification of Radiographs of Pneumoconioses that included a digitized standard images set. The present study compared results of classifications of digital chest images performed using the new ILO 2011 digitized standard images to classification approaches used in the past. Underground coal miners (N = 172) were examined using both digital and film-screen radiography (FSR) on the same day. Seven National Institute for Occupational Safety and Health-certified B Readers independently classified all 172 digital radiographs, once using the ILO 2011 digitized standard images (DRILO2011-D) and once using digitized standard images used in the previous research (DRRES). The same seven B Readers classified all the miners' chest films using the ILO film-based standards. Agreement between classifications of FSR and digital radiography was identical, using a standard image set (either DRILO2011-D or DRRES). The overall weighted κ value was 0.58. Some specific differences in the results were seen and noted. However, intrareader variability in this study was similar to the published values and did not appear to be affected by the use of the new ILO 2011 digitized standard images. These findings validate the use of the ILO digitized standard images for classification of small pneumoconiotic opacities. When digital chest radiographs are obtained and displayed appropriately, results of pneumoconiosis classifications using the 2011 ILO digitized standards are comparable to film-based ILO classifications and to classifications using earlier research standards. Published by Elsevier Inc.

A novel method to guide classification of para swimmers with limb deficiency.

PubMed

Hogarth, Luke; Payton, Carl; Van de Vliet, Peter; Connick, Mark; Burkett, Brendan

2018-05-30

The International Paralympic Committee has directed International Federations that govern Para sports to develop evidence-based classification systems. This study defined the impact of limb deficiency impairment on 100 m freestyle performance to guide an evidence-based classification system in Para Swimming, which will be implemented following the 2020 Tokyo Paralympic games. Impairment data and competitive race performances of 90 international swimmers with limb deficiency were collected. Ensemble partial least squares regression established the relationship between relative limb length measures and competitive 100 m freestyle performance. The model explained 80% of the variance in 100 m freestyle performance, and found hand length and forearm length to be the most important predictors of performance. Based on the results of this model, Para swimmers were clustered into four-, five-, six- and seven-class structures using nonparametric kernel density estimations. The validity of these classification structures, and effectiveness against the current classification system, were examined by establishing within-class variations in 100 m freestyle performance and differences between adjacent classes. The derived classification structures were found to be more effective than current classification based on these criteria. This study provides a novel method that can be used to improve the objectivity and transparency of decision-making in Para sport classification. Expert consensus from experienced coaches, Para swimmers, classifiers and sport science and medicine personnel will benefit the translation of these findings into a revised classification system that is accepted by the Para swimming community. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Classification of Instructional Programs - 2000. Public Comment Draft. [Third Revision].

ERIC Educational Resources Information Center

Morgan, Robert L.; Hunt, E. Stephen

This third revision of the Classification of Instructional Programs (CIP) updates and modifies education program classifications, descriptions, and titles at the secondary, postsecondary, and adult education levels. This edition has also been adopted by Canada as its standard for major field of study classification. The volume includes the…

Eating disorders.

PubMed

Erzegovesi, Stefano; Bellodi, Laura

2016-08-01

Twenty years have passed from the International Classification of Diseases, Tenth Revision (ICD-10) to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and, in the meanwhile, a lot of research data about eating disorders has been published. This article reviews the main modifications to the classification of eating disorders reported in the "Feeding and Eating Disorders" chapter of the DSM-5, and compares them with the ICD-10 diagnostic guidelines. Particularly, we will show that DSM-5 criteria widened the diagnoses of anorexia and bulimia nervosa to less severe forms (so decreasing the frequency of Eating Disorders, Not Otherwise Specified (EDNOS) diagnoses), introduced the new category of Binge Eating Disorder, and incorporated several feeding disorders that were first diagnosed in infancy, childhood, or adolescence. On the whole, the DSM-5 revision should allow the clinician to make more reliable and timely diagnoses for eating disorders.

Clinician's Primer to ICD-10-CM Coding for Cleft Lip/Palate Care.

PubMed

Allori, Alexander C; Cragan, Janet D; Della Porta, Gina C; Mulliken, John B; Meara, John G; Bruun, Richard; Shusterman, Stephen; Cassell, Cynthia H; Raynor, Eileen; Santiago, Pedro; Marcus, Jeffrey R

2017-01-01

On October 1, 2015, the United States required use of the Clinical Modification of the International Classification of Diseases, 10th Revision (ICD-10-CM) for diagnostic coding. This primer was written to assist the cleft care community with understanding and use of ICD-10-CM for diagnostic coding related to cleft lip and/or palate (CL/P).

Concurrent Validity and Classification Accuracy of the Leiter and Leiter-R in Low Functioning Children with Autism.

ERIC Educational Resources Information Center

Tsatsanis, Katherine D.; Dartnall, Nancy; Cicchetti, Domenic; Sparrow, Sara S.; Klin, Ami; Volkmar, Fred R.

2003-01-01

The concurrent validity of the original and revised versions of the Leiter International Performance Scale was examined with 26 children (ages 4-16) with autism. Although the correlation between the two tests was high (.87), there were significant intra-individual discrepancies present in 10 cases, two of which were both large and clinically…

Utilizing Health Records to Characterize Obesity, Comorbidities, and Health-Care Services in One Human Service Agency in the United States

ERIC Educational Resources Information Center

Fisher, Kathleen; Hardie, Thomas L.; Ranjan, Sobhana; Peterson, Justin

2017-01-01

US surveys report higher prevalence of obesity in adults with intellectual disability. Health records of 40 adults with intellectual disability were retrospectively reviewed for data on health status, problem lists with International Classification of Diseases, Ninth Revision codes, medication lists, and health encounters over 18 months. Mean age…

Rates, amounts, and determinants of ambulatory blood pressure monitoring claim reimbursements among Medicare beneficiaries.

PubMed

Kent, Shia T; Shimbo, Daichi; Huang, Lei; Diaz, Keith M; Viera, Anthony J; Kilgore, Meredith; Oparil, Suzanne; Muntner, Paul

2014-12-01

Ambulatory blood pressure monitoring (ABPM) can be used to identify white coat hypertension and guide hypertensive treatment. We determined the percentage of ABPM claims submitted between 2007 and 2010 that were reimbursed. Among 1970 Medicare beneficiaries with submitted claims, ABPM was reimbursed for 93.8% of claims that had an International Classification of Diseases, Ninth Revision, diagnosis code of 796.2 ("elevated blood pressure reading without diagnosis of hypertension") versus 28.5% of claims without this code. Among claims without an International Classification of Diseases, Ninth Revision, diagnosis code of 796.2 listed, those for the component (eg, recording, scanning analysis, physician review, reporting) versus full ABPM procedures and performed by institutional versus non-institutional providers were each more than two times as likely to be successfully reimbursed. Of the claims reimbursed, the median payment was $52.01 (25th-75th percentiles, $32.95-$64.98). In conclusion, educating providers on the ABPM claims reimbursement process and evaluation of Medicare reimbursement may increase the appropriate use of ABPM and improve patient care. Copyright © 2014 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.

Usefulness and applicability of the revised dengue case classification by disease: multi-centre study in 18 countries

PubMed Central

2011-01-01

Background In view of the long term discussion on the appropriateness of the dengue classification into dengue fever (DF), dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS), the World Health Organization (WHO) has outlined in its new global dengue guidelines a revised classification into levels of severity: dengue fever with an intermediary group of "dengue fever with warning sings", and severe dengue. The objective of this paper was to compare the two classification systems regarding applicability in clinical practice and surveillance, as well as user-friendliness and acceptance by health staff. Methods A mix of quantitative (prospective and retrospective review of medical charts by expert reviewers, formal staff interviews), semi-quantitative (open questions in staff interviews) and qualitative methods (focus group discussions) were used in 18 countries. Quality control of data collected was undertaken by external monitors. Results The applicability of the DF/DHF/DSS classification was limited, even when strict DHF criteria were not applied (13.7% of dengue cases could not be classified using the DF/DHF/DSS classification by experienced reviewers, compared to only 1.6% with the revised classification). The fact that some severe dengue cases could not be classified in the DF/DHF/DSS system was of particular concern. Both acceptance and perceived user-friendliness of the revised system were high, particularly in relation to triage and case management. The applicability of the revised classification to retrospective data sets (of importance for dengue surveillance) was also favourable. However, the need for training, dissemination and further research on the warning signs was highlighted. Conclusions The revised dengue classification has a high potential for facilitating dengue case management and surveillance. PMID:21510901

Code Conversion Impact Factor and Cash Flow Impact of International Classification of Diseases, 10th Revision, on a Large Multihospital Radiology Practice.

PubMed

Jalilvand, Aryan; Fleming, Margaret; Moreno, Courtney; MacFarlane, Dan; Duszak, Richard

2018-01-01

The 2015 conversion of the International Classification of Diseases (ICD) system from the ninth revision (ICD-9) to the 10th revision (ICD-10) was widely projected to adversely impact physician practices. We aimed to assess code conversion impact factor (CCIF) projections and revenue delay impact to help radiology groups better prepare for eventual conversion to ICD, 11th revision (ICD-11). Studying 673,600 claims for 179 radiologists for the first year after ICD-10's implementation, we identified primary ICD-10 codes for the top 90th percentile of all examinations for the entire enterprise and each subspecialty division. Using established methodology, we calculated CCIFs (actual ICD-10 codes ÷ prior ICD-9 codes). To assess ICD-10's impact on cash flow, average monthly days in accounts receivable status was compared for the 12 months before and after conversion. Of all 69,823 ICD-10 codes, only 7,075 were used to report primary diagnoses across the entire practice, and just 562 were used to report 90% of all claims, compared with 348 under ICD-9. This translates to an overall CCIF of 1.6 for the department (far less than the literature-predicted 6). By subspecialty division, CCIFs ranged from 0.7 (breast) to 3.5 (musculoskeletal). Monthly average days in accounts receivable for the 12 months before and after ICD-10 conversion did not increase. The operational impact of the ICD-10 transition on radiology practices appears far less than anticipated with respect to both CCIF and delays in cash flow. Predictive models should be refined to help practices better prepare for ICD-11. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Conversion of ICD-9 (International Classification of Diseases, Ninth Revision) and ICPM (International Classification of Procedures in Medicine) Data to ICD-9-CM with Adaptation to DRGs. Part B.

DTIC Science & Technology

1987-08-31

PLEURISY AGE >69 AND/OR C. C. 1.1029 8.5 29 090 004 M SIMPLE PNEUMONIA + PLEURISY AGE 18-69 W/O C. C. 0.9849 7.6 28 091 004 M SIMPLE PNEUMONIA... PLEURISY AGE 0-17 0.5131 4.6 14 092 004 M INTERSTITIAL LUNG DISEASE AGE >69 AND/OR C. C. 1.0370 7.8 28 093 004 M INTERSTITIAL LUNG DISEASE AGE ា W/O C. C... PLEURISY AGE >69 AND/OR C. C. 224 684 668 675 673 679 -3 M SIMPLE PNEUMONIA + PLEURISY AGE 18-69 W/O C. C. 4370 3861 3877 3880 3889 3890 ;1 1:4 v SIMPLE

Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005-2009.

PubMed

Berg, Anne T; Berkovic, Samuel F; Brodie, Martin J; Buchhalter, Jeffrey; Cross, J Helen; van Emde Boas, Walter; Engel, Jerome; French, Jacqueline; Glauser, Tracy A; Mathern, Gary W; Moshé, Solomon L; Nordli, Douglas; Plouin, Perrine; Scheffer, Ingrid E

2010-04-01

The International League Against Epilepsy (ILAE) Commission on Classification and Terminology has revised concepts, terminology, and approaches for classifying seizures and forms of epilepsy. Generalized and focal are redefined for seizures as occurring in and rapidly engaging bilaterally distributed networks (generalized) and within networks limited to one hemisphere and either discretely localized or more widely distributed (focal). Classification of generalized seizures is simplified. No natural classification for focal seizures exists; focal seizures should be described according to their manifestations (e.g., dyscognitive, focal motor). The concepts of generalized and focal do not apply to electroclinical syndromes. Genetic, structural-metabolic, and unknown represent modified concepts to replace idiopathic, symptomatic, and cryptogenic. Not all epilepsies are recognized as electroclinical syndromes. Organization of forms of epilepsy is first by specificity: electroclinical syndromes, nonsyndromic epilepsies with structural-metabolic causes, and epilepsies of unknown cause. Further organization within these divisions can be accomplished in a flexible manner depending on purpose. Natural classes (e.g., specific underlying cause, age at onset, associated seizure type), or pragmatic groupings (e.g., epileptic encephalopathies, self-limited electroclinical syndromes) may serve as the basis for organizing knowledge about recognized forms of epilepsy and facilitate identification of new forms.

A language of health in action: Read Codes, classifications and groupings.

PubMed Central

Stuart-Buttle, C. D.; Read, J. D.; Sanderson, H. F.; Sutton, Y. M.

1996-01-01

A cornerstone of the Information Management and Technology Strategy of the National Health Service's (NHS) Executive is fully operational, person-based clinical information systems, from which flow all of the data needed for direct and indirect care of patients by healthcare providers, and local and national management of the NHS. The currency of these data flows are firstly Read-coded clinical terms, secondly the classifications, the International, Classification of Disease and Health Related Problems, 10th Revision (ICD-10) and The Office of Population Censuses and Surveys Classification of Surgical Operations and Procedures, 4th Revision (OPCS-4), and thirdly Healthcare Resource Groups and Health Benefit Groups, all of which together are called the "language of health", an essential element of the electronic clinical record. This paper briefly describes the three main constituents of the language, and how, together with person-based, fully operational clinical information systems, it enables more effective and efficient healthcare delivery. It also describes how the remaining projects of the IM&T Strategy complete the key components necessary to provide the systems that will enable the flow of person-based data, collected once at the point of care and shared amongst all legitimate users via the electronic patient record. PMID:8947631

Australian diagnosis related groups: Drivers of complexity adjustment.

PubMed

Jackson, Terri; Dimitropoulos, Vera; Madden, Richard; Gillett, Steve

2015-11-01

In undertaking a major revision to the Australian Refined Diagnosis Related Group (ARDRG) classification, we set out to contrast Australia's approach to using data on additional (not principal) diagnoses with major international approaches in splitting base or Adjacent Diagnosis Related Groups (ADRGs). Comparative policy analysis/narrative review of peer-reviewed and grey literature on international approaches to use of additional (secondary) diagnoses in the development of Australian and international DRG systems. European and US approaches to characterise complexity of inpatient care are well-documented, providing useful points of comparison with Australia's. Australia, with good data sources, has continued to refine its national DRG classification using increasingly sophisticated approaches. Hospital funders in Australia and in other systems are often under pressure from provider groups to expand classifications to reflect clinical complexity. DRG development in most healthcare systems reviewed here reflects four critical factors: these socio-political factors, the quality and depth of the coded data available to characterise the mix of cases in a healthcare system, the size of the underlying population, and the intended scope and use of the classification. Australia's relatively small national population has constrained the size of its DRG classifications, and development has been concentrated on inpatient care in public hospitals. Development of casemix classifications in health care is driven by both technical and socio-political factors. Use of additional diagnoses to adjust for patient complexity and cost needs to respond to these in each casemix application. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Use and applicability of the vegetation component of the national site classification system. [Sumter National Forest, South Carolina

NASA Technical Reports Server (NTRS)

Clark, C. A. (Principal Investigator)

1981-01-01

Existing vegetation on a site in Sumter National Forest, South Carolina was classified using high altitude aerial optical bar color infrared photography in an effort to determine if the National Site Classification (NSC) system could be used in the heterogeneously forested southeastern United States where it had not previously been used. Results show that the revised UNESCO international classification and mapping of vegetation system, as incorporated into the NSCS, is general enough at the higher levels and specific enough at the lower levels to adequately accommodate densely forested, heterogeneous areas as well as the larger, more homogeneous regions of the Pacific Northwest. The major problem is of existing vegetation versus natural vegetation.

Discovering Beaten Paths in Collaborative Ontology-Engineering Projects using Markov Chains

PubMed Central

Walk, Simon; Singer, Philipp; Strohmaier, Markus; Tudorache, Tania; Musen, Mark A.; Noy, Natalya F.

2014-01-01

Biomedical taxonomies, thesauri and ontologies in the form of the International Classification of Diseases as a taxonomy or the National Cancer Institute Thesaurus as an OWL-based ontology, play a critical role in acquiring, representing and processing information about human health. With increasing adoption and relevance, biomedical ontologies have also significantly increased in size. For example, the 11th revision of the International Classification of Diseases, which is currently under active development by the World Health Organization contains nearly 50, 000 classes representing a vast variety of different diseases and causes of death. This evolution in terms of size was accompanied by an evolution in the way ontologies are engineered. Because no single individual has the expertise to develop such large-scale ontologies, ontology-engineering projects have evolved from small-scale efforts involving just a few domain experts to large-scale projects that require effective collaboration between dozens or even hundreds of experts, practitioners and other stakeholders. Understanding the way these different stakeholders collaborate will enable us to improve editing environments that support such collaborations. In this paper, we uncover how large ontology-engineering projects, such as the International Classification of Diseases in its 11th revision, unfold by analyzing usage logs of five different biomedical ontology-engineering projects of varying sizes and scopes using Markov chains. We discover intriguing interaction patterns (e.g., which properties users frequently change after specific given ones) that suggest that large collaborative ontology-engineering projects are governed by a few general principles that determine and drive development. From our analysis, we identify commonalities and differences between different projects that have implications for project managers, ontology editors, developers and contributors working on collaborative ontology-engineering projects and tools in the biomedical domain. PMID:24953242

Discovering beaten paths in collaborative ontology-engineering projects using Markov chains.

PubMed

Walk, Simon; Singer, Philipp; Strohmaier, Markus; Tudorache, Tania; Musen, Mark A; Noy, Natalya F

2014-10-01

Biomedical taxonomies, thesauri and ontologies in the form of the International Classification of Diseases as a taxonomy or the National Cancer Institute Thesaurus as an OWL-based ontology, play a critical role in acquiring, representing and processing information about human health. With increasing adoption and relevance, biomedical ontologies have also significantly increased in size. For example, the 11th revision of the International Classification of Diseases, which is currently under active development by the World Health Organization contains nearly 50,000 classes representing a vast variety of different diseases and causes of death. This evolution in terms of size was accompanied by an evolution in the way ontologies are engineered. Because no single individual has the expertise to develop such large-scale ontologies, ontology-engineering projects have evolved from small-scale efforts involving just a few domain experts to large-scale projects that require effective collaboration between dozens or even hundreds of experts, practitioners and other stakeholders. Understanding the way these different stakeholders collaborate will enable us to improve editing environments that support such collaborations. In this paper, we uncover how large ontology-engineering projects, such as the International Classification of Diseases in its 11th revision, unfold by analyzing usage logs of five different biomedical ontology-engineering projects of varying sizes and scopes using Markov chains. We discover intriguing interaction patterns (e.g., which properties users frequently change after specific given ones) that suggest that large collaborative ontology-engineering projects are governed by a few general principles that determine and drive development. From our analysis, we identify commonalities and differences between different projects that have implications for project managers, ontology editors, developers and contributors working on collaborative ontology-engineering projects and tools in the biomedical domain. Copyright © 2014 Elsevier Inc. All rights reserved.

A Comprehensive Approach to Convert a Radiology Department From Coding Based on International Classification of Diseases, Ninth Revision, to Coding Based on International Classification of Diseases, Tenth Revision.

PubMed

McBee, Morgan P; Laor, Tal; Pryor, Rebecca M; Smith, Rachel; Hardin, Judy; Ulland, Lisa; May, Sally; Zhang, Bin; Towbin, Alexander J

2018-02-01

The purpose of this study was to adapt our radiology reports to provide the documentation required for specific International Classification of Diseases, tenth rev (ICD-10) diagnosis coding. Baseline data were analyzed to identify the reports with the greatest number of unspecified ICD-10 codes assigned by computer-assisted coding software. A two-part quality improvement initiative was subsequently implemented. The first component involved improving clinical histories by utilizing technologists to obtain information directly from the patients or caregivers, which was then imported into the radiologist's report within the speech recognition software. The second component involved standardization of report terminology and creation of four different structured report templates to determine which yielded the fewest reports with an unspecified ICD-10 code assigned by an automated coding engine. In all, 12,077 reports were included in the baseline analysis. Of these, 5,151 (43%) had an unspecified ICD-10 code. The majority of deficient reports were for radiographs (n = 3,197; 62%). Inadequacies included insufficient clinical history provided and lack of detailed fracture descriptions. Therefore, the focus was standardizing terminology and testing different structured reports for radiographs obtained for fractures. At baseline, 58% of radiography reports contained a complete clinical history with improvement to >95% 8 months later. The total number of reports that contained an unspecified ICD-10 code improved from 43% at baseline to 27% at completion of this study (P < .0001). The number of radiology studies with a specific ICD-10 code can be improved through quality improvement methodology, specifically through the use of technologist-acquired clinical histories and structured reporting. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

77 FR 20503 - Revision of Cotton Classification Procedures for Determining Cotton Leaf Grade

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-05

...-AD19 Revision of Cotton Classification Procedures for Determining Cotton Leaf Grade AGENCY... amending the procedures for determining the official leaf grade for Upland and Pima cotton. The leaf grade is a part of the official classification which denotes cotton fiber quality used in cotton marketing...

Revision of the ICIDH: mental health aspects. WHO/MNH Disability Working Group.

PubMed

Ustün, T B; Cooper, J E; van Duuren-Kristen, S; Kennedy, C; Hendershot, G; Sartorius, N

1995-01-01

This article reviews the key issues arising in the revision of the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) from a mental health perspective, and describes the work of the Disability Working Group of the WHO's Division of Mental Health. The ICIDH, which describes the consequences of disorders at three levels as impairments, disabilities, and handicaps, is generally applicable and useful for mental health purposes. While some impairments are mainly a consequence of 'mental' disorders (e.g. cognitive impairment), there should be no differences between mental and physical disorders in the classification scheme, to avoid a dichotomy between mind and body. There is also a need to improve the ways in which interference with the performance of social roles is described, since this is often the most obvious consequence of mental disorders. This article presents the potentials of the ICIDH in the field of mental health, and gives recommendations for the development of the revision process of the ICIDH. To stimulate the process of producing a 'common language' in the ICIDH related to mental health issues, former and potential users of the ICIDH are invited to give comments and suggestions.

Developing a science of clinical utility in diagnostic classification systems field study strategies for ICD-11 mental and behavioral disorders.

PubMed

Keeley, Jared W; Reed, Geoffrey M; Roberts, Michael C; Evans, Spencer C; Medina-Mora, María Elena; Robles, Rebeca; Rebello, Tahilia; Sharan, Pratap; Gureje, Oye; First, Michael B; Andrews, Howard F; Ayuso-Mateos, José Luís; Gaebel, Wolfgang; Zielasek, Juergen; Saxena, Shekhar

2016-01-01

The World Health Organization (WHO) Department of Mental Health and Substance Abuse has developed a systematic program of field studies to evaluate and improve the clinical utility of the proposed diagnostic guidelines for mental and behavioral disorders in the Eleventh Revision of the International Classification of Diseases and Related Health Problems (ICD-11). The clinical utility of a diagnostic classification is critical to its function as the interface between health encounters and health information, and to making the ICD-11 be a more effective tool for helping the WHO's 194 member countries, including the United States, reduce the global disease burden of mental disorders. This article describes the WHO's efforts to develop a science of clinical utility in regard to one of the two major classification systems for mental disorders. We present the rationale and methodologies for an integrated and complementary set of field study strategies, including large international surveys, formative field studies of the structure of clinicians' conceptualization of mental disorders, case-controlled field studies using experimental methodologies to evaluate the impact of proposed changes to the diagnostic guidelines on clinicians' diagnostic decision making, and ecological implementation field studies of clinical utility in the global settings in which the guidelines will ultimately be implemented. The results of these studies have already been used in making decisions about the structure and content of ICD-11. If clinical utility is indeed among the highest aims of diagnostic systems for mental disorders, as their developers routinely claim, future revision efforts should continue to build on these efforts. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Who Must We Target Now to Minimize Future Cardiovascular Events and Total Mortality?: Lessons From the Surveillance, Prevention and Management of Diabetes Mellitus (SUPREME-DM) Cohort Study.

PubMed

Desai, Jay R; Vazquez-Benitez, Gabriela; Xu, Zhiyuan; Schroeder, Emily B; Karter, Andrew J; Steiner, John F; Nichols, Gregory A; Reynolds, Kristi; Xu, Stanley; Newton, Katherine; Pathak, Ram D; Waitzfelder, Beth; Lafata, Jennifer Elston; Butler, Melissa G; Kirchner, H Lester; Thomas, Abraham; O'Connor, Patrick J

2015-09-01

Examining trends in cardiovascular events and mortality in US health systems can guide the design of targeted clinical and public health strategies to reduce cardiovascular events and mortality rates. We conducted an observational cohort study from 2005 to 2011 among 1.25 million diabetic subjects and 1.25 million nondiabetic subjects from 11 health systems that participate in the Surveillance, Prevention and Management of Diabetes Mellitus (SUPREME-DM) DataLink. Annual rates (per 1000 person-years) of myocardial infarction/acute coronary syndrome (International Classification of Diseases-Ninth Revision, 410.0–410.91, 411.1–411.8), stroke (International Classification of Diseases-Ninth Revision, 430–432.9, 433–434.9), heart failure (International Classification of Diseases-Ninth Revision, 428–428.9), and all-cause mortality were monitored by diabetes mellitus (DM) status, age, sex, race/ethnicity, and a prior cardiovascular history. We observed significant declines in cardiovascular events and mortality rates in subjects with and without DM. However, there was substantial variation by age, sex, race/ethnicity, and prior cardiovascular history. Mortality declined from 44.7 to 27.1 (P<0.0001) for those with DM and cardiovascular disease (CVD), from 11.2 to 10.9 (P=0.03) for those with DM only, and from 18.9 to 13.0 (P<0.0001) for those with CVD only. Yet, in the [almost equal to]85% of subjects with neither DM nor CVD, overall mortality (7.0 to 6.8; P=0.10) and stroke rates (1.6–1.6; P=0.77) did not decline and heart failure rates increased (0.9–1.15; P=0.0005). To sustain improvements in myocardial infarction, stroke, heart failure, and mortality, health systems that have successfully focused on care improvement in high-risk adults with DM or CVD must broaden their improvement strategies to target lower risk adults who have not yet developed DM or CVD.

78 FR 34915 - Approval and Promulgation of Air Quality Implementation Plans; Virginia; Revision to the...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-11

... ENVIRONMENTAL PROTECTION AGENCY 40 CFR Part 52 [EPA-R03-OAR-2013-0289; FRL-9822-3] Approval and Promulgation of Air Quality Implementation Plans; Virginia; Revision to the Classification and Implementation... approving these revisions to include the classification of Northern Virginia as ``marginal'' for the 2008...

PubMed Central

FARRI, A.; ENRICO, A.; FARRI, F.

2012-01-01

SUMMARY In 1988, diagnostic criteria for headaches were drawn up by the International Headache Society (IHS) and is divided into headaches, cranial neuralgias and facial pain. The 2nd edition of the International Classification of Headache Disorders (ICHD) was produced in 2004, and still provides a dynamic and useful instrument for clinical practice. We have examined the current IHC, which comprises 14 groups. The first four cover primary headaches, with "benign paroxysmal vertigo of childhood" being the forms of migraine of interest to otolaryngologists; groups 5 to 12 classify "secondary headaches"; group 11 is formed of "headache or facial pain attributed to disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structures"; group 13, consisting of "cranial neuralgias and central causes of facial pain" is also of relevance to otolaryngology. Neither the current classification system nor the original one has a satisfactory collocation for migraineassociated vertigo. Another critical point of the classification concerns cranio-facial pain syndromes such as Sluder's neuralgia, previously included in the 1988 classification among cluster headaches, and now included in the section on "cranial neuralgias and central causes of facial pain", even though Sluder's neuralgia has not been adequately validated. As we have highlighted in our studies, there are considerable similarities between Sluder's syndrome and cluster headaches. The main features distinguishing the two are the trend to cluster over time, found only in cluster headaches, and the distribution of pain, with greater nasal manifestations in the case of Sluder's syndrome. We believe that it is better and clearer, particularly on the basis of our clinical experience and published studies, to include this nosological entity, which is clearly distinct from an otolaryngological point of view, as a variant of cluster headache. We agree with experts in the field of headaches, such as Olesen and Nappi who contributed to previous classifications, on the need for a revised classification, particularly with regards to secondary headaches. According to the current Committee on headaches, the updated version of the classification, presently under study, is due to be published soon; it is our hope that this revised version will take into account some of the above considerations. PMID:22767967

76 FR 80278 - Revision of Cotton Classification Procedures for Determining Cotton Leaf Grade

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-23

...-0066] RIN 0581-AD19 Revision of Cotton Classification Procedures for Determining Cotton Leaf Grade... Pima cotton. The leaf grade is a part of the official classification which denotes cotton fiber quality used in cotton marketing and manufacturing of cotton products. Currently, the leaf grade is determined...

Neurodevelopmental Disorders (ASD and ADHD): DSM-5, ICD-10, and ICD-11.

PubMed

Doernberg, Ellen; Hollander, Eric

2016-08-01

Neurodevelopmental disorders, specifically autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) have undergone considerable diagnostic evolution in the past decade. In the United States, the current system in place is the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), whereas worldwide, the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) serves as a general medical system. This review will examine the differences in neurodevelopmental disorders between these two systems. First, we will review the important revisions made from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) to the DSM-5, with respect to ASD and ADHD. Next, we will cover the similarities and differences between ASD and ADHD classification in the DSM-5 and the ICD-10, and how these differences may have an effect on neurodevelopmental disorder diagnostics and classification. By examining the changes made for the DSM-5 in 2013, and critiquing the current ICD-10 system, we can help to anticipate and advise on the upcoming ICD-11, due to come online in 2017. Overall, this review serves to highlight the importance of progress towards complementary diagnostic classification systems, keeping in mind the difference in tradition and purpose of the DSM and the ICD, and that these systems are dynamic and changing as more is learned about neurodevelopmental disorders and their underlying etiology. Finally this review will discuss alternative diagnostic approaches, such as the Research Domain Criteria (RDoC) initiative, which links symptom domains to underlying biological and neurological mechanisms. The incorporation of new diagnostic directions could have a great effect on treatment development and insurance coverage for neurodevelopmental disorders worldwide.

The New Higher Level Classification of Eukaryotes with Emphasis on the Taxonomy of Protists

Treesearch

SINA M. ADL; ALASTAIR G. B. SIMPSON; MARK A. FARMER; ROBERT A. ANDERSEN; O. ROGER ANDERSON; JOHN R. BARTA; SAMUEL S. BOWSER; GUY BRUGEROLLE; ROBERT A. FENSOME; SUZANNE FREDERICQ; TIMOTHY Y. JAMES; SERGEI KARPOV; PAUL KUGRENS; JOHN KRUG; CHRISTOPHER E. LANE; LOUISE A. LEWIS; JEAN LODGE; DENIS H. LYNN; DAVID G. MANN; RICHARD M. MCCOURT; LEONEL MENDOZA; ØJVIND MOESTRUP; SHARON E. MOZLEY-STANDRIDGE; THOMAS A. NERAD; CAROL A. SHEARER; ALEXEY V. SMIRNOV; FREDERICK W. SPIEGEL; MAX F.J.R. TAYLOR

2005-01-01

This revision of the classification of unicellular eukaryotes updates that of Levine et al. (1980) for the protozoa and expands it to include other protists. Whereas the previous revision was primarily to incorporate the results of ultrastructural studies, this revision incorporates results from both ultrastructural research since 1980 and molecular phylogenetic...

The new higher level classification of eukaryotes with emphasis on the taxonomy of protists

Treesearch

Sina M. Adl; Alastair G.B. Simpson; Mark A. Farmer; Robert A. Andersen; O. Roger Anderson; John R. Barta; Samuel S. Bowser; Guy Brugerolle; Robert A. Fensome; Suzanne Fredericq; Timothy Y. James; Sergei Karpov; Paul Kugrens; John Krug; Christopher E. Lane; Louise A. Lewis; Jean Lodge; Denis H. Lynn; David G. Mann; Richard M. McCourt; Leonel Mendoza; Ojvind Moestrup; Sharon E. Mozley-Standridge; Thomas A. Nerad; Carol A. Shearer; Alexey V. Smirnov; Frederick W. Speigel; Max F.J.R. Taylor

2005-01-01

This revision of the classification of unicellular eukaryotes updates that of Levine et al. (1980) for the protozoa and expands it to include other protists. Whereas the previous revision was primarily to incorporate the results of ultrastructural studies, this revision incorporates results from both ultrastructural research since 1980 and molecular phylogenetic...

Infant Mortality: Development of a Proposed Update to the Dollfus Classification of Infant Deaths

PubMed Central

Dove, Melanie S.; Minnal, Archana; Damesyn, Mark; Curtis, Michael P.

2015-01-01

Objective Identifying infant deaths with common underlying causes and potential intervention points is critical to infant mortality surveillance and the development of prevention strategies. We constructed an International Classification of Diseases 10th Revision (ICD-10) parallel to the Dollfus cause-of-death classification scheme first published in 1990, which organized infant deaths by etiology and their amenability to prevention efforts. Methods Infant death records for 1996, dual-coded to the ICD Ninth Revision (ICD-9) and ICD-10, were obtained from the CDC public-use multiple-cause-of-death file on comparability between ICD-9 and ICD-10. We used the underlying cause of death to group 27,821 infant deaths into the nine categories of the ICD-9-based update to Dollfus' original coding scheme, published by Sowards in 1999. Comparability ratios were computed to measure concordance between ICD versions. Results The Dollfus classification system updated with ICD-10 codes had limited agreement with the 1999 modified classification system. Although prematurity, congenital malformations, Sudden Infant Death Syndrome, and obstetric conditions were the first through fourth most common causes of infant death under both systems, most comparability ratios were significantly different from one system to the other. Conclusion The Dollfus classification system can be adapted for use with ICD-10 codes to create a comprehensive, etiology-based profile of infant deaths. The potential benefits of using Dollfus logic to guide perinatal mortality reduction strategies, particularly to maternal and child health programs and other initiatives focused on improving infant health, warrant further examination of this method's use in perinatal mortality surveillance. PMID:26556935

Disorders related to sexuality and gender identity in the ICD‐11: revising the ICD‐10 classification based on current scientific evidence, best clinical practices, and human rights considerations

PubMed Central

Reed, Geoffrey M.; Drescher, Jack; Krueger, Richard B.; Atalla, Elham; Cochran, Susan D.; First, Michael B.; Cohen‐Kettenis, Peggy T.; Arango‐de Montis, Iván; Parish, Sharon J.; Cottler, Sara; Briken, Peer; Saxena, Shekhar

2016-01-01

In the World Health Organization's forthcoming eleventh revision of the International Classification of Diseases and Related Health Problems (ICD‐11), substantial changes have been proposed to the ICD‐10 classification of mental and behavioural disorders related to sexuality and gender identity. These concern the following ICD‐10 disorder groupings: F52 Sexual dysfunctions, not caused by organic disorder or disease; F64 Gender identity disorders; F65 Disorders of sexual preference; and F66 Psychological and behavioural disorders associated with sexual development and orientation. Changes have been proposed based on advances in research and clinical practice, and major shifts in social attitudes and in relevant policies, laws, and human rights standards. This paper describes the main recommended changes, the rationale and evidence considered, and important differences from the DSM‐5. An integrated classification of sexual dysfunctions has been proposed for a new chapter on Conditions Related to Sexual Health, overcoming the mind/body separation that is inherent in ICD‐10. Gender identity disorders in ICD‐10 have been reconceptualized as Gender incongruence, and also proposed to be moved to the new chapter on sexual health. The proposed classification of Paraphilic disorders distinguishes between conditions that are relevant to public health and clinical psychopathology and those that merely reflect private behaviour. ICD‐10 categories related to sexual orientation have been recommended for deletion from the ICD‐11. PMID:27717275

The Psychosomatic Disorders Pertaining to Dental Practice with Revised Working Type Classification

PubMed Central

2014-01-01

Psychosomatic disorders are defined as disorders characterized by physiological changes that originate partially from emotional factors. This article aims to discuss the psychosomatic disorders of the oral cavity with a revised working type classification. The author has added one more subset to the existing classification, i.e., disorders caused by altered perception of dentofacial form and function, which include body dysmorphic disorder. The author has also inserted delusional halitosis under the miscellaneous disorders classification of psychosomatic disorders and revised the already existing classification proposed for the psychosomatic disorders pertaining to dental practice. After the inclusion of the subset (disorders caused by altered perception of dentofacial form and function), the terminology "psychosomatic disorders of the oral cavity" is modified to "psychosomatic disorders pertaining to dental practice". PMID:24478896

The psychosomatic disorders pertaining to dental practice with revised working type classification.

PubMed

Shamim, Thorakkal

2014-01-01

Psychosomatic disorders are defined as disorders characterized by physiological changes that originate partially from emotional factors. This article aims to discuss the psychosomatic disorders of the oral cavity with a revised working type classification. The author has added one more subset to the existing classification, i.e., disorders caused by altered perception of dentofacial form and function, which include body dysmorphic disorder. The author has also inserted delusional halitosis under the miscellaneous disorders classification of psychosomatic disorders and revised the already existing classification proposed for the psychosomatic disorders pertaining to dental practice. After the inclusion of the subset (disorders caused by altered perception of dentofacial form and function), the terminology "psychosomatic disorders of the oral cavity" is modified to "psychosomatic disorders pertaining to dental practice".

Classification of instability after reverse shoulder arthroplasty guides surgical management and outcomes.

PubMed

Abdelfattah, Adham; Otto, Randall J; Simon, Peter; Christmas, Kaitlyn N; Tanner, Gregory; LaMartina, Joey; Levy, Jonathan C; Cuff, Derek J; Mighell, Mark A; Frankle, Mark A

2018-04-01

Revision of unstable reverse shoulder arthroplasty (RSA) remains a significant challenge. The purpose of this study was to determine the reliability of a new treatment-guiding classification for instability after RSA, to describe the clinical outcomes of patients stabilized operatively, and to identify those with higher risk of recurrence. All patients undergoing revision for instability after RSA were identified at our institution. Demographic, clinical, radiographic, and intraoperative data were collected. A classification was developed using all identified causes of instability after RSA and allocating them to 1 of 3 defined treatment-guiding categories. Eight surgeons reviewed all data and applied the classification scheme to each case. Interobserver and intraobserver reliability was used to evaluate the classification scheme. Preoperative clinical outcomes were compared with final follow-up in stabilized shoulders. Forty-three revision cases in 34 patients met the inclusion for study. Five patients remained unstable after revision. Persistent instability most commonly occurred in persistent deltoid dysfunction and postoperative acromial fractures but also in 1 case of soft tissue impingement. Twenty-one patients remained stable at minimum 2 years of follow-up and had significant improvement of clinical outcome scores and range of motion. Reliability of the classification scheme showed substantial and almost perfect interobserver and intraobserver agreement among all the participants (κ = 0.699 and κ = 0.851, respectively). Instability after RSA can be successfully treated with revision surgery using the reliable treatment-guiding classification scheme presented herein. However, more understanding is needed for patients with greater risk of recurrent instability after revision surgery. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Aircrew Availability: Modeling Predictors of Duties Not Including Flying Status

DTIC Science & Technology

2017-07-25

International Classification of Diseases , Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes, were obtained from ASIMS. Participant age...diagnosis category,b no. (%): Diseases of the respiratory system 104,637 (26.83) DoD specific: education or counseling 48,117 (12.34... Diseases of the digestive system 31,177 (7.99) Diseases of the nervous system and sense organs 30,625 (7.85) Symptoms; signs, ill-defined

Development of a template for the classification of traditional medical knowledge in Korea.

PubMed

Kim, Sungha; Kim, Boyoung; Mun, Sujeong; Park, Jeong Hwan; Kim, Min-Kyeoung; Choi, Sunmi; Lee, Sanghun

2016-02-03

Traditional Medical Knowledge (TMK) is a form of Traditional Knowledge associated with medicine that is handed down orally or by written material. There are efforts to document TMK, and make database to conserve Traditional Medicine and facilitate future research to validate traditional use. Despite of these efforts, there is no widely accepted template in data file format that is specific for TMK and, at the same time, helpful for understanding and organizing TMK. We aimed to develop a template to classify TMK. First, we reviewed books, articles, and health-related classification systems, and used focus group discussion to establish the definition, scope, and constituents of TMK. Second, we developed an initial version of the template to classify TMK, and applied it to TMK data. Third, we revised the template, based on the results of the initial template and input from experts, and applied it to the data. We developed the template for classification of TMK. The constituents of the template were summary, properties, tools/ingredients, indication/preparation/application, and international standard classification. We applied International Patent Classification, International Classification of Diseases (Korea version), and Classification of Korean Traditional Knowledge Resources to provide legal protection of TMK and facilitate academic research. The template provides standard terms for ingredients, preparation, administration route, and procedure method to assess safety and efficacy. This is the first template that is specialized for TMK for arranging and classifying TMK. The template would have important roles in preserving TMK, and protecting intellectual property. TMK data classified with the template could be used as the preliminary data to screen potential candidates for new pharmaceuticals. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Classifying psychosis--challenges and opportunities.

PubMed

Gaebel, Wolfgang; Zielasek, Jürgen; Cleveland, Helen-Rose

2012-12-01

Within the efforts to revise ICD-10 and DSM-IV-TR, work groups on the classification of psychotic disorders appointed by the World Health Organization (WHO) and the American Psychiatric Association (APA) have proposed several changes to the corresponding classification criteria of schizophrenia and other psychotic disorders in order to increase the clinical utility, reliability and validity of these diagnoses. These proposed revisions are subject to field trials with the objective of studying whether they will lead to an improvement of the classification systems in comparison to their previous versions. Both a challenge and an opportunity, the APA and WHO have also considered harmonizing between the two classifications. The current status of both suggests that this goal can only be met in part. The main proposed revisions include changes to the number and types of symptoms of schizophrenia, the replacement of existing schizophrenia subtypes with dimensional assessments or symptom specifiers, different modifications of the criteria for schizoaffective disorder, a reorganization of the delusional disorders and the acute and transient psychotic disorders in ICD-11, as well as the revision of course and psychomotor symptoms/catatonia specifiers in both classification systems.

Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2018. Final rule.

PubMed

2017-08-03

This final rule updates the prospective payment rates for inpatient rehabilitation facilities (IRFs) for federal fiscal year (FY) 2018 as required by the statute. As required by section 1886(j)(5) of the Social Security Act (the Act), this rule includes the classification and weighting factors for the IRF prospective payment system's (IRF PPS) case-mix groups and a description of the methodologies and data used in computing the prospective payment rates for FY 2018. This final rule also revises the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) diagnosis codes that are used to determine presumptive compliance under the "60 percent rule," removes the 25 percent payment penalty for inpatient rehabilitation facility patient assessment instrument (IRF-PAI) late transmissions, removes the voluntary swallowing status item (Item 27) from the IRF-PAI, summarizes comments regarding the criteria used to classify facilities for payment under the IRF PPS, provides for a subregulatory process for certain annual updates to the presumptive methodology diagnosis code lists, adopts the use of height/weight items on the IRF-PAI to determine patient body mass index (BMI) greater than 50 for cases of single-joint replacement under the presumptive methodology, and revises and updates measures and reporting requirements under the IRF quality reporting program (QRP).

Access to Care for Transgender Veterans in the Veterans Health Administration: 2006–2013

PubMed Central

Shipherd, Jillian C.; Lindsay, Jan; Blosnich, John R.; Brown, George R.; Jones, Kenneth T.

2014-01-01

A 2011 Veterans Health Administration directive mandated medically necessary care for transgender veterans. Internal education efforts informed staff of the directive and promoted greater access to care. For fiscal years 2006 through 2013, we identified 2662 unique individuals with International Classification of Diseases, Ninth Revision diagnoses related to transgender status in Veterans Health Administration medical records, with 40% of new cases in the 2 years following the directive. A bottom-up push for services by veterans and top-down education likely worked synergistically to speed implementation of the new policy and increase access to care. PMID:25100417

Access to care for transgender veterans in the Veterans Health Administration: 2006-2013.

PubMed

Kauth, Michael R; Shipherd, Jillian C; Lindsay, Jan; Blosnich, John R; Brown, George R; Jones, Kenneth T

2014-09-01

A 2011 Veterans Health Administration directive mandated medically necessary care for transgender veterans. Internal education efforts informed staff of the directive and promoted greater access to care. For fiscal years 2006 through 2013, we identified 2662 unique individuals with International Classification of Diseases, Ninth Revision diagnoses related to transgender status in Veterans Health Administration medical records, with 40% of new cases in the 2 years following the directive. A bottom-up push for services by veterans and top-down education likely worked synergistically to speed implementation of the new policy and increase access to care.

Children Treated at an Expeditionary Military Hospital in Iraq

DTIC Science & Technology

2006-09-01

5) Gastroesophageal reflux (530.81) 1 Rectal prolapse (569.1) 1 Aspirated foreign object (934) 1 Dehydration (276.5) 1 Failure to thrive (783.41) 1...ICD-9, International Classification of Diseases , Ninth Revision. (REPRINTED) ARCH PEDIATR ADOLESC MED/ VOL 160, SEP 2006 WWW.ARCHPEDIATRICS.COM 974...Pediatric diseases and operational deployments. Mil Med. 2000;165:283- 286. 2. Chmatal P, Bohonek M, Dobiasova M, Hasek R, Cernohous M. A humanitarian

Understanding Treatment of Mild Traumatic Brain Injury in the Military Health System

DTIC Science & Technology

2016-04-18

OEF Veterans: Polytrauma Clinical Triad,” Journal of Rehabilitation Research and Development, Vol. 46, No. 6, July 2009, pp. 697–702. Lew, Henry L...pubs/permissions.html. The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities...case definition for mTBI based on codes in the International Classification of Dis- eases, Ninth Revision (ICD-9), Clinical Modification. The team then

Revisiting Desensitization and Allergen Immunotherapy Concepts for the International Classification of Diseases (ICD)-11.

PubMed

Tanno, Luciana Kase; Calderon, Moises A; Papadopoulos, Nikolaos G; Sanchez-Borges, Mario; Rosenwasser, Lanny J; Bousquet, Jean; Pawankar, Ruby; Sisul, Juan Carlos; Cepeda, Alfonso Mario; Li, James; Muraro, Antonella; Fineman, Stanley; Sublett, James L; Katelaris, Constance H; Chang, Yoon-Seok; Moon, Hee-Bom; Casale, Thomas; Demoly, Pascal

2016-01-01

Allergy and hypersensitivity intervention management procedures, such as desensitization and/or tolerance induction and immunotherapy, have not been pondered up to now in the content of International Classification of Diseases (ICD) context because the focus has been on prioritizing the condition implementations. Tremendous efforts have been devoted to implementing allergic and hypersensitivity conditions in the forthcoming ICD-11. However, we consider that it is crucial now to have nomenclature and classification universally accepted for these procedures to be able to provide scientifically consistent proposals into the new ICD-11 platform for the best practice parameters of our specialty. With the aim of promoting a harmonized comprehension and aligning it with the ICD-11 revision, we have reviewed the definitions and concepts currently used for desensitization and/or tolerance induction and immunotherapy. We strongly believe that this review is a key instrument to support the allergy specialty identity into the ICD-11 framework and serves as a platform to perform positive quality improvement in clinical practice. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. All rights reserved.

Criteria for a catastrophically disabled determination for purposes of enrollment. Final rule.

PubMed

2013-12-03

The Department of Veterans Affairs (VA) is amending its regulation concerning the manner in which VA determines that a veteran is catastrophically disabled for purposes of enrollment in priority group 4 for VA health care. As amended by this rulemaking, the regulation articulates the clinical criteria that identify an individual as catastrophically disabled, instead of using the corresponding International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and Current Procedural Terminology (CPT[registered trademark]) codes. The revisions ensure that the regulation is not out of date when new versions of those codes are published. The revisions also broaden some of the descriptions for a finding of catastrophic disability. Additionally, the final rule does not rely on the Folstein Mini Mental State Examination (MMSE) as a criterion for determining whether a veteran meets the definition of catastrophically disabled, because we have determined that the MMSE is no longer a necessary clinical assessment tool.

Has Kahlbaum syndrome disappeared or is it underdiagnosed? Reexamining the nosology of catatonia.

PubMed

Rao, Naren P; Kasal, Vishal; Mutalik, Narayan R; Behere, Rishikesh V; Venkatasubramanian, Ganesan; Varambally, Shivarama; Gangadhar, Bangalore N

2012-03-01

In contemporary psychiatric classification such as the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, and International Classification of Diseases, 10th Revision, catatonia is classified as a subtype of schizophrenia and not as an independent disorder. However, catatonia does not seem to obey nosological boundaries and is seen with both affective and nonaffective psychoses. We conducted a chart review of patients to examine the nosological status of catatonia. Our data suggest that catatonia is a syndrome of varied manifestation possibly related to both affective and nonaffective psychoses with a subgroup independent of both. Further prospective studies examining the natural course are needed, which could have significant implications on future classificatory systems.

International standards for neurological classification of spinal cord injury: classification skills of clinicians versus computational algorithms.

PubMed

Schuld, C; Franz, S; van Hedel, H J A; Moosburger, J; Maier, D; Abel, R; van de Meent, H; Curt, A; Weidner, N; Rupp, R

2015-04-01

This is a retrospective analysis. The objective of this study was to describe and quantify the discrepancy in the classification of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) by clinicians versus a validated computational algorithm. European Multicenter Study on Human Spinal Cord Injury (EMSCI). Fully documented ISNCSCI data sets from EMSCI's first years (2003-2005) classified by clinicians (mostly spinal cord medicine residents, who received in-house ISNCSCI training by senior SCI physicians) were computationally reclassified. Any differences in the scoring of sensory and motor levels, American Spinal Injury Association Impairment Scale (AIS) or the zone of partial preservation (ZPP) were quantified. Four hundred and twenty ISNCSCI data sets were evaluated. The lowest agreement was found in motor levels (right: 62.1%, P=0.002; left: 61.8%, P=0.003), followed by motor ZPP (right: 81.6%, P=0.74; left 80.0%, P=0.27) and then AIS (83.4%, P=0.001). Sensory levels and sensory ZPP showed the best concordance (right sensory level: 90.8%, P=0.66; left sensory level: 90.0%, P=0.30; right sensory ZPP: 91.0%, P=0.18; left sensory ZPP: 92.2%, P=0.03). AIS B was most often misinterpreted as AIS C and vice versa (AIS B as C: 29.4% and AIS C as B: 38.6%). Most difficult classification tasks were the correct determination of motor levels and the differentiation between AIS B and AIS C/D. These issues should be addressed in upcoming ISNCSCI revisions. Training is strongly recommended to improve classification skills for clinical practice, as well as for clinical investigators conducting spinal cord studies. This study is partially funded by the International Foundation for Research in Paraplegia, Zurich, Switzerland.

Bimanual Capacity of Children With Cerebral Palsy: Intra- and Interrater Reliability of a Revised Edition of the Bimanual Fine Motor Function Classification.

PubMed

Elvrum, Ann-Kristin G; Beckung, Eva; Sæther, Rannei; Lydersen, Stian; Vik, Torstein; Himmelmann, Kate

2017-08-01

To develop a revised edition of the Bimanual Fine Motor Function (BFMF 2), as a classification of fine motor capacity in children with cerebral palsy (CP), and establish intra- and interrater reliability of this edition. The content of the original BFMF was discussed by an expert panel, resulting in a revised edition comprising the original description of the classification levels, but in addition including figures with specific explanatory text. Four professionals classified fine motor function of 79 children (3-17 years; 45 boys) who represented all subtypes of CP and Manual Ability Classification levels (I-V). Intra- and inter-rater reliability was assessed using overall intra-class correlation coefficient (ICC), and Cohen's quadratic weighted kappa. The overall ICC was 0.86. Cohen's weighted kappa indicated high intra-rater (к w : >0.90) and inter-rater (к w : >0.85) reliability. The revised BFMF 2 had high intra- and interrater reliability. The classification levels could be determined from short video recordings (<5 minutes), using the figures and precise descriptions of the fine motor function levels included in the BFMF 2. Thus, the BFMF 2 may be a feasible and useful classification of fine motor capacity both in research and in clinical practice.

Pediatric severe sepsis: current trends and outcomes from the Pediatric Health Information Systems database.

PubMed

Ruth, Amanda; McCracken, Courtney E; Fortenberry, James D; Hall, Matthew; Simon, Harold K; Hebbar, Kiran B

2014-11-01

To 1) describe the characteristics and outcomes over time of PICU patients with severe sepsis within the dedicated U.S. children's hospitals, 2) identify patient subgroups at risk for mortality from pediatric severe sepsis, and 3) describe overall pediatric severe sepsis resource utilization. Retrospective review of a prospectively collected multi-institutional children's hospital database. PICUs in 43 U.S. children's hospitals. PICU patients from birth to younger than 19 years were identified with severe sepsis by modified Angus criteria and International Classification of Diseases, 9th Revision, codes for severe sepsis and septic shock. None. Data from the Pediatric Health Information System database collected by the Children's Hospital Association from 2004 to 2012. Pediatric severe sepsis was defined by 1) International Classification of Diseases, 9th Revision, codes reflecting severe sepsis and septic shock and 2) International Classification of Diseases, 9th Revision, codes of infection and organ dysfunction as defined by modified Angus criteria. From 2004 to 2012, 636,842 patients were identified from 43 hospitals. Pediatric severe sepsis prevalence was 7.7% (49,153) with an associated mortality rate of 14.4%. Age less than 1 year (vs age 10 to < 19) (odds ratio, 1.4), underlying cardiovascular condition (odds ratio, 1.4) and multiple organ dysfunction, conferred higher odds of mortality. Resource burden was significant with median hospital length of stay of 17 days (interquartile range, 8-36 d) and PICU length of stay of 7 days (interquartile range, 2-17 d), with median cost/day of $4,516 and median total hospitalization cost of $77,446. There was a significant increase in the severe sepsis prevalence rate from 6.2% to 7.7% from 2004 to 2012 (p < 0.001) and a significant decrease in mortality from 18.9% to 12.0% (p < 0.001). Center mortality was negatively correlated with prevalence (rs = -0.48) and volume (rs = -0.39) and positively correlated with cost (rs = 0.36). In this largest reported pediatric severe sepsis cohort to date, prevalence increased from 2004 to 2012 while associated mortality decreased. Age, cardiovascular comorbidity, and organ dysfunction were significant prognostic factors. Pediatric severe sepsis remains an important cause for PICU admission and mortality and leads to a substantial burden in healthcare costs. Individual center's prevalence and volume are associated with improved outcomes.

Proposal of a new stage grouping of gastric cancer for TNM classification: International Gastric Cancer Association staging project.

PubMed

Sano, Takeshi; Coit, Daniel G; Kim, Hyung Ho; Roviello, Franco; Kassab, Paulo; Wittekind, Christian; Yamamoto, Yuko; Ohashi, Yasuo

2017-03-01

The current AJCC staging system for gastric cancer (AJCC7) incorporated several major revisions to the previous edition. The T and N categories and the stage groups were newly defined, and adenocarcinoma of the esophagogastric junction (EGJ) was reclassified and staged according to the esophageal system. Studies to validate these changes showed inconsistent results. The International Gastric Cancer Association (IGCA) launched a project to support evidence-based revisions to the next edition of the AJCC staging system. Clinical and pathological data on patients who underwent curative gastrectomy at 59 institutions in 15 countries between 2000 and 2004 were retrospectively collected. Patients lost to follow-up within 5 years of surgery were excluded. Patients treated with neoadjuvant therapy were excluded. The data were analyzed in total, and separately by region of treatment. Of 25,411 eligible cases, 84.8 % were submitted from 24 institutions of Japan and Korea, 6.4 % from other Asian countries, and 8.8 % from 29 Western institutions. The T and N categories of AJCC7 clearly stratified the patient survival. Patients with pN3a and pN3b showed distinct prognosis in all regions, and by introducing pN3a and pN3b into a cluster analysis, we established a new stage grouping with better stratification than AJCC7, especially among stage III subgroups. Survival of Siewert type 2 and 3 EGJ tumors was better stratified by this IGCA stage grouping than by either esophageal or gastric scheme of AJCC7. For the next revision of AJCC classification, we propose a new stage grouping based on a large, worldwide data collection.

[Vasculitic neuropathy: novel classification, diagnosis and treatment].

PubMed

Kanda, Takashi

2014-01-01

The international standard of nomenclature and classification in vasculitis, CHCC 1994,was revised as CHCC 2012. In the first part of this review article I briefly summarized the CHCC 2012 and pointed out the changes in this revision, especially on the disorders related to vasculitic neuropathy. Notable changes include the introduction of new terms such as granulomatosis with polyangiitis and eosinophilic granulomatosis with polyangiitis. In the second part, I mentioned the tips for the diagnosis and treatment of vasculitic neuropathy. Because most of the vasculitic neuropathy patients require rigorous, long-standing immunosuppressive therapy, the accurate diagnosis based on the pathological detection of vasculitic changes is mandatory. In this regard, the value of sural nerve biopsy is still not ignorable. In the treatment of vascultic neuropathy, there are no controlled treatment trials and clinical practice is guided by experience from case series and indirectly by analogy with systemic vasculitis. Although combined therapy using prednisolone and cyclophosphamide is usually recommended by experts, tailor-made treatment regimen based on the conditions of each patient would produce the best outcome in vasculitic neuropathy.

The scope and specific criteria of compensation for occupational diseases in Korea.

PubMed

Song, Jaechul; Kim, Inah; Choi, Byung-Soon

2014-06-01

The range of diseases covered by workers' compensation is constantly expanding. However, new regulations are required for the recognition of occupational diseases (ODs) because OD types evolve with changes in industrial structures and working conditions. OD criteria are usually based on medical relevance, but they vary depending on the social security system and laws of each country. In addition, the proposed range and extent of work-relatedness vary depending on the socio-economic conditions of each country. The Labor Standards Act (LSA) and the Industrial Accident Compensation Insurance Act (IACIA) of Korea employ lists based on their requirements without listing causes and diseases separately. Despite a considerable reshuffle in 2003, the basic framework has been maintained for 50 yr, and many cases do not fit into the international disease classification system. Since July 1, 2013, Korea has expanded the range of occupational accidents to include occupational cancers and has implemented revised LSA and IACIA enforcement decrees. There have been improvements to OD recognition standards with the inclusion of additional or modified criteria, a revised and improved classification scheme for risk factors and ODs, and so on.

Epigenetic Patterns of PTSD: DNA Methylation In Serum of OIF/OEF Servicemembers

DTIC Science & Technology

2011-01-01

ascertained via query of the International Classification of Diseases , 9th Revision (ICD-9) codes 290-320. To attempt to control for confounding by other...other CNS tissues is not clear. Although relevant to a different class of disease , many of the aberrations that have been detected in the DNA of...valuable diagnostic tool in various diseases . (50-53) Compared with cultured cells, clinical specimens, such as whole blood, serum, and even brain

Do Adverse Childhood Experiences Increase the Risk of Postdeployment Posttraumatic Stress Disorder in US Marines

DTIC Science & Technology

2010-01-01

GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR( S ) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME( S ) AND...REPORT NUMBER 9. SPONSORING/MONITORING AGENCY NAME( S ) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S ACRONYM( S ) 11. SPONSOR/MONITOR’S REPORT NUMBER( S ) 12...retardation, and substance abuse or dependence. Coding was based on the International Classification of Diseases , Ninth Revision, Clinical

Generational and regional differences in trends of mortality from ischemic heart disease in Japan from 1969 to 1992.

PubMed

Okayama, A; Ueshima, H; Marmot, M; Elliott, P; Choudhury, S R; Kita, Y

2001-06-15

The authors compared generational and regional trends of premature mortality from ischemic heart disease (IHD) from 1969 to 1992 for persons aged 30-69 years. They selected Tokyo and Osaka prefectures as the most urbanized and compared them with the rest of Japan. The data were divided into two periods: period I (1969-1978, International Classification of Diseases, Eight Revision) and period II (1979-1992, International Classification of Diseases, Ninth Revision). In both populations, IHD mortality decreased for both sexes, but mortality from nonspecific heart disease remained constant in men and decreased in women. In Tokyo and Osaka prefectures, the percentage decline per year in IHD mortality for both sexes was significantly smaller in period II than in period I. However, in the rest of Japan, it did not decrease for either sex. Age-specific analysis showed that the percentage decline per year in period II was smallest for the group aged 30-49 years (men, 0.05%; women, 0.76%) in Tokyo and Osaka prefectures, while it was similar for all age groups in the rest of Japan. For men, the IHD mortality rate in 1991-1992 for those aged 30-49 years was higher in Tokyo and Osaka prefectures (9.4/100,000) than in the rest of Japan (5.4/100,000).

Assessing the ability of comorbidity indexes to capture comorbid disease in the inpatient rehabilitation burn injury population.

PubMed

Slocum, Chloe S; Goldstein, Richard; DiVita, Margaret A; Mix, Jacqueline; Niewczyk, Paulette; Gerrard, Paul; Sheridan, Robert; Kowalske, Karen J; Zafonte, Ross; Ryan, Colleen M; Schneider, Jeffrey C

2015-05-01

Burn patients exhibit comorbidities that influence outcomes. This study examines whether existing comorbidity measures capture comorbidities in the burn inpatient rehabilitation population. Data were obtained from the Uniform Data System for Medical Rehabilitation from 2002 to 2011 for adults with burn injury. International Classification of Diseases, 9th Revision, codes were used to assess three comorbidity measures (Charlson Comorbidity Index, Elixhauser Comorbidity Index, Centers for Medicare and Medicaid Services Comorbidity Tiers). The number of subjects and unique comorbidity codes (>1% of frequency) captured by each comorbidity measure was calculated. The study included 5347 patients with a median total body surface area burn decile of 20%-29%, mean age of 51.6 yrs, and mean number of comorbidities of 7.6. There were 2809 unique International Classification of Diseases, 9th Revision, comorbidity codes. The Charlson Comorbidity Index, Elixhauser Comorbidity Index, and Centers for Medicare and Medicaid Services Comorbidity Tiers did not capture 67%, 27%, and 58% of the subjects, respectively. There were 107 unique comorbidities that occurred with a frequency of greater than 1%. Of these, 67% were not captured in all three comorbidity measures. Commonly used comorbidity indexes do not reflect the extent of comorbid disease in the burn rehabilitation population. Future work is needed to assess the need for comorbidity indexes specific to the inpatient rehabilitation setting.

[Principles of management of periprosthetic fractures].

PubMed

Röderer, G; Gebhard, F; Scola, A

2016-03-01

The increasing numbers of primary total hip and knee replacements have subsequently led to growing rates of periprosthetic fractures. In many cases geriatric patients with osteopenia or osteoporotic bone quality are affected. The goal of treatment is the retention or reconstruction of joint function using open reduction and internal fixation or a revision prosthesis. The aim of this article is a description of the basic principles of treatment of periprosthetic fractures of the lower extremities. An exact description of the fracture using current classification systems with imaging diagnostics is mandatory. This also includes an assessment of the stability of the prosthesis. In the case of a stable prosthesis and a good bone stock open reduction and internal fixation should be performed. In these cases locking plates are standard procedure. If fracture reduction is possible minimally invasive procedures can be performed which help to reduce the surgical trauma and accelerate rehabilitation. If the prosthesis is loose it has to be exchanged for a revision implant. If vast bony defects result they can be augmented using wedges. Conservative treatment plays only a subordinate role in selected cases. Periprosthetic fractures show an increasing incidence and occur more frequently in the geriatric patient population. Due to comorbidities and poor bone quality surgical treatment is a challenge. The fracture must be exactly classified using the appropriate classification system in order to clarify if the prosthesis can be retained or if it has to be exchanged.

A revised family-level classification of the Polyporales (Basidiomycota)

Treesearch

Alfredo Justo; Otto Miettinen; Dimitrios Floudas; Beatriz Ortiz-Santana; Elisabet Sjökvist; Daniel Lindner; Karen Nakasone; Tuomo Niemelä; Karl-Henrik Larsson; Leif Ryvarden; David S. Hibbett

2017-01-01

Polyporales is strongly supported as a clade of Agaricomycetes, but the lack of a consensus higher-level classification within the group is a barrier to further taxonomic revision. We amplified nrLSU, nrITS, and rpb1 genes across the Polyporales, with a special focus on the latter. We...

New Casemix Classification as an Alternative Method for Budget Allocation in Thai Oral Healthcare Service: A Pilot Study

PubMed Central

Wisaijohn, Thunthita; Pimkhaokham, Atiphan; Lapying, Phenkhae; Itthichaisri, Chumpot; Pannarunothai, Supasit; Igarashi, Isao; Kawabuchi, Koichi

2010-01-01

This study aimed to develop a new casemix classification system as an alternative method for the budget allocation of oral healthcare service (OHCS). Initially, the International Statistical of Diseases and Related Health Problem, 10th revision, Thai Modification (ICD-10-TM) related to OHCS was used for developing the software “Grouper”. This model was designed to allow the translation of dental procedures into eight-digit codes. Multiple regression analysis was used to analyze the relationship between the factors used for developing the model and the resource consumption. Furthermore, the coefficient of variance, reduction in variance, and relative weight (RW) were applied to test the validity. The results demonstrated that 1,624 OHCS classifications, according to the diagnoses and the procedures performed, showed high homogeneity within groups and heterogeneity between groups. Moreover, the RW of the OHCS could be used to predict and control the production costs. In conclusion, this new OHCS casemix classification has a potential use in a global decision making. PMID:20936134

New casemix classification as an alternative method for budget allocation in thai oral healthcare service: a pilot study.

PubMed

Wisaijohn, Thunthita; Pimkhaokham, Atiphan; Lapying, Phenkhae; Itthichaisri, Chumpot; Pannarunothai, Supasit; Igarashi, Isao; Kawabuchi, Koichi

2010-01-01

This study aimed to develop a new casemix classification system as an alternative method for the budget allocation of oral healthcare service (OHCS). Initially, the International Statistical of Diseases and Related Health Problem, 10th revision, Thai Modification (ICD-10-TM) related to OHCS was used for developing the software "Grouper". This model was designed to allow the translation of dental procedures into eight-digit codes. Multiple regression analysis was used to analyze the relationship between the factors used for developing the model and the resource consumption. Furthermore, the coefficient of variance, reduction in variance, and relative weight (RW) were applied to test the validity. The results demonstrated that 1,624 OHCS classifications, according to the diagnoses and the procedures performed, showed high homogeneity within groups and heterogeneity between groups. Moreover, the RW of the OHCS could be used to predict and control the production costs. In conclusion, this new OHCS casemix classification has a potential use in a global decision making.

Towards an International Classification for Patient Safety: a Delphi survey.

PubMed

Thomson, Richard; Lewalle, Pierre; Sherman, Heather; Hibbert, Peter; Runciman, William; Castro, Gerard

2009-02-01

Interpretation and comparison of patient safety information have been compromised by the lack of a common understanding of the concepts involved. The World Alliance set out to develop an International Classification for Patient Safety (ICPS) to address this, and to test the relevance and acceptability of the draft ICPS and progressively refine it prior to field testing. Two-stage Delphi survey. Quantitative and qualitative analyses informed the review of the ICPS. International web-based survey of expert opinion. Experts in the fields of patient safety, health policy, reporting systems, safety and quality control, classification theory and development, health informatics, consumer advocacy, law and medicine; 253 responded to the first round survey, 30% of whom responded to the second round. In the first round, 14% felt that the conceptual framework was missing at least one class, although it was apparent that most respondents were actually referring to concepts they felt should be included within the classes rather than the classes themselves. There was a need for clarification of several components of the classification, particularly its purpose, structure and depth. After revision and feedback, round 2 results were more positive, but further significant changes were made to the conceptual framework and to the major classes in response to concerns about terminology and relationships between classes. The Delphi approach proved invaluable, as both a consensus-building exercise and consultation process, in engaging stakeholders to support completion of the final draft version of the ICPS. Further refinement will occur.

Cultures in psychiatric nosology: the CCMD-2-R and international classification of mental disorders.

PubMed

Lee, S

1996-12-01

This essay reviews the Chinese Classification of Mental Disorders, Second Edition, Revised (CCMD-2-R, 1995), by assuming the theoretical stance that symptom recognition, disease construction, and taxonomic strategy in psychiatry reflect, and are constrained by, the cultural norms and values as well as the political and economic organizations of the society in which they are embedded. The CCMD-2-R is an ethnomedical classification grounded in both symptomatology and etiology, in which Chinese psychiatrists seek to conform with international classifications on the one hand, and to sustain a nosology with Chinese cultural characteristics on the other. Although broad similarities between the ICD-10 and CCMD-2-R are evident, their blending is legitimately incomplete. Thus, the particular additions (e.g., travelling psychosis, qigong induced mental disorders), deletions (e.g., somatoform disorders, pathological gambling, a number of personality and sexual disorders), retentions (e.g., unipolar mania, neurosis, hysteria, homosexuality), and variations (e.g., depressive neurosis, neurasthenia) reveal not only the changing notions of illness but also the shifting social realities in contemporary China. The CCMD-2-R will be widely used by Chinese psychiatrists and should standardize diagnostic practice and facilitate research, but its impact on everyday clinical work and psychiatric training remains to be evaluated. For Western researchers, it is one avenue for achieving an understanding of the Chinese social world, and should usefully be contrasted with the ICD-10 and DSM-IV as the move towards an international nosology continues.

Towards an International Classification for Patient Safety: a Delphi survey

PubMed Central

Thomson, Richard; Lewalle, Pierre; Sherman, Heather; Hibbert, Peter; Runciman, William; Castro, Gerard

2009-01-01

Objective Interpretation and comparison of patient safety information have been compromised by the lack of a common understanding of the concepts involved. The World Alliance set out to develop an International Classification for Patient Safety (ICPS) to address this, and to test the relevance and acceptability of the draft ICPS and progressively refine it prior to field testing. Design Two-stage Delphi survey. Quantitative and qualitative analyses informed the review of the ICPS. Setting International web-based survey of expert opinion. Participants Experts in the fields of patient safety, health policy, reporting systems, safety and quality control, classification theory and development, health informatics, consumer advocacy, law and medicine; 253 responded to the first round survey, 30% of whom responded to the second round. Results In the first round, 14% felt that the conceptual framework was missing at least one class, although it was apparent that most respondents were actually referring to concepts they felt should be included within the classes rather than the classes themselves. There was a need for clarification of several components of the classification, particularly its purpose, structure and depth. After revision and feedback, round 2 results were more positive, but further significant changes were made to the conceptual framework and to the major classes in response to concerns about terminology and relationships between classes. Conclusions The Delphi approach proved invaluable, as both a consensus-building exercise and consultation process, in engaging stakeholders to support completion of the final draft version of the ICPS. Further refinement will occur. PMID:19147596

The Children's Sleep Comic: Psychometrics of a Self-rating Instrument for Childhood Insomnia.

PubMed

Schwerdtle, Barbara; Kanis, Julia; Kübler, Andrea; Schlarb, Angelika A

2016-02-01

The Children's Sleep Comic is a standardized self-report questionnaire for assessing insomnia in children ages 5-11 years. The goal of the present study is to introduce a revised version of this measure and to present psychometrics and a cut-off score. Therefore, the revised Children's Sleep Comic, the Sleep Self Report, the Children's Sleep Habits Questionnaire, and the Child Behavior Checklist were applied to a sample of 393 children and their parents. Of the parents who participated voluntarily, a subsample (n = 176) was interviewed on the phone to diagnose their children with sleep disorders according to the International Classification of Sleep Disorders, if applicable. The results indicated that the Children's Sleep Comic is a reliable self-rating instrument for diagnosing childhood insomnia. Internal consistency was α = 0.83; and convergent and divergent validity were adequate. The child-friendly format can foster a good therapeutic relationship, and thus establish the basis for successful intervention.

[Gastroenterology in the G-DRG-System 2004].

PubMed

Bunzemeier, H; Frühmorgen, P; Caspary, W F; Roeder, N

2003-11-01

After a year of preliminary voluntarily introduction of casemix funding in hospitals in 2003 nearly every German hospital will be confronted with lump sump payments on the basis of the G-DRG system for their inpatient care starting from January 2004. To analyse weaknesses referring to gastroenterology services within the G-DRG version 1.0 the German Association for Disorders of the Digestive System and Metabolism (DGVS) and the DRG-Research-Group from the University of Muenster conducted a DRG evaluation project. In the analysis patient data from 16 hospitals were included. As a result of the project recommendations for G-DRG adjustments were generated. Those recommendations were implemented in the advancement to G-DRG version 2004. Also the International Classification of Diseases (ICD-10) was modified to ICD-10 German Modification. The classification of procedures OPS-301 was revised. The main adjustments to the G-DRG system and both classifications will be presented in this paper.

[Revision of the TNM Stage Grouping in the Forthcoming Eighth Edition of the TNM Classification for Lung Cancer].

PubMed

Ye, Bo; Zhao, Heng

2016-06-20

The currently adopted staging system for lung cancer is the seventh edition of the TNM staging edited by Union for International Cancer Control (UICC) in January, 2009. In recent years, with the advances of techniques in lung cancer diagnosis and the treatment trends towards precision treatment modalities such as individualized therapy and molecular targeted therapy, the survival and prognosis of lung cancer has been significantly improved. The old staging standard is difficult to satisfy the currentrapidly developing clinical needs. Therefore, the International Lung Cancer Research Society (International Association for the Study of Lung Cancer, IASLC) updated the stage of lung cancer in 2015, and the forthcoming eighth edition of the TNM Classification for Lung Cancer, which will be formally adopted in Jan. 2017, has been published in Journal of Thoracic Oncology. The new staging system has adopted 35 databases from 16 countries, including 94,708 cases treated between 1999 and 2010. The advantages of the new staging lies in its higher prognosis prediction and clinical guidance value.

Comparing ecoregional classifications for natural areas management in the Klamath Region, USA

USGS Publications Warehouse

Sarr, Daniel A.; Duff, Andrew; Dinger, Eric C.; Shafer, Sarah L.; Wing, Michael; Seavy, Nathaniel E.; Alexander, John D.

2015-01-01

We compared three existing ecoregional classification schemes (Bailey, Omernik, and World Wildlife Fund) with two derived schemes (Omernik Revised and Climate Zones) to explore their effectiveness in explaining species distributions and to better understand natural resource geography in the Klamath Region, USA. We analyzed presence/absence data derived from digital distribution maps for trees, amphibians, large mammals, small mammals, migrant birds, and resident birds using three statistical analyses of classification accuracy (Analysis of Similarity, Canonical Analysis of Principal Coordinates, and Classification Strength). The classifications were roughly comparable in classification accuracy, with Omernik Revised showing the best overall performance. Trees showed the strongest fidelity to the classifications, and large mammals showed the weakest fidelity. We discuss the implications for regional biogeography and describe how intermediate resolution ecoregional classifications may be appropriate for use as natural areas management domains.

Patient advocacy and DSM-5.

PubMed

Stein, Dan J; Phillips, Katharine A

2013-05-17

The revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) provides a useful opportunity to revisit debates about the nature of psychiatric classification. An important debate concerns the involvement of mental health consumers in revisions of the classification. One perspective argues that psychiatric classification is a scientific process undertaken by scientific experts and that including consumers in the revision process is merely pandering to political correctness. A contrasting perspective is that psychiatric classification is a process driven by a range of different values and that the involvement of patients and patient advocates would enhance this process. Here we draw on our experiences with input from the public during the deliberations of the Obsessive Compulsive-Spectrum Disorders subworkgroup of DSM-5, to help make the argument that psychiatric classification does require reasoned debate on a range of different facts and values, and that it is appropriate for scientist experts to review their nosological recommendations in the light of rigorous consideration of patient experience and feedback.

Expanding the definition of addiction: DSM-5 vs. ICD-11.

PubMed

Grant, Jon E; Chamberlain, Samuel R

2016-08-01

While considerable efforts have been made to understand the neurobiological basis of substance addiction, the potentially "addictive" qualities of repetitive behaviors, and whether such behaviors constitute "behavioral addictions," is relatively neglected. It has been suggested that some conditions, such as gambling disorder, compulsive stealing, compulsive buying, compulsive sexual behavior, and problem Internet use, have phenomenological and neurobiological parallels with substance use disorders. This review considers how the issue of "behavioral addictions" has been handled by latest revisions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD), leading to somewhat divergent approaches. We also consider key areas for future research in order to address optimal diagnostic classification and treatments for such repetitive, debilitating behaviors.

Air Force Operational Medicine: Using the Enterprise Estimating Supplies Program to Develop Materiel Solutions for the Operational Requirements of the Air Force Ophthalmology Augmentation Team (FFEYE)

DTIC Science & Technology

2010-10-14

non-battle injuries , and illnesses. International Classification of Diseases, Ninth Revision (ICD-9) coded patient conditions, selected by the...for a range of surgical and non- surgical injuries and illnesses, typically seen and treated by an ophthalmologist and one technician working 12-hour...receive them. The “Equipment/supplies” column identifies the items needed to complete the “Insert endo - trach tube” task at that level of capability. Not

Air Force Operational Medicine: Using the Enterprise Estimating Supplies Program to Develop Materiel Solutions for the Thoracic/Vascular Surgery Team (FFGKT)

DTIC Science & Technology

2010-11-10

asset, including combat wounds, non-battle injuries , and illnesses. International Classification of Diseases, Ninth Revision (ICD-9) coded patient...patient conditions and the frequency at which they would present. The resulting illness and injury frequencies characterize the expected patient...The scenario is shown in Table 1. Table 1 Thoracic/Vascular Scenario ICD-9 ICD-9 description No. patients 903.9 INJURY ARM VESSEL NOS 2 904.8

Leading Change: Implementation of a New Care Coordination Model.

PubMed

Ireland, Anne M

2016-05-01

Today's healthcare environment is characterized by a multitude of changes: acquisitions and mergers, streamlining of operations, restructuring and leadership shifts, new regulatory requirements with the 10th revision of the International Statistical Classification of Diseases and Related Health Problems, implementation and meaningful use, and advances in technology driven by the employment of electronic health records. The impact of these changes is complex and fraught with challenges in an industry that historically and culturally is cautious and slow to change. 
.

The 2016 revision of the World Health Organization classification of lymphoid neoplasms | Center for Cancer Research

Cancer.gov

A revision of the nearly 8-year-old World Health Organization classification of the lymphoid neoplasms and the accompanying monograph is being published. It reflects a consensus among hematopathologists, geneticists, and clinicians regarding both updates to current entities as well as the addition of a limited number of new provisional entities.

Diagnosis and management of headache attributed to airplane travel.

PubMed

Mainardi, Federico; Maggioni, Ferdinando; Lisotto, Carlo; Zanchin, Giorgio

2013-03-01

The headache attributed to airplane travel, also named "airplane headache", is characterized by the sudden onset of a severe head pain exclusively in relation to airplane flights, mainly during the landing phase. Secondary causes, such as upper respiratory tract infections or acute sinusitis, must be ruled out. Although its cause is not thoroughly understood, sinus barotrauma should be reasonably involved in the pathophysiological mechanisms. Furthermore, in the current International Classification of Headache Disorders, rapid descent from high altitude is not considered as a possible cause of headache, although the onset of such pain in airplane travellers or aviators has been well known since the beginning of the aviation era. On the basis of a survey we conducted with the courteous cooperation of people who had experienced this type of headache, we proposed diagnostic criteria to be added to the forthcoming revision of the International Classification of Headache Disorders. Their formal validation would favour further studies aimed at improving knowledge of the pathophysiological mechanisms involved and at implementing preventative measures.

Optimization and simplification of the Allergic and Hypersensitivity conditions classification for the ICD-11.

PubMed

Tanno, L K; Calderon, M A; Demoly, P

2016-05-01

Since 2013, an international collaboration of Allergy Academies, including first the World Allergy Organization (WAO), the American Academy of Allergy Asthma and Immunology (AAAAI), and the European Academy of Allergy and Clinical Immunology (EAACI), and then the American College of Allergy, Asthma and Immunology (ACAAI), the Latin American Society of Allergy, Asthma and Immunology (SLAAI), and the Asia Pacific Association of Allergy, Asthma and Clinical Immunology (APAAACI), has spent tremendous efforts to have a better and updated classification of allergic and hypersensitivity conditions in the forthcoming International Classification of Diseases (ICD)-11 version by providing evidences and promoting actions for the need for changes. The latest action was the implementation of a classification proposal of hypersensitivity/allergic diseases built by crowdsourcing the Allergy Academy leaderships. Following bilateral discussions with the representatives of the ICD-11 revision, a face-to-face meeting was held at the United Nations Office in Geneva and a simplification process of the hypersensitivity/allergic disorders classification was carried out to better fit the ICD structure. We are here presenting the end result of what we consider to be a model of good collaboration between the World Health Organization and a specialty. We strongly believe that the outcomes of all past and future actions will impact positively the recognition of the allergy specialty as well as the quality improvement of healthcare system for allergic and hypersensitivity conditions worldwide. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Validation of diagnosis of aplastic anaemia in La Rioja (Spain) by International Classification of Diseases codes for case ascertainment for the Spanish National Rare Diseases Registry.

PubMed

Ruiz, Elena; Ramalle-Gómara, Enrique; Quiñones, Carmen; Rabasa, Pilar; Pisón, Carlos

2015-05-01

To analyse the validity of diagnosis of aplastic anaemia (AA) by International Classification of Diseases codes in hospital discharge data (MBDS) and the mortality registry (MR) of La Rioja to detect cases to be included in the Spanish National Rare Diseases Registry. International Classification of Diseases (ICD) codes were used to detect AA cases during the period 2007-2012 from two administrative databases: the MBDS and the MR of La Rioja (Spain). Medical records of population selected by merging both databases were used to confirm true AA cases. The annual mean incidence rate of AA was calculated using confirmed incident cases. By merging both databases, 62 hypothetical AA incident patients were detected during the period 2007-2012. The medical records of the 89% of them could be revised, and they confirmed that only the 15% of the patients actually suffered AA. The annual mean AA incidence in La Rioja was 4.17 per million inhabitants (6.23 per million, males; 2.10 per million, females). The MBDS and the MR are not in themselves sufficient to ascertain AA cases in La Rioja and medical records should be reviewed to confirm true AA cases to be included in the Spanish National Rare Diseases Registry. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Why is the Diagnostic and Statistical Manual of Mental Disorders so hard to revise? Path-dependence and "lock-in" in classification.

PubMed

Cooper, Rachel

2015-06-01

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders, the D.S.M.-5, was published in May 2013. In the lead up to publication, radical changes to the classification were anticipated; there was widespread dissatisfaction with the previous edition and it was accepted that a "paradigm shift" might be required. In the end, however, and despite huge efforts at revision, the published D.S.M.-5 differs far less than originally envisaged from its predecessor. This paper considers why it is that revising the D.S.M. has become so difficult. The D.S.M. is such an important classification that this question is worth asking in its own right. The case of the D.S.M. can also serve as a study for considering stasis in classification more broadly; why and how can classifications become resistant to change? I suggest that classifications like the D.S.M. can be thought of as forming part of the infrastructure of science, and have much in common with material infrastructure. In particular, as with material technologies, it is possible for "path dependent" development to cause a sub-optimal classification to become "locked in" and hard to replace. Copyright © 2015 Elsevier Ltd. All rights reserved.

Comparisons of survival predictions using survival risk ratios based on International Classification of Diseases, Ninth Revision and Abbreviated Injury Scale trauma diagnosis codes.

PubMed

Clarke, John R; Ragone, Andrew V; Greenwald, Lloyd

2005-09-01

We conducted a comparison of methods for predicting survival using survival risk ratios (SRRs), including new comparisons based on International Classification of Diseases, Ninth Revision (ICD-9) versus Abbreviated Injury Scale (AIS) six-digit codes. From the Pennsylvania trauma center's registry, all direct trauma admissions were collected through June 22, 1999. Patients with no comorbid medical diagnoses and both ICD-9 and AIS injury codes were used for comparisons based on a single set of data. SRRs for ICD-9 and then for AIS diagnostic codes were each calculated two ways: from the survival rate of patients with each diagnosis and when each diagnosis was an isolated diagnosis. Probabilities of survival for the cohort were calculated using each set of SRRs by the multiplicative ICISS method and, where appropriate, the minimum SRR method. These prediction sets were then internally validated against actual survival by the Hosmer-Lemeshow goodness-of-fit statistic. The 41,364 patients had 1,224 different ICD-9 injury diagnoses in 32,261 combinations and 1,263 corresponding AIS injury diagnoses in 31,755 combinations, ranging from 1 to 27 injuries per patient. All conventional ICD-9-based combinations of SRRs and methods had better Hosmer-Lemeshow goodness-of-fit statistic fits than their AIS-based counterparts. The minimum SRR method produced better calibration than the multiplicative methods, presumably because it did not magnify inaccuracies in the SRRs that might occur with multiplication. Predictions of survival based on anatomic injury alone can be performed using ICD-9 codes, with no advantage from extra coding of AIS diagnoses. Predictions based on the single worst SRR were closer to actual outcomes than those based on multiplying SRRs.

Revised classification/nomenclature of vitiligo and related issues: the Vitiligo Global Issues Consensus Conference

PubMed Central

Ezzedine, K.; Lim, H. W.; Suzuki, T.; Katayama, I.; Hamzavi, I.; Lan, C. C. E.; Goh, B. K.; Anbar, T.; de Castro, C. Silva; Lee, A. Y.; Parsad, D.; van Geel, N.; Le Poole, I. C.; Oiso, N.; Benzekri, L.; Spritz, R.; Gauthier, Y.; Hann, S. K.; Picardo, M.; Taieb, A.

2012-01-01

Summary During the 2011 International Pigment Cell Conference (IPCC), the Vitiligo European Taskforce (VETF) convened a consensus conference on issues of global importance for vitiligo clinical research. As suggested by an international panel of experts, the conference focused on four topics: classification and nomenclature; definition of stable disease; definition of Koebner’s phenomenon (KP); and ‘autoimmune vitiligo’. These topics were discussed in seven working groups representing different geographical regions. A consensus emerged that segmental vitiligo be classified separately from all other forms of vitiligo and that the term ‘vitiligo’ be used as an umbrella term for all non-segmental forms of vitiligo, including ‘mixed vitiligo’ in which segmental and non-segmental vitiligo are combined and which is considered a subgroup of vitiligo. Further, the conference recommends that disease stability be best assessed based on the stability of individual lesions rather than the overall stability of the disease as the latter is difficult to define precisely and reliably. The conference also endorsed the classification of KP for vitiligo as proposed by the VETF (history based, clinical observation based, or experimentally induced). Lastly, the conference agreed that ‘autoimmune vitiligo’ should not be used as a separate classification as published evidence indicates that the pathophysiology of all forms of vitiligo likely involves autoimmune or inflammatory mechanisms. PMID:22417114

Revised classification/nomenclature of vitiligo and related issues: the Vitiligo Global Issues Consensus Conference.

PubMed

Ezzedine, K; Lim, H W; Suzuki, T; Katayama, I; Hamzavi, I; Lan, C C E; Goh, B K; Anbar, T; Silva de Castro, C; Lee, A Y; Parsad, D; van Geel, N; Le Poole, I C; Oiso, N; Benzekri, L; Spritz, R; Gauthier, Y; Hann, S K; Picardo, M; Taieb, A

2012-05-01

During the 2011 International Pigment Cell Conference (IPCC), the Vitiligo European Taskforce (VETF) convened a consensus conference on issues of global importance for vitiligo clinical research. As suggested by an international panel of experts, the conference focused on four topics: classification and nomenclature; definition of stable disease; definition of Koebner's phenomenon (KP); and 'autoimmune vitiligo'. These topics were discussed in seven working groups representing different geographical regions. A consensus emerged that segmental vitiligo be classified separately from all other forms of vitiligo and that the term 'vitiligo' be used as an umbrella term for all non-segmental forms of vitiligo, including 'mixed vitiligo' in which segmental and non-segmental vitiligo are combined and which is considered a subgroup of vitiligo. Further, the conference recommends that disease stability be best assessed based on the stability of individual lesions rather than the overall stability of the disease as the latter is difficult to define precisely and reliably. The conference also endorsed the classification of KP for vitiligo as proposed by the VETF (history based, clinical observation based, or experimentally induced). Lastly, the conference agreed that 'autoimmune vitiligo' should not be used as a separate classification as published evidence indicates that the pathophysiology of all forms of vitiligo likely involves autoimmune or inflammatory mechanisms. © 2012 John Wiley & Sons A/S.

The Revisited Classification of GN in SLE at 10 Years: Time to Re-Evaluate Histopathologic Lesions

PubMed Central

Alpers, Charles E.; Cook, H. Terence; Ferrario, Franco; Fogo, Agnes B.; Haas, Mark; Joh, Kensuke; Noël, Laure-Hélène; Seshan, Surya V.; Bruijn, Jan A.; Bajema, Ingeborg M.

2015-01-01

Over 10 years have passed since the latest revision of the histopathologic classification of lupus nephritis. This revision was a significant improvement compared with the previous version, mainly because of clearer and more concise definitions and the elimination of mixed subclasses. Despite these improvements, there are still some difficulties in the classification for lupus nephritis, many of which are in the definitions provided. In this review, we focus on the difficulties surrounding the evaluation of classes III and IV lesions, particularly the definitions of endocapillary and extracapillary proliferation, the use of the terms endocapillary proliferation and hypercellularity, the clinical relevance of segmental and global subdivision in class IV, and the value of distinguishing lesions that indicate activity and chronicity. Vascular and tubulointerstitial lesions are also discussed. Furthermore, we give an overview of the history of the classification to provide background on the origin and development of the definitions in lupus nephritis. The issues raised in this review as well as the suggestions for improvements may assist with a revision of the lupus nephritis classification in the near future. PMID:26152271

Classifying the Standards via Revised Bloom's Taxonomy: A Comparison of Pre-Service and In- Service Teachers

ERIC Educational Resources Information Center

Kocakaya, Serhat; Kotluk, Nihat

2016-01-01

The aim of this study is (a) to investigate the usefulness of Bloom's revised taxonomy (RBT) for classification of standards, (b) to examine the differences and similarities between pre-service teachers' and in-service teachers' classification of the same standards and (c) to determine which standards are vague and broad. The 45 standards, in the…

Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation

PubMed Central

2014-01-01

Background The pediatric complex chronic conditions (CCC) classification system, developed in 2000, requires revision to accommodate the International Classification of Disease 10th Revision (ICD-10). To update the CCC classification system, we incorporated ICD-9 diagnostic codes that had been either omitted or incorrectly specified in the original system, and then translated between ICD-9 and ICD-10 using General Equivalence Mappings (GEMs). We further reviewed all codes in the ICD-9 and ICD-10 systems to include both diagnostic and procedural codes indicative of technology dependence or organ transplantation. We applied the provisional CCC version 2 (v2) system to death certificate information and 2 databases of health utilization, reviewed the resulting CCC classifications, and corrected any misclassifications. Finally, we evaluated performance of the CCC v2 system by assessing: 1) the stability of the system between ICD-9 and ICD-10 codes using data which included both ICD-9 codes and ICD-10 codes; 2) the year-to-year stability before and after ICD-10 implementation; and 3) the proportions of patients classified as having a CCC in both the v1 and v2 systems. Results The CCC v2 classification system consists of diagnostic and procedural codes that incorporate a new neonatal CCC category as well as domains of complexity arising from technology dependence or organ transplantation. CCC v2 demonstrated close comparability between ICD-9 and ICD-10 and did not detect significant discontinuity in temporal trends of death in the United States. Compared to the original system, CCC v2 resulted in a 1.0% absolute (10% relative) increase in the number of patients identified as having a CCC in national hospitalization dataset, and a 0.4% absolute (24% relative) increase in a national emergency department dataset. Conclusions The updated CCC v2 system is comprehensive and multidimensional, and provides a necessary update to accommodate widespread implementation of ICD-10. PMID:25102958

Organ transplant AN-DRGs: modifying the exceptions hierarchy in casemix classification.

PubMed

Antioch, K; Zhang, X

2000-01-01

The study described in this article sought to develop AN-DRG Version 3 classification revisions for organ transplantation through statistical analyses of recommendations formulated by the Australian Casemix Clinical Committee. Two separate analyses of variance were undertaken for AN-DRG Version 2 and for the proposed Version 3 AN-DRGs, using average length of stay as the dependent variable. The committee made four key recommendations which were accepted and incorporated into AN-DRG Versions 3 and 3.1. This article focuses on the classification revisions for organ transplantation.

Air Force Operational Medicine: Using the Enterprise Estimating Supplies Program to Develop Materiel Solutions for the Operational Requirements of the Air Force Oral Surgery Team (FFMAX)

DTIC Science & Technology

2010-10-14

non-battle injuries , and illnesses. International Classification of Diseases, Ninth Revision (ICD-9) coded patient conditions that have been selected...The patient stream was used to simulate the equipment and supply requirements for the range of surgical cases and non-surgical injuries and illnesses...supplies” column identifies the items needed to complete the “Insert endo - trach tube” task at that level of capability. Not shown in this figure are

Screening for emotional disorders in patients with cancer using the Brief Symptom Inventory (BSI) and the BSI-18 versus a standardized psychiatric interview (the World Health Organization Composite International Diagnostic Interview).

PubMed

Grassi, Luigi; Caruso, Rosangela; Mitchell, Alex J; Sabato, Silvana; Nanni, Maria Giulia

2018-06-01

Given the adverse consequences of psychiatric and psychosocial morbidity on the quality of life for patients with cancer, prompt detection of psychological symptoms is mandatory. The authors examined the properties and accuracy of the Brief Symptom Inventory (the 53-item version [BSI] and the 18-item version [BSI-18]) for the detection of psychiatric morbidity compared with the World Health Organization Composite International Diagnostic Interview (CIDI) for International Classification of Diseases-10th Revision psychiatric diagnoses. A convenience sample of 498 patients with newly diagnosed cancer who were recruited in cancer outpatient services participated in the CIDI interview and in BSI and BSI-18 assessments. The prevalence of psychiatric morbidity was 39.75%. When participants were classified as cases using the BSI standard case rule, agreement with the CIDI was potentially acceptable (sensitivity, 72.7%; specificity, 88.7%). In contrast, the accuracy of the BSI-18 in identifying cases was poor according to the standard case rule, with very low sensitivity (29.3%) (misclassification rate, 28.7%). By using a first alternative case-rule system (a BSI-18 global severity index [GSI] T-score ≥57), sensitivity marginally improved (45%), whereas a second alternative case-rule system (a GSI T-score ≥50) significantly increased sensitivity (77.3%). In receiver operating characteristic curve analysis, a further cutoff GSI T-score ≥48 exhibited good discrimination levels (sensitivity, 82.3%; specificity, 72.4%). There were some differences in GSI cutoff T-scores according to the International Classification of Diseases-10th Revision diagnosis and sex. The BSI appeared to have acceptable diagnostic accuracy compared with a standardized psychiatric interview. For the BSI-18, it is mandatory to use alternative case-rule systems, to identify patients with psychiatric morbidity. Cancer 2018;124:2415-26. © 2018 American Cancer Society. © 2018 American Cancer Society.

Population-based trends in pregnancy hypertension and pre-eclampsia: an international comparative study

PubMed Central

Ford, Jane B; Algert, Charles S; Antonsen, Sussie; Chalmers, James; Cnattingius, Sven; Gokhale, Manjusha; Kotelchuck, Milton; Melve, Kari K; Langridge, Amanda; Morris, Carole; Morris, Jonathan M; Nassar, Natasha; Norman, Jane E; Norrie, John; Sørensen, Henrik Toft; Walker, Robin; Weir, Christopher J

2011-01-01

Objective The objective of this study was to compare international trends in pre-eclampsia rates and in overall pregnancy hypertension rates (including gestational hypertension, pre-eclampsia and eclampsia). Design Population data (from birth and/or hospital records) on all women giving birth were available from Australia (two states), Canada (Alberta), Denmark, Norway, Scotland, Sweden and the USA (Massachusetts) for a minimum of 6 years from 1997 to 2007. All countries used the 10th revision of the International Classification of Diseases, except Massachusetts which used the 9th revision. There were no major changes to the diagnostic criteria or methods of data collection in any country during the study period. Population characteristics as well as rates of pregnancy hypertension and pre-eclampsia were compared. Results Absolute rates varied across the populations as follows: pregnancy hypertension (3.6% to 9.1%), pre-eclampsia (1.4% to 4.0%) and early-onset pre-eclampsia (0.3% to 0.7%). Pregnancy hypertension and/or pre-eclampsia rates declined over time in most populations. This was unexpected given that factors associated with pregnancy hypertension such as pre-pregnancy obesity and maternal age are generally increasing. However, there was also a downward shift in gestational age with fewer pregnancies reaching 40 weeks. Conclusion The rate of pregnancy hypertension and pre-eclampsia decreased in northern Europe and Australia from 1997 to 2007, but increased in Massachusetts. The use of a different International Classification of Diseases coding version in Massachusetts may contribute to the difference in trend. Elective delivery prior to the due date is the most likely explanation for the decrease observed in Europe and Australia. Also, the use of interventions that reduce the risk of pregnancy hypertension and/or progression to pre-eclampsia (low-dose aspirin, calcium supplementation and early delivery for mild hypertension) may have contributed to the decline. PMID:22021762

Protocol for a qualitative study exploring perspectives on the INternational CLassification of Diseases (11th revision); Using lived experience to improve mental health Diagnosis in NHS England: INCLUDE study

PubMed Central

Hackmann, Corinna; Green, Amanda; Notley, Caitlin; Perkins, Amorette; Reed, Geoffrey M; Ridler, Joseph; Wilson, Jon; Shakespeare, Tom

2017-01-01

Introduction Developed in dialogue with WHO, this research aims to incorporate lived experience and views in the refinement of the International Classification of Diseases Mental and Behavioural Disorders 11th Revision (ICD-11). The validity and clinical utility of psychiatric diagnostic systems has been questioned by both service users and clinicians, as not all aspects reflect their lived experience or are user friendly. This is critical as evidence suggests that diagnosis can impact service user experience, identity, service use and outcomes. Feedback and recommendations from service users and clinicians should help minimise the potential for unintended negative consequences and improve the accuracy, validity and clinical utility of the ICD-11. Methods and analysis The name INCLUDE reflects the value of expertise by experience as all aspects of the proposed study are co-produced. Feedback on the planned criteria for the ICD-11 will be sought through focus groups with service users and clinicians. The data from these groups will be coded and inductively analysed using a thematic analysis approach. Findings from this will be used to form the basis of co-produced recommendations for the ICD-11. Two service user focus groups will be conducted for each of these diagnoses: Personality Disorder, Bipolar I Disorder, Schizophrenia, Depressive Disorder and Generalised Anxiety Disorder. There will be four focus groups with clinicians (psychiatrists, general practitioners and clinical psychologists). Ethics and dissemination This study has received ethical approval from the Coventry and Warwickshire HRA Research Ethics Committee (16/WM/0479). The output for the project will be recommendations that reflect the views and experiences of experts by experience (service users and clinicians). The findings will be disseminated via conferences and peer-reviewed publications. As the ICD is an international tool, the aim is for the methodology to be internationally disseminated for replication by other groups. Trial registration number ClinicalTrials.gov: NCT03131505. PMID:28871029

Prevalence of aggressive challenging behaviours in intellectual disability and its relationship to personality status: Jamaican study.

PubMed

Tyrer, P; Oliver, P; Tarabi, S A

2014-11-01

Both the classification of personality disorder in intellectual disability (ID) and its identification in practice are deemed to be difficult. A simpler approach to classification and its relationship to challenging behaviours were tested in an adult Jamaican population with ID. The study was carried out in Kingston, Jamaica, as part of a programme of field trials to determine the utility of the proposed revision of personality disorders in the 11th Revision of the International Classification of Diseases (ICD-11), in a population of adults with ID living with their families or in supported care homes. Thirty-eight people with borderline (n = 5), mild (n = 16), moderate (n = 14) and severe (n = 3) ID were assessed at face-to-face interview and with relatives or staff using the provisional criteria for severity of personality disorder and its associated domain traits, and challenging behaviour was assessed using the Problem Behaviour Check List (PBCL) (a 5-point, 7-item scale). Using the severity scale 18 patients (47%) had no personality disorder, 7 (18%) had personality difficulty, 9 (24%) had mild personality disorder, and 4 (11%) had moderate personality disorder. None of the sample had severe personality disorder in which there is high risk of harm to self or others. Of the four major trait domains, provisionally named anankastic, detached, emotional and dissocial, three were evenly distributed in those with personality disturbance with the antagonistic (antisocial) trait less commonly shown (6 only). Scores on the PBCL were higher in those with increasing severity of personality disorder (P = 0.03) and those in the antagonistic personality trait domain had the highest PCL scores. Despite previous difficulties in assessing personality disorder in intellectual difficulties the ICD-11 classification was easy to administer in practice in this population, and the higher problem behaviour scores in those with greater severity of personality disturbance support its construct validity. © 2013 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Amendments to the Center for Devices and Radiological Health federal performance standard for laser products.

PubMed

Dennis, J E

1997-12-01

Federal law requires that all laser products that are imported into or introduced into commerce in the United States comply with the performance standard published in the Code of Federal Regulations (CRF), Title 21, Parts 1040.10 and 1040.11, administered by the Center for Devices and Radiological Health (CDRH), US Food and Drug Administration. Although it contains somewhat different requirements for hazard classification, engineering controls and labeling, the ANSI Z136.1 standard defers to the CDRH standard. The CDRH standard became effective in August, 1976 and was amended, in 1978 and also in 1985. In the early 1990s, US experts met to formulate an approach to bring the requirements of the CDRH standard and those of the International Electrotechnical Commission (IEC) standard, IEC 825, into closer agreement in order to lower barriers to international trade and to remove any excessive compliance burdens on manufacturers. In 1993, the CDRH published, formally in the Federal Register and informally, a Notice of Intent to amend the CDRH standard. Responses to those notices have now been analyzed and informal draft amendments were distributed in 1996. This draft is now being prepared for formal issuance as a Notice of Proposed Rulemaking. Meanwhile, the IEC standard was amended in 1993 and republished as IEC 825-1; these amendments created considerable controversy since they resulted in over classification of the hazard of many products, especially light emitting diodes (LEDs) that have a large divergence and increased source dimensions. Additional amendments are now being developed to correct this problem. The CDRH has carefully monitored developments in the IEC and actively participated in its proceedings as a guide in developing its own proposal. This paper describes the major changes that are being proposed for the CDRH standard and presents some rationale for the major changes. The more significant changes include expansion of applicability to include LEDs, reduced emission durations for classification, revised measurement for hazard classification, reduced performance requirements for lower power visible radiation products, and revised requirements for medical products.

Risk of preterm birth by subtype among Medi-Cal participants with mental illness.

PubMed

Baer, Rebecca J; Chambers, Christina D; Bandoli, Gretchen; Jelliffe-Pawlowski, Laura L

2016-10-01

Previous studies have demonstrated an association between mental illness and preterm birth (before 37 weeks). However, these investigations have not simultaneously considered gestation of preterm birth, the indication (eg, spontaneous or medically indicated), and specific mental illness classifications. The objective of the study was to examine the likelihood of preterm birth across gestational lengths and indications among Medi-Cal (California's Medicaid program) participants with a diagnostic code for mental illness. Mental illnesses were studied by specific illness classification. The study population was drawn from singleton live births in California from 2007 through 2011 in the birth cohort file maintained by the California Office of Statewide Health Planning and Development, which includes birth certificate and hospital discharge records. The sample was restricted to women with Medi-Cal coverage for prenatal care. Women with mental illness were identified using International Classification of Diseases, ninth revision, codes from their hospital discharge record. Women without a mental illness International Classification of Diseases, ninth revision, code were randomly selected at a 4:1 ratio. Adjusting for maternal characteristics and obstetric complications, relative risks and 95% confidence intervals were calculated for preterm birth comparing women with a mental illness diagnostic code with women without such a code. We identified 6198 women with a mental illness diagnostic code and selected 24,792 women with no such code. The risk of preterm birth in women with a mental illness were 1.2 times higher than women without a mental illness (adjusted relative risk, 1.2, 95% confidence interval, 1.1-1.3). Among the specific mental illnesses, schizophrenia, major depression, and personality disorders had the strongest associations with preterm birth (adjusted relative risks, 2.0, 2.0 and 3.3, respectively). Women receiving prenatal care through California's low-income health insurance who had at least 1 mental illness diagnostic code were 1.2-3.3-times more likely to have a preterm birth than women without a mental illness, and these risks persisted across most illness classifications. Although it cannot be determined from these data whether specific treatments for mental illness contribute to the observed associations, elevated risk across different diagnoses suggests that some aspects of mental illness itself may confer risk. Copyright © 2016 Elsevier Inc. All rights reserved.

The Universal Decimal Classification: Some Factors Concerning Its Origins, Development, and Influence.

ERIC Educational Resources Information Center

McIlwaine, I. C.

1997-01-01

Discusses the history and development of the Universal Decimal Classification (UDC). Topics include the relationship with Dewey Decimal Classification; revision process; structure; facet analysis; lack of standard rules for application; application in automated systems; influence of UDC on classification development; links with thesauri; and use…

Why patients visit their doctors: assessing the most prevalent conditions in a defined American population.

PubMed

St Sauver, Jennifer L; Warner, David O; Yawn, Barbara P; Jacobson, Debra J; McGree, Michaela E; Pankratz, Joshua J; Melton, L Joseph; Roger, Véronique L; Ebbert, Jon O; Rocca, Walter A

2013-01-01

To describe the prevalence of nonacute conditions among patients seeking health care in a defined US population, emphasizing age, sex, and ethnic differences. The Rochester Epidemiology Project (REP) medical records linkage system was used to identify all residents of Olmsted County, Minnesota, on April 1, 2009, who had consented to review of their medical records for research (142,377 patients). We then electronically extracted all International Classification of Diseases, Ninth Revision codes noted in the records of these patients by any health care institution between January 1, 2005, and December 31, 2009. We grouped International Classification of Diseases, Ninth Revision codes into clinical classification codes and then into 47 broader disease groups associated with health-related quality of life. Age- and sex-specific prevalence was estimated by dividing the number of individuals within each group by the corresponding age- and sex-specific population. Patients within a group who had multiple codes were counted only once. We included a total of 142,377 patients, 75,512 (53%) of whom were female. Skin disorders (42.7%), osteoarthritis and joint disorders (33.6%), back problems (23.9%), disorders of lipid metabolism (22.4%), and upper respiratory tract disease (22.1%, excluding asthma) were the most prevalent disease groups in this population. Ten of the 15 most prevalent disease groups were more common in women in almost all age groups, whereas disorders of lipid metabolism, hypertension, and diabetes were more common in men. Additionally, the prevalence of 7 of the 10 most common groups increased with advancing age. Prevalence also varied across ethnic groups (whites, blacks, and Asians). Our findings suggest areas for focused research that may lead to better health care delivery and improved population health. Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Brief surgical procedure code lists for outcomes measurement and quality improvement in resource-limited settings.

PubMed

Liu, Charles; Kayima, Peter; Riesel, Johanna; Situma, Martin; Chang, David; Firth, Paul

2017-11-01

The lack of a classification system for surgical procedures in resource-limited settings hinders outcomes measurement and reporting. Existing procedure coding systems are prohibitively large and expensive to implement. We describe the creation and prospective validation of 3 brief procedure code lists applicable in low-resource settings, based on analysis of surgical procedures performed at Mbarara Regional Referral Hospital, Uganda's second largest public hospital. We reviewed operating room logbooks to identify all surgical operations performed at Mbarara Regional Referral Hospital during 2014. Based on the documented indication for surgery and procedure(s) performed, we assigned each operation up to 4 procedure codes from the International Classification of Diseases, 9th Revision, Clinical Modification. Coding of procedures was performed by 2 investigators, and a random 20% of procedures were coded by both investigators. These codes were aggregated to generate procedure code lists. During 2014, 6,464 surgical procedures were performed at Mbarara Regional Referral Hospital, to which we assigned 435 unique procedure codes. Substantial inter-rater reliability was achieved (κ = 0.7037). The 111 most common procedure codes accounted for 90% of all codes assigned, 180 accounted for 95%, and 278 accounted for 98%. We considered these sets of codes as 3 procedure code lists. In a prospective validation, we found that these lists described 83.2%, 89.2%, and 92.6% of surgical procedures performed at Mbarara Regional Referral Hospital during August to September of 2015, respectively. Empirically generated brief procedure code lists based on International Classification of Diseases, 9th Revision, Clinical Modification can be used to classify almost all surgical procedures performed at a Ugandan referral hospital. Such a standardized procedure coding system may enable better surgical data collection for administration, research, and quality improvement in resource-limited settings. Copyright © 2017 Elsevier Inc. All rights reserved.

Erythroleukemia shares biological features and outcome with myelodysplastic syndromes with excess blasts: a rationale for its inclusion into future classifications of myelodysplastic syndromes.

PubMed

Calvo, Xavier; Arenillas, Leonor; Luño, Elisa; Senent, Leonor; Arnan, Montserrat; Ramos, Fernando; Ardanaz, María Teresa; Pedro, Carme; Tormo, Mar; Montoro, Julia; Díez-Campelo, María; Arrizabalaga, Beatriz; Xicoy, Blanca; Bonanad, Santiago; Jerez, Andrés; Nomdedeu, Benet; Ferrer, Ana; Sanz, Guillermo F; Florensa, Lourdes

2016-12-01

Erythroleukemia was considered an acute myeloid leukemia in the 2008 World Health Organization (WHO) classification and is defined by the presence of ≥50% bone marrow erythroblasts, having <20% bone marrow blasts from total nucleated cells but ≥20% bone marrow myeloblasts from nonerythroid cells. Erythroleukemia shares clinicopathologic features with myelodysplastic syndromes, especially with erythroid-predominant myelodysplastic syndromes (≥50% bone marrow erythroblasts). The upcoming WHO revision proposes to eliminate the nonerythroid blast cell count rule and to move erythroleukemia patients into the appropriate myelodysplastic syndrome category on the basis of the absolute blast cell count. We conducted a retrospective study of patients with de novo erythroleukemia and compared their clinico-biological features and outcome with those of de novo myelodysplastic syndromes, focusing on erythroid-predominant myelodysplastic syndromes. Median overall survival of 405 erythroid-predominant myelodysplastic syndromes without excess blasts was significantly longer than that observed in 57 erythroid-predominant refractory anemias with excess blasts-1 and in 59 erythroleukemias, but no significant difference was observed between erythroid-predominant refractory anemias with excess blasts-1 and erythroleukemias. In this subset of patients with ≥50% bone marrow erythroblasts and excess blasts, the presence of a high-risk karyotype defined by the International Prognostic Scoring System or by the Revised International Prognostic Scoring System was the main prognostic factor. In the same way, the survival of 459 refractory anemias with excess blasts-2, independently of having ≥20% bone marrow blasts from nonerythroid cells or not, was almost identical to the observed in 59 erythroleukemias. Interestingly, 11 low-blast count erythroleukemias with 5 to <10% bone marrow blasts from total nucleated cells showed similar survival than the rest of erythroleukemias. Our data suggest that de novo erythroleukemia is in the spectrum of myelodysplastic syndromes with excess blasts and support its inclusion into future classifications of myelodysplastic syndromes.

Clinical and prognostic subforms of new daily-persistent headache

PubMed Central

Grosberg, B.M.; Napchan, U.; Crystal, S.C.; Lipton, R.B.

2010-01-01

Background: According to the International Classification of Headache Disorders (ICHD)–2, primary daily headaches unremitting from onset are classified as new daily-persistent headache (NDPH) only if migraine features are absent. When migraine features are present, classification is problematic. Methods: We developed a revised NDPH definition not excluding migraine features (NDPH-R), and applied it to consecutive patients seen at the Montefiore Headache Center. We divided this group into patients meeting ICHD-2 criteria (NDPH-ICHD) and those with too many migraine features for ICHD-2 (NDPH-mf). We compared clinical and demographic features in these groups, identifying 3 prognostic subgroups: persisting, remitting, and relapsing-remitting. Remitting and relapsing-remitting patients were combined into a nonpersisting group. Results: Of 71 NDPH-R patients, 31 (43.7%) also met NDPH-ICHD-2 criteria. The NDPH-mf and the NDPH-ICHD-2 groups were similar in most clinical features though the NDPH-mf group was younger, included more women, and had a higher frequency of depression. The groups were similar in the prevalence of allodynia, triptan responsiveness, and prognosis. NDPH-R prognostic subforms were also very similar, although the persisting subform was more likely to be of white race, to have anxiety or depression, and to have a younger onset age. Conclusions: Current International Classification of Headache Disorders (ICHD)–2 criteria exclude the majority of patients with primary headache unremitting from onset. The proposed criteria for revised new daily-persistent headache definition not excluding migraine features (NDPH-R) classify these patients into a relatively homogeneous group based on demographics, clinical features, and prognosis. Both new daily-persistent headache with too many migraine features for ICHD-2 and new daily-persistent headache meeting ICHD-2 criteria include patients in equal proportions that fall into the persisting, remitting, and relapsing-remitting subgroups. Our criteria for NDPH-R should be considered for inclusion in ICHD-3. PMID:20421580

Clinical and prognostic subforms of new daily-persistent headache.

PubMed

Robbins, M S; Grosberg, B M; Napchan, U; Crystal, S C; Lipton, R B

2010-04-27

According to the International Classification of Headache Disorders (ICHD)-2, primary daily headaches unremitting from onset are classified as new daily-persistent headache (NDPH) only if migraine features are absent. When migraine features are present, classification is problematic. We developed a revised NDPH definition not excluding migraine features (NDPH-R), and applied it to consecutive patients seen at the Montefiore Headache Center. We divided this group into patients meeting ICHD-2 criteria (NDPH-ICHD) and those with too many migraine features for ICHD-2 (NDPH-mf). We compared clinical and demographic features in these groups, identifying 3 prognostic subgroups: persisting, remitting, and relapsing-remitting. Remitting and relapsing-remitting patients were combined into a nonpersisting group. Of 71 NDPH-R patients, 31 (43.7%) also met NDPH-ICHD-2 criteria. The NDPH-mf and the NDPH-ICHD-2 groups were similar in most clinical features though the NDPH-mf group was younger, included more women, and had a higher frequency of depression. The groups were similar in the prevalence of allodynia, triptan responsiveness, and prognosis. NDPH-R prognostic subforms were also very similar, although the persisting subform was more likely to be of white race, to have anxiety or depression, and to have a younger onset age. Current International Classification of Headache Disorders (ICHD)-2 criteria exclude the majority of patients with primary headache unremitting from onset. The proposed criteria for revised new daily-persistent headache definition not excluding migraine features (NDPH-R) classify these patients into a relatively homogeneous group based on demographics, clinical features, and prognosis. Both new daily-persistent headache with too many migraine features for ICHD-2 and new daily-persistent headache meeting ICHD-2 criteria include patients in equal proportions that fall into the persisting, remitting, and relapsing-remitting subgroups. Our criteria for NDPH-R should be considered for inclusion in ICHD-3.

The World Health Organization 1973 classification system for grade is an important prognosticator in T1 non-muscle-invasive bladder cancer.

PubMed

van de Putte, Elisabeth E Fransen; Bosschieter, Judith; van der Kwast, Theo H; Bertz, Simone; Denzinger, Stefan; Manach, Quentin; Compérat, Eva M; Boormans, Joost L; Jewett, Michael A S; Stoehr, Robert; van Leenders, Geert J L H; Nieuwenhuijzen, Jakko A; Zlotta, Alexandre R; Hendricksen, Kees; Rouprêt, Morgan; Otto, Wolfgang; Burger, Maximilian; Hartmann, Arndt; van Rhijn, Bas W G

2018-04-10

To compare the prognostic value of the World Health Organization (WHO) 1973 and 2004 classification systems for grade in T1 bladder cancer (T1-BC), as both are currently recommended in international guidelines. Three uro-pathologists re-revised slides of 601 primary (first diagnosis) T1-BCs, initially managed conservatively (bacille Calmette-Guérin) in four hospitals. Grade was defined according to WHO1973 (Grade 1-3) and WHO2004 (low-grade [LG] and high-grade [HG]). This resulted in a lack of Grade 1 tumours, 188 (31%) Grade 2, and 413 (69%) Grade 3 tumours. There were 47 LG (8%) vs 554 (92%) HG tumours. We determined the prognostic value for progression-free survival (PFS) and cancer-specific survival (CSS) in Cox-regression models and corrected for age, sex, multiplicity, size and concomitant carcinoma in situ. At a median follow-up of 5.9 years, 148 patients showed progression and 94 died from BC. The WHO1973 Grade 3 was negatively associated with PFS (hazard ratio [HR] 2.1) and CSS (HR 3.4), whilst WHO2004 grade was not prognostic. On multivariable analysis, WHO1973 grade was the only prognostic factor for progression (HR 2.0). Grade 3 tumours (HR 3.0), older age (HR 1.03) and tumour size >3 cm (HR 1.8) were all independently associated with worse CSS. The WHO1973 classification system for grade has strong prognostic value in T1-BC, compared to the WHO2004 system. Our present results suggest that WHO1973 grade cannot be replaced by the WHO2004 classification in non-muscle-invasive BC guidelines. © 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd.

Clinical staging: its importance in therapeutic decisions and clinical trials.

PubMed

Denis, L J

1992-02-01

International collaboration has resulted in a revised and unified 1987 formulation for the TNM classification in solid tumors. The simplification and eliminations of most variables caused difficulties for the clinical use of the system in some tumors such as bladder cancer. The approval of the proposed adaptation covering the tumor mass, subdividing the T4 category and adapting the stage grouping, resolves these difficulties. Published reports demonstrate support for the TNM system as a clinical base for treatment decisions and prognosis. The TNMG stage and grade are important basic prognostic factors, but other prognostic factors, especially biologic tumor activity, are under clinical investigation. The TNM classification is the initial evaluation after histologic confirmation of cancer to guide treatment and prognosis. The quality of the evaluation is enhanced by precise communication on the employed methodology.

Psychometric properties of the Generalized Anxiety Disorder Inventory in a Canadian sample.

PubMed

Henderson, Leigh C; Antony, Martin M; Koerner, Naomi

2014-05-01

The Generalized Anxiety Disorder Inventory is a recently developed self-report measure that assesses symptoms of generalized anxiety disorder. Its psychometric properties have not been investigated further since its original development. The current study investigated its psychometric properties in a Canadian student/community sample. Exploratory principal component analysis replicated the original three-component structure. The total scale and subscales demonstrated excellent internal consistency reliability (α = 0.84-0.94) and correlated strongly with the Penn State Worry Questionnaire (r = 0.41-0.74, all ps <0.001) and Generalized Anxiety Disorder-7 (r = 0.55-0.84, all ps <0.001). However, only the total scale and cognitive subscale (r = 0.48-0.49, all ps <0.05) significantly predicted generalized anxiety disorder diagnosis established by diagnostic interview. The somatic subscale in particular may require revision to improve predictive validity. Revision may also be necessary given changes in required somatic symptoms for generalized anxiety disorder diagnostic criteria in more recent versions of the Diagnostic and Statistical Manual of Mental Disorders (i.e. although major changes occurred from Diagnostic and Statistical Manual of Mental Disorders-III-R to Diagnostic and Statistical Manual of Mental Disorders-IV, changes in Diagnostic and Statistical Manual of Mental Disorders-5 were minimal) and the possibility of changes in the upcoming 11th revision of the International Classification of Diseases.

Gender trouble: The World Health Organization, the International Statistical Classification of Diseases and Related Health Problems (ICD)-11 and the trans kids.

PubMed

Winter, Sam

2017-10-01

The World Health Organization (WHO) is revising its diagnostic manual, the International Statistical Classification of Diseases and Related Health Problems (ICD). At the time of writing, and based on recommendations from its ICD Working Group on Sexual Disorders and Sexual Health, WHO is proposing a new ICD chapter titled Conditions Related to Sexual Health, and that the gender incongruence diagnoses (replacements for the gender identity disorder diagnoses used in ICD-10) should be placed in that chapter. WHO is proposing that there should be a Gender incongruence of childhood (GIC) diagnosis for children below the age of puberty. This last proposal has come under fire. Trans community groups, as well as many healthcare professionals and others working for transgender health and wellbeing, have criticised the proposal on the grounds that the pathologisation of gender diversity at such a young age is inappropriate, unnecessary, harmful and inconsistent with WHO's approach in regard to other aspects of development in childhood and youth. Counter proposals have been offered that do not pathologise gender diversity and instead make use of Z codes to frame and document any contacts that young gender diverse children may have with health services. The author draws on his involvement in the ICD revision process, both as a member of the aforementioned WHO Working Group and as one of its critics, to put the case against the GIC proposal, and to recommend an alternative approach for ICD in addressing the needs of gender diverse children.

Is arson the crime most strongly associated with psychosis?--A national case-control study of arson risk in schizophrenia and other psychoses.

PubMed

Anwar, Sophia; Långström, Niklas; Grann, Martin; Fazel, Seena

2011-05-01

The association of psychosis with certain serious crimes, such as homicide, has been clearly demonstrated, but it is uncertain to what extent psychotic disorders are associated with arson. We used a case-control design to investigate the association of being diagnosed with schizophrenia and other psychoses and committing arson. Data were obtained from Swedish national registers for criminal convictions, hospital discharge diagnoses (International Classification of Diseases, Ninth Revision [ICD-9], and International Classification of Diseases, Tenth Revision [ICD-10]), and sociodemographic factors for 1988-2000. We included all convicted arson offenders of both sexes in Sweden (N=1689) and compared them with a random sample of general population control subjects (N=40,560). After adjustment for sociodemographic confounders, arson offenders were more likely to be diagnosed with schizophrenia (in men, adjusted odds ratio [OR]=22.6, 95% confidence interval [CI]=14.8-34.4; in women, adjusted OR=38.7, 95% CI=20.4-73.5) or other psychoses (in men, adjusted OR=17.4, 95% CI=11.1-27.5; in women, adjusted OR=30.8, 95% CI=18.8-50.6). Individuals with schizophrenia and other psychoses have significantly increased risks of an arson conviction. These risk estimates are higher than those reported for other violent crimes and place arson in the same category as homicide as crimes that are most strongly associated with psychotic disorders. © The Author 2009. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved.

Identifying clinically disruptive International Classification of Diseases 10th Revision Clinical Modification conversions to mitigate financial costs using an online tool.

PubMed

Venepalli, Neeta K; Qamruzzaman, Yusuf; Li, Jianrong John; Lussier, Yves A; Boyd, Andrew D

2014-03-01

To quantify coding ambiguity in International Classification of Diseases Ninth Revision Clinical Modification conversions (ICD-9-CM) to ICD-10-CM mappings for hematology-oncology diagnoses within an Illinois Medicaid database and an academic cancer center database (University of Illinois Cancer Center [UICC]) with the goal of anticipating challenges during ICD-10-CM transition. One data set of ICD-9-CM diagnosis codes came from the 2010 Illinois Department of Medicaid, filtered for diagnoses generated by hematology-oncology providers. The other data set of ICD-9-CM diagnosis codes came from UICC. Using a translational methodology via the Motif Web portal ICD-9-CM conversion tool, ICD-9-CM to ICD-10-CM code conversions were graphically mapped and evaluated for clinical loss of information. The transition to ICD-10-CM led to significant information loss, affecting 8% of total Medicaid codes and 1% of UICC codes; 39 ICD-9-CM codes with information loss accounted for 2.9% of total Medicaid reimbursements and 5.3% of UICC billing charges. Prior work stated hematology-oncology would be the least affected medical specialty. However, information loss affecting 5% of billing costs could evaporate the operating margin of a practice. By identifying codes at risk for complex transitions, the analytic tools described can be replicated for oncology practices to forecast areas requiring additional training and resource allocation. In summary, complex transitions and diagnosis codes associated with information loss within clinical oncology require additional attention during the transition to ICD-10-CM.

Trauma, comorbidity, and mortality following diagnoses of severe stress and adjustment disorders: a nationwide cohort study.

PubMed

Gradus, Jaimie L; Antonsen, Sussie; Svensson, Elisabeth; Lash, Timothy L; Resick, Patricia A; Hansen, Jens Georg

2015-09-01

Longitudinal outcomes following stress or trauma diagnoses are receiving attention, yet population-based studies are few. The aims of the present cohort study were to examine the cumulative incidence of traumatic events and psychiatric diagnoses following diagnoses of severe stress and adjustment disorders categorized using International Classification of Diseases, Tenth Revision, codes and to examine associations of these diagnoses with all-cause mortality and suicide. Data came from a longitudinal cohort of all Danes who received a diagnosis of reaction to severe stress or adjustment disorders (International Classification of Diseases, Tenth Revision, code F43.x) between 1995 and 2011, and they were compared with data from a general-population cohort. Cumulative incidence curves were plotted to examine traumatic experiences and psychiatric diagnoses during the study period. A Cox proportional hazards regression model was used to examine the associations of the disorders with mortality and suicide. Participants with stress diagnoses had a higher incidence of traumatic events and psychiatric diagnoses than did the comparison group. Each disorder was associated with a higher rate of all-cause mortality than that seen in the comparison cohort, and strong associations with suicide were found after adjustment. This study provides a comprehensive assessment of the associations of stress disorders with a variety of outcomes, and we found that stress diagnoses may have long-lasting and potentially severe consequences. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Identifying Pediatric Severe Sepsis and Septic Shock: Accuracy of Diagnosis Codes.

PubMed

Balamuth, Fran; Weiss, Scott L; Hall, Matt; Neuman, Mark I; Scott, Halden; Brady, Patrick W; Paul, Raina; Farris, Reid W D; McClead, Richard; Centkowski, Sierra; Baumer-Mouradian, Shannon; Weiser, Jason; Hayes, Katie; Shah, Samir S; Alpern, Elizabeth R

2015-12-01

To evaluate accuracy of 2 established administrative methods of identifying children with sepsis using a medical record review reference standard. Multicenter retrospective study at 6 US children's hospitals. Subjects were children >60 days to <19 years of age and identified in 4 groups based on International Classification of Diseases, Ninth Revision, Clinical Modification codes: (1) severe sepsis/septic shock (sepsis codes); (2) infection plus organ dysfunction (combination codes); (3) subjects without codes for infection, organ dysfunction, or severe sepsis; and (4) infection but not severe sepsis or organ dysfunction. Combination codes were allowed, but not required within the sepsis codes group. We determined the presence of reference standard severe sepsis according to consensus criteria. Logistic regression was performed to determine whether addition of codes for sepsis therapies improved case identification. A total of 130 out of 432 subjects met reference SD of severe sepsis. Sepsis codes had sensitivity 73% (95% CI 70-86), specificity 92% (95% CI 87-95), and positive predictive value 79% (95% CI 70-86). Combination codes had sensitivity 15% (95% CI 9-22), specificity 71% (95% CI 65-76), and positive predictive value 18% (95% CI 11-27). Slight improvements in model characteristics were observed when codes for vasoactive medications and endotracheal intubation were added to sepsis codes (c-statistic 0.83 vs 0.87, P = .008). Sepsis specific International Classification of Diseases, Ninth Revision, Clinical Modification codes identify pediatric patients with severe sepsis in administrative data more accurately than a combination of codes for infection plus organ dysfunction. Copyright © 2015 Elsevier Inc. All rights reserved.

Use of the International Classification of Diseases, 9th revision, coding in identifying chronic hepatitis B virus infection in health system data: implications for national surveillance.

PubMed

Mahajan, Reena; Moorman, Anne C; Liu, Stephen J; Rupp, Loralee; Klevens, R Monina

2013-05-01

With increasing use electronic health records (EHR) in the USA, we looked at the predictive values of the International Classification of Diseases, 9th revision (ICD-9) coding system for surveillance of chronic hepatitis B virus (HBV) infection. The chronic HBV cohort from the Chronic Hepatitis Cohort Study was created based on electronic health records (EHR) of adult patients who accessed services from 2006 to 2008 from four healthcare systems in the USA. Using the gold standard of abstractor review to confirm HBV cases, we calculated the sensitivity, specificity, positive and negative predictive values using one qualifying ICD-9 code versus using two qualifying ICD-9 codes separated by 6 months or greater. Of 1 652 055 adult patients, 2202 (0.1%) were confirmed as having chronic HBV. Use of one ICD-9 code had a sensitivity of 83.9%, positive predictive value of 61.0%, and specificity and negative predictive values greater than 99%. Use of two hepatitis B-specific ICD-9 codes resulted in a sensitivity of 58.4% and a positive predictive value of 89.9%. Use of one or two hepatitis B ICD-9 codes can identify cases with chronic HBV infection with varying sensitivity and positive predictive values. As the USA increases the use of EHR, surveillance using ICD-9 codes may be reliable to determine the burden of chronic HBV infection and would be useful to improve reporting by state and local health departments.

Multilocus resolution of Mugilidae phylogeny (Teleostei: Mugiliformes): Implications for the family's taxonomy.

PubMed

Xia, Rong; Durand, Jean-Dominique; Fu, Cuizhang

2016-03-01

The interrelationships among mugilids (Mugiliformes: Mugilidae) remain highly debated. Using a mitochondrial gene-based phylogeny as criterion, a revised classification with 25 genera in the Mugilidae has recently been proposed. However, phylogenetic relationships of major mitochondrial lineages remain unresolved and to gain a general acceptance the classification requires confirmation based on multilocus evidence and diagnostic morphological characters. Here, we construct a species-tree using twelve nuclear and three mitochondrial loci and infer the evolution of 71 morphological characters. Our multilocus phylogeny does not agree with previous morphology-based hypotheses for the relationships within Mugilidae, confirms the revised classification with 25 genera and further resolves their phylogenetic relationships. Using the well-resolved multilocus phylogeny as the criterion, we reclassify Mugilidae genera into three new subfamilies (Myxinae, Rhinomugilinae, and Cheloninae) and one new, recombined, subfamily (Mugilinae). The Rhinomugilinae subfamily is further divided into four tribes. The revised classification of Mugilidae is supported by morpho-anatomical synapomorphies or a combination of characters. These characters are used to erect a key to the subfamilies and genera. Copyright © 2015 Elsevier Inc. All rights reserved.

[Tourette syndrome and other tic disorders in DSM-5 – a comment].

PubMed

Roessner, Veit; Ludolph, Andrea G; Müller-Vahl, Kirsten; Neuner, Irene; Rothenberger, Aribert; Woitecki, Katrin; Münchau, Alexander

2014-03-01

The classification of tic disorders has been revised in the new fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The previously expressed suggestion to categorize tic disorders within the "Anxiety and Obsessive Compulsive Disorders" was not implemented. The section "Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence" was revised and renamed as "Neurodevelopmental Disorders." Tic disorders are classified there as movement disorders. Most of the changes are distinct improvements from both a clinical and a scientific perspective. For example, by removing the adjective "stereotype," the definition of tics is more precise and unified. Also, the new time-oriented criteria are more practical in the clinical setting, e.g., the exclusion criterion of a tic-free interval more than 3 months given for chronic tic disorders has been deleted. The renamings from "Transient" to "Provisional Tic Disorder" as well as from "Chronic" to "Persistent Tic Disorder" are welcome changes from a clinical perspective. Overall, the revision of the criteria is an important step towards providing more clarity and feasibility. However, the revised classification of tic disorders is still based only on clinical experience and not on evidence. Future studies should show whether the revised and improved criteria truly provide the optimal classification.

Cross-cultural and comparative epidemiology of insomnia: the Diagnostic and statistical manual (DSM), International classification of diseases (ICD) and International classification of sleep disorders (ICSD).

PubMed

Chung, Ka-Fai; Yeung, Wing-Fai; Ho, Fiona Yan-Yee; Yung, Kam-Ping; Yu, Yee-Man; Kwok, Chi-Wa

2015-04-01

To compare the prevalence of insomnia according to symptoms, quantitative criteria, and Diagnostic and Statistical Manual of Mental Disorders, 4th and 5th Edition (DSM-IV and DSM-5), International Classification of Diseases, 10th Revision (ICD-10), and International Classification of Sleep Disorders, 2nd Edition (ICSD-2), and to compare the prevalence of insomnia disorder between Hong Kong and the United States by adopting a similar methodology used by the America Insomnia Survey (AIS). Population-based epidemiological survey respondents (n = 2011) completed the Brief Insomnia Questionnaire (BIQ), a validated scale generating DSM-IV, DSM-5, ICD-10, and ICSD-2 insomnia disorder. The weighted prevalence of difficulty falling asleep, difficulty staying asleep, waking up too early, and non-restorative sleep that occurred ≥3 days per week was 14.0%, 28.3%, 32.1%, and 39.9%, respectively. When quantitative criteria were included, the prevalence dropped the most from 39.9% to 8.4% for non-restorative sleep, and the least from 14.0% to 12.9% for difficulty falling asleep. The weighted prevalence of DSM-IV, ICD-10, ICSD-2, and any of the three insomnia disorders was 22.1%, 4.7%, 15.1%, and 22.1%, respectively; for DSM-5 insomnia disorder, it was 10.8%. Compared with 22.1%, 3.9%, and 14.7% for DSM-IV, ICD-10, and ICSD-2 in the AIS, cross-cultural difference in the prevalence of insomnia disorder is less than what is expected. The prevalence is reduced by half from DSM-IV to DSM-5. ICD-10 insomnia disorder has the lowest prevalence, perhaps because excessive concern and preoccupation, one of its diagnostic criteria, is not always present in people with insomnia. Copyright © 2014 Elsevier B.V. All rights reserved.

Interrelationship between Autism Diagnostic Observation Schedule-Generic (ADOS-G), Autism Diagnostic Interview-Revised (ADI-R), and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) Classification in Children and Adolescents with Mental Retardation

ERIC Educational Resources Information Center

de Bildt, Annelies; Sytema, Sjoerd; Ketelaars, Cees; Kraijer, Dirk; Mulder, Erik; Volkmar, Fred; Minderaa, Ruud

2004-01-01

The interrelationship between the Autism Diagnostic Interview-Revised (ADI-R), Autism Diagnostic Observation Schedule-Generic (ADOS-G) and clinical classification was studied in 184 children and adolescents with Mental Retardation (MR). The agreement between the ADI-R and ADOS-G was fair, with a substantial difference between younger and older…

Histiocytosis

MedlinePlus

... of diseases has led experts to develop new classifications. Five categories have been proposed: L group -- includes ... J-F, Abla O, Fraitag S, et al. Revised classification of histiocytoses and neoplasms of the macrophage-dendritic ...

Headache classification: criticism and suggestions.

PubMed

Manzoni, G C; Torelli, P

2004-10-01

The International Classification of Headache Disorders 2nd Edition (ICHD-II), published in 2004, marks an unquestionable progress from the preceding 1988 edition, but the in-depth analysis it offers is not immune from drawbacks and shortcomings. First of all, it is still basically a classification of attacks and not of syndromes. For the migraine group, while the revised classification more accurately characterises migraine with aura, it fails to provide a sufficiently structured description of those forms of migraine without aura that over the years evolve to so-called daily chronic forms. These forms are not adequately recognised as chronic migraine, which ICHD-II includes among the complications of migraine. The inclusion of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) in the cluster headache group is bound to generate some perplexity, while the recognition of new daily persistent headache (NDPH) included in the group of other primary headaches as a separate clinical entity appears somewhat premature. Doubts are also raised by the actual existence of triptan-overuse headache, which ICHD-II includes in Group 8 among medication-overuse headaches. Finally, the addition of headache attributed to psychiatric disorder, which is certainly a good option in perspective, is not yet supported by an adequate systematisation.

Evaluation of the ACR and SLICC classification criteria in juvenile-onset systemic lupus erythematosus: a longitudinal analysis.

PubMed

Lythgoe, H; Morgan, T; Heaf, E; Lloyd, O; Al-Abadi, E; Armon, K; Bailey, K; Davidson, J; Friswell, M; Gardner-Medwin, J; Haslam, K; Ioannou, Y; Leahy, A; Leone, V; Pilkington, C; Rangaraj, S; Riley, P; Tizard, E J; Wilkinson, N; Beresford, M W

2017-10-01

Objectives The Systemic Lupus International Collaborating Clinics (SLICC) group proposed revised classification criteria for systemic lupus erythematosus (SLICC-2012 criteria). This study aimed to compare these criteria with the well-established American College of Rheumatology classification criteria (ACR-1997 criteria) in a national cohort of juvenile-onset systemic lupus erythematosus (JSLE) patients and evaluate how patients' classification criteria evolved over time. Methods Data from patients in the UK JSLE Cohort Study with a senior clinician diagnosis of probable evolving, or definite JSLE, were analyzed. Patients were assessed using both classification criteria within 1 year of diagnosis and at latest follow up (following a minimum 12-month follow-up period). Results A total of 226 patients were included. The SLICC-2012 was more sensitive than ACR-1997 at diagnosis (92.9% versus 84.1% p < 0.001) and after follow up (100% versus 92.0% p < 0.001). Most patients meeting the SLICC-2012 criteria and not the ACR-1997 met more than one additional criterion on the SLICC-2012. Conclusions The SLICC-2012 was better able to classify patients with JSLE than the ACR-1997 and did so at an earlier stage in their disease course. SLICC-2012 should be considered for classification of JSLE patients in observational studies and clinical trial eligibility.

Comparing the Utility of the 2000 and 2005 Carnegie Classification Systems in Research on Students' College Experiences and Outcomes

ERIC Educational Resources Information Center

McCormick, Alexander C.; Pike, Gary R.; Kuh, George D.; Chen, Pu-Shih Daniel

2009-01-01

This study compares the explanatory power of the 2000 edition of Carnegie Classification, the 2005 revision of the classification, and selected variables underlying Carnegie's expanded 2005 classification system using data from the National Survey of Student Engagement's spring 2004 administration. Results indicate that the 2000 and 2005…

Translation of the Department of Defense Disease and Injury Codes to the Eighth Revision International Classification of Diseases for use by the Military Services.

DTIC Science & Technology

1976-06-01

with, the DDDIC entity. 3. The ICDA-8 contracts groups of diseases or accidents which had been presented in expanded form in the DDDIC. Example: DDDIC...DDDIC. 4. The ICDA-8 expands groups of entities which had been presented in more condensed folin in the DDDIC. Example: DDDIC ICDA-8 Code Ntmuber Code...rapidly find a disease entity and all closely related entities. At the Naval Health Research Center (N11RC) a new code nunber was given to each

The Tragedy of the Implementation of ICD-10-CM as ICD-10: Is the Cart Before the Horse or Is There a Tragic Paradox of Misinformation and Ignorance?

PubMed

Manchikanti, Laxmaiah; Kaye, Alan D; Singh, Vijay; Boswell, Mark V

2015-01-01

The forced implementation of ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) codes that are specific to the United States, scheduled for implementation October 1, 2015, which is vastly different from ICD-10 (International Classification of Diseases, Tenth Revision), implemented worldwide, which has 14,400 codes, compared to ICD-10-CM with 144,000 codes to be implemented in the United States is a major concern to practicing U.S. physicians and a bonanza for health IT and hospital industry. This implementation is based on a liberal interpretation of the Health Insurance Portability and Accountability Act (HIPAA), which requires an update to ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) and says nothing about ICD-10 or beyond. On June 29, 2015, the Supreme Court ruled that the Environmental Protection Agency unreasonably interpreted the Clean Air Act when it decided to set limits on the emissions of toxic pollutants from power plants, without first considering the costs on the industry. Thus, to do so is applicable to the medical industry with the Centers for Medicare and Medicaid Services (CMS) unreasonably interpreting HIPAA and imposing existent extensive regulations without considering the cost. In the United States, ICD-10-CM with a 10-fold increase in the number of codes has resulted in a system which has become so complicated that it no longer compares with any other country. Moreover, most WHO members use the ICD-10 system (not ICD-10-CM) only to record mortality in 138 countries or morbidity in 99 countries. Currently, only 10 countries employ ICD-10 (not ICD-10-CM) in the reimbursement process, 6 of which have a single payer health care system. Development of ICD-10-CM is managed by 4 non-physician groups, known as cooperating parties. They include the Centers for Disease Control and Prevention (CDC), CMS, the American Hospital Association (AHA), and the American Health Information Management Association (AHIMA). The AHIMA has taken the lead with the AHA just behind, both with escalating profits and influence, essentially creating a statutory monopoly for their own benefit. Further, the ICD-10-CM coalition includes 3M which will boost its revenues and profits substantially with its implementation and Blue Cross Blue Shield which has its own agenda. Physician groups are not a party to these cooperating parties or coalitions, having only a peripheral involvement. ICD-10-CM creates numerous deficiencies with 500 codes that are more specific in ICD-9-CM than ICD-10-CM. The costs of an implementation are enormous, along with maintenance costs, productivity, and cash disruptions.

Classification of Instructional Programs: 2000 Edition.

ERIC Educational Resources Information Center

Morgan, Robert L.; Hunt, E. Stephen

This third revision of the Classification of Instructional Programs (CIP) updates and modifies education program classifications, providing a taxonomic scheme that supports the accurate tracking, assessment, and reporting of field of study and program completions activity. This edition has also been adopted as the standard field of study taxonomy…

77 FR 39747 - Changes in Postal Rates

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-05

... with the Commission of a proposal characterized as a minor classification change under 39 CFR parts 3090 and 3091, along with a conforming revision to the Mail Classification Schedule (MCS).\\1\\ The... Flat Rate Envelope options. \\1\\ Notice of United States Postal Service of Classification Changes, June...

Transition to international classification of disease version 10, clinical modification: the impact on internal medicine and internal medicine subspecialties.

PubMed

Caskey, Rachel N; Abutahoun, Angelos; Polick, Anne; Barnes, Michelle; Srivastava, Pavan; Boyd, Andrew D

2018-05-04

The US health care system uses diagnostic codes for billing and reimbursement as well as quality assessment and measuring clinical outcomes. The US transitioned to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) on October, 2015. Little is known about the impact of ICD-10-CM on internal medicine and medicine subspecialists. We used a state-wide data set from Illinois Medicaid specified for Internal Medicine providers and subspecialists. A total of 3191 ICD-9-CM codes were used for 51,078 patient encounters, for a total cost of US $26,022,022 for all internal medicine. We categorized all of the ICD-9-CM codes based on the complexity of mapping to ICD-10-CM as codes with complex mapping could result in billing or administrative errors during the transition. Codes found to have complex mapping and frequently used codes (n = 295) were analyzed for clinical accuracy of mapping to ICD-10-CM. Each subspecialty was analyzed for complexity of codes used and proportion of reimbursement associated with complex codes. Twenty-five percent of internal medicine codes have convoluted mapping to ICD-10-CM, which represent 22% of Illinois Medicaid patients, and 30% of reimbursements. Rheumatology and Endocrinology had the greatest proportion of visits and reimbursement associated with complex codes. We found 14.5% of ICD-9-CM codes used by internists, when mapped to ICD-10-CM, resulted in potential clinical inaccuracies. We identified that 43% of diagnostic codes evaluated and used by internists and that account for 14% of internal medicine reimbursements are associated with codes which could result in administrative errors.

Ethical aspects of personality disorders.

PubMed

Bendelow, Gillian

2010-11-01

To review recent literature around the controversial diagnosis of personality disorder, and to assess the ethical aspects of its status as a medical disorder. The diagnostic currency of personality disorder as a psychiatric/medical disorder has a longstanding history of ethical and social challenges through critiques of the medicalization of deviance. More recently controversies by reflexive physicians around the inclusion of the category in the forthcoming revisions of International Classification of Diseases and Diagnostic and Statistical Manual of Mental Disorders classifications reflect the problems of value-laden criteria, with the diagnostic category being severely challenged from within psychiatry as well as from without. The clinical diagnostic criteria for extremely value-laden psychiatric conditions such as personality disorder need to be analyzed through the lens of values-based medicine, as well as through clinical evidence, as the propensity for political and sociolegal appropriation of the categories can render their clinical and diagnostic value meaningless.

Fatal anaphylaxis registries data support changes in the who anaphylaxis mortality coding rules.

PubMed

Tanno, Luciana Kase; Simons, F Estelle R; Annesi-Maesano, Isabella; Calderon, Moises A; Aymé, Ségolène; Demoly, Pascal

2017-01-13

Anaphylaxis is defined as a severe life-threatening generalized or systemic hypersensitivity reaction. The difficulty of coding anaphylaxis fatalities under the World Health Organization (WHO) International Classification of Diseases (ICD) system is recognized as an important reason for under-notification of anaphylaxis deaths. On current death certificates, a limited number of ICD codes are valid as underlying causes of death, and death certificates do not include the word anaphylaxis per se. In this review, we provide evidences supporting the need for changes in WHO mortality coding rules and call for addition of anaphylaxis as an underlying cause of death on international death certificates. This publication will be included in support of a formal request to the WHO as a formal request for this move taking the 11 th ICD revision.

78 FR 57870 - Agency Information Collection Activities: Registration for Classification as Refugee; Revision of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-20

... DEPARTMENT OF HOMELAND SECURITY U.S. Citizenship and Immigration Services [OMB Control Number 1615-0068; Form I-590] Agency Information Collection Activities: Registration for Classification as Refugee... Classification as Refuge. (3) Agency form number, if any, and the applicable component of the DHS sponsoring the...

40 CFR 52.321 - Classification of regions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 3 2011-07-01 2011-07-01 false Classification of regions. 52.321 Section 52.321 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Colorado § 52.321 Classification of regions. The revised Denver Emergency Episode Plan, adopte...

40 CFR 52.321 - Classification of regions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 3 2010-07-01 2010-07-01 false Classification of regions. 52.321 Section 52.321 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Colorado § 52.321 Classification of regions. The revised Denver Emergency Episode Plan, adopte...

Incidence of Systemic Lupus Erythematosus in a Population Based Cohort using Revised 1997 American College of Rheumatology and the 2012 Systemic Lupus International Collaborating Clinic Classification Criteria

PubMed Central

Ungprasert, Patompong; Sagar, Vinay; Crowson, Cynthia S.; Amin, Shreyasee; Makol, Ashima; Ernste, Floranne C.; Osborn, Thomas G.; Moder, Kevin G.; Niewold, Timothy B.; Maradit-Kremers, Hilal; Ramsey-Goldman, Rosalind; Chowdhary, Vaidehi R.

2016-01-01

In 2012, the Systemic Lupus International Collaborating Clinic (SLICC) group published a new set of classification criteria for systemic lupus erythematosus (SLE). Studies applying these criteria to real life scenarios have found either equal or greater sensitivity and equal or lower specificity to the 1997 ACR classification criteria (ACR 97). Nonetheless, there are no studies that have used the SLICC 12 criteria to investigate the incidence of lupus. We utilized the resource of the Rochetser Epidemiology Project to identify incident cases of SLE in Olmsted County, Minnesota from 1993-2005 who fulfilled the ACR 97 or SLICC 12 criteria. A total of 58 patients met criteria by SLICC 12 and 44 patients met criteria by ACR 97. The adjusted incidence of 4.9 per 100,000 person-years by SLICC 12 was higher than that by ACR 97 (3.7 per 100,000 person-years, p=0.04). The median duration from the appearance of first criteria to fulfillment of the criteria was shorter for the SLICC 12 than for ACR 97 (3.9 months vs 8.1 months). The higher incidence by SLICC 12 criteria came primarily from the ability to classify patients with renal-limited disease, the expansion of the immunologic criteria and the expansion of neurologic criteria. PMID:27365370

Incidence of systemic lupus erythematosus in a population-based cohort using revised 1997 American College of Rheumatology and the 2012 Systemic Lupus International Collaborating Clinics classification criteria.

PubMed

Ungprasert, P; Sagar, V; Crowson, C S; Amin, S; Makol, A; Ernste, F C; Osborn, T G; Moder, K G; Niewold, T B; Maradit-Kremers, H; Ramsey-Goldman, R; Chowdhary, V R

2017-03-01

In 2012, the Systemic Lupus International Collaborating Clinics (SLICC) group published a new set of classification criteria for systemic lupus erythematosus (SLE). Studies applying these criteria to real-life scenarios have found either equal or greater sensitivity and equal or lower specificity to the 1997 ACR classification criteria (ACR 97). Nonetheless, there are no studies that have used the SLICC 12 criteria to investigate the incidence of lupus. We used the resource of the Rochester Epidemiology Project to identify incident SLE patients in Olmsted County, Minnesota, from 1993 to 2005, who fulfilled the ACR 97 or SLICC 12 criteria. A total of 58 patients met criteria by SLICC 12 and 44 patients met criteria by ACR 97. The adjusted incidence of 4.9 per 100,000 person-years by SLICC 12 was higher than that by ACR 97 (3.7 per 100,000 person-years, p = 0.04). The median duration from the appearance of first criterion to fulfillment of the criteria was shorter for the SLICC 12 than for ACR 97 (3.9 months vs 8.1 months). The higher incidence by SLICC 12 criteria came primarily from the ability to classify patients with renal-limited disease, the expansion of the immunologic criteria and the expansion of neurologic criteria.

Glossary: Defense Acquisition Acronyms and Terms. Revision 2

DTIC Science & Technology

1987-07-01

Approved REPORT DOCUMENTATION PAGE OMBNo. 070-O 18 la. REPORT SECURITY CLASSIFICATION lb. RESTRICTIVE MARKINGS % unclassified 2a. SECURITY CLASSIFICATION ...WORK UNIT Fort Belvoir, VA 22060-5426 ELEMENT NO. NO. NO. ACCESSION NO. 11. TITLE (Include Security Classification ) Glossary Defense Acquisition...DISTRIBUTION/AVAILABILITY OF ABSTRACT 21 ABSTRACT SECURITY CLASSIFICATION [RUNCLASSIFIED/UNLIMITED 0 SAME AS RPT 0 DTIC USERS unclassified 22a. NAME OF

The revised WHO dengue case classification: does the system need to be modified?

PubMed

Hadinegoro, Sri Rezeki S

2012-05-01

There has been considerable debate regarding the value of both the 1997 and 2009 World Health Organization (WHO) dengue case classification criteria for its diagnosis and management. Differentiation between classic dengue fever (DF) and dengue haemorrhagic fever (DHF) or severe dengue is a key aspect of dengue case classification. The geographic expansion of dengue and its increased incidence in older age groups have contributed to the limited applicability of the 1997 case definitions. Clinical experience of dengue suggests that the illness presents as a spectrum of disease instead of distinct phases. However, despite the rigid grouping of dengue into DF, DHF and dengue shock syndrome (DSS), overlap between the different manifestations has often been observed, which has affected clinical management and triage of patients. The findings of the DENCO study evaluating the 1997 case definitions formed the basis of the revised 2009 WHO case definitions, which classified the illness into dengue with and without warning signs and severe dengue. Although the revised scheme is more sensitive to the diagnosis of severe dengue, and beneficial to triage and case management, there remain issues with its applicability. It is considered by many to be too broad, requiring more specific definition of warning signs. Quantitative research into the predictive value of these warning signs on patient outcomes and the cost-effectiveness of the new classification system is required to ascertain whether the new classification system requires further modification, or whether elements of both classification systems can be combined.

Hypochondriasis: considerations for ICD-11.

PubMed

van den Heuvel, Odile A; Veale, David; Stein, Dan J

2014-01-01

The World Health Organization (WHO) is currently revisiting the ICD. In the 10th version of the ICD, approved in 1990, hypochondriacal symptoms are described in the context of both the primary condition hypochondriacal disorder and as secondary symptoms within a range of other mental disorders. Expansion of the research base since 1990 makes a critical evaluation and revision of both the definition and classification of hypochondriacal disorder timely. This article addresses the considerations reviewed by members of the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders in their proposal for the description and classification of hypochondriasis. The proposed revision emphasizes the phenomenological overlap with both anxiety disorders (e.g., fear, hypervigilance to bodily symptoms, and avoidance) and obsessive-compulsive and related disorders (e.g., preoccupation and repetitive behaviors) and the distinction from the somatoform disorders (presence of somatic symptom is not a critical characteristic). This revision aims to improve clinical utility by enabling better recognition and treatment of patients with hypochondriasis within the broad range of global health care settings.

WHO Study on the reliability and validity of the alcohol and drug use disorder instruments: overview of methods and results.

PubMed

Ustün, B; Compton, W; Mager, D; Babor, T; Baiyewu, O; Chatterji, S; Cottler, L; Göğüş, A; Mavreas, V; Peters, L; Pull, C; Saunders, J; Smeets, R; Stipec, M R; Vrasti, R; Hasin, D; Room, R; Van den Brink, W; Regier, D; Blaine, J; Grant, B F; Sartorius, N

1997-09-25

The WHO Study on the reliability and validity of the alcohol and drug use disorder instruments in an international study which has taken place in centres in ten countries, aiming to test the reliability and validity of three diagnostic instruments for alcohol and drug use disorders: the Composite International Diagnostic Interview (CIDI), the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and a special version of the Alcohol Use Disorder and Associated Disabilities Interview schedule-alcohol/drug-revised (AUDADIS-ADR). The purpose of the reliability and validity (R&V) study is to further develop the alcohol and drug sections of these instruments so that a range of substance-related diagnoses can be made in a systematic, consistent, and reliable way. The study focuses on new criteria proposed in the tenth revision of the International Classification of Diseases (ICD-10) and the fourth revision of the diagnostic and statistical manual of mental disorders (DSM-IV) for dependence, harmful use and abuse categories for alcohol and psychoactive substance use disorders. A systematic study including a scientifically rigorous measure of reliability (i.e. 1 week test-retest reliability) and validity (i.e. comparison between clinical and non-clinical measures) has been undertaken. Results have yielded useful information on reliability and validity of these instruments at diagnosis, criteria and question level. Overall the diagnostic concordance coefficients (kappa, kappa) were very good for dependence disorders (0.7-0.9), but were somewhat lower for the abuse and harmful use categories. The comparisons among instruments and independent clinical evaluations and debriefing interviews gave important information about possible sources of unreliability, and provided useful clues on the applicability and consistency of nosological concepts across cultures.

Standardizing texture and facies codes for a process-based classification of clastic sediment and rock

USGS Publications Warehouse

Farrell, K.M.; Harris, W.B.; Mallinson, D.J.; Culver, S.J.; Riggs, S.R.; Pierson, J.; ,; Lautier, J.C.

2012-01-01

Proposed here is a universally applicable, texturally based classification of clastic sediment that is independent from composition, cementation, and geologic environment, is closely allied to process sedimentology, and applies to all compartments in the source-to-sink system. The classification is contingent on defining the term "clastic" so that it is independent from composition or origin and includes any particles or grains that are subject to erosion, transportation, and deposition. Modifications to Folk's (1980) texturally based classification that include applying new assumptions and defining a broader array of textural fields are proposed to accommodate this. The revised ternary diagrams include additional textural fields that better define poorly sorted and coarse-grained deposits, so that all end members (gravel, sand, and mud size fractions) are included in textural codes. Revised textural fields, or classes, are based on a strict adherence to volumetric estimates of percentages of gravel, sand, and mud size grain populations, which by definition must sum to 100%. The new classification ensures that descriptors are applied consistently to all end members in the ternary diagram (gravel, sand, and mud) according to several rules, and that none of the end members are ignored. These modifications provide bases for standardizing vertical displays of texture in graphic logs, lithofacies codes, and their derivatives- hydrofacies. Hydrofacies codes are nondirectional permeability indicators that predict aquifer or reservoir potential. Folk's (1980) ternary diagram for fine-grained clastic sediments (sand, silt, and clay size fractions) is also revised to preserve consistency with the revised diagram for gravel, sand, and mud. Standardizing texture ensures that the principles of process sedimentology are consistently applied to compositionally variable rock sequences, such as mixed carbonate-siliciclastic ramp settings, and the extreme ends of depositional systems.

Characterization of craniomaxillofacial battle injuries sustained by United States service members in the current conflicts of Iraq and Afghanistan.

PubMed

Lew, Timothy A; Walker, John A; Wenke, Joseph C; Blackbourne, Lorne H; Hale, Robert G

2010-01-01

To characterize and describe the craniomaxillofacial (CMF) battlefield injuries sustained by US Service Members in Operation Iraqi Freedom and Operation Enduring Freedom. The Joint Theater Trauma Registry was queried from October 19, 2001, to December 11, 2007, for CMF battlefield injuries. The CMF injuries were identified using the "International Classification of Diseases, Ninth Revision, Clinical Modification" codes and the data compiled for battlefield injury service members. Nonbattlefield injuries, killed in action, and return to duty cases were excluded. CMF battlefield injuries were found in 2,014 of the 7,770 battlefield-injured US service members. In the 2,014 injured service members were 4,783 CMF injuries (2.4 injuries per soldier). The incidence of CMF battlefield injuries by branch of service was Army, 72%; Marines, 24%; Navy, 2%; and Air Force, 1%. The incidence of penetrating soft-tissue injuries and fractures was 58% and 27%, respectively. Of the fractures, 76% were open. The location of the facial fractures was the mandible in 36%, maxilla/zygoma in 19%, nasal in 14%, and orbit in 11%. The remaining 20% were not otherwise specified. The primary mechanism of injury involved explosive devices (84%). Of the injured US service members, 26% had injuries to the CMF region in the Operation Iraqi Freedom/Operation Enduring Freedom conflicts during a 6-year period. Multiple penetrating soft-tissue injuries and fractures caused by explosive devices were frequently seen. Increased survivability because of body armor, advanced battlefield medicine, and the increased use of explosive devices is probably related to the elevated incidence of CMF battlefield injuries. The current use of "International Classification of Diseases, Ninth Revision, Clinical Modification" codes with the Joint Theater Trauma Registry failed to characterize the severity of facial wounds.

Variability in Standard Outcomes of Posterior Lumbar Fusion Determined by National Databases.

PubMed

Joseph, Jacob R; Smith, Brandon W; Park, Paul

2017-01-01

National databases are used with increasing frequency in spine surgery literature to evaluate patient outcomes. The differences between individual databases in relationship to outcomes of lumbar fusion are not known. We evaluated the variability in standard outcomes of posterior lumbar fusion between the University HealthSystem Consortium (UHC) database and the Healthcare Cost and Utilization Project National Inpatient Sample (NIS). NIS and UHC databases were queried for all posterior lumbar fusions (International Classification of Diseases, Ninth Revision code 81.07) performed in 2012. Patient demographics, comorbidities (including obesity), length of stay (LOS), in-hospital mortality, and complications such as urinary tract infection, deep venous thrombosis, pulmonary embolism, myocardial infarction, durotomy, and surgical site infection were collected using specific International Classification of Diseases, Ninth Revision codes. Analysis included 21,470 patients from the NIS database and 14,898 patients from the UHC database. Demographic data were not significantly different between databases. Obesity was more prevalent in UHC (P = 0.001). Mean LOS was 3.8 days in NIS and 4.55 in UHC (P < 0.0001). Complications were significantly higher in UHC, including urinary tract infection, deep venous thrombosis, pulmonary embolism, myocardial infarction, surgical site infection, and durotomy. In-hospital mortality was similar between databases. NIS and UHC databases had similar demographic patient populations undergoing posterior lumbar fusion. However, the UHC database reported significantly higher complication rate and longer LOS. This difference may reflect academic institutions treating higher-risk patients; however, a definitive reason for the variability between databases is unknown. The inability to precisely determine the basis of the variability between databases highlights the limitations of using administrative databases for spinal outcome analysis. Copyright © 2016 Elsevier Inc. All rights reserved.

[Incidence and evolution of congenital heart disease in Spain from 2003 until 2012].

PubMed

Pérez-Lescure Picarzo, Javier; Mosquera González, Margarita; Latasa Zamalloa, Pello; Crespo Marcos, David

2018-03-29

Congenital heart disease (CHD) represents the most common congenital malformation. The objective of this study was to analyse the incidence of CHD in Spain, and it is the first nationwide study so far. A retrospective observational study was performed in order to evaluate the incidence of CHD in Spain. The administrative database (minimum basic data set) from 2003 to 2012 was analysed in children less than one year old admitted to hospital with codes of CHD (International Classification of Diseases, 9th Revision, clinical modification). Cumulative incidence, Incidence relative risk, and standardised incidence ratio were calculated to study geographic variations. There were 64,831 infants with CHD among the 4,766,325 births analysed during the period studied, with an incidence of 13.6‰. The incidence excluding atrial septal defect was 7.29 ‰.The most frequent CHD were atrial septal defect (6.31‰), ventricular septal defect (3.48‰), patent ductus arteriosus (2.71‰), coarctation of the aorta (0.55‰), pulmonary stenosis (0.50‰), transposition of the great arteries (0.49‰), atrioventricular septal defect (0.45‰), and tetralogy of Fallot (0.41‰). Castilla and Leon, together with Extremadura, showed the highest risks for severe and very severe CHD, while Madrid and Cantabria showed the lowest. An increase of mild CHD was observed during the period analysed. This could have been influenced by improvements in diagnostic techniques, extended use of echocardiography, and the International Classification of Diseases, 9th Revision, clinical modification coding system, and to a decrease in very severe CHD, which is less influenced by external factors. Significant geographical differences were found in the incidence of severe and very severe CHD. Copyright © 2018. Publicado por Elsevier España, S.L.U.

Validation of an International Statistical Classification of Diseases and Related Health Problems 10th Revision Coding Algorithm for Hospital Encounters with Hypoglycemia.

PubMed

Hodge, Meryl C; Dixon, Stephanie; Garg, Amit X; Clemens, Kristin K

2017-06-01

To determine the positive predictive value and sensitivity of an International Statistical Classification of Diseases and Related Health Problems, 10th Revision, coding algorithm for hospital encounters concerning hypoglycemia. We carried out 2 retrospective studies in Ontario, Canada. We examined medical records from 2002 through 2014, in which older adults (mean age, 76) were assigned at least 1 code for hypoglycemia (E15, E160, E161, E162, E1063, E1163, E1363, E1463). The positive predictive value of the algorithm was calculated using a gold-standard definition (blood glucose value <4 mmol/L or physician diagnosis of hypoglycemia). To determine the algorithm's sensitivity, we used linked healthcare databases to identify older adults (mean age, 77) with laboratory plasma glucose values <4 mmol/L during a hospital encounter that took place between 2003 and 2011. We assessed how frequently a code for hypoglycemia was present. We also examined the algorithm's performance in differing clinical settings (e.g. inpatient vs. emergency department, by hypoglycemia severity). The positive predictive value of the algorithm was 94.0% (95% confidence interval 89.3% to 97.0%), and its sensitivity was 12.7% (95% confidence interval 11.9% to 13.5%). It performed better in the emergency department and in cases of more severe hypoglycemia (plasma glucose values <3.5 mmol/L compared with ≥3.5 mmol/L). Our hypoglycemia algorithm has a high positive predictive value but is limited in sensitivity. Although we can be confident that older adults who are assigned 1 of these codes truly had a hypoglycemia event, many episodes will not be captured by studies using administrative databases. Copyright © 2017 Diabetes Canada. Published by Elsevier Inc. All rights reserved.

Palliative Care for Hospitalized Patients With Stroke: Results From the 2010 to 2012 National Inpatient Sample.

PubMed

Singh, Tarvinder; Peters, Steven R; Tirschwell, David L; Creutzfeldt, Claire J

2017-09-01

Substantial variability exists in the use of life-prolonging treatments for patients with stroke, especially near the end of life. This study explores patterns of palliative care utilization and death in hospitalized patients with stroke across the United States. Using the 2010 to 2012 nationwide inpatient sample databases, we included all patients discharged with stroke identified by International Classification of Diseases-Ninth Revision codes. Strokes were subclassified as ischemic, intracerebral, and subarachnoid hemorrhage. We compared demographics, comorbidities, procedures, and outcomes between patients with and without a palliative care encounter (PCE) as defined by the International Classification of Diseases-Ninth Revision code V66.7. Pearson χ 2 test was used for categorical variables. Multivariate logistic regression was used to account for hospital, regional, payer, and medical severity factors to predict PCE use and death. Among 395 411 patients with stroke, PCE was used in 6.2% with an increasing trend over time ( P <0.05). We found a wide range in PCE use with higher rates in patients with older age, hemorrhagic stroke types, women, and white race (all P <0.001). Smaller and for-profit hospitals saw lower rates. Overall, 9.2% of hospitalized patients with stroke died, and PCE was significantly associated with death. Length of stay in decedents was shorter for patients who received PCE. Palliative care use is increasing nationally for patients with stroke, especially in larger hospitals. Persistent disparities in PCE use and mortality exist in regards to age, sex, race, region, and hospital characteristics. Given the variations in PCE use, especially at the end of life, the use of mortality rates as a hospital quality measure is questioned. © 2017 The Authors.

Seizure Correlates with Prolonged Hospital Stay, Increased Costs, and Increased Mortality in Nontraumatic Subdural Hematoma.

PubMed

Joseph, Jacob R; Smith, Brandon W; Williamson, Craig A; Park, Paul

2016-08-01

Nontraumatic subdural hematoma (NTSDH) is a common neurosurgical disease process, with mortality reported as high as 13%. Seizure has a known association with NTSDH, although patient outcomes have not previously been well studied in this population. The purpose of this study was to examine the relationship between in-hospital seizure and inpatient outcomes in NTSDH. Using the University HealthSystem Consortium (UHC) database, we performed a retrospective cohort study of adults with a principal diagnosis of NTSDH (International Classification of Diseases, Ninth Revision code 43.21) between 2011 and 2015. Patients with in-hospital seizure (International Classification of Diseases, Ninth Revision codes 34500-34591, 78033, 78039) were compared with those without. Patients with a history of seizure before arrival were excluded. Patient demographics, hospital length of stay (LOS), intensive care unit stay, in-hospital mortality, and direct costs were recorded. A total 16,928 patients with NTSDH were identified. Mean age was 69.2 years, and 64.7% were male. In-hospital seizure was documented in 744 (4.40%) patients. Hospital LOS was 17.64 days in patients with seizure and 6.26 days in those without (P < 0.0001). Mean intensive care unit stay increased from 3.36 days without seizure to 9.36 days with seizure. In-hospital mortality was 9.19% in patients without seizure and 16.13% in those with seizure (P < 0.0001). Direct costs were $12,781 in patients without seizure and $38,110 in those with seizure (P < 0.0001). Seizure in patients with NTSDH correlates with significantly increased total LOS and increased mortality. Direct costs are similarly increased. Further studies accounting for effects of illness severity are necessary to validate these results. Copyright © 2016 Elsevier Inc. All rights reserved.

Summer syncope syndrome.

PubMed

Huang, Jennifer Juxiang; Sharda, Natasha; Riaz, Irbaz Bin; Alpert, Joseph S

2014-08-01

Antihypertensive therapy is associated with significant relative risk reductions in the incidence of heart failure, myocardial infarction, and stroke. However, a common adverse reaction to antihypertensive therapy is orthostatic hypotension, dehydration, and syncope. We propose that continued use of antihypertensive medications at the same dosage during the dry summer months in patients living in the Sonoran desert leads to an increase in syncopal episodes. All hypertensive patients who were treated with medications and admitted with International Classification of Diseases, 9th Revision code diagnosis of syncope were included. They were defined as "cases" if they presented during the summer months (May to September 2012) and "controls" if they presented during the winter months (November 2012 to March 2013). The primary outcome measure was the presence of clinical dehydration. The statistical significance was determined using the 2-sided Fisher exact test. A total of 496 patients with an International Classification of Diseases, 9th Revision code diagnosis of syncope were screened, and 179 patients were included in the final analysis. In patients taking antihypertensive medications, there were a significantly higher number of cases of syncope secondary to dehydration or orthostatic hypotension during the summer months (45%) compared with the winter months (26%) (P = .01). The incidence of syncope was significantly higher in older patients (63%) compared with younger individuals (37%) during the summer months. The incidence of syncope increases during the summer months among people who reside in a dry desert climate and who are taking antihypertensive medications. On the basis of our findings, we describe an easily preventable condition that we define as the "Summer Syncope Syndrome." We recommend judicious reduction of antihypertensive therapy in patients residing in a hot and dry climate, particularly during the summer months. Copyright © 2014 Elsevier Inc. All rights reserved.

The Incidence of Deep Vein Thrombosis in Asian Patients With Chronic Obstructive Pulmonary Disease.

PubMed

Chen, Chung-Yu; Liao, Kuang-Ming

2015-11-01

Most studies have focused on the prevalence of deep vein thrombosis (DVT) and pulmonary embolism in patients with chronic obstructive pulmonary disease (COPD) and acute exacerbation in Caucasian populations. DVT is supposedly less likely to occur among Asians than Caucasians, and the primary purpose of this study was to determine the actual incidence of DVT in patients with COPD in Asian populations.We enrolled patients over the age of 40 with a diagnosis of COPD (International Classification of Diseases, Ninth Revision [ICD-9]: 490-492, 496; A-code: A323 and A325) between 1998 and 2008. The index date was the date of first-time COPD diagnosis. We excluded the patients who had been diagnosed with COPD and DVT (The International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM]: 453.8) before index date. The control group was frequency-matched according to age (3-year stratum), sex, and the year of admission, at a 2:1 ratio. Patients were followed from index date to when either a diagnosis of DVT was made, death occurred, December 31, 2009 was reached, or when the patients withdrew from the National Health Insurance program.The overall incidence rate of DVT was 18.78 per 10,000 person-years in patients with COPD, and the adjusted hazard ration of DVT in patients with COPD was 1.38 (95% confidence interval 1.06-1.80), which was greater than patients without COPD after adjusting for age, sex, atrial fibrillation, hypertension, diabetes, hyperlipidemia, cerebrovascular accident, congestive heart failure, lower leg fracture or surgery, and cancer.Asian patients with COPD had a higher incidence of DVT than non-COPD patients.

A Retrospective Cohort Study of the Incidence, Health Care Resource Utilization and Costs of International Classification of Diseases, Clinical Modification, 9th Revision Diagnosed Influenza and Related Complications in US Children.

PubMed

Buck, Philip O; Smith, David M; Shenolikar, Rahul; Irwin, Debra E

2017-12-01

There is a paucity of data on the clinical and economic impact of seasonal influenza in children. This study estimated the incidence of diagnosed influenza and related complications and associated health care resource utilization and costs in US children. Children ≥6 months and <18 years old diagnosed with influenza using International Classification of Diseases, Clinical Modification, 9th revision codes and enrolled in a health plan during at least one influenza season between 2010 and 2014 were matched to similar patients without diagnosed influenza (GSK study identifier: HO-15-15728). Outcomes included incidence of influenza and complications, health care resource utilization frequency and health care costs during 21 days of follow-up. Adjusted costs were estimated using generalized linear models. Incidence (per 1000) of influenza was 20.3 (commercially insured) and 32.6 (Medicaid), with the highest incidence among 6-35 months old (Commercial: 26.8; Medicaid: 47.9). Approximately 12%-17% of influenza patients experienced complications, with the 6-35 months group having the highest percentage (25%-30%). The 6-35-month-old influenza patients with complications had the highest proportion with hospitalizations (5%-6%) and emergency room visits (Commercial: 19%; Medicaid: 36%). Influenza patients with (vs. without) complications had greater adjusted mean influenza-specific costs (Commercial: $1161 vs. $337; Medicaid: $1199 vs. $354; P<0.05), and influenza cases (vs. controls) had greater adjusted mean all-cause costs (Commercial: $688 vs. $470; Medicaid: $818 vs. $453; P < 0.05). Pediatric patients with influenza incurred higher health care costs compared with matched controls, and influenza-specific costs were greater among those with complications.

Evaluation of Diagnostic Codes in Morbidity and Mortality Data Sources for Heat-Related Illness Surveillance

PubMed Central

Watkins, Sharon

2017-01-01

Objectives: The primary objective of this study was to identify patients with heat-related illness (HRI) using codes for heat-related injury diagnosis and external cause of injury in 3 administrative data sets: emergency department (ED) visit records, hospital discharge records, and death certificates. Methods: We obtained data on ED visits, hospitalizations, and deaths for Florida residents for May 1 through October 31, 2005-2012. To identify patients with HRI, we used codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) to search data on ED visits and hospitalizations and codes from the International Classification of Diseases, Tenth Revision (ICD-10) to search data on deaths. We stratified the results by data source and whether the HRI was work related. Results: We identified 23 981 ED visits, 4816 hospitalizations, and 140 deaths in patients with non–work-related HRI and 2979 ED visits, 415 hospitalizations, and 23 deaths in patients with work-related HRI. The most common diagnosis codes among patients were for severe HRI (heat exhaustion or heatstroke). The proportion of patients with a severe HRI diagnosis increased with data source severity. If ICD-9-CM code E900.1 and ICD-10 code W92 (excessive heat of man-made origin) were used as exclusion criteria for HRI, 5.0% of patients with non–work-related deaths, 3.0% of patients with work-related ED visits, and 1.7% of patients with work-related hospitalizations would have been removed. Conclusions: Using multiple data sources and all diagnosis fields may improve the sensitivity of HRI surveillance. Future studies should evaluate the impact of converting ICD-9-CM to ICD-10-CM codes on HRI surveillance of ED visits and hospitalizations. PMID:28379784

Validation of an International Classification of Diseases, Ninth Revision Code Algorithm for Identifying Chiari Malformation Type 1 Surgery in Adults.

PubMed

Greenberg, Jacob K; Ladner, Travis R; Olsen, Margaret A; Shannon, Chevis N; Liu, Jingxia; Yarbrough, Chester K; Piccirillo, Jay F; Wellons, John C; Smyth, Matthew D; Park, Tae Sung; Limbrick, David D

2015-08-01

The use of administrative billing data may enable large-scale assessments of treatment outcomes for Chiari Malformation type I (CM-1). However, to utilize such data sets, validated International Classification of Diseases, Ninth Revision (ICD-9-CM) code algorithms for identifying CM-1 surgery are needed. To validate 2 ICD-9-CM code algorithms identifying patients undergoing CM-1 decompression surgery. We retrospectively analyzed the validity of 2 ICD-9-CM code algorithms for identifying adult CM-1 decompression surgery performed at 2 academic medical centers between 2001 and 2013. Algorithm 1 included any discharge diagnosis code of 348.4 (CM-1), as well as a procedure code of 01.24 (cranial decompression) or 03.09 (spinal decompression, or laminectomy). Algorithm 2 restricted this group to patients with a primary diagnosis of 348.4. The positive predictive value (PPV) and sensitivity of each algorithm were calculated. Among 340 first-time admissions identified by Algorithm 1, the overall PPV for CM-1 decompression was 65%. Among the 214 admissions identified by Algorithm 2, the overall PPV was 99.5%. The PPV for Algorithm 1 was lower in the Vanderbilt (59%) cohort, males (40%), and patients treated between 2009 and 2013 (57%), whereas the PPV of Algorithm 2 remained high (≥99%) across subgroups. The sensitivity of Algorithms 1 (86%) and 2 (83%) were above 75% in all subgroups. ICD-9-CM code Algorithm 2 has excellent PPV and good sensitivity to identify adult CM-1 decompression surgery. These results lay the foundation for studying CM-1 treatment outcomes by using large administrative databases.

Code-based Diagnostic Algorithms for Idiopathic Pulmonary Fibrosis. Case Validation and Improvement.

PubMed

Ley, Brett; Urbania, Thomas; Husson, Gail; Vittinghoff, Eric; Brush, David R; Eisner, Mark D; Iribarren, Carlos; Collard, Harold R

2017-06-01

Population-based studies of idiopathic pulmonary fibrosis (IPF) in the United States have been limited by reliance on diagnostic code-based algorithms that lack clinical validation. To validate a well-accepted International Classification of Diseases, Ninth Revision, code-based algorithm for IPF using patient-level information and to develop a modified algorithm for IPF with enhanced predictive value. The traditional IPF algorithm was used to identify potential cases of IPF in the Kaiser Permanente Northern California adult population from 2000 to 2014. Incidence and prevalence were determined overall and by age, sex, and race/ethnicity. A validation subset of cases (n = 150) underwent expert medical record and chest computed tomography review. A modified IPF algorithm was then derived and validated to optimize positive predictive value. From 2000 to 2014, the traditional IPF algorithm identified 2,608 cases among 5,389,627 at-risk adults in the Kaiser Permanente Northern California population. Annual incidence was 6.8/100,000 person-years (95% confidence interval [CI], 6.1-7.7) and was higher in patients with older age, male sex, and white race. The positive predictive value of the IPF algorithm was only 42.2% (95% CI, 30.6 to 54.6%); sensitivity was 55.6% (95% CI, 21.2 to 86.3%). The corrected incidence was estimated at 5.6/100,000 person-years (95% CI, 2.6-10.3). A modified IPF algorithm had improved positive predictive value but reduced sensitivity compared with the traditional algorithm. A well-accepted International Classification of Diseases, Ninth Revision, code-based IPF algorithm performs poorly, falsely classifying many non-IPF cases as IPF and missing a substantial proportion of IPF cases. A modification of the IPF algorithm may be useful for future population-based studies of IPF.

Economic Impact of Ketorolac vs Corticosteroid Intra-Articular Knee Injections for Osteoarthritis: A Randomized, Double-Blind, Prospective Study.

PubMed

Bellamy, Jaime L; Goff, Brandon J; Sayeed, Siraj A

2016-09-01

Knee osteoarthritis is a disabling disease that costs billions of dollars to treat. Corticosteroid gives varying pain relief and costs $12 per injection, whereas ketorolac costs $2 per injection, per institutional costs. The aim of this study was to compare ketorolac with corticosteroid based on pain relief using patient outcome measures and cost data. A total of 35 patients were randomized to ketorolac or corticosteroid intra-articular knee injection in a double-blind, prospective study. Follow-up was 24 weeks. Osteoarthritis was evaluated using Kellgren-Lawrence grading. Visual analog scale (VAS) was the primary outcome measure. A query of the institutional database was performed for International Classification of Diseases, Ninth Revision codes 715.16 and 719.46, and procedure code 20610 over a 3-year period. Two-way, repeated measures analysis of variance and Spearman rank correlation were used for statistical analysis. Mean VAS for ketorolac and corticosteroid decreased significantly from baseline at 2 weeks, 6.3-4.6 and 5.2-3.6, respectively and remained decreased for 24 weeks. There was no correlation between VAS and demographics within treatments. There were 220, 602, and 405 injections performed on patients with the International Classification of Diseases, Ninth Revision codes 715.16 and 719.46 during 2013, 2014, and 2015, respectively. The cost savings per year using ketorolac instead of corticosteroid would be $2259.40, $6182.54, and $4159.35 for 2013, 2014, and 2015, respectively, with a total savings of $12,601.29 over this period. Pain relief was similar between ketorolac and corticosteroid injections. Ketorolac knee injection is safe and effective with a cost savings percentage difference of 143% when compared with corticosteroid. Copyright © 2016 Elsevier Inc. All rights reserved.

Mining peripheral arterial disease cases from narrative clinical notes using natural language processing.

PubMed

Afzal, Naveed; Sohn, Sunghwan; Abram, Sara; Scott, Christopher G; Chaudhry, Rajeev; Liu, Hongfang; Kullo, Iftikhar J; Arruda-Olson, Adelaide M

2017-06-01

Lower extremity peripheral arterial disease (PAD) is highly prevalent and affects millions of individuals worldwide. We developed a natural language processing (NLP) system for automated ascertainment of PAD cases from clinical narrative notes and compared the performance of the NLP algorithm with billing code algorithms, using ankle-brachial index test results as the gold standard. We compared the performance of the NLP algorithm to (1) results of gold standard ankle-brachial index; (2) previously validated algorithms based on relevant International Classification of Diseases, Ninth Revision diagnostic codes (simple model); and (3) a combination of International Classification of Diseases, Ninth Revision codes with procedural codes (full model). A dataset of 1569 patients with PAD and controls was randomly divided into training (n = 935) and testing (n = 634) subsets. We iteratively refined the NLP algorithm in the training set including narrative note sections, note types, and service types, to maximize its accuracy. In the testing dataset, when compared with both simple and full models, the NLP algorithm had better accuracy (NLP, 91.8%; full model, 81.8%; simple model, 83%; P < .001), positive predictive value (NLP, 92.9%; full model, 74.3%; simple model, 79.9%; P < .001), and specificity (NLP, 92.5%; full model, 64.2%; simple model, 75.9%; P < .001). A knowledge-driven NLP algorithm for automatic ascertainment of PAD cases from clinical notes had greater accuracy than billing code algorithms. Our findings highlight the potential of NLP tools for rapid and efficient ascertainment of PAD cases from electronic health records to facilitate clinical investigation and eventually improve care by clinical decision support. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Design and validation of a methodology using the International Classification of Diseases, 9th Revision, to identify secondary conditions in people with disabilities.

PubMed

Chan, Leighton; Shumway-Cook, Anne; Yorkston, Kathryn M; Ciol, Marcia A; Dudgeon, Brian J; Hoffman, Jeanne M

2005-05-01

To design and validate a methodology that identifies secondary conditions using International Classification of Disease, 9th Revision (ICD-9) codes. Secondary conditions were identified through a literature search and a survey of Washington State physiatrists. These conditions were translated into ICD-9 codes and this list was then validated against a national sample of Medicare survey respondents with differing levels of mobility and activities of daily living (ADL) disability. National survey. Participants (N=9731) in the 1999 Medicare Current Beneficiary Survey with no, mild, moderate, and severe mobility and ADL disability. Not applicable. Percentage of survey respondents with a secondary condition. The secondary conditions were grouped into 4 categories: medical, psychosocial, musculoskeletal, and dysphagia related (problems associated with difficulty in swallowing). Our literature search and survey of 26 physiatrists identified 64 secondary conditions, including depression, decubitus ulcers, and deconditioning. Overall, 70.4% of all survey respondents were treated for a secondary condition. We found a significant relation between increasing mobility as well as ADL disability and increasing numbers of secondary conditions (chi 2 test for trend, P <.001). This relation existed for all categories of secondary conditions: medical (chi 2 test for trend, P <.001), psychosocial (chi 2 test for trend, P <.001), musculoskeletal (chi 2 test for trend, P <.001), and dysphagia related (chi 2 test for trend, P <.001). We created a valid ICD-9-based methodology that identified secondary conditions in Medicare survey respondents and discriminated between people with different degrees of disability. This methodology will be useful for health services researchers who study the frequency and impact of secondary conditions.

Identifying Adverse Events Using International Classification of Diseases, Tenth Revision Y Codes in Korea: A Cross-sectional Study.

PubMed

Ock, Minsu; Kim, Hwa Jung; Jeon, Bomin; Kim, Ye-Jee; Ryu, Hyun Mi; Lee, Moo-Song

2018-01-01

The use of administrative data is an affordable alternative to conducting a difficult large-scale medical-record review to estimate the scale of adverse events. We identified adverse events from 2002 to 2013 on the national level in Korea, using International Classification of Diseases, tenth revision (ICD-10) Y codes. We used data from the National Health Insurance Service-National Sample Cohort (NHIS-NSC). We relied on medical treatment databases to extract information on ICD-10 Y codes from each participant in the NHIS-NSC. We classified adverse events in the ICD-10 Y codes into 6 types: those related to drugs, transfusions, and fluids; those related to vaccines and immunoglobulin; those related to surgery and procedures; those related to infections; those related to devices; and others. Over 12 years, a total of 20 817 adverse events were identified using ICD-10 Y codes, and the estimated total adverse event rate was 0.20%. Between 2002 and 2013, the total number of such events increased by 131.3%, from 1366 in 2002 to 3159 in 2013. The total rate increased by 103.9%, from 0.17% in 2002 to 0.35% in 2013. Events related to drugs, transfusions, and fluids were the most common (19 446, 93.4%), followed by those related to surgery and procedures (1209, 5.8%) and those related to vaccines and immunoglobulin (72, 0.3%). Based on a comparison with the results of other studies, the total adverse event rate in this study was significantly underestimated. Improving coding practices for ICD-10 Y codes is necessary to precisely monitor the scale of adverse events in Korea.

Validation of an automated electronic algorithm and "dashboard" to identify and characterize decompensated heart failure admissions across a medical center.

PubMed

Cox, Zachary L; Lewis, Connie M; Lai, Pikki; Lenihan, Daniel J

2017-01-01

We aim to validate the diagnostic performance of the first fully automatic, electronic heart failure (HF) identification algorithm and evaluate the implementation of an HF Dashboard system with 2 components: real-time identification of decompensated HF admissions and accurate characterization of disease characteristics and medical therapy. We constructed an HF identification algorithm requiring 3 of 4 identifiers: B-type natriuretic peptide >400 pg/mL; admitting HF diagnosis; history of HF International Classification of Disease, Ninth Revision, diagnosis codes; and intravenous diuretic administration. We validated the diagnostic accuracy of the components individually (n = 366) and combined in the HF algorithm (n = 150) compared with a blinded provider panel in 2 separate cohorts. We built an HF Dashboard within the electronic medical record characterizing the disease and medical therapies of HF admissions identified by the HF algorithm. We evaluated the HF Dashboard's performance over 26 months of clinical use. Individually, the algorithm components displayed variable sensitivity and specificity, respectively: B-type natriuretic peptide >400 pg/mL (89% and 87%); diuretic (80% and 92%); and International Classification of Disease, Ninth Revision, code (56% and 95%). The HF algorithm achieved a high specificity (95%), positive predictive value (82%), and negative predictive value (85%) but achieved limited sensitivity (56%) secondary to missing provider-generated identification data. The HF Dashboard identified and characterized 3147 HF admissions over 26 months. Automated identification and characterization systems can be developed and used with a substantial degree of specificity for the diagnosis of decompensated HF, although sensitivity is limited by clinical data input. Copyright © 2016 Elsevier Inc. All rights reserved.

Pulmonary Hypertension Surveillance

PubMed Central

Schieb, Linda J.; Ayala, Carma; Talwalkar, Anjali; Levant, Shaleah

2014-01-01

Pulmonary hypertension (PH) is an uncommon but progressive condition, and much of what we know about it comes from specialized disease registries. With expanding research into the diagnosis and treatment of PH, it is important to provide updated surveillance on the impact of this disease on hospitalizations and mortality. This study, which builds on previous PH surveillance of mortality and hospitalization, analyzed mortality data from the National Vital Statistics System and data from the National Hospital Discharge Survey between 2001 and 2010. PH deaths were identified using International Classification of Diseases, Tenth Revision codes I27.0, I27.2, I27.8, or I27.9 as any contributing cause of death on the death certificate. Hospital discharges associated with PH were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes 416.0, 416.8, or 416.9 as one of up to seven listed medical diagnoses. The decline in death rates associated with PH among men from 1980 to 2005 has reversed and now shows a significant increasing trend. Similarly, the death rates for women with PH have continued to increase significantly during the past decade. PH-associated mortality rates for those aged 85 years and older have accelerated compared with rates for younger age groups. There have been significant declines in PH-associated mortality rates for those with pulmonary embolism and emphysema. Rates of hospitalization for PH have increased significantly for both men and women during the past decade; for those aged 85 years and older, hospitalization rates have nearly doubled. Continued surveillance helps us understand and address the evolving trends in hospitalization and mortality associated with PH and PH-associated conditions, especially regarding sex, age, and race/ethnicity disparities. PMID:24700091

Validity of administrative database code algorithms to identify vascular access placement, surgical revisions, and secondary patency.

PubMed

Al-Jaishi, Ahmed A; Moist, Louise M; Oliver, Matthew J; Nash, Danielle M; Fleet, Jamie L; Garg, Amit X; Lok, Charmaine E

2018-03-01

We assessed the validity of physician billing codes and hospital admission using International Classification of Diseases 10th revision codes to identify vascular access placement, secondary patency, and surgical revisions in administrative data. We included adults (≥18 years) with a vascular access placed between 1 April 2004 and 31 March 2013 at the University Health Network, Toronto. Our reference standard was a prospective vascular access database (VASPRO) that contains information on vascular access type and dates of placement, dates for failure, and any revisions. We used VASPRO to assess the validity of different administrative coding algorithms by calculating the sensitivity, specificity, and positive predictive values of vascular access events. The sensitivity (95% confidence interval) of the best performing algorithm to identify arteriovenous access placement was 86% (83%, 89%) and specificity was 92% (89%, 93%). The corresponding numbers to identify catheter insertion were 84% (82%, 86%) and 84% (80%, 87%), respectively. The sensitivity of the best performing coding algorithm to identify arteriovenous access surgical revisions was 81% (67%, 90%) and specificity was 89% (87%, 90%). The algorithm capturing arteriovenous access placement and catheter insertion had a positive predictive value greater than 90% and arteriovenous access surgical revisions had a positive predictive value of 20%. The duration of arteriovenous access secondary patency was on average 578 (553, 603) days in VASPRO and 555 (530, 580) days in administrative databases. Administrative data algorithms have fair to good operating characteristics to identify vascular access placement and arteriovenous access secondary patency. Low positive predictive values for surgical revisions algorithm suggest that administrative data should only be used to rule out the occurrence of an event.

The new higher level classification of eukaryotes with emphasis on the taxonomy of protists.

PubMed

Adl, Sina M; Simpson, Alastair G B; Farmer, Mark A; Andersen, Robert A; Anderson, O Roger; Barta, John R; Bowser, Samuel S; Brugerolle, Guy; Fensome, Robert A; Fredericq, Suzanne; James, Timothy Y; Karpov, Sergei; Kugrens, Paul; Krug, John; Lane, Christopher E; Lewis, Louise A; Lodge, Jean; Lynn, Denis H; Mann, David G; McCourt, Richard M; Mendoza, Leonel; Moestrup, Ojvind; Mozley-Standridge, Sharon E; Nerad, Thomas A; Shearer, Carol A; Smirnov, Alexey V; Spiegel, Frederick W; Taylor, Max F J R

2005-01-01

This revision of the classification of unicellular eukaryotes updates that of Levine et al. (1980) for the protozoa and expands it to include other protists. Whereas the previous revision was primarily to incorporate the results of ultrastructural studies, this revision incorporates results from both ultrastructural research since 1980 and molecular phylogenetic studies. We propose a scheme that is based on nameless ranked systematics. The vocabulary of the taxonomy is updated, particularly to clarify the naming of groups that have been repositioned. We recognize six clusters of eukaryotes that may represent the basic groupings similar to traditional "kingdoms." The multicellular lineages emerged from within monophyletic protist lineages: animals and fungi from Opisthokonta, plants from Archaeplastida, and brown algae from Stramenopiles.

Vehicle classification system : FHWA perspective

DOT National Transportation Integrated Search

2000-08-01

Issues related to vehicle classification in light of the Federal Highway Administration (FHWA) Traffic Monitoring Guide (TMG) revision will be discussed. The discussion will look at the expressed needs of the data users and the associated impacts on ...

Medicare program; inpatient rehabilitation facility prospective payment system for federal fiscal year 2015.

PubMed

2014-08-06

This final rule updates the prospective payment rates for inpatient rehabilitation facilities (IRFs) for federal fiscal year (FY) 2015 as required by the statute. This final rule finalizes a policy to collect data on the amount and mode (that is, Individual, Concurrent, Group, and Co-Treatment) of therapy provided in the IRF setting according to therapy discipline, revises the list of diagnosis and impairment group codes that presumptively meet the "60 percent rule'' compliance criteria, provides a way for IRFs to indicate on the Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI) form whether the prior treatment and severity requirements have been met for arthritis cases to presumptively meet the "60 percent rule'' compliance criteria, and revises and updates quality measures and reporting requirements under the IRF quality reporting program (QRP). This rule also delays the effective date for the revisions to the list of diagnosis codes that are used to determine presumptive compliance under the "60 percent rule'' that were finalized in FY 2014 IRF PPS final rule and adopts the revisions to the list of diagnosis codes that are used to determine presumptive compliance under the "60 percent rule'' that are finalized in this rule. This final rule also addresses the implementation of the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), for the IRF prospective payment system (PPS), which will be effective when ICD-10-CM becomes the required medical data code set for use on Medicare claims and IRF-PAI submissions.

Protocol for a qualitative study exploring perspectives on the INternational CLassification of Diseases (11th revision); Using lived experience to improve mental health Diagnosis in NHS England: INCLUDE study.

PubMed

Hackmann, Corinna; Green, Amanda; Notley, Caitlin; Perkins, Amorette; Reed, Geoffrey M; Ridler, Joseph; Wilson, Jon; Shakespeare, Tom

2017-09-03

Developed in dialogue with WHO, this research aims to incorporate lived experience and views in the refinement of the International Classification of Diseases Mental and Behavioural Disorders 11th Revision (ICD-11). The validity and clinical utility of psychiatric diagnostic systems has been questioned by both service users and clinicians, as not all aspects reflect their lived experience or are user friendly. This is critical as evidence suggests that diagnosis can impact service user experience, identity, service use and outcomes. Feedback and recommendations from service users and clinicians should help minimise the potential for unintended negative consequences and improve the accuracy, validity and clinical utility of the ICD-11. The name INCLUDE reflects the value of expertise by experience as all aspects of the proposed study are co-produced. Feedback on the planned criteria for the ICD-11 will be sought through focus groups with service users and clinicians. The data from these groups will be coded and inductively analysed using a thematic analysis approach. Findings from this will be used to form the basis of co-produced recommendations for the ICD-11. Two service user focus groups will be conducted for each of these diagnoses: Personality Disorder, Bipolar I Disorder, Schizophrenia, Depressive Disorder and Generalised Anxiety Disorder. There will be four focus groups with clinicians (psychiatrists, general practitioners and clinical psychologists). This study has received ethical approval from the Coventry and Warwickshire HRA Research Ethics Committee (16/WM/0479). The output for the project will be recommendations that reflect the views and experiences of experts by experience (service users and clinicians). The findings will be disseminated via conferences and peer-reviewed publications. As the ICD is an international tool, the aim is for the methodology to be internationally disseminated for replication by other groups. ClinicalTrials.gov: NCT03131505. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

78 FR 52129 - Cotton Classification and Market News Service: Notice of Request for an Extension and Revision of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-22

... DEPARTMENT OF AGRICULTURE Agricultural Marketing Service [AMS-CN-13-0045] Cotton Classification... Cotton Classification and Market News Service. DATES: Comments received by October 21, 2013 will be... concerning this proposal to Shethir M. Riva, Chief, Research and Promotion Staff, Cotton and Tobacco Programs...

A Lifespan Study of Classification Preference.

ERIC Educational Resources Information Center

Pearce, Kathy A.; Denney, Nancy Wadsworth

Previous research in classification preference has focused on only a few selected age groups. To investigate the classification preferences of individuals from early childhood through old age in the same study, 144 individuals between the ages of 4 and 70 completed a revised version of the Conceptual Styles Test. Analysis of results showed that…

Evaluation of the ADOS Revised Algorithm: The Applicability in 558 Dutch Children and Adolescents

ERIC Educational Resources Information Center

de Bildt, Annelies; Sytema, Sjoerd; van Lang, Natasja D. J.; Minderaa, Ruud B.; van Engeland, Herman; de Jonge, Maretha V.

2009-01-01

The revised ADOS algorithms, proposed by Gotham et al. (J Autism Dev Disord 37:613-627, 2007), were investigated in an independent sample of 558 Dutch children (modules 1, 2 and 3). The revised algorithms lead to better balanced sensitivity and specificity for modules 2 and 3, without losing efficiency of the classification. Including the…

Acetabular Cup Revision.

PubMed

Kim, Young-Ho

2017-09-01

The use of acetabular cup revision arthroplasty is on the rise as demands for total hip arthroplasty, improved life expectancies, and the need for individual activity increase. For an acetabular cup revision to be successful, the cup should gain stable fixation within the remaining supportive bone of the acetabulum. Since the patient's remaining supportive acetabular bone stock plays an important role in the success of revision, accurate classification of the degree of acetabular bone defect is necessary. The Paprosky classification system is most commonly used when determining the location and degree of acetabular bone loss. Common treatment options include: acetabular liner exchange, high hip center, oblong cup, trabecular metal cup with augment, bipolar cup, bulk structural graft, cemented cup, uncemented cup including jumbo cup, acetabular reinforcement device (cage), trabecular metal cup cage. The optimal treatment option is dependent upon the degree of the discontinuity, the amount of available bone stock and the likelihood of achieving stable fixation upon supportive host bone. To achieve successful acetabular cup revision, accurate evaluation of bone defect preoperatively and intraoperatively, proper choice of method of acetabular revision according to the evaluation of acetabular bone deficiency, proper technique to get primary stability of implant such as precise grafting technique, and stable fixation of implant are mandatory.

Applying Classification Trees to Hospital Administrative Data to Identify Patients with Lower Gastrointestinal Bleeding

PubMed Central

Siddique, Juned; Ruhnke, Gregory W.; Flores, Andrea; Prochaska, Micah T.; Paesch, Elizabeth; Meltzer, David O.; Whelan, Chad T.

2015-01-01

Background Lower gastrointestinal bleeding (LGIB) is a common cause of acute hospitalization. Currently, there is no accepted standard for identifying patients with LGIB in hospital administrative data. The objective of this study was to develop and validate a set of classification algorithms that use hospital administrative data to identify LGIB. Methods Our sample consists of patients admitted between July 1, 2001 and June 30, 2003 (derivation cohort) and July 1, 2003 and June 30, 2005 (validation cohort) to the general medicine inpatient service of the University of Chicago Hospital, a large urban academic medical center. Confirmed cases of LGIB in both cohorts were determined by reviewing the charts of those patients who had at least 1 of 36 principal or secondary International Classification of Diseases, Ninth revision, Clinical Modification (ICD-9-CM) diagnosis codes associated with LGIB. Classification trees were used on the data of the derivation cohort to develop a set of decision rules for identifying patients with LGIB. These rules were then applied to the validation cohort to assess their performance. Results Three classification algorithms were identified and validated: a high specificity rule with 80.1% sensitivity and 95.8% specificity, a rule that balances sensitivity and specificity (87.8% sensitivity, 90.9% specificity), and a high sensitivity rule with 100% sensitivity and 91.0% specificity. Conclusion These classification algorithms can be used in future studies to evaluate resource utilization and assess outcomes associated with LGIB without the use of chart review. PMID:26406318

Chronic migraine.

PubMed

Valade, D

2013-05-01

The second edition of the International Classification of Headache Disorders revised in 2006 (ICHD-2R) gives a definition which requires 15 or more headache days per month over the past 3months with at least eight headache days per month that meet criteria for migraine without aura or that responds to migraine specific treatment. Approximately 2% of the global population suffers of chronic migraine (CM). Frequency of headache and degree of disability distinguish CM from episodic migraine (EM). There is a high frequency of medication overuse. The treatment depends on evaluation with education, lifestyle modifications, and trigger management, behavioral and pharmacologic therapies. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

A Strategic Plan for Integrating ICD-10 in Your Practice and Workflow.

PubMed

Bowman, Sue; Cleland, Risë Marie; Staggs, Stuart

2015-01-01

The adoption of the International Classification of Disease (ICD) 10th Revision (ICD-10) diagnosis code set in the United States has been legislatively delayed several times with the most recent date for implementation set for October 1, 2015. The transition from ICD-9 to ICD-10 will be a major undertaking that will require a substantial amount of planning. In the following article, we outline the steps to develop and implement a strategic plan for the transition to the new code set, identify training needs throughout the practice, and review the challenges and opportunities associated with the transition to ICD-10.

Introducing a New Classification of Early Childhood Disorders: DC:0-5™

ERIC Educational Resources Information Center

Zeanah, Charles H.; Carter, Alice S.; Cohen, Julie; Egger, Helen; Gleason, Mary Margaret; Keren, Miri; Lieberman, Alicia; Mulrooney, Kathleen; Oser, Cindy

2017-01-01

This article introduces the revised and updated "DC:0-5™: Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood." The authors describe the past and current efforts to create a developmentally based classification system for very young children. DC:0-3, published in 1994 by ZERO TO THREE,…

The 2010 Standard Occupational Classification (SOC): A Classification System Gets an Update

ERIC Educational Resources Information Center

Emmel, Alissa; Cosca, Theresa

2010-01-01

Making sense of occupational data isn't always easy. But the task is less daunting when the data are well organized. For Federal occupational statistics, the Standard Occupational Classification (SOC) system establishes that organization. And a recent revision to the SOC means that the data will be current, in addition to being well organized. The…

The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After.

PubMed

Bassi, Claudio; Marchegiani, Giovanni; Dervenis, Christos; Sarr, Micheal; Abu Hilal, Mohammad; Adham, Mustapha; Allen, Peter; Andersson, Roland; Asbun, Horacio J; Besselink, Marc G; Conlon, Kevin; Del Chiaro, Marco; Falconi, Massimo; Fernandez-Cruz, Laureano; Fernandez-Del Castillo, Carlos; Fingerhut, Abe; Friess, Helmut; Gouma, Dirk J; Hackert, Thilo; Izbicki, Jakob; Lillemoe, Keith D; Neoptolemos, John P; Olah, Attila; Schulick, Richard; Shrikhande, Shailesh V; Takada, Tadahiro; Takaori, Kyoichi; Traverso, William; Vollmer, Charles R; Wolfgang, Christopher L; Yeo, Charles J; Salvia, Roberto; Buchler, Marcus

2017-03-01

In 2005, the International Study Group of Pancreatic Fistula developed a definition and grading of postoperative pancreatic fistula that has been accepted universally. Eleven years later, because postoperative pancreatic fistula remains one of the most relevant and harmful complications of pancreatic operation, the International Study Group of Pancreatic Fistula classification has become the gold standard in defining postoperative pancreatic fistula in clinical practice. The aim of the present report is to verify the value of the International Study Group of Pancreatic Fistula definition and grading of postoperative pancreatic fistula and to update the International Study Group of Pancreatic Fistula classification in light of recent evidence that has emerged, as well as to address the lingering controversies about the original definition and grading of postoperative pancreatic fistula. The International Study Group of Pancreatic Fistula reconvened as the International Study Group in Pancreatic Surgery in order to perform a review of the recent literature and consequently to update and revise the grading system of postoperative pancreatic fistula. Based on the literature since 2005 investigating the validity and clinical use of the original International Study Group of Pancreatic Fistula classification, a clinically relevant postoperative pancreatic fistula is now redefined as a drain output of any measurable volume of fluid with an amylase level >3 times the upper limit of institutional normal serum amylase activity, associated with a clinically relevant development/condition related directly to the postoperative pancreatic fistula. Consequently, the former "grade A postoperative pancreatic fistula" is now redefined and called a "biochemical leak," because it has no clinical importance and is no longer referred to a true pancreatic fistula. Postoperative pancreatic fistula grades B and C are confirmed but defined more strictly. In particular, grade B requires a change in the postoperative management; drains are either left in place >3 weeks or repositioned through endoscopic or percutaneous procedures. Grade C postoperative pancreatic fistula refers to those postoperative pancreatic fistula that require reoperation or lead to single or multiple organ failure and/or mortality attributable to the pancreatic fistula. This new definition and grading system of postoperative pancreatic fistula should lead to a more universally consistent evaluation of operative outcomes after pancreatic operation and will allow for a better comparison of techniques used to mitigate the rate and clinical impact of a pancreatic fistula. Use of this updated classification will also allow for more precise comparisons of surgical quality between surgeons and units who perform pancreatic surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

The Examination of Alignment between National Assessment and English Curriculum Objectives Using Revised Bloom's Taxonomy

ERIC Educational Resources Information Center

Kozikoglu, Ishak

2018-01-01

Bloom's taxonomy for the classification of the objectives in cognitive domain was developed in mid 1950s and this taxonomy was revised by a group with Anderson and Krathwohl by making some changes and revisions. The purpose of this research was to evaluate the objectives of 8th grade English curriculum and TEOG exam questions (national assessment…

Revision of the International Society of Nephrology/Renal Pathology Society classification for lupus nephritis: clarification of definitions, and modified National Institutes of Health activity and chronicity indices.

PubMed

Bajema, Ingeborg M; Wilhelmus, Suzanne; Alpers, Charles E; Bruijn, Jan A; Colvin, Robert B; Cook, H Terence; D'Agati, Vivette D; Ferrario, Franco; Haas, Mark; Jennette, J Charles; Joh, Kensuke; Nast, Cynthia C; Noël, Laure-Hélène; Rijnink, Emilie C; Roberts, Ian S D; Seshan, Surya V; Sethi, Sanjeev; Fogo, Agnes B

2018-04-01

We present a consensus report pertaining to the improved clarity of definitions and classification of glomerular lesions in lupus nephritis that derived from a meeting of 18 members of an international nephropathology working group in Leiden, Netherlands, in 2016. Here we report detailed recommendations on issues for which we can propose adjustments based on existing evidence and current consensus opinion (phase 1). New definitions are provided for mesangial hypercellularity and for cellular, fibrocellular, and fibrous crescents. The term "endocapillary proliferation" is eliminated and the definition of endocapillary hypercellularity considered in some detail. We also eliminate the class IV-S and IV-G subdivisions of class IV lupus nephritis. The active and chronic designations for class III/IV lesions are replaced by a proposal for activity and chronicity indices that should be applied to all classes. In the activity index, we include fibrinoid necrosis as a specific descriptor. We also make recommendations on issues for which there are limited data at present and that can best be addressed in future studies (phase 2). We propose to proceed to these investigations, with clinicopathologic studies and tests of interobserver reproducibility to evaluate the applications of the proposed definitions and to classify lupus nephritis lesions. Copyright © 2018 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

Bruxism and dental implant failures: a multilevel mixed effects parametric survival analysis approach.

PubMed

Chrcanovic, B R; Kisch, J; Albrektsson, T; Wennerberg, A

2016-11-01

Recent studies have suggested that the insertion of dental implants in patients being diagnosed with bruxism negatively affected the implant failure rates. The aim of the present study was to investigate the association between the bruxism and the risk of dental implant failure. This retrospective study is based on 2670 patients who received 10 096 implants at one specialist clinic. Implant- and patient-related data were collected. Descriptive statistics were used to describe the patients and implants. Multilevel mixed effects parametric survival analysis was used to test the association between bruxism and risk of implant failure adjusting for several potential confounders. Criteria from a recent international consensus (Lobbezoo et al., J Oral Rehabil, 40, 2013, 2) and from the International Classification of Sleep Disorders (International classification of sleep disorders, revised: diagnostic and coding manual, American Academy of Sleep Medicine, Chicago, 2014) were used to define and diagnose the condition. The number of implants with information available for all variables totalled 3549, placed in 994 patients, with 179 implants reported as failures. The implant failure rates were 13·0% (24/185) for bruxers and 4·6% (155/3364) for non-bruxers (P < 0·001). The statistical model showed that bruxism was a statistically significantly risk factor to implant failure (HR 3·396; 95% CI 1·314, 8·777; P = 0·012), as well as implant length, implant diameter, implant surface, bone quantity D in relation to quantity A, bone quality 4 in relation to quality 1 (Lekholm and Zarb classification), smoking and the intake of proton pump inhibitors. It is suggested that the bruxism may be associated with an increased risk of dental implant failure. © 2016 John Wiley & Sons Ltd.

A clinical perspective on the 2016 WHO brain tumor classification and routine molecular diagnostics.

PubMed

van den Bent, Martin J; Weller, Michael; Wen, Patrick Y; Kros, Johan M; Aldape, Ken; Chang, Susan

2017-05-01

The 2007 World Health Organization (WHO) classification of brain tumors did not use molecular abnormalities as diagnostic criteria. Studies have shown that genotyping allows a better prognostic classification of diffuse glioma with improved treatment selection. This has resulted in a major revision of the WHO classification, which is now for adult diffuse glioma centered around isocitrate dehydrogenase (IDH) and 1p/19q diagnostics. This revised classification is reviewed with a focus on adult brain tumors, and includes a recommendation of genes of which routine testing is clinically useful. Apart from assessment of IDH mutational status including sequencing of R132H-immunohistochemistry negative cases and testing for 1p/19q, several other markers can be considered for routine testing, including assessment of copy number alterations of chromosome 7 and 10 and of TERT promoter, BRAF, and H3F3A mutations. For "glioblastoma, IDH mutated" the term "astrocytoma grade IV" could be considered. It should be considered to treat IDH wild-type grades II and III diffuse glioma with polysomy of chromosome 7 and loss of 10q as glioblastoma. New developments must be more quickly translated into further revised diagnostic categories. Quality control and rapid integration of molecular findings into the final diagnosis and the communication of the final diagnosis to clinicians require systematic attention. © The Author(s) 2017. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The usefulness of the revised classification for chronic kidney disease by the KDIGO for determining the frequency of diabetic micro- and macroangiopathies in Japanese patients with type 2 diabetes mellitus.

PubMed

Ito, Hiroyuki; Oshikiri, Koshiro; Mifune, Mizuo; Abe, Mariko; Antoku, Shinichi; Takeuchi, Yuichiro; Togane, Michiko; Yukawa, Chizuko

2012-01-01

A new classification of chronic kidney disease (CKD) was proposed by the Kidney Disease: Improving Global Outcomes (KDIGO) in 2011. The major point of revision of this classification was the introduction of a two-dimensional staging of the CKD according to the level of albuminuria in addition to the GFR level. Furthermore, the previous CKD stage 3 was subdivided into two stages (G3a and G3b). We examined the prevalence of diabetic micro- and macroangiopathies in patients with type 2 diabetes mellitus based on the new classification. A cross-sectional study was performed in 2018 patients with type 2 diabetes mellitus. All of the diabetic micro- and macroangiopathies significantly more common in the later stages of both the GFR and albuminuria. The proportion of subjects with diabetic retinopathy, neuropathy, cerebrovascular disease and coronary heart disease was significantly higher in the G3b group than in the G3a group. The brachial-ankle pulse wave velocity, which is one of the surrogate markers for atherosclerosis, was also significantly greater in the G3b group compared to the G3a group. The subdivision of the G3 stage in the revised classification proposed by the KDIGO is useful to evaluate the risk for diabetic vascular complications. Copyright © 2012 Elsevier Inc. All rights reserved.

ILAE Classification of the Epilepsies Position Paper of the ILAE Commission for Classification and Terminology

PubMed Central

Scheffer, Ingrid E; Berkovic, Samuel; Capovilla, Giuseppe; Connolly, Mary B; French, Jacqueline; Guilhoto, Laura; Hirsch, Edouard; Jain, Satish; Mathern, Gary W.; Moshé, Solomon L; Nordli, Douglas R; Perucca, Emilio; Tomson, Torbjörn; Wiebe, Samuel; Zhang, Yue-Hua; Zuberi, Sameer M

2017-01-01

Summary The ILAE Classification of the Epilepsies has been updated to reflect our gain in understanding of the epilepsies and their underlying mechanisms following the major scientific advances which have taken place since the last ratified classification in 1989. As a critical tool for the practising clinician, epilepsy classification must be relevant and dynamic to changes in thinking, yet robust and translatable to all areas of the globe. Its primary purpose is for diagnosis of patients, but it is also critical for epilepsy research, development of antiepileptic therapies and communication around the world. The new classification originates from a draft document submitted for public comments in 2013 which was revised to incorporate extensive feedback from the international epilepsy community over several rounds of consultation. It presents three levels, starting with seizure type where it assumes that the patient is having epileptic seizures as defined by the new 2017 ILAE Seizure Classification. After diagnosis of the seizure type, the next step is diagnosis of epilepsy type, including focal epilepsy, generalized epilepsy, combined generalized and focal epilepsy, and also an unknown epilepsy group. The third level is that of epilepsy syndrome where a specific syndromic diagnosis can be made. The new classification incorporates etiology along each stage, emphasizing the need to consider etiology at each step of diagnosis as it often carries significant treatment implications. Etiology is broken into six subgroups, selected because of their potential therapeutic consequences. New terminology is introduced such as developmental and epileptic encephalopathy. The term benign is replaced by the terms self-limited and pharmacoresponsive, to be used where appropriate. It is hoped that this new framework will assist in improving epilepsy care and research in the 21st century. PMID:28276062

Impact of the revised (2008) EORTC/MSG definitions for invasive fungal disease on the rates of diagnosis of invasive aspergillosis.

PubMed

Tsitsikas, Dimitris A; Morin, Amelie; Araf, Shamzah; Murtagh, Bernadine; Johnson, Gemma; Vinnicombe, Sarah; Ellis, Stephen; Suaris, Tamara; Wilks, Mark; Doffman, Sarah; Agrawal, Samir G

2012-07-01

Diagnosis of invasive aspergillosis (IA) remains a challenge as the clinical manifestations are not specific, and a histological diagnosis is often unfeasible. The 2002 European Organization for Research and Treatment of Cancer (EORTC) and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (MSG) criteria for classification of cases into possible, probable or proven were revised in 2008. Our objective was to analyze the impact of these revisions on the diagnosis of IA. A retrospective analysis of 589 high risk patient-episodes revealed that 125 of 155 'possible' (81%) and 12 of 16 'probable' (75%) cases of IA should be changed to 'non-classifiable' when the new criteria were applied. We concluded, as expected, that the 2008 EORTC/MSG revised definitions reduced the number of cases classified as 'possible' IA, but additionally, there has been a dramatic reduction in 'probable' cases. These changes have significant implications on the interpretation of clinical trial data based on EORTC/MSG classifications.

Increased Complications for Schizophrenia and Bipolar Disorder Patients Undergoing Total Joint Arthroplasty.

PubMed

Kheir, Michael M; Kheir, You Na P; Tan, Timothy L; Ackerman, Colin T; Rondon, Alexander J; Chen, Antonia F

2018-05-01

Although it has been shown that anxiety and depression are associated with increased complications after total joint arthroplasty (TJA), the outcomes of TJA in patients with a history of psychosis are unknown. This study evaluated the influence of bipolar and schizophrenic disorders on complications after TJA, particularly aseptic and septic revisions. A retrospective review of 156 TJAs (125 primaries and 31 revisions) was performed at a single institution from 2000 to 2015. Bipolar and schizophrenic patients were identified based on International Classification of Diseases, Ninth Revision codes or by those actively taking anti-psychotic medications, followed by manual chart review to confirm diagnoses. The psychosis patient cohort was matched 3:1 for a variety of factors. Revisions and readmissions were evaluated. Survivorship curves were generated. Patients with schizophrenia or bipolar disorder had an increased odds of developing peri-prosthetic joint infection at 90 days (odds ratio [OR] 3.34, P = .049), 2 years (OR 3.94, P = .004), and at any time point (OR 4.32, P = .002). Psychosis patients had increased odds of aseptic and mechanical revisions at all endpoints, particularly from dislocation. Psychosis patients had a higher number of post-operative emergency department visits (P < .001), and were more likely to be discharged to a rehabilitation facility (P < .001). Patients with bipolar affective disorder or schizophrenia may have multiple barriers to self-care after TJA, and are at an increased risk for undergoing revision TJA for prosthetic joint infection and mechanical causes. Increased pre-operative education and screening of this patient population may be necessary prior to performing TJA. Copyright © 2017 Elsevier Inc. All rights reserved.

DIAGNOSTIC CLASSIFICATION OF MENTAL HEALTH AND DEVELOPMENTAL DISORDERS OF INFANCY AND EARLY CHILDHOOD DC:0-5: SELECTIVE REVIEWS FROM A NEW NOSOLOGY FOR EARLY CHILDHOOD PSYCHOPATHOLOGY.

PubMed

Zeanah, Charles H; Carter, Alice S; Cohen, Julie; Egger, Helen; Gleason, Mary Margaret; Keren, Miri; Lieberman, Alicia; Mulrooney, Kathleen; Oser, Cindy

2016-09-01

The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Revised Edition (DC:0-5; ZERO TO THREE) is scheduled to be published in 2016. The articles in this section are selective reviews that have been undertaken as part of the process of refining and updating the nosology. They provide the rationales for new disorders, for disorders that had not been included previously in the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Revised Edition (DC:0-3R; ZERO TO THREE, 2005), and for changes in how certain types of disorders are conceptualized. © 2016 Michigan Association for Infant Mental Health.

Author-Editor Guide to Technical Publications Preparation. Revision

DTIC Science & Technology

1990-01-01

meteorology, climatology, military technical publications. ( ") <- 15: Number of Pages: 68 17. Security Classification of Report: Unclassified 1... Security Classification of this Page: Unclassified 19. Security Classification of Abstract: Unclassified 20. Limitation of Abstract: UL Standard Form 298...34 There are, however, February 1983. numerous exceptions. Although some technical material may not be classified in accordance with security AFR 83-2, Air

Index of NACA Technical Publications: 1915-1949

NASA Technical Reports Server (NTRS)

1949-01-01

The Index of NACA Technical Publications covers reports issued from the date of origin of the Committee in 1915 until approximately September 1949. Because omissions were noted after publication of the Index issued in 1947, and since many new reports have been released since that time, it was decided to issue a new volume to supersede completely the 1947 Index, with supplements to be issued regularly in the future. Commencing with all publications issued after September 1, 1949, subject classifications were revised, the most important change involving the transfer of aircraft loads reports from the Aerodynamics classification to Structures. For those maintaining a file of NACA index cards, it is recommended that cards issued for reports dated prior to September 1, 1949 be removed from the file. This volume includes the same index information. Supplements covering periods following September 1, 1949, will be arranged according to the revised subject classifications. On the pages immediately following, the subject classifications are indexed in order of breakdown. There is included in the back of this volume an alphabetical arrangement of the subject classifications.

[An approach to bacteriological taxonomy by application of Immanuel Kant's transcendental dialectics (author's transl)].

PubMed

Habs, H

1981-01-01

After having altered the name of International Committee for Bacteriological Nomenclature in International Committee on Systematic Bacteriology in 1970, the latter will also have to reflect upon the objects of taxonomy. An approach thereto is recognizable in the revision of the International Code of Nomenclature of Bacteria in 1975. Considerations are being made whether a classification of bacteria does justice to the laws of homogenicity, specification and continuity as laid down by Kant in his transcendental dialectic. Most important of all are definition and determination of the taxon species. As far as contents go the latter is not possible from the biological point of view but applicable to its range in application of the regulations of the code. Within the priorities of taxa the species adopts a preferential position because conceptions of applied bacteriology are contained therein. The variety of infra-subspecific subdivisions is taken into consideration; as far as the formae speciales are concerned considerations as made with regard to species apply.

Mental health professionals' natural taxonomies of mental disorders: implications for the clinical utility of the ICD-11 and the DSM-5.

PubMed

Reed, Geoffrey M; Roberts, Michael C; Keeley, Jared; Hooppell, Catherine; Matsumoto, Chihiro; Sharan, Pratap; Robles, Rebeca; Carvalho, Hudson; Wu, Chunyan; Gureje, Oye; Leal-Leturia, Itzear; Flanagan, Elizabeth H; Correia, João Mendonça; Maruta, Toshimasa; Ayuso-Mateos, José Luís; de Jesus Mari, Jair; Xiao, Zeping; Evans, Spencer C; Saxena, Shekhar; Medina-Mora, María Elena

2013-12-01

To examine the conceptualizations held by psychiatrists and psychologists around the world of the relationships among mental disorders in order to inform decisions about the structure of the classification of mental and behavioral disorders in World Health Organization's International Classification of Diseases and Related Health Problems 11th Revision (ICD-11). 517 mental health professionals in 8 countries sorted 60 cards containing the names of mental disorders into groups of similar disorders, and then formed a hierarchical structure by aggregating and disaggregating these groupings. Distance matrices were created from the sorting data and used in cluster and correlation analyses. Clinicians' taxonomies were rational, interpretable, and extremely stable across countries, diagnostic system used, and profession. Clinicians' consensus classification structure was different from ICD-10 and the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV), but in many respects consistent with ICD-11 proposals. The clinical utility of the ICD-11 may be improved by making its structure more compatible with the common conceptual organization of mental disorders observed across diverse global clinicians. © 2013 Wiley Periodicals, Inc.

75 FR 56015 - Vessel Inspection Alternatives

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-15

... page 88, in Sec. 8.420, paragraph (c) is revised to read as follows: Sec. 8.420 Classification society authorization to participate in the Alternate Compliance Program. * * * * * (c) A recognized classification... (2) Must have performed a delegated function related to general vessel safety assessment, as defined...

Prostatic cancers: understanding their molecular pathology and the 2016 WHO classification

PubMed Central

Inamura, Kentaro

2018-01-01

Accumulating evidence suggests that prostatic cancers represent a group of histologically and molecularly heterogeneous diseases with variable clinical courses. In accordance with the increased knowledge of their clinicopathologies and genetics, the World Health Organization (WHO) classification of prostatic cancers has been revised. Additionally, recent data on their comprehensive molecular characterization have increased our understanding of the genomic basis of prostatic cancers and enabled us to classify them into subtypes with distinct molecular pathologies and clinical features. Our increased understanding of the molecular pathologies of prostatic cancers has permitted their evolution from a poorly understood, heterogeneous group of diseases with variable clinical courses to characteristic molecular subtypes that allow the implementation of personalized therapies and better patient management. This review provides perspectives on the new 2016 WHO classification of prostatic cancers as well as recent knowledge of their molecular pathologies. The WHO classification of prostatic cancers will require additional revisions to allow for reliable and clinically meaningful cancer diagnoses as a better understanding of their molecular characteristics is obtained. PMID:29581876

Causes of death and associated conditions (Codac) – a utilitarian approach to the classification of perinatal deaths

PubMed Central

Frøen, J Frederik; Pinar, Halit; Flenady, Vicki; Bahrin, Safiah; Charles, Adrian; Chauke, Lawrence; Day, Katie; Duke, Charles W; Facchinetti, Fabio; Fretts, Ruth C; Gardener, Glenn; Gilshenan, Kristen; Gordijn, Sanne J; Gordon, Adrienne; Guyon, Grace; Harrison, Catherine; Koshy, Rachel; Pattinson, Robert C; Petersson, Karin; Russell, Laurie; Saastad, Eli; Smith, Gordon CS; Torabi, Rozbeh

2009-01-01

A carefully classified dataset of perinatal mortality will retain the most significant information on the causes of death. Such information is needed for health care policy development, surveillance and international comparisons, clinical services and research. For comparability purposes, we propose a classification system that could serve all these needs, and be applicable in both developing and developed countries. It is developed to adhere to basic concepts of underlying cause in the International Classification of Diseases (ICD), although gaps in ICD prevent classification of perinatal deaths solely on existing ICD codes. We tested the Causes of Death and Associated Conditions (Codac) classification for perinatal deaths in seven populations, including two developing country settings. We identified areas of potential improvements in the ability to retain existing information, ease of use and inter-rater agreement. After revisions to address these issues we propose Version II of Codac with detailed coding instructions. The ten main categories of Codac consist of three key contributors to global perinatal mortality (intrapartum events, infections and congenital anomalies), two crucial aspects of perinatal mortality (unknown causes of death and termination of pregnancy), a clear distinction of conditions relevant only to the neonatal period and the remaining conditions are arranged in the four anatomical compartments (fetal, cord, placental and maternal). For more detail there are 94 subcategories, further specified in 577 categories in the full version. Codac is designed to accommodate both the main cause of death as well as two associated conditions. We suggest reporting not only the main cause of death, but also the associated relevant conditions so that scenarios of combined conditions and events are captured. The appropriately applied Codac system promises to better manage information on causes of perinatal deaths, the conditions associated with them, and the most common clinical scenarios for future study and comparisons. PMID:19515228

Causes of death and associated conditions (Codac): a utilitarian approach to the classification of perinatal deaths.

PubMed

Frøen, J Frederik; Pinar, Halit; Flenady, Vicki; Bahrin, Safiah; Charles, Adrian; Chauke, Lawrence; Day, Katie; Duke, Charles W; Facchinetti, Fabio; Fretts, Ruth C; Gardener, Glenn; Gilshenan, Kristen; Gordijn, Sanne J; Gordon, Adrienne; Guyon, Grace; Harrison, Catherine; Koshy, Rachel; Pattinson, Robert C; Petersson, Karin; Russell, Laurie; Saastad, Eli; Smith, Gordon C S; Torabi, Rozbeh

2009-06-10

A carefully classified dataset of perinatal mortality will retain the most significant information on the causes of death. Such information is needed for health care policy development, surveillance and international comparisons, clinical services and research. For comparability purposes, we propose a classification system that could serve all these needs, and be applicable in both developing and developed countries. It is developed to adhere to basic concepts of underlying cause in the International Classification of Diseases (ICD), although gaps in ICD prevent classification of perinatal deaths solely on existing ICD codes.We tested the Causes of Death and Associated Conditions (Codac) classification for perinatal deaths in seven populations, including two developing country settings. We identified areas of potential improvements in the ability to retain existing information, ease of use and inter-rater agreement. After revisions to address these issues we propose Version II of Codac with detailed coding instructions.The ten main categories of Codac consist of three key contributors to global perinatal mortality (intrapartum events, infections and congenital anomalies), two crucial aspects of perinatal mortality (unknown causes of death and termination of pregnancy), a clear distinction of conditions relevant only to the neonatal period and the remaining conditions are arranged in the four anatomical compartments (fetal, cord, placental and maternal).For more detail there are 94 subcategories, further specified in 577 categories in the full version. Codac is designed to accommodate both the main cause of death as well as two associated conditions. We suggest reporting not only the main cause of death, but also the associated relevant conditions so that scenarios of combined conditions and events are captured.The appropriately applied Codac system promises to better manage information on causes of perinatal deaths, the conditions associated with them, and the most common clinical scenarios for future study and comparisons.

Resource utilization and costs of age-related macular degeneration.

PubMed

Halpern, Michael T; Schmier, Jordana K; Covert, David; Venkataraman, Krithika

2006-01-01

Data were analyzed from the 1999-2001 Medicare Beneficiary Encrypted Files for patients with age-related macular degeneration (AMD), an ophthalmic condition characterized by central vision loss. Classifying AMD subtype by International Classification of Diseases, Ninth Revision, Clinical Modifications (ICD-9-CM) (Centers for Disease Control and Prevention, 2003) code, resource utilization rates increased with disease progression. Individuals with more severe disease (wet only or wet and dry AMD) had greater costs than did those with less severe disease (drusen only or dry only). Costs among patients with wet disease increased yearly at rates exceeding inflation, possibly due in part to increased rates of treatment with photodynamic therapy among these individuals and the aging of the population.

ASAS 095221-4329.8 und ASAS 123034-7703.9 - zwei R-CrB-Stern-Kandidaten aus der ASAS-Datenbank

NASA Astrophysics Data System (ADS)

Huemmerich, Stefan

2011-04-01

During an examination of ASAS Misc-type objects, the stars ASAS 095221-4329.8 GSC 07706-00560, 09:52:21.38 -43:29:40.5) and ASAS 123034-7703.9 (GSC 09416-00380, 12:30:34.22 -77:03:52.7) - both of which show semi-regular variability - were found to exhibit significant obscuration events in their V-band lightcurves. Both stars are likely to be red giants undergoing fading events, possibly of DY Per-type. However, spectroscopy of both stars is needed for a conclusive classification. The corresponding entries in the International Variable Star Index (VSX) have been revised accordingly; variability type was set to "RCB:".

A case report of pornography addiction with dhat syndrome

PubMed Central

Darshan, M. S.; Sathyanarayana Rao, T. S.; Manickam, Sam; Tandon, Abhinav; Ram, Dushad

2014-01-01

A case of pornography addiction with dhat syndrome was diagnosed applying the existing criteria for substance dependence in International Classification for Diseases-10 and Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision. There is a lack of clear-cut criteria for identifying and defining such behavioural addictions and also lack of medical documents on pornography addiction. An applied strategy in lines with any substance addiction is used, and we found it helped our patient to gradually deaddict and then completely quit watching pornography. This is one of the few cases being reported scientifically, and we hope more work will be carried out in this ever increasing pornography addiction problem. PMID:25568482

Queer diagnoses revisited: The past and future of homosexuality and gender diagnoses in DSM and ICD.

PubMed

Drescher, Jack

2015-01-01

The American Psychiatric Association (APA) recently completed a several year process of revising the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). During that time, there were objections raised to retaining DSM's gender identity disorder diagnoses and calls to remove them, just as homosexuality had been removed from DSM-II in 1973. At the conclusion of the DSM-5 revision process, the gender diagnoses were retained, albeit in altered form and bearing the new name of 'gender dysphoria'. The author of this paper was a member of the DSM-5 Workgroup on Sexual and Gender Identity Disorders and presently serves on the WHO Working Group on Sexual Disorders and Sexual Health. Both groups faced similar tasks: reconciling patients' needs for access to care with the stigma of being given a psychiatric diagnosis. The differing nature of the two diagnostic manuals led to two different outcomes. As background, this paper updates the history of homosexuality and the gender diagnoses in the DSM and in the International Statistical Classification of Diseases and Related Health Problems (ICD) as well as what is expected to happen to the homosexuality and gender diagnoses following the current ICD-11 revision process.

77 FR 24585 - List of Approved Spent Fuel Storage Casks: HI-STORM 100, Revision 8

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-25

... Storage Casks: HI-STORM 100, Revision 8 AGENCY: Nuclear Regulatory Commission. ACTION: Direct final rule... revising the Holtec International HI-STORM 100 System listing within the ``List of Approved Spent Fuel...) 72.214, by revising the Holtec International HI-STORM 100 System listing within the ``List of...

A Review of Periprosthetic Femoral Fractures Associated With Total Hip Arthroplasty

PubMed Central

Marsland, Daniel; Mears, Simon C.

2012-01-01

Periprosthetic fractures of the femur in association with total hip arthroplasty are increasingly common and often difficult to treat. Patients with periprosthetic fractures are typically elderly and frail and have osteoporosis. No clear consensus exists regarding the optimal management strategy because there is limited high-quality research. The Vancouver classification facilitates treatment decisions. In the presence of a stable prosthesis (type-B1 and -C fractures), most authors recommend surgical stabilization of the fracture with plates, strut grafts, or a combination thereof. In up to 20% of apparent Vancouver type-B1 fractures, the femoral stem is loose, which may explain the high failure rates associated with open reduction and internal fixation. Some authors recommend routine opening and dislocation of the hip to perform an intraoperative stem stability test to rule out a loose component. Advances in plating techniques and technology are improving the outcomes for these fractures. For fractures around a loose femoral prosthesis (types B2 and 3), revision using an extensively porous-coated uncemented long stem, with or without additional fracture fixation, appears to offer the most reliable outcome. Cement-in-cement revision using a long-stem prosthesis is feasible in elderly patients with a well-fixed cement mantle. It is essential to treat the osteoporosis to help fracture healing and to prevent further fractures. We provide an overview of the causes, classification, and management of periprosthetic femoral fractures around a total hip arthroplasty based on the current best available evidence. PMID:23569704

A revision of chiggers of the minuta species-group (Acari: Trombiculidae: Neotrombicula Hirst, 1925) using multivariate morphometrics.

PubMed

Stekolnikov, Alexandr A; Klimov, Pavel B

2010-09-01

We revise chiggers belonging to the minuta-species group (genus Neotrombicula Hirst, 1925) from the Palaearctic using size-free multivariate morphometrics. This approach allowed us to resolve several diagnostic problems. We show that the widely distributed Neotrombicula scrupulosa Kudryashova, 1993 forms three spatially and ecologically isolated groups different from each other in size or shape (morphometric property) only: specimens from the Caucasus are distinct from those from Asia in shape, whereas the Asian specimens from plains and mountains are different from each other in size. We developed a multivariate classification model to separate three closely related species: N. scrupulosa, N. lubrica Kudryashova, 1993 and N. minuta Schluger, 1966. This model is based on five shape variables selected from an initial 17 variables by a best subset analysis using a custom size-correction subroutine. The variable selection procedure slightly improved the predictive power of the model, suggesting that it not only removed redundancy but also reduced 'noise' in the dataset. The overall classification accuracy of this model is 96.2, 96.2 and 95.5%, as estimated by internal validation, external validation and jackknife statistics, respectively. Our analyses resulted in one new synonymy: N. dimidiata Stekolnikov, 1995 is considered to be a synonym of N. lubrica. Both N. scrupulosa and N. lubrica are recorded from new localities. A key to species of the minuta-group incorporating results from our multivariate analyses is presented.

PSG-EXPERT. An expert system for the diagnosis of sleep disorders.

PubMed

Fred, A; Filipe, J; Partinen, M; Paiva, T

2000-01-01

This paper describes PSG-EXPERT, an expert system in the domain of sleep disorders exploring polysomnographic data. The developed software tool is addressed from two points of view: (1)--as an integrated environment for the development of diagnosis-oriented expert systems; (2)--as an auxiliary diagnosis tool in the particular domain of sleep disorders. Developed over a Windows platform, this software tool extends one of the most popular shells--CLIPS (C Language Integrated Production System) with the following features: backward chaining engine; graph-based explanation facilities; knowledge editor including a fuzzy fact editor and a rules editor, with facts-rules integrity checking; belief revision mechanism; built-in case generator and validation module. It therefore provides graphical support for knowledge acquisition, edition, explanation and validation. From an application domain point of view, PSG-Expert is an auxiliary diagnosis system for sleep disorders based on polysomnographic data, that aims at assisting the medical expert in his diagnosis task by providing automatic analysis of polysomnographic data, summarising the results of this analysis in terms of a report of major findings and possible diagnosis consistent with the polysomnographic data. Sleep disorders classification follows the International Classification of Sleep Disorders. Major features of the system include: browsing on patients data records; structured navigation on Sleep Disorders descriptions according to ASDA definitions; internet links to related pages; diagnosis consistent with polysomnographic data; graphical user-interface including graph-based explanatory facilities; uncertainty modelling and belief revision; production of reports; connection to remote databases.

Implications of the revised consensus body mass indices for asian indians on clinical obstetric practice.

PubMed

Aziz, Nuzhat; Kallur, Sailaja Devi; Nirmalan, Praveen Kumar

2014-05-01

The body mass index (BMI) categories for Asian Indians has been revised based on consensus guidelines. The revised guidelines categorize overweight as a BMI of 23.0 - 24.9 and obesity as a BMI≥25. To determine the change in prevalence of overweight and obese pregnant women, and maternal and fetal associations with overweight and obese pregnant women classified using the revised consensus guidelines for BMI in Asian Indians. A retrospective analysis of case records of pregnant women between January 2010 and December 2012 at a tertiary care institute in India. BMI was classified using the revised consensus guidelines for Asian Indians and the World Health Organization (WHO) criteria. The strength and direction of associations with maternal and fetal outcomes was explored with a multivariate regression model. The prevalence of obesity increased from 11.81% with the WHO criteria to 43.11% with the revised consensus guidelines and led to the re-classification of 1,345 (18.47%) pregnant women from a low risk category to a high risk category.Gestational hypertension, gestational diabetes and large for gestational age babies was associated with overweight or obesity (both Indian and WHO guidelines). Obesity (both Indian and WHO guidelines) was also significantly associated with caesarean sections (adjusted OR 1.23 and 1.51 respectively). The use of the revised guidelines led to a larger classification of high risk Asian Indian pregnant women. Retention of adverse associations of overweight and obesity support adoption of the revised guidelines in obstetric management of Asian Indians.

76 FR 80302 - Amendment to the International Traffic in Arms Regulations: Revision of U.S. Munitions List...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-23

... DEPARTMENT OF STATE 22 CFR Part 121 RIN 1400-AC99 [Public Notice 7736] Amendment to the International Traffic in Arms Regulations: Revision of U.S. Munitions List Category VI AGENCY: Department of... Department of State proposes to amend the International Traffic in Arms Regulations (ITAR) to revise Category...

78 FR 34972 - Approval and Promulgation of Air Quality Implementation Plans; Virginia; Revision to the...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-11

... ENVIRONMENTAL PROTECTION AGENCY 40 CFR Part 52 [EPA-R03-OAR-2013-0289; FRL-9822-2] Approval and Promulgation of Air Quality Implementation Plans; Virginia; Revision to the Classification and Implementation of the 2008 Ozone National Ambient Air Quality Standards for the Northern Virginia Nonattainment Area...

75 FR 28231 - Cotton Classification and Market News Service: Notice of Request for an Extension and Revision of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-20

... DEPARTMENT OF AGRICULTURE Agricultural Marketing Service [AMS-CN-10-0037; CN-10-003] Cotton... Cotton Classification and Market News Service. DATES: Comments received by July 19, 2010. ADDITIONAL... Shethir Riva, Chief, Research and Promotion, Cotton and Tobacco Programs, Agricultural Marketing Service...

Five Systems of Psychiatric Classification for Preschool Children: Do Differences in Validity, Usefulness and Reliability Make for Competitive or Complimentary Constellations?

ERIC Educational Resources Information Center

Postert, Christian; Averbeck-Holocher, Marlies; Beyer, Thomas; Muller, Jorg; Furniss, Tilman

2009-01-01

"DSM-IV" and "ICD-10" have limitations in the diagnostic classification of psychiatric disorders at preschool age (0-5 years). The publication of the "Diagnostic Classification 0-3 (DC:0-3)" in 1994, its basically revised second edition ("DC:0-3R") in 2005 and the "Research Diagnostic Criteria-Preschool Age (RDC-PA)" in 2004 have provided several…

The 2016 revision of the WHO Classification of Central Nervous System Tumours: retrospective application to a cohort of diffuse gliomas.

PubMed

Rogers, Te Whiti; Toor, Gurvinder; Drummond, Katharine; Love, Craig; Field, Kathryn; Asher, Rebecca; Tsui, Alpha; Buckland, Michael; Gonzales, Michael

2018-03-01

The classification of central nervous system tumours has more recently been shaped by a focus on molecular pathology rather than histopathology. We re-classified 82 glial tumours according to the molecular-genetic criteria of the 2016 revision of the World Health Organization (WHO) Classification of Tumours of the Central Nervous System. Initial diagnoses and grading were based on the morphological criteria of the 2007 WHO scheme. Because of the impression of an oligodendroglial component on initial histological assessment, each tumour was tested for co-deletion of chromosomes 1p and 19q and mutations of isocitrate dehydrogenase (IDH-1 and 2) genes. Additionally, expression of proteins encoded by alpha-thalassemia X-linked mental retardation (ATRX) and TP53 genes was assessed by immunohistochemistry. We found that all but two tumours could be assigned to a specific category in the 2016 revision. The most common change in diagnosis was from oligoastrocytoma to specifically astrocytoma or oligodendroglioma. Analysis of progression free survival (PFS) for WHO grade II and III tumours showed that the objective criteria of the 2016 revision separated diffuse gliomas into three distinct molecular categories: chromosome 1p/19q co-deleted/IDH mutant, intact 1p/19q/IDH mutant and IDH wild type. No significant difference in PFS was found when comparing IDH mutant grade II and III tumours suggesting that IDH status is more informative than tumour grade. The segregation into distinct molecular sub-types that is achieved by the 2016 revision provides an objective evidence base for managing patients with grade II and III diffuse gliomas based on prognosis.

Reliability and Validity of the Sensory Component of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI): A Systematic Review.

PubMed

Hales, M; Biros, E; Reznik, J E

2015-01-01

Since 1982, the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) has been used to classify sensation of spinal cord injury (SCI) through pinprick and light touch scores. The absence of proprioception, pain, and temperature within this scale creates questions about its validity and accuracy. To assess whether the sensory component of the ISNCSCI represents a reliable and valid measure of classification of SCI. A systematic review of studies examining the reliability and validity of the sensory component of the ISNCSCI published between 1982 and February 2013 was conducted. The electronic databases MEDLINE via Ovid, CINAHL, PEDro, and Scopus were searched for relevant articles. A secondary search of reference lists was also completed. Chosen articles were assessed according to the Oxford Centre for Evidence-Based Medicine hierarchy of evidence and critically appraised using the McMasters Critical Review Form. A statistical analysis was conducted to investigate the variability of the results given by reliability studies. Twelve studies were identified: 9 reviewed reliability and 3 reviewed validity. All studies demonstrated low levels of evidence and moderate critical appraisal scores. The majority of the articles (~67%; 6/9) assessing the reliability suggested that training was positively associated with better posttest results. The results of the 3 studies that assessed the validity of the ISNCSCI scale were confounding. Due to the low to moderate quality of the current literature, the sensory component of the ISNCSCI requires further revision and investigation if it is to be a useful tool in clinical trials.

Reliability and Validity of the Sensory Component of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI): A Systematic Review

PubMed Central

Hales, M.; Biros, E.

2015-01-01

Background: Since 1982, the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) has been used to classify sensation of spinal cord injury (SCI) through pinprick and light touch scores. The absence of proprioception, pain, and temperature within this scale creates questions about its validity and accuracy. Objectives: To assess whether the sensory component of the ISNCSCI represents a reliable and valid measure of classification of SCI. Methods: A systematic review of studies examining the reliability and validity of the sensory component of the ISNCSCI published between 1982 and February 2013 was conducted. The electronic databases MEDLINE via Ovid, CINAHL, PEDro, and Scopus were searched for relevant articles. A secondary search of reference lists was also completed. Chosen articles were assessed according to the Oxford Centre for Evidence-Based Medicine hierarchy of evidence and critically appraised using the McMasters Critical Review Form. A statistical analysis was conducted to investigate the variability of the results given by reliability studies. Results: Twelve studies were identified: 9 reviewed reliability and 3 reviewed validity. All studies demonstrated low levels of evidence and moderate critical appraisal scores. The majority of the articles (~67%; 6/9) assessing the reliability suggested that training was positively associated with better posttest results. The results of the 3 studies that assessed the validity of the ISNCSCI scale were confounding. Conclusions: Due to the low to moderate quality of the current literature, the sensory component of the ISNCSCI requires further revision and investigation if it is to be a useful tool in clinical trials. PMID:26363591

A revision of infrageneric classification in Astelia Banks & Sol. ex R.Br. (Asteliaceae)

PubMed Central

Birch, Joanne L.

2015-01-01

Abstract Systematic investigations and phylogenetic analyses have indicated that Astelia, as currently circumscribed, is paraphyletic, with Collospermum nested within it. Further, Astelia subgenus Astelia is polyphyletic, and Astelia subgenera Asteliopsis and Tricella are paraphyletic, as currently circumscribed. Revision of the subgeneric classification of Astelia is warranted to ensure classification accurately reflects the evolutionary history of these taxa. Collospermum is relegated to synonymy within Astelia. Astelia is dioecious or polygamodioecious, with a superior ovary, anthers dorsi- or basifixed, pistillodes or pistils that have a single short or poorly defined style, a 3 lobed stigma, and fleshy uni- or trilocular fruit with funicular hairs that are poorly to well developed. Astelia subgenus Collospermum (Skottsb.) Birch is described. A key to Astelia sections is provided. Astelia hastata Colenso, Astelia montana Seem., and Astelia microsperma Colenso pro parte are resurrected and the new combination Astelia samoense (Skottsb.) Birch, comb. nov. is made. PMID:26312037

Stratifying the risks of oral anticoagulation in patients with liver disease.

PubMed

Efird, Lydia M; Mishkin, Daniel S; Berlowitz, Dan R; Ash, Arlene S; Hylek, Elaine M; Ozonoff, Al; Reisman, Joel I; Zhao, Shibei; Jasuja, Guneet K; Rose, Adam J

2014-05-01

Chronic liver disease presents a relative contraindication to warfarin therapy, but some patients with liver disease nevertheless require long-term anticoagulation. The goal is to identify which patients with liver disease might safely receive warfarin. Among 102 134 patients who received warfarin from the Veterans Affairs from 2007 to 2008, International Classification of Diseases-Ninth Revision codes identified 1763 patients with chronic liver disease. Specific diagnoses and laboratory values (albumin, aspartate aminotransferase, alanine aminotransferase, creatinine, and cholesterol) were examined to identify risk of adverse outcomes, while controlling for available bleeding risk factors. Outcomes included percent time in therapeutic range, a measure of anticoagulation control, and major hemorrhagic events, by International Classification of Diseases-Ninth Revision codes. Patients with liver disease had lower mean time in therapeutic range (53.5%) when compared with patients without (61.7%; P<0.001) and more hemorrhages (hazard ratio, 2.02; P<0.001). Among patients with liver disease, serum albumin and creatinine levels were the strongest predictors of both outcomes. We created a 4-point score system: patients received 1 point each for albumin (2.5-3.49 g/dL) or creatinine (1.01-1.99 mg/dL), and 2 points each for albumin (<2.5 g/dL) or creatinine (≥2 mg/dL). This score predicted both anticoagulation control and hemorrhage. When compared with patients without liver disease, those with a score of zero had modestly lower time in therapeutic range (56.7%) and no increase in hemorrhages (hazard ratio, 1.16; P=0.59), whereas those with the worst score (4) had poor control (29.4%) and high hazard of hemorrhage (hazard ratio, 8.53; P<0.001). Patients with liver disease receiving warfarin have poorer anticoagulation control and more hemorrhages. A simple 4-point scoring system using albumin and creatinine identifies those at risk for poor outcomes. © 2014 American Heart Association, Inc.

Predictive ability of positive clinical culture results and International Classification of Diseases, Ninth Revision, to identify and classify noninvasive Staphylococcus aureus infections: a validation study.

PubMed

Tracy, LaRee A; Furuno, Jon P; Harris, Anthony D; Singer, Mary; Langenberg, Patricia; Roghmann, Mary-Claire

2010-07-01

To develop and validate an algorithm to identify and classify noninvasive infections due to Staphylococcus aureus by using positive clinical culture results and administrative data. Retrospective cohort study. Veterans Affairs Maryland Health Care System. Data were collected retrospectively on all S. aureus clinical culture results from samples obtained from nonsterile body sites during October 1998 through September 2008 and associated administrative claims records. An algorithm was developed to identify noninvasive infections on the basis of a unique S. aureus-positive culture result from a nonsterile site sample with a matching International Classification of Diseases, Ninth Revision (ICD-9-CM), code for infection at time of sampling. Medical records of a subset of cases were reviewed to find the proportion of true noninvasive infections (cases that met the Centers for Disease Control and Prevention National Healthcare Safety Network [NHSN] definition of infection). Positive predictive value (PPV) and negative predictive value (NPV) were calculated for all infections and according to body site of infection. We identified 4,621 unique S. aureus-positive culture results, of which 2,816 (60.9%) results met our algorithm definition of noninvasive S. aureus infection and 1,805 (39.1%) results lacked a matching ICD-9-CM code. Among 96 cases that met our algorithm criteria for noninvasive S. aureus infection, 76 also met the NHSN criteria (PPV, 79.2% [95% confidence interval, 70.0%-86.1%]). Among 98 cases that failed to meet the algorithm criteria, 80 did not meet the NHSN criteria (NPV, 81.6% [95% confidence interval, 72.8%-88.0%]). The PPV of all culture results was 55.4%. The algorithm was most predictive for skin and soft-tissue infections and bone and joint infections. When culture-based surveillance methods are used, the addition of administrative ICD-9-CM codes for infection can increase the PPV of true noninvasive S. aureus infection over the use of positive culture results alone.

Validation of chronic obstructive pulmonary disease (COPD) diagnoses in healthcare databases: a systematic review protocol.

PubMed

Rimland, Joseph M; Abraha, Iosief; Luchetta, Maria Laura; Cozzolino, Francesco; Orso, Massimiliano; Cherubini, Antonio; Dell'Aquila, Giuseppina; Chiatti, Carlos; Ambrosio, Giuseppe; Montedori, Alessandro

2016-06-01

Healthcare databases are useful sources to investigate the epidemiology of chronic obstructive pulmonary disease (COPD), to assess longitudinal outcomes in patients with COPD, and to develop disease management strategies. However, in order to constitute a reliable source for research, healthcare databases need to be validated. The aim of this protocol is to perform the first systematic review of studies reporting the validation of codes related to COPD diagnoses in healthcare databases. MEDLINE, EMBASE, Web of Science and the Cochrane Library databases will be searched using appropriate search strategies. Studies that evaluated the validity of COPD codes (such as the International Classification of Diseases 9th Revision and 10th Revision system; the Real codes system or the International Classification of Primary Care) in healthcare databases will be included. Inclusion criteria will be: (1) the presence of a reference standard case definition for COPD; (2) the presence of at least one test measure (eg, sensitivity, positive predictive values, etc); and (3) the use of a healthcare database (including administrative claims databases, electronic healthcare databases or COPD registries) as a data source. Pairs of reviewers will independently abstract data using standardised forms and will assess quality using a checklist based on the Standards for Reporting of Diagnostic accuracy (STARD) criteria. This systematic review protocol has been produced in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) 2015 statement. Ethics approval is not required. Results of this study will be submitted to a peer-reviewed journal for publication. The results from this systematic review will be used for outcome research on COPD and will serve as a guide to identify appropriate case definitions of COPD, and reference standards, for researchers involved in validating healthcare databases. CRD42015029204. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

INCIDENCE AND PREVALENCE OF ACROMEGALY IN THE UNITED STATES: A CLAIMS-BASED ANALYSIS.

PubMed

Broder, Michael S; Chang, Eunice; Cherepanov, Dasha; Neary, Maureen P; Ludlam, William H

2016-11-01

Acromegaly, a rare endocrine disorder, results from excessive growth hormone secretion, leading to multisystem-associated morbidities. Using 2 large nationwide databases, we estimated the annual incidence and prevalence of acromegaly in the U.S. We used 2008 to 2013 data from the Truven Health MarketScan ® Commercial Claims and Encounters Database and IMS Health PharMetrics healthcare insurance claims databases, with health plan enrollees <65 years of age. Study patients had ≥2 claims with acromegaly (International Classification of Diseases, 9th Revision, Clinical Modification Code [ICD-9CM] 253.0), or 1 claim with acromegaly and 1 claim for pituitary tumor, pituitary surgery, or cranial stereotactic radiosurgery. Annual incidence was calculated for each year from 2009 to 2013, and prevalence in 2013. Estimates were stratified by age and sex. Incidence was up to 11.7 cases per million person-years (PMPY) in MarketScan and 9.6 cases PMPY in PharMetrics. Rates were similar by sex but typically lowest in ≤17 year olds and higher in >24 year olds. The prevalence estimates were 87.8 and 71.0 per million per year in MarketScan and PharMetrics, respectively. Prevalence consistently increased with age but was similar by sex in each database. The current U.S. incidence of acromegaly may be up to 4 times higher and prevalence may be up to 50% higher than previously reported in European studies. Our findings correspond with the estimates reported by a recent U.S. study that used a single managed care database, supporting the robustness of these estimates in this population. Our study indicates there are approximately 3,000 new cases of acromegaly per year, with a prevalence of about 25,000 acromegaly patients in the U.S. CT = computed tomography GH = growth hormone IGF-1 = insulin-like growth factor 1 ICD-9-CM Code = International Classification of Diseases, 9th Revision, Clinical Modification Codes MRI = magnetic resonance imaging PMPY = per million person-years.

Quality improvement of International Classification of Diseases, 9th revision, diagnosis coding in radiation oncology: single-institution prospective study at University of California, San Francisco.

PubMed

Chen, Chien P; Braunstein, Steve; Mourad, Michelle; Hsu, I-Chow J; Haas-Kogan, Daphne; Roach, Mack; Fogh, Shannon E

2015-01-01

Accurate International Classification of Diseases (ICD) diagnosis coding is critical for patient care, billing purposes, and research endeavors. In this single-institution study, we evaluated our baseline ICD-9 (9th revision) diagnosis coding accuracy, identified the most common errors contributing to inaccurate coding, and implemented a multimodality strategy to improve radiation oncology coding. We prospectively studied ICD-9 coding accuracy in our radiation therapy--specific electronic medical record system. Baseline ICD-9 coding accuracy was obtained from chart review targeting ICD-9 coding accuracy of all patients treated at our institution between March and June of 2010. To improve performance an educational session highlighted common coding errors, and a user-friendly software tool, RadOnc ICD Search, version 1.0, for coding radiation oncology specific diagnoses was implemented. We then prospectively analyzed ICD-9 coding accuracy for all patients treated from July 2010 to June 2011, with the goal of maintaining 80% or higher coding accuracy. Data on coding accuracy were analyzed and fed back monthly to individual providers. Baseline coding accuracy for physicians was 463 of 661 (70%) cases. Only 46% of physicians had coding accuracy above 80%. The most common errors involved metastatic cases, whereby primary or secondary site ICD-9 codes were either incorrect or missing, and special procedures such as stereotactic radiosurgery cases. After implementing our project, overall coding accuracy rose to 92% (range, 86%-96%). The median accuracy for all physicians was 93% (range, 77%-100%) with only 1 attending having accuracy below 80%. Incorrect primary and secondary ICD-9 codes in metastatic cases showed the most significant improvement (10% vs 2% after intervention). Identifying common coding errors and implementing both education and systems changes led to significantly improved coding accuracy. This quality assurance project highlights the potential problem of ICD-9 coding accuracy by physicians and offers an approach to effectively address this shortcoming. Copyright © 2015. Published by Elsevier Inc.

Administrative database concerns: accuracy of International Classification of Diseases, Ninth Revision coding is poor for preoperative anemia in patients undergoing spinal fusion.

PubMed

Golinvaux, Nicholas S; Bohl, Daniel D; Basques, Bryce A; Grauer, Jonathan N

2014-11-15

Cross-sectional study. To objectively evaluate the ability of International Classification of Diseases, Ninth Revision (ICD-9) codes, which are used as the foundation for administratively coded national databases, to identify preoperative anemia in patients undergoing spinal fusion. National database research in spine surgery continues to rise. However, the validity of studies based on administratively coded data, such as the Nationwide Inpatient Sample, are dependent on the accuracy of ICD-9 coding. Such coding has previously been found to have poor sensitivity to conditions such as obesity and infection. A cross-sectional study was performed at an academic medical center. Hospital-reported anemia ICD-9 codes (those used for administratively coded databases) were directly compared with the chart-documented preoperative hematocrits (true laboratory values). A patient was deemed to have preoperative anemia if the preoperative hematocrit was less than the lower end of the normal range (36.0% for females and 41.0% for males). The study included 260 patients. Of these, 37 patients (14.2%) were anemic; however, only 10 patients (3.8%) received an "anemia" ICD-9 code. Of the 10 patients coded as anemic, 7 were anemic by definition, whereas 3 were not, and thus were miscoded. This equates to an ICD-9 code sensitivity of 0.19, with a specificity of 0.99, and positive and negative predictive values of 0.70 and 0.88, respectively. This study uses preoperative anemia to demonstrate the potential inaccuracies of ICD-9 coding. These results have implications for publications using databases that are compiled from ICD-9 coding data. Furthermore, the findings of the current investigation raise concerns regarding the accuracy of additional comorbidities. Although administrative databases are powerful resources that provide large sample sizes, it is crucial that we further consider the quality of the data source relative to its intended purpose.

Progress of Diabetic Severity and Risk of Dementia.

PubMed

Chiu, Wei-Che; Ho, Wen-Chao; Liao, Ding-Lieh; Lin, Meng-Hung; Chiu, Chih-Chiang; Su, Yu-Ping; Chen, Pau-Chung

2015-08-01

Diabetes is a risk factor for dementia, but the effects of diabetic severity on dementia are unclear. The purpose of this study was to investigate the association between the severity and progress of diabetes and the risk of dementia. We conducted a 12-year population-based cohort study of new-onset diabetic patients from the Taiwan National Health Insurance Research Database. The diabetic severity was evaluated by the adapted Diabetes Complications Severity Index (aDCSI) from the prediabetic period to the end of follow-up. Cox proportional hazard regressions were used to calculate the hazard ratios (HRs) of the scores and change in the aDCSI. Participants were 431,178 new-onset diabetic patients who were older than 50 years and had to receive antidiabetic medications. Dementia cases were identified by International Classification of Diseases, ninth revision, code (International Classification of Diseases, ninth revision, codes 290.0, 290.1, 290.2, 290.3, 290.4, 294.1, 331.0), and the date of the initial dementia diagnosis was used as the index date. The scores and change in the aDCSI were associated with the risk of dementia when adjusting for patient factors, comorbidity, antidiabetic drugs, and drug adherence. At the end of the follow-up, the risks for dementia were 1.04, 1.40, 1.54, and 1.70 (P < .001 for trend) in patients with an aDCSI score of 1, 2, 3, and greater than 3, respectively. Compared with the mildly progressive patients, the adjusted HRs increased as the aDCSI increased (2 y HRs: 1.30, 1.53, and 1.97; final HRs: 2.38, 6.95, and 24.0 with the change in the aDCSI score per year: 0.51-1.00, 1.01-2.00, and > 2.00 vs < 0.50 with P < .001 for trend). The diabetic severity and progression reflected the risk of dementia, and the early change in the aDCSI could predict the risk of dementia in new-onset diabetic patients.

Efficiency of International Classification of Diseases, Ninth Revision, Billing Code Searches to Identify Emergency Department Visits for Blood or Body Fluid Exposures through a Statewide Multicenter Database

PubMed Central

Rosen, Lisa M.; Liu, Tao; Merchant, Roland C.

2016-01-01

BACKGROUND Blood and body fluid exposures are frequently evaluated in emergency departments (EDs). However, efficient and effective methods for estimating their incidence are not yet established. OBJECTIVE Evaluate the efficiency and accuracy of estimating statewide ED visits for blood or body fluid exposures using International Classification of Diseases, Ninth Revision (ICD-9), code searches. DESIGN Secondary analysis of a database of ED visits for blood or body fluid exposure. SETTING EDs of 11 civilian hospitals throughout Rhode Island from January 1, 1995, through June 30, 2001. PATIENTS Patients presenting to the ED for possible blood or body fluid exposure were included, as determined by prespecified ICD-9 codes. METHODS Positive predictive values (PPVs) were estimated to determine the ability of 10 ICD-9 codes to distinguish ED visits for blood or body fluid exposure from ED visits that were not for blood or body fluid exposure. Recursive partitioning was used to identify an optimal subset of ICD-9 codes for this purpose. Random-effects logistic regression modeling was used to examine variations in ICD-9 coding practices and styles across hospitals. Cluster analysis was used to assess whether the choice of ICD-9 codes was similar across hospitals. RESULTS The PPV for the original 10 ICD-9 codes was 74.4% (95% confidence interval [CI], 73.2%–75.7%), whereas the recursive partitioning analysis identified a subset of 5 ICD-9 codes with a PPV of 89.9% (95% CI, 88.9%–90.8%) and a misclassification rate of 10.1%. The ability, efficiency, and use of the ICD-9 codes to distinguish types of ED visits varied across hospitals. CONCLUSIONS Although an accurate subset of ICD-9 codes could be identified, variations across hospitals related to hospital coding style, efficiency, and accuracy greatly affected estimates of the number of ED visits for blood or body fluid exposure. PMID:22561713

[Hospital care for stroke patients in the Valencian Region using the basic minimum data set from the International Classification of Diseases, 9th revision, clinical modification].

PubMed

Geffner-Sclarsky, D

To determine the load and characteristics of cerebrovascular diseases (CVD) admitted in the hospital network throughout the Valencian Region. The paper reports on an analysis of the information included in the basic minimum data set (BMDS) from the 26 hospitals run by the Valencian Regional Ministry of Health in the year 2001. Patients that were selected were those whose main diagnosis was codes C.430 to C.437, according to the International Classification of Diseases, 9th revision, clinical modification (ICD-9-CM). A total of 10,558 patients with CVD were discharged, which accounts for 2.6% of admissions and 3% of hospital stays. The mean age of the series was 71.03 years -standard deviation (SD): 9- and 94.8% were admitted as emergencies. By diagnoses, 3% (319) were subarachnoid haemorrhages (SAH; C.430); 13.4% (1,412) were cerebral haemorrhages (ICH; C.431); 18.5% (1,956) were transient ischemic attacks (TIA; C.435); 49.5% (5,225) were cases of cerebral infarction (CI; C.434 and C.436); and 15.6% involved other vascular processes (C.433 and C.437). Mortality rates were 30.1% in SAH; 33.9% in ICH; 11.7% in CI; and 2.7% in TIA. Mean number of days in hospital: SAH 17.4 (SD: 15); ICH 13.1 (SD: 11.8); CI 9.9 (SD: 6.4) and in cases of TIA 7.2 (SD: 4). The percentages of survivors who were discharged home were 78.9 % in SAH, 83.2% in ICH and 91.9% in the case of CI. In all, 51.3% (5,413 patients) were discharged by neurological units. In spite of possible insufficiencies analysed in this work, the use of the BMDS provides valuable epidemiological information that is very useful for health care management.

On the road to DSM-V and ICD-11.

PubMed

Kupfer, David J; Regier, Darrel A; Kuhl, Emily A

2008-11-01

Development of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) has been ongoing since 1994, though official release will not occur for another 4 years. Potential revisions are being derived from multiple sources, including building on perceived limitations of DSM-IV; broad-based literature reviews; secondary and primary data analyses; and discussions between global members of the mental health community. The current focus on aligning DSM with the International Classification of Diseases-11 (ICD-11) speaks to the importance of creating a unified text that embraces cross-cutting issues of diagnostics, such as developmental, age-related, and cultural phenomena. International discourse is vital to this process and has been fostered by a National Institutes of Health-sponsored conference series on diagnosis-specific topics. From this series, the DSM-V Task Force developed the following set of revision principals to guide the efforts of the DSM-V Work Groups: grounding recommendations in empirical evidence; maintaining continuity with previous editions of DSM; removing a priori limitations on the amount of changes DSM-V may incur; and maintaining DSM's status as a living document. With work group formation complete, members are currently carrying out the research and revision recommendations proposed during the conference series. Ongoing activities include adding specialized advisors to each work group; completing literature reviews and planning data analyses; and forming study groups to discuss integration of cross-cutting issues (e.g., developmental lifespan factors; formation of diagnostic spectra). The road to DSM-V and ICD-11 has been challenging, but members continue to work diligently in their goal of constructing the most harmonious, scientifically sound, and clinically relevant DSM to date.

Adapting a Clinical Data Repository to ICD-10-CM through the use of a Terminology Repository

PubMed Central

Cimino, James J.; Remennick, Lyubov

2014-01-01

Clinical data repositories frequently contain patient diagnoses coded with the International Classification of Diseases, Ninth Revision (ICD-9-CM). These repositories now need to accommodate data coded with the Tenth Revision (ICD-10-CM). Database users wish to retrieve relevant data regardless of the system by which they are coded. We demonstrate how a terminology repository (the Research Entities Dictionary or RED) serves as an ontology relating terms of both ICD versions to each other to support seamless version-independent retrieval from the Biomedical Translational Research Information System (BTRIS) at the National Institutes of Health. We make use of the Center for Medicare and Medicaid Services’ General Equivalence Mappings (GEMs) to reduce the modeling effort required to determine whether ICD-10-CM terms should be added to the RED as new concepts or as synonyms of existing concepts. A divide-and-conquer approach is used to develop integration heuristics that offer a satisfactory interim solution and facilitate additional refinement of the integration as time and resources allow. PMID:25954344

Use of the Dewey Decimal Classification in the United States and Canada.

ERIC Educational Resources Information Center

Comaromi, John P.

1978-01-01

A summary of use of DDC in U.S. and Canadian libraries shows that 85 percent of all libraries use DDC; of these, 75 percent use the most recent full or abridged edition. Divisions needing revision are listed and discussed. Librarians want continuous revision but they do not want numerical designation meanings changed. (Author/MBR)

Development of DSM-V and ICD-11: tendencies and potential of new classifications in psychiatry at the current state of knowledge.

PubMed

Möller, Hans-Jürgen

2009-10-01

A reason for the necessity to revise ICD-10 and DSM-IV is the increase of knowledge in the past 20 years, especially neurobiological knowledge. But is this increase of knowledge, for example in the field of neurogenetics, of such magnitude that a revision of the psychiatric classification is necessary and promises to be fruitful? The current plans for DSM-V or ICD-11, respectively, focus on different improvements. In this context also the introduction of a purely syndromatic/dimensional approach without including etiopathogenetic hypotheses, is discussed. A switch to such a dimensional approach, which was discussed among others in the DSM-V task force Deconstructing Psychosis, would be the most radical development. It could avoid many theoretical pre-assumptions about causal hypotheses, which are still associated with ICD-10 and DSM-IV. This would indeed increase the validity of psychiatric classification, but it would also reduce the information as compared to traditional diagnostic categories with all the current implications concerning etiopathogenesis, therapy and prognosis. Such a dimensional approach would also mean that the syndromes would have to be assessed in a standardized way for each person seeking help from the psychiatric service system or for each person undergoing psychiatric research. This would have to be a multi-dimensional assessment covering all syndromes existing within different psychiatric disorders. Based on the different aspects that must be considered in this context, a careful revision seems more advisable than a radical change of classification.

Minding the body: situating gender identity diagnoses in the ICD-11.

PubMed

Drescher, Jack; Cohen-Kettenis, Peggy; Winter, Sam

2012-12-01

The World Health Organization (WHO) is in the process of revising the International Statistical Classification of Diseases and Related Health Problems (ICD) and ICD-11 has an anticipated publication date of 2015. The Working Group on the Classification of Sexual Disorders and Sexual Health (WGSDSH) is charged with evaluating clinical and research data to inform the revision of diagnostic categories related to sexuality and gender identity that are currently included in the mental and behavioural disorders chapter of ICD-10, and making initial recommendations regarding whether and how these categories should be represented in the ICD-11. The diagnostic classification of disorders related to (trans)gender identity is an area long characterized by lack of knowledge, misconceptions and controversy. The placement of these categories has shifted over time within both the ICD and the American Psychiatric Association's Diagnostic and Statistical Manual (DSM), reflecting developing views about what to call these diagnoses, what they mean and where to place them. This article reviews several controversies generated by gender identity diagnoses in recent years. In both the ICD-11 and DSM-5 development processes, one challenge has been to find a balance between concerns related to the stigmatization of mental disorders and the need for diagnostic categories that facilitate access to healthcare. In this connection, this article discusses several human rights issues related to gender identity diagnoses, and explores the question of whether affected populations are best served by placement of these categories within the mental disorders section of the classification. The combined stigmatization of being transgender and of having a mental disorder diagnosis creates a doubly burdensome situation for this group, which may contribute adversely to health status and to the attainment and enjoyment of human rights. The ICD-11 Working Group on the Classification of Sexual Disorders and Sexual Health believes it is now appropriate to abandon a psychopathological model of transgender people based on 1940s conceptualizations of sexual deviance and to move towards a model that is (1) more reflective of current scientific evidence and best practices; (2) more responsive to the needs, experience, and human rights of this vulnerable population; and (3) more supportive of the provision of accessible and high-quality healthcare services.

Development of the Gross Motor Function Classification System (1997)

ERIC Educational Resources Information Center

Morris, Christopher

2008-01-01

To address the need for a standardized system to classify the gross motor function of children with cerebral palsy, the authors developed a five-level classification system analogous to the staging and grading systems used in medicine. Nominal group process and Delphi survey consensus methods were used to examine content validity and revise the…

Classification of light sources and their interaction with active and passive environments

NASA Astrophysics Data System (ADS)

El-Dardiry, Ramy G. S.; Faez, Sanli; Lagendijk, Ad

2011-03-01

Emission from a molecular light source depends on its optical and chemical environment. This dependence is different for various sources. We present a general classification in terms of constant-amplitude and constant-power sources. Using this classification, we have described the response to both changes in the local density of states and stimulated emission. The unforeseen consequences of this classification are illustrated for photonic studies by random laser experiments and are in good agreement with our correspondingly developed theory. Our results require a revision of studies on sources in complex media.

2015 ISSVD, ISSWSH and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia.

PubMed

Bornstein, Jacob; Goldstein, Andrew T; Stockdale, Colleen K; Bergeron, Sophie; Pukall, Caroline; Zolnoun, Denniz; Coady, Deborah

2016-04-01

In 2014, the executive council of the International Society for the Study of Vulvovaginal Disease, the boards of directors of the International Society for the Study of Women's Sexual Health, and the International Pelvic Pain Society acknowledged the need to revise the current terminology of vulvar pain, on the basis of the significant increase in high-quality etiologic studies published in the last decade. The new terminology was achieved in the following 4 steps. The first involved a terminology consensus conference with representatives of the 3 societies, held in April 2015. Then, an analysis of the relevant published studies was used to establish a level of evidence for each factor associated with vulvodynia. The terminology was amended on the basis of feedback from members of the societies. Finally, each society's board accepted the new terminology. In 2015,the International Society for the Study of Vulvovaginal Disease, International Society for the Study of Women's Sexual Health, and International Pelvic Pain Society adopted a new vulvar pain and vulvodynia terminology that acknowledges the complexity of the clinical presentation and pathophysiology involved in vulvar pain and vulvodynia, and incorporates new information derived from evidence-based studies conducted since the last terminology published in 2003.

2015 ISSVD, ISSWSH, and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia.

PubMed

Bornstein, Jacob; Goldstein, Andrew T; Stockdale, Colleen K; Bergeron, Sophie; Pukall, Caroline; Zolnoun, Denniz; Coady, Deborah

2016-04-01

In 2014, the executive council of the International Society for the Study of Vulvovaginal Disease, the boards of directors of the International Society for the Study of Women's Sexual Health, and the International Pelvic Pain Society acknowledged the need to revise the current terminology of vulvar pain, on the basis of the significant increase in high-quality etiologic studies published in the last decade. The new terminology was achieved in the following 4 steps. The first involved a terminology consensus conference with representatives of the 3 societies, held in April 2015. Then, an analysis of the relevant published studies was used to establish a level of evidence for each factor associated with vulvodynia. The terminology was amended on the basis of feedback from members of the societies. Finally, each society's board accepted the new terminology. In 2015, the International Society for the Study of Vulvovaginal Disease, International Society for the Study of Women's Sexual Health, and International Pelvic Pain Society adopted a new vulvar pain and vulvodynia terminology that acknowledges the complexity of the clinical presentation and pathophysiology involved in vulvar pain and vulvodynia, and incorporates new information derived from evidence-based studies conducted since the last terminology published in 2003.

Variation in post-traumatic response: the role of trauma type in predicting ICD-11 PTSD and CPTSD symptoms.

PubMed

Hyland, Philip; Murphy, Jamie; Shevlin, Mark; Vallières, Frédérique; McElroy, Eoin; Elklit, Ask; Christoffersen, Mogens; Cloitre, Marylène

2017-06-01

The World Health Organization's 11th revision to the International Classification of Diseases manual (ICD-11) will differentiate between two stress-related disorders: PTSD and Complex PTSD (CPTSD). ICD-11 proposals suggest that trauma exposure which is prolonged and/or repeated, or consists of multiple forms, that also occurs under circumstances where escape from the trauma is difficult or impossible (e.g., childhood abuse) will confer greater risk for CPTSD as compared to PTSD. The primary objective of the current study was to provide an empirical assessment of this proposal. A stratified, random probability sample of a Danish birth cohort (aged 24) was interviewed by the Danish National Centre for Social Research (N = 2980) in 2008-2009. Data from this interview were used to generate an ICD-11 symptom-based classification of PTSD and CPTSD. The majority of the sample (87.1%) experienced at least one of eight traumatic events spanning childhood and early adulthood. There was some indication that being female increased the risk for both PTSD and CPTSD classification. Multinomial logistic regression results found that childhood sexual abuse (OR = 4.98) and unemployment status (OR = 4.20) significantly increased risk of CPTSD classification as compared to PTSD. A dose-response relationship was observed between exposure to multiple forms of childhood interpersonal trauma and risk of CPTSD classification, as compared to PTSD. Results provide empirical support for the ICD-11 proposals that childhood interpersonal traumatic exposure increases risk of CPTSD symptom development.

Intellectual developmental disorders: towards a new name, definition and framework for "mental retardation/intellectual disability" in ICD-11.

PubMed

Salvador-Carulla, Luis; Reed, Geoffrey M; Vaez-Azizi, Leila M; Cooper, Sally-Ann; Martinez-Leal, Rafael; Bertelli, Marco; Adnams, Colleen; Cooray, Sherva; Deb, Shoumitro; Akoury-Dirani, Leyla; Girimaji, Satish Chandra; Katz, Gregorio; Kwok, Henry; Luckasson, Ruth; Simeonsson, Rune; Walsh, Carolyn; Munir, Kemir; Saxena, Shekhar

2011-10-01

Although "intellectual disability" has widely replaced the term "mental retardation", the debate as to whether this entity should be conceptualized as a health condition or as a disability has intensified as the revision of the World Health Organization (WHO)'s International Classification of Diseases (ICD) advances. Defining intellectual disability as a health condition is central to retaining it in ICD, with significant implications for health policy and access to health services. This paper presents the consensus reached to date by the WHO ICD Working Group on the Classification of Intellectual Disabilities. Literature reviews were conducted and a mixed qualitative approach was followed in a series of meetings to produce consensus-based recommendations combining prior expert knowledge and available evidence. The Working Group proposes replacing mental retardation with intellectual developmental disorders, defined as "a group of developmental conditions characterized by significant impairment of cognitive functions, which are associated with limitations of learning, adaptive behaviour and skills". The Working Group further advises that intellectual developmental disorders be incorporated in the larger grouping (parent category) of neurodevelopmental disorders, that current subcategories based on clinical severity (i.e., mild, moderate, severe, profound) be continued, and that problem behaviours be removed from the core classification structure of intellectual developmental disorders and instead described as associated features.

The role of Brazilian National Health Information Systems in assessing the impact of Zika virus outbreak.

PubMed

Pavão, Ana Luiza Braz; Barcellos, Christovam; Pedroso, Marcel; Boccolini, Cristiano; Romero, Dália

2017-01-01

The Zika virus (ZIKV) epidemic has become a public health emergency following its association with severe neurological complications. We aim to discuss how the Brazilian National Health Information Systems can help to assess the impact of the ZIKV epidemic on health outcomes potentially related to ZIKV. Health outcomes potentially related to ZIKV infection were described based on a literature review of published studies on ZIKV infection outcomes and on recent protocols developed and published by the Brazilian Ministry of Health for different stages of the life cycle. These outcomes were correlated with the International Classification of Diseases 10th Revision (ICD-10) classification system, as this is the diagnostic classification registered in the Health Information System. A suggested list of 50 clinical manifestations, dispersed into 4 ICD chapters, and their information sources was created to help monitor the ZIKV epidemics and trends. Correlation of these selected ICD-10 codes and the HIS, as well as, a review of the potentialities and limitations of health information systems were performed. The potential of the Health Information System and its underutilization by stakeholders and researchers have been a barrier in diagnosing and reporting ZIKV infection and its complications. The ZIKV outbreak is still a challenge for health practice and the Brazilian Health Information System.

Hypochondriasis: treatment options for a diagnostic quagmire.

PubMed

Starcevic, Vladan

2015-08-01

This article presents the conceptual and diagnostic conundrums surrounding hypochondriasis and reviews current treatment options for this disorder. The removal of hypochondriasis from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and its replacement with two new diagnostic entities have been controversial. It appears that the Eleventh Revision of the International Classification of Diseases will take a more cautious approach and emphasise the links between hypochondriasis, obsessive-compulsive disorder and other anxiety disorders. The cornerstone of any treatment approach to hypochondriasis is establishing a good therapeutic relationship with the patient. Psychological treatments, especially cognitive-behavioural therapy, have been more useful than pharmacotherapy, but there is much room for improving treatment outcomes. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Resource Utilization and Costs of Age-Related Macular Degeneration

PubMed Central

Halpern, Michael T.; Schmier, Jordana K.; Covert, David; Venkataraman, Krithika

2006-01-01

Data were analyzed from the 1999-2001 Medicare Beneficiary Encrypted Files for patients with age-related macular degeneration (AMD), an ophthalmic condition characterized by central vision loss. Classifying AMD subtype by International Classification of Diseases, Ninth Revision, Clinical Modifications (ICD-9-CM) (Centers for Disease Control and Prevention, 2003) code, resource utilization rates increased with disease progression. Individuals with more severe disease (wet only or wet and dry AMD) had greater costs than did those with less severe disease (drusen only or dry only). Costs among patients with wet disease increased yearly at rates exceeding inflation, possibly due in part to increased rates of treatment with photodynamic therapy among these individuals and the aging of the population. PMID:17290647

Mortality in the slave and white populations of Natchitoches Parish, Louisiana, 1850.

PubMed Central

René, A. A.; Daniels, D. E.; Jones, W.; Moore, F. I.

1992-01-01

A review of mortality from the 1850 census mortality schedules of Natchitoches Parish, Louisiana has provided a snapshot of the health conditions of African-American slaves. The cause of death was abstracted from the mortality schedule and categorized according to the ninth revision of the Manual of the International Classification of Diseases. Children under the age of 9 accounted for 44% of the total mortality. Sixty-four percent of all deaths recorded occurred in the slave population. Sixty-two percent of the slave deaths occurred in the male population. Leading causes of death were helminthiasis, whooping cough, fever, cholera, and pneumonia. Reports of mortality due to Cachexia Africana (dirt eating) among slaves are discussed. PMID:1404481

Childhood headache attributed to airplane travel: a case report.

PubMed

Rogers, Kirsty; Rafiq, Nadia; Prabhakar, Prab; Ahmed, Mas

2015-05-01

Headache attributed to airplane flights is a rare form of headache disorder. This case study describes an 11-year-old girl with recurrent, severe, frontal headaches occurring during airplane travel. The episodes were associated with dizziness and facial pallor but no additional symptoms and showed spontaneous resolution on landing. Blood tests and imaging revealed no abnormalities. The present case fulfils the criteria for airplane headache recently included in the revised edition of the International Classification of Headache Disorders (ICHD-III Beta). Only a few cases of airplane headache have been reported in children. To our knowledge, this is the fourth case. We review the current literature on this rare syndrome and discuss various proposed pathophysiological mechanisms. © The Author(s) 2014.

Staging of intrahepatic cholangiocarcinoma

PubMed Central

Ronnekleiv-Kelly, Sean M.

2017-01-01

Intrahepatic cholangiocarcinoma (ICC) comprises approximately 5−30% of primary liver tumors, however it has been increasing over the last several decades. Up to and including the 6th edition of the American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) edition staging system, ICC was staged the same as hepatocellular carcinoma. In the 7th edition AJCC/UICC manual, the staging system of ICC was revised such that a distinct classification was proposed. Pathologic features for prognosis included vascular invasion, tumor multiplicity, local extension, periductal infiltration and lymph nodal metastasis. Over the last decade, as the incidence of ICC has increased and surgery for this indication has become more common, more data has been published on the prognostic factors associated with long-term survival. PMID:28261593

Internal and temporal reliability estimates for informant ratings of personality using the NEO PI-R and IAS. NEO Personality Inventory. Interpersonal Adjective Scales.

PubMed

Kurtz, J E; Lee, P A; Sherker, J L

1999-06-01

This study examines the internal consistency and temporal stability of informant ratings from two widely used instruments for normal personality assessment, the revised NEO Personality Inventory (NEO PI-R) and the Interpersonal Adjective Scales (IAS). Well-known adult targets were selected by 109 undergraduate students and rated on two occasions separated by a 6-month interval. With few exceptions, estimates of internal consistency are adequate to good for both instruments. NEO PI-R domain scores yield coefficient alphas ranging from .89 to .96, with a median of .80 for the 30 facet scales. IAS octant scales show coefficient alphas ranging from .83 to .92. Retest Pearson correlations are above .70 for each of the NEO PI-R domain scores and both IAS axis coordinates, and intraclass correlations are above .60 for all scales from both instruments. Score changes were small but statistically significant for three of the five NEO PI-R domains at retest. The retest stability of IAS type classifications varies as a function of the extremity of the associated octant scores.

National Institute on Alcohol Abuse and Alcoholism and the study of fetal alcohol spectrum disorders. The International Consortium.

PubMed

Calhoun, Faye; Attilia, Maria Luisa; Spagnolo, Primavera Alessandra; Rotondo, Claudia; Mancinelli, Rosanna; Ceccanti, Mauro

2006-01-01

Fetal alcohol syndrome (FAS) is a large and rapidly increasing public health problem worldwide. Aside the full-blown FAS, multiple terms are used to describe the continuum of effects that result from prenatal exposure to alcohol, including the whole fetal alcohol spectrum disorders (FASD). The revised Institute of Medicine (IOM) Diagnostic Classification System and the diagnostic criteria for FAS and FASD are reported, as well as the formation of the four-state FAS International Consortium and its aims, as the development of an information base that systematizes data collection that helps to determine at-high-risk populations, and to implement and test a scientific-based prevention/intervention model for at risk women. The Consortium was further enlarged, with the inclusion of some more states (including Italy), leading to the formation of the International Consortium for the Investigation of FASD. The objectives of the Consortium are reported, as well as its previous activities, the South Africa and Italy Projects (active case ascertainment initiatives), and its future activities.

46 CFR 8.320 - Classification society authorization to issue international certificates.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 1 2010-10-01 2010-10-01 false Classification society authorization to issue... Classification society authorization to issue international certificates. (a) The Commandant may authorize a recognized classification society to issue certain international convention certificates. Authorization will...

2015 ISSVD, ISSWSH, and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia.

PubMed

Bornstein, Jacob; Goldstein, Andrew T; Stockdale, Colleen K; Bergeron, Sophie; Pukall, Caroline; Zolnoun, Denniz; Coady, Deborah

2016-04-01

In 2014, the Executive Council of the International Society for the Study of Vulvovaginal Disease (ISSVD), the Boards of Directors of the International Society for the Study of Women's Sexual Health (ISSWSH), and the International Pelvic Pain Society (IPPS) acknowledged the need to revise the current terminology of vulvar pain, based on the significant increase in high quality etiologic studies published in the last decade. The new terminology was achieved in four steps. The first involved a terminology consensus conference with representatives of the three societies, held in April 2015. Then, an analysis of the relevant published studies was used to establish a level of evidence for each factor associated with vulvodynia. The terminology was amended based on feedback from members of the societies. Finally, each society's board accepted the new terminology. In 2015, the ISSVD, ISSWSH, and IPPS adopted a new vulvar pain and vulvodynia terminology that acknowledges the complexity of the clinical presentation and pathophysiology involved in vulvar pain and vulvodynia, and incorporates new information derived from evidence-based studies conducted since the last terminology published in 2003. Copyright © 2016 International Society for Sexual Medicine. All rights reserved.

26 CFR 601.102 - Classification of taxes collected by the Internal Revenue Service.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Rules § 601.102 Classification of taxes collected by the Internal Revenue Service. (a) Principal... 26 Internal Revenue 20 2010-04-01 2010-04-01 false Classification of taxes collected by the Internal Revenue Service. 601.102 Section 601.102 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF...

"DC:0-3" to "DC:0-3R" to "DC:0-5": A New Edition

ERIC Educational Resources Information Center

Zeanah, Charles H., Jr.; Carter, Alice; Cohen, Julie; Egger, Helen; Keren, Miri; Gleason, Mary Margaret; Lieberman, Alicia F.; Mulrooney, Kathleen; Oser, Cindy

2015-01-01

Originally published in 1994 by ZERO TO THREE as the "Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood" ("DC:0-3") and revised in 2005 by ZERO TO THREE as the "Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised…

46 CFR 8.320 - Classification society authorization to issue international certificates.

Code of Federal Regulations, 2011 CFR

2011-10-01

... classification society authorized to issue international convention certificates. This agreement will define the... 46 Shipping 1 2011-10-01 2011-10-01 false Classification society authorization to issue... Classification society authorization to issue international certificates. (a) The Commandant may authorize a...

Gender incongruence of childhood in the ICD-11: controversies, proposal, and rationale.

PubMed

Drescher, Jack; Cohen-Kettenis, Peggy T; Reed, Geoffrey M

2016-03-01

As part of the development of the eleventh revision of the International Classification of Diseases (ICD-11), WHO appointed a Working Group on Sexual Disorders and Sexual Health to recommend changes necessary in the classification of mental and behavioural disorders in ICD-10 that are related to sexuality and gender identity. This Personal View focuses on the Working Group's proposals to include the diagnosis gender incongruence of childhood in ICD-11 and to move gender incongruence of childhood out of the mental and behavioural disorders chapter of ICD-11. We outline the history of ICD and DSM child gender diagnoses, expert consensus, knowledge gaps, and controversies related to the diagnosis and treatment of extremely gender-variant children. We argue that retaining the gender incongruence of childhood category is justified as a basis to structure clinical care and to ensure access to appropriate services for this vulnerable population, which provides opportunities for education and informed consent, the development of standards and pathways of care to help guide clinicians and family members, and a basis for future research efforts. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Validation of a cutoff point for the short version of the Depression Scale of the Center for Epidemiologic Studies in older Mexican adults].

PubMed

Salinas-Rodríguez, Aarón; Manrique-Espinoza, Betty; Acosta-Castillo, Gilberto Isaac; Franco-Núñez, Aurora; Rosas-Carrasco, Oscar; Gutiérrez-Robledo, Luis Miguel; Sosa-Ortiz, Ana Luisa

2014-01-01

To identify a valid cutoff point associated with Center for Epidemiologic Studies, Depression Scale (CES-D) of seven items, which allows the classification of older adults according to presence/absence of clinically significant depressive symptoms. Screening study with 229 older adults residing in two states of Mexico (Morelos and Tlaxcala), which were part of the sample from the National Survey of Health and Nutrition, 2012. We estimated the sensitivity and specificity associated with the selected cutoff points using the diagnostic criteria of ICD-10 (International Classification of Diseases, 10th revision) and DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition). The cutoff point estimated was CES-D=5. According to the ICD-10 sensitivity and specificity were 83.3 and 90.2%, and ROC was 87%. Using DSM-IV, the values were 85, 83.2, and 84%, respectively. The short version of the CES-D can be used as a screening test to identify probable cases of older adults with clinically significant depressive symptoms.

Revision, uptake and coding issues related to the open access Orchard Sports Injury Classification System (OSICS) versions 8, 9 and 10.1

PubMed Central

Orchard, John; Rae, Katherine; Brooks, John; Hägglund, Martin; Til, Lluis; Wales, David; Wood, Tim

2010-01-01

The Orchard Sports Injury Classification System (OSICS) is one of the world’s most commonly used systems for coding injury diagnoses in sports injury surveillance systems. Its major strengths are that it has wide usage, has codes specific to sports medicine and that it is free to use. Literature searches and stakeholder consultations were made to assess the uptake of OSICS and to develop new versions. OSICS was commonly used in the sports of football (soccer), Australian football, rugby union, cricket and tennis. It is referenced in international papers in three sports and used in four commercially available computerised injury management systems. Suggested injury categories for the major sports are presented. New versions OSICS 9 (three digit codes) and OSICS 10.1 (four digit codes) are presented. OSICS is a potentially helpful component of a comprehensive sports injury surveillance system, but many other components are required. Choices made in developing these components should ideally be agreed upon by groups of researchers in consensus statements. PMID:24198559

The INNs and outs of antibody nonproprietary names

PubMed Central

Jones, Tim D.; Carter, Paul J.; Plückthun, Andreas; Vásquez, Max; Holgate, Robert G.E.; Hötzel, Isidro; Popplewell, Andrew G.; Parren, Paul W.H.I.; Enzelberger, Markus; Rademaker, Hendrik J.; Clark, Michael R.; Lowe, David C.; Dahiyat, Bassil I.; Smith, Victoria; Lambert, John M.; Wu, Herren; Reilly, Mary; Haurum, John S.; Dübel, Stefan; Huston, James S.; Schirrmann, Thomas; Janssen, Richard A.J.; Steegmaier, Martin; Gross, Jane A.; Bradbury, Andrew R.M.; Burton, Dennis R.; Dimitrov, Dimiter S.; Chester, Kerry A.; Glennie, Martin J.; Davies, Julian; Walker, Adam; Martin, Steve; McCafferty, John; Baker, Matthew P.

2016-01-01

An important step in drug development is the assignment of an International Nonproprietary Name (INN) by the World Health Organization (WHO) that provides healthcare professionals with a unique and universally available designated name to identify each pharmaceutical substance. Monoclonal antibody INNs comprise a –mab suffix preceded by a substem indicating the antibody type, e.g., chimeric (-xi-), humanized (-zu-), or human (-u-). The WHO publishes INN definitions that specify how new monoclonal antibody therapeutics are categorized and adapts the definitions to new technologies. However, rapid progress in antibody technologies has blurred the boundaries between existing antibody categories and created a burgeoning array of new antibody formats. Thus, revising the INN system for antibodies is akin to aiming for a rapidly moving target. The WHO recently revised INN definitions for antibodies now to be based on amino acid sequence identity. These new definitions, however, are critically flawed as they are ambiguous and go against decades of scientific literature. A key concern is the imposition of an arbitrary threshold for identity against human germline antibody variable region sequences. This leads to inconsistent classification of somatically mutated human antibodies, humanized antibodies as well as antibodies derived from semi-synthetic/synthetic libraries and transgenic animals. Such sequence-based classification implies clear functional distinction between categories (e.g., immunogenicity). However, there is no scientific evidence to support this. Dialog between the WHO INN Expert Group and key stakeholders is needed to develop a new INN system for antibodies and to avoid confusion and miscommunication between researchers and clinicians prescribing antibodies. PMID:26716992

Review of the literature on benzene exposure and leukemia subtypes.

PubMed

Schnatter, A Robert; Rosamilia, Kim; Wojcik, Nancy C

2005-05-30

The epidemiologic literature on benzene exposure and leukemia in the MEDLINE and TOXNET databases was examined through October 2004 using the keywords "benzene", "leukemia" and "adverse health effects". This search was complemented by reviewing the reference lists from extant literature reviews and criteria documents on benzene. Published studies were characterized according to the type of industry studied and design, exposure assessment, disease classification, and control for confounding variables. Study design consisted of either cohort studies or case-control studies, which were further categorized into population-based and nested case-control studies. Disease classification considered the source of diagnostic information, whether there was clinical confirmation from medical records or histopathological, morphological and/or cytogenetic reviews, and as to whether the International Classification of Diseases (ICD) or the French-American-British (FAB) schemes were used (no studies used the Revised European-American Lymphoma (REAL) classification scheme). Nine cohort and 13 case-control studies met inclusion criteria for this review. High and significant acute myeloid leukemia risks with positive dose response relationships were identified across study designs, particularly in the "well-conducted" cohort studies and especially in more highly exposed workers in rubber, shoe, and paint industries. Risks for chronic lymphocytic leukemia (CLL) tended to show elevations in nested case-control studies, with possible dose response relationships in at least two of the three studies. However, cohort studies on CLL show no such risks. Data for chronic myeloid leukemia and acute lymphocytic leukemia are sparse and inconclusive.

Performance of the 2012 Systemic Lupus International Collaborating Clinics classification criteria versus the 1997 American College of Rheumatology classification criteria in adult and juvenile systemic lupus erythematosus. A systematic review and meta-analysis.

PubMed

Hartman, Esther A R; van Royen-Kerkhof, Annet; Jacobs, Johannes W G; Welsing, Paco M J; Fritsch-Stork, Ruth D E

2018-03-01

To evaluate the performance in classifying systemic lupus erythematosus by the 2012 Systemic Lupus International Collaborating Clinics criteria (SLICC'12), versus the revised American College of Rheumatology criteria from 1997 (ACR'97) in adult and juvenile SLE patients. A systematic literature search was conducted in PubMed and Embase for studies comparing SLICC'12 and ACR'97 with clinical diagnosis. A meta-analysis was performed to estimate the sensitivity and specificity of SLICC'12 and ACR'97. To assess classification earlier in the disease by either set, sensitivity and specificity were compared for patients with disease duration <5years. Sensitivity and specificity of individual criteria items were also assessed. In adult SLE (nine studies: 5236 patients, 1313 controls), SLICC'12 has higher sensitivity (94.6% vs. 89.6%) and similar specificity (95.5% vs. 98.1%) compared to ACR'97. For juvenile SLE (four studies: 568 patients, 339 controls), SLICC'12 demonstrates higher sensitivity (99.9% vs. 84.3%) than ACR'97, but much lower specificity (82.0% vs. 94.1%). SLICC'12 classifies juvenile SLE patients earlier in disease course. Individual items contributing to diagnostic accuracy are low complement, anti-ds DNA and acute cutaneous lupus in SLICC'12, and the immunologic and hematologic disorder in ACR'97. Based on sensitivity and specificity SLICC'12 is best for adult SLE. Following the view that higher specificity, i.e. avoidance of false positives, is preferable, ACR'97 is best for juvenile SLE even if associated with lower sensitivity. Our results on the contribution of the individual items of SLICC'12 and ACR´97 may be of value in future efforts to update classification criteria. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

Validity of International Classification of Diseases (ICD) coding for dengue infections in hospital discharge records in Malaysia.

PubMed

Woon, Yuan-Liang; Lee, Keng-Yee; Mohd Anuar, Siti Fatimah Zahra; Goh, Pik-Pin; Lim, Teck-Onn

2018-04-20

Hospitalization due to dengue illness is an important measure of dengue morbidity. However, limited studies are based on administrative database because the validity of the diagnosis codes is unknown. We validated the International Classification of Diseases, 10th revision (ICD) diagnosis coding for dengue infections in the Malaysian Ministry of Health's (MOH) hospital discharge database. This validation study involves retrospective review of available hospital discharge records and hand-search medical records for years 2010 and 2013. We randomly selected 3219 hospital discharge records coded with dengue and non-dengue infections as their discharge diagnoses from the national hospital discharge database. We then randomly sampled 216 and 144 records for patients with and without codes for dengue respectively, in keeping with their relative frequency in the MOH database, for chart review. The ICD codes for dengue were validated against lab-based diagnostic standard (NS1 or IgM). The ICD-10-CM codes for dengue had a sensitivity of 94%, modest specificity of 83%, positive predictive value of 87% and negative predictive value 92%. These results were stable between 2010 and 2013. However, its specificity decreased substantially when patients manifested with bleeding or low platelet count. The diagnostic performance of the ICD codes for dengue in the MOH's hospital discharge database is adequate for use in health services research on dengue.

New appendix criteria open for a broader concept of chronic migraine.

PubMed

Olesen, J; Bousser, M-G; Diener, H-C; Dodick, D; First, M; Goadsby, P J; Göbel, H; Lainez, M J A; Lance, J W; Lipton, R B; Nappi, G; Sakai, F; Schoenen, J; Silberstein, S D; Steiner, T J

2006-06-01

After the introduction of chronic migraine and medication overuse headache as diagnostic entities in The International Classification of Headache Disorders, Second Edition, ICHD-2, it has been shown that very few patients fit into the diagnostic criteria for chronic migraine (CM). The system of being able to use CM and the medication overuse headache (MOH) diagnosis only after discontinuation of overuse has proven highly unpractical and new data have suggested a much more liberal use of these diagnoses. The International Headache Classification Committee has, therefore, worked out the more inclusive criteria for CM and MOH presented in this paper. These criteria are included in the appendix of ICHD-2 and are meant primarily for further scientific evaluation but may be used already now for inclusion into drug trials, etc. It is now recommended that the MOH diagnosis should no longer request improvement after discontinuation of medication overuse but should be given to patients if they have a primary headache plus ongoing medication overuse. The latter is defined as previously, i.e. 10 days or more of intake of triptans, ergot alkaloids mixed analgesics or opioids and 15 days or more of analgesics/NSAIDs or the combined use of more than one substance. If these new criteria for CM and MOH prove useful in future testing, the plan is to include them in a future revised version of ICHD-2.

Automatic coding and selection of causes of death: an adaptation of Iris software for using in Brazil.

PubMed

Martins, Renata Cristófani; Buchalla, Cassia Maria

2015-01-01

To prepare a dictionary in Portuguese for using in Iris and to evaluate its completeness for coding causes of death. Iniatially, a dictionary with all illness and injuries was created based on the International Classification of Diseases - tenth revision (ICD-10) codes. This dictionary was based on two sources: the electronic file of ICD-10 volume 1 and the data from Thesaurus of the International Classification of Primary Care (ICPC-2). Then, a death certificate sample from the Program of Improvement of Mortality Information in São Paulo (PRO-AIM) was coded manually and by Iris version V4.0.34, and the causes of death were compared. Whenever Iris was not able to code the causes of death, adjustments were made in the dictionary. Iris was able to code all causes of death in 94.4% death certificates, but only 50.6% were directly coded, without adjustments. Among death certificates that the software was unable to fully code, 89.2% had a diagnosis of external causes (chapter XX of ICD-10). This group of causes of death showed less agreement when comparing the coding by Iris to the manual one. The software performed well, but it needs adjustments and improvement in its dictionary. In the upcoming versions of the software, its developers are trying to solve the external causes of death problem.

Changes in the Geographic Patterns of Heart Disease Mortality in the United States

PubMed Central

Casper, Michele; Kramer, Michael R.; Quick, Harrison; Schieb, Linda J.; Vaughan, Adam S.; Greer, Sophia

2016-01-01

Background Although many studies have documented the dramatic declines in heart disease mortality in the United States at the national level, little attention has been given to the temporal changes in the geographic patterns of heart disease mortality. Methods and Results Age-adjusted and spatially smoothed county-level heart disease death rates were calculated for 2-year intervals from 1973 to 1974 to 2009 to 2010 for those aged ≥35 years. Heart disease deaths were defined according to the International Classification of Diseases codes for diseases of the heart in the eighth, ninth, and tenth revisions of the International Classification of Diseases. A fully Bayesian spatiotemporal model was used to produce precise rate estimates, even in counties with small populations. A substantial shift in the concentration of high-rate counties from the Northeast to the Deep South was observed, along with a concentration of slow-decline counties in the South and a nearly 2-fold increase in the geographic inequality among counties. Conclusions The dramatic change in the geographic patterns of heart disease mortality during 40 years highlights the importance of small-area surveillance to reveal patterns that are hidden at the national level, gives communities the historical context for understanding their current burden of heart disease, and provides important clues for understanding the determinants of the geographic disparities in heart disease mortality. PMID:27002081

The contribution of Latin American and Caribbean countries on culture bound syndromes studies for the ICD-10 revision: key findings from a working in progress.

PubMed

Razzouk, Denise; Nogueira, Bruno; Mari, Jair de Jesus

2011-05-01

This review aims to verify the scientific evidences for the inclusion of culture bound syndromes in the International Classification of Diseases towards its 11th edition based on studies from Latin American and Caribbean countries. Studies were identified in Medline, LILACS and EMBASE databases for the period between 1992 and 2008, and then classified according to the type of study, to the mental disorder, country and number of publications per year. 163 studies were selected and classified: 33 in MedlLne, 90 in EMBASE e 40 in LILACS. The percentage of culture bound-syndrome corresponded to 9% in Medline, 12% in EMBASE e 2.5% in LILACS. Among fifteen studies on cultural bound syndromes, two were about "nervios and ataque de nervios", two about "susto", four about the relationship between religion beliefs, witchery, trance and mental disorders, one with a proposal for new diagnostic category, three about theoretic issues and three about the pathoplasty of mental disorders. The scarcity of studies on culture bound syndromes might be due to the indexation problems hindering the screening of studies; lack of interest on publishing such studies in indexed journals (publication bias) and due to difficulty to access them. There is no robust evidence identified among cross-cultural studies to recommend changes for International Classification of Diseases-11th edition.

Changes in the Geographic Patterns of Heart Disease Mortality in the United States: 1973 to 2010.

PubMed

Casper, Michele; Kramer, Michael R; Quick, Harrison; Schieb, Linda J; Vaughan, Adam S; Greer, Sophia

2016-03-22

Although many studies have documented the dramatic declines in heart disease mortality in the United States at the national level, little attention has been given to the temporal changes in the geographic patterns of heart disease mortality. Age-adjusted and spatially smoothed county-level heart disease death rates were calculated for 2-year intervals from 1973 to 1974 to 2009 to 2010 for those aged ≥35 years. Heart disease deaths were defined according to the International Classification of Diseases codes for diseases of the heart in the eighth, ninth, and tenth revisions of the International Classification of Diseases. A fully Bayesian spatiotemporal model was used to produce precise rate estimates, even in counties with small populations. A substantial shift in the concentration of high-rate counties from the Northeast to the Deep South was observed, along with a concentration of slow-decline counties in the South and a nearly 2-fold increase in the geographic inequality among counties. The dramatic change in the geographic patterns of heart disease mortality during 40 years highlights the importance of small-area surveillance to reveal patterns that are hidden at the national level, gives communities the historical context for understanding their current burden of heart disease, and provides important clues for understanding the determinants of the geographic disparities in heart disease mortality. © 2016 American Heart Association, Inc.

Do patient-reported outcome measures cover personal factors important to people with rheumatoid arthritis? A mixed methods design using the International Classification of Functioning, Disability and Health as frame of reference.

PubMed

Dür, Mona; Coenen, Michaela; Stoffer, Michaela Alexandra; Fialka-Moser, Veronika; Kautzky-Willer, Alexandra; Kjeken, Ingvild; Drăgoi, Răzvan Gabriel; Mattsson, Malin; Boström, Carina; Smolen, Josef; Stamm, Tanja Alexandra

2015-02-25

Personal factors (PFs) are internal factors that determine functioning and the individuals' experience of disability. Their coverage by patient-reported outcome measures (PROMs) has not been examined in rheumatoid arthritis (RA) so far. The aims of this study were to identify PFs important in the life stories of people with RA and to determine their coverage by PROMs used in RA. The qualitative data of people with RA was explored to identify PFs. Additionally a systematic literature search was conducted to find PROMs used in RA. PROMs items were linked to the components, domains and categories of the International Classification of Functioning, Disability and Health (ICF) to determine the coverage of important PFs by PROMs. Twelve PFs were found to be important in the life stories of people with RA. The PFs coping and reflecting about one's life in an optimistic way were covered most frequently, each by 14 of the 42 explored PROMs, while job satisfaction was not covered at all. The London Coping with Rheumatoid Arthritis Questionnaire, General Self-Efficacy Scale, Arthritis Self-Efficacy Scale, Rheumatoid Arthritis Self-Efficacy Questionnaire and Revised Ways of Coping Inventory covered most PFs. Nineteen PROMs did not cover any of the PFs. Several PFs were identified as important in the life stories of people with RA, but only 55% of the PROMS covered some of these PFs. When evaluating PFs important to people with RA, health professionals should be alert on which PROMs can be used to assess which PFs.

Validating an instrument for selecting interventions to change physician practice patterns: a Michigan Consortium for Family Practice Research study.

PubMed

Green, Lee A; Gorenflo, Daniel W; Wyszewianski, Leon

2002-11-01

The goal of this study was to develop a psychometric instrument that classified physiciansamprsquo response styles to new information as seekers, receptives, traditionalists, or pragmatists. This classification was based on specific combinations of 3 scales: (a) belief in evidence vs experience as the basis of knowledge, (b) willingness to diverge from common or previous practice, and (c) sensitivity to pragmatic concerns of practice. The instrument will help focus efforts to change practice more accurately. This was a cross-sectional study of physician responses to a psychometric instrument. Paper-and-pencil survey forms were distributed to 3 waves of physicians, with revision for improved internal consistency at each iteration. Participants were 1393 primary care physicians at continuing education events in the Midwest or at primary care clinic sites in the Veteransamprsquo Health Administration system. Internal consistency was measured by factor analysis with orthogonal rotation and Cronbachamprsquos alpha. A total of 1287 usable instruments were returned (106, 1120, and 61 in the 3 iterations, respectively), representing approximately three fourths of distributed forms. Final scale internal consistencies were a = 0.79, b = 0.74, and c = 0.68. The patterns of scores on the 3 scales were consistent with the predictions of the theoretical scheme of physician types. The "seeker" type was the rarest, at fewer than 3%. It is possible to reliably classify physicians into categories that a theoretical framework predicts will respond differently to different interventions for implementing guidelines and translating research findings into practice. The next step is to demonstrate that the classification predicts physician practice behavior.

Chronic daily headache: correlation between the 2004 and the 1988 International Headache Society diagnostic criteria.

PubMed

Bigal, Marcelo E; Tepper, Stewart J; Sheftell, Fred D; Rapoport, Alan M; Lipton, Richard B

2004-01-01

In a previous study, we compared the 1988 International Headache Society (IHS) criteria and the Silberstein-Lipton criteria (S-L) in a subspeciality clinic sample of 638 patients with chronic daily headache (CDH) assessed both clinically and with headache diaries. Both systems allowed for the classification of most patients with CDH. The 1988 IHS classification required multiple diagnoses and was more complex to apply. The aim of this study was to revisit the same database, now comparing the prior classification systems with the new 2004 IHS classification. In contrast with the 1st edition, the 2nd edition includes criteria for chronic migraine (CM), new daily persistent headache (NDPH), and hemicrania continua (HC). We reviewed the clinical records and the headache diaries of 638 patients seen between 1980 and 2001 at a headache center. All patients had primary CDH according to the S-L criteria. Using the S-L criteria as a reference, of the 158 patients with transformed migraine (TM) without medication overuse, just 9 (5.6%) met 2004 IHS criteria for CM. Most of the subjects were classified using combinations of migraine and CTTH diagnoses, much like the 1988 IHS classification. Similarly, using the new IHS system, just 41/399 (10.2%) subjects with TM with medication overuse were classified as probable CM with probable medication overuse. Most patients with NDPH without overuse were easily classified using the 2004 criteria (95.8%). Regarding NDPH with medication overuse, the diagnostic groups were much like results for the 1st edition. All patients with chronic tension-type headache (CTTH) and hemicrania continua (HC) according to the S-L system were easily classified using the 2004 IHS criteria. We conclude that the 2004 IHS criteria facilitate the classification of NDPH without medication overuse and HC. For subjects with TM according to the S-L system, the new IHS criteria are complex to use and require multiple diagnoses. Very few patients with TM in the S-L system could be classified with a single diagnosis in the 2004 IHS classification. In fact, CM was so rare that it would be virtually impossible to conduct clinical trials of this entity using the 2004 IHS criteria. Clinical trials of this entity should therefore be conducted using the S-L criteria. Finally, we propose that in the 3rd edition of the IHS classification, the diagnosis of NDPH be revised so as not to exclude migraine features.

Consciousness as a useful concept in epilepsy classification.

PubMed

Blumenfeld, Hal; Meador, Kimford J

2014-08-01

Impaired consciousness has important practical consequences for people living with epilepsy. Recent pathophysiologic studies show that seizures with impaired level of consciousness always affect widespread cortical networks and subcortical arousal systems. In light of these findings and their clinical significance, efforts are underway to revise the International League Against Epilepsy (ILAE) 2010 report to include impaired consciousness in the classification of seizures. Lüders and colleagues have presented one such effort, which we discuss here. We then propose an alternative classification of impaired consciousness in epilepsy based on functional neuroanatomy. Some seizures involve focal cortical regions and cause selective deficits in the content of consciousness but without impaired overall level of consciousness or awareness. These include focal aware conscious seizures (FACS) with lower order cortical deficits such as somatosensory or visual impairment as well as FACS with higher cognitive deficits including ictal aphasia or isolated epileptic amnesia. Another category applies to seizures with impaired level of consciousness leading to deficits in multiple cognitive domains. For this category, we believe the terms "dyscognitive" or "dialeptic" should be avoided because they may create confusion. Instead we propose that seizures with impaired level of consciousness be described based on underlying pathophysiology. Widespread moderately severe deficits in corticothalamic function are seen in absence seizures and in focal impaired consciousness seizures (FICS), including many temporal lobe seizures and other focal seizures with impaired consciousness. Some simple responses or automatisms may be preserved in these seizures. In contrast, generalized tonic-clonic seizures usually produce widespread severe deficits in corticothalamic function causing loss of all meaningful responses. Further work is needed to understand and prevent impaired consciousness in epilepsy, but the first step is to keep this crucial practical and physiologic aspect of seizures front-and-center in our discussions. Wiley Periodicals, Inc. © 2014 International League Against Epilepsy.

Prevalence of impairments, disabilities, handicaps and quality of life in the general population: a review of recent literature.

PubMed Central

Barbotte, E.; Guillemin, F.; Chau, N.

2001-01-01

OBJECTIVE: To determine the prevalence rates of morbidity in the general population through bibliographic research. METHODS: Articles relating to impairment, disability, handicap, quality of life and their prevalence in the general population, published between January 1990 and March 1998, were selected on the MEDLINE database. FINDINGS: The 20 articles retained out of 433 used 41 different indicators. Indicators of impairment, disability, handicap and low quality of life showed prevalence rates of 0.1-92%, 3.6-66%, 0.6-56% and 1.8-26% respectively, depending on age and the accuracy of indicators. The heterogeneity of the conceptual framework and insufficient recognition of the importance of indicator accuracy, the age factor and the socioeconomic characteristics of the studied populations impede reliable international comparison. CONCLUSION: Further standardization of indicators is therefore required. The revision of the International Classification of Impairments, Disabilities and Handicaps may make it possible to resolve some of the difficulties encountered. PMID:11731812

PTSD and Complex PTSD: ICD-11 updates on concept and measurement in the UK, USA, Germany and Lithuania

PubMed Central

Karatzias, Thanos; Cloitre, Marylene; Maercker, Andreas; Kazlauskas, Evaldas; Shevlin, Mark; Hyland, Philip; Bisson, Jonathan I.; Roberts, Neil P.; Brewin, Chris R.

2017-01-01

ABSTRACT The 11th revision to the World Health Organization’s International Classification of Diseases (ICD-11) proposes two distinct sibling conditions: Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD). In this paper, we aim to provide an update on the latest research regarding the conceptual structure and measurement of PTSD and CPTSD using the International Trauma Questionnaire (ITQ) as per ICD-11 proposals in the USA, UK, Germany and Lithuania. Preliminary findings suggest that CPTSD is common in clinical and population samples, although there may be variations across countries in prevalence rates. In clinical samples, preliminary evidence suggests that CPTSD is a more commonly observed condition than PTSD. Preliminary evidence also suggests that the ITQ scores are reliable and valid and can adequately distinguish between PTSD and CPTSD. Further cross-cultural work is proposed to explore differences in PTSD and CPTSD across different countries with regard to prevalence, incidence, and predictors of PTSD and CPTSD. PMID:29372010

Acute bacterial skin and skin structure infections in internal medicine wards: old and new drugs.

PubMed

Falcone, Marco; Concia, Ercole; Giusti, Massimo; Mazzone, Antonino; Santini, Claudio; Stefani, Stefania; Violi, Francesco

2016-08-01

Skin and soft tissue infections (SSTIs) are a common cause of hospital admission among elderly patients, and traditionally have been divided into complicated and uncomplicated SSTIs. In 2010, the FDA provided a new classification of these infections, and a new category of disease, named acute bacterial skin and skin structure infections (ABSSSIs), has been proposed as an independent clinical entity. ABSSSIs include three entities: cellulitis and erysipelas, wound infections, and major cutaneous abscesses This paper revises the epidemiology of SSTIs and ABSSSIs with regard to etiologies, diagnostic techniques, and clinical presentation in the hospital settings. Particular attention is owed to frail patients with multiple comorbidities and underlying significant disease states, hospitalized on internal medicine wards or residing in nursing homes, who appear to be at increased risk of infection due to multi-drug resistant pathogens and treatment failures. Management of ABSSSIs and SSTIs, including evaluation of the hemodynamic state, surgical intervention and treatment with appropriate antibiotic therapy are extensively discussed.

PTSD and Complex PTSD: ICD-11 updates on concept and measurement in the UK, USA, Germany and Lithuania.

PubMed

Karatzias, Thanos; Cloitre, Marylene; Maercker, Andreas; Kazlauskas, Evaldas; Shevlin, Mark; Hyland, Philip; Bisson, Jonathan I; Roberts, Neil P; Brewin, Chris R

2017-01-01

The 11th revision to the World Health Organization's International Classification of Diseases (ICD-11) proposes two distinct sibling conditions: Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD). In this paper, we aim to provide an update on the latest research regarding the conceptual structure and measurement of PTSD and CPTSD using the International Trauma Questionnaire (ITQ) as per ICD-11 proposals in the USA, UK, Germany and Lithuania. Preliminary findings suggest that CPTSD is common in clinical and population samples, although there may be variations across countries in prevalence rates. In clinical samples, preliminary evidence suggests that CPTSD is a more commonly observed condition than PTSD. Preliminary evidence also suggests that the ITQ scores are reliable and valid and can adequately distinguish between PTSD and CPTSD. Further cross-cultural work is proposed to explore differences in PTSD and CPTSD across different countries with regard to prevalence, incidence, and predictors of PTSD and CPTSD.

Revision of the International Pharmaceutical Federation's Basel Statements on the future of hospital pharmacy: From Basel to Bangkok.

PubMed

Vermeulen, Lee C; Moles, Rebekah J; Collins, Jack C; Gray, Andy; Sheikh, Abdul Latif; Surugue, Jacqueline; Moss, Robert J; Ivey, Marianne F; Stevenson, James G; Takeda, Yasuo; Ranjit, Eurek; Chaar, Betty; Penm, Jonathan

2016-07-15

The processes used to revise the 2008 Basel Statements on the future of hospital pharmacy are summarized, and the revised statements are presented. The process for revising the Basel Statements followed an approach similar to that used during their initial development. The Hospital Pharmacy Section (HPS) of the International Pharmaceutical Federation (FIP) revised the 2008 FIP Basel Statements in four phases, including a survey of hospital pharmacists worldwide, an internal review, online forums, and a face-to-face "World Café" workshop in Bangkok, Thailand. The global survey on the initial Basel Statements included input from 334 respondents from 62 countries. The majority of respondents agreed that most of the initial Basel Statements were acceptable as written and did not require revision. In total, 11 statements were judged by more than 10% of respondents as needing revision or deletion. The FIP HPS executive committee used the survey results to develop 69 initial revised draft statements. After an online discussion with the international hospital pharmacy community, including individuals from 28 countries representing all six World Health Organization regions, a final set of draft statements was prepared for the live discussion involving participants from 20 countries. The final 65 revised Basel Statements were voted on and accepted. Systematic revision of the FIP Basel Statements resulted in an updated reflection of aspirational goals for the future of hospital pharmacy practice. While this revision reflects the development of new goals for hospital pharmacy practice, the core principles of the Basel Statements remain an essential foundation for the discipline. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Revision of the European species of Omphale Haliday (Hymenoptera, Chalcidoidea, Eulophidae)

PubMed Central

Hansson, Christer; Shevtsova, Ekaterina

2012-01-01

Abstract The European species of Omphale Haliday (Eulophidae: Entedoninae) are revised. The revision includes 37 species, of which eleven are newly described and the remaining 26 species are redescribed. The species are classified into six species groups, with six unplaced species. All species are fully diagnosed and thoroughly illustrated. Identification keys are provided for females and males. Two new morphological features to aid classification and identification are introduced: male genitalia and wing interference patterns (WIPs). The former has been used successfully in the classification of New World Omphale and the latter is used for the first time in a taxonomic revision. Male genitalia in Omphale have considerable interspecific variation, an unusual trait among chalcidoid Hymenoptera, and are demonstrated to be useful for classification of species and species-groups, and they also possess the only autapomorphy for Omphale. WIPs are useful to help separate some species, but cannot be used to define either the genus or species groups. Distributional data are compiled for each species and suggest a pan-european distribution for most species. Gall-midges are the known hosts for 14 species, and the absence of host overlap between species suggests that host specialization is a driving force for speciation. Several Omphale species are known only from females, or have a strong female biased sex ratio, suggesting thelytokous development. Apart from the 37 species included in this revision, the status for nine additional species (names) in species group aetius remain unsolved. For nomenclatorial stability, a neotype is designated for Eulophus lugens Nees (= Omphale lugens (Nees)). Elachestus obscurus Förster and Derostenus sulciscuta Thomson are transferred from Holcopelte to Omphale comb. n. Derostenus radialis Thomson and Achrysocharella americana Girault are synonymized with Omphale theana (Walker), and Omphale teresis Askew is synonymized with Omphale phruron (Walker), syn. n. The status of genus Pholema Graham is revised as it is removed from synonymy with Omphale and instead synonymized with Neochrysocharis Kurdjumov, syn. n., and the type species for Pholema, Pholema microstoma Graham, is transferred to Neochrysocharis, comb. n. Eugerium orbatum Szelényi, previously transferred to Omphale, is synonymized with Asecodes congruens (Nees), syn. n. PMID:23226702

Meeting the criteria of a nursing diagnosis classification: Evaluation of ICNP, ICF, NANDA and ZEFP.

PubMed

Müller-Staub, Maria; Lavin, Mary Ann; Needham, Ian; van Achterberg, Theo

2007-07-01

Few studies described nursing diagnosis classification criteria and how classifications meet these criteria. The purpose was to identify criteria for nursing diagnosis classifications and to assess how these criteria are met by different classifications. First, a literature review was conducted (N=50) to identify criteria for nursing diagnoses classifications and to evaluate how these criteria are met by the International Classification of Nursing Practice (ICNP), the International Classification of Functioning, Disability and Health (ICF), the International Nursing Diagnoses Classification (NANDA), and the Nursing Diagnostic System of the Centre for Nursing Development and Research (ZEFP). Using literature review based general and specific criteria, the principal investigator evaluated each classification, applying a matrix. Second, a convenience sample of 20 nursing experts from different Swiss care institutions answered standardized interview forms, querying current national and international classification state and use. The first general criterion is that a diagnosis classification should describe the knowledge base and subject matter for which the nursing profession is responsible. ICNP) and NANDA meet this goal. The second general criterion is that each class fits within a central concept. The ICF and NANDA are the only two classifications built on conceptually driven classes. The third general classification criterion is that each diagnosis possesses a description, diagnostic criteria, and related etiologies. Although ICF and ICNP describe diagnostic terms, only NANDA fulfils this criterion. The analysis indicated that NANDA fulfilled most of the specific classification criteria in the matrix. The nursing experts considered NANDA to be the best-researched and most widely implemented classification in Switzerland and internationally. The international literature and the opinion of Swiss expert nurses indicate that-from the perspective of classifying comprehensive nursing diagnoses-NANDA should be recommended for nursing practice and electronic nursing documentation. Study limitations and future research needs are discussed.

An updated check list of the Cochylina (Tortricidae, Tortricinae, Euliini) of North America north of Mexico including Greenland, with comments on classification and identification

USDA-ARS?s Scientific Manuscript database

We present an updated list of the members of the subtribe Cochylina (Tortricidae) in North America north of Mexico. We summarize the proposed changes in the classification since about 1983. We propose revised status for two genera, Rolandylis Gibeaux, 1985 and Thyraylia Walsingham, 1897. We propose ...

The impact of ICD-9 revascularization procedure codes on estimates of racial disparities in ischemic stroke.

PubMed

Boan, Andrea D; Voeks, Jenifer H; Feng, Wuwei Wayne; Bachman, David L; Jauch, Edward C; Adams, Robert J; Ovbiagele, Bruce; Lackland, Daniel T

2014-01-01

The use of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) diagnostic codes can identify racial disparities in ischemic stroke hospitalizations; however, inclusion of revascularization procedure codes as acute stroke events may affect the magnitude of the risk difference. This study assesses the impact of excluding revascularization procedure codes in the ICD-9 definition of ischemic stroke, compared with the traditional inclusive definition, on racial disparity estimates for stroke incidence and recurrence. Patients discharged with a diagnosis of ischemic stroke (ICD-9 codes 433.00-434.91 and 436) were identified from a statewide inpatient discharge database from 2010 to 2012. Race-age specific disparity estimates of stroke incidence and recurrence and 1-year cumulative recurrent stroke rates were compared between the routinely used traditional classification and a modified classification of stroke that excluded primary ICD-9 cerebral revascularization procedures codes (38.12, 00.61, and 00.63). The traditional classification identified 7878 stroke hospitalizations, whereas the modified classification resulted in 18% fewer hospitalizations (n = 6444). The age-specific black to white rate ratios were significantly higher in the modified than in the traditional classification for stroke incidence (rate ratio, 1.50; 95% confidence interval [CI], 1.43-1.58 vs. rate ratio, 1.24; 95% CI, 1.18-1.30, respectively). In whites, the 1-year cumulative recurrence rate was significantly reduced by 46% (45-64 years) and 49% (≥ 65 years) in the modified classification, largely explained by a higher rate of cerebral revascularization procedures among whites. There were nonsignificant reductions of 14% (45-64 years) and 19% (≥ 65 years) among blacks. Including cerebral revascularization procedure codes overestimates hospitalization rates for ischemic stroke and significantly underestimates the racial disparity estimates in stroke incidence and recurrence. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

47 CFR 63.13 - Procedures for modifying regulatory classification of U.S. international carriers from dominant...

Code of Federal Regulations, 2011 CFR

2011-10-01

... classification of U.S. international carriers from dominant to non-dominant. 63.13 Section 63.13... for modifying regulatory classification of U.S. international carriers from dominant to non-dominant... in its application to demonstrate that it qualifies for non-dominant classification pursuant to § 63...

47 CFR 63.10 - Regulatory classification of U.S. international carriers.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 3 2010-10-01 2010-10-01 false Regulatory classification of U.S. international... and Supplements § 63.10 Regulatory classification of U.S. international carriers. (a) Unless otherwise... issue it raises as to the proper classification of the U.S. carrier. (c) Any carrier classified as...

47 CFR 63.10 - Regulatory classification of U.S. international carriers.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 3 2011-10-01 2011-10-01 false Regulatory classification of U.S. international... and Supplements § 63.10 Regulatory classification of U.S. international carriers. (a) Unless otherwise... issue it raises as to the proper classification of the U.S. carrier. (c) Any carrier classified as...

47 CFR 63.13 - Procedures for modifying regulatory classification of U.S. international carriers from dominant...

Code of Federal Regulations, 2010 CFR

2010-10-01

... classification of U.S. international carriers from dominant to non-dominant. 63.13 Section 63.13... for modifying regulatory classification of U.S. international carriers from dominant to non-dominant... in its application to demonstrate that it qualifies for non-dominant classification pursuant to § 63...

Sensitivity and Specificity of the World Health Organization Dengue Classification Schemes for Severe Dengue Assessment in Children in Rio de Janeiro

PubMed Central

Macedo, Gleicy A.; Gonin, Michelle Luiza C.; Pone, Sheila M.; Cruz, Oswaldo G.; Nobre, Flávio F.; Brasil, Patrícia

2014-01-01

Background The clinical definition of severe dengue fever remains a challenge for researchers in hyperendemic areas like Brazil. The ability of the traditional (1997) as well as the revised (2009) World Health Organization (WHO) dengue case classification schemes to detect severe dengue cases was evaluated in 267 children admitted to hospital with laboratory-confirmed dengue. Principal Findings Using the traditional scheme, 28.5% of patients could not be assigned to any category, while the revised scheme categorized all patients. Intensive therapeutic interventions were used as the reference standard to evaluate the ability of both the traditional and revised schemes to detect severe dengue cases. Analyses of the classified cases (n = 183) demonstrated that the revised scheme had better sensitivity (86.8%, P<0.001), while the traditional scheme had better specificity (93.4%, P<0.001) for the detection of severe forms of dengue. Conclusions/Significance This improved sensitivity of the revised scheme allows for better case capture and increased ICU admission, which may aid pediatricians in avoiding deaths due to severe dengue among children, but, in turn, it may also result in the misclassification of the patients' condition as severe, reflected in the observed lower positive predictive value (61.6%, P<0.001) when compared with the traditional scheme (82.6%, P<0.001). The inclusion of unusual dengue manifestations in the revised scheme has not shifted the emphasis from the most important aspects of dengue disease and the major factors contributing to fatality in this study: shock with consequent organ dysfunction. PMID:24777054

Sensitivity and specificity of the World Health Organization dengue classification schemes for severe dengue assessment in children in Rio de Janeiro.

PubMed

Macedo, Gleicy A; Gonin, Michelle Luiza C; Pone, Sheila M; Cruz, Oswaldo G; Nobre, Flávio F; Brasil, Patrícia

2014-01-01

The clinical definition of severe dengue fever remains a challenge for researchers in hyperendemic areas like Brazil. The ability of the traditional (1997) as well as the revised (2009) World Health Organization (WHO) dengue case classification schemes to detect severe dengue cases was evaluated in 267 children admitted to hospital with laboratory-confirmed dengue. Using the traditional scheme, 28.5% of patients could not be assigned to any category, while the revised scheme categorized all patients. Intensive therapeutic interventions were used as the reference standard to evaluate the ability of both the traditional and revised schemes to detect severe dengue cases. Analyses of the classified cases (n = 183) demonstrated that the revised scheme had better sensitivity (86.8%, P<0.001), while the traditional scheme had better specificity (93.4%, P<0.001) for the detection of severe forms of dengue. This improved sensitivity of the revised scheme allows for better case capture and increased ICU admission, which may aid pediatricians in avoiding deaths due to severe dengue among children, but, in turn, it may also result in the misclassification of the patients' condition as severe, reflected in the observed lower positive predictive value (61.6%, P<0.001) when compared with the traditional scheme (82.6%, P<0.001). The inclusion of unusual dengue manifestations in the revised scheme has not shifted the emphasis from the most important aspects of dengue disease and the major factors contributing to fatality in this study: shock with consequent organ dysfunction.

37 CFR 2.85 - Classification schedules.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 37 Patents, Trademarks, and Copyrights 1 2013-07-01 2013-07-01 false Classification schedules. 2..., DEPARTMENT OF COMMERCE RULES OF PRACTICE IN TRADEMARK CASES Classification § 2.85 Classification schedules. (a) International classification system. Section 6.1 of this chapter sets forth the international...

37 CFR 2.85 - Classification schedules.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 37 Patents, Trademarks, and Copyrights 1 2012-07-01 2012-07-01 false Classification schedules. 2..., DEPARTMENT OF COMMERCE RULES OF PRACTICE IN TRADEMARK CASES Classification § 2.85 Classification schedules. (a) International classification system. Section 6.1 of this chapter sets forth the international...

37 CFR 2.85 - Classification schedules.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 37 Patents, Trademarks, and Copyrights 1 2014-07-01 2014-07-01 false Classification schedules. 2..., DEPARTMENT OF COMMERCE RULES OF PRACTICE IN TRADEMARK CASES Classification § 2.85 Classification schedules. (a) International classification system. Section 6.1 of this chapter sets forth the international...

37 CFR 2.85 - Classification schedules.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 37 Patents, Trademarks, and Copyrights 1 2011-07-01 2011-07-01 false Classification schedules. 2..., DEPARTMENT OF COMMERCE RULES OF PRACTICE IN TRADEMARK CASES Classification § 2.85 Classification schedules. (a) International classification system. Section 6.1 of this chapter sets forth the international...

37 CFR 2.85 - Classification schedules.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 37 Patents, Trademarks, and Copyrights 1 2010-07-01 2010-07-01 false Classification schedules. 2..., DEPARTMENT OF COMMERCE RULES OF PRACTICE IN TRADEMARK CASES Classification § 2.85 Classification schedules. (a) International classification system. Section 6.1 of this chapter sets forth the international...

75 FR 5351 - Proposed Revisions to Accounting Guide for LSC Recipients

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-02

... elements of an adequate accounting and financial reporting system, including the use of specific internal... checklist of accounting procedures and internal controls. The proposed revisions update the checklist to... accounting procedures and internal controls to reflect current best practices; (7) updated and new references...

[Mortality as a result of accidental and intentional injuries in the Federal District from 1970 to 1986].

PubMed

Híjar-Medina, M C

1990-01-01

This article presents the results of a retrospective analysis of unintentional and intentional injury mortality in México City for the period 1970-1986. The mortality rates and trends were obtained out of 73,197 registered deaths, (according to the 9th revision of the International Disease Classification). Deaths due to the earthquakes of 1985 were not included. The trend of mortality is undefined (r = -0.430). The most important causes of death were: traffic accidents, homicides, and others accidents. Males accounted 77 per cent of the deaths. The most affected age groups were 15-19 and 20-24 years. The potential years of life lost were analyzed. This study provides information for the prevention and control of injuries and for future research in this field.

Child maltreatment in DSM-5 and ICD-11.

PubMed

Slep, Amy M Smith; Heyman, Richard E; Foran, Heather M

2015-03-01

Child maltreatment is widespread and has a tremendous impact on child victims and their families. Over the past decade, definitions of child maltreatment have been developed that are operationalized, face valid, and can be reliably applied in clinical settings. These definitions have informed the revised Diagnostic and Statistical Manual (American Psychiatric Association, 2013) and are being considered for the International Classification of Disease-11 (World Health Organization). Now that these definitions are available in major diagnostic systems, primary healthcare providers and clinicians who see children and families are poised to help screen for, identify, prevent, and treat child maltreatment. This article reviews the definitions of maltreatment in these diagnostic systems, along with assessment and screening tools, and empirically supported prevention and intervention approaches. © 2015 Family Process Institute.

Social (pragmatic) communication disorders and autism spectrum disorder.

PubMed

Baird, Gillian; Norbury, Courtenay Frazier

2016-08-01

Changes have been made to the diagnostic criteria for autism spectrum disorder (ASD) in the recent revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and similar changes are likely in the WHO International Classification of Diseases (ICD-11) due in 2017. In light of these changes, a new clinical disorder, social (pragmatic) communication disorder (SPCD), was added to the neurodevelopmental disorders section of DSM-5. This article describes the key features of ASD, SPCD and the draft ICD-11 approach to pragmatic language impairment, highlighting points of overlap between the disorders and criteria for differential diagnosis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

78 FR 13073 - Interim Guidance for Revised Implementation of the International Convention for the Prevention of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-26

... Revised Implementation of the International Convention for the Prevention of Pollution From Ships (MARPOL... July 15, 2011, the International Maritime Organization's (IMO) Marine Environment Protection Committee... Prevention of Pollution from Ships (MARPOL) Annex V, by establishing a general prohibition on discharges of...

Understanding the use of standardized nursing terminology and classification systems in published research: A case study using the International Classification for Nursing Practice(®).

PubMed

Strudwick, Gillian; Hardiker, Nicholas R

2016-10-01

In the era of evidenced based healthcare, nursing is required to demonstrate that care provided by nurses is associated with optimal patient outcomes, and a high degree of quality and safety. The use of standardized nursing terminologies and classification systems are a way that nursing documentation can be leveraged to generate evidence related to nursing practice. Several widely-reported nursing specific terminologies and classifications systems currently exist including the Clinical Care Classification System, International Classification for Nursing Practice(®), Nursing Intervention Classification, Nursing Outcome Classification, Omaha System, Perioperative Nursing Data Set and NANDA International. However, the influence of these systems on demonstrating the value of nursing and the professions' impact on quality, safety and patient outcomes in published research is relatively unknown. This paper seeks to understand the use of standardized nursing terminology and classification systems in published research, using the International Classification for Nursing Practice(®) as a case study. A systematic review of international published empirical studies on, or using, the International Classification for Nursing Practice(®) were completed using Medline and the Cumulative Index for Nursing and Allied Health Literature. Since 2006, 38 studies have been published on the International Classification for Nursing Practice(®). The main objectives of the published studies have been to validate the appropriateness of the classification system for particular care areas or populations, further develop the classification system, or utilize it to support the generation of new nursing knowledge. To date, most studies have focused on the classification system itself, and a lesser number of studies have used the system to generate information about the outcomes of nursing practice. Based on the published literature that features the International Classification for Nursing Practice, standardized nursing terminology and classification systems appear to be well developed for various populations, settings and to harmonize with other health-related terminology systems. However, the use of the systems to generate new nursing knowledge, and to validate nursing practice is still in its infancy. There is an opportunity now to utilize the well-developed systems in their current state to further what is know about nursing practice, and how best to demonstrate improvements in patient outcomes through nursing care. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Total hip arthroplasty revision due to infection: a cost analysis approach.

PubMed

Klouche, S; Sariali, E; Mamoudy, P

2010-04-01

The treatment of total hip arthroplasty (THA) infections is long and costly. However,the number of studies in the literature analysing the real cost of THA revision in relation to their etiology, including infection, is limited. The aim of this retrospective study was to determine the cost of revision of infected THA and to compare these costs to those of primary THA and revision of non-infected THA. We performed a retrospective cost analysis for the year 2006 using an identical analytic accounting system in each hospital department (according to internal criteria) based on allotment of direct costs and receipts for each department. From January to December 2006, 424 primary THA, 57 non-infected THA revisions and 40 THA revisions due to infection were performed. The different cost areas of the patient's treatment were identified.This included preoperative medical work-up, medicosurgical management during hospital stay,a second stay in an orthopedic rehabilitation hospital (ORH) and post-hospitalisation antibiotic therapy after revision due to infection, as well as home-based hospitalisation (HH) costs, if this was the selected alternative option. We used the national health insurance fee schedule found in the "Common classification of medical procedures" and the "General nomenclature of professional procedures" applicable in France since September 1, 2005. Hospital costs included direct costs (hospital overhead costs) and indirect costs, (medical, surgical, technical settings and net general service expenses). The calculation of HH costs and ORH costs were based on the average daily charge of these departments. The cost of primary THA was used as the reference.We then compared our surgical costs with those found for the corresponding comparable hospital stay groups (Groupes homogènes de séjour). The average hospital stay (AHS) was 7.5 +/- 1.8 days for primary THA, 8.9 +/- 2.2 days for non-infected revisions and 30.6 +/- 14.9 days for revisions due to infection. The rate of transfer to a rehabilitation hospital (ORH) was 55% for primary THA, 77% in non infected revision cases and 65% in revisions due to infection. Moreover, 30% of these infected THA were prescribed HH. Non-infected THA revisions cost 1.4 times more than primary THA. THA revisions due to infection cost 3.6 times more than primary THA. The economic impact of THA infections is considerable. The extra costs are mainly due to an extended hospital stay and to longer rehabilitation consuming significant substantial human and material resources. The cost of treating infected THA is high. Treatment strategies should therefore be optimised to increase the success rate and minimise total costs. Level IV. Economic and decision analyses, retrospective study 2010 Elsevier Masson SAS. All rights reserved.

[Educational objectives in the new interdisciplinary subject "Rehabilitation, Physical Medicine, Naturopathic Techniques" under the 9th Revision of the Licensing Regulations for Doctors--consensus recommendations of the German Society for Rehabilitative Sciences and the German Society for Physical Medicine and Rehabilitation].

PubMed

Mau, W; Gülich, M; Gutenbrunner, C; Lampe, B; Morfeld, M; Schwarzkopf, S R; Smolenski, U C

2004-12-01

In October 2003 the 9 (th) revision of the Federal Medical Training Regulations (Approbationsordnung) came into effect. The new compulsory interdisciplinary subject "Rehabilitation, Physical Medicine, Naturopathic Treatment" offers the opportunity to teach all students in comprehensive concepts of Rehabilitation such as the International Classification of Functioning, Disability and Health (ICF) of the WHO and the new book 9 of the German Social Code (SGB 9), as well as Physical Medicine and Naturopathic Treatment. Since the content of this new subject has not been defined up to date a joint task force of the German Society of Rehabilitation Science and the German Society of Physical Medicine and Rehabilitation was founded in order to recommend teaching standards. As part of these teaching standards educational objectives are introduced in this article. They should guide the persons in charge of teaching the subject in the medical faculties. In some areas the students should acquire profound abilities and skills in addition to knowledge. The medical faculties may focus on different educational targets according to their individual teaching profile.

Validity of the Children's Social Behavior Questionnaire (CSBQ) in Children with Intellectual Disability: Comparing the CSBQ with ADI-R, ADOS, and Clinical DSM-IV-TR Classification

ERIC Educational Resources Information Center

de Bildt, Annelies; Mulder, Erik J.; Hoekstra, Pieter J.; van Lang, Natasja D. J.; Minderaa, Ruud B.; Hartman, Catharina A.

2009-01-01

The Children's Social Behavior Questionnaire (CSBQ) was compared with the Autism Diagnostic Interview-Revised (ADI-R), Autism Diagnostic Observation Schedule (ADOS), and clinical classification in children with mild and moderate intellectual disability (ID), to investigate its criterion related validity. The contribution of the CSBQ to a…

Financial Accounting: Classifications and Standard Terminology for Local and State School Systems. State Educational Records and Reports Series: Handbook II, Revised.

ERIC Educational Resources Information Center

Roberts, Charles T., Comp.; Lichtenberger, Allan R., Comp.

This handbook has been prepared as a vehicle or mechanism for program cost accounting and as a guide to standard school accounting terminology for use in all types of local and intermediate education agencies. In addition to classification descriptions, program accounting definitions, and proration of cost procedures, some units of measure and…

20 CFR 410.418 - Irrebuttable presumption of total disability due to pneumoconiosis.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Classification of Radiographs of Pneumoconioses, 1971, or (2) The International Classification of the Radiographs of the Pneumoconioses of the International Labour Office, Extended Classification (1968) (which may be referred to as the “ILO Classification (1968)”), or (3) The Classification of the Pneumoconiosis...

Neurofibromatosis of the head and neck: classification and surgical management.

PubMed

Latham, Kerry; Buchanan, Edward P; Suver, Daniel; Gruss, Joseph S

2015-03-01

Neurofibromatosis is common and presents with variable penetrance and manifestations in one in 2500 to one in 3000 live births. The management of these patients is often multidisciplinary because of the complexity of the disease. Plastic surgeons are frequently involved in the surgical management of patients with head and neck involvement. A 20-year retrospective review of patients treated surgically for head and neck neurofibroma was performed. Patients were identified according to International Classification of Diseases, Ninth Revision codes for neurofibromatosis and from the senior author's database. A total of 59 patients with head and neck neurofibroma were identified. These patients were categorized into five distinct, but not exclusive, categories to assist with diagnosis and surgical management. These categories included plexiform, cranioorbital, facial, neck, and parotid/auricular neurofibromatosis. A surgical classification system and clinical characteristics of head and neck neurofibromatosis is presented to assist practitioners with diagnosis and surgical management of this complex disease. The surgical management of the cranioorbital type is discussed in detail in 24 patients. The importance and safety of facial nerve dissection and preservation using intraoperative nerve monitoring were validated in 16 dissections in 15 patients. Massive involvement of the neck extending from the skull base to the mediastinum, frequently considered inoperable, has been safely resected by the use of access osteotomies of the clavicle and sternum, muscle takedown, and brachial plexus dissection and preservation using intraoperative nerve monitoring. Therapeutic, IV.

A molecular phylogeny and classification of Leptochloa (Poaceae: Chloridoideae: Chlorideae) sensu lato and related genera

PubMed Central

Peterson, Paul M.; Romaschenko, Konstantin; Snow, Neil; Johnson, Gabriel

2012-01-01

Background and Aims Leptochloa (including Diplachne) sensu lato (s.l.) comprises a diverse assemblage of C4 (NAD-ME and PCK) grasses with approx. 32 annual or perennial species. Evolutionary relationships and a modern classification of Leptochloa spp. based on the study of molecular characters have only been superficially investigated in four species. The goals of this study were to reconstruct the evolutionary history of Leptochloa s.l. with molecular data and broad taxon sampling. Methods A phylogenetic analysis was conducted of 130 species (mostly Chloridoideae), of which 22 are placed in Leptochloa, using five plastid (rpL32-trn-L, ndhA intron, rps16 intron, rps16-trnK and ccsA) and the nuclear ITS 1 and 2 (ribosomal internal transcribed spacer regions) to infer evolutionary relationships and revise the classification. Key results Leptochloa s.l. is polyphyletic and strong support was found for five lineages. Embedded within the Leptochloa sensu stricto (s.s.) clade are two Trichloris spp. and embedded in Dinebra are Drake-brockmania and 19 Leptochloa spp. Conclusions The molecular results support the dissolution of Leptochloa s.l. into the following five genera: Dinebra with 23 species, Diplachne with two species, Disakisperma with three species, Leptochloa s.s. with five species and a new genus, Trigonochloa, with two species. PMID:22628365

Intellectual developmental disorders: towards a new name, definition and framework for “mental retardation/intellectual disability” in ICD-11

PubMed Central

CARULLA, LUIS SALVADOR; REED, GEOFFREY M.; VAEZ-AZIZI, LEILA M.; COOPER, SALLY-ANN; LEAL, RAFAEL MARTINEZ; BERTELLI, MARCO; ADNAMS, COLLEEN; COORAY, SHERVA; DEB, SHOUMITRO; DIRANI, LEYLA AKOURY; GIRIMAJI, SATISH CHANDRA; KATZ, GREGORIO; KWOK, HENRY; LUCKASSON, RUTH; SIMEONSSON, RUNE; WALSH, CAROLYN; MUNIR, KEMIR; SAXENA, SHEKHAR

2011-01-01

Although “intellectual disability” has widely replaced the term “mental retardation”, the debate as to whether this entity should be conceptualized as a health condition or as a disability has intensified as the revision of the World Health Organization (WHO)’s International Classification of Diseases (ICD) advances. Defining intellectual disability as a health condition is central to retaining it in ICD, with significant implications for health policy and access to health services. This paper presents the consensus reached to date by the WHO ICD Working Group on the Classification of Intellectual Disabilities. Literature reviews were conducted and a mixed qualitative approach was followed in a series of meetings to produce consensus-based recommendations combining prior expert knowledge and available evidence. The Working Group proposes replacing mental retardation with intellectual developmental disorders, defined as “a group of developmental conditions characterized by significant impairment of cognitive functions, which are associated with limitations of learning, adaptive behaviour and skills”. The Working Group further advises that intellectual developmental disorders be incorporated in the larger grouping (parent category) of neurodevelopmental disorders, that current subcategories based on clinical severity (i.e., mild, moderate, severe, profound) be continued, and that problem behaviours be removed from the core classification structure of intellectual developmental disorders and instead described as associated features. PMID:21991267

DSM-5 and mental disorders in older individuals: an overview

PubMed Central

Sachdev, Perminder S.; Mohan, Adith; Taylor, Lauren; Jeste, Dilip V.

2015-01-01

About every 20 years, the American Psychiatric Association revises its official classification of mental disorders. The fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in 2013, exciting considerable commentary, debate and criticism. This article briefly describes the process that led to the DSM-5 and the main changes from the previous version (DSM-IV) that would be of interest to a geriatric psychiatrist. While there have been a number of changes in the areas of schizophrenia, bipolar disorder, depressive disorders and anxiety disorders, the majority of these changes are minor and unlikely to have major treatment implications. The classification of neurocognitive disorders has however seen a major revision and elaboration in comparison with DSM-IV, with the introduction of Mild and Major Neurocognitive Disorders, the latter equated with dementia. A common language is introduced for the criteria of the various etiological subtypes of neurocognitive disorders. All physicians treating patients with neurocognitive disorders should familiarize themselves with these criteria. Their use in research has the potential to harmonize the field. PMID:26332215

The ICD‐11 developmental field study of reliability of diagnoses of high‐burden mental disorders: results among adult patients in mental health settings of 13 countries

PubMed Central

Reed, Geoffrey M.; Sharan, Pratap; Rebello, Tahilia J.; Keeley, Jared W.; Elena Medina‐Mora, María; Gureje, Oye; Luis Ayuso‐Mateos, José; Kanba, Shigenobu; Khoury, Brigitte; Kogan, Cary S.; Krasnov, Valery N.; Maj, Mario; de Jesus Mari, Jair; Stein, Dan J.; Zhao, Min; Akiyama, Tsuyoshi; Andrews, Howard F.; Asevedo, Elson; Cheour, Majda; Domínguez‐Martínez, Tecelli; El‐Khoury, Joseph; Fiorillo, Andrea; Grenier, Jean; Gupta, Nitin; Kola, Lola; Kulygina, Maya; Leal‐Leturia, Itziar; Luciano, Mario; Lusu, Bulumko; Nicolas, J.; Martínez‐López, I.; Matsumoto, Chihiro; Umukoro Onofa, Lucky; Paterniti, Sabrina; Purnima, Shivani; Robles, Rebeca; Sahu, Manoj K.; Sibeko, Goodman; Zhong, Na; First, Michael B.; Gaebel, Wolfgang; Lovell, Anne M.; Maruta, Toshimasa; Roberts, Michael C.; Pike, Kathleen M.

2018-01-01

Reliable, clinically useful, and globally applicable diagnostic classification of mental disorders is an essential foundation for global mental health. The World Health Organization (WHO) is nearing completion of the 11th revision of the International Classification of Diseases and Related Health Problems (ICD‐11). The present study assessed inter‐diagnostician reliability of mental disorders accounting for the greatest proportion of global disease burden and the highest levels of service utilization – schizophrenia and other primary psychotic disorders, mood disorders, anxiety and fear‐related disorders, and disorders specifically associated with stress – among adult patients presenting for treatment at 28 participating centers in 13 countries. A concurrent joint‐rater design was used, focusing specifically on whether two clinicians, relying on the same clinical information, agreed on the diagnosis when separately applying the ICD‐11 diagnostic guidelines. A total of 1,806 patients were assessed by 339 clinicians in the local language. Intraclass kappa coefficients for diagnoses weighted by site and study prevalence ranged from 0.45 (dysthymic disorder) to 0.88 (social anxiety disorder) and would be considered moderate to almost perfect for all diagnoses. Overall, the reliability of the ICD‐11 diagnostic guidelines was superior to that previously reported for equivalent ICD‐10 guidelines. These data provide support for the suitability of the ICD‐11 diagnostic guidelines for implementation at a global level. The findings will inform further revision of the ICD‐11 diagnostic guidelines prior to their publication and the development of programs to support professional training and implementation of the ICD‐11 by WHO member states. PMID:29856568

The ICD-11 developmental field study of reliability of diagnoses of high-burden mental disorders: results among adult patients in mental health settings of 13 countries.

PubMed

Reed, Geoffrey M; Sharan, Pratap; Rebello, Tahilia J; Keeley, Jared W; Elena Medina-Mora, María; Gureje, Oye; Luis Ayuso-Mateos, José; Kanba, Shigenobu; Khoury, Brigitte; Kogan, Cary S; Krasnov, Valery N; Maj, Mario; de Jesus Mari, Jair; Stein, Dan J; Zhao, Min; Akiyama, Tsuyoshi; Andrews, Howard F; Asevedo, Elson; Cheour, Majda; Domínguez-Martínez, Tecelli; El-Khoury, Joseph; Fiorillo, Andrea; Grenier, Jean; Gupta, Nitin; Kola, Lola; Kulygina, Maya; Leal-Leturia, Itziar; Luciano, Mario; Lusu, Bulumko; Nicolas, J; Martínez-López, I; Matsumoto, Chihiro; Umukoro Onofa, Lucky; Paterniti, Sabrina; Purnima, Shivani; Robles, Rebeca; Sahu, Manoj K; Sibeko, Goodman; Zhong, Na; First, Michael B; Gaebel, Wolfgang; Lovell, Anne M; Maruta, Toshimasa; Roberts, Michael C; Pike, Kathleen M

2018-06-01

Reliable, clinically useful, and globally applicable diagnostic classification of mental disorders is an essential foundation for global mental health. The World Health Organization (WHO) is nearing completion of the 11th revision of the International Classification of Diseases and Related Health Problems (ICD-11). The present study assessed inter-diagnostician reliability of mental disorders accounting for the greatest proportion of global disease burden and the highest levels of service utilization - schizophrenia and other primary psychotic disorders, mood disorders, anxiety and fear-related disorders, and disorders specifically associated with stress - among adult patients presenting for treatment at 28 participating centers in 13 countries. A concurrent joint-rater design was used, focusing specifically on whether two clinicians, relying on the same clinical information, agreed on the diagnosis when separately applying the ICD-11 diagnostic guidelines. A total of 1,806 patients were assessed by 339 clinicians in the local language. Intraclass kappa coefficients for diagnoses weighted by site and study prevalence ranged from 0.45 (dysthymic disorder) to 0.88 (social anxiety disorder) and would be considered moderate to almost perfect for all diagnoses. Overall, the reliability of the ICD-11 diagnostic guidelines was superior to that previously reported for equivalent ICD-10 guidelines. These data provide support for the suitability of the ICD-11 diagnostic guidelines for implementation at a global level. The findings will inform further revision of the ICD-11 diagnostic guidelines prior to their publication and the development of programs to support professional training and implementation of the ICD-11 by WHO member states. © 2018 World Psychiatric Association.

Significant inter-observer variation in the diagnosis of extrapancreatic necrosis and type of pancreatic collections in acute pancreatitis - An international multicenter evaluation of the revised Atlanta classification.

PubMed

Sternby, Hanna; Verdonk, Robert C; Aguilar, Guadalupe; Dimova, Alexandra; Ignatavicius, Povilas; Ilzarbe, Lucas; Koiva, Peeter; Lantto, Eila; Loigom, Tonis; Penttilä, Anne; Regnér, Sara; Rosendahl, Jonas; Strahinova, Vanya; Zackrisson, Sophia; Zviniene, Kristina; Bollen, Thomas L

2016-01-01

For consistent reporting and better comparison of data in research the revised Atlanta classification (RAC) proposes new computed tomography (CT) criteria to describe the morphology of acute pancreatitis (AP). The aim of this study was to analyse the interobserver agreement among radiologists in evaluating CT morphology by using the new RAC criteria in patients with AP. Patients with a first episode of AP who obtained a CT were identified and consecutively enrolled at six European centres backwards from January 2013 to January 2012. A local radiologist at each center and a central expert radiologist scored the CTs separately using the RAC criteria. Center dependent and independent interobserver agreement was determined using Kappa statistics. In total, 285 patients with 388 CTs were included. For most CT criteria, interobserver agreement was moderate to substantial. In four categories, the center independent kappa values were fair: extrapancreatic necrosis (EXPN) (0.326), type of pancreatitis (0.370), characteristics of collections (0.408), and appropriate term of collections (0.356). The fair kappa values relate to discrepancies in the identification of extrapancreatic necrotic material. The local radiologists diagnosed EXPN (33% versus 59%, P < 0.0001) and non-homogeneous collections (35% versus 66%, P < 0.0001) significantly less frequent than the central expert. Cases read by the central expert showed superior correlation with clinical outcome. Diagnosis of EXPN and recognition of non-homogeneous collections show only fair agreement potentially resulting in inconsistent reporting of morphologic findings. Copyright © 2016 IAP and EPC. Published by Elsevier B.V. All rights reserved.

Differences in the causes of death of HIV-positive patients in a cohort study by data sources and coding algorithms.

PubMed

Hernando, Victoria; Sobrino-Vegas, Paz; Burriel, M Carmen; Berenguer, Juan; Navarro, Gemma; Santos, Ignacio; Reparaz, Jesús; Martínez, M Angeles; Antela, Antonio; Gutiérrez, Félix; del Amo, Julia

2012-09-10

To compare causes of death (CoDs) from two independent sources: National Basic Death File (NBDF) and deaths reported to the Spanish HIV Research cohort [Cohort de adultos con infección por VIH de la Red de Investigación en SIDA CoRIS)] and compare the two coding algorithms: International Classification of Diseases, 10th revision (ICD-10) and revised version of Coding Causes of Death in HIV (revised CoDe). Between 2004 and 2008, CoDs were obtained from the cohort records (free text, multiple causes) and also from NBDF (ICD-10). CoDs from CoRIS were coded according to ICD-10 and revised CoDe by a panel. Deaths were compared by 13 disease groups: HIV/AIDS, liver diseases, malignancies, infections, cardiovascular, blood disorders, pulmonary, central nervous system, drug use, external, suicide, other causes and ill defined. There were 160 deaths. Concordance for the 13 groups was observed in 111 (69%) cases for the two sources and in 115 (72%) cases for the two coding algorithms. According to revised CoDe, the commonest CoDs were HIV/AIDS (53%), non-AIDS malignancies (11%) and liver related (9%), these percentages were similar, 57, 10 and 8%, respectively, for NBDF (coded as ICD-10). When using ICD-10 to code deaths in CoRIS, wherein HIV infection was known in everyone, the proportion of non-AIDS malignancies was 13%, liver-related accounted for 3%, while HIV/AIDS reached 70% due to liver-related, infections and ill-defined causes being coded as HIV/AIDS. There is substantial variation in CoDs in HIV-infected persons according to sources and algorithms. ICD-10 in patients known to be HIV-positive overestimates HIV/AIDS-related deaths at the expense of underestimating liver-related diseases, infections and ill defined causes. CoDe seems as the best option for cohort studies.

Validity of the International Classification of Diseases, Tenth Revision code for acute kidney injury in elderly patients at presentation to the emergency department and at hospital admission

PubMed Central

Hwang, Y Joseph; Shariff, Salimah Z; Gandhi, Sonja; Wald, Ron; Clark, Edward; Fleet, Jamie L; Garg, Amit X

2012-01-01

Objective To evaluate the validity of the International Classification of Diseases, Tenth Revision (ICD-10) code N17x for acute kidney injury (AKI) in elderly patients in two settings: at presentation to the emergency department and at hospital admission. Design A population-based retrospective validation study. Setting Southwestern Ontario, Canada, from 2003 to 2010. Participants Elderly patients with serum creatinine measurements at presentation to the emergency department (n=36 049) or hospital admission (n=38 566). The baseline serum creatinine measurement was a median of 102 and 39 days prior to presentation to the emergency department and hospital admission, respectively. Main outcome measures Sensitivity, specificity and positive and negative predictive values of ICD-10 diagnostic coding algorithms for AKI using a reference standard based on changes in serum creatinine from the baseline value. Median changes in serum creatinine of patients who were code positive and code negative for AKI. Results The sensitivity of the best-performing coding algorithm for AKI (defined as a ≥2-fold increase in serum creatinine concentration) was 37.4% (95% CI 32.1% to 43.1%) at presentation to the emergency department and 61.6% (95% CI 57.5% to 65.5%) at hospital admission. The specificity was greater than 95% in both settings. In patients who were code positive for AKI, the median (IQR) increase in serum creatinine from the baseline was 133 (62 to 288) µmol/l at presentation to the emergency department and 98 (43 to 200) µmol/l at hospital admission. In those who were code negative, the increase in serum creatinine was 2 (−8 to 14) and 6 (−4 to 20) µmol/l, respectively. Conclusions The presence or absence of ICD-10 code N17× differentiates two groups of patients with distinct changes in serum creatinine at the time of a hospital encounter. However, the code underestimates the true incidence of AKI due to a limited sensitivity. PMID:23204077

Validity of the International Classification of Diseases 10th revision code for hospitalisation with hyponatraemia in elderly patients

PubMed Central

Gandhi, Sonja; Shariff, Salimah Z; Fleet, Jamie L; Weir, Matthew A; Jain, Arsh K; Garg, Amit X

2012-01-01

Objective To evaluate the validity of the International Classification of Diseases, 10th Revision (ICD-10) diagnosis code for hyponatraemia (E87.1) in two settings: at presentation to the emergency department and at hospital admission. Design Population-based retrospective validation study. Setting Twelve hospitals in Southwestern Ontario, Canada, from 2003 to 2010. Participants Patients aged 66 years and older with serum sodium laboratory measurements at presentation to the emergency department (n=64 581) and at hospital admission (n=64 499). Main outcome measures Sensitivity, specificity, positive predictive value and negative predictive value comparing various ICD-10 diagnostic coding algorithms for hyponatraemia to serum sodium laboratory measurements (reference standard). Median serum sodium values comparing patients who were code positive and code negative for hyponatraemia. Results The sensitivity of hyponatraemia (defined by a serum sodium ≤132 mmol/l) for the best-performing ICD-10 coding algorithm was 7.5% at presentation to the emergency department (95% CI 7.0% to 8.2%) and 10.6% at hospital admission (95% CI 9.9% to 11.2%). Both specificities were greater than 99%. In the two settings, the positive predictive values were 96.4% (95% CI 94.6% to 97.6%) and 82.3% (95% CI 80.0% to 84.4%), while the negative predictive values were 89.2% (95% CI 89.0% to 89.5%) and 87.1% (95% CI 86.8% to 87.4%). In patients who were code positive for hyponatraemia, the median (IQR) serum sodium measurements were 123 (119–126) mmol/l and 125 (120–130) mmol/l in the two settings. In code negative patients, the measurements were 138 (136–140) mmol/l and 137 (135–139) mmol/l. Conclusions The ICD-10 diagnostic code for hyponatraemia differentiates between two groups of patients with distinct serum sodium measurements at both presentation to the emergency department and at hospital admission. However, these codes underestimate the true incidence of hyponatraemia due to low sensitivity. PMID:23274673

Trends in the epidemiology of pediatric severe sepsis*.

PubMed

Hartman, Mary E; Linde-Zwirble, Walter T; Angus, Derek C; Watson, R Scott

2013-09-01

In the past decade, guidelines have been developed for the early detection and management of severe sepsis in children and neonates. However, severe sepsis continues to be a significant U.S. healthcare problem, accounting for over 720,000 annual hospitalizations. Large-scale epidemiologic studies of severe sepsis continue to be limited, particularly in children. We present data from 1995, 2000, and 2005 in seven U.S. states, examining how case mix, outcome, and resource use for pediatric severe sepsis have changed over time. We constructed a database including all acute-care hospitalizations for children in the seven states. For each case, we extracted data on demographic characteristics; the principal diagnosis, up to six secondary diagnoses, and six procedures as classified by the International Classification of Diseases, 9th Revision, Clinical Modification codes; and in-hospital fatality. We identified patients with severe sepsis using International Classification of Diseases, 9th Revision, Clinical Modification codes for both infection and acute organ failure. Retrospective observational cohort dataset from seven U.S. states from 1995, 2000, and 2005. Children in the U.S. 0-19 years old. None. In 2005, 17,542 children were hospitalized with severe sepsis in the seven states; there was an 81% increase in pediatric severe sepsis cases since 1995 and a 45% increase since 2000. This corresponded to an increase in prevalence from 0.56 to 0.89 cases per 1,000 pediatric population. Between 1995 and 2005, the prevalence of severe sepsis in newborns more than doubled, from 4.5 to 9.7 cases per 1,000 births. The most common infecting organisms in all 3 years were Staphylococcus species. From 1995 to 2005, the case-fatality rate decreased from 10.3% to 8.9%. Case fatality associated with Staphylococcus aureus increased, whereas fatality associated with Streptococcus pneumoniae decreased by 75%. Nationally, there were 75,255 pediatric hospitalizations in 2005 involving severe sepsis, with an associated cost of $4.8 billion. Between 1995 and 2005, the prevalence of severe sepsis in U.S. children steadily rose, due to a significant increase in the prevalence of severe sepsis in newborns.

Summer syncope syndrome redux.

PubMed

Huang, Jennifer Juxiang; Desai, Chirag; Singh, Nirmal; Sharda, Natasha; Fernandes, Aaron; Riaz, Irbaz Bin; Alpert, Joseph S

2015-10-01

While antihypertensive therapy is known to reduce the risk for heart failure, myocardial infarction, and stroke, it can often cause orthostatic hypotension and syncope, especially in the setting of polypharmacy and possibly, a hot and dry climate. The objective of the present study was to investigate whether the results of our prior study involving continued use of antihypertensive drugs at the same dosage in the summer as in the winter months for patients living in the Sonoran desert resulted in an increase in syncopal episodes during the hot summer months. All hypertensive patients who were treated with medications and admitted with International Classification of Diseases, 9th Revision code diagnosis of syncope were included. This is a 3-year retrospective chart review study. They were defined as "cases" if they presented during the summer months (May to September) and "controls" if they presented during the winter months (November to March). The primary outcome measure was the presence of clinical dehydration. The statistical significance was determined using the 2-sided Fisher's exact test. A total of 834 patients with an International Classification of Diseases, 9th Revision code diagnosis of syncope were screened: 477 in the summer months and 357 in the winter months. In patients taking antihypertensive medications, there was a significantly higher number of cases of syncope secondary to dehydration during the summer months (40.5%) compared with the winter months (29%) (P = .04). No difference was observed in the type of antihypertensive medication used and syncope rate. The number of antihypertensives used did not increase the cases of syncope in either summer or winter. An increased number of syncope events was observed in the summer months among people who reside in a dry desert climate and who are taking antihypertensive medications. The data confirm our earlier observations that demonstrated a greater number of cases of syncope among people who reside in a dry desert climate who were taking antihypertensive medications during summer months. We recommend judicious reduction of antihypertensive therapy in patients residing in a hot and dry climate, particularly during the summer months. Copyright © 2015 Elsevier Inc. All rights reserved.

Validity of the International Classification of Diseases 10th revision code for hyperkalaemia in elderly patients at presentation to an emergency department and at hospital admission

PubMed Central

Fleet, Jamie L; Shariff, Salimah Z; Gandhi, Sonja; Weir, Matthew A; Jain, Arsh K; Garg, Amit X

2012-01-01

Objectives Evaluate the validity of the International Classification of Diseases, 10th revision (ICD-10) code for hyperkalaemia (E87.5) in two settings: at presentation to an emergency department and at hospital admission. Design Population-based validation study. Setting 12 hospitals in Southwestern Ontario, Canada, from 2003 to 2010. Participants Elderly patients with serum potassium values at presentation to an emergency department (n=64 579) and at hospital admission (n=64 497). Primary outcome Sensitivity, specificity, positive-predictive value and negative-predictive value. Serum potassium values in patients with and without a hyperkalaemia code (code positive and code negative, respectively). Results The sensitivity of the best-performing ICD-10 coding algorithm for hyperkalaemia (defined by serum potassium >5.5 mmol/l) was 14.1% (95% CI 12.5% to 15.9%) at presentation to an emergency department and 14.6% (95% CI 13.3% to 16.1%) at hospital admission. Both specificities were greater than 99%. In the two settings, the positive-predictive values were 83.2% (95% CI 78.4% to 87.1%) and 62.0% (95% CI 57.9% to 66.0%), while the negative-predictive values were 97.8% (95% CI 97.6% to 97.9%) and 96.9% (95% CI 96.8% to 97.1%). In patients who were code positive for hyperkalaemia, median (IQR) serum potassium values were 6.1 (5.7 to 6.8) mmol/l at presentation to an emergency department and 6.0 (5.1 to 6.7) mmol/l at hospital admission. For code-negative patients median (IQR) serum potassium values were 4.0 (3.7 to 4.4) mmol/l and 4.1 (3.8 to 4.5) mmol/l in each of the two settings, respectively. Conclusions Patients with hospital encounters who were ICD-10 E87.5 hyperkalaemia code positive and negative had distinct higher and lower serum potassium values, respectively. However, due to very low sensitivity, the incidence of hyperkalaemia is underestimated. PMID:23274674

Accuracy of Skin Cancer Diagnosis by Physician Assistants Compared With Dermatologists in a Large Health Care System.

PubMed

Anderson, Alyce M; Matsumoto, Martha; Saul, Melissa I; Secrest, Aaron M; Ferris, Laura K

2018-05-01

Physician assistants (PAs) are increasingly used in dermatology practices to diagnose skin cancers, although, to date, their diagnostic accuracy compared with board-certified dermatologists has not been well studied. To compare diagnostic accuracy for skin cancer of PAs with that of dermatologists. Medical record review of 33 647 skin cancer screening examinations in 20 270 unique patients who underwent screening at University of Pittsburgh Medical Center-affiliated dermatology offices from January 1, 2011, to December 31, 2015. International Classification of Diseases, Ninth Revision code V76.43 and International Classification of Diseases and Related Health Problems, Tenth Revision code Z12.83 were used to identify pathology reports from skin cancer screening examinations by dermatologists and PAs. Examination performed by a PA or dermatologist. Number needed to biopsy (NNB) to diagnose skin cancer (nonmelanoma, invasive melanoma, or in situ melanoma). Of 20 270 unique patients, 12 722 (62.8%) were female, mean (SD) age at the first visit was 52.7 (17.4) years, and 19 515 patients (96.3%) self-reported their race/ethnicity as non-Hispanic white. To diagnose 1 case of skin cancer, the NNB was 3.9 for PAs and 3.3 for dermatologists (P < .001). Per diagnosed melanoma, the NNB was 39.4 for PAs and 25.4 for dermatologists (P = .007). Patients screened by a PA were significantly less likely than those screened by a dermatologist to be diagnosed with melanoma in situ (1.1% vs 1.8% of visits, P = .02), but differences were not significant for invasive melanoma (0.7% vs 0.8% of visits, P = .83) or nonmelanoma skin cancer (6.1% vs 6.1% of visits, P = .98). Compared with dermatologists, PAs performed more skin biopsies per case of skin cancer diagnosed and diagnosed fewer melanomas in situ, suggesting that the diagnostic accuracy of PAs may be lower than that of dermatologists. Although the availability of PAs may help increase access to care and reduce waiting times for appointments, these findings have important implications for the training, appropriate scope of practice, and supervision of PAs and other nonphysician practitioners in dermatology.

USE OF ELECTRONIC HEALTH RECORDS TO CHARACTERIZE A RARE DISEASE IN THE U.S.: TREATMENT, COMORBIDITIES, AND FOLLOW-UP TRENDS AMONG PATIENTS WITH A CONFIRMED DIAGNOSIS OF ACROMEGALY.

PubMed

Silverstein, Julie M; Roe, Erin D; Munir, Kashif M; Fox, Janet L; Emir, Birol; Kouznetsova, Maria; Lamerato, Lois E; King, Donna

2018-06-01

Understanding of acromegaly disease management is hampered in the U.S. by the lack of a national registry. We describe medical management in a population with confirmed acromegaly. Inpatient and outpatient electronic health records (EHRs) were used to create a database of de-identified patients assigned the Acromegaly and Gigantism International Classification of Diseases, 9 th revision (ICD-9) code and/or an appropriate pituitary procedure code at 1 of 4 regional hospital systems over a 6- to 11-year period. Information regarding demographics, medical history, labs, procedures, and medications was collected and supplemented with a chart review to validate the diagnosis of acromegaly. Of 367 patients with validated acromegaly, available records showed that during the years studied, pituitary surgery was performed on 31%, 4% received radiosurgery, and 22% were prescribed a drug indicated for acromegaly. Insulin-like growth factor-1 (IGF-1) levels were measured in 62% of patients, 83% of whom had at least 1 normal value. Coded comorbidities reflect those reported previously in patients with acromegaly, with the exception of esophageal reflux in 20% of patient records. Fewer data regarding acromegaly-specific medications and testing were available for patients aged 65 and older. AcroMEDIC is a U.S. multisite retrospective study of acromegaly that captured medical management in the majority of patients included in the cohort. Chart review highlighted the importance of verification of coded diagnoses. Most of the acromegaly-related comorbidities identified here are known to increase with age and obesity. Patients ≥65 appeared to have less active management/monitoring of their disease. Medical attention should be directed to this population to address evolving needs over time. AcroMEDIC = Acromegaly Multisite Electronic Data Innovative Consortium; BMI = body mass index; CCI = Charlson Comorbidity Index; EHR = electronic health record; GH = growth hormone; GHRA = growth hormone receptor antagonist; ICD-9 = International Classification of Diseases, 9 th revision; IGF-1 = insulin-like growth factor-1; SSA = somatostatin analogue.

Traumatic brain injury in the elderly: increased mortality and worse functional outcome at discharge despite lower injury severity.

PubMed

Susman, Mark; DiRusso, Stephen M; Sullivan, Thomas; Risucci, Donald; Nealon, Peter; Cuff, Sara; Haider, Adil; Benzil, Deborah

2002-08-01

The purpose of this study was to compare data obtained from a statewide data set for elderly patients (age > 64 years) that presented with traumatic brain injury with data from nonelderly patients (age > 15 and < 65 years) with similar injuries. The New York State Trauma Registry from January 1994 through December 1995, from trauma centers and community hospitals excluding New York City (45,982 patients), was examined. Head-injured patients were identified by International Classification of Diseases, Ninth Revision diagnosis codes. A relative head injury severity scale (RHISS) was constructed on the basis of groups of these codes (range, 0 = none to 3 = severe). Comparisons were made with nonelderly patients for mortality, Glasgow Coma Scale (GCS) score at admission and discharge, Injury Severity Score, New Injury Severity Score, and RHISS. Outcome was assessed by a Functional Independence Measure score in three major domains: expression, locomotion, and feeding. Data were analyzed by the chi2 test and Mann-Whitney U test, with p < 0.05 considered significant. There were 11,772 patients with International Classification of Diseases, Ninth Revision diagnosis of head injury, of which 3,244 (27%) were elderly. There were more male subjects in the nonelderly population (78% male subjects) compared with the elderly population (50% men). Mortality was 24.0% in the elderly population compared with 12.8% in the nonelderly population (risk ratio, 2.2; 95% confidence interval, 1.99-2.43). The elderly nonsurvivors were statistically older, and mortality rate increased with age. Stratified by GCS score, there was a higher percentage of nonsurvivors in the elderly population, even in the group with only moderately depressed GCS score (GCS score of 13-15; risk ratio, 7.8; 95% confidence interval, 6.1-9.9 for elderly vs. nonelderly). Functional outcome in all three domains was significantly worse in the elderly survivors compared with the nonelderly survivors. Elderly traumatic brain injury patients have a worse mortality and functional outcome than nonelderly patients who present with head injury even though their head injury and overall injuries are seemingly less severe.

Defining pediatric sepsis by different criteria: discrepancies in populations and implications for clinical practice.

PubMed

Weiss, Scott L; Parker, Brandon; Bullock, Maria E; Swartz, Sheila; Price, Carolynn; Wainwright, Mark S; Goodman, Denise M

2012-07-01

Pediatric patients with sepsis are identified using related but distinct criteria for clinical, research, and administrative purposes. The overlap between these criteria will affect the validity of extrapolating data across settings. We sought to quantify the extent of agreement among different criteria for pediatric severe sepsis/septic shock and to detect systematic differences between these cohorts. Observational cohort study. Forty-two bed pediatric intensive care unit at an academic medical center. A total of 1,729 patients ≤ 18 yrs-old. None. All patients were screened for severe sepsis or septic shock using consensus guidelines (research criteria), diagnosis by healthcare professionals (clinical criteria), and International Classification of Diseases, Ninth Revision, Clinical Modification codes (administrative criteria). Cohen's κ determined the level of agreement among criteria, and patient characteristics were compared between cohorts. Ninety (5.2%) patients were identified by research, 96 (5.6%) by clinical, and 103 (6.0%) by administrative criteria. The κ ± standard error for pair-wise comparisons was 0.67 ± 0.04 for research-clinical, 0.52 ± 0.05 for research-administrative, and 0.55 ± 0.04 for clinical-administrative. Of the patients in the clinical cohort, 67% met research and 58% met administrative criteria. The research cohort exhibited a higher Pediatric Index of Mortality-2 score (median, interquartile range 5.2, 1.6-13.3) than the clinical (3.6, 1.1-6.2) and administrative (3.9, 1.0-6.0) cohorts (p = .005), an increased requirement for vasoactive infusions (74%, 57%, and 45%, p < .001), and a potential bias toward an increased proportion with respiratory dysfunction compared with clinical practice. Although research, clinical, and administrative criteria yielded a similar incidence (5%-6%) for pediatric severe sepsis/septic shock, there was only a moderate level of agreement in the patients identified by different criteria. One third of patients diagnosed clinically with sepsis would not have been included in studies based on consensus guidelines or International Classification of Diseases, Ninth Revision, Clinical Modification codes. Differences in patient selection need to be considered when extrapolating data across settings.

78 FR 26398 - Public Comment and Public Meeting on Draft Revisions to the Foreign Missions and International...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-06

... proposals submitted by Federal government agencies for the NCPC review required by law. The Foreign Missions... revised Foreign Missions and International Organizations Element will be available online at http://www...

Treatment outcomes of saddle nose correction.

PubMed

Hyun, Sang Min; Jang, Yong Ju

2013-01-01

Many valuable classification schemes for saddle nose have been suggested that integrate clinical deformity and treatment; however, there is no consensus regarding the most suitable classification and surgical method for saddle nose correction. To present clinical characteristics and treatment outcome of saddle nose deformity and to propose a modified classification system to better characterize the variety of different saddle nose deformities. The retrospective study included 91 patients who underwent rhinoplasty for correction of saddle nose from April 1, 2003, through December 31, 2011, with a minimum follow-up of 8 months. Saddle nose was classified into 4 types according to a modified classification. Aesthetic outcomes were classified as excellent, good, fair, or poor. Patients underwent minor cosmetic concealment by dorsal augmentation (n = 8) or major septal reconstruction combined with dorsal augmentation (n = 83). Autologous costal cartilages were used in 40 patients (44%), and homologous costal cartilages were used in 5 patients (6%). According to postoperative assessment, 29 patients had excellent, 42 patients had good, 18 patients had fair, and 2 patients had poor aesthetic outcomes. No statistical difference in surgical outcome according to saddle nose classification was observed. Eight patients underwent revision rhinoplasty, owing to recurrence of saddle, wound infection, or warping of the costal cartilage for dorsal augmentation. We introduce a modified saddle nose classification scheme that is simpler and better able to characterize different deformities. Among 91 patients with saddle nose, 20 (22%) had unsuccessful outcomes (fair or poor) and 8 (9%) underwent subsequent revision rhinoplasty. Thus, management of saddle nose deformities remains challenging. 4.

Corps of Engineers Hydraulic Design Criteria. Volume I

DTIC Science & Technology

1977-01-01

DESIGN CRITERIA CLASSIFICATION INDEX S000-GENERAL 000 Physical Constants 001 Fluid Properties 010 Open Channel Flow 020 Free Overflow 030 Pressure Flow...Dissipation 113 Erosion below Spillways 120 Chute Spillways 121 Approach Channel 122 Ogee Crests 123 Spillay Chutes S ii124 Spillway Stilling Basins 125...Spillvay Exit Channel Revised 5-59 .. . j1.I.i edCORPS OF ENGINEERS HYDRAULIC DESIGN CRITERIA CLASSIFICATION INDEX (Continued) %. IO0-SPILLWAYS

Fifteen years of the Family Eating and Activity Habits Questionnaire (FEAHQ): an update and review.

PubMed

Golan, M

2014-04-01

The Family Eating and Activity Habits Questionnaire (FEAHQ) is a 32-item self-report instrument designed to assess the eating and activity habits of family members as well as obesogenic factors in the overall home environment (stimulus and behaviour patterns) related to weight. Originally, this questionnaire, which was developed in Israel, was designed for use in family-based weight-management interventions that emphasized changes in the environment, and in parents' knowledge, behaviours and modelling. It was developed for use with children aged 6-11 years and designed for co-completion by parents or caretakers and their children. Over the years, it has been administered in research and clinical settings in Israel, England, Australia and other countries. Its 15-year anniversary calls for an update in the literature regarding adjustments made to improve its use in different settings and with different ethnic populations and the psychometric properties of the revised version. The goal of this paper is threefold: (i) to describe the history and development of the FEAHQ; (ii) to present new data supporting the psychometric properties of the subscales of the Revised FEAHQ (FEAHQ-R) for ages 6-12 years and (iii) to review the clinical and research literature reporting on FEAHQ subscales. The psychometric properties of the revised questionnaire were evaluated in a randomized control trial and in a naturalistic, community-based study to promote healthy lifestyle among families with children 6-12 years of age from different ethnic populations. The tool demonstrated good test-retest reliability when completed by caretakers and very good internal consistency. The questionnaire scores discriminated between obese and normal-weight children and predicted the weight classification of 66% of the participants. The FEAHQ-R is a useful clinical tool for identifying target behaviors for treatment and monitoring treatment progress that centers on overweight prevention and weight management. © 2013 The Author. Pediatric Obesity © 2013 International Association for the Study of Obesity.

Development and content validity testing of a comprehensive classification of diagnoses for pediatric nurse practitioners.

PubMed

Burns, C

1991-01-01

Pediatric nurse practitioners (PNPs) need an integrated, comprehensive classification that includes nursing, disease, and developmental diagnoses to effectively describe their practice. No such classification exists. Further, methodologic studies to help evaluate the content validity of any nursing taxonomy are unavailable. A conceptual framework was derived. Then 178 diagnoses from the North American Nursing Diagnosis Association (NANDA) 1986 list, selected diagnoses from the International Classification of Diseases, the Diagnostic and Statistical Manual, Third Revision, and others were selected. This framework identified and listed, with definitions, three domains of diagnoses: Developmental Problems, Diseases, and Daily Living Problems. The diagnoses were ranked using a 4-point scale (4 = highly related to 1 = not related) and were placed into the three domains. The rating scale was assigned by a panel of eight expert pediatric nurses. Diagnoses that were assigned to the Daily Living Problems domain were then sorted into the 11 Functional Health patterns described by Gordon (1987). Reliability was measured using proportions of agreement and Kappas. Content validity of the groups created was measured using indices of content validity and average congruency percentages. The experts used a new method to sort the diagnoses in a new way that decreased overlaps among the domains. The Developmental and Disease domains were judged reliable and valid. The Daily Living domain of nursing diagnoses showed marginally acceptable validity with acceptable reliability. Six Functional Health Patterns were judged reliable and valid, mixed results were determined for four categories, and the Coping/Stress Tolerance category was judged reliable but not valid using either test. There were considerable differences between the panel's, Gordon's (1987), and NANDA's clustering of NANDA diagnoses. This study defines the diagnostic practice of nurses from a holistic, patient-centered perspective. It is the first study to use quantitative methods to test a diagnostic classification system for nursing. The classification model could also be adapted for other nurse specialties.

Applicability of the 2001 revised diagnostic criteria in Brazilian Vogt-Koyanagi-Harada disease patients.

PubMed

Cardoso, Isabel Habeyche; Zajdenweber, Moysés Eduardo; Muccioli, Cristina; Fimamor, Luciana Peixoto; Belfort, Rubens

2008-01-01

To determine the applicability of the international revised diagnostic criteria for Vogt-Koyanagi-Harada disease. Retrospective study. Medical charts of 140 patients with the diagnosis of Vogt-Koyanagi-Harada disease, from the Uveitis Sector of the Federal University of Sao Paulo (UNIFESP), were revised and classified following the revised diagnostic criteria. Of the 140 patients, 12.85% fulfilled the criteria for complete disease, 29.28% incomplete disease, 28.57% "probable" Vogt-Koyanagi-Harada disease and 28.27% were considered not Vogt-Koyanagi-Harada disease. The authors consider that the international revised diagnostic criteria have good applicability and are very useful to help in the diagnosis of Vogt-Koyanagi-Harada disease.

CytoCom: a Cytoscape app to visualize, query and analyse disease comorbidity networks.

PubMed

Moni, Mohammad Ali; Xu, Haoming; Liò, Pietro

2015-03-15

CytoCom is an interactive plugin for Cytoscape that can be used to search, explore, analyse and visualize human disease comorbidity network. It represents disease-disease associations in terms of bipartite graphs and provides International Classification of Diseases, Ninth Revision (ICD9)-centric and disease name centric views of disease information. It allows users to find associations between diseases based on the two measures: Relative Risk (RR) and [Formula: see text]-correlation values. In the disease network, the size of each node is based on the prevalence of that disease. CytoCom is capable of clustering disease network based on the ICD9 disease category. It provides user-friendly access that facilitates exploration of human diseases, and finds additional associated diseases by double-clicking a node in the existing network. Additional comorbid diseases are then connected to the existing network. It is able to assist users for interpretation and exploration of the human diseases by a variety of built-in functions. Moreover, CytoCom permits multi-colouring of disease nodes according to standard disease classification for expedient visualization. © The Author 2014. Published by Oxford University Press.

Posttraumatic Stress Disorder and Related Disorders among Female Yazidi Refugees following Islamic State of Iraq and Syria Attacks-A Case Series and Mini-Review.

PubMed

Gerdau, Inga; Kizilhan, Jan Ilhan; Noll-Hussong, Michael

2017-01-01

Following the severe attacks by the so-called "Islamic State of Iraq and Syria" on the Yazidi population, which started in summer 2014, the state government of Baden-Württemberg, Germany, funded a Special-Quota Project to bring 1,000 very ill or left-behind women and children who were being held hostage to 22 cities and towns in Baden-Württemberg to receive integrated care. Here, we report for the first time on the cases of four Yazidi women living in Ulm, Germany, focusing on the clinically observed and psychometrically assessed mental phenomena or disorders. Our primary aim was to explore what International Classification of Diseases, 10th Revision diagnoses are present in this population. Although highly traumatized, these women were suffering primarily from adjustment disorder rather than posttraumatic stress disorder according to official classification systems. Despite their symptoms of depression and anxiety, the women's responses to self-assessment questionnaires provided no evidence of compulsion, somatization, or eating disorders. The results suggest that further investigation of the individual-level effects of rape and torture, as well the historic, systemic, and collective effects, e.g., on families and societies, is required.

[Masked depression--history and present days].

PubMed

Miodek, Anna; Szemraj, Paweł; Kocur, Józef; Ryś, Anna

2007-07-01

Masked depression is a special form of an atypical depression. In the 70's and 80's years it was often identified at patients who complained on somatic diseases, without any distinguishable organic disorder. Depression symptoms were of secondary importance, with lesser intensification, some of them didn't appear at all. The psychiatrists of the time created a lot of terms to describe them, i.e.: a depression equivalent, a vegetative equivalent, a depression without a depression, a hidden depression. Current classifications: ICD-10 (International Classification of Diseases, 10th Revision) and DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, published by the American Psychiatric Association) do not contain the term masked depression. It doesn't mean that have disappeared the problem of atypical depression syndrome with a picture significantly different from the commonly known. The american scientists claim that such group contains 6-7% of depression disorders. The lack of proper diagnosis and disease entity qualification leads to serious somatic and psychological consequences for patients. Improper diagnosis and treatment of a patient limits his or her social and professional life, forms suicide rate and makes high costs of diagnosis and treatment.

Annual update of data for estimating ESALs.

DOT National Transportation Integrated Search

2006-10-01

A revised procedure for estimating equivalent single axleloads (ESALs) was developed in 1985. This procedure used weight, classification, and traffic volume data collected by the Transportation Cabinet's Division of Planning. : Annual updates of data...

From Novice to Expert: Problem Solving in ICD-10-PCS Procedural Coding

PubMed Central

Rousse, Justin Thomas

2013-01-01

The benefits of converting to ICD-10-CM/PCS have been well documented in recent years. One of the greatest challenges in the conversion, however, is how to train the workforce in the code sets. The International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) has been described as a language requiring higher-level reasoning skills because of the system's increased granularity. Training and problem-solving strategies required for correct procedural coding are unclear. The objective of this article is to propose that the acquisition of rule-based logic will need to be augmented with self-evaluative and critical thinking. Awareness of how this process works is helpful for established coders as well as for a new generation of coders who will master the complexities of the system. PMID:23861674

A psychometric evaluation of the Rorschach comprehensive system's perceptual thinking index.

PubMed

Dao, Tam K; Prevatt, Frances

2006-04-01

In this study, we investigated evidence for reliability and validity of the Perceptual Thinking Index (PTI; Exner, 2000a, 2000b) among an adult inpatient population. We conducted reliability and validity analyses on 107 patients who met the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision; American Psychiatric Association, 2000) criteria for a schizophrenia-spectrum disorder (SSD) or mood disorder with no psychotic features (MD). Results provided support for interrater reliability as well as internal consistency of the PTI. Furthermore, the PTI was an effective index in differentiating SSD patients from patients diagnosed with an MD. Finally, the PTI demonstrated adequate diagnostic statistics that can be useful in the classification of patients diagnosed with SSD and MD. We discuss methodological issues, implications for assessment practice, and directions for future research.

Defining delirium for the International Classification of Diseases, 11th Revision.

PubMed

Meagher, David J; Maclullich, Alasdair M J; Laurila, Jouko V

2008-09-01

The development of ICD-11 provides an opportunity to update the description of delirium according to emerging data that have added to our understanding of this complex neuropsychiatric syndrome. Synthetic article based on published work considered by the authors to be relevant to the definition of delirium. The current DSM-IV definition of delirium is preferred to the ICD-10 because of its greater inclusivity. Evidence does not support major changes in the principal components of present definitions but a number of key issues for the updated definition were identified. These include better account of non-cognitive features, more guidance for rating contextual diagnostic items, clearer definition regarding the interface with dementia, and accounting for illness severity, clinical subtypes and course. Development of the ICD definition of delirium can allow for more targeted research and clinical effort.

Inclusion of Gaming Disorder in ICD has more advantages than disadvantages

PubMed Central

Király, Orsolya; Demetrovics, Zsolt

2017-01-01

This paper is a response to a recent debate paper in which Aarseth et al. argue that the inclusion of a formal diagnosis and categories for problematic video gaming or Gaming Disorder (GD) in the World Health Organization’s 11th Revision of the International Classification of Diseases (ICD-11) is premature and therefore the proposal should be removed. The present authors systematically address all the six main arguments presented by Aarseth et al. and argue that, even though some of the concerns presented in the debate paper are legitimate, the inclusion of GD in ICD-11 has more advantages than disadvantages. Furthermore, the present authors also argue that the two GD subtypes (“GD, predominantly online” and “GD, predominantly offline”) are unnecessary and rather problematic; the main category for GD would be perfectly sufficient. PMID:28816495

Inclusion of Gaming Disorder in ICD has more advantages than disadvantages.

PubMed

Király, Orsolya; Demetrovics, Zsolt

2017-09-01

This paper is a response to a recent debate paper in which Aarseth et al. argue that the inclusion of a formal diagnosis and categories for problematic video gaming or Gaming Disorder (GD) in the World Health Organization's 11th Revision of the International Classification of Diseases (ICD-11) is premature and therefore the proposal should be removed. The present authors systematically address all the six main arguments presented by Aarseth et al. and argue that, even though some of the concerns presented in the debate paper are legitimate, the inclusion of GD in ICD-11 has more advantages than disadvantages. Furthermore, the present authors also argue that the two GD subtypes ("GD, predominantly online" and "GD, predominantly offline") are unnecessary and rather problematic; the main category for GD would be perfectly sufficient.

Oesophageal diverticula: principles of management and appraisal of classification.

PubMed Central

Borrie, J; Wilson, R L

1980-01-01

In this paper we review a consecutive series of 50 oesophageal diverticula, appraise clinical features and methods of management, and suggest an improvement on the World Health Organization classification. The link between oesophageal diverticula and motor disorders as assessed by oesophageal manometry is stressed. It is necessary to correct the functional disorder as well as the diverticulum if it is causing symptoms. A revised classification could be as follows: congenital--single or multiple; acquired--single (cricopharyngeal, mid-oesophageal, epiphrenic other) or multiple (for example, when cricopharyngeal and mid-oesophageal present together, or when there is intramural diverticulosis. Images PMID:6781091

The societal costs of femoral neck fracture patients treated with internal fixation.

PubMed

Zielinski, S M; Bouwmans, C A M; Heetveld, M J; Bhandari, M; Patka, P; Van Lieshout, E M M

2014-03-01

The study rationale was to provide a detailed overview of the costs for femoral neck fracture treatment with internal fixation in the Netherlands. Mean total costs per patient at 2-years follow-up were 19,425. Costs were higher for older, less healthy patients. Results are comparable to internationally published costs. The aim of this study was to provide a detailed overview of the cost and healthcare consumption of patients treated for a hip fracture with internal fixation. A secondary aim was to compare costs of patients who underwent a revision surgery with patients who did not. The study was performed alongside the Dutch sample of an international randomized controlled trial, concerning femoral neck fracture patients treated with internal fixation. Patient characteristics and healthcare consumption were collected. Total follow-up was 2 years. A societal perspective was adopted. Costs included hospital costs during primary stay and follow-up, and costs related to rehabilitation and changes in living situation. Costs were compared between non-revision surgery patients, implant removal patients, and revision arthroplasty patients. A total of 248 patients were included (mean age 71 years). Mean total costs per patient at 2-years follow-up were 19,425. In the non-revision surgery patients total costs were 17,405 (N = 137), in the implant removal patients 10,066 (N = 38), and in the revision arthroplasty patients 26,733 (N = 67). The main contributing costs were related to the primary surgery, admission days, physical therapy, and revision surgeries. The main determinant was the costs of admission to a rehabilitation center/nursing home. Costs were specifically high in elderly with comorbidity, who were less independent pre-fracture, and have a longer admission to the hospital and/or a nursing home. Costs were also higher in revision surgery patients. The 2-years follow-up costs in our study were comparable to published costs in other Western societies.

Improving the coding and classification of ambulance data through the application of International Classification of Disease 10th revision.

PubMed

Cantwell, Kate; Morgans, Amee; Smith, Karen; Livingston, Michael; Dietze, Paul

2014-02-01

This paper aims to examine whether an adaptation of the International Classification of Disease (ICD) coding system can be applied retrospectively to final paramedic assessment data in an ambulance dataset with a view to developing more fine-grained, clinically relevant case definitions than are available through point-of-call data. Over 1.2 million case records were extracted from the Ambulance Victoria data warehouse. Data fields included dispatch code, cause (CN) and final primary assessment (FPA). Each FPA was converted to an ICD-10-AM code using word matching or best fit. ICD-10-AM codes were then converted into Major Diagnostic Categories (MDC). CN was aligned with the ICD-10-AM codes for external cause of morbidity and mortality. The most accurate results were obtained when ICD-10-AM codes were assigned using information from both FPA and CN. Comparison of cases coded as unconscious at point-of-call with the associated paramedic assessment highlighted the extra clinical detail obtained when paramedic assessment data are used. Ambulance paramedic assessment data can be aligned with ICD-10-AM and MDC with relative ease, allowing retrospective coding of large datasets. Coding of ambulance data using ICD-10-AM allows for comparison of not only ambulance service users but also with other population groups. WHAT IS KNOWN ABOUT THE TOPIC? There is no reliable and standard coding and categorising system for paramedic assessment data contained in ambulance service databases. WHAT DOES THIS PAPER ADD? This study demonstrates that ambulance paramedic assessment data can be aligned with ICD-10-AM and MDC with relative ease, allowing retrospective coding of large datasets. Representation of ambulance case types using ICD-10-AM-coded information obtained after paramedic assessment is more fine grained and clinically relevant than point-of-call data, which uses caller information before ambulance attendance. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? This paper describes a model of coding using an internationally recognised standard coding and categorising system to support analysis of paramedic assessment. Ambulance data coded using ICD-10-AM allows for reliable reporting and comparison within the prehospital setting and across the healthcare industry.

Is hypochondriasis an anxiety disorder?

PubMed

Olatunji, Bunmi O; Deacon, Brett J; Abramowitz, Jonathan S

2009-06-01

Although hypochondriasis is currently classified as a somatoform disorder, the underlying cognitive processes may be more consistent with an anxiety disorder. This observation has important implications for treatment and subsequent revisions of the diagnostic classification of hypochondriasis.

Annual update of data for estimating ESALs : draft.

DOT National Transportation Integrated Search

2008-10-01

A revised procedure for estimating equivalent single axleloads (ESALs) was developed in 1985. This procedure used weight, classification, and traffic volume data collected by the Transportation Cabinet's Division of Planning. : Annual updates of data...

23 CFR 470.115 - Approval authority.

Code of Federal Regulations, 2010 CFR

2010-04-01

... FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PLANNING AND RESEARCH HIGHWAY SYSTEMS Federal... Federal-aid highway system actions involving the designation, or revision, of routes on the Interstate...) The Federal Highway Administrator will approve functional classification actions. ...

78 FR 6765 - Amendment to the International Traffic in Arms Regulations: Revision of U.S. Munitions List...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-31

... revise Category IV (launch vehicles, guided missiles, ballistic missiles, rockets, torpedoes, bombs, and... revises USML Category IV (launch vehicles, guided missiles, ballistic missiles, rockets, torpedoes, bombs... missiles, rockets, torpedoes, bombs, and mines whose jurisdiction would be in doubt based on this revision...

Reliability and Validity of the Brief Insomnia Questionnaire in the America Insomnia Survey

PubMed Central

Kessler, Ronald C.; Coulouvrat, Catherine; Hajak, Goeran; Lakoma, Matthew D.; Roth, Thomas; Sampson, Nancy; Shahly, Victoria; Shillington, Alicia; Stephenson, Judith J.; Walsh, James K.; Zammit, Gary K.

2010-01-01

Study Objectives: To evaluate the reliability and validity of the Brief Insomnia Questionnaire (BIQ), a fully structured questionnaire developed to diagnose insomnia according to hierarchy-free Diagnostic and Statistical Manual, Fourth Edition, Text Revision (DSM-IV-TR), International Classification of Diseases-10 (ICD-10), and research diagnostic criteria/International Classification of Sleep Disorders-2 (RDC/ICSD-2) general criteria without organic exclusions in the America Insomnia Survey (AIS). Design: Probability subsamples of AIS respondents, oversampling BIQ positives, completed short-term test-retest interviews (n = 59) or clinical reappraisal interviews (n = 203) to assess BIQ reliability and validity. Setting: The AIS is a large (n = 10,094) epidemiologic survey of the prevalence and correlates of insomnia. Participants: Adult subscribers to a national managed healthcare plan. Intervention: None Measurements and Results: BIQ test-retest correlations were 0.47-0.94 for nature of the sleep problems (initiation, maintenance, nonrestorative sleep [NRS]), 0.72-0.95 for problem frequency, 0.66-0.88 for daytime impairment/distress, and 0.62 for duration of sleep. Good individual-level concordance was found between BIQ diagnoses and diagnoses based on expert interviews for meeting hierarchy-free inclusion criteria for diagnoses in any of the diagnostic systems, with area under the receiver operating characteristic curve (AUC, a measure of classification accuracy insensitive to disorder prevalence) of 0.86 for dichotomous classifications. The AUC increased to 0.94 when symptom-level data were added to generate continuous predicted-probability of diagnosis measures. The AUC was lower for dichotomous classifications based on RDC/ICSD-2 (0.68) and ICD-10 (0.70) than for DSM-IV-TR (0.83) criteria but increased consistently when symptom-level data were added to generate continuous predicted-probability measures of RDC/ICSD-2, ICD-10, and DSM-IV-TR diagnoses (0.92-0.95). Conclusions: These results show that the BIQ generates accurate estimates of the prevalence and correlates of hierarchy-free insomnia in the America Insomnia Survey. Citation: Kessler RC; Coulouvrat C; Hajak G; Lakoma MD; Roth T; Sampson N; Shahly V; Shillington A; Stephenson JJ; Walsh JK; Zammit GK. Reliability and validity of the brief insomnia questionnaire in the america insomnia survey. SLEEP 2010;33(11):1539-1549. PMID:21102996

Clear-cell differentiation and lymphatic invasion, but not the revised TNM classification, predict lymph node metastases in pT1 penile cancer: a clinicopathologic study of 76 patients from a low incidence area.

PubMed

Mannweiler, Sebastian; Sygulla, Stephan; Tsybrovskyy, Oleksiy; Razmara, Yas; Pummer, Karl; Regauer, Sigrid

2013-10-01

Prediction of lymph node (LN) metastases in penile invasive cancer relies on clinical features and histologic characteristics of the primary tumor. Correct prediction, however, is difficult, as only 50% patients undergoing lymphadenectomies will have LN metastases. In 2009, the tumor, nodes, metastases (TNM) classification for staging of early penile cancers was revised. We tested the predictive accuracy of the revised TNM classification in a low incidence area for penile carcinoma. The presence of LN metastases in 76 men with pT1 penile cancers was correlated with the 2009 TNM subclassification, which is based on a combined evaluation of tumor grade and lymphatic invasion, but also with individual parameters, such as histologic grade, lymphatic invasion, perineural invasion, invasion depth, growth pattern and human papilloma virus (HPV) status. 76pT1 penile cancers were reclassified into 31pT1a squamous cell carcinomas (SCC) and 45pT1b (41 SCC; 4 clear-cell carcinomas); 12/22 men (55%; 8 SCC, 4 clear-cell carcinomas) undergoing lymphadenectomy for enlarged inguinal lymph nodes had metastases, 54 patients without enlarged LN and lymphadenectomies had no LN metastases during follow-up of median 47 months. Statistically, clear cell differentiation of the primary carcinoma was highly associated with metastases (100% clear-cell carcinomas vs. 11% SCC) and poor survival (50% vs. 5.5%). Among conventional SCC, only lymphatic invasion showed a highly significant association with metastases with 100% specificity. The 2009 TNM classification, tumor grade alone, perineural invasion, growth pattern, invasion depth or HPV status could not predict LN status. Lymphadenectomy for enlarged LN resulted in 100% sensitivity and 42% predictive probability for identifying metastases and a 16% false positive rate. Statistically, survival correlated significantly with clear-cell differentiation and with lymphatic invasion in both clear-cell carcinomas and conventional SCC. Penile clear-cell carcinomas are more aggressive cancers than SCC. Our observation suggests a benefit of a prophylactic lymphadenectomy for patients with clear-cell carcinomas. Among conventional SCC, only lymphatic invasion predicted LN metastases. Neither tumor grade alone nor perineural invasion, growth pattern, depth of invasion, and subgrouping according to the revised TNM classification correlated with metastases. Clinical evaluation of the LN status was superior to histologic risk stratification. Copyright © 2013 Elsevier Inc. All rights reserved.

The international spinal cord injury pain basic data set.

PubMed

Widerström-Noga, E; Biering-Sørensen, F; Bryce, T; Cardenas, D D; Finnerup, N B; Jensen, M P; Richards, J S; Siddall, P J

2008-12-01

To develop a basic pain data set (International Spinal Cord Injury Basic Pain Data Set, ISCIPDS:B) within the framework of the International spinal cord injury (SCI) data sets that would facilitate consistent collection and reporting of pain in the SCI population. International. The ISCIPDS:B was developed by a working group consisting of individuals with published evidence of expertise in SCI-related pain regarding taxonomy, psychophysics, psychology, epidemiology and assessment, and one representative of the Executive Committee of the International SCI Standards and Data Sets. The members were appointed by four major organizations with an interest in SCI-related pain (International Spinal Cord Society, ISCoS; American Spinal Injury Association, ASIA; American Pain Society, APS and International Association for the Study of Pain, IASP). The initial ISCIPDS:B was revised based on suggestions from members of the Executive Committee of the International SCI Standards and Data Sets, the ISCoS Scientific Committee, ASIA and APS Boards, and the Neuropathic Pain Special Interest Group of the IASP, individual reviewers and societies and the ISCoS Council. The final ISCIPDS:B contains core questions about clinically relevant information concerning SCI-related pain that can be collected by health-care professionals with expertise in SCI in various clinical settings. The questions concern pain severity, physical and emotional function and include a pain-intensity rating, a pain classification and questions related to the temporal pattern of pain for each specific pain problem. The impact of pain on physical, social and emotional function, and sleep is evaluated for each pain.

78 FR 64533 - Silica Bricks and Shapes From China; Revised Schedule for the Subject Investigation

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-29

... INTERNATIONAL TRADE COMMISSION [Investigation No. 731-TA-1205 (Final)] Silica Bricks and Shapes From China; Revised Schedule for the Subject Investigation AGENCY: United States International Trade Commission. ACTION: Notice. DATES: Effective Date: October 23, 2013. FOR FURTHER INFORMATION CONTACT: Cynthia...

78 FR 52777 - Implementation of the Revised International Guiding Principles for Biomedical Research Involving...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-26

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Implementation of the... Institutes of Health (NIH) is providing guidance to Public Health Service (PHS) awardee institutions on implementation of the revised International Guiding Principles for Biomedical Research Involving Animals...

Reliability, Validity, and Classification Accuracy of the DSM-5 Diagnostic Criteria for Gambling Disorder and Comparison to DSM-IV.

PubMed

Stinchfield, Randy; McCready, John; Turner, Nigel E; Jimenez-Murcia, Susana; Petry, Nancy M; Grant, Jon; Welte, John; Chapman, Heather; Winters, Ken C

2016-09-01

The DSM-5 was published in 2013 and it included two substantive revisions for gambling disorder (GD). These changes are the reduction in the threshold from five to four criteria and elimination of the illegal activities criterion. The purpose of this study was to twofold. First, to assess the reliability, validity and classification accuracy of the DSM-5 diagnostic criteria for GD. Second, to compare the DSM-5-DSM-IV on reliability, validity, and classification accuracy, including an examination of the effect of the elimination of the illegal acts criterion on diagnostic accuracy. To compare DSM-5 and DSM-IV, eight datasets from three different countries (Canada, USA, and Spain; total N = 3247) were used. All datasets were based on similar research methods. Participants were recruited from outpatient gambling treatment services to represent the group with a GD and from the community to represent the group without a GD. All participants were administered a standardized measure of diagnostic criteria. The DSM-5 yielded satisfactory reliability, validity and classification accuracy. In comparing the DSM-5 to the DSM-IV, most comparisons of reliability, validity and classification accuracy showed more similarities than differences. There was evidence of modest improvements in classification accuracy for DSM-5 over DSM-IV, particularly in reduction of false negative errors. This reduction in false negative errors was largely a function of lowering the cut score from five to four and this revision is an improvement over DSM-IV. From a statistical standpoint, eliminating the illegal acts criterion did not make a significant impact on diagnostic accuracy. From a clinical standpoint, illegal acts can still be addressed in the context of the DSM-5 criterion of lying to others.

Unification of Electromagnetic Specifications and Standards. Part 2. Recommendations for Revisions of Existing Practices

DTIC Science & Technology

1983-02-28

tire, .v ,.,, DNA 5433F-2 I 1 UNIFICATION OF ELECTROMAGNETIC -’, SPECIFICATIONS AND STANDARDS Part Ih: Recommendations for Revisions of Existing...ADDRESSEE IS NO LONGER EMPLOYED BY" "• YOUR ORGANIZATION. ... : 1 ,S ::! ,.S ., UNCLASSIFIED SECURITY CLASSIFICATION OF THIS PAGE (When D.e. 6.e1e..c...REPORT DOCUMENTATION PAGE BEFORE COMPETISRM 1 . REPORT NUMBER 2. GOVT ACCESSION NO. 3. RECIPIENT’S CATALOG NUMBER DNA 5433F-2 1 /f9 I;’,71 4. TITLE

Aircraft accidents.method of analysis

NASA Technical Reports Server (NTRS)

1937-01-01

This report is a revision of NACA-TR-357. It was prepared by the Committee on Aircraft Accidents. The purpose of this report is to provide a basis for the classification and comparison of aircraft accidents, both civil and military.

Comparison of the ESHRE–ESGE and ASRM classifications of Müllerian duct anomalies in everyday practice

PubMed Central

Ludwin, A.; Ludwin, I.

2015-01-01

STUDY QUESTION Does the European Society of Human Reproduction and Embryology–European Society for Gynaecological Endoscopy (ESHRE–ESGE) classification of female genital tract malformations significantly increase the frequency of septate uterus diagnosis relative to the American Society for Reproductive Medicine (ASRM) classification? SUMMARY ANSWER Use of the ESHRE–ESGE classification, compared with the ASRM classification, significantly increased the frequency of septate uterus recognition. WHAT IS KNOWN ALREADY The ESHRE–ESGE criteria were supposed to eliminate the subjective diagnoses of septate uterus by the ASRM criteria and replace the complementary absolute morphometric criteria. However, the clinical value of the ESHRE–ESGE classification in daily practice is difficult to appreciate. The application of the ESHRE–ESGE criteria has resulted in a significantly increased recognition of residual septum after hysteroscopic metroplasty, with a possible risk of overdiagnosis of septate uterus and problems for its management. STUDY DESIGN, SIZE, AND DURATION A prospective observational study was performed with 261 women consecutively enrolled between June and September 2013. PARTICIPANTS/MATERIALS, SETTING, AND METHODS Non-pregnant women of reproductive age presented for evaluation to a private medical center. A gynecological examination and 3D ultrasonography were performed to assess the anatomy of the uterus, cervix and vagina. Congenital anomalies were diagnosed using the ASRM classification with additional morphometric criteria as well as with the ESHRE–ESGE classification. We compared the frequency and concordance of diagnoses of septate uterus and all congenital malformations of the uterus according to both classifications. The morphological characteristics of septate uterus recognized by both criteria were compared. MAIN RESULTS AND ROLE OF CHANCE Of the 261 patients enrolled in this study, septate uterus was diagnosed in 44 (16.9%) and 16 (6.1%) patients using the ESGE–ESHRE and ASRM criteria, respectively [relative risk (RR)ESHRE–ESGE:ASRM 2.74; 95% confidence interval (CI), 1.6–4.72; P < 0.01]. At least one congenital anomaly were diagnosed in 58 (22.2%) and 43 (16.5%) patients using the ESHRE–ESGE and ASRM classifications (RRESHRE–ESGE:ASRM, 1.35; 95% CI, 0.95–1.92, P = 0.1), respectively. The two criteria had moderate strength of agreement in the diagnosis of septate uterus (κ = 0.45, P < 0.01). There was good agreement in differentiation between anomaly and norm between the two assessment criteria (κ = 0.79, P < 0.01). The percentages of all congenital malformations and results of the differentiation between the anomaly and norm were obtained after excluding the confounding original ESHRE–ESGE criterion of dysmorphic uterus (internal indentation <50% uterine wall thickness). The morphology of septa identified by the ESHRE–ESGE [length of internal fundal indentation (mm): median 10.7; lower–upper quartile, 8.1–20] significantly differed (P < 0.01) from that identified by the ASRM criteria [length of internal fundal indentation (mm): median, 21.1; lower–upper quartile, 18.8–33.1]. Internal fundal indentation in 16 out of 44 (36.4%) cases was <1 cm in the septate uterus by ESHRE–ESGE and met the criteria for normal uterus by ASRM. LIMITATIONS AND REASONS FOR CAUTION The study participants were women who visited a diagnostic and treatment center specialized in uterine congenital malformations for a medical assessment, not from the general public. WIDER IMPLICATIONS OF THE FINDINGS Septate uterus diagnosis by ESHRE–ESGE was quantitatively dominated by morphological states corresponding to arcuate uterus or cases that were not diagnosed as congenital malformations by ASRM. Relative overdiagnosis of septate uterus by ESHRE–ESGE in these cases may lead to unnecessary overtreatment without the expected benefits. The ESHRE–ESGE classification criteria should be redefined due to confusions in the methodology. Until the criteria are revised, septate uterus should not be diagnosed using this classification system and it should not be used as an eligibility criterion for hysteroscopic metroplasty. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by Jagiellonian University (grant no. K/ZDS/003821). The authors have no competing interests to declare. PMID:25534461

[Evaluation of traditional pathological classification at molecular classification era for gastric cancer].

PubMed

Yu, Yingyan

2014-01-01

Histopathological classification is in a pivotal position in both basic research and clinical diagnosis and treatment of gastric cancer. Currently, there are different classification systems in basic science and clinical application. In medical literatures, different classifications are used including Lauren and WHO systems, which have confused many researchers. Lauren classification has been proposed for half a century, but is still used worldwide. It shows many advantages of simple, easy handling with prognostic significance. The WHO classification scheme is better than Lauren classification in that it is continuously being revised according to the progress of gastric cancer, and is always used in the clinical and pathological diagnosis of common scenarios. Along with the progression of genomics, transcriptomics, proteomics, metabolomics researches, molecular classification of gastric cancer becomes the current hot topics. The traditional therapeutic approach based on phenotypic characteristics of gastric cancer will most likely be replaced with a gene variation mode. The gene-targeted therapy against the same molecular variation seems more reasonable than traditional chemical treatment based on the same morphological change.

Cutaneous manifestations in patients with mastocytosis: Consensus report of the European Competence Network on Mastocytosis; the American Academy of Allergy, Asthma & Immunology; and the European Academy of Allergology and Clinical Immunology.

PubMed

Hartmann, Karin; Escribano, Luis; Grattan, Clive; Brockow, Knut; Carter, Melody C; Alvarez-Twose, Ivan; Matito, Almudena; Broesby-Olsen, Sigurd; Siebenhaar, Frank; Lange, Magdalena; Niedoszytko, Marek; Castells, Mariana; Oude Elberink, Joanna N G; Bonadonna, Patrizia; Zanotti, Roberta; Hornick, Jason L; Torrelo, Antonio; Grabbe, Jürgen; Rabenhorst, Anja; Nedoszytko, Boguslaw; Butterfield, Joseph H; Gotlib, Jason; Reiter, Andreas; Radia, Deepti; Hermine, Olivier; Sotlar, Karl; George, Tracy I; Kristensen, Thomas K; Kluin-Nelemans, Hanneke C; Yavuz, Selim; Hägglund, Hans; Sperr, Wolfgang R; Schwartz, Lawrence B; Triggiani, Massimo; Maurer, Marcus; Nilsson, Gunnar; Horny, Hans-Peter; Arock, Michel; Orfao, Alberto; Metcalfe, Dean D; Akin, Cem; Valent, Peter

2016-01-01

Cutaneous lesions in patients with mastocytosis are highly heterogeneous and encompass localized and disseminated forms. Although a classification and criteria for cutaneous mastocytosis (CM) have been proposed, there remains a need to better define subforms of cutaneous manifestations in patients with mastocytosis. To address this unmet need, an international task force involving experts from different organizations (including the European Competence Network on Mastocytosis; the American Academy of Allergy, Asthma & Immunology; and the European Academy of Allergology and Clinical Immunology) met several times between 2010 and 2014 to discuss the classification and criteria for diagnosis of cutaneous manifestations in patients with mastocytosis. This article provides the major outcomes of these meetings and a proposal for a revised definition and criteria. In particular, we recommend that the typical maculopapular cutaneous lesions (urticaria pigmentosa) should be subdivided into 2 variants, namely a monomorphic variant with small maculopapular lesions, which is typically seen in adult patients, and a polymorphic variant with larger lesions of variable size and shape, which is typically seen in pediatric patients. Clinical observations suggest that the monomorphic variant, if it develops in children, often persists into adulthood, whereas the polymorphic variant may resolve around puberty. This delineation might have important prognostic implications, and its implementation in diagnostic algorithms and future mastocytosis classifications is recommended. Refinements are also suggested for the diagnostic criteria of CM, removal of telangiectasia macularis eruptiva perstans from the current classification of CM, and removal of the adjunct solitary from the term solitary mastocytoma. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Spinal-Exercise Prescription in Sport: Classifying Physical Training and Rehabilitation by Intention and Outcome

PubMed Central

Spencer, Simon; Wolf, Alex; Rushton, Alison

2016-01-01

Context: Identification of strategies to prevent spinal injury, optimize rehabilitation, and enhance performance is a priority for practitioners. Different exercises produce different effects on neuromuscular performance. Clarity of the purpose of a prescribed exercise is central to a successful outcome. Spinal exercises need to be classified according to the objective of the exercise and planned physical outcome. Objective: To define the modifiable spinal abilities that underpin optimal function during skilled athletic performance, clarify the effect of spinal pain and pathologic conditions, and classify spinal exercises according to the objective of the exercise and intended physical outcomes to inform training and rehabilitation. Design: Qualitative study. Data Collection and Analysis: We conducted a qualitative consensus method of 4 iterative phases. An exploratory panel carried out an extended review of the English-language literature using CINAHL, EMBASE, MEDLINE, and PubMed to identify key themes and subthemes to inform the definitions of exercise categories, physical abilities, and physical outcomes. An expert project group reviewed panel findings. A draft classification was discussed with physiotherapists (n = 49) and international experts. Lead physiotherapy and strength and conditioning teams (n = 17) reviewed a revised classification. Consensus was defined as unanimous agreement. Results: After the literature review and subsequent analysis, we defined spinal abilities in 4 categories: mobility, motor control, work capacity, and strength. Exercises were subclassified by functionality as nonfunctional or functional and by spinal displacement as either static (neutral spinal posture with no segmental displacement) or dynamic (dynamic segmental movement). The proposed terminology and classification support commonality of language for practitioners. Conclusions: The spinal-exercise classification will support clinical reasoning through a framework of spinal-exercise objectives that clearly define the nature of the exercise prescription required to deliver intended physical outcomes. PMID:27661792

Validation of Case Finding Algorithms for Hepatocellular Cancer From Administrative Data and Electronic Health Records Using Natural Language Processing.

PubMed

Sada, Yvonne; Hou, Jason; Richardson, Peter; El-Serag, Hashem; Davila, Jessica

2016-02-01

Accurate identification of hepatocellular cancer (HCC) cases from automated data is needed for efficient and valid quality improvement initiatives and research. We validated HCC International Classification of Diseases, 9th Revision (ICD-9) codes, and evaluated whether natural language processing by the Automated Retrieval Console (ARC) for document classification improves HCC identification. We identified a cohort of patients with ICD-9 codes for HCC during 2005-2010 from Veterans Affairs administrative data. Pathology and radiology reports were reviewed to confirm HCC. The positive predictive value (PPV), sensitivity, and specificity of ICD-9 codes were calculated. A split validation study of pathology and radiology reports was performed to develop and validate ARC algorithms. Reports were manually classified as diagnostic of HCC or not. ARC generated document classification algorithms using the Clinical Text Analysis and Knowledge Extraction System. ARC performance was compared with manual classification. PPV, sensitivity, and specificity of ARC were calculated. A total of 1138 patients with HCC were identified by ICD-9 codes. On the basis of manual review, 773 had HCC. The HCC ICD-9 code algorithm had a PPV of 0.67, sensitivity of 0.95, and specificity of 0.93. For a random subset of 619 patients, we identified 471 pathology reports for 323 patients and 943 radiology reports for 557 patients. The pathology ARC algorithm had PPV of 0.96, sensitivity of 0.96, and specificity of 0.97. The radiology ARC algorithm had PPV of 0.75, sensitivity of 0.94, and specificity of 0.68. A combined approach of ICD-9 codes and natural language processing of pathology and radiology reports improves HCC case identification in automated data.

Pathological gambling: a review of the neurobiological evidence relevant for its classification as an addictive disorder.

PubMed

Fauth-Bühler, Mira; Mann, Karl; Potenza, Marc N

2017-07-01

In light of the upcoming eleventh edition of the International Classification of Diseases (ICD-11), the question arises as to the most appropriate classification of 'Pathological Gambling' ('PG'). Some academic opinion favors leaving PG in the 'Impulse Control Disorder' ('ICD') category, as in ICD-10, whereas others argue that new data especially from the neurobiological area favor allocating it to the category of 'Substance-related and Addictive Disorders' ('SADs'), following the decision in the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders. The current review examines important findings in relation to PG, with the aim of enabling a well-informed decision to be made with respect to the classification of PG as a SAD or ICD in ICD-11. Particular attention is given to cognitive deficits and underlying neurobiological mechanisms that play a role in SADs and ICDs. These processes are impulsivity, compulsivity, reward/punishment processing and decision-making. In summary, the strongest arguments for subsuming PG under a larger SAD category relate to the existence of similar diagnostic characteristics; the high co-morbidity rates between the disorders; their common core features including reward-related aspects (positive reinforcement: behaviors are pleasurable at the beginning which is not the case for ICDs); the findings that the same brain structures are involved in PG and SADs, including the ventral striatum. Research on compulsivity suggests a relationship with PG and SAD, particularly in later stages of the disorders. Although research is limited for ICDs, current data do not support continuing to classify PG as an ICD. © 2016 Society for the Study of Addiction.

75 FR 52976 - Issuance of Revised Users' Manual for Commission Mediation Program for Investigations Under...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-30

... INTERNATIONAL TRADE COMMISSION Issuance of Revised Users' Manual for Commission Mediation Program... 65615 (Nov. 8, 2008). The Commission has determined to issue a revised Users' Manual for its program for the mediation of investigations under section 337 of the Tariff Act of 1930. The revised Users' Manual...

Child development in the NANDA-I and International Classification for Nursing Practices Nursing Classifications*.

PubMed

de Souza, Juliana Martins; Veríssimo, Maria De La Ó Ramallo

2013-02-01

Identify and analyze the NANDA-I diagnoses and the focus terms of the International Classification for Nursing Practices (ICNP) related to child development. Literature, reflections about clinical experience, and a model case. DATA SYNTHESE: The current diagnoses proposed by NANDA-I and the ICNP focus terms do not encompass the extent of the child development phenomenon. It is necessary studying the child development concept to improve the definition of the ICNP focus terms and the accuracy of NANDA-I diagnoses. Discussing the nursing classifications can improve their understanding and use. © 2012, The Authors. International Journal of Nursing Knowledge © 2012, NANDA International.

Cochlear implant revision surgeries in children.

PubMed

Amaral, Maria Stella Arantes do; Reis, Ana Cláudia Mirândola B; Massuda, Eduardo T; Hyppolito, Miguel Angelo

2018-02-16

The surgery during which the cochlear implant internal device is implanted is not entirely free of risks and may produce problems that will require revision surgeries. To verify the indications for cochlear implantation revision surgery for the cochlear implant internal device, its effectiveness and its correlation with certain variables related to language and hearing. A retrospective study of patients under 18 years submitted to cochlear implant Surgery from 2004 to 2015 in a public hospital in Brazil. Data collected were: age at the time of implantation, gender, etiology of the hearing loss, audiological and oral language characteristics of each patient before and after Cochlear Implant surgery and any need for surgical revision and the reason for it. Two hundred and sixty-five surgeries were performed in 236 patients. Eight patients received a bilateral cochlear implant and 10 patients required revision surgery. Thirty-two surgeries were necessary for these 10 children (1 bilateral cochlear implant), of which 21 were revision surgeries. In 2 children, cochlear implant removal was necessary, without reimplantation, one with cochlear malformation due to incomplete partition type I and another due to trauma. With respect to the cause for revision surgery, of the 8 children who were successfully reimplanted, four had cochlear calcification following meningitis, one followed trauma, one exhibited a facial nerve malformation, one experienced a failure of the cochlear implant internal device and one revision surgery was necessary because the electrode was twisted. The incidence of the cochlear implant revision surgery was 4.23%. The period following the revision surgeries revealed an improvement in the subject's hearing and language performance, indicating that these surgeries are valid in most cases. Copyright © 2018 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Trainer Engineering Report (Final) for MILES. Volume 2. Revision

DTIC Science & Technology

1981-04-22

formerly a separate document, Data Item AOOX. iii/iv 1A , SECURITY CLASSIFICATION OF THIS PAGE (Uhen Deaa Enterecd) ... __ . ....... REPORT DOCUMENTATION...NAVTRAEQUIPCEN, Orlando, FL 32813 3 14. MON’TORING AGENCY NAME & ADDRESS(II dilletent from CoftrollIn OGlue*) IS. SECURITY CLASS. (of thie twoot...OBSOLETE UNCLASSIFIED S/N 0102蓞-6601 I SECURITY CL.ASSIFICATION OF THIS iPAGE fUlses Data EaieteE i • CONTENTS .I * INTRODUCTION 1-1 1.1 1980 MILES 1-1

77 FR 18266 - Stainless Steel Butt-Weld Pipe Fittings From Italy, Malaysia, and the Philippines; Revised...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-27

... INTERNATIONAL TRADE COMMISSION [Investigation Nos. 731-TA-865-867 (Second Review)] Stainless Steel Butt-Weld Pipe Fittings From Italy, Malaysia, and the Philippines; Revised Schedule for the Subject Reviews AGENCY: United States International Trade Commission. ACTION: Notice. DATES: Effective Date: March...

75 FR 65567 - Revised Regulations Concerning Section 403(b) Tax-Sheltered Annuity Contracts; Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-26

... DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 1 [TD 9340] RIN 1545-BB64 Revised Regulations Concerning Section 403(b) Tax-Sheltered Annuity Contracts; Correction AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Correction to final regulations. SUMMARY: This document contains a...

Making a structured psychiatric diagnostic interview faithful to the nomenclature.

PubMed

Robins, Lee N; Cottler, Linda B

2004-10-15

Psychiatric diagnostic interviews to be used in epidemiologic studies by lay interviewers have, since the 1970s, attempted to operationalize existing psychiatric nomenclatures. How to maximize the chances that they do so successfully has not previously been spelled out. In this article, the authors discuss strategies for each of the seven steps involved in writing, updating, or modifying a diagnostic interview and its supporting materials: 1) writing questions that match the nomenclature's criteria, 2) checking that respondents will be willing and able to answer the questions, 3) choosing a format acceptable to interviewers that maximizes accurate answering and recording of answers, 4) constructing a data entry and cleaning program that highlights errors to be corrected, 5) creating a diagnostic scoring program that matches the nomenclature's algorithms, 6) developing an interviewer training program that maximizes reliability, and 7) computerizing the interview. For each step, the authors discuss how to identify errors, correct them, and validate the revisions. Although operationalization will never be perfect because of ambiguities in the nomenclature, specifying methods for minimizing divergence from the nomenclature is timely as users modify existing interviews and look forward to updating interviews based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the International Classification of Diseases, Eleventh Revision.

Developmental tumors and adjacent cortical dysplasia: single or dual pathology?

PubMed

Palmini, André; Paglioli, Eliseu; Silva, Vinicius Duval

2013-12-01

Developmental tumors often lead to refractory partial seizures and constitute a well-defined, surgically remediable epilepsy syndrome. Dysplastic features are often associated with these tumors, and their significance carries both practical and conceptual relevance. If associated focal cortical dysplasia (FCD) relates to the extent of the epileptogenic tissue, then presurgical evaluation and surgical strategies should target both the tumor and the surrounding dyslaminated cortex. Furthermore, the association has been included in the recently revised classification of FCD and the epileptogenicity of this associated dysplastic tissue is crucial to validate such revision. In addition to the possibility of representing dual pathology, the association of developmental tumors and adjacent dysplasia may instead represent a single developmental lesion with distinct parts distributed along a histopathologic continuum. Moreover, the possibility that this adjacent dyslamination is of minor epileptogenic relevance should also be entertained. Surgical data show that complete resection of the solid tumors and immediately adjacent tissue harboring satellites may disrupt epileptogenic networks and lead to high rates of seizure freedom, challenging the epileptogenic relevance of more extensive adjacent dyslaminated cortex. Whether the latter is a primary or secondary abnormality and whether dyslaminated cortex in the context of a second lesion may produce seizures after complete resection of the main lesion is still to be proven. Wiley Periodicals, Inc. © 2013 International League Against Epilepsy.

Premenstrual dysphoric disorder--review of actual findings about mental disorders related to menstrual cycle and possibilities of their therapy.

PubMed

Zukov, I; Ptácek, R; Raboch, J; Domluvilová, D; Kuzelová, H; Fischer, S; Kozelek, P

2010-01-01

It is known that mood disorders in women explicitly relates to estrogen production. Except for these findings phenomenon as Premenstrual Syndrome and Premenstrual Dysphoric Disorder, directly connected to menstrual cycle in women, is widely discussed. Premenstrual dysphoric disorder (PMDD) is a set of subjectively unpleasant mental and somatic symptoms. It appears in luteal phase of ovarian cycle. During menstruation it remits and disappears up to one week from its termination. DSM IV classified PMDD into the category of "Other specific depressive disorders" and further revision DSM IV-TR classifies PMDD as a separate strictly defined psychiatric diagnosis. The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) does not include any specific category as PMDD or similar. The closest category F38.8 does not represent the core of the phenomenon because it relates only to general depressive symptomatology and does not give specific diagnostic criteria to menstrual cycle related mood disorders (Grady-Weliky, 2003). In the presented article, possible effectivity of PMDD treatment with the focus to antidepressants of SSRI type (Serotonin selective reuptake inhibitors) is discussed. In spite of interesting and significant findings, the treatment of PMDD and accordingly PMS is above all multidisciplinary question and it must be treated like that.

International Geomagnetic Reference Field: the third generation.

USGS Publications Warehouse

Peddie, N.W.

1982-01-01

In August 1981 the International Association of Geomagnetism and Aeronomy revised the International Geomagnetic Reference Field (IGRF). It is the second revision since the inception of the IGRF in 1968. The revision extends the earlier series of IGRF models from 1980 to 1985, introduces a new series of definitive models for 1965-1976, and defines a provisional reference field for 1975- 1980. The revision consists of: 1) a model of the main geomagnetic field at 1980.0, not continuous with the earlier series of IGRF models together with a forecast model of the secular variation of the main field during 1980-1985; 2) definitive models of the main field at 1965.0, 1970.0, and 1975.0, with linear interpolation of the model coefficients specified for intervening dates; and 3) a provisional reference field for 1975-1980, defined as the linear interpolation of the 1975 and 1980 main-field models.-from Author

Characteristics of dysphagia in children with cerebral palsy, related to gross motor function.

PubMed

Kim, Joon-Sung; Han, Zee-A; Song, Dae Heon; Oh, Hyun-Mi; Chung, Myung Eun

2013-10-01

The aim of this study was to report the characteristics of dysphagia in children with cerebral palsy (CP), related to gross motor function. Videofluoroscopic swallow study was performed in 29 children with CP, according to the manual of Logemann. Five questions about oromotor dysfunction were answered. Gross motor function level was classified by the Gross Motor Function Classification System Expanded and Revised. The results of the videofluoroscopic swallowing studies showed that reduced lip closure, inadequate bolus formation, residue in the oral cavity, delayed triggering of pharyngeal swallow, reduced larynx elevation, coating on the pharyngeal wall, delayed pharyngeal transit time, multiple swallow, and aspiration were significantly more common in the severe group (Gross Motor Function Classification System Expanded and Revised IV or V). As for aspiration, 50% of the children with severe CP had problems, but only 14.3% of them with moderate (Gross Motor Function Classification System Expanded and Revised III) CP and none of them with mild CP had abnormalities. In addition, five of the seven aspiration cases occurred silently. This study shows that dysphagia is closely related to gross motor function in children with CP. Silent aspiration was observed in the moderate to severe CP groups. Aspiration is an important cause of medical problems such as acute and chronic lung disease, and associated respiratory complications contribute significantly in increasing morbidity and mortality in these patient groups. Therefore, the authors suggest that early dysphagia evaluation including videofluoroscopic swallow study is necessary in managing feeding problems and may prevent chronic aspiration, malnutrition, and infections.

Parametric estimates for the receiver operating characteristic curve generalization for non-monotone relationships.

PubMed

Martínez-Camblor, Pablo; Pardo-Fernández, Juan C

2017-01-01

Diagnostic procedures are based on establishing certain conditions and then checking if those conditions are satisfied by a given individual. When the diagnostic procedure is based on a continuous marker, this is equivalent to fix a region or classification subset and then check if the observed value of the marker belongs to that region. Receiver operating characteristic curve is a valuable and popular tool to study and compare the diagnostic ability of a given marker. Besides, the area under the receiver operating characteristic curve is frequently used as an index of the global discrimination ability. This paper revises and widens the scope of the receiver operating characteristic curve definition by setting the classification subsets in which the final decision is based in the spotlight of the analysis. We revise the definition of the receiver operating characteristic curve in terms of particular classes of classification subsets and then focus on a receiver operating characteristic curve generalization for situations in which both low and high values of the marker are associated with more probability of having the studied characteristic. Parametric and non-parametric estimators of the receiver operating characteristic curve generalization are investigated. Monte Carlo studies and real data examples illustrate their practical performance.

Issues in Developing a Surveillance Case Definition for Nonfatal Suicide Attempt and Intentional Self-harm Using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) Coded Data.

PubMed

Hedegaard, Holly; Schoenbaum, Michael; Claassen, Cynthia; Crosby, Alex; Holland, Kristin; Proescholdbell, Scott

2018-02-01

Suicide and intentional self-harm are among the leading causes of death in the United States. To study this public health issue, epidemiologists and researchers often analyze data coded using the International Classification of Diseases (ICD). Prior to October 1, 2015, health care organizations and providers used the clinical modification of the Ninth Revision of ICD (ICD-9-CM) to report medical information in electronic claims data. The transition in October 2015 to use of the clinical modification of the Tenth Revision of ICD (ICD-10-CM) resulted in the need to update methods and selection criteria previously developed for ICD-9-CM coded data. This report provides guidance on the use of ICD-10-CM codes to identify cases of nonfatal suicide attempts and intentional self-harm in ICD-10-CM coded data sets. ICD-10-CM codes for nonfatal suicide attempts and intentional self-harm include: X71-X83, intentional self-harm due to drowning and submersion, firearms, explosive or thermal material, sharp or blunt objects, jumping from a high place, jumping or lying in front of a moving object, crashing of motor vehicle, and other specified means; T36-T50 with a 6th character of 2 (except for T36.9, T37.9, T39.9, T41.4, T42.7, T43.9, T45.9, T47.9, and T49.9, which are included if the 5th character is 2), intentional self-harm due to drug poisoning (overdose); T51-T65 with a 6th character of 2 (except for T51.9, T52.9, T53.9, T54.9, T56.9, T57.9, T58.0, T58.1, T58.9, T59.9, T60.9, T61.0, T61.1, T61.9, T62.9, T63.9, T64.0, T64.8, and T65.9, which are included if the 5th character is 2), intentional self-harm due to toxic effects of nonmedicinal substances; T71 with a 6th character of 2, intentional self-harm due to asphyxiation, suffocation, strangulation; and T14.91, Suicide attempt. Issues to consider when selecting records for nonfatal suicide attempts and intentional self-harm from ICD-10-CM coded administrative data sets are also discussed. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

A catch-up validation study of an in vitro skin irritation test method using reconstructed human epidermis LabCyte EPI-MODEL24.

PubMed

Kojima, Hajime; Katoh, Masakazu; Shinoda, Shinsuke; Hagiwara, Saori; Suzuki, Tamie; Izumi, Runa; Yamaguchi, Yoshihiro; Nakamura, Maki; Kasahawa, Toshihiko; Shibai, Aya

2014-07-01

Three validation studies were conducted by the Japanese Society for Alternatives to Animal Experiments in order to assess the performance of a skin irritation assay using reconstructed human epidermis (RhE) LabCyte EPI-MODEL24 (LabCyte EPI-MODEL24 SIT) developed by the Japan Tissue Engineering Co., Ltd. (J-TEC), and the results of these studies were submitted to the Organisation for Economic Co-operation and Development (OECD) for the creation of a Test Guideline (TG). In the summary review report from the OECD, the peer review panel indicated the need to resolve an issue regarding the misclassification of 1-bromohexane. To this end, a rinsing operation intended to remove exposed chemicals was reviewed and the standard operating procedure (SOP) revised by J-TEC. Thereafter, in order to confirm general versatility of the revised SOP, a new validation management team was organized by the Japanese Center for the Validation of Alternative Methods (JaCVAM) to undertake a catch-up validation study that would compare the revised assay with similar in vitro skin irritation assays, per OECD TG No. 439 (2010). The catch-up validation and supplementary studies for LabCyte EPI-MODEL24 SIT using the revised SOPs were conducted at three laboratories. These results showed that the revised SOP of LabCyte EPI-MODEL24 SIT conformed more accurately to the classifications for skin irritation under the United Nations Globally Harmonised System of Classification and Labelling of Chemicals (UN GHS), thereby highlighting the importance of an optimized rinsing operation for the removal of exposed chemicals in obtaining consistent results from in vitro skin irritation assays. Copyright © 2013 John Wiley & Sons, Ltd.

Mapping the rehabilitation interventions of a community stroke team to the extended International Classification of Functioning, Disability and Health Core Set for Stroke.

PubMed

Evans, Melissa; Hocking, Clare; Kersten, Paula

2017-12-01

This study aim was to evaluate whether the Extended International Classification of Functioning, Disability and Health Core Set for Stroke captured the interventions of a community stroke rehabilitation team situated in a large city in New Zealand. It was proposed that the results would identify the contribution of each discipline, and the gaps and differences in service provision to Māori and non-Māori. Applying the Extended International Classification of Functioning, Disability and Health Core Set for Stroke in this way would also inform whether this core set should be adopted in New Zealand. Interventions were retrospectively extracted from 18 medical records and linked to the International Classification of Functioning, Disability and Health and the Extended International Classification of Functioning, Disability and Health Core Set for Stroke. The frequencies of linked interventions and the health discipline providing the intervention were calculated. Analysis revealed that 98.8% of interventions provided by the rehabilitation team could be linked to the Extended International Classification of Functioning, Disability and Health Core Set for Stroke, with more interventions for body function and structure than for activities and participation; no interventions for emotional concerns; and limited interventions for community, social and civic life. Results support previous recommendations for additions to the EICSS. The results support the use of the Extended International Classification of Functioning, Disability and Health Core Set for Stroke in New Zealand and demonstrates its use as a quality assurance tool that can evaluate the scope and practice of a rehabilitation service. Implications for Rehabilitation The Extended International Classification of Functioning Disability and Health Core Set for Stroke appears to represent the stroke interventions of a community stroke rehabilitation team in New Zealand. As a result, researchers and clinicians may have increased confidence to use this core set in research and clinical practice. The Extended International Classification of Functioning Disability and Health Core Set for Stroke can be used as a quality assurance tool to establish whether a community stroke rehabilitation team is meeting the functional needs of its stroke population.

WHO Expert Committee on Specifications for Pharmaceutical Preparations. Forty-ninth report.

PubMed

2015-01-01

The Expert Committee on Specifications for Pharmaceutical Preparations works towards clear, independent and practical standards and guidelines for the quality assurance of medicines. Standards are developed by the Committee through worldwide consultation and an international consensus-building process. The following new guidelines were adopted and recommended for use. Revised procedure for the development of monographs and other texts for The International Pharmacopoeia; Revised updating mechanism for the section on radiopharmaceuticals in The International Pharmacopoeia; Revision of the supplementary guidelines on good manufacturing practices: validation, Appendix 7: non-sterile process validation; General guidance for inspectors on hold-time studies; 16 technical supplements to Model guidance for the storage and transport of time- and temperature-sensitive pharmaceutical products; Recommendations for quality requirements when plant-derived artemisinin is used as a starting material in the production of antimalarial active pharmaceutical ingredients; Multisource (generic) pharmaceutical products: guidelines on registration requirements to establish interchangeability: revision; Guidance on the selection of comparator pharmaceutical products for equivalence assessment of interchangeable multisource (generic) products: revision; and Good review practices: guidelines for national and regional regulatory authorities.

Update on implementation of GHS in Korea and revision of Industrial Safety and Health Act in relation to GHS.

PubMed

Yu, Il Je; Kim, Dong Suk; Lim, Cheol Hong; Choi, Jung Yun; Lee, Je Bong; Chung, Ok-Sun; Kwon, Kyungok; Yum, Young Na; Kim, Jeongho; Kuk, Won-Kwen; Kim, Kyun

2007-12-01

To implement the globally harmonized system of classification and labelling of chemicals (GHS) in Korea, an inter-ministerial GHS committee, involving 8 ministries and an expert working group composed of 9 experts from relevant organizations and one private consultant, have made some progress towards implementation by 2008. As such, the first revision of the official Korean translated version of the GHS in accordance with the GHS purple book revision 1 in 2005, including annexes, started in August, 2006, was completed in December, 2006. The Ministry of Labor also finally revised the Industrial Safety and Health Act (ISHA) relating to the GHS and the detailed notification was announced on Dec 12, 2006 and became effective immediately. The revised ISHA will allow continued use of the existing hazard communication system until Jun 30, 2008. Other revisions of chemical-related regulations will follow soon to facilitate the implementation of the GHS by 2008. Besides, inter-ministerial collaborative efforts on harmonizing regulations and disseminating the GHS in Korea will continue to avoid any confusion or duplication and for the effective use of resources.

77 FR 9515 - List of Approved Spent Fuel Storage Casks: HI-STORM 100, Revision 8

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-17

... Storage Casks: HI-STORM 100, Revision 8 AGENCY: Nuclear Regulatory Commission. ACTION: Direct final rule... regulations by revising the Holtec International HI-STORM 100 dry cask storage system listing within the... and safety will be adequately protected. This direct final rule revises the HI-STORM 100 listing in 10...

Moral Injury, Spiritual Care and the Role of Chaplains: An Exploratory Scoping Review of Literature and Resources.

PubMed

Carey, Lindsay B; Hodgson, Timothy J; Krikheli, Lillian; Soh, Rachel Y; Armour, Annie-Rose; Singh, Taranjeet K; Impiombato, Cassandra G

2016-08-01

This scoping review considered the role of chaplains with regard to 'moral injury'. Moral injury is gaining increasing notoriety. This is due to greater recognition that trauma (in its various forms) can cause much deeper inflictions and afflictions than just physiological or psychological harm, for there may also be wounds affecting the 'soul' that are far more difficult to heal-if at all. As part of a larger research program exploring moral injury, a scoping review of literature and other resources was implemented utilising Arksey and O'Malley's scoping method (Int J Soc Res Methodol 8(1):19-32, 2005) to focus upon moral injury, spirituality (including religion) and chaplaincy. Of the total number of articles and/or resources noting the term 'moral injury' in relation to spiritual/religious issues (n = 482), the results revealed 60 resources that specifically noted moral injury and chaplains (or other similar bestowed title). The majority of these resources were clearly positive about the role (or the potential role) of chaplains with regard to mental health issues and/or moral injury. The World Health Organization International Classification of Diseases: Australian Modification of Health Interventions to the International Statistical Classification of Diseases and related Health problems (10th revision, vol 3-WHO ICD-10-AM, Geneva, 2002), was utilised as a coding framework to classify and identify distinct chaplaincy roles and interventions with regard to assisting people with moral injury. Several recommendations are made concerning moral injury and chaplaincy, most particularly the need for greater research to be conducted.

Reasoning Based Quality Assurance of Medical Ontologies: A Case Study

PubMed Central

Horridge, Matthew; Parsia, Bijan; Noy, Natalya F.; Musenm, Mark A.

2014-01-01

The World Health Organisation is using OWL as a key technology to develop ICD-11 – the next version of the well-known International Classification of Diseases. Besides providing better opportunities for data integration and linkages to other well-known ontologies such as SNOMED-CT, one of the main promises of using OWL is that it will enable various forms of automated error checking. In this paper we investigate how automated OWL reasoning, along with a Justification Finding Service can be used as a Quality Assurance technique for the development of large and complex ontologies such as ICD-11. Using the International Classification of Traditional Medicine (ICTM) – Chapter 24 of ICD-11 – as a case study, and an expert panel of knowledge engineers, we reveal the kinds of problems that can occur, how they can be detected, and how they can be fixed. Specifically, we found that a logically inconsistent version of the ICTM ontology could be repaired using justifications (minimal entailing subsets of an ontology). Although over 600 justifications for the inconsistency were initially computed, we found that there were three main manageable patterns or categories of justifications involving TBox and ABox axioms. These categories represented meaningful domain errors to an expert panel of ICTM project knowledge engineers, who were able to use them to successfully determine the axioms that needed to be revised in order to fix the problem. All members of the expert panel agreed that the approach was useful for debugging and ensuring the quality of ICTM. PMID:25954373

Artificial Outdoor Nighttime Lights Associate with Altered Sleep Behavior in the American General Population.

PubMed

Ohayon, Maurice M; Milesi, Cristina

2016-06-01

Our study aims to explore the associations between outdoor nighttime lights (ONL) and sleep patterns in the human population. Cross-sectional telephone study of a representative sample of the general US population age 18 y or older. 19,136 noninstitutionalized individuals (participation rate: 83.2%) were interviewed by telephone. The Sleep-EVAL expert system administered questions on life and sleeping habits; health; sleep, mental and organic disorders (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision; International Classification of Sleep Disorders, Second Edition; International Classification of Diseases, 10(th) Edition). Individuals were geolocated by longitude and latitude. Outdoor nighttime light measurements were obtained from the Defense Meteorological Satellite Program's Operational Linescan System (DMSP/OLS), with nighttime passes taking place between 19:30 and 22:30 local time. Light data were correlated precisely to the geolocation of each participant of the general population sample. Living in areas with greater ONL was associated with delayed bedtime (P < 0.0001) and wake up time (P < 0.0001), shorter sleep duration (P < 0.01), and increased daytime sleepiness (P < 0.0001). Living in areas with greater ONL also increased the dissatisfaction with sleep quantity and quality (P < 0.0001) and the likelihood of having a diagnostic profile congruent with a circadian rhythm disorder (P < 0.0001). Although they improve the overall safety of people and traffic, nighttime lights in our streets and cities are clearly linked with modifications in human sleep behaviors and also impinge on the daytime functioning of individuals living in areas with greater ONL. © 2016 Associated Professional Sleep Societies, LLC.

[Nursing service certification. Norm UNE-EN-ISO 9001-2008].

PubMed

Salazar de la Guerra, R; Ferrer Arnedo, C; Labrador Domínguez, M J; Sangregorio Matesanz, A

2014-01-01

To certify the nursing services using a quality management system, taking an international standard as a reference, and based on a continuous improvement process. The standard was revised, and the Quality Management System documentation was updated, consisting of a Quality Manual and 7 control procedures. All the existing procedures were coded in accordance with the documentation control process. Each operational procedure was associated with a set of indicators which permitted to know the results obtained, analyze the deviations and to implement further improvements. The system was implemented successfully. Twenty-eight care procedures and eleven procedures concerning techniques were incorporated into the management system. Thirty indicators were established that allowed the whole process to be monitored. All patients were assigned to a nurse in their clinical notes and all of them had a personalized Care Plan according to planning methodology using North American Nursing Diagnosis Association (NANDA), Nursing Interventions Classification (NIC) and Nursing Outcomes Classification (NOC) international rankings. The incidence of falls, as well as the incidence of chronic skin wounds, was low, taking into account the characteristics of the patient and the duration of the stay (mean=35.87 days). The safety indicators had a high level of compliance, with 90% of patients clearly identified and 100% with hygiene protocol. The confidence rating given to the nurses was 91%. The certification enabled the quality of the service to be improved using a structured process, analyzing the results, dealing with non-conformities and introducing improvements. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

Personality disorders and the DSM-5: Scientific and extra-scientific factors in the maintenance of the status quo.

PubMed

Gøtzsche-Astrup, Oluf; Moskowitz, Andrew

2016-02-01

The aim of this study was to review and discuss the evidence for dimensional classification of personality disorders and the historical and sociological bases of psychiatric nosology and research. Categorical and dimensional conceptualisations of personality disorder are reviewed, with a focus on the Diagnostic and Statistical Manual of Mental Disorders-system's categorisation and the Five-Factor Model of personality. This frames the events leading up to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, personality disorder debacle, where the implementation of a hybrid model was blocked in a last-minute intervention by the American Psychiatric Association Board of Trustees. Explanations for these events are discussed, including the existence of invisible colleges of researchers and the fear of risking a 'scientific revolution' in psychiatry. A failure to recognise extra-scientific factors at work in classification of mental illness can have a profound and long-lasting influence on psychiatric nosology. In the end it was not scientific factors that led to the failure of the hybrid model of personality disorders, but opposing forces within the mental health community in general and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Task Force in particular. Substantial evidence has accrued over the past decades in support of a dimensional model of personality disorders. The events surrounding the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Personality and Personality Disorders Work Group show the difficulties in reconciling two different worldviews with a hybrid model. They also indicate the future of a psychiatric nosology that will be increasingly concerned with dimensional classification of mental illness. As such, the road is paved for more substantial changes to personality disorder classification in the International Classification of Diseases, 11th Revision, in 2017. © The Royal Australian and New Zealand College of Psychiatrists 2015.

An Exploratory Study of the Perceptions of AACSB International's 2013 Accreditation Standards

ERIC Educational Resources Information Center

Miles, Morgan P.; Franklin, Geralyn McClure; Grimmer, Martin; Heriot, Kirl C.

2015-01-01

Purpose: The purpose of this paper is to report on the findings of an exploratory survey designed to measure AACSB member deans' perceptions about the recently revised 2013 Association to Advance Collegiate Schools of Business (AACSB) Accreditation Standards. In April of 2013, AACSB International released a major revision of its accreditation…

Psychometric Evaluation of the Life Orientation Test-Revised in Treated Opiate Dependent Individuals

ERIC Educational Resources Information Center

Hirsch, Jameson K.; Britton, Peter C.; Conner, Kenneth R.

2010-01-01

We examined internal consistency and test-retest reliability of a measure of dispositional optimism, the Life Orientation Test-Revised, in 121 opiate-dependent patients seeking methadone treatment. Internal consistency was adequate at baseline (alpha = 0.69) and follow-up (alpha = 0.72). Low socioeconomic status and being on disability were…

76 FR 56797 - Cut-to-Length Carbon-Quality Steel Plate From India, Indonesia, Italy, Japan, and Korea; Revised...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-14

... INTERNATIONAL TRADE COMMISSION [Investigation Nos. 701-TA-388-391 and 731-TA-817-821 ;Second Review] Cut-to-Length Carbon-Quality Steel Plate From India, Indonesia, Italy, Japan, and Korea; Revised schedule for the subject reviews. AGENCY: United States International Trade Commission. ACTION: Notice...

ICD-11 Gaming Disorder: Needed and just in time or dangerous and much too early?

PubMed Central

van den Brink, Wim

2017-01-01

In their debate contribution, Aarseth et al. (2016) strongly argue against the proposal of WHO ICD-11 (International Classification of Diseases, 11th revision) to include Gaming Disorder as a new diagnostic category emphasizing the fact that no consensus exists on the definition and the risk that gaming will be demonized and gamers stigmatized resulting in a tsunami of false positive referrals to treatment. In this commentary, it is argued that gaming is indeed just another relatively innocent recreational activity with only a small minority losing control resulting in gaming-related problems. It is also argued that – despite a lack of full consensus on the diagnostic criteria – there are clear indications that Gaming Disorder is a relevant clinical entity worldwide and that official recognition as a mental disorder is urgently needed to facilitate the further development, accessibility, and reimbursement of the treatment. PMID:28816496

Developing Surveillance Methodology for Agricultural and Logging Injury in New Hampshire Using Electronic Administrative Data Sets.

PubMed

Scott, Erika E; Hirabayashi, Liane; Krupa, Nicole L; Sorensen, Julie A; Jenkins, Paul L

2015-08-01

Agriculture and logging rank among industries with the highest rates of occupational fatality and injury. Establishing a nonfatal injury surveillance system is a top priority in the National Occupational Research Agenda. Sources of data such as patient care reports (PCRs) and hospitalization data have recently transitioned to electronic databases. Using narrative and location codes from PCRs, along with International Classification of Diseases, 9th Revision, external cause of injury codes (E-codes) in hospital data, researchers are designing a surveillance system to track farm and logging injury. A total of 357 true agricultural or logging cases were identified. These data indicate that it is possible to identify agricultural and logging injury events in PCR and hospital data. Multiple data sources increase catchment; nevertheless, limitations in methods of identification of agricultural and logging injury contribute to the likely undercount of injury events.

ICD-11 Gaming Disorder: Needed and just in time or dangerous and much too early?

PubMed

van den Brink, Wim

2017-09-01

In their debate contribution, Aarseth et al. (2016) strongly argue against the proposal of WHO ICD-11 (International Classification of Diseases, 11th revision) to include Gaming Disorder as a new diagnostic category emphasizing the fact that no consensus exists on the definition and the risk that gaming will be demonized and gamers stigmatized resulting in a tsunami of false positive referrals to treatment. In this commentary, it is argued that gaming is indeed just another relatively innocent recreational activity with only a small minority losing control resulting in gaming-related problems. It is also argued that - despite a lack of full consensus on the diagnostic criteria - there are clear indications that Gaming Disorder is a relevant clinical entity worldwide and that official recognition as a mental disorder is urgently needed to facilitate the further development, accessibility, and reimbursement of the treatment.

Occupationally related hydrogen sulfide deaths in the United States from 1984 to 1994.

PubMed

Fuller, D C; Suruda, A J

2000-09-01

Alice Hamilton described fatal work injuries from acute hydrogen sulfide poisonings in 1925 in her book Industrial Poisons in the United States. There is no unique code for H2S poisoning in the International Classification of Diseases, 9th Revision; therefore, these deaths cannot be identified easily from vital records. We reviewed US Occupational Safety and Health Administration (OSHA) investigation records for the period 1984 to 1994 for mention of hazardous substance 1480 (hydrogen sulfide). There were 80 fatalities from hydrogen sulfide in 57 incidents, with 19 fatalities and 36 injuries among coworkers attempting to rescue fallen workers. Only 17% of the deaths were at workplaces covered by collective bargaining agreements. OSHA issued citations for violation of respiratory protection and confined space standards in 60% of the fatalities. The use of hydrogen sulfide detection equipment, air-supplied respirators, and confined space safety training would have prevented most of the fatalities.

Use of hospital discharge data to monitor uterine rupture--Massachusetts, 1990-1997.

PubMed

2000-03-31

Uterine rupture (UR), a potentially life-threatening condition for both mother and infant, occurs in <0.1% of all pregnant women and <1% of women attempting vaginal birth after cesarean section (VBAC) (1-4). During 1990-1997, the proportion of vaginal deliveries among women who had previous cesarean sections (CS) in Massachusetts increased 50%, from 22.3% to 33.5% (5). Concern about a corresponding increase in UR prompted the Massachusetts Department of Public Health and CDC to initiate a state-wide investigation that included an assessment of the validity and reliability of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) (6), codes in hospital discharge data to identify UR cases. This report summarizes the results of the investigation, which indicate that ICD-9-CM codes related to UR, designed before increased concern about UR, lack adequate specificity for UR surveillance and have not been applied consistently over time.

Differential diagnosis in hypersomnia.

PubMed

Dauvilliers, Yves

2006-03-01

Hypersomnia includes a group of disorders in which the primary complaint is excessive daytime sleepiness. Chronic hypersomnia is characterized by at least 3 months of excessive sleepiness prior to diagnosis and may affect 4% to 6% of the population. The severity of daytime sleepiness needs to be quantified by subjective scales (at least the Epworth sleepiness scale) and objective tests such as the multiple sleep latency test. Chronic hypersomnia does not correspond to an individual clinical entity but includes numerous different etiologies of hypersomnia as recently reported in the revised International Classification of Sleep Disorders. This review details most of those disorders, including narcolepsy with and without cataplexy, idiopathic hypersomnia with and without long sleep time, recurrent hypersomnia, behaviorally induced insufficient sleep syndrome, hypersomnia due to medical condition, hypersomnia due to drug or substance, hypersomnia not due to a substance or known physiologic condition, and also sleep-related disordered breathing and periodic leg movement disorders.

Medical Parasitology Taxonomy Update: January 2012 to December 2015.

PubMed

Simner, P J

2017-01-01

Parasites of medical importance have long been classified taxonomically by morphological characteristics. However, molecular-based techniques have been increasingly used and relied on to determine evolutionary distances for the basis of rational hierarchal classifications. This has resulted in several different classification schemes for parasites and changes in parasite taxonomy. The purpose of this Minireview is to provide a single reference for diagnostic laboratories that summarizes new and revised clinically relevant parasite taxonomy from January 2012 through December 2015. Copyright © 2016 American Society for Microbiology.

22 CFR 214.14 - Charter revision.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Charter revision. 214.14 Section 214.14 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT ADVISORY COMMITTEE MANAGEMENT Establishment of Advisory...) Charter revision requires clearances by the advisory committee, the A.I.D. Advisory Committee Management...

The Use and Abuse of Diagnostic/Classification Criteria

PubMed Central

June, Rayford R.; Aggarwal, Rohit

2015-01-01

In rheumatic diseases, classification criteria have been developed to identify well-defined homogenous cohorts for clinical research. Although, they are commonly used in clinical practice, their use may not be appropriate for routine diagnostic clinical care. Classification criteria are being revised with improved methodology and further understanding of disease pathophysiology, but still may not encompass all unique clinical situations to be applied for diagnosis of heterogeneous, rare, evolving rheumatic diseases. Diagnostic criteria development is challenging primarily due to difficulty for universal application given significant differences in prevalence of rheumatic diseases based on geographical area and clinic settings. Despite these shortcomings, the clinician can still use classification criteria for understanding the disease as well as a guide for diagnosis with a few caveats. We present the limits of current classification criteria, describe their use and abuse in clinical practice, and how they should be used with caution when applied in clinics. PMID:26096094

Are All Community Colleges Alike?

ERIC Educational Resources Information Center

Cohen, Arthur M.

While there are many ways to differentiate among community colleges (size, control, student characteristics, etc.), there have been few attempts to categorize them. The Carnegie Foundation's classification system, published first in 1971 and since revised several times, categorizes research universities, comprehensive institutions, liberal arts…

77 FR 6016 - Approval and Promulgation of Implementation Plans; State of Tennessee: Prevention of Significant...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-07

..., and extreme nonattainment (NAA) classifications) and significant emission rates for the 8-hour ozone..., serious, severe, and extreme ozone NAA. \\4\\ On July 18, 1997, EPA promulgated a revised 8-hour ozone NAAQS...

Review and revision of overload permit classification.

DOT National Transportation Integrated Search

2013-02-01

The Michigan Department of Transportation (MDOT) allows trucks that exceed their legal loads to cross : bridges if they apply and are approved for a permit. More than 30,000 permits have been processed each : year since 2002, providing a vital servic...

Complications Are Not Increased With Acetabular Revision of Metal-on-metal Total Hip Arthroplasty.

PubMed

Penrose, Colin T; Seyler, Thorsten M; Wellman, Samuel S; Bolognesi, Michael P; Lachiewicz, Paul F

2016-10-01

Isolated revision of the acetabular component in the setting of total hip arthroplasty has an increased risk of dislocation. With local soft tissue destruction frequently associated with failed metal-on-metal (MoM) bearings, it is presumed that acetabular revision of these hips will have even greater risk of complications. However, no study directly compares the complications of MoM with metal-on-polyethylene (MoP) acetabular revisions. In the context of a large database analysis, we asked the following questions: (1) Are there differences in early medical or wound complications after isolated acetabular revision of MoM and MoP bearing surfaces? (2) Are there differences in the frequency of dislocation, deep infection, and rerevision based on the bearing surface of the original implant? A review of the 100% Medicare database from 2005 to 2012 was performed using International Classification of Diseases, 9th Revision and Current Procedural Terminology codes. We identified 451 patients with a MoM bearing and 628 patients with a MoP bearing who had an isolated acetabular revision and a minimum followup of 2 years. The incidence, odds ratios, and 95% confidence intervals for early medical or wound complications were calculated using a univariate analysis at 30 days with patient sex and age group-adjusted analysis for blood transfusion. The incidence, odds ratio, and 95% confidence intervals for dislocation, deep infection, and rerevision were calculated using a univariate analysis at 30 day, 90 days, 1 year, and 2 years using a subgroup analysis with the Cochran-Mantel-Haenszel test to adjust for patient gender and age groups. There were no differences between the MoM and MoP isolated acetabular revisions in the incidence of 30-day local complications. There was a greater risk of transfusion in the MoP group than the MoM group (134 of 451 [30%] versus 230 of 628 [37%]; odds ratio [OR], 0.731; 95% confidence interval [CI], 0.565-0.948; p = 0.018). There were no differences at 2 years between the MoM and MoP acetabular revisions in the incidence of dislocation, infection, or rerevision. When analyzed by patient sex and age group, there were more infections in the age 70 to 79 years MoP group compared with MoM (10 of 451 [5%] versus 29 of 628 [10%]; OR, 4.47; CI, 1.699-11.761; p = 0.001). There were high rates of dislocation, infection, and rerevision in both revision cohorts. The rate of dislocation was not greater after acetabular revision of MoM bearings at 2 years. Based on these findings, clinicians should counsel these patients preoperatively about the risks of these complications. Dual-mobility and constrained components have specific advantages and disadvantages in these settings and should be further studied. Level III, therapeutic study.

The EAACI/GA²LEN/EDF/WAO Guideline for the Definition, Classification, Diagnosis and Management of Urticaria. The 2017 Revision and Update.

PubMed

Zuberbier, T; Aberer, W; Asero, R; Abdul Latiff, A H; Baker, D; Ballmer-Weber, B; Bernstein, J A; Bindslev-Jensen, C; Brzoza, Z; Buense Bedrikow, R; Canonica, G W; Church, M K; Craig, T; Danilycheva, I V; Dressler, C; Ensina, L F; Giménez-Arnau, A; Godse, K; Gonçalo, M; Grattan, C; Hebert, J; Hide, M; Kaplan, A; Kapp, A; Katelaris, C H; Kocatürk, E; Kulthanan, K; Larenas-Linnemann, D; Leslie, T A; Magerl, M; Mathelier-Fusade, P; Meshkova, R Y; Metz, M; Nast, A; Nettis, E; Oude-Elberink, H; Rosumeck, S; Saini, S S; Sánchez-Borges, M; Schmid-Grendelmeier, P; Staubach, P; Sussman, G; Toubi, E; Vena, G A; Vestergaard, C; Wedi, B; Werner, R N; Zhao, Z; Maurer, M

2018-01-15

This evidence and consensus-based guideline was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. The conference was held on December 1st, 2016. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the EU-founded network of excellence, the Global Allergy and Asthma European Network (GA²LEN), the European Dermatology Forum (EDF), and the World Allergy Organization (WAO) with the participation of 48 delegates of 42 national and international societies. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease, presenting with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria are disabling, impair quality of life, and affect performance at work and school. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Alternative temporal classification of long Gamma Ray Bursts

NASA Astrophysics Data System (ADS)

Alejandro Vasquez, Nicolas; Baquero, Andres; Andrade, David

2015-08-01

In order to increase the understanding on Gamma Ray Bursts, many attempts of classification have been proposed. Starting with the canonical classification into long and short GRBs, alternative classifications taking into account the cosmological origin of GRBs have been analyzed. In the present work we propose an alternative classification based on two temporal estimators, the Auto Correlation Function (ACF) of the light curves and the emission time which considered the time where the bursts engine is active. The time estimators chosen reflects the internal evolution of the GRB and the internal structure. Using a sample of 61 bright GRBs detected by SWIFT satellite with known redshift, we proposed a bimodal distribution of long bursts. The two types of bursts have different internal structure suggesting different progenitors.

DSM-5 and Mental Disorders in Older Individuals: An Overview.

PubMed

Sachdev, Perminder S; Mohan, Adith; Taylor, Lauren; Jeste, Dilip V

2015-01-01

After participating in this activity, learners should be better able to:• Assess the changes in DSM-5 relative to earlier versions.• Evaluate the implications of the DSM-5 for practicing geriatric psychiatrists. About every 20 years, the American Psychiatric Association revises its official classification of mental disorders. The fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in 2013, prompting considerable commentary, debate, and criticism. This article briefly describes the process leading up to DSM-5 and the main changes from the previous version (DSM-IV) that would be of interest to a geriatric psychiatrist. The changes in the areas of schizophrenia, bipolar disorder, depressive disorders, and anxiety disorders have been many, but the majority of them are minor and unlikely to have major treatment implications. The classification of neurocognitive disorders, however, has seen a major revision and elaboration in comparison to DSM-IV; of special note is the introduction of "mild and major neurocognitive disorders," the latter equated with dementia. A common language has also been introduced for the criteria for the various etiological subtypes of neurocognitive disorders. All physicians treating patients with neurocognitive disorders should familiarize themselves with these criteria. Their use in research has the potential to harmonize the field.

76 FR 11344 - Difenoconazole; Pesticide Tolerances

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-02

... be affected. The North American Industrial Classification System (NAICS) codes have been provided to... review of the data supporting the petition, EPA has revised the proposed tolerance for mango, fruit from... there is reliable information.'' This includes exposure through drinking water and in residential...

77 FR 26462 - Dimethomorph; Pesticide Tolerances

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-04

... affected. The North American Industrial Classification System (NAICS) codes have been provided to assist... review of the data supporting the petitions, EPA has revised the proposed tolerance level and commodity....'' This includes exposure through drinking water and in residential settings, but does not include...

Fact Sheet: Revisions to the Occupational Safety and Health Administration Hazard Communication Standards (HCS)

EPA Pesticide Factsheets

On March 26, 2012, Occupational Safety and Health Administration (OSHA) modified its HCS to conform to the United Nations’ (UN) Globally Harmonized System of Classification and Labeling of Chemicals (GHS), to improve consistency and quality of information.

Enumerating bone marrow blasts from nonerythroid cellularity improves outcome prediction in myelodysplastic syndromes and permits a better definition of the intermediate risk category of the Revised International Prognostic Scoring System (IPSS-R).

PubMed

Calvo, Xavier; Arenillas, Leonor; Luño, Elisa; Senent, Leonor; Arnan, Montserrat; Ramos, Fernando; Pedro, Carme; Tormo, Mar; Montoro, Julia; Díez-Campelo, María; Blanco, María Laura; Arrizabalaga, Beatriz; Xicoy, Blanca; Bonanad, Santiago; Jerez, Andrés; Nomdedeu, Meritxell; Ferrer, Ana; Sanz, Guillermo F; Florensa, Lourdes

2017-07-01

The Revised International Prognostic Scoring System (IPSS-R) has been recognized as the score with the best outcome prediction capability in MDS, but this brought new concerns about the accurate prognostication of patients classified into the intermediate risk category. The correct enumeration of blasts is essential in prognostication of MDS. Recent data evidenced that considering blasts from nonerythroid cellularity (NECs) improves outcome prediction in the context of IPSS and WHO classification. We assessed the percentage of blasts from total nucleated cells (TNCs) and NECs in 3924 MDS patients from the GESMD, 498 of whom were MDS with erythroid predominance (MDS-E). We assessed if calculating IPSS-R by enumerating blasts from NECs improves prognostication of MDS. Twenty-four percent of patients classified into the intermediate category were reclassified into higher-risk categories and showed shorter overall survival (OS) and time to AML evolution than those who remained into the intermediate one. Likewise, a better distribution of patients was observed, since lower-risk patients showed longer survivals than previously whereas higher-risk ones maintained the outcome expected in this poor prognostic group (median OS < 20 months). Furthermore, our approach was particularly useful for detecting patients at risk of dying with AML. Regarding MDS-E, 51% patients classified into the intermediate category were reclassified into higher-risk ones and showed shorter OS and time to AML. In this subgroup of MDS, IPSS-R was capable of splitting our series in five groups with significant differences in OS only when blasts were assessed from NECs. In conclusion, our easy-applicable approach improves prognostic assessment of MDS patients. © 2017 Wiley Periodicals, Inc.

International Society for Analytical Cytology biosafety standard for sorting of unfixed cells.

PubMed

Schmid, Ingrid; Lambert, Claude; Ambrozak, David; Marti, Gerald E; Moss, Delynn M; Perfetto, Stephen P

2007-06-01

Cell sorting of viable biological specimens has become very prevalent in laboratories involved in basic and clinical research. As these samples can contain infectious agents, precautions to protect instrument operators and the environment from hazards arising from the use of sorters are paramount. To this end the International Society of Analytical Cytology (ISAC) took a lead in establishing biosafety guidelines for sorting of unfixed cells (Schmid et al., Cytometry 1997;28:99-117). During the time period these recommendations have been available, they have become recognized worldwide as the standard practices and safety precautions for laboratories performing viable cell sorting experiments. However, the field of cytometry has progressed since 1997, and the document requires an update. Initially, suggestions about the document format and content were discussed among members of the ISAC Biosafety Committee and were incorporated into a draft version that was sent to all committee members for review. Comments were collected, carefully considered, and incorporated as appropriate into a draft document that was posted on the ISAC web site to invite comments from the flow cytometry community at large. The revised document was then submitted to ISAC Council for review. Simultaneously, further comments were sought from newly-appointed ISAC Biosafety committee members. This safety standard for performing viable cell sorting experiments was recently generated. The document contains background information on the biohazard potential of sorting and the hazard classification of infectious agents as well as recommendations on (1) sample handling, (2) operator training and personal protection, (3) laboratory design, (4) cell sorter set-up, maintenance, and decontamination, and (5) testing the instrument for the efficiency of aerosol containment. This standard constitutes an updated and expanded revision of the 1997 biosafety guideline document. It is intended to provide laboratories involved in cell sorting with safety practices that take into account the enhanced hazard potential of high-speed sorting. Most importantly, it states that droplet-based sorting of infectious or hazardous biological material requires a higher level of containment than the one recommended for the risk group classification of the pathogen. The document also provides information on safety features of novel instrumentation, new options for personal protective equipment, and recently developed methods for testing the efficiency of aerosol containment.

Validation of the new diagnosis grouping system for pediatric emergency department visits using the International Classification of Diseases, 10th Revision.

PubMed

Lee, Jin Hee; Hong, Ki Jeong; Kim, Do Kyun; Kwak, Young Ho; Jang, Hye Young; Kim, Hahn Bom; Noh, Hyun; Park, Jungho; Song, Bongkyu; Jung, Jae Yun

2013-12-01

A clinically sensible diagnosis grouping system (DGS) is needed for describing pediatric emergency diagnoses for research, medical resource preparedness, and making national policy for pediatric emergency medical care. The Pediatric Emergency Care Applied Research Network (PECARN) developed the DGS successfully. We developed the modified PECARN DGS based on the different pediatric population of South Korea and validated the system to obtain the accurate and comparable epidemiologic data of pediatric emergent conditions of the selected population. The data source used to develop and validate the modified PECARN DGS was the National Emergency Department Information System of South Korea, which was coded by the International Classification of Diseases, 10th Revision (ICD-10) code system. To develop the modified DGS based on ICD-10 code, we matched the selected ICD-10 codes with those of the PECARN DGS by the General Equivalence Mappings (GEMs). After converting ICD-10 codes to ICD-9 codes by GEMs, we matched ICD-9 codes into PECARN DGS categories using the matrix developed by PECARN group. Lastly, we conducted the expert panel survey using Delphi method for the remaining diagnosis codes that were not matched. A total of 1879 ICD-10 codes were used in development of the modified DGS. After 1078 (57.4%) of 1879 ICD-10 codes were assigned to the modified DGS by GEM and PECARN conversion tools, investigators assigned each of the remaining 801 codes (42.6%) to DGS subgroups by 2 rounds of electronic Delphi surveys. And we assigned the remaining 29 codes (4%) into the modified DGS at the second expert consensus meeting. The modified DGS accounts for 98.7% and 95.2% of diagnoses of the 2008 and 2009 National Emergency Department Information System data set. This modified DGS also exhibited strong construct validity using the concepts of age, sex, site of care, and seasons. This also reflected the 2009 outbreak of H1N1 influenza in Korea. We developed and validated clinically feasible and sensible DGS system for describing pediatric emergent conditions in Korea. The modified PECARN DGS showed good comprehensiveness and demonstrated reliable construct validity. This modified DGS based on PECARN DGS framework may be effectively implemented for research, reporting, and resource planning in pediatric emergency system of South Korea.

Adverse events following cervical manipulative therapy: consensus on classification among Dutch medical specialists, manual therapists, and patients.

PubMed

Kranenburg, Hendrikus A; Lakke, Sandra E; Schmitt, Maarten A; Van der Schans, Cees P

2017-12-01

To obtain consensus-based agreement on a classification system of adverse events (AE) following cervical spinal manipulation. The classification system should be comprised of clear definitions, include patients' and clinicians' perspectives, and have an acceptable number of categories. Design : A three-round Delphi study. Participants : Thirty Dutch participants (medical specialists, manual therapists, and patients) participated in an online survey. Procedure : Participants inventoried AE and were asked about their preferences for either a three- or a four-category classification system. The identified AE were classified by two analysts following the International Classification of Functioning, Disability and Health (ICF), and the International Classification of Diseases and Related Health Problems (ICD-10). Participants were asked to classify the severity for all AE in relation to the time duration. Consensus occurred in a three-category classification system. There was strong consensus for 16 AE in all severities (no, minor, and major AE) and all three time durations [hours, days, weeks]. The 16 AE included anxiety, flushing, skin rash, fainting, dizziness, coma, altered sensation, muscle tenderness, pain, increased pain during movement, radiating pain, dislocation, fracture, transient ischemic attack, stroke, and death. Mild to strong consensus was reached for 13 AE. A consensus-based classification system of AE is established which includes patients' and clinicians' perspectives and has three categories. The classification comprises a precise description of potential AE in accordance with internationally accepted classifications. After international validation, clinicians and researchers may use this AE classification system to report AE in clinical practice and research.

A case study of the introduction of the International Classification for Nursing Practice(®) in Poland.

PubMed

Kilańska, D; Gaworska-Krzemińska, A; Grabowska, H; Gorzkowicz, B

2016-09-01

The development of a nursing practice, improvements in nurses' autonomy, and increased professional and personal responsibility for the medical services provided all require professional documentation with records of health status assessments, decisions undertaken, actions and their outcomes for each patient. The International Classification for Nursing Practice is a tool that meets all of these needs, and although it requires continuous evaluation, it offers professional documentation and communication in the practitioner and researcher community. The aim of this paper is to present a theoretical critique of an issue related to policy and experience of the current situation in Polish nursing - especially of the efforts to standardize nursing practices through the introduction and development of the Classification in Poland. Despite extensive promotion and training by International Council of Nurses members worldwide, there are still many countries where the Classification has not been implemented as a standard tool in healthcare facilities. Recently, a number of initiatives were undertaken in cooperation with the local and state authorities to disseminate the Classification in healthcare facilities. Thanks to intense efforts by the Polish Nurses Association and the International Council of Nurses Accredited Center for ICNP(®) Research & Development at the Medical University of Łódź, the Classification is known in Poland and has been tested at several centres. Nevertheless, an actual implementation that would allow for national and international interoperability requires strategic governmental decisions and close cooperation with information technology companies operating in the country. Discussing the barriers to the implementation of the Classification can improve understanding of it and its use. At a policy level, decision makers need to understand that use Classification in eHealth services and tools it is necessary to achieve interoperability. © 2016 International Council of Nurses.

Biological knee reconstruction for combined malalignment, meniscal deficiency, and articular cartilage disease.

PubMed

Harris, Joshua D; Hussey, Kristen; Wilson, Hillary; Pilz, Kyle; Gupta, Anil K; Gomoll, Andreas; Cole, Brian J

2015-02-01

The aim of this study was to analyze patient-reported outcomes in those undergoing the triad of simultaneous osteotomy, meniscal transplantation, and articular cartilage repair. Patients undergoing simultaneous meniscal transplantation, distal femoral or proximal tibial osteotomy, and articular cartilage surgery by a single surgeon (B.J.C.) were analyzed. Meniscal transplantation was performed using bone-in-slot techniques. Distal femoral and high tibial osteotomies were performed for valgus and varus malalignment, respectively. Microfracture, autologous chondrocyte implantation, and osteochondral autograft or allograft were performed for articular cartilage disease. Validated patient-reported and surgeon-measured outcomes were collected. Preoperative and postoperative outcomes and medial versus lateral disease were compared using Student t tests. Eighteen participants (mean age, 34 ± 7.8 years; symptomatic patients, 7.4 ± 5.6 years; 2.4 ± 1.0 surgical procedures before study enrollment; mean follow-up, 6.5 ± 3.2 years) were analyzed. Two thirds of participants had medial compartment pathologic conditions and one third had lateral compartment pathologic processes. At final follow-up, there were statistically significant clinically meaningful improvements in International Knee Documentation Committee (IKDC) subjective classification, Lysholm score, and 4 Knee Injury and Osteoarthritis Outcome Score (KOOS) subscores. Postoperative 12-item short form (SF-12) physical and mental component scores were not significantly different from preoperative scores. The Kellgren-Lawrence classification grade was 1.5 ± 1.1 at 2.5 ± 3.0 years after surgery. There was a significantly higher preoperative SF-12 physical composite score (PCS) in participants with lateral compartment pathologic conditions (v medial compartment conditions) (P = .011). Although there were 13 reoperations in 10 patients (55.5% reoperation rate), only one patient was converted to knee arthroplasty (5.6%) and one to revision cartilage surgery and meniscal transplantation (5.6% revision rate). The most common complication was arthrofibrosis (16.7%). Statistically significant and clinically meaningful improvements in validated patient-reported clinical outcome scores at long-term follow-up were observed in 18 participants undergoing combined meniscal transplantation, osteotomy, and articular cartilage surgery. Although there was a low rate of cartilage or meniscal revision (or both) and total knee arthroplasty, there was a high rate of reoperation. There was no significant difference in outcomes between participants with medial versus lateral pathologic conditions. Level IV, therapeutic case series. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

INTERNATIONAL REPORT: Revised Values for (t90 - t68) from 630°C to 1064°C

NASA Astrophysics Data System (ADS)

Rusby, R. L.; Hudson, R. P.; Durieux, M.

1994-01-01

A revised table of differences (t90 - t68) between values of temperature on the International Temperature Scale of 1990, ITS-90, and the corresponding values on the International Practical Temperature Scale of 1968, IPTS-68, is published at the request of the Comité Consultatif de Thermométrie (CCT). The revision affects only the range 630°C to 1064°C, where the IPTS-68 specified the use of platinum-10% rhodium versus platinum thermocouples. It follows from new intercomparisons of thermocouples carrying IPTS-68 calibrations with platinum resistance thermometers and radiation thermometers calibrated in accordance with the ITS-90. The largest change occurs at 760°C, where the difference formerly tabulated as 0,36°C is now 0,04°C. The revision concerns only the assessment of the differences between the ITS-90 and the IPTS-68, and does not affect the ITS-90 in any way.

Polyp morphology: an interobserver evaluation for the Paris classification among international experts.

PubMed

van Doorn, Sascha C; Hazewinkel, Y; East, James E; van Leerdam, Monique E; Rastogi, Amit; Pellisé, Maria; Sanduleanu-Dascalescu, Silvia; Bastiaansen, Barbara A J; Fockens, Paul; Dekker, Evelien

2015-01-01

The Paris classification is an international classification system for describing polyp morphology. Thus far, the validity and reproducibility of this classification have not been assessed. We aimed to determine the interobserver agreement for the Paris classification among seven Western expert endoscopists. A total of 85 short endoscopic video clips depicting polyps were created and assessed by seven expert endoscopists according to the Paris classification. After a digital training module, the same 85 polyps were assessed again. We calculated the interobserver agreement with a Fleiss kappa and as the proportion of pairwise agreement. The interobserver agreement of the Paris classification among seven experts was moderate with a Fleiss kappa of 0.42 and a mean pairwise agreement of 67%. The proportion of lesions assessed as "flat" by the experts ranged between 13 and 40% (P<0.001). After the digital training, the interobserver agreement did not change (kappa 0.38, pairwise agreement 60%). Our study is the first to validate the Paris classification for polyp morphology. We demonstrated only a moderate interobserver agreement among international Western experts for this classification system. Our data suggest that, in its current version, the use of this classification system in daily practice is questionable and it is unsuitable for comparative endoscopic research. We therefore suggest introduction of a simplification of the classification system.

The Classification of Hysteria and Related Disorders: Historical and Phenomenological Considerations

PubMed Central

North, Carol S.

2015-01-01

This article examines the history of the conceptualization of dissociative, conversion, and somatoform syndromes in relation to one another, chronicles efforts to classify these and other phenomenologically-related psychopathology in the American diagnostic system for mental disorders, and traces the subsequent divergence in opinions of dissenting sectors on classification of these disorders. This article then considers the extensive phenomenological overlap across these disorders in empirical research, and from this foundation presents a new model for the conceptualization of these disorders. The classification of disorders formerly known as hysteria and phenomenologically-related syndromes has long been contentious and unsettled. Examination of the long history of the conceptual difficulties, which remain inherent in existing classification schemes for these disorders, can help to address the continuing controversy. This review clarifies the need for a major conceptual revision of the current classification of these disorders. A new phenomenologically-based classification scheme for these disorders is proposed that is more compatible with the agnostic and atheoretical approach to diagnosis of mental disorders used by the current classification system. PMID:26561836

Testing a tool for the classification of study designs in systematic reviews of interventions and exposures showed moderate reliability and low accuracy.

PubMed

Hartling, Lisa; Bond, Kenneth; Santaguida, P Lina; Viswanathan, Meera; Dryden, Donna M

2011-08-01

To develop and test a study design classification tool. We contacted relevant organizations and individuals to identify tools used to classify study designs and ranked these using predefined criteria. The highest ranked tool was a design algorithm developed, but no longer advocated, by the Cochrane Non-Randomized Studies Methods Group; this was modified to include additional study designs and decision points. We developed a reference classification for 30 studies; 6 testers applied the tool to these studies. Interrater reliability (Fleiss' κ) and accuracy against the reference classification were assessed. The tool was further revised and retested. Initial reliability was fair among the testers (κ=0.26) and the reference standard raters κ=0.33). Testing after revisions showed improved reliability (κ=0.45, moderate agreement) with improved, but still low, accuracy. The most common disagreements were whether the study design was experimental (5 of 15 studies), and whether there was a comparison of any kind (4 of 15 studies). Agreement was higher among testers who had completed graduate level training versus those who had not. The moderate reliability and low accuracy may be because of lack of clarity and comprehensiveness of the tool, inadequate reporting of the studies, and variability in tester characteristics. The results may not be generalizable to all published studies, as the test studies were selected because they had posed challenges for previous reviewers with respect to their design classification. Application of such a tool should be accompanied by training, pilot testing, and context-specific decision rules. Copyright © 2011 Elsevier Inc. All rights reserved.

[Historical outline on the nomenclature of neck lymph nodes as a basis of neck dissection classification].

PubMed

Werner, J A

2001-07-01

The neck dissection classification is based considerably on the organization of the lymph nodes of the neck. Terminology and anatomical allocation of nearly 300 cervicofacial lymph nodes repeatedly changed since the beginning of the 20th century. Analysis of the literature on neck lymph node organization with reference to the development of the neck dissection classification. The first fundamental nomenclature of the neck lymph nodes is founded on the work of Rouviére (1932). Suárez (1963) described the functional neck dissection on the basis of the fascial compartmentalization of the neck. Lindberg (1972) left the predominantly anatomically correlated grouping of the cervical lymph nodes as described by Rouviére and divided the lymphatic system of the neck on basis of pathophysiological mechanisms. The attention regarding the location of occult metastases led to the description of the selective neck dissection. Since the fundamental work of Shah et al. (1981) there was a multiplicity of more or less slight changes of the neck node regions. These changes were again basis for new neck dissection terminologies. A new classification was introduced in the year 2000 as the revised version of the American Head and Neck Society. The revised version of the neck dissection classification can reduce former controversies, particularly regarding an optimized intraoperative allocation of the lymph nodes and a simplified terminology of the selective neck dissection. With the goal of a standardization of the neck dissection forms it remains to be seen if the proponents of the functional neck dissection after Suárez consider the extent of the neck dissection in patients with N0 neck in favor of the selective neck dissection.

[Endoprosthesis failure in the ankle joint : Histopathological diagnostics and classification].

PubMed

Müller, S; Walther, M; Röser, A; Krenn, V

2017-03-01

Endoprostheses of the ankle joint show higher revision rates of 3.29 revisions per 100 component years. The aims of this study were the application and modification of the consensus classification of the synovia-like interface membrane (SLIM) for periprosthetic failure of the ankle joint, the etiological clarification of periprosthetic pseudocysts and a detailed measurement of proliferative activity (Ki67) in the region of osteolysis. Tissue samples from 159 patients were examined according to the criteria of the standardized consensus classification. Of these, 117 cases were derived from periprosthetic membranes of the ankle. The control group included 42 tissue specimens from the hip and knee joints. Particle identification and characterization were carried out using the particle algorithm. An immunohistochemical examination with Ki67 proliferation was performed in all cases of ankle pseudocysts and 19 control cases. The consensus classification of SLIM is transferrable to endoprosthetic failure of the ankle joint. Periprosthetic pseudocysts with the histopathological characteristics of the appropriate SLIM subtype were detectable in 39 cases of ankle joint endoprostheses (33.3%). The mean value of the Ki67 index was 14% and showed an increased proliferation rate in periprosthetic pseudocysts of the ankle (p-value 0.02037). In periprosthetic pseudocysts an above average higher detection rate of type 1 SLIM induced by abrasion (51.3%) with an increased Ki67 proliferation fraction (p-value 0.02037) was found, which can be interpreted as local destructive intraosseus synovialitis. This can be the reason for formation of pseudocystic osteolysis caused by high mechanical stress in ankle endoprostheses. A simplified diagnostic classification scoring system of dysfunctional endoprostheses of the ankle is proposed for collation of periprosthetic pseudocysts, ossifications and the Ki67 proliferation fraction.

MedlinePlus Connect

MedlinePlus

... code requests: Problems/Diagnoses • ICD-9-CM (International Classification of Disease, 9 th edition, Clinical Modification) • ICD-10-CM (International Classification of Disease, 10 th edition, Clinical Modification) • SNOMED ...

Simulation of ICD-9 to ICD-10-CM Transition for Family Medicine: Simple or Convoluted?

PubMed

Grief, Samuel N; Patel, Jesal; Kochendorfer, Karl M; Green, Lee A; Lussier, Yves A; Li, Jianrong; Burton, Michael; Boyd, Andrew D

2016-01-01

The objective of this study was to examine the impact of the transition from International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), to Interactional Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), on family medicine and to identify areas where additional training might be required. Family medicine ICD-9-CM codes were obtained from an Illinois Medicaid data set (113,000 patient visits and $5.5 million in claims). Using the science of networks, we evaluated each ICD-9-CM code used by family medicine physicians to determine whether the transition was simple or convoluted. A simple transition is defined as 1 ICD-9-CM code mapping to 1 ICD-10-CM code, or 1 ICD-9-CM code mapping to multiple ICD-10-CM codes. A convoluted transition is where the transitions between coding systems is nonreciprocal and complex, with multiple codes for which definitions become intertwined. Three family medicine physicians evaluated the most frequently encountered complex mappings for clinical accuracy. Of the 1635 diagnosis codes used by family medicine physicians, 70% of the codes were categorized as simple, 27% of codes were convoluted, and 3% had no mapping. For the visits, 75%, 24%, and 1% corresponded with simple, convoluted, and no mapping, respectively. Payment for submitted claims was similarly aligned. Of the frequently encountered convoluted codes, 3 diagnosis codes were clinically incorrect, but they represent only <0.1% of the overall diagnosis codes. The transition to ICD-10-CM is simple for 70% or more of diagnosis codes, visits, and reimbursement for a family medicine physician. However, some frequently used codes for disease management are convoluted and incorrect, and for which additional resources need to be invested to ensure a successful transition to ICD-10-CM. © Copyright 2016 by the American Board of Family Medicine.

Identifying type 1 and type 2 diabetic cases using administrative data: a tree-structured model.

PubMed

Lo-Ciganic, Weihsuan; Zgibor, Janice C; Ruppert, Kristine; Arena, Vincent C; Stone, Roslyn A

2011-05-01

To date, few administrative diabetes mellitus (DM) registries have distinguished type 1 diabetes mellitus (T1DM) from type 2 diabetes mellitus (T2DM). Using a classification tree model, a prediction rule was developed to distinguish T1DM from T2DM in a large administrative database. The Medical Archival Retrieval System at the University of Pittsburgh Medical Center included administrative and clinical data from January 1, 2000, through September 30, 2009, for 209,647 DM patients aged ≥18 years. Probable cases (8,173 T1DM and 125,111 T2DM) were identified by applying clinical criteria to administrative data. Nonparametric classification tree models were fit using TIBCO Spotfire S+ 8.1 (TIBCO Software), with model size based on 10-fold cross validation. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of T1DM were estimated. The main predictors that distinguished T1DM from T2DM are age <40 years; International Classification of Disease, 9th revision, codes of T1DM or T2DM diagnosis; inpatient oral hypoglycemic agent use; inpatient insulin use; and episode(s) of diabetic ketoacidosis diagnosis. Compared with a complex clinical algorithm, the tree-structured model to predict T1DM had 92.8% sensitivity, 99.3% specificity, 89.5% PPV, and 99.5% NPV. The preliminary predictive rule appears to be promising. Being able to distinguish between DM subtypes in administrative databases will allow large-scale subtype-specific analyses of medical care costs, morbidity, and mortality. © 2011 Diabetes Technology Society.

Updating Allergy and/or Hypersensitivity Diagnostic Procedures in the WHO ICD-11 Revision.

PubMed

Tanno, Luciana Kase; Calderon, Moises A; Li, James; Casale, Thomas; Demoly, Pascal

2016-01-01

The classification of allergy and/or hypersensitivity conditions for the World Health Organization (WHO) International Classification of Diseases (ICD)-11 provides the appropriate corresponding codes for allergic diseases, assuming that the final diagnosis is correct. This classification should be linked to in vitro and in vivo diagnostic procedures. Considering the impact for our specialty, we decided to review the codification of these procedures into the ICD aiming to have a baseline and to suggest changes and/or submit new proposals. For that, we prepared a list of the relevant allergy and/or hypersensitivity diagnostic procedures that health care professionals are dealing with on a daily basis. This was based on the main current guidelines and selected all possible and relevant corresponding terms from the ICD-10 (2015 version) and the ICD-11 β phase foundation (June 2015 version). More than 90% of very specific and important diagnostic procedures currently used by the allergists' community on a daily basis are missing. We observed that some concepts usually used by the allergist community on a daily basis are not fully recognized by other specialties. The whole scheme and the correspondence in the ICD-10 (2015 version) and ICD-11 foundation (June 2015 version) provided us a big picture of the missing or imprecise terms and how they are scattered in the current ICD-11 framework, allowing us to submit new proposals to increase the visibility of the allergy and/or hypersensitivity conditions and diagnostic procedures. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. All rights reserved.

Disability weights based on patient-reported data from a multinational injury cohort

PubMed Central

Lyons, Ronan A; Simpson, Pamela M; Rivara, Frederick P; Ameratunga, Shanthi; Polinder, Suzanne; Derrett, Sarah; Harrison, James E

2016-01-01

Abstract Objective To create patient-based disability weights for individual injury diagnosis codes and nature-of-injury classifications, for use, as an alternative to panel-based weights, in studies on the burden of disease. Methods Self-reported data based on the EQ-5D standardized measure of health status were collected from 29 770 participants in the Injury-VIBES injury cohort study, which covered Australia, the Netherlands, New Zealand, the United Kingdom of Great Britain and Northern Ireland and the United States of America. The data were combined to calculate new disability weights for each common injury classification and for each type of diagnosis covered by the 10th revision of the International statistical classification of diseases and related health problems. Weights were calculated separately for hospital admissions and presentations confined to emergency departments. Findings There were 29 770 injury cases with at least one EQ-5D score. The mean age of the participants providing data was 51 years. Most participants were male and almost a third had road traffic injuries. The new disability weights were higher for admitted cases than for cases confined to emergency departments and higher than the corresponding weights used by the Global Burden of Disease 2013 study. Long-term disability was common in most categories of injuries. Conclusion Injury is often a chronic disorder and burden of disease estimates should reflect this. Application of the new weights to burden studies would substantially increase estimates of disability-adjusted life-years and provide a more accurate reflection of the impact of injuries on peoples’ lives. PMID:27821883

The use of old and recent DSM definitions of premature ejaculation in observational studies: a contribution to the present debate for a new classification of PE in the DSM-V.

PubMed

Waldinger, Marcel D; Schweitzer, Dave H

2008-05-01

The DSM-III definition of premature ejaculation (PE) contains the criterion "control" but not that of "ejaculation time." In contrast, the Diagnostic and Statistical Manual of Mental Disorders (4th edition, Text Revision) (DSM-IV-TR) contains the criterion "short ejaculation time," while it lacks "control." To review the adequacy and consequent use of all criteria of the DSM-IV-TR definition in previously published PE Internet surveys. Reviewing all published cohort studies on PE from 2004 to 2007. MEDLINE and EMBASE computer bibliographies were used. Definitions of DSM-III, DSM-IV-TR, and International Classification of Diseases. Five papers, of which three are original studies, reported inclusion of men with PE according to DSM-IV-TR definition but omitted to apply the required "short ejaculation time" criterion. These studies, which have defined PE according to subjective criteria such as control, actually referred to the DSM-III definition. Using DSM-III-like definitions in three different studies revealed a highly variable prevalence of PE (32.5%, 27.6%, and 13.0%). In contrast, based on studies using a 1-minute cutoff point, being the time that is required to call ejaculation time "short" or using the criterion "persistent occurrence," PE revealed to be far less prevalent (5-6%). Unacceptable discrepancies of PE definitions according to DSM-III (abandoned but still used) and DSM-IV-TR argue strongly in favor of a multidimensional new classification of PE for the DSM-V.

Expert identification of visual primitives used by CNNs during mammogram classification

NASA Astrophysics Data System (ADS)

Wu, Jimmy; Peck, Diondra; Hsieh, Scott; Dialani, Vandana; Lehman, Constance D.; Zhou, Bolei; Syrgkanis, Vasilis; Mackey, Lester; Patterson, Genevieve

2018-02-01

This work interprets the internal representations of deep neural networks trained for classification of diseased tissue in 2D mammograms. We propose an expert-in-the-loop inter- pretation method to label the behavior of internal units in convolutional neural networks (CNNs). Expert radiologists identify that the visual patterns detected by the units are correlated with meaningful medical phenomena such as mass tissue and calcificated vessels. We demonstrate that several trained CNN models are able to produce explanatory descriptions to support the final classification decisions. We view this as an important first step toward interpreting the internal representations of medical classification CNNs and explaining their predictions.

Revisioning Education for All in the Age of Migration: Global Challenges and Opportunities for Lifelong Learning

ERIC Educational Resources Information Center

Guo, Shibao

2014-01-01

This paper revisits and revisions Education for All (EFA) in the age of global migration with the aim of developing more inclusive approaches towards social justice and equity in education. Drawing on cases of internal and international migration in China and Canada, this paper compares and contrasts policies and practices in the education of…

Show Me What I'm Looking for: A Trustee's Guide to Reviewing the New IRS Form 990

ERIC Educational Resources Information Center

Hyatt, Thomas K.

2009-01-01

Much has been made of the Internal Revenue Service's introduction of the completely revised Form 990 last year. The Internal Revenue Service's primary goals in implementing the revised form are to increase transparency and promote accountability and compliance. Indeed, the information required in the new form will offer the clearest picture to…

Psychometric Properties of the School Attitude Assessment Survey-Revised with International Baccalaureate High School Students

ERIC Educational Resources Information Center

Dedrick, Robert F.; Shaunessy-Dedrick, Elizabeth; Suldo, Shannon M.; Ferron, John M.

2015-01-01

In two studies (ns = 312 and 1,149) with 9- to 12-grade students in pre-International Baccalaureate (IB) and IB Diploma programs, we evaluated the reliability, factor structure, measurement invariance, and criterion-related validity of the scores from the School Attitude Assessment Survey-Revised (SAAS-R). Reliabilities of the five SAAS-R subscale…

Cross-Cultural Validity of the Almost Perfect Scale-Revised on the College Students in the United States and Turkey

ERIC Educational Resources Information Center

Aydin, Kamile Bahar

2013-01-01

This study investigated the cultural validity of the almost perfect scale-revised (APS-R) with 300 Turkish and 300 American and international college students. First, the validity of the original APS-R was conducted on American students and international students. Hence, exploratory factor analysis (EFA) offered two-factor scale to be consistent…

The revised Generalized Expectancy for Success Scale: a validity and reliability study.

PubMed

Hale, W D; Fiedler, L R; Cochran, C D

1992-07-01

The Generalized Expectancy for Success Scale (GESS; Fibel & Hale, 1978) was revised and assessed for reliability and validity. The revised version was administered to 199 college students along with other conceptually related measures, including the Rosenberg Self-Esteem Scale, the Life Orientation Test, and Rotter's Internal-External Locus of Control Scale. One subsample of students also completed the Eysenck Personality Inventory, while another subsample performed a criterion-related task that involved risk taking. Item analysis yielded 25 items with correlations of .45 or higher with the total score. Results indicated high internal consistency and test-retest reliability.

76 FR 18895 - Hexythiazox; Pesticide Tolerances

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-06

... Zone Model/Exposure Analysis Modeling System (PRZM/EXAMS), the estimated drinking water concentration... Classification System (NAICS) codes have been provided to assist you and others in determining whether this.... Based upon review of the data supporting the petition, EPA has revised the proposed tolerance levels for...

75 FR 14086 - Clopyralid; Pesticide Tolerances

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-24

... listed in this unit could also be affected. The North American Industrial Classification System (NAICS... notice of filing. Based upon review of the data supporting the petition, EPA has revised the proposed... for which there is reliable information.'' This includes exposure through drinking water and in...

76 FR 55807 - Novaluron; Pesticide Tolerances

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-09

.../Exposure Analysis Modeling System (PRZM/EXAMS) for parent novaluron in surface water; and the Screening... listed in this unit could also be affected. The North American Industrial Classification System (NAICS... supporting the petition, EPA has revised the tolerances for sweet corn forage and determined it is not...

78 FR 9322 - Hexythiazox; Pesticide Tolerances

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-08

... Modeling System (PRZM/EXAMS), the estimated drinking water concentrations (EDWC) of hexythiazox for chronic... manufacturer. The following list of North American Industrial Classification System (NAICS) codes is not... supporting the petition, Gowan Company revised their petition (PP 1F7934) as follows: i. By increasing the...

Development and first validation of a simplified CT-based classification system of soft tissue changes in large-head metal-on-metal total hip replacement: intra- and interrater reliability and association with revision rates in a uniform cohort of 664 arthroplasties.

PubMed

Boomsma, Martijn F; Edens, Mireille A; Van Lingen, Christiaan P; Warringa, Niek; Ettema, Harmen B; Verheyen, Cees C P M; Maas, Mario

2015-08-01

After implantation of a metal-on-metal total hip arthroplasty (MoM THA), a large incidence of pseudotumor formation has been described recently. Several centers have invited patients for follow-up in order to screen for pseudotumor formation. The spectrum of abnormalities found by CT in MoM THA patients can be unfamiliar to radiologists and orthopedic surgeons. Previously, a CT five-point grading scale has been published. In this paper, a simplification into a three-point classification system gives insight in the morphological distinction of abnormalities of the postoperative hip capsule in MoM implants in relation to the decision for revision. The reliability of this simplified classification regarding intra- and interrater reliability and its association with revision rate is investigated and discussed. All patients who underwent MoM THA in our hospital were invited for screening. Various clinical measures and CT scan were obtained in a cross-sectional fashion. A decision on revision surgery was made shortly after screening. CT scans were read in 582 patients, of which 82 patients were treated bilaterally. CT scans were independently single read by two board-certified radiologists and classified into categories I-V. In a second meeting, consensus was obtained. Categories were subsequently rubricated in class A (categories I and II), B (category III), and C (categories IV and V). Intra- and inter-radiologist agreement on MoM pathology was assessed by means of the weighted Cohen's kappa. Categorical data were presented as n (%), and tested by means of Fisher's exact test. Continuous data were presented as median (min-max) and tested by means of Mann-Whitney U test (two group comparison) or Kruskal-Wallis test (three group comparison). Logistic regression analysis was performed in order to study independence of CT class for association with revision surgery. Univariate statistically significant variables were entered in a multiple model. All statistical analysis was performed two-tailed using alpha 5% as the significance level. In total, 664 scores from 664 MoM hips obtained by two observers were available for analyses. Interobserver reliability for the non-simplified version (I-V) was κw = 0.71 (95% CI: 0.62-0.79), which indicates good agreement between the two musculoskeletal radiologists. Intra- and interobserver reliability for the simplified version (A-C) were respectively κw 0.78 (95% CI: 0.68-0.87), and κw = 0.71 (95% CI: 0.65-0.76). This indicates good agreement within and between the two observers. The simplified A-C version is significantly associated with revision exclusively due to MoM pathology, in both patients with unilateral MoM THA (p < 0.001) and patients with bilateral MoM THA (p < 0.044). The simplified A-C version is associated with several clinical measures. In patients with unilateral MoM THA, with or without contralateral THA, in situ time (p < 0.008), cobalt and chromium (p < 0.001) were statistically significant. In patients with bilateral MoM, cobalt (p < 0.001) and chromium (p < 0.027) were statistically significant. Revision is significantly associated with cup size (p < 0.001), anteversion of the cup (p < 0.004), serum ion levels of cobalt and chromium (p < 0.001) and the adapted classification system (p < 0.001). In univariate logistic regression analysis on revision, cup, anteversion of the cup, cobalt-chromium ion serum levels, and the simplified (A-C) CT category system were statistically significant. The simplified (A-C) CT category system was an independent associate of revision, in several multiple logistic regression models. The presented simplified CT grading system (A-C) in its first clinical validation on 48- and 64-multislice systems is reliable, showing good intra- and interrater reliability and is independently associated with revision surgery.

BE-FAST (Balance, Eyes, Face, Arm, Speech, Time): Reducing the Proportion of Strokes Missed Using the FAST Mnemonic.

PubMed

Aroor, Sushanth; Singh, Rajpreet; Goldstein, Larry B

2017-02-01

The FAST algorithm (Face, Arm, Speech, Time) helps identify persons having an acute stroke. We determined the proportion of patients with acute ischemic stroke not captured by FAST and evaluated a revised mnemonic. Records of all patients admitted to the University of Kentucky Stroke Center between January and December 2014 with a discharge International Classification of Diseases, Ninth Revision, Clinical Modification code for acute ischemic stroke were reviewed. Those misclassified, having missing National Institutes of Health Stroke Scale data, or were comatose or intubated were excluded. Presenting symptoms, demographics, and examination findings based on the National Institutes of Health Stroke Scale data were abstracted. Of 858 consecutive records identified, 736 met inclusion criteria; 14.1% did not have any FAST symptoms at presentation. Of these, 42% had gait imbalance or leg weakness, 40% visual symptoms, and 70% either symptom. With their addition, the proportion of stroke patients not identified was reduced to 4.4% (P<0.0001). In a sensitivity analysis, if face weakness, arm weakness, or speech impairment on admission examination were considered in addition to a history of FAST symptoms, the proportion missed was reduced to 9.9% (P=0.0010). The proportion of stroke patients not identified was also reduced (2.6%) with the addition of a history of gait imbalance/leg weakness or visual symptoms (P<0.0001). Of patients with ischemic stroke with deficits potentially amenable to acute intervention, 14% are not identified using FAST. The inclusion of gait/leg and visual symptoms leads to a reduction in missed strokes. If validated in a prospective study, a revision of public educational programs may be warranted. © 2017 American Heart Association, Inc.

Revised version of quality guidelines for presurgical epilepsy evaluation and surgical epilepsy therapy issued by the Austrian, German, and Swiss working group on presurgical epilepsy diagnosis and operative epilepsy treatment.

PubMed

Rosenow, Felix; Bast, Thomas; Czech, Thomas; Feucht, Martha; Hans, Volkmar H; Helmstaedter, Christoph; Huppertz, Hans-Jürgen; Noachtar, Soheyl; Oltmanns, Frank; Polster, Tilman; Seeck, Margitta; Trinka, Eugen; Wagner, Kathrin; Strzelczyk, Adam

2016-08-01

The definition of minimal standards remains pivotal as a basis for a high standard of care and as a basis for staff allocation or reimbursement. Only limited publications are available regarding the required staffing or methodologic expertise in epilepsy centers. The executive board of the working group (WG) on presurgical epilepsy diagnosis and operative epilepsy treatment published the first guidelines in 2000 for Austria, Germany, and Switzerland. In 2014, revised guidelines were published and the WG decided to publish an unaltered English translation in this report. Because epilepsy surgery is an elective procedure, quality standards are particularly high. As detailed in the first edition of these guidelines, quality control relates to seven different domains: (1) establishing centers with a sufficient number of sufficiently and specifically trained personnel, (2) minimum technical standards and equipment, (3) continuous medical education of employees, (4) surveillance by trained personnel during video electroencephalography (EEG) monitoring (VEM), (5) systematic acquisition of clinical and outcome data, (6) the minimum number of preoperative evaluations and epilepsy surgery procedures, and (7) the cooperation of epilepsy centers. These standards required the certification of the different professions involved and minimum numbers of procedures. In the subsequent decade, quite a number of colleagues were certified by the trinational WG; therefore, the executive board of the WG decided in 2013 to make these standards obligatory. This revised version is particularly relevant given that the German procedure classification explicitly refers to the guidelines of the WG with regard to noninvasive/invasive preoperative video-EEG monitoring and invasive intraoperative diagnostics in epilepsy. Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.

The Adult Monteggia Fracture: Patterns and Incidence of Annular Ligament Incarceration Among 121 Cases at a Single Institution Over 19 Years.

PubMed

Hamaker, Max; Zheng, Amy; Eglseder, W Andrew; Pensy, Raymond A

2018-01-01

The purposes of this study were to identify the relative frequency of Monteggia fracture patterns and to investigate the required frequency of open reduction of the proximal radiocapitellar joint. We identified 121 Monteggia fractures at a Level I trauma center from 1996 to 2015 and included 119 in this study. These fractures were identified using a database search for the appropriate International Classification of Diseases, Ninth Revision and Current Procedural Terminology codes as well as individual surgeons' logs. Two fellowship-trained hand surgeons reviewed the identified patients' x-rays and operative notes. Each fracture was classified using Bado's original description, excluding transolecranon and Monteggia variants. Bado I lesion represented 68% (81 of 119) of Monteggia fractures. Annular ligament incarceration preventing radial head reduction occurred in approximately 17% (14 of 81) of this Bado type. Revision fixation of the ulna was not necessary (none of 119 cases) and functional range of motion (average arc, 117°) was recovered in most patients. The reoperation rate of 20% (23 of 119) was related to the severity of the presenting injury and hardware prominence. Most radial head dislocations associated with Monteggia fractures occur anteriorly and will reduce with anatomic plating of the ulna. In cases where the radial head fails to reduce, entrapment of the annular ligament can be expected and open reduction is required. Revision fixation of the ulna to achieve reduction of the radial head is uncommon in our experience. Prognostic IV. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Evaluation of the Components of the North Carolina Syndromic Surveillance System Heat Syndrome Case Definition.

PubMed

Harduar Morano, Laurel; Waller, Anna E

To improve heat-related illness surveillance, we evaluated and refined North Carolina's heat syndrome case definition. We analyzed North Carolina emergency department (ED) visits during 2012-2014. We evaluated the current heat syndrome case definition (ie, keywords in chief complaint/triage notes or International Classification of Diseases, Ninth Revision, Clinical Modification [ ICD-9-CM] codes) and additional heat-related inclusion and exclusion keywords. We calculated the positive predictive value and sensitivity of keyword-identified ED visits and manually reviewed ED visits to identify true positives and false positives. The current heat syndrome case definition identified 8928 ED visits; additional inclusion keywords identified another 598 ED visits. Of 4006 keyword-identified ED visits, 3216 (80.3%) were captured by 4 phrases: "heat ex" (n = 1674, 41.8%), "overheat" (n = 646, 16.1%), "too hot" (n = 594, 14.8%), and "heatstroke" (n = 302, 7.5%). Among the 267 ED visits identified by keyword only, a burn diagnosis or the following keywords resulted in a false-positive rate >95%: "burn," "grease," "liquid," "oil," "radiator," "antifreeze," "hot tub," "hot spring," and "sauna." After applying the revised inclusion and exclusion criteria, we identified 9132 heat-related ED visits: 2157 by keyword only, 5493 by ICD-9-CM code only, and 1482 by both (sensitivity = 27.0%, positive predictive value = 40.7%). Cases identified by keywords were strongly correlated with cases identified by ICD-9-CM codes (rho = .94, P < .001). Revising the heat syndrome case definition through the use of additional inclusion and exclusion criteria substantially improved the accuracy of the surveillance system. Other jurisdictions may benefit from refining their heat syndrome case definition.

[Cause-of-death statistics and ICD, quo vadis?

PubMed

Eckert, Olaf; Vogel, Ulrich

2018-07-01

The International Statistical Classification of Diseases and Related Health Problems (ICD) is the worldwide binding standard for generating underlying cause-of-death statistics. What are the effects of former revisions of the ICD on underlying cause-of-death statistics and which opportunities and challenges are becoming apparent in a possible transition process from ICD-10 to ICD-11?This article presents the calculation of the exploitation grade of ICD-9 and ICD-10 in the German cause-of-death statistics and quality of documentation. Approximately 67,000 anonymized German death certificates are processed by Iris/MUSE and official German cause-of-death statistics are analyzed.In addition to substantial changes in the exploitation grade in the transition from ICD-9 to ICD-10, regional effects become visible. The rate of so-called "ill-defined" conditions exceeds 10%.Despite substantial improvement of ICD revisions there are long-known deficits in the coroner's inquest, filling death certificates and quality of coding. To make better use of the ICD as a methodological framework for mortality statistics and health reporting in Germany, the following measures are necessary: 1. General use of Iris/MUSE, 2. Establishing multiple underlying cause-of-death statistics, 3. Introduction of an electronic death certificate, 4. Improvement of the medical assessment of cause of death.Within short time the WHO will release the 11th revision of the ICD that will provide additional opportunities for the development of underlying cause-of-death statistics and their use in science, public health and politics. A coordinated effort including participants in the process and users is necessary to meet the related challenges.

A definition and classification of status epilepticus--Report of the ILAE Task Force on Classification of Status Epilepticus.

PubMed

Trinka, Eugen; Cock, Hannah; Hesdorffer, Dale; Rossetti, Andrea O; Scheffer, Ingrid E; Shinnar, Shlomo; Shorvon, Simon; Lowenstein, Daniel H

2015-10-01

The Commission on Classification and Terminology and the Commission on Epidemiology of the International League Against Epilepsy (ILAE) have charged a Task Force to revise concepts, definition, and classification of status epilepticus (SE). The proposed new definition of SE is as follows: Status epilepticus is a condition resulting either from the failure of the mechanisms responsible for seizure termination or from the initiation of mechanisms, which lead to abnormally, prolonged seizures (after time point t1 ). It is a condition, which can have long-term consequences (after time point t2 ), including neuronal death, neuronal injury, and alteration of neuronal networks, depending on the type and duration of seizures. This definition is conceptual, with two operational dimensions: the first is the length of the seizure and the time point (t1 ) beyond which the seizure should be regarded as "continuous seizure activity." The second time point (t2 ) is the time of ongoing seizure activity after which there is a risk of long-term consequences. In the case of convulsive (tonic-clonic) SE, both time points (t1 at 5 min and t2 at 30 min) are based on animal experiments and clinical research. This evidence is incomplete, and there is furthermore considerable variation, so these time points should be considered as the best estimates currently available. Data are not yet available for other forms of SE, but as knowledge and understanding increase, time points can be defined for specific forms of SE based on scientific evidence and incorporated into the definition, without changing the underlying concepts. A new diagnostic classification system of SE is proposed, which will provide a framework for clinical diagnosis, investigation, and therapeutic approaches for each patient. There are four axes: (1) semiology; (2) etiology; (3) electroencephalography (EEG) correlates; and (4) age. Axis 1 (semiology) lists different forms of SE divided into those with prominent motor systems, those without prominent motor systems, and currently indeterminate conditions (such as acute confusional states with epileptiform EEG patterns). Axis 2 (etiology) is divided into subcategories of known and unknown causes. Axis 3 (EEG correlates) adopts the latest recommendations by consensus panels to use the following descriptors for the EEG: name of pattern, morphology, location, time-related features, modulation, and effect of intervention. Finally, axis 4 divides age groups into neonatal, infancy, childhood, adolescent and adulthood, and elderly. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

The classification of chronic daily headache in adolescents--a comparison between the second edition of the international classification of headache disorders and alternative diagnostic criteria.

PubMed

Bigal, Marcelo E; Rapoport, Alan M; Tepper, Stewart J; Sheftell, Fred D; Lipton, Richard B

2005-05-01

To compare the second edition of the International Classification of Headache Disorders (ICHD-2) and the Silberstein-Lipton (S-L) criteria in the classification of adolescents with chronic daily headache (CDH). We reviewed the clinical records and the headache diaries of 170 adolescents (13 to 17 years) seen between 1998 and 2003 at a headache center. Relevant information was transferred to a standardized form that included operational criteria for the ICHD-2. CDH subtypes were classified according the criteria proposed by S-L into transformed migraine (TM) with (TM+) and without medication overuse (TM-), chronic tension-type headache (CTTH), new daily persistent headache (NDPH), and hemicrania continua (HC). From the 69 patients with TM- according the S-L criteria, most (71%) could be classified as chronic migraine (CM), while a minority of patients required a combination of diagnosis, mainly migraine and CTTH (14.4%). Of the patients with TM+, just 39.6% met the criteria for probable CM (PCM) with probable medication overuse (PMO). If instead of 15 migraine days per month, we considered 15 or more days of migraine or probable migraine, 84% of the subjects with TM- and 68.7% of those with TM+ could be classified. Of the 27 subjects classified as NDPH without medication overuse according to the S-L system, the majority (51.2%) were also classified as NDPH according the ICHD-2. Interestingly, three (11.1% of the subjects with NDPH without medication overuse) were classified as CM in the ICHD-2 because these patients had an abrupt onset of 15 or more days of migraine per month. All patients with NDPH with medication overuse according to the S-L criteria required a combination of diagnoses in the ICHD-2. All subjects with CTTH received a single diagnosis in both classification systems. (i) Among adolescents with TM, the majority (58.1%) could be classified as CM, according to the ICHD-2. These results were driven by TM without medication overuse. (ii) If the ICHD-2 criteria for CM are revised to require 15 days of migraine or probable migraine, the proportion of patients with TM- who meet the criteria for CM increases from 71% to 84%; for TM+, the proportion with probable chronic migraine and PMO increases from 30% to 68%. (iii) About half of the patients with NDPH according to the S-L criteria have too many migraine features to meet ICHD-2 criteria for NDPH.

Coping with Changes in International Classifications of Sectors and Occupations: Application in Skills Forecasting. Research Paper No 43

ERIC Educational Resources Information Center

Kvetan, Vladimir, Ed.

2014-01-01

Reliable and consistent time series are essential to any kind of economic forecasting. Skills forecasting needs to combine data from national accounts and labour force surveys, with the pan-European dimension of Cedefop's skills supply and demand forecasts, relying on different international classification standards. Sectoral classification (NACE)…

International Standard Classification of Education (ISCED) Three Stage Classification System: 1973; Part 2 - Definitions.

ERIC Educational Resources Information Center

United Nations Educational, Scientific, and Cultural Organization, Paris (France).

The seven levels of education, as classified numerically by International Standard Classification of Education (ISCED), are defined along with courses, programs, and fields of education listed under each level. Also contained is an alphabetical subject index indicating appropriate code numbers. For related documents see TM003535 and TM003536. (RC)

Perspectives on the International Classification of Functioning, Disability, and Health: Child and Youth Version (ICF-CY) and Occupational Therapy Practice

ERIC Educational Resources Information Center

Cramm, Heidi; Aiken, Alice B.; Stewart, Debra

2012-01-01

Classifying disability for children and youth has typically meant describing a diagnosis or developmental lag. The publication of the "International Classification of Functioning, Disability and Health: Child & Youth" version (ICF-CY) marks a global paradigm shift in the conceptualization and classification of childhood disability. Knowledge and…

26 CFR 301.7701(i)-3 - Effective dates and duration of taxable mortgage pool classification.

Code of Federal Regulations, 2010 CFR

2010-04-01

... mortgage pool classification. 301.7701(i)-3 Section 301.7701(i)-3 Internal Revenue INTERNAL REVENUE SERVICE... § 301.7701(i)-3 Effective dates and duration of taxable mortgage pool classification. (a) Effective...(c) of the Tax Reform Act of 1986. (2) Special rule for certain transfers. A transfer made to an...

26 CFR 301.7701(i)-3 - Effective dates and duration of taxable mortgage pool classification.

Code of Federal Regulations, 2011 CFR

2011-04-01

... mortgage pool classification. 301.7701(i)-3 Section 301.7701(i)-3 Internal Revenue INTERNAL REVENUE SERVICE... § 301.7701(i)-3 Effective dates and duration of taxable mortgage pool classification. (a) Effective... connected to the entity's issuance of related debt obligations (as defined in paragraph (b)(3) of this...

ICD-11 and DSM-5 personality trait domains capture categorical personality disorders: Finding a common ground.

PubMed

Bach, Bo; Sellbom, Martin; Skjernov, Mathias; Simonsen, Erik

2018-05-01

The five personality disorder trait domains in the proposed International Classification of Diseases, 11th edition and the Diagnostic and Statistical Manual of Mental Disorders, 5th edition are comparable in terms of Negative Affectivity, Detachment, Antagonism/Dissociality and Disinhibition. However, the International Classification of Diseases, 11th edition model includes a separate domain of Anankastia, whereas the Diagnostic and Statistical Manual of Mental Disorders, 5th edition model includes an additional domain of Psychoticism. This study examined associations of International Classification of Diseases, 11th edition and Diagnostic and Statistical Manual of Mental Disorders, 5th edition trait domains, simultaneously, with categorical personality disorders. Psychiatric outpatients ( N = 226) were administered the Structured Clinical Interview for DSM-IV Axis II Personality Disorders Interview and the Personality Inventory for DSM-5. International Classification of Diseases, 11th edition and Diagnostic and Statistical Manual of Mental Disorders, 5th edition trait domain scores were obtained using pertinent scoring algorithms for the Personality Inventory for DSM-5. Associations between categorical personality disorders and trait domains were examined using correlation and multiple regression analyses. Both the International Classification of Diseases, 11th edition and the Diagnostic and Statistical Manual of Mental Disorders, 5th edition domain models showed relevant continuity with categorical personality disorders and captured a substantial amount of their information. As expected, the International Classification of Diseases, 11th edition model was superior in capturing obsessive-compulsive personality disorder, whereas the Diagnostic and Statistical Manual of Mental Disorders, 5th edition model was superior in capturing schizotypal personality disorder. These preliminary findings suggest that little information is 'lost' in a transition to trait domain models and potentially adds to narrowing the gap between Diagnostic and Statistical Manual of Mental Disorders, 5th edition and the proposed International Classification of Diseases, 11th edition model. Accordingly, the International Classification of Diseases, 11th edition and Diagnostic and Statistical Manual of Mental Disorders, 5th edition domain models may be used to delineate one another as well as features of familiar categorical personality disorder types. A preliminary category-to-domain 'cross walk' is provided in the article.

The economic impact of surgically treated peri-prosthetic hip fractures on a university teaching hospital in Wales 7.5-year study.

PubMed

Jones, Andrew R; Williams, Tim; Paringe, Vishal; White, Simon P

2016-02-01

The number of total hip replacements taking place across the UK continues to grow. In an ageing population, with people placing greater demands on their prostheses, the number of peri-prosthetic fractures is increasing. We studied the economic impact this has on a large teaching hospital. All patients with peri-prosthetic femoral fracture in a 7.5 year period were identified. Radiographic and case note analysis was performed. Costings from the finance departments were obtained. 90 cases were identified, 58 female and 32 male, with a mean age of 76 (range: 38-91). 89 of the cases were managed surgically, 66% undergoing revision and 33% receiving open reduction and internal fixation. According to the Vancouver Classification, 3% were Type A, 79% Type B and 18% Type C. The mean length of stay was 43 days. The mean cost of management was £31,370 (range: £6885-£112,327). Patients with type C fractures had the highest mean length of stay at 53 days and mean cost of £33,417. Including rehabilitation costs, our study illustrated a mean cost of £31,370, roughly four times the current basic NHS tariff of £8552. Although implant costs are greater, treatment with revision where appropriate allows earlier weight bearing, reduced length of stay and lower overall cost. Copyright © 2015 Elsevier Ltd. All rights reserved.

Prevalence of physical health problems among youth entering residential treatment.

PubMed

Nelson, Timothy D; Smith, Tori R; Thompson, Ronald W; Epstein, Michael H; Griffith, Annette K; Hurley, Kristin Duppong; Tonniges, Thomas F

2011-11-01

To examine the prevalence of physical health problems among youth entering residential treatment. The sample included 1744 youth (mean age: 14.6 ± 1.8 years) entering a large residential treatment program between 2000 and 2010. Youth received an intake medical evaluation, including a review of available records, detailed medical history, and physical examination. Medical conditions present at the time of the evaluation were recorded by the examining physician and later coded by the research team. Only diagnoses recognized by the International Classification of Diseases, 10th Revision, were included in the analyses. To maintain the focus on physical health problems, behavioral and emotional disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision were excluded. Obesity, acne, and allergies were also excluded. Approximately one-third (33.7%) of youth had a physical health diagnosis at the time of intake. Asthma was the most prevalent condition diagnosed (15.3% of the sample). Girls were significantly more likely to have a diagnosis than were boys (37.1% vs 31.5%). Age was not associated with diagnostic status. Rates of physical health conditions differed significantly by ethnicity: black (36.4%) and white (35.4%) youth had the highest rates, and Hispanic youth (23.2%) had the lowest. Youth who enter residential treatment have high rates of physical health conditions. These problems could complicate mental health treatment and should be considered in multidisciplinary treatment planning.

Reliability of Instruments Measuring At-Risk and Problem Gambling Among Young Individuals: A Systematic Review Covering Years 2009-2015.

PubMed

Edgren, Robert; Castrén, Sari; Mäkelä, Marjukka; Pörtfors, Pia; Alho, Hannu; Salonen, Anne H

2016-06-01

This review aims to clarify which instruments measuring at-risk and problem gambling (ARPG) among youth are reliable and valid in light of reported estimates of internal consistency, classification accuracy, and psychometric properties. A systematic search was conducted in PubMed, Medline, and PsycInfo covering the years 2009-2015. In total, 50 original research articles fulfilled the inclusion criteria: target age under 29 years, using an instrument designed for youth, and reporting a reliability estimate. Articles were evaluated with the revised Quality Assessment of Diagnostic Accuracy Studies tool. Reliability estimates were reported for five ARPG instruments. Most studies (66%) evaluated the South Oaks Gambling Screen Revised for Adolescents. The Gambling Addictive Behavior Scale for Adolescents was the only novel instrument. In general, the evaluation of instrument reliability was superficial. Despite its rare use, the Canadian Adolescent Gambling Inventory (CAGI) had a strong theoretical and methodological base. The Gambling Addictive Behavior Scale for Adolescents and the CAGI were the only instruments originally developed for youth. All studies, except the CAGI study, were population based. ARPG instruments for youth have not been rigorously evaluated yet. Further research is needed especially concerning instruments designed for clinical use. Copyright © 2016 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Is the Movement Assessment Battery for Children-2nd edition a reliable instrument to measure motor performance in 3 year old children?

PubMed

Smits-Engelsman, Bouwien C M; Niemeijer, Anuschka S; van Waelvelde, Hilde

2011-01-01

Formal testing of 3 year old children is a new feature in the revised version of the Movement Assessment Battery for Children (Movement ABC-2). Our study evaluated the reliability and explored the clinical applicability of the Movement ABC-2 Test in this young age group. A total of 50 typically children were given two trials of the test within a one to two week interval by two physical therapists: same assessor (n=28 children) and different assessors (n=22 children). Psychometric properties were evaluated by calculating internal consistency (Cronbach α), intra-class correlation (ICC), the standard error of measurement (SEM), the smallest detectable difference (SDD) and Kappa values for classification agreement. The results are promising for future implementation of the Movement ABC-2 in clinical practice. The children's performance was highly reproducible when tested by the same assessor (ICC .94) The SEM was 1.7 or 2.1 standard scores for 90% or 95% confidence intervals respectively, making the test sensitive enough to detect individual changes. If two different assessors tested the children the ICC was .76. In conclusion, the revised test can be applied to assess motor performance in typically developing 3-year old children. Future studies are needed to confirm if the same can be said for children with motor delays. Copyright © 2011 Elsevier Ltd. All rights reserved.

Medicare and Medicaid programs; CY 2015 Home Health Prospective Payment System rate update; Home Health Quality Reporting Requirements; and survey and enforcement requirements for home health agencies. Final rule.

PubMed

2014-11-06

This final rule updates Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective for episodes ending on or after January 1, 2015. As required by the Affordable Care Act, this rule implements the second year of the four-year phase-in of the rebasing adjustments to the HH PPS payment rates. This rule provides information on our efforts to monitor the potential impacts of the rebasing adjustments and the Affordable Care Act mandated face-to-face encounter requirement. This rule also implements: Changes to simplify the face-to-face encounter regulatory requirements; changes to the HH PPS case-mix weights; changes to the home health quality reporting program requirements; changes to simplify the therapy reassessment timeframes; a revision to the Speech-Language Pathology (SLP) personnel qualifications; minor technical regulations text changes; and limitations on the reviewability of the civil monetary penalty provisions. Finally, this rule also discusses Medicare coverage of insulin injections under the HH PPS, the delay in the implementation of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), and a HH value-based purchasing (HH VBP) model.

Economic Analysis of 4221 Revisions Due to Periprosthetic Joint Infection in Poland.

PubMed

Babiak, Ireneusz; Pędzisz, Piotr; Janowicz, Jakub; Kulig, Mateusz; Małdyk, Paweł

2017-01-26

Periprosthetic joint infection (PJI) is one of the most severe complications of total hip (THA) and total knee (TKA) arthroplasty. The aim of the study is to determine the number and type of hip and knee prosthesis revisions in Poland performed due to infection and reimbursement of the cost of septic revisions and to compare the costs of septic and aseptic revisions in Poland and other countries. The data published for the period 2009-2013 by the National Health Fund (NHF) were analysed and the average cost of septic and aseptic revisions was calculated. In the years 2009-2013, a total of 260,030 hip and knee arthroplasties including 23,027 revisions (incl. 4,221 septic) were performed in Poland. In 2013, septic revisions accounted for 1.38% of all hip replacement procedures, 2.56% of all knee replacement procedures and 14.67% of all hip revisions and 30.23% of all knee revisions. In 2013, the difference between the average cost incurred by the hospital and the NHF refund for septic revision due to PJI was at least €238 and the cost-refund gap for the entire year was €219198. 1. The system of reporting periprostheticjoint infections currently in use in Poland does not adequately reflect the current classification of PJI and reimbursement for septic revision of joint prosthesis does not match the actual costs. 2. The Polish DRG system does not distinguish between early and late PJI and fails to acknowledge basic guidelines for infection treatment currently followed in Poland and worldwide. 3. According to the DRG system, patients requiring different treatment are placed in one category. 4. Until the year 2013, the less expensive treatment of early infections had been reimbursed on the same basis as the more costly two-stage revision procedures.

Revising the Belgian Nursing Minimum Dataset: from concept to implementation.

PubMed

Sermeus, Walter; van den Heede, Koen; Michiels, Dominik; Delesie, Lucas; Thonon, Olivier; Van Boven, Caroline; Codognotto, Jean; Gillet, Pierre

2005-12-01

The process of revising the Belgian Nursing Minimum Dataset (B-NMDS) started in 2000 and entailed four major phases. The first phase (June-October 2002) involved the development of a conceptual framework based on a literature review and secondary data analysis. The Nursing Interventions Classification (NIC) was selected as a framework for the revision of the original B-NMDS. The second phase (November 2002-September 2003) focused on language development for six care programs evaluated by panels of clinical experts (N=75). These panels identified the following items as priorities for the revised B-NMDS: hospital financing, nurse staffing allocation, assessment of the appropriateness of hospitalisation, and quality management. During this period, we developed a draft instrument with 92 variables using the NIC. This led to an alpha version of a revised B-NMDS. The third phase (October 2003-December 2004) focused on data collection and validation of the new tool. The revised B-NMDS (alpha version) was tested in 158 nursing wards in 66 Belgian hospitals from December 2003 until March 2004. This test generated data for some 95,000 in-patient days. The interrater reliability of the revised B-NMDS was assessed. The criterion-related validity of the revised B-NMDS was compared to that of the original B-NMDS. The discriminative power of the revised B-NMDS was also assessed to select the most relevant variables for data collection. This resulted in a beta version of the revised B-NMDS in December 2004. The records of the revised B-NMDS were linked to the Hospital Discharge Dataset and other mandatory datasets to integrate the revised B-NMDS into the overall healthcare management system. The fourth phase (January 2005-December 2005) is presently focusing on information management. Nationwide implementation is foreseen by January 2007.

26 CFR 301.7701-1 - Classification of organizations for federal tax purposes.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 18 2010-04-01 2010-04-01 false Classification of organizations for federal tax purposes. 301.7701-1 Section 301.7701-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) PROCEDURE AND ADMINISTRATION PROCEDURE AND ADMINISTRATION Definitions § 301.7701-1...

77 FR 70902 - Fenpropathrin; Pesticide Tolerances

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-28

... manufacturer. The following list of North American Industrial Classification System (NAICS) codes is not... response to the notice of filing. Based upon review of the data supporting the petition, EPA has revised... drinking water and in residential settings, but does not include occupational exposure. Section 408(b)(2)(C...

75 FR 70143 - Acequinocyl; Pesticide Tolerances

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-17

.../water/index.htm . Based on the Pesticide Root Zone Model/Exposure Analysis Modeling System (PRZM/EXAMS... be affected. The North American Industrial Classification System (NAICS) codes have been provided to... the data supporting the petition, EPA has revised the proposed tolerance for hop dried cones from 3.5...

78 FR 40017 - Ethalfluralin; Pesticide Tolerances

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-03

.... The following list of North American Industrial Classification System (NAICS) codes is not intended to... filing. Based upon review of the data supporting the petition, EPA has revised the tolerance expression... drinking water and in residential settings, but does not include occupational exposure. Section 408(b)(2)(C...

78 FR 30213 - 1-Naphthaleneacetic acid; Pesticide Tolerances

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-22

... Industrial Classification System (NAICS) codes is not intended to be exhaustive, but rather provides a guide... filing. Based upon review of the data supporting the petition, EPA has revised the proposed tolerance on... for which there is reliable information.'' This includes exposure through drinking water and in...

Should Social Workers Use "Diagnostic and Statistical Manual of Mental Disorders-5?"

ERIC Educational Resources Information Center

Frances, Allen; Jones, K. Dayle

2014-01-01

Up until now, social workers have depended on the "Diagnostic and Statistical Manual of Mental Disorders" ("DSM") as the primary diagnostic classification for mental disorders. However, the "DSM-5" revision includes scientifically unfounded, inadequately tested, and potentially dangerous diagnoses that may lead them…

78 FR 2647 - Dental Devices; Reclassification of Blade-Form Endosseous Dental Implant

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-14

.... FDA-2012-N-0677] Dental Devices; Reclassification of Blade-Form Endosseous Dental Implant AGENCY: Food...) is proposing to reclassify the blade- form endosseous dental implant, a preamendments class III... proposing to revise the classification of blade-form endosseous dental implants. DATES: Submit either...

Learning Disabilities. Final Report.

ERIC Educational Resources Information Center

Delaware State Dept. of Education, Dover.

This report responds to Delaware state legislation requiring the development of proposed revised regulations for the classification of students as learning disabled (LD). The report first describes the current system, noting that in 1997 15 percent of the student population were served under the Individuals with Disabilities Education Act and over…