Clinical Gradings Research Articles

A New Method for Documenting Lens Opacities

We tested an anterior segment camera and digital analyzer on 32 eyes of 22 patients to determine whether its measurement of lens opacities correlated with measurements obtained by a standardized clinical grading system. The lenses were graded clinically for nuclear opacity, nuclear color, cortical opacity, and posterior subcapsular opacity. The lenses were then photographed and analyzed with this new device, and the results were compared. The camera system showed good reproducibility. Its results correlated well with the clinical gradings for nuclear capacity (P = .001) and cortical opacity (P = .001) but less well with posterior subcapsular opacity (P = .3), although there were only seven eyes with posterior subcapsular opacities. This camera system could help document and follow up lens opacity with more accuracy and reproducibility than has been previously possible.

Part-timers losing out

I am trying to discover whether part-time nurses are losing out on their clinical gradings.

An Independent Evaluation of the Lens Opacities Classification system II (LOCS II)

The Lens Opacities Classification System II (LOCS II) has been offered for use in clinical studies of cataract. The system uses slit lamp and retroillumination photographic standards to grade lens opacities into classes of increasing severity. The authors evaluated the reproducibility and validity of LOCS II before its possible use in a natural history study of age-related cataract. The authors found excellent inter- and intraobserver reproducibility when the LOCS II standard photographs were used for clinical or photographic gradings of cataract. There was a tendency to underestimate posterior subcapsular cataracts on photographic gradings compared with slit-lamp gradings. The accuracy of the photographic gradings of posterior subcapsular opacities tended to decrease as the severity of coexisting opacities increased.

Meeting grading appeals deadline is unlikely

HEALTH AUTHORITIES throughout the United Kingdom have predicted that they may find it impossible to meet Kenneth Clarke’s deadline of hearing all formal appeals against clinical gradings before the end of spring.

Evaluation of a Lens Opacities Classification System.

A simple system, based on standard photographs, has been developed to classify lens opacities. The system allows the definition of cataract cases and noncases according to the location of lens opacification (nuclear, cortical, posterior subcapsular) and its extent (early or more advanced). Evaluation of the system has shown good to excellent reproducibility for clinical and photographic classifications. Comparisons of clinical and photograph-derived gradings has shown generally good agreement in classifying the presence and type of cataract; this agreement is highest for nuclear cataract. Photographic gradings of posterior subcapsular and, to a lesser degree, cortical opacities tend to underestimate the extent of opacification found by clinical gradings. The Lens Opacities Case-Control Study system is simple, reproducible, and easy to implement; it is offered for use in case-control and other cross-sectional studies of cataract with compatible classification goals.

Clinical Grading for Subarachnoid Hemorrhage caused by Ruptured Intracranial Aneurysm

Clinical gradings for the cerebral aneurysm, advocated by Botterell, Nishioka or Hunt have been commonly used for evaluating the patient condition and the indication of the aneurysm surgery. In this study, new clinical grading classifying the patient condition according to their level of consciousness, herniation sign and also the accompanying conditions, which are evaluated by computerized tomography (CT) and angiography were reported. These include massive subarachnoid hemorrhage (SAH) in CT, intracerebral hematoma (ICH) with mass signs, such as midline shift and deformity of the ventricle, and vasospasm (VS) detected in angiography. Clinical results of the treatment for aneurysm cases in the acute stage are also reported. Two hundred ninety-one cases of anterior communicating, internal carotid and middle cerebral artery aneurysms which were admitted within 7 days after the last attack were studied. Of these 260 cases were operated on. The mortality of all cases was 16.2% and the morbidity was 13.7%. Number of cases having accompanying conditions were increasing as the grading. Most of the cases in grade 2 and 3 without accompanying conditions recovered to a good condition, except for cases with a rebleeding attack after the admission. The cause of the poor outcome in grade 2 and 3 with SAH and VS was cerebral ischemia following VS. Incidences with the two or three accompanying conditions increased in cases with grade 4 or more. Twenty out of 28 severe cases in grade 5b and 6 showed massive ICH on admission. Good outcome in cases with grade 4 or more were obtained in cases without VS. The accompanying conditions showed the cause of severity in a high grade case and helped to estimate the secondary pathophysiological state and to take preventive methods against it in a low grade case. Acute hydrocephalus was not rated as an accompanying condition, because no correlation was found between clinical severity and outcome. Clinical grading, based on level of consciousness, herniation signs and accompanying conditions were well correlated with the outcome and showed the operative timing and indication.

Asthma--the physiological and clinical spectrum in childhood. Respiratory function studies in its assessment.

Abstract Tests of respiratory function based on spirometry have hitherto proved of limited value in the assessment of asthmatic children in the interval phase. In an attempt to provide more information on this subject, respiratory function studies using a body plethysmograph were carried out in 106 asthmatic children aged 13 to 15 years during an asymptomatic period. The children were selected to cover the whole spectrum of asthma in childhood; they were divided into 4 grades on clinical criteria, and the results of the physiological studies compared with the clinical gradings. Results indicated that maximum expiratory flow volume curves, when combined with an estimation of lung volumes, provided the best assessment of the severity of a child's asthma. Using this test of respiratory function, most children in whom asthma had been a trivial complaint had virtually no abnormality, but a small number had mild airways obstruction. Those with chronic continuing asthma had evidence of severe airways obstruction and pulmonary hyperinflation. In children with episodic asthma, the degree of abnormality was variable and the frequency of the attacks seemed to be a major factor in determining this. It is concluded that respiratory function studies are a valuable tool in evaluating asthma in childhood, particularly when the clinical history is difficult to assess.