Function Classification System Research Articles

Quality‐adjusted life year weights among elderly patients with heart failure

When assessing health-related quality of life (HRQoL) in elderly patients with heart failure (HF), the process of obtaining quality-adjusted life year (QALY) weights is generally complicated and time-consuming. To evaluate whether information regarding HRQoL and QALY weights can be derived directly from the established and widely used New York Heart Association (NYHA) functional classification system. NYHA functional status was assessed independently both by the individual patients and by the examining cardiologist in 323 elderly patients with symptoms of HF recruited from primary care. HRQoL was evaluated using the SF-36 questionnaire and a time trade-off (TTO) scenario. The TTO technique generates direct QALY weights. Both the TTO technique and SF-36 values demonstrated a statistically significant correlation with NYHA functional status. The TTO values also correlated with all SF-36 dimensions. Increasing impairment was associated with statistically significant drops in both SF-36 values and TTO-based QALY weights. For patients in NYHA classes I-IV the QALY weights were 0.77, 0.68, 0.61, and 0.50, respectively. Thus in elderly patients, symptoms of HF have a major impact on perceived quality of life. The results of the present study show that QALY weights, an important instrument in the health economic evaluation of treatment strategies, can be derived directly from NYHA classification in elderly HF patients.

Reliability of a Functional Classification System in the Monitoring of Patients With Idiopathic Scoliosis

Patients with scoliosis from 1999 to 2001 were monitored using radiographs and the Quantec Spinal Imaging System (Quantec) to validate the Functional Classification System (FCS) developed at Children's Hospital of Wisconsin (CHW). To determine the accuracy of the FCS. The authors evaluated different noninvasive ways of evaluating the scoliotic spine. The FCS was developed as a means to predict the degree of scoliotic curve. Consecutive scoliosis visits (543) seen at CHW between 1999 and 2001 for initial or follow-up examination were investigated; of them, 157 had an radiograph within 6 months of Quantec. Subjects were placed into groups based on Cobb Angles. FCS classifications were compared to Cobb angle groupings and calculated sensitivity and specificity. Pearson's correlation coefficient was calculated for 39 subjects. Sensitivity of the FCS for single curve groups ranged from 0.50 to 0.63 and specificity from 0.64 to 0.86. For double curve, both sensitivity and specificity ranged from 0.48 to 0.81. Pearson's correlation was statistically significant (r = 0.45, P < 0.05). Sensitivity, specificity, and Pearson's correlation coefficient reflect the reliability of the Quantec method. Therefore, the FCS can be considered as a reliable tool for monitoring the progression of scoliosis with reduced need of radiographs.

Practical Management: Common Medical Problems in Disabled Athletes

Disabled athletes face many challenges during training and competition. As the number of disabled athletes grows, sports medicine professionals must become proficient in dealing with this population. A functional classification system is used to classify disabled athletes into 1 of 6 categories: wheelchair athletes, amputees, athletes with cerebral palsy, visual impairment, intellectual impairment, and les autres. Injury patterns have been identified for certain groups, with wheelchair athletes typically sustaining upper extremity injuries, blind athletes sustaining lower extremity injuries, and cerebral palsy athletes sustaining both. Common problems affecting wheelchair athletes include autonomic dysreflexia, difficulty with thermoregulation, pressure sores, neurogenic bladder, premature osteoporosis, peripheral nerve entrapment syndromes, and upper extremity injuries. Cerebral palsy athletes often have injuries involving the knee and foot due to problems with spasticity and foot deformities. Amputee athletes sustain injuries to the stump, spine, and intact limbs, while blind athletes suffer lower extremity injuries. Intellectually disabled athletes frequently have underlying ocular and visual defects, congenital cardiac anomalies, and atlantoaxial instability that predispose them to injuries. This article reviews key information pertinent to the care of these athletes.

Pharmacotherapy Implications of Revised Chronic Heart Failure Guidelines

To provide an overview of major drug therapy recommendations within recently revised chronic heart failure (CHF)guidelines. Guideline statements and English-language articles from MEDLINE pertinent to CHF. Recently published guidelines from the American College of Cardiology (ACC)/American Heart Association (AHA) and the Heart Failure Society of America (HFSA) served as the focus of this review. Prospective comparative trials, review articles, and editorials were also considered. Recommendations within the ACC/AHA and HFSA guidelines continue to provide a systematic, evidence-based approach regarding CHF management. The HFSA guidelines recommend that the severity of clinical disease and functional limitation be characterized using the New York Heart association (NYHA) functional classification system. A key feature of the ACC/AHA guidelines is the use of a staging system that recognizes the development and progression of heart failure. Both guidelines stress the importance of neurohormonal blockade with angiotensin-converting enzyme inhibitors and beta-adrenergic blockers. Moreover, the guidelines expand the role of aldosterone antagonists, angiotensin II receptor blockers, and hydralazine/isosorbide dinitrate, particularly in combination with standard treatments. Diuretics and digoxin remain symptomatic treatments only. This article summarizes key drug therapy recommendations from the revised ACC/AHA and HFSA guideline statements. Pharmacists caring for CHF patients should be familiar with these recommendations and aid in their implementation.

Chronic Heart Failure: Developments and Perspectives

To describe the clinical presentation, diagnosis, and contemporary treatment of chronic heart failure (CHF) while emphasizing the important role of the pharmacist. English-language articles from MEDLINE pertinent to CHF. All relevant publications addressing CHF management were considered, including prospective comparative trials, epidemiological studies, guideline statements, review articles, and editorials. Particular focus occurred on the primary literature published after the release of noted guidelines. The Heart Failure Society of America (HFSA), and the European Society of Cardiology (ESC). Heart failure is a common disorder, especially in the elderly. To determine appropriate pharmacotherapy, one must establish the type of dysfunction (systolic versus diastolic) as well as characterize the patient's disease state according to the New York Heart Association (NYHA) functional classification system and from the American College of Cardiology (ACC)/American Heart Association (AHA), stage of diseases. Although most patients have systolic dysfunction ([ejection fraction] less than 40%), the prevalence of diastolic dysfunction (a normal to elevated ejection fraction) is rising and it accounts for at least one-third of all cases. Six drugs/drug classes are contemporary treatments in systolic heart failure, depending on NYHA functional class: angiotensin-converting-enzyme inhibitors, diuretics, beta-blockers, aldosterone antagonists, angiotensin II receptor-blockers, and digoxin. Clinicians should be aware that studies demonstrate all these drugs/drug classes prolong survival in systolic heart failure, except diuretics and digoxin. Some patients with systolic dysfunction also may be candidates for the combination of hydralazine/isosorbide dinitrate as well as nonpharmacological approaches with biventricular pacemakers and/or implantable cardioverter defibrillators. Treatment of diastolic heart failure is less evidence-based, and speculative treatments focus on control of blood pressure, tachycardia, volume overload, and myocardial ischemia. CHF treatment remains a therapeutic challenge. Pharmacists have an essential role in the care of these patients by avoiding drugs known to exacerbate the disease, promoting optimal pharmacotherapy, and ensuring compliance with prescribed drugs and dietary modifications.

Multidimensional Framework for Context-Based Design of Major Urban Thoroughfares

During the post-World War II period, conventional roadway design has been based on a functional classification system that addresses levels of vehicle movement and access to abutting properties. Traffic-carrying capacity has been the dominant consideration. In recent years, more attention has been given to other characteristics of local streets and a small number of major streets. New design standards have been developed for local (neighborhood) streets by some organizations and local agencies. At the same time, the National Environmental Policy Act has increased the importance of environmental considerations in the design of major streets and roads and highlighted the importance of minimizing impacts of roadway projects on natural resources, particularly in rural environments. However, no widely accepted design guidelines have yet been developed for urban major streets. Street design and urban design professionals share a need for a two-dimensional framework that ties together ( a) roadway design criteria for an expanded palette of street types (number of lanes; target speed; pedestrian, transit, bicycle, and motor vehicle functions; other functional criteria) and ( b) a set of place types that reference features of both the public right-of-way and private development fronting on the roadway and in the broader area. The conventional functional class-based design criteria do not satisfy this need. The basic structure of such a framework is discussed.

Paralympic Swimming Performance, Impairment, and the Functional Classification System

The aim was to analyze the relationship between performance and classes of swimmers and between types of physical impairments and medal winners. Participants were 374 swimmers at the 1996 Paralympic Games with six types of impairments: poliomyelitis, cerebral palsy, spinal cord injury, amputation, dysmelia, and les autres. Data included performance times, gender, classification, swimming stroke and distance, and type of impairment. ANOVA and Spearman rank correlation treatment of data revealed significant differences in swimmers’ mean speeds across classes and positive correlations in swimmers’ classes and swimming speeds in all male and female events; no type of impairment dominated the opportunity to participate, win medals, or advance to the finals. It was concluded that the current swimming classification system is effective with respect to generating fair competition for most swimmers.

Some Criteria for Evaluating the “Fairness” of Swimming Classification

In disability swimming, a functional classification system is used in which swimmers with varying impairments compete against each other in one of 10 classes. In classification research, the criterion most often used to judge validity (fairness) is statistical difference in race performance between adjacent classes. Additional criteria are proposed here. First, the world-record swimming speed should decrease in a predictable manner with decreasing functional class. Second, classes should be clearly discriminated by race performances. To aid in evaluating these criteria, a comparison of the competitiveness (depth of the field) of the classes is made. The criteria were not strictly met in all classes. However, the sprint freestyle events approached fairness, especially for men. The exceptions were more due to a lack of maturity of the sport than to fundamental unfairness. Because of the more complex nature of breaststroke, more problems were observed related to classification fairness in this event.

Reduction of beta-adrenergic receptors in atrial cell membranes of patients following mild to moderate heart failure.

The density of cardiac beta-adrenoceptors (Bmax) was measured in eighteen patients [2 with atrial septal defect (ostium secundum), 4 with aortic valve disease, 3 with mitral valve disease, 1 with aortic and mitral valve disease, 5 with a history of myocardial infarction, and 3 with angina pectoris] following mild to moderate cardiac failure. Measures were obtained by cardiac catheterization prior to cardiac surgery and also during the surgical procedures. On the basis of symptoms immediately preceding surgery, the severity of the condition in each patient was categorized as either Class I (n = 5) or Class II (n = 13) following the New York Heart Association (NYHA) functional classification system. The Bmax was measured using right atrial appendage tissue obtained during cardiac surgery. [125I]-iodocyanopindolol was used for the assay. The Bmax of atrial cell membranes in patients with NYHA class II was significantly lower than that of class I (34.1 +/- 2.5 vs 55.4 +/- 9.3 fmol/mg protein, M +/- SE, p < 0.05). Correlation coefficients between the Bmax and hemodynamic parameters measured just prior to cardiac surgery were examined, but only that between Bmax and the minimum value of the time derivative of left ventricular pressure (max negative dp/dt) was significant (r = -0.552, p < 0.05). Further study is needed to understand and clarify the relationship between Bmax and dp/dt min.

An ecosystematic investigation of Themeda triandra (Poaceae: Andropogoneae) in the semi-arid grasslands of southern Africa

Vegetation dynamic studies in the semi-arid grasslands of Southern Africa have indicated that Themeda triandra reacts as a decreaser when vegetation is under- or over-utilized or increaser when vegetation is moderately severely over-utilized. This suggested that different ecotypes within this species may be involved. A study aimed at the ecotypification of important pasture grasses of Southern Africa was initiated, whereby 21 morphological, 21 epidermal, 5 chemical characters and productivity were used in a principle component and cluster analysis. Results presented here indicate that five ecotypes exist within T. triandra in the semi-arid grasslands of Southern Africa. The ultimate grouping of these ecotypes into a functional special purpose classification system can provide rangeland ecologists with lists of ecotypes, to be used when interpreting ecological data and describing plant community dynamics in the semi-arid grasslands of Southern Africa.

An ecosystematic investigation of Eragrostis racemosa (Poaceae:Eragrostideae) in the semi-arid grasslands of southern Africa

Vegetation dynamic studies in the semi-arid grasslands of southern Africa have indicated that Eragrostis racemosa reacts differently to grazing and defoliation. This gave cause for assuming that different ecotypes within the species are involved. A study aimed at the ecotypification of important pasture grasses was initiated, whereby values for 21 morphological characters, production, trichome index and percentage phenolic-containing cells were determined and subjected to a principal component and cluster analysis. Results presented here indicate that four ecotypes exist within E. racemosa in the semi-arid grasslands of southern Africa. The ultimate grouping of these ecotypes into a functional special-purpose classification system can provide plant ecologists with lists of ecotypes, to be used when interpreting ecological data and describing plant communities.

Challenges for receptor theory as a tool for drug and drug receptor classification

Increased understanding in the field of receptor pharmacology, born of the sophisticated techniques now available to us, has confounded rather than simplified the problem of receptor classification. The International Union of Pharmacology (IUPHAR) is currently sponsoring a Receptor Nomenclature Committee whose aims are to recommend a rational system of classification, a formidable task given the complexity and volume of data in the literature (agonist/antagonist potencies, coupling mechanisms, primary structures, etc.) that will need to be incorporated. The Committee's chairman, Terry Kenakin, outlines here the limitations of classical receptor theory for drug receptor classification and suggests that any functional classification system must take into account not only affinity and intrinsic efficacy but also, at the very least, parameters relating to the transducing properties of receptors. If this is not done, then receptor classification data obtained from studies with agonists and antagonists may be different and lead to confusion.

Functional taxonomy: An immodest proposal

The thesis is presented that classical taxonomy is of limited value to ecosystem science, and that the further development of ecosystem theory may actually be hindered by a reliance on the biological (phylogenetic) species as the basic functional unit of ecosystems. It is further argued that this situation could be improved if ecologists could agree on a system of functional classification in which ecological taxa would be distinguished solely on the basis of what they do in the context of an ecosystem, and not on their evolutionary relationships. A functional classification system is proposed in which functional taxa for specific ecosystems (ecological sectors) are defined as broad trophic groups of organisms in common vertical habitat zones, and with common inputs and outputs (ecosystem commodities and services). This system is envisioned as potentially useful in the development of comparative ecosystem theory, for constructing simulation models, for ongoing research in economic versus ecological values, and for cataloging new functional information as it becomes available. The proposed system is tentatively applied to the salt marsh estuarine ecosystem in the southeastern U.S.A. and to the swampforest ecosystem in Louisiana (U.S.A.). Twenty-five sectors are identified in the former and twenty in the latter. “It is by endless subdivisions based upon the most inconclusive differences, that some departments of natural history become so repellingly intricate”. Melville (1851), Moby Dick.

A profile of perceived capabilities for the preschool child

The necessity of evaluating adult perceptions of children's developmental capabilities gains in importance when one considers both the emerging research on expectancy and learning as well as the trend toward multi-source nondiscriminatory assessment as a basis for individualized program planning. This paper presents an adaptation of Iscoe and Payne's Functional Classification System which focuses upon profiling the differential subjective impressions of adults who interact with handicapped and non-handicapped preschoolers. A brief description of the profile is presented as well as its role in the screening, assessment, intervention, evaluation sequence. Preliminary research data on the measure's reliability and practicality are also cited.