Simple Classification System Research Articles

Acute lens opacity induced by different kinds of anesthetic drugs in mice.

To study whether specific anesthetic drugs or tear layer evaporation was primarily responsible for the acute cataract and what the change of lens structure is in anesthetized mice. Five groups were set up in the experiment: Group A (topicamide and phenylephrine mixed eye drop+ chloral hydrate), Group B (tropicamide and phenylephrine mixed eye drop+sevoflurane), Group C (tropicamide and phenylephrine mixed eye drop), Group D (topicamide and phenylephrine mixed eye drop+chloral hydrate, carbomer eye drop in the right eyes), and Group E (tropicamide and phenylephrine mixed eye drop+sevoflurane, carbomer eye drop in the right eyes). A simple classification system was used to assess the severity of lens opacity. And a numerical value from 0 to 3 to each grade was assigned for the cataract index calculation and data analysis. The gross appearance and time course of development of lens opacity were assessed. Hematoxylin and eosin staining was used to observe the lens structure changes in the reversible cataract. Tropicamide did not induce lens opacification in mice. Lens opacity caused by inhaled sevoflurane was similar to injected cholral hydrate. Both inhaled-anesthetic-induced lens opacity and injected-anesthetic-induced lens opacity could be prevented by carbomer eye drop. In the severe opacity lens, a wide range of lens fiber cell structure had disordered. The fiber cells became uneven thickness. The acute reversible lens opacity can unilaterally develop or be induced by a local cause. The structure of lens fiber cells changed in the lens opacity which may influence the permanent connection of the lens fiber cells. This study was not only of practical significance to help maintain lens transparency for eye research, but also of the deeper consideration about the reversible lens opacification phenomenon.

Two column classification of tibial plateau fractures; description, clinical application and reliability

PurposeIn this era of life highly comminuted and multi planar tibial plateau fractures involving the posterior corners are more commonly seen and addressed in the literature than before. Among these several types have not been described in the currently used classification systems. In fact simple classification systems ignore several fracture types and leniently grouped the fractures with different mechanism, morphology, treatment modalities and prognosis in same category. On the other hand, more extensive nature classifications with detailed subdivisions are difficult to remember for clinicians. The clinical reliability of these classifications is another problem. All these issues demand the potential need of a new classification. The aim of this study was to describe a quadrant specific two column classification of tibial plateau fractures and to analyse its inter-observer and intra-observer reliability, clinical assessment and application. Materials and methodsFrom January 2009 to December 2015, 44 patients with tibial plateau fractures were studied retrospectively. The antero-posterior (AP), lateral X-rays and computed tomography (CT) with axial transverse, sagittal, coronal and three dimensional (3D) reconstruction images were performed for all the patients. All of the fractures were categorized according to quadrant specific two column classification and the traditional Schatzker’s classification. The comparative analysis for inter-observer and intra-observer reliability of the new classification and the Schatzker’s classification was conducted by four observers. ResultsThree cases didn’t match any type in the Schatzker’s classification. While on the other hand, all cases were classified by two column classification. The mean kappa values for inter-observer reliability by using the Schatzker’s classification was 0.723 (range, 0.674-0.823), representing substantial agreement, whereas the mean kappa value was 0.939 (range: 0.897-0.974), representing almost perfect agreement according to two column classification. The mean kappa values for intra-observer reliability using the Schatzker’s classification and two column classification were 0.789 (range: 0.590-0.864) and 0.955 (range:0.923-0.948) showing substantial agreement and almost perfect agreement. ConclusionThe quadrant specific two column classification is anatomically oriented, CT based and clinically valid. The different fracture types according to anatomic location are represented alphanumerically so that treatment matched to specific fracture type (quadrant specific anatomic fixation) for optimal outcomes. Furthermore, it demonstrates higher inter-observer and intra-observer reliability. This classification can be adopted to strengthen the traditional Schatzker’s classification, particularly in the multi planar and posteriorly extended plateau fractures. It can be used as a reliable research tool. The database can be used to distinguish different fracture types, individual type incidences, specific treatment and also prognosis. Authors suggest a large multi-centre study.

The left atrial appendage morphology is associated with embolic stroke subtypes using a simple classification system: A proof of concept study

Background and purposeThe current left atrial appendage (LAA) classification system (cLAA-CS) categorizes it into 4 morphologies: chicken wing (CW), windsock, cactus, and cauliflower, though there is limited data on either reliability or associations between different morphologies and stroke risk. We aimed to develop a simplified LAA classification system and to determine its relationship to embolic stroke subtypes. MethodsConsecutive patients with ischemic stroke from a prospective stroke registry who previously underwent a clinically-indicated chest CT were included. Stroke subtype was determined and LAA morphology was classified using the traditional system (in which CW = low risk) and a new system (LAA-H/L, in which low risk morphology (LAA-L) was defined as an acute angle bend or fold from the proximal/middle portion of the LAA and high risk morphology (LAA-H) was defined as all others). As a proof of concept study, we determined reliability for the two classification systems, and we assessed the associations between both classification systems with stroke subtypes in our cohort and previous studies. ResultsWe identified 329 ischemic stroke patients with a qualifying chest CT (126 cardioembolic subtype, 116 embolic stroke of undetermined source (ESUS), and 87 non-cardioembolic subtypes). Intra- and inter-rater agreements improved using the LAA-H/L (0.95 and 0.85, respectively) vs. cLAA-CS (0.50 and 0.40). The LAA-H/L led to classifying 69 LAA morphologies that met criteria for CW as LAA-H. In fully adjusted models, LAA-H was associated with cardioembolic stroke (OR 5.4, 95%CI 2.1–13.7) and ESUS (OR 2.8 95% CI 1.2–6.4). Non-CW morphology was also associated with embolic stroke subtypes, but the effect size was much less pronounced. Studies using the cLAA-CS yielded mixed results for inter- and intra-rater agreements but most showed an association between a non-CW morphology and stroke with no difference among the three non-CW subtypes. ConclusionThe LAA-H/L classification system is simple, has excellent intra and inter-rater agreements, and may help risk identify patients with cardioembolic stroke subtypes. Larger studies are needed to validate these findings.

Limb salvage in diabetic foot disease: A classification to aid successful reconstruction

Diabetes is a global epidemic. If poorly managed, innocuous injury in a diabetic foot leads to intractable ulceration, bone and joint destruction and subsequent major amputation. It is estimated that every week in the UK there are 100 lower limb amputations of which 80 could have been prevented had diabetes been better managed. It is widely recognised that prevention is critical; nonetheless diabetic foot lesions continue to increase in prevalence. Reconstruction of diabetic foot lesions has a dismal reputation despite promising published work. Reconstruction in the correctly chosen patient can be successful. Multiple classification systems and scores have been published, but these do not guide the clinician as to which lesions are reconstructible, and those in which attempts to salvage are futile. These patients would be better served with primary amputation. A tertiary referral centre's experience of diabetic foot reconstruction over 7 years is presented in a series of 22 consecutive patients who were assessed using a new classification system. Twenty-four flaps were performed all of which were either complex (n = 7) or complicated (n = 17) wounds as per our classification. Five patients (22%) had donor site healing problems, but only one flap (5%) in the series failed. Average follow-up was 23 months (range 4-75 months) and all patients were ambulant at discharge. Our simple classification system and aggressive approach to excision and reconstruction of diabetic foot lesions is a useful adjunct to existing systems, and helps promote the cause that limb salvage is warranted in these challenging cases when appropriately managed.

Feasibility of a simplified narrow-band imaging classification system for Barrett's esophagus for novice endoscopists.

Narrow-band imaging (NBI) classifications for Barrett's esophagus have been proposed for the detection of early esophageal adenocarcinoma. We developed a simplified classification system with demonstrated high diagnostic accuracy and reproducibility among experienced endoscopists, but the feasibility of this system among novice endoscopists was unclear. In the present study, eight novice endoscopists with no experience of magnification endoscopy were asked to review 248 images of Barrett's esophagus (72 dysplastic, 176 non-dysplastic) obtained using high-definition magnification endoscopy with NBI 6weeks before (1st test), immediately after (2nd test), and 6weeks after (3rd test) being taught the simplified classification system. The primary outcomes were differences in diagnostic accuracy for dysplasia among the three tests. The specificity and overall accuracy improved significantly in the 2nd vs. 1st test [97% vs. 80% (p < 0.001) and 94% vs. 82% (p < 0.001), respectively], but sensitivity was comparable (87% in both tests; p = 0.42). In the 3rd test, the sensitivity and overall accuracy decreased significantly compared with the 2nd test [82% vs. 87% (p < 0.001) and 93% vs. 94% (p < 0.05), respectively], but there was no significant difference in specificity (97% in both tests; p = 0.16). The kappa values for interobserver agreement for the mucosal pattern, vascular pattern, and predicted histology were substantial, and improved significantly in the 2nd vs. 1st test (0.78 vs. 0.59, 0.70 vs. 0.53, and 0.79 vs. 0.66, respectively; p < 0.001 for all). The simplified NBI classification system may be appropriate for novice endoscopists to use in providing high accuracy and reproducibility.

RMS-MP3 Classification: A Newly Proposed Digital MP3 Classification in Assessing Skeletal Maturity.

ABSTRACTBackgroundGrowth is a crucial inconsistent parameter, which is a primary requisite in diagnosing and planning orthodontic and orthopedic treatment. The use of the epiphyseal development of the middle phalanx of the third finger (MP3) radiograph is advisable instead of hand and wrist radiographs for growth assessment.Aim(1) To propose a simple, precise, and reliable classification system of MP3 staging—RMS MP3 classification and (2) to check the reliability of newly proposed RMS-MP3 classification in assessing the skeletal maturity.Materials and methodsStandardized MP3 digital radiographs of 276 children between 5 years and 13 years of age were included in the study. The epiphysis and diaphysis were measured, and the percentage of epiphysis formed when compared to diaphysis was obtained using our formula. A new classification was designed and proposed. The assessment of the MP3 developmental stages was carried out by all the four investigators (two pedodontists and two nonpedodontists) according to the older classification by Liete et al. and the newly proposed RMS-MP3 classification.ResultsAmong nonpedodontists, there was 51% perfect agreement of maturity stages according to old classification and 90% perfect agreement according to newly proposed classification. Among pedodontists, there was 90% perfect agreement of maturity stages according to old classification and 99% perfect agreement according to the newly proposed classification. An estimated 89% of agreement was seen in RMS-MP3 classification among all the four observers when compared to 38% of agreement in the old classification.ConclusionThe newly proposed RMS-MP3 classification can be an alternative and perfect aid in assessing growth with accuracy, precision, ease, and an increased reliability.How to cite this articleShetty RM, Hanumanta S. RMS-MP3 Classification: A Newly Proposed Digital MP3 Classification in Assessing Skeletal Maturity. Int J Clin Pediatr Dent 2019;12(4):255–260.

Machine learning to predict final fire size at the time of ignition.

Fires in boreal forests of Alaska are changing, threatening human health and ecosystems. Given expected increases in fire activity with climate warming, insight into the controls on fire size from the time of ignition is necessary. Such insight may be increasingly useful for fire management, especially in cases where many ignitions occur in a short time period. Here we investigated the controls and predictability of final fire size at the time of ignition. Using decision trees, we show that ignitions can be classified as leading to small, medium or large fires with 50.4 ± 5.2% accuracy. This was accomplished using two variables: vapour pressure deficit and the fraction of spruce cover near the ignition point. The model predicted that 40% of ignitions would lead to large fires, and those ultimately accounted for 75% of the total burned area. Other machine learning classification algorithms, including random forests and multi-layer perceptrons, were tested but did not outperform the simpler decision tree model. Applying the model to areas with intensive human management resulted in overprediction of large fires, as expected. This type of simple classification system could offer insight into optimal resource allocation, helping to maintain a historical fire regime and protect Alaskan ecosystems.

A New Functional Scale and Ambulatory Functional Classification of Duchenne Muscular Dystrophy: Scale Development and Preliminary Analyses of Reliability and Validity

ObjectiveTo develop a simplified functional scale and classification system to evaluate the functional abilities of patients with Duchenne muscular dystrophy (DMD).MethodsA Comprehensive Functional Scale for DMD (CFSD) was developed using the modified Delphi method. The accompanying Ambulatory Functional Classification System for DMD (AFCSD) was developed based on previously published classification systems.ResultsThe CFSD consists of 21 items and 78 sub-items, assessing body structure and function, activities, and participation. Inter-rater intraclass correlation coefficient values were above 0.7 for 17 items. The overall limits of agreement between the two examiners ranged from -6.21 to 3.11. The Spearman correlation coefficient between the total score on the AFCSD and the Vignos Functional Scale was 0.833, and 0.714 between the total score of the AFCSD and the Brooke scale. Significant negative correlations existed between the total score for each functional level of the AFCSD and each functional grade of the Vignos and Brooke scales. The total scores of the CFSD varied significantly between the functional grades of the Vignos scale, and specific grades of the Brooke scale. For the AFCSD, total scores of the CFSD varied significantly between the functional levels.ConclusionWe have developed a new scale and the associated classification system, to assess the functional ability of children diagnosed with DMD. Preliminary evaluation of the psychometric properties of the functional scale and classification systems indicate sufficient reliability and concurrent validity.

Retroclival Arachnoid Cysts: Case Series, Literature Review, and New Classification Proposal

The retroclival region is among the rarest locations for an arachnoid cyst (AC), with only a few reported cases. No accepted classification system is available for these rare cysts. Such a classification system would solve the nomenclature problem and could result in easier and more systematic management. We reviewed and analyzed data from databases and reported studies of retroclival ACs (RACs) and have proposed a classification system. A retrospective review of RACs was conducted in Marmara and Adiyaman University Hospitals, Turkey. Cysts in the prepontine and/or premedullary cisterns that spared the chiasmatic cistern were included. Additionally, the reported data were searched for relevant studies on cysts. The findings were analyzed to establish a clear nomenclature and classification system, and the clinical presentations, treatment strategies, and surgical approaches were reviewed. We identified 1 adult and 1 pediatric patient, and only the adult had undergone surgery. Additional data searches yielded 14 patients with RACs. The cysts were classified as type 1 if they had extended superiorly beyond the borders of the diencephalic leaf of the Liliequist membrane. If they had not extended, they were classified as type 2. Finally, type 2 cysts that had extended to the anterior spinal cistern were classified as type3. RACs can be more easily and systematically managed using a simple clinical classification system. Together with the previously proposed suprasellar AC classification, our proposed RAC classification should be adequate to classify all ACs in the ventral midline cistern, which could solve the nomenclature problem.

Virtual chromoendoscopy by using optical enhancement improves the detection of Barrett’s esophagus–associated neoplasia

The Seattle protocol for endoscopic Barrett's esophagus (BE) surveillance samples a small portion of the mucosal surface area, risking a potentially high miss rate of early neoplastic lesions. We assessed whether the new iScan Optical Enhancement system (OE) improves the detection of early BE-associated neoplasia compared with high-definition white-light endoscopy (HD-WLE) in both expert and trainee endoscopists to target sampling of suspicious areas. Such a system may both improve early neoplasia detection and reduce the need for random biopsies. A total of 41 patients undergoing endoscopic BE surveillance from January 2016 to November 2017 were recruited from 3 international referral centers. Matched still images in both HD-WLE (n= 130) and iScan OE (n= 132) were obtained from endoscopic examinations. Two experts, unblinded to the videos and histology, delineated known neoplasia, forming a consensus criterion standard. Seven expert and 7 trainee endoscopists marked 1 position per image where they would expect a target biopsy to identify dysplastic tissue. The same expert panel then reviewed magnification images and, using a previously validated classification system, attempted to classify mucosa as dysplastic or nondysplastic, based on the mucosal and vascular (MV) patterns observed on magnification endoscopy. Diagnostic accuracy, sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated. Improvements in dysplasia detection in HD-WLE versus OE and interobserver agreement were assessed by multilevel logistic regression analysis and Krippendorff alpha, respectively. Improvements in diagnostic performance were expressed as an odds ratio between the odds of improvement in OE compared with the odds of improvement in HD-WLE. Accuracy of neoplasia detection was significantly higher in all trainees who used OE versus HD-WLE (76% vs 63%) and in 6 experts (84% vs 77%). OE improved sensitivity of dysplasia detection compared with HD-WLE in 6 trainees (81% vs 71%) and 5 experts (77% vs 67%). Specificity improved in 6 trainees who used OE versus HD-WLE (70% vs 55%) and in 5 experts (92% vs 86%). PPV improved in both an expert and trainee cohort, but NPV improved significantly only in trainees. By using the MV classification and OE magnification endoscopy compared with HD-WLE, we demonstrated improvements in accuracy (79.9% vs 66.7%), sensitivity (86.3% vs 83.4%), and specificity (71.2% vs 53.6%) of dysplasia detection. PPV improved (62%-76.6%), as did NPV (67.7%-78.5%). Interobserver agreement also improved by using OE from 0.30 to 0.55. iScan OE may improve dysplasia detection on endoscopic imaging of BE as well as the accuracy of histology prediction compared with HD-WLE, when OE magnification endoscopy is used in conjunction with a simple classification system by both expert and non-expert endoscopists.

Learning lessons: how to practice nudging around the world

The aim of this article is to cover three things: (1) to introduce the context behind why a report prepared by the Organisation for Economic Co-operation and Development (OECD) in 2017 would be of such importance to researchers in various academic disciplines and public policy, (2) to present the details of a simple classification system that was applied to all 111 case studies of behavioural interventions (better known as nudges) referred to in the OECD (2017a) report, and (3) to discuss what needs to be done to help advance practitioners’ pursuit of effective behavioural interventions. This article aims to highlight the importance of accurately cataloguing the types of behavioural interventions that have been trialled/implemented across the world. By adopting an agreed classification system, researchers and practitioners can benefit from knowing what can work, and where it can work, as well as what does not work, in order to be better armed when considering the use of behavioural interventions to solve social policy issues.

Machine Learning Creates a Simple Endoscopic Classification System that Improves Dysplasia Detection in Barrett's Oesophagus amongst Non-expert Endoscopists.

Introduction Barrett's oesophagus (BE) is a precursor to oesophageal adenocarcinoma (OAC). Endoscopic surveillance is performed to detect dysplasia arising in BE as it is likely to be amenable to curative treatment. At present, there are no guidelines on who should perform surveillance endoscopy in BE. Machine learning (ML) is a branch of artificial intelligence (AI) that generates simple rules, known as decision trees (DTs). We hypothesised that a DT generated from recognised expert endoscopists could be used to improve dysplasia detection in non-expert endoscopists. To our knowledge, ML has never been applied in this manner. Methods Video recordings were collected from patients with non-dysplastic (ND-BE) and dysplastic Barrett's oesophagus (D-BE) undergoing high-definition endoscopy with i-Scan enhancement (PENTAX®). A strict protocol was used to record areas of interest after which a corresponding biopsy was taken to confirm the histological diagnosis. In a blinded manner, videos were shown to 3 experts who were asked to interpret them based on their mucosal and microvasculature patterns and presence of nodularity and ulceration as well as overall suspected diagnosis. Data generated were entered into the WEKA package to construct a DT for dysplasia prediction. Non-expert endoscopists (gastroenterology specialist registrars in training with variable experience and undergraduate medical students with no experience) were asked to score these same videos both before and after web-based training using the DT constructed from the expert opinion. Accuracy, sensitivity, and specificity values were calculated before and after training where p < 0.05 was statistically significant. Results Videos from 40 patients were collected including 12 both before and after acetic acid (ACA) application. Experts' average accuracy for dysplasia prediction was 88%. When experts' answers were entered into a DT, the resultant decision model had a 92% accuracy with a mean sensitivity and specificity of 97% and 88%, respectively. Addition of ACA did not improve dysplasia detection. Untrained medical students tended to have a high sensitivity but poor specificity as they “overcalled” normal areas. Gastroenterology trainees did the opposite with overall low sensitivity but high specificity. Detection improved significantly and accuracy rose in both groups after formal web-based training although it did it reach the accuracy generated by experts. For trainees, sensitivity rose significantly from 71% to 83% with minimal loss of specificity. Specificity rose sharply in students from 31% to 49% with no loss of sensitivity. Conclusion ML is able to define rules learnt from expert opinion. These generate a simple algorithm to accurately predict dysplasia. Once taught to non-experts, the algorithm significantly improves their rate of dysplasia detection. This opens the door to standardised training and assessment of competence for those who perform endoscopy in BE. It may shorten the learning curve and might also be used to compare competence of trainees with recognised experts as part of their accreditation process.

Decreased Probability of Error in Template-Matching Classification Using Aspect-Diverse Bistatic SAR

We extend the concept of monostatic aspect diversity for improved automatic target recognition (ATR) to a bistatic synthetic aperture radar (SAR) platform. We derive the probability of error with respect to the number of aspects used for a simple two-target template-matching classification system. The validity of the error prediction is confirmed using simulated bistatic SAR images. Our results demonstrate the ATR benefits of supplementing monostatic SAR images with one or more bistatic SAR images.

Similarities and differences in surface receptor expression by THP-1 monocytes and differentiated macrophages polarized using seven different conditioning regimens

Macrophages are key in orchestrating immune responses to micro-environmental stimuli, sensed by a complex set of surface receptors. The human cell line THP-1 has a monocytic phenotype, including the ability to differentiate into macrophages, providing a tractable, standardised surrogate for human monocyte-derived macrophages. Here we assessed the expression of 49 surface markers including Fc, complement, C-type lectin and scavenger receptors; TIMs; Siglecs; and co-stimulatory molecules by flow cytometry on both THP-1 monocytes and macrophages and following macrophage activation with seven standard conditioning/polarizing stimuli. Of the 34 surface markers detected on macrophages, 18 altered expression levels on activation. From these, expression of 9 surface markers were consistently altered by all conditioning regimens, while 9 were specific to individual polarizing stimuli. This study provides a resource for the study of macrophages and highlights that macrophage polarization states share much in common and the differences do not easily fit a simple classification system.

A Simplified Adult Acquired Buried Penis Repair Classification System With an Analysis of Perioperative Complications and Urethral Stricture Disease

ObjectiveTo propose a simple classification system for buried penis repairs and present an analysis of perioperative data based on category. MethodsPatients undergoing buried penis repair at a single institution were examined. Classification was as follows: Category I—penile unburying with local flap; II—skin graft; III—scrotal surgery; IV—escutcheonectomy; V—abdominal panniculectomy. Complex repairs were Category III or above. Success was defined as an unburied penis without additional unburying surgery. ResultsBetween 2007 and 2017, 64 patients underwent repair with 44 (69%) considered complex. Patients undergoing complex repairs had a higher body mass index (median 48 vs 36 kg/m2, P < .01). A total of 30 patients (47%) had urethral strictures, with no association to buried penis complexity (P = .43). High-grade complications (Clavien ≥ 3) occurred in 10 patients (23%) in the high-complexity group with none in the low-complexity group (P = .02). Seven of 10 (70%) of high-grade complications were wound related. Successful unburying was seen in 58 patients (91%). All failures occurred in the high-complexity group. Median follow-up was 209 days. ConclusionBuried penis repairs are highly successful. We propose a classification based on surgical complexity. Patients requiring complex repairs have higher body mass index and increased risk of high-grade complications. While urethral strictures are found in nearly half of patients, there is no association with the severity of disease. Ongoing modifications of technique and perioperative care may improve outcomes.

Unified classification of open fractures: Based on Gustilo and OTA classification schemes

BackgroundThe Orthopaedic Trauma Association (OTA) classification scheme for open fractures has improved precision, validity and reliability over the modified Gustilo classification system. However, it needs to be modified into a simple and practical classification system to gain widespread acceptance and application. Material and methodsWe devised a new “unified” classification of open fractures based on the Gustilo and OTA classification systems. The new classification was tested for interobserver reliability on five different fractures classified by 15 surgeons each using the Krippendorff’s alpha. Preference of surgeons for the Gustilo, OTA and unified classifications was assessed. ResultsThe new classification showed excellent interobserver reliability (α = 0.93). A significantly higher number of surgeons expressed preference for the new over the Gustilo and OTA classifications for routine clinical use. ConclusionThe new “unified” classification of open fractures has good validity, reliability and acceptability, and has the potential to replace all other existing classification systems.

Review of medication errors that are new or likely to occur more frequently with electronic medication management systems.

Objective The aim of the present study was to identify and quantify medication errors reportedly related to electronic medication management systems (eMMS) and those considered likely to occur more frequently with eMMS. This included developing a new classification system relevant to eMMS errors. Methods Eight Victorian hospitals with eMMS participated in a retrospective audit of reported medication incidents from their incident reporting databases between May and July 2014. Site-appointed project officers submitted deidentified incidents they deemed new or likely to occur more frequently due to eMMS, together with the Incident Severity Rating (ISR). The authors reviewed and classified incidents. Results There were 5826 medication-related incidents reported. In total, 93 (47 prescribing errors, 46 administration errors) were identified as new or potentially related to eMMS. Only one ISR2 (moderate) and no ISR1 (severe or death) errors were reported, so harm to patients in this 3-month period was minimal. The most commonly reported error types were 'human factors' and 'unfamiliarity or training' (70%) and 'cross-encounter or hybrid system errors' (22%). Conclusions Although the results suggest that the errors reported were of low severity, organisations must remain vigilant to the risk of new errors and avoid the assumption that eMMS is the panacea to all medication error issues. What is known about the topic? eMMS have been shown to reduce some types of medication errors, but it has been reported that some new medication errors have been identified and some are likely to occur more frequently with eMMS. There are few published Australian studies that have reported on medication error types that are likely to occur more frequently with eMMS in more than one organisation and that include administration and prescribing errors. What does this paper add? This paper includes a new simple classification system for eMMS that is useful and outlines the most commonly reported incident types and can inform organisations and vendors on possible eMMS improvements. The paper suggests a new classification system for eMMS medication errors. What are the implications for practitioners? The results of the present study will highlight to organisations the need for ongoing review of system design, refinement of workflow issues, staff education and training and reporting and monitoring of errors.

Time of metastatic disease presentation and volume of disease are prognostic for metastatic hormone sensitive prostate cancer (mHSPC).

Currently, there is no universally accepted prognostic classification for patients (pts) with metastatic hormone sensitive prostate cancer (mHSPC) treated with androgen deprivation therapy (ADT). Subgroup analyses demonstrated that pts with low volume (LV), per CHAARTED trial definition, mHSPC, and those who relapse after prior local therapy (PLT) have longer overall survival (OS) compared to high volume (HV) and de-novo (DN), respectively. Using a hospital-based registry, we aimed to assess whether a classification based on time of metastatic disease (PLT vs DN) and disease volume (LV vs HV) are prognostic for mHSPC pts treated with ADT. A retrospective cohort of consecutive patients with mHSPC treated with ADT between 1990 and 2013 was selected from the prospectively collected Dana-Farber Cancer Institute database and categorized as DN or PLT and HV or LV, at time of ADT start. Primary and secondary endpoints were OS and time to castration-resistant prostate cancer (CRPC), respectively, which were measured from date of ADT start using Kaplan-Meier method. Multivariable Cox proportional hazards models using known prognostic factors was used. The analytical cohort consisted of 436 patients. The median OS and time to CRPC for PLT/LV were 92.4 (95%CI: 80.4-127.2) and 25.6 (95%CI: 21-35.7) months and 43.2 (95%CI: 37.2-56.4) and 12.2 (95%CI: 9.8-14.8) months for DN/HV, respectively, whereas intermediate values were observed for PLT/HV and DN/LV. A robust gradient for both outcomes was observed (Trend test P < 0.0001) in the four groups. In a multivariable analysis, DN presentation, HV, and cancer-related pain were independent prognostic factors. In our hospital-based registry, time of metastatic presentation and disease volume were prognostic for mHSPC pts treated with ADT. This simple prognostic classification system can aid patient counseling and future trial design.

Classifications in Brief: Regan-Morrey Classification of Coronoid Fractures.

Classifications in Brief: Regan-Morrey Classification of Coronoid Fractures.

The validation of simplified EEG derived from the bispectral index monitor in post-cardiac arrest patients

AimsWe aimed to validate retrospectively the accuracy of simplified electroencephalography (EEG) monitoring derived from the bispectral index (BIS) monitor in post-cardiac arrest (CA) patients. MethodsSuccessfully resuscitated CA patients were transferred to the Catherization Lab followed by percutaneous coronary intervention when indicated. On arrival at the coronary care unit, bilateral BIS monitoring was started and continued up to 72 h. Raw simplified EEG tracings were extracted from the BIS monitor at a time point coinciding with the registration of standard EEG monitoring. BIS EEG tracings were reviewed by two neurophysiologists, who were asked to indicate the presence of following patterns: diffuse slowing rhythm, burst suppression pattern, cerebral inactivity, periodic epileptiform discharges and status epilepticus (SE). Additionally, these simplified BIS EEG tracings were analysed by two inexperienced investigators, who were asked to indicate the presence of SE only. ResultsThirty-two simplified BIS EEG samples were analysed. Compared to standard EEG, neurophysiologists interpreted all simplified EEG samples with a sensitivity of 86%, a specificity of 100% and an interobserver variability of 0.843. Furthermore, SE was identified with a sensitivity of 80% and a specificity of 94% by two unexperienced physicians. ConclusionUsing a simple classification system, raw simplified EEG derived from a BIS monitoring device is comparable to standard EEG monitoring. Moreover, investigators without EEG experience were capable to identify SE in post-CA patients. Future studies will be warranted to confirm our results and to determine the added value of using simplified BIS EEG in terms of prognostic and therapeutic implications.