Chronic classification

Apply Summation of Classified Components approach (see 4.1.3.5.5) for chronic classification (Chronic 1, 2, 3, 4 or no need of chronic classification) ... 

A9.7.1.6 Speciation of the soluble form can be affected by pH, water hardness and other variables, and may yield particular forms of the metal ion which are more or less toxic. In addition, metal ions could be made non-available from the water column by a number of processes (e.g. mineralization and partitioning). Sometimes these processes can be sufficiently rapid to be analogous to degradation in assessing chronic classification. However, partitioning of the metal ion from the water column to other environmental media does not necessarily mean that it is no longer bioavailable, nor does it mean that the metal has been made permanently unavailable. 

Class 11 or critical machinery would severely limit production capacity. As a mle-of-thumb, loss of critical machinery would reduce production capacity by 30 per cent or more. Also included in the critical classification are machines or systems with chronic maintenance histories or that have high repair or replacement costs. 

Diagnostic criteria for inhalant use disorders in DSM-IV-TR are similar to those in the International Classification of Diseases, Tenth Revision (ICD-10) (World Health Organization 1992). These criteria include biological, cognitive, and behavioral dimensions. The DSM-IV-TR diagnosis of inhalant dependence is given when three or more of the seven criteria are present (see Table 8-2). The first criteria to be considered here are tolerance and withdrawal. These phenomena are considered to be forms of adaptation to chronic administration of these compounds and were discussed extensively earlier in this chapter. 

In chronic asthma, classification of asthma severity is based on daytime and nighttime symptoms, physical activity, lung function (PEF or FEVfi, PEF variability, and reliever medication use. Because lung function is difficult to measure in preschool children (children 5 years of age or younger), it cannot be used to classify disease severity in this age group. Chronic asthma is classified as mild intermittent asthma, or mild, moderate or severe persistent asthma (Table 11-1). 

TABLE 23-1. NKF-DOQI Classification for Chronic Kidney Disease... 

Levey AS, Coresh J, Balk E, et al. National Kidney Foundation practice guidelines for chronic kidney disease Evaluation, classification, and stratification. Ann Intern Med 2003 139(2) 137-147. 

An alternative classification, the Cierny-Mader staging system, is based on anatomic site and physiologic status of the patient.1 This classification scheme was developed for chronic osteomyelitis involving long bones and has limited application for small bones and digits. The detailed stratification has the greatest utility in clinical trials since it would permit comparison of treatment regimens in patients with diverse comorbidities and infection sites. 

APACHE II Acute Physiology and Chronic Health Evaluation II a severity of disease classification system using a point score based on initial values of 12 routine physiologic measurements, age, and previous health status used to provide a general measure of disease severity. 

Kleinman (1986) claimed that neurasthenia was a cultural form of chronic somatization that outlined several different types of psychopathological disorders, the major depressive disorder included in western classifications being the one that best accounted for this disorder. This would explain the lower rate of prevalence of the diagnosis of depressive disorder among the Chinese population. 

There are various severity of illness scoring systems for sepsis and trauma (R11). Severity scoring can be used, in conjunction with other risk factors, to anticipate and evaluate outcomes, such as hospital mortality rate. The most widely used system is the Acute Physiology, Age, Chronic Health Evaluation II (APACHE II) classification system (K12). The APACHE III was developed to more accurately predict hospital mortality for critically ill hospitalized adults (K13). It provides objective probability estimates for critically ill hospitalized patients treated in intensive care units (ICUs). For critically ill posttrauma patients with sepsis or SIRS, another system for physiologic quantitative classification and severity stratification of the host defense response was described recently (R11). However, this Physiologic State Severity Classification (PSSC) has yet not been applied routinely in ICU setting. 

Liver biopsies for pathologic classification as chronic persistent hepatitis, chronic active hepatitis, or cirrhosis. 

Morphologic classifications are based on cell size. Macrocytic cells are larger than normal and are associated with deficiencies of vitamin B12 or folate. Microcytic cells are smaller than normal and are associated with iron deficiency whereas normocytic anemia may be associated with recent blood loss or chronic disease. 

The diagnosis of chronic bronchitis is based primarily on clinical assessment and history. By definition, any patient who reports coughing up sputum on most days for at least 3 consecutive months each year for 2 consecutive years suffers from chronic bronchitis. Table 43-1 presents a classification and treatment scheme for chronic bronchitis. 

Classification System for Patients with Chronic Bronchitis and Initial Treatment Options... 

A study of 25 patients with chronic granulomatous disease A new classification by correlating respiratory burst, cytochrome b, and flavoprotein. J. Clin. Immunol. 6, 136-45. 

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