Clinician Scores Research Articles

"How well do we know our patients?": Further validation of a complexity rating scale for HIV.

Despite advances in the management and treatment of HIV, identifying risks for disengagement are essential to maximize positive outcomes. The current study investigated the validity of the Clinical Complexity Rating Scale for HIV (CCRS-HIV), a risk-prediction tool, by assessing agreement between patient and clinician scores of patient complexity. 207 patients completed the patient version of the CCRS-HIV (CCRS-HIVP), and six Attending Medical Officers (AMOs) caring for those individuals completed the original clinician version (CCRS-HIVC). Kappa statistics, sensitivity and specificity were used to assess patient-clinician agreement. Patient-clinician agreement was highest for problematic crystal methamphetamine use (86%), polypharmacy (84%) and other physical health concerns (67%). Cut-offs of 40 and 45 for the total CCRS-HIV score were identified as most appropriate, with high sensitivity (79.31% and 76.0% respectively). Overall agreement between the clinician and patient complexity scores was high. These findings provide further evidence of the validity of the scale. The study demonstrates that the unique role of AMOs at the center contributes to them knowing their patients well, allowing them to manage and refer when required for interdisciplinary care which likely contributes to their ongoing engagement in care and may account for the high level of agreement.

Gynecomastia and Its Management In Boys With Partial Androgen Insensitivity Syndrome.

Partial androgen insensitivity syndrome (PAIS) is a rare condition that is reported to be commonly associated with gynecomastia in males. To assess the management of gynecomastia in male PAIS. Retrospective review of males with PAIS over the age of 10 years in the I-DSD registry. Of the 205 eligible cases, information was available for 57 from 13 centers. An androgen receptor gene variant was confirmed in 45 (79%) with a median age at first presentation of 1.0 year (range 0.1, 26.0). Of the 45 genetically confirmed cases, gynecomastia was present in 41 (91%) with a median age at the time of gynecomastia development of 13.5 years (11.0, 29.0). In the other 4 (9%) with no gynecomastia, the median age at last assessment was 15.7 years (10.6, 17.0). In 30 cases with information available, micropenis was present at the time of gynecomastia development in 23 (77%). Of the 35 with information available, 2 (6%) exhibited spontaneous resolution between the ages of 15 and 21 years and 25 (71%) had breast surgery at a median age of 15.7 years (14.0, 23.0). Of these 25, 9 (26%) had previously received medical therapy. The median clinician score of effectiveness for medical therapy was 3 (1, 8) compared to 10 (3, 10) for surgery (P < .0001). In 31 with information available, 13 (42%) had received psychology support. Gynecomastia is common in PAIS but not universal. Surgical management may be more effective than medical therapy, but there is a need for further standardized and systematic studies.

Co-designing discharge communication interventions for mental health visits to the pediatric emergency department: a mixed-methods study

BackgroundDischarge communication is essential to convey information regarding the care provided and follow-up plans after a visit to a hospital emergency department (ED), but it can be lacking for visits for pediatric mental health crises. Our objective was to co-design and conduct usability testing of new discharge communication interventions to improve pediatric mental health discharge communication.MethodsThe study was conducted in two phases using experience-based co-design (EBCD). In phase 1 (Sep 2021 to Jan 2022), five meetings were conducted with a team of six parents and two clinicians to co-design new ED discharge communication interventions for pediatric mental health care. Thematic analysis was used to identify patterns in team discussions and participant feedback related to discharge communication improvement and the Capability, Opportunity, Motivation, Behavior (COM-B) model was used to identify strategies to support the delivery of the new interventions. After meeting five, team members completed the Public and Patient Engagement Evaluation Tool (PPEET) to evaluate the co-design experience. In phase 2 (Apr to Jul 2022), intervention usability and satisfaction were evaluated by a new group of parents, youth aged 16–24 years, ED physicians, and nurses (n = 2 of each). Thematic analysis was used to identify usability issues and a validated 5-point Likert survey was used to evaluate user satisfaction. Evaluation results were used by the co-design team to finalize the interventions and delivery strategies.ResultsTwo discharge communication interventions were created: a brochure for families and clinicians to use during the ED visit, and a text-messaging system for families after the visit. There was high satisfaction with engagement in phase 1 (overall mean PPEET score, 4.5/5). In phase 2, user satisfaction was high (mean clinician score, 4.4/5; mean caregiver/youth score, 4.1/5) with both interventions. Usability feedback included in the final intervention versions included instructions on intervention use and ensuring the text-messaging system activates within 12–24 h of discharge.ConclusionsThe interventions produced by this co-design initiative have the potential to address gaps in current discharge practices. Future testing is required to evaluate the impact on patients, caregivers, and health care system use after the ED visit.

Drug Testing Interpretation in the Peripartum Setting: Results of Clinician Survey.

The objectives of this study were to (1) survey obstetrical and pediatric clinicians' experience, confidence, and training in maternal and neonatal drug testing interpretation; (2) determine their proficiency in drug test interpretation; and (3) assess predictors of correct interpretation. We conducted a cross-sectional survey of clinicians caring for pregnant people or newborns at an urban academic center. We assessed clinicians' demographic characteristics, experience, confidence, and prior training in interpretation of maternal and newborn drug tests. We assessed proficiency in interpreting drug tests using 11 clinical vignettes and categorized scores as poor (0-2), fair (3-5), and good (≥6) performance to facilitate data interpretation. We used descriptive statistics to summarize responses. Multinomial logistic regression was used to determine associations of clinician characteristics and score category (reference category: poor performance). In total, 103 respondents completed the survey including 60 obstetrical clinicians (58.3%), 19 family medicine physicians (18.5%), 21 pediatric clinicians (20.4%), and 3 social workers (2.9%) (response rate, ~40%). The mean correct response was 4.1 (SD, 2.17; range, 0-11). Most respondent scores were fair (n = 47.6%), followed by good (n = 28.2%) and poor (n = 24.3%). Increased frequency, confidence, and training in interpreting maternal screening and confirmatory tests were associated with higher proficiency. Increased confidence and training in interpreting neonatal screening and confirmatory tests, but not frequency, were associated with higher proficiency. Most clinicians demonstrated fair proficiency in interpreting drug tests. Predictors of proficiency were confidence and prior training for drug test interpretation, suggesting that educational interventions could improve proficiency.

Effect of Underlying Mental Health Disorders on the Correlation Between Patient- and Surgeon-Graded Synkinesis Scores.

Background: Little is known about how depression and appearance anxiety affect patient reporting of synkinesis severity. Learning/Study Objective: Measure prevalence of depression and appearance anxiety in facial synkinesis and correlations between subjective and surgeon-graded synkinesis severity. Design Type: Prospective cohort. Methods: Patients with synkinesis volunteered and completed: Synkinesis Assessment Questionnaire (SAQ), facial clinimetric evaluation (FaCE) scale, Center for Epidemiological Studies Depression Scale (CES-D), and Fear of Negative Appearance Evaluation Scale (FNAES). Standardized videos were scored by facial plastic surgeons using Sunnybrook Scale and eFaCE. Multivariate linear regression was used to compare patient- and surgeon-graded metrics. Results: One hundred patients participated, 91 were female. Mean age was 56.4 (12.3). Eight percent identified as Black and 87% White. The most common nerve injury etiology was idiopathic (47%). Mean synkinesis duration was 7.6 years (6.2). Twenty percent and 15% reported history of an anxiety or depressive disorder, respectively. Patient (SAQ, FaCE) and clinician (Sunnybrook, eFaCE) scores were correlated (Pearson's r 0.223-0.294, p < 0.05). Upon adjusting for CES-D/FNAES, correlations between most patient and clinician metrics became stronger. As CES-D and FNAES worsened, patient-clinician correlations weakened. Conclusions: Depression and appearance anxiety may affect patient reporting of synkinesis severity. Worse mental health scores may decorrelate patient and clinician synkinesis assessments.

Psychometric Properties of the Instrument for Scoring Clinical Outcomes of Research for Epidermolysis Bullosapatient score (iscorEB-p): a patient-reported outcome measure.

In contrast to clinical diagnosis via external examination, patient-related outcome measures (PROMs) allow access to patients' internal perceptions. In the case of epidermolysis bullosa (EB) - a rare disease characterized by a wide variety of symptoms and individual disease courses - it is important to integrate the patient's perspective into diagnostic processes. The Instrument for Scoring Clinical Outcomes of Research for EB (iscorEB) is an EB-specific measurement tool, combining a clinician score (iscorEB-c) and a patient questionnaire (iscorEB-p). The aim of this study is to establish the iscorEB-p as an independent PROM tool by exploring its psychometric properties. Sample-based psychometric testing and evaluation were performed on data collected via a multinational online cross-sectional study. Data analysis was performed with n = 95 participants across all EB types. The reliability and internal consistency of the iscorEB-p was excellent (α = 0.90). Principal component analysis with a varimax rotation resulted in a two-factor solution, explaining 55.6% of the total variance, with the distinct factors 'everyday life functioning' and 'specific EB symptoms'. Convergent validity was shown by high correlations to the Satisfaction With Life Scale (r = -0.52, P < 0.001), the Quality of Life in Epidermolysis Bullosa questionnaire (r = 0.72, P < 0.001) and the Epidermolysis Bullosa Family Burden of Disease questionnaire (r = -0.73, P < 0.001). The iscorEB-p is a reliable and valid instrument to assess patient-reported health status of people with EB.

Associations of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician and Group Survey Scores with Interventions and Site, Provider, and Patient Factors: A Systematic Review of the Evidence.

Patient experience is a key aspect of care quality. Since the 2007 release of the Consumer Assessment of Healthcare Providers and Systems Clinician and Group (CG-CAHPS) survey, no systematic review of factors associated with CG-CAHPS scores has been reported. We reviewed 52 peer-reviewed English language articles published in the United States using CG-CAHPS data. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and used the Checklist for Analytical Cross-Sectional Studies. We identified several interventions (eg, adding a care coordinator focused on chronic care management) associated with improved overall provider rating and 2 interventions (eg, peer shadow coaching) that improved provider communication scores. Studies evaluating the implementation of patient-centered medical homes or patient-reported outcomes found mixed results. We identified site-level factors (eg, better team communication) and provider-level factors (eg, physician empathy) associated with better patient experience. In contrast, patient-level factors (eg, medication adherence) found mixed associations with patient experience. Policymakers, clinicians, and healthcare leaders can leverage this evidence for quality improvement efforts and interventions supporting patient-centered care.

Evaluating the ability of a predictive vision-based machine learning model to measure changes in gait in response to medication and DBS within individuals with Parkinson’s disease

IntroductionGait impairments in Parkinson’s disease (PD) are treated with dopaminergic medication or deep-brain stimulation (DBS), although the magnitude of the response is variable between individuals. Computer vision-based approaches have previously been evaluated for measuring the severity of parkinsonian gait in videos, but have not been evaluated for their ability to identify changes within individuals in response to treatment. This pilot study examines whether a vision-based model, trained on videos of parkinsonism, is able to detect improvement in parkinsonian gait in people with PD in response to medication and DBS use.MethodsA spatial–temporal graph convolutional model was trained to predict MDS-UPDRS-gait scores in 362 videos from 14 older adults with drug-induced parkinsonism. This model was then used to predict MDS-UPDRS-gait scores on a different dataset of 42 paired videos from 13 individuals with PD, recorded while ON and OFF medication and DBS treatment during the same clinical visit. Statistical methods were used to assess whether the model was responsive to changes in gait in the ON and OFF states.ResultsThe MDS-UPDRS-gait scores predicted by the model were lower on average (representing improved gait; p = 0.017, Cohen’s d = 0.495) during the ON medication and DBS treatment conditions. The magnitude of the differences between ON and OFF state was significantly correlated between model predictions and clinician annotations (p = 0.004). The predicted scores were significantly correlated with the clinician scores (Kendall’s tau-b = 0.301, p = 0.010), but were distributed in a smaller range as compared to the clinician scores.ConclusionA vision-based model trained on parkinsonian gait did not accurately predict MDS-UPDRS-gait scores in a different PD cohort, but detected weak, but statistically significant proportional changes in response to medication and DBS use. Large, clinically validated datasets of videos captured in many different settings and treatment conditions are required to develop accurate vision-based models of parkinsonian gait.

Artificial Intelligence-Based Face Transformation in Patient Seizure Videos for Privacy Protection

ObjectiveTo investigate the feasibility and accuracy of artificial intelligence (AI) methods of facial deidentification in hospital-recorded epileptic seizure videos, for improved patient privacy protection while preserving clinically important features of seizure semiology. Patients and MethodsVideos of epileptic seizures displaying seizure-related involuntary facial changes were selected from recordings at Taipei Veterans General Hospital Epilepsy Unit (between August 1, 2020 and February 28, 2023), and a single representative video frame was prepared per seizure. We tested 3 AI transformation models: (1) morphing the original facial image with a different male face; (2) substitution with a female face; and (3) cartoonization. Facial deidentification and preservation of clinically relevant facial detail were calculated based on: (1) scoring by 5 independent expert clinicians and (2) objective computation. ResultsAccording to the clinician scoring of 26 facial frames in 16 patients, the best compromise between deidentification and preservation of facial semiology was the cartoonization model. A male facial morphing model was superior to the cartoonization model for deidentification, but clinical detail was sacrificed. Objective similarity testing of video data reported deidentification scores in agreement with the clinicians’ scores; however, preservation of semiology gave mixed results likely due to inadequate existing comparative databases. ConclusionArtificial intelligence-based face transformation of medical seizure videos is feasible and may be useful for patient privacy protection. In our study, the cartoonization approach provided the best compromise between deidentification and preservation of seizure semiology.

Association Between Clinician-Level Factors and Patient Outcomes in Virtual and In-Person Outpatient Treatment for Substance Use Disorders: Multilevel Analysis.

The use of virtual treatment services increased dramatically during the COVID-19 pandemic. Unfortunately, large-scale research on virtual treatment for substance use disorder (SUD), including factors that may influence outcomes, has not advanced with the rapidly changing landscape. This study aims to evaluate the link between clinician-level factors and patient outcomes in populations receiving virtual and in-person intensive outpatient services. Data came from patients (n=1410) treated in a virtual intensive outpatient program (VIOP) and an in-person intensive outpatient program (IOP), who were discharged between January 2020 and March 2021 from a national treatment organization. Patient data were nested by treatment providers (n=58) examining associations with no-shows and discharge with staff approval. Empathy, comfort with technology, perceived stress, resistance to change, and demographic covariates were examined at the clinician level. The VIOP (β=-5.71; P=.03) and the personal distress subscale measure (β=-6.31; P=.003) were negatively associated with the percentage of no-shows. The VIOP was positively associated with discharges with staff approval (odds ratio [OR] 2.38, 95% CI 1.50-3.76). Clinician scores on perspective taking (β=-9.22; P=.02), personal distress (β=-9.44; P=.02), and male clinician gender (β=-6.43; P=.04) were negatively associated with in-person no-shows. Patient load was positively associated with discharge with staff approval (OR 1.04, 95% CI 1.02-1.06). Overall, patients in the VIOP had fewer no-shows and a higher rate of successful discharge. Few clinician-level characteristics were significantly associated with patient outcomes. Further research is necessary to understand the relationships among factors such as clinician gender, patient load, personal distress, and patient retention.

Comparison of Endocrinologists' Physical Examination Documentation for In-person vs Video Telehealth Diabetes Visits.

Outpatient diabetes mellitus (DM) care over video telehealth (TH) requires modifications to how endocrinologists complete physical examinations (PEs). But there is little guidance on what PE components to include, which may incur wide variation in practice. We compared endocrinologists' documentation of DM PE components for in-person (IP) vs TH visits. Retrospective chart review of 200 notes for new patients with DM from 10 endocrinologists (10 IP and 10 TH visits each) in the Veterans Health Administration between April 1, 2020, and April 1, 2022. Notes were scored from 0 to 10 based on documentation of 10 standard PE components. We compared mean PE scores for IP vs TH across all clinicians using mixed effects models. Independent samples t-tests were used to compare both mean PE scores within clinician and mean scores for each PE component across clinicians for IP vs TH. We described virtual care-specific and foot assessment techniques. The overall mean (SE) PE score was higher for IP vs TH (8.3 [0.5] vs 2.2 [0.5]; P < .001). Every endocrinologist had higher PE scores for IP vs TH. Every PE component was more commonly documented for IP vs TH. Virtual care-specific techniques and foot assessment were rare. Our study quantifies the degree to which Pes for TH were attenuated among a sample of endocrinologists, raising a flag that process improvements and research are needed for virtual Pes. Organizational support and training could help increase PE completion via TH. Research should examine reliability and accuracy of virtual PE, its value to clinical decision-making, and its impact on clinical outcomes.

Deep Learning for the Assessment of Facial Nerve Palsy: Opportunities and Challenges.

Automated evaluation of facial palsy using machine learning offers a promising solution to the limitations of current assessment methods, which can be time-consuming, labor-intensive, and subject to clinician bias. Deep learning-driven systems have the potential to rapidly triage patients with varying levels of palsy severity and accurately track recovery over time. However, developing a clinically usable tool faces several challenges, such as data quality, inherent biases in machine learning algorithms, and explainability of decision-making processes. The development of the eFACE scale and its associated software has improved clinician scoring of facial palsy. Additionally, Emotrics is a semiautomated tool that provides quantitative data of facial landmarks on patient photographs. The ideal artificial intelligence (AI)-enabled system would analyze patient videos in real time, extracting anatomic landmark data to quantify symmetry and movement, and estimate clinical eFACE scores. This would not replace clinician eFACE scoring but would offer a rapid automated estimate of both anatomic data, similar to Emotrics, and clinical severity, similar to the eFACE. This review explores the current state of facial palsy assessment, recent advancements in AI, and the opportunities and challenges in developing an AI-driven solution.

Evaluation of fall risk and associated factors in patients with dementia

AbstractBackgroundFalling, which is common in the elderly and leads to negative consequences, can also be seen in dementia patients. The aim of this study is to determine the risk of falls in patients with dementia and to evaluate the factors associated with falls.MethodThe sample of this cross‐sectional study consisted of 95 patients with a diagnosis of definite dementia who attended a dementia outpatient clinic in a university hospital in Istanbul between January and March 2020. Patients using assistive devices while walking were not included in the study. A sociodemographic form, DENN Fall Risk Assessment Scale, Mini Mental State Test (MMSE), Neuropsychiatric Inventory (NPI), Apathy Assessment Scale (AES), Clinical Dementia Rating Scale (CDR), Cornell Depression in Dementia Scale (CSDD), Lawton and Brody Instrumental Activities of Daily Living (Lawton IADL), and Katz Activities of Daily Living (Katz ADL) Scale were used for data collection.ResultsIt was determined that 53.7% of the patients were female and the mean age was 73.1±11.4. Most of the patients (64.2%) had Alzheimer’s type dementia, 49.5% had mild or moderate dementia, 75.8% had an additional chronic disease, 22.1% were semi‐dependent in movement activity. 47.4% of the individuals had a history of fall in the last month, 48.9% had fallen at least 2 times, the average number of falls was 1.5±0.5, 70.5% of the patients had injuries after falling, and the mean DENN Fall Risk score was found to be 10.4±3.4. In the group with a history of falling non‐Alzheimer dementias were more common (p = 0.018), NPI symptom (p&lt;0.001) and bother (p&lt;0.001) scores were higher, Lawton IADL scores were lower (p = 0.009), AES clinician (p = 0.054) and caregiver (p = 0.052) scores and Cornell depression score (CSDD) (p = 0.005) were higher.ConclusionFalling, which is the most common geriatric syndrome in dementia patients, can lead to negative patient outcomes. Most dementia patients have a history of falling and post‐fall injury. Factors associated with falls in dementia patients should be known, and appropriate nursing interventions should be made to prevent falls by recognizing the risk of falling. More work is needed on this subject.

The Association of Organizational Readiness With Lung Cancer Screening Utilization

Lung cancer screening is widely underutilized. Organizational factors, such as readiness for change and belief in the value of change (change valence), may contribute to underutilization. The aim of this study was to evaluate the association between healthcare organizations' preparedness and lung cancer screening utilization. Investigators cross-sectionally surveyed clinicians, staff, and leaders at10 Veterans Affairs from November 2018 to February 2021 to assess organizational readiness to implement change. In 2022, investigators used simple and multivariable linear regression to evaluate the associations between facility-level organizational readiness to implement change and change valence with lung cancer screening utilization. Organizational readiness to implement change and change valence were calculated from individual surveys. The primary outcome was the proportion of eligible Veterans screened using low-dose computed tomography. Secondary analyses assessed scores by healthcare role. The overall response rate was 27.4% (n=1,049), with 956 complete surveys analyzed: median age of 49 years, 70.3% female, 67.6% White, 34.6% clinicians, 61.1% staff, and 4.3% leaders. For each 1-point increase in median organizational readiness to implement change and change valence, there was an associated 8.4-percentage point (95% CI=0.2, 16.6) and a 6.3-percentage point increase in utilization (95% CI= -3.9, 16.5), respectively. Higher clinician and staff median scores were associated with increased utilization, whereas leader scores were associated with decreased utilization after adjusting for other roles. Healthcare organizations with higher readiness and change valence utilized more lung cancer screening. These results are hypothesis generating. Future interventions to increase organizations' preparedness, especially among clinicians and staff, may increase lung cancer screening utilization.

A Computer Method for Pronation-Supination Assessment in Parkinson's Disease Based on Latent Space Representations of Biomechanical Indicators.

One problem in the quantitative assessment of biomechanical impairments in Parkinson's disease patients is the need for scalable and adaptable computing systems. This work presents a computational method that can be used for motor evaluations of pronation-supination hand movements, as described in item 3.6 of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS). The presented method can quickly adapt to new expert knowledge and includes new features that use a self-supervised training approach. The work uses wearable sensors for biomechanical measurements. We tested a machine-learning model on a dataset of 228 records with 20 indicators from 57 PD patients and eight healthy control subjects. The test dataset's experimental results show that the method's precision rates for the pronation and supination classification task achieved up to 89% accuracy, and the F1-scores were higher than 88% in most categories. The scores present a root mean squared error of 0.28 when compared to expert clinician scores. The paper provides detailed results for pronation-supination hand movement evaluations using a new analysis method when compared to the other methods mentioned in the literature. Furthermore, the proposal consists of a scalable and adaptable model that includes expert knowledge and affectations not covered in the MDS-UPDRS for a more in-depth evaluation.

E086 Comparing ankylosing spondylitis disease activity during the COVID-19 pandemic using patient-reported outcome measures with face-to-face clinical evaluation of disease scores pre-pandemic

Abstract Background/Aims During the COVID-19 pandemic, asynchronous consultations were introduced for patients with ankylosing spondylitis (AS). To assess disease activity in the absence of face-to-face clinical review and blood testing, patients submitted patient-reported outcome measures (PROMs) via electronic survey forms which were subsequently triaged by clinicians. We compared pre-pandemic clinician-reported scores with intra-pandemic self-reported scores and assessed clinical outcomes including allocation of follow-up and further management/treatment escalation. Methods Clinician-reported scores were obtained in-person pre-pandemic (defined as 01/01/2019-01/03/2020). Self-reported BASDAI scores were submitted by patients via electronic forms sent out during-pandemic (defined as 01/12/2020-31/03/22). The responses were stored and analysed in a secure database. These scores are analogous to disease activity scores completed by clinicians during outpatient appointments. Score comparison was performed using Wilcoxon Sign Rank testing. We used the need for a follow-up within 3 months as target for those with severe disease. Data analysis was performed in Microsoft Excel and R (version 4.2.1). Results We noted a significantly higher overall level of patient-reported disease activity during the pandemic. In the total cohort of AS patients, the median BASDAI Score collected during-pandemic increased from 5.30 (n = 124, range 0-10) compared to 2.80 pre-pandemic (n = 590, range 0-12) (p &amp;lt; 0.001). The proportion of patients with severe/active disease (defined as BASDAI &amp;gt;4) increased from 36% pre- to 65% during pandemic. In a smaller cohort of 34 patients for whom we had both pre- and during-pandemic scores, all patient parameters worsened during the pandemic. Notably, median BASDAI increased from 2.65 to 5.62 (p &amp;lt; 0.0001). Patients with severe AS increased from 10 (29.4%) to 21 (61.8%) intra-pandemic. Follow-up data was available for 12/21 patients with severe AS during-pandemic. 7/12 patients (58%) received a follow-up appointment within one month; 11/12 (91%) were seen within three months. On subsequent clinician assessment, only 7 (58%) of patients with self-reported severe AS were felt to have active disease; treatment was escalated for 3 patients. Conclusion There was a significantly higher reported level of AS disease activity during the COVID-19 pandemic, with 62 % of patients qualifying for biologic therapy (BASDAI &amp;gt;4). In a focussed sample, 91% of patients with new severe disease during-pandemic were followed up within the target of 3 months. The BASDAI score is independent from clinical examination and inflammatory markers, and therefore self-reported score should reliably reflect a patient’s perception of disease activity. Further work is required to determine the reason for the increased disease activity observed during pandemic, and for the disparity between clinician impression and score results. Disclosure D.A. Kurzeja: None. K. Song: None. M. Mirza: None. M. Ashraf: None. L. James: None. A. Verdiyeva: None. R. Luqmani: None.

Influence of Patient and Clinician Gender on Emergency Department HEART Scores: A Secondary Analysis of a Prospective Observational Trial

Clinical decision aids can decrease health care disparities. However, many clinical decision aids contain subjective variables that may introduce clinician bias. The HEART score is a clinical decision aid that estimates emergency department (ED) patients' cardiac risk. We sought to explore patient and clinician gender's influence on HEART scores. In this secondary analysis of a prospective observational trial, we examined a convenience sample of adult ED patients at one institution presenting with acute coronary syndrome symptoms. We compared ED clinician-generated HEART scores with researcher-generated HEART scores blinded to patient gender. The primary outcome was agreement between clinician and researcher HEART scores by patient gender overall and stratified by clinician gender. Analyses used difference-in-difference (DiD) for continuous score and prevalence-adjusted, bias-adjusted Kappa (PABAK) for binary (low versus moderate/high risk) score comparison. All 336 clinician-patient pairs from the original study were included. In total, 47% (158/336) of patients were women, and 52% (174/336) were treated by a woman clinician. The DiD between clinician and researcher HEART scores among men versus women patients was 0.24 (95% CI-0.01 to 0.48). Compared with researchers, men clinicians assigned a higher score to men versus women patients (DiD 0.51 [95% CI 0.16 to 0.87]), whereas women clinicians did not (DiD 0.00 [95% CI-0.33 to 0.33]). Agreement was the highest among women clinicians (PABAK 0.72; 95% CI 0.61 to 0.81) and lowest among men clinicians assessing men patients (PABAK 0.47; 95% CI 0.29 to 0.66). Patient and clinician gender may influence HEART scores. Researchers should strive to understand these influences in developing and implementing this and other clinical decision aids.

Validation of a pictorial-based range of motion self-assessment tool in shoulder arthroplasty

BackgroundRange of Motion (ROM) assessment is a key method of assessing recovery progress in shoulder arthroplasty. The development of a reliable patient-based self-assessment tool for ROM could reduce the need for clinician dependent modes of outcome assessment after shoulder arthroplasty, allowing for greater optimization of healthcare resources including physician and clinic time. The primary aim of this study was to test the validity and reliability of a pictorial-based patient self-assessment of ROM in postshoulder arthroplasty in terms of the correlation between patient-based and clinician-based ROM assessments. The secondary aim was to determine the relationship between patient- and clinician-based ROM assessment with corresponding patient-reported outcome measures (PROMs). MethodsThis was a cross-sectional study of 126 patients identified from a list of patients scheduled for an elective shoulder arthroplasty postsurgery follow-up visit. Patients completed a pictorial-based ROM self-assessment questionnaire where they identified pictorial diagrams best representing their active shoulder ROM. Shoulder ROM was then assessed by a clinician with a goniometer, and PROMs including the Oxford Shoulder Score, American Shoulder and Elbow Surgeons score, pain score, and satisfaction score were measured. Intraclass correlation coefficients (ICCs) were used to assess interobserver agreement between the clinician and patient-based ROM scores. Pearson correlation and multiple regression analyses were used to analyze the relationship between measured ROM and PROM scores. ResultsStrong correlation was found between patient and clinician measured ROM for forward flexion (ICC = 0.70) and internal rotation (ICC = 0.72), while moderate correlation was noted for abduction (ICC = 0.66) and external rotation (ICC = 0.58). Patients tended to overestimate their shoulder ROM for all four measured movements. Both patient and clinician measured ROM were significantly correlated with PROMs, with forward flexion and abduction being the most correlated with PROMs (coefficient = 0.313-0.544) compared to other ROMs. The questionnaire difficulty was rated as “Very easy,” “Easy,” or “OK” by 96.8% (122/126) of patients. ConclusionsThis pictorial-based ROM self-assessment questionnaire found moderate to high agreement of patient-clinician measured ROM and correlation between measured ROM and PROMs. This easy-to-use self-assessment tool may prove useful in increasing convenience and compliance to outcome assessment in shoulder arthroplasty.

Agreement of Clinician-Administered and Modified Parent-Administered House-Brackmann Scales in Children with Bell's Palsy.

Currently there is no parent administered scale for facial nerve function in children. We set out to assess the agreement between a newly developed parent-administered modified version of the House-Brackmann (HB) scale and the standard clinician-administered HB scale in children with Bell's palsy. Secondary analysis of a triple-blind, randomized, placebo-controlled trial of corticosteroids to treat idiopathic facial paralysis (Bell's palsy) in children (6 months to <18 years). Multicenter study at pediatric hospitals with recruitment in emergency departments. Children were recruited within 72 hours of symptom onset and assessed using the clinician-administered and the parent-administered modified HB scales at baseline, and at 1, 3, and 6 months until recovered. Agreement between the 2 scales was assessed using intraclass coefficient (ICC) and a Bland-Altman plot. Data were available for 174 of the 187 children randomized from at least 1 study time point. The mean ICC between clinician and parent HB scores across all time points was 0.88 (95% confidence interval, CI: 0.86, 0.90). The ICC for the data collected at baseline was 0.53 (95% CI: 0.43, 0.64), at 1 month was 0.88 (95% CI: 0.84, 0.91), at 3 months was 0.80 (95% CI: 0.71, 0.87) and at 6 months was 0.73 (95% CI: 0.47, 0.89). A Bland-Altman plot indicated a mean difference between the 2 scores (clinician-reported minus parent-reported) of only -0.07 (95% limits of agreement -1.37 to 1.23). There was good agreement between the modified parent-administered and the clinician-administered HB scales.

An Evaluation of KELVIN, an Artificial Intelligence Platform, as an Objective Assessment of the MDS UPDRS Part III.

Parkinson's disease severity is typically measured using the Movement Disorder Society Unified Parkinson's disease rating scale (MDS-UPDRS). While training for this scale exists, users may vary in how they score a patient with the consequence of intra-rater and inter-rater variability. In this study we explored the consistency of an artificial intelligence platform compared with traditional clinical scoring in the assessment of motor severity in PD. Twenty-two PD patients underwent simultaneous MDS-UPDRS scoring by two experienced MDS-UPDRS raters and the two sets of accompanying video footage were also scored by an artificial intelligence video analysis platform known as KELVIN. KELVIN was able to produce a summary score for 7 MDS-UPDRS part 3 items with good inter-rater reliability (Intraclass Correlation Coefficient (ICC) 0.80 in the OFF-medication state, ICC 0.73 in the ON-medication state). Clinician scores had exceptionally high levels of inter-rater reliability in both the OFF (0.99) and ON (0.94) medication conditions (possibly reflecting the highly experienced team). There was an ICC of 0.84 in the OFF-medication state and 0.31 in the ON-medication state between the mean Clinician and mean Kelvin scores for the equivalent 7 motor items, possibly due to dyskinesia impacting on the KELVIN scores. We conclude that KELVIN may prove useful in the capture and scoring of multiple items of MDS-UPDRS part 3 with levels of consistency not far short of that achieved by experienced MDS-UPDRS clinical raters, and is worthy of further investigation.