Cohen's Coefficient Research Articles

A new computer-based Farnsworth Munsell 100-hue test for evaluation of color vision

To evaluate a computer-based Farnsworth-Munsell (FM) 100-hue test and compare it with a manual FM 100-hue test in normal and congenital color-deficient individuals. Fifty color defective subjects and 200 normal subjects with a best-corrected visual acuity ≥ 6/12 were compared using a standard manual FM 100-hue test and a computer-based FM 100-hue test under standard operating conditions as recommended by the manufacturer after initial trial testing. Parameters evaluated were total error scores (TES), type of defect and testing time. Pearson's correlation coefficient was used to determine the relationship between the test scores. Cohen's kappa was used to assess agreement of color defect classification between the two tests. A receiver operating characteristic curve was used to determine the optimal cut-off score for the computer-based FM 100-hue test. The mean time was 16 ± 1.5 (range 6-20) min for the manual FM 100-hue test and 7.4 ± 1.4 (range 5-13) min for the computer-based FM 100-hue test, thus reducing testing time to <50 % (p < 0.05). For grading color discrimination, Pearson's correlation coefficient for TES between the two tests was 0.91 (p < 0.001). For color defect classification, Cohen's agreement coefficient was 0.98 (p < 0.01). The computer-based FM 100-hue is an effective and rapid method for detecting, classifying and grading color vision anomalies.

Assignment of tumor subtype by genomic testing and pathologic-based approximations: implications on patient’s management and therapy selection

Breast cancer subtypes can be identified by genomic testing or pathology-based approximations. However, these classifications are not equivalent and the clinical relevance of both classifications needs to be fully explored. Ninety-four patients were randomized to neoadjuvant single agent doxorubicin or docetaxel. Tumor subtype was assessed by pathology-based classification and by gene expression using the PAM50 plus the claudin-low predictor (CLP). Kappa Cohen's coefficient (κ) was used to test the agreement between methods. Multivariate Cox proportional hazards analyses were used to determine the significance of each methodology in the prediction of prognosis. Likelihood ratio statistics of both classifications were evaluated. The agreement between pathology-based classification and PAM50 was moderate [κ = 0.551, 95 % confidence interval (95 % CI) 0.467-0.641]. Tumor subtype assessed by both classifications were prognostic for overall survival (OS) and relapse-free survival (P < 0.05). However, PAM50 + CLP provided more prognostic information, in terms of OS, than the pathology-based classification (P < 0.05). Patients with triple negative tumors as well as basal-like tumors had worse OS when first treated with doxorubicin (HR = 5.98, 95 % CI 1.25-28.67, and HR = 5.02, 95 % CI 0.96-26.38, respectively). However, claudin-low tumors did not show significant differences in OS according to neoadjuvant treatment branch. Indeed, we found that claudin-low tumors treated with pre-operative doxorubicin had significantly better OS than basal-like tumors treated with neoadjuvant doxorubicin (adjusted HR = 0.16, 95 % CI 0.04-0.69, P = 0.014). The assignment of tumor subtype can differ depending on the methodology, which might have implications on patient's management and therapy selection.

Mini-FLOTAC and Kato-Katz: helminth eggs watching on the shore of lake Victoria

BackgroundOne of the challenges for monitoring helminth control programmes based on preventive chemotherapy is the lack of a copro-parasitological gold–standard method that combines good sensitivity with quantitative performance, low cost, and easy-to-learn technique.The aim of our study was to evaluate and compare, the WHO recommended quantitative diagnostic technique (Kato-Katz) and the Mini-FLOTAC.MethodsMini-FLOTAC is an innovative method based on floatation of helminths eggs with two different solutions (FS2 and FS7) using a close system (Fill-FLOTAC) with 5% fixative. Kato-Katz was performed following WHO recommendation. The study was carried out in a rural part of Tanzania, close to Lake Victoria, where the laboratory facilities are fairly scarce, and the basic technique used in the local laboratory (direct smear) was taken as reference standard.Results201 children were screened for intestinal helminths and 91% of them were found to be positive. The agreement among the three techniques was calculated with k Cohen coefficient and was fairly good (k = 0.4), although the Mini-FLOTAC results were more sensitive for hookworm (98%) with FS2, and for S.mansoni (90%) with FS7 followed by Kato-Katz (91% and 60% respectively) and direct smear (30% and 10% respectively). A good agreement was found between Mini-FLOTAC and Kato-Katz (k = 0.81) with FS7 (k = 0.76) for hookworm diagnosis and a fairly good one for S.mansoni diagnosis (k = 0.5). For both infections we had a poor agreement between the two quantitative techniques and the direct smear (k<0.3). Kato-Katz diagnosed a higher number of eggs (calculated by arithmetic mean) both for hookworm (455 vs 424 EPG) and for S.mansoni (71 vs 58 EPG) compared with the Mini-FLOTAC, but the differences were not significant (p = 0.4).ConclusionsMini-FLOTAC is a promising technique, comparable and as sensitive as the Kato-Katz, which is the recommended method in intestinal helminthology for monitoring helminth control programmes. A comparative advantage of the Mini-FLOTAC is that it comprises of a closed system with preserved samples that both protects the operators and allows subsequent examination of the samples. Further studies are needed to validate the mini-FLOTAC with other quantitative techniques (McMaster) and in different settings where other soil-transmitted helminths are also endemic.

Correlation between response to neoadjuvant chemotherapy and survival in locally advanced breast cancer patients

Measurement of residual disease following neoadjuvant chemotherapy that accurately predicts long-term survival in locally advanced breast cancer (LABC) is an essential requirement for clinical trials development. Several methods to assess tumor response have been described. However, the agreement between methods and correlation with survival in independent cohorts has not been reported. We report survival and tumor response according to the measurement of residual breast cancer burden (RCB), the Miller and Payne classification and the Response Evaluation Criteria in Solid Tumors (RECIST) criteria, in 151 LABC patients. Kappa Cohen's coefficient (К) was used to test the agreement between methods. We assessed the correlation between the treatment outcome and overall survival (OS) and relapse-free survival (RFS) by calculating Harrell's C-statistic (c). The agreement between Miller and Payne classification and RCB classes was very high (К = 0.82). In contrast, we found a moderate-to-fair agreement between the Miller and Payne classification and RECIST criteria (К = 0.52) and RCB classes and RECIST criteria (К = 0.38). The adjusted C-statistic to predict OS for RCB index (0.77) and RCB classes (0.75) was superior to that of RECIST criteria (0.69) (P = 0.007 and P = 0.035, respectively). Also, RCB index (c = 0.71), RCB classes (c = 0.71) and Miller and Payne classification (c = 0.67) predicted better RFS than RECIST criteria (c = 0.61) (P = 0.005, P = 0.006 and P = 0.028, respectively). The pathological assessment of tumor response might provide stronger prognostic information in LABC patients.

Measuring adverse event rates in oncology inpatients using trigger tools: An assessment of measurement properties.

235 Background: The Institute for Healthcare Improvement developed the Global Trigger Tool (GTT) for measuring harm rates over time in 2006. Few studies have been published on the measurement properties of GTT and no studies have assessed the value of adding specific modules to the generic GTT. We, therefore, aimed to determine inter-rater reliability, and to evaluate the effect of interrater variation on the reliability of the generic GTT to detect adverse event rates over time. Furthermore to evaluate the effect of adding an oncology specific module to the generic GTT on number and category of adverse events (AEs) identified. Methods: A retrospective chart review was performed by two teams consisting of two primary reviewers. One team used the general GTT, and the other used an oncology specific GTT (GTTO); consisting of the general GTT module plus an additional oncology module. A random sample of 10 charts was selected every two weeks between all discharged patients from a Department of Oncology in 2010. n=240. All charts were reviewed by both teams using standard GTT methods and measures. AEs per 1,000 admission days and AEs per 100 admissions where used to draw Statistical process control (SPC) charts for evaluation of the patient safety process. Inter-rater variability between review teams was assessed calculating the Kappa Cohen coefficient using data from the identical general GTT module. Results: Reliability between the two teams of reviewers to identify an AE was moderate [K=0.45]. A comparison of SPC charts, using the results from the identical general module, showed that moderate agreement gave rise to different conclusions on the patient safety process between teams. Comparing GTT with GTTO we found no significant difference (CI 95% [0.06-0.08]) in number of identified AEs and an equal distribution of the events on harm categories. GTT and GTTO identified 56 and 57 AEs respectively. Conclusions: Moderate agreement between review teams gave rise to different conclusions on the patient safety process suggesting limited use of the GTT to track harm rates over time. Addition of an oncology specific module showed no significant effect on the total number or distribution of AEs on harm categories.

Pixel‐oriented land use classification in energy balance modelling

Mass and energy transfer between soil, vegetation and atmosphere is the process that allows to maintain an adequate energy and water balance in the earth–atmosphere system. However, the evaluation of the energy balance components, such as the net radiation and the sensible and latent heat fluxes, is characterized by significant uncertainties related to both the dynamic nature of heat transfer processes and surfaces heterogeneity. Therefore, a detailed land use classification and an accurate evaluation of vegetation spatial distribution are required for an accurate estimation of these variables. For this purpose, in the present article, a pixel‐oriented supervised classification was applied to obtain land use maps of the Basilicata region in Southern Italy by processing three Landsat TM and ETM+ satellite images. An accuracy analysis based on the overall accuracy index and the agreement Khat of Cohen coefficient showed a good performance of the applied classification methodology and a good quality of the obtained maps. Subsequently, these maps were used in the application of a simplified two‐source energy balance model for estimating the actual evapotranspiration at a regional scale. The comparison between the simulations made by applying the simplified two‐source energy balance model and the measurements of evapotranspiration at a lysimetric station located in the study area showed the applicability and the validity of the proposed methodology. Copyright © 2012 John Wiley &amp; Sons, Ltd.

P5-11-05: Measurement of Neoadjuvant Chemotherapy Tumor Response in Locally Advanced Breast Cancer by Three Methodologies. Correlation with Overall Survival.

Abstract Background Measurement of residual disease following neoadjuvant chemotherapy that accurate predicts long-term survival in locally advanced breast cancer (LABC) is an essential requirement for new drugs efficacy evaluation. Several methods to assess neoadjuvant chemotherapy tumor response have been described. However, to our knowledge, agreement between methods and correlation with survival in independent prospective cohorts has not been reported. Patients &amp; Methods: In this study we report neoadjuvant chemotherapy tumor response and survival in 151 consecutive LABC patients, included in a neoadjuvant clinical trial (http://www.clinicaltrials.gov; NCT00123929). Patients were randomized to either neoadjuvant docetaxel 100 mg/m2 every 21 days or neoadjuvant doxorubicin 75mg/m2, every 21 days, for 4 cycles. Following surgery, response was established according to three methodologies: the measurement of residual breast cancer burden (RBC) as described by Symman's (Symmans WF et al. J Clin Oncol. 2007;25:4414–22), Miller and Payne classification (Ogston KN et al. Breast. 2003;12:320–7) and RECIST criteria. Regarding to Symmans classification we have evaluate both RBC index, as a continuous variable, and RBC classes as a categorical variable (RBC-0,I,II,III). Kappa Cohen's coefficient (K) was used to test agreement between methods. We assessed the correlation between treatment outcome and overall survival (OS) by calculating the Harrell's C- statistic. Results: Median of follow up was 51.9 months. All three methods showed a moderate capacity to classify patients according to OS. The C-statistic to predict OS was 0.76 (IC: 0.67- 0.84) for RBC index and 0.71 (IC: 0.64−0.78) for RBC classes, 0.68 (IC: 0.58−0.78) for RECIST criteria and 0.69 (0.60−0.78) for Miller and Payne classification. Interesting, we did not encountered any death events within RCB-0 class. No significant differences were found between C-statistic when patients were stratified according to therapy. In order to assess the agreement between techniques, we grouped categories 1 and 2 of Miller and Payne classification in 1 category. The agreement between Miller and Payne classification and Symmans method was very high (K=0.87). In contrast, we found a moderate-fair agreement between Miller and Payne classification and RECIST criteria (K=0.46) and Symmans method and RECIST criteria (K=0.27). Conclusion: All three methods predicted fairly well OS. RCB-0 identified the best outcome group. The agreement between methodologies based in pathology analyses was very high. However, the agreement falls off when these methodologies were compared with RECIST criteria. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-11-05.

Enhancement pattern of small hepatocellular carcinoma (HCC) at contrast-enhanced US (CEUS), MDCT, and MRI: Intermodality agreement and comparison of diagnostic sensitivity between 2005 and 2010 American Association for the Study of Liver Diseases (AASLD) guidelines

ObjectiveTo evaluate agreement between contrast-enhanced ultrasound (CEUS), multi-detector row computed tomography (MDCT) and magnetic resonance imaging (MRI) for the assessment of typical and atypical enhancement patterns of small hepatocellular carcinoma (HCC); and to compare diagnostic sensitivity of 2005 and 2010 American Association for the Study of Liver Diseases (AASLD) guidelines. Materials and methodsBetween January 2008 and December 2009, we included cirrhotic patients with newly diagnosed 10–20mm HCC imaged at two contrast-enhanced imaging techniques among CEUS, MDCT, and MRI. Dynamic studies were reviewed by two radiologists to assess enhancement pattern. Percentage of cases with concordant findings and Cohen coefficient (k) were calculated. McNemar's test was used to compare sensitivity between 2005 and 2010 AASLD guidelines. ResultsThere were 91 patients (69 M; 22 F; mean age, 68 years) with 96 HCCs, studied with a combination of CEUS and MDCT (n=59), CEUS and MRI (n=26), or MDCT and MRI (n=11). Intermodality agreement for assessment of tumor enhancement pattern was 67% (k=0.294, P=0.001). Typical enhancement pattern was detected coincidentally at two imaging modalities in 50 (52%) HCCs. Sensitivity for the diagnosis of HCC increased significantly using the 2010 AASLD (81/96 (84%) vs. 50/96 (52%), P<0.001). ConclusionsAgreement between two imaging modalities for the detection of typical tumor enhancement pattern was reached in 52% of cases. The 2010 AASLD guidelines significantly increased the sensitivity for the diagnosis of HCC.

Comparación de dos métodos para la recogida de datos clínicos utilizando el cuestionario de PAINOUT (base de datos europea para la gestión del dolor postoperatorio)

ObjectiveTo compare postoperative pain intensity and incidence of adverse events when the evaluation is performed by a visual numerical scale completed by the patient (PAINOUT), or using a verbal numerical scale completed by ward nurses or the staff of the acute pain unit. MethodsFifty-two postsurgical patients of both sexes (age range 31–80 years) admitted to the general surgery ward were sequentially recruited and evaluated on postoperative day 1. All patients were assessed using both questionnaires, which measure postoperative outcomes using scales of 0 to 10; values≥4 were considered clinically relevant. The test and Cohen coefficient were used for statistical analysis. ResultsUsing the PAINOUT questionnaire, the mean maximum intensity of referred pain was 5.40 (range, 0–10) and the minimum intensity was 1.83 (range, 0–5). Mean values obtained with the verbal numerical scales used by staff on the ward and in the pain clinic were 3.76 (range, 0–10) and 0.97 (range, 0–5), respectively. The differences between the 2 methods of pain assessment were statistically (P=.006) and clinically significant. When evaluating nausea with PAINOUT questionnaire, all patients provided a response; in 88.5% the intensity was less than 4. Six patients reported nausea on the PAINOUT but not in the UDA questionnaire. Moreover, 61% of patients reported drowsiness/sedation in PAINOUT instrument, whereas none reported that effect on the verbal scale. ConclusionsThe intensity of pain and adverse events is significantly higher when the patient evaluates and records its intensity on visual numerical scales compared with verbal numerical scales.

Validation of self-reported motor-vehicle crash and related work leave in a multi-purpose prospective cohort

Validation studies about self-reported motor vehicle crashes and related work leave are scarce. The Seguimiento Universidad de Navarra (SUN) is a multi-purpose cohort study undertaken in Spain. Motor vehicle crash risk factors are assessed within it. The objective of this study was to validate the incidents of self-reported motor vehicle crashes (MVC) and related work leave through mailing and clinical notes' review. The method included questions in the cohort's questionnaire regarding motor vehicle crash incident and work leave. We made both a re-test and a criterion validity study for self-reported answers. The results show a moderate κ Cohen's correlation coefficient for both events. Re-test reliability κ for MVC was 0.55, for MVC-related work leave it was 0.53. Criterion validity κ was 0.25 for MVC and 0.25 for MVC-related work leave. These results show a moderate agreement for re-test both for MVC and work MVC-related leave. For criterion validity, the results show a fair agreement. The magnitude of the agreement is similar to other similar studies and allows the use of these data in epidemiological studies.

Fiabilité des mesures anthropométriques dans le suivi de la croissance à base communautaire des enfants en milieu rural au Rwanda

Background In Rwanda, the community-based growth-monitoring program is implemented via volunteer community nutrition workers. These volunteers are recruited from within their communities, and receive basic training prior to providing services. Utilizing local volunteers improves access to basic nutrition services, and allows the local health jurisdictions to use qualified health care staff more efficiently. In addition to concerns raised in regards to the accountability of unpaid workers, some question the relevance of the data that is collected. We carried out a nutritional survey in the catchment area of Ruli District Hospital to evaluate the reliability of the community nutrition workers’ measurements of anthropometric standards collected within the growth-monitoring framework. Methods A nutritional survey was recently organized in the catchment area of the hospital in December 2006. The prevalence rates of malnutrition from the survey were compared with those from the existing community-based growth-monitoring program. Z-test was used to compare the prevalence rate of underweight from the survey with the prevalence rate determined by data collected from community nutrition workers. The concordance of children classified with moderate and severe underweight in each data set was determined by the coefficient Kappa of Cohen. Results Our findings show that the recent survey reported an overall underweight prevalence rate of 27.2%. Community data calculated a prevalence rate of 28.8% for the same population. The difference is not statistically significant ( P = 0.294). Of 724 children evaluated, the survey and the community were in agreement in regards to 454 children classified in the category of good nutritional status, 143 children classified in moderate underweight and 11 children classified in the severe underweight category. The Kappa of Cohen coefficient of 0.636 indicates strong concordance between data sets. Conclusion Anthropometric measurements provided by the community are reliable. Information gathered from the community can be used for epidemiologic monitoring of malnutrition. To ensure continued reliability, health centers must provide sufficient and permanent training to community nutrition workers. In addition, continued access to essential materials used for measuring nutritional status and maintenance of these materials will be crucial to the program's ongoing success.

High signal in bone marrow at diffusion-weighted imaging with body background suppression (DWIBS) in healthy children

In our experience, diffusion-weighted imaging with body background suppression (DWIBS) is hard to interpret in children who commonly have foci of restricted diffusion in their skeletons unrelated to pathology, sometimes in an asymmetrical pattern. This raises serious concern about the accuracy of DWIBS in cancer staging in children. To describe the signal distribution at DWIBS in the normal developing lumbar spine and pelvic skeleton. Forty-two healthy children underwent an MR DWIBS sequence of the abdomen and pelvis. An axial short-tau inversion-recovery (STIR) echo-planar imaging (EPI) pulse sequence was used. Two radiologists did a primary review of the images and based on these preliminary observations, separate scoring systems for the lumbar spine, pelvis and proximal femoral epiphyses/femoral heads were devised. Visual evaluation of the images was then performed by the two radiologists in consensus. The scoring was repeated separately 2months later by a third radiologist. Restricted diffusion was defined as areas of high signal compared to the background. Coronal maximum intensity projection (MIP) reformats were used to assess the vertebral bodies. For the pelvis, the extension of high signal for each bone was given a score of 0 to 4. Cohen's Kappa interobserver agreement coefficients of signal distribution and asymmetry were calculated. All children had areas of high signal, both within the lumbar vertebral bodies and within the pelvic skeleton. Three patterns of signal distribution were seen in the lumbar spine, but no specific pattern was seen in the pelvis. There was a tendency toward a reduction of relative area of high signal within each bone with age, but also a widespread interindividual variation. Restricted diffusion is a normal finding in the pelvic skeleton and lumbar spine in children with an asymmetrical distribution seen in 48% of normal children in this study. DWIBS should be used with caution for cancer staging in children as this could lead to high numbers of false positive findings or even unjustified upstaging.

Congruence between clinical and research-based psychiatric assessment in bariatric surgical candidates

Background Mental health professionals have become increasingly involved in working with bariatric surgical candidates, particularly in performing preoperative psychological evaluations to clear candidates for surgery. The objective of the present study was to examine the concordance of the psychiatric diagnoses obtained during routine clinical evaluation before bariatric surgery and the diagnoses obtained separately at a research facility using the Structured Clinical Interview for DSM (Diagnostic and Statistical Manual of Mental Disorders)-IV axis I disorders. Methods The study included 68 consecutively enrolled bariatric surgical candidates who had participated in the Longitudinal Assessment of Bariatric Surgery-3 study. The Structured Clinical Interview for DSM disorders data obtained from the research assessments were compared with the diagnostic data from the routine preoperative psychiatric evaluations. The congruence of the current and lifetime diagnoses was assessed using Cohen's coefficient kappa. Results Considerable variability was found among the major diagnostic categories, with generally poor agreement found for the current diagnoses. The kappa coefficients tended to be larger for the lifetime diagnoses. The agreement was moderate for any lifetime mood disorder, with a kappa value of 0.45. Regarding any lifetime anxiety, substance use, and eating disorder, the clinical diagnoses rarely concurred with the results from the Structured Clinical Interview for DSM disorders, with a kappa statistic of 0.30, 0.36, and 0.32, respectively. Conclusion The congruence between the diagnoses assigned during the routine clinical psychiatric evaluations and research assessment using the Structured Clinical Interview for DSM disorders was surprisingly low. These conclusions should be considered tentative, given the interval and the possibility of treatment having occurred between the 2 evaluations. Overall, these data raise interesting questions concerning the use of unstructured psychiatric evaluations before bariatric surgery.

High concordance between self-reported medication and official prescription database information

We set out to compare the agreement between self-reported psychotropic medication use and information obtained from the administrative prescription database of the Social Insurance Institution of Finland. We compared the point prevalence of psychotropic medication use, and self-reported vs. register-based information on antipsychotic medication dosage. The study population consisted of 905 participants from a population-based genetic study of schizophrenia, of whom 366 had schizophrenia spectrum disorder, 56 had bipolar spectrum disorder, and 483 were unaffected family members. Current medication use was obtained by interview and from the prescription reimbursement database. Agreement between data sources was compared using Cohen's kappa statistic and correlation coefficients. The agreement between the two sources was generally good. Kappa values were best for lithium use (0.96; p < 0.0001), followed by antipsychotics (0.87; p < 0.0001) and antidepressants (0.77; p < 0.0001). Agreement was lowest for benzodiazepines (0.42; p < 0.0001). Correlation between antipsychotic medication dose estimates was 0.79 (95% CI 0.76-0.81). The concordance between self-reported psychotropic medication use and information obtained from an official prescription database was good for most psychotropic drugs. More studies are needed to replicate results with other forms of medication and patient groups.

A self-administered questionnaire of ulnar neuropathy at the elbow

We report a new self-administered questionnaire for assessment of symptom severity of ulnar neuropathy at the elbow (UNE). The new UNE and Levine's questionnaires were administered to a sample of UNE subjects and for comparison also to a sample of subjects with carpal tunnel syndrome (CTS). We enrolled 89 consecutive patients (32 women, 57 men, mean age 52.3 years) with UNE and 203 consecutive patients (157 women and 46 men, mean age 53.7 years) with CTS. The protocol of the study consisted in self-administration of the new UNE and Levine's questionnaires, as well as scoring of clinical and electrophysiological severity of entrapment syndromes with ordinal scales. The UNE questionnaire (UNEQ) includes nine questions and considers numbness and tingling in the fourth and fifth fingers, elbow pain and modification of pain and paraesthesia with elbow position. A score from 1 (absence of symptom) to 5 (most severe) is assigned for each question. The overall score is calculated as the mean of the nine scores. Test-retest reliability, internal consistency and validity were assessed. Responsiveness was also tested in a sample of patients undergoing conservative treatment. The UNEQ was reproducible. Spearman's correlation coefficient between scores at successive observations (test-retest reliability), assessed in the first 44 patients, was 0.97 and Cohen coefficients kappa for single items were between 0.64 and 0.81. Internal consistency was high: Cronbach's alpha, which summarises interitem correlations among all items of UNEQ, was 0.87. Validity was demonstrated by a direct correlation with UNE clinical and electrophysiological severity scores (0.65 and 0.35). On the contrary, Spearman's correlation coefficients between UNEQ and clinical and electrophysiological CTS severity scores were low (0.11 and 0.02, respectively). Responsiveness was calculated at 6-8 months follow-up in 25 cases. The effect size was 0.46. The Wilcoxon rank-test showed significant improvement between basal and follow-up UNEQ scores (Z=-2.39, p=0.017), but not Boston Questionnaire scores. There was also significant correlation between UNEQ changes and an arbitrary scale of patient satisfaction at follow-up (r=0.85, p<0.001). The UNEQ is reproducible, internally consistent and valid. Although further studies are required to test its responsiveness to clinical changes, UNEQ may be also considered responsive. UNEQ can be used to measure subjective discomfort in UNE patients.

Analysis of nurse conversation: methodology of the process recording

Analysis of nurse conversation: methodology of the process recording The study explored elements of effective nurse-client interaction between a nurse and a nursing home resident on the third day of the client's recovery from surgery. The interaction was recorded from memory in the form of a process recording then divided into unique conversation segments. Two nurses independently used seven typologies to classify segments of the conversation. Cohen's coefficient kappa for inter-rater reliability of the classifications was 0.98. Findings from the study revealed that two-thirds of the nurse's conversation was effective and consistent with the orientation phase of the nurse-client relationship. The nurse communicated her role through the provision of leadership, resources and help, and technical expertise. Her approaches were rather evenly divided between making requests, giving information, and affirming the client's experience. One-third of the conversation was oriented toward assessment and diagnosis, one half toward treatment of the client's experiences, and the rest toward planning and evaluation. Themes identified in the client's conversation included issues of dependency, disorientation to time, unresolved grief, separation anxiety, and the client's need for validation. These findings are valuable for illuminating the contribution that nurse conversation makes to evidence-based clinical practices. They also have implications for further refinements in the use of the process record and multiple coding schemes for the study of the nurse-client relationship.

Intérêt de la tomodensitométrie en chirurgie sinusienne expérimentale

To study the contribution of computed tomography (CT) to evaluate the intensity of the sinus mucosa's response to an inflammatory stimulus.Eight New-Zealand white rabbits where used. Rabbit n degrees 1 was the control. CT, macroscopic examination with analysis of secretion volumes, and histological examination were used to study the response of the sinuses to inflammation.There was perfect match between the CT scan aspect and the quantity of secretions (kappa and Cohen's coefficient=1). The CT scan aspect well correlated with inflammatory cell infiltration (kappa and Cohen's coefficients=0.8).The CT scan contributes usefully to the analysis of sinus contents and can be used to assess the intensity of the sinus mucosal inflammatory reaction. Consequently, the CT scan can be used not only to validate an animal model of acute or chronic sinusitis, but can also be used to evaluate medical or surgical treatments in such an animal model.

Association between dynamic cerebral autoregulation and mortality in severe head injury

The objective of the study was to test the hypothesis that dynamic cerebral pressure-autoregulation is associated with the outcome of patients with severe head injury and to derive optimal criteria for future studies on the predictive value of autoregulation indices. Repeated measurements were performed on 32 patients with severe head injury. Arterial blood pressure (ABP) was measured continuously with an intravascular catheter, intracranial pressure (ICP) was recorded with a subdural semiconductor transducer and cerebral blood flow velocity (CBFV) was measured with Doppler ultrasound in the middle cerebral artery. Transfer function analysis was performed on mean beat-to-beat values, using ABP or CBFV as input variables and CBFV or ICP as the output variables. A dynamic index of autoregulation (ARI) ranging between 0 and 9 was extracted from the CBFV step response for a change in ABP. No significant differences between survivors and non-survivors were found due to mean values of ICP, ABP, CPP, CBFV, pCO2, GCS, age or heart rate. The transfer functions between ABP-ICP and CBFV-ICP did not show any significant differences either. The median [lower, upper quartiles] ARI was significantly lower for non-survivors compared with survivors [4.8 (0.0, 5.9) v. 6.9 (5.9, 7.4), p = 0.004]. The correlation between ARI and GOS was also significant (r = 0.464, p = 0.011). Cohen's coefficient was optimal for a threshold of ARI = 5.86 (kappa = 0.51, p = 0.0036), leading to a sensitivity for death of 75%, specificity = 76.5%, odds ratio = 9.75 and overall precision = 75.8%. The difference in ARI values between survivors and non-survivors persisted when results were adjusted for GCS (p = 0.028). A similar analysis for the Marshall CT scale did not reach significance (p = 0.072). A logistic regression analysis confirmed that apart from the ARI, no other variables had a significant contribution to predict outcome. In this group of patients, death following severe head injury could not be explained by traditional indices of risk, but was strongly correlated to indices of dynamic cerebral pressure-autoregulation extracted by means of transfer function analysis. Future studies using a prospective design are needed to validate the predictive value of the ARI index, as estimated by transfer function analysis, in relation to death and other unfavourable outcomes.

Inter-observer reproducibility and responsiveness of a clinical severity scale in surgically treated carpal tunnel syndrome.

To test a recently proposed carpal tunnel syndrome (CTS) clinical severity scale for reproducibility between two observers (neurosurgeon and neurophysiologist) before surgery, for responsiveness to changes in clinical status 6 months after surgery, and for correlations with the electrophysiological findings and 'Boston Carpal Tunnel Syndrome Questionnaire' (BQ). The tests were applied prospectively to a consecutive series of 254 hands with idiopathic CTS, referred for surgical decompression. The hands belonged to 219 subjects (177 women and 42 men, mean age 55.6). Percentage agreement between the two observers in assigning severity to the same class was 78% and Cohen coefficient kappa was 0.69 (P < 0.001). The scale was found to be responsive to changes in clinical status after surgery. Direct correlations were also found between the scale and patient age, duration of symptoms, BQ scores and the neurophysiological severity scale. The significance of these associations was maintained for 6 months after the operation. This clinical severity scale is simple, reproducible and sensitive for evaluating severity of CTS in patients undergoing surgery.

Utilities to calculate Cohen's coefficient of agreement in two proprietary software systems

Utilities to calculate Cohen's coefficient of agreement in two proprietary software systems