Discordance In Assessment Research Articles

MARITAL CLOSENESS, SPOUSAL SIMILARITY, AND COGNITION: THE GENDERED IMPACT OF DISCORDANT PERCEPTIONS

Abstract Many older adults are in long-term marriages, and an emerging literature examines the impact of marital attributes on later-life cognitive function. While both spouses’ perceptions of the marital relationship may influence health outcomes in the couple, most research only captures one partner’s report. Using unique data on 2,791 heterosexual married couples from the Wisconsin Longitudinal Study, we analyze the dyad’s evaluations of their similarity and closeness in 2004 and the impact of concordance or discordance in these marital attributes on cognitive health in 2020, when participants were approximately 80 years old and cognitive variation is more manifest. Results from OLS regressions reveal notable gender differences. Compared with dyads in which both spouses reported being “very similar,” women in marriages with discordant views on the partners’ similarity had significantly lower cognition in 2020 (wife gave the poorer rating: b=-0.74, p<.05; husband gave the poorer rating: b=-0.84, p<.05). Men’s cognitive function was not influenced by assessments of similarity in the couple. Furthermore, compared with dyads in which both spouses reported being “very close,” men in marriages with discordant views on the partners’ closeness had significantly lower cognition in 2020 (woman gave the poorer rating: b= -0.88, p < .05). Women’s cognitive function was unrelated to dyadic reports of closeness. Our results suggest that within-couple discordance in assessment of marital closeness and spousal similarity – more than marital attributes themselves – influences later-life cognitive function for women and men in varied ways.

Factors associated with discordance in the assessment of fibrosis stage between transient elastography and liver biopsy in NAFLD patients

Background and aimsFew studies focus on the concordance of fibrosis stage assessment between transient elastography (TE) and liver biopsy (LB) in non-alcoholic fatty liver disease (NAFLD). This study aimed to investigate the rate of discordance and factors associated with discordance in the fibrosis stage assessment between TE and LB. MethodsLB-proven NAFLD patients were enrolled retrospectively. Liver fibrosis was assessed via TE and LB based on Steatosis-Activity-Fibrosis (SAF) criteria. Cohen's kappa was used to estimate the discordance between the fibrosis stage assessment by TE and LB. Logistic regression was utilized to determine the factors associated with discordance. ResultsA total of 172 eligible patients were included. The concordance of fibrosis staging between TE and LB was moderate (kappa = 0.446, p < 0.001). The overall rate of discordance was 52.90% (91/172) and highest in the F2 stage (66.28%) and F3 stage (60.42%), moderate in the F1 stage (23.81%), and lowest in the F4 stage (0.00%). The rate of overestimation and underestimation was 23.66% and 38.71% in patients detected by M-probe, while the rate of overestimation and underestimation was 33.87% and 19.35% in patients detected by XL-probe, respectively. BMI [OR=1.494, p = 0.017] and type 2 diabetes mellitus (T2DM) (OR=4.678, p = 0.008) were significantly associated with the overestimation in fibrosis stage assessment when the M-probe was applied. ConclusionsThe discordance between TE and LB in fibrosis stage assessment was unexpectedly high and mainly observed in F1-F3 patients. BMI and T2DM were the factors associated with overestimation using the M-probe.

"You can't touch, you can't bond": Exploring COVID-19 pandemic impacts on rheumatoid arthritis patient goals and communication with clinicians.

"You can't touch, you can't bond": Exploring COVID-19 pandemic impacts on rheumatoid arthritis patient goals and communication with clinicians.

Does the addition of whole-body MRI to routine imaging influence real-world treatment decisions in metastatic breast cancer?

BackgroundThe assessment of metastatic breast cancer (MBC) can be limited with routine imaging such as computed tomography (CT) especially in bone-only or bone-predominant disease. This analysis investigates the effects of the use of WBMRI in addition to the use of routine CT, bone scintigraphy (BS) and fluorine-18-fluorodeoxyglucose positron emission tomography with computed tomography (FDG-PET/CT) on influencing systemic anti-cancer treatment (SACT) decisions in patients with known MBC.MethodsMBC patients undergoing SACT who had WBMRI undertaken within 8 weeks of either a routine CT, BS or FDG-PET/CT were reviewed retrospectively. The clinical indications for undertaking the WBMRI examinations were recorded. Data on the extent and distribution of the disease were collected and discordance/concordance of disease status across the imaging modalities were compared. SACT decisions at each time point were also evaluated.ResultsThere were 105 MBC patients with 148 WBMRI studies paired with CT, BS or FDG-PET/CT. 50 pairs (33.8%) showed differences in the extent of disease, with 44 pairs due to additional sites (AS) reported on WBMRI alone.81 patients (Group 1) had one WBMRI paired with routine imaging due to a variety of indications, with clinical symptoms (such as bone pain) being the most common (24.7%).24 patients (Group 2) had more than one WBMRI study paired with routine imaging comprising 67 pairs. 13/67 pairs (19.4%) showed discordance in assessments. 10/13 pairs had progressive disease (PD) reported on WBMRI alone.SACT change due to AS reported on WBMRI alone occurred in 21/23 pairs (91.3%) in Group 1. SACT change due to PD reported on WBMRI alone in Group 2 occurred in 6/14 pairs (42.9%). SACT change due to AS/PD in both groups occurred in 11/102 pairs (10.8%) with known invasive ductal carcinoma (IDC) and 13/28 pairs (46.4%) with invasive lobular carcinoma (ILC).ConclusionsThe use of WBMRI in MBC led to earlier recognition of PD and SACT change compared with the other imaging modalities. A higher proportion of discordant response assessments and SACT changes were observed in ILC compared with IDC in our patient group, although larger-scale studies are required to investigate this further.

Patient-physician discordance in assessment of adherence to inhaled controller medication: a cross-sectional analysis of two cohorts

ObjectiveWe aimed to compare patient’s and physician’s ratings of inhaled medication adherence and to identify predictors of patient-physician discordance.DesignBaseline data from two prospective multicentre observational studies.Setting29 allergy, pulmonology and paediatric...

Assessment of reporting quality of abstracts of systematic reviews with meta-analysis using PRISMA-A and discordance in assessments between raters without prior experience

BackgroundReporting quality of systematic reviews’ (SRs) abstracts is important because this is often the only information about a study that readers have. The aim of this study was to assess adherence of SR abstracts in the field of anesthesiology with the reporting checklist PRISMA extension for s (PRISMA-A) and to analyze to what extent will the use of PRISMA-A yield concordant ratings in two raters without prior experience with the checklist.MethodsWe analyzed reporting quality of SRs with meta-analysis of randomized controlled trials of interventions published in the field of anesthesiology from 2012 to 2016 by using 12-item PRISMA-A checklist. After calibration exercise, two authors without prior experience with PRISMA-A scored the abstracts. Primary outcome was median adherence to PRISMA-A checklist. Secondary outcome was adherence to individual items of the checklist. We analyzed whether there was improvement in reporting of SR abstracts over time. Additionally, we analyzed discrepancies between the two raters in scoring individual PRISMA-A items.ResultsOur search yielded 318 results, of which we included 244 SRs. Median adherence to PRISMA-A checklist was 42% (5 items of 12). The majority of analyzed SR abstracts (N = 148, 61%) had a total adherence score under 50%, and not a single one had adherence above 75%. Adherence to individual items was very variable, ranging from 0% for reporting SR funding, to 97% for interpreting SR findings. Overall adherence to PRISMA-A did not change over the analyzed 5 years before and after publication of PRISMA-A in 2013. Even after calibration exercise, discrepancies between the two raters were found in 275 (9.3%) out of 2928 analyzed PRISMA-A items. Cohen’s Kappa was 0.807. In the item about the description of effect there were discrepancies in 59% of the abstracts between the raters.ConclusionReporting quality of systematic review abstracts in the field of anesthesiology is suboptimal, and did not improve after publication of PRISMA-A checklist in 2013. We need stricter adherence to reporting checklists by authors, editors and peer-reviewers, and interventions that will help those stakeholders to improve reporting of systematic reviews. Some items of PRISMA-A checklist are difficult to score.

High level of discordance in assessment of testicular histopathology in male infertility

High level of discordance in assessment of testicular histopathology in male infertility

How well do patients and providers agree on the severity of dyspnea?

Understanding the severity of patients' dyspnea is critical to avoid under- or overtreatment of patients with acute cardiopulmonary conditions. To evaluate the agreement between dyspnea assessment by patients and healthcare providers and to explore which factors contribute to discordance in assessment. Prospective study of patients hospitalized for acute cardiopulmonary diseases at an urban teaching hospital. A numerical rating scale (0-10) was used to assess dyspnea severity as perceived by patients and assessed by providers. Agreement was defined as a score within ±1 between patient and healthcare provider; differences of ≥2 points were considered over- or underestimations. The relationship between patient self-perceived dyspnea severity and provider rating was assessed using a weighted kappa coefficient. Of the 138 patients enrolled, 33% had a diagnosis of heart failure, 30% chronic obstructive pulmonary disease, and 13% pneumonia; median age was 72 years, and 57% were women. In all, 96 patient-physician and 138 patient-nurses pairs were included in the study. The kappa coefficient for agreement was 0.11 (95% confidence interval [CI]: 0.01 to 0.21) between patients and physicians and 0.18 (95% CI: 0.12 to 0.24) between patients and nurses. Physicians underestimated patients' dyspnea 37.9% of the time and overestimated it 25.8% of the time, whereas nurses underestimated it 43.5% of the time and overestimated it 12.4% of the time. Admitting diagnosis was the only patient factor associated with discordance. Agreement between patient perception of dyspnea and healthcare providers' assessment is low. Future studies should prospectively test whether routine assessment of dyspnea results in better patient outcomes. Journal of Hospital Medicine 2016;11:701-707. © 2016 Society of Hospital Medicine.

Patient‐physician discordance in assessments of global disease severity in rheumatoid arthritis

To determine the degree of discordance between patient and physician assessment of disease severity in a multiethnic cohort of adults with rheumatoid arthritis (RA), to explore predictors of discordance, and to examine the impact of discordance on the Disease Activity Score in 28 joints (DAS28). Adults with RA (n = 223) and their rheumatologists completed a visual analog scale (VAS) for global disease severity independently. Patient demographics, the 9-item Patient Health Questionnaire (PHQ-9) depression scale score, the Health Assessment Questionnaire score, and the DAS28 were also collected. Logistic regression analyses were used to identify predictors of positive discordance, defined as a patient rating minus physician rating of >25 mm on a 100-mm VAS (considered clinically relevant). DAS28 scores stratified by level of discordance were compared using a paired t-test. Positive discordance was found in 30% of cases, with a mean +/- SD difference of 46 +/- 15. The strongest independent predictor of discordance was a 5-point increase in PHQ-9 score (adjusted odds ratio 1.61, 95% confidence interval 1.02-2.55). Higher swollen joint count and Cantonese/Mandarin language were associated with lower odds of discordance. DAS28 scores were most divergent among subjects with discordance. Nearly one-third of RA patients differed from their physicians to a meaningful degree in assessment of global disease severity. Higher depressive symptoms were associated with discordance. Further investigation of the relationships between mood, disease activity, and discordance may guide interventions to improve care for adults with RA.

Assessment of prognostic factors and projection of outcomes in renal transplantation.

Analysis of data on renal transplantation collected in two large multicenter observational studies resulted in the concordant identification of five factors that correlated highly and at a substantial level of statistical significance with the outcome of unrelated cadaveric donor transplantation (i.e., they were associated with differences in one-year graft survivals of 0.07-0.21 and P values less than 0.05). These factors were: blood transfusions prior to the transplant, race of the recipient (white or black), prior failure in transplantation, level of sensitization to lymphocyte alloantigens, and diabetes as the cause of end-stage renal failure. Multivariate analysis with a mathematical survival model confirmed the importance and independence of these prognostic factors. Matching of HLA antigens appeared to be beneficial in both studies, but failed to attain high statistical significance in one. Systematic differences in the use of pretransplant splenectomy and, probably, in the nature of the antilymphocyte serum or globulin led to discordance in assessment of the importance of these factors in the two studies. Although advanced age (greater than 45 years) of the recipient was associated with reduced graft survival in both studies, analysis by means of the model failed to detect a significant correlation between the recipient's age and the outcome in one of the studies because the relation was not monotonic. In an illustration of their utility in the detailed assessment of performance, the prognostic factors were found to substantially account for the markedly superior results at one center and partly for lower graft survivals at another. These prognostic factors may be used to predict probable outcomes for populations and for individual patients subjected to particular arrays of conditioning strategies.