High Degree Of Interobserver Reliability Research Articles

Comparison of manual versus robot-assisted contralateral gate cannulation in patients undergoing endovascular aneurysm repair

Robotic endovascular technology may offer advantages over conventional manual catheter techniques. Our aim was to compare the endovascular catheter path-length (PL) for robotic versus manual contralateral gate cannulation during endovascular aneurysm repair (EVAR), using video motion analysis (VMA). This was a multicentre retrospective cohort study with fluoroscopic video recordings of 24 EVAR cases (14 robotic, 10 manual) performed by experienced operators (> 50 procedures), obtained from four leading European centres. Groups were comparable with no statistically significant differences in aneurysm size (p = 0.47) or vessel tortuosity (p = 0.68). Two trained assessors used VMA to calculate the catheter PL during contralateral gate cannulation for robotic versus manual approaches. There was a high degree of inter-observer reliability (Cronbach's α > 0.99) for VMA. Median robotic PL was 35.7cm [interquartile range, IQR (30.8-51.0)] versus 74.1cm [IQR (44.3-170.4)] for manual cannulation, p = 0.019. Robotic cases had a median cannulation time of 5.33 min [IQR (4.58-6.49)] versus 1.24min [IQR (1.13-1.35)] in manual cases (p = 0.0083). Generated efficiency ratios (PL/aorto-iliac centrelines) was 1.6 (1.2-2.1) in robotic cases versus 2.6 (1.7-7.0) in manual, p = 0.031. Robot-assisted contralateral gate cannulation in EVAR leads to decreased navigation path lengths and increased economy of movement compared with manual catheter techniques. The benefit could be maximised by prioritising robotic catheter shaping over habituated reliance on guidewire manipulation. Robotic technology has the potential to reduce the endovascular footprint during manipulations even for experienced operators with the added advantage of zero radiation exposure.

Perioperative changes in pelvic tilt after hip resurfacing using a direct lateral approach

Background: Proper positioning of the acetabular component is critical for prevention of dislocation and excessive wear for total hip arthroplasty (THA) and hip resurfacing. Consideration of preoperative pelvic tilt (PT) may aid in acetabular component placement. The purpose of this study was to investigate how PT changes after hip resurfacing, via pre and post-operative radiographic analysis of anterior pelvic plane (APP), and whether radiographic analysis of the APP is a reproducible method for evaluating PT in resurfaced hips. Methods: A consecutive group of 228 patients from a single surgeon who had hip resurfacing were evaluated. We obtained X-rays from an institutional database for these patients who had their surgeries between January 1 st , 2014 to December 31 st , 2016. PT was measured by two observers before and after resurfacing utilizing a standardized radiographic technique. Correlation coefficients were calculated for PT measurements between observers, and pre- and post-surgery. Results: Mean preoperative PT was 0.7° (SD ±6.6°) and 0.4° (SD ±6.1°). Mean post-operative PT was −1.2° (SD ±6.2°) and −1.2° (SD ±6.0°). Correlations between pre and post-operative PT were R=0.829 (P 10°. Intraclass correlation coefficients between observers were R=0.987 (95% CI, 0.963–0.981; P Conclusions: After hip resurfacing arthroplasty (HRA), the mean difference between preoperative and postoperative PT was less than 1°. These results suggest that near-native PT is maintained with consistency after hip resurfacing, a finding that is variable following THA. Since variations in PT affect functional acetabular position, these results support the use of PT measurement in pre-operative planning for hip arthroplasty with a high degree of inter-observer reliability.

Alcohol in urban streetscapes: a comparison of the use of Google Street View and on-street observation

BackgroundAlcohol-related harm is a major global health issue, and controls on alcohol marketing are one intervention utilized by governments. This study investigated the use of Google Street View (GSV) as a novel research method for collecting alcohol-related data in the urban environment.MethodsThe efficacy of GSV and on-street observation by observer teams was compared by surveying 400 m stretches of 12 streets in Wellington, the capital city of New Zealand. Data on alcohol sale, alcohol-related advertising, health promotion materials, regulatory information and visible alcohol consumption were collected.ResultsA total of 403 retailers with evidence of alcohol sales and 1161 items of alcohol-related communication were identified in on-street observation. Of the latter, 1028 items (89 %) were for alcohol marketing and 133 (11 %) were for alcohol-related health promotion and alcohol regulation. GSV was found to be a less sensitive tool than on-street observation with only 50 % of the alcohol venues identified and 52 % of the venue-associated brand marketing identified. A high degree of inter-observer reliability was generally found between pairs of observers e.g., for the detection of alcohol retail venues the intra-class correlation coefficient (ICC) was 0.93 (95 % CI: 0.78 to 0.98) for on-street observation and 0.85 (95 % CI: 0.49 to 0.96) for using GSV.ConclusionsGSV does not seem suitable for the comprehensive study of the influences on alcohol consumption in the urban streetscape. However, it may still have value for large, static objects in the environment and be more time efficient than traditional on-street observation measures, especially when used to collect data across a wide geographical area. Furthermore, GSV might become a more useful research tool in settings with better image quality (such as more ‘footpath views’) and with more regularly updated GSV imagery.

Axillary View: Arthritic Glenohumeral Anatomy and Changes After Ream and Run

The technique and results of shoulder arthroplasty are influenced by glenohumeral pathoanatomy. Although some authors advocate a routine preoperative CT scan to define this anatomy, ordering a CT scan substantially increases the cost and the radiation exposure for the patient. We asked whether measurements of arthritic shoulders on a standardized axillary view are reliable; if postoperative radiographs can reliably show the changes in glenoid anatomy and glenohumeral relationships after shoulder arthroplasty, and if the axillary view can show differences in glenohumeral pathoanatomy in the different sexes and disease types. These questions were addressed using cross-sectional studies of 344 shoulders with different types of arthritis and of 128 osteoarthritic shoulders having a ream and run arthroplasty (a glenohumeral arthroplasty that combines a noncemented humeral hemiarthroplasty with concentric reaming of the glenoid bone without implantation of a prosthetic glenoid component). Measurements of glenoid type, glenoid version, and glenohumeral contact were made on standardized axillary radiographs. Interobserver reliability was calculated, preoperative and postoperative measurements were compared, and morphologic differences were compared as stratified by sex and disease type. The measurements on axillary views showed a high degree of interobserver reliability and sensitivity to the changes effected by arthroplasty. The ream and run substantially corrected the glenoid type and point of glenohumeral contact. Male shoulders and shoulders with osteoarthritis had more type B glenoids (ie, those with posterior erosion and biconcavity of the glenoid), more retroversion, and a greater degree of posterior displacement of the point of glenohumeral contact. The axillary view provides a practical method of characterizing glenohumeral anatomy before and after surgery that is less costly and exposes the patient to less radiation than a CT scan. Level IV, diagnostic study. See the Instructions for Authors for a complete description of levels of evidence.

Escala de valoración funcional de Hammersmith para niños con atrofia muscular espinal. Validación de la versión española

This study was conducted with the aim of developing the Spanish version of the Hammersmith functional rating scale for children with spinal muscular atrophy (SMA), to establish the interobserver reliability and to adapt it to Spanish children with SMA types II and III. We assessed 31 children with a mean age of 4.7 years (range: 2.5-9 years) and they were re-assessed at 3, 6 and 12 months. The children with SMA type II could not walk and the children with SMA type III were able to walk. Interobserver reliability was 95%. The median of the score in the group with SMA type II was 17 (range: 0-34) and in the SMA type III group it was 39 (range: 37-40). The results of the group with SMA type II at 12 months were poorer, although not to a statistically significant extent, which suggested that the disease was getting worse. The Spanish version presents a high degree of interobserver reliability, is easy to administer in clinical practice and is a good tool for assessing the severity of the disease in patients with SMA, above all in those who are unable to walk.

Validation of a Translated Version of the Modified Japanese Orthopaedic Association Score to Assess Outcomes in Cervical Spondylotic Myelopathy

Although the Japanese Orthopaedic Association (JOA) originally developed in Japan, the modified English version (mJOA) has become widely used and is arguably now the accepted standard. In order to apply the mJOA successfully at an international level, we have translated it with a validated approach into Dutch to pave the way for other translated versions. After a thorough forward and backward translation procedure, a final Dutch version of the mJOA was developed. This translated version was used to assess the interobserver reliability among 2 independent examiners by using a cohort of patients with neurological impairment due to spinal pathology. The mJOA grading scale was used by 2 independent examiners in 25 patients with a variety of spinal diseases. Initially, the interobserver reliability expressed as kappa was 0.56 +/- 0.11. Then, instructions were given to the instructors to refrain from providing patients with an interpretation of the symptoms. Patients were asked to restrict themselves to the questionnaire and select the most appropriate score without bias from the examiner. Kappa increased to 0.78 +/- 0.05. This difference reached statistical significance (P < .001). We present a streamlined approach to translate the mJOA into a language other than English. The approach resulted in a Dutch version of the mJOA that had a high degree of interobserver reliability.

Linear and angular measurements of computer-generated models: Are they accurate, valid, and reliable?

Traditional advanced imaging modalities such as CT and MRI are limited in their ability to perform accurate linear distance and angular measurements regardless of anatomical orientation. The construction of 3D models has been used to perform anthropometric analyses as well as in the reconstruction of rapid prototypes. We hypothesized that such measurements would be precise to within 2 mm or 2 degrees of measurements performed with a coordinate measurement machine (CMM). We also hypothesized that there would be a high degree of interobserver reliability with these measurements.Multiple aluminum screws were implanted in various positions in three foam pelvises which were subsequently scanned by CT and rendered as 3D models using a commercially available software package (Mimics). Linear and angular measurements were performed using a CMM machine, the software package, and a dial caliper or goniometer. The deviation of the measurements from the CMM data was compared using ANOVA. The interobserver reliability of both the manual and computer-generated measurements was calculated.The mean difference between the CMM distances and those measured manually and with the software was 2.12 +/- 1.20 mm and 1.57 +/- 1.05 mm, respectively. The mean difference between the CMM angular measurements and the angular measurements performed manually and with the software was 4.07 +/- 4.70 degrees and 1.62 +/- 1.32 degrees, respectively. In all cases, the manual measurements were significantly less accurate (p < 0.0001) and there was a high degree of interobserver reliability.Computer-generated measurements taken from three-dimensionally reconstructed models are more accurate than manual measurements and are within 2 mm and 2 degrees of measurements performed with a CMM. These measurements have high interobserver reliability.

Linear and angular measurements of computer-generated models: Are they accurate, valid, and reliable?

Introduction: Traditional advanced imaging modalities such as CT and MRI are limited in their ability to perform accurate linear distance and angular measurements regardless of anatomical orientation. The construction of 3D models has been used to perform anthropometric analyses as well as in the reconstruction of rapid prototypes. We hypothesized that such measurements would be precise to within 2 mm or 2° of measurements performed with a coordinate measurement machine (CMM). We also hypothesized that there would be a high degree of interobserver reliability with these measurements.Materials and Methods: Multiple aluminum screws were implanted in various positions in three foam pelvises which were subsequently scanned by CT and rendered as 3D models using a commercially available software package (Mimics). Linear and angular measurements were performed using a CMM machine, the software package, and a dial caliper or goniometer. The deviation of the measurements from the CMM data was compared using ANOVA. The interobserver reliability of both the manual and computer-generated measurements was calculated.Results: The mean difference between the CMM distances and those measured manually and with the software was 2.12 ± 1.20 mm and 1.57 ± 1.05 mm, respectively. The mean difference between the CMM angular measurements and the angular measurements performed manually and with the software was 4.07 ± 4.70° and 1.62 ± 1.32°, respectively. In all cases, the manual measurements were significantly less accurate (p < 0.0001) and there was a high degree of interobserver reliability.Conclusions: Computer-generated measurements taken from three-dimensionally reconstructed models are more accurate than manual measurements and are within 2 mm and 2° of measurements performed with a CMM. These measurements have high interobserver reliability.

Timely Referral of Potential Organ Donors

Timely Referral of Potential Organ Donors

Assessment of Bleeding in Thrombocytopenic Patients (pts) with Immune Thrombocytopenic Purpura (ITP).

Introduction: Assessment of bleeding in ITP is difficult. There is no agreed upon methodology; the WHO bleeding score does not seem useful for ITP. We report an ITP bleeding score including the relationship between site-specific bleeding severity (BLS), platelet count (plt ct), and plt size.Methods: A bleeding score was created which has 11 sites, 9 by history (Hx) of the previous week: skin, oral, epistaxis, GI, GU, GYN, hemoptysis, subconjunctival (SC), and intracranial hemorrhage (ICH); and 2 by Exam (PE): skin and oral. The BLS grades (gr) pts for each site on a defined scale from no bleeding (0) to “major” bleeding (2). Plt cts and large plts (LP) were measured on the Bayer Advia 120. No pt had > 2 study visits.Results: The 65 ITP pts on 100 visits over 6 months had a median (mdn) plt ct of 41,500/uL (41.5k). The mdn age was 31.5 yrs; 20 pts were children. 56 pts had chronic ITP, 26 s/p splenectomy, with a mdn duration of ITP of 6 yrs. There were no GU, SC hemorrhage (hem), or ICH. 72% of all gr 1 hem's were skin whereas 46% of gr 2 hem's were oral. There was 1 GI hem and 3 hemoptysis visits that were gr 2. 42 women on 63 visits had 5 visits each with GYN BLS gr 1 and gr 2. X2 testing correlated plt ct and BLS for 6 sites: both oral and both skin sites, epistaxis, and GYN (p's < 0.05). Oral PE correlated best with the plt ct (fig 1). For oral PE, BLS of gr 2 did not occur at plt cts > 20k.When the BLS was scored independently by two observers (LKP & JB) on 63 of the100 visits, 92% of individual BLS grs were identical (PearsonR=0.75). Skin PE and epistaxis each had 11/63 discrepancies. In addition, 16 BLS for oral (15 for skin) were different comparing Hx and PE (fig 2).LP did not correlate well with site-specific BLS when only plt cts ≤ 30k were included, suggesting that large, young platelets may not primarily determine bleeding severity in ITP. However for Skin Hx, if the BLS was gr 0, 4/6 had LP ≥ 2 whereas only 7/28 LP were ≥ 2 when the BLS was gr 1.Conclusions: The Bleeding Score reported here was validated by: a) the relationship of bleeding severity at multiple sites to plt ct including the absence of gr 2 bleeding at plt cts >20k; and b) the high degree of interobserver reliability despite a low but irreducible error rate based on variability in pt recall. It takes ≤ 3–5 minutes to complete. The significance of LP remains unclear. Studies of the BLS in larger numbers of patients will further determine its usefulness. [Display omitted] [Display omitted]

Neonatal neurological testing in resource-poor settings.

The aim of the study was to design and test a neurological examination for newborns that could be performed reliably by paramedical staff in resource-poor settings. The examination was adapted from a method established by Dubowitz et al., the latest version of which includes an optimality score. The final items in the test were chosen because they were culturally acceptable, could be elicited according to strict but easily comprehensible instructions and because the expected responses could be scored by the descriptions given or by diagrams in the proforma. The shortened examination was easily taught to paramedical staff who achieved a high degree of inter-observer reliability. This shortened version of the examination was piloted by comparing newborns from a Karen refugee camp on the western border of Thailand and from a large maternity hospital in Bangkok with a standardized cohort of newborns in London. The modified shortened version of the test was sufficiently sensitive to identify a number of differences between the cohorts, notably the poor vision performance and markedly reduced tone of the Karen newborns. In conclusion, the test can be used very reliably by paramedical staff and is a useful, simple and portable tool for the neurological assessment of newborn babies where resources are limited.

Quantification of video-taped images in microcirculation research using inexpensive imaging software (Adobe Photoshop).

Study end-points in microcirculation research are usually video-taped images rather than numeric computer print-outs. Analysis of these video-taped images for the quantification of microcirculatory parameters usually requires computer-based image analysis systems. Most software programs for image analysis are custom-made, expensive, and limited in their applicability to selected parameters and study end-points. We demonstrate herein that an inexpensive, commercially available computer software (Adobe Photoshop), run on a Macintosh G3 computer with inbuilt graphic capture board provides versatile, easy to use tools for the quantification of digitized video images. Using images obtained by intravital fluorescence microscopy from the pre- and postischemic muscle microcirculation in the skinfold chamber model in hamsters, Photoshop allows simple and rapid quantification (i) of microvessel diameters, (ii) of the functional capillary density and (iii) of postischemic leakage of FITC-labeled high molecular weight dextran from postcapillary venules. We present evidence of the technical accuracy of the software tools and of a high degree of interobserver reliability. Inexpensive commercially available imaging programs (i.e., Adobe Photoshop) provide versatile tools for image analysis with a wide range of potential applications in microcirculation research.

Computers and psychiatric data recording: Rationale and problems of confidentiality

Increased efficiency in handling medical record data and facilitation of statistical research can be achieved by the use of computers. The application of high speed data handling techniques in medicine poses considerable problems which are perhaps greater in psychiatry than any other speciality. As in medicine generally, items selected for recording must be restricted to questions which may be expected to obtain valid answers with a high degree of interobserver reliability. The personal nature of much of the information obtained at psychiatric interview, and the proportion of qualitative assessments included require particular attention if regional or national data banks for psychiatry are to be both useful and safe.