Inter-examiner Agreement Research Articles

Validity of Digital Imaging of Fiber-Optic Transillumination in Caries Detection on Proximal Tooth Surfaces.

Objective The aim of our study was to evaluate the validity of the digital imaging fiber-optic transillumination (DIFOTI) method in comparison with clinical visual examination (CV) and bitewing (BW) radiography on detecting caries lesions on proximal surfaces of teeth. Materials and Methods Proximal tooth surfaces of premolars and molars (n = 2,103) of 91 voluntary university students aged from 18 to 30 years were examined with CV, BW radiography, and the DIFOTI method. ResultsDIFOTI detected more initial and manifested caries lesions compared with CV and BW. Of the analyzed tooth surfaces, 69.8% were classified as sound by DIFOTI, 80.3% by BW, and 91.6% by CV. Initial caries lesions were found in 21.2% of the surfaces by DIFOTI, in 14.1% by BW, and in 6.2% by CV, whereas the proportions for manifested dental caries lesions were 9.0%, 5.6%, and 2.2%, respectively. The interexaminer agreement regarding the DIFOTI findings between an experienced clinician and a fifth-year dental student was high: κ = 0.67 for initial and κ = 0.91 for manifested caries lesions. ConclusionsThe noninvasive DIFOTI method seems to offer a potential tool for everyday clinical practice. In clinical use, DIFOTI finds well even initial caries lesions on proximal surfaces, thus providing an instrument for detecting lesions potential for arresting as well as for monitoring the outcome after preventive measures.

Evaluation of dental arch relationship of patients with bilateral cleft lip and palate applying bilateral yardstick

Aims: This study aims to verify the applicability and reliability of the Bilateral yardstick on the assessment of interarch relationship in patients with bilateral cleft lip and palate (BCLP) through three-dimensional (3D) virtual casts. Setting and Design: A total of 112 individuals with BCLP, aging 6–12 years old, with no associated syndromes, free from previous orthodontic treatment and from secondary bone grafting. Methods: Plaster casts from the 112 individuals were obtained, randomly numbered and scanned, generating a 3D digital image. Three calibrated orthodontists used the Bilateral yardstick to classify, in two rounds, the interarch relationship on the virtual casts. Descriptive statistics were employed to describe the frequencies of the scores of the Bilateral yardstick. Weighted Kappa statistics were calculated to determine intra- and inter-rater reliability. Results: Raters reported no difficulties in the employment of the Bilateral yardstick on 3D virtual casts. Good occlusal relationship or minor deviation was observed in 60 (53.6%) individuals. No more than 13 (11.6%) patients were classified as having a poor arch form. Intraexaminer kappa values were higher than 0.93 (confidence interval [CI] 0.88–0.98), and interexaminer agreement was higher than 0.78 (CI 0.69–0.87). Conclusion: Bilateral yardstick proved to be applicable to the assessment of dental arch relationship of patients with BCLP through 3D virtual casts. Weighted kappa values indicated good intrarater and good-to-very good agreement, supporting the reliability of this yardstick when employed to virtual casts. Further studies should be encouraged to face the actual lack of evidence in this field.

Fixation preference test: reliability for the detection of amblyopia in patients with strabismus and interexaminer agreement.

The purpose of this study was to analyze the reliability of the fixation preference test (FPT) in the detection of amblyopia, and to determine interexaminer agreement. Eighty patients whose visual acuity could be tested objectively and had a horizontal misalignment of more than 10 prism diopters were enrolled. The best corrected visual acuity (BCVA) and orthoptic findings were all recorded. Non-preferred eye in primary position and fixation preference grade were assessed independently by two masked experienced examiners. The primary outcome measures were reliability of FPT in terms of its correlation with BCVA and interexaminer agreement. There was no significant correlation between fixation preference grades and interocular visual acuity difference as well as the type and amount of deviation, the presence of fusion, stereopsis, anisometropia, and previous strabismus surgery for none of the examiners (p>0.05 for all). Sensitivity was 52.0% for examiner 1 and 54.0% for examiner 2 while specificity was 50.0 and 46.7%, respectively. Interexaminer agreement was 76.7% (p<0.001) for all patients. FPT is widely used in children particularly when the visual acuity cannot be determined in an objective manner. The test may not be accurate and reliable in the detection of amblyopia and also in predicting the visual acuity difference between both eyes, even though it was found to show a high degree of agreement between examiners. In conclusion, it should be kept in mind that the reliability of FPT may be limited and the results should be interpreted with caution and be supported by other tests.

Assessment of Intraobserver and Interobserver Agreement of a New Classification System for Retrograde Periimplantitis.

Retrograde periimplantitis (RPI) is the inflammatory disease that affects the apical part of an osseointegrated implant while the coronal portion of the implant sustains a normal bone-to-implant interface. The aim of the current study was to assess the intraexaminer and interexaminer reliability of a proposed new classification system for RPI. After thorough electronic literature search, 56 intraoral periapical radiographs (IOPA) of implants with RPI were collected and were classified by 2 independent reviewers as per the new classification system into one of the 3-mild, moderate, and advanced-classes based on the amount of bone loss from the apex of the implant to the most coronal part as a percentage of the total implant length. The IOPAs were assessed twice by the same examiners and both were blinded to each other's observations. The intraobserver agreement ranged from 0.85 to 0.91, which falls under the category of almost perfect agreement. The interexaminer agreement was found to be 0.83, also considered as almost perfect agreement. The proposed classification shows good intraexaminer and interexaminer reliability and can be used for treatment planning and prognosis in cases of RPI.

Poor interexaminer agreement on Friedman tongue position

Conclusion: The Friedman tongue position demonstrated only a slight inter-examiner agreement among 15 medical doctors, indicating that the method is difficult to perform and could be an uncertain method to select patients for uvulopalatopharyngoplasty.Objective: The Friedman staging system is a clinical tool for selecting patients with obstructive sleep apnea who are appropriate for uvulopalatopharyngoplasty. The objective of this study was to evaluate the staging system by determining the inter-examiner agreement of one of its key components, the Friedman tongue position.Methods: Eleven residents and four specialists in Otorhinolaryngology were recruited from a course in surgical management of obstructive sleep apnea. They examined each other’s tongue positions, resulting in a total of 210 evaluations. Cohen’s kappa analysis was performed to assess the inter-examiner agreement. The range of kappa is usually between 0–1, where 0 is complete disagreement and 1 is complete agreement.Results: The median kappa was 0.36 (1st and 3rd quartile, 0.23 and 0.42), corresponding to only a slight agreement.

Correlation between a 2D simple image analysis method and 3D bony motion during the pivot shift test

BackgroundThe pivot shift test is the most specific clinical test to detect anterior cruciate ligament injury. The purpose of this study was to determine the correlation between the 2D simple image analysis method and the 3D bony motion of the knee during the pivot shift test and assess the intra- and inter-examiner agreements. MethodsThree orthopedic surgeons performed three trials of the standardized pivot shift test in seven knees. Two devices were used to measure motion of the lateral knee compartment simultaneously: 1) 2D simple image analysis method: translation was determined using a tablet computer with custom motion tracking software that quantified movement of three markers attached to skin over bony landmarks; 2) 3D bony motion: electromagnetic tracking system was used to measure movement of the same bony landmarks. ResultsThe 2D simple image analysis method demonstrated a good correlation with the 3D bony motion (Pearson correlation: 0.75, 0.76 and 0.79). The 3D bony translation increased by 2.7 to 3.5 times for every unit increase measured by the 2D simple image analysis method. The mean intra-class correlation coefficients for the three examiners were 0.6 and 0.75, respectively for 3D bony motion and 2D image analyses, while the inter-examiner agreement was 0.65 and 0.73, respectively. ConclusionsThe 2D simple image analysis method results are related to 3D bony motion of the lateral knee compartment, even with skin artifact present. This technique is a non-invasive and repeatable tool to quantify the motion of the lateral knee compartment during the pivot shift test.

Use of Biologic Agents to Promote Bone Formation in Implant Dentistry: A Critical Assessment of Systematic Reviews.

The use of biologic agents is emerging in bone regeneration procedures due to their ability to increase cellular events in wound healing and therefore to obtain more predictable outcomes. Hence, the aim of the present study was to critically evaluate the methodology of systematic reviews investigating biologic agents in promoting bone formation and implant site development. A literature search for systematic reviews with and without meta-analyses was performed in Medline, Embase, and the Cochrane database, as well as in journals with high impact factors in periodontics and implant dentistry. Titles, abstracts, and full-text articles were analyzed for potential inclusion. Three guidelines--AMSTAR, R-AMSTAR, and the checklist proposed by Glenny et al--were utilized to analyze their methodologic quality. Two calibrated reviewers performed all data extraction and appraisal. Cohen's kappa coefficients were calculated to appraise the interexaminer agreement. A total of 12 systematic reviews, 3 with meta-analyses, were evaluated. Platelet-rich derivatives and BMP-2 were the most widely studied biologic agents and sinus augmentation was the most common procedure evaluated. The R-AMSTAR mean score was 28 (range 14-38) and none of the systematic reviews analyzed met all of the items. In the AMSTAR checklist, the mean score was 5.75 (range 2-9) and the only item met by all the systematic reviews was the a priori design. The Glenny et al checklist mean score was 8.6 (range 4-13) and two items, "focused question" and "to identify all relevant studies," were met by all systematic reviews. Systematic reviews on biologic agents demonstrate substantial methodologic variability. Therefore, caution must be exercised when interpreting their findings.

Validity and reliability of remote dental screening by different oral health professionals using a store-and-forward telehealth model.

Objective This study was conducted to evaluate the validity and reliability of intraoral photographic assessments by different members of a dental team as a means for dental screening in children.Methods The intraoral photographic records of 126 children (2 to 18 years old) were obtained from routine clinical records taken before dental treatment. Intraoral photographs were obtained using a DSLR camera and then uploaded to a cloud-based server using store-and-forward telehealth technology. Images were reviewed by an expert panel to formulate a benchmark screening baseline, to which the screeners' data were compared. The photographic assessments conducted by a mid-level dental practitioner (MLDP) and dentist, were compared to the benchmark expert panel assessment.Results The screeners' assessments by means of intraoral photography, when compared to the expert panel assessment had a sensitivity value of 82-89% and specificity value of 97%. The inter-examiner agreement between the expert panel assessment and photographic method (assessed by a dentist and MLDP), was almost perfect, with a kappa score ranging from 0.82 to 0.88. The mean DFT/dft score for the children as determined by the expert panel's review and photographic assessment ranging from 5.41 to 5.79, with mean scores between the two assessment methods not significantly different (P = 0.746).Conclusion Our results suggested that oral health professionals (other than dentists) have the potential to screen for caries from intraoral photographs with the same diagnostic accuracy and reliability as dentists. This strategy has implications for supporting the use of MLDPs such as dental therapists or hygienists to screen for oral disease using telehealth.

Concordancia de la retinoscopia estática frente al estándar de referencia en un grupo de escolares

&lt;p align="justify"&gt;El protocolo de la Red Epidemiológica Iberoamericana en Salud Visual y Ocular (Reisvo) fue estandarizado mediante el desarrollo de un estudio piloto. Para medir la estandarización se determinó la repetibilidad y reproducibilidad de la prueba, así como el grado de acuerdo de esta respecto al estándar de referencia. &lt;em&gt;Metodología&lt;/em&gt;: se evalúo un grupo de escolares de 5 a 15 años de edad, sanos, que cumplieran con los criterios de inclusión y exclusión, bajo los lineamientos de la Resolución 8430 de 1993. Dos observadores realizaron tres mediciones de la retinoscopia estática y el experto realizó la retinoscopia bajo cicloplejia. &lt;em&gt;Resultados&lt;/em&gt;: las fórmulas esferocilíndricas fueron convertidas al análisis de Fourier en tres componentes: M, J&lt;sub&gt;0&lt;/sub&gt; y J&lt;sub&gt;45&lt;/sub&gt;. La fuerza de acuerdo intra e interexaminador, medida con el coeficiente de correlación intraclase para la retinoscopia estática, mostró un grado de acuerdo alto en el componente M, tanto para la concordancia intra e interexaminador de la retinoscopia estática como para la correlación entre la retinoscopia estática y la retinoscopia bajo cicloplejia. La concordancia para los componentes J&lt;sub&gt;0&lt;/sub&gt; y J&lt;sub&gt;45&lt;/sub&gt;, con grados de acuerdo débiles y nulos, no presentaron diferencias clínicas entre observadores. &lt;em&gt;Conclusiones&lt;/em&gt;: la retinoscopia estática mostró una adecuada repetibilidad y reproducibilidad frente a la retinoscopia bajo cicloplejia en la aplicación del protocolo Reisvo.&lt;/p&gt;

Reliability and interexaminer agreement for induced tropia test: is normal always normal?

The purpose of this study was to evaluate the reliability of the fixation preference testing with 10 and 20 diopter prisms (Δ) in children without strabismus in order to extrapolate its utility to preverbal children and to determine interexaminer agreement. Fourty children (24 girls, 16 boys) aged between 5 and 16years with normal ophthalmological examination except refractive errors were included in the study. The visual acuity, refractive errors, and orthoptic findings were recorded. The base-down prism fixation test was performed by two experienced examiners with 10Δ and 20Δ. The presence of corrective movement was recorded as positive result separately for each eye. Best-corrected visual acuity was 1.0 bilaterally for all patients. All patients had binocular single vision and stereopsis. First examiner noted bilateral fixation movement in 65% patients with 10Δ and in 57.5% with 20Δ, second examiner in 50% with 10Δ, and in 37.5% with 20Δ. Interexaminer agreement was 42.5% for 10Δ and 54.5% for 20Δ (p<0.01). Both examiners observed the fixation movement to be less frequent in older children. The fixation movement can be absent or seen asymmetrically even in children with equal visual acuity and binocular vision. The rate of fixation movement seemed to be reduced with age possibly due to increased concentration and cooperation of the child. In addition, there was a remarkable interexaminer variability in both tests. It should be borne in mind that the findings of prism-guided fixation preference tests may be misleading in preverbal children.

MRI alone versus MRI-CBCT registered images to evaluate temporomandibular joint internal derangement

To evaluate the effect of magnetic resonance imaging-cone beam computed tomography (MRI-CBCT) image registration on inter- and intraexaminer consistency when evaluating temporomandibular joint (TMJ) internal derangement compared to MRI alone. MRI and CBCT images of 25 patients (50 TMJs) were obtained and coregistered using mutual-information rigid image registration via Mirada XD software. Two experienced radiologists independently and blindly evaluated two types of images (MRI alone and MRI-CBCT registered images) at two different times (T1 and T2) for TMJ internal derangement, based on sagittal and coronal articular disc position in relation to the head of the condyle and the posterior slope of the articular eminence. The intraexaminer consistency with MRI alone (examiner 1=0.85 [0.74-0.92]; examiner 2=0.91 [0.84-0.95]) was lower than for the MRI-CBCT registered images (examiner 1=0.95 [0.91-0.97]; examiner 2=0.97 [0.96-0.99]). The interexaminer consistency of evaluating internal derangement with MRI alone (0.52 [0.18-0.73] at T1; 0.71 [0.45-0.84] at T2) was lower than for the MRI-CBCT registered images (0.97 [0.95-0.98] at T1; 0.98 [0.96-0.99] at T2). When disc position classification was dichotomized to normal versus anteriorly displaced, intraexaminer agreement for the two examiners was 0.52 and 0.63 for MRI alone, but was 0.91 and 0.92 for MRI-CBCT registered images. Interexaminer agreement for MRI alone was 0.29 at T1 and 0.42 at T2, but was 0.96 at both examination times for MRI-CBCT registered images. The MRI-CBCT registered images improved intra- and interexaminer consistency in the evaluation of internal derangement of TMJ.

Development and Assessment of Discrimination Exercises for Faculty Calibration in Preclinical Operative Dentistry

The aims of this study were to identify the level of interexaminer agreement among preclinical operative dentistry faculty members when grading Class II preparations performed by first-year dental students; to develop discrimination exercises for specific preparation components where interexaminer agreement was poor; and to evaluate if the discrimination exercises were able to improve inter- and intraexaminer agreement. In the preliminary phase of this study, 13 components of 32 Class II cavity preparations were assessed by eight course faculty members at one U.S. dental school. Analysis of average interexaminer agreement on these components revealed that six were below 60%. These were proximal contact clearance, retention groove placement, retention groove depth, preparation walls, preparation margins, and preparation toilet/debris. A 30-minute calibration session was subsequently developed to provide discrimination exercises utilizing 3-D models and digital images of various levels of student performance for five of the six components. Immediately following calibration, the course faculty assessed the same 32 preparations (Phase I) followed by a delayed assessment without calibration (Phase II) approximately six months later. The results showed that overall interexaminer reliability improved after calibration. Although there was a decline in interexaminer reliability after an interval of six months (Phase II), the degree of variation among examiners was lower than in the preliminary assessment. These findings support the use of discrimination exercises for preclinical operative dentistry course faculty to increase interexaminer agreement and thereby improve the consistency of faculty-student communication.

Classifying medial rectus muscle attachment in consecutive exotropia

To evaluate interexaminer agreement when classifying medial rectus muscle attachment in patients with consecutive exotropia.

Landmark errors on posteroanterior cephalograms.

It is important to reduce the method errors when evaluating posteroanterior cephalograms to see either small deviations from normal or transverse changes caused by orthodontic treatment. The aim of this study was to determine horizontal and vertical intraexaminer and interexaminer agreement in localization of landmarks in posteroanterior cephalograms of adult patients. The sample wasgathered retrospectively from the archives of the Department of Orthodontics of Yeditepe University in Istanbul, Turkey. Radiographs of 39 patients diagnosed with skeletal asymmetries (20 women, 19 men) were drawn manually, and a coordinate system was established with software. The tracings were made by 2 operators, after a calibration session on 29 landmarks (22 bilateral, 7 midline). Intraclass correlation coefficients and the Bland-Altman test were used for detecting interexaminer and intraexaminer agreement for each cephalometric variable. The interexaminer agreement test showed that the most problematic landmark was crista galli, which showed moderate consistency between 2 examiners in the y coordinates at 2 time points. Condylar and zygomatic landmarks showed good agreement. The greater wing inferior and superior orbit, maxillary point, menton, anterior nasal spine, antegonial notch, mandibular and maxillary molar point, maxillary and mandibular incisor point, and maxillary and mandibular incisor edge landmarks had excellent agreement between the 2 examiners at the 2 time points in both the x and y coordinates. There are fewer errors in intraexaminer than in interexaminer correlations in landmark identifications on posteroanterior radiographs. All landmarks investigated except crista galli showed good agreement between measurements.

Evaluation of dental therapists undertaking dental examinations in a school setting in Scotland.

To measure agreement between dental therapists and the Scottish gold-standard dentist undertaking National Dental Inspection Programme (NDIP) examinations. A study of interexaminer agreement between 19 dental therapists and the national gold-standard dentist was carried out. Pre-calibration training used the caries diagnostic criteria and examination techniques agreed by the British Association for the Study of Community Dentistry (BASCD). Twenty-three 5-year-old children (Primary 1) and 17 11-year-old children (Primary 7) children were examined. Agreement was assessed using kappa statistics on d3 mft and D3 MFT for P1 and P7 children, sensitivity and specificity values, and kappa statistics on d3 t/D3 T and ft/FT. Calibration data on P1 and P7 children from 2009-2012 involving dentists as examiners were used for comparison. Economic evaluation was undertaken using a cost minimization analysis approach. The mean kappa score was 0.84 (SD 0.07) ranging from 0.69 to 0.94. All dental therapists scored good or very good agreement with the gold-standard dentist. This compares with historic NDIP calibration data with dentists, against the same gold-standard dentist, where the mean kappa value was 0.68 (SD 0.22) with a range of 0.35-1.00. The mean sensitivity score was 0.98 (SD 0.04) (range 0.88-1.0) and mean specificity score was 0.90 (SD 0.06) (range 0.78-0.96). Health economic analysis estimated that salary costs would be 33.6% lower if dental therapists were substituted for dentists in the year 2013, with an estimated saving of approximately £103 646 per annum on the national budget. We conclude that dental therapists show a high level of interexaminer agreement, and with the appropriate annual training and calibration, they could undertake dental examinations as part of the NDIP programme.

Accuracy and reproducibility of dental caries risk classification in São Paulo, Brazil

Aim: To evaluate the accuracy and reproducibility of the dental caries risk classification applied in the state of São Paulo, Brazil, in an attempt to organize the demand for primary care in oral health. Materials andMethods: Eleven dentists independently examined 120 individuals (75 from 12 to 19 years of age and 45 from 35 to 44 years of age) by visual inspection, and classified them into six codes ranging from A to F, in whichcode A indicated the healthiest individual (low-risk) and F indicated the sickest individual (high-risk). The agreement between the intraexaminer and the gold standard examiner was evaluated by Kappa. The percentageof agreement, sensitivity, specificity, positive predictive value, and negative predictive value regarding the gold standard examiner was also calculated. Results: It could be observed that 60.0% of the individuals examinedwere considered sick, while 40.0% were considered healthy. Values for intra and inter-examiner agreement were k=0.66 and k=0.72, respectively. The percentage of agreement, sensitivity, specificity, positive predictivevalue, and negative predictive values were 83.8%, 82.5%, 85.8%, 90.2%, and 76.9%, respectively. Conclusion: This study suggests that the dental caries risk classification, with its various levels of standardization, presentedgood accuracy and reasonable reproducibility, as well as a low cost and a relatively low demand for resources. As such, this risk classification is recommended for large-scale use.Uniterms: Dental caries. Epidemiology. Oral health. Primary health care.

Approaches adopted by dentists for management of occlusal caries in primary teeth

ABSTRACT Objective To evaluate the approaches used by Family Health Strategy dentists in the city of Campina Grande, Paraíba, Brazil, for management of occlusal caries in primary teeth. Methods In this observational, cross-sectional, census-based, descriptive study, 33 professionals completed a questionnaire designed to evaluate their approach to management of occlusal caries in enamel and dentin of deciduous teeth in different risk situations. Data were analyzed through descriptive and inferential statistics (Fisher's exact test with the level of significance set to 5%). Inter-examiner agreement was evaluated by Cohen's kappa statistic. Results For chronic enamel caries in primary teeth with low risk/activity, the approach of choice was preventive, with fluoride application being the most cited intervention (39.3%). For active carious dentin in primary teeth with high risk/activity and with low risk/activity, invasive approaches were most prevalent (93.9% and 78.8%, respectively), with complete caries removal (74.2%) and glass-ionomer restoration (69.2%) being the most frequent responses. Inter-examiner agreement was moderate (k = 0.44). Conclusion Although a wide range of approaches were adopted by dental practitioners, most preferred invasive interventions, even in situations where preservation of tooth structure was recommended.

Interexaminer agreement dental caries epidemiological surveys: the importance of disease prevalence in the sample.

To identify desirable characteristics, including different sample sizes and dental caries prevalences, in virtual samples that allow, at the same time, higher values of general agreement percentage (GPA) and Kappa coefficient (κ), under a low confidence interval (CI), in reproducibility studies. A total of 384 statistical simulations of inter-examiner calibration, varying sample size (12, 15, 20, 60, 200 and 500 individuals), caries prevalence (30, 50, 60 and 90%) and percentages of positive (PA) and negative (NA) agreement (30, 50, 60 and 90%) were undertaken. GPA and κ were used to measure reproducibility and define deviation between them. The sample of 60 individuals, under caries prevalence of 50%, PA and NA of 90%, presented a GPA and Kappa values of 90 and 80%, respectively, a relative small confidence interval (95%CI 0.65 - 0.95) and a GPA/Kappa deviation of 10.00. A virtual sample of 60 individuals, under caries prevalence of 50%, seems feasible to produce a satisfactory interexaminer agreement at epidemiological conditions. However, epidemiological studies to corroborate or refute this assertion are necessary.

Treatment outcome after neonatal cleft lip repair in 5-year-old children with unilateral cleft lip and palate

IntroductionThe aim of this study was to assess speech outcomes and dental arch relationship of 5-year-old Czech patients with unilateral cleft lip and palate (UCLP) who have undergone neonatal cleft lip repair and one-stage palatal closure. Methods and materialsTwenty-three patients with UCLP, born between 2009 and 2010, were included in the study. Three universal speech parameters (hypernasality, articulation and speech intelligibility) have been devised for speech recordings evaluation. Outcomes of dental arch relationship were evaluated by applying the GOSLON Yardstick and subsequently compared with the GOSLON outcome of other cleft centers. ResultsModerate hypernasality was present in most cases, the mean value for articulation and speech intelligibility was 2.07 and 1.93, respectively. The Kappa values for inter-examiner agreement for all the three speech outcomes ranged from 0.786 to 0.808. Sixty-three percent of patients were scored GOSLON 1 and 2, 26% GOSLON 3, and 10% GOSLON 4. GOSLON mean score was 2.35. Interrater agreement was very good, represented by kappa value of 0.867. ConclusionThe treatment protocol, involving neonatal cleft lip repair and one-stage palatal repair performed up to the first year of UCLP patient's life, has shown good speech outcomes and produced very good treatment results in regard to maxillary growth, comparable with other cleft centers.

Inter-examiner agreement of the systematic physical examination in patients with obstructive sleep disorders.

The goal of this study was to investigate the agreement between examiners who were or were not trained in the physical examination of the upper airway (UA) and the craniofacial skeleton of individuals with obstructive sleep disorders (OSD). A systematic assessment of the UA and craniofacial skeleton was performed on 55 individuals with OSD. The participants were consecutively assessed by three otorhinolaryngologists who specialized in sleep medicine for at least 1year (trained examiners) and two doctors who were attending a residency program in otorhinolaryngology (untrained examiners). When analyzing all of the parameters assessed, the concordance was better in the trained group (k = 0.694, which is considered "good") compared to the untrained group (k = 0.475, "fair") (p < 0.001). The inter-examiner agreement was also better in the trained compared to the untrained group, as follows: craniofacial (k = 0.643 vs. 0.349), nasal (k = 0.657 vs. 0.614), and pharyngeal (k = 0.729 vs. 0.276) abnormalities (p < 0.05). The overall concordance of the physical examination of the UA and craniofacial skeleton was "good" among the trained specialists and "fair" among examiners without appropriate training, despite its subjectivity.