Inter-rater Research Articles

Threat of deepfakes to the criminal justice system: a systematic review

Abstract Background This systematic review explores the impact of deepfakes on the criminal justice system. Deepfakes, a sophisticated form of AI-generated synthetic media, have raised concerns due to their potential to compromise the integrity of evidence and judicial processes. The review aims to assess the extent of this threat, guided by a research question: (1) What threats do deepfakes pose to the criminal justice system? Methods The review was conducted using databases such as Web of Science, ProQuest, Scopus, and Google Scholar, focusing on publications from 2021 to 2022. Search terms were optimised for sensitivity and specificity, and articles were chosen based on criteria including relevance to deepfake threats and deepfake detection research. The methodology included rigorous screening processes using tools like Zotero and Rayyan.ai, with an emphasis on inter-rater reliability to ensure objective selection of studies. Results The search initially identified 1355 articles, with 1200 articles screened for eligibility after duplicates were removed. For the threat of deepfakes to the criminal justice system, 110 studies were selected for full-text review, and 44 were included in the final analysis. Key findings include identification of primary crime categories linked to deepfakes, such as pornography, fraud, and information manipulation, alongside challenges like trust erosion in institutions and evidence falsification issues. Conclusions Deepfakes significantly threaten the criminal justice system, highlighting the necessity for advanced detection methods. These findings underscore the importance of continued research and development in deepfake detection technologies and strategies for legal safeguards and broader implications on policy, national security, and democratic processes.

Evaluation of intra- and inter-rater agreement on ultrasound measurements of dairy cow teats by operators with different experience levels.

Ultrasound is a valuable, non-invasive technique. It allows for detailed examination, precise measurement, and effective monitoring of teats in dairy cows. This study aimed to evaluate the reliability of ultrasound measurements of teats in dairy cows, specifically focusing on intra- and inter-rater agreement between operators with different levels of experience. The study included 51 healthy Holstein cows, with two operators (experienced and inexperienced) performing measurements on ultrasound images obtained before and after milking. The parameters analyzed were teat-canal length (TCL), teat-end width (TEW), teat-wall thickness (TWT), and teat-cistern width (TCW). Differences in teat measurements before and after milking, as well as between operators, were assessed using the Wilcoxon Signed Rank test and the Mann-Whitney U test, respectively. Intra- and inter-rater agreement was calculated using the intra-class correlation coefficient (ICC). Statistical significance was set at p < 0.05. A total of 402 ultrasound images were analyzed. Significant differences were found in TCL, TWT, and TCW before and after milking, while TEW remained unaffected. Statistically significant differences in TWT and TCW were observed between the two operators, while TCL and TEW did not show significant differences. Intra-rater agreement for the experienced operator was excellent, and for the inexperienced operator, it was good. Inter-rater agreement ranged from good to excellent for most parameters, except for TWT, where it was poor. The study confirms that both milking and operator experience influence teat measurements. However, with proper training, ultrasonography can be a reliable tool for assessing udder health in dairy cows, supporting its use in field conditions.

Efficacy and Safety of a Diet Enriched with EPA and DHA, Turmeric Extract and Hydrolysed Collagen in Management of Naturally Occurring Osteoarthritis in Cats: A Prospective, Randomised, Blinded, Placebo- and Time-Controlled Study

This study evaluated a therapeutic diet high in eicosapentaenoic (EPA) and docosahexaenoic acid (DHA) of marine source (EPA:DHA ratio 0.69:1), turmeric extract, and hydrolysed collagen in cats (N = 30) with naturally occurring osteoarthritis (OA) over a 13-week (W) period, followed by a 4-W washout, using four previously validated pain/functional outcomes. Compared to the placebo diet, the therapeutic diet significantly improved peak vertical force (p = 0.017; W16, 64% responders), correlating to enhanced weight bearing; stair assay compliance (p &lt; 0.001; W16, 87% responders), reflecting reduced fatigue related to OA pain; night-time actimetry (cohort effect; p = 0.05, 67% responders), suggesting greater spontaneous mobility and comfort; and MI-CAT(V) score (cohort effect; p &lt; 0.001, 80% responders), indicating reduced functional impairments. The earliest therapeutic response was observed at W06, marked by an inflection point between actimetric linear regressions of both cohorts, confirmed by significant MI-CAT(V) differences (p &lt; 0.007; W08; W12; W16). The MI-CAT(V) clinical metrology instrument was validated for inter-rater reliability, minimal placebo effect (&lt;15% responders), and OA severity clustering. Despite baseline differences in biomechanical assessments (p &lt; 0.05), both moderate and severe OA clusters responded equally positively to the therapeutic diet. Based on all outcomes, the therapeutic diet showed promise for the long-term management of feline OA, with no observed side effects.

Chatbot Demonstrates Moderate Interrater Reliability in Billing for Hand Surgery Clinic Encounters.

Artificial intelligence offers opportunities to improve the burden of health care administrative tasks. Application of machine learning to coding and billing for clinic encounters may represent time- and cost-saving benefits with low risk to patient outcomes. Gemini, a publicly available large language model chatbot, was queried with 139 de-identified patient encounters from a single surgeon and asked to provide the Current Procedural Terminology code based on the criteria for different encounter types. Percent agreement and Cohen's kappa coefficient were calculated. Gemini demonstrated 68% agreement for all encounter types, with a kappa coefficient of 0.586 corresponding to moderate interrater reliability. Agreement was highest for postoperative encounters (n = 43) with 98% agreement and lowest for new encounters (n = 27) with 48% agreement. Gemini recommended billing levels greater than the surgeon's billing level 31 times and lower billing levels 10 times, with 4 wrong encounter type codes. A publicly available chatbot without specific programming for health care billing demonstrated moderate interrater reliability with a hand surgeon in billing clinic encounters. Future integration of artificial intelligence tools in physician workflow may improve the accuracy and speed of billing encounters and lower administrative costs.

X-ray guided anatomy-based fitting: The validity of OTOPLAN.

Anatomy-based fitting (ABF) for cochlear implant users is a new era that seeks improved outcomes. Recently, different imaging modalities, such as plain X-rays, have been proposed to build the ABF as an alternative to the computed tomography (CT) scan. This study aimed to assess the feasibility and validity of OTOPLAN® software in building ABF using plain X-ray imaging. A retrospective evaluation of postoperative CT scans and plain X-ray post-op images of 54 patients was analyzed using the OTOPLAN® software. The post-op analysis was done for the angular insertion depth (AID) and center frequency of each electrode contact using both imaging modalities. Moreover, inter-rater reliability was assessed for measurements obtained from CT scans and plain X-ray images. Non-significant statistical and clinical mismatches were detected when comparing the AID and center frequency measurements assessed using CT and X-rays. The absolute difference between CT and X-ray approaches ranged from 0.0 to 4.6 degrees for AID and 0.2 to 0.5 semitone for frequency. Moreover, the AID and the frequency measurements from CT and X-ray images demonstrated almost perfect agreement between the raters. The inter-observer reliability for CT scans showed that the intraclass correlation coefficient (ICC) exceeded 0.97 for AID and 0.95 for the frequency across all electrode contacts. Our results demonstrated the validity and reliability of using post-operative X-ray images by OTOPLAN® software to build Anatomy-based Fitting maps.

A novel method of acetabular component anteversion measurement on plain radiographs.

Acetabular component anteversion (ACA) markedly impacts the outcome of total hip arthroplasty (THA) and thus is routinely measured on radiographs postoperatively. However, clinical ACA measurement methods are either too complicated or subjective due to three drawbacks: complex calculations, measurement of obscured points, and complex geometric drawings. This study aimed to develop a precise and convenient novel method of measuring ACA on routine radiographs without the three drawbacks and to verify its accuracy and reliability by comparing it against existing methods. A novel geometric principle to measure ACA was developed. Accordingly, a protractor was designed to measure radiographic anteversion (RA) on anteroposterior (AP) hip radiographs. Three researchers measured RA twice, using the protractor, McLaren's, and Pradhan's method on 26 computer-simulated radiographs with pre-set RAs and 20 actual radiographs. Accuracy was assessed by errors on simulated radiographs, and reliability was assessed by results of measurements on simulated and actual radiographs. The absolute error of the novel method (1.01° ± 1.06°) was lower than McLaren's method (1.34° ± 1.16°) (p < 0.05) and not significantly different from Pradhan's method (1.10° ± 1.02°) (p = 0.392). The protractor's intra-rater and inter-rater reliability were good-to-excellent or excellent and higher or equivalent to the two other methods. The novel method avoids the three major drawbacks of conventional methods. Its accuracy is significantly higher than McLaren's method and comparable to Pradhan's. The novel method has higher or non-inferior accuracy and reliability than McLaren's and Pradhan's methods.

Cross-cultural validation of the Clinician-Administered PTSD scale for DSM-5, child and adolescent version in Japan

ABSTRACT Background: The establishment of a formal diagnosis of post-traumatic stress disorder (PTSD) for children and adolescents is the foundation for advancing pertinent clinical research and formulating proper treatment and management. However, a validated diagnostic tool for PTSD in children and adolescents is lacking in Japan. Objective: To examine the cross-cultural validity and reliability of the Japanese Clinician-Administered PTSD Scale for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), child and adolescent version (CAPS-CA-5-J). Method: Overall, 73 children who had experienced potentially traumatic events were recruited from three medical facilities. The linguistically validated CAPS-CA-5-J was conducted by trained psychiatrists and psychologists. Additionally, children and their caretakers completed questionnaires such as the UCLA PTSD reaction index for DSM-5 (PTSD-RI-5), Depression Self-Rating Scale for Children (DSRDC), and Strength and Difficulties Questionnaire (SDQ); 16 participants were randomly selected for the inter-rater reliability assessment. Results: Owing to missing values in the CAPS-CA-5-J and PTSD-RI-5, 68 children were included in the final analysis. Regarding reliability, the CAPS-CA-5-J showed excellent internal consistency (Cronbach’s alpha coefficient = 0.90) and interrater agreement (kappa coefficient = 0.88). Convergent validity was supported by a strong correlation between the total severity scale of the CAPS-CA-5-J and the PTSD-RI-5 scores (Pearson’s correlation coefficient = 0.82). Divergent validity was indicated by a moderate correlation between the CAPS-CA-5-J and DSRDC, and no correlation was found with the SDQ scores. Conclusions: This study is the first to validate a structured clinical interview for children and adolescents with PTSD in Japan. The psychometric properties of the CAPS-CA-5-J were good enough and comparable to those reported in previous validation studies. Therefore, the CAPS-CA-5-J can be considered reliable and valid for use in Japan.

Exploring the Potential of Claude 3 Opus in Renal Pathological Diagnosis: Performance Evaluation.

Artificial intelligence (AI) has shown great promise in assisting medical diagnosis, but its application in renal pathology remains limited. We evaluated the performance of an advanced AI language model, Claude 3 Opus (Anthropic), in generating diagnostic descriptions for renal pathological images. We carefully curated a dataset of 100 representative renal pathological images from the Diagnostic Atlas of Renal Pathology (3rd edition). The image selection aimed to cover a wide spectrum of common renal diseases, ensuring a balanced and comprehensive dataset. Claude 3 Opus generated diagnostic descriptions for each image, which were scored by 2 pathologists on clinical relevance, accuracy, fluency, completeness, and overall value. Claude 3 Opus achieved a high mean score in language fluency (3.86) but lower scores in clinical relevance (1.75), accuracy (1.55), completeness (2.01), and overall value (1.75). Performance varied across disease types. Interrater agreement was substantial for relevance (κ=0.627) and overall value (κ=0.589) and moderate for accuracy (κ=0.485) and completeness (κ=0.458). Claude 3 Opus shows potential in generating fluent renal pathology descriptions but needs improvement in accuracy and clinical value. The AI's performance varied across disease types. Addressing the limitations of single-source data and incorporating comparative analyses with other AI approaches are essential steps for future research. Further optimization and validation are needed for clinical applications.

Analysis of Tumor Proliferation Markers in Early-Stage Luminal Breast Cancer: A Comprehensive Study Using Mitotic Activity Index, Ki-67, and Phosphohistone H3 Expression.

Introduction and Aim: Routinely used proliferation markers such as mitotic activity index (MAI) and Ki-67 index show limited reproducibility due to high interobserver variability in breast cancer assessment. Phosphohistone H3 (PhH3), a novel proliferation marker, is gaining attention in breast cancer research. This study aimed to evaluate the inter-rater agreement among MAI, Ki-67, and PhH3 expressions in early-stage luminal breast cancer and assess the impact of replacing MAI with PhH3 index on tumor histological grading. Materials and Methods: Three pathologists assessed MAI, Ki-67, and PhH3 expressions in 66 early-stage luminal breast cancer specimens. Mitotic Activity Index was scored based on mitotic figures in an area of 2 mm2 while Ki-67 index utilized a 14% threshold for positively stained nuclei. Phosphohistone H3 expression cutoff was set at 13 positive cells per 2 mm2. The inter-rater agreement for the 3 variables was analyzed using Cohen kappa statistics. Results: Among the 3 parameters, the kappa score of the PhH3 expression reflected very strong agreement between the 3 observers (κ = 0.991, 0.907, and 0.916). Only moderate agreement was noted for MAI (κ = 0.898, 0.562, and 0.592) and substantial agreement for Ki-67 index (κ = 0.869, 0.673, and 0.678). Moreover, replacing MAI with PhH3 index led to upgrade of histological grade in 15% to 16% of patients. Conclusion: Our study demonstrated that PhH3 is a more reproducible proliferation marker than MAI and Ki-67. Incorporation of PhH3-based mitotic index in breast cancer grading might reduce the variation in the assessment of histological grade.

Reliability, Concurrent Validity, Responsiveness and Measurement Error of the Portuguese Version of Comprehensive Motor Coordination Scale in Individuals With Parkinson's Disease.

Assessment of motor coordination in patients with Parkinson's disease (PD) is based on motor performance and does not consider movement quality. To validate the Comprehensive Coordination Scale (CCS) in patients with PD and correlate it with motor impairment. This cross-sectional and case-control study included 15 individuals with PD and 15 healthy older individuals as controls. Motor impairments were measured using the MDS-UPDRS (Part III). Motor coordination (CCS) was evaluated by five examiners and classified into four domains: upper and lower limbs and unilateral and bilateral tasks. CCS scores were compared between the groups using the Mann-Whitney test; concurrent validity was evaluated using Spearman's correlation between CCS and PD scales; and the inter-rate reliability was calculated by intraclass correlation coefficient (ICC). There was significant difference between the groups in the upper limb (p<0.001), lower limb (p=0.006), unilateral (p<0.001), bilateral (p=0.015), and total (p<0.001) CCS scores. Total CCS score (ICC 0.78), upper limb (ICC 0.71), lower limb (ICC 0.86) and unilateral (ICC 0.74) showed high inter-rate reliability. Bilateral domain (ICC 0.92) showed very high inter-rate reliability. And, there was negative correlation between CCS upper limb and postural tremor of hands (r=-0.716; p=0.008), unilateral CCS domain with postural tremor of hands (r=-0.687; p=0.012), and CCS total score with postural tremor of hands (r=-0.804; p=0.002). There was high inter-rater agreement for all CCS items, mainly in the lower limb and bilateral tasks. And, there was a moderate-to-very strong correlation between the total and sub-items of the CCS and motor impairment.

Reliability of ultrasound assessment of the rectus femoris muscle thickness: intra-rater, inter-rater, and inter-day analysis accounting for age and sex.

The rectus femoris muscle plays an important role in maintaining lower limb stability and biomechanical control during basic physical activities. Both reduced quadriceps strength and decreased muscle thickness of the rectus femoris, as measured by ultrasound, are associated with an increased risk of falls in older adults. We estimated the relative and absolute intra-rater, inter-rater, and inter-day reliability of the procedure. A female biologist and a male physical educator, both holding a master's degree in human movement and rehabilitation, captured ultrasound images of the right rectus femoris muscle in 106 healthy participants (58 females and 48 males), aged 18 to 73 years. Each rater captured three images per participant during each visit, with two visits 7to10 days apart. A third person subsequently measured the muscle thickness. We calculated the Intraclass Correlation Coefficients (ICC) using a two-way random model and determined the 95% minimal detectable difference (MDD). The mean muscle thickness was 2.12cm. The reliability based on single measurements was as follows: the intra-rater ICC for raters A and B was 0.998 at both visits (MDDs: 0.074-0.082cm). The inter-rater ICC was 0.976 at visit 1 and 0.977 at visit 2 (MDDs: 0.269-0.270cm). The inter-day ICC was 0.973 for rater A and 0.972 for rater B (MDDs: 0.286-0.291cm). Sensitivity analyses accounting for age, sex, and the use of mean measurements produced similar results. The results were homoscedastic. The rectus femoris muscle thickness was measured with good reliability using ultrasonography across all the settings.

CIPAS Scale: Pilot Test for Evaluating Interaction Quality and Secure Attachment Potential

The adult's sensitivity to the child's communicative signals, their prompt and appropriate response to the child's needs for security, protection, and comfort, along with their ability to regulate emotions in the face of childhood stress, are parenting skills associated with attachment quality. Various instruments and observation scales code these constructs. Furthermore, developmental psychology has made significant contributions regarding the affective and communicative exchanges between parents and children during early stages of life and their implications for the formation of emotional bonds. The objective of this study is to describe the development and preliminary analysis of a new observation scale called: Quality of Interaction and Secure Attachment Potential (CIPAS), which aims to simply integrate the different parameters of the interactive relationship between attachment figures and children in early childhood. The construction process and initial psychometric analyses from a pilot sample are presented. The results showed very high inter-rater reliability, with an overall kappa value of κ=0.88. The relevance of CIPAS is discussed not only as a valuable tool for developmental psychology research but also as an effective instrument to guide educational practices in promoting secure attachment and quality interaction in young children.

Interobserver reliability of sonographic measurement of inferior vena cava and aorta parameters in fasting children in the perioperative period: A prospective observational study

Interobserver reliability of sonographic measurement of inferior vena cava and aorta parameters in fasting children in the perioperative period: A prospective observational study

Examining preventive occupational health and safety management in the Swedish welfare sector-questionnaire development, its validity and reliability, and initial findings on employers' knowledge.

A preventive approach to occupational health and safety management (OHSM) can improve working conditions, but more knowledge is needed on how this should be organised in practice. Here, we describe the development, validity and reliability of a questionnaire used to examine employers' preventive OHSM within the Swedish welfare sector. Furthermore, employers' knowledge of preventive OHSM was explored using the survey data. A questionnaire was developed based on interviews with key actors (n = 7), experts (n = 6) and intended respondents (n = 5). Using the final questionnaire, 197 responses were collected from employer (n = 126) and employee representatives (n = 71) and used to assess the validity and reliability of the questionnaire. Qualitative and quantitative analyses of open-ended and multi-choice items were used to assess the response distribution, content validity and interrater reliability (i.e. employer-employee correspondence from 32 matched pairs from the same workplace). Quantitative and qualitative analyses of survey responses from employer representatives were performed to assess their knowledge of preventive OHSM. The final questionnaire included 91 items covering employers' working routines, resources and work environment economics. Qualitative analyses indicated a high content validity in the questionnaire, with a satisfactory response distribution and very small proportion of missing data on individual survey items. Overall, the interrater reliability was high (>60%), but the employer representatives generally gave more examples within different areas of the OHSM compared to the employee representatives. Most of the employer representatives (74%, n = 90) assessed that their organisation had sufficient knowledge regarding preventive OHSM but that the knowledge of work environment economics was lower. By combining work environment research with questionnaire design research, high validity and reliability was achieved for this questionnaire. Furthermore, the employers generally perceived that they have high knowledge of preventive OHSM but that more knowledge is needed on work environment economics.

Erythema, localized edema and heat vs forearm perimeter increase. Time to revise the consensus recommendations on the vortex provocation test in vibratory urticaria-angioedema?

Diagnosis of vibratory urticaria/angioedema is established after performing the vortex provocation test. There is current consensus on measuring the forearm perimeter after running such test to define a positive response to it. We evaluated the frequency of prior symptoms following vibratory stimuli in volunteers using a questionnaire, response to the vortex provocation test in the same volunteers (increase in forearm perimeter, erythema, localized edema, heat, and pruritus), interrater reliability, and correlation between the scores obtained in the questionnaire and response to the test. A total of 40 volunteers participated in this survey, 17 of whom were excluded due to dermographism. A total of 59% out of 123 without dermographism responded positively to ≥ 1 items of the questionnaire. Localized erythema, heat or localized edema were reported in 58.5%, 38.2%, and 32.5%, respectively. A total of 73.6% of volunteers presented with itch. The mean intensity of itch was 3.44 (95%CI, 2.94-3.94). Interrater agreement was low regarding the increase in forearm circumference at 3 levels (intraclass correlation coefficient, 0.477 95%CI, 0.253-0.634; 0.496 95%CI, 0.280-0.647; and 0.370 95%CI, 0.100-0.559, respectively) and optimal regarding erythema, heat and localized edema (Kappa index, 0.868; .756; and .757, respectively). A significant correlation was identified between the questionnaire score and the altered response to the test in its different variables. We propose the following variables: erythema; localized edema; heat; and the intensity/speed of onset/duration of pruritus to define a positive response to the vortex provocation test given their ease of execution and optimal inter-observer agreement.

Using a hybrid Delphi/nominal group technique to develop a tool for appraising the quality of mixed-method grounded theory research.

Among the many methodological approaches used to generate new knowledge in nursing research are mixed methods and grounded theory. However, it can be challenging for researchers to achieve and demonstrate the philosophically congruent integration required in mixed-method, grounded-theory research. To use a hybrid of Delphi and nominal group techniques to develop a tool to appraise the quality of mixed-method, grounded-theory research. The extant literature informed the construction of an evidence-based checklist and explanatory notes that were discussed and voted upon by experienced mixed-method and grounded-theory researchers. The tool was progressively piloted in three projects employing varying grounded-theory approaches. Experienced mixed-method and grounded-theory researchers discussed and voted on the construction of an evidence-based checklist and explanatory notes informed by the extant literature. The researchers piloted the tool in three rounds, with reference to previous studies that used various grounded-theory approaches. This study reports an effective strategy for gaining consensus to develop a tool demonstrating content, inter-rater and concurrent reliability. Nurse researchers of various levels of expertise can use the tool developed in this study, which will accommodate future advances in mixed-method and grounded-theory research.

Multi-institutional Validation of the Interarytenoid Assessment Protocol for Pediatric Laryngeal Cleft.

Current assessment techniques for determining whether a patient has normal interarytenoid anatomy, a deep interarytenoid notch, or a minor laryngeal cleft are highly variable. However, differentiating between these three entities is important, given it may distinguish whether a patient should be considered for surgical intervention. The Interarytenoid Assessment Protocol (IAAP) was developed to provide standardization of interarytenoid anatomy evaluations. We aimed to assess the reliability of the IAAP for assessment of interaytenoid mucosal height (IAMH) through a multi-institutional validation study. Reliability of the IAAP was assessed by 10 pediatric otolaryngologists all from different academic centers. 30 de-identified endoscopic videos of interarytenoid assessments were rated at two separate time points, 2 months apart. Intra-class correlation (ICC) coefficients with two-way models were used to evaluate inter- and intra-rater reliability. Thirty endoscopic videos were collected for patients with a median (IQR) age of 4.9 years (59 months; range: 1 month to 20 years). On the first video assessment, inter-rater reliability was 0.74 (95% CI 0.63-0.84), and on the second video assessment, inter-rater reliability was 0.75 (95% CI 0.63-0.85) indicating strong inter-rater reliability. Overall intra-rater test-retest reliability was 0.75 (95% CI 0.69-0.79) indicating strong agreement. In almost half, 14 (46.6%) raters chose IAAP classification levels within 1 level of each other. Multi-institutional validation of the IAAP demonstrates strong inter- and intra-rater reliability for assessment of IAMH when evaluated through pictorial analysis. Standardization of anatomical evaluations may improve our ability to perform more reliable outcomes studies of pediatric pharyngeal dysphagia in the future. NA Laryngoscope, 2024.

Validation and psychometric properties of the bipolar prodrome symptom interview and scale-full prospective Chinese version to assess individuals at risk for bipolar disorder.

Bipolar disorder (BD) is a chronic, severe mental illness with a significant socio-economic burden. The early recognition of BD requires reliable and valid instruments. We evaluated the psychometric attributes of the Bipolar Prodrome Symptom Interview and Scale-Full Prospective (BPSS-FP)-Chinese version. Altogether, 129 participants, aged 16-35 years meeting DSM-5 criteria for major depressive disorder (MDD, n = 27) or BD (n = 76), and 26 healthy controls were recruited. Subjects were evaluated with the BPSS-FP Chinese version, Young Mania Rating Scale (YMRS), Montgomery-Asberg Depression Rating Scale (MADRS), and Cyclothymic-Hypersensitive Temperament questionnaire (CHT). Internal consistency, interrater reliability, criterion validity, and discriminant validity of the BPSS-FP-Chinese version were assessed. Cronbach alpha indices were 0.87, 0.86, and 0.66 for the manic, depressive, and general subscales of BPSS-FP-Chinese version, respectively. Interrater correlation was high, with total agreements of 0.94, 0.95, and 0.94 for the manic, depressive, and general index, respectively. Significant correlations (r ≥ 0.50) were noted between the BPSS-FP manic subscale and both the YMRS and CHT, the depressive subscale and the MADRS, and the general symptom subscale and the CHT. Moderate correlations were detected between the BPSS-FP general symptoms and both the YMRS and CHT (r = 0.40 ~ <0.50). Furthermore, the BPSS-FP mania index demonstrated a moderate correlation with the MADRS, while the depression index had a small correlation with the YMRS (r = 0.10 ~ <0.40). The BPSS-FP-Chinese version has good psychometric properties and can be applied in both clinical and research settings for screening subjects with a risk for BD.

Evaluating the reliability and validity of a Chinese version of the performance-oriented mobility assessment among patients with chronic stroke

BackgroundThe Performance-Oriented Mobility Assessment (POMA) is a reliable instrument for evaluating the mobility (balance and gait) of patients with chronic stroke to manage their risk of falling; however, it has not been validated among Chinese patients with stroke. This study aimed to evaluate the reliability and validity of the Chinese POMA in patients with stroke.MethodsThe POMA was applied to volunteer patients with stroke from the Shanghai MCC Hospital. The patients underwent the Chinese POMA, Berg balance scale (BBS), and timed up and go (TUG) tests on the first day of inpatient treatment. The same physician repeated the tests the next day to assess test–retest reliability, and upon the patient’s discharge from the inpatient department, two different physicians measured inter-rater reliability.ResultsThe study involved 76 patients with stroke (age: 62.04 ± 9.76 years; 34.2% female). The results showed that the Chinese POMA had good overall internal consistency (σ=. 875), with a moderate consistency between its two subscales (balance σ = 0.875; gait σ = 0.668). The individual items showed high test–retest (ICC = 0.997) and inter-rater reliability (ICC = 0.988). The content validity test showed high correlations between the Chinese POMA, the BBS (rs = 0.70), and the TUG (rs = −0.75). However, the confirmatory factor analysis suggested that the two-factor model (balance and gait) was mediocre.ConclusionThe Chinese POMA showed acceptable reliability and validity for evaluating mobility (balance and gait) in Chinese patients with stroke in terms of their risk of falling. However, further evaluation of the two-factor model (balance and gait) is required.

Adaption of a trigger tool to identify harmful incidents, no harm incidents, and near misses in prehospital emergency care of children.

The emergency medical service (EMS) addresses all chief complaints across all ages in various contexts. Children in EMS present a particular challenge due to their unique anatomical and physical properties, which require specific training that EMS clinicians often report lacking. This combination exposes children to incidents threatening patient safety. The most common method to highlight incidents is the incident reporting system. Studies have shown underreporting of such incidents, highlighting the need for multiple methods to measure and enhance patient safety in EMS for children. Thus, the aim of this study was to modify and adapt the current Ambulance TT for road-based EMS (ATT) to a pediatric version (pATT) with a guide containing definitions of triggers. The adaption of the ambulance trigger tool to a version suitable for children followed a stepwise manner, including (1) a review of previous literature to pinpoint areas of risk regarding patient safety among children in EMS. (2) Three sessions of expert panel discussions via video meetings were held to evaluate each trigger of the ATT in terms of clinical relevance, comprehensibility, language and areas of risk regarding patient safety among children in EMS. (3) Clinical use of the pATT along with Retrospective Record Review (RRR). (4) Calculation of Item-level validity index and positive predictive value (PPV) for each trigger. (5) calculate inter-rater reliability between two independent record reviewers. The literature search revealed 422 respective 561 articles in Cinahl and Medline where headlines and abstracts were read to identify areas posing risks to patient safety in EMS for children. During the structured discussions, one trigger was added to the existing 19 derived from the ATT, and the trigger definitions were modified to suit children. The three most common triggers identified in the 900 randomly selected records were deviation from treatment guidelines (63.9%), incomplete documentation (48.3%), and the patient is non conveyed after EMS assessment (41.1%). The positive triggers were categorized into near miss (54.6%), no harm incident (5.8%), and harmful incident (0.4%). Inter-rater reliability testing showed excellent agreement. This study demonstrates the adaptation of an existing trigger tool (ATT) to one suitable for children. It also shows that the trigger tool, along with retrospective record review, is a feasible method to evaluate patient safety in EMS, thus complementing existing methods.