Inter-rater Correlation Research Articles

Avoidability of drug-induced liver injury (DILI) in an elderly hospital cohort with cases assessed for causality by the updated RUCAM score

BackgroundDrug-induced liver injury (DILI) represents an increasing morbidity in the general population, but more so in the elderly cohort of patients. Despite this, the concept of its prevention through prospective analysis has largely remained unexamined. We evaluated the utility of recently validated adverse drug reactions (ADR) avoidability tool in a cohort of elderly patients with DILI.MethodsWe examined 38 DILI-drug pairs from n=38 patients in a prospective cohort of patients presenting with adverse drug reactions to a Weill Cornell-affiliated tertiary hospital between February 2019 and January 2020. DILI outcomes were adjudicated by the updated Roussel Uclaf Causality Assessment Method (RUCAM). Two clinical pharmacologists and two general physicians utilized the Liverpool adverse drug reactions avoidability tool (LAAT) and the modified Hallas tools to rate the preventability of DILI-drug pairs. Inter-rater, exact agreement proportions, as well as intraclass correlation coefficients were generated and expressed as ordinal outcomes.ResultsThe cases examined for the determination of DILI avoidability had probability likelihood of “probable” or “highly probable” by the updated RUCAM scale. Examination of the 38 DILI-drug pairs (n= 38 patients) resulted in a total of 152 ordinal outcome decisions. We found about 32.3% (50/152) and 34.2% (52/152) of DILI-drug pairs were rated as “avoidable” (“probable” or “definite”) by the LAAT and the modified Hallas tools respectively. The overall median Krippendorf’s kappa with the LAAT was 0.61 (SE 0.12, CI 0.36, 0.85) and for modified Hallas tool was 0.53 (SE 0.18; CI 0.16, 0.89). The inter-rater correlation coefficient (ICC) for the LAAT and modified Hallas were 0.50 [0.32, 0.65] and 0.63 [0.48, 0.76] respectively. Exact pairwise agreement was present in 30/38 (IQR 29.5, 34.5), and 28/38 (IQR 27.5-35.5) of DILI-ADR pairs using the LAAT and modified Hallas tools respectively.ConclusionWe found a significant proportion of drug-induced liver injury adjudicated by the updated RUCAM scale in elderly hospitalized cohort of patients were avoidable with significant implication for therapeutic commissioning as well as cost effectiveness interventions in this cohort of patients.

Capturing teaching practices in language-responsive mathematics classrooms Extending the TRU framework \u201cteaching for robust understanding\u201d to L-TRU

Supporting language in mathematics classrooms requires both curriculum material that follows language-responsive design principles and teaching practices that enact these principles with high instructional quality. This paper presents the analytic framework L-TRU, which was developed to assess language-responsive teaching practices quantitatively. The L-TRU framework draws upon Schoenfeld’s teaching for robust understanding (TRU) framework by adapting its five dimensions to language-responsive classrooms: Mathematical Richness, Cognitive Demand, Equitable Access, Agency, and Use of Student Contributions. It is extended by two further dimensions, namely, Discursive Demand and Connecting Registers. The adapted and extended L-TRU rating scheme was applied to 41 video-recorded lessons of 26 teachers who all used the same language-responsive curriculum material on percentages. The qualitative insights gained from selected transcripts reveal that the dimensions indeed capture important distinctions in valid ways. The analysis of interrater reliability and correlations confirms that distinct dimensions are captured with reliability. The quantitative overview of the ratings of 497 episodes shows that in spite of the shared curriculum material, a large variety of instructional practices were enacted: Consistently high quality was found in the dimensions Cognitive Demand and Equitable Access and a medium quality in Connecting Registers. The dimensions Agency, Discursive Demand and Use of Contributions show the largest variance among teachers, with Discursive Demand separating most. These findings empirically substantiate an important research tool for quantitatively capturing teaching practices with respect to their general mathematics instruction quality and language-responsive quality.

Evaluation of trigeminal nerve tractography using two-fold-accelerated simultaneous multi-slice readout-segmented echo planar diffusion tensor imaging.

Simultaneous multi-slice (SMS) imaging with short repetition time (TR) accelerates diffusion tensor imaging (DTI) acquisitions. However, its impact when combined with readout-segmented echo planar imaging (RESOLVE) on the cranial nerves given the challenging skull base/posterior fossa terrain is unexplored. We evaluated the reliability of trigeminal nerve DTI metrics using SMS with RESOLVE-DTI. Eight healthy controls and six patients with unilateral trigeminal neuralgia (TN) underwent brain MRI scan. Three different RESOLVE-DTI protocols were performed on a 3-T MRI system: non-SMS (TR = 4330ms), SMS with identical TR (4330ms), and SMS with short TR (2400ms). Pontine signal-to-noise ratio (SNR) and DTI metrics of the trigeminal nerve streamlines tracked by two independent raters using deterministic tractography and standardized tracking protocol were obtained. These were statistically analyzed and compared across the three protocols using intra-rater and inter-rater intraclass correlation coefficients (ICCs), one-way analysis of variance (ANOVA), post hoc analysis, and linear regression. On visual screening, there were no artifacts across the trigeminal nerves. All data also cleared objective image quality assurance analysis. Pontine SNR was similar for the two SMS protocols and higher for the non-SMS RESOLVE-DTI (F(2,36) = 4.40, p = 0.02). Intra-rater and inter-rater ICCs were very good (> 0.85). Trigeminal nerve DTI metrics were consistently measured by the three protocols, revealing significant linear relationships between non-SMS- and SMS-derived DTI metrics. SMS RESOLVE-DTI enables fast and reliable evaluation of microstructural integrity of the trigeminal nerve, with potential application in the clinical management of TN. • Readout-segmented diffusion-weighted echo planar imaging (RESOLVE-DTI) reduces image distortion artifacts in the posterior fossa but its long acquisition time limits clinical utility. • Simultaneous multi-slice (SMS) imaging combined with RESOLVE-DTI provides reliable trigeminal nerve tractography with potential applications in trigeminal neuralgia. • Two-fold-accelerated RESOLVE-DTI yields comparable trigeminal nerve streamlines and DTI metrics while near-halving acquisition time.

Inter-Rater Variability of Reflux Finding Score Amongst Otolaryngologists

Laryngopharyngeal reflux (LPR) is an extra-oesophageal variant of gastro-oesophgeal reflux disease. Patients often do not present with the classic reflux symptoms of heartburn or regurgitation. Accurate diagnosis of LPR can be challenging. The reflux finding score (RFS) is system based on the assessment of eight parameters seen on fibre optic laryngoscopy, used to determine the presence and the severity of laryngopharyngeal reflux (LPR). Scoring the RFS is subjective and highly dependent on the examiner's eye and experience. In this study, we investigated the inter-rater reliability between three otolaryngologists scoring a large library of video-recorded laryngoscopies for RFS. To evaluate the usefulness of RFS in daily clinical practice by assessing inter-rater reliability among otolaryngologists when interpreting a bank of identical fibre optic laryngoscopy examinations. Three board-certified otolaryngologists with different subspecialist interests examined video-recorded fibre optic laryngoscopies of 193 patients with or without LPR symptoms and rated each video for RFS. Statistical analysis was performed. Results were compared to determine the inter-rater reliability. Fair to poor correlation was found between the three expert raters for total RFS score, as well as for RFS component items with nonbinary outcomes. For the dichotomous items, the inter-rater reliability was slight to moderate. Inter-rater correlation for determining whether an examination is pathological or nonpathological was fair. The RFS alone was not reliable for confirming the diagnosis of LPR, due to low inter-rater reliability and the subjective nature of the scoring system.

A-240 Enhanced Interpretation of the Behavior Rating Inventory of Executive Function–Adult Version (BRIEF-A)

Abstract Objective The Behavior Rating Inventory of Executive Function®—Adult Version (BRIEF-A) is a standardized measure that captures an adult’s executive functions in his or her everyday environment. The current study provides additional statistical evidence to support interpretation of BRIEF-A scores across raters and over time. Method Participants were adults, ages 18 to 90 years, from the BRIEF-A Self-Report (N = 1,050) and Informant-Report (N = 1,200) standardization samples, as well as an interrater sample (n = 180) and test–retest samples (n = 50 for Self, n = 44 for Informant). Interrater correlations, base rates of interrater differences, and score differences required for statistical significance were examined. Test–retest correlations and score differences required for statistical significance were examined. Base rates of elevated T scores (≥ 65) were calculated for the standardization samples across age groups. Results Interrater correlations ranged from .44 to .68 with an interrater difference of 17–20 T-score points considered significant at p < .05. Approximately 55–73% of raters reported scores within 10 T-score points. Test–retest scores were highly correlated (Self: r = .82–.94; Informant: r = .91–.96), with a between-test difference of 7–11 T-score points considered significant at p < .05. Base rates of elevated T- scores ranged from 3.3% to 15.4% for the Self-Report Form and 4.5% to 16.3% for the Informant-Report Form across the scales/indexes. Conclusions These data allow clinicians to interpret BRIEF-A scores across raters and over time by determining the statistical significance of BRIEF-A score differences, as well as quantifying the frequency of the observed differences.

Motor unit number estimation of facial muscles using the M Scan-Fit method.

M Scan-Fit, an automated method for motor unit number estimation (MUNE), was assessed in muscles innervated by the facial nerve. Healthy volunteers were recruited. M Scans were recorded twice from nasalis and depressor anguli oris (DAO) muscles, and then fitted to a probabilistic model. Twenty-one subjects were evaluated; 38% were females and 62% were males, with a mean age of 34.71 years. The average number of MUs was 38.57 on both testing occasions (t ≤ 0.0001; P = 1.0) for the nasalis. For the DAO, results were 20.62 MUs for the first and 23.48 for the second (t = -2.12; P = .04). Pearson's interrater correlation coefficients were 0.96 (P < .0001) for nasalis and 0.87 (P ≤ .01) for DAO. Intraclass correlation coefficients were 0.88 (P ≤ .01) for nasalis and 0.39 (P = .37) for DAO. M Scan-Fit MUNE is an automated, accurate, reliable method of estimating MU number and size from facial muscles.

Quantifying fascial tension in ventral hernia repair and component separation.

Excessive fascial tension is a major cause of ventral hernia recurrence. Although hernias are commonly characterized by area, the tension experienced by fascia is directly proportional to the surrounding tissue stiffness. We demonstrate an accurate and simple technique for intra-operative measurement of fascial closing tension and quantify the decrease in tension following Component Separation (CS). A tensiometer was created using a spring with a known recoil constant (k) and a surgical clamp. Using Hooke's law (Force = kX; X = spring displacement), fascial tension was calculated. This method was first validated on a bench-top model and then applied to the anterior fascia of 4 fresh cadavers (8 hemi-abdomens) over a range of simulated hernia defect sizes. When fascia could no longer reach midline, CS was performed and measures repeated. Tissue stiffness was calculated by plotting defect size versus resulting tension. Fascial defects ranged from 1- to 18-cm wide with average midline closing tension prior to release 36.1N (range 17-48) and 8.2N (range 5-11) after CS, a mean 76% decrease (range 70%-85%). Mean R2 values between defect size and tension for the synthetic and cadaver models were 0.99 (p < 0.01) and 0.91 (p = 0.01; all hemi-abdomen measurements significant). Inter-rater Pearson's correlation consistently found R2 values > 0.95 (p < 0.01) for each hemi-abdomen, showing high precision and reproducibility. We have applied a cheap, simple, and precise method to sterilely assess fascial tension during herniorrhaphy and also quantified the decrease in tension following component separation. This technique may be rapidly translated into the operating room with minimal equipment to provide objective data critical for intraoperative decision-making.

The Turkish version of the childhood bladder and bowel dysfunction questionnaire (CBBDQ): Cross-cultural adaptation, reliability and construct validity.

Bladder and bowel dysfunction (BBD) are both prevalent health problems in pediatric population. The CBBDQ is a parent-reported tool to evaluate and quantitatively assess bladder and bowel dysfunction symptoms in pediatric patients. This study was designed for the translation the CBBDQ into Turkish and the cultural adaptation of CBBDQ for the use among 5-12-year-old children. Moreover, another aim of this study was that the determination of the reliability and construct validity of the Turkish version. The main hypothesis of our study was that the translation and cultural adaptation of the CBBDQ into Turkish language, so that Turkish parents could understand it. Additionally, we estimated that the Turkish version would have eventual internal consistency and test-retest reliability and admissible construct validity. The CBBDQ was guideline driven translated into Turkish language and administered two times to the parents of children with one week interval to assess test-retest reliability. The internal consistency was determined by using Cronbach's α value and the test-retest reliability was calculated by using the inter-rater correlation coefficient. For the estimation of construct validity, the Dysfunctional Voiding and Incontinence Scoring System (DVISS) and Pediatric Quality of Life Inventory (PedsQL) in 5-7, 8-12 years old children were used as the external criterias. The participants were parents of 5-12-year-old children. The internal consistency was 0.83 that was the Cronbach's α value which reflects a good result. The Turkish-CBBDQ5-12y and the DVISS showed a satisfactory level correlation (r=0.64 P<0.001). There was not any correlation between the Turkish-CBBDQ5-12y and the PedsQL-General Health and PedsQL-Psychological Health (r=-0.17, P=0.1 and r:0.12 P=0.25, respectively). The Turkish-CBBDQ5-12y version is a reliable and valid instrument in terms of the content and construction and can be confidently used in clinical practice.

Correlation of meniscus tears on MRI and arthroscopy using the ISAKOS classification provides satisfactory intermethod and inter-rater reliability

ObjectiveTo evaluate the inter-rater and intermethod correlation (reliability between MRI and arthroscopy) of knee for findings of meniscus tears using International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification on both 1.5 and 3.0 T images.Methods81 knees were evaluated in 69 patients aged 30.0±12.6 years (mean±SD). Consecutive arthroscopy-proven meniscal tears were evaluated by two board-certified radiologists on MRI and two sports surgeons on arthroscopies. The surgically validated ISAKOS classification of meniscal tears was used to describe medial meniscus (MM) and lateral meniscus (LM) tears on MRI and re-evaluation of images from completed arthroscopies. Prevalence-adjusted bias-adjusted kappa (PABAK), t-tests and intraclass correlation coefficient (ICC) were calculated.ResultsFor LM on 1.5 T, the agreements for location, depth, tear length and pattern were good to excellent in all categories except fair for tissue quality (PABAK=0.35–0.41) and zone 2 (PABAK=0.35) identification. For MM, the agreements were good to excellent in all except moderate for tissue quality (PABAK=0.6) and zone 1 and 3 (PABAK=0.40–0.47), and fair for zone 2 identification (PABAK=0.27). Similar results were seen on 3 T with improved LM zonal identification (PABAK=0.52–0.90) and better correlation of tear lengths, which were different on 1.5 T vs 3.0 T (p=0.01–0.03). For 1.5 T cases, both MM and LM tear lengths were larger on MRI versus arthroscopy (MM, p=0.004; LM, p=0.095). For 3 T, the MM tear lengths were larger on MRI versus arthroscopy (p=0.001).ConclusionISAKOS classification of meniscal tears on both 1.5 and 3.0 T MRI provides satisfactory inter-rater and intermethod reliability for use in clinical practice. Level of evidence: IV.

Evaluation of ophthalmology residents' self-assessments and peer assessments in simulated surgery

ObjectiveTo evaluate the accuracy of ophthalmology residents’ self-assessment and peer assessment of surgical skills in a simulation setting. DesignSimulation laboratory assessment. ParticipantsOphthalmology residents novice to cataract surgery. MethodsA modified International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric: Phacoemulsification structured assessment tool for simulated cataract surgery was established by conventional Delphi method. Residents completed 10 independent simulated surgeries that were video-recorded. Two experts graded the videos using the assessment tool. Participants performed self-assessment of their own 10 videos, and peer assessment of 10 of their peers’ videos. ResultsNine cataract surgery experts provided feedback and modifications for the assessment tool. Agreement for the first round of the Delphi method ranged from 55.56% to 100%. Second round agreement was 80% or greater for all answers. The final assessment tool comprised (i) 4 procedural items scored from 0 (not performed) to 7 (competent), and (ii) a global rating scale (GRS) requiring yes/no answers to 4 performance-related questions. Eight residents participated in the study. There was excellent expert inter-rater reliability intraclass correlation ((ICC) = 0.844, 0.875, 0.809, 0.844) and fair to excellent inter-rater reliability between expert and peer scores (ICC = 0.702, 0.831, 0.521, 0.423), but systematic disagreement (ICC = −0.428, −0.038) or poor inter-rater reliability (ICC = 0.298, 0.362) between expert and self-scores. There was poor agreement for all GRS questions (κ statistic < 0.40) except 2 comparisons. ConclusionsIn the simulation setting, experts were able to reliably assess trainees’ performance using the assessment tool. Participants demonstrated inconsistency in assessing their own skills; however, they were adequate at assessing their peers’ overall performance.

The modified sphygmomanometer test for assessment of muscle strength of community-dwelling older adults in clinical practice: reliability and validity

Purpose (a) to investigate the test-retest and inter-rater reliabilities and the criterion-related validity of the modified sphygmomanometer test (MST) for the assessment of muscle strength in community-dwelling older adults, (b) to calculate the standard error of measurement (SEM) and the smallest real difference (SRD); (c) to verify whether the number of trials affect the results. Methods Bilateral strength of lower limbs (LL) and grip muscles were evaluated with the MST and with portable dynamometers in 50 older adults (69.92 ± 5.52 years). Intra-class Correlation Coefficients (ICC) was used to evaluate the inter-rater and test-retest reliabilities and Pearson Correlations was used to investigate the criterion-related validity of the MST. SEM and SRD were also calculated. Analysis of variance was used to investigate whether the number of trials affects the results. Results Significant correlations with high to very high magnitude were found for all muscle groups evaluated for test-retest and inter-rater reliabilities (0.80 ≤ ICC ≤ 0.99; p < 0.001) and validity (0.80 ≤ r ≤ 0.91; p < 0.001). Moreover, the values provided by different numbers of trials were similar. The SEM (3.66 ≤ SEM ≤ 20.46) and the SRD (10.15 ≤ SRD95% ≤ 56.70) were considered low for all outcome measures. Conclusion The MST showed adequate results for all the measurement properties evaluated for the assessment of the muscle strength of older adults. Implications for rehabilitation Older adults often develop sarcopenia and dynapenia that are associated with an increased number of falls and fractures and loss of independence. Portable dynamometer is the standard instrument to evaluate isometric muscle strength, however this instrument is expensive and it is not readily available in the underdeveloped or in developed countries. The Modified Sphygmomanometer Test is an alternative method for the clinical measurement of muscle strength, is portable, has a low-cost and provides an objective measurement. In this study the Modified Sphygmomanometer Test showed adequate results for all the measurement properties evaluated for the assessment of the muscle strength in community-dwelling older adults and a single trial after test familiarization can be used to measure the muscle strength in this population.

A novel method to quantify cutaneous vascular innervation.

To develop a new method to quantify the density of nerves, vessels, and the neurovascular contacts, we studied skin biopsies in diabetes and control subjects. Skin biopsies with dual immunofluorescent staining were used to visualize nerves and blood vessels. The density of nerves, vessels, and their neurovascular contacts were quantified with unbiased stereology. Results were compared with examination findings, validated questionnaires, and autonomic function. In tissue from 19 controls and 20 patients with diabetes, inter-rater and intra-rater intraclass correlation coefficients were high (>0.85; P < .001) for all quantitative methods. In diabetes, the nerve densities (P < .05), vessel densities (P < .01), and the neurovascular densities (P < .01) were lower compared with 20 controls. Results correlated with autonomic function, examination and symptom scores. We report an unbiased, stereological method to quantify the cutaneous nerve, vessel and neurovascular density and offer new avenues of investigation into cutaneous neurovascular innervation in health and disease.

Acceptance and action questionnaire − substance abuse: translation into arabic, content validity and reliability

Background Substance abuse is a chronic illness with complex and intervening treatment process. It is important to have measurement scale to help in the follow-up of individuals throughout the therapeutic and rehabilitation process. It helps to make patients confident in treatment phases and assist health professionals to track their clients’ progress, measuring acceptance and action towards therapeutic process, and its effect on commitment to treatment plan is essential for patients with substance use disorder. Objective The aim was to validate the Arabic version of acceptance and action questionnaire − substance abuse (AAQ-SA) and assess reliability of this questionnaire and translation into Arabic. Patients and methods AAQ-SA has been translated into Arabic. Methodological design was used to investigate content validity index (CVI) reported by eleven expert jurors. Judgment was done by eight psychiatry professors, one psychiatry assistant professor, one psychiatry consultant and an assistant lecturer of psychology, and then, the Arabic version was distributed among 45 substance abuse patients in recovery. Among them, six patients did not attend the second interview. A total of 39 rehabilitated substance abuse patients with remission period from 3 weeks to 28 months completed their interviews. Intraclass correlation coefficient ICC (inter-rater and intrarater agreement) and Cronbach’s α reliability coefficients were addressed to investigate reliability. Results The I-CVI Item CVI for relevance ranged from 0.717 to 1.0 and for clarity from 0.636 to 1.0. The S-CVI Scale CVI was 0.873 for both relevance and clarity. On the contrary, the e-CVI expert CVI ranged from 0.667 to 1.0 for relevance and from 0.778 to 0.944 for clarity. All inter- rater and intrarater correlation coefficients are positive and significant and ranges from 0.48 to 0.92 for inter-rater and from 0.44 to 0.9 for intrarater. The inter-rater and intrarater correlation coefficients of the total score were 0.83 and 0.85, respectively. The total Cronbach’s α of the total scale was 0.92. Cronbach’s α for value commitment and defused acceptance are 0.92 and 0.91, respectively. The mean total scores of pretest rater 1, pretest rater 2, and post-test rater 1 were 68.6±15.7, 70.7±17.9, and 70.6±17.1, respectively, with no statistically significant differences. Conclusion In conclusion, AAQ-SA Arabic version based on the results is valid, reliable, and stable, and its translation is convenient to the culture. More research studies should be done in the field of therapy and rehabilitation for patients with addiction problems in Egypt and the Arabic world.

Objective and Perceived Neighborhood Greenness of Students Differ in their Agreement in Home and Study Environments.

Research has reported the associations between objective or subjective neighborhood greenness and health, with low agreement between the greenness scores. College students are prone to poor health, and data are lacking on home and university environments. We studied the agreement between greenness parameters and the associations of objective greenness with health in different locations. Three hundred and seventy-seven college students were recruited, with a mean age of 24 years, in the city of Graz, Austria. Objective and perceived greenness was assessed at home and at university. Health measures included the WHO-5 questionnaire for mental health, the IPAQ questionnaire (short) for physical activity and sedentariness, and body mass index. Per location, quintile pairs of objective and perceived greenness were classified into underestimates, correct estimates or overestimates. Interrater reliability and correlation analyses revealed agreement between greenness scores at home but not at university. ANOVA models only showed poorer mental health for students underestimating greenness at university (M = 51.38, SD = 2.84) compared to those with correct estimates (M = 61.03, SD = 1.85). Agreement between greenness scores at home but not at university was obtained, and mental health was related to the perception of greenness at university. We conclude that reliable and corresponding methods for greenness scores need to be developed.

Parent- and therapist-rated treatment satisfaction following routine child cognitive-behavioral therapy

This observational study examined treatment satisfaction (TS) following routine outpatient cognitive-behavioral therapy (CBT) in a large sample of children (n = 795; aged 6 to 10 years). TS was investigated in parent and therapist rating. Means, standard deviations and inter-rater correlations were calculated to investigate TS. Regression analysis was conducted to examine potential correlates of TS (patient-related variables, mental disorder characteristics, socio-demographic factors and treatment variables). High TS in parent and therapist rating was found, with therapists showing a lower degree of TS than parents (completely or predominantly satisfied: parent rating 94.1%, therapist rating 69.5%). A statistically significant, moderate inter-rater correlation was found. Regression analysis explained 21.8% of the variance in parent rating and 57.2% in therapist rating. Most of the TS variance was explained by mental disorder characteristics (parent-rated symptoms and therapist-rated global impairment at treatment end) and by treatment variables (especially the therapist-rated cooperation of parents and patients), whereas socio-demographic and patient-related variables did not show any relevant associations with TS. Based on these results, to optimize TS, therapists should concentrate on establishing a sustainable cooperation of parents and children during therapy, and work to achieve a low global impairment at treatment end.

Three-Dimensional Magnetic Resonance Imaging Volumetry of Radial Forearm Flap Reconstructions After Craniomaxillofacial Tumor Resection.

Oral cancer is a common and life threatening disease that requires interdisciplinary treatment and often necessitates complex facial reconstruction. Standard care includes tumor resection, while reconstruction is routinely performed with free radial forearm flaps. As esthetic results are crucial for quality of life, flap size, flap volume, and flap composition have to be considered. To date no standardized measurement of flap volume and shrinkage has been established for routine use. The purpose of this study was therefore to evaluate the transplant volume of radial forearm flaps in craniomaxillofacial reconstruction using magnetic resonance imaging (MRI) volumetry. Ten postoperative MR sequences of 5 patients were included. All patients had received transplantation of radial forearm flaps after tumor resection and radiation therapy. Evaluated parameters were: sex, age, type of flap, flap volume. Two different observers (1 surgeon and 1 radiologist) segmented transplant volume at three different time points in a postoperative MRI independently and in consensus, using both axial and coronal slices. A nonfat saturated T1 spin echo sequence was used. Mean transplant volume was calculated. A total of 90 volumetric measurements were included. Overall Tvolm was 24.83 cm from axial sections and 27.25 cm from coronal sections. Measurements for axial and coronal orientations differed significantly. Results showed excellent intra- and inter-rater correlation, coefficient for rater A and rater B were 0.91 (axial) and 0.96 (coronal). MRI volumetry is a noninvasive reproducible method to quantify volume of free radial forearm flaps in situ but should follow specific considerations for best results.

Reliability, validity and cut-off score of the Chinese version of the panic disorder severity scale self-report form in patients with panic disorder

BackgroundPanic disorder (PD) is often undiagnosed, misdiagnosed, or untreated in non-psychiatric clinical settings. Therefore, a cost-effective, accurate and easy-to-administer instrument for PD assessment is still needed. For that reason, the self-report version of the Panic Disorder Severity Scale (PDSS-SR) has been developed and suggested to be a reliable and useful tool in clinical and research settings. The current study aims to evaluate the reliability and validity of the Chinese version of the PDSS-SR and determine the cut-off score of the PDSS-SR.MethodsA total of 133 patients with PD in Shanghai were assessed by the PDSS-SR, PDSS and Hamilton Anxiety Rating Scale (HAMA). Moreover, 117 patients with non-PD anxiety and 51 healthy subjects also completed the PDSS-SR to construct a receiver operating characteristic (ROC) curve with the scores of PD patients.ResultsThe internal consistency (Cronbach’s α) of the PDSS-SR was 0.72–0.80, and the interrater correlation coefficient was 0.78. The results of principal component analysis and varimax rotation indicated that the PDSS-SR had a two-factor structure, with all seven items having salient loadings. The cut-off score was 4, which was associated with high sensitivity (96.03%) and specificity (61.31%).ConclusionsThe findings demonstrate that these items and the total score of the PDSS-SR have acceptable reliability and validity in patients with PD and that the PDSS-SR can be used by general doctors for clinical screening in China.

In Vitro Evaluation of Urinary Stone Comminution with a Clinical Burst Wave Lithotripsy System

Objective: Our goals were to validate stone comminution with an investigational burst wave lithotripsy (BWL) system in patient-relevant conditions and to evaluate the use of ultrasonic propulsion to move a stone or fragments to aid in observing the treatment endpoint. Materials and Methods: The Propulse-1 system, used in clinical trials of ultrasonic propulsion and upgraded for BWL trials, was used to fragment 46 human stones (5-7 mm) in either a 15-mm or 4-mm diameter calix phantom in water at either 50% or 75% dissolved oxygen level. Stones were paired by size and composition, and exposed to 20-cycle, 390-kHz bursts at 6-MPa peak negative pressure (PNP) and 13-Hz pulse repetition frequency (PRF) or 7-MPa PNP and 6.5-Hz PRF. Stones were exposed in 5-minute increments and sieved, with fragments >2 mm weighed and returned for additional treatment. Effectiveness for pairs of conditions was compared statistically within a framework of survival data analysis for interval censored data. Three reviewers blinded to the experimental conditions scored ultrasound imaging videos for degree of fragmentation based on stone response to ultrasonic propulsion. Results: Overall, 89% (41/46) and 70% (32/46) of human stones were fully comminuted within 30 and 10 minutes, respectively. Fragments remained after 30 minutes in 4% (1/28) of calcium oxalate monohydrate stones and 40% (4/10) of brushite stones. There were no statistically significant differences in comminution time between the two output settings (p = 0.44), the two dissolved oxygen levels (p = 0.65), or the two calyx diameters (p = 0.58). Inter-rater correlation on endpoint detection was substantial (Fleiss' kappa = 0.638, p < 0.0001), with individual reviewer sensitivities of 95%, 86%, and 100%. Conclusions: Eighty-nine percent of human stones were comminuted with a clinical BWL system within 30 minutes under conditions intended to reflect conditions in vivo. The results demonstrate the advantage of using ultrasonic propulsion to disperse fragments when making a visual determination of breakage endpoint from the real-time ultrasound image.

Lengthening of magnetically controlled growing rods caused minimal pain in 25 children: pain assessment with FPS-R, NRS, and r-FLACC.

Descriptive case series. The aim of the study is to investigate the pain associated with magnetically controlled growing rod (MCGR) lengthening procedures. MCGRs have gained popularity because they offer non-surgical lengthening procedures in early-onset scoliosis (EOS) instead of semi-annual open surgery elongations with traditional growing rods. Many aspects of MCGR treatment have been investigated, but pain in conjunction with distraction is only sparsely described in the literature. Pain intensity was assessed in 25 EOS patients before, during and after MCGR lengthening procedures in an outpatient setup. They underwent at least two (range 2-16) lengthening procedures prior to this study. The pain intensity was estimated using patient-reported Faces Pain Scale (FPS-R), caregiver-reported pain numeric rating scale (NRS), and NRS and revised Face, Legs, Activity, Cry, Consolability scale (r-FLACC) by two medically trained observers. The inter-rater reliability and correlation between instruments were analyzed. 23 of 25 EOS patients (8- to 16-year old) with mixed etiology were able to self-report pain. The average pain intensity was mild: median 1 (range 0-6) on all four instruments on a 0-to-10 scale. Afterward, 22/25 patients (88%) were completely pain free and the remaining 3 patients had a pain score of 1. MCGR stalling (i.e. clunking) was encountered in 14/25 (56%) of the patients without impact on the pain intensity. The average maximum pain intensities during the lengthening procedures were mild and pain ceased within few minutes. The inter-rater reliability was good to excellent for NRS and r-FLACC, and there were high correlations between all the four pain instruments, indicating high criterion validity. Level IV, case series.

Weight-Bearing CT Scan After Tibial Pilon Fracture Demonstrates Significant Early Joint-Space Narrowing.

Posttraumatic osteoarthritis (PTOA) is a common and early sequela of tibial pilon fractures resulting in substantial long-term disability. New approaches are needed to objectively and reliably quantify early disease progression in order to critically assess the impact of interventions aimed at preventing or mitigating PTOA. Weight-bearing computed tomography (WBCT) scans provide a means for measuring joint space while the ankle is in a loaded, functional position. We assessed the interrater and intrarater reliability of a standardized, regional method to quantify joint-space loss following tibial pilon fracture compared with the uninjured contralateral ankle. We prospectively enrolled 20 patients with intra-articular tibial pilon fractures that were surgically treated at 1 of 2 level-I trauma centers. Six months after injury, bilateral ankle WBCT scans were obtained. Joint space was measured by 4 reviewers at 9 discrete regions of the tibiotalar articulation on sagittal images. Measurements were repeated by reviewers 2 weeks later. To characterize the measurement method, interrater correlation coefficient estimates and test-retest reproducibility were calculated. The mean tibiotalar joint space was 21% less in the injured ankles compared with the contralateral uninjured ankles (p < 0.0001). The middle-lateral and middle-central regions of the joint demonstrated the greatest decrease in joint space between injured and uninured ankles. The interrater correlation coefficient of the measurement technique was 0.88, and the test-retest reproducibility was 0.80, indicating good reliability and reproducibility of the method. We developed a simple, standardized, and reliable technique to quantify tibiotalar joint space following tibial pilon fracture on WBCT. Significant loss of joint space is seen 6 months after the injury. This tool can be used to longitudinally quantify loss of joint space following pilon fracture and assess the impact of interventions to reduce PTOA.